| BackgroundPeripheral facial paralysis, also known as facial neuritis, and Bell’s palsy is more common in clinical. It is a Chinese medicine category as "Oblique Mouth", also called "Hanging Line Wind" and "Oblique Eye and Mouth", and it is a peripheral nerve disease caused by facial nerve in mastoid stem hole acute non-suppurative inflammation. When patients were acute attacked, clinical manifestations usually were:after waking up, they found that facial muscles on one side feel stiff, numbness and paralysis, the amount of grain disappeared, eye fission was larger, eye tearing exposed, nasolabial shallow, drooping mouth twisted to the contralateral, disease side could not frown, frown, eyes, teeth, drum cheek. Ear pain occurred in some patients at the beginning, caused 2/3 ipsilateral tongue taste diminish or disappear and hyperacusis embolism. Most patients recover better with clinical outcomes if treated in time. But there are some patients due to miss the best treatment time, or due to improper treatment, or because of illness in deeper parts, still left some serious symptoms of facial nerve damage despite aggressive treatment. It often referred to as intractable facial paralysis, or as "refractory facial paralysis," "severe facial paralysis" and so on. Currently, a generally accepted view for treatment of refractory facial paralysis is that it can basically identified as belonging to the category of refractory facial paralysis when there is no significant therapeutic progression after a few months of treatment.Most patients with refractory facial paralysis are treated fairly long period of time, using at least one method. But the illness delayed healing, so traditional acupuncture is difficult to succeed. Many physicians treated refractory peripheral facial paralysis by clinical routine acupuncture with moxibustion, Such as wen acupuncture, cyclotron moxibustion, ginger moxibustion, heat-sensitive moxibustion and so on. It has been reported that ginger and heat-sensitive moxibustion had higher markedly effective rate in treatment of refractory facial paralysis. Ginger moxibustion combines the function of ginger and moxibustion. So it had the stronger functions of driving out the wind and cold, warming meridian, adjusting qi and blood. When treating refractory facial paralysis, ginger moxibustion could retrieve the imbalance of qi and blood, improve meridian nutrition and the symptom of retardation disorders. With improving the nutritional status of the facial nerve, the function of the paralysis facial muscles could be restored. Heat-sensitive moxibustion is a new therapy can greatly improve the efficacy of moxibustion. The heat generated by Ai ignited towards acupuncture point, stimulated diathermy, thermal expansion, heat transfer, no partial (micro) heat but distal portion heat, the surface not (micro) heat but deeper part heat, heat-sensitive sensation but non-thermal, and air conduction. And it imposed individualized amount of saturated eliminate sensitive moxibustion. A study of heat-sensitive moxibustion more than 20 years showed that qi could inspired by heat-sensitive moxibustion, went to the place where the disease lived, reached the ancients requirement of "gas to and effective". Therefore, the effect of heat-sensitive moxibustion had greatly improved over traditional.Currently, the outcomes judgment of facial paralysis is mainly composed of the facial nerve function, such as HB grade,40 points method and Portmann clinical summary score. The outcomes judgment relied on clinical signs and lack of objective quantitative indicators, often influenced by subjective factors. The neurophysiological monitoring sensitive to nerve block and demyelination is a means of monitoring the integrity of the nervous system. Not only to determine the extent and scope of the damage, it also could guide treatment and prognosis, provided better objective quantitative screening method for the treatment of facial paralysis. Commonly used in clinical facial nerve electrophysiological examination including facial nerve motor conduction velocity (MCV), surface electromyography (EMG), facial electromyography (EnoG) and blink reflex (BR) and other projects. They accomplished by reaction that nerve fiber response to electrical stimulation, commonly used the amplitude and latency to express. In this study, the neurophysiological monitoring technology was introduced, combined 40 points method and H-B facial nerve function grading system, compared the outcomes between heat-sensitive moxibustion and ginger moxibustion for refractory peripheral facial paralysis.ObjectiveIn order to provide effective treatment options for the treatment of refractory peripheral facial paralysis and optimize the medical resources, in this study, refractory peripheral facial paralysis was treated by conventional acupuncture with heat-sensitive moxibustion and conventional acupuncture with ginger moxibustion, respectively. Variation of the indicators was observed before and after treatment, and compared the different outcomes of two treatments.MethodTime and place:this clinical trial is completed in acupuncture department of Southern Hospital from May 2013 to December 2014.Experimenter sources:acupuncture department, neurology department, rehabilitation department, and traditional Chinese medicine department of Southern Hospital affiliated to Southern Medical University. With strict control of inclusion and exclusion criteria, a total of 55 cases of patients were collected. They were randomly divided into the experimental group (conventional acupuncture with heat-sensitive moxibustion) 28 cases and the control group (conventional acupuncture with ginger moxibustion) 27 cases.Experimenter information:a total of 55 cases of patients which were randomly divided into the experimental group 28 cases and the control group 27 cases were collected in this study. Two cases in control group without statistical analysis because they dropped out during the study. Finally, a complete collection of 53 cases, 28 cases in experimental group and 23 cases in control group, included 32 males,21 females, the youngest 16 years old, maximum 69 years, the shortest duration of 31 days, up to six months. In experimental group, male 17 cases, female 11 cases,19 cases of facial paralysis on the left side, the right side of nine cases, with an average age of 42.96 ±13.76 years, mean duration of 66.43±33.53 days, the symptom score 12.20±.6.83. In control group,15 males and 10 females,16 cases of facial paralysis on the left side, the right side of nine cases, with an average age of 39.70±14.21 years, mean duration of 67.59±36.47 days and 12.45±5.17 symptom scores. By two independent sample t test, the patient’s sex, age, duration, location and symptom scores between the two groups were not statistically significant.Test process:40 points, House-Brackmann (HB) facial nerve function evaluation and grading system, blink reflex, EMG, ENoG were used to evaluate the outcomes. Treatment process were as follows:(1) Basic treatment:patients of two groups were given mecobalamin tablet 0.5mg po tid from beginning to the end of treatment. (2) Control group:First regular acupuncture, then carried on ginger moxibustion. ① Regular acupuncture:Main points:Yangbai, Taiyang, Sibai, Quanliao, Dicang, Jiache, Qianzheng, Yifeng, Hegu. Minor points:Fengchi, Waiguan, Guanchong, Zusanli, Qihai, Yanglinquan, Cuanzu, Yingxiang, Shuigou, Chengjiang and Taichong, can be used Based on clinical symptoms. Operating: contralateral Hegu, bilateral Zusanli and other points in ipsilateral were taken in operation. Cuanzu and Yangbai penetrated towards Yuyao, Jiache penetrated towards Dicang, Taiyang penetrated towards Jingming, Yingxiang penetrated towards Yintang, Fengchi obliquely pinpricked towards tip of the nose, Shuigou obliquely pinpricked towards ipsilateral, other points were straightly pinpricked. Fill method was carried on Zusanli, while reinforcing and reducing method was carried on other points. Indwell the needle for 30min. ② Control group:Main points:Yangbai, Dicang, Quanliao, Taiyang, Xiaguan, Jiache and Yifeng in ipsilateral. Operating: after acupuncture, took a fresh ginger cut with 0.3cm thick, punctured in number of holes with a needle. The conical moxa which high and bottom diameter was about 1cm rub with the hands was placed on the ginger. Then the ginger was put on seven acupuncture points above-mentioned, fired the moxa at the top of it to carry on ginger moxibustion. A burning sensation was in the patient consciously degree during the operation. If the burning sensation was so strong, lifts the ginger slightly, or adds a thin ginger to keep ginger moxibustion. Changed the moxa when it burnout (5-7 per points average), until the local skin turn flushing but no foaming up. Treatment:1 time a day,10 times as a course of treatment, rest two days during the course of treatment, a total of six courses of treatment. (3) Experimental group: Firstly did regular acupuncture, then the heat-sensitive points were found during indwelling. Two most heat-sensitive points were carried on heat-sensitive moxibustion after the needle pull out. ① Regular acupuncture:as control group. ② Heat-sensitive moxibustion:Taiyang, Yangbai, Xiaguan, Quanliao, Dicang, Jiache and Yifeng in ipsilateral were probed one by one, these points were the high heat-sensitive points in treating facial paralysis. It was the heat-sensitive phenomenon that patients field diathermy, thermal expansion, heat transfer, no partial (micro) heat but distal portion heat, the surface not (micro) heat but deeper part heat, heat-sensitive sensation but non-thermal. So that we made sure it was the heat-sensitive point. Two most heat-sensitive points which marked with signs by pen were chosen to carry on heat-sensitive moxibustion. In order to maintain adequate heat, the ash was dusted every 5 min, the distance between moxa and adjust skin was adjusted in the meantime. Heat-sensitive phenomenon was as the standard of diathermy, thermal expansion, heat transfer, no partial (micro) heat but distal portion heat, the surface not (micro) heat but deeper part heat, heat-sensitive sensation but non-thermal. Heat-sensitive moxibustion was not stopped until the heat-sensitive sensation disappeared. Treatment was as the control group.SPSS 13.0 was used for statistical anlysis of the data obtained. Two groups of data are presented as mean ±standard deviation, using two independent sample t test and χ2 test. P<0.05 is as statistically significant difference.ResultsFirstly, the results of 40 points method:Symptom scores between experimental group and control group before treatment were 12.20±.6.83 and 12.45±5.17, which had no statistically significant difference between them (P=0.72). Symptom score of two group after treatment were 31.00±.6.34 and 22.61±5.76, which has a statistically significant difference compare with the score before treatment (P< 0.05). And the score in experimental group was obviously higher than that in control group after treatment (P<0.05).Secondly, the results of HB facial nerve function evaluation and grading system: The effective rate of experimental group and control group were 92.86% and 80%, which has no statistically significant difference (P>0.05). But he markedly effective rate of two groups were 75% and 44%, which has a statistically significant difference. The effective rate of experimental group was remarkable higher than that of control group(χ2=5.306,P=0.021).Thirdly, BR results:Abnormal rate of BR in two groups before and after treatment were both 100%, but there the abnormal situation had improved; there were 11 patients in each group whose incubation period were prolonged. The difference value of ipsilateral and contralateral R1、R2、R2’ in experimental group after treatment was less than that before treatment(t values were 16.7,6.5,9.1, P values were less than 0.01, respectively). The difference value of ipsilateral and contralateral R1、R2、R2’ in control group after treatment was less than that before treatment(t values were 9.4,8.3,5.7, P values were less than 0.01, respectively).Fourth, ENoG results:Abnormal rate of ENoG in two groups before and after treatment were both 100%. As the main performance, the amplitude decreased though the incubation period were normal in 53 cases. The amplitude decreased ratio of orbicularis oculi and orbicularis muscle in two groups before and after treatment had no significant improvement(P>0.05).Fifth, EMG results:Abnormal rate of EMG(orbicularis oculi and orbicularis muscle) in experimental group and control group before treatment were 53.7%/60.7%,56%/64%, while after treatment were 17.9%/25%、36%/40%. The rate in experimental group after treatment was less than that before treatment(P<0.05), but in control group it had no significant difference before and after treatment(P> 0.05).ConclusionFirstly, the curative effect of heat-sensitive moxibustion and ginger mosibustion on refractory peripheral facial paralysis is exact, and the curative effect of heat-sensitive moxibustion on refractory peripheral facial paralysis is better than that of ginger mosibustion. Secondly, BR and ENoG are sensitive for refractory peripheral facial paralysis, their sensitivity is stronger than EMG. Thirdly, there are significant improvement of BR and EMG in two groups after treatment, but there is obvious hysteresis in ENoG. |
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