Nursing Experience of Intervening in Patients with Peripheral Facial Paralysis Based on the Theory of Huangdi's Inner Needle and the Combination of Moxibustion and Egg Rolling Therapy

: Peripheral facial paralysis refers to facial paralysis caused by pathological changes in the motor fibers of the facial nerve, which is a kind of neural deficiency symptom caused by facial nerve damage leading to facial muscle paralysis. The clinical manifestations are enlarged palpebral fissure, shallower nasolabial folds, drooping mouth corner, drooling, and inability to smoothly perform actions such as frowning, closing eyes, and whistling. Untimely treatment can easily lead to facial paralysis, which seriously affects the patient's facial appearance and daily life. Peripheral facial paralysis has high incidence rate, long disease course, slow recovery, and it brings a huge mental burden to patients, affecting their quality of life, and also induces severe negative emotions. At present, there is still a lack of radical cure for this disease. Studies have found that traditional Chinese medicine nursing techniques have special effects in the care of patients with peripheral facial paralysis. Therefore, it is of great significance to take effective nursing measures for patients with peripheral facial paralysis in a timely manner, to let patients recover as soon as possible, and to improve their quality of life. In our department, we treated this case of peripheral facial nerve paralysis. In addition to the routine symptomatic treatment of traditional Chinese and Western medicine, we intervened the patient's facial paralysis symptoms based on the basic theory of Huangdi's Inner Needle combined with moxibustion and drug egg rolling therapy. The combined treatment effect of this case is satisfactory and provides a reference for clinical nursing of peripheral facial nerve paralysis.


Introduction
Research has found that traditional Chinese medicine nursing techniques have special effects in the care of patients with peripheral facial paralysis [1].I was fortunate to have the opportunity to participate in the national Chinese medicine nursing backbone training organized by the Chinese Nursing Association in 2021.I learned the basic theory of Huangdi's Inner Needle and the rolling egg therapy at the Ruikang Hospital affiliated to Guangxi University of Traditional Chinese Medicine in March 2023, which provided me with ideas in the care of patients with facial paralysis.The Huangdi's Inner Needle therapy originated from the Huangdi Neijing and is a kind of acupuncture therapy summarized and developed by Mr. Yang Zhenhai based on the experience of his predecessors [2].The overall treatment essence of Huangdi's Inner Needle is concentrated in "Su Wen•Yin Yang Ying Xiang Da Lun": Therefore, a good needle user draws yang from yin, draws yin from yang, treats the left with the right, and the right with the left... Yin disease is treated with yang, yang disease is treated with yin, the blood and qi are fixed, and each guards its place.Therefore, the four general rules of Huangdi's Inner Needle therapy were derived.General rule one: treat the upper disease with the lower, and the lower disease with the upper; General rule two: treat the left disease with the right, and the right disease with the left; General rule three: seek the same qi; General rule four: seek the reversal of yin and yang.The heat effect of moxibustion is the basis for the treatment of facial paralysis with moxibustion.Moxibustion is a traditional Chinese medicine external treatment method that directly or indirectly burns moxa on acupoints to alleviate symptoms, and has been widely used in clinical practice [3].The mechanism of moxibustion mainly involves the heat effect, radiation effect and pharmacological action of moxa and its combustion products.Moxibustion heat stimulation affects both the superficial and deep tissues of the skin.By acting on the acupoints on the skin, the moxibustion stimulus is infiltrated into the body through the meridian system, activates the self-healing function of the meridian system, and has the effects of dispelling wind and cold, activating blood circulation, tonifying the righteous and expelling the evil [4].
The egg rolling therapy originated from the witchcraft "chicken divination" of the Miao ethnic group."Chicken Divination" is one of the ancient divination methods, divining good and evil fortune with chicken bones or chicken eggs."Han Shu•Jiao Qi Zhi" records: During the Han Dynasty, Miao witches used egg knocking for divination and looked at ghost trumpets to enhance the mystery of their witchcraft.The boiled chicken egg is rolled on the body, and the color change of the yolk is used to judge the disease danger by observing.After continuous exploration and summary, the egg rolling therapy has been widely applied in ethnic minority areas such as the Zhuang, Yao, and Tujia, and has become a folk characteristic therapy that integrates diagnosis and treatment.Zhuang medicine egg rolling therapy is guided by Zhuang medicine theory and uses chicken eggs to roll back and forth on specific parts and acupoints of the human body.By stimulating the surface meridians of the dragon road and the fire road, it relieves stagnation of the meridians and tunnel, inspires righteousness, expels toxins, regulates qi and blood, restores balance, makes the three qi of heaven, earth, and human return to sync, and promotes the cure of diseases and the recovery of righteousness in the human body [5].The Neijing states: When the righteous qi is present, the evil cannot interfere.Where the evil gathers, the qi must be deficient.Chinese medicine believes that facial paralysis is caused by the deficiency of righteous qi in the human body and wind evil invading when it is weak, and the disease mechanism is that wind and cold invade to cause meridian obstruction and qi and blood stagnation [6]."Yi•Shuogua" also says: Xun is wood, wind, and chicken.Chicken eggs and wind are of the same nature, and match with the wood of the five elements.According to the principle that similar types gather together and similar qi seek each other, chicken eggs can draw wind evil into the egg.Through the conduction and penetration of heat, it leads the wind evil and the accompanying cold evil and damp evil qi out of the body surface.According to the needs of the condition, additional appropriate drugs can be added to boil together, and silver or gold utensils can also be used in conjunction with the operation to increase the power of dispelling evil [7].Therefore, this case chose Qianzheng San for boiling eggs.Qianzheng San is a good prescription for treating "wind disease" in traditional Chinese medicine.It comes from Yang Yan's "Yang's Family Collection Prescription" and is composed of Bai Fu Zi, Bai Jiang Can, and Quan Xie.It has the effects of dispelling wind and resolving phlegm, unblocking meridians, and stopping convulsions.Clinically, it is mainly used for diseases such as facial nerve paralysis, trigeminal neuralgia, and stroke caused by wind evil invading [8].
In view of the above viewpoints, the symptoms of this case of peripheral facial nerve paralysis were intervened based on the basic theory of Huangdi's Inner Needle combined with moxibustion and drug egg rolling therapy.After the overall treatment and nursing intervention, the patient's facial paralysis symptoms significantly improved.Now the summary is as follows.

Clinical Information
The patient, Jia, is a 29-year-old male who was admitted to the hospital due to "deviation of the mouth to the left for 6 days".Upon admission, the patient exhibited the following symptoms: deviation of the mouth to the left, drooling and water leakage from the right corner of the mouth when rinsing and drinking, food retention between the right cheek and teeth, incomplete closure of the right eyelid with about 2mm of white showing, tearing in the right eye, and shallowing of the right forehead wrinkle and nasolabial groove.The patient did not experience any headaches, nausea, loss of consciousness, fainting, limb movement difficulties, or numbness.The patient reported poor appetite and sleep, normal urination, and no bowel movement for 2 days.The patient had a pale tongue, thin white fur, and a floating and tense pulse.Chinese medicine diagnosis: Deviation of the mouth (wind toxin attacking the exterior).Western medicine treatment principles were "nutrient nerves and antiviral", common acupuncture for activating blood and dredging collaterals, and Chinese medicine oral administration was based on "dispelling wind and cold, activating qi and blood, and unblocking collaterals".

Specialist Examination
Cranial nerves: III, IV, VI, enlarged right eye fissure, about 2mm of white showing, no ptosis in both eyes, both eyeballs centered, no protrusion or depression, no limitation in all movements, no gaze, no diplopia, pupils on both sides were equal in size at 3mm, direct and indirect light reflexes on both sides were sensitive, adjustment and convergence reflexes were normally elicited.V: Reduced pain and touch on the right side of the face, temperature sensation not examined, no atrophy of the masseter muscles on both sides, weaker chewing action on the right side than on the left, centered jaw opening, normal corneal reflex on both sides, sucking reflex and mental reflex not elicited.VII: Right forehead wrinkle became shallow, right forehead wrinkle, frowning, closing eyes could not be completed, positive right eyelash sign, right nasolabial groove became shallow, showing teeth mouth corner deviated to the left, cheek blowing, whistling action could not be completed, taste on the anterior 2/3 of the tongue was normal.
House-Brackmann: TCM Syndrome Differentiation: The patient is a 29-year-old male with "deviation of the mouth to the left for 6 days" as the main symptom, which falls into the category of "deviation of the mouth" in TCM.The patient was affected by wind-toxin evil, which flowed through the meridians, causing obstruction of qi and blood, and loss of nourishment to the facial muscles and tendons, resulting in deviation of the mouth.Therefore, the patient exhibited incomplete closure of the right eye, deviation of the mouth to the left, leakage of water when drinking, and food retention between the right teeth.The patient had a pale tongue, thin white fur, and a floating and tense pulse, which are signs of wind-toxin attacking the exterior.Looking at the tongue, pulse, and symptoms, the disease is located in the face, the nature of the disease is mainly substantial, and the pathogenesis is wind-toxin attacking the exterior causing deviation of the mouth.

Technical Plan and Measures
Technical plan: Based on Huangdi's Inner Canon basic theory moxibustion combined with medicinal egg rolling therapy, aiming to dispel wind and cold, and warm and unblock the meridians.
Moxibustion based on Huangdi's Inner Canon basic theory: Since the disease is located in the right side of the face, according to the four general principles of Huangdi's Inner Canon, the face belongs to the upper burner.It is mainly due to the Yangming meridian being affected by cold evil, leading to the obstruction of meridian qi and lack of nourishment to the meridian tendons [9].Following the principle of same-name meridians seeking the same qi, the Shangyang acupoint is followed along the Hand-Yangming Large Intestine Meridian to the Bianli acupoint on the left hand to find the Ah Yes acupoint, where suspended moxibustion treatment is performed to dispel wind and cold, activate blood and unblock meridians, and support the righteous and expel evil.
Medicinal egg rolling therapy: Acupoint pressing is performed at acupoints such as Yintang, Taiyang, Sibai, and Dichang, 3-5 times per acupoint.Then, the medicinal egg prepared with Qianzheng San is used to rub the areas from Yintang to Taiyang, Sibai to Taiyang, Dichang to Qianzheng, and Yifeng to Supraclavicular fossa in sequence, with the aid of manual lifting in between, 3-5 times for each route.The patient's feelings are continuously asked during the treatment to prevent burns.
Health Education: (1) Eat a light diet, avoid spicy, coarse, greasy, hard food.Due to the patient's taste disorder, guide the patient to pay attention to the temperature of the food to prevent burns to the oral mucosa.(2) Guide the patient to eat more fresh vegetables, fruits, coarse grains, soy products, jujubes, lean meat, etc. (3) Rinse the mouth after meals, remove food residues on the affected side of the oral cavity, keep the oral cavity clean to prevent oral infection.(4) Guide the patient to perform actions such as frowning, closing eyes, showing teeth, blowing cheeks, and whistling in front of a mirror, several times a day, each time for 5-15 minutes.(5) Reduce light stimulation, such as less use of computers, TVs, avoid ultraviolet rays, etc.Through the above nursing measures, the patient self-reported that the pain and touch sensation in the right side of the face had recovered, the right chewing ability had returned, the right eye could be closed without showing white when slightly straining, taste sensation had recovered, and the symptoms of facial paralysis had been significantly relieved.See Table 1 for details.

Continuous Care
The patient was followed up by telephone one week after discharge, and the follow-up content was health guidance.The patient was instructed to keep regular habits, avoid wind and cold to prevent colds, and have regular meals, avoiding fatty and rich foods.

Conclusions
As a common and frequent disease of the nervous system, peripheral facial paralysis causes serious effects on patients' facial aesthetics, daily life, work, and psychology due to its resulting facial paralysis.Peripheral facial paralysis has characteristics such as a high incidence rate, long disease course, and slow recovery, which bring a great mental burden to patients, affect their quality of life, and can also trigger serious negative emotions.Currently, there is still a lack of radical cure for this disease.Studies have found that traditional Chinese medicine nursing techniques have special effects in the nursing of patients with peripheral facial paralysis.Therefore, it is necessary to take effective nursing measures for patients with peripheral facial paralysis in a timely manner.Early recovery of patients and improvement of their quality of life are of great significance.In clinical practice, on the basis of routine treatment, the addition of characteristic nursing techniques of traditional Chinese medicine can play a synergistic promotion role, effectively shorten the time for facial symptom improvement, promote facial function recovery, and improve patients' quality of life.As a traditional Chinese medicine nurse, it is a long and arduous task to inherit and innovate traditional Chinese medicine nursing.This requires us to constantly learn new knowledge, think about new problems, and explore new findings in our work, and fully play the role of traditional Chinese medicine nursing backbone.

Table 1 :
Comparison of facial paralysis grade and symptoms before and after treatment Number of Treatments Facial Nerve Paralysis Grade Patient's Main Complaint Patient's Symptoms Before Treatment Grade IV Pain on the right side of the face, reduced touch sensation, weaker right-side chewing movement than the left, reduced taste sensation Incomplete closure of right eyelid, exposing approximately 2mm of white area, shallow nasolabial fold and forehead wrinkle on the right side, mouth corner deviating to the left when showing teeth.After 3 Treatments Grade IV Pain on the right side of the face and reduced touch sensation have improved, weaker right-side chewing movement than the left, reduced taste sensation Incomplete closure of right eyelid, exposing approximately 1mm of white area, shallow nasolabial fold and forehead wrinkle on the right side, mouth corner deviating to the left when showing teeth.After 5 Treatments Grade III Pain on the right side of the face and touch sensation have recovered, right-side chewing movement still weaker than the left, taste sensation has improved than before Complete closure of the right eyelid with no white area exposed, improvement in the shallowness of the right nasolabial fold and forehead wrinkle compared to before, mouth corner deviating to the left when showing teeth has improved compared to before.After 7 Treatments Grade I Right side facial pain, with touch sensation and taste recovered.Complete closure of the right eyelid with no white area exposed, recovery of the right nasolabial fold and forehead wrinkle, no deviation of the mouth corner when showing teeth.