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Case Histories - Menstrual Headaches (2)

A 40-year-old woman had been suffering from headaches before and after the period: interestingly, the headaches had started after an operation for sterilization (tube ligation). The headaches were located behind the eyes, on either side, and were throbbing in nature; they were accompanied by nausea, blurred vision, a bitter taste, thirst and dizziness. Her periods were regular and rather scanty. On interrogation, it transpired that she also suffered from palpitations, dizziness, tingling of her limbs, poor memory, blurred vision and night-sweating. Her tongue was Pale and Swollen and her pulse was Choppy and Weak, particularly on both Rear positions.

Diagnosis

The headaches are typical of Liver-Yang rising with their throbbing character, dizziness, blurred vision and nausea. The bitter taste and thirst also indicated some Liver-Fire. The origin of Liver-Yang rising was primarily Liver-Blood deficiency as was clearly shown by the blurred vision, dizziness, poor memory, tingling, scanty periods, Pale tongue, Choppy pulse and palpitations (this last symptom due to Liver-Blood deficiency affecting Heart-Blood). There was a slight Kidney deficiency as evidenced by the night sweating and Weak pulse on both rear positions. Finally, there was also some Phlegm and Spleen-Qi deficiency as evidenced by the Swollen tongue.

Treatment

The treatment principle adopted was to nourish Liver-Blood, tonify the Spleen, subdue Liver-Yang and tonify the Kidneys. I treated her with herbal medicine and acupuncture.

Acupuncture

I used a simple treatment with few points such as:-

LU-7 Lieque (on the right) and KI-6 Zhaohai (on the left) to regulate the Directing Vessel, regulate the periods and strengthen the Uterus.-
T.B.-5 Waiguan to subdue Liver-Yang and treat the headaches.-
ST-36 Zusanli and SP-6 Sanyinjiao, with warm needle to tonify the Spleen and nourish Blood.

Herbal treatment

I used a decoction based on the Three Treasures (or East West Treasures) remedy Bend Bamboo:

Dang Gui Radix Angelicae sinensis 9g
Chuan Xiong Radix Ligustici Chuanxiong 3g
Shu Di Huang Radix Rehmanniae glutinosae praeparata 9g
Bai Shao Radix Paeoniae lactiflorae 6g
Ju Hua Flos Chrysanthemi morifolii 6g
Man Jing Zi Fructus Viticis 4.5g
Gou Teng Ramulus Uncariae 6g
Bai Ji Li Fructus Tribuli terrestris 3g
Gou Qi Zi Fructus Lycii chinensis 6g
Fu Ling Sclerotium Poriae cocos 6g
Bai Zhu Rhizoma Atractylodis macrocephalae 6g
Ban Xia Rhizoma Pinelliae ternatae 6g
Zhi Gan Cao Radix Glycyrrhizae uralensis praeparata 3g

Explanation

Dang Gui, Shu Di Huang, Bai Shao and Chuan Xiong form the Si Wu Tang Four Substances Decoction which nourishes and invigorates Blood.-
Man Jing Zi, Bai Ji Li, Ju Hua and Gou Teng subdue Liver-Yang and treat headaches.-
Gou Qi Zi nourishes Blood and tonifies the Kidneys.-
Fu Ling, Bai Zhu and Ban Xia tonify Spleen-Qi and resolve Phlegm.-
Zhi Gan Cao harmonizes.

After the first decoction, I added Xia Ku Cao Spica Prunellae vulgaris 4.5g remembering that there was also some Liver-Fire (bitter taste and thirst).

After four courses of decoctions (of 15 days each) she was completely free of headaches.