Acupuncture Treatment of Bell - S Palsy

ACUPUNCTURE TREATMENT OF BELL'S PALSY: A CASE REPORT
By David P. Sniezek, D.C., M.D., Washington, DC
INTRODUCTION (Renzhong), M-HN 18 [Jiachengjiang] (1), M-HN 9

A 56-year-old white female presented with a 3-month (Taiyang), ST 7 (Ziagnuan), ST 36 (Zusanli), ST 44
history of severe right facial pain, weakness, and paralysis. (Neiting), and LI 19 (Heliao).
This patient was referred to an otolaryngologist and a
neurologist at Johns Hopkins, but did not achieve
symptomatic relief. After 15 acupuncture treatments over
an 8-week period, the patient had nearly complete
resolution.
KEY WORDS
Bell's Palsy, Acupuncture, Electroacupuncture, Wiad
and Cold, Qi
PRESENTING COMPLAINT
The patient's right facial paralysis developed
overnight. Associated symptoms included pain in her face,
difficulty speaking clearly, aud hypersensitivity to sound in
the right ear. She was unable to close her right eyelid, and
experienced difficulty with drinking and mastication. She
was evaluated and treated by an otolaryngologist, and
placed on a steroid taper and acyclovir; symptomatic
improvement in facial muscle strength did not occur. Her
facial disfigurement and difficulty speaking impacted on
her occupation (restaurant owner and operator). She
developed mild depression and a secluded behavior.
MEDICATIONS
Prednisolone, Premarin, Acyclovir, DHEA, vitamins,
minerals, and a natural Synthroid substitute.
DIAGNOSTIC TESTS
Autoimmune and serology were negative. Lyme titer
was negative. Thyroid function tests indicated that she was
euthyroid with a slightly decreased TSH level.
PAST MEDICAL HISTORY

This patient had a history of exposure to shingles
(sister) several years prior. She denied a history of chicken
pox or cold sores. She had osteonecrosis of the right hip
that required surgery, pseudotumor of the left orbit,
obesity secondary to long-term steroid use, left knee
surgery, abdominal hysterectomy, tonsillectomy, and
appendectomy.
REVIEW OF SYSTEMS
Neck pain, lower back pain, joint pain, depression,
right facial pain and sensitivity to sounds in the right ear,
with difficulty speaking clearly.
TREATMENT
Chinese medicine attributes this condition to Wind
and Cold of external origin which invade the meridians
traversing the face and disrupt the flow of Qi and Blood,
preventing the vessels and muscles from receiving the
necessary nourishment. Treatment is directed toward
spreading the Qi through the meridians of the face (1).
The patient was treated with an integrated approach of
acupuncture models. Points from a neuroanatomical
model, or for classical indications, were included at each
treatment and primarily used unilaterally. Other points
utilized the energetic approach, and were treated bilaterally.
The following acupuncture points were used without
electrical stimulation. The local points were treated only on
the right side, while the distal points were needled
bilaterally. The principal points included GB 20 (Fengchi),
GB 14 (Yangbai), ST 4 (Dicang), ST 2 (Sibai), and LI 4
(Hegu). The supplemental points included GV 26

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PATIENT
The patient was initially graded with a House-
Brackmann grade 5 paralysis in the right facial muscles (4).
After 10 acupuncture treatments over a 4-week period, she
showed significant motion in her forehead and had total
closure of her eye with maximal effort. However, with
normal effort, she had 1 to 2 mm of scleral fill with good
protection of her cornea. She also had good buccal
movement and increased movement in the muscles
supplied by the mandibular branch of her facial nerve.
After a total of 15 acupuncture treatments over an 8-week
period, she exhibited normal upper division motion and
intact tone in the lower division, with only a mild decrease
in motor strength in this division. Her strength was graded
at approximately a House-Brackmann 2. She had full eye
closure, and intact conjunctivae with slight ectropion.
(Editor's Note: The M-HN points referred to are
"miscellaneous head and face points," according to DISCUSSION
O'Connor and Bensky's Acupuncture: A Comprehensive Bell's Palsy is the most common disease of the facial
Text; see reference 1.) nerve. It is presumably due to an inflammatory reaction in
ST 2 (Sibai) was needled with a straight insertion, or around the facial nerve near the stylomastoid foramen.
while GB 14 (Yangbai) was joined to M-HN 6 [Yuyao] (2). According to Liu (1995), when acupuncture was initiated
These two points may be procured with one needle, or within three days post-onset in 684 cases of facial nerve
connected together with an alligator clip during electro- paralysis, 100 percent of the patients were cured or there
stimulation. ST 4 (Dicang) and ST 6 (Jiache) were treated was a marked improvement (5). Other studies (Gao, Chen,
independently. Because of the weakness in the orbicularis 1991) revealed that 80% of cases that were treated at more
oris, GV 26 (Renzhong) and LI 19 (Heliao) were added. than 2 months post-onset, and 83 percent of severe cases,
M-HN 9 (Taiyang) may be joined to ST 6 (Jiache). were cured or had excellent effect (6). Treatment, as with
However, in this case, the points were treated this patient, may include numerous diagnostic procedures,
independently. The other points can be added in rotation; different classes of medications, lifestyle alterations, and
the best method is a mixture of close points on the face, still, continued suffering. Acupuncture may often lead to
and distant points on the limbs. Superficial insertion of the significant clinical improvement (7).
needles with moderate stimulation is recommended, and
was done in this case. Treatment was carried out on REFERENCES
1. O'Connor J, Bensky D. Acupuncture a comprehensive text. Seattle:
alternating days. Points were treated on the affected side Eastland Press 1981; 367-372.
only, except for LI 4 (Hegu), which was treated bilaterally. 2. Ibid, 609-610.
3. Stux G, Pomeranz B. Acupuncture textbook and atlas. Berlin:
Springer-Verlag 1987; 296
4. Evans RA, Hames ML, Baguley DM, Moffat DA. Reliability of the
House and Brackmann grading system for facial palsy. J Laryngol
Otol Nov 1989; 103(11): 1045.
5. Liu YT. A new classification system and combined treatment
method for idiopathic facial nerve paralysis: report of 718 cases. Am
JAcup 1995; 23(3),205-210.
6. Gao HB, Chen D. Clinical observation on 60 cases of peripheral
facial paralysis treated with acupointure penetration needling. Int J
Clin Acup 1991; 2(1),25-28.
7. NIH Consensus Development Conference on Acupuncture,
National Institutes of Health, Bethesda MD, Nov 1997; 93-109.
AUTHOR INFORMATION
The facial points are in muscles supplied by the facial Dr. David P. Sniezek is in solo private practice
nerve. Treating these points helps to spread Qi through the specializing in Medical Acupuncture, Pain Management,
channels of the face. GB 20 (Fengchi) disperses Wind and and Physical Medicine and Rehabilitation in Washington,
Cold. Stomach and Large Intestine meridians pass through D.C. He is a member of the American Academy of Medical
the face. Treating L1 4 (Hegu), ST 44 (Neiting), and ST 36 Acupuncture.
(Zusanli) on these meridians opens them to the circulation
of Qi. David P. Sniezek, DC, M.D.
Electrical stimulation can be used to intensify the 2021 K Street, NW #710
effect of needling; however, electroacupuncture is Washington, DC 20006
ordinarily reserved until after the first or second week of hone: 202-296-3555 Fax: 202-296-0214 Email:
treatment. This can be accomplished with low frequencies Sniezek@aol.com
of 3-10 Hz (3), for 20 minutes (ITC elec-toacupuncture
stimulator, lC 1107), using GB 14 (++) and LI 4 (- -).
More rapid results may be obtained when acupuncture is
combined with manipulation, hot compresses, or Chinese
and Western oral medication.
Article Source : Medical Acupuncture. A Journal For Physicians By Physicians

Published by The American Academy of Medical Acupuncture; Fall/Winter 1998/1999 - Volume 10/Number 2
Acupuncture Point Source : A Manual of Acupuncture. By Peter Deadman

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ACUPUNCTURE TREATMENT OF BELL'S PALSY: A CASE REPORT

By David P. Sniezek, D.C., M.D., Washington, DC

INTRODUCTION (Renzhong), M-HN 18 [Jiachengjiang] (1), M-HN 9

PAST MEDICAL HISTORY

ACUPUNCTURE TREATMENT OF BELL'S PALSY: A CASE REPORT

Article Source : Medical Acupuncture. A Journal For Physicians By Physicians

ACUPUNCTURE TREATMENT OF BELL'S PALSY: A CASE REPORT

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