ACU-2012-2431-ver9-Clinical-Pearls_1P.
3d 08/14/12 2:21pm Page 1
MEDICAL ACUPUNCTURE
Volume 24, Number 3, 2012
# Mary Ann Liebert, Inc.
DOI: 10.1089/acu.2012.2431
How Do You Treat Bells Palsy in Your Practice?
M y standard practice for the treatment of Bells
palsy is to use a technique called Mei Zen Cosmetic
Acupuncture. The Mei Zen protocol is a facial protocol that
was originally designed for cosmetic purposes but has
been very effective in the treatment of facial pain, facial
paralysis caused by stroke, TMJ, and so on. The protocol
invigorates channels on the face to create a working web of
energy. As with any effective acupuncture treatment, even
when using a specialized protocol, the first step is to examine
the pulses in order to determine energetic imbalances in the
patient. Based on the pulses, I create a prescription of body
acupuncture points that will balance the pulses and follow
that general balancing with the Mei Zen protocol.
One common imbalance is that Qi is not rising up to the
upper part of the body to support the channels on the face.
When a situation like that is felt in the pulses, the goal of
treatment is to increase the flow of Qi in those upper body
channels to improve the effectiveness of any facial needling.
One way to assure proper Qi flow between upper and lower
body is to open up the extraordinary channel called the Dai
Mai or belt channel. The Dai Mai can become blocked
from a variety of incidents, including falls, surgery, child-
birth, or being rear ended to name a few. Another way to
increase Qi flow to the upper part of the body is to do point
combinations like Liver 3 or 5 plus Lung 1 as one continues
to re-examine the pulses to be certain that the Qi has opened
to the upper jiao. Since the imbalances we see in the pulses
may be the root of the Bells palsy symptoms or be exac-
erbating factors, it is important to rectify those imbalances
so that the patient receives benefit from both parts of the
treatment.
Once the bodys energy is balanced, it is time to move on
to the Mei Zen protocol. The acupuncture points in the Mei
Zen protocol are used bilaterally, not just on the affected
side of the face. Points on the San Jiao, Gallbladder, Sto-
mach, Large Intestine, Ren Mai, and Du Mai channels are
activated through the use of SJ 17, Ren 24, GB 14, ST 4,7,8,
LI 20, and Du 20 among others. Not only does the protocol
work locally but the Gallbladder, Du Mai, and San Jiao
channels may have a direct effect on the brain, which is one
of acupunctures goals: to reset CNS activity toward bal-
ance. Once the protocol needles are in, they are left in place
for 30 minutes. Patients are seen at least twice a week and
are taught facial Qigong maneuvers that they can do a few
times daily at home to improve their results.
ACU-2012-2431-ver9-Clinical-Pearls_1P
Type: Clinical Pearls
CLINICAL PEARLS
Martha Lucas, PhD, LAc
Denver Center of Traditional Medicine and Acupuncture
1331 Vine Street
Denver, CO 80206
E-mail: DrMLucas@AcupunctureWoman.com
B ells palsy represents paralysis of the seventh cra-
nial nerve with inability to flex the facial expression
muscles. The process is unilateral, with drooping of the
corner of the mouth and perioribital tissues. Drooling and
excessive lacrimation are frequent complications. Dysgeusia
or hypogeusia in the anterior third of the tongue is a common
feature as well. The disease is more common in the spring
and fall, has a sudden onset, and may exist for a brief period
or persist for months or even years. Etiology is unknown.
Neoplasms, usually malignant, in the vicinity of the stylo-
mastoid foramen or in the parotid gland may encroach upon
the motor fibers and cause paralysis. If neoplasia is detected,
surgical intervention or other treatment to eradicate the tu-
mor must be performed. The acupuncture points used for
Bells palsy or facial paralysis or pain are GB 1, GB 20, ST 7,
ST 8, LI 4, LI 11, (acupuncture LI 4 should not be used
during pregnancy), SI 19, ST 36. Generally, Bells palsy
patients seem to benefit most from our treatment if it is given
as soon as the Bells palsy occurs. The longer the patient
delays acupuncture treatment, the less favorable the result.
For those who wait 6 months or longer, the treatment results
are rather mixed. But if patients are treated immediately
after the palsy is discovered, often only one or two treat-
ments are required to resolve the problem. For those who
suffer for more than 1 month, it is better to keep the needles
at the acupoints for 20 minutes. A mild case could be cured
in 23 weeks.
Gabriel P. Lu, MD, PhD
Albert Einstein College of Medicine and
Montefiore Medical Centre, Bronx, NY
Dominic P. Lu, DDS
School of Dental Medicine, University of Pennsylvania
6505 Rte 30
New Tripoli, PA 18066
E-mail: DominicPLu@gmail.com
1
ACU-2012-2431-ver9-Clinical-Pearls_1P.3d 08/14/12 2:21pm
2 CLINICAL PEARLS
B ells palsy is the most common facial paralysis, af-
fecting 1 in 60 persons in a lifetime.1 Its sudden onset
with no associated symptoms (mastoid tenderness in some
cases) distinguishes it from Lyme disease, shingles, sar-
coidosis (often bilateral), leprosy, Guillain-Barre syndrome,
connective tissue disorders, diabetes, various tumors, and
the rare recurrent paralysis of MelkerssonRosenthal
syndrome.
Diagnosis is clinical. An MRI can confirm swelling in the
geniculate ganglion. In supranuclear paralysis, there is rel-
ative sparing of the upper face. Eighty percent of affected
people recover in a few months. Modern medicine treatment
involves corticosteroids, anti-virals, and lubrication of the
eye.
In Chinese medicine, facial paralysis comes under wind
stroke; supranuclear paralysis is internal wind, Bells palsy
is external wind. Wind and cold disrupt the flow of Qi, and
blood in channels of the face.2
The author uses acupuncture if there is no sign of re-
covery after 1 month, as well as in cases of residual weak-
ness. The beneficial effects of acupuncture have been
confirmed in previous studies.3
The preferred steps are:
1. Open the channels of the face using GV and CV
opening pointsSI 3 + BL 62 and LU 7 + KI 6; add
GV 26 and CV 24reducing method.
2. Select local points from GB 14, TE 23, BL 2, Yu Yao,
SI 18, ST 2, ST 3, ST 4, LI 19, LI 20, ST 6, ST 7,
depending on the area of involvement and only on the
affected sideeven method.
3. Distal pointsLI 4 (Grand point for the face, most
useful); GB 20 if there is headache; TE 5, TE 17 if
mastoid tenderness is presentbilateral use, reduce. If
unilateral stimulation is used, use LI 4 channel on the
opposite side, as LI channels cross at GV 26.
In recalcitrant cases, use high frequency (500 Hz) elec-
trical stimulation at local points.
Auricular pointsif needed.
PrincipalTrigeminal nucleus, Face, Occipital, Point
zero, Shenmen, Thalamus, Lesser occipital nerve, Liver,
Parathyroid.
SupplementalMuscle relaxation, Adrenal C, Master
cerebral, Tranquilizer point.
Chinese herbalQian Zheng SanPulling the upright
powder (pulls the weak muscles into shape).
Homeopathic Causticum 30C often boosts the effects of
acupuncture in Bells palsyboth being bioenergy systems.
REFERENCES
1. Longo DL, Kasper DL, Jameson JL, Fauci AS, Hauser SL,
Loscalzo J, Eds. Harrisons Principles of Internal Medicine.
AU1 c USA: McGraw Hill; 2012:3362.
Page 2
2. OConnor J, Bensky D. Acupuncture: A Comprehensive Text.
Seattle, WA: Eastland Press; 1981:367372.
3. Gao HB, Chen D. Clinical observation on 60 cases of pe-
ripheral facial paralysis treated with acupuncture penetration
needling. Int J Clin Acupunct. 1991;2(1):2528.
Poovadan Sudhakaran, MBBS, MD, PhD, Mast. ACU,
Mast. TCM, D.Hom, DHM, DIH, BIH
26 Tuckers Road
Templestowe, Vic. 3106
Australia
E-mail: dr.p.sudhakaran@gmail.com
N otwithstanding various theories (inflammation/
edema/infection) about its etiology, Bells palsy is de-
fined as acute, idiopathic, peripheral facial nerve palsy.
From a Chinese medical perspective, it is understood mainly
as Wind and Cold invasion, affecting the Yangming and
Shaoyang channels. Having excluded other neurological
deficits and associated conditions, the treatment should be
directed at dispersing Wind and removing channel ob-
structions. Thus GB 20 (include GB 12 for mastoid tender-
ness) and LI 4 are used for Wind; LR 3 for better Qi
circulation. GV 14 and LI 11 reduce Heat; KI 5 is for acute
nerve disorders, KI 10 for chronic; ST8 for phlegm reduction
in the head. Neuroanatomical acupoints1 are the mainstay
for stimulating the seventh cranial nerve, including ST 1-2-
3-4-5-6 and especially ST 7, GB 14, Yuyao, TE 1723,
Taiyang, SI 18, and Jiachengjiang (the mental foramen).
Supplementary points are used according to the patients
condition and constitution. Moxa can be added, especially
for deficiency or chronic states. Contra- and/or ipsi-lateral
scalp MS 6 line for the face, and ear points (cheek, eye,
mouth, Liver, Kidney) can also be needled. Lingual acu-
puncture2 can be added, especially for involvement of the
chorda tympani.
The patient is advised to avoid cold draughts, to warm
the face, massage (in an upward direction) the muscles,
and protect the cornea. The more severe and chronic the
paralysis, the longer the treatment should be; and the
earlier the treatment, the better the results. Reviews of
some acupuncture studies appear to support its efficacy for
facial paralysis such as that of the World Health Organi-
zation.3 In the Cochrane Database Systematic Review
(2004), three included studies showed that the therapeutic
effect of acupuncture alone was superior to that of medi-
cation or that acupuncture combined with medication was
better than medication alone. However, the quality of the
included trials was not adequate. More research with high
quality trials is needed.4 Some trials done in China show
that it is effective not only in the cure rate, but also in
hastening recovery beyond those in the natural history of
Bells palsy.5
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CLINICAL PEARLS 3

REFERENCES intradermal, semi-permanent needles (size #3) should be

inserted and covered with protective tape, rendering them
1. Wong JY. A Manual of Neuro-Anatomical Acupuncture, Vo- functional for up to several weeks. Next, one should treat
lume II: Neurological Disorders. Toronto: The Toronto Pain & any electrically active projections of the facial nerve, as
Stress Clinic Inc.; 2001:8790. well as the upper cervical spine, in all of three phases.
2. Wong JY. A Manual of Neuro-Anatomical Acupuncture, Spe- Direct physical treatment of x-ray-confirmed misalignment b AU2
cial Volume: Intra-Oral Tongue Acupuncture. Toronto: The
and joint dysfunction of the upper cervical spine, through
Toronto Pain & Stress Clinic Inc.; 2008.
specialized upper cervical chiropractic, is significantly ef-
3. World Health Organization. Category 2. Diseases, symptoms
or conditions for which the therapeutic effect of acupuncture fective and complementary. Lasting patient benefit can be
has been shown but for which further proof is needed. Acu- achieved utilizing auricular medicine techniques to select
puncture Review and Analysis of Reports on Controlled Clin- specific complex homeopathic supplementsto address
ical Trials; 2003. microbial causes of Bells palsy safely and naturally. Such
4. He L, Zhou D, Wu B, Li N, Zhou MK. Acupuncture for Bells energy medicines, correctly selected, will boost patients
palsy. Cochrane Database Syst Rev. 2004;1:CD002914. immune systems to overcome underlying chronic infection
5. Ye C, Li Z, Nan X, et al. The clinical observation of acu- (Lyme disease being a common source). Finally, direct
puncture effect on facial paralysisanalysis of 1,014 cases. application of cold laser light to the skin of the face and
Compilation of the abstracts of acupuncture and moxibustion upper cervical spine serves as an additional complement
papers. World Federation of Acupuncture and Moxibustion
to other treatments. The goal is to provide comprehen-
Societies, Beijing; 1987:4950.
sive, whole-body, wellness-based treatment on multiple
levels: (1) the energetic reflex level through auricular
Christopher Lam, MD, CCFP
Clinical Associate Professor, Department of Family
Practice, Faculty of Medicine
University of British Columbia
Affiliate of the University of Victoria
Victoria, British Columbia, Canada
105-2020 Richmond Road
Victoria, BC V8R 6R5
Canada
E-mail: lamchris@uvic.ca

I n my clinical experience, Bells palsy can occur as a

consequence of chronic infection, often undetected by
conventional laboratory testing. It has also been clinically
observed to result from mechanical dysfunction of the
upper cervical spine, resulting neurovascular encroach-
ment, hypothesized to affect cranial nerves via meningeal
irritation. Three-phase auricular medicine serves as a bio-
energetic guide to treatment, yielding exceptional patient
outcomes. Utilizing the vascular autonomic signal, color
light filters, and professionally prepared resonance testing
samples, we commonly see energetic suggestions of cause
factors including bacterial, viral, and structural impedi-
ments. Practitioners should first address energetic block-
ages through three-phase auricular therapymost
commonly, projection sites of the corpus callosum and
pineal gland.1 Points are detected electrically and/or via the
vascular autonomic signal (Nogier pulse). Active points
may exist in any one or all three phases, within a larger
zone (such as the bulk of the tragus for phase 1 corpus
callosum). Electrical stimulation is most effective using an
instrument capable of providing the full spectrum of Nogier FIG. 1. Bells palsy three-phase auricular therapy treatment
frequencies (2.5, 5, 10, 20, 40, 80, 160 Hz). Then, Spinex zones. Copyright Dr. Donald Liebell, 2012.
ACU-2012-2431-ver9-Clinical-Pearls_1P.3d 08/14/12 2:21pm
4 CLINICAL PEARLS
acupuncture; (2) the structural/neurological level via spe-
cialized upper cervical chiropractic correction (Atlas Or-
thogonal procedure);2 (3) the microbial level with complex
homeopathy;3 (4) the cellular level through cold laser
therapyby increasing ATP production, without produc-
F1 c ing free radicals (Fig. 1).
REFERENCES
1. Soliman N. Solimans Auricular Therapy Textbook: New Lo-
calizations and Evidence Based Therapeutic Approaches.
Bloomington, IN: AuthorHouse; 2008.
2. The Sweat Institute of Atlas Orthogonal Chiropractic. Online
document at: www.sweatinstitute.com/content/whatsorthog.php
Accessed July 23, 2012.
3. Soliman N. Homeopathy. Rockville, MD: Alternative Medi-
cine Seminars; 2010.
Donald K. Liebell, DC, BCAO, BA
The Liebell ClinicChronic Pain & Wellness Solutions
Board Certified Atlas Orthogonist (Upper Cervical Spine
Procedure)
Licensed in Acupuncture by the Virginia Board of Medicine
477 Viking Drive Virginia Beach
VA 23452
E-mail: necksecret@gmail.com
I n Korean Hand Acupuncture Therapy (KHT), it is
essential to classify both the individuals affected and
non-affected side syndromes.14 Bells palsy affects persons
with kidney excess syndrome, one of the three syndromes in
KHT. In the case of Bells palsy, if ones syndrome belongs
to the right kidney excess and left yang excess syndrome,
one has facial paralysis on the right resulting in the facial
muscles being pulled to the left side. If ones syndrome is
classified as right yang excess and left kidney excess syn-
drome, the symptoms, described above, affect the opposite
side of the face.5
Using KHT micro meridians on the hand, we treat Bells
palsy by tonifying the heart micro meridian and sedating the
small intestine micro meridian with KHT needles on the
affected side (KHT points G 15, G 7, N 1, J 7, H 2, H 7, I 38,
E 38). The non-affected side of the individual is generally
yang excess constitution. Therefore we tonify lung micro
meridian or sedate large intestine micro meridian (KHT
points C 9, C 11, G13, F 5, D 2, D 7, H 6, and I 38) with
KHT needles. Additionally, we apply moxibustion to both
hands on KHT points A 1, 3, 5, 8, 12, and 16.5 This treat-
ment protocol is undertaken once a day for five consecutive
days. Out of approximately 300 reported cases of Bells
palsy, the overall efficacy rate is more than 70% when the
condition is treated with KHT.6
Page 4
REFERENCES
1. Yoo TW. Korean Hand Therapy, 12th ed. Seoul, Korea: Eum
Yang Maek Jin Publishing Co.; 2009.
2. What is Koryo Hand Therapy? Online document at:
www.koryohandtherapy.com Accessed July 1, 2012.
3. Park KH, Park YE, Yang TI, Yoo TW. Location of primary
headache of outpatients using newly developed meridian and
acupuncture points of Korean Hand Therapy. Med Acupunct.
2010;22(2):121128.
4. Park KH, Kim HJ, Baek SY, Cho BM, Yoo TW. Effect of
acupuncture on blood flow velocity and volume in common
carotid and vertebral arteries in migraine patients. Med Acu-
punct. 2009;21:4754.
5. Yoo TW. Koryp Hand Therapy, 2nd ed. Seoul, Korea: Eum
Yang Maek Jin Publishing Co.; 2009.
6. Yoo TW. Korean Hand Acupuncture Treatment of Bells
Palsy. Seoul, Korea: Korean Hand Acupuncture Co.; 2009.
Kyu Hyun Park, MD, PhD
Professor of Neurology, School of Medicine
Pusan National University
1-10 Amidong
Busan
South Korea 602-739
E-mail: qhynbak@pusan.ac.kr
Tae Woo Yoo, PhD
President, Korean Hand Acupuncture Institute
Korean Hand Acupuncture Institute
Seoul
South Korea
E-mail: khta1004@naver.com
B ells palsy is a common clinical disease. The main
symptoms are drooping of the mouth corners and
numbness on the affected side of the face. Also manifested
are drooling, muscle weakness on the affected side, absence
of forehead wrinkles, and the loss of the ability to frown. The
etiology of Bells palsy is unclear; it may be related to a viral
infection leading to facial nerve paralysis or exposure of the
face to cold wind. In the acute stage, the patient may be
prescribed steroids to reduce the inflammation, or vitamins,
or anti-viral medications. One week later, if the symptoms
persist, the patient should lie supine or sit while acupuncture
is performed at ST 6, LI 20, ST 4, GB 2, ST 2, EX-HN 5, ST
7, and LI 4. The patient is needled on the affected side at a
depth of 510 mm. Needles should be inclined at an angle so
that De Qi is provoked, and they should remain in place for
30 minutes. Infrared radiation or moxibustion therapy
should be applied for 20 minutes. In the recovery stage
phase, acupuncture should be initiated on the above acu-
points, and ST 36 should be added. Electro-acupuncture
 ACU-2012-2431-ver9-Clinical-Pearls_1P.3d 08/14/12 2:21pm
CLINICAL PEARLS
stimulation should be performed on ST 2, LI 20, ST 6, and
ST 4 with a frequency of 2/100 Hz for 30 minutes.
From January 2009 to June 2012, at the Acupuncture
Clinic of the Shanghai Institute of Acupuncture-Moxibustion
and Meridians in Shanghai, China, 31 patients with Bells
palsy were treated with acupuncture. After treatment for
three periods continuously, 20 patients recovered, seven
patients experienced relief from their symptoms, and four
patients did not respond to the treatment.
Xiaomei Wang, MD, PhD
Shanghai Institute of Acupuncture-Moxibustion and
Meridians
650 South Wanping Road
Xuhui District
Shanghai 200030
China
E-mail: wxm123@vip.sina.com or wxm@fudan.edu.cn
Huangan Wu, MD, PhD
Shanghai Institute of Acupuncture-Moxibustion
and Meridians
Shanghai University of Traditional Chinese Medicine
Xuhui District
Shanghai 200030
AU3 c China
B ells palsy affects the seventh cranial nerve that
controls the muscles of facial expression. This condi-
tion causes nerve edema, ischemia, and compression in the
internal path within the temporal petrous bone. Since 1988,
the FES-Iztacala-UNAM (National Autonomous University
of Mexico) acupuncture clinic has been treating patients
with Bells palsy, according to the HerbertSeddon classi-
fication.1 In the last 5 years, we have selected 20 patients
with neuropraxia or axonotmesis of the facial nerve to un-
dergo conventional medical treatment. After three months of
treatment, no improvement was observed.
Bells palsy begins with retroauricular pain and difficulty
in closing the eye, hyperacusis, and deviation of the labial
commissure, among others clinical signs. Treatment in-
volves the application of acupuncture points related to the
neurological organization of the facial nerve.2 We applied
Page 5
5
the following points: SJ 17 on the output of the facial nerve
in the stylomastoid foramen posterior and auricular branch
of VII pair; SI 18 on the facial zygomatic branches; ST 4 on
the facial bucal branches; GB 1 and SJ 23 on the temporary
branches of the facial nerve; BL 2 projected in the occipi-
tofrontal muscle; GB 3 on the division of the temporofacial
nerve; and LI 18 on the path of the cervical branch of the
facial nerve.3,4
After 8 weeks of acupuncture therapy with needles, per-
formed once per week, 70% of the patients had an 85%
excellent functional recovery. All points were stimulated
with acupuncture needles (0.4 mm diameter and 80 mm in
length) inserted unilaterally and stimulated with electro-
acupuncture at 10 Hz during a period of 45 minutes.
REFERENCES
1. Seddon H. Surgical Disorders of the Peripheral Nerves, 2nd
ed. London: Churchill Livingstone; 1975.
2. Finsterer J. Management of peripheral facial nerve palsy. Eur
Arch Otorhinolaryngol. 2008;265(7):743752.
3. Kwon HJ, Kim JI, Lee MS, et al. Acupuncture for sequelae of
Bells palsy: A randomized controlled trial protocol. Trials.
2011;12:71.
4. Diaz-Toral LG, Luengas I, Reyes-Campos M, Rivas J. Efficacy
of acupuncture in Bells palsy. Selected topics in clinical re-
search V, UAM-X, Mexico (Metropolitan Autonomous Uni-
versity-X, Mexico); 1998.
Miguel Jesus Reyes-Campos, MD
CBS (Biological Sciences Health)
UAM-I (Metropolitan Autonomous University-Iztapalapa)
Venecia No 15, Colonia Juarez, CP 06600
Mexico City, Federal District
Mexico
E-mail: migreyca@hotmail.com; migreyca@yahoo.com
Livia Gabriela Diaz-Toral, MD
FESI-EXTENSION
FES-Iztacala-UNAM (National Autonomous University of
Mexico)
Tlalnepantla, Edomex
Mexico
E-mail: gabrieladiaztoral@hotmail.com
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