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ACU-2012-2431-ver9-Clinical-Pearls_1P.

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ACU-2012-2431-ver9-Clinical-Pearls_1P
Type: Clinical Pearls
MEDICAL ACUPUNCTURE
Volume 24, Number 3, 2012
CLINICAL PEARLS
# Mary Ann Liebert, Inc.
DOI: 10.1089/acu.2012.2431

How Do You Treat Bells Palsy in Your Practice?

M y standard practice for the treatment of Bells


palsy is to use a technique called Mei Zen Cosmetic
Acupuncture. The Mei Zen protocol is a facial protocol that
Martha Lucas, PhD, LAc
Denver Center of Traditional Medicine and Acupuncture
1331 Vine Street
was originally designed for cosmetic purposes but has Denver, CO 80206
been very effective in the treatment of facial pain, facial
E-mail: DrMLucas@AcupunctureWoman.com
paralysis caused by stroke, TMJ, and so on. The protocol
invigorates channels on the face to create a working web of
energy. As with any effective acupuncture treatment, even
when using a specialized protocol, the first step is to examine
the pulses in order to determine energetic imbalances in the
patient. Based on the pulses, I create a prescription of body
B ells palsy represents paralysis of the seventh cra-
nial nerve with inability to flex the facial expression
muscles. The process is unilateral, with drooping of the
acupuncture points that will balance the pulses and follow corner of the mouth and perioribital tissues. Drooling and
that general balancing with the Mei Zen protocol. excessive lacrimation are frequent complications. Dysgeusia
One common imbalance is that Qi is not rising up to the or hypogeusia in the anterior third of the tongue is a common
upper part of the body to support the channels on the face. feature as well. The disease is more common in the spring
When a situation like that is felt in the pulses, the goal of and fall, has a sudden onset, and may exist for a brief period
treatment is to increase the flow of Qi in those upper body or persist for months or even years. Etiology is unknown.
channels to improve the effectiveness of any facial needling. Neoplasms, usually malignant, in the vicinity of the stylo-
One way to assure proper Qi flow between upper and lower mastoid foramen or in the parotid gland may encroach upon
body is to open up the extraordinary channel called the Dai the motor fibers and cause paralysis. If neoplasia is detected,
Mai or belt channel. The Dai Mai can become blocked surgical intervention or other treatment to eradicate the tu-
from a variety of incidents, including falls, surgery, child- mor must be performed. The acupuncture points used for
birth, or being rear ended to name a few. Another way to Bells palsy or facial paralysis or pain are GB 1, GB 20, ST 7,
increase Qi flow to the upper part of the body is to do point ST 8, LI 4, LI 11, (acupuncture LI 4 should not be used
combinations like Liver 3 or 5 plus Lung 1 as one continues during pregnancy), SI 19, ST 36. Generally, Bells palsy
to re-examine the pulses to be certain that the Qi has opened patients seem to benefit most from our treatment if it is given
to the upper jiao. Since the imbalances we see in the pulses as soon as the Bells palsy occurs. The longer the patient
may be the root of the Bells palsy symptoms or be exac- delays acupuncture treatment, the less favorable the result.
erbating factors, it is important to rectify those imbalances For those who wait 6 months or longer, the treatment results
so that the patient receives benefit from both parts of the are rather mixed. But if patients are treated immediately
treatment. after the palsy is discovered, often only one or two treat-
Once the bodys energy is balanced, it is time to move on ments are required to resolve the problem. For those who
to the Mei Zen protocol. The acupuncture points in the Mei suffer for more than 1 month, it is better to keep the needles
Zen protocol are used bilaterally, not just on the affected at the acupoints for 20 minutes. A mild case could be cured
side of the face. Points on the San Jiao, Gallbladder, Sto- in 23 weeks.
mach, Large Intestine, Ren Mai, and Du Mai channels are
activated through the use of SJ 17, Ren 24, GB 14, ST 4,7,8, Gabriel P. Lu, MD, PhD
LI 20, and Du 20 among others. Not only does the protocol Albert Einstein College of Medicine and
work locally but the Gallbladder, Du Mai, and San Jiao Montefiore Medical Centre, Bronx, NY
channels may have a direct effect on the brain, which is one Dominic P. Lu, DDS
of acupunctures goals: to reset CNS activity toward bal- School of Dental Medicine, University of Pennsylvania
ance. Once the protocol needles are in, they are left in place 6505 Rte 30
for 30 minutes. Patients are seen at least twice a week and New Tripoli, PA 18066
are taught facial Qigong maneuvers that they can do a few
times daily at home to improve their results. E-mail: DominicPLu@gmail.com

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2 CLINICAL PEARLS

B ells palsy is the most common facial paralysis, af-


fecting 1 in 60 persons in a lifetime.1 Its sudden onset
with no associated symptoms (mastoid tenderness in some
2. OConnor J, Bensky D. Acupuncture: A Comprehensive Text.
Seattle, WA: Eastland Press; 1981:367372.
3. Gao HB, Chen D. Clinical observation on 60 cases of pe-
cases) distinguishes it from Lyme disease, shingles, sar- ripheral facial paralysis treated with acupuncture penetration
coidosis (often bilateral), leprosy, Guillain-Barre syndrome, needling. Int J Clin Acupunct. 1991;2(1):2528.
connective tissue disorders, diabetes, various tumors, and
the rare recurrent paralysis of MelkerssonRosenthal Poovadan Sudhakaran, MBBS, MD, PhD, Mast. ACU,
syndrome. Mast. TCM, D.Hom, DHM, DIH, BIH
Diagnosis is clinical. An MRI can confirm swelling in the 26 Tuckers Road
geniculate ganglion. In supranuclear paralysis, there is rel- Templestowe, Vic. 3106
ative sparing of the upper face. Eighty percent of affected Australia
people recover in a few months. Modern medicine treatment E-mail: dr.p.sudhakaran@gmail.com
involves corticosteroids, anti-virals, and lubrication of the
eye.
In Chinese medicine, facial paralysis comes under wind
stroke; supranuclear paralysis is internal wind, Bells palsy
is external wind. Wind and cold disrupt the flow of Qi, and
blood in channels of the face.2
N otwithstanding various theories (inflammation/
edema/infection) about its etiology, Bells palsy is de-
fined as acute, idiopathic, peripheral facial nerve palsy.
The author uses acupuncture if there is no sign of re- From a Chinese medical perspective, it is understood mainly
covery after 1 month, as well as in cases of residual weak- as Wind and Cold invasion, affecting the Yangming and
ness. The beneficial effects of acupuncture have been Shaoyang channels. Having excluded other neurological
confirmed in previous studies.3 deficits and associated conditions, the treatment should be
The preferred steps are: directed at dispersing Wind and removing channel ob-
structions. Thus GB 20 (include GB 12 for mastoid tender-
1. Open the channels of the face using GV and CV
ness) and LI 4 are used for Wind; LR 3 for better Qi
opening pointsSI 3 + BL 62 and LU 7 + KI 6; add
circulation. GV 14 and LI 11 reduce Heat; KI 5 is for acute
GV 26 and CV 24reducing method.
nerve disorders, KI 10 for chronic; ST8 for phlegm reduction
2. Select local points from GB 14, TE 23, BL 2, Yu Yao,
in the head. Neuroanatomical acupoints1 are the mainstay
SI 18, ST 2, ST 3, ST 4, LI 19, LI 20, ST 6, ST 7,
for stimulating the seventh cranial nerve, including ST 1-2-
depending on the area of involvement and only on the
3-4-5-6 and especially ST 7, GB 14, Yuyao, TE 1723,
affected sideeven method.
Taiyang, SI 18, and Jiachengjiang (the mental foramen).
3. Distal pointsLI 4 (Grand point for the face, most
Supplementary points are used according to the patients
useful); GB 20 if there is headache; TE 5, TE 17 if
condition and constitution. Moxa can be added, especially
mastoid tenderness is presentbilateral use, reduce. If
for deficiency or chronic states. Contra- and/or ipsi-lateral
unilateral stimulation is used, use LI 4 channel on the
scalp MS 6 line for the face, and ear points (cheek, eye,
opposite side, as LI channels cross at GV 26.
mouth, Liver, Kidney) can also be needled. Lingual acu-
In recalcitrant cases, use high frequency (500 Hz) elec- puncture2 can be added, especially for involvement of the
trical stimulation at local points. chorda tympani.
Auricular pointsif needed. The patient is advised to avoid cold draughts, to warm
PrincipalTrigeminal nucleus, Face, Occipital, Point the face, massage (in an upward direction) the muscles,
zero, Shenmen, Thalamus, Lesser occipital nerve, Liver, and protect the cornea. The more severe and chronic the
Parathyroid. paralysis, the longer the treatment should be; and the
SupplementalMuscle relaxation, Adrenal C, Master earlier the treatment, the better the results. Reviews of
cerebral, Tranquilizer point. some acupuncture studies appear to support its efficacy for
Chinese herbalQian Zheng SanPulling the upright facial paralysis such as that of the World Health Organi-
powder (pulls the weak muscles into shape). zation.3 In the Cochrane Database Systematic Review
Homeopathic Causticum 30C often boosts the effects of (2004), three included studies showed that the therapeutic
acupuncture in Bells palsyboth being bioenergy systems. effect of acupuncture alone was superior to that of medi-
cation or that acupuncture combined with medication was
better than medication alone. However, the quality of the
REFERENCES included trials was not adequate. More research with high
quality trials is needed.4 Some trials done in China show
1. Longo DL, Kasper DL, Jameson JL, Fauci AS, Hauser SL, that it is effective not only in the cure rate, but also in
Loscalzo J, Eds. Harrisons Principles of Internal Medicine. hastening recovery beyond those in the natural history of
AU1 c USA: McGraw Hill; 2012:3362. Bells palsy.5
ACU-2012-2431-ver9-Clinical-Pearls_1P.3d 08/14/12 2:21pm Page 3

CLINICAL PEARLS 3

REFERENCES intradermal, semi-permanent needles (size #3) should be


inserted and covered with protective tape, rendering them
1. Wong JY. A Manual of Neuro-Anatomical Acupuncture, Vo- functional for up to several weeks. Next, one should treat
lume II: Neurological Disorders. Toronto: The Toronto Pain & any electrically active projections of the facial nerve, as
Stress Clinic Inc.; 2001:8790. well as the upper cervical spine, in all of three phases.
2. Wong JY. A Manual of Neuro-Anatomical Acupuncture, Spe- Direct physical treatment of x-ray-confirmed misalignment b AU2
cial Volume: Intra-Oral Tongue Acupuncture. Toronto: The
and joint dysfunction of the upper cervical spine, through
Toronto Pain & Stress Clinic Inc.; 2008.
specialized upper cervical chiropractic, is significantly ef-
3. World Health Organization. Category 2. Diseases, symptoms
or conditions for which the therapeutic effect of acupuncture fective and complementary. Lasting patient benefit can be
has been shown but for which further proof is needed. Acu- achieved utilizing auricular medicine techniques to select
puncture Review and Analysis of Reports on Controlled Clin- specific complex homeopathic supplementsto address
ical Trials; 2003. microbial causes of Bells palsy safely and naturally. Such
4. He L, Zhou D, Wu B, Li N, Zhou MK. Acupuncture for Bells energy medicines, correctly selected, will boost patients
palsy. Cochrane Database Syst Rev. 2004;1:CD002914. immune systems to overcome underlying chronic infection
5. Ye C, Li Z, Nan X, et al. The clinical observation of acu- (Lyme disease being a common source). Finally, direct
puncture effect on facial paralysisanalysis of 1,014 cases. application of cold laser light to the skin of the face and
Compilation of the abstracts of acupuncture and moxibustion upper cervical spine serves as an additional complement
papers. World Federation of Acupuncture and Moxibustion
to other treatments. The goal is to provide comprehen-
Societies, Beijing; 1987:4950.
sive, whole-body, wellness-based treatment on multiple
levels: (1) the energetic reflex level through auricular
Christopher Lam, MD, CCFP
Clinical Associate Professor, Department of Family
Practice, Faculty of Medicine
University of British Columbia
Affiliate of the University of Victoria
Victoria, British Columbia, Canada
105-2020 Richmond Road
Victoria, BC V8R 6R5
Canada
E-mail: lamchris@uvic.ca

I n my clinical experience, Bells palsy can occur as a


consequence of chronic infection, often undetected by
conventional laboratory testing. It has also been clinically
observed to result from mechanical dysfunction of the
upper cervical spine, resulting neurovascular encroach-
ment, hypothesized to affect cranial nerves via meningeal
irritation. Three-phase auricular medicine serves as a bio-
energetic guide to treatment, yielding exceptional patient
outcomes. Utilizing the vascular autonomic signal, color
light filters, and professionally prepared resonance testing
samples, we commonly see energetic suggestions of cause
factors including bacterial, viral, and structural impedi-
ments. Practitioners should first address energetic block-
ages through three-phase auricular therapymost
commonly, projection sites of the corpus callosum and
pineal gland.1 Points are detected electrically and/or via the
vascular autonomic signal (Nogier pulse). Active points
may exist in any one or all three phases, within a larger
zone (such as the bulk of the tragus for phase 1 corpus
callosum). Electrical stimulation is most effective using an
instrument capable of providing the full spectrum of Nogier FIG. 1. Bells palsy three-phase auricular therapy treatment
frequencies (2.5, 5, 10, 20, 40, 80, 160 Hz). Then, Spinex zones. Copyright Dr. Donald Liebell, 2012.
ACU-2012-2431-ver9-Clinical-Pearls_1P.3d 08/14/12 2:21pm Page 4

4 CLINICAL PEARLS

acupuncture; (2) the structural/neurological level via spe- REFERENCES


cialized upper cervical chiropractic correction (Atlas Or-
thogonal procedure);2 (3) the microbial level with complex 1. Yoo TW. Korean Hand Therapy, 12th ed. Seoul, Korea: Eum
homeopathy;3 (4) the cellular level through cold laser Yang Maek Jin Publishing Co.; 2009.
therapyby increasing ATP production, without produc- 2. What is Koryo Hand Therapy? Online document at:
F1 c ing free radicals (Fig. 1). www.koryohandtherapy.com Accessed July 1, 2012.
3. Park KH, Park YE, Yang TI, Yoo TW. Location of primary
headache of outpatients using newly developed meridian and
acupuncture points of Korean Hand Therapy. Med Acupunct.
REFERENCES 2010;22(2):121128.
4. Park KH, Kim HJ, Baek SY, Cho BM, Yoo TW. Effect of
1. Soliman N. Solimans Auricular Therapy Textbook: New Lo- acupuncture on blood flow velocity and volume in common
calizations and Evidence Based Therapeutic Approaches. carotid and vertebral arteries in migraine patients. Med Acu-
Bloomington, IN: AuthorHouse; 2008. punct. 2009;21:4754.
2. The Sweat Institute of Atlas Orthogonal Chiropractic. Online 5. Yoo TW. Koryp Hand Therapy, 2nd ed. Seoul, Korea: Eum
document at: www.sweatinstitute.com/content/whatsorthog.php Yang Maek Jin Publishing Co.; 2009.
Accessed July 23, 2012. 6. Yoo TW. Korean Hand Acupuncture Treatment of Bells
3. Soliman N. Homeopathy. Rockville, MD: Alternative Medi- Palsy. Seoul, Korea: Korean Hand Acupuncture Co.; 2009.
cine Seminars; 2010.
Kyu Hyun Park, MD, PhD
Donald K. Liebell, DC, BCAO, BA Professor of Neurology, School of Medicine
The Liebell ClinicChronic Pain & Wellness Solutions Pusan National University
Board Certified Atlas Orthogonist (Upper Cervical Spine 1-10 Amidong
Procedure) Busan
Licensed in Acupuncture by the Virginia Board of Medicine South Korea 602-739
477 Viking Drive Virginia Beach
VA 23452 E-mail: qhynbak@pusan.ac.kr
E-mail: necksecret@gmail.com Tae Woo Yoo, PhD
President, Korean Hand Acupuncture Institute
Korean Hand Acupuncture Institute
Seoul

I n Korean Hand Acupuncture Therapy (KHT), it is


essential to classify both the individuals affected and
non-affected side syndromes.14 Bells palsy affects persons
South Korea
E-mail: khta1004@naver.com
with kidney excess syndrome, one of the three syndromes in
KHT. In the case of Bells palsy, if ones syndrome belongs
to the right kidney excess and left yang excess syndrome,
one has facial paralysis on the right resulting in the facial
muscles being pulled to the left side. If ones syndrome is
classified as right yang excess and left kidney excess syn-
B ells palsy is a common clinical disease. The main
symptoms are drooping of the mouth corners and
numbness on the affected side of the face. Also manifested
drome, the symptoms, described above, affect the opposite are drooling, muscle weakness on the affected side, absence
side of the face.5 of forehead wrinkles, and the loss of the ability to frown. The
Using KHT micro meridians on the hand, we treat Bells etiology of Bells palsy is unclear; it may be related to a viral
palsy by tonifying the heart micro meridian and sedating the infection leading to facial nerve paralysis or exposure of the
small intestine micro meridian with KHT needles on the face to cold wind. In the acute stage, the patient may be
affected side (KHT points G 15, G 7, N 1, J 7, H 2, H 7, I 38, prescribed steroids to reduce the inflammation, or vitamins,
E 38). The non-affected side of the individual is generally or anti-viral medications. One week later, if the symptoms
yang excess constitution. Therefore we tonify lung micro persist, the patient should lie supine or sit while acupuncture
meridian or sedate large intestine micro meridian (KHT is performed at ST 6, LI 20, ST 4, GB 2, ST 2, EX-HN 5, ST
points C 9, C 11, G13, F 5, D 2, D 7, H 6, and I 38) with 7, and LI 4. The patient is needled on the affected side at a
KHT needles. Additionally, we apply moxibustion to both depth of 510 mm. Needles should be inclined at an angle so
hands on KHT points A 1, 3, 5, 8, 12, and 16.5 This treat- that De Qi is provoked, and they should remain in place for
ment protocol is undertaken once a day for five consecutive 30 minutes. Infrared radiation or moxibustion therapy
days. Out of approximately 300 reported cases of Bells should be applied for 20 minutes. In the recovery stage
palsy, the overall efficacy rate is more than 70% when the phase, acupuncture should be initiated on the above acu-
condition is treated with KHT.6 points, and ST 36 should be added. Electro-acupuncture
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CLINICAL PEARLS 5

stimulation should be performed on ST 2, LI 20, ST 6, and the following points: SJ 17 on the output of the facial nerve
ST 4 with a frequency of 2/100 Hz for 30 minutes. in the stylomastoid foramen posterior and auricular branch
From January 2009 to June 2012, at the Acupuncture of VII pair; SI 18 on the facial zygomatic branches; ST 4 on
Clinic of the Shanghai Institute of Acupuncture-Moxibustion the facial bucal branches; GB 1 and SJ 23 on the temporary
and Meridians in Shanghai, China, 31 patients with Bells branches of the facial nerve; BL 2 projected in the occipi-
palsy were treated with acupuncture. After treatment for tofrontal muscle; GB 3 on the division of the temporofacial
three periods continuously, 20 patients recovered, seven nerve; and LI 18 on the path of the cervical branch of the
patients experienced relief from their symptoms, and four facial nerve.3,4
patients did not respond to the treatment. After 8 weeks of acupuncture therapy with needles, per-
formed once per week, 70% of the patients had an 85%
Xiaomei Wang, MD, PhD excellent functional recovery. All points were stimulated
Shanghai Institute of Acupuncture-Moxibustion and with acupuncture needles (0.4 mm diameter and 80 mm in
Meridians length) inserted unilaterally and stimulated with electro-
650 South Wanping Road acupuncture at 10 Hz during a period of 45 minutes.
Xuhui District
Shanghai 200030
China REFERENCES
E-mail: wxm123@vip.sina.com or wxm@fudan.edu.cn
1. Seddon H. Surgical Disorders of the Peripheral Nerves, 2nd
ed. London: Churchill Livingstone; 1975.
Huangan Wu, MD, PhD 2. Finsterer J. Management of peripheral facial nerve palsy. Eur
Shanghai Institute of Acupuncture-Moxibustion Arch Otorhinolaryngol. 2008;265(7):743752.
and Meridians 3. Kwon HJ, Kim JI, Lee MS, et al. Acupuncture for sequelae of
Shanghai University of Traditional Chinese Medicine Bells palsy: A randomized controlled trial protocol. Trials.
Xuhui District 2011;12:71.
Shanghai 200030 4. Diaz-Toral LG, Luengas I, Reyes-Campos M, Rivas J. Efficacy
AU3 c China of acupuncture in Bells palsy. Selected topics in clinical re-
search V, UAM-X, Mexico (Metropolitan Autonomous Uni-
versity-X, Mexico); 1998.

Miguel Jesus Reyes-Campos, MD


B ells palsy affects the seventh cranial nerve that
controls the muscles of facial expression. This condi-
tion causes nerve edema, ischemia, and compression in the
CBS (Biological Sciences Health)
UAM-I (Metropolitan Autonomous University-Iztapalapa)
internal path within the temporal petrous bone. Since 1988, Venecia No 15, Colonia Juarez, CP 06600
the FES-Iztacala-UNAM (National Autonomous University Mexico City, Federal District
of Mexico) acupuncture clinic has been treating patients Mexico
with Bells palsy, according to the HerbertSeddon classi-
E-mail: migreyca@hotmail.com; migreyca@yahoo.com
fication.1 In the last 5 years, we have selected 20 patients
with neuropraxia or axonotmesis of the facial nerve to un-
Livia Gabriela Diaz-Toral, MD
dergo conventional medical treatment. After three months of
FESI-EXTENSION
treatment, no improvement was observed.
FES-Iztacala-UNAM (National Autonomous University of
Bells palsy begins with retroauricular pain and difficulty
Mexico)
in closing the eye, hyperacusis, and deviation of the labial
Tlalnepantla, Edomex
commissure, among others clinical signs. Treatment in-
Mexico
volves the application of acupuncture points related to the
neurological organization of the facial nerve.2 We applied E-mail: gabrieladiaztoral@hotmail.com
ACU-2012-2431-ver9-Clinical-Pearls_1P.3d 08/14/12 2:21pm Page 6

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AU1: Please provide city and state of publication and delete USA.
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