| "Zhongfeng (being effected by wind) " is a disease name in Chinese medicine of what Western medicine refers to the disease of acute cerebral vascular accident as "stroke". Such disease is of acute onset, rapid emergence of chronic brain function limitation or indemnity missing clinical signs of cerebral vascular events. The Chinese medicine concluded it in the category of "being affected by wind", "falling down", "side wind" and "pianku (dried up)". The book of<> described "pianku" as "Person who suffered from "pianku" had a malfunction on one side of his body with pain. He could still speak with no difficulty from before and remained with a clear mind. " The occurrence of stroke is due to the problem in the brain which differs from those internal organs for it cannot be replaced by any artificial devices. There are two types of causes:1. due to cerebral blood vessel rupture from the brain and from the spiderweblike arachnoid; 2. due to some cerebral artery blockage causing the death of the surrounding brain cells, the so-called cerebral infarction. The former case is related to the damage of internal organs and the latter the damage in the meridians. The former case is in serious condition where the patient will not have a clear mind; the latter case is less severe for the patient still has a clear mind. However, both cases may lead to one side of the body in paralysis. Stroke sequelae happened because of any lesions occurred in the meridians. In general, stroke patients are helped with first aid. When they become stable and conscious with a balance of phlem and fire in the body, they find themselves suffering from stroke sequelae. They may also find themselves with various disturbances, such as one side of the body in paralysis, physical fatigue, speaking not clear, the tongue twisting to one side, the mouth and the eyes are not in a balanced position, difficulties with his limbs in movement, joint stiffness, unhealthy skin, stiff tongue, difficult to speak out words, and other disturbances with the mind. Central paralysis, also known as upper motor neuron paralysis, or spastic paralysis, rigid paralysis, is due to the damage of the pyramidal cells in the cerebral cortex motor area and the nerve fibers from the pyramidal tract. As the upper motor neuron damaged, it loses its function of control over the lower motor nerves so that it leads to the release of the spinal cord reflex function. By such, it also causes the weakness of voluntary movement. In the clinical practice, the muscle tension turned out to be great with tendon hyper-reflexia and pathological reflex. This results in spastic paralysis. Peripheral paralysis, is also known as lower motor neuron paralysis, or flaccid paralysis. This comes from the damage of spinal cord anterior horn cells and brainstem motor nuclei, and the issue of skeletal nerve fibers—spinal ventral root, spinal nerves and cranial nerve. As the lower neuron damaged, it dominates no more its muscle with excitability. Clinically it is manifested as decreased muscle tone, reflex reduced or lost with muscle atrophy, but with no pathological reflex. Hemi-paralysis, is also called one side of the body in paralysis. It refers to the movement barrier of the upper and the lower limbs of one side of the body, the faces muscles and the lower part of the tongue muscle. It is a common symptom of an acute cerebro-vascular disease and is also a common sequela of the cerebral apoplexy. Although a patient in mild hemi-paralysis is able to move, he is carrying his upper limb with flexure and the lower limb unbent. He is found walking one step and crossing with a half circle. Such a phenomenon of walking posture is specified as hemi-paralysis gait. Patients in severe cases are often bedridden without working ability. Why would those patients suffer from hemi-paralysis when they got acute cerebrovascular disease? This is mainly due to the damage of the motor nerves of the cerebral hemisphere cortex. From the division of labor in terms of the human brain hemisphere, the right cerebral hemisphere is controlling the left limbs motor through the motor nerves; and the left cerebral hemisphere is controlling the right limbs motor through the motor nerves. Clearly, it is saying that whenever there is any happening of lesions on one side of the body, the other side will result in hemi-paralysis. The most vulnerable part of bilateral cerebral hemispheres is the internal capsule lesion. It is because here is a bean-like artery supplying blood. The artery has a small diameter coming out vertically from the brain and if the blood pressure is great, it will easily erupt and bleed. So, it is also called bleeding artery. However, when the blood pressure comes down, the blood flow becomes low again. But in result there comes the formation of thrombi on its wall. And once those internal capsule fibers, which are arranged very close there passing through upstream and downstream at the area, got damaged, the person will then suffer from contralateral hemi-paralysis, sensory disturbances and hemianopia, the so-called "three-side sign. " Some patients could also find his affected limbs in cyanosis and edema.Stroke comes from the blockage of blood circulation in patients as well as brain ischemia and hypoxia that eventually cause the death of the cells. Apart from the reasons of dysfunction of the brain or the tumor itself, or born deformed, most are caused by systemic vascular diseases and blood system diseases. Other causes might due to trauma, cancer cells, air or fat embolism syndromes. Some scholars believe that it might be due to other factors:e.g. ages, family, race, geographical distribution, local climate, or the patients themselves suffering from chronic diseases such as diabetes or high blood pressure psychosis. However it is found that people who suffered from stroke have increased dramatically and become younger. This is because on one hand the social modernization is in advancement and people's quality of life has improved so much, but on the other hand, they have been found working hastly in daily life while neglecting regular physical exercise, eating violently, lacking of proper rest and so on. Sequelae of stroke is a common clinical disease. Its mortality rate is of high disability. Even the advanced development of modern medical treatment is so speedy that can lead to the decrease of stroke mortality, there still exists three-quarters of the patients suffering from different degrees of dysfunction in China, particularly motor dysfunction. Thus this disease has directly affected the quality of life of patients and created a heavy burden to their families and the society. Being a recovery tool, the technique of Chinese traditional acupuncture & tuina has its unique therapeutic advantages. Evidently, acupuncture & tuina can improve the patient's limb muscle strength, reduce muscle tension, activate cells, increase blood flow and other effective function. It plays a significant role to help the stroke patients to take care of themselves and enable them to achieve a speedy recovery and return to society soon.Objective:This study will observe the clinical efficacy by applying the Jin's 3-needle acupuncture in combination with traditional Chinese meridian tuina so as to find a precise and effective integrated approach for such a disease.Methods:Confirmed 80 cases of stroke in patients with paralysis after the patients are treated in the Department of Acupuncture Branch and Neurology of the First hospital of University of Guangzhou Chinese Medicine, in the clinic of Chuk Lam Tong TCM in Hong Kong, which are in clinic outpatient service cases between April 2008-December 2009。80 cases of patients completed the final observation, were randomly divided into Treatment Group (40 cases), using Jin's 3-Needle acupuncture in combination with tuina treatment, and the Control Group (40 cases), just by tuina treatment. The Jin's 3-Needle acupuncture will cover the following points:the temporal 3-needle points, Sishencong 3-needle points, hand 3-needle points, Zusanli 3-needle points, tongue 3-needle points, shoulder 3-needle points, thigh 3-needle points, knee 3-needle points and ankle 3-needle points. Needles are inserted at the selected points as mentioned on the affected parts of the body after disinfection. Needles in size 1.5-inch, No.3 of Huatuo brand are used. It is advised to check up the patient's condition of pulses before operation and operation of specific acupuncture points should be based on the dialectic of yin and yang selected points.Treatment:①Treatment Group:Jin 3-needle acupunture in combination with Tuina. Jin 3-needle treatment:Temporal 3-needle and Si Shen Cong as main points in addition of other points, if necessary. In most csese, Sequelae of stroke turned out to be hard-paralysis. It is advised to take the techniques of " even reinforcing and reducing the needle. " Drag and insert the needles once after every 5 to 8 minutes for 4 to 5 times in each treatment about 30 mintes. It takes 6 days every week and four weeks as a course. The work of Tuina:It is advised to warm up the body by taking a few minutes of massage before acupuncture begins so that the patient will feel comfortable. After acupuncture, the work of tuina starts. It takes about 30 minutes 1 day and 6 days per week for four weeks as a course. It means that the work of acupuncture and tuina come together at the same time. The method of Tuina: Push and rub along the Bladder Meridian of Foot-Taiyang, Ren Meridian, Du Meridian, Sanjiao Meridian of Hand-Shaoyang and Gallbladder Meridian of Foot-Shaoyang in addition of striking both sides of the spine. Massage on the head and face:The force of hands applied on the patient must be light. The technique includes the methods of pushing, pressing, wiping, sweeping and holding. Massage on the limbs and joints:The technique includes rolling, pressing, kneading looting method, rubbing and shaking. It is advised to apply light and tender hand technique on flaccid paralysis patients but heavier on hard paralysis patients by more tendon treatment. It is much better for both of the doctor and the patient have a feeling of sensory response. Sometimes, the doctor needs to ask the patients themselves to bend their limbs in order to meet the operation. The work of pulling and rotating the patient's limbs must be gentle along with the movement, light and soft during the motor training so that the patient can feel comfortable.②Control Group only works with Tuina. Each group will be evaluated after treatment completion. Clinical Modified Ashworth will be used to assess spasticity. And simplified Fugl-Meyer motor function will be used to assess patient's motor function.Treatments in each group were evaluated after reunification. Clinical improvement of Ashworth spasticity score method to evaluate the extent of a simplified Fugl-Meyer motor function score method to evaluate the patient's motor function.Results:After four weeks of treatment, evaluation of both of the two groups of improvement of Ashworth was significantly lower than that of pre-treatment but the treatment group score is lower than that of the control group. Their difference was significant (P<0.01). Treatment of 4 weeks, FMA upper and lower limb scores and total score of the two groups increased than that of pre-treatment but the treatment group score was higher than that of the control group. The difference between the two groups was significant (P <0.01). Note:The treatment group in the improvement of clinical symptoms predominated.Conclusion:Acupuncture of Jin 3-needle in combination of tuina is an effective treatment for stroke sequelae. On its therapeutic mechanism, we can observe from the results of efficacy:(1) Acupuncture and Tuina can adjust the peripheral nerve function for those damaged limbs, stimulate the central nervous system for killing limb pain, regenerate nerve fibers from the spinal cord, increase blood flow, myelin and cells. In such a way, the body's muscle strength can be improved and the muscle tension can be reduced. Obviously muscle and joints have been nurished as blood circulation has been increased and number of cells have been activated (2) Acupuncture and Tuina can increase the intracranial blood supply and establish collateral circulation causiing the brain to absorpt blood clot and secreted liquida rapidly. It will aslo reduce intracranial pressure so as to restore the cerebral function. (3) Although acupuncture can improve muscle strength, but stroke patients lying on bed need to have initiative movement by themselves. Nevertheless, Tuina can play the role of training for motor function. The work of pushing, holding, dragging, stretching, flexion, retation and other practices can immediately enhance the patient's motor function, correct muscle atrophy, lubricate the joints and enhance its flexibility. The work can also inhibit the abnormal movement of the low central control and relieve spasm. As it says, "One's life will be longer if his tendon is longer. " Not only the stroke patients need to have their tendon and bone rubbed and gripped, normal persons also require to do so every day. A long-term massage can provide stroke patients with health prevention purposes and reduce the chance of stroke recurrence. Therefore, Tuina is actually good as a Chinese medicine treatment for rehabilitation. In fact, acupuncture and tuina can circulate qi and activiate blood, clear the meridians, and balance yin and yang of the body that make the health good.
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