Headache is a subjective symptom. It can be induced by various acute and chronic diseases. As it covers a wide sphere, this section only deals in detail with headache as the predominant symptom. If headache is an accompanying symptom in the development of a certain disease, it will disappear automatically as soon as the disease is cured.
The head is the place where all the Yang meridians of hand and foot meet and qi and blood of the five zang organs and six fu organs all flow upward to the head . Attacks of endogenous or exogenous factors may cause headache due to derangement of qi and blood in the head and retardation and circulation of qi in the meridians that traverse the head. Headache caused by exogenous pathogenic factors is mostly due to invasion of pathogenic Wind into the meridians and collaterals
It is said “when the pathogenic Wind invades the human body, it first attacks the upper portion of the body,” Headache caused by endogenous factors often originates from hyperfunction of the Liver Yang, or deficiency of both qi and blood.
21.1 Etiology and Pathogenesis:
A] Invasion of pathogenic wind into the upper meridians and collaterals cause derangement and obstruction of qi and blood. With stagnation in the collaterals, sudden weather change or exposure to wind usually precipitates an attack of headache.
B] In patients with excessive Yang of body constitution, a headache may be caused by the upsurge of Liver Yang due to stagnation of qi or injury of the Liver after a fit of anger, which damages the Yin.
C] Headache may also be caused by a deficiency of both qi and blood because of irregular food intake, overstrain poor health with a chronic disease or congenital deficiency. The deficiency of qi prevents the clear Yang from ascending and deficiency of blood does not nourish the mind so there is a headache.
A] Headache due to invasion of pathogenic Wind into the meridians and collaterals:
Main manifestations: Headache occurs on exposure to Wind. The pain may extend to the nape of the neck and back regions. It is a violent, boring and fixed pain, accompanied by string –taut Pulse and thin white tongue coating. Such a syndrome is also termed “head Wind”.
Analysis: pain comes from obstruction of qi in the meridians and collaterals on the head caused by invasion of the exogenous pathogenic Wind. Owing to the excess of the pathogenic factor, the pain is violent and boring. Wind is a Yang pathogenic factor and apt to attack the upper portion of the body. So the pain caused by Wind may extend to the nape of the neck and back region, the fixed pain is due to blood stagnation derived from qi stagnation. String –taut Pulse and thin white tongue coating are the signs of meridians and collaterals being invaded by pathogenic Wind.
B] Headache due to the upsurge of Liver – Yang:
Main manifestations: Headache, blurred vision, severe pain on the bilateral sides of the head, irritability, hot temper, flushed face, bitter taste in the mouth, string –taut and rapid Pulse, reddened tongue with yellow coating.
Analysis: Headache and blurred vision are due to the rising of excessive Liver –Yang which attacks the head. bitter taste in the mouth suggests accumulation of heat in the gallbladder Meridian derived from the upsurge of Liver –Yang which affects the gallbladder as the Liver and gallbladder are externally and internally related. Severe pain on the bilateral sides of the head is because the gallbladder meridian travels bilaterally on the side of the head. String –taut and rapid Pulse, reddened tongue with yellow coating are signs of heat in the gallbladder and Liver.
C] Headache due to deficiency of both qi and blood:
Main manifestations: Lingering headache, dizziness, blurred vision, lassitude lustreless face, pain relieved by warmth and aggravated by cold, overstrain or mental stress, weak and thready Pulse, pale tongue with a thin and white coating.
Analysis: Lingering headache is due to the head being affected by the deficiency of qi that fails to make the clear Yang ascend and the turbid Yin descend. Pain aggravated by overstrain and stress is due to further consumption of qi. Lassitude, pain which is relieved by warmth and aggravated by cold suggests a failure in the distribution of Yang qi.↓
Lustreless face, dizziness, and blurred vision indicate poor nourishment of the face and head due to deficiency of blood. Pale tongue with a thin white coating and weak, thready Pulse are signs of deficiency of both qi and blood.
Clinically, varieties of headache should be also differentiated according to the locality and related meridians and collaterals. Pain in the occipital region and nape of the neck is related to the Bladder Meridian of foot-TaiYang, pain at the forehead and supraorbital region is related to the Stomach Meridian of foot –Yangming pain in bilateral or unilateral temporal region is related to the gallbladder Meridian of Foot – ShaoYang, and that in the parietal region is related to the Liver Meridian of foot –JueYin
21.3 Case no 23
Patient’s Name: MrBalwantDalvi
Address: 785 Bhavani Peth Pune BhavaniPethagarval Colony
C/O: Lingering headache, dizziness, blurred vision, lassitude lustreless face, pain relieved by warmth and aggravated by cold, overstrain or mental stress, weak and thready Pulse, pale tongue with a thin and white coating
Pulse Pattern: Liv↓Gb↓St↓ UB↓
A] Headache due to invasion of pathogenic Wind into meridians and collaterals:
Method: to dispel the Wind, remove obstruction in the meridians and collaterals regulate the qi and blood and check the pain by puncturing the local points combined with distal points along the related meridians. The reducing method with needle retention is used.
Prescription: occipital headache:
Fengchi (G 20), Kunlun (B 60), Houxi(S I 3).
Frontal headache: TaiYang (Extra), Shuaigu (G 8), Waiguan (S J 5), Zulinqi (G 41).
Parietal headache: Baihui (Du 20), Houxi(S I 3), ZhiYin (B 67), Taichong (Liv 3).
Explanation: The above prescription are formulated by combining local points with distal points according to the location of the headache and the affected meridian.
Occipital headache – points of the Tai-Yang Meridians of hand and foot.
Frontal headache –points of the Yang-ming meridians of hand and foot.
Temporal headache – points of the ShaoYang Meridians of hand and foot plus those of the JueYin Meridian of foot.
B] Headache due to upsurge of Liver Yang:
Method: Select points of JueYin and ShaoYang Meridians of hand and foot as the principal points to pacify the Liver Yang. Puncture with the reducing method.
Prescription: Fengchi (G 20), Baihui (Du 20), Xuanlu (G 5), Xiaxi (G 43), Xingjian (Liv 2).
Explanation: the JueYin Meridian of Foot reaches the parietal region and the ShaoYang Meridians run up to the bilateral sides of the head. Combining the local points with distal points can reduce heat in the meridians and pacify the Liver Yang.
C] Headache due to deficiency of both qi and blood:
method : to tonify and regulate circulation of qi and blood , promoting the clean qi to ascend and the turbid qi to descend by needling points of the Du and Ren Meridians and the corresponding Back-(Shu) points.puncture with the reinforcing method.
Prescription : Baihui(Du 20),Qihai(Ren 6),Ganshu(B 18),Pishu(B 20), Shenshu(B 23 ),Zusanli(S 36).
Explanation: Qihai (Ren 6) is chosen to notify the primary qi and Baihui (Du 20) is for lifting up the clean Yang. Ganshu (B 18), Pishu (B 20) and Shenshu (B 23) are the points associated with the Liver, Spleen, and Kidney. Since the Liver stores blood, the spleen controls blood, and the Kidney stores and produces essence and blood, these three points can be used to strengthen essence in the Kidney and the notify qi and blood. Zusanli, (St 36), punctured with the reinforcing method, can benefit the stomach which is the productive source of qi and blood.
A] Headache occurs in various diseases of modern internal medicine, surgery, neurology, psychosis, ear, nose, Throat, etc.
Acupuncture gives gratifying results in migraine and in vascular and neurotic headache.
b] Tapping with cutaneous needles and coughing methods:
Main points: Area along L 1to S 4 Secondary points: Fengchi (GB 20), TaiYang (Extra) Yangbai (Gb 14)
Method: Tap on the area from L 1to S 4 then Tap on the local area and along the afflicted meridians. For acute Pain, TaiYang (Extra) and Yangbai (GB 14) may be tapped to slightleeding, then apply cupping.
1) Cheng Xinnong(1993), ChineseAcupuncture and Moxibustion ,1st ed. Foreign Language Press , Beijing
2) Jeremy Ross(1995),ZANG FU The organ systems of traditional chiness Medicines 2nd Ed
3) Guyton & Hall (1998) Chap. 53 in Textbook of Medical Physiology 9thed.
4) YinHuihe,et .al, (1995) Fundamentals of Traditional Chinese medicine
5) Ted J Kaptchuk(1983)Chinese Medicine ‘The web that has no weaver’
6) Huang Fu Mi(1979) ‘Systematic Classic of Acupuncture with annotations’
7) Y.Omura(1998), ‘ Acupuncture Medicine’
8) O’ Connor , J &Bensky Dan (1983) ‘Acupuncture A Comprehensive Text’
9) LewithGeorge, Julian Kenyon , Lewis Peter(nineteen ninty six) ‘Complimentary Medicine An integrated Approach
10) HanshH.Rhyner(1998) ‘Ayurveda The Gentle Health System
11) Nanjing College of Traditional Medicine ,’ Concise Traditional Chinese Gynecology’
12) Beijing college of TCM, Shanghai college of TCM, Naning college of TCM &Acupuncture Institute of Academy compiled ‘Essentials of ChineseAcupuncture’
13) Sung J. Liao Mathew H.M Lee & Lorenz K.Y(1974) ‘ Principles and Practice of Contemporary Acupuncture’ USA
14) Felix Mann (1987) ‘Textbook of Acupuncture’
15) B.K Parekh, &Tarun Kumar Giroti,(2000), ‘Dental Markers to Systemic Diseases’
16) Rao, C.D(1970), ‘A Statistical Study of Young Pigmentation in man’
17) New Scientists(18/11/2000)