Concussion treatments with Traditional Chinese Medicine

By Melissa Carr, BSc, DrTCM

A patient walked into my treatment room with a slight limp. He told me that a fall the day before had resulted in low back pain, but as he spoke, that became less and less my primary concern. While he does have bipolar disease, and I have seen him in episodes of both the ups and downs of mood and behavior, something about his disposition that day was different.

“Did you hit your head?” I asked him.

“I don’t think so,” was his answer.

With further questioning I found out that he had a mild headache, slight dizziness, and he had been feeling particularly tired and in a “low mood” all day. These symptoms were not uncommon for him, but there was a slightly longer gap  between my asking a question and his response—he was taking more time to process than usual. Thinking he might have suffered a concussion, that became the focus of my treatment.

In Traditional Chinese Medicine (TCM), we address a patient’s health concerns with two main things in mind: branch and root. The branch is the symptoms, and root is the underlying cause. For chronic conditions, we typically focus on the root, while for acute issues, we are more likely to pay attention to the branch.

Treating the Branch

In TCM, the main result of an injury is stagnation, the lack of normal circulation. From an anatomical perspective, that can mean poor blood flow, impaired lymphatic drainage, or impinged nerve, though in TCM, we call it Qi and/or Blood stagnation. When there is stagnation, on the other side of the blockage there is deficiency—inadequate nutrient supply.

To treat a concussion or traumatic brain injury (TBI), there are several approaches we can take with acupuncture. Though there are many acupuncture points located on the head, distal points can be chosen based on the injury location and the type of tissue damaged.

The most common point is LI4 (Large Intestine 4; he gu)—the “command point of the face and mouth”—which is found in the muscle on the back of the hand, in the tender spot found halfway up the radial side of the second metacarpal bone. It’s a great point to teach patients to acupressure to help manage headaches, especially frontal ones.

A point found just proximal to the styloid process of the radius, LU7 (Lung 7; lie que), is the “command point of the head and back of the neck.” Another point, SI3 (Small Intestines 3; hou xi), is sometimes nicknamed “crick in the neck point.” Make a loose fist to find it at the tip of the distal palmar crease on the ulnar side, proximal to the fifth metacarpophalangeal joint.

 For issues that influence the eyes, including eye pain and visual disturbances, as well as dizziness and vertigo, LIV3 (Liver 3; tai chong), can be used, and it is located on the dorsum of the foot, just distal to the junction of the first and second metatarsal bones.

The “influential point of the tendons and ligaments,” GB34 (Gallbladder 34; yang ling quan), can be used if whiplash is suspected or diagnosed. It is found just anterior and distal to the head of the fibula.

Because the nervous system is badly disrupted by a head injury, selecting points that calm the patient are important. Though it may seem counterintuitive to those who have never experienced it, one of the most popular points (I call it the “most requested acupuncture point”) is found midway between the medial ends of the eyebrows. Is it a coincidence that its unicorn horn placement is almost magical? I think not.

There are also a series of points at the vertex of the head that can be helpful. On the midline of the head, at the midpoint of a line connecting the apexes of the auricles, DU20 (GV20; governing vessel 20; bai hui), is used to treat headaches, dizziness, irritability, tinnitus, mental and physical fatigue, and more. Points that are sometimes added to enhance treatment of those symptoms include a series of non-channel, extra points called si shen cong. These are a total of four points that are found in front of, behind, and to each side of DU20.

TCM practitioners may also choose to do scalp acupuncture to treat a brain injury. A more contemporary form of acupuncture, points are mapped onto the head based on brain anatomy and function. There are specific areas to treat motor or sensory issues, balance, vertigo, vision, hearing, speech, and tremors. This style of acupuncture requires needling at a steep angle under the scalp and rapidly stimulating the needles.  

Treating the Root

It helps that I knew my patient well before he came in with symptoms of a concussion. As a result, I could easily choose points that address his constitution—him as a person, not just the injury. In TCM, we ask a wide range of questions to form a TCM diagnosis, a complex thing to describe. However, simply put, we try to optimize the body’s ability to heal itself. This means making sure that digestive issues, insufficient sleep, stress, and more are addressed.

Other treatments

I always make dietary recommendations for patients with TBIs, including making sure to get enough high-quality protein and essential fatty acids (omega 3s), as well as limiting sugar and processed foods, while upping intake of foods that are anti-inflammatory, such as ginger, berries, and cruciferous vegetables. I may also prescribe herbs or supplements, including curcumin, vitamin B12, coenzyme Q10 (or ubiquinol), or lion’s mane mushroom.

Concussion Patients

After three acupuncture treatments over the next ten days, this patient noted an improvement back to his pre-concussion state.

Other concussion patients I’ve treated have needed many more treatments and sometimes periodic follow up sessions over the following years, particularly when the TBI is severe or when there are multiple traumas to the head.

Another patient with a severe TBI that had been sustained three years prior to coming in for treatment had serious impairment. Amongst other things, she couldn’t tolerate the noise of busy restaurants or family gatherings; would get nauseous if she stood on land and watched the ocean waves or if someone wore busily patterned clothing; couldn’t recall if she had left on the stove if she left the kitchen; found it difficult to cross a street as she couldn’t judge the distance or speed of oncoming traffic; was unable to read to her kids; and felt emotionally flat and disconnectedan. After three months of weekly acupuncture sessions, followed by another three months of sessions every two to four weeks, she was able to drive the mountainous and windy three-day travel with her kids to attend a family event. However, she still comes in for tune-ups when she notices her symptoms starting to return.

Some of the key things I’ve learned about treating TBIs include:

• Consider the potential of a TBI even if a patient reports that they did not hit their head.
• Getting to know the patient’s baseline is helpful in evaluating changes that may be missed by others, including the patients themselves.
• Recognize and treat the emotional effects of a TBI, along with the physical and cognitive.
• Teach the patient and family members to note if symptoms are starting to return after the initial course of treatment is complete.
• Make sure that there is rehabilitation treatment and homework. I refer to other practitioners—physiotherapists, kinesiologists, counsellors, etc.—who can help the patient attain both physical and mental recovery.