Trigeminal Neuralgia

Question 1

which TCM category?

Answer 1

facial pain and temporal headache

Question 2

Which nerve is affected?

Answer 2

cranial nerve 5- sensory fx

v1-eye
v2-upper jaw/nose
v3-lower jaw

V2/3 most common

Question 3

triggers:

Answer 3

facial massage, cold drinks, touch
fall/spring time
zone: corner of mouth/nose

Question 4

common western drug:

Answer 4

1) carbamazepine
2) baelofen
3) phenytoin

Question 5

etiology

Answer 5

1) W-C————————–\
2) emotions \
3) diet \
4) febrile disease SHI
5) excessive sexual activity—–/
6) long term illness—XU
7) constitution——–/

Question 6

Patterns

Answer 6

1) W-C
2) Damp-heat in LIV/GB
3) ST-fire
4) obstruction by W-PH
5) blood stg
6) Qi and blood xu
7) flare up of XU fire

Question 7

Burning pain on face and cheek and gum, aggravated by heat, redness of face and eyes, dryness of mouth, halitosis, constipation, dark yellow urine

Answer 7

Flare up of ST fire

Question 8

flare up of ST fire T/P:

Answer 8

T- red, yellow coat

P- slippery, rapid, flooding

Question 9

dull pain, numbness of the face, heaviness and cloud of head, stuffy sensation in chest, too much sputum, numbness of face

Answer 9

Obstruction by W-PH

Question 10

obstruction by W-PH T/P:

Answer 10

T- puffy, white sticky coat

P- wiry, slippery

Question 11

recurrent dull or hollow pain, severe in stand up, mild when lie down, aggravated by overwork, pale face, fatigue, SOB, poor appetite

Answer 11

Qi and blood xu

Question 12

QI and blood xu T/P

Answer 12

T- pale, white coat

P- thready

Question 13

acute onset, severe contract pain which is alleviated by warmth aggravated by W-C, aversion to W-C, headache, running nose

Answer 13

Invasion W-C

Question 14

Invasion W-C T/P:

Answer 14

T- thin white coat

P- floating, light

Question 15

dull distension pain, tic or numbness of the face, aggravated by anger, insomnia, poor memory, soreness and weakness of lumbar

Answer 15

flare up of XU fire

Question 16

flare up of XU fire T/P:

Answer 16

T- red, little/no coat

P- thready and rapid

Question 17

recurrent fixed stabbing pain, severe at night, numbness after pain, dull face

Answer 17

blood stg

Question 18

blood stg T/P:

Answer 18

T- dark purple, petechiae, thin white coat

P- wiry, tight, choppy

Question 19

paroxysmal burning pain, referred to the corner of the head, frequently precipitated by emotional frustration, irritability, redness of face and eyes, bitter taste

Answer 19

D-heat in LIV/GB

Question 20

D-heat in LIV/GB T/P:

Answer 20

T- red tip/edges, yellow sticky coating

P- wiry, rapid

Question 21

blood stg points

Answer 21

SP-10, UB-17

Question 22

DX:

Answer 22

1) 40+
2) sudden lightning like paroxysmal pain in 1 or more branches of 5th cranial nerve
3) trigger points- around mouth

Question 23

differentiate:

Answer 23

1) toothache
2) migraine (4 stages- preheadache, neuralgia stage, headache, postheadache)
3) cluster headaches

Question 24

Qi and blood xu points

Answer 24

ST-36, RN-6

Question 25

invasion W-c points

Answer 25

LI-4, GB-20

Question 26

obstruction w-PH points

Answer 26

ST-40, GB-20

Question 27

D-heat in LIV/GB points

Answer 27

GB-20, LIV-3

Question 28

flare up ST-fire points

Answer 28

ST-44, LI-11

Question 29

flare up XU fire points

Answer 29

K-3, SP-6

Question 30

definition:

Answer 30

sudden, lightning-like paroxysms of pain in the distribution of one or more divisions of the trigeminal nerve due to primary and secondary injuries of the nerve.

Question 31

SHI VS XU:

Answer 31

SHI VS XU
acute, severe chronic, dull
distending, burning pain constant, hollow pain
short duration long duration
less frequent more frequent
contracting pain lingering pain

Question 32

which patterns are the most common in clinic?

Answer 32

1) W-C
2) D-heat in LIV/GB
3) flare up XU fire
4) blood stg

Question 33

POT:

Answer 33

circ. collaterals, move blood to stop pain

Question 34

severe case tx:

Answer 34

long retention (1 hour)

Question 35

which meridians affected?

Answer 35

yangming

shaoyang

Question 36

common points:

Answer 36

general: ST-7, SI-19, ashi
distal: LI-3/4, SJ-3/5, ST-44, Liv 3
local: opthalmic branch (eye): UB-2, GB-14, yuyao
maxillary branch (nose): ST-2/3, SI-18
mandibular branch: jia cheng jiang, ST-4/5/6

Question 37

ALT remedies:

Answer 37

acute treat twice a week
Retain needle 30 min

1) moxa (cold)
2) electro: mixed wave (200/50 Hz= SHI, 25/5 Hz= XU) 10-15 min
* for during the attack only!!(cant trigger attack during remission)
3) herbs
4) auricular (bleed ear apex first, temple, forehead, jaw, shenmen, sympathetic, subcortex, LIV, SP, ST)

Question 38

EDU:

Answer 38

1) avoid EPF
2) reg. emotions
3) reg. sexual activity
4) reg. diet

Question 39

V1 points

Answer 39

Yuyao 
St 8
SJ 23
GB 14
UB 2

Question 40

V2 Points

Answer 40

ST 2/7
SI 18
LI 20

Question 41

V3 Points

Answer 41

Jia Cheng Jiang

ST 4/5/6