Volume 9, Number 3 | Fall 2014

Clinical Report 1 (Acupuncture)
One Case in Which Moxibustion Applied at GV12 andBl17 Seemed to have been Markedly Effective forHeadaches and Physical Fatigue Aggravating after HighSchool Entrance Examinations

patient expressed her wish to try it if possible andAkio Manabe

needle was forced through (difficult to express inAcupuncture Department ofwords). She was constantly uncomfortable andEhime Prefectural Central Hospital

influenced by the weather (rain and humidity had anthus visited the acupuncture and moxibustion
section of the department of Kampo internalmedicine in this clinic.
The had strong parietal headaches that felt like aaggravating tendency). Severe headaches werePatient: 17-year old girl, first-year high schoolaccompanied by nausea.

student

Currently she feels shooting pain whenever she

Chief complaint: headaches, general physical fatigue

moves her head and in association with that

Past history:

develops mild nausea. Moving is painful.

From the age of 13 she started to suffer from

General physical fatigue developed from about theheadache attacks once or twice a month. When shesame time the headache attacks started and areattended a training camp of her high school club atcurrently so trying that commuting to school is not

the age of 16, she developed a high fever. After thatpossible.

the frequency of the headaches increased so that she

In the department of pediatrics in hospital N avisited pain clinic T, where she was diagnosed withcombination

migraine without aura and prescribed sodium"Keishikajutsubuto"

valproate and ibuprofen, but the frequency ofindication of the formula "Keikyososooushinbuto".

of"Maobushisaishinto"

andwastheprescribedforheadaches increased still further. Due to the weakeffects of ibuprofen, she visited in August of X-1 theCurrent condition: 163 cm,60 kg

headache center of hospital T. There too an

Tonguepurple;aggravationindentations; thin white coat; varicose veins present.

ofthenausea,

vomiting,

diagnosis:

lightminor

teeth

hypersensitivity to light and sound was observed,

Pulse diagnosis: deep, slightly rapid.

was also diagnosed with migraine without aura andAbdominal diagnosis: abdominal wall tone 4/5; mildprescribed a triptane preparation. Based on a 49-feeling of pressure below the heart; mild degree ofpoint score using a self-evaluation diary for

rigidity and fullness in the lower abdomen on thedepressive mood, she was diagnosed as being "mildlyleft; mild degree of hypochondrial fullness anddepressive".

tenderness.

However,sincenoimprovement(decrease) in the frequency of the headaches wasSkin: many bruises; on the back many skin eruptions.

achieved in this headache center, she consulted in

Chilling: objectively the feet are very cold from below

January of X-year the department of pychosomaticsthe ankles, but subjectively the patient does notin hospital N. Yet, even there the conditions

complain of cold feet.

improved only very little, so that the physician in

Meridian point diagnosis:

charge of the psychosomatic ambulance referred thetender depressions: GV12, GV4

patient to physician U of the pediatric department.

tender indurations: BL17, KI2

Based on the Kampo treatment initiated byfine floating vessels: in the vicinity of GV12

physicianedema: parietal region

therewasimprovement,but

physicianUacupunctureandmoxibustion

treatment.

20Uatendency

towardrecommended

Time-series analysis and treatment planTheThe Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

Volume 9, Number 3 | Fall 2014

Based on the time-series analysis, a past history ofIn the acupuncture and moxibustion treatment

chronic paranasal sinusitis, irritability and quick-section the moxibustion treatment was continued,

tempered character traits conceivably indicates afine floating vessels in the interscapular region wereclassification as detoxication constitution according

punctured, and moxa needling at GV12, BL17 andto the "Ikkando medical view". Since she had her

GV4 added to the treatment regimen.

menarche at the age of 10 and after that experienced

Dr. Kakuto of the department of Kampo internal

abdominal pain, headaches, dizziness as symptoms

medicine added GB40.

of menstrual pain, she may also be considered toFifth visit (X, 9, 13)suffer from a stagnant blood constitution.

WhileAlso,

she

still

haddifficulties

gettingup,

while she is already 17 years old, she gives ancommuting to school became possible. She reported

immature impression, so that the use of GV12 anda decreased frequency of the headaches.

GV4 said to be highly effective for infants according

The acupuncture and moxibustion treatment wasto the Sawada style moxibustion was considered,

the same as during the previous session.

presuming the liver to be the viscera mainly affected

Sixth visit (X, 10, 21)

and thus the conceived treatment plan based on theSchool

concept of relieving blood stagnation (improving

headaches had reportedly decreased.

circulation)

The acupuncture and moxibustion treatment wasandimproving

thedetoxication

constitution, helping to improve the circulation of qi.

attendance

possible;frequency

ofthethe same as during the previous session.
Course evaluation questionnaire
Headaches ・・・・・・・ B (have improved, but areCourseoccasionally bad)First visit (X, 6, 21)
Moxibustion: at GV12, BL17, GV4, SP6, KI2

Generalized fatigue ・・・ B (has improved, but isoccasionally bad)Second visit (X, 7, 7)
Headache relieved from 10→3
Physician U at hospital N changed the prescription
from goreisan to nichinto.

Menstrual pain ・・・・・・ B (has improved, but isoccasionally bad)
Easy irritability ・・・・・・・ B (has improved, but

Addition of GB21 and GV9 to the initial moxibustion
points and warming moxibustion on the lower

is occasionally bad)
Quick temper ・ ・ ・ ・ B (has improved, but isoccasionally bad)abdomen.
Third visit (X, 7, 28)Seventh visit (X, 11, 25)

The patient apparently suffered since July 25 from a

She reported still having headaches, but wasright-sided temporal headache that felt, like she had

nevertheless able to attend school and classes.

been beaten.

The acupuncture and moxibustion treatment was

Physician U at hospital N changed the prescription

continued.

to keishininjinto.

Physician U at hospital N prescribed shinbuto andIn our clinic the moxibustion treatment was

bushi (aconiti tuber).

continued.

Through the treatment by Dr. Kakuto of theFourth visit (X, 8, 16)

department

The headache apparently peaked upon getting up in

developed more energy and recovered to the degree,

the morning, by 1 o'clock in the afternoon andthat she became motivated to study.

around 6 o'clock in the evening.

Eighth visit (X, 12, 21)ofKampo

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

internalmedicine

she21

Volume 9, Number 3 | Fall 2014

She reported still having headaches, but wastrend.

Usingmoxibustion

nevertheless able to attend school and classes.

symptoms and relieves stress, but by relying on

The acupuncture and moxibustion treatment wasparents for support we would like to see, even if thiscontinued.

is still a premature conclusion, a reduction in theBased on information from Physician U at hospitalsuicide rate.

N, currently only shinbuto is prescribed.
Nineth visit (X+1, 1, 27)
VAS assessment
Headache：10→3.5

Generalized fatigue：10→4
She

wasabletoperform

daily

moxibustion

treatment at home. She also reported having theimpression shinbuto was effective. The frequency ofthe headaches as her chief complaint

decreased

and the migraine without aura showed a tendency
towards improvement. The generalized fatigue alsoimproved.
Discussion
Blood stagnation being considered to be the main
pathology in this patient the, we used the meeting
point of the blood BL17. Again, according to theIkkando classification we thought, we were dealing
with a detoxication constitution and thus applied
moxibustion at KI2 to improve this constitution. We
also used GV12 to regulate the flow of qi. This
treatment seemed to have been markedly effective inthis patient. In this case the compliance regarding
moxa treatment at home was almost 100%, showing
the potential of care by the parents.
Conclusions
This patient gave the impression, that her visiting
our clinic was like she would clutch even at straws
considering her background of severe headaches
caused by migraine without aura, which had forced
her to repeat a year in high school.
Recently many teenage children have visited ourclinic, revealing a glimpse at the magnitude of thestressfulenvironmentofthesechildren.

TheJapanese Cabinet too has pointed out, that thesuicide rate among teenagers shows an increasing

22

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

not

onlyimproves