| Stroke is a very common and frequently-occurring disease for middle- or aged people in China. Every year, there are about 1.5 million people newly developed, amounts to 6 million people suffering, 1.2 million people died of this disease. Moreover, among all stroke patients, 18–38% has aphasia, which is the main cause of after-stroke depression, cognitive dysfunction and bad neurological function rehabilitation. These subsequences of aphasia bring out many agonies for aphasia patients and their families. Previously, western therapeutics for stroke patients with aphasia mainly emphasizes the rehabilitation in the convalescent period.Although Chinese medicine researchers have explored the therapeutics of stroke aphasia with acupuncture and the combination of acupuncture and Chinese medicine, there are some problems with the early researches such as unclear classification and definition, incorrect therapeutic evaluation standard, and absence of mechanism exploration. Little work has been done on the study of aphasia in acute brain ischemic patients.This study evaluated the therapeutic effect of the combining therapy of acupuncture and Chinese medicine (CAC) in treating aphasia in acute brain ischemic patients; then analyzed the clinical classification and Chinese medicine syndrome differentiation; and finally studied the effect of electric acupuncture in the brain blood infusion of patients with acute stroke with aphasia with single photon emission computed tomography, so as to the possible mechanism of the acupuncture effect in treating aphasia.CLINICAL RESEARCHAccording to the Main Diagnostic Points of Each Kind of Cerebral Vascular Diseases, Examination of Chinese Language Aphasia, and Chinese medicine differentiation standard, 63 patients with acute stroke with aphasia were recruited. The patients were randomly divided into observation group with 32 patients and control group with 31 patients. Patients in control group received standard western medicine therapeutics, while those in observation groups received CAC according to differentiation, in addition to the standard therapeutics. The principal of acupuncture treatment is dispelling the wind and promoting circulation, waking up and facilitating speaking. The Chinese medicine was prepared according to long-term experience of Professor Gao. He usually differentiates patients into four subtypes: Deficiency of Qi, Excess of Yang, phlegm-wetness, and phlegm-fire, and gives the Chinese medicines accordingly each day. The changes of Chinese language aphasia, the integral calculus of Neurological functions (NIHSS), Chinese medicine syndromes, blood lipid and four blood clot tests were collected to compared the difference before and after the treatment, and between two groups as well. The distribution of clinical classification and Chinese syndrome among all recruited patients were analyzed as well.The comparison of general clinical therapeutic effects shows that, there are significantly more people in the observation group getting better than those in control group. Although all the spontaneous language speak score, including vocal comprehensive ability, repeat ability and denomination ability in patients of both groups have improved significantly after treatment; the abilities of spontaneous language speak and repeat ability in patients of observation group after treatment are significantly better than those of control group. The neurological scores as detected by the NIHSS evaluation in both groups are very significantly lower after treatment than those before treatment; those in observation group showed the tendency of higher reduction rate than the control group. In general Chinese medicine syndrome evaluation, both groups have relative improvement rate in facial expression, appetite, stool and tongue expression after treatment. The improvement rate of stool in observation group is significant than that in control group. In blood lipid, Patients of the observation group after treatment have significant lower triglyceride (TG) and cholesterol (TCHO) lever than before, and very significant changes with higher HDL and lower LDL; the TG and LDL in control group very significantly changed after treatment, with the significant change in TCHO. The comparison between observation group and control group after treatment shows significant change in TG. The blood clot time evaluation of PT, APTT, TT in both group are significant prolonged after treatment, but no difference between two groups.The Chinese medicine differentiation analysis indicated that, the phlegm syndrome is the predominant, account for 81%, including the phlegm-fire 39.7%,and phlegm-wetness 41.3%, Qi deficiency accounts for 15.9%, Yang excess type accounts for 4.8%. The distribution of phlegm in acute stroke aphasia is relatively higher than that in acute ischemic stroke. There are significant difference between groups of phlegm-wetness and Qi deficiency in TG, TCHO and LDL; also t here are significant difference between TH and Qi deficiency in LDL. Phlegm-wetness and Phlegm-fire groups have significant shorter TT, APTT and PT, and higher Fib, this indicates that patients of phlegm syndrome having higher blood lipid and blood clotting feasibility.This study indicates that the CAC in more effective than conventional treatment in treating aphasia patients of acute ischemic stroke, with better improvement in language abilities, general symptoms. The Chinese medicine differentiation analysis of aphasia shall provide new proof for the theory of treating aphasia from phlegm by Chinese medicine.EXPERIMENTAL STUDYTo further explore the mechanism of the acupuncture effect in treating aphasia, the effect of electric acupuncture in the brain blood infusion of patients with acute stroke with aphasia was studied with single photon emission computed tomography (SPECT).Four subjects, who were firstly suffering from acute ischemic stroke with aphasia only, were recruited. Another subject is brain ischemia with aphasia and stroke. All patients were studied with 7-10 days after stroke. The schedule is the 2 times of SPECT research before and after electric acupuncture (EA). And the brain blood infusion pf patients were compared before and after EA with the assessment of qualitative way and region of interesting (ROI) semi-quantity radiological account ratio (L/N).The qualitative analysis indicated that after EA in the language area, the low-blood-infusion areas of frontal brain are obviously decreased in 3 patients with ischemic frontal brain infarction area. And the areas of low-blood-infusion of temporal lobe were obviously decreased in 3 of 4 temporal brain ischemic infarction patients. In one case without brain ischemia, there are obvious enhancement of blood infusion in both front brain ischemic area, with predominantly increase in left temporal and frontal brain. The study of semi-quantity radiological ROI account ratio comparison indicated that L/N was significantly increased in the left frontal brain of 3 patients of frontal infarction, with the average increase of 10.8%. The blood infusion L/N was significantly increased in 4 temporal infarction patients after EA, with average increase of 4.2%. In the case of non-brain infarction patient, the L/N of frontal brain was 0.887 before EA, and was 0.970 after EA. This result indicated that EA the 1st language area can significantly improve the blood infusion in acute ischemic stroke patients, with predominantly in frontal brain. In addition, the correlation of the SPECT and other clinical information including MRI was analyzed case by case to provid the detail information for study the effect of EA in patients.This research firstly indicated that there are close relationship between language area of scalp acupuncture and the blood infusion in the language center of the brain by demonstrating that early electric acupuncture treatment in the scalp language area was effective in improving the brain blood infusion in acute brain ischemic patients. Meanwhile, the better effect of frontal brain than the temporal lobe after EA in the 1st language area of aphasia patient indicated that the scalp acupoint area might be somewhat locally correlative to the brain functional area. |
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