Kai Chen Ph.D. in
Chinese Medicine
TCM Dr. in British Columbia, Canada
205 Burnside Road East, Victoria, B.C. V9A 1A4 Canada
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TCM Dr. in British Columbia, Canada 205 Burnside Road East, Victoria, B.C. V9A 1A4 Canada |
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Stroke (Cerebrovascular Accident) Introduction
Stroke
is a focal neurological deficit due to a vascular lesion resulting from
intracerebral hemorrhage (20%) and ischemic diseases (thrombosis, embolism, or
vascular insufficiency), which is most common reason (80%).
Thrombosis is the most common cause of stroke in middle-aged and elderly,
among whom there is a higher incidence of atherosclerosis, diabetes, and
hypertension. Thrombosis causes
ischemia in brain tissue supplied by the affected vessel as well as congestion
and edema. Hemorrhage results from
chronic hypertension or aneurysms, which cause sudden rupture of a cerebral
artery. The rupture diminishes
blood supply to the area served by this artery and the hematoma further
compresses neural tissue. Thrombosis
the onset usually occurs more gradually -- over minutes to hours; on rare
occasions it progresses over days to weeks. The symptoms for an ischemic stroke
are extremely variable depending on the area of the brain that has been
affected. The most common symptom is weakness or paralysis of one side of the
body or the other. There may be partial or complete loss of voluntary movement
of and/or sensation in a leg and/or arm. A stroke can result in speech problems
and weak muscles of the face, which can cause drooling. Numbness or tingling is
very common. Other symptoms include dizziness, vomiting, loss of muscle tone,
major seizures, and possibly coma. Hemorrhage typically begin very suddenly and
evolve over several hours and include headache, nausea and vomiting, and altered
mental states. When the hemorrhage is a subarachnoid type, warning signs (abrupt
headaches, nausea and vomiting, sensitivity to light, and various neurologic
abnormalities) can occur from the leaky blood vessel a few days to a month
before the aneurysm fully develops and ruptures. When the aneurysm ruptures, the
stroke victim may experience a terrible headache, neck stiffness, vomiting,
confusion, and altered states of consciousness. The eyes may become fixed in one
direction or lose vision. Stupor, rigidity, and coma can result. Diagnosis of
stroke is based on observation of clinical features, a history of risk factors,
and results of diagnostic test, such as CT, MRI and lumber puncture, etc. TCM etiology and Pathology In TCM, both of hemorrhage and ischemic
diseases is diagnosed as Zhong Feng (Wind stroking) and the treatments are
similar, therefore they are discussed together. In the acute stage, based on the symptoms, it can be divided
two types: Zhong Zang Fu (wind attacking visceral) and Zhong Jing Luo (wind
attacking channels and collaterals), the former is severe, often loss
consciousness, the later is not serious, perhaps hemiplegia but not loss
consciousness. 1. Emotion changes 2. Diet disorders 3. Deficient constitutions 4. Weather changes In the acute or middle-aged patients,
the illness often is excessive and in the chronic or senior often is deficient
with excessive syndromes. The
excessive may be fire, internal wind that is hyperactivity liver yang, phlegm or
blood stasis. The deficient may be
qi or yin deficiency. Blood stasis
is basic pathological change in the late stage, because any reason finally
causes blood circulation disorder. TCM
differentiation and treatment 1. Acute stage 1. 1. Wind-stroke attacking the visceral 1.1.1. Obstructive
type Clinical manifestation: Sudden onset, loss
consciousness, clenched jaws, flushed face, coarse breathing, or rattling in the
throat, red tongue with yellow fur, taut and forceful pulse Treatment principle: Herbal prescription: Ling
Jiao Gou Teng Tang (Decoction of Antelope抯
horn and Uncaria stem) Acupuncture Renzhong (DU 26), Laogong (PC 8),
Taichong (LR 3), Yangquan (K1), Fenglong (ST 40), 12 channels Jing (well) points 1.1.2 Collapsing type Clinical manifestation: Sudden
onset, loss consciousness, incontinence of urine and loose, cold and flaccid
paralysis limbs, shallow and weak breath, flaccid tongue, weak and deep pulse Treatment principle: Reinforcing yang and qi,
bring back resuscitation Herbal prescription: Shenfu Tang (Decoction of
ginseng and aconite) and Shengmaiyin (Pulse-activating powder) Acupuncture: Shenque (RN 8), Qihai (RN 6),
Guanyuan (RN 4) 1. 2. Wind-stroke attacking the channels and
collaterals Compared with wind attacking the organs, this
type is mild. The main symptoms are
hemiplegia, or limbs numbness and weak, or slurring speaking, etc, but not loss
consciousness, most is thrombosis, some hemorrhage. 1.2.1 Hyperactivity yang with yin deficiency Clinical manifestation: Often headache, or
vertigo, or tinnitus, sudden onset, but not loss consciousness, hemiplegia,
numbness or weak of limbs, deviated tongue, slurring of speech, and red tongue
with white or yellow fur, taut and slippery pulse Treatment principle: Tonifying
Kidney yin and subduing liver yang Herbal prescription: Tianma
Gouteng Yin (Decoction of Gastrodia and Uncaria) Acupuncture: Fengchi (BL20), Waiguan (SJ5), Taichong (Liv2),Taixi (KI3) 1.2.2 Wind mixed with phlegm blocking channels
Clinical manifestation: Sudden onset, but not
loss consciousness, hemiplegia, numbness or weak of limbs, deviated tongue,
slurring of speech, or headache and dizziness, or profuse sticky phlegm, or
constipation, red tongue with yellow greasy fur, taut and slippery pulse Treatment principle: Herbal prescription: Modified
Xingluo Chengqi Tang (Decoction for purging down digestive qi with arisaema
tuber with bile and trichosanthes fruit) Acupuncture: Baihui
(DU20), Hegu (LI4), Quchi (LI11), Yanglingquan (GB34), Fenglong (ST40) 2. Recovery and sequela stages In
the clinic, those two stages diagnosis and treatment are similar. The
pathological changes mainly are two: long term illness leading qi deficiency,
showed as body weak and fatigue, and blood stasis in the channels, manifested as
hemiplegia and other function disability, also might be phlegm blocking or liver
yang hyperactivity or kidney deficiency. 2.1
Hemiplegia Clinical
manifestation: Hemiplegia, numbness or weak of limbs, deviated tongue, slurring
of speech, pale tongue with white fur, weak and thin pulse in the ill side arm Treatment principle: Herbal prescription Buyang
Huanwu Tang (Decoction of Invigorating Yang for Recuperation) Acupuncture: Upper limb: Lower limb: Huantiao (GB 30), Yanglingquan (GB
34), Fengshi (GB 31), Zusanli (ST 34), Sanyinjiao (SP6), Fengshi (GB31),
Yinlingquan (SP9), Weizhong (BL40) Deviation of the eye and mouth 2.2 Speaking ability damaged Clinical manifestation: Remarkable slurring
speech or dyslalia, or hemiplegia, or numbness or weak of limbs, or deviated
tongue, light red tongue with white greasy fur, taut pulse
Treatment principle: Acupuncture: Lianquan (RN 23),
Yamen (DU15), Tongli (HT5), Hegu (LI4) Copyright by Kai Chen Ph.D. in Chinese Medicine
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