Treating Cerebro-Vascular-Accident (C.V.A.) with Acupuncture
by Shmuel Halevi Ph.D
Birth control pills increase the risk of ischemic stroke 1.9 times, to 8.5 strokes per 100,000 women, according to a well-performed “meta-analysis” cited in a report in the journal MedLink Neurology1. (a meta-analysis combines the results of multiple studies.) This is still a small risk; 24,000 women would have to take birth control pills to cause one additional stroke, according to the report, resulting sometime in death or in hemiplegia.
This case is about a 25 year old woman from Malta, who has come to my clinic in Israel for treatment, suffering a severe case of hemiplegia, occurring four months prior to her arrival. The results were excellent, and eventually, she had recovered completely.
Some Western Medicine facts
For healthy young women without any stroke risk factors, the risk of stroke associated with oral contraceptives is small. However, in women with other stroke risk factors, the risk seems higher and, in most cases, oral contraceptive use should be discouraged. Strokes associated with oral contraceptives were first reported in 1962. Early versions of the pill contained doses of synthetic estrogen as high as 150 micrograms. Most birth control pills now contain as little as 20 to 35 micrograms. None contain more than 50 micrograms of synthetic estrogen. There are about 4.4 ischemic strokes for every 100,000 women of childbearing age. But for women who take birth control pills and also smoke, have high blood pressure or have a history of migraine headaches, the stroke risk is significantly higher. Such women should be discouraged from using oral contraceptives. Hormone replacement therapy with estrogen alone or combined with progesterone increases the risk of ischemic stroke by 40 percent; the higher the dose, the higher the risk.2
In mid December 2012, I received a call from Malta. The caller had identified himself as Liz's father, telling me that his daughter, 25 years old at that time, was suffering from severe hemiplegia, resulting from a stroke which had been associated with the use of birth control pills. Following this conversation, Liz and her parents came from Malta to my clinic in Nahariya, Israel, for treatment, a week or so later.
Liz condition has not been changed or improved during the past four months since the occurrence of the disease. It had all started after a year of taking the pill on a regular basis. She started having spells of dizziness, sometimes to the verge of fainting. Regular checkups at a local clinic, in a village near Valleta where she lives, as well as a thorough medical investigation in a hospital, did not reveal any abnormal findings. At the day of the stroke, Liz felt another spell of acute vertigo, and she suddenly lost sensation in the left side of her body. After being rushed to Valleta's main hospital, a CT scan revealed a major damage in the right hemisphere of her brain. The CT scan conclusion stated as follows: "...multifocal areas of infarction, the largest in the right basal ganglia and internal capsule region...". This had been associated with the pills she was taking during the preceding year. She was then and there given some blood thinning medications and referred to intensive physiotherapy.
During the four months that followed, Liz received intensive physiotherapy as well as acupuncture, but nothing seemed to improve her condition. Her acupuncturist suggested that she would contact me in Israel, knowing that I had had experience treating this syndrome.
Observing Liz upon her arrival, her hemiplegic paralysis seemed of the tight, spastic type, unable to move her arm at all and just a fraction of her fingers. Her arm was clenched proximally to her chest, and her gait very slow, swaying and heavily limping. She had made the short walk from her (hired) apartment to my clinic, accompanied and aided by both her parents, in a considerable long time, however, optimistic and enjoying the exercise. I checked her physically and here is a summary of my observation:
A C.V.A. resulting from the use of contraceptive pills, is always connected with the kidneys in Chinese Medical theory. The kidneys being the source of reproductive energy3, have much to do with hormones in general, and especially with the specific hormones associated with fertility and reproduction. The kidneys are also directly connected by their energetic system with the spinal cord and the brain itself 4. Thus, using hormonal medications, and especially the contraceptive pill, have a direct impact on the kidneys' energetic system, e.g., the spinal cord and brain. Stagnation occurring due to weakening of kidney Qi in these areas of influence, may cause dizziness, weakness, emotional instability and in some cases also paralysis. Going over the symptoms and signs of my observation, we can easily associate the findings of tender G-25 jingmen as well as deep pulse, anxiety, aversion to cold etc., with a state of injury to kidney Qi. Severe stagnation of kidney Qi due to deficiency, may cause taut, deep and thin pulse. A state of anxiety (fear) may cause the pulse to be somewhat fast, and a short tongue which is hard to extend can point to a condition of marked stagnation and even paralysis.
The Treatment Plan
My initial treatment planning was to invigorate the Qi and blood circulation in the brain and left side of the body. This could not be done without reinforcing and replenishing kidney Qi, warming the Yang Qi, and supporting Liz's confidence and optimism. I explained my views to Liz and her parents, using a reassuring plain language, avoiding any alarming and distressing vocabulary and prognoses. I encouraged Liz to do striding exercise as much as possible, breathing, hot bath, diet that supports kidney Qi, etc. We scheduled a daily treatment session of half an hour every day, for the next three weeks.
The opening basic point formula was devised as follows:
Right Li-4 hegu, Li-11 quchi, followed by both G-20 fengchi, followed by left Li-15 , Li-11 quchi, Li-4 hegu, St-36 zusanli, St-41 jiexi
Using this choice of points, I aimed at activating the system of yangming (large intestine and stomach) meridians. These channels are said to be the richest in Qi and blood5, thus being able to exert the strongest effect of mobilizing and dispersing Qi and blood along the paralyzed limbs. In order to achieve this goal, I commenced with the points on the right (and unaffected limb), the yangming being also the only channel that traverses the body from one side to the other6. Proceeded with the most effective local points (in my opinion) G-20 fengchi on the head region, and continued with the yangming points situated on the affected arm and leg. All these points were manipulated in dispersion technique, i.e., strong twirling and wagging of the needle handle in the direction of the intended movement of Qi. Thus, needles on the right hand were vigorously manipulated in order to propagate Qi towards the head, G-20 fengchi with deep insertion caused a Qi sensation traveling anteriorly in the general direction of the eye. The rest of the points situated on the paralyzed limbs, were manipulated in order to produce a Qi sensation traveling distally in the direction of the fingers and foot.
The second set of points which I have chosen, were intended at replenishing kidney Qi, and for general fortifying of Qi and blood. These were:
K-3 taixi, Sp-6 sanyinjiao, Ren-4 guanyuan and Ren-6 qihai.
This ages old combination7 is renowned for its strong enhancing effect on the kidney Qi in particular, as well as an overall tonification of Qi and blood in general. The points were needled in mild tonifying techniques, occasionally with the implementation of moxa over the needle handle - in order to enhance activation of kidney Yang. Supplementing basic Qi and blood should have provided the "material" or essence, whereupon my rather vigorous needle maneuvering had acted upon, and recruited, in order to mobilize the stagnant Qi in the paralyzed extremities.
After using the first set of points in several sessions, I started importing occasionally few other points as well, in order to enhance and expand its effectiveness. These were:
Du-20 baihui - along with its four "satellites" m-hn-1 sìshéncōng (specialized for wind afflictions and hemiplegia)8, Sj-5 waiguan (within its indications are paralysis of the upper extremity) 8, Gb-34 yanglinquan (same indication but for the lower extremity), and G-39 xuanzhong (the hui-meeting point of marrow and indicated also for hemiplegia)8.
The Treatment Outcome
Fortunately, Liz proved herself to posses considerable stamina and endurance. Quite early in the process, I realized I could exert rather vigorous needle manipulations on her, a requisite for conditions involving marked stagnation of Qi and blood in the jing-luo system, of long duration.
As most of the needles were used in reducing-dispersing techniques, I usually have inserted the needles slowly and deeply, and withdrew the needles with faster movements to a more superficial level, several times in a row. After that, I usually wagged the needle handle back and fro, massaging the meridian route with my other hand in the desired direction. As in most other cases which have been discussed in my various previous articles9, after only few sessions Liz's meridian system has learned the pattern, and there had been no further necessity in intentionally propagating the Qi sensation any more. Insertion of the needle and slight twirling, was enough to have caused the desired Qi sensation to travel up until the end station.
After the first seven days, Liz have been able to stride faster and with much less difficulty from her hired apartment down to my clinic (about 500 meters). Also, she was now able to relax her left arm and push it from her chest down to her hip. Slight movements of her fingers were also noticed. This had definitely had a tremendous impact on her mood, and she doubled her efforts in the qigong exercises I have taught her to perform.
After the end of her second week, her gait had become much better, her arm could extend freely at will from the chest to the hip, and back to the chest - still with effort but very well nonetheless. At this stage, I referred Liz and her parents to a nearby physiotherapy clinic, employing the hydrotherapy approach. I also added the bāxié m-ue-22 extra points on her left hand. These points are indicated for stiffness and numbness of the fingers, as well as movement incapability.
At the end of the third and last week, Liz condition had improved dramatically. She walked much better, could move her arm and, above all, could do simple tasks using her hand and fingers. She was advised to keep on with physiotherapy and hydrotherapy at home, and encouraged to keep having acupuncture and massage back in Malta. I bade her farewell and requested that she kept in touch, informing me of her progress.
Eight months after returning to Malta, Liz recovered completely.
1,2 - The report is titled “Hormonal Contraception and Stroke.” It is an update of a report originally published in Medlink Neurology in 2003.
3 - Manual of Acupuncture (Peter D. & al) pp. 93
4 - Manual of Acupuncture (Peter D. & al) pp. 93
5 - The Spiritual Pivot classification of the relative state of the qi and blood in the six channels states that yangming channel is abundant in Qi and blood, and this theory is frequently called upon to explain the use of the Large Intestine and Stomach channels in the treatment of atrophy disorder and painful obstructions.
6 - Acupuncture A Comprehensive Text, Eastland Press 1985, pp. 48
7 - Classical Point Combinations and Clusters of Points in Acupuncture Therapy, Shmuel Halevi Ph.D. (1990) - http://www.acumedico.com.
8 - Manual of Acupuncture (Peter D. & al) pp. 260, 315, 574, 324.
9 - For example here: Severe Traumatic Injury of the 3rd Cranial Nerve, Shmuel Halevi Ph.D. Journal of Chinese Medicine No. 111 June 2016, or here: http://www.acumedico.com/cranial.htm.
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