Electroacupuncture: an introduction and its use for peripheral facial paralysis

By: Mayor, David F.

Abstract
Acupuncture and electrotherapy interface in the practice of electroacupuncture (EA). This article introduces some of the basic concepts and terminology of EA, its advantages and electrical parameters. The aetiology and incidence of peripheral facial paralysis (PFP), its pathology and prognosis are then covered. Conventional treatment of PFP is briefly mentioned, followed by a more detailed discussion of Western electrotherapy for the condition and the evidence for its clinical use. Background information on manual acupuncture (MA) and PFP is given. The literature on EA is reviewed, and EA treatment is then described according to the stage and severity of paralysis. Comparisons between EA and other modalities and combinations with ancillary methods are outlined, and the acupoints and electrical parameters used are analysed in some detail. A final discussion summarises some suggestions for safe and effective treatment. This article is based on the chapter on peripheral motor disorders in the author's recently published textbook on electroacupuncture, (1) together with material from the clinical studies database at wwww.electroacupunctureknowledge.com and an internet trawl of recent research.
Keywords: Acupuncture, electroacupuncture, electrotherapy, Bell's palsy, facial paralysis, neurapraxia (neuropraxia), neurotmesis, nerve, muscle, stages, motor point, denervation, tetany, clinical studies database, superficial needling, point-to-point needling, synkinesis, contracture, exercise, heat
Electroacupuncture, electrotherapy and peripheral facial paralysis--the background
Electroacupuncture: an introduction
Acupuncture and electrotherapy interface in the practice of electroacupuncture (EA). Here this is defined as the electrical stimulation of acupuncture points (acupoints) through needles. After the needles are inserted and deqi obtained in the usual way, electricity is passed through pairs of needles to give a continued stimulation, usually for 20-30 minutes.
Related treatments include probe or point TENS (pTENS, electrical stimulation using a small diameter handheld probe) and transcutaneous electrical acupoint stimulation (TEAS, stimulation of acupoints via surface electrodes). Another approach is laser acupuncture (LA), the application of low intensity laser light to acupoints, either transcutaneously or through an inserted hollow needle. pTENS, TEAS and non-invasive LA are useful if patients find needles unacceptable, although their effects are not identical.
EA is applied at the same points as traditional or manual acupuncture (MA), and has been used for most conditions for which MA is indicated, especially when manual stimulation has not brought a response, or when strong reduction is appropriate (e.g. for severe or acute qi and/or blood stagnation). It is less commonly used in deficiency conditions.

Like other forms of electrotherapy, EA is particularly indicated for pain (as in painful obstruction [bi] syndrome), paralysis (both flaccid and spastic) and muscle wasting (as in atrophy disorder [wei syndrome]). It has beneficial effects on microcirculation, inflammation and nerve damage. (1)
Advantages of EA include:
* EA is more effective than MA in some situations, and often potentiates the effects of traditional methods, particularly when strong, continued stimulation is required, as when treating paralysis or some forms of pain. (2)
* EA can be less time consuming and less demanding of the practitioner than MA, in both training and practice.
* Results may in some cases be more rapid, (3) and longer lasting. (4)
* EA may have specific effects on pain, relaxation, circulation and muscle that are different from those of MA. (5)
* EA is more readily controlled, standardised and objectively measurable than MA.
* Non-invasive stimulation methods can also be cost effective for home treatments, perhaps between sessions with a practitioner, although some forms of treatment will require supervision.
* EA allows stronger, more continuous stimulation than MA, (6) and with less tissue damage.
EA differs from MA in several respects (see table 1):
The parameters of EA
The electric current used in EA has various characteristics: polarity, frequency, amplitude/ intensity, mode, pulse duration, waveform.
Polarity (and pulse duration)
Current should be biphasic (as in alternating current) rather than monophasic (as in direct current). In other words, current should flow one way and then the other way between the needles, rather than always the same way:
Frequency
Frequency (more accurately, the pulse repetition rate or number of pulses delivered per second) is measured in units of Hertz (Hz). In EA, a 'low frequency' (LF) would be approximately 2-4 Hz or pulses per second. A 'high frequency' (HF) would be 50-200 Hz.
Amplitude/intensity
Depending on the type of equipment used, amplitude may be a measure of current or voltage. In EA, maximum amplitude may be of the order of 12 mA (milliamperes), or 9 V (volts), but these figures will vary considerably depending on equipment design, and will take account of safety issues for the particular device in question. The strength of sensation experienced by the patient depends on amplitude more than on frequency. Sometimes the level of stimulation is described as 'sensory' (feelable), 'motor' (resulting in muscle twitching) or 'noxious' (frankly painful).
Mode
Stimulation may be continuous (CW) (as in Fig. 1a above), intermittent (burst), 'dense-disperse' (DD, alternating higher and lower frequencies), or otherwise modulated:
Waveform
We usually think of waves as curving, rolling, moving forms in nature. In EA, however, square (or rectangular) waves are mostly used, as illustrated here, although some EA devices produce spike or other waveforms.
Stimulation ranges
It is helpful to consider two main types of stimulation: low frequency (LF)/high intensity (subjectively strong, though still tolerable), and high frequency (HF)/low intensity (subjectively gentle and comfortable). Because of the way these were developed and researched--the former predominantly as EA in China and the latter predominantly as TENS (transcutaneous electrical nerve stimulation) in the West, I have called them 'acupuncture-like stimulation' (ALS) and 'TENS-like stimulation' (TLS), whether they are applied through needles or surface electrodes.
At around 15 Hz, a frequency between the LF and HF ranges, effects may depend on both mechanisms. There is still lack of agreement on whether frequency or intensity is more important in terms of outcome.
EA is frequently used in the treatment of peripheral facial paralysis. The discussion that follows illustrates some of the basic principles involved.
Cautionary note
Electroacupuncture, like any form of electrotherapy, should only be practised following proper instruction and with knowledge of its safety aspects.
Peripheral facial paralysis (PFP) (Bell's palsy, idiopathic facial paralysis)
Aetiology and incidence
Facial paralysis is the result of a motor neuron lesion. This may be peripheral (lower, below the nucleus of the nerve cell, or 'infranuclear') or central (upper, 'supranuclear').
Most cases (around 60-75% (7)) of peripheral facial paralysis (PFP) result from virally induced inflammation of the peripheral facial nerve (cranial nerve VII), (8) or its compression due to vasospasm or oedema, generally in the mastoid region. Occasionally the condition is bilateral. (9) It is particularly associated with herpes simplex or zoster infection, and may be precipitated by exposure to draughts on the face. (10) An unpleasant variant is Ramsay Hunt's syndrome (herpes zoster oticus), in which paralysis is associated with a herpetic rash in or around the ear or on the roof the mouth. (11) This condition also involves the acoustic nerve (cranial nerve VIII), which emerges from the brain just behind the facial nerve. (12)
The facial nerve may also be damaged by surgery for removal of an acoustic neuroma, or by trauma. In one standard physical therapy textbook, surgical damage was estimated to be responsible for 13% of cases of PFP, and other trauma for about 6%. (13)
As with any nerve injury, compression to the facial nerve results in neurapraxia (often spelled neuropraxia), a localised conduction block that recovers relatively quickly (within days or weeks) or, if more severe, in axonotmesis, degeneration of the nerve beyond the injury, with subsequent slow regrowth of the nerve (at an average of some 1 mm daily). Complete severance of the nerve, neurotmesis, may mean that it is highly unlikely to grow back to its target tissue.
PFP or Bell's palsy is not uncommon, with a reported incidence of 13-34 per 100,000 according to different epidemiological surveys, (14) occurring most frequently between the ages of 20 and 40 (15) (although I had it myself as a teenager, after sitting in a draught after suffering chicken pox).
In some instances, the supranuclear pathway is involved as a result of cerebrovascular accident, with cortical or corticobulbar lesions, dissociation of voluntary and involuntary facial movements, and possibly other ipsilateral paralysis or aphasia. This can be differentiated from PFP by assessing the effects of magnetic stimulation of the cortex and facial nerve on the electromyogram (EMG) of the mentalis (chin) muscle. (16) However, the possibility of simultaneous PFP and asymptomatic cerebral infarction should not be overlooked. (17) Furthermore, as with sensory disorders and the development of chronic pain, when motor conditions become chronic the distinction between peripheral and central may be less clear as cortical reorganisation occurs. (18) Treatment may need to take this into account, working with neuroplasticity within the central nervous system as well as being directed at peripheral regeneration and repair.
Apart from stroke, Lyme disease, brain tumour and other possible causes such as multiple sclerosis and Guillain-Barre syndrome should be ruled out before treating as PSP. (19,20,21)
Pathology and prognosis
Pain behind or in front of the ear may precede the paralysis, which affects the muscles of expression (mimesis), such as those above the eyes (frontalis and orbicularis oculi superioris). Clinical symptoms are likely to include incomplete closure of the eye, drooping of the mouth, and an inability to frown, raise the eyebrow, close the eye, blow out the cheek, show the teeth or whistle. (22) Disordered lacrimation and salivation (too much or too little (21)) occur not only because of loss of muscle control, but also because fibres from the facial nerve innervate both the lacrimal gland and the parotid gland and plexus (parotidectomy may in fact induce temporary facial paresis, (23) or even, unfortunately, permanent paralysis (21)). Further symptoms may include continued pain or numbness, (19) loss of taste in the anterior two-thirds of the tongue due to lesion of the (sensory) geniculate ganglion of the facial nerve, and hyperacusis due to paralysis of the stapedius muscle (innervated by the stapedial branch of the nerve). (24) Muscle twitching may also occur, (19) and one unfortunate sequela can be synkinesis, abnormal involuntary muscle movement accompanying voluntary movements of other facial muscles ('jaw winking', or twitching of the eyelid with voluntary movement of the lips, for example (25)). These sometimes develop as recovery progresses. (26) Contractures were reported in one early electrotherapy RCT to occur in 23% of those with initial complete muscle denervation. (27) (Early fibrillation is not, unfortunately, a sign that muscle is recovering. (28))
Chinese acupuncture studies usually describe three (or sometimes four) stages of PFP:
1. Acute phase (up to 7 days), during which symptoms usually worsen.
2. Stable (or 'resting') period (8-14 days).
3. 'Convalescence' (from 15 days), during which there is usually a gradual improvement in symptoms. (22)
4. Chronic phase (from 2 months onwards). (29)
Without treatment, some 85% of PSP patients show initial signs of recovery within 3 weeks, a further 15% within 3-5 months. Around 66% are fully recovered by 3 months. (30) Thus in one study of 54 patients, voluntary movement appeared 16 days post onset on average, with full recovery by 6.3 weeks. (31)
Overall, a fortunate 80%-84% (32) recover to an acceptable level within weeks to months, although 20-30%, (14) or even one-third (30) of patients may be left with some residual symptoms. More optimistic figures have been given by one Chinese author (19) (75% complete recovery, mostly within 2-3 weeks, 15% with persistent facial asymmetry, and only 5-10% showing poor recovery at 4 months).
For those who suffer Ramsay Hunt's syndrome, there is a less than 20% chance of spontaneous recovery. (11)
Prognosis is better for those with milder symptoms at onset, and who start to recover more quickly, indicating the presence of a neurapraxia and only partial denervation of muscle. (33) A less favourable outcome is likely in those with complete facial weakness (suggesting axonotmesis or even neurotmesis and total muscle denervation), pain other than in or around the ear, and systemic hypertension, (34) as well as in those aged over 50 (15) or 60 (35) at onset.
Conventional treatment and electrotherapy
Conventional treatment of PFP tends to be based on antiviral medication (Acyclovir, Valtrex (36)) and a steroid such as Prednisolone in the acute phase, (8,37,38,39,40) with surgical decompression reserved for serious cases (compound muscle action potential amplitude decrease greater than 90% within 2-3 weeks after onset). (41) It may also include EMG biofeedback, (14) and neuromuscular retraining to inhibit the development of synkinesis. (26)
Electrotherapy originally developed in the West following the discovery in the ancient world that discharges from electric fish, particularly the mediterrranean torpedo and Nile catfish (malopterus electricus), could be used therapeutically (although not to my knowledge for PFP). It is intriguing that Li Shizhen mentions the use of a different catfish (parasilurus asota) as a treatment for facial paralysis in his Bencao Gangmu, (42) but this particular species (like other known species of fish in Chinese waters) does not have the shocking potential of its distant cousins in the Nile. (43) Electrotherapy in China is a Western import.
Electrotherapy has been used for various forms of paralysis since the mid-eighteenth century, usually with the notion that eliciting muscle twitches will somehow encourage recovery. Where applied electrical stimulation results in maximum contraction is termed the muscle's motor point. However, whereas in neurapraxia (partial denervation) it is still possible to excite facial muscle via the motor nerve, in neurotmesis (complete denervation) muscle no longer has any motor point/s and muscle fibre has to be stimulated directly. Without electrical and neurochemical input, muscle soon atrophies, with increasing degeneration and fibrosis, a process beginning within 1 to 2 weeks after the initial lesion and complete (and very possibly irreversible) by about 3 years. (44) Facial muscle, however, tends to atrophy somewhat more slowly than other larger muscles, (14) and perhaps for this reason electrical stimulation can have a greater effect on the small muscles involved in PFP than on larger muscles elsewhere in the body. (32)
There is much controversy over the usefulness of stimulating denervated muscle. With reduced circulation, self-repair becomes more difficult in the event of trauma, so excessive exercise (electrically induced or otherwise) is best avoided as it may increase fibrosis. It may also delay reconnection of nerve and muscle, (28) and activate neurochemical feedback that in fact slows nerve regrowth. (45) Thus poorly selected electrical parameters may even inhibit neural regeneration after peripheral nerve injury. (46,47) However, stimulation can benefit the muscle by maintaining nourishment to the tissue and aiding repair, so delaying atrophy and fibrosis even if not completely preventing them. (44,48) It also fosters a return to normal voluntary use once reinnervation occurs. (49)
One form of muscle stimulation called trophic electrical stimulation (TES) uses low frequencies and amplitudes based on the 'patterned' firing characteristics of motor units themselves, rather than the 'more is better' tradition of most methods that use constant frequencies. (50) It is therefore less fatiguing, (51) and appears to maintain muscle tone by altering metabolism rather than by providing a form of 'induced exercise'. (14,52) For PFP, TES uses a range of frequencies between 5 Hz and 15 Hz. (53) Interestingly, frequencies in the physiological tremor range (~10 Hz) may be more effective than twitch (slower) or tetanic (faster) frequencies in stimulating circulation (and so enhancing tissue repair). (54,55,56,57)
Sustained contraction of muscle (tetany) occurs if completely denervated muscle is stimulated at around 3-10 Hz (a much lower frequency than in normal muscle). (58) It would thus seem logical to use low-intensity LF (59,60) stimulation with short pulse durations, rather as in TES, in preference to the strong and long higher-frequency tetanic pulses often advocated in the past. (61) Long interruptions (of 30 seconds, (62) 4 minutes, (63) even 15 minutes (64)) between contractions have also been advocated, with short treatments repeated at least twice or even three times (65) daily to reduce muscle fatigue, (63) although muscle fatigue as such may have little effect either way on the rate of reinnervation. (66) Despite these various suggestions, there are no generally accepted guidelines on optimum parameters.
If reinnervation is possible, except in simple neurapraxia it is in a race against muscle degeneration. Clearly then it is important to begin stimulation as soon as possible after the lesion, (66,67) while it may appear futile to attempt to work an apparently fibrosed muscle. In between these two extremes, it is a matter of clinical judgement whether to stimulate or not.
Once normal innervation is re-established, there is little to be gained by continuing stimulation. (49)
Electrotherapy for PFP: the evidence
Experimentally, electrical stimulation has been shown to benefit axon regeneration in rabbits with traumatic facial nerve injury. (68) Despite such evidence, and despite considerable theoretical support for the application of electrical methods in the treatment of PFP, there are surprisingly few clinical studies that unequivocally support the use of electrotherapy for this condition. (14,52) In their 2003 review, Rosie Quinn and Fiona Cramp found for example that 'conclusive findings relating to the efficacy of electrotherapy in Bell's palsy are still lacking' (as so often, because of methodological shortcomings in clinical studies). However, they also suggested that 'there is no evidence to suggest that electrical stimulation is beneficial to patients with acute Bell's palsy, but evidence does exist to suggest beneficial effects of electrical stimulation in patients with chronic Bell's palsy'. Another 'best evidence' review again found no evidence (published in English) that electrotherapy is beneficial in acute PFP, although stating that its use might be justifiable in long term Bell's palsy. (69) When it comes to other electrotherapy modalities, Quinn and Cramp concluded that ultrasound may benefit acute Bell's palsy, but that there is no convincing evidence that shortwave diathermy and low intensity laser therapy (LILT) are useful for the condition. (14)
Given the paucity of good quality research, it is hardly surprising that an official US report from 1984 found that 'electrotherapy ... has no demonstrable beneficial effect in enhancing the functional or cosmetic outcomes in patients with Bell's palsy', (70) or that in 1989, a standard physical therapy textbook still concluded that 'electrotherapy may not be clinically effective' for this condition. (13) Some authors even state categorically that electrical stimulation should not be used for facial paralysis. (71) Others suggest that any electrical stimulation is contraindicated if its purpose is to stimulate flaccid muscles, as this may foster the development of synkinesis, where the aim should be to inhibit contracture rather than to encourage it. (26) Thus Medicare in the USA does not cover electrotherapy for the treatment of PFP, (72) while some insurance companies consider electrical stimulation only as 'investigational/ not medically necessary'. (7)
It is interesting that the one study that meets with the approval of all the reviewers is one on TES. (73)
Acupuncture
Acupuncture has frequently been used for Bell's palsy. One Chinese review of the acupuncture literature on PFP over 50 years cites over a thousand articles, of which just over 15% were randomised controlled trials (RCTs) or controlled trials (CTs). (74) Traditionally, acupuncture is considered very effective for the condition. Thus another Chinese non-systematic review of 50 studies carried out over a 10-year period found a complete recovery rate averaging some 81% (37%-100%). (75) There are other claims of 95%76 or even 99.6%. (77)
Given the ~80% spontaneous recovery rate, it is perhaps not surprising that there are many reports of MA being helpful for facial paralysis. (78,79,80,81,82) MA has also been employed for facial paralysis due to diabetic (motor) neuropathy, particularly of the oculomotor nerve, (80,83) and is sometimes combined with other traditional interventions such as bleeding (84) or cupping. (85) Reviews of the many acupuncture-based methods used have been published, (75,29,86) as well as a 2003 Cochrane systematic review on the subject. This authoritative if poorly reported and very limited source, based on a total of only 288 patients in three RCTs in which acupuncture (or acupuncture plus medication) was reported as superior to medication alone, found that there is still 'insufficient evidence from randomised trials to decide whether acupuncture is helpful' for Bell's palsy. (15) It is important to note that this review was limited to cases treated within 14 days from onset and excluded chronic sequelae and cases involving diabetes, herpes zoster or other causes. Also excluded were TEAS, pTENS and LA.
In general, clinicians and less systematic reviewers have concluded, like Zhang Hong in this journal, (22) that acupuncture, whether MA or EA, can shorten time to recovery and enhance curative effect. (87,88,89,90)
Predictably, less good results are reported for Ramsay Hunt's syndrome, (91) while in one large Russian review facial paralysis of vascular origin had the least good prognosis of all the types treated. (35) (However, any intervention that improves local circulation is likely not only to help release local nerve compression but also to assist nerve regeneration. (92) MA, for instance, has been found to increase facial temperature in patients with Bell's palsy, (93,94) with temperature also increasing in response to auricular MA in one successful case. (95))
Traditional Chinese medicine (TCM) and PFP
In TCM terms, PFP is usually considered to result from the invasion of wind-cold due to an underlying deficiency of qi or poor circulation in the channels and collaterals in the face, with resultant stagnation of qi and blood. The condition may also be complicated by pre-existing phlegm. (19) Disharmony of Liver qi has also been proposed as a contributory factor. (96) Acupoints may be selected according to a further differentiation (channel blockage due to wind-cold or wind-heat, qi and blood stagnation, or qi and blood deficiency). (29) Once PFP has become chronic, Liver and Kidney yin deficiency may complicate the picture. (29) One author has suggested that PFP caused by invasion of wind-cold is most responsive to acupuncture treatment. (97) It is instructive that Julius Althaus, one of the greatest European electrotherapists of the nineteenth century, attributed most cases of Bell's palsy to the influence of damp and cold. (98)
Bleeding (at jing-well points), (99) and bleeding and cupping, (100) have been used in the acute phase of PFP, as well as bleeding alone for chronic PFP with blood stagnation. (101)
In keeping with conventional electrotherapy findings, better results have been reported with MA when higher electrical potentials are found at acupoints on the affected side than at symmetrical points on the opposite side, particularly if these potentials increase markedly with the first treatment. (102) One group of researchers has also used temperature differentials between the affected and unaffected side to determine MA point selection. (103)
Electroacupuncture in the treatment of peripheral facial paralysis
Because of its effects on pain, paralysis, muscle wasting, microcirculation, inflammation and nerve damage, we would expect EA to be perfectly suited to the treatment of PFP (although Bruce Pomeranz has suggested that simple manual needling may in fact induce electrical 'current of injury' levels and densities in precisely the range required for nerve regrowth (104)).
Indeed, in experimental studies EA has been found to benefit facial nerve regeneration following trauma, (105,106) while a quick Medline search (February 2007) using the terms 'facial paralysis' AND 'electr*' reveals more studies on EA than on all other forms of electrotherapy for PFP, at least in recent years.
Furthermore, in the present journal (Journal of Chinese Medicine, 1979-2006 (107)), 8 of 16 articles, case studies or abstracts on PFP included discussion of EA. And in one 2005 comprehensive review of the Korean acupuncture literature (1983-2001), (108) of 124 studies retrieved, 9 were on PFP, and of these only one did not make use of electrical stimulation.
The clinical studies database at www.elecroacupunctureknowledge.com currently includes 167 studies on PFP, including full details of acupoints and electrical parameters used in each study (if known). Please note that this database does not include or exclude studies on the basis of methodological merit. While it provides an essential contribution for the formulation of further treatment and research protocols, authors' claims as to outcome may not be sustainable when subjected to rigorous scientific criteria.
Analysis of the clinical studies database indicates that many authors have observed that EA gives better results than MA for PFP (75) (see too below, under Comparisons and Combinations). Some have gone so far as to suggest that acupoint electrostimulation (without needles) is 'a method of choice' for Bell's palsy, (109) although others, more cautious, have stated categorically that electrical stimulation should not be used for facial paralysis. (78)
Treatment according to stage and severity of paralysis
The three standard stages of PFP described in the Chinese literature have been mentioned above. Selecting appropriate acupuncture treatment at each stage may speed up recovery110 and improve results. (111,112)
1. Acute phase
Symptoms normally worsen during the 7 days or so of this phase and then level off. Thus early aggravation may be erroneously attributed to acupuncture (although it may also result from incorrect treatment). (22) On the other hand, stability of symptoms in one case study when treatment was started only towards the end of the acute phase was attributed to EA! (19)
Except in cases of simple neurapraxia it is usually considered important to begin stimulation as soon as possible after the lesion occurs, even though the effects of acupuncture may not be evident until the acute phase is over (113) (except perhaps to the electrophysiologist (114)). Thus in acupuncture generally, the emphasis is very much on early treatment. (97,115,116,117,118,119,120,121,122) In one small study (N = 22) of EA initiated between 1 and 30 days after onset of PFP, for example, results were better in those treated earlier. (123) Similarly with LILT, with better results in those treated less than 15 days after onset reported in another small study (N = 17). (9) Despite such plausible evidence, Zheng Qiwei and Li Zhenbo have cautioned that EA should not be used initially, for fear of inducing spasm. (124,19) Authors such as Cui Shugai, (125) Qiu Meihua (126) and Wu Yixin et al (120) have followed this approach.
One approach to initiating treatment during the acute phase is to use points on the healthy side of the face, and points on the affected side only in the stable period. In one MA study this gave better results than routine acupuncture and moxibustion in all three phases. (127) In another, results with contralateral MA were better than with TDP to the affected side along with intravenous medication. (128) Surprisingly, there appear to be very few studies in which EA was applied on the nonparalysed side, (129) although there are some in which it was used bilaterally on facial points. (130,131,132)
Superficial needling has been used in several acupuncture studies, (133) in at least one explicitly during the acute phase and early stable period (with better results for MA than standard Western medicine, WM). (134) In another such study, although overall results were similar for both superficial needling and conventional acupuncture (MA), sequelae were less with the former, (135) and in one RCT superficial needling was better than point-to-point needling (disease stage unclear from the study abstract). (136) Superficial needling has also been used for chronic PFP. (85)
Gentle needling was found superior to strong stimulation in one MA report on early stage PFP (137) (and to improve and speed up results with standard WM in another). (87) However, this may not be a universal finding: strong stimulation (with point-to-point needling) in a study of acute stage and early stable period PFP resulted in a 100% total effective rate (herbal medication and a steroid only providing 55%). (138)
Although in one large RCT on acute PFP (N = 477), superficial MA was found superior to 1 Hz EA, (139) EA with carefully controlled parameters (140,141,142,123) (as well as other forms of acupoint electrostimulation (143)) has been found helpful during the acute phase. Thus, in another controlled trial (N = 80) where gentle (just perceptible) EA was started within 14 days of onset, results were considerably better than when treatment was begun later. (22) Such studies appear to contradict the cautions of Zheng Qiwei and Li Zhenbo against using EA at all during the initial acute phase (of course relatively gentle EA is by no means contraindicated later on (144)).
Nonetheless it should not be forgotten that strong local electrical stimulation of the affected side may well be counterproductive. (145,19) Such stimulation of denervated muscle may potentially lead to contractures and synkinesis, (146) especially early on. (124) However, one much cited electrotherapy RCT from 1958 found that interrrupted galvanic stimulation (pTENS) sufficient to elicit only 'minimal' contractions did not adversely affect the development of facial muscle contracture despite being used in the acute phase of PSP. (27) Provided treatment is carefully designed and carried out, electrical stimulation is not contraindicated during the acute phase of PFP.
There is also some justification for using both ultrasound (14) and (possibly) microwave diathermy (147) or TDP (148) during the acute phase.
2. Stable period
Most MA and EA studies consider the acute phase and stable period together, dividing treatment into that started in the first two weeks after onset and treatment begun later.
3. Convalescence (and chronic phase)
Prolonged sequelae of PFP (more likely in older patients) tend to be refractory to both MA and EA. Thus, as already stated, most sources emphasise the importance of starting treatment early. In a comparison of two EA case histories by Li Zhenbo, for example, PFP first treated at two months responded more slowly and less well than acute Bell's palsy treated only five days after onset. (19) In contrast, one standard NMES (neuromuscular electrical stimulation) protocol, perhaps erring on the side of caution, advocates delaying treatment until two months after onset. (149)
In line with standard acupuncture practice, treatment may usefully be continued for some weeks after apparent clinical recovery, depending on EMG findings, (150) although not all agree that this is essential once normal innervation is re-established.
In contrast to acute phase PSP, strong stimulation may now be appropriate. (121) This was found superior to uniform reinforcing-reducing in one comparative trial of MA, for example. (151,152) Similarly, in a number of EA studies in the clinical studies database treatment is started gently, gradually increasing intensity (and sometimes frequency) as the condition becomes more chronic.
Severity of the condition
The severity of a nerve injury will determine how rapidly recovery will take place, and what effect EA will have on this. Treatment will give poorer results in those with more severe pathology. (153)
The presence of incomplete paralysis in the first week is a favourable prognostic sign. (154) The response of affected muscles to an initial session of intermittent EA has itself been used to assess prognosis (155) (more accurate prognosis may be obtained through electrical measurement (31,156,157,158,159,102) or other methods (160)). In simple neurapraxia, EA may not even be needed.
If recovery is delayed, then more than a simple neurapraxia may be involved, with axonotmesis or degeneration of the nerve peripheral to the lesion (as often occurs following neuroma surgery). In these cases, recovery is likely to be incomplete. As degeneration can set in within a few days, many physical therapists consider early treatment to be important, directed at first to relieving pressure on the nerve in the case of neurapraxia. (161) However, even treatment several years after the initial insult can produce useful results in cases of axonotmesis if patients (and practitioners) are willing to persist with it. (146) At this stage, the aim of treatment is to assist nerve repair and facilitate muscle reeducation.
Lesion location
Several studies indicate that the lower (more peripheral) the lesion along the facial nerve, the better the therapeutic effect of acupuncture (162,163,24) and moxibustion. (164) The authors of one RCT found that whereas cases with lesions outside the facial (nerve) canal tend to recover spontaneously, lesions within the canal benefit from acupuncture. (165)
Comparisons and combinations
Comparisons
EA is more effective than MA according to a number of studies, (166,167,168,117,169) with fewer treatments required. (117,170) However, in a large RCT (N = 477) on acute PFP, MA (with multiple superficial needling) was superior to 1 Hz EA. (139) On the other hand, LF EA gave better results than vitamin B12 acupoint injection plus medication in another report (171) (in another RCT, point injection was found better than routine MA (172)).
pTENS ('galvano-acupuncture') was found to be more effective than 'ordinary acupuncture' in one RCT. (173)
TEAS was more effective than MA in one study, with fewer treatments required. (174) In another, the effects of EA and TEAS were similar, (175) whereas in a third the combination of TEAS and TDP with MA improved the results compared with those from MA alone. (176)
LA and MA were equally effective in some studies, (177,178) although LA was less useful than MA (or MA plus moxibustion) in one large RCT. (179) However, the addition of Helium-Neon LA to LF EA improved rate of cure (but not overall effective rate) in one 2003 CT. (180)
TDP (plus medication) gave similar results to MA in one CT, but took longer to achieve them. (128)
Combinations
Somewhat surprisingly, EA appears from the clinical studies database to be combined most commonly with acupoint injection for PFP.
EA has frequently been combined with TDP (possibly even more than with moxibustion), and in recent years with microwave diathermy (giving better results than diathermy alone in one report on acute stage PFP (142)). Given the TCM aetiology of the condition, it is quite surprising that there are not more studies combining MA and moxibustion.
Moxibustion in combination with EA has been used in the treatment of facial paralysis, (181) with heat considered particularly appropriate in chronic cases by some authors. (182,183) A common sunlamp has also been used, (86) as has far infrared. (184 185) Both moxibustion (in one study at Yangbai GB-14, Xiaguan ST-7 and Qianzheng N-HN-20, (183) in another at Yifeng SJ-17 (186)) and far infrared (TDP) (148) appear to improve the results of EA, as well as MA. (176,184) The combination of far infrared with MA has also been claimed to reduce the amount of treatment needed. (185) In keeping with reports that EA often gives better results than MA, the combination of EA with moxibustion was found superior to MA in one RCT. (168)
Further analysis of comparisons and combinations may be found in my textbook. (1)
The role of exercise
LF EA has been combined with functional exercises. (170) In studies comparing acupuncture plus facial exercises with acupuncture alone, results were significantly better in the former group. (187,188) Adjunctive exercises (whether volitional or induced) have an important role to play in PFP, (52) particularly once recovery begins, (115) although exercises have also been effectively combined with LF EA in acute phase PFP. (189) However, too much emphasis on mirror work (making faces) can be disheartening if progress is slow. (190) Exercise has to be tailored to recovery stage. (26)
Points used
A TCM approach
Traditionally, points are selected according to pattern of differentiation. Ren Xiaoqun, for example, suggests the following points:
* For channel blockage due to wind-cold: Fengchi GB-20, Hegu L.I.-4 (with moxibustion).
* For channel blockage due to wind-heat: Yifeng SJ-17, Yanglingquan GB-34.
* For qi and blood stagnation: Waiguan SJ-5, Sanyangluo SJ-8, Taichong LIV-3
* For qi and blood deficiency: Zusanli ST-36, Sanyinjiao SP-6. (29)
Anatomical acupuncture
Others have preferred a Westernised approach (see Table 3 on the website version of this article), one group suggesting that selecting points according to the distribution of the main branches of the facial nerve can be effective even with gentle or superficial MA, (133) another author using such points for stronger MA with point-to-point needling in cases of more chronic PFP (ST-6 to ST-4; an empirical point midway between Yangbai GB-14 and Sizhukong SJ-23 to Xiaguan ST-7; Yifeng SJ-17). (152) A rational selection of points might include Zanzhu BL-2, Sizhukong SJ-23, Yangbai GB-14 and Taiyang M-HN-9 for involvement of the first (temporal) branch of the facial nerve, Quanliao SI-18 and Chengqi ST-1 for second (zygomatic) branch involvement and Dicang ST-4 with Jiache ST-6 for the third (mandibular) branch. (182) (See too Table 3). An important point is Yifeng SJ-17, located where the facial nerve emerges from within the skull. (191)
Incidentally, there are very few PFP studies comparing the effects of stimulation at acupoints and non-acupoints. In one, EA at points over the nerve trunk had a better effect than similar EA at standard acupoints, (192) while in another EA at Hegu L.I.-4 and the auricular Mouth point gave superior results to MA at nonspecific points (193) (hardly a fair comparison). Non-acupoints over the trajectory of the facial nerve were stimulated in one very small uncontrolled LILT study (N = 4). (194)
An alternative approach is based more on the muscles involved rather than the nerves (see Table 3). Thus Zanzhu BL-2 and Yangbai GB-14 have been recommended for difficulty in frowning, Sizhukong SJ-23 and Yangbai GB-14 for difficulty in raising the eyebrow, Juliao ST-3 and Dicang ST-4 for an inability to smile, and Yifeng SJ-17, Dicang ST-4 and Jiache ST-6 as general points. (195) Point-to-point needling from Zanzhu BL-2 to Yuyao M-HN-6, with Yangbai GB-14, is another method taught for incomplete eye closure in China. (196) Other points for EA have been suggested by Zheng Qiwei: Taiyang M-HN-9 and Zanzhu BL-2 or Sibai ST-2 for incomplete eye closure; Yingxiang L.I.-20 and Quanliao SI-18 or Xiaguan ST-7 for difficulty sniffing; either Dicang ST-4 and Jiache ST-6 or Xiaguan ST-7 and Dicang ST-4 for difficulty in puf.ng out the cheeks; and Kouheliao L.I.-19 and Dicang ST-4 for deviation of the philtrum. (124) Wong has given a useful account of some nontraditional muscle levator points. (191)
Staging treatment
Ren Xiaoqun suggests that during the acute (and resting) stage, only distal and proximal but not facial points should be utilised (Yifeng SJ-17, Wangu GB-12, Fengchi GB-20, Taichong LIV-3, Hegu L.I.-4, for example). If facial points are used at all, only a few should be stimulated (Xiaguan ST-7 to Taiyang M-HN-9, Jiache ST-6 to Dicang ST-4, for instance). (29) Zheng Qiwei also recommends that not many points should be stimulated initially, maybe two to four from the affected area. (124) Chen Kezhen, another experienced reviewer, suggests Dicang ST-4 and Xiaguan ST-7, with Yingxiang L.I.-20 and Taiyang M-HN-9 on the affected side, together with Hegu L.I.-4 on the opposite side. (86)
Rather than connecting points on the face, Li Zhenbo in one case report paired Hegu L.I.-4 with Dicang ST-4 and Hegu L.I.-4 with Jiache ST-6, alternately. (19) Simple combinations of Yangbai GB-14-Hegu L.I.-4, Sibai ST-2-Xiaguan ST-7 or Dicang ST-4-Hegu L.I.-4 have been recommended for use with single-output stimulators. (197)
The use of distal points
Although Wong is rather disparaging about the use of distal points, (191) the authors of one MA study consider that stimulating distally does add to the effect of purely local treatment. (198) When using EA, one advantage of stimulating points away from the affected area is of course that there is no risk of inducing contracture or synkinesis in the early stages of PFP. Thus Zheng Qiwei quite happily recommends the early use of EA at Hegu L.I.-4 and Waiguan SJ-5 (with bilateral Hegu L.I.-4 points connected to one output of the EA device and the Waiguan SJ-5 points to a separate output). (124) In the clinical studies database there are many reports in which distal points on the limbs are used bilaterally in this way, and probably almost as many in which Hegu L.I.-4 is used, but only on the healthy side (although in one MA study, bilateral stimulation of hand points was found to be more effective than unilateral treatment (97)).
Mining the clinical studies database
Looking through the numerous studies in the database, it is clear that predominantly local points are used, selected to activate particular paralysed muscles, together with some distal points. The most commonly used points appear to be Yangbai GB-14, Dicang ST-4, Jiache ST-6 and Xiaguan ST-7, with Hegu L.I.-4 (indicated > 70 times in the database ), followed by Yifeng SJ-17, Yingxiang L.I.-20, Sibai ST-2 and Taiyang M-HN-9 (> 50 times), Zanzhu BL-2 and Fengchi GB-20 (> 40 times), Sizhukong SJ-23, Quanliao SI-18, Chengqiang REN-24, Renzhong DU-26 and Yuyao M-HN-6, with Zusanli ST-36 (> 20 times). Mentions of the stellate ganglion (199) and the crossing point of the Large Intestine and Gall Bladder channels above the clavicle (200) are intriguing.
It should not be forgotten that stimulation of totally denervated muscle (without sensation as well as movement) is unlikely to give good results.
Parameters used
Intensity and pulse duration
Chen Kezheng has suggested that low-intensity EA should be used, just strong enough to elicit muscle contraction. (86) Alexander Meng and Gertrude Kubiena also suggest gentle motor level stimulation locally (10-15 minutes of DD or intermittent), stronger stimulation being appropriate at distal points, (182) with the option of gentle and brief TEAS, daily initially for 4-5 days, then twice weekly, and so on. Only 5-10 minutes of mild motor level LF EA (every other day) is recommended in one Hong Kong text. (5) However, in the clinical studies database, while motor level stimulation ('to induce slight contraction of facial muscle') is emphasised, 'gentle' stimulation or stimulation 'to patient's comfort' occurs far less frequently than the standard Chinese 'intensity to tolerance' (or even 'maximum tolerance').
To obtain movement in muscle that is completely paralysed, longer pulse durations will be required (201) (even as long as 1-100 msec (146)).
Frequency and mode
From the clinical studies database, the most frequently used frequencies and modes for EA treatment are LF, intermittent or DD stimulation, although 20 Hz, 50 Hz, 80 Hz and even 125 Hz are also mentioned. The Acupad NT 10, a TENS-like device found useful in home treatment of PFP, provides an output at a fixed 22 Hz. (1)
In one interesting RCT (N = 147), a combination of continuous (CW) followed by DD stimulation gave better results than CW alone. (202) In another RCT (N = 80), intermittent stimulation gave better and more rapid results than LF CW (TDP was used in both groups). (203) This appears to be in line with standard electrotherapy practice involving interrrupted HF stimulation to patient tolerance, eliciting visible muscle contractions if possible. (149)
On the other hand, the authors of one case study suggested that for elderly or debilitated patients, weaker (HF) EA is more appropriate than strong (LF) EA. (204)
Another approach (extrapolating from MA studies) could be LF stimulation of scalp points at around 3.3 Hz. (79) Users of the Likon device were at one time taught to utilise frequencies in the 5-10 Hz range, modulated at 0.25-0.33 Hz, for PFP. (197)
Treatment frequency
One RCT comparing daily and twice-weekly EA for PFP found no significant difference in therapeutic effect when treatment was initiated within three months of onset. (205)
Other approaches
As a form of supervised self-treatment, low-intensity trophic electrical stimulation (TES) using low variable frequencies as found in normal motor unit action potentials (MUAPs) may be beneficial: 5-8 Hz, 80 [micro]s, alternating two seconds on and off, for up to eight hours daily, (44) or with submotor stimulation as described in a study by Robert Targan and colleagues. (146) A useful patient handbook on facial paralysis by one of the originators of TES is now available. (206)
In a wonderfully simple protocol by He Qinglin, suited to an unsophisticated rural practice, Dicang ST-4 and Jiache ST-6 are stimulated using from one to four ordinary 1.5 V batteries ('economic, convenient and effective'). (207) If such non-charge-balanced stimulation really has to be used (which with needles it should not), it may be helpful to position needles or electrodes so that the more distal one is negative. (1)
Staging treatment
Many authors emphasise gentle stimulation (with more superficial needling) during the acute phase, as mentioned above. During the convalescent stage, stronger EA becomes appropriate, with point-to-point needling (29) to maximise stimulation of the facial muscles themselves (rather than just the nerve fibres that feed them).
After limiting treatment to mild stimulation in the first week (acute phase), it can then be made a little stronger. This strategy is frequently found in the clinical studies database. Interestingly, the authors of one report on TEAS for various stages of PFP gradually increased both frequency and amplitude to their patients' tolerance. (173)
Bearing in mind MA studies by Yu (208) and Ni (209) on the relation between duration of needle retention and therapeutic effect, it would seem sensible to start with shorter treatments and only lengthen them after the acute (or even 'resting') phase. This approach was adopted in EA studies by Wang, (210) Liu and Li, (211) Tang and Fang, (140, 141) and Yang et al, (212) for example. Electrostimulation for long periods should be avoided in the early stages of PFP or if spasm is already present. (197, 29)
On the other hand, in keeping with traditional guidelines on acupuncture treatment, Li Zhenbo suggests that early on treatment should be given daily, or every other day, but only every few days if the condition is chronic. (19)
Discussion: some thoughts on treatment
In this article, electroacupuncture and electrotherapy are introduced, and their application in the treatment of PFP is outlined. There is a lack of good quality data on treating PFP with electrotherapy, but a surprising amount of information is available on its treatment with EA. Each can learn from the other.
What is clear from reviewing the literature is that many different approaches have been adopted. There is no one right way to treat PFP, although there do seem to be some wrong ways. The following guidelines are suggested:
* Treatment must be adapted to the three (four) stages of PFP, with only gentle stimulation applied in the acute phase and at only a few acupoints.
* In terms of needle technique, this means superficial rather than point-to-point needling.
* For EA, it means using a low frequency at a low intensity (and possibly with a relatively brief pulse duration): sensory (even submotor) level first, motor level later.
* Initially, 15-20 minutes of EA may suffice, later 20-30 minutes.
* If in doubt, use EA during the first week only at distal points, away from the face altogether.
* In general, however, the same points are used with EA as with MA, although it is helpful to select points according to their anatomical (muscle/nerve) location as well as their TCM function.
* The combination of local and distal points is likely to give better results than using just one or the other.
* Despite the frequent use of TLS for acute pain disorders, LF EA should be used initially (although not at high intensity, as in ALS), and possibly even through to stage 3 PFP (with increasing intensity).
* In general, DD is more likely to be effective than CW, but chronic (stage 4) PFP may perhaps respond to HF or intermittent stimulation.
* However, given that the one study that meets with the approval of all the electrotherapy reviewers is one on TES, it would seem sensible to adapt the parameters developed for this method for use with EA, perhaps using variable frequencies in the 5-8 Hz range or at around 10 Hz, rather than the more common 2-4 Hz. Treatment should be designed to foster local circulation and nerve healing, rather than simply provide induced exercise for paralysed muscles.
* Concomitant use of heat and other ancillary treatments may potentiate the effect of EA. Facial exercises are also very important.
* Treatment twice a week may be as effective as daily treatment when using standard EA (but not with protocols based on TES).
Note: This article is abridged due to space constraints. The full article at www.jcm.co.uk/JCM Journal/Latest Issue includes a comprehensive table of facial muscles, nerves and corresponding acupuncture points and full references.
This article on the JCM website
The References to this article can be found on the JCM website at www.jcm.co.uk/JCM Journal/Latest Issue, together with the following Tables:
Table 3. The main muscles affected by peripheral facial paralysis, their innervation and possible motor point/acupoint correspondences
Table 4. Studies on EA and related modalities for PFP
Acknowledgements
To Elsevier (Churchill Livingstone) for permission to adapt and reprint material used in my textbook on electroacupuncture.
To Diana Farragher OBE FCSP and Wendy Walker MCSP of the Lindens Clinic in Sale, Cheshire, for taking the time to read this paper and for their helpful criticism, comments and references (I have found the website www.bellspalsy.com particularly useful).

To Professor Huang Longxiang of the China Academy of Chinese Medical Sciences for his assistance with translation of electrical and other terms in some of the more recent studies used.
To Danny Maxwell for his skilful editorial help.
To Ruben de Semprun at Allerton Press for assistance with references in the International Journal of Clinical Acupuncture.
Abbreviations used
~ Approximately
ALS acupuncture-like stimulation
CT Controlled trial (non-randomised)
CW Continuous stimulation (at constant frequency)
DD Dense-disperse (alternating frequencies)
EA Electroacupuncture
EHF Extremely high frequency
EMG Electromyogram
HF High frequency
LA Laser acupuncture
LF Low frequency
MA Manual or traditional acupuncture
MUAP Motor unit action potential
N Number of patients in a study
NMES Neuromuscular electrical stimulation
PFP Peripheral facial paralysis (Bell's palsy)
pTENS probe or point TENS, using a small diameter handheld probe
RCT Randomised controlled trial
TCM Traditional Chinese medicine
TDP Te ding dian ci bo pu (type of far-infrared lamp)
TEAS Transcutaneous electrical acupoint stimulation
TES Trophic electrical stimulation
TENS Transcutaneous electrical nerve stimulation
TLS TENS-like stimulation
WM Western medicine
Terms that may be unfamiliar to some readers
Axonotmesis = Degeneration of nerve beyond the point of injury
Compound muscle action potential amplitude = A measure of electrical activity in a group of muscles
Contralateral = Pertaining to the opposite side
Cortical = Pertaining to the (cerebral) cortex
Corticobulbar = Pertaining to the cerebral cortex and brainstem
Denervation = Interruption of nerve supply to tissue (may be partial or total)
Hyperaesthesia = Increased, sometimes extreme, sensitivity to stimuli
Hyperacusis = Exceptionally acute hearing, sometimes accompanied by pain
Infranuclear = Below or peripheral to the nucleus of a neuron
Ipsilateral = Situated on the same side
Neurapraxia (neuropraxia) = Conduction block in injured nerve that recovers relatively quickly
Neuropathic pain = Pain that originates from trauma or injury to the nervous system itself
Neurotmesis = Complete severance of a nerve
Ramsay Hunt's syndrome = Facial paralysis associated with a herpetic rash in or around the ear or on the roof the mouth
Segment = Section of the spinal cord, with the skin, muscle, bone and organ regions innervated by the associated spinal nerves
Supranuclear = Above or central to the nucleus of a neuron
Supraspinal = Pertaining to the region above the spine
Synkinesis = Abnormal involuntary muscle movement accompanying voluntary movements of other muscles
Tolerance = Reduced response to treatment following prolonged or repeated us

David F Mayor is the editor of Electroacupuncture: A practical manual and resource (Elsevier/Churchill Livingstone 2007) and the online clinical studies database at www.electroacupunctureknowledge.com.
This searchable database contains more than 8,000 clinical studies on EA and associated modalities, and is available on the CD version of his electroacupuncture textbook as well as freely accessible on the website. Full details of acupoints and electrical parameters used in each study are given where possible.
A traditionally trained acupuncturist in private practice in Welwyn Garden City, David Mayor lectures on electroacupuncture at a number of acupuncture colleges in the UK. He was first exposed to electrotherapy when he contracted Bell's palsy as a teenager. An interest in electroacupuncture developed some fifteen years later, when he translated some of loan Dumitrescu's work on acupuncture from the Romanian. He is a member of the British Acupuncture Council and an honorary member of the UK Acupuncture Association of Chartered Physiotherapists (AACP).
Table 1: Some differences between MA and EA
MA EA
Needle manipulation is Stimulation is continued
brief and intermittent for the duration of treatment
Only 'low frequency' is possible No limitation to frequency of
(twirling or lifting-thrusting) stimulus (frequency-specific effects occur)
Strong manipulation risks tissue Strength of stimulation only
damage limited by patient tolerance

Table 2: Some differences between 'accupuncture-like' and 'TENS-like' stimulation
Acupuncture-like stimulation (ALS) TENS-like stimulation (TLS)
LF (high intensity) HF (low intensity)
2-4 Hz 50-200 Hz
Pulse duration of around Pulse duration of 80-100
200 [micro]sec appropriate [micro]sec optimum
May be used locally or Used locally (for instance
distally (at extrasegmental or at ipsilateral rather than
contralateral acupoints, for contralateral points)
example)
Has segmental and supraspinal Has segmental effects (large
neurophysiological effects diameter fibres inhibit pain signals in small
diameter fibres in the spine)
Releases [beta]-endorphin and Met- Releases dynorphin in the spinal
enkephalin neurotransmitters in cord (and other peptides in the
the brain brain)
Strong stimulation elicits High intensity may be
deqi-like sensation uncomfortable
LF does not produce muscle spasm HF may result in uncomfortable
at high intensity (in normal tetany (but may also be useful
muscle) for spasticity)
Intermittent pulse trains at Intermittent pulse trains at
high intensity may result in low intensity enhance comfort
uncomfortable tetany
Central effects mean analgesia has Spinal mechanism means analgesia
slow onset and lasts longer--30 has rapid onset and does not last
minutes may suffice for ongoing long--longer periods of treatment
effect (cumulative) may be necessary
No 'tolerance' develops from such Tolerance may develop from
short treatments longterm use
Tends to be used more for chronic Tends to be used more for acute
pain pain
For deep, aching, throbbing pain For superficial pain associated
with inflammation
May be helpful for neuralgia May be helpful for neuralgia and
and other neuropathic pain other neuropathic pain (local)
(contralateral or distal)
May benefit peripheral (sensory)
nerve injury
May be used in hyperaesthesia May aggravate hyperaesthesia
(especially if cutaneous)
Used for flaccid paralysis Used for spasticity
(stroke, Bell's palsy)

(Based on Mayor 2007 (1))

Bell's Palsy

Chief Complaint: Facial Paralysis

Western diagnosis: Bell's Palsy

Medical History: This 46 yr old female patient came to me with a recent case of Bell's Palsy.(2 days). Complained of chronic low back pain, headaches, and a feeling of weakness for the last 3 months. Tried to eat conscienciously but often had little/no appetite. too tired to work out because work schedule was too intense.Complained of being cold easily.

Questioning exam: Upon further questioning we discerned that she had much stress with her job. When asked if she felt that she had "support" in her life she admitted that that was precisely her personal complaint. (Low back pain can sometimes be an indication that the patient feels that he/she is unsupported).

Pulse exam: Pulse was thin, weak, particularly on the rear positions. Complexion was pale.

Tongue exam: Tongue was pale with a slight white coating.

OM Diagnosis: This facial paralysis was due to external wind invasion on a basis of kidney yang and qi deficiency.

Treatment Principle: Dispel facial wind, open Du to relieve back pain, tonify Kd yang and Qi

Point Prescription: Patient was given 2 needling sessions. Lv3,Li4 to open 4 gates and dispel facial wind. Because invasion was still active no local points were given in the face. Patient was then given Si3 and Ub 62 to open Du, dispel back pain. With St 36 to tonify Qi and far infrared at mingmen Du4 to tonify Kd yang. Ear seeds applied before the patient left at: uriculotempo nervous point, nervous system subcortex, Shenmen, and occiput.

Lifestyle prescription: We discussed taking yoga classes to ease stress and relieve lower back pain and tonify internal strength. Discussed diet and supplements.

Results: Patient called the next day exstatic. Facial paralysis almost completely alleviated, patient had first good night's rest in months. No back pain. Coming back in 2 days for local facial points.

Occipital neuralgia

Chief Complaint: Shooting pains in (L) occipital and parietal regions of the head, radiates to top of the head.

Western diagnosis: Occipital neuralgia

Medical History: 73 yr old status post surgery for throat cancer. Developed tingling and pressure sensation in occipital region which developed into severe shooting pains over a period of about 8 months. Shooting pains are rated at 9/10 level and occur 3-4 times/day. Patient has had 7 nerve blocks and surgery none of which helped to reduce symptoms.

PMH: Throat cancer 1997 treated with chemo therapy and radiation for 13 weeks. Developed inability to swallow due to scarring from radiation which required placement of gastric tube for feeding. Surgery to reduce scarring in the throat was unsuccessful.

Other surgeries: Hysterectomy, Hypertension

Meds: Neurontin, Darvocet, prilosec, Tylenol ES, Paxil, Catapress patch

Family history: Father died of cancer. Patient does not exercise and has liquid diet for tube feeding.

Questioning exam: Appetite: Poor Complains of frequent bloating.

Thirst: Always thirsty with dry mouth and throat. Sips water but is not allowed to drink thin liquids.

Energy level: Poor. Worn out from the pain.

Sleep: Takes sleeping pills, otherwise wakes constantly with pain

Eyes: frequent tearing

Always feels cold, palms of hands are red and feel hot at times.

Sweat: no

Urination: Frequent

BM: usually daily, tendency towards loose bowels.

Chest: Cough with dry yellow phlegm.

Dry skin, Bruise easily

Mental / emotional: worries a lot + easily angered or irritated

Pulse exam: Pulse: Thready, Slow
Very tender on palpation along spleen, liver, and gallbladder meridians.
Reduced range of motion in cervical spine with severe scarring in (L)occipital and parietal region. Very tight upper traps and SCM muscle.

Tongue exam: Tongue: Red, yin deficiency cracks, ulceration and dark red areas in the center and on the sides.

OM Diagnosis: Liver yang rising with underlying yin deficiency. Qi / blood stagnation in GB / UB channels.

The tongue, pulse, and symptoms such as; thirst, dry throat, shooting pain in UB/GB area radiating to vertex, teary eyes, irritability, HTN, all point towards yin deficiency with yang rising. The tingling sensation and shooting / stabbing pains point towards qi and blood stagnation.

Treatment Principle: Move qi and blood in the channels. Subdue liver yang.

Point Prescription: (L) HT4, 7, GB41

® KD3, SP6
This treatment initially gave great relief with less frequent attacks + reduced pain intensity. Patient was able to reduce pain medication. However when patient got angry or went through periods of stress the pain would come back. I tried some electrical stimulation and needled ashi points in the scalp which gave further relief.

Patient claimed 70% relief of symptoms.

Herbal Formula: Herbal Formula:
Bai shao 9
ge gen 9
yan hu suo 6
qiang huo 6
wei ling xian 6
tian ma 9
gou teng 9
long dan cao 6
mai men dong 9
shi hu 9
huang lian 6
wu zhu yu 2
hai piao xiao 9
mu li 9
chen pi6
fu ling 9
bai zhu 9
gan cao 6
After about one month of just acupuncture I added the above herbal formula to open the channels, subdue LV yang, and assist the digestive system.
The herbal formula did not give much relief and in the end we just continued with acupuncture treatments.

Lifestyle prescription: Tuina: Passive stretches neck / shoulder muscles. Loosen up scar tissue in occipital region. Traction. Taught patient to use acupressure points to control symptoms if experiencing a flare- up.

Results: Patients quality of life had much improved but she continued to have little flare-ups here and there at which time she would come back for more therapy. About 5 months after the initial start of treatment the patient had an MRI which showed a popcorn like bony tumor at the base of her skull partly in the UB channel distribution.

I started adding UB60 to her acupuncture prescription which made a big difference and she was able to go without treatment for about 5 months.

Synopsis: Recently the patient had some other medical problems after which the head pains started flaring up again.
I now use intradermals at UB60 and occasionally GB41 both on the left side. Whenever the patient has an episode she presses those points and her pain subsides within 1-2 minutes. Once every few weeks the patient comes back for an acupuncture treatment and this way she has been able to sustain a good treatment effect.
I believe the reason why this patient was unable to make full recovery is because of the tumor that is still there pressing on the occipital nerve.

Iridology: the windows to the body, mind, and soul

By: Smolnik, Jane

Nature has provided us with an invaluable insight into the vital status of the health of any individual through the sciences of Iridology and Sclerology. Analyzing the eyes enables us to ascertain a person's genetic predisposition to health and disease, their general constitution, the state of each individual organ, levels of toxic accumulations, as well as organ and gland influence on other bodily systems. Personality tendencies, thought and emotional patterns, and deeper soul-level issues can also be recognized, making the eyes truly the windows to not only the body, but the mind, and soul as well.

Iridology is the science and practice of analyzing the iris, the most complex external structure of the human anatomy. The practice of Iridology is expanding rapidly as it is becoming known as a valuable tool for preventive healthcare. The iris is connected to every organ and tissue of the body by way of the brain and nervous system. It is in direct contact with the bio-energetic, biochemical, structural, hormonal, and metabolic processes of the body via the nerves, blood vessels, muscle fibers, and lymph. Holistically, it can be used to accurately assess the physical, mental, emotional, and spiritual patterns and weaknesses for a complete health analysis. It is completely painless, non-invasive, and economic while providing valuable information for restorative and preventive health care.

Sclerology is the study of the whites of the eyes, or sclera, interpreting the red lines, colorations, and markings in the sclera as they relate to a person's health. This science is not new, but several thousand years old. The Chinese view of the sclera was based on the twelve meridians and the yin and yang aspect of each meridian. The Chinese saw the lines in the sclera as a reflection of the lymphatic fluid, which bathes every cell. Imbalances in the meridian energy register in the sclera. Traditionally, some Native American Indians also analyzed the eyes to get a better understanding of the stresses affecting a person's health. Iridology has progressed tremendously since the mid 1800s. Numerous doctors and scientists have researched iridology on humans over the past 125 years, and it has become a respected practice, used by many medical doctors and naturopaths worldwide. (1) Dr. Bernard Jensen, renowned Iridologist and Nutritionist, pioneered the science of Iridology here in the U.S. Dr. David J. Pesek has continued and expanded upon his work developing one of the most comprehensive iris charts used today, integrating the thought and emotional patterns with the physical health and improving the understanding of the 'brain flare' areas.

With today's technology and the use of microscopes and fine digital imaging, many medical doctors, naturopaths, and psychologists from England, Germany, Italy, France, United States, Australia, Canada, and Russia have been advancing the field of iris analysis over the past twenty years and have documented seemingly unlimited potential. The brain areas have been defined further and emotional and spiritual health have been incorporated more into the work. Research projects being done by the American College of Iridology, to be completed later this year, will help iridology to become an integral part of the preventive health care system. More practitioners and patients will appreciate its help in increasing understanding of genetic influences and instructing how to properly care for the body to avoid approaching diseases.

John Andrews, a top Iridologist and researcher from the United Kingdom publishes the Advanced Iridology Research Journal quarterly, including many works from Dr. Danielle LoRito, MD from Italy, Dr. Mikhail Dailakis, MD from Greece, Dr. Vincent Di Spazio from Italy, Dr. David Borow, an oncologist and medical Iridologist from Austria, Prof. Javier Griso Salome from Spain, Prof. Serge Jurasunas from Portugal, anti many others. These include topics such as profiling aging through iridology, multiple sclerosis and iridology, hypoglycemia, dysbiosis /intestinal immunology, biophysics and quantitative and qualitative biochemistry, and iridology's potential in medicine.

The iris can alert us to the early signs of approaching "disease." As the evaluations are made and the stress conditions understood, proper corrective measures can be applied. The body can then more easily adjust and alleviate the abnormal stress, resulting in a greater degree of health and enabling a person to prevent potential health problems.

Each eye gives us different information. The left eye correlates with the left side of the body and the right side of the brain, which is the feminine, creative, conceptual, intuitive side, relating to our emotional selves. The right eye correlates to the right side of the body and the left side of the brain, which is the analytical, practical, linear, masculine side, and relates to our work and logical self.

Thus the eye is the very aware "informant" about the cause of body stresses. People trained in interpreting the indications portrayed in the eye have the advantage of occupying "command central" rather than a peripheral monitor such as blood, hair, tongue, or urine analysis.

Although these diagnostic systems provide specific valuable information, they do not have full access to all the body's information. Practically speaking, the right hand may not know what the left hand is doing, but the brain centers know what both hands are doing simultaneously and the eye is privy to that information.

Knowing the various stressors on the body can be essential in preventive health care. These stressors may be simple, moderate, or severe and can represent conditions such as nutritional deficiencies, poor circulation, congestion, fatigue, pH imbalance, infections (bacterial, viral, parasitic), nerve stress, toxic accumulations, and abnormal cellular activity. Patterns may register an abnormal stress development long before any serious effects are experienced. With the stress conditions understood, proper corrective measures can be applied by addressing the causes with natural therapies (nutrition, herbology, enzyme therapy, homeopathy, acupuncture, chiropractic, massage
, counseling, etc.), leading to a greater degree of health.

Iridology and Sclerology, combined with sound nutritional and naturopathic knowledge and wise application, provides people with the ability to consciously support their health and longevity, overcome and alleviate stress, and live a more healthful life. Some doctors understand the value in such an iridology analysis and will-refer clients for an Iridology Report so they may proceed with proper care or order the correct tests, often reducing the discomfort, costs, and time involved for the patient.

As healing progresses, iridology can also show us the cleansing and healing signs as the body adjusts to a more optimum state of health. All we need are the keys to understanding the symbols. We have the information to help in disease prevention and healing, by looking right into our eyes!

(1) Holistic Iridology, by Dr. David J. Pesek, The International Institute of Iridology, and Insights in the Eyes, An Introduction to Sclerology, by Dr. Jack Tipps, ND., PhD., The International Sclerology Institute.

Dr. Jane Smolnik is a Naturopathic Doctor, board certified in Holistic Iridology, the vice president of the American College of Iridology, and is a graduate and associate teacher at The International Institute of Iridology with Dr. David Pesek. Also a graduate of the Stillpoint Institute of Advanced Energy Healing and a certified Intuitive Healer, Jane has a private practice in Asheville, NC and can be reached at 828-645-9593 or www.ultimatehealing.com.

Right shoulder pain

Chief Complaint: Right shoulder pain

Medical History: Patient is a 54 year old female massage therapist seeing 10-15 people per week. She has been seeking help for this problem for the past 2 years with the results being that it takes the pain away yet it always returns. Her outlook is positive and she has healthy diet and exercise habits.

Questioning exam: The pain is worse stress and on palpations her whole right side is tender along that gallbladder channel. Patient has bouts of insomnia which have no particular cycle.

Pulse exam: Pulse in generally thin and weak, especially in SP and Ki Yin positions.

Tongue exam: Tongue is pale with a red tip.

OM Diagnosis: Ki Yin is weak since patient is post menopausal. The weakness of the spleen is not nourishing the muscles causing the inherent weakness.

Treatment Principle: Nourish SP Qi and Ki Yin

Point Prescription: Front tx: Ki 3, SP6, ST36, Ren4, GB 34, LI15, SI6
Back: LI16, SI13, Ashi, GB30, GB34, UB20, UB21, UB23

Strong stimulation til spasm to release muscle tension. Massage was incorporated after needles were removed to stretch the muscle. After 6 treatments, massage was added during needling to stretch the muscle as the spasm was being released.

Herbal Formula: Essential oils of Lavender and Clary Sage.

Results: On the 12th treatment, the shoulder girdle moved with an audible pop back into place. The next visit, patient was ready to deal with other issues.

Synopsis: Chronic long term pain has responded well to the combination of acupuncture, massage with theraputic-grade essential oils.

Diabetes Mellitus, Hypertension, Shoulder pain

Chief Complaint: Shoulder pain and reduced ROM

Western diagnosis: Diabetes Mellitus, Hypertension, Shoulder pain

Medical History: 69 yr old lady, sedentary, average american diet, slightly obese, mentally and socially well adapted. On Beta blocker, lasix, glucophage, and human insulin.

Questioning exam: Patient reported that she'd like to be off all her meds and would like to be able to used her shoulders which had gradually deteriorated over a period of 1 year.

Pulse exam: Crepitis in shoulders with very restricted active ROM, and pain elicited on passive ROM study. Pulse Wide, slippery, firm and forceful.

Tongue exam: Swollen, especilly perimeter.

OM Diagnosis: Bi syndrome(fixed), with overall excess condition. Damp. According to classical diagnosis through Color, Sound Odor and Emotion, Spleen is indicated.

Treatment Principle: To move qi, to move spleen qi and clear damp.

Point Prescription: All the following points were used, not all at the same treatment
LI 15 Disperse
SJ 14 Disperse
St 14 Disperse
St 38 Disperse
St 41 Disperse
Sp 3 Disperse
Sp 8 Disperse
Sp 9 Disperse

Treatment began twice weekly for about 2 months, followed by once a week for 2 months. She currently has treatment every 3 weeks.

Herbal Formula: None given

Lifestyle prescription: Walking around the block, especially when blood sugar is high. Swimming. Eat a diet guided by the glycemic index.

Results: After 6 weeks of treatment this patient had no pain in shoulders with full range of motion. After 8 weeks she had no need of the glucophage, insulin and lasix. She has stable blood sugar levels 80-110. She has much more energy, a much greater sense of well being. She no longer is edemic. She has lost 20 lbs. These improvements persist after 35 treatments in eight months. Her blood pressure is still elevated whenever she reduces her beta blocker.

Synopsis: Not only did this patient respond very well to acupuncture, she has been an ideal patient in following our recommendations to the letter. In her case an in many, not only did the main complaint resolve, her general health is much improved, with some progress still to be made, but her well being and mental alertness has been susbstantially benefitted by the combination of treatment and changes she has made in her lifestyle.

S/P stroke (Left cerebral)

Chief Complaint: Stroke

Western diagnosis: S/P stroke (Left cerebral)

Medical History: 51 year old female, CVA 9/99 due to hypertensive bleeding. Sustained right sided paralysis (about 90%), with cognitive difficulties. Underwent extensive rehab. Is currentloy on proper diet and medications.

Questioning exam: She cannot exercise, walked with a cane, favors right side. Could not use hand to grip (claw hand). Had almost total disuse of right arm and leg. Foot turned inward. She could not extend her fingers.

Pulse exam: Weak, sinking Chi Xe pulse, wiry

Tongue exam: Pale, petechiae at tip, thin white coat, scalloped

OM Diagnosis: Channel and network wind stroke, wind-phlegm static blood, impeded/obstructed vessels and networks

Treatment Principle: Transform phlegm and extinguish wind, quicken the blood and free the network vessels

Point Prescription: SI3 with Bl62: opening point of DuMai with coupled point on Yang Heel Vessel. LI16, LI15,LI11,LI4: Drain yang-ming energy level without detriment to source Qi, etc. GB34: gathering point for sinews and invigorates Qi, blood.GB39: gathering point for marrow and, nourishes marrow, and eliminates wind, epecially chronic interior wind. GB38: indirectly eliminates wind by subduing liver-yang. Scalp UE & LE motor areas. Applied 1000 Hz TO LI16-LI11;LI4-LI14,GB34-GB39 to expel wind.

Herbal Formula: da Huo Luo Dan initially

Lifestyle prescription: Blood pressure medications.

Results: After 3 sessions, congnitive abilities (short term memory, concentration)returned. After 12 sessions, strength and voluntary movements improved significantly. Can move her foot and walks better, without a cane. Can extend fingers better and hold things in right hand, although not for long.Acupuncture continuing.

Synopsis: 51 year old with stroke and significant disability, told by conventiopnal doctors that she would not improve. Has made remarkable progress despite date of stroke. Continues to make progress with additional treatment once a week.

Forty cases of insomnia treated by multi-output electric pulsation and auricular plaster therapy

By: Weizhe, Liu

The author reports on the effectiveness of ear acupuncture in the treatment of 40 cases of insomnia. The age range was 18-51 years and the duration of disease was from 2 weeks--30 years. Those with organic brain disease or mental illness were excluded from the study. The main points used were Ear Shenmen, Heart, Mouth (experience point to promote sleep), Occiput, Anterior Lobe (Neurasthenia) and Subcortex. Additional points were given according to the differential diagnosis as follows: for deficiency of the Heart and Spleen, Ear Spleen; for disharmony between the Heart and Kidney, Ear Kidney; for Liver fire, Ear Liver; for deficiency of the Heart and Gallbladder, Ear Gallbladder; and for dysfunction of the Stomach, Ear Stomach. Electrodes from a self-made multi-electrode device were placed on the points and stimulated with a continuous wave to the patient's maximum tolerance for 20 minutes. Ear seeds were then applied on both ears and patients asked to press on alternate ears for 20 seconds 3x daily. Ten treatments constituted one course. Cure was defined as sleeping for more than six hours, remarkable effectiveness as more than four hours and effectiveness as intermittent sleep with a slight alleviation of symptoms (undefined). The cure rate was 50%, remarkable effectiveness was 27.5%, effectiveness was 12.5% and 10% had no result. A typical case history was given in which the patient required two courses of treatment (60 days) to be able to sleep 6-8 hours a night without medication. On follow-up a year later she was still sleeping well.

Tinnitus

Chief Complaint: Tinnitus

Western diagnosis: Tinnitus

Medical History: 43year old caucasian male patient had an oral surgery on his left side of his jaw 5 weeks ago. Since then he was hearing high pitch ringging sound in his left ear. Patient was healthy until this condition. He also complains of tenderness around the surgical area, and also suffers from insomia and depression since. Healthy diet and exercises regularly.

Questioning exam: Do you have insomnia because of pain or sounds? Sounds(tinnitus)
Any medications? Taking anti-anxiety medication and took antibiotics for 2weeks after the surgery.

Pulse exam: Left Heart (full, rapid)
Liver (Full,wiry)
kidney (deep,weak)

Tongue exam: purple body,red tip,scanty coating, swollen

OM Diagnosis: Heart fire, liver yang rising, kidney yin deficiency.

Treatment Principle: Tonify kidney yin to harmonize the Heart
Soothe liver yang.

Point Prescription: tonify Lu8, Liv4, Liv3, Sp3, St36
sedate H8, Liv2, GB2, 3, SJ17

Herbal Formula: none

Lifestyle prescription: suggested yoga to relax himself

Results: Sound has diminished with two consecutive days of TX.
With 7 more TXs. every other day, the ringging was completely gone.
Sleeps normally, pain on face is gone.

Treating different diseases with the point Ear Apex

By: Wang, Xiaoyan

Abstract

The function of the auricular point Ear Apex (Erjian M-HN-10) is discussed in this paper and case histories showing the effective treatment of herpes zoster, acute conjunctivitis, high fever, pharyngitis and aphonia by bleeding Ear Apex with a three-edged needle are discussed.

In each case the patients' suffering was alleviated within a few minutes.

Keywords: Ear apex, bloodletting, bleeding, herpes zoster, acute conjunctivitis, high fever, pharyngitis, aphonia, acupuncture

Introduction

The auricle is a microcosm of the human body and the area of confluence of the twelve primary channels. The point Ear Apex is located at the tip of the helix. With the posterior half of the ear folded forward, the point is located at the highest point of the superior crease. Its action is to promote qi and blood circulation, clear damp-heat and toxic pathogens, remove stagnant qi and blood, resolve swelling and alleviate pain. It is very effective for diseases of head and neck, especially those characterised by excess of yang, heat and pain.

In this article we recount a number of case histories of patients whose disorders were treated by bleeding the point Ear Apex with a traditional three-edged needle using the "pinching method". With this technique, the point to be treated is pinched between the thumb and index finger. This action isolates the points and promotes venous pooling, which facilitates bleeding. The point to be bled is swabbed with 70% isopropyl alcohol and allowed to dry naturally. The discomfort of bleeding can virtually be eliminated via a rapid insertion to the desired shallow depth of about 0.05-0.1 cun.

Case History 1: Herpes zoster

A 60-year-old male complained of a severe burning pain with red rashes on his neck and behind his right ear for the past five days. He had hypersensitivity to touch, anorexia and restlessness. Associated symptoms included a bitter taste in the mouth, a poor appetite, dry throat, constipation and scanty deep-coloured urine. His greatest concern was that he had hardly slept for five days and nights. His condition showed no improvement after taking medication and his friend recommended him to me. On examination, he had small clusters of blisters filled with clear liquid, redness of the tongue tip and sides with a thin yellowish coating, and a wiry and rapid pulse. The diagnosis was herpes zoster and the differentiation was damp-heat and toxic pathogens affecting the Liver and Gall Bladder channels. After strictly sterilising the point Ear Apex with Betadyne and alcohol, I pricked the points bilaterally to let out seven or eight drops of blood. He immediately reported that most of the pain had been relieved and that he felt a relaxing sensation in his head and neck. Then auricular taping of Wang Bu Liu Xing (Vaccaraie Semen) was applied on his left ear at points Liver, Gallbladder, Neck, Heart and Ear Shenmen, to be retained for seven days. When he visited the next day, he reported that he felt much better and had had five-hours of deep sleep the previous night. After one more treatment, his disease was cured.

Case History 2: Acute conjunctivitis

A 35-year-old male had been suffering from painful and itching eyes for two days. He had headache, photophobia, red-looking eyes with copious sticky yellow-discharge, stabbing pain, lacrimation and the sensation of a foreign body in the eyes, but his vision was normal. The tip of the tongue was red and his pulse was slightly wiry. The diagnosis was acute conjunctivitis and the differentiation was wind-heat affecting the Liver channel. Point Ear Apex was bled as above. During the treatment, he reported that his eyes were comfortable and cool. Following one more treatment the next day, he was cured.

Case History 3: High vever

A 22-year-old male had suffered fever for one day. He had mild chills, pain over the whole body, weakness, sore throat and a poor appetite. The temperature was 40[degrees]C. The white blood cell count was 10,300. His tongue was red with a thin yellow coating and his pulse was rapid and floating. The diagnosis was high fever and the differentiation was hyperactivity of heat-evil at the Qi level. After pricking the point Ear Apex to let out about seven or eight drops of blood, he instantly felt more comfortable and his sore throat had almost gone. His temperature dropped to 39.5[degrees]C and one hour later reduced to 38[degrees]C. He was given Ban Lan Gen (Radix Isatidis seu Baphicacanthi) to take away with him. Two days later, his fever had completely gone.

Case History 4: Pharyngitis

A 40-year-old male had caught a cold and subsequently suffered from a sore and itching throat for two weeks, accompanied by a dry mouth and a dry cough without phlegm. His throat was red and his tonsils were swollen. The tip and sides of the tongue were red and his pulse was floating and a little rapid. The diagnosis was pharyngitis and the differentiation was wind-heat evil in the upper jiao. After bloodletting at Ear Apex, I punctured a red spot near Feishu BL-13 and let out 3-4 drops of blood. Following the treatment, he said that his sore throat had almost gone. Next day his dry mouth had resolved, he only occasionally had dry cough, his pharynx was slightly red and the swelling in his tonsils had reduced. I pricked and bled Ear Apex again and he totally recovered.

Case History 5: Aphonia

A 26-year-old female had had a cold for five days and had been unable to speak for two days, with a painful throat and a dry mouth. Her throat was red with no swelling of the tonsils. The tip and sides of her tongue were red, and her pulse was floating. The diagnosis was aphonia and the differentiation was impairment of the Lung by attack of wind-heat evil. After pricking and bleeding of Ear Apex, she felt cool and comfortable in her throat and could speak in a low voice. After one more treatment the next day, she was totally cured.

Discussion

Auricular therapy has several advantages over body acupuncture, for example simplicity, practicality and easy acceptance by patients. Pricking and bleeding Ear Apex is an ideal method for treating any diseases of the head and neck caused by invasion of the body by damp-heat, wind-heat and toxic pathogens.

During the treatment, attention should be paid to the following points.

1. Do not treat patients who are weak, fasting, or in a nervous state.

2. Do not use this kind of treatment for patients who suffer from anaemia, hypotension, any hemorrhagic diseases etc.

3. During the treatment, sureness, accuracy and speed are the key to a good technique.

4. If a distinct capillary near Ear Apex is observed, bleeding it instead of the more conventional location may produce dramatic results.

Bibliography

Bai, Xinghua, (1994). Chinese Auricular Therapy. Beijing: Scientific and Technical Documents Publishing House.

Sun, Guojie, et al., (1998): Acupuncture and Moxibustion. Shanghai: Shanghai Scientific and Technical Publishing House.

Brazil, J., et al., (1997): Clean Needle Technique Manual for Acupuncturists. Washington, D. C.: National Acupuncture Foundation.

Xiaoyan Wang has been a licensed acupuncturist in Richmond, Virginia, USA and has published about 20 peer-reviewed papers. She was a Traditional Chinese Medicine (TCM) Doctor in charge in the TCM Hospital of Qinghai Province and Hospital of Southeast University, China for 11 years.

Clinical study on therapeutic effect of acupuncture on Behcet's disease

By: Peng, Yu

Behcet's disease, a severe type of recurrent aphthous ulcers, is treated with the administration of corticosteroids and immunosuppressives in Western medicine, but there is a very high recurrence rate. This study looked at the comparative effects of acupuncture treatment in 26 cases and Western drugs in 20 cases treated with this condition. Among the 26 cases in the treatment group, 12 were male and 14 female, ranging in age from 30 to 46 years. The shortest duration of disease was 5 years, and the longest, 28 years. Of the 20 cases in the control group, 9 were male and 11 female, ranging in age from 30 to 45 years. The shortest duration of disease was 5 years, and the longest, 27 years. The location and size of the ulcers were similar in patients of the two groups. The differences in the levels of IgA, IgM, IgE, IgG, C3 and [C.sub.4], and microelements such as Cu, Zn, Fe, and Mg were not statistically significant between the patients of the two groups (P>0.05). In the treatment group, auricular points unilateral Kou (mouth), Gan (Liver), and Shen (Kidney) were pricked with a three-edged needle to let out 1-2 drops of blood. The treatment was given once every two days, with points on the right and left ear used alternately. 3 sessions constituted one therapeutic course. Patients were usually given two courses of treatment. For body acupuncture, No. 28 needles of 2-cun in length were inserted into Taixi KID-3, Ganshu BL-18 and Shenshu BL-23, and then the handles of the needles were connected to a G6805 electroacupuncture stimulator for 30 minutes at 3v output voltage and 80 Hz frequency. The treatment was given once daily, with 10 sessions constituting one therapeutic course. Most patients were given two courses of treatment with an interval of two days between courses. In the control group, transfer factor (2ml) was subcutaneously injected once every week, with 5 sessions (35 days) constituting a course of treatment. In addition, dexamethasone tablet was orally administered in a dose of 0.75 mg t.i.d, with chlorotetracycline ointment applied topically. Results of the treatment were classified as follows. Cured: Disappearance of the triad of uveitis, oral ulcers, genital ulcers and other symptoms after two courses of treatment, with no recurrence in a 12-month follow-up period. Effective: Disappearance of the same symptoms, but with a recurrence at a longer interval, that is, within one year. Ineffective: No improvement noticed in the duration of onset and the interval of the recurrence after spontaneous extinction of the ulcers. Results: Of 26 cases treated by acupuncture, 19 were cured, 5 effective, and 2 ineffective, compared with 2, 16 and 2 respectively of the 20 control group cases. The total effective rate in the treatment group was 92.3% and that in the control group, 90.0%, with no difference in total effective rate between the two groups (P>0.05). However, the cure rate of 73.1% in the treatment group was significantly higher than the cure rate of 10.0% in the control group (P<0.01). The electroacupuncture also appeared to have a role in enhancing the absorption and reducing the excretion of plasma Zn as higher levels of zinc were found in the patients with the best remission of symptoms.

Sports sprain

Chief Complaint: big toe hurts, neck pain

Western diagnosis: sports sprain

Medical History: a football athlete from Steelers, his left big toe hit the ground straight when playing football. No pain killers. Regular diet, no regular rest, a lot of competition

Questioning exam: Q: How long did you hurt your big toe?
A: About a month ago.
Q: What is the pain level and how often?
A: About 7-8, hurts all the time
Q: Does the ice or heat make a difference?
A: I'll say ice makes it feel better.
Q: How is sleeping and digestion?
A: Fine.
Q: Lots of stress?
A: Not really.

Pulse exam: (left)heart slow and strong,the other two are normal (right)normal, typical athlete pulse

Tongue exam: red tip(in summer), pink tongue with slight white coating

OM Diagnosis: Local Qi and Blood stagnation(big toe area and related liver-spleen meridian),based on injury history and no internal organ imbalance pattern

Treatment Principle: improve circulation in related area and meridian, support energy flow in the toe and neck

Point Prescription: neck: only TuiNa with rolling and one-Finger technique
Toe: Liv3(L), sp1(L),Sp2(L),Ashi points.Combined with moxa everyday and TuiNa

Herbal Formula: TNJ for energy

Lifestyle prescription: Eat balanced diet, reduce or stop coffee, not a lot alcohol. Stop ice, more heat to the affected area. TNJ to affected area if needed.Avoid position to touch it incorrectly and wear comfortable shoe

Results: after 1st acupuncture treatment and TuiNa, neck pain is gone. Toe is better, still hurts. I asked him to use moxa everyday, each time 10 mins at least; after a week, his toe much better. He is now in competiton again.

Synopsis: note: moxa is the best solution for soft tissue injury

Yeast infection/candida

Chief Complaint: yeast infections

Western diagnosis: yeast infection/candida

Medical History: Patient complains of consistent vaginal yeast infections. She excercises regularly, eats a lot of sugar in her diet and is on the birth control pill. She is a first year lawyer and is under a great deal of pressure.

Questioning exam: Q:Are you on the birth control pill?
A: yes, for 5 years
Q: Do you have any digestive problems?
A: fullness in stomach, bloating
Q: How is your energy:
A: low, feel sluggish
Q: How often are you getting yeast infections?
A: once a month
Q: have you seen your dr. about this matter? have you had a recent hiv test?
A: yes and yes...I am healthy and negative for HIV
Q: do you have vaginal discharge? what color?
A: yes, white
Q: How is your appetite?
A: low
Q: How much water do you drink?
A: not much...drinks a lot of soda

Pulse exam: Pulse: right side: slippery, weak. left side: slightly bowstring

Tongue exam: pale color and greasy, white coating. Patient is slightly overweight. pale face

OM Diagnosis: Spleen qi deficiency with dampness

patient is suffering from a spleen qi deficiency which is leading to a decrease in the amount of transformation/transportation of fluids in the body. This is causing a dampness to occur. This dampness is affecting the middle and lower body giving her abdominal fullness, lack of appetite and yeast infections (with white vaginal discharge)

Treatment Principle: Expel dampness, tonify spleen qi

Point Prescription: ST 40, ST 36, Sp 6, PC 6
moxa on Kid 7 (great for yeast infections!)

Herbal Formula: Er Chen Tang (pill form): 8 pills 3 X day. For one month then, si jun zi tang pills 8 3X day for one month

Lifestyle prescription: I gave her the following information: Controlling Yeast Infections with Diet

In Chinese medicine we say the Spleen is in charge of digestion & transforming/transporting fluids throughout the body. If the spleen becomes deficient (common when the body is under stress), fluids are not transported and dampness in the body occurs. Symptoms of dampness include a general feeling of heaviness in the body, fatigue, phlegm, nasal congestion, yeast infections and even weight gain. There are many foods that make it hard for the spleen to function properly (especially when your body is prone to dampness). The following are some basic foods to avoid/add to your diet:

Decrease consumption of cold beverages/raw food:

The yeast and "dampness" creating foods are those which are cold in temperature, too sweet or salty, mucus-producing, and stale/rancid. Too much raw food can also affect your digestion leading to dampness.

Decrease consumption of carbohydrates:

Foods rich in carbohydrates must be used moderately since they are usually somewhat mucus- and acid-forming, and therefore any small excess can contribute to yeast conditions.

Decrease consumption of sweeteners/fruits:

All refined and concentrated sweeteners (e.g., sugar molasses) and fruits help propagate yeast in the body and should be avoided.

Avoid milk/dairy products:

Most milk products, eggs and red meats can also promote yeast and are not recommended. (fish and chicken are okay)

Increase intake of Garlic:

Garlic has exceptional anti-viral/fungal properties and does not damage the healthful intestinal flora. (you can eat �? clove of garlic twice a day before meals or get garlic pills at the health food store)

Increase amounts of cooked/warm foods:

I highly recommend you eat mostly cooked foods. Lots of soups that are warm and even a cup of hot water (with or without tea) before bed at night to help your digestion (spleen/stomach).

Increase amounts of chlorophyll:

Chlorophyll promotes the growth of beneficial intestinal flora. Parsley, kale, collard, watercress, romaine lettuce, cabbage and micro-algae, wheat grass all contain significant amounts of chlorophyll. (Go to the juice bar and get lots of fresh wheat grass!)

These are simple things to take into account with your diet to avoid and decrease the amount of yeast infections in your body. In Chinese Medicine, we believe that everything should be done in moderation, so don秒t feel that you have to eliminate any foods all together. You should just watch the amount of damp-causing agents that you take into your body AND increase the amount of Spleen-aiding agents.

Results: Results were great! Her yeast infections stopped once on the er chen tang. And her stomach discomforts are relieved and appetite is back! Sometimes when she feels she is getting another yeast infection, she comes in for a preventative acupuncture treatment.

Synopsis: Since her yeast infection consisted of white discharge, I didn't have to clear any heat in her system. However, this is an important fact to consider. Cleansing her dampness with acupuncture and herbs AND making some very important dietary changes can make a huge difference in this scenario.