TCM Acupuncture and Massage

Chapter 45 Cardiovascular and Cerebrovascular System Diseases (3)
[-]. Point massage

([-]) Acupuncture therapy

1. Select acupoints from Baihui, Fengchi, Yifeng, Pishu, Ganshu, Shenshu, Zhongwan, Qihai, Hegu, Neiguan, Yanglingquan, Zusanli, Fenglong, Sanyinjiao, Taichong.

2. Positioning
Baihui—on the head, 5 inches straight above the center of the front hairline, or the midpoint of the line connecting the two ear tips.

Fengchi—Neck, under the occipital bone, level with Fengfu, the depression between the sternocleidomastoid muscle and the upper end of the trapezius muscle.

Yifeng—behind the earlobe, the depression between the mastoid process and the angle of the mandible.Pishu—back, below the spinous process of the 11th thoracic vertebra, 1.5 cun laterally.

Ganshu—back, below the spinous process of the 9th thoracic vertebra, 1.5 cun laterally.

Shenshu—waist, below the spinous process of the second lumbar vertebra, 2 cun laterally.

Zhongwan—Abdomen, on the front midline, 4 cun above the middle of the navel.

Sea of ​​Qi—lower abdomen, on the front midline, 1.5 cun below the middle of the navel.Hegu—the back of the hand, between the 1st and 2nd metacarpal bones, at the midpoint of the radial side of the 2nd metacarpal bone.Neiguan—on the palm side of the forearm, on the connecting line between Quze and Daling, 2 cun above the transverse crease of the wrist, between the palmar longus tendon and the flexor carpi radialis tendon.Yanglingquan—on the outer side of the calf, in the depression anteriorly and inferiorly to the head of the fibula.Zusanli - anterolateral side of the calf, 3 cun below the calf's nose, one finger (middle finger) away from the front edge of the tibia.

Fenglong—anterior lateral side of calf, 8 cun above the tip of lateral malleolus, two transverse fingers (middle finger) beside the front edge of tibia.

Sanyinjiao—the inner side of the calf, 3 inches above the tip of the medial malleolus, behind the medial surface of the tibia.

Taichong—on the dorsal side of the foot, in the depression behind the first metatarsal space.

([-]) Self-massage
1. To push the head, use two palms and four fingers on the ventral side, and press more vigorously on the Baihui and Dazhui points on the front hairline pushing meridian.Then push the Gallbladder Meridian of Foot Shaoyang on both sides of the head, from the front hairline to the back hairline, emphatically push the Fengchi point in it.Finally, wipe the forehead with four fingers, from Yintang to temple.Push each part for 5 minutes.

2. Push the back and reverse the hand, use four fingers to push the bladder meridian of the foot sun on both sides of the spine from top to bottom, first push 1.5 inches away from the spine, and then push 3 inches away from the spine.

Then press the Shenshu and Mingmen points.Push each meridian for 5 minutes, and press each point 18 times.This method can be performed by another person with the help of another person.

3. Rubbing the abdomen Put the right hand on the abdomen, cover the left hand with the right hand, rub the entire abdomen with the palm for about 5 minutes.

4. Pinching acupuncture points Use pinching to point Jianjing, Shaohai, Shenmen, Hegu, Zusanli, Sanyinjiao, Weizhong, Chengshan, Fuliu, and Xingjian.Choose 4 of them each time, and you can also use a massager to vibrate.

Cerebrovascular accident (stroke)

An overview of the disease

([-]) Relevant knowledge

1. Concept and epidemiological situation Cerebrovascular accident, also known as stroke, is the loss of brain function caused by a sudden decrease in blood supply to the brain.Like all organs in the body, brain tissue requires a constant supply of oxygen-rich blood.The drop or lack of oxygen supply can damage and destroy brain cells. The result can range from temporary dizziness to death within minutes.Stroke is the third leading cause of death after heart disease and cancer.Cerebrovascular disease is a common and frequently-occurring disease among middle-aged and elderly people, which seriously endangers human health.It is characterized by fast onset, slow recovery, many deaths and severe disability.

It has brought great mental and physical pain to people, and also caused serious economic losses to people.The results of a large-scale population survey in my country show that the incidence of stroke is 109.7-217 cases per 10 people, and the mortality rate is 116-141.8 cases per 10 people.It is calculated from this that there are about 130 to 260 million new stroke patients in my country every year, and the number of deaths is about 140 to 170 million.The morbidity and mortality of stroke vary greatly in different regions of my country.Comparing according to different latitudes and longitudes, the statistical results show that the morbidity and mortality of stroke have a general trend of decreasing gradually from north to south, and gradually decreasing from west to east.In Tibet, which is located on a high plateau, most of the cerebrovascular diseases are hemorrhagic, and the fatality rate is very high.The morbidity and mortality of stroke both increase with age, and increase significantly after the age of 5, and the increase is most obvious for people over the age of 45. The incidence rate of people over the age of 65 is 75 to 45 times that of the 54-5 age group.

2. Knowledge about brain tissue and cerebrovascular
(1) Brain tissue: The weight of the adult brain is about 1500 grams, accounting for 2-3% of the body weight; the blood flow through the brain is about 750-1000 ml/min, accounting for 15-20% of the cardiac output.That is to say, the blood flow required by the brain tissue, which accounts for 2-3% of the body weight, accounts for 15-20% of the whole body. It can be seen that the blood demand of the brain tissue is very large.At the same time, the workload of the brain is very large, and the demand for energy is also very large.The energy source of brain tissue depends almost entirely on the metabolism of oxygen and glucose.The oxygen consumption of brain tissue is far more than that of other tissues, about 50 ml/min, accounting for 20-30% of the total oxygen consumption of the whole body, and more than 20 times that of muscle oxygen consumption at rest.Of the glucose supplied by the normal liver, 70% is utilized by brain tissue.Glucose, like oxygen, is transported to the brain tissue through the blood circulation. Once the cerebral blood flow is insufficient or the blood sugar is too low, neurological and mental symptoms may occur.Such as fatigue, sweating, pale complexion, drowsiness, syncope, coma, etc., and death may occur in severe cases.Therefore, a normal blood supply to the brain is an essential condition to maintain the life activities of the body, especially the high-level neural activities of the body.

(2) Cerebrovascular: Human brain tissue is a whole, and the composition and connection of cerebral blood vessels are very ingenious.There are four arteries that pass through the neck and supply blood to the brain.The first two are called the internal carotid arteries, and extend to the anterior cerebral artery and the middle cerebral artery, forming the anterior circulation of the brain; the latter two are called the vertebral arteries, and extend to the posterior cerebral arteries, forming the posterior circulation of the brain.

The connection between the anterior and posterior circulation of the brain is ingenious.The left and right anterior cerebral arteries are connected by the anterior communicating artery; the middle cerebral artery and the posterior cerebral artery on the same side are respectively connected by the posterior communicating artery.In this way, a hexagon is formed at the bottom of the brain. This interesting structure is medically called the cerebral artery ring.Therefore, the arteries and vessels of the entire brain become a whole through the arterial ring at the base of the brain, and when the blood supply at any end of this circular blood vessel weakens, they can regulate each other to ensure the stability of the blood supply to the brain.The blood supply of cerebral arteries has a clear division of labor.The internal carotid artery system is the anterior circulation of the brain, supplying blood to the anterior 3/5 of the cerebral hemispheres and the eyes; the vertebrobasilar system is the posterior circulation of the brain, supplying the posterior 2/5 of the cerebral hemispheres, thalamus, brainstem, and cerebellum blood.

(3) The relationship between cerebrovascular and brain tissue: The brain is an important organ of the human body, and the metabolism of the brain tissue is particularly vigorous. Its energy source mainly depends on oxygen and glucose, which are transported to the brain tissue through arteries.The human brain tissue has almost zero storage of oxygen and glucose, so the brain tissue needs a continuous supply of oxygen and glucose.

Studies have shown that blocking cerebral blood circulation for any reason will affect the metabolism of brain nerve cells and cause damage to brain tissue.The longer the blood flow to the brain is blocked, the more severe the brain damage.

The blood flow of brain tissue is blocked for 30 seconds, and the metabolism of brain nerve cells begins to be damaged.

The blood flow in the brain tissue was blocked for 2 minutes, and the metabolism of the brain nerve cells stopped, showing different degrees of coma.If blood flow is restored, brain nerve cells can restore metabolic function.

The blood flow to the brain tissue was blocked for 5 minutes, and the neurons in the cerebral cortex began to suffer permanent irreversible damage.

The blood flow to the brain tissue is blocked for 10 to 15 minutes, and permanent damage to the cerebellum begins.

The blood flow in the brain tissue is blocked for 20 to 30 minutes, and the breathing and circulation centers of the brainstem begin to be permanently damaged, and people's breathing and heartbeat stop one after another.

([-]) Disease classification

There are three main types of stroke: transient ischemic attack, ischemic stroke, and hemorrhagic stroke.Ischemic stroke includes cerebral thrombosis and cerebral embolism; hemorrhagic stroke includes cerebral hemorrhage and subarachnoid hemorrhage.All three of these conditions cut off the blood and oxygen supply to part of the brain tissue, leading to a stroke.Occasionally, a brain tumor squeezes one of the surrounding cerebral arteries, interrupting the blood supply to its distribution area and causing a stroke.

1. Transient ischemic attack (TIA), also known as "transient ischemic attack", "refers to a short-term and often repeated attack of local blood supply disturbance in the brain, resulting in localized neurological deficit symptoms in the blood supply area." Every The second attack lasts from several minutes to 1 hour, and it will recover completely within 24 hours, but there are often repeated attacks.Therefore, some people call it "intermittent claudication of the brain". The etiology of TIA is mainly atherosclerosis, which is related to the obstruction of microemboli and cerebral vasospasm. TIA tends to occur in middle-aged and elderly people, more common in 50-70 years old, more men than women.The onset is sudden, the condition reaches its peak in about 5 minutes, the duration is short, the recovery is fast, no sequelae is left, and the attack can be repeated, and the symptoms of each attack are relatively constant. TIA is recognized as the most important risk factor for ischemic stroke, recent frequent episodes of TIA is a super-alert of cerebral infarction, and active treatment must be carried out.

2. Ischemic stroke, also known as "cerebral infarction", is actually a kind of brain death, but it does not occur in the whole brain, but in a certain part of the brain tissue.Cerebral tissue ischemic necrosis or encephalomalacia caused by brain tissue ischemia and hypoxia due to cerebral blood supply disorder.Cerebral infarction is divided into cerebral thrombosis and cerebral embolism, two diseases that lead to the death of brain tissue due to blockage of blood vessels supplying the area.Cerebral infarction accounts for about 80% of all strokes.

(1) Cerebral thrombosis: refers to the formation of thrombus on the basis of cerebral artery intima lesions, resulting in stenosis or occlusion of the vessel cavity, causing cerebral infarct necrosis in its blood supply area, and thus producing corresponding neurological symptoms and signs. Acute ischemic cerebrovascular disease is a common type of acute cerebrovascular disease.The most common cause is cerebral atherosclerosis.

(2) Cerebral embolism: refers to various emboli entering the intracranial arterial system with the blood flow, causing acute occlusion of the vascular cavity, causing ischemic necrosis of the brain tissue in the corresponding blood supply area and brain dysfunction.Embolus mainly comes from the heart (mainly rheumatic heart disease), other parts (aortic arch, carotid artery or vertebral artery atherosclerotic plaque and attachment shedding are common reasons, and there are other factors such as fat, worm eggs, air, etc.) and Embolus of unknown origin and other three aspects.Cerebral embolism is less common than cerebral thrombosis, accounting for about 15% of cerebral infarction.The most common embolized vessel is the middle cerebral artery.

Although both cerebral thrombosis and cerebral embolism are blood vessel blockages, their mechanisms of occurrence are completely different.Cerebral thrombosis is the coagulation of blood in diseased cerebral vessels.Cerebral embolism is an embolus in other parts of the body, which flows into the cerebral arteries through blood circulation, causing acute occlusion of cerebral blood vessels.The location of embolism has nothing to do with whether there is lesion in the cerebral blood vessels, but is related to the caliber of the blood vessels.

3. Hemorrhagic stroke

(1) Cerebral hemorrhage: Cerebral hemorrhage refers to primary non-traumatic intraparenchymal hemorrhage.The brain tissue is surrounded by the hard skull, the blood cannot flow out, and it coagulates in the brain, compressing the brain tissue, and the consequences are very dangerous.Cerebral hemorrhage has a high morbidity and mortality rate, accounting for 20-30% of all strokes.Common causes of cerebral hemorrhage include long-term hypertension (the most common cause of cerebral hemorrhage), acute blood pressure increase in non-hypertensive patients (especially on the basis of atherosclerosis), cold stimulation, cerebral hyperperfusion, congenital Cerebral vascular malformation or cerebral aneurysm rupture and bleeding, amyloid cerebrovascular disease (a common cause of non-hypertensive cerebral hemorrhage in the elderly over 60 years old).

(2) Subarachnoid hemorrhage: There is a very thin membrane on the surface of the brain tissue, and there are abundant small blood vessels on the membrane to form a network structure similar to a spider web, which is called arachnoid.These small blood vessels can rupture for a variety of reasons, causing bleeding, and blood flows into the space between the arachnoid and the pia mater on the surface of the brain tissue, which is called subarachnoid hemorrhage.The most common etiology of subarachnoid hemorrhage is the rupture of congenital intracranial aneurysms, followed by cerebral arteriovenous malformations.Subarachnoid hemorrhage accounts for 20% of hemorrhagic strokes.

([-]) Clinical manifestations

There are many inducements for the onset of this disease (sudden climate change, overwork, emotional agitation, hard work, etc.).Before the disease, there are often aura symptoms such as dizziness, headache, numbness of limbs, and weakness.More acute onset.The main symptoms are dizziness, hemiplegia, awkward speech or aphasia, crooked tongue, and numbness in one side of the body.The second symptoms are headache, dizziness, vertigo, vomiting, incontinence or obstruction, irritability, convulsions, excessive phlegm, and hiccups.Good hair over 40 years old.

1. Stages of stroke Stroke can generally be divided into three stages: acute stage, recovery stage and sequelae stage.

(1) The acute phase refers to within two weeks to one month after onset.

(2) The recovery period refers to within two weeks or one month to half a year of major onset.

(3) The sequela period refers to the onset period of more than half a year.

2. Premonitory symptoms About 70% of stroke patients often have the following premonitory symptoms before stroke:
(1) Dizziness: Sudden dizziness, especially vertigo.

(2) Headache: the original headache suddenly aggravates or persists and is difficult to relieve, especially if the headache is throbbing or occipital pain.

(3) Tinnitus: Sudden unilateral or bilateral tinnitus, which may be accompanied by hard of hearing or vertigo.

(4) Numbness: bursts of numbness on one side of the limb, face or around the mouth.

(5) Dyskinesia: Sudden weakness or inflexibility of one limb, unsteady walking, easy to fall, or weakness and drooling of one side of the mouth.

(6) Language barrier: Slurred speech, inflexible mouth and tongue.

(7) Visual impairment: intermittent blurred vision in one or both eyes, or even temporary loss of vision.

(8) Impairment of consciousness: sudden drowsiness, drowsiness, or frequent fainting recently.

(9) Mental disorders: Sudden memory impairment, personality changes or mental disorders.

(10) Convulsions: Sudden local or general convulsions of unknown origin.Some of the above symptoms reflect sudden changes in blood pressure, some are caused by cerebral blood circulation disorders, or actually represent the occurrence of small strokes, so we should pay close attention to them.Of course, these symptoms can be a precursor to a stroke, or they can be manifestations of other diseases.However, if these symptoms occur in people with stroke risk factors or stroke constitution, the possibility of stroke aura should be fully considered.

([-]) Diseases closely related to cerebrovascular diseases
1. Hypertension At present, there are more than 1 million hypertensive patients in my country.Hypertension is the most common and modifiable risk factor for cerebrovascular disease.According to statistics, the number of patients with cerebrovascular disease with high blood pressure is 7 times higher than that without high blood pressure.

The harm of hypertension to cerebrovascular diseases is mainly reflected in the following aspects:
(1) Increase the tension of cerebral arteries, and damage the blood vessel wall and vascular intima.

(2) It causes the pressure in the cerebral blood vessels to increase, so that the lipids in the blood can easily penetrate into the blood vessel wall, forming atherosclerotic plaques, and the plaques are easy to fall off and form emboli, causing cerebral embolism.

(3) Chemical substances that can cause vasoconstriction in the blood of hypertensive patients increase, which further damage the arterial wall, induce platelet adhesion and aggregation, and lead to thrombus formation.

(4) It thickens the wall of the cerebral artery and narrows the lumen, leading to the occurrence of this disease.

(5) It can cause the wall of small arteries in the brain to expand and protrude outward, forming an aneurysm.When the pressure suddenly rises, the aneurysm ruptures, causing bleeding in the brain.

2. Hyperlipidemia Most cerebrovascular diseases occur in patients with atherosclerosis, and hyperlipidemia is closely related to the formation of atherosclerosis, which can cause and accelerate the formation of atherosclerosis.The blood vessels that have formed atherosclerosis are very fragile and easy to rupture, leading to cerebral hemorrhage; the shedding of atherosclerotic plaques can block blood vessels and cause cerebral embolism.

Hyperlipidemia is one of the important factors leading to cerebrovascular diseases. Regulating blood lipid metabolism is of great significance to prevent the formation of atherosclerosis and reduce the occurrence of cerebrovascular diseases.

(End of this chapter)