Left side face numbness for 2 weeks

Name of Student Clinician: Johnson Su

Name of Supervisor: Jessica

Patient: XXX

Date of First Visit: 3/6/08

Sex: M

Age: 26

	Description
CHIEF COMPLAINT:	Left side face numbness for 2 weeks.
DESCRIPTION: (4 diagnostic methods)	.
A) Asking
Present illness complaints:	The patient went to Rotorua for holiday and it is winter when the patient went there. He was in the spa for too long and the spa pool was outside. It was really cold and windy that day. After coming back to Auckland from Rotorua, the patient felt that the left side of the face is numb and he can not drink water and the water will leak out from the lips. The eyes can not close and tears will come out from the eyes when shitting the eyes. It is on the left side of the face, the patient can not frown and can not smile, only half of the face can smile and frown and other half can not. No chill or fever, appetite good, defecation normal and urination normal. Sleeping is good, but when the patient sleeps at night the eyes can not close properly. Sweating normal. Mild lower back pain. No tinnitus, no hot flushes, no cold limbs and no bitter mouth and no dry mouth. Sometimes thirsty and like to drink cold water and gets tired easily.
Past history including past health conditions and other previous illness:	NAD.
Life Style:	BUSY STUDENT.
Family history:	NAD
Menstruation, marital & obstetrical history / Men’s sexual health	SINGLE.
B) Inspection
General:	Small body built; normal facial complexion, normal moving states and body shape: small body built.
Others:	NAD
Tongue:	Red big swollen tongue body with big red Spots and yellow coating and red tip. Crack on center.
C) Ausculation / Olfaction
Sound:	Voice is normal and breathing is normal
Odours:	NAD
D) Palpation
Body Areas:	NAD
PULSE	wiry , thin and weak in chi ( kidney both side)

Case Summary

FACIAL PALSY:

Definition: A disease characterized by deviation of the mouth and eye due to motor impairment of the facial muscles.

BELL PALSY:

NON- SPECIFIC INFLAMMATION OF FACIAL NERVE

TCM ETIOLOGY AND PATHOLOGY:

· DEFICINECY OF DEFENDING QI AND EMPTY COLLATERAL

· INVASION OF PATHOGENIC WIND.

TCM SYDNDROME DIFFERENTIATION:

1. ATTACK BY WIND COLD

SUFFER COLD BEFORE

NORMAL TONGUE THIN WHITE COATING FLOATING AND TENSE PULSE

2. ATTACK BY WIND HEAT

HAD FEVER/ INFECTION HISTORY BEFORE

PAIN INSIDE EARS OR AROUND MASTOID PROCESS

RED TONGUE, THIN YELLOWISH COATING AND FLOATING AND RAPID PULSE.

DIAGNOSIS:
TCM Disease:	Wiry face / FACIAL PARALYSIS.
TCM type/pattern:	Qi and blood deficiency and invasion of the exogenous wind cold pathogenic attacking the exterior of the skin and kidney yin deficiency.
C) Explanation:	The wry face showed by deviation of eye and mouth means facial paralysis and mostly occurs during winter and autumn time, This patient happened in winter time and this can occurs any age and this patient is quite young to get this kind of disease. It is more frequently in males. When body is weak the meridians are empty, the pathogen gets inside and blocks the flow of Qi, this results in a lack of nourishment to the tendons and muscles. Can become chronic, this causes an eventual Yin deficiency with Heat and/or deficiency Wind. This condition may cause the deviation to move to the other side of the face. The deviation of the eyes and mouth is due to paralysis of the facial muscle caused by attack of the pathogenic wind and coldness when the patient went to Rotorua in cold and windy winter caused attack of the pathogenic factors on the yangming and shaoyang channel, which leads to malnutrition of the muscle and the channels. This is a sudden onset when patient came back from Rotorua and one side of the face which is the affected side ( left side mainly) has numbness feeling and even muscles paralysis unable to frown and eyes can not closed, inability to swallow. Etc…QI deficiency due to easily tired. Yin deficiency includes the red tongue body with big red spots and thin pulse. And crack in the center for tongue.
TREATMENT:
A) Treatment Principle	Dispelling pathogenic wind and cold and removing obstruction from the channels and tonify qi and blood, tonify kidney yin.
B) Treatment Method	.
1. Needling
Select techniques:	Filiform ( / ) three edged needle ( ) plum blossom ( ) intradermal ( )
Select Acu-points and Manipulation:	Hegu ( tonify ) Zusanli-( tonify_) Fenchi, ( reduce_ Xiaguan: tonify Weiguan: reduce Dicang: tonify Jiache: tonify Quanliao: tonify Sibai : tonify Cuanzhu: tonify
Explain the reasons for your selection:	Hegu ( tonify )- for used to promote the circulation of qi and large intestine and stomach channels and they can eliminates the pathogenic wind form the head and facial area. Used filform needling to promote qi in the large intestine and stomach channel. Zusanli-( tonify_)for used to promote the circulation of qi and large intestine and stomach channels and they can eliminates the pathogenic wind form the head and facial area. Used filform needling to promote qi in the large intestine and stomach channel Fenchi, ( reduce_- to eliminates pathogenic wind from San Jiao cahnnel and GB channel and stop pain, used filform needlng to eliminates the pathogenic wind. Weiguan: reduce_- to eliminates pathogenic wind from San Jiao cahnnel and GB channel and stop pain, used filform needlng to eliminates the pathogenic wind. Xiaguan: tonify are local points they can promote the qi of the effected side. Used filfrom needling to promote the qi on the effected side of the face. Dicang: tonify are local points they can promote the qi of the effected side. Used filfrom needling to promote the qi on the effected side of the face. Jiache: tonify are local points they can promote the qi of the effected side. Used filfrom needling to promote the qi on the effected side of the face. Quanliao: tonify are local points they can promote the qi of the effected side. Used filfrom needling to promote the qi on the effected side of the face. Sibai : tonify are local points they can promote the qi of the effected side. Used filfrom needling to promote the qi on the effected side of the face. Cuanzhu: tonify are local points they can promote the qi of the effected side. Used filfrom needling to promote the qi on the effected side of the face.
2. Moxibustion
Select techniques:	moxa cone ( ) moxa roll ( ) indirect moxa ( )
Select Acu-points:
Explain the reasons for your selection:
3. Cupping	N/A
Select techniques:	Stationary ( ) mobile ( )
Select Acu-points retention time:
Explain the reasons for your selection:
4. Microsystem
Select Microsystems:	Ear ( ) hand ( ) foot ( ) scalp ( ) nose ( ) brow ( ) dentition ( )
Points	.
Diagnosis is confirmed by across checking with at least one other Microsystems system:
Explanation the reasons of your selecting:
5. Lifestyle Advice:	Do regular exercise. Massage the face to loose hardness. Avoid wind and cold weather we going out maybe needle something To cover the face area.

Follow Up Consultations

Patient Name: Treatment Number: 2

TCM Disease: WIRY FACE/ FACIAL PALSY.

TCM Types/Pattern: Qi and blood deficiency and invasion of the exogenous (cold and wind) pathogenic factor attacking the exterior of the skin and kidney yin deficiency.

Date: 5/06/08

Current Condition/Changes:

The palsy becomes better.

Before she smiles her feel stiffness on the face but now much better.

Treatment Principle Dispelling pathogenic wind and cold and removing obstruction from the channels and tonify qi and blood, tonify kidney yin.

Prescription This time I used electrical needling and to stimulate the effected area. I have connected mustly on the local area of the face.

Hegu (tonify)

Zusanli-( tonify_)

Fenchi, ( reduce_

Xiaguan: tonify

Weiguan: reduce

Dicang: tonify

Jiache: tonify

Quanliao: tonify

Sibai : tonify

Cuanzhu: tonify

Explanation:. Hegu (tonify) - for used to promote the circulation of qi and large intestine and stomach channels and they can eliminates the pathogenic wind form the head and facial area. Used filform needling to promote qi in the large intestine and stomach channel.

Zusanli-( tonify_)for used to promote the circulation of qi and large intestine and stomach channels and they can eliminates the pathogenic wind form the head and facial area. Used filform needling to promote qi in the large intestine and stomach channel

Fenchi, ( reduce_- to eliminates pathogenic wind from San Jiao cahnnel and GB channel and stop pain, used filform needlng to eliminates the pathogenic wind.

Weiguan: reduce_- to eliminates pathogenic wind from San Jiao cahnnel and GB channel and stop pain, used filform needlng to eliminates the pathogenic wind.

Xiaguan: tonify are local points they can promote the qi of the effected side. Used filfrom needling to promote the qi on the effected side of the face.

Dicang: tonify are local points they can promote the qi of the effected side. Used filfrom needling to promote the qi on the effected side of the face.

Jiache: tonify are local points they can promote the qi of the effected side. Used filfrom needling to promote the qi on the effected side of the face.

Quanliao: tonify are local points they can promote the qi of the effected side. Used filfrom needling to promote the qi on the effected side of the face.

Sibai : tonify are local points they can promote the qi of the effected side. Used filfrom needling to promote the qi on the effected side of the face.

Cuanzhu: tonify are local points they can promote the qi of the effected side. Used filfrom needling to promote the qi on the effected side of the face.

Lifestyle Advice: Do regular exercise.

Massage the face to loose hardness.

Avoid wind and cold weather we going out maybe needle something

To cover the face area

WMS:

Bell's palsy

Bell's palsy is a paralysis of cranial nerve VII (the facial nerve) resulting in inability to control facial muscles on the affected side. Several conditions can cause a facial paralysis, e.g., brain tumor, stroke, and Lyme disease. However, if no specific cause can be identified, the condition is known as Bell's Palsy. Named after Scottish anatomist Charles Bell, who first described it, Bell's palsy is the most common acute mononeuropathy (disease involving only one nerve), and is the most common cause ofacute facial nerve paralysis.

Bell's palsy is defined as an idiopathic unilateral facial nerve paralysis, usually self-limiting. The trademark is rapid onset of partial or complete palsy, usually in a single day.

It is thought that an inflammatory condition leads to swelling of the facial nerve. The nerve travels through the skull in a narrow bone canal beneath the ear. Nerve swelling and compression in the narrow bone canal are thought to lead to nerve inhibition, damage or death. No readily identifiable cause for Bell's palsy has been found, but clinical and experimental evidence suggests herpes simplex type 1 infection may play a role.

Doctors may prescribe anti-inflammatory and anti-viral drugs. Early treatment is necessary for the drug therapy to have effect. The effect of treatment is still controversial. Most people recover spontaneously and achieve near-normal to normal functions. Many show signs of improvement as early as 10 days after the onset, even without treatment.

Often the eye in the affected side cannot be closed. The eye must be protected from drying up, or thecornea may be permanently damaged resulting in impaired vision.

Case Conclusion

The TCM diagnosis is wiry face or facial paralysis and TCM syndrome differentiation is Qi and blood deficiency and invasion of the exogenous (wind cold) pathogenic attacking the exterior of the skin and kidney yin deficiency. And treatment principle is dispelling pathogenic wind and cold and removing obstruction from the channels and tonifies qi and blood, tonify kidney yin. The wiry face is occurs mostly in the winter period. The patient went to Rotorua and was invaded by exogenous pathogenic attacking the exterior of the skin. The Mostly affects young adults, acute, usually one side of the face is affected, can’t close eye, or mouth, causes tearing and drooling. When body is weak the meridians are empty, the pathogen gets inside and blocks the flow of Qi, this results in a lack of nourishment to the tendons and muscles. Can become chronic, this causes an eventual Yin deficiency with Heat and/or deficiency Wind. This condition may cause the deviation to move to the other side of the face. I have treated this patient twice and the points used are Hegu Zusanli, Fenchi, and Xiaguan: Weiguan: Dicang: Jiache: Quanliao, Sibai and Cuanzhu. Hegu and zusanli for )- for used to promote the circulation of qi and large intestine and stomach channels and they can eliminates the pathogenic wind form the head and facial area. Used filform needling to promote qi in the large intestine and stomach channel. And Fengchi and Weiguan are used to promote the circulation of qi and large intestine and stomach channels and they can eliminate the pathogenic wind form the head and facial area. Used filform needling to promote qi in the large intestine and stomach channel. Xiaguan: Dicang: Jiache: Quanliao,Sibai and Cuanzhu are used for points they can promote the qi of the effected side. Used filfrom needling to promote the qi on the effected side of the face. The 2^nd treatment I used electrical needling to stimulate the effected area and good for treat numbness of the face, the points are mainly chosen for local area like Xiaguan: Dicang: Jiache: Quanliao, Sibai and Cuanzhu. I have learned that this case is very common case and this have to be treated as soon as possible, if no treatment ahs been done after 2 week or more, it main have side effect. Acupuncture is great for this kind of disease and good to stimulate the nerve around the face on the effected area. The stimulation can not be too strong maybe the patient will felt worse. Therefore lifestyle advice is given to patient after treatment. During the treatment avoid the wind cold to affect eh face and massage the face and warm the face will be really helpful. Prevention infection of the eyes is strongly considered, the patient can use eyeshade and eyes drop two or three times a day to avoid infection in the eyes. I would consider these points if the TCM diagnosis and TCM pattern are the same.

REFERENCE

SOURCE FROM WIKIPEDIA FOR WMS.

http://en.wikipedia.org/wiki/Bell's_palsy

.TCM SOURCE from

1. NZCCM AUCPUNCTURE THERPEUTIC- Disease of nervous /cardiovascular /blood/endocrine system and health care.

2. ACUPUNCTURE AND MOXIBUSTION- ACADEMY PRESS- BY BEIJING UNIVERSITY OF TCM. Printed in 1999 october.