TREATING HEADACHE AND MIGRAINE

Transcription

1 4 IMBALANCES AND 5 ORGANS A New System for Diagnosis and Treatment TREATING HEADACHE AND MIGRAINE Jeremy Ross

2 HEADACHE AS AN EXAMPLE The new system We can now look at how the new system works for treating a specific disorder, taking the treatment of headaches as an example. Classification of headaches is not done here according to conventional medicine, but according to the new system and Chinese medicine Headache syndromes can be organized according to: 4 Imbalances Additional disorders Temperature Organ syndromes

3 4 IMBALANCES All disorders can be organized according to the 4 Imbalances system. Headache and disturbance Most chronic headaches are associated with Liver Hyperactive Yang, a Disturbance syndrome, for which the principle of treatment is to calm. However, this basic Disturbance syndrome may be associated with syndromes of Deficiency, Stagnation, or Excess. Disturbance + other Imbalances So headache patterns can be classified as: Disturbance Deficiency + Disturbance Stagnation + Disturbance Excess + Disturbance

4 tonify DEFICIENCY + calm + DISTURBANCE calm DISTURBANCE HEADACHE 4 IMBALANCES STAGNATION + DISTURBANCE EXCESS + DISTURBANCE move + calm drain + calm

5 DEFICIENCY tonify + DISTURBANCE calm DISTURBANCE calm Are you chronically tired or exhausted? Are your headaches worse when you are tired? Are your headaches better with physical rest? Does stress easily make you nervous? Are your headaches worse with anger, fear, anxiety? Are your headaches better with calm surroundings? 4 IMBALANCES Differential Questions Diagram STAGNATION move + DISTURBANCE calm EXCESS drain + DISTURBANCE calm Do you feel blocked, frustrated, or depressed? Do you have sensations of too much energy? Are your headaches worse with emotional constraint? Are your mood and your headaches better with exercise? Are your headaches with full sensations in head? Are your headaches with severe pain or feeling hot?

6 HEADACHE ADDITIONAL DISORDERS The Problem There are over 20 single herbs and 19 combinations that can be used to treat headache. So the important question is: How do I choose the right headache herb or combination for my patient? The solution: Additional disorders In the new system for classifying disorders that is shown here, each headache is classified according to Additional disorder, that is, one of the other main disorders of the patient. Example The practitioner chooses headache as the main disorder for the patient, and then chooses depression as the additional disorder, since this is also important to the patient. Combination search The practitioner then looks for herbs or herb combinations that treat both headache and depression. This narrows the choice from 19 combinations down to one combination, as shown in slide 14. Additional disorders Table This shown on the next slide, with division into the 4 Imbalances.

7 HEADACHE ADDITIONAL DISORDERS TABLE HEADACHE Additional Disorders DISTURBANCE + fear + anxiety DISTURBANCE + DEFICIENCY + anemia + muscle tremors + anemia + intolerances + hypoglycaemia, mild + tinnitus + restlessness + exhaustion + hypertension + exhaustion + burnout + anger: chronic phase HEADACHE Additional Disorders DISTURBANCE + STAGNATION + depression + PMS dysmenorrhea + facial neuralgia + sinusitis DISTURBANCE + EXCESS + PMS + anger + hypertension + anger + burnout + anger: acute phase DISTURBANCE + EXTERIOR WIND + conjunctivitis + myalgia

8 TEMPERATURE Matching herbs and patients Herbs and combinations can be classified in terms of temperature, and patients can be classified according to the same system. Then herbs and combinations can be matched to the patient s need. Caution If the temperature of the patient and the temperature of the herb or combination do not match, then the patient may become worse instead of better. Differential questions To determine the patient s temperature, you can use questions from the Patient Temperature Differential Question Table on the next slide. Of course, you can also check a patient s temperature by palpation of hands, feet, arms, legs, head, and body. TEMPERATURE BALANCING PATIENT Herb/combo hot cold warm cool sl. warm sl. cool neutral neutral sl. cool sl. warm cool warm cold hot

9 TEMPERATURE CATEGORY hot warm neutral cool cold PATIENT TEMPERATURE Differential Questions DIFFERENTIAL QUESTIONS Do you feel not just warm, but hot? Do you prefer cold rooms, and do you avoid even slightly warm rooms? Do you feel warm, but not hot? Do you prefer cool rooms, but not cold rooms? Do you feel neither cool nor warm, but more or less normal? Do you have no preference for warm or cool rooms, or does it vary? Do you feel cool, but not cold? Do you prefer warm rooms, but not hot rooms? Do you feel not just cool, but cold? Do you prefer hot rooms, and do you avoid even slightly cool rooms?

10 HEADACHE CHINESE SYNDROMES Headache Chinese syndromes diagram on the next slide, shows some of the Chinese syndromes associated with headache and migraine, organized in terms of the 4 Imbalances. Differential questions for the common combinations of Chinese syndromes associated with headaches are shown in the Headache Finder Table on slide Combinations of syndromes The types of headaches discussed below nearly all involve Liver Hyperactive Yang, but usually this syndrome is paired with another syndrome, depending on the additional disorder.

11 DEFICIENCY LR Deficient Qi LR Deficient Blood LR Deficient Yin KI Deficient Qi KI Deficient Yin SP Deficient Qi tonify + calm DISTURBANCE calm LR Hyperactive Yang LR Wind KI Fear HT Spirit Disturbance (HSD) HEADACHE Chinese Syndromes Diagram STAGNATION move + calm EXCESS drain + calm LR Stagnant Qi KI-BL channel Stagnant Qi UT Stagnant Qi Stagnant Qi/Blood in channels LU Phlegm LR Excess Heat ST Excess Heat Wind Heat Wind Cold

12 CHOOSING HERB COMBINATIONS Combinations Summary Table on slides 13 and 14 summarizes the 19 herb combinations for headache available in Die Rezepturen. Die Rezepturen Most of these combinations are described in Rezepturen, but some of them were written after Rezepturen went to print. These are listed as NEW in the Page column of the Combinations Summary Table. Table organization 4 Imbalances The headache combinations in the Table are first divided according to the 4 Imbalances. Additional disorders Then the combinations are organized according to the additional disorders to headache. For example, headache + intolerances, headache + anemia, and so on. Organs This column of the Table shows the Organs associated with the specific headache combination. The Organs are colorcoded for quick recognition. Temperature This column shows the overall temperature of each combination, color-coded for visual impact. The temperature of the combination should always be checked against the temperature of the patient. Combination name The short form of the combination name is given in the Combination Summary Table, and the full name of the combination is given in the Combination Comparison Table. For example, the full name for Lavandula 4 is: LAVANDULA 4 headache + anxiety Liver Hyperactive Yang + Heart Spirit Disturbance

13 HEADACHE COMBINATIONS SUMMARY Additional Disorder(s) Organs Combination Temp. Page DISTURBANCE calm Anxiety LR HT LAVANDULA 4 cool 500 Fear LR KI RUTA 8 neutral 642 DISTURBANCE calm DEFICIENCY tonify Intolerances LR SILYBUM 6 warm NEW Anemia LR SALVIA 5 warm 656 Muscle tremors + anemia LR SCUTELLARIA 2* neutral 668 Hypoglycaemia LR SP AVENA 1 warm NEW Tinnitus LR KI CIMICIFUGA 6 cool 356 Restlessness + exhaustion LR KI CIMICIFUGA 1 cool 350 Hypertension + exhaustion LR KI SCUTELLARIA 3* cool 670 Burnout + anger: chronic phase LR SCUTELLARIA 7* cool 678

14 HEADACHE COMBINATIONS SUMMARY, cont. Additional Disorder(s) Organs Combination Temp. Page DISTURBANCE calm STAGNATION move PMS + depression LR ROSMARINUS 9 warm 622 PMS + dysmenorrhea LR ARTEMISIA 8 warm 280 Facial neuralgia LR ROSMARINUS 6 neutral 618 Sinusitis LU LR ANGELICA 10 warm 250 DISTURBANCE calm EXCESS drain PMS + anger LR HUMULUS 1 cool-cold 466 Hypertension + anger LR VALERIANA 3 cool-cold 754 Burnout + anger: acute phase LR SCUTELLARIA 6* cool 676 DISTURBANCE calm EXTERIOR WIND drain Conjunctivitis LR TANECETUM 2 cool 706 Myalgia LR SALVIA 4 warm 654

15 COMBINATION EXAMPLE SALVIA 5 headache + anemia Liver Hyperactive Yang + Deficient Blood Symptoms headache with empty sensation in head, maybe faintness or dizziness on standing up; worse with blood loss, for example after menstruation anemia with exhaustion, dull pale complexion, floaters in visual field, maybe tics and tremors maybe sensations of cold or numbness in extremities Temperature The overall temperature of the combination is warm to treat cool conditions. Dispensing Adult dose is ml of tincture, in quarter cup of water, 3 times per day. Duration Can be taken for up to 1-2 months, with appropriate cautions, breaks, and modifications. Cautions See Die Rezepturen. Contraindicated n conception, pregnancy, and lactation.

16 SALVIA 5 HEADACHE + ANEMIA Liver Hyperactive Yang + Deficient Blood Herb Ratio Temp. Taste Salvia off. 1 (warm)-cool aromatic, bitter, acrid Rosmarinus 1 warm aromatic, bitter, acrid Artemisia abs. 1 warm-cool aromatic, bitter Valeriana 1 cool bitter, sweet, aromatic Passiflora 1 neutral-cool bitter Lycium 1 neutral sweet, sl. astringent Angelica sin. 1 warm sweet, acrid, aromatic, bitter Zingiber (dried) 0.5 hot acrid, aromatic

17 CHOOSING SINGLE HERBS Four Tables are shown here to facilitate herb choice for headache and migraine. All four Tables are organized according to the 4 Imbalances. There are other, more detailed Tables also, but this is a short seminar. 4 Imbalances Table Temperatures Table Finder Table Herb Details Table Further herb information See Eine Klinische Materia Medica for details of 120 herbs Headache + 4 imbalances Table organizes the herbs for headache according to the 4 Imbalances and gives the herbs a star rating for each Imbalance. Stars ratings are given from zero to five stars. Zero ratings Herbs with a zero star rating are not shown in the Table, for example, Avena has a zero rating for Excess, and Anemone has a zero rating for Deficiency.

18 DEFICIENCY Tonic Herbs HEADACHE HERBS 4 Imbalances STAGNATION Moving Herbs Artemisia abs. Rosmarinus Avena Artemisia abs. Rosmarinus Cimicifuga Salvia off. Ruta Scutellaria lat. Salvia off. Cimicifuga Mentha pul. Ruta Verbena Verbena Anemone Viola tri Lavandula Humulus Lavandula

19 DISTURBANCE Calming Herbs HEADACHE HERBS 4 Imbalances EXCESS DRAINING Herbs Anemone Anemone Humulus Humulus Lavandula Piscidia Piscidia Scutellaria bai. Valeriana Valeriana Mentha pul. Viola tri. Nepeta Cimicifuga Passiflora Salvia off. Rosmarinus Tanecetum Tanecetum Artemisia abs.

20 DISTURBANCE Calming Herbs HEADACHE HERBS 4 Imbalances EXCESS DRAINING Herbs Verbena Avena Avena Passiflora Cimicifuga Ruta Ruta Scutellaria lat. Salvia off. Tilia Scutellaria bai. Scutellaria lat. Tilia Artemisia abs. Viola tri.

21 Herb Temp. HEADACHE HERBS Temperature DEFICIENCY STAGNATION DISTURBANCE EXCESS tonify move calm drain Mentha pul. warm Rosmarinus warm Lavandula sl. warm Melissa sl. warm Artemisia abs. warm-cool Nepeta warm-cool Ruta warm-cool Avena neutral Verbena neutral Passiflora neutral-cool Scutellaria lat. neutral-cool

22 Herb Temp. HEADACHE HERBS Temperature DEFICIENCY STAGNATION DISTURBANCE EXCESS tonify move calm drain Tilia neutral-cool Salvia off. (warm-)cool Cimicifuga cool Tanecetum cool Valeriana cool Viola tri. cool Anemone cold Humulus cold Piscidia cold Scutellaria bai. cold

23 HERB AND COMBINATION FINDER TABLE Table organization Specific for headache This box in the Table shows all twenty one herbs for treating headache and migraine that are discussed in this chapter. 4 Imbalances The Table is then divided into four sections, by the usual yellow title bars, for each of the 4 Imbalances: into cognitive disorders associated with Disturbance, Deficiency, Stagnation and Excess. Chinese syndromes The Table is next divided, by the Organ color-coded title bars, according to the Chinese syndrome, or combination of syndromes, associated with the headache. For example: headache associated with Liver Hyperactive Yang + Kidney fear, or headache associated with Liver Hyperactive Yang + Heart Spirit Disturbance. Additional syndromes Parallel to the organization by Chinese syndromes is the organization according to the disorders additional to headache, shown in the pale grey title bars. For example: LR Hyperactive Yang (LHY) Headache + KI Fear + Fear Differential questions Three Differential questions are given to help you identify the Chinese syndrome combination of each headache type. For example, one of the Differential questions for the pattern shown above is: Are your headaches associated with fear or frightening situations?

24 HERB AND COMBINATION FINDER TABLE, cont. Herbs, pairs, trios, and combinations For each headache pattern, the Table shows the choice of available single herbs and herb combinations, and also a selection of possible herb pairs and herb trios that can be used. Importance of the table This Table gives you the differential questions to identify your patient s headache pattern and then shows you the herbs, pairs, trios, and combination(s) to treat that pattern. Example Let us say that your patient has the following headache pattern: Three single herbs are shown in the Finder Table: Artemisia absinthium, Rosmarinus, and Salvia officinalis. Temperature Table You could use the Temperature Table to differentiate between these three herbs, where you can see that: Artemisia is warm-cool Rosmarinus is warm Salvia is (warm-) cool If your patient is warm, then Salvia is the herb of choice. LR Hyperactive Yang (LHY) Headache + LR Deficient Blood + Anemia Herb Details Table But let us say that you want more details about these three herbs before you make your choice. Then you can go to the Herb Details Table shown on slides

25 Herbs specific for headache HEADACHE Herb and Combination Finder Anemone Artemisia Avena Cimicifuga Humulus Lavandula Melissa Mentha pul. Nepeta Passiflora Piscidia Rosmarinus Ruta Salvia off. Scutellaria bai. Scutellaria lat. Tanecetum Tilia Valeriana Verbena Viola tri.

26 HEADACHE + ADDITIONAL DISORDER DISTURBANCE calm LR Hyperactive Yang (LHY) Headache General Symptoms + Irritability Differential Questions Do you have dizziness or tinnitus, and are your headaches associated with these? Do you have eyestrain or photophobia, and are your headaches associated with these? Are your headaches associated with hypersensitivity to noise, irritability, impatience, or anger? Herbs Pairs Trios Combos all herbs listed as specific for headache except Avena and Viola see additional syndromes below see additional syndromes below see additional syndromes below Points SJ.5, GB.14, GB.20, GB.41 E or Rd; SP.6 Rf or: PC.6, LR.3, LR.14, GB.20, GB.34 E or Rd

27 HEADACHE + ADDITIONAL DISORDER DISTURBANCE calm, cont. LR Hyperactive Yang (LHY) Headache + KI Fear + Fear Differential Questions Are your headaches associated with fear or frightening situations? Did you have any frightening shock or trauma, for example, before the headache started? Do you have asthma, urinary frequency, or diarrhea that is aggravated by fear? Herbs Anemone Lavandula Passiflora Scutellaria lat. Cimicifuga Mentha pul. Ruta Pairs headache + fearfulnness Anemone + Ruta headache + fearfulness Trios Anemone + Mentha pul. + Ruta headache + fearfulness + exhaustion Anemone + Ruta + Avena* Combos Points RUTA 8: headache + fear LR Hyperactive Yang + KI fear SJ.5, GB.14, GB.20, GB.41 E or Rd; Du 20 E; KI.6, SP.6 Rf alternate Du. 20; SI.3, BL. 10, BL.62, LU.7, KI.6 E

28 HEADACHE + ADDITIONAL DISORDER DISTURBANCE calm, cont. LR Hyperactive Yang (LHY) Headache + HT Spirit Disturbance + Anxiety Differential Questions Are your headaches associated with anxiety or over-excitement? Do you have insomnia or palpitations, and are your headaches, associated with these? Do you sometimes talk too much or too fast, and do you ever stammer when stressed? Anemone Avena Humulus Lavandula Melissa Mentha pul. Herbs Nepeta Passiflora Piscidia Ruta Salvia off. Scutellaria lat. Tilia Valeriana Pairs headache + anxiety Anemone + Lavandula headache + anxiety + insomnia Trios Combos Anemone + Lavandula + Scutellaria lat. Headache, severe + anxiety + insomnia Anemone + Humulus+ Valeriana LAVUNDULA 4: headache + anxiety LR Hyperactive Yang + HT Spirit Disturbance Points Du 20, PC.6, LR.3, GB.20, GB.40 E; HT.6, SP.6 Rf.

29 HEADACHE + ADDITIONAL DISORDER DISTURBANCE calm, cont. LR Hyperactive Yang (LHY) Headache + LR Deficient Blood + Anemia Differential Questions Do you have a relatively mild headache with empty sensation in the head, and do you sometimes feel dizzy on standing up? Are you anemic, and is your headache worse after blood loss, such as after menstruation? Do you have blurred vision, floaters in the visual field, or thin brittle nails? Herbs Artemisia Rosmarinus Salvia off. Pairs headache + anemia Rosmarinus + Salvia off. Trios Combos headache + anxiety + insomnia Anemone + Lavandula + Scutellaria lat. headache + anemia Artemisia + Rosmarinus + Salvia off. SALVIA 5: headache + anemia LR Hyperactive Yang + HT Spirit Disturbance Points Du 20, BL. 18, BL.20, LR.3, LR.8, SP.6, S.36 Rf

30 HERB DETAILS TABLE Herb Details Table This is the best place to compare similar herbs. All twenty-one herbs for headache are shown in alphabetical order. For each herb the Table shows Imbalance star ratings, Temperature, Taste, Organs entered, and the main actions of the herb in treating headaches. Special items The two main types of data shown for each herb that make this Table special are: Additional disorders to headache Differences from similar herbs

31 HEADACHE Herb Details Herb Temp. Tastes Organs Main action in headache Additional disorders to headache DEFICIENCY TONIFY STAGNATION move DISTURBANCE calm EXCESS drain Differences from similar herbs Anenome cold Bitter HT, KI, LR strong anxiolytic Headache + spasm and pain elsewhere in the body, eg. Earache, facial neuralgia, dysmenorrhea Fear, anxiety, anger, facial neuralgia, heat sensations, earache, dysmenorrhea, muscle spasm, muscle tremors Artemisia warm-cool bitter, aromatic LR, GB, SP, UT Like avena, for headache in menopause + hot flushes, but anemone is for this + hyperactivity, whilst avena is for this + exhaustion Drowsiness not reported, unlike humulus, lavandula, and valeriana Depressive effect not reported, unlike humulus Hepatobiliary regulator, menstrual regulator Like cimicifuga, for headache + pms, but artemisia is specific for headache + hepatic weakness + intolerance of fatty food or medications, whilst cimicifuga is specific for menopausal headache Anemia, exhaustion, hangover, muscle tremors, convulsions, PMS, menstrual irregularity More for liver headaches, whilst ruta is more for kidney headaches Avena neutral sweet, sl. bitter, sl. astringent SP, HT, KI Sweet nutrient tonic Hypoglycaemia, depression, exhaustion, nervous exhaustion, emotional lability, menopausal disorders Like Melissa, for anxiety and/or depression, but Avena is specific for mood swings + malnourishment or nervous exhaustion Like Salvia, for headache in menopause + hot flushes + exhaustion, but Avena is more for physical and mental exhaustion, whilst Salvia is for anemia or restlessness + heat sensations

32 HEADACHE Herb Details Herb Temp. Tastes Organs Main action in headache Additional disorders to headache DEFICIENCY TONIFY STAGNATION move DISTURBANCE calm EXCESS drain Differences from similar herbs Cimicifuga cool acrid, sl. bitter, sl. sweet KI, LR, UT menstrual and menopausal regulator Like Ruta, for headache + pms, but Cimicifuga is specific for headaches + influenza, arthritis, or menopause, whilst Ruta is specific for headaches + fear or excess sex Influenza, exhaustion, fear, heat sensations, eye strain, ear pain, myalgia, muscle spasm, muscle tremors, convulsions, pms, menopausal disorders, tinnitus Sometimes aggravates headache: if in doubt, supply in a separate bottle from main prescription Humula cold bitter HT LR, IN strong anxiolytic Colder than Valeriana and more likely to aggravate depression Anger, anxiety, heat sensations, irritability, intestinal colic Specific for headache + colitis + nervous tension Lavandula sl. warm aromatic, bitter, sl. acrid HT LR, IN, KI, LU anxiolytic, mild antidepressant May cause drowsiness and reduced attention during driving Anger, anxiety, heat sensations, insomnia, irritability, irritable bowel syndrome, muscle spasm, muscle tremors, convulsions Lavandula is specific for headache + anxiety and mild depression, but Rosmarinus is specific for headache + depression + cold sensations

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