The TCM Approach to CVA Rehabilitation Brian W.W. Jackson, L.Ac. University of Maryland School of Medicine Department of Family and Community Medicine Center for Integrative Medicine 10.23.17

A Historical Prospective 中风 The Yellow Emperor’s Internal Cannon (770-221 BC) Pu Ji Sudden Falls Da Jue Sudden Loss of Consciousness Pian Ku Hemiparalysis with flaccidity Chinese physicians were the first to characterize the clinical symptoms and define the causes of stroke:

Characteristics Medical History and Precursors to a stroke Majority of patients have a history of: Dizziness, Headaches, Vertigo, Hemidiaphoresis, Palpitations, Numbness and Tingling in the extremities (typically over one half of the body). Precursory Signs and Symptoms: Sudden fall, loss of consciousness, excessive phlegm leading to raspy breathing, hemiplegia, and spasticity of the tendons.

Early “Causal” Description Wind 風: Heat Wind 热风 Cold Wind 寒风 Heat Wind 热风: Those with hypertension, heart disease, diabetes, obesity, and a history of cardiovascular disease with major arterial occlusion. Cold Wind 寒风: Those with weak constitutions who are generally cold, thin, and PAD.

Differential Diagnosis 闭症 Closed Syndrome: 脱症 Emptying Syndrome： 闭症 Closed Syndrome: Spasticity of the tendons, constipation, urine retention, difficulty speaking, difficulty swallowing, unable to stretch or open the hands or the extremities. Mostly in those with Heat Wind. 脱症 Emptying Syndrome：Atrophy of the muscles, slackness of the lips, incontinence, unable to move the extremities. Mostly in those with Cold Wind.

A Change in Understanding Jin Yuan Dynasty (1115-1368) 刘河间: Hemorrhagic Stroke 李东垣: Embolic Stroke 朱丹溪: Ischemic Stroke (Atherosclerosis) STROKE-LIKE CONDITIONS 刘河间, Liu He Jian: Anger, Irritability, and an over expression of emotions – Fire. Hemorrhagic Stroke 李东垣, Li Dong Yuan : Insufficiency of nutrients and weak constitution – Qi Xu. Embolic Stroke 朱丹溪, Zhu Dan Xi: Dampness causes phlegm, phlegm causes heat, heat causes internal wind – Dampness. Ischemic Stroke (Atherosclerosis)

Traditional Acute Herbal Medicine Treatment 闭症 Closed Syndrome: Xu Ming Tang: Ephedra, Ligusticum, dried Ginger, Gypsum, Ginseng, Angelica Root, Cinnamon branch, Licorice, Almonds. 续命汤：麻黄，川芎，干姜，石膏，人参，当归，桂心，甘草，杏仁。 闭症 Closed Syndrome: Remove blockages and restore circulation first.

Traditional Acute Herbal Medicine Treatment 脱症: Shen Fu Tang: Ginseng, Monkshood Branched Root. 参附汤: 人参，附子。 San Sheng Yin Jia Ren Shen: Bile-prepared Arisaema, Camphorwood, Aconite Root, Ginseng, Monkshood Branched Root. 三生饮加人参：南星，木香，川乌，附子，人参 脱症: Immediately warm and supplement the body. Recover the qi then remove the wind.

Rehabilitation Herbal Medicine: Sheng Mai San (ginseng, ophiopogon tuber, schisandra fruit). Tui Na (Chinese massage and manual manipulations) Acupuncture

Acupuncture Yang Ming Jing (Stomach and Spleen)

Acupuncture Shao Yin Jing (Kidney and Heart)

Scalp-Acupuncture Somatomotor Cortex Somatosensory Cortex