Idiopathic facial nerve palsy is characterized by paralysis of the facial expression muscles on one side, loss of frontal wrinkles, inability to close the eyelids, shallowing of the nasolabial fold, and inability to pull the face toward the healthy side or to puff the cheeks. The cause and pathogenesis are not fully understood. The triggering factors may be wind-cold, viral infection and autonomic instability, which cause local neurotrophic vasospasm, resulting in ischemic edema of the nerve (Advanced Medical Textbook – Neurology 4th Edition), leading to paralysis of the innervated muscles of the facial nerve.
”Acupuncture is an important tool in the treatment of this disease in Chinese medicine, but some scholars believe that acupuncture on the affected face, especially electroacupuncture, may aggravate the neuroedema and demyelination pathology and induce facial muscle spasm in the posterior phase. In accordance with the law of medical ethics, in order to avoid secondary damage to the facial nerve, the author advocates the early implementation of massage on the paralyzed face on the basis of conventional treatment to improve blood flow, and can avoid the objection that early acupuncture on the affected side is not appropriate. In the clinical evidence, it was found by chance that patients with facial paralysis had no abnormal response on the side, but “pressure pain points” could often be found under the zygomatic bone on the opposite side of facial paralysis, i.e. the healthy side. The effect of finger pressure on this point is very good. According to the data, the location of this pressure point is obviously different from the neighboring acupuncture points, such as the following guan, cheek car and shouzheng.
The pressure point is on the opposite side of the facial palsy, i.e., the “healthy side”; it is basically located below the middle of the zygomatic arch; and it can “correct” the skewed corners of the mouth. The name “Jianzheng” seems to be more appropriate. Therefore, in clinical practice, “Jianzheng” must be used as the main point for patients with facial palsy. Evidence for “Jianzheng” as a new acupoint
(1) It is consistent with the three definitions of odd points, i.e., location, name, and primary disease.
(2) It is not duplicative of all currently registered acupoints in terms of location and name.
(3) The point is characterized by “odd numbers”. While other odd points appear in pairs on both sides of the body, “Jianzheng” appears only on the healthy side of the person with facial palsy, i.e., there is only one “Jianzheng”.
(4) Unlike the A-Yi point. Jianzheng is also based on pressure and pain points, but it is different from the “A-Yi” point. Reasons
(1) The basic feature of “Ah Yes” is the “pressure point” at the site of the disease, whereas Jianzheng is based on pressure pain on the healthy side;
②Traditional “Ah Yes” points are based on the pain point, which is variable, and the location of the point is not fixed; however, “Jian Zheng” is located under the zygomatic arch on the healthy side of the person with facial palsy, and its location is fixed.
(5) Most other odd points are paired and may be classified as meridians over time, but “Jianzheng” is only found on the healthy side of the facial palsy, which is an “odd number of points” and is difficult to classify as a meridian, so it has more “odd point” characteristics.
(6) “Jianzheng” was discovered in clinical practice and is the main treatment for facial nerve palsy, which is specific and based on evidence-based medicine.
Comparison of “Jianzheng” acupuncture points with the nearby “Xuanzheng” and “Xiaoguan” acupuncture points
(1) Comparison of acupuncture points.
①Jianzheng point: 5 minutes – 1 inch in front of the earlobe. Chinese Acupuncture and Moxibustion. (1995 edition).
②Xiaoguan point: depression in front of the mandibular condyle, taken with the mouth closed “Chinese Acupuncture and Moxibustion”. (1995 ed.). Its characteristics: closed mouth is the point, open mouth is closed (Higher Medicine Textbook – Acupuncture).
③ Jianzheng acupoint: pressure point below the midpoint of the zygomatic arch on the contralateral side (healthy side) of facial palsy.
Example of treatment.
Patient 1, female, 36 years old.
On August 3, 2009, she came to the clinic with salivation at the corners of her mouth for 2 days; she complained of discomfort on the right side of her face due to cold, and found that her “mouth was crooked” in the morning. Physical examination: the left frontal lines disappeared, the left upper and lower eyelids could not be closed, the left nasolabial fold was shallow, and the cheeks could not be puffed due to air leakage from the corner of the mouth when puffing. There was no obvious pressure pain point on the affected side of the face; pressure pain was obvious in the middle of the lower zygomatic arch on the healthy side. The patient was diagnosed as having idiopathic facial nerve palsy and was given conventional treatment and told to press the Jianzheng point by himself. On the 4th day of the disease, he was encouraged by a colleague to find an individual doctor to apply a plaster on the side of facial palsy. 3 days later (7 days after the disease), he felt local burning pain and found that the skin was red and swollen when he removed the plaster. On the same day (the 7th day after the disease), I started acupuncture on “Jianzheng” with the affected side of the hand Sanli; once a day, I kept the needles for 15 minutes each time, twisting with manipulation, without electro-acupuncture. By the end of the second week, the eyelid could be closed, but the muscle strength was weak; the right nasolabial fold was slightly shallow.
Patient 2, male, 20 years old, presented to the clinic on August 3, 2009. He was obsessed with the Internet and had a midnight fight and blew the air conditioner. The next day, he found that his mouth was crooked and his father accompanied him to the clinic. Physical examination: general condition is good. The right frontal line disappeared, the eyelid could not be closed, the lid fissure was enlarged, the right nasolabial fissure was significantly shallowed, he could not whistle, and the corner of the mouth was obviously deviated to the left when he showed his teeth. Diagnosis: acute idiopathic facial nerve palsy. At the same time, the pressure pain point under the zygomatic arch on the cheek was treated with acupuncture at the Jianzheng point on the cheek, and the Hand Sanli point on the affected side was treated without electroacupuncture. On the 8th day of treatment, the frontal lines showed signs of activity, the eyelids could be closed but not completely, the nasolabial folds on the right side were still shallower than those on the left side, the cheeks could be puffed, and there was no air leakage from the corners of the mouth; on the 17th day of treatment, the nasolabial folds on both sides were basically symmetrical, and the eyelids were completely closed. On the follow-up visit on day 33, the facial features were as before the disease, and the patient was clinically cured.
Discussion
After the Ming Dynasty, medical practitioners referred to the acupuncture points that were not found in the early medical books of China, such as the Nei Jing, Jia Yi Jing, and the Copper Man Acupuncture and Moxibustion Book, as extra-medical odd points. In short, an odd point is an effective acupuncture point that is not recorded in the literature or cannot be entered into a particular meridian. The term “odd” is relative to the term “regular”, which means that the 14 meridian points are the regular points, and are defined as acupoints with fixed names, locations, and therapeutic effects outside of the 14 meridian points. They are characterized by a fixed name and location, and are clinically effective, but are not yet included in the fourteen meridians system. These acupoints have been scattered in Huangdi Neijing, such as “Suwen – Theory of Stabbing”, “stabbing between the ten fingers”, “stabbing the two veins under the tongue”, etc., and later in the “Prepared Emergency Thousand Gold Essentials” and “Wai Tai Secret Essentials”. The “Curious Acupuncture Points” were not listed until the “Good Recipes for Curious Effects”. With the development of science and medicine, new treatments and points have been discovered in recent times. The appendix point, gallbladder point, posterior ball point, etc. are also included in the list of extra-magical points.
For more than 40 years, I have been willing to learn and use acupuncture because it is simple, convenient, effective and inexpensive. Especially after “learning Chinese from the West”, I have been able to use the acupuncture tools with me in the clinic, and whenever I encounter suitable symptoms, I can immediately relieve the pain with a single needle. Because I am a neurologist, I see a lot of “facial palsy” in my practice, and since there is no domestic “treatment guideline” for choosing the timing of needling, I advocate “massage” in order to avoid secondary damage to the facial nerve. In order to avoid secondary damage to the facial nerve, we advocate “massage” and “pointer” techniques. During the consultation process, due to the patient’s response, we found a “pressure and pain response point on the healthy side of facial palsy” that had not been recorded in the literature, and after searching for new information, we found that the “Jianzheng” point was not recorded in the literature or canonical texts, and its location and naming did not duplicate the registered points in the canonical texts. The experimental use of this point in the treatment of idiopathic facial nerve palsy is effective and in accordance with the rules for the discovery of “odd points”. It should be considered as a newly discovered odd point.