As part of Migraine and Headache Awareness Month, we’re pleased to share a clinical case study contributed by Jason Smith Zamaria, Professor of Chinese Medicine and Acupuncture based in Madrid, Spain. This case explores the treatment of a 25-year-old woman suffering from chronic headaches and dizziness, with a complex presentation involving multiple TCM patterns—including Liver-Blood Deficiency, Liver-Yang Rising, Phlegm, and Blood Stasis. Jason’s thoughtful diagnostic process and integrative approach using acupuncture and herbal formulas provide a valuable learning opportunity for practitioners navigating similarly layered clinical presentations.
Case Study: Headaches and Dizziness;
A 25-year-old woman sought treatment for headaches and dizziness that started two years previously.
She presented with two types of headaches, one dull, all over the head, and another that was stabbing in nature, alternating between left and right temples; occasionally it also went behind the eyes. The sensation was described as a “knife being stabbed” at her eyes and temples.
The dizziness occurred at any time, and she would not leave her home alone for fear of falling.
Upon interrogation the following patterns were established:
- Liver-Blood Xu: Floaters, blurred vision, tingling of the limbs, pale complexion, itchy vertex, dizziness, scanty periods.
- Liver-Yang Rising: throbbing headaches on the temples. Liver-Yang rising obviously derived from Liver Blood Xu.
- Phlegm in the head: Dull headaches and dizziness.
- Liver-Qi Stagnation: occasionally she experienced a slight feeling of lump in the throat and felt like crying. This was diagnosed as a secondary Liver-Qi Stagnation, deriving from the Liver-Blood Xu.
- Spleen-Yang Xu: slow digestion, cold hands, feet and abdomen. The stools however were hard and dry, but this could be due to the severe Liver Blood Xu.
- Dampness in the digestive system: feeling sleepy after lunch, swollen abdomen after eating, absence of thirst.
- Cold in Uterus: Feeling of cold and spastic pain during period.
- Blood stasis: Clots during first two days of period. The Blood stasis derived from Cold in the Uterus.
The tongue was pale (confirming the Liver-Blood Xu and the Spleen- Yang Xu) but with slightly red sides (from Liver-Yang rising). The tongue was also swollen, indicating the presence of Phlegm. The sides of the tongue appeared also slightly more swollen, probably due to Liver-Heat from Liver-Yang rising. There was also a rootless yellow coating at the back of the tongue accounting for the Dampness in the digestive system.
Diagnosis
Although there are many patterns, it was established that the throbbing headaches were caused by Liver-Yang rising due to Liver-Blood Xu (and aggravated by the Liver-Qi stagnation) and Phlegm. Phlegm and Liver-Blood Xu were also responsible for the dizziness. So it was decided that the principle of treatment would be to resolve Phlegm, nourish Liver-Blood and subdue Liver-Yang.
Pattern-Based Treatment Protocol
Her patterns were addressed with acupuncture and the Three Treasures and Women’s Treasure formulas. Because of the location of headaches and the fact that several channels are affected, the Yang Qiao Mai was chosen.
- BL-62 (R) SI-3 (L) to open the Yang Qiao Mai
- LIV-3 (L) LI-4 (R) to Subdue Liver-Yang, move Qi, stimulate ascending and descending of Qi. LIV-3 and LI-4 act also as distal points
- GB-43 (R) TB-5 (L) to distal points to treat the Shao Yang channels
- SP-3 bilateral to nourish Liver-Blood and tonify the Spleen
- SP-6 bilateral to nourish Liver-Blood and tonify the Spleen
- ST-36 bilateral to nourish Liver-Blood and tonify the Spleen
- LIV-8 bilateral to nourish Liver-Blood
- Ren-4 to nourish Liver-Blood
- Local points along the Gall Bladder channel such as GB-4, 5, 8, 9, 20, 14 as well as Yuyao, ST-8.
She was given Precious Sea to take continuously. This formula is a general Qi and Blood tonic for women. During the first month she was also given Clear Yang, a Three Treasures formula to address Phlegm in the head, Liver-Yang rising, Blood Xu and Kidney-Yang Xu.
After one month of acupuncture and herbal formulas the dizziness had mostly disappeared as well as the Phlegm-type dull headaches. However the Liver-Yang rising headaches still persisted so Clear Yang was changed for Bend Bamboo, a formula that specifically addresses Liver-Yang rising from Liver-Blood Xu. After this she experienced a remarkable recovery, with the throbbing headaches disappearing gradually and being absent for the past month.
We invite fellow practitioners to contribute their own case studies to help build a richer knowledge base for our community. If you have a case you’d like to share, please submit it here>>