TEMPOROMANDIBULAR JOINT SYNDROME (TMJ)

Clinical Manifestations
  • The temporomandibular joint (TMJ) acts like a sliding hinge, connecting the jawbone to the skull. There is one joint on each side of the jaw. TMJ disorders can cause pain in the jaw joint and in the muscles that control jaw movement.

    The exact cause of a person's TMJ disorder is often difficult to determine. The pain may be due to a combination of factors, such as genetics, arthritis or jaw injury. Some people who have jaw pain also tend to clench or grind their teeth (bruxism), although many people habitually clench or grind their teeth and never develop TMJ disorders.

    In most cases, the pain and discomfort associated with TMJ disorders is temporary and can be relieved with self-managed care or nonsurgical treatments. Surgery is typically a last resort after conservative measures have failed, but some people with TMJ disorders may benefit from surgical treatments.

    Signs and symptoms of TMJ disorders may include:

    • Pain or tenderness of the jaw
    • Pain in one or both of the temporomandibular joints
    • Aching pain in and around the ear
    • Difficulty chewing or pain while chewing
    • Aching facial pain
    • Locking of the joint, making it difficult to open or close the mouth

    TMJ disorders can also cause a clicking sound or grating sensation when the mouth is opened or when or chewing. But if there's no pain or limitation of movement associated with jaw clicking, treatment is not necessary for a TMJ disorder.

Treatment Principle
Herb Formulas
Points
Clinical Manifestations
  • Pain
  • Numbness
  • Heaviness of the jaw joint
  • Body aches
  • Uneasy opening and closing of the mouth
  • Lack of Heat or redness in the jaw area
  • Pain is worse with Cold and better with warmth
  • T: Slightly purple or purple spots
  • C: Thick and white
  • P: Slippery or Slightly superficial or slightly rough or Slow and Soft or Wiry and tight or Floating and wiry
Treatment Principle
  • Expel Wind-Cold Dampness
Herb Formulas
Points
  • LI-4, SJ-5, ST-7, ST-40
    For pain in the upper border of the zygomatic arch: + GB-3
    For pain in the lower jaw: + ST-6
    For pain in the cheek bone: + SI-18
    For pain behind the ear, earache or tinnitus: + SJ-17
    For pain in front of the ear, earache or tinnitus: + GB-2
    For pain in the temples: + Taiyang
    For pain in the forehead: + GB-14, ST-8
    For muscle spasms: + LIV-3
    For swelling: + SP-9
    For severe pain: + SJ-3 or LI-3
    For neck and shoulder tension: + GB-21, UB-10
    For insomnia or restlessness: + DU-24, HT-5, HT-7
Clinical Manifestations
  • Paroxysmal spasmodic, unbearable facial pain
  • Pain is worse with Cold and better with Warmth
  • Facial pallor during the pain
  • Possible facial swelling
  • Heavy-headedness or
  • Head distention
  • T: Pale
  • C: Thin and white or thick and white
  • P: Floating and tight or Soft and slippery
Treatment Principle
  • Disperse Wind
  • Scatter Cold
  • Dissolve Phlegm
  • Unblock the channels
Herb Formulas
Points
  • LI-4, SJ-5, ST-7, ST-40
    For pain in the upper border of the zygomatic arch: + GB-3
    For pain in the lower jaw: + ST-6
    For pain in the cheek bone: + SI-18
    For pain behind the ear, earache or tinnitus: + SJ-17
    For pain in front of the ear, earache or tinnitus: + GB-2
    For pain in the temples: + Taiyang
    For pain in the forehead: + GB-14, ST-8
    For muscle spasms: + LIV-3
    For swelling: + SP-9
    For severe pain: + SJ-3 or LI-3
    For neck and shoulder tension: + GB-21, UB-10
    For insomnia or restlessness: + DU-24, HT-5, HT-7
Clinical Manifestations
  • Swelling, Heat and redness in the jaw area
  • Severe pain
  • Uneasy opening and closing of the mouth
  • Possible general effusion of Heat
  • Restlessness
  • Aversion to Heat
  • Preference for Cold
  • T: Red tip
  • C: Yellow and dry
  • P: Floating and rapid
Treatment Principle
  • Dispel Wind
  • Clear Heat
  • Unblock the channels
Herb Formulas
Points
  • LI-4, LI-11, ST-7, ST-40
    For pain in the upper border of the zygomatic arch: + GB-3
    For pain in the lower jaw: + ST-6
    For pain in the cheek bone: + SI-18
    For pain behind the ear, earache or tinnitus: + SJ-17
    For pain in front of the ear, earache or tinnitus: + GB-2
    For pain in the temples: + Taiyang
    For pain in the forehead: + GB-14, ST-8
    For muscle spasms: + LIV-3
    For swelling: + SP-9
    For severe pain: + SJ-3 or LI-3
    For neck and shoulder tension: + GB-21, UB-10
    For insomnia or restlessness: + DU-24, HT-5, HT-7
Clinical Manifestations
  • Severe, paroxysmal, lancinating pain
  • Pain worse with Heat and better with Cold
  • A red facial complexion
  • Fever
  • Sweating
  • Dry mouth
  • Dark-colored urine
  • T: Red
  • C:Yellow and dry
  • P: Wiry, slippery and rapid
Treatment Principle
  • Dispel Wind
  • Clear Heat
  • Dissolve Phlegm
  • Unblock the channels
Herb Formulas
Points
  • LI-4, LI-11, ST-7, ST-40
    For pain in the upper border of the zygomatic arch: + GB-3
    For pain in the lower jaw: + ST-6
    For pain in the cheek bone: + SI-18
    For pain behind the ear, earache or tinnitus: + SJ-17
    For pain in front of the ear, earache or tinnitus: + GB-2
    For pain in the temples: + Taiyang
    For pain in the forehead: + GB-14, ST-8
    For muscle spasms: + LIV-3
    For swelling: + SP-9
    For severe pain: + SJ-3 or LI-3
    For neck and shoulder tension: + GB-21, UB-10
    For insomnia or restlessness: + DU-24, HT-5, HT-7
Clinical Manifestations
  • Grinding of the teeth
  • Heart vexation
  • Bad breath
  • Thirst with a preference for cold drinks
  • Quick digestion with rapid hungering
  • Vomiting
  • Clamoring Stomach
  • Possible immediate vomiting of undigested food
  • T: Red
  • C: Yellow and dry
  • P: Slippery, wiry and rapid
Treatment Principle
  • Clear the Stomach
  • Drain Fire
Herb Formulas
Points
  • HT-5, LI-4, ST-7, ST-44
    For pain in the upper border of the zygomatic arch: + GB-3
    For pain in the lower jaw: + ST-6
    For pain in the cheek bone: + SI-18
    For pain behind the ear, earache or tinnitus: + SJ-17
    For pain in front of the ear, earache or tinnitus: + GB-2
    For pain in the temples: + Taiyang
    For pain in the forehead: + GB-14, ST-8
    For muscle spasms: + LIV-3
    For swelling: + SP-9
    For severe pain: + SJ-3 or LI-3
    For neck and shoulder tension: + GB-21, UB-10
    For insomnia or restlessness: + DU-24, HT-5, HT-7
Clinical Manifestations
  • Grinding of the teeth at night during sleep
  • Insomnia
  • Chest and epigastric glomus and oppression
  • Anorexia
  • Epigastric fullness, distention and pain with dislike of pressure
  • Belching with rotten food smell
  • Acid regurgitation
  • Detests food or
  • Vomits after eating
  • Distention is reduced after vomiting
  • Dark urine
  • Diarrhea with abdominal pain or
  • Unformed stools or
  • Knotted constipation
  • T: Pink
  • C: Thick and greasy or Greasy and slightly yellow
  • P: Slippery
  • (Note: this syndrome does not generally cause TMJ on its own but is often a complicating factor with syndromes involving the Liver, Spleen and Stomach)
Treatment Principle
  • Clear Food
  • Conduct Stagnation
Herb Formulas
Points
Clinical Manifestations
  • Abdominal distention and pain
  • Gas
  • Borborygmus
  • Diarrhea
  • Distention and pain in the sides or flanks
  • Suffocating sensation in the chest
  • Tendency to sigh
  • Melancholy
  • Depression
  • Irritability
  • Inappropriate anger
  • Women:
    Irregular menses
    Dysmenorrhea
    Breast distention and pain before and during menses
  • T: Pink
  • C: White and greasy
  • P: Slippery and wiry
Treatment Principle
  • Soothe the Liver
  • Invigorate the Spleen
Herb Formulas
Points
Clinical Manifestations
  • Burning facial pain, commonly brought on by emotional upset
  • Pain exacerbated by Heat
  • Severe, splitting headaches with dizziness
  • Sudden tinnitus or
  • Sudden deafness
  • Flushed face
  • Red, swollen, painful eyes
  • Irritability
  • Irascibility with violent angry outbursts
  • Dry mouth and throat
  • Bitter taste in mouth
  • Thirst
  • Chest oppression
  • Vomiting sour or bitter liquid
  • Insomnia
  • Restlessness
  • Constipation or dry stools
  • Rib and/or flank pain
  • Five-Sole-Heat
  • Frequent sighing
  • Profuse dreams
  • Dark-colored urine
  • Dry stools
  • In severe cases:
    Mania
    Hemoptysis
    Hematemesis
    Epistaxis
  • T: Red
  • C: Yellow
  • P: Wiry and rapid
Treatment Principle
  • Clear the Liver
  • Purge Fire
  • Unblock the channels
  • Alleviate pain
Herb Formulas
Points
  • LI-4, LIV-2, SJ-6, ST-7
    For pain in the upper border of the zygomatic arch: + GB-3
    For pain in the lower jaw: + ST-6
    For pain in the cheek bone: + SI-18
    For pain behind the ear, earache or tinnitus: + SJ-17
    For pain in front of the ear, earache or tinnitus: + GB-2
    For pain in the temples: + Taiyang
    For pain in the forehead: + GB-14, ST-8
    For muscle spasms: + LIV-3
    For swelling: + SP-9
    For severe pain: + SJ-3 or LI-3
    For neck and shoulder tension: + GB-21, UB-10
    For insomnia or restlessness: + DU-24, HT-5, HT-7
Clinical Manifestations
  • Grinding of the teeth
  • Dizziness and vertigo to the point of falling over
  • Headache with a drawing sensation
  • Numbness and tremor of limbs
  • Twitching and involuntary writhing of hands and feet
  • Dysphasia
  • Unsteady gait
  • Malar flush
  • Night sweats
  • Five-Sole-Heat
  • Dry mouth and throat
  • With Wind-Stroke:
    Sudden loss of consciousness
    Tongue stiffness with aphasia
    Facial paralysis
    Hemiplegia
  • Maybe coma
  • Sometimes death
  • T: Red and dry
  • P: Thready, wiry and rapid
Treatment Principle
  • Nourish Yin
  • Pacify the Liver
  • Nourish the Kidneys
  • Subdue Yang
  • Extinguish Wind
Herb Formulas
Points
Clinical Manifestations
  • Pain in the temporomandibular joint area
  • Uneasy opening and closing of the mouth
  • Loose teeth
  • Limited opening of the mouth
  • Facial complexion pale and sallow
  • Both cheeks slightly red
  • Dizziness
  • Dry eyes
  • Blurred vision
  • Spots before the eyes
  • Numbness of limbs
  • Flaccid paralysis (Wei syndrome), weakness
  • Tinnitus
  • Deafness
  • Forgetfulness
  • Low back and knees sore and painful
  • Throat dry and painful
  • Five Sole Heat
  • Low-grade fever
  • Night sweats
  • Irritability
  • Insomnia
  • Profuse dreams
  • Stools difficult to pass
  • Constipation
  • Men:
    Spermatorrhea
  • Women:
    Irregular menses or
    Scanty menses or
    Amenorrhea
    Vaginal discharge
  • T: Red or pale red
  • C: None
  • P: Thready and rapid
Treatment Principle
  • Nourish and Reinforce the Liver and Kidneys
Herb Formulas
Points
  • GB-39, KI-7, LI-4, ST-7, UB-11
    For pain in the upper border of the zygomatic arch: + GB-3
    For pain in the lower jaw: + ST-6
    For pain in the cheek bone: + SI-18
    For pain behind the ear, earache or tinnitus: + SJ-17
    For pain in front of the ear, earache or tinnitus: + GB-2
    For pain in the temples: + Taiyang
    For pain in the forehead: + GB-14, ST-8
    For muscle spasms: + LIV-3
    For swelling: + SP-9
    For severe pain: + SJ-3 or LI-3
    For neck and shoulder tension: + GB-21, UB-10
    For insomnia or restlessness: + DU-24, HT-5, HT-7
Clinical Manifestations
  • Chronic pain
  • Enduring attacks
  • Severe, lancinating, fixed pain
  • Pain worse at night
  • Possible spasms
  • A somber, white facial complexion
  • Scaly skin
  • Aversion to Wind
  • Spontaneous perspiration
  • Shortness of breath
  • Disinclination to speak
  • Fatigue
  • Lassitude
  • T: Pale with possible maculae or static spots
  • C: Thin and white
  • P: Deep, choppy and weak
Treatment Principle
  • Tonify Qi
  • Invigorate the Blood
  • Transform Stasis
  • Unblock the channels
  • Alleviate pain
Herb Formulas
Points
  • LI-4, SP-6, ST-7, ST-36
    For pain in the upper border of the zygomatic arch: + GB-3
    For pain in the lower jaw: + ST-6
    For pain in the cheek bone: + SI-18
    For pain behind the ear, earache or tinnitus: + SJ-17
    For pain in front of the ear, earache or tinnitus: + GB-2
    For pain in the temples: + Taiyang
    For pain in the forehead: + GB-14, ST-8
    For muscle spasms: + LIV-3
    For swelling: + SP-9
    For severe pain: + SJ-3 or LI-3
    For neck and shoulder tension: + GB-21, UB-10
    For insomnia or restlessness: + DU-24, HT-5, HT-7
Clinical Manifestations
  • Grinding of the teeth
  • Possible facial swelling
  • A somber white or sallow facial complexion
  • Lassitude
  • Fatigue
  • Weakness
  • Loose stools
  • Poor appetite
  • Abdominal distention after meals
  • Dizziness
  • Pale face
  • Pale lips and nails
  • Weak voice
  • Shortness of breath
  • Reluctance to speak
  • Sweating with little or no exertion
  • Cold hands and feet
  • Palpitations
  • Insomnia
  • Dry skin
  • Dry hair
  • Poor memory
  • Scanty periods
  • T: Pale possible with teethmarks or Pale, thin and dry or Pale
  • C: Thin and white
  • P: Weak or Thin and choppy or Thready and weak
Treatment Principle
  • Tonify Qi
  • Nourish the Blood
Herb Formulas
  • Ba Zhen Tang modified
  • For Qi Deficiency predominant with more facial swelling than pain:  modified
Points
  • LI-4, SP-6, ST-7, ST-36
    For pain in the upper border of the zygomatic arch: + GB-3
    For pain in the lower jaw: + ST-6
    For pain in the cheek bone: + SI-18
    For pain behind the ear, earache or tinnitus: + SJ-17
    For pain in front of the ear, earache or tinnitus: + GB-2
    For pain in the temples: + Taiyang
    For pain in the forehead: + GB-14, ST-8
    For muscle spasms: + LIV-3
    For swelling: + SP-9
    For severe pain: + SJ-3 or LI-3
    For neck and shoulder tension: + GB-21, UB-10
    For insomnia or restlessness: + DU-24, HT-5, HT-7
Clinical Manifestations
  • Grinding of the teeth during sleep
  • Stomach glomus
  • Intermittent abdominal pain
  • Addiction to peculiar foods
  • A sallow facial complexion
  • cold hands and feet
  • Fatigue
  • A tendency toward loose stools
  • Possible itching in the nostrils
  • Blue macules or speckles in the whites of the eyes
  • White-colored roundworm macules on the face
  • Translucent milliary eruptions on the inside of the lips
  • Bright red, speckled eruptions on the tip, sides or middle of the tongue
  • T: Pale or Red
  • C: White, possibly flowery and peeled
  • P: Deep, wiry and slippery
  • (Note: This syndrome may describe many different types of parasitic infestation and is appropriate as long as they are a combination of severe Qi Deficiency, Liver Qi Stagnation, Damp-Heat and Cold.)
Treatment Principle
  • Strengthen the Spleen
  • Transform Dampness
  • Clear Heat
  • Expel Worms
Herb Formulas
Points