Pediatric cerebral palsy has no name in the Chinese medical literature, but from the symptom analysis, it belongs to the category of “five delays and five softnesses”. The five delays: late standing, late walking, late speaking, late hair, late teeth, refer to the growth and development of language, walking, hair and teeth of the child is slower than normal children of the same age. The five softnesses: soft head, soft mouth, soft hands, soft feet, and soft muscles, refer to the evidence of softness and weakness of the tendons and muscles of children, mainly manifesting as weakness of the head, weakness of the mouth, weakness of the chewing muscles, weakness of the hands and feet, and weakness of the flaccid muscles. It is also called fetal weakness and fetal timidity because it is characterized by growth retardation and muscle weakness and is related to fetal deficiency.
In the “Treatise on the Origin of Diseases” of the Sui Dynasty, there were cases of “the inability to produce teeth”, “the inability to walk at several years of age”, “the inability to produce hair”, “the inability to speak at four or five years of age “The first affiliated hospital of Henan College of Traditional Chinese Medicine has the following records about the growth retardation of children. Zhang Jiankui, Department of Pediatrics, The First Affiliated Hospital of Henan College of Traditional Chinese Medicine
In the Song Dynasty, “Taiping Shenghui Fang” recorded the prescriptions for the treatment of “late speech, late movement and late hair” and other symptoms.
In the Qing Dynasty, Zhang’s Medical General clearly put forward the name of “standing late, walking late, speaking late, hair late, teeth late”, and made a comprehensive explanation of its etiology: “If the growth is not standing, standing and the bone is soft, big can’t walk, walking is tendon soft; all liver and kidney qi and blood is not full, tendon impotence and weakness of the reason. ” The treatment of cerebral palsy in TCM mainly includes the following methods: massage therapy; acupuncture therapy (head acupuncture, body acupuncture, acupuncture point closure therapy); Chinese medicine treatment (evidence-based treatment, Chinese patent medicine, Chinese external medicine); and the combination of TCM and physical therapy (drug fumigation, electroacupuncture, meridian guidance, etc.).
The advantages of TCM are not only in the treatment of cerebral palsy itself, but also in the treatment of the combined symptoms of cerebral palsy children and the adjustment of their physical constitution.
1. Differential treatment
There is no systematic treatment of cerebral palsy by the ancients, but according to its clinical manifestations, there are mainly the following types of evidence.
(1) Kidney deficiency and marrow deficiency
(1) Kidney deficiency and marrow deficiency: low intelligence, dull reaction, eyes with no brightness, backward development of movement, turning over, sitting, crawling, standing, walking, etc. are later than normal children of the same age. The tongue is light, with little coating and weak pulse.
Treatment: Tonify the kidneys to produce essence, fill in the marrow and benefit the brain.
Remedy: Tonifying the Kidney and Dihuang Pill with addition and subtraction. Radix Rehmanniae, Rhizoma Dioscoreae, Poria, Zeligia, Cornu Cervi Pantotrichum, Mudanpi, Fructus Lycii, Fructus Lycii, Radix Bone Marrow, Rhizoma Polygonati, Deer Antler, Fructus Puzzlee, etc.
(2) Deficiency of spleen and kidney
Symptoms: weakness of the waist and spine, unstable sitting and standing, impotence and weakness of muscles, slowness in walking, little movement in lying down, yellow face and thin form, pale tongue with thin white fur, weak pulse.
Treatment: Benefit Qi and strengthen the spleen, tonify the kidney and strengthen the bones.
Remedies: Tonic Sky Dazao Wan. Radix Angelicae Sinensis, Tortoise Plate, Radix Astragali, Ginseng, Atractylodes Macrocephala, Poria, Zizyphus, Deer antler, Fructus Lycii, Bonesetter, etc.
(3) Heart blood deficiency
Symptoms: mental retardation, sluggishness, delayed speech development or unclear speech, or no speech for several years, with no color, thin and withered hair. Pale tongue with little coating and weak pulse. Treatment: Benefit Qi and nourish the heart. Ginseng, Acorus calamus, Medlar, Yuan Zhi, Radix Angelicae Sinensis, Fu Shen, Chuan Xiong, Bai Shao, Shu Di, Cornu Cervi Pantotrichum, Deer Antler Gum, etc. (4) Phlegm and stasis blocking the orifice Symptoms: stiff joints, unfavorable flexion and extension, backward movement, or crossed lower limbs, toe on the ground, hand clenching fist, head recoiling, unfavorable speech, or deafness and aphasia, dark tongue, greasy coating, slippery pulse. Treatment: Removing phlegm and activating blood stasis, opening the orifices and clearing the channels. Whole worm, centipede, wu hua, stiff silkworm, calamus, yujin, bile star, white fenugreek, white mustard seed, Chuanxiong, sinkiang, etc. 2. Prepared Chinese medicine
Due to the difficulty of taking Chinese medicine for infants and children, proprietary Chinese medicines are more widely used in the treatment of pediatric cerebral palsy, not only for the treatment of brain injury and brain developmental delay, but also for the improvement of physical fitness and digestive and absorption functions of children with cerebral palsy.
(1)Backward brain development – Liu Wei Di Huang Wan and He Che Da Zuo Wan.
(2) Brain injury and blood circulation stagnation – Danshen injection, Angelica injection, Chuanxiong injection.
(3)
Digestive disorders – anorexia, diarrhea, chancre, nutrient deficiency – Ginseng and Atractylodis Macrocephalae, Guei-Spleen Pill, Infantin, Wizi’s Spirit Granules, Jianshuang Blood Granules, Jian’s Food Dissipation Oral Liquid, etc.
(4) Immunocompromise – recurrent exanthesia – Yu Ping Feng San, Cordyceps preparations (Jin Shui Bao, Bai Ling, Zhi Ling Capsules), Ling Zhi preparations (Bo Zhi Glycopeptide Injection).
(5) Calcium and phosphorus metabolism disorder – Longmu strong bone punch.
(6) Awaken the brain and open the mind – musk injection.
(7) Commonly used Chinese patent medicines ①Gui Shen Wan Ingredients: Radix et Rhizoma Ginseng, Rhizoma Atractylodis Macrocephalae, Radix Astragali, Poria Cocos, Radix et Rhizoma Polygonati, Radix et Rhizoma Polygonati, Radix et Rhizoma Longan, Radix Angelicae Sinensis, Radix et Rhizoma Jujubae, Radix Glycyrrhiza Uralensis. It is suitable for children with cerebral palsy who have deficiency of heart, spleen, qi and blood. Ingredients: Radix et Rhizoma Ginseng, Poria, Rhizoma Atractylodis Macrocephalae, Rhizoma Yam, Lentil, Lotus Seed, Radix et Rhizoma Polygonati, Semen Coicis, Radix et Rhizoma Sand. Functions: Strengthening the spleen and benefiting qi, harmonizing the stomach and permeating dampness, applicable to cerebral palsy with spleen and stomach qi deficiency type. Heche Dazaozuo Pill Ingredients: Zi He Che, Shu Di Huang, Tian Dong, Mai Dong, Du Zhong (fried with salt), Niubizi (fried with salt), Huang Bai (fried with salt), Gui Jia. Functions: Nourishing Yin and clearing heat, tonifying the kidney and benefiting the lung. It is used for children with cerebral palsy of lung-kidney yin deficiency. Six-flavored Dihuang Pill Ingredients: Radix Rehmanniae, Cornu Cervi Pantotrichum, Poria, Rhizoma Atractylodis Macrocephalae, Rhizoma Atractylodis, Rhizoma Polygonati. It is suitable for children with cerebral palsy who have congenital deficiency and kidney essence deficiency. ⑤ Longmu Zhuangbone Punch Ingredients: Radix et Rhizoma Ginseng, Poria, Atractylodes Macrocephala, Radix et Rhizoma Huaiyang, Radix Astragali, Fructus Schisandrae, Radix et Rhizoma Longbone, Oyster, Tortoise Plate, Medlar, Vitamin D, etc. Functions: Strengthening the spleen, benefiting qi and nourishing yin, suitable for those with cerebral palsy who have weakness of spleen and stomach and yin deficiency. (6) Yu Ping Feng San Ingredients: Astragalus, Fructus, Atractylodes. Functions: Tonifying the lung, benefiting Qi and consolidating the surface, applicable to cerebral palsy with weak lung Qi. (7) Compound Danshen Injection Composition: Each ml is equivalent to 1g each of Danshen and Radix et Rhizoma. Functions: Invigorating blood circulation, dispersing blood stasis, inhibiting platelet agglutination, dilating blood vessels, improving microcirculation, increasing blood flow in human tissues, improving the body’s tolerance to hypoxia, correcting blood hypercoagulability, regulating immune function, etc. It can be routinely applied to children with cerebral palsy. Dosage: It can be used for acupuncture point closure, intravenous drip, etc. Acupoint closure is 0.1-0.5ml per acupoint; intravenous drip is 0.5ml/kg/d. ⑧ Angelica Sinensis Injection Composition: Chinese medicine Angelica Sinensis extract. Functions and indications: similar to compound Dan Shen injection. Usage and dosage: Same as Compound Salvia injection. ⑨ Musk Injection ⑩ Bozhi Glycopeptide Injection 3. Massage therapy
Massage therapy has the function of unblocking meridians, running qi and blood, and balancing yin and yang. In the rehabilitation treatment of pediatric cerebral palsy, it can relieve muscle spasm, reduce muscle tone, improve muscle strength, strengthen muscles and bones, promote motor development, dredge tendons and channels, smooth joints, correct posture, etc. It can also improve digestion, enhance immunity and strengthen the body.
It is the main rehabilitation treatment method for pediatric cerebral palsy.
(1) The basic treatment principles of Tui Na massage The techniques of Tui Na massage therapy require persistence, strength, uniformity, gentleness and deep penetration. To overcome the rigidity with softness – for those with severe spasticity, the techniques should be soft and slow. To rigidly restrain the soft – for weak and feeble, the technique should be heavy.
Spasticity – Reduce muscle tension.
Hand and foot movement – to relieve tension and reduce excitability.
Combination of massage and exercise therapy – first massage to relieve spasticity, and then exercise training. Tui-na massage and exercise training who is the main and who is secondary, who is long and who is short, according to the condition, the different stages of rehabilitation vary from person to person.
(2) The time and duration of massage
Manual therapy 1 to 2 times a day, 15 to 45 minutes each time. The length of time depends on the age and physical condition.
Treatment 6 days a week, a course of treatment per month.
(3) The basic techniques of Tui Na massage
Basic techniques – pushing and pressing the meridians, point pressure, local massage, posture correction.
Strengthen the body, improve immunity, promote digestion and absorption – chiropractic, pediatric massage, traditional massage techniques.
① pushing and pressing in the direction of meridian circulation or muscle movement, using a combination of pushing and pressing techniques, mainly pushing, depending on the location of the finger pushing method, palm pushing method. Because the meridians “belong to the internal organs, external contacts in the limbs”, is the total control system of the human body, pushing and pressing the meridians can unblock the whole body, accelerate the blood circulation of the whole body, so as to improve the nutrition of the skin and muscles, can prevent muscle atrophy, promote movement, strengthen the muscles and bones. ②Acupuncture point pressure The use of point rubbing and pressure compound techniques on important acupuncture points throughout the body has a strong stimulation on acupuncture points, which has the effect of opening occlusion, activating blood and relieving pain, and adjusting the function of internal organs. By pointing and pressing acupuncture points on the skin, muscle joints, tendons, nerves, meridian acupoints, can relieve muscle spasm, promote local blood circulation, accelerate metabolism, regulate nerve function and improve muscle strength. ③ abnormal parts of muscle massage on the abnormal parts of the child’s muscles using kneading, pressing, rolling and other techniques, on the parts of high muscle tone, with soft and gentle techniques, can relieve spasm, reduce muscle tone; on the parts of low muscle strength, with heavy techniques, to improve muscle strength. It is a combination of TCM massage and modern rehabilitation techniques. This method not only applies the basic techniques of TCM massage, but also combines the evaluation of the child’s muscle strength, muscle tone and motor function in modern rehabilitation theory. Posture correction The techniques of wrenching, shaking and stretching are used to promote the movement of limbs and joints of children with cerebral palsy and to correct abnormal posture, which has the effects of slipping and sharpening joints, enhancing joint movement and draining tendons and channels. 4. Modern research on massage therapy In recent years, some experimental studies and theoretical researches on massage therapy for pediatric cerebral palsy have been conducted, mostly from the study of the effects of massage on human electromyography, immune function, hemodynamics and other aspects. Cui Rongqing et al. applied the lumbar thoracic spinal evoked potential (TL-SCEP) technique to observe the effects of tui na on somatosensory pathways and cortical activities in children with cerebral palsy, and found that tui na could improve peripheral local microcirculation and promote the functional activities of muscles and nerve endings in the affected limbs. Zhu found that the immune indexes of IgG, IgA, C3 b-R and ANAE of the modeled animals before tui-na were lower than those of the normal group (P<0.05), and after tui-na, the indexes of the modeled rabbits were not significantly different from those of the normal group except for IgA (P<0.05), while the indexes of the control group were in the unrecovered state. This indicates that Tui Na has a strong effect on improving and adjusting humoral and cellular immunity. In contrast, Li reported that the CD3, CD4, CD4/CD8 and IgA values of children with cerebral palsy were lower than normal, suggesting that children with cerebral palsy have a certain degree of immune deficiency. Tui-na massage can not only promote the motor development of the children and correct their abnormal posture, but also improve their immune function. Zhai reported that 20 of 29 children with cerebral palsy had reduced local cerebral blood perfusion on SPECT examination. Liang's clinical observation of the changes of microcirculation in the nail fold before and after tui na in healthy people, patients with cervical spondylosis, cerebral arteriosclerosis and hand trauma revealed that the main indicators of microcirculation disorders such as reduction in the number of tubular loops, unclear outline of tubular loops, dark red blood color, stasis at the top of loops, slowed blood flow, abnormal flow pattern and exudation were significantly improved after tui na, indicating that tui na can cause vasodilation in a certain range, lower peripheral resistance, faster blood flow and Blood flow increased. This suggests that massage can also promote blood flow, improve blood circulation, and indirectly affect the blood supply to the brain of children with cerebral palsy. In the treatment of cerebral palsy, acupuncture therapy is more commonly used, including body acupuncture, head acupuncture, water acupuncture (acupoint closure), ear acupuncture and plum acupuncture.
(1) Scalp acupuncture
It can accelerate the blood flow in the brain, improve the blood circulation of children with cerebral palsy, promote brain metabolism, facilitate the rehabilitation of children with cerebral palsy, improve the intelligence of children with cerebral palsy, and promote the language and hearing development of children with cerebral palsy.
Generally, Jiao’s head acupuncture zoning and treatment method is mostly used. According to the theory of cortical functional localization, Jiao’s has divided 14 stimulation zones in the corresponding areas of the scalp as head acupuncture treatment sites, and its indications are neurological diseases, which are most widely used in China.
Scalp acupuncture primary zone: motor zone
Scalp acupuncture auxiliary zone: balance zone, language zone 2, language zone 3, visual zone, etc.
Acupuncture technique: select 0.5-1.5 inch milli-needle, rapid needle, and the scalp level at an angle of 15 degrees, rapid twisting and then stay for 30 minutes to 1 hour, 15 minutes acupuncture once, once a day, 1 month for a course of treatment.
(2) acupuncture point injection therapy
Also known as water needle therapy, is a treatment method of injecting drugs into acupuncture points, which can play the multiple effects of needles, acupuncture points and drugs.
Tools: the use of sterile syringes and needles, according to the dose of drugs used and the depth of the prick to choose different syringes and needles (currently the clinical use of disposable syringes).
Commonly used drugs: water injection commonly used drugs are the following.
Chinese herbal preparations: such as compound angelica injection, danshen, chuanxiong, musk, wei lingxian injection, etc.
Vitamin preparations:such as vitamin B6, B12 injection, etc.
Other commonly used drugs: such as cerebrolysin, cerebrolysin myostatin, nerve growth factor, cytidylcholine, etc.
(3) Body injection
Body acupuncture: acupuncture points and needles are taken and needled according to the traditional method, and in younger people, only point-pricking is possible, and it is inconvenient to keep needles, which may affect the therapeutic effect of acupuncture. For acupuncture at the site of spasm, especially in the limbs of tense hand and foot tachycardia, there is still controversy, and some experts believe that there is a possibility of aggravating spasm. For hypotonia and weak muscle strength, the effect is relatively good.
6. Modern research on the treatment of pediatric cerebral palsy by acupuncture
By acupuncture in pediatric cerebral palsy patients and observing the immediate changes of EMG, Yu H. et al. found that acupuncture could cause significant inhibition of F waves in spastic patients, indicating that acupuncture treatment could lead to significant improvement of spastic activity in spastic patients.
By performing scalp acupuncture on children with cerebral palsy, Yin Huaicheng et al. observed the changes of auricular microcirculation before and after treatment and found that the auricular venous blood flow rate was significantly accelerated after treatment, indicating that head acupuncture treatment for cerebral palsy could promote auricular microcirculation. Cheng Rongqi et al. performed transcranial Doppler ultrasound examination on children with cerebral palsy before and after head acupuncture treatment, and the results showed that the cerebral artery blood flow velocity increased in varying degrees in most children after treatment.
Wu explored the mechanism of the effect of acupuncture on pediatric cerebral palsy and compared the efficacy and changes in blood rheology and brain SPECT in the acupuncture group plus basic treatment group with the basic treatment group alone, and concluded that acupuncture improved the nutrition and blood supply to the brain through neuromodulation and humoral effects.
7. Combination of Chinese medicine theory and physical therapy techniques
(1) Meridian conductive leveling therapy
The Meridian Conductive Therapy Instrument is a new TCM treatment device based on the meridian and yin-yang theory of TCM, combined with modern bio-electronic movement balance theory, and developed with the latest electronic technology. It is mainly used for the treatment of motor and sensory disorders. “It uses high voltage pulsed current to stimulate the bioelectricity running in the muscle, so as to regulate the meridians and balance yin and yang. Through high-voltage electrical pulses, instead of acupuncture and acupressure, the Meridian Conductive Balancing Therapist stimulates the body’s acupuncture points, and adopts specific balancing therapies for different conditions, and adjusts the relevant meridian points separately to promote balance in the body.
(2) Electro-acupuncture therapy
It is a combination of modern physical therapy instruments and Chinese medicine meridians and acupuncture point theory, stimulating the corresponding acupuncture points through low-frequency pulse current, playing the dual role of electrotherapy and acupuncture.
(3) Chinese medicine fumigation treatment
The increased muscle tone and spasm in children with cerebral palsy is a manifestation of the detrusor reflex, and the receptor is the muscle shuttle. Under the effect of fumigation, the local temperature of skeletal muscle rises, the excitability of afferent and efferent fibers of the muscle shuttle decreases, so that the muscle tone decreases and the muscle spasm is relieved. By using Chinese medicine fumigation treatment, the dual effect of heat and medicine during fumigation, as well as the characteristics of the muscle shuttle conduction affected by temperature, can effectively loosen the spasm, reduce the muscle tone, improve the motor function of the child, and create a good foundation for limb rehabilitation exercise.
(4) Chinese medicine bathing
Chinese herbal fumigation treatment also makes use of the dual effect of warmth and medicine during fumigation, as well as the characteristics of muscle shuttle conduction affected by temperature, to effectively relax spasm and reduce muscle tone.
Drugs: Radix et Rhizoma, Radix Rehmanniae, Peach kernel, Safflower, Salviae Miltiorrhizae, Radix Chrysanthemum, Radix Achyranthes Bidentatae, Radix Angelicae Sinensis, Radix Paeoniae Alba, Papaya, Eucommia, Dog’s spine etc.
Method: After decocting the drug, first fumigate with the heat of the liquid, and then take a bath for about 30 minutes when the water temperature drops to 30-40 degrees.
8. Summary After long-term clinical observation and a large number of summaries, the traditional rehabilitation methods of Chinese medicine have an important role in the rehabilitation treatment of pediatric cerebral palsy, and they are effective in relieving spasticity, reducing muscle tone, improving muscle strength and correcting posture in children with cerebral palsy, but we should also see that the traditional rehabilitation methods of Chinese medicine are effective in promoting the movement of children, especially the training of active motor ability, coordination of movement, flexibility and fine motor training. In the process of rehabilitation treatment, the best therapeutic effect can only be achieved by combining traditional Chinese medicine rehabilitation methods with modern rehabilitation techniques. If a certain treatment method is used or emphasized, without paying attention to comprehensive rehabilitation, especially motor rehabilitation, the rehabilitation effect will be affected.