Most cerebral infarcts belong to the category of stroke diseases in Chinese medicine. It is also commonly seen in vertigo, wind vertigo, wind rash, wind forbidden and other pathologies.
I. Classification and clinical typing of cerebral infarction
(A) Classification of cerebral infarction
Common cerebral infarction includes: atherosclerotic thrombotic cerebral infarction, embolic cerebral infarction, lacunar cerebral infarction and multiple cerebral infarction as well as hemorrhagic infarction.
(II) Clinical typing of cerebral infarction
The 2005 edition of the Chinese Guidelines for the Prevention and Treatment of Cerebrovascular Disease suggests that due to differences in the site and size of cerebral infarction, the compensatory capacity of collateral circulation, and secondary cerebral edema, there can be different clinicopathological types, and their treatment is very different, which requires rapid and accurate staging in the acute phase, especially in the ultra-early phase (within 3-6 h). The Oxfordshire Community Stroke Study Staging (OCSP) does not rely on imaging findings, and can be rapidly staged according to clinical manifestations before conventional CT and MRI can detect the lesion and indicate the size and location of the occluded vessel and infarct, which is clinically simple and easy to use, and is of great value in guiding treatment and assessing prognosis.
1, complete anterior circulation infarction (TACI): manifested as a triad, i.e., the manifestation of complete middle cerebral artery (MCA) syndrome: impairment of higher neural activity in the brain (impaired consciousness, aphasia, aphasia, spatial disorientation, etc.); isotropic hemianopia; and more severe motor and/or sensory impairment in three contralateral sites (face, upper limbs and lower limbs). Most of them are proximal trunks of MCA, and a few are large brain infarcts caused by occlusion of siphon segment of internal carotid artery.
2. Partial anterior circulation infarction (PACI): two of the above triad signs are present, or only higher neural activity impairment, or sensory-motor deficits are more limited than TACI. It is suggested that MCA distal trunk, branches at all levels or ACA
and branch occlusion caused by medium and small infarcts.
3. Posterior circulation infarction (POCI): manifests as various degrees of vertebral-basilar artery syndrome: it can manifest as ipsilateral cerebral nerve palsy and contralateral sensorimotor deficits; bilateral sensorimotor deficits; binocular synergistic activity and cerebellar dysfunction without long bundle sign or visual field deficits, etc. Brainstem and cerebellar infarcts of varying sizes caused by occlusion of vertebral-basilar arteries and branches.
4. Lacunar infarction (LACI): manifests as lacunar syndrome, such as pure motor light hemiparesis, pure sensory stroke, ataxic light hemiparesis, and clumsy hand – dysarthria syndrome. Most of them are small cavernous foci caused by lesions in the basal ganglia or small penetrating branches of the pons.
Chinese medicine diagnosis and treatment
(I) General treatment
Keep the respiratory tract unobstructed. If the respiratory tract is obstructed and there is difficulty in breathing, tracheotomy should be performed to avoid asphyxia; Keep the bowels open.
(II) Identification and treatment
Clinical staging is the outline and evidence is the goal. The basic idea is to treat the disease in a comprehensive manner by staging and differentiation. Staging is mainly based on the time of onset and the severity of the disease. The division of evidence is based on the outline of deficiency and actuality, with evil Qi prevailing as actuality and deficiency of essence as deficiency; evil actuality is mainly blamed on the liver and stomach, and positive deficiency is mainly in the spleen and kidney. In the acute stage of cerebral infarction, the symptoms of the symptoms are prominent, so the treatment should be mainly to dispel the evil, and treatment methods such as pacifying the liver and quenching the wind, resolving phlegm and clearing the internal organs, activating blood circulation, and awakening the mind and opening the orifices are commonly used. Closed, off two evidence when treated separately to dispel the evil and open the orifice to wake up the spirit, fixed off, save Yin and fix Yang. As the so-called “internal closure and external detachment”, awakening and opening the mind can be used in conjunction with supporting the root. In the recovery period and the sequelae period, most of them are mixed with deficiency and reality, the evil reality has not been cleared but the positive deficiency has appeared, so the treatment should help the positive and dispel the evil, commonly used to nurture yin and extinguish wind, benefit qi and activate blood.
(C) Classification of evidence and treatment
1.Phlegm-heat internal closure of the heart and orifices
Cerebral infarction with dizziness and confusion, snoring and phlegm, strong collar and body heat, restlessness and disturbance, or frequent convulsions. The tongue is red and vivid, the tongue coating is brownish yellow and dry, and the pulse is smooth and slippery. Treatment: Clearing heat and resolving phlegm, awakening the mind and opening the orifice. Commonly used formula: Calamus Yujin Tang with addition and subtraction, together with Angong Niuhuang Wan and Zixue Dan. (Nasal feeding) Basic prescription: antelope horn powder (punch) 2g, hooked vine 15g, scutellaria 15g, geranium 12g, dandan bark 10g, calamus 12g, yujin 15g, yuanzhi 6g, ginger and bamboo rhizome 12g, artificial cowry powder (punch) 2g. 400ml of water decoction, nasal feeding, 2-3 times a day. For strong spasms and convulsions of the limbs, add 9g of whole scorpion and 12g of dilong; for fever, add 30g of honeysuckle; for constipation, add 9g of rhubarb. can be combined with brain-awakening Jing injection for intravenous drip.
2. Wind and fire disturbing the clear orifices
Dizziness, confusion, hemiplegia. Usually there is vertigo, numbness, sudden change of emotion, strong spasms of limbs, constipation, dry stool, red and vivid tongue, yellow and dry tongue coating, smooth and large pulse. Treatment: Clearing the liver and diarrhea of fire, quenching the wind and suppressing spasm, opening the orifice and awakening the mind. Commonly used formulas: Antelope horn and hooked vine soup and Liver quenching and wind quenching soup. Basic prescription: Antelope horn powder (punch) 2g, hooked vine 15g, gardenia 15g, dilong 12g, dandruff 12g, rhubarb 6g, yujin 15g, calamus 12g, huai niu knee 18g, pearl powder (punch) 3g. 400ml of water decoction, orally or intranasally, 2-3 times daily. For phlegm, add 12g of Tianzhu Huang and 30ml of fresh bamboo; for vomiting, add 6g of Huang Lian and 15g of bamboo; for fever, add 30g of Jin Yinhua and 15g of Scutellaria baicalensis, which can be combined with intravenous drip of Awakening Brain Jing injection, etc.
3.Phlegm and dampness blocking the heart and orifices
Cerebral infarction with mental faintness and hemiplegia. The limbs are lax and limp and not warm, or even the limbs are cold, the face is white with dark lips, and the phlegm and saliva are congested. The tongue is dull, the tongue coating is white and greasy, and the pulse is sunken and smooth or sluggish. Treatment: Warming Yang and benefiting Qi, cleansing phlegm and opening the orifice to awaken the mind, and adjuvantly invigorating Blood and opening the veins. Commonly used formula: Purging Phlegm Soup, Ginseng and Radix Soup. Basic prescription: Hanxia 9g, Tiannanxing 12g, Taoren 9g, Calamus 12g, Atractylodes 30g, Ginseng 12g, Poria 18g. 400ml of water decoction, nasal feeding, 2-3 times daily. The limbs are lax and limp plus Baji Tian 18g, Duzhong 18g, Epimedium 15g; the limbs are cold plus Hosin 6g, Shu Shu Pei Zi 12g. can nasal feeding Suhe Xiang Wan.
4.Defeat of vital energy, disorder of the mind
Sudden mental faintness, confusion, limb weakness. Cold hands and limbs, excessive sweating, heavy dampness and coldness all around the body, and self-induced loss of bowels. Thin tongue, purple and dark tongue, white and greasy moss, sunken and weak pulse. Treatment: Benefit Qi and consolidate detachment, return Yang to save rebellion. Commonly used prescriptions: Ginseng and Radix Soup, Shengwen San, Doujian Tang. Commonly used drugs: Ginseng 12g, Radix et Rhizoma 9g, Medlar 30g, Wu Wei Zi 12g, Cornus officinalis 30g, Dragon Bone 30g, Oyster 30g. 400ml of water decoction, nasal feeding, 2-3 times daily. Benefiting Qi and fixing detoxification: Jilin ginseng, Wu Wei Zi, Mai Dong, raw dragon’s tooth. Returning Yang and rescuing rebellion: Radix et Rhizoma rehmanniae. This type is mostly critical, mostly by intravenous pushing or intravenous drip, commonly used to rescue with ginseng injection, ginseng and wheat injection, raw pulse injection, ginseng injection, etc.
5.Liver yang hyperactivity, wind and fire disturbing the evidence After cerebral infarction, the symptoms include dizziness and headache, heat in the face and ears, bitterness in the mouth and dryness in the throat, irritability, red urine and dryness in the stool. The tongue is red or red-red, with thin yellow tongue coating,
The pulse is stringent and strong. Treatment: Clearing away heat and fire, calming the liver and quenching the wind, and adjuvantly activating blood circulation. Commonly used formula: Antelope horn and hooked vine soup or liver quenching and wind quenching soup, etc. Basic prescription: Antelope horn powder (punch) 2g, hooked vine 15g, gardenia 12g, chrysanthemum 20g, white peony 30g, dandan bark 10g, dilong 12g, huai niu knee 18g, fresh bamboo leek 90ml (divided into 3 times). Decocted in water, take 400ml in 2 times warm or nasal feeding. For headache and vomiting, use 30g of Shijiazhuang, add 6g of Gentiana, 15g of Mian Yin Chen and 15g of Jiang Zhu Ru; add 12g of Tianzhu Huang for cough and phlegm; add 30g of Artemisia annua and 15g of Scutellaria baicalensis for fever.
6.Wind, phlegm and blood stasis, paralysis and arterioles
Dizziness and dizziness are seen after cerebral infarction. The tongue is dark and pale, with thin white or white greasy tongue coating and slippery pulse. Treatment: Extinguishing wind and eliminating phlegm, activating blood circulation. Commonly used formula: Hexia, Atractylodes and Tianma Tang with Peach and Red Four Objects Soup, etc. Basic prescription: Tianma 15g, Rhizoma Atractylodis Macrocephalae 30g, Semen 9g, Tiannanxing 6g, Salvia 20g, Angelica 12g, Peach kernel 12g, Safflower 9g, Cinnamomum 9g, Chuanxiong 9g. 400ml of decoction in water, divided into 2 doses or nasal feeding. The patient’s limbs are in a state of restraint, plus 9g of scorpion or 3 centipedes, 30g of white peony, 12g of calamus, 12g of yujin, 30g of Radix et Rhizoma ginseng, 30g of astragalus, and 30g of astragalus for qi deficiency.
7.Phlegm-heat and internal organs, wind-phlegm upheaval
After cerebral infarction, the symptoms include abdominal distension and constipation, dizziness and dizziness, phlegm or excessive phlegm. The tongue is dark red or dark, the coating is yellow or yellowish greasy, and the pulse is slippery. Treatment: To remove heat from the internal organs, cleanse phlegm and awaken the mind, and extinguish the wind and open the ligaments. Commonly used formula: Rhubarb-rhubarb Tang with addition and subtraction. Basic prescription: 9g of rhubarb, 6g of mannitol, 30g of rarotto, 2g of antelope horn powder (punch), 15g of hooked vine, 12g of dirong, 12g of tianzhuhuang, 60ml of fresh bamboo lei (tui), 18g of bamboo rhizome, 6g of bile south star. 400ml of water decoction, divided into 2 warm doses, until the stool is clear and the tongue becomes thin; at the same time, pay attention to prevent injury to yin. If the stool is dry and tongue is dry, add Radix et Rhizoma Ginseng; if the abdominal distension is very high, add Citrus aurantium and Houpu; Panax ginseng or Ginkgo biloba can be used.
8.Qi deficiency and blood stasis
The symptoms after cerebral infarction are white or yellowish, short of breath and weakness, salivation in the mouth, sweating, palpitations and loose stools, swelling of hands and feet. The tongue is dull, the tongue coating is thin and white or white and greasy, and the pulse is sunken, thin and slow or thin. Treatment: Tonifying Qi and Blood, invigorating Blood and promoting circulation. Commonly used formula: tonifying Yang and Returning the Five Elements with addition and subtraction. Basic prescription: Astragalus membranaceus 45-90g, Radix Angelicae Sinensis 12g, Rhizoma Ligustici Chuanxiong 9g, Salviae Miltiorrhizae 20g, Radix Dioscoreae 12g, Rhizoma Safflower 12g, Radix et Rhizoma Huaiyao Knee 18g, Radix et Rhizoma Puerariae 15g. 400ml of decoction in water, divided into 2 warm doses. If the affected limbs are flaccid and weak, add 12g of Gui Zhi, 6-9g of Gunner’s Fructus, 18g of Dulcimer; if the speech is bold or aphasic, add 12g of Shi Calamus and 9g of Yuan Zhi; if the breath is short and the nasal discharge is poor, add 9g of Ginseng.
9.Yin deficiency and wind movement
Symptoms after cerebral infarction include irritability and insomnia, vertigo and tinnitus, heat in the hands and feet. The tongue is red-red or dark red, with little or no moss, and the pulse is fine string or fine string count. Treatment: Nurture Yin and submerge Yang, nourish the liver and quench the wind, invigorate the blood and promote blood circulation. Commonly used formula: Nourishing and nourishing liquid cream. Basic prescription: 30g of Mai Men Dong, 20g of Radix et Rhizoma Polygonati, 15g of Araliaceae, 30g of Black Sesame, 15g of Chrysanthemum, 20g of Fructus Lycii, 15g of Radix Angelicae Sinensis, 15g of Dendrobium, 20g of Radix Paeoniae Alba, 24g of Radix Rehmanniae, 30g of Radix Salviae Miltiorrhizae, 10g of Colla Corii Asini, 30g of Radix Rehmanniae, 15g of Salviae Miltiorrhizae. 400ml of decoction in water, divided into 2 doses or nasally. For irritability and insomnia, add 20g of sour date palm; for tinnitus, add 15g of Cornus officinalis; for burning of hands and feet, add 15g of Dangpi and 30g of Medlar; pulse nimbus injection is also available.
(iv) Other treatments Acupuncture, tui na and rehabilitation can be chosen.