Post Ischemic Stroke

Integrative Rehabilitation of Post-Ischemic 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-ischemic stroke often results in persistent motor, sensory, cognitive, and systemic impairments despite conventional rehabilitation. Integrative approaches combining Traditional Chinese Medicine (TCM) with biomedical rehabilitation may enhance recovery outcomes.

Case Presentation: A 52-year-old male (Mr. X) with a history of ischemic stroke presented with fatigue, Qi and Blood deficiency, phlegm accumulation, cervical swelling, right-sided numbness, muscle weakness, cognitive slowing, and episodic circulatory instability. An integrative treatment protocol incorporating herbal medicine, acupuncture, moxibustion, cupping, Gua Sha, manual therapy, and close physiological monitoring was implemented.

Results: The patient demonstrated significant improvement in cognitive responsiveness, sleep quality, appetite, cervical swelling (≈75% reduction), right-hand swelling (≈90% reduction), postural stability, and overall functional tolerance. Motor and sensory recovery progressed gradually, with residual neurological deficits persisting.

Conclusion: This case suggests that integrative rehabilitation combining TCM and biomedical approaches may improve functional outcomes and quality of life in post-ischemic stroke patients, particularly when cardiovascular risk is carefully monitored.

Keywords: Ischemic stroke; Post-stroke rehabilitation; Traditional Chinese Medicine; Acupuncture; Integrative medicine

Introduction

Ischemic stroke is a leading cause of long-term disability worldwide and frequently results in persistent motor weakness, sensory impairment, cognitive dysfunction, and systemic imbalance. Although biomedical rehabilitation focuses on neuroplasticity and functional retraining, recovery may be incomplete, especially in chronic stages.

Traditional Chinese Medicine (TCM) conceptualizes stroke (中风) as a disorder involving deficiency of upright Qi, Blood stasis, phlegm obstruction, and dysfunction of the Liver, Kidney, and Du channel. Integrative rehabilitation combining TCM and biomedical principles may offer synergistic benefits. This article presents a detailed case study of integrative rehabilitation in a patient recovering from ischemic stroke.

Case Presentation

Patient Information

Mr. X, a 52-year-old male with a history of ischemic stroke, presented for integrative rehabilitation. The patient reported persistent fatigue, low Qi and Blood, internal heat sensation, phlegm accumulation, numbness of the right hand and leg, cervical swelling, muscle atrophy in the neck and upper limbs, limited hand elevation above the shoulder, and occasional blurred vision.

The patient had a cardiovascular history, including prior coronary issues and previous anticoagulant use, which had been discontinued one year prior to presentation.

Clinical Findings

Physical examination revealed reduced muscle strength in both upper and lower extremities, more pronounced on the right side, persistent sensory numbness, cervical and upper back swelling, and limited shoulder and hand mobility. Independent ambulation was preserved.

During treatment, a transient episode of circulatory or functional block occurred, characterized by pallor, limb numbness, weakness, and near-syncope. The episode resolved with rest, hydration, and appropriate intervention.

TCM Diagnostic Findings

• Tongue: Purple, mildly swollen, thin white coating, possible teeth marks

• Pulse: Initially rapid; normalized after hydration

These findings indicated Blood stasis, Damp-Phlegm accumulation, Spleen Qi deficiency, and a mixed Cold-Heat pattern.

Diagnosis

Biomedical Diagnosis

• Post-ischemic stroke (ICD-10: I63.x), recovery phase

• Residual motor and sensory deficits

• Post-stroke muscle atrophy and deconditioning

• Episodic circulatory instability with cardiovascular risk factors

Traditional Chinese Medicine Diagnosis

• Qi and Blood deficiency

• Blood stasis obstructing the collaterals

• Phlegm accumulation

• Liver deficiency affecting tendons and circulation

• Kidney deficiency impairing marrow and nerve recovery

Treatment Principles

The treatment strategy focused on:

• Tonifying Qi and nourishing Blood

• Transforming phlegm and resolving stasis

• Clearing internal heat while supporting Yang

• Regulating Liver and Kidney function

• Opening the Du channel and collaterals

• Stabilizing circulation and calming the Shen

Treatment Intervention

Herbal Medicine

A combined herbal approach using Chai Hu Tang and Er Chen Tang was prescribed to regulate Liver Qi, transform phlegm, clear heat, and support Qi and Blood. Key ingredients included Bupleurum, Pinellia, Poria, Scutellaria, Bai Shao, Chi Shao, Astragalus, and Codonopsis. Dosages were adjusted according to tolerance and clinical response.

Acupuncture and Adjunct Therapies

• Scalp acupuncture: Motor and affected cortical areas

• Body acupuncture: Neck, back, limb, and organ-related meridians

• Emergency intervention: GV26 activated during near-syncope, resulting in recovery of consciousness

• Manual therapies: Gua Sha, acupressure, spinal and gluteal manipulation (GB30)

• Cupping: Sliding and localized techniques

• Moxibustion: Full back, spine, legs, and hands; turmeric leaf used under moxa to enhance warming and anti-inflammatory effects

• Auricular therapy: For calming and systemic regulation

Emergency Medical and Rehabilitation Considerations

Given the patient’s cardiovascular history and observed circulatory instability, treatment intensity was carefully titrated. Hydration, rest intervals, posture support, and continuous monitoring were emphasized to prevent syncope and ensure patient safety during rehabilitation.

Mechanisms of Action

Traditional Chinese Medicine Mechanism

In TCM theory, ischemic stroke arises from deficiency of upright Qi combined with Blood stasis and phlegm obstruction. Herbal therapy replenishes Qi and Blood, while acupuncture and moxibustion reopen blocked channels, support Yang Qi, nourish marrow, and stabilize circulation, thereby facilitating neurological recovery.

TCM Kinesiology Perspective

Motor and sensory impairment reflects disrupted Qi-Blood flow to tendons and muscles governed by the Liver and Kidney systems. Regulation of these organs and the Du channel supports restoration of strength, coordination, and postural control.

Biomedical Mechanism

Scalp acupuncture may enhance cortical reorganization and neuroplasticity. Peripheral needling improves proprioceptive feedback, while manual therapies enhance fascial mobility and circulation. Moxibustion increases local blood flow and reduces inflammation, supporting tissue recovery.

Clinical Outcome

Following integrative treatment:

• Cervical swelling reduced by approximately 75%

• Right-hand swelling reduced by approximately 90%

• Cognitive responsiveness and alertness improved

• Sleep quality and appetite improved

• Independent ambulation maintained

• Motor and sensory recovery progressed gradually, with residual numbness persisting

Prognosis and Probability of Recovery

Considering age, stroke chronicity, cardiovascular history, and observed response to treatment:

• Partial functional recovery: 80–85%

• Meaningful functional independence: 60–70%

• Complete neurological recovery: 30–40%

From a TCM perspective, the patient demonstrates gradual restoration of Qi-Blood circulation and reopening of channels, indicating a moderate-to-good long-term prognosis with continued therapy.

Discussion

This case illustrates the potential benefits of integrative rehabilitation for post-ischemic stroke patients with complex neurological and systemic conditions. The observed improvements suggest synergistic effects between TCM modalities and biomedical rehabilitation, particularly when treatment safety and cardiovascular monitoring are prioritized.

Conclusion

Integrative rehabilitation combining Traditional Chinese Medicine and biomedical approaches resulted in meaningful improvements in neurological function, systemic stability, and quality of life in a post-ischemic stroke patient. This model may serve as a valuable adjunct in chronic stroke rehabilitation.

Acknowledgments

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