Wind Stroke

Etiology and Pathogenesis. Wind stroke often occurs in the aged who are in poor health, with deficiency of qi and blood, or deficiency in the lower part of the body and excess in the upper part. It may be caused by deficiency of the kidney yin due to sexual indulgence, or by irregular food intake, which impedes the transportation and transformation function of the spleen, leading to production of phlegm from accumulated dampness and transformation into heat. Then there appears imbalance of yin and yang in the zang - fu organs. Other causative factors are exasperation, agitation, alcohol indulgence or overeating, overstrain and stress, or invasion ol exogenous pathogenic wind, all leading to upsurge of liver yang and heart fire, which makes qi and blood go upward together with turbid phlegm, disturbing the mind and resulting in this disease. In mild cases there are only symptoms showing dysfunction of the meridians and collaterals, while in severe cases both dysfunction of zang - fu organs and that of the meridians and collaterals are manifested. The syndrome indicating the attack on the zang - fu organs may be subdivided into tense (excess) type and flaccid (deficiency) type.

Tense (excess) syndrome results from disturbance of the mind by the phlegm heat, or collection of excessive fire in the heart and liver, while flaccid (deficiency) syndrome results from deficiency of the primary qi or collapse of the kidney yang. In untreated or improperly treated cases, the tense syndrome tends to become flaccid and the prognosis is often poor.

Tense syndrome (bi zheng)

Main manifestations: Falling down in a fit with loss of consciousness, tightly closed hands and clenched jaws, flushed face. coarse breathing, rattling in the throat, retention of urine, constipation, red tongue with thick yellow or dark gray coating, string - taut, rolling and forceful pulse.

Analysis: Wind stirred up by upsurge of liver yang sends qi and blood upwards, which together with the accumulated phlegm Fire disturb the mind, leading to sudden loss of consciousness with tightly closed hands and clenched jaws, flushed face, coarse breathing, retention of urine and constipation. Excessive wind phlegm brings about rattling in the throat. Red tongue with thick yellow coating or dark gray coating, string - taut, rolling and forceful pulse are the signs of wind combined with phlegm Fire.

Differentiation

Wind Fire

red face
Acupuncture – *Du 26, Shi Xuan (bleed), *PC 6, LR 3, GB 20, all open orifices to revive patient and clear externally caused Liver Wind

Phlegm-Fire

red face, rough noisy breathing
Acupuncture – *Du 26, Shi Xuan, *PC 6, ST 40, Ren 22

Phlegm-Damp

similar to Cold Bi, limbs are more flaccid than with Heat, gurgling sound in throat, cold limbs
Acupuncture - *Du 26, *PC 6, Shi Xuan, ST 36, SP 6, ST 40, Ren 6 (moxa)

Additional Method: Points of the Du Meridian, the Liver Meridian of Foot - Jueyin and the twelve jing-well points are selected as the main points to promote resuscitation, reduce wind and Fire and resolve phlegm. Either reducing method or pricking, to cause little bleeding, is applied.

Prescription:

[DU20 - DU26 - ST40 - LR3 - KI1 - twelve jing-well points on both hands (LU11, HT9, MH9, LI1, TH1)]

Supplementary Points:

Clenched Jaws: [ST7 - ST6 - LI4]
Aphasia and stiffness of tongue: [DU15 - RN23 - HT5].

Explanation: As the condition is due to disturbance of the heart by phlegm associated with up surging of liver yang and upward flowing ofqi and blood, DU20 and DU26 are selected to regulate qi of the Du Meridian, effecting resuscitation, KI1 is selected to conduct the heat downward, and LR3 to subdue the upsurging of qi in the Liver Meridian and pacify the liver yang. Pricking the twelve jing-well points on both hands, where qi of the three yin and three yang meridians meet, may dispel heat and regain consciousness. The spleen and stomach are the source of phlegm production. ST40, the luo-connecting point of the Stomach Meridian can invigorate the functions of the spleen and stomach and help to resolve the turbid phlegm. Since the Yangming Meridians of Hand and Foot supply the cheeks, ST7, ST6 and LI4 are chosen to promote the circulation of qi and blood for relieving the clenched jaws. DU15 and RN23, being local and adjacent points of the tongue, and HT5, the luo- connecting point of the Heart Meridian, may relieve stiffness of tongue

Flaccid syndrome (tou zheng)

Main manifestations: Falling down in a Fit and sudden loss of consciousness with mouth agape and eyes closed, snoring but feeble breathing, flaccid paralysis of limbs, incontinence of urine, flaccid tongue, thready, weak pulse, and in severe cases cold limbs, or flushing of face as rouged, fading or big floating pulse.

Analysis: Severe weakness of primary qi, separation of yin and yang and exhaustion of qi in the zang organs are indicated in mouth agape, eyes closed, snoring but feeble breathing, flaccid paralysis, and incontinence of urine. Flaccid tongue and thready weak pulse suggest the deficiency of blood and prostration of the kidney yang. If complicated with cold limbs, flushed face, fading or big floating pulse, it is a critical case, indicating exhaustion of yin in the lower portion of the body and upward going of the isolated yang.

Explanation: RN8, RN6 and RN4 are located on the lower abdomen along the Ren Meridian and are the main points effective for collapse. Heavy moxibustion applied on RN4, a meeting point of the Ren Meridian and three yin meridians, can strengthen the primary qi, and restore yang from collapse.

There are two categories. One is that only the meridians and collaterals are attacked without the zang - fu organs being involved. The other is that after wind stroke the functions of the affected zang - fu organs have been restored, yet there exists stagnation of qi and blood in the meridians and collaterals.

Main manifestations: Hemiplegia, numbness of the limbs, deviated mouth, slurring of speech, accompanied by headache, dizziness, vertigo, twitching of muscles, red eyes and flushed face, thirst, dryness of the throat, irritability, string taut and rolling pulse.

Analysis: Wind phlegm enters the meridians and collaterals due to imbalance of yin and yang, or after treatment the functions of the affected zang - fu organs have been restored, but wind phlegm still blocks the meridians and collaterals, causing retarded circulation ofqi and blood. Hence appears hemiplegia, numbness of the limbs, deviated mouth and slurring of speech. 'If complicated with upsurging of liver yang, and upward disturbance of wind yang, the symptoms are headache, dizziness, vertigo and twitching of muscles. If there is excessive fire in the heart and liver, there may be red eyes and flushed face, thirst, dryness of the throat and irritability. Stagnation of wind phlegm in the meridians and collaterals leads to a string - taut and rolling pulse.

Method: Points along the Du Meridian and the yang meridians of the affected side are mainly used to regulate qi and blood, remove obstruction from the meridians and collaterals and reduce the wind. Needle with even movement first from the healthy side and then the affected side.

Prescription: [DU20 - BL7 - DU16].

Upper limbs: [LI15 - LI11 - TH5 - LI4].

Lower limbs: [GB30 - GB34 - ST36 - ST41].

Supplementary points: Upward disturbance of wind yang: Reducing is applied to GB20 and LR3, and reinforcing to KI3 and SP6. Excessive fire in the heart and liver: Reducing is applied to MH7 and LR2, and reinforcing to KI3.

Deviated mouth: [ST4 - ST6].

Explanation: Du Meridian is the sea of all yang meridians. DU20, DU16 combined with BL7 can eliminate wind and remove obstruction from the meridians and collaterals. Since the yang meridians dominate the exterior of the body and qi, points of the yang meridians are selected to regulate qi and blood of the body and promote smooth circulation in the upper and lower portions of the body. For the upper disturbance of wind yang, GB20 and LR3 are selected to reduce the wind and pacify the liver. Reinforcing applied to KI3 promotes the production of the kidney yin to nourish the liver. Reinforcing applied to SP6 nourishes yin and paciFies yang.

For excessive fire in the heart and liver, reducing MH7 and LR2 can eliminate the fire, while reinforcing KI3 nourishes yin to reduce the fire. ST4 and ST6 are selected for the purpose of promoting a free circulation ofqi in the meridians and collaterals around the facial region.

Liver Yang suddenly rises

emotional stress, overwork, hemiplagia, stiff tongue, mouth deviation, dizziness, headache, red face & eyes, easy to anger, constipation, yellow urine, P- strong wiry, T- red (or deep red) with yellow and/or dry coat.
Acupuncture – Du, hand Jueyin, foot Shaoyang, *Du 26 & *PC 6 (open orifices), *SP 6, LR 3, LI 11, SJ 5,   GB 30, 34, HT 1, Ren 23, Jin Jin/Yu Yue (bleed)

Wind-Phlegm

hemiplagia, deviation, numbness and spasm of limbs, dizziness, cloudy mind, blurred vision, T- greasy coat, P- wiry slippery, generally more overweight people
Acupuncture – Du, foot Taiyin, Shaoyang, *Du 26, *PC 6, * SP 6, ST 36, 40, SP 9, HT 1, LI 11, SJ 5, GB 30, 31, 34

Yangming excess with Phlegm-Heat

same as above, with sticky mouth and constipation, T- red smoky coat
Acupuncture – foot Yangming, *Du 26, *PC 6, * SP 6, ST 25, 37, 40, HT 1, LI 11, SJ 5, HT 1, GB 30, 31, 34

Qi deficiency with Blood Stasis

hemiplagia with flaccid limbs, numbness, shortness of breath, spontaneous sweats, palpitations
Acupuncture - *Du 26, *PC 6, * SP 6, HT 1, LI 11, SJ 5, GB 30, 31, 34, Ren 6, BL 23, ST 36, Du 14 (stop   sweat), Moxa

Liver Kidney Yin deficient Wind

Acupuncture - *Du 26, *PC 6, *SP 6, HT 1, LI 11, SJ 5, GB 30, 31, 34, BL 23, KI 3, LR 3

Zang Fu effected

Caused by Wind and Fire attacking the organs, this is more severe than meridian invasion.

auricular- subcortes, brainstem, frontal, occipital, temporal, LR, HT, KI, effected body parts
scalp- wait until the situation is stable, puncture opposite side of paralysis, use motor, motor sensory, and speech regions.
electrical- must wait until situation is stable, use on head, arm, leg, 2 points each, intermittent, or alternating frequency

 *For chronic stroke patients, alternate puncturing the effected side and the normal side.

Prevention points: GB 31, 39

Wind stroke is referred to cerebral hemorrhage, thrombosis, embolism, subarachnoid hemorrhage, etc. When the acute stage is over, there may be sequelae, such as hemiplegia, monoplegia, aphasia, etc.

Prophylactic measures for wind stroke: The old aged with. deficiency of qi and excessive phlegm, or with manifestations of up surging of liver yang marked by dizziness and palpitations, may have premonitory symptoms such as stiff tongue, slurred speech and numbness of the Finger tips. Attention should be paid to diet and life style and avoid overstraining. Frequent moxibustion on ST36 and GB39 may prevent an attack of wind stroke.