By Andrew Gaeddert
Stroke is a serious disabling condition that affects about 600,000 to 700,000 persons in the U.S. each year (American Heart Association, Heart and Stroke Statistical Update, 1998; Stroke 29: 415-421, 1998). About one quarter of those who have a stroke die within a year (Neurologic Clinics 10: 177-191, 1992), and only about 25% recover fully. Biomedically, there are several well-documented risk factors for stroke including hypertension, cigarette smoking, cardiac disease, transient ischemic attacks, sickle cell disease, among others. Certainly, patient education is the key in preventing stroke. However, before such efforts can fully take hold among the general public, effective treatment remains the primary way to reduce the mortality and morbidity of this disorder. Alternative medicine, especially traditional Chinese medicine, can play an important role in stroke therapy. In this article, we present cases from our clinic.
STROKE ACCORDING TO CHINESE MEDICINE
Descriptions of stroke appear as early as in the Nei Jing (Yellow Emperor’s Inner Classic, c. 100 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 overexertion; 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 neurologic problems.
Stroke is a condition that is known as “root- deficient, branch-excessive,” 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.
CASE 1
Gertrude is a 68 year-old retired schoolteacher. When she came to our clinic, she was at least fifty pounds overweight. She recently had a stroke caused by cerebral thrombosis, and was affected by weakness and numbness on the left side of her body. She had difficulty remembering certain words. She was receiving physical therapy and was under the care of her physician and a visiting nurse. To prevent future thromboses, she had been placed on the anticoagulant, warfarin (Coumadin). Her pulse was irregular and her tongue had a dark yellow coating.
We recommended AC-Q formula, 2 capsules TID for the first week. Ac-Q is a comprehensive remedy designed to open the channels, and increase mobility and strength; similar formulas are used in China to help stroke patients. When Gertrude returned two weeks later, there was no change. We suggested that she add Marrow Plus (1 capsule TID first week, 2 capsules 2 TID thereafter), a formula designed to tonify the qi and blood. Marrow Plus contains herbs such as Astragalus and Salvia traditionally used by doctors in China to help people recover from stroke. Gertrude took the herbs for over six months, experiencing gradual improvement in strength and mobility, as well as in the numbness.
DISCUSSION
As a general precaution, we always recommended clients take herbs and drugs two hours apart to avoid any untoward interactions. As Gertrude was on warfarin (Coumadin), we recommended that she start the herbs at ½ the recommended dosage. We also advised her to stop the herbs if there were signs of unusual bleeding. As the course of treatment continued and there were no side effects, we increased the dosage of AC-Q, and slowly added Marrow Plus.
CASE 2
Harold, a retired 72 year-old, had suffered a severe stroke that left him in a coma for two weeks. He was in a wheelchair because of weakness and poor balance; he was also experiencing slurring of speech. He was referred to us by his acupuncturist who had already helped Harold considerably. Traditional Chinese examination revealed that Harold’s pulse was thready and slightly irregular.
We recommended AC-Q and Mobility Three, 2 capsules of each formula QID. After four weeks there was little change, so we suggested increasing the dosage of Mobility Three to 3 capsules QID; he continued to take AC-Q (2capsules QID). We also recommended cooking raw Astragalus in soups as much as possible because of its tonifying effects. After two months, Harold reported that he was regaining strength in his legs and had started swimming class as part of his physical therapy. He also indicated that his outlook on life had improved greatly.
CASE 3
Elliot, an accountant in his early 60s, had a stroke several months ago. He complained of dizziness, tiredness, speech problems, high blood pressure, and diabetes. He was on numerous medications including diuretics, ACE inhibitors, and tolbutamide. Traditional Chinese examination found that his pulse was slippery and his tongue was red with a yellow coating.
We suggested the formulas Clear Phlegm, 2 capsules QID and Gastrodia Relieve Wind, 2 capsules QID. We also recommended that he eat protein at each meal and increase his vegetable and fruit intake while limiting complex carbohydrates, since he is diabetic; he was already on a restricted-salt diet. After two weeks, he reported dry mouth, so in addition to suggesting he increase his water intake, we indicated that he reduce Clear Phlegm to 1 capsule QID, and increase Gastrodia Relive Wind to 3 capsules QID. After one month, we substituted AC-Q for Clear Phlegm, and maintained him on Gastrodia Relieve Wind. After three months on the herbs, Elliot reported more energy and greater well being.
DISCUSSION
Clear Phlegm, also known as Wen Dan Tang, is a formula aimed at transforming phlegm. It is used in China to treat stroke. Traditional indications include dizziness, with a slippery pulse and copious phlegm. Clear Phlegm is generally not used long term because it is drying. The combination of Clear Phlegm and Gastrodia Relive Wind (Tian Ma Gou Teng Yin), was used by the famous ancient herbalist Zhu Dan Xi (1281-1358) to treat stroke.
CASE 4
Raoul, a 44 year-old stockbroker had recently had a hemorrhagic stroke affecting the right side of his body including the tongue, shoulder, feet, and arms. He remarked that he always felt cold on that side. He walked with a limp and did not have voluntary control of his right hand, he had to use his left hand to aid the right hand with any movement. He also complained of fatigue and poor sleep. He was receiving physical and occupational therapies, as well as acupuncture, all of which were helpful. Traditional Chinese examination revealed that his left pulse (unaffected side) was weak in the kidney position and slippery in all positions. On the right side (affected side) his pulse was weak, slippery, and slightly irregular in all positions.
We recommended the formulas AC-Q along with Clear Phlegm (both formulas 2 capsules QID). Raoul called back a week later in a panic because his blood pressure had suddenly risen. We advised him that the herbs were not likely to have caused this phenomenon. Could there be any other events causing the rise in blood pressure? He replied that he was sure it was the herbs. We then suggested he keep taking the herbs and call back in a few days. When he did, he was again agitated, saying that his blood pressure was still remained high. At this point, we instructed him to reduce the dosage of both formulas by ½.
Meanwhile we consulted with his acupuncturist who said that Raoul had just returned to his stock brokerage job full time despite the recommendation that he do so on a limited schedule. The acupuncturist felt strongly that Raoul’s rise in blood pressure was due to going back to a highly stressful job in a weakened condition.
In his follow up visit two weeks later Raoul’s blood pressure had dropped slightly. We suggested that he develop a stress reduction program and continue with physical therapy as well as acupuncture and herbs. We also advised he reduce his work load if possible. His pulse and tongue were unchanged. The herbs were continued at the original dosage. Over the following two months, Raoul’s pulse became less slippery but weaker, therefore we substituted Clear Phlegm with Astra Essence (3 capsules QID). He continued taking the AC-Q. Although Raoul persisted in working long hours despite his condition, he began to experience gradual improvement in his energy level, sleep and mobility.
DISCUSSION
We have rarely encountered a case in which herbs have caused an increase in blood pressure. In this case it was important to obtain feedback from the other practitioner to ascertain why Raoul’s blood pressure would have increased, especially since the formulas were aimed at rebalancing his system, including normalizing his blood pressure. AC-Q and Clear Phlegm were suggested to open the channels and reduce phlegm, respectively. Astra Essence was later added to tonify Qi, blood, and Kidney Yin and Yang.
CONCLUSION
From the above cases, we can see that stroke can have wide-ranging sequelae depending on the severity of attack. Treatment should take on a multi-prong approach, including alternative methods such as acupuncture and herbs, and conventional modalities such as physical therapy. Clearly, the sooner treatment is begun following the stroke, the better the chances are for successful recovery.
Andrew Gaeddert is an herbalist and author of the books, Healing Digestive Disorders and Chinese Herbs in the Western Clinic.