Summary of TCM Treatment Techniques and Approaches for Trigeminal Neuralgia
Author: Gu Yuxi Editor: Gu Yuxi Translator: Gu Yuxi
Western Medicine Definition
Trigeminal nerve is a Western medicine term, referring to the fifth cranial nerve out of the twelve pairs of cranial nerves, and it is one of the mixed cranial nerves. The peripheral processes of the trigeminal ganglion respectively form the three major branches of the trigeminal nerve: the ophthalmic nerve, the maxillary nerve, and the mandibular nerve. In the Western medicine definition, trigeminal neuralgia is a neurological disorder characterized by recurrent episodes of intense pain in the distribution area of the trigeminal nerve (ophthalmic, maxillary, and mandibular branches) on one side of the face, and it is known as ‘the most painful condition in the world.’ The nature of the pain is electric shock-like, knife-like, or tearing, with sudden onset and cessation, each episode lasting from a few seconds to 2 minutes.
Traditional Chinese Medicine Definition
From the perspective of traditional medicine from China, this ailment is classified within the categories of ‘facial discomfort’, ‘cephalic wind’, and ‘malar discomfort’. The ancient medical text Huangdi Neijing calls it ‘primary wind’, and the Zhang Shi Yi Tong refers to it as ‘facial wind discomfort’.
【Ni Haisha】：
Clinically, this discomfort extends along three channels in traditional medicine’s meridian system: the lesser yang of the foot gallbladder channel, the yang brightness of the foot stomach channel, and the lesser yang of the hand triple burner channel. The lesser yang of the hand triple burner channel pertains to the water pathways – the way of water and fire, and the granary of grains; the lesser yang of the foot is the gallbladder channel, and the yang brightness of the foot is the stomach channel.
The activity of all meridians originates from various internal organs. Once this motive force cannot flow freely within the meridians, twitching pain will inevitably occur. Therefore, effectively clearing the meridians is the fundamental solution.
Different medicinals enter different meridians. My prescriptions only use three ingredients that target the aforementioned three channels, maintaining their smooth and unimpeded flow, thus achieving good results.
【Zi Ji】：
Having learned the principles of Si Sheng Xin Yuan (Four Sacred Sources), it is understood that the lesser yang channel of the hand goes from the hand to the head, while the lesser yang channel of the foot goes from the head to the foot; the yang brightness stomach channel of the foot also goes from the head to the foot. The descending of the body’s Qi mechanism, indeed all descending processes, originate from the descending of the stomach earth, with the gallbladder fire descending accordingly to warm the kidney water.
The crucial issue with this ailment is insufficient descending pathways, preventing proper downward movement. This situation necessitates primarily promoting the descending of the stomach, while simultaneously astringing the gallbladder fire.
The failure of the meridians to descend still lies in their obstruction. Therefore, the treatment involves appropriately using blood-activating medicinals to clear the meridians, promoting the descending of the stomach, and astringing the gallbladder fire. Once the gallbladder fire is contained, it needs to be directed downward. If this fire is made to descend, the pain in the trigeminal nerve area at the back of the head can be alleviated.
There is a saying in traditional medicine from China: where there is flow, there is no discomfort; where there is discomfort, there is no flow. This means that if the meridians are obstructed and cannot circulate, the areas before the blockage – those lacking nourishment, lacking the nourishment of ying and wei Qi – will suffer malnourishment and cause discomfort. In front of the obstruction, there will be dull pain, stabbing pain, distending pain, and the pathogenic factors will also be unable to circulate outwards. This is what is meant by where there is no flow, there is discomfort; where there is discomfort, there is no flow.
There are twelve principal meridians, plus the eight extraordinary meridians, totaling twenty. Each medicinal has its specificity, meaning specific ailments have their specific remedies. Medicinals that enter the lesser yang channel are chai hu and white peony root. Medicinals that enter the yang brightness channel are angelica root and kudzu root.
【Li Ke】：
This condition is considered to have a fundamental deficiency of upright Qi as its basis, with the disease mechanism residing in the kidneys, thus treatment should be discussed from the perspective of the kidneys. The Su Wen (Plain Questions) states: “Headache and epilepsy, deficiency below and excess above, the fault lies in the lesser yin of the foot and the greater yang, severely it enters the kidneys.”
Looking at cases over the years, numbering around a hundred, all belonged to the pattern of kidney yin deficiency with the fire of the ministerial fire blazing upwards, without exception. The longer the course of the illness, the more apparent the disease mechanism becomes.
The kidneys are the root of pre-heaven essence, harboring the true fire of the gate of life, being organs of water and fire. Water and fire embrace each other, resulting in the harmony of yin and the secure enclosure of yang. If, due to external contraction or internal injury, water is deficient below, then fire loses its restraint. The ancients likened this to shallow water not nourishing the dragon, thus it strays from its position and ascends. Alternatively, if kidney water is extremely cold, it forces the true fire to float upwards, leading to a pattern of fire not returning to its origin. Moreover, the liver and kidneys share a common origin. If kidney water is deficient, the liver loses its nourishment, and the thunder fire residing in the liver will inevitably blaze upwards along with the dragon fire in the kidneys, forming a conflagration, hence the various manifestations of heat above.
Overall TCM Pattern Differentiation Framework
The following summarizes the treatment techniques and approaches for trigeminal neuralgia, primarily based on the framework and techniques of Lin Jiaming, with supplementary content from other practitioners interspersed.
Lin Jiaming believes that trigeminal neuralgia in many patients can transform into facial muscle spasms and contractures, as well as facial paralysis. These three conditions share similarities in treatment and have many commonalities in their underlying disease mechanisms. In treating trigeminal neuralgia, one must first differentiate according to the six channel theory to establish a foundational formula, and then add specific medicinals for trigeminal neuralgia based on the individual’s condition. Therefore, the summary below is organized according to this framework:
Trigeminal Neuralgia within the Shaoyin bing Framework
Within this, there are also two main types. One is the exterior deficiency cold pattern of the Hu Xishu system, which can also be understood as shen yang xu, and the other is shen yin xu. Lin Jiaming believes that trigeminal neuralgia most commonly manifests clinically as shaoyin bing. Shaoyin bing presents with exterior deficiency cold, and its pain is often accompanied by unresolved exterior conditions and cold. Trigeminal neuralgia is a pain caused by the contracture of the meridians and sinews of the face.
shen yang xu：
【Lin Jiaming’s Traditional Chinese Medicine Treatment Techniques and Approaches】：
The two foundational formulas that Lin Jiaming uses most frequently are Mahuang Fuzi Xixin Tang and Zhenwu Tang.
【Foundational Formula One: Mahuang Fuzi Xixin Tang】
It can guide pathogenic factors outward, leading these factors from the sanyin bing to the sanyang bing. Mahuang Fuzi Xixin Tang in the treatment of trigeminal neuralgia primarily resolves the presence of cold on the exterior and underlying yang xu. This corresponds to a combined shaoyin taiyin hebing, although sometimes there are no exterior symptoms. The patient’s pulse is tight and hesitant, especially in the cun position, while the chi position is deep, thin, and weak. In such cases, Mahuang Fuzi Xixin Tang can be used. Among its components, mahuang not only has the function of inducing sweating and releasing the exterior but also possesses significant analgesic effects, mainly by dispelling cold to relieve pain. Additionally, it has a tong yang (unblocking yang) effect. Mah Huang achieves this by promoting the circulation of yang qi in the upper body; its main role in treating stroke is to promote the circulation of yang qi in our central nervous system. Xixin can separate cold and dampness. Fuzi warms yang. Mah Huang, fuzi, and xixin are three medicinals with a very high standing in the treatment of trigeminal neuralgia.
【Foundational Formula Two: Zhenwu Tang】
The second commonly used formula is Zhenwu Tang. It is also a formula for shaoyin taiyin hebing. Its main manifestations are a hidden, aching pain or a dull pain. Its primary treatment approach involves using baizhu and fuling to strengthen and move the middle jiao, fortify the spleen, and promote water metabolism, resolving the condition through urination. The patient’s presentation includes facial pain, headache, a weak chi pulse, aversion to cold, a swollen tongue, and a red tongue. These two formulas are used most frequently.
【Key Differentiating Points Between Mahuang Fuzi Xixin Tang and Zhenwu Tang】：
1. Mahuang Fuzi Xixin Tang is for pain that is more severe and intense, while Zhenwu Tang is for a hidden, aching pain or a dull pain.
2. The interior deficiency pattern of Zhenwu Tang is more pronounced, showing symptoms of spleen and stomach deficiency with water retention, which is not the case with Mahuang Fuzi Xixin Tang.
3. Lin Jiaming suggests that if it’s truly difficult to differentiate, one can simply combine the two formulas.
【Several TCM Specific Medicinals】：
【Specific Medicinal One: Shaoyao Gancao Tang】
For treating pain, use Shaoyao Gancao Tang. Regardless of the condition – cold or heat, deficiency or excess – based on the previous pattern differentiation, add Shaoyao Gancao Tang. In the original text, this formula treats spasms and contractures, and trigeminal neuralgia presents with these symptoms. The dosage should be 60 to 120 grams. This dosage may potentially cause abdominal pain and diarrhea, but its mechanism is different from that of formulas like Chengqi Tang. Shaoyao Gancao Tang induces diarrhea by promoting intestinal peristalsis and relieving spasms and contractures. If 90 grams are prescribed and the patient is in severe pain and unable to take the medicine, reduce the dosage to 60 grams. If there is only mild pain and slight diarrhea, continue taking it.
【Specific Medicinal Two: Chuanxiong (Rhizoma Chuanxiong)】
Chuanxiong is acrid and dispersing, ascends to the head and eyes, dispels cold, and alleviates pain.
【Specific Medicinal Three: Five Insect Medicinals】
Ten centipedes, 50 grams each of earthworms, jiangcan (Bombyx Batrytricatus), cicada sloughs, and scorpions, ground into powder and put into capsules. They can also be made into pills. Two formulas can be used: the first is Zhijing San (Spasm-Stopping Powder), with scorpions and centipedes. The second is Dizhi Wan (Earthworm and Leech Pill), with earthworms and leeches. This is Zhu Liangchun’s experience.
【Hu Tianxiong’s Traditional Chinese Medicine Treatment Techniques and Approaches】：
“[Formula Name]: Chong Er Bai Yi Cao Tang (Self-Formulated Formula)
[Ingredients]: Cicada slough 5g, jiangcan 10g, scorpion 5g, baifuzi 10g, white peony root 15g, licorice root 5g.
[Pattern Differentiation and Approach]:
The medicinals in this formula are directly indicated in its name, making it easy to remember. ‘Three insects’ (san chong) refers to jiangcan, cicada slough, and scorpion; ‘two whites’ (er bai) refers to baifuzi and white peony root; ‘one herb’ (yi cao) refers to licorice root. The entire formula has the effect of dispelling wind, relieving spasms, and alleviating pain.
I initially formulated this prescription to treat facial nerve spasm in a female accountant, Ms. Chen, in the college’s health clinic. Her facial muscle twitching worsened with tension, causing her great distress due to her concern for her appearance. Coincidentally, I had business at the health clinic and prescribed this formula. Five doses yielded significant improvement, and ten doses resulted in a cure. Blood-nourishing medicinals were used to consolidate the therapeutic effect.
Later, I encountered many patients suffering from trigeminal neuralgia for years. This formula also proved effective for them. The Bie Lu (Miscellaneous Records) states that baifuzi ‘treats hundreds of diseases of the face’, thus it should be the principal medicinal in this formula. For those with blood deficiency and a weak pulse, tonifying Qi and blood should be prioritized before using this formula; one should not be rigid.”
shen yin xu
【Lin Jiaming’s Traditional Chinese Medicine Treatment Techniques and Approaches】：
【Foundational Formula: Yin Huo Tang (Leading Fire Downward Decoction)】
From Chen Shiduo’s Bian Zheng Lu, its composition is: Shudi (san liang), bajitian (yi liang), fuling (wu qian), maidong (yi liang), wuweizi (er qian).
Yin Huo Tang is also frequently used for trigeminal neuralgia caused by upward blazing of deficiency fire. Its main manifestations are a floating and large pulse in both cun positions, which becomes weak upon heavy pressure, a weak chi pulse, and most importantly, a red tongue with little or no coating. This indicates insufficient kidney water. A heavy dosage of shudi is used, 60 to 90 grams, sometimes up to 120 grams, although a regular dosage of 90 grams can usually achieve the desired effect.
[Specific Medicinals]: Add the four specific medicinals mentioned above as needed.
【Li Ke’s Traditional Chinese Medicine Treatment Techniques and Approaches】：
“[Foundational Formula]: Yin Huo Tang combined with a large dose of Shaoyao Gancao Tang
[Specific Medicinals]: Considering the chronic nature of the illness and the prolonged pain having entered the collaterals, add insect medicinals to dredge and eliminate, further using xixin to guide the formula into the shaoyin channel to dispel latent cold while also implying the meaning of venting constrained fire.
[Full Formula Composition]:
Prepared Rehmannia Root (shudi huang) 90g, Salt-cured Morinda Root (yan bajitian), Dwarf Lilyturf Root (tian maidong) each 30g, Poria (yun ling) 15g, Schisandra Fruit (wuweizi) 6g, White Peony Root (bai shao) 100g, Prepared Licorice Root (zhi gancao) 30g, Asarum (xixin) 15g, Whole Scorpions 12 pieces (powdered and taken with the decoction), Centipedes 3 pieces (powdered and taken with the decoction).
For those with spleen and stomach weakness prone to diarrhea, add charred ginger (jiang tan) 10g, Amomum Fruit (sharen) 10g (mixed with the prepared rehmannia root). For those with unconstrained upward flaring of ministerial fire, add cinnamon bark powder (you gui fen) 1.5g (scrape off the rough outer layer, grind into powder, steam glutinous millet to make pills, swallow before taking the medicine), to guide the rootless fire downwards to return to the kidneys, with even faster results.
[Symptoms]: Suffering from primary trigeminal neuralgia for 8 years, with increasingly frequent attacks in recent years. Exposure to wind-cold, extreme joy or anger, overexertion, loud talking, chewing food, washing the face and brushing teeth, and yawning can all trigger the pain. Simultaneously, a sensation of heat rises from the sole of the right foot along the inner side of the leg, attacking the head and face as fast as lightning. Immediately afterwards, the entire right side of the head feels like being bitten by a snake or stung by a scorpion, with burning and electric shock-like excruciating pain, causing crying out and disturbing the neighbors. Each attack lasts about 5 minutes, occurring more than 30 times, having persisted for 3 hours. The pulse is overwhelmingly large, the tongue is dry and red with no coating. There is dizziness, weakness of the legs, ice-cold feet and knees, dry mouth, and dry stools with bowel movements every 3 to 4 days.”
Trigeminal Neuralgia within the Shaoyang bing Framework
【Lin Jiaming’s Traditional Chinese Medicine Treatment Techniques and Approaches】：
【Foundational Formula One: Xiao Chaihu Tang (Minor Bupleurum Decoction)】
For yang patterns, the most important foundational formula is Xiao Chaihu Tang. Some patients with trigeminal neuralgia primarily present with symptoms of the half-exterior, half-interior. The location of the pain can be predominantly on the left or right side. Remember the eight major indications for Xiao Chaihu Tang, but these are not the most crucial, and the eight indications may not necessarily all be present. The key is its role in facilitating the turning point of the illness. Symptoms may include constipation, dry stools, and a white tongue coating. After taking Xiao Chaihu Tang, the upper jiao is unblocked, fluids descend, and the stomach Qi is harmonized.
[Specific Medicinals]: Add the four specific medicinals mentioned above as needed.
【Foundational Formula Two: San Pian Tang (Migraine-Dispelling Decoction)】
Chen Shiduo’s San Pian Tang heavily uses chuanxiong. The dosage of chuanxiong is 30 to 45 grams; I prefer to use 30 grams. The original formula dosage is: chuanxiong (yi liang), baizhi (wu fen), white peony root (baishao) (wu qian), white mustard seed (baijiezi) (san qian), cyperus rhizome (xiangfu) (er qian), chaihu, yuliren, and licorice root (gancao) each (yi qian). San Pian Tang has several underlying principles. First, it contains the structure of Shaoyao Gancao Tang. Second, San Pian Tang closely resembles Zhang Xichun’s Shengxian Tang and shares the approach of Li Dongyuan’s Buzhong Yiqi Tang. Yuliren and xiangfu are used in dosages of 3 to 6 grams. Baijiezi resolves phlegm, working on both internal and external phlegm. Baizhi also dispels cold to alleviate pain and clears the nasal passages. Yuliren can promote bowel movements and moisten the intestines.
[Specific Medicinals]: In this regard, Lin Jiaming did not specifically emphasize adding specific medicinals. Zhu Zhongrui has shared his experience of combining and modifying Wen Dan Tang when using San Pian Tang.
【Jin Wenqing’s Traditional Chinese Medicine Treatment Techniques and Approaches】：
“[Formula Name]: San Pian Ding Tong Yin (Migraine-Dispelling and Pain-Alleviating Drink)
[Ingredients]: Shengdi (Radix Rehmanniae Recens) 30g, danggui (Radix Angelicae Sinensis) 15g, chuanxiong (Rhizoma Chuanxiong) 20g, chishao (Radix Paeoniae Rubra) 20g, baishao (Radix Paeoniae Alba) 20g, taoren (Semen Persicae) 10g, honghua (Flos Carthami) 10g, baojili (Fructus Tribuli) 15g, tianma (Rhizoma Gastrodiae) 10g, shijue ming (Concha Haliotidis) 30g, niubangzi (Fructus Arctii) 20g, shengma (Rhizoma Cimicifugae) 10g, digupi (Cortex Lycii) 30g, baijiezi (Semen Sinapis Albae) 15g, xixin (Radix et Rhizoma Asari) 6g, baizhi (Radix Angelicae Dahuricae) 10g, gancao (Radix Glycyrrhizae) 10g, Zhijing San (Spasm-Stopping Powder) (taken separately) 6g.
[Pattern Differentiation]: Qi stagnation and blood stasis, wind-phlegm obstructing the collaterals.
[Treatment Principle]: Activate blood and unblock the collaterals, pacify the liver and dispel wind, alleviate pain.”
【Xia Duhang’s Traditional Chinese Medicine Treatment Techniques and Approaches】：
“[Formula Name]: Si Wei Shaoyao Tang (Four-Herb Peony Decoction).
[Ingredients]: White Peony Root (baishao) 30g, Raw Oyster Shell (sheng muli) 30g, Salvia Root (danshen) 15g, Licorice Root (gancao) 15g.
[Pattern Differentiation]: Liver Yang rising upwards, disturbing the clear orifices.
[Treatment Principle]: Soften the liver and subdue Yang, harmonize the collaterals and extinguish wind.”
【Jiang Sen’s Traditional Chinese Medicine Treatment Techniques and Approaches】：
“[Formula Name]: Chuanxiong Zhitong Tang (Chuanxiong Pain-Stopping Decoction)
[Ingredients]: Chuanxiong (Rhizoma Chuanxiong) 20-30g, jingjie (Herba Schizonepetae) 10-12g, fangfeng (Radix Saposhnikoviae) 10-12g, Whole Scorpion (quanxie) 10-12g, Earthworm (dilong) 15-25g, Asarum (xixin) 3-6g.
[Pattern Differentiation]: Wind pathogen invading internally, blood stasis obstructing the blood vessels.
[Treatment Principle]: Expel wind and alleviate pain, activate blood and resolve stasis.”
Trigeminal Neuralgia within the Shaoyin bing and Shaoyang bing Combined Framework
Lin Jiaming’s Traditional Chinese Medicine Treatment Techniques and Approaches:
Foundational Formula: Xiao Chaihu Tang combined with Si Ni Tang
Another presentation of Xiao Chaihu Tang pattern involves yang xu, specifically a combination of the half-exterior, half-interior condition with lower jiao yang xu. In such cases, Xiao Chaihu Tang combined with Si Ni Tang is used as the foundational formula.
Specific Medicinals: Add the four specific medicinals mentioned above as needed.
Trigeminal Neuralgia within the Shaoyang bing and Yangming bing Combined Framework
【Lin Jiaming’s Traditional Chinese Medicine Treatment Techniques and Approaches】：
1.No dry stool, only Yangming exterior heat.
Foundational Formula One: Xiao Chaihu Tang with Gypsum
If the presentation of pain aligns with the Yangming bing pattern, specifically the Yangming exterior syndrome without dry stool, Xiao Chaihu Tang with gypsum can be used. Gypsum is a relatively important herb, with a dosage of 45 to 90 grams.
Specific Medicinals: Add the four specific medicinals mentioned above as needed.
Foundational Formula Two: Da Chaihu Tang (Major Bupleurum Decoction)
Foundational Formula Three: Xiao Chaihu Tang combined with San Yi Cheng Qi Tang
2、Heat and dry stool combined.
If heat and dry stool are combined, with dry stools, severe, unbearable pain, constipation for two or three days, a slightly hard abdomen, and a wiry and slippery guan pulse, it indicates that the Yangming is stuck in the middle jiao. At this point, regardless of the presence of exterior symptoms, it is necessary to use purgation to treat the upper body.
For patients with a relatively robust constitution, Da Chaihu Tang can be used. For those with a weaker constitution and a pulse that is not so forceful, primarily wiry and thin, Xiao Chaihu Tang combined with a Cheng Qi Tang formula should be used. If you are unsure how to differentiate between Da Cheng Qi Tang, Xiao Cheng Qi Tang, and Tiao Wei Cheng Qi Tang, then use San Yi Cheng Qi Tang, which combines these three formulas. You can use a combination of Xiao Chaihu Tang and this San Yi Cheng Qi Tang.
[Specific Medicinals]: Add the four specific medicinals mentioned above as needed.
【Guo Ziguang’s Traditional Chinese Medicine Treatment Techniques and Approaches】：
[Medicinal Composition]: Quanxie 10g (washed, decocted together), dilong, jiangcan, mudanpi, yanhusuo each 15g, baishao, shigao, rendongteng each 30g, gancao 10g.
[Actions and Indications]: Clears heat, unblocks collaterals, alleviates pain. Suitable for trigeminal neuralgia belonging to blood stasis in the collaterals with heat accumulation due to prolonged stagnation. Symptoms include paroxysmal, burning, needle-like excruciating pain on the side of the face involving the upper and lower jaw, extending to the nasal ala, eye, and ear. Patients are often awakened by pain in the middle of the night, and attacks are also frequently triggered by speaking, eating, etc. Accompanied by fatigue and weakness, flushed complexion, redness of the eye on the affected side, thin and red dry tongue, thin yellow coating, fine and rapid pulse, etc.
Trigeminal Neuralgia within the Sanyang hebing Framework
【Zhao Xiwu’s Traditional Chinese Medicine Treatment Techniques and Approaches】
[Formula Name]: Sancha Tang (Trigeminal Decoction)
[Ingredients]: Raw Gypsum (sheng shigao) 24g, Kudzu Root (gegen) 18g, Red Peony Root (chishao), Gambir Plant (gouteng), Cocklebur Fruit (cangerzi), Bupleurum Root (chaihu), Vitex Fruit (manjingzi) each 12g, Scutellaria Root (huangqin), Peppermint (bohe), Schizonepeta Spica (jingjie sui), Licorice Root (gancao) each 9g, Whole Scorpion (quanxie) 6g, Centipedes (wugong) 3 pieces.
For severe eye pain, add Mulberry Leaf (sangye) and Chrysanthemum Flower (juhua); for severe tooth pain, add Asarum (xixin), Raw Rehmannia Root (shengdi), and Achyranthes Root (niuxi). Decocted in water, one dose daily.
[Pattern Differentiation and Treatment Principle]: Liver Yang rising, wind-fire disturbing upwards. Clear heat and purge fire, pacify the liver and stop spasms. Zhao believed that this disease is caused by dryness-heat in the stomach and intestines, wind-fire in the liver and gallbladder, and obstruction of the meridians and collaterals, impinging on the nerves. This formula primarily uses herbs to clear wind-fire from the stomach, intestines, liver, and gallbladder, combined with herbs to activate blood, reduce swelling, relieve spasms, and alleviate pain. The formula composition is precise, and the combination of herbs is appropriate, thus often achieving good clinical efficacy.
Trigeminal Neuralgia within the Taiyang bing Framework
【Ni Haixia’s Traditional Chinese Medicine Treatment Techniques and Approaches】：
[Foundational Formula: Gegen Tang (Kudzu Decoction)] [Specific Medicinals]: Baifuzi, jiangcan – to dispel wind and alleviate pain. Gou teng, chuanxiong – essential medicinals for headache. HT-25 (a pill for treating trigeminal neuralgia, specific composition unknown). Symptoms are: trigeminal neuralgia on the right side of the face, stabbing pain, aggravated by wind. Difficulty sweating, aversion to wind. Fear of cold. Not thirsty. Neck easily stiff, legs easily sore. Floating and rapid pulse, white and moist tongue.
Trigeminal Neuralgia within the Taiyin bing and Jueyin bing Combined Framework
【Hu Xishu’s Traditional Chinese Medicine Treatment Techniques and Approaches】：
[Foundational Formula: Banxia Xiexin Tang with Wuzhuyu]
[Symptoms]: Left-sided migraine for one year, diagnosed by Western medicine as trigeminal neuralgia. Recurrent attacks, sometimes mild, sometimes severe. Past history of hepatitis. Recent attacks are more severe, with pain in the left side of the head and face, and eyelid, accompanied by dizziness and vertigo, loose stools, 2-3 times a day, which upon closer questioning has also been occurring for about a year. Dry mouth with no desire to drink, white greasy tongue coating at the root, deep, thin, and wiry pulse. The pattern is upper heat and lower cold, treated with bitter and acrid herbs to open and descend.
[Dosage]: Banxia 12g, dangshen 9g, huangqin 9g, huanglian 6g, ganjiang 6g, prepared licorice root (zhi gancao) 6g, jujubes (dazao) 4 pieces, wuzhuyu 9g.
[Follow-up]: After taking three doses of the above medicine, the headache and loose stools improved. The above formula was modified by reducing huangqin to 6g and adding raw gypsum (sheng shigao) 30g. After continuing with 12 doses, the headache resolved, and bowel movements returned to normal.
Summary
Actually, I’ve also collected the experiences and insights of many renowned veteran TCM doctors, but they are mostly similar. There are also some purely empirical formulas that I currently lack the expertise to analyze well, so I haven’t included them. Among the methods of so many masters, I find Lin Jiaming’s approach to be relatively more operable and replicable.
It mainly follows three steps:
Step one: Differentiate the six stages of Shanghan Lun to determine the foundational formula and restore the body’s overall environment to normal.
Step two: Treat the specific disease and alleviate pain. Usually using peony (shaoyao) and licorice (gancao) and other drugs to soften the liver and relieve pain.
Step three: Use insect medicinals and acrid-dispersing drugs to unblock the meridians and dispel blood stasis.
Disclaimer:
The experiences and insights shared above represent the author’s personal usage and understanding, and are provided for reference only as part of academic exchange. Please do not blindly replicate or apply them; any consequences arising from such actions are solely your responsibility. As individual constitutions vary, medication should be tailored accordingly. It is advisable to use such treatments under the guidance of a qualified physician. If you have additional experiences to share, comments and submissions are welcome.
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