Dr Zijing Hu (M.B. M.

Med)

The Therapeutics of Lecturer: Department of

Complementary Medicine

Acupuncture and Moxibustion (Acupuncture)

Faculty of Health Sciences
University of Johannesburg
Headache
• Definition
• Headache is defined as a pain arising from the
head or upper neck.

• Common medical conditions:

• Primary headache
• Cluster headache
• Migraine
• Tension headache
• …
• Secondary headaches: A secondary headache is a symptom of a disease that can
activate the pain-sensitive nerves of the head. Possible causes of secondary headaches
include:
• Acute sinusitis, arterial tears, blood clot (venous thrombosis) within the brain, brain
aneurysm, brain tumor, concussion, dental problems, ear infection (middle ear),
encephalitis, hypertension, influenza and other febrile (fever) illnesses, stroke, …
• Aetiology

Exogenous pathogens
Blockage of qi and blood (or
poor circulation) in the head, Headache
Endogenous factors Malnourishment of the head
• Syndrome differentiation
• Main symptoms: a dull pain, distending pain, stabbing pain or other kinds of pain in the
head region, may be part of the head or the whole head, etc.

• Yangming headache: mostly presents in the forehead, including pain in the superciliary
arch, nose, upper gum.
• Shaoyang headache: the region is similar to a migraine, including pain due to the ear
• Taiyang headache: in the occiput, including stiff neck or cervical problems
• Jueyin headache: in the cranialvertex, including headache due to hypertension
• Headache in the whole head: patients may experience pain in the whole head; however,
it is hard to locate a specific region
• Treatment principles:
• Activating qi and blood circulation. Acupuncture only, a reinforcing or reducing manipulation
according to syndrome differentiation
• Main acupoints: mainly focus on the local points and distal points
• Yangming headache: EX-HN3 (yintang), DU23 (shangxing), GB14 (yangbai), BL2 (cuanzhu)
through EX-HN4 (yuyao) and SJ23 (sizhukong), LI4 (hegu), ST44 (neiting)
• Shaoyang headache: EX-HN5 (taiyang), SJ23 (sizhukong), SJ20 (jiaosun), GB8 (shuaigu), GB20
(fengchi), SJ5 (waiguan), GB41 (zulinqi)
• Taiyang headache: BL10 (Tianzhu), GB20 (fengchi), SI3 (houxi), BL62 (shenmai), Bl60 (Kunlun)
• Jueyin headache: DU20 (baihui), BL7 (tongtian), LV3 (taichong), LV2 (xingjian), KD3 (taixi), KD1
(yongquan)
• Headache in the whole head: Du20 (baihui), EX-HN3 (yintang),EX-HN5 (taiyang), ST8 (touwei),
GB14 (yangbai), LI4 (hegu), GB20 (fengchi), SJ5 (waiguan)
• Due to exogenous pathogens: add GB20 (fengchi), BL12 (fengmen)
• Wind-cold: add DU14 (dazhui) (moxibustion)
• Wind-heat: add LI11 (quchi) (reducing)
• Wind-damp: add SP6 (sanyinjiao) (reducing)
• Phlegm: add ST40 (fenglong), ST36 (zusanli)
• Qi stagnation and blood stasis: add LI4 (hegu), LV3 (taichong), BL17 (geshu)
• Qi and blood def.: add RN6 (qihai), SP10 (xuehai), ST36 (zusanli)
• Hyperacitve liver yang: same as Jueyin headache
• A-shi points may be added to the above
• Needling techniques:
• The acupoints on the head are mostly inserted horizontally, some may be inserted
perpendicularly, such as GB20 (fengchi), BL10 (Tianzhu).
• Special attention should be paid to the insertion direction and depth on GB20 (Fengchi)
• A reducing manipulation approach may be applied to headaches due to wind-cold,
phlegm, qi stagnation and blood stasis and hyperactive liver yang
• Prick to bleed technique may be applied to the a-shi points of headaches due to qi
stagnation and blood stasis
• A reinforcing manipulation approach or moxibustion may be applied in qi and blood def.
• Acute headaches: once or twice a day, keep the treatment for 30 minutes to 1 hour
• Chronic headaches: once a day or once every second day
• Other treatment approaches:
• Skin needling technique: Mainly focus on EX-HN3 (yintang), EX-HN5 (taiyang), a-shi
points for 5-10 minutes each treatment, till slightly bleeding, suitable for headaches due to
wind-cold-dampness and hyperactive liver yang
• Three-edge needling technique: severe headache, prick to bleed on EX-HN3 (yintang),
EX-HN5 (taiyang), DU20 (baihui), DU14 (dazhui), BL2 (cuanzhu), 3-5 drops of blood on
each point
• Electro-acupuncture: electrical stimulation on the above acupoints after De Qi, con. wave
for 20-30 minutes, suitable for headaches due to qi stagnation and blood stasis
• Auricular acupuncture: occiput, temple, forehead, subcortex, ear shenmen. Select 2-3
points each time and insert with filiform needles
• Note:
• Also focus on the causes of the headache if due to other diseases
Dizziness
• Definition
• Refers to a feeling that everything is spinning
around you and you are not able to balance, in
some mild conditions, the patient may report
blurred vision only.

• Common medical conditions:

• Meniere's disease
• Hypertension
• Benign Paroxysmal Positional Vertigo (BPPV)
• Different kinds of cerebrovascular disease
• …
• Aetiology
• The disease location is in the brain and related to emotions, diet, over exertion and qi and
blood conditions.

Excess emotion Internal fire due to Hyperactive liver yang

qi stagnation

Greasy diet Spleen dysfunction Phlegm blockage

Malnourishment
Over exertion Kidney essence def. in the brain

Recovery from diseases Qi and blood def.

Dizziness
• Syndrome differentiation
• Main symptoms: dizziness, vertigo, with or without blurred vision, may be accompanied
with nausea, vomiting, tinnitus, deafness, sweating, a pale facial complexion, etc.

• Due to hyperactive yang: dizziness, tinnitus, distending feelings in the eyes and ears,
irritation, bad temper, insomnia, dream disturbed sleeping, a red facial complexion, red
eyes, a bitter taste, a red tongue with yellow coating, a wiry rapid pulse
• Due to phlegm: dizziness, vertigo, heaviness sensation in the head, chest tightness,
nausea, vomiting with phlegm, sticky mouth, poor appetite, a pale tongue with white
greasy coating, a wiry, slippery pulse
• Due to qi and blood def.: dizziness, blurred vision, a pale or light yellow facial
complexion, fatigue, palpitations, insomnia, abdominal distension, poor appetite, a pale
tongue with thin white coating, a weak pulse
• Due to liver and kidney yin def.: dizziness for a long period, poor version, poor memory,
insomnia, irritation, dry mouth, tinnitus, fatigue, weakness in the waist and knees, a red
tongue with thin coating, a wiry, thready pulse
• Treatment principles:
• Due to hyperactive yang: reducing hyperactive yang; acupuncture only with a reducing
manipulation approach
• Due to phlegm: Clearing phlegm, tonifying spleen and dispelling dampness; a
combination of acupuncture and moxibustion, an even manipulation approach
• Due to qi and blood def.: tonifying qi and blood, a combination of acupuncture and
moxibustion, a reinforcing approach
• Due to liver and kidney yin def.: nourishing liver and kidney, tonifying yin; focus on
acupuncture, an even manipulation approach
• Main acupoints: mainly focus on the local points and the foot shaoyang meridian
• DU20 (baihui), GB20 (fengchi), ST8 (touwei), EX-HN5 (taiyang), GB39 (xuanzhong)

• Due to hyperactive yang: add LV2 (Xingjian), LV3 (taichong), KD3 (taixi)
• Due to phlegm: add PC6 (neiguan), RN12 (zhongwan), ST40 (fenglong)
• Due to qi and blood def.: add RN6 (qihai), SP10 (xuehai), ST36 (zusanli)
• Due to liver and kidney yin def.: add BL18 (ganshu), BL23 (shenshu), KD3 (taixi)
• Needling techniques:
• Special attention should be paid to the insertion direction and depth on GB20 (fengchi)
• Severe conditions: twice a day, keep the treatment for 30 minutes to 1 hour
• Other treatment approaches:
• Three-edge needling technique: severe dizziness, prick to bleed on EX-HN3 (yintang),
EX-HN5 (taiyang), DU20 (baihui), ST8 (touwei), 3-5 drops of blood on each points
• Auricular acupuncture: adrenal gland, subcortex, occiput, brain, ear shenmen, forehead,
internal ear; due to hyperactive liver yang, add liver, gallbladder; due to phlegm, add
spleen, rim; due to qi and blood def., add spleen, stomach; due to liver and kidney yin
def., add liver and kidney. Select 3-5 points each time (one side of ear each time) and
insert with filiform needles
• Scalp acupuncture: related location, medium stimulation, 20-30 minutes, once a day
• Note:
• Diet: avoid greasy food, alcohol, spicy food, etc.
Essential hypertension
• Definition: Hypertension, also known as high or raised blood pressure, is a condition in
which the blood vessels have persistently raised pressure. In accordance with most major
guidelines it is recommended that hypertension be diagnosed when a person’s systolic
blood pressure (SBP) in the office or clinic is ≥140 mm Hg and/or their diastolic blood
pressure (DBP) is ≥90 mm Hg following repeated examinations.

• Symptoms can include chest pain, shortness of breath, palpitations, claudication,

peripheral oedema, headaches, blurred vision, nocturia, haematuria, dizziness.

• Hypertension can also cause strokes by blocking or bursting arteries that supply blood
and oxygen to the brain, as well as kidney damage, which can lead to kidney failure. High
blood pressure causes damage to the heart by hardening arteries and decreasing the
flood of blood and oxygen to the heart.
• Blood Pressure Measurement and Diagnosis of Hypertension
• Whenever possible, the diagnosis should not be made on a single office visit. Usually 2–3
office visits at 1–4-week intervals (depending on the BP level) are required to confirm the
diagnosis of hypertension. The diagnosis might be made on a single visit, if BP is
≥180/110 mm Hg and there is evidence of cardiovascular disease (CVD).
• White Coat and Masked Hypertension

• Examination:
• Blood test: Sodium, potassium, serum creatinine and estimated glomerular filtration rate
(eGFR). If available, lipid profile and fasting glucose.
• 12-lead ECG, echocardiography, carotid ultrasound, kidneys/renal artery and adrenal
imaging, brain CT/MRI, etc.
• Cardiovascular Risk Factors
• The most common additional risk factors are diabetes, lipid
disorders (elevated low-density lipoprotein-cholesterol [LDL-
C] and triglycerides), overweight-obesity, hyperuricemia and
metabolic syndrome, as well as unhealthy lifestyle habits (eg,
smoking, high alcohol intake, sedentary lifestyle).
• Other Risk Factors:Age (>65 years), sex (male>female),
heart rate (>80 beats/min), increased body weight, diabetes,
high LDL-C/triglyceride, family history of CVD, family history
of hypertension, early-onset menopause, smoking habits,
psychosocial or socioeconomic factors. HMOD: LVH (LVH
with ECG), moderate-severe CKD (CKD; eGFR <60
ml/min/1.73m2), any other available measure of organ
damage.
• Disease: previous coronary heart disease (CHD), HF, stroke,
peripheral vascular disease, atrial fibrillation, CKD stage 3+.
• Hypertensive Emergencies
• A hypertensive emergency is the association of substantially elevated BP with acute
Hypertension-Mediated Organ Damage (HMOD). Target organs include the retina, brain,
heart, large arteries, and the kidneys.
• This situation requires rapid diagnostic workup and immediate BP reduction to avoid
progressive organ failure. Intravenous therapy is usually required. The choice of
antihypertensive treatment is predominantly determined by the type of organ damage.
Specific clinical presentations of hypertensive emergencies include:
• Malignant hypertension: Severe BP elevation (commonly >200/120 mm Hg) associated
with advanced bilateral retinopathy (haemorrhages, cotton wool spots, papilloedema).
• Hypertensive encephalopathy: Severe BP elevation associated with lethargy, seizures,
cortical blindness and coma in the absence of other explanations.
• Hypertensive thrombotic microangiopathy: Severe BP elevation associated with
haemolysis and thrombocytopenia in the absence of other causes and improvement with
BP-lowering therapy.
• Other presentations of hypertensive emergencies include severe BP elevation associated
with cerebral haemorrhage, acute stroke, acute coronary syndrome, cardiogenic
pulmonary oedema, aortic aneurysm/dissection, and severe preeclampsia and eclampsia.
• Patients with substantially elevated BP who lack acute HMOD are not considered a
hypertensive emergency and can typically be treated with oral antihypertensive therapy.
• The clinical presentation of a hypertensive emergency can vary and is mainly determined
by the organ(s) acutely affected. There is no specific BP threshold to define a
hypertensive emergency.
• Symptoms include headaches, visual disturbances, chest pain, tachypnoea, neurologic
symptoms, dizziness, and more unspecific presentations.
• Medical history: preexisting hypertension, onset and duration of symptoms, potential
causes (nonadherence with prescribed antihypertensive drugs, lifestyle changes,
concomitant use of BP elevating drugs [NSAIDS, steroids, immune-suppressants,
sympathomimetics, cocaine, antiangiogenic therapy]).
• Modifiable risk factors contribute to hypertension:
• Unhealthy diets (excessive salt consumption, a diet high in saturated fat and trans fats,
low intake of fruits and vegetables), physical inactivity, consumption of tobacco and
alcohol, and being overweight or obese.

• Non-modifiable risk factors, including a family history of hypertension, age over 65

years and co-existing diseases such as diabetes or kidney disease.

• Hypertension can be managed by reducing and managing mental stress, regularly

checking blood pressure and consulting with health professionals, treating high blood
pressure and managing other medical conditions. Cessation of tobacco use and the
harmful use of alcohol, as well as improvements in diet and exercise, can help reduce
symptoms and risk factors from hypertension.
• Ethnicity, Race and Hypertension
• Populations from African descent
• Black populations, whether residing in Africa, the Caribbean, United States, or Europe,
develop hypertension and associated organ damage at younger ages, have a higher
frequency of resistant and night-time hypertension, and a higher risk of kidney
disease, stroke, HF, and mortality, than other ethnic groups.
• This increased cardiovascular risk may be due to physiological differences including a
suppressed RAAS, altered renal sodium handling, increased cardiovascular reactivity,
and early vascular aging (large artery stiffness).
• Management of hypertension:
• – Wherever possible, annual screening for hypertension is advised for adults 18 years
and older.
• – Lifestyle modification should place additional focus on salt restriction, increased
intake of vegetables and fruits (potassium intake), weight management, and reducing
alcohol intake.
• – First-line pharmacological therapy is recommended as a single pill combination
including a thiazide-like diuretic plus CCB or CCB plus ARB (see Sections 8 and 12).
• – Among RAS-inhibitors, ARBs maybe preferred as angioedema is about 3 times
more likely to occur with ACE inhibitors among black patients.
• Populations From Asia
• Ethnic-specific characteristics are recognized for east Asian populations. Hypertensive
patients have a greater likelihood of salt-sensitivity accompanied with mild obesity. When
compared to Western populations, east Asian people present with a higher prevalence of
stroke (particularly haemorrhagic stroke) and nonischaemic HF.
• Morning hypertension and night-time hypertension are also more common in Asia,
compared with European populations.
• South Asian populations originating from the Indian subcontinent have a particularly high
risk for cardiovascular and metabolic diseases, including CAD and type 2 DM.

Reference:
Unger, T., Borghi, C., Charchar, F., Khan, N., Poulter, N., Prabhakaran, D., Ramirez, A., Schlaich, M., Stergiou, G., Tomaszewski, M., Wainford, R., Williams, B., Schutte, A. (2020). 2020
International Society of Hypertension Global Hypertension Practice Guidelines. Hypertension: 75:1334–1357. https://doi.org/10.1161/HYPERTENSIONAHA.120.15026
• Aetiology
• Related to the kidney yin def., hyperactive liver yang, improper diet and excess emotions,
etc.
• The essential hypertension falls in the categories of headache and/or dizziness.
• Syndrome differentiation
• Main symptoms: many patients have no obvious symptoms; some patients may
present with headache, dizziness, vertigo, blurred vision, tinnitus, palpitations,
insomnia, poor memory, etc.
• Due to liver fire: dizziness, headache, irritation, a red facial complexion, red eyes, a
bitter taste, constipation, a red tongue with dry yellow coating, a wiry pulse
• Due to hyperactive yang and yin def.: dizziness, headache, a heavy sensation of the
head, tinnitus, feverish sensation in the palms and soles, palpitations, insomnia, poor
memory, a red tongue with thin white coating, a wiry, thready and rapid pulse
• Due to phlegm: dizziness, headache, a heaviness sensation of the head, chest
tightness, palpitations, nausea, vomiting with phlegm, a white greasy coating, a slippery
pulse
• Due to qi def. and blood stasis: dizziness, headache, a dark yellow facial complexion,
palpitations, fatigue, shortness of breath, poor appetite, bluish lips and nails, a purple
tongue with or without purple spots, a thready hesitant pulse
• Yin and yang def.: dizziness, headache, a dark facial complexion, tinnitus, palpitations,
shortness of breath or polypnea after exercising, weakness in the waist and knees,
insomnia, dream disturbed sleep, excess urination at night, oedema, a pale or red
tongue with white coating, a thready pulse
• Treatment principles:
• Due to hyperactive liver yang and/or yin def.: tonifying yin and reducing hyperactive yang,
acupuncture only with a reducing manipulation approach;
• Due to phlegm: clearing phlegm and tonifying spleen, a combination of acupuncture and
moxibustion with an even manipulation approach;
• Due to qi def. and blood stasis: tonifying qi and blood, activating blood circulation, a
combination of acupuncture and moxibustion with reinforcing and reducing manipulation
approaches;
• Due to yin and yang def.: tonifying yin and yang, a combination of acupuncture and
moxibustion with a reinforcing manipulation approach
• Main acupoints:
• ST9 (Renying), DU20 (baihui), LI11 (quchi), LI4 (hegu), LV3 (taichong), SP6 (sanyinjiao)
• Due to hyperactive liver yang: add GB20 (fengchi), LV2 (xingjian)
• Due to yin def.: add KD3 (taixi), BL18 (ganshu)
• Due to phlegm: add ST40 (fenglong), ST36 (zusanli)
• Due to qi def. and blood stasis: add SP10 (xuehai), BL17 (geshu)
• Due to yin and yang def.: add RN4 (guanyuan), BL23 (shenshu)
• Accompany with palpitations: add PC6 (neiguan), HT7 (shenmen)

• Needling techniques:
• Due to phlegm, qi def. and blood stasis, yin and yang def., moxibustion may be added to
DU20 (baihui);
• LV3 (taichong): needling towards KD1 (yongquan)
• Other treatment approaches:
• Skin needling technique: Mainly focus on the nape, lower back and both sides next to the
trachea; once a day
• Three-edge needling technique: prick to bleed on ear apex, DU20 (baihui), DU14
(dazhui), EX-HN3 (yintang), LV3 (taichong), LI11 (quchi), select 1-2 acupoints each time,
3-5 drops of blood on each point, apply once every 2-3 days
• Auricular acupuncture: Groove, adrenal gland, ear apex, cortex, ear shenmen, heart,
select 3-4 points each time and insert with filiform needles
• Note:
• Patients are not suggested to stop medication immediately after the acupuncture
treatment, for those who are already taking tablets.
Hypotension
• Definition: A blood pressure reading lower than 90 millimeters of mercury (mm Hg) for the
systolic pressure or 60 mm Hg for the diastolic pressure is generally considered low blood
pressure.
• Symptoms can include dizziness or light-headedness, fainting, blurred or fading vision,
nausea, fatigue, poor concentration, palpitations; severe cases may present with
confusion, especially in older people, cold, clammy, pale skin, rapid, shallow breathing,
weak and rapid pulse.
• Aetiology
• Related to qi def. of the heart, lung, spleen and kidney;
• Hypotension falls in the categories of dizziness, headache and general deficiency (weak
constitution).

• Syndrome differentiation
• Main symptoms: many patients may present with dizziness, headache, poor appetite,
fatigue, a pale facial complexion, indigestion; or palpitations, difficulty breathing,
slurred speech, extremely cold extremities, etc.
• Due to heart yang def.: dizziness, poor memory, fatigue, a pale facial complexion,
indigestion, cold extremities, a pale swollen or tender tongue, a deep thready or slow
weak pulse
• Due to qi def. of the middle jiao: dizziness, shortness of breath, spontaneous
sweating, fatigue, poor appetite, a pale tongue with white coating, a slow and weak pulse
• Due to heart and kidney def.: dizziness, tinnitus, palpitations, weakness of the waist
and knees, sweating, cold extremities, low libido, increased night urination, a pale
tongue with thin white coating, a deep thready pulse
• Due to the collapse of yang qi: dizziness, a pale facial complexion, nausea, vomiting,
sweating, cold extremities, unconsciousness, a pale tongue, a deep thready and weak
pulse
• Treatment principles:
• Tonifying heart, spleen, kidney, harmonise qi and blood circulation, a combination of
acupuncture and moxibustion, reinforcing manipulation approach;

• Main acupoints: Mainly focus on the back transporting points on the foot taiyang
meridian
• DU20 (baihui),RN6 (qihai), BL15 (xinshu), BL20 (pishu), BL23 (shenshu), ST36 (zusanli)
• Due to heart yang def.: add RN17 (danzhong), BL14 (jueyinshu)
• Due to qi def. of the middle jiao: add RN12 (zhongwan), BL21 (weishu)
• Due to the heart and kidney def.: add PC6 (neiguan), KD3 (taixi)
• Due to the collapse of yang qi: add RN8 (shenque), RN4 (guanyuan)
• Accompany with dizziness/headache: add EX-HN3 (yintang), EX-HN5 (taiyang)
• Accompany with insomnia: add EX-HN1 (sishencong)
• Accompany with cold extremities: add moxibustion on DU14 (dazhui), DU4 (mingmen)
• Emergencies: add PC6 (neiguan), DU25 (suliao)
• Needling techniques:
• Moxibustion may be applied on DU20 (baihui)
• Moxibustion on ST36 (zusanli) may always be applied
• Other treatment approaches:
• Skin needling technique: the above acupoints, 2-3 minutes each time
• Auricular acupuncture: select the heart, adrenal gland, accompany with dizziness, add
kidney, occiput; fatigue, add spleen; poor memory, add subcortex, the midpoint of rim；
palpitations, chest tightness, add chest, ear shenmen; select 3-5 acupoints, treatment
may be applied every second day
 Dr Zijing Hu (M.B. M.Med)
Lecturer: Department of Complementary Medicine
(Acupuncture)
Room 7106d John Orr Building DFC
Faculty of Health Sciences
University of Johannesburg
Tel: 011 559 6999
E-mail: zhu@uj.ac.za