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
- 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.
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.
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.
- 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.
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!
I hope you enjoyed this two-part case study. Please educate your patients and everyone you know about the benefits of acupuncture and Bell’s Palsy.
It really works and the AcuGraph documents their progress every step of the way! Watch this video to see AcuGraph in action.
Talk to you again soon…
Kimberly Thompson, L.Ac.
Acupuncture Research Analyst