Stroke - Cerebral vascular accident - Wind

Stoke can be classified as 2 types - either deficiency (open) or excess (closed) patterns

Cerebral vascular accident (CVA), hemorrhagic, embolism, aneurysm, sudden onset of hemiplagia, loss of voice, stiff tongue. Any stress on the neck through an accident or exercise may trigger stroke.

There are 2 types of strokes:

1. Blockage – blood stasis, phlegm (embolism), happens more at night

2. Hemorrhagic – aneurysm, happens during activity i.e. difficult bowel movements or physical activity, may or may not have a headache, associated with hypertension.

*Western Medicine uses CT scans or CSF tests to determine stroke type.

Top 3 complaints that may point to the possibility of Stroke

1. Dizziness 2. Headache 3. Numbness

*Hypertension is another.

***Ask the elderly about these things first during a visit. Also inquire about palpitations, shortness of breath, and chest pain.Middle aged people complain in the reverse order – numbness and headache first.

Traditional Chinese Medicine – Liver, Heart, Kidney. Wind, Phlegm, Fire, can cause a disharmony of Yin and Yang, poor regulation of Qi and Blood, and Shen can’t control the body Qi. Either meridians get invaded, or the organs get effected.

1. Closed – blockage (phlegm/stasis) – Huang Qi, Dan Shen

2. Open – loss/collapse of Yin/Yang – calm Liver herbs *Both may show Heat or Cold

*Both may associate with Phlegm

*Both may have paralysis

Excess - happens during an activity, usually involves bleeding and high blood pressure or blood vessels disorders or brain tumor or trauma (close observation for 48 hours post trauma)  

Deficiency - attack occurs during quiet time, involves blockage with blood stasis, embolisms or fat and phlegm stasis or trauma(close observation for 48 hours post trauma)

Post trauma pre stroke symptoms - nausea, vomit, headache, blurred vision (brain edema)  

Symptoms of Ischemia Stroke

Blockage Hemorrhagic - Bleeding Headache Slight or none - Severe Nausea/Vomiting Possible - Severe Stiff Neck Possible Always Coma/Loss of Mental Capacity Slight, short period of time Occurs quickly lasting 30-60 min Paralysis One part of body Ratio - ie left face, right arm Striking Time During restful period Occurs during activity Constipation Possible Often Stroke will always involve either Interior or Exterior Wind. If there is wind and phlegm it will give rise to Epilepsy

- Ban Xia Bai Zhu Tian Mai Tang

Wind and Yang - dizziness, stomach/Large intestine (Liver and Kidney Yin deficiency with either Yang or Fire)

Wind and Fire - with phlegm connects to heart with headache (Liver and Kidney Yin deficiency with either Yang or Fire)

Wind either attacks the organ or the meridian: Organ - Yang - more closed pattern - wind, fire, phlegm

Treatment Methods For Stroke:

Kai Qiao - open orifices Xi Feng/Qian yang - calm mind Zhi Bu Gan Shen - tonify liver and kidney Que Tan/Huo Xue - move phlegm and promote blood circulation

Formulas for Yang Closed Pattern: Heat Phlgm, Phlegm Fire An Gong Niu Huang Wan Zi Xue Dan Zhi Bao Dan

Formulas for Yin - open pattern, more dangerous - yin and yang collapse: Si Ni Jia Ren Shen Tang Qi Fu Tang Shen Fu Tang Mai Dong, Wu Wei Zi Sheng Mai San

Yin Closed Pattern: Cold Phlegm Su He Xiang Wan Meridian - Collaterals - Lou - Local area effected - Meridians - Jing - usually half the body, ie - half arm

Chinese Medicine Differentiation and Treatment

Meridians Invasion Patterns

Liver Yang suddenly rises emotional stress, overwork, hemiplagia, stiff tongue, mouth deviation, dizziness, headache, red face and eyes, easy to anger, constipation, yellow urine, P- strong wiry, T- red (or deep red) with yellow and/or dry coat.

Acupuncture points – Du, hand Jueyin, foot Shaoyang, *Du 26 and *PC 6 (open orifices), *SP 6, Liver 3, Large Intestine 11, SJ 5, Gall bladder 30, 34, Heart 1, Ren 23, Jin Jin/Yu Yue (bleed)

Wind-Phlegm hemiplagia, deviation, numbness and spasm of limbs, dizziness, cloudy mind, blurred vision, T- greasy coat, P- wiry slippery, generally more overweight people

Acupuncture points – Du, foot Taiyin, Shaoyang, *Du 26, *PC 6, * Spleen 6, Stomach 36, 40, Spleen 9, Heart 1, Large Intestine 11, SJ 5, Gall bladder 30, 31, 34

Yangming excess with Phlegm-Heat same as above, with sticky mouth and constipation, T- red smoky coat

Acupuncture points – foot Yangming, *Du 26, *PC 6, * Spleen 6, Stomach 25, 37, 40, Heart 1, Large Intestine 11, SJ 5, Heart 1, Gall bladder 30, 31, 34

Qi deficiency with Blood Stasis hemiplagia with flaccid limbs, numbness, shortness of breath, spontaneous sweats, palpitations

Acupuncture points - *Du 26, *PC 6, * Spleen 6, Heart 1, Large Intestine 11, SJ 5, Gall bladder 30, 31, 34, Ren 6, Bladder 23, Stomach 36, Du 14 (stop sweat), Moxa

Liver Kidney Yin deficient Wind

Acupuncture points - *Du 26, *PC 6, *SP 6, Heart 1, Large Intestine 11, SJ 5, Gall bladder 30, 31, 34, Bladder 23, Kidney 3, Liver 3

Zang Fu effected

Caused by Wind and Fire attacking the organs, this is more severe than meridian invasion.

Bi Zheng (closed/tense patterns):

Wind Fire red face

Acupuncture points – *Du 26, Shi Xuan (bleed), *PC 6, Liver 3, Gall bladder 20, all open orifices to revive patient and clear externally caused Liver Wind

Phlegm-Fire red face, rough noisy breathing

Acupuncture points – *Du 26, Shi Xuan, *PC 6, Stomach 40, Ren 22

Phlegm-Damp similar to Cold Bi, limbs are more flaccid than with Heat, gurgling sound in throat, cold limbs

Acupuncture points - *Du 26, *PC 6, Shi Xuan, Stomach 36, Spleen 6, Stomach 40, Ren 6 (Moxa)

Tou Zheng (open/flaccid patterns):

Yin and Yang collapse

Acupuncture points – Ren 4, 8 *heavy Moxa), *Du 26, *PC 6, Stomach 36, Du 20, Si Shen Cong  

Acupuncture General

Open – tonify, do not use Jing-well points

Closed – use Jing-well Both – Du 26, Du 20, moxa Post-stroke – TCM can treat well (sooner the better), acupuncture (scalp with electro), formulas, meditation

After 1 year it becomes quite difficult to treat..

Acupuncture Pre-Stroke

closed pattern-Pc 9, Pc 8, Du 20,Du 26, Lv 3, Kidney 1, Ren 22, St 40, Ren 12 open pattern -Moxa Du 20-Ren 4-Ren 6-Ren 8, Pc 6, Du 25

Acupuncture Post Stroke:

Use points on the Yang Meridians (more Qi and Blood) Use Du meridian Pts - governs all yang meridians and directly goes inside brain

Prevention of Stroke:

1900's - Ren Shen, \Ban Xia, Bai Zhu, Chen Pi, Dang Gui, Sheng Jiang, Huang Qi, Niu Xi, Zhu Li, Mai Dong, Shu Di Huang Now - Dang Gui, Bai Shao, Gou Teng, Fu Ling, Gan Cao, Ban Xia, Niu Xi, Sheng Di Huang, Shi Chang Pu, Di Long, Huang Qi Keep regular bowel movements +/- 1/day, treat constipation Keep blood pressure balanced, too high or too low can cause stroke If at risk, be careful in hot tubs, 45 minutes to 1 hour is too long

Signs of Menningeal Irritation:

Patient Symptoms: Headache, anxious, irritability, skin sensitivity, photophobia, sensitive hearing, nausea, vomiting

Other Symptoms: stiff neck tension, vomiting, fever, disturbed consciousness, spasm, involuntary movement

TCM - Head - connects to Stomach, Large Intestine and Bladder (Tai Yang, Yang Ming)

Brain - connects to Kidney, Heart (Shao Yin, Jue Yin)Shao Yang - - can be either connect to Head or Brain!

Alternative Treatment Methods

Ear Acupuncture- subcortes, brainstem, frontal, occipital, temporal, LR, HT, KI, effected body parts

scalp Acupuncture- wait until the situation is stable, puncture opposite side of paralysis, use motor, motor sensory, and speech regions.

electrical Acupuncture- must wait until situation is stable, use on head, arm, leg, 2 points each, intermittent, or alternating frequency

*For chronic stroke patients, alternate puncturing the effected side and the normal side. Prevention points: Gall bladder 31, 39