This disease belongs to the category of “Stroke” in Chinese medicine according to the characteristics of the symptoms, but from the analysis of the location and nature of the disease, it is more directly related to “retention of blood”, “blood vein clotting”, “liver yang However, from the analysis of the location and nature of the disease, it is more directly related to “retention of blood”, “blood vessel clotting”, “liver yang” and “liver wind”. Although the pathogenesis of stroke is complex, it can be summarized into six causes: external deficiency (yin deficiency, qi deficiency), fire (liver fire, heart fire), wind (wind phlegm, damp phlegm), qi (qi reversal), and blood (blood stasis), among which liver and kidney yin deficiency is the root. Under certain conditions, these six ends affect each other and interact with each other to cause sudden onset. Those who are attacked by external evil are called external wind, also known as true stroke or true stroke; those who develop without external evil are called internal wind, also known as class stroke or class stroke. From the clinical point of view, the disease is mostly caused by internal causes. In the case of ischemic stroke complicated by obesity, it is often accompanied by phlegm and phlegm stagnation, phlegm and phlegm stasis or wind and Yang phlegm and fire blocking the clear orifices and veins, and the stroke occurs. In the acute period, the main manifestation is wind-phlegm stasis, phlegm-heat stasis or phlegm-stasis, internal knotting of phlegm and internal organs, inflammation of liver and fire, and movement of Yang and wind, etc. In the recovery period and sequelae period, due to the lingering disease, “long-standing disease will lead to deficiency” and “long-standing disease will lead to deficiency”. “The deficiency evidence rises to be the main contradiction, which makes the liver and kidney deficient, the qi and blood deficient, and the wind, phlegm, stagnation and blood paralyzing the veins and ligaments, presenting a mixed pathological mechanism of deficiency and reality. The identification is related to the liver, heart, spleen and kidney. Aging and weakness, deficiency of qi and blood, imbalance of yin and yang is the root of the disease, irritation, or drinking and eating, or obesity, or room strain, or external evil attack and other triggers, resulting in obstruction of qi and blood, skin and tendons are not moistened; or yin deficiency in the lower, liver yang, yang into the wind, blood with qi reversal, holding phlegm and fire, across the meridians, obscuring the clear orifices, and the formation of the upper real and lower deficiency, yin and yang do not maintain each other’s critical symptoms.
1. Liver and Yang hyperactivity, wind and fire disturbance
Main symptoms: hemiplegia, distorted mouth and tongue, strong tongue or no speech, numbness, dizziness and headache, red face and red eyes, dry mouth and throat, irritability, red urine and dry stool, or even sudden change of the disease, coma, straight neck, coarse breathing, red or red-red tongue, thin yellow or yellowish coating on the tongue, strong string or string pulse.
Analysis of the symptoms: Due to the hyperactivity of liver yang, yang rises and wind moves, blood gushes upward with the reversal of qi, resulting in dizziness and headache, redness of the face and eyes; in some cases, the clear orifices are clouded and the mind becomes comatose, the neck is tense and straight, and the breath is coarse. The liver is a fructus yin and wind-wood organ, with yin and yang in the body. Liver yin loss, liver yang hyperactivity and liver wind; wind is a yang evil, liver wind with phlegm upward disturbance, flowing through the meridians, so suddenly there is a strong tongue and speech, distorted mouth and eyes, paraplegia or partial body numbness. If the liver fire is strong, the urine is red and the stool is dry. If fluid is depleted, the mouth is dry and throat is dry. If the heart and mind are disturbed, the heart is irritable. The thin yellow tongue coating or yellowish brown, and the strong string or string number of the pulse are signs of liver fire and liver wind disturbance.
Treatment: Calming the liver and submerging the Yang, quenching the wind and suppressing spasm.
Remedy: Add and subtract antelope and hooked vine soup. (Treatise on Typhoid Fever in Common Use)
Prescription: Antelope horn powder 0,2g (punch), hooked vine, chrysanthemum, Xia Gu Cao, mother-of-pearl (first decoction) 30g each, raw groundnut, stone cassia, ground dragon, Chuan Niu Kne 15g each, red peony, stiff silkworm, danpi 10g each.
Explanation: Antelope horn enters the liver meridian, cools the liver and quenches the wind; hooked vine clears the liver and pacifies the liver, quenches the wind and reduces fire; total alkaloids of hooked vine and hooked mushroom alkaloids have the effect of lowering blood pressure, and together they are the monarch. The combination of Sheng Shijiao and mother-of-pearl subdue the liver and subdue Yang, Chuan Niu Knee draws blood downward, Chrysanthemum pungently cools and drains, Xia Ku Cao pacifies the liver and quenches the wind to strengthen the effect of cooling the liver and quenching the wind, subduing Yang and lowering fire, and is used as the subject medicine. “The treatment of wind first treats the blood, the blood moves the wind to extinguish”, so the use of Sheng Di Huang, Dan Pi, Red Peony to cool the blood and invigorate the blood, nurturing Yin and softening the liver, Di Long to open the meridians and activate the channels, the stiff silkworm to dispel phlegm and dispel wind, the above-mentioned are co-adjuvant drugs.
Add reduction: if the disease into the evidence of Yang closed, can first nasal feeding to Bao Dan or Angong Niuhuang Wan to pungent cool to open the orifice, and then followed by the above decoction, in order to thwart the development of the disease passed, but should not be over with bitter cold. One is bitter and dry to hurt Yin, the other is to hinder the blood stasis dispel.
2, wind, phlegm and blood stasis, paralysis blocking the ligaments
Main symptoms: hemiplegia, distortion of the mouth and tongue, strong tongue or no speech, numbness, dizziness, numbness and heaviness of the limbs, white face with phlegm, dark purple tongue, thin white or white greasy tongue coating, smooth pulse.
Analysis of the symptoms: Due to the flow of wind and phlegm through the meridians, blood vessels are paralyzed and blocked, the channels and tunnels are blocked, the qi cannot move and the blood cannot moisten, so the limbs are useless or partially paralyzed, or the body is partially numb. If phlegm and phlegm stasis block the meridians, the mouth and tongue will be distorted, the tongue will be strong and speech will be bold or inarticulate, and if phlegm and phlegm disturb the clear channels and channels, the head will be dizzy and the eyes will be dizzy, the limbs will be numb and heavy, and the face will be white with phlegm. Dark purple tongue, thin white or white greasy tongue coating, and slippery pulse are all signs of blood stasis and phlegm blockage.
Treatment: Invigorate blood to dispel wind, resolve phlegm and clear the channels.
Prescription: Radix Bupleurum and Rhizoma Atractylodis Macrocephalae Tang with Addition. (Medical Heart Enlightenment)
Prescription: Radix Panax Notoginseng, Rhizoma Atractylodis Macrocephalae, Rhizoma Tianma, Radix Bupleurum, Hovenia, Rhizoma Dioscorea, Acorus Calamus, 10g each, Rhizoma Chuanxiong, Rhizoma Wailingensis, 12g each, Rhizoma Crotalis, 15g.
Explanation: Radix Panax notoginseng dries dampness and resolves ectoplasm, which has a hypotensive effect; tianma calms the liver and quenches the wind, the combination of the two is the key medicine for treating wind and phlegm, and is the ruling medicine. Atractylodes Macrocephala strengthens the spleen and dampness, while Biliary South Star, Chuanbei, Citrus Aurantium and Acorus calamus clear heat and resolve phlegm, and regulate Qi and open the orifices as subjects to help resolve phlegm. Stipula, Di Long, Chuan Xiong, Wei Ling Xian, and Hooked Vine are used to invigorate blood circulation, resolve phlegm and quench wind as adjuvants, together with the effect of invigorating blood stasis, dispelling wind and phlegm.
Addition and subtraction: If yellow tongue coating is greasy and slippery pulse, for phlegm and heat, add Huang Lian 6g, Scutellaria Baicalensis 12g, Fried Gardenia 10g to clear the heat of heart, liver and spleen; if drowsiness and unconsciousness are seen in the internal organs, take Su Tongxiang Pill to warm and open the orifice or Niuhuang Qingxin Pill and Bureau Fang Zhibao Dan to open the orifice with pungency and coolness.
3.Phlegm-heat and internal organs, wind and phlegm disturbance
Main symptoms: hemiplegia, distortion of the mouth and tongue, strong tongue and wuxiang or no wuxiang, numbness of the partial body, dizziness, red face and body heat, thick breath and bad breath, restlessness, phlegm or phlegm, abdominal distension and constipation, dark red tongue, yellow or yellowish greasy coating, slippery pulse or slippery and large pulse on the side of hemiplegia.
Analysis of the symptoms: Due to the liver yang, coupled with poor diet and excessive alcohol consumption, resulting in dampness and phlegm, phlegm becomes heat, internal wind and phlegm disturbs the meridians, resulting in hemiplegia, paraplegia and numbness, distorted mouth and eyes. If phlegm and heat stagnate in the middle jiao, the conduction function is lost, ascending and descending is obstructed, the lower part of the bowel is blocked and the abdomen is swollen and constipated, the upper part is dizzy, dizzy and coughing phlegm because the clear yang is not ascending, the internal heat and dryness is red, the body is hot, the breath is coarse and the mouth is foul, and the fire and heat disturb the mind is agitated and restless. If the wind and phlegm block the tongue and the veins are not smooth, then the speech is sluggish or inarticulate. Yellow or greasy tongue coating and slippery pulse are phlegm-heat. The pulse is large for the disease into the tongue paralysis and the pulse is smooth and large, by phlegm blocking the ligament, the disease has a development trend.
Treatment: To remove phlegm from the internal organs and quench the wind to clear the ligaments.
Remedy: Add reduction to Da Cheng Qi Tang. (Treatise on Typhoid)
Prescription: Raw rhubarb (later down), yuanming powder, bile south star, peach kernel, Chuanxiong, Chuanxiu Knee, Di Long 10g each, Salviae Miltiorrhiza, Quan Guaou 15g each, senna leaf, whole scorpion 6g each.
Explanation: Rhubarb, Yuanming and Senna leaves cleanse the intestines and stomach, and release heat from the internal organs as the ruler. Psidium guajava and Gallus gallus are the subjects to clear heat and resolve phlegm. Tao Ren, Dan Shen, Chuan Xiong and Chuan Niu Kne invigorate blood circulation and resolve blood stasis, dispersing Qi and blood; Di Long and Quan Scorpion extinguish the wind and open the ligaments as adjuvants, which together can promote the effect of unblocking internal Qi, resolving phlegm and eliminating blood stasis, extinguishing the wind and opening the ligaments.
Addition and reduction: If the phlegm sound in the throat is soggy, the sound is dark and inarticulate, and even the heart is confused and dizzy, this is due to the phlegm erosion and congestion, disturbing the brain and spirit, which is the progress of the disease, there is the possibility of the internal organs, it is appropriate to increase the dose of the above-mentioned Chinese medicine to pass the internal organs, and also add Pores stone rolling phlegm pill, monkey jujube powder, rhubarb powder, etc., to play the function of phlegm heat down and drain, pass the internal organs and wake up the brain.
4.Qi deficiency and blood stagnation, stagnation of veins and ligaments
Main evidence: hemiplegia, distorted mouth and tongue, strong tongue or no speech, numbness of the deviated body, most of the disease has reached the recovery period or the sequelae period, common facial color, shortness of breath, weakness, salivation, sweating, palpitations and loose stools, swelling of the hands and feet, dull tongue, thin white or white greasy tongue coating, sunken, slow or thin string pulse.
Analysis of the symptoms: The patient has a deficiency of qi and is unable to move blood, resulting in stagnation of the arteries and veins and loss of moistening of the tendons and muscles, resulting in hemiplegia, paraplegia, numbness of the body, distortion of the mouth and eyes. Qi deficiency, Qi and blood cannot be glorified on the face, so the face has no color, the Spleen Qi is weak, the transportation and transformation are not in order, so the hands and feet are swollen, and the stool is loose. Inability to moisten the heart, mind and limbs results in shortness of breath and palpitations. If the Wei Qi is weak and cannot fix the surface, then spontaneous sweating occurs. Thin white or white greasy tongue coating and sunken, slow or thin string pulse are signs of Qi deficiency and blood stagnation.
Treatment: Benefit Qi, invigorate Blood, clear the meridians and harmonize the channels.
Remedy: tonifying Yang and returning the five tones with added flavor. (Correcting Errors in Medicine)
Prescription: Astragalus membranaceus and Radix Rehmanniae 30g each, Radix Angelicae Sinensis and Radix Paeoniae 12g each, Rhizoma Peach-Kernel, Rhizoma Safflower, Rhizoma Dioscorea, Rhizoma Atractylodis Macrocephalae, Rhizoma Chuanxiong, Rhizoma Chuanxiu Knee 10g each, Rhizoma Cinnamomum 6g, Radix Scorpion Powder 2g (divided).
Explanation: Astragalus is used in this formula to nourish the vital energy of the spleen and stomach, so that the Qi and blood can flow, dispel blood stasis and open the channels. Radix Angelicae Sinensis is good at invigorating Blood and has the advantage of resolving blood stasis without harming Blood, which is the subject herb. Rhizoma Chuanxiong, Radix Paeoniae, Rhizoma Peach, Rhizoma Safflower and Radix Angelicae Sinensis are added to invigorate the Blood and dispel blood stasis, while Radix et Rhizoma Dioscoreae is used to invigorate the meridians and activate the collaterals.
Add and subtract: Qi deficiency and weakness in transportation can easily produce dampness and phlegm, which will disturb the clear orifices and aggravate vertigo, tongue and tongue. It is generally believed that stroke belongs to the liver and kidney yin deficiency evidence, easy to Yang hyper-transformation, and even can lead to the internal organs of the dangerous disease; Qi deficiency and blood weakness evidence, easy to cause the blood vessels do not work and aggravate the ligament stasis, so that in the meridians of the evidence lingering.
5.Yin of liver and kidney, deficiency of wind within the movement
Main symptoms: hemiplegia, oblique mouth and tongue, strong tongue or no speech, numbness of the partial body, mostly in the recovery period or sequelae, common dizziness and tinnitus, fever in the hands and feet, soreness and weakness of the waist and knees, frequent nocturnal urination, stiffness and constriction of the affected side or numbness and weakness, dreaminess and forgetfulness, red or purple-red tongue, little or no moss, thin and stringy or deficient pulse.
Analysis of the symptoms: The patient has deficiency of kidney yin, hyperactivity of liver yang, blood deficiency and qi reversal, resulting in upper strength and lower deficiency, hence dizziness and headache, tinnitus and dizziness, little sleep and dreaminess and leg weakness. Yin deficiency and internal heat result in heat in the hands and feet, dreaminess and forgetfulness, lack of kidney qi results in frequent nocturnal urination, wind and yang move within the body, carrying phlegm to move the meridians and veins, and the mouth and eyes are distorted if the veins are not smooth; the tongue is strong and the speech is bold, the body is partially paralyzed, or the affected side is stiff and constricted or numb and weak. Red or purple-red tongue, little or no moss, thin and stringy pulse or deficient stringy pulse are all signs of liver and kidney yin deficiency and internal movement of deficient wind.
Treatment: Nourish yin and submerge yang, extinguish the wind and open the ligaments.
Remedies: Zuo Gui Wan and Hu Qian Wan plus or minus. (Jing Yue Quan Shu, Dan Xi Xin Fa)
Prescription: 30g of raw oyster (first decoction), 20g of rehmanniae, 15g of each of shouwu, shanshu flesh, cistanches, huai niu knee and tortoise shell (first decoction), 12g of each of white peony, Zhi mu, peach kernel, safflower and angelica, 8g of each of ground dragon and cypress, and 2g of whole scorpion powder (divided and brewed).
Explanation: In this formula, Shu Di Huang is used to nourish the kidney and benefit the essence, filling the true yin as the monarch, Shan Lai Yu nourishes the liver and nourishes the kidney, astringent and astringent; Shou Wu, Cistanches, Tortoise Nail and Bai Shao benefit yin and tonify yang, taking the meaning of “seeking yin in yang” as the ministerial medicine. Zhi Mu and Huang Bai nourish Yin and clear heat to clear down deficiency fire and induce fire downward; raw oyster pacifies the liver and submerges Yang to extinguish wind; peach kernel, safflower, angelica and dilong invigorate blood circulation, resolve blood stasis and clear the channels; whole scorpion searches phlegm and extinguishes wind to reach the meridians, all of them are adjuvants.