WORLD JOURNAL OF ACUPUNCTURE-MOXIBUSTION

Vol.10 No.2,  June, 2000

Clinical Observation  

Effect of  Acupuncture on the Intelligence 

of Cerebrovascular Dementia Patients

by Chen Bangguo(陈邦国)

(Dept. of Acupuncture, Moxibustion, Orthopedics and Traumatology, 

Hubei College of TCM, Wuhan 430061, China)

Cerebrovascular dementia is a common disease in the old and meddle-aged people. Its morbidity constitutes about 10-20% of all the dementia patients and results mainly from all-round decline of the brain function due to cerebral atheroscleorsis and cerebral infarction. The author of the present paper adopted acupuncture therapy to treat this kind of disease and observed its effect on dementia patients' intelligence. Here is the report.

Clinical Data

A total of 38 cerebrovascular dementia patients were observed in this study. Among them, 26 were male and 12 female, ranging in age from 50 to 60 years in 14 cases and above 60 years in 24 cases at an average of 63.2 years. Among them, 7 cases experienced cerebral infarction with a large area and 31 cases had multiple cerebral infarction. The shortest duration of disease was 5 months and the longest 3 years.

Diagnosis: 1). Cerebral CT scanning suggested cerebral infarction; 2). Intelligence decline (low calculation capability, decline of understanding and judgment ability or disturbance of thinking); 3). Dysmnesia (any one of the disturbances of cognition, speech, personality and orientation); 4). The patient might have abnormal gait, incontinence of defecation and urination, pseudobulbar paralysis, or limb paralysis; 5). Fundus and rheoencephalogram examinations suggested cerebral atherosclerosis; and 6). on the basis of the diagnostic standards for cerebrovascular dementia formulated in the 3rd edition (DSM-III) of “Handbook for American Diagnosis and Statistical Analysis of Psychonosema" and combining psychic cognitive capacity examination (CCSE) and social functional questionnaire (FAQ), patients with CCSE≤20 marks and FAQ≥5 marks were diagnosed as dementia.

Accumulative total of marks of CCSE and FAQ was employed to determine the state of patient's intelligence before and after treatment.

Treatment Methods

Acupoint selection: Baihui (GV 20), Fengfu (GV 16), Shuigou (GV 26), Quchi (L I 11, both), Shenmen (HT 7, both), Sanyinjiao (SP 6, both), Taixi (KI 3, both), and Taichong (LR 3, both).

Operation: After insertion and achieving needling sensations, the needle in Baihui (GV 20) was advanced transversely along the subcutaneous tissues forwards, backwards, leftwards and rightwards, causing the needling sensations spreading outwards. The needle in Fengfu (GV 16) was controlled to advance slowly towards the mandible and manipulated with twirling reducing method to cause the needling sensations to reach the vertex. The needle in Shuigou (GV 26) was controlled to advance upwards, obliquely and deeply, then lifted and thrusted repeatedly for enhancing the needling sensations. The needle in Quchi (LI 11) was lifted, thrusted and twirled repeatedly with reducing method. Shenmen (HT 7) and Taichong (LR 3) were stimulated with uniform reinforcing and reducing method. Sanyinjiao (SP 6) and Taixi (KI 3) were stimulated with lifting, thrusting and twirling combined with reinforcing method. The needles were all retained for 30 min, and manipulated once again every 5 to 10 min. The treatment was conducted once daily, with 10 sessions being a therapeutic course. All the cases were treated for 4 course s.

Criteria for Evaluating the Therapeutic Effect

Markedly effective: After treatment, the patient's main symptoms and signs disappeared basically, the mind was conscious, orientation sound, answering correct, reaction sensitive, the patient could take care of himself or herself in daily life, could take part in general social activity, CCSE score was 25-28 and FAQ sc ore 2-4. Effective: The main symptoms were relieved or disappeared partially, the signs were relieved apparently, the patient could take care of himself or herself basically, answer questions basically correctly but the reaction was obtuse . CCSE score increased above 4 and FAQ score decreased above 3. Ineffective: T he principal symptoms and signs had no any striking changes, the patient could not take care of himself or herself in daily life, could not answer questions correctly and had a dementia complexion. His or her CCSE and FAQ scores had no any improvement.

Treatment Results

After acupuncture treatment, of the 38 cases of dementia patients, 13 cases underwent a significant improvement, 20 were effective and 5 ineffective. CCSE an d FAQ scores before and after acupuncture treatment were shown in the following table.

Comparison of CCSE and FAQ Scores 

before and after Acupuncture (M±SD)

From the above table, it can be seen that CCSE and FAQ scores have a significant change after acupuncture treatment (P<0.001).

Discussion

Cerebrovascular dementia belongs to the category of “Dai Bing" (idiocy) in traditional Chinese medicine and manifests mainly as mental dullness and slow reaction. It is held in TCM that the brain is considered as an extraordinary organ, the sea of the accumulated marrow; the kidney is in charge of bones, products marrow and is closely related to the brain. Dementia is often seen in the middle- aged and aged people due to deficiency of the kidney, insufficiency of the marrow, blockage of meridians by phlegm, up-stirring of wind-phlegm, lucid Yang failing to rise, and degeneration of the brain. Thus, the acupuncture treatment of cerebraovascular dementia starts with regulating functions of Zang  and Fu organs, combined with reinforcing the kidney to enrich the essence, removing accumulated phlegm, elevating the clear Qi and lowering the turbid Qi, and improving brain functions.

In the present paper, after acupuncture treatment, the patient's intelligence had a significant improvement and the total effective rate was up to 87%, showing a considerable recovery of the dementia patients' intelligence after acupuncture. Acupuncture of Baihui (GV 20) and Fengfu (GV 16) of Du meridian combined with Shuigou (GV 26) can reinforce the kidney to enrich the marrow, elevating the lucid Yang and make the brain being clear in thinking. Quchi (LI 11), one point of the Yangming Meridian, can function in dredging meridians, clearing away turbid materials, promoting blood circulation and eliminating blood stasis. Shenmen (HT 7) of the Heart Meridian is used to ease the mind. Sanyinjiao (SP 6), the crossing point of the three Yin meridians of the Foot, combined with Taixi (KI 3), serves to invigorate the kidney and replenish the marrow. Taichong (LR 3), the source point of the Kidney Meridian, combined with Sanyinjiao (SP 6), can tonify the congenitive and acquired essence to enrich Qi and blood for nourishing the brain. Taichong (LR 3), the source point of the Liver Meridian, can reinforce the liver and kidney to clear the orifice of the brain, especially for patients with hyperactivity of the liver-Yang. The above-mentioned acupoints used together are used to treat both the principal and the secondary aspects of the disease at the same time.

Modern medicine holds that dementia results from changes of hemodynamics of the blood circulation due to disorder of the systolic and diastolic activities of blood vessels, or from disturbance of blood supply of the cerebral tissues because of changes of the vascular wall and lumen, blood pressure and vascular filling state, or from multiple small infarction-induced lesion and fragmentation of the conducting fibres in the white substance. It is also associated with high blood hyperviscosity, etc.. Studies demonstrated that acupuncture of Baihui (GV 20) , Fengchi ( GB 20), Shuigou (GV 26), Quchi (LI 11), etc. could dilate cerebral blood vessels, improve brain circulation, increase oxygen supply, raise the utilization ratio of glucose in the brain tissues, prevent proteins from degeneration and improve the intelligence state; while acupuncture of Quchi (LI 11), Sanyinjiao (SP 6) and Taichong (LR 3) had functions of lowering blood lipid, lowering blood pressure, antiplatelet agglutination. It thus had a good therapeutic effect in improving the state of higher viscosity, accumulation and stagnancy. For this reason, acupuncture possesses a comprehensive regulative effect in treatment o f vascular dementia. In addition, the author also realizes that in treatment of this disease, the shorter the duration of disease and the younger the patient is , the better the therapeutic effect achieved, meaning the importance of early diagnosis and early treatment.