MEDICAL ACUPUNCTURE Volume 26, Number 5, 2014 # Mary Ann Liebert, Inc. DOI: 10.1089/acu.2014.2652
CLINICAL PEARLS
How Do You Treat Poststroke Aphasia with Acupuncture in Your Practice?
P
ost-stroke aphasia can be devastating. Conventional treatment options are limited, and although speech therapy can be helpful, it is by no means a panacea. If acupuncture has any potential to assist patients who have aphasia, this modality would certainly be worth using it as an adjunct. Acupuncture techniques are commonly used in China for poststroke rehabilitation, including aphasia.1 In Traditional Chinese Medicine (TCM), cerebrovascular accidents are generally attributed to a combinative Excess of endogenous Wind, Liver Yang rising, and Phlegm. But there is often a concomitant deficiency of Qi and Blood, particularly in elderly patients, which may not become apparent until sometime later after the stroke. There are therefore at least two phases when considering intervention: immediate (1–3 months, mostly for Excess) and delayed (post 3 months, mostly for Deficiency). Patients mostly frequently seek acupuncture in the latter phase in which their likely energetic pattern will be a combination of Qi Deficiency, Blood Stagnation, and varying amounts of of Phlegm. Standard acupuncture for aphasia includes bleeding the points M-HN 20 (Jinyin [EX-HN-12] and Yuye [EXHN 13]).2 These are usually accompanied by a few body points such as KI 6 (Zhaohai), HT 5 (Tongli), CV 12 (Zhongwan), and CV 23 (Lianquan). KI 6 and CV 23 open the Yin Qiao and Ren Mai, both of which travel to the face. HT 5 opens the Luo channel of the Heart, which penetrates the Heart and goes to the root of the Tongue. CV 23 is needled 2 cun toward the root of the Tongue, to bring Qi to the Tongue, while bleeding the sublingual veins is designed to mitigate Blood Stagnation. One potential difficulty with this protocol is that needling inside the mouth may potentially repel patients away from the whole idea of acupuncture. However, there may be another option, especially if the veins are not particularly engorged. One simple approach involves electroacupuncture stimulation
of the Shegen region (in the midline at the base of the tongue (Fig. 1).3 Although I have only tried this once myself, the technique proved to be acceptable to the patient involved. Shegen can be combined either with HT 5 (Tongli) or HT 9 (Shaochong). A few body points can be added to tonify the Spleen/Kidney Qi, such as CV 4 (Guanyuan), CV 12 (Zhongwan), ST 36 (Tsusanli), SP 6 (Sanyinjiao), and KI-3 (Taixi); and to strengthen the Yang, such as BL 23 (Shenshu), GV 4 (Mingmen), and GV 15 (Yamen); see Table 1. I attach the red lead to one of the Heart points and connect the black lead to a needle, which is then used to touch the Shegen point at the base of the tongue, not penetrating the mucous membrane. If I choose HT 9, the electrode may
FIG. 1. Yuye, Jinyin, and Shegen regions on underside of tongue.
Medical Acupuncture is pleased to continue this regular feature, Clinical Pearls, which we have found to be very useful for, and practical to, the readership, and very popular. All of us are confronted with clinical challenges, especially when dealing with therapeutic strategies. We hope this ongoing collection of Clinical Pearls will be easily accessible and ready to put into action for the benefit of our patients, and even ourselves. How often do we ask our colleagues: ‘‘How do you treat. ?’’ This time, we posed the question: ‘‘How do you treat poststroke aphasia in your practice?’’ Herein lie your contributions. We trust that our readership will continue to participate in this section by either asking the questions or supplying the ‘‘Pearls.’’ If you have a ‘‘question’’ you would like to see answered, please send it to our managing editor, Yael Benporat, at: [email protected] We encourage and welcome your input and participation. Please address your answers to ‘‘Pearls’’ to our managing editor, Yael Benporat, at: [email protected]
298
CLINICAL PEARLS
299
Table 1. Local and Distal points for Treating Poststroke Dysphasia/Aphasia Pattern
Local points
Standard protocol Shegen stim [Sp/KI Qi
Electrical stimulation
Jinyin & Yuye bleeding KI 6/CV 23 HT 5 or HT 9/Shegen CV 4 &12, ST 36, SP 6, & KI 3
CV 23: 2 cun toward root of tongue Electrical stim (2–8 Hz) for 10–20 minutes Electrical stim (2–8 Hz) for 10–20 minutes [Ki Yang BL 23 & GV 4 & 15
stim, stimulation.
have to be fixed to the skin with adhesive. I use lowfrequency stimulation (2–8 Hz) to get a bit of a tongue twitch and then, gradually and gently, turn the intensity up to the maximum that the patient can handle. I continue this for 10–20 minutes. Scalp acupuncture can also be used, but there are several techniques to choose from. Perhaps the most traditional approach involves needling points relevant to the speech area on the lower 2/5ths of the motor line.4 Again, I add low-frequency electrical stimulation (2–8 Hz) for 10–20 minutes. Herbs too, can be useful adjuncts. Bu Yang Huan Wu Tang is a versatile formula that can be used over the longterm. The formula is used to addresses both Blood Stagnation and Qi Deficiency and is appropriate even months or years poststroke. If there is significant Phlegm, intermittent courses of Xiao Huo Luo Dan can be added.5 Treatments should be fairly frequent, ideally daily, or at least 2–3 times per week, for a couple of months. Keep in mind that acupuncture needs to be just one aspect of a more holistic approach (known as Daoyin) that should include a range of other modalities, such as physiotherapy, counseling, herbs, meditation, and speech therapy.6
ACKNOWLEDGMENTS Graphics were designed by Dr. Greenwood’s son, Richard Greenwood, BFA, MFA (website: www.richardgreenwood.ca).
REFERENCES 1. Sun Y, Xue SA, Zuo Z. Acupuncture therapy on apoplectic aphasia rehabilitation. J Trad Chin Med. 2012;32(3):314–321. 2. Xiang Y, Ding X. Windstroke: Approaches to acupuncture treatment. J Chin Med. 2000;(62):23–25. 3. Xiao F, Liu W. Observation on the treatment of dysphasia due to cerebrovascular accident with electroacupuncture at Shegen point. J Chin Med.1996;(50):27–29. 4. Chu L, Yeh S, Wood D. New methods and developments In: Acupuncture Manual: A Western Approach. New York: Marcel Dekker; 1979. 5. Fruehauf H. Stroke and post-stroke syndrome: Prevention and treatment by Chinese herbal medicine. J Chin Med. 1994; (44):23–36. 6. Zhu MQ, Siu M. Can Acupuncture Really Benefit Stroke Recovery? Online document at: www.scalpacupuncture.org/
wp-content/uploads/2013/05/Can-Acupuncture-Really-BenefitStroke-Recovery.pdf Accessed July 7, 2014.
Michael T. Greenwood MB, BChir (MD), FCFP, CAFCI, FAAMA 103–284 Helmcken Road Victoria, British Columbia V9B 1T2 Canada E-mail: [email protected]
A
ccording to the website of the U.S. National Institute of Neurological Disorders and Stroke, aphasia is a disorder caused by damage to the parts of the brain that control language.1 The National Aphasia Association, also in the United States, states that aphasia is an acquired communication disorder and is one of the most feared symptoms of a stroke that impairs a person’s ability to process language, but it does not affect intelligence.2 Approximately 21%–38% of acute stroke survivors suffer from aphasia, a devastating neurologic condition affecting a person’s ability to communicate and, thus, reintegrate into society.3 In the FES-Iztacala-UNAM (National Autonomous University of Mexico) acupuncture clinic, the Psychiatric Hospital of Yucata´n, Mexico, and the Neuropsychiatric Institute of Yucata´n, Mexico, we have been treating 2 patients with acupuncture for poststroke aphasia, by medical staff of the acupuncture clinic of the FES-Iztacala-UNAM, as a complementary treatment to conventional pharmacologic and rehabilitation therapy, which is provided by doctors of the Psychiatric Hospital of Yucatan and the Neuropsychiatric Institute of Yucatan. These two institutions work collaboratively withus at the university’s acupuncture clinic. According to the theory of energetics of living systems applied to acupuncture, poststroke aphasia is caused by a disturbance of the Kidney and the Spleen, creating Deficiencies of Qi, Blood, and Yin. These Deficiencies cause the body to be overwhelmed by Wind, Phlegm, Fire, and Stasis according to Traditional Chinese Medicine. Preservation of core language-processing areas will generate minimal right-hemisphere recruitment and vice versa. Some experimental studies seem to suggest that the improvement linked to a particular hemisphere can be modulated by specific therapy methods.4,5 We selected points of the Thoroughfare vessel (SP 4, ST 30, and PC 6)—
300
CLINICAL PEARLS
a meridian-related Taiyin functional group that is related to Phlegm and to and points of Yangqiaomai vessel—and complementary points CV 23, BL 10; and BL 59 related to the disturbance of motor aphasia and related to Fire, which favor the energetic transition of the Thoroughfare vessel to the Yangqiaomai vessel according to the theory of energetics of living systems as applied to acupuncture.6 In addition, we also used the points CV 23 and BL 10 to remove the Excess of Phlegm in the cephalic region, and to scatter the energy of a Thoroughfare-vessel obstruction. In each treatment, for a primary symptom (such as poststroke aphasia), we used SP 4, ST 30, ST 8, and PC 6, with electrical stimulation in the ST 8 and PC 6, acupuncture points, using a tonifiying method at low frequencies (10 Hz) for 60 minutes with middle insertion of the needles (1 inch), repeated twice per week for 8 weeks. For a symptom (such as aphasia) occurring for a second time, we used the points of the Yangqiaomai vessel (BL 62, HT 5, and SI 3) and electrical stimulation at CV 23 and BL 10 (the Sky Window point), using a tonification method with high frequencies (200 Hz) deep needle insertion for 60 minutes, twice a week for 8 weeks. Treatment of poststroke aphasia with the use of acupuncture shows a lot of promise for rehabilitation.
REFERENCES 1. National Institute of Neurological Disorders and Stroke (NINDS). NINDS Aphasia Information Page. Online document at: www.ninds.nih.gov/disorders/aphasia/aphasia.htm Accessed July 8, 2014. 2. National Aphasia Association. Aphasia Definitions. Online document at: www.aphasia.org/content/aphasia-definitions Accessed July 8, 2014. 3. Berthier ML. Poststroke aphasia: Epidemiology, pathophysiology and treatment. Drugs Aging. 2005;22(2):163–182. 4. Anglade C, Thiel A, Ansaldo AI. The complementary role of the cerebral hemispheres in recovery from aphasia after stroke: A critical review of literature. Brain Inj. 2014;28(2): 138–145. 5. Shah PP, Szaflars JP, Allendorfer J, Hamilton RH. Induction of neuroplasticity and recovery in post-stroke aphasia by non-invasive brain stimulation. Front Hum Neurosci. 2013; 7:888. 6. Mussat M. Physiological Energetics of Acupuncture [in French], 1st ed. Paris: Librairie le Francois; 1979.
Miguel Jesu´s Reyes-Campos, MD University Extension Acupuncture Clinic, FES-Iztacala National Autonomous University of Mexico Venecia Number 15 Colonia Jua´rez, CP 06600, Mexico City Mexico E-mail: [email protected]
Livia Gabriela Dı´az-Toral, MD CBS (Biological Sciences Health) UAM-I (Metropolitan Autonomous University-Iztapalapa) Colonia Jua´rez, Me´xico City Me´xico Patricio Guillermo Basulto-Sosa, MD, PhD Neuropsychiatric Institute of Yucata´n Merida Mexico Primo F. Reyes-Campos, MD, PhD Psychiatric General Hospital Merida, Yucata´n Mexico
T
he effectiveness of acupuncture for addressing apoplectic aphasia has been shown in studies.1,2 The Chinese name Zhong Feng (Wind Stroke) indicates Internal Wind as the pathogenic factor, and Internal Wind is a Liver Disharmony. Deficient Kidney Yin or Liver Yin cannot restrain the Liver Yang, which, therefore, rises, producing Internal Wind that facilitates the formation of Phlegm, which then obstructs the channels. There are two types of strokes: (1) a severe type with loss of consciousness (involvement of the internal organs) and (2) a milder type with no loss of consciousness (involvement of the channels only). In both types, aphasia can be present. The throat energy center that regulates speech and communication is represented in the back of the body by GV 15 and GV 16; and on the front by CV 22 and CV 23. GV 15 and GV 16 provide the link between the brain and speech. HT 5 regulates communication by providing mental clarity and rapid thinking, which form the basis of communication. This point also helps to clear thinking by calming the mind and emotions. HT 5 also regulates the Tongue thereby increasing the fluency of speech. KI 6 benefits the throat. All the above points are reduced in the first 4 weeks following the stroke and then, by even method, after the stroke is over. GB 20, PC 6, GV 20, SP 6, Jinjin Yuye, and Zengyin (Increasing Sound)—an Extra point 0.5 cun infero lateral to ST 9—may be added if needed. Scalp acupuncture is effective, it is not done along with body acupuncture, but can be done in alternation—using Speech 1 for Motor Aphasia, Speech 2 for Nominal Aphasia, and Speech 3 for Sensory Aphasia (all on the opposite side). For auricular acupuncture, select from Brain, Adrenal Gland E, Adrenal Gland C, Point Zero, ShenMen, Master Cerebral, Sympathetic Autonomic Point, Endocrine Point, Tongue C, Tongue E, and Heart C. These points help patients who have disordered speech in general. Tenderness to pressure is the guide for selecting point. A point detector may be used instead.
CLINICAL PEARLS Other manifestations of stroke, such as hemiplegia etc., and other Disharmonies that contributed to the development of the stroke will also need attention. Improvement in the initial stages may appear to be fluctuating, but the baseline tends to move upward toward recovery. Obvious improvements may be noticed in the patient’s vocabulary, quickness in formulating responses to questions, clarity of the mind, choice of words, performing naming tasks, and constructing sentences. If a patient is seen within 3 months of a stroke, treatment is given every day; if the patient is seen between 3 and 6 months poststroke, treatment is given every second day. After sixteen treatments, the frequency may be reduced to once or twice per week, with a break of 2–3 weeks after 1 month. If treated early, a total cure rate of 35% and a marked improvement of a further 20% can be expected. Approximately 5% of patients will not respond. This compares with a total cure rate of 20% without treatment at 6 months.3 Perseverance is the key; even cases treated after months of neglect have shown improvement. In addition,
301 the patient may be given a Chinese herb, Jie Yu Dan (Relaxing Speech pill).
REFERENCES 1. Sun Y, Xue SA, Zuo Z. Acupuncture therapy on [sic] apoplectic aphasia rehabilitation. J Tradit Chin Med. 2012;32(3):314–321. 2. Li G, Yang ES. An fMRI study of acupuncture-induced brain activation of aphasia stroke patients. Complement Ther Med. 2011;19(suppl1):S49–S59. 3. Pedersen PM, Jorgensen HS, Nakayama H, Raaschou Ho, Olsen TS. Aphasia in acute stroke: Incidence, determinants, and recovery. Ann Neurol.1995;38(4):659–666.
Poovadan Sudhakaran, MBBS, PhD, MastACU, MastTCM 26 Tuckers Road, Templestowe, Victoria 3106 Australia E-mail: [email protected]
CLINICAL PEARLS
How Do You Treat Poststroke Aphasia with Acupuncture in Your Practice?
P
ost-stroke aphasia can be devastating. Conventional treatment options are limited, and although speech therapy can be helpful, it is by no means a panacea. If acupuncture has any potential to assist patients who have aphasia, this modality would certainly be worth using it as an adjunct. Acupuncture techniques are commonly used in China for poststroke rehabilitation, including aphasia.1 In Traditional Chinese Medicine (TCM), cerebrovascular accidents are generally attributed to a combinative Excess of endogenous Wind, Liver Yang rising, and Phlegm. But there is often a concomitant deficiency of Qi and Blood, particularly in elderly patients, which may not become apparent until sometime later after the stroke. There are therefore at least two phases when considering intervention: immediate (1–3 months, mostly for Excess) and delayed (post 3 months, mostly for Deficiency). Patients mostly frequently seek acupuncture in the latter phase in which their likely energetic pattern will be a combination of Qi Deficiency, Blood Stagnation, and varying amounts of of Phlegm. Standard acupuncture for aphasia includes bleeding the points M-HN 20 (Jinyin [EX-HN-12] and Yuye [EXHN 13]).2 These are usually accompanied by a few body points such as KI 6 (Zhaohai), HT 5 (Tongli), CV 12 (Zhongwan), and CV 23 (Lianquan). KI 6 and CV 23 open the Yin Qiao and Ren Mai, both of which travel to the face. HT 5 opens the Luo channel of the Heart, which penetrates the Heart and goes to the root of the Tongue. CV 23 is needled 2 cun toward the root of the Tongue, to bring Qi to the Tongue, while bleeding the sublingual veins is designed to mitigate Blood Stagnation. One potential difficulty with this protocol is that needling inside the mouth may potentially repel patients away from the whole idea of acupuncture. However, there may be another option, especially if the veins are not particularly engorged. One simple approach involves electroacupuncture stimulation
of the Shegen region (in the midline at the base of the tongue (Fig. 1).3 Although I have only tried this once myself, the technique proved to be acceptable to the patient involved. Shegen can be combined either with HT 5 (Tongli) or HT 9 (Shaochong). A few body points can be added to tonify the Spleen/Kidney Qi, such as CV 4 (Guanyuan), CV 12 (Zhongwan), ST 36 (Tsusanli), SP 6 (Sanyinjiao), and KI-3 (Taixi); and to strengthen the Yang, such as BL 23 (Shenshu), GV 4 (Mingmen), and GV 15 (Yamen); see Table 1. I attach the red lead to one of the Heart points and connect the black lead to a needle, which is then used to touch the Shegen point at the base of the tongue, not penetrating the mucous membrane. If I choose HT 9, the electrode may
FIG. 1. Yuye, Jinyin, and Shegen regions on underside of tongue.
Medical Acupuncture is pleased to continue this regular feature, Clinical Pearls, which we have found to be very useful for, and practical to, the readership, and very popular. All of us are confronted with clinical challenges, especially when dealing with therapeutic strategies. We hope this ongoing collection of Clinical Pearls will be easily accessible and ready to put into action for the benefit of our patients, and even ourselves. How often do we ask our colleagues: ‘‘How do you treat. ?’’ This time, we posed the question: ‘‘How do you treat poststroke aphasia in your practice?’’ Herein lie your contributions. We trust that our readership will continue to participate in this section by either asking the questions or supplying the ‘‘Pearls.’’ If you have a ‘‘question’’ you would like to see answered, please send it to our managing editor, Yael Benporat, at: [email protected] We encourage and welcome your input and participation. Please address your answers to ‘‘Pearls’’ to our managing editor, Yael Benporat, at: [email protected]
298
CLINICAL PEARLS
299
Table 1. Local and Distal points for Treating Poststroke Dysphasia/Aphasia Pattern
Local points
Standard protocol Shegen stim [Sp/KI Qi
Electrical stimulation
Jinyin & Yuye bleeding KI 6/CV 23 HT 5 or HT 9/Shegen CV 4 &12, ST 36, SP 6, & KI 3
CV 23: 2 cun toward root of tongue Electrical stim (2–8 Hz) for 10–20 minutes Electrical stim (2–8 Hz) for 10–20 minutes [Ki Yang BL 23 & GV 4 & 15
stim, stimulation.
have to be fixed to the skin with adhesive. I use lowfrequency stimulation (2–8 Hz) to get a bit of a tongue twitch and then, gradually and gently, turn the intensity up to the maximum that the patient can handle. I continue this for 10–20 minutes. Scalp acupuncture can also be used, but there are several techniques to choose from. Perhaps the most traditional approach involves needling points relevant to the speech area on the lower 2/5ths of the motor line.4 Again, I add low-frequency electrical stimulation (2–8 Hz) for 10–20 minutes. Herbs too, can be useful adjuncts. Bu Yang Huan Wu Tang is a versatile formula that can be used over the longterm. The formula is used to addresses both Blood Stagnation and Qi Deficiency and is appropriate even months or years poststroke. If there is significant Phlegm, intermittent courses of Xiao Huo Luo Dan can be added.5 Treatments should be fairly frequent, ideally daily, or at least 2–3 times per week, for a couple of months. Keep in mind that acupuncture needs to be just one aspect of a more holistic approach (known as Daoyin) that should include a range of other modalities, such as physiotherapy, counseling, herbs, meditation, and speech therapy.6
ACKNOWLEDGMENTS Graphics were designed by Dr. Greenwood’s son, Richard Greenwood, BFA, MFA (website: www.richardgreenwood.ca).
REFERENCES 1. Sun Y, Xue SA, Zuo Z. Acupuncture therapy on apoplectic aphasia rehabilitation. J Trad Chin Med. 2012;32(3):314–321. 2. Xiang Y, Ding X. Windstroke: Approaches to acupuncture treatment. J Chin Med. 2000;(62):23–25. 3. Xiao F, Liu W. Observation on the treatment of dysphasia due to cerebrovascular accident with electroacupuncture at Shegen point. J Chin Med.1996;(50):27–29. 4. Chu L, Yeh S, Wood D. New methods and developments In: Acupuncture Manual: A Western Approach. New York: Marcel Dekker; 1979. 5. Fruehauf H. Stroke and post-stroke syndrome: Prevention and treatment by Chinese herbal medicine. J Chin Med. 1994; (44):23–36. 6. Zhu MQ, Siu M. Can Acupuncture Really Benefit Stroke Recovery? Online document at: www.scalpacupuncture.org/
wp-content/uploads/2013/05/Can-Acupuncture-Really-BenefitStroke-Recovery.pdf Accessed July 7, 2014.
Michael T. Greenwood MB, BChir (MD), FCFP, CAFCI, FAAMA 103–284 Helmcken Road Victoria, British Columbia V9B 1T2 Canada E-mail: [email protected]
A
ccording to the website of the U.S. National Institute of Neurological Disorders and Stroke, aphasia is a disorder caused by damage to the parts of the brain that control language.1 The National Aphasia Association, also in the United States, states that aphasia is an acquired communication disorder and is one of the most feared symptoms of a stroke that impairs a person’s ability to process language, but it does not affect intelligence.2 Approximately 21%–38% of acute stroke survivors suffer from aphasia, a devastating neurologic condition affecting a person’s ability to communicate and, thus, reintegrate into society.3 In the FES-Iztacala-UNAM (National Autonomous University of Mexico) acupuncture clinic, the Psychiatric Hospital of Yucata´n, Mexico, and the Neuropsychiatric Institute of Yucata´n, Mexico, we have been treating 2 patients with acupuncture for poststroke aphasia, by medical staff of the acupuncture clinic of the FES-Iztacala-UNAM, as a complementary treatment to conventional pharmacologic and rehabilitation therapy, which is provided by doctors of the Psychiatric Hospital of Yucatan and the Neuropsychiatric Institute of Yucatan. These two institutions work collaboratively withus at the university’s acupuncture clinic. According to the theory of energetics of living systems applied to acupuncture, poststroke aphasia is caused by a disturbance of the Kidney and the Spleen, creating Deficiencies of Qi, Blood, and Yin. These Deficiencies cause the body to be overwhelmed by Wind, Phlegm, Fire, and Stasis according to Traditional Chinese Medicine. Preservation of core language-processing areas will generate minimal right-hemisphere recruitment and vice versa. Some experimental studies seem to suggest that the improvement linked to a particular hemisphere can be modulated by specific therapy methods.4,5 We selected points of the Thoroughfare vessel (SP 4, ST 30, and PC 6)—
300
CLINICAL PEARLS
a meridian-related Taiyin functional group that is related to Phlegm and to and points of Yangqiaomai vessel—and complementary points CV 23, BL 10; and BL 59 related to the disturbance of motor aphasia and related to Fire, which favor the energetic transition of the Thoroughfare vessel to the Yangqiaomai vessel according to the theory of energetics of living systems as applied to acupuncture.6 In addition, we also used the points CV 23 and BL 10 to remove the Excess of Phlegm in the cephalic region, and to scatter the energy of a Thoroughfare-vessel obstruction. In each treatment, for a primary symptom (such as poststroke aphasia), we used SP 4, ST 30, ST 8, and PC 6, with electrical stimulation in the ST 8 and PC 6, acupuncture points, using a tonifiying method at low frequencies (10 Hz) for 60 minutes with middle insertion of the needles (1 inch), repeated twice per week for 8 weeks. For a symptom (such as aphasia) occurring for a second time, we used the points of the Yangqiaomai vessel (BL 62, HT 5, and SI 3) and electrical stimulation at CV 23 and BL 10 (the Sky Window point), using a tonification method with high frequencies (200 Hz) deep needle insertion for 60 minutes, twice a week for 8 weeks. Treatment of poststroke aphasia with the use of acupuncture shows a lot of promise for rehabilitation.
REFERENCES 1. National Institute of Neurological Disorders and Stroke (NINDS). NINDS Aphasia Information Page. Online document at: www.ninds.nih.gov/disorders/aphasia/aphasia.htm Accessed July 8, 2014. 2. National Aphasia Association. Aphasia Definitions. Online document at: www.aphasia.org/content/aphasia-definitions Accessed July 8, 2014. 3. Berthier ML. Poststroke aphasia: Epidemiology, pathophysiology and treatment. Drugs Aging. 2005;22(2):163–182. 4. Anglade C, Thiel A, Ansaldo AI. The complementary role of the cerebral hemispheres in recovery from aphasia after stroke: A critical review of literature. Brain Inj. 2014;28(2): 138–145. 5. Shah PP, Szaflars JP, Allendorfer J, Hamilton RH. Induction of neuroplasticity and recovery in post-stroke aphasia by non-invasive brain stimulation. Front Hum Neurosci. 2013; 7:888. 6. Mussat M. Physiological Energetics of Acupuncture [in French], 1st ed. Paris: Librairie le Francois; 1979.
Miguel Jesu´s Reyes-Campos, MD University Extension Acupuncture Clinic, FES-Iztacala National Autonomous University of Mexico Venecia Number 15 Colonia Jua´rez, CP 06600, Mexico City Mexico E-mail: [email protected]
Livia Gabriela Dı´az-Toral, MD CBS (Biological Sciences Health) UAM-I (Metropolitan Autonomous University-Iztapalapa) Colonia Jua´rez, Me´xico City Me´xico Patricio Guillermo Basulto-Sosa, MD, PhD Neuropsychiatric Institute of Yucata´n Merida Mexico Primo F. Reyes-Campos, MD, PhD Psychiatric General Hospital Merida, Yucata´n Mexico
T
he effectiveness of acupuncture for addressing apoplectic aphasia has been shown in studies.1,2 The Chinese name Zhong Feng (Wind Stroke) indicates Internal Wind as the pathogenic factor, and Internal Wind is a Liver Disharmony. Deficient Kidney Yin or Liver Yin cannot restrain the Liver Yang, which, therefore, rises, producing Internal Wind that facilitates the formation of Phlegm, which then obstructs the channels. There are two types of strokes: (1) a severe type with loss of consciousness (involvement of the internal organs) and (2) a milder type with no loss of consciousness (involvement of the channels only). In both types, aphasia can be present. The throat energy center that regulates speech and communication is represented in the back of the body by GV 15 and GV 16; and on the front by CV 22 and CV 23. GV 15 and GV 16 provide the link between the brain and speech. HT 5 regulates communication by providing mental clarity and rapid thinking, which form the basis of communication. This point also helps to clear thinking by calming the mind and emotions. HT 5 also regulates the Tongue thereby increasing the fluency of speech. KI 6 benefits the throat. All the above points are reduced in the first 4 weeks following the stroke and then, by even method, after the stroke is over. GB 20, PC 6, GV 20, SP 6, Jinjin Yuye, and Zengyin (Increasing Sound)—an Extra point 0.5 cun infero lateral to ST 9—may be added if needed. Scalp acupuncture is effective, it is not done along with body acupuncture, but can be done in alternation—using Speech 1 for Motor Aphasia, Speech 2 for Nominal Aphasia, and Speech 3 for Sensory Aphasia (all on the opposite side). For auricular acupuncture, select from Brain, Adrenal Gland E, Adrenal Gland C, Point Zero, ShenMen, Master Cerebral, Sympathetic Autonomic Point, Endocrine Point, Tongue C, Tongue E, and Heart C. These points help patients who have disordered speech in general. Tenderness to pressure is the guide for selecting point. A point detector may be used instead.
CLINICAL PEARLS Other manifestations of stroke, such as hemiplegia etc., and other Disharmonies that contributed to the development of the stroke will also need attention. Improvement in the initial stages may appear to be fluctuating, but the baseline tends to move upward toward recovery. Obvious improvements may be noticed in the patient’s vocabulary, quickness in formulating responses to questions, clarity of the mind, choice of words, performing naming tasks, and constructing sentences. If a patient is seen within 3 months of a stroke, treatment is given every day; if the patient is seen between 3 and 6 months poststroke, treatment is given every second day. After sixteen treatments, the frequency may be reduced to once or twice per week, with a break of 2–3 weeks after 1 month. If treated early, a total cure rate of 35% and a marked improvement of a further 20% can be expected. Approximately 5% of patients will not respond. This compares with a total cure rate of 20% without treatment at 6 months.3 Perseverance is the key; even cases treated after months of neglect have shown improvement. In addition,
301 the patient may be given a Chinese herb, Jie Yu Dan (Relaxing Speech pill).
REFERENCES 1. Sun Y, Xue SA, Zuo Z. Acupuncture therapy on [sic] apoplectic aphasia rehabilitation. J Tradit Chin Med. 2012;32(3):314–321. 2. Li G, Yang ES. An fMRI study of acupuncture-induced brain activation of aphasia stroke patients. Complement Ther Med. 2011;19(suppl1):S49–S59. 3. Pedersen PM, Jorgensen HS, Nakayama H, Raaschou Ho, Olsen TS. Aphasia in acute stroke: Incidence, determinants, and recovery. Ann Neurol.1995;38(4):659–666.
Poovadan Sudhakaran, MBBS, PhD, MastACU, MastTCM 26 Tuckers Road, Templestowe, Victoria 3106 Australia E-mail: [email protected]
