1. ACUPUNCTURE TREATMENT
OF BELL’S PALSY USING TWO
DISTAL PONINTS:
SHENMAI (V62) AND HOUXI
(ID3)
DR. OSCAR RODRIGO MENDIZABAL
POLANCO
MÉDICO CIRUJANO UNAM
ESPECIALISTA EN ACUPUNTURA IPN

2. Definition
 Acute unilateral paralysis or
paresis of facial expression
muscles consistent with a
peripheral nerve damage,
without a detectable cause.
Coker NJ, Vrabec JT: Acute Paralisys of the Facial Nerve. En Bailey BJ, Calhoun KH, Healy GB,
Pillsburry HC, Johnson JT et al. Head and Neck Surgery-Otolaryngology. 2006, 4th Ed. Lippincott
Williams & Wilkins. Ch 144 pp 1843-1858.

3. Etiology
 Associated to viral infections:
 HSV 1
 EBV
 Positive serology in 6-10% of
patients
Linder T, Bossart W, Bodmer D. Bell’s palsy and herpes simplex virus: fact or mystery? Otol Neurotol
2005;26:109-13.

4. Pathophysiology
???
Facial n. edema
Nerve compression
Neuropraxia
Axonomnesis
Neuromnesis
Facial palsy
Danner CJ. Facial Nerve Paralysis Otolaryngol Clin North Am 2008; 41(3): 619-32,

6. Cuadro clínico

7. Diagnsis
 Sudden onset
 Unilateral paresis or paralysis of all muscle
groups on one side of the face
 Absence of central neurological signs
 Absence of otic and cerebropontine
angle pathology
Mattox DE: Clinical Disorders of the Facial nerve. En Cummings CW, Haughey BH, Thomas
JR, Harker LA, Flint PW. Cummings Otolaryngology: Head and Neck Surgery. 2005, 4th Ed.
Mosby. Ch 147 pp 3333-3354.

8. Stadification
House-Brackmann scale
Benecke JE: Facial Paralysis. Otlolaryngol Clin N Am. 2002; 35:357-365.
I Normal Normal function
II Mild Thorough inspection
III Moderate Obvious with maximum effort
IV Moderately severe Disfigures w/movement
V Severe Disfigures at rest
VI Complete No movement

9. Treatment
 Prednisone 1 mg/kg/day for 7 days.
 Antivirals have not shown better
outcomes.
 85% full recovery at 2 months.
 4% sequels after 6 months.
Danner CJ. Facial Nerve Paralysis Otolaryngol Clin North Am 2008; 41(3): 619-32.

10. Rehabilitation
 Surgical reanimation.
 Auricular major N.
 Sural N.
 Hypoglossal n.
 Botox.
 Facial excercises.
Danner CJ. Facial Nerve Paralysis Otolaryngol Clin North Am 2008; 41(3): 619-32.

11. CHINESE
MEDICINE
APPROACH

12. Definition
 Qi and Xue stagnation in
channels and colaterals of
the face, mainly the
yangming system due to
invasión of wind and cold.
Zhaofa Z, Ding Z (Editors), Tai W (Translator): Fundament and Clinical Practice of
Electroacupuncture. 1994. Beijing Science and Technology Press. Ch 6, pp 185-187.
Mayor DF: Electroacupuncture: An Introduction and its use for Periphereal Facial
Paralysis. J Chin Med. 2007. 84: 1-19.

13. Staging
o Four stages:
- Acute stage: from onset to day
7, symptoms usually progressive.
- Stable stage: day eight to
fourteen.
Mayor DF: Electroacupuncture: An Introduction and its use for Periphereal Facial
Paralysis. J Chin Med. 2007. 84: 1-19.

14. Staging
- Convalesence stage: from
day 15 until begining of
second month.
- Chronic stage: from month
2.
Mayor DF: Electroacupuncture: An Introduction and its use for
Periphereal Facial Paralysis. J Chin Med. 2007. 84: 1-19.

15. ETIOLOGY AND
PATHOPHISIOLOGY

16. Facial paralysis
Zheng Qi
deficiency
Qi/Xue stagnation on
Jingluo
Poor Qi/Xue circulation on face
Jingluo
Pre existing
phlegm
Liver Qi stagnation
Wind/cold
Couli not compacted

17. Syndromes
a) Invasion of wind/cold.
b) Jingluo obstuction by wind and
phlegm.
c) Internal wind due tu Xue
deficiency.
Zuo Y (Compiler in chief), Zhongbao Z, Yezhong H, Jinwen T, Zhaoguo L (Translators). A Newly
Compiled Practical English-Chinese Library of Traditional Chinese Medicine: Chinese Acupuncture and
Moxibustion. 2002. Publishing House of Shanghai University of Traditional Chinese Medicine. Ch 5,
pp 299-300.
Zhaofa Z, Ding Z (Editors), Tai W (Translator): Fundament and Clinical Practice of Electroacupuncture.
1994. Beijing Science and Technology Press. Ch 6, pp 185-187.
Ross J: Acupuncture Point Combinations: The Key to Clinical Success. 2005. Churchill Livingstone. Ch 32,
pp 426.

18. Treatment
Acute stage  distal points;
local points with shallow
insertion and no
manipulation.
Stable stage  local points
with strong stimulation.
Zuo Y (Compiler in chief), Zhongbao Z, Yezhong H, Jinwen T, Zhaoguo L (Translators). A Newly
Compiled Practical English-Chinese Library of Traditional Chinese Medicine: Chinese Acupuncture
and Moxibustion. 2002. Publishing House of Shanghai University of Traditional Chinese Medicine.
Ch 5, pp 299-300.

19. Prevention
Avoid spicy foods.
Protection from wind
and cold.
Relaxed emotional life.
Zhaofa Z, Ding Z (Editors), Tai W (Translator): Fundament and Clinical Practice of Electroacupuncture.
1994. Beijing Science and Technology Press. Ch 6, pp 185-187.
Ross J: Acupuncture Point Combinations: The Key to Clinical Success. 2005. Churchill Livingstone. Ch 32,
pp 426.

20. Rehabilitation
Focused on stage 4 
local points with strong
stimulation.
Synkinesis (internal wind
and K-H deficiency ) 
very hard to treat.
Zhaofa Z, Ding Z (Editors), Tai W (Translator): Fundament and Clinical Practice of Electroacupuncture. 1994.
Beijing Science and Technology Press. Ch 6, pp 185-187.

21. Complemetary treatment
methods
 Low frequency electro acupuncture
 Better results compared with manual acupuncture (not to
be used during the first 15 days from onset).
 Cupping
 Moxibustion
 Tuina
Zhaofa Z, Ding Z (Editors), Tai W (Translator): Fundament and Clinical Practice of Electroacupuncture.
1994. Beijing Science and Technology Press. Ch 6, pp 185-187.
Mayor DF: Electroacupuncture: An Introduction and its use for Periphereal Facial Paralysis. J Chin Med.
2007. 84: 1-19.
Zuo Y (Compiler in chief), Zhongbao Z, Yezhong H, Jinwen T, Zhaoguo L (Translators). A Newly Compiled
Practical English-Chinese Library of Traditional Chinese Medicine: Chinese Acupuncture and Moxibustion.
2002. Publishing House of Shanghai University of Traditional Chinese Medicine. Ch 5, pp 299-300.

22. Points to use
 Houxi
- Location:
 At the ulnar side of the hand, at the
depression proximal to the head of the
5th metacarpal, between the two skins.
Deadman P, Al-Khafaji M, Baker K: A Manual of Acupuncture. 1998. Journal of Chinese
Medicine Publications. Ch 11, pp 233-234.

24. Points to use
 Houxi
- Actions:
 Benefits the nape, neck and back,
activates the cannel and relieves
pain, disperses wind and hot, calms
the spirit and treats epilepsy, clears
heat and benefits sense organs,
regulates Du Mai.
Deadman P, Al-Khafaji M, Baker K: A Manual of Acupuncture. 1998. Journal of Chinese
Medicine Publications. Ch 11, pp 233-234.

25. Points to use
 Shenmai
- Location:
 On the lateral aspect of the foot, 0.5 cun
inferior to the inferior border of the
external maleolus, at a depression
posterior to the fibular tendons.
Deadman P, Al-Khafaji M, Baker K: A Manual of Acupuncture. 1998. Journal of Chinese Medicine
Publications. Ch 11, pp 320-322.

27. Points to use
 Shenmai
- Actions:
 Pacifies internal wind and expells external
wind, calms the mind and treats epilepsy,
benefits the head and eyes, opens and
regulates Yang Qiaomai, activates the
cannel and aleviates pain.
Deadman P, Al-Khafaji M, Baker K: A Manual of Acupuncture. 1998. Journal of Chinese Medicine
Publications. Ch 11, pp 233-234.

28. Material and methods
 Inclusion criteria:
 Patients between 18 and 70 years old
attending to the acupuncture clinic of
the ENMyH, with periphereal facial
paralysis.

29. Material and methods
 Exclusion criteria:
 Central facial paralysis.
 Periphereal facial paralysis of known
cause.
 Repetition paralysis.
 Evolution greater than two months.

30. Material and methods
 Elimination criteria:
 Patients who wished to abandon the
study.
 Patients who did not completed at least
80% of sessions.

31. Material and methods
 Variables:
 Independent: acupuncture at
Houxi (ID3) and Shenmai (V62).
 Dependent: staging according to
House- Brackmann scale.

32. Material and methods
 Technique:
 Patient lying on his back.
 Needle insertion at the proposed
points with monomanual bidigital
technique, starting with Shenmai
(V62), then Houxi (ID3) on the
affected side.

33. Material and methods
Wind dispersing manipulation
technique at Shenmai (V62).
Cold dispersing technique at
Houxi (ID3).
Needle retention for 30 min,
manipulation at 0, 15 and 30
min.

34. Material and methods
A total of 3 weekly sessions
during 3 consecutive weeks
with weekly staging
according to House-
Brackmann scale.

35. RESULTS
 A total of 18 patients, 10
female and 8 male, 15 of them
met inclusion criteria. Thirteen
completed the three week
treatment course.

36. RESULTS
46%
54%
Sex distribution
female
male
Male: 8; female: 7

37. RESULTS
46%
54%
Laterality
right left
Left: 8; right: 7

38. RESULTS
10
2
3
0
2
4
6
8
10
12
< 2 weeks < 1 month < 2 months
Time of onset

39. RESULTS
1
4 4
2
3
0
0.5
1
1.5
2
2.5
3
3.5
4
4.5
21-30 31-40 41-50 51-60 61-70
Age distribution

40. RESULTS
7
6
1 1
0
1
2
3
4
5
6
7
8
VI V IV III
Initial stage

41. Name Age Sex Time Side W0 W1 W2 W3
MIR 48 F 5 d L IV III I I
AMG 38 M 4 d R V III II I
ETJ 69 M 2 m R V IV IV IV
VGG 59 M 2 m R V IV III III
MEF 42 M 9 d R VI III II I
JGS 50 F 7 d L VI IV III III
CCP 66 F 9 d R VI V V IV
JLA 36 M 3 d R III I I I
IIS 34 M 8 d L VI V IV III
MZR 45 M 1 m R VI V V V
SST 60 M 2 m L V IV III III
RTM 30 F 3 s L VI V III -
PGF 68 F 7 d L VI V IV -
GHA 50 F 8 d L V IV III III
AGA 29 F 9 d R V IV II I

42. RESULTS
 All of the patients diminished one stage
according House-Brackmann scale at the
end of week one.
 Recovery percentage at week 1 of
25.42% (p<0.05).

43. RESULTS
 At the end of week 3, 5 patients
(33.3%) were fully recovered, all of
them had less tan 10 days of
evolution.
 Total improvement percentage
was 52% (p < 0.05)

44. CONCLUSIONS
 Acupuncture at Shenmai (V62) and
Houxi (ID3) has a beneficial effect
on patients with acute or sub acute
Bells palsy and should be
considered as an adjuvant to
conventional therapy.