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Prosopalgia

[Introduction]

Prosopalgia refers to recurrent, short, paroxysmal, lightning-like, stabbing or burning pain in the trigeminal region. Clinically the second and third branches of trigeminal nerve on one side are often involved. Prosopal-gia often occurs among people over 40, especially women. It is either primary or secondary. Clinically primary pros-opalgia is usually encountered. The following discussion mainly focuses on primary prosopalgia. This disease per-rains to the conception of "facial pain" in TCM. It is usu-ally caused by wind attacking the meridians, or upward adverse flow of liver and stomach fire, or consumption of qi and blood as well as stagnation of the vessels and meridians.

[Syndrome differentiation]

1. Wind attacking meridians

Constant severe facial pain like stabbing and burning, accompanied by aversion to wind or sweating, nasal ob-struction and running nose, thin and white tongue fur, taut and tense or taut and slippery pulse.

2. Upward adverse flow of liver and stomach fire

Facial pain accompanied by dysphoria and susceptibil-ity to rage, flushed cheeks and excessive eye secretion, dryness and bitter taste in the mouth, yellow urine and constipation, red tongue with yellow fur, taut, rapid and slippery pulse.

3. Consumption of qi and blood as well as stag-nation in the vessels and meridians

Lingering illness, moderate pain, spiritual lassitude and fatigue, lusterless complexion, light-colored tongue or with purplish appearance and ecchymoses, thin and weak pulse.

[Treatment]

1. Body acupuncture

Prescription: Hegu (LI 4) ; Taiyang (EX-HN 5 ), Cuanzhu (BL 2) and Yangbai (GB 14) for pain of the first branch; Sibai (ST 2), Yingxiang (LI 20) and 0uanliao (SI 18) for pain of the second branch; Xiaguan (ST 7), Da-ying (ST 5) and Jiachengjiang (Ext.) for pain of the third branch.

Modification: For wind attacking the meridians, Waiguan (TE 15) and Fengchi (GB 20) are added; for up-ward adverse flow of liver and stomach fire, Taichong (LR 3) and Neiting (ST 44) are added; for consumption of qi and blood as well as stagnation in the vessels and me-ridians, Sanyinjiao (SP 6), Zusanli (ST 36) and Geshu (BL 17) are added.

Performance: Local selection of acupoints is made according to the pathological conditions. Twirling and ro-tating or mild reinforcing and reducing needling tech-niques are used. Hegu (LI 4) is needled with reducing needling technique; Sanyinjiao (SP 6 ) and Zusanli ( ST 36) are needled with reinforcing needling technique with the addition of moxibustion; Geshu (BL 17 ) is needled with mild reinforcing and reducing needling techniques. The manipulative techniques for the local acupoints should be mild, while the manipulative techniques for the distal acupoints should be drastic. The needles are retained for 30 minutes or for 1 hour for severe cases and manipulated several times at intervals according to the pathological conditions. The needling is done once a day or once every other day for patients with chronic disease or weak consti-tution.

2. Ear acupuncture

Prescription: Forehead (AT1), Mandible (L03), Ear Shenmen (TF4), Cheeks (LOs, 6i ) and Sympathetic (AH6a).

Performance: Each time 2 - 3 acupoints are selected and needled with strong stimulation. The needles are re-tained for 30 minutes. Or Wangbuliuxingzi (Semen Vaccariae) is used for ear pressure on both ears in alter-nation. The patients are advised to press themselves 3 - 4 times a day and 2 - 3 minutes each time.


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