1 Hospital of Traditional Chinese Medicine, Zhabei District, Shanghai 200072, China

2 Shanghai Research Institute of Acupuncture and Meridian, Shanghai 200030, China

SPECIAL TOPIC STUDY

Exploration of Clinical Regularity in Acupuncture for Apoplexy Sequelae Based upon ‘Traditional Chinese Medical Acupuncture-moxibustion Information Databank’

Zhang Yi-ming1, Huang Qin-feng2

1 Hospital of Traditional Chinese Medicine, Zhabei District, Shanghai 200072, China

2 Shanghai Research Institute of Acupuncture and Meridian, Shanghai 200030, China

Author: Zhang Yi-ming, associate chief physician.

E-mail: 13651666319@139.com

In review of acupuncture literature from 1949 to 2010, in accordance with the data in ‘Traditional Chinese Medical Acupuncture-moxibustion Information Databank’, the accounting analysis was used for comprehensive analysis and regularity summery of acupuncture therapy for apoplexy sequelae. The results showed that Hegu (LI 4), Zusanli (ST 36), Quchi (LI 11), Jianyu (LI 15), Sanyinjiao (SP 6), Yanglingquan (GB 34), Lianquan (CV 23), and Waiguan (TE 5) were used at the highest frequency. In the therapeutic methods, acupuncture was used at the highest frequency, followed by scalp acupuncture, and simultaneous application of acupuncture and herbal medicine.

Acupuncture-moxibustion Therapy； Stroke； Complications； Bibliometrics；Evaluation Studies； Databases, Bibliographic； Traditional Chinese Medicine

Apoplexy sequelae refer to the symptoms of motor disturbance on one-sided limb, sensory disturbance, deviated mouth and eye, difficult speaking, and numb sensation of varying degrees, left over after the onset of cerebral accidents (cerebral hemorrhage, cerebral thrombosis or cerebral infarction) for half a year. The main pathological changes were ischemia, necrosis and edema of involved cerebral tissues due to hemorrhage or obstruction of blood flow. This disease belongs to the scope of ‘wind’ and‘stroke’ in traditional Chinese medicine (TCM) and is most commonly caused by emotional dysfunction, deficiency of essential qi, improper food ingestion, dysfunction between yin and yang, and reverse and chaotic flow of qi and blood. Apoplexy sequelae is one of the effective cases in acupuncture treatment[1-3].

In accordance with the collected information, literature on apoplexy sequelae was analyzed systematically to summarize the applying regularity of points and therapeutic methods, in a hope to master the research status and open up the thinking for further promoting the clinical application of acupuncture therapy for apoplexy sequelae.

1 Source of Literature

In this article, in accordance with the data of ‘Traditional Chinese Medical Acupuncture-moxibustion Information Databank’ (original ‘China Modern Acupuncture-moxibustion Information Databank’), the accounting analysis was conducted for comprehensive analysis of the literature on acupuncturein the seventy four journals of acupuncture, Chinese herbal medicine, and integration of Chinese and Western medicine from 1949-2010. The profound process was performed for the input scope, input standard, literature processing, index, and references in ‘Traditional Chinese Medical Acupuncturemoxibustion Information Databank’, and the data were profoundly explored by mathematical model[4].

In this article, the consultation was given in the statistical chapter of ‘Traditional Chinese Medical Acupuncture-moxibustion Information Databank’ by inputting names or codes of diseases, such as apoplexy sequelae, shoulder-hand syndrome/ apoplexy sequelae or 0528, seudobulbar palsy/ apoplexy sequelae or 0538, aphasia/apoplexy sequelae or 0634, swallowing disorders/apoplexy sequelae or 1116, depression/apoplexy sequelae or 1128, hemiplegia/apoplexy sequelae or 1176, vascular dementia/apoplexy sequelae or 1300, constipation/apoplexy sequelae or 1810, hiccup/ apoplexy sequelae or 1811, incontinence/apoplexy sequelae or 1814, urinary retention/apoplexy sequelae or 1815, etc., for statistical analysis of the searching results.

Acupuncture for apoplexy sequelae was first seen in 1950s[5-6]. From 73 185 data recorded in‘Traditional Chinese Medical Acupuncturemoxibustion Information Databank’, totally 1 713 articles of apoplexy sequelae in conformity with the inclusion criteria were detected, including paralysis, pseudobulbar palsy, dysphagia, aphasia, vascular dementia, shoulder-hand syndrome, depression, urinary disorders, hiccups, constipation. The total observed patients were 146 101 cases. The effective patients were 135 019 cases. The average effective rate was 90.3%.

2 Results and Analysis

2.1 Feature of acupoint selection

2.1.1 Commonly used points

It is shown in the statistical results that totally 384 points were used for apoplexy sequelae, including 293 meridian points, 43 ear points, 23 extraordinary points, and 25 scalp points. Please see Table 1 for frequency of the fourteen meridian points, extraordinary points, and stimulating zones of scalp acupuncture. Because there were fewer about the clinical application of ear points, no statistic was done.

Table 1. Statistics of frequency of points

2.1.2 Combination of common points

In the analytic comparison of the points listed in the first eight positions of frequency for the treatment of apoplexy sequelae by two-two combination of the points, the points with the matching combination above 50% were regarded as the best combination of points, such as Hegu (LI 4) with Yanglingquan (GB 34), Zusanli (ST 36), Waiguan (TE 5), Quchi (LI 11), Jianyu (LI 15)； Zusanli (ST 36) with Yanglingquan (GB 34), Jianyu (LI 15), Quchi (LI 11),Waiguan (TE 5)； Quchi (LI 11) with Yanglingquan (GB 34), Waiguan (TE 5), Jianyu (LI 15)； Jianyu (LI 15) with Yanglingquan (GB 34), Waiguan (TE 5)； Sanyinjiao (SP 6) with Zusanli (ST 36), Hegu (LI 4), Quchi (LI 11).

In treatment of apoplexy sequelae, there were mainly the following methods for the combination of points.

The combination of the upper and lower points. Because the motor and sensory disturbance of the lower limb is the main symptom of apoplexy sequelae, usually the combination of the upper points and lower points can be used to promote the rehabilitation of the limb functions, such as Hegu (LI 4) with Yanglingquan (GB 34), Zusanli (ST 36), Sanyinjiao (SP 6)； Zusanli (ST 36) with Jianyu (LI 15), Quchi (LI 11), Waiguan (TE 5)； Quchi (LI 11) with Yanglingquan (GB 34)； Jianyu (LI 15), Waiguan (TE 5) with Yanglingquan (GB 34), etc.

The combination of the points from the same name meridian. The points were mainly selected from Yangming Meridians, together with the points from other yang meridians additionally, for greatly arising qi of yang meridians and restoring the limb functions, such as Hegu (LI 4), Quchi (LI 11), Jianyu (LI 15) with Zusanli (ST 36)； Zusanli (ST 36) with Jianyu (LI 15), Quchi (LI 11)； Yanglingquan (GB 34) with Waiguan (TE 5).

The combination of the points from the meridians in the exterior and interior relationship. The combination of the points from the meridians in the exterior and interior relationship can be used to treat both the interior and exterior meridians, and balance the liver and extinguish wind, such as Yanglingquan (GB 34) with Taichong (LR 3).

The combination of the points for patterns. Namely, the points were combined based upon the patterns and symptoms, such as Zusanli (ST 36) with Lianquan (CV 23), Taichong (LR 3) with Lianquan (CV 23), etc. 2.1.3 Feature of selection of meridians and points

The commonly used meridians and points were successively the Large Intestine Meridian of Hand Yangming (2 716), Stomach Meridian of Foot Yangming (2 488), Gallbladder Meridian of Foot Shaoyang (2 263), Governor Vessel (1 388), Bladder Meridian of Foot Taiyang (1 314), Triple Energizer Meridian of Hand Shaoyang (1 111), Conception Vessel (1 097), Spleen Meridian of Foot Taiyin (939), Pericardium Meridian of Hand Jueyin (634), Liver Meridian of Foot Jueyin (605), Heart Meridian of Hand Shaoyin (490), Kidney Meridian of Foot Shaoyin (482), Small Intestine Meridian of Hand Taiyang (440), and Lung Meridian of Hand Taiyin (249).

The most frequently used meridians were the Large Intestine Meridian of Hand Yangming and Stomach Meridian of Foot Yangming. Because apoplexy sequelae were often characterized by the symptoms of flaccidity and weakness in the limbs and tendons, and even misuse due to paralysis, and ‘the stomach is a sea of water and grain’, ‘source of the production of qi and blood’ and ‘much qi and blood in Yangming Meridians’, ‘Yangming Meridians are specifically selected for paralysis’, and Yangming Meridians are mainly selected and supplemented by other yang meridians, such as the Gallbladder Meridian of Foot Shaoyang and Bladder Meridian of Foot Taiyang. The next one was the Governor Vessel, because the Governor Vessel ‘enters the brain’.

2.1.4 Feature of point selection by body parts

The commonly used body parts and points were successively the points on yang aspect of the leg (3 330), points on yang aspect of the arm (2 753), points on the neck (2 681), points on the face (1 629), points on the dorsum of the hand (1 312), points on yin aspect of the arm (1 164), points on yin aspect of the foot (1 035), points on yin aspect of the leg (956), points on the dorsum of the foot (731), points on the upper back (564), points on the lower abdomen (403), points on the lower back (374), points on the chest and epigastric region (272), and points on the palm (258).

In the selection of the points by body parts, the points from yang aspect of the leg and arm were used at the highest frequency, reflecting the thoughts of‘Yangming Meridians specifically selected for paralysis’. The improvement of the functions of the lower limbs was very significant for the enhancement of the patient’s life and survival quality. Therefore, the points from yang aspect of the leg were mostly selected to promote the restoration of the limb functions. The next was the points on the neck, because the points on the neck are close to the pathological region of the brain. In other body parts, the points were mostly selected by pattern and disease differentiations.

2.2 Summary of the therapeutic methods

The various therapeutic methods used in frequency were successively acupuncture (1 227), scalp acupuncture (360), combination of acupuncture and medication (314), electroacupuncture (EA) (280), rehabilitation (157), hydro-acupuncture (90), moxibustion (86), bleeding method (44), acupuncture apparatus (41), cupping method (34), tongue acupuncture (29), eye acupuncture (25), cutaneous needling (21), ear acupuncture (21), acupointembedding method (11), fumigation (10), acupoint application method (9), hand-foot acupuncture (8), acupoint-magnetic method (6), acupressure (5), fire acupuncture (4), acupotomy (3), acupointiontophoresis (3), face acupuncture (3), scrappingrubbing method (2), picking therapy (2), and Tanboplucking acupoint (1).

It can be seen that acupuncture is used at the highest frequency, and then scalp acupuncture and combination of acupuncture and medication. Acupuncture can be used to restore the functions of the limbs. Scalp acupuncture can be used to reach the diseased area. Simultaneous application of acupuncture and herbal medicine can be used for a symptom or a syndrome. Acupuncture can be used for major pattern and herbal medicine can be used for accompanying pattern. The commonly used herbal formulae wereBu Yang Huan Wu Tang,Ban Xia Bai Zhu Tian Ma Tang, andZhen Gan Xi Feng Tang, etc. EA therapy is electric impulse stimulation based upon acupuncture, giving a continuous stimulation to the points, muscles and nerves, and can induce a passive movement of the limbs and enhance the therapeutic effect. In recent years, acupuncture plus rehabilitation has been comparatively emphasized in the treatment. The rehabilitating training means to give an active or passive training according to the impaired situation of various aspects in the patients with apoplexy sequelae. The passive training mainly includes the restorative training of the patients with various equipments, to control the patient’s body manually by the therapist, for changing the sports mode, muscular tension and sports quality, such as Bobath therapy, etc.

The pathological situation is complicated in apoplexy sequelae. Therefore, different therapeutic methods can be selected to enhance the therapeutic effect, relieve or eliminate the influence of various symptoms to the patient’s quality of life.

2.3 Feature of point selection for apoplexy complications (Table 2)

2.3.1 Pseudobulbar palsy

Pseudobulbar palsy is caused by damage of corticobulbar tract, clinically manifested by difficulty swallowing, hoarse voice, slurred speech, salivation, and even forced crying and laughing. It threatens the life in severe cases. In treatment, the local points are mainly selected, for directly reaching the disease area, such as Lianquan (CV 23) and Fengchi (GB 20), Lianquan (CV 23) mainly for aphasia； and Jinjin (EX-HN 12), Yuye (EX-HN 13) and Yifeng (TE 17) mainly for difficulty swallowing. Distal points such as Fenglong (ST 40), Neiguan (PC 6), and Sanyinjiao (SP 6) are used at higher frequency for pseudobulbar palsy.

2.3.2 Hemiplagia

Hemiplagia is one of the common complications of apoplexy sequelae. The points used at the highest frequency for hemiplagia are Quchi (LI 11), Hegu (LI 4), Zusanli (ST 36), Jianyu (LI 15), points from Yangming meridians, in a meaning of ‘Yangming Meridians specifically selected for paralysis’. Secondly, Sanyinjiao (SP 6) and Neiguan (PC 6) are the major points for apoplectic hemiplagia. Then, Yanglingquan (GB 34), Waiguan (TE 5) and Huantiao (GB 30) are the points selected from Shaoyang Meridians, for consolidating the therapeutic effect. And Taichong (LR 3) is selected to balance the liver and extinguish wind.

2.3.3 Shoulder-hand syndrome

Shoulder-hand syndrome refers to sudden swelling and pain of the hand and shoulder, and impaired functions of the hand. The points used at the highest frequency for shoulder-hand syndrome are Jianyu (LI 15), Quchi (LI 11) and Hegu (LI 4), in a meaning of‘Yangming Meridians specifically selected for paralysis’, and then, Waiguan (TE 5), Jianliao (TE 14) and Jianzhen (SI 9) from yang meridians for enhancing the therapeutic effects.

2.3.4 Depression

Depression refers to emotional disorder commonly seen after apoplexy, characterized by the physical symptoms of persistent low mood and anhedonia, often accompanied by sleep disorders, loss of appetite, and sexual hypoesthesia, and belongs to the scope of ‘melancholia’ and ‘hysteria’ in TCM[7]. In recent years, the papers on acupuncture treatment of depression have been increased gradually. The points used at the highest frequency are Baihui (GV 20), and then Neiguan (PC 6), Taichong (LR 3), Sanyinjiao (SP 6), Shenmen (HT 7), Sishencong (EX-HN 1), Yintang (GV 29), and Zusanli (ST 36).

2.3.5 Dementia

Dementia refers to chronic decline of intelligent function and other cognitive skills, clinically characterized by slow decline of the mentality, accompanied by change in the personality at varying degrees, but by no conscious disturbance. It is in slow onset and longer duration. Acupuncture treatment for senile dementia is mainly used for vascular dementia, accounting for 67.1% of the total number of papers. This disease belongs to the scope of‘dementia’ and ‘forgetfulness’ in TCM[8]. Because the brain is ‘a house of the primary spirit’, the points are mainly selected from the head, such as Baihui (GV 20), Shuigou (GV 26), Fengchi (GB 20), and Sishencong (EX-HN 1).

2.3.6 Hiccups, constipation, voiding dysfunction

Hiccups, constipation, and voiding dysfunction are common complicated symptoms in apoplexy. In acupuncture treatment, the points are mainly selected by syndrome differentiation, such as Neiguan (PC 6), Zusanli (ST 36), and Geshu (BL 17) selected for hiccups； Tianshu (ST 25) selected for constipation；Guanyuan (CV 4) selected for voiding dysfunction, etc.

Table 2. Analysis of clinical point selection for apoplectic complications

We used to analyze the clinical regularity on constipation[9], depression[10], and dementia[11], similar to the basic prescriptions for constipation, depression and dementia complicated after apoplexy. We suggest that in treatment of apoplectic complications, the points are mainly selected upon the basic prescription for apoplexy sequelae and its complications.

3 Proposal

3.1 Therapeutic principles

To tonify qi, activate blood, dissolve phlegm, dredge the collaterals, extinguish wind, and stop spasm.

3.2 Selection of points

3.2.1 Basic points

Hegu (LI 4), Zusanli (ST 36), Fengchi (GB 20), Baihui (GV 20), Neiguan (PC 6), Sanyinjiao (SP 6)； Anterior Oblique Line of Vertex-temporal (MS 6), and Motor Area in scalp acupuncture

3.2.2 Modification by symptoms

Taichong (LR 3) and Fengchi (GB 20) added for hyperactivity of liver yang； Xuehai (SP 10) and Guanyuan (CV 4) added for qi deficiency and blood stasis； Fengfu (GV 16) and Fenglong (ST 40) added for obstruction of meridians by wind and phlegm； Taixi (KI 3) and Shenshu (BL 23) added for motion of wind due to yin deficiency； Jianyu (LI 15), Quchi (LI 11), Shousanli (LI 10), Waiguan (TE 5), Hegu (LI 4), Huantiao (GB 30), Futu (ST 32), Fengshi (GB 31), Xuanzhong (GB 39), Jiexi (ST 42), Taichong (LR 3) selected accordingly for hemiplegia； Dicang (ST 4), Jiache (ST 6), and Xiaguan (ST 7) added for deviated mouth； Lianquan (CV 23), Jinjin (EX-HN 12), and Yuye (EX-HN 13) added for aphasia and dysphagia of pseudobulbar palsy； Baihui (GV 20), Neiguan (PC 6), and Taichong (LR 3) added for depression； Neiguan (PC 6) added for hiccups； Tianshu (ST 25) added for constipation； Guanyuan (CV 4) added for voiding dysfunction.

3.3 Therapeutic methods

3.3.1 Acupuncture

Each time, the basic points were selected, plus the adjunct points by pattern identification. The needles were manipulated by even needling technique or the needling technique for reinforcing deficiency and reducing excess. The needles were retained for 15-20 min. The treatment was given once every day.

3.3.2 Scalp acupuncture

Body acupuncture can be combined with scalp acupuncture. Motor Area and Foot Motor Sensory Area on the opposite side can be selected for hemiplegia. Sensory Area on the opposite side can be used for sensory dysfunction. Vasomotor Area can be used for edema in the limbs. Speech Area can be added for aphasia. Vertigo-auditory Area can be added for dizziness. Every needle was inserted subcutaneously for 1 cun and manipulated with the twisting technique by 200 times/min. The needles were manipulated continuously for five minutes. Then after five-minute interval, the needles were twisted again. This procedure was repeated for three times. The needles were retained for 30-60 min. The treatment was given once every day or every other day.

3.3.3 EA

Every time, 2-3 groups of the points were selected (two points in each group), on the side of the affected limb dominantly, and the frequency of EA was 20 Hz, in continuous wave, with its intensity to cause the throbbing of the muscles, but not cause any discomfort in the patients. The treatment was given once every day.

3.3.4 Moxibustion

The points were as same as those for acupuncture treatment. Ten moxa cones were applied to each point till warm sensation appeared. The treatment was given once every day.

3.3.5 Hydro-acupuncture

Jianyu (LI 15), Binao (LI 14), Quchi (LI 11), Shousanli (LI 10), Waiguan (TE 5), Biguan (ST 31), Futu (ST 32), Zusanli (ST 36), and Xuanzhong (GB 39) were selected, 2-4 points each time. Each point was injected with 0.5-0.1 mL of Coenzyme A, Vitamin B1, Vitamin B12injection orDang Gui(Radix Angelicae Sinensis) injection,Dan Shen(Radix Salviae Miltiorrhizae) injection. The treatment was given once every day. This method is suitable for the patients with cerebral accidents at the later stage.

3.4 Health advice

It is advisable to adjust the diet properly, eat less animal fat and saturated fatty foods, and eat more vegetables, fruits, protein and vegetable oil.

It is necessary to actively prevent heart disease, diabetes； actively eliminate adverse factors, such as obesity, smoking, improper diet habit, and emotional factors, etc.

Once the premonitory symptoms of apoplexy appear, such as dizziness, headache, numbness, paralysis, suddenly fell to the ground, aphasia, etc., the great attention should be paid to.

Medical rehabilitation is very important for the prevention of complications and reducing the morbidity. After the pathological condition becomes stable, it is advisable to start the functional exercises of the limbs, first passive exercises, or massage, by massaging the shoulder, elbow, hip, knee, ankle, hand, and foot along the meridians, from distal to proximalparts. After the voluntary movement appears, by the voluntary movement in predominance, and passive movement in supplementation, the healthy side is exercised to lead the sick side.

After the pathological situation is stable, it is necessary to start language training, first start the exercise of the mouth form and phonation to train the lip and tongue, and then start the exercises to strength and enlarge the speaking ability gradually from the simple language.

4 Discussion

Apoplexy sequelae belongs to the scope of ‘severe syncope’, ‘paralysis’ and ‘hemiplegia’ in TCM, mostly caused by congenital weak constitution, imbalance between yin and yang, reverse and chaotic flow of qi and blood, and obstruction of phlegm and blood stasis. All these factors may result in the symptoms of syncope, hemiplegia, numbness in the limb, and aphasia due to stiffness in the tongue. In TCM, the pathological position is in the brain, closely related to the heart, liver, spleen and kidney. Phlegm and blood stasis are the main pathological factors. The obstruction of the meridians and collaterals by phlegm and blood stasis cause the limb unable to move voluntarily, leading to the wasting and numbness in the limb over time. The clinical manifestations can be divided into 4 patterns: sudden hyperactivity of liver yang, qi deficiency and blood stasis, obstruction of collaterals by wind and phlegm, and wind stirring due to yin deficiency[10]. The clinical manifestations of apoplexy seqeulae are numerous and the points should be selected mainly from Yangming Meridians and other yang meridians, in the conformity to the theory of ‘Yangming Meridians specifically selected for paralysis’[11].

There are better therapeutic effects in the treatment of apoplexy sequelae by acupuncture. In recent ten years, the therapeutic idea of the early interference is highly emphasized, scalp acupuncture and points on the head are adopted, such as Fengchi (GB 20) and Baihui (GV 20). At the same time, the points selected from the joints are combined, such as Hegu (LI 4), Zusanli (ST 36), Quchi (LI 11), Jianyu (LI 15), Sanyinjiao (SP 6), Waiguan (TE 5), Taichong (LR 3), Neiguan (PC 6), Fengchi (GB 20), Huantiao (GB 30), Fenglong (ST 40), Shousanli (LI 10), Jiexi (ST 42), Taixi (KI 3), Tongli (HT 5), Weizhong (BL 40), etc. Apoplexy sequelae are mostly accompanied by motor and sensory disturbance in the limb. Therefore, He-Sea point, Yuan-Primary points and Luo-Connecting points of the four limbs are used at higher frequency, such He-Sea points as Zusanli (ST 36), Quchi (LI 11), Weizhong (BL 40), Chize (LU 5), Yinlingquan (SP 9), and Shaohai (HT 3)； such Yuan-Primary points as Hegu (LI 4), Taichong (LR 3), Qiuxu (GB 40), and Yangchi (TE 4)； such Luo-Connecting points as Waiguan (TE 5), Neiguan (PC 6), and Xuanzhong (GB 39). He-Sea points are located near the elbow and knee joint and are where the meridian qi penetrate to communicate with Zang-fu organs. Yuan-Primary points are the sites where Yuan-Primary qi passes through and stays. Luo-Connecting points can communicate with the meridians in the exterior and interior relationship and are used for the problems of the same meridians and also for the problems of the meridians in the exterior and interior relationship. It can be seen that the stimulation on those points can give the effects to excite the meridian qi and dredge the meridians. According to the pathological positions, the points are selected from around the brain, such as Fengchi (GB 20), Baihui (GV 20), Shuigou (GV 26), Fengfu (GV 16), Dazhui (GV 14) and Anterior Oblique Line of Vertex-temporal (MS 6), Motor Area, Posterior Oblique Line of Vertex-temporal (MS 7), First Speech Area, Foot Motor Sensory Area, Lateral Line 1 of Vertex (MS 8) in the scalp acupuncture. Long-term apoplexy sequelae will surely damage the kidney qi, so, Guanyuan (CV 4), Shenshu (BL 23), and Qihai (CV 6) are selected to reinforce the kidney and benefit essence.

It is believed in TCM that ‘the head is a gathering site of all yang’. After 1980s, scalp acupuncture is extensively used in clinics, forming numerous academic thoughts[12]. In scalp acupuncture, the points are selected in combination of the local and adjacent points with the distal points along the meridians, and simultaneously with the functional zones of the cerebral cortex[13]. According to the crisscross-dominating principle of the cerebral cortex center, acupuncture applied on Motor Area of the opposite side for the patients with hemiplegia can have better effects to restore the functions of the limbs. Motor Area is located in the temporal side of the head. It has been shown in the study that acupuncture has the effects to dredge qi and blood[14]. Anterior Oblique Line of Vertex-temporal (MS 6) is equivalent to the projection of the precentral gyrus (motor center) of the cerebral cortex on the scalp, and the direct stimulation can improve blood circulation of the cerebral cortex, and increase blood oxygen saturation, so as to relieve the cerebral blood flow disturbance of the corresponding ischemic area, and quickly restore the excitement of the cerebral cells under shock or hibernation, thereby enabling the motor functions of the limbs to be restored gradually.

At the same time, the representative to treat apoplexy sequelae by selecting the points from yin meridians in predominance is ‘brain-refreshing and orifice-opening method’[15]. In this method, the major points are selected from yin meridians, by focusing onits pathogenesis of the pathological position of apoplexy on the brain and ‘failure of the spirit to guide qi due to orifice-closing and spirit-collapse’.

With the development of the rehabilitative techniques, the studies on the treatment of apoplexy sequelae by acupuncture plus modern rehabilitative technology have been increased in recent years[16].

The methods are numerous and multiple in acupuncture treatment of apoplexy sequelae. Acupuncture, scalp acupuncture and EA are the most common therapeutic methods. During the treatment, it is necessary to choose the proper acupuncture methods according to different diseases and also to optimize the program by the joint application of multiple methods. For numerous complications in apoplexy sequelae, it is advisable to achieve the effects by treating the pathogens, and also by treating main symptoms and complicated symptoms simultaneously, and also by treating the corresponding symptoms only[17]. We suggest that in the treatment of apoplectic complications, the points should be selected based upon the basic prescription for apoplexy sequelae and basic points for complications in predominance.

Generally, it is necessary to select different points and different therapeutic methods according to the patient’s manifestations in the acupuncture treatment of apoplexy sequelae, in order to enhance the survival quality of the patients.

Conflict of Interest

The authors declared that there was no conflict of interest.

Acknowledgments

This work was supported by National Basic Research Program of China (973 Program, No. 2009CB522900); Leading Academic Discipline Project of Acupuncturemoxibustion and Tuina.

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Translator:Huang Guo-qi

R246.6

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Date:January 20, 2014