Trigeminal Neuralgia - Liver-Fire Blazing Pattern

Dr. Li Wei, DACM

Trigeminal Neuralgia · Liver-Fire Blazing Pattern

Updated: June 23, 2026

Reviewed by: Dr. Li Wei, DACM

Reading Time: 7 min

Body Area: Head

Pattern Overview

Liver-Fire Blazing is a common pattern in trigeminal neuralgia, characterized by sympathetic excitation decreasing pain threshold, severe facial pain triggered by stress, irritability, red eyes, and bitter taste. The core pathogenesis is emotional stress causing Liver depression transforming into Fire, leading to sympathetic excitation, lowered pain threshold, and severe pain.

Key Symptoms and Differentiation Points

| Differentiation Dimension | Manifestations |

| :— | :— |

| Primary Symptoms | Severe paroxysmal facial pain, triggered by stress, irritability |

| Associated Symptoms | Red eyes, bitter taste, headache, dizziness, insomnia |

| Tongue and Pulse | Red tongue with yellow coating, wiry and rapid pulse |

| Pathogenesis | Liver depression transforming into Fire |

| Etiology | Emotional stress, anger, irritability, sleep deprivation |

Acupuncture Point Prescription

| Point | Location | Function |

| :— | :— | :— |

| Taichong (LR3) | Dorsum of the foot, between the 1st and 2nd metatarsals | Source point of Liver meridian; clears Liver Fire |

| Xingjian (LR2) | Dorsum of the foot, between the 1st and 2nd metatarsals, proximal to the web margin | Spring point of Liver meridian; drains Liver Fire |

| Fengchi (GB20) | Depression below the occipital bone, between the sternocleidomastoid and trapezius | Disperses Wind and clears Heat |

| Hegu (LI4) | Dorsum of the hand, between the 1st and 2nd metacarpals | Disperses Wind and unblocks collaterals |

| Xiaguan (ST7) | In the depression on the lower border of the zygomatic arch, below the temporal process of the zygomatic bone | Key point for trigeminal neuralgia |

Clinical Recommendation: Filament needle, reducing method; may combine with pricking at Xingjian to enhance Liver Fire drainage.

Herbal Formula

Base Formula: Long Dan Xie Gan Tang (龙胆泻肝汤)

Composition:

Gentian Root (Long Dan Cao), Scutellaria (Huang Qin), Gardenia (Zhi Zi), Bupleurum (Chai Hu), Alisma (Ze Xie), Akebia (Mu Tong), Angelica (Dang Gui), Rehmannia (Sheng Di), Licorice (Gan Cao)

Action: Clears Liver-Fire, calms the meridians, and relieves pain.

Modifications

| Associated Symptoms | Additions/Subtractions |

| :— | :— |

| Severe pain | Add Quan Xie, Wu Gong to search out Wind and stop pain |

| Irritability | Add Yu Jin, He Huan Pi to soothe Liver and relieve depression |

| Headache | Add Ju Hua, Xia Ku Cao to clear Liver Fire |

| Insomnia | Add Suan Zao Ren, Long Gu to calm the spirit |

| Constipation | Add Da Huang to drain heat |

Western Mechanism Reference

Sympathetic excitation decreasing pain threshold, with sympathetic-adrenal system excitation and substance P release. Liver-Fire Blazing corresponds to trigeminal neuralgia associated with stress, where sympathetic excitation and substance P release contribute to lowered pain threshold and severe pain.

References

  1. Internal Medicine of TCM - Facial Pain with Liver Fire.

  2. Zang-Fu Pattern Differentiation: Liver-Fire Blazing → Clearing Pathway.

  3. WHO. (2023). Neurological health. World Health Organization.

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