CASE STUDES - Facial Pain Quiz

Question 1

1 Case Study Diagnosis

Answer 1

A 50 year old male complains of pain on the left side of his face, burning, heaviness, and numbness sensation, pain is intermittent but heaviness and numbness is constant, patient is slightly over weight and admits poor diet due to work schedule, he does feel nauseous during pain episode, feels better with cold AC.

What is your diagnosis and explain why?

ANSWER: Facial Pain due to Phlegm Fire Harassing Above

Question 2

2 Case Study Diagnosis

Answer 2

A 65 year old female states that for the past week she has been experiencing facial pain that comes and goes on her right side, she also experiences occasional dizziness and ringing in the ears, low back pain and neck pain, dry mouth and hot flashes and night sweat, patient is always tired and has poor digestion.

What is your diagnosis and explain why?

ANSWER: Facial Pain due to Yin Deficiency/Yang Rising causing Blood Stasis, also Spleen Qi Deficiency

Question 3

3 Case Study Diagnosis

Answer 3

A 35 year old male comes in complaining of a sudden pain on his left side of the head for the past 3 days, very severe, sharp, short in duration but almost unbearable and happen about 10 times a day. Last week he was starting to get sick with a cold but was able to get rid of it with over the counter cold remedies, he still has aversion to cold.

What is your diagnosis and why?

ANSWER: Wind Cold

Question 4

Facial Paralysis/Bell’s Palsy

Distal Points selected based on channel most involved:

Answer 4

Li 4: command point of head/face, if selected could be combined with Liv 3 (reduces wind, pacify Liver)
Sj 5: expels wind and releases exterior, benefits the head, primary and sinew channels run through face.

Question 5

Facial Paralysis/Bell’s Palsy

Local Points & Adjacent Points

Answer 5

Local Points
Gb 14, Bl 2, Yuyao, Sj 23, Gb 1, St 2, Si 18, Li 20, St 7, St 6, St 4, Li 19, Ren 24, Du 26
Adjacent Points
Sj 17, Gb 20, Du 16

Question 6

Facial Paralysis following a stroke (Wind-Stroke) is

called what in Western medicine?

Answer 6

Central facial paralysis - since it comes from damage to the central nervous system

Question 7

Peripheral facial paralysis occurring without a stroke is due to injury to the ______ nerves alone.

Answer 7

Peripheral

Question 8

In facial paralysis following a stroke (Wind-Stroke) the nerves located ________ are not affected.

Answer 8

Above the Eye

i.e. movement of eyebrows/frowning are not affected but there will be deviation of the eye and mouth.

Question 9

In peripheral facial paralysis the patient will only be able to move _________ when trying to frown.

Answer 9

One Eyebrow

Question 10

Treatment for Facial Paralysis following a stroke and Peripheral Facial Paralysis are treated differently or similarly in TCM?

Answer 10

Similarly

Question 11

Central facial paralysis (Wind-Stroke) is due to _______Wind, while peripheral facial paralysis is due to ______Wind.

Answer 11

Central (Wind-Stroke) = Internal

Peripheral (Bell’s Palsy) = External

Question 12

Facial Paralysis/Bell’s Palsy

Upon physical examination, the patient should be asked to ___________ in order to identify the extent of the paralysis and help with local point selection.

Answer 12

close eyes
frown
smile
whistle
bulge the cheeks

Question 13

______ points should needled with ______ methods if conditions has been suffered for less than a month, and ______ methods if condition has been suffered for longer

Answer 13

Less than 1 month = Distal points w/ reducing methods

More than 1 month = even methods

Question 14

For very prolonged cases ________ and/or _______ may be used over affected area

Answer 14

Moxibustion

Cupping

Question 15

Local points can be selected based on which of the Trigeminal nerve is affected. To determine nerve, the practitioner should observe the area where pain is manifesting, then perform this simple method of assessment:

Answer 15

If pain is felt when pressing BL 2, 1st branch (Opthalmic) is affected, St 2, 2nd branch (Maxilary) is affected, St 5 3rd branch (Mandibular) is affected.

Question 16

Local Points for Facial Pain

Answer 16

1st Branch: Bl 2, Yu Yao, Tai Yang, Gb 14, Li 20, ashi pts.
2nd Branch: St 2, St 3, Si 18, St 7, ashi pts.
3rd Branch: St 6, St 5, St 4, Ren 24, St 7, Jia Cheng Giang (1 cun lat to Ren 24) ashi pts.

Question 17

If acute/excess pathology, _______ stimulation is advised.

Answer 17

Strong

Question 18

Besides acupuncture, what forms of treatment could help facial pain?

Answer 18

Herbs will improve results.

Electro Acupuncture could enhance treatment.

Question 19

If just using acupuncture to treat facial pain, how many sessions (minimum) are recommended?

Answer 19

2 sessions minimum per week, 3 being better.

Question 20

Facial Pain

Defined as…
Onset…
Characteristics…

Answer 20

severe intermittent pain in the facial region.
Onset is usually abrupt.
Described as an electric shock, sharp, burning.

Question 21

Facial Pain is referred to in Western Medicine as

Answer 21

Trigeminal Neuralgia

Question 22

Location of Facial Pain

Answer 22

Around periorbital, over nasolabial grove, cheek bones (maxillary, zygomatic), and mandible.

Question 23

If ____, ____, ____ invade the body from the outside, it may lodge in the channels of the face where they may obstruct the free flow of _____ & _____ and thus cause pain

Answer 23

Wind, Cold, Heat

Qi & Blood

Question 24

_______ factors can cause liver depression which can cause fire and affect the paired channel Shao Yang (___) of the face and its Divergent Channel.

Answer 24

Emotional

SJ

Question 25

Facial pain due to Cold, Wind or Heat is more commonly seen in the elderly due to...

Answer 25

Wei Qi being deficient and unable to protect the body, this will eventually cause Blood Stasis and pain.

Question 26

Physical factors affecting Facial Pain. | By age 40...

Answer 26

Yin is half consumed, so Yin Blood fails to nourish and moisten the LV impairing its coursing Yin also fails to control Yang allowing it to become hyperactive and resulting in Liver Yang Raising This also influences KD Yang's warming and steaming functions being deficient with age.

Question 27

Spleen vacuity (Def) or Qi stagnation can evolve into __________ which can transform into _____ and obstruct the channels.

Answer 27

Endogenous Dampness | Phlegm

Question 28

If Spleen deficiency reaches the KD, it can result is _____. Furthermore, _____, _____, ____ may result in Blood Stasis.

Answer 28

Yang Deficiency | Qi Def, Qi Stag, Yin/Yang Def

Question 29

Identification of Patterns and Treatment of Facial Pain - Wind Cold & Phlegm Sx

Answer 29

Abrupt onset of recurrent episodes Spastic, cramping, cutting pain, severe, difficult to bear, like an electric shock Attacks only lasting a few seconds or minutes accompanied by pale complexion Pain is aggravated by cold and improves w/heat Pressure induces pain Other Sx: runny nose, lacrimation, salivation

Question 30

Identification of Patterns and Treatment of Facial Pain - Wind Cold & Phlegm Tx Principle

Answer 30

Course wind Scatter Cold Resolve Dampness Remove obstruction from channels

Question 31

Identification of Patterns and Treatment of Facial Pain - Wind Cold & Phlegm Main acupuncture points

Answer 31

Gb 20: expel pathogenic wind Li 4: command point for face/mouth, courses wind, scatters cold. Lu 7: command point for the head and neck, courses wind, scatters cold. Local points depending upon region of pain.

Question 32

Identification of Patterns and Treatment of Facial Pain - Wind Heat & Phlegm

Answer 32

Abrupt onset of recurrent episodes Burning/hot, cutting, piercing pain difficult to bear, affecting mostly one side of head/face Red facial complexion & sweating during episode Aggravated by heat, better with cold, possible dry mouth

Question 33

Identification of Patterns and Treatment of Facial Pain - Wind Heat & Phlegm Tx Principle

Answer 33

Course Wind Scatter Heat Resolve phlegm Remove obstruction from channels

Question 34

Identification of Patterns and Treatment of Facial Pain - Wind Heat & Phlegm Main acupuncture points

Answer 34

Li 4: command point for face/mouth, courses wind, scatters heat. Sj 5: courses heat, scatters heat. Gb 20: expel pathogenic wind Local points depending upon region of pain

Question 35

Identification of Patterns and Treatment of Facial Pain - Wind Cold & Phlegm Tongue & Pulse

Answer 35

T: Thin white coat, P: Tight. If Phlegm also, facial puffiness T: pale, fat w/thick white slimy coat, P: rolling tight.

Question 36

Identification of Patterns and Treatment of Facial Pain - Wind Heat & Phlegm Tongue & Pulse

Answer 36

T: Red with yellow coat, P: Tight rapid. If phlegm, there will also be dizziness, numbness of the limbs, chest oppression, T: Thick slimy yellow coat, P: Tight slippery rapid

Question 37

Identification of Patterns and Treatment of Facial Pain - Liver Qi Stagnation causing Liv Fire Sx

Answer 37

One-sided head and facial burning pain Irritability, anger, depression, red face and eyes, HA Pain is aggravated by emotional distress In severe cases - muscle spasms & facial ticks Other possible Sx - dry mouth/throat, sighing, sleep disturbance, dark yellow urine T: Red w/ dry coat, P: Tight rapid

Question 38

Identification of Patterns and Treatment of Facial Pain - Liver Qi Stagnation causing Liv Fire Tx Principle

Answer 38

Course Liver Drain Fire Free flow of Qi on the channels

Question 39

Identification of Patterns and Treatment of Facial Pain - Liver Qi Stagnation causing Liv Fire Main acupuncture points

Answer 39

Li 4: command point for the face and mouth Liv 2: clears the Liver and drains Heat Gb 41: clears the Liver and drains Heat Local points depending upon the region of pain

Question 40

Identification of Patterns and Treatment of Facial Pain - Phlegm obstructing the channels

Answer 40

Piercing one side face/head pain accompanied by heaviness and/or numbness Possible vomiting at time of pain T: Dark pale w/ glossy slippery coat, P: Slippery

Question 41

Identification of Patterns and Treatment of Facial Pain - Phlegm obstructing the channels Tx Principle

Answer 41

Resolve phlegm | Free the flow in the vessels

Question 42

Identification of Patterns and Treatment of Facial Pain - Phlegm obstructing the channels Main acupuncture points

Answer 42

Li 4: command point for the face/mouth Sp 6: move blood and remove stasis St 40: transform phlegm Local points depending upon region of pain

Question 43

Identification of Patterns and Treatment of Facial Pain - Phlegm Fire Harassing Above Sx

Answer 43

``` Oppression, burning, distention and pain Desire for cold to be placed in the affected area Dry mouth but no desire to drink Feeling of heaviness of the head, chest Abdominal oppression and distention Occasional vomiting, drool, irritability T: Red w/ slimy yellow coat, bowstring, P: Rolling rapid ```

Question 44

Identification of Patterns and Treatment of Facial Pain - Phlegm Fire Harassing Above Tx Principle

Answer 44

Transform phlegm Clear Heat Free the flow in the channels and stop pain

Question 45

Identification of Patterns and Treatment of Facial Pain - Phlegm Fire Harassing Above Main acupuncture points

Answer 45

Li 4: command point for the face/mouth (better for lower jaw) St 40: transforms phlegm St 44: clear heat (better for upper jaw) If heat is more from LV depression than ST, then substitute Liv 2 for St 44 Local points depending upon region of pain

Question 46

Identification of Patterns and Treatment of Facial Pain - Qi deficiency & Blood stasis Sx

Answer 46

More enduring and continuous chronic aching/pain, unbearable and piercing Dark complexion, Possible tics following pain Fear of wind, spontaneous sweating, tiredness, no desire to speak, low voice T: pale white w/ purple spots, P: deep fine weak

Question 47

Identification of Patterns and Treatment of Facial Pain - Qi deficiency & Blood stasis Tx Principle

Answer 47

Tonify Qi Quicken the Blood Free the flow on the vessels Stop pain

Question 48

Identification of Patterns and Treatment of Facial Pain - Qi deficiency & Blood stasis Main acupuncture points

Answer 48

Li 4: command point for face/mouth Sp 6: moves blood and remove stasis St 36: supplements the center and boost Qi Local points depending upon region of pain.

Question 49

Identification of Patterns and Treatment of Facial Pain - Yin deficiency/Yang Rising & Blood stasis Sx

Answer 49

Recurrent episodes of severe, burning/hot, fixed, one-sided facial/head pain Afternoon tidal fever, malar flush, dizziness, Tinnitus, LBP, knee soreness, agitation, red eyes T: Red w/ thin yellow or dry coat, bowstring P: Fine rapid

Question 50

Identification of Patterns and Treatment of Facial Pain - Yin deficiency/Yang Rising & Blood stasis Tx Principle

Answer 50

Supplement Kidneys Nourish Yin Clear Heat Free the flow of the channels

Question 51

Identification of Patterns and Treatment of Facial Pain - Yin deficiency/Yang Rising & Blood stasis Main acupuncture points

Answer 51

Li 4: command point for the face/head. Ki 7: KD channel Water point, enriches Yin, supplements KD. Sp 6: Mtg point of 3 leg yin, supplementing KD, LV, Sp. Local points depending upon region of pain