Shanghai Traditional Chinese Medicine Integrated Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 200082, China

CLINICAL STUDY

Clinical Observation of Acupuncture-moxibustion for Alzheimer’s Disease

Cui Li

Shanghai Traditional Chinese Medicine Integrated Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 200082, China

Author:Cui Li, master of medicine, resident.

E-mail: cuili0627@163.com

Objective: To observe the clinical efficacy of acupuncture-moxibustion in treating Alzheimer’s disease (AD).

Methods: Forty-eight eligible AD patients were enrolled to receive acupuncture plus herb-partitioned moxibustion. Mini-mental state examination (MMSE) was adopted for evaluation before and after intervention, and the therapeutic efficacy was observed.

Results: After intervention, the MMSE score changed significantly (P＜0.01), and the total effective rate was 83.3%.

Conclusion: Acupuncture-moxibustion can significantly improve the cognitive function of AD patients, beneficial to the general promotion of the quality of life.

Acupuncture-moxibustion Therapy; Acupuncture Therapy; Moxibustion Therapy; Indirect Moxibustion; Alzheimer Disease

Alzheimer’s disease (AD) is a kind of progressive neurodegenerative disease with an insidious onset. It’s clinically manifested by memory loss, aphasia, apraxia, agnosia, visuospatial impairment, disturbance in executive functioning, personality and behavioral changes, while the cause is not clear yet. With the increased sense of health and aging of population in China, the incidence of AD has been growing rapidly. Meanwhile, as AD patients cannot manage themselves well, and their behaviors are often unacceptable, AD not only deeply affects the quality of life of the patients, but also brings heavy burden to the family and society[1]. Currently, many researches focusing on the cause and pathology of AD have been conducted, but there is no specific drug for AD yet[2]. In recent years, to discover an effective treatment protocol based on traditional Chinese medicine (TCM), we have adopted acupuncture and moxibustion in treating AD, and the report is now given as follows.

1 Clinical Materials

1.1 Diagnostic and inclusion criteria

In conformity with the relevant diagnostic criteria of AD in theDiagnostic and Statistical Manual of Mental Disorders(the fourth edition, revision, DSM-IV-R) by American Psychiatric Association and the criteria proposed by the National Institute of Neurological and Communicative Disorders and Stroke (NINCDS) and the Alzheimer’s Disease and Related Disorders Association (ADRDA)[3]: decreased cognitive function and activities of daily living (ADL) ≥6 months; Hamilton depression rating scale (HAMD) ≤14,modified Hachinski ischemic scale ≤6, and moderate and severe depression and vascular dementia were excluded; AD patients diagnosed as mild or moderate dementia by DSM-IV-R and scored 10-24 by mini-mental state examination (MMSE); each patient was asked to receive a brain CT or MRI examination and other relevant tests.

1.2 Exclusion criteria

Vascular dementia, Pick’s disease, dementia with Lewy bodies, or dementia caused by hypothyroidism, or vitamin B1deficiency; severe diseases involving heart, lung, liver, or kidney; taking other anti-dementia drugs and/or drugs that evoke cerebral cells; MMSE score in the following range associated with education level: the illiterate ≤4, primary school ≤7, and above middle school ≤10.

1.3 Statistical method

All data were processed by computer, and the statistical analyses were performed by using SPSS 13.0 version software. Measurement data were expressed by mean ± standard deviationand the intra-group comparison was analyzed by pairedt-test.P＜0.05 indicated a statistical significance.

1.4 General data

Forty-eight AD patients were enrolled from the Acupuncture Rehabilitation and Tuina Department of Shanghai Traditional Chinese Medicine Integrated Hospital between November 2012 and January 2014. There were 28 males and 20 females; aged 55-89 years old, average age 69; 7 cases were illiterate, 14 cases were of primary school level, 17 cases of middle school, and 10 cases were undergraduate (including junior college).

2 Treatment Methods

2.1 Acupuncture

Acupoints: Baihui (GV 20) and Sishencong (EX-HN 1).

Operation: The patient took a prone position. After standard sterilization, filiform needles of 0.30 mm in diameter and 40-50 mm in length were used for treatment. The needles were inserted by 30° under galea aponeurotica. The needles were then applied with twirling manipulations by thumb and index finger, without lifting-thrusting, 200 times a minute. The needles were twirled for 2-3 min and then retained for 5 min. The needles were removed after another two times of twirling manipulation. When the needles were twirled and retained, the family members should keep communicating with the patient and help the patient move their limbs. The needling holes were pressed by dry cotton ball to prevent bleeding.

2.2 Moxibustion

Composition of herbal cake:Fu Zi(Radix Aconiti Laterails Preparata),Ma Huang(Fructus Aristolochiae),Rou Gui(Cortex Cinnamoni), Gan Jiang(Rhizma Zingiberis), etc.

Operation: The above herbs were ground to powder, then mixed with proper volume of water and honey, and made into tiny round herbal cakes of 1 cm in height and 5 cm in diameter. The cakes were placed in the shade to dry before using. Before treatment, moxa wool was made into cones of 3 g. During acupuncture treatment, herbal cakes were placed on Dazhui (GV 14) and bilateral Shenshu (BL 23), with a moxa cone placed on each cake. Then the moxa cone was ignited and replaced by a new one when burnt out. Totally 3 moxa cones were used for each point. If the patient felt unbearable scorching pain, the practitioner can place a new herbal cake between the old one and skin. The whole process cost about 30 min.

The acupuncture-moxibustion treatment was given once a day, 10 successive treatments as a treatment course. There was a 3-day interval between two courses. The therapeutic efficacy was evaluated after 3 treatment courses.

3 Observation of Therapeutic Efficacy

3.1 Observation indexes

The MMSE was adopted as the major observation index. MMSE includes 30 items, respectively examining the functions from the following 7 aspects: orientation to time, orientation to place, recent memory, calculation, registration and motor ability, language and complex commands. The full mark of this examination is 30 points, 1 point for each subitem. Score ≥17 points among the illiterate, ≥20 points for educational attainment of primary school, and ≥24 points for the level of middle school or above all indicate a normal state. Otherwise, dementia should be considered.

MMSE is the most influential tool for detecting cognitive impairment, and has been widely used in the whole world as it’s sensitive and easy-to-operate. Besides, MMSE has a content reliability. Its intra-class correlation coefficient reaches 0.99, and reaches 0.91 in the re-examination in 48-72 h[4].

3.2 Criteria of therapeutic efficacy[1]

To calculate the improvement rate based on the MMSE score before and after intervention.

Improvement rate ＝ (Post-treatment score －Pre-treatment score) ÷ Pre-treatment score× 100%.

Markedly effective: The improvement rate ＞20%.

Effective: The improvement rate ≥10%, but≤20%.

Invalid: The improvement rate ＜10%.

3.3 Treatment result

Before treatment, the MMSE score was (19.8±5.2) points, versus (22.8±6.6) points after treatment, and the difference was statistically significant (P＜0.01). After intervention, of the 48 subjects, 12 cases showed markedly effective, 28 cases showed effective, 8 cases failed, and the total effective rate was 83.3%. It indicated that this treatment protocol can significantly improve the mental state of AD patients.

4 Discussion

AD belongs to the scope of dementia diseases in TCM. It’s either caused by insufficient sea of marrow due to deficiency of kidney essence and failure of qi, blood, essence, and fluid to go up and nourish brain, or caused by blockage of orifices by phlegm or blood stasis[5]. Relevant studies have proven that hemorheological abnormity is the pathological factor of dementia. It’s found that acupuncture at scalp acupoints can significantly improve six parameters of hemorheology, indicating that acupuncture at scalp acupoints can activate the cerebral cortex, improve cerebral arterial elasticity, dilate blood vessels, increase cerebral blood flow, and subsequently ameliorate the thick, sticky, accumulated and stagnated condition of blood, beneficial to the blood circulation in brain, increase of brain cell nutrition, and the healing of brain tissues[6]. Baihui (GV 20) is located at the vertex, and as a point of the Governor Vessel, it can boost yang qi, connect with marrow and brain, regulate the function of the organs, and thus improve the mental and motor function of the patients[7]. Sishencong (EX-HN 1) are extraordinary points, working to calm and soothe mind, tonify brain and benefit intelligence, and thus effective for brain diseases. The combination of the above points can regulate qi activity and unblock meridians and collaterals, for reinforcing kidney and the origin, tonifying qi and generating blood, consequently supplementing brain and marrow, and improving dementia[8-10].

Selecting Dazhui (GV 14) for moxibustion is also to treat AD by intervening the Governor Vessel. Because Dazhui (GV 14) is the crossing point of the qi of the three yang meridians and the Governor Vessel, moxibustion can activate yang qi and connect with marrow and brain through working on it. Clinical studies have shown that acupuncture at Baihui (GV 20) and Dazhui (GV 14) can produce a content efficacy in treating senile dementia[11]. Shenshu (BL 23) was selected for tonifying kidney as kidney deficiency is the root of AD. As the congenital foundation, kidney is playing a predominant role in the whole development of life, from birth to death, thus it’s closely related to the onset and development of AD. The memory of human is also associated with the kidney essence. Although AD is diseased in brain, it’s in fact induced by the deficiency of kidney essence. When kidney deficiency leads to insufficient sea of marrow and malnutrition of brain, symptoms such as poor memory, intelligence impairment, and remote expression will occur and dementia will then develop. Nowadays, it’s often reported that tonifying kidney and brain is effective in treating senile dementia. It proves that kidney deficiency is a crucial factor in the degeneration of brain and the progress of dementia. Kidney qi is transported into lumbar region via Shenshu (BL 23), which is internally connected with Mingmen (GV 4). The Yuan-Primordial qi is transported to brain and organs by the Bladder Meridian of Foot Taiyang. Therefore, Shenshu (BL 23) can directly work on the root of AD, tonifying kidney and strengthening the foundation, generating marrow and benefiting intelligence[7]. Previous laboratory studies also improved that acupuncturemoxibustion at Shenshu (BL 23) can improve the learning ability of AD rat models[12], providing evidence for the treatment of cognitive disorders with acupuncture-moxibustion.

AD is a difficult clinical issue, so far without a cure. Although medication is always the major method for AD, its side effects and adverse effects are significant, because the poor function states of the liver and kidney in the elderly reduce the absorption but increase the sensitivity, and extend the digesting time in the body[13]. Acupuncture-moxibustion is free of these problems, and it’s safe and effective, easy-to-operate, and beneficial to the general improvement of the quality of life of AD patients, worthy of further promotion in clinic.

Conflict of Interest

The author declared that there was no potential conflict of interest.

Acknowledgments

This work was supported by Shanghai Traditional Chinese Medicine Integrated Hospital, Shanghai University of Traditional Chinese Medicine.

Statement of Informed Consent

All of the parents of the children in the study signed the informed consent.

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Translator: Hong Jue

R246.6

: A

Date:July 5, 2014