Chen Ning (陈宁), Min Jie (闵婕)

1 Acupuncture Department, Taizhou Jiangyan Hospital of Traditional Chinese Medicine, Jiangsu 225500, China

2 Acupuncture Department, Taizhou No.2 People’s Hospital, Jiangsu 225500, China

Special Topic Study

Combining acupuncture and copper-tube moxibustion for 39 cases of recurrent peripheral facial paralysis

Chen Ning (陈宁)1, Min Jie (闵婕)2

1 Acupuncture Department, Taizhou Jiangyan Hospital of Traditional Chinese Medicine, Jiangsu 225500, China

2 Acupuncture Department, Taizhou No.2 People’s Hospital, Jiangsu 225500, China

Objective:To observe the clinical effect of acupuncture combined with copper-tube moxibustion on peripheral facial paralysis.

Moxibustion Therapy; Acupuncture-moxibustion Therapy; Facial Paralysis; Thermal Box Moxibustion

Peripheral facial paralysis (aka Bell’s palsy) is more commonly seen in winter and summer. It can affect people of any age groups, especially the young and middle-aged population. With timely treatment, most patients can fully recover; otherwise, its sequela may affect the patients’ quality of life[1-2]. Recurrent Bell’s palsy is extremely uncommon and only accounts for 2.7% of peripheral facial paralysis. As a result, there are few clinical reports on this condition. We’ve treated 39 cases of recurrent Bell’s palsy with acupuncture plus copper-tube moxibustion. The results are now summarized as follows.

1 Clinical Materials

1.1 Diagnostic criteria

This was based on the diagnosis criteria for peripheral facial paralysis in thePrinciple and Practice of Acupuncture and Moxibustion[3]: deviation of the eye and mouth corner, one-sided facial stiffness, numbness, paralysis and absence of forehead wrinkles, widened palpebral fissure, incomplete eye closure, lacrimation, shallowing of the nasolabial groove, mouth corner drooping and deviated to the healthy side, inability to frown, close eyes and blow; some patients may experience pain behind the ears, coupled with hypogeusia (reduced ability to taste things) or ageusia (loss of taste functions) and hyperacousis (oversensitivity to certain frequency and volume ranges of sound).

Traditional Chinese medicine (TCM) patterns were based onTraditional Chinese Medicine Therapies for Neurological Conditions[4].

Wind-cold obstructing meridians: Sudden deviation of the eye and mouth, incomplete eye closure, chills, fever, headache, neck stiffness, and contracture and pain of the limbs. Patients often have a history of cold attacking the face. The tongue coating is thin and white.The pulse is superficial and tense or superficial and moderate.

Wind-heat obstructing meridians: Sudden deviation of the eye and mouth, incomplete eye closure, fever, headache, a dry mouth, mild thirst, and muscle or joint soreness. The tongue coating is thin and yellow. The pulse is superficial and rapid.

Wind-phlegm obstructing meridians: Deviation of the eye and mouth, incomplete eye closure, facial spasm, numbness or distension, general heaviness, chest tightness, and stomach stuffiness. The tongue is swollen with white greasy coating. The pulse is wiry and slippery.

Accumulation of toxic-heat: Deviation of the eye and mouth, incomplete eye closure, fever, restlessness, red face and eyes, and thirst. The tongue is red with yellow coating. The pulse is slippery and rapid.

Liver qi stagnation: Deviation of the eye and mouth, emotional depression, chest tightness, frequent sighing, dizziness, blurred vision, pain in the rib area, breast distension, and irregular menstruation. The tongue is pale or dark with thin coating. The pulse is wiry.

Stagnant blood obstructing meridians: Persistent deviation of the eye and mouth, facial stiffness with occasional spasm or pain. The tongue is dark purple or with ecchymosis or petechiae. The pulse is hesitant and slow.

Deficiency of qi and blood: Deviation of the eye and mouth, facial muscle atrophy, lusterless complexion, shallow breathing, reluctance to talk, fatigue and spontaneous sweating. The tongue is pale. The pulse is deficient and weak.

1.2 Inclusion criteria

Those who met the above diagnostic criteria for Bell’s palsy; two or more recurrence involving the same side; aged above 12 and there were no gender limitation.

1.3 Exclusion criteria

Patients having initial or bilateral peripheral facial paralysis; central or otogenic facial paralysis; having meningitis, Guillain-Barre syndrome or space occupying brain lesion; and aged below 12 years old.

1.4 General data

A total of 39 eligible outpatients were recruited in this study. There were 23 males and 16 females. Their ages were between 12 and 72. The duration lasted from 1 d to 2 weeks. Of the 23 males, 17 cases had left facial paralysis and 6 cases had right facial paralysis. Of the 16 females, 9 cases had left facial paralysis and 7 cases had right facial paralysis. Six (2 males and 4 females) cases had 3 times of facial paralysis: 2 males had left facial paralysis, 3 females had left facial paralysis and 1 female had right facial paralysis. Three (1 male and 2 females) cases had 4 times of facial paralysis: 1 male had left facial paralysis and 2 females had right facial paralysis.

2 Treatment Methods

2.1 Points

Group 1: Zusanli (ST 36) and Wangu (SI 4)[5-6].

Group 2: Fengchi (GB 20), Yangbai (GB 14) towards Yuyao (EX-HN 4), Sibai (ST 2) towards Yingxiang (LI 20), Dicang (ST 4) towards Jiache (ST 6) (affected side) and Hegu (LI 4) on both sides.

Group 3: Yiming (EX-HN 14), Sizhukong (TE 23) towards Tongziliao (GB 1), Xiaguan (ST 7) towards Qianzheng (EX-HN 17, location: 0.5 cun anterior to the ear lobe), Jiache (ST 6) towards Dicang (ST 4) (affected side) and Taichong (LR 3) on both sides.

Modifications: For wind-cold obstructing meridians, add Quchi (LI 11) and Waiguan (TE 5); for wind-heat blocking meridians, add Dazhui (GV 14) and Neiting (ST 44); for wind-phlegm obstructing meridians, add Fenglong (ST 40); for deficiency of qi and blood, add Xuehai (SP 10); and for deficiency of the liver and kidney, add Taixi (KI 3) and Sanyinjiao (SP 6).

Points of group 1 were punctured on both sides alternately. Points of group 2 and 3 were punctured alternately.

2.2 Materials

Self-made copper-tube moxibustion tools (small, medium and large sizes) are 0.5-0.8 cm in diameter and 5-6 cm in length. Small holes of 0.1-0.2 cm in diameter were made through the copper tube. There are 12-16 holes in each tube for ventilation. Make one end of the tube oblique to place moxa cone. Wrap the other end with cotton to prevent burns (Figure 1).

Figure 1. Copper-tube moxibustion tool

2.3 Methods

The patient took a sitting or supine lying position. After routine sterilization, the physician punctured the distal points first and then the points on the face with slow insertion and bird-pecking needling technique[7]: placing the ring finger (the one to hold the needle) closeto the point and tremble the needle using the thumb, index and middle fingers via the rapid movement of the wrist joint. The amplitude was 1-2 mm and the frequency was 100-120 times per min. At the same time, the physician also applied a rotating/twirling manipulation of less than 90° and 30-40 times per min in frequency (Note: This technique is not used for an acute facial paralysis within one week). During needle retention, moxa cone of 0.2-0.3 g was ignited and placed on the oblique end of the copper-tube moxibustion tool. The other end of the tool was wrapped with cotton (Figure 1 and Figure 2). The patient was supposed to feel warm but not burning pain. Five Zhuangs were used for each treatment, followed by five times of bird-pecking needling (15-30 s), one for each Zhuang. The needles were retained for 30-40 min. The patient should always feel the needling sensation.

Figure 2. Copper-tube moxibustion in the ear

2.4 Course of treatment

The treatment was done once a day, and 10 d made up a course of treatment. There was a 3-day interval between two courses. The clinical effects were statistically analyzed after 4 courses of treatment.

3 Treatment Results

3.1 Therapeutic efficacy criteria

This was based on theCriteria of Diagnosis and Therapeutic Effects of Diseases and Syndromes in Traditional Chinese Medicine[8].

Recovery: Total absence of signs and symptoms, recovery of facial muscle functions, dynamic symmetry of bilateral mimetic muscle and normal eyes, mouth corner, forehead wrinkles and nasolabial groove.

Improvement: Almost absence of signs and symptoms, static symmetry of bilateral mimetic muscles and almost normal eyes, mouth corner, forehead wrinkles and nasolabial groove.

Failure: Clinical symptoms such as deviation of the eye and mouth and facial paralysis remain unchanged.

3.2 Results

Of the 39 cases, 18 cases obtained recovery, 15 cases got improvement and 6 cases got no effect. The total effective rate was 84.8%.

3.3 Case study

A 42-year-old male patient came for the first visit on February 16, 2011.

Chief complaints: Deviation of the left eye and mouth, lacrimation with wind, incomplete eye closure for 2 d. The patient claimed that this was the second time of facial paralysis.

History of present illness: Two days ago, the patient experienced facial weakness and stiffness in the morning, coupled with deviation of the face to the right side, salivation, water coming out of mouth while brushing the teeth, retention of food residue in left gum, eye distension, inability to frown, lacrimation, intolerance of cold, and appetite, bladder and bowel movements are all ok.

History of past illness: The patient had left facial paralysis in January 2009. In addition, he had 6 years of diabetes and has been taking antidiabetic agents.

Physical examination: Left facial muscle weakness and deviated to the right side, incomplete closure of the left eye, bigger palpebral fissure, flexible movement of the eyeballs, drooping of right mouth corner, poor blowing and teeth exposing, the tongue is in the middle upon extension, normal taste, shallowing of nasolabial groove, philtrum deviated to the right side, no skin rashes in the external auditory meatus, no tenderness behind the ears and over the mastoid process, distension behind the ears, and facial muscle deviated to the right side while smiling. Other results include positive Bell test, normal findings of other neurological examination and no abnormal findings by cranial MRI. The patient had declined taste in the tip of the tongue. The tongue coating was thin and white. The pulse was thready and wiry.

Diagnosis in Chinese medicine: Facial paralysis due to wind-cold obstructing meridians.

Diagnosis in Western medicine: Recurrent Bell’s palsy.

TCM differentiation: Meridian qi deficiency, external contraction of wind-cold and incoordination between qi and blood.

Treatment strategies: Warm and unblock meridians, remove wind, dissipate cold and harmonize qi and blood.

Method: Group 1 points include Zusanli (ST 36), Wangu (SI 4), Quchi (LI 11) and Waiguan (TE 5) (left side). Group 2 points include Fengchi (GB 20), Yangbai (GB 14) towards Yuyao (EX-HN 4), Sibai (ST 2) towardsYingxiang (LI 20) and Dicang (ST 4) towards Jiache (ST 6) (left side) and Hegu (LI 4) (left side). The group 1 points were punctured first and then the group 2 points. The patient took a supine lying position. The physician pressed the points using the thumb to check for sensation and punctured distal points first and then points on the face with slow insertion and bird-pecking needling technique. Copper-tube moxibustion was combined during needle retention. The treatment was done once a day.

Medical advice: Stay away from wind and cold and avoid hot spicy food.

Treatment process: On February 17, 2011, the patient’s deviation of the eye and mouth got slightly better; however, incomplete closure of the left eye, absence of left nasolabial groove and deviation of the mouth corner to the right side still remained. The tongue was pale with a white coating. The pulse was deep and thready. Then the above points of group 1 were punctured first, followed by points of group 3: Yiming (EX-HN 14), Sizhukong (TE 23) towards Tongziliao (GB 1), Xiaguan (ST 7) towards Qianzheng (EX-HN 17), Jiache (ST 6) towards Dicang (ST 4) (affected side) and Taichong (LR 3) on the right side. The same needling and copper-tube moxibustion were applied. On February 25, 2011, the patient’s left facial weakness got slightly better; however, facial numbness, incomplete closure of the left eye, mild drooping of the right mouth corner, poor blowing, and deviation of the philtrum still remained. The tongue coating was thin and white. The pulse was thready and wiry. The same treatment protocol was continued. On March 1, 2011, the patient’s deviation of the left eye and mouth got better; however, he still couldn’t completely close the left eye. The tongue was pale with a white coating. The pulse was deep and thready. The patient recovered after a total of 4 courses of treatment and showed no relapse after a 2-year follow-up.

4 Discussion

Recurrent Bell’s palsy shares the same etiology with initial peripheral facial paralysis. Currently, most scholars believe it occurs as a result of inflammation of the facial nerve, pressure is produced on the nerve where it exits the skull within its bony canal[9]. Contributing factors include facial nerve ischemia due to vascular contracture, capillary dilation and tissue swelling compression following extraction of cold, viral infection and unstable autonomic nerve[10-11]. In Western medicine, the treatment strategies are to improve local circulation of blood, alleviate facial nerve edema and restore facial nerve functions.

In TCM, Bell’s palsy is caused by meridian qi deficiency, irregular lifestyles and external contraction of wind-cold. A history of facial paralysis and re-contraction of external pathogenic factors may block meridian qi and result in muscle flaccidity and subsequently, recurrent facial paralysis. Acupuncture can help alleviate edema due to facial neuritis and shorten the course of disease. In this study, Zusanli (ST 36) and Wangu (SI 4) can unblock the Stomach and Small Intestine Meridians; Hegu (LI 4) and Taichong (LR 3) can regulate qi and blood on the face. Acupuncture combined with copper-tube moxibustion can supplement healthy qi, remove wind, activate meridian qi, unblock meridians, harmonize qi and blood and restore normal functions of the facial muscles.

Tube moxibustion is a moxibustion method to place a reed or bamboo tube (as a moxibustion tool) into the ear. It’s often used to treat facial problems. This method has been recorded in numerous ancient literatures[12-14].

Compared with initial facial paralysis, recurrent Bell’s palsy takes a longer time to recover and the results are not so good, especially for those having more than 3 times of recurrence. To facilitate the clinical effect, this study adopted acupuncture and copper tube (compared with reed or bamboo tubes, copper ones are simple, safe and comfortable) moxibustion[15]. Moxibustion can increase phagocytosis and local blood circulation and regulate tissue nutrition. Copper-tube moxibustion can transmit the moxa effect to facial nerve canals via eardrum, eardrum room and (tegmen tympani) the thin plate of bone, resolve inflammatory edema, relieve compression to the facial nerve and restore nerve functions. Therefore, copper-tube moxibustion should be applied to facial paralysis as early as possible[16].

In addition to peripheral facial paralysis, copper-tube moxibustion is also helpful to dizziness/vertigo, headache, neck pain, and ear problems[17]. It’s easily accepted by patients and worthy of further clinical application.

Conflict of Interest

The authors declared that there was no conflict of interest in this article.

Statement of Informed Consent

Informed consent was obtained from all individual participants included in this study.

Received: 6 March 2015/Accepted: 13 April 2015

[1] Jia XY, Jiang LL, Zhao Y. Overview of study on treating peripheral facial paralysis with TCM. Shiyong Zhongyi Neike Zazhi, 2013, 27(2): 138-140.

[2] Tu XS. Neurology. Beijing: Military Medical Science Press, 1999: 300.

[3] Wang QC. Principles and Practice of Acupuncture and Moxibustion. Beijing: China Press of Traditional Chinese Medicine, 2003: 69.

[4] Cai R, Wang XP, Zhao FS. Traditional Chinese Medicine Therapies for Neurological Conditions. Beijing: Huaxia Press, 1994: 37.

[5] Chen N. Effects of blood pressure on acupuncture treatment for peripheral facial nerve paralysis. JCAM, 2013, 29(1): 11-13.

[6] Chen N, Li DS. Exploration and clinical application of Wangu (SI 4). Zhongguo Zhen Jiu, 2000, 20(4): 223-225.

[7] Wang LL, Wang QC. Clinical Experience of Acupuncture and Moxibustion. Beijing: People’s Medical Publishing House, 2007: 331.

[8] Bei ZP. Diagnostic Criteria for Internal Medicine. Beijing: Science Press, 2001: 813.

[9] Wu J. Neurology. Beijing: People’s Medical Publishing House, 2005: 119-120.

[10] Chen ZL, Dai XL, Li YQ. The localization diagnosis of peripheral facial paralysis and evaluation of curative effect of acupuncture. JCAM, 2014, 30(10): 25-26.

[11]Ling Shu(Spiritual Pivot). Beijing: People’s Medical Publishing House, 1980: 306

[12] Sun SM.Bei Ji Qian Jin Yao Fang(Important Formulas Worth a Thousand Gold Pieces for Emergency). Beijing: People’s Medical Publishing House, 1995: 170.

[13] Yang JZ.Zhen Jiu Da Cheng(Great Compendium of Acupuncture and Moxibustion). Beijing: People’s Medical Publishing House, 1963: 334.

[14] Liao RH. Collections of Acupuncture and Moxibustion. Beijing: Cathay Bookshop Publishing House, 1986: 11.

[15] Xu LH, Bai YP, Li QY. Observation on infrared thermography monitoring heat sensitive point moxibustion treatment for peripheral facial paralysis. Shanghai Zhenjiu Zazhi, 2013, 32(3): 183-184.

[16] Tian FW, Wang ZX, Lu Y, Gou CY, Li N, Wang H. Controlled observation onGuan-moxibustion and suspended moxibustion for treatment of herpes simplex virus facial neuritis. Zhongguo Zhen Jiu, 2006, 26(3): 166-168.

[17] Tian FW, Yang JR. Clinical research of tube moxibustion therapy on sudden deafness. Chengdu Zhongyiyao Daxue Xuebao, 2011, 34(1): 27-29.

Translator: Han Chou-ping (韩丑萍)

针刺配合铜管灸治疗复发性周围性面瘫39例

目的：观察针刺配合铜管灸治疗复发性周围性面瘫临床疗效。方法：共纳入39例复发性周围性面瘫患者, 给予针刺配合自制铜管灸器灸, 每日治疗1次, 10天为1疗程, 疗程间休息3 d, 治疗4个疗程后统计疗效。结果：39例中痊愈18例, 好转15例, 未愈6例, 总有效率84.6%。结论：针刺配合铜管灸治疗复发性周围性面瘫疗效肯定。

灸法; 针灸疗法; 面神经麻痹; 温灸器灸

R246.6 【

】B

Author: Chen Ning, vice chief physician of traditional Chinese medicine.

E-mail: ning666666666@sina.com

Methods:A total of 39 recurrent Bell’s palsy patients were treated with acupuncture plus self-made copper-tube moxibustion, once a day. Ten days made up a course of treatment. The patients were treated for 4 courses of treatment. There was a 3-day interval between two courses. The therapeutic efficacies were statistically analyzed after 4 courses of treatment.

Results:Of the 39 cases, 18 cases obtained recovery, 15 cases got improvement and 6 cases failed. The total effective rate was 84.6%.

Conclusion:Acupuncture combined with copper-tube moxibustion is effective for recurrent peripheral facial paralysis.