Different TCM Views On The Origin And Development Of Stroke

Stroke refers to a disease caused by the reversed flow of Qi-Blood leading to cerebral thrombosis or hemorrhage, on the basis of dysfunction of Qi and blood and imbalance of yin and yang, together with the common pathogenesis of chronic fatigue and internal injury, emotional disorder, climate change, excessive smoking and drinking or prolonged disharmony, etc.. The main clinical presentation includes are hemiparalysis, wry mouth and eyes, loss of consciousness, stiff tongue and dysphasia, hemianesthesia. Stroke is a disease characterized by acute onset, volatile change and critical condition and is a disease common among the middle-aged group and elderly with poor health.Cerebrovascular accident(CVA) also known as Stroke, is the rapid loss of brain function due to disturbance in the blood supply to the brain and should belong to the "zhongfeng/wind" disease category of TCM. Stroke is becoming the major disease seriously affecting health and quality of life middle-aged group and the elderly. Although our government puts huge investment on stroke prevention, its morbidity, recurrence rate, mortality and disability rate are still high. CVA is ranked the2nd cause of death of urban and rural residents which is a heavy burden on society and family. Therefore, prevention, treatment and rehabilitation of Stroke is a hot issue for medical experts all around the world. Integrated TCM and western medicine on prevention and treatment of stroke has a certain positive result and progress is made especially on the interference of stroke’s risk factors, early diagnosis, thrombolytic therapy, neural protection, interventional therapy, combined rehabilitation, etc.. Stroke unit with characteristics of TCM theme and methods will benefit the majority of stroke patients.Ancient TCM doctors have taken profound studies on stroke for more than 2000years. Stroke is the head of four major hard-to-cure diseases in the ancient times. In Song dynasty, the government paid great attention to curing stroke and even established the department of "feng/wind" specialty in the Imperial Academy of Medicine (TaiYiYuan). Since Huangdi’s canon of medicine, every ancient TCM doctor has their own point of view or understanding about stroke which made the treatment of stroke diverse. Until the late Qing dynasty, western medicine has wide spread and great influence on TCM and the TCM doctors started combining western medical knowledge in explaining stroke. Although in TCM we consider stroke almost equivalent to cerebrovascular disease in modern medicine, but the TCM concept of stroke is still in confusion. Part of TCM stroke theory is out-dated and come from modern clinical medicine, TCM stroke theory is only partially equivalent to western medicine. There are difficulties on evaluation of curative effect and academic exchange because of the lack of unifying and standardizing diagnosis, definition and classification of stroke in TCM. The content of the TCM textbook is based on the ancient medical materials and these textbook have been used for many years without any update. TCM diagnostic criteria of stroke have also not been updated since1995. For the sustainable development of TCM stroke, TCM textbook and diagnostic criteria should be updated. This is also the main theme of this thesis, to suggest a better and updated content of stroke by studying the origin and development of stroke in TCM.Therefore, this thesis titled as "Origin and development of stroke in TCM" which studies stroke in TCM from2sides. One side is studying the broad meaning of "zhongfeng"(found in ancient medical literatures with named "zhongfeng") and other side is studying the narrow meaning of "zhongfeng"(stroke/cerebrovascular disease) in order to have a comprehensive content of stroke in TCM.ObjectiveProvide a better, updated and suitable content of stroke in TCM and help to standardize the TCM diagnostic criteria of stroke by summarizing the origin and development of stroke, combined and compared with cerebrovascular disease in modern medicine. MethodsCollect nearly50ancient medical literatures and books with the "zhongfeng"’s symptoms, classification, naming, syndrome differentiation, pathogeny and pathogensis. Summariation, analysis and comparison with cerebrovascular disease in modern medicine, and then suggest a updated content of stroke in TCM.This thesis has8sections:Section one is mainly about the origin and development of Stroke from TCM and western medicine. Section two is collection of ancient medical literature on the topic of "zhongfeng" Section three is about up-to-date clinical information and textbook of stroke. Section four is discussion of asymptomatic stroke. Section five is comparison of the TCM stroke and cerebrovascular disease, the relationship between damaged part of the brain and classification of TCM stroke. Section six is "zhongfeng" represents other diseases besides cerebrovascular disease. Section seven is discussion of improvement of nowadays TCM stroke content and section eight is providing suggestion and new ideas for TCM stroke.Study through literature:1. Basic concept of stroke. The earliest records of "zhongfeng" theory is found in Huangdi’s Canon of Medicine. From the context of Canon of Medicine, meaning of "zhongfeng" is totally different from that nowadays."Zhongfeng" refers to the pathogen of "wind-evil" or exogenous diseases, without the symptoms of stroke such as hemiplegic paralysis or aphasia. Stroke is named hemiplegia(pianku), hemiplegia after apoplexy(fengfei), sudden syncope (bojue), etc.. People recognize "zhongfeng" as a disease caused by exogenous pathogenic factor-exogenous wind-evil until Sui Dynasty. The concept of traditional stroke has changed from exogenous disease to a specific disease with the symptoms of hemiplegia and aphasia in Tang and Song Dynasty. During Ming and Qing Dynasty, especially in the late Qing Dynasty, the eastward transmission of western science made a huge impact on TCM. Famous TCM doctors "3zhang" integrated TCM and western medicine on explaining the pathogenesis of stroke, laid the foundation of modern understanding of stroke in TCM. 2. Transformation of the etiology and pathogensis of stroke. There is a controversy on the etiology and pathogenesis of stroke by different ancient TCM doctors. The pathogenesis of TCM stroke was changed from exogenous wind-evil to endogenous wind-evil, the former is the main pathogenesis before Tang and Song Dynasty, the latter is the main pathogenesis during Jin and Yuan period. There is no unified pathogenesis of stroke due to biased point of views of Ancient TCM doctors.3. Relationship between Stroke and other diseases. There are more than one meaning of "zhongfeng" in the ancient medical literature. Ancient TCM doctors diagnosed stroke based on the symptoms and there were many symptom descriptions of "zhongfeng" in Huangdi’s canon of medicine, also there is no unified definition of stroke that leads to the mixture of different "zhongfeng". Whenever there is a disease with symptoms of consciousness, limbs activity and dysphasia, it belongs to "zhongfeng". Analysis based on modern medicine, some of the "zhongfeng" diseases actually belong to other kind of diseases rather than cerebrovascular disease. Therefore,"zhongfeng" is a disease with a broad definition different from the narrow definition of stroke.4. Relationship between stroke and cerebrovascular disease. Cerebrovascular disease has several major types including subarachnoid hemorrhage, cerebral hemorrhage, cerebral embolism, cerebral thrombosis and asymptomatic stroke and it is different from the classification of stroke in TCM in which is only partially equivalent to cerebrovascular disease and there is a need to suggest an updated version of stroke in TCM.