By Shihan Bolz
Master of Science Oriental Medicine
Master Martial Arts Instructor, 6th Degree Black Belt
Bell’s Palsy is described in allopathic medicine (Western medicine) as idiopathic (of unknown cause) unilateral facial paralysis of sudden onset. According to the Merck Manual, seventeenth edition, the mechanism presumably involves swelling of the nerve due to immune or viral disease, with ischemia and compression of the facial nerve in the narrow confines of its course through the temporal bone. Many times pain behind the ear may precede facial weakness. The weakness sometimes develops into complete paralysis. The affected side of the face becomes flat and expressionless. The eye can not close in more severe cases.
There may be a numb or heavy feeling in the face but there is no actual sensory loss demonstrated. Salivation, taste and lacrimation (tearing of the eyes) may be affected. In allopathic medicine, weakness of the entire half of the face distinguishes Bell’s Palsy from supranuclear lesions, meaning stroke or cerebral tumor, in which the weakness is partial, affecting the forehead and the eye less than the muscles in the lower part of the face. There are other disorders of the facial nerve which manifest as unilateral facial weakness. These disorders could be geniculate herpes (Ramsay Hunt’s syndrome), middle ear or mastoid infections, sarcoidosis, Lyme disease, carcinomatous leukemic nerve invasion, chronic meningeal infections and tumors. Skull x-rays and CT and MRI scans are obtained when the diagnosis is in doubt. An MRI may show contrast enhancement of the facial nerve. CT and x-rays generally do not show anything. But they may show a fracture line, bony erosion due to infections or neoplasm, or internal auditory canal expansions due to a tumor.
These diseases can then be known or ruled out. Blood test are done for Lyme disease. A chest x-ray and serum ACE are used to detect sarcoidosis, a possible cause of facial nerve paralysis. It appears that allopathic medicine treatment is mainly just to let Bell’s Palsy go away on its own. Acute (sudden onset) partial facial paralysis has a predicted complete recovery in several months. The main thing that allopathic medicine advocates is to keep the cornea from drying out. The use of natural tears, isotonic saline and methyl cellulose drops are put in the eye and the eye is taped to keep it closed. It is not a common treatment, but some studies have been made using corticosteroids, such as prednisone at the onset to help reduce residual facial paralysis and expedite recovery. However, no report that this was successful was given in the research. It was only mentioned as a study. Allopathic treatment with hypoglossal facial nerve anastomosis (surgery creating a pathway connection) may partially restore facial function if none has returned in 6 to 12 months but this procedure results in difficulty in eating and speaking.
Persons with Bell’s Palsy lose the natural cleansing action of the lips and cheek on the tooth surfaces of the affected side, resulting in unilateral decay unless oral hygiene is scrupulous. Usually fluoride and sealant treatments are repeated by their dentist to help this.
What does Traditional Oriental Medicine have to say about Bell’s Palsy? Chinese medicine ascribes this condition to Wind and Cold of external origin which invade the channels traversing the face and disrupt the flow of Qi and blood, preventing the vessels, muscles and nerves from receiving the necessary moistening and nourishment. Indeed, upon questioning many patients who have had an occurrence of sudden onset of Bell’s Palsy, they can recall having been exposed to wind and/or cold such as having been lying at night with a window open with the breeze blowing on them. Persons affected may not have felt cold particularly, but there was the exposure in one way or another. Not all people exposed to wind and cold, of course, get Bell’s Palsy. There is some underlying imbalance or predisposition in the personâ€™s system that would make them susceptible. What that weakness or susceptibility is can be determined by a practitioner of Oriental medicine. Many times, these people are sensitive to wind and often this disease will suddenly occur in the spring season, or at the change of seasons, such as winter ending and spring beginning.
In Traditional Oriental Medicine, treatment is directed toward spreading the Qi through the channels of the face. Acupuncture can be quite effective in achieving this. Traditional Chinese medicinal formulas are also helpful. Prognosis for success can be understood to a good degree by whether the patient can make wrinkles on his/her forehead or not. If the person can make wrinkles on the forehead, there is likely a central nervous system problem such as upper motor neuron lesions. This suggests that recovery is not so easy. If the patient is unable to make wrinkles on the forehead, it is likely a peripheral nervous system problem, or lower motor neuron lesion involving the facial nerve. This suggests that acupuncture can be quite helpful in resolving the problem. Electro-acupuncture is especially effective, but should not be used on the first few treatments, since it is a stronger stimulation Manual acupuncture is usually used for the first week or two of treatment with a light stimulation. The facial nerve passes through and exits the stylomastoid foramen (a foramen is an anatomical opening or hole), behind the earlobe, between the ramus of the mandible and the mastoid process. There is an acupoint (acupuncture point) located here, which, when needled, is very helpful for this condition. When the glossopharyngeal nerve is affected the patient may possibly lose their sense of taste. This problem may also be addressed with the acupuncture. Of course, not only one acupoint is used.
Acupoints are selected by the practitioner according to the individual case, but this point and the point Feng Chi, located at the occiput of the head (on the back of the skull near the nape of the neck) are almost always used. Feng Chi is specific for many wind conditions. Large intestine and stomach points on the face are also used. Scalp acupuncture can be used on the facial area in the Motor area on either the affected or opposite side of the head. More rapid results can be obtained when acupuncture is combined with manipulation, hot herbal compresses, or Chinese oral herbal therapy. It will take at least two weeks to effect a cure with acupuncture treatment given every day or on alternating days. Ten treatments usually constitute one course. If, after electro stimulation the muscles twitch, it is a sign that recovery will be relatively rapid. Even if this does not occur, it does not mean that recovery will not occur, it will just take longer. Sometimes cutaneous (superficial, on the surface of the skin only) needles are used at some of the acupoints to cause a small amount of bleeding. After tapping the points with the cutaneous needle, small cups are applied for 5-10 minutes to stimulate the blood flow in the area. This method works especially well for facial muscle spasms with the mouth being awry.
In some studies done in China with 288 subjects, it was determined that acupuncture as a stand-alone therapy was more effective than drug therapy alone. When acupuncture and drug therapy was combined, the results were faster. The word “drug” was not defined in this study. In China, this could mean medicinal herbal therapy as well as allopathic drugs. At any rate, the Traditional Chinese Medicinal herbs have been prescribed for the condition along with acupuncture for hundreds, at the least, and more likely, a couple thousand years.
What is the expected recovery period with acupuncture? If the condition is caught within the first three months there is generally good recovery. The first week of acupuncture, treatment is generally 3 times and the second week at least two times. If the patient has been suffering for only one week, the acupuncture would likely effect a cure in 7-10 days. If the patient has had the condition for 2 weeks, then acupuncture would likely effect a cure after 2 weeks. If the condition is within 6 months, but more than three months, it gets more difficult; however, it is not impossible and with persistence and more frequent treatments, it can be cured. But the recovery period will probably be longer than the period of suffering if the patient has had it more than 3 months. If the condition is more than 6 months old, the recovery is difficult, but not impossible; all former history from the patient must be obtained. If the facial palsy is associated with severe pain and a zoster-type eruption in the ear, this is the Ramsay-Hunt syndrome. There may be ear pain, swollen ears and a rash around the face. Acupuncture can treat this condition as well, as it is also good in the treatment of Herpes Zoster. It will take two weeks at least for the recovery and the older a person is, the longer the recovery period. But one can recover! Nature is miraculous when you understand what tools help it to do its job.