JOURNAL OF CHINESE MEDICINE NUMBER 52 SEPTEMBER 1996

ACUPUNCTURE TREATMENT OF COMPLETE TRAUMATIC PARAPLEGIA

Analysis of 261 Cases
by Gao Xipeng, Gao Chenming, Gao Jincui, Han Chenggang, Han Fei, Han Bing, Han Ling

raumatic paraplegia is commonly seen in cases of injury of the spinal cord. Based on the significant therapeutic effectiveness obtained from our acupuncture treatment of facial paralysis, monoplegia, hemiplegia and multiple neuritis, we started to treat traumatic paraplegia with acupuncture in 1963. From 1976 to 1993, 261 patients were diagnosed as having complete traumatic paraplegia and were treated by acupuncture.

mittent urinary incontinence), complete loss of sensation under the level of the injury and inability to flex or extend muscles. In addition dystrophy, oedema and bed sores may occur.

Method of treatment
Traditional Chinese medicine holds that traumatic paraplegia is the consequence of damage to the Du Channel. The Du Channel travels along the back and is in charge of the yang qi of the whole body. Damage to the Du Channel may cause yang deficiency. The loins are the place where the Kidneys are situated, and the Kidneys store the essence of life, regulate the water metabolism, determine the condition of the bones and marrow, and have their specific openings in the urogenital orifice and the anus. Abnormal urination and defecation are a common consequence of traumatic paraplegia. Damage to the Du Channel leads to obstruction of the channels and collaterals and sudden stagnation of qi and blood circulation; thus the limbs are paralysed owing to the dystrophic changes. The principle of treatment should be to clear and activate the channels and collaterals, promote blood circulation to dissipate blood stasis, reinforce the Kidneys and support yang The acupoints are selected according both to the systemic symptoms and signs, as well as for urinary incontinence, etc. 1. Points selected for systemic symptoms and signs Group 1: Huatuojiaji (Extra) points between the first and second spinal processes above and below the level of injury Shenshu BL-23 Mingmen DU-4 Pangguangshu BL-28 Dachangshu BL-25 Ciliao BL-32 Huantiao GB-30 Weizhong BL-40 Yinmen BL-37

About the patients

Of the 261 cases, 247 were male and 14 female. The age was 70 years in 1 case, 50-69 in 9 cases, 30-49 in 84 cases, 20-29 in 149 cases, 10-19 in 13 cases, and 1-9 in 5 cases. The course of trauma before hospitalisation was 1-6 months, 7-12 months, 1-2 years, 2-5 years and over 5 years in 24, 32, 92, 97 and 16 cases respectively. The sites of injuries were located at cervical, cervical-thoracic, thoracic-lumbar, and lumbar-sacral segments in 19, 47, 182 and 13 cases respectively. 146 cases were caused by crush injury, 39 cases by fall, 25 cases by falling from a height and 51 cases by traffic accidents.

Criteria of diagnosis
The diagnosis was made by a comprehensive analysis of clinical signs, physical findings, X-ray film of the spinal column and findings in surgical exploration. Clinically, a presumptive diagnosis of complete transverse injury of the spinal cord (from cervical 1 to sacral 2 segments) was based on i. fragmentation of the spinal cord confirmed by exploratory surgery, ii. osseous obstruction due to fracture or dislocation of the spinal column as revealed by X-ray films of the spinal column, and iii. the main clinical manifestations: at the beginning, the patient was in the stage of spinal shock, both arms and legs or both lower extremities presenting complete flaccid paraplegia; as the spinal shock relieved gradually, both lower limbs became spastic or else complete flaccid paralysis remained; there was widespread muscular atrophy, central dysuresia (uroschesis or inter-

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JOURNAL OF CHINESE MEDICINE NUMBER 52 SEPTEMBER 1996

Chengfu BL-36 Chengshan BL-57 Kunlun BL-60 Group 2: Guanyuan REN-4 Zhongji REN-3 Zhongwan REN-12 Qihai REN-6 Tianshu ST-25 Fengchi GB-20 Hegu L.I.-4 Yangchi SJ-4 Waiguan SJ-5 Quchi L.I.-11 Jianyu L.I.-15 Zhongzhu SJ-3 Fengshi GB-31 Yanglingquan GB-34 Zusanli ST-36 Sanyinjiao SP-6 Qiuxu GB-40 Taichong LIV-3 The two group of points were applied alternately every other day with the uniform reinforcing-reducing method, and the needles were retained for 30 minutes. 12 sessions constituted one course of treatment. 2. Points selected for treatment of urinary incontinence, etc: The disturbance of co-ordination between the detrusor muscles of the bladder and the sphincter muscles after spinal injuries may lead to urinary retention and incontinence, infections of the urinary tract and dysfunction of the kidney. In patients with urethral catheters, the catheter not only brings bacteria into the urinary tract, but also frequently injures the mucous membrane. For this reason the catheter should be withdrawn as early as possible to avoid infection. The following two groups of points were selected for treatment of urinary retention and incontinence: Group 1: Shenshu BL-23 Pangguangshu BL-28 Dachangshu BL-25 Ciliao BL-32 Weizhong BL-40 Chengshan BL-57 Kunlun BL-60 Group 2: Guanyuan REN-4 Zhongji REN-3 Zhongwan REN-12 Qihai REN-6 Tianshu ST-25 Yinlingquan SP-9 Yanglingquan GB-34 Sanyinjiao SP-6 Taichong LIV-3

For patients with spinal injuries at the thoracic-lumbar segment, early therapy should be given with the uniform reinforcing-reducing method. Needles were retained for 30 minutes. 12 sessions constituted one therapeutic course of treatment. After two courses, the catheter could in most cases be withdrawn, and urination would take place with the help of massage. The acupoints Guanyuan REN-4 and Zhongji REN-3 may be used alternately, with oblique insertion of the needle to a depth of 3 cun, to induce a needling sensation of local soreness and distension radiating toward the external genitalia. Before needling, the bladder should be free of urine. The depth of insertion for the Huatuojiaji (Extra) points was 1-1.5 cun with a needling sensation transmitted bilaterally or a tightening sensation in the corresponding body cavity.

Analysis of Therapeutic Results

Criteria of therapeutic effectiveness: Essential cure: basic recovery of the functions of the nervous system, ability to walk freely without help, and almost voluntary urination. Marked effectiveness: partial recovery of the functions of the nervous system, walking on crutches and restoration of urinary bladder reflex. Improvement: some improvement of the functions of nervous system, including movement, defecation and/or urination. Ineffectiveness: no significant changes after treatment. Therapeutic results: Of the 261 cases, 8 cases (3.1%) were essentially cured, 92 cases (35.2%) were markedly effective, 149 cases (57.1%) were improved, and 12 cases (5.0%) were ineffective. The total effective rate was 95.0%. Of the 8 essentially cured patents, 1 case was 50 years old, 3 cases 20-29 years old and 4 cases 10-19 years old; the injured segments were at thoracic-lumbar in 1 case and lumbar-sacral in 7 cases; the causes of injuries were crush for 5 cases and fall for 3; the duration of trauma before hospitalisation was 3-6 months.

Typical case
Liu, a male student of South California University, was injured at his 9th thoracic vertebra in a traffic accident in July, 1982. He underwent surgery in the Paraplegia Hospital in Los Angeles, USA, and was carefully treated in the Paraplegia Convalescent Centre in Los Angeles. When the first author of this report attended an international conference in the USA in July 1984 and met the patient, he had already been in a complete paralysed state for 2 years and had to rely on a urethral catheter to urinate. After 10 days acupuncture therapy, he was able to urinate at regular intervals with the help of massage but without the catheter. In May 1985, when the author was again in the USA, the patient was treated with acupuncture for an additional 3 months, and he was subsequently able to walk independently on crutches.

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Comments
A large amount of experimental data has demonstrated that intrinsic regenerative potential of the central nervous system does exist in mammals, especially in newborn and infant animals. Axons can be regenerated in a suitable microenvironment, as well as budding of the lateral branches and reconstruction of synapses. Improving the microcirculation in the spinal cord may promote the regenerative potential of the central nervous system. We hold that under certain conditions, the stimulus elicited by acupuncture may induce the regenerative process of the injured nerves and promote restoration of their functions. Acupuncture may be one of the measures to solve the problem of regeneration of the spinal cord. The more prompt the adoption of acupuncture in patients with traumatic paraplegia, the sooner the recovery of their functions, which is possibly related to the regenerative potential of the injured spinal cord. Therefore, we consider that the patient should be treated with acupuncture as early as possible. Of course, there are some patients in whom the ability of the spinal cord to regenerate has been lost, and in these cases acupuncture can no longer restore their functions.
Gao Xipeng, Gao Chenming, Gao Jincui, Han Chenggang and Han Fei, work at the Paralysis Institute, Yuci 030610, Shanxi Province, Han Bing at Shanxi Medical College, and Han Ling at Guangzhou College of TCM.

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