I have spent many years treating pain in the face and head, which has led me to delve into many facets to expand upon my knowledge base including structural and postural considerations, auricular (ear) acupressure/acupuncture strategies, and emotional stress. This post focuses on yet another tack – neurological correlations for chronic pain.
The upper neck and head represent a more complex and layered area. Even studies performed by medical scientists can not definitively determine how chronic pain in the head and neck is developed, While shorter pain episodes are often explained as transitory imbalances of soft tissues, or attributed to some type of stressor, chronic pain is more often linked with a disruption of the nerves. As to the specific type of neurological pain, theories range from neurological to nociceptive (over-stimulation of pain receptors) to inflammatory.
There is also the fact that the autonomic nervous system governs many of the movements of the head such as blinking, swallowing, and facial expressions. The way we move, talk, and even breathe is based on patterns developed over time, and also dependent upon how we innately process cues from the environment, and from others. I have learned that acupuncture excels when an issue involves one of these reticular brain centers, including the vagus nerve, where processing between the body and mind occur.
While some modern sources emphasize the neuroanatomy of an acupuncture point, linking its location to a particular nerve pathway, i.e., Stomach 5 acupuncture point to the facial and trigeminal nerve (Robinson, 2016), and asserting that this phenomenon determines acupuncture efficacy, this is not integral to true acupuncture tenets. Acupuncture is based upon a system that correlates not only anatomy, but energetics. Every organ represents a specific energy that can be tapped in order to promote regulatory centers of not just the nervous system, but the entire organism including circulatory, lymphatic, and respiratory.
The Stomach channel in general is very effective in treating both temporomandibular and trigeminal pain, as this channel is considered the most replete in qi and Blood. Therefore, a local point, or one adjacent to the tissue or structure being treated, can release stagnation in the channel and regulate pain receptors, reducing sensation of pain. When treating trigeminal nerve pain, there are Stomach channel points for each of the branches – ophthalmic (eye), maxillary (cheek and lower nose), and mandibular (lower jaw and lateral face adjacent to and above the ear). Thus it is easy to promote cellular renewal and regulate nerve signals for any of the three branches. The most commonly affected branch is mandibular (Sharav & Benoliel, 2008) as per textbook, and I have found this to be same in practice. I have been able to help reduce pain levels from 10/10 to 3/10 or 4/10, and even lower in some cases.
A good acupuncture treatment requires the use of both local and distal points, at least most of the time. The patient may present with tachycardia, a red tongue tip, and reported anxiety, in which case points on the Pericardium or Heart meridians would be chosen to reduce sympathetic tone, or in TCM terms “calm the Shen.” Yet if this patient presented with a different overall systemic pattern, such as Spleen Qi deficiency in which there is a history of swelling of tissues, slow wound healing, and chronic fatigue, points that regulate immune cells such as Stomach 36 and Spleen 3 would be chosen. There is an intricate way of diagnosing that is key to identifying such patterns in practice.
The dorsal points on the back, called “huotojiaji” are of particular interest when treating head and neck issues. Understanding the myotomal and dermatomal (muscle and skin referred areas) that correspond with the neural pathways is helpful because they not only corroborate classic indications for acupuncture points, they provide another layer of understanding. The upper cervical points (C1 and C2) innervate both the tongue and the muscles underlying the scalp. The lower cervical nerves (C3 through C7) innervate muscles of the neck and arm, as well as the diaphragm (Waxembaum et. al., 2022). These are points I needle with very thin needles and insert very shallowly as any needle in the upper body has a strong impact since the impulse is so close to the brain. These points are useful if there is an imbalance between the muscular areas of the neck and the back, and needling both areas may be required to help correct this.
The spine is visualized as an avenue for transporting the energy generated in the dan tien, or source of core energy located below the umbilicus, and the segments of the spine provide the structural support as this energy travels from lower centers to higher centers, eventually reaching the brain. Raising energies in the body is an ancient practice, and also anatomically represented by the ascending branches of the nervous system and the flow of cerebrospinal fluid. Using acupuncture or moxibustion (warming with herbs) can release areas of stagnancy that occur due to trauma, emotions, stress, or simply structural changes.
Palpating along the spine can reveal areas of constriction, and one example of this is gummy areas in the tissues, created when there is an area of pull or imbalance. Those with blood sugar issues, for example, often have this type of adhesion along the area of T-11 and T-12 (lower thoracic) which corresponds to the Stomach and Spleen organs and needling in this area both regulates function and affects the tone of organs and tissues.
There are many choices for points on the face and anterior neck that significantly impact pain and dysfunction. Scalp points are also of tremendous value because they address neurological crossing centers of the brain, and can assist when there are associated problems of speech, memory, or thought processing. I often add at least one scalp point to any treatment to make sure cognitive function is addressed. Auricular points are another way to address the brain as the ear is the only place on the external anatomy to access the trigeminal nerve. Massaging the ear can provide a type of stimulation that eases the congestion of tissues involved in many jaw and head disorders.
REFERENCES
Magidoff, A. [Acu Vidya]. (2017, Aug 27). Exploring acupuncture points, the Du channel [Video]. YouTube. https://www.youtube.com/watch?v=qFY1_1hkgMA
Robinson, N. (2016) Interactive Medical Acupuncture Anatomy. Teton NewMedia.
Sharav, Y & Benoliel, R. (2008). Orofacial pain & headache. Elsevier.
Waxenbaum JA, Reddy V, & Bordoni B. (2022). Anatomy, head and neck, cervical nerves. StatPearls Publishing.
Channel Acupuncture & Herbs 