The characteristic symptom of trigeminal neuralgia is intense pain (usually described as stabbing, shooting or lightening-like) of short duration along one or more divisions of the trigeminal nerve in the face. Early in the disease process attacks are short (one to two minutes in duration) and infrequent with asymptomatic periods up to several months between them. As the disease advances, however, the attacks last longer and become more frequent. In extreme cases the patient is seldom free from pain. In some cases hypersensitive areas when subjected to light tactile stimulation (such as shaving, brushiing the teeth, talking or eating) are capable of initiating a full-blown attack of trigeminal neuralgia.
The treatment of trigeminal neuralgia is both medical and surgical, but neither is very safe or effective in most cases. Medical management entails the use of various analgesics, carbamazepine (Tegretol) or diphenylhydantoin (Dilantin). The adverse reactions or undesirable side-effects of these drugs, however, can be extremely serious or even fatal.
Surgical therapy includes: 98% alcohol injection into the involved branch of the trigeminal nerve or cutting it as it exits from its cranial foramina or insertion of a piece of plastic. These techniques are hazardous and may result in facial paralysis, but have resulted in remission for as long as 24 months.
Some patients have their teeth pulled in a desperate effort to rid themselves of this excruciating pain which seem like a severe toothache in some cases. but the pain persists.
Acupuncture has a high rate of success for trigeminal neuralgia and is of course safer than drugs or surgery. It has been successful in many cases after surgery has failed to give relief of pain. Usually 6 - 10 treatments are required for relief of pain.
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.