BACKGROUND: Hemorrheologic indexes and the disturbances of lipid metabolism are closely correlated with stroke. Whether scalp acupuncture can correct the abnormality of hemorrheologic indexes, and improve the hyperviscosity of stroke patients, and then ameliorate their brain function? OBJECTIVE: To observe the curative effect of internationally standardized scheme of scalp acupuncture on stroke, and analyze the influence of scalp acupuncture on the hemorrheologic indexes, levels of blood lipids and plasma endothelin in stroke patients. DESIGN: A randomized controlled observation. SETTING: Department of Acupuncture and Moxibustion, Wuhan Hospital of Integrated Traditional Chinese and Western Medicine. PARTICIPANTS: Totally 128 stroke inpatients were selected from the Department of Acupuncture and Moxibustion, Wuhan Hospital of Integrated Traditional Chinese and Western Medicine from May 2000 to June 2005, including 72 males and 56 females, with an average age of 64 +/- 37 years. All the subjects were accorded with the diagnostic standards of stroke in the criteria for the traditional Chinese medicine (TCM) diagnosis and efficacy evaluation (in trial) and the diagnostic key points for cerebrovascular diseases revised by Chinese Association of Neurology, and they were all confirmed by cranial CT scanning. Of the 128 patients, there 73 cases of cerebral infarction, 48 of cerebral hemorrhage, and 7 of mixed type. For TCM diagnosis, there were 79 cases of stroke involving channels and 49 cases of stroke involving zangfu organs. The stroke patients with randomly divided into scalp acupuncture group (n = 66) and body acupuncture group (n = 62). Meanwhile, 15 healthy physical examinees were taken as the normal control group. All the subjects were informed and agreed with the treatment scheme. METHODS: (1) Scalp acupuncture group: anterior oblique line of vertex-temporal (from Qianshencong to Xuanli (GB6)) and posterior oblique line of vertex-temporal (from Baihui (DU20) to Qubin (GB7)) were selected as the acupoints to perform acupuncture successively with 3 needles. At approximately 30 degree angle, the needle was quickly inserted beneath the scalp. When the needlepoint reached the lower layer of galea aponeurotica and less resistance was felt by fingers, the needle was inserted horizontally as scalp for another 1.0 to 1.5 cun, then twirled rapidly and continuously at the speed of about 220 times per minute. Afterwards the needle was retained for thirty minutes and twirled once every five minutes, and every twirling lasted for two or three minutes. During the retention, the affected part should be moved about either actively or passively. (2) Body acupuncture group: the acupoints were Jianyu (LI15), Quchi (LI11), Hegu (LI14), Waiguan (SJ5), Huantiao (GB30), Yanglingquan (GB34), Zusanli (ST36) and Sanyinjiao (SP6), etc, and eight to ten acupoints of them were inserted each time using acupuncture needles (1.0 to 4.0 cun). Having brought about the needling sensation in acupuncture treatment, uniform reinforcing-reducing method was conducted. The needles were also retained for 30 minutes with hand manipulating of the needles once every five minutes. Both groups received treatments once a day and six treatments as a course, there was a one-day interval between two courses, continuously for 4 courses. (3) The Criteria for Diagnosis and Therapeutic Effect Evaluation of Apoplexy was applied to evaluate the curative effects of all the patients after 4 courses. (4) At one day before the treatment and after four courses of treatment, the hemorrheologic indexes were assayed with LBY-N6 hemorrheologic apparatus produced by Tianjin Techcomp Ltd, and blood lipids were tested with automatic biochemical analyzer, while radioimmunoassay (RIA) was used to measure the level of plasma endothelin. (5) Difference of ranked data were compared by means of Radit analysis. And t test was used for comparison between two groups while pairing t test was used for comparison of enumeration data before and after treatment. MAIN OUTCOME MEASURES: (1) Comparison of curative effects between the scalp acupuncture group and body acupuncture group; (2) changes of hemorrheologic indexes, levels of blood lipids and apolipoprotein in the stroke patients before and after scalp acupuncture treatment; (3) comparison of level of plasma endothelin between the scalp acupuncture group and normal control group before and after scalp acupuncture treatment. RESULTS: Thirty-six patients in the scalp acupuncture group were excluded due to incomplete data, thus there were 30 cases in the scalp acupuncture group, 62 cases in the body acupuncture group and 15 controls entered into the result analysis. (1) Comparison of curative effects between the scalp acupuncture group and body acupuncture group: there was no significant difference in the curative effects between the scalp acupuncture group (91%, 60/66) and body acupuncture group (86%, 54/62) (u = 1.77, p > 0.05). (2) Changes of hemorrheologic indexes, blood lipids and level of apolipoprotein in the stroke patients before and after scalp acupuncture treatment: in the scalp acupuncture group, the whole blood viscosity at high shear rate, plasma high shear rate, hematocrit, erythocyte aggregation index and whole blood reduction viscosity after treatment (4.44 +/- 1.08 mPas, 2.00 +/- 0.53mPas, 38.46 +/- 5.88%, 1.99 +/- 0.38, 22.76 +/- 6.78 mPas) were obviously lower than those before treatment (5.08 +/- 0.92 mPas, 2.34 +/- 0.58 mPas, 41.69 +/- 5.89%, 2.36 +/- 0.57, 29.96 +/- 7.92 mPas, t = 2.156 to 1.783, p < 0.05 to 0.01); whereas the deformation index increased significantly after treatment (0.91 +/- 0.33, 0.75 +/- 0.21, t = 2.240, p < 0.05). In addition, the levels of total cholesterol, triglyceride, low density lipoprotein cholesterol along with apolipoprotein B were remarkably reduced in the scalp acupuncture group after treatment as compared with those before treatment (4.80 +/- 1.16, 3.22 +/- 1.31 mmol/L, 0.93 +/- 0.26 g/L; 5.56 +/- 1.22, 1.76 +/- 0.45, 4.28 +/- 1.29 mmol/L, 1.23 +/- 0.53 g/L, t = 2.473 to 3.158, p < 0.05 to 0.01); meanwhile, the ratio of apolipoprotein A and B was elevated (1.92 +/- 1.05, 1.49 +/- 0.71, t = 2.154, p < 0.05). (3) Effect of scalp acupuncture group was notably than that in the normal control group of plasma endothelin in the scalp acupuncture group was notably higher than that in the normal control group (117.93 +/- 31.80, 54.80 +/- 13.21 mg/L, t = 7.345, p < 0.01), but declined dramatically after treatment (70.87 +/- 29.49 ng/L, t = 5.943, p < 0.01). CONCLUSION: (1) Scalp acupuncture treatment has been proved to have an affirmative curative effect on stroke, identical as that of body acupuncture treatment. (2) Moreover, scalp acupuncture can improve the hemorrheologic indexes, accommodate disturbances in lipid metabolism and reduce the level of plasma endothelin in stroke patients.

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