Definition: Facial paralysis is a disease that mainly manifests itself by tilting the mouth and eyes to one side, also known as “boiling thinness of the mouth and eyes”. Characteristics: 1. The disease can occur at any age, 2. Most common in winter and summer. 3. Rapid onset, with one side of the face being the most common. 4. The disease is equivalent to peripheral facial nerve palsy in Western medicine, most commonly Bell’s palsy. A few cases are caused by feeling chickenpox – herpes zoster virus infection. Second, the etiology and mechanism of modern medicine that local wind or cold stimulation, causing inflammation, ischemia, edema of the facial nerve tube and its surrounding tissues, or autonomic dysfunction, local nutrient vasospasm, resulting in tissue edema, so that the facial nerve pressure and inflammatory changes. Chinese medicine believes that overwork, the body is not enough positive qi, the veins and collaterals are empty, the guard is not solid, wind, cold or wind-heat to take advantage of the weakness into the facial meridians, resulting in qi and blood paralysis, dysfunction of the meridians and tendons, tendons and muscles out of constraint, appearing Fei А hand, foot Yang meridian are on the head and face, when the disease and evil stagnation of the face meridians, especially the hand sun (its branch, after walking behind the armpit, the back of the Lian, the up around the shoulder blades, around the neck, the tendon out of the foot sun in front of the knot behind the ears and bones; the branch of the It enters the middle of the ear; the straight one goes out of the ear, knots in the lower part of the jaw, and belongs to the outer canthus of the eye. The branch of the same goes up to the curved teeth, and follows the front of the ear, and is attached to the outer canthus of the eye, and the upper forehead is attached to the horn). And the foot Yangming (“Ling Shu. Meridian tendons” on the neck, the upper hostage mouth, and (nine pages) the lower knot nose, the upper knot (foot) Sun Sun for the upper outline of the eyes (originally “net” this according to the “A B”, “Taisu” to change) Yangming for the lower outline of its own from the cheek knot in front of the ear) meridian tendon dysfunction, can lead to facial paralysis occurs. Peripheral facial paralysis includes eye and cheek tendon symptoms, due to the foot sun meridian tendons for the “eye on the Gang”, foot yangming meridian tendons for the “lower Gang”, so the eyelids can not be closed for the foot sun and foot yangming meridian tendon dysfunction caused by the cheeks, mainly for the hands of the sun and the hands and feet. The cheeks of the mouth are mainly dominated by the hand sun and the hand and foot yangming meridian tendons, therefore, the crooked mouth is mainly caused by the dysfunction of these three meridian tendons. Clinical manifestations The main feature is the distortion of the eyes and mouth. Often when waking up from sleep, one side of the facial muscles are stagnant, numb, paralyzed, frontal lines disappeared, eye fissure is big, eye tears, nasolabial folds become shallow, the corner of the mouth drooped and tilted to the healthy side, and the diseased side can’t frown, knit the forehead, close the eyes, show the teeth and bulge the cheeks; some of the patients have pain behind the ear at the beginning, and there can be a loss or disappearance of the sense of taste of the front two thirds of the tongue of the diseased side, and auditory hypersensitivity and other symptoms. If the disease is prolonged for a long time, contracture of paralyzed muscles may occur, and the corner of the mouth may be pulled back to the affected side, or even facial muscle spasm may occur, forming the phenomenon of “inverted error”. (Supplementary introduction of the five major symptoms of facial paralysis sequelae: facial muscle atrophy, spasm, inversion, linkage, crocodile tears, etc.) Electromyography shows monophasic waves or no action potentials, reduced polyphasic waves, and even positive sharp waves and fibrillatory waves. Pathological examination shows early deceptive lesions of facial nerve paralysis as edema and demyelination of the facial nerve. Supplementary identification of central facial paralysis and peripheral facial paralysis: Type Peripheral facial paralysis Central facial paralysis Age of onset Can occur at any age, mostly in young people, most often in the elderly Etiology Mostly due to cold and wind, or by viral infections. Most commonly seen in cerebrovascular disease Location of lesion The area below the facial nerve nucleus, such as the lower part of the pons, the facial neural tube, the middle ear, or the parotid gland, is located between the facial nerve nucleus and the cortical centers, i.e., facial palsy is caused when one side of the cortical brainstem tract is damaged. Symptoms: Paralysis of all expression muscles on the affected side. The facial expression muscles below the eye fissure on the opposite side of the lesion are paralyzed, often accompanied by paralysis of the limbs on the same side of the facial paralysis, and there are no taste and salivary secretion disorders. Signs: Frontal line disappears, the eye fissure is large, the eye is open and watering, nasolabial groove becomes shallow, the corner of the mouth droops and is tilted to the healthy side, and the diseased side is unable to wrinkle the eyebrow, knit the forehead, close the eyes, show the teeth and bulge the cheeks; some patients have pain behind the ear in the initial stage, and the front two-thirds of the tongue of the affected side may also be present. Some patients have pain behind the ear at the beginning, and there may also be loss of taste or loss of the sense of taste in the anterior 2/3 of the tongue on the affected side, and auditory hypersensitivity. The corners of the mouth are drooping and tilted, accompanied by limb paralysis, tongue paralysis, and positive cone-bundle sign. Dialectic typing Symptoms Symptoms Specific features Tongue and pulse Wind-cold syndrome is seen at the early stage of the disease, with history of cold exposure to the face and pale tongue, thin white moss, and a floating, tight pulse. Wind-heat syndrome Seen in the early stage of disease, mostly secondary to fever from cold, red tongue, thin yellow moss, floating pulse. Qi-blood deficiency Seen in recovery or patients with long duration of disease, with drowsiness and weakness of the limbs, pale color of the face, and dizziness. The tongue is pale, the moss is thin and white, and the pulse is fine. 4. Basic Treatment Typology Rule of Treatment Prescription Operation Main prescription (formulae) Dialectical additions and subtractions Wind-cold syndrome Invigorate the blood and channels, dredge and regulate the meridians and tendons, and use acupuncture and moxibustion to make up for the cold in a flat and even manner. Focus on localized cheeks and acupoints of the Foot Yangming meridian. Yangbai, Sibai, Zygomatic, Zygomatic, Cheek Che, Dicang, Cataract, Hegu. Facial acupoints can regulate local meridians and tendons, invigorate Blood and open the channels; Hegu is a distal acupoint following the meridian (face mouth and Hegu collection), and matches with the proximal acupoint, Cataract, to dispel Wind and open the channels. Fengchi dispels wind and disperses cold. Facial acupoints are used in the flat tonic and flat diarrhea method, and moxibustion can be added in the recovery period. In the acute stage, facial acupoints should not be over-heavy, and acupoints at the distal end of the limbs are used in the diarrhea method, and heavy techniques are preferred; in the recovery period, Hegu is used in the flat tonic and flat diarrhea method, and foot Sanli is used in the tonic method. Wind-heat syndrome Quchi disperses wind and disperses heat; For distortion of the chin-lip groove, add Chengjiao. V. Other therapies (1) Skin needling: percussion of Yangbai, zygomatic s, dicang, cheek car, to the extent of local flushing. Applicable to the recovery period. (2) Acupuncture and cupping: use three-pronged needles to puncture Yangbai, zygomatic s, dicang, cheek car, and then cupping. 2 times a week. Applicable to the recovery period. (3) Electroacupuncture: take the sun, Yangbai, Dicang, cheek car, connect the electroacupuncture instrument, stimulate with intermittent wave for 10~20 minutes, the intensity of the patient’s facial muscles can be tolerated to the extent of the slightest throbbing. Applicable to the recovery period. (4) 穴位贴敷: choose sun, Yangbai, zygomatic s, dicang, cheek car. Strychnine filed into powder about 1 ~ 2 minutes, sprinkled on the adhesive tape, and then affixed to the acupoints, 5 ~ 7 days for 1 time; or with castor beans pounded plus a little musk, take mung bean grains a large mass, affixed to the acupoints, every 3 ~ 5 days to replace the l time; or with the white aconite research finely powdered, plus a little bit of ice to make the cake, affixed to the acupoints. 1 time a day. Acupuncture and moxibustion treatment of facial paralysis has good efficacy, is the current treatment of this disease is safe and effective method of choice. 2. The face should avoid wind and cold, and wear mask and eye mask if necessary; because of incomplete eyelid closure, dust is easy to invade people, and eye drops should be ordered 2~3 times a day to prevent infection. 3. The prognosis of peripheral facial paralysis is closely related to the degree of damage to the facial nerve. Generally speaking, the prognosis of facial paralysis caused by aseptic inflammation is better, while the prognosis of facial paralysis caused by viruses (e.g. Hunter’s facial paralysis) is worse. 4. This disease should be differentiated from central facial paralysis. 1. Hunter’s syndrome, also known as herpes zoster, is caused by varicella zoster virus infection of the geniculate ganglion of the facial nerve itself, or its adjacent parts. In addition to the symptoms of peripheral facial paralysis, this type of patients can also be seen in the right auricular cavity and the external auditory canal with intensive skin deep herpes, clinically Hunt’s facial paralysis (Hunt’s) is relatively rare, but the difficulty of healing, the course of treatment is long. Due to the deeper site of viral infection, involving a relatively large number of nerve distribution, coupled with ineffective treatment measures, improper conditioning, often leaving muscle atrophy, facial numbness or tingling, auditory hypersensitivity, tinnitus or deafness and other sequelae are often accompanied by varying degrees of facial paralysis symptoms. All of them were treated with antiviral, nerve-nourishing Chinese and western medicines and acupuncture. 2. Central facial palsy and peripheral facial palsy with different symptoms: As the cells in the upper part of the facial nerve nucleus receive fibers from the cortical brainstem bundles on both sides, and their axons form the motor fibers of the facial nerve, which innervate the expression muscles above the ipsilateral ophthalmic fissure, whereas the cells in the lower part of the facial nerve nucleus receive fibers from the cortical brainstem bundles on the contralateral side, and their axons form the motor fibers of the facial nerve, which innervate the expression muscles below the ipsilateral ophthalmic fissure, therefore, the symptoms of central facial palsy are as follows Therefore, central facial paralysis is characterized by paralysis of the facial expression muscles below the ophthalmic fissure on the contralateral side of the lesion, often accompanied by paralysis of the limbs on the same side of the facial paralysis, and the absence of impaired sense of taste and salivary secretion. 3. Type Peripheral facial paralysis Central facial paralysis Age of onset May occur at any age, mostly in young people, mostly in the elderly Etiology Caused by cold and wind, or by viral infection. Most commonly seen in cerebrovascular disease Location of lesion The area below the facial nerve nucleus, such as the lower part of the pons, the facial neural tube, the middle ear, or the parotid gland, is located between the facial nerve nucleus and the cortical centers, i.e., facial palsy is caused when one side of the cortical brainstem tract is damaged. Symptoms: Paralysis of all expression muscles on the affected side. The facial expression muscles below the eye fissure on the opposite side of the lesion are paralyzed, often accompanied by paralysis of the limbs on the same side of the facial paralysis, and there are no taste and salivary secretion disorders. Signs: Frontal line disappears, the eye fissure is large, the eye is open and watering, nasolabial groove becomes shallow, the corner of the mouth droops and is tilted to the healthy side, and the diseased side is unable to wrinkle the eyebrow, knit the forehead, close the eyes, show the teeth and bulge the cheeks; some patients have pain behind the ear in the initial stage, and the front two-thirds of the tongue of the affected side may also be present. Some patients have pain behind the ear at the beginning, and there may also be loss of taste or loss of the sense of taste in the anterior 2/3 of the tongue on the affected side, and auditory hypersensitivity. The corners of the mouth are drooping and askew, accompanied by limb paralysis, tongue paralysis, and a positive cone beam sign. The differentiation of central facial paralysis is obvious in those with obvious paralysis, but difficult in those with very mild paralysis. The following aspects can be relied on: First, by expression movement, peripheral paralysis is more obvious, while central paralysis does not show paralysis when crying or laughing. The palm-chin reflex is absent or diminished in peripheral facial paralysis and present or hyperactive in central facial paralysis, but this method is less reliable. Thirdly, it is most reliable when other signs are associated. 4. 4. Peripheral facial palsy, widely known as Bell palsy in Western medicine, idiopathic facial palsy due to unintentional inflammation of the facial nerve of the stems and mastoid foramen, and Hunt’s syndrome due to herpes zoster virus infection, are common and frequent clinical diseases, and were recognized by the World Health Organization earlier. It is also one of the 43 diseases that the World Health Organization earlier recognized acupuncture as adapted to treat. The efficacy of acupuncture in the treatment of peripheral facial paralysis is well known and indisputable. However, the timing of clinical implementation of acupuncture treatment is still subject to some debate. Some scholars of traditional Chinese and Western medicine believe that the use of acupuncture in the acute phase can promote inflammation, edema, and denaturation of the facial nerve, which can lead to poor healing of the patient, and therefore advocate that acupuncture should be prohibited during the acute phase, so as not to exacerbate the condition and affect the recovery; some practitioners also believe that the best time to treat the disease is during the acute phase. Some practitioners also believe that the best time for acupuncture treatment of this disease is in the acute stage, through acupuncture can effectively control the development of inflammation of the facial nerve, and promote the early recovery of patients. There are two opinions on the timing of acupuncture treatment for peripheral facial paralysis: one is that acupuncture is not appropriate in the acute stage, and the other is that acupuncture can be used in the acute stage, and the earlier the better. Many scholars (Zhu Chunhua, Su Yunyu) and others have divided the course of facial paralysis into three stages: the first stage is the developmental stage, which refers to 1-7 days after the onset of the disease; the second stage is the stationary stage, which refers to 7-20 days after the onset of the disease; and the third stage is the recovery stage, which refers to 20 days after the onset of the disease. It is also believed that the best time for acupuncture to treat this disease is the stationary period, because the body and the disease are in the stage of resistance during the development of facial paralysis, the sinews and veins are empty during this period, and the positive is not able to win over the evil, and local acupuncture points are easy to injure the positive qi, which leads to the positive qi being more weak and the evil qi being more prevalent. Fang Meishan et al. analyzed 108 patients who received acupuncture treatment within 7 days of the onset of the disease as an observation group and 36 patients who received acupuncture treatment after 7 days of the onset of the disease as a control group. The results showed that the efficacy of the observation group was significantly better than that of the control group, i.e., benign stimulation of the facial nerve during the acute phase of peripheral facial nerve palsy could improve the cure rate. Xu Wei divided 278 patients with peripheral facial paralysis into 3 groups according to the time of starting acupuncture treatment, and each group was treated in stages according to the course of the disease, to explore the relationship between the time of starting acupuncture and the therapeutic effect. The results found that the early start of acupuncture treatment has a high healing rate, which is significantly better than the other two groups, and the early acupuncture treatment can also reduce the use of hormones. 5. Controversy about electroacupuncture: Whether to use electroacupuncture in the acute stage of peripheral facial paralysis is also a controversial issue among acupuncture colleagues. Some people think that the use of electroacupuncture in the acute stage can make the main branches of the affected area excited without damaging the nerves, which has an immediate and good regulating effect on the function of the facial nerve, and through certain stimulation, it can promote the circulation of blood, improve the local nutrient metabolism, increase the contraction of muscle fibers, and make the inflammatory exudate absorbed, so as to achieve the effect of opening up the collaterals, regulating the qi and blood and balancing yin and yang, and ultimately improve the transmission of the nerve impulses and promote the recovery of the nerve fibers. Recovery of nerve fibers. Li has made clinical observations on the timing of treatment of peripheral facial paralysis and whether acupuncture and electroacupuncture can be applied in the acute stage. It was found that not only could acupuncture and electroacupuncture be applied during the acute stage of peripheral facial paralysis, but also that it was a good time for acupuncture and electroacupuncture, and that the earlier the treatment was given, the higher the cure rate would be, and at the same time the course of treatment would be shortened markedly, only that the optimal amount of stimulation needed to be strictly mastered. It is also believed that in the early stage of peripheral facial paralysis, due to the congestion and edema of the nerve, the muscle is in a state of delayed paralysis, which requires a certain amount of recovery time, although the electric current can stimulate the function of the damaged nerve, however, at this time, the nerve is in a state of paralysis, so that it is not able to adapt to the stimulation of this electric current, which aggravates the oedema of the facial nerve, denaturation, resulting in the swelling of the facial muscles, and even spasms. Thus, the irreversible reaction of the damaged nerve is unfavorable to the recovery, so it is considered that the use of electroacupuncture is prohibited in the acute stage. Bit Meng Yuan et al. believe that in the acute stage of peripheral facial paralysis, the nerve is in the stage of acute inflammation and edema, and continuous stimulation with electro-acupuncture will aggravate the edema of the nerve tissue and further damage the facial nerve. The circulation of the small intestine meridian of the sun of the hand: its branch: from the lack of basin through the neck, up the cheek, to the sharp canthus of the eye (5), but into the middle of the ear. Its branch: don’t cheek (out of the page) (6), against the nose, to the eye canthus (oblique in the zygomatic). The Foot Yangming Stomach Meridian starts from the sides of the nose (Yingxiang) and goes up to the root of the nose to meet the Foot Sun Meridian, down along the outside of the nose into the upper gingiva, back out around the mouth and lips, down to meet in the chin-lip groove Chengjian, and then backward along the back of the lower part of the mouth and cheeks, out of the mandibular Daiying to follow the angle of the jaw cheeks Che, up to the front of the ear, through the Shangguan, along the hairline, and arrive at the forehead (the vestibule). Facial Branches: from the front of Da Ying, it goes down to Ren Ying, along the throat, into the lack of basin, down through the diaphragm, belonging to the Stomach and contacting the Spleen.