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Acupuncture in stroke recovery: A literature review

Article  in  Complementary Therapies in Medicine · October 1996

DOI: 10.1016/S0965-2299(96)80087-2

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Complementary Therapiesin Medicine (1996)4, 258-263
©PearsonProfessionalLtd 1996
L I T E R A T U R E R E VIE W
Acupuncture in stroke recovery: a literature review
V. Hopwood
Hythe Hospital, Southampton, UK
SUMMARY. Acupuncture is commonly used in painful conditions but has a long history of use in traditional
Chinese medicine for many other illnesses, including neurological conditions. There is an upsurge of interest in
the treatment of hemiplegia by acupuncture and this review investigates the most recent research literature and
concludes that there are good grounds for further investigation within rigorous scientific guidelines.
INTRODUCTION: DOES ACUPUNCTURE
HAVE AN EFFECT ON STROKE RECOVERY?
The theories of traditional Chinese medicine (TCM)
claim that the symptoms and sequelae of stroke
respond to treatment by acupuncture. It is defined as
windstroke and the recommended form of treatment
is either to use body points alone, with or without
electrical stimulation, or combine these with scalp
acupuncture. 1 Many studies have been done in China,
comparing the different techniques and combinations
but, although very large numbers of patients are often
involved, for instance Ge 2 who treated and assessed
684 cases of windstroke at the Air Force Hospital in
Shengyang, since they are not usually controlled, they
can only have a limited validity. Where several types
of acupuncture are compared one with another, it is
interesting to see the differences, but the basic
assumption that acupuncture can affect recovery is
not proven unless there is a control group who do not
receive it.
Randomized, controlled clinical trials (RCTs) are
the foundation of evidence-based medicine. The evi-
dence provided by RCTs is essential before any med-
ical intervention is taken seriously these days. There
is an increasing amount of evidence published
with regard to acupuncture trials but by no means all
the trials are appropriately controlled. The main
trials discussed in this review were all controlled but
not all were blinded. This is in part due to the diffi-
culty of double-blinding an acupuncture trial. It is
relatively easy to keep the assessor from knowing
what treatment the patient has received but a patient
is well aware if he or she has received an invasive tech-
nique like acupuncture. There is still much discussion
over the validity of sham acupuncture, with some
Val Hopwood, MCSP, SRR DipAc (Nanjing), Physiotherapy
Department, Hythe Hospital, Southampton SO4 5ZB, UK.
258
authorities claiming that any type of acupuncture will
have some effect and cannot be a true placebo. 3
For the purposes of this review, a thorough search
was made of the Centralised Information Service
for Complementary Medicine (CISCOM) database
together with that of BIDS, Medline. Additional
information was obtained from the Acupuncture
Research Resource Centre, York. The key words
used were:
CVA, Stroke, Hemiparesis, Hemiplegia, Sub-
Arachnoid Haemorrhage, Neurological Damage/
Change, Acupuncture, and Scalp Acupuncture, and
particular weight was given to references with clini-
cal trials.
PREVIOUS STUDIES
The main questions arising from a study of the liter-
ature about acupuncture used to treat stroke are as
follows:
1. Is it effective?
2. Should acute, sub-acute or chronic patients be
treated?
3. Should the treatment be confined to body points
or scalp points, or both?
4. When should it commence?
5. How frequent should it be and how long should it
be given for?
Only seven controlled studies have been reported in
recent years where acupuncture was used to treat
paralysis due to stroke, and these will be discussed in
some detail in order to answer the above questions,
where possible. (A summary is given in the Table)
Interest in the possible effect of acupuncture on
stroke has been increasing over the last five years. The
recent work linking acupuncture with the treatment
of stroke is mainly being done in the Scandinavian
countries and the USA. Some research work has been
 A c u p u n c t u r e in stroke recovery 259

Table Summary of significant studies on the use of acupuncture in stroke

Study Type Sample size Outcome measures Results

Zhang et al Randomized, controlled trial. Ac 53 Muscle strength 83% effective or markedly effective,
(1987)19 Not blinded Control 41 6 joints: hip knee ankle acupuncture group.
shoulder, elbow, wrist. 63% similar outcome in control group.
(P<.05)
Naeser et al Randomized, controlled trial. Ac 10 Range of movement at hip, Significant difference (> 10%) in
(1992)1° Double-blind Control 6 knee, ankle and shoulder, acupuncture group improvement
over controls

Naeser et al Randomized, controlled trial. Ac 20 Range of movement at hip, Good response P<013 with CT scan
(1993)15 Double-blind Control 3 knee, ankle and shoulder, lesionsite as a variable

Hu et al (1993)4 Randomized, controlled trial. Ac 15 Neurological deficit score. Neurological deficit for acupuncture
Pilot study Control 15 ADL Barthel Index. group significantly better at 1 and 3
Not blinded months. Score better in severe cases.
Johansson et al Randomized, controlled trial. Ac 38 Walking and balance Acupuncture group recovered faster and
(1993)7 Not blinded Control 40 ADL Barthel Index to a larger extent than controls.

Magnusson Randomized, controlled trial. Ac 22 Balance Balance, acupuncture group significantly

(1994) Not blinded Control 26 ADL Barthel Index better than controls
(Linked with ADL, lasting improvement tested at 2
previous trial) years
Naeser et a113 Randomized, controlled trial. Ac 8 Hand/finger dexterity Good response P<0003 with CT scan
(1994) Double blind Control 2 and strength lesion site as a variable
Chronic cases

Sfillstr6m et al Randomized, controlled trial. Ac 24 Motor Assessment Scale Acupuncture group completer and faster
(1995)I6 Not blinded Control 21 Sunnaas ADL Index recovery. Sustained rate for 12 months.
Nottingham Health

done in Taiwan, 4 but in China, where acupuncture is
in general use, studies tend to be rather poorly con-
trolled a l t h o u g h the groups o f patients involved are
always very large.
Possibly the best controlled was that undertaken
by H u et al 4 in Taiwan. Treatment was c o m m e n c e d in
the acute patient within 36 hours o f the onset o f
symptoms, and continued three times per week for
four weeks, together with all n o r m a l supportive ther-
apy. Assessment was at one m o n t h and three months.
In this study, with a total o f 30 patients aged 46-74,
a l t h o u g h the n u m b e r o f patients was relatively small,
the neurological o u t c o m e for the acupuncture group
was significantly better than for the controls. The
improvement in neurologic status was greatest in
patients with a p o o r neurologic score at baseline. The
Barthel Index was used for assessment - an interna-
tionally recognized, if n o t wholeheartedly approved,
measurement tool. 5 The authors conceded the small
numbers and intended to use this as a pilot for a
larger trial, for which no data are published as yet.
Z h a n g et al 6 conducted a study on the use o f
acupuncture in the treatment o f limb paralysis after
stroke, at the H u a Shah Hospital, Shanghai in 1987.
This was a controlled study with 94 patients. Change
in muscle strength was taken as the o u t c o m e measure.
The acupuncture group received treatment, including
electro-acupuncture, six times per week for four weeks.
The level o f significance for a g o o d result an increase
o f muscle strength o f 1 or 2 grades - was P<0.05,
although b o t h the treatment and control groups
showed improvement: 83% and 63% respectively.
Some work was d o n e in Sweden in 1993, where a
neurologist, Barbro Johansson 7 conducted a r a n d o m -
ized study which considered acupuncture simply as a
f o r m o f sensory stimulation. A group o f 38 subjects,
all acute stroke patients, i.e. starting at 4-10 days
post-stroke, were given o r t h o d o x traditional Chinese
acupuncture together with all n o r m a l physiotherapy
and occupational therapy care. T h e y were given a
total o f 20 treatments, twice a week for ten weeks. The
treatment was b o t h by dry needling and electro-
acupuncture stimulation. The control group, 40
patients, received only the n o r m a l therapy treatment,
starting at the same time.
Significantly greater improvement was observed in
walking, balance, and activities o f daily living, quality
o f life, mobility, and emotional state. To some extent,
these factors must be supposed to be interdependent;
for instance, if the walking and balance improve, then
mobility and general quality o f life should also
improve and this will affect m o o d . The m o s t impor-
tant conclusion drawn from this study was economi-
cal, the acupuncture group had, overall, fewer days in
nursing homes and rehabilitation facilities with a sub-
sequent saving over the control g r o u p o f $26 000 per
patient. It m a y be that the cost o f rehabilitation med-
icine in Sweden is high c o m p a r e d to that in the U K ,
but these figures were taken seriously by the Swedish
health authorities.
260 Complementary Therapies in Medicine
Johansson8 concluded that the mechanism was not
yet clear. Vascular factors should be relevant in the
acute stage but would not be important in the sub-
acute and chronic stages of recovery.
Various kinds of sensory stimulation can enhance brain plasticity and
this might be a possible mechanism behind functional improvement...
Whether expectation (i.e. placebo) can by itself have a lasting effect
on brain reorganization is a possibility that has not been ruled out.
However, it seems likely that factors related to the acupuncture-
induced sensory stimulation should at least have an additive effect.
The intervention in Johansson's study was made
relatively early with what were undoubtedly acute
patients. However, the effects seem to have been long-
lasting. The outcomes measured at one, three and
twelve months later all showed a continuing signifi-
cant improvement on the control group. A further
randomized, controlled trial was undertaken by
Magnusson et al in 19939 investigating the normaliza-
tion of postural control after stroke and using the
same acupuncture treatment group. This group, now
totalling 22, was matched again with 26 survivors
from the original control group and a further 23 age-
matched healthy subjects. Subjects had their balance
disturbed by vibrators applied to calf muscles or by
galvanic vestibular stimulation and postural control
was evaluated in terms of sway variance or sway
velocity using a model previously validated for
human postural control. Significantly more patients
in the treatment group than in the original control
group maintained stance during the stimulations
(P<0.01) Among patients capable of maintaining bal-
ance, the control group was characterized by a signif-
icant divergence from normal values in two of the
three characteristic parameters of dynamic postural
control (i.e. swiftness and stiffness; P<0.05), com-
pared with treatment subgroup or the age-matched
subjects.
The conclusion was that the acupuncture had
enhanced the recovery of postural function in the
original treatment group and this was still evident two
years later. The original work done by Johansson7was
a good demonstration of the effects of acupuncture,
both on physical and mental recovery. The scoring in
the Nottingham Health Profile showed a clear
improvement in the quality of life, again with what
appeared to be an enduring effect, the last measure-
ment being taken a year after the stroke. Johansson
has postulated that the change in mood produced by
the acupuncture stimulation might be the most
important aspect of the treatment.
Margaret Naeser has done several detailed smaller
studies and also made an attempt at an overall analy-
sis of the current work. In addition, she has investi-
gated a lot of the anecdotal Chinese studies. Her own
studies were carefully controlled but fail to convince
fully because the numbers are small. She has intro-
duced two new elements in using laser acupuncture in
one study and the inclusion of computed tomography
(CT) scan data.
The first s t u d y 10 w a s conducted with sub-acute
patients one to three months after the onset of stroke.
The study was randomized and double blinded for
pre- and post-arm and leg motor evaluation by physi-
cal therapists. It was single-blind for the acupunctur-
ists administering the real or sham acupuncture
treatment. The subjects included ten cases who
received real acupuncture in addition to normal
physiotherapy and six cases who were given sham
acupuncture and all normal therapy. There was a
wide age range: from 44 to 74.
The acupuncture treatment consisted of needling
to recognized acupoints on the affected arm and leg.
These have been shown to exhibit decreased electrical
resistance. T M Scalp acupuncture was also used, along
the so-called 'motor cortex line' on the side opposite
the paralysis. A low frequency stimulation (1-2 Herz)
was used on the needles for twenty min but no high-
frequency stimulation was used. A total of 20 treat-
ments was given, five times per week for four weeks.
The sham acupuncture utilized carefully located
points of normal electrical resistance. Needles were
inserted at these points on the unaffected side and left
for 20 min. A sham electro-acupuncture unit was also
used, no current being transmitted. In this study,
when the 20 control treatments were completed, the
patients were told that they had been part of the con-
trol group and offered the acupuncture treatment. It
is not stated how many accepted.
A good response was defined as a 10% change in
isolated active range of motion. Six ranges of move-
ment were recorded: hip, knee, ankle, shoulder, elbow,
and forearm pro- and supination. No improvement
was recorded in the patients receiving the sham
acupuncture. Four out of the ten acupuncture
patients had a good result.
In this study, evidence from CT scans was intro-
duced and, when matched with the results, showed
that, where there was a lesion of less than half of the
motor pathway areas on the scan, particularly in the
periventricular white matter area, acupuncture was
effective. Further work is necessary, however, to con-
firm what must only be speculation at present.
The total results showed that four out of ten
patients given acupuncture achieved a good response
where none of those with the sham intervention did.
When the real and sham groups are each divided into
two groups, one with less than half the motor path-
ways involved and one group with more than half
involved, then the results do look interesting. With
less than half motor pathways damaged three out of
four of those treated with acupuncture achieved a
good response but none of the sham group did.
Naeser uses paired t tests in her analysis and claims
some significant results. 10
This study opens the way for a better analysis of the
link between CT scans and the efficacy or otherwise
of acupuncture treatment, but it is impossible to
generalize from so few patients. However, while it is

logical that those with less damage do better, these
results seem to be at odds with the work done by
Han-Hwa Hu g which showed that those patients with
the poorer neurologic scores actually did significantly
better with acupuncture treatment.
Naeser's first two studies were followed in the next
year with a different design. ~3The sham acupuncture
was abandoned and chronic cases were included
with no control, using the cases themselves as control.
This study observed that all stroke cases who had
hand paresis had a good response following 20-40
acupuncture treatments, even though the treatment
was started relatively late, between two and eight
years after the stroke. Good response was defined as a
clear improvement in timed finger dexterity and
strength tests which were now taken as a measure
both of progress and prognosis. TM A correlation was
attempted between the number of acupuncture treat-
ments received and the number of improved hand/fin-
ger tests. Significant results are claimed, but only
eight chronic cases were treated, with a wide range of
age, 43-72 years, so it is difficult to see this work as
indicating more than an interesting direction for fur-
ther research. She has begun to use the evidence from
CT scans 1° to demonstrate the exact site of the lesion
and use it to predict possible success with acupunc-
ture treatment. This could be very important in decid-
ing whom to treat in the future.
In a study published in April 1995 Naeser 15 has
tested laser acupuncture on a small group of stroke
patients. Again, she has achieved good results but
with only seven patients, so no conclusions can be
drawn. She used laser acupuncture, but this is not
really a validated alternative to needle acupuncture
and needs further investigation as a modality.
To date, the most recently published work is from
Sfillstr6m in Norway ~6 and, from the translation, it
would seem that similar good effects have been
observed. This was a study by physiotherapists
trained in traditional Chinese acupuncture. This was
a controlled trial - the median time from stroke
onset to inclusion in the trial was 40 days. All the
patients underwent a comprehensive, multidiscipli-
nary, individually adapted rehabilitation programme
with acupuncture being added to the treatment of a
group of 24 out of the total of 45 sub-acute patients.
The 24 patients in the acupuncture group were
treated three to four times per week for six weeks
and assessed on entry and at the end of the six
weeks. Suzanne S/illstr6m tested motor function,
activities of daily living (ADL), and quality of life.
Both groups improved significantly in motor func-
tion and ADL, not surprisingly given the natural
history of the condition, 17 but the acupuncture
group improved significantly more, and only the
acupuncture group rated a significantly improved
quality of life.
The acupuncture group made significant progress
for emotional reactions, pain and physical movement
Acupuncture in stroke recovery 261
as shown by the Nottingham Health Profile scores.
The control group also reported improved physical
movement but, in addition, reported worsened sleep.
Johansson's theory that the change in mood and
energy produced by the effects of the endorphin
increase in acupuncture patients has much to do with
their more successful rehabilitation would seem to
have some support from the Siillstr6m study. It
would be interesting to do further work to see if any
other form of mood-enhancer would have the same
effect.
POSSIBLE MECHANISMS INVOLVED IN THE
ACTION OF ACUPUNCTURE ON STROKE
The effect of acupuncture needling on pain has been
relatively well researched, and the possible mecha-
nisms by which it could be acting have been postu-
lated, if not proved conclusively. Some of the work
done has shown effects on the circulation. For exam-
ple, Omura 18 has shown that one effect of acupunc-
ture was to alter haemodynamics by producing
prolonged augmentation of the microcirculation in
the peripheral tissue and the brain. Not enough work
has been done in this field as yet to justify more than
speculation as to the physiological effect of acupunc-
ture on stroke-damaged neural tissue.
Acupuncture in the restoration of motor function is
thought by many practitioners to either increase mus-
cle power and/or decrease spasticity, but the underly-
ing neurophysiology remains unknown and untested.
There are some reports which describe the use of
acupuncture in cases of stroke, and study the possible
mechanisms, such as reduction of blood viscosity,
increased cerebral blood flow, and improvement in
microcirculation~9 21 but these are uncontrolled stud-
ies. Each has recorded the treatment of large numbers
of stroke patients with acupuncture including blood-
chemistry studies. Significant decreases in fibrinogen,
fibrin-degradation products and serum triglycerides
were reported in all three studies.
An interesting Danish research paper 22, describing
a randomized, double-blind, placebo-controlled
study of the effects of citalopram, showed that the
post-stroke depression occurring in 20-50% of
patients responded very well to this drug. If, as is
demonstrated by Mao et a123, electro-acupuncture
performed on patients with chronic pain also raises
the platelet serotonin level significantly, this may well
be one of the ways in which acupuncture is able to
affect stroke recovery, since electro-acupuncture stim-
ulation is usually part of the recommended treatment
for hemiplegia.
Omura, TM showed an increase in local circulation to
the stroke side of the brain and the affected hand
when the acupuncture point, Stomach 36, Zusanli,
was needled on the affected leg. He showed that there
was an immediate circulatory response to the inser-
262 Complementary Therapies in Medicine
tion and manipulation of the needle, the recorded
phases were as follows:
First phase: Vasoconstriction usually lasting between
15 and 30 seconds;
Second phase: Quasi control, usually lasting between
10 s and 2 min;
Third phase: Vasodilation lasting between 2 min and
2 weeks.
This response was found locally in the affected
hand and also in the brain on the side of the lesion. He
tested a large number of patients (400) but there was
varying morbidity and a very wide age-range, from
5-85. However, the improvement in brain circulation
was seen only in the patients suffering from stroke, and
among these only in those who were less than seven
years from onset. N o significant effect was seen in
patients who suffered from stroke longer than this.
The strength of grip was also measured in this
group and it was found that the m a x i m u m hand-grip
of the affected hand improved significantly, particu-
larly in those who scored low before this acupuncture
intervention.
Only one paper, by Y a m a m o t o and Ishiko) 4 has
been written with regard to the effect of scalp
acupuncture on the weight-lifting capacity of the
healthy and paralysed lower limb. These doctors
needled only one point on the scalp, corresponding
roughly to the lower end of the m o t o r line. They
demonstrated a marked increase in weight-lifting
capacity of paralysed legs, although all their results
showed considerable variation with healthy limbs
decreasing in capacity as well as increasing by +/-20%.
The results seemed to show no apparent benefit in
needling the scalp on the opposite side to the problem.
SO, DOES A C U P U N C T U R E HAVE AN E F F E C T
ON STROKE RECOVERY?
It would seem, in answer to the primary question of
this article, that enough work has been done around
the world to make the question very intriguing. The
studies done so far have opened up the field but have
not been conclusive. Where the studies have been
carefully controlled and blinded, the numbers have
been too small and the inherent variability of stroke
has not been accounted for. All the studies have been
conducted in a period when natural recovery would
have occurred, 17 and have not, with the exception of
the Scandinavians', taken this into account by includ-
ing larger numbers and increasing the power of the
study. The major Chinese studies treat very large
numbers, necessary because of the wide variation of
symptoms within this patient group, 25 but do not
include controls.
This review is not exhaustive and has been quite
selective, a formal analysis of the quality of each
study was not undertaken and some form of meta-
analysis would now seem to be indicated. With regard
to the possible mechanisms whereby acupuncture
might have an effect on stroke recovery, no controlled
trials were found, but some of the findings in the
Chinese research could indicate useful direction for
new work.
With regard to the sub-questions, the answer is no
clearer. It would seem reasonable, in the absence of
any evidence to the contrary, to pursue the classic
form of treatment with both body acupuncture points
and scalp acupuncture. The average length of time for
treatment is six weeks and the frequency is three to
four times per week. The evidence of practice seems
to be in favour of a very early start to treatment, as
soon as the patient is medically stable after the haem-
orrhage and none of the studies has suggested that is
detrimental.
I f the CT scan evidence is reliable (very few cases
have been considered after all) taken together with
Hu's results, 4 it may be possible to predict in future
which patients will respond best to acupuncture.
Acupuncture is a modality that is increasingly used
within Western medicine. Both doctors and physio-
therapists are now using it commonly within the
National Health Service for the treatment of pain-
related problems. 26 Physiotherapists, in particular, are
much concerned in the treatment and rehabilitation
of stroke patients and would welcome a W new tool
that could extend and improve the rehabilitation
period, making the more orthodox therapy treatment
even more effective.
REFERENCES
1. Chen A. Effectiveacupuncture therapy for stroke and
cerebro-vasculardisease. Part II. Am J Acup
1993;21(3):205-219.
2. Ge Shuhan. The effect of acupuncture in cerebral
thrombosis: a report of 684 cases. Intl J Clin Acup 1992; V
3(2): 125-129.
3. Dowson D I, Lewith G T, Machin D. The effectsof
acupuncture versus placebo in the treatment of headache.
Pain 1985;21:35-42.
4. Hu HH et al. A randomised, controlled trial on the treatment
for acute partial ischaemc stroke with acupuncture.
Neuroepidem 1993;12:106 113.
5. Collin C, Wade D. Assessingmotor impairment after stroke: a
pilot reliability study. J Neurol Neurosurg Psychiat
1990;53:576-579.
6. Zhang Wet al. Acupuncture treatment of of apopleptic
hemiplegia. J Trad Chin Med 1987;7; 157-160.
7. Johansson Bet al. Can sensory stimulation improvethe
functional outcome in stroke patients? Neurology
1993;43:2189-2192.
8. Johansson B. Acupuncture in stroke rehabilitation. Acup Med
1995;13(2):81-84.
9. Magnusson M, Johansson K, Johansson B B. Sensory
stimulation promotes normalisation of postural control after
stroke. Stroke 1994;25(6): 1176-1180.
10. Naeser M A et al. Real versus sham acupuncture in the
treatment of paralysis in acute stroke patients: a CT scan
lesion site study. J Neurol Rehab 1992;6(4): 163 174.
11. Pomeranz B, Cheng R, Law R Acupuncture reduces
electrophysiologicaland behavioural responses to noxious
stimuli: pituitary is implicated. Exp Neurol 1977; 54;172-178.
12. Hyvarinen J, Karlsson M. Low resistancepoints that may
coincide with acupuncture loci. Med Biol 1977;55:88-94.

13. Naeser M A e t al. Acupuncture in the treatment of
hand paresis in chronic and acute stroke patients-
improvement observed in all cases. Clin Rehab
1994;8(2):127-141.
14. Sunderland A, Tinson D, Bradley L, Langton Hewer R, Arm
function after stroke. An evaluation of grip strength as a
measure of recovery and a prognostic indicator. J Neurol
Neurosurg Psychol 1989;52: 1267-1272.
15. Naeser M A et al. Laser acupuncture in the treatment of
paralysis in stroke patients; a CT scan lesion site study. J Am J
Acup 1995;23 (1):13-28.
16. Sfillstr6m Set al. Acupuncture in the treatment of stroke
patients in the sub-acute stage. J Norweg Med Assoc 1995;23:
2884-2887.
17. Parker VM, Wade DT, Langton Hewer R. Loss of arm
function after stroke: measurement, frequency and recovery.
Int Rehabil Med 1986;8:69-73.
18. OmuraY. Pathophysiology of acupuncture treatment; effects
of acupuncture on cardiovascular and nervous systems. Acup
Electrotherap Res 1975; 1:51-140.
19. Zhang W e t al. Acupuncture treatment of apoplectic
hemiplegia. J Trad Chin Med 1987;7:157 160.
L E T T E R TO T H E E D I T O R
Dear Sir
The study of iris diagnosis by Buchanan et al (Comp
Ther Med 1996; 4(2) 98-102) highlights the draw-
backs of applying a disease-orientated analysis to
what is essentially a qualitative, patient-orientated
tool. The authors found that there was no statistically
significant correlation between a number of signs
commonly used in iris diagnosis and several clinically
established systemic diseases. On the basis of their
results, and those of other studies they cite - all of
which used end-point pathologies as their compara-
tive criteria - the authors, wisely, do not suggest
that iris diagnosis is worthless but there is a danger of
others jumping too hastily to negative conclusions.
Many practitioners who use iridology as a diag-
nostic adjunct would concur with the findings of this
skillfully designed analysis; the classical iris signs do
not always equate with known pathologies and may
even contradict them. An investigation making such
comparisons, however, ignores a fundamental princi-
pal of complementary medicine, which is that it is
concerned with assessing and treating patients, not
diseases. In other words, if the iris reveals anything
about a patient, it may be in terms of tissue tone and
View publication stats
Acupuncture in stroke recovery 263
20. Qi L Y et al. Observation on acupuncture treatment of 322
cases of cerebral infarction and changes in serum HDL-C
fibrinigen, FDP, hemorrheological indices etc during
treatment. Int J Clin Acup 1990;1(1):39~t6.
21. Jiao Xinmin, Chang Xingguo, Yin Kejing, Gao Yawei et al.
Clinical and experimental studies on acupuncture therapy of
stroke-related blood stasis. Int J Clin Acup 1992;3 (3):
229-241.
22. Andersen G, Vestergaard K, Lauritzen L. Effective treatment
of post-stroke depression with the selective serotonin
reuptake inhibitor citalopram. Stroke 1994;25; 1099-1104.
23. Mao W, Ghia JN, Duncan GH, Gregg JM. High versus low
intensity acupuncture analgesia for treatment of chronic pain:
effects on platelet Serotonin. Pain 1980;8:331-342.
24. Yamamoto T, Ishiko N. The effect of scalp acupuncture on
the weight-lifting capacity of the healthy and paralysed lower
limb. Am J Acup 1992;20 (1):47 54.
25. Riddoch M J, Humphreys G W, Bateman A. Stroke, issues in
recovery and rehabilitation. Physiotherapy 1995; 81 ( 11):
689-694.
26. Hopwood V. Acupuncture in physiotherapy. Compl Ther Med
1993; 1(2): 100-104.
potential for breakdown or recovery rather than as an
indicator of overt disease.
Setting aside the lack of anatomical evidence for
a connection between iris zones and body organs
(a shortcoming of many well-established therapies,
such as acupuncture, auricular therapy, and foot
reflexology) there are many practitioners who find
observation of the iris a valuable guide to the
constitutional strengths and weaknesses of their
patients. (As to the contention that iridologists may
rely on information other than that gleaned from
examination of the eyes, there are some German
experts who even prescribe solely on the basis of iris
diagnosis without resort to anamnesis or other exam-
inations, reputedly with great success.)
Clearly there is now a need to find new ways of
testing the validity of the iris signs as an aid to assess-
ing the functional integrity of body tissues and to
selecting appropriate therapeutic interventions.
R. Newman Turner BAc, ND, DO,
Practising Osteopath and Naturopath,
111 Norton Way South,
Letchworth, Herts, UK.