Stroke, Heart Attack, Atherosclerosis and DVT

Paul L. Reller L.Ac. / Last Updated: August 03, 2017

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Utilizing Complementary Medicine and Integrative Medical Approaches Effectively to Reduce Cardiovascular Risk and Treat Atherosclerosis and Recurrence of Stroke and Heart Attack

The goal for many cardiovascular patients is to reduce risk of thrombosis, or formation of a blood clot, that is the leading cause of strokes. Atherosclerotic plaque on the inside of major arteries is highly associated with thrombosis, as well as stenosis, or narrowing of the artery. An emobolism is an obstruction or occlusion of an artery by a detached thrombus. When an atheroembolism, or large blood clot composed of atherosclerotic plaque, breaks off in the Aorta, or large central artery, or in the carotid artery, the obstruction, or occlusion of blood flow, to parts of the brain, causes destruction of some of the brain tissue. This is called a stroke, or if mild, a transitory ischemic attack (TIA). Much research has been accomplished to elucidate the exact mechanisms of formation of these atheroembolisms in the last 10 to 20 years. These modern findings are vitally important for the patient that tries to find the best way to reduce risk of stroke. We have come a long way from early assumptions that atherosclerotic plaque is composed mainly of cholesterol, and that lowering cholesterol will prevent atherosclerosis and stroke.

There are two main assumptions driving the standard treatment of atherosclerosis and atherembolism. One, that atherosclerotic plaque is caused by a simple high amount of cholesterol in the circulating blood. We have come a long way from this simplistic explanation. Two, that recurrence of atheroembolism in the distal aorta, which is the leading mechanism of strokes, is treatable by simply staying on anticoagulation and antiplatelet drugs. This also may not be true. When considering the need for more comprehensive complementary therapy to reduce risk of stroke and atherosclerosis, the patient needs to understand these two health mechanisms and make objective decisions on the best course of overall care. To repeat, the goals of therapy are, one, to reduce, reverse, or prevent atherosclerotic plaque, and two, to prevent the formation of embolism. These are the main causes of both strokes and heart attacks. Some patients may also need to explore other cardiovascular problems, such as sustained high blood pressure, weak or thin areas of the arteries, or problems with the heart muscle and valve tissues. Today, many progressive M.D.s, such as Dr. Andrew Weil, state that the scientific evidence and clinical data may show that herbal and nutrient medication will produce a better long-term outcome than the pharmaceuticals, and have none of the side effects and risks associated with treatment.

We now know that atherosclerotic plaque is formed by inflammatory injury to the inside of the artery. A new standard of risk assessment is the C-reactive protein (CRP), which indicates levels of arterial blood heat and inflammation. When chronic inflammation continues in the body, the system of repair of the arterial walls, via the inflammatory system, is not working properly. The body is not able to achieve the goal of the inflammatory process, which is to repair and replace old or injured tissue with healthy new tissue. Instead, inflammatory mediating chemicals and clotting agents build up on the artery wall and calcium deposits gather, causing further irritation. Behind this accumulation of inflammatory mediating immune cells, or macrophages, and collected calcium deposits, cholesterol that is being transported in the blood may accumulate. Around this accumulation is scar tissue, or fibrosis, and collagens. The most problematic portion of this accumulated plaque is the macrophages, which release nitric oxide and other toxins that contibute to tissue necrosis and debris. A number of factors play a role in this immune dysfunction.

One of these factors, or dysfunctions, that contribute to atherosclerotic plaque, are advanced glycosylation endproducts, or AGEs. While the term given to these metabolites sounds complicated, the dysfunction is actually rather simple. When our bodies process sugar, or carbohydrates, these sugar metabolites of course combine with other molecules, such as fats (lipids) and proteins (amino acid combinations). This is called glycosylation. Our diets are now composed of simple sugars, or carbohydrates, to a large extent. This is a rather modern phenomenon, and our bodies are still adapting to these processed simple sugars, or carbohydrates. The main type of these AGEs is called A1C, which is a sugar metabolite that is attached to hemoglobin protein in your red blood cells. Too much of this hemoglobin A1C is highly associated with diabetes, and this test is now an important test that the M.D. runs to check for diabetes. AGEs, or advanced glycosylation endproducts, are also highly associated with atherosclerosis, for three reasons. One, these sugar metabolites link with arterial lining cells, or lipoproteins, and what we call cholesterol, or LDL, and harden these cells. Hardening of the arteries occurs. Two, the AGEs react with receptors on the immune cells, and they produce too many inflammatory mediators and oxidants, or free radicals, which are highly associated with atherosclerosis. Three, AGEs also inhibit nitric oxide, a cellular chemical that is important in vasodilation, lowering blood pressure, and maintaining a healthy arterial lining. High AGE levels in your body, such as A1C, create atherosclerotic plaques independantly from diabetic states, according to recent scientific study.

Imbalances in the AGE receptor (RAGE) metabolism are highly associated with atherosclerosis. A number of factors create this imbalance. When there are excess AGEs over time, when there is insulin resistance, when there is chronic inflammatory dysfunction, and when there is high circulating glucose, even episodically, there may be too few circulating AGE receptors open (esRAGE), and an excess of total AGE receptors (sRAGE). This creates a thickening of the arterial lining over time, called hardening of the arteries, which is almost synonymous with atherosclerosis. Atherosclerosis does not cause symptoms, and goes unnoticed, until it becomes severe. The smart patient starts early in life and prevents this severe atherosclerotic plaque from becoming severe enough to cause stroke or heart attack. A comprehensive treatment protocol with Complementary Medicine will balance the AGE metabolism, control chronic inflammation, help the antioxidant metabolism, decrease arterial plaque accumulation, lower blood pressure, and help your body achieve improved health of the arterial linings and tissues of the heart.

Scientific study has found that a number of healthy nutritional supplements and herbal chemicals help to reduce AGE (advanced glycoylation endproducts). P5P, the active form of Vitamin B6, helps inhibit AGE formation and platelet clumping. Vitamin B1 thiamine, and the metabolite of thiamine, benfotiamine, both protect cells from excess AGE, and inhibit superoxide radicals and excess inflammatory mediators called nuclear factors (NFKbeta). There are many different antioxidants, and some of them are particularly effective in inhibiting AGE formation and accumulation. These include L-Carnosine, N-acetyl cysteine, and alpha-lipoic acid (ALA). Of course, dietary changes, such as eating less simple carbohydrates, or refined foods, and more real whole grains, fresh vegetables and whole beans and legumes, will also help. Herbs have been well studied and various medicinal herbs have been shown to reduce AGE and arterial plaque accumulation, aid healthy sugar metabolism, improve inflammatory function, lower blood pressure, and provide antioxidant chemicals. Unlike pharmaceutical medications, herbal formulas contain many chemicals that work synergistically to provide a complete and holistic treatment.

In March of 2013, the results of a large multicenter study of the use of chelation therapy to reduce cardiovascular risk, funded by the U.S. National Institutes of Health (NIH) was completed, and published in the Journal of the American Medical Association (see link to the NIH report below). To the surprise of almost all standard cardiovascular experts in standard medicine, chelation therapy proved to have modest benefits in reducing cardiovascular risk, and could be included in a holistic protocol. The Trial to Assess Chelation Therapy (TACT) showed that this therapy, involving promotion of clearance of heavy metal toxins in the tissues, reduced cardiovascular events in patients that had experienced a heart attack 6 weeks or more before being enrolled in the study, and were 50 years of age or older. While the use of chelators, such as sodium EDTA, are often infused alone intravenously in therapy, a growing interest and study has produced an effective oral chelation therapy as well. This medicine has the advantage of combining a variety of known herbal, nutrient, and chemical chelators, and is easily administered with a low cost. Such study demonstrates how important the restoration and maintenance of cardiovascular tissues is to reduction of cardiovascular risk.

Atherosclerotic plaque begins to build up on the endothelial lining of arteries when pro-inflammatory mediators create adhesion molecules that adhere monocytes to the arterial wall. A number of factors stress the arterial wall and stimulate inflammatory mediators, including sustained high blood pressure, stress, and modified low density lipoproteins (LDL). A number of Chinese herbs have now been proven effective in decreasing atherosclerotic plaque by inhibiting specific pro-inflammatory mediators, such as tumor necrosis factor alpha. The most studied in this regard is the herb Huang lian (Coptis chinensis), which contains berberine, and a number of formulas that contain this herb have now undergone clinical trials and have been proven effective. TNFalpha also increases reactive oxygen species, which is a major cause of vascular inflammation, and the reason that antioxidants are important in the reversal of atherosclerosis. As research progresses, professional herbal formulas are modified to deliver the most proven combination of herbal chemicals to achieve the goal of preventing and reducing atheroscleritic plaque and promoting healthy arterial linings. Drugs in standard medicine do not achieve these goals, and thus integration of professional herbal formulas, specific nutrient medicines, and acupuncture are important if your goal is actual restoration of healthy arteries to decrease cardiovascular risk. In time, these regimens may create arterial health, normalize blood pressure, reduce stress, stimulate healthier immune response, and promote better metabolic balance, reducing the need for long term use of pharmaceuticals.

Directly treating the formation and accumulation of atherothrombi with safe and effective herbal and nutrient medicines is now proven effective

Research has uncovered a number of effective anti-thrombotic treatments that are safe and effective in Complementary Medicine. Enzymes are proteins that regulate the rate of our physiological processes, and certain enzymes are now proven to help break up atherothrombi, or clot accumulation on the inside of unhealthy blood vessels. Nattokinase and serratiopeptidase are two of these natural enzymes that have passed human clinical trials and shown to be both safe and effective to break up unwanted clots, fibrins, and atherothrombi.

These potent enzymes should be prescribed professionally, though, with individualized attention to dosage and the patient cardiovascular history. With patients at risk of cerebral blood vessel damage and microbleeds, taking too much anti-clotting medicine can be as much a risk as taking too little, especially when aspirin is taken daily. We have taken the question of daily aspirin therapy as a sensible and safe therapy to prevent atherothrombi too lightly. As far back as 1993, large studies have indicated that daily aspirin use, even at a low dose, comes with considerable adverse effects. A study by Monash University in Prahran, Victoria, Australia in 1993 (Clin Pharm 1993;(54), 84-89), followed 400 patients on low-dose aspirin, and found that in a randomized, placebo-controlled human trial, there were significantly higher rates of gastrointestinal symptoms, bleeding, and decreases in hemoglobin. This signified that aspirin was negatively affecting the body's ability to maintain tissue respair and health, and increasing the risk of bleeding, including cerebral microbleeds. Large studies even predating this were conducted in Great Britain in 1988, showing that while low-dose aspirin could reduce the incidence of fatal strokes, that the evidence of overall benefit greater than risk was not evident. The use of aspirin was finally promoted purely as a safer treatment for many patients without risk of cerebral bleeding than anti-platelet medications as a prophylactic treatment.

What has been overlooked in the preventive therapy for atherothrombi are the proper treatment protocols with professional herbal and nutrient medicine. A study at the Chungchou Institute of Technology in Changhua, Taiwan, in 2009, studied 47 patients with high lipids, comparing the effects of placebo to nattokinase 50 mg, and nattokinase combined with Red Yeast Rice extract. The patients receiving this combination therapy reduced triglycerides by 15%, total cholesterol by 25%, low density lipoprotein cholesterol (LDL-C) by 41%, and increased the high density lipoprotein by 7.5%. These levels were achieved in the first month and sustained for the trial during 6 months time. The added benefits would occur with decrease in atherothrombi and fibrins with nattokinase, and the potential of effecting long-lasting benefits that would be sustained without supplements. Addition of Chinese herbal formulas to the treatment protocol may enhance these effects as well, without risk of adverse effects. A 2010 study at Guangzhou University of Chinese Medicine, and China, studied the effects of two common herbs included in cardiovascular formulas, Dang gui and Hong hua, and found that both exhibited antithrombotic effects in animal studies, but when given concurrently with the drug clopidogrel, did not increase the specific effects of this drug. An array of Chinese herbs have now demonstrated antithrombotic effects, and a number of studies are cited below in additional information with links describing these findings. The combination of proven nutrient medications with Chinese herbal formulas can no longer be doubted.

Understanding the physiology of atherosclerosis and reversing this process over time

It is estimated that one in four Americans are affected by atherosclerosis, and this causes approximately 42% of all deaths. About half of these deaths are due to atherosclerotic plaque affecting the heart and coronary arteries. Many other deaths related to atherosclerosis affect the brain, where strokes occur when arterial plaque breaks off, or when arteries in the brain become unhealthy. Atherosclerois is the hardening of arterial walls and decrease of the potential flow of arterial blood through both inflexiblity of the vessels and stenosis, or narrowing due to plaque accumulation. Consequences of atherosclerotic plaque accumulation include obstruction of small arteries, formation of thrombi on roughened arterial plaque, hemorrhage of the artery under the atherosclerotic plaque, breaking off of the plaque deposit and creating an obstruction of blood flow downstream, and encroachment of the plaque into the arterial wall, causing a weak spot, and aneurysm. The goal of therapy should not be just to block cholesterol production and lower blood pressure, but to actually decrease atherosclerotic plaque and repair and maintain healthy blood vessels.

A sensible approach by the patient involves restoring healthy tissue to these arteries, as well as the muscles and valves of the heart. As stated, one way that our poor diets have contributed to this hardening of the arteries is through advanced glycosylation endproducts (AGEs), which gradually accumulate when circulating sugars and high oxidative stress combine. Another way is when red meat consumption becomes too much a part of our diet, producing an excess of unhealthy essential fatty acids, namely arachidonic acids, which are not offset by healthy omega-3 and omega-6 fatty acids. While we are led to believe that all of our omega-3 fatty acids are gotten from fish oil capsules, the truth is that many foods contain these healthy essential fatty acids, and supplements, as their name implies, are only meant to supplement our normal intake via a healthy diet. Currently, the subject of omega-3 fatty acids is not being made clear to the patient, though, and a profit driven approach is contributing to fatty acid imbalance in many patients. The important aspect of essential fatty acid balance in our bodies is the word balance. When there is a chronic imbalance of excess omega-6 arachidonic acid, increased omega-3 acids, especially EPA and DHA, may be needed, but many patient concurrently minimize red meat consumption and take omega-3 supplement, which may throw the balance in the other direction. This too may create problems with inflammatory regulation. A more extensive article on omega-3 fatty acid metabolism is found on this website. Our diet should also contain healthy and effective antioxidants, of which there are a wide variety. Deficient consumption of antioxidant chemicals also plays a part in formation of atherosclerotic plaque, particularly when poor health, overwork, tissue injury, or emotional problems cause an excess of harmful oxidants, or free radicals. These free radical, or oxidant, producing factors are called stress.

One result of these physical stressors, besides formation of excess free radical oxidants, is a chronic adrenal stress syndrome. The adrenal glands are part of the kidneys and constantly respond with hormonal regulators to protect and restore metabolic balance. When chronic stress produces adrenal dysfunction, one of these hormonal regulators, cortisol, is not produced efficiently to maintain the health. The slow adrenal responses mean that not enough cortisol is produced at one time of the day, and subsequently, an excess is produced later. Excess cortisol accelerates atherosclerosis by increasing high blood pressure, insulin resistance, and increasing fatty accumulation in the organs, especially the liver, which controls both inflammatory mediators and cholesterol regulation. Cortisol imbalance may also contribute to thyroid deficiency, hypothalamic deficiency, and overall hormone imbalance. When estrogen and progesterone deficiency occurs, the lack of estrogens, and the estrogen progesterone imbalance, reduces the ability of your body to decrease atherosclerotic plaque accumulation. Estrogen has been shown to contribute a potent antioxidant effect in cardiovascular tissue, as well as the liver and uterus. Progesterone has been shown to present a significant antioxidant effect in brain tissue. Relative excess of testosterone has been shown to decrease antioxidant effects of superoxide dismutase, leading to increased lipid peroxidation. To protect yourself and restore all of the factors that contribute to atherosclerosis, holistic approach to hormonal and metabolic balance is necessary. There is no simple solution.

How does the body try to decrease this accumulated atherosclerotic plaque? Phagocytosis is the term used to describe the body's attempt to clear the atherosclerotic plaque. This phagocytosis is impaired by oxidative stress. The low density lipoproteins (LDL) that accumulate are oxidized LDL. Oxidized blood cells need to be reduced, including oxysterols, and antioxidants are created by your body to reduce them. There are so many types of antioxidant chemicals in the body that we are still discovering new ones. Not only antioxidant chemicals in your diet, but also your ability to produce antioxidants is important. A number of effective antioxidants and antioxidant building blocks are now used in nutrient medicine. Alpha-lipoic acid, N-acetyl-cysteine, and L-carnosine have been mentioned and proven effective in scientific study. Co-Q10 is a powerful antioxidant that is often deficient in our body and proven effective to decrease atherosclerosis with antioxidant activity. Atherosclerotic plaque also contains certain proteins and peptides that increase irritating nitric oxide and other irritants. Some of these proteins are even associated with the cellular plaque deposits noted with Alzheimers, namely amyloid precursor protein and beta-amyloid peptide. These unhealthy protein accumulations need to be cleared just like the free radicals, or excess oxidants. The body uses proteolytic enzymes to clear these problematic proteins and parts of proteins, which are called peptides. Nutrient medicine also utilizes effective proteolytic enzymes in therapy, and high quality antioxidants and proteolytic enzymes are a key part of the overall treatment protocol. Nattokinase and serratiopeptidase are two proteolytic enzymes discovered that are especially effective.

In addition of antioxidants and proteolytic enzymes, a number of herbs have been thoroughly studied and proven to benefit the reduction of atherosclerotic plaque accumulation. Well known herbs, such as aged garlic, are widely used by the public now, but Chinese research has found evidence to support the use of a number of herbs to reduce atherosclerotic plaque. Not only choice of the herbs, but also quality and professional production methods are important. In an unregulated industry, many companies fail to process and select the herbs properly, reducing or nullifying their effects. A professional herbalist looks into quality and selection to insure success. Besides herbal formulas and tinctures, and antioxidants and proteolytic enzymes, key essential fatty acids help the body to regulate inflammatory processes better and are highly recommended in the treatment protocols around the world. The essential fatty acids EPA and DHA were discovered when researchers found that people native to the arctic regions had almost no incidence of cardiovascular disease. They found that these essential fatty acids were a big part of their diet, consumed in fresh ocean fish. Vegans may increase the EPA and DHA by taking dried powders of the blue-green algaes, such as chlorella and spirulina.

In addition, high levels of homocysteine in the body are now known to be an important key, or marker, to formation of large atheroembolisms, and herbal and nutrient therapy is effective to control this hyperhomocysteinemia, which indicates an imabalance of the glutathione metabolism of cellular detoxification and antioxidant clearing. Use of just one type of supplement may have limited benefit. A combination of these herbs and nutrients individually tailored to the patient may have a profound effect.

While none of us wants to take a large number of nutrient supplements, it is important to keep in mind that a proper course of therapy will produce the results we need, and then we won't need these supplement pills and herbs. Health maintenance after correction of the problem will involve healthy dietary and exercise habits. Maintenance with Complementary Medicine may involve a periodic checkup and therapy, with advice to keep you on course. Compare this with the allopathic approach of staying on pharmaceutical medicines forever with increasing side effects, and potentially decreasing overall health. The decision for many is to utilize Complementary Medicine and work with your medical doctor to decrease chemical dependancy and improve overall health to achieve a preventative state.

Quality of herbs and nutrients is essential to effective therapy, and this cannot be emphasized enough. For example, researchers found that certain types of aged garlic, such as Moascus pilosus, that was properly fermented in aging, was potently effective in inhibiting atherosclerotic plaque, while standard commercial powders were often ineffective. This quality aged garlic had a number of beneficial effects, reducing triglycerides and LDL-C, antioxidant effects, inhibiting free radicals and glycation endproducts, and significant reduction of thrombocyte and erythgrocyte aggregation. While raw garlic had beneficial effects on artery dilation, it showed no effects on reducing LDL-C. The professional herbalist utilizes quality professional products and often does the research to insure that proven herbal remedies with quality herbs and nutrients are used in your care. This type of research evidence is now widespread as the popularity and proof of Complementary Medicine expands exponentially. This area of scientific research may be confusing to the lay person, and when one reads that a study found that garlic is ineffective in reducing cardiovascular risk, few people look to see whether they were testing raw garlic or aged Moascus pilosus variety. To be certain of the health facts, consult with a knowledgeable professional.

Integration of TCM in Subacute Stroke Rehabilitation

There are many scientific studies verifying the neuroprotective and restorative potential of Chinese herbs, nutrient medicines, and acupuncture, and in China today, acupuncture, herbal medicine and Tui Na physiotherapy are successfully integrated with standard medicine for very many stroke patients. Unfortunately, achieving randomized controlled human clinical trials for these treatments in stroke rehabilitation is problematic, and requires that stroke patients with severe debility, and often with speech impairment and difficulty with mental processes, agree to be control subjects in randomized trials. Of course there are no actual randomized controlled human clinical trials found for standard therapy, but acupuncture and TCM protocol has been held to this standard. Past studies of acupuncture for stroke rehabilitation, one of which I was a participant in, proved very popular with almost all patients, even skeptical ones, and appeared to benefit with a number of measurable parameters, and integrated stroke rehabilitation clinics in China, one of which I visited during my studies, provided a daily array of acupuncture, herbal medicine and Tui Na, which was greatly appreciated by patients, and appeared to have amazing effects in recovery and functional restoration, even for very severe cases.

In 2014, a multicenter randomized controlled human clinical trial of 360 paired patients in Chinese hospitals will receive either standard therapy or integrated therapy, with acupuncture and Chinese herbal medicine included for 8 weeks. This may be the first trial of this design that will be published, and is sponsored by the Zhejiang Chinese Medical University, in Huangzhou, China, and an organization affiliated with Five Branches University Graduate School of Traditional Chinese Medicine, in San Jose, California, U.S.A. Reforms in the study design mandated by CONSORT and STRICTA in 2010 have allowed studies of this type to finally be accepted as high quality evidence, with the mandated practice of blinding the treating physicians to the use of actual acupuncture or so-called sham or placebo acupuncture finally eliminated. There is still a persistence to pay for RCTs that are designed to fail for acupuncture, and these are still readily published, but they do not show the actual outcomes of TCM clinical practice. To see the study design for the above mentioned large RCT, click here: http://bmjopen.bmj.com/content/4/12/e007080.full

The use of CIM/TCM therapy for stroke rehabilitation has been heavily discouraged and derided. For instance, in 2002, the BMC Complementary and Alternative Medicine journal published a research article from the University of Ottawa and the University of Saskatchewan, in Canada, that surveyed patients who had undergone stroke rehabilitation at Sakatoon City Hospital, in Saskatoon, Canada, to see if they had utilized what these researchers and standard medicine called "alternative" medicine. The study found that 26.5 percent of the patients admitted to using some form of Complementary Medicine, but 61.3 percent stated that they did not report this to their Medical Doctor, obviously fearing a negative response. The types of so-called "alternative" medicine used lumped acupuncture with simple vitamins and massage therapy, and since the average spent on these therapies was only $56.70 per month, indicating that few of these patients actually used an effective course of acupuncture and TCM protocol, as this figure may cover just one acupuncture treatment. No adverse effects were reported, and 51.7 percent of these patients were still using this type of treatment, with 67.7 percent of these stating that they were still using the therapy regularly. The study determined that this use of so-called "alternative" treatment was consistent with other such studies in Europe. The point of the study was to alert Medical Doctors to the fact that they obviously weren't effective enough in the complete discouragement of Complementary and Integrative Medicine (CIM) in stroke rehabilitation. The conclusion was that although a fourth of the patients admit to using some form of CIM, that it wasn't effective and was not recommended. Of course, if we didn't really know whether they just used multivitamins or light massage, as compared to professional treatment with a complex course of TCM therapy, with acupuncture, electroacupuncture, herbal formulas and Tui Na physiotherapy combined in each treatment, it would be hard to consider this a realistic study of effective CIM/TCM therapy. The point of these studies was to show that this safe and effective therapy was being effectively denied to the poor patients who were often desperate to find some effective rehabilitation and restorative therapy, which standard medicine often does not provide. In fact, guidelines in the 1990s in the U.S. established as system where patients with more severe stroke symptoms were denied even standard physical therapy if they did not make functional improvement in the first 2-3 weeks following their stroke. These patients were usually just kept on 'blood thinners" and an array of hypertension medications and statin drugs. Finally, these guidelines were changed in 2013, and these poor patients are sometimes not denied care in this situation now. We still do not see an offering of relatively inexpensive CIM/TCM therapy, though. To see this cynical survey study, click here:http://www.ncbi.nlm.nih.gov/pmc/articles/PMC117436

To see research concerning TCM therapies and the CNS or brain, you may go to the article on this website entitled Brain Health and Function.

Few studies of CIM/TCM therapies in subacute stroke rehabilitation have been published in standard journals or databases, despite the fact that this integrative approach has been successful in China, South Korea and other countries, including Australia. The studies designed in the past did not usually present a realistic treatment protocol, and most used no needle stimulation technique due to the need to double-blind the procedure to the physicians performing the treatment. Finally, realistic study designs are being used and published, and these are proving the potential benefits to these simple harmless and inexpensive sets of adjunct therapies. Often, these studies reveal amazing effects in the damaged areas of the brain, which may not produce immediate relief of symptoms, but will help greatly in the long-term restoration of CNS function, and subsequently, bodily function. Studies of these biochemical and restorative effects are perhaps more important than the actual randomized controlled human clinical trials in evaluating the efficacy of integrative stroke rehabilitation care. Here are a few of the examples found:

  1. A 2005 study of acupuncture in the treatment of stroke rehabilitation was conducted by The Catholic University of Korea, in Seoul, South Korea, where the effects of just one of the acupuncture points commonly used, GB34, was studied with fMRI in a randomized controlled human clinical trial. The results showed that this stimulation beneficially modulated activity in the brain cortex and somatomotor areas of the brain that were damaged by the stroke. Actual strong stimulation of the needles repeated in four short stimulations was used, instead of the usual insertion without actual needle stimulation that was common in RCTs of past designs. This is just the first step in a series of studies that will be conducted to provide evidence for integration of acupuncture into stroke rehabilitation, not a definitive study. The actual TCM clinical protocol integrates an array of synergistic treatment modalities that are individualized to the patient needs and proceeds in a step-by-step restorative manner, not a one-size-fits-all dumbed-down treatment: http://www.ncbi.nlm.nih.gov/pubmed/16173531
  2. In 2010, a Chinese study of the effects of electroacupuncture stimulation used a randomized controlled study of laboratory animals with induced cerebral hemorrhagic stroke, applying daily stimulation for 14 days. The animals receiving electroacupuncture stimulation reversed measures of increased Siit-Robo GTPase activity and decreased cell division cycle 42 (Cdc 42) induced by the infarction. Such study elucidates how a short course of acupuncture could benefit CNS recovery within an integrated protocol: http://www.ncbi.nlm.nih.gov/pubmed/26237968
  3. A 2013 randomized controlled study of laboratory animals with induced cerebral infarction mimicking a hemorrhagic stroke, by Chonqing Medical University, in Chongqing, China, showed that a simple short course of electroacupuncture at the points P6 and ST36 daily for 14 days upregulated the expression of Siit 2 and Robo 1 proteins in the damaged cerebrum to achieve immunoactivity known to effect functional restoration after a stroke: http://www.ncbi.nlm.nih.gov/pubmed/24261294
  4. A 2013 randomized controlled study of laboratory animals with induced focal cerebral ischemia, mimicking a hemorrhagic stroke, by the Chongqing Medical University, in China, found that electroacupuncture at the points DU20 and LI4 at 2/100 Hz applied for 20 minutes every 12 hours for 48 hours significantly decreased IL-1beta levels of inflammation increased by the stroke, and upregulated the expression of IKKbeta protein in the hippocampus to facilitate recovery: http://www.ncbi.nlm.nih.gov/pubmed/24261295
  5. A 2015 meta-review of all published studies of the integration of acupuncture into standard treatment protocol for subacute stroke rehabilitation was conducted by experts at Tianjin University of Traditional Chinese Medicine, in Tianjin, China, and the Federal University of Rio Grande do Sul, in Porto Alegre, Brazil, finding that only 17 randomized controlled human clinical trials met the study criteria, and only five of these met the standards of high quality. Of these 17, 14 showed that addition of a short course of acupuncture stimulation to standard care improved outcome. These researchers noted that the acupuncture intervention needed to be better defined in future studies as to modality and length of treatment. The real challenge is using the RCT to actually judge the efficacy of the whole package of care in TCM, and individualized treatment protocols, which are necessary for the best results. Inclusion of real integrated holistic parameters is nearly impossible in the RCT design, and this is reflected in the minute number of studies and "poor quality". The fact that acupuncture and TCM care has virtually no adverse effects, and is good for the overall health of the patient is rarely mentioned in the study summaries: http://www.ncbi.nlm.nih.gov/pubmed/25828908
  6. A meta-review of acupuncture to reduce spasticity in stroke rehabilitation, by the University of Extremadura School of Medicine, in Badajoz, Spain, showed that simple acupuncture treatment improved passive resistance to stretching, reduced spasticiy, improved motor function of the affected limb, and increased personal independence, but that these measures "were not clinically relevant changes" as per the aims of the study design. In other words, this superficial acupuncture treatment by itself did not produce a miraculous recovery for these severely impaired stroke patients. What such studies do not show is that a real clinical TCM protocol for these patients would involve more than this short superficial course of acupuncture, and would be integrated with standard care. Even at this stage of recovery, though, the acupuncture stimulation would help with brain recovery before the spasticity would be strongly relieved, and the patient would need both soft tissue mobilization (Tui Na) and herbal medicine to achieve the desired results. Such study design as this does not represent what actual therapy is like in Chinese and South Korean hospitals. Still, this small part of the therapy was proven beneficial, and had no adverse effects, yet it was discounted: http://www.ncbi.nlm.nih.gov/pubmed/26168934
  7. A 2015 study at the Harbin Medical University School of Medicine, in Heilongjiang, China, studied the effects of a standardized extract of Gingko biloba, emphasizing the effects of Gingkolide B, a diterpene chemical. A dose-dependent effect on comatose patients who had suffered a severe hemorrhagic stroke showed that the herbal medicine decreased intracranial pressure within 45 minutes and increased cerebral perfusion pressure after one hour, with no change in blood pressure. The blood gases remained within the normal range. A measure of lactate to pyruvate ratio and improved 18 percent over 2 hours. No adverse effects were noted: http://www.ncbi.nlm.nih.gov/pubmed/26064244
  8. A 2014 study of the effects of a typical Chinese herbal formula used to treat stroke recovery, in this case in the form of a patent medication called Hua tou Zai zao Pill, showed on laboratory animals induced with a middle cerebral arterial stroke, that the herbal formula significantly increased the number of new neurons in the cerebral area of the penumbral cortex, with an increase of ERK and CREB protein enzymes improving phosphorylation of VEGF and BDNF growth factors as the mechanism of activity. Such study clearly demonstrates that the use of a Chinese herbal formula could aid neurogenesis after injury by a severe stroke. The herbal ingredients in this formula are Chuanxiong, Bai shao, Dang gui, Hong hua, Ren shen, Wu wei zi, Ma qian zi, Tian nan xing and Bing pian, which represent a longstanding type of herbal formula used in these cases:http://www.ncbi.nlm.nih.gov/pubmed/25204185