by Duo Xiuying
(Tianjin Municipal Academy of Traditional Chinese Medicine and Pharmacy, Tianjin 300020, China )
　　
　　

The author has treated l00 cases of intractable migraine by acupuncture and cupping with satisfactory therapeutic results, as reported as follows.

Clinical Data
There were 100 cases in this series, including 38 males and 62 females. 8 cases were between l8 to 25 years old; 27, 26 to 40; 52, 4l to 55; and l3 over 55 years. The shortest duration of disease was 6 months, and the longest 25 years. 12 cases were due to trigeminal neuralgia, l7 nasosinusitis, and 7l were vascular.

Method of Treatment
Location of the point: The point is located on the left or right side of and 4.5 cun lateral to the midline of the back, parallel to the inferior border of the third thoracic vertebra. The point on the affected side was punctured.
Manipulation: The patient was asked to take a sitting position and to place both upper extremities on the table with level shoulders. The needle was inserted rapidly and obliquely towards the head. Then, the needle was twirled at a frequency of 300/minute to produce strong stimulation until the patient felt a sensation of aching and distension in the punctured area, which could radiate to the shoulder and arm. After obtaining needling sensation, the needle was withdrawn. The punctured area was squeezed until black and purple blood was extruded from the pinprick. .
Cupping: After acupuncture, a cotton ball was rinsed with alcohol and burnt in a cup of 5-6 cm in calibre for a moment, and then the cup was put on the punctured area for 30 minutes. After cupping, a little bleeding and white secretion may be seen in the punctured area.

Therapeutic Results
Criteria for scoring the pain: Severe pain, which is not stopped until morphine-like drugs are administered, scores 4; the pain, which is severe but can be relieved with common analgesics, scores 3; the pain, which is moderate in severity and can be relieved by itself, scores 2; the vague pain scores l; and no pain scores 0.
Criteria for therapeutic effects: Cured: Pain score is 0 and a 3-month follow-up shows no recurrence. Markedly improved: Pain score is 1. Improved: Pain score is 2. Ineffective: No obvious improvement.
Therapeutic effects: After 1-3 treatments with a 3-month follow-up, 57 cases (57%) were cured; 26 (26%) were markedly improved; 11 were improved; and 6 (6%) were ineffective. The total effective rate was 94%.

Typical Case
A 37-year-old male worker paid his first visit on Sep. l4, l997, with a complaint of severe migraine on the right side for 2 days, accompanied by nausea. The pain could not remit after taking ergotamine. So, he asked for injection of morphine. The patient had suffered from right-side migraine since August, l969. The pain was gradually exacerbated, with shortening of recurrent periodicity and lengthening of pain duration. Usually, each episode lasted 3 to 5 days, accompanied by nausea, dizziness, and fullness in the eye. There was an interval of l0 to l5 days between each two episodes. The pain became even severer 6 months previously and it was intolerable to the patient and could not remit after oral analgesics and vasodilators except injection of morphine and the like.
After one treatment by acupuncture and cupping as mentioned above, the pain obviously remitted. Next day, he had slight pain and a tight sensation in the nose, but tinnitus and the feeling of fullness in the head disappeared. Same treatment was given. On his third visit the fourth day, the pain was found to be relieved completely and one more treatment was given to consolidate the therapeutic effect. No recurrence was found in a 6-month follow--up.

Comments
Migraine is a frequently-encountered disease which is difficult to treat. Intractable migraine produces severe pain during episode, and is dreadful to the patient especially when it become periodic. On the other hand, the fearful mental state usually induces the attack of migraine.
Traditional Chinese medicine holds that the head is the confluence of all the Yang meridians and acts as the house of lucid Yang. The essence and blood of five Zang-organs and the lucid Yang-qi of six Fu-organs ascend to the head. Therefore, normal circulation of sufficient Qi and blood in meridians is the guarantee for keeping a clear head. Invasion of the six exogenous pathogens or blockage by phlegm and blood stasis can give rise to headache likewise. Acupuncture can exert the action of promoting a free flow of Qi and blood in meridians, so that lucid Yang can ascend and turbid Yin descend. Strong stimu1ation by acupuncture can quickly relieve the pain, and cupping following acupuncture can bring about rapid elimination of phlegm and blood stasis.