.:: PAIN AND ACUPUNCTURE ::.   In the broadest sense, acupuncture is a scientific treatment which is developed on pain. MIGRAINE AND ACUPUNCTURE Acupuncture is being used on migraine widely in most of the countries of the world for many years. Migraine, as we well know, is a throbbing type of a headache which occurs in %90 of women and it is characterized either with nausea or vomiting. Vessels are its origin. Occasionally, pain is either one-sided or double-sided. May start from the nape and reach to the eye or it may start from the back of the eye and from there pass to the nape. The pain may sometimes come once in a month or in sort of a crisis like 2-3 times a week. Patients may frequently foresee the pain before a day and when the pain crisis realizes itself, discomfort from light and sound becomes into existence. At this point acupuncture prevents the migraine pain by effecting the oscillation of some substances (such as, bradykinin, endorphin, prostaglandin, serotonin, and histamine) or some hormones in the liquids of spinal cord and body. The pain threshold level of the patients who have migraine is very low, acupuncture increases this. Therefore, instead of stopping the migraine pain crisis, acupuncture either prevents the pain reach to the point or delays the pain’s arrival time. Researches which have been carried out all around the world indicate that, acupuncture is more or less %80 effective on migraine. Migraine treatment with acupuncture is applied for 10 sessions which would be undertaken almost everyday or every other day. Every session lasts for 30-40 minutes in terms of piercing specific steel needles (without hurting at all) to the special acupuncture points which exist in head, hand, feet. Afterwards, the patient rests in the bed with those needles for 30-40 minutes (again, when the needles remain pierced in the body, no pain felt as well). Generally, after 6-7 sessions an evident result is observed. After 10 sessions, a 7-10 days break is given to the treatment. Subsequently, the sessions are undertaken more infrequently (i.e. once in a week, then, one session in 3 months and must be kept under control for a year). Moreover, acupuncture is effective in the treatment of neck calcification, sinusitis, stress, and headaches related to tension.   ARTHROSIS (CALCIFICATION) AND ACUPUNCTURE The expression known as “calcification” among public is, in fact, is not the proper functioning of cartilage tissue which exists between bones and therefore, causing the accumulation of calcium pieces both in the cartilage and bone edge points. In this condition, calcium pieces stimulate the nerves of the cartilage (together with the nerves which encircle the cartilage) and as a matter of fact, cause the pain. The most probable reasons are the unhealthy growing up of the bones and cartilages congenitally and not making genetic exercises of cartilages due to over-weight. Calcification may exist almost every articulation (neck, shoulder, elbow, hand, fingers, haunch, backbone, and knee) of the body. If one of the reasons which lie behind this is over-weight, acupuncture can be used to get rid of this weight. Besides that, acupuncture is being widely used as a supporting treatment method in light and medium level arthrosis (calcification) around the world. Treatment is applied for 10-14 sessions which would be undertaken almost everyday or every other day. Then, sessions are carried on once in a week, once in a month and once in 3 months. If the patient responds to the pain after 4-5 sessions, this can be taken as a good sign, however, stubborn cases can also exist, and therefore, acupuncture cure must be carried out for a year. The amount of success is related to the case but in terms of reducing the pain, approximately %60-70 affluent results can be received.   FACE PAINS (TRIGEMINAL NEURALGIA) AND ACUPUNCTURE It is an impetuous pain (the worst -such as a lightning flash type pain- can a human being feel) which can be expressed in terms of seconds (and if lasted for long, surely can cause one to commit suicide). After some time, the pain takes leave of this impetuous position and may act in a plump way. Acupuncture can be applied -just like its application to the other body neuralgias- successfully to the face pains as well. In this treatment, 10 sessions, 2-3 times a week is applied more or less 30-40 minutes. Afterwards a break of 10 days is given. Subsequently, it is applied once in a week and then once in 15 days. According to the condition of the patient, the treatment may be ended.   HERPES AND ZONA ZOSTER PAIN AND ACUPUNCTURE Zona pain, both in acute and chronic condition, can be treated successfully with acupuncture. Herpes or Zona zoster virus which settle down on the environmental nerves that exist generally between breast cage and abdomen region, cause occurrences such as, pimple, and if not treated carefully, can causes pains which may last for many years under the occupied region. Again here, acupuncture needles are applied around the pimpled regions along with root edges of the related nerve paths. The amount of success in this method is %90. Whereas the sessions are applied for 10 times, the treatment lasts 30-40 minutes everyday and when the one is relieved of pain, the treatment is concluded.   HEADACHES AND THEIR TREATMENT THROUGH ACUPUNCTURE In the general sense, headache is regarded as the most frequent disease one can encounter. Above all, headaches are subjective cases. Can be a symptom of either acute (urgent) or chronic (constant) diseases. If a headache is a symptom of a disease (i.e. brain tumor, tonsillitis, myopia, acute middle ear inflammation), first of all the reason of the case should be exterminated and as a matter of fact, treatment is necessary. Consequently, headache ends by the extermination of its reason. So, to what kind of headaches acupuncture should be applied? These are mainly: 1- Every type of migraine and any other vessel-origin headaches, 2- Tension (muscle spasm) headaches, 3- Sinusitis (acute or chronic), antibiotic added or not, 4- Headaches related to neck calcifications.   Indeed, even nowadays, migraine does not respond to medicine treatments. Acupuncture, which has been carried out for 5000 years and taught as a branch in all the universities of China, gets successful results (%75-90) in migraine treatment. In acupuncture, migraine treatment should be carried out either for 3 or for 6 months. In acupuncture, migraine treatment is implemented in terms of sessions (for instance, 30 minutes for a day, as a starting point).   CLASSIFICATION OF HEADACHES ACCORDING TO T.C.M. Headaches are mainly divided into two groups according to T.C.M (Traditional Chinese Medicine): 1- Exogenous Factors: Wind, cold, moisture and heat 2- Endogenous Factors: These are chiefly related to the spleen, liver and kidney meridians.   ETIOLOGY   ENDOGEN FACTORS A- Liver Yang Hyper activity, B- Insufficiency of Kidney Qi, C- Moisture headache, D- Blood blockage A-EXOGEN FACTORS a) Wind and cold type Decrease in the sense of thirstiness, Tongue: White and thin wrap, Pulse: Superficial, slow or tensed, Basic points: DU(GV) 14 LI 4 b) Wind and heat type, General symptoms: - Generally together with tension and very strong pain type, - First single then dual, - Red skin and face, - Yellow urine and constipation. Tongue: Yellow wrapped Pulse: Superficial and fast Basic points: Du(GV) 14 LI 11 c) Wind and moisture type, General symptoms: - Headache together with pressure and tension, - Mostly frontal or general, - Sense of plump in chest, - Thin gaita Tongue: White wrap and sticky, Pulse: Rolling, Basic points: SP 9, ST 40, ST 8   B- ENDOGEN FACTORS These are related especially to liver, kidney, and spleen. a) Liver Yang Hyper activity: Etiology: Liver plays the vital role especially in terms of Qi’s free circulation. If any reason (i.e. anxiety, distress) destroys this, Qi cannot circulate around the body normally and as a matter of fact, becomes clogged. Symptoms: - Headache, significantly throbbing type (like an heartbeat), - Pain, most likely single sided, - Vertigo, hypochondriac pain (can also be assisted by the difficulty of falling into sleep), - Sense of dryness in mouth and throat, - Sense of bitterness in tongue,   Tongue: Red, generally thick and yellow wrapped, Pulse: Thready strong pulse Treatment: GB 20,GB 5,GB 41,DU(GV) 20,LV 3,SP 6,LI 4, Additionally: SP 9 in hypochondriac pains. P 6 Irregularity of sleep Method: Sedation Ear points: Shenmen, Liver, Temporal, Anti-aggression   b) Insufficiency of Kidney Qi: Symptoms: - Headache together with the sense of emptiness in the head, - Vertigo, ear ringing (can be accompanied by insomnia), - Mostly, bottom loins ache, - Generally observed in people who feel weak and weary.   Tongue: Pale and thin, white wrapped, Pulse: Weak, especially in kidney region, Treatment: Mostly, back alarm and points on feet Shaoyin meridian should be selected. (UB 23, K 3, especially for kidney tonification, LI 4 DU (GV) 20 GB 39, bone marrow influential point). Method: Tonification (increasing the available energy of a bodily part or system). Ear points: Kidney, shenmen   c) Insufficiency of Qi and Blood: Symptoms: - Constant headache and sense of lethargy, - Especially the pain which starts after tiredness, - Weariness, exhaustion, lack of appetite along with sense of palpitation, - Pale face.   Tongue: Pale, with thin white wrapped (or not), Pulse: Weak and deep at every region Treatment: Blood and Qi ought to be strengthened particularly. Moxa can be used. Meridians should be harmonized. DU (GV) 20,Ren 6 (Qi tonification), ST 36,SP 6 (for Qi and blood), UB 23 (for kidney Qi’s tonification), UB 20,UB 18 (for blood), LI 4. In addition to those: For CV 12 anorexia, H 7, PC 6, PC 7 (for palpitation and insomnia). Method: Tonification Ear points: Kidney, shenmen   d) Phlegm (Mist) caused headaches: Symptoms: - Headache especially with the sense of confusion in the mind, - Plump in chest and epigastria region, - Can be accompanied by coughing and nausea, - Anorexia. Tongue: Sticky white wrapped, mostly red, Pulse: Rolling, Treatment: Pulling down of Qi. Phlegm dissolution, opening of meridian and collaterals is selected from the points which exist generally on Ren (CV) and foot Yangmin meridian. ST 8 (especially in order to reduce the sense of lethargy in the head), Ren (CV) 17 (for plump in chest), PC 6 (nausea), Ext 3 (Taiyang), ST 40 (in order to dissolve Phlegm), LI 4, SP 9 (in order to dissolve dampness). Method: Sedation Ear points: Kidney, Shenmen e) Headaches dependent on blood blockage: Symptoms: - Constant, stubborn headache in the plain region, - Headache (cavitary, biting type) - Sometimes trauma story Tongue: Purple and less wrapped, Pulse: Like cord, Treatment: Activation of the blood circulation - Removing the blockage, - AH-SHI points, hand Yangmin and foot Taiyang points LI 4,(SP 6,UB 17,SP 10 for blood), UB 2 (effective in pains which hit the eye) Method: Sedation or Tonification Ear points: Shenmen, Subcortex, Occiput, Frontal or Temporal.   CLASSIFICATION OF HEADACHES ACCORDING TO THE MERIDIANS 1- TAIYANG Headache: Especially the aches in occipital and neck. For treatment, hand and foot Taiyang meridians should be selected most likely. 2-YANGMING Headache: Especially the headaches which hit the eye and frontal. For treatment, hand and foot Yangmin meridian is used. 3-SHAOYANG Headache: May be come in terms of temporal and parietal headaches. For treatment, the points which exist on Shaoyang meridian should be selected. 4-JUEYIN Headache: Especially the vertical headaches which hit the eye. For treatment, the points which exist on the hand and foot Taiyang and Jueyin meridians are used. According to those: VERTEX HEADACHE TREATMENT 1: DU(GV) 20,SI 3,UB 67,LV 3 "  2: DU(GV) 20,UB 7,LV 2,ah-Shi points FRONTAL HEADACHES ST 8 (Needle direction is backwards), Yintang (Ext 1), DU(GV) 23 (towards back) LI 4 ST 44 LATERAL HEADACHES: Taiyang (Ext 3),(GB 8, SJ(TE) 3,SJ(TE) 5,ve GB 41 very important) OCCIPITAL HEADACHES: GB 20,UB 10,UB 60,SI 3,UB 62, In all those treatments Ah-shi points are added. Can be undertaken by applying sedative or pricking (perforating with needle) methods. ADDITIONAL TREATMENT METHODS: 1- Plum-Blossom technique: Taiyang, Yintang, Ah-Shi points, 2- Cupping Method: Can be applied to the points of Plum-Blossom, 3- Scalp Acupuncture: Here sensorial line can be used. The first two methods can specifically be applied on: - Exogenous caused headaches, - Liver Yang Hyper activity, - Headaches dependent on blood blockage. PROGNOSIS: After the general T.C.M. classification has done completely regarding headaches, treatment should be undertaken. Occasionally, headaches of the patients cannot be classified exactly and the case can fall into the scope of two different groups. Under such a circumstance, first, the final symptoms of the disease, and then the beginning period symptoms of the disease are treated according to the etiology. Mostly, after having applied the treatment to the patient, the treatment should take a break of 7-10 days. The treatment should be started with classical acupuncture. And if the pains are still in the same condition after 3-4 sessions, electro-acupuncture should be implemented urgently. In electro-acupuncture, the combination of the points can be in various ways. For instance, if the patient has come to the session with headaches, bilateral Electro-Acupuncture (EA) can be applied to head points (i.e. GB 14, GB 20, UB 10, UB 2, Taiyang, and ST 8, in addition to those, distal points such as, LI 4, LV 3, ST 36, GB 34). At that point, the treatment should take a break of either 30 or 45 minutes. It should be borne in mind that even if the pain of the patient has been reduced at the end of the treatment, pain may start with its former intensity after 2-4 hours, therefore, the patient should be made aware of that fact. If the patient has less amount of pain on his/her arrival to the second phase of the treatment, s/he has to be taken to 6-8 sessions (2-3 times a week) more. According to the following prognosis, patients should be kept under control for 3-4 months under the same conditions. Their control treatments should be done at every 6 months and a year (especially in the case of migraine). If the prognosis of the patient does not change at all in the first 10 sessions, the treatment ought to be altered definitely or some anti-depressants should be added. (i.e. maprotiline, Hydrochloride: Ludiomil 25 mg). In spite of those, if there still cannot be observed any change in the prognosis, the treatment should be regarded as unsuccessful and should be exterminated.