THE TREATMENT OF ACUTE BRAINSTEM INJURY WITH ACUPUNCTURE - A CASE REPORT

BENJAMIN T. BROWN, M.D., F.A.A.F.P., L.Ac.

ABSTRACT - This case report describes the successful treatment of a 39 year old male who was unresponsive to all stimuli except deep pain, one month after brainstem injury subsequent to a high speed pedestrian-motor vehicle accident. Following acupuncture treatment emphasizing the use of Windows of the Sky points and the deep drainage circuit of Triple Heater/ Pericardium, this patient was able to begin cognitive and neuromuscular improvement, progressing at an unexpectedly rapid pace.

     Mr. J. is a 39 year old male who was working on the engine under the hood of his car when the back of his automobile was hit at high speed by another motor vehicle, on July 4, 1992. As soon as the patient was admitted to the University of Virginia Hospital, his wife requested the addition of complementary medicine modalities to his traditional management. During the first few weeks he seemed to greatly benefit from homeopathic treatment that was added. Yet, after approximately 4 weeks, his progress plateaued and he remained in a vegetative condition.
     After full discussion with the wife -concerning the appropriate perspective on the use of acupuncture for his condition, Mr. J. was first evaluated on August 5, 1992. The homeopathic treatments had by then been discontinued. His chart diagnoses included brainstem injury to the pons region, a C2 "hangman's fracture", left rib fractures, contusions to the chest, and a left knee ligamentous injury. More recently, he had developed constipation and fever from an unknown source and was on broad-spectrum antibiotics.
     The initial physical exam revealed a diaphoretic white male, supine with his eyes open and rolled upward. He was 1. Pulses taken by the 12 meridian method of Fire-Wood-Water 2. Windows of the Sky points: BL 10, Ll 18, ST 9, LU 3, TH 16, S responsive to pain only with a random motion, primarily of the torso and right side. No motion was elicitable from the left lower extremity. There was bilateral clonus of the lower extremities, left greater than right. His upper extremities were in decorticate posture. There was gaseous abdominal distention with decreased bowel sounds. His neck had been placed in a Philadelphia collar and his left knee was in a straight brace.
     Elements important to his oriental medical status included a pre-accident history of minor depression with sugar and dairy tropism. Outbursts of anger were also noted. His oriental medical examination revealed a moderately thin and delicate build. Hand morphology (1) was that of metal and less so for fire. Oriental pulses¹ revealed generally good yin strength and superficial yang excess, presumably related to his fever. Specifically, relative spleen and kidney deficiencies were noted. The tongue was difficult to view due to the collar worn by the patient, but generally had a thick, white, coating, with the appearance of a yeast overgrowth.
     The acupuncture approach for the first treatment centered on the use of the Windows of the Sky points² and the Triple Heater/Pericardium deep drainage circuit³. In addition, a Tai-Yin/Yang-Ming circuit was inserted in order to influence gastrointestinal function (specially his constipation) and to stimulate the immune system.
     Mr. J. responded remarkably well from the first treatment on. By the second visit, he looked directly at the physician and followed him around the room with his eyes. He could open and shut his eyes upon request. He was no longer diaphoretic and his abdomen was soft and flat. He was thereupon taught a "yes/no" signal with the right hand by his wife. Each subsequent treatment was noted by his wife to be followed by a leap in neuromuscular function within 24-48 hours. Attempts at verbalization began and his level of awareness and cooperation improved dramatically. Left sided neuromuscular improvement was evident. The progress in physical therapy was rapid. He was transferred to the Blue Ridge Rehabilitation Hospital after five treatments, approximately two weeks after initiation of therapy.
     Progress continued during rehabilitation, with the patient being able to speak sentences. His thinking revealed to be quite clear. Swallowing function returned and the gastrostomy tube was removed. He began walking with help. The wife and staff at the hospital both noted rapid progress, again usually with a quantum jump in function within 24-48 hours post acupuncture treatment. The patient was discharged following four more acupuncture treatments. He is now being treated on an outpatient basis.

DISCUSSION
     The proper flow of Chi energy throughout the body ensures normal cellular function, including repair and regeneration. The fundamental effect of acupuncture is an alteration of the Chi flow in one or more areas of the body. In 3. Deep drainage of Triple Heater/Pericardium: PC 1, TH 16, GV 20 this context, Mr. J.'s brainstem injury and C2 fracture represented a difficult problem. The massive acceleration/deceleration injury caused significant stagnant blood and Chi flow to the lower brain and neck region. In addition, the use of the Philadelphia collar made normal range of motion, which would help re-establish energetic flow, impossible.
     The use of the Windows of the Sky (WOS) points was indicated, 1) to reestablish the normal Chi flow between the brain and the rest of the body, 2) because of their local effect, since they are situated near the injury. The Triple Heater/Pericardium circuits are frequently compared to the Parasympathetic/Sympathetic nervous system in their function. The massive injury would represent a shock to his Autonomic Nervous System (ANS). Additionally, the brainstem injury and C2 fracture occur near the site of ANS function in the brain. Therefore a deep drainage of the TH/PC was used. These points also include WOS points and their energetic link traverses the area of injury.
     Accessory treatment approaches were utilized. Kidney tonification was felt to be important because of the pulse deficiency as well as the brain being the Sea of Marrow ruled by Kidney Yin. This was treated with N/N+1 circuits of the type described by Helms (2).
     Periodically, the patient's anger would flare, and this would be diagnosed in the Oriental model as "Wood excesses", and treated with the lateral Seem protocol (3) and so addressing the Shao Yang (using the Yang Oe and Tai Mo). During these treatments, GB 39, the Roe point of brain and marrow, was also included.
     For the left sided weakness N/N+1 circuits were rotated on the left. Addressing Mr. J.'s underlying Metal deficiency was important for coordinating the overall balance. This was accomplished through the use of N/N+1 circuits on Tai Yin/Yan Ming. Finally, local circuits for left knee ligamentous injuries were done.
     Reference literature on the acupuncture treatment of acute central nervous system injury is primarily focused upon cerebrovascular accidents (4,5,6). Comparative improvements in the rehabilitative progress of stroke victims treated with acupuncture has been demonstrated. Additionally, Ji Nan (4) shows improvement in the progress of a mixed group of CNS insults due to CVA or acute injury. He does not separate the two groups for study. This interesting study shows an improvement in microcirculation and edema, and a reduction in blood viscosity subsequent to acupuncture use. His approach used the scalp acupuncture system.
     This case describes a distinct initiation of improvement in a severely brainstem injured patient subsequent to acupuncture treatment in a clinical situation that is known to usually have a slow and meager progress. Considering the highly electrical nature of neurons, acupuncture seems a natural choice for stimulating healing in acute neurological injuries. A sufficiently large number of patients and controls would be needed, however, to demonstrate a significant difference in the acupuncture-treated group of patients suffering from acute brainstem injury.

REFERENCES
1. Requena, Y. Morphotypological Hand Diagnosis in Acupuncture. Editions Solal, 1986.

2. Helms, J. Syllabus of Medical Acupuncture for Physicians. UCLA Extension. Santa Monica, 1990.

3. Seem, M. Acupuncture Imaging. Healing Arts Press. Rochester, Vermont. 1990.

4. Nan Ji, et al. A Study on the Mechanism of Acupuncture Therapy in the Treatment of Sequelae of Cerebrovascular Accident or Cerebral Injury. Journal of Traditional Chinese Medicine. 1987; 7(3): 165-168.

5. Chen, Ye-Meng and Fang, You-An. 108 Cases of Hemiplegia Caused by Stroke: The Relationship Between CT Scans Results, Clinical Findings and the Effect of Acupuncture Treatment. Acupuncture and Electrotherapeutics Res., Int.J. 1990; Vol 15: pp 9-17.

6. Fang, You-An, et al. Acupuncture for Treatment of Stroke. Shanghai Translation Publishing Co. 1987; p. 49.