| Cerebrovascular disease is one of the three leading causes of death in human diseases,and aphasia after stroke is one of the most serious clinical sequelae in stroke.Although the modern medical and diagnostic techniques are flourishing,the disability rate of the disease is still very high,epidemiological investigations[1]show that about 80%of survivors after stroke are left with severe disabilities,and there are about 2 million new stroke cases in China each year,with an estimated 3/4 of patients left with varying degrees of neurological impairment,of which about 25%stroke patients are accompanied by aphasia.[2]The use of traditional Chinese medicine and acupuncture treatment to cure post-stroke aphasia have a long-established history,both clinical research and clinical practice do accumulated an ample experience,and in view of the modern medicine on pathogenesis of the disease and treatment options,it shows that there is no unified consensus has ever been achieved,the use of acupuncture to treat this disease demonstrates an unique advantages of TCM and the significance of clinical efficacy is also positive.Objective:Through the clinical research and observation,in order to explore the effectiveness of Professor Lin's empirical acupoint in treating Broca' s aphasia after stroke.The subjects are patients with Broca' s aphasia after stroke,and the systematic study of this topic is carried out by using prospective,randomized controlled research methods and also the study under the principles of evidence-based medicine.Actively explore the theoretical connotation of empirical acupoints by the use of acupuncture,prescription of acupoints selection,operation technique,course of treatment and curative effect,etc.Not only helps to optimize the clinical prescription acupoints selection,but also to blaze new trails for a new set of simple and safe,with economic benefits and high efficacy acupoint application,improve the effect of acupuncture treatment of the disease,ease the pain of those patients who suffering from aphasia,enrich the academic significance of clinical application research field,for other similar research to provide systematic clinical data as well.Methods:1.Literature Research:Reference and review of traditional Chinese medicine,acupuncture and modern medicine on the Broca ' s aphasia after stroke history,understanding,research,pathogenesis and treatment options,so as to verify the research program of traditional Chinese medicine theoretical efficiacy and feasibility on treating this disease.2.Clinical study:Simple random digital grouping method is adopted according to the minimum quantity clinical trial requiremen.A total number of 60 patients have been divided into study group(empirical acupoint)30 cases and control group(traditional acupoint)30 cases.Method:Prepare 60 opaque envelopes and according to 1,2,3......and numbered,make randomization cards and according to 1,2,3......and numbered,mark card number on the randomization card,randomized number,group and treatment method.Study the randomization table and get 60 randomized numbers accordingly.The odd number will be assigned to the study group and the even number will be assigned to the control group.Fill in the randomzation card then put it into the corresponding numbered envelope,all the envelopes should be kept by the custodian.Once the targeted patient enters the study,open the envelope in ordinal number,the patient will receive the appropriate treatment just according to the order of the randomzation card.3.Acupoints Selection:The study group is assigned to use Professor Guohua Lin empirical acupoints prescription for the treatment,acupoints selection:Danzhong(RN17)and bilateral Jianshi(PC5).Operation Method:Find out the tenderness point above Danzhong then penetrate the needle to that direction within the range of 2 inches under skin.Secondly,puncture the needle to bilateral Jianshi perpendicularly within the range of 0.5-1 inch under skin.All acupoints are manipulated under the uniform reinforcing-reducing method,the acupuncturist pinches the needle handle and manipulate the needle every 15 minutes 1 time,retain the needles for 30 minutes.The control group is assigned to use the traditional acupoint prescription for the treatment,acupoints selection:Baihui(DU22),Shangxing(DU23),bilateral Fengchi(GB20),Jinjin(EX-HN12),Yuye(EX-HN13),Lianquan(RN23),bilateral Tongli(HT5).Operation Method:Both Jinjin and Yuye use pricking method;both Baihui and Shangxing puncture the needle horizontally within the range of 0.5-0.8 inch under skin;Lianquan puncture obliquely to the root of the tongue within the range of 0.5-0.8 inch.Bilateral Fengchi,point the needle to the tip of the nose and puncture obliquely within the range of 0.8-1.2 inch(es)under the skin,bilateral Tongli puncture the needle perpendicularly within the range of 0.5-0.8 inch.In addition to Jinjin and Yuye,the above acupoints are manulpated under the uniform reinforcing-reducing method,the acupuncturist pinches the needle handle and manipulate the needle every 15 minutes 1 time,retain the needles for 30 minutes.Both groups are treated continuously for 5 days a week,rest for 2 days,2 weeks for continuous treatment,and a total of 1 course will be treated.4.Statistical analysis:This clinical study uses a total number of 60 cases in the study group and the control group for general clinical data analysis,i.e.the analysis of different syndrome type,the comparison of theefficacy of different pathological nature,the comparison of clinical efficacy in the stage of disease,the comparison of the tenderness point distribution of Danzhong,and the comparison of language proficiency test scores including:China Rehabilitation Research Center Aphasia Examination(CRRCAE)[3]and The Chinese Functional Communication Profile(CFCP)[4].After collected the above data of the two groups,the statistical data processing and analysis will be carried out,both communication competency and language skills of the two groups will be compared before and after treatment,and the clinical efficacy of Professor Lin' s empirical acupoints and traditional prescription acupoints in the treatment of Broca's aphasia after stroke will be observed and discussed.Provide validation for the promotion of empirical acupoints to the clinical applications.Results:1.Before the treatment,a baseline study according to the basic data of the study group and control group are being analyzed,and patients ' age,gender,educational level,left or right handedness,pathological nature,stage of disease are also compared as well.The gender comparison uses Pearson' s chi-squared test,the age comparison uses the independent sample t test,compliance to the normality test(P>0.05)and the homogeneity of variance test(P>0.05),the education level is compared by the Z test.After X2 test,t test and Z test,there is no statistical significance(P>0.05),which suggests that the two groups are comparable.The pathological nature and the stage of disease use Pearson' s chi-squared test,the left or right handedness uses the continuity correction chi-squared test.After X2 test,there is no statistical significance(P>0.05)which suggests that the two groups are comparable.Through the data comparison between two groups,there is no significant difference in general information and it meets the statistical requirements.It proves that both groups are baseline equilibrium which means an objective comparison can be made.2.Clinical efficacy:After the course of treatment,the statistical result of CRRCAE shows that the total efficiency rate of the study group is 70.00%,while the total efficiency rate of the control group is 63.30%,and the difference between the study group and the control group is no statistical significance(P>0.05),which indicates that the efficacy between both groups is similar.3.Comparison of the China Rehabilitation Research Center Aphasia Examination(CRRCAE)score in study group and control group:3.1 Before the treatment,the CRRCAE score is compared between both groups by t test and both groups are compliance to the normality test(P>0.05)and the homogeneity variance test(P<0.05),by applying the independent sample t test,t=-1.039,P=0.307,there is no statistical significance between both groups(P>0.05),which indicates that they are clinical comparability.3.1.1 The CRRCAE score is compared within a group,the result of study group before the treatment score:46.53±16.37 and after the treatment score:64.70±22.59.After different interventions have been given,the comparative difference in the study group is consistent with the normality test(P>0.05),by applying the pairing sample t test,t=-8.816,P=0;control group before the treatment score:50.767±14.274 and after the treatment score:66.433±18.175,the difference is consistent with the normality test(P>0.05),by applying the pairing sample t test,t=-8.227,P=0,there is statistically significance between both groups(P<0.05),which indicates that both therapies can improve the CRRCAE score.3.1.2 The CRRCAE score is compared between both groups,the study group after the treatment score:64.70±22.59 and the control group after the treatment score:66.433±18.175,in accordance to the normality test(P>0.05)and the homogeneity variance test(P<0.05),by applying the independent sample t test,t=-0.313,P=0.756,there is no statistically significance(P>0.05),t=-0.313,P=0.756,the scores of both groups are improved,there is no statistically significance between both groups(P>0.05).However,the score of the study group is slightly lower than that of the control group,but it dose not truly reflect the reality,because there is no statistical significance between both groups,which suggests that both groups have similar efficacy,it requires further large-scale clinical trial to be conducted for verification.3.2 Before the treatment,the CRRCAE item score is compared between both groups,including:Listening Comprehension,Retelling,Speaking,Vocal Reading,Reading and Calculation,and there is no statistical significance between both groups(P>0.05),which means they are clinically comparable.3.3 The CRRCAE items scores are compared within a group:3.3.1 Comparison of CRRCAE items scores in study group:Before the treatment ? Listen Comprehension:12.57±4.20,Retelling:10.53±3.15,Speaking:9(7,12),Vocal Reading:6.23±2.54,Reading:5(3,6),Calculation:4(2,5).After the treatment-Listen Comprehension:16.97±4.41,Retelling:14±4.16 Speaking:12(8,16),Vocal Reading:8.33±3.78,Reading:6.5(4,9),Calculation:6.5(4,9).The before and after treatments in the study group,the difference between Listening Comprehension,Retelling and Vocal Reading is consistent with the normality test(P>0.05),by applying the pairing t test,the other rest does not meet to the normality test(P<0.05),the rank sum test is adpoted.After statistical analysis,the scores of Listening Comprehension,Retelling,Speaking,Vocal Reading,Reading and Calculation after treatment in the study group are compared with those before treatment,the difference is statistical significant(P<0.01),which shows that the treatment of empirical acupoints can obviously improve the scores of the above items and alsothe linguistic function of the patients as well.3.3.2 Comparison of CRRCAE items scores in control group:Before the treatment-Listen Comprehension:13.23±3.58,Retelling:10(8,13),Speaking:10(8,12),Vocal Reading:7(6,9),Reading:6(3,8),Calculation:3(2,5).After the treatment-Listen Comprehension:17.57±3.73,Retelling:14(12,17),Speaking:11(10,16),Vocal Reading:8.5(7,10),Reading:7(5,9),Calculation:5(4,7).The before and after treatments in the control group,the Listen Comprehension is consistent with the normality test(P>0.05),by applying the pairing t test,while the other does not conform to the normality test(P<0.05),the rank sum test is adpoted.After statistical analysis,the scores of Listening Comprehension,Retelling,Speaking,Vocal Reading,Reading and Calculation after treatment in the control group are compared with those before treatment,and there is a remarkable statistical significance(P<0.01),which shows that the treatment of traditional acupoints can obviously improve the scores of the above items and also the linguistic function of the patients as well.3.4 After treatment,the CRRCAE items scores are compared between both groups:Study Group-Listen Comprehension:18(14,20),Retelling:14(12,17),Speaking:11(10,16),Vocal Reading:8.5(7,10),Reading:6.63±3.52,Calculation:6.57±3.91.Control Group-Listen Comprehension:18(16,21),Retelling:15(10,17),Speaking:12(8,16),Vocal Reading:8(6,10),Reading:7.23±3.23,Calculation:5.63±2.71.The after the treatment scores between the study group and the control group are compared.After the treatment,both reading and calculation scores are comformed to the normality test(P>0.05)and the homogeneity variance test(P<0.05),the pairing t test is used,while the other are not comformed to the normality test(P<0.05)or the homogeneity variance test(P<0.05),the rank sum test is adpoted.After statistical analysis,there is no statistical difference(P>0.05)between the scores of listening comprehension,retelling,speaking,vocal reading,reading and calculation after treatment in the control group,which indiciates that both threapies can improve the CRRCAE score,but this did not explain the problem,because the data of the two groups were not statistically significant after comparison,this shows that the two groups had similar efficacy.It requires further large-scale clinical trial to be conducted for verification.4.Comparison of the Chinese Functional Communication Profile(CFCP)score in study group and control group:4.1 Before the treatment,the CFCP score is compared between both groups,through the normality test(P<0.05),the data of both groups is not normally distributed,by applying the rank sum test,the study group is compared with the control group before treatment,Z=-0.062,P=0.951,there is no statistical significance between both groups(P>0.05),which indicates that they are clinical comparability.4.2 The CFCP score is compared within a group,the result of study group before the treatment score:90.5(65,162),after treatment score:(104,201),Z=-4.783,P=0:the control group before the treatment score:91.5(65,160)and after the treatment score:128.5(98,192),Z=-4.784,P=0,both groups indicate the same result,there is a remarkable statistical significance within each group(P<0.01),which suggests that both therapies can improve the CFCP score.4.3 The CFCP score is compared between both groups,the study group after the treatment score:130(104,201)and the control group after the treatment score:128.5(98,192),Z=0.350,P-0.727,the scores of both groups are improved,there is no statistical significance between both groups(P>0.05),the efficacy of the study group is slightly better than that of the control group,but due to the current sample size issue,it needs further large-scale clinical trial to be conducted for verification.5.In the comparison of clinical efficacy of the pathological nature of both groups,the total number of ischemic stroke effective rate is:32(68.09%),and the invalidation rate is:15(31.91%),and the total number of hemorrhagic stroke effective rate is:8(61.54%),invalidation rate is:5(38.46%).By applying the Pearson' s chi-square test,the statistical result shows no statistical significance(P>0.05),which suggests that the efficacy of acupuncture treatment for both ischemic stroke and hemorrhagic stroke is similar.6.In the comparison of clinical efficacy of phases in different stage of disease of both groups,the total number of acute phase effective rate is:22(66.67%),and the invalidation rate is:11(33.33%),and the total number of recovery phase effective rate is:18(66.67%),and the invalidation rate is:9(33.33%).By applying the Pearson' s chi-square test,the statistical result shows that there is no statistical significance(P>0.05),which indicates that the efficacy of acupuncture treatment for the stroke patients in acute phase and recovery phase is similar.7.In the comparison of tenderness distribution on Danzhong,the location of the tenderness point of the Danzhong in the study group is:14(46.67%),7(27.33%)and the right 9(30.00%),while the position of the tenderness point in the Danzhong of the control group is:14(46.67%),8(26.67%)and right 8(26.67%).By applying the rank sum test,there is no statistical significance between the two groups(P>0.05),although there is not much difference in the distribution of tenderness points between the two groups,but it can be seen from the bar chart that the number of tenderness point on the left side is more than in other places,which is consistent with Professor Lin' s clinical observation,it might be related to the holography of the disease,which attains clinical research value and requires further exploration.Conclusion:Synthesize the results above,by the use of Danzhong and Jianshi to treat the patients with Broca' s aphasia after stroke not only demonstrates a significant improvement in their linguistic function,but also similar to the efficacy of the traditional acupoints acupuncture.Such breakthrough confirms the practicability and feasibility of the empirical acupoints.Through the use of empirical acupoints,the whole body qi and blood can be adjusted,it has an effect of stimulating the external and adjusting the internal,the operation is comparitively quick and easy,also more acceptable by the patients.The essence of the empirical acupoints is reflected in Professor Lin' s skillful use of the functional characteristics of Danzhong and Jianshi.Understand that the treatment of this disease can be adjusted in the body of Qi,that is,using Danzhong to achieve the functions of tonifying qi,regulating qi and induce qi,and combined with an important acupoint to treat aphasia-Jianshi,with the participation of Jianshi,a new set of acupoints is innovated,not only to increase the clinical cure rate effectively and improve patients' quality of life,but also consolidate the psychological quality of patients with disease resistance,with limited side effects and instantaneous-immediate efficacy,and this is one of the special features of the empirical acupoints treatment.It should be widely promoted to the clinical and continuously optimize and improve for clinical practice. |
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