Observation on Treatment of Dysphasiadue to Cerebrovascular Accident withElectroacupuncture at Shegen point
by Xiao Fei and Liu Wei
Dysphasia or aphasia is one of the most intractable Sequelae of cerebrovascular accident, and causes considerable suffering to patients. Improving thespeech function in post-CVA patients is a hard task forclinicians. The authors have tried various acupuncturemethods in treating dysphasia, such as scalp acupuncture,pricking with long filiform needles at Jinjin (Extra) andYuye (Extra), and electroacupuncture at Lianquan REN-23and Tongli HE-5. However, therapeutic results were notsatisfactory, After years of practice, the authors developeda method of electroacupuncture at the Shegen point andhave obtained a relatively good effect, in comparison to theabove approaches.
Non-disposable stainless steel filiform needles (28-30 gauge,15-100 mm in length) and an electrostimulator were used.The electrostimulator the authors used was the G-6805made in Shanghai.
70 patients suffering from dysphasia or aphasia secondaryto cerebrovascular disease were taken as study subjects. Ofthese, 12 had severe dysphasia (inability to say a singleword), 33 had moderate dysphasia (able to say single words),and 25 had mild dysphasia (able to say simple sentences).The duration of the illness ranged from 1 month to 6 months(mean: 2.3 months). Patients were divided randomly intotwo groups: the study group and the control group.
Routine acupuncture treatment method was applied toboth groups, using the following points:For paralysis of the upper limbJianyu L.I.-15Quchi L.I.-11Waiguan SJ-5Hegu L.I.-4For paralysis of the lower limbHuantiao GB-30Yanglingquan GB-34Xuanzhong GB-39Kunlun BL-60For paralysis of the faceDicang ST-4Jiache ST-6For dysphasia or aphasia, Shegen (an empirical point) andTongli HE-5 or Shaochong HE-9 were used in the studygroup, and Lianquan REN-23 and Tongli HE-5 were used in the control group.
Shegen point is the author’s empirical point, located at themost sensitive area in the root of the tongue. When electricallystimulated, it generates a forceful tic of the tongue. Its location and needling are introduced below:
Firstly a filiform needle, 25 mm in length which hasalready been connected to an electric stimulator (the passiveelectrode) was punctured into Tongli HE-5, 0.3-0.5 cun.If Shaochong HE-9 was used, the passive electrode wasfixed on the point with adhesive plaster. The stimulator wasturned on and the volume control knob turned up slightly.The other (negative) electrode was connected to a 75-100mm long filiform needle which was held against the mostsensitive point on the tongue root. The most sensitive areawas defined as the site where stimulation causes the tongueto contract the most forcefully. Note that the needle washeld against this area and did not penetrate the skin. Thenthe output volume of the electrostimulator was increased tothe level of maximum toleration of the patient. Needleswere retained for 30 minutes.Treatment was performed once a day. Fifty sessions constitutedone treatment course.
A. Remarkable effect: Speech was remarkably improved,e.g. from slurred speech to fluent, or from aphasia to sayingsimple sentences.B. Moderate effect: Speech improved, e.g. from slurredspeech to relatively fluent speech, or from aphasia to sayingsimple words.C. Ineffective: patients were not improved markedly aftertwo treatment courses.For those patients who responded, the therapeutic effectswere evaluated within a maximum period of four courses oftreatment.
ResultsThe therapeutic effects in both the study group and thecontrol group are listed in Table 1.
Table 1Comparison of effects between the two groupsComparing effects in the two groups, there is significant difference (P<0.01), suggesting that electroacupuncture at the point Shegen is better in improving speech than the routine method.The therapeutic effects analysed based on degrees of illness are listed in Table 2.
Table 2 Effect comparison between degrees of illness
Comparing effects in the three groups, there is a significant statistical difference between the mild and the moderategroups (P<0.05) and between the mild and the severe groups (P<0.01), and there is no statistical difference between the moderate and the severe groups (P>0.05). These results indicate that the milder the patient’s condition is, the better the effect of acupuncture.
Mr Zhang, a 56 year old official, was admitted into hospital on 21st September 1994 complaining of paralysis of the right side of his body and slurred speech for 2 months.He had suddenly developed paralysis of the right part of his body and moderate dysphasia on 17th July 1994. Examination by MRI at Shandong Medical University showed that there was a low density area about 1.5 x1.2 x 1cm in size. He was treated with both Western medicine and Chinese medicine and his limb function especially improved rapidly. His speech, however, did not improve significantly. Before he began acupuncture treatment it was difficult for him to say a sentence fluently, and stiffness of his tongue resulted in stammering speech.He was assigned to the study group and treated with the designated acupuncture protocol. After 25 treatments (one month) his speech became normal.
1. From a TCM perspective the tongue has a very close relationship with the zangfu and channels which explain show stimulating the tongue itself can have a therapeutic effect.
i. Concerning the zangfu, the Heart controls the tongue and the tongue serves as the outer orifice of the Heart. Since the Heart dominates mental activities, only if the Heart functions well can the tongue move flexibly and the speech be fluent. In cases of dysfunction of the Heart there may be dysphasia, aphasia and stiffness of the tongue. Therefore,stimulating Shegen point can improve the Heart function of dominating speech.
ii. Concerning the channels, the tongue has a close relation with various channels and collaterals. Some terminate directly at the tongue, such as the Spleen primary and divergent channels, the Kidney channel and the Heart luo connecting channel, and some (more than 10) reach the vicinity of the tongue, such as the Stomach, Heart, Liver,Du, Ren and Chong channels.
2. From a Western medicine perspective, the function of the speech is controlled by the brain and implemented by the co-ordinated contraction of the pharynx, the palate, the tongue and the lips. The hypoglossal nerve distributed in the back of the tongue controls movement of the tongue.Firstly, electroacupuncture at the point Shegen can stimulatethe hypoglossal nerve and bring about contraction of the muscles of the tongue. Subsequently, the motor function as well as the nutritional condition of the tongue are improved. Secondly, since the tongue root is close to the throat, electroacupuncture at the tongue root can influence the organs affecting speech. Besides, the tongue as a very nimble organ possesses a relatively large reflection area inthe cerebral cortex, so stimulating the Shegen point can exert a strong regulatory action on the cerebral function.
Compared with other methods, electroacupuncture at Shegen point has the characteristics of being simple to perform, bringing about less suffering and better therapeutic effects. The author ’s initial observation also showed that it is not only effective for dysphasia and aphasia resultingfrom cerebrovascular accident but also effective for ischaemicheart disease and angina pectoris.
Xiao Fei works at the Affiliated Hospital of Shandong Collegeof Traditional Chinese Medicine, and Liu Wei at Jinan MunicipalTCM Hospital, China.