THE JOURNAL OF ALTERNATIVE AND COMPLEMENTARY MEDICINE

Volume 19, Number 5, 2013, pp. 474–477

ª Mary Ann Liebert, Inc.
DOI: 10.1089/acm.2012.0163

Acupuncture Helps Regain Postoperative Consciousness

in Patients with Traumatic Brain Injury: A Case Study

Ying-Jung Tseng, MD,1 Yu-Chiang Hung, MD, PhD,1 and Wen-Long Hu, MD, MS1–3

Abstract

Objective: This report of one case illustrates the potential effect of acupuncture therapy in addition to Western
medicine for regaining postoperative consciousness in patients with traumatic brain injury (TBI).
Clinical features: A 65-year-old man experienced a TBI after being involved in a motor vehicle accident. His
initial Glasgow Coma Scale (GCS) score was E1V1M2, and brain computerized tomography showed a right-
sided subdural hemorrhage. He received emergency medical treatment and underwent craniotomy to remove
the lacerated portions of brain as well as subtemporal decompression, followed by a decompressive craniectomy
the following day to remove an intracerebral hematoma due to late-onset temporo-parietal rebleeding. Twelve
days after surgery, the patient remained in poor condition due to serious complications and the GCS was
E2VeM4. His family then underwent counseling and he subsequently received acupuncture treatment.
Intervention and outcome: This patient was treated with acupuncture three times each week, consisting of strong
stimulation at GV26 (Shuigou) and the 12 Well points using the half-needling technique. After 3 weeks of
consecutive treatment, his GCS score improved to E4VtM6. In addition, he regained consciousness and could
tolerate rehabilitation programs.
Conclusions: We believe that an experienced physician may use acupuncture as complementary therapy in
patients with TBI who fail to regain consciousness postoperatively.

Introduction to evacuate any hematoma. Decompressive craniectomy can

be lifesaving, but the prognosis may remain grave.2

I n Taiwan, traumatic brain injury (TBI) accounts for

12.5% of all traumatic injuries and leads to death in 55% of
cases.1 The lives of many patients with critical TBI have been
saved because of developments in the field of neurocritical
care medicine. However, an unfortunate outcome of these
injuries is that patients often experience loss of consciousness
and permanent disability.
Despite improvements leading to more rapid diagnosis
and surgical intervention, outcomes in patients with severe
head injury remain poor. Mortality rates among patients
admitted to the hospital with TBI range from 20% to 40%.
One-fifth of patients who survive the injury will have sig-
nificant long-term neurologic disability. Less than one-third
of patients whose best initial Glasgow Coma Scale (GCS)
score is £ 8 will have a favorable outcome.2 Patients whose
GCS score is £ 8 and who have abnormal findings on head
computerized tomography (CT) following head injury will
usually require intracranial pressure monitoring and surgery
Some studies conducted and published in China have
suggested that acupuncture may be beneficial in the acute
treatment and rehabilitation of TBI.3 This paper presents a
case of a patient with TBI who underwent craniectomy and
removal of intracerebral hematoma and whose GCS score
improved from E2VeM4 to E4VtM6 with a restoration to
consciousness after 3 weeks of acupuncture treatment, in
addition to Western medicine.
Case Report
History and examination
A 65-year-old man in good health with no past medical or
surgical history suffered a TBI after a motor vehicle accident
on May 26, 2011. He presented with a severe head contusion
and was comatose upon arrival to the emergency room. In
the emergency room, his first GCS score was E1VeM2, his
pupils were dilated to 5/5 mm without a noticeable light

1
Department of Chinese Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine,
Kaohsiung, Taiwan.
2
Kaohsiung Medical University College of Medicine, Kaohsiung, Taiwan.
3
Fooyin University College of Nursing, Kaohsiung, Taiwan.

474
ACUPUNCTURE FOR TRAUMATIC BRAIN INJURY
FIG. 1. Head computed tomography (CT) reveals right
fronto-temporo-parietal subdural hematoma with mass ef-
fect (a) and soft tissue swelling of the scalp over the right
parietal area due to traumatic injury (b).
reflex, and muscle strength was 4/2/2/1 (right arm/right
leg/left arm/left leg). Head CT showed a right-sided sub-
dural hemorrhage over the cerebellar tentorium and falx
cerebri with midline shift (Fig. 1).
Due to the presence of severe brain edema and the critical
condition of the patient, he underwent craniotomy to remove
the lacerated portions of the right fronto-temporo-parietal
lobes and partial resection of the right temporal tip for de-
compression. The day following initial operation, tremors
475
were noted, indicating late-onset temporo-parietal rebleed-
ing. Decompressive craniectomy was performed to remove
additional intracerebral hematoma and to institute intracra-
nial pressure monitoring in the neurosurgical intensive care
unit. The patient did not regain consciousness after the sec-
ond operation and experienced residual left hemiplegia. The
patient remained in poor condition due to development of
pneumonia, malnutrition, and electrolyte imbalance due to
diarrhea and was dependent on mechanical ventilation due
to respiratory failure. Twelve days after the initial operation,
the GCS score remained E2VeM4. He was unable to be
weaned from the ventilator, and a tracheostomy was per-
formed on June 21, 2011.
Acupuncture therapy and outcome
Acupuncture intervention was suggested as a comple-
mentary therapy. The patient’s family underwent counseling
and the patient subsequently received the first acupuncture
treatment on June 8, 2011. He received acupuncture therapy
three times per week. Aims of treatment included improve-
ment in consciousness and movement of his left limbs. Each
therapeutic session began with strong stimulation at the
GV26 (Shuigou) point (at the junction of the upper and
middle third of the philtrum). Following the stimulation, a
half-needling technique was used that included the 12 Well
points of all four limbs. After nine therapeutic acupuncture
sessions, the patient’s GCS score improved to E4VtM6. Due
to the improvements in his condition, he was weaned from
mechanical ventilation and transferred to a general medical
ward on June 27, 2011. He was subsequently able to begin
rehabilitation programs (Fig. 2).
Discussion
Although decompressive craniectomy can be lifesaving for
patients with severe TBI, the prognosis may remain grave.
Patients who survive the initial injury may experience loss of
FIG. 2. Serial Glasgow Coma
Scale (GCS) scores over time and
timeline of treatments throughout
the patient’s course of hospitaliza-
tion. NSICU, neurosurgical inten-
sive care unit. Graph illustrates
timing of surgeries (green trian-
gles), acupuncture treatments (red
squares), and medication adminis-
tration. Time is indicated by
month/date and begins at the time
of hospitalization. Operations on 5/
26 and 5/27 were for head injury
and on 6/21 for tracheostomy.
476
consciousness and neurologic disability, which may have
long-term implications for recovery. We provided pre-
acupuncture counseling to the patient’s family by explaining
that acupuncture is a widely used treatment modality for
different neurological disorders, and because TBI has the
same pathophysiology as many other neurological disorders,
acupuncture may also be beneficial in TBI treatment or re-
habilitation.3 Furthermore, we explained that scalp acu-
puncture would be avoided to prevent interference with the
healing of the operation wound.
Shuigou is the point of intersection for Shouyangming,
Zuyangming, and the Governor Vessel; it is an essential
point for first aid. Acupuncture on Shuigou can restore
consciousness and promote resuscitation. Twelve meridians
reach the head, with the exception of the lung and pericar-
dium meridians. Twelve Well points were selected, based on
‘‘places where meridian passed, treatments thereby can be
reached.’’ Acupuncture at the 12 Well points can clear the
stagnant qi and blood within the meridians, adjust organs,
promote harmony within organs, un-impede meridians,
balance blood and qi, and promote harmony of yin and yang,
thus facilitating the treatment of the disease.4 For example,
a previous study showed that blood-letting punctures at
12 Well points of the hand improved the consciousness of
patients with small brain injuries.5
TBI has various outcomes, which depend on the severity
of the insult to the brain. Many patients recover gradually
over a prolonged period; however, some studies have re-
ported that patients with severe head injury have a mortality
rate of as high as 90%.2 A study that used electroencepha-
lographic (EEG) reactivity for the prognostic evaluation of
consciousness recovery in post-acute brain injury revealed
that 92% of the patient group with uncertain progress re-
covered consciousness within 5 months from EEG record-
ing.6 Our patient’s GCS score improved from E2VeM4 to
E4VtM6 with a restoration to consciousness after 3 weeks of
acupuncture treatment, in addition to Western medicine.
Therefore, acupuncture may have a role in facilitating con-
sciousness recovery.
The patient’s muscle strength was 3/1/2/1 (right arm/
right leg/left arm/left leg) after craniectomy and 3/2/2/1
when transferred to the general medical ward. A previous
study reported on a 10-week acupuncture treatment per-
formed on patients who were stable after neurosurgical op-
eration. The study revealed that early acupuncture can
improve the limb motor function of patients with severe
head injury.7 When our patient was finally discharged from
the rehabilitation ward on August 20, 2011, his muscle
strength was 4/3/4/3. Thus, combining rehabilitation with
acupuncture may have helped improve his left limb motor
function.
TBI can cause a range of debilitating sequelae that require
cognitive, motor, communication, emotional, or behavioral
rehabilitation of varying intensities and durations. In a study
that used acupuncture in combination with point-injection
therapy in posttraumatic coma patients, the GCS value in the
treatment group was higher than that of the control group,
but with no statistical significance ( p > 0.05).8 Electro-
acupuncture therapy has been shown to promote con-
sciousness in patients with long-term coma due to severe
craniocerebral trauma. The average awake time and awake
rate were 40.1 days and 73.3%, respectively, in the observa-
TSENG ET AL.
tion group, which were better than the respective values of
51.8 days and 28.6% in the control group.9
Acupuncture has been shown to be effective in improving
prolonged coma after brain surgery and also improving
muscle contractures induced by long periods of bed rest. A
slight increase in cerebral blood flow (CBF) along with the
recovery of consciousness was induced following acupunc-
ture therapy, suggesting a strong connection between CBF
and symptomatic improvement.10 The addition of acupunc-
ture therapy to conventional treatment for patients who fail
to regain consciousness after TBI without serious complica-
tion can enhance brain activation and restore conscious-
ness, leading to better therapeutic outcomes and increased
recovery and cure rates.11–15
The results of the various studies suggest that acupuncture
is efficacious for the acute treatment and/or rehabilitation of
TBI. However, the low methodological quality of the studies
renders the results questionable and does not allow us to
definitely conclude the efficacy and safety of acupuncture in
the acute treatment and/or the rehabilitation of TBI. The
beneficial role of acupuncture for these indications remains
uncertain. Further research with high-quality trials is re-
quired.3
Conclusions
Acupuncture at the GV26 and 12 Well points was associ-
ated with the recovery of postoperative consciousness and
shortening of healing time for this patient with TBI in poor
condition due to serious complications. An experienced
physician may use acupuncture as a complementary therapy
in surgically treated patients with TBI who fail to regain
consciousness. Thus, better outcomes can be achieved
through the combination of Western and Chinese treatments,
expediting and boosting treatment efficacy and ultimately
leading to decreased medical costs.
Author Disclosure Statement
No competing financial interests exist.
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