Clenched jaw

Inability to open the mouth. A sign of tetanic disease, wind stroke, and fright wind. When accompanied by foaming at the mouth, clenched jaw is generally a sign of epilepsy. When associated with a phlegm rale in the throat and deviation of the eyes or mouth, it indicates wind stroke.

Biomedical correspondence: trismus.

Patterns

Externally contracted wind-cold: (风寒 fēng hán) Clenched jaw due to wind-cold results when externally contracted wind, cold, or dampness evils enter the three yáng channels causing hypertonicity of the sinews. It appears in patients suffering from heat effusion, aversion to cold, headache, stiff nape and back, either absence of sweating or sweating, white tongue fur, and a tight floating pulse.

Medicinal therapy: Diffuse external evil with Pueraria Decoction (葛根汤 gé gēn tāng).

Acumoxatherapy: Base treatment for all clenched jaw patterns mainly on ST and LI. Main points: ST-6 (Cheek Carriage, 颊车 jiá chē), ST-4 (Earth Granary, 地仓 dì cāng), ST-7 (Below the Joint, 下关 xià guān), and LI-4 (Union Valley, 合谷 hé gǔ). For externally contracted wind-cold, add GB-20 (Wind Pool, 风池 fēng chí) TB-5 (Outer Pass, 外关 wài guān), LU-7 (Broken Sequence, 列缺 liè quē), and TB-17 (Wind Screen, 翳风 yì fēng); needle with drainage and add moxa.

Exuberant internal heat (裏热 lǐ rè): Clenched jaw due to internal heat results when wind-cold enters the exterior and transforms into heat or when warm heat enters the interior causing congestion in the qì aspect or stirring liver wind. It is associated with stiff neck, arched-back rigidity, hypertonicity of the limbs, vigorous heat [effusion], yellow face and eyes, parched lips, constipation and rough urination, red tongue with yellow fur and a stringlike rapid or forceful rapid sunken pulse.

Medicinal therapy: Clear and drain internal heat. Exuberant yáng brightness (yáng míng) heat is treated with White Tiger Decoction (白虎汤 bái hǔ tāng) or Major Qì-Coordinating Decoction (大承气汤 dà chéng qì tāng). If heat toxin scorches qì and blood or congests the throat, use variations of Scourge-Clearing Toxin-Vanquishing Beverage (清瘟败毒饮 qīng wēn bài dú yǐn), which clears heat and resolves toxin as well as clearing the blood and draining fire. Exuberant liver channel heat stirring wind with convulsions and arched-back rigidity can be treated by clearing heat, draining fire, and extinguishing wind, using variations of Gentian Liver-Draining Decoction (龙胆泻肝汤 lóng dǎn xiè gān tāng) or Antelope Horn and Uncaria Decoction (羚角钩藤汤 líng jiǎo gōu téng tāng). Clouded spirit and coma can be treated by clearing the heart and opening the orifices using Peaceful Palace Bovine Bezoar Pill (安宫牛黄丸 ān gōng niú huáng wán).

Acumoxatherapy: Exuberant yáng brightness (yáng míng) heat is treated with adding to above main points LI-11 (Pool at the Bend, 曲池 qū chí), ST-44 (Inner Court, 内庭 nèi tíng), ST-25 (Celestial Pivot, 天枢 tiān shū), and ST-37 (Upper Great Hollow, 上巨虚 shàng jù xū); needle with drainage.

• If heat toxin scorches qì and blood or congests the throat, add LI-11 (Pool at the Bend, 曲池 qū chí), TB-5 (Outer Pass, 外关 wài guān), BL-40 (Bend Center, 委中 wěi zhōng), and ST-43 (Sunken Valley, 陷谷 xiàn gǔ); needle with drainage. and pricking LU-11 (Lesser Shang, 少商 shào shāng), PC-9 (Central Hub, 中冲 zhōng chōng), and HT-9 (Lesser Surge, 少冲 shào chōng) to bleed.
• For exuberant liver channel heat stirring wind with convulsions and arched-back rigidity, add LR-2 (Moving Between, 行间 xíng jiān), LR-3 (Supreme Surge, 太冲 tài chōng), LI-11 (Pool at the Bend, 曲池 qū chí), GV-20 (Hundred Convergences, 百会 bǎi huì), GV-14 (Great Hammer, 大椎 dà zhuī), and GV-16 (Wind Mansion, 风府 fēng fǔ); needle with drainage. and pricking Ten Diffusing Points (十宣 shí xuān) to bleed.
• For clouded spirit and coma, add PC-8 (Palace of Toil, 劳宫 láo gōng), PC-6 (Inner Pass, 内关 nèi guān), HT-8 (Lesser Mansion, 少府 shào fǔ), and GV-26 (Water Trough, 水沟 shuǐ gōu); needle with drainage and prick Twelve Well Points (十二井穴 shí èr jǐng xué) to bleed.

Yīn depletion and blood vacuity (阴亏血虚 yīn kuī xuè xū): Clenched jaw due to yīn depletion and blood vacuity mostly occurs in the advanced stages of warm disease when heat evil has damaged yīn-liquid, or after sweating or precipitation has damaged yīn and the evil has abated. It is accompanied by dizzy head and flowery vision, convulsions of the limbs or hypertonicity of the limbs, emaciation, red tongue without fur, and a rapid fine sunken pulse. There may be heat effusion. Enrich yīn, nourish the blood, and extinguish wind with Major Wind-Stabilizing Pill (大定风珠 dà dìng fēng zhū).

Acumoxatherapy: To the main points given above add ST-36 (Leg Three Lǐ, 足三里 zú sān lǐ), SP-6 (Three Yīn Intersection, 三阴交 sān yīn jiāo), KI-1 (Gushing Spring, 湧泉 yǒng quán), LR-3 (Supreme Surge, 太冲 tài chōng), GV-20 (Hundred Convergences, 百会 bǎi huì), GV-8 (Sinew Contraction, 筋缩 jīn suō), and GB-20 (Wind Pool, 风池 fēng chí); needle with supplementation.

Direct strike by cold evil (寒邪直中 hán xié zhí zhòng): Clenched jaw preventing speech due to direct strike by cold evil is accompanied by shivering limbs, hypertonicity, reversal cold of the extremities, abdominal pain and diarrhea, blue-green or purple facial complexion, dark tongue with white fur, and a sunken stringlike and rough pulse.

Medicinal therapy: Warm the center and dispel cold. Use variations of Counterflow Cold Decoction (四逆汤 sì nì tāng) or Great Rectifying Powder (大顺散 dà shùn sǎn).

Acumoxatherapy: To the main points given above add ST-36 (Leg Three Lǐ, 足三里 zú sān lǐ), CV-6 (Sea of Qì, 气海 qì hǎi), CV-4 (Pass Head, 关元 guān yuán), and CV-8 (Spirit Gate Tower, 神阙 shén què)^mx; needle with drainage and large amounts of moxa.

Qì depression and phlegm congestion (气郁痰壅 qì yù tán yōng): Clenched jaw due to qì depression and phlegm congestion is observed in miscellaneous disease when phlegm and qì become depressed and bound, block the clear orifices, and, as happens in some cases, carry wind through the channels and network vessels. It may occur with clouding reversal and convulsions of the limbs, or with physical collapse, phlegm congestion in the throat, hasty panting, thin white or slimy white tongue fur and a sunken stringlike or slippery stringlike pulse.

Medicinal therapy: Rectify qì, open the orifices, and sweep phlegm. Use Costusroot Qì-Regulating Powder (木香调气散 mù xiāng tiáo qì sǎn). For unclear spirit-mind, first use Storax Pill (苏合香丸 sū hé xiāng wán) to open the orifices.

Acumoxatherapy: To the main points given above add SI-3 (Back Ravine, 后溪 hòu xī), ST-36 (Leg Three Lǐ, 足三里 zú sān lǐ), ST-40 (Bountiful Bulge, 丰隆 fēng lóng), PC-6 (Inner Pass, 内关 nèi guān), and LR-3 (Supreme Surge, 太冲 tài chōng); needle with drainage, and add GV-26 (Water Trough, 水沟 shuǐ gōu) and PC-5 (Intermediary Courier, 间使 jiān shǐ) for clouded spirit.

External wind toxin damage (外伤风毒 wài shāng fēng dú): Clenched jaw can arise when wind toxin enters through an open wound or sore. In such cases, it is associated with stiff neck, hypertonicity of the limbs, and even arched-back rigidity, as well as with alternating heat and cold, a white slimy tongue fur, and a stringlike pulse.

Medicinal therapy: Settle tetany and dispel wind. Make use of chong products such as scorpion (Scorpio, 全蝎 quán xiē), centipede (Scolopendra, 蜈蚣 wú gōng), silkworm (Bombyx Batryticatus, 白僵蚕 bái jiāng cán), and earthworm (Pheretima, 地龙 dì lóng). Use formulas such as True Jade Powder (玉真散 yù zhēn sǎn) or Five-Tigers-Chasing-the-Wind Powder (五虎追风散 wǔ hǔ zhuī fēng sǎn).

Acumoxatherapy: To the main points add GV-20 (Hundred Convergences, 百会 bǎi huì), GB-20 (Wind Pool, 风池 fēng chí), GV-14 (Great Hammer, 大椎 dà zhuī), GV-12 (Body Pillar, 身柱 shēn zhù), GV-26 (Water Trough, 水沟 shuǐ gōu), GV-1 (Long Strong, 长强 cháng qiáng), and SI-3 (Back Ravine, 后溪 hòu xī); needle with drainage, and add GV-26 (Water Trough, 水沟 shuǐ gōu) and KI-1 (Gushing Spring, 湧泉 yǒng quán), and prick Twelve Well Points (十二井穴 shí èr jǐng xué) to bleed for clouded spirit or arched-back rigidity.

Etymology

Chin 口 kǒu, mouth; 噤 jìn, closed of the mouth (related to 禁 prohibit, bar, ban). 牙 yá, tooth; 关 guān, gate, pass; 紧 jǐn, tightly; 闭 bì, closed.