Trigeminal neuralgia is a transient and recurrent severe pain in the distribution of the trigeminal nerve of unknown origin. There are two types of trigeminal neuralgia, primary and secondary, the latter with clear secondary factors and the former with unknown etiology. In this article, we focus on primary trigeminal neuralgia.
Trigeminal neuralgia can be classified as “headache” and “head wind” in Chinese medicine.
Etiology and pathology
The occurrence of this disease is related to the blockage of the ligaments by external evil (wind evil is the main cause, easily mixed with cold and heat), wind-phlegm blockage, fire-heat attack, Yin deficiency and Yang hyperactivity, and blood stasis blocking the ligaments. The main point of the disease mechanism is the occlusion of the ligaments and veins, which is painful if they do not pass. The location of the disease is mainly in the facial meridians and is closely related to the liver, gallbladder, spleen, stomach and other internal organs.
Identification and classification
1. Wind-cold attack on the ligaments: transient sharp pain like cutting on the face, triggered or aggravated by cold, with tightness on the face during attack, localized warmth, evil wind-cold, no thirst, thin white fur, floating and tight pulse.
2. Wind-heat injury evidence: transient burning or cutting-like pain on the face, aggravated by heat, slightly reduced by cooling, red face when painful, accompanied by fever, evil wind, dry mouth and sore throat, red tongue, thin yellow moss, floating pulse.
3, Stomach fire attack evidence: facial paroxysmal burning pain, forehead pain, red face and eyes, gum swelling and pain, dry mouth, thirst for cold drinks, constipation and urination, red tongue, yellow moss, smooth pulse.
4, liver and gallbladder fire incandescence evidence: facial paroxysmal electric shock-like severe pain, burning cheeks, red face and eyes, dizziness, irritability, bitter mouth and dry throat, chest fullness, constipation, urinary redness, red tongue, yellow dry coating, pulse string count.
5. Wind-phlegm obstruction: painful facial twitching, numbness, dizziness, stuffiness in the chest and epigastrium, vomiting and salivation, white and greasy coating, smooth pulse.
6. Internal obstruction of blood stasis: repeated facial pains, like needles and knives when severe, dark face, no obvious cold or heat inducements, purple tongue or petechiae, string and astringent or fine pulse.
7.Yin deficiency and Yang hyperactivity evidence: prolonged illness or elderly patients, facial paroxysmal convulsion-like severe pain, dizziness, insomnia, irritability, dry throat and bitter mouth, soreness and weakness of the waist and knees, red tongue with little fluid, thin and counted pulse.
Diagnosis and treatment
1. Wind and cold attacking the ligament
[Treatment] Dispersing wind and cold, promoting circulation and relieving pain.
[Chuanxiong Xiong Cha Tiao San plus or minus.
2.Wind-heat injury to ligaments
[Treatment] Drain wind-heat, clear heat, clear ligaments and relieve pain.
[Remedy] Ligusticum dahurianum and gypsum soup with addition and subtraction.
3.Stomach fire attack
[Treatment] Clear the stomach and relieve fire.
[Remedy] Clear Stomach San with addition and subtraction.
4.Incandescent liver and gallbladder fire
[Treatment] Clearing the liver and draining heat, lowering fire and relieving pain.
[Remedy] Gentian and liver diarrhea soup with addition and subtraction.
5.Wind and phlegm blocking the ligament
[Treatment] Expel wind and phlegm, relieve spasm and pain.
[Remedy] Purging phlegm with addition and subtraction.
6.Blood stasis and internal obstruction
[Treatment] Promoting blood circulation, resolving blood stasis, promoting circulation and relieving pain.
[Remedy] Tongkang and Blood circulation Tang with addition and subtraction.
7.Yin deficiency and Yang hyperactivity
[Treatment] Nourishing Yin and submerging Yang, resting wind and clearing ligaments.
[Remedy] Tianma and Hooked Vine Drink with addition and subtraction.
Empirical formula
1.Ephedra with seeds and pine soup with added flavor
[Drug composition] 9 grams of Ephedra, 10 grams of Radix et Rhizoma, 4-6 grams of Radix et Rhizoma, 6-9 grams of Beechwood.
[Indications] Wind-cold obstruction.
2.Xi Feng He Yang Tang with Addition
[Drug composition] Radix et Rhizoma Dioscoreae, Radix Paeoniae Alba, Dampi, Radix cassiae (first decoction), Mother-of-pearl, Radix nux vomicae, Antelope’s horn, Crotalus, Tribulus terrestris, Mulberry leaf, Chrysanthemum, Sclerotium, Cicada molasses.
[Indications] Yin deficiency and wind movement evidence.
3.Shuguang trigeminal neuralgia formula
[Drug Composition] 9 grams each of Acanthopanax charcoal, Silkworm, Tribulus terrestris, and fried cranberry, 30 grams each of raw cassia (first decoction), 12 grams each of fried yuan hu and hooked vine (later entry), 4.5 grams each of dahurica dahurica and Chen Pi, and 3 grams of whole scorpion powder (separately swallowed).
[Indications] Wind-phlegm obstruction.
4.Healing Pain San
[Drug composition] 150g of whole scorpion, 100g of white dahurica, 200g of each of dahurica, Chuanxiong and Stachybotrys.
[Indications] Trigeminal neuralgia.
[Usage] Powdered and mixed, 2 grams each time, taken twice daily with hot wine, 10 days as a course of treatment, generally 2-3 courses of treatment.
5.Peach Red Soup with Spasm Stopper
[Drug composition] 10 grams of peach kernel, 5 grams of safflower, 12 grams each of red peony, Chuanxiong and white silkworm, 30 grams of salvia, two centipedes, 4.5 grams of whole scorpion (research and swallow).
[Indications] Evidence of internal obstruction of blood stasis.
6.Chuanxiong Xiong Pain Relief Soup
[Composition] Chuanxiong 20-30 grams, Thornbush, Bupleurum, Scorpion, Wicker, 10-12 grams each, Centipede, Tianma, 10 grams each, Hessian 3-6 grams.
[Indications] Wind-cold attacking the ligament.
7.Trigeminal Pain Relief Soup
[Composition] 20 grams of raw gypsum, 9 grams each of Huang Lian, Sheng Di Huang, Angelica sinensis and Dang Pi, 12 grams each of Chuan Xiong and Bai Zhi, 6 grams each of Sheng Ma, Hossein, Chuan Pepper, All Scorpion and Stiff Silkworm.
[Indications] Stomach fire attack evidence.
8.San Worm Capsule
[Drug composition] Equal parts each of Di Long, Tu Fu Zi, and Stiffworm.
[Indications] Wind-phlegm obstruction.
[Usage] Dried and powdered, packed into capsules, about 0.5 grams per capsule, 4 capsules each time, 3 times a day.
Chinese Prepared Medicine
1.Xiongju Shangqing Pill
[Indications] Stomach fire attack and wind-heat disturbance.
2.Yangjiao Punch
[Indications] Evidence of liver fire attack.
3.Yuanhu Pain Relief Capsule
Appropriate techniques
1.Acupuncture
[Acupuncture points] Eye branch: Zanzhu, Yangbai, Yuzhang, Taichong.
Maxillary branch: Sibai, zygomatic s, xiaoguan, neiting, pupil s.
Mandibular branch: Chengjiao, Cheek Che, Hearing, Hegu, Daying.
[Operation] 2 to 3 points at a time, 1 to 2 times daily, with strong stimulation.
2.Front acupuncture points
[Acupuncture points] The main acupuncture point is taken from the Sun, the 1st branch pain with Yangbai through the fish waist; the 2nd branch pain with Sibai; the 3rd branch pain with Shimonoseki and Chengjue; wind chill with Fengchi and Hegu; liver and stomach fire with Neiting and Yanglingquan; Yin deficiency fire with Zhaohai, Sanyinjiao, Taichong and Taixi.
[Operation] Sterilize the sharp needle and puncture the main acupuncture point, about 0.2-0.3 cm into the needle, and immediately after starting the needle, pull the fire cupping to make 2-3 ml of bleeding. The supporting points are pricked with a milli-needle, tonic deficiency, diarrhea cold plus moxibustion. Stab once every two days, 3 times as a course of treatment, the interval between courses of treatment 3 to 5 days.
3.Water acupuncture
[Main points] Shimonoseki, Hegu, and Aye points.
[matching points] Branch 1 add Sun, Zanzhu and Yangbai points; Branch 2 add Sibai, Zygomatic s and Yingxiang points; Branch 3 add Bu Che, Di Cang and Chengjiao points.
[Drug] Prednisolone acetate 25 mg, 1% procaine 10 ml, vitamin B12 250 mcg.
[Operation] Routinely sterilize the local area, pierce the acupuncture point with a No. 5 injection needle, and then inject 0.5 ml of the prepared drug solution when the patient feels the needle and draws back the syringe without returning blood, treat once every 7 days, 3 times as a course of treatment.
4.Auricular acupressure method
[acupuncture points] cheeks, upper jaw, forehead, Shen Men.
[Operation] Apply the seeds of Wang Bu Liuxing to the acupuncture points with adhesive tape and press them 3 to 5 times a day for 3 to 5 minutes each time, and replace them once every 3 to 6 days.
5.External application
(1) Externally applied formula Ⅰ
[Drug Composition] One centipede, 10 grams of ground dragon, 10 grams of mole crickets, 10 grams of five times the seeds, 15 grams of raw gall bladder, 10 grams of raw half asia, 10 grams of white fenugreek, 10 grams of mucuna pruriens.
[Usage] Finely powdered: take an appropriate amount each time, mix with vinegar into a cake, apply to the affected temple, cover with gauze dressing and fix with adhesive tape, change the medicine once a day.
(2) Externally applied formula Ⅱ
[Drug Composition] Equal parts each of raw aconite, raw nancellus and white fenugreek.
[Usage] Finely grind together, add one white onion with beard, 5 slices of ginger, chopped and pounded like mud, mix well, wrap with gauze and steam hot, apply to the painful area.
(3) External application formula Ⅲ
[Drug Composition] 10g of camphor, 10g of pseudostellaria, 12g of peppermint, 15g of wujiapi, 30g of scorpion, 30g of tortoise shell gum, 30g of angelica, 30g of angelica dahurica, 30g of bone fungus, 45g of dandelion, 45g of zihua dingding, 45g of Chuanxiong.
[Usage] Except for camphor and gum, all are concocted, dried and crushed. 500-750 grams of sesame oil is taken and boiled in a pot until water drips into pearls. Each pill is 3 grams, when using slightly warmed and pressed into a round cake, paste the affected side, according to the different nerves involved, choose different points, once every 3 days.
(4) Bai Wu Paste
[Drug composition] 15 grams each of raw Chuan Wu and raw Cao Wu, 15 grams of Angelica dahurica, 100 grams of Huang Dan and 100 grams of sesame oil.
[Usage] Soak the above medicine in sesame oil for 24 hours, fry and remove the dregs, slowly pour in the yellow dahurian, boil into a paste, then pour into cold water and dip for 24 hours (to remove the fire poison) and set aside. Heat a little of the ointment and spread it on gauze and put it on the affected area, and change it once every 5 days.