Headache is a common clinical condition. Migraine occupies a considerable number in acupuncture clinics, and when it occurs violently, it can seriously affect the work and study of patients, so how to improve the efficacy of the disease in acupuncture clinics has important clinical significance. Now I will talk about my personal experience in combination with the literature, trying to clarify the ** and classification of migraine ** and the law of acupuncture ** from a clinical perspective.
Theory**
The cause of this disease has been concisely recorded in the classic literature. "Lingshu Convulsion Chapter" cloud: "The first half of the cold pain, first take the hand Shaoyang, Yangming, and then take the foot Shaoyang, Yangming." "Through rich clinical practice, generations of doctors have a more specific understanding of this disease, and we believe that migraine has many characteristics in addition to the common properties of general headache through clinical observation and literature records.
(a)**
The occurrence of this disease is of great significance due to internal causes. Because the head is the meeting of the sun, the place where the essence rises and falls, there are hair, hair, flesh, tendons, and bones on the outside, and there is a clear yang on the inside. In other words, those who have wind and evil and take advantage of the void to be less yang are mostly wind and cold, suffocated by yang qi, and those who are blocked by less yang meridians are mostly spleen deficiency and dampness, liver and gallbladder wind and heat, and those who are against phlegm are mostly phlegm fire. It is really a combination of wind, phlegm, and fire and becomes a disease.
In terms of external causes, wind chill is the most common among the six prostitutions, but from a clinical point of view, wind chill is an external cause and a "condition". The basis for the onset of the disease is still "intrinsic". As stated in "Su Wen: The Theory of Vitality and Vitality", ......The flesh is closed, although there is a strong wind and poison, and Fu can do harm. It is an appropriate reflection of the objective role of internal and external factors in the occurrence and development of the disease.
(2) Typing
We classify this condition based on clinical differentiation.
(1) Outside wind type:External wind is an important factor in the occurrence of this disease, according to the "Su Wen Feng Treatise": "...The wind's good deeds change ,......Therefore, the wind is also ,...... longIts evil enters from the Yu acupoint, follows the meridians, or merges into the Shaoyang meridians and causes the unfavorable veins and other ways, causing the meridians of half of the head to stagnate, and it is a migraine. Therefore, in the history of the disease, lying in the wind at night, sweating when the wind is an important basis for dividing this type, in the symptoms, there is persistent swelling pain on the side of the head, which is aggravated every time it encounters wind and cold, and there are more pains at the acupoints of the wind pool, tightness, etc., or cough, Xiang Qiang, cold intolerance, pain in the joints of the whole body, etc., and the pulse is more floating. In the pathogenesis, it is the wind evil guest network, the veins are occluded, and the wind is used to clear the meridians on the **.
(2) Real heat type:Hepatobiliary fever is the basic cause of the disease. The liver belongs to the wind wood, hides the soul, is angry in the will, the main article is reached, if the will is not successful, the liver qi is stagnant, and after a long time, it turns into fire and wind. In terms of symptoms, the hemicephaly is throbbing pain, the pain is like a crack, the face is red and the eyes are red, the temperament is irritable, the tongue is red and greasy, and the pulse is like a string. In terms of pathogenesis, the liver and gallbladder are blazing, and the head is reversed, and even the liver and gallbladder are blazing. The treatment is mostly to calm the liver and diarrhea fire. The prognosis is worse than that of the upper type, the process is longer, and the short-term effect of those with external wind is good, and it is also easy.
(3) Wet sputum type:Weakness of the spleen and stomach is the basic cause of the occurrence of this disease, and the liver and wood are multiplied by the soil and the phlegm is reversed, which is an important condition for the occurrence of this disease. In the symptoms, the head is dull and painful, swollen and stuffy, and the chest is stuffy, the bad smell is less eaten, the tongue coating is thick and greasy, and the pulse is slippery or slow. In terms of pathogenesis, the spleen and stomach are weak, the middle qi cannot be transported into the water valley, the phlegm and dampness block the middle coke, the liver and wood multiply the soil, and the phlegm is reversed along the Shaoyang meridians, or the three coke deficiency and fire float as migraine. **It is advisable to strengthen the spleen and dissolve phlegm, calm the liver and reduce adversity. The selection and coordination of the two methods of strengthening the spleen and flattening the liver in the prognosis are of great significance to the course and effect of the disease, and the appropriate application can achieve healing. However, this type of migraine is complex and difficult to achieve quick results.
(3) **Summary
On the basis of following the general principle, fully according to the symptoms, the syndrome differentiation and treatment were flexibly carried out, and the following is discussed from three aspects: acupuncture points, the use of bloodletting and acupuncture techniques.
(1) Acupuncture and formula
We take meridian activation, wind and pain relief as the basic formula of each type, and select silk and bamboo empty permeability valley, Hegu, column shortage, foot crying, with wind pool, Qu Chi, absolute bone and other acupoints as a group.
Each acupoint in this group has the effect of Xuantong foot and Shaoyang meridians, dispelling wind and relieving pain. From the meaning of the word, the silk bamboo empty is the place where the foot Shaoyang vein qi originates, and it is also the termination point of the hand Shaoyang meridians, and the acupuncture point itself can ** migraine, penetrate along the skin to the rate valley, and strengthen the role of dredging the hand and foot Shaoyang meridians. This is because the rate valley acupoint is not only the acupuncture point of the Zu Shao Yang meridian, the main treatment of migraine, but also it is the acupoint of the Zu Shao Yang and the two meridians of the Zu Shao Yang, which has the effect of evacuating the wind and heat of the Shao Yang and making it follow the Sun meridian to the surface.
Therefore, the Sizhu Empty Permeability Valley is the main acupoint of Xuanxuan Shaoyang meridian wind heat, and it is the effective Yu acupoint of all migraines, in all of our cases, more than 90% of the cases have used this acupoint, and they have obtained quite good results.
Hegu, Lieqi, Hegu is the original acupoint of hand Yangming, which has a wide range of ** effects and has the characteristics of calming pain and relieving pain. According to Ma Danyang Tianxing's 12 acupoints for the treatment of miscellaneous diseases, it is recorded that "the column is good at curing migraines." Matching with Hegu acupoint, it has the meaning of the original network acupoint.
Foot crying is the foot less yang gallbladder meridian Yu acupoint, is the bile meridian note, according to the theory of the five acupoints for the "Yu Mu" acupoint. It has a good effect on diarrhoea and less yang wind heat. Because it is far away from the sick place, it has the effect of inducing heat to descend. "The Wings of the Book of Analogy" says that "those who have more wood should pour out this, so that the fire is empty and the wood is flat", which also confirms the importance of this acupoint in dispelling fire.
The above formula is not only suitable for migraine of external wind type, but also the "basic formula" of damp phlegm type and real heat type, the latter as long as it is properly matched with the acupuncture points of strengthening the spleen and dissolving phlegm, flattening the liver and dispelling fire.
Damp phlegm type migraine, with cranial suspension, jaw disgust, middle navel, Zusanli or Fenglong, qi sea (acupuncture and moxibustion). In addition to having a prominent effect on migraine in the meridian circulation, it is also the Yu acupoint where the two meridians of Zu Shaoyang and Yang Ming intersect, and it has the effect of channeling the stomach and invigorating the middle yang. As for the middle navel, it is the meeting of the six intestines, which is particularly effective in warming the phlegm and dampness of the middle coke, and reducing the upward rush of stomach qi. The sea of qi mainly treats the deficiency of true qi, treats all kinds of losses and damages, and strengthens the gasification of the lower coke, so that the middle earth will benefit itself. Moxibustion can be added.
For patients with real heat, it is often equipped with silk bamboo air, inner Yingxiang bloodletting, four gods, and acupoints such as between the lines. The silk bamboo is pierced into the bloodletting, the liver and gallbladder are blazing, and the inner Yingxiang has an immediate effect on the migraine caused by the heat of the head and the stagnation of the veins and the blood stasis. "Lingshu Convulsive Pain" "syncope headache, head pulse pain, heart sorrow, good crying, optic cephalic artery reversal, puncture to remove blood, and then adjust the foot syncope yin" was the earliest record of the method of bloodletting **headache.
In addition to the local analgesic effect, it has a significant effect on flattening the liver and soothing the wind.
We take a group of acupuncture points of "Silk and Bamboo Empty Valley, Hegu, Column Deficiency, and Foot Crying" as the "basic formula" of various migraines, and we use this group of prescriptions in clinical practice, and have obtained certain effects on various types of migraines. Although there are many primitive migraines, they are more or less invaded by external winds. Therefore, it is important to first use dispelling wind to achieve short-term pain relief, and then consider ways to cure the root cause. It also embodies the spirit of the "Neijing" in which the urgency is to treat the symptoms, and the slow is to cure the root cause.
(2) Application of bloodletting
Bloodletting is an important part of acupuncture, in the "Lingshu Nine Needles and Twelve Originals" and "Small Needle Solution" Blood Network Theory" have detailed records of the role, differentiation and technique of bloodletting, such as "Yun Chen is removed" ("Nine Needles and Twelve Originals"), and those who are removed by Chen are also removed from the blood vein" ("Small Needle Solution"), these records of the "Neijing" all show that bloodletting can eliminate stagnation in the blood, so bloodletting has the effect of removing stasis and passing through the meridians.
Because migraine is locally manifested as a pathogenesis of "pain if it is not general", we administer phlebotomy clinically, not only for solid patients, but also for hypocrisy. According to the principle of "those who see the cephalic artery is anti-prosperous, puncture and remove blood", sometimes we choose the "inner Yingxiang acupoint" to bleed. In terms of operation, the number of solid bloodletting, the amount of blood can be more, the acupuncture is deeper, and the virtual one can be reduced. In short, clinically, it is necessary to flexibly grasp the patient's state at that time, the situation of the virtual and real veins, the depth of the blood, the viscosity of the blood, and the difficulty of bleeding.
(3) Technique requirements
Acupuncture techniques have an important relationship with the efficacy of diseases, and due to the different techniques of each family, the following only proposes the techniques that we commonly use in clinical practice.
For unilateral migraine, most of them only needle the affected side, each acupoint uses the laxative method, the head acupoints use the twisting and turning laxative method, and the acupuncture points of other parts use the lifting and inserting laxative method, and the acupoints far away from the sick place, such as Hegu and the feet are crying, then use heavy techniques to make the acupuncture sensation disperse to the extremities along the meridians or go up to the trunk. A few have direct access to the clinic. According to our experience, the farther the sense, the better the effect.
Typical case
Example 1:Zhou, male, 55 years old, medical record number 675. Date of initial visit: October 5, 1961. He reported that he suddenly had a headache on the right side six days ago, with a throbbing sensation, involving the root of the ear and neck, aggravated by the wind, and the two pulses slowed down. The syndrome is invaded by external winds, and the guest is in the Shaoyang meridians, and the method of dispelling wind and relieving pain is given, and the affected side is acupuncture: Sizhu Empty Permeability Valley, Fengchi, Hegu, Lieqi, Puff Wind, Hearing, use the laxative method, and leave the needle for 20 minutes.
Second diagnosis: On October 7, the headache after acupuncture was significantly improved, only a little pain around the evening, and the shoulder and neck were still uncomfortable.
Example 2:Liang, medical record number 2212, male, 43 years old, date of first consultation: January 4, 1963. Left side headache for 11 years, long treatment has not healed, sometimes light and sometimes severe, in the past month due to work fatigue, the pain has intensified, even the left eye swelling pain, accompanied by tinnitus, dizziness, numbness in the left half of the body, sluggish consciousness, acceptable food intake, because of the headache restlessness, thin white tongue, thin pulse. The syndrome is excessive exhaustion of qi and blood, so that the water does not contain wood, and the wind evil takes advantage of the void to enter the guest Shaoyang, induces the liver wind, disturbs the clear body, first intends to clear the wind to dispel the evil, pass the menstruation to relieve pain, and the rest of the evidence is slowed down. Acupuncture points: silk bamboo empty permeability valley, wind pool, valley, column shortage, foot weeping, puff wind, all needles on the affected side, all use laxative method, leave the needle for 20 minutes.
Second diagnosis: On January 6, the post-acupuncture migraine was not made, and then the original policy was used twice, and it was easy to regulate qi and blood. He was cured with a second injection. Note: The rapid effect of this case is due to the fact that the patient's diet is still good, the spleen and stomach are relatively healthy, the qi and blood are easy to regulate, and the external wind is shallow, so the pain is relieved after only three injections, and the pain is cured after five times.
Example 3:Fan, female, 30 years old, medical record number 174245 date of first consultation: March 27, 1961. The left migraine involves the brow bone, sometimes mild and sometimes severe, irritability and thirst, nausea, stomach discomfort, and white pulse. The syndrome is soil deficiency and wood multiplication, liver and gallbladder deficiency and heat coerce stomach qi upward reversal, involving Shaoyang, mimicking the liver and reducing inversion, and relieving menstruation and pain. Acupuncture points: silk bamboo air permeability valley, wind pool, Hegu, column gap, Taichong, use laxative method, needle the affected side, leave the needle for 20 minutes.
Second diagnosis: On March 29, the post-acupuncture headache was reduced, but the irritability and thirst were not reduced, the stomach was painful, and the pulse was stringy. Take the front plus the middle navel, full of three miles.
Third diagnosis: On March 31, the headache was significantly reduced, the stomach did not hurt, the irritability and thirst were also light, and the stomach was still nauseated, and the pulse was slightly stringy. According to this symptom, the trial system of Shaoyang meridians has been opened, and the liver wood has not yet been calmed, so it is mainly to calm the liver and reduce adversity. Acupoints: Zhongguan, Period Gate, Zusanli, Taichong, with Hegu, Lieqi, the same technique as before, Periodgate, Zusanli, Taichong are both sides of the needle, Hegu and Lie Gap are all needles on the affected side, and the needles are left for 20 minutes.
Fourth diagnosis: On April 3, the symptoms after the injection were significantly reduced, and then the original policy.