Headache

Headache is a subjective symptom that may appear in many acute and cronic diseases. The headache stated here refers to that as a main symptom in many exogenous or miscellaneous internal diseases. It does not include headache as an accompanying symptom in the progression of certain diseases. Headache can be seen in many infectious diseases with fever in modern medicine such as hypertension, intracranial diseases, psychoneurosis and migraine.

Cause and Machanism
Exogenous type of headache is ofen caused by the invasion of wind, cold, dampness or heat in the chasnnels and collaterals in the head, leading to obstruction of the lucid yang in the head. Endogenous type of headache is mostly caused by emotional stimulation that further causes the stagnation of liver Qi. The Qi stagnation then turns into fire to disturb the head, the clear organ. Kidney Yin dificensy can lead to failure of kidney water to irrigat the wood so that there will be hyperactivity of liver cause headache. Improper diet such over intake of greasy oily food can impair the function of the spleen in transforming and transporting and production of turbid dampness in the interior of the body. The dampness formed interior will halt the lucid yang to develop headache. Blood deficieny du to prolonged illness or ecessive loss of blood may also cause headache because of inaequate up going blood to nourish the head. Lingering headache over a long periode of time can affect the collaterals, leading to stasis of blood in collaterals. Traumatic injurieas affecting the brain and its marrow may also lead to poor circulation of Qi in blood, leading to stasis type of headache.

Differentation

1. Exogenous Type of Headache
This type of headache is characterized by a sudden onset of pain in paroxysmal attacks. The pain is severe in nature and may radiate to the back. It can sometimes be kind of pricking pain in a fixed location. The tongue coating is thin and white and the pulse is wiry and tense.

2. Endogenous Type of Headache This type of headache is characterized be a slow onset of dull, hallow pain with dizzy sensation. It may bother the patient off an on, but definitely worse with overstrain.

(1) Liver Yang Type of Headache The chief manifestations includes pain, dizziness, irritability, shortness of temper, poor sleep, redness of the face, congested eyes, bitter taste in the mouth, red tongue proper, thin yellow tongue coating, and wiry forceful pulse.

(2) Turbid Phlegm Type of Headache The chief manifestations includes pain in the forehead as if the head is wrapped up, fullness sensation in the chest, nausea, vomiting of saliva in severe case, loose stools, white greasy tongue coating and wiry slippery pulse.

(3) Blood Deficiency Type Headache The chief manifestations include pain in the forehead, dizziness, lingering pain worsened by overstrain and alleviated by rest, lassitude, shortness of breath, palpitation, poor memory, poor appetite, pallor complexion, pale tongue proper, thin white coating, and thready feeble pulse. (4)Blood Stasis Type of Headache The chief manifestations includes a fixed stabbing pin that lasts for a long time, blurring or vision, poor memory, purplish spots on the tongue, and thready hesitant pulse.

Treatment
1. Exogenous Type of Headache Principle: Eliminate wind, remove obstruction from the channels, activate blood and stop pain by using mainly the local points plus points from the affected channels.

Prescription: Fengchi(GB20) Touwei(ST Baihui(DU20) Hegu(LI4)

Explanation: Fengchi (GB20) is used to eliminate wind and stop pain, viz, to relieve the Shaoyang headache and dispel the wind form the neck and nape areas. Touwei(ST further eliminate wind form the channels and stop pain, particularly the wind from the Yangming channel. Baihui(DU20) where The Liver Channel of Foot-Jueyin merges in the vertex is used to quench the wind in the vertex. Head is the merging of all yang while face is the home place of Yangming channels. Therefore, Hegu(LI4) is used to eliminate wind from the facial area. The joint use of the above points may eliminate wind and relieve pain.

Point Modification: Add Shangxing(DU23), Yangbai(GB14) and Yintang(Extra) for frontal headache; Tianzhu(BL10), Kunlun(BL60) and Houxi(ST3) for occipital headace; Taiyang(EX-HN3), Shuaigu(GB and Waiguan(SJ5) for temporal headache; Tongtian(BL7), Naokong (GB19) and Taichong(LR3) for pain in the vertex. Method: Apply filiform needles with reducing method and retain the needles for 15-20 minutes, manipulation then two to three times. If the pain is severe during the attack, continue to manipulate the needles until the pain lessens.

2. Endogenous Type of Headache
(1) Liver Yang Type of Headache
Principle: Soothe the liver, sedate its Yang and quench the wind by using points mainly from the Gallbladder Channel of Foot-Shaoyang, and The Liver Channel of Foot-Jueyin.
Prescription: Fengchi(GB20) Xuanlu(GB5) Taiyang(EX-HN5) Xingjian(LR2) Xiaxi(GB43) Taixi(KI 3)
Explanation: Fengchi (GB20) and Xuanlu (GB5), points from the Gallbladder Channel of Foot-Shaoyang have the effect of elimination head, quenching the wind and stopping pain. They just quench the wind that is disturbing the head. Taiyang (EX-HN5) promotes the circulation of Qi in the local area. Xingjian(LR2) and Xiaxi(GB43), respectively the Ying-spring points of the liver and gallbladder channels, eliminate the pathogenic heat from these two channels. Taixi(LI3) tonifies kidney water in order to build up Yin to restrict hyperactive Yang. The joint use of the above points may soothe the liver, quench the wind and stop the pain.
Point Modification: Add Guanchong(SJ1) for pricking for congestion in the eyes; Ganshu(BL1 and Jianshi(PC5) for restlessness and shortness of temper.
Method: Apply filiform needles with reducing method except Taixi(KI3) that is punctured with reinforcing method, and retain the needles for 10-20 minutes, manipulating them two to three times. Taiyang (EX-HN5) may also be applied with three-edged needles to cause bleeding.

(2) Turbid Phlegm Type of Headache
Principle: Resolve phlegm and sedate the turbidity, remove obstruction from the channels and collaterals and stop pain by using points mainly form The Ren Channel and The Stomach Channel of Foot-Yangming. Prescription: Zhongwan(RN12) Fenglong(ST40) Baihui(DU20) Yintang(EX-HN3) Xuanzhong(GB39)
Explanation: Zhongwan(RN12) us used in combination with Fenglong(ST40) to strengthen the spleen and stomach and resolve dampness. This is to treat the root cause of the disease. Xuanzhong(GB39) eliminates the turbid dampness from the SanJiao. Baihui(DU20) and Yintang(EX-HN3) helps to dispense the lucid Yang in the head, remove obstructions from the channels and collaterals and stop pain. The joint use of above points may solve phlegm, remove obstructions and stop pain.
Point Modification: Add Neiguan(PC6) for vomiting of saliva; Tianshu(ST25) for those loose stools.
Method: Apply filiform needles width reducing method and retain the needles for 15 - 20 minutes, manipulation then two to three times.

(3) Blood Deficiency Type of Headache
Principle: Reinforce Qi, nourish the blood, promote channels circulation and stop pain by using mainly the Back-Shu points.
Prescription: Ganshu(BL1 Pishu(BL20) Shenshu(BL23) Genshu(BL17) Qihai(RN6) Baihui(DU20) Zusanli(ST36) Sanyinjiao(SP6)
Explanation: The Liver stores the blood. The spleen governs the blood. Brain is the sea of marrow, and the marrow is manufactured by the kidney. Therefore, the Back-shu points of the liver, spleen and kidney, plus Geshu(BL17) and Sandyinjiao(SP6) are used to nourish both Qi and blood. Zusanli (ST36) is used to strengthen the source for providing the acquired energy. Qihai (RN6) regulates Qi of the general body. Baihui(DU20) lifts the lucid Yang in order to guide Qi and blood to go upwards to nourish the brain. The joint use of above points may replenish Qi and blood, nourish the sea of marrow and stop headache.
Method: Apply filiform needles with reinforcing method and retain the needles for 20-30 minutesm manipulation them one to two times.

(4) Blood Stasis Type of Headache
Principle: Active blood, resolve blood stasis, promote Qi circulation and stop pain by using points mainly from The Large Intestine Channel of Head - Yangming and The Spleen Channel of Foot-Taiyin, plus some Ahshi points.
Prescription: Ahshi point Hegu(LI4) Sanyinjiao(SP6) Gshu(BL17)
Explanation: Ahshi point is used to eliminate the local blood stasis an promote the circulation of Qi in the local area. Hegu(LI4) is good for treating head and facial disorder because of its ascending and dispensing property. Sanyinjiao(SP6) is used in combination with Geshu(BL17) to activate blood and resolve blood stasis and stop pain.
Point Modification: Add Zanzhu(BL2) for pain in the superciliary ridge; Taiyang (EX-HN5) for migraine; Yuzhen(BL9) for occipital headache; and Sushencong (EX-HN1) for pain in the vertex.
Method: Apply filiform needles with even method or both reinforcing and reducing methods. Hegu(LI4) is applied with reducing method and the rest of the points with even method. Retain the needles for 15-20 minutes, manipulation them two to three times. Ahshi point is applied with three-edged needle to cause bleeding.

Alternative treatment:
1. Auricular Acupuncture Prescription: Subcortex Vertex Occipital Taiyang Ear-Shenmen Liver Spleen Kidney Method: Apply filiform needles at three to four points each time with moderate stimulation and retain the needles for 15-20 minutes. Strong stimulation is suggested for severe headache. Pricking on the ear dorsum is also applicable for the severe headache. Embedding of ear seeds or subcutaneous ear seeds is also applicable.

2. Plum-blossom Needle Therapy Prescription: Taiyang(EX-HN5) Yintan(EX-HN3) Ahshi point
Method: Use the plum-blossom needles to tap in the local area until the skin turns red. This method is used for headache due to invasion of exogenous pathogenic wind and that due to hyperactivity of liver Yang.

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