Patient's question:
How is my friend's facial paralysis treated? UrgentDoctor's answer:
Analysis of the Condition:Most patients suddenly notice facial paralysis on one side during morning activities like washing their face or brushing their teeth. In cases of complete facial paralysis on the affected side, the forehead wrinkles disappear, the eye fissure widens, the nasolabial groove flattens, the mouth corner droops, and the mouth corner deviates to the healthy side when smiling. The affected side cannot perform actions like frowning, squinting, closing the eyes, blowing air, or pursing the lips. When blowing cheeks or whistling, the affected lip cannot close, causing air leakage. Food residue often remains in the affected cheek and teeth gaps, and saliva may drip from that side. Due to the inversion of the lower eyelid, the lacrimal point cannot drain tears normally, leading to overflow. It is divided into peripheral and central types. Peripheral facial paralysis has a high incidence, with the most common form being facial nerve palsy or Bell's palsy. The facial paralysis commonly referred to by laypeople usually refers to facial nerve palsy. Because facial paralysis can cause a grotesque appearance, it is often called the "disfiguring disease."
The root cause of facial paralysis is often the misalignment of cervical vertebrae, which compresses the nerve, leading to spasm and paralysis of the facial nerve, resulting in complete facial muscle paralysis, such as the disappearance of forehead wrinkles, widening of the eye fissure, flattening of the nasolabial groove, drooping mouth corner, and deviation of the mouth corner when smiling.
Psychological Factors and Facial Paralysis:
Surveys indicate that psychological factors are one of the significant causes of facial nerve palsy. Before the onset of facial nerve palsy, many patients experience physical fatigue, insufficient sleep, mental tension, and discomfort. It is important to maintain a positive mood: the best way to prevent facial paralysis is to stay in a good mood, ensure adequate sleep, and engage in appropriate physical exercise to enhance immunity.
Symptoms of Bell's Palsy (Facial Paralysis):
1. Paralysis of facial muscles on one side (or both sides) of the face (shallow or absent forehead wrinkles on the affected side, widened eye fissure, incomplete eyelid closure, shallow nasolabial groove, mouth corner deviating to the healthy side, air leakage when blowing cheeks).
2. Initial ear pain around the ear, with some patients experiencing severe pain at the Wind Pool (GB20) point behind the ear, or even skin-penetrating pulling pain.
3. May be accompanied by reduced taste sensation in the anterior 2/3 of the tongue, hyperacusis, or hearing loss.
Classification of Facial Paralysis:
Based on the location of nerve damage, facial paralysis is divided into peripheral facial paralysis (peripheral facial nerve palsy) and central facial paralysis (central facial nerve palsy), with different clinical manifestations.
- Peripheral Facial Paralysis is caused by lesions in the facial nerve motor fibers, which may occur below the facial nerve nucleus, such as in the lower pons, facial nerve canal, middle ear, or parotid gland. The entire facial muscles on the affected side are paralyzed,,,,,2/3,（）.
- Central Facial Paralysis occurs when the lesion is above the facial nerve nucleus to the cerebral cortex, such as when one side of the corticobulbar tract is damaged. Since the upper cells of the facial nerve nucleus receive fibers from both sides of the corticobulbar tract, their axons form facial nerve motor fibers that control the facial muscles above the eye fissure. In contrast, the lower cells of the facial nerve nucleus only receive fibers from the contralateral corticobulbar tract, forming facial nerve motor fibers that control the facial muscles below the eye fissure. Therefore, in central facial paralysis, the facial muscles below the eye fissure on the affected side are paralyzed, often accompanied by paralysis of limbs on the same side, without taste or salivary secretion disorders.
Treatment Recommendations:
There are many methods for treating facial paralysis, but few are widely used and highly effective in clinical practice. Currently, effective treatments include applying topical ointments (e.g., Facial Paralysis Cream, Compound Qian Zheng Ointment), acupuncture, oral traditional Chinese medicine, and oral or injectable Western medicine.
Acupuncture Treatment:
The primary method is acupuncture, with manual techniques without additional drugs or electroacupuncture.
- Principle: Dispel wind and unblock meridians.
- Points: He Gu (LI4), Tai Chong (LR3), Qian Zheng (LI20), Che Che (ST6) penetrating Di Chang (LI4), Di Chang penetrating Che Che (ST6), Feng Chi (GB20), Xia Guan (ST7), Ying Xiang (LI20), Cheng Jiang (GV26) or Che Cheng Jiang (ST7). Three or four points are selected per session.
- Modifications:
- If eyelids cannot close or tears leak, add Zan Zhu (BL2), Yu Yao (BL8), Si Zhu Kong (BL1), Yang Bai (GB2) penetrating Yu Yao.
- For ear pain, add Yi Feng (GB20).
- For reduced taste, add Lian Quan (CV23).
- Technique: Even-strength stimulation (bi-penetrating and draining).
- Operation:
- He Gu, Tai Chong, and Feng Chi are treated with draining techniques.
- Xia Guan, Qian Zheng, Ying Xiang, and Cheng Jiang are perpendicularly inserted with even-strength stimulation.
- Yang Bai is inserted downward perpendicularly to Yu Yao.
- Di Chang is inserted perpendicularly to Che Che, with oblique insertion and the "pulling needle" technique to stimulate the facial muscles backward.
- Keep the needles for 20 minutes.
- Other points are treated with even-strength stimulation.
Western Medicine Oral and Injected Medications:
Commonly used in clinical practice include corticosteroids (e.g., prednisone, prednisolone), B vitamins (e.g., B1, B12), and blood-activating herbs to reduce inflammation, edema, and improve microcirculation.
It is evident that corticosteroid drugs have strong side effects, and their efficacy is not entirely certain. Overuse of corticosteroids can lead to many adverse effects, such as edema, fluid retention, weakened immunity, and delayed recovery. B vitamins (B1, B12) are neurotrophic drugs but take a long time to take effect and are relatively weak, requiring a prolonged treatment period. Therefore, patients must be cautious during treatment, especially within the first 15 days, which is the ischemic and edematous phase of facial nerve paralysis. This is also the acute stage of the disease, and acupuncture should be avoided at this time, as it may worsen facial nerve damage. Many patients left with sequelae after early acupuncture use are due to excessive or inappropriate needle manipulation, which can easily damage nerves.
It is crucial for patients to choose scientific and reasonable treatment methods and effective medications, as this has a vital impact on recovery.
Lifestyle Care:
Apply the blood of a live eel to the paralyzed facial skin and remove it after 24 hours (or at least 12 hours). Improvement may be observed within a week.
Ba Dou Wine [Medicinal Ingredients]
- Ba Dou (Euphorbia pekinensis seeds) 3–5 seeds
Function and Indication:
Warm the meridians, dispel phlegm, and unblock meridians.
Indicated for facial nerve palsy.
Usage and Dosage:
Fumigate the center of the palm (Lao Gong point) on the affected side for 1–2 hours per session. Severe cases may extend to 4 hours. Use once daily for five sessions as a course.
Preparation Method:
Grind Ba Dou and place it in an aluminum pot or glass bottle. Add 500 ml of 75% ethanol or high-quality liquor, heat, and use externally.