Integrated Chinese and Western Medicine Nursing Care for a Patient with Posterior Circulation Ischemia of Liver-Kidney Deficiency Type: A Case Report

Wang Ying, Wang Xiaoxiao, Shu Xin
Department of Internal Medicine, Eye Hospital, China Academy of Chinese Medical Sciences, Beijing, 100040

Abstract

This paper summarizes the clinical nursing experience of integrated Chinese and Western medicine care for a patient with posterior circulation ischemia (PCI) of liver-kidney deficiency type. Through comprehensive nursing assessment and traditional Chinese medicine (TCM) syndrome differentiation, we implemented integrated nursing care based on syndrome differentiation by combining routine nursing measures (daily care, dietary guidance, emotional care, and health education) with two characteristic TCM nursing techniques: head gua sha and wheat-grain moxibustion. This integrated approach effectively improved the patient's clinical symptoms, including dizziness and poor sleep, enhanced patient comfort, and improved quality of daily life.

Keywords: liver-kidney deficiency; posterior circulation ischemia; head gua sha; wheat-grain moxibustion; integrated Chinese and Western medicine nursing

Posterior circulation ischemia (PCI) is a common cerebrovascular disease in clinical practice, primarily encompassing posterior circulation transient ischemic attack and brainstem or cerebellar stroke, accounting for approximately 20% of all ischemic cerebrovascular patients [1]. Vertigo due to posterior circulation ischemia is its most typical symptom, present in over 60% of vertigo patients [2]. Posterior circulation ischemic vertigo is characterized by its tendency to recur and become chronic, with no specific clinical treatment currently available [3].

The pathogenesis of PCI is complex, and treatment approaches are diverse. However, long-term pharmacotherapy often produces side effects, while surgical intervention carries certain risks. Traditional Chinese medicine has a long history in treating vertigo with diverse therapeutic modalities [4]. This paper summarizes the integrated Chinese and Western medicine treatment and nursing experience for one patient with PCI of liver-kidney deficiency type, reported as follows.

1 Clinical Data

The patient was a 57-year-old female who experienced sudden onset vertigo with visual rotation three years prior, causing her to fall and sit on the ground. Symptoms lasted approximately 1-2 minutes before resolving. One month before admission, her dizziness recurred with a sensation of head tightness and neck stiffness, worsening when bending the head forward. She was admitted to our ward on June 5, 2024, for systematic integrated Chinese and Western medicine treatment.

At admission, the patient presented with dizziness, head tightness, neck stiffness (worsened by head flexion), poor sleep with frequent dreams, and normal bowel and bladder function. She had a history of PCI for over three years, cervical spondylosis for over three years, hyperlipidemia for over three years, and hyperuricemia for over three years. She had no history of hypertension, type 2 diabetes, hepatitis, tuberculosis, surgery, trauma, poisoning, or blood transfusion. No drug or food allergies were reported, and no family genetic history was present.

Physical examination at admission revealed: temperature 36.4°C, pulse 72 beats/min, respiration 18 breaths/min, and blood pressure 127/60 mmHg. Auxiliary examinations showed: brain CT indicating ischemic lesions; cervical CT showing narrowing of the spinal canal at C4-5 level; carotid ultrasound revealing left carotid atherosclerosis with plaque formation; and laboratory tests showing triglycerides at 2.41 mmol/L.

TCM four-diagnosis examination revealed: inspection—clear consciousness, pale complexion, moderate body type, pale red tongue with white greasy coating; auscultation and olfaction—clear speech, even breathing, no oral odor; inquiry—preference for warmth, night sweating, dizziness, preference for warm food; palpation—deep and wiry pulse. Based on TCM diagnosis, the patient was diagnosed with vertigo (liver-kidney deficiency syndrome), and Western medicine diagnosis was posterior circulation ischemia.

After admission, integrated Chinese and Western medicine treatment was administered according to the patient's condition. TCM treatment focused on nourishing liver and kidney, calming liver and extinguishing wind, combined with head gua sha therapy (once daily) and wheat-grain moxibustion therapy (once daily). Western medicine treatment included atorvastatin calcium tablets 10 mg orally every night for lipid regulation and plaque stabilization, and 0.9% sodium chloride injection 250 ml + gastrodin injection 6 ml intravenous drip daily for improving circulation. After 14 days of integrated treatment and nursing intervention, the patient's symptoms of dizziness and poor sleep improved significantly, demonstrating remarkable clinical efficacy.

2 Nursing Care

2.1 Nursing Assessment

The patient's primary symptoms included dizziness, head tightness, neck stiffness (worsened by head flexion), poor sleep with frequent dreams, and anxiety. The Vertigo Comprehensive Rating Scale score was 4 points (moderate vertigo, uncomfortable but able to walk). The Barthel Index for activities of daily living was 100 points (independent). Fall risk score was 2 points. Pittsburgh Sleep Quality Index (PSQI) score was 14 points. Self-Rating Anxiety Scale (SAS) score was 65 points (moderate anxiety). Based on these assessments, identified nursing problems included: (1) vertigo, (2) sleep pattern disturbance, (3) risk of injury, (4) anxiety, (5) altered comfort, and (6) knowledge deficit.

2.2 Nursing Interventions

2.2.1 Daily Care

We maintained a quiet and comfortable environment with appropriate rest. The patient was instructed to move slowly during activities and avoid overexertion. During dizziness episodes, bed rest was recommended, with acupressure massage at Yintang, Taiyang, and Fengchi points for symptom relief. Blood pressure was monitored regularly. The patient was advised to quit smoking and limit alcohol consumption while maintaining regular bowel movements.

2.2.2 Dietary Care

The dietary plan emphasized light, high-vitamin, high-calcium, low-fat, low-cholesterol, and low-salt foods. Energy intake was controlled, with complex carbohydrates such as starch and corn recommended. Foods that nourish liver and kidney were provided, including a therapeutic recipe of black rice and longan porridge. Black rice, which is neutral in nature and sweet in flavor, nourishes yin, supplements the kidney, and boosts qi and blood circulation. Longan fruit effectively treats blood deficiency insomnia caused by liver-kidney deficiency. Additionally, a medicinal tea was prepared using licorice, floating wheat, jujube, and goji berries, washed and boiled in water.

2.2.3 Emotional Care

Regular communication and interaction were maintained. The method of shifting emotions and transforming temperament was employed to divert attention and help the patient maintain a pleasant mood, avoiding negative emotional stimuli such as worry and anger. Five-element music therapy was implemented. Since liver corresponds to wood and its sound is "jue," while kidney corresponds to water and its sound is "yu," and considering the patient's deficiency syndrome, the selected musical pieces were "Lush Green Grass," "Leaves in the Wind," "Sorrow of Lady Zhao," and "Music from Beyond the Frontier." These were played daily between 21:00-23:00 (during the peak activity of the triple burner meridian) for 30 minutes each session. If any discomfort occurred during the process, the therapy was immediately discontinued.

2.2.4 Health Education

We assessed the patient's understanding of disease-related knowledge and developed corresponding education plans based on her comprehension level. Learning progress was documented regularly, with feedback provided every weekend. Based on learning outcomes, evaluation and positive reinforcement were given.

2.3 TCM Nursing Techniques

2.3.1 Head Gua Sha Therapy

Head gua sha was administered once daily as prescribed. The method involved: (1) scraping both sides of the head from Taiyang to Fengchi points, passing through Touwei, Hanyan, Xuanlu, Xuanli, Shuaigu, Naokong, and other points; (2) scraping the anterior head from Baihui to the anterior hairline, passing through Qianding, Tongtian, Xinhui, Shangxing, Shenting, Chengguang, Wuchu, Qucha, Toulinqi, and other points; (3) scraping the posterior head from Baihui to the posterior hairline, passing through Houding, Luoque, Qiangjian, Naohu, Yuzhen, Naokong, Fengfu, Yamen, Tianzhu, and other points; (4) scraping the entire head in radial patterns centered at Baihui, covering all head acupoints and motor, sensory, speech, vertigo-auditory, visual, gastric, thoracic, and reproductive areas.

Precautions included: (1) no medium needed for head gua sha, (2) avoid performing when excessively hungry, full, or nervous, (3) use balanced tonifying and reducing technique, (4) scrape each area until the scalp feels warm (local soreness, numbness, distension, or pain are normal), (5) keep warm and avoid cold exposure, (6) treatment duration generally not exceeding 25 minutes, (7) rest in bed for 10-20 minutes after treatment with appropriate warm water or ginger juice if needed, and (8) avoid washing hair within 4 hours after treatment.

2.3.2 Wheat-Grain Moxibustion

Wheat-grain moxibustion was administered once daily as prescribed. The method involved placing wheat-grain-sized moxa cones directly on the skin and igniting them. From top to bottom, the following acupoints were used: Baihui (regulates qi and blood, improves circulation, harmonizes yin-yang [5]), Fengchi (dispels wind and evil, regulates qi and blood [4]), Dazhui (activates blood and resolves stasis, supplements and disperses nodules [6]), Jianjing (unblocks blood vessels, promotes qi and blood circulation [7]), Quchi (warms and unblocks meridians, regulates qi and blood, improves blood pressure [8]), Jianshi (improves cardiac blood supply [4]), and Zusanli (improves transient ischemic attack in posterior circulation [9]). Zusanli received five moxa cones, while the other six points received three cones each.

Precautions included: (1) patient should maintain relaxed muscles and natural posture during treatment, (2) promptly remove the moxa cone when the patient feels burning, then continue with the next application, and (3) keep warm and avoid bathing within 4 hours after treatment.

2.4 Discharge Guidance

At discharge, the patient was instructed to take medication regularly without arbitrary changes, maintain a reasonable diet, ensure adequate rest, avoid overexertion, protect against cold exposure, and maintain emotional balance. Regular follow-up examinations were recommended, with prompt medical consultation for any discomfort.

2.5 Effect Evaluation

At discharge, the patient's symptoms of dizziness, head tightness, neck stiffness (worsened by head flexion), and poor sleep with frequent dreams had significantly improved compared with admission, and anxiety was resolved. The Vertigo Comprehensive Rating Scale score was 0 points (asymptomatic). The Barthel Index remained at 100 points (independent). Fall risk score was 0 points. PSQI score was 6 points. SAS score was <50 points (no anxiety). During hospitalization, no falls or injuries occurred, and the patient mastered disease-related knowledge.

2.6 Follow-Up

One week after discharge, telephone follow-up revealed that the patient's dizziness had markedly improved with no recurrence of anxiety or other negative emotions. The patient expressed high recognition and praise for the integrated Chinese and Western medicine treatment, nursing care, and characteristic TCM techniques provided by our department.

3 Discussion

Posterior circulation ischemia refers to a group of diseases caused by vertebrobasilar artery system ischemia leading to brain tissue hypoperfusion. In TCM, PCI belongs to the category of "vertigo," with the disease location in the brain and related to the liver and kidney. Vertigo occurs when kidney deficiency fails to nourish the liver, leading to imbalance of liver yin and yang [10]. This patient was a middle-aged woman with naturally declining yin qi, liver-kidney deficiency, inability of yin to restrain yang, and hyperactivity of liver yang, resulting in vertigo. The TCM treatment principle focused on nourishing liver and kidney, calming liver and extinguishing wind. Therefore, TCM treatment included herbal decoction, medicinal tea, dietary therapy, and emotional care based on syndrome differentiation, combined with two appropriate TCM techniques: head gua sha and wheat-grain moxibustion.

According to TCM theory, "the head is the meeting point of all yang meridians," with eight meridians traversing the head, including the Ren, Du, Foot Yangming Stomach, Foot Shaoyang Gallbladder, Hand Yangming Large Intestine, Hand Shaoyang Triple Burner, Hand Taiyang Small Intestine, and Foot Taiyang Bladder meridians. Additionally, numerous acupoints on the head connect with these meridians, serving to circulate qi and blood, activate blood and resolve stasis, warm and unblock meridians, and balance yin-yang [11]. In this case, head gua sha therapy achieved the effects of soothing liver qi [12], activating blood and resolving stasis [13], improving cervical blood supply, relieving dizziness, and improving sleep quality [14].

Wheat-grain moxibustion, as a form of moxibustion therapy, features precise location, strong heat penetration, and short treatment duration [15]. Research indicates [4] that wheat-grain moxibustion combines the dual effects of acupuncture and moxibustion. In this patient, wheat-grain moxibustion achieved the therapeutic effects of smoothing qi flow, activating meridian qi, harmonizing qi and blood, and regulating organ yin-yang balance.

In summary, implementing head gua sha and wheat-grain moxibustion combined with TCM syndrome differentiation nursing for PCI patients can enhance nursing efficacy, improve patient satisfaction, and increase patient comfort. Conventional nursing models generally adopt systematic nursing interventions that lack comprehensive, in-depth, targeted care. In contrast, characteristic TCM nursing and personalized interventions, based on the concept of syndrome differentiation nursing, provide patients with tailored exercise, dietary, and emotional care plans. This approach promotes positive nurse-patient relationships, provides symptom-targeted treatment, alleviates symptoms, promotes physical recovery, and positively impacts quality of life and complication prevention, making it worthy of clinical promotion.

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