What is a stroke? A stroke, also known as a “cerebral infarction,” is a condition characterized by sudden onset of facial asymmetry, slurred speech, hemiplegia, or loss of consciousness. In modern medicine, the term “stroke” generally encompasses conditions such as cerebral hemorrhage, cerebral thrombosis, subarachnoid hemorrhage, cerebral vasospasm, and facial nerve palsy. Patients may experience sudden, severe headaches, dizziness, brief loss of consciousness, hemiplegia, or speech difficulties; in severe cases, death can occur immediately. This condition most commonly affects the elderly.
The earliest ancient records of stroke can be found in the *Inner Canon of Huangdi*, which describes the condition differently based on varying symptoms and stages of onset. During periods of coma caused by stroke, distinctions were made between “pu ji,” “da jue,” and “bo jue”; during periods of hemiplegia, terms such as “pian ku,” “pian feng,” “shen pian bu yong,” and “sui feng” were used.
I. Etiology and Pathogenesis of Stroke
The primary cause of this disease lies in the patient’s chronic deficiency of qi and blood, as well as an imbalance of yin and yang in the heart, liver, and kidney. Compounded by triggers such as worry, overthinking, anger, excessive alcohol consumption, overeating, excessive sexual activity, or invasion by external pathogens, the circulation of qi and blood becomes obstructed, and the skin, tendons, and vessels fail to receive proper nourishment; or, due to yin deficiency in the lower jiao, a sudden surge of liver yang occurs; this yang transforms into wind, causing blood to reverse with qi, carrying phlegm and fire as it races through the meridians and collaterals, obscuring the clear orifices, and resulting in a critical condition characterized by excess above and deficiency below, with yin and yang failing to maintain mutual balance.
Medical scholars throughout history have held quite divergent views on the etiology of stroke. Before the Tang and Song dynasties, the prevailing theory was “internal deficiency with external pathogenic factors invading,” holding that stroke resulted from insufficiency of true qi, emptiness of the meridians and collaterals, and the invasion of wind-pathogens taking advantage of this vulnerability. This type of stroke caused by external wind invasion came to be known in later generations as “true stroke.” After the Tang and Song dynasties, particularly during the Jin and Yuan periods, the theory of “internal wind” came to the fore. The causes of internal wind were attributed to theories such as “sudden and severe heart fire,” “inherent deficiency of vital energy,” and “damp phlegm generating heat.” This type of stroke, caused by the disturbance of internal wind, came to be known in later generations as “pseudo-stroke.”
Modern medicine attributes the etiology of stroke to atherosclerosis, such as arterial degeneration, vascular malformations, ruptured aneurysms, narrowing or occlusion of the vascular lumen, or emboli entering the bloodstream and blocking cerebral arteries, thereby causing localized cerebral ischemia.
II. Diagnosis of Stroke
In middle-aged and elderly patients with a history of hypertension or atherosclerosis, the diagnosis is not difficult when sudden symptoms such as impaired consciousness, slurred speech, facial asymmetry, or limb paralysis occur, especially when confirmed by CT scans and other imaging tests.
III. Differential Diagnosis and Treatment in Traditional Chinese Medicine
Stroke is classified as a syndrome characterized by “root deficiency and branch excess.” The “root” involves deficiency of the liver and kidneys and depletion of qi and blood; the “branch” involves the prevalence of wind, fire, phlegm, and heat, as well as stagnation of qi and blood. The severity of the condition varies, and the progression of root deficiency and branch excess can differ in terms of sequence and urgency. Clinically, stroke is often divided into two major categories: **affecting the meridians** and **affecting the zang-fu organs**. Cases affecting the collaterals generally involve no changes in mental status and are relatively mild; cases affecting the zang-fu organs often involve impaired consciousness and are severe.
1. Affecting the Collaterals
(1) Deficiency of the collaterals; invasion by wind-pathogen: Due to deficiency of vital energy, weakness of the collaterals, obstruction of qi and blood, and inadequate nourishment of the tendons and vessels, wind-pathogen invades from the exterior, causing disharmony between the nutritive and defensive qi. Consequently, patients present with sudden facial asymmetry (crooked mouth and eyes), numbness in the hands and feet, drooling from the corners of the mouth, and may also experience slurred speech. In severe cases, hemiplegia may occur, possibly accompanied by chills, fever, stiffness of the limbs, and aching joints. The tongue coating is thin and white, and the pulse is string-like and thin or floating and rapid. The treatment principle should be to dispel wind, unblock the meridians, invigorate blood circulation, and harmonize the nutritive and defensive qi. The Qianzheng San formula may be modified as appropriate, with ingredients added according to the specific symptoms. For example, if exterior syndrome is accompanied by hemiplegia and numbness, Qianghuo, Duhuo, and Qin Jiao may be added; if heat is present, ingredients such as Shigao and Huangqin may be included.
(2) Liver-Kidney Yin Deficiency with Wind-Yang Disturbing the Upper Body: Due to Liver-Kidney Yin deficiency, Wind-Yang disturbing the upper body, and Liver Wind carrying phlegm as it runs rampant through the meridians, patients typically present with chronic headaches, dizziness, tinnitus, vertigo, lower back soreness, and weak legs. Suddenly, they may develop a stiff tongue, slurred speech, facial asymmetry, and hemiplegia. The tongue is red with a yellow coating, and the pulse is string-like, fine, and rapid. The treatment principle should be to nourish yin and subdue yang, calm the liver, and extinguish wind; the Zhen Gan Xi Feng Decoction with appropriate modifications may be used for treatment.
2. Affection of the Zang-Fu Organs
Affection of the Zang-Fu organs is divided into two syndromes: “Closure” and “Collapse.” “Closure” refers to internal obstruction caused by pathogenic factors; “Collapse” refers to the impending loss of yang qi. The “Closure” syndrome is further subdivided into Yang Closure and Yin Closure.
(1) Closure Syndrome
① Yang-Closure: Due to a sudden surge of Liver Yang, Yang rises and wind stirs, causing Qi and blood to reverse upward. Phlegm and fire are carried upward to obscure the clear orifices; wind, fire, phlegm, and heat disturb the clear orifices, leading to internal closure. The patient presents with sudden fainting, loss of consciousness, tightly clenched jaws, an inability to open the mouth, retention of urine and stool, and rigid spasms of the limbs, accompanied by facial flushing, fever, coarse breathing, bad breath, and restlessness. a red tongue with a thick, yellow coating, and a string-like, slippery, and rapid pulse. The treatment principle should be to use pungent-cool herbs to open the orifices and clear the liver to subdue wind. First, administer Zhibao Dan orally; subsequently, treat with modified Lingyangjiao Decoction, adjusting the formula according to the specific symptoms. For example, in cases of convulsions, add Jiancan, Wugong, and Quanshe.
② Yin-Closure: The patient presents with sudden collapse, loss of consciousness, tightly clenched jaws that cannot be opened, retention of urine and stool, rigid spasms of the limbs, accompanied by a pale face and cyanotic lips, copious phlegm and saliva, cold limbs, calmness without restlessness while lying still, a white, greasy tongue coating, and a deep, slippery, and slow pulse. The treatment principle is to open the orifices with pungent-warm herbs, eliminate phlegm, and subdue wind. First, administer Suhexiang Pills orally; subsequently, treat with modified Ditang Decoction.
(2) Collapse Syndrome
Due to extreme depletion of primordial qi, the imminent separation of yin and yang, and weakness of the righteous qi leading to the impending loss of yang qi, the patient presents with sudden collapse, loss of consciousness, eyes closed and mouth agape, faint and weak snoring, limp hands and cold limbs, profuse and unstoppable sweating, involuntary urination and defecation, flaccid limbs, a withered tongue, and a faint pulse on the verge of ceasing. The treatment principle should be to tonify qi, restore yang, support the righteous qi, and consolidate against collapse. Shenfu Decoction, modified according to the specific condition, may be used for treatment.
3. Treatment of Hemiplegia and Speech Impairment Following a Stroke
After receiving active emergency treatment, some stroke patients regain consciousness but are left with hemiplegia or speech impairment. Treatment should focus on tonifying qi, invigorating blood circulation, dispelling wind, and resolving phlegm. Bu Yang Huan Wu Decoction or Jieyu Dan, modified according to the specific condition, may be used for treatment.
Acupuncture and moxibustion can promote recovery. Select the acupoints Baihui, Fengfu, and Tianchuang; for upper limb paralysis, add Jian, Quchi, Waiguan, and Hegu; for lower limb paralysis, add Huantiao, Yanglingquan, Zusanli, and Juegu; for a crooked mouth, add Dicang and Jiache, among others.
4. Measures to Prevent Stroke
To prevent stroke, one should focus on treating and preventing hypertension.
① Avoid sudden outbursts of anger in daily life; ② Avoid overexertion and reduce sexual activity; ③ Follow a low-salt diet; ④ Follow a low-fat diet; ⑤ Quit smoking and drinking; ⑥ Eat more foods rich in potassium and calcium; ⑦ Eat fresh fruits and vegetables regularly; ⑧ Engage in appropriate physical activities such as walking or practicing Tai Chi; ⑨ Treat hypertension: Patients with hypertension should take antihypertensive medications under a doctor’s guidance and avoid lifting heavy objects. ⑩ Patients with high blood viscosity should consistently take appropriate doses of blood-activating medications to prevent cerebral thrombosis. Traditional Chinese herbal medicines are effective in promoting blood circulation and preventing thrombosis.