Stroke Rehabilitation and Chinese Medicine

By Jiang Liu, Diplomate of Oriental Medicine
AR Licensed Acupuncturist and Herbalist
Acupuncture & Chinese Medicine Clinic
2024 Arkansas Valley Dr., Suite 402
Little Rock, AR 72212


A stroke is the rapidly developing loss of brain function(s) due to disturbance in the blood supply to the brain. This can be due to ischemia (lack of blood flow) caused by blockage (thrombosis or arterial embolism), or a hemorrhage (leakage of blood). As a result, the affected area of the brain is unable to function, leading to inability to move one or more limbs on one side of the body, inability to understand or formulate speech, or an inability to see one side of the visual field.

A stroke can cause permanent neurological damage, complications, and even death. It is the leading cause of adult disability in the United States and Europe and it is the number two cause of death worldwide. Risk factors for stroke include advanced age, hypertension, previous stroke or transient ischemic attack, diabetes, high cholesterol, cigarette smoking and atrial fibrillation.

Signs and symptoms
Stroke symptoms typically start suddenly. The symptoms depend on the area of the brain affected and the amount of tissue damaged. The more extensive the area of brain affected, the more functions that are likely to be lost. The affected areas include three prominent central nervous system (CNS) pathways, brain stem and cerebral cortex.

A stroke affecting three prominent CNS pathways (spinothalamic tract, corticospinal tract, and dorsal column) may produce the symptoms:

  • Hemiplegia and muscle weakness of the face
  • Numbness
  • Reduction in sensory or vibratory sensation

A stroke affecting the brain stem can produce symptoms relating to deficits in these cranial nerves:

  • Altered smell, taste, hearing, or vision (total or partial)
  • Drooping of eyelid and weakness of ocular muscles
  • Decreased reflexes: gag, swallow, or pupil reactivity to light
  • Decreased sensation and muscle weakness of the face
  • Balance problems and nystagmus
  • Altered breathing and heart rate
  • Weakness in sternocleidomastoid muscle with inability to turn head to one side
  • Weakness in tongue (inability to protrude and/or move from side to side)

A stroke affecting cerebral cortex, in addition to the symptoms of CNS pathways may produce the following symptoms:

  • Aphasia
  • Dysarthria (motor speech disorder)
  • Apraxia (altered voluntary movements)
  • Visual field defect
  • Memory deficits
  • Hemineglect
  • Disorganized thinking, confusion, hypersexual gestures
  • Anosognosia (persistent denial of the existence of a general, stroke-related, deficit)

Acute Stroke Management
Management of patients with acute stroke remains multifaceted and includes several aspects of care. The recommendations and guidelines are found in American Heart Association.

  • Pre-hospital management and field treatment
  • Designation of stroke centers
  • Emergency evaluation and diagnosis of acute stroke
  • Early diagnosis: brain and vascular imaging
  • Emergency treatment: depends on whether it is an ischemic stroke or a hemorrhagic stroke. For hemorrhagic stroke, the focuses are on controlling bleeding and reducing pressure in brain. For ischaemic stroke, early thrombolysis is standard practice. Surgery may also be used to help control future risk.
  • General supportive care and treatment of acute complications

Stroke recovery and rehabilitation
The impact of stroke depends on the area of the brain involved and the amount of tissue damaged. Stroke can affect patients physically, mentally, emotionally, or a combination of the three. The following symptoms are often observed in the clinic.
Physical disabilities

  • Muscle weakness
  • Numbness
  • Pressure sores
  • Pneumonia
  • Incontinence
  • Apraxia (inability to perform learned movements)
  • Difficulties carrying out daily activities,
  • Appetite loss
  • Speech loss
  • Vision loss
  • Pain
  • Seizures

Cognitive deficits

  • Speech problems
  • Dementia
  • Problems with attention and memory, or anosognosia

Emotional difficulties

  • Anxiety
  • Panic attacks
  • Mania
  • Apathy
  • Psychosis
  • Flat affect
  • Depression
  • Emotional lability

Following emergency treatment, stroke care focuses on helping to regain strength, recover as much function as possible and return to independent living. It also aims to help the survivor understand and adapt to difficulties, prevent secondary complications and educate family members to play a supporting role. Rehabilitative therapy begins after the patient’s medical condition has been stabilized. Rehabilitation care usually includes multidisciplinary efforts such as physiotherapy, occupational therapy, speech and language therapy, and psychotherapy. Rehabilitation team often involves nursing staff, physical therapists, rehab physicians, psychologists, and social workers.

Acupuncture and herbal medicine
Acupuncture and/or herbal medicine have been used for both acute stroke and post-stroke rehabilitation in China from ancient times and they are routine treatment for stroke. In recent years, acupuncture is increasingly applied in post-stroke rehabilitation in western countries. Beneficial results have been reported in studies with different designs and treatments from 24 hours to 8 years after stroke onset. In its Conclusions and Recommendations section, the panel of the NIH Consensus Development Conference on Acupuncture recently stated that “there are other situations such as…stroke rehabilitation…where acupuncture may be useful as an adjunct treatment or an acceptable alternative or be included in a comprehensive management program.

Experimental studies have demonstrated that acupuncture stimulates skin and muscle afferent nerves, improves blood circulation, and releases transmitters and peptides in brain and spinal cord. Intracellular recordings of cortical neurons in primates as well as neuroimaging and neurophysiological studies in humans have demonstrated that cortical sensorimotor representation areas can be modified by sensory stimulation. Clinical studies show improvement of acupuncture in multiple aspects in stroke patients.

  • Improve post-stroke depression and anxiety
  • Improve insomnia by reducing the sympathetic nervous activity
  • Induce word generation activation in post-stroke aphasia patients
  • Improve language and acoustics level
  • Improve balance function
  • Improve index of blood rheology
  • Improve blood circulation in the brain
  • Improve cerebral vasomotoricity
  • Stimulate perilesional and use-dependent reorganized site
  • Increase spinal motor neuron excitability in paretic limbs
  • Improve muscle tone of hemiplegic limb
  • Facilitate the motor function recovery
  • Improve swallowing difficulty
  • Improve ischemic cerebral apoplexy
  • Improve upper-limb motor function
  • Improve joint mobility with hemiplegic shoulder subluxation
  • Increase rehabilitation level for hemiplegia
  • Decrease the muscle tension of stroke patients with spastic hemiplegia
  • Decrease spasticity of impaired wrist joint
  • Decrease ankle plantarflexor spasticity and increase dorsiflexor strength
  • Reduce increased muscle tone and motor neuron excitability in spastic hemiplegia
  • Reduce post-stroke hand spasm
  • Improve spastic dyskinesia of the patient with hemiplegia
  • Improve patients’ ability to perform daily life activities
  • Improve the quality of life in post stroke with dysphagia
  • Increase psychological and social functions, and life satisfaction

Classification of stroke
Affecting meridians and channels

  • Liver yang extremely high with wind and fire upward disrupting
  • Wind and phlegm stagnating blood circulation and meridian blockage
  • Phlegm and heat attacking organs with wind and phlegm upward disrupting
  • Qi deficiency and blood stagnation

Affecting internal organs

  • Wind and fire up-disturbing
  • Phlegm and wetness blockage
  • Phlegm and heat blockage
  • Yuan qi collapse leading to spirit scattering
  • Yin deficiency and wind moving

Treatment of Stroke
1. Herbal medicine
Affecting meridians and channels
1) Liver yang extremely high with wind and fire upward disrupting
Principle of treatment: regulate liver, drain fire, and open meridian.
Treatment: tian ma go teng yin (plus or minus according to the symptoms).

2) Wind and phlegm stagnating blood circulation and meridian blockage
Principle of treatment: stimulate blood circulation, eliminate stagnation, resolve phlegm, and open meridian.
Treatment: hua tian tong luo tang (plus or minus according to the symptoms).

3) Phlegm and heat attaching organs with wind and phlegm upward disrupting
Principle of treatment: eliminate phlegm, open organ, and drain heat.
Treatment: hua tian tong luo tang (plus or minus according to the symptoms).

4) Qi deficieny and blood stagnation
Principle of treatment: tonify blood, activate blood circulation, eliminate phlegm and open meridian.
Treatment: bu yang huan wu tang (plus or minus according to the symptoms).

Affecting internal organs
1) Wind and fire up-disturbing
Principle of treatment: eliminate heat, suppress wind, and open meridian.
Treatment: tian ma guo teng yin (plus or minus according to the symptoms).

2) Phlegm and wetness blockage
Principle of treatment: warm yang, eliminate phlegm and open meridian.
Treatment: di tan tang (plus or minus according to the symptoms).

3) Phlegm and heat blockage
Principle of treatment: eliminate heat, dissolve phlegm, drain and open mind.
Treatment: ling yang jiao tang (plus or minus according to the symptoms).

4) Yuan qi collapse leading to spirit scattering
Principle of treatment: tonify qi and rescue yang.
Treatment: herbal medicine: shen fu tang (plus or minus according to the symptoms).

5) Yin deficiency and wind moving:
Principle of treatment: tonify yin and eliminate wind.
Treatment: zhen gan xi feng tang (plus or minus according to the symptoms).

2. Acupuncture Acupuncture can be applied according to the classification, cause, symptom of stroke, or a combination of all three.

According to stroke classifications
Meridians and channels affected

  • Scalp acupuncture: according to designated area
  • Body acupuncture:
    • hand area: jianou, quchi, shousan, hegu, waigan penetrating naiguan, hougu
    • foot area: zhusanli, yanglinquan, jugu, futu, yinlinquan, sanyijiao, taihen

Internal organs affected

  • Scalp acupuncture: sishencong, Baihui
  • Body acupuncture:
    • head area: RenZhong
    • hand area: naiguan, chize, quchi, hegu, hougu
    • foot area: sanyijao, wizhong, yongqian, taihen, xiehai, zusanli, yanglinquan

According to the causes

  • Having wind: fengchi
  • Having fire: chize
  • Having phlegm: fenglong
  • Having blood stagnation: moxibustion to zusanli, guanyuan and qihai
  • Having yin deficiency and yang dominancy: taixi

According to the symptoms

  • Mouth and eye muscle weakness: dicong, jiache
  • Aphasia: language area, lianquan, yamen, tongli
  • Weakness in tongue: jinjing, yuyie
  • Swallowing problem: fengchi, yifeng, lianquan, renying, fengfu, hegu, bailao, naigu, jinjing, yuyie
  • Arm weakness: jianou, jianmu, qiuchi, shousanli, waiguan, hegu, chize
  • Leg weakness: huantiao, fengshi, piguan, yanglingquan, zisanli, xuanzhong, kunluong, qixu, weizhong, sanyinjiao, yinlingquan
  • Shoulder pain and stiff: jianou, jiannailing, jianwailing, jianzhen, jianzhongshu, jianwaishu, taokou
  • Foot flexion: jiexi, qiuxu penetrating zhaohai, kunluong, zhubin
  • Many more

3. Others In addition to acupuncture, other modalities of Chinese medicine can be applied according to individual’s situation, such as electrical acupuncture, moxibustion, TuiNa and so on.