Tuesday, March 13, 2012
Case Study: Trigeminal Neuralagia & Sinusitis
Chief Complaint: Female age 63 presented with trigeminal neuralgia facial pain, worse with chronic sinusitis. Onset 7y ago. Worse in winter due to sinusitis: inflammation presses on trigeminal nerve, triggering pain. Swelling of right eye, center of lower eyelid. Frequent associated headaches.
Other symptoms: Celiac disease, food allergies which seem to trigger facial pain. Pain begins 20 minutes after eating offending foods: wheat products or anything with mold. Perennial allergies: onset birth – breast milk: red eyes, sneezing, nasal and sinus congestion. Shortness of breath. Fatigue, bruises easily, heavy limbs, weak muscles. Hypothyroid, diagnosed 47y earlier. RLS: .5mg Clonozepem nightly.
Pain: Described as electric, stabbing, shocking sensation. Over a 5y period, progressed from mild pain to severe pain. Aggravated with pressure applied to the affected area. Headache dull ache, level 8-9 [1-10 scale]. Red/purple coloration on scalp associated with increased pain.
Location: Foot Yang Ming Stomach (ST) meridian of face, in a line from the center of the lower eyelid to the lateral corner of the mouth. Foot Tai Yang, Bladder meridian & Du meridian, Governor’s vessel from vertex of the head to front hairline. Headache: Foot Shao Yang Gallbladder (GB) meridian, along hairline at forehead, left.
Tongue/Pulse: P: Right – hidden, Left – Weak. Tongue: Dusky, puffy with teeth marks. Constraint petechiae and red sides with red tip.
Treatment: Dr. Tan’s Balance Methodacupuncture + custom granule herbal formula. Tx #1: 8 magic points for digestive and lung disorders + ahshi points along the Large Intestine, Pericardium and Heart (HT) meridians between the elbow and wrist crease to treat the GB & ST meridian pain.
Tao Hong Si Wu Tang (Peach Seed & Safflower + Four Substance Decoction) + Sudden Smile Powder (Shi Xiao San) to treat pain due to blood stagnation: stabbing pain and dusky tongue indications poor blood circulation in the affected meridians (Foot Yang meridians + Du channel).
Bu Zhong Yi Qi Tang (Augment the Center to Lift the Qi Decoction) to treat chronic sinusitis and weak Spleen: food allergies, weak, heavy limbs, bruise easily, fatigue, hypothyroid.
Dan Zhi Xiao Yao Wan (Augmented Rambling Powder): T: red edges and petechiae, Shao Yang headaches.
Jade Windscreen: Improve immune function: allergies.
Results: Marked decrease in pain after 1st acupuncture treatment. Facial pain: 1x/5days, stabbing pain, level 2 [1-10 scale]. Several mild headaches. No ear pain. Decreased facial swelling.
Treatment: repeated acupuncture and herbal formula. Slight modification to herbal formula to address allergies.
Result: After 1 week - Occasional pain: pressure to face causes mild, stabbing pain, level 2. No headache. 1 mild occipital headache, possibly due to caffeine. RLS: 2 nights. No nasal/sinus congestion or shortness of breath, occasional sneezing.
Treatment: Repeated tx #1. Modified herbal formula to increased heat clearing (red tongue).
Result: One week later: Decreased facial pain: 2 twinges of stabbing pain, level 1. Facial swelling, sensitivity to touch. No RLS. Occasional sneezing, + post nasal drip, no congestion.
Treatment: Repeated tx #1, no HT channel points (no GB pain). Refilled herbal rx with modifications to address post nasal drip due to chronic sinusitis, including andrographitis (chuan xin lian), and facial swelling. Continued weekly acupuncture treatments and herbal therapy, with modifications, based on presenting symptoms for 2 weeks. Then decreased to monthly treatments and continued herbal therapy.
Result: 3 months after initial treatment: In past 2 weeks, no pain, no headache, no sinusitis, pressure or rhinitis. Occasional RLS associated with strenuous activity. Energy normal. KB