Disease and Condition Overview
Stroke, or CVA (cerebrovascular accident), is characterized by a sudden loss of consciousness and is often accompanied by partial facial paralysis, slurred speech, and hemiplegia. Due to the sudden onset of the disease, its multiple symptoms, and the rapid change in condition, stroke is considered similar to properties of wind.

Clinically, it is important to differentiate between the ischemic and hemorrhagic types of stroke. In diagnosis, use CT scans and MRI to assess the location and severity of the stroke. In application of acupuncture therapy, it is crucial to determine the gravity of the disease (whether it is an attack on the zang-fu organs or on the meridians and luo-connecting channels), the current stage of the disease (onset, acute, recovery, or stroke rehabilitation) and finally the patients individual clinical specifications (body constitution, tongue diagnosis, pulse diagnosis, etc.).

Pair-Point Treatment Combinations

1. Baihui (DU20), Shuigou / Renzhong (DU26)
Baihui (DU20): on the head, 5.0 cun superior to the midpoint of the anterior hairline, at the midpoint connecting the apexes of both ears.
Shuigou (DU26): on the face, at the unction of the upper third and middle third of the philtrum.
Baihui (DU20) and Shuigou (DU26) are both on the Du channel and are similarly effective in reviving the mind and opening orifices. Use them in conjunction to achieve synergetic effects. Both points are appropriate for use in the acute stage, tense syndrome and excess syndrome.

Needling techniques:
Baihui (DU20) posterior oblique insertion 1 cun.
Shuigou / Renzhong (DU26) oblique insertion 1 cun toward the nasal septum.
For both points, use strong stimulation or reducing method. Alternatively, use a three-edged needle to bleed a few drops of blood at Baihui (DU20).

2. Baihui (DU20), Yinbai (SP1)
Baihui (DU20): on the head, 5.0 cun superior to the midpoint of the anterior hairline, at the midpoint connecting the apexes of both ears.
Yinbai (SP1): on the medial side of the distal segment of the big toe, 0.1 cun proximal to the corner of the nail.
Baihui (DU20) is located at the apex of the body (the top of the head). Yinbai (SPI) is located at the tip of the big toe. Use these two points, located at opposite ends of the body, simultaneously to elevate yang and revitalize the collapsed. This technique is appropriate m the acute stage for closed or collapsed yang.

Needling techniques:
Baihui (DU20) posterior oblique insertion 1 cun.
Regarding Yinbai (SP1), different manipulation is used depending on the nature of the condition. In cases of excess, use a needle (regular or three-edged) to prick the tip of the toe. In cases of deficiency, treat with wheat moxa pillet until the limbers are warm, sweating has stopped and regular pulse has been restored.

3. Baihui (DU20), Fengfu (DU16)
Baihui CDU20): on the head, 5.0 cun, superior to the midpoint of the anterior hairline, at the midpoint connecting the apexes of both ears.
Fengfu (DU16): on the neck, 1.0 cun superior to the midpoint of the posterior hairline, directly below the external occipital protuberance in the depression between the trapezius muscle of both sides.
Baihui (DU20) and Fengfu (DU16) are both entry points where qi and blood passes through the brain. Needling both points in conjunction will revive the mind and regulate qi in the brain. This technique is appropriate for all types of stroke and all stages of the disease.

Needling techniques:
Baihui (DU20) posterior oblique insertion 1 cun.
Fengfu (DU16) perpendicular insertion 0.5-1 cun.
Use the even method at both points.

4. Guanyuan (RN4), Qihai (RN6)
Guanyuan (RN4): on the lower abdomen, on the anterior midline, 3 cun inferior to the umbilicus.
Qihai (RN6): on the lower abdomen, on the anterior midline, 1.5 cun inferior to the umbilicus.
Guanyuan (RN4), Qihai (RN6) are both on the Ren channel and belong to the dan-tian area. When used in conjunction, these two points can strengthen yuan and reverse the collapse of yang. Treatment focused on this pair of points is best suited for stroke in the acute stage of the flaccid syndrome.

Needling techniques:
Guanyuan (RN4), Qihai (RN6): Apply moxa using moxa stick or until the patient breaks a sweat and regains focus.

5. Hegu (LI4), Taichong (LV3)
Hegu (LI4): on the dorsum of the hand, midway between the junction of the first and second metacarpal bones.
Taichong (LR3): on the dorsum of the foot, in the depression distal to the junction of the first and second metatarsal bones.
Hegu (LI4) is the yuan-source point of the hand-yangming channel; Taichong (LV3) is the yuan-source point of foot-jueyin channel. Combine both points, they facilitate clearing the blockage of the zang fu organs and flow of the qi, in addition, they also pacify liver and subdue yang. It is suitable for liver yang uprising type of stroke.

Needling techniques:
Hegu (LI4) perpendicular insertion l-l.5 cun.
Taichong (LV3) perpendicular insertion 1 cun.When needling, use reducing method.

6. Yamen (DU15), Lianquan (RN23), Yamen (DU15),
Yamen (DU15): on the neck, 0.5 cun superior to the midpoint of the posterior hairline, below the first cervical vertebra.
Lianquan (RN23): on the neck, on the anterior midline, in the depression above the superior border of the thyroid bone.
Yamen (DU15) is located on the midline on the back of the neck, belongs to the Du channel: Lianquan (RN23) is located on the midline on the front of the neck, belongs to the Ren channel. Pairing both points front and back has a synergistic effect, Used in conjunction, the Ren and Du channels regulate the qi at the base of the tongue and throat. It is usually used for aphasia, difficulty swallowing, pseudobulbar palsy, and dysphagia patients.

Needling techniques:
Yamen (DU15) perpendicular insertion 0.5-1 cun
Lianquan (RN23) towards the back of the tongue perpendicular insertion 1 cun.
Use even needling method.

7. Quchi (LI11), Hegu (LI4), Quchi (LI l l), Hegu (LI4)
Quchi (LI l l): In the depression at the lateral end of the transverse cubital crease. Midway between Chize(LU5) and the lateral epicondyle of the humerus, when elbow is half flexed.
Hegu (LI4): on the dorsum of the hand, midway between the junction of the first and second metacarpal bones.
Hegu (LI4) is hand-yangming channel yuan-source point, Quchi (LI11) hand-yangming channel hesea point. When yuan-source point and he-sea point are used together, they have the effects of revitalizing the luo-eonnecting channels and dredging the qi and blood of the yangming channel. This treatment is generally used for those patients who have difficulty in upper body motor function.

Needling techniques:
Quchi (LI11) perpendicular insertion l.5 cun.
Hegu (LI4) perpendicular insertion l-1.5 cun.
Use dao-qi or the "guiding qi" method.

8. Huantiao (GB30), Yanglingquan (GB34), Huantiao (GB30), Yanglingquan (GB34)
Huantiao (GB30): on the postero-lateral side of the hip joint, one third of the distance between the prominence of the great trochanter and the sacro-coccygeal hiatus.
Yanglingquan (GB34): on the lateral side of the lower leg, in a depression anterior and inferior to the head of the fibula.
Huantiao (GB30), Yangtingquan (GB34) are both the foot-shaoyang liver channel, when used in combination, they connect three foot-yang channels, possess the property of regulate the qi and blood of the lower limb sinews. Appropriate for those who have difficulty in lower body motor functions.

Needling techniques:
Huantiao (GB30) perpendicular insertion 3 cun
Yanglingquan (GB34) perpendicular insertion l.5 cun.
Use dao-qi or the "guiding qi" method.

9. Quze (PC3), Weizhong (BL40), Quze (PC3), Weizhong (BL40)
Quze (PC3): at the midpoint of the transverse cubital crease, on the ulnar side of the tendon of the biceps brachii.
Weizhong (BL40): at the back of the knee, on the midpoint of the popliteal crease, between the tendons of biceps femoris and semitendinosus.
Quze (PC3) is the hand-jueyin channel he-sea point. Weizhong (BL40) is the foot-taiyang channel he-sea point. These two points, one yang and one yin, of opposing nature, working in synergy, have stronger effects to harmonize the yin and yang, to promoting qi and to activate blood. Suitable for the acute stage of stroke in particular, bi syndrome and post rehabilitation those whose limbs were withered.

Needling techniques:
Quze (PC3) perpendicular insertion 1 cun
Weizhong (BL40) perpendicular insertion 1.5 cun
Also can use puncturing the collateral or blood letting method.

Houxi (SI3), Sanjian (LI3), Houxi (SI3), 2-N(L13)
Houxi (SI3): on the ulnar side of the hand, when the fist is formed, it is located at the end of the transverse crease proximal to the fifth metacarpo-phalangeal joint, on the junction of the red and white skin.
Sanjian (L13): on the radial side of the index finger, in the depression proximal to the second metacarpo-phalangeal joint on the radial side. Slightly clench fist to locate the point.
Sanjian (LI3) is a point on the hand-yangming channel; Houxi (SI3) is a point on the hand-taiyang channel. Using both points can strengthen the qi in the hand yang channels. Appropriate for those who suffer from fingers rigidity and spasticity.

Needling techniques:
Houxi (S13) towards Sanjian (LI3) penetration needling 1.5 cun.
Sanjian (LI3) towards Houxi (SI3) penetration needling 1.5 curt.
Could use dao-qi or the "guiding qi" method, or sticking of needle technique.

10. Zusanli (ST36), Xuanzhong (GB39), Zusanli (ST36), Xuanzhong (GB39)
Zusanli (ST36): on the anteriolateral side of the lower leg, 3 cun inferior to Dubi (ST35), one finger breadth (middle finger) lateral to the anterior crest of the tibia.
Xuanzhong (GB39): on the lateral side of the lower leg, 3 cun superior to the tip of the lateral malleolus, on the anterior border of the fibula.
Zusanli (ST36) is the foot- yangming channel he-sea point. It has the effect of harmonizing qi and blood. Xuanzhong (GB39) is the hui-meeting point for Marrow has the property of strengthening the sinew and tonifying the marrow. Combining both points have synergetic effects on regulating qi, blood, benefiting both marrow and brain. Used to treat threatened apoplexy, minor strokes and prevent recurrence of strokes,

Needling techniques:
Zusanli (ST36) perpendicular insertion l.5 cun.
Xuanzhong (GB39) perpendicular insertion 1 cun.
Moxibustion may be used as well.

Commentaries
Stroke is a common disease clinically. Many acupuncture doctors in the past throughout ages have accumulated tremendous amount of experience and knowledge in the treatment and prevention of stroke, especially in the area of treatment point combination depending on disease conditions. However, selecting the appropriate combinations alone is only half of the treatment plan. Employing the correct manipulation method is just as import to produce maximum treatment result.
To prevent reoccurrence of stroke, one can use the Zusanli (ST36), Xuanzhong (GB39) combination, the key element is to use moxibustion.
During the acute stage of stroke, bi syndrome, one should use Baihui (DU20), Shuigou / Renzhong(DU26) combination.
The collapsed syndrome can use Qihai (RN6) with reducing method or strong stimulation, and use moxa extensively on Guanyuan (RN4).
For treatment of aphasia, pseudobulbar palsy, use Yamen (DU 15), Lianquan (RN23) combination.
For stroke hemiplegia patients, use Quchi (LIll), Hegu (LI4) combination to treat the upper limb while using Huantiao (GB30), Yanglingquan (GB34) to treat the lower limb. Usually use dao-qi or the "guiding qi" method.
For post stroke rehabilitation patients, one can prick Quze (PC3), Weizhong (BL40) to squeeze a few drops of blood.
For those patients with finger rigidity and spasticity, use Houxi (SI3), Sanjian (LI3) combination and sticking needling method, it will immediately unfasten the clutched fingers.