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Headache

HeadacheKey Diagnostic Points:

  • Headache is a subjective symptom that can accompany many other syndromes. This section is designed for patients whose chief complain is headache.
  • Headache can be included in various acute and chronic diseases such as hypertension, migraine, intracranial diseases, and inflammatory febrile diseases.

Differential Diagnosis:

Headache due to invasion of pathogenic wind into the channels and collaterals.

a) Headache due to wind-cold evil manifested as headache with stiff nape and back, chilliness, general aching, stuffy nose with watery discharge.

Tongue: Thin white coating
Pulse: Floating and tense

b) Headache due to wind-heat evil manifested as sever distending headache in the whole head, aversion to wind, fever, stuffy nose with discharge, thirst with desire to drink, constipation, and dark urine.

Tongue: Thin yellow coating
Pulse: Floating and rapid

c) Headache due to wind-cold-damp evil manifests as a feeling of heaviness as if the head were wrapped up, lassitude, heavy closed sensation in the chest, nausea, poor appetite, dry mouth with no thirst.

Tongue: Greasy coat
Pulse: Soft and floating, or slow and floating.

2) Headache due to an upsurge of Liver Yang Headache, distention of the head, irritability, easily angered, dizziness, and blurred vision.

Tongue: Red tongue, with thin yellow coat
Pulse: Rapid pulse

3) Headache due to adverse rising of phlegm.
Heavy, muzzy pain feeling as if the head were wrapped in a cloth. Severe headache, foggy thinking, dizziness, lassitude, restlessness, paraphasia (whereby inappropriate words are substituted for the correct ones), feeling of oppression over the chest, nausea, rapid breathing, excess salivation or drooling, and cold limbs.

Tongue: Thick greasy coat
Pulse: Wiry and slippery

4) Headache due to blood stasis.
Obstruction of collaterals by blood stasis resulting form head trauma or long-standing pain. Stabbing, splitting, localized intermittent but lingering headache.

Tongue: Purple spots
Pulse: Choppy pulse

5) Headache due to a deficiency of Qi and/or blood.
Dull aching at the vertex, or everywhere in the head with slight muscle spasms or twitching at the temples due to deficiency wind. Dizziness blurred vision, pale face, skittish or easily startled, and palpitations.

Tongue: Thin white coat
Pulse: Weak and thready

6) Headache due to deficiency of Kidney Jing.
Dull headache in the whole head, with a feeling of emptiness in the head. Dizziness, tinnitus, soreness and weakness of the loins and knees, fatigue, and amnesia.

Tongue: Red tongue, very little coat
Pulse: Thready and weak

Diagnosis according to Channel differentiation: (according to "The Medical Talks from the Deserted Cottage")

7) Tai Yang Type Headache
Affects the occiput

8) Yang Ming Type Headache
Affects the forehead

9) Shao Yang Type Headache
Affects the sides of the head

10) Jue Yin Type Headache
Affects the top of the head. The Tai Yin and Shao Yin channels do not ascend to the head, but Phlegm can prevent Qi from descending and the pure Yang from ascending freely to the head.

Channel differentiation provides a useful guideline in clinical practice for a quick identification of the channel involved in a given type of headache.

However, this is only a broad guidline which firstly, needs to be further refined and secondly, needs to be integrated with the identification of internal-organ patterns.

For example, while a headache on the top of the head often involves the Jue Yin channel, i.e. the Liver Channel, it can be due to either Liver Yang rising, or Liver blood deficiency.

Furthermore, a headache on the top of the head can also be due to deficient Qi and/or blood unable to reach the head and not necessarily reflect a Liver channel involvement at all.

1) Top of the head Headache.
The Liver channel reaches the top of the head.
a) Most often due to deficient Liver blood being unable to reach the area. This headache will be dull in character.
b) Due to Liver Yang Rising. This creates a sharp headache.
c) Deficient Qi and blood (not related to the Liver channel.)

2) Headaches on one or both sides of the head. Possibly in the temples.
This areas correspond to the Foot Shao Yang, GB channel. This headache is most frequently associated with Liver Yang, Liver Fire, or Liver Wind rising, which gives rise to the headaches on the GB channel. These headaches are sharp and throbbing in character.

3) Headaches behind the eyes.
If the pain is dull, it is due to liver-blood deficiency.
If the pain is sharp and severe, it is due to Liver Yang rising.

4) Headaches on the forehead.
Stomach channel of foot Yang Ming.
a) Stomach Deficiency will create a dull frontal headache. Stomach heat will give rise to a sharp frontal headache.
b) Dampness or phlegm being retained in the head and preventing the clear Yang from ascending to the head to brighten the sensory orifices. This headache is associated with a heavy sensation of the head, a muzzy feeling of the head, and a lack of ability to concentrate.
c) In a few cases, frontal headaches can be due to a residual pathogenic factor, such as external wind which has not been expelled after an invasion of exterior wind-damp, wind-cold, or wind-heat.

5) Occipital Headaches
a) Acute headaches here are due to invasion of external wind tightening the Tai Yang channel. This type of headache is accompanied by stiffness of the back and the neck.
b) Chronic headaches are due to a Kidney deficiency manifesting on the UB channel.

6) Headaches that effect the entire head
a) Chronic headaches in this area are due to Kidney Jing deficiency. The Kidney Jing nourishes the brain but lacks this ability when the Jing is deficient. This can give rise to dull headaches in the whole head accompanied by a feeling of emptiness of the head.
b) Acute headaches affecting the whole head are due to invasion of external wind. These are severe and sharp in character. Sometimes, accompanied by a tight pulling sensation.
c) If the area of the headache changes all the time and the headache is experienced in different parts of the head at different times, it either indicates the presence of Wind Evil or Liver Wind. This pain will be accompanied by a pulling sensation.

Treatment Principle and Point/Technique Prescriptions

1) Headaches due to invasion of pathogenic wind into the meridians and collaterals:
Treatment Principle: Dispel wind, remove obstruction in the meridians and collaterals.

GB 20 (Feng Chi-Wind Pool) (Reduce) Wind evil is said to collect in this depression easily. It's a very important point to dispel wind.
L.I. 4 (Reduce) Combining Yuan Source with...
Lu 7 (Reduce) Lung's Luo Collateral. L.I. Channel reaches to the head, Lu 7 is one of the four key points, in this case, for diseases of the head and neck.
SI 3 (Reduce) Shu-stream/wood point. Wind belongs to wood, so SI 3 can dispel wind.

Wind-Heat: Add Du 14 (Reduce) , L.I. 11 (Reduce)
Wind-Cold: Add Moxibustion
Wind-Damp: Add Sp 9 (Reduce) , St 40 (Reduce)

2) Headaches due to Liver Yang rising:
Treatment Principle: Pacify the Liver, subdue rebellious Yang. Provide Kidney water for the growth of wood, or in other words, tonify Liver Yin to subdue to Liver Yang.

GB 20 is used as a local point to subdue Liver Yang. It also provides relief from Liver Wind and is specific for headaches from these two causes. It will also relax the muscles of the upper neck and brighten the eyes.
Liv3 (Reduce) is the distal point to calm the Liver and subdue the rising Yang.
Liv2 (Reduce) , GB 43 (Reduce) Ying-Spring points of the Liver and Gall Bladder channels dispel heat and fire. Where there is Liver Yang rising, there is a likely chance for fire to follow. Liver Yang rising can lead to Liver Fire and Wind Heat in the Shao Yang channel rising to the head.
GB 9 (Reduce), Tai Yang (Reduce) are local points.
Sp 6 (Reinforcing) is the crossing point of the Liver, Spleen and Kidney channels. Needling this location will nourish the Liver and Kidney Yin and hence, provide water for the growth of wood, or tonify the Liver Yin to control the rising Yang. This also calms the mind and helps to promote sleep. If the person does not sleep well, it will be much more difficult to cure the headaches.
Liv8 (Reinforcing) He-sea point of the Liver channel. It's the water point. Tonifying the mother point will provide water for the growth of the wood.
Ki 3 (Reinforcing) Nourishes Kidney Yin
SJ 5 Reduced to subdue the Liver Yang because this is the relationship between the San Jiao and the Gall Bladder, both belong to the Shao Yang Channel system. The relationship between Yang hand and foot channels is very close indeed because the Jing Qi in the San Jiao channel flows directly into the Gall Bladder channel in the head. This point, SJ 5, is the Luo-connecting point especially suited to treat channel problems. It's used to pacify rebellious Yang within the two Shao Yang Channels.

3) Headaches due to Phlegm
Treatment Principle: Resolve phlegm, harmonize middle Jiao.
St 8 (reduce) Local point

Du 20 (even stimulation, neither reducing, nor reinforcing) This point is the crossing of six Yang channels and the Du channel. Yang converges at the head to stimulate the ascending of clear Yang to the head.
Ren 12 (reducing) Front-mu point of the Stomach, and the influential points of the Fu organs. Spleen and Stomach are where phlegm is produced. For this reason, because of its control over the stomach, Ren 12 is good for phlegm.
St 25 (reducing) the front mu of the L.I.. If you want regulate the stomach, you must empty the Large Intestine by encouraging a bowel movement. This point will enable that.
Ren 6 Sea of Qi. If you want to eliminate phlegm, you must regulate Qi.
St 25 (bilateral), Ren 12, and Ren 6, together are called the "Four Doors" The can regulate Qi to eliminate phlegm as well as regulate the function of the Spleen and Stomach.
L.I. 4 (reducing) Yuan source point of the L.I. channel can remove Qi, and regulate Qi.
St 40 (reducing) Luo connecting point of the Stomach channel, can regualte Stomach and Spleen, resolve phlegm.

Headache due to Blood Stasis
Treatment Principle: Move blood and Qi, stop pain. All points in this section either reduced or even stimulation.

Local Points Ashi Points on the head.
UB 17 The influential Point of the blood which can move blood.
L.I. 4 Together, with Liver 3, it activates Qi and Blood, and...
Liv3 expells pathogenic factors from the head.
Sp 6 Moves blood (blood is a part of Yin, the substance for which this point is best known.)

Headaches due to Deficiency of Qi and Blood
Treatment Principle: Tonify Qi and raise Qi, nourish blood. All points in this section are reinforced.

Du 20 Crossing point of six Yang channels and Du channel, raises clear Yang Qi.
Ren 6 Sea of Qi, tonifies and raises Qi.
UB 15 Heart Shu, Heart controls blood circulation.
UB 18 Liver Shu, Liver stores and regulates blood.
UB 20 Spleen Shu stimulates the spleen to produce more Qi and blood.
St 36 He-sea point, the Earth point on the Earth channel, a strong point to tonify Earth for more Qi and Blood.
Sp 6 Crossing point of three foot ying channels. Tonifies yin, of which is included blood.

Headaches due to Kidney Jing Deficiency
Treatment Principle: Tonify the kidney, nourish marrow. All points in this section are reinforced.

Du 20 Du channel enters into the brain. It is the crossing point of all the Yang channels located at the top of the head, and can attract Qi up towards the head to nourish the marrow.
GB 19 (Nao Kong-Empty brain) attracts Kidney Jing up to the brain. Fills the brain with marrow. This is a local point for Kidney deficiency headache.
UB 23 Kidney Shu. Kidney determines the condition of bone and marrow, and the brain is the sea of marrow.
GB 39 The influential point of marrow.
Kid 3 Tonifies the Kidneys Jing
St 36, Sp 6 Tonify the Qi and blood which will help to tonify the Kidney essence.

Headache treatments by Anatomical Differentiation

Frontal Headache

Local Points: Du 23, St 8, Yin Tang, GB 14, St 41

Temporal Headache

Local Points: Tai Yang, GB 8
SJ 5 Shao Yang point for Shao Yang Headache
GB 41 Another Shao Yang point for Shao Yang Headaches. Additionally, GB 41 is a Shu Stream (wood point on wood channel) helps to move the Qi throughout the Shao Yang system.
These two points represent the hand and foot Shao Yang, they meet in the head.

Occipital Headache

Local Points: UB 10, DU 16, UB 60

Vertex Headache

Local Point: Du 20
Liv 3 Used because the Liver channel travels through the vertex of the head.

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