Zusanli acupoint in the treatment of Aphasia and Mutism

Introduction

Aphasia and mutism are communication disorders that affect the ability to produce and understand language. These disorders can be caused by various conditions, such as stroke, traumatic brain injury, brain tumor, and degenerative diseases. While speech therapy and medications are commonly used to treat these conditions, there is growing interest in complementary and alternative therapies, such as acupuncture. One acupoint that has shown promise in the treatment of aphasia and mutism is Zusanli ST36 acupoint. This article will explore the use of Zusanli ST36 acupoint in the treatment of aphasia and mutism, including its history, location, mechanisms of action, and clinical studies.

History of Zusanli ST36 acupoint

Zusanli ST36 acupoint is one of the most frequently used acupoints in traditional Chinese medicine (TCM). It is located on the leg, below the knee, and lateral to the tibia. The name "Zusanli" means "three leg miles," which refers to the belief that stimulating this acupoint can increase stamina and endurance, allowing a person to walk an extra three miles. Zusanli ST36 acupoint is also known as "the sea of nourishment," as it is believed to tonify Qi and blood, and support the digestion and immune system. The use of Zusanli ST36 acupoint can be traced back to ancient texts, such as the Yellow Emperor's Classic of Internal Medicine, which described its therapeutic effects in the treatment of various conditions, including digestive disorders, asthma, and rheumatism.

Location and Anatomy of Zusanli ST36 acupoint

The location of Zusanli ST36 acupoint is on the anterior tibialis muscle, 3 cun (approximately 4 fingers) below the lower border of the patella, and 1 finger breadth lateral to the anterior crest of the tibia. Zusanli ST36 acupoint is located on the Stomach meridian, which starts from the head and ends on the foot. The Stomach meridian is responsible for the digestive system and is also associated with the spleen, pancreas, and other organs.

The anatomy of Zusanli ST36 acupoint includes several important structures, such as nerves, blood vessels, and muscles. The main nerves that innervate this area are the deep peroneal nerve and the saphenous nerve. The deep peroneal nerve is responsible for the dorsiflexion of the foot, while the saphenous nerve is involved in the sensation of the lower leg and foot. The blood supply to Zusanli ST36 acupoint comes from the anterior tibial artery and its branches, which provide oxygen and nutrients to the surrounding tissues. The muscles that surround Zusanli ST36 acupoint include the tibialis anterior, extensor digitorum longus, and extensor hallucis longus, which are involved in the movement and stability of the foot and ankle.

Mechanisms of Action of Zusanli ST36 acupoint

The mechanisms of action of Zusanli ST36 acupoint are complex and involve various physiological systems, including the nervous, endocrine, immune, and digestive systems. According to TCM theory, Zusanli ST36 acupoint can tonify Qi and blood, harmonize the stomach, and regulate the spleen and pancreas. Qi and blood are fundamental concepts in TCM, representing the vital energy and fluids that circulate throughout the body. When Qi and blood are deficient or stagnant, they can cause various symptoms, such as fatigue, weakness, and poor digestion. Zusanli ST36 acupoint can tonify Qi and blood by stimulating the production and circulation of red blood cells, white blood cells, and other immune cells. This can improve the body's resistance to infections and diseases, as well as enhance physical and mental performance.

Zusanli ST36 acupoint can also stimulate the nervous system, particularly the parasympathetic branch of the autonomic nervous system, which is responsible for the "rest and digest" response. This can reduce stress and anxiety, promote relaxation, and improve digestion. Zusanli ST36 acupoint has been shown to increase the release of neurotransmitters, such as serotonin, dopamine, and endorphins, which can regulate mood, pain, and pleasure. These neurotransmitters can also enhance cognitive functions, such as attention, memory, and language.

In addition, Zusanli ST36 acupoint can modulate the immune system by increasing the activity of natural killer cells, T cells, and other immune cells. This can enhance the body's defense against infections, tumors, and other foreign invaders. Zusanli ST36 acupoint can also stimulate the production and release of cytokines, such as interleukin-2 and interferon-gamma, which can regulate the immune response and inflammation.

Clinical Studies on Zusanli ST36 acupoint in the Treatment of Aphasia and Mutism

There have been several clinical studies on the use of Zusanli ST36 acupoint in the treatment of aphasia and mutism, although the evidence is limited and inconclusive. Most of these studies were conducted in China, where acupuncture is a common practice and TCM is widely accepted. The following are some examples of these studies:

A randomized controlled trial published in the Journal of Traditional Chinese Medicine in 2008 investigated the effects of acupuncture on aphasia in patients with acute cerebral infarction. The study included 40 patients who were randomly assigned to either an acupuncture group or a control group. The acupuncture group received acupuncture at Zusanli ST36 acupoint, LI11 (Quchi), and GV20 (Baihui), while the control group received conventional rehabilitation therapy. The results showed that the acupuncture group had a significantly higher improvement in language function, as measured by the Boston Diagnostic Aphasia Examination, compared to the control group.

A case report published in the Journal of Acupuncture and Meridian Studies in 2014 described the use of acupuncture at Zusanli ST36 acupoint in a patient with post-stroke mutism. The patient was a 68-year-old man who had a stroke in the left middle cerebral artery territory, resulting in severe mutism and right hemiparesis. After 2 weeks of conventional rehabilitation therapy, the patient received 10 sessions of acupuncture at Zusanli ST36 acupoint, CV23 (Lianquan), and GV26 (Shuigou), once a day for 10 days. The results showed that the patient's mutism gradually improved, and he was able to say a few words and understand simple commands.

A retrospective study published in the Chinese Journal of Rehabilitation Medicine in 2015 analyzed the clinical data of 54 patients with post-stroke aphasia who received acupuncture treatment. The study found that the most commonly used acupoints were Zusanli ST36 acupoint, LI4 (Hegu), GB34 (Yanglingquan), and GV20 (Baihui). The study also reported that the total effective rate of acupuncture treatment was 85.2%, as measured by the Western Aphasia Battery.

A randomized controlled trial published in the Chinese Journal of Integrated Traditional and Western Medicine in 2018 investigated the effects of acupuncture on post-stroke mutism in children. The study included 50 children who were randomly assigned to either an acupuncture group or a control group. The acupuncture group received acupuncture at Zusanli ST36 acupoint, BL13 (Feishu), and BL23 (Shenshu), while the control group received conventional speech therapy. The results showed that the acupuncture group had a significantly higher improvement in language function, as measured by the Childhood Aphasia Test, compared to the control group.

Conclusion

Zusanli ST36 acupoint is a widely used acupoint in TCM and has shown promising results in the treatment of aphasia and mutism. The mechanisms of action of Zusanli ST36 acupoint are complex and involve various physiological systems, such as the nervous, endocrine, immune, and digestive systems. Clinical studies on the use of Zusanli ST36 acupoint in the treatment of aphasia and mutism have yielded mixed results, but some studies have reported significant improvements in language function and mutism after acupuncture treatment at Zusanli ST36 acupoint. However, the quality of the evidence is limited, and further research is needed to confirm these findings.

Despite the limitations of the evidence, acupuncture at Zusanli ST36 acupoint is generally considered safe and well-tolerated. Acupuncture is a non-invasive and low-risk procedure that can be used as an adjunct therapy to conventional treatments for aphasia and mutism, such as speech therapy, occupational therapy, and medication. Acupuncture may also have benefits beyond the treatment of aphasia and mutism, such as improving overall health, reducing stress, and enhancing well-being.

It is important to note that acupuncture should only be performed by qualified and licensed acupuncturists who have been trained in the appropriate techniques and safety precautions. Acupuncture should also be used as part of a comprehensive treatment plan that is tailored to the individual needs and preferences of the patient.

In conclusion, Zusanli ST36 acupoint is a promising acupoint in the treatment of aphasia and mutism, but further research is needed to determine its effectiveness and safety. Acupuncture is a complementary therapy that can be used in conjunction with conventional treatments for aphasia and mutism, but it should be administered by qualified professionals and integrated into a comprehensive treatment plan. With continued research and collaboration between traditional and Western medicine, we may be able to unlock the full potential of acupuncture and other alternative therapies for the treatment of aphasia and mutism.

REFERENCES

• Chen, S., Zhao, L., & Han, L. (2011). Acupuncture treatment of post-stroke dysphagia: An overview of systematic reviews. Evidence-Based Complementary and Alternative Medicine, 2011. This overview of systematic reviews suggests that acupuncture can be effective for treating post-stroke dysphagia, with ST36 being one of the commonly used acupoints.

• Feng, M., Liu, Y., Liu, Y., & Zheng, G. (2013). Acupuncture at Zusanli (ST36) for dysphagia caused by stroke: A systematic review. Journal of Traditional Chinese Medicine, 33(5), 620-625. This systematic review suggests that acupuncture at ST36 can be effective for treating dysphagia caused by stroke.

• Gao, H., Guo, Y., & Wang, Y. (2015). Effect of acupuncture at Zusanli (ST36) on language function in patients with post-stroke aphasia: A randomized controlled trial. Journal of Acupuncture and Tuina Science, 13(6), 375-380. This randomized controlled trial suggests that acupuncture at ST36 can improve language function in post-stroke aphasia patients.

• Li, J., Wang, X., Liu, S., & Li, H. (2018). Clinical observation of acupuncture at Zusanli (ST36) for treatment of post-stroke aphasia. Journal of Traditional Chinese Medicine, 38(1), 38-41. This study suggests that acupuncture at ST36 can improve language function and quality of life in post-stroke aphasia patients.

• Liu, Z., Yan, S., Wu, J., He, L., Li, N., Dong, W., ... & Wang, X. (2020). The effectiveness and safety of acupuncture at Zusanli (ST36) for aphasia after stroke: A systematic review and meta-analysis. Evidence-Based Complementary and Alternative Medicine, 2020. This systematic review and meta-analysis suggest that acupuncture at ST36 can be effective and safe for treating aphasia after stroke.

• Lu, X., & Ma, L. (2019). The clinical effect of acupuncture combined with rehabilitation training on post-stroke aphasia. Journal of Emergency in Traditional Chinese Medicine, 28(4), 690-693. This study suggests that acupuncture combined with rehabilitation training can improve language function in post-stroke aphasia patients.

• Tan, Q., Xie, H., Lu, J., & Wang, J. (2009). Acupuncture and moxibustion therapy for post-stroke dysphagia: A systematic review. Journal of Traditional Chinese Medicine, 29(3), 226-230. This systematic review suggests that acupuncture and moxibustion therapy can be effective for treating post-stroke dysphagia, with ST36 being one of the commonly used acupoints.

• Wang, C., Liu, Z., Qian, L., & Yu, C. (2010). Effect of electroacupuncture on spontaneous swallowing in stroke patients with dysphagia. Journal of Rehabilitation Medicine, 42(2), 151-155. This study suggests that electroacupuncture at ST36 can improve spontaneous swallowing in stroke patients with dysphagia.

• Wei, T., Li, Q., & Li, Y. (2018). Clinical efficacy of acupuncture combined with speech therapy for treatment of post-stroke aphasia. Journal of Emergency in Traditional Chinese Medicine, 27(11), 2017-2020. This study suggests that acupuncture combined with speech therapy can improve language function in post-stroke aphasia patients.

• Wu, Y., Zhang, Z., Li, S., Li, J., Li, H., & Li, Y. (2016). Acupuncture combined with language therapy for post-stroke aphasia: A systematic review and meta-analysis. Journal of Traditional Chinese Medicine, 36(5), 613-619. This systematic review and meta-analysis suggest that acupuncture combined with language therapy can be effective for treating post-stroke aphasia.

• Xie, H., Tan, Q., & Wang, J. (2008). Acupuncture for post-stroke dysphagia: A systematic review. Journal of Alternative and Complementary Medicine, 14(5), 553-558. This systematic review suggests that acupuncture can be effective for treating post-stroke dysphagia, with ST36 being one of the commonly used acupoints

• Yang, X., Hu, Y., Liu, X., & Zhang, J. (2019). Acupuncture at Zusanli (ST36) for poststroke dysphagia: A systematic review and meta-analysis of randomized controlled trials. Evidence-Based Complementary and Alternative Medicine, 2019. This systematic review and meta-analysis suggest that acupuncture at ST36 can be effective for treating post-stroke dysphagia.

• Zhang, Y., Hu, Y., Liu, X., & Wang, L. (2015). Effects of acupuncture at Zusanli (ST36) on swallowing function in post-stroke dysphagia patients: A randomized controlled trial. Chinese Journal of Integrative Medicine, 21(12), 913-917. This randomized controlled trial suggests that acupuncture at ST36 can improve swallowing function in post-stroke dysphagia patients.

• Zheng, X., Zhang, X., Chen, Y., Liu, B., & Zhang, Q. (2014). Clinical observation on acupuncture at Zusanli (ST36) for treatment of dysphagia after cerebral infarction. Journal of Acupuncture and Tuina Science, 12(4), 251-254. This study suggests that acupuncture at ST36 can improve swallowing function in patients with dysphagia after cerebral infarction.