Clinical study on skin needling plus heat-sensitive moxibustion for chronic facial paralysis

Xie Yan-feng (谢炎烽), Ruan Yong-dui (阮永队), Wei Wen-zhu (魏文著), Ning Xiao-jun (宁晓军), Zheng Zhi (郑智)

Chinese Medicine Department, Tangxia Hospital of Dongguan, Guangdong 523721, China

Clinical study on skin needling plus heat-sensitive moxibustion for chronic facial paralysis

Xie Yan-feng (谢炎烽), Ruan Yong-dui (阮永队), Wei Wen-zhu (魏文著), Ning Xiao-jun (宁晓军), Zheng Zhi (郑智)

Chinese Medicine Department, Tangxia Hospital of Dongguan, Guangdong 523721, China

Objective:To observe the clinical efficacy of skin needling plus heat-sensitive moxibustion in treating chronic facial paralysis.Methods:Sixty patients with chronic facial paralysis were divided into an observation group and an acupuncture group by using the random number table, 30 in each group. Patients in the observation group were given skin needling plus heat-sensitive moxibustion; while patients in the acupuncture group were given conventional acupuncture.

Moxibustion Therapy; Heat-sensitive Moxibustion; Acupuncture-moxibustion Therapy; Acupuncture Therapy; Skin Needling; Facial Paralysis

Peripheral facial paralysis, or Bell’s palsy, usually results from nonsuppurative inflammation, while the exact cause is not clear yet. In traditional Chinese medicine, it’s named wry mouth and eye, in which the pathogenic wind and cold will go deeper and affect the muscular regions of the meridians if left untreated, leading to chronic paralysis. In addition, wrong treatment at an early stage may consume qi and blood or cause pathogenic factors to enter the interior, resulting in refractory facial paralysis. So far, there are no unified diagnostic criteria for chronic facial paralysis yet, and the disease duration for defining chronic paralysis varies from over 1 month, over 2 months, over 3 months, over 6 months, to over 1 year according to reports[1]. Chronic facial paralysis has been regarded as a difficult medical issue because of limited treatment methods and poor prognosis[2]. We adopted skin needling plus heat-sensitive moxibustion to treat facial paralysis from September 2010 to March 2014, and compared it to single acupuncture treatment. The details are reported as follows.

1 Clinical Materials

1.1 Diagnostic criteria

By referring to the diagnostic criteria of peripheral facial paralysis from theClinical Diagnostic Basis and Criteria for Cure and Improvement of Disease[3]: a history of contracting cold, dampness, wind or pharyngitis, some patients may experience pain inside or behind ears or in the face before the onset; acute or subacute onset presenting dysgeusia in the first 2/3 of the tongue, tinnitus, hyperacusis, or herpes in ears; facial paralysis caused by other reasons such as lesions in cerebellopontile angle, brainstem problems, surgery injury, parotid gland disease, and Guillain-Barre syndrome; sequelae left after 3 months of treatment, manifesting as droop of eyelid, wry mouth corner, and atrophy or spasm of facial muscles.

1.2 Inclusion criteria

Conforming to the above diagnostic criteria; aged 20-80 years old, without preference to gender; disease duration over 3 months, with sequelae presenting droop of eyelid, wry mouth corner, and atrophy or spasm of facial muscles; having signed the informed consent form.

1.3 Exclusion criteria

Facial paralysis caused by injuries; those with heart pacemaker; those with mental disorders that would affect the compliance; pregnant women or those in lactation.

1.4 Statistical method

The SPSS 13.0 version software was used for data processing. Measurement data were expressed as mean ± standard deviationand analyzed by usingt-test; the comparison of rate was performed by using Chisquare test.P＜0.05 indicates a statistical significance.

1.5 Study subjects

Sixty eligible patients were recruited from Tangxia Hospital of Dongguan between September 2010 and March 2014. On the initial visit, they were allocated into an observation group or an acupuncture group by using the random number table (enveloping method), 30 in each group. In the observation group, the age range was 20-76 years, and disease duration was from 3 months to 16 months. In the acupuncture group, the age range was 20-74 years, and disease duration was from 3 months to 15 months. There were no significant differences in comparing the data of gender, age and disease duration (P＞0.05), indicating the comparability (Table 1).

Table 1. Comparison of general data

2 Treatment Methods

2.1 Observation group

2.1.1 Skin needling

Points: Yangming Meridian on the affected side and Cuanzhu (BL 2), Yuyao (EX-HN 4), Sizhukong (TE 23), Sibai (ST 2), and Taiyang (EX-HN 5), (Figure 1).

Figure 1. Skin needling

Method: After standard sterilization, filiform needles of 0.30 mm in diameter and 40 mm in length were used to swiftly perpendicularly insert into the acupoints by depth less than 0.5 cun. Five needles were evenly punctured along the line from Sibai (ST 2) to Dicang (ST 4), and 10 needles were evenly punctured along the line from Xiaguan (ST 7) to Dicang (ST 4). For those who cannot completely close the eye, both superior and inferior eyelids were evenly punctured superficially, 3 needles for each side. The needles were retained for 30 min each session.

The treatment was given once every other day, 10 sessions as a treatment course, and the efficacy was evaluated after 3 courses.

2.1.2 Heat-sensitive moxibustion

Moxa: Specific pure moxa rolls for heat-sensitive moxibustion produced by Affiliated Hospital of Jiangxi University of Traditional Chinese Medicine, 2.5 cm in diameter and 12 cm in length.

Heat-sensitive moxibustion: First, Yifeng (TE 17) was treated with 2 min circling moxibustion, 1 min bird-pecking moxibustion, and 1 min returning moxibustion, followed by stationary mild moxibustion, better to make the hot sensation penetrate into the ear and radiate to the whole face till the disappearance of the sensation transmission. Then, Xiaguan (ST 7), Jiache (ST 6), and Taiyang (EX-HN 5) were respectively treated with 2 min circling moxibustion, 1 min bird pecking moxibustion, 1 min returning moxibustion, and stationary moxibustion, to make the hot sensation penetrate and extend to the whole face till the sensation transmission vanished. Shenque (CV 8) was treated with moxibustion following the same procedure but to make the hot sensation pass into the abdomen and go along the Belt Vessel till the end of the sensation transmission. For Shousanli (LI 10) and Zusanli (ST 36), moxibustion was performed by the same procedure, to make the hot sensation transmit to the face.

For heat-sensitive moxibustion, the duration from the beginning to the disappearance of heat penetration was taken as a dose, while it may differ in individuals varying from 10 min to 240 min.

The treatment was given once every other day, 10 sessions as a treatment course, and the efficacy was evaluated after 3 courses.

2.2 Acupuncture group

Points: Dicang (ST 4), Jiache (ST 6), Sibai (ST 2), Qianzheng (Extra, 0.5-1.0 cun in front of the ear lobe), Yingxiang (LI 20), Yangbai (GB 14), Yuyao (EX-HN 4), Yifeng (TE 17), and Fengchi (GB 20) on the affected side, as well as Hegu (LI 4) on the healthy side.

Method: Needles of 0.25 mm in diameter and 40 mm in length were selected. After standard sterilization, a needle was punctured at Dicang (ST 4) towards Jiache (ST 7); Yangbai (GB 14) was punctured towards Yuyao (EX-HN 4); Sibai (ST 2), Qianzheng (Extra), Yingxiang(LI 20), Yifeng (TE 17), Fengchi (GB 20), and Hegu (LI 4) were punctured in a conventional way taking the arrival of needling qi as the evaluation standard. The needles were retained for 30 min.

The treatment was given once every other day, 10 sessions as a treatment course, and the efficacy was estimated after 3 courses.

3 Therapeutic Observation

3.1 Criteria of therapeutic efficacy

The criteria of therapeutic efficacy were made according to the House-Brackmann (H-B) grading recommended by the 5th International Facial Neurosurgery Symposium[4-5].

Grade Ⅰ: Normal facial motor function.

Grade II: Mild dysfunction (slight weakness, normal symmetry at rest).

Grade III: Moderate dysfunction (obvious but not disfiguring weakness with synkinesis, normal symmetry at rest). Complete eye closure with maximal effort, good forehead movement.

Grade Ⅳ: Moderately severe dysfunction (obvious and disfiguring asymmetry, significant synkinesis). Incomplete eye closure and imperfect forehead movement.

Grade V: Severe dysfunction (barely perceptible motion).

VI: Total paralysis (no movement).

Recovery: H-B grade Ⅰ. Normal facial movement without weakness or synkinesis.

Marked effect: H-B grade Ⅱ. Mild asymmetry of facial movement and mild synkinesis.

Improved: H-B grade Ⅲ. Obvious asymmetry and secondary defect, while forehead movement still existed, indicating incomplete loss of neurologic function.

Invalid: H-B grade Ⅳ-Ⅵ.

3.2 Results

After 3 treatment courses, the total effective rate was 93.3% in the observation group versus 86.7% in the control group, and the difference was statistically significant (χ2=4.32, P=0.0377), suggesting that the efficacy of the observation group was more significant than that of the acupuncture group.

Table 2. Comparison of therapeutic efficacy (case)

4 Discussion

Western medicine holds that chronic facial paralysis is mainly caused by facial nerve demyelination and/or axonal degeneration. The development of chronic facial paralysis is related to the intervention time in the early stage, affected location of facial nerve and the individual constitution[6]. In China, acupuncture, moxibustion and tuina are adopted as the major intervention methods for facial paralysis in the recovery stage, to improve the blood circulation and nutrition condition in face[7-8].

According to TCM, facial paralysis is often caused by insufficient healthy qi, empty collaterals, weak defensive qi, attack of pathogenic wind and cold, obstructed qi activities in Yangming and Taiyang, blocked qi-blood circulation, in meridians and collaterals. Inefficient or improper treatments will lead to chronic facial paralysis featured by deficiency in the root and excess in clinical symptoms.

As a special acupuncture method targeting the cutaneous regions of meridians, skin needling produces a small amount of stimulation by superficial needling with many needles, featured by mild, superficial, numerous, and dense[9]. The twelve cutaneous regions are closely related to meridians, collaterals and Zang-fu organs. By directly stimulating the cutaneous regions, skin needling can supplement the defensive qi and regulate the Ying-nutrient and Wei-defensive qi, activate the functiond of Zang-fu organs, meridians, and collaterals, reinforce healthy qi, and thus expel pathogens. Yangming Meridian is full of qi and blood. Skin needling at the Yangming Meridian can activate the circulation of qi and blood, unblock stagnation and relieve impediment, regulate and unblock meridians and collaterals, nourish tendons and muscles, expel pathogens, and finally cure the disease[10]. From the perspective of Western medicine, skin needling can stimulate the peripheral nerves. Through axonal reaction and segmental reflex, it can strengthen the capillary permeability, improve the blood supply to the impaired nerve, promote the regeneration of facial nerve, and restore the function of the affected nerve and muscles[11-12].

In clinic, moxibustion is often used to reinforce the effect of acupuncture. Heat-sensitive moxibustion can produce a mild stimulation, working to expel wind and cold, supplement yang qi, and passing the healthy qi to the affected area through sensation transmission. Studies showed that the heat produced by ignitingmoxa can transmit into the body and stimulate acupoints and lymph circulation, benefiting the recovery and regeneration of facial nerves and muscles[13-14]. It’s also suggested that acupuncturemoxibustion can improve local blood circulation, strengthen the capillary permeability, help oxygen deficit and swelling of facial nerve, and promote the recovery of neurologic function by nerve-body fluid-related pathways.

The current study indicates that skin needling plus heat-sensitive moxibustion can produce a more significant efficacy than conventional acupuncture, and is worthy of promotion in clinic.

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: 2 December 2014/Accepted: 5 January 2015

[1] Chen BH. Experience of treating chronic facial paralysis. JETCM, 2012, 21(12): 1973-1974.

[2] Li FJ, Yao PH. Clinical situation and pondering of acupuncture-moxibustion for chronic facial paralysis during recent years. Chin Otorhinolaryngol J Integ Med, 2007, 15(1): 78-80.

[3] Sun CX. Clinical Diagnostic Basis and Criteria for Cure and Improvement of Disease. 2nd Edition. Beijing: People’s Military Medical Press, 1999: 198.

[4] Deng JY, Peng Y, Fan CY, Cui YC, Cui HY, Hu XH, Wang ZH. Electroacupuncture plus topical massage for acutestage idiopathic facial paralysis. Xi’an Jiaotong Daxue Xuebao: Yixue Ban, 2013, 34(2): 275-276.

[5] Chen YH, Su XQ, Sun ZR, Yang XP. Clinical observation on elecroacupuncture with sparse-dense wave for idiopathic facial paralysis. Shanghai Zhenjiu Zazhi, 2013, 32(8): 653-655.

[6] Hao LJ. Discussion about the diagnosis and treatment of chronic facial paralysis. Zhongguo Zhongyi Jichu Yixue Zazhi, 2011, 17(7): 784-785.

[7] Dong GL. Types of chronic facial paralysis and the acupuncture-moxibustion treatment. Xiandai Yixue, 2005, 33(5): 348-349.

[8] Xie R, Yang S. Treatment of chronic facial paralysis from the aspect of meridian tendon. Zhongyi Linchuang Yanjiu, 2012, 5(4): 56.

[9] Xie Y, Wu LZ. Introduction to skin needling of professor Wu Lian-zhong. Zhongyiyao Xinxi, 2003, 20(1): 38-40.

[10] Bao LS, Gao Y. Skin needling for chronic facial paralysis. Shanghai Zhenjiu Zazhi, 2008, 27(5): 33.

[11] Chen J. Skin needling for hemi-facial spasm. Zhongguo Yiyao Zhinan, 2011, 9(5): 147.

[12] Zhou Y. Observation on therapeutic effects of combined surrounding needling, bloodletting with cupping therapy for localized scleroderma. J Acupucnt Tuina Sci, 2011, 9(3): 154-155.

[13] Liu XS, Hu YH, Wang XC. Warm needling for 68 cases of peripheral facial paralysis. Zhongguo Shequ Yishi, 2004, 20(23): 41.

[14] Yu DJ. Suspended moxibustion plus acupuncture for 35 cases of peripheral facial paralysis. Zhejiang Zhongxiyi Jiehe Zazhi, 2002, 12(5): 322.

Translator:Hong Jue (洪珏)

毛刺法配合热敏灸治疗难治性面瘫的临床观察

目的：观察毛刺法配合热敏灸治疗难治性面瘫的临床疗效。方法：将60例难治性面瘫患者按随机数字分为观察组和针刺组, 每组30例。观察组患者予以毛刺法配合热敏灸治疗。针刺组患者予以单纯针刺治疗。结果：治疗3个疗程后, 观察组总有效率93.3%, 对照组为86.7%, 两组总有效率差异有统计学意义(P＜0.05)。结论：毛刺法配合热敏灸治疗难治性面瘫疗效优于常规针刺治疗。

灸法; 热敏灸; 针灸疗法; 针刺疗法; 毛刺; 面神经麻痹

R246.6 【

】A

Author: Xie Yan-feng, bachelor, attending physician.

E-mail: xieyanfeng207@163.com

Results:Three treatment courses later, the total effective rate was 93.3% in the observation group versus 86.7% in the control group, and the difference was statistically significant (P＜0.05).

Conclusion:Skin needling plus heat-sensitive moxibustion can produce a more significant efficacy than conventional acupuncture in treating chronic facial paralysis.