ADVANCES IN CLINICAL AND EXPERIMENTAL STUDIES ON ACUPUNCTURE TREATMENT OF ACUTE CEREBRAL HEMORRHAGE

In the present paper, the authors review recent advances in clinical and experimental studies on acupuncture treatment of cerebral hemorrhage(CH). Regarding clinical studies, the resuscitation-inducing needling maneuver, and main points of Shuigou(水沟GV 26),Baihui(百会 GV 20) and scalp-points Motor Area(MS 6), Sensory Area(MS 7), etc. are often involved. Concerning experimental studies, the underlying mechanisms of acupuncture of GV-26+“Neiguan”(内关 PC 6), GV-20,GV-26+GV-20, etc. in improving acute CH are introduced. In a word, acupuncture therapy works well in improving clinical symptoms and signs of CH patients, and acupuncture stimulation induced ameilioration of cerebral blood flow, favorable modulation of some bioactive substances as excitatory and inhibitory amino acids, endothelin, CGRP, heat shock protein 70, etc. and neuro-endocrine-immune network may contribute to the effect of acupuncture on CH. In addition, acupuncture combined with medicine and earlier application of acupuncture therapy in the acute stage of CH are recommended in clinical practice.

The Effect of Zhu Yu Hua Tan Tang on IntracranialPressure in Case of Acute Cerebral Hemorrhage

The therapeutic effect of Zhu Yu Hua Tan Tang (逐瘀化痰汤Decoction for removing blood stasis and resolving phlegm) plus general and modern treatment on acute cerebral hemorrhage in 44 cases, and the pressure-lowering effect of Zhu Yu Hua Tan Tang and mannitol in 20 cases of acute cerebral hemorrhage in the basilar region, and in rabbits with experimental encephaledema induced by injection of olive oil into the common carotid artery were observed in this study. The results showed that Zhu Yu Hua Tan Tang plus general treatment can better improved the conscious state of the patients than western medicine, and it can make the intracranial pressure drop clinically by 40.44%. The intracranial pressure-lowering effect of Zhu Yu Hua Tan Tang, though slow, is smooth and long-lasting without any rebound phenomenon, as compared to those of mannitol. Similar results were found in animal experiments, but the intracranial pressure-lowering amplitude of Zhu Yu Hua Tan Tang was stronger than that of mannitol. The difference between the clinical and experimental results needs to be further studied.

Cerebral arterial blood flow,attention,and executive and cognitive functions in depressed patients after acute hypertensive cerebral hemorrhage

BACKGROUND Intracerebral hemorrhage mainly occurs in middle-aged and elderly patients with hypertension,and surgery is currently the main treatment for hypertensive cerebral hemorrhage,but the bleeding caused by surgery will cause damage to the patient's nerve cells,resulting in cognitive and motor dysfunction,resulting in a decline in the patient's quality of life.AIM To investigate associations between cerebral arterial blood flow and executive and cognitive functions in depressed patients after acute hypertensive cerebral hemorrhage.METHODS Eighty-nine patients with depression after acute hypertensive cerebral hemorrhage who were admitted to our hospital between January 2019 and July 2021 were selected as the observation group,while 100 patients without depression who had acute hypertensive cerebral hemorrhage were selected as the control group.The attention span of the patients was assessed using the Paddle Pin Test while executive function was assessed using the Wisconsin Card Sorting Test(WCST)and cognitive function was assessed using the Montreal Cognitive Assessment Scale(MoCA).The Hamilton Depression Rating Scale(HAMD-24)was used to evaluate the severity of depression of involved patients.Cerebral arterial blood flow was measured in both groups.RESULTS The MoCA score,net scores I,II,III,IV,and the total net score of the scratch test in the observation group were significantly lower than those in the control group(P<0.05).Concurrently,the total number of responses,number of incorrect responses,number of persistent errors,and number of completed responses of the first classification in the WCST test were significantly higher in the observation group than those in the control group(P<0.05).Blood flow in the basilar artery,left middle cerebral artery,right middle cerebral artery,left anterior cerebral artery,and right anterior cerebral artery was significantly lower in the observation group than in the control group(P<0.05).The basilar artery,left middle cerebral artery,right middle cerebral artery,left anterior cerebral artery,and right anterior cerebral artery were positively correlated with the net and total net scores of each part of the Paddle Pin test and the MoCA score(P<0.05),and negatively correlated with each part of the WCST test(P<0.05).In the observation group,the post-treatment improvement was more prominent in the Paddle Pin test,WCST test,HAMD-24 score,and MoCA score compared with those in the pre-treatment period(P<0.05).Blood flow in the basilar artery,left middle cerebral artery,right middle cerebral artery,left anterior cerebral artery,and right anterior cerebral artery significantly improved in the observation group after treatment(P<0.05).CONCLUSION Impaired attention,and executive and cognitive functions are correlated with cerebral artery blood flow in patients with depression after acute hypertensive cerebral hemorrhage and warrant further study.

Effect of Tianhuang Granule(田黄冲剂) on Intracranial Pressure and Serum Matrix Metalloproteinase-9 in Patients with Acute Cerebral Hemorrhage

Objective： To study the effect and mechanism of Tianhuang Granule （田黄冲剂, THG） on hydrocephalus in the patients with acute cerebral hemorrhage （ACH） through intracranial pressure （ICP） monitoring, serum matrix metalloproteinase-9 （MMP-9） level observation, and National Institutes of Health Stroke Scale （NIHSS） scoring （for nerve function deficit）. Methods： Sixty patients with ACH were equally randomized into two groups by lottery, the control group and the THG group; all were treated with conventional therapy, but to the patients in the THG group, THG was given orally in addition for 28 days. Changes of ICP, MMP-9 expression, and NIHSS scores, as well as the degree of cerebral hematoma and hydrocephalus （by cranial CT scanning） in the patients, were estimated and compared. Results： （1） ICP was lowered more significantly in the THG group, showing a significant difference between groups on day 7 （P〈0.05）. （2） MMP-9 expression was down-regulated in the THG group more significantly and earlier than that in the control group. （3） The degrees of cerebral hematoma and hydrocephalus in the THG group on day 7 were reduced significantly as compared with those on day 3 （P〈0.05）, but in the control group, the day of significant reduction was delayed to day 14, and the degrees on day 7 and day 14 in the two groups were significantly different （P〈0.05 and P〈0.01）. （4） NIHSS score was significantly lower in the THG group than that in the control group on day 14 and day 28 （P〈0.05 and P〈0.01）. Conclusion： THG can effectively lower ICP, down-regulate MMP-9 expression, promote the absorption of cerebral hematoma and hydrocephalus, and improve the nerve function, showing a clinical effectiveness than conventional therapy.

EFFECT OF ELECTROACUPUNCTURE OF SCALP-POINTS ON ABNORMAL DISCHARGES OF NEURONS AROUND THE CEREBRAL HEMORRHAGE FOCUS IN THE RAT

Objective: To study the mechanism of electroacupuncture (EA) of scalp-points for regulating abnormal discharges of neurons in different regions around the cerebral hemorrhage focus by using neuro-electrophysiological methods. Methods: 80 Wistar rats (anesthetized with 20% urethane 1 g/kg, i.p.) were randomly divided into normal, saline, model and EA groups, with 20 cases in each group. Cerebral hemorrhage model was established by intracerebral injection of the rat’s own arterial blood sample (40 uL). In rats of saline group, the same volume of saline was given for intracerebral injection. Extracellular electrical activity of neurons of the caudate nucleus and parafascicular nucleus and Tail flicking latency (TFL) were used as the indexes. “Baihui”(百会 GV 20) and “Taiyang”(太阳 EX-HN 5) were punctured from GV 20 towards EX-HN 5 with filiform needles and stimulated electrically with stimulating parameters of strength of 1 V, frequency of 15 Hz and duration of 15 min. Results: Compared with normal group, TFL values of model group and EA group increased significantly (P<0.01); and compared with model group, those of EA group decreased significantly (P<0.01), suggesting that the pain threshold increased significantly in cerebral hemorrhage rats while after acupuncture stimulation, it lowered strikingly. Compared with normal and saline groups, the latency values of the pain excitement and inhibitory responses of the cellular discharges of the caudate and parafascicular nuclei in model and EA groups increased significantly (P<0.05～0.01), while after EA, it recovered apparently (P<0.01), showing an apparent regulative effect of EA on the abnormal changes of discharges of neurons around the cerebral hemorrhage focus. Conclusion: Scalp-acupuncture possesses an apparent regulatory effect on the abnormal electrical activity of neurons around the cerebral hemorrhage focus which may favor the early recovery of functional activity of neurons near the focus tissues.