Dangyang City Chinese Medicine Hospital researchers conclude that the addition of acupuncture and herbs to usual care improves outcomes for spinal injury paraplegia patients. The researchers assessed several parameters. Eighty-five patients with spinal injury related paraplegia were assessed based on activities of daily living, limb mobility, and factors including nerve growth factor (NGF) and brain-derived neurotrophic factor (BDNF), as well as overall clinical efficacy. The results indicate that the addition of acupuncture and herbal medicine to usual care protocols produces significantly better outcomes than usual care alone. [1]
Participants in the trial were randomly assigned to receive either acupuncture and herbal medicine plus usual care (n=43) or usual care monotherapy (n=42). The traditional Chinese medicine (TCM) group was comprised of 27 male and 16 female participants, with a mean age of 38.75 years. Of these patients, 10 had injuries to the thoracic spine, 20 had injuries to the lumbar spine, and 13 had combined injuries. Among these, 17 injuries were complete, resulting in full loss of function in the affected limbs, and 26 were incomplete, resulting in partial loss of function.
The control group was comprised of 28 male and 14 female participants, with a mean age of 39.65 years. Of these patients, 9 had injuries to the thoracic spine, 18 had injuries to the lumbar spine, and 15 had combined injuries. In this group, 15 injuries were complete and 27 were incomplete. There were no significant differences in baseline characteristics between the two groups.
For inclusion in the study, the participants were required to be in stable condition, have a TCM diagnosis of qi deficiency and stagnation in the collaterals, and have the ability to give informed consent. Patients with tuberculosis, unstable vital signs, unconsciousness, concurrent brain, kidney, or liver dysfunction, autoimmune disorders, psychiatric disorders, poor compliance, and pregnant or lactating women were excluded from the study.
Usual Care
The participants in both groups received standard rehabilitation therapy including education to improve understanding of their condition and increase confidence, physical training to improve muscle strength and mobility, and bowel and bladder retraining. The participants were also prescribed oral vitamin B1 (thiamine) tablets and were administered IV monosialotetrahexosylganglioside (also known as GM-1). Gangliosides such as GM-1 are compounds which occur naturally in cell membranes and play a role in the protection, and possibly repair of, neurons. These compounds have shown some promise in the treatment of spinal injuries.
In addition to the usual care regimen, participants in the TCM group were also treated with acupuncture and Yi Qi Huo Xue decoction. According to TCM principles, paraplegia involves qi stagnation and blood stasis preventing proper circulation to the limbs, leading to atrophy. This may be coupled with kidney yang deficiency or depletion of yin and yang. The primary treatment principles are to warm the channels and promote circulation. Acupuncture was administered at the following acupoints:
- Huatuojiaji (MBW35)
- Dazhui (GV14)
For patients with paralysis of the upper limbs, the following acupoints were added:
- Shousanli (LI10)
- Waiguan (TB5)
- Quchi (LI11)
For patients with paralysis of the lower limbs, the following acupoints were added:
- Sanyinjiao (SP6)
- Zusanli (ST36)
- Yanglingquan (GB34)
- Taixi (KD3)
- Huantiao (GB30)
For patients with disorders of the zang-fu, the following acupoints were added:
- Ganshu (BL18)
- Weishu (BL21)
- Zhongji (CV3)
For patients with bowel or bladder dysfunction, the following acupoints were added:
- Qihai (CV6)
- Shenshu (BL23)
- Pangguangshu (BL28)
Following standard disinfection, needles were inserted into the chosen acupoints and were manually stimulated using a balanced reinforcing-reducing technique. After the arrival of deqi, the needles were rotated to produce a strong distending sensation to patient tolerance levels. Needles were retained for 30 minutes and treatment was administered daily. The patients in the TCM group were also prescribed Yi Qi Huo Xue decoction containing the following herbs:
- Huang Qin 20g
- Dan Shen 20g
- Shu Di 20g
- Bai Shao 20g
- Ren Shen 10g
- Chuan Xiong 10g
- Dang Gui 10g
- Di Long 10g
- Hong Hua 6g
- Gan Cao 6g
For patients suffering from convulsions the following herbs were added:
- Gou Teng 10g
- Shen Jin Cao 10g
- Wu Gong 3 pieces
For patients suffering from localized swelling, Di Long was removed from the original formula and was replaced with Tao Ren (10g). The herbs were simmered in 400ml of water and the resulting decoction was split into two doses to be taken, while warm, in the morning and evening. For each treatment, one course consisted of 30 days and a total of three courses were administered.
Outcomes and Discussion
Outcomes for the study included assessments of daily living, limb mobility, neurotrophic factors, and clinical efficacy. Daily living was assessed using the Barthel Index for Activities of Daily Living, a 100 point scale rating patients in the areas of feeding, bathing, grooming, dressing, bowel and bladder control, transfers, and mobility. Higher scores indicate better functioning, with scores of 100 indicating complete independence. Prior to treatment, mean Barthel scores were 40.27 in the TCM group and 39.95 in the control group. Following treatment, scores rose to 67.33 and 57.06 respectively. Both groups showed significant improvements and improvements were significantly greater in the TCM group.
Limb mobility was assessed using the American Spinal Injury Association (ASIA) scale, which rates the function of various muscle groups to give an overall score out of 100, with higher scores indicating increased function. Mean pretreatment scores were 58.46 in the TCM group and 59.85 in the control group. Following treatment, these scores rose to 72.18 and 63.15 respectively. Both groups showed significant improvements but improvements were significantly greater in the TCM group.
Neurotrophic factors NGF and BDNF were measured fasting venous blood samples taken before and after treatment. Mean pretreatment NGF levels were 113.62pg/mL in the TCM group and 112.36pg/mL in the control group. Following treatment, these scores rose to 161.37pg/mL and 140.23pg/mL respectively. Mean pretreatment BDNF levels were 3.24ng/mL in the TCM group and 3.16ng/mL in the control group. Following treatment, these scores rose to 4.81ng/mL and 3.91ng/mL respectively. Both groups showed significant improvements but improvements were significantly greater in the TCM group. Clinical efficacy was rated according to the following criteria:
- Patients able to completely resume independent living, walk and lift heavy loads unassisted, and regain complete control of their bowels and bladder were classified as cured.
- For patients showing significant improvements in daily living activities, increased muscle strength, walking short distances with assistance from mobility aids, and improved bowel and bladder control, the treatment was classified as highly effective.
- For patients showing some improvements in daily living activities and bowel and bladder control, but were unable to walk short distances without assistance, the treatment was classified as effective.
- For patients showing no significant improvements, the treatment was classified as ineffective.
The cured, highly effective, and effective rates were added together to give the total effective rates for each group. The TCM group had a total effective rate of 38%, significantly greater than the control group, which had a total effective rate of 30%.
Outcomes from this study suggest that treatment with acupuncture and herbal medicine offers significant clinical advantages for patients with paraplegia due to spinal injuries. The results suggest that an integrative medicine approach to care combining traditional Chinese medicine (i.e., acupuncture, herbal medicine) and usual care produces optimal patient outcomes.
Reference
1. Wang Huaiquan (2018) “Observation on the effect of Yiqi Huoxue decoction combined with acupuncture treatment on spinal cord injury paraplegia” Modern Journal of Integrated Chinese and Western Medicine Vol.27 (28) pp. 3165-3167.
