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

Differential Diagnosis & Treatment

1.

Clear Inner Wind Basic points:

4 gates
4 gates + LI-11 + GB-34

4 pts for Inner Wind

6 pts for Inner Wind
8 pts for Inner Wind
10 pts for Inner Wind

[one ea. from normal side = crossing technique esp. good for wind-stroke]
6 pts + SP-6 + P-6 [best on normal side]

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 sxs of LIV
Yang Rising which then
suddenly turn into LIV /
Inner Wind

May be d/t age,

hypertension

- Early signs: dizziness, vertigo, headaches,

tinnitus, numbness of extremities, local
weakness [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

Subdue LIV Yang,

Nourish LIV & KID Yin,
Remove Inner Wind

----------------GB-20; DU-16, 20
KID-3, 6; SP-6; LIV-3; SJ-5
GB-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

T: Red, small, thin

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

Points around joints for

hemiplegia:
GB-40, 30; LI-15

More Yang type

(fire, wood types)

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/ high

cholesterol
- Early: heavy head, headaches, heaviness of one
side of the body, foggy head or mental confusion
- Profuse yellow, sticky phlegm/sputum w/ chest
tightness
- Nausea, vomiting; dark yellow urination,
constipation
- Followed by: deviation of mouth; hemiplegia;
dysphagia, aphasia; numbness or flaccidity on one
side of the body
- Unsteady gait
- Dizziness and vertigo

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

T: Red, may be swollen

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

2.2

Acute Stage Wind Stroke of Organs

YANG CLOSING
LIV Yang rising w/
Rebellious Qi &
Blood w/ Inner
wind

Closed/
Tense
Syndrome
Loss of
consciousness

- Rising of LIV yang will

carry up Qi and blood
-Ex. people who are
angry and then suddenly
collapse OR people who
drink too much, then
collapse

Total Excess type

Clenched teeth,
mouth, jaw, fist

YIN CLOSING
Turbid Phlegm
blocking the 5
sense organs w/
Inner Wind

Yang Shi Sx:

- Clearly related to emotional d.o.
- Sudden falling into convulsion with LOC
- Clenched teeth and mouth; closed fist; Tetany
or 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

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 may
suffocate
T: Normal or pale; may be swollen
C: Thick, greasy white
P: Deep and slippery

YANG
COLLAPSE

Collapse
syndrome/
flaccid
syndrome

Sedate LIV Yang,

Remove Inner Wind,
Descend Qi and
Blood, Open orifices
---------------Five essential points (for
consciousness & to open the
HT):
DU-20, 26; HT-1; P-8;
KID-1
Also: GB-20; LIV-2, 3
SJ-5; DU-15, 16

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

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

Save Yang from collapse

T: Pale, swollen (with teeth marks)

C: Wet, moist
P: Deep, feeble, slow - indistinctive

> Single red ginseng

decoction (w/ ginseng that
is over 50 yrs old)

-------------Moxa is very important

REN-4, 6; DU-20, 4
UB-35 (mtg of Yang)
Moxa on REN-8: indirect
with salt.

Xu syndrome
Exhaustion of yin
with collapse of
yang

YIN
COLLAPSE
Last stage of
Wind
attacking the
organ

3.

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

Save Yin from collapse

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

w/ strong stim
KID-1, 3; SP-6
-DU-20, REN-8, 4, 6
When secondary syndrome
under control, then treat
primary syndrome.

T: Scarlet red, thin

C: Mirrored, peeled
P: Thin, weak, swift (ji mai) [= 140-180 bpm]

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 strong
and vital Qi of body is
weakened, so more Xu.

Retention of
Damp-Phlegm with
SP Qi Xu

Pathogen and Vital Qi of

body both weakened.

- 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

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

T: Scarlet, small, thin

C: Peeled coating with cracks
P: Deep, wiry, thin and rapid
- 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)
P: Slippery w/o strength

C: Thick, greasy

- deep and weak on right side; if damp phlegm is more

excessive, 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 or
2nd type
Usually SP Qi xu and HT
blood Xu. Usually in
later stages pathogen
has impaired Vital Qi of
body.

- Exhaustion; pale face; poor spirit

- Poor memory (esp. short term), forgetfulness, bad
concentration
- 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

Tonify Qi, Nourish Blood

---------Si shen cong

ST-36, SP-6; UB-15, 17, 20, 21
SP-10; REN-14, 15
Remove inner wind:

GB-20, 34; DU-16

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

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/t
damage caused by damage to brain
will still have wrinkles on
forehead

2.

Peripheral facial paralysis

damage to facial nerves ex.
Bells palsy one side of face will
not have wrinkles will have
tender point behind ear (SJ-17,
GB-20)

Hemiplegia

Difficult to treat to
recovery. If treat within 6
months with acupuncture,
Western medicine and
physical therapy good
prognosis.
If more than one year,
difficult to recover or
improve because muscle
stiffness, etc.

Aphasia

- Deviation of tongue and

mouth if drink water
and eat, will fall out of
corner of mouth.
- Lateral nasolabial groove
disappears on one side
- If severe, one eye cannot
be closed
- If mouth deviated to one
side, its the other side
that is affected

-May have numbness or weakness

or special sensation on affected
side
- Motor limitation motor
impairment
- Spasm paralysis spasm of
effected limb hypersensitivity
- Flaccid paralysis no spasm
only sx of numbness or weakness
or motor limitation.

Ancient text says to use points on

Yang 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/t

reduced sensitivity

- Impairment of speech
- Stiff tongue

Difficult to treat
needs long time to treat.

Dysphagia
(difficulty swallowing)

- Difficulty swallowing d/t

blockage of nerve system
- Eating may cause choking

*Similar to treatment for Bells Palsy

Yin tang, Tai yang, Qian zhen (0.5 cun anterior to ear
lobe correct deviation)

LI-20; SI-18, 19
ST-3, 4, 6, 7
REN-24
*Do not need to use pts for forehead as in bells
- Can use gauze w/ Zheng Gu Shui w/ a metal
square (as conductor) for e-stim

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/ needles
Anterior 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. Puncture
opposite side of affected side retain 30 minutes
and ask patient to move around. Manipulate every
5-10 minutes twist 100-200x/min.

3- Hua Tuo Jia Ji points many disorders of

zang 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, 40
Spasm paralysis, use yin and yang channels:
Yin Channel points:
HT-1; LU-5; P-6; SP-6, 9; UB-40
HT-5 (luo connecting point)
DU-15 (gate of muteness)
REN-23
Jing Jin (L) and Yu Ye (R) prick for blood
letting
LU-7 + KID-6
4 cm scalp-line w/ GB-8 as center (speech area III)
REN-23, 22; ST-9; LI-18
LU-7 + KID-6 (open REN)
LI-17; SJ-16; SI-16, 17; LU-7; KID-6 (treat disease of
diaphragm and throat)