*This subject was one of the major scientific research projects of Hubei Science and Technology Commission(Serial number: 971 P 1401)
　　by Wu Xuping(吴绪平 Zhou Shuang(周爽 Liu Youxiang(刘又祥Wang Yawen(王亚文Zhou Dengfang(周登方 Sun Guojie(孙国杰(Hubei College of TCM, Wuhan 430061，China)Abstract In the present study, the therapeutic effect of acupuncture at Shuigou(GV 26), Neiguan (PC 6) and Zusanli (ST 36) in treatment of 30 cases of ischemic cerebral apoplexy patients and its action on plasma β-EP (endorphine) level were observed . After treatment, of the 30 inpatients, 16 cases were cured basically, 9 had marked improvement, 4 had slight improvement and the rest one had no any changes. The significantly effective rate was 83.3% and the total effective rate w as 96.7%. Before acupuncture treatment, the content of plasma β-EP inpatient s with ischemic stroke increased significantly in comparison with that of normal group (P<0.01). While after treatment, plasma β-EP level decreased to approach to the normal level, which may be one of the mechanisms of acupuncture in alleviating stoke patients.Key Words Ischemic cerebral apoplexy Acupuncture treatment Plasma β-EP
　　In order to study the therapeutic effect of acupuncture in treatment of ischemic apoplexy and analyze its mechanism, we conducted clinical observation in inpatients and analyzed changes of plasma β-EP level after acupuncture.Clinical Data
　　A total of 30 cases of ischemic cerebral apoplexy patients were inpatients from the Department of Acupuncture and Moxibustion of the Affiliated Hospital of Hubei College of Traditional Chinese Medicine (TCM). They all accorded with the diagnostic criteria[1] revised by the Second National Academic Symposium on Cerebrovascular Diseases of the Chinese Medical Association, and were verified by skull CT examination. Among them, 18 cases were male and 12 female. The oldest was 75 years and the youngest 38 years, with an average age of 61.5 years. The duration of disease was from 2 to 15 days. In 17 cases, the left limbs were involved and in 13 cases, the right limbs were involved. 30 health volunteers were made up of normal control group.
　　Therapeutic Methods 
　　The patient was ordered to take a sitting position or supine position. After routine sterilization, a filiform needle was obliquely inserted into Shuigou (GV 26), with the needle tip toward the nose root and to a depth of about 0.8 cun. Both Neiguan (PC 6) and Zusanli (ST 36) were needled with filiform needles perpendicularly, with the needle tips to the depth of about 1-1.5 cun . The needles were then connected to a G-6805 Electroacupuncture Therapeuti c Apparatus. The acupoints were stimulated continuously for 30 min with an electrical current of 1 mA, frequency of 30 Hz and continuous wave form. The treatment was conducted once daily, with 14 days being a therapeutic course, continuously for 2 courses. The interval between two therapeutic courses was 2 days.
　　Criteria for Evaluating the Therapeutic Effect 
　　According to the “Evaluation Criteria of the Diagnosis and Therapeutic Effect of Stroke" issued by the State Administration of TCM[2], the therapeutic effects were assessed as “cure, remarkable progress, progress, slight progress , failure and worsening". There was no any worsened cases in this study.Determination of Plasma β-EP Level1.5 ml blood sample was taken from each patient and then put into a glass tube mixed with 30 μl trasylol and 50 μl EDTA·2Na anticoagulant and was centrifugated (4000 rpm) for 10 min in low temperature. The supernate was drawn out to be put into EP tube and preserved under -20oC for detection. β-EP content was detected with RIA (provided by the Neurobiology Teaching and Research Section of the Second Military Medical University) and by using a radioimmunity -γ-counter (made in Shanghai Hefu Photo-electric Instrument Limited Company). All the procedures were carried out following the instructions of RIA reagent box. The data were analyzed by using a computer and student t-test method.Results
　　After treatment, out of the 30 cases of ischemic cerebral apoplexy, 16 cases were cured basically, 9 had remarkable progress, 4 had slight progress and one had no any significant changes. The markedly effective rate was 83.3% and the tot al effective rate was 96.7%. Changes of plasma β-EP are shown as following:Table. Comparison of Plasma β-EP Contents between Acupunctureand Control Groups before and after Acupuncture (pg/ml, X±SD)

　　Cases
　　β-EPControl group

30
　　29.71±2.04
　　Acupuncture group
　　Pre-acupuncture
　　30
　　 61.91±10.61**

Post-acupuncture
　　30
　　31.72±8.51##
　　**P<0.01, compared with control group; ## P<0.01, compared with pre-treatment
　　From the above table, it can be known that before acupuncture treatment, plasma β-EP content of the ischemic cerebral apoplexy patients is obviously higher than that of normal group (P<0.01). After acupuncture treatment, plasma β-EP level in patients with ischemic apoplexy decreased significantly in comparison with pre-treatment (P<0.01) and was close to the normal level.Discussion
　　β-EP is one of the endogenous opioid peptides. Research demonstrated that it is involved in the physiological process of the respiratory system, cardiovascular system, neuro-endocrine system. Particularly, it has a close relation with ischemic cerebral injury. It was reported that in animals with acute cerebral ischemia, β-EP content in the cerebral cortex increased remarkably, while in the pons and medulla oblongata where no obvious ischemia was found, the β-EP contents had no obvious changes. The β-EP content in the cerebral cortex was related with the severity of edema of brain tissues in the corresponding time[3]. After intraventricular or intravenous injection of naloxone or β-EP antiserum (the inhibitor of the opioid peptide receptors), the cerebral edema was alleviated[4], indicating an involvement of β-EP in the pathological and physiological processes of ischemic cerebral tissues. Results of the present study are similar to those of the relevant report[5]. It indicated that after cerebral ischemia, β-EP release from the hypophysis increased, resulting in elevation of plasma β-EP content. After acupuncture treatment, with the alleviation or disappearance of clinical symptoms, plasma β-EP level turned to normal gradually. For this reason, the down-regulation action of acupuncture on plasma β-EP in ischemic cerebral apoplexy patients may contribute to the improvement of clinical symptoms and signs.