4. Discussion
muscular contractions, spasticity, stroke, Post-stroke spasticity, blockages, paralysis, stroke spasticity, post-stroke spasms, spasms, hemiplegia
STROKE, DISEASE, DYSFUNCTION, COMPLICATION, NA DEFICIENCY, PATHOGENESIS
Post-stroke spasticity is a common clinical complication with most patients experiencing spasms in the affected limb. The main clinical symptoms are paralysis of the lower limb flexor and upper limb extensor muscles, and increased muscle tension.Muscular tension is the amount of tension produced by a muscle during activity, and it is directly related to posture; body posture is determined by muscular tension. Currently, muscular tension is commonly measured in the clinic with the Modified Ashworth Scale. This scale consists of 6 grades; 0, 1, 1+, 2, 3, and 4, with grade 0 representing no increased muscle tone and grade 4 representing the highest muscle tone. Increased resistance during passive flexion of the joint represents increased extensor muscle tone, and increased resistance during passive extension of the joint represents increased flexor muscle tone.According to the Chi Jie Zhen Xie treatise in the Classic of the Miraculous Pivot (or Ling Shu), paralysis occurs when the body is very weak with poor circulation, and when the internal defense systems are weak, good energy flows out while bad energy remains, leading to hemiplegia. Wang Qingren from the Qing Dynasty also mentioned that paralysis in the lower half of the body was due to poor health. Therefore, the characteristic pathogenesis of spasmodic paralysis after stroke is a deficiency in yang energy, poor blood and systemic circulation, and insufficient nutrients in the meridians. In the Sheng Qi Tong Tian Treatise in the Plain Question (Su Wen), yang energy nourishes the mind and tendons. The essence of the governor vessel meridian is yang; hence, it is also considered to be the ocean of the yang meridians. Thus, regulating the governor vessel is the first step toward regaining energy in yang. Once the meridians related to the governor vessels are no longer obstructed, and the exertion of yang energy becomes normal, the limbs and muscles will be warmed and nurtured, and muscular contractions, such as spasms, can be alleviated. Therefore, acupoints on the meridian of the governor vessel were selected for the treatment. The governor vessel stores the energy of the 6 yang meridians, and the acupoints of the governor vessel meridian can be used to energize the 4 extremities and stimulate yang energy in the body.The Tuina technique based on Tongjing Tiaoxing aims to clear blockages in the meridians, and regulate energy and blood flow so that energy and blood flow smoothly to the organs to achieve the goal of regulating the body form and treating spasms. Studies have shown that Tuina plays a significant role in the recovery of motor dysfunction in patients with stroke spasticity, promotion of muscular coordination, and strengthening of muscular control to exert a significant inhibitory effect on spasticity, enhance the motor function of limbs, and improve the ability of patients to perform activities of daily living.Scalp acupuncture is used to treat the communication pathways between the central nervous system and the 4 limbs, and Tuina to enrich and integrate the meridians to inject energy into the internal organs. These 2 methods combine to promote circulation in the meridians and treat the root cause of limb spasms, regulate the form of limb spasms to manage the symptoms, ultimately achieving the goal of treating both symptoms and disease, and restoring harmony in both physical form and mind. Scalp acupuncture is an important component of the acupuncture and moxibustion system, and is widely used in the clinical treatment of stroke. Similar to other acupuncture and moxibustion physiotherapies, this operation is simple at low cost, inexpensive, safe, and effective. Studies have shown that scalp acupuncture has therapeutic potential for improving motor function of the limbs and reducing the severity of spasticity.The Modified Barthel Index is specifically designed to evaluate the ability to perform activities of daily living, and is an important basis for assessing whether the patient requires life assistance. The scale includes ten items, including feeding, bathing, grooming, dressing, bowel control, bladder control, toileting, chair transfer, ambulation and stair climbing. It is used to evaluate the ability of patients to perform activities of daily living after stroke, and its reliability and validity have been validated by experts and scholars worldwide.In summary, as population aging has become an increasingly prominent issue in China today, coupled with the high incidence and severe forms of stroke, there is an urgent need to include TCM programs in the execution of the Healthy China Strategy. The comprehensive TCM rehabilitation program represented by a combination of Tuina for Tongjing Tiaoxing with scalp acupuncture and kinesiotherapy has the characteristics of “simplicity, convenience, efficacy, and cost-effectiveness,” and can effectively reduce the incidence of post-stroke spasms, increase the treatment efficacy of post-stroke spasms, improve the patients’ ability to perform activities of daily living, and improve their quality of life. Therefore, this standard treatment program should be promoted.