世界针灸学会联合会

三叉神经痛后发病的周围性面神经麻痹的一例针灸治疗

作者:孙梦晓 来源:本站原创 点击:1806次 更新:2018-08-22
  

南云三枝子Mieko Nagumo1, 和辻直Tadashi Watsuji2,3


1南云针灸诊所,北海道0030021,日本; 2日本传统针灸学会学术部,东京医疗专科学校,东京1600008,日本; 3明治国际医疗大学大学院针灸学研究生学科传统针灸学专业,京都6290392,日本

1 Nagumo Acupuncture & Moxibustion Clinic, Hokkaido 0030021, Japan; 2 Academic Department, The Japan Traditional Acupuncture and Moxibustion Society,Tokyo Medical Vocational College,Tokyo1600008,Japan; 3 Field of Traditional acupuncture and moxibustion, Graduate School of Acupuncture and Moxibustion, Meiji University of Integrative Medicine,Kyoto 6290392,Japan


摘要:研究背景和目的:关于伴随疼痛的周围性面神经麻痹的报道很少。本次,我们对在鼻粘膜上感染疱疹病毒造成三叉神经痛发病后出现周围性颜面神经麻痹的病例采用针疗,获得了改善疗效,故在此进行报道。患者:66岁妇女。初诊:201X-1年12月1日。主诉:右眼不能闭合。右侧脸部有僵硬感,口难以张开、不能漱口。右侧脸部(眉毛、鼻子、太阳穴和耳周围)有疼痛感。既往病史:27岁,右侧颈部病发带状疱疹;52岁,罹患左侧面神经麻痹。现病史:X-1年10月,由于老毛病支气管哮喘影响睡眠;11月12日,因右耳和颞区剧痛前往耳鼻科就诊。结果被诊断为右鼻深部粘膜上感染疱疹病毒引起三叉神经痛,因此服用抗病毒药物,无耳鸣,无听力衰减,耳穴无水泡;11月20日,早晨醒后右眼闭合困难,脸部有僵硬感,照镜子发现脸部歪斜,于是前往脑神经外科就诊,服用类固醇、维生素B12制剂、外周血流改善药物(门诊治疗2周)。检查结果:右眼不能闭合、不能皱眉头、口角运动明显不对称、总体印象是因明显的麻痹导致左右差异明显。右脸的压痛(++)。治疗:为了改善表情肌的血液循环和抑制三叉神经的疼痛以及缓和颈肩部的肌紧张,选用TE17、GB2、ST7、ST4、LI20、BL2、GB9、CV24、GB12、GB21、LI4、ST36穴位,留针10分钟。至201X年10月18日为止进行了43次治疗。治疗使用日本制造的毫针直径0.12mm×长30mm和梅花针直径0.2mm×长0.6mm(日本Seirin公司)。治疗进展:三叉神经痛的NRS(数字评价量表)从10变为2(治疗前:10、无痛:0);右眼可以闭合;脸颊可鼓起,嘴可以合拢,可用吸管喝水;脸部无痉挛,患侧眼可出眼泪。讨论/结论:本病例患者过去曾患颈部带状疱疹,左侧面神经麻痹(贝尔麻痹)。提示单纯疱疹病毒1型的再激活所导致的病毒性神经炎是引起周围性面神经麻痹的原因之一。研究推测通过针疗改善了血流,产生了促进表情肌(眼轮匝肌、口轮匝肌等)的功能恢复的疗效。此外,还推测对三叉神经产生了预期的影响,起到了镇痛的作用。研究提示针疗对三叉神经痛和周围性面神经麻痹的治疗是有用的。

关键词:针灸学;面神经麻痹;三叉神经痛;毫针

Key words:Acupuncture, Facial paralysis, Trigeminal neuralgia, Filiform needles


参考文献

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Presenter Biography: Mieko Nagumo. Born on March 26, 1948.Female. The president of Acupuncture & Moxibustion Nagumo Clinic. E-mail:mkam@nagumo.ptu.jp

Graduated from the Acupuncture & Moxibustion Department, Toyo Acupuncture Vocational school in Tokyo,1969. The president of Acupuncture & Moxibustion Nagumo Clinic in Sapporo from 1974.

Nagumo Acupuncture & Moxibustion Clinic: 17-11-15 Sakaedori Siroishi-ku Sapporo-shi Hokkaido 003-0021 JAPAN.

Title:A case of acupuncture for facial paralysis following trigeminal neuralgia

Mieko Nagumo1,Tadashi Watsuji2,3

1 Nagumo Acupuncture & Moxibustion Clinic, Hokkaido 0030021, Japan; 2 Academic Department, The Japan Traditional Acupuncture and Moxibustion Society,Tokyo Medical Vocational College,Tokyo1600008,Japan; 3 Field of Traditional acupuncture and moxibustion, Graduate School of Acupuncture and Moxibustion, Meiji University of Integrative Medicine,Kyoto 6290392,Japan


Abstract: Background and Objective:There are few reports of peripheral facial paralysis accompanied by pain. We report a case in which acupuncture improved peripheral facial paralysis occurring after trigeminal neuralgia following herpes infection of nasal mucosa.Patient: A 66-year-old woman.Initial consultation:December 1,201X-1.Chief complaint:Inability to close right eye. Stiff sensation in face (R), difficulty opening mouth, inability to gargle.Facial pain (R) (eyebrow, nose, temple, around ear). Past history:27-years; herpes zoster on neck (R), 52-years; facial paralysis (L). Present illness:October, 201X-1; chronic bronchial asthma interrupting sleep. November 12; ENT examination for severe pain in ear and temporal region (R). Diagnosed with trigeminal neuralgia induced by herpes infection in inner nasal mucosa (R), and antiviral administered. No tinnitus or hearing difficulty, no blisters at ear hole. November 20: difficulty closing eye (R) and facial stiffness on waking. Examined by neurosurgeon after seeing facial distortion in mirror. Steroid, vitamin B12, and peripheral circulation improver administered (2-weeks regular clinic treatment). Findings:Unable to close eye (R), unable to raise eyebrows, distinct asymmetry of mouth corner movement, and overall impression of obvious paralysis with clear L/R difference. Facial tenderness (R)(++) Treatment:To improve circulation in mimetic muscles, relieve trigeminal nerve pain, and alleviate neck/shoulder muscle tension, needles retained for 10-minutes at TE17, GB2, ST7, ST4, LI20, BL2, GB9, CV24, GB12, GB21, LI4, and ST36. Treated 43-times to October 18, 201X. Treatment using Japanese-made filiform needles:0.12mmΦ (diameter) ×30 mm H(height)and Pyonex0.2mm Φ x 0.6mm H(Seirin Corporation, Japan).Course:Trigeminal neuralgia NRS (Numerical Rating Scale) improved from 10 to 2 (Before: 10, Painless: 0). Able to close eye (R). Able to puff up cheeks, purse lips, and drink with straw. No facial spasm. Tears from eye on affected side.

Discussion/Conclusion:The patient had suffered herpes zoster on the neck and facial paralysis (L) (Bell’s palsy) in the past. A possible cause of the peripheral facial paralysis was viral neuritis caused by reactivation of herpes simplex 1. We sought to improve blood flow with acupuncture and surmise it resulted in improvement of mimetic muscle (orbicularis oculi muscle, orbicularis oris muscle, etc.) function. We further surmise it had a desirable effect on the trigeminal nerve and alleviated pain. These results suggest acupuncture is useful for trigeminal neuralgia and peripheral facial paralysis.

Keyword:Acupuncture, Facial paralysis,Trigeminal neuralgia,Filiform needles

References

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2)Ogata K,Kondo H,Hanawa T et al.: Ganmentsu wo heihatsu shita masshoseiganmen shinkei mahi kanja ni taisuru shinkyu chiryou no ichishorei (A case of acupuncture for peripheral facial paralysis with concomitant facial pain); The Japanese journal of acupuncture & manual therapies2016(5)138-142.

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4)Kasuya D,Yamamoto K,Tojima H et al.: Acupuncture Treatment for Peripheral Facial Paralysis. Journal of the Japan Society of Acupuncture and Moxibustion 2002; 52 (1): 32-42.

5)Ebiko K,Tanba S,Kikkawa M et al.: Effects of Acupuncture on Refractory Bell's Paralysis and Hunt's Syndrome: Examination of 29 Patients with a Minimum ENoG of 0% and NET scale-out, Journal of the Japan Society for Oriental Medicine 2009; 60: 347-355. 

6)Kasuya D:Masshosei ganmen shinkei mahi ni taisuru shinkyuu chiryo Sono 1 (Acupuncture for peripheral facial paralysis – Part 1); The Japanese journal of acupuncture & manual therapies 2009; 796: 78-85.

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8)Mukaino Y: Ganmen shinkei mahi ni taisuru shinkyuu igakuteki approach (Acupuncture medicine approach to peripheral facial paralysis); Facial N Res Jpn 2010; 30: 25-28.

9)Shiozawa K, Yoshimoto S,Mitsukawa N et al.:Study on the terminal branches of the facial nerve in mimetic muscles (orbicularis oculi muscle and orbicularis oris muscle); Journal of The Showa Medical Association2012; 72(6): 656-661.


Presenter Biography: Mieko Nagumo. Born on March 26, 1948.Female. The president of Acupuncture & Moxibustion Nagumo Clinic. 

Graduated from the Acupuncture & Moxibustion Department, Toyo Acupuncture Vocational school in Tokyo,1969. The president of Acupuncture & Moxibustion Nagumo Clinic in Sapporo from 1974.

Nagumo Acupuncture & Moxibustion Clinic: 17-11-15 Sakaedori Siroishi-ku Sapporo-shi Hokkaido 003-0021 JAPAN.