(Note to readers: This post addresses the issue of facial nerve Bell’s) palsy due to viral infection. The research review and treatment algorithm do not apply to facial nerve palsy of other etiologies; for example, traumatic injury or stroke.)
As many a Poz reader likely already knows, my longtime friend and ACT UP brother woke up with half of his face paralyzed a day or so ago.
The dreaded inflammation of and subsequent compromise of cranial nerve VII.
It’s a frightening experience, as you might imagine. It happened to me during a high-stress period in my life around 2005 or so. And a woman in my program here at Pacific had it as a sequela of Lyme disease. The NINDS tells us that, “Bell’s palsy afflicts approximately 40,000 Americans each year: men and women equally and can occur at any age, but it is less common before age 15 or after age 60. It disproportionately affects people who have diabetes or upper respiratory ailments such as the flu or a cold.” They might need to update this to include Borrelia burgdorferi infection (aka “Lyme”).
(If I may add parenthetically here.. if I were a woman (or man for that matter--although I am told the risk is much less for young men) in my 30s or 40s infected with Lyme, I would seriously consider seeing a Chinese herbalist once my Lyme had been successfully (or, worst case scenario, unsuccessfully) treated in order to “soothe” my immune system so as to minimize the risk of developing any secondary autoimmune disorders. This is one thing I am convinced that Chinese medicine does really well--again, assuming you have an experienced or resourceful and thoughtful herbalist.)
That said, the Traditional Chinese Medicine teaching of and treatment approach to Bell’s palsy has long infuriated me. We are taught that it is caused by a “pathological Wind” and are quaintly instructed to, well, “expel” the Wind and maybe “warm the channels” and “restore the qi mechanism” to the (exclusively Yang) meridians that originate or end in the face: Stomach, Large Intestine, Urinary Bladder, and 3 others.
At a Society for Acupuncture Research conference I was attending in Ann Arbor this past spring, this peppy group of Chinese (TCM) researchers (from Chengdu TCM University) enthusiastically reported their results of electro-acupuncture on a rather large group of hospital patients who presented (quite early I must say) with this facial nerve palsy. “Symptoms resolved completely or near completely within 7-10 days in nearly 80% of the people,” they gushed. Sounds great but guess what: symptoms resolve completely or nearly completely within 7-10 days in people who do absolutely nothing! Folks who seek prompt (and I mean PROMPT) medical attention will very likely be prescribed an antiviral medication (typically an acyclovir (anti-HSV) product: if memory serves, valacyclovir is actually much more effective than the old acyclovir; or, where Lyme disease is implicated, I imagine doxycycline would be used) and a short course of prednisone (to reduce the inflammation). Under these conditions, I have seen the facial paralysis dramatically improve within a mere 24 hours. And disappear almost completely with 2-3 days. (Thank you, Dr. Shay! Isn’t it great when you have a physician who knows what s/he’s doing?)
I have heard numerous tales of exuberant acupuncturists (through no real fault of their own; they were just doing what they were taught in this country’s woefully remedial, largely TCM-dominated acupuncture schools) recounting how their rigorous training and deftly honed acupuncture skills “cured” their patients’ Bell’s palsy in 3 months, 2 months, sometimes 1 month. It causes me great sadness and embarrassment for someone who hopes one day to count myself among their fold. For better or worse (and only a fool would argue for the latter), we do not live in the time of the mythical Yellow Emperor or even Zhang Zhongjing, and, as such, we as students of this medicine in a post-Galenic, post-Renaissance, post-Enlightenment era of bioscience and best evidence methods need to apprise ourselves (remember Harvey, Hunter, Virchow, Lister?) of the entire constellation of treatment options in cases like this--and choose the best possible modalities for our patients. Sometimes it is acupuncture; sometimes it is Chinese herbal medicine (but not in the case of Bell’s palsy!); but it might also be CBT, deep tissue massage, physiatry, hypnosis, chiropractic, guided self-care, breathing exercises, or yes, even surgery or prescription pharmaceuticals.
From what I have seen, acupuncture can be a useful adjunct to Western medicine--but it should not replace it. My advice to a family member would be to seek Western med first. If after 7-10 days symptoms have not resolved 90% or so (sometimes there is an eye that won’t quite close on its own, or a slight asymmetry if one looks really, really closely), then you might want to seek out a (highly trained and experienced) acupuncturist. Of course, it doesn’t hurt to pursue the two in parallel (if you’re flush with cash, have good insurance and live somewhere where this is an option) from Day 1 (okay, Day 2), but there is not yet any compelling evidence to show that acupuncture shortens the time to resolution of symptoms.
I am not aware of any Chinese herbal formulas that are effective (certainly not Qian Zheng San), but am open to the prospect of a utility for moxibustion--it’s just that I am pretty sure I would not want people burning things on my face! Since some of these “Yang” channels of the face begin (or end) at the finger and toes, it of course possible that the moxibustion could be done there.
I had a long discussion with the woman from the China research team and the impressive fellow who heads up the University of Maryland’s integrative medicine program. He, and another very impressive researcher from Stanford who also did the Mandarin-English translations during the session, and I agreed that the studies that need to be done in acupuncture for facial nerve palsy are ones that look at differences in time to resolution of symptoms--West medicine or no rx +/- acupuncture. To my knowledge, these studies have still not been competently performed. Until then, it’s all (as, sadly are many aspects of TCM acupuncture) an article of faith.
This has been my experience and observation over the past 5 years. I welcome corroborative and dissenting first-hand evidence. I see that the Society for Acupuncture Research has Bell’s palsy “on deck” for its next (which now itself has grown somewhat controversial, I realize) EBM guidelines.
Mike Barr is a board certified acupuncturist and herbalist and can be reached at Manhattan Acupuncture Associates, with offices at Columbus Circle and Flatiron. His expertise and interests include sports acupuncture, pain syndromes, liver health, immunological support, low energy, mood disorders, anxiety, insomnia, GI complaints, and herbal and acupuncture approaches to getting off/putting off prescription medications of unsatisfactory or unclear benefit, and in helping to manage the side-effects of other necessary and life-saving biomedical interventions. He has also been busy exploring the application of East Asian herbal therapies, and specific acupuncture protocols, for all aspects of sexual health and anti-senescence.