21.偏头痛合颈椎病  Migraine & cervical spondylosis, vertebra disease

2014.3.8   女  63岁 身高150，体重116，着棉衣 血压：150/89

 右侧肩、颈椎痛，牵连同侧头痛。有时两侧头跳痛。时有烦躁。低头血往上涌。多年痼疾。中西医罔治，包括针灸。曾在胶南住院10天。常年止疼片，胃伤。烧心。手脚不觉冷。夜饮次数多，3-4次，但量不大。头怕风，不能摘帽子。手脚不冷。

睡觉咬舌头，肠鸣甚。向左侧卧有，右侧无。

喜饮温水、似乎白天比夜里重；以前老觉得枕头里面有东西。10年前，海上挖海蛎子受凉、感冒，开始有此证。伏邪.

脉：左尺、右寸弱

舌：尖细、白腻、干。尖细主气血不足、白腻主寒、干而饮少，上焦无火、肾气不升。

面红、体丰、发白，双脚跟失养，无血色、皲裂甚，秋天开始包着塑料布。

肩井按痛，顺经而上至太阳

大便成形，但一天2-3次，量少。纳好、

印象：寒聚经络，血不流通，脉络失养，

治则：温经通络

针：少阳、太阴、膀胱、阿是穴

 2014/3/10

第二次针，肠鸣消失。称腰部痛减。头项肩背痛无变化。

加健侧外关、四渎。余如前

 2014/3/11

天牖穴上一寸痛甚。赶集后，昨天减轻。但腰已不痛，髋痛。第三次针：针如前，加双液门、双太冲对侧三阴交。针：居髎周围三针。未肠鸣。

因家境困难，未开汤药，仅予丽水堂头风散

 2014/3/12

药服一次，晨起大好，头颈轻松，但骑车后震动开始有感觉。按压痛减。夜里未肠鸣。起夜一次，夜饮减少至2次。腰未痛、胯骨痛减。有轻度肠鸣。右臂发麻，以前有过。

  2014/3/14

第一剂头汗出，未遵医嘱立服第二剂，等到晚上再服，未出汗，只是身上舒服。但腰胯痛均愈。脚跟皲裂明显减轻。噩梦多，交鬼神。厉兑放血。

 2014/3/17

服散剂三次，舌白苔褪净，口渴大减。头及颈项松快，痛未发。以前饭后嗜睡，现在精神明显好，寐好，夜梦大减。

 2014/4/1

昨天又取头风散10天量。

称膻中部不适，气不顺，阻遏隐痛，但不是每日发。舌干白又回，严重。有照。似乎是萎缩性胃炎的典型舌苔。腹诊按压剑突下，无明显按痛，不是心下痞。服头风散胃不舒服，嚼食生花生米解。腹部较硬。膻中部按压痛。几年前曾因夜里打呼噜憋醒难以呼吸，棰顿后背缓解。说话多则嗓子干痒，需咳嗽。双尺沉。

印象：整体阴液不足，肾为胃之关，肾阴亏虚则胃液竭，极似萎缩性胃炎舌象，无以供奉上焦，久则络脉焦干而偏头痛。

治以滋阴补津、化瘀通络

 2014/4/3

电询：一付药后头未痛，膻中舒畅，白苔稍减。无其他不适。感觉不错。

 2014/4/8

电询：头未痛、骑摩托车稍稍有感，很快消失。前胸仍不适。

 2014/4/15

头痛未发，膻中部舒适，颈椎不适。舌苔稍有改变。有照。舌尖变圆，柔和。

 2014/4/16

骑车颠簸，颈椎又受伤。针后拔罐，痛大减。

苔白薄，脾阴不足之象，不能再动燥，加山药待舌苔变厚，再入辛香之剂。

 2014/4/22

颈椎又不舒服。舌苔白干如故，（雨三：金水两亏）。湿邪重，气机不升，则气血不升，不能涵养上窍。燥湿行气、

平胃散加减

 2014/4/27

舌苔白腻减轻，有照，胃舒服。出汗频繁。

2014/4/30

舌苔明显变润、淡。干白苔大减。头痛、髋痛均未发。足跟皲裂基本愈合如初。昨天稀便2次。余可。体重118（着单衣）

 停诊。

小结：偏头痛一证，到了中医诊所，多半为久疾，且绝不仅是头部的问题。当追问病发历史和复发条件。循证判断。本案患者早起因外感，未及时治愈，伏邪在经，常年服止痛药，伤及脾胃。脾胃一伤，身体失却涵养，则发脾病，证见髋痛、颈椎病。复又影响经络疏通，头痛加重，以致后来经常双侧头痛。针灸通常可以暂时减缓头痛，但必须用汤药彻底改变病发环境，才能一劳永逸，杜绝再发。

3.8.2014.  63-year-old female. H:150cm,

weight:58kgs (127lbs), B/P: 150/89

Right side shoulder pain with migraine and spondylosis. Temples throbbed pain. feel fidget. head bending forward could feel blood going up. Over years tried every possible way, including acupuncture, no improvement. reply on pain killer, heart burn. pee at night 3-4 times, but not much at a time. wearing a knitted cap year-round. limbs not cold. often bit tongue during sleep, borborygmus on right side stance. prefer warm water. always feel something in the pillow. started ten years ago at beach.

Symptoms: thin tongue with white dry coating. looks health (Hypertension), white hair, heels deep cracks wrapped with plastic cloth.

should pain under pressure, all the way up to temple.

Impression: coldness blocked channels, weak blood circulation and supply.

Principle: warm up and activate channels

3.10. borborygmus gone. back pain easier. no change at shoulder and neck.

3.11 no backpain. headache easier. could not afford herbs. just offered Migraine powders made by Lishuitang.

Till 3.17, tongue coating completely changed to normal. pee once at night. Hipp pain gone. sleep deeper.

Stopped treatment

Till 4.30 headache didn't come back and the heels almost fully recovered. Stopped treatment.

When patients came to CM clinic usually the illness was there for years. And it's hard to cure merely by acupuncture because it's more than only a headache. Otherwise, the pain will come back sooner or later. The related pain might be found on hips and on the neck. It's a time for herbal therapy. No doubt about it.

It's also important to find how it was first got. If it was caused after catching a cold, it's not too later to expel the coldness.