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Title: Effect of the staging comprehensive treatment with acupuncture-moxibustion on Bell's facial palsy in the acute stage.
Author: Chen J, Shi H, Gao W, Li X, Shu Y, Wang Y, Jiang B, Yang J, Wang P.
Journal: Zhongguo Zhen Jiu; 2024 Jan 12; 44(1):51-56. PubMed ID: 38191159.
Abstract:
OBJECTIVES: To compare the clinical effect on Bell's facial palsy in the acute stage between the staging comprehensive treatment with acupuncture-moxibustion and western medication. METHODS: Sixty patients with Bell's facial palsy in the acute stage were randomly divided into an observation group and a control group, with 30 cases in each one. The patients in the control group were administered orally with prednisone acetate tablets and methylcobalamin tablets until the 28th day of illness. In the observation group, the staging comprehensive treatment with acupuncture-moxibustion was adopted. On the affected side, Qianzheng (EX-HN 16), Yifeng (TE 17), Sibai (ST 2), Yangbai (GB 14), Jiache (ST 6), Dicang (ST 4) and Touwei (ST 8), etc. were stimulated. In the acute stage (Day 1 to 7 of illness), the routine acupuncture and the point-toward-point needle insertion were delivered, no any manipulation was exerted at acupoints, and the needles were retained for 30 min. In the subacute stage (Day 8 to 14 of illness), on the base of the treatment as the acute stage, the depth of needle insertion was adjusted at a part of acupoints and the even needling technique was operated by twisting needle. Besides, electroacupuncture (EA) was attached to Qianzheng (EX-HN 16) and Dicang (ST 4), with continuous wave of low intensity and high frequency, 100 Hz, for 20 min. In the recovery stage (Day 15 to 28 of illness), on the base of the treatment as the subacute stage, the heavy stimulation of acupuncture was given, in which, the sticking and lifting needle techniques were delivered after the needles were inserted from Sibai (ST 2) toward Dicang (ST 4), and from Dicang (ST 4) toward Jiache (ST 6), separately; warm needling was operated at Yifeng (TE 17), and EA changed to stimulate the acupoints with the intermittent wave of high intensity and low frequency, 2 Hz, for 30 min. Acupuncture-moxibustion was given once every other day until the end of the 28th day of illness. The level of House-Brackmann facial nerve function rating scale (H-B grade),the score of Sunnybrook facial nerve grading system (Sunnybrook), the score of facial disability index (FDI), the temperature difference in the infrared thermal imaging facial area and electromyogram (EMG) situation of the affected muscle group were observed before and after treatment in the two groups. Using musculoskeletal ultrasound,the facial nerve diameter was detected and the clinical effect was compared between the two groups. RESULTS: After treatment, the level of H-B grade, Sunnybrook score, the scores of physical function and social life function in FDI were improved when compared with those before treatment in the patients of either group (P<0.01, P<0.05), and the results of these evaluations in the observation group were better than those of the control group (P<0.05). After treatment, the temperature difference of the frontal area, the eye area, the zygomatic area and the mouth corner was declined in comparison with that before treatment in the two groups (P<0.05), and the temperature difference in each area in the observation group was lower than that of the control group (P<0.05).The root mean square (RMS) of the frontal muscle group, the zygomatic muscle group and the orbicularis muscle group on the affected side increased in comparison with that before treatment in the two groups (P<0.01), and RMS of the observation group was higher than that of the control group (P<0.05) after treatment. Before treatment, the diameter of the facial nerve on the affected side was larger than that on the healthy side (P<0.01), and after treatment, the diameter on the affected side was reduced when compared with that before treatment in the two groups (P<0.01); the diameter of the facial nerve on the affected side in the observation group was smaller than that of the control group (P<0.05), while, the diameter on the affected side was larger when compared with the healthy side in the control group (P<0.05). The total effective rate of the observation group was 93.3% (28/30), higher than that of the control group (83.3% [25/30], P<0.05). CONCLUSIONS: The staging comprehensive treatment with acupuncture-moxibustion is clearly effective on Bell's facial palsy in the acute stage, which affirms the effectiveness of acupuncture-moxibustion for the acute stage of Bell's facial palsy in comparison with conventional western medication. 目的: 比较针灸分期综合治疗与西药治疗急性期贝尔面瘫的临床疗效。方法: 将60例急性期贝尔面瘫患者随机分为观察组和对照组，每组30例。对照组给予醋酸泼尼松片联合甲钴胺片口服治疗，治疗至病程第28天结束。观察组采用针灸分期综合治疗，穴取患侧牵正、翳风、四白、阳白、颊车、地仓、头维等，急性期（发病1~7 d）给予常规针刺联合透刺治疗，针刺不行手法，留针30 min；亚急性期（发病8~14 d）在急性期治疗基础上，调整部分针刺深度，并行捻转平补平泻手法，牵正、地仓连接电针，予低强度、高频率的连续波，频率100 Hz，电针刺激20 min；恢复期（发病15~28 d）在亚急性期治疗基础上加重针刺手法，四白透刺地仓、地仓透刺颊车行滞针提拉手法，配合翳风行温针灸，电针改为高强度、低频率的断续波，频率2 Hz，电针刺激30 min。针灸隔日治疗1次，至病程第28天结束。观察两组患者治疗前后H-B量表分级、Sunnybrook面神经分级系统评分、面部残疾指数（FDI）评分，采用红外热成像仪检测面部区域温度差，采用表面肌电图分析系统评估患侧肌群肌电情况，采用肌骨超声检测面神经直径，并比较两组临床疗效。结果: 治疗后两组患者H-B量表分级、Sunnybrook面神经分级系统评分、FDI躯体运动功能及社会生活功能评分均较治疗前改善（P<0.01，P<0.05），观察组均优于对照组（P<0.05）。治疗后，两组患者面部额区、眼区、颧区、口角区温度差均较治疗前降低（P<0.05），观察组各区域温度差均低于对照组（P<0.05）。治疗后，两组患者患侧额肌群、颧肌群、口轮匝肌群均方根（RMS）均值较治疗前升高（P<0.01），观察组高于对照组（P<0.05）。治疗前，两组患者患侧面神经直径大于健侧（P<0.01）；治疗后，两组患者患侧面神经直径均较治疗前减小（P<0.01），观察组患侧面神经直径小于对照组（P<0.05），对照组患侧面神经直径大于健侧（P<0.05）。观察组总有效率为93.3%（28/30），高于对照组的83.3%（25/30，P<0.05）。结论: 针灸分期综合治疗急性期贝尔面瘫疗效确切，验证了急性期贝尔面瘫针灸治疗的适宜性，较常规西药治疗有更好的疗效。.

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