Bilateral effect of acupuncture on cerebrum and cerebellum in ischaemic stroke patients with hemiparesis: a randomised clinical and neuroimaging trial

 Patients with post stroke hemiparesis, acupuncture bilateral stimulation on the following acupoints:（LI4）、（PC6）、（LI11）、（ST36）、（GB34）and（SP6）exerted significant effects on functional connectivity of cerebrum and cerebellum and improvement in clinical assessment. The followings are the cited summary of the clinical trials reported by Dr. Chen T et al.

Background: Acupuncture involving the limb region may be effective for stroke rehabilitation clinically, but the visualised and explanatory evidence is limited. Our objectives were to assess the specific effects of acupuncture for ischaemic stroke (IS) patients with hemiparesis and investigate its therapy-driven modification in functional connectivity.

Methods: IS patients were randomly assigned (2:1) to receive 10 sessions of hand-foot 12 needles acupuncture (HA, n=30) or non-acupoint (NA) acupuncture (n=16), enrolling gender-matched and age-matched healthy controls (HCs, n=34). The clinical outcomes were the improved Fugl-Meyer Assessment scores including upper and lower extremity (ΔFM, ΔFM-UE, ΔFM-LE). The neuroimaging outcome was voxel-mirrored homotopic connectivity (VMHC). Static and dynamic functional connectivity (sFC, DFC) analyses were used to study the neuroplasticity reorganisation.

Results: 46 ISs (mean(SD) age, 59.37 (11.36) years) and 34 HCs (mean(SD) age, 52.88 (9.69) years) were included in the per-protocol analysis of clinical and neuroimaging. In clinical, ΔFM scores were 5.00 in HA group and 2.50 in NA group, with a dual correlation between ΔFM and ΔVMHC (angular: r=0.696, p=0.000; cerebellum: r=-0.716, p=0.000) fitting the linear regression model (R2=0.828). In neuroimaging, ISs demonstrated decreased VMHC in bilateral postcentral gyrus and cerebellum (Gaussian random field, GRF corrected, voxel p<0.001, cluster p<0.05), which fitted the logistic regression model (AUC=0.8413, accuracy=0.7500). Following acupuncture, VMHC in bilateral superior frontal gyrus orbital part was increased with cerebro-cerebellar changes, involving higher sFC between ipsilesional superior frontal gyrus orbital part and the contralesional orbitofrontal cortex as well as cerebellum (GRF corrected, voxel p<0.001, cluster p<0.05). The coefficient of variation of VMHC was decreased in bilateral posterior cingulate gyrus (PPC) locally (GRF corrected, voxel p<0.001, cluster p<0.05), with integration states transforming into segregation states overall (p<0.05). There was no acupuncture-related adverse event.

Conclusions: The randomised clinical and neuroimaging trial demonstrated acupuncture could promote the motor recovery and modified cerebro-cerebellar VMHC via bilateral static and dynamic reorganisations for IS patients with hemiparesis.

Reference:

Bilateral effect of acupuncture on cerebrum and cerebellum in ischaemic stroke patients with hemiparesis: a randomised clinical and neuroimaging trial.

Chen T, Chen T, Zhang Y, Wu K, Zou Y. Stroke Vasc Neurol. 2024 Jun 21;9(3):306-317. doi: 10.1136/svn-2023-002785.PMID: 38336368 Free PMC article. Clinical Trial.

https://pubmed.ncbi.nlm.nih.gov/38336368/

Acupuncture significantly improved chronic prostatitis/chronic pelvic pain syndrome and extended therapeutic effect to 24 weeks following treatment

 True acupuncture treatment of 8-week, compared with sham acupuncture,  significantly improved the symptoms of the patients with moderate to severe chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS), with sustainable effects of 24 weeks following treatment. The study was published in the Journal of Annals of Internal Medicine, one of the most widely-cited medical journals in the world.

The CP/CPPS are long-term conditions in men. They cause a range of symptoms including pain, urinary problems, reduced quality of life and sexual dysfunction that are difficult to treat and for which there is currently no cure. CP/CPPS can have a deleterious effect on an individual’s psychological wellbeing. Conventional treatments include antibiotics, alpha-blockers, anti-inflammatory agents and other medical agents, however none of which has proven to be totally effective.

Acupuncture has been used to treat CP/CPPS with positive outcome, however the number of patients with CP/CPPS were limited in many clinical studies. Recently a multiple centres, randomized, sham-controlled clinical study involving men with CP/CPPS was carried out in China. A total of 440 patients with CP/CPPS were recruited and randomly allocated into acupuncture (n=220) and sham acupuncture (n=220). The treatment protocol included a total of seven acupuncture points bilaterally (BL33, BL35, BL23, SP6) for acupuncture group. For the sham acupuncture group, minimally invasive needles were inserted to a depth of 2 to 3 mm at bilateral non-acupoints (15 mm lateral to BL23, BL33, and BL35 and 10 mm lateral to SP6) without manipulation. Overall treatment lasted for 30 minutes in both groups. All participants received 3 treatments for the 1^st consecutive 4-week, then 2 treatments for the 2^nd consecutive 4-week.

The primary result was a reduction of at least 6 points from baseline in the NIH-CPSI total score. The NIH-CPSI was managed at weeks 1 to 8, 20, and 32. Response was evaluated immediately after week-8 treatment and followed up at 24 weeks after treatment. The data showed that 20 sessions of acupuncture over 8 weeks in acupuncture group resulted in a significant improvement in symptoms of moderate to severe CP/CPPS, with durable effects 24 weeks after treatment compared with sham acupuncture group.

Data showed acupuncture treatment is able to decrease pain, positively impact quality of life and potentially modulate inflammation and suggested acupuncture could be a potential therapeutic option for men with CP/CPPS.

Although precise mechanisms of action of acupuncture are not completely clear, it could include gate control of pain pathways, increased endogenous opioid release and altered sympathetic tone.

Reference

Sun Y, Liu Y, Liu B, etc. Efficacy of Acupuncture for Chronic Prostatitis/Chronic Pelvic Pain Syndrome : A Randomized Trial. Ann Intern Med. 2021 Aug 17. doi: 10.7326/M21-1814.

https://pubmed.ncbi.nlm.nih.gov/31037757/

Acupuncture reduced risk of stroke in patients with fibromyalgia

 

A nationwide matched cohort study in Taiwan showed the acupuncture treatment was effective on reducing risk of stroke in patients with fibromyalgia compared with patients with fibromyalgia but not received acupuncture treatment. The data was reported the results on the Plos One journal.

Fibromyalgia is a disorder characterized by chronic widespread musculoskeletal pain accompanied by fatigue, sleep, memory and mood issues. The cause of fibromyalgia is not clear. It is believed that fibromyalgia amplifies painful sensations by affecting the way the brain and spinal cord process painful and nonpainful signals. Factors such as genetics, infections and physical and emotional events may lead to the occurrence of disorder. There is presently no cure for the condition. Pain reliever, antidepressants, physiotherapy and counselling should help alleviate symptoms. Acupuncture has been shown to effectively relief the muscle pain and reduce stress for a long time.

Studies showed that patients with fibromyalgia, particularly younger patients, had a higher risk tendency of stroke than those without fibromyalgia. Depression and sleep disorders, closely linked with fibromyalgia were also associated with a higher risk of stroke.

A group of scientists in Taiwan conducted a nationwide matched cohort study to evaluate the effectiveness of acupuncture in reducing risk of stroke in patients with fibromyalgia. Patients diagnosed with fibromyalgia between 1 January 2000 and 31 December, 2010 recorded in the Taiwanese National Health Insurance Research were enrolled in the study.

The comparison between the age, sex and comorbidities, and the hazard ratios of acupuncture and non-acupuncture cohorts were analysed using a Cox regression model. The difference in the prevalence of stroke between the acupuncture and non-acupuncture cohorts was assessed using the Kaplan–Meier method and the log-rank test. Patients with fibromyalgia were identified and divided into acupuncture (n=65,487) and non-acupuncture (n=65,487) cohorts with similar distributions in the baseline characteristics after performing a propensity score matching with a 1:1 ratio.

The Kaplan-Meier analysis with the log-rank test showed a significantly lower cumulative incidence of stroke in the acupuncture cohort than that in the non-acupuncture cohort (p<0.0001). In the follow-up 5-year period, 4,216 patients in the acupuncture cohort (11.01 per 1000 person-years) compared with 6,849 patients in the non-acupuncture cohort (19.82 per 1000 person-years) suffered from stroke (adjusted HR 0.53, 95% CI 0.51–0.55).

The data showed that acupuncture decreased the incidence of stroke regardless of the patient’s age, sex, comorbidities, and conventional drug use in patients with fibromyalgia in Taiwan.

Reference:

Acupuncture decreased the risk of stroke among patients with fibromyalgia in Taiwan: A nationwide matched cohort study. Huang MC, Yen HR, Lin CL, Lee YC, Sun MF, Wu MY.PLoS One. 2020 Oct 1;15(10):e0239703. doi: 10.1371/journal.pone.0239703.

https://pubmed.ncbi.nlm.nih.gov/33002009/

Treatment of Covid-19 disease with traditional Chinese medicine

Acupuncture and herbal medicine are effective for the treatment of COVID-19 virus. An article published on the Healthcmi.com website reported that 87% of COVID-19 patients in Beijing received traditional Chinese medicine (TCM including acupuncture and herbs) and the total effective rate for patients receiving TCM is 92%, quoted from the Beijing Health Commission report.

Coronaviruses are a large group of viruses that are known to infect both humans and animals and in humans cause respiratory illness that range from common colds to much more serious infections. The most well-known case of a coronavirus epidemic was Severe Acute Respiratory Syndrome (Sars), which, after first being detected in southern China in 2002, went on to affect 26 countries and resulted in more than 8,000 cases and 774 deaths. Cases of Covid-19 first emerged in late 2019, when a mysterious illness was reported in Wuhan, China. The cause of the disease was soon confirmed as a new kind of coronavirus, and the infection has since spread to many countries around the world and become a pandemic.

While the cause of the current outbreak was initially unknown, on January 7 2020 Chinese health authorities identified that it was caused by to a strain of coronavirus that hadn’t been encountered in humans before. Five days later the Chinese government shared the genetic sequence of the virus so that other countries could develop their own diagnostic kits. That virus is now called Sars-CoV-2. However, to avoid confusion with SARS the WHO calls it the covid-19 virus (coronavirus disease 2019) when communicating with the public.

Although symptoms of covid-19 virus are often mild – the most common symptoms are a fever and dry cough – in some cases they lead to more serious respiratory tract illness including pneumonia and bronchitis. These can be particularly dangerous in older patients, or people who have existing health conditions, and this appears to be the case with Covid-19 disease.

Qing Fei Pai Du Tang is recommended by the Chinese National Administration of Traditional Chinese Medicine (NATCM) for treating Covid-19 disease. In a study led by Dr. Li Yu that 701cases of COVID-19 patients treated with Qing Fei Pai Du Tang, 130 patients were cured, symptoms including fever and coughing completely resolved in an additional 51 patients, symptom improvements occurred in an additional 268 patients, and stabilization occurred in 212 patients. In a detailed analysis of 351 patients, Dr. Li and colleagues noted that 112 patients had a body temperature in excess of 37.3 degrees Celsius. After taking Qing Fei Pai Du Tang for one day, 51.8% of patients’ body temperatures returned to normal. After 6 days, 94.6% returned to normal temperature.

Of the 351 patients, 214 had coughs, one day of after drinking Qing Fei Pai Du Tang, 46.7% of patients’ coughs completely resolved. Six days later, 80.6% had significant reductions in coughing. In related findings from two independent investigations, the herbal medicine Lian Hua Qing Wen Capsule helped resolve COVID-19 symptoms and promoted recovery.

The China Association of Acupuncture and Moxibustion issued Acupuncture Treatment Guidelines for COVID-19 (2nd ​edition). The guidelines have been divided into three stages: prevention, treatment, and recovery.

Prevention stage, acupuncture is to strengthen zheng qi (healthy energy) and to benefit lung and spleen functions to combat foreign pathogens, basically improve immune system. The primary acupoints are categorized into 3 groups; 1–2 acupoints are selected from each group during one acupuncture session:

Group 1: BL12 (Fengmen), BL13 (Feishu), BL20 (Pishu);

Group 2: LI4 (Hegu), LI11 (Quchi), LU5 (Chize), LU10 (Yuji);

Group 3: CV6 (Qihai), ST36 (Zusanli), SP6 (Sanyinjiao)

A secondary set is added dependent upon individual symptoms.

For fever, the following acupoints are added: GV14 (Dazhui), CV22 (Tiantu), LU6 (Kongzui)

For nausea, loose stools, enlarged tongue with greasy coating, and soft (soggy) pulse, the following acupoints are added: GV14 (Zhongwan), ST25 (Tianshu), ST40 (Fenglong)

For fatigue and poor appetite, the following acupoints are added: CV12 (Zhongwan), CV9 (Shuifen), CV7 (Yinjiao), KI16 (Qizhousixue), BL20 (Pishu)

For clear nasal discharge, sore and painful back, pale tongue with white coating, and moderate pulse, the following acupoints are added: BL10 (Tianzhu), BL12 (Fengmen), GV14 (Dazhui)

Treatment stage, acupuncture is applied to interrupt disease progress based on the Pei Tu Sheng Jin (bank up earth to engender metal) principle and to relieve low mood. The primary acupoints selected for this stage are categorized into 3 groups.

For mild to moderate cases, 2–3 acupoints are selected from groups 1 and 2 during each acupuncture session. For severe cases, additional 2–3 acupoints are recommended from group 3.

Group 1: LI4 (Hegu), LR3 (Taichong), CV22 (Tiantu), LU5 (Chize), LU6 (Kongzui), ST36 (Zusanli), SP6 (Sanyinjiao)

Group 2: BL11 (Dashu), BL12 (Fengmen), BL13 (Feishu), BL15 (Xinshu), BL17 (Geshu)

Group 3: LU1 (Zhongfu), CV17 (Danzhong), CV6 (Qihai), CV4 (Guanyuan), CV12 (Zhongwan)

A secondary set is added dependent upon individual symptoms.

For persistent fever, the following acupoints are added: GV14 (Dazhui), LI11 (Quchi), EX-UE11 (Shixuan), EX-HN6 (Erjian)

For chest tightness and shortness of breath, the following acupoints are added: PC6 (Neiguan), LU7 (Lieque), CV14 (Juque), LR14 (Qimen), KI6 (Zhaohai)

For coughing with sputum, the following acupoints are added: LU7 (Lieque), ST40 (Fenglong), EX-B1 (Dingchuan)

For diarrhea with loose stools, the following acupoints are added: ST25 (Tianshu), ST37 (Shangjuxu)

For cough with yellow and sticky sputum and constipation, the following acupoints are added: CV22 (Tiantu), TB6 (Zhigou), ST25 (Tianshu), ST40 (Fenglong)

For low grade fever, nausea, loose stools, and a pale-red tongue with a white-greasy coating, the following acupoints are added: BL13 (Feishu), ST25 (Tianshu), SP14 (Fujie), PC6 (Neiguan)

Recovery stage, acupuncture is applied to eliminate pathogens from the body and to recover lung and spleen functions. The following primary acupoints are recommended: P6 (Neiguan), ST36 (Zusanli), GV14 (Zhongwan), ST25 (Tianshu), CV6 (Qihai)

A secondary set of acupuncture points are added dependent upon individual symptoms. For lung and spleen qi deficiency, sets of points are added for specific conditions:

If lung symptoms (e.g., chest tightness, shortness of breath) are pronounced, CV17 (Danzhong), BL13 (Feishu), and LU1 (Zhongfu) are added.

If spleen symptoms (e.g., poor appetite, diarrhea) are pronounced, CV13 (Shangwan) and SP9 (Yinlingquan) are added. 

For patients with qi and yin deficiency, the following acupoints are recommended for specific presentations:

If there is fatigue and shortness of breath, CV17 (Danzhong) and CV8 (Shenque) are added.

If there is dry mouth and thirst, KI3 (Taixi) and TB4 (Yangchi) are added.

If there are palpitations, BL15 (Xinshu) and BL14 (Jueyinshu) are added.

If there s profuse sweating, LI4 (Hegu), KI7 (Fuliu), and ST36 (Zusanli) are added.

If there is insomnia, HT7 (Shenmen), EX-HN3 (Yintang), EX-HN 19 (Anmian), and KI1 (Yongquan) are added.

Additional guidelines were published for patients with sputum and stasis blocking the channels with underlying lung and spleen deficiency:

For patients with lung, spleen and heart symptoms (e.g., chest tightness, shortness of breath), BL13 (Feishu), BL20 (Pishu), BL15 (Xinshu), BL17 (Geshu), LU1 (Zhongfu), and CV17 (Danzhong) are added. If sputum is unproductive, ST40 (Fenglong) and EX-B1 (Dingchuan) are added.

The aforementioned acupoints can be stimulated with acupuncture, moxibustion, or massage. If acupuncture is used, needles should be manipulated with the mild reinforcement and attenuation (Ping Bu Ping Xie) technique during the 20–30 minute needle retention time. If moxibustion is applied, the moxa should warm the points for 10–15 minutes. Treatment is administered once daily.

Reference:

https://www.healthcmi.com/Acupuncture-Continuing-Education-News/2010-acupuncture-and-herbs-covid-19-coronavirus-findings

Acupuncture therapy improved radiation-induced xerostomia in cancer patients

Acupuncture treatment has been shown to significantly reduce severe radiation-induced xerostomia in patient with head and neck cancer compared with standard care control in a randomized clinical trial, according to the data published in the JAMA Network Open.

Xerostomia, or oral dryness, is one of the most common complaints experienced by cancer patients who have radiotherapy of the oral cavity and neck region. Radiation-induced xerostomia (RIX), together with difficulty in chewing, swallowing and speaking can have a significant impact on the quality of life. At present there is no causal treatment for established xerostomia. Temporary symptomatic relief can be provided by moistening agents and saliva substitutes. Acupuncture has been reported to effectively relieve RIX.

A phase 3, randomized, sham-controlled, patient- and assessor-blinded clinical trial was conducted to assess effect of true acupuncture (TA n=132), compared with sham acupuncture (SA n=134) or a standard care control (SCC n=133) on the incidence or severity of RIX among patients with head and neck cancer. Acupuncture treatment was given concurrently with a 6- to 7-week course of radiation therapy. In TA group acupuncture needles were inserted into following body acupoints: Ren 24, LU7, and K6. The following ear points were used: Shenmen, Point Zero, Salivary Gland 2' (SG 2-prime), and Larynx. All points were used bilaterally except for Ren 24, which is located in the midline. In SA group non-penetrating needles with the Park device were placed at inactive points 0.5-1.0 cun away from true acupoints. In SCC group patients received standard care information about oral hygiene such as brushing with fluoride toothpaste, flossing, and daily use of fluoride tray applications.

The criterion standard for measuring xerostomia XQ was used to compare patient-reported outcome scores for xerostomia among the TA, SA, and SCC groups. The acupuncture expectancy scale18 was used to evaluate the association of baseline expectations related to acupuncture with clinical response. Adverse events were recorded using Common Terminology Criteria for Adverse Events version 3.0. Patient-reported Xerostomia Questionnaires (XQs) and sialometry data were collected at baseline, at the end of radiation therapy (week 7), and 3, 6, and 12 months after the end of radiation therapy.

Results showed that xerostomia score in the TA group was significantly lower than in the SCC group and marginally lower but not statistically significant different from the SA group. One year after radiation therapy follow-up showed that incidence of clinically significant xerostomia followed a similar pattern with 38 patients in the TA group (34.6%), 54 patients in the SA group (47.8%), and 60 patients in the SCC group (55.1%) experiencing clinically significant xerostomia.

Data from this phase 3, randomized clinical trial suggested that acupuncture therapy statistical significantly reduced the incidence of radiation-induced xerostomia compared with standard care controls in patients with head and neck cancer.

Reference:

Garcia MK, et al. (2019) Effect of True and Sham Acupuncture on Radiation-Induced Xerostomia Among Patients With Head and Neck Cancer: A Randomized Clinical Trial. JAMA Netw Open. PMID 31808921.     https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2757250

Acupuncture effect is more sustainable than drug treatment in treating irritable bowel syndrome

When acupuncture was compared with medication in treating irritable bowel syndrome (IBS), it was found improvement induced by acupuncture was more significant and lasted markedly longer than medication. The study was published in the journal of China and Foreign Medical Treatment. 

IBS is a common, long-term condition that affects the large intestine. Signs and symptoms include cramping, abdominal pain, bloating, gas, and diarrhoea or constipation, or both. IBS is a chronic condition that you'll need to manage it for long term. The precise cause of IBS isn't known; however it is believed that it's related to increased sensitivity of the gut and problems digesting food. Conventional medication relieves symptoms but causes advertise effect if it is chronically used. Acupuncture has been used to help improve the symptoms of IBS for a long time in China.

A clinical study to compare the effectiveness of acupuncture with conventional medication was conducted with recruitment of 98 patients who suffered from type-D (diarrhea predominant) IBS, that were allocated into acupuncture group (n=49) and drug treatment group (n=49) respectively. In acupuncture group needles were applied on the following acupoints ST36, ST37, ST39, ST25 and CV4, once daily for consecutive 5 days (one course), then 2-day interval for total 4 courses.  Patients in drug treatment group were treated with the drugs flupentixol/melitracen (0.5/10 mg) and bacillus licheniformis (0.25 g) once daily for consecutive 4 weeks. Outcome measures included symptom scores and the total effective rates for each group. Symptom scores were used to assess loose bowel movements, frequency of bowel movements, and mucus in the stools. The total effective rates were calculated according to the degree of improvements. The cured, markedly effective, and effective cases were added together to calculate the total effective rate for each group. All measurements were monitored at the base line, the end of the treatment and 6 months after treatment.

The results showed that the acupuncture treatment had significantly greater relief, with a total effective rate of 97.96%, compared with 83.67% in the drug treatment group. Six-month follow up showed that only 6.12% of patients receiving acupuncture experienced recurrence of symptoms, compared with 24.49% in the drug treatment group.

The study indicated that acupuncture is not only more effective for relieving IBS symptoms but has more sustainable effect.

Reference:

Wang X, Therapeutic Effect of warm needle acupuncture on Diarrhea-Type Irritable Bowel Syndrome. China and Foreign Medical Treatment, 2018, Vol.29 pp.173-174.   https://www.healthcmi.com/Acupuncture-Continuing-Education-News/1972-acupuncture-beats-drugs-for-ibs-relief

Acupuncture is more effective than drug treatment in relieving gout symptoms

Acupuncture therapy is shown to be more effective than conventional medication for gouty arthritis in a clinical study which was recently reported in the journal of Chinese Medicine Report.

Gouty arthritis is caused by a build-up of a substance called uric acid in the blood, resulting in the formation of small crystal deposits in and around the joints. It's estimated that 1-2% people are affected by gout in the developed countries. Men over 30 and women after the menopause are more likely affected. Gout is seen more common in men than women. People with obesity, diabetes mellitus, hypertension, hyperlipidaemia, and chronic renal disease are prone to developing gout. Conventional medications help relief pain and reduce hyperuricaemia. However, long term use of such medications could cause many adverse effects. Acupuncture has been used to effectively treat gout for a long time.

A clinical study has been recently conducted to assess the efficacy of acupuncture on the gout in comparison with conventional medication. A total of 92 patients with acute gouty arthritis were recruited and randomly allocated to either acupuncture group (n=46) or the medication group (n=46). In acupuncture group the filiform needles were applied on the following primary acupoints bilaterally: Zusanli (ST36), Sanyinjiao (SP6), Yinlingquan (SP9), Quchi (LI11) and ashi points for 30 mins a day for 5 consecutive days, then 2-day break followed by another 5-day consecutive treatment. In addition some secondary acupoints were applied according to patient’s affected joints. In medication group, patients were given indomethacin enteric-coated 75 mg tablets twice daily for 10 days. The study’s outcome measures included a VAS (visual analog scale) for pain, serum levels of uric acid and pro-inflammatory chemokine interleukin 8 (IL-8), and monitored at the beginning and end of the study.

Results showed that mean VAS scores were 4.26 in the medication group and 4.31 in the acupuncture group before treatment. The scores fell to 1.61 and 0.78 respectively at the end of treatment, indicating significant decrease in pain in both groups. However, pain reduction in the acupuncture group is greater (p<0.05) than medication group. Mean uric acid levels were 519.92 µmol/L in the medication group and 525.06 µmol/L in the acupuncture group respectively before treatment. Uric acid levels fell to 437.28 µmol/L and 426.53 µmol/L respectively following treatment. Mean IL-8 levels were 38.24 µg/L in the medication group and 38.81 µg/L in the acupuncture group before treatment, then, IL-8 levels fell to 26.23 µg/L and 26.04 µg/L respectively after treatment. The clinical symptoms e.g. mean mobility scores were 1.57, redness and swelling were 1.92 and joint function was 1.63 in medication group before treatment. In acupuncture group corresponding scores were 1.59, 1.99, and 1.65 respectively before treatment. At the end of treatment, these scores fell to 0.89, 1.25, and 0.92 in the medication group and 0.56, 0.72, and 0.72 in the acupuncture group. Although both groups demonstrated improvements in clinical conditions, symptom relief was significantly greater in the acupuncture group (p<0.05) than that of medication group.

Present study demonstrated that acupuncture markedly improved clinical symptoms and reduced both serum uric acid and IL-8 levels in patients with gouty arthritis and offers an effective and well-tolerated alternative treatment for gout.

Reference:

Z Chen (2019) “Clinical Observation on Acupuncture Treatment of Acute Gout Arthritis” Chinese Medicine Research Vol.16(3) pp.75-78.

Acupuncture improves chemotherapy-induced hand-foot syndrome in cancer patients

Patients with rectal cancer treated with acupuncture showed a significant reduction in severity of chemotherapy-induced hand-foot syndrome compared with control group. The report was published in the World Journal of Acupuncture-Moxibustion.

Hand-foot syndrome (HFS) is also called palmar-plantar erythrodysesthesia. It is an adverse effect of some cancer chemotherapies. Hand-foot syndrome causes abnormal sensation, such as tingling, numbness, burning or itching on the palms and soles, as well as redness, swelling, and pain on the palms of the hands and/or the soles of the feet. Sometimes blisters appear. Hand-foot syndrome sometimes occurs elsewhere on the skin, such as the knees or elbows. But this is less common.

Relieving side effects is an important part of cancer care and treatment. Topical anti-inflammatory medications may help relieve some symptoms. In addition, the doctor may lower the chemotherapy dose or change your chemotherapy schedule, or even may need to temporarily stop your chemotherapy until the symptoms of hand-foot syndrome improve. This could significantly hamper the efficacy of chemotherapy. Acupuncture has been used to treat inflammatory-related conditions.

Recently a clinical study was conducted to assess effect of acupuncture on hand-foot syndrome induced by chemotherapy in patients with rectal cancer. A total of sixty patients with rectal cancer were enlisted and randomly divided into acupuncture group (n=30), and vitamin 6 group (n=30) as the control. The primary acupoints included GV20, LI4, TB5, ST36 and ashi points and supplementary acupoints included KD3, SP6 and GB34 when it is necessary. Acupuncture needles were applied on above acupoints and retained for 30 mins, daily for 2 weeks. Patients within control group took vitamin B6 (oral, 300mg) daily for a total of two weeks.

The primary outcome measures included the Common Toxicity Criteria of the National Cancer Institute of Canada (CTC) and the Karnofsky Performance Scale (KPS). The CTC grades symptoms using a scale of 1–4, with higher scores indicating increased severity. The KPS is on a scale of 0–100, with higher scores indicating an increased ability to perform daily activities and lower scores indicating increased levels of disability. Patients whose CTC scores were reduced to grade 1 following treatment, with a disappearance of symptoms and a KPS score of ≥ 90 were categorized as cured. For patients whose CTC scores were reduced to ≥ grade 1, with an improvement in symptoms, and a KPS score of 80–89, the treatments were categorized as effective. For patients showing no obvious improvements and had KPS scores of < 80, the treatments were categorized as ineffective. In addition, the QLQ-C30 (Quality of Life Questionnaire Core), a 30-item functional scale covering the areas of PF (physical function), RF (role function), CF (cognitive function), EF (emotional function), and SF (social function) were also monitored before and after the treatment.

The results showed that in the acupuncture group, there were 5 cured (16.7%), 16 effective (53.3%), and 9 ineffective (30%) cases, yielding a total effective rate of 70.0% for rectal cancer patients receiving chemotherapy. In vitamin B6 control group, there were 4 cured (13.3%), 7 effective (23.3%), and 19 ineffective (63.3%) cases, yielding a total effective rate of 36.7% for rectal cancer patients receiving chemotherapy. Positive outcomes with improvements in PF, EF, and CF were greater in the acupuncture group, being of statistical significance (p<0.05) compared with vitamin B6 group.

The data of this study suggests that acupuncture is an effective treatment for hand-foot syndrome, with the ability to alleviate symptoms and improve overall quality of life with rectal cancer patients receiving chemotherapy.

Reference:

F Li et al., Chemotherapy-induced hand-foot syndrome in rectal cancer treated with acupuncture. World Journal of Acupuncture-Moxibustion. 2018, Vol.28 pp. 151-155.     https://www.sciencedirect.com/science/article/pii/S1003525718301144

Acupuncture is very effective in improving essential tremor

Acupuncture with different techniques was used to treat essential tremor. Zone style scalp needling technique produced a 96% total effective rate, compared to conventional acupuncture which produced a 73% total effective rate, is more effective in improving essential tremor. The results of the clinical study were published in the Shanghai Journal of Acupuncture and Moxibustion.

Essential tremor is a neurological disorder that causes uncontrollable shake or tremble of parts of the body. The shake usually appears in hands first and, then gradually affects other parts of body such as arms, head, eyelids, other muscles and even voice box (larynx). The shake is more noticeable when the person is trying to hold a position or do something, such as drink or writes and can be triggered by anxiety, fatigue, caffeine, poor sleep. The cause of essential tremor is not clear, but  it is believed to be linked with genetic and environmental factors. Medications such as propranolol can reduce in tremor while produce adverse effects with long term use. Alternative treatment such acupuncture has shown its effective in help improve essential tremor with only minor side effects.

Dr. C Wang colleagues in Heilongjiang University of Chinese Medicine, China conducted a comparative study to assess the effectiveness of zone style scalp needling acupuncture and conventional scalp acupuncture in treating patients with essential tremor. Sixty patients with essential tremor were randomly allocated into two equal groups, one received zone style scalp acupuncture with body acupoints and the other receiving standard scalp acupuncture with body style acupoints.

In the zone style scalp acupuncture group, acupuncture needles were inserted over a wedge-shaped area around GV20 and MHN1 acupoints and applied bilaterally to the middle third portion of the chorea tremor control area. The needles were swiftly inserted at 30^o to a depth at the epicranial aponeurosis level. The twirling technique was applied at 200 per minute, two minutes per needle for scalp points. The complimentary body acupoints: GB20 (Fengchi), MHN9 (Taiyang), LI11 (Quchi), TB5 (Waiguan), LI4 (Hegu), GB31 (Fengshi), GB34 (Yanglingquan), ST36 (Zusanli), SP6 (Sanyinjiao), LV3 (Taichong) were inserted perpendicularly.

In conventional acupuncture group, following acupoints were applied: Chorea tremor control area, GV20 (Baihui), GV14 (Dazhui), GB20 (Fengchi), LI4 (Hegu), SI8 (Xiaohai), LI11 (Quchi), LI10 (Shousanli), TB5 (Waiguan). The needles were inserted perpendicularly and twirled slightly.

In both groups, acupuncture treatments were administered for 30 mins, once a day for six consecutive days, each week, for total four weeks. Essential tremor scores were assessed before and after treatment. A follow-up interview, three months follow-up after the end of acupuncture treatments, was used to assess relapse rates.

The data showed that zone style scalp acupuncture produced a 96% of the total effective rate, compared with 73% (P<0.05) of total effective rate by conventional scalp acupuncture. The relapse rate of the zone style scalp acupuncture group was 13.81% and was 45.5% for the conventional scalp acupuncture group (P<0.05) respectively. The clinical study suggested that zone style scalp acupuncture is more effective than conventional acupuncture in improving essential tremor.

Reference

C Wang & Z Zheng. Therapeutic Observation of Scalp Cluster Needling in Treating Essential Tremor. Shanghai Journal of Acupuncture and Moxibustion 10 (2017): 1216-1219.
https://caod.oriprobe.com/issues/1769687/toc.htm

Electroacupuncture helped improve bowel and bladder function in patients with transverse myelitis

Electroacupuncture was used to treat patients with transverse myelitis to help improve bowel and bladder functions. Results of the clinical study were published in the journal of Acupuncture in Medicine.

Transverse myelitis is a condition in which a section of the spinal cord becomes inflamed. This neurological disorder often damages the insulating material myelin, the covering for nerve cell fibers, disrupting the messages that the spinal cord nerves send throughout the body. As a result, communications between nerve cells in the spinal cord and the rest of the body can be interrupted. The exact reason for transverse myelitis is not know. There are many conditions that appear to initiate the disorder, including infection, multiple sclerosis etc. Symptoms of transverse myelitis range from back pain to more serious problems, such as paralysis or loss of bowel control and bladder dysfunction. There is no cure for transverse myelitis. The treatments to prevent or minimize the permanent dysfunction include corticosteroid, antiviral and other immunosuppressive medications. Alternative medications such as acupuncture have been used to enhance patient’s recovery.

Recently, a small clinical study was conducted to explore the effect of electroacupuncture on bowel and bladder function of patients with transverse myelitis. Sixteen participants were recruited. Electroacupuncture was applied at acupoints bilateral BL32, BL33, and BL35 for 30 min, once a day, five times a week for the first 4 weeks; and once every other day, three times a week for the following 4 weeks. Patients were then followed up for 6 months. Bladder and bowel function were assessed at baseline, 8-week after acupuncture and 6-month follow respectively.

Data showed that at baseline, all 16 patients had abnormal voiding and needed assisted measures >50% of the time to empty the bladders. Following 8-week treatment, five patients (31%) resumed normal voiding; six patients (38%) achieved partially normal voiding assisted by pressing the abdomen to empty the bladder without catheterization, and five patients (31%) didn’t show significant improvement. The residual urine volume (RUV) markedly decreased by 100 mL (IQR 53–393 mL) in nine patients with bladder voiding dysfunction. The number of weekly urinary incontinence episodes, 24-hour urinary episodes, and nocturia episodes per night statistical significantly diminished by 14 (95% CI 5 to 22), 5 (95% CI 1 to 9), and 4 (95% CI 0 to 7) episodes, respectively in 11 patients with urinary incontinence. Following 8-week acupuncture treatment to eight patients with faecal retention, four (50%) resumed normal bowel movements, three (38%) regained partially normal bowel movements, and one (13%) didn’t have any change.

It has been suggested that electroacupuncture stimulation at BL32 and BL33 might directly or indirectly involved in the S2–3 nerve roots, which are the parasympathetic centre of the spinal cord, innervate the muscles in the pelvic area, such as the pelvic floor, urethral sphincters, bladder and anal sphincter muscles. It is plausible that acupuncture stimulation at S2–S3 might enhance recovery of the muscle function.

The preliminary study showed that electroacupuncture might be a promising alternative for the management of bladder and bowel dysfunction in patients with transverse myelitis. Further studies with larger sample and randomized controlled trials are needed to validate the present results.

Reference

Wu J et al., Effects of electroacupuncture on bladder and bowel function in patients with transverse myelitis: a prospective observational study. Acupunct Med. 2018 Aug;36(4):261-266   https://www.ncbi.nlm.nih.gov/pubmed/29909400

Acupuncture is significantly more effective than donepezil in improving cognitive function in patients with mild to moderate Alzheimer's disease

Acupuncture has shown the much better improvement in cognitive function than donepezil in patients with mild to moderate form of Alzheimer’s disease in a 24-week clinical trial. The study was published in the journal of BMC Complementary and Alternative Medicine.

Alzheimer’s disease (AD) is characterized by memory impairment and personality changes and is the most common type of dementia. The conditions lead to a loss of personal independence which has wide range of impact on the individual, families and societies; as it is predicted that the prevalence of AD will rise exponentially in elderly people from 1% at age of 65 to approximately 40-50% by the age of 95. So far the medications used to treat AD include cholinesterase-inhibitors such as donepezil which offers only modest symptomatic relief, but produced significantly higher rates of adverse effects and discontinuation of treatment. So, alternative treatment for the condition is urgently needed. Acupuncture has been used to alleviate some symptoms of AD in China for a long time.

Recently a randomized, drug-controlled, parallel group clinical study was conducted to determine the efficacy and safety of acupuncture compared with donepezil in patients with mild to moderate AD. Eighty seven patients qualified to the study were randomly allocated into two groups: acupuncture group (AG, n=43) and drug group (donepezil, DG, n=44).

The primary outcome measures included (1) Alzheimer's Disease Assessment Scale-Cog (ADAS-cog). (2) Clinician Interview-Based Impression of Change plus caregiver input (CIBIC-Plus). The second outcome measures were (1) Activities of Daily Living Inventory (ADAS-ADL23). (2) The Neuropsychiatric Inventory–Questionnaire (NPI). Those measures were performed at the baseline, 12-week treatment period, and 12-week follow-up period respectively.

Basic acupuncture acupoints included RN17 (danzhong), RN12 (zhongwan), RN6 (qihai), ST36 (zusanli), SJ5 (waiguan) and SP10 (xuehai). Complementary acupoints: LR3 (taichong), GB39 (xuanzhong), ST40 (fenglong), BL17 (geshu), ST44 (neiting), ST25 (tianshu) and RN4 (guan yuan), could be selected as auxiliary acupoints according to patient’s symptoms and tongue manifestation. The needles were retained in situ for 30 min each time. Acupuncture treatment was given three times weekly for 12 weeks. The patients in the DG group received 5 mg/day of donepezil hydrochloride for the first 4 weeks and then, 10 mg/day for 8 weeks.

The results shown that acupuncture treatment statistically significantly improved cognitive function, global clinical status compared with donepezil according to the scores of ADAS-cog, CIBIC-Plus both at the end of 12-week treatment and 12-week follow-up period. However, there was no significant difference in the activities of daily living and behavioral symptoms based on the scores of ADCSADL23 and NPI between AG and DG groups. Further, In the AG group, 5 cases of insomnia, 4 cases of constipation, 6 elderly male cases with benign prostate hyperplasia and 2 cases of knee arthritis reported that their symptoms were clearly improved. However, patients in the DG group did not show any equivalent improvements.

During the trial, 4 patients (9.3%) in AG experienced punctuate hemorrhage after the needles were taken out, and 1patient (2.3%) had bruising. No serious adverse effects were reported and no patients withdrew from the AG. Seven patients (15.9%) in DG reported some adverse effects, including dizziness, nausea, loss of appetite, diarrhea, constipation; fatigue and agitation. 4 of 7 cases (9.09%) withdrew from the trial.

The study showed that acupuncture treatment could significantly improve cognitive function, global clinical status in patients with mild to moderate AD, compared with donepezil, with less adverse effects.

Reference

Jia Y, Zhang X, Yu J, Han J, Yu T, Shi J, Zhao L, Nie K., Acupuncture for patients with mild to moderate Alzheimer's disease: a randomized controlled trial. BMC Complement Altern Med. 2017 Dec 29;17(1):556.     https://www.ncbi.nlm.nih.gov/pubmed/29284465

Acupuncture significantly alleviated joint pain related to aromatase inhibitors among women with early-stage breast cancer

True acupuncture treatment showed a statistically significant reduction in joint pain at 6 weeks, compared with sham acupuncture or with waitlist control, among postmenopausal women with early-stage breast cancer and aromatase inhibitor–related arthralgias. The results of clinical study were recently published in the Journal of the American Medical Association.

Despite the well-proven efficacy of aromatase inhibitors (AIs), namely anastrozole, letrozole and exemestane for the treatment of hormone-sensitive breast cancer, some patients suffer from side effects or even stop treatment early due to undesirable toxicities. The most common side effects of AIs are hot flashes, vaginal dryness, musculoskeletal pain and headache etc.

Acupuncture is utilized to treat pain-related conditions including cancer related pain. However, the controversial reports indicated its effect is the same as the sham acupuncture.

This multicenter randomized blinded sham- and waitlist controlled clinical trial was conducted to evaluate the effect of acupuncture on joint pain related to aromatase inhibitors among women with early-stage breast cancer. Study participants were randomized 2:1:1 to the true acupuncture group, the sham acupuncture group, or the waitlist control group. Briefly, both true acupuncture and sham acupuncture consisted of twelve 30- to 45- minute sessions administered over a period of 6 weeks (2 per week) followed by 1 session per week for 6 weeks.

The results showed that the mean observed the Brief Pain Inventory Worst Pain (BPI-WP item, score range, 0-10; higher scores indicate greater pain) score was 2.05 points lower (reduced pain) at 6 weeks in the true acupuncture group, 1.07 points lower in the sham acupuncture group, and 0.99 points lower for the waitlist control group, with differences in adjusted 6-week mean BPI-WP scores between true acupuncture vs sham acupuncture of 0.92 points(95% CI,0.20-1.65; P = .01) and between true acupuncture vs waitlist control of 0.96 points (95% CI, 0.24-1.67; P = .01), in comparison with baseline. Patients randomized to the true acupuncture group had statistically significant improved symptom scores compared with those randomized to the sham acupuncture and waitlist control groups at 6 weeks according to BPI average pain, pain severity, and worst stiffness, and according to the modified assessment and quantification of chronic rheumatic affections of the hands (M-SACRAH), Western Ontario and McMaster Universities Arthritis Index (WOMAC) measures. Bruising was the most common adverse incident reported for those receiving true acupuncture or sham acupuncture. 

This is the first large multicenter trial to investigate the effect of acupuncture in treating AI-induced joint symptoms in breast cancer patients. The data clearly showed that true acupuncture statistically and significantly outperformed the sham acupuncture in joint pain relief of those patients.

Reference

DL. Hershman et al., Effect of Acupuncture vs Sham Acupuncture or Waitlist Control on Joint Pain Related to Aromatase Inhibitors Among Women With Early-Stage Breast Cancer A Randomized Clinical Trial. JAMA. 2018;320(2):167-176. doi:10.1001/jama.2018.8907.
https://www.ncbi.nlm.nih.gov/pubmed/29998338

Effect of scalp acupuncture on neurological disorders – a review study

Scalp acupuncture therapy has been used to treat many conditions in China since 5 BC. Scalp acupuncture needles are penetrated into the specific areas of the scalp or lines on the scalp, and it differs significantly from classic acupuncture in that it has its own theoretical basis and its acupoints are quite different from traditional acupoints. Modern scalp acupuncture was established on the base of traditional Chinese acupuncture, modern anatomy and physiology, by integrating traditional Chinese needling methods with western medical knowledge of representative areas of the cerebral cortex. This modern system of acupuncture was developed at a fast pace since 1970s, and scalp acupuncture acupoints were standardized in 1991 when the World Health Organization announced the International Standard Nomenclature for Scalp Acupuncture Points.

There are three basic features of scalp acupuncture that differentiate it from body acupuncture. Firstly, treatment zones (14 lines or zones) that have been mapped onto the scalp are associated with body functions and broad body regions, and are based on the ideas of different schools of scalp acupuncture. Secondly, scalp acupuncture is characterized by inserting needle into a thin layer of loose tissue beneath the scalp surface, at a low angle of about 15-30 degrees, with an insertion distance of about 1 cum (approximately one inch for adult). Thirdly, the needles in scalp acupuncture are subjected to rapid stimulation, which may be performed a variety of ways including twirling, pulling/thrusting and electro-stimulation.

Despite its relatively short history, scalp acupuncture has been now used to treat a wide range of conditions in many countries. Scalp acupuncture has been proven effective for the treatment of brain-related conditions such as cerebrovascular diseases and neurodegenerative disorders; but also for other conditions e.g. tinnitus and attention deficit hyperactive disorder.  In this review article, recent development of scalp acupuncture application on some neurological disorders were summarized.

The study found that scalp acupuncture provides an important complementary/alternative treatment approach for improving symptoms of many neurological disorders symptoms. By closely stimulating affected areas of the central nervous system, scalp acupuncture has showed advanced and more effective results compared to other acupuncture techniques. The studies also demonstrated that scalp acupuncture treatment is safer, more effective, and caused fewer side effects compared with conventional treatment such as medications in the respective conditions.

Although the studied cited above showed a certain effect of scalp acupuncture on stroke, PD and MS, the quality of studies were variable. Because many of the studies did not follow the Consolidated Standards of Reporting Trials (CONSORT) 2010 checklist and the revised Standards for Reporting Interventions in Clinical Trials of Acupuncture (STRICTA) guidelines. For example, there were no sham acupuncture controls in majority studies. None of the included studies adopted assessor blinding.  STRICTA checklist items i.e. "depth of insertion," "description of participating acupuncturists" and “the optimal dosage for the scalp acupuncture treatment” were not mentioned. So following CONSORT and STRICTA recommendation are strongly recommended, and well-designed studies with rigorous methodologies are required to confirm the effectiveness of scalp acupuncture for neurological disorders.

Reference

BY Zeng, Scalp acupuncture treatment for neurological disorders. The Journal of Chinese Medicine and Acupuncture. 2018, Vol.25:1, 25-31.   https://www.atcm.co.uk/news-events/atcm-journals

Acupuncture improved gait impairment of patients with multiple sclerosis

Acupuncture treatment significantly improved gait impairment of patients with multiple sclerosis compared. It was reported in the Journal of Alternative and Complimentary Medicine.

Multiple sclerosis is a demyelinating neurological disorder, caused by the inflammatory reaction to dysfunction of immune system.  Multiple sclerosis affects the brain and spinal cord, causing a wide range of potential symptoms, including sensation, balance, vision and movement such as gait impairment. Acupuncture has been reported to effectively improve many symptoms of multiple sclerosis including fatigue, pain, depression and sleep interference.

Recently Dr. MB Criado and colleagues conducted a clinical study to investigate the effect of acupuncture on gait impairment of patients with multiple sclerosis. Twenty patients were recruited for the study and blindly and randomly allocated into true acupuncture and sham acupuncture treatment groups. In true acupuncture group acupoints ST34, BL40 and BL57 were selected and in sham acupuncture group points located 2 cun laterally to true acupoints. Leopard spot technique was applied in both true and sham groups. One month after first treatment, patients in both groups were swapped for the crossover study. Gait impairment was evaluated in all patients by the 25-foot walk test (T25WF) before and after the treatments.

The results found that there was no statistically significant difference with the 25-foot walk test at the base line between two groups. However, true acupuncture treatment significantly improved gait impairment judged by T25WF test compared with its baseline. Similarly, true acupuncture statistically and significantly improved gait compared with sham acupuncture which was not different from the baseline assessment. Patients in true acupuncture groups felt much better balanced movements.

The study showed acupuncture treatment can markedly improve gait impairment, in addition to other symptoms of multiple sclerosis.

Reference

Criado MB et al., Effects of Acupuncture on Gait of Patients with Multiple Sclerosis. J Altern Complement Med. 2017 Nov;23(11):852-857.   https://www.ncbi.nlm.nih.gov/pubmed/28410453

Treatment of scalp acupuncture for stroke

Stroke is the second most common cause of death preceded only by heart attacks and the major cause of disability in the western societies. Stroke occurs when the blood supply to part of the brain is cut off and is mainly caused by ischemic or hemorrhagic. Ischemic stroke is the most common subtype of stroke, accounting for about 80% of all strokes. Treatment of stroke depends on the type of stroke and which part of brain is affected. Conventional approaches include medication to prevent and dissolve the blood clots and reduce blood pressure, and surgery to remove blood clots, treat brain swelling and reduce the risk of further bleeding in case of hemorrhagic stroke. However, people who survived stroke are often left with long-term problems caused by injury to their brains. 

Scalp acupuncture is a modern acupuncture technique in which needles are penetrated the specific area of the scalp or lines on the scalp, and differs significantly from classic acupuncture in that it has its own theoretical basis and its acupoints are quite different from traditional acupoints. Scalp acupuncture has integrated traditional Chinese needling methods with western medical knowledge of representative areas of the cerebral cortex. This modern system of acupuncture, although explored since 1930s, has really been developed since 1970s and standardized in 1991 when the World Health Organization announced the International Standard Nomenclature for Scalp Acupuncture Points (WHO, 1991).

Despite its relatively short history, scalp acupuncture has been used to treat a wide range of conditions in many countries. Scalp acupuncture has proven effective for the treatment of cerebrovascular diseases and neurodegenerative disorders (Hao et al., 2013; Li et al., 2014; Wang et al., 2009). Furthermore, a number of clinical trials have reported therapeutic effects of scalp acupuncture for the treatment of stroke (Chen et al., 2014; Lee et al., 2014). Here, recent research developments of scalp acupuncture treatment on stroke are summarized. 

Preclinical studies
Acupoint Baihui (GV20) is located on the highest point of the head and is an intersecting point of the Governing Vessel, Bladder, Gall Bladder, Triple Heater and Liver meridians. According theory of traditional Chinese medicine, acupuncture stimulation at Baihui can clear the mind, lift the spirits, tonify yang, strengthening the ascending function of spleen, eliminate interior wind and promote resuscitation. Indeed, Baihui acupoint has been used to effectively treat neurological disorders such as stroke in China for thousand years. 

A systematic review and meta-analysis to assess the current evidence for the effect of Baihui (GV20)-based scalp acupuncture in animal models of focal cerebral ischemia was conducted by Wang et al., (2014). Meta-analysis results showed that of 54 studies 12 reported significant effects of GV20-based scalp acupuncture for improving infarct volume compared with middle cerebral artery occlusion group, and 32 studies reported significant effects of GV20-based scalp acupuncture for improving the neurological function score when compared with the control group. It was concluded that GV20-based scalp acupuncture could improve infarct volume and neurological function score and exert potential neuroprotective role in experimental ischemic stroke.

Recently effect and mechanisms of scalp acupuncture on neurological dysfunction of intracerebral hemorrhage stroke rat model was investigated (Liu et al., 2017). Rat model of intracerebral hemorrhage (ICH) received scalp acupuncture at acupoint DU20 through GB7 on the lesion side, for 30 mins, twice a day, from day one of surgery for consecutive 7 days. A group of intracerebral hemorrhage model not receiving scalp acupuncture and a group of sham surgery and a group of naïve were used as controls. Behavioral tests included a composite neurological scale, corner turn test, forelimb placing test, wire hang task and beam walking were conducted at days 3 and 7, followed by biochemical studies, such as western blot analysis and histopathologic examine. The data showed that at day 3 after intracerebral hemorrhage, there was no significant difference of behavioral tests between scalp acupuncture group and ICH. However, at day 7 after surgery, there was a significant improvement of neurological deficits in scalp acupuncture treated group compared with ICH. Biochemical studies showed that brain content of tumour necrosis factor alpha and nuclear factor KappaB protein expression, inflammatory markers, was markedly decreased in scalp acupuncture group compared with ICH and sham groups.  The results demonstrated that improved behavioral effects by scalp acupuncture were associated with decreased markers of inflammation in rat model of intracerebral hemorrhage. 

Together, the studies above showed that scalp acupuncture improved neurological functions in both ischemic and hemorrhage models of stroke.

Clinical studies
Patients with ischemic stroke of subacute stage recovered better following combination of body acupuncture and scalp acupuncture treatment compared to conventional therapy. It is believed that subacute stage of stroke occurs between 1-6 months after onset of stroke. Better recovery in the subacute stage of stroke is crucial for patient’s long-term revival. Chen et al., (2014) carried out a randomized controlled clinical trial to assess the efficacy of combination of body acupuncture and scalp acupuncture in patients of subacute stroke. One hundred twenty-six patients were divided into acupuncture treatment group (n=61) and conventional treatment group (n=65). Acupuncture was given 5 times a week for total 8 weeks. The Fugl-Meyer scale and NIHSS scale and Barthel index were used to evaluate the motor functioning, balance, sensation, joint functioning and activity of daily living before and during and after acupuncture treatment and follow-up. Assessment after 4-week acupuncture showed a very good improvement compared to baseline judged by all parameters but did not show significant difference from conventional treatment group. At the end of 8-week acupuncture patients demonstrated markedly improvement in all assessments compared to baseline. Acupuncture showed a significant functional improvement compared to conventional group at the end of 8-week treatment and 3-month follow-up assessment (Chen et al., 2014). Authors conclude that combination of body acupuncture and scalp acupuncture achieved better clinical efficacy in stroke recovery compared to conventional treatment. 

Recently, the study of the influence of scalp acupuncture on levels of inflammation in patients with acute cerebral infarction (ACl) was conducted to investigate its mechanism underlying improvement of ACI (Wang et al., 2016). A total of 61 patients with ACI were randomly allocated to scalp acupuncture group (n = 31) and control (medication) group (n = 30). Scalp acupuncture stimulation of bilateral Dingnieqianxiexian (MS 6) and Dingniehouxiexian (MS 7) was performed daily plus medication for 7 days, while patients in control group were given medication only. Clinical neurological dysfunction scales such as NDS, 0-45 points for consciousness, gazing, facial palsy, speech, myodynamia, walking-ability were monitored at the baseline and at the end of scalp acupuncture. Serum levels of inflammation markers, such as high-sensitivity C-reactive protein (hs-CRP), TNF-α, IL-6, and IL-1β, were assessed at the baseline and 3 and 7-day after scalp acupuncture. At the end of 7-day scalp acupuncture, patients showed a significant improvement of the neurological deficits compared with the baseline scores, and there was marked improvement in neurological dysfunction compared with control group. The levels of all inflammation markers were significantly decreased at both 3 and 7-day scalp acupuncture compared with baseline levels. The levels of inflammation makers were significantly lower in scalp acupuncture compared with control group. There was a correlation between the improved neurological deficits scores and decreased serum inflammation markers (Wang et al., 2016).

Conclusion
The results from the brief review study showed that scalp acupuncture is effective in improving neurological deficits of patients with stroke, and it could be an important part of rehabilitation program for stroke recovery.

References
Chen LF et al., [Motor dysfunction in stroke of subacute stage treated with acupuncture: multi-central randomized controlled study]. Zhongguo Zhen Jiu. 2014 Apr;34(4):313-8.  
Hao JJ et al., Treatment of multiple sclerosis with chinese scalp acupuncture. Glob Adv Health Med. 2013, 2(1):8-13. 
Lee SJ, Shin BC, Lee MS, Han CH, Kim JI. Scalp STRICTA recommendations for stroke recovery: a systematic review and meta-analysis of randomized controlled trials. Eur J Integr Med. 2013;5:87–99.
Li SK, [Effects of scalp acupuncture combined with auricular point sticking on cognitive behavior ability in patients with vascular dementia]. Zhongguo Zhen Jiu. 2014 May;34(5):417-20.  
Liu H et al., Scalp acupuncture attenuates neurological deficits in a rat model of hemorrhagic stroke. Complementary Therapies in Medicine 32 (2017) 85–90. 
Wang JH et al., Effect of Scalp-acupuncture Treatment on Levels of Serum High-sensitivity C-reactive Protein, and Pro-inflammatory Cytokines in Patients with Acute Cerebral Infarction. Zhen Ci Yan Jiu. 2016 Feb;41(1):80-4.
Wang S et al., Study on the mechanism of electroacupuncture scalp point penetration therapy in action on apoptosis in the Parkinson's disease rat model. Zhongguo Zhen Jiu. 2009 Apr;29(4):309-13.  
Wang WW et al., A systematic review and meta-analysis of Baihui (GV20)-based scalp acupuncture in experimental ischemic stroke. Sci Rep. 2014 Feb 5;4:3981. doi: 10.1038/srep03981. 
WHO Scientific Group on International Acupuncture Nomenclature. A proposed standard international acupuncture nomenclature. Report of a WHO scientific group. Geneva: World Health Organization; 1991.   http://apps.who.int/iris/handle/10665/40001