Acupuncture for Cerebral Arteriosclerosis: Diagnosis and Treatment

Cerebral arteriosclerosis refers to a syndrome characterized by widespread reduction in cerebral blood flow, extensive cerebral tissue changes, and neurological dysfunction caused by atherosclerosis of the cerebral arteries, arteriolosclerosis, and hyaline degeneration of the microarterioles. Disorders of fat metabolism are a significant factor in the development of arteriosclerosis, but it is also related to age, endocrine factors, hypertension, dietary habits, living environment, and other factors. Pathological evidence confirms that over 90% of elderly individuals have varying degrees of cerebral arteriosclerosis, though not all exhibit symptoms of the condition. Cerebral arteriosclerosis is directly related to the diameter of the affected arteries: atherosclerosis predominantly occurs in large and medium-sized arteries with a diameter greater than 500 μm; diffuse arteriolosclerosis is more common in small arteries with diameters between 150–500 μm; hyaline degeneration of microarterioles and fibrosis of capillaries mainly occur in microarterioles and capillaries with diameters smaller than 150 μm. These three pathological types of cerebral arterial wall degeneration are collectively referred to as cerebral arteriosclerosis. Different types may coexist or occur independently. Severe and widespread cerebral arteriosclerosis often leads to local or global reduction in cerebral blood flow, resulting in cerebral hypoxia, and ultimately cerebral atrophy. Sclerosis of the fine cerebral arterioles frequently causes multiple microinfarcts, commonly found in the basal ganglia, internal capsule, pons, thalamus, and cerebellar cortex, leading to a lacunar state (status lacunaris).

I. Diagnostic Key Points

**Cerebral Arteriosclerosis** Cerebral arteriosclerosis typically has a gradual onset after the age of 50, with a male predominance (approximately 2:1). It is often accompanied by systemic arteriosclerosis, particularly coronary and renal arteriosclerosis. Occasionally, it may occur in younger individuals. The main clinical manifestations of cerebral arteriosclerosis can be categorized as follows: 1. **Neurasthenic Syndrome of Cerebral Arteriosclerosis**: Patients commonly complain of headache, dizziness, memory loss, difficulty concentrating, slowed thinking, reduced work capacity, easy fatigability, and numbness in the limbs. Neurological examination usually reveals no specific positive signs, except for retinal small-artery sclerosis on fundoscopy. Clinical misdiagnosis as neurosis or autonomic dysfunction is thus common. 2. **Arteriosclerotic Dementia**: The most prominent clinical features are memory impairment and personality changes. Recent memory is diminished, while remote memory remains relatively preserved. Gradually, patients develop disorientation to time, place, and person; impoverished thinking; reduced speech; slowed reaction; emotional apathy; and indifference to the external environment. Personality may conversely become selfish, stubborn, suspicious, or delusional; behavior may appear childish, unrestrained, and emotionally labile, with confabulation or fabrication. In severe cases, childlike dementia may manifest. 3. **Pseudoparkinsonism Syndrome and Pseudobulbar Palsy**: These result from multiple cerebral infarctions. Main clinical features include bilateral pyramidal signs, increased muscle tone in all limbs, bradykinesia, and a mask-like facies resembling parkinsonism. However, patients also display pseudobulbar palsy, involuntary laughing or crying, gait difficulty, positive pyramidal signs, and varying degrees of dementia in some cases. 4. **Subcortical Arteriosclerotic Encephalopathy**: This primarily affects white matter, with gray matter usually spared. The underlying pathology involves multiple small ischemic foci due to small-artery ischemia leading to sclerosis. Clinical manifestations include chronic progressive dementia, cortical blindness, seizure episodes, language disturbance, apathy, gait instability, and involuntary movements. 5. **Lacunar State (Microinfarction)**: This consists of multiple small ischemic necrotic foci, the most common pathological change in hypertensive cerebral arteriosclerosis. Lacunar states are usually asymptomatic; however, if lesions involve critical areas, they may produce pseudobulbar palsy with increased muscle tone, pyramidal signs with ipsilateral cerebellar ataxia, pure hemiparesis, etc. **Examinations** 1. **Blood Biochemistry**: Hyperlipidemia is common, with elevated cholesterol, β-globulin, and triglycerides. 2. **Cerebrospinal Fluid (CSF)**: Mostly normal; a few patients show mildly elevated protein and abnormal colloidal gold test. 3. **Electroencephalography (EEG)**: Often shows mild diffuse abnormalities, slowing of alpha rhythm, increased slow waves over the occipital lobes, and a small number of alpha and delta waves in both hemispheres. Focal delta waves may appear in cases of focal cerebral infarction. 4. **Rheoencephalography (REG)**: Four characteristic features: ① blunted main wave (>90°); ② diminished or absent dicrotic wave with a notch <1 mm, and indistinct or absent double peaks; ③ prolonged rise time (>0.08 sec); ④ decreased amplitude. 5. **Cerebral Angiography**: Main findings include irregular vessel caliber (some narrowed, some dilated), tortuous vessels, and visualization of terminal arteries. 6. **Doppler Ultrasound**: Can detect cerebral artery stenosis, especially in the extracranial portion of the carotid artery. 7. **CT Scan**: May show localized hypodense areas, ventricular enlargement, cerebral atrophy, and asymmetric sylvian fissures. 8. **MRI**: Superior to CT in demonstrating various abnormalities of cerebral arteriosclerosis. Main findings include: (1) Focal and diffuse atrophy. (2) Multiple lacunar infarcts and other types of cerebral infarcts, all showing prolonged T1 and T2 signals. (3) Periventricular ischemic demyelination changes, appearing as prolonged T1 and T2 signals surrounding the lateral ventricles, especially at the anterior and posterior horns.

II. Treatment

(1) Acupoints and Needling Methods

1. **Taiyang (EX-HN5, bilateral)**: Located in the temporal region, in the depression 1 cun posterior to the midpoint between the lateral end of the eyebrow and the outer canthus. Use a 30-gauge, 2-cun filiform needle. After routine local disinfection, insert obliquely toward GB8 (Shuaigu) approximately 1.8 cun. Needle sensation: distension and pain in the temporal region. 2. **GV20 (Baihui)**: Located on the vertex, 5 cun directly above the midpoint of the anterior hairline and 7 cun directly above the midpoint of the posterior hairline, in the depression at the midpoint of the line connecting the apexes of both ears. Use a 30-gauge, 1-cun filiform needle. After routine local disinfection, insert obliquely toward GV19 (Houding) approximately 0.8 cun. Needle sensation: local distension and pain. 3. **GB8 (Shuaigu, bilateral)**: Located 1.5 cun directly above the apex of the ear. Use two 30-gauge, 1.5-cun filiform needles. After routine local disinfection, insert obliquely and posteriorly approximately 1.3 cun. Needle sensation: distension and pain in the temporal region. 4. **GB20 (Fengchi, bilateral)**: Located in the nape, below the occipital bone, 1 cun above the posterior hairline, level with GV16 (Fengfu), in the depression between the sternocleidomastoid muscle and the upper end of the trapezius muscle. Use two 30-gauge, 2-cun filiform needles. After routine local disinfection, insert obliquely toward the spine approximately 1.8 cun. Needle sensation: local distension and pain.

(2) Methods

The patient assumes a seated position. The aforementioned acupoints are needled according to the standard method. The needles are retained for 40 minutes and then removed, with one intermediate manipulation (twisting) performed. Treatment is administered once daily, with 10 sessions constituting one course of treatment. A 5-day rest is taken before resuming needling.

3. Commentary

Acupuncture treatment for cerebral arteriosclerosis yields favorable therapeutic outcomes, particularly for patients in the early stage. It is notably effective in restoring memory decline, relieving headache, dizziness, improving concentration, reducing fatigue, and alleviating numbness in the limbs. However, for patients with more advanced arteriosclerosis who present with dementia, suspiciousness, delusions, childish behavior, lack of discretion, emotional lability (alternating between joy and anger), confabulation, and fabrication, recovery tends to be slower—though some therapeutic benefits are still observed. In summary, acupuncture is a relatively effective modality for treating cerebral arteriosclerosis.

Pathophysiology and Clinical Manifestations of Cerebral Arteriosclerosis

Cerebral arteriosclerosis is a progressive vascular disorder marked by atherosclerosis, arteriolosclerosis, and hyaline degeneration of cerebral microarterioles, leading to a widespread reduction in cerebral blood flow and neurological dysfunction. Disorders of fat metabolism are a primary etiological factor, though age, endocrine imbalances, hypertension, dietary habits, and environmental influences also contribute. Clinically, patients present with chronic symptoms such as dizziness, headache, memory impairment, and emotional instability, which may progress to more severe conditions like vascular dementia or stroke. Diagnosis relies on neuroimaging (e.g., MRI, CT angiography) and assessment of systemic vascular risk factors. Traditional Chinese Medicine (TCM) identifies this condition as a pattern of blood stasis and phlegm turbidity obstructing the cerebral vessels, often accompanied by kidney and liver deficiencies. In this context, acupuncture treatment for cerebral arteriosclerosis symptoms is recognized as a complementary approach that aims to restore vascular function and alleviate neurological deficits by targeting specific pathophysiological pathways.

Mechanisms of Action: How Acupuncture Benefits Cerebral Circulation

Understanding how does acupuncture help cerebral arteriosclerosis requires exploring its multi-level physiological effects. Acupuncture stimulates peripheral sensory nerves, activating the central nervous system to release neurotransmitters and vasoactive substances such as nitric oxide and calcitonin gene-related peptide, which promote vasodilation and increase cerebral blood flow. This improved hemodynamics helps counteract the ischemic changes caused by arteriosclerotic narrowing. Furthermore, acupuncture modulates the autonomic nervous system, reducing sympathetic overactivity that contributes to hypertension and vascular stiffness. At the cellular level, it enhances endothelial function, reduces oxidative stress, and suppresses inflammatory cytokines (e.g., TNF-α, IL-6), thereby slowing the progression of atherosclerosis. Clinical studies also indicate that regular acupuncture sessions can lower serum lipids and improve lipid metabolism, addressing a core pathogenic factor. By integrating these mechanisms, acupuncture does not merely palliate symptoms but actively supports vascular recovery and neural plasticity, making it a valuable adjunct to conventional pharmacological therapy for cerebral arteriosclerosis management.

Acupuncture Points for Recovery and Treatment Protocol

Selection of acupuncture points for cerebral arteriosclerosis recovery is guided by TCM principles of dredging meridians and balancing organ systems. Commonly employed points include Baihui (GV20), which enhances cerebral perfusion and mental clarity; Fengchi (GB20), to relieve dizziness and improve vertebrobasilar circulation; and Neiguan (PC6), which regulates heart function and reduces chest discomfort. Additional points such as Zusanli (ST36) and Fenglong (ST40) address phlegm and digestive disturbances, while Taixi (KI3) and Sanyinjiao (SP6) nourish kidney and liver yin, correcting underlying deficiencies. A typical protocol involves 20–30 minute sessions, two to three times weekly for at least three months, with electroacupuncture sometimes applied to augment vasodilation. It is crucial that such treatment be administered by a licensed practitioner and integrated with lifestyle modifications—diet, exercise, and stress management—as well as standard medical care. While acupuncture is not a standalone cure, its targeted application can significantly alleviate symptoms, improve quality of life, and support neurological recovery in patients suffering from cerebral arteriosclerosis.