Stroke (Wind Stroke/Cerebrovascular Attack)
TCM Style



ischemic_stroke.jpg



Sources:
1. The Practice of Chinese Medicine, The Treatment of Disease with Acupuncture and Chinese Herbs Vol 1, pgs 665-684; Giovanni Maciocia
2. The Practice of Chinese Medicine, The Treatment of Disease with Acupuncture and Chinese Herbs Vol 2; pgs1191-1218; Giovanni Maciocia

3. http://www.veinskin.com/files/uploads/ischemic_stroke.jpg
4. Lotus Institute of Integrative Medicine (John Chen). Clinical Manual of Oriental Medicine: An Integrated Approach, City of Industry, CA: Lotus Institute of Integrative Medicine, 2006.
5. Ni, M. and McNease, C. The Tao of Nutrition, Los Angeles, CA: Tao of Wellness Press, 2009.




Herbal, Dietary & Lifestyle Information



Dietary information from The Tao of Nutrition. (TN)
Herbal, dietary, and lifestyle information from Clinical Manual of Oriental Medicine: An Integrated Approach (CMOM)

TN
grape, p. 59 Contraindication: Wine should not be combined with fatty foods because it can result in phlegm and heat that rises to the heart and can cause strokes and heart attacks.
blood clots. p. 100 Quail eggs. Contraindicated in allergies to eggs.

CMOM
Stroke, p. 101
subcategories:
  1. pts. w/increased risk of stroke due to excess type hypertension
  2. pts w/increased risk of stroke due to deficient type hypertension
  3. pts. w/increased risk of stoke due to high cholesterol levels
  4. pts w/increased risk of stoke due to coronary heart disease
  5. treats the complications of stroke; to be used only after hemorrhage stops
  6. facial paralysis






Patterns of Disharmony/Diagnosis:
In Chinese medicine, Wind-Stroke (Zhong Feng) is the same as four major conditions:
-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.


Wind-Stroke pathology can be summarized by four words: WIND-PHLEGM-FIRE-STASIS

All four of these factors do not have to be present concurrently to lead to Wind-Stroke, but at least three of them do. They may also be present in various degrees of severity leading to various different types of Wind-Stroke. These are only the pathogenic factors causing Wind-Stroke. Qi, Blood, Kidney or Liver Yin Deficiencies will also be present. Tongue presentation is also important in the diagnosis and prevention of wind-Stroke.


Tongue appearance before wind-Stroke:

Tongue diagnosis in Wind-Stroke is more important for prevention than actual treatment. For example; if an elderly person's tongue shows the appearance of the any of the above descriptions it strongly suggests the possibility of Wind-Stroke. If the tongue is Reddish-Purple, Stiff and Swollen it displays all four of the pathogenic factors of Wind-Stroke; Fire, Stasis, Wind and Phlegm.
Pathogenic Factor: Wind
Tongue Appearance: Stiff, Moving, Deviated, Quivering

Pathogenic Factor: Phlegm
Tongue Appearance: Swollen, Sticky Coating

Pathogenic Factor: Fire
Tongue Appearance: Red tongue body

Pathogenic Factor: Stasis
Tongue Appearance: Reddish-Purple tongue body


The Differentiation of Diagnosis of Wind-Stroke
There are two major types of Wind-Stroke; Severe Type and Mild Type.
The Severe Type attacks the internal organs and the channels and the Mild type attacks only the channels.

Severe Type: attacks the organs and the channels and is characterized by apoplexy, loss of consciousness, possibly coma, aphasia, paralysis, and numbness.

The severe type is further divided into two patterns, Closed (Tense) and Open (Flaccid).
Closed (Tense) corresponds to the collapse of Yin.
Open (Flaccid) corresponds too the collapse of Yang.

After a Severe Type of Wind-Stroke affects a patient's organs a survivor will suffer the secondary stage where the Mild Type symptoms will manifest, such as unilateral paralysis of the limbs, numbness, and slurred speech. They may rise on their own or from the attack on the organs themselves.

Mild Type: attacks only the channels and is characterized by unilateral paralysis, numbness, and slurred speech, there is no loss of speech or consciousness.

The Mild Type is divided further as an attack on the main channels with manifestations of hemiplegia and numbness, or an attack on the Connecting Channels characterized by numbness alone.




Patterns of Disharmony/Diagnosis
Clinical Manifestations

Tense or Closed Type: Collapse of Yin
sudden collapse, loss of consciousness, coma, clenched teeth, closed fists, locked-jaw, red face and ears, profuse sputum, rattling sound in the throat, coarse breathing, constipation, retention of urine.


Further Subset:

Mild Type: Attack of Main Channels
Facial paralysis, hemiplegia, numbness of limbs, limitation in movement, slurred speech (not always present).

Mild Type: Attack of Connecting Channels Only
Unilateral numbness of the face and limbs,, slurred speech (not always present).

Open or Flaccid Type: Collapse of Yang
sudden collapse, loss of consciousness, coma, hands and mouth open, eyes closed, pale face, oily sweat beads on the forehead, incontinence of stools and urine, cold limbs.


Pulse/Tongue
T ense or Closed Type: Collapse of Yin
Tongue: Red body, Stiff, Deviated, Sticky-Yellow Coating.
Pulse: Wiry, Full, Rapid, Slippery

Open or Flaccid Type: Collapse of Yang
Tongue: Pale, Swollen
Pulse: Minute, Hidden, Scattered


TREATMENT PRINCIPlES:
For the Severe Type/Attack on the Internal Organs:

During the acute stage of Wind-Stroke it is imperative to work with Western Medicine for treatment.
The Principles are:
1. Relieve Spasm
2. Induce Resuscitation
3. Lower Blood Pressure


General Treatment
POINTS:
PC-6 Reducing
SP-6 Reducing
GV-26 Reducing
LI-4 Reducing
LI-11 Reducing
ST-36 Reducing
LIV-3 Reducing
KD-3 Reinforcing Method
Done every 6 hours without retention of needles.


Tense/Closed Type:

Treatment Principles: Induce resuscitation, relax spasm, clear heat, subdue wind, resolve phlegm, open orifices
POINTS:
GV-26 needled oblique upwards, promotes resuscitation
GV-20 needled horizontally forwards
GV-16 subdue internal wind
GB-20 subdue internal wind
KD-1 subdues wind, lowers blood pressure and relaxes spasm
PC7 or 8 opens orifices and clear heat
12 Well Points of the Hand, with bleeding method, subdue wind and clear heat


Variations: other points to use according to symptoms:
LOCK JAW: ST-36, ST-7, LI-4
PROFUSE SPUTUM: CV-22, ST-4, both reducing method
APHASIA: CV-23, HT-5


Flaccid/Open Type:

Treatment Principle: Recapture Yang, induce resuscitation
POINTS:

CV-6 recaptures yang with moxa cones
CV-4 recaptures yang with moxa cones
CV-8 moxa cones are applied to the salt placed into the umbilicus
ST-36 strengthen Heart Yang to relieve collapse of Yang
SP-6 strengthen Heart Yang to relieve collapse of Yang
PC-6 strengthen Heart Yang to relieve collapse of Yang
GV-4 with moxa, will strengthen the Fire of the Gate of Vitality and also relieves Collapse of yang
BL-23 with moxa, will strengthen the Fire of the Gate of Vitality and also relieves Collapse of yang


The distinction between Tense and Flaccid is not always clear, or the pattern changes from Tense to Flaccid or the other way around. When this happens needle the following points:
GV-26

ST-36
SP-6
PC-6: needled even method to induce resuscitation and subdue wind
Yintang: needled even method to induce resuscitation and subdue wind


Attack of the Channels Alone:
Treatment Principles:
1. Remove obstructions from the channels
2. Subdue Wind and Resolve Phlegm
3. Invigorate the Connecting Channels
4. Regulate the circulation of Qi and Blood in the Channels


Hemiplegia Points:
GV-26 Subdue Wind
GV-20 Subdue Wind
BL-7 Subdue Wind


Paralysis of the Arm:
LI-15
TB-14
LI-11
LI-10
TB-5
LI-4
SI-3


Paralysis of the Leg:
BL-23
GB-30 very important for this condition
GB-29
ST-31
GB-31
ST-32
Bl-40
GB-34
ST-36
Bl-57
GB-39
ST-41
BL-60
GB-40

Three to four points are used on each limb. They are selected accordingly to the joint involved. They are needled deep and intramuscular penetration of two points with one needle is used.
Examples:
LI-15 to LI-14
ST-36 to ST-37
TB-5 to PC-6
LI-11 to HT-3
GB-34 to SP-9
GB-39 to SP-6


HYPERTENSION:
When blood pressure id high it must be lowered.
POINTS:
LI-4 and LIV-3 reducing method to subdue Liver Yang and Liver Wind
KD-3 reinforcing method to tonify Kidney and Liver Yin
ST-9 empirical point to lower blood pressure
Additional Points:
ST-36 and GB-39 with Moxa
ST-9, PC-6, SP-6 tapped with a plum-blossom needle


FACIAL PARALYSIS:
POINTS:
Distal
LI-4
TB-5

Local
GB-14 horizontal downwards
BL-2 horizontal downwards or towards Yuyao
Yuyao horizontal towards BL-2
TB-23 towards Yuyao
GB-1 towards Yuyao
ST-2 horizontal downwards
SI-18 horizontal towards LI-20
LI-20 towards SI-18
ST-7 towards ST-4
ST-6 towards ST-4
ST-4 towards ST-6
LI-19 horizontal towards Li-20
CV-24 towards ST-4
GV-26 towards LI-19

Adjacent Points
TB-17 towards opposite eye, deep puncture (at least 1 cun)
GB-20 towards eye ipsilaterally


INCONTINENCE OF STOOLS AND URINE
FOR BOTH:
BL-33 should propagate to pelvic cavity
BL-25
CV-6 propagate toward genitals
CV-4 propagate toward genitals
SP-6
GV-4 strengthen the Fire of the Gate of Vitality to control the lower orifices
BL-23


DIZZINESS:
POINTS:
LIV-3 and Bl-18 reduce to subdue Liver-Wind
BL-23, KD-3, CV-4 reinforcing to nourish the Kidneys
GV-20, GB-20 subdue Internal Wind


STIFFNESS AND CONTRACTION OF THE MUSCLES:
SHOULDER JOINT:

LI-15 towards LI-14

ELBOW JOINT:
LI-11 towards HT-3


FINGER JOINTS:
LI-3 at least 1 cun towards SI-3
SI-3 at least 1 cun towards LI-3
general points to subdue wind may be added such as:
LI-4
LIV-3
TB-17
GB-20


Yin points used for rigidity and stiffness:

HT-1 shoulder joint
LU-5 with PC-3 elbows
PC-6 finger joints
SP-12 hip joint
LIV-8 knee joint
SP_5 with KD-3 toe joints


PATTERNS IN SECONDARY STAGE (FOR SEVERE TYPE)

WIND-PHLEGM

Clinical Manifestations:
contraction of limbs, severe dizziness, giddiness, stiffness, a stiff and deviated tongue and a wiry pulse.


Treatment Principle:
Resolve Phlegm and extinguish wind.

POINTS:
GV-20 subdue wind
GV-16 subdue wind
GB-20 subdue wind
ST-40 reducing or even method to resolve damp
LU-9 reducing or even method to resolve damp


DAMP PHLEGM
Clinical manifestations:
a feeling of heaviness in the body and oppression of the chest, profuse sputum, a rattling sound in the throat, blurred vision, dizziness, a swollen tongue with sticky coating and a slippery pulse.


Treatment Principle:

Tonify the Spleen, drain dampness and resolve phlegm.

POINTS:
BL-20 and CV-12 reinforcing method to tonify Spleen to resolve Phlegm
ST-40 and SP-6 even method to reduce Phlegm


STAGNATION OF QI AND BLOOD
CLINICAL MANIFESTATIONS
hemiplegia, pains in the shoulder and hip, a purple tongue and a firm pulse


Treatment Principle
Move Qi and Regulate Blood

POINTS:
CV-17 even method to move Qi in order to move Blood
BL-17 even method to move blood
SP-10 even method to move blood


YIN DEFICIENCY WITH EMPTY-HEAT
CLINICAL MANIFESTATIONS
feeling of heat in the afternoon and evening, dizziness, tinnitus, night sweating five-palm heat, feeling of heaviness of the upper part of the body and weakness of the lower part of the body when walking, a red tongue, no coating, and a floating, empty and rapid pulse.


TREATMENT PRINCIPLES

Nourish Yin and Clear Empty Heat

POINTS:
KD-6 reinforcing method to Nourish Kidney YIN
KD-3 reinforcing method to Nourish Kidney YIN
CV-4 reinforcing method to Nourish Kidney YIN
HT-6 reducing method to clear empty heat
GB-20 subdue Wind


Patient Education/Recommendations
Prevention is the best way to treat Wind-Stroke. Lifestyle changes in diet, exercise and stress reduction are the best.

Prognosis
Best results are obtained if treatments are received within one month of Wind-Stroke and within 3 months good results are possible. When stroke happens within three months the treatments should be done daily. If more than three months the treatments should be done every other day. Herbal treatments are extremely beneficial, as is Electrical Acupuncture, and Scalp Acupuncture.