Bell’s Palsy
Bell’s Palsy is named after Scottish physician and anatomist Charles Bell (1774-1842). His work helps us understand what happens in Bell’s Palsy, or problems with the Facial Nerve (Cranial Nerve VII) and it’s branches. CN VII controls the muscles of facial expression, which is why a problem with it leads to dysfunction of the muscles of the face.
Bell’s Palsy in particular, refers to a condition specifically involving CN VII. There are many other conditions which may cause facial paralysis such as stroke, though, and these must be ruled out.
Symptoms of Bell’s Palsy
Bell’s Palsy patients most often experience weakening or paralysis of facial muscles. They may find themselves suffering from ptosis, or inability to close the eyelid fully, as well as deviation of the lips, and obliteration of the nasolabial fold.
These may come suddenly, and in Chinese Medicine these are attributed to invasion of Wind into the channels of the face. This leads to obstruction of the flow of Qi and Blood.
Acupuncture for Bell’s Palsy
When I was studying in China, I encountered a whole gaboodle of Bell’s Palsy patients. I can roughly estimate that one out of every ten patients would be consulting the clinic for facial paralysis. Even here, I have encountered a good number of acupuncture patients seeking help for this. Yet it seems that the treatment is not as effective as it should be.
It is known that this disease can heal by itself, given time. Is acupuncture then just a fancy placebo while the body heals itself? I would say no, and present one study that may show why some acupuncture sessions may not cause as good an effect as others.
The Deqi Sensation
“Deqi” is a Chinese phrase that literally means “arrival of Qi”. It refers to the sensation of heaviness brought about by insertion and stimulation of an acupuncture needle. According to the Huangdi Neijing (click here to learn more about this), it is essential for acupuncture treatment success.
The study I would like to share is entitled “Effectiveness of strengthened stimulation during acupuncture for the treatment of Bell palsy: a randomized controlled trial” and published in the Canadian Medical Association Journal. (link) The study defines deqi as:
The traditional Chinese theory of acupuncture emphasizes that the intensity of acupuncture must reach a threshold to generate de qi, which is necessary to achieve the best therapeutic effect. De qi is an internal compound sensation of soreness, tingling, fullness, aching, cool, warmth and heaviness, and a radiating sensation at and around the acupoints. However, the notion that de qi must be achieved for maximum benefit has not been confirmed by modern scientific evidence.
Interesting. Now this is what they did:
We performed a prospective multicentre randomized controlled trial involving patients with Bell palsy. Patients were randomly assigned to the de qi (n = 167) or control (n = 171) group. Both groups received acupuncture: in the de qi group, the needles were manipulated manually until de qi was reached, whereas in the control group, the needles were inserted without any manipulation. All patients received prednisone as a basic treatment. The primary outcome was facial nerve function at month 6. We also assessed disability and quality of life 6 months after randomization.
This means that all patients received standard treatment of prednisone. This is because the goal of the study was not to compare acupuncture to no acupuncture, but needling sensation to no needling sensation.
Here is the result:
After 6 months, patients in the de qi group had better facial function (adjusted odds ratio [OR] 4.16, 95% confidence interval [CI] 2.23-7.78), better disability assessment (differences of least squares means 9.80, 95% CI 6.29-13.30) and better quality of life (differences of least squares means 29.86, 95% CI 22.33-37.38). Logistic regression analysis showed a positive effect of the de qi score on facial-nerve function (adjusted OR 1.07, 95% CI 1.04-1.09).
In laymen’s terms, there was a true difference in results if one has a deqi sensation vs just inserting the needles. (see my previous entry, “Rotating acupuncture needles better than sticking them in” here).
And incidentally, it shows that, and I quote the study: “Among patients with Bell palsy, acupuncture with strong stimulation that elicited de qi had a greater therapeutic effect, and stronger intensity of de qi was associated with the better therapeutic effects.”