During the initial interview, Jennifer chronicled a 15 year history of seeking treatment for facial pain. She had worked with physicians, nutritionists, allergists, and dentists trying to alleviate the pain. Although she never found complete relief, some of the treatments reduced the tingling and pain for a short period of time.

Patients gather information about their lifestyle and health goals before the Program begins. The Stress Map Jennifer had completed showed that she was at “strain” or “burnout” in her personal and work life. Her physical, behavioral, and emotional symptoms all signaled “distress.” During the first visit as I paged through her health goals, I noticed Jennifer had left one of the responses blank: “Consider the major relationships in your life. Choose three relationships and briefly describe an ideal day with each person.” Jennifer had carefully answered every other question. I wondered if the blank section was an oversight.

“Jennifer,” I asked, “did you mean to leave this section blank?”

This bright, articulate, caring woman looked down, her eyes filled with tears. “Yes,” she said quietly. “I don’t have any significant relationships in my life.”

Jennifer had moved to Portland, Oregon six months earlier, leaving a difficult family situation in another state in hopes of finding a more supportive community. Her initial attempts at forming relationships were deeply disappointing. I knew in that moment that all of the lifestyle recommendations for Jennifer would be aimed at supporting her physical health and connecting her with the larger community.

We began with dietary changes, increasing whole grains and vegetables, and reducing caffeine and sugar. During the second phase of the Program, Jennifer focused on exercise. We researched dance classes, hoping to revive her passion for dancing and increase her social contacts. The facial pain, however, had kept her from exercising for several years, and Jennifer had to increase her aerobic capacity before she could pursue dancing. Jennifer invited co-workers at the office to go to an aerobics class at a nearby gym.

By the third week in the Program, Jennifer was working with her diet and gradually increasing exercise, but the facial pain remained unchanged. She also felt increasingly fatigued. I reviewed her history and noted that one period of improvement coincided with taking an anti viral drug, Acyclovir.

On the next visit, I asked Joan about her history of Herpes simplex I, or “oral herpes.” “When did you have your last outbreak of oral herpes?”

“Oh,” said Jennifer, pausing thoughtfully, “I would say about 15 years ago.”

“About the time the facial pain started?”

“Yes,” she said, her eyes registering surprise. “About the same time the pain and tingling started in my face.”

I explained that I had been considering oral herpes as a possible cause of the facial pain. The same virus causes both Herpes simplex I (oral) and II (genital). After the first outbreak, the herpes virus remains in the nerve root, even when no lesions are visible. When the immune system is strong, and the body is relatively free of stress, the immune system can contain the virus in the nerve root. When the immune system is overburdened, the virus “escapes” and moves along the nerve root and onto the surface of the skin, causing the characteristic tingling, pain, and fluid-filled bumps.

Herpes simplex II, or genital herpes, often moves up the nerve root over time. The first eruptions, for example, may occur in the buttocks area. Subsequent outbreaks may occur progressively closer and closer to the spinal cord, where the nerve root originates from. I suddenly wondered whether the same progression might happen with oral herpes — could the virus travel farther up the nerve root, causing pain deep within the trigeminal nerve of the face, without causing an eruption on the skin?

Jennifer was eager to experiment with dietary changes that might discourage the virus. The amino acid arginine can exacerbate both oral and genital herpes; conversely, foods rich in the amino acid lysine tend to discourage it. Within a week of cutting arginine-rich foods from her diet (chocolate, hazelnuts, peanuts without skins, almonds and sardines – see chart below), Jennifer’s facial pain reduced by about 40 percent. We then added an herbal tincture (liquid extract) of dandelion root to improve liver function; astragalus, a Chinese herb known to support immune function; goldenseal for its anti-microbial activity and strengthening of mucous membrane tissue; passionflower, a sedative and pain reliever; and biscuit root, or lomatium, for its anti-viral activity.

When Jennifer returned for a three-month follow-up, her facial pain was reduced by about 90 percent. Reducing the pain helped to restore Jennifer’s energy and passion for life.

The below chart is from Encyclopedia of Natural Medicine by Michael Murray, N. D. and Joseph Pizzorno, N. D.