Exploring the Timing of Acupuncture in Facial Nerve Paralysis Treatment – Is Early Intervention in the Acute Phase Beneficial?

Facial nerve paralysis, also known as facial neuritis or Bell’s palsy, is clinically divided into three phases:

1. Acute Phase (days 1–7 after onset)

2. Stagnation Phase (days 8–15 after onset)

3. Recovery Phase (more than 15 days after onset)

The optimal timing for acupuncture treatment in facial nerve paralysis has long been a subject of debate. Traditionally, some argue that acupuncture should be avoided during the acute phase because the facial nerve is extremely vulnerable and early needling might further damage it. However, recent clinical observations suggest that providing a gentle, positive stimulus to the nerve during the acute phase may actually improve the chance of recovery.

Clash Between Traditional Views and Modern Observations

Traditionally, experts have expressed concerns that applying acupuncture during the acute phase might trigger local inflammation and worsen nerve injury. As a result, many recommended waiting until the condition stabilizes before initiating treatment. Yet, recent clinical studies are challenging this notion:

• Research by Fang Meishan and Colleagues
  In one study, facial paralysis patients were divided into two groups:

  • Acute Phase Group: Patients whose onset was within 7 days

  • Control Group: Patients with onset beyond 7 days (including stagnation and recovery phases)

  Both groups received acupuncture at the same acupoints. The results showed that the acute phase group achieved a cure rate of 85.2% and an overall effective rate of 100.0%, whereas the control group had a cure rate of only 66.7% and an effective rate of 97.2%. Statistical analysis (P < 0.01) indicated that acupuncture treatment during the acute phase significantly improves the likelihood of recovery.

• Li Hong’s Perspective
  Li Hong advocates that the best time to perform acupuncture is during the acute phase. She suggests applying gentle and shallow needling to the facial acupoints in the acute phase—using distant acupoints such as Hegu and Taichong with a dispersing (or “draining”) technique to minimize stimulation. Then, during weeks 2–6 of the recovery phase, electroacupuncture can be introduced to enhance stimulation, while after week 6, a shift to a retention needle technique is recommended. Clinical observations have shown that this phased approach yields significantly higher cure and effective rates compared to waiting for later phases (P < 0.05).

Why Might Early Acupuncture in the Acute Phase Be Advantageous?

Recent clinical observations suggest that during the early (acute) stage, the facial nerve is in an initial phase of injury. At this stage, providing an appropriate, benign stimulus may:

• Activate Nerve Cells: Improve local blood circulation and stimulate nerve regeneration.

• Prevent Muscle Atrophy: Assist in muscle activation to maintain tone and function of the facial muscles.

• Promote Functional Reorganization: Early intervention may encourage cortical reorganization in the brain, enhancing the potential for nerve recovery.

However, acupuncture in the acute phase requires strict control over the technique—using a gentle, shallow insertion to avoid excessive stimulation that could cause local inflammation or pain.

Clinical Considerations

1. Individualized Treatment: Every patient’s condition and constitution vary, so the acupuncture approach in the acute phase should be tailored accordingly.

2. Gentle Technique: Acupuncture in the acute phase should be performed using gentle, superficial needling to avoid excessive stimulation.

3. Monitor Patient Response: It is crucial to closely monitor the patient’s response during treatment, and adjust the treatment plan if any adverse reactions occur.

4. Phased Management: Different phases of the disease should be managed with different techniques—gentle acupuncture in the acute phase, possibly followed by electroacupuncture or retention needling as recovery progresses.

Conclusion

In summary, while traditional views caution against acupuncture during the acute phase of facial nerve paralysis, a growing body of clinical evidence indicates that gentle and appropriate acupuncture intervention during this phase is not only safe but may significantly enhance cure and overall effective rates. Future research should further clarify the optimal acupuncture techniques for each phase, paving the way for more individualized and precise rehabilitation strategies.

What are your thoughts on using acupuncture in the acute phase for treating facial paralysis? Feel free to share your experiences and viewpoints in the comments below!

https://www.hanspub.org/journal/paperinformation?paperid=96613