What are the treatment methods for facial paralysis?

Patient's question:

How is my friend's facial paralysis treated? Urgent

Doctor's answer:

Analysis of the Condition: Most patients suddenly discover that one side of their face is numb or paralyzed when they wake up in the morning to wash their face or brush their teeth. In cases of complete facial paralysis on the affected side, the forehead wrinkles disappear, the eye fissure widens, the nasolabial groove becomes flat, the mouth corner droops, and when smiling, the mouth corner deviates to the healthy side. The affected side cannot perform actions such as frowning, wrinkling the brow, closing the eyes, blowing air, or pouting. When blowing cheeks or whistling, air leaks due to the inability of the affected lip to close. Food residue often remains in the teeth and cheek gaps on the affected side, and saliva frequently drips from that side. Due to the downward inversion of the lower eyelid, the lacrimal point cannot drain tears normally, causing them to overflow. It is divided into peripheral and central types. Among them, peripheral facial paralysis has a high incidence, with the most common being facial nerve palsy or Bell's palsy. The facial paralysis commonly referred to by people in daily life usually refers to facial nerve palsy. Because facial paralysis can cause a very strange appearance, it is often called the "disfiguring disease." The root cause of facial paralysis lies in the misalignment and distortion of the cervical vertebrae, which compresses the nerves, leading to nerve spasm and paralysis of the facial nerves, 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 to the healthy side when smiling. Psychological factors can easily trigger facial paralysis: surveys show that psychological factors are one of the important causes of facial nerve palsy. Before the onset of facial nerve palsy, a significant number of patients experience physical fatigue, insufficient sleep, mental tension, and physical discomfort. It is important to maintain a good mood: the best way to prevent facial paralysis is to pay attention to maintaining a good mood, ensuring adequate sleep, and engaging in appropriate physical exercise to enhance the body's immunity.
Symptoms of Bell's Palsy (Facial Paralysis):
1. Paralysis of one side (rarely both sides) of the facial expression muscles (the affected side's forehead wrinkles become shallow or disappear, the eye fissure widens, eyelid closure is incomplete, the nasolabial groove becomes shallow, the mouth corner deviates to the healthy side, and air leaks when blowing cheeks).
2. Initial symptoms often include ear pain around the ear, with some patients experiencing severe pain at the Xifeng acupoint behind the ear, or even percutaneous pulling pain.
3. May be accompanied by reduced taste sensation in the anterior two-thirds of the tongue, hyperacusis, or hearing loss.
Classification of Facial Paralysis:
Facial paralysis should be classified into peripheral facial paralysis (peripheral facial nerve palsy) and central facial paralysis (central facial nerve palsy), with different clinical manifestations.
- Peripheral facial paralysis refers to facial paralysis caused by lesions in the motor fibers of the facial nerve. The lesion can be located below the facial nerve nucleus, such as in the lower pons, facial nerve canal, middle ear, or parotid gland. The entire expression muscles on the affected side become paralyzed,,,, may have auditory changes, reduced taste sensation in the anterior two-thirds of the tongue, and salivary secretion disorders. The most common type is facial nerve palsy (i.e., Bell's palsy).
- Central facial paralysis refers to facial paralysis caused by damage to the facial nerve nucleus above the brainstem to the cerebral cortex. When one side of the corticobulbar tract is damaged, facial paralysis occurs. 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, controlling the facial expression muscles above the eye fissure. The lower cells of the facial nerve nucleus only receive fibers from the contralateral corticobulbar tract, their axons form facial nerve motor fibers, controlling the facial expression muscles below the eye fissure. Therefore, in central facial paralysis, the facial expression muscles below the eye fissure on the affected side become paralyzed, often accompanied by paralysis of the limbs on the same side as the facial paralysis, without taste sensation or salivary secretion disorders.
Guidance on Treatment:
Currently, there are many methods for treating facial paralysis, but few are widely used in clinical practice and produce good results. Effective treatment methods include applying ointments (such as Facial Paralysis and Compound Qian Zheng Ointment), acupuncture, oral traditional Chinese medicine, and oral or injectable Western medicine.
Acupuncture Treatment:
The main method is acupuncture, with emphasis on manual techniques without the use of drugs or electroacupuncture.
- Principle: Dispel wind and unblock meridians.
- Prescription: Hegu, Taichong, Qian Zheng, Che Chen through Dicang, Dicang through Che Chen, Fengchi, Xiaguan, Yingxiang, Chengjiang or Che Chengjiang. Three or four points are selected each time.
- Modifications:
- If eyelid closure is impossible and tears leak, add Zanzhu, Yu Yao, Sizhu Kong, and Yangbai through Yu Yao.
- If ear pain occurs, add Xifeng.
- If taste sensation is reduced, add Lianquan.
- Technique: Even-toned tonification and sedation, with needle pulling.
- Operation:
- Hegu and Taichong are treated with sedation, Xiaguan, Qian Zheng, Yingxiang, and even-toned tonification and sedation.
- Yangbai is vertically pierced downward through Yu Yao, Dicang is horizontally pierced toward Che Chen, and Che Chen is obliquely pierced toward Dicang, with needle pulling to make the facial muscles move backward. Retain the needles for 20 minutes.
- The remaining points are treated with even-toned tonification and sedation.
Western Medicine Oral and Injected Medications:
In clinical practice, corticosteroids (such as prednisone and prednisone) and B vitamins (such as B1 and B12) are often used, along with blood-activating and anti-inflammatory drugs to achieve anti-inflammation, reduce edema, and improve microcirculation. It is obvious that the side effects of steroid drugs are severe, and since they are only symptomatic and supportive treatments, their efficacy is not certain. However, excessive use of steroids can lead to many adverse effects and side effects, such as obesity, edema, decreased immunity, and slow recovery. B1 and B12 are nerve-nourishing drugs, but they take a long time to take effect, are weak in action, and have a long treatment cycle. Therefore, patients must be cautious during treatment, especially within the first 15 days of the disease, which is the ischemic and edematous stage of facial nerve paralysis. This is also the acute stage of facial paralysis, and acupuncture should be avoided at this time, as it may worsen facial nerve damage. Many patients who leave behind sequelae are due to early acupuncture use. Moreover, if the acupuncture physician's technique is not proficient, or if the depth and accuracy of the needle insertion are not properly controlled, nerve damage may occur, leading to sequelae. Patients must be cautious when choosing treatment methods and drugs, as a scientific and reasonable approach is crucial for recovery.
Lifestyle Care:
Apply the blood of a live eel to the paralyzed facial skin after slaughtering it. Wash it off after 24 hours or at least 12 hours. Improvement can be seen within about a week.
Ba Dou Wine [Medicinal Composition]
- Ba Dou (Castor Bean Seeds): 3–5 seeds
[Function and Indication]
- Function: Warm the meridians, dispel phlegm, and unblock meridians.
- Indication: Facial nerve paralysis.
[Usage and Dosage]
- Fumigate the palm center (Laogong acupoint) of the affected hand for 1–2 hours each time. Severe cases can be treated for 4 hours. Use once a day, with five treatments constituting one course.
[Preparation Method]
- Grind Ba Dou and place it in an aluminum pot or glass bottle. Add 500 ml of 75% ethanol or good brandy, heat it, and use it externally.