Acupuncture plus Chinese Medicinal Fumigation and Washing for Edema of the Stroke-affected Limb

The Third Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou 310000, China

SPECIAL TOPIC STUDY

Acupuncture plus Chinese Medicinal Fumigation and Washing for Edema of the Stroke-affected Limb

Wu Bin

The Third Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou 310000, China

Author: Wu Bin, master of medicine, resident physician.

E-mail: liuazhena@163.com

Objective: To evaluate the therapeutic efficacy of acupuncture plus Chinese medicinal fumigation and washing in treating edema of the affected limb in post-stroke hemiplegia.

Methods: Two hundred patients with edema of the stroke-affected limb from our hospital were randomized into two groups according to their visiting sequence. In the observation group, 100 subjects were intervened by acupuncture plus Chinese medicinal fumigation and washing in addition to oral administration of diuretics, while the other 100 subjects in the control group were only given diuretics. The therapeutic efficacy was evaluated after successive 2-week treatments.

Results: The total effective rate was 90.0% in the observation group, significantly higher than 66.0% in the control group, indicating that there was a significant difference in comparing the overall therapeutic effect (P＜0.01).

Conclusion: Acupuncture plus Chinese medicinal fumigation and washing in addition to oral administration of diuretics is effective in treating edema of the affected limb in post-stroke hemiplegia.

Acupuncture Therapy; Steaming Washing Therapy; Acupuncture Medication Combined; Stroke; Complications; Hemiplegia; Edema

Edema of the stroke-affected limb is one of the common stroke-related complications, as stage Ⅰ of the post-stroke shoulder-hand syndrome, with the incidence approaching 12.5%-74.1%[1]. The edema is often occurs as a result of poor blood circulation or insufficient neurotrophy, manifested by edema of the affected limb, especially in the extremity. In severe cases, it may affect the rehabilitation training and prolong the disease duration[2]. From January of 2013 to April of 2014, I have treated edema of the stroke-affected limb with acupuncture plus Chinese medicinal fumigation and washing in addition to oral administration of diuretics. The report is given as follows.

1 Clinical Materials

1.1 Diagnostic criteria

By referring theStandard for Diagnosis and Therapeutic Effect Evaluation of Stroke(trial)[3]stipulated by the Collaborative Group of Acute Encephalopathy of State Administration of Traditional Chinese Medicine.

1.1.1 Diagnostic criteria for stroke

Chief symptoms: Hemiplegia, mental confusion, slurred speech or aphasia, hemiparesthesia, wry mouth and tongue.

Secondary symptoms: Headache, dizziness, alteration of pupil, choke by intake of water, loss of blink reflex, dystaxia.

Onset: Acute onset, usually with inducing factors and precursory symptom.

Affected age: Mostly over 40 years old.

The diagnosis is confirmed by ≥2 chief symptoms, or 1 chief symptom plus 2 secondary symptoms, associated with the onset, inducing factor, signal symptom, and age.

1.1.2 Diagnostic criteria for edema of stroke-affected limb

With a history of stroke and presenting symptoms of hemiplegia, accompanied by edema of the affected limb to different extent. The edema was classified into 3 levels according to the chief complaints.

Grade Ⅰ: Mild edema, tolerable, not affecting the motor function.

Grade Ⅱ: Moderate edema, comparatively severe, distending and uncomfortable, with limited motor function.

Grade Ⅲ: Severe edema, distending and intolerable, affecting the limb function.

1.2 Inclusion criteria

Conforming to the above diagnostic criteria; disease duration 1-6 months; in-hospital patients aged 40-75 years old; willing to participate the study and having signed the informed consent form.

1.3 Exclusion criteria

Against the above diagnostic or inclusion criteria; heart failure or respiration failure at acute stage; mental diseases; pregnant women or women during lactation; people with bad compliance.

1.4 Statistical analysis

The SPSS 17.0 version software was used for statistical analysis. The comparison of rate was performed by using Chi-square test.

1.5 General data

Two hundred patients with edema of the limb affected by post-stroke hemiplegia recruited from our hospital were randomized into an observation group and a control group by their visiting sequence, 100 in each group. There were no significant differences in comparing age, gender, disease duration or edema grade between the two groups (allP＞0.05), indicating the comparability (Table 1).

Table 1. Comparison of general data

2 Treatment Methods

2.1 Observation group

2.1.1 Western medication

Dihydrochlorothiazide 25 mg and Triamterene 50 mg, oral administration, twice a day.

2.1.2 Acupuncture

Point selection and operation for post-stroke hemiplegia were conducted according to theInternal Medicine of Traditional Chinese Medicine[4].

Acupoint: Yangxi (LI 5), Yanggu (SI 5), Zhigou (TE 6), Sanjian (LI 3), Zhongzhu (TE 3), and Taiyuan (LU 9) for upper limb; Fuliu (KI 7), Jiexi (ST 41), Yangfu (GB 38), Zhongfeng (LR 4), Taixi (KI 3), Zulinqi (GB 41), Xiangu (ST 43), and Taichong (LR 3) for lower limb.

Operation: After routine sterilization, the above points were treated by using filiform needles of 0.30 mm in diameter and 50-75 mm in length. The needles were retained for 15 min, while the needles were operated with wide-amplitude lifting-thrusting and twirling manipulations twice, within the patients’endurance, for enforcing the stimulation. The treatment was given once a day, 5 d as a treatment course, and courses were separated by a 2-day interval, for successive 2 weeks.

2.1.3 Chinese medicinal fumigation and washing

Composition:Gui Zhi(Ramulus Cinnamoni) 30 g,Xi Xin(Herba Asari) 6 g, preparedRu Xiang(Olibanum) 15 g, preparedMo Yao(Myrrha) 15 g,Niu Xi(Radix Achyranthis Bidentatae) 30 g,Su Mu(Lignum Sappan) 20 g,Mu Gua(Fructus Chaenomelis) 30 g, andXue Jie(Sanguis Draconis) 5 g.

Method: The herbs were put into 2 000 mL water and cooked gently for 15 min after boiled. Afterwards, the affected limb was fumigated and then washed by using the decoction with the herbs kept inside. Meanwhile, the patient can soak a tower in the decoction and then apply it to the affected limb. The treatment was given once a day, 5 d as a treatment course, with an interval of 2 d, for successive 2 weeks.

2.2 Control group

The control group was treated only by using the same Western medication at the same dosage as used in the observation group.

3 Therapeutic Efficacy

3.1 Observation indexes

Evaluation of edema according to the affected area: Topical area of single limb, single limb, and both upper and lower limbs respectively scored 1, 2, and 3.

Evaluation according to the degree of edema: According to the depression, cold and damp skin, influence on limb function, and the distending pain, the edema was evaluated as absence, mild, moderate, or severe, respectively scored 0, 1, 2, and 3.

The edema scores of the two groups were recorded according to the above scoring standard.

3.2 Criteria of therapeutic efficacy

The therapeutic index was calculated by using Nimodipine method[2].

Therapeutic index ＝ (Pre-treatment edema score－ Post-treatment edema score) ÷ Pre-treatment edema score × 100%.

Recovery: Edema was totally relieved, and the therapeutic index ≥85%.

Marked effect: The degree of edema was lowered, and the therapeutic index ≥50% but ≤84%.

Effective: The therapeutic index ≥20% but≤49%.

Invalid: The change of edema was not noticeable, and the therapeutic index ＜20%.

3.3 Results

There were no dropouts in the two groups. The total effective rate was 90.0% in the observation group, versus 66.0% in the control group, and the total effective rate of the observation group was significantly higher than that in the control group (P＜0.01).

Table 2. Comparison of therapeutic efficacy (case)

4 Discussion

The pathogenesis of edema of limb affected by post-stroke hemiplegia possibly involves the following factors[5]: dysfunction of nervous system due to disorders of cerebral cortex, e.g. diencephalon, frontoparietal, or temporal area, or reflex sympathetic dystrophy; injuries of cortex and subcortex or conduction tract, vasomotor paralysis; obstruction of venous reflux caused insufficient sport exercises in hemiplegia patients; leaking and infiltration of medicinal fluid during venous drops. Currently, the Western doctors mainly adopt rehabilitation trainings and diuretics for treatment via improving the function of vessels and promoting local blood circulation, but the results turn out not so satisfactory.

In traditional Chinese medicine, the edema of the affected limb in post-stroke hemiplegia falls under the scope of Bi-Impediment syndrome, caused by insufficient spleen-yang, deficient kidney-yang, accumulated dampness, or excessive body water[6]. Acupuncture and Chinese medicinal fumigation and washing can achieve distinctive effects in treating stoke and stroke-related edema[5-8].

The modern traditional Chinese medicine holds that acupuncture can trigger the autoregulation of the body via sending the stimulation to the central nervous system, and thus improve the microcirculation of the affected limb and alleviate the water[9]. In this study, Yangxi (LI 5), Yanggu (SI 5), Zhigou (TE 6) were selected for the affected upper limb, and Fuliu (KI 7), Jiexi (ST 41), Yangfu (GB 38), Taixi (KI 3), and Taichong (LR 3) were selected for the affected lower limb, for promoting the microcirculation, alleviate water retention, and finally reduce the edema symptoms.

Fumigation and washing therapy uses the hot decoction to fumigate and wash the skin or affected area, working to unblock the meridians, activate blood circulation and disperse stagnation, improve circulation, and promote rehabilitation[10].Gui Zhi(Ramulus Cinnamoni) andXi Xin(Herba Asari) function to warm meridians and relieve the cold and unblock collaterals; preparedRu Xiang(Olibanum), preparedMo Yao(Myrrha),Su Mu(Lignum Sappan), andXue Jie(Sanguis Draconis) can activate blood circulation and unblock stagnation, unblock collaterals and kill pain;Mu Gua(Fructus Chaenomelis) can relax tendons and unblock collaterals;Niu Xi(Radix Achyranthis Bidentatae) activates blood circulation and unblocks meridians, tonifies kidney to relieve water retention. The herbs work together to warm meridians and disperse the cold, activate bloodcirculation to unblock stagnation, reinforce spleen to relieve water. The current study showed that the patients in the observation group had significant relief of edema symptoms after receiving acupuncture and Chinese medicinal fumigation and washing, better than the effect showed in the control group. We can see that acupuncture plus Chinese medicinal fumigation and washing can activate blood circulation and unblock collaterals, relieve water retention, and promote limb function in treating patients with edema of the affected limb in post-stroke hemiplegia.

In a word, Chinese medicinal fumigation and washing can warm and unblock meridians and collaterals, and efficiently alleviate edema symptoms; while acupuncture evokes the regulation inside the body, harmonizing qi and blood, and alleviating edema. The two therapies together can achieve a content clinical efficacy, providing an effective treatment protocol in the treatment of edema due to post-stroke hemiplegia, worthy of further research and promotion.

Conflict of Interest

The authors declared that there was no potential conflict of interest.

Acknowledgments

This work was supported by the Third Affiliated Hospital of Zhejiang Chinese Medical University.

Statement of Informed Consent

All of the patients in the study signed the informed consent.

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Translator:Hong Jue

R246.6

: A

Date:May 20, 2014