Trigeminal Neuralgia
Overview
Facial pain (miantong) is characterized by paroxysmal, electric-shock-like or knife-like severe pain on one side of the face, corresponding to trigeminal neuralgia in Western medicine. It is commonly caused by external invasion of wind-cold or wind-heat, emotional constraint with liver qi stagnation transforming into fire, deficiency of qi and blood failing to nourish the collaterals, or chronic illness entering the collaterals with blood stasis obstructing the network vessels. The disease is located in the facial meridians and collaterals, closely related to the three yang meridians of hand and foot and the liver, stomach, and gallbladder zang-fu organs. Clinically, it is marked by sudden onset and cessation, electric-shock-like pain, and fixed or migratory pain, often triggered by washing the face, brushing teeth, chewing, or speaking. Pattern differentiation should distinguish deficiency from excess: excess patterns are mostly attributed to wind, fire, phlegm, and stasis; deficiency patterns to insufficiency of qi, blood, yin, and yang. The general treatment principle is to unblock the collaterals and stop pain; for excess, dispel pathogens and unblock collaterals; for deficiency, support the upright qi and unblock collaterals. External therapies such as acupuncture and tuina may be combined to enhance efficacy.
Pattern differentiation (clinical patterns)
Wind-Cold Attacking the Collaterals
Facial pain induced or aggravated by wind-cold, severe pulling pain, fixed location, relieved by warmth, accompanied by aversion to cold, headache, nasal congestion with clear discharge, pale red tongue with thin white coating, and a floating tight pulse.
Disperse wind and scatter cold; unblock the collaterals and stop pain.
Liver Depression Transforming into Fire
Burning or electric-shock-like facial pain with paroxysmal exacerbation, induced by emotional distress, accompanied by irritability, bitter taste, dry throat, red eyes, insomnia and dream-disturbed sleep, red tongue with yellow coating, and a wiry rapid pulse.
Clear the liver and drain fire; unblock the collaterals and stop pain.
Qi and Blood Deficiency
Dull lingering facial pain that comes and goes, not severe, aggravated by fatigue or at night, accompanied by pale complexion, fatigue, dizziness, palpitations, insomnia and poor memory, pale tongue with thin white coating, and a fine weak pulse.
Benefit qi and nourish blood; harmonize the collaterals and stop pain.
Connections
Daily care & prevention
Patients should avoid exposure of the face to wind-cold, keep warm when going out, and wear masks and scarves. Diet should be light; avoid spicy food, alcohol, tobacco, and excessively cold or hot foods; avoid chewing hard objects. Maintain emotional calm and avoid worry and anger. Wash the face and brush teeth gently to avoid touching trigger points. Keep a regular schedule, ensure adequate sleep, and exercise moderately to strengthen the constitution. Self-massage acupoints such as Hegu (LI4), Taichong (LR3), and Fengchi (GB20) for 3-5 minutes each time until a sore distending sensation is felt. If pain occurs frequently or worsens, seek timely follow-up to adjust the treatment plan.
When to seek medical care
If facial pain is accompanied by deviation of the mouth and eye, limb weakness, unclear speech, severe headache, vomiting, blurred vision, or impaired consciousness, be alert to critical conditions such as stroke or intracranial space-occupying lesions, and seek immediate medical attention for cranial imaging. If pain persists without relief, expands in area, or is accompanied by fever or rash, secondary causes such as herpes zoster or nasopharyngeal tumors should be ruled out. The elderly and weak, or those with chronic unrelieved pain, should have regular follow-ups to prevent complications.