The Chinese have been combining Traditional Chinese Medicine and western medicine for many years. Specifically, for stroke treatments they use Physical therapy, Electroacupuncture, Carotid Drug Injection, Chinese herbal formulas, Massage therapy and Craniosacral therapy. Research on this is available in the attached research study completed inHubeiProvincein 1996. Now western medicine is studying the effects of adding Traditional Chinese Medicine techniques to their medical repertoire. The cun’ent stroke research proposal seeks to duplicate some of the Chinese research in a western rehabilitation hospital.
1. Introduction to Traditional Chinese Medicine
The term “Traditional Chinese medicine” T.C.M., makes reference to a number of practices, especially acupuncture, moxibustion and herbal formulas and their theoretical basis that has developed in China during a period of about 2,500 years. A theory of nature — and of health and disease — was set forth in the concepts of two essential forces yin and yang, the five elements, six climatic influences, seven emotional factors, eight principles of therapy, fourteen meridians, and other notions numbered as an aid to memorizing the information.
1.1 Ancient but Still Alive
The Huang-di Nei-jing or Inner Classic of the Yellow Emperor is the source of all Chinese medical theory, the Chinese equivalent of Hippocratic corpus. Compiled by unknown authors between 300 and 100 B.C.E., it is the oldest of the Chinese medical texts. The knowledge and theoretical formulations it contains are the basic medical ideas developed and elaborated by later thinkers.
In China today, the primary textbooks used to train traditional doctors are contemporary interpretations and clarifications of Qing dynasty (1644-1911) formulas and commentaries.
These books are, in turn, clarifications of Ming dynasty (1368-1644) reworkings, which are also reworkings of earlier material. This process goes all the way back to Han dynasty (202 B.C.E.- 220 C.E). Such transmission through the dynastic pathway not only preserved and encapsulated the original sources, but also elucidated and reformed them.
The first book about acupuncture, translated into Dutch and Latin, appeared in the West during the 15th Century. Europeans, most notably the French, have been involved in acupuncture therapy for the last 300 years.
Acupuncture has been known in the United Statesfor hundreds of years as well. Benjamin Franklin, during his career as Ambassador toFrancein 1781, received acupuncture treatments and even did experiments with it. After Nixon visited China in 1972, widespread interest in this healing art was revived in theUnited States.
1.2 The Yin–Yang And The Five–Element Theory In T.C.M.
T.C.M. considers everything has two sides, they are called Yin and Yang. The Yin and Yang are philosophical terms in ancient China, referring to the things or characters opposite to each other. The condition that appears as active, external, upward, hot, bright, functional, exciting and hyperactive is attributed to Yang. The condition that appears as asthenic, internal, downward, cold, dim, material, inhibitive and declining is attributed to Yin.
Yin- Yang theory is widely used in T.C.M. for explaining the physiological and pathological phenomena of the human body and for directing the diagnosis and treatment of a disease. For example superficial syndrome, heat syndrome, sthenic syndrome are attributed to Yang. Interior syndrome, cold syndrome, asthenic syndrome are attributed to Yin.
The five element theory is a theory based on philosophy in ancient China, classifying the material characters and the mutual relationship of the five elements, which are considered as the essential constituents of the material universe. Their motion is in accordance to certain rules (germination, restriction, etc). In T.C.M. the five element theory is chiefly used for explaining the properties of the five viscera organs (liver, heart, lung, spleen, kidney) of the human body, their mutual relations, physiological phenomena and pathological changes. It also serves as a guide for diagnosis and treatment. The five element cycle is arranged in a definite order.
T.C.M. considers that heart is fire, liver is wood, spleen is earth, lung is metal and kidney is water, which are the five viscera organ’.
The term for five viscera organs do not completely match those used in western medicine from the standpoint of anatomy and physiology. In T.C.M they are considered functional systems and their suffering causes disease. So the physiology and pathophysiology in T.C.M are very important.
1.3 Vital substances in T.C.M.
Vital energy (Qi), blood and body fluids are the vital substances in T.C.M. theory.
Vital energy (Qi)
Vital energy is the motive force of internal organs and the tissues of the body as well.
It has five functions: a) promotion function b) warming function c) defensive function d) checking function and e) nourishing function.
Blood is an important component of the body derived from the refined substance of the food through a series of complex processes. It circulates in the blood vessels to nourish all parts of the body.
Fluids in the body include sweat, saliva, stomach fluid, intestinal fluid, urine etc. Their function is to moisten the skin, the hair, the muscle, the throat, the joints etc.
Meridians are important components of the human body. Meridians and their collaterals act as an important route for circulating vital energy and blood, connecting viscera with extremities, communicating the upper with the lower and the interior with the exterior and regulating the activities of viscera and other parts of the body. The meridians play an important role in joining the tissues and organs of the body to build up an organic entity.
There are fourteen regular meridians in the body and they are the main passages connecting different parts of the body in which the vital energy and blood circulates. The meridian energy flows through the meridians in regular cycle by definite order.
Selection of treatment based on the differential diagnosis
Making a diagnosis and selecting the treatment is based on the analysis and comprehension of the clinical data collected by the four methods of examination with the basic theories of the five viscera organs (liver, heart, lung, spleen, kidney) meridians and pathogens.
1.4 Four Methods of Examination:
- Inspection: Observing the patient’s mental status, posture, appearances of the tongue and its fur, the quality of urine, feces and other excretions and secretions, etc.
- Listening and smelling: Listen to patient’s voice during speaking, breathing, coughing and moaning, and to smell the odor of the secretion and excretion.
- Inquiring: Interrogate the patient about his present illness, past history, menstruation and childbirth history, living and food habits, as well as age, native place, occupation and other related information.
- Palpation: Various parts of body surface of the patient are palpated for the purpose of investigating the condition of the pulse, chest, abdomen and extremities to establish a diagnosis.
1.5 Major therapeutical methods in T.C.M.
A. Methods of treatment by Chinese herbal medicine
There are eight methods of treatment used in Chinese herb medicine.
- Diaphoresis therapy: It possesses the actions of antipyretic, promoting eruption, reducing edema and antirheumatic by inducing perspiration.
- Emetic therapy: Elimination of harmful substances from the throat, esophagus and stomach by the application of drugs or physical stimuli that can induce vomiting.
- Purgation therapy: A treatment of eliminating the undigested food by the application of mild purgatives.
- Regulating therapy: Includes various treatments such as the dispersion of stagnated liver-energy, the coordination of the functions of the liver and spleen or of the liver and stomach.
- Warming therapy: Expelling cold by warming the meridians, rejuvenating the depleted Yang, lowering fever with drugs of sweet flavor and warm nature.
- Heat – clearing therapy: A treatment of clearing away the heat with cold natured drugs, applicable to febrile diseases of heat – syndrome.
- Invigoration therapy: A therapy for various types of asthenia syndrome, generally classified into invigoration of vital energy, toning the blood, invigoration of Yin and Yang.
- Dispelling therapy: A treatment for dispersing stagnated energy, blood stasis, phlegmwetness, undigested foods.
Herbal therapies are best for functional disorders, hormonal imbalances, and “organic problems” (change in tissue structure). The effects of herbs are usually seen after several days of regular use, rather than immediately, but once the effects are established, they often persist for a long time. The use of acupuncture plus herbs usually provides the most dramatic results.
B. Methods of treatment by acupuncture and moxibustion
Acupuncture therapy: Application of metal needles including the filiform needle, intradermal needle and plum-blossom needle are used to stimulate certain specific superficial definite locations for the treatment of a disease. In cases of blood transmitted disease or skin lesions electro-acupuncture or laser beam acupuncture is applicable.
Acupuncture is a very safe system of health care when done by a well-trained practitioner. It feels like a needle prick but nothing like getting an injection. During the treatment the patient will experience some sensations of energy movement, but not pain. Most people fall asleep when left with the needles, and wake refreshed and relaxed.
The number of treatments varies according to the condition. Acute problems may respond with just a few treatments. A chronic problem that exists for years may require a longer series of treatments. Treatments are usually once or twice a week.
Acupuncture therapy has wide applications. The world health organization has officially recognized acupuncture as suitable for the treatment of more than two hundred common clinical disorders. These would include: Gastrointestinal disorders, urogenital disorders, gynecological problems, muscle and joint pain, respiratory problems, circulatory disorders, immune system disorders, endocrine disorders, neurological disorders, headache, emotional problems, addictions, pediatrics, and supportive therapy dealing with chronic pain, basic energy enhancement and harmony.
Moxibustion therapy; A method of applying therapeutic heat produced by ignited moxa wool or roll over the well-defined skin surfaces. The moxa is made by an herb called “Artemisia bulgaris”.
Other methods of treatment
Massage: a) Also called pushing and grasping; a method of prevention and treatment of diseases by applying various massage manipulation, or by passive movements of extremities. b) One of the eight manipulations of bone setting, used for relaxing the muscles, dissipating blood stasis and promoting subsidence of swelling.
Qigong (breathing exercise): A mental and physical self training for the prevention and treatment of diseases and also for Health care and prolongation of life, by which life activities are self-adjusted and self-controlled with the help of the inducement of mind and the regulation of respiration and spirit.
Therapeutic exercises: Taiji (also called Tai Chi), Gong fu, jogging, five animal exercises and other exercises prevent disease and strengthen the human body.
1.6 Electroacupuncture, Carotid Drug Injection and Herbal Supplements as a Potential Treatment Option in Stroke Patients
Descriptions of stroke appear as early as in the Nei ling (Yellow Emperor’s Inner Classic, c.lOO B.C.). In Chinese medicine, the risk factors for stroke are explosive anger or protracted pent-up emotions; poor diet – especially one high in fat or sugar; excessive alcohol and tobacco use; long term stress and fatigue; lack of exercise; sudden physical over-exertion; change in season or climate. The common syndrome patterns include: movement of internal wind; excessive emotions transforming into fire; phlegm blocking the channels; irregularity of the Qi mechanism; and blood stasis.
Chinese medicine categorizes strokes into two types depending on severity. A channel stroke usually does not result in loss of consciousness. Headache, numbness of the extremities (unilateral), disturbance of vision and/or speech, are common presentations.
An Organ stroke is more involved and usually consciousness is impaired, with major neurological problems. Stroke is a condition that is known as “root-deficient, branchexcessive,” meaning that an underlying deficiency has caused the excess presentations. The treatment strategy is to first resolve the symptoms of excess during the acute phase; these symptoms can include wind, phlegm-heat, and blood stasis depending on the syndrome pattern. Then, during the recovery stage, the causal deficiency is addressed. Thus formulas used include ingredients to extinguish wind, transform phlegm-heat, invigorate the blood and tonify the constitution. As a general precaution, we always recommend to take herbs and drugs two hours apart to avoid any untoward interactions. The herbal formulas recommended for this study are attached to this proposal.
Over the past 40 years knowledge about the physiological basis of control of pain has increased more than at any time in the history. The growth has been based mainly on studies on the neural and neurochemical basis of inhibition of pain at various levels of the central nervous system such as the spinal cord, the brain stem, and higher subcortical center. Although acupuncture was introduced in the Western world as early as in the 1600′ s it remained largely unknown until the first reports of operations under acupuncture analgesia were reported from China. Research on the neurochemical mechanisms of acupuncture analgesia has been conducted in the Department of Physiology,Beijing Medical Universitysince 1965. More than 250 papers have been published, most of them in Chinese. There are over 50 scientific papers on the clinical observation of the curative effect on cerebral infarction with acupuncture. Electrostimulation of the acupuncture points transmits into the central system through the sensory nerves and exerts effect. After the integration of the brain, the treatment works directly on the local cerebral tissue to dilate the cerebral vessels and to increase cerebral blood flow, subsequently improving the blood circulation, increasing the oxygen pressure of the cerebral tissue, improving the nourishment of the cerebral cells around the focus, and promoting the repair of the cerebral tissues. In addition, when the motor nerves are stimulated around the acupoints, the muscles twitch, consequently dilate and contract the vessels, promote blood circulation, increase the volume of the local cells and tissues and promote the recovery of the nerves and muscles of the paralytic limps.
Incorporating Carotid Drug Injection into the treatment of stroke is popular in China. The prescription of the Carotid Drug injection consists of 40ml sodium chloride of 0.9%, 6ml novocaine of 2% (containing O.12g), 2-4ml ligustrazine hydrochloride (containing 40- 80mg), O.5ml dexamethasone (containing 2.5mg). The above drugs were mixed up into 50ml that was used for carotid injection. In the prescription mentioned above, ligustrazine hydrochloride dilates the vessels to improve microcirculation and to inhibit platelet agglutination. Novocaine which dilates small vessels not only can relieve vascular spasm, but also activates carbonic acid in the blood, increases the density of C02 in the blood and eventually leads to reflexing dilation of the cerebral vessels and hence the increase of cerebral blood flow. Dexamethasone is powerful in antiinflammation and dehydration, thus eliminating cerebral edema and improving cerebral anoxia. When the above drugs are added with sodium chloride and injected slowly into the cervical artery, the medicinal mixture flows into the anterior cerebral artery and the middle cerebral artery, directly exerting effect on the infracted region. As a result there is improvement of the cerebral blood circulation, softening and exfoliating of the focal plaque, dilation of the cerebral vessels, elimination of cerebral edema, improvement of the elasticity of the cerebral vascular wall and decrease blood viscosity. Increased cerebral blood flow will provide the oxygen supply needed to repair the function of the impaired cerebral cells and promote the functions of the affected limbs. For details of the exact procedure see the attached paper.
According to the paper the control group was treated by simple carotid drug injection while the observation group was treated by electroacupuncture plus carotid drug injection. The total effective group for the observation group was 96.2% and the control group 83.7%. The control group received more than just physical therapy because the Chinese do not use a treatment of just physical therapy for stroke patients. They are more advanced in that area and include electroacupuncture and herbs as a part of the standard treatment for stroke along with physical therapy.
2. Research Plan
The study will replicate part of the research described in the attached paper published in the Shanghai Journal of Acupuncture and Moxibustion in 1998.
2.1 Ideas for Discussing in the Study
The study will treat 120 patients with PNS (partial non progressive stroke) affected by the most common site’ for obstructive disease, the carotid artery. In Caucasians, the carotid artery is responsible for atherothrombotic stroke six to seven times more frequently than is the main trunk of the middle cerebral artery. In my experience the patients should have their blood pressure stabilized for at least a week before we start them in to this program.
The patients will be divided into four treatment categories:
- Physical therapy, Electroacupuncture, Carotid Drug Injection, Chinese herbal formulas, Massage therapy and Craniosacral therapy
- Physical therapy, Craniosacral therapy, Massage therapy
- Physical therapy, Carotid Drug Injection, Craniosacral therapy and massage
- Control group (Physical therapy only).
The first group will alternate carotid drug injection with electroacupuncture. Starting Monday with carotid drug injection, Tuesday electroacupuncture and so on. Herbal formulas will be taken continuously (9 pills per day) during the course of the treatment. Massage therapy and craniosacral therapy will be administered once a week. The physical therapy will similar to the control group’s physical therapy.
The second group will have craniosacral therapy and massage therapy once a week. Physical therapy will be similar to the control group.
The third group will have carotid drug injection every other day plus craniosacral therapy and massage once a week. Physical therapy will be similar to the control group.
And the fourth group will have physical therapy only.
3. Can modern and Chinese medicine be combined?
Not only can the two systems of medicine be combined, they can enhance each other’s effects. Chinese herbs may make it possible to take a lower dosage of modern medicines, to reduce their side effects, and obtain a better overall effect. Modern drugs may provide emergency relief for serious conditions that will allow long-term application of Chinese herbs the rest of the time. It is advised that modern drugs be taken at a different time (e.g. two hours apart) from herb combinations in order to avoid any chance of interaction, and that monitoring of the effects of the drugs be continued, and perhaps increased, while an herb therapy is being used. Acupuncture is compatible with virtually all modern techniques.
4. Concluding remarks
Traditional Chinese medicine can be considered an art, and it can claim to be a science. But the important question is: Does it work? Is Chinese medicine just an interesting philosophical curiosity or is it a viable system of healing? Can it treat what the West defines as real diseases? And can Western science measure its results and appreciate its Value?
Because of the unique history of modern China, traditional medicine has been the subject of comprehensive study and testing over the past fifty-five years.
Western clinical studies of traditional Chinese medicine, by proving its practical efficacy, have helped it win its battle for survival in the twentieth century, and promise it a place in the future of medicine.
Some English–Language Sources
Clinical observation of the Curative Effect on Cerebral Infarction of Elecroacupuncture Plus Carotid drug Injection. Wang Dajun et. al. 1997
Xing Hongyi. Commentary Summarization on the Mechanism of Acupuncture in Treating Cerebral Ischemia. China Journal of Acumoxi, 1996,-(5):57
Zhong Qi. Effect of Acupuncture on the Cerebral Blood Flow of the Patients with Ischemic Cerebrovascular Disease. Liaonig Journal ofTCM, 1991; (8): 11
Revision at the Second National Conference on Cerebrovascular Disease. Diagnosticlissentials on Various Cerbrovascular Diseases. China Journal of Neurology and Phys iq logy, 1987,-(1):60
Department of Philosophy of Medicine and Science, cornp. Theories and philosophies of Medicine. New Delphi:Institute ofHistory of Medicine and Medical Research 1973.
Fung, Yu-Lan. A History of Chinese Philosophy. 2 vols. Translated by Derk Bodde.Prinston,N.J.:PrinstonUniversity Press 1973.
Porckert, Manfred. The Theoretical Foundations of Chinese Medicine. M.LT. East Asian Science Series, Vol. 3.Cambridge,Mass.: M.I.T. Press, 1974.
Ted l. Kaptchuck. The Web That Has No Weaver. Congdon & Weed, Inc,New York, 1983.
i Mayer, DJ., Price, D.D. Rafii, A.1977. Antagonism of Acupuncture Analgesia in Man by Narcotic Antagonist Naloxone. Brain Research. 121 :368-72.
Mayer, D.l., Price, D.D. Rafii, A. 1975.Acupuncture Hypalgesia: Evidence for activation of a central control system as a mechanism of action. First World Congress Pain Florence, p.276 (abstr)
Mc Leennan, B., Gilfillan, K, Heap, Y. 1977. Some Pharmacological Observations on the Analgesia Induced by Acupuncture in Rabbits. Pain 3: 229-38.
Han, C. S., Chou, P.B., Lu, C.C., Jen, M. F. 1979. The Role of Central 5–hydroxytryptamine in Acupuncture Analgesia. Sci. Sin. 22:91-104.
Chan, Wing-Tsit, trans. and comp. A source book in Chinese Philosophy. Prinston, N.l.:
PrinstonUniversitypress, Prinston Paperbacks, 1963. Cited as Chinese Philosophy.
Mayer, H.L., Price, D.D. 1976. Central Nervous System Mechanisms of Analgesia. Pain 2:379-404.
Han 1.S., Terenius L 1982. Neurochemical Basis of Acupuncture Analgesia. Ann. Rev. Pharmacol. Toxicol. 22: 193-220.
Liu X. 1986. The Role of Nucleus Raphe Magnus in Acupuncture Analgesia and its Control by Some Higher Analgesia Structure. Acupuncture Research 9:91-100.
Huard, Pierre, and Wong, Ming. Chinese Medicine. New York, Toronto: WorldUniversity Library, McGraw-Hill, 1968.
Leslie, Charles, ed. Asian Medical Systems. Berkeley,Calif.:University of California Press.