Stroke, also known as cerebrovascular accident, stroke, etc., is a general term for a group of vascular diseases of the brain caused by various etiologies, divided into two categories: hemorrhagic (cerebral hemorrhage, subarachnoid hemorrhage) and ischemic (transient ischemic attack, cerebral thrombosis and cerebral embolism).
Transient ischemic attack (TIA) is an episodic transient decrease in cerebral blood flow caused by various reasons, and the local symptoms of cerebral ischemia that disappear transiently (within 24h) are called transient ischemic attack or transient cerebral ischemic attack. This disease is called stroke aura in Chinese medicine. It is believed that liver and kidney yin deficiency, liver and yang hyperactivity, phlegm and dampness stagnation of blood, upward blockage of brain ligaments, and contracture of brain ligaments after paralysis, resulting in loss of the cerebral house to be supported by qi and blood, and a series of symptoms such as limb movement or sensory impairment.
Stroke, also known as stroke, includes two major categories: ischemic and hemorrhagic.
According to Chinese medicine, stroke is a disease caused by Qi and blood rebellion, resulting in paralysis of the cerebral veins or blood overflowing in the brain, with paralysis of the body, numbness of the limbs, lame tongue, and even sudden fainting. The pathogenesis of the disease is that the orifice is closed and the spirit is hidden, and the spirit does not guide the qi. Specifically, it can be divided into two aspects: paralysis of the cerebral veins and blood overflow in the brain.
Diagnostic criteria
1. Transient ischemic attack is based on the criteria developed by the American TIA Study Group
(1) TIA is a transient focal abnormality of brain function caused by blood vessels.
(2) Rapid onset, usually within 2 min, with all symptoms appearing within a maximum of 5 min.
(3) Duration of the attack, usually 2 to 30 min, but occasionally lasting 24 h.
(4) Rapid cessation, usually all symptoms disappear within 2 to 3 min.
(5) The frequency of seizures varies.
(6) TIA of the internal carotid artery system and TIA of the vertebral artery system can be classified according to the symptoms at the time of the attack, but it should be emphasized that the diagnosis of TIA should be attributed to the previous condition of the attack, independent of the presence of intracranial and extracranial vascular lesions.
Appendix: Symptoms of TIA of the internal carotid artery system
(1) Symptoms appear on one half of the body (motor and sensory deficits, loss of vision in one eye, aphasia, etc.).
(2) Few episodes with the same symptoms in each episode.
(3) It is easy to cause cerebral infarction.
Appendix: TIA symptoms of vertebral artery and basilar artery system
Aphasia (from mild to severe, may also be accompanied by reading and writing disorders);
(1) Symptoms appear on half or both sides of the body.
(2) cerebral neurological symptoms (diplopia, dizziness, dysphagia, loss of vision on both sides, hemianopia, etc.)
(3) More frequent attacks, with different symptoms for each attack.
(4) Less likely to cause cerebral infarction.
2.Stroke diagnostic criteria
(1) hemiplegia, distorted mouth and tongue, strong tongue and speech, partial numbness, or even trance, confusion, dizziness and confusion are the main symptoms.
(2) The onset of the disease is rapid, with a gradual development process. The disease is preceded by dizziness and headache, numbness of the limbs and other aura.
(3) There are often factors such as old age, physical weakness, fatigue and internal injury, addiction to tobacco and alcohol, and thick taste. It is triggered by anger, fatigue, alcoholism, cold, etc.
(4) Blood pressure, neurological system, cerebrospinal fluid, routine blood and fundus examinations. CT and MRI examinations may be done if available, and there may be abnormal manifestations.
(5) Attention should be paid to differentiate from epilepsy, syncope, spasm, etc.
Identification criteria
1.Medium meridian
(1) Tyrannical hyperactivity of liver yang: hemiplegia, strong tongue, lame speech, distorted tongue and mouth, dizziness and headache, red face and red eyes, irritability, bitter mouth and dry throat, constipation and yellow urine. The tongue is red or vivid, the coating is yellow or dry, and the pulse is strong and stringent.
(2) Wind-phlegm obstruction: hemiplegia, distorted mouth and tongue, strong tongue and speech, numbness of limbs or hand and foot restraint, dizziness. The tongue coating is white or yellowish greasy, and the pulse is smooth.
(3) Phlegm-heat and internal organs: hemiplegia, strong tongue and inarticulate, distorted tongue and mouth, sticky phlegm in mouth, abdominal distension and constipation, red face and irritable heat in the afternoon. The tongue is red, the coating is yellowish greasy or grayish black, and the pulse is slippery and large.
Qi deficiency and blood stasis: hemiplegia, weakness of limbs, numbness of partial body, distorted tongue and speech, swelling of hands and feet, pale face, shortness of breath and weakness, palpitation and sweating. The tongue is dark and pale, with thin white or white greasy coating, and the pulse is thin and slow or thin and astringent.
(5) Yin deficiency and wind movement: hemiplegia, numbness of limbs, strong tongue, insomnia, dizziness and tinnitus, constriction or writhing of hands and feet. The tongue is red or dark, with little coating or light flaking, and the pulse is thin and stringent or counted.
2.Intermediate organs
(1) Wind and fire obscuring the orifices: sudden fainting, unconsciousness, both eyes squinting or looking straight. The face is red, the eyes are red, the limbs are tense, the mouth is noisy, the neck is strong, the hands are tightly held, or even convulsions, and the horns are reversed. The tongue is red or vivid, the coating is yellow and dry or burnt black, and the pulse is stringy.
(2) Phlegm-fire closed orifice: sudden fainting, confusion and incoherence, restlessness, tonicity of limbs. Phlegm with shortness of breath, straight eyes, snoring and body heat, constipation, red tongue, yellow and thick greasy coating, smooth and strong pulse.
(3) Phlegm-dampness clouding the orifice: sudden drowsiness, paralysis of the body and limbs. The face is obscure, phlegm is abundant, and the limbs are cold. The tongue is dull, the coating is white and greasy, and the pulse is sunken and slippery or slow.
(4) Failure of vital energy: fainting, pale face, dilated pupils, rebellious hands and limbs, incontinence of the bowels, shortness of breath, sweating and cool skin. Pale purple or atrophied tongue, white and greasy coating, scattered or weak pulse.
Treatment principles and selection of acupuncture points
1, in the treatment of stroke should follow the principle of treating the symptoms in an urgent manner, and treating the root cause or both the symptoms and the root cause in a slow manner, and the basic treatment principle of waking up the brain and regulating the mind and unblocking the meridians in the meridians. The basic treatment principle is to awaken the brain and open the orifices for those who are in the internal organs, and to return the Yang to fix the detachment for those who have lost the evidence, and to open and enlighten the orifices for those who have closed the evidence.
2. In the selection of acupuncture points according to the pathogenesis and meridian circulation, the points are selected according to the Chinese medical theory that the Directing Vessel enters the brain, the brain is the house of the Yuan Shen, and the heart is the master of blood vessels, etc. The specific principles of acupuncture point selection are as follows.
(1) In meridians, the condition is milder, and the main points are Shuigou of the Directing Vessel, Neiguan of the Pericardial Meridian, and Sanyinjiao of the Foot Taiyin Meridian, with Jiquan, Quchi, Waiguan, Hegu, Huanjiao, Yanglingquan, and Feosanli as supplementary points, and then selected according to the etiology and pathogenesis of the disease. Liver-Yang hyperactivity with Fengchi, Taichong, Taixi to calm the liver and submerge Yang and clear liver fire; wind-phlegm obstruction with Fenglong and Yinlingquan to strengthen the spleen and resolve dampness and phlegm; phlegm-heat and internal heat with Tianshu, Shangjiu and Fenglong to clear heat from the internal organs; Qi deficiency and blood stasis with Qihai and Kidney Yu to replenish vital energy, Blood Sea and Diaphragm Yu to activate blood circulation and resolve stasis, and Dazhi to help Yang and stop sweating; Yin deficiency and wind movement with Kidney Yu, Taixi, Taichong, Shenmen and Daling to nourish Yin and submerge Yang, and at the same time to tonify Heart Qi and traffic Heart and kidney. For strong tongue and difficulty in swallowing, combining with Jin Jin, Yu Liquid, Lian Quan, Tai Xi and Shang Qiu to unblock the tongue. In case of constipation, diarrhea is associated with Tianshu and Fenglong.
Additional acupuncture points of Yin Bai, Tian Wu and Fu Tu can improve the efficacy of acupuncture for hemiplegia.
(2) In the case of closed viscera, select Shuigou, Shuxuan, and Neiguan as the main points, and then match the points according to the etiology of the disease. For wind-fire obscured orifices, Fengchi and Taichong are used to clear the liver and quench the wind; for phlegm-fire obscured orifices, Fenglong and Tiantou are used to rejuvenate phlegm; for phlegm-damp obscured orifices, Foot Sanli, Sanyinjiao, Fenglong and Qihai are used to strengthen the spleen and stomach and warm the phlegm; for visceral dislocation, Guan Yuan and Shen Que are used as the main points and large moxibustion is applied to return Yang and fix dislocation.
(3) Select acupoints according to disease location and symptoms.
(1) Hemiplegia: according to the location of the disease, it can be divided into Yang slow Yin urgent and Yin slow Yang urgent. If the lower extremity has foot exotropia and the upper extremity can be extended but not flexed is yin slow and yang urgent, the yin meridian of the upper and lower extremity should be tonic and moxibustion, and the yang meridian should be lax; if the lower extremity has foot entropion and the upper extremity can be flexed but not extended is yang slow and yin urgent, the yin meridian of the upper and lower extremity should be lax and the yang meridian should be tonic and moxibustion. The acupoints of Yang meridian are often used as Quchi, Waiguan, shoulder k, arm, ring jump, commission, wind city, Yanglingquan, foot Sanli, hanging bell, Xiexi, etc. The acupoints of Yin meridian are often used as Jiquan, Shouze, Quze, Kong most, inter-branch, Neiguan, Jiimen, Blood Sea, Yinlingquan, Diji, Zhubin, Sanyinjiao, Taixi, Shangqiu. When selecting acupuncture points, consider which meridians and muscle groups govern a particular joint, e.g., if the wrist is hanging or the fingers are contracted, the acupuncture points of the forearm should be the main ones; if the elbow is restricted in flexion and extension, the acupuncture points of the upper arm should be the main ones.
(ii) Swallowing and phonation difficulties: choose Fengchi, Wanbone, Tianzhu, Shanglianquan, Jinjin, Yuyi, Aye points on the posterior pharyngeal wall, Tongli.
(③) crooked mouth and eyes: choose Di Cang, Bu Che, Yang Bai, Si Bai, Ying Xiang, He Gu, Nei Ting.
④Constipation: select the left channel, Guilai, Zhigou, Fenglong.
3, available head acupuncture, take the parietal temporal anterior oblique line, parietal temporal posterior oblique line (both for the opposite side of the paralysis), milli-needle flat acupuncture with high frequency twisting method of 120 revolutions / time for 1 to 3 minutes, 5 to 10 minutes to perform acupuncture once.
Acupuncture prescription
Recommended prescription 1
Treatment: Awakening the brain, toning the mind, and unblocking the meridians.
Main points: Shuigou(⊥) Yin Tang(⊥) Neiguan(⊥) (awakening the mind and opening the orifices)
Jiuquan(⊥) Shizhe(⊥) Guizhong(⊥) (Drainage of meridians)
Sanyinjiao (T) (nourishes the liver and kidneys, unblocks the meridians)
For liver-yang hyperactivity, add Tai Chong (⊥) and Tai Xi; for wind-phlegm obstruction, add Feng Long (⊥) and He Gu (⊥); for phlegm-heat and internal organs, add Qu Chi (⊥), Neiting (⊥) and Feng Long (⊥); for qi deficiency and blood stasis, add Foot San Li (T) and Qi Hai (T); for yin deficiency and wind movement, add Tai Xi (T) and Feng Chi; for dysphagia, add Cataract (⊥), Shang Lian Quan (⊥), Jin Jin (↓) and Yu Liquid (↓); for orofacial distortion, add Cheek Che (⊥) and Di Cang (⊥); for upper limb disorders add Shoulder k (⊥), Hand San Li (⊥), He Gu (⊥); for lower limb disorders add Ring Jump (⊥), Yang Ling Quan (⊥), Yin Ling Quan (⊥), Feng Shi (⊥); for dizziness add Feng Chi (T), Wan Bone (T), Tian Zhu (T); for foot entropion add Qiu Hui through Zhao Hai (⊥); for constipation add Shui Dao (⊥), Guilai (⊥), Feng Long (⊥), Zhi Gou (⊥); for diplopia add Feng Chi (⊥) , Tianzhu(⊥), Miming(⊥), Houguo(⊥); urinary incontinence, urinary retention plus Zhongji(⊥), Qubiao(⊥), Guangyuan(⊥).
Operation Use the diarrhea method for Neiguan; use the bird pecking method for Shuigou to moisten the eyes. When stabbing Sanyinjiao, make a 45° angle with the skin along the medial edge of the tibia so that the needle tip pierces the Sanyinjiao point, using the lifting and inserting method of tonicity; when stabbing Jiquan, take the point 2 inches below the original point location on the heart meridian, avoid the axillary hairs, and stab straight into the needle, using the lifting and inserting method of diarrhea, so that the patient has a numbness and twitching sensation in the upper extremity; Shouze and Wei Zhong are stabbed straight, using the lifting and inserting method of diarrhea so that the limb has a twitching sensation. The remaining points are operated routinely.
Recommended prescription 2
Treatment: Regulating the Directing Vessel and clearing the meridians.
Main points: Baihui(│) Fengfu(│) Dazhi(│) Tao Dao(│) Body pillar(│) Shen Dao(│) (regulating the Directing Vessel)
Zhiyang(│) Tendon(│) Chi Zhong(│) Hang Shu(│) Fate Gate(│) Waist Yang Guan(│) Chang Qiang(│) (regulates the Directing Vessel)
Matching points: for upper limb disorders, add shoulder k (⊥), quchi (⊥), hand sanli (⊥), hegu (⊥); for lower limb disorders, add ring jump (⊥), foot sanli (⊥), san yin jiao (⊥), xiexi (⊥); for swallowing difficulties, add cataract (⊥), upper lianquan (⊥), jinjin (↓), yu yi (↓).
Operation: routine operation.
The prognosis of stroke disease is related to many factors, first of all, it depends on the severity and extent of brain damage, and the delay of recovery from brain shock at the periphery of the injury or inferior level can indicate the degree of brain damage, which has some reference significance for prognosis. Generally speaking, the longer the period of brain shock, the more serious the brain damage and the less hope for motor rehabilitation of the innervated side of the limb. The early recovery from brain shock is easy for the dominant part such as the lower limb, while the slow recovery is difficult for the upper limb. Generally speaking, the more flexible the limb is, the more difficult it is to recover the motor function. Therefore, the recovery of the distal limb function is slower than the proximal limb. The upper limb, which is usually more flexible, is slower to recover than the lower limb. Among the upper limbs, the recovery of hand movement is the most difficult. Acupuncture is more effective in the treatment of stroke, especially for the recovery of neurological functions such as limb movement, language, swallowing function, etc. The earlier the acupuncture, the better the effect, and should be combined with functional exercises during treatment. In the acute phase of stroke, comprehensive treatment measures should be taken when high fever, dizziness, heart failure, increased intracranial pressure, upper gastrointestinal bleeding, etc. occur. Patients with stroke should pay attention to prevent bedsores and ensure unobstructed airway. Prevention of this disease should be emphasized. If you are over 40 years old and have frequent dizziness and headache, numbness of the limbs, occasional episodes of unfavorable language, impotence and weakness of the limbs, it is mostly a precursor of stroke, and prevention should be strengthened.