II. Treatment of Cerebral Hemorrhage

II. Treatment of Cerebral Hemorrhage

Cerebral hemorrhage refers to bleeding caused by rupture of cerebral blood vessels; its pathological basis lies in the hardening of cerebral arteries. Arterial sclerosis makes blood vessels brittle and prone to rupture, and when blood pressure rises sharply, the force exerted on the vessels increases dramatically—this is precisely when cerebral hemorrhage often occurs. Sudden increases in blood pressure can be triggered by extreme emotional tension or excitement.

In summary, cerebral hemorrhage is a common complication of hypertension and arterial sclerosis; in TCM, it is referred to as “Cerebral Stroke,” also known as “Internal Stroke,” because this type of stroke differs fundamentally from external stroke caused by external pathogenic factors—while the latter is considered an external stroke, the former is classified as an internal stroke. When treating cerebral stroke, I often use the following formulas:

1. Bu Yang Huan Wu Decoction: Astragalus, Angelica Sinensis, Red Peony Root, Chuanxiong, Safflower, Peach Kernel, Earthworm—boiled in water and taken as one dose per day. This formula originated from “Yi Lin Gai Che,” suitable for early-stage cerebral hemorrhage, characterized by loss of consciousness, facial deviation, hemiplegia, unsteady gait, and slurred speech. Astragalus should be used in large doses; if blood pressure is not high, the Astragalus dosage can range from 30 to 100g, and the Earthworm dosage should also be between 20 and 30g. My experience shows that this formula is most effective when treating early-stage cerebral hemorrhage, when the patient’s consciousness is still clear and blood pressure has slightly decreased. You can add 3g of Sanqi from the Han Dynasty (divided and taken as a decoction), as well as Cortex Moutan, Charcoal from Chen Zhuang, Large Thistle Charcoal, Mint Charcoal, and Blood Remains Charcoal—these charcoal colors are black, and you should stop using charcoal when blood appears black. If cerebral hemorrhage persists for more than a week and no new signs of bleeding are detected, you can add 3g of Sanqi from the Han Dynasty (divided and taken as a decoction), along with 10g of leeches (divided and taken as a decoction), to promote blood circulation and remove stasis. Patients with unclear consciousness may benefit from nasal feeding.

2. Blood Palace Dispersing Stasis Decoction: Angelica Sinensis, Chuanxiong, Red Peony Root, Rehmannia Root, Bupleurum, Citrus Peel, Platycodon, Licorice, Huai Niuxi, Peach Kernel, Safflower—boiled in water and taken as one dose per day. This formula originated from “Yi Lin Gai Che,” suitable for sequelae after cerebral hemorrhage—headaches, dizziness, tinnitus, blurred vision, facial deviation, hemiplegia, and other symptoms. My experience shows that this formula is effective for old cerebral hemorrhages or for headaches following cerebral hemorrhage. It also has a significant effect on headaches caused by cerebral infarction. Adding 3g of Sanqi from the Han Dynasty (divided and taken as a decoction) and 10g of leeches (divided and taken as a decoction) to the formula enhances its blood-dispersing effect; if the headache is severe, add Bai Zhi, Xie Xin, Qiang Huo, Du Huo, Fang Feng; for hemiplegia, add Earthworm, Ginger Worm, Whole Scorpion, and Centipede; for numbness in the hands and feet, add Mulberry Branch, Thin Grass, and Wuling Xian.

3. Zhen Gan Xi Feng Decoction: Huai Niuxi, Raw Dragon and White Peony Root, Raw Hematite, Raw Turtle Shell, Raw White Peony Root, Yuan Shen, Autumn Bamboo, Raw Wheat Germ, Artemisia, Licorice—boiled in water and taken as one dose per day. The important role of this formula is blood pressure reduction; it can be used for patients with cerebral hemorrhage whose blood pressure remains elevated despite treatment, and its effectiveness in relieving headaches and dizziness is particularly satisfying. My experience shows that this formula also has a notable hemostatic effect; it is estimated that the hemostatic effect may be an indirect result of blood pressure reduction. In the spring of 2000 (Gengchen year), Mr. Wang suffered from cerebral hemorrhage and persistent hypertension, with loss of consciousness and hemiplegia. Due to financial difficulties, he had no money for hospitalization and emergency observation. At the request of his family, I administered Zhen Gan Xi Feng Decoction in the outpatient clinic. The next day, his family reported that Mr. Wang’s consciousness had cleared, and his movement in the hemiplegic area had improved compared to before. After taking the above formula for 10 doses, Mr. Wang was able to walk on his own. A CT scan later confirmed that he had suffered from cerebral hemorrhage. Subsequently, Mr. Wang took 10 doses of Zhen Gan Xi Feng Decoction, ground them into powder, sifted them, and took them three times a day, 6g each time, diluted with warm water. Two months later, his blood pressure remained normal, his hemiplegia was only mildly present, he was able to carry out daily activities, and he could even participate in agricultural work.

4. Dihuang Yin Zi: Rehmannia Root, Cornus Fruit, Poria, Cinnamon, Processed Aconite, Mai Dong, Five-Flavor Berry, Dendrobium, Farthest Mind, Farthest Spirit, Morinda Root,菖蒲, Mint, Fresh Ginger, Jujube—boiled in water and taken as one dose per day. This formula originated from “Xuan Ming Fang,” originally used by Hejian to treat phlegm and turbidity rising to the upper respiratory tract, causing voice impairment, paralysis of the legs, dizziness, and facial deviation. In recent years, there have been numerous reports of treatment for hypertension-related arterial sclerosis, senile dementia, retinal artery lesions, and central retinal inflammation. My experience shows that this formula is highly effective in treating sequelae after hypertension-related cerebral hemorrhage; it also demonstrates significant efficacy in treating cerebral infarction. This formula should be taken over a long period, with gradual treatment—not too quickly. In my experience, it is advisable to add blood-dispersing herbs such as Red Peony Root, Chuanxiong, Dan Shen, Safflower, Sanqi, and leeches for even better results. Sanqi and leeches should be taken as decoctions, avoiding high-temperature boiling to prevent a significant reduction in their blood-dispersing effects.

5. Er Xian Tang: Herba Phragmites, Epimedium, Morinda Root, Anomoea, Phellodendron, Angelica Sinensis—boiled in water and taken as one dose per day. This formula originated from Shanghai Shuguang Hospital, a famous formula that emerged in the 1950s, specifically designed for treating hypertension-related arterial sclerosis and hyperlipidemia, with particularly good efficacy in treating hypertension-related cerebral arterial sclerosis. My experience shows that this formula is most suitable for treating sequelae after cerebral infarction and cerebral hemorrhage, and is considered the preferred formula. It is still necessary to add Sanqi, leeches, and other blood-dispersing herbs to the formula. For patients experiencing tinnitus, ear ringing, or impaired thinking, taking the formula in pill or powder form for more than six months often yields satisfactory results—but because long-term use may harm the spleen and stomach, it is advisable to add ingredients like Wood Odor and Grass Cardamom to tonify qi and strengthen the spleen.