Stroke rehabilitation
Stroke is a stroke or "cerebrovascular accident", which refers to a disease caused by obstruction or rupture of cerebral blood vessels and cerebral blood flow and circulation disorders and damage to the function or structure of brain tissue. Stroke is divided into two categories: ischemic and hemorrhagic. Among them, ischemic stroke includes cerebral thrombosis and cerebral embolism, which are equivalent to the meridians in stroke in traditional Chinese medicine; hemorrhagic stroke includes cerebral hemorrhage and subarachnoid hemorrhage, which is equivalent to the internal organs in stroke in traditional Chinese medicine. The clinical onset is acute and changes rapidly, with symptoms such as disturbance of consciousness, difficulty in speaking, hemiplegia or confusion. Whether it is ischemic stroke or hemorrhagic stroke, it will cause different ranges and degrees of brain tissue damage, resulting in a variety of neuropsychiatric symptoms, which may be life-threatening in severe cases. Many patients will have sequelae after recovery.
Stroke, as the first of the four most difficult diseases in traditional Chinese medicine (wind, tuberculosis, diarrhea and diaphragm), has always been the focus of research by clinical doctors. Today, Kuaiwenjun is here to talk to you about the treatment of "stroke". Combining cases with experience, we can understand stroke more clearly, prevent stroke, and gradually eliminate stroke.
Case introduction
Stroke
Case 1: Luo, male, 57 years old, suffered from hemiplegia for 43 days. Symptoms include paralysis of the right limb, crooked mouth and eyes, difficulty in speaking, soreness and weakness in the waist and knees, palpitations and shortness of breath, frequent urination at night, constipation, and forgetfulness. , the tongue is extended to the right, the tongue is pale, there are ecchymoses on the edges, the fur is thin, and the pulse is thin and weak. Brain MRI showed: acute pontine cerebral infarction; lacunar infarction; no display of the left middle cerebral artery (congenital variation was considered). The syndrome is insufficient kidney qi, weak kidney essence, and blocked brain collaterals. The treatment is to nourish the kidney, activate blood circulation, and unblock collaterals.
recipe with Yougui Pill addition and subtraction, medicinal Rehmannia glutinosa 20g, cornus 10g, yam 20g, mulberry 20g, dodder 20g, antler glue 10g, Achyranthes bidentata 20g, Yizhiren For 2 months, the patient's right limb paralysis and other symptoms improved significantly. He was told to make a soup with black beans, deer tail, red ginseng or panax notoginseng to help the kidneys to replenish their essence. After adding or subtracting the above medicines for about a year, the symptoms were significantly reduced or disappeared.
Case 2: Wang, male, 67 years old, suffered from hemiplegia for 7 days. Symptoms include paralysis of the right limb, difficulty speaking, crooked mouth and tongue, dizziness, pale complexion, chest tightness and chest pain, shortness of breath and fatigue, drooling at the corner of the mouth, spontaneous sweating and palpitations, and indigestion. Abdominal distension and loose stools, pale tongue, fat body, tooth marks and ecchymoses on the edges, thin and white fur, tongue extension to the left, and slow and thready pulse. He had a 20-year history of hypertension, a 16-year history of coronary heart disease, and dyslipidemia. Brain MRI showed: acute cerebral infarction in the medulla oblongata; multiple lacunar infarcts; brain atrophy. My teacher believes that the syndrome is deficiency of the spleen and stomach, insufficient righteousness, phlegm, turbidity and blood stasis, obstruction of the meridians. The treatment is to replenish qi and activate blood circulation, remove blood stasis and unblock the meridians.
Liujunzi Hebuyanghuanwu Decoction addition and subtraction: Astragalus 60g, Poria 15g, Codonopsis 20g, Atractylodes 15g, Tangerine Peel 10g, Pinellia 20g, Nanxing 20g, Red Peony 420g , 10 grams of Ligusticum chuanxiong, 15 grams of Angelica sinensis, 15 grams of Dilong, 10 grams of safflower, 30 grams of Spatholobus, 15 grams of turmeric, 15 grams of Paoshan beetle, plus 5 centipedes, 10 grams of whole scorpions, etc. Phlegm and blood stasis in the middle. After 3 months of additive and subtractive treatment based on the above, the symptoms were significantly relieved. He was told to make soup with Panax notoginseng and red ginseng to help the medicine. After one year of treatment, the patient's blood lipids returned to normal and his blood pressure stabilized, except for the right limb. Except for slight difficulty in activities, all other symptoms were alleviated or disappeared.
Case 3: Zhang, female, 46 years old, had difficulty moving her right limbs and had numb skin for 1 month. Symptoms include hemiplegia, tense limbs, crooked mouth and tongue, occasional dizziness, heavy head, chest tightness, nausea, and slight nausea. There are cold and heat, spontaneous sweating, tongue extension to the right, pale tongue, thin white greasy coating, and slow and moist pulse. Mild abnormality in blood lipids; brain MRI showed: acute cerebral infarction in the left basal ganglia (lenticular nucleus); local stenosis and thinning of the proximal end of the left middle cerebral artery. My teacher pointed out that this is caused by insufficient healthy energy, empty collaterals, external evils and wind invading the human body, causing internal phlegm to block the collaterals, and the treatment is to expel wind, remove phlegm, and unblock the collaterals.
Recipe uses Xiaoxuming Decoction combined with Banxia Atractylodes and Gastrodia Decoction. Additions and subtractions: 10 grams of ephedra, 10 grams of almonds, 15 grams of cinnamon twigs, 15 grams of angelica root, 20 grams of Chuanxiong, 15 grams of Codonopsis pilosula, 15 grams of white peony root, 10 grams of skullcap, and Fangfeng 15 grams, 15 grams of silkworm, 15 grams of Sichuan clam, 15 grams of pinellia, 15 grams of Atractylodes, 15 grams of Gastrodia, 15 grams of tangerine peel, 10 grams of Poria, and 10 grams of licorice. After taking the medicine mainly with and without modification for 3 months, the symptoms were significantly reduced or disappeared. After that, my master asked him to make soup with purple river chariot or blood clam, intending to use the flesh and blood to moisten the meridians, so as to facilitate the meridians and nourish the internal organs and meridians. Especially for this patient's menopause, it can regulate qi and blood. , replenishing kidney essence and nourishing the uterus.
Case 4: Sun, male, 53 years old, suffered from hemiplegia of the left limb for 2 weeks. Symptoms include hemiplegia of the left limb, dizziness, fatigue and shortness of breath, headache, insomnia, excessive dreams and easy awakening, fatigue, palpitations and forgetfulness, indigestion, and abdominal distension. , excessive urination, loose stools, pale and fat tongue with tooth marks on the edges, thin and greasy coating, and thready and astringent pulse. Brain MRI showed: acute cerebral infarction in the right thalamus; multiple lacunar infarcts. My teacher’s syndrome differentiation analysis concluded that the syndrome is deficiency of the heart and spleen, blood stasis blocking the collaterals, and the treatment is to nourish the heart and strengthen the spleen, activate blood circulation, and unblock the collaterals.
Guipi Decoction and Suanzaoren Decoction are added and subtracted. Medicinal Codonopsis 20g, Astragalus 20g, Atractylodes 15g, Polygala 15g, Poria 15g, Acosta 10g, Amomum villosum 10g, Fried jujube 20g, Baiziren 10g, Angelica 15g, Chuanxiong 20g grams, 3 slices of ginger, 10 jujubes. After taking the medicine for 2 weeks, the dizziness, insomnia, dreaminess and easy awakening were obviously improved, but the improvement of other symptoms was not obvious. For the second diagnosis, 10 grams of Fangfeng, 10 grams of Yizhiren, 5 centipedes, 10 grams of whole insects were added and 6 more pills were taken. Months later, the symptoms improved significantly. Later, he was told to make soup with astragalus and angelica to nourish qi and blood.
Case 5: Liu, male, 60 years old, suddenly fell into coma and was unconscious for one day. He was admitted to the hospital with symptoms of unconsciousness, eyes closed and mouth open, limbs limp, weak breathing, pale complexion, incontinence of feces and urine, and dilated pupils. The tongue is light purple and curled, the coating is white and greasy, and the pulse is thready and rapid. He had a 25-year history of hypertension and hyperlipidemia. Brain MRI showed: large-area acute cerebral infarction in the left temporo-parietal lobe with focal hemorrhage; multiple lacunar infarctions; white matter desheathing changes; and brain atrophy.
This patient suffered from a second stroke. My doctor’s analysis concluded that the essence of the internal organs had declined, and the triggers were added, which suddenly caused the yin to be exhausted below and the yang to float above. Syndrome differentiation is urgent to replenish qi and return yang, strengthen the body and stabilize the condition. Take Shenfu Decoction, 60 grams of ginseng and 60 grams of Fuzi are taken in decoction, and add and subtract Rehmannia glutinosa to replenish true yin and warm and strengthen kidney yang.
2 days later, the patient was awake, but could not speak or move. The remaining symptoms were not relieved, and he was still taking Dihuang Yinzi with or without addition. One week later, the patient could speak a little and complained of insomnia and dreaminess, soreness and weakness in the waist and knees, blurred vision, and right hemiplegia. The mouth and tongue are crooked, the tongue is dark red with petechiae on the edges, there is little coating, and the pulse is thin and weak. Following the modified treatment with Guifu Dihuang Pills, 30 grams of Fuzi, 15 grams of Guizhi, 30 grams of Rehmannia glutinosa, 15 grams of Cornus officinalis, 30 grams of Huaishan, 15 grams of Alisma, 10 grams of paeonol, 15 grams of Poria, and 15 grams of Angelicae. , 15 grams of red peony root, 10 grams of peach kernel, 15 grams of curculigo, 10 grams of fairy spleen, 30 grams of raw keel, and 30 grams of calcined oyster. My teacher pointed out that the syndrome is excessive excess at the top and deficiency at the bottom, and the treatment should be to nourish yin and subdue yang, induce blood to flow downward, and prevent liver yang from floating up. The liver body is yin and the yang is used, supplemented by medicines that nourish the blood, activate blood circulation and remove blood stasis, to help regulate the liver qi. You can choose products that are nourishing, lowering, and flavorful. They can be used to replenish the deficiency of yin essence in the lower Jiao. The medicine should be sweet, warm and moist, not cold. , the method seeks to complement both yin and yang, which means "seeking yin from yang". The medicine was mainly used for 3 months. The patient had no special discomfort except for difficulty in moving the right limbs and oblique mouth and eyes. My teacher recommended long-term traditional Chinese medicine conditioning and instructed him to regularly make spine soup with soybeans, black beans, Panax notoginseng, Huaishan, etc. to warm the spleen and kidneys, unblock collaterals and activate blood circulation to help the patient recover from the disease. After half a year, the patient's difficulty in limb movement and squinting of the mouth and eyes improved significantly. .
My teacher pointed out that it is necessary to trace the origin of the disease in treating the disease. The cause, pathogenesis, course, nature and location of the disease change with the development of the disease. This is especially true for stroke. The clinical syndrome cannot only be based on The diagnosis and treatment based on the syndrome differentiation and classification in textbooks or a certain guide should start from the cause, pathogenesis, nature and location of the disease itself, and constantly adjust the medication according to the evolution of the disease. What it has changed.
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This article comes from "Luo Luyi's Clinical Experience Collection" edited by Luo Luyi, a senior doctor on the Kuaiwen platform. It was first published in Toutiao. Please indicate the source and source when reprinting. The pictures are from the Internet, and the copyright belongs to the original author. Red envelopes are waiting for you! Hee hee!
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