Alternative Medicine That Works for Regular Folks
     
Updated June 15, 2004
 
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Integrating Chinese and Western Medicine for Post-Stroke Aphasia
By Brian B. Carter, MS, LAc


Brain Scan of Stroke Survivor

As a writer, my passion for the last five years has been to explain Chinese medicine to regular people. I'm on the verge of publication of my first full book on that topic.

As a thinker, one of my biggest curiosities is about how Chinese medicine can be explained in terms of Western medicine, and how Western medicine might be clarified or interconnected by Chinese medicine. This is one reason I'm preparing to go to medical school in 2006.

The first thing I learned about that stimulated my interest in this area was Zang-Hee Cho's experiments with acupuncture and PET-scans of the brain (I've described this elsewhere).

Then, while writing other articles, I made many forays into the vast wilderness of PubMed, the National Library of Medicine's database of millions of abstracts of scientific research. On one such journey, I found another interesting integrative connection…

Strokes, Difficulty Speaking, and Acupuncture

After a stroke, some people have difficulty speaking. This is called aphasia. It may be due to an inability to control the muscles of speaking (the tongue and/or muscles of the jaw), or the stroke may have damaged the language centers of the brain.

The first study I ran across on this topic was a 2003 University of Hong Kong fMRI study of acupuncture on 17 healthy males.(1) The acupuncture points stimulated were San Jiao 8 (SJ8) and Du15, both of which were called "language-implicated acupoints." This may have been a reference to other research on the effect of these acupoints on the brain's language centers.

Traditionally, SJ8 is said to improve conditions of the throat, (and perhaps by extension, the vocal cords), and Du15 benefits the tongue, treats muteness, treats flaccid tongue, loss of voice, and stiff tongue with inability to speak.
In the experiment, the Hong Kong researchers stimulated one or the other acupoint with electricity (it doesn't state that they needled them as in typical electroacupuncture, so it may have simply been a TENS, or transcutaneous electrical stimulator). They report getting the same brain activity results on the fMRI from either point.

The brain activity from these points was in the "right inferior frontal gyrus and in the left and right superior temporal gyri. Nevertheless, no activation was seen in the left inferior frontal gyrus." The reason they thought it significant that there was no activation in the left inferior frontal gyrus was that this is the side where normal speech originates. (ERROR corrected from print version) Normal "syntactic and semantic processing" activates the inferior frontal gyrus on both sides. (2) The Hong Kong researchers concluded that, "although (their) results support the notion of acupoint-brain activation, applying acupuncture at SJ 8 or Du 15 does not activate the typical language areas in the left inferior frontal cortex."

Seemingly, they were baffled by the results, and went no further with their investigation. But I wondered, why would they get results atypical of normal speech from points that should restore normal speech? I also wondered when else this strange grouping of three brain areas would become active. So, I searched PubMed for that information.

Not coincidentally, I found a study of how the brain compensates for how strokes impair normal language operation.(3) They found that stroke survivors with aphasia who recover language ability use the exact areas of the brain activated by acupuncture in the other study. As they said, "these differential activation patterns suggest a hierarchy within the language-related network regarding effectiveness for improvement of aphasia; ie, right hemispheric areas contribute, if left hemispheric regions are destroyed."

This aphasia study had nothing to do with acupuncture. It's possible neither group of researchers knows the others' research exists. Each contained a piece of the puzzle. The picture formed by both pieces suggests that acupuncture could increase the ability of aphasic post-stroke patients to recover normal speech.

Of course, more research should be done to compare two groups of stroke survivors- we need a study that compares an acupuncture group to a control group. In the meantime, clinicians can add acupuncture to the stroke recovery regimen.

References:

  1. Li G, Liu HL, Cheung RT, Hung YC, Wong KK, Shen GG, Ma QY, Yang ES. An fMRI study comparing brain activation between word generation and electrical stimulation of language-implicated acupoints. Hum Brain Mapp. 2003 Mar;18(3):233-8. This is not a large group, and wouldn't be sufficient for an RCT, but for a mechanism study like this, it is enough to establish a pattern.
  2. Ni, W., Constable, R.T., Mencl, W.E., Pugh, K.R., Fulbright, R.K., Shaywitz, S.E., Shaywitz, B.A., Gore, J.C., Shankweiler, D. An event-related neuroimaging study distinguishing form and content in sentence processing. Journal of Cognitive Neuroscience 12 (1), pp. 120-133. 2000.
  3. Heiss WD, Kessler J, Thiel A, Ghaemi M, Karbe H. Differential capacity of left and right hemispheric areas for compensation of poststroke aphasia. Ann Neurol. 1999 Apr;45(4):430-8.
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All information herein provided is for educational use only and not meant to substitute for the advice of appropriate local experts and authorities.

Copyright 1999-2074, Pulse Media International, Brian Carter, MSci, LAc, Editor