Overview
TN (Trigeminal Neuralgia / tic douloureux) is a disorder of the fifth cranial (trigeminal) nerve that causes episodes of intense, stabbing, electric shock-like pain in the areas of the face where the branches of the nerve are distributed --lips, eyes, nose, scalp, forehead, upper jaw, and lower jaw. The condition occurs most often after age 40, especially in women. It belongs to "facial pain" and is due to wind attack, upper flaming of liver fire, irregular circulation of qi and blood or blood stagnation caused by qi deficiency after long disease duration according to location, nature, inducing factors, and accompanied symptoms and signs of facial pain in TCM. It is treated by herbs for dispersing pathogenic wind, dredging collaterals, promoting blood circulation to relieve pain.

Treatment
1. Xiaguan (ST7)
When ST7 is used to relieve the pain in the third branch of trigeminus, it should be deeply needled with 2 cun filiform needle with mild lifting-thrusting and retained for half an hour or one hour for serious case. It is required to get an electric shock-liking sensation spreading to submaxilla and tongue. It is a chronic disorder and should be treated twice or three times a week for 30 sessions as a therapeutic duration. The disorder can be treated by point injection with 1% procaine (0.5-1 ml), or vitamin B1 (100 mg) or B12 (0.1 mg) on the same point every other day or every two days.

2. Quanliao (SI18)
Quanliao (S118) is used to stop pain in the first branch of trigeminus. It is located directly below the outer canthus, in the depression on the lower border of zygoma. It is perpendicularly needled at a depth of 2 - 2.5 cm with 3 cun filiform needle, producing electric shock-liking sensation to the whole face, then manipulated with reducing method or even reinforcing and reducing method, and retained for 15-30 minutes. The needle should be manipulated every 10 minutes. Treatment is done once every day or once every other day for 10 sessions.

3. Yuyao (EX-HN4)
This is an extra point locating on the eyebrow directly above the pupil. It is used to release the pain in the first branch of trigeminus. The needle should be inserted lateral-downward at a depth of 0.3-0.5 cun with 1-1.5 cun 28 gauge filiform needles producing electric shock-liking sensation to the forehead, manipulated with mild lifting-thrusting and retained for 30 minutes, once everyday or every other day for 30 sessions.

4. Sibai (ST2)
ST2, for checking the pain in the second branch of trigeminus, is inserted lateral-downward at a depth of 0.5 cun, producing electric shock-liking sensation transmitting to the upper lip, then manipulated with mild lifting-thrusting, and retained for 30 minutes, once every day or once every other day for 30 times.

5. Jiachengjiang
This is an extra point which is located 0.5 cun lateral to the RN24. The needle tip should be inserted toward trigeminal nerve. Producing needling sensation transmitting to the lower labrum, then manipulated and retained for 30 minutes. It is in needling once every day or once every other day. 30 times make up one course of treatment.

6. Sanchadian
This is an ear point, a sensitive spot locating between the brain of Antitragus and Antitragus apex. Point injection can be applied. After the sterilization, it is subcutaneously injected with 0.1 ml lidocaine hydrochloride unilaterally or bilaterally, once every day or once every other day for 5 times.

Note
Acupuncture therapy is one of the effective ways to treat the primary trigeminal neuralgia. Its recurrence rate is comparatively higher. To improve the clinical effect, practitioners should choose points in the pain area and stimulate the involved nerve with heavy needling sensation around whole pain area, which is better alternatively applied with electric stimulation, point injection and ear acupuncture.