Chinese Medicine Book Club Issue 1079
One issue daily, accompanying the growth of TCM practitioners
IIntroduction: It is said that acupuncture is advantageous for treating facial paralysis, and this is discussed in acupuncture textbooks, but it may not always be effective in clinical practice. Online experiences vary widely, making it hard to know whom to trust. Here, Teacher Wang will tell you: how to treat facial paralysis? Why treat it this way? To learn more about “Meridian Medicine,” please download the Linglan TCM App to read the related content. (Editor/Wali)
Acupuncture Treatment for Facial Paralysis
Author/Wang Juyi
-
Case Study
Li, male, 68 years old, first diagnosed on December 3, 2009.
Main complaint: left facial paralysis for 6 days.
Symptoms: Initially, stiffness in the left neck (Taiyang Meridian), followed by discomfort in the left eye, tearing, and then left facial paralysis, pain in the left neck, jaw, below the eye, and ear, with facial numbness. The left eye cannot close completely, forehead lines become shallow, cannot puff cheeks, and the mouth is tilted to the right. The tongue coating is white, greasy, and slippery. The pulse is right stringy and slippery, left deep and slippery. The rest is normal.
Meridian examination: Abnormalities in the Taiyang Meridian, Hand Taiyin Meridian, and Hand Yangming Meridian.
Diagnosis: Disease in the Taiyang Meridian and Yangming Meridian.
Selected Meridians: Taiyang Meridian and Yangming Meridian.
Selected Acupuncture Points: Zhiyin (bloodletting), acupuncture on the left side at Tianzhu, Tongtian, Wangu, Hegu, and Pianli points.
Second diagnosis: Headache and tearing have lessened. Only a feeling of fullness in the top of the head, cheeks, and jaw remains. Bloodletting at Shaoze on the left, acupuncture at left Tianzhu, left Hegu, left Yanglao, and left Zusanli.
Third diagnosis: Disease in the Taiyang Meridian and Shaoyang Meridian. Bloodletting at both Shaoze and Guanchong, 12 drops. Acupuncture at left Wangu, left Zanzhu, left Pianli, left Zusanli, and left Shousanli.
Fourth diagnosis: Paroxysmal pain in the left temple, bilateral cheek numbness, and numbness in the left toes. Acupuncture at Fengchi, Shousanli, Yuzhen, Tianzhu, Chengjiang, left nasal sinus, Neidicang through the cheek, and Pianli.
Fifth diagnosis: Left side of the head still has paroxysmal fullness and pain, other symptoms have reduced. Same treatment plan as before, reducing Fengchi and left Pianli, adding Zhiyin, left Wenliu, and left Daying.
Sixth to tenth diagnosis: Facial numbness has significantly improved. The main points remain Tianzhu and Siguans. Adjustments made according to symptoms.
Treatment outcome: Cured after 10 sessions of acupuncture.
-
Case Analysis
The patient had previously suffered from peripheral facial nerve paralysis (mouth deviation) and was cured after treatment. This year, the condition recurred on the opposite side of the face. When encountering a patient with facial paralysis, it is essential to first understand the specific condition and medical history, then carefully observe the paralyzed area, comparing the affected side with the healthy side.
Instructions for the patient: ① Frown, observe the wrinkles between the eyebrows; ② Raise eyebrows, observe forehead wrinkles; ③ Close eyes, observe whether they can close and the wrinkles around the eyes; ④ Sniff, observe the nasolabial fold; ⑤ Pout, observe the lip lines and the degree of mouth deviation; ⑥ Puff cheeks, observe the degree of deviation in the nasolabial fold; ⑦ Close mouth, observe if there is air leakage. The affected side generally has no wrinkles or the wrinkles are not obvious. Observing the wrinkles can help the doctor understand the progress during treatment. Therefore, before each treatment, first check the wrinkles and record any changes.
This case conducted meridian examinations focusing on the affected side’s meridians. However, both sides’ meridians should be examined to accurately diagnose. It is crucial to check the meridians in the head and neck, especially whether there is pain in the mastoid area or any abnormal sensations. Pain in the mastoid area is most commonly found at Tianzhu, Fengchi, Wangu, but can also occur at Yuzhen, NaoKong, Zhemai, Fengfu, and Dazhui, requiring careful palpation. If abnormal pain is found, these points should be treated first, rather than the facial points. After alleviating mastoid inflammatory pain, treatment for facial paralysis sequelae can proceed. In this patient, the left Tianzhu was abnormal, indicating that it was still in the acute phase.
During the meridian examination, abnormalities were found in the Taiyang Meridian and Yangming Meridian. The Taiyang Meridian governs the exterior and is responsible for resolving cold pathogens. This patient, due to excessive fatigue, had a deficiency of Yang Qi in the Taiyang Meridian, allowing wind-cold pathogens to invade, leading to stagnation of cold pathogens, resulting in symptoms such as mouth deviation, headache, neck pain, and ear pain. The Yangming Meridian runs through the face, and the relaxation of the Yangming Meridian’s tendons is directly related to mouth deviation (facial asymmetry). The “Lingshu – Jingjin” states: “The tendons of the Foot Yangming Meridian: the tendons of the Foot Yangming… ascend to the neck, alongside the mouth, connecting to the jaw, ending at the nose, and connecting to the Taiyang. The Taiyang governs the upper eye, and the Yangming governs the lower eye. Its branches connect from the cheek to the front of the ear. Its disease: sudden mouth deviation (mouth corner deviation), in acute cases, the eyes cannot close, and if hot, the tendons are slack, and the eyes cannot open. If the cheek tendons are cold, it leads to acute symptoms, and if hot, the tendons are slack and cannot withstand the burden, hence deviation.” The Yangming Meridian governs closure, and external pathogens first invade the Taiyang Meridian, subsequently leading to internal stagnation and heat in the Yangming Meridian, causing mouth deviation symptoms.
The patient’s abnormalities in the Taiyang Meridian and Yangming Meridian suggest that acupuncture at Wangu and Hegu can promote the flow of original Qi in both meridians, warming Yang and resolving the exterior, and unblocking the meridian. The Wangu point can be adjusted, so careful palpation is necessary. Wangu is the source point of the Hand Taiyang Meridian, which can warm Yang and tonify Qi, treating symptoms related to facial nerve paralysis associated with the Taiyang Meridian. Hegu is the source point of the Hand Yangming Meridian, which is abundant in Qi and blood, with strong Qi-moving effects. Its effects are broad, capable of warming Yang, resolving the exterior, and tonifying Qi. The addition of Pianli can help distribute the original Qi of the meridian to a wider area.
In the second diagnosis, acute symptoms such as ear pain, neck pain, and headache have lessened but are not yet cured, so bloodletting at the Jing point Shaoze was performed. The patient also reported a feeling of fullness in the head, and inflammation in the mastoid area remains, so Tianzhu and Yuzhen were selected to disperse the Taiyang wind pathogen and elevate Yang Qi. Yanglao is the Xi point of the Hand Taiyang Meridian, which can regulate the Qi of the meridian and clear the head and brighten the eyes, treating neck and back pain.
After the third diagnosis, acute symptoms have generally lessened. Facial numbness and mastoid inflammation have also reduced, allowing for the selection of facial points. Local points are chosen based on wrinkle examination and other symptoms. First, treat the most obvious and severe sequelae, starting with the upper nasal sinus (treating numbness beside the nasal sinus), Chengjiang (treating mouth deviation), and Neidicang through the cheek. Re-examine the meridians, and all three Yang meridians show abnormalities. Combined with Hegu, Wenliu, Tianzhu, Wangu, Shugu, and Taichong for treatment, Taichong is the source point of the Foot Jueyin Meridian, which governs Yin blood and can help distribute Qi and blood throughout the body, thus regulating the meridians and treating facial numbness and finger numbness caused by blood deficiency. After the tenth diagnosis, symptoms disappeared, and the smile was natural. (Note: Due to space limitations, the other three cases attached to the original text are omitted)
-
Experiences in Acupuncture Treatment for Facial Paralysis
All four patients in this article have peripheral facial paralysis, but the causes and onset times differ, leading to different treatment methods. The first case, Li, primarily involved the Taiyang Meridian with Yangming Meridian abnormalities; the second case, Xu, primarily involved Shaoyang Meridian and Yangming Meridian abnormalities, caused by herpes zoster; the third case, Jin, primarily involved abnormalities in the Taiyang Meridian, Shaoyang Meridian, and Yangming Meridian; the fourth case, Wang, primarily involved Yangming Meridian and Shaoyang Meridian abnormalities, affecting the Jueyin Meridian. This indicates the importance of meridian examination.
First, accurate differentiation and selection of meridians at the early stage of the disease is key to treatment.
In the early stage of the disease, if there is pain in the mastoid area, careful examination of the meridians in the mastoid area is necessary. If the Taiyang Meridian is abnormal, generally, the Tianzhu point will have an abnormal response, and the Yuzhen point may also occasionally respond. If the patient has abnormalities in both the Taiyang Meridian and Shaoyang Meridian, it is essential to carefully examine the mastoid area for abnormalities in both meridians, checking for abnormalities at Wangu, Fengchi, Tianzhu, Zhemai, Yuzhen, or NaoKong; occasionally, there may be responses at Fengfu and Dazhui in the Governing Vessel, all requiring careful palpation.
When treating acute mastoid inflammation, focus on the mastoid area points on the affected side, avoiding facial points. It may also be considered to perform bloodletting at the Taiyang Meridian’s Jing points to guide Yang and open the meridians. If there are signs of deficiency, the source points of the affected Taiyang Meridian can be added for warming and tonifying the exterior. If there are abnormal responses, consider selecting points at the top of the Taiyang Meridian, such as Tongtian and Quqiao on the affected side. As the condition is caused by wind-cold, moxibustion at Dazhui can be added to disperse cold and resolve the exterior. After inflammation subsides or lessens, facial points can be selected.
The mastoid area is the starting point of the facial nerve nucleus. Inflammation of the facial nerve nucleus due to wind-cold or wind-heat indicates congestion. Many chronic facial nerve paralysis sequelae arise from the treating physician’s neglect of mastoid inflammation, leading to nutritional disorders of the facial nerve, causing degeneration of the facial nerve nucleus, resulting in irreversible facial nerve damage. Pain in the mastoid area greatly aids the physician’s understanding of the pathogenesis of facial nerve paralysis, especially in recognizing early pathogenesis.
Therefore, in the early stages of facial nerve paralysis, it is crucial to pay full attention to the presence and disappearance of inflammation in the mastoid area; the shorter the onset time, the faster the recovery. The longer the onset time, the more difficult the recovery. First, treat acute inflammation to supply nutrition to the facial nerve; when pain subsides or alleviates, local points can be selected. Do not rush to treat local points.
Second, understanding facial nerve paralysis should not be limited to the Yangming Meridian; it is essential to differentiate the causes, pathogenesis, and treatment periods (timing).
Facial nerve paralysis is generally divided into two main categories.
1. Central facial nerve paralysis. This is related to cerebrovascular diseases, cerebral hemorrhage, and hemiplegia. Recovery can occur after controlling or improving cerebrovascular diseases, and points such as Tongli and Zhaohai can be used to open the brain meridians.
2. Peripheral facial nerve paralysis. This is commonly seen by acupuncture practitioners, accounting for over 95%.
The causes are generally divided into two types: wind-cold and wind-heat. One type occurs when the patient is fatigued and exposed to wind-cold, while the other is caused by wind-heat invasion.
In treatment, detailed examination of the meridians is necessary to provide important evidence for differentiation and confirmation of the disease location and pathogenesis. It is also essential to distinguish between early and recovery stages. “In acute cases, treat the symptoms,” as the early stage has heavy pathogens, it is necessary to first dispel the pathogens—disperse cold or clear heat; in the early stage, first treat mastoid pain. In the recovery stage, after mastoid pain has disappeared, treatment for local facial nerve paralysis can proceed.
Wind-cold external pathogens mostly invade the Taiyang Meridian, related to the direction and attributes of the Taiyang Meridian. The Taiyang governs the exterior and can receive stimulation from the six Qi, resolving and preventing the invasion of cold pathogens. If the Yang Qi of the Taiyang Meridian is deficient, it cannot secure the exterior, making it susceptible to wind-cold, leading to stagnation of Qi and blood in the meridian, resulting in headache and facial paralysis. Wind-cold type facial nerve paralysis can also involve the Shaoyang Meridian. When the Taiyang Meridian is blocked, the Shaoyang Meridian’s ability to disperse is also weakened, and the disease remains in the Taiyang Meridian, so it is essential to protect this meridian to prevent re-infection by external pathogens.
Wind-heat-induced peripheral facial nerve paralysis is often due to viral infections, primarily affecting the Yangming Meridian. The wind-heat toxin causes internal heat stagnation in the Yangming Meridian, but can also include abnormalities in the Shaoyang Meridian and Taiyang Meridian. In the early stage, there is mastoid fullness and pain on the affected side, so the most sensitive points should be selected, such as Tianzhu, Fengchi, Yuzhen, and NaoKong. In the early stage, avoid needling the face, but shallow needling at the forehead points, such as the affected side’s Touwei and Yuyan, can be considered. In the early stage, bloodletting at the affected side’s Shangyang can be performed to clear heat and detoxify, along with needling the affected side’s Hegu, Quchi, and Zusanli. Blood cupping can also be applied to the affected side’s Zusanli. In the recovery stage, focus on facial points.
|
I Copyright Statement
I Submission Email [email protected] |
【Comprehensive Search】Clarification, 【Selected Articles】Teaching, 【Classic Recitation】Preaching, 【Clinical Reference】Practical. Welcome to download the Linglan TCM App to upgrade your TCM “equipment.” Please long press to recognize the QR code below or click the lower left corner “Read the original text” to download directly, or search for 【Linglan TCM】 in major app stores.
