Acupuncture in Facial Paralysis [by David Mayor]

[Guest guest]

Hi All,

 

Congratulations to David Mayor for a great article " Electroacupuncture: An

introduction & its use for peripheral facial paralysis " in Journal of Chinese

Medicine, Number 84, June 2007, 52-70).

 

The main points (Pts) mentioned were:

 

(1) PTS ON AFFECTED SIDE OF FACE

BL02-Zanzhu

GB12-Wangu

GB14-Yangbai

LI19-Kouheliao

LI20-Yingxiang

M-HN-6-Yuyao

M-HN-9-Taiyang

SI18-Quanliao

SJ23-Sizhukong

ST01-Chengqi

ST02-Sibai

ST03-Juliao

ST04-Dicang

ST06-Jiache

ST07-Xiaguan

Empirical Pt midway between GB14 & SJ23

 

(2) NEARBY / REGIONAL PTS:

GB20-Fengchi

SJ17-Yifeng

 

(3) DISTAL PTS ON LIMBS BILATERALLY:

GB34-Yanglingquan

LI04-Hegu

LV03-Taichong

SJ05-Waiguan

SJ08-Sanyangluo

SP06-Sanyinjiao

ST36-Zusanli

 

(4) OTHER PTS:

Auricular Mouth Pt

Pts on contralateral side of face

Pts over affected nerve trunk on face

Pt-to-Pt needling

 

Here is my edited summary of the section on " Points used to treat facial

paralysis " :

 

A TCM APPROACH:

Traditionally, Pts are selected according to pattern of differentiation. Ren

Xiaoqun, for example, suggests the following Pts:

o For Channel Block dt Wind Cold: GB20, LI04 (w moxa);

o For Channel Block dt Wind Heat: SJ17, GB34;

o For Qi-Xue Stag: SJ05, SJ08, LV03;

o For Qi-Xue Xu: ST36, SP06.

 

ANATOMICAL ACUPUNCTURE:

Others prefer a Westernised approach (see Table 3 on the website version

of this article), one group suggesting that selecting Pts according to the

distribution of the main branches of the facial nerve can be effective even w

gentle / superficial MA, another author using such Pts for stronger MA w Pt-

to-Pt needling in cases of more chronic PFP (ST06 to ST04; an empirical Pt

midway between GB14 & SJ23 to ST07; SJ17).

 

A rational Pt selection might include BL02, SJ23, GB14 & Taiyang M-HN-9

for involvement of the first (temporal) branch of the facial nerve, SI18 &

ST01 for second (zygomatic) branch involvement & ST04 + ST06 for the

third (mandibular) branch. SJ17, located where the facial nerve emerges

from within the skull, is an important Pt.

 

There are very few PFP studies comparing the effects of stimulation at

acupoints & non-acupoints. In one, EA at Pts over the nerve trunk had a

better effect than similar EA at standard acupoints, while in another EA at

LI04 & Auricular Mouth Pt gave superior results to MA at nonspecific Pts

(hardly a fair comparison). Non-acupoints over the trajectory of the facial

nerve were stimulated in one very small uncontrolled LILT study (N = 4).

 

An alternative approach is based more on the muscles involved rather than

the nerves (see Table 3). Thus BL02 & GB14 have been recommended for

difficulty in frowning, SJ23 & GB14 for difficulty in raising the eyebrow, ST03

& ST04 for an inability to smile, & SJ17, ST04 & ST06 as general Pts. Pt-to-

Pt needling from BL02 to Yuyao M-HN-6, + GB14, is another method taught

for incomplete eye closure in China.

 

Zheng Qiwei suggested other Pts for EA: Taiyang M-HN-9 & BL02 / ST02

for incomplete eye closure; LI20 & SI18 / ST07 for difficulty sniffing; either

ST04 & ST06 / ST07 & ST04 for difficulty in puffing out the cheeks; LI19 &

ST04 for deviation of the philtrum. Wong has given a useful account of

some nontraditional muscle levator Pts.

 

STAGING TREATMENT:

Ren Xiaoqun suggests that during the acute (and resting) stage, only distal

& proximal but NOT facial Pts should be utilised (SJ17, GB12, GB20, LV03,

LI04, for example). If facial Pts are used at all, only a few should be

stimulated (ST07 to Taiyang M-HN-9, ST06 to ST04, for instance). Zheng

Qiwei also recommends that not many Pts should be stimulated initially,

maybe 2-4 Pts from the affected area. Chen Kezhen, another experienced

reviewer, suggests ST04 & ST07, w LI20 & Taiyang M-HN-9 on the affected

side + LI04 on the opposite side. Rather than connecting Pts on the face, Li

Zhenbo in one case report paired LI04 + ST04 & LI04 + ST06, alternately.

Simple combinations of GB14 + LI04, ST02 + ST07 / ST04 + LI04 have

been recommended for use w single-output stimulators.

 

THE USE OF DISTAL PTS:

Although Wong disparages the use of distal Pts, the authors of one MA

study consider that stimulating distally does add to the effect of purely local

treatment. When using EA, one advantage of stimulating Pts away from the

affected area is of course that there is no risk of inducing contracture /

synkinesis in the early stages of PFP. Thus Zheng Qiwei quite happily

recommends the early use of EA at LI04 & SJ05 (w bilateral LI04 Pts

connected to one output of the EA device & bilateral SJ05 Pts to a separate

output). In the clinical studies database there are many reports in which

distal Pts on the limbs are used bilaterally in this way, & probably almost as

many in which LI04 is used, but only on the healthy side (although in one MA

study, bilateral stimulation of hand Pts was found to be more effective than

unilateral treatment).

 

For the full text (free), see http://tinyurl.com/2kqea2

 

Best regards,