Migraine is a neurovascular headache with recurrent attack and long history. It is quite difficult in clinic for the healing of migraine. The author, since 1993, has treated migraineurs with point injection, acupuncture combined with Chines e herbs in special migraine clinic of Zhejiang College of TCM, and meantime, made full short-term and long-term observation and received satisfied results.   

General Data
There are 250 migraineurs in total, including 195 females and 55 males. 4 cases of them were in age from 10 to 20 years, 156 cases from 21-40 years, 70 cases from 41-60 years and 20 cases above 60 years. About the duration of disease, 32 cases were less than 5 years; 63 cases 6-10 years; 89 cases 11-20 years; and 66 cases above 20 years. All cases had been treated by Western, Chinese herbs and acupuncture in other hospitals but without any obvious effect before receiving treatment in our special migraine clinic. 

Diagnostic Criteria And Differentiation Of Syndromes In TCM  
The author adopted the method of “combination of identifying disease by Western medicine and differentiating syndromes by TCM". The diagnositic criteria of migraine formulated by International Headache Association in 1988 were adopted. Differentiation of syndromes was based on clinical symptoms and according to identifying disease, the migraine was divided into: (1) wind dampness invading collaterals type, (2) liver qi stagnation type, (3) liver fire type, (4) hyperactivity of liver yang type, (5) stagnant blood obstructing collaterals type, and  (6) deficiency of both qi and blood type. In all patients possibility of other  encephalic or extracranial problems was excluded through neurological examinations and CT or MR scan in hospitals. 

Methods 
1. Items of observation  
The items of observation were stressed mainly on clinical manifestations because there were no specific measures for migraine. “The judgement of according to intensity", the author divided migraine into three grades.  A normal person is regarded as 100 points and migraine patients, based on their clinical manifestations, are graded as. 

(1) Headache severity 
a) Severe (severe unbearable headache and the patient could not go to work or live normally):-40 points. 
b) Moderate (moderate headache  which can be tolerated, and the patient could man age to go to work and live with effort): -30 points. 
c) Mild (slight headache without affecting normal work or life): -20 points 

(2) Headache frequency (per 30 days) 
a) >1 times 30 days were considered as -30 points 
b) =1 time 30 days -20 points 
c) <1 time 30 days -10 points 

(3) Headache duration in each attack 
a)  4 hours: -30 points 
b) 12-24 hours: -20 points 
c) <12 hours: -10 points 

(4) Judgment of migraine severity 
First grade: 0-10 points in total; 
Second grade: 20-30 points in total; 
Third grade: 100>toral mark >40.   

2. Criteria of Therapeutic Effect  
The short-term therapeutic effect was judged following three months of treatment and the long-term therapeutic effect evaluated 1 year after treatment.  
(1) Clinical cure: All symptoms disappeared and the total mark was 100 points. (2) Apparently effective: Migraine occurred by accident with great relief in severity, and the total mark increased by 30-40 points. 
(3) Effective: Migraine recurred with reduced severity , and the total mark increased by 10-20 points.
(4) No effect: Migraine had no any improvement after treatment.

3. Therapeutic Method  
(1) Point injection and acupuncture: 10% Danggui (Chinese angelica root) injection was injected into Neiguan (PC 6), unilaterally or bilaterally, with 2 ml for  each point. Acupoints were supplemented according to differentiation of syndromes: (1) wind-dampness invading collaterals type: Fengchi (GB 20) and Zusanli(ST  36); (2) stagnation of liver qi type: Fengchi (GB 20) and Taichong (LR 3); (3)  liver fire type: Fengchi (GB 20) and Taichong(LR 3); (4) hyperactivity of liver  yang type: Fengchi (GB 20), Taichong (LR 6) and Sanyinjiao (SP 6); (5) stagnant  blood obstructing collaterals type:  Ashi point; and (6) deficiency of qi and blood type: Zusanli (ST 36) and Sanyinjiao (SP 6). These acupoints were  stimulated with reinforcing method for deficiency syndrome and with reducing method for excess syndrome. 

(2) Chinese medicinal herbs: Self  designed migraine formula was adopted. According to author's clinical observation in many years, migraineurs, due to long duvation of disease, always, always suffer to some extent from “blood stasis" and  “deficiency" syndromes. So the author selected Chuanxiong Rhizome Chinese Angelica Root, Red Peony Root, Red Sage Root, Astragalus Root, Polose Asiabell Root,  White Atractylodes Rhizome, Chinese Yam, Tuckahoe, Dahurian Angelica Root, Ligus ticum Root, Bupleurum Root, and Tangerine Peel as the basic ingredients. Supplementary ingredients were: (1) wind dampness invading collaterals type: Asarim Herb and Notopterygium Root; (2) liver qi stagnation: Nutgrass Flatsedge Rhizome  Toosendan Fruit and Curcuma Root, (3) liver fire type: Gentian Root and Capejasmine Fruit; (4) hyperactivity of liveryang type: Dried Rehmannia Root, Achyrant hes Root and Cyathula Root, Mulberry Leaf and Chrysanthemum Flower. 

(3) Treatment course: For point injection and acupuncture, 12 treatments were regarded as one course, and 7 days' interval remained between courses; for herbs, 1 month was regarded as one therapeutic course. The therapy would not be terminated until patients had not suffered from migraine attack for one month. The total treatment duration was limited within 6 courses. All other relative medications, including Western drugs and Chinese herbs, would not be taken during this treatment.  

Results 
Short-term therapeutic results: Clinical cure: 144 cases (57.6%); apparently effective: 94 (37.6%); effective 12 (4.8%); total effective rate: 100%. The long-term therapeutic results: Cure: 119 cases (47.6%); apparently effective: 104( 41.6%); effective: 18 (7.2%); no effect: 9(3.6%); total effective rate: 96.4%. 

Discussion 
1. Migraine is a sort of headache and is difficult to heal. In the Western medicine, its onset is closely related to cerebral neurovascular dysfunction. Unfortunately, there is little substantial comprehension on its primary causes, although many theories exist at home and abroad. But recently, such a theory has been accepting internationally that the conset of migraine is firstly caused by disorder of cerebral neurofunction which secondly induces dysfunction of cerebral vascular action. The early records had been found about migraine in ancient Chinese  medical works, and it was under the category of “head wind syndrome". The author considered that the onset of migraine, in view of TCM, was closely related to  “blood stasis" and “deficiency" throughout more than ten years' study and detailed clinical observation. Its repeated occurrence, protracted history and lingering character are actually due to “blood stasis" and “deficiency" in patients ' body. The “blood stasis" and “deficiency" in the process of onset of migraine  are always interactive. “Blood stasis" hinders the smooth circulation of qi and blood to induce repeated attack of migraine and to worsen the “deficiency" further; meanwhile, qi and blood fail to circulate normally due to “deficiency", which further aggravates the “blood stasis". The interaction between “blood stasis" and “deficiency" forms a vicious circle, which gradually make the condition of headache become worse and worse and headache becomes protracted and difficult to cure. Therefore, the author holds that the key point for treatment of migraine, besides treatment of symptoms, should be mainly emphasized on removing blood stasis and reinforcing deficiency. About treating migraine through “removing blood stasis and reinforcing deficiency", the author had discussed in another  academic thesis published in Journal of Zhejiang College of TCM.

2. There are two requirements in treatment of migraine: Firstly, promptly try to relieve pain during attack of acute migraine and secondly, prevente or eradicat e recurrence of migraine. Here the short-term and long-term therapeutic effect  in treatment of migraine was observed. 

3. About the design of this therapy: Early in 1991, the author already finished a scientific researching item on treatment of migraine with the therapy of point injection of Neiguan(PC 6) combined with acupuncture, and achieved good result s. But the results were estimated in three months after finishing treatment. The follow up showed that in some migraineurs, migraine recurred to some extent in half a year. In order to improve the therapeutic effect, the author combined the knowledge of the Western medicine and TCM on migraine with author's  clinical experience and designed a special herbal formula for migraine so as to  enhance the effect on “removing blood stasis and reinforcing deficiency" and re ached the purpose to cure migraine. So this therapy applied pointinjection and acupuncture to control acute migraine attack for treating the superficiality and used Chinese herbs to regulate pathologic conditions of the whole body for treating the root cause. 

In view of the Western medicine, the onset of migraine is closely related to the concentration of 5HT in plasma, blood viscosity and the functional state of platelet. Their abnormal changes are quite similar with “blood stasis" in TCM. It had been approved through clinical practice and relative experiments that the pointinjection with Danggui solution and most of Chinese herbs in  the formula adopted in the therapy all could effectively adjust the abnormal conditions of concentration of 5HT in plasma, viscosity of blood and platelet functions. Hence ,“blood stasis" was removed and migraine cured at last.   

4. The therapeutic effects showed that there was no statistic significance between these two groups both in short-term and long-term effect, indicating a stable and reliable therapeutic effect of combined treatment of migraine with acupuncture and Chinese medicinal herbs.  

By Ye Debao