Wen Mu-sheng (溫木生)

Chinese Medicine Hospital of Ba’nan District, Chongqing City, Chongqing 401320, China

Therapeutic observation of superficial needling for hemifacial spasm

Wen Mu-sheng (溫木生)

Chinese Medicine Hospital of Ba’nan District, Chongqing City, Chongqing 401320, China

Objective:To observe the therapeutic efficacy of superficial needling in treating hemifacial spasm.

Acupuncture Therapy; Wrist-ankle Acupuncture; Superficial Needling; Point, Ashi; Facial Spasm

Hemifacial spasm is a common indication of acupuncture-moxibustion therapy and usually seen as a primary disease. It can be caused by attack of wind pathogen, qi-blood deficiency, and internal stir of liver wind. In acupuncture treatment, body points[1]and local points are usually selected to treat hemifacial spasm, but the treatment result is not so satisfactory and aggravation may occur in severe cases because the selected points are not enough for sedation[2]. However, superficial needling has been found effective for this condition[3]. Since 2010, we adopted superficial needling in treating hemifacial spasm, and the report is given as follows.

1 Clinical Materials

1.1 Diagnostic criteria

According to Western medicine, the diagnostic criteria of hemifacial spasm were based on theNeurology[4]: onset in middle age, more common in women; the contraction usually begins from orbicularis oculi, then affects cheek, orbicularis oris, and even platysma; aggravated under tension or fatigue, ceased during sleep, and unable to control; without positive physical signs according to neurological examination, and secondary hemifacial spasm caused by peripheral facial paralysis, trigeminal neuralgia, Meige syndrome, epilepsia, neurosis and other intracranial lesions should be excluded; space-occupying lesions excluded by head CT scan or MRI examination.

1.2 Inclusion criteria

Conforming to the above diagnostic criteria; cooperative during the whole treatment with complete data; signed the informed consent form.

1.3 Exclusion criteria

Complicated with severe primary diseases involving cardio-cerebral vessels and hemotopoietic system, etc.; mental disorders; against the inclusion criteria, or failed to follow the study rules, or incomplete medical data; those who adopted other uninvolved treatments during the study.

1.4 Statistical method

Statistical software SPSS 13.0 was adopted for data analyses. Measurement data were expressed asand inter-group comparison was performed byt-test; enumeration data were expressed as percentages, and inter-group comparison was conducted by Chi-square test.P＜0.05 indicated a statistical significance.

1.5 General data

The 80 subjects were all from the Inpatient Department of our hospital, and were randomized into two groups, 40 in each group. In the observation group, the age ranged from 20 to 68 years; disease duration was from 20 d to 3 years. In the control group, the age ranged from 25 to 62 years; disease duration was from 32 d to 4 years. There were no significant differences in comparing the general data (P＞0.05), indicating the comparability (Table 1).

Table 1. Comparison of general data (case)

2 Treatment Methods

2.1 Observation group

Acupoints: Ashi points, wrist-ankle points Upper 1, Upper 2, Upper 3.

Method: The Ashi points were located at the spastic area. Filiform needles of 0.3 mm in diameter and 15 mm in length were swiftly inserted beneath the skin, with the needle handle naturally dropped and needle tip poked up the skin. Totally 4-7 needles were punctured into the spastic area, 1 cm between two needles (Figure 1). When Ashi points were punctured, the wrist-ankle points were punctured by needles of 0.3 mm in diameter and 40 mm in length after standard sterilization, with the thumb and index finger fixing the needle, 15° between the needle and skin and needle tip towards proximal part by depth of 37 mm. The needles were retained for 30 min (Figure 2). The two hands were treated alternately.

2.2 Control group

Acupoints: Ashi points, Cuanzhu (BL 2), Yangbai (GB 14), Sizhukong (TE 23), Yingxiang (LI 20), Sibai (ST 2), Juliao (ST 3), Quanliao (SI 18), Xiaguan (ST 7), Dicang (ST 4), and Jiache (ST 6).

Method: Filiform needles of 0.3 mm in diameter and 40 mm in length were inserted into the above points and retained for 30 min after needling qi arrived.

Figure 1. Local acupuncture

Figure 2. Wrist-ankle acupuncture

Both groups were treated once a day, 7 treatments as a course, with a 3-day interval between two courses. The therapeutic efficacies were evaluated after 3 treatment courses.

3 Therapeutic Observation

3.1 Criteria of therapeutic efficacy

The criteria were made by referring to theCriteria of Diagnosis and Therapeutic Effects of Diseases and Syndromes in Traditional Chinese Medicine[5].

Recovery: Contraction of facial muscles was completely relieved, and didn’t recur during the 6-month follow-up study.

Markedly effective: Contraction of facial muscles was completely relieved, but recurred during the 6-month follow-up study.

Effective: Contraction of facial muscle was obviously improved, and the frequency was lowered.

Invalid: There was no significant improvement after intervention.

3.2 Treatment result

After 3 treatment courses, the recovery rate and total effective rate of the observation group weresignificantly higher than those of the control group (P＜0.05), indicating that the therapeutic efficacy of the observation group should be superior to that of the control group (Table 2).

Table 2. Comparison of therapeutic efficacy (case)

3.3 Case study

A male patient, 42 years old, and the initial visit was on October 24, 2013.

Chief complaints and present history: Episodic spasm of right lower eyelid had lasted for half a year and did not respond well to medications. Recently, the spasm gradually affected the cheek muscles, so the patient came to visit.

Diagnosis: Hemifacial spasm.

Treatment: The spastic area and wrist-ankle acupoints Upper 1, Upper 2, and Upper 3 were selected. Superficial needling was applied to the points on face; subcutaneous needling was performed at the wrist-ankle points. The needles were retained for 30 min. The treatment was given once a day, and the condition was improved after 3 treatments and the spasm was ceased after a treatment course. The spasm didn’t recur during the follow-up study.

4 Discussion

Hemifacial spasm falls under the scope of spastic muscle and tendon in traditional Chinese medicine (TCM). The range of Yangming meridians is usually affected, and the disease is located at the muscle regions. The liver opens into the eyes and dominates tendons, so liver is the root for tendon diseases. While it’s the muscles that are contracting, and the spleen dominates muscles and opens into mouth, hence the contraction of facial muscles is related to spleen.

Hemifacial spasm is often caused by contraction of wind and cold in collaterals, internal stirring of liver wind, and deficiency of qi and blood. It’s usually treated by calming liver and ceasing wind, expelling wind and unblocking collaterals, supplementing qi and blood, nourishing kidney and liver, and reinforcing spleen and stomach. As this disease is located at superficial layer, so superficial needling should be adopted to disperse cold and relax tendons, harmonize qi and blood, improve the flow of qi and blood, and nourish tendons and muscles to cease the spasm.

During the recent years, more and more scholars have been involved in the study of hemifacial spasm, and a significant progress has been achieved[6-8]. Some people believe that episodic facial spasm is caused by ectopic excitement of facial nerve or pseudo-synaptic transmission[9]. Superficial needling was applied to the spastic area, producing mild stimulation. It can effectively inhibit the ectopic excitement. The suspended needle handle can help cease the spasm and promote the recovery of facial muscles. According to wrist-ankle acupuncture, the spastic area is in the charge of Upper 1, Upper 2 and Upper 3 points. Superficial needling at the Upper 1, Upper 2, Upper 3 points can regulate the nerve functions of the corresponding areas. Meanwhile, this method combines the local points and distal points, thus can sedate the abnormal excitement and release the spasm.

When needles are inserted into facial points, intense shaking will occur in the local area, which can expel the pathogen. The needle tip should reach to beneath the skin, featured by the suspended needle body, otherwise, it would be either too deep and damage the muscle or too shallow to approach the affected area[10-12].

It’s found that the disease duration can greatly affect the therapeutic efficacy, the shorter the disease duration, the better the effect and prognosis. For those with comparatively long disease duration, the condition can only be improved to some extent but the patients cannot be cured.

Because superficial needling is safe and shallow, with gentle manipulation and less pain, it can relieve the anxiety and fright of the patients and is easily accepted by them. Therefore, it is a suitable treatment method for hemifacial spasm and is worth promoting in clinic.

Conflict of Interest

The authors declared that there was no conflict of interest in this article.

Statement of Informed Consent

Informed consent was obtained from all individual participants included in this study.

Received: 25 January 2015/Accepted: 26 February 2015

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Translator:Hong Jue (洪玨)

皮下針療法治療面肌痙攣療效觀察

目的：觀察皮下針療法治療面肌痙攣的療效。方法：選擇面肌痙攣患者80例, 按隨機(jī)數(shù)字表隨機(jī)分為兩組, 每組40例。觀察組予以皮下針刺局部阿是穴及腕踝針上1、上2和上3穴治療, 對(duì)照組使用常規(guī)針刺法。兩組均每日1次, 7次為一個(gè)療程, 治療2個(gè)療程后觀察療效。結(jié)果：觀察組總有效率和痊愈率分別為97.5%和57.5%, 對(duì)照組分別為85.0%和37.5%, 兩組痊愈率及總有效率差異均有統(tǒng)計(jì)學(xué)意義(P＜0.05)。結(jié)論：皮下針治療面肌痙攣療效優(yōu)于常規(guī)針刺。

針刺療法; 腕踝針; 浮刺; 穴, 阿是; 面肌痙攣

R246.6 【

】A

Author: Wen Mu-sheng, chief physician of traditional Chinese medicine.

E-mail: 56030900@163.com

Methods:Eighty patients with facial spasm were randomized into two groups by the random number table, 40 cases in each group. The observation group was intervened by superficial needling at local Ashi points and wrist-ankle acupuncture at the Upper 1, Upper 2 and Upper 3 points; while the control group was by ordinary acupuncture. For both groups, the treatment was given once a day, 7 times as a treatment course, and the therapeutic efficacy was evaluated after 3 courses.

Results:The total effective rate and recovery rate were respectively 97.5% and 57.5% in the observation group versus 85.0% and 37.5% in the control group, and the differences were statistically significant (P＜0.05).

Conclusion:Superficial needling can produce a more significant efficacy in treating hemifacial spasm than ordinary acupuncture.