Bell's Palsy (Facial Paralysis) by Fay Meling von Moltke Pao, Hon.DHSc., B.HSc., Hon.B.A. Fay-Meling von Moltke Pao practices Oriental Medicine in downtown Toronto, Ontario. She is experienced in treating patients using acupuncture, herbal medicine, nutritional counselling, tuina, and qigong. For more information on Bell's palsy or other health concerns, please contact her at meling at simpatico dot ca

One of your eyes has a swollen eyelid that can no longer close shut. When you try to eat, you keep biting your lip because you can no longer feel it, and the numbing sensation is starting to radiate to the other side of your face. For most people with Bell's palsy, the effects can be severely disfiguring and can cause great anxiety. Often the first thing that people think of is that they've had a stroke.

This was the case for a fifty-one year old male who worked as a medical lab technician and was experiencing soreness in his left eye for the past two weeks prior to coming to our clinic. The patient had been recently diagnosed with Bell's palsy by his family physician and was prescribed Valtrex (an anti-viral) that he took consistently (50mg, 2 tablets 3x/day for 7 days). On his initial visit, he mentioned that he had been unable to close his left eye for the past four days. The entire left side of his face was frozen and numb, and the numb sensation was especially noticed when trying to eat. The numbness had begun to radiate towards the right lower lip and the right side of his nose. Upon general inspection, the patient's face looked flushed and the skin on the left side of his face looked swollen and taut, especially above his left eyebrow and below his lower lip. The swollenness and tautness extended towards the right side.

Bell's palsy is a peripheral (affecting the peripheral rather than the central nervous system) facial paralysis that results from damage to the seventh cranial nerve, or "facial nerve." Due to paralysis of the facial nerve, symptoms can include inability to lift or close one eye, difficulty moving facial muscles on one side of the face, lacrimation (eye tearing) on the affected side, distortion of taste (especially on the first 2/3 of the tongue) and tingling around the lip area (all on the affected side). The condition has an abrupt onset and is idiopathic in nature (no known cause). Bell's affects approximately 40, 000 people in the United States each year. Persons who tend to be most at risk are pregnant women, and persons afflicted with the flu virus, cold, respiratory illness, or diabetes. Some patients have reported having severe ear, nose, mouth or gum infections and/ or headaches prior to developing Bell's palsy. While the cause of Bell's palsy has not been confirmed, it is likely that viruses such as the herpes simplex virus (that contributes to mouth sores) as well as other herpes viruses such as herpes zoster (which leads to shingles) are responsible for the inflammation of the facial nerve causing facial paralysis. Common treatment therapies involve the use of acyclovir or Valtrex (an anti-viral drug for targeting the herpes viruses), prednisone (which blocks immune function to prevent inflammation of the affected nerve and surrounding tissue), and corticosteroids (for reducing inflammation around the nerve and any pain associated with the inflammation). The prognosis for Bell's palsy ranges from complete recovery within a few weeks (85% of patients) to chronic symptoms of facial paralysis (15% of patients). In addition, it is necessary to rule out other causative factors for facial paralysis including those that affect the central nervous system such as cerebrovascular accidents (stroke) and intracranial tumours. This can be determined through differential diagnoses and X-rays, ultrasound, and MRI.

In this particular patient's condition, the typical symptoms of tingling and numbness in the affected region combined with an inability to close the left eyelid and motor impairment of the lips and mouth on the affected side are all indicative of Bell's palsy. In traditional Chinese medicine, this condition is due to pathogenic wind-cold attacking the Shaoyang (Liver, Gall Bladder) and Yangming (Stomach, Large Intestine) channels as well as the tendons and muscles. This can occur when a patient is exposed to wind (e.g.sleeping near an open window, driving with the windows down, going on a boat when the winds are strong) and is more common in the spring and autumn months. Often people with Bell's palsy have a deficient immune system (possibly due to genetics, unresolved or chronic illness, improper diet, rest, exposure to toxic chemicals or drugs, or undue physical and emotional stress). As a result, they are more vulnerable to outside sources such as further exposure to physical and emotional stress factors or viral and bacterial pathogens. The exposure to the external source causes the immune system to produce an inflammatory response in the affected region resulting in swelling of the surrounding tissues. This swelling can then obstruct the normal function of the nerves and vessels (ie. the facial nerve). As a result, there is an obstruction of qi (vital energy) and blood in these areas that leads to malnourishment of the tendons and muscles and thus a propensity for the facial muscles to become lax or paralyzed. The lack of nourishment to the local area can therefore cause symptoms of numbness and tingling, which are common signs of qi and/or blood deficiency in TCM (Traditional Chinese Medicine).

The treatment principle used in this patient's case was to use a few distal and several local acupuncture points to eliminate wind, regulate qi and blood in the Shaoyang and Yangming channels in order to remove obstruction and restore facial nerve function. After four treatments within a one-week period, the patient's facial muscles and facial nerve function were fully restored. While some cases of Bell's palsy will spontaneously resolve within a few weeks, this is likely due to the severity of the attack (e.g., the less severe, the easier and less time it takes for the body to fight off the disease). In most Bell's palsy cases however, the patient has a deficient immune system that prevents them from effectively combating the illness and subsequently, the condition may linger or even return. Since acupuncture can help to move the blood circulation and energy to the affected site to help restore function, and also has immune enhancing effects, it is a welcome addition to the treatment of peripheral facial paralysis that can increase the potential for a faster and complete recovery. To prevent future recurrences of the disease, it is also necessary to eliminate any possible factors that can tax the immune system, and maintain a healthy lifestyle involving proper rest, moderate exercise, a balanced, nutritious diet (lots of fruits, vegetables, whole grains, nuts, legumes, fish, and reduced portions of red meat, poultry and dairy), and creative outlets for relieving stress.

In my experience, many people afflicted with long-term peripheral facial paralysis who have not improved after taking western drugs, are then entered into programs that work to rehabilitate the facial muscles. While these programs are effective to a certain extent, incorporating traditional Chinese medicine on a regular basis through acupuncture, cupping, and herbal medicine can significantly improve results and help to resolve the condition. So for those who are currently suffering from Bell's, don't give up hope!

References:

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