The Bandits’ Rebellion
On the Pathogenesis of Headache
We’re getting ready to launch our online headache course in the next couple of weeks. It will kick off with a free live session on December 16th; the session will run for an hour and it will count as 1 CEU for several acu-orgs (including NCCAOM). If you are interested, you can find out more and sign up here.
Headache: A Qīng-era Perspective
I’ve been compiling the last bits of content to cram into the presentation (my students well know how I like to stuff my lectures with information). I am concentrating on acupuncture in the course, though there will be herb formula recommendations given as well. It is a clinically focused course, so there is not a lot of historical discussion, but I will still drop some old texts in here and there. One of the passages I will touch on comes from Zhēn Jiǔ Féng Yuán (針灸逢源, Encountering the Origins of Acumoxa) by Lǐ Xuéchuān, written in 1815 during the Qīng era. It offers an interesting take on the differentiations and treatment that are usually taught in TCM programs.
頭痛 風寒客於經絡。令人振寒頭痛。身重惡寒
腦痛連兩額屬太陽 頭額痛連目齒屬陽明 頭額痛連耳根屬少陽 太陽穴痛屬脾虛 巔頂痛屬腎 目系痛屬肝
百會 天柱（真頭痛速灸此三穴） 風池 風府 前頂 上星 攢竹 後谿 腕骨 少海解谿 絲竹空 中渚 合谷 頭維 頭臨泣 足臨泣（絲竹空下治偏頭痛。以上諸穴當驗邪所從來擇用之）
Headache: Wind cold lodges in the channels and network vessels, causing shivering and headache, heaviness of the body and aversion to cold.
Pain in the brain together with the forehead pertains to tàiyáng; frontal head pain together with the eyes and teeth pertains to yángmíng; frontal head pain together with the ear root pertains to shǎoyáng; pain at the Tài Yáng point [i.e., temples] pertains to spleen vacuity; vertex pain pertains to the kidney; pain in the eye system pertains to the liver.
Bǎi Huì [GV20], Tiān Zhù [UB10] (for true headache, quickly apply moxibustion to these three points), Fēng Chí [GB20], Fēng Fǔ [GV16], Qián Dǐng [GV21], Shàng Xīng [GV23], Zǎn Zhú [UB2], Hòu Xī [SI3], Wàn Gǔ [SI4], Shǎo Hǎi [HT3], Jiě Xī [ST41], Sī Zhú Kōng [TB23], Zhōng Zhǔ [TB3], Hégǔ [LI4], Tóu Wéi [ST8], Tóu Línqì [GB15], Zú Lín Qì [GB41] (Treat below TB23 for one-sided headache. The above-named points should be selected for use based on examining the location of the pathogenic factors).
Mulch comments:
· The differentiations here vary somewhat from those we see in books like Maciocia’s The Practice of Chinese Medicine, in which frontal headache pertains to yángmíng, occipital headache pertains to tàiyáng, temporal headache pertains to shǎoyáng, and vertex pain pertains to juéyīn. Maciocia references Lù yǐ 陆以, Lěng lú yī huà 冷庐医话 [Medical talk from the deserted cottage] from 1897, which is of course also a Qīng-era perspective.
· Spleen vacuity showing at the temples is something I talk about in the course, though it shows up in my clinic as a spleen pattern with shǎoyáng channel heat.
· True headache is a term that denotes a severe life-threatening condition. These days, it might be something along the lines of a sub-arachnoid hemorrhage. Wáng Xùgāo says in Yī Xué Chú Yán: 真正頭痛，痛連及腦，手足寒冷至節，死不治，用黑錫丹。[In true headache, the pain reaches to the brain, and the arms and legs are frigid up to the joints, one will die without treatment, use Hēi Xī Dān.]
There is a more extensive discussion on headache later in Zhēn Jiǔ Féng Yuán; I likely won’t have time to unpack it in the live session but I will just post my working translation of it here.
頭痛
頭為天象六腑清陽之氣。五臟精華之血。皆會於此。天氣六淫之邪。人氣五。賊之逆皆能相害或矇蔽其清明。或壅遏其經隧。與正氣相搏。鬱而成熱脈澀而痛。若邪氣稽留脈滿而氣血亂。則痛乃甚。此實痛也。寒濕所侵真氣虛弱。雖不相搏成熱。然邪客於脈外。則血澀脈寒。捲縮緊急。引小絡而痛。得溫則痛減此虛痛也。因風痛者抽掣惡風。因熱痛者。煩心惡熱。因濕痛者。頭重。天陰轉甚。因痰痛者。昏重。憒憒欲吐。因寒痛者絀急而惡寒戰慄。氣虛痛者。惡勞動。其脈大血虛痛者。善驚惕其脈芤頭痛自有多因。而古方每用風藥者。高巔之上惟風可到。味之薄者。陰中之陽。自地昇天者也。在風寒濕者。固為正用。即虛與熱者。亦假引經。
Headache
The head serves as the celestial appearance of the clear yáng qì of the six fǔ, and the essence and bloom of the blood of the five zàng. It all meets here: the celestial qì’s evils of the six excesses, and the five human qì. The bandits’ rebellion can cause injury among them or cover over their clarity and brilliance, or congest and obstruct the channel passages. As it engages in mutual struggle with the correct qì, the depressed qì causes the formation of heat and a choppy pulse as well as pain. If the evil qì is detained and lodges, the pulse will be full and the qì and blood will be in chaos. As a result, the pain will be extreme. This is a replete type of pain. As cold and dampness encroach, the true qì becomes empty and debilitated. Even though there is no mutual struggle, heat will form. Thus, the guest evil is outside the vessels, and so the blood is rough and the vessels are cold. There is urgent curling up and contraction from tension in the tiny network vessels causing pain. If the pain is diminished with warmth, this is a vacuity type of pain. Pain caused by wind will result in contractions and pulling along with aversion to wind. Pain caused by heat will result in heart vexation and aversion to heat. Pain caused by dampness will result in heaviness of the head and extreme turning of the celestial yīn [i.e., clouding]. Pain caused by phlegm will result in severe dizziness and confusion, and a desire to vomit. Pain caused by cold will result in urgent stitching pain and aversion to cold with shivering. Pain from qì vacuity will result in aversion to physical labor; the pulse is large. In blood vacuity pain, there is a tendency to fright and apprehensiveness; the pulse is hollow and it frequently causes spontaneous headache. The ancient formulas all use wind medicinals. Only wind can reach all the way to the vertex. These are light-flavored medicinals that are yáng within yīn. They naturally rise from earth to heaven. They are in the wind-cold-damp [category]. Securing [medicinals] are proper to use if there is vacuity along with heat. Also add channel conducting [medicinals].
醫書多分頭痛頭風為二門。然一病也。淺而暴者名頭痛。深而久者名頭風。頭風必害眼者。經所謂東風生於春。病在肝。目者肝之竅。肝風動。則邪害空竅也。
Medical texts frequently divide headache and windstrike into two different chapters. Nevertheless, they are one disease. Cases that are superficial and acute are called headaches. Cases that are deep and chronic are called windstrike. Cases of head wind will cause harm to the eyes. The classic opines that the east wind is engendered in the springtime. The disease is in the liver. The eyes are the orifice of the liver. When liver wind stirs, then the evil will injure its empty orifices.
久頭痛而略感風寒便發。須重綿包裹者。此屬鬱熱。蓋本熱而標寒也。因其本有鬱熱。毛竅長疏。故風寒易入。□□內熱。閉逆為痛。惟瀉火涼血。佐以辛溫散表。
If in chronic headache a slight contraction of wind cold then develops, it will feel heavy as if wrapped in cotton. This is categorized as depressive heat. The root is in fact heat but the branch is cold. The root cause is depressive heat. The hair orifices are always lax, therefore wind and cold can easily enter. [?? text missing] …internal heat. Blockage and reversal result in pain. Just drain fire and cool blood. Assist it with acrid warming to scatter the exterior.
Mulch comments: the bit of missing text here went missing in every online copy of the text I could find. I suspect it referred to the process of obstruction by exterior evils causing internal heat.
頭痛雖各經皆有火證。陽明為最。正以陽明胃火盛於頭面。而直達頭維故其痛必甚。脈必洪。多內熱口渴。其或頭腦振振痛而兼脈絕無表邪者。必火邪也。白虎湯加生地麥冬木通澤瀉。他經則芍藥花粉芩連知蘖龍膽梔子擇用之。但治火不宜佐以升散。蓋外邪之火。可散而去。內郁之火。得升愈熾矣。
With headache, although there is a fire pattern for each of the channels, yángmíng causes the most. Yángmíng stomach fire exuberance shows up primarily in the head and face, and it spreads through Tóu Wéi [ST8], so the pain is severe. The pulse will be flooding. Often the interior heat makes one thirsty. Cases involving the head and brain with trembling and pain as well as both pulses exhausted and no exterior evil must be caused by fire evil. Use Bái Hǔ Tāng [White Tiger Decoction], adding Shēng Dì [Radix Rehmanniae], Mài Dōng [Radix Ophiopogonis], Mù Tōng [Caulis Akebiae], Zé Xiè [Rz Alismatis]. For the other channels, use Sháo Yào [Rx Paeoniae], Huā Fěn [Rx Trichosanthis], Qín [Rx Scutellariae Baicalensis], Lián [Rz Coptidis], Zhī [Rz Anemarrhenae], Niè [Fr Hordei Germinatus], Lóng Dǎn [Rx Gentianae], Zhī Zi [Fr Gardeniae]. However in treating fire it is inappropriate to use ascending and scattering [medicinals]. This will build up the external evils’ fire. One can use scattering and discharging for internal depression fire, but the more it ascends, the more it blazes.
That’s all I’ve got for now. As always, thanks for reading.
Note: this publication is for information purposes only and is not intended as medical advice. Please seek the opinion of a health care professional for any specific medical issues you may have.
References
Lǐ, X. (1815). Zhēn jiǔ féng yuán. https://jicheng.tw/tcm/book/%E9%87%9D%E7%81%B8%E9%80%A2%E6%BA%90/index.html
Maciocia, G. (2022). The practice of Chinese medicine: The treatment of diseases with acupuncture and Chinese herbs. (3rd Edition). Elsevier Health Sciences (US).
Wáng, X. (1862). Yī xué chú yán. https://jicheng.tw/tcm/book/%E9%86%AB%E5%AD%B8%E8%8A%BB%E8%A8%80/index.html
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