Retrospective Study Of Acupuncture And Moxibustion In The Treatment Of Bell’s Palsy In Recent 10 Years

Objective:To analyze the clinical characters of Bell’s palsy in Guangdong Province,research the influences of Bell’s palsy clinical effects in the treatment of acupuncture and moxibustion,and the injure condition of facial nerve,such as the situation of onset,different therapeutic method,basic diseases.To obtain a proper,effective,comprehensive treatment protocols.Methods:Collect clinical information of inpatient from Traditional Chinese Medicine Hospital of Guangdong Province according to the observation of Bell’s palsy medical cases in the recent 10 years.Use SPSS 23.0 to realize the statistics and analysis,including ANOVA,Spearman rank correlation analysis,logistic regression,data-mining,ect.Results:277 cases of Bell’s palsy:Male 138(49.8%),female 139(50.2%).Age range:4-86 years old,average 51.3±15.79 years old.Average length of stay:15.69±5.46d.Average diagnose time:1.71±1.23d.Onset season:Spring 71(25.6%),Summer 66(23.8%),Autumn 65(23.5%),Winter 75(27.1%).The most common inducement is blowing and catching cold(41.8%).The most common syndrome is obstruction of collateral due to wind-phlegm.(62.1%).Disease location:under stylomastoid foramen 222(80.1%),tympanic cord 34(12.3%),stapedial branch 21(7.6%).Most patients are HB IV:206(74.4%).Recovery patients 15(5.4%),Effective 191 cases(69%),low effective 57(20.6%),non-effective 14(5.1%).Previous medical history:hyper lipidaemia 138(49.8%),hypertension 99(35.7%),hyperuricemia 92(33.21%),insomnia 72(26%),diabetes 64(23.1%);Refers to 10 concomitant symptoms,facial nerve injure under stylomastoid foramen are common with lacrimation,earache,facial pain.Tympanic cord:earache,lacrimation,facial paresthesia.Stapedial branch:earache,lacrimation,tinnitus.Treatment timing:Corticosteroid(3.37d),Neurotrophy medicine(4.34d),Antiviral drug(5.24d),Acupuncture(5.92d),Moxibustion(7.24d),Rehabilitation therapy(16.04d),HPO treatment 17.72d).263 cases of scalp acupuncture treatment,according to cluster analysis,there are two efficient clustering:middle forehead line-Parietal&temporal oblique front line-temporal front line;Parietal sideline Ⅰ-Parietal sideline Ⅱ-forehead front line.When distance 15,dendrograms shows two clusters:one is motor area 2/5-blood stretch-contraction section,the other is 10 acupoints rest.Abdominal acupuncture according to cluster analysis,there are three efficient clustering:Qingre-jiedu points-wind-damp triangulation points-RN9-RN11,Qipang-Qixue,ST25-SP15;When distance 15,dendrograms shows three clusters:RN12-RN10-RN6-RN4-KI19,ST24-ST25-ST26-KI17-SP15-Qipang-Qixue;Qing re-jiedu points-wind-damp triangulation points-RN9-RN11.Body acupuncture gets 2 efficient clustering:DU20-DU29;GB14-ST4-EX-HN5-LI4-LR3.Moxa-cone moxibustion gets 3 efficient clustering:ST36-ST6,Qianzheng-EX-HN5-SJ7-GB14-ST4,BL5-BL19,When distance 20,dendrograms shows 3 clusters:BL20-BL21-RN12,facial pressure points-EX-HN14;Blood-letting puncture shows 3 clusters:SJ17-EX-HN5,BL17-BL19,BL12-BL12,dendrograms shows Ear apex-Ear back-DU14 could form flexible compatibility of other acupoints.Auricular points show 3 clusters:Sympathy-Cervical spine,Gallbladder-kidney,Heart-Shenmen.When distance 10,dendrograms shows 2 clusters:Heart-Spleen-Shenmen-Cheek,Gallbladder-kidney-Sympathy-Cervical spine.In single factor analysis of facial nerve injure fators:anxiety(Z=-2.38),insomnia(Z=-2.480),disease location(χ2=8.341),NLR(Z=-2.059),P<0.05,all have statistics significance.Consistency check shows House-Brackmann does not match with EMG(Kappa=-0.09,P<0.05).In logistic regression model,two factors are significant:anxiety(β=-1.515,OR=0.220,95%CI=0.051-0.943,P<0.05),wind-heat syndrome(β=2.576,OR=13.15,95%CI=1.026-168.587,P<0.05),which indicate among moderate-severe patients,anxiety is independent factor,wind-heat syndrome is protective factor.Spearman rank correlation analysis shows that the degree of facial nerve injure is correlated positively with clinical effect.Rank-sum test shows 7 factors related:the degree of facial nerve injure(χ2=16.809,P<0.01),disease location(χ2=7.132,P<0.01),high postprandial blood glucose(Z=-2.280,P<0.05),stroke(Z=-2.084,P<0.05),facial palsy history(Z=-2.096,P<0.05),rehabilitation therapy(Z=-2.022,P<0.05),therapeutic regimen(χ2=98.728,P<0.01).In logistic regression model(χ2=26.897,P<0.001),four factors are significant which are facial palsy history(OR=5.607),stroke(OR=2.085),earache(OR=1.096),different therapeutic regimen(1:OR=26.629,2:OR=25.687,3:OR=33.818,4:OR=24.337),It indicates that facial palsy,stroke are independent factors of medical efficacy,concomitant symptom of earache could be a protective factors of Bell’s palsy,therapeutic regimen of Group1-4 may improve clinical effects than Group 5.Conclusion:1.In this study,the rate of Bell’s palsy is higher in middle-aged people without obvious gender distribution.In morbidity season distribution,winter spring two seasons slightly common.2.Most of patients belongs to syndrome of obstruction of collateral due to wind-phlegm.HBIV is the most common type.Most patients could acquire earlier diagnosis and treatment,average1.71d.Average in 7d got medicine and acupuncture and moxibustion treament after onset,rehabilitation and HPO treatment started average 15d after onset.3.In Guangdong hospital of traditional Chinese medicine acupuncture department,our comprehensive treatment plan refluects the principle of syndrome differentiation of Zang-fu viscera,especially attach importance to heart,gallbladder,spleen,stomach.Selecting distant also local points to realize the regulation of mind.4.The affecting factors of facial nerve injury include:Anxiety,wind-heat syndrome,high NLR,disease location,insomnia.5.The affecting factors of the acupuncture curative effect could be divided into three parts:(1)Disease features:the degree of severity of Bell’s palsy,injury location,the syndrome of earache.(2)Patient conditions:Previous medical history of facial palsy or stroke,postprandial blood glucose.(3)Different treatments interact with each other:neurotrophy medicine and antiviral drug treatment could improve the effect of acupuncture,but corticosteroid is a undetermined factor.The effect of acupuncture and moxibustion combined therapy maybe inconsistent with hormone.6.As for evaluate the function of facial nerve,consistency check shows House-Brackmann does not match with EMG.House-Brackmann is more suitable for early clinical diagnose.