Apoplexy is divided into the two types of "apoplexy involving meridians and collaterals" and "apoplexy involving viscera" in TCM. The former generally refers to freedom from changes of mentality and the latter often to the more serious state of illness with unconsciousness. The main clinical manifestation is hemiplegia, namely paralysis of unilateral limbs. Therefore, the disease is also called "ban shen bu sui" (hemiplegia), "plan ku" (hemilateral withering) and "plan fei" (unilateral disuse) in TCM. The patients are often accompanied by facial distortion. If the disease lasts long, the affected limbs are skinny and numb. Syndrome differentiation and treatment Blood stasis due to qi deficiency It manifests hemiplegia of limbs, pale and lusterless complexion, emaciation, spontaneous sweating, numbness of skin, or swelling of hands and feet, spasm of muscle or with stabbing pain of unilateral body, squamous and dry skin, enlarged tongue with dental marks or dim and sluggish tongue with ecchymosis and petechiae, taut and thready or unsmooth and intermittent pulse. It is advisable to benefit qi and activate blood circulation, and dredge meridians and collaterls. The prescription used is the modified Buyang Huanwu Decoction (Yang-Strengthening Decoction for Recuperation). In the case of severe numb limbs and body, add Sangjisheng (Ramulus Loranthi ), Wugong (Scolopendra) and Jixueteng (Caulis Spatholobi); in the case of paralysis of upper limbs, add Sangzhi ( Ramulus Mori ) , Guizhi ( Ramulus Cinnamomi ) and Weilingxian (Radix Clematidis); in the case of paralysis of lower limbs, add Chuanniuxi (Radix Cyathulae). Asthenia of the liver and kidney It manifests hemiplegia, numbness and trembling of limbs and body, aching pain and flaccidity of the waist and legs, or odontoseisis and baldness, tinnitus, amnesia, light-headedness, stiff tongue with non-fluent speech, dull expression, red tongue with a little fur, taut and thready pulse. It is advisable to strengthen the liver and kidney. The prescription used is the modified Qiju Dihuang Decoction (Decoction of Six Drugs, Rehmannia with Wolberry and Chrysanthemum). In the case of palpitation and insomnia, add parched Zaoren (Semen Ziziphi Jujubae), Baiziren ( Semen Biotae ), Fuling (Poria) and Yejiaoteng (Caulis Polygoni Multiflori ); in the case of dry mouth and red tongue, add Tainmendong (Radix Asparagi) and Ejiao (Colla Corii Asini ). As for the Chinese patent drug, it is suitable to use Qiju Dihuang Bolus(Bolus of Six Drugs, Rehmannia with Wolfberry and Chrysanthemum). Phlegm and dampness due to asthenia of the spleen It manifests paralysis and numbness of the limbs and body, cold limbs, facial edema, chest tightness with abdominal distension, poor appetite, lassitude without physical strength, loose stool, fat body, yellowish complexion with pale lips, or cough with short breath, profuse sputum, pale tongue with white and greasy fur, taut and slippery pulse. It is advisable to strengthen the spleen, resolve phlegm and remove dampness. The prescriptions used are the Xiangsha Liujunzi Decoction Decoction of Cyperus and Amomum with Six Noble Ingredients) in combination with Erchen Decoction (Two Old Drugs Decoction) with the additional ingredients of Shichangpu ( Rhizoma Acori Graminei ), Yuanzhi ( Radix Polygalae), Yujin (Radix Curcumae) and Baijiangcan (Bombyx Batryticatus ). Rehabilitation methods Functional training When the patients gradually restore their functions of limbs and the body, they may be supported to practice some simple free activities in bed such as getting up, raising arms, lifting legs and lifting feet. The patients should leave the bed as early as possible to practice standing and slow walking. At the beginning, the patients should be supported by the medical and nursing staff to practice these activities. Then gradually increase the amount of exercise from the moment the patients use the walking stick to the moment the patients stop using it. Or the patients may do some knitting by hand to have functional training. The patients with stiff tongue and non-fluent speech may say simple words during the training. Then practice saying longer sentences gradually. As for the keep-fit patting method, please refer to the relevant content in Chapter 5.8.4. As for functional training of fingers and upper limbs, it is advisable to adopt the method of playing games. As for the relevant detailed content, please refer to Chapter 5.3.4. Acumox Acupuncture: Select Qihai (CV 6), Guanyuan (CV 4), Zusanli (ST 36), Shenshu (BL 23), Taixi (KI 3) and Xuehai (SP 10) as the main acupoints; Jianyu (LI 15), Shousanli (LI 10), Quchi (LI 11), Waiguan (TE 5), Hegu (LI 4), Huantiao (GB 30), Fengshi (GB 31), Yahglingquan (GB 34), Feiyang (BL 58), Juegu (LI 16) and Xuanzhong (GB 39) as the adjunct acupoints. Select 3 to 4 main acupoints and adjunct acupoints respectively. Adopt the reinforcing method when needling Qihai (CV 6), Guanyuan (CV 4), Shenshu (BL 23), Zusanli (ST 36) and Mingmen (GV 4); apply the reducing manipulation while puncturing Taixi (KI 3) and Xuehai (SP 10) as well as the acupoints of limbs. Add Fenglong (ST 40) and Yinlingquan (SP 9) in the case of phlegm and dampness due to splenic asthenia. It is advisable to apply moxibustion on every acupoint of the above with moxa sticks for 10 to 15 minutes in patients with asthenia. Acupoint injection: Inject 4ml of magnesium sulfate injection or injection of compound Danggui (Radix Angelicae Sinensis), 1 ml each acupoint" As for the upper limbs, select Neiguan (PC 6 ), Quchi (LI 11 ) and Shousanli (LI 10); as for the lower limbs, select Sanyinjiao (SP 6), Zusanli (ST 37), Yanglingquan (GB 34) and Chengshan (BL 57). Select two acupoints from the upper and lower limbs respectively each time. First, puncture the acupoints with the syringe needle while injecting the medicine to enhance the stimulation until there appears the sensation of soreness and distension. Then inject the drug. Inject the drug once every other day, and five times in succession constitute one course of treatment. Assume the second course of treatment after three-day rest. Stop the treatment when the muscular strength of the affected limbs reaches degree four during the treatment. Scalp acupuncture Select the motor area and sensory area of the healthy side of the head and the adjunct foot motor sensory area of the two sides of the head. Add the speech area in the case of stiff tongue and difficult speech. Insert the filiform needle with the size of 1.5 to 2 cun quickly beneath the skin section by section with the depth of 1 to 1.5 cun. First twirl the needle for 5 minutes at the frequency of 200 times per minute. Then twirl the needle for 5 minutes again after a ten-minute rest. Repeat the acupuncture for three times. Afterward, withdraw the needle. Puncture the scalp once a day, and five times in succession make up one course of treatment. It is also advisable to replace the manual twirling with electric impulses. Besides, it is also suitable to penetrate Qubin (GB 7) (the healthy or affected side) from Baihui (GV 20), or penetrate Xuanlu (GB 5) (motor area) from Qianding (GV 21), which is very effective as well. Ear acupuncture: Alternately puncture all the acupoints of Shen, Naogan, Ershenmen (MA-TF 1 ), Xin, Zhen and Pizhixia (MA- AT 1). It is also advisable to use needle-embedding method. Massage Shift the manipulations from gentle ones to heavy ones, and increase the strength gradually as the patients adapt to the methods until no muscular spasmodic contraction is caused. Generally, use the rubbing method first. Then gradually shift to kneading method, proceeding from the distal end to the proximal end of the limbs for five minutes. The massage points of the upper limbs include Quepen (ST 12), Jianyu (LI 15), Jianzhen (SI 19), Quchi (LI 11), Chize (LU 5), Shaohai (HT 3), Daling (PC 7), Yangchi (TE 4), Yangxi (LI 5), Yanggu (SI 5), Shousanli (LI 10) and Hegu (LI 4); the massage points of lower limbs include Qichong (ST 30), Huantiao (GB 30), Juliao (GB 29), Fengshi (GB 31), Zusanli (ST 36), Yanglingquan (GB 34), Xuehai (SP 10), Weizhong (BL 40), Chengshan (BL 57), Taixi (KI 3), Kunlun (BL 60) and Jiexi (ST 41). Passive activities may be adopted at the same time in combination with massage. The doctors may guide the patients to have various passive activities for the affected limbs with the help of the healthy limbs. When the muscle has slight autonomic activities, use forceful manipulations with kneading and pinching the muscle as the main manipulations. Reduce acupoint massage, but still massage more on the acupoints of the yangruing meridians such as Shousanli (LI 10) and Zusanli (ST 36). The patients should mainly have sports events and medical training after the adjunct massage when the limbs restore autonomic activities, but resistance still exists in the muscle. It is advisable to knead and pinch the muscle, strike and pat the whole limbs to promote the excitability of tissues. At the end of the activities, it is suitable to massage with the kneading, rolling and palm-pushing manipulations from the distal end to the proximal end. The manipulations may promote muscular relaxation and venous return. Dietary therapy For the patients with blood stasis due to qi deficiency, cook gruel with 30 g of Huangqi ( Radix Astragali seu Hedysari), 30 g of Shanzha ( Fructus Crataegi) and a proper amount of Jingmi (Fructus Oryzae Sativae ). Eat the gruel in the morning and evening, one dose a day. For the patients with asthenia of the liver and kidhey, cook 15 g of Huaishanyao ( Rhizoma Dioscoreae ), 30 g of Guiban ( Carapax et Plastrum Testudinis ) ( to be decocted first) and 60 g of lean meat until the ingredients are done. Eat the food in different times of a day for 10 days in succession, one dose a day. For the patients with phlegm and dampness due to splenic asthenia, cook 30 g of Yiyiren (Semen Coicis), 30 g of Baibiandou ( Semen Dolichoris Album), 30 g of Huaishanyao (Rhizoma Dioscoreae ), 60 g of radish and 60 g of Jingmi (Fructus Oryzae Sativae). Eat the food for 7 to 10 days in succession, one dose a day. Sangzhi Tea (Tea of Ramulus Mori) Add 600 ml of water to 20 g of Sangzhi (Ramulus Mori), and decoct it until there is 200 ml of water left. Use the decoction as tea to drink. It is applicable to hemiplegia, swelling and distension of unilateral limbs and body with pain and numbness, unsmooth flexion and extension after apoplexy. It is also applicable to hypertension, numbness of limbs and the body as well as underlying apoplexy. Immortals' Food Grind 1,000 g of Tianmendong (Radix Asparagi ) and 100 g of Xingren( Semen Armeniacae Amarum) into powder. Soak the powder in honey. Take the powder twice a day, 5 g each time. It is applicable to sequelae of apoplexy, numbness of limbs and the body, pain and contracture as well as constipation. Nursing in daily life Keep defecation unobstructed. The patients should eat bland foods, and avoid greasy and fine foods. Abstain from drinking and smoking. Strengthen the nursing of the affected limbs, and take care to keep the local part warm. If the conditions permit, the patients may jointly play a musical instrument, play chess and practice calligraphy and painting to cultivate the mind. At the late stage of rehabilitation, the patients may jointly have traditional sports therapies like five mimic-animal games and Taijiquan.
