Trigeminal Neuralgia

Question 1

List the most common branches that are involved and the least common?

Answer 1

V2 and V3 or V2 alone

V1 occurs in 5% of patients only

Question 2

Which season does it get worse in?

Answer 2

Fall and Spring time

Question 3

which meridians are involved?

Answer 3

Yangming and shaoyang on the face

Question 4

how would you diagnose someone with trigeminal neuralgia

Answer 4

Age group - patients over 40, by 40 years old half of yin has been consumed
characteristics - sudden, lightning like, paroxysmal in one or more of the branches of the 5th cranial nerve
trigger points usually around the mouth
Medical history is very important

Question 5

List the 3 excess patterns

Answer 5

Invasion of W-C
Damp heat in LV and GB
Flare up of ST fire

Question 6

acute onset, severe contract pain which is alleviated by warmth and aggravated by wind cold, aversion to wind cold, headache, running nose

tongue: thin and white coating
pulse: floating and tight

Answer 6

wind cold invasion

Question 7

paroxysmal burning pain, referred to the corner of the head, frequently precipitated by emotional frustration, irritability redness of the face and eyes, bitter taste
Tongue: red tip and edge, yellow and sticky coating
pulse: rapid and wiry

Answer 7

Damp heat in LV and GB

Question 8

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

tongue: red tongue with yellow coating
pulse: slippery and rapid or flooding

Answer 8

Flare up of ST fire

Question 9

List the deficiency patterns

Answer 9

Flare up of deficiency fire

Qi and Blood Deficiency

Question 10

And list the mix pattern with an underlying deficiency

Answer 10

Obstruction by wind phlegm

Question 11

list the 7 patterns

Answer 11

Qi and Blood deficiency
Blood Stasis
Obstruction by wind phlegm 
Flare up of deficiency fire
Flare up of Stomach fire
Damp head in LV and GB 
Invasion of wind cold

Question 12

Dull or distension pain, tic or numbness of the face, aggravated by angry, insomnia, poor memory, soreness and weakness in lumbar region, and yin xu

tongue: red tongue with little or no coating
pulse: thready and rapid

Answer 12

Flare up of deficiency fire

Question 13

Dull pain or numbness of the face, heaviness, and cloudy head, stuffy sensation in the chest, too much sputum, numbness of the face

tongue: puffy tongue with white and sticky coating
pulse: wiry and slippery

Answer 13

Obstruction by wind phlegm

Question 14

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

tongue: dark and purple tongue with petechiae, thin white coating
pulse: wiry and tight or choppy

Answer 14

Quicken blood to stop pain

Question 15

recurrent dull or hollow pain, severe in stand up mild when lie down, aggravated by over load, pale face, fatigue, SOB, poor appetite
Tongue: pale tongue with white coating
pulse: thready

Answer 15

Qi and Blood Xu

Question 16

General treatment protocol

Answer 16

1. Mainly on the face of Yang ming and Shao yang meridian - related to LV and Sp, circulate collaterals, move blood to stop pain
2. Choose points from Yang mind, Shaoyang and Jueyin meridians
3. Reduce for excess, and tonify for Xu, moxa for cold
4. Retain needles for 30 minutes, severe cases retain for 1-2 hours
5. Minimal treatment during attack is twice a week, better if 3x a week

Question 17

what is V1 and which needles would you use?

Answer 17

Opthalmic branch

Yuyao, UB2, GB 14, SJ23, St8

Question 18

V2 and points to use?

Answer 18

Maxillary branch

St2, St7, St3, SI18 and LI 20

Question 19

V3 and points you would use?

Answer 19

Mandibular branch

Jiachengjiang, St 4, 5 and 6

Question 20

Which auricular points would you use?

Answer 20

bleeding ear apex to release heat
forehead, occupital, temple, upper jaw, lower jaw, shen men, sympathetic, subcortex
choose organs that are related to LV, GB and SP

Question 21

Education

Answer 21

1. Avoid xie qi, strong wind
2. regulate emotions and sexual activity
3. Diet, based on pattern, D-H avoid spicy and greasy food
4. Tea - cautious, avoid cooking for too long, light herbals to go up, wind herbals, cook no longer than half and hour
5. Chronic cases - add blood herbals

Question 22

Where are the trigger zones?

Answer 22

Bucca, beside the mouth and beside the nose