The Use of Acupuncture as a Method for the Examination of the Function of Parietal Lobe and Investigation of Phantom Limb Xue Chongcheng
(Department of Neuro-psychiatry and Neurosurgery, The People's Hospital, Guanxi Zhiangzu Autonomous Region)
In 1939 channel linear sense was found to be present on a phantom limb and it had been doubtful until liberation. Then a series of investigations was under-taken, such as phantom channel with patients who had absence of limbs either congenital or acquired; spontaneous propagated sensation along channel phenomenon with lesions of cerebral somato-sensorimotor cortex; the comparison of alterations of cortical sensation and PSC when the cerebrum was affected; bilateral PSC induced when acupuncturing unilaterally etc. To review these events mentioned above and compare the credits of neurological researches, a conclusion can be made that the PSC is produced on the cerebral cortex and can not be used as a certification of existence of a tube structure of the channel. Five theoretical points about PSC are preferred in this paper, (1) phylogenetic; (2) spreading of impulse along a specific pattern on the cerebral cortex; (3) the spreading and perception are accomplished in different areas of the cortex respectively; (4) PSC is older than cortical sensation phylogenetically; (5) senses of soreness, distention and numbness etc. elicited by acupuncture too are percepted at a lower level of the brain differed from the cortical sensation and PSC. The biological significance of PSC is a very valuable problem for neurological science.
1. Phantom limb and phantom channel. Twenty-five patients were observed, female 3 and male 22, age of observation at 25-50 years and amputation taken (acquired only) at 17-41 years. The interval between amputation and observation was from 7 days to 22 years. Thirty-five limbs including upper and lower extremities of both sides were affected. The longest length of absence is 70 cm. All of them developed phantom limb by acupuncture and so were phantom channels except one congenital who refused to continue needling when the phantom limb began to be developing because she was afraid of it.
2. Spontaneous PSC. There were 2 male and 2 female adult patients who suffered from intracranial tumours and head injury. The PSC manifested themselves with epileptic attacks and could be controlled with dilantin. The propagation phenomena of one of parietal meningioma disappeared with co-existence of paralysis of the opposite leg after operation and reappeared when the leg had been getting to recovery.
3. The counterview of changes of cortical sensations and PCS phenomena. There were 15 patients, male 9 and female 6, aged 11-70 years old. The locations of the lesions were at parietal lobe and internal capsule, 6 at left side and 7 right and 2 bilateral. The nature of the lesions was of injuries and space occupying diseases. Result revealed that the changes of both kinds of sensation were identical with location and in degrees of severity. The changes were bilateral for patients whose affections were of both sides. The characteristics of PSC phenomenon such as intensity, time maintenance and length of propagation were principally proportional. Cortical sensation and PSC might be dissociated. The soreness, numbness and distending sense of acupuncture did not change with PSC and cortical sensations but with superficial sensations. The endurability of PSC against diseases showed stronger than cortical sensation.
4. Bilateral PSC phenomena for unilateral acupuncturing. There were two adult males only. The site for eliciting bilateral reaction was restricted, one localized at both Touwei points merely and the other at the points in the lower part of the body. The presence of bilateral PSC was not concerned with other sensations.
All instances of each group were mentally clear, co-operative and communicative in language. The usual long sharp pointed hair-like needle, made of stainless steel, was used. The manual skill applied varied as well as different situations of the subjects.
It can be supposed that a channel structure is existed based on the presence of phenomenon of PSC on the parts of the body when they are exhibited before our eyes, but it would not be thus considered when the phenomena are present on the phantom parts of the body. Hecaen and Penfield declared that phantom limbs could be elicited by stimulating parietal lobe and abolished by excision of it and these events gave a belief that the cerebral cortex would be the material foundation of phantom limbs. However a presumption can be made that PSC would have the same material foundation because they can ever be present on phantom limbs. Further evidences such as spontaneous PSC occurred by stimulative lesions on the cortex without any peripheral needling; but on the other hand, no PSC could be elicited by peripheral acupuncture in presence of destructive lesions on the cortex even stimulating persistently and its intimate ralationship with the cortical sensations observed in intracranial diseases all verified this viewpoint.
The body schema engram theory about the phantom limbs has not been insistently believed since the declaration of the genetic theory. The facts that PSC has no engram and can be present on the phantom limb support the genetic theory of the normal body pattern. Simultaneously these facts indicate the genetic origin of the PSC itself too. It can be present for everyone under certain conditions without any difference in character among races and its important therapeutic actions are also in support of this viewpoint. It is evident that the specific channel spreading pattern in the cerebrum had been developed by phylogenesis and evolution.
However PSC is a kind of sensation and I have called it channel or meridian sensation. Sensation is not delivered at the peripheral site where stimulation is applied but in the cerebrum especially its cortex. When some part of the cortical body representation is stimulated or impulse reaches it, sensation develops and is felt at the corresponding peripheral part by projection. Reversely, sensation propagated along certain course like a line or a band over a peripheral part of the body must have impulse spreading along a phylogenetic channel specific pattern over the part of the corresponding body representation of the cortex.
Recognition of PSC must be at Brodmann's areas 3,1,2, because it is a kind of discriminative sensation. But it can be dissociated with cortical sensation and manifest itself bilaterally when stimulation was applied unilaterally. Furthermore its spreading conditions such as speed is disproportional to the size of the body representation areas of sensory area I (SI) and the order of spreading of PSC beginning at the point from near to far (vice versa when it returns back towards the point) is not entirely identical with the order of the arrangement of the sensory homunculus of SI. Therefore it may be closely related to SI but the spreading is not at there and rather likely to be at other sensory area such as sensory area II (SII) probably. It is thought that the specific spreading pattern may be at SII and the completion of recognization is at SI. All the clinical phenomena such as the identification in the changes of cortical sensation and channel sensation, the dissociation of them and the bilateral projections of channel sensation could be explained by this two-step viewpoint. From the phylogenetic standing point of view and the stronger endurability of the channel sensation against illness, channel sensation would be older than cortical sensation. Concerning the problem of ancientry of the two sensory areas there has still had some dispute. Channel sensation introduced into neurologic science prefers SII being older than SI.
In accordance to the changes of various kinds of sensations produced by acupuncture upon patients of cortical destructive lesions, the channel sensation changed equally with the cortical sensations and the senses of soreness, numbness and distention changed to be accompanied closely with the superficial sensations. It may be supposed that the channel sensation goes into consciousness being at the cortex and the latter may be percepted subcortically.
It is possible that use of acupuncture as a method for the examination of the function of the parietal lobe can be adopted. Practice stated in this paper is favourable for this. It would be a new technique since no further method was reported for the clinical sensory examination after the recommendation of bilateral simultaneous stimulation by Bender in 1952.
The methodology for the investigation of phantom limbs has not been over the extent of inquisition for more than four hundred years. During the observation of phantom channel all cases developed phantom limb by means of acupuncture including patients who were failed to get it by questioning previously. The phantom limbs elicited by acupuncture were more bright, alive, complete, near the actual length and size of the original limbs. Furthermore they were obtained during the application of needling and could be controlled by manipulation and the patients could tell or point out the extending end of the phantom limbs when they reached. Therefore acupuncture is preferable for investigation of phantom limb rather than the methods usually used before. Meanwhile it was found that phantom limb pain and stump pain could be easily checked by acupuncture and it would be the first choice for treatment of those pains and its mechanism is at least similar with the theory of increasing the level of inhibition of reticular formation to treat phantom limb pain.
(Department of Neuro-psychiatry and Neurosurgery, The People's Hospital, Guanxi Zhiangzu Autonomous Region)
In 1939 channel linear sense was found to be present on a phantom limb and it had been doubtful until liberation. Then a series of investigations was under-taken, such as phantom channel with patients who had absence of limbs either congenital or acquired; spontaneous propagated sensation along channel phenomenon with lesions of cerebral somato-sensorimotor cortex; the comparison of alterations of cortical sensation and PSC when the cerebrum was affected; bilateral PSC induced when acupuncturing unilaterally etc. To review these events mentioned above and compare the credits of neurological researches, a conclusion can be made that the PSC is produced on the cerebral cortex and can not be used as a certification of existence of a tube structure of the channel. Five theoretical points about PSC are preferred in this paper, (1) phylogenetic; (2) spreading of impulse along a specific pattern on the cerebral cortex; (3) the spreading and perception are accomplished in different areas of the cortex respectively; (4) PSC is older than cortical sensation phylogenetically; (5) senses of soreness, distention and numbness etc. elicited by acupuncture too are percepted at a lower level of the brain differed from the cortical sensation and PSC. The biological significance of PSC is a very valuable problem for neurological science.
1. Phantom limb and phantom channel. Twenty-five patients were observed, female 3 and male 22, age of observation at 25-50 years and amputation taken (acquired only) at 17-41 years. The interval between amputation and observation was from 7 days to 22 years. Thirty-five limbs including upper and lower extremities of both sides were affected. The longest length of absence is 70 cm. All of them developed phantom limb by acupuncture and so were phantom channels except one congenital who refused to continue needling when the phantom limb began to be developing because she was afraid of it.
2. Spontaneous PSC. There were 2 male and 2 female adult patients who suffered from intracranial tumours and head injury. The PSC manifested themselves with epileptic attacks and could be controlled with dilantin. The propagation phenomena of one of parietal meningioma disappeared with co-existence of paralysis of the opposite leg after operation and reappeared when the leg had been getting to recovery.
3. The counterview of changes of cortical sensations and PCS phenomena. There were 15 patients, male 9 and female 6, aged 11-70 years old. The locations of the lesions were at parietal lobe and internal capsule, 6 at left side and 7 right and 2 bilateral. The nature of the lesions was of injuries and space occupying diseases. Result revealed that the changes of both kinds of sensation were identical with location and in degrees of severity. The changes were bilateral for patients whose affections were of both sides. The characteristics of PSC phenomenon such as intensity, time maintenance and length of propagation were principally proportional. Cortical sensation and PSC might be dissociated. The soreness, numbness and distending sense of acupuncture did not change with PSC and cortical sensations but with superficial sensations. The endurability of PSC against diseases showed stronger than cortical sensation.
4. Bilateral PSC phenomena for unilateral acupuncturing. There were two adult males only. The site for eliciting bilateral reaction was restricted, one localized at both Touwei points merely and the other at the points in the lower part of the body. The presence of bilateral PSC was not concerned with other sensations.
All instances of each group were mentally clear, co-operative and communicative in language. The usual long sharp pointed hair-like needle, made of stainless steel, was used. The manual skill applied varied as well as different situations of the subjects.
It can be supposed that a channel structure is existed based on the presence of phenomenon of PSC on the parts of the body when they are exhibited before our eyes, but it would not be thus considered when the phenomena are present on the phantom parts of the body. Hecaen and Penfield declared that phantom limbs could be elicited by stimulating parietal lobe and abolished by excision of it and these events gave a belief that the cerebral cortex would be the material foundation of phantom limbs. However a presumption can be made that PSC would have the same material foundation because they can ever be present on phantom limbs. Further evidences such as spontaneous PSC occurred by stimulative lesions on the cortex without any peripheral needling; but on the other hand, no PSC could be elicited by peripheral acupuncture in presence of destructive lesions on the cortex even stimulating persistently and its intimate ralationship with the cortical sensations observed in intracranial diseases all verified this viewpoint.
The body schema engram theory about the phantom limbs has not been insistently believed since the declaration of the genetic theory. The facts that PSC has no engram and can be present on the phantom limb support the genetic theory of the normal body pattern. Simultaneously these facts indicate the genetic origin of the PSC itself too. It can be present for everyone under certain conditions without any difference in character among races and its important therapeutic actions are also in support of this viewpoint. It is evident that the specific channel spreading pattern in the cerebrum had been developed by phylogenesis and evolution.
However PSC is a kind of sensation and I have called it channel or meridian sensation. Sensation is not delivered at the peripheral site where stimulation is applied but in the cerebrum especially its cortex. When some part of the cortical body representation is stimulated or impulse reaches it, sensation develops and is felt at the corresponding peripheral part by projection. Reversely, sensation propagated along certain course like a line or a band over a peripheral part of the body must have impulse spreading along a phylogenetic channel specific pattern over the part of the corresponding body representation of the cortex.
Recognition of PSC must be at Brodmann's areas 3,1,2, because it is a kind of discriminative sensation. But it can be dissociated with cortical sensation and manifest itself bilaterally when stimulation was applied unilaterally. Furthermore its spreading conditions such as speed is disproportional to the size of the body representation areas of sensory area I (SI) and the order of spreading of PSC beginning at the point from near to far (vice versa when it returns back towards the point) is not entirely identical with the order of the arrangement of the sensory homunculus of SI. Therefore it may be closely related to SI but the spreading is not at there and rather likely to be at other sensory area such as sensory area II (SII) probably. It is thought that the specific spreading pattern may be at SII and the completion of recognization is at SI. All the clinical phenomena such as the identification in the changes of cortical sensation and channel sensation, the dissociation of them and the bilateral projections of channel sensation could be explained by this two-step viewpoint. From the phylogenetic standing point of view and the stronger endurability of the channel sensation against illness, channel sensation would be older than cortical sensation. Concerning the problem of ancientry of the two sensory areas there has still had some dispute. Channel sensation introduced into neurologic science prefers SII being older than SI.
In accordance to the changes of various kinds of sensations produced by acupuncture upon patients of cortical destructive lesions, the channel sensation changed equally with the cortical sensations and the senses of soreness, numbness and distention changed to be accompanied closely with the superficial sensations. It may be supposed that the channel sensation goes into consciousness being at the cortex and the latter may be percepted subcortically.
It is possible that use of acupuncture as a method for the examination of the function of the parietal lobe can be adopted. Practice stated in this paper is favourable for this. It would be a new technique since no further method was reported for the clinical sensory examination after the recommendation of bilateral simultaneous stimulation by Bender in 1952.
The methodology for the investigation of phantom limbs has not been over the extent of inquisition for more than four hundred years. During the observation of phantom channel all cases developed phantom limb by means of acupuncture including patients who were failed to get it by questioning previously. The phantom limbs elicited by acupuncture were more bright, alive, complete, near the actual length and size of the original limbs. Furthermore they were obtained during the application of needling and could be controlled by manipulation and the patients could tell or point out the extending end of the phantom limbs when they reached. Therefore acupuncture is preferable for investigation of phantom limb rather than the methods usually used before. Meanwhile it was found that phantom limb pain and stump pain could be easily checked by acupuncture and it would be the first choice for treatment of those pains and its mechanism is at least similar with the theory of increasing the level of inhibition of reticular formation to treat phantom limb pain.
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