Hominis Placental is a dried placenta isolated from healthy pregnant women after delivery; it has been used to invigorate vital essences and blood in traditional medicines in East Asia [1].

Hominis Placental extracts have been used in traditional Oriental medicine to improve physiological function. Recently, there have been several reports that Hominis Placental pharmacopuncture (HPP) can be applied to pathologic conditions such as peripheral facial paralysis [2], osteoporosis [3], nerve injury [4] and anemia [5].

A hemifacial spasm presents as an involuntary contraction of the muscles on either side of the face [6], which occurs secondary to compression of the facial nerve by a vascular loop at the root exit zone [7, 8].

Traditionally, hemifacial spasm treatment includes several approaches such as anticonvulsant medications, and chemical or nerve decompression [9].

Hemifacial spasm is considered to be an eyelid convulsion in Oriental medicine literature and an eyelid convulsion, Anpojindo, Poyunjindo refers to a blepharospasm in Oriental medicine literature [10]. According to Oriental medicine, the treatment methods of Sopungsanhan (remove the pathogenic Qi), Bogigeodamsikpung (increase vitality and eliminate abnormal body fluids), Pyeonggansikpung (stabilize liver Qi and remove the pathogenic wind Qi) and Soganigi (recover liver Qi) are usually used [11].

Research on Oriental medicine for treating facial spasms includes a literature investigation [12], an acupuncture study [13, 14] and a Soyeom Pharmacopuncture study [15], but no study of HPP has yet to be reported. In this study, we treated facial spasms with acupuncture and HPP, and we evaluated the effect by using Scott’s scale [16].

The research involved 32 patients who visited the Acupuncture & Moxibustion Department at Semyung University Hospital of Oriental Medicine for facial spasm treatment from March 1, 2012, to December 31, 2012. Exclusion criteria included the following: cerebrovascular accident (CVA), hypersensitivity or active skin disease, active infectious disease requiring medical care for the entire body, mental diseases and alcoholism and/or drug addiction.

HPP was prepared by using the following protocol provided by the Korean Pharmacopuncture Institute; Hominis Placental was hydrolyzed with HCL at 101℃, and the extracts were heated at 80-100℃ for 10 h, autoclaved, and filtered with a 0.1-μm filter membrane. The final product was kept refrigerated until usage.

With disposable 2-cc syringes (SIR Medical Co, Ltd.) and 30-G needles, the subjects were injected 0.1-0.2 cc and 1~2 cm deep, respectively, at each meridian point once a day, three times a week. Before acupuncture, the HPP procedures were mainly performed at the Sabaek (ST2), Seung-eup (ST1), Gwal-lyeo (SI18), Chanjuk (BL2), Sajukgong (TE23), Hagwan (ST7), Hyeopgeo (ST6), Jichang (ST4), Wan-gol (SI4) and Yepung (TE17) of the inconvenient part. The treatment was performed once a day, three times a week.

The acupuncture needles were disposable, stainless-steel filiform needles (0.30 ㎜ x 40 ㎜) from Dongbang Acupuncture, Inc. Following the meridian points, the needles were inserted 5~10 ㎜ deep once a day, three times a week, The treatment was at Sabaek (ST2), Seung-eup (ST1), Gwallyeo (SI18), Chanjuk (BL2), Sajukgong (TE23), Hagwan (ST7), Hyeopgeo (ST6), Jichang (ST4), Wan-gol (SI4) and Yepung (TE17) of the inconvenient position and Hapgok (LI4), Taechung (LR3), Haeng-gan (LR2) and Pungnyung (ST40) of the convenient prat. Combined symtoms (neck or shoulder pain) were also treated by acupuncture at trigger points. The acupuncture needle’s retaining times were 15 min. The treatment was performed by a clinical specialist with more than 2-yr experience.

Physiotherapy (Infrared Ray (I.R.), Silver Spike Point (S.S.P). at face, Hot Pack (H/P) at neck and shoulder) were applied as additional treatment. All the patients understood and agreed to these treatments. They also signed a consent form that we have provided.

To determine the general characteristics of the patients and to evaluate the effect of HPP, we investigated the following:1) gender and age, 2) areas affected by the facial spasm, 3) other combined symptoms, 4) timing onset of the facial spasm, 5) Scott’s grade (Table 1) before treatment, 6) number of treatment, and 7) treatment results(change in Scott’s grade [16], and improvement results), According to Scott’s grade, an eyelid spasm has five degrees from normal to serious, the latter causing problems with reading, driving, walking, etc.

The data were analyzed by SPSS/ 10.0 for windows program with descriptive statistics, paired t-test, Shapiro-Wilk normality test. Improvement were described as excellent (improvement of more than 70%), improved (improvement of 30 to 70%), mildly improved (improvement of less than 30%), or failure (no improvement). In other to minimize the bias, practitioners also evaluated the degree of the eyelid spasm by using Scott’s grade.

The 32 patients in this study were composed of 11 men and 21 women, and the age distribution is shown in (Table 2) The facial spasm was located on the left (Lt) side in 24 patients and on the right (Rt) side in 8 patient; the distribution of locations is shown in (Table 3)

Fifteen patients complain of only facial spasm, 12 patients  of neck or shoulder pain on the same side, and 5 patients  of neck or shoulder pain on the opposite side (Table 4)  The onset of facial spasm was less than 1 month in 18 patients,  1~3 months in 8 patients, and more than 3 months  in 6 patients.

The Scott’s grade at the first , was grade 1 in 20 patients,  grade 2 in 7, and grade 3 in 5. Fourteen patients were treated  fewer them 4 times, 13 patients were treated 4 ~ 8 times,  and 5 patients were treated more than 8 times.

According to the improvement results, 23 patients reported  their condition as excellent, 8 as improved and 1 as  mildly improved.

After treatment, 25 patients were Scott’s grade 0, 6 were  Scott’s grade 1, 1 was Scott’s grade 2, and none was Scotts  grade 3. A comparison of the Scott’s grades before and after  treatment showed that 20 patients changed from grade  1 before treatment to grade 0 after treatment. Of the 7 patients  with grade 2 before treatment, 4 changed to grade  0 and 3 changed to grade 1. Of the 5 patients with grade 3  before treatment, 1 changed to grade 0, 3 changed to grade  1, and 1 changed to grade 2 after treatment (Table 5)

After treatment, the Scott’s grade 1 group was given an  average of grade 0, the Scott’s grade 2 group was given an  average of grade 0.47, and the Scott’s grade 3 group was  given an average of grade 1 (Fig 1)

The results of Shapiro-Wilk normality test showed that,  the data followed a normal distribution. Before treatment,  the Scott’s grade average was 1.53 ± 0.664, but after it was  0.25 ± 0.39 (P = 0.003). In the paired t-test, the Scott’s grade  decreased significantly.

The results of this investigation were found to be clinically  significant and are as:

The facial spasms occurred mainly on one side. The  spasms occurred more frequently on the left side, with the  left side to right side ratio being about 19:8. A large number  of facial spasm patients have other symptoms at the same  time. More than half of the patients had a comorbidity  such as neck or shoulder pain. Patients tended to visit the  hospital soon after the onset of symptoms. Approximately  56% of the patients visited the hospital within one month  after the onset, 25% of the patients visited the hospital 1-2  months after the onset, and 19% of the patients visited the  hospital three months or more after the onset.

After only four times treatments, 14 patients reported  improved symptoms and did not visit anymore. Of the remaining  patients, 13 patients received treatment 4-8 times  and only five patients received treatment more than 8  times. About 72% of patients reported excellent improvement with the combination treatment. In Scott grade, 25  patients (78%) were improved to grade 0, and 6 (18%) to  grade 1. Only one patient (3%) was improved to grade 2.  According to the statistical analysis of the effects of HPP  treatment, symptoms decreased significantly, and HPP  combination therapy had a great effect on patients with  severe symptoms.

Pharmacopuncture is an oriental treatment method in  which certain amounts of ingredients extracted from Oriental  medicine herbs are injected into meridian points or  reaction points on the body’s surface after a diagnosis of  the patient’s physical constitution and disease status has  been established. This therapy has clinical advantages in  exhibiting both acupuncture and drug effects [17].

HPP is one of the most widely used herb-acupunctural  materials to replenish vital essence and blood in Oriental  traditional medicine [18]. Many studies have reported on  the the rapeutic effectiveness of HPP. HPP as a treatment  has effects on peripheral facial paralysis [2], the capacity  to regulate bone resorption [19], protection against osteoporosis  [3], protection against radiation enteropathy [20],  and the growth-promoting activity of nerve regeneration  [4].

Facial spasms usually occur on one side of the face, and  abnormal muscle spasms occur around the eyes, mouth,  and platysma muscle. They usually occur at ages form  40 to 50 and more often in women. They usually begins  around the eyes and move to around the mouth. They are  worsened by stress or fatigue, and can accompany some  facial muscle weakness, but there is no paresthesia [21].

Hemifacial spasm is considered to be an eyelid convulsion  in Oriental medicine literature, and eyelid convulsion,  Anpojindo, Poyunjindo, refers to a blepharospasm  in Oriental medicine literature [10]. According to Oriental  medicine, the treatment methods of Sopungsanhan (remove  the pathogenic Qi), Bogigeodamsikpung (increase  vitality and eliminate abnormal body fluids.), Pyeonggansikpung  (stabilize liver Qi and remove the pathogenic  wind Qi), and Soganigi (recover liver Qi) are usually occur with facial spasm [22].

In this study, we treated facial spasm with acupuncture  and HPP, and we found the following: Thirty-two patients  visited the Acupuncture & Moxibustion Department at  Semyung University Hospital of Oriental Medicine for facial  spasm treatment from March 1, 2012, to December 31,  2012. The patients included 11 men and 21 women; 4 were  21~30 yr old, 7 were 31~40 yr old, 11 were 41~50 yr old, 6  were 11, 51~60 yr old, and 4 were more than 61 yr old 4  (Table 2) There were no significant differences in the demographic  characteristics (Table 2)

As to the areas affected by the facial spasms, the Lt eye  was involved in 10 patients, the Rt eye in 5, the Lt cheek  in 2, the Rt cheek in 2, the Lt mouth in 6, the Rt mouth in  1, the Lt eye and cheek in 3, the Lt cheek and mouth in  2, and the Lt eye and mouth in1 (Table 3) More patients  had facial spasms on left side spasm had them on the right  side (Table 3) Fifteen patients complained of only facial  spasm, 12 of neck or shoulder pain on the same side, and  5 of neck or shoulder pain on the opposite side. More than  half the patients appealed combined of other symptoms  (Table 4) The onset of facial spasm was less than 1 month  in 18 patients, 1~3 months in 8, and more than 3 months in  6 patients. More than a half of patients visited within one  month of the onset. Because they were worried about serious  CVA diseases, so visited earlier.

As to the Scott’s grade before treatment at the first time  visit, 20 patients were in grade 1, 7 in grade 2, 5 in grade 3  and none in grade 4. In this study, the number of grade 1  patients was more than the numbers of patients with other  grades. The number of treatments was, fewer than 4 in 14  patients, 4 ~ 8 times in 13, and more than 8 times in 5. Usually  when the patients themselves thought that the symptoms  had improved, they did not visit any more.

After treatment, results were reported as excellent by  23 patients, improved by 8 and mildly improved by 1. In  this study, most patients reported excellent or improved  results. After treatment, 25 patients were in Scott’s grade  0, 6 in Scott grade 1, 1 in Scott 1, grade 2, none in Scott’s  grade 3. In this study, after treatment, most patients were  improvement in Scott’s grade 0 or 1. A comparison of the  Scott’s grades before and after treatment showed that 20  patients changed from grade 1 before treatment to grade 0  after treatment. Of the 7 patients with grade 2 before treatment,  4 change to grade 0 and 3 changed to grade 1. Of  the 5 patients with grade 3 before treatment, 1 changed to  grade 0,3 change to grade 1, and 1 changed to grade 2 after  treatment (Table 5) Facial spasms of all grade 1 patients  before treatment were improved to grade 0, but those of  grade 2 and 3 patients, although improved, were not all patients  improved to grade 0; there was a tendency that high  grade spasms were less improved than low grade spasms (Table 5)

After treatment, the Scott’s grade-1 group was given an  average of grade 0, the grade-2 group an average of grade  0.47 grade, and the grade-3 group an average of grade 1  (Fig 1) Before treatment, the Scott’s grade average was  1.53 ± 0.664, but after it was 0.25 ± 0.39 (P = 0.003). In the  paired t-test, the Scott’s grade decreased significantly.

Cho et al.’s study [13] used only acupuncture treatment  on a hemifacial spasm. Four of the 5 patients had had the  affliction for more than a year and did not show any remedial  effect. One case (relatively short period of disease)  showed an effect of treatment (reduction to Scott’s grade  0), auricular acupuncture treatment.

In Kim et al.’s study [14], Dong’s acupuncture treatment  was applied. The study involved three patients, and all had  had the affliction for more than a year. With these cases,  the treatment was acupuncture with Ceuksamri, Ceukhasamri.  One case involved 15 treatments with acupuncture  and herbal medicine of unknown duration. Another  case involved 56 acupuncture treatments (28 Dong’s acupuncture  and 28 acupuncture) and herbal medicine for  28 days. For the other case, no precise treatment count  was reported, but the treatment period was 50 days. These  three patients showed improvement from Scott’s grade 3  to 1 or 0.

In the research of Heo et al. [15], general acupuncture  and Soyeom pharmacopuncture treatment only at Pungji  (G20) were used in 10 cases. In this research, 3 cases  showed excellence results, 4 cases showed improvement,  2 cases showed little improvement, and 1 case showed no  sign of change. The facial spasm grades were as follows:  Scott’s grade 0 : 2 cases, grade 1 : 3 cases, grade 2 : 3 cases,  grade 3: 1 case and grade 4: 1 case.

Comparing exactly existing papers with our study is difficult,  however, we conclude that it would be better in medical  treatment to use acupuncture accompanied with HPP,  to use the Wan-gol (SI4), and the Yepung (TE17) acupuncture  points around the neck, and to treat neck or shoulder  pain.

In summary, we treated 32 facial spasm patients with acupuncture  and HPP, and the facial spasms of most patients  were greatly improved. However, this study included relatively  few participants, so the statistical analysis was difficult.  Thus, further studies are required to investigate the  efficacy of treating facial spasms with HPP.