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Study 5
On pages 46-47 of issue #7, 2004, of Ji Lin Zhong Yi Yao (Jilin Chinese Medicine & Medicinals), Wang Qiu-yue published "The Treatment of 46 Cases of One-sided Headache with Acupuncture."

Cohort Description
All 46 patients enrolled in this study were seen as outpatients at the Chinese author's hospital in Shandong province. Among them, there were 14 males and 32 females aged 17-62 years. These patients had had migraines for durations ranging from one month to 16 years. All met the diagnostic criteria for migraines published in Shen Jing Bing Xue (A Study of Neurological Diseases), written by Wang Wei-zhi and published by the People's Health & Hygiene Press in Beijing in 2001.

Treatment Method
The following points were needled on the affected side:

• Feng Chi (GB 20)
• Shuai Gu (GB 8)
• Tai Yang (M-HN-9)

While the remaining points were needled bilaterally:

• He Gu (LI 4)
• Wai Guan (TB 5)
• Tai Chong (Liv 3)

Two-inch long, 0.38mm in diameter needles were used. Feng Chi was needled with the point of the needle angled toward the tip of the nose to a depth of 1.5 inches. Large amplitude twisting and turning and small amplitude lifting and thrusting hand techniques were used to propagate a needle sensation to the temporal region. Shuai Gu was needled transversely to a depth of 1.5 inches to connect with Tou Wei (St 8). Tai Yang was needled posteriorly to connect with He Liao (TB 22). These three needles were manipulated with small amplitude twisting and turning technique. He Gu, Wai Guan, and Tai Chong were needled with standard methodology. These points were needled once per day, with the needles retained for 30 minutes each time. Ten treatments equaled one course, and a five-day rest was allowed between each successive course.

Study Outcomes
Clinical cure was defined as disappearance of the clinical symptoms and no recurrence within six months. Some effect was defined as marked decrease or disappearance of the symptoms. However, there was a recurrence within six months. No effect was defined as a lack of improvement in clinical symptoms after two courses of treatment. Based on these criteria, 33 cases (71.74%) of the patients were judged cured, another ten (21.74%) got some effect, and only three (6.52%) got no effect. Therefore, the total effectiveness rate was published as 93.48%.

Discussion
According to Dr. Wang, migraines are associated with the shao yang and yang ming channels and are mostly due to wind cold, phlegm damp, and static blood obstructing the flow of qi and blocking the clear orifices. Because the channels and network vessels are not freely flowing, there is pain. Feng Chi is an intersection of the foot shao yang channel and yang wei vessel. It is able to dispel wind and open the orifices, free the flow of the channels and stop pain. Its effect is markedly better when it is needled deeply. Tai Yang is an extraordinary point on the head region that can treat one-sided head pain. Tou Wei is a foot yang ming channel point. Shaui Gu is a foot shao yang channel point. When these three points are used together, they are able to extinguish wind, transform phlegm, and stop tetany, clear the eyes, and stop pain. He Gu is the hand yang ming source point. It is an essential point for freeing the flow of the channels and settling pain in the head and face regions. Wai Guan is the foot shao yang network vessel point. Tai Chong is the foot jue yin source point. The liver and gallbladder have an interior/exterior relationship, and these are their respective source and network vessel points that untie the two. Therefore, they are able to course and disinhibit qi stagnation of the liver and gallbladder channels and vessels. Thus, the flow of the qi and blood are freed and eased or smoothed, yin and yang are harmonized and regulated, pain is eliminated, and the spirit is quieted.

Study 6
On pages 40-41 of issue #4, 2005, of Hei Long Jiang Zhong Yi Yao (Heilongjiang Chinese Medicine & Medicinals), Zhao Yue published "The Treatment of 58 Cases of Migraine Headache with the Four Bars Plus Electro-acupuncture."

Cohort Description
All 50 patients in this study had been diagnosed by both Chinese and Western medicine as suffering from migraine headaches. Among them, there were 19 males and 39 females aged 12-69 years, with an average age of 35.6 years. These patients had suffered from migraines for durations ranging from seven days to 23 years.

Treatment Method
The main points consisted of the following:

• He Gu (LI 4)
• Tai Chong (Liv 3)
• Feng Chi (GB 20)
• Tai Yang (M-HN-9)

If there was dizziness, Si Shen Cong (M-HN-1) was added.

If there was vomiting, Nei Guan (Per 6) was added.

If there was insomnia, Shen Men (Ht 7) was added.

After disinfection with 75% alcohol, the main points were needled with 28 gauge 1.5-2-inch needles. He Gu was needled towards Hou Xi (SI 3) to a depth of 1-1.5 inches. Tai Chong was needled towards Yong Quan (Ki 1) to a depth of 1-1.5 inches. These two points were needled with even supplementing-even draining hand technique, and the needles were moved once every ten minutes. Feng Chi was needled towards the inner canthus of the eye to a depth of 0.8-1 inch. Tai Yang was needled with the tip of the needle pointing medial and inferior to a depth of 0.8-1 inch. After obtaining the qi at these two points, they were attached to a G6805 electro-acupuncture machine, Tai Yang connected to Feng Chi on the same side. A dense-dispersing wave form was used. All the needles were retained for 30 minutes, with one treatment given per day and ten times equaling one course. After one course, a one-day rest was allowed before starting a second course. Outcomes were analyzed after two courses.

Study Outcomes
Marked effect was defined as complete disappearance of headaches and any accompanying symptoms with no recurrence on follow-up within three months. Some effect was defined as disappearance of headaches and accompanying symptoms. However, these did recur if the patient was overstimulated or fatigued. Nevertheless, repeat acupuncture treatment was able to make the headaches go away again. No effect was defined as no obvious decrease in the headaches or accompanying symptoms. Based on these criteria, 38 cases (65.52%) got a marked effect, 15 cases (39.47%) got some effect, and five cases (8.62%) got no effect, for a total effectiveness rate of 91.38%.

Discussion
According to Dr. Zhao, migraine headaches are mostly due to ascendant liver yang hyperactivity with phlegm and stasis mutually binding, thus resulting in non-upbearing of the clear yang, or turbid evils harassing above depriving the clear orifices of nourishment. Tai Chong is the source point of the foot jue yin liver channel and relates to the blood, while He Gu is the source point of the hand yang ming large intestine channel and relates to the qi. Therefore, the four bars move the qi and quicken the blood as well as settle pain and resolve tetany or spasm. Feng Chi courses and resolves the shao yang channel qi. It also promotes the upbearing of the clear qi and the downbearing of turbid evils. When combined with the local point Tai Yang, they promote the diffusion and spreading of the channel qi in the diseased area, and freedom of flow leads to absence of pain. Electro-stimulation of these latter two points with a dense-dispersing wave and strong stimulation increases these points' therapeutic effect.

Study 7
On page 90 of issue #1, 2005, of the Shi Yong Zhong Yi Nei Ke Za Zhi (Journal of Practical Chinese Medical Internal Medicine), Guo Yu published "Clinical Observations on the Treatment of 50 Cases of Migraine Headache with Electro-acupuncture."

Cohort Description
All 50 migraineurs in this study were seen and treated at the Shen Yang Municipal Chinese Medicine Hospital in Liaoning province. Among these 50 patients, there were 21 males and 29 females aged 13-51 years, with a median age of 28.1 ± 4.8 years. In 15 cases, migraine headache was a new occurrence, while in 35 cases, migraines had been a recurrent condition. These 50 patients were randomly divided into two groups: a treatment group and a comparison group. In the treatment group, the youngest patient was 13 and the oldest was 50, while in the comparison group, the age ranged went from 16 to 51.

Treatment Method
All members of the treatment group received acupuncture at the following points:

• Tai Yang (M-HN-9)
• Shuai Gu (GB 8)
• Shen Men (Ht 7)
• Lie Que (Lu 7)
• Feng Chi (GB 20)
• Yang Ling Quan (GB 34)

If there was phlegm turbidity obstruction and stagnation, Feng Long (St 40) was added. After obtaining the qi via twisting and turning needle manipulation, these points were stimulated with electro-acupuncture using a G-6805 electro-acupuncture machine with dense wave and as strong a stimulation as the patient could bear.

All members of the comparison group were orally administered 1mg of ergotamine per day. This dose was able to be increased but did not exceed 6 mg per day. Seven days of treatment equaled one course for both groups, and results were analyzed after two such courses.

Study Outcomes
Remission was defined as complete disappearance of headaches with no recurrence within six months. Marked effect was defined as complete disappearance of pain. However, there was a recurrence within six months. Some effect was defined as a decrease in pain, which was now bearable. No effect meant that none of these foregoing criteria was met. Table 1 shows the outcomes based on these definitions.

Table 1 shows that the electro-acupuncture protocol was significantly more effective than the ergotamine. The P-value for the difference between the total marked effectiveness of these two treatments was published as (P > 0.005). Further, the 18 cases in the treatment group whose pain completely disappeared got this therapeutic effect with only one course of treatment.

Table 1: Study 7 Outcomes

Discussion
Tai Yang, Shuai Gu, and Feng Chi are all local points on the affected area, the head. Dr. Guo deems them all essential points for the treatment of migraine. Tai Chong is a liver channel transport point homing to or affecting both the external and internal branches of this channel. Its effect is to calm or level the liver. Shen Men's effect is to quiet the spirit, while Lie Que is an essential point for the treatment of diseases of the head and face in general.

Study 8
On page 105 of issue #2, 2007, of the Zhe Jiang Zhong Yi Za Zhi (Zhejiang Journal of Chinese Medicine), Wang Cheng-guo and Xu Cun-hua published "The Treatment of 35 Cases of Menstrual Period Migraine with the Hua Tuo Jia Ji Points."

Cohort Description
Altogether, there were 70 patients randomly divided into two groups of 35 patients each. In the treatment group, the patients were 18-41 years of age, with an average age of 34.7 years. These patients' course of disease had lasted from eight months to seven years. Four cases had bilateral headaches, 27 had consistently one-sided headaches, and four cases experienced headaches that shifted from side to side. In the comparison group, the patients' ages were 17-45 years, with an average age of 34.3 years. These patients had suffered from menstrual migraines from one to six years. Five cases had bilateral headaches, 25 had consistently one-sided headaches, and five cases had headaches that shifted from side to side. Therefore, in terms of age, disease duration, and disease condition, these two groups were considered statistically comparable.

Treatment Method
All members of the treatment group were needled at Feng Shi (GB 20) and Hua Tuo paravertebral points 5, 7, 9, 11, and 14. Feng Chi was needled with a 1.5-inch needle with the needle inserted to a depth of one inch and the tip of the needle pointed toward the inner canthus of the opposite eye. After obtaining the qi, the needles were manipulated with twisting and turning draining technique. The needle sensation was propagated along the shao yang channel to the cheeks or to the Tai Yang (M-HN-9) area on the temples. Afterwards, the needles were removed. The Hua Tuo paravertebral points were needled with 1.5-inch needles to a depth of approximately one inch with the tips of the needles angled medially towards the spine at an angle of 75% to the skin. The needle sensation at these points was propagated up and down the spinal column. This treatment was begun three days before the expected onset of menstruation and was continued once per day through the menstrual period. Three menstrual periods equaled one course of treatment.

All members of the comparison began orally taking ten milligrams of an unidentifiable Western drug (Xi Bi Ling, probably imipramine) each day, three days before the expected onset of menstruation, and three menstrual cycles also equaled one course of treatment for this group.

Study Outcomes
Cure was defined as complete disappearance of headaches and any accompanying symptoms with no recurrence on follow-up after one year. Marked effect meant that there was marked improvement in both headaches and accompanying symptoms or that there was simply a very slight headache. Some effect meant that there was some improvement in the headaches and accompanying symptoms, but this improvement was not pronounced. No effect meant that there was no improvement in either the headaches or accompanying symptoms. Table 2 shows the outcomes of the two groups based on these criteria.

Therefore, the acupuncture regime was deemed more effective overall than the Western drug treatment.

Table 2: Study 8 Outcomes

Discussion
According to the authors of this study, the Hua Tuo paravertebral points regulate the function of the internal viscera. In Chinese medicine, this condition is related to liver channel depressive heat and phlegm and stasis obstructing the network vessels. The combination of Feng Chiua Tuo paravertebral points 5, 7, 9, 11, and 14 can level the liver and extinguish wind, fortify the spleen and transform phlegm, nourish blood and free the flow of the network vessels. Therefore, it achieves fully satisfactory therapeutic effects for this condition.

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