Volume 6, Number 1 | Spring 2011

Clinical Report 2 (Kampo Medicine)
Headache 1

In the present paper I would like to briefly
discuss a few cases of tension headache andMihoh 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 I have seen in our outpatient department.
Each case will be discussed focusing on the qi-bloodbody fluids aspects, trying to keep the terminology
as simple as possible.

[Introduction]
Headache is a symptom frequently encountered■ Casesin an outpatient office specialized on Kampo.

<Tension headache; prolonged cold, phlegm>

Generally, this condition is classified into

Case (1):46 years, female, housewife, clinic visit

primary headache, which in turn is classified into

in January XX

1) migraine, 2) tension headache, 3) cluster

Chief complaint: right shoulder pain, headache,headache, 4) headache associated with overuse of

dizziness (floating feeling), pollinosis

theAnamnesis: at age 35: enucleatic myomectomy

medications,andsecondary

headacheoccurring in the presence of an underlying disease.

At age 45: total hysterectomy because of myoma

Even

induced anemia

thoughremarkableprogresshasbeenof

At this time there were adhesions of the small

headache, the number of patients suffering fromintestines, requiring reoperation, during which aheadacheportion of the small intestines was removed.

achieved

regardingstill

theremains

pharmacotherapy
high.

The

migraineguidelines of the American Headache Society®
(AHS)

recommend

that"treatmentofacuteconditions should be individualized". Moreover,regarding the ideal pharmacotherapy for theprevention of attacks.
The relationship between diagnoses according to
the above described classification and specific"patterns" has not yet been clarified. Yet, throughintegration of TCM diagnostic methods a usefulconcept pertaining to the "individualized therapy"
can possibly be provided.
Practicing Kampo therapy and looking back at
cases with chronic headache, it appears that often
several patterns are involved. So far there has beena tendency of patterns like cold, blood deficiency,
blood stasis and phlegm being rather frequent, but
I believe the heat excess patterns are also on therise. Moreover, in cases of headache associated withrefractory diseases or overuse of the medications,
I have often experienced that the use of theformula that expel blood stasis led to an early
alleviation of the symptoms.

At age 45: pollinosis
Present illness:
Development of a chronic sense of fatigue
following the total hysterectomy, at rest discomfort
that felt like the right were about to solidify andpain of the right shoulder joint was so severe, thatit prevented sleep; chilling around the waist andthe thighs and a generalized feeling of edema overthe entire body. Considering the presence of pain as
if from pinching the right upper arm and stagnationof liver qi as well as blood deficiency into account,the formula nijutsuto and kamishoyosan wereprescribed. After 4 months of treatment theshoulder

pain

had

been

alleviatedalmostcompletely and the pollinosis considerably.
By the sixth months of the treatment theheadache and sense of floating grew worse andsymptoms were highly sensitive to low atmosphericpressure. The headache was reportedly associatedwith a slightly depressive heaviness. Recurrence ofthe temporarily relieved edema of the legs. The
patient

originally

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

hasatendency

towards
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Volume 6, Number 1 | Spring 2011indigestion. The husband is currently living alone

nervous and anxious. At that time she wasabroad because of his work.

diagnosed with amyloidosis of the skin and Sjörgren
syndrome. Headache often developed in case ofFindings:
Moderate build, skin slightly brown. Good
appetite, bowel movements and micturition normal,
but has a tendency towards constipation whennervous. During bathing the patient felt on thecontrary cold. She was the type of person that does
notsweat.

Herphysicalcondition

usedtodeteriorate in spring. Pulse was deep, slippery andwiry / weak right cun pulse, the tongue was pale redfatigue or when she had been under stress;
endurance of the symptom generally led to a
gradual increase in the pain, so that she had to takeanalgesics and lie down. The stomach responded
sensitively to the mental status and she complained
about heartburn, stomach disorder and a sense ofdistention.
Findings upon first visit:

but had a thick white fur coating its entire surface

Fair-skinned and leptosomatic habit, sloping

and teeth marks, sublingual veins were somewhat

shoulders. Visible amyloid depositions on theengorged. Mild degree of fullness, tenderness orabdomen and lumbar regions. Easily sweats on the

discomfort of the hypochondrium.

palms. Poor sleep. Occasionally soft stools. Thin

Pattern: Spleen – stomach deficiency -> phlegm,

and weak pulse, the tongue being pale red with aupward harassment of wind phlegm

thick, greasy white fur, stickiness within the mouth.

Prescription: hangebyakujutsutenmato

Engorgement

Following the third day of taking the prescription

ofabdominal wall.

patient

Pattern:reportedlyinvigorated.

Theveins.

Abdominal

palpation reveals clapotage and tension of thethe perceived fog in the head cleared and left thefeeling

sublingual

spleendeficiency,qistagnation,

heavyheadedness too improved. She experienced

countercurrent of phlegm

regular bowel movements, became able to sweat

Prescription: bukuryoingohangekobokuto

when bathing and thus felt fine. Temporarily
switching the prescription to ryokeijutsukantoresulted in recurrences of the headache, regularadministration of hangebyakujutsutenmato twice
daily and an additional dose when symptomaticallowed to control the symptoms and the patient iscurrently continuing this schedule. The patientreported that taking the medication helps to brace
her physically and makes her feel lighter both
physically and mentally.

Course:She started to enjoy her meals, the severity of theheadaches decreased and often she even forgot
about them. No use of analgesics. Use of single
doses of goreisan produced marked relief in case shehadaheadache.

Later,

targetingtheeasy

fatigability, xerophthalmia, poor sleep and the skin
symptoms her condition improved using a combinedprescription with ninjinyoeito, she could sleep
soundly and the headaches disappeared.

<Tension headache; spleen deficiency, countercurrent

Four years later, after she finally came to termsof phlegm>

regarding the death of her husband and her

Case (2): age 47, female, dental assistantstomach maintained a good functional condition,

Chief complaint: headache, stomach disharmony,treatment with bukuryoingohangekobokuto was

amyloidosis of the skindiscontinued. The nature of her work facilitated theAnamnesis:

development of high tension and easily led to theAfter the death of her husband she became24development of posture induced shoulder stiffness,

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

Volume 6, Number 1 | Spring 2011

which resulted in headaches (dull pain), but sinceFindings:

the condition of her stomach had improved, theFair-skinned obese, normal appetite, sleep andgoreisan had weakened, while
shakuyakukanzoto now had become markedlyexcretion. Becomes easily nauseated. Her condition

effective. It turned out to be a medication, which in

was enlarged, pale white, had teeth marks,

single doses provided refreshing relief and bestowed

sublingual veins had disappeared, the pulse wasupon her a feeling, as if the neck were straightening

deep and thin, the abdomen showed a generalized

and sometimes even extended to the head.

hardness and was mildly tender, there was fullness,

effectsof<Tension headache; spleen deficiency, cold phlegm,
blood deficiency >Case (3): age 40 years, female. Assistant in former
family business (restaurant)

used to vary with the menstrual cycle. The tongue

tenderness or discomfort of the hypochondrium andchilliness of the lower abdomen.
Pattern: blood deficiency, phlegm
Prescription: ryokeijutsukanto plus tokishakuyakusan

Chief complaint: headache, anxiety

Headaches tended to become worse during theAnamnesis:

latter half of the menstrual cycle and the lingual

At the age of 20 iron deficiency anemia (shefindings too suggested the necessity to take blood

sometimes takes iron supplements)

deficiency into account, but since the so far

At the age of 37 hypertension (initiation ofprescribed ryokeijutsukanto could not be expectedantihypertensive pharmacotherapy)

toPresent illness:

tokishakuyakusan was added. After the ingestion

have

any

blood

supplementing

effects,

From the age of 38 her nervousness increased, amarked improvements were observed and four days

sense of her body floating and palpitations

later the symptoms had disappeared. Later, whileappeared;

type

the dose was adjusted according to the findings,

tranquilizers 2 to 3 times a day; from the age of 39

after continued treatment using the combined

she took ryokeijutsukanto for about one year after

formulation with tokishakuyakusan the headaches

which the symptoms had almost be alleviated. The

did not occur any longer.

sheusedbenzodiazepine

use of western medications was reduced to about

And yet, severe headaches occurred on days

once per month for preventive purposes and she

typhoons hit the country and on these occasions thestarted to work as a kindergarten assistant. Yet,patient complained, that she would on the contrary

she used to complain about headaches lasting 2-3

like to cool her head. The body felt hot and sheweeks. The headaches were located on the foreheadbecame restless and nervous. Originally she did not

like a headband, producing a pain as if thislike the summer. senkyuchachosan was prescribedheadband were tightened, so that she used to press

and had marked effects, leaving her feelingdown on the painful areas while taking deep

refreshed and comfortable.

breaths and reported that warmth provided someAfterthat

theadministrationofincreased in the evening with increasing fatigue.

tokishakuyakusan from autumn through spring
and a combined formulation with senkyuchachosan

On this occasion the symptoms had appeared 5 days

from the rainy season through summer prevented

ago on the last day of her menstruation.

aggravation of the headaches and stabilized therelief of the symptoms. Severity of the symptoms

patient both physically and mentally.

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

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