Mr. Borduas, 50, auto mechanic, consults for headaches. For the past month, he has felt pressure in his temples, which increases throughout the day. Her doctor diagnosed her with a high pressure headache and recommended that she rest and take pain relievers as needed. What he did, but with more or less satisfactory results; it works, but the pain usually returns the next day. He comes to consult with the hope that we can help him more, but he admits to being skeptical.

1- Question

The acupuncturist first tries to locate the pain in one of the analysis grids (see Examinations) of Traditional Chinese Medicine (TCM). The type of pain, its location, the aggravating and relieving factors, as well as the symptoms that accompany the attacks, are the most relevant data to collect in the presence of a headache. Mr. Borduas describes his pain “like a squeeze” on either side of his temples, as if he had his head in a vice that gradually tightened during the day. Deaf when you wake up, the pain then gets worse, reaching the back of the neck and shoulders. It is increased by alcohol and can appear indifferently on a day of work or off. Warm baths in calm do him good; he takes it every night. Mr. Borduas does not experience nausea, dizziness, or any visual symptoms such as “black flies” during his seizures.

When asked the question, Mr. Borduas clearly states that it is stress that is at the root of his seizures. For several weeks, he has been experiencing tensions with his daughter and, obviously, things will not be resolved anytime soon. In addition, Mr. Borduas says that three years ago, he experienced a similar episode that lasted four months. According to him, a couple problem was at the origin of this crisis, which ended the day he emptied his heart. We are dealing with a man who knows himself quite well.

The second part of the questioning makes use of the Ten Songs (see Questioning), by which the acupuncturist tries to collect more systemic symptoms in order to orient his energy balance. Over the course of the questions, Mr. Borduas realizes, among other things, that he is more thirsty than before. For the past two weeks or so, he’s been buying soft drinks more often, which he likes cold, from the vending machine in the garage. Because he’s thirsty, but also to get rid of that bitter taste in his mouth. His appetite is normal, but he has more difficulty having a bowel movement, sometimes skipping a day, which is unusual for him. Regarding his lifestyle, Mr. Borduas drinks a coffee a day and says he is very active, particularly fond of golf.

2- Auscultate

Auscultation is not used in this case.

3- Palpate

The pulse is stringy and slightly rapid. Palpation of the cervical region and trapezius muscle is essential, as the acupuncturist will be able to detect Ashi pain points there. He will also palpate the points of different meridians connected to the head in order to confirm the other data.

Although emotions seem to predominate in the explanation of the headache, it is still important to perform a physical examination to detect signs of possible muscle tension or other structural problems. This is all the more important since Mr. Borduas’ work can be very demanding on his neck. In addition, it is at the age when cervical spondylosis can begin to manifest itself as pain in the neck, shoulders or headaches. We see that Mr. Borduas is not limited in his movements of rotation of the head, but that he makes a face during movements of lateral bending.

4- Observer

The tongue is red, flaky in places. At the time of the consultation, Borduas had bloodshot whites of his eyes, a detail he said he had noticed for about two weeks.

While Mr. Borduas’ tension headache clearly appears to be of emotional origin, it remains important to examine the other concurrent causes. Indeed, not all people who experience intense emotions or stress suffer from such headaches. Headaches do not only depend on the tensions generated by everyday life, but also on the simultaneous presence of other factors.

Chinese medicine divides the origin of headaches into two main categories: either a Void (of Qi, Blood, Yin or another Substance), or Stagnation and possibly Excess (of Yang or Fire) .

Among the causes of headaches caused by a Void, we find:

• Overwork, both at work and in leisure (excessive sportsmen, for example).
• Sexual excesses (see Sexuality)
• Childbirth and miscarriages.

The causes of headaches from Excess are:

• Hormonal changes (which will cause premenstrual headaches).
• Certain foods (chocolate, cheese, fruit, alcohol, fatty foods, etc.).
• Trauma, particularly falls on the back or automobile accidents resulting in whiplash.
• Excess emotions (anger, anxiety, fear, constant worry, etc.). (See Causes – Internal.)

Interestingly, Western medicine identifies the same emotional factors, stress, worry, and anxiety, as listed causes of headaches.

In the case of Mr. Borduas, the emotion in question is primarily resentment, resulting from a repressed anger and contained over a long period. The TCM explains that this excess emotion can turn into a tension headache according to a very specific process that the energy balance will highlight.

Several analysis grids (see Examinations) can be used to establish the energy balance of a headache. Based on the data collected throughout the examination, the acupuncturist oriented his choice towards the Viscera grid.

The type of pain tells us about the energetic nature or about the Substance involved in the pain. Mr. Borduas describes his pain as first being dull when he wakes up, then changing to a “tightness” on either side of his temples. The tightening in TCM corresponds to a state of Stagnation: the Qi is blocked, the Blood can no longer circulate well, hence the feeling of having the skin of the skull too small. Over the course of the day, Mr. Borduas has less and less energy, the Qi gradually decreases and, conversely, the tension in the head increases.

Location is a determining factor in establishing the balance sheet, and tells us which Meridian is involved. The head is the most Yang part of the body; it is here the tendino-muscular meridian (see Meridians) of the gall bladder, which irrigates the lateral part of the head, which is in question (see diagram).

The Gallbladder, which is part of the Bowel, maintains a close Yin Yang relationship with its corresponding Organ, the Liver (see Five Elements). This explains why resentment causes headaches. The Liver, when it assumes its function of free movement, ensures that the emotions flow in us: that we feel them, then that they pass. The repression of an emotion acts like a cork on a pressure cauldron. Qi can no longer circulate, it stagnates and becomes in a way an explosive potential. The tension headaches are the result of the explosion: the overflow accumulated by the liver is evacuated through the Meridian of the Gallbladder, which rises to the head.

It’s no surprise that alcohol increases symptoms, as it only adds more Yang where there is already too much. The other signs that have appeared in the last weeks, thirst for cold drinks, bitter taste in the mouth, constipation, dry stools and red eyes are signs of Fire, which dries up body fluids. But then one might wonder why hot baths and not ice baths relieve Mr. Borduas. In fact, if the heat does her good, it is because it relaxes the muscles of her neck and her shoulders, thus allowing a better circulation of Qi and temporarily restoring the supply of Blood in the upper body. The stress caused by the emotion remains however well anchored, which explains why it all starts again the next day.

The slightly rapid cord pulse (see Palpate) confirms the agitation that the Fire creates in the Blood: it circulates too quickly and beats hard in the arteries. The red tongue and flaky in places is also the result of the Fire which burns the Liquids: the tongue loses its coating, which represents the Yin aspect.

Energy balance: Stagnation of the Qi of the Liver which produces Fire.

The acupuncture treatments will aim to clarify the Fire of the Liver and the Gallbladder, and to drain the Qi blocked in the Liver, in order to prevent a new Stagnation from creating again the Fire. We will especially seek to lower the Yang movement which is rampant in the head.

In addition, the body, by its dynamics of homeostasis, has been trying for a month to refresh the Fire and obviously does not succeed. It may have harmed the Kidney Yin, which nourishes the Liver Yin. It will therefore be important to balance the acupuncture treatment with points that will nourish the Yin aspect of the Kidneys in the long term.

When you can’t eliminate the source of stress – be it family, professional or otherwise – we can still act on how to cope with it or consider it. First of all, it is desirable to learn to relax, which nourishes the Yin. Meditation and Qigong breathing exercises help to relax while re-energizing the body and mind. In addition, they often give back a grip to patients who feel powerless in the face of situations they consider to be hopeless.

It is also important to avoid anything that can invigorate the Yang, which is already in excess. Coffee, tea, sugar, alcohol and spices should be put aside, or else consumed in very small amounts. The application of heat is beneficial for the neck and shoulders. On the other hand, it would be preferable to apply ice on the temples, in order to reduce the excess Yang.