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Clinical Observation on the Treatment of Apoplexy by Acupuncture Combined


Clinical Observation on the Treatment of Apoplexy by Acupuncture Combined with Herbs

  
Abstract: Apoplexy involves cerebrovascular accident, such as cerebral hemorrhage, cerebral thrombosis, cerebral infarction, subarachnoid hemorrhage, etc. and its sequelae in modern medicine. The author treated 81 cases of apoplexy using acupuncture combined with herbs. Among them, 36 cases were male, accounting for 44 % ; 45 cases fema1e, accounting for 56 %. The o1dest was 82 years old, and youngest 28 years old. The shortest course of disease was one day, and the longest over 3 years. The treatment results show that 60 cases were cured, accounting for 74. 07%; 16 cases markedly effect, accounting for 19. 75 %; 3 cases improved, accounting for 3. 7 %; 2 cases ineffective, accounting for 2. 48 %. The total effect rate was 97. 52 %.

Keywords: Apoplexy Cerebrovascular accident Combined treatment of acupuncture and herbs

Apoplexy is in the first place of diseases, and one of four great difficult and complicated cases of il1ness. Most of patients suffer from the disease at over middle age. In clinic, it is told and visible that patients got sudden fall, unconsciousness, or deviation of the eye and mouth, or dysphasia, salivation, hemiparalysis, etc.. It involves cerebrovascular accident, such as cerebral hemorrhage, cerebral thrombosis, cerebral infarction and subarachnoid hemorrhage, etc. And its sequelae in modern medicine. The author adopted acupuncture combined with herbs, that is, acupuncture was used first, then the herbs were used together to treat it, and got the better effecacy. It is reported as follows.

Clinical Data:
Among 81 cases of apoplectic patients, 36 cases were male, accounting for 44%, 45 cases female, accounting for 56%; the oldest was 82 years old, the youngest 28 years old; the shortest course of disease was one day, and the longest course of illness over three years.

Treatment Methods:
1. Acupuncture
(l ) Eight Chief Acupoints for Prevention of Apoplectic Premonition (personal experiential prescription): Baihui (GV 20 ) (using Tongtian needling method, see be1ow), Zhengying (GB 17) (using Tongchong needling method, see below), Fengchi (GB 20 ), Dazhui (GV l4 ), Zusanli (ST36), Juegu (GB 39), Yongquan(KI 1 ) and Taichong(LR 3).

(2 ) Six Chief Acupoints for Emergency Treatment of Apoplexy (personal experiential prescription);Baihui(GV 20) (using Tongtian needling method), Zhengying(GB l7) (using Tongchong needling method ), Dazhui (GV 14 ), Fengchi (GB 20 ), Taichong(LR 3 ) and Yongquan (KI 1). For the patients with serious cerebral hemorrhage, Fengfu (GV 16) and Yamen(GV 15) are added.

(a) Bizheng(excess syndrome of stroke):
Laogong (PC 8 ), Renzhong (GV 26 ), Hegu(LI 4), and twelve well-points are added to induce resuscitation, calm the endopathic wind, purge away the heat and eliminate phlegm. Use strong stimulus or bloodletting with pricking method, once or twice a day, don' t retain the needle.

(b) Tuozheng(prostration syndrome):
Renzhong(GV 26 ), Neiguan (PC 6 ), Zusanli(ST 36), Qihai(CV 6), Guanyuan(CV 4 ) and Shenque (CV 8), are added, stimulate Renzhong, Neiguan and Zusanli with strong stimulus and reinforcing method, and retain needle for 30 min; Guanyuan, Shenque and Zusanli are stimulated with salt-separated moxibustion, so as to recuperate depleted yang and consolidate collapse.

(3) Eighteen Chief Acupoints for Sequelae of Apoplexy (personal experiential prescription): Baihui(GV 20) (using Tongtian needling method), Zhengying(GB 17 ) (using Tongchong needling method ), Fengfu (GV l6 ), Fengchi (GB 20), Dazhui (GV 14 ), Jianyu (LI 15 ), Shousanli(LI 10), Quchi(LI l1), Waiguan(TE 5), Hegu (LI 4 ), Zusanli (ST 36 ), Yanglingquan(GB 34), Zhongzhu(TE 3), Huantiao (GB 30), Juegu (GB 39 ), Taichong (LR 3 ), Yongquan(KI 1 ) and Guanyuan(CV 4 ).

(4) Modified prescription according to differentiation of syndrome and manipulation of needling: If it belongs to the disease of blood vessel, use reinforcing middle-jiao and replenishing qi method:

1 ) Tongtian needling method, i. e., Shenting (GV 24), Shangxing(GV 23), Xinghui (GV 22), Qianding (GV 21 ) and Baihui (GV 20) are selected. The above five acupoints belong to Governor Vessel Meridian, are located at the median line of the vertex, which are connected as one group of acupoints, the needle is inserted from Shenting, along under the skin passing through Baihui about 2 fen, the needling sensation must make the whole vertex distend.

2) Tongchong needling method using Zhengying principally, i. e., Linqi (GB 15), Muchuang (GB 16 ), Zhengying (GB 17 ) and Chengling(GB 18) are selected. The above four acupoints belong to Gallbladder Meridian, which are connected as the other group of acupoints (there is a group on each side of the right and left), the needle is inserted from Linqi, along under the skin passing through Chengling 2 fen, the needling sensation is a local distending pain. At the same time, Dazhui, Shenshu (GV 12) Zhongwan (CV 4 ), Qihaishu (BL 24 ), Neiguan, Zusanli, Sanyinjiao(SP 6), Yongquan are needled; the affected limbs are usually treated with warming and promoting Yangming Channel, selecting Jianyu (LI 15 ), Binao (LI 14 ), Jianjing (GB 21 ), Quchi, Shousanli, Hegu, Waiguan, Zhongzhu(TE 3) and Laogong (PC 8); the affected lower limbs are usually treated with nourishing Shaoyang Channel, selecting Huantiao, Fengshi (GB 31 ), Yanglingquan(GB 34 ), Zusanli, Lianqiu (ST 34 ), Chengshan(BL 57 ), Juegu (GB 39 ), Kunlun (BL 60), Jiexi(ST 41 ), Zulinqi(GB 41 ), Tai-chong(LR 3), Sanyinjiao(SP 6) and Yongquan. When the patient menifests mental symptoms, we need to regulate the heart-qi, needling Jianshi(PC 5 ), Tongli(HT 5), Laogong, Juque(CV 14), Xinshu(BL 15) and Qihai(CV 6); for expelling phlegm and dampness, it may be to needle Zhongwan (CV l6 ), Pishu (BL 20 ) and Fenglong(ST 40); for expelling the wind, it may be to needle Fengchi, Fengfu and Taichong; if the patient has dysphasia, we need to needle Yamen(GV 15 ), Lianquan(CV 23 ) and Tongli (HT 5); fr facial palsy, needle Xiaguan (ST 7), Sibai(ST 2), Dicang(ST 4 ), Yifeng (TE l7), Liangqiu(ST 34) and Hegu, or needle eight confluence acupoints, namely, Shenmai (BL 62 ), Houxi (SI 3 ), Waiguan (TE 5 ), Zulinqi (GB 41 ), Neiguan, Gongsun (SP 4 ), Lieque(LU 7) and Zhaohai (KI 3 ). The aboveotwo groups of acupoints are alternately used. For patients with serious cerebral hemorrhage, Yamen and Fengfu may be needled to a depth of one cun, even if the patient is fatty, the needle should not be inserted over 1. 5 cun deep; the tip of the needle should be directed to the mouth or submaxilla; strickly forbid to deeply insert the needle towards the great occipital foramen and repeatedly lift and thrust, twirl and twist the needle. The other acupoints are needled by routine method, and the needles are retained for 30 min to one hour.

(5) Comments
Eight Chief Acupoints for Prevention of Apoplectic Premonition, Six Chief Acupoints for Emergency Treatment of Apoplexy and Eighteen Chief Acupoints for Sequelae of Apoplexy are mainly used at three phases of before, during and after attack of disease respectively. (a) Apoplectic premonition usually manifests dizziness, numbness of limbs, muscu1ar spasm, numbness in the tongue tip, tenseness in the root of the tongue, dysphasia sometimes, feeling of heavyness in the head and lightness in the feet, fat, hemihydrosis, flushed face and conjunctival congestion, liable to impatience and anger, hypertension, red tongue with greasy fur, slippery and rapid pulse, or deep, thready and taut pulse. The principles of treatment are as follows: This disease is related to pathogenic wind, it should be treated by calming or suppressing method; it is related to fire, which should be treated by purging or clearing method; it is related to phlegm, which should be treated by eliminating or resolving method. Eight Chief Acupoints for Prevention of Apoplectic Premonition is used to regulate patients' health through nourishing the brain and tonifying the kidney, supplementing the earth to eliminate phlegm, nourishing the blood and removing obstruction in the channels. (b) Apoplexy may be divided into 4 types: first, it is called apoplexy involving the collaterals if the patient has distortion of the face and numbness of skin; secondly, it is called apoplexy involving the channels if the patient gets hemiparalysis on the right or left side of the body, stiffness and dysfunction of muscle and joint; thirdly, it is called apoplexy involving the hollow organs if the patient is in unconsciousness but can still respond to the call, who has no urination and defecation during the attack; and fourthly, it is called apoplexy involving the solid organs if the patient is in unconsciousness and aphasia, unresponsiveness to the call, salivation due to paralytic lips. The above-mentioned symptoms may appear alone or mixed, but when the treatment, it needs to distinguish between Bi Zheng (excess syndrome) and Tuo Zheng (prostration syndrome). For Bi Zheng dispersion and purgation method is used, while for Tuo Zheng the method of consolidating collapse should be used. On the basis of Six Chief Acupoints for Emergency Treatment Of Apoplexy, the modified method is adopted according to differentiation. (c ) Sequelae of apoplexy are also divided into three types: Of the first type the chief manifestations are hemiparalysis, inability to raise the limbs, deviation of the eye and mouth, heavyness and numbness of legs strephenopodia or strephexopodia, taut and uneven pulse of taut and slippery pulse, etc.. Of the second type the main manifestations are cataplexy, unconsciousness, mental retardation and loss of memory after resuscitation, foolish laugh and cry, irrelevant answer, soiloquy, impoliteness. Of the third type the chief manifestations are stiff tongue and aphasia or f1accid tongue and aphasia, Wry tongue and numbness of tongue, etc.. When treating the patient with apoplectic sequelae the Eighteen Chief Acupoints for sequeae of Apoplexy may be all used at the same time, once every other day, or some of the acupoints are selected to be used, once a day continuously.

2. Chinese Medicinal Herbs
(1 ) Buyang Huanwu Tang(modified Decoction of Invigorating Yang for Recuperation):
Astragalus Root (Huangqi ) 65g (may be used to 125g for one time), Tail of Chinese Angelica Root (Guiwei ) 30g, Red Peony Root (Chishao) 15g, peach Kernl(Taoren) l2g, Safflower (Honghua ) 7g, Rhizome (Chuanxiong )12g, Earthworm (Chuandilong) 30g, Bighead Atractylodes Rhizome(Baizhu) 30g, Pora(Yunling) 30g, Red Sage Root (Danshen) 30g, Spatholobus Stem (Jixueteng ) 30g, Prepared Licorice(Zhicao) 5g (do not use it for the patient with hypertension).

(2 ) Zhao's Decoction of Removing Heat from the Blood and Invigorating Deficiency Prepared with Chicken-Willow Parasite (a proved recipe handed down from author's ancestors). The decoction is prepared as follows: A white cock or hen depilating feather and discarding viscerae is reserved to be used. A big Willow-Parasite (or two small ones ), Safflower (Chuanhonghua) 10g, Medicated Leaven(Liuqu) 25g, Salt(Qingyan) l2g and Red Sage Root (Danshen) 30g are used to be ground together, the mixed herb powder is filled in the thoracico-abdominal cavity of the chicken, then the chicken is cooked well, the residue of herb is discarded, let the patient drink soup and eat meat of the chicken. In addition, the bones of chicken are baked dry over a new tile, ground into powder and sieved, order the patient to take it after being infused in hot soup of chicken or boiling water, 10g a time, three times a day untill it all has been taken. The Decoction of Invigorating Yang for Recuperation is taken first, then the Decoction of Removing Heat from the Blood and Invigorating Deficiency Prepared with Chicken-Willow Parasite is taken one dose.

(3) Zhao's Powder of Dispelling Wind and Dredging Collaterals (capsule):
Astragalus Root (Huangqi) 65g, Pubescent Angelica Root(Duhuo) 20g, Atractylodes Rhizome(Cangzhu) 30g, Prunella Spike(Xiakucao) 65g, Red Sage Root (Danshen) 30g, Leech (Shuizhi) 12g, Bark of Chinese Cassia Tree (Cinnamin Bark ) 12g, Black Snake (Wushe) 20g, Giant Typhonium Tuber (Baifuzi) 30g, Spatholobus Stem (Jixueteng ) 30g, Arisaema with Bile (Dannanxing)12g, raw Rhubarb (Shichangpu) 15g, Centipede 3 pieces(Wugong) and Powder of Notoginseng. The abov herbs are ground together and sieved, preparing a medicinal powder or capsule. It is taken with boiled water before meal, 3 -- 6g each time, twice or three times a day. This herb is mainly used to prevent premonitation of apoplexy and treat sequelae in convalescence stage.

(4) Dietetic restraint: Lard, pungency, cigarette and alcoholic drink are prohibited to be eaten.

Therapeutic effects:
1. Criteria of therapeutic effects: Referring to the national diagnostic standards of apoplexy, the therapeutic effects are evaluated in the light of 5 physical signs and comprehensive functions of patients before treatment.
(1) Cure: The patient can take care of his/her life completely by himself/herself, comprehensive functional activities are normal, can take part in normal mental and physical labour.

(2) Marked effectiveness: The patient can take care of his/her life basically by himself/herself and participate in lighter mental or physical labour.

(3) Improvement: A part of symptoms are improved, but recovery is not complete.

(4) Ineffectiveness: There is no change in symptoms and the main functions are not recovered.

2. Results of Treatment
Of 8l cases, 60 cases were cured, accounting for 74. 07%; l6 cases were markedly effective, accounting for 19. 75 %; 3 cases improved, accounting for 3. 7%; 2 cases ineffective, accounting for 2. 48 %. The total effective rate was 97. 52 %. Among 81 case, l3 cases were treated with Eight Chief Acupoints for Prevention Of Apoplectic Premonitation, 25 cases with Six Chief Acupoints for Emergency Treatment of Apoplexy and Eighteen Chief Acupoints for Sequelae of Apoplexy (it is called 18 chief acupoints for short), and 43 cases with 18 chief acupoints.

Typical case:
Mrs Zhang, aged 63 years. Her blood pressure was a little high with dizziness. On July 18, 1978, because she was tired, she had a mixed feeling of joy and anger for the household duties, catched cold and fell two times when she went to the lavatory at that night, then she could not move on the right side of the body, she was in unconsciousness, closed eyes and open mouth, salivating, red complexion, grip of both hands, cold on the right half body, wry mouth with distorted eyes, dry mouth and depressed feeling in chest, dysphasia, sluggishness, incontinence of urine and feces, blood pressure being not high, excessive sweating, red tip of tongue, yellowish-greasy fur, taut, slippery and forceful pulse. It belongs to Bi Zheng(excess syndrome of stroke) caused by deficiency of both qi and the blood, insufficiency of the liver- and kidney-qi, upward interfering of deficient wind, up-stirring of liver-wind and upward accumulating of phlegm. The principle of treatment should be calming the liver to stop the wind, nourishing yin and restraining the hyperactivity of the liver-yang, removing phlegm and dissipating blood stasis, and dredging meridians and inducing resuscitation. She received treatment on August l6. The prescription of Six Chief Acupoints for Emergency Treatment of Apoplexy was selected, moreover, Fengfu and Yamen were added with strong stimulus or pricking method for blood-letting. Then the prescription of Eighteen Chief Acupoints for sequelae of Apoplexy was selected and modified in accordance with symptoms and signs. The treatment was given once every other day, needling healthy side and moxibusting affected side, so as to reduce excess and reinforce deficiency. At the same time, the patient took midified Decoction of Invigorating Yang for Recuperation 15 doses in all, then took a dose of decoction of Removing Heat from Blood and Invigorating Deficiency prepared with chicken andwillow parasite, etc.. After treatment, the patient could take care of her life basically by herself, and could go out with stick. After she took another 15 doses of the Decoction of Invigorating Yang for Recuperation and 3 doses of Zhao's Powder of Dispelling Wind and Dredging Collaterals, she was cured basically, could manage household affairs, or do some physical labour, no sequelae were left.

Experimence:
Apoplexy is one of main diseases which endanger people's health, the treatment of cerebrovascular disease and its sequelae with acupuncture combined with herbs has a good effect. Author considers:

(1 ) Treatment of apoplexy should pay attention to nourishing blood and activating blood circulation. It is said in Chinese medical classics that treating wind stroke must be to treat blood first, blood circulating is leading to calming the wind. Yangming has a closed relation to the flaccidity of limbs in paralysis because the normal activities of muscles and extremities need to depend on Yangming-qi. Yangming meridians are ones of plentiful qi and blood, they have a role of general regulation of the body, so, the treatment of paralysis should mainly use Yangming meridians. But when essence and blood wither, muscles tendons lose nourishment, the flaccidity of muscles and joints may also be manifested, which should be treated with the method, of nourishing yin to suppress yang. The related acupoints of yin meridians(Liver and Kidney Meridians) are selected and needled with reinforcing method, it can make yin and yang balance. The above treatment can not only regulate middle-jiao energy, but also protect the kidney-yin.

(2) It is the key ling of improving therapeutic effect to correctly use acupuncture manipulation. Reinforcing and reducing manipulation p1ays an important role in regulation of deficiency and excess of the patient's body. Generally, use the compound reinforcing and reducing method of lifting and thrusting, twirling and twisting, expirating and inspirating, and puncturing along and against the direction of channels respectively; or the reinforcing and reducing methods of heat-producing needling and cool-producing needling. Illness of deficiency type should be treated by tonifying method, while excess syndrome should be treated with the method of purgation and reduction, both reinforcing and reducing are used together, so as to balance between yin and yang, then the disease is cured.

(3 ) According to the theory of traditional Chinese medicine, apoplexy is usually caused by blood stasis. Author used acupuncture at the acupoints of limbs and body to achieve the purpose of curing disease through activating blood circulation and removing blood stasis.

(4) Prevention is very important to apoplexy, every one must pay attention to: (a) abstinence of eating and drinking, namely, don’t have crapulnce, don’t eat pungent and irritant food, forbid smoking and wine;(b)regular life, namely, alternate work with rest and recreation, living is regular, take part in proper exercise and don’t do overwork of the mental or physical labour;(c) regulating emotion, namely, don’t overexcite, don’t anger violently at something unpleasant to prevent up-tirring of liver-fire. In addition, this disease may be prevented with Eight Chief Acupoints for Prevention of Apoplectic Premonitation of taking Zhao’s Powder of Dispelling Wind and Dredging Collaterals.

In a word, apoplexy is an acute and fulminant disease, moreover, it often rescurs. It is frequently encountered and obstinately treated at present. I treated it adopting acupuncture-moxibustion combined with Chinese herbs and gained a good result.

By Zhao Hongwei,

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