Kai-Jun Zhang, Jia-Chun Xu, , Zhen Zhou*

1Tianjin University of Traditional Chinese Medicine, Tianjin, China. 2Department of Neurology, The Second Hospital Affiliated to Tianjin University of Traditional Chinese Medicine, Tianjin, China.

Abstract Objective: Hemifacial spasm (HFS) is characterized by involuntary unilateral contractions of the muscles, usually starting around the eyes before progressing inferiorly to the cheek, mouth, and neck. Here we described the use of fire needle combined with filiform needle for a patient with HFS on the left face. Methods: The fire needle was inserted into the points of Du meridian and the first lateral line of bladder meridian, combined with the points of the Ashi points around the left eye, Guanyuan (CV 4), Qihai (CV 6), Xiawan (CV 10), Zhongwan (CV 12), Tianshu (ST 25), Guilai (ST 29) and Daheng (SP 15). The filiform needle was used to acupuncture the points located on the left side of face including Cuanzhu (BL 2), Tongziliao (GB 1), Yangbai (GB 14), Fengchi (GB 20), Sizhukong (TE 23) and Sibai (ST 2). Results:The patient received the combined therapy of fire needle and filiform needle for 9 times in 5 weeks. After that, the symptoms of dull sensation in the left facial area and the twitching of the muscles of the left eye were improved remarkably. Conclusions: The fire needle combined with filiform needle therapy has the potential to cure HFS.

Key words: Hemifacial spasm, Fire needle, Filiform needle

Introduction

Hemifacial spasm (HFS) is a movement disorder that is characterized by intermittent involuntary contractions of the facial muscles. It begins with contractions of the orbicularis oculi, gradually spreads to the rest of the ipsilateral facial muscles. Bilateral HFS is rare and the muscle contractions were usually asymmetrical and asynchronous, which differentiates them from other disorders of facial movement, such as blepharitis spasm and orofacial dystonia.

The incidence of HFS in population is 9.8 persons every 100,000 persons and the average age of onset is 44 years old [1]. Botulinum neurotoxin (BONT) injections therapy is an excellent noninvasive tool to treat HFS and it is recommended as the most popular treatment for this condition [2]. However, it just provides low-risk but limited symptomatic relief. Although microvascular decompression (MVD) is a surgical intervention that provides long term symptomatic relief by reducing compression of the facial nerve root, the intraoperative technique and monitoring is still needed to be improved[3]. A research showed that acupuncture by filiform needle therapy kept the poor repeat treatment ratio because of dissatisfactory therapeutic effect [4]. An observation of fire needle therapy for HFS indicated the efficacy of fire needle is superior to simple filiform needle therapy, but the curative course lasted as long as 15 weeks [5].

As shown in the ancient book named Lingshu·jingjin(B.C. 475～221, Han Dynasty), cold evil attacked face and mouth and then leaded to the contractions of face and mouth [6]. It further resulted in the Yin and blood deficiency of tendon and vessel. According to the record in another ancient book named Lingshu·guanzhen (B.C.475～221, Han Dynasty), because of the effects of warming and smoothing channels as well as promoting the circulation of Qi and blood, fire needle was involved in the therapy of Bi symptom of Chinese medicine induced by wing and cold evil [7]. It indicates that fire needle has the potentials to achieve the satisfactory curative effects in the therapy of HFS. Especially to those patients who refused to receive the therapy of BONT injections and surgery, fire needle therapy is more likely to be accepted. Here we present a patient who suffered from HFS for 6 mouths and showed a complete clinical response after 5-weeks of fire needle combined with filiform needle treatment.

Case report

In 18 December 2017, a-30-year-old female complained of discomfort and dull sensation in the left facial area,mainly accompanied with twitching of the muscles of the eye. The facial examination showed there was a mild swelling on the left eye, incomplete closing of the eye lids, wrinkles on the forehead, and normal nasolabial groove. Slight eye muscle twitching could be found by careful observation. Physical examination showed that the patient was slightly thin (BMI: 18.4) in body figure and well in mental state. The blood pressure was 120/80 mmHg and the heart rate were 78 beats/min. No abnormity was found in the heart and lungs by chest auscultation and electrocardiogram. The tongue was pink with little yellow coating, and the pulse presented string-thin. Electromyography and head CT examination showed there were no obvious abnormalities.

She has suffered from intermittent involuntary contractions of the left eye muscles for 6 months. She had received the acupuncture of filiform needle the Ashi points located on face for 1 week and cupping on the points of back for 6 times. She refused to be treated with BONT injection or MVD. After these therapies, she always suffered from involuntary eyelid closure and eyebrow elevation when she was in bad mood.

Treatment and outcome

Because the patient had received acupuncture of filiform needle and achieved unsatisfactory effects, the fire needle combined with filiform needle was applied to treat her.First of all, the fire needle was applied on the back points of Du meridian and the first lateral line of bladder meridian, the Ashi points around the left eye, and other points including Guanyuan (CV 4), Qihai (CV 6), Xiawan(CV 10), Zhongwan (CV 12), Tianshu (ST 25), Guilai(ST 29), Daheng (SP 15). The fire-needle was inserted 5-10mm in depth and was withdrawn swiftly without retaining. After that, the filiform needle was applied to the points located on the left face of the patient including Jingming (BL 1), Cuanzhu (BL 2), Tongziliao (GB 1),Yangbai (GB 14), Yuyao (EX-HN6), Sizhukong (TE 23),Sibai (ST 2), Fengchi (GB 20) (Figure 1 A, B). The needles were inserted 10-15 mm and retained for 30min.

The patient was prescribed a total of nine-time treatments during five weeks. After that, the dull sensation in the left facial area and the twitching of the muscles of the eye disappeared.

Figure 1 Filiform needle points in the therapy of hemifacial spasm

Discussion

The fire needle is made of tungsten-manganese alloy, so it has the characteristics of high temperature resistance,rigidity and straightness. The fire needle therapy is a treatment method that swiftly penetrates a certain point or part of the human body after it is heated on fire and arrives at a high temperature. The theory of TCM think that HFS is resulted from the attacking of cold and wind on the face and mouth. Due to the characters of expelling wind and cold as well as warming and smoothing the meridians, the fire needle could exhibit the therapeutic effects of in the treatment of HFS.

According to the conception of meridian’s transmission,Du meridian is the sea of Yang meridians. Acupuncturing these points located on Du meridian with fire needle could invigorate Yang Qi. The back Shu points, including Feishu (BL 13), Xinshu (BL 15), Ganshu (BL 18), Pishu(BL 20) and Shenshu (BL 23), are the intersections which infusing Qi coming from channel into Zang and Fu.Besides, back is of Yang and acupuncturing the bladder meridian is involved in stimulating the circulation of Yang Qi and Yin blood of human body.

The Ashi points were used to relieve the discomfort and dull sensation in the left facial area. The local points,consisting of Jingming (BL 1), Cuanzhu (BL 2),Tongziliao (GB 1), Yangbai (GB 14), Yuyao (EX-HN6),Sizhukong (TE 23), Sibai (ST 2), Fengchi (GB 20), were selected for relieving the spasm and contraction of eye muscular.

For the patient with HFS in the present case, the therapy of fire needle combined with filiform needle,appeared to result in the large improvement, which suggest the possibility that the fire needle and filiform needle may serve as an alternative therapy for HFS.