Explanations
• In most cases when there is invasion of toxic Heat, the Bright Yang channel is affected, thus the points from the Large Intestine channel and Stomach channel are usually selected.
• LI-2 and ST-44 are two important points here in this case, because LI-2 and ST-44, the Spring points of these two channels, are able to clear Heat and reduce Fire, so as to eliminate the redness and swelling. Besides, they are the Water points according to the Five Element theory, and Water controls Fire, so it is appropriate to use these two points.
• LI-4, the Source point, and LI-11, the Sea point, clear Heat and circulate the channel so as to sedate pain. In most cases of invasion of Toxic Heat, there could be fever. When these two points are applied together, they will be more effective in reducing the fever.
• ST-42 and ST-36, which are the same as LI-4 and LI-11, the Source point and Sea point respectively, have a function in clearing Heat in the foot Bright Yang channel and sedating the pain.
• ST-5, ST-6 and ST-7 dispel Heat and harmonise the collateral, so they treat the pain in the locality.
Modifications
I. If there is fever due to flaring-up of Fire-Heat, add GV-14 to clear Heat and reduce the fever.
2. If there is nasal bleeding due to invasion of the Lung system by Heat, add LU-6 and LU-IO 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 to the Liver channel, add LR-2 and Extra Taiyang 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 HT-3 and HT-8 to clear Heat from the Heart.
5. If there is nausea due to penetration of toxic Heat from the channel to the Stomach organ, add PC-6 and CV-12 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 ST-25 and ST-37 to promote defecation so as to clear the Heat.
INVASION OF WIND-COLD
Symptoms and signs
Sharp pain at the face with spasm feeling, aggravation of pain after exposure to cold, alleviation with warmth, a purplish face or slight blue colour on the face, a thin and white tongue coating, and a superficial and tight pulse.
Principle of treatment
Dispel Wind, eliminate Cold, and promote circulation of the collateral and sedate the pain.
HERBAL TREATMENT
Prescription
CHUAN XIONG CHA TIAO SAN
Ligusticum-Green Tea Regulating Powder
Chuan Xiong Rhizoma Ligustici Chuanxiong 6 g
Jing Jie Herba Schizonepetae 6 g
Fang Feng Radix Ledebouriellac 6 g
Bai Zhi Radix Angelicae Dahuricae 6 g
Yan Hu Suo Rhizoma Corydalis 10 g
Man Jing Zi Fructus Viticis 10 g
Dang Gui Radix Angelicae Sinensis IOg
Xi Xin Herba Asari 3 g
Gan Cao Radix Glycyrrhizae 5 g
Qiang Huo Rhizoma s eu Radix Notopterygii 6 g
Explanations
• Jing Jie and Fang Feng dispel Wind and eliminate Cold.
• Chuan Xiong, Xi Xin, Bai Zhi and Qiang Huo dispel Wind-Cold and sedate the facial pain.
• Man Jing Zi and Yan Hu Suo arrest the facial pain.
• Dang Gui tonifies Blood and strengthens the Liver so as to harmonise the collateral.
• Gan Cao harmonises the prescription.
Modifications
1. If there is a runny nose with white discharge and sneezing due to invasion of the Lung system by Wind-Cold, add Cang Er Zi Fructus Xanthii 10 g and Cong Bai Bulbus Allii Fistulosi 10 g to dispel the Wind-Cold.
2. If there is headache due to stagnation of Qi and Blood in the head resulting from invasion of Wind-Cold, add Gao Ben Rhizoma et Radix Ligustici 10 g to eliminate the Wind-Cold in the head and sedate the headache.
3. If there is an aversion to cold and the hands and feet are cold because of impairment of the Yang-Qi by Cold, add Gui Zhi Ramulus Cinnamomi 10 g and Gan Jiang Rhizoma Zingiberis 5 g to warm the Yang and dispel the Cold.
4. If there is spasm of facial muscles due to Cold accumulation, add Bai Fu Zi Rhizoma Typhonii 5 g to relieve the muscle spasm.
Patent remedy
Chuan Xiong Cha Tiao Wan Ligusticum-Green Tea
Regulating Pill
ACUPUNCTURE TREATMENT
LU-7 Lieque, LI-4 Hegu, TE-5 Waiguan, GB-20 Fengchi,
ST-7 Xiaguan and SI-18 Quanliao. Reducing method is used. Moxibustion should also be used.
Explanations
• LU-7 and LI-4 are two important points in treating facial pain due to invasion of Wind-Cold. Wind-Cold often attacks the superficial parts of the face, and LU-7 opens the skin pores and relieves external invasion. LI-4 is a key point for treating problems on the head and face. When they are used together, they can promote the dispelling of Wind-Cold and the sedation of pain in the face.
• TE-5, the Connecting point of the Triple Burner and the Confluent point of the Yang Linking Vessel, is effective in relieving External invasion especially in the Lesser Yang channel causing pain
around the ears. In this case, TE-5 is often combined with GB-20 in order to dispel Wind-Cold from the Lesser Yang channels. In fact, GB-20 can also be used with other points to dispel External invasion.
• ST-7 is the local point selected, as it has the function of circulating the collateral and sedating pain. This point is especially useful when there is an invasion of the Stomach channel by Wind-Cold causing pain at the mandible region; it is often combined with ST- 5, ST-6 and ST-40 to promote circulation of the Stomach channel and relieve pain.
• SI-18 is used when there is an invasion of the Small Intestine channel by Wind-Cold causing pain around the cheek mandibular region; it is often combined with SI-4, SI-6 and SI-7, to circulate the Small Intestine and sedate the pain.
Modifications
1. If there is a runny nose with white discharge and sneezing due to invasion of the Lung system by Wind-Cold, add BL-12 and BL-13 to dispel the Wind-Cold.
2. If there is headache due to stagnation of Qi and Blood in the head resulting from invasion of Wind-Cold, add GV-16 to relieve Wnd-Cold in the head and sedate the headache.
3. If there is an aversion to cold and cold hands and feet due to the impairment of the Yang-Qi by Cold, add ST-36 with moxibustion to warm the Yang and dispel the Cold.
4. If there is spasm of the facial muscles due to Cold accumulation, add SP-3 and LR-3 to relieve the muscle spasm.
Case history
A 40-year-old woman had suffered from facial pain for 2 weeks. For the first 4 to 5 days, she felt contractions or spasms in the face, which were alleviated with warmth (she used a warm towel and took showers), slight general body pain, aversion of cold, and slight fever. She rested for a couple of days at home and all the symptoms went away except for the facial problems. She was very afraid of her face being paralysed. When she came for consultation, her tongue was thin and white, and her pulse was superficial and tight.
Diagnosis
Blockage of the collateral due to uncompleted disappearance of Wind-Cold.
Principle of treatment
Harmonise the collateral and dispel Wind-Cold.
Acupuncture treatment
LI-4 Hegu, LU-7 Lieque, ST-3 Juliao, ST-7 Xiaguan, ST-40 Fenglong and SI-7 Zhizheng. Moxibustion was prescribed on LI-4, ST-3, ST-7 and ST-40. Reducing method was used. Treatment was given once every other day.
Explanations
• Moxibustion warms the channels and dispels Cold in the collateral.
• Ll-4 and LU-7 dispel Wind-Cold, especially on the face.
• ST-3 and ST-7 regulate the Qi and Blood circulation on the face and sedate the facial pain.
• ST-40, the Connecting point of the Stomach channel, and SI-7, the Connecting point of the Small Intestine channel, harmonise the collateral on the face.
After a 10 day treatment, her facial pain disappeared.
FLARING UP OF LIVER-FIRE
Symptoms and signs
Painful face with burning feeling, aggravation of the pain by emotional upset and nervousness, restlessness, irritability, fullness of the chest, insomnia, headache, a bitter taste in the mouth, constipation, a red tongue with a yellow coating and a wiry and rapid pulse.
Principle of treatment
Clear Heat, reduce Fire, and sedate the pain.
HERBAL TREATMENT
Prescription
LONG DAN XIE GAN TANG
Gentiana Draining the Liver Decoction
Long Dan Cao Radix Gentianae 6 g
Huang Qin Radix Scutellariac 9 g
Zhi Zi Fructus Gardcniae 9 g
Ze Xie Rhizoma Alismatis 12 g
Mu Tong Caulis Akebiae 9 g
Xiao Ku Cao Spica Prunellae 10 g
Dang Gui Radix Angelicae Sinensis 3 g
Sheng Di Huang Radix Rehmanniae Recens 9 g
Sang Ye Folium Mori 10 g
Explanations
• Long Dan Cao, Sang Ye and Xia Ku Cao clear the Heat in the Liver and reduce the Liver-Fire.
• Mu Tong and Ze Xie clear the Heat by means of urination.
• Zhi Zi and Huang Qin clear the Heat and reduce the Fire in the body.
• Sheng Di Huang cools the Heat and eliminates the toxin in the Liver.
• Dang Gui harmonises the Liver.
Modifications
1. If there is emotional upset or depression due to stagnation of Liver-Qi, add Bai Shao Radix Paeoniae Alba IOg and Chai Hu Radix Bupleuri 5 g to promote the Liver-Qi circulation and relieve depression.
2. If there is stomach pain due to the invasion of the Stomach by Liver-Fire, add Qing Dai Indigo Naturalis 5 g and Yan Hu Suo Rhizorna Corydalis 10 g to clear the Heat in the Stomach and sedate the pain.
3. If there is a headache due to disturbance of Clear Yang in the head by Liver-Fire, add Gou Teng Ramulus Uncariae cum Uncis 10 g to suppress the Liver-Fire and relieve the headache.
4. If there is restlessness, palpitations and insomnia due to disturbance of the Mind by Liver-Fire, add Huang Lian Rhizoma Coptidis 5 g and Long Gu Os Draconis 15 g to clear the Heat in the Heart and tranquillise the Mind.
5. If there is a bitter taste in the mouth with vomiting due to uprising of the Gall Bladder-Qi, add Yin Chen Hao Herba Artemisiae Capillaris 10 g and Xuan Fu Hua Flos Inulae 10 g to cause the Gall Bladder-Qi to descend and relieve the vomiting.
6. If there is constipation, add Da Huang Radix et Rhizoma Rhei 10 g to promote defecation and clear Heat in the Bright Yang Fu organs.
Patent remedy
Long Dan Xie Gan Wan Gentiana Draining the Liver Pill
ACUPUNCTURE TREATMENT
LI-4 Hegu, LR-3 Taichong, LR-2 Xingjian, LR-8 Ququan, GV-20 Baihui, GB-2 Tinghui, GB-20 Fengchi and GB-43 Xiaxi. Reducing method is used on all the points except LR-8 and GB-2; even method should be used on these last points.
Explanations
• This case is mostly caused by a prolonged persistence of emotional disturbance, including stress, frustration, anger, depression, upset, etc. If there is facial pain due to flaring of Liver-Fire, the side of the face is often affected, thus the points from the Liver and Gall Bladder channel are mainly selected. In case of invasion of the Stomach by Liver-Fire, points from the Stomach channel can also be applied.
• LI-4 and LR-3, the so-called ‘four gate points’, are effective in subduing Excessive-Fire and Wind, and reducing the pain and subduing the Liver-Fire.
• LR-2, the Spring point of the Liver channel, and GB-43, the Spring point of the Gall Bladder channel, together with GV-20 and GB-20, cool the face, reduce the Fire and clear the Heat, so as to treat the root cause.
• LR-8, the Water point from the Liver channel, nourishes Water so as to control the Liver-Fire. Also, this point is the Sea point from the Liver channel, and is good for treating Liver disorders generally.
• GB-2 treats facial pain at the side of the face. This point is also good for relieving tinnitus and ear pain, since flaring up of Liver-Fire often causes these two symptoms.
Modifications
1. If there is emotional upset or depression due to stagnation of Liver-Qi, add BL-18 and LR-14 to promote the Liver-Qi circulation and relieve the depression.
2. If there is pain occurring around the Stomach channel (i.e. in the cheek region) due to invasion of the Stomach by Liver-Fire, add SP-6, ST-7 and ST-44 to clear the Heat in the Stomach channel and sedate the pain.
3. If there is headache due to disturbance of clear Yang in the head by Liver-Fire, add GB-I and GV-19 and GV-21 to suppress the Liver-Fire and relieve the headache.
4. If there is restlessness, and palpitations and insomnia, due to disturbance of the Mind by Liver-Fire, add HT-3 and PC-8 to clear the Heat in the Heart and tranquillise the Mind.
5. If there is a bitter taste in the mouth with vomiting due to uprising of Gall Bladder-Qi, add GB-34 and PC-6 to cause the Gall Bladder-Qi to descend and relieve the vomiting.
Case history
A 65-year-old man was suffering from time to time with facial pain. This lasted for more than 4 years. His facial pain could be greatly influenced by his emotions and alcoholic drinking. He would easily lose his temper and drink one to two glasses of red wine every day. Besides this, he liked pungent food very much. When he was young, he had suffered from hepatitis B. As he came for consultation, his face was red and slightly sweating, restless, his blood pressure was 170/100 mmHg, and he also had insomnia, sometimes a headache at the vertex, red eyes, a constant feeling of warmth over the body, occasional ear pain, constipation, thirst, a red tongue, (especially at the edges) with a yellow, thick and slight dry tongue coating and a wiry and rapid pulse.
Diagnosis
Flaring-up of Liver-Fire and accumulation of Heat in the Bright Yang channel.
Principle of treatment
Calm the Liver, reduce Fire and clear Heat in the Bright Yang channel.
Acupuncture treatment
LR-2 Xingjian, LR-8 Ququan, GB-20 Fengchi, GB-43 Xiaxi, LI-4 Hegu, ST-3 Juliao, ST-7 Xiaguan and ST-44 Neiting. Reducing method was used. Treatment was given once a week.
Explanations
• LR-2, the Spring point of the Liver channel, clears Heat in the Liver and reduces Liver-Fire. LR-8, the Sea jK)int and Water point of the Liver channel, controls Liver-Fire to treat the root cause.
• GB-20 suppresses Liver-Fire and clears Heat in the head. GB-43, the Spring point of the Gall Bladder channel, cools the Gall Bladder so as to reduce the Fire in the Liver.
• LI-4 and ST-44 clear Heat in the Large Intestine and Stomach.
• ST-3 and ST-7 harmonise the collateral and sedate the pain.
In addition to above treatment, a herbal prescription based upon Long Dan Xie Gan Tang Gentiania Draining the Liver Portfolio was given. Drinking of alcoholic and eating of pungent foods were forbidden during the treatment. After a 4 month treatment, his facial pain was under control.
