Treatment of Headache in Traditional Chinese Medicine

Material taken from the book "Treating Pain with Traditional Chinese Medicine" by Dagmar Riley, with Prescriptions by Prof. Liu De Quan (Acupuncture) and Prof. Zhang Chun Rong (Chinese Medicinal Formulas).

Headaches – Painfully Common

Pain in the whole head or in certain parts of the head, such as the forehead, occiput, sides or vertex, is called headache. Headache may be caused by six excesses external contraction (liu yin wai gan) or by bowel and visceral internal damage. Pain is caused by impaired flow in the channels and network vessels, such as in cases of blocked yang qi, turbid evils that ascend and obstruct clear yang, ascending liver yang, essence marrow depletion, or qi blood depletion.  Headache can be classified according to the following nine forms:

1. Wind-cold headache
2. Wind-heat headache
3. Wind-damp headache
4. Liver yang headache
5. Kidney vacuity headache
6. Qi vacuity headache
7. Blood vacuity headache
8. Phlegm turbidity headache
9. Blood stasis headache

Points of Attention for Headache – Physiology

Generally, headaches, like other pain syndromes, are specifically brought about by disease giving rise to obstruction of qi and blood flow. However, due to the location of the head and its specific physiology, the causes of headaches and their pathomechanisms bear certain special characteristics that are explained below.

The Head is the Uppermost Part of the Body

Because the head is the uppermost part of the body, it is easily affected by wind evil assailing the exterior. Wind evil is a yang evil and as such tends to affect the yang parts of the body, i.e. the upper part and the exterior. Other external evils, such as cold, damp, and heat, tend to attach themselves to wind evil to invade the head. When wind evil assails the head it obstructs clear yang qi, congeals and obstructs qi and blood, and results in stoppage in the channels and network vessels, thus causing pain.

• Wind evil assailing the head and combining with cold evil causes cold congealing blood stagnation, giving rise to pain.
• Wind evil assailing the head and combining with heat evil causes wind-heat flaming upward, giving rise to pain.
• Wind evil assailing the head and combining with dampness evil clouds the clear orifices, and obstructs clear yang, giving rise to pain.
• The head is the confluence of the yang channels, and the brain is the sea of marrow. Clear yang qi moves upward to nourish the head and brain, including the five senses. The remainder turns into turbid yin, which is a combination of used yang qi and waste. Turbid yin must descend, otherwise it can obstruct clear yang, giving rise to pain. The brain is the sea of marrow and the kidney engenders marrow, hence they are closely related and kidney vacuity may bring about an insufficiency of the sea of marrow, giving rise to pain.

Consideration for Diagnosis of Headache: Pain Location (Indication of the Affected Channel)

The head is the confluence of the yang channels, and the three yang channels and the reverting yin channel flow to the head. By determining the location of the pain, one can establish which channel is affected.

• Pain in the posterior of the head (vertex, occipital region, neck, back) indicates blockage of the greater yang (Tai Yang) channel.
• Pain in the forehead (forehead, eyebrows) indicates blockage of the yang brightness (Yang Ming) channel.
• Pain of the lateral sides indicates blockage of the lesser yang (Shao Yang) channel.
• Pain just at the vertex indicates blockage of the reverting yin (Jue Yin) channel.

Channel Conductors

Channel conductor medicinals conduct the action of the other medicinal in the prescription to certain channels. The following channel conductors are relevant to the treatment of headaches:

External Contraction Headache and Internal Damage Headache

Headache can be divided into external contraction headaches and internal damage headaches.

• External contraction headaches: External contraction headaches are characterised by recent and rapid onset, with the patient showing signs and symptoms of an exterior pattern. The course of disease is usually of short duration.

Pain characteristics: The pain, which tends to be intense and uninterrupted, is mostly pulling pain (che tong), scorching pain (zhuo tong), distending pain (zhang tong), or heavy pain (zhong tong).

• Internal damage headaches: Patients with internal damage headache commonly suffer from chronic headache and do not show any signs of an exterior pattern. The course of disease tends to be of long duration.

Pain characteristics: The pain tends to periodically appear and disappear, and it is mostly dull pain (yin tong), empty pain (kong tong), or, in the case of blood stagnation, stabbing pain (ci tong) with fixed location. Pain usually gets worse with taxation (meaning mental or physical exhaustion) or affect damage (excessive or lasting emotions or mental activities).

Vacuity and Repletion Pattern

Vacuity patterns include kidney vacuity headache, qi vacuity headache, and blood vacuity headache. Repletion patterns include external contraction headaches and liver yang headache. Mixed patterns tend to be phlegm turbidity headache or blood stasis headache.

Causes and Pathomechanisms of Headaches: Identifying Patterns

1. Wind-Cold Headache

Causes and Pathomechanism of Wind-Cold Headache

“Wind damage first affects the upper part of the body”. Externally contracted wind-cold evil enters the greater yang channel (the greater yang channel governs the exterior of the body), causing obstruction of clear yang qi. This gives rise to pain along the foot greater yang channel (the vertex, occipital region, neck, and back) and pain in the joints. If the wind-evil lodges and is not removed, the headache recurs in irregular intervals and can appear both as hemilateral and medial headache. This is called head wind (tou feng).

• Pain along the vertex, occipital region, and neck.
• Aversion to cold and wind.
• Pain exacerbated by cold.
• The patient likes to cover his head (such as with a hat or scarf).
• No thirst.
• Painful joints.
• Thin tongue and white fur.
• Tight floating pulse.

Treating Wind-Cold Headache Using Medicinals

Method of Treatment: Course wind, dissipate cold, and check pain.

Prescription: Chuan Xiong Cha Tiao San [Cnidium Tea Formula].

All dosages in raw herbs:

• Chuan Xiong [Cnidium] 120 g
• Jing Jie [Schizonepeta] 120 g
• Bai Zhi [Angelica] 60 g
• Qiang Huo [Notopterygium] 60 g
• Gan Cao [Licorice] 60 g
• Xi Xin [Asarum] 30 g
• Fang Feng [Siler] 45 g
• Bo He [Mentha] 240 g

Prescription Analysis

Chuan Xiong Cha Tiao San is the principal prescription for wind-cold headache. It is mainly a combination of acrid-dissipating and wind-dispelling medicinals which courses wind, dissipates cold, and checks pain. Since this prescription contains many medicinals with acrid and warm properties which course wind and dissipate cold, it is suitable for external contraction headache and head wind attributed to wind cold.

Chief Medicinals

Cnidium especially treats lesser yang (shao yang, lateral side) headaches and reverting yin (jue yin, vertex) headaches. Notopterygium treats greater yang (tai yang, posterior side – vertex, occipital region, neck, back). Angelica treats yang brightness (yang ming, forehead, eyebrows) headache.

Support Medicinals

Asarum, Mint, Schizonepeta, and Saposhnikovia are all acrid-dissipating medicinals that conduct the action of the medicinals upwards and course and dissipate wind. These medicinals assist the chief medicinals. They increase the action of coursing wind and dissipating cold, and they resolve the exterior.

Assistant and Conductor Medicinals

Licorice harmonises the properties of all the medicinals. When Chinese tea is added to the prescription, it prevents the other medicinals from being overly warming and drying or too upbearing and dissipating. This effect is achieved because of the cold and bitter properties of Chinese tea, which are both clearing and downbearing. This effect is known as ‘downbearing within upbearing’.

Variation According to Signs

If aversion to cold is especially strong, or if the patient is also vomiting, add ingredients such as Sheng Jiang [Fresh Ginger], Su Ye [Perilla Leaf], or Gui Zhi [Cinnamon Twig] to enforce the dissipation of cold and stop the vomiting.

Treating Wind-Cold Headache Using Acupuncture

Points for wind-cold headache:

• Wai Guan (TB-5 Outer Pass)
• He Gu (LI-4 Union Valley)
• Feng Chi (GB-20 Wind Pool)
• Feng Fu (GV-16 Wind Mansion]
• Tai Yang (M-HN-9 Greater Yang Extra Point)

Prescription Analysis

GB-20, the intersection point (Jiao Hui Xue) of the foot lesser yang gallbladder channel and the yang linking vessel, dispels wind. GV-16, a point where wind tends to gather, dispels both interior wind and exterior wind-cold. TB-5 is the network point of the hand lesser yang triple burner channel. Combining TB-5 with LI-4 and M-HN-9 quickens the network vessels and checks pain.

2. Wind-Heat Headache

Causes and Pathomechanism of Wind-Heat Headache

Wind-heat headache is caused by either unresolved wind-cold that transforms into heat or by wind combined with heat evil that strikes the yang network vessels. Heat, a yang evil, has the tendency to bear upward and dissipate, hence, the headache is characterised by distending pain (zhang tong).

Important Signs of Wind-Heat Headache

This kind of headache is characterised by distending pain that worsens with heat to the point where the head feels like it is going to split apart. Heat effusion and aversion to cold, red face and eyes, swollen and painful throat and cough, dry mouth and thirst. The tongue has a red tip and a thin yellow coating. Rapid and floating pulse.

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