Efficacy of acupuncture and moxibustion in treating Bell's palsy: a multicenter randomized controlled trial in China

Bell's palsy, also known as idiopathic facial palsy, is a common condition that causes acute facial paralysis due to inflammation of the facial nerve, resulting in significant functional, esthetic, and psychosocial disturbances in patients. Although acupuncture and moxibustion have traditionally been used in China to treat this condition because of their multiple advantages, until now there had been no robust scientific evidence based on high-quality randomized controlled trials.

This multicenter, randomized, single-blind, controlled study was conducted between September 2001 and July 2003, involving 480 patients from four clinical centers in China. Inclusion criteria covered patients with unilateral facial nerve palsy, age between 16 and 70 years, and onset of facial paralysis between 1 and 90 days prior. Excluded were patients with acute or chronic ear diseases, head or otologic trauma, known central or peripheral neurological disorders, autoimmune diseases, or herpes zoster oticus.

The 439 patients who completed the study were randomized into three groups: the control group received conventional treatment with prednisone, vitamins B1 and B12, and bendazol; treatment group 1 received only acupuncture and moxibustion; and treatment group 2 received the combination of both therapies. The acupuncture protocol used specific points on the affected side: Dicang (ST-4), Jiache (ST-6), Hegu (LI-4), Yangbai (GB-14), Xiaguan (ST-7), and Yifeng (TE-17), in addition to bilateral Hegu. Filiform needles were inserted with moderate stimulation to obtain the sensation of qi and were retained for 30 minutes. Suspended moxibustion was applied for five minutes at each point, once a day, five times per week, for four weeks.

The results were evaluated using the House-Brackmann scale, specifically developed to evaluate facial palsy disorders, and the Facial Disability Index (FDI), which assesses physical impairments and psychosocial status. Statistical analysis revealed significant differences between control and treatment groups after treatment (χ²=15.265, P=0.018). The group that received only acupuncture and moxibustion showed the best results, with a cure rate of 41.0% compared to 28.1% in the control group, this difference being statistically significant (Z=-2.827, P=0.005).

Treatment effectiveness was greater in cases of mild and acute facial paralysis compared to severe and non-acute cases. At three- and six-month follow-up after treatment, although no significant differences were found between the three groups, all patients showed some degree of improvement in facial nerve function, reaching grade III or better on the House-Brackmann scale. Notably, no serious adverse effects were observed during the study, such as fainting during acupuncture or burns during moxibustion.

The clinical implications of this study are significant, as it provides robust scientific evidence for the use of acupuncture and moxibustion in the treatment of Bell's palsy. The authors recommend that all patients with this condition receive acupuncture and moxibustion treatment, considering its convenience, low cost, and short treatment course. The study also highlights that, although corticosteroid treatment is widely accepted, evidence from randomized controlled trials does not show significant benefit, and prednisone treatment always carries side effects, while the efficacy of vitamins B1, B12, and bendazol in the treatment of Bell's palsy remains uncertain.