Shihan Mary Bolz, L. Ac., M. Sc.,
Each day 1200 Americans suffer a stroke, and four hundred of them become permanently disabled. Stroke is the leading cause of disability and the third leading cause of death in the United States. In 1992, a report from the National Institute of Health stated that more than two million Americans suffer long-term disabilities from stroke, at a cost to our society of $25 billion each year.
In China, there is less incidence of stroke than in Western countries, and there is greater recovery of function after a stroke. This is not because Chinese people are physically different from Americans, but because of differences in diet, lifestyle, and post-stroke treatment. This will be changing in the near future, however, as the Chinese adopt a Western diet more and more of coffee, meat, and overly sweet baked goods.
A stroke occurs when part of the brain is damaged because its blood supply is disturbed. As a result, the physical or mental functions controlled by the injured area of the brain are permanentlydamaged or sometimes may be partially restored via alternate pathways. The disturbance may be from one of three types of vascular disorders: cerebral thrombosis (clotting within a blood vessel), cerebral embolism (blockage of a vessel by an embolus which could be a blood clot, fat or air), or cerebral hemorrhage (bleeding in the brain).
Some of the symptoms that a stroke may be occurring are sudden numbness or weakness of the face, arm, or leg, especially on one side of the body. There may also be sudden confusion, difficulty in talking and forming understandable sentences, sudden trouble with vision in one or both eyes, difficulty in walking, dizziness, or loss of balance or coordination and sudden severe headache with no known cause. If a person is complaining of “the worst headache of my life,” this could be the precursor to a stroke, especially if they have never had that occur before. You would be wise to call an M.D. you can get hold of immediately or have that person go the the Emergency Room of the nearest hospital. Stroke is more common in middle-aged and old people, of course, since there has been a longer number of years for the blood to get stagnated and stuck. It can occur in young people, though.
The definitive method of diagnosing a stroke, and the most reliable, is computed tomography (CT) scanning. It is the preferred diagnostic technique for acute stroke. It is helpful in the determination of location and extent of cerebral necrosis (tissue death). Another imaging device used for stroke patients is the magnetic resonance imaging (MRI) scan. MRI uses magnetic fields to detect subtle changes in brain tissue content.
There are three forms of stroke as classified by Western medicine. A cerebral thrombosis, can occur when an artery that supplies blood to the brain is narrowed, usually from atherosclerosis (degenerative disease of the arteries). A plaque, or large deposit of cholesterol, at the narrowed and roughened, weakened portion of the artery may break open and create a place within or without the arterial wall where the blood can coagulate and form a thrombus, or clot. This thrombus may grow until it partiallyor completely blocks the artery.
A cerebral embolism is also a blockage, but it is caused by an embolus, which is a clump of material in the bloodstream. The embolus may be a chunk of debris from a section of an artery where atherosclerosis has occurred, or a small clot from a diseased heart or blood vessels. It is carried in the bloodstream until it becomes wedged in a place where it obstructs the crucial flow of blood that goes to an area of the brain. In some cases where injury has occurred, fat or air may enter damaged arteries and pass through the bloodstream to cerebral vessels, causing a stroke.
With a cerebral hemorrhage, the artery is not blocked; it bursts or leaks. Blood spreads from the rupture site into the surrounding brain tissue until the bleeding stops because blood pressure falls or because blood clots seal the leak. The initial effects of a hemorrhage may be more severe than those of a thrombosis or embolism, but the long-term effects of all three types of stroke depend on which part and how much of the brain is affected.
During the acute stage of stroke, Chinese medicine plays only a secondary role to Western medicine, but during after the first two weeks of the disease, Chinese medicine plays a primary role. Acupuncture in particular gives excellent results in the treatment of hemiplegia (weakness in one half of the body) and facial paralysis. The time factor, however, is very important: best results are obtained if treatment is given within one month of the attack. More than six months after its occurrence treatment becomes increasingly difficult.
What does TCM (traditional Chinese medicine) have to say about stroke? Chinese medicine theory recognizes four main pathological factors (agents) of stroke: Wind, Fire, Phlegm, and Stasis. There are also considered to be four leading contributing factors to stroke related to lifestyle: emotional stress, overwork, poor diet, and excessive sexual activity. Dietary factors are major.
Because there are a number of contributing factors to stroke and these factors tend to play out over a long period of time, and because the stroke itself can manifest in a number of ways, it can be difficult to assess the exact cause in a scientific manner. But remember that strokes don’t “just happen” for “no reason.” Any of the following lifestyle factors, experienced over a period of years, could eventually result in a stroke: working long hours under stressful conditions without adequate rest; physical overwork, including excessive, strenuous sports activities; emotional strain; irregular eating habits; excessive consumption of fats, dairy products, greasy or fried foods, sugar, or alcohol; and/or excessive sexual activity (what constitutes “excessive” sexual activity depends on the age and general physical condition of the individual).
The internal organs most likely to be weakened by these factors are the Kidney and the Spleen, causing deficiencies of Qi, Blood, and Yin. Deficiency of Qi means a deficiency of the life-force energy on both a physical, mental and spiritual level of the human being. Deficiency of blood most people can understand. We are talking about the deficiency of the quality of the blood. Extreme blood deficiency would show up on a laboratory test as anemia. Yin is a little bit more difficult for the Westerner to understand in terms of medicine and the human body. Think of yin as the opposite of the fire (yang), meaning the fluid, both interstitial and intercellular, even including the blood. Phlegm can be looked at as excessive and unwanted material and wastes lodged in the body. Stasis refers to blood stasis, meaning the congealing and thickening of blood in the vessels, tissues, and organs of the body. Deficiencies of Qi, Blood, orYin permit the body to be overwhelmed by the pathological factors of Wind, Phlegm, Fire, and Stasis, resulting in such stroke-related patterns as Liver Yang Rising, Stasis of Qi or Blood, Phlegm combining with Fire, Liver Wind, or Wind in the particular channel(s) or meridian (s).
In general, practitioners of Chinese medicine attribute stroke to a chronic weakness of qi that eventually blocks the flow of Blood through the brain. Chinese medicine has equated stroke and heart attack for centuries. Western medicine has come to this view only recently.
To treat stroke, TCM practitioners prescribe herbs that open the blood vessels and promote the flow of Blood. These include, but by no means are limited to hawthorn, frankincense, myrrh, santalum wood, aristolochia root, and borneol crystals. Bear in mind that treatments are not standard. One shoe does not fit all, meaning that each patient who has suffered a stroke will have an individualized treatment and customized herbal formula. There is no “stroke formula” or “stroke herb.” This is the beauty of Oriental medicine; it takes into account the underlying imbalance and predominant pattern of either excess or deficiency of each individual. Acupuncture is exceptionally effective for post-stroke sequallae and other helpful therapies include exercise such as Tai Ji and Qi Gong.
Obviously, the most effective way to prevent a stroke from occurring is to modify the lifestyle factors that lead to stroke. Physical work and exercise should be appropriate to a persons age and physical condition. The person needs to get adequate rest, which is different from person to person. The same advice goes for sexual activity. It is important for everyone to learn to manage stress, especially people with a history of cardiovascular problems. Relaxation, meditation, and gentle exercise like yoga or Tai Ji (Tai Chi) are proven ways of lowering blood pressure and stress-related chemicals in the body. The most important factor is diet. The traditional Chinese and Japanese diet is high in fiber and low in fat, sugar, and dairy products. It is seen over and over again around the world that populations who eat this type of diet have dramatically lower incidence of heart attack, stroke, and diabetes than populations who eat the typical modern Western diet.
A useful Chinese, as well as Western herb that can help to prevent stroke is ginkgo biloba (bai guo ye). Harvard University’s Dr. Elias Corey published his research on ginkgo in 1988 which shows that ginkgo stimulates cerebral circulation (blood flow in the brain). This improves mental functioning and can prevent blood cells from forming blood clots in the brain. Research indicates that ginkgo improves blood circulation, strengthens mental capacity, lowers plasma cholesterol concentrations, benefits Alzheimer’s patients, and can prevent stroke and heart attack. In order to achieve maximum effect, ginkgo should be taken in a therapeutic dose. Because there are no universal pharmacological standards applied to herbal preparations, concentrations of ginkgo may vary from company to company, so it is hard to say what a therapeutic dose is. Traditional Chinese Medicine goes a number of steps further, in that each individual’s condition is analyzed for an underlying pattern imbalance and a formula is prepared of a number of herbs that matches each individual’s pattern. Thus herbal preparations are not just hit and miss or a guess for each person.
In the case of stroke, Chinese medicine plays both a preventative and a rehabilitative role. In its prevention role, Chinese medicine is used to treat manyof the common risk factors for stroke, such as hypertension and diabetes. In its rehabilitative role, Chinese medicine is used to treat the effects of stroke. Accordingly, Chinese medicine is useful for side effects such as paralysis, speech issues, muscle weakness/flaccidity, etc.
From a TCM (Traditional Chinese Medicine)Theory perspective, stroke is related to the Liver, Spleen and Kidney systems. The predisposing factors for stroke may take years to develop and are often the result of emotional and physical strain, overwork, poor diet and lack of relaxation. These lifestyle habits deplete the body of vitality which often leads to an accumulation of Phlegm and/or Wind. Over time these internal factors of phlegm and wind build to varying degrees and may culminate in a stroke.
Phlegm is the result of the Spleen being weakened by a poor diet and/or physical/mental strain. An accumulation of Phlegm disrupts the smooth flow of Qi within the body and may result in symptoms such as poor concentration/muddled thinking, and/or numbness of the limbs. Over time this Phlegm will stagnate and transform into Phlegm-heat which may rise to the head and ultimately cause a stroke.
Wind is often the result of emotional and mental strain, lack of relaxation and poor dietary habits. Too much physical and mental stress in life can deplete the Yin of both the Kidneys and the Liver which can lead to Wind rising up and causing a stroke or symptoms such as high blood pressure, headaches, emotional issues, etc.
The treatment theories for stroke are divided into two main categories – those that effect the muscles/channels (generally mild) and those that effect the internal organs (more serious). The internal channel differentiations are further subdivided into a general deficiency pattern or an excess one. In clinical practice, patients will often have a mix of deficiency and excess symptoms. Additionally, as patients with more severe strokes move into the rehabilitation stage they will be treated according to the muscles/channels differentiations which deal with the side effects of a stroke.
Using acupuncture to stimulate the peripheral nervous system as well as the central nervous system can be quite successful in the rehabilitation. People should know that they should start the acupuncture in the third week post incident or as soon as the patient is stabilized by Western medicine, whichever is first. It may be less time or more time after the incident. But, it is best to start acupuncture and/or Chinese herbal formulas within the first month for optimal results. Best results are obtained if acupuncture is done within the first six months. This is not to say results can not be obtained after six months. They can. The improvement is much slower, however, than if the treatments were taken sooner. Nothing is impossible, but recovery always takes work, time, correct treatment and therapy, and patience.