03 Feb Post-Stroke Hemiplegia, Acupuncture & Wet Cupping
Clinical Observations of 98 Cases of Wind-stroke Hemiplegia Treated with a Combination of Great Needling, Network Vessel Puncturing & Cupping
abstracted & translated by
Honora Lee Wolfe, Lic. Ac., Dipl. Ac. FNAAOM (USA)
Great needling (ju zhen) is one of the “nine needling methods” from the Ling Shu (Spiritual Axis). It consists of needling deeply points on the healthy side of the body when pathology is one-sided. This is in comparison with cross needling, another of the nine needling methods, which consists of shallow contralateral needling.
This article was published in issue #9, 2003 of Jiang Xi Zhong Yi Yao (Jiangxi Chinese Medicine & Medicinals), by Wen Ling-jie and Yu Lan-ying from Shanghai. The article is located on pages 43-44 of that journal, and a summary is given below.
Cohort Description:
Altogether, there were 170 patients enrolled in this two-winged study. There were 98 patients in the great needling and bleeding/cupping group and 72 patients in a comparison group. All these patients suffered from post-stroke hemiplegia.
In the treatment group, there were 53 males and 45 females aged 46-83 years. these patients’ disease duration ranged from as short as one month to as long as two years. Sixty cases were diagnosed with ischemic (or dry) stroke and 38 cases with hemorrhagic (or wet) stroke.
In the comparison group, there were 34 males and 38 females aged 43-81. These patients had been ill from one month to 1.5 years. Forty-three of these patients had had an ischemic stroke and the other 29 had had hemorrhagic strokes.
Treatment method:
In the treatment group, for upper extremity paralysis, great needling was done at Jian Yu (LI 15), Qu Chi (LI 11), Wai Guan (TB 5), He Gu (LI 4), and Hou Xi (SI 3). For lower extremity paralysis, great needling was done at Xue Hai (Sp 10), Yang Ling Quan (Sp 9), Zu San Li (St 36), Jue Gu(GB 39), Tai Chong (Liv 3), and San Yin Jiao (Sp 6). First the points on the healthy side were needled. Afterwards the points on the affected side were needled. Thirty gauge needles were used with even supplementing-even draining technique and a retention time of 30 minutes. Then the upper back was bled with a skin needle (also called a seven star or plum blossom needle), mainly on the governing vessel and bladder channel, followed by cupping. Typically, 5-10ml of blood in total was withdrawn per treatment. Great needling was done once per day, and bleeding was done once every five days, with 10 times equaling one course of treatment. A 6-7 day rest was allowed between successive courses, and, typically, patients underwent 1-3 courses.
In the comparison group, patients were needled at the same points with the same size needles and the same hand technique and retention times. However, the points were only needled on the affected side. Acupuncture was done daily, with 10 treatments equaling one course of treatment. Again, a 6-7 day rest was allowed between successive courses, and patients in this group typically received 2-4 courses.
Treatment outcomes:
Disease severity after treatment was measured using the following scale 0 – 6.
Zero (0) – patient has regained normal strength and function.
One (I) – patient could take care of themself, could stand by themself, and could do some work.
Two (II) – person could basically stand by themself but certain limited areas still needed strengthening.
Three (III) – patient could only partially take care of themself and large areas of the body still remained affected.
Four (IV) – patient could stand and walk but required others to help them do this.
Five (V) – patient could only lie down or sit and required others’ assistance to conduct their daily affairs.
Six (VI) – patient could only lie down, only had part of their mental faculties, but could still eat.
Clinical outcomes were tied to the above scale. Cure meant that the disease severity after treatment was 0-I and the patient’s cognition was normal, their speech was clear, and their bodily functions had basically returned to normal. These patients were able to take care of themselves and had returned, at least partially, to work. A marked effect was defined as a disease severity of II-III, normal cognition, speech and upper or lower extremity function which had not quite returned to normal, but still the ability to take care of oneself. Improvement was defined as a disease severity of IV-V with improvement in the patient’s condition, cognition, speech, but inability to take care of onself. No effect mean that the patient’s disease severity was categorized as VI.
Based on these criteria, 52 patients (53.1%) of patients in the treatment group were considered clinically cured, 23 (23.5%) got a marked effect, 17 (17.3%) improved, and six (6.1%) got no effect. Therefore, the total effectiveness rate in this group was 93.9%. In the comparison group, 21 cases (29.2%) were judged clinically cured, 10 (13.9%) got a marked effect, 19 (26.4%) improved, and 22 (30.6%) got no effect. Therefore, the total effectiveness rate in this group was only 69.5%. In addition, the cure rate in the treatment group was almost double that in the comparison group. Outcomes were also analyzed in terms of types of stroke within the treatment group. Thirty-four cases (56.7%) of those who had had an ischemic stroke were cured, 14 (23.3%) got a marked effect, nine (15.0%) improved, and three (5.0%) got no effect. Eighteen cases (47.4%) with hemorrhagic stroke were cured, nine (23.7%) got a marked effect, eight (21.1%) improved, and three (7.95) got no effect. Therefore, this protocol seems to work well on both wet and dry stroke with slightly better outcome percentages in the patients who had suffered a dry stroke.
Discussion:
According to the Chinese authors, many patients with post-stroke paralysis do not recuperate completely when treated with fine needle acupuncture on the affected side even after years of treatment. Thus, the authors decided to try great needling to see if they could get a more satisfactory effect. According to the Nei Jing (Inner Classic), this method is mainly for the treatment of diseases in the channels and vessels. Clinically, it has previously mostly been used for channel and vessel obstruction and stagnation and non-freely flowing qi and blood leading to bodily pain and disturbances in movement. According to the authors, this acupuncture method can improve the circulation of blood in the diseased side of the brain and promote recuperation of the balance and function of the qi and blood of the entire body. The authors also say that skin needling the upper back and then cupping in order to cause bleeding can regulate the function of the viscera and bowels and channels and network vessels via the back transport points. In particular, this technique promotes the removal of static and obstructed qi and blood which further leads to improvement in blood circulation.
Copyright © Blue Poppy Press, 2004. All rights reserved.
