WORLD JOURNAL OF ACUPUNCTURE-MOXIBUSTION

Vol.10 No.2,  June, 2000

Clinical Observation  

Clinical Observation on Apoplexy Treated by Transverse Acupuncture of Anterior Oblique Line of  Vertex-Temporal

by Sui Minghe(睢明河) Zhang Zhaofa(张兆发)

(Beijing College of Acupuncture and Orthopedics, Beijing 100015, China)

Abstract 72 cases of apoplexy were randomly divided into two groups: group A (40 cases) and group B (32 cases). In group A, we used transverse acupuncture of anterior-oblique line of vertex-temporal plus acupuncture of commonly-used body acupoints for apoplexy. After 30 times of treatments, the results were as follows: In group A, basic recovery rate was 20%, marked improvement rate was 5 0%. In group B, basic recovery rate was 9.4%, marked improvement rate was 25%. T he total therapeutic effect in group A was better than that in group B. This indicated: Transverse acupuncture of anterior-oblique line of vertex-temporal has definite therapeutic effect for apoplexy and has better therapeutic effect than acupuncture along the line.

Key Words Apoplexy Acupuncture therapy Scalp acupuncture

Clinical Data

1. General Data

A total of 72 cases of apoplexy (out-patients) including 46 males and 26 females were involved in this study. Their ages ranged from 40 to 81 years old. Among these patients there were 10 cases between 40 and 49 years old, 13 cases between 50 and 59 years old, 29 cases between 60 and 69 years old, 18 cases between 70 and 79 years old, and 2 cases between 80 and 89 years old. In this series, there were 27 cases in acute stage (duration of the disease within four weeks), 21 cases in recovery stage (duration of the disease from five weeks to half a year), 24 cases in sequela stage (over half a year). In all the cases, there were 12 with cerebral bleeding, 60 with cerebral infarction.

2. Selection of Cases

According to Diagnostic and Therapeutic Effective Criteria of Apoplexy drawn up by National Administration Bureau of TCM in 1995 to select cases.

(1) Main symptoms: hemiplegia, unconsciousness, aphasia, deviation of the tongue and mouth.

(2) Minor symptoms: headache, dizziness, pupil change, drinking choke, deviation of the eyeballs.

(3) The way of onset: Acute onset, mostly with inducing factors, often with aura l symptoms. There are two main symptoms or more, or one main symptom with two minor symptoms, which combine with the way of onset, the inducing factors, aural symptoms and age, we can diagnose it as apoplexy, if without above conditions it can be diagnosed by combination with the result of CT examination.

Treatment Methods

72 cases of apoplexy were randomly divided into two groups: group A with 40 cases, group B with 32 cases.

1. Group A

(1) Instruments: For scalp acupuncture we used needles (50 mm long, 0.3 mm ) made by Suzhou Acupuncture and Moxibustion Appliance Factory. For body acupuncture we used needles (0.30 mm, different length) made by the same factory.

(2) Selecting acupoints:

Scalp acupuncture: Anterior-oblique line of vertex-temporal on the side with cerebral bleeding or infarction, was selected and divided into three segments. Upper 1/3 segment was used for paralysis of lower extremities, middle 1/3 segment for paralysis of upper extremities, and lower 1/3 segment for facial paralysis or aphasia.

Body acupuncture: The following acupoints, were selected, such as, Jianyu (LI 15 ), Quchi (LI 11), Shousanli (LI 10), Waiguan (TE 5), Hegu (LI 4), Houxi (SI 3), Huantao (GB 30), Zusanli (ST 36), Yanglingquan (GB 34), Jiexi (ST 41), Taichong (LR 3), Sanyinjiao (SP 6), just on the affected side.

(3) Manipulation

For paralysis of lower extremities, we used three needles to puncture subcutaneously into 1.5 cun from 1 cm anterior to the upper 1/3 of the line backward vertically. We did manipulation of lifting and thrusting for 2-3 min, at the same time the patient was asked for moving lower extremities, (including stamping foot and walk). After 20 min, the body acupuncture treatment was given, retaining need les for 30 min. Then all needles were withdrawn.

For paralysis of upper extremities ,we used three needles to puncture subcutaneously into 1.5 from 1 cm anterior to the middle 1/3 of the line backward vertically and subcutaneously 1.5 cun. We did manipulation of lifting and thrusting f or 2-3 min, at the same time, the patient was asked for moving upper extremities , (or due to an assistant helped him or her moving). 20 min later, body acupuncture was given, retaining needles for 30 min. Then all the needles were withdrawn.

For facial paralysis or aphasia, lower 1/3 of the line was selected, and the same method was used.

(4) Course of treatment : Once a day , 30 times of treatment in all.

2. Group B:

(1) Instruments: The same as that of group A.

(2) Selecting points: The same as that of group A.

(3) Manipulation: In scalp acupuncture, for paralysis of lower extremities, we s elected upper 1/3 of the anterior-oblique line of vertex-temporal, punctured from the upper end of the 1/3 downward along the line, the depth was 1.5 cun. For paralysis of upper extremities, we selected middle 1/3 of the line ,punctured subcutaneousy into 1.5 cun along the line. For facial paralysis or aphasia, we selected lower 1/3, punctured subcutaneously into 1.5 cun along the line. The stimulated method, the way of movement and retaining time were the same as that of group A.

In body acupuncture, the method of acupuncture was the same as that of group A.

(4) Course of treatment : The same as that of group A.

Criteria of Therapeutic Effect

According to the Trail criteria, the percentage of therapeutic effect is calculated by following equation:

score before treatment-score after treatment

score before treatment×100%

Criteria of therapeutic effect are:

(1) Basic recovery: ≥ 81%, less than 6 marks.

(2) Marked improvement: ≥ 56%, < 81%

(3) Improvement: ≥ 36%, < 56%

(4) Slight improvement: ≥ 11%, < 36%

(5) No change: < 11%

(6) Deterioration (including death): < 0%

Result of Treatment 

1. Comparison of general therapeutic effect (See Table 1).

2. Comparison of myodynamia before and after treatment (See Table 2).

Table 1. Comparison of General Therapeutic Effect between the Groups

X²=9.8, P<0.05, showing significant difference, and the efficacy of group A was remarkably superior to that of group B.

Table 2. Comparison of Myodynamic 

Improvement between the Two Groups

 There was no remarkable difference on myodynamia between the two groups before the treatment (P>0.05). But after the treatment, there was remarkable difference between the two groups (P<0.05), and there was also very remarkably difference between before and after the treatment in the same group (P<0.01).

Discussion

Having used the treatment of combination scalp acupuncture with body acupuncture for apoplexy, we had achieved relatively good result both in the group A and in the group B. But therapeutic effect of the group A was superior to that of the group B. The difference of the treatment between the two groups was: (1) In the group A, we did scalp acupuncture with the needles vertical to the anterior-oblique line of vertex-temporal. In the group B, with the needles along the line. ( 2) In the group A, we used three needles within one-third of the line. In the group B, we used one needle within one-third of the line. At present, the mechanical principles about scalp acupuncture are mainly as follows.

(1) “All of essence of the five-zang and six-fu organs reach head". Among the fourteen meridians, six yang-meridians of hand and foot, the meridian of Hand-Shaoyin, that of Foot-Jueyin, and Du meridian directly reach head or face. Other five meridians are also indirectly reach head or face by divergent meridians.

(2) The impulse of needle sensation on the scalp corresponding area directly goes through the skull and acts on cortex corresponding area, so promote connection and interaction between the acupoint exciting point and pathogenic area exciting point.

At present, though some scholars have different opinions on the above theory. Bu t if this theory exists actually, both transverse acupuncture and longitudinal acupuncture would have effects. In the article we had good result both in group A and in group B. This is accordant with the theory. But there was difference between transversely puncturing three needles within the same one-third of the line and longitudinally puncturing one needle. Transversely puncturing three needles produces more impulse of needle sensation on the scalp corresponding area, then the energy directly acting on cortex corresponding area is stronger so it has better result than longitudinal puncturing one needle. In the article, group A having better result than group B is accordant with this point.

References

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