Recovering From Stroke with Acupuncture

Q: I had a stroke 7 years ago. It was due to a blood clot in the brain. I am making a good recovery, but I am curious to know if acupuncture would benefit me.
Tim

A: Tim, the best time to get acupuncture for stroke is immediately afterwards - ideally while still in the hospital, if the docs will allow it. Seven years is a long time to wait for acupuncture. But it still may help you… You won't know unless you try it.

Scalp Acupuncture
Usually scalp style acupuncture is used for stroke. Needles are "threaded" along the scalp underneath the skin. There are at least three different scalp systems (Dr. Jiao Shun Fa's original style from the 1970s, Dr. Zhu's, and Dr. Yamamoto's styles). Call local acupuncturists and find out if they have experience with scalp acupuncture.

How Many Treatments?
It may take 10-20 treatments to get results. In China, they treat patients every day. That's not financially realistic here, but 2 or 3 times per week is good. In your case - after 7 years - it may take sustained and intense stimulus to make a change.

Complementary Therapies
You can also take herbal formulas to balance out the constitutional issues that led to the stroke, and help repair the damage. Acupuncture can be combined with physical rehab. It can improve both motor function (ability to move muscles) and sensory (ability to feel). You may recover function to some degree, but in more serious strokes there may be no response.

Will it Work for Me?
It's hard to say whether an individual will respond and how much- partner with the acupuncturist - they will get to know you case thoroughly, integrate what they're doing with your other medical providers. See the acupuncturist until you hit a plateau. Then your acupuncturist may try another system or strategy.

Stroke and Acupuncture Research
What's clear from several studies is that very severe stroke patients may be less likely to respond to acupuncture. This issue has not been thoroughly researched. Typically, American researchers have used inadequate acupuncture (style, points, and frequency of treatments). They conduct and review studies using points that Chinese acupuncturists would not use, and then conclude that acupuncture doesn't work. I say, "No, it's your brain that doesn't work, because you don't do a thorough literature review before designing your studies!"

As James Rotchford, MD, (a medical doctor and acupuncturist who has reviewed hundreds of acupuncture research studies and reviews on his website, www.acubriefs.com) mentions below, there are many approaches within acupuncture. Scalp styles (there are 3 - who knows which is most effective when - a good research topic) appear to be best for neurological conditions like stroke, MS, and post-concussion syndrome. To study body acupuncture points for stroke demonstrates unfamiliarity with the work that has been done thus far.

Is the acupuncture (style, points, and frequency of treatments) studied in most research considered the most effective kind by acupuncture experts?

It is not.

Why study acupuncture points and styles that clinicians themselves don't think work?

Three possibilities come to mind:

Arrogance: "Even though Chinese have been doing acupuncture for thousands of years, they don't know anything about it." This isn't so implausible - mainstream American docs and researchers already ignore European research - why not Chinese, too? If their methodology differs from the drug-model, it's because they aren't as advanced as us. And if we disagree with the results, the methodology is criticized. Otherwise, it's fine. Psychological studies of the research review process have proven this bias.
Idiocy: It's hard to imagine that someone smart enough to do research isn't smart enough to read the literature, but I suppose it's possible, or
Conspiracy: "Let's do the wrong acupuncture on purpose so we have proof that acupuncture doesn't work." This would be fool's work, since there is already incontrovertible evidence that it does.
If the studies suck, then why review them?

Because a review of multiple studies carries more weight than just one study. It's easier to convince people with a review.

The major issue with research reviews is that if the studies were inadequate in the first place, then the review's conclusions will be wrong. Until the methodology and study designs are improved, what's the point?

Again, we suggest researchers review the Chinese medicine literature. Rotchford advocates outcome studies rather than drug-style RCT's. In outcome studies, no placebo is used, but there is no satisfactory placebo for acupuncture research.

When acupuncture studies are done well, why aren't the results always positive?

Rotchford says, "Dr. Naeser has shown that the extent of CT demonstrated destruction does make a distinct difference in response to acupuncture. Why are Western studies equivocal when those from China and Japan so heavily support a role for acupuncture treatment in thousands of cases?

"First, the acupuncture approach is different. In the Orient, acupuncture is done daily to twice daily for maximum stimulation of the nervous system. Various experts recommend treating 3 times weekly as a minimum; more would be better.
"Second, Western studies use standard major Yang Ming and Shao Yang points. Chinese studies indicate that using scalp points alone or in addition to provide a stronger input. A newer approach, Xingnao Kaiqiao (A consciousness awakening), generated by Dr. Shi Xuemen and co workers, appears extremely attractive. They treat PC 6, GV 26, SP 6, BL 40, HT 1 (a bit distal to the usually designated point), LU 5, and LI 4 in sequence each to the point of tears (GV 26) and muscle jerking. In a series of 3200 patients, an essential cure is claimed in 58% and 90% effective improvement to the point of reasonable self sufficiency. Other points are added for pseudobulbar palsy, where good results are reported in over 300 patients. Comparing this technique to traditional Yang points and to scalp acupuncture, they denote excellent results in 76% versus 36%.
"I suggest a study such as done by Johansson's group, using Xingnao Kaiqiao, and with treatment given at least 5 days a week. Third, we must consider Qi transmission from healer to patient in any therapy, especially in acupuncture. I believe intent is essential; and the intensity of interest and empathy might create a much improved healing. Considering this, the background and training of the involved acupuncturists in a study should be noted." - from his review of "Acupuncture For Dysphagia Following Stroke." (see link below)

So, the people doing acupuncture research don't study Chinese medical acupuncture, but rather their own strange version of it - who knows where it comes from. I have no idea who's teaching them (are they teaching themselves?), or what books they are reading, if any. I'm not usually so bluntly critical of people's work, but as a body of work, I'd say that American acupuncture research has earned the distinction of being mostly useless.