How can we help stroke sequelae & rehabilitation?

Tiejun Tang

In the UK, strokes are a major health problem. Every year, around 110,000 people have a stroke in England and it is the third largest cause of death^[1]. The treatment of and productivity loss arising from stroke results in total societal costs of £8.9 billion a year, with treatment costs accounting for approximately 5% of total UK NHS costs^[2]. More than half of the costs are incurred on rehabilitation of following strokes.

After survival from the acute stage, stroke patients usually will be discharged from hospital. Patients still have hemiplegia, numbness in one side of the body, distortion of the face and tongue, slurred speech or dysphasia. A long term rehabilitation care and treatment is very necessary. Good treatment can greatly improve the symptoms of stroke sequelae, in many cases patients can return completely back to normal. If there is no treatment or inappropriate treatment in sequelae stage, patients will have a high risk of a second and even worse stroke.   

There are two main causes of stroke:  The ischemic cerebrovascular disease accounts for 85% of all cases, others are hemorrhagic cerebrovascular disease. Some risk factors are main reasons of these two acute cerebrovascular attacks. Include: high blood pressure, high cholesterol, diabetes, obesity, smoking, drinking excessive alcohol, lack of exercise and emotional stimulation which may cause a temporary rise in blood pressure.

TCM Perspective

Stroke in TCM is called Zhong Feng. It means attacked by wind. It is an internal wind, which is caused by liver yang excess and/or kidney yin deficiency. In some cases healthy qi deficiency and blood stasis or wind phlegm obstruction can became the main reasons.

Acupuncture especially electric acupuncture and scalp acupuncture can help to reduce muscular atrophy and improve the myodynamia. A randomized controlled clinical trial showed acupuncture can significantly increase cerebral blood flow velocity of post stroke patients^[3]. Another 3 clinical studies also suggest that acupuncture increases quality of life and improves mobility and activities of daily living ^[4].

Buyang Huanwu Decoction is a famous traditional Chinese medicine formula, and has been used extensively in the treatment of stroke for centuries. Many clinical trial and experimental studies suggest this decoction can benefit strike sequelae through many molecular mechanisms^[5].

In the acute stage of stroke, western medicine must be the first choice, but in the sequelae stage Chinese medicine should be a better choice. The effect of acupuncture and herbs can enhance each other.  Chinese Tuina massage or acupressure also can help a lot in the rehabilitation of hemiplegia.

Reference:

1.      http://www.nhs.uk/conditions/Stroke/Pages/Introduction.aspx

2.      Omer Saka. Cost of stroke in the United Kingdom. Age Ageing (2009) 38 (1): 27-32.

3.      Ratmansky M. The Effects of Acupuncture on Cerebral Blood Flow in Post-Stroke Patients: A Randomized Controlled Trial. J Altern Complement Med. 2015 Nov 16

4.      Farmer C. Bringing holistic treatments to the attention of medicine: acupuncture as an effective poststroke rehabilitation J Evid Based Complementary Altern Med. 2015; 20 (2):120-5

5.      Guo Q.  A Systems Biology Perspective on the Molecular Mechanisms Underlying the Therapeutic Effects of Buyang Huanwu Decoction on Ischemic Stroke. Rejuvenation Res. 2015; 18(4):313-25. 

Stress, Depression, Anxiety and TCM treatment

Tiejun Tang

Stress, depression and anxiety are three different mental health disorders.

Stress is the most common condition, nearly everyone experiences stress at one time or another. According to the findings from the Office for National Statistics (ONS), nearly one-fifth of adults in the UK experience anxiety or depression.

The clinical manifestations of these three emotional disorders are different;

Stress is the feeling of being under too much mental or emotional pressure. It can cause a lot of physical symptoms including: low energy, headaches, stomach upset, diarrhoea, constipation and nausea, aches, pains, and tense muscles, chest pain and rapid heartbeat, insomnia and low libido.

Depression is a mood disorder that causes a persistent feeling of helplessness, hopelessness and sadness and loss of interest in daily activities, anger or irritability, appetite or weight changes, sleep changes, loss of energy, self-loathing and reckless behaviour.

Anxiety is a feeling of unease, such as worry or fear. The clinical symptoms vary depending on the type of anxiety disorder, but generally include: Feelings of panic, fear, and uneasiness, sleeping disorder, cold or sweaty hands and/or feet, shortness of breath, palpitations, restlessness, dry mouth, numbness or tingling in the hands or feet.

Living in modern society everybody has to face a stressful life of working or studying. Long term stress often causes depression and anxiety.  Many other reasons also can lead to depression and anxiety, including marital or relationship problems, unemployment, alcohol or drug abuse, early childhood trauma or abuse, health problems or chronic pain and family history.

TCM Perspective

Traditional Chinese medicine believes these diseases are caused by seven emotions disorder. In ancient classic text these conditions have been diagnosed as Yu Zheng. In TCM most of depression and irritable moods are due to liver qi stagnation; most of sleeping problems and palpitation are due to heart shen disturbance or heart qi deficiency; some symptoms of the digestive system are due to spleen and stomach disharmony.

Acupuncture can regulate the function of these internal organs by 

stimulating certain points on certain meridians. A systematic review and meta-analysis study suggests that acupuncture combined with antidepressant medication is effective, has an early onset of action, safe and well-tolerated over the first 6-week treatment period ^[1]. In depression treatment, a cost-effectiveness analysis study from UK suggests that acupuncture is cost-effective compared with counselling or usual care alone ^[2].

Chinese herbs also can have good effect in relieving depression and anxiety symptoms. Some antidepressant-like effects were obtained from ethanolic extract of Chinese herb Suanzaoren and Hehuan^[3]. These antidepressant-like extracts come from natural herbs; they don’t have any side effects unlike synthetic antidepressants.

Generally speaking TCM can be very helpful in the treatment of stress, depression and anxiety and is therefore a better alternative option.

Reference:

1. Chan YY. The benefit of combined acupuncture and antidepressant medication for depression: A systematic review and meta-analysis. J Affect Disord. 2015 May 1;176:106-17.
2. Spackman E. Cost-effectiveness analysis of acupuncture, counselling and usual care in treating patients with depression: the results of the ACUDep trial. PLoS One. 2014 Nov 26;9(11):e113726.
3. Liu J. Antidepressant-like effect of the ethanolic extract from Suanzaoren & Hehuan Formula in mice models of depression. J Ethnopharmacol. 2012 May 7;141(1):257-64