Migraines & Classical Chinese Herbalism
As those who suffer from them know, migraines can be debilitating. They can present—often out of the blue—with not only a severe headache, but with neck pain; visual and auditory disturbances; dizziness; mood fluctuations; numbness and/or tingling; and digestive issues, including nausea, vomiting, food cravings, and stool changes. A migraine is really a whole-body phenomenon that can leave a person exhausted and fearful of when the next one might attack.
Classical Chinese herbalism approaches migraines in a nuanced way. There’s not just one standard herb or herbal formula for a migraine patient. Instead, the herbalist has to figure out the cause of the migraine, and prescribe the appropriate herbs that address that cause.
I tend to look for five possible imbalances that can result in migraine:
(1) Fluid Metabolism Dysfunction
In the case of a migraine due to disharmonious fluid metabolism, there will be accompanying problems in fluid dynamics, such as excessive thirst; nausea upon ingestion of fluids; unsmooth urination; edema; dizziness; loose stool; and strong aortic pulsation. Often, these types of migraines occur in the morning, since fluids can stagnate and accumulate overnight. For this type of migraine, I’d prescribe a formula like Wuling San (“Five-Ingredient Powder”), which consists of five herbs that “leech out” excess fluids and revitalize water metabolism.
(2) Weak Heart Yang
Often, when the pumping power (Yang) of the Heart organ system is compromised, the cardiovascular system can continue to send warmth and nutrition upward and outward, but it lacks the strength to pull back downward and inward. It’s as if there’s only sunrise with no sunset, expansion with no contraction. This leaves a relative “excess” in the upper regions of the body, including the head, which can manifest as migraine.
This presentation will include such symptoms as cold feet (amid a generally cold constitution) and a tendency toward anxiety, sweating, and facial flushing. It requires the use of Guizhi (cinnamon twig) to strengthen Heart Yang and resolve “upward counterflow.” A representative formula would be Guizhi jia Gui Tang (“Cinnamon Twig Decoction, with extra Cinnamon”), which consists of cinnamon twig, peony root, ginger rhizome, jujube fruit, and licorice root.
(3) Digestive Stagnation
Sometimes, a migraine is the result of stagnation in the person’s digestive system. There’s not efficient flushing away of waste through (a) the Liver organ system and/or (b) the Intestines. This back-up leads to congestion in the upper body, resulting in migraine. Often, I can feel the stagnation with my abdominal palpation—the tissue might feel tight and hard, and the person might wince at the pressure. In these instances, I’d draw on Dahuang (rhubarb) to clear out the Intestines or Chaihu (bupleurum) to “dredge” the Liver pathway.
(4) Heat
Occasionally, migraines can occur on account of intense heat in the person’s system. Fire flares upward, disturbing the head and its sensory organs. In these cases, the person will present with heat signs and symptoms, like subjective warmth, irritability, insomnia, redness, and rapidity (in speech, in movement, in the pulse). This presentation requires cooling and descending herbs, like Huanglian (coptis rhizome) or Zhizi (gardenia fruit).
(5) Cold
A final cause for migraines is “cold in the center” (in particular, cold in the Stomach and Liver organ systems). Migraines arising from this imbalance tend to manifest with intense nausea and vomiting. It’s as if incoming food and water are repelled back upward by a wall of cold. Wuzhuyu (evodia fruit) is the core herb for this type of migraine. I’ll typically prescribe it in combination with ginger, jujube, and ginseng (or its substitute codonopsis) in the formula Wuzhuyu Tang (“Evodia Fruit Decoction”). This formula warms the center and “downbears counterflow”—that is, it redirects Qi downward so that the person experiences relief from the “upwardness” of nausea and head pain.
Once, I gave Evodia Fruit Decoction to a young woman whose life had been derailed by migraines with severe nausea and vomiting. She thought she had resolved these bouts as an adolescent, but they now returned with a vengeance. She presented with a weak and cold constitution, with icy extremities; aversion to cold; a weak yet tense wrist pulse; a slight build; and loose stools. She worked long hours in a nail salon; it’s possible she was consistently exposed to some chemicals that her body couldn’t process efficiently, due to the cold in her system. Evodia Fruit Decoction—warming, drying, and descending—gave her the relief she couldn’t find anywhere else.