Cerebrovascular disease (including cerebral hemorrhage and cerebral infarction) belongs to the category of “stroke” in Chinese medicine, and is a common and frequent clinical disease with high mortality and disability rates, which brings a heavy burden to families and society. Modern medicine has studied the etiology and pathology of stroke, and has shown great advantages in the treatment of acute cerebrovascular disease, such as craniotomy, stereotactic cone craniotomy, extraventricular drainage, and stroke unit establishment, which have absolute advantages in improving the survival rate of patients.
In Chinese medicine, stroke is divided into ischemic stroke and hemorrhagic stroke, which are treated very differently by modern medicine. If we talk about the treatment of Chinese medicine, the first thing we should do is to identify the symptoms, whether they belong to the internal organs or the meridians, and then treat them. In the past, it was thought that acupuncture was not appropriate in the acute stage of hemorrhagic stroke, but with the development of medicine, this view has changed, and in the 1980s, there were scientific reports on the exact and safe efficacy of acupuncture in the acute stage of cerebral hemorrhage, including Mute Gate and Fengfu. Acupuncture and Chinese herbal medicine treatment of stroke should also strive for a time window, that is, early acupuncture treatment to facilitate the recovery of limbs and language. Through research and analysis of various medical texts, combined with decades of clinical experience, we have discussed and organized the rules of staging and identification of stroke disease and the rules of acupuncture and medicine treatment.
(A) Dysfunction of internal organs as the root cause of the disease, wind, fire, phlegm and stasis as the symptoms
Since the beginning of the Nei Jing, stroke disease has been discussed from different perspectives by various medical practitioners in different generations. Before the Tang and Song dynasties, the “external wind” theory was the main theory, mostly from the “internal deficiency of evil” theory, that stroke is due to the deficiency of true qi, veins and veins are empty, wind evil invasion. After the Tang and Song dynasties, the theory was based on “internal wind” and gradually formed “wind”, “fire”, “phlegm” and “stasis”. “qi”, “stasis” and “deficiency” as the etiology and pathogenesis of stroke, of which “wind” includes external wind and other climate change The “fire” includes liver fire, heart fire, and qi-depression fire; the “qi” includes qi-depression, qi-rage, and other factors of the seven emotions; the “phlegm” includes phlegm-dampness and “Phlegm” includes phlegm-dampness and phlegm in fat people; “Stasis” includes blood stasis and blood stagnation in the brain from the menstruum; “Deficiency” includes qi deficiency and liver-kidney yin deficiency. It is a qualitative leap in the understanding of the etiology of stroke, which has improved the theory of stroke pathogenesis.
We believe that most strokes are due to old age and physical decline, or fatigue and internal injury, or long term illness and deficiency of qi and blood, or addiction to thick sorghum and alcohol and tobacco, so that the internal organs are dysfunctional. If the liver and kidney Yin deficiency body, Yin does not control Yang, Yang hyperactivity in the upper, Yin deficiency in the lower, when triggered by touching, such as climate change, five will too extreme, so that the liver Yang flare up, internal wind moving over, or wind and fire with phlegm internal fleeing meridians; or Qi and blood rebellion, on the offense of brain veins, clear orifice occlusion hair for stroke. If the body is deficient in qi and blood, or qi is weak in transporting blood, blood stagnation, paralysis of the cerebral vasculature; or qi and blood deficiency, the cerebral vasculature is not nourished, blood flow is not smooth for stroke.
In conclusion, the disease is a deficiency of the internal organs, liver and kidney Yin deficiency, Qi and blood deficiency as the cause of the disease, wind, fire, phlegm and stasis as the symptoms of the disease, the two can be mutual cause and effect, mutual transformation. The transformation of the pathogenic mechanism is determined by the strength and weakness of wind, fire, phlegm, stasis and other pathogens and the body’s positive qi. In the acute stage, the evil qi is scops and the cerebral veins are paralyzed, if the positive qi does not fail, the treatment opportunity to make the heat clear, wind extinguished, phlegm, stasis removed, the condition improves and tends to heal; if the positive qi fails first, the evil qi is too strong, the orifice is closed, the internal organs are disordered, the qi and blood are depleted, the vital energy is lost, the condition is critical. In the recovery period, although the evil is greatly reduced, but the positive qi has been injured, especially the old and weak, the medulla is empty, qi and blood loss has not been restored, wind, fire, phlegm, stasis still stagnate in the meridians, and every see paraplegia, mouth and tongue boiling thin (13) miscellaneous lutetium can dementia and other evidence.
In addition, the initial stage of stroke, the heat is not obvious, but the internal wind incites, phlegm, stasis of blood, Yang Qi is depressed, there is a tendency to turn into heat, if the internal heat is strong, not only burns the vital energy, but also can scintillate liquid into phlegm, and even wind forced blood, and aggravate the momentum of Qi and blood upward, which is a problem worth noting in the transformation of stroke pathogenesis.
To sum up, although the cause of stroke is complex, it is summarized in the following six factors: deficiency (Yin and blood deficiency, Qi deficiency), fire (liver fire, heart fire), wind (liver wind), phlegm (phlegm turbidity), gas (Qi rebellion, gas stagnation), stasis (blood stasis).
(2) Adhere to the pathological mechanism of identification and treatment, and administer acupuncture and prescriptions in stages
The treatment principle of stroke disease should be guided by the holistic concept and diagnosis and treatment, combined with the stage of the disease, the onset of the season and other factors, according to the time and the person, that is, emphasizing the holistic and individualized treatment. The so-called holistic treatment requires that when we understand stroke disease, we should focus on the whole body, regulate the whole body, and pay attention to the interplay of comorbidities, rather than singularly targeting brain lesions, and at the same time, people and nature are also a unified whole, so we also need to adapt to the times. In addition, because each person has different physical factors and the onset of the disease is also different, so the treatment should be differentiated and individualized. If there is internal movement of liver wind and stagnation in the meridians, we should treat the symptoms urgently by firstly pacifying the liver and quenching the wind, and then unblocking the meridians, and finally by tonifying the liver and kidneys. If there is deficiency of both qi and yin, as well as qi stagnation and blood stasis, and phlegm-heat in the internal organs, the treatment should be urgent with the method of clearing the internal organs and resolving phlegm, so that the internal Qi can be smooth and the turbid evil can be lowered, and then treated with the method of tonifying and resolving stasis.
The course of the disease can be divided into three stages: acute stage refers to within 2 weeks after the onset of stroke, and the internal organs can be up to 1 month; recovery stage refers to within 2 weeks or 1 month to 6 months after the onset of stroke; and the sequelae stage refers to more than 6 months after the onset of stroke. Distinguish different disease stages, can grasp the different pathological characteristics of each stage, to give targeted evidence-based treatment, is conducive to the improvement of curative effect.
In short, stroke a disease, the condition of a thousand changes, involving a number of internal organs, mixed with the real, cold and heat, Yin and Yang changeable. Therefore, the treatment of acupuncture should be appropriate to the priorities, random, careful to observe the disease mechanism, examination of the cause and treatment, according to the evidence of legislation, according to the law, the formula and points, to achieve the theory, law, formula, medicine points, complete unity, reflecting the essence of evidence-based treatment.
1.The law of acupuncture treatment
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(1)Wind in the internal organs, the treatment should be divided into clear closed off.
(2) Wind in the meridians, also should regulate the internal organs as the first.
(3) Although the stroke is prolonged, the treatment should not forget to dispel the evil.
(4) Stroke and disease, the treatment is divided into the main and secondary sequence.
2.Chinese medicine treatment rules
1.Acute stage
(1) Middle meridians
A. Wind, phlegm and stasis type. To phlegm and phlegm stasis paralysis of the meridians as the key to its pathogenesis, to hemiplegia, mouth fee algae feed (13) T weng knife yao (5) tug-of-war file Ρ “谆虬啄塑性塑性孝孝孝一嬷ひ恪A taxis Bao Ben Dioshao goblet (18) (19) hurried members of the beautiful purse bottom cha mackerel Roach slug said dropping sole slug made europium Xin sole (18) = smash made the border grizzly Xinzhi mix Hhuanghuang government ash Seri Liao Gui Yao Yue bun confusion
B. Wind-phlegm-fire hyperactivity type. The key to the disease is that the liver fire is vigorous, the Yang is hyperactive, and the wind moves across the meridians. The main points of identification are sudden onset, irritability, sticky phlegm, red tongue with yellow coating, and slippery pulse. There are often more changes within a week after the onset of the disease, so the treatment is to calm the liver and quench the wind. During this period, attention should be paid to the reasonable application of Jin Shi Jie class and other heavy sedative products to subdue the rebellious, if the heavy evidence of hyperactivity of Yang and wind, non-Jin Shi Jie Bei’s heavy sedative can not submerge its Yang and extinguish its wind. This type of patient is easy to fluctuate emotionally, we should pay attention to avoid aggravating the disease with excessive emotion. According to Wang Yongyan academician’s experience, the most prominent change in this type of patient before recurrence is the change in tongue image, with red and vivid tongue, and gradually peeling off of tongue moss, or even no moss, which means that yin deficiency is aggravated and stomach qi is deficient, and there is a great risk of recurrence at this time, so a large dose of nourishing yin and subduing yang should be used to stop the source of internal wind agitation. C. Phlegm-heat and internal organs.
C. Phlegm-heat and internal organs solid type. The disease is more serious, with phlegm-heat obstruction and internal Qi obstruction as the key to the disease mechanism. Dizziness and headache, abdominal distension and constipation, phlegm and bad breath, red tongue with yellow coating and dryness, and slippery pulse are the main points of identification. Although the treatment is necessary to clear heat and phlegm, it is often difficult to get quick results, only the pass down method can quickly clean the stagnation in the internal organs, the internal Qi is smooth, then the evil heat down the drain, phlegm and fire go with it, the Qi and blood to spread, the symptoms improve, so the correct mastery and use of the pass down method is the key to the treatment of this evidence. One should master the timing of the pass down, under the not averse to early; two to master the pass down should not be excessive, to the degree that the stool is smooth, the elimination of phlegm and heat; three to know this evidence this method is easy to hurt the fluid and consume gas, so when less adjuvant sweet flat, nourishing yin, beneficial products.
D. Yin deficiency and wind movement type. The cause of wind movement is liver and kidney yin deficiency, with hemiplegia, dizziness, tinnitus and forgetfulness, irritability of the five hearts, red tongue with less moss and thin pulse as the main points of identification. Therefore, in addition to the use of Jin Shi Jie class submerged Zhen medicine, should be used to nourish the liver and kidney essence and blood products, so that the kidney essence is full, the liver can be nourished, then the liver Yang will not be hyper and harm, the source of internal wind can be clarified, always bear in mind that the liver is a rigid organ, not soft not to grasp, the liver likes to strip, not smooth not to regulate the characteristics, flexible use of drugs.
(2) Central viscera
A. Closed evidence
a. Wind and fire disturbing the clear orifices. This is a light evidence of Yang closure. The basic pathogenic mechanism is that the wind and fire disturb the mind, and there is often a tendency to reverse the transmission of the pericardium and close the orifices internally. Therefore, the key to treatment is to remove the evil to prevent the orifices from being closed. After the condition is stabilized and the mind becomes clear, then focus on regulating qi and blood to promote the improvement of hemiplegia and other symptoms.
b. Phlegm-heat internal closure of clear orifices. This is a heavy evidence of Yang closure, which can be initial, or can be caused by phlegm-heat, internal organs and wind and fire. The dizziness, hemiplegia starts suddenly and rapidly, mostly in a moment, often due to anger, the disease to evil heat, phlegm, blood stasis and other real evil, so the main purpose is to dispel evil, can be given Qing Kai Ling injection and other static drip. If actively treated, those who are gradually awake can get out of danger, but the disability rate is high and often leaves after-effects. If the treatment is wrong, it can often turn into a dehiscence or other evidence, and the prognosis is not good.
c. Phlegm-dampness congestion on the clear orifices. This evidence is closed Yin, the evil for phlegm and dampness, non-pungent, non-warm, so the treatment of more than the use of pungent and warm products, such as good at removing phlegm and turbidity, pungent and warm aromatic calamus, specializing in dispelling wind and phlegm, pass through the meridians, open the occlusion of bile South Star, etc.. But pungent and warm, dry and strong, easy to hurt the yin and move the wind, so do not overuse, the disease is stopped.
B. Discharge
If the treatment is timely, there is still hope that the danger can be turned into success and the evidence of decompensation can be turned into safety. If there is sweating and urination in the closed evidence, it is a sign of deterioration; if there is strong spasm of the limbs and slippery pulse after emergency treatment, it is a sign of the gradual recovery of positive energy and the fight between positive and evil. For the treatment of decompensation, doctors have used ginseng, fenugree, gui and so on to return Yang and save the reverse. But the disease of stroke, mostly due to yin deficiency and yang hyperactivity, or to the deficiency of both qi and yin for the root, if the use of pungent warmth, large heat of gui and annex, more likely to consume yin and injure fluid, resulting in moving wind, blood, fire, or even fire to help wind power evolution of the disease. When the Western ginseng, ginseng, Chinese wolfberry, yellow essence and other drugs to supplement the consolidation of vital energy, the maintenance of true yin, yin in the search for yang, so that yin back to yang back.