HEADACHE

Lee Chong Leng

1

CONTENTS

1)

Introduction 6 - 7

2)

Clinical Manifestations 8 -16

3)

Essentials for Diagnosis 17 - 18

4)

Treatment with Tuina Therapy

19 - 64

5)

Cautions 65 - 665

HEADACHE

Pain in the upper part of the head due to pathological changes inside or outside the cranium

A commonly encountered subjective symptom and can be found in many different acute or chronic diseases

6

HEADACHE Four causes of headache

Intracranial pathologic changes

Extracranial pathologic changes

General diseases

Neurosis

If the headache is a secondary symptom caused by injury, wound or some other diseases, it will disappear after the main symptoms are eliminated.

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CLINICAL MANIFESTATIONS

1. Wind cold 风寒头痛2. Wind heat 风热头痛3. Summer-heat 暑湿头痛4. Hyperactivity of liver yang 肝阳头痛5. Phlegm and turbid substance 痰浊

头痛6. Blood deficiency 血虚头痛7. Kidney deficiency 肾亏头痛8. Blood stasis 瘀血头痛

8

CLINICAL MANIFESTATIONS

1. Wind cold 风寒头痛 Involvement of the nape and

back, aversion to wind and cold, aching limbs and joints

Preference for wrapping the head, no thirst

Light and whitish tongue coating, floating or tense pulse

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CLINICAL MANIFESTATIONS

2. Wind heat 风热头痛3. Distending headache, or even

splitting pain in the head

4. Aversion to wind, fever, reddish complexion and eyes, thirst and preference for drinking, reddish and sore throat, yellowish urine

5. Reddish tongue tip & light yellow coating, floating and rapid pulse10

CLINICAL MANIFESTATIONS

3. Summer-heat 暑湿头痛4. Binding pain

5. Abdominal distension, anorexia, lassitude, heaviness, and pain in the body, feverish body and spontaneous sweating, dysphoria, thirst

6. Greasy coating, soft and rapid pulse 11

CLINICAL MANIFESTATIONS

4. Hyperactivity of liver Yang 肝阳头痛 Headache and dizziness, especially

in both sides

Dysphoria, restless sleep, reddish complexion, dry and bitter taste, hypochondriac distension

Reddish tongue and light yellowish or scanty tongue coating, taut and strong or taut, thin and rapid pulse

12

CLINICAL MANIFESTATIONS

5. Phlegm and turbid substance 痰浊头痛

Marked by distension headache

Fullness sensation in the chest and diaphragm, anorexia, lassitude, profuse saliva and fluid, vomiting

Whitish and greasy tongue coating and slippery pulse

13

CLINICAL MANIFESTATIONS

6. Blood deficiency 血虚头痛 Headache, vertigo

Aggravation of pain after overstrain, languor, dark complexion, poor appetite, palpitation, short respiration

Light tongue, thin and limp or unsmooth pulse

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CLINICAL MANIFESTATIONS

7. Kidney deficiency 肾亏头痛 Severe pain

languor, tinnitus and vertigo, amnesia and insomnia, weakness of waist and limbs, seminal emission and leukorrhagia

Headache due to Yang deficiency is marked by cold limbs, light and plump tongue, sink thin and limp pulse

Headache due to Yin deficiency is marked by dry mouth with scanty fluid, reddish tongue, thin and rapid pulse

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CLINICAL MANIFESTATIONS

8. Blood stasis 瘀血头痛9. Repeated headache occurrence,

difficulty to heal

10.Fixed location, puncturing pain, or with a history of traumatic injury of the head

11.Purple and dark tongue and unsmooth pulse

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ESSENTIALS FOR DIAGNOSIS

1. Headache, involving the forehead, tempus, vertex and occiput or the whole head, characterized by flicking pain, stabbing pain, distending pain, vertigo or vague pain. It may occur suddenly or recur frequently and linger. It may last for several minutes, hours days or weeks

2. History of sudden onset or repeated occurrence due to invasion of exogenous pathogenic factors or endogenous ones

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ESSENTIALS FOR DIAGNOSIS

3. Take blood routine test, blood pressure test, cerebrospinal fluid test and EEG test as well as Doppler, cranial and cerebral CT and MRI test if possible, in order to rule out organic disease and decide diagnosis

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TREATMENT WITH TUINA THERAPY

Principle:

Dredging meridians, prompting Qi and blood flow （疏经通络，行气活血）

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TREATMENT WITH TUINA THERAPY

Acupoints and location:

Yintang (EX-HN 3), Touwei (ST 8), Taiyang （ EX-HN5),Yuyao (EX-HN 4), Cuanzhu (BL 2), Yangbai, Baihui (GV 20), Sishencong, Jianjing (GB 21), Fengchi (GB 20), the head, face, nape and neck regions

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TREATMENT WITH TUINA THERAPY

Operation 1:(1)Patient - sitting position (back)(2)Use one-finger pushing method to push down through the neck, where the bladder meridian of foot-Taiyang runs, for about three minutes(3)Press Fengchi (GB 20), Fengfu (GV 16), Tianzhu (BL 10)(4)Grasp Fengchi (GB 20) and Jianjing (GB 21), 1 minute for each(5)Grasp along the neck where the bladder meridian of foot-Taiyang runs for 4-5 times

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Fengchi ( 风池 )

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Fengfu ( 风府 )

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Tianzhu ( 天柱 )

25

Jianjing ( 肩井 )

TREATMENT WITH TUINA THERAPY

Operation 2:(1)Patient - sitting position (front and back)(2)Use one-finger pushing method to push from Yintang (EX-HN 3), the hairline up to Touwei (ST 8) and Taiyang (EX-HN5) for 3-4 times(3)Press Yintang (EX-HN 3), Yuyao (EX-HN 4), Taiyang (EX-HN 5) and Baihui (GV 20)(4)Grasp with five fingers from vertex to Fengchi (GB 20)(5)Grasp with three fingers the bladder meridian of foot-Taiyang down to Dazhui (GV 14) for 3-4 times

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Yintang ( 印堂 )

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Touwei ( 头维 )

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Taiyang ( 太阳 )

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Yuyao ( 鱼腰 )

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Baihui ( 百会 )

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Dazhui ( 大椎 ) ， Feishu (肺俞 )

MANIPULATIONSACCORDING TO

SYNDROME DIFFERENTIATION

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(1) COLD AND WIND

Roll the neck and back for about 2-3 minutes

Press and rub Feishu (BL 13) and Fengmen (BL 12) Grasp both sides of Jianjing (GB 21)

Rub bladder meridian at both sides of the back until it is warm

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Dazhui ( 大椎 ) ， Feishu (肺俞 )

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Fengmen ( 风门 )

(2) WIND AND HEAT

Press and rub Dazhui (GV 14), Feishu (BL 13), Fengmen (BL 12), one minute each

Grasp Jianjing (GB 21), Quchi (LI 11), shousanli (LI 10), Hegu (LI 4) until there is aching and distending feeling in the local area

Knock the back until it becomes warm

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Quchi ( 曲池 )

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Shousanli ( 手三里 )

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Hegu ( 合谷 )

(3) SUMMER-HEAT

Press and rub Dazhui (GV 14) and Quchi (LI 11)

Grasp Jianjing (GB 21) and Hegu (LI 4)

Knock the bilateral courses of the bladder meridian until the skin turns red

Pinch Yintang (EX-HN 3) and neck until it turns red

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(4) HYPERACTIVITY OF LIVER YANG

Push Qiaogong up and down for 20 times each

Clean and dissipate tempus where the gallbladder meridian runs

Press and rub Jiaosun (TE 20), Taichong (LR 3) and Xingjian (LR 2) for about 10 times

Rub Yongquan (KI 1) until it turns warm

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Qiaogong ( 桥弓 )

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Jiaosun ( 角孙 )

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Dadun ( 大敦 ) ， Xingjian ( 行间 ) ， Taichong ( 太冲 )

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Yongquan ( 涌泉 )

(5) PHLEGM AND TURBID SUBSTANCE

Push and rub the abdomen, specially Zhongwan (CV 12), and Tianshu (ST 25) for 6-8 minutes

Press and rub Pishu (BL 20), Weishu (BL 21), Dachangshu (BL 25)

Rub the left back horizontally until it is warm

Press and rub Zusanli (ST 36), Fenglong (ST 40) and Neiguan (PC 6)

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Zhongwan ( 中脘 ) ， Tianshu ( 天枢 ) ， Qihai ( 气海 )

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Geshu ( 膈俞 ) ， Ganshu ( 肝俞 ) ， Pishu ( 脾俞 ) ， Shenshu ( 肾俞 )

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Weishu ( 胃俞 )

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Shenshu ( 肾俞 ) ， Dachangshu (大肠俞 )

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Zusanli ( 足三里 )

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Fenglong ( 丰隆 )

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Neiguan ( 内关 )

(6) BLOOD DEFICIENCY Rub the abdomen for 6-8

minutes, especially Qihai (CV 6), Zhongwan (CV 12) and Guanyuan (CV 4)

Rub the left back horizontally and the governor vessel vertically until it is warm

Press and rub Xinshu (BL 15), Geshu (BL 17), Zusanli (ST 36) and Sanyinjiao (SP6) until it is slightly aching and distending

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Zhongwan ( 中脘 ) ， Tianshu ( 天枢 ) ， Qihai ( 气海 )

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Yingxiang ( 迎香 ) ， Cuanzhu ( 攒竹 )

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Xinshu ( 心俞 )

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Geshu ( 膈俞 ) ， Ganshu ( 肝俞 ) ， Pishu ( 脾俞 ) ， Shenshu ( 肾俞 )

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Sanyinjiao ( 三阴交 )

(7) KIDNEY DEFICIENCY

Rub in circle the abdomen for 6-8 minutes, especially Qihai (CV 6) and Guanyuan (CV 4)

Rub the governor vessel horizontally

Press Shenshu (BL 23) and Mingmen (GV 4) and waist until warmth is felt

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Shenshu ( 肾俞 ) ， Dachangshu (大肠俞 )

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Mingmen ( 命门 )

(8) BLOOD STASIS

Press and knead Taiyang (EX-HN 5), Cuanzhu (BL 2), forehead and tempus where the gallbladder runs

Rub the forehead and both sides or Taiyang (EX-HN 5) until it is warm

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CAUTIONS1. Patients with headache due to

exogenous pathogenic factors must keep warm, avoiding wind and cold and taking sufficient rest

2. Patients with headache due to hyperactivity of liver Yang should frequently test blood pressure, pay attention to the undulation of blood pressure and its influence on the heart.

3. Patients with headache due to blood deficiency and kidneys deficiency should avoid excessive sexual intercourse

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CAUTIONS

4. Stop smoking and drinking is helpful for healing different types of headache

5. Tuina therapy is not suitable for intracerebral diseases, such as cerebrovascular disease at the acute stage, cerebral contusion, and encephalic traumatic hematoma

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THANK YOU