Bell’s palsy treatment with Traditional Chinese Medicine

Photo Cred: Antonika Chanel/Unsplash

By Melissa Carr, BSc, DrTCM

When I did three months of my internship training for Traditional Chinese Medicine (TCM) at two hospitals in China, we saw a wide range of health issues. One very commonly and successfully treated condition was Bell’s palsy.

In my own practice in North America, I don’t see many cases of Bell’s palsy. However, Bell’s palsy is the most common cause of facial paralysis, and while it usually does gradually improve over time, it can greatly affect a person’s self-confidence, ability to eat or speak properly, and it includes a risk of damage to the eye if it is unable to close completely. For those with more severe cases of total paralysis, it may also result in irreversible damage to the facial nerve.

While the cause of Bell’s palsy is still unclear, it is thought that viral infection or immune system dysfunction are the most likely reasons. In the past, conventional healthcare practitioners considered the only trigger to be exposure to a cold wind, such as from driving with the car window down or sitting close to an air conditioner. This is still in line with TCM’s most common etiology for this condition, Wind attacking the channels of the face.

In the case of one five-year-old girl we treated in China, her parents reported that she woke with the paralysis after sleeping with the window open next to her bed. It is possible that the cold wind lowered her immune system’s ability to effectively respond to a virus that was already present. Regardless, her condition took three sessions on consecutive days to resolve and we noted significant improvement immediately after the first acupuncture treatment.

As with all TCM and acupuncture therapies, the starting point to effective treatment is a proper TCM diagnosis. In my clinic, my patients had already seen a medical doctor and been diagnosed with Bell’s palsy, having excluded stroke, tumor, and Lyme disease as other conditions with similar presentations.

The most common TCM diagnosis, as mentioned, is Wind attacking the channels of the face. For Wind to manifest as facial paralysis, there must be some underlying condition of imbalance in the affected patient, otherwise everyone out on a cold windy day would also be afflicted.

In line with the current understanding that Bell’s palsy is likely to be caused by a virus attacking the cranial nerves, TCM practitioners most often note a deficiency in Zheng Qi (upright Qi), which is a general term to identify the various types of energy used to defend the body against exogenous pathogens.

Zheng Qi deficiency can occur when a person is constitutionally weak, after periods of draining stress or overwork, post-illness, with poor diet, or following insufficient sleep. These are all things that can weaken an effective immune system response and create feelings of fatigue.

Depending on the TCM organs most affected by the Qi deficiency, chosen acupuncture points and herbal remedies can vary. However, some Qi tonifying points to consider include ST36, SP6, LU7, KI3, UB13, UB15, UB18, UB20, UB23, DU4 (GV4), REN4 (CV4), and REN6 (CV6). Some base formulas that could be modified include Si Jun Zi Tang, Bu Zhong Yi Qi Tang, Yu Ping Feng San, and Jin Gui Shen Qi Wan, depending on the most affected organ systems.

Other underlying patterns to consider include Qi and/or Blood stagnation and Phlegm stagnation.

Case Study

Mary, age 62, woke up in the middle of the night unable to move the left side of her face. Afraid she may have had a stroke, she went to the hospital where she was diagnosed with Bell’s palsy and prescribed prednisone and acyclovir. When she came in to see me a week later, she was finished her medications and the swelling of her face was reduced, but she still had a considerable amount of paralysis. The left side of her face was drooping, she was unable to blink or effectively close her left eye, she could not puff out her cheeks, and she had a hard time speaking clearly. According to the grading system developed by House and Brackman, on a scale of grade I to VI, she ranked as having a severe dysfunction, grade V. She was also experiencing some blurred vision, though this was likely caused by the lubricating eye drops she had to apply frequently.

Prior to the onset, she had noticed pain in the upper part of her neck, near her left ear, and had felt sensitivity to sound in that ear. Other than noting poor circulation, she had felt healthy, had been sleeping well, and had low stress levels, so this condition took her by complete surprise, and she was struggling with some anxiety about it. She had a general tendency to experience fear, often overthinking situations and causing herself anxiety.

Her tongue was pale purplish, and her pulse was choppy. Her TCM diagnosis was Wind attacking the channels of the face, Blood stagnation, and Kidney Qi deficiency.

This was her first ever acupuncture session, but she was excited to experience some improvement, so in addition to doing some distal acupuncture at ST36, SP10, SP6, KI3, LIV3, and LI4, I was also able to do local area points at ST4, ST5, ST7, and SJ23 on the left side. I also recommended vitamin B12, a high-quality fish oil, and curcumin. After the first appointment, she noted an improvement in her ability to move her eyelid and more definition in her face. She also felt less anxious.

Though the treatments varied somewhat with each appointment, other chosen points included ST5, ST8, LI20, GB2, GB8, SJ17, taiyang, yintang, and GB34. I also used a microcurrent machine to work the muscles of her face after each acupuncture session.

Though in China, I most often saw the recommended frequency was daily for a course of 10 sessions, in North America, most patients find this to be too daunting, both for time and finances. Instead, she had five sessions over three weeks and by the completion of those sessions, though her eye closure was incomplete she was able to blink, she had regained her nasolabial crease, her mouth was able to turn up at the corner, she was able to puff out her cheek, and she spoke much more clearly.

She no longer had pain and she was comfortable with her vision and able to drive again. She returned to part-time work and I saw her weekly for two more sessions. After that, her face did not show much asymmetry at rest, though she noted that she still felt like there was swelling around her mouth, especially as she tired over the day at work. She was able to close her eye fully when lying supine and three-quarters closed when upright.

I will continue to see her weekly or biweekly over the next month or two to help her regain the remaining movements and function, but she now feels confident in her ability to recover fully.

References

Taylor, D. (2019) Bell Palsy Clinical Presentation. Medscape. Retrieved from: https://emedicine.medscape.com/article/1146903-clinical#b4