A Quote from the Doctor’s Letter of Referral
”Almost daily headaches for hours on the right temple, prodromal scintillating scotoma.
No conspicuous neurological findings between the attacks. No abnormalities in the MRI scan of the brain.
Diagnosis: severe migraine with visual aura”.
Anamnesis and Findings
The following answers and findings, collected on the occasion of the first consultation of June 6, 2016, are mentionable:
- migraine attacks since February 2016
- The patient goes tingly all over about 10 minutes before the pain starts. She feels numb at the front on the right side laterally (area of the acupuncture point Touwei ST8), and non-pointly in the area of the right cheek (energetic supply zone of the stomach channel as well).
- The frequency and the intensity of the migraine attacks can be reduced with the aid of magnesium in large doses (patient: 3 x 7.5mmol, standard dose: 2 x 7.5mmol). However, taking this prophylaxis the patient suffers from heavy diarrhea.
- Tongue: normal red, slightly swollen
- Pulse: 68 beats per minute, regular, wiry
Inconspicuous anamnesis and findings for the rest.
Severe migraine due to liver yang rising and liver wind together with qi and xue stagnation of the stomach channel (foot yangming)
Acupuncture Treatment Strategy:
- Lower the liver yang, pacify liver wind, tonify liver yin
- Move qi and xue in the stomach channel (foot yangming)
Timely Optimized Strategies
The first session takes place on June 10, 2016 at 9:00 a.m.. The Time Acupuncture App shows the following up to date strategies:
Location, Date & Time (Time Zone)
The setting shows the location (8.23°E for Sarnen, Switzerland), the date (10.06.2016), the time 09:19, as well as the definition of the time zone in question (UTC+02:00, according to the Central European Daylight Saving Time – CEDT).
Clock Time – Solar Time
The clock time 09:19 is automatically converted to solar time according to the setting of the iPhone or iPad. Solar time is the relevant time for all biological systems. The red marker of the solar clock points to 07:52.
Zi Wu Liu Zhu Zhen Fa – Na Zi Fa – Meridian Clock Strategies
The stomach channel is open from 07:00 to 09:00 (solar time) according to the meridian clock. The pericardium channel is coupled with the stomach channel according to the noon-midnight law. That’s why both channels are amenable to meridian clock strategies at the current time.
The main localization of the symptoms accords with the course of the stomach channel. Therefore we have arranged the following sessions always in the time frame from 08:30 to 10:30 (clock time).
I have treated several points of the open stomach channel at a time. About 3 points were chosen according to the prevailing situation. I have adapted the strategy from session to session according to the response to my treatment.
The noon-midnight connected pericardium channel can be integrated into the treatment as well.
Local points: Touwei ST8, Xiaguan ST7, Juliao ST3, ..
Distal points: Lidui ST45 (jing-well indications, sedation point), Neiting ST44 (ying-spring yang channel indications), Xianggu ST43 (shu-stream yang channel indications), Chongyang ST42 (yuan-source indications of the yang channels), Liangqiu ST34 (xi-cleft indications of the yang channels), etc.
Zhongchong PC9 (jing-well indications, wood-indications), Neiguan PC6 (luo-connecting indications), etc.
The associated indications are explained in detail by clicking the corresponding points in the app.
Zi Wu Liu Zhu Zhen Fa – Na Jia Fa – Joker Points
This system offers no joker points at the time of the first session (see figure above for 10.06.2016; 9:19).
Whenever a joker point is open at the treatment time I usually integrate it into the treatment concept. The reason for this is the great effectiveness of the Na Jia Fa system.
In that way, for example on 22.06.2016; 9:00 (see adjacent figure), the joker points Yangxi LI5 and Shangyang LI1 are offered. Besides their effectiveness as joker points they fit perfectly into the concept of balancing the yangming level.
Ling Gui Ba Fa
The Ling Gui Ba Fa in its original style as well as in its simple style (called Fei Teng Ba Fa) use the eight extraordinary channels. Going over these channels we reach the yuan or constitutional level, thus we deal with the essential value of the essence-jing. In this respect, the problem of our patient does not directly fit to the Ling Gui Ba Fa methods.
Besides the primary indications, however, meridian conditions of the open extraordinary channel can be treated via the Ling Gui Ba Fa as well. In this spirit, in the first session on 10.06.2016 (see respective figure), for example, the Yin Wei Mai could be taken into account. Its characteristic “treatment of psycho-emotional symptoms” represents certainly an aspect of the patient’s problem.
In addition, its opening point Neiguan PC6 belongs interestingly to the noon-midnight connected pericardium channel.
Migraine – Basic Therapy
I combine the timely optimized strategies as described above with acupuncture concepts according to the energetic imbalance. In this case, I add to the timely points the points Baihui GV20, Fengchi GB20, and Taichong LV3 in every acupuncture session in order to pacify liver wind and rising liver yang.
The Progress of the Case
The patient was treated with acupuncture once a week. She responded promptly to the treatment. The headaches decreased continually with respect to intensity and frequency. The numbness of the face on the right side in the energetic supply zone of the stomach channel improved slowly. Magnesium was reduced to 7.5mmol every two to three days. However, it could not be stopped completely as headaches started again in this case. The low-dose magnesium prophylaxis, however, didn’t cause any problems. Diarrhea, a common side effect of magnesium, didn’t occur any more.
The treatment was tentatively stopped after 10 sessions on 01.09.2016. The patient observes the further progress, and she will report and come back in the case of a recurrence of the problem.
On the one hand we will first discuss the strategies that were applied, on the other hand we will make some more general considerations.
Treatment of the affected channel during its corresponding time division
In this case the symptoms can be clearly assigned to the stomach channel (foot yangming) by a targeted anamnesis.
By chance, the patient came to the first session just at the time of the open stomach channel. The following sessions were arranged in the time division 07:00 – 09:00 (solar time) since this fits optimally to the diagnosis, and since the patient responded so promptly to the treatment.
Treatment according to the noon-midnight law
However, a treatment of the affected channel during its corresponding time division is not possible in each and every case, be it that the optimum time is at nighttime or be it that the optimum time isn’t suitable either for the patient or for the therapist.
If the optimum time falls into the nighttime hours we can apply the noon-midnight law. In order to put the focus of our treatment on the zang organ liver (01.00 – 03:00; solar time), to stay with our example, we could treat the patient at the small intestine channel’s time (13:00 – 15:00, solar time).
Treatment of the zang organ liver
The combination of the corresponding shu-stream und back-shu points is an ideal strategy to treat the zang organs. In our case the combination of Taichong LV3 and Ganshu BL18 would then be indicated.
Guidance of the qi to the desired level
Besides their specific indications some of the currently open acupuncture points can be used in a more general way in order to guide your qi to the desired level of the problem.
- An open yin shu-stream point can guide the qi to the zang organ level in general.
In concrete terms: At 07:00 – 09:00 use Daling PC7 (noon-midnight connection); at 09:00 – 11:00 use Taibai SP3, and so on.
- An open yang shu-stream point can guide the qi to the yang channel level.
In concrete terms: At 07:00 – 09:00 use Xianggu ST43; at 09:00 – 11:00 use Zhongzhu TE3 (noon-midnight connection).
- An open yang he-sea point can guide the qi to the fu organ level.
In concrete terms: At 07:00 – 09:00 use Zusanli ST36; at 09:00 – 11:00 use Weiyang BL39 (lower he-sea point, noon-midnight connection).
- An open jing-well and/or ying-spring point can put the focus on their heat clearing action.
In concrete terms: At 07:00 – 09:00 use Lidui ST45 and/or Neiting ST44; at 09:00 – 11:00 use Yinbai SP1 and/or Dadu SP2.
- An open xi-cleft point can put the focus on its action in acute conditions and pain.
In concrete terms: At 07:00 – 09:00 use Liangqiu ST34; at 09:00 – 11:00 use Diji SP8.
- And so on.Such a timely treatment can be combined with any other acupuncture points according to your patient’s problem and according to your very personal acupuncture style.