Facial pain (Treatment of Pain with Chinese Herbs and Acupuncture) Part 1

The face is the place where all the Yang channels meet; facial pain can be caused by a disturbance of one or more of these channels. Pain may occur at one side or on both sides of the face, but it is most commonly confined to one side.

Facial pain is often caused, according to TCM, by invasion of External factors, also by flaring up of Liver-Fire, accumulation of Heat in the Bright Yang Fu organs, or of Wind-Phlegm in the channels, deficiency of Qi, or stagnation of Qi and Blood. Facial pain may be attributed to any of the following disorders in Western medicine: primary or secondary trigeminal neuralgia, mumps, rhinitis, caries, trauma, post-facial operation, herpes zoster and its sequelae, and acute facial dermatitis.

Aetiology and pathology

Invasion of External factors

Overexposure to Wind, Cold or Heat may cause these pathogenic factors to invade the face. Cold is characterised by contraction and stagnation. In Wind-Cold invasion, there is a contraction of the channels and muscles on the face, leading to stagnation of Qi and Blood, and pain follows. Heat is characterised by uprising and burning. In Wind-Heat invasion, Qi and Blood in the channels, especially the Bright Yang channels, will be disturbed, leading to accumulation of Qi and Blood in local regions, then swelling, redness and pain occur.

Furthermore, an invasion of the face by Toxic Heat or insect bites may also cause an accumulation of Toxin in the channels, and stagnation of Qi and Blood occurs, leading to facial pain.


Flaring up of Liver-Fire

Overstress, overstrain, excessive anger or anxiety, or too much meditation, may also cause disharmony of the Liver and impede its function of promoting Qi circulation, leading to stagnation of Qi in the Liver. If this stagnation persists for a long time, this may generate Liver-Fire, causing flaring up of Liver-Fire to the face, and facial pain occurs.

Accumulation of Heat in the Bright Yang channels

Overeating of pungent, sweet or fatty food, or drinking too much alcohol, may cause Heat accumulation in the Bright Yang Fu organs, leading to constipation, a big appetite, bleeding of the gums, a foul smell in the mouth and thirst. This Heat may also ascend along the Bright Yang channels to the face and disturb the Qi and Blood circulation, so causing facial pain.

Accumulation of Wind-Phlegm in the channels

If External Wind invasion is not completely expelled, it may accumulate in the channels. When Phlegm accumulates in the body then Wind might mix with this Phlegm and block the channels, causing facial pain.

Deficiency of Qi

Overstrain or prolonged sickness may cause consumption of Qi, leading to Qi deficiency, then the face is not properly nourished, and this causes facial pain.

Stagnation of Qi and Blood

Qi and Blood should be freely circulated on the face. If Qi and Blood stagnate owing to various causes, the channels become blocked, causing pain. Physical trauma or inappropriate facial surgery may directly damage the channels and muscles leading to stagnation of Qi and Blood, and causing pain.

Treatment based on differentiation

Differentiation

Differentiation of External or Internal origin

—    Acute onset of facial pain, mild in intensity, accompanied by External symptoms such as an aversion to cold, fever, muscle pain, a runny nose, cough and superficial pulse, is usually caused by invasion of External factors.

—    A chronic history of facial pain, mild or severe in intensity, associated with diet, emotioned state or other physical conditions, is usually caused by disorders of the Internal Zang-Fu organs.

Differentiation of character of the pain

—    Acute sharp facial pain with a burning sensation, a thin and yellow tongue coating, together with some External symptoms, is usually caused by invasion of Wind-Heat.

—    Acute sharp facial pain, together with some External symptoms, such as an aversion to cold, low-grade fever, muscle pain, absence of thirst, is usually caused by invasion of Wind-Cold.

—    Acute sharp facial pain with a burning sensation, swelling of the face, redness, heat, fever, a thick or thin and yellow coating on the tongue, together with some symptoms caused by Toxic Heat, such as an aversion to cold, headache, throat pain and swelling, restlessness and constipation, etc., is usually caused by invasion of Toxic Heat.

—    Chronic sharp facial pain with a burning sensation, redness and pain of the eyes, with aggravation of the pain by emotional upset, nervousness or dizziness, is usually caused by flaring-up of Liver-Fire.

—    Chronic sharp facial pain with a burning sensation, redness of the face, aggravation of facial pain by consumption of some pungent food, a foul smell in the mouth, thirst and constipation is usually caused by accumulation of Excessive-Heat in the Bright Vang channels.

—    Stabbing facial pain with a fixed location, which gets worse at night, with a purplish colour of the tongue, is usually caused by stagnation of Blood.

—    Slight intermittent facial pain, with aggravation by exertion and during the day, poor vision, tiredness, an aversion to cold, cold hands and feet, a pale tongue with a thin, white and slight greasy coating, and a thready and weak pulse, is usually caused by deficiency of Qi.

—    Chronic facial pain with numbness or a tingling feeling, intermittent facial pain, spasm of the facial muscles, local swelling on the face, mostly on one side, tic in the face, a thin, white and greasy tongue coating, and a wiry and slippery pulse, is usually caused by accumulation of Wind-Phlegm in the channels.

Treatment

INVASION OF WIND-HEAT

Symptoms and signs

Facial pain with a burning sensation, or a prickling sensation, or a sharp pain, constant pain, redness of the face, sweating, aggravation of pain by exposing to warmth, alleviation of pain by cold, thirst or fever, deep yellow urine, a red tip to the tongue and a thin and yellow coating, and a superficial and rapid pulse.

Principle of treatment

Dispel Wind, clear Heat and calm the pain.

HERBAL TREATMENT

Prescription

XIONG ZHI SHI GAO TANG

Cnidium, Angelica and Gypsum Decoction

Chuan Xiong Rhizoma Ligustici Chuanxiong 10 g

Bai Zhi Radix Angelicae Dahuricae 10 g

Shi Gao Gypsum Fibrosum 20 g

Sang Ye Folium Mori IOg

Ju Hua FIos Chrysanthemi 10 g

Jin Ying Hua Flos Lonicerae 10 g

Man Jing Zi Fructus Viticis 10 g

Cang Er Zi Fructus Xanthii IOg

Sheng Di Huang Radix Rehmanniae 10 g

Explanations

•    Sang Ye, Jin Yin Hua and Ju Hua dispel the Wind and clear the Heat.

•    Man Jing Zi and Cang Er Zi dispel the Wind-Heat and sedate the pain.

•    Bai Zhi and Chuan Xiong sedate the pain on the face.

•    Shi Gao clears the Heat and reduces the fever.

•    Sheng Di Huang cools the Heat and removes the Toxin from the face.

Modifications

1.    If there is a high fever, add Da Qing Ye Folium lsatidis 10 g and Ban Lan Gen Radix lsatidis 10 g to reduce the fever.

2.    If there is redness and swelling on the face, add Pu Gong Ying Herba Taraxaci IOg and Zi Hua Di Ding Herba Violae 10 g to clear the Heat, remove the Toxin and reduce the swelling.

3.    If there is throat pain, add Xuan Shen Radix Scrophulariae 10 g to benefit the throat and relieve the throat pain.

4.    If there is cough and expectoration of yellow phlegm add Sang Bai Pi Cortex Mori Radicis 10 g, and Zhe Bei Mu Bulbus FritiHariae Thunbergii 10 g to clear the Heat and eliminate the Phlegm.

5.    If there is blocked nose with running nose, add Er Bu Shi Cao Herba Centipedae 10 g to open the nose and relieve the blockage in the nose.

Patent remedies

Yin Qiao Pian Honeysuckle and Forsythia Tablet

Yin Qiao Jie Du Pian Honeysuckle and Forsythia Tablet to Overcome Toxins

ACUPUNCTURE TREATMENT

LI-4 Hegu, LI-Il Quchi, TE-5 Waiguan, ST-6 Jiache,

ST-7 Xiaguan, GB-20 Fengchi. Reducing method is used for all these points.

Explanations

•    LI-4 and LI-Il are used to clear Heat, especially in the Bright Yang channel of the hand. These two points are suitable for pain around the nose since the Large Intestine channel ends at the nose. Besides, these two points can dispel the Wind-Heat and reduce fever. If there is a blocked nose, add LI-20, LU-7, LU-IO and Extra Bitong to circulate the channel and open the nasal orifice.

•    ST-6 and ST-7 are used especially to circulate the channel and sedate the pain to treat pain in the cheek region since the Stomach channel passes through this region. In fact, Stomach channel disturbance is one of the main causes of facial pain. In this case, ST-4 and ST-5 should be used together to sedate the pain. ST-34, ST-40 and ST-42 can be prescribed at the same time. ST-34 is the Accumulation point of the Stomach channel, which has a good effect on relieving the pain in the Stomach channel. ST-40 is the Connecting point, which is effective for harmonising the collateral. ST-42 is the Source point, being effective for circulating the channel and stopping the pain.

•    GB-20 is used to dispel the Wind-Heat and stop the pain. This point is prescribed especially for pain occurring near the ear that refers to the neck, causing a painful and stiff neck. This point also relieves headache, and in this case it would be best to combine it with TE-5, since this is the point that connects to the Yang Linking Vessel. And it is also the Connecting point of the Triple Burner, so it is effective in relieving pain on the side of the head. TE-5 is also effective for dispelling Wind and clearing Heat.

Modifications

1.    If there is a fever, add GV-14, and ST-44, the Spring point of the Stomach channel, to reduce fever.

2.    If there is throat pain and swelling, add LU-10 to relieve the pain and reduce the swelling.

3.    If there is headache, add Extra Taiyang and Extra Yintang to sedate the headache.

4.    If there is a swollen face with redness add ST-44 and LI-I to clear the Heat and reduce the swelling.

Case history

A 30-year-old man had been suffering from facial pain with a burning feeling for 5 days. At the beginning, he had fever, throat pain, headache, an aversion to cold and runny nose with a white discharge, so he went to his general practitioner and took antibiotics for 3 days. Generally his symptoms improved slightly, but the burning facial pain remained. He also had general body pain, a tidal fever and aversion to cold, a slight thirst, a dry mouth, a red tip to his tongue, and thin and slightly yellow coating, and a superficial and slightly rapid pulse.

Diagnosis

This case was clearly a condition of facial pain due to invasion of Wind-Heat. The key symptoms of external invasion of Wind-Heat were: he was a young man who had never complained about these symptoms before, it was an acute attack, it was facial pain with a burning feeling, fever, an aversion to cold, throat pain, and the conditions of the tongue and pulse.

Principle of treatment

Dispel Wind, clear Heat, harmonise the collateral and sedate the pain.

Acupuncture treatment

LI-4 Hegu, TE-5 Waiguan, ST-3 Juliao, ST-7 Xiaguan, SI 18 Quanliao, GB-20 Fengchi. Reducing method was used on these points. Treatment was given once every other day.

Explanations

•    LI-4 and TE-5 dispel Wind-Heat in general. Also, LI-4 and GB-20 can dispel Wind-Heat in the upper body, especially the face.

•    ST-3, ST-7 and SI-18, all local points, are used to harmonise the collateral and sedate the facial pain.

•    Normally, LI-Il is recommended to be added to the prescription; however, in this case there was not much fever, so this point can be omitted.

Due to the short duration of his problem, the facial pain was under control in 2 weeks.

INVASION OF TOXIC HEAT

Symptoms and signs

Acute occurrence of facial pain, redness, swelling and burning feeling on the face, formation of pus on the face, itching, fever, thirst, constipation, deep yellow urine, restlessness, a poor appetite, a red tongue with a yellow and dry coating and a rapid and wiry pulse.

Principle of treatment

Clear Heat, reduce Fire and eliminate Toxin.

HERBAL TREATMENT

Prescription

PUJI XIAO DUYIN

Universal Benefit Decoction to Eliminate Toxin

Huang Qin Radix Scutellariae 10 g

Huang Lian Rhizoma Coptidis 10 g

Xuan Shen Radix Serophulariae 6 g

Zhi Zi Fructus Gardeniae 10 g

Ban Lan Gen Radix lsatidis 6 g

Lian Qiao Fructus Forsythiae 3 g

Ma Bo Lasiosphaerae seu Calvatiae 3 g

Niu Bang Zi Fructus Arctii 3 g

Bo He Herba Menthae 3 g

Jiang Can Bombyx Batryticatus 3 g

Sheng Ma Rhizoma Cimicifugae 3 g

Gan Cao Radix Glyeyrrhizae 6 g

Da Qing Ye Folium lsatidis 10 g

Zhe Bei Mu Bulbus Fritillariae Thunbergii 10 g

Explanations

•    Huang Qin, Huang Lian and Zhi Zi clear Heat, reduce the swelling and eliminate the Toxin.

•    Ma Bo and Xuan Shen eliminate the Toxin.

•    Ban Lan Gen, Lian Qiao, Bo He, Sheng Ma and Da Qing Ye dispel the Heat, reduce the fever and clear the toxin.

•    Niu Bang Zi, Jiang Can and Zhe Bei Mu resolve the Phlegm and harmonise the collateral on the face.

•    Gan Cao harmonises the herbs in the prescription and eliminates the Toxin.

Modifications

1.    If there is fever due to flaring up of Fire-Heat, add Shi Gao Gypsum Fibwsum 20 g and Zhi Mu Rhizoma Anemarrhenae 10 g to clear Heat and reduce the fever.

2.    If there is nasal bleeding due to invasion of the Lung system by Heat, add Sheng Di Huang Radix Rehmanniae Recens 10 g and Sang Bai Pi Cortex Mori Radicis 10 g to clear Heat in the Lung system and stop the bleeding.

3.    If there is redness and swelling of the eyes with yellow secretion due to invasion of Heat into the Liver channel, add Xia Ku Cao Spica Prunellae 10 g and Long Dan Cao Radix Gentianae 5 g to clear Heat in the eyes and reduce the swelling.

4.    If there is restlessness due to invasion of the Heart channel by Heat, add Dan Zhu Ye Herba Lophatheri 10 g to clear Heat from the Heart.

5.    If there is nausea due to the penetration of Toxic Heat from the channel to the Stomach organ, add Xuan Fu Hua Flos Inulae 10 g to harmonise the Stomach and cause the Stomach-Qi to descend.

6.    If there is constipation due to blockage of the Large Intestine by Heat, add Da Huang Radix et Rhizoma Rhei 10 g to promote defecation so as to clear the Heat.

Patent remedies

Niu Huang Jie Du Wan Cattle Gallstone Pill to Resolve Toxin

Yin Qiao Jie Du Wan Honeysuckle and Forsythia Pill to Overcome Toxins

ACUPUNCTURE TREATMENT

LI-2 Erjian, LI-4 Hegu, LI-Il Quchi, ST-5 Daying, ST-7

Xiaguan, ST-36 Zusanli, ST-42 Changyang, and ST-44

Neiting. Reducing method is used on these points.

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