- Email: [email protected]
Treatment of 30 patients with intractable facial paralysis by warming-needle moxibustion at Băihuì (GV 20) combined with penetration needling
WorldJournal ofAcupuncture-Moxibustion (WJAM) Vol.25, No.4, 30th Dec. 2015
·48·
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Clinical Report
Treatment of 30 patients with intractable facial paralysis by warming-needle moxibustion at Baihul (1§"~ GV 20) combined with penetration needling Ef~r&~~~~1C$tJ1iU1itrTJW!U!IJt1:00~30f91J LID Xiao-yu (~tl ~-*), YANQuan (I'YANSen (I'- .), LIU Zhi-li (~IJ ~ #lJ)
±),
XIE Wei (jM- ~), JIANG Xue-yu (~~'*),
Department II ofAcupuncture and Moxibustion, Yueyang Hospital of rcM, Yueyang 414000, Hunan Province, China (Wli¥H§'-ffilSErP9='~~*~-#, im1¥i-ffi1SE 414000, 9='00)
ARTICLE INFO First author: L1U Xiao-yu (1982-), female, attending physician. Research field: clinical study on spine and spine related diseases. E-mail: [email protected] Accepted on September 17, 2015
ABSTRACT Objective To observe the clinical efficacy of moxibustion at Baihul Cs ~ GV 20) combined with penetration needling in treatment of intractable facial paralysis. Methods Sixty patients with intractable facial paralysis included in the study were divided into two groups according to the random number table, with 30 patients in observation group (group A), and 30 patients in control group (group B). Moxibustion at GV 20 combined with penetration needling were adopted in group A, and simple penetration needling was applied in group B. Once daily, thirty days of treatment were required. The House Brackmann (H-B) facial nerve function grading and improvement of clinical symptoms were observed. Results The H-B function grading and improvement of clinical symptoms in group A were superior to group B, and the difference was statistically significant (P
Facial paralysis is a common disease with the main characteristic of dyskinesia of facial mimetic muscle group and the main manifestations of deviation of the eye and mouth. The patients may not be able to finish the actions of raising eyebrow, closing eyes or pouting. Facial paralysis is called "deviation of the eye and mouth" or "deviation of the mouth". According to the pathogenesis of facial paralysis, the patients can recover within two months'". If the facial function cannot recover within two months due to therapeutic error or not proper treatment, the facial paralysis is intractable facial paralysis!". Intractable facial paralysis is difficult to treat, and sequela may be left. The authors found that moxibustion at Baihui (8 ~ GV 20) can improve efficacy effectively. Clinical data of 60 patients with intractable facial paralysis admitted
to our department from June 2014 to June 2015 were reported as follow.
CLINICAL DATA General data Sixty patients with intractable facial paralysis were randomly divided into an observation group (group A) and a control group (group B) according to the random number table. Moxibustion at GV 20 combined with penetration needling were adopted in group A, and simple penetration needling was applied in group B. There were 30 patients in group A with 14 males and 16 females, the average age of onset was (35.0±6.4) years old, and the courses of disease were 2-6 months with the average of
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WorldJournal ofAcupuncture-Moxibustion (WJAM) Vol. 25, No.4, 30th Dec. 2015
4.1 months. There were 30 patients in group B with 15 males and 15 females, the average age of onset was (33.0 ± 5.8) years old, and the courses of disease were 2-6 months with the average of 4.3 months. The general information such as gender, age and course of disease was not statistically significant through statistical analysis (all P>0.05) with comparability.
Diagnostic criteria (l) TCM diagnostic criteria was determined by reference to the diagnostic criteria of facial paralysis in Therapeutics ofAcupuncture and Moxibustion chiefly edited by WANG Qi-cai[3l . (2) Diagnostic criteria in western medicine'"; suddenly onset, pain occurs behind the ear or in mastoid region at first, and then paralysis occurs on the face; ® the angulus oris of healthy side slants towards the affected side, palpebral fissure enlarges, eyelids cannot close, nasolabial groove is shallower, the angulus oris prolapse, and such actions as frown, eyes closure or grin cannot be completed, and with air leakage when cheek-bulging; ® accompanying with hyperdacryosis, and dysgeusia in 2/3 of the front of the tongue.
CD
Inclusive criteria
·49· (&m~ SI 18), from SiMi
([9
S
ST 2) to Taiyang (ir.
~S EX-HN 5), from Cuanzhu (~rr BL 2) to Yuyao (ia)]l EX-HN 4), and from Yangbai (~S S GB 14) to Sizhukong (~rr3:: TE 23). After conventional
disinfection with 75% ethyl alcohol, 0.35 mmX 40 mm or 0.35 mmX75 mm Hwato filiform needles were rapidly inserted into acupoints in the depth of 25-75 em, After the method of even reinforcement and reduction was performed, Jiajian CMNS6-1 type electroacupuncture device was connected, with the frequency of discontinuous wave of 100 Hz and proper intensity. The needles were retained for 30 min, and the treatment was conducted once daily. One day was free of treatment after ten times, and 30 times were needed in total.
Moxibustion at GV 20 Moxibustion box made of bamboo was fixed on the head at the site of GV 20 (as shown in Figure 1). After being ignited, the moxa stick was placed into the box through the hole on the cover, and fixed by the clip inside. The moxa stick burned with the distance of 1-3 em to GV 20, and the moxibustion temperature was adjusted by controlling the depth of moxa stick to meet the tolerance of patients' skin. The treatment was lasted for 30 min each time, and it was conducted once daily. One day was free of treatment after ten times, and 30 times were needed in total.
Patients conforming to the abovementioned diagnostic criteria in TCM and western medicine with the course of disease of over two months.
Exclusive criteria Patients with peripheral facial paralysis caused by other pathogenesis, or facial paralysis secondary to other diseases, such as cerebrovascular disease, trauma, tumor, surgery or systemic disease; pregnant or lactating women; patients accompanying with other severe diseases like liver, kidney or cardiovascular diseases; patients with mental disease or severe psychoneurosis.
METHODS Moxibustion at GV 20 combined with penetration needling were adopted in group A, and simple penetration needling was applied in group B. The acupuncture method of penetration needling in the two groups were the same.
Figure 1 The location of the moxibustion box for patient of intractable facial paralysis
OBSERVATION OF EFFICACY Observational index
Penetration needling
Grading standard of House Brackmann (H-B) facial nerve function evaluation'";
The patient was asked in supine position, and acupoints at affected side were selected. Penetration was conducted from Dicang (:I:t!!-ft ST 4) to Yingxiang (:i!1!W LI 20), from Jiache (~$ST 6) to Quanliao
Grade I : normal, with eukinesia of facial muscles in each regions. Grade II: mild dysfunction. Gross: mild facial myasthenia, very slight synkinesis.
World Journal ofAcupuncture-Moxibustion (WJAM)
Vol. 25, No.4, 30th Dec. 2015
·50·
Rest: symmetric face, and normal muscular tension. Movement: normal frontal part movement, eyes can close with a little strength, and the angulus oris is not symmetric slightly. Grade lll: moderate dysfunction. Gross: obvious facial myasthenia and synkinesis, without facial deformation, but with spasm in the half of face. Rest: symmetric face, and normal muscular tension. Movement: weakened frontal part movement, eyes can close with strength, and the angulus oris is not symmetric slightly after maximum exertion. Grade N: moderate and severe dysfunction. Gross: obvious facial myasthenia and! or facial deformation. Rest: symmetric face, and normal muscular tension. Movement: without frontal part movement, eyes cannot close completely, and the angulus oris is not symmetric after maximum exertion. Grade V: severe dysfunction. Gross: facial action cannot be detected. Rest: asymmetric face. Movement: without frontal part movement, eyes cannot close completely, and the angulus oris move slightly. Grade VI: complete paralysis, without movement.
Efficacy evaluation Efficacy was evaluated according to facial neural functional recovery standard [6]. Cured: all the regions on the face were normal; markedly effective: slight miopragia could be observed through careful observation, with slight synkinesis, symmetric face at rest, normal tension, and moderate frontal part movement, eyes could close completely with a little strength, and the angulus oris was not symmetric slightly; effective: with obvious miopragia, but without damaging dissymmetry, a little synkinesis, contracture and! or spasm on the half of face could be observed, with normal tension at rest, and weakened frontal part movement, eyes could close completely with strength, and the angulus oris was not symmetric obviously; ineffective: with asymmetric face at rest, without frontal part movement, eyes cannot close completely, and the angulus oris move slightly.
Statistical analysis All data were analyzed by SPSSI6.0 software. Measurement data were expressed as mean ± standard deviation (x±s), the intra-group comparison before and after treatment was tested by t-test, intergroup comparison was tested by grouping t-test; enumeration data were tested by chi-square test, and
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P<0.05 indicated that the difference was statistically
significant.
RESULTS H-B facial nerve function grading before and after treatment There were significant differences in the patients with intractable facial paralysis in the two groups in terms ofH-B facial nerve function grading before and after treatment (P
Patients
Before treatment
After treatment
A
30
4.51±0.38
1.64±0.23 1)2 )
B
30
4.32±OAO
2.55±0.401)
Notes: compared with that in the same group before treatment, l)P
Efficacy comparison After treatment, the difference of total effective rate of patients with intractable facial paralysis in the two groups was not statistically significant (P>0.05), however, the cure rate and markedly effective rate of group A were superior to that of group B obviously (P<0.05), as shown in Table 2.
TYPICAL CASE A female patient, 28 years old, went to our department in May 2014, who was diagnosed with peripheral facial neuritis. Treatment course: the patient suffered from facial paralysis on the right face caused by catching a chill in February, and has received treatment in department of neurology of local hospital. After drug treatment, her condition was improved slightly, but the efficacy was not significant. She went to our hospital on May 20,2014, with the symptoms of facial paralysis and numbness on the right face, right eye cannot close, lacrimation on right eye, angulus oris warped towards left, and water leaking when gargle. Examination: hypalgesia on the right face; wrinkles at forehead was obvious, eyebrow can be lifted slightly, frown cannot be finished; right eye cannot close, dacryocystitis was about 3 mm; right
Table 2 Comparison of clinical efficacy of patients with intractable facial paralysis in the two groups Groups
Patients
Cured
Markedly effective
Effective
A
30
3
14
12
56.tJ
96.7
B
30
o
5
24
16.7
96.7
Note: compared with that in group B, IJp<0.05.
Ineffective
Cure-remarkable-effectiveness rate (%)
Cases
Total effective rate (%)
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WorldJournal ofAcupuncture-Moxibustion(WJAM) Vol. 25, No.4, 30th Dec. 2015
nasolabial groove was shallow, with air leakage when cheek-bulging; whistling cannot be finished, and the tongue was in the middle. Therapeutic regimen of group A was adopted, penetration needling was conducted first, and then moxibustion at GV 20 was applied for 30 min. After treatment for 30 days, the symptoms of patient improved significantly: without obvious facial paralysis on right face at rest, angulus oris was outward when talking and smiling; there was not feeling of numbness on right face; right eye cannot close completely, lacrimation on right eye occasionally, and without water leaking when gargle. Examination: right face was normal, wrinkles at forehead was shallower, eyebrow raising and frown can be finished; right eye cannot close completely; right nasolabial groove was shallow, without air leakage when cheekbulging; whistling can be finished, and the tongue was in the middle.
EXPERIENCE In the theory of traditional Chinese medicine, facial paralysis is caused by healthy qi insufficiency, collaterals inanition, and exterior wei insecurity; exogenous pathogenic factors invade the meridians and collaterals on the face, thus qi and blood was obstructed, meridians was loss of nourishment, so that the muscle cannot contract. Head is the confluence of all yang-meridians, and the origin of all vessels; yang meridians are easy to be invaded by exogenous pathogenic factors, and facial paralysis is formed if wind chill invades meridians and collaterals. Facial paralysis for a long time may develop into intractable facial paralysis. Although pathogenic qi is dispelled, healthy qi is insufficient, sinews and vessels cannot be repaired and nourished, function cannot recover, so healthy qi should be reinforced, yang qi should be warmed and supplemented, and sinews and vessels should be nourished. GV 20 is the confluence of all vessels, with the attribute of yang, it can reach yin and yang collaterals, playing an important role in regulating yin-yang balance. Moxibustion can warm yang and supplement qi, dispel cold and relieve pain, supplement deficiency and rescue from desertion, warm the meridians and unblock the collaterals, remove stasis and dissipate masses, and supplement the center and boost qi. In Bencao Congxin (<<*1it.M. if», Thoroughly Revised Materia Medica) written by WU Yi-luo, "Aiye C)tllf, Folium Artemisiae Argyi) is acrid warm, it is warm when raw and hot when roast, it can save the collapse yang, reach twelve meridians and three yin, rectify qi and blood and dispel colddamp-» the litten moxa can penetrate all meridians,
• 51 • and treat all diseases." It is indicated from modem researches that moxibustion at GV 20 can reduce the levels of IgA, IgG and IgM of patients with intractable facial paralysis, which may be one of its mechanism of action in treating intractable facial paralysis!". Penetration needling can stimulate the meridian sinew on patient's face, and promote qi and blood circulation. Electroacupuncture on facial nerve can improve local microcirculation, enhance neurotrophy, promote tissue metabolism, enhance nervous excitation, strengthen muscle fiber contract, and effectively prevent and treat muscle atrophy, which contributes to rapid rehabilitation of damaged facial nerve function'". It is indicated from this study that the clinical efficacy of moxibustion at GV 20 combined with penetration needling in treatment of intractable facial paralysis is definite. Compared with penetration needling, although the total effective rates of the two methods are the same, moxibustion at GV 20 has a higher cure-remarkable-effectiveness rate, and it is worth being promoted and applied clinically.
REFERENCES [1]
[2]
[3]
[4]
[5] [6]
[7]
[8]
Bao CL, Yu C, Cheng WY, Zhou YL, Dong GR. Clinical pathway exploration and clinical efficacy evaluation of acupuncture and moxibustion in treatment of facial paralysis. I Shanghai Univ Tradit Chin Med (Chin) 2015; 29(2): 31-34. Dai LL, Li Y, Bai R. Ma TM. Discussion on acupuncture and moxibustion combined with pattern differentiation and treatment in treatment of intractable facial paralysis. Clin I Chin Med (Chin) 2014; 4(4): 92-93. Wang QC. Therapeutics ofAcupuncture and Moxibustion (Chin). Beijing: China Press of Traditional Chinese Medicine; 2004: 69-70. Chen GT,Yang SS. Practical Diagnostics and Therapeutics of Integrated Traditional Chinese and Western Medicine (Chin). Beijing: China Medical Science Press; 1991: 795. House JW. Facial Nerve Grading Systems. Lanyngoscope 1983; 93(8): 1056 Yang Y, Zhang W, Zhu IP. Efficacy observation of different acupuncture and moxibustion methods in treatment of peripheral facial paralysis in acute phase. Chin Acup-Mox (Chin) 2009; 29(6): 453-454. Wang HW, Wen X, Wei QL. Moxibustion at Biiihui Cs ~ GV 20) for intractable facial paralysis and its impacts on immunoglobulin. Chin Acup-Mox (Chin) 2013; 33(4): 306-308. Chen X, Cao LY, Zhang W, Bao XY, Yu LQ, Leng FQ, et al. Clinical efficacy observation on electro-acupuncture combined with moxibustion at Baihui (8 ~ GV 20) in treatment of intractable facial paralysis in rehabilitation phase. I ClinAcup-Mox (Chin) 2014; 30(3): 40-42.
World Journal ofAcupuncture-Moxibustion (WJAM) Vol. 25, No.4, 30th Dec. 2015
·52·
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ABSTRACT IN CHINE SE
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News WFAS 2015 Conference was held in Toronto, Canada tltWitlJ*2015~~mit1R~*:tiJfi"1~1£1J~~*~ft~~7f WFAS International Acupuncture Conference was held from 25 to 27 September 2015 at the International Plaza Hotel, Toronto, Ontario, Canada. This conference was co-sponsored by World Federation of AcupunctureMoxibustion Societies (WFAS) and China Academy of Chinese Medical Sciences (CACMS), organized by the Chinese Medicine and Acupuncture Association of Canada (CMAAC), and supported by China Association of Acupuncture-Moxibustion (CAAM) and local TCM and acupuncture associations. More than 300 delegates from 26 countries in 6 continents attended this conference and 50 delegates were acupuncture experts from China. Distinguished guests addressed the opening ceremony were Prof. LID Bao-yan, President ofWFAS, Mr. YAN Shu-jiang, Vice Commissioner of the State Administration of Traditional Chinese Medicine (SATCM) of People's Republic of China, Prof. Joanne Pritchard Sobhani, President of the College of Traditional Chinese Medicine Practitioners and Acupuncturists of Ontario, Mr. SHEN Jian-lei, Consul of China in Toronto, Representative of the Ontario Minister of Health and Professor FAN Ji-ping, Deputy Director-General ofCACMS. The conference received congratulatory letters from the Rt. Hon. Stephen Harper, Canadian Prime Minister, LUO Zhao-hui, Chinese Ambassador to Canada, Kathleen Wynne, Premier of Ontario, John Tory, Mayor of Toronto and XUE Bing, Consul-General of China in Toronto. In recent years, acupuncture of traditional Chinese medicine has gained increasing attention and respect in Canada and is more widely accepted by the Canadian people. Prime Minister Stephen Harper expressed in his letter that TCM is a safe and reliable procedure. He said that this conference provided a great opportunity for acupuncture professionals across the globe to take stock of the growth and increased awareness ofTCM in Canada, and meanwhile to make new connections and explore issues of mutual interest. Ambassador LUO Zhao-hui stated that TCM was a treasure in world medicine and this conference which offered a platform to inherit and advance the development and application of acupuncture globally would play an important role in world healthcare system by strengthening medical and cultural exchange between China and other countries. Vice Commissioner YAN Shu-jiang affirmed and praised WFAS for its achievements in promoting international communication of TCM. He emphasized that SATCM would continue to support WFAS as always and would facilitate WFAS in carrying out research programs in cooperation with WHO, CACMS or other international institutions. Meanwhile, he wished that WFAS could go on functioning as a bridge linking acupuncture professions in various countries and could further strengthen cooperation with international associations in science, education, medical service and production. He hoped WFAS could further contribute to the advancement of acupuncture-moxibustion as well as world medicine in the 21st century by serving international exchanges. QIU De-liang, Director of Jilin Provincial Administration of Traditional Chinese Medicine of People's Republic of China, and ZHU Hai-dong, Deputy Director General of the Department of International Cooperation of SATCM were among the honored guests who attended the opening ceremony. The theme of this conference was "Connect, Collaborate and Innovate-Throughout the past and present, the tree of acupuncture is flourishing; throughout the west and east, the flower of TCM is blooming". There were 129 academic papers presented in 6 keynotes, 75 orals and 14 workshops in 3 parallel sessions. Delegates were able to present and share their ideas on acupuncture related topics such as the mechanisms, educational standards, legislation and regulation, practical skills, the evaluation of safety and efficacy, acupuncture cosmetology, gerontology, and preventive healthcare. There was also a parallel exhibition where new technologies and products of acupuncture were on display. This was the second time that CMAAC - a founding member ofWFAS - had organized a WFAS International Acupuncture Conference in Toronto. The first One was 27 years ago. (YANG Yu-yang, the Secretaviat ofWFAS)
·48·
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Clinical Report
Treatment of 30 patients with intractable facial paralysis by warming-needle moxibustion at Baihul (1§"~ GV 20) combined with penetration needling Ef~r&~~~~1C$tJ1iU1itrTJW!U!IJt1:00~30f91J LID Xiao-yu (~tl ~-*), YANQuan (I'YANSen (I'- .), LIU Zhi-li (~IJ ~ #lJ)
±),
XIE Wei (jM- ~), JIANG Xue-yu (~~'*),
Department II ofAcupuncture and Moxibustion, Yueyang Hospital of rcM, Yueyang 414000, Hunan Province, China (Wli¥H§'-ffilSErP9='~~*~-#, im1¥i-ffi1SE 414000, 9='00)
ARTICLE INFO First author: L1U Xiao-yu (1982-), female, attending physician. Research field: clinical study on spine and spine related diseases. E-mail: [email protected] Accepted on September 17, 2015
ABSTRACT Objective To observe the clinical efficacy of moxibustion at Baihul Cs ~ GV 20) combined with penetration needling in treatment of intractable facial paralysis. Methods Sixty patients with intractable facial paralysis included in the study were divided into two groups according to the random number table, with 30 patients in observation group (group A), and 30 patients in control group (group B). Moxibustion at GV 20 combined with penetration needling were adopted in group A, and simple penetration needling was applied in group B. Once daily, thirty days of treatment were required. The House Brackmann (H-B) facial nerve function grading and improvement of clinical symptoms were observed. Results The H-B function grading and improvement of clinical symptoms in group A were superior to group B, and the difference was statistically significant (P
Facial paralysis is a common disease with the main characteristic of dyskinesia of facial mimetic muscle group and the main manifestations of deviation of the eye and mouth. The patients may not be able to finish the actions of raising eyebrow, closing eyes or pouting. Facial paralysis is called "deviation of the eye and mouth" or "deviation of the mouth". According to the pathogenesis of facial paralysis, the patients can recover within two months'". If the facial function cannot recover within two months due to therapeutic error or not proper treatment, the facial paralysis is intractable facial paralysis!". Intractable facial paralysis is difficult to treat, and sequela may be left. The authors found that moxibustion at Baihui (8 ~ GV 20) can improve efficacy effectively. Clinical data of 60 patients with intractable facial paralysis admitted
to our department from June 2014 to June 2015 were reported as follow.
CLINICAL DATA General data Sixty patients with intractable facial paralysis were randomly divided into an observation group (group A) and a control group (group B) according to the random number table. Moxibustion at GV 20 combined with penetration needling were adopted in group A, and simple penetration needling was applied in group B. There were 30 patients in group A with 14 males and 16 females, the average age of onset was (35.0±6.4) years old, and the courses of disease were 2-6 months with the average of
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WorldJournal ofAcupuncture-Moxibustion (WJAM) Vol. 25, No.4, 30th Dec. 2015
4.1 months. There were 30 patients in group B with 15 males and 15 females, the average age of onset was (33.0 ± 5.8) years old, and the courses of disease were 2-6 months with the average of 4.3 months. The general information such as gender, age and course of disease was not statistically significant through statistical analysis (all P>0.05) with comparability.
Diagnostic criteria (l) TCM diagnostic criteria was determined by reference to the diagnostic criteria of facial paralysis in Therapeutics ofAcupuncture and Moxibustion chiefly edited by WANG Qi-cai[3l . (2) Diagnostic criteria in western medicine'"; suddenly onset, pain occurs behind the ear or in mastoid region at first, and then paralysis occurs on the face; ® the angulus oris of healthy side slants towards the affected side, palpebral fissure enlarges, eyelids cannot close, nasolabial groove is shallower, the angulus oris prolapse, and such actions as frown, eyes closure or grin cannot be completed, and with air leakage when cheek-bulging; ® accompanying with hyperdacryosis, and dysgeusia in 2/3 of the front of the tongue.
CD
Inclusive criteria
·49· (&m~ SI 18), from SiMi
([9
S
ST 2) to Taiyang (ir.
~S EX-HN 5), from Cuanzhu (~rr BL 2) to Yuyao (ia)]l EX-HN 4), and from Yangbai (~S S GB 14) to Sizhukong (~rr3:: TE 23). After conventional
disinfection with 75% ethyl alcohol, 0.35 mmX 40 mm or 0.35 mmX75 mm Hwato filiform needles were rapidly inserted into acupoints in the depth of 25-75 em, After the method of even reinforcement and reduction was performed, Jiajian CMNS6-1 type electroacupuncture device was connected, with the frequency of discontinuous wave of 100 Hz and proper intensity. The needles were retained for 30 min, and the treatment was conducted once daily. One day was free of treatment after ten times, and 30 times were needed in total.
Moxibustion at GV 20 Moxibustion box made of bamboo was fixed on the head at the site of GV 20 (as shown in Figure 1). After being ignited, the moxa stick was placed into the box through the hole on the cover, and fixed by the clip inside. The moxa stick burned with the distance of 1-3 em to GV 20, and the moxibustion temperature was adjusted by controlling the depth of moxa stick to meet the tolerance of patients' skin. The treatment was lasted for 30 min each time, and it was conducted once daily. One day was free of treatment after ten times, and 30 times were needed in total.
Patients conforming to the abovementioned diagnostic criteria in TCM and western medicine with the course of disease of over two months.
Exclusive criteria Patients with peripheral facial paralysis caused by other pathogenesis, or facial paralysis secondary to other diseases, such as cerebrovascular disease, trauma, tumor, surgery or systemic disease; pregnant or lactating women; patients accompanying with other severe diseases like liver, kidney or cardiovascular diseases; patients with mental disease or severe psychoneurosis.
METHODS Moxibustion at GV 20 combined with penetration needling were adopted in group A, and simple penetration needling was applied in group B. The acupuncture method of penetration needling in the two groups were the same.
Figure 1 The location of the moxibustion box for patient of intractable facial paralysis
OBSERVATION OF EFFICACY Observational index
Penetration needling
Grading standard of House Brackmann (H-B) facial nerve function evaluation'";
The patient was asked in supine position, and acupoints at affected side were selected. Penetration was conducted from Dicang (:I:t!!-ft ST 4) to Yingxiang (:i!1!W LI 20), from Jiache (~$ST 6) to Quanliao
Grade I : normal, with eukinesia of facial muscles in each regions. Grade II: mild dysfunction. Gross: mild facial myasthenia, very slight synkinesis.
World Journal ofAcupuncture-Moxibustion (WJAM)
Vol. 25, No.4, 30th Dec. 2015
·50·
Rest: symmetric face, and normal muscular tension. Movement: normal frontal part movement, eyes can close with a little strength, and the angulus oris is not symmetric slightly. Grade lll: moderate dysfunction. Gross: obvious facial myasthenia and synkinesis, without facial deformation, but with spasm in the half of face. Rest: symmetric face, and normal muscular tension. Movement: weakened frontal part movement, eyes can close with strength, and the angulus oris is not symmetric slightly after maximum exertion. Grade N: moderate and severe dysfunction. Gross: obvious facial myasthenia and! or facial deformation. Rest: symmetric face, and normal muscular tension. Movement: without frontal part movement, eyes cannot close completely, and the angulus oris is not symmetric after maximum exertion. Grade V: severe dysfunction. Gross: facial action cannot be detected. Rest: asymmetric face. Movement: without frontal part movement, eyes cannot close completely, and the angulus oris move slightly. Grade VI: complete paralysis, without movement.
Efficacy evaluation Efficacy was evaluated according to facial neural functional recovery standard [6]. Cured: all the regions on the face were normal; markedly effective: slight miopragia could be observed through careful observation, with slight synkinesis, symmetric face at rest, normal tension, and moderate frontal part movement, eyes could close completely with a little strength, and the angulus oris was not symmetric slightly; effective: with obvious miopragia, but without damaging dissymmetry, a little synkinesis, contracture and! or spasm on the half of face could be observed, with normal tension at rest, and weakened frontal part movement, eyes could close completely with strength, and the angulus oris was not symmetric obviously; ineffective: with asymmetric face at rest, without frontal part movement, eyes cannot close completely, and the angulus oris move slightly.
Statistical analysis All data were analyzed by SPSSI6.0 software. Measurement data were expressed as mean ± standard deviation (x±s), the intra-group comparison before and after treatment was tested by t-test, intergroup comparison was tested by grouping t-test; enumeration data were tested by chi-square test, and
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P<0.05 indicated that the difference was statistically
significant.
RESULTS H-B facial nerve function grading before and after treatment There were significant differences in the patients with intractable facial paralysis in the two groups in terms ofH-B facial nerve function grading before and after treatment (P
Patients
Before treatment
After treatment
A
30
4.51±0.38
1.64±0.23 1)2 )
B
30
4.32±OAO
2.55±0.401)
Notes: compared with that in the same group before treatment, l)P
Efficacy comparison After treatment, the difference of total effective rate of patients with intractable facial paralysis in the two groups was not statistically significant (P>0.05), however, the cure rate and markedly effective rate of group A were superior to that of group B obviously (P<0.05), as shown in Table 2.
TYPICAL CASE A female patient, 28 years old, went to our department in May 2014, who was diagnosed with peripheral facial neuritis. Treatment course: the patient suffered from facial paralysis on the right face caused by catching a chill in February, and has received treatment in department of neurology of local hospital. After drug treatment, her condition was improved slightly, but the efficacy was not significant. She went to our hospital on May 20,2014, with the symptoms of facial paralysis and numbness on the right face, right eye cannot close, lacrimation on right eye, angulus oris warped towards left, and water leaking when gargle. Examination: hypalgesia on the right face; wrinkles at forehead was obvious, eyebrow can be lifted slightly, frown cannot be finished; right eye cannot close, dacryocystitis was about 3 mm; right
Table 2 Comparison of clinical efficacy of patients with intractable facial paralysis in the two groups Groups
Patients
Cured
Markedly effective
Effective
A
30
3
14
12
56.tJ
96.7
B
30
o
5
24
16.7
96.7
Note: compared with that in group B, IJp<0.05.
Ineffective
Cure-remarkable-effectiveness rate (%)
Cases
Total effective rate (%)
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WorldJournal ofAcupuncture-Moxibustion(WJAM) Vol. 25, No.4, 30th Dec. 2015
nasolabial groove was shallow, with air leakage when cheek-bulging; whistling cannot be finished, and the tongue was in the middle. Therapeutic regimen of group A was adopted, penetration needling was conducted first, and then moxibustion at GV 20 was applied for 30 min. After treatment for 30 days, the symptoms of patient improved significantly: without obvious facial paralysis on right face at rest, angulus oris was outward when talking and smiling; there was not feeling of numbness on right face; right eye cannot close completely, lacrimation on right eye occasionally, and without water leaking when gargle. Examination: right face was normal, wrinkles at forehead was shallower, eyebrow raising and frown can be finished; right eye cannot close completely; right nasolabial groove was shallow, without air leakage when cheekbulging; whistling can be finished, and the tongue was in the middle.
EXPERIENCE In the theory of traditional Chinese medicine, facial paralysis is caused by healthy qi insufficiency, collaterals inanition, and exterior wei insecurity; exogenous pathogenic factors invade the meridians and collaterals on the face, thus qi and blood was obstructed, meridians was loss of nourishment, so that the muscle cannot contract. Head is the confluence of all yang-meridians, and the origin of all vessels; yang meridians are easy to be invaded by exogenous pathogenic factors, and facial paralysis is formed if wind chill invades meridians and collaterals. Facial paralysis for a long time may develop into intractable facial paralysis. Although pathogenic qi is dispelled, healthy qi is insufficient, sinews and vessels cannot be repaired and nourished, function cannot recover, so healthy qi should be reinforced, yang qi should be warmed and supplemented, and sinews and vessels should be nourished. GV 20 is the confluence of all vessels, with the attribute of yang, it can reach yin and yang collaterals, playing an important role in regulating yin-yang balance. Moxibustion can warm yang and supplement qi, dispel cold and relieve pain, supplement deficiency and rescue from desertion, warm the meridians and unblock the collaterals, remove stasis and dissipate masses, and supplement the center and boost qi. In Bencao Congxin (<<*1it.M. if», Thoroughly Revised Materia Medica) written by WU Yi-luo, "Aiye C)tllf, Folium Artemisiae Argyi) is acrid warm, it is warm when raw and hot when roast, it can save the collapse yang, reach twelve meridians and three yin, rectify qi and blood and dispel colddamp-» the litten moxa can penetrate all meridians,
• 51 • and treat all diseases." It is indicated from modem researches that moxibustion at GV 20 can reduce the levels of IgA, IgG and IgM of patients with intractable facial paralysis, which may be one of its mechanism of action in treating intractable facial paralysis!". Penetration needling can stimulate the meridian sinew on patient's face, and promote qi and blood circulation. Electroacupuncture on facial nerve can improve local microcirculation, enhance neurotrophy, promote tissue metabolism, enhance nervous excitation, strengthen muscle fiber contract, and effectively prevent and treat muscle atrophy, which contributes to rapid rehabilitation of damaged facial nerve function'". It is indicated from this study that the clinical efficacy of moxibustion at GV 20 combined with penetration needling in treatment of intractable facial paralysis is definite. Compared with penetration needling, although the total effective rates of the two methods are the same, moxibustion at GV 20 has a higher cure-remarkable-effectiveness rate, and it is worth being promoted and applied clinically.
REFERENCES [1]
[2]
[3]
[4]
[5] [6]
[7]
[8]
Bao CL, Yu C, Cheng WY, Zhou YL, Dong GR. Clinical pathway exploration and clinical efficacy evaluation of acupuncture and moxibustion in treatment of facial paralysis. I Shanghai Univ Tradit Chin Med (Chin) 2015; 29(2): 31-34. Dai LL, Li Y, Bai R. Ma TM. Discussion on acupuncture and moxibustion combined with pattern differentiation and treatment in treatment of intractable facial paralysis. Clin I Chin Med (Chin) 2014; 4(4): 92-93. Wang QC. Therapeutics ofAcupuncture and Moxibustion (Chin). Beijing: China Press of Traditional Chinese Medicine; 2004: 69-70. Chen GT,Yang SS. Practical Diagnostics and Therapeutics of Integrated Traditional Chinese and Western Medicine (Chin). Beijing: China Medical Science Press; 1991: 795. House JW. Facial Nerve Grading Systems. Lanyngoscope 1983; 93(8): 1056 Yang Y, Zhang W, Zhu IP. Efficacy observation of different acupuncture and moxibustion methods in treatment of peripheral facial paralysis in acute phase. Chin Acup-Mox (Chin) 2009; 29(6): 453-454. Wang HW, Wen X, Wei QL. Moxibustion at Biiihui Cs ~ GV 20) for intractable facial paralysis and its impacts on immunoglobulin. Chin Acup-Mox (Chin) 2013; 33(4): 306-308. Chen X, Cao LY, Zhang W, Bao XY, Yu LQ, Leng FQ, et al. Clinical efficacy observation on electro-acupuncture combined with moxibustion at Baihui (8 ~ GV 20) in treatment of intractable facial paralysis in rehabilitation phase. I ClinAcup-Mox (Chin) 2014; 30(3): 40-42.
World Journal ofAcupuncture-Moxibustion (WJAM) Vol. 25, No.4, 30th Dec. 2015
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News WFAS 2015 Conference was held in Toronto, Canada tltWitlJ*2015~~mit1R~*:tiJfi"1~1£1J~~*~ft~~7f WFAS International Acupuncture Conference was held from 25 to 27 September 2015 at the International Plaza Hotel, Toronto, Ontario, Canada. This conference was co-sponsored by World Federation of AcupunctureMoxibustion Societies (WFAS) and China Academy of Chinese Medical Sciences (CACMS), organized by the Chinese Medicine and Acupuncture Association of Canada (CMAAC), and supported by China Association of Acupuncture-Moxibustion (CAAM) and local TCM and acupuncture associations. More than 300 delegates from 26 countries in 6 continents attended this conference and 50 delegates were acupuncture experts from China. Distinguished guests addressed the opening ceremony were Prof. LID Bao-yan, President ofWFAS, Mr. YAN Shu-jiang, Vice Commissioner of the State Administration of Traditional Chinese Medicine (SATCM) of People's Republic of China, Prof. Joanne Pritchard Sobhani, President of the College of Traditional Chinese Medicine Practitioners and Acupuncturists of Ontario, Mr. SHEN Jian-lei, Consul of China in Toronto, Representative of the Ontario Minister of Health and Professor FAN Ji-ping, Deputy Director-General ofCACMS. The conference received congratulatory letters from the Rt. Hon. Stephen Harper, Canadian Prime Minister, LUO Zhao-hui, Chinese Ambassador to Canada, Kathleen Wynne, Premier of Ontario, John Tory, Mayor of Toronto and XUE Bing, Consul-General of China in Toronto. In recent years, acupuncture of traditional Chinese medicine has gained increasing attention and respect in Canada and is more widely accepted by the Canadian people. Prime Minister Stephen Harper expressed in his letter that TCM is a safe and reliable procedure. He said that this conference provided a great opportunity for acupuncture professionals across the globe to take stock of the growth and increased awareness ofTCM in Canada, and meanwhile to make new connections and explore issues of mutual interest. Ambassador LUO Zhao-hui stated that TCM was a treasure in world medicine and this conference which offered a platform to inherit and advance the development and application of acupuncture globally would play an important role in world healthcare system by strengthening medical and cultural exchange between China and other countries. Vice Commissioner YAN Shu-jiang affirmed and praised WFAS for its achievements in promoting international communication of TCM. He emphasized that SATCM would continue to support WFAS as always and would facilitate WFAS in carrying out research programs in cooperation with WHO, CACMS or other international institutions. Meanwhile, he wished that WFAS could go on functioning as a bridge linking acupuncture professions in various countries and could further strengthen cooperation with international associations in science, education, medical service and production. He hoped WFAS could further contribute to the advancement of acupuncture-moxibustion as well as world medicine in the 21st century by serving international exchanges. QIU De-liang, Director of Jilin Provincial Administration of Traditional Chinese Medicine of People's Republic of China, and ZHU Hai-dong, Deputy Director General of the Department of International Cooperation of SATCM were among the honored guests who attended the opening ceremony. The theme of this conference was "Connect, Collaborate and Innovate-Throughout the past and present, the tree of acupuncture is flourishing; throughout the west and east, the flower of TCM is blooming". There were 129 academic papers presented in 6 keynotes, 75 orals and 14 workshops in 3 parallel sessions. Delegates were able to present and share their ideas on acupuncture related topics such as the mechanisms, educational standards, legislation and regulation, practical skills, the evaluation of safety and efficacy, acupuncture cosmetology, gerontology, and preventive healthcare. There was also a parallel exhibition where new technologies and products of acupuncture were on display. This was the second time that CMAAC - a founding member ofWFAS - had organized a WFAS International Acupuncture Conference in Toronto. The first One was 27 years ago. (YANG Yu-yang, the Secretaviat ofWFAS)