No Place Like Home (Buffy, Season 5, Episode 5)


In this  episode we discover that Dawn is not really Buffy’s sister.  While that does not make Dawn ‘unreal’ — she is certainly real, and sought after — it will add a layer of complexity to future treatments involving Dawn.  We also watch Buffy find a glowing orb and have her first encounter with Glory, the exiled goddess who just wants to go home. Meanwhile, Buffy’s mother continues to have headaches — this time, Joyce comments, the initial headache brought along some friends.

What Joyce seems to be describing is a cluster headache, more common among men (it is nicknamed the ‘male migraine’), although we know the cause is due to her brain tumour(s).  Just as biomedicine has a few types of headaches — cluster and migraines among them — so also in Chinese medicine is a headache ever just ‘a headache.’  Most Chinese medical practitioners are not going to tell a patient to ‘take two and call me in the morning’ if they phone in with a headache, precisely because even mild headaches in Chinese medicine fall into one of several categories.  Instead of ‘take two’, a few questions will be asked, typically beginning with ‘where is the headache located’.  This may be followed by, ‘what sort of pain is it?’  Finally, a few questions about associated symptoms may be discussed:  ‘Are you feeling cold?  Do you have tight neck and shoulders?  Sore throat?  Did you wake up groggy?  Are you nauseous?  Is your urine bubbly?’

The various types of Chinese Headaches are well known by practitioners of Chinese Herbal Medicine, because certain herbs are prescribed depending on the location of the pain.  Studies into the receptor proteins for the active compounds of these herbs, and the particular tissues in which those proteins are located, may give some clue to the biomedical genesis of various types of headaches.  Of course, then the public would need to be educated to describe their headaches by location, pain, and associated symptoms.

Headaches defined more by location of the pain include TaiYang, YangMing, ShaoYang, jueyin, and Du Mai.  These are regions of the head through which the associated channels pass.  Note:  the associated herbs are never given alone, but only in combination with other herbs to alleviate associated symptoms.

TaiYang headaches are felt around the occiput and back of the head, as the TaiYang channel passes from the thoracolumbar aponeurosis upwards along the erector spinae muscles, over the cranial aponeurosis and to the top of the orbital ridge.  To treat a TaiYang headache, use Qiang Huo

Yang Ming headaches are your typical sinus headaches:  cheekbones, above the eyebrows, perhaps part of the jaw.  They cluster around the Stomach meridian, which travels from the toes up the leg, the rectus abdominis, SCM, and encircles the jaw and travels upwards along the sides of the nose to the inner canthus of the eye.  For Yang Ming headaches, use Bai Zhi

ShaoYang headaches are the headaches experienced at the temples, on the side of the head.  These are the most common types of headaches seen without symptoms associated with colds or sinus infections.  For these cases, use Chai Hu.

JueYin headaches are orbital headaches — around the eyes, between the eyebrows.  The herb which used to be used was Xi Xin; it must always be combined with ginger to reduce its toxicity.  It must not be given to patients with compromised kidney function (kidneys in the biomedical sense of the term).  ONLY THE ROOTS AND RHIZOME OF XI XIN SHOULD BE USED.  The aerial portions are high in aristolochic acid.  For more information, see this paper:  http://www.ncbi.nlm.nih.gov/pubmed/18693102

A headache at the top of the head only is a Du Mai headache.  The Du Mai, or Governing Vessel, passes along the spine from the tip of the coccyx to the middle of the upper lip.  For such a headache, use Du Huo.  Qiang Huo and Du Huo are often combined because of the geographic overlap in types of headaches they treat.

Often, headaches are associated with the common cold.  The common cold is also divided into several types in Chinese Medicine, characterised by whether the accompanying symptoms are ‘cold’ or ‘hot’ in nature.  Being relatively superficial in nature, rather than an internal issue with the body’s overall physiology, these diseases are classified as ‘external wind’ — wind being the element of change which disrupts the body’s external defences.  (Think of sleeping in a cold draft and waking up with a stiff neck.)  Jing Jie is a good herb for any external wind invasion.

Wind-cold invasions are the typical cold which begins with slight aches, slight runny nose, no change in tongue coating.  Gui Zhi Tang or Ma Huang Tang are commonly prescribed for these conditions, depending on the constitution of the individual.  A strong, hardy person is given Ma Huang Tang, a less robust person who tends to exhaust easily is given Gui Zhi Tang.   For tight neck and shoulders, use add Ge Gen (Kudzu root).  For headaches caused by a clenched jaw, add some Tian Hua Fen.  A simple herbal formula for TMJ that I use is Shao Yao Gan Cao Tang, with 3 – 5 g Tian Hua Fen (Gua Lou Gen) added as an ‘envoy’ or carrier herb.

Wind-heat headaches see the tongue coat become slightly yellow, the patient feels hot (although objective temperature may not be raised), and the throat is a little sore.  Light, floating herbs work well here.  Ju Hua (Chrysanthemum flower), Bai Ho (Chinese Mint), and Jin Yin Hua (Honeysuckle) all work well.  If the headache foreshadows a cold, adding some Da Qing Ye or Ban Lan Gen is not a bad idea.  Ge Gen can also be used in cases of wind-heat.

Wind-damp invasions lead to a sense of a heavy head, difficulty concentrating, thick white or slimy tongue coating, and bubbles in the urine (although bubbly urine is also indicative of internal dampness).  Fang Feng is used in this case; for internal dampness causing grogginess, Bai Zhu and Fu Ling are often useful, perhaps with some Bi Xie added to maintain physiological fluids while draining out pathological ones.  See ‘nobose’ below.

Finally, other symptoms reflect fluid physiology in the body:

A sharp pain is indicative of blood stagnation – Chuan Xiong is the best herb here.  Chuan Xiong is, in fact, useful to use in nearly all types of headaches.  Because it moves blood, it also helps expel external wind.  Its properties can be modulated to treat either wind heat or wind cold conditions, depending on the other herbs with which it is combined.

Nobose (fluid counterflow) is a pathology known in Kanpo, Japanese herbal medicine.  Reversal of the ordinary flow of fluids in the body, particularly when the fluids have become cold due to a lack of yang transformation can result in migraines.  The Japanese might prescribe Wu Zhu Yu Tang to treat migraines, rather than a Liver Qi moving herb.  For some schools of Kanpo, the key aspect of migraines is the extreme pain which is a symptom of cold damage.  The treatment principle is to warm the fluids, which will restore their natural flow in the body.

Qi stagnation causes dull pain.  Most often qi stagnation type headaches are assigned to the Liver, although what ‘Liver Qi Stagnation’ actually means is rarely described in detail in the classroom.   One function of the Liver in the body is to harmonise wei qi and ying qi.  When the Liver is weak, the relationship between external wei qi and internal ying qi is disrupted, leaving the body vulnerable to external wind invasions.  Gui Zhi Tang, because it contains the herb pairs gui zhi-bai shao and da zao-sheng jiang, harmonises wei qi and ying qi.  As such, it is a representative formula for proper Liver physiology.  A closer look at the flavour components as defined by fragments of the Tang Ye Jing Fang support that idea.  (I have written about this earlier, but if you want an elaboration, please ask for one in the comments section.)

Acupuncture treatments for headache also vary by type of headache.  LI-4, He Gu, is the most common point used to treat headaches, but TW3, between the middle and fourth fingers, can also be used.  SI-3, which opens the Du Mai, is another single point which is useful.  Many hand points, in fact, are useful for treating headaches; but so are a few points on the feet:  LV-3, ST-44, GB-41.

In Joyce’s case, knowing what else is going on, I would use either GB points exclusively, or I would use SI-3, points along the Du Mai, GB-13, and GB-41.  (The Gallbladder meridian runs along the side of the head, but is also associated with the brain itself; the Du Mai penetrates the brain.)  A more innovative approach would be to needle LV-1 (to activate the entire channel), DU-20 (the end point of one branch of the Liver Channel, at the top of the head), and LV-6, the xi-cleft point of the LV.  Xi-cleft points are recommended to treat pain.  LV-6 is particularly useful for pain experienced when recovering from hepatitis.  It clears heat and re-establishes proper circulation between qi and blood.  In Joyce’s case, it should ease both sharp and dull pain.

As always, these posts are for educational and entertainment purposes only.  If you feel Chinese Medicine may benefit you in helping ease your (physical) headaches, please see a qualified practitioner.

Happy Slayage!

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