Clinical effects of Xingnao Kaiqiao acupuncture on neurological impairment following cerebral infarction

BACKGROUND： Although the curative effects of acupuncture have been confirmed by various treatments of cerebral infarction, few studies have investigated when acupuncture can attain the best clinical effect. OBJECTIVE： Four different time points were selected for acupuncture treatment of cerebral infarction to evaluate the appropriate time course for Xingnao Kaiqiao therapy in terms of improved neurological function. DESIGN： Controlled observation. SETTING： Department of Traditional Chinese Medicine Rehabilitation and Physiotherapy of the Affiliated Hospital of Medical College of Chinese Armed Police Forces. PARTICIPANTS： A total of 120 inpatients with cerebral infarction of different stages, including 75 males and 45 females, aged 41-75 years, were selected from November 2005 to December 2006 at the Department of Traditional Chinese Medicine Rehabilitation and Physiotherapy in Affiliated Hospital of Medical College of Chinese Armed Police Forces. Diagnostic criteria： in accordance with ＂main points of diagnosis on different cerebrovascular disease＂ secondly revised in the Second Cerebrovascular Disease Academic Meeting of Chinese Medicine Association in 1986. All accepted subjects provided confirmed consent, and the experiment received ethical permission from the hospital＇s ethics committee. METHODS： ① Experiment grouping： All inpatients were divided into four groups with non-stochastic concurrent control method according to the disease course： Group Ⅰ （onset within 7 hours）, group Ⅱ （onset from 7 hours to 3 days）, group Ⅲ （onset within 4-7 days）, and group IV （onset within 21-180 days）. On the basis of symptomatic treatment with western medicine, each group received Xingnao Kaiqiao therapy after onset within 7 hours, 7 hours to 3 days, 4 to 7days, and 21 to 180 days. ① The principal acupoints were Neiguan, Renzhong, and Sanyinfiao. ② The auxiliary acupoints were Jiquan, Chize, and Weizhong. ③Acupuncture manipulations： initially, Neiguan （PC6, bilateral） was needled at 0.5-1.0 cun vertically with a reducing technique achieved by rotating-swirling and lifting-inserting for l minute. Subsequently, Renzhong （GV26） was needled at 0.3-0.5 cun obliquely towards the nasal septum, with a heavy bird-pecking method until eyeballs were moist or shed tears. Sanyinjiao （SP6, affected limb） was needled at 1.0-1.5 cun obliquely along the medial border of the tibia with a 45° angle between the needle and skin. The technique of reinforcing was achieved by a lifting-inserting method until the affected lower limb twitched three times. The auxiliary acupoint, Jiquan, was selected when the patient extended the affected upper limb abduction. Jiquan was along the downward channel, l cun from the quondam Jiquan （HT1） acupoint; the armpit hair was avoided. Jiquan （affected limb） was needled vertically at 1.0-1.5 cun. The technique of reduction was achieved by lifting-inserting until the affected upper limb twitched three times. Chize （LU5） was selected when the patient flexed the elbow at 120°. Chize was vertically needled at l cun with a lifting-inserting reducing technique until the affected forearm and fingers twitched three times. Weizhong （BL40） was selected when the patient＇s leg was raised straight in a supine position. Weizhong was vertically needled at 0.5 1.0 cun with a lifting-inserting reducing technique until the affected lower limb twitched three times. ⑤ Acupuncture manipulations were achieved by the doctor who is an associate chief physician and doctor of acupuncture and moxibustion and has aptitude for the post＇s specification. ⑥One course of treatment lasted for 10 days and each group was treated for two courses of treatment. ⑦Experiment evaluation： To apply neurological impairment scores for evaluating clinical curative effects before and after treatment with Xingnao Kaiqiao therapy on day 7, 14, and 21（range of 0 45; decreasing score indicates functional improvement）.To evaluate clinical curative effect by clinical effective power： Basic recovery： equal to or more than 81%; significant improvement： 56% to 81% （including 56%）; Improvement： between 36% to 56% （including 36%）; Slight Improvement： 11% to 36% （including 11%）; No change： less than 11%; Aggravation （including death）： negative value. Total effective rate was computed at the same time. MAIN OUTCOME MEASURES： The total effective rate and amelioration of neurological impairment of the patients after treatment. RESULTS： All 120 patients with cerebral infarction were included in the final analysis, without deletion. ① Comparison of the total effective rate： the total effective rate of group Ⅰ, group Ⅱ, group Ⅲ and group IV was 97%, 93%, 93%, and 67%, respectively. There were significant differences of interclass synthetic curative effects （x^2 = 36.351 7, P 〈 0.01）. ② Amelioration of neurological impairment： A decreased neurological impairment score was observed in group Ⅰ on day 7, 14, and 21 after Xingnao Kaiqiao therapy. The differences between group Ⅳ and the remaining three groups were significant （P 〈 0.05）. CONCLUSION： Xingnao Kaiqiao therapy is helpful for amelioration of neurological impairment in patients during the acute stage cerebral infarction.

Exploring the mechanism of Xingnao Kaiqiao acupuncture method for ischemicstroke based on EEG dynamic changes: a study protocol of an exploratory,prospective,interventional trial

Background: The Xingnao Kaiqiao acupuncture method, founded by Academician ShiXuemin, has outstanding efficacy in the treatment of ischemic stroke and has been widelyused at home and abroad. However, after half a century of animal experiments and clinicalstudies, clearly and intuitively revealing its therapeutic mechanism is still a great challengefor researchers. Therefore, this experiment is based on the combination of medicine andengineering to study the immediate effects of the acupuncture method in treating patientsby recording the electroencephalography (EEG) activities of subjects during the acupunctureprocess and to further reveal the therapeutic mechanism at the brain level. Methods: Thistrial is an exploratory, prospective, single-arm interventional study involving a total ofpatients with ischemic stroke. Physicians will record EEG data from patients duringacupuncture as the primary outcome indicator. After pre-processing the EEG data,researchers will use various methods to analyze the immediate effects of acupuncture toobtain brain effectiveness. Deep learning will then be used to identify acupoint stimuli andreceive correspondence between the acupuncture effect and the brain’s internal state.National Institutes of Health Stroke Scale score before and after the acupuncture process willbe used as the secondary outcome indicator. Conclusion: This is the first study protocol toapply dynamic changes in EEG to explore a range of mechanisms of action of acupuncture inthe treatment of ischemic stroke. We propose a method to analyze EEG signals ofacupuncture patients. The deep learning model will be applied for supervised training toobtain the compelling relationship between the acupuncture method and internal brainstates, providing a new prospect for the digitization of traditional Chinese medicine.

Meta-analysis of the clinical efficacy of Xingnao Kaiqiao acupuncture combined therapy in the treatment of infantile cerebral palsy

Objective:To evaluate the clinical efficacy of Xingnao Kaiqiao acupuncture combined therapy in treating infantile cerebral palsy by meta-analysis.Methods:CNKI,VIP,Wanfang knowledge service platform,CBM,PubMed,Embase and Cochrane library databases were searched.The retrieval time period was pushed back to the establishment of the database in March 2021.Through layers of screening and quality evaluation of the included literature,the data were analyzed with Revman 5.4.Results:9 articles were included,a total of 748 cases.The results of meta-analysis showed that compared with other therapies(control group),Xingnao Kaiqiao acupuncture combined therapy(treatment group)could improve the total clinical effective rate(or=3.32,95%CI[2.14,5.13],P<0.00001),improve the ability of language acceptance(MD=1.13,95%CI[0.92,1.34],P<0.00001),and improve the ability of language expression(MD=1.28,95%CI[1.03,1.54],P<0.00001),improve gmfm88 score(MD=23.13,95%CI[18.75,27.51],P<0.00001),improve dysarthria score(MD=0.33,95%CI[0.26,0.41],P<0.00001),improve MCA of cerebral ultrasound blood flow examination(MD=13.12,95%CI[9.22,17.01],P<0.00001),and ACA of cerebral ultrasound blood flow examination(MD=9.45,95%CI[6.28,12.62],P<0.00001).Conclusion:Compared with other therapies,Xingnao Kaiqiao acupuncture combined therapy in the treatment of infantile cerebral palsy can improve the total clinical efficiency,and has obvious advantages in improving language function,gross motor function,dysarthria,MCA and ACA of cerebral ultrasonic blood flow examination,but it still needs more and higher quality literature to prove it.

Evaluation of the Curative Effect of "Xingnao Kaiqiao" Acupuncture Based on Brunnstrom Staging on Upper Limb and Hand Motor Function in the Recovery Period after Stroke

Objective: To observe the effects of Xingnao Kaiqiao acupuncture(醒脑开窍针) on the motor function of upper limb and hand in the recovery period after stroke. Methods: Seventy-six cases of hemiplegia patients with ischemic stroke were divided into the treatment group and the control group(n=38 in each). Based on the Brunnstrom's stage of Xingnao Kaiqiao acupuncture combined with rehabilitation training was used in the treatment group, and the control group was given rehabilitation training. FuglMeyer Assessment of the upper extremity(FMA-UE), Action Research Arm Test(ARAT) and Simple Test for Evaluating hand Function(STEF) were adopted separately to compare scores before treatment and 8 weeks after treatment. Results: The difference was not statistically significant in the two groups of patients for comparison of FMA-UE, ARAT and STEF scores before treatment(P>0.05). The difference was statistically significant in the two groups of score comparison of FMA-UE, ARAT and STEF after treatment(P<0.05). Conclusion: The Xingnao Kaiqiao acupuncture has its unique advantages in improving recovery of motor function of upper limb and hand in recovery period after stroke.

醒脑开窍针法对急性缺血性脑卒中患者的临床疗效及预后预警模型建立

ObjectiveTo explore the clinical effectiveness of xingnao kaiqiao (regaining consciousness and opening orifice) acupuncture therapy for patients with acute ischemic stroke, and establish a prediction model for prognosis for the target population through Logistic regression analysis.MethodsNinety-six patients with acute ischemic stroke were randomly assigned to either an ozone therapy group or an ozone therapy plus xingnao kaiqiao acupuncture group (OA group) with a 1:1 ratio. The patients in the ozone group was treated with ozone therapy, and those in the OA group were treated with acupuncture at Nèiguān (内关PC6), Shuĭgōu (水沟GV26), Sānyīnjiāo (三阴交SP6), lower Jíquán (下极泉Extra, lower HT1), Wĕizhōng (委中BL40) and Chĭzé (尺泽LU5) on the basis of the treatment as the ozone therapy group. The treatment was given once daily for 7 days as a session and 3 consecutive sessions were required. Before treatment and 48 h after treatment, the serological indicators (interleukin-6 [IL-6], tumor necrosis factor-α [TNF-α] and hypersensitive C-reactive protein [hs-CRP]) were tested. Using the National Institute of Health stroke scale (NIHSS) score and Montreal cognitive assessment (MoCA) score, the neurological and cognitive functions of patients were assessed. The clinical efficacy was evaluated with the modified Rankin scale, and the incidence of adverse effects was analyzed statistically in two groups. The multivariate Logistic regression analysis was adopted to detect the risk factors of the prognosis in patients and the nomographic prediction model was established.Results(1) clinical therapeutic effect: after treatment, the levels of IL-6, TNF-α and Hs-CRP in the OA group were significantly lower than that in the ozone group (all P < 0.05). After treatment, compared with the ozone therapy group, NIHSS score was lower and the scores of BI and MoCA were significantly higher in the OA group (all P < 0.05). The total effective rate of the OA group was 91.67%, higher than that of the ozone therapy group (62.50%, P < 0.05). The incidence of adverse effects in the OA group was lower when compared with that in the ozone group (P < 0.05);(2) establishment of prediction model for prognosis: age, history of diabetes, cardiogenic cerebral embolism, high density lipoprotein-cholesterol (HDL-C), white blood cell (WBC) and treatment methods were independent risk factors of the unfavorable prognosis for the patients with acute stroke. The established model had sound accuracy for prediction of prognosis.ConclusionXingnao kaiqiao acupuncture was effective on acute ischemic stroke, and the prognosis of this therapy was increased significantly when combined with the ozone therapy. The preventive measures should be set up for patients with risk factors, e.g. advanced age, diabetes, cardiogenic cerebral embolism, low HDL-C and abnormal WBC, in order to further reduce the risk of unfavorable prognosis in patients with acute stroke.