| Objective: To examine the relationship among De Qi, psychological factors, and the efficacy of acupuncture treatment, and to verify the roles of De Qi and neuropsychological factors in acupuncture treatment.Methods: 306 Bell's palsy patients were enrolled from 11 medical centers in China. All patients were divided into acupuncture Manipulation group and Non-manipulation group by single-blind designing and random sampling. We select the acupoints for treatment which are most widely used in clinical practice and have been proven exact efficacy: Yangbai (GB 14), Dicang (ST 4), Jiache (ST 6), Xiaguan (ST 7), Yifeng (SJ 17), Hegu (LI 4). Patients in manipulation group were acupunctured with lifting, thrusting, and twirling technique by acupuncturists. When De Qi occurred, the patients felt the internal compound sensation of soreness, numbness, distension, pain, cold, warmth, heaviness, and radiation at and around acupuncture points while the acupuncturists felt the sensation of sinking, astringent, stagnancy, and tightness. The stainless steel filiform needles were retained for 30min. Patients in non-manipulation group were just inserted the needles by acupuncturist, without any acupuncture technique with the identical therapy time of 30 min. During the treatment, the insertion and withdrawal were at an stable speed by acupuncturists. It lasts 5 days for a course, 2 days off a week and the total treatment were 4 course. The clinical efficacy in patients were evaluated with House Brackmann (HB)grading system scale, Facial Disability Index (FDIP, FDIS), the World Health Organization Quality of Life-Bref (WHOQOL-BREF) scores; The levels of De Qi for patients and acupuncturists were assessed by subjective acupuncture sensation scale (SASS); the psychological factors in patients were test with personality tests cartels (Catell-16PF), cancellation test, and belief in acupuncture.Results: (1)There was no statistical difference of HB scores in two groups for patients before treatment (P>0.05); however, on day 180 after treatment, the HB score in manipulation group (1.39±0.65) was significantly less than that in non-manipulation group (1.91±0.88) (t = -5.87, P<0.0001); (2) On day180 after the treatment, the FDIP score in manipulation group (99.77±1.19) was significantly higher than that in non-manipulation group (97.04±4.69) (t = 7.01, P<0.0001). FDIS score in manipulation group (94.83±8.72) was also distinctly higher than non-manipulation group (88.89±6.67) (t = 6.68, P<0.0001). (3) Comparison of the WHOQOL-BREF: the scores of four domains (physical domain, psychological domain, social domain, environmental domain) in manipulation group were significantly higher than those in non-manipulation group (t = 7.28, P<0.0001; t = 9.15, P<0.0001;t=6.05,P<0.0001;t=6.38,P<0.0001);(4) Comparison of the SASS scores: the average score of De Qi for patients in manipulation group (22.49±3.89) was significantly higher than non-manipulation group (13.45±2.99) (t = 22.79, P<0.0001); the average scores of De Qi for acupuncturists in manipulation group (12.39±1.91) was also significantly higher than non-manipulation group (9.36±1.54) (t =15.29, P <0.0001); the total scores of De Qi for patients and acupuncturists in manipulation group (34.88±5.38) was significantly higher than non-manipulation group (22.82±4.14) (t = 22, P<0.0001); (5) Comparison of 16PF scores: there was no difference in the 16PF scores for patients between the two groups (P>0.05); ( 6) The cancellation test: there were no significant difference in the scores for patients between two groups (P>0.05); (7)Suggestibility scores: there were no significantl differences in the dimensions and total scores between the two groups(P>0.05);(8) subjective experience of acupuncture efficacy scale score: scores of subjective experience for patients in two groups showed no significant different before treatment (P>0.05) whereas there was a significant difference after treatment (t = 10.66, P <0.0001); (9)The relationship among primary outcome measure HB scores and De Qi, psychological factors, acupuncture manipultion, and other factors : Acupuncture manipultion, the average of De Qi for patients, state of illness, and apprehension personality factors were filtered into the regression equation by the multiple stepwise regression analysis, The partial regression coefficients were as follows: acupuncture manipultion (B = 0.6322, P<0.0001); average of De Qi for patients (B =- 0.1303, P<0.0001), Apprehension personality (B =- 0.0376 , P = 0.0398); state of illness (B = 0.5034, P<0.0001);the relationship among De Qi and psychological factors, acupuncture manipultion, and other factors were assessed by the multiple stepwise regression analysis. Acupuncture manipultion, state of illness, attention, belief in acupuncture were filtered into the regression equation, and the partial regression coefficients were as follows: Acupuncture manipultion (B = 8.988, P <0.0001); state of illness (B = 0.987, P<0.0001); attention (B =0.256, P = 0.013); belief in acupuncture(B=0.114,P=0.027); (10)The relationship between the secondary outcomes and De Qi, psychological factors was test by the canonical correlation analysis. The correlation coefficient between average De Qi for patients and the secondary therapeutic indexes were greater than that of average De Qi for acupuncturists and therapeutic indexes although they changed in the similar way; The correlation coefficients for psychological factors and curative effects were very small.Conclusions: In patients with Bell's palsy, acupuncture treatment significantly improves facial function and quality of life. The therapeutic effect on Bell's palsy produced by acupuncture were achieved mainly by increasing the level of deqi;. Psychological factors play a limited role in acupuncture treatment: Apprehension personality factor is associated with the efficacy of bell's palsly; patients with high attention and high belief in acupuncture were more prone to obtain De Qi.. Psychological Factors Are Closely Associated with the Occurrence of Bell's Palsy : A Case-Control StudyObjective: To explore the risk factors for Bell's palsy (BP) and to examine whether psychological factors are the potential risk factors for the occurrence of BP.Methods: We conducted a case-control, multi-center trial. 695 subjects were assigned to the case group (n=355) and control group (n=340). All the BP patients were enrolled from 11 State Hospitals in China, and all the controls were selected from the same district to match for the patients. The study was coordinated by a tertiary referral centre, Tongji Hospital. We used the House–Brackmann grading system and Facial Disability Index (FDI) to assess the BP patients, and employed Catell 16PF scale to evaluate the personality factors for all subjects. Psychological stress, personality factors, cold wind, fatigue, upper respiratory tract infections, gum infections, and family history of BP have been assessed in the study, which were regarded as the possible risk factors for BP. The baseline characteristics were analyzed byχ2 tests or Mann–Whitney tests; forward likelihood ratio logistic regression analysis was used to explore the risk factors for BP.Results: Byχ2 test, there are significant differences in the history of cold wind, history of fatigue, psychological stress, and upper respiratory tract infections. By the Mann–Whitney tests, the comparison of the 16PF (personality factor A, I, L, O, and Q4) scores between two groups are significantly different. By the logistic regression analysis, among the risk factors, psychological stress(OR=2.81, 95% CI : 1.70-4.65, P<0.001) , personality factor B(OR=1.60, 95% CI: 1.10-2.33,P=0.014), I(OR=1.85, 95% CI : 1.22-2.79, P=0.004), O(OR=1.66, 95% CI : 1.05-2.62, P=0.031), and Q4 (OR=1.62, 95% CI : 1.12-2.33, P=0.010) were found to influence the onset of BP. In addition, cold wind, fatigue, upper respiratory tract infections, and gum infections were also involved in the logistic equation.Conclusions: The results show that psychological factors (psychological stress and personality) are the key risk factors for the occurrence of BP, and other factors (cold wind, fatigue, upper respiratory tract infection, and gum infection) also paly an important role in the occurrence of BP, which should be concerned seriously in the further study.
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