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Joining Needling for Facial Paralysis
Tou ci or joining needling is one of the techniques of acupuncture
where one uses a single needle to stimulate more than one acupoint
at a time. Typically, a longish needle is inserted transversely
entering at one point and then penetrating through to the region
of another. This technique is considered an advanced method of
treatment. Although I find that some Western acupuncturists are
squeamish about its use, it is a very useful and effective technique
in certain conditions. In particular, this technique is often
used in the acupuncture treatment of facial paralysis. In fact,
some Chinese studies suggest that the use of this technique is
necessary to get better therapeutic results in the treatment of
facial paralysis. One such study was published in issue #1, 2003
of Tian Jin Zhong Yi Yao (Tianjin Chinese Medicine & Medicinals)
by Jin Zhi-xun (a.k.a. Kim Je-hyun) of Korea on pages 70-73 of
that journal. This article is titled, “A Clinical Audit of
the Treatment of Facial Paralysis by the Method of Joining Needling
of the Channel Sinews.” A summary of its main clinical points
is presented below.
Cohort description:
There were 74 patients enrolled in this study, all of whom met
the diagnostic criteria for facial paralysis set forth in Shi
Yong Shen Jing Bing Xue (A Practical Study of Neurological Diseases)
and Sheng Jing Su Ji Bing Ding Wei Zhen Duan (The Location &
Diagnosis of Nervous System Diseases). Patients either had simple
facial neuritis, Bell’s palsy, or Hunt’s palsy. Patients
with parotid gland disease, surgical damage, tubercular paralysis,
cerebellar pathologies, peripheral facial paralysis, etc. were
excluded. These 74 patients were all seen as out-patients at the
author’s clinic between September 2000 and April 2002. They
were randomly divided into two groups. In one group, called the
joining needling group, there were 44 patients, 24 males and 20
females. Fifteen of these were 29 years old or less, 20 were 30-50
years old, and nine were 51 years old or more. Thirty-one of these
cases had been suffering from facial paralysis for 15 days or
less, eight had suffered from 16-30 days, three for 31-90 days,
and two for more than 90 days. Eleven of the patients in the joining
needling group were diagnosed with simple facial neuritis, 24
with Bell’s palsy, and nine with Hunt’s palsy. In the
other or comparison group, there were 30 patients, 16 males and
14 females. Eight of these patients were 29 years old or less,
17 were 30-50 years old, and five were 51 years old or more. Nineteen
of these patients had been suffering from facial paralysis for
15 days or less, seven for 16-30 days, two for 31-90 days, and
two for more than 90 days. Nine of these patients were diagnosed
with simple facial neuritis, 13 with Bell’s palsy, and eight
with Hunt’s palsy.
Treatment method:
The main points used in the joining needle group consisted of:
Di Cang (St 4) joined to Jia Che (St 6), Jia Che (St 6) joined
to Xia Guan (St 7), Xia Guan (St 7) joined to Quan Liao (SI 18),
Quan Liao (SI 18) joined to Di Cang (St 4), Yang Bai (GB 14) joined
to Yu Yao (M-HN-6), and Si Bai (St 2) joined to Ying Xiang (Li
20). Auxiliary points consisted of: Zan Zhu (Bl 2) joined to Yu
Yao (M-HN-6) and Si Zhu Kong (TB 23) joined to Yu Yao (M-HN-6)
if there was closed eye or exposed eyeball. If deviation of the
mouth was severe, Cheng Jiang (CV 24) was added. If there was
retroauricular pain, Yi Feng (TB 17) was added. If there was mastoid
process area pain, Wan Gu (GB 12) was added. If the nasal philtrum
was deviated, Shui Gou (GV 26) was added, and, during the initial
stage of facial paralysis, Feng Chi (GB 20) and He Gu (LI 4) on
the healthy side were added. Needles at points pricked with joining
needling were inserted transversely at a 15 degree angle and inserted
to a depth of 3.3-5.0cm. Even supplementing-even draining hand
technique was used. Cheng Jiang, Shui Gou, and Wan Gu were needled
perpedicularly to a depth of 1.6-3.3cm. Feng Chi, Yi Feng, and
He Gu were also needled perpendicularly to a depth of 2.7-3.3cm.
These points were needled with twisting and turning draining technique.
Needles were left in all these points for 20-30 minutes.
In the comparison group, the main point needled were Di Cang (St
4), Jia Che (St 6), Yang Bai (GB 14), Si Bai (St 2), and He Gu
(LI 4). Auxiliary points consisted of Zan Zhu (Bl 2) if there
was inability to lift the eyebrow. For deviation of the nasolabial
area, Ying Xiang (LI 20) was added. For pain in the mastoid process
area, Yi Feng (TB 17) was added. For deviation of the nasal philtrum
area, Shui Gou (GV 26) was added. For deviation of the side of
the mouth, Cheng Jiang (CV 24) was added, and for numbness of
the tongue and disappearance of taste, Lian Quan (CV 23) was added.
These points were needled according to standard needling techniques
depending on the nature of the points, but they were not needled
with deeply penetrating joining needling. For initial stage disease,
these needles were stimulated with twisting and turning draining
technique. During the later stage of disease, they were needled
with twisting and turning supplementing technique. All these needles
were also retained for 20-30 minutes. Further, both groups received
one treatment per day, with 15 treatments equaling one course
of therapy. A 3-5 day rest was allowed between successive courses,
and results were tabulated after two such courses.
Treatment outcomes:
Cure was defined as complete return to normal of the face. Marked
effect was defined as slight remaining decrease in function of
the affected area. However, there was no obvious paralysis and
ability to open the mouth was normal and the eye could completely
shut. There slight asymmetry of the mouth. Some effect meant that
there was still marked decrease in function. However, there was
no pronounced asymmetry in appearance between the two sides of
the face and the face looked normal. Upper forehead movement was
weak, and it required force to close the eyes completely. No effect
meant that the face was not even when relaxed, the upper forehead
could not move, the eye was not able to close completely, and
the movement of the mouth was also still weak. Based on these
criteria, 24 (54.55%) out of 44 cases in the joining needle group
were judged cured, 16 cases (36.36%) got a marked effect, three
cases (6.82%) got some effect, and one cases (2.27%) got no effect.
Therefore, in the joining needle group, the combined cure and
marked effect rate was 90.91% and the total effectiveness rate
was 97.73%. In the comparison group, nine cases (30.00%) out of
30 were cured, 14 cases (46.67%) got a marked effect, five cases
(16.67%) got some effect, and two cases (6.66%) got no effect.
Therefore, the combined cure and marked effect rate in the comparison
group was only 76.67% and the total effectiveness rate was only
93.34%. This suggests that joining needling is markedly more effective
than standard needling in terms of cure and marked effect rates
in the treatment of facial paralysis. Further, the total effectiveness
rate for those with simple facial neuritis in the joining needle
group was 100% in one course of treatment. It was 91.67% for those
with Bell’s palsy and only 77.78% for those with Hunt’s
palsy. With two courses of treatment, the total effectiveness
rate in the Bell’s palsy group needled with point-joining
method improved to 100% and it improved in those with Hunt’s
palsy to 88.89%.
Discussion:
According to Dr. Kim, the younger the patient, the quicker facial
paralysis heals, and the older the patient, the poorer the treatment
effect is. Dr. Kim believes this is because facial paralysis is
due to emptiness and vacuity of the network vessels and vessels.
Thus external evils may take advantage of vacuity to enter the
body and assail the sinews and vessels in the area of the face.
This results in the qi and blood becoming obstructed and stagnant
in the affected area and the flesh and muscles cannot relax and
contract. The assumption is that, the older the patient, the more
vacuous and insufficient they are and, therefore, the less righteous
qi they have to combat the external evils.
In this case, qi vacuity is the root and qi and blood impediment
and obstruction are the branches or tips due to wind evils entering
and striking. Therefore, this pattern should be categorized as
a root vacuity with a branch repletion. The yang ming channel
moves across the region of the face and, as a channel, has lots
of qi and lots of blood. Thus, Dr. Kim believes that the yang
ming channel points on the face should be chosen as the main ones.
These can be combined with tai yang and shao yang channel points
in order to course and free the flow of the channel qi in the
face region. “Joining needling of the channel sinews”
refers to needling the channel sinews of the 12 channel vessels,
and it is this method that the author chose to use on the main
points on the hand and foot yang ming channel sinews which traverse
the face. This method promotes the movement of the qi and blood,
scatters stasis, frees the flow of the channels, and quickens
the network vessels. Hence the flow of the qi and blood become
smooth and normal and the constructive and defensive are harmonious
and regulated. The flesh and muscles and channel sinews obtain
full and sufficient construction and nourishment. Therefore, they
are automatically disinhibited and the condition cured.
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