Cerebrovascular Accident (CVA) / Stroke / Wind Stroke (zhong feng) Diagnosis and treatmet with Acupuncture

8/17/2019 Cerebrovascular Accident (CVA) / Stroke / Wind Stroke (zhong feng) Diagnosis and treatmet with Acupuncture

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Cerebrovascular Accident (CVA) / Stroke / Wind Stroke ( zhong feng)

Differential Diagnosis & Treatment

1. Clear Inner Wind Basic points:

4 pts for Inner Wind 4 gates6 pts for Inner Wind

4 gates + LI-11 + GB-34[one ea. from normal side = “crossing technique” – esp. good for wind-stroke]

8 pts for Inner Wind 6 pts + SP-6 + P-6 [best on normal side]

10 pts for Inner Wind 8 pts + LI-15 + GB-41 [best on normal side]

2. 1 Acute stage – Wind stroke of meridians:

Liver Yang Rising

d/t

LIV and KID Yin

Xu w/ Inner Wind

May first have sx’s of LIV

Yang Rising which thensuddenly turn into LIV /

Inner Wind

May be d/t age,

hypertension

More Yang type

(fire, wood types)

- Early signs: dizziness, vertigo, headaches,tinnitus, numbness of extremities, localweakness [hx of LIV Yang ^]

- Followed by: sudden deviation of the mouth,dysphagia, aphasia; hemiplegia; facial paralysis(central facial paralysis); disorientation; lose

balance/unsteadiness

- LIV & KID Yin Xu Sx:Weakness of lower back, …

*Some patients may have more sx of excess and

some with more sx of Xu – if Yin Xu: red face, 5

palm heat, etc – if Xu will have: lower back pain,

weakness of lower back and knees

*Pre-symptoms: eye twitching, feel numbness of

limbs

T: Red, small, thin

C: Thin yellow; or less or peeledP: Wiry, fast; may be superficial

Subdue LIV Yang,

Nourish LIV & KID Yin,

Remove Inner Wind -----------------

GB-20; DU-16, 20

KID-3, 6; SP-6; LIV-3; SJ-5GB-34

Sedate LIV Yang:LIV-3; SJ-5; GB-20; DU-20 (use

blood letting at DU-20, esp if high

bp)

Tonify LIV and KID Yin:

KID-3; SP-6; UB-52

Remove inner wind:

4 gates, DU-16

Points around joints for

hemiplegia:GB-40, 30; LI-15

Damp-Phlegm and

Inner Wind

harassing the

meridians

- Acute onset -

May be d/t high

cholesterol,

overweight

More Yin type

(water, earth types)

- Hx of overweight or weight gain/obesity, w/ highcholesterol

- Early: heavy head, headaches, heaviness of oneside of the body, foggy head or mental confusion

- Profuse yellow, sticky phlegm/sputum w/ chesttightness- Nausea, vomiting; dark yellow urination,constipation

- Followed by: deviation of mouth; hemiplegia;dysphagia, aphasia; numbness or flaccidity on oneside of the body- Unsteady gait

- Dizziness and vertigo

T: Red, may be swollen

C: Thick, greasy, white or yellowP: Wiry, slippery (fast)

Remove Inner Wind by

eliminating Damp-Phlegm;

Benefit meridians -----------------

Remove inner wind:

DU-16, 20; GB-20 -wind

Remove phlegm:

REN-17, 12; ST-40; SP-9; P-6


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2.2 Acute Stage – Wind Stroke of Organs

YANG CLOSING

LIV Yang rising w/

Rebellious Qi &

Blood w/ Inner

wind

- Rising of LIV yang willcarry up Qi and blood

-Ex. people who are

angry and then suddenly

collapse OR people whodrink too much, then

collapse

Yang Shi Sx:

- Clearly related to emotional d.o.- Sudden falling into convulsion with LOC

- Clenched teeth and mouth; closed fist; Tetanyor convulsions; red face

- Eyes remain open

- Warm or hot body temperature; no sweating- Constipation / retention of stool and urine- Restlessness; irritability

T: Scarlet C: Yellow, brown, black, dry

P: Slippery, wiry, fast

Sedate LIV Yang,

Remove Inner Wind,

Descend Qi andBlood, Open orifices

----------------

Five essential points (forconsciousness & to open the

HT): DU-20, 26; HT-1; P-8;

KID-1

Also: GB-20; LIV-2, 3SJ-5; DU-15, 16

Closed/

Tense

Syndrome

Loss ofconsciousness

Total Excess type

Clenched teeth,mouth, jaw, fist YIN CLOSING

Turbid Phlegm

blocking the 5

sense organs w/

Inner Wind

Yin Shi Sx:

- Clearly related to emotional d.o.

- Sudden falling down with convulsion, LOC- Pale face; clenched teeth, jaw, mouth; tight

faced

- Eyes are closed- No bm, no sweat- Cold limbs; cooler body temperature- No restlessness (may lie quiet)

- Rattling sound of phlegm in throat, or rough,fast breath, or wheezing

- Must remove phlegm/mucous or PT maysuffocate

T: Normal or pale; may be swollenC: Thick, greasy – whiteP: Deep and slippery

Remove Turbid Phlegm

and Inner Wind;Open orifices of internal

organs -------------------

5 Essential points:

DU-20, 26; HT-1; P-8;KID-1

REN-17, 12; ST-40; SP-9

Also:P-6; DU-16; GB-20, 34;

REN-11, 12; 4 gates

Collapse

syndrome/

flaccid

syndrome –

YANG

COLLAPSE

Yang Xu Sx:

- Sudden falling with LOC- Open mouth with eyes closed

- Incontinence + Yang Xu Sx- Incontinence of urine/stool, tears, nasal discharge,

saliva, …- Profuse loose or watery, cold sweating; feeble

breath- Cold extremities; pale face

T: Pale, swollen (with teeth marks)

C: Wet, moistP: Deep, feeble, slow - indistinctive

Save Yang from collapse

--------------

Moxa is very importantREN-4, 6; DU-20, 4UB-35 (mtg of Yang)

Moxa on REN-8: indirectwith salt.

> Single red ginsengdecoction (w/ ginseng that

is over 50 yrs old)


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Xu syndrome

Exhaustion of yinwith collapse ofyang

YIN

COLLAPSE

Last stage of

Windattacking the

organ

Yin Xu Sx:

- Suddenly fall down w/ LOC, or semi-conscious- Profuse, sticky, warm sweating (Essence comes

out)

- Red cheeks; warm limbs- Incontinence of urine/stools- Rapid & rough breath

T: Scarlet red, thinC: Mirrored, peeledP: Thin, weak, swift ( ji mai) [= 140-180 bpm]

Save Yin from collapse -------------------

REN-1 (w/ > 2 cun needle)w/ strong stim

KID-1, 3; SP-6

--

DU-20, REN-8, 4, 6When secondary syndromeunder control, then treat

primary syndrome.

3. CONVALESCENCE/ Recovery STAGE OF WIND STROKE:

LIV & KID Yin Xu

w/ Inner Wind

[Xu root: LIV Yang ^

is no longer present]

Pathogen is not so strongand vital Qi of body is

weakened, so more Xu.

- Headaches, dizziness, semi-consciousness – may

have several hours where lucid and then LOC- Twitching of muscles and skin- Red face- Tinnitus; trembling or stiff tongue; hemiplegia,

dysphagia, aphasia- Flaccidity / weakness of lower extremities, lower back pain; 5 palm heat, low grade fever, etc.- Constipation: may have 2nd bleeding d/t difficult bm

T: Scarlet, small, thin

C: Peeled coating with cracksP: Deep, wiry, thin and rapid

Nourish LIV and KID Yin;

Remove Inner Wind;

Prevent LIV Yang Rising -------------

KID-1, 3, 6; SP-6; LIV-3, 8;GB-39; DU-15, 16 (remove inner

W, sea of marrow)

UB-23, 52, 43

Retention of

Damp-Phlegm with

SP Qi Xu

Pathogen and Vital Qi of body both weakened.

- Semi-consciousness; drowsy, sleepy- Foggy headed; heavy sensation of body- Pale face; wooden

- Chest distension w/ nausea, vomiting w/ mucous- Poor appetite- Snoring with rattling sound of phlegm in throat

SP Qi xu:

- Loose stool; decreased appetite

T: Pale (swollen w/ tm) C: Thick, greasyP: Slippery w/o strength

- deep and weak on right side; if damp phlegm is moreexcessive, left side will be more wiry and slippery.

Tonify SP Qi; Remove

Damp-Phlegm and

Inner Wind -----------------

GB-8, 20; Yintang; REN-17, 22

Tonify SP Qi:ST-36, SP-6, UB-20, 21

Remove damp phlegm:

SP-9, REN-12, 17, ST-40

Remove inner wind: GB-20, DU-16, GB-34

Qi and Blood Xu

May arise from 1st or2nd type

Usually SP Qi xu and HT blood Xu. Usually in

later stages – pathogenhas impaired Vital Qi of

body.

- Exhaustion; pale face; poor spirit

- Poor memory (esp. short term), forgetfulness, badconcentration

- Insomnia, dd sleep, nightmares- Numbness or flaccidity of one side, local

weakness;twitching of muscles & skin, eyelids

- Hemiplegia, aphasia- Palpitations, poor appetite; loose stool or

diarrhea; alopecia

T: Pale C: Thin white coatP: Thin and weak; deep, thin, thready

Tonify Qi, Nourish Blood ----------

Si shen congST-36, SP-6; UB-15, 17, 20, 21SP-10; REN-14, 15

Remove inner wind:

GB-20, 34; DU-16


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4. SEQUELLAE STAGE OF WIND STROKE:

Central Facial Paralysis

To test for facial paralysis, have

patient blow (puff up cheeks)* Should distinguish:

1.

Central facial paralysis – d/tdamage caused by damage to brain

– will still have wrinkles on

forehead

2. Peripheral facial paralysis –damage to facial nerves – ex.

Bell’s palsy – one side of face willnot have wrinkles – will have

tender point behind ear (SJ-17,

GB-20)

- Deviation of tongue and

mouth – if drink waterand eat, will fall out ofcorner of mouth.

- Lateral nasolabial groove

disappears on one side- If severe, one eye cannot

be closed- If mouth deviated to one

side, it’s the other sidethat is affected

*Similar to treatment for Bell’s Palsy

Yin tang, Tai yang, Qian zhen (0.5 cun anterior to earlobe – “correct deviation”)

LI-20; SI-18, 19ST-3, 4, 6, 7

REN-24

*Do not need to use pts for forehead as in bell’s

- Can use gauze w/ Zheng Gu Shui w/ a metal

square (as conductor) for e-stim

Hemiplegia

Difficult to treat to

recovery. If treat within 6months with acupuncture,Western medicine and

physical therapy – good

prognosis.If more than one year,difficult to recover or

improve because musclestiffness, etc.

-May have numbness or weaknessor special sensation on affectedside

- Motor limitation – motorimpairment- Spasm paralysis – spasm ofeffected limb – hypersensitivity

- Flaccid paralysis – no spasm –only sx of numbness or weaknessor motor limitation.

Ancient text says to use points onYang Ming channel.

Now also use points on Shao Yang

channel.First do points on affected side – if

long time, do on healthy side to

balance.

Moxa is ok, but be careful d/treduced sensitivity

1- Pts on the Yang Ming for flaccidity (wei)

syndrome:LI-4, 11, 15; ST-31, 36, 40; etc.

2- Scalp acupuncture:- On opposite side- Long duration (3 hrs or overnight)- Strong stimulation, esp. w/ e-stim

- Do physical therapy w/ needlesAnterior oblique line of vertex – temporal (Si sheng

cong to GB-6) upper 1/5 for lower limb – middle

2/5 for upper limb – lower 2/5 for head. Punctureopposite side of affected side – retain 30 minutes

and ask patient to move around. Manipulate every5-10 minutes – twist 100-200x/min.

3- Hua Tuo Jia Ji points – many disorders ofzang fu organs:

*C3 - T3 – disorder of upper limbs*L1 - S1 – disorder of lower limbs

4- Body acupuncture:Flaccid paralysis, mainly Yang:

SJ-4, 5, 14; GB-30, 31, 34, 40; ST-36, 40Spasm paralysis, use yin and yang channels:Yin Channel points:

HT-1; LU-5; P-6; SP-6, 9; UB-40

Aphasia

Difficult to treat

– needs long time to treat.

- Impairment of speech- Stiff tongue

HT-5 (luo connecting point) DU-15 (“gate of muteness”) REN-23

Jing Jin (L) and Yu Ye (R) – prick for bloodletting

LU-7 + KID-64 cm scalp-line w/ GB-8 as center (speech area III)

Dysphagia

(difficulty swallowing)

- Difficulty swallowing d/t blockage of nerve system- Eating may cause choking

REN-23, 22; ST-9; LI-18LU-7 + KID-6 (open REN)

LI-17; SJ-16; SI-16, 17; LU-7; KID-6 (treat disease of

diaphragm and throat)

Documents

Cerebrovascular Accident (CVA) / Stroke / Wind Stroke (zhong feng) Diagnosis and treatmet with Acupuncture