Châm cứu và Trung dược trong điều trị bại não

Châm cứu và Trung Quốc truyền thốngThuốc được sử dụng để điều trị bệnh bại nãotrừu tượngHầu hết y học cổ truyền Trung Quốc (TCM)phương pháp điều trị bệnh bại não ở trẻ em làcác liệu pháp không dùng thuốc, chẳng hạn như châm cứu, xoa bóp tui na và tắm thuốc.So với các phương pháp phục hồi chức năng thông thường, châm cứu, tập tễnh và các liệu pháp khácđược gọi là các liệu pháp phục hồi chức năng TCM. Ngày nay, tất cả chúng đều được cung cấp dưới dạngchăm sóc y tế cho trẻ em bại nãoở Trung Quốc. Hầu hết bệnh nhân trải qua điều trị TCM ở Trung Quốc. Ở các nước khác, liệu pháp điều trị TCM được coi là phương pháp điều trị bổ sungcho bệnh nhân bại não. Tuy nhiên,nghiên cứu nên được thiết kế khách quan hơn

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Medicine Used to Treat Cerebral Palsy Shuyun Jiang

Contents

Introduction 2

Treatment 2

Acupuncture and Moxibustion 2

Tui Na Therapy (Massage Therapy) 5

Traditional Chinese Medication for Topical Use 7

Comprehensive Chinese Medicine Therapy and Intervention 7

Complications 8

Pain 8

Infection 8

Acupuncture Syncope 8

Allergy 8

Curved or Fixed Needles 8

Case 1 8

Conclusion 12

Cross-References 12

References 12

Abstract

Most traditional Chinese medicine (TCM)

treatments for cerebral palsy in children are

nonpharmaceutical therapies, such as

acupunc-ture, tui na massage, and medicated baths

Compared with the conventional

rehabilita-tion, acupuncture, tui na, and other therapies

are called TCM rehabilitation therapies Now-adays, all of them are provided as primary medical care for children with cerebral palsy

in China Most patients experience TCM treat-ment in China In other countries, TCM thera-pies are considered complementary treatments for patients with cerebral palsy However, research should be designed more objectively Keywords

Cerebral Palsy · Acupuncture · Tui na therapy · Chinese medicine

S Jiang ( * )

Yueyang Hospital of Integrated Traditional Chinese and

Western Medicine, Shanghai University of Traditional

Chinese Medicine, Shanghai, China

e-mail: yadancoo@hotmail.com

# Springer International Publishing AG, part of Springer Nature 2018

F Miller et al (eds.), Cerebral Palsy,

https://doi.org/10.1007/978-3-319-50592-3_90-1

1

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Chinese medicine has a more than 5000-year

his-tory Even in today’s era, Chinese medicine still

plays a signiﬁcant role throughout the world In

China, most clinicians would choose a therapy

from traditional Chinese medicine (TCM) in

com-bination with conventional rehabilitation as the

primary intervention for children with cerebral

palsy It is necessary for patients to improve their

motor function before and after surgery, and

treat-ment with TCM helps them do this TCM is the

preferred treatment for families of children with

cerebral palsy, particularly those who live in

remote areas In other countries around the

world, TCM is considered to be an alternative

solution when families and physicians believe

that primary medical services could not solve the

problems Many TCM therapies are available for

patients with cerebral palsy, such as acupuncture,

tui na massage, medications for external use, as

well as the combined use of these treatments

In TCM, no such disease as cerebral palsy

exists However, some similar diseases were

described in the ancient Chinese literature Cao

Yuan Fang, a famous physician during the Sui

Dynasty (600 A.D.), described such as disease in

his book The Source of All Disease: Various

Syn-dromes in Children,“The kids cannot walk,

can-not talk at the age of 4, no tooth is grown, or no

hair is grown.” Ceng Shi Rong, in the Yuan

Dynasty (1200 A.D.), described in his book New

Viewpoints of Children“ﬁve softness,” which can

be explained as “the muscle weakness of [the]

head, neck, arm[s], feet and body.” Xu Chun Fu,

in Ming Dynasty (1500 A.D.) described “ﬁve

stiffness and ﬁve paralysis” syndrome, which

can be explained as tensions of the head, neck,

arms, feet, and body, in addition to theﬁve

paral-ysis above In 1700 A.D., the Textbook of

Tradi-tional Chinese Medicine deﬁned a series of “ﬁve

paralyses,” “ﬁve stiffnesses,” and “ﬁve delays”

(delays in standing, walking, speaking, body

growth, and tooth growth) as symptoms of

cere-bral disabilities in children To treat these

symp-toms, medicinal fumigation, acupuncture, and tui

na massage therapies were applied Nowadays

these theories have been developed more fully,

and many families prefer to apply acupuncture, tui na massage, and Chinese herbal medicine externally to treat children with cerebral palsy

Treatment

Acupuncture and Moxibustion

According to the etiology and pathogenesis of cerebral palsy, acupuncture and moxibustion treatments of cerebral palsy mainly include scalp acupuncture, electrical acupuncture, acupuncture point injection, among other treatment methods Scalp Acupuncture Therapy

In classic theory from one Chinese medicine book, Ling Shu stated, “The twelve meridians line, three hundred and sixty-ﬁve collaterals line, all the Xue (blood) and Qi (gas) are on the surface and ﬂow through channels.” The brain is the headquarters of human activities and is in charge

of people’s spiritual consciousness and various activities Scalp acupuncture is based on the func-tional localization of the cerebral cortex and uses corresponding stimulation areas to treat a variety

of diseases

The scalp acupuncture is a method in which acupuncture needles are placed in the head to manage various conditions Based on theories of the meridians system and collaterals of organs, clinicians select the relevant acupuncture points

on the surface of the head for treatment

For perform scalp acupuncture, patients take a sitting or lying position, depending on which acu-puncture points and areas need to be stimulated for the particular disease For example, when only one limb is involved, a contralateral stimulation area needs to be chosen if both limbs are involved, the therapist should select the respective stimulation area Before treatments, therapists should disinfect the areas

Acupuncturists usually use 1.5 to 2 in stainless steel needles The angle between the needle and scalp should be about 30 The needles should be inserted into the scalp quickly When the needle enters the lower layer of galea aponeurotica, the therapist will feel less resistance from the scalp

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Then the needle is set parallel to the scalp and

rotation continues Based on the acupuncture

point, therapists usually pierce 0.5–1.0 in deep

with the needle

Scalp acupuncture needles are only

manipu-lated through rotation (they are not lifted or

inserted) To keep a relativelyﬁxed depth and to

switch needles easily, hold the handle of the

nee-dle with the palmar side of the thumb and the

radial side of the indexﬁnger, quickly ﬂex and

extend the metacarpophalangeal joints in an

uninterrupted motion, and then make the needle

rotate from right to left and vice versa The

needles can rotate up to 200 times each minute,

turn continuously for 2–3 min, and are retained in

place for 5–10 min; this is repeated two to three

times, after which the needles areﬁnally removed

Hemiplegic patients are asked to exercise their

limbs the needles are in place in order to

strengthen the legs’ functional ability (For

patients who cannot actively move, the therapist

helps them perform passive movements) The

therapist should pull the needle out quickly or

slowly Finally, the therapist presses a sterile, dry

cotton ball to the pinhole for 1 min to prevent

bleeding

Usually, the therapist performs scalp

acupunc-ture every day or every other day, 10–15 times for

one course, and then every 5–7 days After that,

the patients continue on to the next course

Dr Dong (famous acupuncture specialist in

neurological diseases such as stroke, cerebral

palsy, etc.) developed an innovate theory of

scalp acupuncture combined with Wuzhang

acu-puncture in the back to make better progress in

treating children with cerebral palsy (Yang et al

2014) His scalp acupuncture program was based

on both the characteristics of the pathogenesis of

children with cerebral palsy and the classical

TCM theory that“All diseases should be managed

by the spirit” and “The speciﬁc acupuncture

points are relevant with the essential organs.”

This theory also emphasizes that“Scalp

acupunc-ture administer the mind and make the neuron

network more active,” “Utilizing the acupuncture

points in the back could manage signiﬁcant

func-tion,” and “Acupuncture therapy combined with

modern rehabilitation could reconstruct func-tional activity.”

One randomized controlled clinical study explored the impact of scalp acupuncture on motor function in children with cerebral palsy (Wang et al 2010) In that study, 74 children with cerebral palsy were randomly assigned to either the treatment group or the control group Children in the treatment group were treated with

an individual acupuncture treatment plan com-bined with physical exercise The researchers selected the Sishencong acupuncture point and many others based on motor and balance areas in Jiao’s acupuncture theory They also added more speciﬁc acupuncture points and areas according to patients’ individual disabilities For spastic cere-bral palsy, acupuncture points at the premotor area and the Ashi acupuncture point (located in the spindle of spastic muscles) were selected For cerebral palsy with involuntary movement and poor coordination, the acupuncture points in the application area and the Niesanzhen point were added For mental retardation, the Ewuzhen point was added The control group was treated with Jinsanzhen therapy, which is a set of acupuncture points at Zhisanzhen, Sishencong, Niesanzhen, and Naosanzhen Treatment was conducted every other day for 3 months The Gross Motor Function Measure (GMFM) was used to evaluate patients both before and after treatment The scores of children with spastic cerebral palsy were signiﬁcantly different before and after treat-ment (P< 0.01) The GMFM grade was consid-erably improved in both groups (P < 0.01), but the treatment group experienced more improve-ment than the control group (P < 0.05) Scalp acupuncture combined with rehabilitation exer-cise has a positive effect on the motor functions

of children with cerebral palsy Individual acu-puncture treatment plans improve the motor func-tions of children with spastic cerebral palsy better than conventional treatment

One study combined acupuncture and physical therapy to manage motor functions and intelli-gence in children with cerebral palsy and to pro-vide more epro-vidence for medical decisions (Wang

et al.2011) The results showed that the combina-tion of scale acupuncture with rehabilitacombina-tion could

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effectively improve the motor function and

cog-nitive ability of children with cerebral palsy –

more so than conventional acupuncture combined

with rehabilitation treatment

Another randomized controlled trial compared

outcomes of different retaining time of scalp

acu-puncture therapy (Yuan et al.2006) The results

showed that retaining the needles in the points for

an appropriate duration has a positive effect on

improving motor function in children with

cere-bral palsy The optimal duration was 60 min

Fur-thermore, while the needles were retained, the

therapeutic effect was more signiﬁcant in children

being treated with tui na massage at the same time

Electrical Acupuncture Therapy

Electrical acupuncture therapy could regulate the

body’s physiological function, reduce pain,

man-age sedation, promote blood circulation, and

adjust muscle tension, among other effects The

amount of stimulation during electrical

acupunc-ture treatment in patients with cerebral palsy is

objective, and the frequency of stimulation can be

reduced, which may lead to abnormal responses in

children

A randomized trial noticed effects of treatment

with and without electrical acupuncture on spastic

cerebral palsy (Qi et al 2008) Both the study

group and the control group received

conven-tional rehabilitation therapy and massage The

study group also received electrical acupuncture

therapy, whereas the control group did not receive

any acupuncture treatment Patients laid on the

bed, and the following acupuncture points were

selected: Yongquan, Taixi, Chengshan, Chengjin,

Heyang, Fuyang, and Feiyang The results

showed that, compared with the control treatment,

electrical acupuncture might reduce spasticity,

correct the severity of toe-walking, and improve

gait in children with cerebral palsy

Another study focused on the effect of

electri-cal acupuncture therapy in reducing spasticity in

patients with cerebral palsy (Xie and Wang2009)

Thirty children with cerebral palsy were randomly

divided into two groups: the control group,

receiv-ing conventional rehabilitation, and the treatment

group, which received conventional rehabilitation

and electrical acupuncture as treatment The

acupuncture points were Huatuo and Jiaji The results showed that electrical acupuncture with the Huatuo and Jiaji acupuncture points might reduce the spasticity of children with cerebral palsy Moreover, the study suggested that if the duration of treatment had been extended, the results would have been much better

One randomized controlled trial used a method combining electrical acupuncture and exercise therapy for children with cerebral palsy under the age of 3 (Tan et al.2009) The results showed that electrical acupuncture therapy combined with exercise therapy made a significant difference compared with simple exercise therapy only, and the younger the patient, the better the effect The research noted that the early diagnosis of cerebral palsy in children plays an important role in early treatment Brain Doppler ultrasonography also confirmed that the scalp acupuncture could improve cerebral bloodflow in children with cere-bral palsy

Acupuncture Point Injection Therapy Acupuncture point injection, also known as

“water needling.” So-called water needles or syringe needles are relative to original metal needles used in acupuncture The main part of acupuncture point injection therapy is to inject medicine into an acupuncture point, which is thought to significantly increase the drug’s thera-peutic effects The medicine can be from Chinese medicine, Western medicine, or both Acupunc-ture point injection therapy was founded in the 1950s, and it vigorously modernized Chinese medicine Many clinicians started to use syringe needles instead of original acupuncture needles in clinical practice The acupuncture point injection method quickly expanded to many researchfields, such as acupuncture point treatment for analgesia, and fostered significant developments

This therapy is quite different from traditional acupuncture The reaction that occurs after the medicine gets into the meridian and collaterals is completely different from that which occurs with traditional acupuncture Acupuncture point injec-tion therapy has shown efﬁcient clinical out-comes, but the traditional meridians and

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collaterals theory cannot fully explain and guide

modern acupuncture point injection therapy

The medicine for acupuncture point injection

therapy is divided into two categories: vitamins

and Chinese medicine Vitamins include vitamin

B12, vitamin D2-calcium fructose injection

Vita-min B12 is necessary for cell division and myelin

integrity in nerve tissue It also participates in

nucleoprotein synthesis and methyl conversion,

maintains, promotes tetrahydrofolate recycling,

and promotes nerve myelin quality synthesis

Cal-cium ions are necessary to maintain the proper

functions of nerves, muscles, and bones; they

also are involved in regulating the secretion and

storage of neurotransmitters, maintaining normal

muscle excitability, and promoting the absorption

of vitamin B12

An excellent TCM theory says,“Stasis leads to

pain.” Chinese medicine refers to the use of herbs,

such as salvia miltiorrhiza and Angelica sinensis,

with the role of activating blood circulation to

reduce stasis Injection of the drug into the TCM

meridian and collaterals system might enhance its

effects

Modern medical research shows that the

med-ication used in topical areas might promote blood

circulation, expand peripheral blood vessels,

improve peripheral blood distribution, repair

damaged bioﬁlms, reduce tissue damage,

recon-struct homeostasis, ease disturbance of blood

ﬂow, and improve brain blood supplication with

anti-inﬂammatory and abirritative effects

Other clinical research showed a signiﬁcant

effect of acupuncture point injection therapy

com-bined with functional exercise in children with

cerebral palsy (Xu et al.2008) One randomized

controlled trial explored acupuncture point

injec-tion therapy combined with exercise, compared

with exercise alone, in the treatment of children

with cerebral palsy (Chen et al.2009) The results

showed that acupuncture point injection therapy

could improve the motor function of children with

cerebral palsy, as well as develop their

intelli-gence and language and correct behavioral

abnor-malities Therefore, a combination intervention

including Chinese and Western medical therapies

for children with cerebral palsy might have a

better outcome than a single method

Acupuncture point injection therapy was used

to treat hypoxic-ischemic encephalopathy (Guo

2009) The results showed that the combination

of intravenous infusion of brain protein hydroly-sates and acupuncture point injection with Salvia was signiﬁcantly better than intravenous infusion alone

Tui Na Therapy (Massage Therapy)

Tui na therapy is a manipulative therapy based on the meridian and collaterals theory of Chinese medicine In general, tui na therapy comprises various categories of manipulation, such as push-ing, holdpush-ing, rubbpush-ing, shakpush-ing, jigglpush-ing, presspush-ing, and plucking The primary principles of tui na therapy are to smooth the meridian and collaterals, make joints ﬂexible, regulate yin and yang, and accelerate blood circulation The classical TCM book, Yellow Emperor Confucian, described treating weakness and spasticity with manipula-tive therapies The effect of tui na therapy on patients with cerebral palsy is based on the rela-tion between the force of tui na stimularela-tion and the function of the viscus Tui na therapy could regu-late the tension and elasticity of muscles and strengthen their power and function (Jiang et al

2009) Also, tui na therapy might make the liga-ments and joints more mobile and ﬂexible, and accelerate the blood and lymphatic circulation (Ku et al.2009) All these effects may eliminate joint synovial ﬂuid stagnation, stasis, and joint capsule contracture

recommended for most children with cerebral palsy, tui na therapy has good opportunities for further development Tui na therapy can be applied to the following anthropometric areas and acupuncture points to treat children with cere-bral palsy (Huang et al.2013; Lu and Jiang2015) Supine Position

First, move from the acupuncture points of Yintang to Shangxing then Touwei using the wip-ing method, then press and rub the area of motion

at the scalp acupuncture points Second, knock the acupuncture point of Sishencong and rub the

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Baihui acupuncture point Third, press, knead,

pinch, and clutch the limbs After point-pressing

the Yanglingquan acupuncture point, pinch and

squeeze the lateral part of the lower leg muscles

After pinching the Taichong and point-pressing

the Weizhong acupuncture points, pinch and rub

the posterior of the calf down to the Achilles

tendon Then pinch and knead the Achilles

ten-don, rubbing the Yongquan acupuncture point

After point-pressing the Huantiao acupuncture

point, pinch the adduction muscles of the lower

limbs After point-pressing the Zhongfu

acupunc-ture point, pinch and rub the anterior muscles of

the upper arms After point-press the Jianjing

acupuncture point, pinch and rub the posterior

and anterior muscles of the forearms Finally,

pinch the Shaochong acupuncture point

Prone Position

First, push the ridge area along the spine, from top

to bottom, with the palmar surfaces of the index

and middleﬁngers 20 times Second, point-press

and knock the acupuncture points from Zhiyang

to Mingmen along the spine Then point-press all

the acupuncture points of the Pangguang

merid-ian Finally, push the Pangguang and Du

meridians

Alternative Treatment

According to the individual’s gait analysis, the

following alternative treatments are available

Triceps Surae Spasticity

Roll along the posterior calf, from the popliteal

fossa to the Achilles tendon, and repeat the

manip-ulation ~5–10 times The therapist should

dorsiﬂex the ankle and toes, with the at knee 90

ﬂexion With the palmar surface of the thumb,

knead the acupuncture points of Weizhong,

Chengshan, Zusanli, Yanglingquan, and Xiexi

Each acupuncture point takes about half a minute,

and the best effect is achieved with feelings of

sourness, pain, numbness, and bloating in the

areas of the acupuncture points and meridians

Knee Hyperextension

In children with mildﬂexion of the lower limb,

place a soft pillow under the knee joint Push with

the thumb on the Zusanyang and Zusanyin merid-ians around the knee joint; repeat this three times With the palmar surface of the thumb, slightly rub the Heding acupuncture point and inside and out-side the Xiyan, Liangqiu, Zusanli, Feiyang, and Yanglingquan points The best effect is achieved with a feelings of sourness, pain, numbness, and bloating in the area of the acupuncture points and meridians Rub the bilateral collateral ligament from the popliteal fossa, rubbing around both sides of the Xiyan acupuncture point and patella until the patient feels warm

Adductor Muscle Spasticity The therapist places the involved leg in abduction until the maximum passive range of motion is achieved, while the assistant helps to hold the pelvis and the involved leg at the hip joint This

is repeated for 3–5 min Then the therapist pushes and rubs the adductor muscles from the hip to the knee, repeating three to ﬁve times This is followed by a light plucking method used to pluck the thighs, inside the rigid tendon, dozens

of times Finally, the therapist presses and rubs the acupuncture points of Huantiao, Fengshi, Zhongdu, Yangyingquan, Xuehai, and Jimen, for about a half minute at each point until the patient feels sourness, pain, numbness, and bloating in the areas of the acupuncture points

Children with cerebral palsy might experience gastrointestinal disorders, resulting in malnutri-tion and a poor physical state Studies have shown that one-ﬁfth of total nutrients absorbed are supplied to the nervous system Simple research indicated that tui na therapy, which focuses on promoting gastrointestinal function (Qian et al.2009), can improve the quantities of serum iron, zinc, and hemoglobin in children with cerebral palsy and can make their physical situa-tion better With the assistance of comprehensive rehabilitation, the children can further improve the function of their entire body

Selective spinal tui na therapy based on the main acupuncture points of the Du meridian reported that the severity of muscle spasticity and joint mobility were improved after treatment (Sun et al.2017) A study that mainly explored the therapeutic effect of antagonistic muscles on

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children with cerebral palsy showed that toe

walk-ing was corrected in the majority of children, and

their lower-limb motor dysfunction improved

sig-niﬁcantly after the treatment Tui na therapy

applied to antagonistic muscles provides an

alter-native solution to spasticity in patients with

cere-bral palsy patients (Zhao2008)

Tui na therapy combined with ankle orthosis in

children with cerebral palsy might relieve

spastic-ity of the lower limb The results of one study

showed that combined treatment plays a

signiﬁ-cant role in improving function in children with

cerebral palsy (Tang et al.2009) The short-term

effects of tui na therapy, which promotes the

development of motion, could improve overall

gross motor function in children with cerebral

palsy Also, the function gained can be maintained

for a short time (Chen et al.2012; Yang and Li

2016)

Traditional Chinese Medication

for Topical Use

Some traditional Chinese medications are applied

externally, through baths, fumigation, or other

methods These traditional Chinese medications

are absorbed quickly into the skin and accelerate

blood circulation, relax muscle spasticity, and

smooth the meridian

According to TCM theories, the

pathophysio-logic mechanisms of cerebral palsy are described

as an overpowering of Gan (the liver), a weakened

Pi (spleen), and the existence of phlegm stasis on

the meridian Chinese herbal baths, including

Lycopodii herb, Gramineae, mulberry twigs,

Angelica, cassia twig, caulis spatholobi, and

Radix Paeoniae Alba, when combined with tui

na therapy, can reduce spasticity in children with

cerebral palsy These treatments work through

two principal mechanisms First, the herbal bath

can improve blood circulation and nutritional

sup-plies in local muscles, thereby strengthening the

muscles Second, tui na therapy can release

mus-cle tension and spasticity (Guo et al.2014)

A combined treatment using TCM fumigation

with modern rehabilitation therapy in children

with spastic cerebral palsy was reported (Xiao

and Xi 2012) In the treatment group, 24 cases were treated with TCM fumigation, which con-tains Lycopodium clavatum, Artemisia rupestris, and unprocessed Radix Aconiti, combined with modern rehabilitation therapy Gross motor func-tion was evaluated before and after treatment, and the results showed that TCM fumigation com-bined with modern rehabilitation therapy had sig-niﬁcant therapeutic effects on global function in children with spastic cerebral palsy (Xiao and Xi

2012)

Comprehensive Chinese Medicine Therapy and Intervention

In the treatment of cerebral palsy with Chinese medicinal therapy, families often try multiple combinations of treatments for their children with cerebral palsy It is common for a child to receive both Chinese medicinal treatments and modern conventional rehabilitation at the same time With this dual treatment, the families and clinicians expect more practical outcomes for cerebral palsy

One study applied plum blossom needle com-bined with scalp acupuncture, tui na therapy, and modern rehabilitation methods to explore a solu-tion to involuntary mosolu-tion in children with cere-bral palsy Sixty cases were randomly divided into two groups: the control group, which received only conventional rehabilitation methods (Bobath, tui na therapy, and scalp acupuncture), and the treatment group, which received conven-tional rehabilitation and the addition of plum blos-som needles on the back, at the lumbosacral spine,

at the Du and Jiaji acupuncture points The two groups’ outcomes were compared, and the incur-vation reﬂex and spasticity of muscles are improved after 3 months of treatment Results showed that both types of treatment had signiﬁ-cant therapeutic effects, but the treatment group, which received the plum blossom needle, showed better results (Han et al.2010)

A complicated issue is how to improve the body functions after selective dorsal rhizotomy

A study that combined Chinese medicine and rehabilitation used electrical acupuncture,

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instantaneous biofeedback, tui na therapy, and

other physical therapies showed very good

results Because weakened muscle strength is a

complication of selective dorsal rhizotomy, it is

necessary to use appropriate functional

improve-ment therapies after the operation (Xu2013)

Complications

Many complications may occur during the TCM

treatments TCM is not suggested for use in

patients with spontaneous hemorrhagic disease

or skin infection/ulcers

Pain

After puncturing the needles into the acupoints

and beginning needle rotation, patients may feel

sourness, numbness, swelling, and pain These

symptoms are completely normal and will

disap-pear after the treatment If many capillaries exist

near the acupoints, the puncturing may cause

bleeding and blood congestion, andﬁnally pain

Infection

Puncturing devices and needles that are not

thor-oughly disinfected could cause infection in

chil-dren This also applies to the acupoints

themselves

Acupuncture Syncope

If children are nervous or fearful, weak, or hungry,

acupuncture may cause them to faint If fainting

occurs, remove the needle immediately and allow

the child to rest until their condition returns to

normal

Allergy

Acupuncture point injection therapies and herbal

baths may cause drug allergies An allergy test

must be applied before those treatments are implemented

Curved or Fixed Needles

If the muscles tense or the body is in the wrong position, the needles could become too hard to efﬁciently puncture or could become curved Ner-vous tension before the treatment may also cause the needle to curve or beﬁxed

Case 1

Case 1 describes a 23-year-old woman with a diagnosis of cerebral palsy and diplegia, with a Gross Motor Function Classiﬁcation System score of 2 She was not born premature and did not have a low birth weight She could walk independently until the age of 3.5 years She was diagnosed with cerebral palsy at age 4 at Huashan Hospital, Shanghai, China, which has a famous neurological department When the physician diagnosed the girl with cerebral palsy and told the family that she merely had mild motion disor-der with normal cognition, there was no perfect treatment that could cure her condition at that time The parents were concerned that ineffective treatment might cause side effects, so she never received special treatment for the cerebral palsy– neither physical therapy nor acupuncture or tui na therapy to manage her mild spasticity Because she had normal cognition, the girl went to a com-mon school After she graduated with good grades, she found a great job far from home, and she had to take the subway back and forth to the ofﬁce However, the problem of instability while walking still exists, especially when going down stairs, and she must rely on handrails for help One day, she fell going down stairs and fractured her right lateral malleolus While she was recovering from the surgery, she got a prescription for a gait analysis to help make a decision for rehabilitation She made an appoint and received a full gait analysis at a gait laboratory in Shanghai

The woman’s gait problems were listed as follows:

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1 Absent heel initial contact

2 Drop foot during the swing phase

3 Overﬂexion of the knee upon energy

absorption

On the basis of data from the gait analysis, we

found that the patient had hip joint adduction and

excessive ﬂexion, a forward pelvis, and a

plantarﬂexed ankle joint Thus a tui na therapy

program was applied Tui na therapy was

referenced in 1998 by the People’s Republic of

China Ministry of Health, which launched the

“Chinese Rehabilitation Medicine Routine.” Tui

na therapy is applied with the patient in two

positions:

1 With the patient in the prone position, roll the

patient on the back from the bottom of the

spine to the thoracic and lumbar spine, and

roll and press the Zutaiyang and Pangguang

meridians Combine this with passive hip

extension Point and move the bilateral

acupuncture points of Chengshan, Weizhong, and Zusanli for 20–30 s per acupuncture point Then roll the triceps surae through the Achilles tendon while the ankle undergoes passive dorsiﬂexion (on both sides but with focus on the left side, three toﬁve times)

2 With the patient in the supine position, point and rub the acupuncture points of Biguan and Xuehai for 20–30 s per acupuncture point Then roll the lateral side of the thigh muscles, and combine this with passive hip abduction The entire process takes about 45 min twice a week for 3 months

After 3 months of treatment, the woman felt more powerful and more conﬁdent when she was walking, especially down stairs Her lower limbs were much more powerful, but the left ankle showed a more signiﬁcant result (Fig.1) External tibial torsion improved on the right side (Fig.2), and the maximum angle of hip extension in

Patient Name: shenyi

I.D #

Test Date: 3/17/16

Measure: Sagittal Joint Powers (Watts/kg) Condition Labels

2015.12.14 2016.3.17

Multiple Conditions Comparison

MotionAnalysis

Comparison Overlay Comment:

File Name: TRIMMED_WALK17.XLS Norm File:

Right (RHS to RHS) 3.00

2.00 1.00 0.00 –1.00 –2.00

3.00 2.00 1.00 0.00 –1.00

2.00 1.00 0.00 –1.00 –2.00 –3.00

3.00 2.00 1.00 0.00

2.00 0.00

–1.00 –2.00

–3.00

Generation

Absorption

Ankle

Knee

Hip

Generation

Absorption

Generation

Absorption

Left (LHS to LHS) Data Properties by Condition 21.nrm

File (Solid) TRIMMED_WAL:

TRIMMED_WAL:

Rt Cycles 2 3 2 1 3 2

2 3 3 2 2 3

Lt Cycles

File (Dashed) TRIMMED_WAL:

TRIMMED_WAL:

Rt Cycles 1 2 2 2 2 2

2 2 2 2 2 2

Lt Cycles

File (Dotted) Rt Cycles Lt Cycles

Fig 1 The power of the lower limbs

Trang 10

TRIMMED_WAL:

Rt Cycles 2 3 2 1 3 2

2 3 3 2 2 3

Lt Cycles

TRIMMED_WAL:

Rt Cycles 1 2 2 2 2 2

2 2 2 2 2 2

Lt Cycles

10.0 0.0 –10.0 –10.0

–20.0 –20.0

–30.0

10.0 0.0 –10.0 –20.0 –30.0 Internal

Valgus

Extension

Flex/Extension

Varus/Valgus

Tibial Torsion

Flexion

20.0 10.0 0.0

20.0 0.0 –20.0

80.0 60.0 40.0

20.0 0.0 –20.0

80.0 60.0 40.0

–10.0 –20.0

20.0 10.0 0.0

Varus

External

Right (RHS to RHS) Left (LHS to LHS) Data Properties by Condition

Condition Labels

2015.12.14 2016.3.17

Measure: Knee Joint Angles (deg)

Comparison Overlay Comment:

File Name: TRIMMED_WALK17.XLS Norm File: 21.nrm

Patient Name: shenyi

I.D #

Test Date: 3/17/16

Fig 2 Knee joint motion

Right (RHS to RHS) Left (LHS to LHS) Data Properties by Condition

TRIMMED_WAL:

Rt Cycles 2 3 2 1 3 2

2 3 3 2 2 3

Lt Cycles

TRIMMED_WAL:

Rt Cycles 1 2 2 2 2 2

2 2 2 2 2 2

Lt Cycles

Internal

Adduction

Extension

Flex/Extension

Abd/Adduction

Rotation

Flexion

Abduction

External

40.0

15.0 10.0 0.0

–12.6

15.0 10.0 0.0

–12.6

20.0 0.0 –20.0 –40.0

60.0 40.0 20.0 0.0 –20.0

40.0 20.0 0.0 –20.0 –40.0

Fig 3 Hip joint motion

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