Introduction
Prosopalgia refers to recurrent, short, paroxysmal, lightning-like, stabbing or burning pain in the trigeminal region.  Clinically the second and third branches of trigeminal nerve on one side are often involved. Prosopalgia often occurs among people over 40, especially women. It is either primary or secondary. Clinically primary prosopalgia is usually encountered. The following discussion mainly focuses on primary prosopalgia. This disease pertains to the conception of “facial pain” in TCM. It is usually caused by wind attacking the meridians, or upward adverse flow of liver and stomach fire, or consumption of qi and blood as well as stagnation of the vessels and meridians.

Syndrome Differentiation
1. Wind Attacking Meridians
Constant severe facial pain like stabbing and burning, accompanied by aversion to wind or sweating, nasal obstruction and running nose, thin and white tongue fur, taut and tense or taut and slippery pulse.

2. Upward Adverse Flow of Liver and Stomach Fire
Facial pain accompanied by dysphoria and susceptibility to rage, flushed cheeks and excessive eye secretion, dryness and bitter taste in the mouth, yellow urine and constipation, red tongue with yellow fur, taut, rapid and slippery pulse.

3. Consumption of Qi and blood as well as Stagnation in the Vessels and Meridians
Lingering illness, moderate pain, spiritual lassitude and fatigue, lusterless complexion, light-colored tongue or with purplish appearance and ecchymoses, thin and weak pulse.

Treatment
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 Quanliao (SI 18) for pain of the second branch; Xiaguan (ST 7), Daying (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 upward 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 meridians, 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 rotating or mild reinforcing and reducing needling techniques 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 constitution.

2. Ear Acupuncture
Prescription: Forehead (AT1), Mandible (LO3), Ear Shenmen (TF4), Cheeks (LO5, 6i ) and Sympathetic (AH6a).

Performance: Each time 2 - 3 acupoints are selected and needled with strong stimulation. The needles are retained for 30 minutes. Or Wangbuliuxingzi (Semen Vaccariae) is used for ear pressure on both ears in alternation. The patients are advised to press themselves 3 - 4 times a day and 2 - 3 minutes each time.