Introduction: As time flies, it is almost summer in South Africa. Yang energy is arising gradually alongside with the temperature. Our clinic received three post-stroke patients in the last three months.
The age ranges from young, middle-age and senior. Two of them suffered from twice stroke within two months; some of them were right brain while one of them was left brain.One of them accepted both Chinese herbal medicine and acupuncture treatments within one week after onset, while the other two patients accepted Chinese herbal medicine and/or acupuncture treatments nearly 6-8 weeks after stroke onset. Some of them also suffered from other chronic diseases such as hypertension and diabetics.
They are truly quite representative in terms of TCM rehabilitation treatment on stroke sequela. So we are planning to share these three series articles on TCM treatments of stroke sequela for your reference.
As we known, our brain hemispheres on both sides are not complete symmetrical in terms of functions. There are dominant and non-dominant hemisphere. The dominant hemisphere is more related to speech, logical thinking and analysis. Most of us, the dominant hemispheres are on the left side, while only very small amount of right handed and half of left handed people, the dominant hemisphere might on the right side. Stroke affected in different locations may lead to different clinical symptoms.
In the previous two articles, we have introduced two types of stokes, one is ischemic stroke and the other is intracerebral haemorrhage. Although they were two very different strokes, patients were experiencing rather similar symptoms such as facial disorder and paralysis on the left side due to the fact that they were both affected on the right hemisphere.
Today, we are going to talk about another ischemic stroke. In this case, the patient suffered from left hemisphere ischemic stroke. She was not only paralysed on the right side but also suffering speech disorder.
Case 3: Female, 60+ years old. No any chronic medical conditions before onset.
On 7th of September,2017, she was suffering dizziness and weakness on the right hand suddenly. She was sent to Netcare Waterfall Hospital directly. Brain MRI showed that there was ischemic shroke on the left hemisphere. About four weeks after being admitted to the hospital, gradually, she suffered from weakness on the left legs. She could not walk independently and even could not speak.
A follow up brain MRI showed that she had another stroke in the left hemisphere. She was with conventional treatment and physiotherapy for almost one month before being transferred to Mid stream rehabilitation centre. No significant improvement had been achieved.
She came to us on 24th of October. She was conscious. She could not put her tongue out of the mouth and could not speak at all. Both of her right upper and lower limbs could not move actively as well. Myodynamia: left upper limb: 0, left lower limb: 0. Activities of daily living scale (ADL) score: 30.
The first day treatment: Acupuncture points GB20, PC6, Lu5, LI11,GB30, SP6... tongue-three-needles were applied for 30 minutes.
The second day treatment: the second day before the second treatment, she could lift her right leg up and down. She still could not speak. Acupuncture treatment was applied with the same treatment plan as above.When the second treatment finished, she could speak out her surname “Chow chow”.
The third day treatment: acupuncture treatment was applied as above. She not only could count numbers 1-10 but also sing Happy Birthday and children’s songs. Right lower limb was improving. Her family requested to use Chinese herbal medicine together. Herbal medicine was applied from the four day with the functions of tonify Yang energy and activate circulation.
The fourteenth day treatment: She has been walking with a walking stick for quite a few days with the assistance of her family. Her walking posture was much better than before.
However, her right foot was weak and could not lift up as the foot was dragging on the floor when she walked. Acupuncture point KI3, ST4, GB40 were added to the previous treatment.
The fifteenth day treatment: her right foot improved as she could lift up her right foot without dragging on the floor.
The 22nd day treatment: The movement of her tongue was flexible in all directions.
She is still with acupuncture and herbal medicine treatment every day. She is also requested to keep practicing. Her speaking is improving significantly.
Summary:
1. This patient suffered twice strokes within one month in this senior age (69 years old). She sought for Chinese Medicine treatment one and half month after onset. It was quite a complicated and difficult case.
When drafting a Chinese Medicine treatment plan, detailed evaluation such as medical history/conditions and medication currently used shall be considered with special attention. Both acupuncture and herbal medicine prescription shall be modified if the patients conditions have changed.
2. When treating a speech disorder patient due to stroke, besides the treatment for the brain hemisphere, the function of the tongue itself shall not be ignored. When making a Chinese Medicine treatment plan, we shall not only focus on rehabilitation but also prevention. (Prevent the next stroke.)
3. In senior ones, all rehabilitation training shall be well conducted to avoid any injuries such as falling down. In some patients, encouragement is paramount important due to the fact that some patients feel depressed easily.