Regulating the Heart with Acupunctureduring the Rehabilitation Stageof Wind Stroke
by Deng Baiying, Zhou Enhua, Li Yangfan, Su Shengyong & Sun Peilin
Both in China and overseas, it is well known that acupuncturecan play an important role in the treatment of windstroke,especially during the rehabilitation stage. However, in the treatment of windstroke most acupuncturists prefer to choose acupuncture points from the yang channels, whilst points from the yin channels are not so frequently prescribed.Furthermore, the importance of Heart regulation is often neglected. Based on the theoretical literature of Chinese medicine and our clinical practice over the past two decades,the authors believe that Heart regulation in the treatmentof windstroke, especially during the rehabilitation period,is of extreme importance.
windstroke, cerebrovascular accident,acupuncture.
1. The difference between wei syndrome andhemiplegia
The idea of primarily applying points of the yang channels in treating windstroke probably derives from a passage in the Neijing (Yellow Emperor’s Inner Classic). The chapter
‘Atrophy’ from the Suwen (Essential Questions) states:
“[herbs and acupuncture] are used from the yangming[channel] in the treatment of wei [syndrome]”.However, it is wrong to confuse wei syndrome (atrophy disorder) with hemiplegia due to windstroke; they are two different concepts both in theory and practice. Wei syndrome refers to a condition characterised by a lack of strength in the four limbs and the muscles, especially in the lower limbs.There is a gradual appearance of bilateral muscle atrophy,tiredness, poor concentration and memory, and difficulty in walking, speaking, swallowing and breathing, followed by suffocation and finally death. This progression may be seen in diseases such as amyotrophic lateral sclerosis (ALS) and multiple sclerosis (MS).
Hemiplegia is a condition characterised by paralysis of the limbs, usually unilateral, accompanied by slurred speech,deviation of the mouth and eyes, and in some cases coma or impaired consciousness.There are three important differences between wei syndrome and hemiplegia:
a. Wei syndrome occurs bilaterally, whilst hemiplegia isusually unilateral.
b. The onset of wei syndrome is gradual, whilst hemiplegiafrom windstroke has a sudden onset.
c. There is no change of consciousness in wei syndrome,whilst there is usually a change in consciousness and speechin windstroke.
Thus it can be seen that it is inappropriate to apply thesame treatment principles in both diseases.
2. The zangfu chiefly involved in windstroke is the Heart
Based on modern anatomy, physiology and pathology, it is considered that windstroke is mainly caused by cerebral accident, due either to haemorrhage or thrombosis. Most modern practitioners of Chinese medicine have followed the above theories and formed the conclusion that it is the brain which is the chief location and site of injury in windstroke. As far as the cause of windstroke is concerned, the Neijing
states: “people with yang excess may have a separation of body and qi when suffering excessive anger, which causes uprising of blood, thus an attack of stroke occurs” (Suwen:Discussion on Qi Production and Heaven Communication)and “Simultaneous uprising of blood and qi may causeattack of stroke”(Suwen: Discussion on Channel Regulation).
However, these statements only describe the aetiology and pathology (uprising of qi and blood) of windstroke,and neither one confirms the theory that the location of windstroke is in the brain.If a clear analysis of the clinical symptoms and signsis made, it can be seen that the organ chiefly involved in windstroke is the Heart rather than the brain.The three main symptoms of windstroke are
a. changes in consciousness, b. slurred speech or aphasia, and c. hemiplegia.
In view of the Heart’s relationship to consciousness, speech, blood circulation and the blood vessels, we propose that these are closely related to the physiological functions of the Heart.
The Heart is referred to as the emperor of the body, for the Heart is where the shen (spirit) is housed. Consciousness,memory, awareness, physical sensation and emotions,the total expression and interaction of our being, the full extent of our expansion, maturation and development, in other words the shen or spirit, are all ruled by the Heart.The Heart maintains these physiological functions by integrating and communicating our experiences, establishing an inter-connectedness between our inner life and the external universe.The shen denotes the totality of a person’s life capacity at any given moment, both in health and sickness. When the shen is strong, the body, psyche and personality are in harmony, reflected by an aliveness of emotional expression,clear judgement, presence of mind, good memory, bright eyes and a lustrous complexion.
After windstroke, patients often suffer from impaired consciousness or even coma, poor memory, headache,dizziness, poor vision and a dark complexion which are indications of Heart disorder.
In determining the prognosis of stroke, it can be generalised that in those patients who show a strong shen, the sickness is milder and they are likely to recover more quickly, whilst in those who show weakness and impairment of the shen,the sickness is more severe and the prognosis worse.
The Heart opens into the tongue, and the Heart is the foundation of the shen, which gives rise to the capacity for thought, speech, the clarity of the voice and communication. After windstroke, especially when the zangfu have been affected, a stiff tongue, difficult tongue movement, slurred speech, a low voice, aphasia or difficulty in communication are often seen in the clinic, symptoms which are closely associated with a disturbance of the Heart.
The Heart governs the blood and blood vessels of the entire body and propels the blood through the body.This continuous flow of blood through the vessels both nurtures the body and limbs and serves as a vehicle for communication. The blood communicates with each and every part, pervading all regions of the body. The blood propelled from the Heart enfolds the shen in order to maintain awareness, serving as the material matrix of the psyche.
When the Heart fails to maintain its physiological function, insufficiency of blood supply to the body and four limbs, or stagnation of blood in the blood vessels, may occur.The concurrent qi stagnation may lead to the formation of phlegm, which, combined with stagnant blood in the body and tissues, may lead to lack of force in the limbs, weakness of the muscles, disturbance of the mind, dysfunction of the sense organs, bodily pain and paralysis with gradually occurrence of muscle atrophy.
Furthermore, since it is considered that the Heart is the emperor of the body and governor of all the zangfu, any physiological and mental disturbance to the Heart can subsequently cause impairment of the function of the other zangfu. Since the Heart is mainly affected in windstroke, it follows that the physiological and pathological condition of the Heart can determine the severity and prognosis of windstroke.
3. The Heart is the chief governor of the brain
As early as the Neijing there appear descriptions of the brain, for example “The brain is a sea of marrow. Its point above is the top of the head [Baihui DU-20]; below it is Fengfu [DU-16]”. The book Yixue Yuanshi (Origin of Medical Science by Wang Honghan, Qing Dynasty) states “the sense organs, i.e., the ears, eyes, mouth and nose, are in the head close to the brain. Owing to their highest and most obvious position, they may perceive objects, which will impress the brain directly and remain in the brain”.
Moreover, it was suggested in the Yilin Gaicuo (Medical Correction by Wang
Qingren, 1830) that thinking and memorisation are the main functions of the brain.The brain is described in Chinese medicine as the sea of marrow, the filling of which depends on the jing (essence) of the Kidney. Moreover, unrestraint and patency of the its all functions of the brain relies to a certain degree upon the Liver. However, since the main physiological functions of the brain are thinking and memorisation, Chinese medicine considers the Heart to be the main governor of the brain.
Disturbance of the Heart may therefore cause change in consciousness and mental activities.
4. Heart regulation in the treatment of windstroke
In China, acupuncture is frequently applied alongside modern medicine and Chinese herbs in the treatment of windstroke, even in the earliest stages. However, it is primarily used during the rehabilitation stage.There are different approaches to the acupuncture treatment of windstroke.
Regulation of the Heart is a traditional, yet neglected, method, for example Liu Hejianin the Wenxuan Jiyuan Bingshi (Exploration of Pathogenesis in Familiar Conversation, Aetiology Based on Plain Questions,1188) stated that windstroke is caused by “excess of Heart fire resulting from all kinds of emotional disturbance”.In recent years, regulation of the Heart has again been adopted as an important method in the treatment of windstroke.
Jiquan HE-1, Shaohai HE-3, Tongli HE-5 and Neiguan P-6.Reducing method is applied to these points.
Yongquan KID-1, Sanyinjiao SP-6, Renzhong DU–26,Huantiao GB-30, Weizhong BL-40, Zusanli ST-36 and Xuanzhong GB-39. Reducing method is applied onthese points.
• Jiquan HE-1 is used to promote blood circulation,eliminate blood stasis, smooth the channels and regulatethe collaterals
.• Shaohai HE-3, the he-sea point of the Heart channel, isused to promote blood circulation, eliminate blood stasis,relax the channels and blood vessels, regulate the Heart,benefit the spirit, open the Heart orifice and harmonise themind.
• Tongli HE-5, the luo-connecting point of the Heartchannel, is used to harmonise and regulate the collaterals,smooth the qi circulation in the collaterals, eliminate bloodstasis, and regulate the Heart and mind.
• Neiguan P-6, the luo-connecting point of the Pericardiumchannel and the confluent point for the Yin Linkingvessel (Yin Wei Mai), is used to relax the chest, regulateqi circulation in the body, calm the Heart, tranquillise themind, resolve damp-phlegm in the vessels, eliminate bloodstasis, harmonise the collaterals and soothe pain.Together, these points are prescribed to regulate thephysiological functions of the Heart so as to restore itsgoverning position in housing the mind.Supplementary points
• Yongquan KID-1 is used to promote communicationbetween the Heart and Kidney, open the Heart orifice andrestore consciousness.
• Sanyinjiao SP-6, the crossing point of the three yinchannels of the foot, is used to smooth the circulation inthese three channels, promote blood circulation, eliminateblood stasis, alleviate pain, activate the Spleen and resolvedamp-phlegm.
• Renzhong DU-26 is a crossing point of the hand and footyangming channels (which are rich in qi and blood) withthe Governing vessel, whilst the Governing vessel connectsinternally with the Heart zang. This point is used to awakenthe mind and brain, regulate the Heart, and smooth all theyang channels of the body.
• Huantiao GB-30, a crossing point of Gall Bladder andBladder channels, and Weizhong BL-40, the he-sea pointof the Bladder channel, are used to smooth the channels,harmonise the collaterals, eliminate blood stasis andalleviate pain.
• Zusanli ST-36, the he-sea point of the Stomach channel,which is also the acquired source of human life, andXuanzhong GB-39, the confluent point for the marrow, areused to promote the production of qi and jing, benefit andharmonise the blood, strengthen the muscles and fill upthe vessels.
• If there is paralysis of the upper limbs, add Hegu L.I.-4,Shousanli L.I.-10, Quchi L.I.-11, Jianyu L.I.-15 andWaiguan SJ–5
.• If there is slurred speech or aphasia add LianquanREN-23, Jinjin and Yuye (M-HN-20) to improve themovement of the tongue and benefit the speech.
• If there is difficulty in swallowing, add Tiantu REN–22and Yamen DU-15 to descend the qi and improve theswallowing function.
• If there is paralysis of the lower limbs, add YanglingquanGB-34, Jiexi ST-41, Kunlun BL-60, Zhaohai KID-6 andShenmai BL-62 to improve the movement of the lowerlimbs.
• If there is a hyperactivity of Liver yang, add FengchiGB-20 and Baihui DU-20 to calm the Liver and suppressyang
.• If there is deficiency of yin of the Liver and the Kidney,add Taixi KID-3 and Ququan LIV-8.
.5. Typical case history
Mrs Ye, Chinese, 69 years old.
Sequelae from CVA (cerebralthrombosis).
First consultation: 20 November, 2002.
: paralysis of the left limbs with aphasia for 43 days.
: she had been suffering from hypertension for 18 years and coronary heart disease for 12 years.
: paralysis of the left limbs. Muscle power at the upper left limb was III, muscle power at lower leftlimb was II. Aphasia.
CT scan: cerebral thrombosis.
: Rehabilitation period after windstroke with affection of the zangfu.
Jiquan HE-1, Shaohai HE-3, Tongli HE-5, Neiguan P-6,Yongquan KID-1, Sanyinjiao SP-6, Renzhong DU-26,Huantiao GB-30, Weizhong BL-40, Zusanli ST-36 andXuanzhong GB-39 were mainly selected. Massage of the leftlimbs was also added after each session of acupuncture.Supplementary points: Jinjin and Yuye (M-HN-20), QuchiL.I.-11, Hegu L.I.-4, Yanglingquan GB-34 and ShenmaiBL-62. Moxibustion at Guanyuan REN-4 and Zusanli ST–36.
After sterilisation of the skin, the needles were inserted perpendicularly. Lifting and thrusting together with twirling and rotating method was applied. Renzhong DU–26 was punctured with reducing method with the tip of the needle directed slightly upwards in order to cause slightl acrimation. Jiquan HE-1, Neiguan P-6 and Sanyinjiao SP–6 were punctured to produce a radiating needle sensation toward the extremities. Jiquan HE-1 was punctured without retention of the needle. Jinjin and Yuye (M-HN-20) were pricked to cause 1-3ml of bleeding.
Needles were retained for 30 minutes after the arrival of qi. Manipulation at all needles was repeated once every 10 minutes. Treatment was given once every other day.
After the first treatment, the patient could count out loud from one to ten.At the sixth visit she could say some simple words, the muscle power of her left lower limb had reached III, and that of the left upper limb had reached IV. At the twelfth visit she could say some simple sentences, the power of her left lower limb was normal, that of the left upper limb had reached IV, and her fingers could bend and extend freely. At the fifteenth visit the power of her left upper limbs was normal.Her speech was much clearer at the twentieth visit.
Deng Baiying is professor and doctor of acupuncture at Guangxi University of TCM, Nanning. Zhou Enhua, Li Yangfan and Su Shengyong are doctors of TCM and students for the Masters Degree in GuangxiUniversity of TCM. Sun Peilin is a professor of TCM and practisesin Belgium.This project was supported by The Scientific Research Fund, GuangxiUniversity of TCM, China. Project code Y200348.