[Abstract]: Objective: To establish a standard treatment protocol for facial neuritis. Methods: To retrospectively analyze the data of facial neuritis cases treated by the Department of Acupuncture and Moxibustion of the PLA General Hospital in the past five years. The diagnosis and treatment of facial neuritis based on the anatomical composition of the facial nerve and the prescription of acupuncture treatment were introduced in detail. RESULTS: All 478 cases of facial neuritis were treated effectively, among which 70 cases were cured after ineffective acupuncture treatment in outside hospitals, with 88.46% of significant rate and 100% of effective rate, and no serious facial spasm. Conclusion: The healing of facial neuritis is not related to the degree of facial neuritis symptoms and disease duration, and the main factor affecting the healing is whether it is accompanied by facial muscle linkage and facial muscle spasm. Establishing a unified, standard and fixed treatment protocol for facial neuritis is the current requirement of evidence-based medicine for facial neuritis.
ABSTRACT Objective to establish standard treating project for facial nerve infection with acupuncture. method retrospectively analyzed clinical material of facial nerve infection with acupuncture in department of acupuncture of the PLA General Hospital five years later and introduced treating The method for facial nerve infection according to facial nerve anatomy with acupuncture in detail. The apparent rate was 88.46%, the Conclusion the critical factor that affected the prognosis of facial nerve infection was wither There was not related to degree of facial nerve symptom and duration. According to evidence-based medicine, it was important for facial nerve infection to establish integrated standard regular treating project with Acupuncture.
[Keyword]: acupuncture, facial neuritis, standardization
Keyword: acupuncture facial nerve infection standardization
Facial neuritis is one of the more than 40 indications for which acupuncture has been recognized by the International Health Organization as having definite efficacy, and it is also the main clinical condition of acupuncture in China. It is undeniable that the question of whether facial neuritis should be treated with acupuncture and at what stage of the disease acupuncture treatment should be started has always been questioned by the modern medical community. One reason for this is that there have been no convincing large-sample, multicenter randomized controlled studies (RCTs) of acupuncture for facial neuritis, and more importantly, the confusion in the clinical approach to acupuncture for facial neuritis. The adverse effects of many traditional acupuncture therapies on facial neuritis are evident. There is an urgent need to standardize the methods of acupuncture for the treatment of facial neuritis. Based on the tenet of evidence-based medicine, it is necessary to explore an acupuncture method with clear therapeutic effects, fixed protocols, and low safety side effects. The acupuncture department of PLA General Hospital has gradually developed a set of treatment methods for facial neuritis since the establishment of the department, and after the accumulation of several thousand cases, the clinical effect is remarkable. Combined with 478 cases of clinical data review summary, reported as follows.
【Clinical data】.
1. Case data.
We collated 478 cases of facial palsy patients treated in our outpatient clinic in the past five years, with an average age of 39.7±3.2 years, the oldest age being 84 years old and the youngest age being a 4-month-old child; male:female=235:243, and the longest duration of disease was 7 years.
2. Symptom evaluation criteria.
The House-Brackmann grading method [1], which is currently widely cited internationally, was used (Table 5). It was also supplemented with our electrical response assessment method. The assessment method of electrical response was divided into four levels: level I: good electrical response, with obvious tonic contraction of expression muscles in the frontal, zygomatic and mandibular areas seen after electrical stimulation; level II: tonic contraction of expression muscles seen after electrical stimulation, or slight muscle twitching seen in one part; level III: slight twitching of expression muscles seen in three parts after electrical stimulation; level IV: complete non-response of expression muscles in each part after electrical stimulation. The two grading schemes correspond to the corresponding scores.
3.Treatment methods
(1) Acupuncture points: fixed prescription points for facial palsy, ten in total (see discussion for specific positioning).
(2) Operation: conventional 75% alcohol disinfection of the skin, 1 inch milli-needle, frontal acupuncture points using the flat pricking method, the needle tip pointing to the ipsilateral eyebrow, into the needle 3-4 minutes; all other parts are used straight pricking method, no manipulation. In the frontal, cheek area, jaw area corresponding points, connected to KWD-808 electro-acupuncture therapy instrument, selected intermittent wave output, output frequency of 0-10Hz, intensity for the expression muscle tonic contraction, the patient no pain for the degree; no electrical response patients, to the patient no pain of the maximum power. Each time 30 minutes, once a day. If the patient showed involuntary contraction and beating of the expression muscle, and it did not disappear after three days of discontinuation of electrical stimulation, the acupuncture treatment was stopped.
Criteria for evaluation of treatment efficacy.
The criteria for determining the efficacy refer to the House-Brackmann facial nerve function evaluation grading system [2]: ①cured: all areas of the face are normal. ②effective: careful observation can reveal a slight decrease in function and possibly a slight joint band movement; the face is stationary
symmetry at rest, normal tension. The upper forehead movement is moderate. The eyes were completely closed with light force and the mouth was mildly asymmetrical. (iii) Valid: Significant hypofunction, but non-damaging bilateral asymmetry, not severe joint band movements, contractures or hemifacial spasm may be observed; normal facial tension at rest. Suprafrontal movements are weak. The eyes can be completely closed with force and the corners of the mouth are clearly asymmetrical. ④ Ineffective: asymmetry of the face at rest. No movement of the upper forehead. The eyes could not be completely closed and the mouth only slightly moved.
4. Results:
Among the 408 patients who came to our department for the first time, 138 patients whose disease duration was less than 7 days, 4 cases had changes in their condition after treatment, and the electrical response changed from good to poor. 2 cases started electroacupuncture treatment after 3 days of onset, and the electrical response suddenly disappeared after one and three treatments, respectively; 1 case started treatment after 5 days of onset, and the electrical response disappeared after one treatment; 1 case started treatment after 6 days of onset, and the electrical response disappeared after two The electrical response disappeared after the second treatment. The treatment results of these 4 cases are shown in (Table 6). 404 cases are shown in (Table 7). 70 referral cases are shown in (Table 8).
【Discussion】.
1, Peripheral facial palsy is a general term for the signs caused by damage to the facial nerve from below the facial nucleus. The causes of peripheral facial palsy can include: facial neuritis, which is often referred to as Bell’s palsy; medically induced facial palsy, which refers to medically induced facial nerve injury, mostly caused by surgery in the middle ear, mastoid and temporal bone areas; and temporal bone fracture, which is mostly accompanied by temporal bone fracture in cranial trauma. Because of the anatomical location, they can generally lead to facial nerve injury and cause peripheral facial palsy. Clinical acupuncture treatment of facial palsy mainly belongs to the category of facial neuritis. The Department of Acupuncture of the PLA General Hospital has treated several thousand cases of facial neuritis over the past decades. After several generations of summing up and figuring out, a set of treatment methods for facial neuritis has been summarized. Its main elements include.
(1) Composition of acupuncture prescriptions based on the anatomical positioning of the innervation area of the facial nerve
The innervation area of facial nerve includes: forehead area: the main muscles include occipital frontal muscle, frowning muscle, which belongs to the temporal branch of facial nerve and completes the action of lifting the forehead; orbicularis oculi muscle, which belongs to the temporal branch and zygomatic branch of facial nerve and completes the action of blinking and closing the eyes. Around the nose are mainly the upper lip nasal muscles, which belong to the buccal branch of the facial nerve; around the corners of the mouth are mainly: the superficial orbicularis oris muscle, upper lip lifting muscle, zygomaticus minor muscle, zygomaticus major muscle, laughing muscle and lowering corners of the mouth muscle, which belong to the buccal branch, zygomaticus branch and mandibular rim branch of the facial nerve respectively, completing the actions of closing the mouth, lifting the upper lip, opening the nostrils, making the corners of the mouth outward and downward; the middle layer includes the lifting corners of the mouth muscle and lowering lower lip muscle, which belong to the buccal branch of the facial nerve, completing the actions of lifting the upper The deeper layer includes the buccal and chin muscles, which belong to the buccal branch of the facial nerve and the mandibular rim branch, making the lip close to the gums and sending the lower lip forward. Five pairs of ten points are designed for the distribution of the muscles innervated by the facial nerve. They are: forehead area: point 1: Yangbai level to the midline level by 0.5 cm, point 2: midpoint of the line connecting the hanging skull and the silky hollow. Cheek area: point 3: the upper Yingxiang, point 4: 0.5 cm outward from the level of the Yingxiang point. Point 5: the giant s point is shifted outward 0.5 cm, point 6: the zygomatic s point is shifted outward 0.5 cm, point 7: the diaconal point is shifted outward 2 mm horizontally, point 8: the midpoint of the line connecting point 4 and point 7; mandibular region: point 9 and point 10: two intersections at the corners of the mouth and the outer canthus of the eyes are drawn downward in a vertical line, respectively, with the corners of the mouth 1 cm below the parallel mandibular margin drawn in an arc (see Figure 1). The five pairs of acupuncture points cover the major expressive-motor functions possessed by the facial nerve and provide independent, targeted stimulation of the large muscle groups innervated by the facial nerve. On the one hand, the paralyzed muscles can be maximally excited, and on the other hand, the linkage effect between different muscles can be minimized.
(2) Using electrical stimulation
The intermittent wave of the electroacupuncture stimulator is selected. The above-mentioned acupoints 1 and 2, acupoints 3 and 4, acupoints 5 and 8, acupoints 6 and 7, and acupoints 9 and 10 are in five groups, covering the five major innervated regions of the facial nerve, respectively. Tonic contractions of the corresponding innervated muscles were seen after energization. Thirty minutes each time. Once a day.
(3) Within one week of onset, the power can be reduced as appropriate, and only slight muscle contraction can be seen.
(4)
This set can be used to diagnose the extent of facial neuritis and also to determine the prognosis of facial neuritis. At the patient’s first visit, electrical stimulation of selected acupuncture points can be applied to the three major areas, i.e., forehead, cheek, and jaw, and the prognosis is better if there is a standard electrical response, i.e., a substantial contraction of the corresponding muscles for physiological function. All 378 cases of Bell’s palsy had a very satisfactory outcome with a mean duration of 23.2±3.1 days (4 patients with changes in condition were not included in the statistics). 26 cases of hunt’s syndrome also had a satisfactory outcome. If there was no standard electrical response, but only a small contraction of the muscle, the course of treatment was slightly longer, but also completely healed. If there is no muscle response, and the patient has only local pain and never muscle contraction after the power is increased, the facial nerve injury is more severe, and the prognosis can be judged only if the treatment shows an electrical response. The longer the time of the appearance of the electrical response, the more difficult it is to judge the prognosis. Some cases may have sequelae, such as bilateral asymmetry of the nuzzling mouth; the eye fissure on the affected side becomes smaller when the teeth are wrapped with force, etc., but there will be no obvious muscle linkage, much less facial muscle spasm.
2, The latest experiments proved that nerve electrical stimulation is able to shorten the time of damaged axon repair out of bud [3], transcutaneous electrical stimulation can significantly improve the symptoms of facial nerve injury [4], and the placement of electrodes, current intensity, waveform and time of stimulation all have a direct impact on the prognosis of facial nerve injury. We also found that the depth of needle insertion, the shape of the patient’s skull, and the thickness of the expression muscles all had an effect on the electrical response, which directly affected the efficacy.
Acupuncture treatment for facial neuritis has never been able to be standardized, with more than a dozen methods reported in the literature [5]. Even the treatment methods in higher-specification controlled studies are questionable [6] [7]. The allocation of acupuncture points, the technique of acupuncture, the timing of acupuncture treatment interventions, and the selection of acupuncture treatments for facial neuritis are very confusing, which seriously contradicts the main idea of evidence-based medicine advocated by today’s medicine, and also greatly hinders the application of acupuncture in the treatment of facial neuritis, casting doubt on the effectiveness of acupuncture in treating facial neuritis, and many methods even bring harm to patients.
(1) Misconceptions about acupuncture points in the treatment of facial neuritis.
(1) Acupuncture prescription: the therapeutic effect of acupuncture is inseparable from the anatomy and neurology of modern medicine. In fact, the efficacy of acupuncture is largely dependent on modern neuroendocrinology for its manifestation. The vast majority of acupuncture prescriptions for the treatment of facial neuritis include acupuncture points such as hypoguan and cheek car. From an anatomical point of view, these two acupoints are completely unnecessary; their anatomical structures are both facial chewing muscles, whose innervation is not part of the facial nerve, and are completely unhelpful in the treatment of facial neuritis and can be left out. The motto of acupuncture is “the face and mouth of the Hegu are closed”. However, the role of “hegu” in the treatment of facial neuritis is debatable. In the thousands of cases we treated, the Hegu point was not used, and no difference in treatment effect was observed. In response to this problem, we observed 20 patients with no statistical difference in treatment results (t=0.76, p>0.05). As for other acupuncture points, such as foot San Li and Feng Chi, none of them had a significant role in the treatment of facial neuritis.
(2) Acupuncture techniques: there is a wide variety of acupuncture methods for the treatment of facial neuritis. A search of the literature revealed [5] that more than ten acupuncture methods are involved in the treatment of facial neuritis, including acupuncture, which is subdivided into milli-needle acupuncture, penetrating acupuncture, and acupuncture on the healthy side based on the balance theory; electroacupuncture, which is subdivided into continuous wave, sparse wave, and intermittent wave; acupuncture point patching, acupuncture point cutting, and acupuncture point buried wire. As shown in Figure 2, the facial nerve endings in the face are widely divided, slender and dense, any trauma can lead to damage to the facial nerve, axonal repair of the misalignment. The misfiring of nerve endings is the pathological basis of facial muscle spasm. We have seen several cases of facial muscle spasm that developed several years later due to only a mild contusion of the face. The damage to the facial nerve from traditional acupuncture, bloodletting, excision, and some of the corrosive topical therapies is evident. We have seen 70 patients with facial neuritis who have been treated in outside hospitals, covering the current common TCM treatments, and all of them have obtained good results after our efforts. We advocate accurate anatomical localization of acupuncture in the treatment of facial neuritis, without traditional acupuncture techniques, and the depth of acupuncture should be based on the appearance of the corresponding muscle contraction in the electrical response and the absence of pain in the patient. We oppose over-stimulation and excessive power. Based on clinical practice, the author believes that the therapeutic effect of Chinese herbal medicine for internal and external application on neuritis is debatable. The effectiveness of its treatment needs to be further studied.
3, long-term clinical observation, we have a new understanding of the impact of the course of facial neuritis on the healing. In the past, there was a consensus that patients with facial neuritis of more than three months’ duration were difficult to heal, and most of them would have sequelae. In our observation of 26 patients with a disease duration of more than three months, the main influence on the healing of the cases was the electrical response that we emphasized earlier, and a good electrical response is the basis for the healing of facial neuritis. It is also the basis for determining whether facial muscle linkage and facial muscle spasm are present. In patients with a disease duration of more than three months, the longest case was seven years. This case was a seven-year-old child of Sichuan origin with peripheral facial palsy found at birth. After sixteen months of treatment, the condition showed significant improvement and the H-B classification could reach grade four, and for economic reasons, the treatment was interrupted and not counted. In the 12 patients without facial muscle linkage and facial muscle spasm, the total effective rate was 100%. among the 478 patients, the total number of cases with a disease duration of more than three months before treatment was 31, and the number of cured cases reached 16, with an average number of 59.1±2.3 treatments. The length of disease duration seems to have an effect only on the number of treatments.
4. Timing of acupuncture treatment interventions.
There has been debate as to when to start acupuncture in facial neuritis. A more consistent view is that acupuncture should be started after the acute phase (seven days of onset) of facial neuritis [8]. It has also been reported [9] [10] that the cure rate of acupuncture treatment started within seven days of the onset of facial neuritis is better than that of treatment after the acute phase. Among the Bell’s palsy cases we observed, the duration of the disease was less than seven days (including seven days) in a total of 127 cases, and the duration of the disease was between seven days and twenty days in 219 cases. The electrical response was good in 204 cases, and in two cases with a duration of illness of less than three days the electrical response became worse after acupuncture, and the duration and efficacy of treatment are shown in (Table 6). The duration of treatment and efficacy are shown in (Table 6). Two of the cases with a duration of less than seven days had a worse electrical response after acupuncture, and the duration of treatment was more than 11 months. All other cases were cured. There was no difference in the comparison of the duration of treatment, with the median number of days at 15.7 ± 3.5 days. The duration of the disease between seven and twenty days was 20.8±2.7 days. The degree of electrical response was the main determinant of healing. The cases with good electrical response were basically healed within thirty days. In the past, we also used electroacupuncture within seven days, because there were four cases of change in condition after electroacupuncture treatment in the observed cases, we modified the treatment plan and still used electroacupuncture within seven days, but the current was reduced until the patient had a twitching sensation, and then returned to maximum contraction of the affected expression muscle when the duration of the disease was greater than seven days. we have two hypotheses for the reason of change in condition in the four patients, which need to be further studied. One is that the natural course of facial neuritis, which can worsen within 72 hours of onset, causes the change in condition. The second is that patients have different responses to electroacupuncture and aggravated nerve damage.
5, the self-limiting problem of facial neuritis. Modern medicine believes that facial neuritis is a self-limiting disease. In particular, the vast majority of Bell’s palsy can be healed within one to three months. In the cases involved in this study, there were 16 cases of Bell’s palsy over one month, and 11 cases that improved significantly, with symptoms still evident. Clinically, it was observed that in self-remitting cases of facial neuritis, the function of the major expression muscles such as zygomaticus major, zygomaticus minor, laughing muscle, and occipital frontalis muscle improved faster, but the muscle strength was still less than that of the healthy side. While lifting the upper lip muscle, lifting the upper lip nasal muscle, lifting the corners of the mouth muscle, descending lip muscle, descending corners of the mouth muscle is more difficult to recover without treatment.
6, Hunter syndrome, as a special type of facial nerve infection, because of the special pathogen, the severity of the infection, the efficacy is poor, the course of the disease is longer. We treated 26 cases with a mean duration of 184.3±7.7 days, 9 cases were cured and 8 cases were effective, with a total effective rate of 65.38%. A total of 13 cases showed mild linkage of the mouth and eyes, and the patients showed smaller eye fissures during opening and closing of the mouth. In the author’s opinion, it is especially important to treat Hunter syndrome gently and stimulate accurately. Emphasis on doctor-patient communication and accurate mastering of the intensity and frequency of stimulation is the key to effective treatment of Hunter syndrome and reduction of complications and sequelae.
7. We advocate taking prednisone tablets for patients within one week of onset. The dosage is divided into two types: one is prednisone tablets, 30 mg once daily; stop after seven days; the second is prednisone tablets at 1 mg/kg, 20 mg each time, three times daily for three days, changed to 15 mg each time, three times daily for three days, changed to 10 mg three times daily for three days, 10 mg once daily for three days, stop after three days.
[Abstract]: Objective: To establish a standard treatment protocol for facial neuritis. Methods: To retrospectively analyze the data of facial neuritis cases treated by the Department of Acupuncture and Moxibustion of the PLA General Hospital in the past five years. The diagnosis and treatment of facial neuritis based on the anatomical composition of the facial nerve and the prescription of acupuncture treatment were described in detail. RESULTS: All 478 cases of facial neuritis were treated effectively, among which 70 cases were cured after ineffective acupuncture treatment in outside hospitals, with 88.46% of significant rate and 100% of effective rate, and no serious facial spasm. Conclusion: The healing of facial neuritis is not related to the degree of facial neuritis symptoms and disease duration, and the main factor affecting the healing is whether it is accompanied by facial muscle linkage and facial muscle spasm. Establishing a unified, standard and fixed treatment protocol for facial neuritis is the current requirement of evidence-based medicine for facial neuritis.
ABSTRACT Objective to establish standard treating project for facial nerve infection with acupuncture. method retrospectively analyzed clinical material of facial nerve infection with acupuncture in department of acupuncture of the PLA General Hospital five years later and introduced treating The method for facial nerve infection according to facial nerve anatomy with acupuncture in detail. The apparent rate was 88.46%, the Conclusion the critical factor that affected the prognosis of facial nerve infection was wither There was not related to degree of facial nerve symptom and duration. According to evidence-based medicine, it was important for facial nerve infection to establish integrated standard regular treating project with acupuncture
[Keyword]: acupuncture, facial neuritis, standardization
Keyword: acupuncture facial nerve infection standardization
Facial neuritis is one of the more than 40 indications for which acupuncture has been recognized by the International Health Organization as having definite efficacy, and it is also the main clinical condition of acupuncture in China. It is undeniable that the question of whether facial neuritis should be treated with acupuncture and at what stage of the disease acupuncture treatment should be started has always been questioned by the modern medical community. One reason for this is that there have been no convincing large-sample, multicenter randomized controlled studies (RCTs) of acupuncture for facial neuritis, and more importantly, the confusion in the clinical approach to acupuncture for facial neuritis. The adverse effects of many traditional acupuncture therapies on facial neuritis are evident. There is an urgent need to standardize the methods of acupuncture for the treatment of facial neuritis. Based on the tenet of evidence-based medicine, it is necessary to explore an acupuncture method with clear therapeutic effects, fixed protocols, and low safety side effects. The acupuncture department of PLA General Hospital has gradually developed a set of treatment methods for facial neuritis since the establishment of the department, and after the accumulation of several thousand cases, the clinical effect is remarkable. Combined with 478 cases of clinical data review summary, reported as follows.
[Discussion].
1. Peripheral facial palsy is a general term for the signs caused by damage to the facial nerve from below the facial nucleus. Causes of peripheral facial palsy can include: facial neuritis, which is often referred to as Bell’s palsy; medically induced facial palsy, which refers to medically induced facial nerve injury, mostly caused by surgery in the middle ear, mastoid and temporal bone areas; temporal bone fracture, which is mostly accompanied by temporal bone fracture in cranial trauma. Because of the anatomical location, they can generally lead to facial nerve injury and cause peripheral facial palsy. Clinical acupuncture treatment of facial palsy mainly belongs to the category of facial neuritis. The Department of Acupuncture of the PLA General Hospital has treated several thousand cases of facial neuritis over the past decades. After several generations of summing up and figuring out, a set of treatment methods for facial neuritis has been summarized. Its main elements include.
(1) Composition of acupuncture prescriptions based on the anatomical positioning of the innervation area of the facial nerve
The innervation area of facial nerve includes: forehead area: the main muscles include occipital frontal muscle, frowning muscle, which belongs to the temporal branch of facial nerve and completes the action of lifting the forehead; orbicularis oculi muscle, which belongs to the temporal branch and zygomatic branch of facial nerve and completes the action of blinking and closing the eyes. Around the nose are mainly the upper lip nasal muscles, which belong to the buccal branch of the facial nerve; around the corners of the mouth are mainly: the superficial orbicularis oris muscle, upper lip lifting muscle, zygomaticus minor muscle, zygomaticus major muscle, laughing muscle and lowering corners of the mouth muscle, which belong to the buccal branch, zygomaticus branch and mandibular rim branch of the facial nerve respectively, completing the actions of closing the mouth, lifting the upper lip, opening the nostrils, making the corners of the mouth outward and downward; the middle layer includes the lifting corners of the mouth muscle and lowering lower lip muscle, which belong to the buccal branch of the facial nerve, completing the actions of lifting the upper The deeper layer includes the buccal and chin muscles, which belong to the buccal branch of the facial nerve and the mandibular rim branch, making the lip close to the gums and sending the lower lip forward. Five pairs of ten points are designed for the distribution of the muscles innervated by the facial nerve. They are: forehead area: point 1: Yangbai level to the midline level by 0.5 cm, point 2: midpoint of the line connecting the hanging skull and the silky hollow. Cheek area: point 3: the upper Yingxiang, point 4: 0.5 cm outward from the level of the Yingxiang point. Point 5: the giant s point is shifted outward 0.5 cm, point 6: the zygomatic s point is shifted outward 0.5 cm, point 7: the diaconal point is shifted outward 2 mm horizontally, point 8: the midpoint of the line connecting point 4 and point 7; mandibular region: point 9 and point 10: two intersections at the corners of the mouth and the outer canthus of the eyes are drawn downward in a vertical line, respectively, with the corners of the mouth 1 cm below the parallel mandibular margin drawn in an arc (see Figure 1). The five pairs of acupuncture points cover the major expressive-motor functions possessed by the facial nerve and provide independent, targeted stimulation of the large muscle groups innervated by the facial nerve. On the one hand, the paralyzed muscles can be maximally excited, and on the other hand, the linkage effect between different muscles can be minimized.
(2) Using electrical stimulation
The intermittent wave of the electroacupuncture stimulator is selected. The above-mentioned acupoints 1 and 2, acupoints 3 and 4, acupoints 5 and 8, acupoints 6 and 7, and acupoints 9 and 10 are in five groups, covering the five major innervated regions of the facial nerve, respectively. Tonic contractions of the corresponding innervated muscles were seen after energization. Thirty minutes each time. Once a day.
(3) Within one week of onset, the power can be reduced as appropriate, and only slight muscle contractions can be seen.
(4) This method can be used to diagnose the extent of facial neuritis and also to determine the prognosis of facial neuritis. At the patient’s first visit, electrical stimulation of selected acupuncture points can be applied to the three major areas, i.e., forehead, cheek, and jaw, and the prognosis is better if there is a standard electrical response, i.e., a substantial contraction of the corresponding muscles for physiological function. All 378 cases of Bell’s palsy had a very satisfactory outcome with a mean duration of 23.2±3.1 days (4 patients with changes in condition were not included in the statistics). 26 cases of hunt’s syndrome also had a satisfactory outcome. If there was no standard electrical response, but only a small contraction of the muscle, the course of treatment was slightly longer, but also completely healed. If there is no muscle response, and the patient has only local pain and no muscle contraction after the power is increased, the facial nerve injury is more severe, and the prognosis can be judged only if the treatment shows an electrical response. The longer the time of the appearance of the electrical response, the more difficult it is to judge the prognosis. Some cases may have sequelae, such as bilateral asymmetry of the nuzzling mouth; the eye fissure on the affected side becomes smaller when the teeth are wrapped with force, etc., but there will be no obvious muscle linkage, much less facial muscle spasm.
2, The latest experiments proved that nerve electrical stimulation is able to shorten the time of damaged axon repair out of bud [3], transcutaneous electrical stimulation can significantly improve the symptoms of facial nerve injury [4], and the placement of electrodes, current intensity, waveform and time of stimulation all have a direct impact on the prognosis of facial nerve injury. We also found that the depth of needle insertion, the shape of the patient’s skull, and the thickness of the expression muscles all had an effect on the electrical response, which directly affected the efficacy.
Acupuncture treatment for facial neuritis has never been able to be standardized, with more than a dozen methods reported in the literature [5]. Even the treatment methods in higher-specification controlled studies are questionable [6] [7]. The allocation of acupuncture points, the technique of acupuncture, the timing of acupuncture treatment interventions, and the selection of acupuncture treatments for facial neuritis are very confusing, which seriously contradicts the main idea of evidence-based medicine advocated by today’s medicine, and also greatly hinders the application of acupuncture in the treatment of facial neuritis, casting doubt on the effectiveness of acupuncture in treating facial neuritis, and many methods even bring harm to patients.
(1) Misconceptions about acupuncture points in the treatment of facial neuritis.
(1) Acupuncture prescription: the therapeutic effect of acupuncture is inseparable from the anatomy and neurology of modern medicine. In fact, the efficacy of acupuncture is largely dependent on modern neuroendocrinology for its manifestation. The vast majority of acupuncture prescriptions for the treatment of facial neuritis include acupuncture points such as hypoguan and cheek car. From an anatomical point of view, these two acupoints are completely unnecessary; their anatomical structures are both facial chewing muscles, whose innervation is not part of the facial nerve, and are completely unhelpful in the treatment of facial neuritis and can be left out. The motto of acupuncture is “the face and mouth of the Hegu are closed”. However, the role of “hegu” in the treatment of facial neuritis is debatable. In the thousands of cases we treated, the Hegu point was not used, and no difference in treatment effect was observed. In response to this problem, we observed 20 patients with no statistical difference in treatment results (t=0.76, p>0.05). As for other acupuncture points, such as foot San Li and Feng Chi, none of them had a significant role in the treatment of facial neuritis.
(2) Acupuncture techniques: there is a wide variety of acupuncture methods for the treatment of facial neuritis. The treatment of facial neuritis involves more than ten acupuncture methods, including acupuncture, which is divided into milli-needle acupuncture, penetrating acupuncture, and acupuncture on the healthy side based on the theory of balance; electroacupuncture, which is divided into continuous wave, sparse wave, and intermittent wave; acupuncture point patching, acupuncture point cutting, and acupuncture point buried thread. As shown in Figure 2, the facial nerve endings in the face are widely divided, slender and dense, any trauma can lead to damage to the facial nerve, axonal repair of the misshapen. The misfiring of nerve endings is the pathological basis of facial muscle spasm. We have seen several cases of facial muscle spasm that developed several years later due to only a mild contusion of the face. The damage to the facial nerve from traditional acupuncture, bloodletting, excision, and some of the corrosive topical therapies is evident. We have seen 70 patients with facial neuritis who have been treated in outside hospitals, covering the current common TCM treatments, and all have obtained good results after our efforts. We advocate accurate anatomical localization of acupuncture in the treatment of facial neuritis, without traditional acupuncture techniques, and the depth of acupuncture should be based on the appearance of the corresponding muscle contraction in the electrical response and the absence of pain in the patient. We oppose over-stimulation and excessive power. Based on clinical practice, the author believes that the therapeutic effect of Chinese herbal medicine for internal and external application on neuritis is debatable. The effectiveness of its treatment needs to be further studied.
3, long-term clinical observation, we have a new understanding of the impact of the course of facial neuritis on the healing. In the past, there was a consensus that patients with facial neuritis of more than three months’ duration were difficult to heal, and most of them would have sequelae. In our observation of 26 patients with a disease duration of more than three months, the main influence on the healing of the cases was the electrical response that we emphasized earlier, and a good electrical response is the basis for the healing of facial neuritis. It is also the basis for determining whether facial muscle linkage and facial muscle spasm are present. In patients with a disease duration of more than three months, the longest case was seven years. This case was a seven-year-old child of Sichuan origin with peripheral facial palsy found at birth. After sixteen months of treatment, the condition showed significant improvement and the H-B classification could reach grade four, and for economic reasons, the treatment was interrupted and not counted. In the 12 patients without facial muscle linkage and facial muscle spasm, the total effective rate was 100%. among the 478 patients, the total number of cases with a disease duration of more than three months before treatment was 31, and the number of cured cases reached 16, with an average number of 59.1±2.3 treatments. The length of disease duration seems to have an effect only on the number of treatments.
4. Timing of acupuncture treatment interventions.
There has been debate as to when to start acupuncture in facial neuritis. A more consistent view is that acupuncture should be started after the acute phase (seven days of onset) of facial neuritis [8]. It has also been reported [9] [10] that the cure rate of acupuncture treatment started within seven days of the onset of facial neuritis is better than that of treatment after the acute phase. Among the Bell’s palsy cases we observed, the duration of the disease was less than seven days (including seven days) in a total of 127 cases, and the duration of the disease was between seven days and twenty days in 219 cases. The electrical response was good in 204 cases, and in two cases with a duration of illness of less than three days the electrical response became worse after acupuncture, and the duration and efficacy of treatment are shown in (Table 6). The duration of treatment and efficacy are shown in (Table 6). Two of the cases with a duration of less than seven days had a worse electrical response after acupuncture, and the duration of treatment was more than 11 months. All other cases were cured. There was no difference in the comparison of the duration of treatment, with the median number of days at 15.7 ± 3.5 days. The duration of the disease between seven and twenty days was 20.8±2.7 days. The degree of electrical response was the main determinant of healing. The cases with good electrical response were basically healed within thirty days. In the past, we also used electroacupuncture within seven days, because there were four cases of change in condition after electroacupuncture treatment in the observed cases, we modified the treatment plan and still used electroacupuncture within seven days, but the current was reduced until the patient had a twitching sensation, and then returned to maximum contraction of the affected expression muscle when the duration of the disease was greater than seven days. we have two hypotheses for the reason of change in condition in the four patients, which need to be further studied. One is that the natural course of facial neuritis, which can worsen within 72 hours of onset, causes the change in condition. The second is that patients have different responses to electroacupuncture and aggravated nerve damage.
5, the self-limiting problem of facial neuritis. Modern medicine believes that facial neuritis is a self-limiting disease. In particular, the vast majority of Bell’s palsy can be healed within one to three months. In the cases involved in this study, there were 16 cases of Bell’s palsy over one month, and 11 cases that improved significantly, with symptoms still evident. Clinically, it was observed that in self-remitting cases of facial neuritis, the function of the major expression muscles such as zygomaticus major, zygomaticus minor, laughing muscle, and occipital frontalis muscle improved faster, but the muscle strength was still less than that of the healthy side. While lifting the upper lip muscle, lifting the upper lip nasal muscle, lifting the corners of the mouth muscle, descending lip muscle, descending corners of the mouth muscle is more difficult to recover without treatment.
6, Hunter syndrome, as a special type of facial nerve infection, because of the special pathogen, the severity of the infection, the efficacy is poor, the course of the disease is longer. We treated 26 cases with a mean duration of 184.3±7.7 days, 9 cases were cured and 8 cases were effective, with a total effective rate of 65.38%. A total of 13 cases showed mild linkage of the mouth and eyes, and the patients showed smaller eye fissures during opening and closing of the mouth. In the author’s opinion, it is especially important to treat Hunter syndrome gently and stimulate accurately. Emphasis on doctor-patient communication and accurate mastering of the intensity and frequency of stimulation is the key to effective treatment of Hunter syndrome and reduction of complications and sequelae.
7. We advocate taking prednisone tablets for patients within one week of onset. The dosage is divided into two types: one is prednisone tablets, 30 mg once daily; stop after seven days of continuous use; the second is prednisone tablets at 1 mg/kg, 20 mg each time, three times daily for three days, changed to 15 mg each time, three times daily for three days, changed to 10 mg three times daily for three days, 10 mg once daily for three days, stop after three days.