The less the better - Traditional Chinese Medicine (TCM) clinical study on stroke sequela 2

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.

Stroke includes both hemorrhagic and ischemic cerebrovascular diseases, such as intracerebral hemorrhage (ICH), subarachnoid hemorrhage as well as cerebral infarction. The rehabilitation result is greatly related to age, affected location and size/volume. In the previous article, we have introduced a ischemic stroke case treated with Chinese Medicine. Hereafter, we are going to introduce an ICH case.

There are more than one million people suffer from ICH annually all over the world. ICH accounts for 10-15% of all strokes but results in a disproportionately high morbidity and mortality. Approximately 40-50% ICH patients die within one month after onset. In other word, almost half ICH patients die within one month.What’s more, only 1 in every 10 patients can recover almost completely. 65% of ICH patients may not be able to live independently and 10% of them would require care in a nursing home or long term care facilities.

Case 2:male, 30+ years old. He was diagnosed with “Type 2 diabetes” for 10 years and has gone through a routine conventional treatment; diagnosed with “Chronic renal failure” for 4 years”;“Coronary Artery Bypass Grafting ”4 years.

On 28th of August, 2017, the patient suffered from sudden facial disorder and left limbs (both upper and lower limbs) weakness when went to toilet at night. He was sent to local hospital. Brain CT scan showed large intracerebral haemorrhage in the region of the right basal ganglia (69×28mm) (It expanded to 80×44mm one week afterwards). After a few days conventional treatment, he was transferred to Life Glynnwood Hospital for further treatment. In mid July, he was transferred to Morehill rehabilitation centre for rehabilitation. After one and half month treatment and rehabilitation, no significant improvements have been achieved.

When he came to our clinic on 15th of August, he was still completely paralysed on the left side. Both his left upper and lower limbs could not move actively at all. He also suffered from left facial disorder. Myodynamia: left upper limb: 0, left lower limb: 0. Activies of daily living scale (ADL) score: 30; National Institutes of Health Stroke Scale (NIHSS) score:11.

Treatment plans:

Group 1 (Affected side):Du20, Ex-HN1 (Front), Du26, ST4 through ST6, Lu5, LI11, PC6, GB30, GB31, BL40, SP6;

Group 2 (Affected side) Du 26, ST4 through ST6, Lu5, LI11, SJ3, SI5, LI5, GB30, BL4, SP6, LR3, EX-LE10, EX-UE9.

Treatment frequency: 30 min per time,1 time per day. Group 1 and 2 points were applied in turns day by day. Electroacupuncture was applied.

The first day treatment: acupuncture points in group 1 were applied.In the second morning, his left leg could move not only side to side but also up and down.

The third day treatment: continue the treatment plan as above, he could walk about 20 steps with walking stick with assistance of his wife.

The fifth day treatment: his left arm could move both side by side and up and down. His walking posture was improving. Continue the same treatment plan.

The fourteenth day treatment: he could walk upstairs and downstairs (4 steps) with the assistance of a handrail.

The fifteen day treatment: In this morning, he was conscious but suffered from speech disorder suddenly. He was transferred back to Life Glynnwood Hospital for further examination. Brain CT showed no new haemorrhage had been noted. The result indicated that he might have suffered from ischemic stroke. The reason of this stroke might be the discontinuous using of anticoagulant which was required for the post Coronary Artery Bypass Grafting surgery.

He was admitted to the ICU ward for further treatment. Acupuncture treatment was permitted to be carried on in the ICU ward. His speech function recovered in that afternoon.

After 9 weeks treatment since 15th of August: acupuncture treatment was constantly applied every day. He can walk uphill, downhill, upstairs and downstairs independently. ADL score: 95.

Acupuncture treatment frequency has been reduced to twice per week. He is required to keep practicing.

Summary:

1. This patient suffered from twice strokes within two month, ICH and ischemic stroke. Thinking of his several chronic medical conditions, it is absolutely a rather complicated case. In order to avoid the adverse drug reaction, this patient was not using herbal medicine due to the fact that he was taking anticoagulant (warfarin).

2. Although this patient started to have acupuncture treatment after one and half month, quite significant results have been achieved. Acupuncture treatment if being applied within 90 days after stroke, marvellous results might be acquired. Patients are also required to keep practicing as hard as they can.

3. The reason for this patient to have stroke is that although he was using conventional medicine for diabetics and heart disease, he did not notice that some drugs were overdosed as he did not follow up with his doctors. Patients with chronic diseases are advised to follow up with their doctors regularly.

4. When making a Chinese Medicine treatment plan, detailed evaluation such as medical history/conditions and medication currently used shall be considered with special attention.


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