1. HEADACHE Lee Chong Leng 1

5. CONTENTS 1)Introduction6 - 76 - 7 2)Clinical Manifestations8 -16 3)Essentials for Diagnosis17 - 18 4)Treatment with Tuina Therapy19 - 64 5)Cautions65 - 66 5

6. HEADACHE  Pain in the upper part of the head due to pathological changes inside or outside the cranium  A commonly encountered subjective symptom and can be found in many different acute or chronic diseases 6

7. HEADACHE  Four causes of headache  Intracranial pathologic changes  Extracranial pathologic changes  General diseases  Neurosis  If the headache is a secondary symptom caused by injury, wound or some other diseases, it will disappear after the main symptoms are eliminated. 7

8. CLINICAL MANIFESTATIONS 1.Wind cold 风 寒 头 痛 2.Wind heat 风热头 痛 3.Summer-heat 暑湿 头 痛 4.Hyperactivity of liver yang 肝阳 头 痛 5.Phlegm and turbid substance 痰 浊头 痛 6.Blood deficiency 血虚 头 痛 7.Kidney deficiency 肾亏头 痛 8.Blood stasis 瘀血 头 痛 8

9. CLINICAL MANIFESTATIONS 1. Wind cold 风 寒 头 痛  Involvement of the nape and back, aversion to wind and cold, aching limbs and joints  Preference for wrapping the head, no thirst  Light and whitish tongue coating, floating or tense pulse 9

10. CLINICAL MANIFESTATIONS 2. Wind heat 风热头 痛  Distending headache, or even splitting pain in the head  Aversion to wind, fever, reddish complexion and eyes, thirst and preference for drinking, reddish and sore throat, yellowish urine  Reddish tongue tip & light yellow coating, floating and rapid pulse 10

11. CLINICAL MANIFESTATIONS 3. Summer-heat 暑湿 头 痛  Binding pain  Abdominal distension, anorexia, lassitude, heaviness, and pain in the body, feverish body and spontaneous sweating, dysphoria, thirst  Greasy coating, soft and rapid pulse 11

12. CLINICAL MANIFESTATIONS 4. Hyperactivity of liver Yang 肝阳 头 痛  Headache and dizziness, especially in both sides  Dysphoria, restless sleep, reddish complexion, dry and bitter taste, hypochondriac distension  Reddish tongue and light yellowish or scanty tongue coating, taut and strong or taut, thin and rapid pulse 12

13. CLINICAL MANIFESTATIONS 5. Phlegm and turbid substance 痰 浊头 痛  Marked by distension headache  Fullness sensation in the chest and diaphragm, anorexia, lassitude, profuse saliva and fluid, vomiting  Whitish and greasy tongue coating and slippery pulse 13

14. CLINICAL MANIFESTATIONS 6. Blood deficiency 血虚 头 痛  Headache, vertigo  Aggravation of pain after overstrain, languor, dark complexion, poor appetite, palpitation, short respiration  Light tongue, thin and limp or unsmooth pulse 14

15. CLINICAL MANIFESTATIONS 7. Kidney deficiency 肾亏头 痛  Severe pain  languor, tinnitus and vertigo, amnesia and insomnia, weakness of waist and limbs, seminal emission and leukorrhagia  Headache due to Yang deficiency is marked by cold limbs, light and plump tongue, sink thin and limp pulse  Headache due to Yin deficiency is marked by dry mouth with scanty fluid, reddish tongue, thin and rapid pulse 15

16. CLINICAL MANIFESTATIONS 8. Blood stasis 瘀血 头 痛  Repeated headache occurrence, difficulty to heal  Fixed location, puncturing pain, or with a history of traumatic injury of the head  Purple and dark tongue and unsmooth pulse 16

17. ESSENTIALS FOR DIAGNOSIS 1. Headache, involving the forehead, tempus, vertex and occiput or the whole head, characterized by flicking pain, stabbing pain, distending pain, vertigo or vague pain. It may occur suddenly or recur frequently and linger. It may last for several minutes, hours days or weeks 2. History of sudden onset or repeated occurrence due to invasion of exogenous pathogenic factors or endogenous ones 17

18. ESSENTIALS FOR DIAGNOSIS 3. Take blood routine test, blood pressure test, cerebrospinal fluid test and EEG test as well as Doppler, cranial and cerebral CT and MRI test if possible, in order to rule out organic disease and decide diagnosis 18

19. TREATMENT WITH TUINA THERAPY Principle: Dredging meridians, prompting Qi and blood flow （ 疏 经 通 络， 行气活血 ） 19

20. TREATMENT WITH TUINA THERAPY Acupoints and location: Yintang (EX-HN 3), Touwei (ST 8), Taiyang （ EX-HN5),Yuyao (EX-HN 4), Cuanzhu (BL 2), Yangbai, Baihui (GV 20), Sishencong, Jianjing (GB 21), Fengchi (GB 20), the head, face, nape and neck regions 20

21. TREATMENT WITH TUINA THERAPY Operation 1: (1)Patient - sitting position (back) (2)Use one-finger pushing method to push down through the neck, where the bladder meridian of foot-Taiyang runs, for about three minutes (3)Press Fengchi (GB 20), Fengfu (GV 16), Tianzhu (BL 10) (4)Grasp Fengchi (GB 20) and Jianjing (GB 21), 1 minute for each (5)Grasp along the neck where the bladder meridian of foot-Taiyang runs for 4-5 times 21

22. 22 Fengchi ( 风池 )

23. 23 Fengfu ( 风府 )

24. 24 Tianzhu ( 天柱 )

25. 25 Jianjing ( 肩井 )

26. TREATMENT WITH TUINA THERAPY Operation 2: (1)Patient - sitting position (front and back) (2)Use one-finger pushing method to push from Yintang (EX-HN 3), the hairline up to Touwei (ST 8) and Taiyang (EX-HN5) for 3-4 times (3)Press Yintang (EX-HN 3), Yuyao (EX-HN 4), Taiyang (EX-HN 5) and Baihui (GV 20) (4)Grasp with five fingers from vertex to Fengchi (GB 20) (5)Grasp with three fingers the bladder meridian of foot-Taiyang down to Dazhui (GV 14) for 3-4 times 26

27. 27 Yintang ( 印堂 )

28. 28 Touwei ( 头维 )

29. 29 Taiyang ( 太阳 )

30. 30 Yuyao ( 鱼腰 )

31. 31 Baihui ( 百会 )

32. 32 Dazhui ( 大椎 ) ， Feishu ( 肺俞 )

33. MANIPULATIONS ACCORDING TO SYNDROME DIFFERENTIATION 33

34. (1) COLD AND WIND  Roll the neck and back for about 2-3 minutes  Press and rub Feishu (BL 13) and Fengmen (BL 12) Grasp both sides of Jianjing (GB 21)  Rub bladder meridian at both sides of the back until it is warm 34

35. 35 Dazhui ( 大椎 ) ， Feishu ( 肺俞 )

36. 36 Fengmen ( 风门 )

37. (2) WIND AND HEAT  Press and rub Dazhui (GV 14), Feishu (BL 13), Fengmen (BL 12), one minute each  Grasp Jianjing (GB 21), Quchi (LI 11), shousanli (LI 10), Hegu (LI 4) until there is aching and distending feeling in the local area  Knock the back until it becomes warm 37

38. 38 Quchi ( 曲池 )

39. 39 Shousanli ( 手三里 )

40. 40 Hegu ( 合谷 )

41. (3) SUMMER-HEAT  Press and rub Dazhui (GV 14) and Quchi (LI 11)  Grasp Jianjing (GB 21) and Hegu (LI 4)  Knock the bilateral courses of the bladder meridian until the skin turns red  Pinch Yintang (EX-HN 3) and neck until it turns red 41

42. (4) HYPERACTIVITY OF LIVER YANG  Push Qiaogong up and down for 20 times each  Clean and dissipate tempus where the gallbladder meridian runs  Press and rub Jiaosun (TE 20), Taichong (LR 3) and Xingjian (LR 2) for about 10 times  Rub Yongquan (KI 1) until it turns warm 42

43. 43 Qiaogong ( 桥弓 )

44. 44 Jiaosun ( 角孙 )

45. 45 Dadun ( 大敦 ) ， Xingjian ( 行间 ) ， Taichong ( 太冲 )

46. 46 Yongquan ( 涌泉 )

47. (5) PHLEGM AND TURBID SUBSTANCE  Push and rub the abdomen, specially Zhongwan (CV 12), and Tianshu (ST 25) for 6-8 minutes  Press and rub Pishu (BL 20), Weishu (BL 21), Dachangshu (BL 25)  Rub the left back horizontally until it is warm  Press and rub Zusanli (ST 36), Fenglong (ST 40) and Neiguan (PC 6) 47

48. 48 Zhongwan ( 中脘 ) ， Tianshu ( 天枢 ) ， Qihai ( 气海 )

49. 49 Geshu ( 膈俞 ) ， Ganshu ( 肝俞 ) ， Pishu ( 脾俞 ) ， Shenshu ( 肾俞 )

50. 50 Weishu ( 胃俞 )

51. 51 Shenshu ( 肾俞 ) ， Dachangshu ( 大肠俞 )

52. 52 Zusanli ( 足三里 )

53. 53 Fenglong ( 丰隆 )

54. 54 Neiguan ( 内关 )

55. (6) BLOOD DEFICIENCY  Rub the abdomen for 6-8 minutes, especially Qihai (CV 6), Zhongwan (CV 12) and Guanyuan (CV 4)  Rub the left back horizontally and the governor vessel vertically until it is warm  Press and rub Xinshu (BL 15), Geshu (BL 17), Zusanli (ST 36) and Sanyinjiao (SP6) until it is slightly aching and distending 55

56. 56 Zhongwan ( 中脘 ) ， Tianshu ( 天枢 ) ， Qihai ( 气海 )

57. 57 Yingxiang ( 迎香 ) ， Cuanzhu ( 攒竹 )

58. 58 Xinshu ( 心俞 )

59. 59 Geshu ( 膈俞 ) ， Ganshu ( 肝俞 ) ， Pishu ( 脾俞 ) ， Shenshu ( 肾俞 )

60. 60 Sanyinjiao ( 三阴交 )

61. (7) KIDNEY DEFICIENCY  Rub in circle the abdomen for 6-8 minutes, especially Qihai (CV 6) and Guanyuan (CV 4)  Rub the governor vessel horizontally  Press Shenshu (BL 23) and Mingmen (GV 4) and waist until warmth is felt 61

62. 62 Shenshu ( 肾俞 ) ， Dachangshu ( 大肠俞 )

63. 63 Mingmen ( 命门 )

64. (8) BLOOD STASIS  Press and knead Taiyang (EX-HN 5), Cuanzhu (BL 2), forehead and tempus where the gallbladder runs  Rub the forehead and both sides or Taiyang (EX-HN 5) until it is warm 64

65. CAUTIONS 1.Patients with headache due to exogenous pathogenic factors must keep warm, avoiding wind and cold and taking sufficient rest 2.Patients with headache due to hyperactivity of liver Yang should frequently test blood pressure, pay attention to the undulation of blood pressure and its influence on the heart. 3.Patients with headache due to blood deficiency and kidneys deficiency should avoid excessive sexual intercourse 65

66. CAUTIONS 4.Stop smoking and drinking is helpful for healing different types of headache 5.Tuina therapy is not suitable for intracerebral diseases, such as cerebrovascular disease at the acute stage, cerebral contusion, and encephalic traumatic hematoma 66

67. 67 THANK YOU