It's not uncommon to have headache as a chief complaint, as the main reason that somebody's coming to see you as an acupuncturist. They'll say, I get these headaches, and they'll tell you about the headaches. And we want to be able to understand why these headaches are where they are and what the underlying pathology of these headaches are so we can treat them effectively. So we certainly have different kinds of headaches, and Dung loves using our eight principles to separate these into internal and external headaches. External headaches are generally more acute, more severe, rapid onset, and they come with exterior signs or external signs.
So at this point, we should be pretty comfortable with knowing these external signs are fever, with chills and some balance between them, maybe aversion to cold or wind. And often this will be a, you know, we could have a sudden headache, a sudden strong headache. And if it's with a fever, we sometimes call this epidemic heat.
So, in general, we know from our own personal experience that if we're catching a cold or we're fighting off a flu, often there will be a headache with it, right? And then dung separates out this one. category where if you have a sudden strong stabbing headache accompanied by a high fever, he says be concerned of some sort of epidemic heat disease that this might be going on.
So we think about highly infectious diseases that go through the body quickly, and we'll certainly touch on that more in a little bit. Internal is a variety of headaches, mild or severe, mild to severe headaches, depending. They may come and go intermittently.
And we really need to get into the woods about, you know, what what each headache might be actually rooted in, which patterns it might be rooted in. And confusingly, when we get into these internal diseases, Dung calls these miscellaneous. One of the main reasons that we see headaches within our patient base has to do with liver function. So a lot of the headaches we see are related to stress.
And sometimes people even describe them to you as a stress headache, right? I ask each of my patients about stress in one way or another. And especially if they said, you know, if they started to describe higher stress, I want to know where they hold it.
How do they know when they're stressed? And often they'll describe neck and shoulder tension, they'll describe jaw tension, and sometimes they'll describe headaches, and often all of these together. So this neck and shoulder tension, jaw tension, and then this sort of temporal headache that comes around here.
And sometimes they even describe to you the route of the gallbladder channel, and you're like, oh, you are describing to me the channel that I'm going to treat to actually reduce the stagnation here. So we're certainly not surprised that the first one that Dunk talks about is binding. depression of liver qi, which we will say is roughly equivalent to liver qi stagnation.
I don't think that we need to nuance out the big difference if there are differences of this. Dung knows that this is often, but not always, a one-sided headache or an orbital headache. What does orbital mean? Are we talking about a headache in space?
Yes, Maya is gesturing. It means the orbital bones around the eyes, so headaches around the eyes. And we know about this liver and eyes relationship. Along with this headache, we expect all the various grab rags of signs and symptoms that we expect to see with liver cheat. depression stagnation.
So irritability, anger, I'll put anger parenthetically, because some people say if it's angry, that means it's hot, just irritable, impatient. We're not talking about heat here yet. We're just talking about a stuck liver.
Sighing, chest tension. All of these things are indications that the liver is stuck. I just want to get this to move. And like often this is sort of a liver depression, cheese stagnation, headache position where people kind of press on the sides of their brows, press on their temples.
Dung describes it as either a one-sided headache or an orbital headache, and this kind of eye headache that we see among stressed out office workers is very commonly liver cheese stagnation. We can certainly use liver points and gallbladder points to very effectively treat this. Let's see if I have any other comments about that.
I think that's all we need to say about liver depression cheese stagnation here. If this gets more severe, and this liver depression has been around for a while, we can end up with liver fire flaming up. We'll find this liver fire flaming up described in a couple different different verbiages.
So we're going to stick with liver fire flaming up, but if you see other language that kind of sounds like liver fire flaming up, maybe it's just, they say liver fire, or maybe that's, maybe, maybe it's just liver fire flaming upwards, and that's all we need to remember. I will say though, that it's important, it's not hyperactive ascension of liver yang. which is a separate pattern. So I just want to highlight that because there is often confusion about is liver fire the same thing as hyperactive ascension of liver yang and it is not.
Hyperactive ascension of liver yang is a mixed excess and deficiency pattern. Liver fire flaming upwards is pure excess. And at this point I hope we can recall a lot of this. This is going to be a more severe headache. The image here is that this liver has gotten so hot it's actually flaming upwards and there's energy stuck in the head from this fire, from this compressed liver that's gotten so hot.
And we certainly expect some sort of psycho-emotive affect change with this. This person will be angry or very irritable and you know we could say loud voice or maybe even shouting. When the liver gets up to the head, it starts to make everything in the head kind of knocked offline.
So sometimes we end up with dizziness, often insomnia. If the heat is serious, the spirit just can't sink. It's being blown up by the fire continuously. We may have ear signs like tinnitus.
And this tinnitus or tinnitus that shows up, it'll often show up like somebody gets angry and they hear a ringing in their ear. where it's like, I got so pissed off. And I might even say, I see red.
So, you know, bloodshot eyes, burst blood vessels within the eye can also be a sign of liver fire rising. So there's this image of the sheet in the body just rising up, right? We expect the pulse to be wiry and rapid.
And we probably expect to see a hot tongue. So, you know, what is a hot tongue? Probably red body.
This is definitely one of the patterns that we see for migraine people, especially if the migraine people are people that they get stressed out for a while and then something tips it over the edge and they get this excess. heat pattern, but there's a number of other migraine patterns too. So I, and a lot of them have a mix of deficiency and fall into hyperactive ascension of liver yang.
We have liver yang rising, and I'll just note that this is sometimes called hyperactive ascension. And it's sometimes called upsurge of liver yang. Thank you So these are all the same phrase, and please don't be thrown off by this. Can anybody, when I said this is a mix of excess and deficiency, what's the deficiency here? Do you all remember?
Why is this? Yeah, so it is a deficiency of yin. It's a yang excess. Because the yin is an anchor. Exactly.
In deficiency of yin or blood. And that can be yin or blood of the liver or of the liver and kidney. There's a saying that will say liver and kidney share the same root.
Another way that this is sometimes described as in the five element or five phase, we would say that water fails to nourish wood. So I think this is a really great example of the different rubrics that we can put together to understand the same thing, right? Um, so we can certainly have liver young rising base just in a deficiency of blood of the liver or yin of the liver, or it could be liver and kidney. And this is all going to be yin deficiency because we don't really talk about kidney blood very much. And we know if the yin of the liver is compromised and the blood of the liver is also compromised, right?
So the idea here being that the, you know, here's our, here's our happy liver hanging out here. It's supposed to be nice and wet, but if it's not wet enough, then the fire can flame upwards out of it because it's not being held down. And then we can throw the kidneys underneath this.
These are my kidneys. Why I'm an acupuncturist and not an artist. And the idea of the kidneys is that they're supposed to root the liver.
They're supposed to provide the yin for the liver. They are the root of the liver. Bloody yin deep organs of the liver and the kidney are dry, and this creates an opportunity for the liver yang to just flare upwards.
Water fails to nourish. Sometimes we say water fails to moisten wood. So we know that on the five phase diagram that we have, water is the mother of wood, right? So if the water phase is weak.
and by this we mean kidney, but we also need all the yin of the body because that's the water phase, then the wood will not behave the way it's supposed to. And we'll end up with this wood that's just rising up and creating all sorts of different problems. Symptomatically, we expect some sort of red in the upper, so red eyes, maybe red cheeks, insomnia commonly. This insomnia can be due to blood deficiency.
And if there's marked insomnia with palpitations, then we think heart is also involved, right? If we end up with five-palm heat, we start to think, oh, is there more yin deficiency now? You may have vexation. So feeling vexed, feeling restless. If the liver balances very often, we might end up with dizziness and vertigo.
And this is all the yang energy moving up into the head, kind of blowing you around a little bit. And this is also another common migraine pattern. So if you suspect that your migraine patient may be suffering from liver young rising, a great question would be to ask about their cycle and if there's any relationship between their migraines and their cycle, if they do have a cycle, right? Because there is a pretty clinically common thing where around a cycle, some women get, some people that menstruate get migraines. And the basic idea here is that as the blood gathers around the uterus, there's less blood for the liver.
The liver has moved its blood to the uterus. And if we're blood deficient, we don't. necessarily have enough blood to let the uterus do what it needs to do while the liver is needing to do what it does by anchoring the yang.
So the blood moves from the liver into the uterus, and then the liver blood is skinny, and then the yang rises right up, migraine headache. Right. So very, very good to dial this into questions about the menstrual cycle. If we expect blood deficiency as being part of this or yin deficiency as being part of this.
And in which case, actually, you know, if we get to our patients in a week or two before their cycle and we can give them good blood nourishing herbs, maybe they'll have enough blood to keep both the uterus and the liver happy. Right. So blood nourishment beforehand is much more effective than I have this PMS migraine.
oh, here, take this blood nourishing. It's kind of too late at that point. You know, it takes a while for the nourishment to actually add up into the body. And we can certainly recommend to them to do more blood nourishing foods throughout their cycle.
And that should also help with the migraine pattern. And certainly any acupuncture points on the body that say, hey, energy, we want to root you, you know, so anything that reminds the body, yes, energy comes up, but let's put it back down. So kidney points around the ankles, spleen points around the ankles, anything to kind of bring.
the qi down and in will definitely help with the liver yang headache. Parenthetically, as a treatment anecdote, I will say that most of the acupuncturists, all the acupuncturists that I work with in my practice, but many other acupuncturists that I spoke to, generally don't do local points for migraine. So if somebody is having a migraine, often there's no points put into the head because that can lift more energy to the head, even if it's on the sort of lifting it to encourage it to go down.
Often, you know, there's an anecdotal clinical experience of many people that that can make a migraine worse. So I will do head points on almost all of my patients, but migraine patients, they typically do not get head points unless I know that they've benefited from it in the past. And, you know, one of the things that I wanted to highlight about headaches is that this, compared to a lot of the other pathologies that we talk about or symptoms that we talk about in the semester, this is actually a real common reason that we see people in clinic. So I am going to touch on some basic ideas of treating headache, which you won't be responsible for learning, but I think it's a very good way to start putting meridian theory and acupuncture points together with simple diagnostics, because you don't need advanced treatment to actually approach headaches fairly effectively. Last week, I think we just covered the first three of these, which all have to do with liver.
And we mentioned that binding depression of liver chi is the same thing as liver chi stagnation for our purposes, where the smooth energetic flow through the whole system is restricted, and this can result in a certain kind of headache. We could think about liver fire flaming out upwards as being a further development of binding depression of liver qi, where if the qi gets stuck for any period of time, it's like a resistor on a circuit. It gets hotter and hotter at a certain point that heat is going to flare upwards. And then we'll have probably a headache that's marked by more obvious heat signs, red eyes, perhaps nosebleeds, perhaps a stronger headache, and also accompanied by a certain heightened emotional tenor. So binding depression of liver qi we expect to manifest as irritability, impatience, maybe a little bit of depression.
Liver fire flaming upwards, we're really thinking strong irritability and anger, right? And this would be sort of the textbook. And, you know, red bloodshot eyes, signs of heat in the face and chest also are things that we can think about here. And then the last one that we hit, we said is a mixed excess and deficiency pattern, right? So hyperactive ascension of liver yang, or also known as liver yang rising, right?
This is another way that it's often called, and it's the same pattern. We're not. identifying a new pattern by changing the name of it. We're just translating different words into Chinese. And we said this is a mixed pattern because it's a mix of some sort of stuck energy in the liver system that's then not rooted, right?
And what is the liver qi rooted in? Can anybody remind us? When I say it's not rooted, what supplies the root for the liver qi? I've named two organs that were involved in this blood and yin, which are the two organs that come to our mind with the liver-yong rising pattern. That we should all remember, which is liver and kidney share the same root, which means that the yin of the liver is like directly adjacent to the yin of the kidney.
And if, you know, first we think of the blood of the liver declining under stress and then the yin of the liver declining, and then we actually get to the kidney yin declining as well. So these are all on a spectrum and we could almost think of the reservoir of blood and yin that the liver holds as being tapped into the source of the kidneys, almost like the liver yin is, you know, Hetch Hetchy or something like that. And the kidneys are the Sierras, you know, so anything that's in Hetch Hetchy comes from the moisture of the Sierras. Anything that's in the liver comes from the moisture of the kidney system.
Right. Clinically, remind me some questions that would help me identify whether this deficiency for liver yang rising is due to just liver or liver and kidney together. So what are some questions we could ask our patient or observations we could make to determine whether we want to just treat liver yang rising due to liver blood deficiency, liver yin deficiency, or liver and kidney yin deficiency?
And maybe I'll make a note of that whiteboard so we can workshop it together. Liver Yang rising, this is a common abbreviation you're going to see. And liver blood deficiency, liver yin deficiency, liver and kidney deficiency. So I think that night sweats will start to point us. we have night sweats, will start to point us towards some kind of yin deficiency, right?
But then how would we try to isolate this to being, let's say, yes, I do have night sweats, you know, oh, I've got, you know, this headache. And you ask me, oh, yeah, I'm pretty irritable. And it happens sort of over my temporal lobe.
And maybe it's associated more with the cycle or something like that. Then we say, oh, yeah, do you get night sweats and say, yes, I do. So now we're like, okay, we think that it's probably we one of these two, liver yin deficiency or liver and kidney yin deficiency, how do we know whether we need to give them kidney herbs or just liver herbs? What would be a follow-up question that would help us get a differential diagnosis between kidney or liver? So we know that the kidney governs the urinary system in this regard, right?
And kidney inefficiency, we could expect to have a decrease in total urine volume or... the short reddish urine or darker colored urine. And we wouldn't necessarily expect to see that with the liver.
What are some other general kidney signs? We might ask about areas of the body that are related to the kidney and see if there's any kind of problems with that. And when we think about areas of the body related to the kidney, what do we think about? So we say that the low back is the abode.
of the kidney. And I recommend clinically when you're in with patients, you might want to preface this kind of association question a little bit, right? So, you know, hey doc, I have headaches.
And the next thing somebody's asking you is about your knees and your lower back. And some people are down for the ride and other people are like, no, we're talking about a headache. Like help me understand the connection between.
a headache and whether I have back or knee pain. So what's a phrase we could use with our patients that might help them understand that, these pithy little communication things, you know? How would you make asking about back and knees related to a headache make sense to a patient without busting out your lecture notes from Foundations One?
One of the recommendations from my Foundations teacher, Steve Woodley, was never name an organ because people will freak out. I don't actually hew to that 100%. And I kind of try to read the room and I see, and sometimes, especially if I have a relationship with somebody and they have some familiarity with Chinese medicine, I'll talk to them about the Chinese medicine kidney. And I'll say the Chinese medicine kidney is not necessarily these bean-shaped organs that live in your mid-back, but they're actually a zone of influence that extends towards some symptom, some function that we think of as kidneys being urinary function, but also reproductive function in your long-term health. I'll say sometimes headaches are due to a general decline of your kidney energy.
This doesn't mean that you have a kidney issue or that you're going to have renal failure, but rather that your Chinese medicine kidney is a little bit compromised. And so, you know, that's four sentences that took about 45 seconds to say. And usually that's enough, but especially if somebody is hypochondriac or they come to me and they say, like, give me some random piece of Western medical information that is clearly already out of context, then I won't. add fuel to the fire by talking about their kidneys, you know, you know, oh, you know, I think you might have a little bit of kidney deficiency.
I knew it. My adrenals are shot. I need to get an adrenal support right away.
And I'm like, okay, we're not even talking about adrenals right now. That may or may not be relevant. You know, we're talking about your Chinese medicine kidney. So, um, yeah, thank you for the reminder to read the room there.
Okay, so we have some ideas of where we can ask, and generally we'll ask for tropisms. For liver yin deficiency, we might also, you know, we might look at the tongue and see if the sides of the tongue are a little bit more red. Is the back of the tongue a little bit more red? That could be kidney versus liver yin deficiency. We could feel the pulses and look to see positionally, are we feeling more compromised in the middle pulses or the mature third position pulses, and kind of do a comparative, and if they both seem equally weak.
then maybe this points us towards liver and kidney and deficiency. If it's just the middle position that seems weak, then that might point a little bit towards liver deficiency. If there's any kind of eye problem, that's going to point us more towards liver, you know, liver blood deficiency, liver yin deficiency. These can both be dry eyes. If there's more redness in the eyes, we think more liver yin deficiency because that's a deficient heat sign, right?
We might also palpate their tendons. And, you know, if their tendons feel ropey and dry, this just confirms liver, blood, or yin deficiency. And, you know, we can ask our other questions about kidney on top of that.
Okay. Okay. So let's move on. I think that it's very, very worthy for us to spend a little bit of time reviewing those three liver chi, liver. involved headaches because they're super, super, super common.
So we certainly don't want to underestimate how common they are. But the next couple that we're going to talk about, and I'm going to clear the slide here, are related to phlegm. And the first thing we'll say is that phlegm is a many-splendored beast in Chinese medicine, right?
The phlegm we're talking about here is largely going to be under the category of insubstantial phlegm, right? So let's remember that we have two big categories. We have substantial phlegm and then we have insubstantial phlegm. Substantial phlegm is what most people think about as phlegm.
It's phlegm in the actual respiratory tract and respiratory organs, right? And the reason it's called substantial is because you can express it outside of your body potentially by coughing, by blowing your nose, by doing something like that. The substantial phlegm, we can actually move it out of our body. So this is generally going to be respiratory.
Anything from the nose to the lungs, we can think about the whole lung, the lung viscous. Clinically, we do deal with respiratory phlegm and we've talked about a few different ways. There's hot phlegm, there's cold phlegm, there's dry phlegm, which we see actually, I gave somebody at AAMC a dry phlegm formula for post-COVID and it cleared up her dry cough in two days. So raw formula, very, very powerful for dry phlegm. When we deal with headaches, more of what we're going to deal with is this insubstantial phlegm, right?
It does say Dung Yang, Z-A-N-G, which means viscous, right? A blood-filled organ. Insubstantial phlegm, on the other hand, is phlegm that is not in the respiratory system.
So this can be phlegm in the channels. It can be phlegm in the orifices. It can be phlegm in the interstitial spaces. It can be phlegm in nodules.
It can be phlegm in tumors. It can also be phlegm in the organs, but not the lung. The way that I've found to really come to grips with insubstantial phlegm is to think about it as energetic gunk, right?
we can't be thrown by the idea that you can actually palpate some versions of insubstantial phlegm. So, for instance, nodules and tumors, you know, if you have a little Baker's cyst or something like that, this would actually be some sort of insubstantial phlegm, even though there's a nodule there that you can palpate. Right.
So that can be tricky. And I want to highlight that, that insubstantial doesn't necessarily mean that you can't. located physically, it means that it's not in the respiratory tract.
So I want to pause there and make sure that everybody understands that because that's a place where a lot of people go off. Does that make sense? Maybe it doesn't make sense.
Maybe we shouldn't call it insubstantial phlegm and we're just translating something from Chinese that could be called something different. But I want to make sure that everybody acknowledges that insubstantial phlegm is something that we're defining it by location, not by whether there's something physical that you can necessarily touch. Really, substantial phlegm, we're thinking about snot or mucus.
Exactly. Something that under ideal conditions can be expectorated. If the lung qi is weak or if it's too dry, it might be difficult to expectorate, but you could get it up and out that way.
Whereas you're never going to expectorate a nodule or a tumor. So this insubstantial phlegm, which we've now reviewed, do we remember where it comes from and or its relation to dampness? It originates in the middle jowl. And then they say substantial phlegm is drafted to the lungs. So there's this route of middle jowl, which is the digestion, we'll remember.
And then it's drafted to the lungs. So there's this idea that inefficient digestion or digestion of the wrong kinds of foods or foods aided the wrong cadence or pattern can be turned into dampness. And then that digestive dampness.
sometimes will actually move into the lungs and create substantial phlegm. This insubstantial phlegm is usually the byproduct of longstanding dampness in the system, right? So somebody will have a dampness that's been around for a while or poor dietary habits for a long time.
And then as a consequence of that, we might end up with all sorts of insubstantial phlegm building up in various channels and in various systems that we're going to deal with right now. So that's our phlegm review. The kinds of phlegm that we're going to deal with for headaches is predominantly insubstantial. A few markers of phlegm in a system, especially if it blocks orifices. By orifices, we really mean perceptive faculties, right?
I think I hear what you're saying where phlegm is sort of a, it's an efficient explanation for something we can't necessarily see except for the side effects of it, right? For insubstantial phlegm, you know, insubstantial phlegm that's a nodule or a growth or a tumor, I would say that's not the case. And usually with nodules, growths, and tumors, it's phlegm with blood stasis.
And some people say the blood stasis that forms the actual substance. And it's the phlegm that forms the energetic, gunky pattern for things to stagnate there. A phlegm is sort of like a gunky, energetic pattern where maybe there's like energy flowing.
And then for some reason, it just kind of bogs down in one area before flowing. And then over time, we started to get like a layer of blood stasis around it. And then we can think of that as becoming a growth. I always think that the energetic pattern.
precedes the material manifestation, right? That something is slowing down energetically and this slow energy that's not transforming at the rate that it should, then gradually the physical aggregates around it, right? So I hope that kind of makes sense.
But if we're dealing with even conditions that the first place we go is like, oh, you know, uterine fibroids, we think of this as being some sort of blood stasis typically, but there's almost always phlegm involved also. long-term injuries. When I studied orthopedics in my doctoral program, Anthony Vondermill was very, very clear. He's like, no, there's blood stasis involved with a long-term injury, but there's also phlegm involved.
You know, there's often phlegm. And often when we treat these areas with extractive techniques, such as wet cupping, where we actually like do a seven-star needling and pull blood out of an area to figure out this blood stasis, sometimes we'll get blood, but we'll also sometimes get yellowish or clear fluid as well. And that's when we're like, oh, maybe we're seeing the insubstantial phlegm, you know. For our purposes today, we're going to talk about phlegm blocking the orifices, right? And that messes with our perceptive faculties.
With this phlegm, phlegm, because it does have this middle jaw connection, we may see a headache with this clouding dizziness. And by clouding dizziness, I'll suggest this means some sort of... some sort of vertigo-ish sensations and some sort of lack of clarity.
we will all encounter patients in clinic where we ask them a question and it sometimes go like this like you say like um how's your diet and they say oh it's pretty good like well what does pretty good mean what did you have for breakfast and they say well this morning i got up and you know my dog really old and has loose stools so i let her out in the yard and then i found the newspaper and the newspaper had this article did you see this thing about the berkeley mayor And that kind of digressive thinking is often an indication of phlegm. It's like the Grandpa Simpson thing. I'm probably dating myself, but like, you know, there's a character on the Simpson, Grandpa Simpson, you ask him one question and he digresses off.
And so we associate this, of course, with aging and senility, but also this lack of clarity and the lack of ability to give the correct response as some sort of phlegm. When we talk about diagnostics, we talked about observation as being a very strong diagnostic tool. If you make eye contact with your patient and you feel there's something fuzzy between you, maybe they're not making, maybe there's something about the way that the eye-to-eye contact is not quite there.
This can also suggest phlegm. So this would be phlegm clouding the orifices. And if you're phlegmed out, then maybe it's you. But living in the East Bay, a lot of us have experiences with people with serious mental health problems on the street.
And often we do see this clouding. of the perceptions where it seems like they're seeing a different world than we are because of the phlegm that's accumulated around their perceptual orifices right um with that in mind you know we have a large diversity of uh expressions of uh of how we perceive reality and we also have people that do exist on on various spectrums and often their eye contact will be different than other people so we need to be respectful of that too that doesn't necessarily just because somebody has been identified as Asperger's or on the autism spectrum that they have phlegm necessarily, just to be aware of that. Then we will often have digestive symptoms because of this idea that the phlegm is generated from the middle jowl. So we might have fullness, oppression of epigastric area.
We may have nausea. or vomit if it's more extreme. And this would be this phlegm bogging down the middle jowl function, right? And then Dunk talks about heaviness. And when he talks about heaviness and nausea and vomit, here what we're really seeing is this close relationship with damp.
So Giovanni spends a lot of time in his book differentiating the symptoms of phlegm and dampness. but they're on a spectrum. Like we can't actually chop them cleanly apart from each other. They're a pathology of fluid mechanism and energetic circulation, right?
Dampness tends to be heavier. Dampness tends to drain down and dampness tends to fill the limbs. But we can also have dampness in the head. So we can't hold onto that too much. Phlegm creates dizziness and dampness does not.
Phlegm creates numbness. So phlegm is blocking the channels. That would be phlegm, not dampness. Dampness doesn't create numbness.
And then there's another condition. Also, let's just clarify. So this clouding dizziness, a headache with clouding dizziness, accompanied by some digestive symptoms. And then we expect the tongue to have some sort of sticky or slimy coat. There's something on the tongue that's called a bancha tongue, bancha being one of these herbs that dries phlegm and dampness very, very well.
And the Bancha tongue is supposed to be a tongue that has, let me draw our poor tongue here. I'm going to color it yellow, but it doesn't necessarily need to be a yellow thing, but these two lines down the tongue. And these are sometimes called phlegm lines or Bancha lines. And they're actually commonly more white, but I can't color white in.
But, you know, if I color it yellow, you're going to start to think that it's, I'll color it blue. Because it is more commonly white. than it is yellow, although we can have yellow too, and that just indicates heat as well.
So I hope we're getting an image of phlegm. And the idea here is that the presence of phlegm obstructs the clear circulation of energy up and down out of the head, right? And this can create all sorts of different problems, including headaches. This is not an uncommon migraine manifestation. But we talked about how liver young rising, liver fire, these can also be migraine manifestations depending, right?
All of these can also have digestive symptoms. If the liver overacts on the middle jaw, we can have nausea and vomit with wood earth disharmony, which we went into last week. I'm going to go to the next slide here or the next whiteboard if that's okay. If I need to go back, we can. We have them all saved.
Within phlegm, there's a few different kinds of phlegm headaches that we'll just tease out here for a second. And this is just to build vocabulary as much as anything else. Wind phlegm, phlegm fire, which is just phlegm plus heat, and then phlegm reversal.
counterflow. So wind phlegm, we have the phlegm, which we spoke about, but then we have this wind, right? And anytime that we see wind, we need to think about things changing quickly, right?
Things changing quickly. This kind of wind phlegm headache would be a headache leading to some sort of more dramatic expression in the body that might be like convulsions. tightly shut eyes, sometimes vomit, and all of this is rapid onset, right? Because it's wind. So when I say rapid onset, I mean the convulsions onset rapidly.
The phlegm takes a long, phlegm does not happen overnight, right? You don't go out and catch phlegm. Phlegm Substantial phlegm takes a while to develop even when you get a cold and then insubstantial phlegm takes even longer to develop.
So wind phlegm would be a headache that also has more extreme evidence of some sort of like we could think about as sort of a seizure or something like that. And that's very common when wind gets together with phlegm. When you think about phlegm fire, it's really just, it's a phlegmy headache plus liver fire. So the fire we're talking about is. liver fire. And we talked about this last week, so we can expect maybe bloodshot eyes, maybe anger.
This is typically a one-sided headache or temporal headache or orbital headache with liver fire signs, signs and symptoms. The pathology here is that the stagnant phlegm has hung out in one place for a while, and then when anything hangs out for a while in our biology, it tends to heat up, and then this heat irritates the liver yang, and we end up with phlegm fire. The last kind of phlegm that we'll talk about is phlegm reversal or counterflow phlegm, and this is where we start to talk about phlegm blocking the orifices. And orifices again here are our mechanisms for sense perception.
So this is when the phlegm really gets a little bit out of control. So the reversal aspect of this is our Draney limb reversal which we spoke about, cold limbs, right? The idea here being that this energetic gunk has restricted the free flow of energy and yang and blood to the extremities. So our extremities get cold, right?
And then the phlegm blocking the orifices. This is typically, we see this by some sort of unsettled spirit. And we could end up with, I think Dung says weird speech, which I love.
But we think about. some sort of incoherent delirious speech, dizziness, nausea, which we've seen before. Oh, I think this is actually this kind of phlegm blocking the orifices is very close to phlegm harassing the heart.
I think when we say phlegm harassing the heart, what we're putting in the foreground is not the headache or the perception changes, but the emotional state, right? So when phlegm harasses the heart, we're usually pointing towards mania, right? Some sort of manic behavior, often accompanied by delusion and delirious speech.
So we have one of the orifices when we talk about phlegm harasses the heart because the heart controls the tongue and the tongue controls speech, right? So maybe if we're using that, we're actually zooming in on specifically addressing the psycho-emotive complaints of the patient or the presentation of the patient. Whereas if we say phlegm blocking the orifices, maybe we're dealing more with general perception. Um, and we'll notice that with this phlegm reversal or counterflow, we're not saying that it's heat. Whereas we are saying, um, with phlegm harassing the heart, we, it's usually phlegm heat, phlegm fire harassing the heart.
So that the mania, the hyperactive speech, that kind of stuff, we usually associate with, um, phlegm fire harassing the heart in particular. The point that I want to loop back with you on that is that the heart is really the master of everything we perceive, right? So when we look through the eyes, yes, the eyes are the organ of the liver, but what we see when we look in somebody else's eyes is their heart spirit, right? You know, when somebody speaks, yes, the mouth is, I guess the tongue is the orifice of the heart, so we get that directly.
You know, the ears are the orifice of the kidney, but what hears is the shun, not the kidneys. The kidneys aren't listening. The kidneys are handing that information to the shun.
So phlegm harassing the heart is sort of a broader global category for that. more roots of psycho-emotive disturbance that we might see in our patients. Draney is not a hot or a cold pattern. Draney means that there's a disturbance in the flow of energy, blood, and yang to the extremities. It can just be sort of, you know, there's a formula sinisan, which means frigid extremities powder, right?
And it's used to create cold extremities due to basically liver cheese stagnation, right? But then there's another one, sinitang, which is cold extremities decoction, which we use to... deal with cold extremities due to kidney yang deficiency, where we're trying to rekindle the kidney yang.
So in and of itself, Draney doesn't, doesn't, doesn't give you a clear diagnosis. It gives you sort of a picture of what it points you towards a number of different things. Then you have to do a differential diagnosis. Yeah.
Far the most common reason that we see cold extremities and I wouldn't call this Draney. I would just call this cold extremities is blood deficiency, like blood deficiency in women is really where we see this the most is. My hands and feet are always cold.
You know, they're like ice blocks. And it's way more common than a yang deficiency. It's just a simple blood deficiency, not enough blood to the limbs.
Interesting, this phlegm reversal counterflow, this is considered a fairly advanced pathology because you have two things going on. You have the phlegm. that's actually blocking the qi circulation, but then you also have it really, really, really disrupting the heart spirit as well. So sometimes this is called a head breaking and our pulse here will be slippery.
may be wiry. And the reason we have a wiry pulse here is less to do with the liver and more to do with the pain, right? So slip ratio is some sort of stagnation of fluids or energetic circulation, energetic gunk. And the wiry here points more towards this pain rather than a liver cheese stagnation directly.
Interestingly, when we treat this, we'll often use stomach channel points. Right, stomach channel points. And there's a couple of different reasons for that. One of them is that the stomach channel occupies all this real estate on the face. And the other one is that phlegm is created in the middle jiao and drafted to the rest of the system.
So I think the idea here is that if we can get the stomach to descend and process things, then we'll have less phlegm to reverse and counter flow the rest of the qi. Okay, so just a couple other excess. headache patterns. And let's get through those and then we'll take, we will take a break here in just a second. So are we good to go to the next whiteboard slide?
So blood stasis, give me a quick refresher on the characteristics of blood stasis pain as contrasted to cheese stagnation pain. What are some adjectives or some phrases that we remember about blood stasis? Does it have rapid onset?
Generally, the etiology of any kind of blood stasis is long-term, right? It's long-term. Blood stasis doesn't happen overnight unless it's in reaction to an acute injury, which it may be. But generally, this is going to be longer term.
So we expect our patients to be able to tell us, and this is a very, for headaches, you know, for pain in general, if we use meridian theory, asking where they feel things actually does help, you know, which isn't always the case when we ask about things from a bioanatomical standpoint, you know, you know. My shoulder hurts. Well, it's actually your gallbladder.
We see things like this referral pain patterns or my toe hurts, but it's actually in your lower back. When we talk about channel patterns, information really, really can help. And so I encourage you for your patients to, that have pain to tell you where it's happening.
Cause they'll identify channels, right? For a blood stasis headache. When you say, where does it hurt? They should be able to point to exactly where they should be able to, Oh, it hurts right here, or it's the whole top of my head, or it's right over here. Right?
So they should be able to be able to identify the area of pain. The pain should be fairly intense, fairly fixed. And often there will be a history of injury.
So in my practice where I see the most common blood stasis headaches is concussions, right? Somebody's taking a blow to the head and actually often the headache doesn't start right away, but 10, 14, 21 days, they start to get this headache that's just right in that area where they got hit. And we can think about that as being really, you know, static blood that's stuck there.
Chinese medicine is pretty effective for this kind of stuff. So sometimes we have a history of head injury. And I want to highlight this can be acute. It can also be chronic.
Acute head injury, I was fixing my roof and a tile fell on my head, right? Chronic, I played high school football, right? Or I used to spar every week.
or I boxed for 15 years. And maybe they didn't get that one knockout, but people that engage in contact sports, almost all of them, myself included, have a history of just blood stasis, you know, where various areas of their body, because they were impacted for so long, you know, you cup their back and you're like, where's all this purple coming from? Oh yeah, I did Brazilian jujitsu, blah, blah, blah, blah.
HX is an abbreviation for history. Yes, it is. Thank you. And we look for blood stasis signs, general signs.
So our tongue, textbook is dusky or purple. The pulse, choppy or rough. Both of these show blood stasis or wiry if the pain is predominant. And then generally a darker complexion.
And I'll highlight that, of course, we are not talking about pigmentation here. We're talking about a guest complexion. So host complexion is what you're born with. Guest complexion is what the world does to you. If you are suffering from blood stasis over the long time, then your complexion may be darker than your host complexion, the complexion given to you by your ancestors.
Chronic blood stasis will start to show a darker complexion sometimes and also a darker tongue. And we could also say macules on the tongue, right, would be another sign of blood stasis. So are we getting a picture of this blood stasis patient? It's pretty clear. I think it takes less braining around than phlegm.
Phlegm is a little bit trickier. Blood stasis is like, yeah, you got hit on the head or got hit on the head repeatedly over time, or your circulation has been very low for a long time, and now the blood is stagnant. And then the last one, whoa, go back.
The last excess headache that we'll talk about is called headwind. And we are translating a Chinese phrase here, 头风, where this means head, what just happened, this means wind. We need to think about a headwings headache as a headache that's resultant from a long-term exterior invasion, right?
So Cam calls this a headache due to pathogenic wind. So we think that it was... probably there's some sort of history of exterior invasion, right? Person caught a cold. The headache here is pretty severe, and it's often accompanied by things that we might associate with, if you're familiar with meningitis.
Meningitis gestures in this direction. So meningitis is an inflammation of the meninges of the neck and the brain. right, an inflammation of the membrane that surrounds the spinal cord up through the neck to the head.
And if you get a meningitis and one of the symptoms is a stiff neck, you won't want to turn your head or move your neck. So neck stiffness is a sign for this one. We may also have eye pain. numbness.
So here's this kind of wind and phlegm relationship maybe. And the last one is dripping foul nasal mucus. So I'm a little bit hesitant to make direct analogs to Western modern diseases that we diagnose. But we can kind of think about this.
Maybe this has some overlap with a very persistent nasal infection, right? A sinus infection. where you actually have a discharge of foul nasal mucus.
I don't know if anybody here has ever had a severe sinus infection where it's just like your head feels like it's exploding and maybe like you actually have some numbness in the area and there's this really foul mucus coming out. So maybe this has some analog with some sort of advanced sinus infection. which in Chinese medicine is to believe, believed to be a sequela of an exterior invasion. Something came in, your body didn't fight it off, and now it's moved in for a while, right? Other analogs that Nigel Wiseman brings up, he says that, you know, this might be associated with also brain tumors, maybe chronic rhinitis.
which is an inflammation of the nasal membranes, sometimes glaucoma, and certain migraines. So in terms of learning goals today, just understanding generally that there is a phrase headwind, and that headwind is a type of headache that follows some sort of exterior invasion. often, and then has some of these symptoms, that's enough for us now. I don't think that we need to dial into particular Western analogs. You know, we won't necessarily see neck stiffness in all of these, eye pain in all of these, or numbness in all of these, but just be aware that this phrase exists, and we're describing a stronger headache when we talk about this.
Impossible loss of vision, dripping of foul smell and mucus, nausea, dizziness. Oh, tinnitus is in there, yeah. Numbness, numbness of head, rigidity of neck, yeah. So sure, tinnitus could be in there too. Thank you.
The next few headaches are actually pretty straightforward. We're going to talk about deficiency headaches. And this weird oblong shape over here is my idea of cross-section of a head. And we talked about how in excess headaches, really what's happening is there's often too much qi coming up into the head and then kind of pressing out against the edges of the head, causing discomfort. So it's an excess of qi in the head.
And this is true of liver fire, liver yang rising. We could think about blood stasis as maybe not something rising up, but something stuck in a particular place in the head, creating issues, phlegm causing chi disturbances and energy generally rising up and hitting the roof is the image here. When we get to deficiency headaches, it's going to be a little bit different with the idea being much more that there's not enough inside the head to keep the head happy. So it's almost like there's an internal pressure in the head is. empty. And this emptiness creates a discomfort also.
From broad brushstrokes, when we talk about deficiency headaches, there's only a few to really consider. And we've got our kidney jing deficiency, our blood deficiency, our qi deficiency, and then yin and yang deficiency are the main categories. Each of these is describing a different aspect of our righteous energy and substance, our righteous fluids. our righteous, the spectrum of things that make us happy and healthy being a little bit short of the mark. And we'll start with kidney gene deficiency.
And the general idea here is that we know that the brain has been described classically as the sea of marrow. Just like marrow fills our bones, the brain is considered this special kind of marrow that fills the head bone, right? And if our jing is deficient, there's an idea that this marrow is not quite nourished enough. And this starts to give us, all of these headaches are going to be mild and dull because they're empty headaches. And then we just look and see what are the accompanying signs and symptoms.
if we have a mild dull headache and then kidney Jing deficiency signs or symptoms, we can certainly diagnose the kidney Jing deficiency headache. When we think about kidney Jing deficiency, we're really talking about either premature aging. So, you know, the natural aging process is the decline of our Jing. So anybody that looks much older than their age, we can think about them as having deficient Jing, right?
So withered skin, reduced mental acuity. chronic soreness of the lumbus and the knees, genitourinary signs and symptoms such as impotence, clear vaginal discharge. These things can all be signs of Jing deficiency, but really we're looking for some sign that either development has been arrested or the person in general is in decline, right? It doesn't just have to be aging. So we also know that people that are So users of certain kinds of drugs, especially stimulants like methamphetamine, they deplete their gene.
You know, this is what it does. It's squeezing the years of life that you would have into the years of life that you have right now and give you extra energy so that you don't have to sleep for a week. Right.
But you're taking that off of the gene that you would have had for later. Right. So this is our sort of general picture of gene deficiency.
And we'll just remind you that you can have a headache because of this. Right. And it especially can be accompanied by things like.
poor memory, right? And, you know, all sorts of reproductive weakness. And I'm saying weakness deliberately because it's very general. Like, so this could be infertility, both male and female infertility, right?
This could be, this could be gene deficiency if it's accompanied by other aging signs or symptoms, right? When we move into blood deficiency, we don't see that much difference except that it isn't quite as deep and we expect to see our blood deficiency signs and symptoms. So certainly we can localize this to heart or liver.
You know, if we have more palpitations and that's more heart, if we have more liver blood signs and symptoms, we would look for changes in the menstruation, changes in the tendons and ligaments, changes in the nails and things like that. It could have insomnia and numbness. We mentioned it for wind and phlegm.
Numbness can also be a sign of blood deficiency. But again, a mild headache. And generally, if somebody reports a mild headache, you're going to do your differential diagnosis and try to figure out, is it jing, blood, qi, yin or yang, or some combination of these all together.
The main hallmark of our qi deficiency headache is going to be worse with exertion, right? So how are you feeling? Well, I get this headache. When do you get it?
I walk upstairs and I get this headache or after I go jogging or at the end of a long day of work, I get this headache, right? So we see a lot of, these days we see a lot of qi deficiency headaches mixed with liver blood deficiency, the two of them together because people are working long hours, they're stressed out and they're staring at a monitor, right? So their qi goes down and their blood goes down and then we get eye dryness, general fatigue, a dull headache at the end of a work day.
It will often be. a qi deficiency headache. And then we'll just say for yin and yang deficiency, yin and yang deficiency, fairly nonspecific.
We can kind of point at various organs if we want to, but we'll just say that if you have yin deficiency signs plus a headache, yang deficiency signs plus a headache, we just kind of identify as close as we can, probably zongfu diagnosis to identify which particular zong or fu are mostly focused in this yin or yang deficiency. But I'll just... Bill vocabulary again here that you ensure means the end of vision heat or empty heat, whereas here on the young deficiency, we expect to see cold sides right so. We took a little bit longer on the excess headaches, but these deficiency headaches are actually fairly common.
We deal with a lot of people that are certainly not nutritionally deficient, but are energetically or blood deficient due to lifestyle, due to overdoing it, and also not resting adequately, right? When we do encounter a deficiency headache like this, we just need to do a differential diagnosis. Does that sort of make sense? Okay, awesome.
So it's not... strictly in the purview of this class, but I wanted to just touch on some ideas about treating headaches. And actually, before I do that, I want to talk about channel headaches, right? The location of a headache gives us lots of information, right?
And often we will say, where does it hurt? And the patient will point to the region that is on a channel distribution. So where does it hurt? Oh, it hurts right over here. This is very common.
What channel is this? This is gallbladder channel for folks that haven't gotten to it yet. And gallbladder channel headaches are very, very common.
And if somebody identifies the channel that their headache is on, wow, it gives us all this great material for actually moving towards treatment. And for gallbladder headaches, which are very common, will often stimulate gallbladder point at the back of the neck called GB20, gallbladder point at the top of the shoulder called GB21, and very often gallbladder points on the ankles, right? So GB40, GB41. all of these kind of points at the opposite end of the channel.
With the idea that often this gallbladder channel headache is caused because there's Qi stagnation in the gallbladder channel right here, we can empty it by opening up the gate to the head and clearing out the shoulder also so this region flows smoothly, and then tractioning the energy down to GB40 or something like that. Alternately, we might try to stimulate the liver and ask the liver to absorb and move some of this Qi from the gallbladder. So we might use points like liver three.
to treat a gallbladder headache as well. Patients will often, they complain about sinus headaches and they say, oh, I have a history of sinusitis, something like this. And they'll point to where it hurts. We go straight to Yang channel. We go to the large intestine channel and LI4 is a brilliant, brilliant point for opening up sinuses.
And in fact, I will say that in terms of like... Instant clinical changes. LI4 is one of the points that can often give you that really quickly. People will come in with a sinus headache and not be able to breathe through their nose.
And if you stimulate LI4 strongly, sometimes their sinus will pop open. And then they think you're a miracle worker. And you're like, no, it's just a large intestine channel.
It's wonderful. And of course, we can also use other Yang Ming points for working with sinus headaches as well. And this works with the idea that sinus headaches often involve phlegm, right?
And so stomach helps us resolve phlegm. stomach 36, stomach 40, this kind of point, very, very useful. If we get this vertex headache, this is a liverish headache, right?
And often liver points are going to be very helpful. We could also think kidney points because liver and kidney share the same root for a vertex headache. If we get occipitable headaches or headaches that start on the beginning of the eye, here we're really talking about UB channel, the Taeyang channel. So Taeyang channel on the hand, Taeyang channel on the ankles can be very, very useful for this.
So I just want to kind of bring out this idea that for certain, especially pain patterns, maybe the zhongfu diagnosis is important, but maybe the channel diagnosis is more important. Where does it hurt and how can I move that stuck energy where it hurts, right? And I bring this up because this is also very good for acupressure. So even if you're not comfortable sticking needles in people yet, if you want to play with your channel anatomy, and you or somebody you know is experiencing a headache, acupressure for this can be very, very effective. So acupressure on LI4, acupressure on liver 3, acupressure across the entire base of the skull.
It's just really, really good because you got the GB20, you got the UB10, all these really juicy points. And this can be very, very effective for relieving all sorts of headaches. So please, please, please do experiment with this.
You may have a nice result, even if you're not comfortable stabbing people with needles yet. Does that make sense from a theoretical perspective about channel headaches? And I'm certainly not going to test anybody on treatment, but treatment's kind of the fun stuff. So if we can tie it together with diagnosis, that's often useful. Oh, yeah.
And we also have some we have topical products that you can use for headaches as well. So there's white flower oil or any kind of aromatic oil, sometimes for sinus headaches and things like that. Putting it on the upper lip can just open up.
the sinus is a little bit in help. So we have a lot of, and you know, if it's a tension headache, which is super, super common now, these tension headaches that people report, they'll say, oh, I have stiff neck and shoulders and I get headaches and I grind my teeth. And then if you cup their upper back, it can just be such a miracle maker because you've opened up this area of tension and it allows the energy to sink out of the head. Culturally, we're at a point where energy rises and it doesn't sink. Right?
People can't sleep. They can't get out of their heads. They cleanse their jaws.
They spend all the time processing information. This is all drawing energy up. Anything we can do to help ground people is going to help them out in this respect. And it doesn't have to be acupuncture, right? It can be qigong.
It can be grounding and breathing exercises. It can be stomping your heels, you know, all this very basic stuff to kind of get energy to drop. Sometimes it's eating a heavy meal that can also get energy to drop, right?
Put something rich in your stomach and that brings the energy down, assuming your spleen can handle it, right? Sometimes your spleen can.