Description for medicine or protocol of treatment in detail:
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1. Experimental group (XNKQ acupuncture)
(1) XNKQ acupuncture
Acupoints:
bilateral PC6, GV26, affected side SP6, affected side GB34, affected side BL40, affected side GB40.
Acupuncture Manipulation:
With the participants in the supine position, and after skin disinfection by 75% alcohol cotton ball, using Hwato brand disposable acupuncture needles (size 0.25 × 40mm, produced by Suzhou Medical Supplies Factory Co., Ltd., Suzhou, China). PC6: acupuncture needles were inserted approximately 0.5 to 1.0 B-cun (13mm-25mm) into the skin perpendicularly, applying combinative manipulation (lifting-thrusting and twirling-rotating) with reducing method bilaterally for 1 min. GV26: Oblique insert upwards to the nasal septum for 0.3-0.5 B-cun (8mm-13mm) with heavy bird-pecking method until the patient's eyeballs have moistened or tears flow. SP6: Oblique insert the point edged the posterior tibia by 45° with skin for 1.0-1.5 B-cun (25mm-40mm), and apply tonifying method of lifting-thrusting till the affected side lower limb has jerked 3 times. GB34: acupuncture needles were inserted perpendicularly into the skin approximately 1.0-1.5 B-cun (25mm-40mm), applying tonifying method of lifting-thrusting for 1minutes. BL40: Perpendicular insert with the affected side lower limb straight raised for 45°, and apply reducing method of lifting-thrusting till the lower limb has jerked 3 times. GB40: acupuncture needles were inserted perpendicularly into the skin approximately 0.5-0.8 B-cun (13mm-20mm) towards KI6, applying tonifying method of lifting-thrusting for 1minutes. Following needle insertion, small, equal manipulations of twirling, lifting, and thrusting were performed on needles to reach de qi (a composite of sensations including soreness, numbness, distention, heaviness, and other sensations). Each acupoints retained needles lasting for 30 minutes besides GV26 and BL40. Paired electrodes from the SDZ-Ⅱ electroacupuncture apparatuses (Hwato brand, Suzhou Medical Supplies Factory Co., Ltd., Suzhou, China, DZ-6x) were attached transversely to the needle handles at affected side GB34 and GB40 after manipulation. The electroacupuncture stimulation lasted for 30 minutes with a dilatational wave of 5 to 10 Hz and a current intensity of 1 to 3 mA (preferably with the skin around the acupoints shivering mildly without pain).
2. Control group 1(XNKQ acupuncture + PT)
(1) XNKQ acupuncture: As above.
(2) Physical Therapy: Focusing on the lower limb rehabilitation, adjusted flexibly according to patients motor function. Acute stage: Good limb position put and passive motion in affected side limb. Recovery stage: adding active motion, exercise training, standing training and walking training on the bed by degrees, under the guidance of therapist. PT was performed for 30min after acupuncture immediately.
3. Control group 2 (sham acupuncture + PT)
Acupoints:
Sham acupoint nearby the above acupoints: The sham PC6, SP6, BL40, GB34 and GB40 points were 0.4 B-cun (≈10 mm) lateral to PC6, SP6, BL40, GB34, and GB40 points, and the sham GV26 point was 0.2 B-cun (≈5 mm) horizontal to GV26.
Acupuncture Manipulation:
The sham PC6, SP6, BL40, GB34 and GB40 were shallow needle insertion, approximately 0.2 to 0.3 B-cun (5mm-8mm), with mild reinforcing-reducing method at above sham acupoints for 1 min without de qi. Each sham acupoints retained needles lasting for 30 minutes besides sham GV26 and sham BL40. GB34 and GB40 were attached to the above electroacupuncture apparatuses with no electricity output for 30min.
4. basic treatments for stroke
(1) Secondary prevention: antiplatelet, anticoagulation, blood pressure regulation, lipid-lowering, glucose-lowering, etc.
(2) Complication prevetion: pressure ulcers and pneumonia, etc.
(3) Nutritional support.
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Exclusion criteria:
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1. The subjects who had been dependent on daily activities before the stroke;
2. Stroke patients who have received thrombolysis or thrombectomy treatment;
3. Infection of acupuncture site and (or) objects unable to tolerate acupuncture treatment;
4. Patients with other serious concomitant diseases (aphasia, moderate to severe edema of lower limbs, venous thrombosis of lower limbs, arteriosclerosis occlusion of lower limbs, diabetic lower extremity vascular disease, peripheral neuropathy, myelopathy, brain trauma, intracranial infection, brain tumor, etc.), secondary diseases (such as heart, liver, renal failure, etc.);
5. Patients with contraindications to MRI (claustrophobia, surgical implantation of metal devices, etc.);
6. Subjects with MMSE score: illiterate < 17, primary school < 20, middle school and above < 24; Hamilton Depression Scale (HAMD-17) score > 17; Hamilton Anxiety Scale (HAMA) score >= 14.
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