CLINICAL APPLICATIONS

* Bell’s palsy

* Facial paralysis 

* TMJ (temporomandibular joint) pain

* Trigeminal neuralgia

* Migraine headache due to wind, phlegm, and blood stagnation

* Post-stroke sequelae, such as twitching of muscles

 

WESTERN THERAPEUTIC ACTIONS

* Neurological benefits to treat facial paralysis, trigeminal neuralgia and migraine headache

* Analgesic effect to relieve pain

* Anti-inflammatory effect to reduce swelling and inflammation

* Antiseizure and antiepileptic effects to treat post-stroke sequelae and relieve nerve-related pain

 

CHINESE THERAPEUTIC ACTIONS

* Releases exterior wind

* Opens the channels and collaterals

* Activates qi and blood circulation

 

DOSAGE

Take 4 to 6 capsules three times daily. Herbal therapy should begin immediately on notice of the first warning signs. If necessary, the dosage may be increased to 8 capsules three times daily on day one of herbal therapy to achieve faster onset of action. If the herbs are irritating to the stomach where the patient reports nausea or epigastric discomfort, take the herbs after meals.

 

INGREDIENTS

Bai Fu Zi (Rhizoma Typhonii)

Bai Zhi (Radix Angelicae Dahuricae)

Chuan Xiong (Rhizoma Chuanxiong)

Dang Gui (Radix Angelicae Sinensis)

Fang Feng (Radix Saposhnikoviae)

Jiang Can (Bombyx Batryticatus)

Jing Jie (Herba Schizonepetae)

Quan Xie (Scorpio)

Si Gua Luo (Retinervus Luffae Fructus)

Wu Gong (Scolopendra)

Yan Hu Suo (Rhizoma Corydalis)

 

BACKGROUND

Bell’s palsy, facial paralysis, trigeminal neuralgia, and TMJ (temporomandibular joint) disorder are complicated neurological disorders that affect the head region. These disorders affect different nerves in the face and the head, leading to numbness, pain, and loss of sensory or musculoskeletal functions. The causes are not always known, but are generally attributed to damage to the cranial nerves.

 

FORMULA EXPLANATION

According to traditional Chinese medicine, trigeminal neuralgia and facial paralysis are two conditions characterized by wind attacking the channels and collaterals in the facial regions, leading to blocked circulation of qi and blood. As a result, there is often severe pain, numbness, loss of muscle tone, and paralysis of the muscles. Optimal treatment of this condition requires use of herbs to release exterior wind, open the channels and collaterals, and activate qi and blood circulation.

        Symmetry is formulated based on Qian Zheng San (Lead to Symmetry Powder), a classic formula that treats deviation of the eyes and mouth by restoring symmetry of the face. Following this general principle, Symmetry uses Fang Feng (Radix Saposhnikoviae), Bai Zhi (Radix Angelicae Dahuricae) and Jing Jie (Herba Schizonepetae) to release exterior wind, and Quan Xie (Scorpio) and Wu Gong (Scolopendra) to dispel interior Liver wind. In addition, Bai Fu Zi (Rhizoma Typhonii) and Jiang Can (Bombyx Batryticatus) dispel wind and eliminate phlegm obstruction. Dang Gui (Radix Angelicae Sinensis) tonifies blood in the channels and collaterals, and treats the underlying deficiency. Yan Hu Suo (Rhizoma Corydalis) and Chuan Xiong (Rhizoma Chuanxiong) activate qi and blood circulation and relieve pain. Si Gua Luo (Retinervus Luffae Fructus) opens the peripheral channels and collaterals.

        Overall, Symmetry is a strong formula to treat various disorders of the face, including but not limited to trigeminal neuralgia, facial paralysis, TMJ disorder, and migraine headache.

 

CAUTIONS & CONTRAINDICATIONS

* This formula is strong and potent, and contains herbs that are considered slightly toxic in traditional Chinese medicine. Therefore, the dosage should be prescribed carefully according to the age, body weight and severity of the condition. For additional details, see Strategic Dosing Guidelines for age-to-dose and weight-to-dose charts on page 14.

* This formula is contraindicated during pregnancy and nursing. It should be used with extreme caution in pediatric and geriatric patients, and only when the benefits outweigh the risks.

* This herbal formula contains herbs that invigorate blood circulation, such as Dang Gui (Radix Angelicae Sinensis). Therefore, patients who are on anticoagulant or antiplatelet therapies, such as Coumadin (warfarin), should use this formula with caution, or not at all, as there may be a higher risk of bleeding and bruising.[1]^,[2],[3]

 

CLINICAL NOTES

* Early and frequent treatment of Bell’s palsy will ensure proper recovery. Acupuncture and moxa are extremely effective to treat this condition. In acute cases, patients are recommended to receive acupuncture treatment three times a week. Moxa on the local area for at least 20 minutes each day will also enhance recovery.

* Stress or Liver qi stagnation may be triggering factors for many women who suffer from Bell’s palsy. In such cases, maintenance and preventative formulas such as Calm or Calm (ES) should be taken regularly to prevent repeated attacks in the future.

* Bell’s palsy is the prodromal sign of a future stroke in some patients. After successfully treating the symptoms, patients should be put on another formula to nourish yin or lower Liver wind to prevent future attacks. See Supplementary Formulas.

* This formula is an adjunct formula to acupuncture treatment. Optimal results will occur when acupuncture, electro-stimulation and herbs are all included in the treatment regime.

* For deviation of the eyes and mouth, topical application of herbs is also beneficial. The topical preparation may be prepared by mixing extract powder of Bai Jie Zi (Semen Sinapis) with concentrated green tea. This herbal paste is to be applied topically to the affected area for four to eight hours (the affected side in Bell’s palsy can be determined by the side of the eye that cannot close). This process may be repeated daily, or every other day.

* For trigeminal neuralgia, the topical use of herbs is also very beneficial. One topical preparation that has been used with great success contains Ma Qian Zi (Semen Strychni) 30g, Zhi Chuan Wu (Radix Aconiti Praeparata) 15g, Zhi Cao Wu (Radix Aconiti Kusnezoffii Praeparata) 15g, Ru Xiang (Gummi Olibanum) 15g, and Mo Yao (Myrrha) 15g. This topical preparation is made by grinding all the ingredients into a fine powder and then mixing it with oil to form an herbal paste. A small amount of herbal paste is to be applied topically to acupuncture points around the affected area, such as Taiyang, Xiaguan (ST 7), and Jiache (ST 6). [Note: These five herbs must be used only topically, and not internally, as internal ingestion of some of these herbs may be toxic.]

 

SUPPLEMENTARY FORMULAS

* For post-stroke patients with mental and physical deterioration, combine with Neuro Plus.

* For severe nerve pain, combine with Flex (NP).

* For severe and acute migraine headache, combine with Corydalin (AC).

* For chronic and moderate migraine headache due to blood deficiency, combine with Corydalin (CR).

* With neck and shoulder pain, add Neck & Shoulder (AC).

* With excessive stress, add Calm or Calm (ES).

* For postpartum Bell’s palsy with qi and blood deficiency, add Imperial Tonic.

* With high blood pressure or prevention of stroke, add Gastrodia Complex or Gentiana Complex.

 

ACUPUNCTURE TREATMENT

Traditional Points:

* Bell’s palsy or facial paralysis:

§ Needle the affected side (the side with the eye and/or mouth that cannot close): Jiache (ST 6), Dicang (ST 4), Xiaguan (ST 7), Sibai (ST 2), Yangbai (GB 14), Taiyang, Yingxiang (LI 20), Chengjiang (CV 24), Yifeng (TH 17), Fengchi (GB 20), Hegu (LI 4), Zanzhu (BL 2)

§ In severe cases, more aggressive treatment is necessary. Thread the needle underneath the skin from Dicang (ST 4) towards Jiache (ST 6), Yangbai (GB 14) towards Yuyao, Zanzhu (BL 2) towards Jingming (BL 1), Yingxiang (LI 20) towards Sibai (ST 2), and Renzhong (GV 26) towards Dicang (ST 4). These points are needled subcutaneously at least 1 cun parallel to the skin. Once the needle is inserted, be careful to not have the tip of the needle penetrate out of the skin.

* Trigeminal neuralgia:

§ Strongly stimulate the following points: Zanzhu (BL 2), Xiaguan (ST 7), Daying (ST 5), Yuyao, Sibai (ST 2), Chengjiang (CV 24), Yintang, Tinggong (SI 19)

§ Alternate points in Group 1 and 2 from treatment to treatment. Needle and bleed these points.

§ Group 1: Shangxing (GV 23), Wuchu (BL 5), Chengguang (BL 6), Tongtian (BL 7), Luoque (BL 8)

§ Group 2: Qianding (GV 21), Baihui (GV 20), Toulinqi (GB 15), Muchuang (GB 16), Zhengying (GB 17), Chengling (GB 18)

§ Select a few points and alternate between them: Hegu (LI 4), Taiyang, Yangbai (GB 14), Zanzhu (BL 2), Tongziliao (GB 1), Xiaguan (ST 7), Juliao (GB 29), Jiache (ST 6), Daying (ST 5), and Tinghui (GB 2).

 

Classic Master Tung Points:

* Facial paralysis: Sanchasan (T 22.17)*, Wanshunyi (T 22.08), Wanshuner (T 22.09), Dizong (T 44.09), Cesanli (T 77.22), Cexiasanli (T 77.23), Yizhong (T 77.05), Erzhong (T 77.06), Sanzhong (T 77.07), Shangquan (T 88.22), Zhongquan (T 88.21), Xiaquan (T 88.20) , Zhenghui (T 1010.01), Dicang (ST 4), Jiache (ST 6), Zhisanzhong (T 11.14). Bleed dark veins nearby the temporal area. Bleed before needling for best result. 

* TMJ (temporomandibular joint) pain: Tianhuang (T 88.13), Minghuang (T 88.12), Qihuang (T 88.14), Tongshen (T 88.09), Shangquan (T 88.22), Xiaquan (T 88.20), Wanshunyi (T 22.08), Wanshuner (T 22.09), Sanzhong (T 77.07), Huoying (T 66.03)

* Trigeminal neuralgia: Yizhong (T 77.05), Erzhong (T 77.06), Sanzhong (T 77.07), Shangquan (T 88.22), Zhongquan (T 88.21), Xiaquan (T 88.20), Cesanli (T 77.22), Zhongjiuli (T 88.25). Bleed the ear lobe and the ah shi points. Bleed before needling for best result.

* Migraine: Linggu (T 22.05), Dabai (T 22.04), Cesanli (T 77.22), Yizhong (T 77.05), Erzhong (T 77.06), Sanzhong (T 77.07), Liuwan (T 66.08), Zhongjiuli (T 88.25)

* Post-stroke sequelae (twitching of muscles): Minghuang (T 88.12), Tianhuang (T 88.13), Qihuang (T 88.14), Zhenghui (T 1010.01), Qianhui (T 1010.05), Houhui (T 1010.06), Houxi (SI 3) to Laogong (PC 8), Gongsun (SP 4) to Yongquan (KI 1), Sanchayi (T 22.15)*, Sanchaer (T 22.16)*, Sanchasan (T 22.17)*, Bafeng, Baxie

 

Balance Method by Dr. Richard Tan:

* Left side: Sanjian (LI 3), Zhongzhu (TH 3), Ququan (LR 8)

* Right side: ah shi points around Chize (LU 5) to Kongzui (LU 6), Quze (PC 3) to Ximen (PC 4), Shaohai (HT 3) to Lingdao (HT 4), Zulinqi (GB 41), Xiangu (ST 43)

* Alternate sides from treatment to treatment. Patient should receive acupuncture treatment at least twice a week for optimal result.

 

Auricular Medicine by Dr. Li-Chun Huang:

* Trigeminal neuralgia: Auricular Temporal Nerve, Brain Stem, San Jiao. Bleed Ear Apex.

§ For neuralgia of the first branch of the trigeminal nerve, add Forehead and Eye.

§ For neuralgia of the maxilla nerve, add Upper Jaw and Upper Palate.

§ For neuralgia of the mandibular nerve, add Lower Jaw and Lower Palate.

* Facial paralysis: Cheek Area, Brain Stem, Sanjiao, Endocrine, Adrenal Gland, Mouth, Sympathetic, Liver, Spleen, Coronary Vascular Subcortex. Bleed Ear Apex and Helix 5.

* Epilepsy: Epilepsy Point, Brain, Brain Stem, Nervous Subcortex, Occiput, Shenmen, Kidney, Liver. Bleed Ear Apex.

* Temporomandibular joint (TMJ) pain: TMJ (front and back), San Jiao, Teeth and Larynx, Mouth. Bleed Helix 4 or Helix 5.

 

NUTRITION

* Consume adequate amounts of vegetables for vitamins A, B₁, B₂, C and E.

* Encourage a diet with a diverse source of all nutrients, including raw fruits, vegetables, whole grains, nuts, and seeds. B vitamins are important to maintain nerve health.

* Avoid cold, icy food and beverages, fried, smoked or barbecued foods. Stop smoking and avoid drinking alcohol.

* Advise patients to avoid all aluminum products, which may be found in antacids, cookware, aluminum foil, and certain foods. Drinking steam-distilled water has a chelating effect in the blood to remove unwanted aluminum from the body.

 

LIFESTYLE INSTRUCTIONS

* Advise patients to exercise daily and maintain a positive, hopeful outlook toward the future.

* Regular workout and deep breathing exercises are excellent ways to oxygenate the blood and improve circulation to all parts of the body to facilitate recovery.

* When recovering from a stroke or Bell’s palsy, engage in regular and mild exercises, such as walking and tai chi chuan [tai ji chuan]. However, it is important to advise the patient to avoid exposure to wind and cold. In addition, biking, and direct exposure to either fans or air conditioning is strictly prohibited.

 

CASE STUDIES

* B.T., a 33-year-old male, presented with Bell’s palsy located on the left facial area without wrinkles on his forehead. The patient was able to close his left eye with effort and needed to wear an eye patch at night. The action he was unable to perform was lifting the left angle of his mouth or smile. Attempted treatments by ER doctors included short courses of prednisone and Zovirax (acyclovir). Previously, before it occurred, the patient had recently installed an air conditioner in his room in addition to experiencing increased stress. The client was not experiencing pain at this time. With the TCM diagnosis of invasion of wind and Liver qi stagnation, Symmetry was prescribed. After three treatments and five days of taking Symmetry, the client was able to close his eye comfortably without needing the eye patch at night. He was also able to raise the left angle of his mouth and wrinkle his forehead by 30% of normal. Submitted by C.S., Hood River, Oregon.

* A 44-year-old male presented with Bell’s palsy affecting the right side of his face, which had begun one week prior. Additional symptoms included left side frontal headache, fatigue, and stress. His medical reports ruled out possible ischemic and hemorrhagic strokes. Objective findings during his neurological exam were the patient being unable to pucker his lips, smile, or close and blink his right eye. The practitioner diagnosed this condition as wind phlegm and damp obstructing the channels of the face. Symmetry was prescribed at six capsules three times a day. He continued taking it for three bottles. Treatment of acupuncture was given four times a week with smokeless moxa as well on the right side of his face. After the first acupuncture treatment, his mouth was getting better and he was able to smile. Furthermore, after eleven days of contracting Bell’s palsy, the patient had reported a 70% improvement. The patient’s pucker and facial dimples returned and he no longer need to tape his eye closed at night after receiving three treatments of acupuncture and taking Symmetry. Submitted by G.T., San Diego, California.

* S.H., a 54-year-old female, presented with acute symptoms of numbness of the tongue, pain and inability to close the mouth. Objective findings were drooping eyes and lips, affected smile, and tenderness on the left nostril. Her mother had died around the same age due to a stroke. She has a tendency to ride her bike to work, enjoying the wind, and works a stressful job. Pulse was wiry and tongue was deviated with thick greasy tongue coating. The practitioner diagnosed the condition as exterior wind attack blocking the channels. Her Western diagnosis was Bell’s palsy with one-sided facial paralysis. The patient was given Symmetry for a period of two weeks. With Symmetry the patient returned to pre-stroke condition after just two weeks. Submitted by K.F., Honolulu, Hawaii.

* M.H., a 75-year-old male, presented with fatigue, overworked, and had recently experienced a mini-stroke in which he could not walk for 24 hours. Tongue was slightly deviated to the left and pulse was deep and slippery. The TCM diagnosis was Spleen and Kidney yang deficiencies; the Western diagnosis was a 6 mm lesion in the poris medulla. After taking Symmetry and Neuro Plus, the patient felt less confused, more focused, and was able to walk again without struggle. He continued to take the herbs for five months to maintain his results. Submitted by V.G., Virginia Beach, Virginia.

* A 50-year-old female suffered from deviation of her eye and mouth on the right side of the face. The patient had yellow tongue coating, and a wiry, fine, slippery, and rapid pulse. Upon more inquiry, the condition was diagnosed as wind attacking the channels and collaterals, with underlying deficiencies. The patient was treated with both electro-acupuncture and modified Symmetry. In addition, the patient was instructed to apply herbs topically to the affected area at night, removing them in the morning (the topical preparation was made by mixing Bai Jie Zi (Semen Sinapis) with concentrated green tea). After three courses of treatment, the overall condition was greatly improved. The deviation was not noticeable at rest, and only slightly noticeable when laughing. The patient continued to be treated on a regular basis, and eventually reported complete recovery. Submitted Anonymously.

 

PHARMACOLOGICAL AND CLINICAL RESEARCH

Symmetry is designed specifically to treat disorders affecting the facial regions, such as facial paralysis or hemiplegia in stroke sequelae, Bell’s palsy, TMJ (temporomandibular joint) pain and trigeminal neuralgia. Symmetry contains herbs with neurological benefits to treat facial paralysis, analgesic effects to relieve pain, anti-inflammatory effects to reduce swelling and inflammation, and antiseizure and antiepileptic effects to treat post-stroke sequelae.

        Bai Fu Zi (Rhizoma Typhonii), Jiang Can (Bombyx Batryticatus) and Quan Xie (Scorpio) are the three principle herbs in this formula. Together, these three herbs have shown remarkable effect via numerous clinical studies to treat facial paralysis, trigeminal neuralgia and migraine headache. According to one study, concurrent use of acupuncture and herbs [Bai Fu Zi (Rhizoma Typhonii), Jiang Can (Bombyx Batryticatus), Quan Xie (Scorpio) and others] were successful in treating 52 of 60 patients with facial paralysis.[4] According to another study, concurrent use of acupuncture and herbs [Bai Fu Zi (Rhizoma Typhonii), Jiang Can (Bombyx Batryticatus), Quan Xie (Scorpio) and others] for two days to one year was associated with 95% effective rate in 88 patients with facial paralysis.[5] In addition, use of these three herbs in an herbal formula successfully treated 50 patients with facial paralysis with a 98% rate of effectiveness (complete recovery in 44 cases, significant improvement in 3 cases, moderate improvement in 2 cases, and no effect in 1 case).[6] For trigeminal neuralgia, one study reported 94.2% rate of effectiveness among 52 patients when treated with Bai Fu Zi (Rhizoma Typhonii), Jiang Can (Bombyx Batryticatus), Quan Xie (Scorpio) and others.[7] Finally, these three herbs also showed good results to treat 25 patients with stubborn migraine headache. The overall rate of effectiveness was 92%.[8]

        Symmetry also contains many herbs with analgesic effects to relieve pain and anti-inflammatory effects to reduce swelling and inflammation. Yan Hu Suo (Rhizoma Corydalis), Bai Zhi (Radix Angelicae Dahuricae) and Dang Gui (Radix Angelicae Sinensis) all have excellent analgesic and anti-inflammatory effects. Yan Hu Suo (Rhizoma Corydalis) may be used to treat pain of various origins.[9]^,[10] Bai Zhi (Radix Angelicae Dahuricae) is most effective for treating headache.[11]^,[12] Dang Gui (Radix Angelicae Sinensis) is excellent for migraine headache, with a potency comparable to that of acetylsalicylic acid.[13]^,[14] Chuan Xiong (Rhizoma Chuanxiong) has been used in various formulas to treat headache (95.1% success rate),[15] vascular headache (96.3% rate of effectiveness),[16] trigeminal nerve pain (90.6% rate of effectiveness),[17] and trigeminal neuralgia.[18] Lastly, Bai Fu Zi (Rhizoma Typhonii) in formulas has been shown to have good success to treat numbness and pain of the facial nerves.[19]

        Many herbs in Symmetry also have marked antiseizure and antiepileptic effects to prevent seizure and epilepsy, and to treat post-stroke sequelae. Herbs with such actions include Jiang Can (Bombyx Batryticatus),[20] Quan Xie (Scorpio),[21] and Wu Gong (Scolopendra).[22] In addition, use of these herbs is associated with very little toxicity in mice studies.[23]

   In summary, Symmetry is an excellent formula to treat disorders affecting the face. It restores symmetry to the face for disorders such as facial paralysis and Bell’s palsy. It also relieves pain to treat TMJ (temporomandibular joint) pain, trigeminal neuralgia, and migraine headache.

 

COMPARATIVE ANALYSIS

Neurological disorders are complicated illnesses that encompass many different diseases, including but not limited to Bell’s palsy, facial paralysis, TMJ (temporomandibular joint) pain, and trigeminal neuralgia. From Western medicine perspectives, these diseases are well-defined and accurately diagnosed, but not successfully treated. Though there are some drugs available for symptomatic treatment, such as use of antiseizure or tricyclic antidepressants for nerve pain, none are very effective and all have serious side effects. Furthermore, there are simply no effective pharmaceutical treatments for either the symptoms or the cause of conditions such as Bell’s palsy and facial paralysis. As a result, these conditions continue to deteriorate, creating more debilitation and suffering.

        TCM has long excelled in the treatment of such neurological disorders with both acupuncture and herbs. There are numerous options available to stimulate the central and peripheral nervous systems to help relieve symptoms and restore normal functions. Generally speaking, the prognosis is excellent if treatment begins within three months from the onset of illness, positive within one year, and hopeful if within three years. TCM treatments using both acupuncture and herbs should be explored and aggressively implemented as early and as much as possible to achieve maximum results. Time delay before treatment only decreases the overall success rate.

        TCM treatments offer safe and effective options for treatment of these neurological disorders, and are significantly superior to Western medicine.