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Pain effectively treated by scalp acupuncture!

Yamamoto New Scalp Acupuncture can also appreciably improve paralysis and speech disorders after strokes.

T. Yamamoto, Th. Schockert

A valuable complement to the treatment of acute apoplectic strokes.

Summary:

Key words:
Yamamoto New Scalp Acupuncture, stroke, stroke unit

Yamamoto New Scalp Acupuncture is a fast and easy-to-learn method amongst other applications for the treatment of acute strokes and represents a valuable complement to conventional schemes of treatment. Therapy should be initiated by the emergency doctor, continued during treatment at the hospital and stroke unit and, if necessary, extended beyond the rehabilitation phase by the patient's family doctor.

Dr. Toshikatsu Yamamoto, M.D., Ph.D.

Dr. Toshikatsu Yamamoto, M.D., Ph.D.

The Yamamoto New Scalp Acupuncture method was first published in 1973 and has been continuously extended and supplemented ever since.

Above all, pain and motor disturbances of the locomotor system and pareses of the extremities are treated by basic points.

A - subdivided 1-7, cervical spine

B - shoulder, neck

C - subdivided 1-6, shoulder joint, upp. arm, elbow, 
   low. arm, wrist, hand, fingers

D - subdivided 1-6, lumbar spine/sacrum,
   low. extremities

E - subdivided 1-12, chest, thoracic spine

H - lumbago

I - ischiadic nerve

All illustrations are taken from Helene and Toshikatsu Yamamoto and some of them can be found in their current textbook published by Springer-Verlag, Japan, (see below).

basic points

Internal diseases are mainly treated by needle acupuncture of the so-called Y points in the temple region. These Y points have been known since 1980.

Aphasia Points

Aphasia Points are not Y-Points, but care demonstrated here because of their position. It is of special interest that Broca´s aphasia is treated with the Yin Point, and Wernicke´s aphasia with the Yang Point

L
Liv
H
P
G
SI
S/P

= lungs
= liver
= heart
= pericardium
= gall bladder
= small intestine
= spleenpancreas

Th
S
D
LI
K
BlI
B

= triple heater
= stomach
= duodenum
= large intestine
= kidney
= bladder
= brain

Finally, the brain points discovered in 1995 as well as the aphasia points have provided additional possibilities of treating strokes.

YNSA Brain Points in the Yin position. The Basal Ganglia Point is elongated between the Cerebrum Point and the Cerebellum Point, extending slightly more posteriorly than the other two Brain Points.

YNSA Brain Points in the Yin position

In the meantime, Dr Yamamoto has discovered other somatotopes which still remain to be published. The points of different somatotopes mutually complement and reinforce each other. They can be combined with each other as required.

Needles are applied daily to patients suffering from apoplectic stroke for a period ranging from three weeks to three months. If necessary, the therapy can be extended by a further three months.

The aim of YNSA is a restitutio ad integrum. Paralysis and aphasia will recede completely, especially if therapy is initiated in good time.

YSNA has also proved very successful in treating the following disorders:

  • all kinds of motor disturbances, hemiplegia, paraplegia, migraine, trigeminal neuralgia,
  • Parkinson's disease, MS, endocrine disturbances, vertigo, tinnitus, aphasia, impaired vision, dementia,
  • Alzheimer's disease, epilepsy, insomnia, depression and other psycho-neurological disorders.

If the efficiency of body acupuncture is compared to a pebble thrown into a lake then scalp acupuncture can be compared to a paving stone thrown into a garden pond since applying needles, for example, to a Y point influences the entire meridian assigned to it.

The earlier therapy begins, the faster and more effective is its success. However, even if months or years have elapsed between the stroke and the start of therapy, the patient's condition can still be considerably improved.

Diagnosis of the Neck and Abdomen

Therapy usually starts with the basic points. The therapist decides which Y points are to be used after palpitating the diagnostic zones on the neck and abdomen. The sensitivity to pressure of the diagnostic area recedes immediately after applying the needles to the corresponding acupuncture point if the needles are positioned correctly.

YNSA neck diagnostic zones / areas.

YNSA neck diagnostic zones / areas.
All neck diagnostic areas are bilateral

L
Liv
H
P
G
SI
S/P

Diagnosis of the Abdomen

= lungs
= liver
= heart
= pericardium
= gall bladder
= small intestine
= spleenpancreas

Th
S
D
LI
K
BlI
B

= triple heater
= stomach
= duodenum
= large intestine
= kidney
= bladder
= brain

The neck and abdomen are thus suitable for diagnostic purposes as well as for an immediate check on the progress of treatment. This is absolutely new and unique in the history of acupuncture since the perfect position of the needles can now be monitored

From the ethical perspective, on the basis of present experience the benefits of YNSA should no longer be

withheld from stroke patients. To the end, physicians must be trained as rapidly and intensively as possible.

The greatest priority should be given to training all neurological and internal specialists, as well as doctors

employed in the rescue services. As a complement to the therapeutic guidelines described in the "Ärzteblatt"

(Physicians' Gazette) no. 17/1999, as an immediate therapeutic measure YNSA would have an extremely

positive influence on the prognosis for acute strokes. In the case of patients unable to be treated by lysis

therapy, YNSA should be initiated by the emergency doctor. Furthermore, YSNA must become an integral

part of basic therapy at all stroke units. The basic principles of YNSA can be learned in a few days, after

which any medical therapist can apply efficient treatment. As yet, data are only available on stroke therapy

via the basic points. There is a lack of studies investigating the success rate of the extended therapy via

basic, Y and brain points. Scalp acupuncture treats sensorimotor deficiency, regulates body temperature,

and reinforces and supports the effectiveness of all other conventional measures. YNSA encourages blood

circulation and has a neuroprotective effect; in acute cases the success of treatment often becomes apparent

after just a few minutes.

Statistics

Because there are very few statistics and experiments, the success of treatment with patients is presented as evidence.

Many thermographs were taken but not analyzed statistically. Some of the thermographs can be seen with the patient presentations on previous pages.

All thermographs were taken after the patient had been in the same room at constant temperature for about 30 minutes: first before YNSA, then during treatment, and again approximately 5 minutes after withdrawal of the acupuncture needles. Most patients showed a temperature increase, evidence of improved blood circulation. When acupuncture was used for pain relief, there was often an increased temperature at the site of pain before acupuncture which subsided after YNSA treatment.

Brunnstorm stage, an internationally recognized measure of movement in hemiplegic patients, has also been used and shown in graphs with the patient presentations.

Some statistics were compiled for patients treated with YNSA Basic Points for pain relief and hemiplegia. Although statistics have not been compiled since the use of Y-Points, an even higher level of improvement is certain.

In Figure 1, the high success rate of pain relief is clearly seen. With Basic Points A, B, C, D, and E the green column shows almost total pain relief.

The graphs in Figures 2, 3 and 4 show some statistics relating to stroke patients after treatment with only YNSA Basic Points. As can be seen, treatment success is not limited by age. It is important to start acupuncture treatment as soon as possible after the stroke.

Age-related effect of YNSA for hemiplegic patients.

Fig. 3 Age-related effect of YNSA for hemiplegic patients.

YNSA Basic Points used for pain relief

Fig. 1 YNSA Basic Points used for pain relief

Time-related results with YNSA Basic Points.

History

Fig. 2 Time-related results with YNSA Basic Points.

Combination of YNSA Basic C and D Points.

Fig. 4 Combination of YNSA Basic C and D Points.

Dr Yamamoto holds YNSA courses at his clinic and rehabilitation centre in Japan. In Germany, amongst others the DÄGfA (German Medical Society for Acupuncture) holds courses in.

Information on short team training courses for hospitals and rehabilitation centres can be obtained from
info@schaedelakupunktur.com or info@ynsa.net (Please contact us in english or german language)

Dr Yamamoto's YNSA courses are extremely interesting. His slides and films showing the progress of treatment for paralysed patients up to complete recovery are especially exciting and impressive. Dr Yamamoto is not only an expert teacher, he is also a resourceful researcher; he treats patients, instructs physicians and performs research with infectious humour and enthusiasm!

Dr Toshikatsu Yamamoto and his wife with participants

Dr Toshikatsu Yamamoto and his wife with participants
at a seminar for doctors at Miyazaki, Japan, in October 2003.

Seminar 2004

Dr Toshikatsu Yamamoto and his wife with participants
at a seminar for doctors at Miyazaki, Japan, in October 2004.

Seminar 2005

Dr Toshikatsu Yamamoto with participants
at a seminar for doctors at Miyazaki, Japan, in October 2005.

 

 

Seminardatas 2011

Announcement via Telefax / eMail / Telephone

Date

Place and Instructor

Information

January 8/9

Koeln, Germany
Dr. Susanna Schreiber

IAN/YNSA
ian-med@vodafone.de

March 05

Salzburg, Austria
Dr. Schockert

Einführung in die YNSA
YNSA im Rettungsdienst
Einführung in die spagyrische Blutkristallanalyse,
thomas-schockert@gmx.net

March 19/20

Hamm, Germany
Dr. Rudolf Helling

akuforum@t-online.de

April 2

Wetzlar, Germany
Dr. Kersten, Dr. Schockert,

YNSA in der Notfallmedizin, Feuerwehr und Rettungsdienst
Daniel.Kersten@lahn-dill-kreis.de

April 09-12

Meran, Südtirol
Dr. Oskar Ausserer

www.zdn.info

April 16/17

Hannover, Germany
Dr. Fink

juergensen@aim-hannover.de

May 23-27

Miyazaki, Japan
Dr. Yamamoto

thcmkyet@gmail.com

May 31-June 1

Bad Nauheim, Germany
Dr. Yamamoto, Dr. Ogal

fz@daegfa.de

June 18

Witten, Universität Witten/Herdecke, Germany
Dr. Schockert

YNSA im Rettungsdienst
tcm@uni-wh.de

July 15-17

Grafing, Germany

Gisela Kraus gisela.kraus@facm.de

October 10-14

Miyazaki, Japan
Dr. Yamamoto

thcmkyet@gmail.com

November 14-18

Miyazaki, Japan
Dr. Yamamoto

thcmkyet@gmail.com

November 23

Köln, St. Marien-Hospital,
Germany
Dr. Schockert

YNSA im Rettungsdienst
thomas-schockert@gmx.net.

November 30

Köln, St. Marien-Hospital,
Germany
Dr. Schockert

YNSA im Rettungsdienst
thomas-schockert@gmx.net.

 

 

 

 

 

References

Yamamoto T., Yamamoto, H.: Yamamoto New Scalp Acupuncture,
Axel Springer Japan Publishing Inc. 1998
ISBN 4-89589-169-0

Dr. Toshikatsu Yamamoto, M.D., Ph. D. Aishinkai
Yamamoto Hospital Acupuncture Institute, Nichinan
Rehabilitation Clinic Miyazaki, Kyushu, Japan

Dr. med. Thomas Schockert, Facharzt für Allgemeinmedizin, Naturheilverfahren
Am Eisernen Kreuz 2c, 52385 Nideggen, Tel.: +49 (2427) 90 24 24
eMail:
info@ynsa.net

 

 

The Effectiveness of Yamamoto New Scalp Acupuncture (YNSA)
for the Relief of Pain of the Locomotor System

An Open, Prospective, Topometrically Controlled Study

 

Summary

The aim of the study presented here was to identify the effectiveness of YNSA for the relief of pain of the locomotor system. We intended to show how rapidly and sustainably YNSA acts, the complaints for which it is particularly effective and also whether YNSA is suitable for emergency application.
Furthermore, our investigations also considered whether patients unfit for work with painful restrictions of the locomotor system could be reintegrated into the work process faster and thus more cost-effectively by YNSA.

Method

One hundred and four patients were treated by one single application according to the relevant rules of YNSA via basic points and Y points. The points were selected according to the palpatation results of a neck diagnosis. Points from the pubic area and Yamamoto New Chest Acupuncture were not applied. Depending on the duration of topometry, the needles were left in position for 3 to 9 minutes. A topometer developed by Prof. Schumpe served as the measuring instrument. This topometer was used to record patients' movements by an external computer-controlled ultrasonic emitter with an accuracy in the millimetre range. Before treatment began, all the patients had performed the movements that caused them pain. After treatment, the movements recorded topometrically were measured again for comparison and to check effectiveness. The participants described their subjective sensation of pain before and after treatment by means of a visual analogue scale (VAS) for pain. All the patients were interviewed by telephone once again a few weeks later in order to document the success of the treatment.

Results

Altogether, 93.3% (n=97) of the patients regarded a single, brief application of YNSA as effective.

50% of the patients (n=52) stated that they experienced complete absence of symptoms subjectively and by using the VAS scale after a single application of YNSA. 43.3% of the patients (n=45) experienced some relief after YNSA. Seven patients did not subjectively experience any effect.

58.5% (n=55) of the patients experienced both objectively measurable (topometry) and also subjectively stated relief or complete absence of symptoms (VAS) lasting for a period ranging from 1 hour to 13 months. For 35.1% of the patients (n=33) their overall movement after YNSA remained constant in topometric measurements. For 6.4 of the patients (n=6) their overall movement measured topometrically was worse after YNSA than before.

Conclusions

YNSA is an effective treatment especially for pain of the locomotor system and achieves a subjective improvement for 93.3% of patients. YNSA thus resembles the effectiveness of an intravenous injection or an intramuscular application of analgesics in treating movement-related pain. Due to its ease of application and its reliability, YNSA is particularly well suited for application in emergency treatment since a good long-term effect can be achieved by leaving the needles in position for just 3 to 9 minutes. Patients with YNSA can therefore be rapidly re-integrated into the work process.

Introduction

In my daily work with YNSA, I regularly encounter so-called instantaneous phenomena that are otherwise only found in neural therapy after Huneke: immediately after YNSA treatments, patients experience long-term absence of symptoms. These observations were the motivation for studying YNSA in more detail.
Participants for the YNSA study were sought by advertisements in the specialist journal "Naturarzt" and the daily paper "Bonner Generalanzeiger" [12, 13]. The advertisements were aimed at patients with severe movement-related pain. A total of 104 patients finally took part, including 103 experiencing pain.
The study was performed purely for scientific reasons and did not receive financial support from any source. All the measurements were performed at the Institute of Biophysics and Biomechanics in the Orthopaedic Department of the University of Bonn by Prof. Schumpe, who himself had no experience of acupuncture prior to this study. Since Prof. Schumpe (technical observer) had not been trained in acupuncture, in the same way as the participants, he was unable to know whether verum or placebo points were being used.
In the study presented here only verum points were used. All the patients were only treated by acupuncture on one single occasion and, without exception, by the same physician (Dr. med. Schockert), who had been trained by Dr. med. Yamamoto himself [5,6,7,8,9,10,11].

Questions to be Answered

  1. How effective is YNSA for pain of the locomotor system?
  2. Can permanent relief or even elimination of symptoms be achieved by one single treatment?
  3. How fast does Yamamoto New Scalp Acupuncture act?
  4. How long does the relief or elimination of symptoms last?
  5. Is the effectiveness of YNSA dependent on the needles remaining in place for 20 minutes?
  6. Is YNSA suitable for application in emergency treatment?

Methodology of Yamamoto New Scalp Acupuncture

Yamamoto New Scalp Acupuncture (YNSA) is a special form of traditional acupuncture. The method is based on a somatotope of the scalp. In the same way as for ear or mouth acupuncture, the total organism is projected onto a defined area on the scalp. The locomotor system is situated on either side of the boundary between forehead and hair; the internal organs are represented by Y points on both sides of the temple region. Scalp acupuncture distinguishes a yin somatotope on the front of the scalp and a yang somatotope on the rear. With the aid of special Japanese neck diagnostics, the related Y therapy points in the temple region are identified by means of pressure-sensitive points in the neck region. As a representative of every meridian, there is a pressure point on the neck and a related treatment point in the temple region. If, for instance, the kidney point on the neck is pressure-sensitive a needle is applied to the associated Y point in the temple. If the needle in the temple region is correctly positioned the pressure sensitivity on the neck disappears successively, thus providing an immediate verification of the correct positioning of the needle. In this study, diagnostic and therapeutic controls are in each case performed with the aid of neck diagnosis. In addition to the Y points, the so-called base points in the boundary between the forehead and hair are also used. In this case, the needle was applied to the maximum point of a pressure-sensitive region in the associated treatment area. Without exception, all the patients were treated just once by needle acupuncture. The needles remained in position for 3 to 9 minutes, i.e. the length of time required to perform the topometric control measurements [2, 9, 10, 11, 12, 13].

Inclusion Criteria

Only those patients took part in the study who were experiencing severe pain associated with movement or pain that was increased by movement. Patients with movement-related muscular pain were included in the study because the movements most painful for the patients had to be recorded by topometry before and after the treatment for comparison.

Exclusion Criteria

Patients who had been treated with Marcumar or who only experienced pain at rest were excluded from the study. In the same way, patients with headaches were excluded since headache cannot be recorded topometrically.

Consent

All patients gave their consent verbally before treatment started.

Real-time Ultrasonic Topometry

Complex issues in diagnosis and in progress control within the framework of training, therapy and rehabilitation require an objective and reproducible measuring technique covering as many functional parameters as possible. This method must consider both the evaluation of the performance of the individual (isolated) articular muscles as well as the movement sequences involving several joints. In order to record the geometrical position of body points in space by the measuring technique, the measuring principle of running time measurements, TR, of ultrasonic pulses between spatially separated ultrasonic transmitters and ultrasonic receivers was applied. Multiplying the running time, TR, by the temperature-related speed of sound, vt, yields the distance covered by ultrasound, D1. If in this way three distances, D1,2,3, from an ultrasonic transmitter to three ultrasonic receivers located at fixed distances from each other in space are measured then the location of the transmitter in relation to a predefined coordinate system (X,Y,Z) can be determined. A fourth receiver is fixed in a defined relation to the other three in order to verify the measured data. The correctness of the individual measurements can be verified by the fourth redundant measurement. If the measurement is repeated several times during one measuring period the transmitter can be moved during this period thus enabling a movement trace of the transmitter to be calculated. The measuring system permits measuring frequencies, F, from 1 to 100 Hz. The resolution achievable during measurements with the ultrasonic topometer depends on the measuring period within which the data are recorded. This data acquisition time is 1/100,000 of a second (10µsec). For comparison, in optical systems this corresponds to an image repetition frequency of 100,000 images per second or a camera shutter speed of 0.00001seconds. Within this period, a point moving at a speed of 125 m/sec covers just one millimetre. The measuring accuracy is therefore sufficient to record a moving transmitter with an accuracy of better than 1mm. The topometer can cover a measuring space of at least 5m x 4m x 3m; the resolution of the individual transmitter pulses being independent of the distance from the receiver. Since, with the exception of some movement sequences in certain sports disciplines, human bodily movements never exceed these velocities the transmitters can be attached to certain body points in order to record the body positions with this accuracy.
The dimensions of the ultrasonic transmitters are so small (diameter: 1 – 1.5 cm, height: 05 – 1 cm, weight: 2 – 3 g) that they can be attached to the human body without difficulty. The transmitters do not influence a person's sequence of movements. Furthermore, the transmitters have a largely spherically symmetrical emission of the pulsed wave (± 55 degrees) so that rotation of the transmitters about their axis of symmetry does not lead to a falsification of the measured data. Up to 12 transmitters distributed over various locations on the test subjects can be recorded simultaneously. This is sufficient to identify the patients' specific medical problems and to detect improvements to the locomotor system brought about by rehabilitation measures. These data can also be used to calculate moments of rotation, accelerations, velocities etc., which in the past, have been used to measure the success of certain forms of rehabilitation [5, 6, 7].

Criteria for Evaluating the Topometry

1. Posture Angle (WT)
The posture angle shows changes in the patients' mobility. In the recording, pain is indicated by disturbed, that is to say, not sinusoidal, movement curves at the time of the change of posture. Measurements were made of the respective changes in the angle of the individual transmitters.

2. Angular Velocity (UW)
The angular velocity provides information about coordination ability.

3. Angular Acceleration (AW)
The angular acceleration provides information on how much force a person must exert for a movement. The angular acceleration therefore represents muscular strength plus gravity. If the angular acceleration alone has changed then an improvement in the dynamics of the movement can be assumed; however, this is not visible to the eye. Only the measurement can detect such a positive change.
The parameters of posture angle, angular velocity and angular acceleration must be evaluated in a differentiated manner. The information provided depends on the harmony of the movement and the reproducibility of a movement.

4. Harmony of the Movement
The harmony of the movement is the parameter providing the greatest amount of information since a sinusoidal, fluid harmonious movement approximates most closely to that which can be called normal or physiological.

5. Secondary Movements
Secondary movements are an expression of unsteady sequences of movement distorted by pain, and of movements perpendicular to the sequence of movement. For example, when rising from a seated position the patients throw their arms forward to gain momentum or bend their upper body forward to an unphysiological extent. Or when the patient is asked to rotate the cervical vertebrae a sideways movement of the cervical vertebrae unintentionally occurs as a secondary movement. The more secondary movements that occur, the further removed is the patient from a physiological, harmonious movement.

6. Reproducibility
a) The reproducibility of a movement corresponds to the ease with which the patients move.
b) Factors for a lack of reproducibility include lack of strength, lack of practice, pain, uncertainty, control problems related to the cerebellum.

Visual Analogue Scale (VAS) for Pain

The VAS enables patients to adjust a red slide in a white visual field to subjectively represent their sensation of pain on a scale between "no pain" (in which case the red bar can be withdrawn completely from the window) and "most intense pain" (the red bar completely fills the window). On the reverse of the VAS, hidden from the patient, the therapist can read off the participant's subjective assessment in figures on a scale between zero and one hundred [1, 3].

Implementation of the Experiment

After their case histories had been discussed, all the patients were requested to demonstrate the movement that caused them most pain. Some of the patients had their pain intensified and provoked, for example, by placing weights in their hands to increase the pain of frozen shoulder before performing the movement or fixing gonarthrosis weights on their feet making it more difficult for them to move their lower legs when seated. This was intended to create the most realistic possible "everyday conditions", to simulate load pain, and to authentically experience pain when lifting, carrying loads, or bending over. After the painfully limited movement had been assessed, Prof. Schumpe fixed the ultrasonic transmitter in a suitable position by using strong Velcro fastening. In order to rule out measuring errors as far as possible, Prof. Schumpe performed all the measurements himself without exception. Before starting the therapy, all the patients indicated their acute pain during movements by means of the visual analogue scale (VAS).

YNSA was performed after the first topometric measurements. All the patients without exception were treated in a seated position. The technical observer was himself not previously trained in acupuncture so that he could not know whether the needles were applied to verum or placebo points. Only basis points and Y points were used. The new points of Yamamoto New Chest Acupuncture and the points in the pubic area were not used in this study to avoid repeated undressing and dressing. The second topometric measurements were performed after the therapy and then the patients' control assessments using the VAS. The treatment was then concluded and the needles removed again. Depending on the duration of the topometric measurements, the needles remained in position for three to nine minutes. A few weeks or months after the therapy, the patients were interviewed by telephone concerning their subjective state of health. It was not possible to contact all the patients within the same period of time. Furthermore, only one interview was performed so that the values presented here on relief of symptoms and elimination of symptoms merely indicate a lower estimate of the true duration of successful therapy.

Results

Demography: 104 persons, including 103 patients experiencing pain, took part in the study. There were 64 women (61.5%) and 40 men (38.5%).
Age:
The youngest female patient was 17 and the oldest 87. The youngest male patient was 26 and the oldest 79.

Diagnoses

The majority of patients (n=52/50%) complained of pain in the lumbar region. 20 test subjects (19.2%) experienced pain in the cervical vertebrae, 12 patients (11.5%) had hip problems, 8 (7.7%) shoulder and 7 (6.7%) knee complaints. The frequency of pain in the region of the thoracic vertebrae, the ankle and wrist was under 2%, respectively.

Visual Analogue Scale (VAS) as a Subjective Assessment Criterion

103 patients expressed their sensation of pain before and after therapy by means of VAS. The VAS values were on average 63/100 points before treatment and 19/100 points afterwards. The difference in the mean before/after was minus 44 points and the median of the difference between before/after was minus 45 points.
A comparison by means of a t-test for paired random samples yielded the following results: the mean of the intraindividual differences (after-before) of the VAS values differs significantly from zero (error 1, type = α<0.001).

Relief of Symptoms, Elimination of Symptoms

Seven patients (6.7%) did not profit from YNSA. They did not experience freedom from symptoms nor any relief. 45 patients (43.3%) reported that they had experienced relief, 52 participants (50%) experienced freedom from symptoms for different periods of time after a single session of scalp acupuncture lasting 3 – 9 minutes. The maximum period of relief of symptoms reported was 113 days and of freedom from symptoms 382 days.

Topometry as an Objective Evaluation Criterion

In the objective measurements, movement was worse for 6 patients (6.4%) and remained the same for 33 patients (35.1%). Fifty-five patients (58.5%) experienced an objectively measurable improvement. For 10 patients it was not possible to perform a topometric evaluation for the following reasons. Due to their severe pain, two patients were not able to perform the movements in such a manner that they could be evaluated for the measurement. A computer crash and problems with data saving meant that the data from 8 patients were irretrievably lost. Nevertheless, these patients' subjective statements on the basis of VAS are available for evaluation.

Topometric Evaluation

The six topometric evaluation criteria must be assessed in a differentiated manner. The criterion providing the greatest amount of information is harmony of movement. In order to obtain the rating "better" in the overall assessment ("better"/"same"/"worse") the test subjects' sequence of movements must have clearly improved in at least two categories. This led to the following results; for 55 persons (58.5%) it was possible to objectively establish an improvement in movements by the measuring procedure after a single acupuncture treatment. The result of the ultrasonically controlled recording of the sequence of movements was regarded as the "same" if only one assessment parameter displayed a positive change. Those patients whose movement curves remained identical before and after acupuncture were also considered to be the "same". A deterioration in the topometry was identified either if movement patterns had occurred in which the harmony was poorer or if several evaluation criteria displayed a deterioration. This would include, for example, an increase in secondary movements or a lack of precision in the reproduction of the movement.

Fig. 1

Patients who did not report any improvement in their symptoms (n=7) had on average an improvement of 20 points in the VAS score (95% confidence interval:[-2;43]).
Patients who had at least experienced some relief (n=44) specified an improvement of on average 40 VAS points, i.e. twice as many (95% CI:[34;46]).
Patients who experienced no symptoms for at least one day (n=52) had an even higher average improvement in their VAS values (50 points, 95% CI:[44;56]).
The difference between these three groups was significant with respect to their VAS values (variance analysis with linear contrast, p=0.01). A comparison of the two subjective parameters, VAS and disappearance/relief of symptoms, yielded good agreement (i.e. the greater the improvement in a person's symptoms the greater is the difference in the VAS values). The VAS values before acupuncture did not differ between the three groups.

Fig. 2

This is a comparison between the subjective variable, VAS, and the objective variable, topometry, (overall evaluation). It can also be seen in this case that the difference in the VAS values was the greater, the greater the improvement in the patients' symptoms measured by topometry.
Those persons whose condition was "worse" according to topometry (n=6) still had an average improvement on the VAS of 21 points (95% CI: [7;35]), although this improvement is even more apparent in the other two groups (topometry "same" (n=33, average improvement = 33, 95% CI: [29;46]) and topometry "better" (n=54, average improvement = 50, 95% CI[45,56])).
In this case as well, the variance analysis with linear contrast revealed a significant difference between the three groups (p<0.01). Here, the VAS values before treatment did not differ between the two topometry groups "same"/"better". The VAS values in the topometry group "worse" were on average lower than in the other two groups. However, there were only n=6 patients in this group.

Case Description

Before acupuncture treatment, a 60-year-old female patient with polyarthrosis and Guillain-Barre syndrome complained of pain in her shoulders and upper arms and said that she suffered from tingling paraesthesia after several movements of her arms. The VAS before therapy was 88. The patient was treated at Y and base points on both sides of the scalp. After therapy the VAS was 0. The patient had the subjective impression that "… the pain's gone, that's really brilliant…" (freedom from symptoms 78 days, relief of symptoms for a total of 104 days). In the subsequent telephone survey, the patient said she had been able to perform movements that had been impossible for a long time. In the topometric assessment, backward abduction and adduction of the right arm was observed. The diagrams show a clear improvement in angular velocity and angular acceleration. The reproducibility and the harmony of the movement also improved perceptibly after scalp acupuncture. Subjective assessment and topometry are in agreement here.

Fig. 3

The diagram shows the recording of the posture angle and serves to assess the harmony and reproducibility

Fig. 4

The diagram illustrates the velocity of the movement sequence before and after acupuncture

Fig. 5

Representation of movement acceleration

Discussion

The effectiveness of Yamamoto New Scalp Acupuncture determined objectively by real-time ultrasonic topometry is 58.5% (n=55). That is to say 55 patients experienced an objectively measured relief or elimination of their symptoms, which was also subjectively recorded by the visual analogue scale. This freedom from symptoms lasted a maximum of 382 days, for example in the case of pain due to a prolapsed intervertebral disc.

93.3% of all test subjects (n=93%) subjectively considered the single application of YNSA to be effective as recorded on the VAS. In this connection, attention must be drawn to physician/patient interaction. Patients who were willing to take part in the study may be assumed to have a positive attitude to acupuncture and also positive expectations of therapy. It must be remembered that the results presented in this study were achieved by a single application of acupuncture with the needles left in position for three to nine minutes. The positive result of the treatment does not therefore depend on the needles remaining in position for 20 minutes. It is therefore recommended that this approach should also be used by the medical emergency services. Since the needles remain in position for such a short period, it is not necessary to monitor the patient's circulation and/or respiration as may be the case after an intravenous application of analgesics. The success achieved by YNSA therapy resembles the effectiveness of an intravenous application of analgesics. In 93.3% of the participants, YNSA brings about immediate subjective relief or elimination of pain, which remains for a considerably longer period than the effect of an analgesic applied intravenously. In the case of two men, dysregulation of the circulation occurred during the application of YNSA. On of them had a previous cardiac condition and the other patient, who collapsed upon application of the needles, had been persuaded by his wife to take part in the study. Both participants got over the incident well without any negative consequences. YNSA therapists should therefore be in a position to apply any emergency medical treatment that may be required.

Due to the possibly rapid reintegration into working life of the patients after having been unfit for work because of pain, the results presented here hold out prospects of economic benefits and also a considerable reduction in costs for the health service.

New research findings on so-called pain memory, which is generally established in patients suffering from chronic pain, provide reasons why a single, short-term application of YNSA can bring about an elimination of symptoms lasting 382 days [4]. None of the currently licensed analgesics is capable of erasing a pain memory that has already been formed. Even analgesics from the opoid group that have a central effect are probably unable to erase a pain memory. The application of so-called counterirritation methods such as transcutaneous electric nerve stimulation, physical stimulation (heat or cold) or acupuncture are known to inhibit pain beyond the duration of the actual stimulation for hours or days. YNSA seems to be a therapeutic method capable of erasing pain memories especially rapidly and sustainably. It seems doubtful whether patterns of movement that have been learnt incorrectly can be erased from the brain and replaced by new physiological programmes. The topometric recordings seem to confirm this. The observation that after acupuncture treatment the movement patterns of six patients had become worse in the topometric recordings points to the fact that here acupuncture seems to have a certain effect on motoricity. This deterioration might be a so-called initial deterioration as can be observed after the administration of homeopathic remedies. The reason for this phenomenon cannot be clearly identified at present.

Another question also remains open after the study: How effective would the treatment have been if, for example, it had been applied by Dr Yamamoto himself? That is to say, how dependent is scalp acupuncture on the therapist? These results should be a motivation for further research! The data on the therapy of pareses given by Dr Yamamoto in his YNSA textbook, for instance after apoplectic insults, should be verified on European patients.

The findings presented in this study and processed by objective topometry should induce the representatives of the German public health insurers – who are undoubtedly aware that the WHO recommends acupuncture not just for three but for a total of 42 indications [2] – to reconsider the meaningfulness of the so-called "Model Project" for acupuncture. With the aid of topometry, it is possible to objectively determine and carefully document the success of acupuncture treatment for patients with back and joint pain. Would it not be advantageous if treatment and technical observation including documentation were undertaken by different persons? The undoubtedly purely coincidental (and certainly successful for physician and patient) therapy of, for example, pollinosis or asthma within the framework of the model project, unfortunately cannot, however, be properly documented by topometry!

Acknowledgements

I would like to thank Prof. Günter Schumpe, who made this study possible. I hope that topometry will become more widely used in research. Special thanks are due to Toshikatsu Yamamoto and Reza Schirmohammadi, who by passing on their medical knowledge have decisively influenced and enriched my medical therapy.

References

  1. Huskisson, E.C.: Measurement of pain, Lancet 2 (1974) 1127-1131
  2. Kampik, G.: Propädeutik der Akupunktur, Hippokrates (1998) 276, 359
  3. Neugebauer, E. et al.: Schmerzmessung und –dokumentation, Anästhesiologie und Intensivmedizin 12 (1993), 391-397
  4. Sandkühler, J.: Schmerzgedächtnis - Entstehung, Vermeidung und Löschung, Dt. Ärzteblatt 42 (2001) S. B2343
  5. Schumpe, K.G.: Bewegungsmessungen von Körperpunkten und ihr Aussagewert bezüglich der Körpergelenke, VSI-Berichte 882 (1991), 569-581
  6. Schumpe, K.G.: Die Aussagekraft von Ganganalysen am Becken-Bein-Skelett, Z. f. Orthopädie 3, 119 (1981), 306-314
  7. Schumpe, K.G.; Morscher, E.: Ganguntersuchungen und funktionelle Wirbelsäulenvermessungen mittels eines neu entwickelten Echtzeit-Ultraschall-Topometers (EUST) in der Orthopädie, Enke, 69 (1979)
  8. Schumpe, K G; Schockert, Th.: Effizienz der Yamamoto neue Schädelakupunktur (YNSA) bei Schmerzen am Bewegungsapparat; eine topometrisch kontrollierte Studie. Abstract, Deutsche Zeitschrift für Akupunktur, Hauck (2001)245f
  9. Yamamoto T., Yamamoto H.: Yamamoto New Scalp Acupuncture, Poster, Springer Japan (1998)
  10. Yamamoto T., Yamamoto H.: Yamamoto New Scalp Acupuncture, Springer Japan (1998)
  11. Yamamoto T: Neue japanische Schädelakupunktur, Chun-Jo, Freiburg/Breisgau (1985)
  12. Yamamoto T., Schockert Th.: Folgen von Schlaganfall und Schmerzen lindern, Naturarzt 8, Access (2000)
  13. Yamamoto T., Schockert, Th.: Mit Schädelakupunktur Schmerzen erfolgreich behandeln, www.ynsa.net

 

Thomas Schockert, Babak Boroojerdi, Toshikatsu Yamamoto, Günter Schumpe

Successful treatment of stroke by Yamamoto New Scalp Acupuncture (YNSA)
An open prospective topometrically controlled study

Summary
After coronary heart disease and carcinoma diseases, apoplectic insult is the third major cause of death in Germany. Due to a lack of efficient treatment concepts in classical medicine, strokes are the most frequent cause of invalidity in old age. Twenty percent of those affected die immediately as a result of the insult. Since only a minority of patients have access to lysis therapy, YNSA can represent a valuable complement to existing treatment strategies. In particular, this study also focuses on the benefits to the national economy of YNSA in stroke therapy.
The aim of the pilot study presented here was to show the efficiency of YNSA in treating stroke patients with the aid of topometry.

Method
Twenty-three stroke patients were examined neurologically immediately prior to YNSA. The mobility of the arms or legs with residual paralysis was documented objectively by topometry in three dimensions. After YNSA treatment, the patients were assessed neurologically and topometrically once again. The patients were questioned about their subjective impressions immediately after therapy and then three weeks later.

Results
The topometric examination showed that 14 of the 23 patients displayed significantly improved mobility after a single treatment with YNSA. Subjectively, this positive effect continued for up to 17 days. In the neurological examination, it was not possible to verify an improvement in the mobility of the arm or leg before and after acupuncture.

Conclusion
With the exception of lysis, no efficient therapy is available for the treatment of apoplectic insult. YNSA represents a valuable complement to existing therapy concepts. It can be demonstrated that patients benefit subjectively and objectively from YNSA. YNSA, which is simple to apply, should therefore be employed at the earliest possible stage – for example by the emergency services. Furthermore, successful YNSA treatment would lead to considerable economic benefits, for instance by eliminating the need for nursing care and by achieving reintegration into working life.

Keywords
Yamamoto New Scalp Acupuncture, topometry, stoke treatment

Introduction

After coronary heart disease and carcinoma diseases, apoplectic insult is the third major cause of death in Germany. Strokes are also the most frequent cause of invalidity in old age. Twenty percent of those affected do not survive the apoplectic insult. Seventy percent retain some physical incapacity for the rest of their lives and in some cases are dependent on nursing care [11]. Basic therapy for acute ischaemic insult involves maintaining blood pressure at the higher end of the normal range, keeping the respiratory tract open and monitoring the breathing function, establishing normoglycaemia, optimizing cardiac output, lowering body temperature, reducing cerebral compression, initiating nursing measures as an aspiration prophylaxis and in order to promote early mobility [3].

As the only classical cause-related therapeutic approach, lysis therapy is, however, only available to a minority of those affected. Within a period of 18 months, as part of a study 4032 patients with the tentative diagnosis "acute stroke" were admitted to hospital in Cologne. Of the 453 patients selected for acute lysis therapy, only 100 fulfilled the criteria for systematic lysis with rt-PA (recombinant tissue plasminogen activator) [8]. The criteria are: onset of symptoms less than three hours previously, patient under eighty years of age, no severe disturbance of consciousness. The question therefore arises of what therapy options are open to patients who do not fulfil the criteria for systematic lysis therapy. This is where YNSA offers a valuable complement to basic therapies [2,3,8,36].

YNSA was presented to the world for the first time in 1973. The therapy, consisting at that time of a 5-point system, has in the meantime been considerably extended by the discovery of new treatment points and new microsystems (basis and Y points, pubic area, Yamamoto New Chest Acupuncture). A very individual, selective and efficient treatment accommodating the patient's needs can be applied on the basis of the diagnostic possibilities offered by abdominal wall and neck diagnosis. Attention should be drawn here to our first study on the efficiency of YNSA for pain of the locomotor system (German Journal of Acupuncture 2/2002). The conclusion drawn from this study is that YNSA is an efficient therapy for pain of the locomotor system which achieved a subjective improvement for 93.3% (n=104) of the patients treated. 58.5% of those treated experienced both an objectively measurable and also subjectively experienced relief or absence of symptoms, in part lasting longer than one year, after a single treatment [26].

Questions to be answered

  • Can YNSA positively influence partial and residual paralysis after apoplectic insult?
  • Can such an effect be determined after one single treatment?
  • How long can positive effects be subjectively experienced after one single treatment?
  • Is YNSA therapy suitable for use by the emergency services for the treatment of acute apoplectic insult?

Methodology of Yamamoto New Scalp Acupuncture

Yamamoto New Scalp Acupuncture (YNSA) is a special form of traditional acupuncture. The method is based on a somatotope of the scalp. In the same way as for ear or mouth acupuncture, the total organism is projected onto a defined area on the scalp. The locomotor system is situated on either side of the boundary between forehead and hair; the internal organs are represented by Y points on both sides of the temple region. Scalp acupuncture distinguishes a yin somatotope on the front of the scalp and a yang somatotope on the rear. With the aid of special Japanese neck diagnostics, the related Y therapy points in the temple region are identified by means of pressure-sensitive points in the neck region. As a representative of every meridian, there is a pressure point on the neck and a related treatment point in the temple region. If, for instance, the kidney point on the neck is pressure-sensitive a needle is applied to the associated Y point in the temple. If the needle in the temple region is correctly positioned the pressure sensitivity on the neck disappears successively, thus providing an immediate verification of the correct positioning of the needle. In this study we additionally concentrated on the brain points (basal ganglia, cerebrum, cerebellum). The brain points requiring treatment were revealed by sensitivity to pressure on the sternum and the xiphoid process. If the needle has been applied correctly, a pressure sensitivity previously felt at the thorax also disappears. Furthermore, the so-called base points in the boundary between the forehead and hair were also used. In this case, the needle was applied to the maximum point of a pressure-sensitive region in the associated treatment area. 36,37,38,39 Without exception, all the patients were treated just once by needle acupuncture. The needles remained in position for 5 to 9 minutes, i.e. the length of time required to perform the topometric control measurements. Use was exclusively made of sterile, disposable steel needles (0.25 x 25 mm).

Methods
Inclusion and exclusion criteria
The study involved patients who had retained paralysis or partial paralysis of the extremities after apoplectic insult. Minimal mobility of the arm or leg was desirable to facilitate the evaluation of comparative topometric measurements before and after acupuncture. Patients with sensorimotor aphasia or neglect syndrome were excluded from the study.

Patients
We examined 23 patients (8 women and 15 men aged from 38 to 86) who had suffered a stroke between 18 months and 11 years previously. In the case of 11 patients the diagnosis was cerebral infarction and in 12 cases cerebral haemorrhage. All patients gave their written consent before treatment began after having received comprehensive verbal and written information.

Neurological examinations
A neurological examination was performed to assess motoricity (degree of paralysis ranging from 0 to 5 on the MRC scale, reflexes, pyramidal tract sign). In addition, all patients were assessed according to the motor part of the NIH stroke scale (paralysis of the face, arm, leg and pyramidal tract sign). The results before and after YNSA were compared with the aid of a two-sided paired T-test.

Real-time Ultrasonic Topometry
Complex issues in diagnosis and in progress control within the framework of training, therapy and rehabilitation require an objective and reproducible measuring technique covering as many functional parameters as possible. This method must consider both the evaluation of the performance of the individual (isolated) articular muscles as well as the movement sequences involving several joints. In order to record the geometrical position of body points in space by the measuring technique, the measuring principle of running time measurements, TR, of ultrasonic pulses between spatially separated ultrasonic transmitters and ultrasonic receivers was applied. Multiplying the running time, TR, by the temperature-related speed of sound, vt, yields the distance covered by ultrasound, D1. If in this way three distances, D1,2,3, from an ultrasonic transmitter to three ultrasonic receivers located at fixed distances from each other in space are measured then the location of the transmitter in relation to a predefined coordinate system (X,Y,Z) can be determined. A fourth receiver is fixed in a defined relation to the other three in order to verify the measured data. The correctness of the individual measurements can be verified by the fourth redundant measurement. If the measurement is repeated several times during one measuring period the transmitter can be moved during this period thus enabling a movement trace of the transmitter to be calculated. The measuring system permits measuring frequencies, F, from 1 to 100 Hz. The resolution achievable during measurements with the ultrasonic topometer depends on the measuring period within which the data are recorded. This data acquisition time is 1/100,000 of a second (10µsec). For comparison, in optical systems this corresponds to an image repetition frequency of 100,000 images per second or a camera shutter speed of 0.00001seconds. Within this period, a point moving at a speed of 125 m/sec covers just one millimetre. The measuring accuracy is therefore sufficient to record a moving transmitter with an accuracy of better than 1mm. The topometer can cover a measuring space of at least 5m x 4m x 3m; the resolution of the individual transmitter pulses being independent of the distance from the receiver. Since, with the exception of some movement sequences in certain sports disciplines, human bodily movements never exceed these velocities the transmitters can be attached to certain body points in order to record the body positions with this accuracy.
The dimensions of the ultrasonic transmitters are so small (diameter: 1 – 1.5 cm, height: 05 – 1 cm, weight: 2 – 3 g) that they can be attached to the human body without difficulty. The transmitters do not influence a person's sequence of movements. Furthermore, the transmitters have a largely spherically symmetrical emission of the pulsed wave (± 55 degrees) so that rotation of the transmitters about their axis of symmetry does not lead to a falsification of the measured data. Up to 12 transmitters distributed over various locations on the test subjects can be recorded simultaneously. This is sufficient to identify the patients' specific medical problems and to detect improvements to the locomotor system brought about by rehabilitation measures. These data can also be used to calculate moments of rotation, accelerations, velocities etc., which in the past, have been used to measure the success of certain forms of rehabilitation [26,27,28,29].

Criteria for Evaluating the Topometry
1 Posture Angle (WT)
The posture angle shows changes in the patients' mobility. In the recording, pain is indicated by disturbed, that is to say, not sinusoidal, movement curves at the time of the change of posture. Measurements were made of the respective changes in the angle of the individual transmitters.

2. Angular Velocity (UW)
The angular velocity provides information about coordination ability.

3. Angular Acceleration (AW)
The angular acceleration provides information on how much force a person must exert for a movement. The angular acceleration therefore represents muscular strength plus gravity. If the angular acceleration alone has changed then an improvement in the dynamics of the movement can be assumed; however, this is not visible to the eye. Only the measurement can detect such a positive change.
The parameters of posture angle, angular velocity and angular acceleration must be evaluated in a differentiated manner. The information provided depends on the harmony of the movement and the reproducibility of a movement.

4. Harmony of the Movement
The harmony of the movement is the parameter providing the greatest amount of information since a sinusoidal, fluid harmonious movement approximates most closely to that which can be called normal or physiological.

5. Secondary Movements
Secondary movements are an expression of unsteady sequences of movement distorted by pain, and of movements perpendicular to the sequence of movement. For example, when rising from a seated position the patients throw their arms forward to gain momentum or bend their upper body forward to an unphysiological extent. Or when the patient is asked to rotate the cervical vertebrae a sideways movement of the cervical vertebrae unintentionally occurs as a secondary movement. The more secondary movements that occur, the further removed is the patient from a physiological, harmonious movement.

6. Reproducibility
a) The reproducibility of a movement corresponds to the ease with which the patients move.
b) Factors for a lack of reproducibility include lack of strength, lack of practice, pain, uncertainty, control problems related to the cerebellum.

Implementation
Two weeks before the start of the study, the case history of the subjects was recorded and they were informed about the nature of the tests. Before the measurements took place, the patients underwent a preliminary neurological examination by Boroojerdi and then Schumpe performed the topometry. Fourteen patients were treated by Yamamoto and nine by Schockert. The topometric control was performed by Schumpe immediately after acupuncture. Finally, all the patients underwent a neurological examination by Boroojerdi.

Results
Topometry
The topometric examination revealed an improvement according to at least one of the above-mentioned assessment criteria for 14 of the 23 participants. The topometry did not reveal any change in mobility after the acupuncture treatment for nine of the participants.

Absolute change of angel

The figure shows an example of the change in the motoricity of a leg with residual paralysis by a representation of the topometry before and after acupuncture.

Subjective perception of the patients
Seventeen of the 23 patients experienced an improvement in their condition. Twelve patients were in agreement in reporting an improvement in the mobility of the extremities affected, a feeling of loosening, lightness, decrease in spasticity, gain in well-being and increase of confidence in their movements.

Neurological examination and NIH stroke scale
It was not possible to verify any improvement in the mobility of the arm or leg before and after acupuncture by a neurological examination. The NIH stoke scale did not show any significant change after scalp acupuncture for any of the four areas.

Discussion
Apoplectic insult is the third major cause of death in Germany and worldwide it is the most frequent cause of invalidity in old age [11,20]. Apart from in-patient lysis treatment for a minority of those affected, no efficient methods of treatment addressing the cause of the insult are available for stroke patients. There is an 8.8 percent risk of cerebral haemorrhage after lysis therapy [1]. As a valuable complement to this type of therapy, YNSA can be offered to all stroke patients who do not fulfil the criteria for lysis treatment [8].

The need for improved medical care for stroke patients has also been identified by Schenkel and Diener since lysis is only available for a minority of patients [25]. The World Health Organization (WHO) and the National Institutes of Health recommend acupuncture for the treatment of stroke patients [14,17]. This therapy has been applied worldwide on many occasions and is recommended on the basis of its effectiveness [4,6,9,10,13,16,19,23,35,36,37,38,39,41]. In the Wiener Medizinische Wochenschrift, Ernst and White come to the conclusion that acupuncture is helpful in rehabilitation after stroke [5]. Lyxin regards stroke treatment by acupuncture as indispensable for modern neurology since in China 90 percent of patients treated by acupuncture after apoplectic insult are discharged from hospital alive [40].

Pie et al. Show that early acupuncture treatment in the case of acute stroke considerably improves the motor functions and also provides relief in performing the activities of everyday life [22]. Critical voices argue that the needle acupuncture of traditional Chinese medicine is not appropriate for achieving any improvement in stroke patients[15,21,30,33,34]. In particular, the lack of sham acupuncture and control groups has frequently been criticized in meta-analysis. In response, it must be said that due to the lack of experience with sham acupuncture it cannot be regarded as completely reliable [24].

Although the earliest possible treatment with YNSA is recommended, even ten years after an apoplectic insult scalp acupuncture treatment is still of considerable benefit. Early treatment with YNSA gives rise to the hope that both mortality and also secondary diseases can be reduced in frequency and severity. In China and Japan, acupuncture treatment for stroke begins as early as possible. Grotte also proposes that treatment should start early, for example in hospital emergency rooms [9].

Ericson recommends first treating stroke patients by acupuncture two weeks after the acute event because results of studies on TCM needle acupuncture indicate that acupuncture opens cerebral arteries and that this widening sets improved perfusion in motion. In the case of arterial occlusion these effects would be beneficial and desirable. In the case of acute haemorrhage, however, this effect that should be avoided. There are currently no reliable studies providing recommendations as to the most favourable point for beginning acupuncture treatment of stroke patients [4]. The studies described in the literature on acupuncture treatment for stroke patients all refer without exception to the application of traditional Chinese needle acupuncture, electroacupuncture or transcutaneous electric nerve stimulation [18] and are in part extremely contradictory [5,21].

A definitive assessment of the effectiveness of acupuncture in follow-up treatment for stroke in meta-analyses seems particularly difficult to some critics because the quality and design of studies on Chinese acupuncture is found wanting. Smith, Moore and Mc Quai consider that the benefits of Chinese needle acupuncture for stroke treatment have not yet been proven [30,34].

No ongoing studies on the efficiency of YNSA in stroke treatment are available at present. Since such good retrospective experience with YNSA for stroke patients is available we decided not to make use of sham acupuncture for ethical reasons. As use was made of topometry we did not consider it absolutely necessary to include a blind test or control groups. Attention should be drawn here to the significance of topometry which is able to record sequences of movements in three dimensions with an accuracy in the millimetre range. In the present study , the medical treatment (Yamamoto, Schockert), the technical observation by topometry (Schumpe), and the physical examination (Boroojerdi) were strictly separated.

As far as a double-blind is concerned, it is difficult to image that the therapist could treat the patient blindfold and that the patient would know by heart all the YNSA treatment points and their effects. (Neurological humour test!) Sham acupuncture was rejected because the continuous development of the various acupuncture systems with the discovery of new points means that the presence of an acupuncture point at a particular point on the body can never be ruled out with absolute certainty. The placebo acupuncture needle developed by Streitberger was not used either because even acupressure or micropressure[12] could possibly initiate a therapeutically positive response [24,31,32].

The immediate effects achieved by YNSA point to the superiority of Japanese scalp acupuncture in comparison to traditional Chinese needle acupuncture for stroke treatment. The positive effects, lasting up to 17 days, described by patients after a single application of YNSA support this assumption.

Cost
Attention should be drawn here to the considerable economic benefits of this method. According to information from the head of a health insurance company (Techniker Krankenkasse in Aachen), care of a stroke patient in the first six months of his illness costs on average € 80,000. Even if only a fraction of those affected could have their motoricity improved by YNSA to such an extent that, for example, nursing care would no longer be necessary, then this would be an extremely valuable service for those affected. Economic factors are also involved in the realistic possibility that a considerable number of patients could be rapidly reintegrated into the work process. Speech disorders can also be positively influenced and treated by YSNA [36,39].

No appreciable additional costs would have to be borne by the patient's health insurance for in-patient YNSA treatment. Five to ten needles are used for treatment resulting in maximum costs of at present € 1.50. Sponsors are currently being sought for promoting the YNSA training of physicians throughout Germany.

Men and women have subjectively reported on an often considerable increase in well-being, quality of life and an improvement in motor activities after one single application of YNSA. Even in cases where no objective demonstration of improved motoricity was possible by topometry, patients nevertheless experienced a subjective benefit.

In contrast, the neurological examination did not reveal any significant change after YNSA. For ethical reasons, the data presented here should be investigated in further, more extensive studies.

On the basis of 30 years of experience with YNSA and the unanimously positive reports from therapists and patients worldwide it appears meaningful and appropriate that stroke patients in Europe should also be offered complementary YNSA treatment [6,10,23,36,37,38,39]. The results of this pilot study also confirm retrospective observations by Toshikatsu Yamamoto from 1983. In his textbook "YNSA", Yamamoto describes the effectiveness of YNSA for the efficient treatment of partial paralysis after apoplectic insult [36]. Since scalp acupuncture is relatively easy to perform after proper training, treatment could be initiated by the emergency physician, continued in hospital and during rehabilitation, and finally also applied by the patient's family doctor.

According to information from the German Physicians Association for Acupuncture (DÄGfA) in Munich, 2500 physicians have been trained in YNSA by the DÄGfA alone. In cooperation with other German (Gottfried Gutmann Akademie, Hamm) and international associations, Yamamoto also offers YNSA training courses. Thousands of physicians have now been trained in YNSA therapy worldwide.

I myself have already gathered very valuable experience with YNSA in emergency medical treatment. Even in the case of patients who had to be transported to hospital by helicopter there was no difficulty in applying YNSA. Since the needles are applied tangentially to the scalp even the earphones protecting the patient from noise in the helicopter do not obstruct application.

Conclusion
The as yet unexploited potential of YNSA should also be applied as soon as possible for the benefit of stoke patients.

Acknowledgements
We would like to thank all those who participated in the study as patients.

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Authors` Information

  • Dr. med. Thomas Schockert, Facharzt für Allgemeinmedizin, Akupunktur, Naturheilverfahren, Am Eisernen Kreuz 2c, 52385 Nideggen
  • Privatdozent Dr. med. Babak Boroojerdi, Neurologische Klinik der RWTH Aachen, Pauwels-Str. 30, 52074 Aachen
  • Dr. med. Toshikatsu Yamamoto, M.D., PhD. Aishinkai Yamamoto Hospital und Yamamoto Rehabilitation Clinic, Miyazaki, Japan
  • Prof. Dr. med. Dr. rer nat. Dipl. Ing. K.G. Schumpe, Orthopädische Universitätsklinik Bonn, Biomechanik/Biophysik, Sigmund-Freud-Str. 25, 53127 Bonn

 

 

Author's Address:

    Dr. med. Thomas Schockert
    Am Eisernen Kreuz 2c
    52385 Nideggen
    eMail: info@ynsa.net

 

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