Wind+Stroke+(Stroke)

=Wind Stroke/Zhòng Fēng= Wind Stroke/Zhòng Fēng refers to a condition of varying severity characterized by hemiplegia, aphasia or slurred speech, and unilateral facial paralysis; the onset may or may not be preceded by sudden loss of consciousness. The Chinese see to the sudden and acute onset, multiple symptoms and rapidly changing manifestations of this condition as characteristic of Wind, hence its name.

Relevant Biomedical Disorders
-Transient ischemic attack (TIA) -Ischemic stroke (CVA) -Hemorrhagic stroke (CVA) -Subarachnoid hemorrhage -Brain tumor -Cranial arteritis -Bell’s palsy

TIA: Stroke Precursor
-A transient ischemic attack (TIA) is a risk factor for ischemic stroke. -In a TIA, arterial blockage in the brain occurs briefly and resolves on its own, without causing tissue death. -Approximately 10% of ischemic strokes are preceded by a TIA. -Approximately 40% of patients who experience a TIA will have a stroke.

Types of Stroke:
Ischemic Hemorrhagic

Ischemic Stroke
Approximately 80% of strokes are ischemic. They can develop in: -major blood vessels on the surface of the brain (called large-vessel infarcts) -small blood vessels deep in the brain (called small-vessel infarcts). Types of ischemic stroke include embolic infarct, thrombotic infarct, and lacunar infarct. Infarct of undetermined cause accounts for approximately 30% of cases of ischemic stroke.

1. Embolic infarct (approx. 20-30% of cases): occurs suddenly when a blood clot (embolism) forms in one part of the body (usually the heart or carotid artery), travels through the bloodstream, and lodges in and obstructs a blood vessel in the brain. 2. Thrombotic infarct (approx. 10-15% of cases): occurs when a blood clot forms in an artery that supplies the brain, causing tissue death. This type usually occurs as a result of plaque build-up in arteries (atherosclerosis ) and develops over time. 3. Lacunar infarct (approx. 20% of cases): usually occurs as a result of arterial blockage caused by high blood pressure (hypertension). This type of stroke has the best prognosis.

Hemorrhagic Stroke
Occurs when a blood vessel in the brain ruptures and bleeds into surrounding tissue. Bleeding compresses nearby blood vessels and deprives surrounding tissue of oxygen, causing stroke. Usually affects a large area of the brain, is severe, and carries a high risk of death.

Types of Hemorrhagic Stroke
1. Intracerebral hemorrhage: occurs when a blood vessel inside the brain bursts and damages surrounding brain tissue; HTN is the most common cause of this type of hemorrhagic stroke. 2. Subarachnoid hemorrhage: bleeding occurs in a large artery on or near the surface of the brain and spills into the space between the surfaces of your brain and your skull; often signaled by a sudden, severe "thunderclap" headache; commonly caused by a ruptured aneurysm, which can develop with age or be genetically inherited; after the hemorrhage, vasospasm may cause further brain cell damage by limiting blood flow to parts of your brain.

The Severity of Ischemic Versus Hemorrhagic Stroke
People who suffer ischemic strokes have a much better chance for survival than those who experience hemorrhagic strokes. Among the ischemic stroke categories, the greatest dangers are posed by embolic strokes, followed by thrombotic and lacunar strokes. Studies suggest, however, that survivors of hemorrhagic stroke have a greater chance for recovering function than those who suffer ischemic stroke.

Factors Affecting Stroke Recurrence
The risk for recurring stroke is about 14% in the first year and about 5% thereafter Specific risk factors for early recurrence include: -Older age -Evidence of blocked arteries (a history of coronary artery disease, peripheral artery disease, ischemic stroke, or TIA) -Hemorrhagic or embolic stroke -Diabetes -Alcoholism -Valvular heart disease -Atrial fibrillation

Etiology and Pathogenesis

 * Unconsolidated channels with invasion of exterior Wind:** When protective Qi is deficient, it fails to consolidate the body surface and defend against exterior pathogenic invasion, leading to stroke. In addition, exterior Wind may also trigger pre-existing hidden Phlegm in the body; together, Wind and Phlegm obstruct the channels, causing Wind Stroke. This type of Wind Stroke presents with facial paralysis and sensory or motor impairment without systemic symptoms such as loss of consciousness.


 * Improper diet:** this can impair the Spleen’s function to transform and transport, causing generation of Phlegm which can cloud/block the Heart orifice and obstruct the flow of Qi in the channels. Corresponding manifestations include loss of consciousness or hemiplegia and aphasia.


 * Emotional stress:** excessively emotional stimulation affects both the Liver and Heart. When disturbed by intense emotional stress, Heart Fire can explosively flare upwards, whereas hyperactive Liver Yang may generate Liver Wind. Mutually aggravating each other, Heart Fire and Liver Wind will further cause Qi and Blood to rush upwards to the brain, resulting in sudden loss of consciousness.


 * Aging, chronic illness, constitutional vacuity, excessive exertion:** these can cause Liver and Kidney Yin deficiency below with excess above. In this condition, the Qi and Blood rebelled upwards following hyperactive Liver Yang. Additionally, Phlegm may also be drafted upwards to obstruct the flow in the channels or block the clear orifices.

The pathogenesis of Wind Stroke is complex, involving: -Deficiency: Yin and Qi -Fire: Liver and Heart -Wind: Liver and, sometimes, exterior Wind -Phlegm: Wind-Phlegm and Phlegm-Dampness -Rebellion: of Qi and Blood -Blood Stasis

Categorization ofWind Stroke/Zhòng Fēng
-Channel-Collateral Stroke -Zang-Fu/Organ Stroke -Tension Stroke -Yang Tension or Closed Stroke -Yin Tension or Closed Stroke -Desertion or Flaccid Stroke -Sequelae -Hemiplegia -Slurred Speech -Facial Paralysis

Channel vs. Organ Involvement
Involve only the channels and collaterals Symptoms affect the periphery, are relatively milder in severity, and are non-systemic //Person’s consciousness and cognition remain intact// Additional symptoms include numbness and weakness of the affected area, facial paralysis, dysphasia
 * Channel**

Organs affected (KI, LV, HT, SP) Severe symptoms with systemic manifestations //Characterized by loss of consciousness and alterations in cognition// Additional symptoms may include hemiplegia, aphasia, and difficulty swallowing
 * Organ**

Tension vs. Desertion/Flaccid Stroke
Symptoms include locked jaws, clenched fists, rigid limbs, fecal and urinary retention Fire and Turbid Phlegm trapped within the body Flaccid muscles, fecal and urinary incontinence, profuse sweating, and minute, weak pulse Collapse of Yang Qi
 * Tension**
 * Desertion**

Prognosis
The extent and severity of motor, sensory, and cognitive damage plays a role in stroke prognosis. Age, general health status, and type of stroke are important factors to consider. Persistent alterations in consciousness and cognition along with hiccups, contraction and rigidity of the four extremities, hematemesis, and blood in the stools indicate poor prognosis.

Timing of treatment, frequency of treatment, experience of the practitioner, and the extent to which patient receives physical therapy must be considered in prognosis.

Exterior Wind invasion plays role in pathogenesis Pathogenesis due entirely to internal organ disharmony generating internal Wind
 * True Wind Stroke**
 * Wind-like Stroke**

Differential Diagnosis
Four disorders in TCM share the common symptom of loss of consciousness; they can be differentiated as follows: Wind Stroke: additional manifestations include facial paralysis, hemiplegia, and sequelae after restoration of consciousness. Epilepsy: additional manifestations include convulsions and drooling of white froth; sequelae are absent during remission. Syncope: additional manifestations often include pale complexion and frigid extremities; neither paralysis nor convulsions are present. Hypertonicity disorder: nuchal rigidity is the primary symptom, though muscle spasms and convulsions may also be present; opisthotonos occurs in the most severe cases

Acute stage:
focus generally on branch excess (except for Desertion/Flaccid stroke) Unblock channels-collaterals Expel or extinguish Wind and resolve Phlegm Move Qi and Blood in the channels-collaterals Induce resuscitation (i.e., open the orifices and awaken the Spirit) Expel or extinguish Wind and resolve Phlegm (Tension) Boost Qi, revitalize Yang (Desertion/Flaccid) Note: at this stage, patients require hospitalization and biomedical treatment for stabilization
 * Attack on channels-collaterals:**
 * Attack on the internal organs:**

Sequela stage:
a combination of deficiency and excess manifests, with deficient Righteous Qi and continued presence of pathogens. Therefore, treatment should emphasize supporting the Righteous Qi to expel pathogens.

Invasion by Wind Due to Deficient Channels and Collaterals
[Qin Jiao (Large Gentian Root) 9g, Qiang Huo (Notopterygium Root) 3g, Fang Feng (Ledebouriella Root) 3g, Xi Xin (Asarum) 1.5g, Bai Zhi (Angelica Root) 3g, Du Huo (Angelica Root) 6g, Shu Di Huang (Cooked Rehmannia Root) 3g, Dang Gui (Tangkuei) 6g, Chuan Xiong (Ligusticum Root) 6g, Bai Shao Yao (White Peony Root) 6g, Sheng Di Huang (Rehmannia Root) 3g, Huang Qin (Scutellaria Root) 3g, Shi Gao (Gypsum) 6g, Bai Zhu (Ovate Atractylodes Root) 3g, Fu Ling (Poria) 3g, Zhi Gan Cao (Honey-fried Licorice Root) 6g]
 * Main Symptoms:** Abrupt onset of deviation of mouth & eyes, drooling from corner of mouth of affected side, headache, dizziness with heavy sensation of head, profuse expectoration of sputum; abrupt onset of hemiplegia, numbness, heaviness & pain of the face & four limbs, contracture and spasm of hands & feet; transient mental confusion, rigidity of tongue & slurred speech; hemiplegia in severe cases
 * Additional symptoms:** Aversion to wind or cold, fever; possible sore aching joints
 * Tongue:** Thin, white coating
 * Pulse:** Floating, superficial, slippery
 * Treatment Principles:** Dispel Wind, nourish Blood, unblock the channels and collaterals
 * Acupuncture Treatment:** SP9, ST36, ST40, GB34, GB30, LI11, SJ5, HT1
 * Herbal Treatment:** Da Qin Jiao Tang (Large Gentian Decoction)

Deficient Liver & Kidney Yin with disturbance by Ascendant Wind-Phlegm
[Huai Niu Xi (Achyranthes Root) 30g ,Bai Shao Yao (White Peony Root) 15g, Dai Zhe Shi (Hematite) 30g, Long Gu (Dragon Bone) 15g, Mu Li (Oyster Shell) 15g, Gui Ban (Tortoise Plastron) 15g, Xuan Shen (Scrophularia Root) 15g, Tian Men Dong (Asparagus Tuber) 15g, Chuan Lian Zi (Toosendan Fruit) 6g, Mai Ya (Barley Sprout) 6g, Yin Chen Hao (Artemesia Capillaris) 6g, Gan Cao (Licorice Root) 4.5g]
 * Main Symptoms:** Abrupt onset of deviation of mouth & eyes, headache, dizziness with heavy sensation of head; abrupt onset of hemiplegia; transient mental confusion, rigidity of the tongue & slurred speech
 * Additional Symptoms:** LV & KI Yin Vacuity- history of dizziness and vertigo, headache, blurred vision, tinnitus, irritability, insomnia, dream-disturbed sleep, weak and achy low back and knees, hot flashes
 * Tongue:** Red with scanty (possibly greasy) coating
 * Pulse:** Thready, rapid, wiry or wiry and slippery
 * Treatment Principles:** Nourish Liver & Kidney Yin, subdue Yang, extinguish internal wind, clear the channels and collaterals
 * Acupuncture Treatment:** LR3, KI3, BL23, BL18, GB34
 * Herbal Treatment:** Zhen Gan Xi Feng Tang (Liver-Settling Wind-Extinguishing Decoction)

Yang Tension Stroke
[Ling Yang Jiao (Antelope Horn) 3g, Gui Ban (Tortoise Plastron) 30g, Sheng Di Huang (Rehmannia Root) 15g, Mu Dan Pi (Moutan Root Bark) 12g, Bai Shao Yao (White Peony Root) 12g, Chai Hu (Bupleurum Root) 6g, Bo He (Field Mint) 6g, Chan Tui (Cicada Molting) 6g, Ju Hua (Chrysanthemum Flower) 12g, Xia Ku Cao (Prunella Spike) 12g, Shi Jue Ming (Abalone Shell) 30g]
 * Main Symptoms:** Sudden loss of consciousness, coma; Tense Syndrome: clenched teeth, locked jaws, hands clenched into fists, wheezing and rattling sound in throat, retention of urine and stool, muscular spasms and rigidity of the limbs
 * Additional Symptoms:** Red face, lips and ears, fever, heavy breathing with foul breath, agitation and restlessness
 * Tongue:** Red, yellow greasy coating
 * Pulse:** Wiry, full, rapid, slippery
 * Treatment Principles:** Open the orifices with cool, pungent medicines, clear the Liver, extinguish Wind
 * Acupuncture Treatment:** Shi Xuan, ST40, CV22, PC8, PC9, LR3, LI4, GB41, KI3, LR3, Bleed Hand Jing-Well Points
 * Herbal Treatment:** Ling Yang Jiao Tang (Antelope Horn Decoction)

Yin Tension Stroke
[Fa Ban Xia (Pinellia Tuber) 9g, Tian Nan Xing (Arisaema Root) 6g, Chen Pi (Tangerine Peel) 9g, Zhi Shi (Unripe Bitter Orange) 9g, Fu Ling (Poria) 12g, Ren Shen (Ginseng) 6g, Shi Chang Pu (Acorus Root) 9g, Zhu Ru (Bamboo Shavings) 9g, Sheng Jiang (Fresh Ginger Root) 6g, Gan Cao (Licorice Root) 3g]
 * Main Symptoms:** Sudden loss of consciousness, coma; Tense Syndrome: clenched teeth, locked jaws, hands clenched into fists, wheezing respiration and rattling sound in throat, retention of urine and stool, muscular spasms and rigidity of the limbs
 * Additional Symptoms:** Pale complexion, grayish lips, tranquil state without restlessness, cold extremities, profuse sputum, general Yang Vacuity constitution
 * Tongue:** White, greasy coating
 * Pulse:** Deep, slippery
 * Treatment Principles:** Open the orifices with warm, pungent medicines, expel Phlegm, extinguish Wind
 * Acupuncture Treatment:** Shi Xuan, ST40, ST36, CV22, LR3, LI4, CV12, DU20
 * Herbal Treatment:** Di Tan Tang (Phlegm-Flushing Decoction)

Desertion/Flaccid Syndrome
[Ren Shen (Ginseng) 30g, Zhi Fu Zi (Aconite Tuber) 15g] + [Ren Shen (Ginseng) 9g, Wu Wei Zi (Schizandra Berry) 6g, Mai Men Dong (Ophiopogon Tuber) 15g]
 * Main Symptoms:** Sudden loss of consciousness, coma; Flaccid Syndrome: closed eyes and opened mouth, relaxed hands, cold extremities, incontinence, flaccid paralysis of limbs
 * Additional Symptoms:** shallow breathing, snoring, copious persistent perspiration (oily)
 * Tongue:** flaccid tongue, pale, swollen
 * Pulse:** Thready, faint, minute (barely palpable)
 * Treatment Principles:** Boost Qi, revitalize Yang, secure Yang desertion
 * Acupuncture Treatment:** Moxa CV4, CV6, CV8, DU20, KI1
 * Herbal Treatment:** Shen Fu Tang + Sheng Mai San (Ginseng & Aconite Decoction + Pulse-Engendering Beverage)

Qi Deficiency with Blood Stasis
[Huang Qi (Astragulus Root) 30-120 g, Dang Gui (Angelica) 6g, Chi Shao Yao (Red Peony Root) 6g, Di Long (Earthworm) 3g, Chuang Xiong (Ligusticum Root) 3g, Hong Hua (Carthamus Flower) 3g, Tao Ren (Peach Kernel) 3g]
 * Main Symptoms:** Hemiplegia, slurred speech, fatigue
 * Additional Symptoms:** Numbness on affected side (or complete loss of sensation if severe), weakness and flaccidity of affected limbs, sallow complexion
 * Tongue:** Dark, purple, stasis macules
 * Pulse:** Thready, choppy, forceless
 * Treatment Principles:** Boost Qi, quicken the Blood, unblock the channels and collaterals
 * Acupuncture Treatment:** BL15, BL17, BL20, CV6, ST36, SP10
 * Herbal Treatment:** Bu Yang Huan Wu Tang (Yang-Supplementing Five-Returning Decoction)

Liver & Kidney Vacuity and Ascendant Hyperactivity of Liver Yang
[Huai Niu Xi (Achyranthes Root) 30g, Bai Shao Yao (White Peony Root) 15g, Dai Zhe Shi (Hematite) 30g, Long Gu (Dragon Bone) 15g, Mu Li (Oyster Shell) 15g, Gui Ban (Tortoise Plastron) 15g, Xuan Shen (Scrophularia Root) 15g, Tian Men Dong (Asparagus Tuber) 15g, Chuan Lian Zi (Toosendan Fruit) 6g, Mai Ya (Barley Sprout) 6g, Yin Chen Hao (Artemesia Capillaris) 6g, Gan Cao (Licorice Root) 4.5g]
 * Main Symptoms:** Hemiplegia with rigidity and spasticity and difficulty with flexion and extension, slurred speech and/or aphasia
 * Additional Symptoms:** dizziness, tinnitus, headache, flushed face, agitation
 * Tongue:** Red, scanty coating
 * Pulse:** Thready, wiry, rapid
 * Treatment Principles:** Nourish Yin, settle the Liver, subdue Yang, extinguish Wind, unblock the channels and collaterals
 * Acupuncture Treatment:** LR2/LR3, BL18, BL23, KI3, SP6
 * Herbal Treatment:** Zhen Gan Xi Feng Tang (Liver-Settling Wind-Extinguishing Decoction)

Obstruction of Wind-Phlegm & Blood Stasis
[Zhi Bai Fu Zi (Aconite) 6g, Shi Chang Pu (Acorus Root) 6g, Yuan Zhi (Polygala Root) 6g, Tian Ma (Gastrodia Root) 9g, Quan Xie (Scropion) 3g, Qiang Huo (Notopterygium Root) 6g, Tian Nan Xing (Arisaema Root) 6g, Mu Xiang (Saussurea Root) 6g, Gan Cao (Licorice Root) 6g]
 * Main Symptoms:** **Stiffness of the tongue, difficulty speaking**, deviation of the mouth and eyes, numbness of the limbs
 * Additional Symptoms:** dizziness, headache, loss of coordination, numb extremities
 * Tongue:** Dark and purple, white, slimy coating
 * Pulse:** Slippery, wiry
 * Treatment Principles:** Dispel Wind, resolve phlegm, remove obstruction and open the orifices
 * Acupuncture Treatment:** BL20, CV12, ST36, SP9, ST40
 * Herbal Treatment:** Jie Yu Dan (Slurred Speech Relieving Elixir)

Kidney Essence Deficiency
Acupuncture Treatment: BL18, BL23, HT6, HT7, KI3, LR3
 * Main Symptoms:** weak or flaccid tongue with slurred speech or aphasia, weakeness of the low back and knees
 * Additional Symptoms:** palpitations, dizziness and blurred vision, possible SOB or fecal or urinary incontinence
 * Tongue:** thin, small tongue with thin coating
 * Pulse:** deep, weak, thready
 * Treatment Principles:** Supplement Kidney Essence, nourish Yin, open the orifices
 * Herbal Treatment:** Di Huang Yin Zi(Rehmannia Drink), [Shu Di Huang (Cooked Rehmannia) 15g, Ba Ji Tian (Morinda Root) 9g, Shan Zhu Yu (Cornus Fruit) 9g, Rou Cong Rong (Cistanche Stem) 9g, Shi Hu (Dendrobium Stem) 9g, Wu Wei Zi (Schisandra Berry) 3g, Fu Ling (Poria) 9g, Mai Men Dong (Ophiopogon Tuber) 9g, Shi Chang Pu (Acorus Root) 6g, Yuan Zhi (Polygala Root) 6g, Sheng Jiang (Fresh Ginger Root) 6g, Bo He (Field Mint) 3g, Zhi Fu Zi (Aconite Tuber) 6g, Rou Gui (Cinnamon Bark) 3g, Da Zao (Jujube) 2 pc]

Channel Involvement

 * Basic Points:** GB20, DU20, DU16, DU14, LI4
 * Invasion by Wind Phlegm due to Deficient Channels and Collateral:** SP9, ST36, ST40, GB34, GB30, LI11, SJ5, HT1
 * Deficient Liver & Kidney Yin with disturbance by Ascendant Wind-Phlegm:** LR3, KI3, BL23, BL18, GB34

Organ Involvement

 * Basic Points:** DU26, PC6, SP6, GB20
 * Yang Tension Stroke:** Shi Xuan, ST40, CV22, PC8, PC9, LR3, LI4, GB41, KI3, LR3, Bleed Hand Jing-Well Points
 * Yin Tension Stroke:** Shi Xuan, ST40, ST36, CV22, LR3, LI4, CV12, DU20
 * Desertion/Flaccid Stroke:** Moxa CV4, CV6, CV8, DU20, KI1

Sequelae:

 * Basic Points:** PC6, SP6, GB20
 * Qi Deficiency with Blood Stasis:** BL15, BL17, BL20, CV6, ST36, SP10
 * LV/KI Vacuity with Yang Rising:** LR2/LR3, BL18, BL23, KI3, SP6
 * Obstruction by Wind-Phlegm & Blood Stasis:** BL20, CV12, ST36, SP9, ST40
 * KI Essence Vacuity:** BL18, BL23, HT6, HT7, KI3, LR3

Paralysis of upper limb add: LI15, LI11, SJ5, LI4 Paralysis of lower limb add: GB30, ST36, ST41, GB34 Facial Paralysis depending on area affected add: ST1, ST4, ST6, ST7, LI4, ST44, GB14, LI20, BL2, Yu Yao, SI6, BL60, SJ17 Rigid tongue/aphasia add: DU15, CV23, HT5 Ear Acupuncture: Adrenal, Shen Men, Kidney, Spleen, Heart, Liver, Eye, Gallbladder, Brain, Apex, Hypotensive Groove
 * __Supplementary Points:__**
 * Scalp Acupuncture:** motor sensory zones as relevant

Clinical Tips
Patients require hospitalization and biomedical care for treatment and stabilization during the acute stage of Wind Stroke. Use TCM for recovery and rehabilitation during the sequela stage. Prompt intervention promotes recovery and diminishes the likelihood of permanent impairment from Wind Stroke. Treatment within the first three months yields relatively good effects; after six months, the prognosis should be more guarded; after one year, prognosis is generally poor four significant recovery.

//Treatment should be given a minimum of three times per week and ideally everyday//; once per week is not sufficient to yield significant results. Prognosis should include an assessment of the severity of the stroke, treatment frequency, the skill of the practitioner, patient access to physical therapy, patient’s age

Preventive measures: identifying warning signs of an impending stroke and implementing early interventions will help prevent a stroke from occurring. The following symptoms, particularly in the middle-aged or elderly patient, are indicators of a possible TIA: dizziness or vertigo, tinnitus, transient numbness or weakness on one side of the body or face, or transient numbness of the tongue with difficulty speaking, difficulty speaking or finding words, difficulty understanding words, blurred or double-vision.