Wind stroke

Also wind strike.

1. The sudden appearance of hemiplegia, deviated eyes and mouth, and impeded speech that may or may not start with sudden clouding collapse (loss of consciousness).

History: In The Inner Classic (内经 nèi jīng), the term zhòng fēng is used in the general sense of contracting wind evil, and terms such as major reversal, vehement reversal, hemilateral withering, disablement, and deviated mouth most closely match what is now called wind stroke.

It was Zhāng Jī (Zhāng Zhòng-Jǐng) who in Essential Prescriptions of the Golden Cabinet (金匮要略 jīn guì yào lüè) first used the term 中风 zhòng fēng in the sense intended here (see definition 3 below). Zhāng Jī attributed wind stroke to contraction of wind evil, and distinguished between network stroke, channel stroke, bowel stroke, and visceral stroke on the basis of signs: When the evil is in the network [vessel], the skin is insensitive; when it is in the channels, [the body] is heavy and unwieldy; when it is in the bowels, [the patient] does not recognize people; when in the viscera, the tongue has difficulty in speaking and [the patient] drools at the mouth. Wind stroke continued to be attributed to external wind until the Northern Sòng (900–1127), when fire, phlegm, and vacuity also came to be identified as causes.

In the Yuán Dynasty (1271–1368) Wáng Lǚ (王履, aka 安道Ān-Dào) made a clear distinction between true wind stroke, i.e., wind stroke attributed to externally contracted wind and wind-like stroke, which is attributed to internal wind or other causes.

In the Míng Dynasty, Lǐ Zhōng-Zǐ (李中梓, aka Shì-Cái 士材) made the distinction between block patterns and desertion patterns (see ahead).

Modern understanding: In the modern view, wind-like stroke is much more common, and usually only mild cases are ever considered to be true wind stroke, although external wind may trigger wind-like stroke. For this reason, in modern texts, wind stroke usually refers to wind-like stroke. Wind-like stroke occurs a) when depletion of yīn essence or sudden anger causes hyperactivity of liver yáng which stirs liver wind; b) when, owing to a predilection for rich, fatty foods, phlegm heat congests in the inner body and transforms into wind; c) when vacuity of qì and blood causes vacuity wind; or d) when a patient suffering from internal vacuity suddenly contracts external wind.

In modern clinical practice, wind stroke (wind-like stroke) arises when insufficiency of kidney yīn, intense heart fire, and ascendant liver yáng cause liver wind to stir or when congestion of damp phlegm transforms into heat and engenders wind. Other contributing factors include qì vacuity, qì counterflow, etc. Internal wind is the essential cause, although it may be brought on by external wind. The main signs are sudden clouding collapse that leaves the patient with hemiplegia, deviated eyes and mouth, and sluggish or difficult speech. In some cases, there is only deviated eyes and mouth.

Biomedical correspondence: cerebrovascular accident (cerebral hemorrhage, cerebral embolism, cerebral thrombosis); cerebral angiospasm; toxic encephalopathy; Bell’s palsy (facial paralysis).

See true wind stroke; wind-like stroke.

2. Greater yáng (tài yáng) wind strike, i.e., an externally contracted disease pattern causes by external wind. See greater yáng (tài yáng) wind strike pattern. The Chinese 中风 zhòng fēng refers to this as well as to definition (1) above. We distinguish the two conditions by the minor difference in words, although in theory they could be represented by a single English term.

Patterns

Channel and Network Stroke

The signs are deviated eyes and mouth, inhibited speech, and hemiplegia with no change in spirit-mind.

Medicinal therapy: If caused only by internal wind, it is treated by calming the liver and extinguishing wind with Liver-Settling Wind-Extinguishing Decoction (镇肝熄风汤 zhèn gān xī fēng tāng) or Gastrodia and Uncaria Beverage (天麻钩藤饮 tiān má gōu téng yǐn). If brought on by external wind, it can be treated by dispelling wind and freeing the network vessels and nourishing the blood and harmonizing provisioning, using formulas such as Pull Aright Powder (牵正散 qiān zhèng sǎn) or Large Gentian Decoction (大秦艽汤 dà qín jiāo tāng).

Acumoxatherapy: Base treatment mainly on hand and foot yáng brightness (yáng míng) LI/ST, assisted by greater yáng (tài yáng) and lesser yáng (shào yáng). The principle of treatment applied is to free the channels and regulate qì and blood. Main formula: LI-15 (Shoulder Bone, 肩髃 jiān yú), LI-11 (Pool at the Bend, 曲池 qū chí), LI-4 (Union Valley, 合谷 hé gǔ), TB-5 (Outer Pass, 外关 wài guān), GB-30 (Jumping Round, 环跳 huán tiào), GB-34 (Yáng Mound Spring, 阳陵泉 yáng líng quán), ST-42 (Surging Yáng, 冲阳 chōng yáng), and BL-60 (Kunlun Mountains, 昆仑 kūn lún). In addition, one of the three following methods can be used.

1. First drain the unaffected side, then supplement the affected side.
2. Needle or moxa the two sides alternately.
3. Only needle the affected side, using a medium or strong stimulus. In enduring cases, needle and moxa on both sides to supplement.

Point selection according to causes: For liver wind stirring internally, add GV-20 (Hundred Convergences, 百会 bǎi huì), GB-20 (Wind Pool, 风池 fēng chí), LR-3 (Supreme Surge, 太冲 tài chōng), SP-6 (Three Yīn Intersection, 三阴交 sān yīn jiāo), and KI-1 (Gushing Spring, 湧泉 yǒng quán). When external evil is contributory factor, add BL-17 (Diaphragm Transport, 膈俞 gé shù), BL-23 (Kidney Transport, 肾俞 shèn shù), BL-18 (Liver Transport, 肝俞 gān shù), GB-20 (Wind Pool, 风池 fēng chí), LR-3 (Supreme Surge, 太冲 tài chōng), and SP-6 (Three Yīn Intersection, 三阴交 sān yīn jiāo).

Point selection according to affected area: See hemiplegia.

Bowel and Visceral Stroke

The main signs are sudden collapse and loss of consciousness. Distinction is made between block patterns, which are characterized by clenched jaw and clenched hands and desertion patterns, which are marked by open mouth, limp hand, open eyes, enuresis, snoring voice, and in some cases, by spontaneous sweating.

Block patterns

Medicinal therapy: Diffuse the orifices and open the block with Supreme Jewel Elixir (至宝丹 zhì bǎo dān) or Storax Pill (苏合香丸 sū hé xiāng wán) poured into the patient’s mouth while he still unconscious; if necessary, first loosen tightly clenched jaws by rubbing Storax Pill or finely ground raw arisaema (Arisaematis Rhizoma Crudum, 生南星 shēng nán xīng) and borneol (Borneolum, 冰片 bīng piàn) on the gums. Follow this with treatment to nourish yīn and subdue yáng, clear the liver and extinguish wind, and sweep phlegm with formulas such as Antelope Horn and Uncaria Decoction (羚角钩藤汤 líng jiǎo gōu téng tāng) or Phlegm-Abducting Decoction (导痰汤 dǎo tán tāng).

Acumoxatherapy: Base treatment mainly on GV, and Twelve Well Points (十二井穴 shí èr jǐng xué), supported by hand and foot reverting yīn (jué yīn) PC/LR, and yáng brightness (yáng míng) ST/LI channel points. Select Twelve Well Points (十二井穴 shí èr jǐng xué), GV-26 (Water Trough, 水沟 shuǐ gōu), LR-3 (Supreme Surge, 太冲 tài chōng), PC-8 (Palace of Toil, 劳宫 láo gōng), ST-40 (Bountiful Bulge, 丰隆 fēng lóng), and KI-1 (Gushing Spring, 湧泉 yǒng quán); needle with drainage or prick to bleed with a three-edged needle.

Point selection according to signs: For clenched jaw, add ST-6 (Cheek Carriage, 颊车 jiá chē), ST-7 (Below the Joint, 下关 xià guān), and LI-4 (Union Valley, 合谷 hé gǔ). For clenched hands, add PC-6 (Inner Pass, 内关 nèi guān), SI-3 (Back Ravine, 后溪 hòu xī), and LI-4 (Union Valley, 合谷 hé gǔ).

Desertion patterns

Medicinal therapy: Use large doses of Ginseng and Aconite Decoction (参附汤 shēn fù tāng) to support right and stem desertion.

Acumoxatherapy: Base treatment mainly on CV. Burn moxa cones at CV-4 (Pass Head, 关元 guān yuán), and CV-6 (Sea of Qì, 气海 qì hǎi), and apply moxibustion on salt or ginger at CV-8 (Spirit Gate Tower, 神阙 shén què) until the sweating ceases, the limbs become warm, and pulse rises.

Point selection according to signs: For persistent sweating, add HT-6 (Yin Cleft, 阴郄 yīn xī), LI-4 (Union Valley, 合谷 hé gǔ), and ST-36 (Leg Three Lǐ, 足三里 zú sān lǐ). For aftermath of wind stroke, see hemiplegia.

2. Any of various diseases like wind stroke. See fire stroke; vacuity stroke; dampness stroke; cold stroke; summerheat stroke; qì stroke; food stroke; malignity stroke.

3. From On Cold Damage (伤寒论 shāng hán lùn). An external wind contraction, one type of greater yáng (tài yáng) disease. On Cold Damage (伤寒论 shāng hán lùn) states, Greater yáng (tài yáng) disease, with heat effusion, sweating, aversion to wind, and a pulse that is moderate, is called wind stroke. The term wind strike is often preferred as the translation of 中风 zhòng fēng in this sense to avoid confusion with stroke (apoplexy). Note that in Zhāng Jī’s work, the term 中风 zhòng fēng is used in two distinct senses.