Headache

Key Diagnostic Points:

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

Differential Diagnosis:
1) 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

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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.

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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

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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

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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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