Chapter 3 Complications, part 1
3.1 Migraine and other headaches
Migraine can be very devastating to the life of the sufferer. It is unpleasant for some but can be incapacitating for others. As we understand now, it is a consequence of vascular disorder. More precisely, it is the expansion of arterioles on the side of the head. As such, events which causes alteration of blood flows to the head could affect the migraine episode. Among them is the menstrual events which tend to cause the emotional fluctuation, loss of blood and the body’s response to all these events. It is no wonder female migraine sufferer outnumbers male by a large number.
Pathologically, as capillaries expand on the temporal area of the head, they pressurize the adjacent nerve receptors and hence trigger the headache. The root cause is that the tissues in these area demand more blood flow. Unfortunately, as with other bodily event, the pain actually triggers musculature of the area. It triggers the head and the neck to tense up which further reduce the blood flow into the head.
Therefore, our modern medicine of treating the migraine has been to constrict the arterioles to reduce the pressure to the nerve. It works in reducing pain for as long as the medicine remains potent. On the other hand, the true culprit, the demand of more blood flow is not been resolved setting up for the next episode of migraine.
3.1.1 A 55 year old female, artist complained having severe headache for over 20 years. It happened every day. She had not had a restful night all these years. It showed on her face and work, excessive aging. She also complained about tight neck muscle and some low back issues, she attributed that to the moving her big art works.
She also had the hot flush disturbing sleeping at night for two years. She couldn’t take medicine because that would trigger her asthma attack.
Naturally, her neck and upper trap were tight to touch. It felt like pressing on wood board. It turned out that she was attacked once by an intruder. She was choked from behind and that she was so certain that she would die. Years past, she still remembered the incident vividly.
I treated her with the above protocols for neck and shoulder. Within a few weeks, the headache was reduced to twice a week. A few months later, the headache had stopped all together. The tightness of neck/shoulder muscle had improved, although not totally disappeared, as unconscious reminder of the attack. The headache never return when checked one year later.
3.1.2 A male patient of 62 years old auto mechanic had debilitating headache, continuously throughout the day and night. This happened after surgery to fuse cervical spine. Before the surgery, he had chronic neck pain due to “wear and tear”. He worked as auto mechanic.
Surgery scar was about 3 inches long, visible at the front right side of neck above the collar bone. The surgery did not resolve his problem. Instead, ever since the surgery; he had headache, neck pain, chest tightness, arm pain. He couldn’t raise left arm for more than 45 degree without excruciating pain going down from deltoid to anterior aspect of his arm. His left arm pain was worse than the right. He was taking Celebrex. The senses of the left fingers were diminishing due to what his doctor diagnosed as atrophic nerve from diabetes. For which the doctor prescribed Neurontin (This is kind of odd prescription, as Neurontin diminishes nerve activity to suppress pain sensation.).
Acupuncture brought him a lot of relieve. Following the same procedure of releasing the neck shoulder and occipital explained above. Unfortunately, the worker’s comp was very biased against acupuncture. He had very hard time to get continued acupuncture. Overall, he was able to get 12 visits over two year’s time. That was considered as lucky. He still had headache although at a much less intense level. It would gradually become worse and needed be treated pay from own pocket. He is still trying to get the insurance company to authorize more acupuncture.
More on Headache
Headache is a very common problem. It is annoying at the least. In serious situation, it is quite debilitating, as is frequently the case with migraine sufferers. The presenting symptoms vary a lot: heaviness of head, foggy head, pins and needles, knifing sensations, pressure, and vise gripping at the side of the head.
The most important issue in treating headache is accuracy of diagnosis. It dictates the effectiveness. Because the head is always exposed to the outside world, it is subjected to the impact of environmental factors. For instance, without proper head protection in the extreme cold, head would be hurting. When sinus problem is triggered by the weather and acts up, headache ensures. Situations like these are easy to diagnose and easier to resolve. When headache persist, people become dreadful of brain tumor. Fortunately, that instance is rare and can easily rule out by modern imaging technique. In addition, the pain is usually unrelenting that does not vary much throughout day and night. There are also likely to have other unusual neurological events as well, such as pain or strange sensation in other parts of body that is difficult to diagnose. On the other hand, most brain tumors do not cause headache.
A 30-year old female employed at a cosmetic company had a strange complaint. For many years, she had this headache which was located deep behind her left eye. The pain usually got worse in the afternoon. Medication was not able to help her relieve the problem. Other than the pain, she appeared healthy and energetic.
Upon questioning, she recalled an accident she had as a child where she sustained a head injury that required suturing of the scalp about two inches above the lateral edge of the left eyebrow. The doctor had assured her that the injury had completely healed. Hidden under the hair, the scar could be felt from the suturing.
The best way of removing blood stasis at the body surface is using moxibustion together with electro-acupuncture. After three visits, her headache disappeared.
Head injury can cause headache in the later years. In 1999, I had this beautiful female patient in her 30s came in for acupuncture. She came with a small baby in baby carriage. She did modeling in Europe before moving to the United States. Everything was great for her except she had this bad headache that just would not go away for many years. No medical doctor could find anything that leads to her condition. No medical treatment was able to solve it.
It turned out that on her head there was a quarter size spot that was painful to pressure.
This is indeed an interesting case. In TCM, it is well known that in numerous situations, pain is caused by blood stagnation. Such stagnation can be resolved by bleeding. This is accomplished by acupuncture needles or a special needle that has three edged tip. Mostly, only a small drop of blood is let out. In a severe situation, it is coupled with a procedure called cupping where a suction cup was applied to the needled spot to facilitate the bleeding of the stagnated blood. This is rarely done in U.S. as we are very sensitive about blood spill in this country.
Bleeding is not uniquely TCM. It was the main stay of medical treatment in Western world such as France and America in the 17th century. In that good old times, whenever people had a fever or distention of the head( possibly high blood pressure), they would go to their favorite barber shop and had some blood drained. Barbers at the time was competing with surgeons for business and winning. George Washington, founding father of U.S.A. had a fever and was treated by bleeding. Unfortunately, he died the day after the treatment.
Instead of doing blood letting, I did moxibustion on her head for a few minutes. The pain subsided and the headache was gone.
As with the diversity of symptoms for headache, there is diversity of causes. The list includes stress from physical and emotional, traumatic injury, vascular excess or deficiency. Since pain sensation is a neurological event, it is no surprise that nerves are always involved, so is the mind/ emotion of the patients. As long as the source of the problem remains unresolved, pain will continue.
SO, it is important to know the history or progress of the disease. For instance, if the person has neck and shoulder pain first and then the headache started to show up, then it is most likely the headache is the consequence of neck problem. The first line of treatment is to resolve the neck issue with minor focus of symptomatic treatment of the headache. Neglect the neck problem, the headache will never disappear
Headache with high blood pressure
High blood pressure would cause headache. In TCM, this is called Liver Yang rising. With severe cases, Yang rising can trigger Liver Wind and patient will experience dizziness. It could result in Wind Stroke and the person becomes unconscious. In modern terms, this is called stroke due to bleeding in the brain. As we age, our capillaries become stiff, less elastic and break easier under high pressure.
A family friend is a Philippine lady in her early 60s. With stressed life and rich Philippine food, she developed high blood pressure. Naturally, she is on med. The headache would frequently occur and it would be so debilitating. Following the acupuncture protocol above for the neck and shoulder, adding Lv 3 for liver and Tai Yang for temporal tension, her headache would subside. Life would then be better for a while.
A strange case of headache
A female student in her late 40s had this weird headache for as long as she can remember. The pain is located at the top of the head, about 2 inches radius. She always had hot sensation at this area. She could not recall how it could have happened. She also had the problem of eyes that became blurry walking into a closed space.
I did indirect moxibustion on her head for about 5 minutes. She felt warm and comfortable with heating. She felt the pain was reduced somewhat. However, after overnight, she started to feel uncomfortable at the whole head. That discomfort lasted for five days, and then in the morning, her eyes started twitching. After the dinner, her right eye felt tension. At about 10:30pm her son asked her what happened to her right eye as the lateral half of her right eye appeared blood shot. All she can recall was that she felt something pop inside the skin at the temporal area before this happened.
The funny thing is that her 40 some year’s headache had disappeared. Strangely, the “heat” sensation at the top of the head was also disappeared.
The red eye was caused by internal capillary bleeding in the right eye. Certain capillary inside temporal area supplying for her right eye was leaking. She went to family doctor and was told that indeed there was capillary leakage and it was not serious although it looked awful.
Apparently, this lady had a long standing blood stagnation issue that caused for her lifelong headache. As is frequently the case, the blood stagnation turned to heat as body tried to resolve the problem (modern language: inflammation, which caused headache). With the moxibustion, the body was able to revive the stagnated blood and found an outlet and resolved the issue. Since I did not do bleeding, her body found its outlet which lead to the right eye.
I saw her the day after the red eye happened; I applied indirect moxa around her eyes (never moxa over the eyes) and told her to do it at home. She also had fellow students did acupuncture work around GB 1. In a week, most of the redness has disappeared. The headache never comes back.
By week three, the redness in the eye was almost gone but now her complaint was about tension around the right eye. The tension was made better with indirect moxa, needling at UB 1 and Tai Yang. Later on, I found that she had LASIX surgery to correct her vision which had been causing her tension around the right eye and perpetual dry eyes. So the tension around her eyes might not be related to the treating of her headache.
3.2 Ringing in the ear
Ringing in the ear is very annoying. For severe sufferer, it is devastating. One patient was sent in by his wife because he had “missed lots of conversation” according to his wife. He knew he had ringing problem but was not aware the hearing issue.
The incident of ringing increases with age. Older people frequently have it. In TCM, it is customary to distinguish ringing problem to the pitches of the noise. Older patients tend to have low pitch noise while younger patients would have high pitch. My experience is that regardless of the age, the noise sensation is mostly caused by the excessive muscle tension around the ears, particularly, the TMJ muscle. Therefore, most of the time, people with ringing in the ear would have tender and tight muscle groups surrounding the ear. The acupoint below the ear lobe, SJ 17, would be tender to pressure for them.
As the result, any treatment that would help relax the tension of these associated muscles and get the Qi moving would also be beneficial to reduce the noise.
Therefore, the starting point (no pun intended) is to relax the neck and shoulder tension using the above protocol, followed by needling of SJ 17. Because the GB meridians also go through the ears, it is helpful to needle the GB meridian at some distal points such as GB 39. Additional benefit would result by warming the area around the affected ear(s) using a heat lamp. Apply Moxa stick indirectly on the tense area surround the ear is extremely helpful. Because LI 4 is very effective in regulating the Qi, It should be included as well.
With these points in place, patient will literally feel the noise level decreases. For most patients, such problems have been with them for a long while. Their neck and shoulder muscles tend be always tense. It is expected to have more than a couple treatments to change such situation. The result can be further enhanced during treatment by having the patient taking a few very deep breathe during treatment.
The treatment would be more difficult if the patient had been treated surgically that aimed to” correct the inner ear defect”. I have a male patient who had this problem for a long while; he also had many procedures done to the inner ear, including surgical drainage, to no avail. These procedures created additional problems like scar tissues, deceases the flexibility of the ear musculature (similar to situation with elderly patients.). The treatment then has to rely heavily on moxibustion as well as electro acupuncture. It was effective as well. Moxibustion is not very easy to undertake here but is essential in this situation.
Another interesting case happened to me in school’s clinic. A female student in her early 30’s had chronic “wave noise” issue in her left ear. She was trim, tall, big eyes of Indian decent. Unfortunate for her, such issue had been with her since her childhood. Initially I used the above protocol to treat her ringing, believing it should be sufficient. To my surprise, the ringing only subsided partially. Then I started palpating her temporal area surrounding her ear. I discovered that she had a tender spot directly above her left ear. She never complained about that. Turned out that as a child she had an accident and sustained an injury of head above the ear. I applied indirect moxa over the tender area a few minutes, once each week for three weeks. The tenderness disappeared. The noise also disappeared as well. It was a strange feeling for her not having ringing in the ear.
There are mainly two types of dizziness based on the mechanism of the problem. One is the lack of blood/oxygen to the brain. In the severe case, a person can pass out. There are myriad of causes that lead to such blood deficiency, such as clotting of certain artery to the brain, blood vessel spasm, insufficient of blood circulation to the head. One common phenomenon that causes under such category is orthostatic hypotension. Whenever we change our posture like standing up from lying down, our body has to raise the blood pressure quickly to maintain proper blood pressure in the head to avoid transitory low blood supply in the head. Such reflex mechanism tends to weaken with age and for some elderly, it becomes a troubling issue. It can leads to a bad fall. For the same reason, many people fell light headed after acupuncture because the body becomes so relaxed that orthostatic low blood pressure kicks in.
The other type of dizziness comes from disorder in the inner ear. Our inner ear has sensors that give the information to our brain about our body’s balance. These sensors can be disturbed and we would lose sense of balance. It can also make us feel like the world around us is spinning. This could also easily cause the reflex reaction in the stomach and induces nausea. Doctors commonly blame it on the excess fluid in the inner ear and call the symptom Meniere's disease. So the medical approach is to reduce the amount of fluid by draining fluid from the body trough medication, or try to surgically drain the fluid. Surgery has the potential of causing harm to the hearing organ.
In Chinese herbal medicine, there is a formula called True Warrior decoction (Zhen Wu Tang) that is very effective to drain excess fluid in the body. This formula can be effective in treating such problem. Better result can be achieved by combination of acupuncture and moxibustion. The theory behind it is that provided the inner ear structure is not damaged, the fluid excess is merely a Qi stagnation phenomenon. Such stagnation stops normal drainage of the fluid and leads to fluid accumulation. As the result, sensory function of the inner ear becomes disorderly. Once the Qi is restored, the fluid draining function in the inner ear return normal and dizziness goes away.
There are a few meridians surround the ear- the gall Bladder, the San Jiao and the small intestine. All of these meridians can be involved. The situation is very much like the issue with tinnitus. The treatment for this disorder is the same as ringing in the ear. This is called treating different disease with same method. For Qi perspective, both diseases have similar disorder- Qi stagnation in the inner ear.
If the inner ear is damaged from prior infection or traumatic encounter such as injury or surgery. It would be more difficult to treat as the situation involves more than just Qi stagnation. Simple Qi restoration through AcuMoxa a few times would not be sufficient .
TMJ is one of the problems that are most suitable for acupuncture and moxibustion. It could be caused by toothache, tension, stress or injury resulted in inflammation at the joint. The muscles surrounding the Junction become exceedingly tight. The protocol for neck and shoulder (N-K protocol)is the first step for treatment, followed by Moxibustion and electro acupuncture at the St 6 and SJ 17. At times, the temporal area may be very tender and Tai Yang (extra point) has to be needled obliquely.
This procedure helped a 38-year old lady with pain resulting from dental work on her molars two days earlier. The day after her dental procedure, opening the mouth caused excruciating pain. She was not able to open her mouth more than 2 cm wide. She phoned the dentist and was referred to an oral surgeon. Instead, she came to my office, two acupuncture visits later and the problem was completely resolved. The dentist was very happy to pay her acupuncture bill. Turns out, such incidents from dental work happen common enough, apparently many dentists are not very tending to their patients suffering.
Such incidents are acute problems. A few acupuncture treatments are all is needed. For chronic sufferer of TMJ, more acupuncture visits will definitely be required. Many people would have an emotional component as well.
3.5 Grinding teeth
This is a frequent patient complaint, often told by their dentists or hygienist. The standard practice is to wear mouth guard to” prevent” excessive teeth wearing. Most people have no idea what it is about. Some people however do have issue with tight jaw.
A 50-year old executive had a complaint of grinding of the teeth. Although he was not overtly complaint about the neck and shoulder region, palpation revealed that these areas were very tense. As a result, excessive tension was created in the temporal and masseter muscles near the temporomandibular joint (TMJ). Therefore, the 1st thing to do is to treat the neck and shoulder following the N-S protocol and then add SJ17 and St 6. Adding electro acupuncture and moxibustion enhances result. Many people who have this issue tend to be under lots of mental stress and therefore it is important to address this issue as well. Different people carry the stress on different part of their bodies.
3.6 Toothache and other dental problems
Toothache is one reason people pay visit to dentists. This is especially true in the old days before the cosmetic dentistry exists. However, it should be clear that most toothache is not related to dental work. I do think acupuncturist can do better job of relieving patients toothache if the acupuncturist knows how to treat such problem. At the least, it is minimum invasive. No harm is done to the tooth.
The key is the knowledge. Most of the time, the tooth pain is related to Qi congestion at the junctions between the upper and lower jaw. It is not the individual tooth that is causing the pain even it appears so. “When Qi is congested, it will be painful”, as is frequently repeated in Traditional Chinese medicine.
Examine the cheek with fingers. First, opening mouth wide, press at the spots a few fingers width in front of the ear lobes. You can feel spots open between bones. When these two spots become tender to pressure, you are in trouble.
Massage with thumbs on and around the tender spots will help the tension. Warm up the spots are very beneficial. Another way of reducing the pain is to stick index fingers inside the mouth and massage the junction between the upper and lower jaw. It should feel sore and nice. Close the mouth or bite down the teeth while the finger is still in for a few times(watch out for finger.). As you do these things, you would notice that the tooth pain decreases.
The interesting thing is that it may appear that the pain originates from certain individual tooth, but to release the pain, you should focus on the jaw junctions, not the individual tooth. For acupuncture treatment, because these areas are where Stomach meridian populate, needling the foot Stomach meridian would be very beneficial, such as St 41, St 44 in addition to St 7 on the cheek.
This procedure does not work very well if the pain is caused by ulceration of the lining or infection of the gum. Gum infection needs to treated, preferably with antibiotics locally. Pus from infection, if any, should be drained to speed up recovery.
3.7 Trigeminal neuralgia
This is a type of facial pain that appears along one or more of the three branches of trigeminal nerve. As with other nerve pain, moxibustion is the best way to speed the recovery. One of the hallmarks of this pain is that there can be a spot too painful to be touched. Needling should be paced around this location. This is a special technique called Yang (meaning: rising) needling.