Acupuncture Alleviates Cognitive Dysfunction After Stroke
Acupuncture combined with herbal medicine outperforms drugs for alleviating cognitive dysfunction after a cerebral infarction. Researchers (Wang et al.) compared the therapeutic effects of acupuncture plus herbs with that of a pharmaceutical medication. Two groups were compared. The Traditional Chinese Medicine (TCM) group received acupuncture to benefit the occipital blood vessels and nerves. In addition, the herbal formula Bu Yang Huang Wu Tang was prescribed. The drug group received piracetam, a nootropic derivative of GABA, in tablet form. Nootropic medications are prescribed to benefit memory and cognitive function. The acupuncture plus herbs group achieved a 90% total treatment effective rate. The drug group achieved a 70% total effective rate.
Acupuncture was applied to Fengchi (GB20) and extra point Gongxue. In this study, Gongxue is located 1.5 cun below Fengchi. However, note that Lifang et al. use an alternate location for Gongxue (1 cun below GB20) in their research entitled Additional effects of acupuncture on early comprehensive rehabilitation in patients with mild to moderate acute ischemic stroke: a multicenter randomized controlled trial. Notably, Lifang et al. conclude that “acupuncture is safe and has additional multi-effect in improving neurologic deficits….”
Getting back to the Wang et al. research, Fengchi and Gongxue were selected for their proximity to the lesser occipital nerve branches and the occipital blood vessels. The focus was to enhance vertebral artery and internal carotid artery blood circulation to benefit the brain. Bu Yang Huang Wu Tang was chosen for its ability to promote qi and blood circulation, dispel blood stasis, and dredge the meridian blockages. Wang et al. cite research demonstrating the Bu Yang Huang Wan Tang is an appropriate herbal formula for this application noting that it regulates the ratio of Bc1 to Bax (Wang, Tong & Sun), effectively benefitting mitochondria, mitigating downregulation of 5-HT, and increasing the concentration of monoamine neurotransmitters in the brain. The focus was to improve brain metabolism and protect cells.
The drug group received 3 tablets of piracetam, three times per day for 8 weeks. The acupuncture group received nape acupuncture at Fengchi and Gongxue with 0.30 mm x 40 mm acupuncture needles. The needle retention time was 30 minutes per acupuncture session. Acupuncture therapy was conducted once per day, 6 days per week, followed by a 1 day break for the duration of the 8 week study. Bu Yang Huang Wu Tang was administered in the following modified version:
- Huang Qi
- Dang Gui Wei
- Chuan Xiong
- Chi Shao
- Tao Ren
- Hong Hua
- Di Long
- E Zhu
- Shi Chang Pu
- Shui Zhi
Notice the addition of the last three herbs, which are very powerful blood invigorators. The decoction was prepared with normal water boiling processes down to a 400 ml serving, ingested once in the morning and once at night. The results demonstrate that acupuncture has a 90% total effective rate for the alleviation of cognitive dysfunction after a cerebral infarction. Furthermore, acupuncture has been shown to benefit brain function in additional studies.
This research underscores the importance of acupuncture for the treatment of post-stroke syndrome. Scalp acupuncture is often a leading style used for this condition. According to scalp acupuncture theory, there are several windows of opportunity to benefit from acupuncture after a stroke. The most effective window of opportunity is the 24 – 72 hour period after a stroke. Here, treatment results may potentially be completely restorative. Next, there is the 1, 2, and 3 week windows of time. Each sequential week after a stroke brings new challenges. Efficacy diminishes significantly if the first acupuncture treatment is applied outside of the three week window.
Gu et al. confirm that acupuncture benefits stroke patients using the Fugl-Meyer Assessment (FMA) of sensorimotor recovery after stroke. Researchers (Gu et al.) from the Second Hospital (Jiaxing) conducted the study to investigate the treatment efficacy of scalp electroacupuncture after a stroke. Two groups were compared. Each received identical functional recovery therapies and medications, with one exception. The treatment group also received scalp electroacupuncture.
Stainless steel acupuncture needles (0.25 mm x 40 mm) were applied to the scalp motor and sensory areas, including the upper and lower limb regions. Mild reinforcing and reducing techniques were applied with lifting, thrusting, and twirling. Once manual acupuncture achieved the arrival of deqi, electroacupuncture was applied. A disperse-dense wave of 10 – 15 Hz was applied with an intensity level set to patient tolerance levels or until muscle contractions were observable. Electroacupuncture was applied once per day, 20 minutes per acupuncture session, 6 times per week, for a total of 6 weeks. Using the FMA, the researchers concluded that acupuncture assists in the functional rehabilitation of stroke patients, including improvements in both motor and sensory functions.
Tang et al. confirm that acupuncture benefits stroke patients. Using FMA, National Institutes of Health Stroke Scale (NIHSS), and Barthel Index (BI) assessments, the Chongqing Medical University researchers determined that acupuncture lowers the incidence of fatality and paralysis for stroke patients. Measurements were taken at 3 and 6 months following completion of the acupuncture treatment sessions.
Tang et al. cite prior research (Andersson & Lundeberg) determining that acupuncture promotes regulation of neurotransmitters and peptides in the brain and spinal cord. Two groups were compared in the study. Both groups received conventional neurological therapies. One group, however, also received acupuncture. The acupoints used were the following:
- Qianshencong – Xuanli (anterior oblique scalp line of vertex-temporal)
- Neiguan (PC6)
- Jiquan (HT1)
- Chize (LU5)
- Jianyu (LI15)
- Xiaoluo (TB12)
- Tianjing (TB10)
- Waiguan (TB5)
- Sanyinjiao (SP6)
- Weizhong (BL40)
- Xuehai (SP10)
- Taixi (KD3)
- Zusanli (ST36)
- Huantiao (GB30)
- Yanglingquan (GB34)
- Xuanzhong (GB39)
Scalp acupuncture needles were applied to achieve deqi with manual techniques followed by rotations for 2 – 3 minutes. Needles were rotated every 5 minutes and total needle retention time was 30 minutes. The remaining acupuncture needles were manually stimulated using reinforcing and reducing techniques. Needles were manually re-stimulated every 10 minutes during the 30 minute needle retention time. Acupuncture sessions were once per day for 20 days. The results demonstrate that adding acupuncture to conventional therapy produces superior patient outcomes to using only conventional therapy. Acupuncture lowered the incidence of fatalities and paralysis.
Wang ZD, Xin GL & Lin FY. (2013). Clinical Observation on Nape Acupuncture plus Bu Yang Huan Wu Decoction for Cognitive Disorder after Cerebral Infarction. Shanghai Journal of Acupuncture and Moxibustion. 32(10).
Wang XG, Tong ET & Sun SG. (2005). Bu Yang Huan Wu Decoction in treating cerebral ischemia and its effect on rat cortical neurons. Journal of Modern Medicine. 14(3): 306-309.
Chen, Lifang, Jianqiao Fang, Ruijie Ma, Xudong Gu, Lina Chen, Jianhua Li, and Shouyu Xu. “Additional effects of acupuncture on early comprehensive rehabilitation in patients with mild to moderate acute ischemic stroke: a multicenter randomized controlled trial.” BMC Complementary and Alternative Medicine 16, no. 1 (2016): 226.
Gu XD, Wu H, Fu JM, Wang J, Ma QW, Zhao HW, Lu ZL, Jiang WH, Liu H. (2013). Electroacupuncture of the scalp combined with sensory reeducation for the functional rehabilitation of stroke patients. Chin J Phys Med Rehabil. 35(6).
Yao B, Huang XM, Jiang XM et al. (2007). Rehabilitation of post-stroke patient’s sensory dysfunction. Chinese Journal of Physical Medicine and Rehabilitation. 29: 314-316.
Tang X, Huang L, Xie HW. (2013). Clinical observation of Yin and Yang acupuncture. China gerontological society. 19(33).
Andersson S, Lundeberg T. Acupuncture: from empiricism to science: functional background to acupuncture effects in pain and disease. Med Hypothesis, 1995; 45(3): 271-81．