bubble_chart Concept

Facial pain refers to the symptom of pain in part or the entire skin, bones, and other tissues of the face. Clinically, pain on one side of the face is the most common.

Neijing mentions "pain in both jaws" and "cheek pain". Yixue Gangmu, "Xue Ji Medical Cases", Puji Benshi Fang all contain medical cases treating facial pain.

Additionally, conditions such as mumps, maxillary osteomyelitis, toothache, eye diseases, and nasal diseases can also cause facial pain. However, these conditions often involve local redness and swelling, which differ from simple facial pain, and are not within the scope of discussion in this article.

bubble_chart Pattern Analysis

1. Wind-heat with Phlegm Obstructing the Collaterals︰The pain is often paroxysmal, burning, or knife-like and unbearable. Sometimes there are trigger points near the nose or lips, and accidental stimulation can suddenly trigger an episode of pain. Pain is more common in the middle and lower parts of the face, but it can also involve the entire half of the face. Bilateral pain is rare. During the attack, the face may turn red, and sweating occurs. The pain worsens with heat and slightly alleviates with cold. It may also be accompanied by fever, dry mouth, dark urine, a red tongue with yellow and dry coating, and a wiry, rapid pulse. If phlegm-fire obstructs the collaterals, additional symptoms such as dizziness, chest tightness, limb numbness, a red tongue with yellow and greasy coating, and a slippery, rapid pulse may appear. The head and face are where the yang meridians of the body converge. The foot three yang Jingjin combine at the cheekbone (zygomatic region), while the hand three yang Jingjin meet at the temples (lateral head). If there is an inherent spleen deficiency with internal excess of phlegm-dampness, compounded by invasion of wind-heat or wind-cold, wind pathogens carrying phlegm block the meridians, leading to obstruction of the collaterals—"obstruction causes pain." Wind, being a yang pathogen, is swift and changeable. When wind carries phlegm, it may gather and disperse abruptly, resulting in sudden and intermittent pain. If wind-heat carries phlegm, it may also manifest signs of external contraction of wind-heat (flushed face, red eyes, preference for cold, red tongue with yellow coating, rapid pulse, or mild fever with aversion to wind and cold). The treatment should focus on dispersing wind, clearing heat, resolving phlegm, and harmonizing the collaterals. The self-prescribed "Trigeminal Neuralgia Formula No. 1" is recommended.
2. Wind-cold Phlegm Obstruction︰It is mostly paroxysmal, twitching-like pain, severe and unbearable, with pale complexion during the pain, aggravated by cold and relieved by warmth, pale tongue with thin white coating, and tight pulse. If caused by cold-phlegm obstructing the collaterals, it may also manifest as facial puffiness, a heavy-headed sensation, pale and swollen tongue with thick white greasy coating, and soggy-slippery pulse. The head and face are the convergence points of all yang meridians of the body. The foot three yang Jingjin combine at the cheekbone (facial zygomatic region), while the hand three yang Jingjin converge at the temple (lateral head area). If the patient has inherent spleen deficiency and internal exuberance of phlegm-dampness, coupled with invasion of wind-heat or wind-cold, wind-pathogen carrying phlegm obstructs the meridians and collaterals, leading to blockage of the vessels—"blockage causes pain." Wind is a yang pathogen, characterized by rapid movement and frequent changes. When wind-pathogen carries phlegm, it may suddenly gather or disperse, resulting in intermittent pain. If it is wind-cold carrying phlegm, it may also present with signs of external contraction of wind-cold (non-flushed face, preference for warmth, pale tongue with thin white moist coating, tight pulse, or accompanied by fever and significant aversion to cold). The treatment should focus on dispersing wind and dissipating cold, clearing phlegm, and unblocking collaterals, using the self-formulated "Trigeminal Neuralgia No. II Prescription."
3. Liver Depression Transforming into Fire︰Facial burning pain, often triggered by emotional depression or sudden anger, worsens with heat, accompanied by a bitter taste in the mouth, dry throat, irritability, chest tightness, hypochondriac fullness, frequent sighing, feverish sensation in the palms and soles, restless sleep, dark yellow urine, dry stools, a red tongue with yellow and dry coating, and a wiry and rapid pulse. From the perspective of disease etiology, liver depression transforming into fire is often caused by excessive worry or anger damaging the liver, leading to the loss of its free-flowing nature and the subsequent generation of fire. When liver fire flares upward, it results in facial pain. This condition is also marked by clear symptoms of liver fire, such as red eyes, flushed face, hypochondriac pain, distension, irritability, bitter taste in the mouth, dry throat, a red tongue with yellow and dry coating, and a wiry and rapid pulse. The treatment should focus on clearing the liver and draining fire, as well as dredging the meridians and activating collaterals, using the self-formulated "Trigeminal Neuralgia Formula No. III."
4. Qi Deficiency and Blood Stasis︰In cases of long-standing trigeminal neuralgia, the pain persists for extended periods, with diminished episodic characteristics, and manifests as unbearable stabbing pain that remains fixed in location. The complexion appears dull; in severe cases, the skin may become scaly. Occasionally, the pain is accompanied by convulsions, aversion to wind, spontaneous sweating, shortness of breath, reluctance to speak, and a faint, weak voice. The tongue appears pale or may have static blood spots, and the pulse is deep, thin, and weak. Qi deficiency and blood stasis often result from years of trigeminal neuralgia, leading to depletion of qi and blood, pathogenic factors entering the blood and collaterals, and stagnation in the vessels. Hence, the tongue appears pale or with stasis spots, and the pulse is deep, thin, and weak. Treatment should focus on replenishing qi and invigorating blood, dispelling stasis to unblock collaterals, using the self-formulated "Trigeminal Neuralgia Formula IV."

Clinically, the aforementioned syndromes often present in a complex and intermingled manner, and treatment should accordingly address all aspects. However, when pain persists for a long time, the pathogenic factors often penetrate deeply into the blood vessels, necessitating the inclusion of insect-based medicines for thorough elimination, such as scorpion, centipede, stiff silkworm, and ground beetle, to achieve efficacy.

bubble_chart Documentation

1. Zhengzhi Zhunsheng-Zabing: "Trigeminal neuralgia is all related to fire, ... sudden pain is mostly due to excess, long-term pain is mostly due to deficiency. Adverse rising treated by inhibition, depression should be opened, blood heat should be cooled, qi deficiency should be tonified, and one should not solely focus on clearing heat with bitter cold."
2. Zhangshi Yitong: "There was an elderly person who overworked and experienced trigeminal neuralgia when hungry, Middle-Tonifying Qi-Replenishing Decoction was added with Scutellaria, Gardenia, Forsythia, Arctium, and Scrophularia. Due to accumulated depression leading to stomach heat, trigeminal neuralgia developed, Depression-Resolving Pill was added with Gardenia, Forsythia, Fritillaria Bulb, and red tangerine exocarp."