Stroke is a common acute disease, most of the patients are middle-aged and elderly people, the disease is sudden fainting, unconsciousness, paralysis, or confusion, the corner of the mouth? The main symptoms are sudden fainting, unconsciousness, paralysis, confusion and slanting of the mouth. The disease is characterized by sudden fainting, unconsciousness, paralysis, confusion, and slanting of the corners of the mouth. In ancient literature, the disease was called “stroke” and “partial depression” according to its rapid onset and symptoms. According to the depth of the disease and the severity of the disease, it is divided into two types of symptoms, namely, the middle meridian and the middle viscera, as the basis for identification and treatment. This disease includes cerebral hemorrhage, cerebral thrombosis, cerebral infarction and other cerebrovascular accident diseases.
The efficacy of acupuncture in the treatment of stroke is obvious to all, but when should acupuncture be used after a stroke has occurred? How to do it? People are still not clear.
I. Time of acupuncture intervention in stroke disease.
1, stroke disease in cerebral hemorrhage, that is, hemorrhagic stroke, the most common is hypertensive cerebral artery rupture hemorrhage. Domestic statistics, hypertensive patients have about 1/3 chance of cerebral hemorrhage. Cerebral hemorrhage is the acute cerebrovascular disease with rapid onset, rapid progression and the most serious, and its death and disability rates are high. In addition, there are non-hypertensive causes such as cerebral artery amyloid angiopathy, cerebrovascular malformation, intracranial aneurysm, etc. Since the development of “brain stereotactic surgery” in cerebral surgery, a bold attempt has been made to treat patients with cerebral hemorrhage with early postoperative acupuncture intervention. After the brain stereotactic surgery, patients in the ICU monitoring period, after the western medicine treatment, the vital signs are basically stable, randomly selected post-operative awake patients 56 cases, 31 men, 25 women; the minimum age of 40 years old, the maximum age of 84 years old. After acupuncture treatment, it was found that the patients responded differently to early intervention at different times after surgery. All selected subjects were treated with acupuncture by taking body acupuncture at Neiguan, Sanyinjiao and the affected limb, giving flat tonic and flat diarrhea method, electroacupuncture by selecting sparse and dense wave, and retaining acupuncture for 30 minutes, and Tai Chong point was given heavy diarrhea to calm the liver and submerge Yang. Because of the strong stimulation of the Shuigou point, which can significantly promote cerebral blood circulation, it is not advisable to take it at this time. After treatment, it was found that in patients with stable postoperative blood pressure within 3 days (blood pressure of 140/90 to 160/110 mmHg), blood pressure fluctuated more significantly in the day after the needle, with 31 cases of elevated blood pressure, and some patients were more irritable than before the needle, especially in the range of 20 to 40 mmHg about half an hour after the needle, with no decrease in blood pressure seen. One study showed that in patients with stable vital signs for more than 3 to 7 days acupuncture was given with the same method of treatment, and blood pressure fluctuations were significantly reduced. For patients with cerebral hemorrhage, early intervention with acupuncture must be closely observed for changes in blood pressure, and in terms of stable improvement of the patient’s condition, early intervention with acupuncture is considered appropriate after at least 3 days of stable vital signs.
2, cerebral thrombosis and cerebral embolism in stroke, that is, ischemic stroke, cerebral thrombosis is the most common cause of cerebral atherosclerosis, clinically atherosclerotic thrombosis cerebral infarction is more common. Cerebral embolism is a foreign body from other parts of the body that enters the blood circulation, runs with the blood flow, and blocks the cerebral arteries, resulting in cerebral tissue ischemia and hypoxia in its blood supply area causing cerebral infarction. It is also divided into cardiogenic and non-cardiogenic cerebral embolism. The onset of cerebral embolism is rapid, and hemiparesis occurs without prodromal symptoms. Within the first week after the onset of cerebral thrombosis, the brain nerve cells in the center of the necrotic focus have already died, which is irreversible damage, but there is a ring-shaped “semi-dark zone” of varying sizes between the necrotic nerve cells and the surrounding completely normal brain tissue. In the “semi-dark zone”, there are a large number of brain nerve cells that are less damaged and not dead, which are swollen, metabolically disturbed, and temporarily lose their functions. If the clinical treatment is not timely and inappropriate, a large number of damaged brain nerve cells in the “semi-dark zone” may die, and the necrotic foci may expand, making the condition worse. In the first week of cerebral thrombosis, a large amount of harmful substances can be produced in the center of the necrotic foci, while there are different degrees of cerebral edema in the “semi-dark zone”. Cerebral embolism is the entry of emboli into the cerebral circulation and embolism in the cerebral arteries, causing cerebral infarction in the area supplied by the embolized blood vessel, and the pathological changes in the infarcted area are basically the same as cerebral thrombosis.
For patients with stroke caused by cerebral thrombosis and cerebral embolism, acupuncture treatment should be carried out promptly and early, and it is better to carry out acupuncture treatment within the first week of onset. Acupuncture early intervention can reduce the pathological damage of brain nerve cells in the “semi-dark zone”, which can reduce the degree of disability, and anti-brain edema treatment is generally started by Western medicine at 3 to 6 hours after the onset of stroke, and continuous treatment for 5 to 7 days. Acupuncture treatment should be carried out at the same time. After the diagnosis of cerebral infarction is confirmed by CT, acupuncture and integrated treatment with Chinese and Western medicine are performed, because most patients seek medical treatment more than 3 to 6 hours after the onset of the disease, and after the diagnosis is confirmed, acupuncture interventions are mostly performed 1 day after the onset of the disease, but the efficacy is significantly better than the efficacy of patients previously treated after the acute phase of infarction of 1 to 2 weeks after the onset of the disease.
II. Differential treatment of hemorrhagic stroke and ischemic stroke
Only acupuncture treatment is discussed here, mainly in the early stage after the onset of stroke, i.e. the acute phase stage. There is generally no major difference between the recovery period and the post-stroke period. With the rapid development of medicine nowadays, the treatment of stroke disease is now a combination of Chinese and Western medicine. Hemorrhagic stroke can be treated by “opening and closing the orifices” and “pacifying the liver and calming the wind”, with Neijingguan, Shuigou, Sanyinjiao and Taichong as the main points. Neiguan is one of the eight meeting points of the eight veins and is connected to Yinwei, which is a ligament point of the sympathetic Yin pericardium meridian and has the function of nourishing the heart and tranquilizing the mind and unblocking qi and blood. Sanyinjiao is a meeting point of the Foot Taiyin Spleen, Foot Convulsive Yin Liver, and Foot Shao Yin Kidney meridians, and has the function of nourishing the kidneys, nourishing Yin, and generating marrow. The kidney is the master of essence, which generates marrow, and the brain is the sea of marrow, which promotes the recovery of the physiological functions of the brain. Shuigou is the meeting point of the Governor’s Vessel and Yangming of the hand and foot. The Governor’s Vessel starts in the middle of the cell and moves upward into the brain to reach the upside down, so diarrhea of Shuigou can adjust the Governor’s Vessel, open and close the orifices to strengthen the brain and calm the mind. In the author’s opinion: for patients with cerebral hemorrhage, this method is still used in patients whose condition has been stable for more than a week, to prevent the blood pressure from rising, along with the corresponding body acupuncture. For patients with cerebral hemorrhage, head and tongue needles are not used for strong stimulation in the acute stage, and are also used with caution in the recovery period. For patients with ischemic stroke, as long as the blood pressure is stable below 140/90 mmHg, use Baihui, the motor area and sensory area of head acupuncture; add the language area if there is language disorder, and match the corresponding body acupuncture, such as Fengchi, Quchi, Hegu, Neiguan, Feet Three Miles, Sanyinjiao, Taichong, etc. Tongue acupuncture can also be used for treatment.
Modern medicine believes that the recovery of limb motor function in most stroke patients is a natural process. A large number of clinical and experimental evidence shows that acupuncture has a protective effect on neurons after cerebral ischemia, which can reduce cerebral edema and infarct volume. Acupuncture can inhibit ischemic neuronal apoptosis and improve the synthesis or release of endogenous neurotrophic factors in the post-ischemic brain. The method of early acupuncture intervention treatment can significantly improve the daily living ability of stroke patients and significantly improve their motor function and cognitive function. Early and timely acupuncture treatment for stroke patients can stop the continued development of the disease, improve the self-repair and compensatory capacity of the nervous system, accelerate the natural recovery process, shorten the course of the disease, lay a good foundation for functional recovery, reduce the disability rate, improve the quality of life of patients, and enable patients to return to their families and society. Therefore, as long as the patient has stable vital signs, clear knowledge and stable condition, acupuncture treatment can be performed at an early stage. Patients with cerebral infarction can be treated with acupuncture 48 hours after the onset of stroke; patients with cerebral hemorrhage can be treated with acupuncture 1 week after the onset of stroke.
Prevention of stroke
The prevention of stroke should be carried out at two levels, namely general prevention and key prevention.
1, the general prevention of stroke is mainly for the general population, especially the susceptible people with risk factors for stroke, to carry out publicity and education and active treatment to change lifestyle and control risk factors.
Change of poor lifestyle behaviors In life, certain lifestyle behavioral factors are closely related to the risk of stroke development. For example, smoking, excessive alcohol consumption, high-fat diet, sedentary work and lifestyle, and long-term mental stress. For these factors, adjustments and changes should be made on an individual basis. For example, smokers should quit smoking or limit the amount of smoking, drink alcohol in moderation and avoid overdrinking; reduce the intake of animal fat in the composition of the diet and eat more fruits, vegetables, fish, soybean products and dairy products; do physical activity or physical exercise in moderation; avoid long-term mental tension, maintain an optimistic state of mind and avoid overexertion. All these measures can help reduce the risk of stroke.
Actively treat and control risk factors for stroke Stroke is caused by the long-term effects of hypertension, diabetes, heart disease, hyperlipidemia and obesity, which lead to damage of cerebrovascular function. When the cerebrovascular function is damaged to a certain extent, the stroke develops prompted by triggering factors. Therefore, once you discover that you have risk factors associated with stroke, you should take active measures to treat and control them. For example, patients with hypertension should adjust their blood pressure levels to below 140/90 mmHg as recommended by their physicians. Patients with heart disease, diabetes, hyperlipidemia, carotid artery stenosis and obesity should also be seen in a hospital, treated and controlled according to the advice of a specialist, and a stroke prevention program should be developed accordingly.
The above measures are the basis of stroke prevention and can slow down the process of impaired cerebrovascular function, which can reduce the risk of stroke development to varying degrees.
2, the focus of stroke prevention is on the basis of general prevention, through scientific detection means, to screen out high-risk individuals from the stroke prone population, and carry out focused intervention.
Checking cerebrovascular function to assess the risk of stroke: Cerebrovascular hemodynamic testing is a non-invasive method for testing cerebrovascular function. The cerebrovascular function score can quantitatively evaluate the functional status of cerebrovascular vessels and the risk of stroke onset. The score is 100 for normal individuals, and a score of 75 or less indicates varying degrees of abnormal cerebrovascular function; the lower the score, the greater the likelihood of stroke. In people over 55 years old, when the score value decreases below 75, 13% of people have a stroke within 5 years, and the risk of stroke is 7 times higher than that of normal peers; when the score decreases below 25, an average of 1 in 5 people have a stroke, and the risk of stroke onset is more than 14 times higher than that of normal peers. The risk of stroke is higher when the cerebrovascular function score is reduced in combination with hypertension.
Drug prevention: When cerebrovascular function is impaired, that is, when the score is below 75, in addition to treating stroke-related diseases as recommended by a specialist, drug prevention should be carried out. The following drugs are definitely effective at present
Aspirin: Foreign studies have concluded that a daily dose of 100 to 300 mg of aspirin can reduce the risk of stroke.
Aspirin-resistant patients can add clopidogrel 75mg/d, which can reduce the incidence of ischemic stroke The combination of the two has significant advantages for secondary prevention in patients.
Statins: A large number of clinical studies have found that statins, such as pravastatin, simvastatin and other lipid-lowering drugs, also have a certain role in preventing the onset of stroke.
Other: the effect of other drugs to prevent stroke is not very clear, can be used according to the advice of physicians.
3. Review cerebrovascular function on time: When you are undergoing treatment for stroke related diseases and prevention with key drugs as described above, you should review cerebrovascular function once or twice a year. If the indicators of cerebrovascular blood flow, blood flow rate and cerebrovascular function score increase, it indicates that the prevention and treatment effect is good, otherwise, the prevention and treatment plan should be adjusted in time.
Blood donation: Some studies have proved that blood donation has a direct effect on the blood rheology of the donor, and the blood viscosity is reduced. Adherence to regular and appropriate blood donation can reduce the incidence of cerebrovascular disease. Tip: Regular and appropriate blood donation by healthy citizens of appropriate age has a positive contribution to the prevention of cerebrovascular disease
For patients who have already had a stroke, it is important to prevent the recurrence of stroke while actively carrying out rehabilitation treatment. The measures to prevent recurrence are basically the same as those described above for preventing the first recurrence.