Understanding of the mechanism of acupuncture in the treatment of cerebral palsy

  The development of the nerve conduction system begins at 7 months of life, the nerve fibers gradually penetrate from the white matter to the cortex, but by the time of birth there is not only horizontal direction, but also oblique and tangential lines, the connection between nerve cells is complicated the development of the outer myelin sheath of nerve fibers is different, the spinal nerve begins at 4 months of life, then gradually the sensory nervous system (2-3 months after birth) and the motor nervous system, the conus at 5 months after birth The cortical formation of the pyramidal body is even later, from 5 months to 4 years of age. Therefore, the differentiation of cortical cells, the development of the neural drive system and the development of the outer myelin sheath of nerve fibers in the pediatric brain develop gradually from the fetal period to 4 years of age, and the early comprehensive treatment for children with cerebral palsy seizing this stage can further promote the development of the nervous system with obvious efficacy and high therapeutic value [81]. Comprehensive TCM treatment brings hope for children with cerebral palsy, and early diagnosis and early treatment are especially important.  Combined with the modern medical theory of cortical function localization, acupuncture treatment can stimulate the corresponding motor areas of the cerebral cortex, improve local blood supply, and promote the recovery of brain cell function. In the past, brain cell damage has been considered irrecoverable, but some clinical studies have confirmed that treatment by effective methods can promote brain electrical activity and neurotransmitter secretion [82, 83], potentially activating the compensatory function of other cells, and by acupuncture acupoints related to the brain, it can promote the formation of collateral circulation, vasodilation and release of spasm in the brain tissue of the focal area, and at the same time can activate the brain cells in a state of inhibition [82, 83]. brain cells in an inhibited state, which contributes to the recovery of the disease [84]. Clinical treatment has also confirmed the curability of cerebral palsy. Acupuncture therapy focuses on acupuncture points and techniques that regulate qi and blood, tonify the kidney and educate the mind, and achieve therapeutic goals by improving cerebral blood flow, increasing the compensatory function of brain cells, decreasing serum osteocalcin concentration, and increasing serum growth hormone levels. Liu Zhenhuan [85] made observations of nail fold microcirculation in children with cerebral palsy before and after acupuncture treatment and found that while the symptoms improved significantly, the nail fold microcirculation also improved greatly, and it was hypothesized that the mechanism of acupuncture treatment for cerebral palsy lies in improving the blood supply to the brain and promoting the functional metabolism of brain cells. Wu Meiqian [86] explored the mechanism of action of acupuncture on pediatric cerebral palsy, observed the relationship between clinical efficacy and changes in blood rheology and brain SPECT, and concluded that acupuncture improved the nutrition and blood supply to the brain through neuromodulation and humoral effects. Yu, H. [87] observed the immediate effect of acupuncture on evoked muscle power in pediatric cerebral palsy patients and found that acupuncture could suppress the giant F waves in children with spastic cerebral palsy, inferring that acupuncture could increase the compensatory functional activity of the brain. Cheng Rongqi [88] found a significant increase in cerebral blood flow in pediatric cerebral palsy patients treated with head acupuncture using TCD, which facilitated the correction of cerebral hypoxia and the recovery of brain function. Shi B. P. et al [89, 90] found that the EEG, cerebral hemogram, central neurotransmitters, plasma cortisol, and serum lipid peroxide in children with cerebral palsy improved to different degrees before and after treatment. It has been suggested [91, 92] that there is still a considerable extent of reversible damage area around the necrotic area of cerebral tissue in cerebral palsy, where brain tissue is pale, small thrombus formation or lumen thinning in the blood vessels, and insufficient perfusion of blood flow leads to loss of function of brain nerve cells, but necrosis has not yet occurred, i.e., adventitial nerve cells. Acupuncture improves cerebral blood flow, regulates cortical function, improves the pathological state, and restores the function of adventitial cells (also called dormant cells), thus achieving the purpose of treatment. Shi B-Pei [93, 94] also observed an increase in bone mineral density, a decrease in serum osteocalcin concentration, and an increase in serum growth hormone levels in children with cerebral palsy before and after acupuncture. This indicates that cerebral palsy is related to the weakness of kidney yang and the loss of brain marrow nourishment, and that acupuncture adjusts the function of qi, blood and internal organs, improves the blood supply to tissues and organs, and can play an educational and growth-promoting role by tonifying the kidneys. Luo Zhongda et al [95] showed that the results of acupuncture on ischemic rats showed that electroacupuncture could inhibit the apoptosis of nerve cells in the brain after ischemia, and could enhance the expression of nerve growth factor receptor (NGFR) in brain tissue of rats with focal cerebral ischemia, which had a certain protective effect on ischemic brain injury, providing a theoretical basis for acupuncture to treat cerebral palsy. Wang Qinyu et al [96] studied the results of acupuncture on neuronal and brain tissue nerve growth factor (NGF) expression in the hippocampal CA1 region of young rats with cerebral palsy, which showed that acupuncture could increase the density of hippocampal neurons after cerebral ischemia and hypoxia and increase the long-time positive expression of NGF, which was considered as one of the important mechanisms of acupuncture for the treatment of ischemic-hypoxic cerebral palsy.  The underlying lesion of cerebral palsy is in the central nervous system. In prenatal cases, there is often diffuse brain tissue lesions, varying degrees of cerebral atrophy and cortical hypoplasia, disorganized neuronal cell arrangement, cortical malformation, irregular arrangement of neurofilaments and microtubules, myelin relaxation, separation and reduced number of synaptic vesicles under electron microscopy; in perinatal and postnatal cases, scarring, sclerosis or softening, partial cerebral atrophy and brain parenchymal defects are predominant. Acupuncture promotes the secretion of adrenaline from the adrenal medulla, which stimulates the tissue to increase the synthesis of nerve growth factor, and nerve factor directs the growth of nerve cell synapses toward the organ that synthesizes nerve growth factor to complete the regeneration of nerves. It is important to emphasize that the therapeutic effect of acupuncture should be the sum of its benign adjustment effects on all systems and multiple organs and tissues of the body. Acupuncture of head acupoints can cause microvascular dilation of the corresponding brain tissues, compensate for collateral circulation, increase cerebral blood flow, restore the function of brain cells, and promote brain tissue imaging changes. Functional training can promote the functional reconstruction of brain cells. And acupuncture of somatic acupoints may enhance such effects. At the same time, acupuncture stimulation improves the functional state of peripheral circulation and activates sensory function, and also improves intracranial blood circulation and improves the electrical activity of the human cerebral cortex.