Click the blue word "International Circulation" above to follow us, then click the "..." menu in the upper right corner and select "" Overview According to WHO statistics, one in every six people in the world suffers from stroke, and one person dies every six seconds. As for stro

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Overview

According to WHO statistics, one in every 6 people in the world suffers from stroke. One person dies from a stroke every second, and one person is permanently disabled due to a stroke every six seconds. Stroke is divided into ischemic stroke and hemorrhagic stroke. Hemorrhagic stroke accounts for about 30% of acute cerebrovascular diseases in my country. The mortality rate in the acute stage is 30% to 40%. More than half of the survivors have sequelae such as paralysis and aphasia.

Currently, there is great emphasis on the use of comprehensive treatment methods of traditional Chinese and Western medicine for hypertensive hemorrhagic stroke. As a modern TCM encephalologist, we should fully realize that in the treatment of this disease, we should pay equal attention to both traditional Chinese and Western medicine, and use a combination of traditional Chinese and Western medicine for diagnosis and treatment.

The following measures should be paid attention to in modern medical treatment:

Use modern medical tools to monitor vital signs, continuous cardiopulmonary monitoring, oxygen inhalation and respiratory support therapy, and pay attention to blood pressure and blood sugar management. Grasp the indications for surgery and seek timely consultation with a brain surgeon. For those who meet the indications for surgery, the hematoma should be removed as soon as possible to eliminate the mass effect and reduce the mortality rate. Prevent and treat secondary infections and pay attention to the complications of intracranial hypertension and use western medicine for treatment. Therefore, while emphasizing the use of Western medicine for diagnosis and treatment, Chinese medicine cannot be ignored and should be involved in the entire process of diagnosis and treatment.

三

Traditional Chinese medicine identifies the cause and pathogenesis, determines the treatment principles and methods, and uses Xingnao Kaiqiao decoction to treat

hemorrhagic stroke. This disease mostly occurs in middle-aged and elderly people. The dysfunction of the organs and the deficiency of qi and blood are the basis of the disease. Tiredness, internal injuries, worry and anger, improper diet, and sudden changes in climate are the causes of the disease. For this reason, blood stasis, internal phlegm, or yang wind movement, qi and blood are reversed, causing blood to overflow outside the brain vessels, resulting in hemorrhagic stroke, severe cases of orifices, coma, hemiplegia and other symptoms. I believe that the treatment should be based on the methods of activating blood circulation and removing blood stasis, eliminating phlegm and calming wind, and refreshing the brain and resuscitation. Taken from the clinical application of Xingnao Kaiqiao Decoction.

Xingnao Kaiqiao Decoction, the prescription consists of: 6g notoginseng powder (taken in four times), 15g angelica root, 15g salvia miltiorrhiza, 10g safflower, 10g chuanxiong, 13g turmeric, 13g fritillary, polygala 13g, ochre 15g, beef 15g knee, 10g tangerine peel, 15g malt. Efficacy: Promoting blood circulation and removing blood stasis, eliminating phlegm, extinguishing wind, refreshing the brain and resuscitation. Indications: hemorrhagic stroke, craniocerebral trauma, hematoma and postoperative coma. Usage: The above is a daily dose. Decoction the first and second decoction into a total of 400ml and divide it into four times by nasogastric feeding.

This recipe uses Panax notoginseng powder, Angelica sinensis, Salvia miltiorrhiza, safflower and Ligusticum chuanxiong to activate blood circulation and remove blood stasis, remove intracerebral stasis and swelling, stop bleeding and dissipate blood stasis, promote awakening and resuscitation, Fritillaria fritillaris, Yujin and Polygala to clear away heat, resolve phlegm and rejuvenate the orifice, acting as a soothing agent for ocher. To calm the liver and relieve wind, Achyranthes achyranthes can expel phlegm, unblock meridians and induce blood to flow downward. Tangerine peel and malt can harmonize the stomach and regulate qi movement to help remove blood stasis and remove phlegm. The combined use of all medicines has the effects of activating blood circulation, removing blood stasis, eliminating phlegm, extinguishing wind, refreshing the brain and resuscitation.

Pay attention to the following four points when adding or subtracting clinical symptoms:

1. Excessive wind, fire and phlegm (yang closed syndrome)

(1) Add 1g of antelope horn (take in four divided doses) 15g of Gastrodia elata, 10g of Dannanxing and 13g of Tianzhuhuang.

(2) When the viscera is blocked and the constipation occurs, use 3g of rhubarb powder (infused) once to relieve constipation and then stop using it.

(3) Take Angong Niuhuang Pills. Take 1 pill for the first time, and adjust the dosage according to the symptoms after 6 hours.

(4) Qingkailing 40ml dissolved in 100ml of 0.9% sodium chloride injection intravenously twice a day.

2. Excessive wind, phlegm and dampness (Yin Shu syndrome)

(1) Add 13g of Acorus, 10g of Nanxing, 10g of Pinellia, and 13g of Bombyx, and remove Fritillaria, Polygala and Yujin.

(2) For constipation and constipation, add 10g of rhubarb, 13g of peach kernels, 15g of radish seeds and 10g of citrus aurantium.

(3) Take Suhexiang Pills. After taking one pill for the first time, adjust the dosage according to the evolution of the symptoms.

3. Comatose patients after craniocerebral trauma and hematoma removal: add 2g of leech powder by gavage in four divided doses, and add 15g of agrimony and 15g of cattail to the original recipe.

4. When the above types of diseases are accompanied by severe deficiency, to prevent the transformation from closed syndrome to desyndrome, 30g of American ginseng can be decocted and fed in multiple portions.

4 When treating hemorrhagic stroke with traditional Chinese medicine, the following points should be noted.

. Traditional Chinese medicine treatment should intervene as early as possible. For comatose patients, regardless of Yang or Yin syndrome, the method of promoting blood circulation and removing blood stasis is the most important method. Because blood stasis cannot be removed, bleeding will not stop, and syndromes will occur.

. It is currently recognized that the simple application of hemostatic drugs is ineffective for cerebral hemorrhage. As the theory of traditional Chinese medicine refers to "stop bleeding, hemostasis", so it is important to pay attention to the use of hemostatic drugs to remove blood stasis.

. Xingnao Kaiqiao Decoction mainly uses methods of activating blood circulation and removing blood stasis, and uses many medicines to remove blood stasis. Among them, Panax notoginseng powder can both remove blood stasis and have hemostatic effect. Among them, the blood-activating medicines are all nourishing and activating blood circulation medicines. safe to use.

. Pay attention to improving the method of taking Chinese patent medicines for resuscitation and pay attention to closing the middle and removing symptoms.

. Acupuncture therapy should not be ignored: Acupuncture therapy should be paid attention to the acupuncture treatment method created by Master Shi Xuemin to awaken the brain and rejuvenate the mind, which is worthy of effectiveness. According to current literature reports, it can comprehensively adjust cardiovascular and cerebrovascular functions, improve hemodynamics, and regulate neurotransmitters in patients. It is also reported that a statistical analysis of 2,492 patients treated with acupuncture in 25 units across the country was effective in adjusting and stabilizing blood pressure, with an effective rate of 71 to 98%.

Pay attention to early rehabilitation and etiological treatment

. Comatose patients after stroke and hematoma removal should receive early rehabilitation treatment integrating traditional Chinese and Western medicine and pay attention to etiological treatment.

. Early rehabilitation treatment helps to establish collateral circulation of the brain and improve the blood circulation and oxygen supply status of the brain, promote the normal recovery of self-regulation function, and avoid the occurrence of various complications.

. A large number of clinical and basic studies have shown that brain function recovery is fastest in the first 3 months after stroke, so rehabilitation treatment should also be started as early as possible.

. Training time for early rehabilitation: Most scholars believe that rehabilitation treatment should be started 48 hours after the patient's vital signs are stable and neurological defects no longer develop.

. In addition to classic rehabilitation methods such as exercise exercises and language training, more attention should be paid to the overall syndrome differentiation and comprehensive treatment of traditional Chinese medicine.

. The treatment of the cause cannot be ignored: patients with hypertension should take Western antihypertensive drugs to stabilize blood pressure, and patients with diabetes should pay attention to the use of hypoglycemic drugs to control and stabilize blood sugar. This not only helps to refresh the mind, but is also an indispensable treatment measure to prevent recurrence of stroke.

Brief introduction to the six cases

[Example 1] Ah XXX, a 62-year-old male, was first diagnosed on December 10, 2009.

He has been suffering from hypertension for more than 10 years. He has been taking antihypertensive drugs intermittently. Two days ago, he suddenly fainted at the door when he returned home in the afternoon. With severe vomiting, he was rushed to a hospital for treatment. His blood pressure was 200/110mmHg. Brain CT showed: hemorrhage focus in the left basal ganglia area with a bleeding volume of about 40ml. He was diagnosed as hypertensive cerebral hemorrhage. Western antihypertensive drugs were taken to reduce intracranial hemorrhage. After treatment with high-pressure drugs, the condition worsened. Hematoma removal surgery was performed late at night, and a Chinese medicine practitioner was invited for consultation the next day after the operation. Diagnosis showed: coma, flushed complexion, snoring and phlegm, strong nape and body heat, hemiplegia, strong spasm of the limbs, occasional twitching of the lower limbs, no stool for three days, yellow greasy and dry fur, dark red tongue. Stringy and slippery pulse, TCM diagnosis: hemorrhagic stroke, syndrome of phlegm-heat and wind-fire closing the brain orifices, use pungent cool to open the brain, remove blood stasis and clear away heat, resolve phlegm, extinguish wind and unblock collaterals, Xingnao Kaiqiao decoction can be treated with modified method.

prescription

antelope horn powder 1g (take in three doses)	Angelica sinensis 13g	Panax notoginseng powder 5g (take in three doses)
Salvia miltiorrhiza 13g	Safflower 10g	Chuanxiong 10g
Dan Nanxing 6g	Tianzhu Huang 10g	Turmeric 10g
Fritillaria 10g	Polygala 10g	Raw Land 10g
Prunella vulgaris 13g	generations of ocher 15g	Achyranthes 10g
tangerine peel 6g	Malt 13g

3 doses, decoction in water, take one dose a day, take warmly in two times

In addition: Rhubarb powder 3g, drink once a day (discontinue after bowel movement)

Angong Niuhuang Pills and a half Pill three times a day

Qingkailing injection 40ml dissolved in 0.9% sodium chloride injection for intravenous drip, 2 times a day

[Second diagnosis] is unconscious, the lower limbs are no longer twitching, snoring and phlegm have disappeared, and there is no vomiting. , the stool has become unobstructed, the pulse is stringy and slippery, the fur is slightly greasy and yellow, and the tongue is dark red. The original prescription removes rhubarb powder, bamboo root, and replaces ocher. Three doses. Angong Niuhuang Pills and Qingkailing Injection can still be used according to the original method. Acupuncture and massage treatments can be added.

[Third diagnosis] was in coma for more than a week and woke up yesterday. However, he was aphasic, hemiplegic, and had one loose stool every two days. His fur was thin, greasy and slightly yellow, and his pulse was stringy and slippery.

For the follow-up consultation, remove antelope horn powder, make Nanxing, Tianzhu Huang, Qifu.

Stop taking Angong Niuhuang Pills

Qingkailing injection and change it to 40 ml once a day. Use it for five days and stop after the condition stabilizes.

After being hospitalized for one month, he came to the outpatient clinic in a wheelchair. He felt dizzy and headache when his blood pressure was 150/90 mm Hg, his speech was astringent, hemiplegia on the right side of his body, his pulse was stringy, and his coating was greasy. He was treated with modified Gastrodia Uncaria decoction.

prescription

gastrodia elata 10g	uncaria 13g	mother of pearl 30g
cassia seed 15g	raw ground 13g	red peony root 13g
white peony root 13g	red flower 10g	chuanxiong 10g
Curcuma 10g	Fritillaria 10g	Polygala 10g
Tangerine peel 6g	Malt 13g	Achyranthes 10g

7 doses, decoction in water, daily One dose, taken warmly in two times

, combined with acupuncture, massage, and long-term treatment with traditional Chinese medicine. Blood pressure should be monitored daily. Antihypertensive drugs should not be stopped at will, and the rehabilitation department should be asked to cooperate with the treatment.

[Press]: This case underwent intracranial hematoma evacuation immediately after admission. After the operation, he was still in coma and hemiplegia, with phlegm, fire and blood stasis, and viscera-qi obstruction. Rhubarb powder, Dannanxing, and Tianzhuhuang were added to the Xingnao Kaiqiao Decoction. Angong Niuhuang Pills can clear the viscera and remove blood stasis, relieve phlegm and fire and promote recovery. After the third diagnosis, the stool became unobstructed. The symptoms of phlegm, fire, blood stasis, heat and wind movement were greatly reduced. I became conscious. I stopped taking Angong Niuhuang Pills and switched to Gastrodia elata. Add or subtract Tengyin, combined with acupuncture and massage therapy to help recovery.

[Example 2] Lu XX, a 59-year-old male, November 20, 2008

[First diagnosis] has suffered from hypertension for more than ten years. He was diagnosed with hypertensive cerebral hemorrhage in another hospital two weeks ago, and underwent surgery in the right basal ganglia area. Two weeks after the hematoma evacuation, he was treated in our hospital. The diagnosis showed: he was conscious in and out, drowsy, and his speech was astringent. He often coughed, thirsty, sweaty, dry stools, the skin all over the body was moist, and the muscle strength of his left upper limb was 0. Level I, left lower limb muscle strength level, ADL scale 0 points, stringy and thin pulse, thin and greasy coating, dark and slightly red tongue, fat and enlarged tongue body. TCM syndrome diagnosis is that after the removal of stroke hematoma, the collaterals will be injured during the operation, so The blood stasis still remains, and the damage to qi and blood after surgery will lead to a loss of qi and yin, and a loss of nourishment for the brain and spirit. Therefore, it is still necessary to treat both the symptoms and the root causes by promoting blood circulation, removing blood stasis, clearing the orifices, and replenishing qi and nourishing blood. A modified combination of Xingnao Kaiqiao Decoction and Yupingfeng Powder can be used to treat this.

prescription

Angelica sinensis 13g	Salvia miltiorrhiza 13g	Red peony root 10g
Calamus 10g	Fritillaria 10g	Astragalus 13g
Atractylodes 10g	Fangfeng10g	Raw ground 13g
Radix ginseng 13g	Pueraria lobata 13g	Tangerine peel 6g
Stir-fried Citrus aurantium 6g	Achyranthes root 10g

7 doses, decoction in water, one dose per day, divided into two

Rehabilitation department treatment with sub-temperature administration, combined with acupuncture and massage therapy, strengthening body movements, speech function rehabilitation training, and persisting in taking Western antihypertensive drugs to stabilize blood pressure. After more than two months of addition and subtraction treatment, I can stand, but my speech is poor. The upper limb muscle strength was grade II, and the left lower limb muscle strength was grade III. Five months later, the muscle strength of the left upper limb was grade III, the muscle strength of the left lower limb was grade V-, and the ADL scale was 85 points. Three years later, I came to the outpatient clinic for treatment of a cold. I saw that the patient was walking around on his own. His left upper limb muscle strength was level IV, and his left lower limb muscle strength was level V. He could basically take care of himself.

[Press]: I came to the hospital for diagnosis and treatment two weeks after surgery for cerebral hemorrhage and hematoma removal. Symptoms include episodic consciousness, poor speech, excessive sweating, thirst, hemiplegia, fat and enlarged tongue, dark and greasy tongue coating, and weak pulse. Thin strings. This is because there is still residual blood stasis after the operation. After the operation, the qi and blood will be damaged, resulting in deficiency of qi and yin, stasis in the brain collaterals, and loss of brain and spirit nourishment. It can be treated with Xingnao Kaiqiao Decoction combined with Yupingfeng Powder, combined with acupuncture, massage, and After five months of rehabilitation treatment, the patient could basically take care of himself.

Expert profile

Shen Baofan is currently the chief expert, professor of internal medicine, chief physician, postdoctoral co-supervisor of the Affiliated Traditional Chinese Medicine Hospital of Xinjiang Medical University (Autonomous Region Traditional Chinese Medicine Hospital), member of the academic department of the China Academy of Chinese Medical Sciences, executive director of the World Association of Integrated Traditional Chinese and Western Medicine, and encephalopathy of the Chinese Association of Traditional Chinese Medicine Consultant of the Society and the National Health Commission's Stroke Prevention and Treatment Project Professional Committee on Integrated Traditional Chinese and Western Medicine, academic member of the Academic Committee of the Encephalopathy Syndrome and Treatment Department of Beijing University of Chinese Medicine, National Traditional Chinese Medicine Emergency Committee for Public Emergencies, and National "New Emergencies of Infectious Diseases Traditional Chinese and Western Medicine" "Integrated Clinical Treatment Platform", member of the expert group of the National Alliance for Research on Coronary Heart Disease, emergency branch of the World Society of Traditional Chinese Medicine Integrated Traditional Chinese and Western Medicine, classic prescription research branch of the World Society of Chinese Medicine, consultant of the World Association of Chinese Medicine Integrated Health and Care Research Association, and National Nomenclature Committee of Traditional Chinese Medicine Expert advisor to the Terminology Approval Committee.

(Source: "International Circulation" editorial department)

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