The first thing you think when you’re experiencing your first episode of Bell’s Palsy is, “am I having a stroke?!” Thank goodness the answer is no, you are not having a stroke! While a stroke is due to the blockage of blood flow to the brain, Bell’s Palsy (also called idiopathic facial paralysis) is not a result of brain damage nor a blockage of blood flow. It is a temporary disorder of the facial nerve (7th cranial nerve) that leads to flaccidity and drooping of the facial muscles it innervates, leaving the face looking lop-sided and the affected eye unable to close right away. No one is at particular risk of getting Bell’s Palsy as it is a rather democratic condition that can affect anyone at any point, but there is a strong correlation between Bell’s Palsy and recent viral upper respiratory infections as well as some correlation between Bell’s Palsy and pregnancy, diabetes, and autoimmune conditions.1 Some health professionals relate Bell’s Palsy to a complication with the herpes simplex virus (cold sores) or herpes zoster (shingles).2 This is why when you go to the doctor with Bell’s Palsy they’ll send you home with an anti-viral medication, a corticosteroid to reduce inflammation, and eye drops to ensure your eye on the affected side does not get too dry.
So the good news is that Bell’s Palsy usually isn’t indicative of a serious health condition. The not-so-good news is that you never know when it will go away - it can take anywhere from 2 weeks to 6 months to resolve, with 85% of cases showing improvement within 3 weeks.1,3 That is a long time to wait with uncertainty, and in many cases it can take months to regain total function of the facial muscles.
Bell's Palsy, Acupuncture, and Chinese Medicine
This is where acupuncture can help. Recommended by many esteemed Western medical institutions such as John’s Hopkins and the Mayo Clinic as an alternative treatment for Bell’s Palsy, acupuncture and Chinese herbal medicine have diagnosis and treatment tools that lend itself to the enigmatic nature of Bell’s Palsy. In Chinese medicine Bell’s Palsy and other forms of paralysis are seen as a result of the pathogenic factor called wind that has gotten trapped in the channels on the face that closely trace the 7th cranial nerve. We can tell if wind is present by the pulse and sometimes the tongue, although acute-onset conditions don’t always show themselves on the tongue. Wind can be generated by several factors - external invasion (aka common cold), poor diet, overwork, and stress to name a few.
Chinese Medicine - and the broader East-Asian Medicine which roots itself in the Chinese classic texts - has many ways to approach expelling wind in the case of Bell’s Palsy. As the saying goes, 'there are many ways to skin a cat'. Some practitioners use electro-stimulation, others rely solely on herbal formulas, while others use massage and other bodywork techniques. As a practitioner of Japanese Meridian Therapy, I focus treatment for Bell’s Palsy based on the lineage popularized by Ikeda Masakazu (referred to as Ikeda Sensei) which uses needles, moxibustion, and herbal formulas based on the famous text the Shang Han Lun. Below is a case study of one of my patients who made a complete recovery from Bell’s Palsy in 13 days after initial onset with the help of 5 acupuncture treatments and an herbal formula.
13 Days, 5 Acupuncture Treatments, 1 Herbal Formula
Helen*, 30 year old female, came to my clinic presenting with unilateral facial paralysis on the left side. Onset was 2 days prior, at which point she visited the ER where she was diagnosed with Bell’s Palsy.
Treatment #1 - 2 days after initial onset
During our initial intake, it was revealed that she was going through a breakup with her partner of 9 years, was having very painful periods that were irregular, had chronic shoulder tightness, and was having poor sleep for several weeks. Her pulse was almost textbook from the Facial Paralysis section of Ikeda Sensei’s book “The Practice of Japanese Acupuncture and Moxibustion” - overall wiry and slightly rapid with deficient Liver and Kidney pulses with floating Stomach and Large Intestines pulses, leading to a diagnosis of Liver Deficiency Yin Deficiency Heat leading to wind in the Yangming channels on the face. That was helpful as the treatment was relatively straight forward - initial focus was on strategic points on the hands, feet, and abdomen related to the moving excess from the Yangming meridians, followed by points on the face that had a “hard” quality to them, then the root treatment to address the underlying Liver Deficiency (aka blood deficiency) with needles and moxibustion. Then the patient flipped onto her front so I could work on her back where we worked on loosening her shoulders using a gua sha scraping technique, since Ikeda Sensei emphasizes that patients cannot recover from facial paralysis quickly if their shoulders remain tight. After gua sha needles were placed in areas the mimicked the treatment on the front, with the addition of SJ17, GB20 and UB10 to help expel wind from the face while simultaneous helping to release the shoulder and neck tension. After the treatment I instructed her to cover her neck, face and head at all times since it was especially windy in the East Bay during this time. No herbs were given at this time.
LI2 St44 LI11 R12 St25 St4 St3 YuYao St7 LI20 St6 St8 R24 Du24 + root (Lv8 Kd10), moxa St36 moxa Sp6 moxa R4, SJ17 GB20 UB10, Kd chnl back (aka HuaTouJiaJi) 3 pts both sides, SI11 SI10R, UB18 UB21 UB23 UB25 UB58
Treatment #2 - 4 days after initial onset
Helen came to the next appointment with “cautious optimism” - she has been noticing small signs of improvement when doing certain tasks such as putting on chapstick and drinking water. She lied directly on the table so I could feel her pulses - it was similar to the last treatment except now her Heart pulse was deficient and the quality had gone from wiry to thin. Because of the heart pulse I asked about her sleep, at which point she revealed she didn’t sleep at all the night before because she was extremely hot as she used to run a fan at night to keep her cool but over the last few days she did not as per my instructions to protect herself from wind. We then proceeded with the treatment, which was very similar to the first treatment with more emphasis on nourishing blood and relieving shoulder tension in order to speed up recovery. A raw herbal formula was given with an emphasis on expelling wind and damp from the face and slightly nourishing blood and yin. Although herbally I tend to stay in line with classic Shang Han Lun Formulas, I didn't have all of the herbs available that I needed so had to improvise using a variation of the 4-3-2-1 method taught to me by Dennis Von Elgg during graduate school.
Front: LI2 St44 LI4 LI11 Lu7 Du24 Du26 Ren24 St2 St3 St4 St6 St7 UB2 LI20 St8 GB15 YuYao, 3 ASHI points under mandible, SI19 St40 St21 moxa St25 moxa Sp6 moxa St36
Root: Lv8 Kd10
Back: SJ17 UB10 GB20, gummy pts on back Kd line, SI14 UB17 WeiGuanShaShu UB18 UB20 UB21 UB23 UB25 UB58
Herbal Formula: Custom Formula for Facial Paralysis based off of Ge Gen Tang + Si Wu Tang
extinguish wind (in face): FangFeng (50g) ShengMa (50g) ChaiHu (30g)
release muscle layer: GeGen (30g) GuiZhi (10g)
nourish blood: SiWuTang [ShuDi (10g) BaiShao (10g) DangGui (10g) ChuanXiong (10g)]
drain damp/calm spirit - FuShen (15g)
Treatment #3 - 6 days after initial onset
Helen returned to the clinic, this time controlling her giddiness at the progress she had been making over the previous 2 days. She reported feeling tingling under her zygomatic arch, "almost like the nerve is waking up", and seeing a marked improvement in the ability to move her face - her left lip corner actually lifted when she smiled, her eye was closing more to the point where last night she didn't need to tape it shut, and she could more easily sip water and brush her teeth. As for the herbal formula, she was grateful I wasn't next to her when she first drank it because it tasted "so nasty" that she would have had a few choice words for me :) Still she was being diligent about taking it every day and felt it was contributing to her face's marked improvement. She laid down almost immediately upon entering the clinic so that I could take her pulse, which was showed a similar picture as to the previous too treatments only this time her Spleen pulse was feeling rather choppy. I asked if she had any bowel changes and she reported that the formula was making her rush to the bathroom about 20 minutes after ingesting it. So I proceeded with a treatment very similar to the previous treatment, emphasizing on strengthening her digestion so that she could more easily assimilate the herbal formula, which she was instructed to continue with until the next appointment.
Front: LI2 St44 Lu7 LI4 LI11 St37, moxa St36 Sp6 St19 St25
Face: St2,3,4,5,6,7,8 LI20 UB2 YuYao QianJiang Du24 Du26 Ren24 Ren23 2 ashi next to Ren23 SI19 GB14 GB15 GB2
Root: Lv8 Kd10 contact Lv1 contact Kd1
Back: Myofacial release on levator/rhomboid, moxa ashi (SI chnl), SJ17 GB20 UB10 SI14 Du14 HuaTouT2/5/7 UB17 UB15 UB18 UB23 UB58
Treatment #4: 9 days after initial onset
Helen came into the clinic outright optimistic - she was making significant progress to the point where her family noticed a huge difference. Her left smile was now 70% recovered and her eye was closing 95% of the way. She hopped up on the table right away and in taking her pulse I noticed her Liver and Kidney pulses were very deficient and her Gallbladder pulse wasn't present, which would indicate Liver Deficiency Yang Deficiency rather than Yin Deficiency. I asked about her digestion and menses and she said her cycle was likely to start within the week and that she was having some diarrhea, which would explain the pulse change. The positive progress in her pulse was seen in the Large Intestines and Stomach pulses, which were no longer bounding and excess with only her LI pulse slightly floating. This meant that the wind was leaving those channels on her face, which would explain the progress. This treatment was different from the previous ones in terms of the root treatment and the amount of moxa used because of the pulse change. She was instructed after the treatment to continue with the herbal formula until it was finished which was just in time for her next scheduled appointment
Front: LI2 St44 LI4 Lu7 LI11 St25
Face: Ren23 2 ASHI on chin Ren24 St4 St5 St6 St7 St3 St2 QianJiang YuYao UB2 GB1 GB14 GB15 Du24 St8 UB4
Root: Kd3 Lv3 GB40 Sp1 moxa Sp6 moxa Kd3
Back: UB42 UB44 UB18 UB19 UB20 UB23, 3 pts each side HuaTou between C7 & T8, UB58
Treatment #5: 11 days after initial onset
Helen arrived at her next appointment in almost disbelief - her face had 95% recovered. Her smile was almost symmetrical, even showing her left dimple slightly, her eye was closing 100% and she could lift her left eyebrow normally. In taking her pulse she showed no further signs of wind in the channels and her pulse was back to showing Liver Deficiency Yin Deficiency but not nearly as much as it did in her first appointment and with a slight choppiness overall. The treatment focused much more on building blood to prevent any recurrence and the points on the face we did were more prophylactic than anything. We also focused on releasing shoulder tension as it was a chronic problem for her. After the treatment I sent her home with a granule formula to help her with her upcoming menses while continuing to build blood.
Front: Lv8 Kd10 Lv1 Kd1 LI4 Ren12 moxa Sp6 moxa St36
Face: Ren24 Du24 Du26 St4 St3 St2 GB1 YuYao St6 GB14 GB15 St8 UB2
Back: ontake roller upper back to release muscle layer, GB20 UB10 3 ASHI HuaTou UB13 UB15 UB17 UB18 UB23 UB58
Herbal Formula: Tao Hong Si Wu Tang granules
Treatments #6 on: 13+ days after initial onset
At her next appointment Helen was 100% recovered and continues to see me to this day to work on constitutional disharmonies more than anything.
My hope is that this case study proves to be helpful to patients and practitioners alike in demonstrating the power of acupuncture, moxibustion, and herbal medicine can have on reversing facial paralysis and Bell's Palsy. Helen's progress was profound, but it should be stated that she sought treatment immediately after initial onset and so it took less treatments to recover than it might for someone who has been afflicted for several months. Ikeda Sensei explains that recovery can happen anywhere from 3 to 20 treatments, but that in his 50+ years of experience his all his facial paralysis patients have significantly improvement if not recovered.
*name has been change to maintain privacy
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