Study Demonstrates Acupuncture's Efficacy with Coma Patients

Though not routinely seen in American acupuncture clinics, working with unconscious patients, including those in a coma, is something that practitioners are taught in school and familiar with. I post the study below largely because we do frequently see brain injury, strokes and neurologic problems which respond similarly well.

A recent study, which can be read here, found that,

Acupuncture improves the time it takes to regain consciousness from a coma after a severe brain injury.

Cerebral Vasospasm Treated by Acupuncture and Chinese Herbology

A recent Chinese study demonstrated impressive results for patients suffering from cerbral vasospasm, a severe constriction of the arteries of the subarachnoid cavity of the brain. This type of problem can lead to decreased blood flow to the area and may cause ischemia, infarction, stroke and death. (a summary of the paper may be read here).

The research showed that,  

... combining acupuncture, herbal medicine and pharmaceutical medication together is significantly more effective than using only drugs.

 Here, at the clinic, we treat vasospasm but also many of the sequelae such as stroke paralysis and aphasia. 

Acupuncture, Chinese Medicine and Stroke

At the Northside Holistic Center we see many post-stroke patients each week, presenting a wide variety of symptoms related to the damage caused by the cerbrovascular accident (CVA). The health issues we see include paralysis, aphasia (problems with speech), changes in the ability to smell and taste, general confusion, dizziness and other balance issues, and difficulty breathing. Luckily, with certain caveats, these problems tend to respond to treatment. The best results tend to be achieved if treatment is begun as soon as possible post-stroke. Improvement, sometimes dramatic, can be seen even with long term neurological damage but the chances are reduced.

Many studies have been done on Chinese medicine and acupuncture for the various stroke related problems and this page will be incrementally added to as I find time to aggregate them here. 

An interesting and award winning documentary on acupuncture and stroke, 9000 Needles, is an informational and inspirational film which I recommend.

Research and Articles

The results of several studies on stroke damage and acupuncture are summarized here. The studies find that acupuncture reverses brain damage after stroke: 

A new MRI study finds acupuncture and electroacupuncture effective for treating brain tissue injuries and neurological disorders caused by cerebral ischemia/reperfusion injury (CIRI). This type of brain damage is caused by the return of blood circulation to the brain after a period of ischemia, restricted blood supply. The sudden return of blood to oxygen and circulation deprived brain tissues causes inflammation and oxidative stress. Acupuncture biochemically ameliorates this condition and reduces infarct (tissue necrosis due to circulation obstruction) size. Consequently, acupuncture and electroacupuncture benefit the brain after a stroke due to ischemia.

Cerebral ischemia/reperfusion causes brain edema and swelling. This is caused by sequelae including increased permeability of the blood brain barrier, tissue inflammation and upregulation of the biochemicals matrix metalloproteinase 2 (MMP2) and aquaporin (AQP). Researchers have discovered that acupuncture and electroacupuncture successfully regulate MMP2, AQP and inflammatory cell infiltration caused by CIRI. The researchers added that acupuncture and electroacupuncture “significantly reduced infarct size and improved neurologic function.” As a result, the researchers conclude that acupuncture and electroacupuncture exert “neuroprotective actions” and may “find utility as adjunctive and complementary treatments to supplement conventional therapy for ischemic stroke.”

Scientific Data
Several types of evaluations confirmed the decrease in infarct size and successful regulation of biochemicals by acupuncture and electroacupuncture after CIRI. The researchers used microscopic evaluation, fMRI, hematoxylin-eosin staining, quantitative real-time polymerase chain reaction evaluation, immunofluorescence analysis, immunohistochemical analysis and western blot analysis. Subjective evaluation of neurological deficits was also evaluated. The researchers conclude, “acupuncture and electroacupuncture are effective treatments for brain tissue injury and neurological deficits following CIRI in rats. Therefore, this study adds to the growing arsenal of research supporting the view that acupuncture and electroacupuncture, which are derived from Traditional Chinese Medicine, can serve as complementary and alternative treatments to supplement the conventional management of ischemic stroke.” 

The study design was a laboratory rat experiment of middle cerebral artery occlusion causing cerebral ischemia/reperfusion. Acupuncture points GV20 and ST36 were applied. The results demonstrated several repeatable scientific phenomenon in fMRI imaging and biochemical analyses. GV20 and ST36 reduced infiltration of inflammatory cells, downregulated expression of proinflammatory enzyme MMP2, reduced expression of water channel proteins AQP4 and AQP9, reduced brain ischemia and decreased brain edema due to inflammation. Neurologic function was increased and verified by improved motor tests such as muscle status and movement capabilities; sensory tests including visual, tactile and proprioceptive evaluation; improvements in balance tests and improvements in reflex tests. Additionally, infarct size significantly reduced.

A Taiwanese study found good evidence that acupuncture is superior to biomedical approaches to balance issues, subsequent to a stroke. The research, which can be read about in detail here, found that:

The acupuncture group demonstrated clinically superior clinical outcomes for hemiplegic stroke patients.

A recent study was written about in Business Insider and describes research which demonstrates that acupuncture stimulates specific regions of the brain in patients who have suffered a stroke.

Most studies addressing the specificity of meridians and acupuncture points have focused mainly on the different neural effects of acupuncture at different points in healthy individuals.

Dr. Ji Qi and co-workers from School of Traditional Chinese Medicine, Southern Medical University in China examined the effects of acupuncture on brain function in a pathological context, and compared the effects between Waiguan and sham points in 16 patients with ischemic stroke.

Compared with sham acupuncture, acupuncture at Waiguan in stroke patients inhibited Brodmann area 5 on the healthy side.

These findings indicated that the altered specificity of sensation-associated cortex (Brodmann area 5) is possibly associated with a central mechanism of acupuncture at Waiguan for stroke patients.

The study has been published in the journal, Neural Regeneration Research.

A study from the Journal of Neuroinflammation found that acupuncture protects the brain from post-stroke deterioration, caused by transient cerebral ischemic injury. An excerpt from the study (which can be read about here) reads,

The researchers discovered that electro-acupuncture treatment activates a special alpha-7 nicotinic receptor located in the brain, alpha-7nAChR. Modern research confirms that alpha-7 nicotinic receptors are involved in the reduction of inflammatory neurotoxicity due to stroke, heart attack, sepsis and alzheimers disease. Acupuncture helps to protect the brain by activating alpha-7nAChR receptors. Once activated, they inhibit the release of HMGB1, a protein responsible for inflammation and necrosis.

Measuring the shutting down of HMGB1 release following a stroke is one of the first examples of mapping the exact biochemical mechanism by which acupuncture reduces brain cell death following a stroke. This helps to explain several beneficial effects measured in the study: electro-acupuncture reduces infarct volume, improves neurological outcomes, and inhibited neuronal apoptosis. The researchers conclude that electro-acupuncture provides “strong protection against transient cerebral ischemic injury….”

Chinese Medicine Has Potent Treatments for Dementia

While acupuncture and Chinese medicine are frequently used to treat dementia in many parts of the world, the practice is not as frequently used in the United States as it should be. At the Northside Holistic Center we often treat dementia stemming from a variety of causes. The results can often be very gratifying.

Research/Articles

This article from the Taiwan News describes research into one of the herbs, Tian Ma that we frequently use in practice. The article, which can be read here, says:

...studies conducted by the Taiwanese institution have shown that tianma can be effective in curbing the effects of diseases ranging from dementia to spino-cerebellar atrophy, Huntington’s Disease and other ailments of the cerebral and nervous system. Research has shown that tianma can slow or reduce the effects of these diseases but so far it has not been established whether it can actually cure the diseases themselves.

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While it is true that we treat dementia with some moderate success and that Tian Ma may be one of the herbs that would be included in a formula and acupuncture protocol for this type of complaint, it would never be true that we would use one ingredient alone for such a purpose. Still, it for the purpose of research, it is useful to have yet another item in our toolbox validated by Western methods.

Another interesting reductionist, yet fascinating, study is one published by Japanese researchers and viewable here, looks at the effect of one acupuncture point that we might choose to treat cognitive issues. Again, this point would not be used on it's own, but only in the larger context of a treatment protocol. The study suggests that acupuncture enhances blood flow to the brain without altering the overall blood pressure in the region, a highly desirable goal.

Scientists measured the effects of acupuncture at [acupoint] DU-20 on blood flow velocities in the middle cerebral artery (MCA) and anterior cerebral artery (ACA), in 10 healthy male subjects. Mean MCA and ACA blood flow velocities at rest increased significantly after DU-20 acupuncture treatment, whereas mean arterial blood pressure and pulse rate at rest did not change significantly.

Another study which looked at the herbal aspect of what acupuncturists do for people with dementia, looks at one of the many formula which we may use for patients who come to us for Alzheimer's disease. This study, published in Neuroscience Letters (and readable here) found that,

Treatment with the Chinese herbal formula Fuzhisan (FZS) may have a positive effect on cognition, behavioral functions, and cerebral glucose metabolism in patients with mild-to-moderate Alzheimer's disease 

Twenty-two subjects were randomly assigned to receive FZS or placebo for 12 weeks. Positron emission tomography (PET) was used to study the regional cerebral metabolic rate of glucose consumption (rCMRglc) at baseline and week 12. Compared with placebo, FZS significantly improved cognitive and behavioural scores at week 12. In addition, FZS treatment favorably improved rCMRglc in the bilateral temporal and parietal cortices, hippocampus and posterior cingulate gyrus.

 Two recent studies, which can be read about here, finds further evidence that acupuncture is very useful in the treatment of vascular dementia – the type most commonly linked to strokes. The first concluded that,

. . . that acupuncture is effective in improving cognition . . . [and] observed that acupuncture measurably reduced levels of 8-OHdG, a marker of oxidative damage. As a result, the researchers conclude “that acupuncture is beneficial at least in part by preventing oxidative damage.”

The second study compared two different acupuncture protocols to one another. These two types, termed 'scalp acupuncture' and 'body acupuncture' were both found to be very useful in treating vascular dementia but,

The scalp acupuncture group showed significantly greater improvements in cognition than the body-style acupuncture group. Social behavior scores and ADL (Activities of Daily Living) improved significantly in both groups. The researchers concluded that scalp acupuncture significantly improves cognition, activities of daily living, TCM (Traditional Chinese Medicine) signs and symptoms, mental state and social behavior in patients with vascular dementia.