Medical Dialogue

医学会话

Review on the Treatment of Headache
复习头痛的针灸治疗

Two third-year acupuncture students, Diane Gabel and Kay Bold, meet for tea one afternoon to study together. There will be an exam involving the treatment of headaches in a few days, so their discussion turns to that subject.

diane:There is certainly a lot of diverse information regarding the diagnosing of headaches. There are so many different causes.
kay:That's for sure; there are so many different patterns to consider.
diane:Yes, and then after identifying the pattern, we need to set up a good treatment plan. And treatment is usually as important as the diagnosis.
kay:I'm a little worried about this test. Actually even Rick said he was worried!
diane:I only have an hour to sit here with you, so let's start by looking at three pattern categories, from the different possibilities that I have considered.
kay:I thought there were two pattern categories, interior and exterior.
diane:Well, that's true. There are exterior patterns, and they are all from wind. The wind carries either heat, cold or dampness. And then there are interior patterns, and there are ten or twelve of those.
kay:I know, but I separated interior patterns into those caused by a deficiency and those caused by an excess.
diane:All right, let's do it that way. Let's look at wind cold, since the weather has yet to warm up. And for an interior pattern of excess, let's look at liver qi stagnation. Everyone has liver qi stagnation, at least at school!
kay:I want to go into women's health, so let's use blood deficiency for the deficient interior pattern. Many headaches in women have something to do with their menstrual cycle, and sometimes are caused by a blood deficiency.
diane:Yes, or blood stagnation, which would be an excessive headache.
kay:True, but I think blood stagnation could be caused by a pattern of blood deficiency.
diane:Wait a minute. Let's first list all the excess type headaches.
kay:Good idea, I will write them down. And I have our text, so we can check after we list them from memory. You go first, with the excess type.
diane:OK, here goes: (1) liver depression, (2) liver wind, (3) dampness headache, also called yang brightness headache, (4) blood stasis, (5) phlegm-turbidity, (6) food retention, (7) heat in the stomach, (8) cold stagnation in the meridians. That's all I can remember.
kay:I notice that the liver seems to be often involved with headaches. You missed headaches from liver yang ascending hyperactivity and liver fire flaming upward, and the cold stagnation headache is actually cold in the liver channel.
diane:Let's check the textbook. Wow, we got all but one — we missed phlegm turbidity with wind.
kay:Yes, so phlegm turbidity with wind would involve the spleen, because dampness can transform into phlegm, and there's wind, so another condition with liver involvement.
diane:That sounds right to me. So, how would we treat a liver depression /qi stagnation headache?
kay:Well, since it's meridian is usually across the forehead to the temples, we need to be sure it is not a stomach deficiency headache, although there may be some conditions with stomach involvement.
diane:Liver qi stagnation headaches usually are caused by stress, and that can also cause poor digestion and other abdominal symptoms like bloating and belching. And the pain of a liver qi stagnation headache is usually more intense than a stomach deficiency headache.
kay:It also can move from side to side, unlike a yang brightness headache. And I would check for nervousness, pain under the ribs, especially on the right side. The pulse would be more wiry than slippery. That could help differentiate from a stomach deficiency headache.
diane:Agreed. So, we would pacify the liver, remove or eliminate stagnation. Using LR3 and LI4, I would pacify the liver, eliminate stagnation and get a positive effect on the head, both with physical pain and emotional stress.
kay:I like that. I would add zusanli, ST36 because of the stomach involvement, as well as GB34 which relieves stagnation of the liver. And GV24 helps remove stagnation in the head.
diane:And we could add yintang, to calm the spirit, in this case.
kay:Agreed. Let's move on, I need to be in class soon. Besides, my tea is getting cold!
diane:Speaking of cold, let's do wind cold headaches next. This type invades the greater yang, bladder and small intestine meridians at the back of the neck and head.
kay:But also some gall bladder points, such as GB20, which has wind, feng, as part of its name. So I would use GB20, to expel wind, LU7 to release the exterior, GV16, which also has wind in its name, to expel wind and maybe GV20 since it affects the whole head.
diane:You forgot to state the treatment principle: to release exterior, dissipate cold, dispel wind and clear the channels obstruction.
kay:Right, thanks, but the points imply that.
diane:Hey, this is for an exam, not your private clinic! We also could include SI3 and BL62, as together they clear the governor vessel and affect the greater yang area.
kay:Good thinking, and we could use B160, kunlun, if the pain goes into the shoulders and lower neck. Let's move on to the next differentiation.
diane:OK. One more, deficiency type of headache, blood deficiency.
kay:I will start with the treatment plan! This headache is because blood is deficient, and it fails to reach the brain. And since blood is the mother of qi, not enough qi rises to nourish the brain. Therefore, nourish blood and raise qi.
diane:Right. These headaches usually have something to do with liver and heart blood, and they affect the top of the head. Memory and concentration are probably negatively affected, and this often occurs after menses due to loss of blood. Points?
kay:Bladder 18 and 20 used together are very good at nourishing liver blood. And of course, sanyinjiao, spleen 6 and zusanli, ST36 used together are very effective at nourishing blood and tonifying qi.
diane:You could also use BL15 to nourish heart blood, GV20 to raise qi, Liver 8 to nourish liver blood, and HT5 to nourish heart blood.
kay:I feel like we missed some stuff. Should we go back and double check?
diane:I would love to, but I have student clinic in 15 minutes, so I have to go. I think we did a good job. I am concerned mostly about the last one, and other ways to nourish blood. Maybe CV 4 or 6?
kay:Well, get going and stop worrying. You can double check and study more on your own later. That's what I am going to do.
diane:Yeah, and when you study at home, it's easier to keep your tea warm!