baffling case

October 1, 2005

Hello,

I have a patient whose chief concern is " pressure in the head, as if it is going

to bust. " It comes and goes, and is mostly felt at the temples, forehead, and

eyes. There is no faintness; contrary, if she bends to the floor, the pressure

gets much worse. There is no temperature change, and no anger. To her, her

eyes feel like they're bugging out; to other, they look very staring and set,

yet at the same time, have a very distant look. Also, at the times of pressure

in her head, it is very easy to lose balance and she cannot concentrate on

anything. Her pulse is (L) generally wiry, Sp--floating and forceful. She also

has intermittent high blood pressure. My question is: is this a case of Liver

Qi Congestion (can it congest in the head space) with underlying Liver Yin and

Blood Xu, or is it a case of Liver Yang Rising even though there are no

temperature or emotional changes?

For 3 weeks, I have used Jiang Ya Pian to try to reduce her blood pressure, with

no effect. And, with mostly non-overlapping raw herbs, I have used the

following prescription to try to reduce the pressure in her head: Chai Hu 3,

Bai Shao 4, Chuan Xiong 2, Qing Pi 3, Niu Xi 2, Zhi Ke 2, Bai Ji Li 3, Shi Jue

Ming 4, Dang Gui 2, Shu Di 3.

Jiang Ya Pian is: Chong Wei Zi, Niu Xi, Sheng Di, E Jiao, Dang Gui, Gou Teng,

Tian Ma, Chen Xiang, Xia Ku Cao, Mu Dan Pi, Da Huang, Huang Lian, Ling Yang

Jiao, Hu Po.

Neither formula has had any effect on her blood pressure nor on the pressure in

her head/eyes.

I appreciate responses to this email. I need helpful information quickly.

Young Song

L.Ac., Dipl.OM

for Good

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October 2, 2005

Hi Young,

It is difficult to say what the cause and diagnosis is of your patient's

symptoms with the minimal information you have presented. Questions that come

to mind follows: Does she have high blood pressure (have you taken it)? Does

she experience dizziness? Does this pressure come and go, or is it constant?

Is it better or worse any time of day, or with different weather patterns? What

is her constitution? Do you see evidence of liver depression, liver yang

rising, dampness, or phlegm? Does she have a history of sinus problems? Is

this pressure recent or long-standing (could it be an external invasion of wind

with cold, damp, heat)? Are you in an area where there have been recent Santa

Ana wind patterns?

I have been experiencing headaches with two different sets of symptoms in the

last few weeks. One symptom was severe pressure and pain on the left side of my

head that originated as a wind cold attack from sleeping under an open window on

a cold night. Other features included severe stiff neck, pain behind my left

eye, and the headache would get worse as the day went on, with throbbing that

also got worse if I bent over, sneezed, coughed, or did anything else that sent

more energy into my head. The other set of symptoms were more of a feeling of

heaviness and pressure in my entire head, particularly in and behind my eyes,

with a sort of dull ache, severely stuffy but dry sinuses, difficulty

concentrating, and severe exhaustion. My blood pressure is historically low

(one doctor once told me I have the blood pressure of a dead person, and another

told me that if it was any lower, I wouldn't have any!). I have a spleen qi xu

constitution with dampness and phlegm. I also have

kidney yin and liver blood deficiency, leading to rising liver yang. The

headaches would go away at night, and return a couple hours after waking, and

worsen throughout the day, for more than 2 weeks. Humidity and the heat of day

made all of the symptoms worse, as did being near a fan or air conditioner.

Over this time, I did lots of reading about herbal formulas and tried many

things. Ge Gen Tang helped with the initial stiff neck. Bi Yan Pian opened my

nose, but did not relieve the pains in my head. I tried various formulas for

phlegm, and some for yang rising, all of which did not help. Chuan Xiong Cha

Tiao San also did not help. I took lots of Tylenol (sorry, everyone!).

Finally, I found a formula by Giovanni Maciocia called Clear Yang, which is a

modification of Ban Xia Bai Zhu Tian Ma Tang. It is altered to address not only

patterns of spleen qi deficiency-generated dampness and phlegm rising into the

head on the winds of rising liver yang, but also to help descend the liver yang

as well. This helped a bit, but was not the brilliant solution I hoped it would

be. Since the nature of the pain was so sharp and stabbing and fixed, I decided

to add a formula for blood stagnation, and only after a couple of days of this

did the headache really change. The formula I've used

is specific for stagnant menstrual blood, but it is the only blood stagnation

formula I had on hand, so I used it, and it worked.

The headache lasted so long and was so unchanging in nature, that I was getting

scared and concerned. I never had a headache like that before. Acupuncture

made no impact. Finally what I surmised is that the original wind cold invasion

had caused a constriction of the blood vessels in my head (blood stagnation),

and it was this blockage that responded to the blood stagnation formula. Today

is the first day I don't have a headache of any kind (wow, am I ever grateful!).

If it had continued much longer, I would have gone to the doctor to check me out

for an aneurysm, tumor, or something similar.

Pay close attention to the details - her constitution, the genesis of the head

pressure, the specific symptoms, weather, and what makes it better or worse.

All the clues you need are in those details.

Let us know what you find, and what works.

Young Song <youngsong1210 wrote: