David London
Acupuncture Physical Medicine Information

Condition: Facial Paralysis (Bell’s Palsy)

1. Maciocia, G. (2008). The practice of Chinese medicine: The treatment of diseases with acupuncture and Chinese herbs. Second Edition. Europe: Churchill Livingstone, Elsevier.
2. Seem, M. (2000). Acupuncture physical medicine: An acupuncture touchpoint approach to the treatment of chronic fatigue, pain, and stress disorders. Boulder, CO: Blue Poppy Press.
3. Seem, M. (1993). A new American acupuncture: Acupuncture osteopathy. Boulder, CO: Blue Poppy Press.
4. Tortora, G. J., & Derrickson, B. (2006). Principles of anatomy and physiology. Eleventh Edition. Hoboken, NJ: John Wiley & Sons, Inc.

General Overview of Facial Paralysis (Bell’s Palsy) from an APM Perspective:
The authoritative text Principles of Anatomy and Physiology (Tortora & Derrickson, 2006), describe facial paralysis or Bell’s Palsy as “a unilateral paralysis of the muscles of facial expression” (p. 337). It is caused by damage to the facial nerve (VII). This damage can be caused by a variety of factors such as ear infections, ear surgery, or the herpes simplex virus. The result of this paralysis shows certain features, “The person can not wrinkle the forehead, close the eye, or pucker the lips on the affected side” (p. 337). This definition and description of this condition helps us to orient its symptoms within the APM perspective.
The Ventral Zone of the body, as described in A New American Acupuncture (Seem, 1993) “includes the major muscles of the face and front and side of the neck, especially the zygomaticus major and minor, the orbicularis oculi, the sternocleidomastoid, the masseter, the platysma and the scalenes” (p. 119). Based on this description, facial paralysis such as bell’s palsy would clearly fit into the Yang Ming Zone of treatment due to the involvement of the muscles of facial expression. However it is important to mention that this zone treatment should perhaps be viewed not as an excess pain condition, but as an atrophy/wei syndrome deficiency type condition. This distinction will be reflected in the diagnosis and treatment principles.

Patterns of Disharmony: Yang Ming Zone Dysfunction.

Clinical Manifestations: In this case the manifestations of this condition are the same as listed above in the general overview, “The person can not wrinkle the forehead, close the eye, or pucker the lips on the affected side”). A further description is included under palpatory findings.

Palpatory Findings: In the APM model of acupuncture cross fiber palpation is generally used to find tight tender areas of excess muscle constriction often characterized as acute or chronic pain conditions. In the case of facial paralysis this type of palpation is, in this writer’s opinion, not clearly applicable, as it does not easily help us discern the area of paralysis. However the assessment of the location of the paralysis is essential for the proper picking of both local and distal points within this zone. For this reason I have included the tips mentioned in the TCM portion of this topic to give some simple steps and guidelines for assessing the location of dysfunction:
Maciocia (2008) suggests that “one should ask the patient to close the eyes, bulge the cheeks, grin and whistle in order for the site and extent of paralysis to be ascertained” (p. 1203). He makes several other statements to help the practitioner understand the location of the paralysis; “The eye on the paralysed side will not close completely, the mouth will deviate towards the unaffected side, and the lips on the paralysed side will not move on attempting to grin” (p. 1203).

Treatment Principles: Based on the diagnosis of Yang Ming Zone Dysfunction, the treatment principle might be: Regulate Yang Ming Zone. (In this case the term Excess has been omitted from the end of the treatment principle as facial paralysis is a wei syndrome, deficiency type condition.

Treatment Strategies: In this case the Yang Ming Zone has been chosen for treatment due to the location of the muscular paralysis. It is important to note the two yang channels involved in the ventral zone, the Stomach and Large Intestine channels. Upon closer observation one can see that it is these two channels specifically which are involved in facial paralysis. The Stomach channel, beginning with the internal pathway at LI 20, curves up and then descends down through the eye, around the side of the mouth and up the lateral aspect of the face to the lateral forehead. The Large intestine meridian rising up past the mouth ending on the lateral side of the nose is also clearly involved with the muscles of facial paralysis.
Our strategy is to open the ventral zone with Jing level points, tonify the Yang Ming/Tai Yin circuit, and most importantly, use distal and local points along the ST and LI meridian to move and tonify the Qi and Blood of these areas.

Treatment Plan:

Jing Level:
Distal points include: SP4, PC6, to open chong mai and yin wei mai if there is complex zang fu dysfunction.
OR LU7, KD6, to open ren mai and yin qiao mai for kidney-lung disharmony.
(This writer would like to suggest the later of the two choices, as the ren meridian comes up to the face.)
Local points include: KD 11-21 and ST30, paired with the first of the above two choices.
OR CV 1-23, paired with the second choice.

Ying Level:
Distal points include: SP2 and SP3, LU9 and LU10.
OR other strategies for lung and spleen patterns if relevant.
Local points include: LU1 and LV13 (Lu and Sp front mu points).
And BL13 and BL 20 (Lu and Sp back shu points).

Wei Level:
Distal points include: LI4 and LI10 for the masseter and SCM.

Also, LI 6 and 11 are used as distal points for this ventral zone, as well as ST 43, 40, 39, 38, 37 and 36.

Local points include: points chosen are based on the examination steps mentioned above focusing on the weakened areas, specifically all facial points along the ST and LI meridians can be used.

Other specific local points for the ventral zone include:
ST 5-7 for the masseter, and medial and lateral pterygoid muscles.
ST 8 for the frontalis muscle.
ST 3-4 for the zygomaticus major muscle.
ST 1-2 for the orbicularis oculi
LI 19-20 orbicularis oris.

(This protocol was compiled from Acupuncture Physical Medicine, Seem, 2000, p. 135, and from A New American Acupuncture, Seem, 1993, pp. 121-123.)

Patient Education/Recommendations: Upon research of this topic no specific patient recommendations were found regarding the treatment of facial paralysis from an APM perspective. At times the APM style refers to TCM for certain aspects of theory and treatment. As was explained in the TCM section of this topic, facial paralysis is often viewed as external wind from a TCM perspective. Based on this idea, the APM practitioner might recommend to their patient who is recovering from or who is predisposed to disease caused by external/wind conditions, that they keep their head, neck and back covered when exposed to strong wind and cold.

Prognosis: No specific information concerning the number of treatments or outcome of treatment of this condition was found during research of this subject.