Class 6: Headache, facial pain

1. Class 6: Headache, facial pain Xianhui Li

2. Headache • Headache is a subjective symptom. It can be induced by various acute and chronic diseases. Here we just study in detail with headache as the predominant symptom

3. Etiology and pathology • The head is the place where all the yang meridians of hand and foot meet, and qi and blood of the five zang and six fu 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 of circulation of qi in the meridians that traverse the head • External pathogenic factors • Invasion of wind into the meridians and collaterals • Endogenous factors • Hyperfunction of the liver yang • emotions • overwork • dampness • Accidents • Blood stasis • Deficiency of qi and blood

4. Diagnosis • Diagnosis according to channels • Top of the head, behind eyes -------liver channel • Sides of the head-----shaoyang channel • Forehead------yangming channel • Back of the head (occiput)------ taiyang channel • Diagnosis according to the nature of pain • Dull ache, hollow pain, feeling of empty • Feeling of heaviness, heavy, muzzy, wrapped in a cloth • Distending pain, throbbing, bursting, pulsating, wind heat, liver yang rising, liver fire • Stiff, occiput: wind cold • Pulling pain: spasmodic in nature and short in duration—liver wind • Stabbing pain: splitting headache--blood stasis • Diagnosis according to amelioration and aggravation • Time, weather, emotions, posture, menstruation, activity/rest

5. Patterns • Invasion of pathogenic wind • Liver yang rising • Liver fire blazing • Accumulation of dampness • Blood stasis • Qi and blood deficiency

6. Local and distal points according to the position of headache • Frontal headache: Du23 shang xing, GB14 yang bai, ST44, LI4 • Headache on vertex: DU20, Du21 qian ding, LIV2, LIV3 • Occipital headache: BL10 tian zhu, Du19 hou ding, DU16 feng fu, BL60 kun lun, SI3 • Temporal headache: GB8 shuai gu, Taiyang, GB41 zu lin qi, TB5

7. Invasion of pathogenic wind • Clinical Manifestations • Headache worse on exposure to wind. The pain may extend to the neck and back region or with a stiffness on the occiput. Acute onset, short duration, thin coat, floating pulse • Treatment principle • Release the exterior and remove the obstruction from the channels • Acupuncture local points, LU7, GB20, DU16, LI4, TB5, SI3, BL60 • LU7 releases the exterior and expel wind cold by stimulating the diffusing and descending of lung qi. It also affects the head and relieves headaches. It can be used for headaches from wind cold, wind heat and also turbid phlegm • GB20 expel wind from the head • DU16 expels wind from the head and treats the greater yang channel area • LI4 releases the exterior, expels wind heat, and is a special point to affect the head and face • TB5 expels wind heat and relieves headache • SI3 expels wind from the head and treats the greater yang channel area • BL60 is used if the headache also affects the lower part of the neck and the top of the shoulder • Herbal treatment: chuan xiong cha tiao san, sang ju yin, qiang huo sheng shi tang

8. Liver yang rising • Clinical Manifestations • Distending, bursting or throbbing headache, irritability, tinnitus and dizziness, symptoms of liver and kidney yin deficiency. Wiry pulse • Treatment principle • Pacify liver, nourish Yin and alleviate pain • Acupuncture, local points, GB20, LIV3, SP6, KI3 • GB20 is used as adjacent point to subdue liver yang. It subdues liver yang and liver wind and is specific for headache from these two causes. • LV3 is the main distal point to pacify the liver and subdue liver yang, it also the main distal point for this type of headache • SP6 nourishes yin and liver blood and pacify liver, it also calms spirit and promotes sleep • KI3 tonifies kidney yin • Herbal treatment: tian ma gou teng yin

9. Liver fire blazing • Clinical Manifestations • Distending, bursting or throbbing headache, irritability, tinnitus and dizziness, thirst, bitter taste, scanty-dark urine, constipation with dry stools, red eyes, a red tongue with yellow coating, wiry rapid pulse. • Treatment principle • Pacify liver and clear fire • Acupuncture: local points, GB20, LIV2, SP6, LI11 • GB20 expels wind from the head and subdue liver fire • LV2 is the main distal point to clear liver fire • SP6 is used to nourish yin and to prevent injury of yin from liver fire • LI11 clear heat • Herbal treatment: long dan xie gan tang

10. Accumulation of dampness • Clinical Manifestations • The headache is dull and feels as if the head is wrapped in a cloth or full of cotton wool. Sensation of heaviness and difficulty in thinking. Dizziness. Symptoms worse in the mornings. Nausea, lack of appetite, a feeling of fullness of the chest and epigastrium, loose stool, thick sticky tongue coating and a slippery pulse. • Treatment principle • Resolve dampness and ascend clear yang • Acupuncture: local points, ST8. SP3, LI4, Ren12, BL20, SP9, ST40 • ST8 is a local point for headaches from phlegm or dampness • SP3 eliminates dampness and helps to resolve phlegm. It affects head. • LI4 is used as a distal point to eliminate pathogenic factors from the face and head. It also regulates the ascending and descending of qi • Ren12 and BL20 tonify spleen and stomach and resolve dampness • SP9 tonify the spleen and resolve dampness • ST40 is a specific point for dampness and phlegm • Herbal treatment: ban xia bai zhu tian ma tang

11. Blood stasis • Clinical Manifestations • Severe and intense headache, stabbing or boring in character, it seems like ‘nail being driven into the head’ and fixed in its location. Dark complexion, painful periods with dark clotted blood. Purple tongue with spots. Wiry pulse. • Treatment principle • Quicken blood and open orifices • Acupuncture: Ashi points and local points, LI4, SP6, LIV3, SP10, BL18 • Ashi points on the head are important and essential part of the treatment • LI4 in combination with LV3 expels pathogenic factors from head. LV3 soothe the liver and invigorate the blood • SP6 invigorates and quicken the blood • SP10 quicken the blood and remove blood stasis. • Bl18 soothe the liver and remove liver blood stasis • Herbal treatment: tong qiao huo xue tang or tao hong si wu tang

12. Qi and blood deficiency • Clinical Manifestations • Headache comes in bouts, it is dull in nature and is alleviated by rest and aggravated by excessive work. Poor appetite, tiredness, loose stools, slight breathlessness, pale tongue, thin weak pulse. • Treatment principle • Tonify and raise qi, nourish the blood • Acupuncture: local points, ST36, DU20, SP6, Ren6, BL20 • ST36 SP6 and BL20 tonify the spleen and stomach that is the source of the qi and blood • DU20 raises qi • Ren6 tonify qi • Herbal treatment: ba zhen tang

13. Facial pain • Facial pain is a kind of severe pain occurring in transient paroxysms in a certain facial region. It mostly occurs in one side of the forehead, maxillary region or mandibular region. The onset is abrupt like an electric shock and pain is cutting, burning and intolerable. Each attack lasts a few seconds or one to tow minutes. It may recur several times a day.

14. Etiology and Pathogenesis • exterior pathogenic wind cold • improper diet • emotional disturbance • disorders of teeth, mouth, ear nose

15. Differentiation and treatment • Pain at the supraorbital region: GB14 yang bai, Taiyang, BL2 zan zhu • Pain at the maxillary region: ST3, SI18 quan liao, LI20 • Pain at the mandibular region: ST7, ST6, ST5 da ying, Jiachengjiang

16. Facial pain due to invasion by pathogenic wind and cold • Clinical Manifestations • Aversion to cold, wind, local spasm, running nose, lacrimation, salivation • Treatment principle • Expel wind cold and relieve pain • Acupuncture: local points plus GB20, LI4, LU7, TB5 • GB20 can be used to dispel wind and to check pain • LI4 and TB5 are the yuan and luo points along the hand-yangming and hand shaoyao which go upward to the facial region • LU7 releases the exterior and expel wind cold by stimulating the diffusing and descending of lung qi. It also affects the head and relieves headaches. It can be used for headaches and facial region problems from wind cold, wind heat and also turbid phlegm • Herbal treatment: chuan xiong cha tiao san

17. Facial pain due to excessive fire in the liver and stomach • Clinical Manifestations • Irritability, hot temper, thirst, constipation, red tongue, yellow tongue coating, wiry rapid pulse • Treatment principle • Clear fire and stop pain • Acupuncture: local points plus ST44, LIV2, LIV3, ST40, ST25 • ST44 can clear heat and drain fire from the stomach • LV2 and LV3 drain the liver fire and soothe the liver • ST25 clear heat in the large intestine • ST40 is used if there is phlegm heat in the stomach • Herbal treatment: xiong zhi shi gao tang

18. Facial pain due to deficiency of yin and empty heat • Clinical Manifestations • Malar flush, soreness in the lumbar region, lassitude, pain aggravated by fatigue, thready and rapid pulse, red tongue little coating, thin rapid pulse. • Treatment principle • Nourish yin clear empty heat and stop pain • Acupuncture: local points KI3, KI6, SP6, KI2 ran gu • KI3 tonify the kidney • KI6 and SP6 tonify yin and reduce the fire • KI2 clear empty heat and cools the blood • Herbal treatment: zhi bai di huang tang

19. Case study • Female, 37years • She has headache that is related to stress for five years. Sometimes it is distending, bursting or throbbing headache, sometimes it is heavy pain and she feels as if the head is wrapped in a cloth. She also has dizziness, bitter taste in the mouth, lack of appetite, scanty-dark urine, sometimes constipation with dry stools, sometimes loose stools, her menstrual cycle is 37 days. Her period is dark color. a red tongue with yellow thick coating, wiry rapid pulse