面颊疼痛是脱臼？！对证下针，针到病除！Cheek pain is dislocation? ! Right treatment is the best solution!

 Hi，我是一名中医师，陈佩晶医师-陈医师

近日有一位男性患者C先生因右颊疼痛、紧绷不适就诊。
细问病情，原来C先生右颊疼痛已经2周，原咬合或张口就疼痛，经过他处中医师治疗后，疼痛稍微减轻，用力咬合或张口幅度较大仍见疼痛。
经过望闻问切，诊断其为颞下颌关节炎，简单地描述就是咬合肌发炎，治疗方案包括针灸及中药。

然而，C先生听到针灸面露难色，我以为C先生是害怕针灸，便安慰道：“我们先试几针，如果实在害怕，我们才停止针灸治疗”。
C先生立马解释，他这2周在他处治疗了6次（一周3次），对针灸有点阴影，还吃了2周中药，没什么好转。
我便劝解并保证先在主要穴位下针，尤其右颊处数根就行，中药也可只配4日量，后续可看病情变化如何再复诊。
C先生一脸惊讶道：“要扎针在脸颊上？”，听到这句话轮到我惊讶了，反问之前都是针灸在什么部位。
原来C先生之前每次治疗都是针灸、刮痧和拔罐三件套，都集中在耳后、右颈部而已。

虽然，我对这番操作有点疑惑，一方面是治疗部位，另一方面是6次的刮痧和拔罐。
秉持着专业素养，我并未予任何评价，直接劝C先生尝试针灸，因为不同医师的治疗方案及手法皆不同，若不适应则会马上中止该治疗。

当C先生侧躺于治疗床并准备好进行治疗后，我首先在C先生的左手虎口扎针并让其活动面颊及咬合，查看是否疼痛、紧绷感有所缓解。
C先生惊喜地表示疼痛的确神奇地减少了很多。看C先生对针灸治疗更放心及充满信任后，我继续在其右颊及风池等穴位下针，每次都确保C先生可以接受针刺刺激方继续下针。

完成整个针灸治疗后，C先生明显感觉右颊疼痛缓解甚多，我嘱咐C先生将4天的中药服完，若尚余紧扯不适感再复诊，若已痊愈则短期忌辛辣即可。

隔日，收到C先生的短信述右颊疼痛、紧绷感已明显缓解，只余10%，相信服完中药就会痊愈，他感到非常高兴，并表示自己在他处花了2周RM1000多都还没解决的问题，竟然在这里花了2天RM100多就几乎痊愈。

我打趣地跟客服说我帮C先生省了好多钱，内心对此感到非常欣慰。

 

这案例让我想起了几年前也遇过另一起面颊疼痛就诊的X女士。
X女士因面颊疼痛到自称是中医也是Chiro的治疗师就诊，诊断X女士关节脱臼了，治疗费一次RM200多，需要治疗3次左右就会痊愈，并表示当天付3次的费用可以再折扣一些。

X女士因费用问题，没有当场做治疗，推脱需要考虑后再回去治疗，然后便找到了附近的另一家医馆的我。

我诊断其为颞下颌关节炎，治疗方案跟C先生相似。
X女士表示我看起来比较可靠（我内心谢谢^.^）即选择直接做治疗。

完成针灸治疗后，面颊疼痛明显缓解，张口疼痛明显消失，嘱其注意休息，按时服药，忌辛辣数日即可。

 

陈医师内心：“啊！又是帮大家省钱的日子！”

Hi, I am a Traditional Chinese Medicine (TCM) Practitioner, TCM Practitioner Tan PeiChin.

Recently, a male patient, Mr. C, came in for treatment due to pain and tightness in his right cheek.
After inquiring about his condition, I knew that Mr. C had been experiencing pain in his right cheek for two weeks and he felt pain when biting or opening his mouth.
After treatment from another TCM practitioner, the pain slightly reduced, but he still felt pain when biting or opening his mouth wide.

After performing a thorough examination, I diagnosed him with temporomandibular joint (TMJ) arthritis, which means inflammation of the chewing muscles.The treatment plan included acupuncture and Chinese herbal medicine.
However, Mr. C showed signs of reluctance when he heard about acupuncture. I assumed he was afraid of it, so I comforted him, saying, "Let's try a few needles first, we will stop the treatment if you really can't handle it."

Mr. C immediately clarified that  he had undergone treatment six times (three times a week) elsewhere over the past two weeks, which left him with a bit of a phobia with acupuncture. He also mentioned that he had been taking Chinese medicine for two weeks without much improvement.
I reassured him and promised to needle only a few main points, particularly a few on the right cheek, and that I could prescribe just four days' worth of herbal medicine. We could reassess based on his condition later.

Mr. C looked surprised and said, "You are going to needle my cheek?" Hearing this left me astonished, and I reflexively asked where he thought acupuncture was usually done. It turned out that all his previous treatments involved acupuncture, gua sha, and cupping, but they were all focused on the areas behind his ears and on the right side of his neck.

While I found this approach somewhat puzzling—both in terms of treatment areas and the six sessions of gua sha and cupping. I maintained my professional demeanor and offered no comments. At the same time, I encouraged Mr. C to try acupuncture since different practitioners have varying treatment plans and techniques, and if he felt uncomfortable, we could always stop. Then, he agreed to try.

Once Mr. C lay sideways on the treatment bed and was ready for treatment, I first inserted a needle in the tiger’s mouth of his left hand and asked him to move his cheek and bite down to check if the pain and tightness alleviated. Mr. C was pleasantly surprised, stating that the pain had miraculously decreased significantly. Seeing that Mr. C was more at ease and trusting of the acupuncture treatment, I continued to insert needles in his right cheek and other relevant points, ensuring he could tolerate the needle stimulation before proceeding.

After completing the acupuncture treatment, Mr. C felt a noticeable reduction in the pain of his right cheek. I advised him to finish the four days' worth of herbal medicine, and if there was still a lingering sense of tightness, he could come back for a follow-up. If he had healed, he should simply avoid spicy foods for a short period.

The next day, I received a message from Mr. C stating that the pain and tightness in his right cheek had significantly improved, leaving only about 10%. He believed that completing the herbal medicine would lead to a full recovery. He was very happy and expressed that he had spent over RM1000 at another place without solving his problem, yet here he had spent only over RM100 in two days and was almost healed.

I jokingly told the customer service that I had helped Mr. C save a lot of money, in deep I felt very gratified.

This case reminded me of another instance from a few years ago when I treated a woman named Ms. X, who also came in for facial pain. Ms. X went to a clinic where the practitioner, who claimed is a TCM practitioner and a chiropractor, diagnosed her with a joint dislocation. The treatment cost over RM200 per session, and she would need about three sessions to recover. The practitioner also indicated that she could get a discount if she paid for all three sessions on that day.

Due to the cost, Ms. X did not proceed with treatment on the spot, citing the need to consider it further before returning, and she then found me at a nearby clinic. I diagnosed her with temporomandibular joint arthritis, and the treatment plan was similar to that of Mr. C. Ms. X expressed that I seemed more reliable (I felt thankful inside ^.^), and she chose to go ahead with the treatment immediately.

After completing the acupuncture treatment, her facial pain significantly decreased, and the pain when opening her mouth disappeared. I advised her to rest well, take her medicine on schedule, and avoid spicy foods for a few days.

My inner thoughts: "Awww! Another day of helping everyone save money!"