STROKE (Cerebrovascuar Attack) APM Style

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SOURCES:

1. A Manual of Acupuncture, pages 95-121,125-174; Deadman, Al-Khafaji, Baker
2. The Practice of Chinese Medicine, The Treatment of Disease with Acupuncture and Chinese Herbs Vol 2; pgs1191-1218; Maciocia,Giovanni
3. Acupuncture A Comprehensive text, pages 497-50; Bensky, Dan
4. Acupuncture Physical Medicine, pages 85-95, 97-120,121-130, Seem, Mark
5. Handout from Carolyn Bengston's Scalp Acupuncture Class (Photocopies of Acupuncture a Comprehensive Text)

-----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------DESCRIPTION OF CONDITION:

In APM and Chinese medicine, Wind-Stroke (Zhong Feng) is the same as four major conditions in western medical diagnosis:
-cerebral hemorrhage
-cerebral thrombosis
-cerebral embolism
-spasm of a cerebral vessel

Zhong=Sudden Onset
Feng=Wing


Cerebral hemorrhage is bleeding into the subarachnoid space form the intracerebral artery.

Cerebral thrombosis is partial or total obstruction of a cerebral artery from a thrombosis resulting in infarction and anoxia of the surrounding tissue. A thrombosis is a blot clot that forms in the artery lining and remains attached to where it originated.

Cerebral embolism is an embolus that detaches from the thrombus and closes the cerebral artery causing infarction and anoxia of the cerebral tissue. Embolus is a bubble of air or a piece of a thrombosis that gets detached and travels along the arterial system causing the closing of an artery.

Spasm of cerebral vessel is caused by the closing of the vessel temporarily in which it contracts. A passing embolus may be the cause in which it temporarily narrows the vessel's lumen causing anoxia or infarction of the surrounding tissue. Because this is the least serious of the four it usually results in complete recovery.

Aetiology and Pathology:
Wind-stroke is a complex condition because although it occurs quickly it has been brewing up over years. It has four main factors:

1. Overwork, Emotional Stress and Excessive Sexual Activity: Kidney Yin Deficiency is caused by working long hours in stressful conditions, lack of rest, emotional strain, and excessive sexual activity. These combinations are the most common cause of Kidney Yin deficiency in industrialized societies. Kidney Yin Deficiency leads to Liver Yin Deficiency and then Liver Yang Rising. The Rising of Liver Yang often in elderly leads to Liver Wind, which causes apoplexy, coma, mental cloudiness, paralysis, and the tongue is moving, deviated or stiff. There may also be interactions between Internal and External wind, as External wind may cause the stirring of Internal Wind.

2. Irregular Diet and Physical Overwork: Irregular eating or the eating of excessive amounts of fats, dairy, greasy, fried foods and sugar will weaken the Spleen causing Phlegm and can also lead to obesity. Over time this causes Phlegm-Fire. Numbness of the limbs, mental cloudiness, slurred speech, or aphasia, and a swollen tongue with a sticky coating are caused by Phlegm.

3. Excessive Sexual Activity and Inadequate Rest: Kidney-Essence is weakened by these factors and leads to marrow deficiency. When marrow is deficient it fails to nourish the Blood and will lead to Stasis. Blood stasis causes weakness of the limbs and the tongue to be purple.

4. Physical Overwork and Inadequate Rest: Physical overwork, including excessive lifting, exercise or sports weakens the Spleen, the muscles and the channels. Pre-existing Internal Wind exploits Qi and Blood Deficiency in the channels and penetrates them. Paralysis of the limbs is caused by External Wind setting off Internal Wind.

WIND-PHLEGM-FIRE-STASIS

(TPOCM, pages 1191-1218; Maciocia)


PATTERNS OF DISHARMONY(FACES OF FATIGUE; ZONE OR TM DYSFUNCTION):

Zone: Yang Ming ST and LI Meridian

Full Aspect:
Internal wind
Phlegm
Fire
Blood stasis

Empty Aspect:
Qi and Blood Deficiency
Yin Deficiency


(TPOCM, pages 1191-1218; Maciocia)

CLINICAL MANIFESTATIONS:

Attack of the Internal organs:

Severe Type:

Two Types of Severe;
1. Tense/Closed Type is a Collapse of Yin with sudden collapse, loss of consciousness, coma, clenched teeth, closed fists, lock jaw, red face and ears profuse sputum, rattling sounds in the throat, coarse breathing, constipation and retention of urine. Pulse: Wiry, Full, Rapid, Slippery. Tongue:Red Body, Stiff, Deviated, Sticky Yellow Coating.

2. Open/Flaccid Type is a Collapse of Yang with sudden collapse, loss of consciousness, coma, hands and mouth open, eyes closed. Pulse: Minute, hidden, Scattered. Tongue: Pale, Swollen.

Mild type:
1. Attack of the Main Channels: Facial paralysis, hemiplegia, numbness of limbs, limitation of movement, slurred speech (not always present).
2. Attack of Luo Connecting Channels Only: unilateral numbness of face and limbs, slurred speech (not always present).


(TPOCM, pages 1191-1218; Maciocia)

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PALPATORY FINDINGS:

Palpation of the Yang Ming Zone: ST and LI Meridians for Kori's/Sensitive Points along the Channels, indicating the points that will be used for treatment of paralysis, numbness, and tingling. Also, palpate the head for sensitive dents or spots along the Motor Line and the Sensory Line indicating the points along these Lines to be used in treatment of paralysis, numbness, tingling and aphasia

Stomach Meridian: Specific Points to palpate along the entire Channel: From ST-31 to St-40.
Large intestine Meridian: Specific Points to Palpate along the Channel: LI-4 to LI-15.

(AMOA, Deadman)


TREATMENT PRINCIPLES:

From the APM perspective Stroke does not fall into the Four Patterns of Fatigue, Organs in an Uproar, Musculoskeletal Straightjackets, or Chronic Fatigue, so the Yang Ming Circuit and scalp points are best utilized to treat the symptoms of stroke. The scalp points are from Dan Bensky's book "Acupuncture A Comprehensive Text."



TREATMENT STRATEGIES: From a TCM/APM Approach.

Attack of the Internal Organs: Tense and Flaccid Types
Acute Stage:

Relieve Spasm
Induce Resuscitation
Lower Blood Pressure


Tense Type:
Induce Resuscitation
Relax Spasm
Clear heat
Extinguish Wind
Resolve Phlegm
Open the Orifices


Flaccid Type:
Recapture yang
Induce Resuscitation


Attack of the Channels Alone:

Remove Obstruction From the Channels
Extinguish wind
Resolve Phlegm
Invigorate the Luo Channels
Move Qi and Blood in the Channels

(TPOCM, pages 1191-1218; Maciocia)


TREATMENT PLAN:

The treatment plan will come from scalp acupuncture to treat the sensory and motor symptoms and limb points along the Yang Ming ST/LI meridians to treat local hemiplegia, numbness, and tingling.

The Scalp treatments are done on the contralateral side of the head of the affected Stroke side.

The head is divided into areas of Motor Area, Sensory Area, and Speech area. Imaginary lines are visualized as in the photos below:

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IMG_0118.JPG IMG_0115.JPG





IMG_0113.JPG IMG_0114.JPG

When locating the points on the scalp within the areas or lines that are needed, locate the points by a dent or senstive spot, there may be more than one dent or sensitive spot, needle the most sensitive. Needles in the scalp are strongly stimulated and are needled with a #26-28 gauge filiform needles from 2.5-3 inches in length. Needles are inserted horizontally to the scalp without touching the bone with slow rotation until the requisite portion of the needle is inserted. Once in place needles are not raised or thrusted but rather rapidly twirled (200 times per minute is best) in wide amplitude (2-3 rotations forward and 2-3 rotations backward) until De-Qi is achieved. Continue the twirling for 3-4 minutes, retain needles 5-10 minutes and then twirled again. Repeat procedure 2-3 times and then remove needles. A cotton ball must be used when removing the needle to prevent hematomas, bleeding and lumps. Most commonly the sensation felt is of heat, usually on the limb opposite side of where needled. Precise location of scalp points is important for effectiveness. Stimulation of needles must be strong for results. It may be best to have patient lie down before treatment to fainting. (ACT, page 498; Bensky)

PARALYSIS OF UPPER LIMB:
Needle Second and Third Fifths of the Sensory Line on opposite side of effected limb
LI-3 difficulty flexing and extending the fingers
LI-4 painful obstruction, hemiplegia, contraction of the fingers
LI-5 contraction of the five fingers
LI-8 hemiplegia,
LI-9 pain and numbness of shoulder, arm, elbow, hemiplegia from wind-stroke, numbness of the limbs
LI-10 wind-stroke, paralysis of the arm, numbness of arm, contraction and inflexibility of elbow
LI-11 hemiplegia, atrophy of lower limbs
LI-12 contraction, numbness and immobility of the upper arm
LI-13 pain, numbness, or contraction of elbow and upper arm
LI-14 pain, numbness, wasting weakness of upper limb
LI-15 hemiplegia, contraction and numbness of upper limb, wind paralysis, wind stroke, wind atrphy disorder
LI-16 difficulty in raising the arm
LI-17

PARALYSIS OF LOWER LIMB:
Needle Upper Fifth Motor Area Line on opposite side of effected limb
Needle Leg Motor and Sensory Area for paralysis, pain, or numbness of lower limb
ST-31 paralysis of the leg if tender or Kori is Present
ST-32 if numbness and contraction of the muscles
ST-33 atrophy of leg muscles
ST-36 lock-jaw, loss of consciousness
ST-37 hemiplegia, leg Qi, numbness and pain obstruction of the lower limb
ST-38 atrophy of lower limb
ST-39 hemiplegia, painful obstruction of lower limb
ST-40 hemiplegia, painful obstruction of lower limb, withering of the lower limb

LOSS OF CONSCIOUSNESS:

LI-1 loss of consciousness
LI-19 lock jaw, deviation of the mouth, loss of consciousness

APHASIA/SPEECH:

Needle Upper Motor Neuron for paralysis of face, motor aphasia, dribbling saliva, impaired speech
Needle Speech #2 nominal aphasia
Needle Speech #3 receptive aphasia
LI-17 sudden loss of voice, rattling noise in throat
LI-18 sudden loss of voice, rattling noise in throat


FACIAL PARALYSIS/LOCK JAW:
Needle Chorea and tremor control area for tremors in face and upper/lower limbs, facial palsy
Needle Upper Motor Neuron for paralysis of face, motor aphasia, dribbling saliva, impaired speech

LI-19 lock jaw, deviation of the mouth, loss of consciousness
LI-20 deviation of the mouth

Electroacupuncture may also be used in this treatment. Electro-Stim of the head motor and sensory points as well as most tender points of the upper and lower extremities is done. This can be quite intense and many patients will opt out of Electro-stim. For an in depth treatment using electroacupuncture see KM Stroke Treatment Wiki.


Scalp points from Bensky
ST/LI Points from Deadman


PATIENT EDUCATION/RECOMMENDATIONS:

The patient must make lifestyle changes concerning diet, stress and exercise. Together these can reduce the chances of another stroke on the opposite side of the brain.



PROGNOSIS:

For best results the patient should begin acupuncture treatments within the first three months of stroke. Physical therapy is also essential to the recovery of hemiplegia, numbness and tingling
.