J. Acupunct. Tuina. Sci. 2012, 10 (3): 165-168 DOI: 10.1007/s11726-012-0596-7

© Shanghai Research Institute of Acupuncture and Meridian and Springer-Verlag Berlin Heidelberg 2012︱● 165 ●

Clinical Study

Observation on Clinical Efficacy of Acupuncture Therapy for Posterior Circulation Ischemia Vertigo

针刺治疗后循环缺血性眩晕临床疗效观察 Liu Guang-xia (刘广霞), Chen Yun (陈赟), Yang Ya (杨娅) Acupuncture Hospital Affiliated to Anhui College of Traditional Chinese Medicine, Hefei 230061, P. R. China

【摘要】目的：观察针刺治疗后循环缺血性眩晕的临床疗效。方法：将 71 例后循环缺血性眩晕患者按就诊顺序随机分为 2 组，针刺组 37 例，采用针刺治疗；药物组 34 例，采用口服盐酸氟桂利嗪治疗。治疗 6 星期后观察疗效。结果：治疗后，针刺组椎动脉(Vertebral Artery ,VA)、基底动脉(Basilar Artery, BA)的平均血流速度(Mean Blood Flow Velocity, VM) 均明显增加，与本组治疗前比较，差异有统计学意义(P<0.05)；血管搏动指数(Pulsatility Index，PI) 虽有降低，但与治疗前差异无统计学意义。治疗后，药物组 VA、BA 的平均血流速度有所增加，与本组治疗前比较，差异有统计学意义(P<0.05)；PI 与治疗前比较差异无统计学意义(P>0.05)。针刺组 VM 的改善程度优于药物组，两组差异有统计学意义(P<0.05)；两组 PI 改善程度差异无统计学意义。从临床疗效上分析，针刺组及药物组均有效，但针刺组要优于药物组，差异有统计学意义(P<0.05)。结论：针刺治疗后循环缺血性眩晕疗效优于口服盐酸氟桂利嗪。 【关键词】针刺疗法；穴，夹脊；头针；头针刺激区；椎-基底动脉供血不足；短暂性脑缺血发作； 眩晕 【中图分类号】R246.2 【文献标志码】A 【Abstract】 Objective: To observe the clinical efficacy of acupuncture for posterior circulation ischemia vertigo (PCIV). Methods: A total of 71 PCIV cases were randomly allocated into an acupuncture group (37 cases) and a medication (oral Flunarizine Hydrochloride) group (34 cases). After 6 weeks of treatment, the therapeutic efficacies in the two groups were analyzed. Results: After treatment, the mean blood flow velocities (VM) of both the vertebral artery (VA) and the basilar artery (BA) in acupuncture group were significantly increased, showing statistical differences when compared with the pre-treatment result of the same group (P<0.05); despite some decrease in pulsatility index (PI) after treatment, there was no statistical difference when compared with the pre-treatment result. After treatment, the mean blood flow velocities of both VA and BA in the medication group were increased, showing statistical differences when compared with the pre-treatment result of the same group (P<0.05); there was no statistical difference in PI before and after the treatment (P>0.05). Regarding the improvement of VM, the acupuncture group was superior to the medication group, showing a statistical difference (P<0.05); there was no statistical difference in PI improvement between the two groups. Considering from the clinical efficacy, both acupuncture and medication are effective. However, acupuncture obtained a significantly better effect than medication (P<0.05). Conclusion: Acupuncture therapy can obtain a better effect than oral Flunarizine Hydrochloride for posterior circulation ischemia vertigo. 【Key Words】Acupuncture Therapy; Point, Jiaji (Ex-B 2); Scalp Acupuncture; Scalp Stimulation Areas; Vertebrobasilar Insufficiency; Transient Ischemic Attack; Vertigo

As a common ischemic cerebrovascular disease, posterior circulation ischemia vertigo (PCIV) is more often seen in middle-aged or elder population

Author: Liu Guang-xia, professor, chief physician. E-mail: lgx0551@163.com

above the age of 40. It is clinically characterized by paroxysmal vertigo, nausea, vomiting and ataxia. In addition, it may reoccur and last for a long period of time, which may further result in acute cerebro- vascular accidents (CVA). As a result, the early diagnosis of PCIV is of great significance to prevent

J. Acupunct. Tuina. Sci. 2012, 10 (3): 165-168

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and minimize the risk of CVA. We treated 37 PCIV cases with acupuncture between January 2010 and June 2011, and compared the therapeutic effect with the medication group. The results are now summarized as follows.

1 Clinical Data

1.1 Diagnostic criteria

The diagnostic criteria in Western medicine are based on the relevant studies in China[1] and the criteria recommended by World Health Organization (WHO) in 1989[2]. The diagnostic criteria in Chinese medicine are based on the criteria for vertigo in Guiding Principles for Clinical Study of New Chinese Medicines[3]. 1.2 Inclusion criteria

(1) Those who met the above diagnostic criteria; (2) men and women aged between 35 and 70 years old; (3) a sudden onset; (4) major symptoms include vertigo, headache, dysarthria, tumbling, ataxia, abnormal eyeball movements, double vision, cross dyskinesia or sensory disorder, and unilateral or bilateral loss of vision; (5) the symptoms are often temporary but recurrent, lasting from 10 to 15 min (within 1 h and maximally no less than 24 h); (6) patients can have a complete recovery without any left-over neurological impairment signs; (7) exclusion of intracranial conditions that may share similar manifestations with transient ischemic attack (TIA) by cranial CT scan. 1.3 Exclusion criteria

(1) Those who experienced vertigo but have normal examination results by cervical X-ray or transcranial doppler (TCD); (2) cervical hyperplasia; (3) less than twice attacks of vertigo; (4) vertigo with complications of severe hypertension; (5) those with co-morbidities involving the inner ear, vestibular nerve, brain stem, cerebellum or cerebrum. 1.4 Statistical method

The SPSS18.0 version software was used for statistical process. Mean ± standard deviation ( x ±s) was for expression of measurement data, and managed with t-test; Chi-square test for comparison of rate. 1.5 Research subjects

A total of 71 PCIV outpatients from our hospital

were allocated into an acupuncture group of 37 cases and a medication group of 34 cases by stratified random sampling. There were no statistical differences in age, gender and duration between the two groups, indicating that the two groups were comparable (table 1).

The flow chart of clinical management is shown as follows. Table 1. Comparison of general materials between the two groups (case)

Gender Groups n

Male Female

Age (year)

Duration (month)

Acupuncture 37 18 19 60.46±8.47 5.04±3.32Medication 34 14 20 59.83±9.36 4.56±2.67

Fig.1. Flow chart of clinical management

2 Treatment Methods

2.1 Acupuncture group

Major acupoints: Cervical Jiaji (Ex-B 2). Adjunct acupoints: Baihui (GV 20), Lower-

lateral Line of Occipit (MS 14) and Lower-lateral Line 1 of Occipit (a parallel line 1.5 cun lateral to MS 14).

Method: Puncture the cervical Jiaji (Ex-B 2) points using filiform needles of 0.25 mm in diameter and 25 mm in length. Regarding the location of scalp stimulation areas, refer to the Standardized Manipulations of Acupuncture and Moxibustion-Part 2: Scalp Acupuncture. Puncture the Lower-lateral Line of Occipit and Lower-lateral Line 1 of Occipit subcutaneously from top to bottom using filiform needles of 0.25 mm in diameter and 50 mm in length. After the arrival of qi, apply electric stimulation to Baihui (GV 20) and

Acupuncture groupn=37

Completed casesn=37

Completed casesn=34

Grouping by stratified randomization

Recruited PCIV cases n=71

Dropout, n=0Dropout, n=0

Medication groupn=34

J. Acupunct. Tuina. Sci. 2012, 10 (3): 165-168

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cervical Jiaji (Ex-B 2) points, connecting the pair of output electrodes on the same side of the body and using sparse-dense wave and tolerable intensity. Perform 5-minute interval after 15 min of electric stimulation and re-stimulate for 15 min before removing the needles. After this, conduct cupping on the nape and back for 3-5 min. The treatment was performed once a day. Two weeks of treatment made up one treatment session. There was a 5-day interval between two sessions. The therapeutic efficacy was statistically analyzed after 3 sessions. 2.2 Medication group

Of 10 mg Flunarizine Hydrochloride was taken once every night before sleep, and 2 weeks made up 1 session. The therapeutic efficacy was statistically analyzed after 6 weeks.

3 Observation of Therapeutic Efficacy

3.1 Observation indexes

The indexes include the mean blood flow velocity (VM) of bilateral vertebral artery (VA) and basilar artery (BA) before and after treatments by TCD and carotid duplex ultrasound, coupled with changes in pulsatility index (PI). 3.2 Criteria of therapeutic efficacy

The therapeutic efficacy standard was self made on the basis of the efficacy evaluation standard for vertigo by the Guiding Principles for Clinical Study of New Chinese Medicines[3] .

Recovery: Absence of clinical symptoms or signs

of vertigo. Remarkable effect: Significantly alleviated

vertigo, mild dizziness, absence of self or object spinning, and capability to manage daily life and work.

Improvement: Alleviated vertigo and mild self or object spinning that slightly affected daily life and work.

Failure: Clinical symptoms including vertigo remain unchanged or become worse. 3.3 Results 3.3.1 Comparison of hemodynamic indexes between the two groups

Before treatment, there were no statistical differences in VM and PI between the two groups. After treatment, the VM and PI in both groups were significantly improved, showing statistical differences (P<0.05); The VM improvement in the acupuncture group was more noticeable than the medication group, showing a statistical difference (P<0.05). There was no statistical difference between the two groups in PI change (table 2). 3.3.2 Comparison of therapeutic efficacies between the two groups

The total effective rate in the acupuncture group was 89.2%, versus 64.7% in the medication group, showing a statistical difference (P<0.05). This indicates that despite the fact that both methods are effective for PCIV, acupuncture showed a better effect than medication (table 3).

Table 2. Comparison of VM and PI between two groups before and after treatments ( x ±s)

VM (cm/s) PI Groups n Time

Right VA Left VA BA Right VA Left VA BA

Pre-treatment 27.41±5.7 26.90±4.2 29.74±4.0 1.16±0.12 1.18±0.16 1.23±0.25 Acupuncture 37

Post-treatment 32.60±4.91)2) 34.80±4.31)2) 36.10±4.41)2) 0.72±0.18 0.81±0.21 0.78±0.23

Pre-treatment 27.30±4.5 27.15±4.1 29.50±4.7 1.15±0.18 1.19±0.21 1.25±0.26 Medication 34

Post-treatment 29.12±4.7 30.35±4.2 31.21±5.2 0.85±0.17 0.91±0.22 0.80±0.19

Note: Compared with the pre-treatment results of the same group, 1) P<0.05; compared with the post-treatment result of the medication group, 2) P<0.05

Table 3. Comparison of therapeutic efficacies between the two groups (case)

Note: Compared with the medication group, 1) P<0.05

Groups n Recovery Remarkable effect Improvement Failure Recovery rate (%) Total effective rate (%)

Acupuncture 37 10 12 11 4 27.01) 89.21)

Medication 34 3 8 11 12 8.8 64.7

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4 Discussion Vertigo is one of the main clinical manifestations

of posterior circulation ischemia. The posterior circulation is also known as the vertebrobasilar artery system, which consists of the vertebral artery and posterior cerebral artery. Posterior circulation ischemia vertigo refers to circulation disturbance of the vertebrobasilar artery system, causing insufficient blood supply to the corresponding brain areas, which further results in dysfunctions of the brain stem, cerebellum and posterior cerebral hemisphere. This will in turn cause vestibular functional impairment. Patients may experience vertigo symptoms such as spinning of objects, nausea and vomiting. This condition is most often seen in middle-aged and elderly population due to their increased blood viscosity, slower blood flow and high-coagulation or microthrombus in blood. These abnormal changes may result in atherosclerosis of the vertebrobasilar artery and posterior cerebral artery and increase of blood flow resistance, eventually leading to blood circulation disorder in the brain, decreased brain tissue perfusion and symptoms such as vertigo. As a result, the essential treatment principles for this condition are to improve local circulation of blood, increase oxygen supply to brain tissue and restore the vestibular function.

In Chinese medicine, the pathogenic location of vertigo is in the brain but closely relates with five Zang and six Fu organs. Because the human body is considered as a whole, essential qi of all Zang-fu organs ascend to the brain and travel along the back of the neck. Consequently, cervical Jiaji (Ex-B 2) points, Lower-lateral Line of Occipit (MS 14) and Lower-lateral Line 1 of Occipit were selected to dredge meridians in the occipit and back of the neck, coordinate functions of the Zang-fu organs, restore qi and blood transformation to nurture the brain and alleviate vertigo[4-6]. This study has proven that both needling cervical Jiaji (Ex-B 2) points and oral Flunarizine Hydrochloride can alleviate vertigo.

However, acupuncture can also improve the cerebral blood circulation possibly by regulating vasomotor balance and dilating the blood vessels, which may further accelerate blood flow in the vertebrobasilar artery system and increase blood supply to the brain. In summary, needling cervical Jiaji (Ex-B 2) points is reliable and effective for PCIV and has no adverse reactions. It is therefore worth spreading in clinical practice.

Conflict of Interest The authors declare that there is no conflict of interest.

Acknowledgments This work was supported by Acupuncture-moxibustion

Hospital Affiliated to Anhui College of Traditional Chinese Medicine. Statement of Informed Consent

All the patients who took part in the research knew the facts of the clinical trial.

References [1] You GX, Jia QD, Shi YK. Brain stem auditory evoked

potential study on mild vertebrobasilar artery ischemic vertigo. Zhong Hua Shen Jing Jing Shen Ke Za Zhi, 1988, 21(1): 14-16.

[2] Special report from the National Institute of Neurological Disorders and Stroke. Classification of cerebrovascular diseases III. Stroke, 1990, 21(4): 637-676.

[3] Ministry of Health of the People’s Republic of China. Guiding Principles for Clinical Study of New Chinese Medicines. Beijing: People’s Medical Publishing House, 1993: 24-25.

[4] She RP. Clinical observations on acupuncture of nape- occipital eight points for cervical vertigo. Shang Hai Zhen Jiu Za Zhi, 2008, 27(11): 14-15.

[5] Qi LZ, Yang L. Application of nape acupuncture in treatment of vertebral-artery type cervical spondylosis. J Acupunct Tuina Sci, 2009, 7(1): 47-50.

[6] Qin BM, Gu TT. Observations on the efficacy of electroacupuncture plus suspended moxibustion over Baihui (GV 20) in treating cervical vertigo. Shang Hai Zhen Jiu Za Zhi, 2010, 29(7): 454-455.

Translator: Han Chou-ping (韩丑萍)

Received Date: February 25, 2012

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