A 24-year-old man who developed acute right-sided facial paralysis one day after the acute phase of a COVID-19 infection was successfully managed using a heat-clearing, Wind-dispersing herbal strategy combined with acupuncture and tuina.

Case ID: CHC-0070

Case Summary

This case describes a 24-year-old man who presented with acute right-sided facial paralysis (Bell’s Palsy) shortly after experiencing a COVID-19 infection with high fever and a sore throat. The original report documented a conventional diagnosis of peripheral facial neuritis complicating a novel coronavirus infection, and a TCM assessment of Facial Paralysis (Mian Tan) driven by Wind-Heat Attacking the Collaterals. He was managed through an integrative approach combining a dynamic heat-clearing herbal decoction with acupuncture, tuina (massage), and targeted physical therapies to rapidly extinguish the viral heat and restore nerve function.

Patient Presentation

• Patient: 24-year-old male (Surname: Wu).
• Main Complaint: Sore throat for 7 days, right-sided facial stiffness for 1 day.
• History: The patient sought initial consultation on January 14, 2023. Seven days prior, he contracted COVID-19, experiencing a fever up to 39.0°C, muscle aches, and a sore throat. After self-medicating, the fever and body aches subsided, but a mild sore throat remained. One day before the visit, he suddenly developed right-sided facial stiffness, a leftward deviation of his mouth, an inability to fully close his right eye, and leaking of air and water when speaking or drinking.
• Physical Exam: The right forehead wrinkles were shallow, and the right eye exhibited incomplete closure. Showing teeth revealed a leftward mouth deviation. He could not properly puff his cheeks or whistle without leaking air.

Examination and Diagnosis

• Conventional Diagnosis: Peripheral facial neuritis complicating novel coronavirus infection.
• TCM Tongue and Pulse: The tongue was red with a yellow, greasy coating. The pulse was floating and rapid (脉浮数).

TCM Assessment

The original practitioner interpreted the presentation as Facial Paralysis driven by Wind-Heat Attacking the Collaterals (面瘫 – 风热袭络证).

According to the holistic principles of yin and yang Chinese Medicine the patient’s initial COVID-19 infection was characterized by strong Heat (high fever, sore throat). While the systemic fever subsided, the Wind-Heat pathogen remained trapped in the upper body and invaded the facial collaterals.

This localized pathogenic heat severely disrupted the circulation of Qi and blood to the face, causing the facial sinews to lose their nourishment and mechanical control (resulting in paralysis). The red tongue, yellow greasy coating, and floating-rapid pulse provided objective textbook confirmation of this active Wind-Heat pathogen, sharply contrasting with typical Wind-Cold presentations of Bell’s Palsy.

Treatment Approach

The primary treatment principle was to dispel wind and clear heat, unblock collaterals and stop spasms (祛风清热，通络止痉). The strategy integrated cooling, wind-extinguishing herbs to clear the viral toxicity with localized mechanical stimulation (acupuncture/tuina) to restore facial microcirculation.

Interventions and Herbal Formulas

• Acupuncture & Physical Therapy: Immediate application of acupuncture, infrared heat therapy, intradermal needles, low-frequency pulse electrotherapy, and targeted head/face tuina and acupressure. (Conventional supportive medications like Acyclovir, Dexamethasone, and Mecobalamin were also utilized).
• Initial Herbal Formula (Acute Phase – January 14, 2023): A 15-herb decoction focused on clearing heat and dispelling wind.
  • Clearing Heat and Toxicity: Shi Gao (Gypsum, 30g), Lian Qiao (6g), Pu Gong Ying (Dandelion, 15g), Jin Yin Hua (Honeysuckle, 9g), and Huang Qin (6g) powerfully cleared the viral heat and inflammation from the upper body.
  • Dispersing Wind and Unblocking Collaterals: Mi Ma Huang (Honey-fried Ephedra, 12g), Ge Gen (Pueraria, 20g), Sheng Ma (6g), Cang Er Zi (10g), Quan Xie (Scorpion, 3g), and Chan Tui (Cicada Slough, 3g) vented the trapped wind from the surface and forcefully unblocked the paralyzed facial meridians. Tao Ren (6g) and Bai Shao (6g) nourished and moved blood, while Gan Cao (6g) harmonized. (3 doses).
• Second Visit (January 17, 2023): The facial stiffness and eye closure slightly improved. With the intense heat subsiding, the formula shifted to further dispel wind and resolve phlegm-dampness, adding Jing Jie, Fang Feng, Zhi Bai Fu Zi (Typhonium, a key herb for facial wind-phlegm), Ji Xue Teng (Spatholobus), Di Long (Earthworm), and Jiang Can (Silkworm) to strongly seek out wind and unblock the collaterals. (3 doses).
• Third & Fourth Visits (Late January 2023): The facial paralysis steadily improved. The practitioner transitioned the formula to begin tonifying the underlying Qi while maintaining the collateral-unblocking strategy. Huang Qi (Astragalus, 20g), Fu Ling (20g), and Yi Yi Ren (Coix Seed, 20g) were added to boost Qi and drain residual dampness.

Follow-Up

• The patient continued outpatient acupuncture and facial tuina 1-2 times per week through February and March.
• By April 2, 2023, the patient’s symptoms had basically resolved, achieving a full clinical recovery with only occasional tearing when the eye was exposed to wind.

Why This Case Is Interesting (Clinical Reasoning)

The notable feature of this case is the strict adherence to TCM pattern differentiation (辨证论治) over standard disease protocols for Bell’s Palsy.

The original commentary emphasizes that doctors must not “rigidly follow a map” (不可按图索骥). While many facial paralysis cases are caused by Wind-Cold, this patient’s COVID-19 infection left him with a clear Wind-Heat presentation (red tongue, yellow coat, rapid pulse). By recognizing this distinction and aggressively utilizing heat-clearing herbs like Shi Gao, Lian Qiao, and Jin Yin Hua instead of typical warming medicinals, the practitioner accurately addressed the specific viral pathology and rapidly restored the patient’s neurological function.

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Source Original source: Zhanjiang Second Hospital of Traditional Chinese Medicine Original title: 【以案说医】招仕富：治疗新冠病毒感染并发面瘫案（一） Practitioner: Professor Zhao Shifu (招仕富) Publication date: August 24, 2024 Original language: Chinese ChineseHerb.org version: English translation and editorial adaptation