Acupuncture and herbs improve walking, gait, cognitive function, and urination control for a normal pressure hydrocephalus (NPH) patient. NPH is a neurological disorder characterized by the abnormal accumulation of cerebrospinal fluid (CSF) in the brain’s ventricles, leading to their gradual enlargement, without an associated increase in CSF pressure. This condition primarily affects older adults and is often underdiagnosed, as its symptoms can mimic those of other neurodegenerative disorders such as Parkinson’s disease or Alzheimer’s disease.
A recent case report from Kyung Hee University Medical Center in Seoul, South Korea, documents a significant clinical response in a patient with idiopathic normal-pressure hydrocephalus (iNPH) who failed to improve following ventriculoperitoneal (VP) shunt surgery. Through a 42-day course of acupuncture, electroacupuncture, and the classical Chinese herbal formula Siryeongtang, the patient demonstrated quantifiable improvements in gait balance and speed, verified using WIN-TRACK pressure mapping technology [1].
The 56-year-old woman presented with progressive gait impairment, urinary incontinence, and cognitive decline. She had undergone VP shunt placement two years earlier with no improvement, and pharmacological treatment with donepezil and memantine was ineffective. Initial computed tomography (CT) imaging revealed ventricular dilation consistent with iNPH. Her symptoms included repeated falls, postural instability, and inability to feed herself independently. Based on clinical pattern differentiation, she was diagnosed with a damp-heat syndrome and treated with acupuncture and herbal medicine [1].
Acupuncture was performed daily for 42 consecutive days using 0.25 mm × 40 mm sterile stainless steel needles (Dongbang Acupuncture Inc., Seongnam, Korea). Points selected included GV20 (Baihui), EX-HN1 (Sishencong), LI4 (Hegu), TB5 (Waiguan), LI11 (Quchi), LI10 (Shousanli), ST36 (Zusanli), GB34 (Yanglingquan), GB39 (Xuanzhong), and LV3 (Taichong). Needles were retained for 20 minutes per session. Electroacupuncture was applied bilaterally at three pairs of points: LI11–LI10, ST36–GB39, and ST41 (Jiexi)–LV3, using the STN-111 device (Stratek Co., Ltd., Anyang, Korea), delivering a continuous 4 Hz current for 20 minutes per session [1].
Concurrently, the patient was prescribed Siryeongtang, taken orally as a decoction three times daily, 100 mL per dose, for 42 days. The daily formula was decocted for two hours in 1.8 L of water using a pressure extractor (Kwandong Extractor, Korea) and included the following ingredients:
- Bai zhu (Atractylodis rhizoma alba, 12 g)
- Ban xia (Pinelliae tuber, 9 g)
- Gan cao (Glycyrrhizae radix et rhizoma, 6 g)
- Huang qin (Scutellariae radix, 6 g)
- Fu ling (Poria sclerotium, 9 g)
- Zhu ling (Polyporus, 12 g)
- Ze xie (Alismatis rhizoma, 15 g)
- Gui zhi (Cinnamomi ramulus, 6 g)
- Ren shen (Ginseng radix, 6 g)
- Chai hu (Bupleuri radix, 18 g) [1].
Siryeongtang (Si Ling Tang, 四苓湯) is a classical herbal formula derived from the combination of two foundational prescriptions: Soshiho-tang (Xiao Chai Hu Tang, 小柴胡湯) and Wuling San (Oryeongsan, 五苓散). Soshiho-tang traditionally includes Chai Hu (Bupleuri radix), Huang Qin (Scutellariae radix), Ban Xia (Pinelliae tuber), Sheng Jiang (Zingiberis rhizoma recens), Ren Shen (Ginseng radix), Zhi Gan Cao (Glycyrrhizae radix preparata), and Da Zao (Jujubae fructus), and is known for its ability to harmonize the Shaoyang and reduce internal inflammation.
Wuling San consists of Ze Xie (Alismatis rhizoma), Zhu Ling (Polyporus), Fu Ling (Poria sclerotium), Bai Zhu (Atractylodis rhizoma alba), and Gui Zhi (Cinnamomi ramulus), and is primarily used to resolve dampness and promote urination. By integrating these two formulas, Siryeongtang offers both anti-inflammatory and diuretic actions, making it particularly suitable for conditions involving damp-heat, fluid retention, and cerebral edema. Soshihotang has been shown to reduce neuroinflammation via cytokine suppression, while Wuling San reduces brain edema by inhibiting aquaporin-4 expression in cerebral tissue [1].
Gait performance was objectively measured using the WIN-TRACK system (Medicapteurs, France), which evaluates spatiotemporal gait parameters and foot pressure distribution through a sensorized platform. The symmetry index of step length improved markedly, from 111% at day 15 to 37% by day 42. Similarly, the symmetry index of step speed improved from 77% to just 5% over the same period. These indexes are calculated such that lower values indicate improved bilateral symmetry. Additionally, the time required to walk 5 meters improved from 13 seconds (day 15) to 9 seconds (day 42) [1].
Step speed (mm/ms) was calculated by dividing step length by step duration. On day 15, the left and right sides were measured at 0.09 and 0.04 respectively; by day 42, both values reached 0.10 mm/ms, indicating normalized gait velocity [1].
The patient’s cognitive symptoms and urinary incontinence also improved. The clinical rationale for the combined treatment draws from the biomedical pathophysiology of iNPH, where chronic ventricular enlargement, periventricular white matter changes, aquaporin-4 overexpression, and inflammatory cytokine elevation (notably IL-6 and IL-8) contribute to neurological dysfunction. The use of Siryeongtang targets these factors through dampness elimination, inflammation reduction, and improved cerebrospinal fluid (CSF) dynamics.
Acupuncture contributes by enhancing cerebral blood flow (CBF), particularly in the prefrontal cortex and supplementary motor area. Key points such as GV20, ST36, and GB39 are traditionally and experimentally linked to improved systolic velocity and reduced peripheral vascular resistance [1].
Though limited to a single case without post-treatment imaging, this report underscores the measurable potential of integrative East Asian medicine for gait restoration in iNPH cases unresponsive to standard care. Notably, the treatment also enabled a tapering of several allopathic medications during the protocol, minimizing polypharmacy risk. Future studies incorporating MRI follow-up and long-distance gait assessments are recommended by the HealthCMi medical team.
Source
1. Moon-Young Ki, Han-Gyul Lee, Seungwon Kwon, Woo-Sang Jung, and Sang-Kwan Moon, “Herbal Prescription Siryeongtang and Acupuncture Treatment for Gait Disturbance Due to Idiopathic Normal Pressure Hydrocephalus: A Case Report,” Explore 21 (2025): 103097.
