| Objectives:This paper studies the therapeutic effectiveness of combined acupuncture at "Cervical Three Points" and "Four Gods Points" on relieving cervical vertigo, based on random case-control study samples and compares that to the control group in which conventional practice of cervical traction and naprapathy are performed. Clinical efficacy is determined through objective scoring of 3 assessment surveys:the "cervical vertigo symptoms and functional assessment survey", the "quality of life assessment survey (SL-36) " and the "self-assessment of symptoms survey (SCL-90) ". In addition, the maximum systolic and minimum diastolic blood flow velocities were measured at the cervical and basilar arteries as an indicator of therapeutic efficacy. The results are evaluated and used to determine whether the use of "Cervical Three Points" and "Four Gods Points" should be advocated as treatment of choice for patients with cervical vertigo, based on its effectiveness, safety, and potential ability of improving quality of life.Methods:1. SAMPLING60 patients with cervical vertigo were randomly selected during the period of March 2009 to February 2010. Under the same basic treatment conditions, the patients were then divided into 2 groups of 30 people each. The control group is treated using cervical traction and naprapathy method while the trial group is treated using combined "Cervical Three Points" with "Four Gods Points" acupuncture.Scoring based on the three surveys:the "cervical vertigo symptoms and functional assessment survey", the "quality of life assessment survey (SL-36)" and the "self-assessment of symptoms survey (SCL-90)" were collected both prior to and after treatment. Blind evulation was performed and the clinical efficacy of each treatment were investigated based on the results. In addition, the velocities of vertebral arterial systole and diastole were measured and compared between the two groups through the use of transcranial Doppler.2. TREATMENT PLANa. Combined "Cervical Three Points" and "Four Gods Points" acupuncture (Trial group)i. Placement of points Major points:"Four Gods Points", "Cervical Three Points" (Tian Zhu,Bailao,Da Zhu). Placement of points based on diagnosis:modified according to the symptoms of CV.ii. Treatment regimen Two courses. A course is defined by once daily treatment for five consecutive days, followed by a rest period of two days, and start of another five-day treatment.b. Cervical traction with naprapathy (Control group) Naprapathy treatment:i. Method Relaxation therapy on paravertebral or focal soft tissue. Focus on Sternocleidomastoid on either sides of the neck, the Trapezius, transverse processes of cervical vertebrae and the Splenius. Techniques include rolling, point pressuring and rubbing until heat is generated on the target areas. Acupressure is then applied to five points:Fengchih, Fengfu, Chienching, Chienwaishu, Tientsung, for 30 seconds each. After that, plucking of pain-pressure points on the Trapezius, Splenius and Levator Scapulae is followed by gentle massage of the muscles on neck and shoulders.ii. Treatment regimenTwo courses. A course is defined by daily treatment of 20 minutes each for 10 consecutive days. Cervical traction treatment: i. Method Assisted with medical equipment:computerized cervical traction apparatus. Treatment perform in sitting position. Traction is carried out intermittently at an angle of 15 to 30 degrees to the front. Traction force is approximately 10 to 30% of patient's body weight, with small initial force and increasing gradually over the days of the course. Extend of traction is primarily based on patient's tolerance to the force applied. Throughout the course, attention should be paid on patient's response to treatment and adjustments should be made accordingly.ii. Treatment regimen Single course. A course is defined by 10 treatments of 20 minutes each, performed every other day.Results:1. Sample population. There is no statistical significance in the initial symptom differences presented in the two groups of patients selected to perform the two treatments. That is, the patients were randomly selected, all their symptoms of cervical vertigo are similar and possible errors due to selection bias can be ruled out. However, looking at the patients as a whole, patients with poor circulating blood volume take up the highest percentage, followed by those with poor liver and kidney functions and then those with turbid phlegm. This clinical observation agrees with the physiopathology of the condition.2. Treatment efficacy. Analysis of treatment result shows after two treatment courses, the trial group has 10 patients with the condition cured,11 patients with significant improvement,6 patients with improvement and 3 patients with no effects. Overall efficacy is 90%. In contrast, the control group has 7 cases of cure,9 cases of significant improvement,6 cases of improvement and 8 cases of no improvement. Overall efficacy is 73.33%. On the aspects of cured population and overall efficacy, the trial group has a more superior result compared to that of the control group. However, the difference is of no statistical difference suggesting that both treatment are effective with higher treatment efficacy being the trial treatment.3. Assessment of quality of life. When compared to the data collected prior to treatment, there is improvement in all 5 aspects of quality of life (PF, RP, PB, GH, SF) in the trail group after treatment, which is of statistical significance (with P< 0.05). On the contrary, the control group showed improvement in only two aspects of quality of life (RP, BP) which is again of statistical significance (with P< 0.05). The other three aspects of quality of life (PF, GH, SF) has higher improvement in the trial group and the finding is of statistical significance. Therefore, it illustrates that trial group provides a better improvement in quality of life than the control group.4. Assessment of cervical vertigo symptoms and cervical functions in the two groups before and after two treatment courses. Comparisons were made within the group, which showed that significant improvement were noted following treatment (with P< 0.05). Hence, both treatment were effective. Comparing trial group with control group, there was no significant difference in survey result prior to treatment, making the results valid for comparison. Following treatment, trial group has a significant improvement on vertigo symptoms with compared to the control group (P< 0.05). This shows that trial group is more effective in improving vertigo symptoms compared to the control group.5. Self-assessment of symptoms. According to the assessment result of different components of the survey SCL-90, trial group has an overall decrease in scores after the treatment. In particular, there were obvious decrease in points related to somatization, anxiety, depression, psychotic symptoms following treatment, and the result is of clinical significance (P< 0.05). On the other hand, there is less significant improvement following the control treatment. Statistical significance was only observed in three areas:interpersonal relationships, depression and anxiety. When comparing to the control group, the trial group has significantly lower scores in aspects of somatization, phobia, psychosis and other symptoms which is of statistical significance (P< 0.05). Only in the aspect of depression did the control group achieve better improvement than the trial group, however, the difference is of no statistical significance. Summing up, the trial treatment provides positive effects on reducing symptoms such as somatization, phobia, psychotic behaviours, and provides the patient with better psychological health in various aspects post treatment.6. Maximum systolic and minimum diastolic blood flow velocity in both left and right cervical arteries and basilar artery. There is no difference of statistical significance among maximum systolic velocities of blood flow in basilar, left and right cervical arteries of trial and control groups prior to treatment (P< 0.05). After treatment, the maximum blood flow velocity is significantly lower in the trial group compared to the control group. When compared to the pre-treatment value, the maximum blood flow velocity has lowered significantly in the trial group (P< 0.05). Whereas in the control group, little difference can be observed post treatment. Overall, there is significant improvement in lowering the maximum systolic blood flow velocity in basilar, left and right cervical arteries in trial group comparing to control group.Likewise, there is no difference of statistical significance among minimum diastolic velocities of blood flow in basilar, left and right cervical arteries of trial and control groups prior to treatment (P< 0.05). Post treatment, the minimum blood flow velocity is significantly lower in the trial group compared to the control group. When compared to the pre-treatment value, the minimum diastolic blood flow velocity has lowered significantly in the trial group (P< 0.05). Whereas in the control group, little difference can be observed post treatment. Overall, there is significant improvement in lowering the minimum diastolic blood flow velocity in left and right cervical arteries in trial group comparing to control group. However, improvement is similar for both groups in basilar artery.In the trial group, the lowering of maximum systolic blood flow velocity is more obvious than the control group. The same applies for the minimum diastolic blood flow velocity in the trial group. This implies that the reduction of blood flow is due to relieve of neck pathology post treatment, in particular the vascular spasms caused by stimulated cervical sensory nerves and vertebral arteries.Conclusion:It is found in this study that the combined acupuncture at " Cervical Three Points " and "Four Gods Points" has a more superior therapeutic efficacy than the traditional treatment method of cervical traction and naprapathy on relieving cervical vertigo. This conclusion is based on investigations on cure rate, treatment efficacy and the three assessment surveys:the "cervical vertigo symptoms and functional assessment survey", the "quality of life assessment survey (SL-36)" and the "self-assessment of symptoms survey (SCL-90)". In addition, the trial group with combined acupuncture displayed a lowered maximum systolic and minimum diastolic blood flow velocity in both left and right cervical arteries. Hence improving blood supply to the brain via vertebral and basilar arteries with the reduction of cerebral blood flow resistance. Improvement of blood supply can also be seen in the inner ear labyrinth artery. |
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