Volume 2, Number 3 | Fall 2007

Clinical Report 2

Headache
Mihoh Koga

will be discussed focusing on the qi-blood-water
aspects, trying to keep the terminology as simple aspossible.

Division of General Medicine,
Division of Clinical Pharmacology & Therapeutics
Jikei University School of Medicine

Introduction
Headache is a symptom frequently encounteredin an outpatient office specialized on Kampo.
Generally, this condition is classified into primaryheadache, which in turn is classified into 1)
migraine, 2) tension headache, 3) cluster headache,
4) headache associated with prolonged drug abuse,and secondary headache occurring in the presenceof an underlying disease. Even though remarkableprogress has been achieve regarding thepharmacotherapy of headache, the number ofpatients suffering from headache still remains high.
The migraine guidelines of the American Headache
Society® (AHS) recommend that "treatment of acuteconditions should be individualized". Moreover,egarding the ideal pharmacotherapy for theprevention of attacks: there are currently nosuitable drugs.
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 the rise.
Moreover, in cases of headache associated withrefractory diseases or prolonged drug abuse, I haveoften experienced that the use of blood stasis
expelling drugs led to an early alleviation of thesymptoms.
In the present paper I would like to briefly
discuss a few cases of tension head and migraine I
have seen in our outpatient department. Each case

Cases
<Tension headache; prolonged cold, phlegm-rheum>
Case (1): 46 years, female, housewife, clinic visit inJanuary YYYY
Chief complaint: right shoulder pain, headache,dizziness (floating feeling), pollinosis
Anamnesis:
At age 35: enucleatic myomectomy
At age 45: total hysterectomy because of myoma
induced anemia
At this time there were adhesions of the small
intestines, requiring reoperation, during which a
portion of the small intestines was removed.
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, that it
prevented sleep; chilling around the waist and thethighs and a generalized feeling of edema over theentire body. Considering the presence of pain as if
from pinching the right upper arm and stagnation ofliver qi as well as blood deficiency into account, theformula nijutsuto, kamishoyosan plus Coicis
Seemen was prescribed. After 4 months oftreatment the shoulder pain had been alleviatedalmost completely and the pollinosis considerably.
By the sixth months of the treatment the headacheand sense of floating grew worse and symptoms
were highly sensitive to low atmospheric pressure.
The headache was reportedly associated with aslightly depressive heaviness. Recurrence of thetemporarily relieved edema of the legs. The patientoriginally has a tendency towards indigestion. The
husband is currently living alone abroad because of
his work.
Findings:
Moderate build, skin slightly brown. Good
appetite, bowl movements and micturition normal,
but has a tendency towards constipation when

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Volume 2, Number 3 | Fall 2007

nervous. During bathing the patient felt on thecontrary cold. She was the type of person that does
not sweat. Her physical condition used todeteriorate in spring. Pulse was deep, slippery andwiry / weak right cun pulse, the tongue was pale red
but had a thick white fur coating its entire surface
and dental impressions, sublingual veins were
somewhat engorged. Mild degree of fullness,tenderness or discomfort of the hypochondrium.
Pattern: Spleen – stomach deficiency ->phlegm-rheum, upward harassment of wind phlegm
Prescription: hangebyakujutsutemmato
Following the third day of taking the prescription
the perceived fog in the head cleared and left thepatient feeling reportedly invigorated. The
heavyheadedness too improved. She experienced
regular bowl movements, became able to sweat
when bathing and thus felt fine. Temporarily
switching the prescription to ryokeijutsukanto
resulted in recurrences of the headache, regularadministration of hangebyakujutsutemmato twice
daily and an additional dose when symptomaticallowed controlling 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.
<Tension headache; spleen deficiency, countercurrentof phlegm-rheum>
Case (2): age 47, female, dental assistantChief complaint: headache, stomach disharmony,
amyloidosis of the skinAnamnesis:
After the death of her husband she became
nervous and anxious. At that time she wasdiagnosed with amyloidosis of the skin and Sjörgren
syndrome. Headache often developed in case of
fatigue 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 of
distention.

16

Findings upon first visit:
Fair-skinned and leptosomatic habit, sloping
shoulders. Visible amyloid depositions on theabdomen and lumbar regions. Easily sweats on thepalms. Poor sleep. Occasionally soft stools. Thin andweak pulse, the tongue being pale red with a thick,greasy white fur, stickiness within the mouth.
Engorgement of sublingual veins. Abdominal
palpation reveals clapotage and tension of theabdominal wall.
Pattern:
spleendeficiency,qi
depression,countercurrent of phlegm-rheum
Prescription: bukuryoingohangekobokuto
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 she
had a headache. Later, targeting the easy
fatigability, xerophthalmia, poor sleep and the skin
symptoms her condition improved using a combinedprescription with ninjin’yoeito, she could sleep
soundly and the headaches disappeared.
Four years later, after she finally came to terms
regarding the death of her husband and herstomach maintained a good functional condition,
treatment with bukuryoingohangekobokuto was
discontinued. The nature of her work facilitated thedevelopment of high tension and easily led to thedevelopment of posture induced shoulder stiffness,
which resulted in headaches (dull pain), but since
the condition of her stomach had improved, theeffects of goreisan had weakened, while
shakuyakukanzoto now had become markedly
effective. It turned out to be a medication, which insingle doses provided refreshing relief and bestowed
upon her a feeling, as if the neck were straightening
and sometimes even extended to the head.
<Tension headache; spleen deficiency, cold phlegm,
blood deficiency>
Case (3): age 40 years, female. Assistant in former
family business (restaurant)
Chief complaint: headache, anxiety
Anamnesis:
At the age of 20 iron deficiency anemia (sheThe Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

Volume 2, Number 3 | Fall 2007

sometimes takes iron drugs)
At the age of 37 hypertension (initiation ofantihypertensive pharmacotherapy)
Present illness:
From the age of 38 her nervousness increased, asense of her body floating and palpitations
appeared;sheusedbenzodiazepine
type
tranquilizers 2 to 3 times a day; from the age of 39
she took ryokeijutsukanto for about one year after
which the symptoms had almost be alleviated. The
use of western medications was reduced to about
once per month for preventive purposes and she
started to work as a kindergarten assistant. Yet, sheused to complain about headaches lasting 2-3 weeks.
The headaches were located on the forehead like aheadband, producing a pain as if this headband
were tightened, so that she used to press down on
the painful areas while taking deep breaths andreported that warmth provided some relief of thesymptoms. Severity of the symptoms increased in
the evening with increasing fatigue. On thisoccasion the symptoms had appeared 5 days ago on
the last day of her menstruation.
Findings:
Fair-skinned obese, normal appetite, sleep andexcretion. Becomes easily nauseated. Her condition
used to vary with the menstrual cycle. The tongue
was enlarged, pale white, had dental impressions,sublingual veins had disappeared, the pulse wasdeep and thin, the abdomen showed a generalized
hardness and was mildly tender, there was fullness,tenderness or discomfort of the hypochondrium andchilliness of the lower abdomen.
Pattern: blood deficiency, phlegm rheum
Prescription: ryokeijutsukanto plus tokishakuyaku-sanHeadaches tended to become worse during thelatter half of the menstrual cycle and the lingual
findings too suggested the necessity to take blood
deficiency into account, but since the so farprescribed ryokeijutsukanto could not be expected
to have any blood supplementing effects,
tokishakuyakusan was added. After the ingestion
marked improvements were observed and four days
later the symptoms had disappeared. Later, while

the dose was adjusted according to the findings,
after continued treatment using the combined
formulation with tokishakuyakusan the headaches
did not occur any longer.
And yet, severe headaches occurred on days
typhoons hit the country and on these occasions thepatient complained, that she would on the contrary
like to cool her head. The body felt hot and she
became restless and nervous. Originally she did not
like the summer. senkyuchachosan was prescribedand had marked effects, leaving her feelingrefreshed and comfortable.
After
that
the
administrationoftokishakuyakusan from autumn through spring anda combined formulation with senkyuchachosan fromthe rainy season through summer prevented
aggravation of the headaches and stabilized thepatient both physically and mentally.
<Tension headache; spleen and stomach cold
deficiency, deficiency of heart and spleen>
Case (4): age 49, female, visited our clinic in
February YYYY.
Chief complaint: headache, anxiety, discomfort in
the gastric region, arthralgia of multiple joints
Present illness:
At the age of 27, triggered by a pregnancy, thepatient started to suffer from frequent headaches.
She is regularly using commercial analgesics, butsince half a year ago their effects were declining.
The headaches were a sort of pinching pain from theback of the head down the back of the neck and at
the same time associated with ocular pain,
repeating cycles of alleviation and aggravation
almost daily. The anxiety influenced the gastricdiscomfort, so that she could eat, but felt nauseatedon an empty stomach and therefore constantly ate
little portions. She had no sense of satiety. Anotherdoctor diagnosed reflux esophagitis and prescribed a
protective agent for the gastric mucosa, but its effectwas obscure. Moreover, about 1 year earlier thepatient had been diagnosed with chronicrheumatoid arthritis and is currently under
treatment. Three months ago development of frozen
shoulder. Three years ago she had to worry about

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family matters and this problem now got worse
about
half
a
year
ago,
so
that
saikokaryukotsuboreito was recommended in a
pharmacy, which she is currently using.
Findings upon first visit:
The facial complexion was yellowish-white andthe patient had a leptosomatic habit, she was
occupied by worries about her symptoms anddescribed the circumstances of their developmentwith dissatisfaction. She repeatedly asked: "Whatshould I do?" This gave the impression that she had
started to panic because of what was going on withher both mentally and physically. There was a mild
degree of chilliness of both hands and feet, recently
her visual acuity deteriorated and she noticed
nocturnal urine and dryness of the mouth during
the night. One bowl movement every three days. No
feeling of exhaustion. The pulse was thin andslippery, the tongue had a thick white fur and she
had a bitter taste in the mouth. The abdomen
showed chilliness and increased resistance of theepigastric region and a mild degree of fullness,tenderness or discomfort of the hypochondrium,
softness of the lower abdomen, tenderness of both
inguinal regions, marked palpitation above theumbilicus were observed.
Pattern: deficiency of both heart and spleen,
deficiency cold (stagnation of liver qi)
Prescription: kamikihito, keishininjinto
Course: The patient expressed strong anxiety
regarding
discontinuationofthesaikokaryukotsuboreito she was using so far, so thattheprescription
was
first
changedtokeishikaryukotsuboreito, taking her feelings into
account. This helped to overcome her anxiety andsettle down, but still left the symptoms incompletely
controlled, with no changes in the incidence ofheadaches and gastric discomfort. After persuading
the patient to use a prescription with added
keishininjinto the incidence of the headaches
decreased to once per week. Later, using kamikihito
as the main formula and reducing the dose ofkeishikaryukotsuboreito to 1/3 both headaches andgastric discomfort improved and after three weeks
were almost completely alleviated. The arthralgia

18

and anxiety also improved and the patient now
presents with a calm expression.
<Tension headache; liver qi stagnation, transverse
invasion of the stomach>
Case (5): age 41, female, employee
Chiefcomplaint:
headache,gastrointestinal
weakness
Present illness:
From the time she became employed the patient
repeatedly experienced stomach disorders, belching,abdominal distention, a bitter taste in the mouth
and reduced appetite, occasionally gastric pain.
After examination she was diagnosed with neurotic
gastritis and was prescribed western medicine, butlater visited our clinic, because the symptoms did
not improve. The headaches developed at the sametime and were characterized by a slowly progressive
and continuous dull pain.
Findings upon first visit:
Intermediate build, the skin appeared slightly
yellowish brown and there was some edema. She
had difficulties waking up in the morning and felt
exhausted and headheavy from morning; usually
did not have any appetite in the morning. Although
she had one bowl movement a day, there was always
a sense of incomplete evacuation. The menstruation
was regular, but prior to the onset of themenstruation the headaches grew worse. She
complained about shoulder stiffness. The pulse wasthin and wiry, the tongue was faintly dark red andhad a thick white fur and dental impressions, theabdomen showed a marked degree of fullness,tenderness or discomfort of the hypochondrium.
Pattern: liver qi stagnation, transverse invasion of
the stomach
Prescription: saikokeishito
Course:After about 2 months of treatment, the ease withwhich she could wake up in the morning improvedand both the sense of exhaustion and headheavinessdecreased. Her stomach felt comfortable too, but she
was easily susceptible to influence from stress atwork. Improvement of the shoulder stiffness. Since
after about one year of treatment almost all

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Volume 2, Number 3 | Fall 2007

symptoms had healed, the dose was tapered, butsince complete interruption of the treatment
resulted in a deterioration of her physical condition,
she currently continues on a low dose schedule.
<Migraine; tension headache; blood stasis>
Case (6): age 24 years, female, employee
Chief complaint: headacheAnamnesis: At the age of 21 onset of a collagendisease, that was treated over a period of one yearwith steroids and the therapy then terminated.
Present illness:
Onset of repeatedly occurring headaches after thepatient started to work in an office at the age of 23.
Her work requires that she uses a computer. The
headaches were characterized by throbbing,pulsating pain (1) in the occipital region and (2) the
temporal regions and occasionally she also felt likeshe had be hit or (3) a pain as if a heavy stone wereplaced in the center of her head. The incidence
fluctuated but was higher on hot days with fairweather so that summers were difficult for her. A
neurosurgeon diagnosed migraine and tension
headache. The use of acetaminophen during periodsof pain became increasingly frequent. Currently, sheuses analgesics on average 5 times per week.
Findings upon first visit:
Obese physique, muscular, face was flushed red,
there was acne on the mandible, she disliked heatand there was no sense of coldness. She had a good
appetite, but since about one and a half years ago
she experienced almost daily heartburn and gastricdiscomfort. She had a dry mouth and preferred cooldrinking water. There was a tendency toward easy
development of edema of the face and extremities.
She had difficulties falling asleep and experienced
night sweats all over her body. She had 1 to 2 bowl
movements per day (in the morning). Her eyestended to tire easily and she was also easily
irritated. Her menstrual cycle ranged between 30 to
35 days, lasted for 3 days, she had little menstrual
flow and the menstrual blood was dark red. Latestage. The pulse was slippery and wiry, the tongue
pale and the sublingual veins thin, there wasdistention of the lower abdomen and tenderness on

the right side next to the naval.
Pattern: exterior-interior evil repletion
Prescription: bofutsushosan
Course:Two weeks later she experienced comfortablebowl movements and lost about 1 kg in body weight.
Both frequency and intensity of the headaches
decreased. Pulse was wiry and thin, tongue slightly
red. Six weeks later improvement of the sense ofbody heat. Headaches and dizziness occurring
during the forenoon sometimes were alleviatedwhen she had diarrhea. There was a strong sense offullness, tenderness or discomfort of the
hypochondrium, the entire lower abdomen was
tender and even stroking it hurt. Drugs for
expelling blood stasis and rectifying qi wereconsidered necessary and thus a modified formula of
bofutsushosan used. Ten weeks later the usage ofanalgesics had decreased to 1-2 times per week andwithout her really realizing since when, she noticed
that the gastric symptoms did not longer bother her.
She continues to take the medicine.
<Migraine / tension headache; blood stasis>
Case (7): age 62 years, female, housewife
Chiefcomplaint:
headache,dyshidrosis,
constipation
Present illness:
Since 10 years, following her climacteric age, thepatient experienced hot flashes and abnormal
sweating, constipation and was prescribed atanother clinic unseiin plus tokakujokito and similar
formulas, which improved these symptoms. Recently,
the same symptoms recurred and the patient visited
our clinic, also because of the headaches she hadsince her youth.
The headaches started at the age of 20, hereyesight deteriorated and she experienced
throbbing pain 2-3 times a month. On theseoccasions she used commercial analgesics andrested for 2-3 days, but sometimes these symptoms
were also accompanied by nausea and vomiting.
Also, from her climacteric age onward she
experienced in the morning upon getting up a senseof headheavyness and felt as if she wore a hat.

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Volume 2, Number 3 | Fall 2007

Formerly,shereported that the use of
kamishoyousan reduced the frequency of analgesic
use. She also had been constipated since her teensand could not have bowl movements without the useof cathartics. She used a cathartic from a Kampo
pharmacy (content unknown) and had one bowl
movement every 3 to 5 days. There was also cervicalspondylosis (C7).
Findings upon first visit:
Fair-skinned large-built person, obese, lightbrown complexion of the face with many freckles. In
her daily life she is working industriously. She has a
big appetite, gets up twice for nocturnal urine,
dreams a lot, is under stress relating to family
matters, her legs are prone to easy development of
edema, her face flushes and she sweats abnormallyon her head and back, dislikes summers, does notcomplain of chilliness. The pulse was deep and wiry,
the tongue deep red with a white fur and dental
impressions, engorged sublingual veins, theabdomen showed a mild degree of fullness,tenderness or discomfort of the hypochondrium andthere was a marked degree of tenderness on bothsides of the naval.
Pattern: blood stasis, qi stagnation
Prescription:tsudosan
Course:
The administration of tsudosan led to a quick
alleviation of the headache and 2 months later theuse of analgesics had decreased to half its former
frequency. The frequency of the use of commerciallyavailable cathartic did not change, but upon
combination with daiobotampitpo, she experienced
from the following month onwards comfortable bowl
movements and in association with this the use ofanalgesics decreased to the range between one andtwo tenth. Since the alleviation of the symptoms
was also associated with improvements in the bloodstasis findings of the tongue and abdomen, she
continued to take this formula and gradually
improved. She stabilized mentally too.
<Migraine, chronic continuous dysentery, yangdeficiency, blood deficiency, blood stasis, liver
depression and qi stagnation>

20

Case (8): age 35 years, female, pharmacist, visitedin March YYYY
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 theuse of 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, themuscles of the right upper arm produce a dragging
pain, after which she reports the development ofpharyngeal

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 the normal amount of
senna. Serious of character. Previously the use of

tokakujokito for constipation caused the onset ofsevere 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,engorged sublingual veins, presence of fullness,tenderness or discomfort of the hypochondrium,
chilling of the epigastric region and tenderness on
the left side of the naval.
Pattern: yang deficiency, blood deficiency, bloodstasis, liver depression and qi stagnation
First prescription: tokishigyakukagoshuyushokyoto
Course:The prolonged use of senna had led to chronic
continuous dysentery and thereby induced blood

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

Volume 2, Number 3 | Fall 2007

stasis, while the liver depression and qi stagnation

their flow preventing their even distribution pain

was considered to prevent recovery. First, in order towill result." This may be caused by influence of thereliefdysenteryexternal world (six excesses) or emotions (seventokishigyakukagoshuyushokyoto was chosen, theemotions), exhaustion, unwholesome dietary habits

use of senna for the constipation discontinued andand similar factors, variations in the body's internal

instead Mashiningan once daily prescribed. This

environment or disorders causes by exogenous

also improved the effects of analgesics used for thepathogenic factors.

thechronic

continuous

treatment of the headache, the severity of which

The clinical aspects of headache too have to be

gradually decreased, but since their frequency did

considered depending on the pathologic condition.

not

In other words, there are three different views of thechange,

they

still

causedanxiety.

Bowl

condition, including the questions A) Is there a

movements improved to once every three days.
Taking the medication over a period of half a year

stagnation of qi, blood or water?; B) Is there be a

improved the sense of coldness of hands and feet,deficiency of qi and blood or yin essence or else

but the sense of exhaustion did not even improve

nutrients (nourishment)?; and C) Are there any

with sleep and increasingly strong stress at work

mental factors leading to aggravation of the pain?

influenced also the pulse and abdominal findings, so

These different aspects A, B and C do influence each

that

other

the

prescriptionwasswitched

tomutually

and

are

often

observedyokukansankachimpihange. Although the coagulasimultaneously. It is important to ascertain the realin the menstrual blood disappeared and thenature of the pathologic condition, but depending on

menorrhalgia improved, the patient suffered fromthe symptoms this may often prove to be difficult.

severe headaches during the latter half of theYet, among these aspects the one mentioned undmenstrual cycle. Prescription after half a year:b) "presence of deficiency" (insufficiency) causes

yokukansankachimpihange and tokishakuyakusan

pain and is therefore called "deficiency pain". Qi and(each 2/3 of the dose).

blood mutually generate each other and supplement

After one month of treatment improvements ofshortages, so that states of deficiency continuing

both the frequency and severity of the headaches

over extended periods of time will eventually result

were observed and after half a year the use of

in deficiencies of both qi and blood. For this reasons

analgesics had become unnecessary and headaches

pain that has become chronic, will also becomeweresingledoses

ofrefractory to treatment and the deterioration of thethepatient

hadbodily environment and the ensuing insufficiency in

comfortable bowl movements even without the use

pharmacokinetics may then possibly result in aof mashiningan once every 1-2 days.

decrease of the efficacy of analgesics.

alleviatedtokishakuyakusan.

with
By

then

Also,

Discussion"chronic

diseasesinevitably

areaccompanied by blood stasis" and it is said, that "in

1. “Pain”
In Kampo medicine pain is considered to havethe following causes. "For the activities of mind andbody qi, blood, and water (bodily fluids) must
circulate without excess or deficiency. However,when there are deficiencies in the functions of qi,
blood, and water (bodily fluids) or a stagnation of

the presence of blood stasis, treat this first".
Therefore, in cases of chronic headache it isimportant to take blood stagnation = blood stasis
also into consideration.
2. Types of headache and pathologic condition
Here I would like to discuss, adding a few

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Volume 2, Number 3 | Fall 2007

comments about the individual cases, the types ofCase No. 5 is an example of qi stagnation caused

headache and their correlation to the patterns.

by the stress after employment.

1) Tension headache2) Migraine

Tension headache is characterized by a sense ofMigraine is characterized by a throbbing paintightening of the head with a heavy, dull kind of

occurring several times a month in form of attacks,

pain that continues typically on a daily basis andassociated with nausea, hypersensitivity towards

which is usually triggered by increased muscle

light and sound and similar symptoms. Generally,

tension or stress.

compared to tension headache, the pain is severe.

The heavy, dull pain is characteristic for astagnation of water. It also resembles this conditionin that it is alleviated by massage etc. The
generation of moisture due to spleen deficiency is
considered to be one of the distal factors andillustrated in the cases (1), (2) and (3). Improvementof all symptoms after administering Bukuryouin topatients visiting our clinic with headache andchronic gastritis is something we experience on arather regular basis in our outpatient department.
Again, a state of muscle tension can be considered torepresent a state of malnutrition for the muscles
themselves and considering that the spleen is
supposed to nourish the skin and underlying flesh,relaxation of the muscles is an essential aspect of
the treatment and suggests that there is somecorrelation between the state of the health of spleenand stomach on the one hand and tension headacheon the other hand. Among these patients in

Regarding severe pain there is a marked
correlation with excess patterns. In cases of excessof the blood this manifests as blood stasis, while qi
excess gives rise to qi stagnation or qi reversal. On
the other hand, water in these cases often occupies
the third space and causes quietly concealed
infiltration. Therefore, it is considered that even incases of excess there is no sudden rise in local
internal pressure and thus severe pain. Naturally, ifwater were to be enclosed within cerebral ventricles
or the capsule of surrounding tumors, it may cometo excess condition in these restricted spaces
producing severe pain. Also, the hyperesthesia'sthat often occur in conjunction with the migraine
are a pathological condition in which the evil of anexcess pattern is present and may easily imaginable
trigger either locally or systemically an state of hightension, suggesting a correlation with the excess
pattern.
Blood stasis is often responsible for locally fixed,

particular case (2) was interesting, considering thestabbing

fact that the effective prescription for single use

stagnation often produces wandering pain that feels

variedlike stretching or swelling. In case No. 6 the "paindepending

on

with

the

presenceofgastrointestinal symptoms.

or

else

lancinating

pain,

while

qi

like being hit" is a form of lancinating pain often

Moreover, in cases of blood deficiency theobserved with blood stasis. The "pain as if a heavy

reactivity towards the pain decreased and thesestone lies inside" improved with treatment topatients characteristically presented often with aregulate qi and thus is possibly related to qi

mild, but nagging and continuous pain.

stagnation. In this patient the treatment shouldThis resembles the pain of tension headache.
When like in case No. 3 the condition was based on

probably have aimed from the beginning at
expelling stasis and regulating qi.

anemia, or in case No. 4 where the condition was

In case No. 7 too blood stasis and qi stagnation

triggered by a pregnancy, a post partum or

induced symptoms were prominent and tsudosan

post-menstrual headache should be considered.

proved to be markedly effective. The persistent

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

Volume 2, Number 3 | Fall 2007

constipation required combination therapy with

daiobotampitpo, indicating that the nature of theheadaches and constipation as well as the mental
condition are important criteria for the treatment.
Otherwise, I often experienced that during thetherapeutic course following treatment of malignant
tumors or treatment of collagen diseases and thelike conditions migraine may develop and treatment
were found to be markedly effective in cases
complicated by agitation and constipation.
The cold deficiency of spleen and stomach
induced by prolonged use of senna in case No. 8 led
to the development of a yang deficiency. Since"Bloodcirculates

by

being

warmed"coldness

obstructs the circulation of blood. For chilling of thehands and feet in the presence of chronic continuous
dysentery

and

blood

stasisinthepelvistokishigyakukagoshuyushokyoto is very effective.
Moreover, circulation of the blood also requires theflow of qi. The stress at work impeded recovery fromthe blood stasis further and thus I focused on
regulating qi once the coldness had been alleviated,but the treatment still required the use of

tokishakuyakusan with its blood stasis expelling
action to supplement the blood.

Conclusion
Among the forms of chronic headache tension
headache and migraine are frequently observed in
the Kampo outpatient practice. I presented a few
cases and discussed them briefly. I also offered one
opinion pertaining to the characteristics of bothconditions and their pathological conditions in the
Kampo medical sense.
Combination of western medical diagnosis with
TCM theory appears to be useful for providing the"individualized

therapy"mentionedatthebeginning recommended by the AHA. Integration of
TCM theory into the therapy is considered tocontribute also to the development of western
medical care.

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

23