This disease is more common in middle-aged and elderly people. It can occur in all seasons, but is most common in winter and spring.
Stroke seriously endangers human health, with high mortality and high disability rate. It ranked first among the causes of death among the urban population in my country in 1994 and was one of the top three causes of death among the population in developed countries. 
Stroke is a critical and serious illness and is extremely common in clinical practice. The main cause of the disease is accumulated damage and decline. The disease is located in the brain, often involving the heart, liver, kidneys, and spleen. Its pathogenesis is mostly caused by the reversal of Qi and blood, resulting in cerebral artery blockage or blood overflow outside the cerebral artery. Clinically, it is divided into two categories: middle meridians and middle viscera according to the degree of damage to the brain and spinal cord and the presence or absence of mental confusion. In terms of the nature of the disease, it is mostly defined as deficiency in origin and excess in excess. In the origin, it is deficiency of liver and kidney yin, with weak Qi and blood; in the underlying condition, it is caused by wind and fire, excessive phlegm and dampness, blood stasis, and reverse Qi and blood. In terms of treatment, based on the type of disease (differences in meridians and internal organs), disease stage (differences in acute phase, recovery phase, sequelae phase) and syndrome characteristics, the methods of activating blood circulation and removing blood stasis, resolving phlegm and dredging collaterals, calming the liver and extinguishing wind are adopted. , clearing away phlegm and heat, clearing the viscera and resolving phlegm, replenishing qi and activating blood, nourishing yin and extinguishing wind, refreshing the mind and resuscitating the mind, restoring yang and consolidating phlegm, etc. The treatment of stroke should adopt comprehensive therapy and pay attention to rehabilitation training. Before the disease occurs, if there are signs of stroke, it must be actively prevented and treated.
1. Syndrome differentiation and treatment of stroke
Middle meridians
1. Wind, phlegm and blood stasis, obstruction of the meridians
Symptoms: Hemiplegia , crooked tongue, strong tongue, stammering or silence, numbness on one side of the body, dizziness, tongue texture Dull, thin white or greasy tongue coating, stringy and slippery pulse.
Treatment method: activate blood circulation and remove blood stasis, resolve phlegm and unblock meridians.
Recipe : Taohong Siwu Decoction and Ditan Decoction.
In the prescription, Taohong Siwu Decoction promotes blood circulation, removes blood stasis and unblocks collaterals; Ditan Decoction clears phlegm and opens the mind. If the symptoms of blood stasis are prominent, the tongue is dark purple or there are ecchymoses, the dosage of peach kernel, safflower and other drugs can be increased to enhance the power of activating blood circulation and removing blood stasis. For those with yellow and greasy tongue coating, irritability and heat symptoms, add skullcap and gardenia to clear away heat and relieve fire. For dizziness and headache, add chrysanthemum and prunella vulgaris to soothe the liver and calm the wind. If you have difficulty in defecation, you can add rhubarb to relieve heat and cool the blood. The dosage of rhubarb should be light to remove phlegm and heat accumulation, but not excessive. This type can also choose the modern empirical prescription Huatan Tongluo Decoction, which contains Pinellia ternata, Poria cocos and Atractylodes macrocephala to strengthen the spleen and remove dampness; Dannanxing and Tianzhuhuangqing resolve phlegm and heat; Gastrodia elata calms the liver and calms wind; Cyperus rotisserie soothes the liver and regulates qi and regulates qi. machine to help the spleen transport and transform; with Salvia miltiorrhiza to activate blood circulation and remove blood stasis; rhubarb to relieve heat and cool blood.
2. Hyperactivity of liver yang, disturbance by wind and fire
Symptoms: hemiplegia, numbness on one side of the body, strong tongue or speechlessness, or crooked mouth and tongue, dizziness and headache, red face and eyes, bitter mouth and dry throat, upset and irritable, urination Red and dry stools, red or crimson tongue, stringy and strong pulse.
Treatment method: calm the liver and extinguish wind, clear away heat and activate blood circulation, and nourish the liver and kidneys.
Prescription: Gastrodia Uncaria Drink.
In the prescription, Gastrodia elata and Uncaria soothes the liver and calms wind; Cassia spp. calms the liver and subdues yang; Scutellaria baicalensis and Gardenia clear away heat and purge fire; Achyranthes achyranthes causes blood to descend; Motherwort promotes blood circulation and diuresis; Eucommia ulmoides and Mulberry nourish the liver and kidneys; Nocturnal intercourse Vine and Poria calm the mind and calm the mind. For dizziness and headache, add chrysanthemum and mulberry leaves to dispel wind and clear away heat; for irritability and irritability, add paeonol bark and turmeric to cool blood and relieve depression; for dry stools and constipation, add raw rhubarb. If the patient's consciousness is trance-like or hazy, it is caused by wind and fire disturbing the clearing of the orifices and transforming from the middle meridians to the middle viscera. Niuhuang Qingxin Pills or Angong Niuhuang Pills can be combined to clear the mind and awaken the mind.
3. Phlegm is hot and the bowels are full, and wind and phlegm disturb
Symptoms: hemiplegia, crooked mouth and tongue, slurred or silent speech, numbness on one side of the body, abdominal distension, dry stools, constipation, dizziness, expectoration or excessive phlegm, dark red or dull tongue , ·Yellow or greasy coating, stringy and slippery pulse or stringy, slippery and large pulse on the side of hemiplegia.
Treatment method: clear the bowels and resolve phlegm.
Recipe: Dachengqi Decoction with added flavor.
The raw rhubarb in the prescription cleanses the stomach and intestines, clears the intestines and relieves heat; Glauber's salt is salty and cold, softening the hardness; Citrus aurantium extract relieves phlegm; Magnolia officinalis is wide and full. You can add Trichosanthes trichosanthes and Dan Nanxing to clear away heat and resolve phlegm; add Salvia miltiorrhiza to activate blood circulation and unblock meridians. For those with obvious heat symptoms, add Gardenia jasminata and Scutellaria baicalensis; for those who are old and frail and suffer from body fluid deficiency, add Rehmannia glutinosa, Ophiopogon japonicus and Scrophulariaceae. This type can also choose Fang Xinglou Chengqi Decoction based on modern experience. The prescription contains rhubarb and Glauber's salt to cleanse the stomach and intestines and relieve heat; Trichosanthes trichosanthes and Dan Nanxing clear away heat and resolve phlegm.
If the stool remains unresolved for many days, and the phlegm-heat is stagnant, causing restlessness, restlessness, drowsiness, and delirium, this is a sign of turbid qi that does not fall and carries qi and blood upwards, invading the brain orifices, and is a syndrome of the middle viscera. , treat according to the phlegm-heat in the internal organs and internal obstruction and clearing of the orifices.
Needle can treat the obstruction of the fu-organs and Qi in this syndrome, and the method of resolving phlegm and unblocking the fu-organs can firstly unblock the fu-organs' qi, remove blood stasis and reach the collaterals, apply a compress on the qi and blood, and further improve symptoms such as hemiplegia; secondly, it can remove the phlegm-heat blocking the gastrointestinal tract. The accumulation of stagnation prevents turbid evil from disturbing the gods, and the reversal of qi and blood can be corrected, achieving the purpose of preventing closure and prolapse; thirdly, Yin can be stored in the lower body quickly to prevent Yin from being catastrophic inside and Yang from being expelled from the outside.
4. Qi deficiency and blood stasis
Symptoms: hemiplegia, crooked mouth and tongue, salivation at the corners of the mouth, slurred or silent speech, numbness on one side of the body, pale complexion, shortness of breath and fatigue, palpitations, spontaneous sweating, loose stools, swollen hands and feet, dark tongue, tongue coating Thin white or white and greasy, pulse is heavy, slow or stringy.
Treatment method: Replenishing Qi and activating blood circulation, strengthening the body and dispelling evil.
Prescription: Bu Yang Huan Wu Decoction.
This prescription emphasizes the use of astragalus to replenish qi, combined with angelica to nourish blood, and combined with red peony root, chuanxiong rhizome, peach kernel, safflower, and earthworm to activate blood circulation, remove blood stasis and unblock meridians.
In the recovery and sequelae stages of stroke, qi deficiency and blood stasis are the basic pathogenesis, so this prescription is often used in the treatment of the recovery and sequelae stages. For patients with obvious qi deficiency, add Codonopsis pilosula and Radix Pseudostellariae to replenish qi and unblock collaterals; for speech problems, add Polygala, Acorus and Yujin to expel phlegm and improve the orifices; for palpitations and wheezing, add cinnamon twig and Zhigancao to warm the meridians and unblock yang; for numbness of the limbs. Add papaya, Shenjincao and Fangji to relax the muscles and activate the collaterals; for those with partial upper limbs, add cinnamon twigs to unblock the collaterals; for those with weak lower limbs, add Chuanduan, mulberry, Eucommia ulmoides and Achyranthes bidentata to strengthen the muscles and bones; for urinary incontinence, add mulberry octopus and octopus. Yizhiren is used to warm the kidneys and fix astringency; for severe blood stasis, add zedoary, leech, ghost arrow feather, chicken blood vine and other blood-breaking and dredging products.
5. Hyperactivity of liver yang
Symptoms: hemiplegia, crooked mouth and tongue, strong tongue or no words, numbness on one side of the body, irritability and insomnia, dizziness and tinnitus, heat in the palms and soles, red or dark red tongue, little or no coating, The pulse is thin and stringy or stringy.
Treatment method: Nourish the liver and kidneys, subdue yang and extinguish wind.
Recipe: Zhengan Xifeng Decoction.
In the prescription, Achyranthes achyranthes nourishes the liver and kidneys and draws blood downward; dragon bone, oyster, and ocher calm the liver and subdue yang; turtle shell, white peony root, scrophulariaceae, and asparagus nourish yin fluid to control excessive yang; wormwood, malt, Sichuan dongzi clears liver yang and reaches the liver qi; licorice, malt and stomach are regulated. It can also be combined with Uncaria and chrysanthemum to extinguish wind and clear away heat. For those with phlegm and heat, add Tianzhuhuang, bamboo drain, and Fritillaria fritillary to clear away the phlegm and heat; for those who are upset and insomniac, add Scutellaria baicalensis and Gardenia to clear the mind and relieve troubles, and add Noctua japonica and Pearl of Pearl to soothe the mind. To soothe the nerves; for severe headaches, add Cassia and Prunella vulgaris to clear the liver and calm wind.
middle internal organs;
1.·Phlegm-heat internal obstruction to clear the orifices (yang closure)
Symptoms: sudden onset, dizziness or coma, hemiplegia, snoring and phlegm, strong spasm of limbs, neck and back body heat, restlessness Disturbance and restlessness, severe coldness of the hands and feet, frequent twitching, occasional vomiting of blood, red tongue, yellow and greasy or dry tongue coating, stringy and slippery pulse.
Treatment method: clear away heat and resolve phlegm, awaken the mind and rejuvenate the mind.
Prescription: Lingjiao Uncaria Decoction combined with oral administration or nasal feeding of Angong Niuhuang Pills.
Antelope horn is the main medicine for clearing the liver and extinguishing wind; mulberry leaf soothes the wind and clears away heat; Uncaria and chrysanthemum soothe the liver and calm the wind; Rehmannia glutinosa clears away heat and cools the blood; white peony root softens the liver and nourishes the blood; Fritillaria fritillaris and bamboo root clear away heat and resolve phlegm; Fu Shen It nourishes the heart and calms the mind; licorice harmonizes various medicines. Angong Niuhuang Wan can be pungent and cool to penetrate the body.
If phlegm-heat is present in the body and there is phlegm sound in the throat, you can add bamboo drain water to relieve phlegm and relieve spasm. For those with strong liver fire, flushed face, red eyes, stringy and strong pulse, you can add gentian and gardenia to clear the liver and purge the fire; for those with excess heat in the viscera, abdominal distension and constipation, and yellow and thick fur, cut raw rhubarb, citrus aurantium, and Glauber's salt. To clear the fu organs and induce stagnation.
2. Phlegm and dampness congesting the mind and mind (yin closure)
Symptoms: Yang deficiency in the body, sudden dizziness, hemiplegia, loose limbs, limpness and lack of warmth, or even cold limbs, white face and dark lips, excessive phlegm and saliva, tongue texture Dull, white and greasy tongue coating, slippery or slow pulse.
Treatment method: Warm yang and resolve phlegm, awaken the mind and rejuvenate the mind.
Prescription: Ditan Decoction combined with oral administration or nasal feeding of Suhexiang Pills.
In the prescription, pinellia, tangerine peel and poria strengthen the spleen, dry dampness and resolve phlegm; Dannanxing and Bamboo Ruqing resolve phlegm and heat; Acorus calamus resolves phlegm and opens the mind; ginseng supports healthy qi. The aroma of Suhexiang Pills dissolves turbidity, awakens the mind and refreshes the mind. If the cold sign is obvious, add cinnamon twigs to warm the yang and turn it into a drink; if there is wind sign, add Gastrodia elata and Uncaria to calm the liver and calm the wind.
3. Loss of vitality and confusion (dispersion)
Symptoms: sudden dizziness or coma, limp limbs, excessive cold sweating with hands withdrawn, in severe cases, the whole body is clammy, incontinence of bowel movements, impotence of the tongue, dark purple tongue, and white coating Greedy, slow, slow pulse.
Treatment method: Replenish qi, restore yang and solidify the disease.
Recipe: Shenfu Decoction.
In the prescription, ginseng greatly replenishes vitality, while aconite warms the kidneys and strengthens yang. The two medicines are used together to replenish qi, restore yang and strengthen the body. If the sweating is not stopped, add cornus, astragalus, dragon bone, and oyster to stop sweating and consolidate the sweat; if there is stasis, add salvia miltiorrhiza.
This certificate is the detachment mentioned in the key points of syndrome differentiation.
Stroke is a medical emergency. It has an acute onset and changes rapidly. During the acute attack period, especially the closure and withdrawal of the middle organs should be based on opening, closing and solidification. The following treatment methods can be used. Those with serious illness should actively cooperate with Western medicine. treatment. During the sequelae stage, the following external treatments can be used to promote recovery.
1． Qingkailing injection can be used for intravenous infusion of yang blockage, twice a day. It can be combined with oral administration of Niuhuang Qingxin Pills, 1-2 pills each time, 3-4 times a day. Those with excessive phlegm and heat can be treated with Chuanhujingjing drops. Ischemic stroke can be treated with Mailuoning Injection, Ligustrazine Injection, and Salvia Miltiorrhiza Injection based on syndrome differentiation.
2． Shengmai injection and Shenfu injection can be used to treat prolapse.
3. Recipe for external washing to treat contracture of hands and feet: Sophora twigs, willow branches, mulberry branches, eggplant branches, moxa mugwort, boiled in 3 buckets of water, soak hands and feet to above the wrist and ankle, 15-20 minutes each time, once a day.
Outcome and prognosis
The mortality and disability rates of stroke are both high. The outcome and prognosis are related to the strength of the constitution, the rise and fall of righteousness, the depth of evil, the severity of the illness, whether the treatment is correct and timely, and whether the care is appropriate. etc. are closely related.
There is no mental disorder in the meridians, but mainly hemiplegia. For mild cases, it will stabilize and enter the recovery period in 3-5 days, and recovery is expected in about half a month; for severe cases, if treated properly, recovery will begin in about 2 weeks. period, the prognosis is better. On the basis of general nursing, we should pay attention to syndrome differentiation and care according to the pathogenesis characteristics of each syndrome. However, there are a few severe cases of middle meridian disease, which can worsen within 3-7 days. Not only does hemiplegia worsen, but even confusion occurs and symptoms of middle viscera syndrome occur. Those with internal organs are in a coma and generally have a poor prognosis. In , patients with visceral obstruction syndrome can regain consciousness after rescue treatment, and the prognosis is better. If the syndrome turns from closed to out of syndrome, it is a sign of worsening of the condition. Especially when symptoms such as hiccups, convulsions, Yang Yang, vomiting blood, blood in the stool, and reverse limbs occur, the prognosis is even worse. The sequelae of stroke are mostly characterized by deficiency in origin and excess in excess, and recovery is often slow and difficult to fully recover. If hemiplegic limbs change from relaxation to spasm, accompanied by a strong tongue, twitching from time to time, or even mental disorder, it is mostly due to deficiency of healthy qi, increasing evil qi, and worsening of the disease. If you have headaches, dizziness, or numbness in your limbs from time to time, there is a risk of recurrence and you should pay attention to prevention.
Prevention and care
The prevention of stroke lies in careful living, diet, keeping distant relatives, and flirting. . To live cautiously means to have a regular life, pay attention to appropriate work and rest, and pay attention to appropriate physical exercise. Dieting refers to avoiding overeating fatty, sweet and spicy foods, tobacco, alcohol and spicy food. The distant house curtain refers to the abstinent sexual life. Flirtation refers to always keeping a comfortable mood, stabilizing emotions, and avoiding harm from the seven emotions.
Paying attention to the observation of aura symptoms and active treatment are the keys to preventing stroke. Strengthening nursing care is an important step in improving clinical cure rates, reducing comorbidities, and reducing mortality and disability rates. Patients in the acute stage should rest in bed, especially those with internal organs. The condition should be closely observed, focusing on consciousness, pupils, breath, pulse, etc., to understand the transformation of closure and prolapse.
Keep the respiratory tract and intestines unobstructed. Prevent infections in the lungs, mouth, skin, perineum and other parts of the body. Those who have language disadvantages should strengthen language training in a step-by-step manner.After the condition is stable, it can be combined with massage and functional training, and the patient can be guided to self-exercise to promote the recovery of the function of the affected limb.
