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Headache and Chinese medicine

Headache is pain or discomfort that occurs in one or more areas of the head, face, mouth, or neck. Headache can be chronic, recurrent, or occasional. The pain can be mild or severe enough to disrupt daily activities. There are many different types of headaches. The following are three major categories of headaches:

1. Primary headaches: they account for about 90% of all headaches. There are three major types of primary headache: migraine, tension-type headache and cluster headache:

• Tension headaches are the most common type of primary headache; as many as 90% of adults have had or will have tension headaches. their cause is not known. The most likely cause is contraction of the muscles that cover the skull. When the muscles covering the skull are stressed, they may spasm and cause pain.
• Migraine headaches are the second most common type of primary headache. An estimated 28 million people in the United States (about 12% of the population) will experience migraine headaches. See Migraine in this web site.
• Cluster headaches are a rare type of primary headache, affecting 0.1% of the population. The cause of cluster headaches is uncertain. It may be that certain parts of the brain begin to malfunction for an unknown reason. The hypothalamus is responsible for the body's biologic clock and may be the part of the brain that is the source for the headaches.

2. Secondary headaches: caused by underlying conditions such as head and neck traumas, cranial or cervical vascular disorders, substance or its withdrawal, infection, disorders of homeostasis, disorder of cranium, neck, eyes, ears, nose, sinuses, teeth, mouth or other facial or cranial structures, psychiatric disorders.

2. Cranial neuralgias: a group of headaches caused by nerve inflammation in the head and upper neck. Facial pain and a variety of other causes for headache are included in this category.

Conventional treatment

For the secondary and cranial neuralgic headache, treatment should go to underlying diseases. For the primary headaches, over the counter medicine and prescription could be used:

• Tension headaches: over-the-counter (OTC) analgesics: acetaminophen (Tylenol) and non-steroidal anti-inflammatory drugs (NSAIDs) such as aspirin and non-aspirin (ibuprofen-Advil, Nuprin, Motrin IB, Medipren; and naproxen –Aleve).
• Migraine headaches: OTC analgesics: acetaminophen (Tylenol) and non-steroidal anti-inflammatory drugs (NSAIDs) such as aspirin and non-aspirin (ibuprofen-Advil, Nuprin, Motrin IB, Medipren; and naproxen –Aleve). Narcotics and butalbital-containing medications, dihydroergotamine, prochlorperazine and valproate may be used in severe cases. 
• Cluster headaches: Cluster headaches may be very difficult to treat and treatment options may include oxygen treatment, corticosteriods, calcium channel blocking agent, antiepileptic drugs, intranasal applications such as Lidocaine, ergotamine agents, sumatriptan (Imitrex). For those who do not respond to the medications, surgery may be recommenced.

Chinese Medicine

Chinese medicine such as acupuncture and Chinese herbs has been applied to headaches from the earliest beginnings of Chinese medicine. Acupuncture, as well as Chinese herbals is effective for tension headaches, migraine headaches, cluster headaches, post-traumatic headaches, and disease-related headaches that might be due to sinus problems, high blood pressure or sleeping disorders. Some OTC medications and prescription medicine can have serious side effects. Unlike synthetic drugs, the greatest advantage of Chinese medicine is that it is natural and has virtually no side effects. Since the chronic nature of headaches and side effects of synthetic chemical medicine, more and more headache sufferers are seeking acupuncture or herbal medicine for the cure. 

Various clinical studies on effectiveness of acupuncture have been performed. Even though standardized accupoint protocol was used instead of using individualized accupoints that is the beauty of Chinese medicine, the results show the effectiveness of acupuncture on different kind of headaches. The following are a few of those studies.

• Acupuncture for tension-type headache (Linde K et al. Explore (NY). 5(6):356-8, 2009). BACKGROUND: Acupuncture is often used for tension-type headache prophylaxis but its effectiveness is still controversial. This review investigated whether acupuncture is a) more effective than no prophylactic treatment/routine care only; b) more effective than 'sham' (placebo) acupuncture; and c) as effective as other interventions in reducing headache frequency in patients with episodic or chronic tension-type headache. This review included eleven trials with 2317 participants. Two large trials compared acupuncture to treatment of acute headaches or routine care only. Both found statistically significant and clinically relevant short-term (up to 3 months) benefits of acupuncture over control for response, number of headache days and pain intensity. Six trials compared acupuncture with a sham acupuncture intervention, and five of the six provided data for meta-analyses. Small but statistically significant benefits of acupuncture over sham were found for response as well as for several other outcomes. Three of the four trials comparing acupuncture with physiotherapy, massage or relaxation had important methodological or reporting shortcomings. AUTHORS' CONCLUSIONS: acupuncture could be a valuable non-pharmacological tool in patients with frequent episodic or chronic tension-type headaches.
• Use of acupuncture in the therapy of chronic daily headache (Naprienko MV et al. Zh Nevrol Psikhiatr Im S S Korsakova. 103:40-4, 2003).  To determine efficacy of acupuncture (AC) in combined treatment of chronic daily headache (CDHA), 90 patients with this disorder were studied, using clinico-neurologic tests. Severity of patient's state was evaluated with Clinical Global Impression (CGI) scale, including scoring of disease severity, global evaluation of the post treatment state dynamics and the index of therapeutic efficacy. Headache intensity was assessed with VAS. A state of functional activity of nociceptive and antinociceptive systems was studied, using nociceptive flexor reflex (NFR). For treatment, the patients were randomly divided into two clinically matched groups: group 1 received combined drug therapy, group 2--combined drug therapy and additional acupuncture course. The results revealed high efficacy of AC combined with drug therapy for CDHA treatment. Most efficient was use of AC in patients with significantly reduced activity of antinociceptive systems and presence of drug abuse allowing to reduce analeptics withdrawal time. Besides, more pronounced clinical effect of AC was obtained in patients with transformed migraine.

Etiology & clinical manifestations

In Chinese medicine, headaches are caused by multiple factors and the following are the common ones:

External factors

• Wind-cold: due to the invasion of wind and cold evil that disturbs the vertex of body, the meridians are clotted and stagnated.  Symptoms and signs: headache involved in neck and upper back, tightness or aversion wind and cold, no thirsty. Thin tongue coat and superficial, tight pulse.
• Wind-hot: due to invasion of wind and heat to vertex of the body, the meridians are disharmonized. Symptoms and signs: distensive headache, fever, aversion to cold, red face and red eye, thirsty with desire of water and constipation.  Red tongue tip, thin yellow tongue coat, and superficial, fast pulse.
• Wind-damp: invasion of wind and damp into vertex of body. Symptoms and signs: tight headaches, heavy extremities, tight chest, poor appetite, and loose stools. Greasy, white tongue coat and lingering pulse.

Internal factors

• Blood deficiency: qi and blood can not go up due to their deficiency, resulting in poor nourishment of meridians. Symptoms and signs: light headache with occasional dizziness, palpitation, insomnia, poor complexion, low spirit and tiredness. Light-colored tongue with thin, white coat and thin, weak pulse.
• Blood stasis: blood stasis leads to obstruction and stagnation of meridians, which results in headache. Symptoms and signs: long, lasting headaches and could not be cured, stabbing pain, always localized in one area, may have the history of head trauma. Dark, purple tongue with or without petechia or ecchymosis; thin, white coat, and thin, lingering pulse.
• Liver-yang ascending: liver lost harmony that leads to qi stagnation. qi stagnation become fire, which make yang dominant and wind moved up. Symptoms and signs: dizziness and distensive headache, much severer in bilateral head, anxiety and easy to get angry, poor sleep, bitter mouth, red face, bilateral flank pain. Red tongue with yellow coat and taut, fast pulse.
• Kidney deficiency: deficiency of kidney essence and marrow result in brain dysfunction. Symptoms and signs: headache with empty feeling, dizziness with tinnitus, sore low back and knees without strength, low sprit and tiredness, spermatorrhoea or morbid leucorrhoea. Red tongue with scanty coat and thin, weak pulse. 
• Phlegm stasis: spleen could not perform normal function so that phlegm is stagnated, eventually ascending to the head and causing headache. Symptoms and signs: dizziness and headache, full and distensive feeling of chest, poor appetite, vomit. White, greasy tongue coat and slippery or taut slipper pulse.

Principle of treatment

External factors

• Wind-cold: dispel wind and cold, and stop the pain
• Wind-hot: dispel wind, decrease heat and pacify meridians
• Wind-damp: dispel wind, overcome damp and smooth the meridians

Internal factors

• Blood deficiency: tonify blood, nourish yin, harmonize meridians and suppress pain
• Blood stasis: activate blood, dissolve blood stasis and smooth meridians
• Liver-yang ascending: pacify liver, reduce yang and extinguish wind
• Kidney deficiency: tonify yin, nourish kidney, supply essence and stimulate marrow production 
• Phlegm stasis: strengthen spleen, neutralize phlegm damp, dissolve phlegm and descend ascended phlegm

Chinese medicine practitioners treat headache patients according to patient’s initial cause, symptoms and signs, presentation of pulse and tongue. Acupuncture, herbal medicine and some other Chinese medicine modalities can be used alone, or combined, which depend on individual situation.  Acupuncture, twice a week for 4 weeks, is a common practice. And herbal medicine, twice a day for 10 days, is often used in clinic practice.  Responses to acupuncture or herbal medicine are different, so treatment course and modalities used are different. 

Migraine and Chinese Medicine

Migraine is a common type of chronic headache that may occur with symptoms of nausea, vomiting, diarrhea, facial pallor, cold hands, cold feet, and sensitivity to light and sound. Migraine headaches usually are described as an intense, throbbing or pounding pain that involves one temple. But sometimes the pain may be located in the forehead, around the eye or at the back of the head. The pain can be unilateral or bilateral and usually is aggravated by daily activities such as walking upstairs. Some migraine attacks are preceded by premonitory (warning) symptoms lasting hours to days.  

Causes and triggers

The exact cause of migraine headaches is not clearly understood. There are different theories described by the scholars such as depolarization theory (neurological activity is depressed over an area of the cortex of the brain, which results in the release of inflammatory), vascular theory (blood vessels in the brain contract and expand inappropriately), serotonin theory (low serotonin levels in the brain may lead to a process of constriction and dilation of the blood vessels which trigger a migraine), neural theory (certain nerves or an area in the brain stem become irritated, a migraine begins), and unifying theory (both vascular and neural influences cause migraines).   

Various factors can trigger migraine in certain people prone to developing migraine. They include 1) Environmental factors: bright lights, loud noises, and certain odors or perfumes; 2) Physiological factors: certain foods (chocolate, cheese, nuts, smoked fish, chicken livers, nitrates-containing food such as bacon, hot dogs and salami, and monosodium glutamate), alcohol, caffeine, cigarette, fasting, emotional or physical stress, sleep disturbances, hormone changes (birth control pills, menstrual cycle fluctuations or menopause), or allergic reactions.

Chinese Medicine

Chinese medicine has been used in the treatment and prevention of migraine for thousand years and it is natural, effective and no side-effects. In the western world, even though OTC medicine and prescription are useful and helpful for the migraine, more and more people suffered from migraine are seeking Chinese medicine for the cure, since migraine is a chronic condition and OTC medicine and prescription often have some side-effects.  Multiple clinical studies have been performed and the results show the effectiveness of Chinese medicine on migraine. Since the complexity of Chinese herbal medicine, these clinical studies have mainly focused on acupuncture. The following are some of recent studies on migraine.

The effectiveness of acupuncture for chronic daily headache: an outcomes study (Plank S et al. Military medicine.174(12):1276-81, 2009):With the increased incidence of migraine headaches noted in the military population it becomes imperative to find safe and effective treatment options for soldiers. Acupuncture may be one of those options. This pilot study used a standardized set of well-known acupuncture points over a predetermined time interval on 26 subjects suffering from chronic daily headache, the majority being migraineurs, and found a reduction in the frequency and intensity of their headaches. Headache calendars and validated measurements were compared 12 weeks before and 12 weeks after the acupuncture intervention. Results showed continued improvements 12 weeks after the last treatment. Traditionally, acupuncture treatments are individualized at each visit. However the absence of a standardized treatment regimen obstructs data reproducibility across the discipline. A standardized approach may be useful. Variations of these acupuncture points have been used in recent research studies for migraines and acupuncture for headaches for the past 2,000 years.

Acupuncture at points of the liver and gallbladder meridians for treatment of migraine (Zhong GW et al. Zhongguo Zhenjiu. 29(4):259-63, 2009): in a multi-central, randomized and controlled trial, 253 cases of migraine were divided into an acupuncture group and a western medicine group. The acupuncture group was treated with acupuncture at points of The Liver and Gallbladder Channels with Taichong (LR 3), Yang-lingquan (GB 34), Fengchi (GB 20), Ququan (LR 8) selected as main points, and the western medicine group with oral administration of Flunarizine tablets for 4 therapeutic courses. The total therapeutic effects 3 and 6 months after the treatment, the scores of various symptoms of migraine before and after treatment, and the stability of therapeutic effect in one-year following-up survey were observed in the two groups. RESULTS: After treatment, mean times and duration of the headache attack were significantly improved in the two groups (all P < 0.01) with the acupuncture group better than the western medicine group (P < 0.05). The total effective rates for stopping pain after treatment, 3 months and 6 months after treatment in the acupuncture group were 93.0%, 93.0% and 87.7%, respectively, which were better than 85.6%, 86.5% and 69.2% in the western medication group (all P < 0.01). One year later, the stability of the therapeutic effect in the acupuncture group was better than that in the western medicine group (P < 0.05); the adverse reaction and the compliance in the acupuncture group were significantly superior to those in the western medicine group. CONCLUSION: Acupuncture at points of The Liver and Gallbladder Meridians for treatment of migraine is safe, effective, and with stable long-term therapeutic effect.

Effects of acupuncture preventive treatment on the quality of life in patients of no-aura migraine (Zhang Y et al. Zhongguo Zhenjiu. 29(6):431-5, 2009). In this randomized controlled, double-blind and double-dummy research, 60 cases were randomly divided into an observation group and a control group, 30 cases in each group. The observation group was treated with acupuncture combined with oral administration of Flunarizine Hydrochloride vacuity capsules, and Baihui (GV 20), Shenting (GV 24) and Benshen (GB 13) were selected as main points. The control group was treated with oral administration of Flunarizine Hydrochloride capsules combined with acupuncture at placebo-points, thrice each week, for 4 weeks. The SF-36 QOL Scale and effective rate were used for assessment of therapeutic effects before treatment, after treatment and 3 months later. RESULTS: There were significant differences in each dimension scores of SF-36 at 3 time points between the two groups (all P < 0.05). The dimension of the physiological function in the observation group was superior to that of the control group after treatment (P < 0.05). After treatment and 3 months later, the effective rates were 68.0%, 68.0% in the observation group and 24.0%, 32.0% in the control group, respectively, with significant differences between the two groups (all P < 0.05). CONCLUSION: Acupuncture preventive treatment can effectively improve the life quality of the patients with migraine and reduce the migraine attack and acupuncture is more effective in reducing the migraine attack days.

Acupuncture for treating acute attacks of migraine: a randomized controlled trial (Li Y et al. Headache. 49(6):805-16, 2009). A total of 218 patients with migraine were recruited for the study; One group received verum acupuncture while subjects in the other 2 groups were treated with sham acupuncture. Each patient received 1 session of treatment and was observed over a period of 24 hours. The main outcome measure was the differences in visual analog scale (VAS) scores before treatment and 0.5, 1, 2, and 4 hours after treatment. RESULTS: Significant decreases in VAS scores from baseline were observed in the fourth hour after treatment when VAS was measured in the patients who received either verum acupuncture or sham acupunctures (P < .05). The VAS scores in the fourth hour after treatment decreased by a median of 1.0 cm, 0.5 cm, and 0.1 cm in the verum acupuncture group, sham acupuncture group 1, and sham acupuncture group 2, respectively. Similarly, there was a significant difference in the change in VAS scores from baseline in the second hour after treatment among the 3 groups (P = .006). Moreover, at the second hour after treatment, only patients treated with verum acupuncture showed significant decreases in VAS scores from baseline by a median of 0.7 cm (P < .001). Significant differences were observed in pain relief, relapse, or aggravation within 24 hours after treatment as well as in the general evaluations among the 3 groups (P < .05). Most patients in the acupuncture group experienced complete pain relief (40.7%) and did not experience recurrence or intensification of pain (79.6%). CONCLUSION: Verum acupuncture treatment is more effective than sham acupuncture based on either Chinese or Western nonacupoints in reducing the discomfort of acute migraine. Verum acupuncture is also clearly effective in relieving pain and preventing migraine relapse or aggravation.

Electroacupuncture at Qiuxu (GB 40) for treatment of migraine (Jia CS, et al. Journal of Traditional Chinese Medicine. 29(1):43-9, 2009). In a clinical multicentral random controlled study,  275 migraine patients were admitted in 3 hospitals and randomly divided into a treatment group treated by EA at Qiuxu (GB 40), and a control group treated by EA at Tianshu (ST 25). RESULTS: There was a significant difference in VAS score between the two groups of the 3 clinical centers (P<0.01). The therapeutic effects of a 4-week treatment were much better in the treatment group than that of the control group. The 3-month follow-up survey showed that the long-term effects were in favor of the treatment group of the first and third clinical centers, though no significant difference was found in the treatment group of the second clinical center as compared with the control group. The results from the 6-month follow-up survey showed better effects in the treatment group of all the 3 clinical centers. CONCLUSION: EA at Qiuxu (GB 40) may show effect for migraine.

The design and protocol of acupuncture for migraine prophylaxis (Zhang Y , et al. Trials [Electronic Resource]. 10:25, 2009). In a multicenter randomized controlled trial, 140 migraine patients are randomly allocated to two different groups. The acupuncture groups (n = 70) is treated with acupuncture and placebo medicine; while the control group (n = 70) is treated with sham acupuncture and medicine (Flunarizine). Both Flunarizine and placebo are taken 10 mg once per night for the first 2 weeks and then 5 mg once per night for the next 2 weeks. Patients in both groups receive 12 sessions of verum/sham acupuncture in 4 weeks. DISCUSSION: The study design and the long term clinical practice of acupuncturists guarantee a high external validity for the results. The results of our trial will be helpful to supply the evidence on the efficacy of acupuncture for migraine prophylaxis in China.

Effect of ear point combined therapy on plasma substance P in patients of no-aura migraine at different stages (Yang DH, Zhongguo Zhenjiu. 29(3):189-91, 2009). In this study, thirty cases of no-aura migraine at different stages were treated with ear point combined therapy, including blood-letting at the ear back, injection of auto-blood into Fengchi (GB 20), Yanglingquan (GB 34), and pricking at ear points Nie (AT2), Yidan (CO11), Shenmen (TF4), etc. Their clinical therapeutic effects were evaluated at the end of one therapeutic course, and substance P (SP) contents were detected before and after treatment. RESULTS: The clinical effective rate was 86.7%, and the effective rate was 87.5% at the attack stage and 86.4% at the remission stage with no significant difference between the attack stage and the remission stage (P>0.05); after treatment, SP content had significant change as compared with that before treatment (P<0.05, P<0.01), and there was very significant difference in SP content between the attack stage before treatment and the remission stage (P<0.01). CONCLUSION: The ear point combined therapy can relieve pain possibly through decreasing plasma SP content, and the SP con tent possibly is one of main factors inducing migraine attack.

Etiology & clinical manifestations

There are multiple factors causing migraine and the following are the common causes of irregular period:

• Wind invasion into meridian:

1. Wind-cold evil into brain: headache with stiff neck and back, chilliness, general aching and stuffy nose with watery discharge. Tongue: thin, white coating; Pulse: floating and tense.

2. Wind-heat evil into brain: severe distending headache in the whole head, aversion to wind, fever, stuffy nose with discharge, thirsty with desire to drink, constipation and dark urine. Tongue: thin, yellow coating; Pulse: floating and rapid.
3. Wind-cold-damp evil into brain: head heaviness and head tightness, lassitude, tight chest, nausea, poor appetite and dry mouth with no desire to drink. Tongue: greasy coat; Pulse: soft and floating, or slow and floating.

• Liver yang ascending: distending headache, irritability, easily angered, dizziness and blurred vision. Tongue: red tongue with thin coat; Pulse: rapid.

• Wind-fire invasion into liver meridian: headache in one side with severer in the temple, red eye and red face, sensitive to light, bitter and dry month, anxiety and anger, nausea and vomit. Tongue: red with yellow coat; Pulse: string-like and fast.
• Phlegm ascending: Severe headache with heavy, tight, muzzy feeling, foggy thinking, dizziness, lassitude, restlessness, paraphasia, oppressed chest, nausea, rapid breathing, excess salivation or drooling, and cold limbs. Tongue: thick, greasy coat; Pulse: wiry and slippery.
• Blood stasis: Stabbing, splitting, localized intermittent but lingering headache, Tongue: purple spots, Pulse: choppy.
• Deficiency of qi and/or blood: Dull pain at the vertex, or everywhere in the head with slight muscle spasms or twitching at the temples, dizziness, blurred vision, pale face, skittish or easily startled, and palpitations. Tongue: thin, white coat; Pulse: weak and thready.
• Deficiency of kidney essence and blood: Dull headache in the whole head with empty feeling in the head, dizziness, tinnitus, soreness and weakness of the waist and knees, fatigue and amnesia. Tongue: red with little coat; Pulse: thready and weak.

Principle of treatment

• Invasion of wind into meridian: Dispel wind, activate blood and stop pain.
• Liver yang ascending: Pacify the liver, subdue rebellious yang, nourish water for normal wood function.
• Wind-fire invasion into liver meridian: Pacify liver, suppress wind and extinguish fire.
• Phlegm ascending: Resolve phlegm and suppress the ascending of phlegm.
• Blood stasis: Activate blood and resolve blood stasis.
• Deficiency of qi and/or blood: Tonify qi and nourish blood.
• Deficiency of kidney essence and blood: Nourish kidney essence and tonify marrow, as well as supply qi and tonify blood.

Chinese medicine practitioners treat migraine patients according to patient’s initial cause, symptoms and signs, presentation of pulse and tongue. Acupuncture, herbal medicine and some other Chinese medicine modalities can be used alone, or combined, which depend on individual situation.  Acupuncture, twice a week for 4 weeks, is a common practice. And herbal medicine, twice a day for 10 days, is often used in clinic practice.  Responses to acupuncture or herbal medicine are different, so treatment course and modalities to be used are different.

Amenorrhea and Chinese Medicine  

Amenorrhea (loss of menstrual period) is the absence of menstruation or absence of periods. Women normally do not menstruate before puberty, during pregnancy, and after menopause. There are two types of amenorrhea: primary amenorrhea and secondary amenorrhea. Primary amenorrhea is when a young woman has not had her first period by the age of 16. Secondary amenorrhea is when a woman who has had normal menstrual cycles stops getting her monthly period for 3 or more months. Many conditions that cause amenorrhea have other serious complications: for example, polycystic ovary syndrome is associated not only with infertility but also with a higher risk for uterine cancer, heart disease and diabetes; hypothyroidism, another common cause of amenorrhea, carries serious physical and mental risks; amenorrhea associated with reduced estrogen levels increases the risk for osteoporosis (loss of bone density).  

Causes

Amenorrhea can be caused by any changes in the organs, glands and hormones involved in menstruation. The most common cause of primary amenorrhea is delayed puberty due to some genetic factor. In many cases, the cause of primary amenorrhea is not known. Common causes of secondary amenorrhea include: pregnancy, breast feeding, stopping the use of birth control, some birth control methods such as Depo-Provera and menopause. Other causes of secondary amenorrhea include:

• Stress
• Poor nutrition
• Depression
• Certain drugs
• Extreme weight loss
• Over-exercising
• Ongoing illness
• Sudden weight gain or being very overweight (obesity)
• Hormonal imbalance due to polycystic ovarian syndrome (PCOS)
• Thyroid gland disorders
• Tumors on the ovaries or brain

Conventional treatment

Treatment depends on the cause of amenorrhea. Treat the underlying causes such as surgery for hypothalamic and pituitary tumors or anatomical abnormalities of the genital tract. Prescription medications used to treat amenorrhea include birth control pills, medroxyprogesterone, gonadotropin-releasing hormone (GnRH) or gonadotrophin therapy, dopamine agonists or hormone replacement therapy according to underlying causes.  

Chinese medicine

Acupuncture improves hormonal imbalances that can be associated with amenorrhea and related conditions, such as polycystic ovary syndrome (PCOS). In a number of preliminary trials1,2,3,4, acupuncture has been shown to induce ovulation in women with disorders involving lack of ovulation. Preliminary studies show that levels of estrogen and progesterone, as well as levels of the related hormones LH (luteinizing hormone) and FSH (follicle-stimulating hormone), may all be affected by acupuncture5,6. One preliminary trial found it helpful for women who have widely separated menstrual cycles7. In controlled trial8,9, amenorrheic women showed a trend toward normalizing hormone levels following acupuncture. Acupuncture could cure some anovulatory patients in a highly effective rate possibly by regulating the dysfunction of Hypophyseal-Pituitary-Ovarian Axis in several ways, including some gene expression of brain, thereby, normalizing secretion of some hormones, such as GnRH, LH and E2.  

Etiology and clinical manifestations

In Chinese medicine, the liver, spleen and kidneys are the most important organs that regulate blood and menstruation; and qi and blood are the key fundamental substances. The liver "stores the blood," and is responsible for maintaining a smooth, even flow of blood and qi.  Emotions such as anger, irritation, resentment and anxiety can lead to stagnation of liver qi, which in turn can lead to blood stasis. A main function of the spleen is to produce qi and blood. If the spleen is weak, there will eventually be a deficiency of qi and/or blood, so there will not be enough blood for normal menstruation or enough qi to regulate normal cycles. Also, if the spleen is too weak, it can lead to a condition of dampness in the body, and phlegm-damp can obstruct the uterus. The kidneys are the organ responsible for conception, reproduction and aging over time. Kidney-essence is the ultimate origin of menstrual blood. The following are the common causes of Amenorrhea.

• qi and blood deficiency: There is a gradual cessation of menstruation. Typically, periods become shorter and scantier and eventually stop completely. Signs and symptoms include: absence of menstruation, pale complexion, general fatigue and weakness, dizziness, blurred vision, palpitations, bruises easily, headaches, weakness of the limbs, loose stools, palpitations, sleepiness, breathlessness, insomnia, dream-disturbed sleep, dry skin, lusterless hair and brittle nails.
• Liver and kidney deficiency: There is a gradual cessation of menstruation. At first, the menses become thin and scanty, then gradually stops completely. Signs and symptoms include: absence of menstruation for a significant period of time, fatigue, soreness and weakness in the loins and legs, lower back pain, dizziness, headaches, tinnitus, anxiety, hot flashes, excessive perspiration, lusterless hair, brittle nails and frequent urination.
• qi stagnation: There is an irregular menstrual cycle initially and then the menstruation stops gradually or suddenly. Emotional stress is the most common origin of this pattern. Signs and symptoms include: absence of menstruation, depression, anxiety, a sensation of fullness in the chest and under the rib cage, swelling or fullness of the abdomen with an aversion to pressure, breast tenderness, headaches, lack of appetite and alternating diarrhea/constipation, and frequent sighing.
• Blood stasis: There is an irregular menstrual cycle initially and then the menstruation stops gradually or suddenly. Emotional stress or trauma is the most common origin of this pattern. Signs and symptoms associated are the same as the above symptoms of qi stagnation but the pain may be intensified. Other signs and symptoms may include a palpable abdominal mass, purple lips, headaches, sallow complexion and dark skin macules.
• Phlegm/dampness obstruction: There is delayed period and then menstruation gradually stops. Being overweight as well as the habitual consumption of cold, raw, or greasy foods (especially dairy products) are most likely the cause of this pattern. Signs and symptoms include: absence of menstruation, obesity, excessive sticky and clear vaginal discharge, nausea, headaches, chest constriction, phlegm in the throat, abdominal bloating, edema, fatigue and general weakness.

Principle of treatment

• qi and blood deficiency: Supply qi, nourish blood, regulate menstruation and reduce pain
• Liver and kidney deficiency: Tonify kidney, nourish liver and regulate menstruation
• qi stagnation: Regulate qi, smooth liver and eliminate stagnation
• Blood stasis: activate blood, eliminate stasis and smooth meridian
• Phlegm/dampness obstruction: Tonify spleen, remove damp phlegm and expel cold from meridians

References

1. Chen, BY et al, Relationship between blood radioimmunoreactive beta endorphin and hand skin temperature during the electro-acupuncture induction of ovulation. Acupuncture & Elctro-Therapeutics Research The International Journal 16(1), 1-5, 1991
2. Stener-Victorin E, Waldenstrom U, Tagnfors U, et al. Effects of electro-acupuncture on anovulation in women with polycystic ovary syndrome. Acta Obstet Gynecol Scand 2000;79:180–8.
3. Mo X, Li D, Pu Y, et al. Clinical studies on the mechanism for acupuncture stimulation of ovulation. J Tradit Chin Med 1993;13:115–9.
4. 3. Yu J, Zheng HM, Ping SM. Changes in serum FSH, LH and ovarian follicular growth during electroacupuncture for induction of ovulation. Chung Hsi I Chieh Ho Tsa Chih 1989;9:199–202,195 [in Chinese].
5. Mo X, Li D, Pu Y, et al. Clinical studies on the mechanism for acupuncture stimulation of ovulation. J Tradit Chin Med 1993;13:115–9.
6. 5. Yu J, Zheng HM, Ping SM. Changes in serum FSH, LH and ovarian follicular growth during electroacupuncture for induction of ovulation. Chung Hsi I Chieh Ho Tsa Chih 1989;9:199–202,195 [in Chinese].
7. 6. Gerhard I, Postneek F. Possibilities of therapy by ear acupuncture in female sterility. Geburtshilfe Frauenheilkd 1988;48:165–71 [in German].
8. 7. Kubista E, Boschitsch E, Spona J. Effect of ear-acupuncture on the LH-concentration in serum in patients with secondary amenorrhea. Wien Med Wochenschr 1981;131:123–6 [in German].
9. Bo-Ying Chen, Acupuncture Normalizes Dysfunction of Hypothalamic-Pituitary-Ovarian Axis. Acupuncture & Electro-Therapeutics Res., Int. J., Vol. 22, pp. 97-108, 1997

Irregular Periods and Chinese Medicine

Normal menstruation has a regular cycle (26-32 days) with bleeding that lasts 4-6 days and a consistent flow pattern without clots. An irregular period is any type of bleeding that is abnormal when compared to usual menstrual cycle. This can include an early period, a late period or bleeding between periods. It can also appear as particularly heavy bleeding (menorrhagia) or scanty bleeding. Many women also experience irregular periods in the form of a missed period, continuous periods, or periods that occur twice in one cycle. 

Causes

Normal period is regulated by woman hormones and irregular menstruation generally related to disruptions in the balance of hormones. A wide variety of factors can be responsible for irregular periods, among them:

• Significant weight gain or loss
• Over-exercise
• Poor nutrition (or a diet too high in carbohydrates)
• Smoking
• Drug use
• Caffeine
• Excessive alcohol use
• Eating disorders
• Increased stress
• Polycystic ovarian syndrome/estrogen dominance
• Uterine abnormalities (fibroids/cysts/polyps/endometriosis)
• Hormonal imbalance related to perimenopause
• Medications such as hormonal birth control methods
• Chemotherapy
• Radiation therapy
• Recent childbirth, miscarriage, or Diltion and Curettage (D&C)
• Breastfeeding
  

Conventional treatment 

Hormonal contraceptives are often used to help regulate menstrual cycles. These contraceptives combine estrogen and progesterone and they are available by prescription and come in oral, patch, ring, and injectable forms. If you have a specific hormone problem, such as overproduction of testosterone, hormonal supplements may be able to help regulate your periods. Carbohydrate metabolism abnormalities are often treated with a combination of diet and medications. 

Chinese Medicine

Chinese medicine has a long history in the management of irregular period. It a natural approaches to encourage your body to re-establish regular ovulation and to get your hormones back in balance. Although its primary basis rests on empirical evidence, more and more basic researches and clinical trials support its therapeutic modalities in many fields including gynecology. Researches show that acupuncture:

• Reduce stress hormones responsible for irregular periods
• Impact on blood levels of follicle-stimulating hormone (FSH), luteinzing hormone (LH), estradiol (E2), and progesterone (P)
• Accelerate the release of brain and pituitary ß-EP, which inhibits the over-production of GnRH and LH
• Normalize the hypothalamic-pituitary-ovarian axis, a key process of normal menstruation
• Promote the function of hypothalamic pituitary-adrenal axis (HPAA) leading to increase in the synthesis and secretion of adrenal steroid hormones, which resets the negative feedback of estrogen to HPOA

In a clinical study, four hundred and five patients with irregular menstruation were enrolled and treated with Chinese herbal formulae Tiaojing Zhixue (n=304) or Fuxuening (n=101). 78.3% and 97.4% of the patients in the two treatment groups restored regular menstruation. Over 80% of patients showed improved clinical symptoms, including reductions in weakness, insomnia and pain. No harmful effects, toxicity or side effects were noticed (Ma K, et al. 2003). Chinese herbal medicine (Xiaoyan Zhixue Capsule) was further reported to treat abnormal uterine bleeding caused by intrauterine devices (IUD) with a 90.3% effectiveness rate, significantly higher than the rate (43.5%) in a control group (Ren JF, et al 2004). 

Etiology & clinical manifestations

  There are multiple factors causing period irregulation and the following are the common causes of irregular period:

Early Menstruation

• Hot in the blood - Red face, hot body, red/dry lips, dry mouth, irritability, easily angered, headache, dizziness, constipation and brighter colored blood  
• qi deficiency - Pale, shiny face, tired spirit, palpitations, lighter colored blood
• Congealed blood - Hemorrhage, purplish blood with clots, heavy and/or irregular menstruation, lack of smooth blood flow, abdominal distention, abdominal masses and bloating.

Late Menstruation

• Blood deficiency - Patient may be thin and/or weak, sallow complexion, dry skin, palpitations, insomnia, pale blood and scanty menstruation.
• Cold & deficient - Shiny, pale face, aversion to cold, tired spirit, blood is thin & watery. 
• qi constraint - Depression, premenstrual emotional issues (moodiness, etc.), chest/subcostal tension, breast tenderness, abdominal distention prior to menstruation and purplish menstrual blood.   

Chaotic Menstruation (sometimes early and sometimes late)

• Spleen deficiency - Fatigue, sallow complexion and poor appetite
• exhausted liver & kidney- Pale or dark complexion, dizziness, weakness in the lower body, pale colored menstrual blood
• Constrained qi- Dizziness, chest oppression, abdominal distention prior to menstruation, abdominal pain, purple or dark blood with uneven menstrual flow.

Principle of treatment:

Early Menstruation

• Hot in blood: Cool the blood and disperse liver fire 
• qi deficiency: Tonify qi  and spleen
• Congealed blood: Dissolve blood stagnation and restore the smooth flow of blood and qi

Late Menstruation

• Blood deficiency:  Tonify the spleen, blood and yuan qi
• Cold & deficient: Tonify the blood and the yang
• qi constraint: Calm the spirit and resolve qi stagnation

Chaotic Menstruation

• Spleen deficiency: Tonify spleen and blood
• Exhausted liver & kidney: Tonify liver and kidney
• Constrained qi: Smooth qi flow
  

Acupuncture or herbal medicine can be used alone or combined with each other. The treatment course is depended on individual situation such as original causes, severity, responses to acupuncture or herbal medicine.