CASE STUDES - Facial Pain Quiz Flashcards
1 Case Study Diagnosis
A 50 year old male complains of pain on the left side of his face, burning, heaviness, and numbness sensation, pain is intermittent but heaviness and numbness is constant, patient is slightly over weight and admits poor diet due to work schedule, he does feel nauseous during pain episode, feels better with cold AC.
What is your diagnosis and explain why?
ANSWER: Facial Pain due to Phlegm Fire Harassing Above
2 Case Study Diagnosis
A 65 year old female states that for the past week she has been experiencing facial pain that comes and goes on her right side, she also experiences occasional dizziness and ringing in the ears, low back pain and neck pain, dry mouth and hot flashes and night sweat, patient is always tired and has poor digestion.
What is your diagnosis and explain why?
ANSWER: Facial Pain due to Yin Deficiency/Yang Rising causing Blood Stasis, also Spleen Qi Deficiency
3 Case Study Diagnosis
A 35 year old male comes in complaining of a sudden pain on his left side of the head for the past 3 days, very severe, sharp, short in duration but almost unbearable and happen about 10 times a day. Last week he was starting to get sick with a cold but was able to get rid of it with over the counter cold remedies, he still has aversion to cold.
What is your diagnosis and why?
ANSWER: Wind Cold
Facial Paralysis/Bell’s Palsy
Distal Points selected based on channel most involved:
Li 4: command point of head/face, if selected could be combined with Liv 3 (reduces wind, pacify Liver)
Sj 5: expels wind and releases exterior, benefits the head, primary and sinew channels run through face.
Facial Paralysis/Bell’s Palsy
Local Points & Adjacent Points
Local Points
Gb 14, Bl 2, Yuyao, Sj 23, Gb 1, St 2, Si 18, Li 20, St 7, St 6, St 4, Li 19, Ren 24, Du 26
Adjacent Points
Sj 17, Gb 20, Du 16
Facial Paralysis following a stroke (Wind-Stroke) is
called what in Western medicine?
Central facial paralysis - since it comes from damage to the central nervous system
Peripheral facial paralysis occurring without a stroke is due to injury to the ______ nerves alone.
Peripheral
In facial paralysis following a stroke (Wind-Stroke) the nerves located ________ are not affected.
Above the Eye
i.e. movement of eyebrows/frowning are not affected but there will be deviation of the eye and mouth.
In peripheral facial paralysis the patient will only be able to move _________ when trying to frown.
One Eyebrow
Treatment for Facial Paralysis following a stroke and Peripheral Facial Paralysis are treated differently or similarly in TCM?
Similarly
Central facial paralysis (Wind-Stroke) is due to _______Wind, while peripheral facial paralysis is due to ______Wind.
Central (Wind-Stroke) = Internal
Peripheral (Bell’s Palsy) = External
Facial Paralysis/Bell’s Palsy
Upon physical examination, the patient should be asked to ___________ in order to identify the extent of the paralysis and help with local point selection.
close eyes frown smile whistle bulge the cheeks
______ points should needled with ______ methods if conditions has been suffered for less than a month, and ______ methods if condition has been suffered for longer
Less than 1 month = Distal points w/ reducing methods
More than 1 month = even methods
For very prolonged cases ________ and/or _______ may be used over affected area
Moxibustion
Cupping
Local points can be selected based on which of the Trigeminal nerve is affected. To determine nerve, the practitioner should observe the area where pain is manifesting, then perform this simple method of assessment:
If pain is felt when pressing BL 2, 1st branch (Opthalmic) is affected, St 2, 2nd branch (Maxilary) is affected, St 5 3rd branch (Mandibular) is affected.
Local Points for Facial Pain
1st Branch: Bl 2, Yu Yao, Tai Yang, Gb 14, Li 20, ashi pts.
2nd Branch: St 2, St 3, Si 18, St 7, ashi pts.
3rd Branch: St 6, St 5, St 4, Ren 24, St 7, Jia Cheng Giang (1 cun lat to Ren 24) ashi pts.
If acute/excess pathology, _______ stimulation is advised.
Strong
Besides acupuncture, what forms of treatment could help facial pain?
Herbs will improve results.
Electro Acupuncture could enhance treatment.
If just using acupuncture to treat facial pain, how many sessions (minimum) are recommended?
2 sessions minimum per week, 3 being better.
Facial Pain
Defined as…
Onset…
Characteristics…
severe intermittent pain in the facial region.
Onset is usually abrupt.
Described as an electric shock, sharp, burning.
Facial Pain is referred to in Western Medicine as
Trigeminal Neuralgia
Location of Facial Pain
Around periorbital, over nasolabial grove, cheek bones (maxillary, zygomatic), and mandible.
If ____, ____, ____ invade the body from the outside, it may lodge in the channels of the face where they may obstruct the free flow of _____ & _____ and thus cause pain
Wind, Cold, Heat
Qi & Blood
_______ factors can cause liver depression which can cause fire and affect the paired channel Shao Yang (___) of the face and its Divergent Channel.
Emotional
SJ
Facial pain due to Cold, Wind or Heat is more commonly seen in the elderly due to…
Wei Qi being deficient and unable to protect the body, this will eventually cause Blood Stasis and pain.
Physical factors affecting Facial Pain.
By age 40…
Yin is half consumed, so Yin Blood fails to nourish and moisten the LV impairing its coursing
Yin also fails to control Yang allowing it to become hyperactive and resulting in Liver Yang Raising
This also influences KD Yang’s warming and steaming functions being deficient with age.
Spleen vacuity (Def) or Qi stagnation can evolve into __________ which can transform into _____ and obstruct the channels.
Endogenous Dampness
Phlegm
If Spleen deficiency reaches the KD, it can result is _____. Furthermore, _____, _____, ____ may result in Blood Stasis.
Yang Deficiency
Qi Def, Qi Stag, Yin/Yang Def
Identification of Patterns and Treatment of Facial Pain - Wind Cold & Phlegm
Sx
Abrupt onset of recurrent episodes
Spastic, cramping, cutting pain, severe, difficult to bear, like an electric shock
Attacks only lasting a few seconds or minutes accompanied by pale complexion
Pain is aggravated by cold and improves w/heat
Pressure induces pain
Other Sx: runny nose, lacrimation, salivation
Identification of Patterns and Treatment of Facial Pain - Wind Cold & Phlegm
Tx Principle
Course wind
Scatter Cold
Resolve Dampness
Remove obstruction from channels
Identification of Patterns and Treatment of Facial Pain - Wind Cold & Phlegm
Main acupuncture points
Gb 20: expel pathogenic wind
Li 4: command point for face/mouth, courses wind, scatters cold.
Lu 7: command point for the head and neck, courses wind, scatters cold.
Local points depending upon region of pain.
Identification of Patterns and Treatment of Facial Pain - Wind Heat & Phlegm
Abrupt onset of recurrent episodes
Burning/hot, cutting, piercing pain difficult to bear, affecting mostly one side of head/face
Red facial complexion & sweating during episode
Aggravated by heat, better with cold, possible dry mouth
Identification of Patterns and Treatment of Facial Pain - Wind Heat & Phlegm
Tx Principle
Course Wind
Scatter Heat
Resolve phlegm
Remove obstruction from channels
Identification of Patterns and Treatment of Facial Pain - Wind Heat & Phlegm
Main acupuncture points
Li 4: command point for face/mouth, courses wind, scatters heat.
Sj 5: courses heat, scatters heat.
Gb 20: expel pathogenic wind
Local points depending upon region of pain
Identification of Patterns and Treatment of Facial Pain - Wind Cold & Phlegm
Tongue & Pulse
T: Thin white coat, P: Tight.
If Phlegm also, facial puffiness
T: pale, fat w/thick white slimy coat, P: rolling tight.
Identification of Patterns and Treatment of Facial Pain - Wind Heat & Phlegm
Tongue & Pulse
T: Red with yellow coat, P: Tight rapid.
If phlegm, there will also be dizziness, numbness of the limbs, chest oppression,
T: Thick slimy yellow coat, P: Tight slippery rapid
Identification of Patterns and Treatment of Facial Pain - Liver Qi Stagnation causing Liv Fire
Sx
One-sided head and facial burning pain
Irritability, anger, depression, red face and eyes, HA
Pain is aggravated by emotional distress
In severe cases - muscle spasms & facial ticks
Other possible Sx - dry mouth/throat, sighing, sleep disturbance, dark yellow urine
T: Red w/ dry coat, P: Tight rapid
Identification of Patterns and Treatment of Facial Pain - Liver Qi Stagnation causing Liv Fire
Tx Principle
Course Liver
Drain Fire
Free flow of Qi on the channels
Identification of Patterns and Treatment of Facial Pain - Liver Qi Stagnation causing Liv Fire
Main acupuncture points
Li 4: command point for the face and mouth
Liv 2: clears the Liver and drains Heat
Gb 41: clears the Liver and drains Heat
Local points depending upon the region of pain
Identification of Patterns and Treatment of Facial Pain - Phlegm obstructing the channels
Piercing one side face/head pain accompanied by heaviness and/or numbness
Possible vomiting at time of pain
T: Dark pale w/ glossy slippery coat, P: Slippery
Identification of Patterns and Treatment of Facial Pain - Phlegm obstructing the channels
Tx Principle
Resolve phlegm
Free the flow in the vessels
Identification of Patterns and Treatment of Facial Pain - Phlegm obstructing the channels
Main acupuncture points
Li 4: command point for the face/mouth
Sp 6: move blood and remove stasis
St 40: transform phlegm
Local points depending upon region of pain
Identification of Patterns and Treatment of Facial Pain - Phlegm Fire Harassing Above
Sx
Oppression, burning, distention and pain Desire for cold to be placed in the affected area Dry mouth but no desire to drink Feeling of heaviness of the head, chest Abdominal oppression and distention Occasional vomiting, drool, irritability T: Red w/ slimy yellow coat, bowstring, P: Rolling rapid
Identification of Patterns and Treatment of Facial Pain - Phlegm Fire Harassing Above
Tx Principle
Transform phlegm
Clear Heat
Free the flow in the channels and stop pain
Identification of Patterns and Treatment of Facial Pain - Phlegm Fire Harassing Above
Main acupuncture points
Li 4: command point for the face/mouth (better for lower jaw)
St 40: transforms phlegm
St 44: clear heat (better for upper jaw)
If heat is more from LV depression than ST, then substitute Liv 2 for St 44
Local points depending upon region of pain
Identification of Patterns and Treatment of Facial Pain - Qi deficiency & Blood stasis
Sx
More enduring and continuous chronic aching/pain, unbearable and piercing
Dark complexion, Possible tics following pain
Fear of wind, spontaneous sweating, tiredness, no desire to speak, low voice
T: pale white w/ purple spots, P: deep fine weak
Identification of Patterns and Treatment of Facial Pain - Qi deficiency & Blood stasis
Tx Principle
Tonify Qi
Quicken the Blood
Free the flow on the vessels
Stop pain
Identification of Patterns and Treatment of Facial Pain - Qi deficiency & Blood stasis
Main acupuncture points
Li 4: command point for face/mouth
Sp 6: moves blood and remove stasis
St 36: supplements the center and boost Qi
Local points depending upon region of pain.
Identification of Patterns and Treatment of Facial Pain - Yin deficiency/Yang Rising & Blood stasis
Sx
Recurrent episodes of severe, burning/hot, fixed, one-sided facial/head pain
Afternoon tidal fever, malar flush, dizziness, Tinnitus, LBP, knee soreness, agitation, red eyes
T: Red w/ thin yellow or dry coat, bowstring
P: Fine rapid
Identification of Patterns and Treatment of Facial Pain - Yin deficiency/Yang Rising & Blood stasis
Tx Principle
Supplement Kidneys
Nourish Yin
Clear Heat
Free the flow of the channels
Identification of Patterns and Treatment of Facial Pain - Yin deficiency/Yang Rising & Blood stasis
Main acupuncture points
Li 4: command point for the face/head.
Ki 7: KD channel Water point, enriches Yin, supplements KD.
Sp 6: Mtg point of 3 leg yin, supplementing KD, LV, Sp.
Local points depending upon region of pain
