Bell’s Palsy: An Acupuncture Case Study

I have a great story you are going to want to share with your patients. It involves Bell’s Palsy, a pregnant woman, AcuGraph, Auriculotherapy and this awesome text message:

 

Questions:

• Have you treated Bell’s Palsy in your clinic?
• Do you get great results?
• Have you educated your patients and community to call you IMMEDIATELY if they (or anyone they know) has a Bell’s Palsy attack?

There’s no way to know when someone is going to wake up with a Bell’s Palsy attack. Here’s what I do know… Most patients panic at the onset. It’s traumatic waking up in the morning with loss of function on one side of the face. The best way to deal with a traumatic situation is education and having the right resources.

Today’s blog is about educating your patients and giving them resources. YOU, the acupuncturist, are the perfect resource!

In a couple of days I’ll send you a follow-up Case Study–including graph analysis, treatment strategies, and before/after pictures of Heather, my pregnant patient who DID NOT panic when she woke up with Bell’s Palsy. She had already been educated regarding acupuncture. Instead of panicking, she made the best choice possible and called her acupuncturist right away.

 

Differential Diagnosis:

The first and most important step in differential diagnosis of Bell’s Palsy is to ensure your patient is not having a stroke, which is an emergency condition requiring immediate medical intervention. The following chart gives quick reference points to help differentiate between the two conditions:

**********

Once you’ve ruled out stroke, you can proceed with Bell’s Palsy treatment. Of course, this condition is commonly also seen in a Western medical setting. So what’s the difference between Western Medicine and Traditional Chinese Medicine (TCM), when it comes to Bell’s Palsy?

 

Interesting statistic:

This condition seems to be more common in patients ranging between the ages of 15 and 60 and in those with diabetes and/or upper respiratory ailments such as flu/cold.

 

How acupuncturists think differently:

 

Diagnosis:

An acupuncturist will not only look at the presenting symptoms on the face, involving the facial nerve; but will also look at other underlying “patterns” and energetic blockages in the acupuncture channels to determine what led to the Bell’s Palsy attack. Patterns are determined by asking questions that may not seem related to the present symptoms; but indeed help the acupuncturist know how best to resolve the problem. Palpation and measurements of electrical skin resistance in the channel will also help the practitioner determine underlying causative factors. *Common TCM Patterns are listed in the chart above.

Along with questions, palpation and measurements of electrical skin resistance, your practitioner may also feel your pulses and look at your tongue to determine the correct diagnosis.

 

Pattern Analysis:

Wind is the pattern that presents for Bell’s Palsy.

The Practical Dictionary of Chinese Medicine describes wind as follows:

• Wind is the natural movement of air. It “comes and goes quickly, moves swiftly, and blows intermittently.”
• Wind becomes problematic when its onset is swift–leading to convulsions, tremors, shaking of the head, dizziness, and wandering pain and itching.
• Wind invades the upper part of the body and exterior, especially the head; the lung; and the skin.

Wind causes facial paralysis. This may seem odd, because we just described wind as wandering and moving. In the case of facial paralysis, internal wind is actually blocking movement.

Wind in relation to Bell’s Palsy is called: Wind-Induced Deviation. The treatment strategies include resolving wind and moving blocked energy in the affected channels.

*It’s interesting to note that common TCM patterns in type II diabetes and upper respiratory tract infections include Liver Qi Stagnation and Heat. Liver Qi Stagnation, if left unchecked, eventually leads to a Wind condition. Upper respiratory ailments are considered Wind Cold and Wind Heat attacks, according to TCM.

 

Channel Diagnosis:

Multiple acupuncture channels run through the face. Specific channels that affect Bell’s Palsy include the Stomach, Large Intestine, Small Intestine, and the Triple Energizer.

When internal wind creates blockages in these particular channels, acupuncturists often find great results using electrical stimulation. My personal experience shows that if treatment is done early, five visits are usually sufficient to resolve symptoms of Bell’s Palsy.

 

Problem:

The band aid approach offered through Western medicine works for some. This is why Western medicine has deemed Bell’s Palsy to disappear on its own in many cases. In my opinion, taking the “wait and see” approach is risky. Why risk having symptoms at the end–when you could have tried TCM. It’s proven to work.

I can’t tell you how many people I’ve met over the years that call me months to years after a Bell’s Palsy attack, asking if acupuncture can help. First, they waited the initial two weeks suggested by the Western MD to see if  the symptoms would resolve; then they continued to wait the extended 3-6 month recovery time.

What was the result? Unfortunately, they didn’t receive the “hoped for” full recovery presumed by their Western doctors. Obviously, no one had educated them regarding the benefits of acupuncture EARLY ON for Bell’s Palsy.

In order to get EXCELLENT results for Bell’s Palsy, it’s important to treat the underlying pattern and channel blockages, that only the acupuncturist understands, immediately! I like to teach my patients that the sooner they get in, the better their prognosis will be. I even keep myself available for same day and weekend treatment for Bell’s Palsy cases. Treating the underlying pattern and channel imbalances before treating symptom relief brings the best results.

About 40,000 people in the United States experience a Bell’s Palsy attack each year. Let’s teach them that acupuncture can help!

**********

You’re probably wondering what points I used and what my treatment strategies were. Keep reading, because I’ve got a great case study to share!

---

How often do you treat Bell’s Palsy? I’m guessing not very often in relation to everything else you treat.

When a Bell’s Palsy patient comes through the door, are you ready to handle the problem immediately?

Before I move into the case study portion of this blog let’s take care of two issues.

#1: Did you read my blog from a couple of days ago: Bell’s Palsy–Part 1?

#2: I want to share a few things I’ve learned via my “research time” on this article.

I looked through PILES of TCM textbooks looking for a classic Bell’s Palsy protocol.

Could I find one? NO!

I found a ton of information in relation to the patterns I spoke of in my last blog: Heat, Liver Qi Stagnation, Blood Deficiency, etc.; but I couldn’t find a great discussion and treatment strategy on the subject of Bell’s Palsy.

I even tried looking in the modern textbooks that break information into Western and TCM approaches.

Here’s the thing that disturbed me most about this problem… What if I were trying to find a protocol IMMEDIATELY to treat Bell’s Palsy? My huge pile of TCM textbooks weren’t helping me.

Here’s the good news. Luckily, I was doing all of my “textbook surfing” for this article AFTER I had successfully treated the patient. In order to get started immediately, I didn’t need to search all of my texbooks. Instead, I went right into the reference section of my AcuGraph and found EXACTLY what I needed!

Okay, now that I got that off my chest, let’s move on to the case study.

**********

Case Study: 28-year-old female

Chief Complaint: Bell’s Palsy–right sided

• Onset: 8 days ago
• Characteristics:
  • Started with a feeling of numbness in her tongue. The next day it moved to her eye, and then progressed to her nose and mouth. Dull pain behind the ear. Numbness stayed at the same level; eight days later she was just as numb as on day one.
  • Only able to taste food on the left side of her mouth. Food on the right side tasted like plastic.
  • Earache in the right ear–touched TE 17.
• Western treatment: A “tapering pack” of Prednisone for six days; started at six per day and progressed to one per day. Symptoms did not go down, but they did not increase. Wearing a patch over the eye at night, because the eye wouldn’t close fully when sleeping.
• Related factors:
  • 27 weeks pregnant
  • Eye twitching–often. Occasional muscle spasms.
  • Husband keeps a fan on at night.
  • Restless leg. Worse since pregnancy. Had the problem since childhood. Hereditary.
  • Has had two wind/heat attacks since pregnancy.
  • Tends toward nasal congestion.
• Tongue: Red petechia, deviated.
• Pulse: Thin and wiry.

Working diagnosis BEFORE graph analysis:  Liver Qi Stagnation leading to internal heat and wind. Lingering external W/H attack.

Let’s take a look at her graph on her first visit. I’ll talk about what comes to my mind when I’m looking at each individual graph.

 

Baseline Graph

In this graph, we’re looking at upper body channels versus lower body channels. In general, there are a few things that come to mind:

• Both the Triple Energizer and the Gallbladder channels are split. Notice that they are both more excess on the right side than the left. This makes sense to me because the patient is presenting with right-sided Bell’s Palsy.
• The Small Intestine channel is excess as well. The Small Intestine channel goes right through the problem areas of the face. Both sides are excess. I’m guessing she has shoulder tension as well.
• I can also click on each of these splits to show the patient the pathways they affect. She really liked seeing these pictures. It helped her have faith in my diagnostic skills and my understanding of her problem. The graph “made sense” to her!
• Out of all of the channels that could be effecting her face, the graph helped me think maybe the Triple Energizer was the main problem.

Yin/Yang Graph

The Yin/Yang Graph helps me decide which yin channels are my priority for the ROOT treatment.

• Based on the Yin/Yang Graph, my goal for treatment is first tonify the Liver channel and then to sedate the Kidney channel. (NOTE: If you studied Jake Fratkin’s advanced training seminar, Clinical Applications of AcuGraph Meridian Diagnostics, this will make perfect sense to you.)
• I’m questioning whether the patient’s heat came from Liver Qi Stagnation or Liver Blood Deficiency. Usually when the Kidney channel is excess I see a yin deficiency pattern. Hmmm…. This leads me to ask more questions. Have you had night sweats? Have you been dizzy? Do you have dry skin? How about floaters in your vision? She confirms with a yes to all questions.

I usually look at the yang channels in relation to tendinomuscular treatment. Today this is not my priority, but I do notice a few things:

• The Small Intestine Channel is excess and the Bladder is deficient. The Tai Yang paired channels are not working together. If I were to treat BL 58, the two channels would balance. Bladder 58 is the Luo point. The Luo point is like a secret passage between the two channels. With treatment, it will allow some of the excess from the Small Intestine channel to flow over into the Bladder channel.
• The imbalance in the Shao Yang paired organs are obviously in relation to the Bell’s Palsy. Both are split, both go through the face, and they are both excess on the right.

 

Energy Cycle Graph

The energy cycle graph is a nice way to explain what happens in the body when energy isn’t flowing the way it needs to. It gives the patient a really nice visual.

• I can easily show the patient why the Small Intestine channel is excess. Because the Small Intestine channel is holding onto energy, the Bladder channel becomes deficient.
• The same goes for the progression of energy from the Triple Energizer to the Gallbladder to the Liver. Do you see the gradual downward slope after the Triple Energizer channel, all the way to the Liver? When looking at the flow of energy via the Energy Cycle Graph, often you can see the original cause of problems.

 

Diagnosis AFTER Graph analysis:

Yin and Blood Deficiency leading to internal heat and wind. Lingering Wind Heat attack.

 

Treatment

• Root treatment–balance the graph: KI 3, LR 3, SP 3
• Branch treatment–Bell’s Palsy: TE 17, GB 14, Tai Yang, SI 18, ST 7, ST 4, ST 6 and LI channel ashi points 8-12. (Note: These points are listed in the reference section of AcuGraph)
• Branch treatment–shoulder tension: BL 58

You might wonder why I didn’t choose to treat Large Intestine 4. I wanted to be cautious because Large Intestine 4 is contraindicated in pregnancy. My thought process created an internal struggle because Large Intestine 4 is also the main point for any problems in the face and head. For her first visit, I chose not to treat it, but I did send an email to my friend Debra Betts–world renowned pediatric acupuncturist–to ask her advice. This was her reply:

The answer to your question is that is possible to use LI 4 if you want–you just need to take into consideration the stage of the pregnancy and be prepared that she may experience contractions after the treatment–but this is not the same as inducing labor. The best points [really] depend on the channel pathway affected. If needed, TE 5 can also be useful as a distal point, as can the Stomach and Gallbladder spring points.

It also depends on how long she has been experiencing symptoms as you can expect more response from acute conditions, while you may need to use stronger points for [Bell’s Palsy] over a 3-week duration. I hope that helps.

Best wishes,

Debra Betts

 

5 days later…

Her graph changed tremendously. I won’t go through my entire thought process from graph to graph for the second treatment, but I will share a few thoughts.

• The Small Intestine channel has gone down considerably! She is no longer experiencing shoulder tension. I really love using BL 58!
• The Triple Energizer is looking a LOT better.
• The Kidney channel went from excess to deficient. When I see excess in the Kidney channel I’m thinking yin deficiency heat presenting as excess in the channel. I don’t always expect a RED Kidney channel to change to GREEN with a single treatment. Once the excess heat is resolved, it usually then changes to BLUE because the Kidney is still deficient. Once the excess heat is resolved I focus on tonifying the Kidney channel.

The patient reported that the pain behind her ear had gone down significantly; and at times it was gone completely. She said that her hearing was sharper in the right ear and that her mouth “started smiling again.” Basically, she reported that she was experiencing gradual changes day by day.

Here’s how I treated on her second visit.

#1: Balance the Graph (Root Treatment)

• PC 7: Source point; works well for tonifying or sedating.
• KI 3: Source point; works well for tonifying or sedating.
• LR 3: Source point; works well for tonifying or sedating.

(*The basic theory in AcuGraph is to treat the tonification point for deficient channels and the sedation point for excess channels. In our Advanced Training Seminar with Dr. Jake Fratkin, he teaches alternative points to tonify and sedate.)

#2: Bell’s Palsy (Branch Treatment)

• Repeat of points from five days previous: TE 17, GB 14, Tai Yang, SI 18, ST 7, ST 6; LI channel ashi 8-9.
• Electrical Stimulation: TE 17 to TE 3; ST 7 to ST 44 (25 hz for 30 minutes)

One week later:

I treated the patient one more time with the same strategy. First, I balanced the graph; then I added the treatment recommendations from AcuGraph–with electrical stimulation. The only thing I did different on the third visit was add TE 20 ashi because when I palpated this point she felt radiation from her area of lingering pain all the way to the little bit of remaining stagnation in her eye.

Because of holiday travel schedules, I wasn’t going to be able to see her again for two weeks, so I opted to send her home on the last visit with ear seeds. I asked her to press on the ear seeds 3-5 times per day and touch base with me in a couple of weeks after the holidays.

(*I don’t recommend ear treatment as the only source of treatment for Bell’s Palsy. Auriculotherapy is a great adjunctive treatment, but balancing the graph and treating the problem channels are key.)

 **********

Since you already know the end of this story, I don’t have to go into a long elaborate happy ending. The truth of the matter is, I never saw her again. The part that makes me smile is the text message she sent me after the first of the year.

You’ve heard it from me before, but I have to say it again… I REALLY LOVE MY JOB!

 

---

We’ve talked about how to educate your patients about Bell’s Palsy. Now, if you’ve educated everyone well, your patients and their friends should know when to call you.

Next, we talked about how to treat a Bell’s Palsy patient to get excellent results.

When I finished up the case study up to the point above, I felt like something was missing. It’s been bothering me ever since.

How many times have we done an awesome job treating a patient, and then we never see or hear from them again?

Somehow, this Bell’s Palsy patient fell through the cracks. The fact that “I never saw her again” tells me that I failed to teach her something important.

Bell’s Palsy is preventable. 

 **********

Since writing this Bell’s Palsy series, I’ve received emails and talked to a number of people who have had recurring bouts of Bell’s Palsy. From a Western perspective, recurring Bell’s Palsy is just the luck of the draw. Some get it and some don’t. If you get it, you’re one of the unlucky ones.

From a Traditional Chinese Medicine (TCM) perspective–there are preventative lifestyle choices the patient can make to avoid the “odds” of getting Bell’s Palsy.

In Bell’s Palsy–Part 1 we talked about the nature of INTERNAL wind and how it manifests in the body according to TCM.

I failed to mention how EXTERNAL wind can also attack the body. According to TCM, external wind is either natural or artificial. Natural wind is easy to understand. If you can see the trees and bushes moving, there is wind. Artificial “wind” is a little different. This wind comes from cold/hot air generated from an air conditioning or heating vent, riding in a vehicle with the window open, and even riding on a motorcycle or in the back of a pick-up truck without proper covering.

The latter type of “wind” enters externally through the pores of the skin causing similar imbalances as internal wind. Here’s the difference.

Internal wind is generated within and manifests internally first–seizures, convulsions, stroke, etc.

External wind enters through the pores of the skin and starts out more on a superficial level. When someone gets a cold or the flu–we call this an external attack of Wind/Cold or Wind/Heat. This type of wind enters the body through open orifices such as the mouth, nose, eyes, etc. It can also enter through any exposed area of skin and seems to be most susceptible near the neck, upper back and shoulders. The Chinese figured out early on that airborne illness can be transferred from person to person through the air via external “wind.”

Wind from Bell’s Palsy can be either internal or external in nature. The two main TCM diagnoses for Bell’s Palsy are:

• Liver Qi Stagnation leading to internal heat and wind.
• External attack of wind resulting in obstruction in the channels affecting the face.

The good news: Most wind is preventable.

**********

How to PREVENT Bell’s Palsy:

#1: Teach your patients the value of wearing a scarf.

Have you ever notice how people from Eastern cultures wear scarves? It’s not just a fashion statement!

• Wearing a scarf protects the most susceptible wind-attacked areas from the elements. It doesn’t have to be a big bulky scarf. Even thin scarves will protect your neck and shoulders. Keep one in your car for sudden changes in weather. Always have a scarf in your bag when you get on an airplane.
• Avoid sitting near an air conditioning vent. (Use a scarf if you can’t avoid it!)
• Don’t sleep with a fan blowing on you.
• Avoid sitting or sleeping in cold drafty areas.
• Never ride in the back of a pick-up truck or on a motorcycle without protecting your neck.
• When you get out of a hot tub, swimming pool or even a shower–cover up immediately. When your pores are open you are even more susceptible to external wind.

#2: Monthly wellness AcuGraph analysis and wellness treatment.

FACT: None of my wellness patients have ever come in with a Bell’s Palsy attack. Is that just the luck of the draw? I don’t think so!

Wellness patients come in at least once a month for a balancing treatment. AcuGraph analysis shows how the patient is progressing from treatment to treatment. It allows the practitioner to take care of potential problems before they turn into something bigger. Comparing graphs on a monthly basis allows the practitioner to see when something has shifted for the patient.

Take a look at the graphs above. I treat this patient on a monthly basis. For the most part, she does pretty well. Look at Month 3. She had a bad month. Notice the SI, TE and LI channels. They are all excess. She was holding onto a lot of shoulder tension. I don’t see excess in the Liver channel (it actually shows as deficient). Let’s take a look at those excess shoulder channels. Shoulder tension is one of the first steps to a build up of stagnation and heat in the body. Western medicine calls this inflammation. You can tell that stress is sneaking in!

I’ve taught my patients not to panic when looking at what they consider a “bad graph.” Here’s my typical response.

“It looks like you are experiencing “LIFE” and that’s okay. I’m glad you’re here to put your body back into balance. Relax and enjoy your treatment. Everything will be flowing smoothly when we are done.”

The likelihood of developing Liver Qi Stagnation to the point of further evolving into heat and internal wind are not likely if the patient is receiving regular acupuncture.

Patients who have a tendency toward Liver Qi Stagnation should also be taught lifestyle habits to be incorporated at home to keep Liver Qi moving so stagnation and heat do not evolve.

• Daily exercise.
• Don’t work too long in front of a computer without getting up to move qi. I suggest patients take a walk around the office every 2 hours. My favorite way to move qi while I’m at work is to use a mini trampoline two or three times per day.
• Find a way to release stagnant emotion–such as journal writing, talking to a friend or learning good communication skills through a counselor.

**********

It’s nice when preventative medicine is enjoyable! My wellness treatments typically consist of AcuGraph, acupuncture and a little bit of back and shoulder massage.

And for those who are trying to avoid Bell’s Palsy, who doesn’t’ enjoy a new scarf (or two)? Right?!

Maybe I’ll send this article to my long-lost Bell’s Palsy patient so I don’t get that panic call later.

Have a great day!

Read ‘Bell’s Palsy…a Case Study’ here.

.  ………

---

Related Reading

• Acupuncture Cured Angelina Jolie’s Bell’s Palsy
• The Stubborn Graph: A Case Study
• Case Study: The Kidney Return Protocol