Volume 12, Number 2 | Summer 2017

Clinical Report 1 (Acupuncture)
A Case in which an Improvement Was Seen in Facial Nerve
Paralysis Owing to Acupuncture and Moxibustion
Treatment of the Upper and Lower Legs
Mariko Oikawa1) and Shuichi Katai2)
1) Center for Integrative medicine, Faculty of Health
Sciences, Tsukuba Univercity of Technology2) Department of Health, Faculty of Health Sciences,
Tsukuba University of Technology

by conservative treatment, facial nerve decompression
is chosen.
In Eastern medicine, peripheral facial nerve
paralysis is mainly treated by acupuncture andmoxibustion

treatment.

The

WHO

identifies

neuroparalysis as a disease that is susceptible totreatment by acupuncture and moxibustion, andperipheral facial nerve paralysis also falls under thisscope. Clinical reports to date mainly discuss theapplication of needle retention therapy and electro-[Introduction]
Facial nerve paralysis is a disease where thenerves that control the facial muscles are damaged
for some reason, and causes the face to be paralyzed1).
It is roughly classified into central paralysis andperipheral paralysis, depending on the where thedamage occurs, but most cases of facial nerve
paralysis seen in the otorhinolaryngology field are
peripheral facial nerve paralysis. Peripheral facial
nerve paralysis can be divided into intracranial,intercranial, and extracranial facial nerve paralysis,
dependingonthelocationofthedamage.

Intercranial facial nerve paralysis accounts forapproximately 80% of all cases of facial nerve
paralysis. It is most frequently caused as a result of
Bell’s palsy, Ramsay Hunt syndrome, temporal bone
fracture caused by head trauma, tympanitis, middle
ear surgery, and congenital disorder6).
The cardinal signs of peripheral facial nerve
paralysis mostly appear in the form of facial

acupuncture therapy to the face.
This

paper

reports

on

a

case

where

an

improvement was seen in the symptoms of facial
nerve paralysis as result of performing acupuncture
and moxibustion treatment by mainly applying
stimulations to distant regions of the body, namely
the upper and lower legs, instead of to the affected
region.
[Case]
67-year-old male. Height 175cm, weight 58kg.
Unemployed. Family history: Dementia in mother.
Medical history: Amnesic attack after a traffic
accident (at age 40), asthma (at age 45), lung cancer(at age 67).
The patient’s first visit was on Oct. 23, 20XX. His
chief complaint was paralysis of the right side of his
face (Bell’s palsy).
[History of present illness]

movement disorders caused by paralysis of facial

On Oct. 12, 20XX, the patient felt a strangenessmuscles, but also frequently accompany suchon the right side of his face while jogging to the park.

associated symptoms as abnormal watering of the

He stopped jogging and went home. The strangenesseyes, hyperacusis, dysgeusia, hearing loss, vertigo,

persisted thereafter, so he made an emergency visit

post-auricular pain, and oppressive facial pain2).

to T Hospital in the late afternoon of the same day.

Generally, the cure rate of peripheral facial nerve

An MRI of the head and X-P were performed, but noparalysis treatment is 70% to 80% or more, andproblem was found. The patient was given an IV

relatively high. However, the remaining 30% at theinfusion and sent home. On the following day, themost are said to be left with some form of aftereffects

patient received another IV infusion at the same

due to poor prognosis3). In Western medicine,

hospital, and on the day after that, he was diagnosed

peripheral facial nerve paralysis is mainly treated bywith nerve paralysis on the right side of this facedrug therapy and stellate ganglion block therapy(Bell’s palsy) by an anesthesiologist at the hospital.

today. When sufficient improvement cannot be seen

According to the Yanagihara facial nerve grading

8

The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

Volume 12, Number 2 | Summer 2017

system (a score of 36 and above indicates normal

LI10, LI10, LI4, LI11, KI2, SP4, HT3, SP3 and KI4

movement), the patient’s facial movement scored 8

on both sides. The needles were left inserted for 12

out of 40. He was told his facial paralysis is severe,minutes. Moxa sticks were placed between the KI7

and that it would take from one to three months toand KI3 on both sides for 5 to 6 minutes. In prone

cure. The patient went to T Hospital every day the

position, a stainless steel needle (Seirin Corporation)

following week, and received an IV infusion and

40m long and 0.16mm thick was inserted to a depth

stellate ganglion block therapy. On the eleventh dayof 3 to 4mm in the LI10 point on the right hand.

of developing the disease, the patient visited ourStainless steel needles (Seirin Corporation) 50mm

hospital on recommendation of the anesthesiologist

long and 0.18mm thick were inserted to a depth of 3

at T Hospital.

to 4mm in the BL10, the BL9, the longissimusState of illness at first visit: Blood pressuremuscle, splenius muscle, and semispinal muscle on

131/72mmHg, pulse 83/min (regular). Yanagihara

both sides. The needles were left inserted for 7

facial nerve grading system: 8. No facial pain,

minutes. Immediately after the treatment, thetenderness. Sagging of the eye and mouth on the sidepatient himself noticed that he could slightly moveof the paralysis. Tension in the longissimus muscle,

his nostril on the paralyzed side. The same

splenius

acupuncture treatment was applied on the patient’s

muscle,semispinal

muscleofneck,rhomboideus muscle, erector muscle of spine, andbrachioradial muscle, on the right side. In a NET
test, nasolabial fold was 4.7mA, and ENoG value was
71.8% on the affected side. In our hospital, doctors
determined that there was a difference in the NET
test and ENoG value between the right and left sides,
and surface EMG indicated minor synkinesis. In
terms of ADL, the paralyzed side of the face wasdifficult to move, foods spilled from the mouth wheneating or drinking, the eye frequently watered on theparalyzed side (especially in the wind), the nosewatered on the paralyzed side, but no loss of hearing,tinnitus, vertigo or dysgeusia were observed.

second visit and thereafter.
[Evaluation method]
The acupuncture treatment for peripheral facial
nerve paralysis was evaluated by the Yanagihara
facial nerve grading system, a paralysis criteria
recommended by the Japan Society of Facial Nerve
Research, and also by palpation for responses of thesurface of the face, neck, shoulder, back and upperand lower legs.
The Yanagihara facial nerve grading system is aregional evaluation system that evaluates major
facial functions by dividing the face into a number ofunits and evaluating each unit individually. It
assesses the degree of paralysis by total score.

[Name of disease]
Nerve paralysis on the right side of face (Bell’sThis case is presented here with the patient’s

palsy) (M Hospital)consent.

[Treatment plan][Progress of treatment]

Improvement of blood flow around the face,

Second visit (Oct. 29)

neurological

For a whole day after the first treatment, thefunctions, mitigation of tension in neck and shoulder

patient’s watery eye and runny nose on the

promotingtheimprovementofparalyzed side stopped. This allowed the patient to[Treatment method]
In supine position, stainless steel needles (Seirin
Corporation) 40mm long and 0.16 thick wereinserted to a depth of 3 to 4 mm in the TE8, TE5,

spend the day with a measure of comfort. However,
the watery eye and runny nose gradually returned
from the following day (although to a lesser degree
than the first visit). Additionally, he had found it

The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

9Volume 12, Number 2 | Summer 2017difficult to see with his right eye, on the paralyzed

that he became able to put some strength into hisside, but became able to see with his right eye again.

eyelid on his paralyzed side when intentionally

The skin of his cheek had felt a layer thicker, but it

closing his eye.

felt as though it became slightly thinner. He became

Fourth visit (Nov. 2)

able to move his mouth on the paralyzed side. He

The watery eye and runny nose on the patient’s

found it easier to eat and drink, compared to before

paralyzed side stopped. However, he still felt like his

receiving treatment. On October 28, he visited Teyes would water up. When looking in the mirror, aHospital, and was told that his symptoms have

nasolabial fold gradually appeared on the paralyzed

improved. From this day, he was instructed to lightly

side. When eating, food would sometimes still collectmassage his face, and he commenced doing as he wasin his mouth, but he was becoming able to eat

instructed. He also began self-care at home.

without spilling, as he did before he developed the

Yanagihara facial nerve grading system: 16 points.

disease. He would sometimes spill water from his

The tension in his brachioradial muscle, longissimus

mouth when gargling, but he was getting better at it,

muscle, semispinal muscle, and splenius muscle

little by little. He still felt as though his mouth was

decreased compared to before.

shifted toward the unaffected side.

The same treatment was performed as in the firstYanagihara facial nerve grading system: 30 points.

visit. The patient noticed that he had a clear double

The tension in the brachioradial muscle, longissimus

eyelid on the paralyzed side after treatment.

muscle, semispinal muscle, and splenius muscle

Third visit (Oct. 30)

decreased compared to before.

From after the treatment on his second visit, theThe pain from lumbago on the right side of thepatient’s watery eye and runny nose stopped on thepatient’s body was improving compared to before theparalyzed side. However, the watery eye and runny

previous treatment. However, he felt a stretchingnose gradually returned from the following day,sensation and strangeness when he bent forward or

although to a much lesser degree compared to before.

flexed the right side of his body.

When eating, food tended to collect in his mouth, but

The same treatment was performed as on Octoberit had gradually become easier to eat and drink.

30. Immediately thereafter, the patient became able

There was still some strangeness and difficulty into open his mouth slightly on the paralyzed side, andmoving his mouth, eye, and nose, in this order. He

the difference with the left side decreased. His facial

felt as though his mouth was shifted toward themuscles improved compared to before treatment, but

unaffected side.

he still felt some strangeness when moving the

40-point grading system: 20 points. The tension inmuscles in his face.

the brachioradial muscle, longissimus muscle,

Fifth visit (Nov. 6)

semispinal muscle, and splenius muscle decreased

Food no longer collected in the patient’s mouthcompared to before.

when eating. He also spilled food less often. When

There was a complaint from the patient that he felt

talking for a long time, he felt his voice becamea slight pain from his lower back to the outer side ofmuffled, but he was gradually improving since

his buttock when walking or lying on the sofa, frombeginning treatment. There was still a slight feelingbefore. Thus, treatment for lumbago was added tothat his mouth was shifted to the unaffected side.

his treatment regimen from this day.
The KI9 and GB34 were added to the patient’s

Yanagihara facial nerve grading system: 32
points. The tension in the brachioradial muscle,

initial treatment regimen, for lumbago treatment.

longissimus

Immediately after treatment, the patient noticed

splenius muscle decreased compared to before. There10

muscle,The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

semispinal

muscle,andVolume 12, Number 2 | Summer 2017

was tension in the sternocleidomastoid and posterior

The same treatment was performed as onscalene muscle. There was a deficiency response

November 6. Immediately after the treatment, the(less suppleness compared to the unaffected side,patient found it easier to close his eye and mouth on

and depression when palpated) in the lower part ofthe paralyzed side, and became able to put somethe ST4 and ST3 on the face, and an excess responsestrength into these parts.

(tension when palpated) in the SI18. There was also

Seventh visit (Nov. 13)

a deficiency response (depressed when palpated) in

The patient went to T Hospital on November 11
and was told that his condition was favorable, andthe SP3.
The lumbago on the right side of the bodythat treatment at T Hospital has been completed.
Subjectively, the patient hardly felt any difference

disappeared.
The application of moxa sticks to the LR4 point,

between the left and right sides of this face, and no

SP5 point, the lower part of the ST4 point, ST3, SI18,

strangeness in his paralyzed side. Foods no longer

and SP3 on the right side was added to the treatmentcollected in his mouth when eating. He still felt agiven on October 30. Immediately after theslight sense of his voice muffling when talking for atreatment, the patient became able to move hislong time, but that feeling was mostly negligible.

mouth on the paralyzed side. (Compared to before

Yanagihara facial nerve grading system: 40 points.

treatment, the tension in the muscles of the neck,

Tension in the brachioradial muscle, longissimus

shoulderthemuscle, semispinal muscle, and splenius muscle.

deficiency/excess reaction in the face improved, andThere was a deficiency response (less strength

palpation found the patient’s condition to be moving

compared to the unaffected side, and depression) in

toward the unaffected state.)the lower part of the ST4 and ST3 on the face, andSixth visit (Nov. 9)

an excess response (tension) in the SI18. There wasandforearm

hadlightened,

Foods hardly collected in the patient’s mouth any

also a deficiency response (depressed) in the SP3, butmore when eating. He no longer spilled foods when

the tension in the muscles of the neck, shoulder andeating or drinking. The feeling that his mouth was

forearm had lightened compared to before, theshifted to the unaffected side began to wane.

deficiency/excess reaction in the face improved, andGradual improvements were observed, but thepalpation found the patient’s condition to be moving

patient still slightly felt that his voice became

toward the unaffected state.
The same treatment was performed as on

muffled when talking for a long time.
40-point grading system: 36 points. Tension in theNovember 6. Immediately after the treatment, thebrachioradial

patient said he felt better compare to before themuscle,longissimus

muscle,semispinal muscle, and splenius muscle. There wastreatment, and more comfortable.

a deficiency response (less strength compared to theEighth visit (Nov. 13) – Eleventh visit (Dec. 25)

unaffected side, and depression) in the lower part ofSince the seventh visit, there seemed to be

the ST4 and ST3 on the face, and an excess response

nothing wrong with the patient’s facial symptoms.

(tension) in the SI18. There was also a deficiency

However, the patient worried about a possible

response (depressed when palpated) in the SP3, but

recurrence, and a palpation found a difference

the tension in the muscles of the neck, shoulder andbetween the left and right corners of the mouth

forearm had lightened compared to before, the(the affected side did not display appropriate

deficiency/excess reaction in the face improved, andelasticity), so treatment was continued until there

palpation found the patient’s condition to be moving

was no difference between the left and right sides.

toward the unaffected state.

On the eleventh visit (Dec. 25), moderate elasticity

The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

11

Volume 12, Number 2 | Summer 2017

was confirmed in the right corner of the mouth

below 10 out of 40 indicate incomplete paralysis, andthrough palpation, and there was no longer any

scores below 8 indicate complete paralysis. It also

difference between the affected and unaffected

deems scores above 20 as mild cases, scores from 18

sides of the face, so treatment was agreed to be

to 10 as intermediate cases, and scores below 8 as

terminated.

severe cases. Recovery is mostly achieved with ascore of 36 or above and an absence of any medium-[Observations]
A patient who developed peripheral facial nerve
paralysis (Bell’s palsy) was treated 11 days later by
acupuncture and moxibustion mainly to distantregions in the upper and lower legs, a total of eleventimes over a period of two months, with the result
that

his

symptoms

improved

andeventuallydisappeared.
Bell’s palsy accounts for 60% of all cases of facial
nerve paralysis, and has the highest frequency ofoccurrence. The annual incidence rate is 20 to 30
people per 100,000 people in Western countries. In
Japan, a survey conducted in 1985 found as many as
30 to 40 cases nationwide. There is no genderdifference in its frequency of occurrence. There is nodifference in which side of the face is affected, but
simultaneous

bilateral

paralysis

occursinapproximately 1% of cases, and recurs on one side at
a rate of 4.9%. The age of onset ranges from infants
to the elderly, but most frequently occurs to people in
the thirties to sixties age range, at an average age of
44. There is no distinct period or seasonality ofoccurrence. Patients have diabetes at a rate of 9%and high blood pressure at a rate of 16%, and develop
the disease mostly from having a stiff shoulder,
physical fatigue, and emotional fatigue. Complete
recovery is seen in most cases, and particularly
where the conductivity of facial nerves is maintainedby electroneuronography (ENoG), complete recovery
is achieved at a rate of 90%6).
In the case presented here, the patient wasdiagnosed with peripheral facial nerve paralysis of
the right side of the face, and rated a score of 8 outof 40 in a facial movement grading system. He had
severe symptoms of incomplete paralysis, andimprovement was expected to take time. In the
Yanagihara facial nerve grading system, scores
12

degree pathological associated movements5).
In Eastern medicine, facial nerve paralysis iscalled “deviation of the eye and mouth.” Facial nerve
paralysis is classified into a number of patterns, but
the case presented in this report was thought to berelated to the Interior Wind meridian. The concept of
the Interior Wind meridian (salivation due to cold) isthat when the meridian becomes empty, exteriorwind enters the empty meridian, attacks the middle
yang of the hands and feet and causes causing poor
meridian flow, making it difficult to close the mouth,
and thus causing salivation4). In the said case, thepatient had just begun to exercise after undergoingan operation for lung cancer in March andrecognizing a decline in physical strength. He
developed facial nerve paralysis around the time
when temperatures were gradually falling during
the turn of the season. A cold wind had been blowing
on that day.
The patient had also been caring for his motheraround this time, and was probably exhausted inboth mind and body. Thus, irregular emotion could
also have been a cause of his paralysis. Paralysis
caused by irregular emotion means that a feeling ofanger has been aggravated by “five emotions inexcess”4). Furthermore, yin deficiency could cause“water failing to nourish wood,” and when irregularemotion is added to this and liver yang is aggravated,
an aggravation of anger may also be induced. Thiscondition activates wind and fire so that qi and blood
rise and cause “deviation of the eye and mouth.” In
the said case, treatment was applied based on thisthinking.
Treatment focused mainly on acupuncture points
in the upper and lower legs, and not the affected
region. Treatment of the upper and lower legs was

The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

Volume 12, Number 2 | Summer 2017

also performed to relieve the tension that waspoor

observed in the neck and shoulder of the affected side.

treatment was applied to the affected region in theAtpatient

fifth treatment. As a result, movement at the corner

experienced a runny nose and excessive watering ofof the mouth improved, and the patient subjectively

the eye on the affected side of his face, but thesefelt a change in his symptoms immediately after

symptoms disappeared immediately after treatment,

treatment. By applying moxibustion to the affectedalbeit for a short period time, and disappeared forregion in addition to the treatment applied to distantlonger periods of time with each treatment. The

regions, the difference between the left and rightLarge Intestine meridian and Triple Energizer

corners of the mouth improved. This is thought tomeridian were used to treat the runny nose andhave promoted better circulation around the facewatery eye symptoms. These are meridians that flow

and accelerated the improvement of the symptoms.

around the eyes and mouth. It is thought that

There have hardly been any reports on moxibustion

treatment of these points stimulated the sensory

treatment for facial nerve paralysis2) in the past, butorgans on the side of the face that developed nerve

since the corner of the mouth moved better

paralysis due to some type of damage. From theimmediately after moxibustion treatment in thisperspective of Western medicine, it is thought thatcase, moxibustion treatment could be expected to befacialeffective for facial nerve paralysis.

thebeginning

nerve

of

paralysistreatment,(Bell’sthepalsy)

isanmovement

there.

Therefore,

moxibustion

exacerbation mechanism of paralysis that occurs

In this case of facial nerve paralysis, treatment

when latent HSV-1 infection in the geniculate

was applied not only to the affected region, but also

ganglionandto acupuncture points at the periphery of meridians

stimulation as fatigue, coldness, tooth extraction,that mainly flow through the face. As the patientand pregnancy, causing paralysis through viral

recovered in two months, the result suggests thatneuritis, and the neuritis causing edema, which thenacupuncture and moxibustion treatment to distantbrings about a vicious circle of osseous compression

regions is effective. However, in this case, ENoG

in the neural canal, constriction and ischemia6).

value was 71.8% in an electrophysiologic study. Thisisreactivated

by

such

stressIn acupuncture and moxibustion treatment, it ishigh ENoG value and minimum neurologicalthought that a somatic-visceral reflex occurred as adisorder may have contributed to the patient’s early

result of acupuncture stimulation and acted on therecovery after treatment. Stellate ganglion blockautonomic nerves in some way to stop the patient’s

shots were applied every day for a week after therunny nose and watery eye. Additionally, it isonset

thought that an improvement was observed in themoxibustion treatment was applied thereafter. The

patient’s symptoms by improving the blood flow

combination of these treatments may have also led

around the face, promoting the improvement ofto the patient’s early recovery.

of

the

disease,andacupunctureandneurological functions, and mitigating the tension in

Acupuncture and moxibustion treatment wasneck and shoulder that occurred accompanying theperformed 11 times in this case. The patient hadother symptoms. In the latter half of the treatment,

never experienced acupuncture treatment before, so

inconveniences in the patient’s ADL gradually

he had some feelings of worry and fear about

improved, and he became able to live more

receivingcomfortably. However, some paralysis remained in

acupuncture and moxibustion treatment to distantthe corner of the mouth. He scored low in theregions in the upper and lower legs mitigated the

Yanagihara facial nerve grading system for thepatient’s burden (worry and fear) compared tocorner of the mouth, and palpation also confirmed

applying treatment directly to the affected region,thetreatment.

The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

It

isthoughtthat13Volume 12, Number 2 | Summer 2017and led to his positive attitude to receiving

medicine to treat peripheral facial nerve paralysis

treatment. In the criteria for facial nerve paralysis,

also contributed to the patient’s early recovery.

a score of 36 or higher in a 40-point system and theabsence of pathologicalassociated movements

References

constitute recovery5). Since the patient scored 40 out

1) Shimoji, Koki; Yoneyama, Kimihiro: Facial nerveof 40 in the seventh treatment, the doctor could haveparalysis, Information Center for Standard

judged the patient as having recovered andMedical Treatments, 2014.

completed the treatment. However, because the2) Yamaguchi, Tomo: Illustrated technical guide topatient was worried about a possible recurrence ofacupuncture and moxibustion therapy II, Part 6

the symptoms, and also because a palpation of the

Otological and ophthalmic disorders-2, Facial

face found a weakness (deficiency) around the corner

nerve paralysis, 930-939, 2012.

of the mouth on the affected side compared to theunaffected side, treatment was continued with the3) Tsuji,

Sadatoshi

et

al.:

Standard

nerve

treatment: Bell’s palsy, 171-185, 2008.

patient’s consent until there was no difference4) Hyodo, Akira (translation supervisor) + Gotobetween the left and right sides. This case showed

College Traditional Chinese Medicine Institutethat rather than making a judgment based only on(trans.), Acupuncture and Moxibustion Series

an objective evaluation method, it is important totetralogy, Acupuncture and Moxibustion Series 2,

listen to the patient’s feelings of concern and reach a

Tianjinmutual agreement regarding treatment, including

Medicine + Goto College Traditional Chinese

the prevention of recurrence, between the patient

Medicine Institute (ed.), 278-285, 460-465, 1993.

UniversityofTraditional

Chinese5) Nishida, Takeshi: Qualitative evaluation based

and physician.

on the 40-point facial nerve paralysis grading
system using principal component analysis.
6) Nomura, Yasuya et al. (total ed.): CLIENT21—[Summary]
Acupuncture and moxibustion treatment wasapplied to distant regions in the upper and lower legs

21stcentury

clinicalpracticeintheotolaryngology field—.

eleven days after a patient developed peripheral

7) Furuya, Yoshiro: Guidebook on facial nerve

facial nerve paralysis (Bell’s palsy), with the result

paralysis treatment—Bell’s palsy and Huntthat

syndrome—1-year edition, Kanehara & Co., Ltd.

thepatient’s

symptoms

improved

andeventually disappeared. The treatment had aparticular effect in improving the excessive wateringof the eyes and runny nose. In clinical reports to date,treatment had been mostly applied directly to theaffected region. However, this case suggested theeffectiveness of treatment to distant regions in theupper and lower legs. Acupuncture and moxibustion
treatment to the distance regions in the upper andlower legs allowed treatment to be performed while
mitigating the patient’s burden (worry and fear)
compared to direct treatment of the affected region.
The combined use of Western medicine and Eastern

14

The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

Volume 12, Number 2 | Summer 2017

FigureChange over time according to Yanagihara facial nerve grading system

40(Normal)

40

40

40

36
32

30

30
20

20
10

(Complete paralysis)

8

8
0

16
Acupuncture
treatment

Drug therapy
10月12日
10月23日Oct. 12Oct. 23
発症of disease
Onset(day of treatment)
10月29日Oct. 29

10月30日Oct. 30

11月2日
Nov. 2

11月6日
Nov. 6

11月9日
Nov.
9

11月13日Nov. 13
発症から一ヵmonthafter onset
月

12月25日
Dec.
25
(診療日)
最終日
final
treatment

The above figure shows the evaluation of thepatient’s condition according to the Yanagihara
facial nerve grading system in the said case, by dayof treatment.
Total score: 40 points
8 points or lower: Complete paralysis
36 points or higher: Normal

The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

15