Stroke, also known as stroke, is a disease characterized by sudden fainting, hemiplegia, slanting of the mouth and tongue, speech or aphasia, and numbness of the body, with the characteristics of rapid onset, rapid change, critical condition, and high death and disability rates. It is equivalent to the acute cerebrovascular disease in modern medicine. Therefore, effective treatment of stroke patients is an important measure to ensure their early recovery. In clinical research treatment, acupuncture therapy has been proven to have significant efficacy on motor dysfunction in stroke. Clinically, we often divide stroke into the internal organs and meridians, and the disease is staged into the acute, recovery and sequelae periods.
I. Etiology and pathogenesis
Risk factors: The most important risk factor for this disease is hypertension, other than atherosclerosis, diabetes, obesity, smoking, alcohol consumption, heart disease, nutritional factors (such as low protein) and hyperlipidemia.
Causes of stroke: old age and physical decline, depression and irritation, uncontrolled alcohol and food, excessive strain and abnormal endowment. Most of them are middle-aged or above, with the pathological basis of deficiency of qi and blood, deficiency of liver and kidney, and hyperactivity of liver and yang, which are triggered by the addition of emotion, diet and living disorders, and strain.
Pathological mechanism: In the acute stage, wind, fire, phlegm and stasis are the main pathologies. It is caused by the above-mentioned causes, such as qi stagnation turning into fire, yang hyperactivity turning into wind, accumulation of dampness producing phlegm and internal stasis of blood. In the recovery period, wind, phlegm, stagnation and deficiency are common.
The etiology, pathogenesis, and treatment of stroke have been discussed differently by various medical practitioners. The general view is that the main cause of stroke is wind, fire, phlegm, stasis, and deficiency. The lesions involve the heart, liver, spleen, kidney and other organs. The occurrence of stroke mainly lies in the imbalance of yin and yang, internal wind, fire, phlegm, blood stasis, deficiency and disorder.
Identification and treatment
According to the differences between the acute and recovery periods and between the internal organs and the meridians, we should treat them differently. In the acute stage, the main treatment is based on the actual evidence, and in the internal organs, the treatment is usually based on clearing heat from the internal organs, clearing the liver and quenching the wind, and opening the orifices with phlegm. In the middle meridians, the method is usually to extinguish the wind and submerge the yang, and to remove phlegm and open the ligaments; in the recovery period, the deficiency or the deficiency is dominant, so attention should be paid to supporting the righteousness and eliminating the evil, benefiting the qi and invigorating the blood, nourishing the yin and extinguishing the wind. In case of phlegm-dampness and blood stasis, we can cooperate with the method of searching wind, removing phlegm and removing blood stasis to open the ligaments.
(I) Acute stage (within 2 weeks of onset, up to 1 month for the internal organs)
Middle viscera: according to the different etiology and pathogenesis, it is divided into closed and decompensated evidence.
1.Phlegm-heat and internal organs, wind-activated orifice closure
Main symptoms: sudden fainting, unconsciousness, restlessness, closed teeth, snoring in the throat, thick breath and phlegm, red face and body heat, hemiplegia of limbs, constipation. The tongue is yellowish and greasy, and the pulse is stringent.
Treatment: To resolve phlegm and clear the internal organs, extinguish wind and open the orifices.
Acupuncture prescription: Renzhong, 12 wells, Taichong, Fenglong
Zhi Gou Tian Shu
2.Liver wind spinning inside, wind and fire blocking the orifices
Symptoms: sudden fainting, unconsciousness, squinting or straightening of the eyes, redness of the face, redness of the eyes, tonicity of the limbs, silence of the mouth, strong neck, clenching of the hands, convulsions in case of constraint and anxiety, angular arch, red or vivid tongue, yellow and dry moss or scorched black, string pulse.
Treatment: Clearing heat and quenching wind, opening the orifice and awakening the mind.
The main points are the Governor’s Vessel, the Foot Conjunctive Yin meridian points and the twelve well points. Stimulate strongly or use trigeminal needles for bleeding.
Acupuncture prescription: Ren Zhong, Twelve Wells, Tai Chong, Feng Long
Chengyu, Laogong, Daling, Yongquan, Xingma
3.Phlegm-dampness clouding the heart, wind-phlegm internal obstruction
Symptoms: sudden fainting, or drowsiness at first, gradually drowsiness, confusion, restlessness, phlegm and saliva, white face and dark lips, skewed mouth, paralysis of limbs. The tongue coating is white and greasy, and the pulse is sunken and slippery.
Treatment: Cleansing phlegm and opening the orifices, pacifying the liver and quenching the wind.
Acupuncture prescription: Renzhong, 12 wells, Tai Chong, Fenglong
Foot San Li and Bai Hui
4.Defeat of vital energy and disorganization of mind and spirit
Main symptoms: confusion, snoring, pale face, eyes and mouth open, cold hands and limbs, sweating more than once, loss of bowel movements, limb weakness, sunken or weak pulse.
Treatment: Returning the Yang to fix the detachment.
Take the Ren pulse meridian as the mainstay. Moxibustion with large moxa cones, regardless of the number of strong, in order to sweat to collect the limbs warm, the pulse up as degree.
Acupuncture prescription: Guan Yuan, Shen Que
Qi Hai, Kidney Yu, Life Gate, Foot San Li.
Middle meridians.
1. Hyperactivity of liver and Yang, wind and fire disturbance
Symptoms: sudden distortion of the mouth, hemiplegia, restraint of the affected limb, strong tongue, dizziness and headache, redness of the face and rising fire, bitterness of the mouth and dryness of the throat, irritability of the heart, but the mind is still clear. The tongue is red, with yellow or white fur, and the pulse is stringy.
Treatment: Relieving wind and clearing fire by subduing Yang.
2.Phlegm-heat from the internal organs, wind and phlegm entering the lobe
Main symptoms: hemiplegia, numbness of the limbs, distortion of the corners of the mouth, strong tongue and speech, phlegm, constipation, foul-smelling breath. The tongue is purple and dark or with petechiae, the moss is yellow and greasy, and the pulse is string and slippery.
Treatment: To resolve phlegm and ventilate the internal organs, extinguish the wind and ventilate the collaterals.
Treatment:1. Body acupuncture plus blood pricking treatment.
Body acupuncture: upper limbs take Qu Ze, Shou Ze, Qu Chi, lower limbs take Wei Zhong, Wei Yang, Foot San Li as the main. Finger movement disorder plus Yangchi, Yangxi, Zhongzhu, foot entropion plus Shouhai, foot exoporation plus Shen Yi. Each time the points are selected, bloodletting plus fire cupping is added.
Head penetrating acupuncture point method.
Take the main point of the parieto-temporal anterior oblique line of the head on the opposite side of the affected limb (motor area), together with the functional exercise of the affected limb. Main acupuncture point: frontal frontal oblique line: i.e., take the frontal top point of the head on the opposite side of the affected limb to the hanging line, from top to bottom, upper 1/3, middle 1/3, and lower 1/3, with 3-4 needles. The matching points: high blood pressure plus the top middle line (top center line, from the Baihui point through the front parietal point; unclear speech plus the frontal middle line (frontal center hairline, from the Shenting point, 1 inch forward along the Governor’s vein); urinary incontinence plus the frontal side three lines (between the Ben Shen point and the head Wei point, downward needle 1 inch).
(II) Recovery period (2 weeks to 6 months after onset.)
After rescue treatment during the acute phase of stroke, the internal organs and spirit gradually clear, the meridians and channels of phlegm and heat gradually calm, the wind potential has been reduced, and gradually enter the recovery period, at this time, the original deficiency and standard real, and the original deficiency occupies an important position, attention should be paid to support the right, while taking acupuncture, physical therapy, and appropriate exercise, language training and other comprehensive treatment, is very important for functional recovery.
1.Phlegm and stasis blockage
Main symptoms: hemiplegia, oblique tongue and mouth, strong tongue and speech or no speech, numbness, salivation at the corners of the mouth, dizziness, dark tongue, thin white or white greasy coating, smooth pulse.
Treatment: Removing phlegm, quenching wind and clearing ligaments
2.Qi deficiency and blood stasis
Main symptoms: hemiplegia, weakness of limbs, unfavorable speech, crookedness of the corners of the mouth, pale face, or puffiness of the hands and feet. Pale purple tongue, thin white coating, thin and astringent pulse.
Treatment: Benefit Qi and invigorate Blood.
3.Yin deficiency and wind movement
Main symptoms: Partial numbness, hemiplegia, limb restraint and sometimes movement, raspy tongue, dizziness and tinnitus, soreness and weakness of the waist and knees, heat in the hands and feet, dry mouth and tongue, or dry stool. The tongue is red with little coating and the pulse is fine.
Treatment: Nourishing Yin and quenching wind.
. Acupuncture points.
(i). Supine position.
Main acupuncture points: head acupuncture (motor zone, sensory zone, speech zone, balance zone, dizziness and hearing zone, etc.) Select Yin Tang, Feng Chi and Sanyinjiao according to the different clinical signs.
Companion points: Jiquan, Shouze, Neiguan
Add or subtract according to the symptoms: pseudobulbar palsy: Jinjin, Yuyi, Lijiao or Tongli to keep the needles.
Upper limb dyskinesia: shoulder k, hand sanli, four sutures, eight evils, etc. Lower limb dyskinesia: spleen guan, jus s, blood sea, foot san li, shining sea, tai chong, eight winds, etc.
Unfavorable urination: Zhongji, Guangyuan.
Disorders of bowel movement: Tianshu, Qihai.
(ii). Taking the lateral position.
Main points: Baihui, Sishencong, Shangxing
Supporting points: Quchi, Huanjiao, Yanglingquan.
Add or subtract with symptoms: speech disorders or pseudobulbar palsy: Lianquan, Punlianquan, Wanbiao. Improving cerebral blood supply: Tianzhu, Fengfu. Upper limb movement disorders: shoulder ching, arm, san yang luo, yang xi, he gu, bai xi, etc. Lower limb movement disorders: Liangqiu, Fenglong, Hangzhong, Xiexi, Qiuxu. Urinary disorders: bladder yu; bowel disorders: large intestine yu or eight s. Epilepsy: dazhi, changqiang.
(C) Post-ictal period: (after 6 months of onset.)
After the stroke is treated, although the mind is awake, there are often sequelae such as hemiplegia and unfavorable speech. In addition to adding and subtracting drugs according to the principle of dialectical treatment, it is often necessary to combine the treatment with products that activate blood circulation, resolve phlegm and open ligaments.
1. Hemiplegia.
Causes and mechanisms: Due to deficiency of qi and blood, wind and phlegm flow through the meridians, blood vessels are closed and blocked, blood stagnation and qi stagnation, the meridians and tunnels are blocked, qi cannot move, blood cannot be honored, so the limbs are useless and cannot be used.
Main symptoms: hemiplegia, restricted movement, weakness of tendons and bones, inability to walk, tongue stiffness, inability to speak, dry mouth, inability to think about drinking, sunken and weak pulse.
Treatment: Benefit Qi, invigorate Blood, nourish the lower yuan, dispel wind, resolve phlegm and open the orifice.
Upper extremity: shoulder k, quchi, hegu, wai guan
Lower extremity: Huanjiao, Yanglingquan, Feosanli, Xiexi
Clinical additions and subtractions: Hand San Li, Shoulder Wai Yu, Arm Yang Chi, Chichibian, Feng Shi, Tai Chong, Kun Lun, Yin Men, Wei Zhong, Cheng Shan, Tai Xi can be used with reference.
2.Language disadvantage
Etiology: wind and phlegm blocking the meridians.
Treatment: Dispel wind and phlegm, promote orifices and clear the channels.
Lianquan, Shanglianquan, Jinjin, Yuyi, Lijiao or Tongli
3.Distorted mouth and eyes
Etiology and pathogenesis: distortion of the mouth and eyes is mostly caused by wind and phlegm blocking the ligaments.
Treatment: dispel wind, remove phlegm, and clear ligaments.
Acupuncture prescription: Di Cang, Bu Che Che, Hegu
Clinical additions and subtractions: Xia Guan, Cataract, Wai Guan, Sun, Yang Bai, Si Bai, Zygomatic s can be used with discretion.
Clinical observation confirms that after scientific treatment with the combination of acupuncture and Chinese medicine, patients with mild stroke can basically return to normal after 4-8 weeks, and patients with severe stroke can achieve self-care after 12 weeks of treatment. It is especially important to emphasize that the above methods should be combined with rehabilitation, psychology, diet and health education under the guidance of doctors in order to achieve the best treatment effect of reducing the disability rate, shortening the rehabilitation period and improving the quality of life.