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Corydalin (CR)

CLINICAL APPLICATIONS

* Chronic headache with underlying deficiency

§ Migraine headache 

§ Tension headache 

§ Cluster headache 

 

WESTERN THERAPEUTIC ACTIONS

* Analgesic action to relieve pain

* Anti-inflammatory influence to reduce inflammation

 

CHINESE THERAPEUTIC ACTIONS

* Relieves pain

* Subdues hyperactive yang qi

* Tonifies blood and yin

* Extinguishes Liver wind

* Relieves qi and blood stagnation

 

DOSAGE

Take 3 to 4 capsules three times daily. For severe pain, the dosage may be increased to 6 to 8 capsules every four to six hours as necessary. For maximum effectiveness, take the herbs on an empty stomach with warm water.

 

INGREDIENTS


Bai Shao (Radix Paeoniae Alba)

Bai Zhi (Radix Angelicae Dahuricae)

Chuan Xiong (Rhizoma Chuanxiong)

Dang Gui (Radix Angelicae Sinensis)

Ge Gen (Radix Puerariae Lobatae)

Ju Hua (Flos Chrysanthemi)

Long Gu (Os Draconis)

Man Jing Zi (Fructus Viticis)

Sang Ji Sheng (Herba Taxilli)

Shu Di Huang (Radix Rehmanniae Praeparata)

Tian Ma (Rhizoma Gastrodiae)

Yan Hu Suo (Rhizoma Corydalis)

Yu Jin (Radix Curcumae)


 

BACKGROUND

Headache is pain in any part of the head, including the scalp, face and interior of the head. Causes of headache vary, including hypertension, stress, anxiety, injuries, infection, glaucoma, hematoma, and tumor. Proper diagnosis requires careful review of medical history and physical exam. Optimal treatment combines elimination of cause and relief of pain.

 

FORMULA EXPLANATION

Corydalin (CR) is designed specifically to relieve the most common forms of migraine and tension headaches. The focus of this formula is directed at the jueyin and shaoyang meridians, the ones most commonly affected in migraine and tension headache syndromes. Corydalin (CR) contains herbs that tonify Liver blood and yin, subdue hyperactive yang qi, extinguish Liver wind, regulate Liver qi and blood, and relieve pain.

        Corydalin (CR) is an empirical formula based on the classic Chinese herbal formula Si Wu Tang (Tangkuei Four Combination). The four main herbs in this formula, Shu Di Huang (Radix Rehmanniae Praeparata), Dang Gui (Radix Angelicae Sinensis), Bai Shao (Radix Paeoniae Alba) and Chuan Xiong (Rhizoma Chuanxiong), tonify Liver blood and yin. In addition, Chuan Xiong (Rhizoma Chuanxiong) and Yan Hu Suo (Rhizoma Corydalis) regulate and invigorate the blood, and are two of the primary herbs in the Chinese pharmacopoeia to treat headache. Yu Jin (Radix Curcumae) regulates wood element qi (Gallbladder/shaoyang), and relieves blood stasis. In combination with Chuan Xiong (Rhizoma Chuanxiong), Yu Jin (Radix Curcumae) serves to invigorate and harmonize yin and yang, and Liver blood and qi. Ju Hua (Flos Chrysanthemi) tonifies Liver yin, clears Liver heat, and subdues hyperactive Liver yang. Man Jing Zi (Fructus Viticis), Bai Zhi (Radix Angelicae Dahuricae) and Ge Gen (Radix Puerariae Lobatae) are combined for their benefits in relieving pain, relaxing muscle tension and relieving spasms by increasing peripheral blood circulation. Tian Ma (Rhizoma Gastrodiae) and Long Gu (Os Draconis) are added to extinguish Liver wind and subdue and anchor hyperactive Liver yang. Sang Ji Sheng (Herba Taxilli) is added to tonify Liver yin.

        In summary, Corydalin (CR) contains herbs that address both acute and chronic aspects of headaches by treating excess and deficiency. It contains herbs to relieve pain by activating qi and blood circulation, calming hyperactive yang qi, and extinguishing Liver wind. Furthermore, it treats the underlying cause of headache by tonifying the blood and yin to remedy deficiencies in those areas.

 

CAUTIONS & CONTRAINDICATIONS

* Patients with persistent pain not relieved by Corydalin (AC) or Corydalin (CR) should seek further examination to rule out structural or functional abnormalities.

* Should prominent signs of diminishing vision and vomiting occur in addition to the headache, refer the patient to a medical doctor immediately for a CT scan or MRI to rule out intracranial pressure due to a tumor, aneurysm, or cerebral stenosis.

* This herbal formula contains herbs that invigorate blood circulation, such as Dang Gui (Radix Angelicae Sinensis). Therefore, patients who are on anticoagulant or antiplatelet therapies, such as Coumadin (warfarin), should use this formula with caution, or not at all, as there may be a higher risk of bleeding and bruising.[1],[2],[3]

 

CLINICAL NOTES

* Corydalin (CR) is a great formula for chronic headache, especially if the headache is due in part to blood deficiency. It can be taken on a long-term basis to minimize recurrences and the severity of pain. The maintenance dose is 2 capsules twice daily.

* Corydalin (AC) is best for acute headaches with severe pain, and is most effective for symptomatic relief. Corydalin (CR) is most effective when taken on a long-term basis to control and prevent the recurrence of headaches.

* For headache in which herbs cannot achieve maximum relief, the cervical vertebrae (C1 to C3) should be checked for any abnormality. Check for specific trigger points in the neck or any uneven tension of cervical muscles bilaterally. If one side is stiffer than the other, this may be an indication of a cervical disorder. In cases where the neck and shoulder are also stiff due to misalignment resulting in headaches, Neck & Shoulder (AC) can be added.

* For women who suffer from periodic headaches, especially preceding menstrual cycles, it is important to treat blood stagnation. The headaches usually subside with the passage of blood clots. The recommended formulas include Mense-Ease and Resolve (Lower).

* The late Dr. John H.F. Shen created this formula. The formula explanation was provided by Dr. Ray Rubio. This is an effective formula to treat migraine, tension, and cluster headaches.

 

Pulse Diagnosis by Dr. Jimmy Wei-Yen Chang:

* Migraine headache: a pulse next to a pulse on the right chi. A pulse next to a pulse is when a thin pulse can be felt next to a thick pulse.

* Headache due to Liver fire: forceful and floating pulse on the left guan. Temperature of the entire arm will feel hot.

* Headache due to wind-heat: floating and forceful pulse on the right cun, and long and forceful pulse on the right chi. Temperature above the elbows and the back of the neck will feel hot.

* Headache due to wind-cold: floating and thready pulse on the right cun, and thready and long pulse on the right chi. Temperature above the elbows and the back of the neck will feel cold.

* Headache due to poisoning: forceful pulse on both chi and left guan positions.

 

SUPPLEMENTARY FORMULAS

* For acute headache with severe pain, add Corydalin (AC).

* For headache from wind-heat, add Lonicera Complex.

* For headache from excess and heat conditions, add Gardenia Complex.

* For headache associated with infection, add Herbal ABX or Herbal AVR.

* For headache associated with infection of ear, nose and throat, add Herbal ENT.

* For headache caused by stress and tension, add Calm, Calm (ES), or Calm ZZZ.

* For headache related to sinus congestion, add Pueraria Clear Sinus or Magnolia Clear Sinus.

* For headache with neck and shoulder stiffness, add Neck & Shoulder (AC).

* For migraine headache with Liver wind rising, combine with Gastrodia Complex or Gentiana Complex.

* If headache is caused by recent traumatic or musculoskeletal injury, add Flex (TMX).

* For headache due to old trauma or injury or blood stagnation, add Circulation (SJ).

* For Kidney yin deficiency, add Nourish or Kidney Tonic (Yin).

* With headache due to underlying damp and phlegm with Spleen qi deficiency, add Pinellia Complex.

 

ACUPUNCTURE TREATMENT

Traditional Points:

* Renzhong (GV 26), Lieque (LU 7), Zusanli (ST 36), Xingjian (LR 2), Taichong (LR 3), Geshu (BL 17), Baihui (GV 20), Xuehai (SP 10)

 

Classic Master Tung's Points:

* Needle contralateral to the pain. If the pain is in the center, needle bilaterally or the side with the more ah shi points. If the pain is bilateral, needle bilaterally.

* Headache (general): Linggu (T 22.05), Dabai (T 22.04), Huolian (T 66.10), Huoju (T 66.11), Huosan (T 66.12). Bleed dark veins on the dorsal aspect of the feet. Bleed before needling for best result.

* Headache (occipital): Linggu (T 22.05), Dabai (T 22.04), Fanhoujue (T 22.12)*, Zhengjin (T 77.01), Zhengzong (T 77.02), Wanshunyi (T 22.08), Wanshuner (T 22.09), Tongbei (T 88.11), Huofu (T 88.41)*, Huochang (T 88.43)*, Huoliang (T 88.42)*, Dihuang (T 77.19), Boqiu (T 77.04), Zhengshi (T 77.03). Bleed the sacral region or Weizhong (BL 40) or dark veins nearby. Bleed before needling for best result.

* Headache (frontal): Linggu (T 22.05), Dabai (T 22.04), Biyi (T 1010.22), Xinling (T 33.17)*, Zhongbai (T 22.06), Taiyang, Huoju (T 66.11), Wuhu (T 11.27), Zhenjing (T 1010.08), Sifuyi (T 1010.11), Sifuer (T 1010.10), Tongtian (T 88.03). Bleed Sihuashang (T 77.08), Sihuaxia (T 77.11), Sihuazhong (T 77.09), Fuchang (T 77.12), ST channel on the lower limb and dark veins nearby. Bleed before needling for best result.

* Headache (temporal): Linggu (T 22.05), Shangbai (T 22.03), Zhongbai (T 22.06), Xinling (T 33.17)*, Cesanli (T 77.22), Cexiasanli (T 77.23), Shangjiuli (T 88.26), Zhongjiuli (T 88.25), Xiajiuli (T 88.27), Jianzhong (T 44.06), Sihuawai (T 77.14), Liuwan (T 66.08), Menjin (T 66.05), Huoying (T 66.03), Qihu (T 77.26), Waisanguan (T 77.27), Yizhong (T 77.05), Erzhong (T 77.06), Sanzhong (T 77.07), Taiyang, Waiguan (TH 5) penetrating through Neiguan (PC 6). Bleed any dark veins or tender points nearby the lateral malleolus. Bleed at a 45 degree angle the dark veins nearby the other temporal area. Patient needs to lean downwards, hold his/her breath and exhale to help push blood out. Bleed before needling for best result.

* Headache (vertex): Linggu (T 22.05), Dabai (T 22.04), Xinling (T 33.17)*, Zhenghui (T 1010.01), Qianhui (T 1010.05), Shuitong (T 1010.19), Shuijin (T 1010.20), Zhengjin (T 77.01), Shenting (GV 24), Shangxing (GV 23), Huozhu (T 66.04), Huolian (T 66.10), Huoju (T 66.11), Huosan (T 66.12), Zhengzong (T 77.02)

* Headache (migraine): Linggu (T 22.05), Dabai (T 22.04), Cesanli (T 77.22), Yizhong (T 77.05), Erzhong (T 77.06), Sanzhong (T 77.07), Liuwan (T 66.08), Zhongjiuli (T 88.25)  

* Headache (supraorbital): Erjiaoming (T 11.12), Shangbai (T 22.03), Sanchayi (T 22.15)*, Huaguyi (T 55.02), Shangli (T 1010.09), Tianhuangfu [Shenguan] (T 77.18)  

* Headache (hypertension): Linggu (T 22.05), Dabai (T 22.04), Xinling (T 33.17)*, Zhenghui (T 1010.01), Qianhui (T 1010.05), Shuitong (T 1010.19), Shuijin (T 1010.20), Sansheng (T 55.07)*, Weizhong (BL 40), Shenting (GV 24), Shangxing (GV 23), Huozhu (T 66.04), Tongtian (T 88.03), Fuding (T 44.04), Houzhi (T 44.05), Jianfeng (T 44.31)*, Tongshan (T 88.02), Tongguan (T 88.01), Zhitong (T 44.13). Bleed Huoshan (T 33.06), Huoling (T 33.05) or dark veins nearby. Bleed before needling for best result.

* Headache (common cold): Linggu (T 22.05), Dabai (T 22.04), Xinling (T 33.17)*, Zhenghui (T 1010.01), Qianhui (T 1010.05), Shuitong (T 1010.19), Shuijin (T 1010.20), Sanzhong (T 77.07), Sihuashang (T 77.08), Sihuazhong (T 77.09), Sihuawai (T 77.14), Sihuaxia (T 77.11), Shenting (GV 24), Shangxing (GV 23), Huozhu (T 66.04), Dizong (T 44.09)

* Headache (menstruation): Linggu (T 22.05), Dabai (T 22.04), Xinling (T 33.17)*, Zhenghui (T 1010.01), Qianhui (T 1010.05), Shuitong (T 1010.19), Shuijin (T 1010.20), Sanzhong (T 77.07), Sihuashang (T 77.08), Sihuazhong (T 77.09), Sihuawai (T 77.14), Sihuaxia (T 77.11), Shenting (GV 24), Shangxing (GV 23), Huozhu (T 66.04), Dizong (T 44.09)

* Headache (injury): Zhengjin (T 77.01), Zhengzong (T 77.02) with strong stimulation, Yizhong (T 77.05), Erzhong (T 77.06), Sanzhong (T 77.07), Zhengshi (T 77.03). Bleed dark veins nearby the medial malleolus or Shuijing (T 66.13). Bleed before needling for best result.

 

Master Tung’s Points by Dr. Chuan-Min Wang:

* Headache

§ Frontal: Cesanli (T 77.22), Tianhuangfu [shenguan] (T 77.18)

§ Temporal: Cesanli (T 77.22), Zhongjiuli (T 88.25)

§ Occipital: Cesanli (T 77.22), Zhengjin (T 77.01), Zhengzong (T 77.02)

§ Vertex: Needle bilaterally Cesanli (T 77.22), Huozhu (T 66.04).

§ Migraine: Cesanli (T 77.22), Menjin (T 66.05)

§ Behind the eyes: Cesanli (T 77.22), Tianhuangfu [shenguan] (T 77.18)

 

Balance Method by Dr. Richard Tan:

* On the same side of the migraine, needle Fengshi (GB 31), Diwuhui (GB 42), and Shaofu (HT 8).

* On the opposite side, needle Taichong (LR 3), Xiguan (LR 7), Waiguan (TH 5), and Tianjing (TH 10).

 

Auricular Medicine by Dr. Li-Chun Huang:

* Migraine: Temple, Sympathetic, External Sympathetic, Nervous Subcortex, Coronary Vascular Subcortex. Bleed Ear Apex.

* Frontal headache: External Sympathetic, Forehead, Nervous Subcortex. Bleed Ear Apex.

§ For headache due to sinus or rhinitis, add Internal Nose.

§ For headache due to ametropia, add Vision II.

* Occipital headache: Occiput, Lesser Occipital Nerve, Nervous Subcortex. Bleed Ear Apex.

§ For occiput headache due to cervical vertebral C3 to C4 degeneration, add Cervical Vertebral C3 and C4 (frontal and back of ear).

* Temporal headache: Temple, Sympathetic, External Sympathetic, Nervous Subcortex, Coronary Vascular Subcortex. Bleed Ear Apex.

* Vertex headache: Vertex, External Sympathetic, Nervous Subcortex. Bleed Ear Apex.

 

NUTRITION

* Avoid intake of cold drinks, cold foods, and sour fruits. Cold and sour substances constrict vessels, channels and collaterals.

* If headaches are food related, the diet must be regulated and controlled to reduce or eliminate triggers.

* Consume adequate amounts of fruits, vegetables, grains, and raw nuts and seeds.

* One of the most common causes of headache is caffeine. Gradually decrease and stop consumption of caffeine-containing drinks, such as coffee, tea, cola, energy drinks, and specialty beverages with caffeine.

* Avoid foods containing tyramine, which can trigger headaches, such as alcohol, chocolate, bananas, citrus, avocado, cabbage, and potatoes. Also avoid cakes, dairy products (except yogurt), processed or packaged foods (because of colorants, preservatives and other additives), tobacco and junk food.

* Monosodium glutamate (MSG) should be avoided by individuals sensitive to it. MSG is generally found in canned soups, TV dinners, some meats, many pre-prepared frozen dishes and restaurant foods.

 

The Tao of Nutrition by Dr. Maoshing Ni and Cathy McNease:

* Migraines or headaches due to high blood pressure, menstrual cycles, emotional stress or tension

§ Recommendations: chrysanthemum flowers, mint, green onions, oyster shells, pearl barley, carrots, prunes, buckwheat, peach kernels.

§ Take lemon juice and 1/2 tablespoon baking soda mixed in a glass of water and drink.

§ Make tea of Chinese prunes, mint, and green tea.

§ Mash peach kernels and walnuts, mix with rice wine and lightly roast; take two tablespoons three times daily.

§ Avoid spicy food, lack of sleep, alcohol, smoking, excess stimulation, eye strain, and stress.

 

LIFESTYLE INSTRUCTIONS

* Avoid allergens as much as possible, as allergens may trigger headache.

* Installation of an air purifier will minimize the presence of allergens in the air and reduce the risk of allergy and headache.

* Avoid stressful situations and environments whenever possible. Ease tension with massage, warm baths, and an exercise program.

* Avoid direct exposure to air conditioning, fans, drafts or wind blowing on the head and neck region.

* Tension headaches can be relieved by gentle massage of the neck and shoulders to relax the muscles. A hot Epsom salts bath or soaking the feet is also helpful.

* Headache due to poor circulation will respond to a vigorous scalp massage.

* Regular exercise, adequate rest, and normal sleeping habits are essential for optimal health.

 

CASE STUDIES

* M.M., a 42-year-old female, presented with recurring tension headaches, which worsened with lack of sleep and overwork. Daily activities such as using her computer and iPad were straining her neck which then aggravated the headaches more. Yoga and breathing techniques were used temporarily to help improve the headaches. Additional symptoms included malaise and a desire to lie down. The location started in the occipital area, throbbing pain around the vertex, forehead and behind the eyes. The TCM diagnosis was Kidney and Liver yin deficiencies with Liver yang rising. This condition was treated with Corydalin (CR) four spoons once daily. The patient reported immediate relief and improved sensation of well being. Overall the frequency of headaches was less and the patient felt more balanced. Submitted by M.M., Alameda, California.

* S.G., a 29-year-old female, presented with headaches, which she had been experiencing three to four times per week and 50% of them were migraines. It was also noted that she had low back and neck pain, as well as insomnia with sleep duration of only four hours each night. Her pulse was thin and wiry and her tongue was pale with thick white coat. The practitioner diagnosed the condition as Liver overacting on the Spleen, Spleen qi and Liver blood deficiency with dampness. Corydalin (CR) was prescribed at four capsules three times per day. She received acupuncture treatment as well. With taking the herbs the patient had only one episode of a headache and one episode of a migraine in the following month. She has not needed to return for any additional treatment since. Submitted by C.C., San Diego, California.

* F.R., a 48-year-old female, presented with tension and cluster headaches, about five to seven days per week. The practitioner diagnosed this condition as qi and blood stagnation, along with Liver blood and yin deficiencies. For treatment, Corydalin (CR) was prescribed at three capsules three times per day, as well as taking Corydalin (AC) as needed. Acupuncture treatment was received as well. During the first two weeks of taking the herbs, the patient reported four to six headaches. By the fifth week of taking the herbs, the headaches reduced to only one per week. After eight weeks she seldom experienced any headaches. Submitted by S.L., Yuma, Arizona.

* A 44-year-old female presented with chronic migraines, described as a tight sharp pain. It was mentioned that she had been having headaches for the past 30 years and she was also experiencing neck and arm pain. Objective findings included tight muscles upon palpation of the sternocleidomastoid, trapezius, biceps and deltoid muscles. The TCM diagnosis was Liver qi stagnation along with qi and blood stagnation; Western diagnosis was repetitive muscle syndrome. Corydalin (CR) for headaches and Herbal ANG for muscle discomfort were prescribed and directed to take as needed. The patient had been treated on and off by these herbs for the past six months and had finally gotten off all her medications. She had sworn by them, mentioning they gave better results than her anti-inflammatories. Submitted by J.L., San Diego, California.

* J.A., a 52-year-old female, presented with having migraines with a pain level of 10 out of 10. They were described as throbbing, beginning at the occipital region, travelling down the Urinary Bladder and Gallbladder channels. The practitioner diagnosed this condition as Liver yin deficiency and Liver yang rising. Liver overacting on Spleen and Gallbladder damp-heat were also present. For treatment, Corydalin (CR) was prescribed. In response to receiving acupuncture and taking the herbs, the patient’s migraines were well controlled. After an analysis of her diet, it was discovered that she had food allergies to certain foods which had increased onset of her migraines. Since then she has been limiting these foods from her diet. Submitted by V.G., Virginia Beach, Virginia.

* M.L., a 13-year-old female, presented with migraine headache with no other significant complaints. She was diagnosed with qi and blood stagnation. Corydalin (CR) was prescribed at 6 grams daily. In the first two weeks, the patient reported the headache occurred approximately four times a week. During the third and fourth week of herbal treatment, the headache reduced to twice a week. During the fifth week, the headache was completely gone and the patient felt she had more energy. She also received acupuncture throughout the five weeks. Submitted by W.F., Bloomfield, New Jersey.

* V.B., a 49-year-old female, presented with migraines she had been experiencing for the previous five years, lasting every month for four to six days and usually occurring prior to the onset of her period. She worked as an on-site manager in a large complex and stated the migraines were aggravated by the stress of her job. She also suffered from uterine prolapse and was experiencing significant tension in her neck and shoulders as well. In addition, she had difficulty falling and staying asleep so she was taking Ambien (zolpidem) on a regular basis. The TCM diagnosis was primarily Spleen qi deficiency with blood deficiency, accumulation of dampness, and central qi sinking; Liver blood deficiency generating wind, and Liver qi stagnation were also present. An additional assessment from the practitioner was that the migraines had been due to a histamine response. She was prescribed both Corydalin (CR) and Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction). She was also taking Ferro Food, a product for anemia recommended by her alternative medicine practitioner. While taking Corydalin (CR) along with receiving three or four acupuncture treatments, cupping, and body therapy for her upper body tension over a four month period, the patient reported she did not have any migraines. During one of the last treatments she had just contracted a headache prior to the visit, and it had completely resolved afterwards within one day. She said she was able to stop taking the prescribed medication Topamax (topiramate). It was advised by the practitioner that the patient increase her intake of foods containing magnesium, and reduce any foods containing tyramine. Submitted by M.M., Burlington, Wisconsin.

 

PHARMACOLOGICAL AND CLINICAL RESEARCH

Corydalin (CR) is formulated to treat a variety of headaches, including but not limited to migraine, tension and cluster headaches. The mechanism of action of the herbs includes an analgesic effect to relieve pain, anti-inflammatory action to reduce inflammation, and specific constituents to target and treat headache.

Yan Hu Suo (Rhizoma Corydalis) is one of the strongest and most potent herbs for treatment of pain. It has a strong analgesic effect that is comparable to morphine. In fact, the analgesic effect of Yan Hu Suo (Rhizoma Corydalis) is so strong and reliable that it has been used with satisfactory anesthetic effect in 98 out of 105 patients (93.4%) who underwent surgery.[4] The analgesic effect can be potentiated further with concurrent acupuncture therapy. Overall, it is well understood that Yan Hu Suo (Rhizoma Corydalis) has a marked effect to treat pain.

        Dang Gui (Radix Angelicae Sinensis) is a commonly used herb in Chinese medicine and has notable strength to relieve various types of pain, including but not limited to migraine, pain of the low back and legs, and menstrual cramps.[5],[6] Pharmacologically, it has shown analgesic and anti-inflammatory actions.[7] The anti-inflammatory property of Dang Gui (Radix Angelicae Sinensis) is attributed to the inhibition of pro-inflammatory mediators, including nitric oxide and prostaglandin E2 in peritoneal macrophages.[8] In comparison to aspirin, the anti-inflammatory action of Dang Gui (Radix Angelicae Sinensis) is approximately 1.1 times stronger and its analgesic effect is approximately 1.7 times stronger.[9] Clinically, a preparation of Dang Gui (Radix Angelicae Sinensis) was found to have an 82.9% effective rate in treating 35 patients with migraine headache.[10]

        Dang Gui (Radix Angelicae Sinensis) and Chuan Xiong (Rhizoma Chuanxiong) are two herbs frequently used together to treat headaches. Pharmacologically, Chuan Xiong (Rhizoma Chuanxiong) has a marked effect to suppress inflammation via its inhibitory activity on tumor necrosis factor-alpha (TNF-α) production and bioactivity.[11] Clinically, one study reported 95.1% success rate to treat various types and causes of headache using an herbal formula that contained Dang Gui (Radix Angelicae Sinensis) and Chuan Xiong (Rhizoma Chuanxiong).[12] In another clinical study, 50 patients with headache were treated with herbal formulas with great success using such ingredients as Dang Gui (Radix Angelicae Sinensis), Chuan Xiong (Rhizoma Chuanxiong), Bai Zhi (Radix Angelicae Dahuricae), and Ju Hua (Flos Chrysanthemi).[13]

        Bai Shao (Radix Paeoniae Alba) is commonly used for its analgesic and antispasmodic effects.[14] Common applications include pain, spasms and cramps, and trigeminal pain.[15] Paeonol, one of the main active compounds of Bai Shao (Radix Paeoniae Alba), has anti-inflammatory and antioxidant activities.[16] In addition, the total glucosides of Bai Shao (Radix Paeoniae Alba) exert anti-inflammatory effects by modulating the production of pro-inflammatory mediators.[17] Clinically, Bai Shao (Radix Paeoniae Alba) helps relieve pain and stiffness of neck and shoulder muscles associated with headache.

        Bai Zhi (Radix Angelicae Dahuricae) has definite analgesic and anti-inflammatory activities, and is frequently used for a variety of headaches.[18] Pharmacologically, Bai Zhi (Radix Angelicae Dahuricae) reduce inflammation by inhibiting lipopolysaccharide-induced production of nitric oxide, prostaglandin E2 and TNF-α via mitogen-activated protein kinases and nuclear factor-kappaB in macrophages.[19] Clinically, there have been various clinical studies proving Bai Zhi (Radix Angelicae Dahuricae) effectively treats headache. In one clinical study, patients with occipital headache were treated twice daily with Bai Zhi (Radix Angelicae Dahuricae). Out of 73 patients, 69 showed significant improvements, 3 showed slight improvement, and 1 showed no effect.[20] In another study, 54 out of 62 patients with chronic headache showed significant improvement using a 5% solution of Bai Zhi (Radix Angelicae Dahuricae) for 10 to 15 days per course of treatment, for one to two courses total.[21] In short, Bai Zhi (Radix Angelicae Dahuricae) is an extremely useful and effective herb for headache treatment.

        In addition to the herbs listed above, Corydalin (CR) utilizes many other herbs with marked analgesic and anti-inflammatory activities. Ge Gen (Radix Puerariae Lobatae) has a strong analgesic effect and is effective to treat migraine headache. Many isoflavonoid compounds from Ge Gen (Radix Puerariae Lobatae), including daidzin, daidzein, dihydrodaidzein, and p-ethylphenol, demonstrated significant analgesic and muscle-relaxant activities.[22] In a clinical study of migraine headache, a Ge Gen (Radix Puerariae Lobatae) preparation containing 100 mg of puerarin was reported 83% effective when used three times daily for 2 to 22 days.[23] Furthermore, Tian Ma (Rhizoma Gastrodiae) has analgesic and anti-inflammatory activities. The mechanism of action is attributed to the inhibition of cyclo-oxygenase (COX) I and II activities.[24] Gastrodin, one compound from Tian Ma (Rhizoma Gastrodiae), shows good results in treating 156 patients with neurasthenic headache and 72 patients with vascular headache.[25] Lastly, the methanol extract of Yu Jin (Radix Curcumae) showed a significant effect to inhibit cyclo-oxygenase-2 activity and reduce inflammation and relieve pain.[26]

        In summary, Corydalin (CR) contains herbs that have shown through historical applications and clinical trials to be effective in treating a variety of headaches, including but not limited to migraine, tension, and cluster headaches.

 

COMPARATIVE ANALYSIS

Pain is a basic bodily sensation induced by a noxious stimulus that causes physical discomfort (such as pricking, throbbing, or aching). Pain may be of acute or chronic state, and may be of nociceptive, neuropathic, or psychogenic origin. For migraine, three classes of drugs commonly used to treat pain include non-steroidal anti-inflammatory agents (NSAID), opioid analgesics, and serotonin agonists. NSAID’s [such as Motrin (ibuprofen) and Voltaren (diclofenac)] are generally used for mild to moderate pain, and are most effective to reduce inflammation and swelling. Though effective, they may cause such serious side effects as gastric ulcer, duodenal ulcer, gastrointestinal bleeding, tinnitus, blurred vision, dizziness and headache. Opioid analgesics [such as Vicodin (APAP/hydrocodone) and morphine] are usually used for severe to excruciating pain. While they may be the most potent agents for pain, they also have the most serious risks and side effects, including but not limited to dizziness, lightheadedness, drowsiness, upset stomach, vomiting, constipation, stomach pain, rash, difficult urination, and respiratory depression resulting in difficult breathing. Furthermore, long-term use of these drugs leads to tolerance and addiction. Lastly, serotonin agonists, such as Imitrex (sumatriptan), are specifically used for migraine. Common side effects of this drug include flushing, tingling feeling, feeling of warmth or heaviness, drowsiness, dizziness, upset stomach, diarrhea, vomiting, irritation of the nose, and muscle cramps. Though effective, these drugs do not change the course of illness, and do not reduce the frequency or severity of recurrent migraine attacks. In brief, it is important to remember that while drugs offer reliable and potent pain relief, they only treat symptoms and not the cause. They should only be used if and when needed. Frequent use and abuse leads to unnecessary side effects and complications.

        Treatment of migraine is a sophisticated balance of art and science. Proper treatment of pain requires a careful evaluation of the type of disharmony (excess or deficiency, cold or heat, exterior or interior), characteristics (qi and/or blood stagnations), and location (upper body, lower body, extremities, or internal organs). Furthermore, optimal treatment requires integrative use of herbs, acupuncture and tui-na therapies. All these therapies work together to tonify underlying deficiencies, strengthen the body, and facilitate recovery from chronic pain. TCM pain management targets both symptoms and the causes of pain, and as such, often achieves immediate and long-term success. Furthermore, TCM pain management is often associated with few or no side effects.

        For treatment of mild to severe pain due to various causes, TCM pain management offers similar treatment effects with significantly fewer side effects. However, as is true of any therapeutic modality, it is important to recognize the limitations of TCM pain management. In some cases, such as acute, excruciating migraine, drugs are superior to herbs, as they are more immediately potent and have a more rapid onset of action (especially if given via injection). Therefore, optimal treatment may require the integration of Western medicine to treat acute pain, and herbal medicine to provide long-term healing of underlying causes and prevent recurrence of migraines.

 



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