Volume 1, Special Edition | Current Japanese Acupuncture and Moxibustion 2010

Clinical Application:
Cerebrovascular Disorders

renaissance of the application of acupuncture andmoxibustion for diseases already being treated with

Cerebrovascular disorders were quite prevalent inJapan, but with the medical progress in recent years,
their

incidence

began

to

decrease

after

1965.

Currently, they rank third as the cause of death, after
malignant neoplasms and heart diseases. Yet, theirprevalence is rising. Annually, one in 400,000 people
have the disease in some form, and among these,
130,000 die from it. The number of patients withsequelaeisapproximately

1.4

to

1.5

million.

Previously, the cause for stroke was often cerebral
hemorrhage, but today the incidence of cerebral
infarction increases1,2).
This disease, regardless of whether it has beencaused by hemorrhage or infarction, is an indication
for acupuncture treatment. During the acute phase,modern western medicine is currently used for thetreatment and acupuncture is not considered to be anindication. This treatment modality is administered ina small number of special cases.
However, in times when medical care was not as
good as it is today, treatment during the early stages,
often had to rely on acupuncture. Diagnosis had notbeen as exact as it is today so that the treatment ofstroke was based on clinical symptoms. Patients, only
a few days after their attack, presented an indication
for acupuncture treatment. Before the concepts ofrehabilitationwere

generally

acknowledged,

acupuncture had already been applied for such
purposesNote1). The methodology applied at that time
wasatraditional

Japaneseone.

Subsequently,

therapies based on unique new views, were added.
Concepts of modern medicine of the day were also
integrated and thus a fairly coherent treatment
proposed.

Later,

duetotreatment

increasingly

centered on western medicine, the application ofacupuncture gradually declined.
Completely new developments in the treatment ofstroke occurred in the 1990’s when Chinese "Xing Nao
Kai Qao Fa" (activating the brain and opening theorifices method - Note2 and Zhu's scalp acupuncture Note3) were introduced in Japan. At the same time, a54

western

medicalmethods

andrehabilitation,heightened the interest in this therapeutic modality.
A brief introduction to the treatment of these
diseaseswithacupunctureandmoxibustionasperformed in recent years in Japan is presented below.
1. Acute stage
Western

medicaltreatment

receives

priority

during the acute stage of stroke. During this stage
there will be almost no occasions to use acupuncture
and moxibustion treatment, but Prof. Akao at the Gifu
University Hospital, has treated many stroke patientsduringtheacupuncture

acute
and

stage

and

moxibustion

also

performed

treatment

whenwestern medical treatment alone did not produce
sufficient effects. He reported that he has observed
comparatively quick improvement in consciousness
among these patients3). For this purpose, the "Xing
Nao Kai Qao Fa" method, in particular for GV26,
appeared to be effective for people with impaired
consciousness and blood letting performed at the well
points traditionally performed in Japan, has also beenfound to be effective.
Bunshi Shirota (1900-1974), who had a great dealof experience with treating stroke patients during theacute stage, stated: "perform minimal blood letting at
GV20 , BL7 , and additionally at the well points of both
hands and feet. When patients feel irritated, thehealthy side should not be moved, micropuncturingperformed for blood letting at GB12 of the healthy sideand the use of cupping to drain some blood should be
performed. Many patients will calm down after thistreatment." He indicated needling at GB20, GB12,
LI10, LI4, GB34, ST36, LI3 (single insertion, depth 1-2cm)4). The beneficial effects of blood letting performedat the well points during the acute stage has been
pointed out by many acupuncturists, one of whom
spent half of his life on research into the effects ofblood letting, Kunimasa Kudo (1918-1889). He also
recommended this method based on a wealth of clinicalexperience5). Generally this treatment form is not
used.

The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

Volume 1, Special Edition | Current Japanese Acupuncture and Moxibustion 2010

2. Transition from the acute to the chronic stage

as well as shiatsu, were the only treatment forms that

During this stage, one usually waits for thefulfilled this role. Rehabilitation is an independentcondition to stabilize and then initiates rehabilitation

therapeutic system and not related to acupuncture andtherapy, but it is also an indication for acupuncture

moxibustion, but a combination of these treatment

and moxibustion treatment.

forms produces even better effects. Today, efforts are

Shirota used the same treatment as applied
during the acute stage several days after the attack

made to propose even better therapies achieved by a
combination of these different modalities.

and added his "Doshi" technique. He also described theMethodologically there is no way that acupuncture

application of moxibustion on GV20, CV12, LI10,

and moxibustion can be applied to the site of the stroke

GB34 and the Sawada style KI34).

lesion itself, and in practice, this is not possible either.

Yet, the most efficient treatment during this stage

Nevertheless, when symptoms typical for the affected

appears to be the "Xing Nao Kai Qao Fa" method

region are observed, the therapy may be directed atdeveloped by Prof. Xue-Min Shi. This treatment shouldthose symptoms. In particular the "Xing Nao Kai Qao

be initiated as early as possible and it is desirable toFa" explains in detail the treatment of symptoms

beginmoxibustion

including impairment of consciousness, hemilateraltreatment as soon as symptoms have been stabilized

motor or sensory paralysis, central facial paralysis,throughShidysphasia,

articulation

disorders,disordersoffrequently visits Japan and has instructed many

deglutition,

disturbancesof(visualfield

Japanese acupuncturists in this technique. In several

defects),

hospitals he has actually treated patients himself.

application of this method allows for treatment of

Direct observation of the dramatic improvement hasthese symptoms. The basic points used for the "Xingsurprised Japanese acupuncturists. After receiving his

Nao Kai Qao Fa" method are as follows. On thesetutelage, many acupuncturists in Japan perform thispoints, lifting-thrusting, twirling, reinforcement or

treatment.

reduction techniques are used for the needling. For

with

the

westernacupuncture
medicalandtreatment.

Prof.

Since the introduction of this treatment, themethod today is applied in facilities with experienced

andurinary

visionincontinence.

Practical

other associated symptoms, other necessary points
may be added6).

acupuncturists. People observing for the first time howhemiplegic patients with complete paralysis of either

Main points: PC6, GV26, SP6

an arm or a leg start moving the affected arm or leg

Supplementary points: HT1, LU5, BL40, GB20, GB12,

immediately after the treatment cannot conceal their

BL10astonishment.

Other points added depending on the presence of

However, among Japanese rehabilitative medical

associated symptoms:societies and academic societies of acupuncture and* central facial paralysis: GB20, EX-HN5, ST7,

moxibustion, a consensus has not been reached as topenetrating needling from ST4 to ST6, LI4 on

when acupuncture and moxibustion treatment should

healthy side
* pes equinovarus: ST41, penetrating needlingbe started.

from GB40 to KI6* motor aphasia: blood letting at EX-HN12,

3. Chronic stage
Currently,

treatment

of

this

diseasewith

acupuncture and moxibustion is restricted in Japan

EX-HN13* receptive aphasia: penetrating needling fromalmost entirely to this stage. The introduction of

GV23 to GV20, GB20, HT7

rehabilitation concepts is a comparatively recent event* disturbances of vision: GB20

and up to that time no such concepts had been

* hearing impairment (hearing loss): GB20, TE21,

available. Among them, acupuncture and moxibustion

SI19, GB2

The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

55

Volume 1, Special Edition | Current Japanese Acupuncture and Moxibustion 2010

* disordersofarticulationordeglutition

in a comparatively quick recovery of motor function.

(pseudobulbar paralysis): GB20 or TE176, GB12

However, at some point in time, the effectiveness of* urinary incontinence: PC6, GV26 or EX-HN3,

this method decreases and requires moxa treatment ofpenetrating needling from GV23 to GV20, KI3,

specific points on the entire body. At that time, the use

CV2.

of 5 half grain sized moxa cones each on GB21, LI15,
BL10, LI11, LI10, LI8, PC5, GB31, ST36, ST41 is

Shirotareported

increasing

the

of

indicated. The description includes records of thepointsusedforacupuncture

moxibustion following the

10th

and

progress in stroke patients actually treated in this way

day after the attack,including patients from one week to several years afteralso including important points on the paralyzed side.

the attack. These records contain descriptions that are

In patients with dysarthria, he added GV15 or GV16.

noteworthy even today7).

therapeutic

numberContinued performance of micropuncturing for blood

Manyexperienceswith

acupunctureandletting is also said to be beneficial. He further reported

moxibustion treatment have been gathered and thepuncturing areas on the back of the neck or shoulders

above described example is definitely not unique.

marked by blood congestion and the application of

Yamada stated that the three main purposes of

cupping to drain some of the blood, as well as theacupuncture and moxibustion treatment during thatsuitability of the use of well points GV20, or thestage are: (1) recovery of basic functions as a part of"clearing of nutrient" method etc.

the rehabilitative measures like exercise therapy, (2)The treatment for the chronic stage recommended
by Shirota is as follows4).

prevention of various complications, and (3) alleviationof pain8).
The chronic stage is often associated with pain andAcupuncture: GV20, GB12, LI10, LI4, GB34, ST36,

patients frequently experience extremely severe pain.

LR3, BL2, BL10, TE15, BL15, BL18, BL25, BL32,

Acupuncture is effective for central pain like thalamic

GB30 on the affected sidepain, but its efficacy for the various forms of peripheral

Moxibustion:

pain on the paralyzed side in patients with hemiplegia,

CV12, CV9, GV12, TE15, BL25,

LI11, GB34, GV20

are an even better indication. In particular, pain of the

Only on the affected side: LU1, ST27, SI11, SI10, LI15,

shoulder joint is encountered frequently and many

LI10, LI4, TE4, PC7, GB31, Kampu, ST36, LR4, GB40

patients stop walking because of the pain that is(half rice grain size, 3 to 5 cone on each point)

triggered during walking. For this condition, Prof. Shi
states that he needles LI15, Kengairyo and Kennairyo

During this stage, moxibustion is also effective.

in order to promote the flow in the local channels andIsaburo Fukaya (1900-1974), who dedicated his entire

punctures painful spots for blood letting in attempts tolife to the research and clinical application ofdissolve blood stasis and alleviate pain. Kitamura

moxibustion, has written his treatment records in theneedled "ashi" (tender) points to treat pain upon

form of a diary and published this as a book entitledelevation of the arm and subsequently achieved an

Stories About Healing Diseases with Moxibustion. In

improved ROM through active and passive exercise.

this

of

He did not treat just the shoulder simply because it ismoxibustion on the fingertips for stroke induced

painful, but also needled points like BL62 or GB26,

hemiplegia. For example, apply moxa for paralysis of

ST36, SP9 and GB34; and thus reportedly achieved

the arm using points at the fingertips on the affected

alleviation of the shoulder pain8).

book,

he

recommended

theapplicationside (approximately 3-4 mm on the midline proximal to

Spasticity too is a great problem. Prof. Xue-Min

the edge of the nail). If the patient feels the heat, use

Shi has pointed out that slightly stronger stimulation

only one moxa cone. If he/she does not feel the heat,of LI14 for flexion and contractures of hands anduse several cones. This treatment reportedly resulted
56

The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

Volume 1, Special Edition | Current Japanese Acupuncture and Moxibustion 2010

fingers induces instant relaxation6). Moreover, in casereportedly led to an amazing degree of alleviation4).

of spasticity of the biceps muscle, Kitamura also used

In the collection of essays by Shirota, Records ofmotor points of that muscle and applied electric

Clinical Acupuncture and Moxibustion, he emphasizes

current of an intensity that does not induce joint

the importance of persistent and careful treatment,

movements and a frequency of 30 Hz for a period of 5

describing it as follows. "After a long time after aminutes, followed by 2 minutes of rest and thenstroke, local treatment of the late effects is particularly

repeated these cycles three times. Thus he reportedly

important. The muscles, nerves and blood vessels that

achieved, although only temporarily, some relief of the

supply the affected area need special attention. In

spasticity. Based on the principle of reciprocalorder to improve their function, careful treatment

innervation, heof theshould be given. Treatment of the arms is importantantagonist is also beneficial8). These therapies arewhen the goal is to regain the ability to use a brush oreffective immediately after their application, but thechopsticks. Yet, treatment of the legs is also required.

effects do not last very long and thus require repeatedEven minor improvements in the condition of the legs

treatment and exercise therapy should preferably behelp to make walking easier. When walking becomes

performed while the therapeutic effect lasts. It iseasier, the maintenance of equilibrium improves andimportant that the patient remembers the relevant

thus stabilizes the entire body. Even if 1 or 2 years

sensations.

have passed since the attack, treatment will graduallystated that

stimulation

Although the number of case reports describing

lead to improvements. Although it may not be possible

stroke patients is not small, the number of suchto expect a full recovery, it should be sufficient toreports coupled with reports on detailed western

achieve a certain degree of improvement. The patient's

medical examination is not high. Acupuncturists likejoy will thereby be increased."10)

Shirota of about one generation ago, published a large
number of case reports, attesting to the abundance ofNote 1:clinical experiences, but many of these records are

The concepts of rehabilitation were clarified innevertheless incomplete by modern medical standards.

Japan in the 1950s. Later, after many deliberations,

Yet, in recent years, the number of reports providing

the Japanese Association of Rehabilitation Medicine

findings of both medical systems has been increasing.

(JARM) was founded in 1963. In the same year, theFor example, Yukimachi, et al. started to treat afirst school for the training of physiotherapists and72-year old woman and a 76-year old man (both ofoccupational therapists was opened. Three years later,which were diagnosed with lacunar infarction based on

in 1966, the first graduates left that school and the

MRI findings) with acupuncture and moxibustion fromfirst state examination was held. This created the first

the first week of hospitalization. Patient management

generation

was performed based on western medicine and these

therapists and led to the foundation of the Japanesepatients reportedly healed without any late effects9).

Physical Therapy Association and the Japanese

There are not yet any clear statements regarding

Associationofofphysiotherapists

Occupational

andoccupational

Therapists.

Later,

the long-term prognosis when acupuncture andrehabilitation was integrated into medical care andmoxibustion therapy are used for the treatment ofplayed an important role in the various fields ofpatients with this disease. Shirota reported that

medicine. Since acupuncture and moxibustion on thepersistent treatment resulted in patients regaining theother hand remained outside the framework of medical

power to power to write, and patients who had

care, the treatment of late effects of stroke that used todifficulties to walk, found it easier to walk. Also,be an indication for acupuncture and moxibustion, felltreating patients with contractures and fixed joints in

into the category of rehabilitation, so treatment by

the same way as patients with RA or neuralgia, has

acupuncturists decreased.

The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

57

Volume 1, Special Edition | Current Japanese Acupuncture and Moxibustion 2010

Note 2:

References:

The Xing Nao Kai Qao Fa ("Xing Nao Kai Qiao" =1. Ministry of Health, Labor and Welfare: 2001,

XNKQ, activating the brain and opening the orifices)

Estimated

method was developed by Professor Xue-Min Shi at therehabilitation

First Teaching Hospital of Tianjin University of TCM.
This therapy, which adds new views to the traditional
theories and is applied from the acute stage of a stroke tothe sequelae developing during the chronic stage, is anepoch-making

techniqueimprovements

immediately

allowing
after

the

dramatic
treatment.

Professor Shi himself introduced this technique in Japanand there is a Japanese textbook which describes thismethod. It is being practiced in many medical facilities.
Note 3:
Zhu's scalp acupuncture is a therapy that has beendeveloped by Professor Ming-Qing Zhu at Beijing
University of Traditional Chinese Medicine (which has
absorbed the former Beijing College of TCM). Various
therapeutic areas are used on the scalp and stimulated
by needling, applying a unique technique. The
technique is applied not only for the treatment ofstroke, but also for a wide spectrum of otherneurological diseases. Professor Zhu himself has
introduced this technique in Japan and there is aJapanese textbook which describes this method. It isbeing practiced in a number of medical facilities.

vital
of

statistics(determinate),

cerebrovasculardisorders,

http://www.mhlw.go.jp/toukei/saikin/hw/jinkou/ka
kutei01/hyo4.html
2. Ministry of Health, Labor and Welfare: 2002,

General conditions of the patients, total numberofpatients

with

the

main

disabilities,

http://www.mhlw.go.jp/toukei/saikin/hw/kanja/kan
ja99/5.html
3. Akao M.: Round-table discussion "Acupuncture

therapy for cerebral stroke", Ido no Nihon, No. 714,
p25-36, 2003
4. Shirota

B.:

Practical

acupuncture

therapy

centering on descriptions of clinical case reports(Vol. one), p252-279, Sogen Publisher, 1966
5. Kudo K.: Illustrated Blood Letting Therapy,
p93-96, Shizen Publisher, 1980
6. Xue-Min Shi: Pictoral explanation of acupuncture

therapy for cerebrovascular disorders, Oriental
Medicine Publisher, 1991
7. Fukaya I.: Stories About Healing Diseases with

Moxibustion, Collection Nos 1 through 12, Shinkyu
no Sekai Publisher, 1972

(The section of clinical applications continues on page 67)

58

The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)