Therapeutic efficacy observation on combining interaction and routine acupuncture for intractable facial palsy

Wang Zu-hong (王祖紅), Guo Chun-yan (郭春艷), Li Li (李莉), Wang Su-na (王蘇娜), Duan Xiao-rong (段曉榮), Huang Pei-dong (黃培冬), Yang Qi-ming (楊騏銘)

Acupuncture Department, Kunming Hospital of Traditional Chinese Medicine, Yunnan 650011, China

Therapeutic efficacy observation on combining interaction and routine acupuncture for intractable facial palsy

Wang Zu-hong (王祖紅), Guo Chun-yan (郭春艷), Li Li (李莉), Wang Su-na (王蘇娜), Duan Xiao-rong (段曉榮), Huang Pei-dong (黃培冬), Yang Qi-ming (楊騏銘)

Acupuncture Department, Kunming Hospital of Traditional Chinese Medicine, Yunnan 650011, China

Objective:To observe the clinical efficacy of interaction acupuncture combining with routine acupuncture for intractable facial palsy.

Acupuncture Therapy; Facial Paralysis; Point, Hegu (LI 4); Points, Head & Neck

Facial palsy is mainly characterized by an inability to control facial muscles and deviation of the eye and mouth corner. Patients with facial paralysis cannot perform frowning, eye closure and blowing cheeks. This condition is known as facial nerve paralysis in Western medicine. It can affect any age group but is more commonly seen in people aged between 20 and 40 years. It occurs all year round but more commonly occurs in spring and autumn. Epidemiological survey has shown an incidence of 425.7/100 000 in big cities and 258/100 000 in the countryside[1]. With proper treatment, facial palsy may resolve within 2 months. However, delayed or inappropriate treatment may cause it to be intractable[2]. Intractable facial palsy may greatly affect the patients’ body, mind, work and life. We’ve treated intractable facial palsy with interaction and routine acupuncture (acupuncture combining with patients’ active movement). The results are now summarized as follows.

1 Clinical Materials

1.1 Diagnostic criteria

This was based on the diagnostic criteria in theCriteria of Diagnosis and Therapeutic Effects of Diseases and Syndromes in Traditional Chinese Medicine[3]: a sudden onset or a history of contracting cold or wind; some patients may experience pain in the ear or discomfort in the forehead, most patients are caught accidentally; flattened nasolabial folds, deviated mouth corner, absence of forehead wrinkles, incomplete cheekblowing and food retention in the mouth; decreased corneal reflex, orbicularis oculi reflex, orbicularis oris reflex and blink reflex; facial muscle spasm on the affected side during remissive stage, occasional crocodile tears (tears when chewing food); some patients may experience taste loss of anterior 2/3 of the tongue when chorda tympani nerve (a branch of the facial nerve) is affected; some may have auditory disturbance when stapedius is affected; some may have pain in the mastoid process, sensory disorder in the external ear and auricles or herpes-like lesion when the geniculate ganglion is affected, coupled with decreased tears and saliva; and disease duration lasted from over 2 months to 2 years.

1.2 Inclusion criteria

Those who met the above diagnostic criteria; willing to participate in this clinical trial and sign the informed consent; men and women aged between 18 and 65 years old.

1.3 Exclusion and rejection criteria

Pregnant or breast-feeding women; facial nerve paralysis due to trauma, brain diseases, parotid gland tumor, purulent or aural problems, Guillain-Barre syndrome; disease duration is shorter than 2 months or longer than 2 years; having an allergic constitution; having heart disease; those who are scared of needles; and those who failed to follow the treatment protocol.

1.4 Statistical method

The SPSS 18.0 version software was used for database establishment and statistical analysis. Thewas used to express measurement data,t-test was used for normal distribution, and rank sum test was used for skew distribution. The Chi-square test was used for enumeration data. A significant level ofα=0.05 was used for the two-sided test. APvalue of less than 0.05 indicated a statistical significance.

1.5 General data

All cases were treated at Acupuncture Department, Kunming Hospital of Traditional Chinese Medicine between June 2012 and June 2014. They were diagnosed as Bell’s palsy and did not respond well to treatment after 2 months to two years. These patients were randomly allocated into a treatment group (n=30) and a control group (n=30). As for the treatment group, the patients’ duration was between 2 months and 2 years; and 14 cases had facial paralysis of the left side and 16 cases had facial paralysis of the right side. As for the control group, there were 16 males and 14 females. They were aged between 16 and 63 years. Their disease duration was the same as that in the treatment group; and 12 cases had facial paralysis of the left side and 18 cases had facial paralysis of the right side. There were no between-group statistical differences in gender, mean age, mean duration and affected side, indicating that the two groups were comparable (Table 1).

Table 1. Between-group comparison in baseline data

2 Treatment Methods

2.1 Treatment group

Distal points: Bilateral Hegu (LI 4), Waiguan (TE 5), Yanglingquan (GB 34) and Zusanli (ST 36).

Local points: Bilateral Fengchi (GB 20), Taiyang (EX-HN 7), Yangbai (GB 14) and Xiaguan (ST 7); Cuanzhu (BL 2), Sibai (ST 2), Dicang (ST 4), Jiache (ST 6), Yingxiang (LI 20) and Chengjiang (CV 24) on the affected side.

Method: The patients were asked to empty their bladder before acupuncture and take a supine lying position. Points were located according to the textbookMeridians and Points[4]. Filiform needles of 0.25 mm in diameter and 25-40 mm in length were used for acupuncture after sterilization.

First, bilateral Hegu (LI 4), Waiguan (TE 5), Yanglingquan (GB 34) and Zusanli (ST 36) were punctured. Specifically, Hegu (LI 4) and Waiguan (TE 5) were punctured 0.5-1.0 cun perpendicularly, Yanglingquan (GB 34) was punctured 1.0-1.5 cun perpendicularly and Zusanli (ST 36) was punctured 1.0-1.5 cun perpendicularly. Upon arrival of qi, the patients were asked to frown, close eyes, expose teeth, blow cheeks and pout and remain 5-10 s at the maximal degree, and then repeated above movements, for a total of 10 min. The needles were retained afterwards.

Then bilateral Fengchi (GB 20), Taiyang (EX-HN 7), Yangbai (GB 14) and Xiaguan (ST 7), and Cuanzhu (BL 2), Sibai (ST 2), Quanliao (SI 18), Dicang (ST 4), Jiache (ST 6) and Yingxiang (LI 20) on the affected side as well as Chengjiang (CV 24) were punctured using the standard method. Specifically, Fengchi (GB 20) was punctured0.8-1.0 cun obliquely towards the tip of the nose; Taiyang (EX-HN 7) was punctured 0.3-0.5 cun obliquely; Yangbai (GB 14) was punctured 0.3-0.5 cun perpendicularly; Xiaguan (ST 7) was punctured 0.5-1.0 cun perpendicularly; Cuanzhu (BL 2) was punctured 0.5-0.8 cun subcutaneously; Sibai (ST 2) was punctured 0.3-0.5 cun perpendicularly; Quanliao (SI 18) was punctured 0.3-0.5 cun perpendicularly; Dicang (ST 4) was punctured 1.5-2.0 cun obliquely towards Jiache (ST 6) and Chengjiang (CV 24) was punctured 0.3-0.5 cun obliquely. The needles were retained for 30 min after arrival of qi.

2.2 Control group

Patients in the control group only received routine acupuncture method (no combination of patients’active movement) on the same local points (on the head and face) as those in the treatment group. No distal points were punctured.

Cautions: Upon arrival of qi, reinforcing manipulation was applied to the facial points on the affected side, whereas reducing manipulation was applied to the facial points on the healthy side. Even reinforcingreducing method was applied to the rest points. The treatment was done once every other day and 10 times made up a course of treatment. The patients were treated for a total of three courses; there were no intervals between two courses.

3 Therapeutic Efficacy Analysis

3.1 Therapeutic efficacy criteria

This was based on the therapeutic efficacy criteria for facial palsy in theShanghai Diagnostic and Therapeutic Guidelines of Traditional Chinese Medicine[5]and theCriteria of Diagnosis and Therapeutic Effects of Diseases and Syndromes in Traditional Chinese Medicine[3].

Recovery: Presence of forehead wrinkles on the affected side, symmetrical forehead wrinkles and nasolabial folds, almost complete eye closure and no difficulty in blowing cheeks and exposing teeth.

Improvement: Presence of forehead wrinkles on the affected side but shallower than the healthy side, delayed eye closure on the affected side, occasional lacrimation with wind and mild disturbance in closing eyes and exposing teeth.

Failure: Symptoms remain unchanged, asymmetrical forehead wrinkles and nasolabial folds and severe disturbance in closing eyes and exposing teeth.

3.2 Between-group comparison in clinical efficacy

After 3 courses of treatment, the recovery and total effective rates were 56.7% and 93.3% in the treatment group, versus 26.7% and 76.7% in the control group, indicating between-group statistical differences (P＜0.05), (Table 2).

Table 2. Between-group comparison in clinical efficacy (case)

4 Discussion

Acupuncture combining with patients’ passive movement, also known as interaction acupuncture, is based on theory of ‘internal causes are the basis of change, whereas external causes are the condition of change’ as well as the holistic view in Chinese medicine. It activates patients’ self-regulating ability through acupuncture coupled with physical and/or mental activities[6]. Currently, this method is often used for pain: needling distal points combining with patients’ active or passive movement to unblock meridian qi, relieve muscle spasm and alleviate pain[7-8]. By needling distal points, this method can avoid needle bending, stuck or breaking due to severe pain or muscle spasm. Since it does not directly puncture the painful area, it's easier for patients to accept.

Intractable facial paralysis has been listed as one of the top 10 conditions by China Association of Acupuncture and Moxibustion. Poor effect and long course of treatment may cause physical and mental stress to patients[9]. Left untreated or treated inappropriately, early or middle-stage facial paralysis may become intractable due to healthy qi deficiency and retention of pathogenic factors. During our treatment, we asked the patients to frown, close eyes, expose teeth, blow cheeks and pout to activate facial muscle groups and unblock meridian qi and blood; we punctured local points to circulate qi and blood to nourish facial muscles and correct mouth and eye deviation. Of the selected points, Hegu (LI 4), the Yuan-Primary point of the Large Intestine Meridian, acts to remove pathogenic factors in Yangming and Taiyang Meridians. It is indicated for problems of the head, face and five sense organs[10], including Bell’s palsy. Waiguan (TE 5) is the Luo-Connecting point of the Triple Energizer Meridian, which connects with Yang Link Vessel that holds all yang meridians together[11]. Needling this point can regulate qi activities of the three Jiao and remove pathogenic factors out of the body. Zusanli (ST 36) is akey point for facial paralysis. As the lower He-Sea point of the stomach, this point can tonify qi and blood to reinforce healthy qi. Yanglingquan (GB 34) is an influential point of tendon. Needling this point can relax muscles, unblock meridians, remove wind, resolve dampness, warm meridians, dissipate cold and nourish muscles and tendons. In addition, it is the lower He-Sea point of the gallbladder and often used for tendon problems. In addition to the aforementioned four points, we also used local points such as Taiyang (EX-HN 7), Yangbai (GB 14), Xiaguan (ST 7), Cuanzhu (BL 2), Quanliao (SI 18), Yingxiang (LI 20), Dicang (ST 4), Jiache (ST 6), Yingxiang (LI 20), Chengjiang (CV 24) and Fengchi (GB 20) to unblock meridian qi and blood in local area. The points combining can reinforce qi, circulate blood, remove wind, nourish muscles and tendons and balance yin and yang[12-15].

Over time, chronic facial paralysis may cause malnourishment of meridians, qi deficiency and blood stasis and further become intractable. Our treatment aims to balance qi, blood, yin and yang. Clinically, such purpose cannot be achieved by needling the affected side alone. As a result, we also punctured some points on the healthy side to activate meridian qi on both sides and harmonize qi, blood, yin and yang. This can also prevent perverted facial paralysis in later stage.

We’ve found that acupuncture combining with patients’ active movement can obtain better effect in activating meridian qi than routine acupuncture method. This offers a new therapy for intractable facial paralysis and extends the vision of acupuncturists.

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: 20 May 2015/Accepted: 25 June 2015

[1] Dai LL, Li Y, Bai R, Ma TM. Treating intractable facial paralysis by thorn plus moxibustion. Zhongyi Linchuang Yanjiu, 2012, 4(4): 92-93.

[2] Li CW, Li ZF. A Treatment Handbook of Integrated Chinese and Western Medicine for Neurological Conditions. Beijing: People’s Medical Publishing House, 2006: 118.

[3] State Administration of Traditional Chinese Medicine. Criteria of Diagnosis and Therapeutic Effects of Diseases and Syndromes in Traditional Chinese Medicine. Nanjing: Nanjing University Press, 1994: 189-190.

[4] Shen XY, Xu NG. Meridians and Points. Beijing: People’s Medical Publishing House, 2012.

[5] Shanghai Municipal Health Bureau. Shanghai Diagnostic and Therapeutic Guidelines of Traditional Chinese Medicine. 2nd Edition. Shanghai: Publishing House of Shanghai University of Traditional Chinese Medicine, 2003: 410-411.

[6] Wang Y. Overview on acupuncture combining with patients’ passive movement. Sichuan Zhongyi, 2013, 31(7): 169-172.

[7] Zhou JH, Wu YC, Sun YJ, Zhang JF. Clinical study on puncturing Houxi (SI 3) toward Hegu (LI 4) plus lumbar movement for acute lumbar sprain. J Acupunct Tuina Sci, 2013, 11(1): 53-56.

[8] Xu JW. Therapeutic observation on acupuncture at the second metacarpal holographic point plus exercise with needles for heel pain. Shanghai Zhenjiu Zazhi, 2013, 32(9): 755-756.

[9] Liu XL, Wang ZX. Therapeutic efficacy observation on cupping after bloodletting combining with cotton moxibustion for intractable facial paralysis. Hubei Zhongyi Zazhi, 2007, 29(4): 46-49.

[10] Cai DJ, Liu XG, Zhao ZY, Zhou QZ. Extended research on indications of Hegu (LI 4). Chengdu Zhongyiyao Daxue Xuebao, 2011, 34(1): 5-6.

[11] Zeng TJ, Huang Y, Zhang GF. Research on specificity of Sanjiao (TE 5). Shizhen Guoyi Guoyao, 2008, 19(12): 2982-2984.

[12]Zheng QP, Zhang BM. Therapeutic efficacy observation on mild lifting and superficial pulling point-towards-point needling for intractable facial palsy. J Acupunct Tuina Sci, 2014, 12(1): 39-43.

[13]Zhang YY, Gao SH. Clinical observation on point-to-point acupuncture treatment for lagophthalmos in refractory peripheral facial paralysis. Shanghai Zhenjiu Zazhi, 2013, 32(2): 110-111.

[14]Chen JW, Xu YL, Ye FW. Clinical research of therapy of facial paralysis with point through point subcutaneous needling. Liaoning Zhongyiyao Daxue Xuebao, 2011, 13(3): 59-60

[15]Tian G, Meng ZH. Dose-effect study on acupuncture at Hegu (Li 4) in treating central facial palsy. Shanghai Zhenjiu Zazhi, 2015, 34(2): 95-98.

Translator: Han Chou-ping (韓丑萍)

運動針法結合常規針刺治療頑固性面癱療效觀察

目的：觀察運動針法結合常規針刺治療頑固性面癱的臨床療效。方法：將60例頑固性面癱患者按照隨機數字表法隨機分為治療組和對照組, 每組 30例。治療組采用運動針法結合常規針刺治療, 對照組僅采用常規針刺治療, 隔日治療1次, 10次為1療程, 治療3個療程后進行療效評定。結果：治療組治愈17例, 有效11例, 無效 2例, 總有效率 93.3%; 對照組治愈 8例, 有效 15例, 無效 7例, 總有效率 76.7%, 差異具有統計學意義(P＜0.05)。結論：運動針法結合常規針刺治療頑固性面癱療效優于常規針刺治療。

針刺療法; 面神經麻痹; 穴, 合谷; 穴位, 頭頸部

R246.6 【

】A

Author: Wang Zu-hong, vice chief physician.

E-mail: wangzuhong@sina.com

Methods:A total of 60 eligible cases were randomly allocated into a treatment group (n=30) and a control group (n=30). Cases in the treatment group received interaction and routine acupuncture, whereas cases in the control group received routine acupuncture alone. The treatment was done once a day and 10 times made up a course of treatment. The patients were treated for a total of 3 courses and there were no intervals between two courses.

Results:The total effective rate was 93.3% in the treatment group (including 17 recovery cases, 11 improvement cases and 2 failure cases), versus 76.7% in the control group (including 8 recovery cases, 15 improvement cases and 7 failure cases), showing a statistical difference (P＜0.05).

Conclusion:Combining interaction and routine acupuncture can obtain better effect than routine acupuncture alone for intractable facial palsy.