Cerebrovascular+Disease

See also stroke //Western Diagnosis:// Stroke, CVA ---2nd most common cause of neurologic disability in the West after Alzheimer’s disease ---3rd most common cause of death most secondary to AS, hypertension

Types
1. cerebral insufficiency 2. infarction 3. hemorrhage

Ischemic
Insufficient cerebral circulation a. AS plaques: thrombosis, emboli b. interruption of blood supply c. brain ischemia d. infarction if ischemia longer than a few min. a. focal neurologic abN b. sudden onset, brief duration c. AS - cerebral emboli d. sudden onset, last 2-30 mins, no permanent sx e. sxs depend on area of brain involved: ---confusion, vertigo, blindness, paresthesia, weakness, dysarthria ---variable frequency f. may indicate upcoming stroke g. treatment i. address underlying cause ii. hypertension, DM, hyperlipidemia, smoking stroke in evolution a. enlarging infarction b. neuro deficits increase over 24-48 hours c. unilateral sx d. continuous stepwise progression over days a. infarction manifested by neuro deficits of varying degree b. abrupt onset c. AS thrombosis, embolism, stenosis d. very common e. rapid sx, maximum within a few minutes i. clinical suspicion ii. AS thrombosis, embolism, stenosis iii. carotid vascular bruits iv. possible HA v. CT, MRI i. 20% die ii. age, health, site, size all important iii. the sooner improvement begins, the better the outcome iv. deficits after 6 mos. usually permanent i. prevention ii. maintenance iii. anti-coagulants contra-indicated in hypertensives - possible hemorrhage iv. rehab
 * etiology**
 * TIA’s**
 * Completed stroke**
 * diagnosis**
 * prognosis**
 * Treatment**

Hemorrhagic
1. bleeding into brain or meningeal spaces 2. intracerebral a. rupture of AS vessel from hypertension or made ischemic from thrombus - some from aneurysm b. sxs & sns i. abrupt severe HA ii. steadily inc neuro deficits iii. N,V, delirium, seizures, loss of consciousness iv. large hemorrhages fatal in >50% v. neuro deficits dec as blood resorbed vi. some degree of deficits remain c. diagnosis i. CT d. tx i. anti-coagulants contra-indicated 3. subarachnoid a. bleeding into subarachnoid space b. ruptured congenital intracranial aneurysm c. head trauma d. sxs & sns i. asx until rupture ii. sudden, severe HA iii. syncope iv. V, dizziness v. stiff neck vi. focal sns in 25% e. diagnosis i. CT ii. LP f. mortality 35%, 15% more die of another in a few wks g. after 6 mos., second rupture 3% per yr h. overall bad prognosis

Treatment i. anti-coagulants contra-indicated ii. surgery

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 * IBIS:**

Definition:
CVA (cerebrovascular disease, stroke) is defined as an ischemic vascular injury to the brain. TIA (transient ischemic attack): a type of minor stroke: refers to focal neurologic abnormalities of sudden onset and brief duration (typically minutes) that arise from injury in the internal carotid-middle cerebral or vertebral-basilar arterial system.

Etiology:
• TIA: often, the attacks are recurrent and are premonitions for a full stroke in the future. Most TIAs are from arteriosclerotic emboli. Risk factors include high blood pressure, heart disease, atherosclerosis, diabetes mellitus, and polycythemia.

• CVA: In a classic stroke, the neurologic defects continue to expand for 24-48 hours after the infarction occurs ("stroke in evolution"). The most frequently seen stroke is called a "completed stroke", whose symptoms develop rapidly and maximally within a few minutes to an hour. The term "completed stroke" also refers to the fully established neurologic deficits after the stroke, whether from the acute or gradual kind. Neurologic symptoms solely relate to the area of cerebral infarction.

Somatic therapies:
• aerobic exercise: to prevent

Nutrition:
eating principles: • low sugar, low cholesterol • low fat diet of unsaturated fats • calorie percentages: 70% complex carbohydrates, protein 12-15%, fat 15-18% • high fiber • low Sodium/ Sodium-restricted diet • vegetarian cleansing diet or short fasts • Fasting, General Sample Diet, General Guidelines for Eating, Sample Vegetarian Diet

therapeutic foods: • high Potassium foods, millet, buckwheat, oats, rice, raw goat's milk, raw leafy vegetables, watermelon, garlic, onions, rutin-rich foods, cornsilk tea, diuretic foods, Magnesium foods, garlic, broccoli, celery, cherries, nectarines, pineapple, kumquats, watermelons, squash, pomegranate, guava, parsley, cucumber, dandelion greens • increase foods rich in Calcium, Phosphorus, Manganese, Sulfur, Iodine, tryptophan (Jensen, p. 63) • egg yolk, kale, celery, fish, raw goat's milk, veal joint broth, cod roe, rice polishings, brewer's yeast, nutritional yeast (Jensen, p. 63) • increase omega-3 and omega-6 fatty acids: vegetable, nut, seed oils, salmon, herring, mackerel, sardines, walnuts, flaxseed oil, evening primrose oil, black currant oil

fresh juices: • celery, carrot, prune (Jensen, p. 63) • prune and rice polishings (Jensen, p. 63) • raw goat's milk and 1 tsp. sesame, sunflower, or almond butter, 1 tsp. honey and sliver of avocado (Jensen, p. 63) • black cherry and egg yolk (Jensen, p. 63) • carrot, celery, parsley, and spinach (Walker, p. 149) • carrot and spinach (Walker, p. 149) • carrot, beet, and celery (Walker, p. 149) • carrot, spinach, turnip, and watercress (Walker, p. 149)

avoid: • salt, salty foods: pickles, olives, chips, packaged snacks, meat, especially ham, frankfurters, bacon, bologna, corned beef and lunch meats, frozen fish fillets, sardines, herring, caviar, anchovies, shellfish, dairy products, spicy foods: salsa, white and black pepper, mustard, ginger and hot foods, canned tomato juice, V-8 juice, processed cheese, canned, dried or instant soups, frozen peas and beans, most processed and refined foods, MSG, mayonnaise, salad dressings, gravies, ketchup, food with Sodium benzoate as a preservative, Sodium proprionate in cheese and bread, baking powder, baking soda, ice cream, milkshakes, soft drinks, smoked meats and fish, Jello, pretzels, potato chips, salted nuts, candy, rennet tablets, pudding mixes, beverage mixes, spicy foods, alcohol, fried foods, fatty foods, pork, overeating, low levels of calcium

Botanicals
• Achillea millefolium: thrombotic conditions with hypertension, including cerebral and coronary thromboses; with Tilia platyphyllos (lime blossom) in essential hypertension (British Herbal Pharmacopoeia, p. 145) • Allium sativum • Arnica montana (toxic, homeopathic mother tincture): 25 drops three times daily, for tissue changes, to prevent further coagulation (Mittman) • Aspidosperma quebracho-blanco: apoplexy (Ellingwood, p. 248) • Capsicum frutescens: following stroke (Sherman) • Crataegus spp.: strengthens connective tissue (Ellingwood, p. 218) • Ginkgo biloba (standardized extract): to increase circulation, dilates cerebral blood vessels (NCNM Botanicals) • Trifolium pratense: contains coumarin; not in hemorrhagic stroke or for person on anticoagulants (Mittman)

Chinese Formulae
» CVA/stroke: • Ren Shen Zai Zao Wan (Tsaitsuowan) (patent); Da Huo Luo Dan (patent): Liver Wind Stirring: Strokes with symptoms such as facial paralysis, limb paralysis, hemiplegia, numbness of limbs, pain, limb contractures, poor articulation and speech output problems. Administer as soon as possible after the stroke, once bleeding is stabilized (Ren Shen Zai Zao Wan: Zhu, p. 142; Da Huo Luo Dan: Zhu, p. 139) • Xiao Huo Luo Dan: Numbness, paralysis, muscle spasms. (Yeung, p. 257; Bensky and Barolet, p. 398) • Bu Yang Huan Wu Tang: Hemiplegia, deviation of mouth & eyes, difficult speech, salivation, frequent or incontinent urination. (Yeung, p. 50; Bensky and Barolet, p. 320) • Zhen Gan Xi Feng Tang: Thrombosis due to Liver Wind Stirring. (Yeung, p. 284; Bensky and Barolet, p. 402) • An Gong Niu Huang Wan (patent): Fire Toxin with Heart Agitated by Phlegm Fire (Zhu, p. 129) • Salvia Shou Wu (patent) plus Styrax 14 (patent) (Dharmananda, 1990: Salvia Shou Wu, p. 55: Styrax, p. 58)

» TIAs: to prevent strokes: Ren Shen Zai Zao Wan (Tsaitsuowan) (patent); Jiang Ya Wan (Hepatico-Tonic Pills) (patent); Mao Dong Qing (patent); Salvia Shou Wu (patent) plus Styrax 14 (patent) (Ren Shen: Zhu, p. 142; Jiang Ya Wan: Zhu, p. 175; Mao Dong Qing: Zhu, p. 242; Salvia Shou Wu: Dharmananda, 1990, p. 55; Styrax 14: Dharmananda, 1990, p. 58)

Acupuncture
after assessing the person and palpating, consider these patterns: Penetrating Wind; Liver Fire; Phlegm, esp. Heart Misted by Cold Phlegm; Yang Shi (Excess); Yin Xu (Deficiency); Liver Yang Rising Causing Liver Wind; Stirring of Liver Wind

» illustrative combinations: • yin tang, LI-11, St-36 and Lv-3: prevent stroke (Finkelstein, p. 95) • GV-15, PC-8, Sp-6, Kd-1, Kd-3, CV-12, GB-30, St-36 and LI-4 are the Nine Needles for Returning the Yang (Li, p. 627-628; Ellis, et al, 1988, p. 66) • GV-20, Lv-3, Kd-1, CV-22, St-40, PC-6, LI-11, Ht-5 and CV-23 for a cerebrovascular accident due to closed-type Wind-stroke caused by Liver Yang Rising with accumulation of Phlegm (Jirui and Wang, p. 145) • GV-15 and TW-1 to treat "sluggish tongue and inability to speak" (Ellis, et al, 1988, p. 380) • GV-15, CV-23, St-6, Ht-5 and CV-22 to treat apoplexy, aphasia, and sudden loss of voice (Flaws, 1989, p. 98) • LI-15, LI-11, LI-4 and jing bi to treat stroke, hemiplegia, rheumatic arthritis, infantile paralysis in the upper limbs (Flaws, 1989, p. 100) • LI-15, LI-11, LI-4, TW-5, zhi tan #1 and bi zhong (can also use: TW-14, LI-10, TW-4 and TW-3) for sequelae of cerebrovascular accident effecting the upper limb(s) (Shanghai, p. 620) • GB-30 and GB-34 to treat strokes, hemiplegia, rheumatic arthritis, and infantile paralysis in the lower limbs (Flaws, 1989, p. 100) • GB-30, GB-31, GB-34, lan wei xue, GB-39, St-41, jiu nei fan, jiu nei fan #1, jiu nei fan #2, and St-36 (can also add: tan li, luo di, UB-60, Lv-3, GB-41 and UB-64) for sequelae of cerebrovascular accident effecting the lower limb(s) (Shanghai, p. 621; Lee and Cheung, p. 250) • CV-22 and CV-23 (-): resolve Phlegm and open Orifices to clear throat and restore speech • GV-26, 12 Jing Well points, Kd-1, PC-8, GB-20, PC-6, LI-4 (also consider CV-4, CV-6, St-36, PC-7, Lv-2, St-25, St-37, CV-17, UB-23, GV-4, Lv-3, GB-34, CV-22 and St-40) for collapse type of stroke (Lee and Cheung, p. 249) • LI-15, LI-11, LI-4, TW-5, lan wei xue, shen xi and bi zhong (also consider TW-14, LI-10, TW-4, TW-3, etc., select and match accordingly) for sequelae of cerebrovascular accident effecting the upper limb(s) (Lee and Cheung, p. 249) • shang lian quan and Ht-5 (also consider GV-15 and Kd-6) for dysarthria, rigidity of tongue and dyscatabrosis (Lee and Cheung, p. 250) • TW-17, St-4, St-2, St-6, LI-4 and qian zheng (also consider UB-2, GB-14, GV-26, SI-18 and jia cheng jian) for distortion of mouth and eyes (Lee and Cheung, p. 250) • LI-11, LI-5, LI-4, TW-3, LI-10, GB-38 and UB-60 for paralysis (Lee and Cheung, p. 252) • LI-4, LI-10, GB-21, LI-11, GB-30, Sp-10, GB-34, Sp-9, St-36, GB-39 and UB-60 for cerebrovascular accident with hemiplegia (Lee and Cheung, p. 250) • GV-16 and GV-20: treat brain disorders (Finkelstein, p. 81)

Homeopathy
• Arnica montana: cerebral lesion is similar to a bruise, a hematoma (for post acute crisis survival) • Belladonna: face flushed, throbbing headache, pain < light, noise, jar, lying down and in the afternoon, > half erect posture. • Kali muriaticum: absorbs clot (for post acute crisis survival) • Natrum muriaticum: face pale, throbbing headache, nausea, vomiting • Nux vomica: when the stroke occurs after a heavy meal or too much alcohol; vertigo with momentary loss of consciousness • Opium: when the patient is unconscious, breathing heavily; face is dusky and cyanosed • Sulphur: for the heavy red-faced beer-drinking type; heat on top of head • Veratrum album: when the clinical picture is one of collapse; shock, sweating and cold; cold sweat on forehead

Subtle Support
• notes: A#, B, C, D#, E, G, G#

• chords: diminished 8th, C Major, D# Major, G# Major (Gimbel, p. 116)

cardiovascular: • The Barcarole • The Blue Danube • Chopin's A minor Waltz • Tango music • Humoresque • Cui's Orientale • Song of India • Donna e Mobile • Oley Speak's Sylvia (Heline, p. 18)

Mind/Body
• Dominant and often obsessive need to control one's environment; LACK OF TRUST; difficult if not impossible to trust the intention or activities of others; continually fears for financial and material security and well-being; strong association with feelings of vulnerability and belief that external world is unsafe. (Shealy, p. 171) • Giving up; resistance; rather die than change; rejection of life. (Hay, 1984, p. 185)

Chinese psychophysiology: • Liver ~ Gan is the home of the Hun (Ethereal Soul); it relates to decisiveness, control, and the principle of emergence; stores and cleanses the Xue (Blood); maintains smooth flow of Qi and Xue (Blood); controls the muscles, especially their contractility; reflects emotional harmony and movement; opens into the eyes; and expresses itself in the nervous system. » Healthy expressions are kindness, spontaneity, and ease of movement. » Liver Xu (Deficiency) signs include impotence; frigidity; pain in thighs, pelvic region, and throat; ready tendency to "the blahs" (Seem, p. 28); timidity; depression; irritability; vertigo; pruritus; dry skin and/or tendons; asthma; aching at the waist; hernia; and difficulty raising head up and down. Liver Xue Xu (Blood Deficiency) predisposes to Xue Yu (Blood Stasis). Liver Yin Xu (Deficiency) predisposes to the Shi (Excess) conditions of Liver Wind, Liver Yang Rising, and Liver Fire Blazing. » Liver Shi (Excess) signs include discontent; anger; pain in lumbar region and genitals (Seem, p. 28); muscular tension; excessive sex drive; insomnia; moodiness; excitability; genital diseases; red, tearing eyes; compulsive energy; and bitter taste in the mouth. » Liver Wind derives from Liver Yin Xu (Deficiency) and/or Liver Xue Xu (Blood Deficiency) and their subsequent inability to embrace the Yang, and can manifest as joint stiffness, dizziness, tremor, paralysis, convulsions, and neurological problems.