ACUPUNCTURE FOR TREATMENT CVA AND BELL

PALSY

By balgis MD MSc CM-FM Sp Ak

CEREBROVASCULAR DISEASE
 Most frequent of all neurological problems
 Incidence: third leading cause of death in U.S. – half a million people
a year – one third will die from it
 Due to blood vessel pathology:
 Lesions on walls of vessels leading to brain
 Occlusions of vessel lumen by thrombus or embolus
 Vessel rupture
 Alterations of blood quality
CV disease leads to two types of
brain abnormalities :

1. Ischemia (with or without infarct)

2. Hemorrhage
INCIDENCE

 Highest risk > 65 years of age

 But about 1/3 (28%) are < 65 years old
 Tends to run in families
 More often seen in females
 More often seen in Blacks, perhaps due to increased incidence of
hypertension
RISK FACTORS

 Arterial hypertension
 Heart disease
 Myocardial infarction or endocarditis
 Atrial fibrillation
 Elevated plasma cholesterol
 Diabetes mellitus
 Oral contraceptives
 Smoking
 Polycythemia and thrombocythemia
Stroke Warning Signs
CHINESE MEDICINE EFFICACY

The 1997 National Institute of Health Consensus Conference on

Acupuncture stated;

 "The data in support of acupuncture are as strong as those for many accepted Western
medical therapies.“

 "One of the advantages of acupuncture is that the incidence of adverse effects is

substantially lower than that of many drugs or other accepted medical procedures used
for the same conditions."
ACUPUNCTURE FOR STROKE

 In China and Japan, an acupuncturist is likely to start therapy as soon as

possible after a stroke
 Acupuncture is done on a daily basis in China.
 in Western countries, some acupuncturists with experience in treating
stroke with acupuncture believe treatment 3 times a week is optimal.
 Several different approaches have been used to treat stroke,
demonstrating that acupuncture for this disorder remains a healthcare art:
Traditional Chinese Yang meridian point therapy, Chinese scalp
acupuncture,
LANJ

 Dr. Yamamoto's YNSA Japanese scalp therapy, Korean Koryo Chim hand
acupuncture, supplemental ear (auricular) acupuncture, and Xingnao
KaiQiao (a newer therapy by Professor Shi Xuemin) are each advocated by
a number of treatment centers in Oriental countries. One need not know in
depth the approach of each, but it is important to know that more than one
approach is available and used.
 Adding acupuncture to rehabilitation therapy obviously increases the cost;
daily-to-3 times-weekly treatment is needed for 2-4 weeks or longer.
 Concern for added cost would perhaps disappear if the end result
demonstrates more self-care and less dependence on family and health
providers
DOES ACUPUNCTURE REALLY WORK TO HELP
STROKE VICTIMS IMPROVE?

 Many studies involving thousands of patients have been published in China and
Japan, and 2 of 3 studies from Scandinavia, demonstrated significant help.
 These studies indicate that patients get well faster, perform better in self-care,
require less nursing and rehabilitation therapy, and use less healthcare dollars.
ORIENTAL MEDICINE COST EFFECTIVENESS

Acupuncture Treatment Results In Decreased Days In Hospital Or Nursing

Home

Half of 78 stroke patients receiving standard rehabilitative care were randomly

chosen to receive adjunctive acupuncture treatment. Patients given acupuncture
recovered faster and to a greater extent, spending 88 days/patient in hospital
and nursing homes compared to 161 days/patient for standard care alone.

Cost savings: $26,000 per patient.

Johansson K et al (1994), "Can sensory stimulation improve the functional outcome in stroke patients?", Neurology 43:2189-2192.
ACUPUNCTURE TODAY.COM

 Acupuncture Study at Kansas Hospital Shows Dramatic Improvement in

Stroke Patients (Jan.2004)

Media outlets throughout Kansas have reported that an acupuncture study

conducted on stroke patients at Wesley Rehabilitation Hospital in Wichita
has produced improvements so dramatic, officials have decided to stop the
study early so that they can offer the service to all stroke patients who
qualify.
 ACUPUNCTURE STUDY AT KANSAS HOSPITAL
SHOWS DRAMATIC IMPROVEMENT IN STROKE
PATIENTS

 33 patients who had suffered their first stroke were 90

randomly assigned to receive either acupuncture or 80
traditional speech, occupational and physical 70
therapy. Acupunc
60
 Ninety percent of the patients in the acupuncture ture
50 group
group improved so much that they were able to go
home rather than another facility after leaving the 40
hospital, compared to just 33 percent of patients in 30 Tradition
the traditional therapy group. al
20 therapy
 Stroke patients who received acupuncture also 10 group
showed more improvement in the ability to carry 0
out tasks such as as dressing, bathing, grooming, go home
walking and changing position.
MORE DOCTOR BELIEVING IN ACUPUNCTURE
PERAN AKUP PD CVA

 Mekanisme kerja akupunktur melalui efek lokal, segmental dan sentral shg
timbul efek:
1. Meningkatkan aliran darah ke otak terutama ke daerah lesi
2. Memperbaiki kegiatan elektrik otak
3. Memperbaiki mikrosirkulasi otak
4. Meregulasi lemak darah
5. Menghilangkan radikal bebas
6. Mempengaruhi kadar katekolamin dan endorfin
HASIL PENELITIAN

 Penelitian yg dilakukan Wu HM et al  Wang el al 2012. scalp acupuncture

dg judul Acupuncture for stroke for acute ischemic stoke:
rehabilitation.Stroke 2008,39:517-518 metaanalysis of randomized
controled trials
 Akupunktur dapat digunakan untuk
meningkatkan fungsimotorik,  Akupuktur kulit kepala dapat
sensorik, berbicara, kognitif dan meningkatkan nilai defisit
neurologikal pada pasien stroke neurological scr klinis efektif
dibandingkan hanya dg terapi
konvensional barat.
LANJ

 Penelitian yg dilakukan oleh Chen et el dg sampel 250 pasien stroke iskemik akut
 terbagi dalam 2 kelompok
 akupunktur dilakukan selama 3 minggu.
 Assessment mengggunakan MMSE dan Montreal cognitive Assessment (MoCA)
sdg untuk fungsi motorik dinilai dg Fugl-Meyer Assessment
TITIK YANG DIGUNAKAN

Extremitas sup Extremitas inf

 jianyu (LI15)  Liang Qiu (ST 34)

 Quchi (LI 11)  Zusanli (ST36)
 Sho san li (LI10)  Yang ling quan (GB 34)

 Waiguan (SJ5)  Sp6 ( San Yin Jiao)

 Hegu (LI4)  Fenglong( ST 40)

 Jie xi (ST41)
 Taichong (Liv3)
DAPAT DITAMBAHKAN

Disfagi Kognitiv ringan

 GB 20 ( Feng Chi)  DU 20 ( baihui)

 EXHN14 (Yi Ming)  Du 24 ( shen Ting)
 BL 10 ( tian Zhu)  GB 13 (ben Shen)
 Du16 ( Feng FU)  EX-HN1 ( sishen chong)
 Gong Xue( 1cun below GB20)
 RN23 (lian Quan)
LANJUT

 Elektroakupunktur jianyu (LI15), Quchi (LI 11), Zusanli

(ST36),Sp6 ( San Yin Jiao) dg gelombang intermiten dan
frekuensi rendah 2hz
 Hasil akupunktur efektif memperbaiki gangguan fungsi
motorik, menelan dan kognitif
SHIN ET AL

 Mendapatkan bahwa akupunktur dapat meningkatkan SOD ( Superoxide

dismutase) , TAX 2 darah dan PGI2
 Dg peningkatan aktifitas dari SOD mk kerusakan neuron akibat LPO dapat
dihambat
 PGI2 dan TAX2 merupakan faktor penting dlm mempertahankan sirkulasi darah
dan mencegah pembentukan trombus
ZHENG ET AL

 Akupunktur dapat mengurangi kerusakan jaringan otak akibat iskemi melalui

mekanisme:
1. regulasi neuromediator
2. RNA sel
3. dan Genom dalam inti sel
shg timbul perlindungan terhadap sel otak yg menghambat proses kerusakan
jaringan.
JUN ET AL

 EA dapat :
1. mengurangi jmlh apoptosis pd daerah infrak dikorteks serebri
2. mengurangi neurotoksisitas dari asam amino yg dihasilkan oleh proses iskemi
3. dan menghambat ekspresi c-fos serta memperkuat ekspresi dari protei bcl-2 yg
dapat menghambat apoptosis
THE EFFECT OF ACUPUNCTURE ON STROKE
CHIN-YI CHENG AND JAUNG-GENG LIN 2018
 Thrombolytic therapy is of proven benefit in ischemic stroke but its associated risk of intracerebral hemorrhage has encouraged the search for
alternative medicines, including acupuncture treatment.
 In clinical research, acupuncture has exhibited significant effects on motor dysfunction, shoulder-hand syndrome, balance impairment, cognitive
impairment, and dysphagia in the subacute or chronic stage of stroke.
 During cerebral ischemia, pathological processes including inflammatory response, oxidative stress, and apoptosis are evoked, which exacerbate
cerebral ischemia-reperfusion (I/R) injury.
 In animal models of cerebral ischemia, acupuncture (electroacupuncture [EA] or manual acupuncture) stimulation provides neuroprotective effects
through
1. the downregulation of inflammation-related molecules (including tumor necrosis factor-α [TNF-α], interleukin [IL] -1β, IL-6, matrix
metalloproteinases [MMPs], chemokines, and aquaporins)
2. and enzymes (cyclooxygenase-2 [COX-2] and myeloperoxidase [MPO])
3. and modulation of oxidative stress-related molecules (including malondialdehyde [MDA], superoxide dismutase [SOD], glutathione peroxidase
[GSH-Px], and gamma-glutamylcysteine synthetase [γ-GCS]) in the ischemic area.
4. The anti-apoptotic effect of acupuncture can be attributed to the upregulation of anti-apoptotic proteins (Bcl-2 and Bcl-xL), and downregulation
of pro-apoptotic proteins (Bad and Bax) and caspases (including caspase-3, 8, and 9) through various signaling pathways.
5. Acupuncture stimulation also induces neurogenesis through modulation of BrdU/nestin, collapsin response mediator protein-4 (CRMP-4),
microtubule-associated protein-2 (MAP-2), retinaldehyde dehydrogenases, dopamine D2 receptors, astrocytes, and glycogen synthase kinase-
3β (GSK-3β) protein phosphatase 2A (PP2A) expression in the ischemic area.
REVIEW MECHANISMS OF ACUPUNCTURE THERAPY IN ISCHEMIC STROKE
REHABILITATION: A LITERATURE REVIEW OF BASIC STUDIES LINA M. CHAVEZ 1 ,
SHIANG-SUO HUANG 2 , IONA MACDONALD 1 , JAUNG-GENG LIN 3 , YU-CHEN LEE
1,4,5,* AND YI-HUNG CHEN 1,5,6,*

 Acupuncture is recommended by the World Health Organization (WHO) as an alternative

and complementary strategy for stroke treatment and for improving stroke care.
 Clinical trial and meta-analysis findings have demonstrated the efficacy of acupuncture in
improving:
1. balance function
2. reducing spasticity
3. and increasing muscle strength and general well-being post-stroke.
4. The mechanisms underlying the beneficial effects of acupuncture in stroke
rehabilitation remain unclear
LANJ

 The aim of this study was to conduct a literature review

summarize the current known mechanisms in ischemic stroke
rehabilitation through acupuncture and electroacupuncture (EA)
therapy and to detail the frequently used acupoints implicated
in these effects..
5 MAJOR DIFFERENT MECHANISMS ARE INVOLVED IN THE BENEFICIAL EFFECTS OF
ACUPUNCTURE/EA ON ISCHEMIC STROKE REHABILITATION:

1. Promotion of neurogenesis and cell proliferation in the central nervous system (CNS)
2. Regulation of cerebral blood flow in the ischemic area
3. Anti-apoptosis in the ischemic area(through modulation of specific and non-specific
apoptotic pathways)
4. Regulation of neurochemicals such as: (a) Neurotransmitters and receptors, (b)
Antioxidant enzymes, (c) Inflammatory mediators, (d) Neurotrophic factors, (e)
Anerobic metabolism
5. and Improvement of impaired long-term potentiation (LTP) and memory after stroke
The arrows in the Scheme indicate the probable areas in the
brain that relate to particular mechanisms.
THE MOST FREQUENTLY USED ACUPOINTS
IN BASIC STUDIES
 Baihui (GV20)
 Zusanli (ST36)
 Quchi (LI11)
 Shuigou (GV26)
 Dazhui (GV14)
 and Hegu (LI4).
SUMMARY OF MAIN ACUPOINTS SELECTED IN THE REVIEWED STUDIES .

 Baihui (GV20) 16  Fengfu (GV16) 2

 Zusanli (ST36) 16  Chengjiang (CV24) 2

 Quchi (LI11) 9  Fengchi (GB20) 2

 Shuigou (GV26) 7  Shenting (GV24) 1

 Chize (LU5) 1
 Dazhui (GV14) 5
 Sanyinjiao (SP6) 1
 Hegu (LI4) 4
 Jiaji (Ex-B2) 1
 Qihai (CV6) 3
 Shendao (GV11) 1
 Tanzhong (CV17) 2 Zhongwan (CV12) 2
Xuehai (SP10) 2  Qubin (GB7) 1
 Neiguan (PC6) 1
THE MOST COMMON COMBINATIONS OF ACUPOINTS

 Zusanli + Quchi
this combination involved the following mechanisms: Neurogenesis: increased production
of retinoic acid [23]. Cell proliferation in ischemic tissue: activation of the Wnt/β-catenin
pathways [24], ERK1/2 pathways [26,27], and increased expression of cell cycle proteins and
BDNF [28]. Anti-apoptosis: upregulation of the PI3K/Akt pathway [38,39]. Anti-
inflammatory activity: suppression of the TLR4/NF-kB pathway [58].
 Dazhui + Baihui
this was the second most used acupoint formula and involved the following mechanisms:
Neurogenesis: increased levels of neurotrophic factors including BDNF and VEGF [22].
Release of vasodilative mediators increased acetylcholine and endothelial nitric oxide
synthase discharge at the ischemic cerebral cortex [31]. Anti-apoptosis: activated the
MEK1/2/ERK1/2/p90RSK/bad signaling pathway [43] and suppressed JAK2-mediated
apoptosis [46].
LANJ

 Baihui + Shuigou
together, these acupoints exert an anti-apoptotic effect by activating Akt-mediated pathways and
suppressing pro-apoptotic caspase-9 [37]. This combination also produces an antioxidative effect,
enhancing the expression of respiratory chain-related enzymes such as succinic dehydrogenase,
NADH dehydrogenase and cytochrome C oxidase in the penumbra zone [55].
 Zusanli + Baihui
the stimulation of these acupoints results in an antioxidative effect, suppressing the activity of
NADPH oxidase and its subunits in the hippocampus [53], and results in anti-inflammatory activities
through inactivation of mediators, such as HSP70 and TNFα [57].
 Shigou + Chengjiang
these produce anti-apoptotic effects by inactivating TRPM7 [45] and modulating neurotransmission,
reducing the expression of the NMDA receptor NR1 in ischemic cortical areas [64].
STRUCTURAL CHANGES INDUCED BY ACUPUNCTURE IN THE RECOVERING BRAIN
AFTER ISCHEMIC STROKE PING WU , 1 YU-MEI ZHOU,1 CHEN-XI LIAO,1 YU-ZHI TANG,1 YONG-XIN LI , 2 LI-HUA QIU,3 WEI QIN,4
FANG ZENG , 1 AND FAN-RONG LIANG 1

 Te aim of this study was to observe the grey matter (GM) tissue changes of ischemic stroke patients, to explore the therapy responses
and possible mechanism of acupuncture.
 21 stroke patients were randomly assigned to receive either acupuncture plus conventional (Group A) or only conventional (Group B)
treatments for 4 weeks.
 All patients in both groups accepted resting-state functional magnetic resonance (fMRI) scan before and afer treatment, and the
voxel-based morphometry (VBM) analysis was performed to detect the cerebral grey structure changes
 The modifed Barthel index (MBI) was used to evaluate the therapeutic efect.
 Compared with the patients in Group B, the patients in Group A exhibited a more signifcant enhancement of the changes degree of
MBI from pre- to post-treatment intervention. VBM analyses found that afer treatment the patients in Group A showed extensive
changes in GMV.
 In Group A, the lef frontal lobe, precentral gyrus, superior parietal gyrus, anterior cingulate cortex, and middle temporal gyrus
signifcantly increased, and the right frontal gyrus, inferior parietal gyrus, and middle cingulate cortex decreased (� < 0.05, corrected).
 In addition, lef anterior cingulate cortex and lef middle temporal gyrus are positively related to the increase in MBI score (� < 0.05,
corrected). In Group B, right precentral gyrus and right inferior frontal gyrus increased (� < 0.05, corrected).
 In conclusion, acupuncture can evoke pronounced structural reorganization in the frontal areas and the network of DMN areas, which
may be the potential therapy target and the potential mechanism where acupuncture improved the motor and cognition recovery
TERAPI AKUPUNKTUR

1. Pada CVA ischemi terapi dianjurkan sedini mungkin, sebaiknya dilakukan 48

jam setelah tanda vital stabil (WHO)
2. Pada CVA haemorhage umumnya dilakukan 3 minggu setelah serangan
setelah sadar dan tanda vital terutama tekanan darahnya stabil, dimulai
dengan rangsangan ringan dan scr bertahap rangsangan ditingkatkan
TITIK2 YG DIGUNAKAN UNTUK MEMBANGKITKAN
KESADARAN

 Renzhong
 Fengchi
 Neiguan
CHEN G.S. DAN ERDMANN W

 Perangsangan titik renzhong (GV 26) dapat meningkatkan PO2 scr cepat pd lobus
frontalis korteks serebri.
 Diduga bahwa perangsangan pd titik renzhong menstimulasi sistem simpatis
termasuk eksitasi dari reseptor betha pada pembuluh arteri serebral akan
menyebabkan vasodilatasi shg terjadi peningkatan aliran darah kapiler
RENCANA TERAPI

1. Pada periode syok otak

 Digunakan jarum halus
 Bisa digunakan EA dg gel yg jarang
 Sehari sekali selama 20-30 menit
 satu seri terapi 10 kali
 Istirahat 2 hari sebelum msk seri kedua
 Merangsang sisi yg sehat
TITIK UNTUK EKSTREMITAS SUP

1. Jianyu
2. Quchi
3. Waiguan
4. Hegu
5. Houxi
TITIK UNTUK EKSTREMITAS INF

1. Biguan
2. Xuehai
3. Yanglingquan
4. Xianzhong
5. Taichong
RENCANA TERAPI

2. Periode Spastik
 Digunakan jarum halus
 Bisa digunakan EA dg gel yg jarang
 Sehari sekali selama 20-30 menit
 satu seri terapi 10 kali
 Istirahat 2 hari sebelum msk seri kedua
 Merangsang otot antagonis dr otot yg spastis, meredakan tonus tinggi otot yg
spastik, memulihkan posisi tubuh shg menjadi normal
TITIK UNTUK EKSTREMITAS SUP

1. Jianyu
2. Jianliao
3. Tianjing
4. shousanli
5. Waiguan
6. Hegu
7. zhongzhu
8. Houxi
TITIK UNTUK EKSTREMITAS INF

1. Nei Biguan
2. Xia Xuehai
3. Yanglingquan
4. Xiaxi
RENCANA TERAPI

3. Periode pemulihan
Saat ini dapat ditambahkan akupuktur kulit kepala untuk meningkatkan
vaskularisasi dan merangsang hidup sel neuron
titik yg digunakan fengchi, gongxue (lebar 2 jari tgk lurus dibawah fengchi),
Shishencong
A RETROSPECTIVE COHORT STUDY COMPARING STROKE RECURRENCE
RATE IN ISCHEMIC STROKE PATIENTS WITH AND WITHOUT
ACUPUNCTURE TREATMENT
BELL'S PALSY

 Bell's Palsy is presumably due to an inflammatory reaction in or around the facial

nerve near the stylomastoid foramen
 Bell's palsy, also known as idiopathic facial paralysis because of its unclear
etiology.
 It is the most common disease of the facial nerve that causes important
functional, aesthetic, and psychosocial disturbances in the patients.
BELL'S PALSY

 Pada umumnya bersifat akut

 Tiba tiba
 biasanya disadari saat bangun tidur
 Pada anamnesa penderita sering ada riwayat terkena angin waktu berkendaraan
atau tidur dg jendela terbuka
GEJALA PADA SISI LUMPUH

 Akibat kelumpuhan serabut somatomotoris n fasialis

1. Dahi tidak dapat dikerutkan
2. Mata tidak dapat menutup (lagopthalmus)
3. Dalam usaha menutup mata bola mata kerap berputar keatas ( bell’s
phenomen)
4. Lipat nasolabial jadi datar
5. Mulut tidak bisa diangkat baik scr spontan maupun atas perintah
6. Sudut mulut tertarik ke arah sisi yg sehat,
 gangguan perasaan pengecapan pd 2/3 anterior lidah ( sisi kelainan)
akibat kelumpuhan serabut viscerosensoris n facialis
TERAPI AKUPUNKTUR PD BELL’S PALSY

 Merangsang otot wajah yg

lumpuh baik dg titik lokal maupun
titik jauh
 Titik akup yg sering digunakan:
1. Yifeng  Yingxiang
2. Xiaguan  Zanzhu
3. Yangbai  Quanliao
4. Sibai  Hegu
5. Dichang  Sizhukong
LANJ

 Rangsangan penjaruman atau dengan EA

 Setiap kali dirangsang 5-6 buah titik
 3 kali perminggu
CASE

 A 56-year-old white female presented with a 3-month history of

severe right facial pain, weakness, and paralysis.
 This patient was referred to an otolaryngologist and a
neurologist at Johns Hopkins, but did not achieve symptomatic
relief.
PRESENTING COMPLAINT

 The patient's right facial paralysis developed overnight.

 Associated symptoms included pain in her face, difficulty speaking clearly, and
hypersensitivity to sound in the right ear.
 She was unable to close her right eyelid, and experienced difficulty with drinking and
mastication.
 She was evaluated and treated by an otolaryngologist, and placed on a steroid taper
and acyclovir
 symptomatic improvement in facial muscle strength did not occur.
 Her facial disfigurement and difficulty speaking impacted on her occupation
(restaurant owner and operator).
 She developed mild depression and a secluded behavior.
MEDICATIONS

 Prednisolone
 Premarin
 Acyclovir
 DHEA
 vitamins,
 Minerals
 and a natural Synthroid substitute.
LANJ

  DIAGNOSTIC TESTS
Autoimmune and serology were negative.
Lyme titer was negative.
Thyroid function tests indicated that she was euthyroid with a slightly decreased
TSH level.
 REVIEW OF SYSTEMS
Neck pain, lower back pain, joint pain, depression, right facial pain and sensitivity
to sounds in the right ear, with difficulty speaking clearly.
TREATMENT

 Chinese medicine attributes this condition to Wind and Cold of external origin
which invade the meridians traversing the face and disrupt the flow of Qi and
Blood, preventing the vessels and muscles from receiving the necessary
nourishment.
 Treatment is directed toward spreading the Qi through the meridians of the
face (1).
 The patient was treated with an integrated approach of acupuncture models.
 Points from a neuroanatomical model, or for classical indications, were
included at each treatment and primarily used unilaterally.
 Other points utilized the energetic approach, and were treated bilaterally.
LANJ

 The following acupuncture points were used without electrical stimulation.

 The local points were treated only on the right side, while the distal points
were needled bilaterally.
 The principal points included GB 20 (Fengchi), GB 14 (Yangbai), ST 4
(Dicang), ST 2 (Sibai), and LI 4 (Hegu).
 The supplemental points included GV 26 (Renzhong), M-HN 18
[Jiachengjiang] (1), M-HN 9 (Taiyang), ST 7 (Ziagnuan), ST 36 (Zusanli), ST
44 (Neiting), and LI 19 (Heliao).
RESPON PASIEN

 Pasien awalnya dinilai dengan kelumpuhan House-Brackmann grade 5 di otot wajah

kanan
 Setelah 10 perawatan akupunktur selama periode 4 minggu:
1. Dia menunjukkan gerakan yang signifikan di dahinya dan menutup matanya secara
total dengan upaya maksimal. Namun, dengan usaha normal, ia memiliki 1 sampai 2
mm dari scleral fill dengan perlindungan kornea yang baik.
2. Dia juga memiliki gerakan bukal yang baik dan peningkatan gerakan pada otot yang
disuplai oleh cabang mandibula dari saraf wajahnya.
 Setelah total 15 perawatan akupunktur selama periode 8 minggu, ia menunjukkan gerakan
divisi atas normal dan nada utuh di divisi bawah, dengan hanya sedikit penurunan kekuatan
motorik di divisi ini. Kekuatannya dinilai kira-kira di House-Brackmann 2. Dia memiliki
penutupan mata penuh, dan konjungtiva utuh dengan sedikit ektropion.
 
HASIL PENELITIAN

 Menurut Liu (1995), ketika akupunktur dimulai dalam tiga hari setelah onset
pada 684 kasus kelumpuhan saraf wajah, 100 persen pasien sembuh atau ada
peningkatan yang nyata (5).

 Studi lain (Gao, Chen, 1991) mengungkapkan bahwa 80% kasus yang
dirawat lebih dari 2 bulan setelah onset, dan 83 persen kasus yang parah,
sembuh atau memiliki efek yang sangat baik
LANJ

 Abstract: Background Bell’s palsy involves acute facial paralysis due to inflammation of the
facial nerve. Acupuncture and moxibustion (acu-moxi) is beneficial in treating facial palsy. In
order to verify the efficacy of acu-moxi on Bell’s palsy, a randomized single-blind, multicenter
clinical trial was performed.

 Methods A total of 480 patients from four clinical centers were involved in this trial, of whom
439 completed the trial and 41 did not. All patients were randomly assigned to either the control
group or to one of two treatment groups.
 The control group was treated with prednisone, vitamin B1, vitamin B12, and dibazole; the
treatment groups were treated either with acu-moxi alone or in combination with prednisone,
Vitamin B1, vitamin B12, and dibazole.
 Symptoms and signs, the House-Brackmann scale, and facial disability index (FDI) scores were
assessed and determined both pre- and post-treatment to evaluate the effectiveness of the
treatment methods.
LANJ

Results
 The characteristics of the control and two treatment groups were comparable without
statistically significant differences before treatment.
 There were significant differences between the control and treatment groups after
treatment (χ2=15.265, P=0.018).
 According to evaluations based on the House-Brackmann scale and FDI scores, the
effectiveness of treatment in the two treatment groups was better than in the control
group and was most effective in patients receiving acu-moxi treatment alone (Z=-2.827,
P=0.005).

Conclusion
 The efficacy of acu-moxi treatment for Bell’s palsy is verified scientifically.
LANJ

 Treatment group 1 was given acu-moxi treatment.

 The acupuncture points used were Dicang (ST4), Jiache (ST6), Hegu (LI4), Yangbai
(GB14), Xiaguan (ST7), and Yifeng (SJ17) on the affected side, and Hegu (LI4)
bilaterally.
 Filiform needles (1-1.5 cun, 0.32 mm) were used with moderate stimulation to get
an acupuncture sensation, and the needles were retained for 30 minutes.
 Hanging moxibustion was applied for five minutes at each point, once a day,
 five times a week, for a total of four weeks.
CLINICAL OBSERVATION ON TREATMENT OF ACUPUNCTURE FOR
DIFFERENT STAGES OF BELL'S PALSY

 ObJECTIVE: To observe the therapeutic effects of acupuncture for treatment of

different stages of Bell's palsy, and explore the best intervention period.
 METHODS: Forty cases of Bell's palsy patients were divided into three groups
according to their onset time: an active stage group, a resting stage group and a
recovery stage group.
All three groups were treated with acupuncture. Fengchi (GB 20), Dicang (ST 4),
Jiache (ST 6), Qianzheng (Extra), Sibai (ST 2), Yangbai (GB 14) on the affected side
and Hegu (LI 4) on the healthy side were selected as main points. Dazhui (GV 14),
Chengjiang (CV 24), Shuigou (GV 26) and Cuanzhu (BL 2), Yuyao (EX-HN 4), Yifeng
(TE 17), Tinghui (GB 2), Quanliao (SI 18), Xiaguan (ST 7), Yingxiang (LI 20) on the
affected side were selected as adjuvant points.
LANJ

 RESULTS: (1) Acupuncture was effective for the Bell's palsy in active stage,
resting stage and recovery stage (all P<0. 01); (2) The obvious effective rate
of acupuncture for treatment of Bell's palsy in the active stage group was
obviously superior to those of resting stage group and recovery stage (both
P<0. 01). (3) There was no significant difference of the obvious effective
rate between the resting stage group and the recovery stage group (P>0.
05).

 CONCLUSION: Acupuncture has a good therapeutic effect for treatment of

Bell's palsy, and the therapeutic effect is most obvious with intervention of
treatment in the active stage.