Volume 6, Number 4 | Winter 2011

Clinical Report 2 (Kampo Medicine)
Headache 3

Mihoh Koga, M.D., Kampo Specialist

Research Assistant of Division of Clinical Pharmacology
and Therapeutics and Division of General Medicine
Jikei University School of Medicine< Migraine, chronic continuous dysentery, yangdeficiency, blood deficiency, blood stasis, liver qi
stagnation >Case (8): age 35 years, female, pharmacist, visited inMarch XY
Chief complaint: headache, sense of coldness of thelower half of the body, constipation, insomnia, easy
susceptibility common cold, menorrhalgia
Present illness:
Since her high-school days she developed every
afternoon a headache that radiated to the left
temporal region and required in severe cases the useof commercial analgesics. Recently she has been
under the impression that the effectiveness of theanalgesics

hasdecreased.

Severeheadaches

occurring once or twice a month require that she
takes to bed, but they seem not to be related to her
menstrual cycle. Although she has sufficient energy,
she lacks physical strength. When tired, the musclesof the right upper arm produce a dragging pain, after
which she reports the development of pharyngeal
pain and fever. She has been constipated since her
youth with one bowl movement every 10 days, or 1-2
bowl movements per week, if she took 1.5 times thenormal amount of senna. Serious of character.
Previously the use of tokakujokito for constipation
caused the onset of severe dizziness and headaches.
Findings upon first visit:
Average height and weight with a normal bodytemperature of 36.3℃, little facial expression andspeech as if suppressing her voice. Menstrual cycleof approximately 30 days, containing blood clots,
menorrhalgia. The pulse was thin and wiry, thetongue dark red and moist with a white fur, engorgedsublingual veins, presence of fullness, tenderness or
discomfort of the hypochondrium, chilling of theepigastric region and tenderness on the left side of
the naval.
Pattern: yang deficiency, blood deficiency, bloodstasis, liver qi stagnation
First prescription: tokishigyakukagoshuyushokyoto
Course:The prolonged use of senna had led to chronic
continuous dysentery and thereby induced bloodstasis, while the liver qi stagnation was considered toprevent recovery. First, in order to relief the chronic
continuous dysentery tokishigyakukagoshuyushokyoto
was chosen, the use of senna for the constipation
discontinued and instead Mashiningan once dailyprescribed. This also improved the effects ofanalgesics used for the treatment of the headache, theseverity of which gradually decreased, but since theirfrequency did not change, they still caused anxiety.
Bowl movements improved to once every three days.
Taking the formula prescription over a period ofhalf a year improved the sense of coldness of hands
and feet, but the sense of exhaustion did not even
improve with sleep and increasingly strong stress atwork influenced also the pulse and abdominal
findings, so that the prescription was switched to
yokukansankachinpihange. Although the coagula in
the menstrual blood disappeared and themenorrhalgia improved, the patient suffered fromsevere headaches during the latter half of themenstrual cycle. Prescription after half a year:
shakuyakukanzoto (each 2/3 of the dose).
After one month of treatment improvements ofboth the frequency and severity of the headaches
were observed and after half a year the use ofanalgesics had become unnecessary and headaches
werealleviatedwithsingle
dosesoftokishakuyakusan. By then the patient had
comfortable bowl movements even without the use of
Mashiningan once every 1-2 days.
■ Discussion
1.

"Pain"In Kampo medicine pain is considered to have thefollowing causes. "For the activities of mind and bodyqi, blood, and body fluids must circulate without

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Volume 6, Number 4 | Winter 2011

excess or deficiency. However, when there are

2. Types of headache and pathologic condition

deficiencies in the functions of qi, blood, and body

Here I would like to discuss, adding a few

fluid or a stagnation of their flow preventing theircomments about the individual cases, the types ofeven distribution pain will result." This may beheadache and their correlation to the patterns.

caused by influence of the six excesses or seven

1) Tension headacheemotions, exhaustion, unwholesome dietary habits

Tension headache is characterized by a sense ofand similar factors, variations in the body's internaltightening of the head with a heavy, dull kind of pain

environment or disorders causes by exogenousthat continues typically on a daily basis and which ispathogenic factors.

usually triggered by increased muscle tension or stress.

The clinical aspects of headache too have to be

The heavy, dull pain is characteristic for aconsidered depending on the pathologic condition. In

stagnation of dampness. It also resembles thisother words, there are three different views of thecondition in that it is alleviated by massage etc. Thecondition, including the questions A) Is there ageneration of dampness due to spleen deficiency isstagnation of qi, blood or body fluids?; B) Is there

considered to be one of the distal factors andmaybe a deficiency of qi and blood or yin essence orillustrated in the cases (1), (2) and (3). Improvement

else nutrients (nourishment)?; and C) Are there anyof all symptoms after administering bukuryoin tomental factors leading to aggravation of the pain?

patients visiting our clinic with headache andThese different aspects A, B and C do influence eachchronic gastritis is something we experience on aotherobserved

rather regular basis in our outpatient department.

simultaneously. It is important to ascertain the real

Again, a state of muscle tension can be considered tonature of the pathologic condition, but depending on

represent a state of malnutrition for the muscles

the symptoms this may often prove to be difficult.

themselves and considering that the spleen ismutuallyandareoften

Yet, among these aspects the one mentioned andsupposed to nourish the skin and underlying flesh,b) "presence of deficiency" causes pain and isrelaxation of the muscles is an essential aspect of thetherefore called "deficiency pain". Qi and blood

treatment

mutually generate each other and supplement

correlation between the state of the health of spleen

shortages, so that states of deficiency continuing

and stomach on the one hand and tension headacheover extended periods of time will eventually resulton the other hand. Among these patients inin deficiencies of both qi and blood. For this reasonsparticular case (2) was interesting, considering thepain that has become chronic, will also becomefact, that the effective prescription for single use

refractory to treatment and the deterioration of thevaried

bodily environment and the ensuing insufficiency ingastrointestinal symptoms.

pharmacokinetics may then possibly result in adecrease of the efficacy of analgesics.
Also,"chronicdiseases

inevitably

andsuggests

dependingon

thatwith

there

theis

some

presenceofMoreover, in cases of blood deficiency thereactivity towards the pain decreased and theseareaccompanied by blood stasis" and it is said, that "inpatients characteristically presented often with amild, but nagging and continuous pain.

the presence of blood stasis, treat this first".

This resembles the pain of tension headache.

Therefore, in cases of chronic headache it isWhen like in case No. 3 the condition was based on

important to take blood stagnation = blood stasis

anemia, or in case No. 4 where the condition wasalso into consideration.

triggered by a pregnancy, a post partum or postmenstrual headache should be considered.

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The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

Volume 6, Number 4 | Winter 2011

Case No. 5 is an example of qi stagnation causedby the stress after employment.

daiobotanpito, indicating that the nature of theheadaches and constipation as well as the mental
condition are important criteria for the treatment.

2)

Migraine

Otherwise, I often experienced that during theMigraine is characterized by a throbbing pain

therapeutic course following treatment of malignant

occurring several times a months in form of attacks,

tumors or treatment of a collagen diseases and theassociated with nausea, hypersensitivity towards

like conditions migraine may develop and treatment

light and sound and similar symptoms. Generally,

were found to be markedly effective in cases

compared to tension headache, the pain is severe.

complicated by agitation and constipation.

Regarding severe pain there is a marked

The cold deficiency of spleen and stomach induced

correlation with excess patterns. In cases of excess ofby prolonged use of senna in case No. 8 led to thethe blood this manifests as blood stasis, while qi

development of a yang deficiency. Since "Bloodexcess gives rise to qi stagnation or rebellious qi. On

circulates by being warmed" coldness obstructs thethe other hand, fluid in these cases often occupies thecirculation of blood. For chilling of the hands and feetthird space and causes quietly concealed infiltration.

in the presence of chronic continuous dysentery and blood

Therefore, it is considered that even in cases ofstasis in the pelvis tokishigyakukagoshuyushokyoto isexcess there is no sudden rise in local internalvery effective. Moreover, circulation of the blood alsopressure and thus severe pain. Naturally, if fluid

requires the flow of qi. The stress at work impeded

were to be enclosed within cerebral ventricles or therecovery from the blood stasis further and thus I

capsule of surrounding tumors, it may come to excess

focused on regulating qi once the coldness had been

condition in these restricted spaces producing severe

alleviated, but the treatment still required the use ofpain. Also, the hyperesthesia's that often occur intokishakuyakusan with its blood stasis expelling

conjunction with the migraine are a pathologicalaction to supplement the blood.

condition in which the evil of an excess pattern ispresent and may easily imaginable trigger either
locally or systemically an state of high tension,suggesting a correlation with the excess pattern.

■ Conclusion
Among the forms of chronic headache tension
headache and migraine are frequently observed inBlood stasis is often responsible for locally fixed,

the Kampo outpatient practice. I presented a few

stabbing or else lancinating pain, while qi stagnation

cases and discussed them briefly. I also offered one

often produces wandering pain that feels like

opinion pertaining to the characteristics of bothstretching or swelling. In case No. 6 the "pain likeconditions and their pathological conditions in thebeing hit" is a form of lancinating pain often

Kampo medical sense.

observed with blood stasis. The "pain as if a heavystone lies inside" improved with treatment toregulate qi and thus is possibly related to qi
stagnation. In this patient the treatment should
probably have aimed from the beginning at expellingstasis and regulating qi.
In case No. 7 too blood stasis and qi stagnation

Combination of western medical diagnosis withTCM theory appears to be useful for providing the"individualized therapy" mentioned at the beginningrecommended by the AHA. Integration of TCM
theory into the therapy is considered to contributealso to the development of western medical care.

induced symptoms were prominent and tsudosan
proved to be markedly effective. The persistentconstipation required combination therapy withThe Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

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