Facial Pain

Introduction

Facial pain is a kind of severe pain occurring in transient paroxysms in acertain facial region. It mostly occurs in one side of the forehead, maxillaryregion or mandibular region. The onset is abrupt like an electric shock, and thepain is cutting, burning and intolerable. Frequent recurrence denotes a chronicdisease. In most cases it starts after middle age in women.

Etiology and Pathogenesis

A sudden attack of this disease is due to invasion of the meridians and collaterals on the face by pathogenic wind cold which contracts the meridians and collaterals and retards the circulation of qi and blood. In Chapter 38 of Plain Questions, it says: When pathogenic cold comes and stays in the meridians it impedes and slows down the circulation. If it lodges outside the vessels, the blood supply is decreased, and if it remains in the vessels, the passage of qi is obstructed, resulting in a sudden attack of pain.

Facial pain may also arise from excessive fire of the liver and stomach which flares up and attacks the face. The fire in the stomach is produced by retention of food caused by irregular food intake. The fire of the liver is due to the stagnation of qi in the liver. Furthermore, facial pain may be due to deficiency of yin producing excess of fire in the patients with a body constitution of yin deficiency and excessive sexual activity which consumes essence. In addition, diseases of the teeth, mouth, ear, nose, or mental disorders may also induce facial pain.

Differentiation

Facial pain due lo invasion by pathogenic wind and cold:

Main manifestations: Abrupt onset of pain occurs like an electric shock. The pain is cutting, boring and intolerable, but transient and paroxysmal. Each attack lasts a few seconds or one to two minutes. It may recur several times a day. Tender points can be found on the supraobital foramen, infraorbital foramen, cheek foramen, lateral side of ala nasi, angle of the mouth, and nasolabial groove, where pressure induces the attack of pain. The pain is often accompanied by local spasm, running nose and lacrimation, salivation, or by exterior symptoms with string - taut and tense pulse.

Analysis: Pain is caused by the obstruction of circulation ofqi and blood in the meridians and collaterals on the face due to invasion of pathogenic wind and cold. Pain aggravated by pressure suggests that the pathogenic factors are in excess. Burning pain comes from the fierce fight between the antipathogenic qi and pathogenic factors. String - taut and tense pulse is the sign of invasion by pathogenic wind cold. Endogenous wind heat comes from prolonged accumulation of exogenous pathogenic cold wind, giving rise to spasm, running nose, lacrimation and salivation.

Facial pain due to excessive fire in the liver and stomach:

Main manifestations: The attack of pain as described above is accompanied by irritability, hot temper, thirst, constipation, yellow and dry tongue coating, and string - taut, rapid pulse.

Analysis: Irritability and hot temper are due to fire caused by prolonged depression of the liver qi. Burning pain is caused by endogenous heat coming from prolonged retention of food in the stomach, which rises to the face through the Stomach Meridian. Thirst and constipation are due to heat in the stomach. Yellow dry tongue coating, string - taut and rapid pulse are signs of accumulation of fire in the liver and stomach.

facial pain due to deficiency ofyin and excessive fire:

Main manifestations: Insidious pain, emaciation, malar flush, soreness in the lumbar region, lassitude, pain aggravated by fatigue, thready and rapid pulse, reddened tongue with little coating.

Analysis: The kidney stores essence and dominates water. When the kidney essence is insufficient, lassitude, soreness in the lumbar region and emaciation occur. Insufficiency of kidney water fails in controlling fire, which flares up along the meridians and reaches the face, causing malar flush and facial pain. Thready, rapid pulse, reddened tongue with little coating are signs deficiency of yin with flaming fire.

Treatment

Method: Select the local points in combination with distal points according to the location of pain and the meridians affected. For facial pain due to invasion of pathogenic wind and cold, reducing method is used to promote the circulation of qi and blood in the diseased area. For facial pain due to excessive fire in the liver and stomach, the points along the Foot - Jueyin and Yangming Meridians are punctured with the reducing method to bring down the fire. For facial pain due to deficiency of yin and excessive fire, the points along the Foot - Shaoyin Meridian should be added and punctured with the reinforcing method to nourish the yin and to dissipate the fire.

Prescription:

  • Pain at supraorbital region: [GB14 - taiyang - BL2 - TH5].
  • Pain at maxillary region: [ST2 - SI18 - LI20 - LI4].
  • Pain at mandibular region: [ST7 - ST6 - ST5 - jiachengjiang - LI4].

Supplementary points:

  • Invasion by pathogenic wind and cold: GB20.
  • Excessive fire in the liver and stomach: [LR3 - ST44].
  • Deficiency of yin and excessive fire: [KI6 - SP6].

Explanation: The above prescriptions are formulated by combining the local points with the distal points according to the location of pain and the meridians affected. For instance, ST7, ST6 and jiachengjiang (Extra) are the points located at the mandibular region. LI4 and TH5 are the points along the Hand - Yangming and Hand - Shaoyang Meridians which go upward to the facial region. The above prescription has the effect of promoting circulation of qi of the meridians and collaterals in the affected area, and the function of reducing excess and relieving pain. GB20, the meeting point of the Foot - Shaoyang and Yangwei Meridians, can be used to dispel wind and to check pain. LR3 and ST44 can be chosen for the purpose of eliminating excessive fire in the liver and stomach. KI6 and SP6 nourish the yin and reduce the fire. For a chronic disease, local points on the affected side can be punctured with the reinforcing method, shallow insertion and needle retention. Or the reducing method with long retaining of needles can be applied to the corresponding local points of the healthy side.

Remarks

Facial pain is referred to trigeminal neuralgia in modem medicine.

Acupuncture is effective in pain of primary trigeminal neuralgia. For secondary trigeminal neuralgia accompanying intracranial diseases or lesions of the nervous system, in which the pain is usually continuous with paroxysms of aggravation, treatment should be aimed at its primary cause.