Intense Acupuncture Benefits Bell's Palsy

Susan Jeffrey

March 08, 2013

Results of a randomized, controlled trial suggest that use of an acupuncture approach that achieves intense stimulation, called de qi, was associated with better recovery of facial muscle function in patients with Bell's palsy versus acupuncture without such stimulation.

"There is a long-held belief in the traditional theory and clinical practice of acupuncture that the intensity of the stimulus must reach a threshold to elicit de qi, which plays a pivotal role in achieving the best therapeutic effects," the researchers, with lead author Wei Wang, Department of Neurology, Key Laboratory of Neurological Diseases of Chinese Ministry of Education, Wuhan, Hubei, China, write.

"Among patients with Bell['s] palsy, acupuncture with strong stimulation that elicited de qi had a greater therapeutic effect, and stronger intensity of de qi was associated with the better therapeutic effects," the researchers conclude. Acupuncture with de qi was associated with improved facial muscle recovery, disability, and quality of life.

"De qi and its related techniques should be properly appreciated in acupuncture practice and research, and should be considered for inclusion in clinical guidelines for acupuncture," the authors conclude.

Their results were published online February 25 in CMAJ.

Increasing Attention

In their report, the researchers point out that acupuncture is gaining "increasing attention worldwide." Part of traditional theory and clinical practice of acupuncture holds that to achieve the best results, the intensity of treatment has to reach a threshold that will elicit de qi, which they describe as "an internal compound sensation of soreness, tingling, fullness, aching, cool, warmth, heaviness, and a radiating sensation at and around acupoints."

However, they note, this long-held belief hasn't been supported by sufficient evidence from randomized controlled trials. "Consequently, de qi and its related techniques have been neglected in acupuncture practice and research. As such, the therapeutic effects of acupuncture may be seriously compromised."

The current study, then, was a prospective, randomized, controlled trial that included 338 patients with Bell's palsy from 11 tertiary hospitals in China. Both groups received acupuncture provided by 1 of 15 experienced acupuncturists. In the active treatment group, the needles were manipulated manually to achieve de qi; in the control group, the needles were inserted without any manipulation.

All patients received prednisone as basic treatment. Acupuncture in both groups was provided during five 20-minute sessions per week for 4 weeks.

The primary outcome was facial-nerve function measured by using the House-Brackmann score; grade 1 on this scale indicates normal function and grade 6, complete paralysis. Patients were asked to show 4 standard facial expressions (at rest, raised eyebrows, eyes tightly closed, and showing teeth) that were recorded by using a digital camcorder and assessed and graded by 3 independent neurologists blinded to treatment assignment.

Secondary outcomes included disability, measured with the Facial Disability Index, and health-related quality of life, measured with the World Health Organization's Quality of Life (brief version).

At 6 months, patients in the de qi group had better facial function (adjusted odds ratio [OR], 4.16; 95% confidence interval [CI], 2.23 - 7.78]).

Table. Distribution of House-Brackmann Scores

Score De qi Group, n (%) Control Group, n (%)
2 8 (4.8) 10 (5.9)
3 88 (52.7) 93 (54.4)
4 54 (32.3) 57 (33.3)
5 17 (10.2) 11 (6.4)


Patients in the de qi group also had better disability assessments (differences of least-squares means, 9.80; 95% CI, 6.29 - 13.30), as well as better quality of life (differences of least-squares means, 29.86; 95% CI, 22.33 - 37.38).

Logistic regression analysis also showed a positive effect of the de qi score on facial-nerve function, the authors note (OR, 1.07; 95% CI, 1.04 - 1.09).

"We found evidence that acupuncture with de qi improved facial muscle recovery, disability and quality of life among patients with Bell['s] palsy," they conclude. "Stronger intensity of de qi was associated with better therapeutic effects."

The work was supported by grants from the National Science Fund for Distinguished Young Scholars, the Natural Science Foundation of China, and the National Basic Research Program. The authors have disclosed no relevant financial relationships.

CMAJ. Published online February 25, 2013. Abstract