Acupuncture therapy on apoplectic aphasia rehabilitation

Online Submissions:http://www.journaltcm.com [email protected]

J Tradit Chin Med 2012 September 15; 32(3): 1-2 ISSN 0255-2922 © 2012 JTCM. All rights reserved.

REVIEW

Acupuncture therapy on apoplectic aphasia rehabilitation

Youzhi Sun, Steve An Xue, Zhengyun Zuo aa Youzhi Sun, The School of Chinese Medicine, The University of Hong Kong, Hong Kong, China; Jiangxi University of Traditional Chinese Medicine, Nanchang 330004, China Zhengyun Zuo, Jiangxi University of Traditional Chinese Medicine, Nanchang 330004, China Steve An Xue, IM International Health Management Ltd., Shenzhen 518000, China Correspondence to: Prof. Youzhi Sun, The School of Chinese Medicine, The University of Hong Kong, Hong Kong, China. [email protected] Accepted: July 18, 2011

puncture. Tongue bleeding, deep insertion and strong stimulation were adopted by many practitioners. The ten most frequently used acupoints (or areas) were Lianquan (RN 23), Jinjin (EX-HN 12), Yuye (EX-HN 13), Tongli (HT 5), Fengchi (GB 20), Neiguan (PC 6), Baihui (DU 20), No. 1, 2 and 3 language sections, Sanyinjiao (SP 6) and Yamen (DU 15). CONCLUSIONS: Controlled clinical studies and a systematic literature review demonstrate that acupuncture has therapeutic effects on aphasia after stroke. © 2012 JTCM. All rights reserved.

Abstract OBJECTIVE: Acupuncture has often been used for aphasia rehabilitation in China. The purpose of this paper was to: 1) provide a historic overview of acupuncture for aphasia due to stroke; 2) summarize the commonly used acupuncture approaches; and 3) objectively comment on the effectiveness of acupuncture for the rehabilitation of this type of disorder.

Key words: Acupuncture therapy; Poststroke syndrome; Anomia; Rehabilitation

INTRODUCTION Aphasia is an acquired language disorder in which language modalities are impaired. The disorder usually results from lesions in the language-relevant areas of the frontal, temporal and parietal lobes of the brain and the neural pathways between them, and may include difficulty in producing or comprehending spoken or written language. Stroke is a common cause of damage to these areas that leads to aphasia. According to some reports,1,2 about 1/3 stroke survivors suffer speech or language disorders, and 30%-42% of these patients have long-term aphasic symptoms; as a result, they often need long-term care, which is a major burden for all involved. Currently, speech-language therapy is considered the most effective method for the management of aphasia and is used by most therapists. Acupuncture has also been widely used for this type of disorder in China, in both ancient and modern times. In the past few de-

METHODS: The Elsevier database and a Chinese database (CNKI) were searched through December, 2010 with the key words "aphasia, acupuncture" in English and Chinese, respectively. Case reports, uncontrolled clinical observations and controlled clinical trials were all included if acupuncture was the sole treatment or the main component of complex intervention for the rehabilitation of aphasia caused by cerebrovascular disease. RESULTS: More than 100 relevant articles were found. After analyzing these articles, we found that acupuncture for apoplectic aphasia most often included tongue, scalp, body and combination acuJTCM | www. journaltcm. com

314

September 15, 2012 | volume 32 | Issue 3 |

Sun YZ et al. Acupuncture therapy on apoplectic aphasia rehabilitation cades, many clinical observations and trials of acupuncture for post-stroke aphasia have been conducted, aimed at determining whether this technique can aid in decreasing recovery time or increasing the degree of recovery. Although several general reviews3-7 of the effects of acupuncture on apoplectic aphasia are available, all of them summarize articles published within only a limited period of time, and most of have duplicate contents. The objective of the present paper is comprehensively to review the history of the development of acupuncture for apoplectic aphasia, to summarize frequently utilized acupuncture methods (e.g. acupuncture points or areas and manipulation) and objectively to evaluate the effectiveness of acupuncture for post-stroke aphasia rehabilitation.

similar content conducted by same authors were excluded. Data extraction All articles were read fully and relevant data were collected and analyzed in terms of the characteristics of the content and the acupuncture methods used, including acupuncture points or areas and manipulation.

RESULTS General information One hundred and four relevant articles published during last three decades were identified. Most of the articles published in the early part of this period were case studies, whereas those published during last two decades were mainly clinical observations or controlled clinical trials (Figure 1). The first article about acupuncture treatment of post-stroke aphasia was published by Jiwen, who claimed to have cured a 55-year-old woman with aphasia after cerebral infarction within one month by puncturing Yongquan (KI 1) with strong stimulation.8 Subsequently, case reports9,10 of different acupuncture methods for aphasia related to cerebrovascular disease were also published. Lizhong11 published the first clinical observation, in which nine patients with aphasia resulting from cerebral infarction or cerebral hemorrhage were treated with acupuncture; most experienced different levels of recovery. At the same time, the first controlled clinical trial12 showed that acupuncture was equally or more effective than other techniques in aiding recovery from aphasia. In this study, 75 participants with acute cerebral infarction were involved, 45 of which had various types of unspecified aphasia. The subjects were divided into three groups that received acupuncture, VNRT (an undefined pharmacologic agent) or vitamin B. Up to 73% of the acupuncture group, 70% of the VNRT group and 33% of the vitamin B group were described as being essentially cured (disappearance of hemiplegia and aphasia) or markedly improved (hemiplegia and aphasia obviously improved).

METHODS Data sources A Chinese database (CNKI) was searched from its inception through December, 2010 with the key words "acupuncture, aphasia and (stroke or apoplectic or cerebrovascular attack or cerebrovascular accident or cerebrovascular* or cerebral infarction or cerebral hemorrhage or cerebral*)" in Chinese. Relevant articles in the Elsevier database were also searched with the same key words in English. Soft copies of all articles were obtained and read in full.

Amount of Published Articles

Study selection More than 360 relevant articles were retrieved. Case reports, clinical observations and prospective clinical trials that utilized acupuncture as the main therapy for post-stroke rehabilitation were all selected to review the history of acupuncture for apoplectic aphasia and to summarize the methods that have been adopted. Only controlled clinical studies with clear diagnostic and evaluation criteria and employing acupuncture as the sole treatment or an adjunct to speech-language therapy were selected to assess the effectiveness of acupuncture for apoplectic aphasia rehabilitation. Those with

Figure 1 Numbers of relevant articles published in different periods CRs: clinical reports; UOSs: uncontrolled observational studies; CCTs: controlled clinical trials JTCM | www. journaltcm. com

315

September 15, 2012 | volume 32 | Issue 3 |

Sun YZ et al. Acupuncture therapy on apoplectic aphasia rehabilitation Figure 1 demonstrates that research on the use of acupuncture to treat apoplectic aphasia made great progress in terms of quantity and quality in the last two decades. Thirty-three relevant articles were published between 1991 and 2000, whereas from 2001 to 2010 the number almost doubled, rising to 65. Moreover, more scientific designs were utilized and more participants were involved in these studies. From 1991 to 2000, eight controlled trials were performed, including three randomized controlled trials, whereas 39 controlled trials were conducted between 2001 and 2010, of which 34, or almost 90% , were randomized. Dozens of subjects were involved in almost all studies, and some studies even recruited hundreds of subjects.13-17 Acupuncture approaches for apoplectic aphasia Tongue acupuncture, scalp acupuncture and body acupuncture, or combinations of two or even three of these, with the exception of combined scalp and body

Amount of Related Articles

acupuncture, were frequently used (Figure 2). The probable reason why integrated scalp and tongue acupuncture was rarely used might be the difficulty of performing these two types of manipulation at the same time. Selection of appropriate acupuncture points (or areas) plays an important role in achieving a good therapeutic effect. Although various acupoints were selected by different therapists for apoplectic aphasia, Lianquan (RN 23), Jinjin (EX-HN 12), Yuye (EX-HN 13), Tongli (HT 5), Fengchi (GB 20), Neiguan (PC 6), Baihui (DU 20), No. 1, 2 and 3 language sections, Sanyinjiao (SP 6), Yamen (DU 15), Zusanli (ST 36) and Shanglianfquan (LI 9) were most frequently utilized (Table 1). Different acupuncturists tended to adopt different procedures, but tongue bleeding was generally considered to be an effective manipulation and was widely applied.18-27 Electronic acupuncture28-35 and strong stimulation34,36-38 were also recommended.

Figure 2 Use of different acupuncture approaches TA: tongue acupuncture; SA: scalp acupuncture; BA: body acupuncture

aphasia was most commonly used. Reviewing the relevant articles,26,34,36,48-50 we found that most acupuncturists utilized No. 1 language section for motor aphasia, No. 2 for anomic aphasia, No. 3 for sensory aphasia, and No. 1 combined with No. 2 for mixed aphasia. Some practitioners29,32,34,35 connected needles left in place with low frequency electric waves to increase the rehabilitation effect on different regions of the cerebral cortex. Furthermore, some innovative scalp acupuncture approaches have been introduced in the last 10 years. Ganghui51,52 and colleagues punctured around the area of the scalp shown by CT to correspond to the focus of aphasia due to stroke, and found that this new method had a better therapeutic effect than traditional scalp acupuncture (i.e. acupuncture of No. 1, 2 and 3 language sections). A similar method was employed by Hongying,53 who used CT or MRI to define the area of projection of the focus on the scalp and punctured this area from four directions (front, rear, left and right) toward the center with one needle each. Cluster-needling stimulation, another new method in which scalp acupoints are punctured intensively within a limited area or along a certain line, was also applied recently.54-56 Wei15 and Xiuli57 adopted an approach in which catgut

Tongue acupuncture As mentioned above, swift pricking to cause bleeding was the most frequently used approach for tongue acupuncture. Most acupuncturists39-41 did not leave the needle in place and used acupoints beneath the tongue, such as Jinjin (EX-HN 12) and Yuye (EX-HN 13), to manage aphasia after acute stroke. In contrast, others20, 25 punctured the surface of the tongue. Both obtained good therapeutic effects. Horizontal and deep puncturing approaches were also commonly used to aid recovery from apoplectic aphasia. Horizontal puncture refers to piercing the tongue from one side to the other;39,42,43 deep puncture uses long needles punctured deep toward the root of the tongue from acupoints at the tip42, 44 or sides43,44 or from beneath16,37,45,46. In addition, special procedures were also applied by some acupuncturists. For instance, Cuiping47 used "Guan's tongue acupuncture" as the main measure for patients with apoplectic aphasia. Scalp acupuncture Several scalp acupuncture methods have been applied for the rehabilitation of apoplectic aphasia. Puncturing of different language sections according to the type of JTCM | www. journaltcm. com

316

September 15, 2012 | volume 32 | Issue 3 |

Sun YZ et al. Acupuncture therapy on apoplectic aphasia rehabilitation was buried under the Baihui (DU 20) acupoint and No. 1, 2 and 3 language sections, also with good therapeutic effect.

and others19,28,75-78 tended to use all three together. Additionally, it was noted that speech-language therapy, a widely recognized treatment for aphasia in Western medicine, was increasingly used by TCM practitioners, and increasing numbers of acupuncturists25,33,49,53,55,56,79,80 are integrating acupuncture therapy with language training for the treatment of aphasia caused by cerebral diseases.

Body acupuncture Two types of body acupuncture were commonly used for treating aphasia after stroke. In the first, the acupuncturist selected appropriate acupoints based on his clinical experience. For instance, the Xingnaokaiqiao (inducing resuscitation) therapy developed by Xuemin,58 principally punctured the Neiguan (PC 6), Sanyinjiao (SP 6) and Shuigou (DU 26) acupoints.59-62 Various other acupoints have been selected by different acupuncturists. Yuhua63 and colleagues selected Juque (RN 14), combined with Neiguan (PC 6) and Renzhong (DU 26); Yanhong64 punctured Lianquan (RN 23) deeply (to 2 cun) with a long needle to treat a patient with aphasia due to stroke and obtained a good therapeutic effect; Taiyuan (LU 9), Taixi (KI 3), Shanglianqian (LI 9) and Zusanli (ST 36) were selected by Fengying;65 Yamen (DU 15), Fengfu (DU 16) and Xianaohu (DU 17), located along the Governor Vessel Meridian, were punctured by Fei66 with a warming needle to treat aphasia caused by cerebral diseases; and Hong67 punctured Fengchi (GB 20), Neiguan (PC 6), Sanyinjiao (SP 6), Fenglong (ST 40), Taichong (LI 3), Fengfu (DU 16), Yamen (DU 15), Lianquan (RN 23) and Qihai (RN 6) to treat aphasia caused by cerebral infarction. In the second approach, acupoints were selected by differentiation (a comprehensive analysis of all symptoms to determine the patient's syndrome according to traditional Chinese medicine (TCM)). This was frequently used to increase the therapeutic effect of scalp or tongue acupuncture.19,68-72 These acupuncturists usually chose certain acupoints for initial puncturing, then punctured other acupoints on the basis of the patient's syndrome. Although diverse acupoints were selected by different therapists, particular acupoints were often adopted for certain syndromes. Fenglong (ST 40) , for example, was always punctured in patients with the syndrome of up-attacking of wind-phlegm; Taixi (KI 3) and Fuliu (KI 7) were often used for kidney deficiency syndrome; Taichong (LI 3) was frequently utilized for the syndrome of hyperactivity of liver yang; Zusanli (ST 36) was applied for the syndrome of insufficiency of Qi and blood; and Xuehai (SP 10) was usually punctured to remove blood stasis.

Table 1 The most frequently used acupuncture points (or areas) Number of relAcupuncture point Location of evant articles (or area) acupuncture 21 Baihui (DU 20) No.1, 2 and 3 language 21 Head sections Sishencong (EX-HN1)

Neck

Limbs and trunk

31 41

Fengchi (GB 20)

25

Yamen (DU 15)

20

Shanglianquan (LI 9)

12

Fengfu (DU 16)

8

Tongli (HT 5)

27

Neiguan (PC 6)

22

Sanyinjiao (SP 6)

20

Shuigou (DU 26)

16

Fenglong (ST 40)

14

Zusanli (ST 36)

14

Taichong (LI 3)

13

Hegu (LI 4)

10

Quchi (LI 11)

9

Taixi (KI 3)

9

Yongquan (KI 1)

5

Zhaohai (KI 6)

5

Efficacy of acupuncture for aphasia due to stroke Although acupuncture is widely utilized for the rehabilitation of aphasia due to stroke, its effectiveness remains unclear due to issues related to experimental design. For example, standardization of entry criteria (acute vs. chronic) and quantitative measures of language, cognitive or motor speech skills were not adopted in most of the clinical studies mentioned above. Nevertheless, some controlled clinical studies with objective measurements and large sample sizes show that acupuncture had a positive therapeutic effect. Several controlled clinical studies with large sample sizes22,27,31,38,74,81 were conducted to investigate the therapeutic effect of various acupuncture therapies. In these studies, patients with aphasia due to stroke were usually randomly divided into two groups receiving two different acupuncture therapies and their language ability scores were assessed using the Chinese Language Test of Aphasia82 before and after treatment. The results show that either therapy could significantly raise patients' language ability score.

Combination therapy In recent years, the simple therapies mentioned above were rarely used as sole treatments for aphasia after stroke; increasingly, therapists prefer to combine two or three of these methods. As shown in Figure 2, combinations of therapies were common, except for scalp plus tongue acupuncture. Some acupuncturists21,31,36,73 combined scalp with body acupuncture, some22,39,60,74 preferred to integrate tongue and body acupuncture, JTCM | www. journaltcm. com

Jinjin and Yuye (EX-HN12; EX-HN13) Lianquan (RN 23)

Tongue

5

317

September 15, 2012 | volume 32 | Issue 3 |

Sun YZ et al. Acupuncture therapy on apoplectic aphasia rehabilitation Many clinical research studies have confirmed acupuncture to be an effective adjuvant therapy to language training in the management of apoplectic aphasia. For instance, Jiao et al.61 conducted a randomized controlled clinical trial to observe the effect of Xingnao Kaiqiao acupuncture plus language rehabilitation training for motor aphasia caused by cerebral infarction. In their study, 90 patients with motor aphasia, 15-90 days after cerebral infarction, were randomly divided into an acupuncture plus language training group, an acupuncture alone group and a language training group, with 30 patients in each. The patients' aphasia quotient (AQ), four basic speaking functions (spontaneous speech, auditory verbal comprehension, repetition and object naming) and communicative ability in daily life (CADL) were evaluated with the Western Aphasia Battery before and after treatment. After five days' treatment, AQ, CADL and scores for all four basic speaking functions were significantly improved in all three groups (P<0.05 or P<0.01). Compared with the language training group, the AQ, CADL and spontaneous speech, repetition and object naming were significantly improved in the acupuncture plus language training group (P<0.05 or P<0.01). Scores for CADL, repetition and object naming were also significantly increased in the acupuncture alone group (P<0.05). Weiping, et al.25 observed the therapeutic effects of tongue acupuncture combined with language training on motor aphasia induced by ischemic apoplexy. Using a table of random digits, they divided 60 subjects, within half a year of onset, into a tongue acupuncture (swift pricking at the surface of the tongue to cause bleeding) with language training group and a control group treated with simple language training (including speech organ training, mouth shape and voice training, spoken language expression training and practical communication ability training). The Aphasia Battery of Chinese (ABC) was used to evaluate the patients' language ability before and 30 days after treatment. The scores for the ABC items, including information content, speech fluency, repetition, vocabulary denomination, color naming, response denomination, confirmation or negation, acoustic recognition and carrying out instructions, were significantly increased in the treatment group compared with the control group (P< 0.05). Similar studies26,33,48,53,56,80,83 were performed to investigate the effect of scalp acupuncture (or electronic scalp acupuncture or a combination of scalp and body acupuncture) plus language rehabilitation training; all of their results demonstrate that the combined therapy was more effective than simple language training in improving basic language skills such as spontaneous speech, auditory comprehension, repetition, object naming and communication ability. To obtain a more accurate and objective evaluation of the therapeutic effect of acupuncture for apoplectic aphasia, Yong et al.7 performed a systematic review of the relevant randomized controlled trials using CoJTCM | www. journaltcm. com

chrane systematic assessment methods (extracting qualified data and conducting meta-analysis). The results indicate that there was a statistically significant difference between acupuncture and language training in terms of cure rate; acupuncture combined with language training was statistically superior to language training alone, supporting the conclusion that acupuncture (or acupuncture combined with language training) is effective for aphasia due to apoplexy. However, the authors pointed out that the quality of the included literature was low, and suggested that more randomized controlled trials of high methodological quality needed to be conducted. With regard to the efficacy of different acupuncture therapies, many of the reviewed studies22,27,31,74,81 demonstrate that combination acupuncture therapies were more effective than simple body acupuncture in improving language ability. A randomized controlled clinical trial with 160 participants performed by Ming32 indicated that electronic scalp acupuncture therapy was more useful than body acupuncture, and another study38 with 62 participants showed that tongue acupuncture was more effective than body acupuncture. The mechanism of the effect of acupuncture for aphasia due to stroke Possible mechanisms of the effect of acupuncture on apoplectic aphasia were also explored. Shengxiu[84] found that puncturing scalp acupoints increased the amount of cortical blood flow and thereby improved cortical hypoxia, resulting in functional recovery of the cortex. Puncturing scalp acupoints also facilitated the establishment of collateral circulation in the affected part and the reconstruction of neural pathways. Hongxing and Tangfa85 confirmed that scalp acupuncture regulated the neuroendocrine system and the systolic and diastolic functions of blood vessels through stimulating the cerebral cortex to reduce the amount of plasma endothelin released by nerve and endothelial cells, improving blood flow in the affected parts and aiding the functional recovery of brain cells, thereby promoting language rehabilitation. Xinsheng and colleagues86 discovered that acupuncture significantly improved most hemorheology indices in patients with aphasia after acute stroke, suggesting that lowering of blood viscosity might be a possible mechanism. Weihong et al.40 found that tongue acupuncture shortened the latency times of N2 and P3 waves in P300 and increased the amplitude of P3. N2 and P3, as components of the event-related potential (an electrical physiological index reflecting high-grade mental activity), are closely related to the recognition and processing of certain stimuli in the brain. These authors inferred that acupuncture might accelerate the classification, coding and discrimination of external signals in the brain, influence the strength of processing perception and reduce the time taken for processing, thereby improving overall ce318

September 15, 2012 | volume 32 | Issue 3 |

Sun YZ et al. Acupuncture therapy on apoplectic aphasia rehabilitation rebral function including speech and linguistic function. Li'an and colleagues87 also considered shortening of the latency time of P300 to be a possible mechanism of the effect of Xingnao Kaiqiao acupuncture for aphasia in the early stage of stroke.

10 11

12

DISCUSSION Acupuncture therapy for aphasia caused by stroke made significant progress in the past two decades. Various approaches were developed and their efficacy was confirmed. Combination acupuncture therapy and the combination of acupuncture with language training had the best curative effect. Increased cerebral blood flow and shortening of the P300 latency time are possible mechanisms. However, we should be aware of the possible flaws and limitation of the above studies. For example, the duration of study, intensity of treatment, standardization of entry, reliability of measurements, and acupoints and procedures used differed between researchers, which prevents solid conclusions and limits generalization. Additionally, few studies compared the effectiveness of different acupuncture therapies for a particular type of aphasia, or of one acupuncture therapy for different aphasia types. For this reason, it is unknown which types of aphasia benefit most from which types of acupuncture therapy. To resolve these problems, it will be necessary to conduct multicenter clinical trials with rigorous design, the same duration and intensity of treatment, standardized entry criteria, quantitative measures, and standardized acupoints and procedures.

13

14

15

16

17

18 19

20

21

REFERENCES 1

2

3

4

5

6 7

8 9

Stegmayr B , Asplund K, Wester PO. Trends in incidence, case-fatality rate and severity of stroke in northern Sweden. Stroke 1994; 25(9): 1734-1745. Laska AC, Hellbolm A, Murray V, et al. Aphasia in acute stroke in relation to outcome. J Int Med 2001; 249(5): 413-422. Wang XZ, Gong HT, Wang HJ. Review of research on apoplexy aphasia in Traditional Chinese medicine. Beijing Zhong Yi Yao Da Xue Xue Bao 1996; 19(1): 6-9. Feng YG, Zhang ZJ. Research advances of treatment of apoplexy aphasia in acupuncture. Zhen Jiu Lin Chuang Za Zhi 2003; 19(4): 58-59. Fang W. Overview of apoplexy aphasia treated by acupuncture therapy at last ten decades. Gansu Zhong Yi 2007; 20(2): 4-6. Gao FX. Clinical research advances of acupuncture treatment for aphasia. Xin Zhong Yi 2007; 39(6): 102-103. Pang Y, Wu LB, Liu DH. Acupuncture therapy for apoplectic aphasia: a systematic review. Zhongguo Zhen Jiu 2010; 30(7): 612-616. He JW. Two cases of aphasia treated by acupuncture. Hubei Zhong Yi Za Zhi1983; (4): 41. Cai XM. Experience of treating aphasia with acupuncture.

JTCM | www. journaltcm. com

22

23

24

25

26

27 28

319

Chongqing Yi Xue 1984; 13(5): 38. Xiao SQ. Four cases of clinical practice with acupuncture. Tianjin Zhong Yi Yao 1988; (5): 42. Wu LZ. Acupuncture for treating 9 cases of aphasia due to cerebral diseases. Zhongguo Kang Fu Yi Xue Za Zhi 1988; 3(1): 34. Chan JF, Ye MF, Wei J. Hemorrheological study on the effect of acupuncture in treating cerebral infarction. J Tradit Chin Med 1988; 8(3): 167-172. Li SB, Meng QL, Li PJ. Clinical observation on 240 cases with aphasia due to cerebral diseases treated by scalp acupuncture combined with body acupuncture. Zhen Jiu Lin Chuang Za Zhi 1996; 12(12): 15. Li LM, Li YQ, Zhang LF. 155 cases with aphasia due to stroke treated by electronic acupuncture. Zhen Jiu Lin Chuang Za Zhi 1998; 14(2): 25-26. Jiao W, Fan JM. Observation on effect of burying catgut under scalp acu-points for 317 post-stroke cases of aphasia. Jiangsu Zhong Yi Yao 1999; 20(4): 27. Bai YL. Clinical observation on 300 cases with aphasia due to cerebrovascular accident treated by tongue acupuncture. Beijing Zhong Yi 1999; (2): 47. Zhang YH. 208 apoplexy aphasia cases treated by the method of Tongguankaiqiao. Xian Dai Zhong Xi Yi Jie He Za Zhi 2008; 17(12): 870. Dong YP. 130 apoplexy aphasia cases treated by pricking therapy. Beijing Zhong Yi 1994; 13(4): 58. Li ZJ. 45 apoplexy aphasia cases treated by the combination of body acupuncture and scalp acupuncture. Sichuan Zhong Yi 2001; 19(7): 75. Meng FX, Ma ZL. 19 apoplexy aphasia cases treated by tongue acupuncture. Shi Yong Zhong Yi Yao Za Zhi 2003; 19(10): 540. Ye LP, Zheng XB, Zhang CT, Song HF. Clinical observation and nursing of patients with aphasia after apoplexy treated with pricking blood therapy. Zhong Yi Yan Jiu 2005; 23(7): 1332-1337. Liao JF. 52 cases with motor aphasia after stoke treated by pricking Jinjin and Yuye acu-points. Zhen Jiu Lin Chuang Za Zhi 2007; 23(5): 35-36. Ding ZL, Gao L, Gu SZ. Effect of the combination of acupuncture and Chinese medicine in treating aphasia in patients of acute ischemic stroke. Zhong Yi Yao Xin Xi Za Zhi 2007; 14(5): 12-14. Xin X, Xu QY. 30 cases with motor aphasia after stroke treated by acupuncture. Shaanxi Zhong Yi Yao Za Zhi 2008; 29(5): 595-596. Luo WP, Huang HY, Zhu JY. Acupuncture combined with language training for treatment of motor aphasia caused by ischemic apoplexy. World J Acup Moxib 2008; 18(4): 9-16. Zhuang HJ. Treatment of aphasia caused by acute stroke by scalp and body acupuncture therapies combined with language training. Zhen Jiu Lin Chuang Za Zhi 2010; 26 (9): 27-28. Li ZY, Wu YJ. Observation on effect of bleeding therapy for apoplexy aphasia. Yi Xue Xin Xi 2010; (8): 2053. Li LM. 125 cases of apoplexy aphasia treated by puncturing three acu-points beneath tongue. Gansu Zhong Yi Xue Yuan Xue Bao 1996; (8): 54-55. September 15, 2012 | volume 32 | Issue 3 |

Sun YZ et al. Acupuncture therapy on apoplectic aphasia rehabilitation 29

30

31

32

33

34

35

36

37 38

39

40

41

42 43 44

45

46 47

48

Han BJ. Clinical observation on effect of scalp acupuncture and electronic acupuncture for treating apoplexy aphasia. Tianjin Zhong Yi Yao 2000; 17(5): 31. Liu LA, Mou S, He X, Li SZ. Clinical observation of electronic scalp acupuncture combined with language training for treating apoplexy aphasia. Zhongguo Zhen Jiu 2000; 20(3): 145-148. Wang SX, Yang CB. Clinical observation on effect of scalp acupuncture treating 50 post-stroke aphasia cases. Xin Zhong Yi 2001; 33(9): 47. Sun M. Clinical observation on effect of scalp acupuncture pricking on language section treating 100 apoplexy aphasia cases. Zhen Jiu Lin Chuang Za Zhi 2004; 20(8): 29. Zhang XL, Wang AP, Zhang JR. Clinical study of aphasia after acute stroke treated by electronic stimulation. Shi Yong Shen Jing Ji Bing Za Zhi 2005; 8(1): 16-17. Qian BY, Cao LS. Fifty-six cases of stroke aphasia treated with scalp acupuncture in combination with XNKQ (awaken and enlighten one's mind) therapy. World J Acup Moxib 2008; 18(1): 65-68. Li J. Clinical observation on effect of electronic acupuncture in combination with scalp acupuncture treating 45 aphasia cases due to cerebral diseases. Shanxi Yi Xue Za Zhi 2005; 34(11): 993-994. Wu ZJ, Li JQ. 72 cases with aphasia due to verebrovascular diseases treated by acupuncture. Shanghai Zhen Jiu Za Zhi 1997; 16(2): 19. Wang H. Apoplexy aphasia treated by under tongue acupuncture. Zhongguo Min Jian Liao Fa 2003; 11(12): 15. Li ZP, Li Y, Fu WB. Clinical observation of 32 apoplexy aphasia cases treated with tongue acupuncture. Xin Zhong Yi 2004; 36(9): 47-48. Yang YY, Han LX. 150 cases with aphasia after stroke treated by horizontal puncturing the tongue. Shanghai Zhen Jiu Za Zhi 1996; 15(3): 105. Wang WH, Zhang ZZ. 19 cases with aphasia due to acute stroke treated by tongue acupuncture. Xian Dai Kang Fu 2000; 4(11): 19. Lin YG, Men YS. 36 caese with apoplectic aphasia treated by puncturing Jinjin and Yuye. Jiangsu Zhong Yi Yao 2001; 22(3): 25. Ye XX. 15 cases with apoplexy aphasia treated by tongue acupuncture. Shanghai Zhen Jiu Za Zhi 1997; 16(6): 29. Tian CW. 186 cases with speech disability treated by puncturing tongue. Zhongguo Zhen Jiu 1992; 12(5): 9. Dong JF. 100 cases with language impairment after stroke treated by SheSanZhen. Zhen Jiu Lin Chuang Za Zhi 1996; (1): 18. Shao FY, Chen LP. Observation on the effect of the treatment of tongue acupuncture and language training for apoplexy aphasia. Zhen Jiu Lin Chuang Za Zhi 1997; 13(1): 19-20. Wang P, Huang Y. 30 cases with apoplexy aphasia treated by tongue acupuncture. Jiangsu Zhong Yi Yao 1999; 20(2): 40. Guo CP. 56 cases with apoplexy aphasia treated by "Guan's tongue acupuncture". Zhongguo Zhen Jiu 2008; 28(2): 127-128. Tian YC. Observation on the effect of acupuncture for aphasia after stroke. Xian Dai Zhong Xi Yi Jie He Za Zhi

JTCM | www. journaltcm. com

49

50

51

52

53

54

55

56

57

58

59

60

61

62

63

64

65

66

320

2006; 15(8): 1049. Xie L. Clinical observation of 56 cases with aphasia treated by scalp acupuncture in combination with language training. Zhongguo Min Jian Liao Fa 2007; 15(3): 52. Li HZ. Observation on the effect of scalp acupuncture in combination with function training for apoplexy aphasia. Zhong Xi Yi Jie He Xin Nao Xue Guan Bing Za Zhi 2010; 8(5): 553-554. Jiang GH, Li YH, Chen ZH. Clinical observation on surrounding needling under CT location for treatment of aphasia due to apoplexy. Zhongguo Zhen Jiu 2001; 21(1): 15-16. Jiang GH, Xu XY, Chen ZH, He J, Liao MX. Clinical study on surrounding needling under CT location for treatment of aphasia due to apoplexy. Shandong Zhong Yi Yao Za Zhi 2009; 28(8): 555-556. Huang HY. Effect of scalp acupuncture combined with speech therapy on ischemic stroke. Zhongguo Kang Fu Li Lun Yu Shi Jian 2009; 15(12): 1180-1182. Wang Y. The effect of cluster-needling in combination with language training on the language ability of motor aphasia patients. Zhong Yi Yao Xue Bao 2002; 30(4): 19. Liu Y, Zhang LG, Mao SZ. The TCM-combined treatment for aphasia due to cerebrovascular disorders. J Tradit Chin Med 2006; 26(1): 19-21. Zhang HM. Clinical treatment of apoplexy aphasia with multi-needle puncture of scalp-points in combination with visual-listening speech training. Zhen Jiu Yan Jiu 2007; 32(3): 190-191. Guo XL. Observation on treatment of burying catgut under Baihui acu-points for 116 cases of aphasia due to stroke. Zhong Hua Zhong Yi Yao 2001; 16(3): 78. Shi XM. Stroke and the acupuncture method of Xing Nao Kai Qiao. Tianjin: Tianjin Science and Technology Press, 1998. Wang LQ, Wang JW. Clinical observation of the treatment of Xingnao Kaiqiao acupuncture for apoplexy aphasia. Guangxi Zhong Yi Yao 2002; 25(4): 24-25. Zhou B, Xie MD. Clinical observation of 72 patients with apoplectic aphasia treated by Xingnao Kaiqiao therapy. Shanghai Zhong Yi Yao Za Zhi 2004; 23(1): 9-10. Mou J, Fu LX, Lu YM, Ren YL, H JY, Qi YZ. Clinical observation on the Xingnao Kaiqiao acupuncture plus language rehabilitation training for motor aphasia caused by cerebral infarction: A report of 30 cases. J Tradit Chin Med 2010; 51(5): 428-431. Li J. 30 cases of aphasia due to stroke treated by Xingnao Kaiqiao acupuncture. Henan Zhong Yi 2010; 30(6): 598-599. Chen YH, Zhao B, Sui QZ. The treatment of apoplexy aphasia with puncturing Juque acu-point. Shandong Zhong Yi Yao Za Zhi 1992; 11(5): 46. Liu YH. The treatment of deep puncturing Lianquan acu-point with long needle. Sichuan Zhong Yi 1996; 14 (4): 54. Wei FY. 36 cases of apoplexy aphasia treated by mainly puncturing Taiyuan and Taixi acu-points. Zhongguo Zhen Jiu 1999; 19(5): 287. Lin F. Analysis of therapeutic effect of Dusanzhen for recovery of 20 patients with aphasia caused by cerebral disSeptember 15, 2012 | volume 32 | Issue 3 |

Sun YZ et al. Acupuncture therapy on apoplectic aphasia rehabilitation 67

68

69

70

71

72

73

74

75

76

77

78

eases. Hebei Zhong Xi Yi Jie He Za Zhi 1999; 8(1): 81-82. Cui H. Clinical observation of acupuncture for aphasia caused by cerebral infarction. Henan Zhong Yi 2004; 24 (6): 62. Zhao BX, Meng XK, Yu MZ. Clinical observation of 35 cases with aphasia due to stroke treated by acupuncture. Zhongguo Zhen Jiu 1998; 18(10): 581-583. Zhan L. Clinical observation of 56 cases with aphasia due to stroke treated by acupuncture. Zhen Jiu Lin Chuang Za Zhi 2000; 16(4): 20. Xia C, Wang Y, Wu X. Clinical observation on treatment of aphasia due to stroke with acupuncture of governor vessel and tongue. Zhongguo Zhen Jiu 2001; (9): 519-521. Zhang XF. 46 cases with apoplexy aphasia treated by mainly puncturing Kaiyin acu-point. Shanghai Zhong Yi Yao Za Zhi 2006; 25(4): 25. Qin RY. The effect of acupuncture in combination with Chinese herbs for treating aphasia due to acute stroke. Zhongguo She Qu Yi Sheng 2008; 10(14): 114. Qin YX. 79 cases with apoplexy aphasia treated by scalp acupuncture in combination with body acupuncture. Shaanxi Zhong Yi 2007; 28(2): 198. Mi JP, Zhu XP. Xiaoping Z. Clinical observation on the treatment of 43 apoplectic aphasia patients by tongue acupuncture as a main method. Shanghai Zhen Jiu Za Zhi 2004; 123(7): 8-9. Mu R. Observation on therapeutic effect of acupuncture on aphasia due to cerebral infarction. Zhongguo Zhen Jiu 2003; 23(1): 19. Zou JY. Clinical observation on triple acupuncture on motor aphasia after stroke. Liaoning Zhong Yi Yao Da Xue Xue Bao 2006; 8(14): 109-110. Chen AL, Li XP, Zhou J. Clinical observation of 30 cases with aphasia due to stroke treated by scalp and tongue acupuncture. Henan Zhong Yi 2008; 28(12): 75-76. Chao WB. Clinical Study on Treatment of Aphasia due to Apoplexy with Acupuncture. Zhongguo Zhong Yi Ji Chu

JTCM | www. journaltcm. com

79

80

81

82

83

84

85

86

87

321

Yi Xue Za Zhi 2009; 15(8): 619. Feng XE, Tian CD. Observation on the effect of the treatment mainly using scalp acupuncture on 50 cases with aphasia caused by cerebrovascular diseases. Zhongguo Zhen Jiu 1996; (8): 53-54. Liu F, Tong LP, Bao JY. Clinical observation on the treatment of scalp and body acupuncture in combination with language training on 33 patient with aphasia due to cerebrovascular diseases. Heilongjiang Yi Xue Za Zhi 2002; 26 (1): 33. Lin GH, Li LX, Li YH, Zhang HL. Clinical observation on the treatment of scalp acupuncture in cooperation with body acupuncture for aphasia due to ischemic stroke. Zhen Jiu Lin Chuang Za Zhi 2005; 21(8): 25. Wang XD, Cai XJ. Analysis of the results of assessment for using the "Chinese language test of aphasia (draft)" in healthy person. Zhonghua Shen Jing Ke Za Zhi 1996; 29 (4): 241. Li P. Observation on therapeutic effect of different rehabilitation approaches on cerebral apoplexy patients complicated with aphasia. Hu Li Yan Jiu 2007; 21(4): 1066. Tang SX. Clinical research on the coherence effect of promoting blood circulation and removing blood stasis of ischemic stroke sequelae treated by scalp acupuncture. Zhongguo Zhen Jiu 2002; (2): 79. Zhang HX, Zhang TF. Scalp acupuncture for treatment of apoplexy and effect on plasma ET content. Zhongguo Zhen Jiu 2002; (12): 83. Lai XS, Liu JY, Jiang GM. Effect of combination of acupuncture treatment at Lianquan acu-point and plum blossom needle treatment at the tip of tongue on aphasia after stroke and its significant on hemorheology. Zhongguo Lin Chuang Kang Fu 2004; 8(19): 3818-3820. Liu LA, Guo RY, Feng SM, et al. Clinical study of acupuncture in combination with language training for treating aphasia at the early stage of stoke. Zhong Yi Han Shou Tong Xun 2006; 24(12): 2256-2259.

September 15, 2012 | volume 32 | Issue 3 |