Prescription acupoint selection
The face belongs to the place where Yangming and Shaoyang meridians follow, and because Yangming meridians are rich in qi and blood, acupoints are mainly selected along Yangming meridians to stimulate the qi of meridians. Encourage Yangming to channel qi, promote qi and promote blood circulation, dredge meridians and direct diseases.
Acupoint selection is mainly based on Yangming meridian of hands and feet and facial acupoints. Main acupoints: Xiaguan, Toubucha, Taiyang, cheekbones, Sibai, Dujuan, Fengchi, Yifeng, Hegu (healthy side) and Zusanli. Matching points: Xiang Ying and Bai Yang pass through fish waist, ditch, slurry bearing, straight (the midpoint of the connecting line between the cheek car and the basement), Taichong and Chengqi. Choose 6-8 acupoints at a time and use them alternately. If it is difficult to close your eyes, add fish waist and bamboo hollow, and the nasolabial groove is flat to welcome the fragrance. If the person's groove is crooked, the chin and labial groove are crooked, add pulp support, and the tongue is numb and tasteless. If it recovers slowly, add Zusanli.
Acupuncture treatment method
1. Acupuncture (electroacupuncture) is the main treatment.
Acupuncture (electroacupuncture) is the main method to treat facial paralysis, and its clinical effect is positive. 200 cases of peripheral facial paralysis were treated by Xie Jianmou [1] shallow needling, and 192 cases were cured, accounting for 96%, and 8 cases were markedly effective, accounting for 4%. The shortest treatment is 5 days, and the longest treatment is 35 days. Wang Fusheng [2] treated 22 cases of peripheral facial paralysis with penetrating needling and electroacupuncture, in which 65438 04 cases were cured, 6 cases were markedly effective, 2 cases were improved and 0 cases were ineffective, with a total effective rate of 65438 000%. Generally, it can be cured in 2 courses. The shorter the course of disease, the better the curative effect. Wang Zichen et al. [3] treated 3/kloc-0 cases of peripheral facial paralysis with "acupuncture by stages", and the remarkable efficiency was 90.3%. Li Yanhui [4] treated facial paralysis 136 cases with acupuncture at local points on the affected side, and 134 cases all disappeared; Symptoms and signs were obviously improved, but there were 2 cases with slight tooth asymmetry, and the effective rate was 100%.
In addition to routine acupuncture therapy, there are also reports of using special acupuncture to treat facial paralysis. Liu Xiaojuan [5] treated 65 cases of facial paralysis mainly by pricking collaterals, 58 cases were cured and 7 cases were markedly effective. Liu Hongshi et al. [6] used Hegu acupuncture to treat 96 cases of facial paralysis, 68 cases were cured, 3 cases were markedly effective 10, 5 cases were improved10, and the total effective rate was 94.79%. Li Liangping [7] used wrist-ankle acupuncture to treat facial paralysis, and the statistical results showed that its curative effect was better than conventional acupuncture. Li Shucheng [8] treated 60 cases of traumatic facial paralysis by acupuncture at the motor area of the contralateral scalp point, and 39 cases were cured, with a total effective rate of 86.7%. Liu [9] used ear acupuncture to treat peripheral facial paralysis 105 cases, and compared with 40 cases treated with body acupuncture. Results The total cure rate of the treatment group was 865,438 0.90%, while that of the control group was 55%. Song Shoujun [10] treated 30 cases of facial paralysis with bee acupuncture, and set 22 cases as control group. Results After statistical treatment, the total effective rate of the two groups was significantly different (P < 0.05), and the treatment group was significantly better than the control group. Huang Youcai [1 1] et al. used bee needle combined with triangular needle bloodletting therapy to treat 58 cases of facial paralysis. Li Ping [12] et al. used five-element magnetic acupuncture to treat facial paralysis, mainly taking local acupoints, with bipolar acupuncture layout, and using magnetic field effect to penetrate acupoints to form a closed magnetic circuit. 166 cases, 54 cases were cured, and the cure rate was 92.77%. Li used floating needle therapy to treat 34 cases of facial paralysis. All patients were unilateral first-episode, including 29 males and 6 females. According to the degree of mouth-eye deviation, the treatment plan is determined. After routine disinfection, use 1 ~ 1 0.5 inch filiform needle to make the needle tip aim at the selected acupuncture point and quickly enter the needle horizontally. After piercing the skin, insert the needle body horizontally under the skin until it reaches the needle handle. 32 cases were cured, accounting for 94.7%.
2. Combination of acupuncture and other therapies
Acupuncture therapy is often combined with other therapies to increase the curative effect. Acupuncture is often combined with moxibustion, cupping and massage. Liu Cunben [14] randomly divided 1 16 patients with peripheral facial paralysis into acupuncture combined with warm moxibustion to stop wind treatment group and acupuncture control group, and observed the difference of clinical efficacy. Results The curative effect of the treatment group was significantly higher than that of the control group (P < 0.0 1). Duan Ling [15] treated 50 cases of facial paralysis with facial point penetration, ginger-separated moxibustion and traditional Chinese medicine, 40 cases were cured, 8 cases were markedly effective and 2 cases were effective. Li Xiaohua [16] 42 cases of peripheral facial paralysis were treated by puncture and cupping, and 30 cases were set as control group (routine acupuncture) for observation. After statistical treatment, the difference in curative effect between the two groups was statistically significant (P < 0.05), and the observation group was better than the control group. Feng Juan [17] 37 cases of intractable facial paralysis were treated by electroacupuncture combined with acupoint massage, and the total effective rate was 95%. Tong [18] used acupuncture combined with massage to treat 80 cases of facial paralysis. The cure rate was 52.50%, the effective rate was 42.50%, and the remarkable efficiency was 95%. Xie Liangzhu [19] and others used balance acupuncture massage to treat facial paralysis. After treatment, all patients were effective, among which 30 cases were cured, 6 cases were markedly effective and 2 cases were effective.
The combination of acupuncture and oral medicine is also reported. Zhan Guangzong [20] treated 78 cases of facial paralysis by oral administration of traditional Chinese medicine combined with electroacupuncture, 69 cases were cured and 9 cases were effective, with a total effective rate of 100%. The shortest course of treatment is 1 and the longest course of treatment is 4. Liu Wei [2 1] treated 77 cases of facial paralysis with acupuncture and medicine. The cure rate is 80.52% and the effective rate is 94.85438 0%. Li Shurong et al [22] used acupuncture combined with medicine to treat 35 cases of facial paralysis, the cure rate was 85.7%, and the total effective rate was 97.65438 0%. Li Huangtong et al [23] treated 32 cases of acute peripheral facial paralysis with contralateral acupuncture and oral prednisone. After 18 acupuncture treatments, 29 cases were cured, 2 cases were markedly effective, 0 cases were improved, and 0 cases were ineffective. Sun Yuehua [24] and others used acupuncture combined with traditional Chinese and western medicine to treat 3 1 case, 28 cases were cured within 1 course of treatment, and 3 cases were cured within 2 courses of treatment, with a total cure rate of 100%. Cui Liping [25] treated 52 cases of this disease with comprehensive therapy, local acupoint electroacupuncture and oral Zheng Qian powder, and 50 cases were cured after 3 courses.
Acupuncture combined with acupoint application is also a common treatment. Wu Xiaohong [26] used electroacupuncture combined with acupoint application of traditional Chinese medicine to treat 45 cases of intractable facial paralysis, and the effective rate was 93.3%. 50 cases of facial paralysis were treated with acupuncture therapy such as Ji Qiaoling [27] and external application of traditional Chinese medicine Semen Strychni, 40 cases were cured, 7 cases were markedly effective, and 3 cases were improved. The total effective rate was 65438 000%. Yang Jingmin [28] and others used comprehensive therapy to treat 63 patients with facial paralysis. A triangular needle is tied around the second molar on the occlusal line of the upper and lower teeth on the inner side of the affected cheek, and a small piece of white mustard seed cake is stuck on the outer side of the cheek. All of them were cured after treatment, including 54 cases cured by/kloc-0 once and 9 cases cured by twice.
Acupuncture plus acupoint injection is a good method to treat facial paralysis. He Zhifang [29] treated 80 cases of severe peripheral facial paralysis with acupuncture and acupoint injection, and injected 0.25g of citicoline, 0/21000 ug of vitamin B and 40mg of lidocaine. 54 cases were cured, accounting for 67.5%, and the total effective rate was 93.7%. Among all effective cases, the shortest course of treatment was 1, the longest was 3 months, and the average course of treatment was 1.5 months. Du [30] was treated with acupoint injection of monocrotaline phosphate and vitamin B 12. Clinical observation showed that 72 cases were cured, 56 cases were cured, 2 cases were markedly effective 12, and 4 cases were effective. The total effective rate was 100%. Ye Tianshen et al [3 1] used acupuncture combined with acupoint injection of mecobalamin to treat 35 cases of intractable facial paralysis. After treatment, the score of improved Portmann scoring system (RPA) was significantly improved.
Acupuncture combined with acupoint irradiation has also been reported. Zhou Shuying et al [32] mainly treated facial paralysis with acupuncture and infrared radiation, and the total effective rate was 100%. Xu Linbo [33] treated 300 cases of facial paralysis, acupuncture combined with TDP irradiation, 245 cases were cured, 42 cases were effective, and 3 cases were ineffective/kloc-0. Song Jianning [34] treated 50 cases with electroacupuncture combined with TDP, 48 cases were cured, and 2 cases were markedly effective. The total effective rate was 100%, and the shortest treatment time was 6544.
Course of treatment and precautions
Acupuncture/kloc-0 times a day, 20 ~ 40 minutes each time. 10 is 1 course of treatment, with 2 courses of treatment and 3 days' rest between courses.
Acupuncture should not be too strong in the early stage of the disease, and oral treatment with traditional Chinese medicine should complement each other. The course of the disease is short, the age is young and the curative effect is good. Long course of disease, old age and poor curative effect. During the treatment, instruct the patients to apply hot compress 1 time every day, each time lasting 15 minutes. Don't wash your face with cold water, pay attention to keep warm around the affected side and ears to avoid cold. You can massage your face by yourself to promote the recovery of facial paralysis.
Therapeutic effect standard
At present, it is generally believed that symptoms and signs disappear and the appearance is normal for recovery. Only when laughing or frowning, the corners of the mouth are slightly inclined to the healthy side, and the forehead and nose on the healthy side are shallow. Self-conscious symptoms improved, the appearance was slightly asymmetrical with the healthy cheek, the affected eyes were not closed tightly, and the corners of the mouth were slightly skewed. There was no significant change before and after treatment. 〔35~36〕
conclusion
Facial paralysis is a common disease in acupuncture clinic. Most of them are caused by deficiency pulse, and the evil of wind-cold invades Yangming and Shaoyang pulse, resulting in the obstruction of menstruation and qi, dystrophy of meridians and collaterals, and obstruction of tendons and veins. Its treatment is mainly to dispel wind and cold and dredge meridians. Differentiation of facial paralysis should first distinguish between deficiency and excess. Generally, the initial pathological changes are mostly empirical, and most of them are common cold attacking collaterals or heat stagnation meridians. If the course of disease is long, or if it is treated for a long time in the middle and late stage, it is mostly deficiency syndrome (or deficiency of essence and excess of substance), which is often deficiency of qi and blood or deficiency of middle qi. On the basis of syndrome differentiation and treatment, the treatment of facial paralysis should be based on the principles of combining symptomatic acupoint selection with syndrome differentiation, combining local treatment with overall treatment, and combining palliative treatment with radical treatment. Specifically, there are four methods: expelling wind and clearing heat, tonifying deficiency and dredging collaterals.
At the initial stage of the lesion, pathogenic factors enter the skin first, and the pathogenic factors are in the exterior, and the positive is deficient and the evil is solid. It is advisable to strengthen the body resistance and eliminate evil, select fewer points, acupuncture should be shallow, the technique should be light, and the needle retention should be short; In the development stage, the evil is flourishing, and the evil due to cold is in the meridians, and the evil enters the interior, and the good and evil contend. Acupuncture is mainly based on diarrhea, which leads out evil spirits; In the recovery period, the pathogenic factors have declined, the vital qi is also deficient, and the vital qi is insufficient to love evil. Penetrating acupuncture is used to stimulate the qi of meridians and promote the circulation of qi and blood. The channels and collaterals are opened, the tendons and veins are raised, and the mouth and eyes can be gradually stopped.
Acupuncture is a good method to treat facial paralysis, but the mechanism is unclear, and the research focuses on clinic, with various methods, and comprehensive treatment is often used. However, there is no standard treatment plan at present, and the scope of indications is not clear. There are different views on the factors that affect the curative effect, such as acupuncture timing, acupoint selection and manipulation, and various observation conclusions are different. The design lacks randomized control, does not realize real randomization, and does not use the evaluation system to evaluate the treatment effect, which affects the credibility. In addition, acupuncture treatment is influenced by many factors, and the comprehensive treatment of facial paralysis lacks multi-factor and multi-level statistical analysis, so it is difficult to judge the dose-effect relationship between the effects of various treatment factors and clinical efficacy.