Acupuncture with de qi improves facial muscle recovery in Bell palsy patients

Patients with Bell palsy who received acupuncture that achieves de qi, a type of intense stimulation, had improved facial muscle recovery, reduced disability and better quality of life, according to a randomized controlled trial published in CMAJ (Canadian Medical Association Journal).

Bell palsy is sudden onset of facial paralysis that is usually temporary, resolving within weeks or months, although it can sometimes be permanent.

Acupuncture is used to treat a variety of conditions and is gaining acceptance worldwide. De qi is a combination of sensations stimulated by manipulation of acupuncture needles - soreness, tingling, coolness, warmth and others radiating at the insertion points - but has not been validated by randomized controlled trials.

"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," writes Dr. Wei Wang, Department of Neurology, Key Laboratory of Neurological Diseases of Chinese Ministry of Education, Wuhan, Hubei, China, with coauthors.

In a randomized controlled trial with 338 patients, Chinese researchers sought to understand the efficacy of acupuncture with weak stimulation or strong (de qi) stimulation. The trial, conducted at 11 tertiary hospitals in China, involved 15 experienced acupuncturists who administered acupuncture to the de qi group (167 people), which received intense stimulation, and the control group (171 people), which received needles but no stimulation. Patients' facial expressions, a marker of facial-nerve function, were rated on a 6-point scale and videotaped to ensure consistent findings across hospital sites.

Six months after randomization, facial-nerve function, disability and quality of life were better in patients in the de qi group than in the control group.

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

"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.