Three Successful Cases of Treating Hemifacial Spasm with Acupuncture and Chinese Herbal Medicine

Recently, I have successfully treated three patients with severe hemifacial spasm. I want to share with you the etiology of hemifacial spasm, its treatment in both Western and Traditional Chinese medicine (TCM), and present these three cases treated with a combination of acupuncture and herbal medicine.

Hemifacial spasm (HFS) is an involuntary, intermittent contraction of the muscles on one side of the face. It typically begins around the eye and gradually spreads to the cheek and the area around the mouth. This is primarily related to the distribution of the facial nerve (the seventh cranial nerve) (see diagram below).

Facial nerve and muscles

https://med.stanford.edu/facialnervecenter/about-the-facial-nerve.html

According to the Cleveland Clinic website, this condition is more common in women and usually presents in middle to older age. It is considered a rare disorder, with an incidence of approximately 8 to 11 cases per 100,000 people. Stress, fatigue, anxiety, or voluntary facial movements may trigger or exacerbate the symptoms.

1. Symptoms of Hemifacial Spasm

Unilateral twitching: Involuntary, rhythmic muscle twitching that typically occurs on only one side of the face (i.e., hemifacial).

Progression of symptoms: Usually begins in the eyelid area (orbicularis oculi muscle) and gradually spreads downward over months to years to the lower half of the face (including the cheek, perioral area, and neck).

Muscle contractions: Symptoms range from mild twitching to, in rare severe cases, forceful closure of the eyelid and even pulling of the mouth corner.

Persistence: Unlike common eyelid twitching, hemifacial spasm persists even during sleep.

Associated symptoms: Some patients may experience clicking sounds in the ear, hearing loss, or facial pain.

2. Western Medicine: Etiology, Examination, and Treatment

(1) Etiology:

Vascular compression: The most common cause (accounting for 80–95% of primary cases) is compression of the facial nerve by a blood vessel (artery or vein) near the brainstem, leading to damage to the protective myelin sheath surrounding the nerve.

Nerve injury/damage: Residual nerve damage from prior conditions such as Bell's palsy.

Tumor or lesion: In rare cases, tumors, cysts, or vascular malformations may compress the facial nerve.

(2) Diagnostic Imaging:

High-resolution MRI or MRA: Essential for identifying the position of the vessel compressing the nerve or to rule out tumorous lesions.

Electromyography (EMG) or nerve conduction studies: Used to measure the electrical activity of muscles and nerves.

(3) Treatment Methods:

Botulinum toxin (Botox) injections: The most commonly used treatment. Botox is injected into the affected muscles every 3–4 months to temporarily paralyze them and block spasms. This is a symptomatic treatment — it addresses the symptoms but not the root cause. Efficacy is reported at 85–95%. Some patients do not respond well, often due to a combination of technique, dosage, individual differences, or diagnostic issues. One of the patients described in this article was a case in which Botox injections were ineffective.

Microvascular decompression (MVD): A surgical procedure in which a small pad (typically made of Teflon) is placed between the compressing vessel and the nerve to relieve pressure. This surgery is currently considered the only curative treatment. However, because it is performed in the densely structured posterior cranial fossa, there is a certain risk of complications. Common complications include temporary, permanent, or delayed facial palsy (4–9.5%), temporary or permanent hearing impairment (1–4%), and rare but serious cerebral complications.

Medication: Anticonvulsants (e.g., carbamazepine, gabapentin) are used primarily to inhibit nerve impulses, but their efficacy is generally inferior to Botox injections or surgery.

3. TCM: Etiology, Pathogenesis, and Treatment

In TCM, hemifacial spasm is classified under the categories of mianfeng (facial wind), jinji (muscle tension), and jinti roushun (muscle twitching). The core pathogenesis is considered to be wind as the dominant pathogenic factor, often accompanied by phlegm, blood stasis, and deficiency, leading to malnourishment of the meridians and constriction of the sinews and vessels.

Case 1: Patient HL

Female, 67 years old. Initial visit: April 10, 2026.

She reported spasms in her left eye and cheek for 4–5 years. Her family doctor did not give any specific diagnosis, only telling her that "there is no way to treat this condition." For the first three years, she had been receiving acupuncture treatment at another clinic. Each treatment cycle lasted 4–5 months (once weekly), after which symptoms would be controlled, but they would return after 4–5 months. She continued this pattern for three years. However, the acupuncture gradually became less effective, her symptoms worsened, and the facial muscles became increasingly tight. During each spasm, she would vigorously massage the area with her hands; the spasm would stop after 7–8 minutes but would resume after an interval ranging from 10 to 60 minutes. The muscle tightness had affected her ability to open her mouth to eat and speak. She came to me through a friend's referral.

I first identified tender points on her face. She had multiple tender points around her cheek and ear. After one session of electroacupuncture combined with cupping, she immediately felt significant relaxation of her facial muscles. She commented that my acupuncture points and needling sensation were different from her previous acupuncturist. After the second treatment, she felt a 50% reduction in facial muscle tightness, and eating and speaking became much more comfortable. To speed up her recovery, she came for regular weekly treatments. However, because her insurance did not cover it, she initially declined Chinese herbal medicine. I explained to her that acupuncture and herbal medicine work through different mechanisms and that combining both yields the best results. After three acupuncture sessions, she agreed to take herbs. After nine consecutive acupuncture treatments and 20 days of herbal medicine, when she came for her tenth acupuncture session on June 15, she reported that her hemifacial spasm had completely resolved.

Case 2: Patient HK

Female, 51 years old. Initial visit: February 19, 2026.

She reported having a stroke during the 2023 New Year period and received Western medical treatment. Subsequently, she experienced left shoulder pain, a blocked sensation in the left side of her neck, left-sided headache, tingling and spasms in her left cheek, weakness in her left leg, and severe snoring during sleep. Additionally, she had fatty liver disease with liver fibrosis (stage 2), diabetes, and hypercholesterolemia. In addition to taking Western medications for blood sugar, cholesterol, and fatty liver, her doctor had prescribed duloxetine for depression, anxiety, and neuromuscular pain, but it offered little relief.

This patient also had multiple tender points around her cheek and ear. She accepted my recommendation for combined acupuncture and herbal medicine. I prescribed half a month of Chinese herbal medicine and treated her neck and shoulder pain with acupuncture, after which she immediately felt significant pain reduction. From the second session onward, I treated her facial spasms and pain. After four sessions of electroacupuncture combined with cupping, her facial pain and spasms decreased from 8–9/10 before treatment to 2/10.

Due to work commitments and caring for four elderly family members, she paused treatment when her condition improved. On April 23, she returned because she felt chest tightness and shortness of breath. She reported that under stress, she would experience a tingling sensation on the left side of her face. Acupuncture immediately relieved her chest tightness and shortness of breath. I advised her that continuous treatment was necessary for her facial spasms to completely resolve. After that, she came for weekly treatments. By June 5, after 14 acupuncture sessions, one bloodletting treatment, and 20 days of herbal medicine, her cheek tingling, spasms, and headache had completely disappeared.

Case 3: Patient CC

Female, 57 years old. Initial visit: January 31, 2026.

She initially came for treatment of lower back pain. During the consultation, she mentioned that she had developed Bell's palsy in July 2024. Although Western medicine significantly improved the palsy symptoms, her right eye and face began to spasm and twitch. The spasms gradually worsened and occurred continuously throughout the day, with each episode lasting about 15 minutes, a 3-minute pause, and then repetition. The neurologist's diagnosis was "seems to have synkinesis." She received five Botox injections, but they did not help. This case may represent the minority of patients who do not respond well to Botox injections.

Upon inquiry, she did not have the typical abnormal neurological manifestations of synkinesis (where one movement triggers another unintended movement). Additionally, she had fibromyalgia and sclerosis.

I treated her lower back pain that same day and suggested that she try combined acupuncture and herbal medicine for her facial spasms at her next visit.

After one acupuncture session, her lower back pain significantly improved, and she scheduled an appointment for February 7 to treat her facial spasms. She also had multiple tender points around her cheek and ear. After acupuncture, cupping was performed, and Chinese herbal medicine was prescribed. After three sessions of electroacupuncture combined with cupping, her continuous daily spasms reduced to six episodes per day, each lasting about 5 minutes. Afterward, due to insurance issues, she did not come weekly as recommended, but continued intermittently for five more sessions. When she returned on June 20, she reported that she now had an average of three spasms per day, each lasting about 5 minutes. When I palpated her previous tender points, she no longer felt significant pain. In other words, after nine acupuncture sessions and 20 days of herbal medicine, although occasional spasms still occurred, the tender points had resolved. I advised her to continue treatment until her symptoms completely disappear.

Summary

All three patients had previously seen Western medicine practitioners, received ineffective treatment, or been told that nothing could be done before coming to me. Acupuncture treatment requires continuity. The latter two patients stopped continuous treatment after their symptoms improved due to insurance and time constraints, causing a temporary relapse, which prolonged their overall treatment duration.

TCM states that Pain arises when there is blockage; no blockage, no pain. All three patients had multiple distinct tender points around the face and ears. Through the "four examinations" — inspection, auscultation/olfaction, inquiry, and palpation — a TCM practitioner can identify many issues that Western medicine might overlook. Because of the severity of their symptoms, I also performed one bloodletting treatment for each of the latter two patients. All three patients took Chinese herbal medicine for 20 days alongside their acupuncture treatments. Among them, HK and HL had essentially complete resolution of symptoms, while CC requires a few more sessions.

Many of the patients I treat come to seek TCM after Western medicine has offered little hope. In the vast majority of such cases, this is precisely where TCM excels.