Philip A.M. Rogers MRCVS

AP and the Cardiovascular System


Bao_XY et al (1996) Relationship Between Stimulating Quantity and Therapeutic Effects in Treatment of Apoplectic Hemiplegia by AP points of the Scalp. Adapted from WWW. The Second Affiliated Hospital, Heilongjiang Coll of TCM, 150001 PRC. 100 cases of apoplectic hemiplegia were assigned at random to 2 groups for treatment: A=Scalp AP twice/d and; B= Scalp AP once/d. One course consisted of 10 d. Therapeutic effects were assessed after two courses. The clinical effect in Group A was better than in Group B; myodynamia and skin pain threshold showed variable improvements, but the effects in Group A were better than that in the Group B. The therapeutic effects of Scalp AP correlated with the amount of stimulus.

Chen_CH; Chou P; Hu HH; Tsuei JJ (1994) Further analysis of a pilot study for planning an extensive clinical trial in traditional medicine, with an example of AP treatment for stroke. AJCM 22(2):127-136. Inst of Statistical Science, Academia Sinica, Taipei, Taiwan, ROC. Statistical methods for evaluating the effects of treatments and prognostic factors in clinical trials are discussed, including exploratory data analysis, nonparametric methods, regression modelling, and regression diagnostics of influential cases. These methods were applied to the analysis of a pilot 'randomized' controlled trial of AP-treatment of acute stroke. The use of this analysis to modify patient eligibility criteria, determine the required sample size and use stratified randomization in a future extensive stroke trial is discussed.

Chen_DZ (1990) [Evaluation of therapeutic effects of AP in treating ischemic cerebrovascular disease]. Chung Hsi I Chieh Ho Tsa Chih Sep 10(9):526-528, 515. Liaoning College of TCM, Shenyang. In this article, the therapeutic effects of AP and routine drugs in treating 20 cases of ischemic cerebrovascular disease, and in comparison with another 20 cases treated with sole routine drugs were studied. Effects of AP were evaluated from the degree of functional nervous damage, EEGs and SEPs. After treatment, mean functional nervous damage in the test group was reduced by 13 points, as compared with only 3.75 points in the control group (p <.001). Mean EEG slow wave in the test v control groups was reduced by 1.7 v 0.05 points (p <.001); theta wave was reduced 1.05 v 0.25 points (p <.001). The diversity of latent period of P45 peak wave value between left limbs and right limbs were reduced evidently in the test group and showed a significant statistical difference (p <.05) as compared with the control group. The therapeutic effects of AP were objective and were based on neurophysiological mechanism.

Chen_Y (1992) Clinical research on treating senile dementia by combining AP with AP point-injection. AETRIJ 17(2):61-73. Acupuncture Dept., Hua Shan Hospital, Shanghai Med Univ, PRC. Combining AP with AP point-injection of aceglutamide was used to treat 38 cases of senile dementia. The therapy was effective for the cases of multi-infarct dementia; total success rate was 86% (excellent 43%, improved 43%). The rating was based on the revised Hasegawa Dementia Scale and the Functional Activity Questionnaire. Also, the high density lipid-cholesterone component increased significantly after treatment.

Chen_YM; Fang YA (1990) 108 cases of hemiplegia caused by stroke: the relationship between CT scan results, clinical findings and the effect of AP treatment. AETRIJ 15(1):9-17. AP Dept., Hua Shan Hospital, Shanghai Med Univ, PRC. The location of the pathological focus on the film of CT scan was related to the degree of paralysis, and to the result of AP in hemiplegia patients. Retrospective analysis of the clinical data revealed interlinking relationships. In general, early AP treatment (in the first 3 wk) produced better results (improvement in 91% of patients treated) than treatment initiated >3 wk after stroke (improvement in 71% of patients treated).

Deng_QS; Fang ZC; Yin Y (1995) Ionic mechanism of AP on improvement of learning and memory in aged mammals. AJCM 23(1):1-9. Inst of Materia Medica, Chinese Acad of Medical Sciences, Beijing. Memory impairment is one of the most frustrating problems for older people. Several AP points were used to treat memory loss in old rats, and the elemental mechanism of AP therapy was studied with Inductively Coupled Plasma Spectroscopy. AP improved learning and memory ability significantly in aged animals when compared with controls. Elevations of 8 essential elements (B, Ca, Cu, Fe, K, Mg, Na, and P) in the brain were the ionic basis for the therapeutic effect of AP. A hypothetical model of the mechanism of AP therapy is described.

Hu_HH; Chung C; Liu TJ; Chen RC; Chen CH; Chou P; Huang WS; Lin JC; Tsuei JJ (1993) A randomized controlled trial on the treatment for acute partial ischemic stroke with AP. Neuroepidemiology 12(2):106-113. Dept of Neurology, Taipei Veterans General Hospital, Taiwan, ROC. The effectiveness of AP in acute stroke remains largely untested. A randomized, controlled trial was done to study the feasibility of AP in combination with conventional supportive treatment for acute stroke. After appropriate screening, 30 patients, aged 46-74, with the onset of symptoms within 36 h were enrolled into the study. All patients gave informed consent. Based on the same supportive treatment, patients were assigned at random to a treatment with or without AP. AP point selection was decided after several meetings of a group of senior AP doctors in Taiwan. AP was applied 3 times/wk for 4 wk. There were no problems with this trial in terms of physician cooperation and patient acceptance and availability. As assessed by neurological outcome on d 28 and d 90, AP helped stroke patients significantly. Neurological improvement was greatest in patients with a poor baseline neurological score. There were no important side effects except for one episode of dizziness related to AP treatment. The data and results of this study will be used as a guideline for planning a full-scale clinical trial, e.g. sample size calculation, method of randomization with stratification of prognostic factors, choosing AP points and technique of AP.

Johansson_K; Lindgren I; Widner H; Johansson B; Wiklund I (1993) [AP therapy in stroke: Patients experience significant improvement]. Lakartidningen 28 Jul 90(30_31):2597-2600. Neurology Clinic, Univ of Lund, Sweden.

Johansson_K2; Lindgren I; Widner H; Wiklund I; Johansson BB (1993) Can sensory stimulation improve the functional outcome in stroke patients? Neurology Nov 43(11):2189-2192. Dept of Neurology, Lund Univ Hospital, Sweden. After obtaining informed consent, we randomized 78 patients with severe hemiparesis of the left or right side within 10 d of stroke onset: 40 to a control group receiving daily physiotherapy and occupational therapy; 38 to a group that were given additional sensory stimulation (AP) twice/wk for 10 wk. Median age of both groups was 76 yr. Motor function, balance, and FROML (Barthel's Index) were assessed before the start of treatment and at 1 and 3 mo after stroke onset; FROML was also assessed after 12 mo. We assessed the quality of life (QL) using the Nottingham Health Profile 3, 6, and 12 mo after stroke onset. Patients given sensory stimulation recovered faster and to a larger extent than the controls, with a significant difference for balance, mobility, FROML, QL, and days spent at hospitals/nursing homes. Whether AP per se causes the differences requires further study.

Lai_FS (1992) Ischemic apoplexy treated with AP using the principle of replenishing Qi and promoting blood circulation. Chung-Kuo Chung Hsi i Chieh Ho Tsa Chih Apr 12(4):216-218, 196. Dept of Xiyuan Hospital, Acad of TCM, Beijing, PRC. 32 cases of ischemic apoplexy were treated by AP using the principle of replenishing Qi and promoting blood circulation. The clinical efficacy and the change of nail-fold microcirculation and haemorheology before and after the treatment were observed. Total effective rate was 94%. Before treatment, the microcirculation of nail-fold was markedly abnormal, and the criteria of haemorheology was abnormally elevated. But after the treatment, together with the recovery of nail-fold microcirculation and haemorheology, the clinical symptom and sign of the patients also improved. Thus it showed that AP method had the function of changing the microcirculation and the hypercoagulability of the patients' blood, further promote the recovery of the function of affected cerebral tissue.

Li_Y; Jin R (1994) Clinical study on the sequelae of cerebral vascular accident treated with temporal-point AP. Chen Tzu Yen Chiu - AP Research 19(2):4-7. Guangzhou Coll of TCM, Guangzhou, PRC. 108 cases of sequelae of CVA were assigned at random to 2 groups: TA=Temple-point AP (n=58 cases); BA=Body-point AP (n=50 cases). After 30 sessions, the therapeutic effects between the 2 groups were significantly different statistically (p <.01). Both AP therapies improved blood rheology but the effect of AP at points on the temple was better than at body points.

Naeser_MA; Alexander MP; Stiassny-Eder D; Galler V; Hobbs J; Bachman D (1994) AP to treat paralysis in chronic and acute stroke patients: improvement correlated with specific CT scan lesion sites. AETRIJ Oct-Dec 19(4):227-249. Boston Univ Sch of Med, MA, USA. A total of 20 stroke patients received AP, including 10 chronic and 10 acute patients. Based on CT scan lesion site data alone, 19/20 patients (95%) were correctly classified regarding a prognosis of a beneficial response to AP, versus poor response. Patients with beneficial response had damage to <50% of the motor pathway areas on CT scan, especially in the periventricular white matter area (PVWM) at the level of the body of the lateral ventricle. Overall, 8/20 patients receiving AP had beneficial response with measurable objective improvement in motor function, including 3/10 chronic patients treated at >3 mo poststroke, and 5/10 acute patients treated at <3 mo poststroke. Among the 8 patients with beneficial response, significant improvements were observed in knee flexion, knee extension, and shoulder abduction. Neither age, nor months poststroke when AP was begun, was significantly correlated with the total number of improved tests, post-AP. 2 chronic patients with beneficial response first began receiving AP at 3 yr and 6 yr poststroke. Most improvements were sustained for >4 mo after the last AP treatment.

Pang_H (1994) 52 cases of apoplexy treated with scalp AP by the slow-rapid Bu-Xie (Reinforcing-Reducing) method. JTCM Sep 14(3):185-188. Inst of AP, China Acad of TCM, Beijing, PRC. 85 cases of apoplexy were treated with scalp AP, including 52 cases by the method of slow-rapid reinforcing-reducing and 33 cases by the method of flat twisting. The total effective rates differed insignificantly between the 2 methods. However, in respects of improving the myodynamia and motile functional disturbances of the limbs, the method of slow-rapid reinforcing-reducing was markedly superior to the method of flat twisting.

Price_TR (1990) Stroke in patients treated with thrombolytic therapy for acute myocardial infarction: The thrombosis in myocardial infarction clinical trial and a review of placebo-controlled trials. Stroke Nov 21(11) Suppl, III8-9. Dept of Neurology, Univ of Maryland Hospital, Baltimore 21201. The frequency of stroke among patients in six recent placebo-controlled trials of thrombolytic therapy for AMI is reviewed. Three trials used streptokinase and three used tissue plasminogen activator as the thrombolytic agent. While thrombolytic therapy greatly reduces the morbidity and mortality of acute myocardial infarction, it increases the rate of intracerebral haemorrhage.

Qie_ZW; Cheng FK; Cheng LH (1991) Blood flow capacity of the vertebral and cervical artery affected by Propagated Channel Sensation due to AP stimulation. Chung Hsi i Chieh Ho Tsa Chih (Chin J of Modern Developments in Trad Med) Jan 11(1):31-33 and 35. A method to measure total blood flow capacity in the head was improved. AP stimulation of the Propagated Channel Sensation (PCS) was induced in 55 cases of cervical vertebra disease [AP points: LI10, BL11, GV12, SI03], and in 66 cases of cerebral ischemia due to insufficiency of the vertebral arterial supply [AP points: LI04, LI11, LI16, TH15]. There was an obvious effect on head-blood flow (p<.05-.01) in the group in which PCS reached the affected area, some effect in the partial PCS group, and little effect in the group which felt a local needle sensation only. AP excitation of PCS relieved vascular and muscle spasm and ease the degree of vascular tension and Stasis (obstruction). Good PCS significantly increased the blood flow capacity of the cervical and vertebral artery; it promoted blood circulation to Clear Xue Stasis and improve tissue nutrition and function of the ANS. An important component in promoting the clinical effect was to induce the AP-excited PCS to reach the affected area.

Sõllstroem_S; Kjendahl A; Osten PE; Stanghelle JK; Borchgrevink CF (1995) [AP therapy in stroke during the subacute phase: A randomized controlled trial]. Tidsskr Nor Laegeforen Sep 115(23):2884-2887. Sunnaas sykehus, Nesoddtangen. The aim of this study was to investigate whether AP treatment, if given to stroke patients in subacute phase in addition to rehabilitation would influence motor function, activity of daily living (ADL) and quality of life. After obtaining informed consent, 45 patients (median age 57 yr) were randomised into a control group (n=21) and an AP group (n=24). Median time from onset of stroke to inclusion in the study was 40 d. The inclusion criterion was hemiparesis after a first-ever stroke. When included and 6 wk later all patients were evaluated by 3 measurement systems: the Motor Assessment Scale for stroke patients, Sunnaas Index of ADL and Nottingham Health Profile. All patients underwent individually adapted rehabilitation therapy. The patients in the treatment group were given classical AP 3-4 times/wk for 6 wk, each session lasting 20-30 min. Both groups improved significantly in motor function and ADL. However, improvement was significantly greater in the AP group than in the controls. Only the AP group rated a significantly improved quality of life. AP gave an added therapeutic benefit when given to stroke patients during their rehabilitation programme in the subacute phase.

Wang_Y; Xu G; Li G; Li D; Fang Y; Li Y; Wu F (1993) Treatment of apoplectic hemiplegia with scalp AP in relation to CT findings. JTCM Sep 13(3):182-184. Third People's Hospital, Datong, Shanxi Province, PRC.

Xiao_J1 (1993) Clinical observation of 50 cases of hemiplegia treated by AP. Chen Tzu Yen Chiu - AP Research 18(3):172-173. Dept of AP, Beijing Railway General Hospital, PRC. 50 cases of hemiplegia were treated by AP-needling of Scalp points. 14% were basically cured, 24% cases markedly effective, 62% cases improved. The total effective rate was 100%.

Yamashiro_H; Shimada M; Fukui S; Fukano T; Gotoh Y (1990) [Treatment of chronic retinal artery obstruction with stellate ganglion block and electric AP]. Masui Oct 39(10):1413-1416. Dept of Anaesthesia, Hamamatsu Med Ctr. A 56-yr-old man (160 cm, 64 kg) having right visual field defect due to obstruction of the central retinal artery for 6 mo was treated with stellate ganglion block and electric AP. His visual field improved slightly immediately after preliminary treatment with stellate ganglion block and electric AP judging from perimeter recording and his complaints. Stellate ganglion block once/d and EAP every 2 d were performed for 10 d and there after these treatments were done twice/wk. 20 d after starting the treatment, his visual field improved on his perimeter examination. We discussed that the cause of improvement was activation of slept cone cells which needed more energy for activation than rod cells by increasing retinal blood flow with stellate ganglion block and electric AP. We recommend vasodilating treatments such as stellate ganglion block and electric AP for visual field defect due to obstruction of central retinal artery even in chronic state.

Yu_YH; Wang HC; Wang ZJ (1995) The effect of AP on spinal motor neuron excitability in stroke patients. Chung Hua I Hsueh Tsa Chih (Taipei) Oct 56(4):258-263. Dept of Physical Med and Rehab, Taipei Municipal Yang-Ming Hospital, Taiwan, R.O.C. BACKGROUND. Spasticity is a common symptom in stroke patients, and its management constitutes a major problem in their rehabilitation. AP has been applied with moderate effect; their has been clinical experience but little objective evidence to support its use. H-reflex recovery time and H recovery curve were quantitative methods applied to measure spinal motor neuron excitability. AP for stroke patients as treatment to spastic hemiparesis was studied to see the AP effect on increased spinal motor neuron excitability in spasticity. METHODS. 16 stroke patients with spastic hemiparesis were collected to evaluate the therapeutic effect of AP on their spinal motor neuron excitability. H-reflex recovery time and H recovery curve were applied as quantitative evaluations of spinal motor neuron excitability. 11 age-matched normal volunteers were used as a control group. Results: The mean H-reflex recovery time of normal controls was 73.3+18.3 ms; that of the sound-side limbs of stroke patients was 67.1+21.5ms. The difference was not significant statistically (p=.2). However, the mean H-reflex recovery time of the paretic limbs of stroke patients was 52.3+16.8 ms, significantly shorter than for the normal controls (p=.003). The mean H-reflex recovery time of the paretic limbs of stroke patients became 57.6+19.9 ms after AP, significantly prolonged as compared with that before AP (p=.03). The H recovery curve of the paretic limbs after AP also was close to that of the normal controls. ConclusionS. This result provides positive evidence of increased spinal motor neuron excitability in paretic limbs of stroke patients and also of the AP effect which decreased that excitability. The study also presents a simple and practical technique for measuring the effects of various types of treatments, including AP, on other types of CNS disorders.

Zhai_Na1; Du Y; Shi X; Xu P (1993) [Morphological study on AP in interfering experimental cerebral infarction in rat: 1: Compensation of cerebral PIA mater artery in cerebral surface]. Chen Tzu Yen Chiu 18(1):8-13. Dept of AP, Coll of TCM, Tianjin. Occluding unilateral middle cerebral artery (MCAo) of rat, the compensatory blood vessels (CBV) within ischemic area in cerebral surface shown by cerebral perfusion and effect of AP were observed dynamically. Perfusing immediately after MCAo, there was no any blood vessel in the ischemic area. In AP group, the CBV had extended a lot from anastomotic network of cerebral pia mater (ACA-MCA, PCA-MCA) located in marginal zone of ischemic area 3 hs after MCAo. 6.24 and 48 hs after MCAo, the CBV increased much more than control group (non-AP) p <.01. The experiment pointed out that there existed a serious vasospasm in the MCA system in initial stage of MCAo, which led up to decompensation in the ischemic area. The AP can remit the vasospasm, and reverse the deteriorated process in early.

Zhai_Na2; Lu X; Shi X; Xu P (1993) [Morphological study on AP in interfering experimental cerebral infarction in rats: 2: Change of ischemic area in cerebral interior]. Chen Tzu Yen Chiu 18(3):209-212. Dept of AP, First Affiliated Hospital, Coll of TCM, Tianjin, PRC. Occluding unilateral middle cerebral artery (MCAO) of rat, the ischemic volume within cerebrum shown by nitroblue tetrazolium (N-BT) histochemistry method and effect of AP were observed dynamically. 18 hs after MCAO, the ischemic area began to extend from cerebral cortex into subcortical area. 36 hs after MCAO, there was a large ischemic area in cortical and subcortical area, whose volume occupied 20.7% of the whole. Whereas the ischemic area in the cortex disappeared in the AP group, the ischemic volume reduced to 6.3% of the whole. The experiment pointed out that the AP is an effective therapeutic procedure for cerebral infarction.

Zhang_D3; Gao H; Wei Z; Wen B (1991) [The thermographic observation of the relationship between the retention of AP needles and the effect of nose temperatures]. Chen Tzu Yen Chiu 16(1):73-75, 60. Inst of AP and Moxibustion, China Acad of TCM, Beijing, PRC. This is an observation of the relationship between the retention of AP needles and its effect on nose temperature in 74 patients with facial nerve paralysis. 100 patients were assigned to 5 groups according to the period of retention of needles: 0, 10, 20, 30 and 40 min (n=20/group). Nose temperature fell immediately after AP; then it rose to a maximum at 20 min after AP, then fell again; for group with retention for 0, 10 and 20 min, nose temperature rose again during 30-40 min after AP; however, this did not happen in groups with retention for 30 or 40 min. There was a general tendency for a greater change of temperature, of shorter duration in the groups of retention for longer time than in the groups of retention for shorter time. Some theories in ancient books about the retention of AP needles are based in scientific fact.

Zhang_S; Luo Y; Bo M (1991) Vertigo treated with scalp AP. JTCM Mar 11(1):26-28. Dept of E.N.T., Hengshui District Hospital, Hebei Province, PRC.

Zhao_C (1990) Treatment of acute cerebrovascular diseases and sequelae with AP. JTCM Mar 10(1):70-73. Inst of AP and Moxibustion, China Acad of TCM.

Zou_X; Wang D (1990) [Comparative study of AP versus Calan tablets to treat cerebral infarction]. Chung Hsi I Chieh Ho Tsa Chih Apr 10(4):199-202, 195. Beijing Coll of AP-Moxibustion and Orthopaedics-Traumatol, PRC. 55/63 patients were diagnosed as cerebral infarction by computer tomography. Diagnosis of 8 cases relied on history, symptoms, signs together with CSF examination. This article compares the curative effects of Calan tablets versus AP on 6 AP points on Yang Channels in treating cerebral infarction. Patients were assigned at random to 2 treatment groups: 1=AP (n=32 cases) and; 2=Calan tablet (n=31 cases). The AP group was needled once/d for 6 wk, mainly at LI15, LI11, LI04 and GB30, GB34, GB37. LV03, GB20, ST25, ST40, ST36, SP06, KI03 were added, depending on the Syndrome differentiation. Needle manipulation was by lifting and thrusting. The needles were retained for 30 min after the patient felt local sourness, distension and heaviness. Group 2 got a 5 mg Calan tablet 3 times/d for 6 weeks also. Result: The total effective rates were 94% and 84% respectively. AP had a much better therapeutic effect than Calan tablets (p <.05). In both groups, most haemorheological indices were much higher than normal for the same age group.