Hemiplegia

Integrative Rehabilitation of Post-Stroke Sequelae Using Traditional Chinese Medicine and Biomedical Approaches: A Case Study

NAO¹, CBL²

¹Intern Student, BTCM 
²Clinical Supervisor, Department of Traditional & Integrative Medicine

Abstract

Background: Post-stroke patients frequently experience persistent motor, sensory, and musculoskeletal impairments despite standard rehabilitation. Integrative approaches combining Traditional Chinese Medicine (TCM) with biomedical rehabilitation may enhance functional recovery.

Case Presentation: A 58-year-old female in the recovery phase of right-sided ischemic stroke presented with gait instability, sacral swelling, low back pain, upper limb spasticity, auricular discomfort, and sleep disturbance. An integrative treatment protocol including herbal medicine, acupuncture, moxibustion, cupping, Gua Sha, Tuina, and rehabilitation monitoring was applied.

Results: Significant improvements were observed in gait stability, posture, sacral swelling (≈90% reduction), upper limb spasticity, auricular symptoms, and overall functional capacity.

Conclusion: This case suggests that integrative rehabilitation combining TCM and biomedical principles may promote neuroplasticity and functional recovery in post-stroke patients. Further controlled studies are warranted.

Keywords: Stroke rehabilitation; Traditional Chinese Medicine; Acupuncture; Buyang Huanwu Decoction; Integrative medicine

Introduction

Stroke remains a leading cause of long-term disability worldwide. Although advances in acute management and rehabilitation have improved survival, many patients continue to experience residual neurological and musculoskeletal impairments. Traditional Chinese Medicine (TCM) has historically been utilized in stroke rehabilitation, emphasizing restoration of Qi and Blood circulation, unblocking of channels, and nourishment of brain and marrow. This case study presents an integrative rehabilitation model combining TCM interventions with biomedical rehabilitation principles in a post-stroke patient.

Case Presentation

Patient Information

A 58-year-old female with a history of right-sided ischemic stroke in the recovery phase presented for integrative rehabilitation. The primary complaints included gait instability, sacral swelling, low back pain, right-hand spasticity, auricular heaviness, difficulty sitting and lying supine, and sleep disturbance related to mental overactivity.

Clinical Findings

Physical examination revealed impaired balance, reduced lower limb stability, sacral edema, postural imbalance, and residual upper limb contracture. Tongue examination showed a pale-pink tongue with a slight purple hue and thin white coating. Pulse was moderate, even, and soft-strong, indicating partial recovery of Qi and Blood with residual stasis.

Diagnosis

Biomedical Diagnosis

• Post-ischemic stroke, recovery phase

• Residual motor dysfunction and spasticity

• Musculoskeletal deconditioning

• Vestibulo-auditory disturbance secondary to neurological injury

Traditional Chinese Medicine Diagnosis

• Qi deficiency with Blood stasis obstructing the collaterals

• Phlegm obstructing the sensory orifices

• Liver Qi stagnation affecting sinews

• Kidney Yang weakness impairing Du channel regulation

Treatment Principles

Treatment aimed to tonify Qi and Yang, invigorate Blood circulation, resolve phlegm, open the sensory orifices, regulate the Du and Bladder channels, and calm the Shen to support neurological recovery.

Treatment Intervention

Herbal Medicine

A modified Buyang Huanwu Decoction (补阳还五汤) was prescribed, consisting of Astragalus membranaceus, Angelica sinensis (tail), Paeonia rubra, Persicae semen, Carthami flos, and Ligusticum chuanxiong. Di Long was omitted and Curcuma (E Zhu) was added to enhance Blood-invigorating effects. The formula was administered twice daily in 7-day cycles.

Acupuncture and Adjunct Therapies

Scalp acupuncture targeting motor cortex regions was combined with body acupuncture at Hua Tuo Jia Ji points (T1–L5), LI4, LI11, ST36, GB39, and LR3. Auricular stimulation was applied at Shenmen, Ear Apex, and Inner Ear points. Adjunct therapies included sliding and bloodletting cupping, moxibustion at BL23 and GV4, scalp Gua Sha, and channel-based Tuina.

Emergency Medical and Rehabilitation Considerations

From an emergency and rehabilitation perspective, continuous neurological monitoring, fall-risk reduction, posture stabilization, and early mobilization were emphasized to prevent secondary complications and ensure continuity of care.

Mechanisms of Action

Traditional Chinese Medicine Mechanism

In TCM theory, stroke results from deficiency of upright Qi with concomitant Blood stasis and obstruction of channels. Buyang Huanwu Decoction replenishes Qi to drive Blood circulation, while acupuncture restores channel patency and Du channel communication. Moxibustion supports Kidney Yang, facilitating nourishment of marrow and brain, while auricular and scalp therapies promote orifice opening and Shen regulation.

TCM Kinesiology Perspective

Motor impairment reflects disrupted Qi-Blood flow to tendons and muscles. Regulation of the Liver, Kidney, and Du channel restores coordinated movement, strength, and balance.

Biomedical Mechanism

From a biomedical perspective, scalp acupuncture may enhance cortical neuroplasticity, while peripheral needling improves proprioceptive input and motor relearning. Improved circulation reduces inflammation and muscle hypertonicity, and manual therapies support musculoskeletal alignment and functional mobility.

Clinical Outcome

Following treatment, sacral swelling was reduced by approximately 90%. Gait stability, posture, and balance improved markedly. Upper limb spasticity and hand contracture decreased, auricular heaviness resolved with minimal residual discomfort, and sleep quality improved.

Prognosis and Probability of Recovery

Considering patient age, recovery-stage intervention, consistent functional improvement, and absence of severe comorbid deterioration, prognosis was favorable.

• Partial functional recovery: 85–90%

• Near-complete functional independence: 65–75%

• Full neurological cure: 40–50%

From a TCM perspective, the patient had entered a Yang Qi recovery and channel reopening stage, supporting a positive long-term outlook.

Discussion

This case demonstrates potential synergistic effects of combining TCM modalities with biomedical rehabilitation in post-stroke recovery. While complete neurological reversal cannot be guaranteed, functional independence and quality-of-life improvement appear achievable through integrative intervention.

Conclusion

Integrative rehabilitation incorporating Traditional Chinese Medicine and biomedical principles resulted in meaningful functional improvement in a post-stroke patient. This approach may serve as a valuable adjunct in chronic stroke rehabilitation.

Acknowledgments

The authors acknowledge Mr. CBL for clinical supervision and guidance. This case report was prepared by Intern Student NAO.-neuronk@gmail.com