Research Article

Effectiveness and Safety of Acupuncture for Poststroke Dysphagia: Study Protocol for a Pragmatic Multicenter Nonrandomized Controlled Trial

Table 1

Locations, indications, and manipulations of the acupoints selected for the project.

PointsLocationIndicationsManipulation

GB20 (Feng Chi)In the depression between m. sternocleidomastoideus and m. trapezius, level with Fengfu (DU 16) point (on the Du meridian, 1 cun above the posterior hairline). [If the hairline is not easily determined, the level of bilateral earlobe tip connection will be used.]Headache, stiff neck, red and painful eyes, nose bleeding, tinnitus, stroke, swallowing difficulty, deviated mouth, and eyes.Puncture at a depth of 0.8–1.2 cun with the needle tip pointing towards the throat. After obtaining needling sensation, rotate the needles with reinforcing techniques (rotating 180°–270° at 30 times/min for 30 seconds) till the needling sensation radiating to the whole tongue and throat.

GB12 (Wangu)On the head, in the depression posterior-inferior to mastoid process.Headache, neck stiffness, toothache, facial palsy.Similar to GB20

CV23 (LianQuan)With the patient’s head slightly tilting backward, the point is directly above the Adam’s apple and at the midpoint of the upper border of the hyoid bone.Swelling and pain in the tongue, excessive salivation, stroke with stiffness of the tongue, sudden loss of voice, difficulty in swallowing.Insert obliquely for about 1.0 cun towards the root of the tongue, followed by applying mild lifting and thrusting technique for about 1 min till soreness and distending sensation (de qi) is felt in the tongue and throat.

Shanglianquan1 cun above CV23 (with the patient in a sitting position and the patient’s head slightly tilting backward, the point is directly above the Adam’s apple, and on the midpoint of the upper border of the hyoid bone).Alalia, sore throat, difficulty in swallowing, difficulty in speechInsert the needle obliquely to a depth of 1.0–1.5 cun towards the root of the tongue. Then followed by mild lifting and thrusting the needle for around 30 seconds until soreness and distending sensation is felt in the tongue and throat.

HangsangOn the posterior wall of the throat.Sore throat, difficulty in speech.Patient is asked to open the mouth, with the tongue pressed by a tongue depressor to expose the posterior wall of the throat clearly. Then a needle of 75 mm in length will be applied to prick the posterior wall of the throat at the depth of about 0.15 cunfor 4 times. After the needle is withdrawn, the patient is asked to move the tongue in and out for 10 times.

Lower 2/5 of the motor zone of the scalpThe motor zone is a line connecting the following two points: the first is 0.5 cm posterior to the midpoint of the anteroposterior midline over the vertex; the second is the intersection of the lateral eyebrow-occiput line with the anterior border of the hairline at the temple. The motor zone can be divided into 5 portions.Facial paralysis, swallowing difficulty.Insert the needle transversely at 15° angle to the skin surface and push the needle to about 1.0 cun in depth, then use twirling method (rotating 180°–270° about 200 times/min) to manipulate the needle for about 30 seconds.

DU20 (Bai Hui)7 cun above the midpoint of the posterior hairline, or at the junction of the midline at the vertex with the line joining the two ear apexes.Headache, tinnitus, vertigo, stroke with difficulty to speak.Puncture obliquely at an angle of 30 degrees to a depth of 0.5 to 0.8 cun, then use rotating motion (rotating 180°–270° at about 200 times/min) to manipulate the needle for about 30 seconds before withdrawing the needle.

LI4 (HeGu)On the dorsum of the hand, between the first and second metacarpal bones, approximately in the middle of the second metacarpal bone on the radial side.Swollen and sore throat, headache, toothache, deviated mouth and eye, fever, delayed labour.Puncture perpendicularly for 0.5 to 1.0 cun, then apply for 30 seconds reinforcing technique with the lifting and thrusting movement (strong thrusting and gentle lifting for short duration with small amplitude and low frequency).

HT5 (Tongli)1 cun above the shenmen point, which is at the medial end of the transverse crease of the wrist, in the depression on the radial side of the tendon of the flexor carpi ulnaris.Painful and swollen throat, sudden loss of voice, stiff tongue with difficulty in speech.Puncture perpendicularly to a depth of 0.5cun, then apply reinforcing technique with the lifting and thrusting movement for 30 seconds.

ST40 (Fenglong)8 cun above the external malleolus, 2 cun lateral to the anterior crest of the tibia.Headache, cough and stroke with phlegm as the pathogenic cause.Puncture perpendicularly for 1.5 cun, then apply reducing technique by lifting and thrusting the needle (gentle thrusting and strong lifting with large amplitude and high frequency) 30 seconds.

LR3 (Taichong)On the dorsum of the foot, in the depression distal to the junction of the 1st and 2nd metatarsal bones.Headache, dizziness, blurred vision, deviated mouth, stroke.Puncture perpendicularly for 0.5–1.0 cun, then apply reducing techniques by lifting and thrusting the needle for 30 seconds.

KI3 (Taixi)At the depression between the medial malleolus and the tendon calcaneus.Sore throat, deafness, coughing blood, impotence, frequent urination and lumbar pain.Insertion perpendicularly for 0.5–1.0 cun, then apply for 30 seconds reinforcing technique with the lifting and thrusting movement.

UB23 (Shen Shu)Level with the lower border of the spinous process of the 2nd lumbar vertebra, 1.5 cunlateral to the posterior midline.Blurred vision, deafness, tinnitus, edema and lower back pain.Straight insertion for 0.5–1.0 cun, then apply for 1 min reinforcing technique with the lifting and thrusting movement.