Vascular dementia (VD) is the result of a decline in brain function due to an impairment in the blood supply to brain tissue caused by cerebrovascular lesions. Many studies have shown that VD can be prevented, and it is the only type of dementia that can be prevented so far. By prevention, we mean preventing the disease before it occurs, i.e., preventing the disease from changing, with emphasis on the latter. At present, there are no satisfactory methods and drugs in Western medicine, but the treatment plan of Chinese medicine has been clinically effective by identifying the evidence to wake up the brain, tonify the liver and kidneys, and activate blood circulation. The author used a combination of acupuncture and medicine according to this principle, which can significantly improve the symptoms of dementia, and is reported below.
I. Clinical data
1. General data
Eighty patients with VD were observed clinically. Elderly and pre-elderly patients (age ≥ 45) were selected, and those with disease duration of more than 6 months were excluded, and the stratified random grouping method was used, with half of the treatment group and half of the control group, 16 cases of cerebral hemorrhage and 64 cases of cerebral infarction.
2. Diagnostic criteria
All the selected cases had a history of cerebrovascular disease and were diagnosed with cerebral infarction or cerebral hemorrhage by relevant experimental examination. Those who met one of the two scales were included in the observation population.
The HDS criteria were <24 points for the secondary school or higher literacy group, <20 points for the elementary school group, and <16 points for the illiterate group, all of which were considered to have cognitive impairment.
The MMSE criteria were ≤23 points for college students, <22 points for high school, <21 points for middle school, <20 points for elementary school, and <19 points for illiterate. Among them, 23-20 scores were mild cognitive impairment; 19-11 scores were moderate cognitive impairment; less than 10 was severe cognitive impairment.
3.Exclusion of medical history criteria
Patients with end-stage cerebrovascular dementia; patients with severe neurological deficits, such as various kinds of aphasia and dyscognition; other kinds of dementia, combined with serious primary diseases such as liver, kidney, hematopoietic system and endocrine system, and patients with psychiatric diseases; those who did not use medication according to the regulations and could not judge the efficacy or incomplete information, etc. affecting the judgment of efficacy or safety.
4.Observation index
HDS, ADL, SOD, MDA, blood rheology and other items were evaluated and observed before and after treatment using the above diagnostic criteria.
5.Efficacy evaluation criteria
According to the “Diagnosis, classification and efficacy assessment criteria of senile dementia” formulated by the Chinese Academy of Traditional Chinese Medicine in 1990, and with reference to the criteria of “Clinical research guideline of new Chinese medicine for dementia”.
Significantly effective: the symptom score value after treatment is ≥2/3 compared with that before treatment;
Effective: decrease in 1/3-2/3;
Ineffective: ≤1/3.
II. Treatment method
In the treatment group, the triple acupuncture method was used, i.e., brain-awakening acupuncture, Guo’s back three acupuncture and scalp acupuncture, and the three acupuncture methods were used in combination. The control group was treated with Ducoxib, 1 tablet (40mg) each time, twice a day for 30 days. Both groups were treated for two courses. During the treatment period, other drugs and therapies related to the treatment of VD were stopped, and all patients were instructed to have a low-salt and low-fat diet, to abstain from smoking and alcohol, and to read and listen to the newspaper more often.
III. Comparison
1. Table 1 Comparison of HDS in two groups
Group Before treatment After treatment Improvement value
Needle and medicine group 17.3±4.1 24.3±5.4 8.3±3.1
Drug group 16.8±3.1 21.5±3. 2 6.4±2.8
2. improvement of living ability
Table 2 Comparison of ADL between two groups
Group Before treatment After treatment Improvement value
Needle and medicine group 54.5±14.9 47.3±12.8 7.7±3.5
Drug group 55.8±12.5 50.6±10.7 5.9±4.4
The improvement in the needle group was better than that in the drug group (P<0.05)
3. Comparison of efficacy
Table 3 Comparison of the efficacy of the two groups
Group Number of cases Improvement No change Deterioration Improvement rate (%)
Needle group 40 29 5 6 73%
Drug group 40 21 11 8 52%
There was a significant difference between the two groups (P<0.01), indicating that the efficacy of the needle and medicine group was better than that of the drug group.
IV. Discussion
The incidence rate of dementia in Chinese people over 65 years old is about 39%, and VD is the first one accounting for 68.5%. the group of mild to moderate patients in VD accounts for about 2/3, and the value of this group for treatment is very large. Furthermore, the disease progresses in a stepwise manner, so with timely and correct treatment, about 20-40% of patients with dementia (mild to moderate) have the possibility of obtaining varying degrees of remission or avoiding more severe dementia.
According to TCM, the etiology of VD is based on liver and kidney deficiency, deficiency of qi and blood, and deficiency of medulla oblongata, with phlegm, dampness, blood stasis, and qi stagnation as the symptoms. Therefore, the author proposes to benefit the qi and nourish the blood, fill the essence and fill the marrow as the main treatment method, and selects the Five Ginseng Shunyi capsule, which is based on American ginseng, Salvia, bitter ginseng, Panax ginseng and Salvia, and research shows that this formula has a comprehensive effect of improving brain function, increasing cerebral artery blood flow and protecting brain nerve cells.
We chose to use a combination of three acupuncture methods, namely, brain-awakening acupuncture, scalp acupuncture and Guo’s back three acupuncture. Among them, the awakening and enlightening acupuncture method focuses on awakening and opening, i.e., awakening the brain and opening the veins, while the scalp acupuncture is the crystallization of the combination of Chinese and Western medicine, and its function is to activate the brain nerve cells in the functional area. Experimental research has proved that the mechanism of waking up the brain and opening up the body acupuncture method and scalp acupuncture method in treating vascular dementia is, firstly, to protect brain nerve cells and prevent damage to nerves from cerebrovascular diseases, thus improving brain function; secondly, to improve microvascular morphology and increase the amount of cerebrovascular perfusion and activation; thirdly, to scavenge free radicals, reduce peroxidative damage and slow down brain aging. Guo’s back three needles through subcutaneous penetration, one needle through several points, with mobilization of Yang Qi, revitalization, through the marrow to reach the brain, the efficacy of the body acupuncture is not as effective, its mechanism of action to be further studied.