Volume 4, Number 1 | Spring 2009

Clinical Report 3

Goshuyuto was Effective in One Case of Headache
Mitsuyuki Takamura
Mie University Occupational Health Research Project

Hiromichi Yasui
Japan Institute of TCM Research

Case: Female of 54 years old
Initial visit: May 7 of year X
Chief complaint: Spasmodic headache
History of present illness: Had suffered migraine
onset since 12 years old. The frequency had been
about once a month for nearly 20 years. The onset
was accompanied by dazzled eyes and a corner ofan object shape becoming invisible, and then athrobbing pain developed on a part of the headwith nausea and vomiting.
At the same time, the shoulders became stiff
and a heat sensation appeared in the neck andforehead. Hands became cold. Although the bodyin general felt very cold, the face became red andfelt hot. There was a stuffy sensation in thestomach. If the pain was left unattended, it
became intolerably severe and lasted one to twodays. At every moment, commercially available
bufferin was used. However, once a pain developed,
the medicine did not work. Sumatriptan, which
was prescribed about a year ago, was discontinued
soon after it was found ineffective. A headachetended to occur at a relaxed state after stress orwith constipation. Headaches are not linked toweather conditions. In the middle of April, such
onset as described above occurred. Lying down did
not help relieving the headache. The patient wasin a crisis.
The patient had mouth dryness, a sensation ofcold hands and feet, stiffness in the neck andshoulders and swollen lower extremities.
Present condition: 162cm, 57kg, 132/80mmHg
Pulse condition: Sunken, thin and slightly
slipperyTongue condition: Pale red with thin white furs.
Sublingual veins.

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Abdominal condition: Resilience ( ＋ ), stuffinessand rigidity below the heart, and theaccumulation of gas in the left abdomen.
Splashing sound (－)
Diagnosis: Headache due to phlegm-dampness orheadache due to cold of liver and stomach
Formulation and course: Initially the Extract ofgoreisan 6.0g/day was administered. After theadministration, a headache did not occur. On somedays, the occurrence was feared, but actually it did
not occur. In the morning after three weeks, aheadache aura was seen: stiff shoulders, nausea
and vomiting, and an invisible corner of an object.
Lying down once brought a relief but theconditions recurred. The patient thought it would
progress to an attack and visited us. The patient
still experienced squeezing headaches, although
not very serious, stiff shoulders, and a heatsensation from the shoulders to the sides of theneck. The forehead also felt a heat sensation. She
still had nausea and cold hands and legs.
The Extract of goshuyuto 2.5g was used asneeded.
Thirty minutes after the use, stiff shoulders
became lightened and nausea disappeared. So
instructions were given to the patient to takethree doses of the formulation 2.5g during the day.
Then she returned home. On the following day, she
told on the telephone that the headache did notdisappear completely, but did not develop into theattack. The patient also told that stiff shoulders
were resolved and was able to have an easy time.
On the following morning, the headache still
lingered slightly and same formulation 2.5g wasused, which completely dispelled the pain. And thevolume of urine increased. Then goshuyuto wascontinued. And a migraine headache did not recurat all and the formulation was discontinued on
October 1 of year X. In march of the following year
when she visited us for other illness, migraine
headaches remained subsided.

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

Volume 4, Number 1 | Spring 2009

Discussion
This patient had mouth dryness and adecrease in the urine volume and the possibility ofwater-dampness being eccentrically located.
Generally this type of patient often develops aheadache with a decrease in atmospheric pressure.
However, in this patient, there is no relationshipbetween headaches and weather changes.
I had a point about headache triggers as
mentioned above that I wanted to confirm andupon a consultation with the patient,
theExtract of goreisan was administered. Althoughheadaches seemed to be contained by the use ofgoreisan, an aura preceding a headache attack
occurred. This attack was of a typical migraine
classified as “migraine with aura” under theInternational
ClassificationofHeadache
Disorders (ICHD-II). Distinctive symptoms ofcold of liver and stomach＋upward gush of thestomach Qi, such as cold hands and legs, sudden
stiffness of the shoulders accompanied by nausea
and vomiting. For this type of headache,goshuyuto that has the action of warming the liverand stomach ＋ lowering adverse flow andarresting vomiting is used.
In fact, 30 minutes after the administration,
the headache became resolved and the aura did
not progress to an attack.
Goshuyuto often has effects on migraine
attacks. Although dependent on the timing ofadministration, efficacy appears within 30
minutes to 2 hours to relieve the headache. It is amatter of course that it is not the case for every
headache sufferer.
Generally migraines often began to develop
during a period of 20s to 30s and last for decades
and types of migraine often gradually change withtime. The patient relatively kept the condition of
the first migraine attack.
The form of attack in the patient is typicalconditions or sho of goshuyuto. However, as mouthdryness and urination disorder were presented,
goreisan was administered with an agreementwith the patient to verify whether the patient’s
headaches were caused by phlegm-dampness. Atthe beginning, it seemed the formulation waseffective but mouth dryness and urination
disorder remained unchanged. In the third week,
an aura occurred and goshuyuto was administeredwith the result of quick effects. Urination disorderremaining unchanged with the administration ofgoreisan improved with goshuyuto and theurination volume rapidly increased. These might
have resulted from the recovery of yang qi of liverand its free coursing.

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

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