AN Hong-mei’experience in treating migraine from Qi

Rong-Rong Zhen, Yan-Jie Qu,Hong-Mei An

Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 200032, China

Keywords:Migraine The movement of qi Famous doctor’s experience AN Hong-mei

ABSTRACT To summarize the experience of Professor AN Hong-mei in the treatment of migraine. It is considered that wind, cold, dampness and heat are the inducement, qi movement disorder caused by liver dysfunction and emotional damage is the basic pathogenesis, and it is mainly to regulate qi flow in clinical diagnosis, pay attention to stomach qi, treat its root, and increase or decrease along with the symptoms.

An hongmei is the chief physician and professor of longhua hospital affiliated to Shanghai university of traditional Chinese medicine. Engaged in the clinical and scientific research work of traditional Chinese medicine internal medicine encephalopathy for more than 20 years, good at insomnia, forgetfulness, dementia, depression, headache and other neurological diseases treatment.

Migraine is a kind of headache, which is a common nervous system disease, characterized by repeated attacks of moderate and severe headache, accompanied by autonomic nerve symptoms [1], belonging to the category of "partial head wind" in traditional Chinese medicine. According to the international classification of headache diseases published by the international headache association in 2004, there are six types of migraine, the most common being migraine with or without aura. [2] pulsating pain on one or both sides is common, often accompanied by dizziness, nausea, vomiting, photophobia, fear of sound and other manifestations [3]. Daily physical activity or emotional changes can aggravate the pain, which usually occurs in women aged 20-35. The Synopsis of Golden Chamber says, thousand difficults, but it is the three, therefore, the causes of migraine can be divided into external cause and internal cause. "Plain ask · bone empty theory" records: "the wind enters from outside, make a person shake cold, sweat, have a headache, heavy body, hate cold." [4] it is believed that most of the external causes begin with evil wind and evil cold. "Spirit pivot · jue disease" said : "have a headache is not desirable to Shu, strike abortion, evil lies in the blood." [5] It is believed that internal blood stasis may be the internal cause. Migraine symptoms are more obvious, mild dull pain frequent, severe headache, and accompanied by insomnia, irritability, nausea, vomiting symptoms. Migraines tend to occur on both sides, where liver meridien circulates [6], and liver can relieve liver qi. Professor an believes that migraines are mostly related to qi. Qi inversion, qi stagnation, qi deficiency and other qi transport disorders lead to dysfunction of the viscera, which can lead to migraines. Professor an with changchang qi as a breakthrough, mood is comfortable, qi qi to reach the migraine symptoms will be reduced accordingly. Professor an's experience in treating migraine is summarized below.

1. Etiology and pathogenesis

1.1 Wind, cold, humidity and heat are common external causes

"Lingshu · evil spirit viscera disease form" recorded : "twelve meridians, three hundred and sixty-five collaterals, its blood and spirit are on the surface and go empty orifices." [5] it suggests that both external evil and internal injury can cause headache through the head. "On the wind, plain question," said: "when the general mood follows the wind, it is the wind of the brain; New bath stroke, it is the first wind." The wind for the Yang evil, easy to attack the Yang, the head for the Yang will, so vulnerable to the wind evil. Wind evil good and number change, reason has a headache place the position is not fixed, hair is in both sides migraine. "Ask · odd disease theory" said: "when have to make big cold, go to marrow inside, marrow person is given priority to with the brain, the brain is opposite reason makes have a headache, the tooth also is painful." [4] cold is Yin evil, easy to hurt the head Yang qi, its nature is attracted, so cold evil caused by the headache have a tight pain. The majority of patients due to the cold air caused by the wind, cold and often appear at the same time. "Plain ask · angry tong tian theory" recorded: "because of wet, such as wrapped up." Evil damp, sticky heavy turbidity, head heavy stuffy. In addition, heat is too hot, pushing qi and blood to attack the brain, prone to swelling pain. The above mentioned six evil qi can be the cause of headache, which is often accompanied by symptoms such as aversion to cold and fever, and migraine is often caused by internal injury [7], which can be treated dialectically.

1.2 The fundamental pathogenesis is caused by abnormal gas movement

"Plain ask · lift painful discussion" recorded : "all disease is born of gas." "Also" volume 67 various valves · all qi unification theory "said:" in theory, although Yin and Yang are big, not from qi...... Therefore, qi is calm, qi is ill." [8] all things come from gasification. "on the yellow emperor's difficult classic" : the root of life is vitality. All explain the importance of qi, qi normal movement, then life, if qi disorder, viscera disorder, disease subsequently appear. The disorder of qi is often caused by liver failure and internal injury, so migraine is also related to both.

1.2.1 Hepatic dysplasia

Liver for wind wood dirty, main drainage. Its cathartic work can be adjusted chang systemic qi, so qi is not free mostly with liver. Of liver cathartic disorder, have the liver gas to go against the grain and liver gas yu knot of difference, be like "kind of card to treat cut" words: "every rise of gas, from liver and go out..." [9] the liver is the general's tube and also the root of the end of the war. Excess of liver qi and excessive drainage will lead to the opposite of qi, splitting headache on both sides. The lack of liver and qi drainage will affect the rise and fall of spleen and stomach qi, resulting in no rising of clear qi and no falling of turbidified qi. Besides head distension and head tightness, chest tightness, belching, sadness, sadness and anxiety [10], irregular menstruation, and loss of appetite will also occur.

1.2.2 Seven internal injuries

According to the book, all diseases are born from qi, and the changes of qi are reflected through emotional changes such as joy, anger, thinking, sadness, fear and surprise. [4] it indicates that different emotional changes will affect qi, and the seven emotions correspond to the five internal organs and six internal organs. Emotional changes are the external manifestation of viscera diseases. "Qi up" is often manifested as zang-fu qi should be healthy, but on the contrary, common to the lung and stomach, lung and stomach qi on the inverse, disturb the qi, resulting in the qingyang not rising, cloudy Yin not falling, no clear light products in the obe, then hair for a headache. Think and sad often see with depressed disease, because think too much, gas knot in brain obe, bring about a head to bilge, the head is frowsty appear together with have a headache, with temple bilge ache is main expression. The frightened person's qi and blood function is out of order, the internal organs and qi organs are in disorder, Yin and Yang are out of balance, and the overall environment inside the body is out of balance, leading to headache, dizziness, nausea and vomiting, loss of consciousness and fainting. According to lingshu and Ben shen, "deficiency of liver and qi can lead to fear, but actually anger." Emphasizing the five internal organs of qi is the internal basis of the expression of different emotions. Therefore, the movement of qi is influenced by the regulation and sentiment of the five zang organs.

2. Treatment experience

The sufferer of migraine is in the majority with young woman, and have the commonality such as job pressure is big, spirit is nervous, too fatigue, can be aggravated with menstruation sometimes come tide. The above factors as the cause of migraine attack, will cause emotional changes and mechanical disorders. Professor an regards regulating qi as the foundation, qi inverse is reduced, qi stagnation is carried out, qi deficiency is compensated, according to the length of the course of the disease, the degree of pain and the accompanying condition, syndrome differentiation and treatment, the curative effect is good.

2.1 Reduce liver qi and relieve pain

Gastrodia elata is the medicine of atmosphere of liver classics, yuan dynasty doctor luo tianyi said: "eye black head is dazzled, the wind is empty inside make, blame gastrodia elata cannot treat." Another "compendium of materia medica" said: "hook rattan pericardium in the liver wood, the wind calm fire rest, then all the symptoms of selfhealing also. [11] therefore, gastrodia elata is a common medicine for headache and dizziness in order to calm the classical medicine of internal wind. If accompanied by vertigo, you can add rigor silkworm, cicada slough and other wind and spasmodic; If have tinnitus, can add the asarum, xanthium.

2.2 Emotional and pain reliefIn

The qing dynasty, zhang shugu said, "the air inside and outside is always in and out of the three coke." There is zhou xuehai "reading medical essays" recorded: "through the inside and outside, should be the principle and the main body of the half table half li, for the little Yang three coke gas. [12] migraines tend to occur on both sides of the head, where shaoyang meridional circulation occurs, and are often accompanied by symptoms of upset mouth, etc. Professor an often USES xiaochaihu decoction as the basis, and USES bupleurum, yu jin, huang qin, ginger pinellia, and ligusticum chuanxiong, aiming at resolving shaoyang, relieving pressure, regulating sentiment, and treating it from the origin. For the majority of female patients, often accompanied by premenstrual or menstrual period migraine, so the salvia miltiorrhiza instead of small bupleurum soup in the ginseng, while promoting blood analgesia can raise blood calm. White peony root soft liver pain relief, if there is no form of stool Fried with. In addition, professor an believes that migraines and insomnia go hand in hand, enhance the power of calm to assist sleep, sleep quality improvement can alleviate the attack of migraine. If accompanied by upset insomnia and other manifestations, often with huai wheat, jujube mind, or lotus seed heart fire.

2.3 Invigorating qi, generating blood and relieving pain

"Lingshu · evil qi zang fu fu fu evil" said: "twelve meridians, three hundred and sixty-five collaterals, the blood and gas are on the surface and empty orifices. [5] lack of marrow, unable to produce enough qi and blood, loss of nine obe in the mind, will appear a headache, even tinnitus. Professor an often with angelica blood tonic soup, yi qi sheng blood, improve the deficiency of blood vessels fine disease, of course, qi is insufficient, can not transport water wet, patients often accompanied by body weight, sputum and other manifestations, professor an good use of alisma, poria, atractylodis, coicis, yam, such as kidney water, spleen wet. Brain for medullary sea, kidney can produce medullary, tonifying kidney produces medullary for medullary sea insufficiency type migraine fundamental treatment method, professor an likes to use medicine such as Chinese achyranthium, mulberry parasitic, morindorrhizae officinalis, ligustrum son, harmonic kidney Yin kidney Yang.

2.4 Protect stomach qi and relieve pain

"Lingshu · mouth ask piece" recorded: "stomach not solid, then all veins empty." [5] in another book, "the theory of plain question and inverse tune," it is said, "if the stomach is disagreeing, it will be uncomfortable." In professor an's formula concept, special attention is paid to harmonizing the spleen and stomach. Upset mouth bitter often use rhizoma coptidis, cortex phellodendri and other drugs, but because of its bitter cold, with Fried malt, Fried atractylodes and other drugs spleen and stomach. If there is acid regurgitation in the stomach, reduce the use of acid drugs, and commonly use calcinated corrugated seeds to inhibit the secretion of gastric acid [13], so as to harmonize the qi of the spleen and stomach. If there is qi stagnation stomach distension, commonly used abdominal skin, semen radish abdominal gas, reduce the discomfort of patients. If the appetite loss, can add chicken inside gold. If the use of nourishing products, prevent greasy stomach, often raw hawthorn, white cardamom, sand kernel, malt and other aromatic wet, in order to prevent food stagnation in the stomach.

3. Case review

3.1 Basis 1

The patient, female, 33 years old, was first diagnosed on May 16, 2019. Chief complaint: left temple throbbing pain for more than 10 years. History of present illness: 10 years ago, the patient had left temple throbbing pain without obvious inducement, the pain was generally tolerable, painkiller was taken when the pain was severe, head CT(-), carotid artery b-ultrasound showed no obvious abnormality, it was diagnosed as migraine, and western medicine treatment was not effective. Half a year ago, the pain was aggravated due to work pressure, and the pain occurred twice a month, accompanied by nausea and vomiting. Write: left temple throbbing pain, sometimes oral pain reliever, accompanied by upset, nausea and vomiting, photophobia, hand tingling, associated with menstrual cycle. Sleep can, can, can, menstruation can. Denied the history of hypertension and diabetes, fat tongue, weak tongue, moss thin greasy, pulse moisten. Western medicine diagnosis: headache, traditional Chinese medicine diagnosis: migraine (liver disorder, qi block, internal obstruction of wet turbidity). Treat when adjust liver gas, fall stomach gas, dehumidify turbid. Prescription: bupleurum 12g, scutellaria 15g, stir-fried white peony 30g, ginger pinellia 12g, salvia miltiorrhiza 15g, stir-fried liquorice 6g, huai wheat 30g, jujube 9g, gastrodia elata 9g, rattan 15g, silkworm 12g, kudzu 30g, huoxiang15g, perrin 15g, atractylodis 15g, lily 15g, anemarrhena 9g. 14 , a daily , Fried in water, once in the morning and once in the evening.

June 1, 2019, second diagnosis: the left temple throbbing pain is shortened, the pain degree is less than before, still attack twice a month, there is nausea without vomiting, fear of light and voice is reduced, hand numbness is not obvious, sleep can, naco, stool twice a day. Tongue body fat, tongue light, moss thin white, pulse moisten. Add zedoary turmeric above 12g, 14, decoction method as before.

June 22, 2019 three diagnosis: during the medication migraine attack, nausea, no vomiting, hand numbness is not obvious, stool a row a day, weak tongue, moss thin white, pulse moisten. Original prescription 14 paste, decoction method as before.July 6, 2019 four diagnosis: a slight headache yesterday, no nausea and vomiting, numbness disappeared, remaining stable. Weak tongue, thin white moss, pulse moisten. Prescription: bupleurum 12g, stir-fried white peony 30g, scutellaria scutellaria 15g, ginger pinellia 12g, salvia miltiorrhiza 15g, prepared glycyrrhiza 6g, huai wheat 30g, jujube 9g, gastrodia 9g, rattan 15g, rigicoricum 12g, pueraria 30g, huoxiang15g, atractylodes 15g, lily 15g, anemarrhena 9g, zedoary 12g, ligustrum 15g. 14 paste, decoction as before.

Note: the patient is a middle-aged female, due to the work pressure caused by the liver qi is not comfortable, qi-inverse disorder, so headache aggravation, stomach gas on the inverse nausea and vomiting. "Plain ask · dildo theory" record: "liver advocate the fascia of the body." Liver disorder, abnormal qi and blood flow, fascia can not be raised, so there is numbness in the hands. Liver main store blood, menstrual period classics quantity is too much, the qi blood that raises the fascia is insufficient, reason causes the hand hemp to often be associated with menstrual cycle. Qi disorder, unable to turn the water into blood, gathered into wet sputum, tongue coating pulse are evidence. The prescription of bupleurum root, scutellaria baicalensis root, pinellia ginger, processed liquorice root, jujube as small bupleurum soup, conditioning shaoyang qi machine, antinausea; Fried white peony root, salvia miltiorrhiza raise blood and promote blood circulation, soft liver pain; Gastrodia elata, rattan, bombyx mori to calm the liver wind; Pueraria root encourages the qi of qingyang in spleen and stomach, and huoxiang, perrin and atractylodes help transport and remove spleen dampness. Huai wheat with jujube, mind and peace, lily with aemu Yin qingxin, enhance the power of peace. Two diagnosis of zedoary, zedoary moisten liver through, take the meaning of its blood line gas. Three diagnosis symptom alleviation, to control, so use the original prescription. Four diagnosis symptoms gradually stable, moist turbidity relief, peri orchid, add ligustron son tonic liver and kidney, enhance qi.

3.2 Basis 2

The patient, female, 31 years old, was first diagnosed on February 19, 2019. Chief complaint: left migraine for more than 10 months. History of present illness: in 2018, I was hospitalized twice in our hospital due to headache and tinnitus, with high intracranial pressure (＞ 300mmH2O) as the main abnormality. On September 28, 2018, I underwent DSA examination in our department, and no sign of venous sinus thrombosis was found. The symptoms were relieved after rivaroxaban anticoagulation (20mg/d). Due to limited diplopia and abduction, symptoms were alleviated after treatment in huashan hospital and xuanwu hospital, but the diagnosis was not clear and cerebrospinal fluid pressure was ＞ 300mmH2O. For further treatment, outpatient service was conducted. Previous history: history of left cerebral decompression in huashan hospital on December 12, 2018; History of anemia.Diagnosis: headache head is heavy, change body committee has head bilge feeling, see thing is clear, walk steady, memory can, sleep can, can, two then adjust. The menstrual cycle is normal, with a longer period. Auxiliary examination: MRI enhancement of skull base in huashan hospital: pituitary height about 3.5mm empty sella. Cranial MRV: poor development of the left bracket sinus, more abnormal possibility. Bilateral globus pallidum MR scan (-). Cerebrospinal fluid of huashan hospital: routine (-), biochemical (-) immune index and oligoclonal analysis (-), anti-nuclear antibody: positive. Enhancement of cranial MRr in huashan hospital: no obvious abnormality was found. Tongue veins: tongue sharp red edge, thin white moss, thin veins.Western diagnosis: increased intracranial pressure. TCM diagnosis: headache (lack of vital energy and blood, loss of vital marrow, obstruction of phlegm and dampness).Treatment: qi qi blood, warm Yang qi, dry wet phlegm. Prescription: angelica blood tonic soup with wuling sanhe two Chen tang to add flavor, the prescription is as follows: raw astragalus 30g, angelica 12g, Fried atrachis 15g, alisma 30g, poria cocos 30gZhu ling 15g, cassia branch 9g, raw liquorice 6g, red peony root 15g, white root 30g, fangfeng 9g, tangfengpi 9g, ginger pinellia 12g, agaricus root 15g, mulberry parasitic 15g, ligustrum 15g 14.

Second diagnosis on March 5, 2019: headache alleviated, head weight disappeared, head distension disappeared after changing body position, no dry mouth, clear vision, sleep, natrol, stool adjustment, urine frequency and amount were slightly more than before taking the medicine. Slightly afraid of the cold. Weak tongue, thin white moss, thin pulse. Prescription: add 15g 14 posts of xianling spleen above.

March 19, 2019 three diagnosis: headache may, slightly afraid of cold, sleep may, naco, stool, urine volume is more. Weak tongue, thin white moss, thin pulse. Recipe: add morinda day 15g 14 posts

aboveThe prescriptions are as follows: raw astragalus 30g, angelica 12g, Fried ataricus 15g, alisma 30g, poria cocos 30gZhu ling 15g, cassia branch 9g, raw liquorice 6g, red peony root 15g, white root 30g, fangfeng 9g, tangerine peel 9g, ginger pinellia 12g, sichuan achyranthes 15g, mulberry parasite 15g, ligustrum 15g, xianling spleen 15g, morinda 15g.

Massage language: the head is the meeting of various yangs, shrewd government, the brain is the sea of marrow, its qi is interlinked with kidney, "ling shu · evil qi viscera disease evil" yue: "12 meridians, 365 collateral, its blood and spirit are on the surface and go empty orifices." The patient is a middle-aged woman, who has a history of anemia, deficiency of vital energy and blood, loss of vital marrow, and disadvantageous nine orifices. The tongue and pulse are all evidence. Treat with benefit gas generation blood, warm Yang changes gas, reason gas and in. Square with angelica blood tonic soup he wuling sanhe two Chen tang flavor. Angelica root is intended to strengthen and cure the root cause by nourishing the blood and nourishing the qi and generating the blood. Wuling sanli water infiltration wet, warm Yang gas, through the three coke channel; Two Chen tang dry dampening phlegm, regulating qi and in, and five ling SAN jointly adjust the coke qi machine, qing qing enlightenment. Radix paeoniae alba and rhizome of radix paeoniae alba clear heat and cool blood to stop bleeding, to prevent excessive warming and bleeding; Chinese achyranthes, mulberry parasitic, ligustrum, nourishing liver and kidney. Second diagnosis of the patient's symptoms improved, slightly afraid of cold, add xianling spleen kidney Yang. Three diagnosis still have the symptom of cold, add morinda day to enhance the function of tonifying kidney and aphrodisiac.