Introduction

Bell’s palsy is sudden, temporary weakness in facial muscles. It can paralyze parts of the face, making it droop. It is caused by some kind of trauma to the seventh cranial nerve [1-3].

The nerve responsible for the control of the facial muscles passes through a narrow corridor of the bone surrounding the face. Patients with Bell’s palsy experience inflammation of the cranial nerve, caused by a viral infection or any sort of trauma on the cranial nerve. Besides facial muscles, the nerve affects tears, saliva, taste and a small bone in the middle of the ear [1-3].

It may occur at any age. The exact cause is unknown. It is believed to be the result of swelling and inflammation of the nerve that controls the muscles on one side of the face. It can also occur as a reaction after a viral infection [1-3].

For most people, Bell’s palsy is temporary. Symptoms usually start to improve within a few weeks, with complete recovery in about six months. A small number of people continue to have some of Bell’s palsy symptoms for life. It can rarely recur [1-3].

Purpose

The purpose of this study is to demonstrate the importance of considering the invasion of Wind and Cold as a causative factor in patients with weakened energy on the development of Bell’s palsy.

It is another goal to address the importance of an energybased treatment, to treat the energy imbalances of each patient individually, instead of only performing localized treatment.

Methods

The study was developed with the use of the effective treatment of three patients, which presented Bell’s palsy.

Literature regarding Bell’s palsy causes and treatment on Western medicine and traditional Chinese medicine were also analyzed. All analyzed articles were Pubmed indexed.

Case Report 1

A patient named Z.R.N.C, a 60-year-old female, married, retired. At the beginning of 2019, the patient was facing severe emotional distress with family problems. In August 2019, the patient noticed a small swelling point on the interior of her left ear and thought it was a pimple and squeezed it. On the following morning, all her ear lobule had blisters. Within the day, the blisters became hot and swollen.

The patient searched for a doctor, who first diagnosed a bacterial infection. The patient performed treatment for three days with antibiotics, with no improvement. After returning to the doctor, she was diagnosed with herpes zoster, receiving a prescription of antiviral medication, anti-inflammatory medication, and B complex. In three days, the blisters were gone, but the hyperemia on the ear persisted as shown in Figure 1.

Five days after this incident, the patient noticed her face was deviated to the right side. The episode happened on the morning, she had just got out of the bed with the body warm and went to the bathroom, which was in a lower temperature than the bedroom, when she returned, and she noticed the paralysis. She also perceived alteration in speaking and a certain loss of muscular strength on the face. On the following morning, her left eye stopped blinking naturally, and she perceived she had Bell’s palsy.

The patient lost the photos of the beginning of her symptoms. The first photos available date from the middle of the treatment, in (Figure 2).

The patient was choked with the diagnosis, which had a negative effect on her self-esteem. She started treatment with medication and physical therapy. After 10 days of suffering from Bell’s palsy without significant improvement with the treatment she was performing, she received an indication of acupuncture. She was diagnosed with Kidney Yin and Yang deficiency and Heat retention, according to TCM. Treatment was started to rebalance Yin, Yang, Qi and Blood energies and take out Heat retention, besides localized treatment on the face with systemic acupuncture, using needles.

The treatment consisted of Chinese dietary counseling, which was to avoid all raw and cold foods, suspend all dairy products, avoid frying, eggs, coconut, honey, chocolate, alcoholic beverages, and melted cheese. She receiveid indication to drink lukewarm water. She also received auricular acupuncture, systemic acupuncture on the paralyzed spot associated with apex ear bloodletting.

The patient also passed through the procedure of radiesthesia to measure the energy of the chakras meridians. The results showed that all chakras were at the minimum level (1), from a scale from 1 to 8. Treatment for replenishing the energy of the chakras was started with homeopathy, according to the Constitutional Homeopathy of the Five Elements Theory based on Traditional Chinese Medicine, developed by the author. Crystal-based medications were also used.

Results Case Report 1

In the first acupuncture session, the patient perceived some wrinkles of her skin returning, which let the patient really happy, as her skin had no movement, and she notices that the treatment was already being effective. After 18 days of acupuncture sessions five days a week, her left eye returned to blink. With almost two months of paralysis, her mouth appeared with significant improvement, the paralysis appearing only when she would smile or talk, as shown in Figure 3.

The patient is still being treated. The treatment was stopped in March 17, 2020, due to the coronavirus outbreak.

The infection the patient had on the ear, before the Bell’s palsy, improved without the use of antibiotics medication, only with Chinese dietary counseling and auricular acupuncture associated with apex ear bloodletting.

Case Report 2

A patient named L.G, 45-year-old male. His symptoms started on June 07 of 2019 (winter in Brazil). The patient passed through a thermal shock, leaving a very hot environment inside his house and going out to work with his motorcycle. He left his house around 8 AM, it was a cold morning. Around midday, the patient went back home to have lunch and started noticing his eyes were watery and his vision was blurry. He went back to work, and when he arrived home at 6 PM, he was drinking water and noticed he was not able to drink it and he was drooling. He went to the mirror and found his face as crooked. His right eye was not able to blink, the right eyebrow did not move and his mouth was twisted down on the right side.

On the next day, he sought a neurologist, who advised him there was nothing to do and ask him to wait for the natural improvement. The doctor also indicated an ophthalmologist to take care of the patient’s’ eyes. The ophthalmologist recommended an eye drop for dry eye and physiotherapy. He performed a tomography and nothing was found. The patient was then diagnosed with Bell’s palsy. He performed physiotherapy for two weeks with no positive results.

The patient then did research and found that acupuncture could be effective on this kind of symptom. He sought treatment with ancient medical tools, which started on June 24, 2019. He was diagnosed with Kidney Yin deficiency and internal Heat, according to TCM. He started treatment with Chinese dietary counseling, the same as orientations as in the first case, systemic acupuncture (localized treatment on the face) and auricular acupuncture associated with apex ear bloodletting (twice a week). The patient also received measurement of the chakras, through radiesthesia. All his chakras were rated on a minimum level (1), on a scale of 1 to 8. Treatment with homeopathy according to the theory of the author entitled Constitutional Homeopathy of the Five Elements based on Traditional Chinese Medicicne and crystal-based medication to replenish the energy of the chakras was also done. When he first started treatment with TCM, his face was very crooked for the right side, as it is possible to see in Figure 4.

In Figure 5, it is possible to see the recovery of the patient after two weeks of treatment.

The patient continued treatment with acupuncture and Chinese dietary counseling, until October 10th of 2019. He is still taking the homeopathy and crystal-based medication, recommended for a year.

Results Case Report 2

Within the first month, he recovered movement of the face. Within four months of treatment, the patient had complete recovery of the symptoms, as can be seen in Figure 6.

Case Report 3

A patient named S.R., a 60-year-old female. The symptoms of Bell’s palsy started on July 29 of 2019, with pain and tinnitus on the ear. On July 30 and 31, the pain started to be more intense. On August 1, in the morning, the patient felt a tingling on her mouth and soon after, her mouth was crooked. On the previous day, the patient also had had alteration on the arterial pressure.

The first cause of Bell’s pals, according to Western medicine, was a thermal shock. She was indicated dexamethasone with B complex, acetylsalicylic acid (ASA), ergoloid, prednisone. The patient was also using dextran on the form of eye drops and other eye drops composed of retinol acetate 10,000 UI, amino acids 25mg, methionine 5mg, and chloramphenicol 5mg. The pain on the ear continued and herpes zoster was detected through physical examination.

The patient then started treatment with ancient medical tools. On her first appointment, she was diagnosed with Kidney Yin and Yang deficiency and Heat retention, according to TCM. Treatment for rebalancing Yin, Yang, Qi, and Blood started with Chinese dietary counseling (the same as the first case) auricular and systemic acupuncture, associated with apex ear bloodletting, associated with the localized treatment on the face with systemic acupuncture.

The patient received measurement of the chakras, through a procedure called radiesthesia. In the first session, the patient already felt improvement on the tinnitus on the ear and on the pain.

The results of her chakras measurement showed a deficiency in six of the seven-evaluated chakra. The seventh was normal, in level 8 and the other six were at the minimum level, rated in 1.

The patient also had great difficulty in seeing properly on the paralyzed eye and reported that acupuncture improved this feeling as well, diminishing her discomfort. Figure 7 shows the facial paralysis of the patient before treatment. Figure 8 shows the facial paralysis of the patient during treatment. The points used are described in Figure 8. They were ST6 inserted in direction to ST4, GB14 only on the side of the paralysis. The needle used was a stemless needle (40mm).

Results Case Report 3

The patient was still being treated and had significant improvement of the mouth deviation and is able to close her eyes. Her self-esteem also had improvement, with the patient feeling emotionally stronger. The treatment was stopped in March 17th, due to the coronavirus outbreak. She will continue treatment. The patient’s improvement after three months of treatment can be observed in Figure 9.

Discussion

Western medicine and Bell’s palsy

According to Western medicine, Bell’s palsy is the title given to paralysis of the muscles of the face. It can be unilateral, partial or complete. In the article entitled Bell’s palsy, published by Julian Holand, it is stated that the majority of the patients present natural recovery within a month [1-3].

The symptoms are more prompt to happen with patients aged 15 to 40 years old. Symptoms of loss of ability to taste and smell are associated with Bell’s palsy physiopathology [1-3].

The study of Anthony Zandian entitled The neurologist’s dilemma: A comprehensive clinical review of Bell’s palsy, with emphasis on current management trends, states that 60% of patients report the previous viral illness [4].

The main symptoms are rapid onset of mild weakness to total paralysis on one side of the face-occurring within hours to days.

• Facial droop and difficulty making facial expressions, such as closing the eye or smiling;

• Drooling;

• Pain around the jaw or in or behind the ear on the affected side;

• Increased sensitivity to sound on the affected side;

• Headache;

• A decrease in the ability to taste;

• Alterations in the amount of tears and saliva produced [4]. In

Western medicine, although the exact reason Bell’s palsy occurs is not clear, it is often related to exposure to a viral infection. Different viruses can cause the disease, some of them being herpes simplex (causative of cold sores and genital herpes), herpes zoster (causative of chickenpox and shingles), Epstein-Barr (causative of mononucleosis), cytomegalovirus, adenovirus (causative of respiratory illnesses), rubella (causative of German measles), mumps virus (causative of mumps) and influenza B (causative of the Flu) [5].

The current management of the disease aims to reduce inflammation to the facial nerve and/or preventing corneal complications. Protecting the cornea from excessive dryness and abrasions should be addressed by the clinician through proper patient education. Corticosteroids are constantly used to reduce inflammation [5].

Traditional Chinese Medicine and Bell’s palsy

The condition that is congruent with Bell’s palsy in traditional Chinese medicine is called “Zhong Feng – Zhong Jing Lao”, which literally translates to “wind attack the meridians.” According to TCM, Bell’s palsy is caused when the exogenous.

pathogenic Wind and Cold invade the meridians, muscles, and tendons of the face. [6-7]. It was attributed to ‘Wind’ by past dynasties. ‘Qi’ refers to the vital substances comprising the human body and the physiological functions of viscera and bowels, channels and collaterals. It maintains life activities and reflects the resistance of the human body [6-7].

In the study entitled The effect of acupuncture on Bell’s palsy: an overall and cumulative meta-analysis of randomized controlled trials written by Xiao-Wen Zhang, it is addressed the history and etiology of the use of auricular and systemic acupuncture on the treatment of Bell’s palsy [8]. Several other articles appear to demonstrate the effectiveness of acupuncture on the treatment of the pathology. For example, Jessica Cooper, Yong Deng and Jeffrey Langland on the article entitled Enhanced Recovery from Bell’s Palsy with Acupuncture and Chinese Herbal Medicine: A Case Report, in which the use of Chinese herbal medicine appeared effective on this case report [9].

Invasion of Wind

The Wind is one of five external pathogenic factors that characterize the five seasons according to traditional Chinese medicine [7]. According to the study entitled The Concept of Wind in Traditional Chinese Medicine, the invasion of Wind in the body resembles the wind in nature; thus, it produces change and acceleration in what otherwise would be steady and slow. When excessive, it might imbalance other energies [7]. According to this study, Wind attacks the body by penetrating the skin and the pores, an important result in TCM is the emergence of imbalances of external origin caused by climatic aggression pathogenic factors [7]. Previous scholars, such as Huangdi Neijing states that Wind when in the upper body has a pernicious influence on Yang energy. Because Wind is light and related to the element of Air, it is believed to influence mainly the upper body, especially the face, skin and sweat glands, and lungs [7].

When the body is invaded from outside, it is because its defensive capabilities are weakened, causing a mismatch in the opening and the closing of the pores in the entire body, leading to the invasion of other pathogenic factors causing diseases with symptoms such as some headaches, nasal obstruction, painful and itching throat, facial edema, abnormal aversion to wind, and perspiration [7].

Traditional Chinese Medicine: The main differences between the two approaches

The representation of a tree creates a parallel on how diseases are treated today from the point of view of Western medicine and according to traditional Chinese medicine. In other articles of the author, it is stated the importance of this metaphor, in order to address how Western and ancient perspectives could work together [10-16]. TCM explains the functioning of the human body through a holistic view. Therefore, external factors such as Wind, Cold, Heat, Dryness, Humidity, diet and internal factors such as emotions may have an influence on wellbeing. The tree has a trunk with several branches (Figure 10). Each branch represents each medical specialty and each leaf that comes out of each branch represents the symptoms and diseases of each specialty. In the case of Bell's palsy, the manifestation of the symptom is on the leaf-level on the branch of neurology. The focus is to treat each leaf in each specialty [10-16].

The part of the tree that is below the earth - invisible to the naked eye - are the roots of the tree. This part remains unknown to western medicine mainly because its existence is not recognized or discussed in the medical faculties [10-16].

In the case of Bell’s palsy, the importance is to consider the influence that the tree suffers from the external factors, especially Wind. On the root of the tree, it is possible to see the Five Elements and Yin and Yang theory. The two theories were extensively explained by the author in other articles, presentations and case report studies. The main idea contained in the two theories is the functioning of the body as a whole, and the placement of the symptoms as a leaf on the tree metaphor. The symptoms of Bell’s palsy, for example, were only a reflex of an energy imbalance, caused by the invasion of Wind, in a weakened body due to imbalances present on the root of the tree [10-16].

According to the experience of the author, this treatment, based on the root of the problem, is the cornerstone of the diagnosis and treatment of all patients of the author and is based on the analysis of one specific case the author had in 2007. The patient in question presented symptoms of pain in the legs and received treatment with Chinese Dietary counseling, auricular acupuncture and systemic acupuncture associated with apex ear bloodletting to treat these symptoms, according to his energy imbalances (Kidney Yang deficiency) [2-7].

The patient presented an improvement of his pain in the legs after 10 acupuncture sessions and returned to the clinic to be evaluated again. On this occasion, he revealed to the author that he also had a major improvement in a symptom the author was not aware he had. He was being treated for glaucoma in the last 40 years, with no significant improvement. For the first time, his intraocular pressure diminished from 40mmHg to 17mmHg. The treatment for Kidney Yang deficiency not only improved his symptoms of pain in the legs but also improved his intraocular pressure [2-7].

This was part of a study presented in 2015, at an acupuncture research conference at the Faculty of Medicine of Harvard University in Boston, entitled ACUPUNCTURE VIEWED HOLISTICALLY CAN TREAT ALL THE PATIENT’S DISEASES SIMULTANEOUSLY - A CASE STUDY. The summary of this study states that if we treat the patients’ energy imbalances, we will treat all the patient’s symptoms at the same time; even if the doctor does not know the patient has such a symptom. With this type of reasoning, we will be able to treat all diseases of all specialties at the same time, as we treat in this case, the root of the problems and not only the symptoms [2-7].

When treating these energy imbalances, the author is proportioning the faster improvement and recovery from the Bell’s palsy, besides the localized treatment, done with acupuncture, leading to improvement of all the other symptoms the patient may have, such as anxiety, depression, insomnia, etc. It is also important to add, the patients received a specific way of treatment, based on the energy of the chakras. As demonstrated in other studies of the author, the chakras are correspondent to the five massive organs of the Five Elements Theory. When measuring the chakras, as performed on the three patients described in the case reports, it is possible to query that the massive organs are being measured on their energy level [10-16].

The scale used on the measure ranges from 1 to 8. The procedure is done with a crystal-pendulum and it is called radiesthesia. All three patients had their energy measured and had a very low level of energy in all the chakras, with the exception of the seven chakras in one of the patients [10-16]. Therefore, it was suggested that the patients started a specific treatment for the replenishment of the energy of the chakras directly, with the use of homeopathy and crystal-based medication [10-16]. The homeopathy used was based on the theory of the author entitled Constitutional Homeopathy of the Five Elements based on Traditional Chinese Medicine, a study presented by the author worldwide, for the last time in Cape Town, South Africa, in 2018, on the LMHI World Homeopathy Conference. This study is a cornerstone for the reasoning of the replenishment of the chakras energy meridians for improving different symptoms and pathologies. The correspondence between the chakras and the Five Elements, as well as the homeopathy and crystal-based medication chosen, are described in (Figure 11) and in (Table 1) respectively.

In this study, it was demonstrated that patients with Bell’s palsy, present an energy imbalance on the root-level, which propitiates more vulnerability to the influence of external pathogenic factors, mainly Wind, leading to the symptoms presented by the patients. On the three case reports, the cases 1 and 3 had herpes zoster on the ear, on the same side of the Bell's palsy before presenting the symptoms. In TCM, herpes symptoms are caused by Heat retention, which is another energy imbalance generated by the deficiency of energy in all the chakras. This condition was controlled only with Chinese dietary counseling, avoiding food that would harm even further the energy of the patients, auricular acupuncture associated with apex ear bloodletting and homeopathy and crystal-based medication.

Arndt-Schultz’s Law

Arndt-Schultz’s law, originally formulated in 1888, states the effects of different drug concentrations on an individual basis, Figure 12. The rule states that for all substances, small doses stimulate, moderate doses inhibit and overdoses kill [10-16] (Figure 12).

According to this law, highly diluted drugs improve organic processes, while high concentrations harm health. In the case of prescription drugs with high concentrations, in any case, they will be reducing more the vital energy, as demonstrated on the three case reports on this study, which already had deficiency of energy on all the chakras before acquiring Bell’s palsy [10-16]. In the three case reports described in this study, the patients received indication of the use of several high-concentrated medications, as demonstrated the patients already had energy deficiencies, and the use of these medications, despite cause some symptomatic improvement, could harm the vital energy of the patient, maintaining the imbalance, what could cause other diseases on the future such as diabetes, depression, hypertension, anxiety, etc, already published by the author in other articles [10-16].

Traditional Chinese Medicine and Western Medicine – Yin and Yang Metaphor

Nowadays, Western and Traditional Chinese Medicine are seen as different by most physicians around the world. However, they can be integrated. The body, and therefore, the possible treatments, is not only physical and constituted of organs and tissues. It is formed of energy. In (Figure 13), a metaphor of Yin and Yang as the different kinds of medicine was created. For the adequate treatment of Bell’s palsy, it is important to associate Traditional Chinese Medicine and Western medicine, so the patient can treat the symptoms and the root of the problem, which are the energy imbalances, causing the predisposition for the development of Bell’s palsy [10-16].

Conclusion

In this study, it was concluded that patients with Bell’s palsy have an energy deficiency on the chakras centers that make them more prone to invasion of Wind and Cold, due to weakened energy, leading, in this case, to the formation of Bell’s palsy. In this study, TCM tools were used for restoring the function of the facial nerves and muscles and rebalancing all the energy of the patients (Yin, Yang, Qi and Blood and chakras energy). The use of high-concentrated medication, such as corticosteroids, normally used in Western Medicine treatment, may harm the vital energy of the patients even more, worsening or maintaining the condition of energy imbalance, and therefore, Bell’s palsy.

Figure 1: Infected Ear of the Patient.

Figure 2: Patient in the middle of the treatment.

Figure 3: Photo of the Patient Four Months after Starting Treatment.

Figure 4: Recovery from Bell’s palsy with Auricular and Systemic Acupuncture (Patient on the first consultation).

Figure 5: Recovery from Bell’s palsy with Auricular and Systemic Acupuncture (Patient on the second week of treatment).

Figure 6: Recovery from Bell’s palsy with Auricular and Systemic Acupuncture (Patient after one month of treatment).

Figure 7: Case Report 3 Patient on the Beginning of the Treatment.

Figure 8: Patient with acupuncture during treatment.

Figure 9: Patient after Three Months of treatment.

Figure 10: Schematic Relationship between Traditional Chinese Medicines.

Figure 11: Correspondence between the Chakras and the Five Elements.

Figure 12: Arndt-Schultz Law.

Figure 13: Traditional Chinese Medicine and Western Medicine Metaphor.

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