Effectiveness of strengthened stimulation during acupuncture for the treatment of Bell palsy: a randomized controlled trial

This multicenter randomized clinical trial investigated the efficacy of the 'de qi' sensation in acupuncture for the treatment of Bell's facial palsy. De qi is a composite sensation described as pain, tingling, heaviness, warmth, cold, and radiation around the acupuncture points, traditionally considered essential for maximal therapeutic effect. The study included 338 patients with Bell's palsy at 11 tertiary Chinese hospitals between October 2008 and April 2010. Inclusion criteria were unilateral facial nerve weakness with no identifiable cause within 168 hours of symptom onset, age between 18 and 65 years, and no prior treatment.

Patients were excluded if they were illiterate, had paralysis from herpes zoster, recurrent paralysis, prior facial asymmetry, or serious comorbidities. Participants were randomized into two groups: the de qi group (n=167) received acupuncture with manual manipulation of the needles until de qi was elicited, while the control group (n=171) received only needle insertion without manipulation. Both groups received prednisolone as basic treatment for 14 days. Treatment consisted of 20 sessions of 30 minutes over 4 weeks, using specific points: Yangbai (GB-14), Dicang (ST-4), Jiache (ST-6), Xiaguan (ST-7), Yifeng (TE-17), and contralateral Hegu (LI-4).

The primary outcome was facial nerve function measured by the House-Brackmann scale at 6 months. Secondary outcomes included functional disability (Facial Disability Index) and quality of life (WHOQOL-BREF). The intensity of de qi was assessed by visual analog scale across 8 sensory dimensions. The results demonstrated significant superiority of the de qi group.

At 6 months, 89.8% of patients in the de qi group achieved complete recovery versus 70.8% in the control group (adjusted OR 4.16; 95% CI 2.23-7.78). The de qi group also showed better disability scores (difference 9.80 points; 95% CI 6.29-13.30) and quality of life (difference 29.86 points; 95% CI 22.33-37.38). Logistic regression analysis showed a positive dose-response effect between de qi intensity and recovery (adjusted OR 1.07; 95% CI 1.04-1.09). The mean de qi score was significantly higher in the intervention group (22.74 ± 3.56) versus control (14.85 ± 2.61).

Adverse events were mild and similar between groups, including minor bleeding, pain at the needle site, and bruising. The clinical implications are substantial, as the study provides robust scientific evidence for the traditional importance of de qi in acupuncture. The findings suggest that adequate stimulation techniques are crucial to optimize therapeutic outcomes, contradicting practices that neglect stimulation intensity. This may explain negative results in some acupuncture trials that used inadequate stimulation.

Limitations include the inability to use placebo acupuncture due to Chinese cultural trust in acupuncture, and the fact that 17.1% of patients were unable to adequately assess de qi. Nevertheless, the recovery rate in the control group (77.1%) was similar to that reported with corticosteroids in Cochrane reviews (76.7%), suggesting that the control group had a placebo-like experience. The study reinforces the need to include appropriate de qi techniques in clinical guidelines and acupuncture practice.