Beth Conroy Compendium - Stroke - Traditional Chinese Medicine

1/4/13
Beth Conroy Compendium - Stroke - Traditional Chinese Medicine
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Stroke (Wind Stroke/Cerebrovacular Attack) TCM Style
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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
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
C e r e b r a lh e m o r r h a g e is bleeding into the subarachnoid space form the intracerebral artery. C e r e b r a lt h r o m b o s i si s 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. C e r e b r a le m b o l i s m 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
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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. S p a s mo fc e r e b r a l 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. Preexisting 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-Stroke pathology can be summarized by four words: WIND-PHLEGM-FIRE-STASIS *inadequate rest *apolpexy *emotional stress------KD Yin Def. not --------LIV Yang Rising-----LIV WIND---*coma *excessive sex nourishing LIV Yin *mental cloudiness *paralysis
*numbness of limbs *irregular diet---------SP Deficiency----SP & KD Yang Def.-----PHLEGM FIRE----*mental cloudiness *physical overwork *aphasia *sticky yellow tongue coat
*excessive sex-----KD Def.-----Def of Marrow-----Blood Def---BLOOD STASIS----*stiffness and

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-*stiffness and *inadequate rest *pain in limbs
*physical overwork------Weakness of----Internal Wind in Channels----WIND IN CHANNELS---*paralysis *inadequate rest Channels Stirred by External Wind 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: 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 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.
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
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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. ATTACK OF INTERNAL ORGANS---SEVERE TYPE---TENSE TYPE ---SEQUALAE--HEMIPLEGIA, NUMBNESS, SLURRED SPEECH FLACCID TYPE ATTACK OF CHANNELS ONLY---MILD TYPE---ATTACK OF MAIN CHANNELS--HEMIPLEGIA, NUMBNESS ATTACK OF LUO CHANNELS---NUMBNESS
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 theSevere 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:
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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 V a r i a t i o n s :o t h e rp o i n t st ou s ea c c o r d i n gt os y m p t o m s :
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: T r e a t m e n tP r i n c i p l e :R e c a p t u r eY a n g ,i n d u c er e s u s c i t a t i o n P O I N T S :
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
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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
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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:
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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:
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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 fivepalm 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.
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