Research ArticleEffects of Electroacupuncture on Facial NerveFunction and HSV-1 DNA Quantity in HSV-1 InducedFacial Nerve Palsy Mice

Hongzhi Tang1 Shuwei Feng1 Jiao Chen1 Jie Yang1 Mingxiao Yang1

Zhendong Zhong2 Ying Li1 and Fanrong Liang1

1 Chengdu University of Traditional Chinese Medicine Chengdu Sichuan 610075 China2 Sichuan Academy of Medical Sciences amp Sichuan Provincial Peoplersquos Hospital Chengdu Sichuan 610072 China

Correspondence should be addressed to Ying Li mumuazaaza163com and Fanrong Liang acuresearch126com

Received 21 March 2014 Accepted 20 May 2014 Published 3 June 2014

Academic Editor Lijun Bai

Copyright copy 2014 Hongzhi Tang et al This is an open access article distributed under the Creative Commons Attribution Licensewhich permits unrestricted use distribution and reproduction in any medium provided the original work is properly cited

Acupuncture is a common and effective therapeutic method to treat facial nerve palsy (FNP) However its underlying mechanismremains unclear This study was aimed to investigate the effects of electroacupuncture on symptoms and content of HSV-1 DNA inFNPmice Mice were randomized into four groups an electroacupuncture treatment group saline group model animal group andblank control group Electroacupuncture was applied at Jiache (ST6) and Hegu (LI4) in electroacupuncture group once daily for 14days while electroacupuncture was not applied in model animal group In electroacupuncture group mice recovered more rapidlyand HSV-1 DNA content also decreased more rapidly compared with model animal group We conclude that electroacupunctureis effective to alleviate symptoms and promote the reduction of HSV-1 in FNP

1 Introduction

Peripheral facial nerve palsy (FNP) is an acute peripheralfacial nerve disorder usually affecting unilateral facial mus-cle orifices and related tissues The clinical symptoms varyaccording to the location of the lesion of the facial nervealong its course to the muscles but include drooping ofthe brow incomplete eyelid closure drooping of the cornerof the mouth impaired closure of the mouth dry eyeshyperacusis impaired taste or pain around the ear [1] AnFNP patient can appear expressionless when he or she issmiling [2] The annual incidence of FNP is estimated to be20ndash25 cases per 100000 people [3ndash5] In theUnited States theannual incidence was 25100000 people [2 6] comparedwith258100000 in China [7] FNP may influence individuals ofall age groups [4] with the peak incidence lying between 20and 40 years of age Females and males are equally affected[4] but a slight female preponderance has been observed[8] The etiology of FNP is controversial but viral infectionvascular ischemia heredity and autoimmune inflammationhave been proposed as possible underlying causes [9 10]

Evidence suggests that viral infection with herpes simplexvirus type 1 (HSV-1) may predominantly occur if the immunesystem is compromised [4 11ndash13] Additionally HSV-1 DNAwas detected in clinical specimens endoneurial fluid andsaliva from FNP patients [14 15] The herpes simplex virus(HSV) mediated viral inflammatory immune mechanism istherefore widely accepted as the major cause of FNP [14 16]

Treatmentmethods of FNP are still controversial Clinicaltrials investigating the efficacy of specific antiviral treatmentdid not show a significant benefit compared with alterna-tive therapy [17ndash19] Acupuncture is an essential part oftraditional Chinese medicine (TCM) which has a historyof thousands of years Electroacupuncture is a techniquecombining acupuncture with electric currents A number ofstudies provide evidence for a beneficial effect of acupunctureon FNP [20ndash22] However the mechanism underlying theeffects of acupuncture on FNP induced by HSV-1 infectionis not fully understood

Because of difficulties in obtaining clinical specimensfrom patients basic research using animal models is neces-sary to investigate the effects of electroacupuncture in FNP

Hindawi Publishing CorporationEvidence-Based Complementary and Alternative MedicineVolume 2014 Article ID 693783 7 pageshttpdxdoiorg1011552014693783

2 Evidence-Based Complementary and Alternative Medicine

[23] In this study we established a mouse model of FNPinduced by HSV-1 infection [24ndash27] The purpose of thisstudy was to investigate the effects of electroacupuncture onthe alleviation of symptoms and content of HSV-1 in FNPmice

2 Materials and Methods

21 Animals We used 4-week-old Balbc mice (185ndash205 g)purchased from Chengdu Dashuo Biological TechnologyCompany for this experiment All mice were maintained inLaboratory Animal Center of Chengdu University of TCMand cared for in compliance with the Guideline for AnimalExperimentation at Ehime University School of Medicine

22 Virus Inoculation and Groups Mice were randomlydivided into three groups an FNP model group (119899 = 156)saline group (119899 = 30) and blank control group (119899 =30) The KOS strain of HSV-1 was prepared in Vero cellsand plaque-titrated at 67 times 107 plaque-forming units (PFU)per milliliter Mice in the FNP model group were generallyanaesthetized with intraperitoneal injection of sodium pen-tobarbital (50mgkg) and the posterior auricular branch ofright facial nerve was incised by 2mm and inoculated with25 120583L virus solution (17times106 PFU) on a 2mmtimes 3mmgelatinsponge whichwas placed in the notchThen the incisionwasclosed In the saline group normal saline solutionwas appliedinstead Nothing was used on the mice in the blank controlgroup Animals were returned to their cages upon completionof the procedure

23 Evaluation of FNP Model The model was evaluated byscores of blink reflex vibrissae movement and position ofapex nasi daily after the virus inoculation [27] The blinkreflex was evoked twice by blowing air onto the eye throughan 18-gauge needle with a 5mL syringe The degree of blinkreflex was graded on a 0 to 2 scale (0 no difference betweentwo sides 1 the blink reflex was delayed compared with theunaffected side 2 the blink reflex disappeared completely)Vibrissae movement was observed for 30 s and scored on a 0to 2 scale (0 no difference between both sides 1 the vibrissaemovement was weaker than that on the healthy side 2 thevibrissaemovement disappeared completely)The position ofthe apex nasi was scored on a 0 to 1 scale (0 the position isin the middle 1 the position is to the unaffected side) Thetotal score was defined as the sumof all scoresWhen the totalscore was 3 or 4 points we recognized that the FNP modelwas established

Only mice that developed a transient and homolateralFNP after the primary infection were used for the followingexperiments Ninety mice (58) developed FNP exclusivelyon the same side as the inoculation and 60 FNP model micewere randomly divided into two groups an electroacupunc-ture group (119899 = 30) and a model animal group (119899 = 30)

24 Experiment Procedures There were four groups with30 mice in each Group A blank control group Group B

saline group Group C model animal group and Group Delectroacupuncture group

241 Electroacupuncture Treatment Group Based on previ-ous study [22] two frequently used acupoints Jiache (ST6)and Hegu (LI4) were selected The location of the twoacupoints was found according to Experimental Acupuncture[28] with both Jiache (ST6) and Hegu (LI4) on the paralyzedside Both acupoints were punctured 3ndash5 mm in depth Elec-troacupuncture was given by a G6805 after fixing the mice(Qingdao Xin Sheng Industrial Co Ltd Qingdao China)The filiform needles were sterile Hwato acupuncture needlesfor single use 25ndash40mm in length and 030mm in diameter(Suzhou Medical Supplies Factory Co Ltd Suzhou China)The stimulation frequency was 3-4Hz and intensity was 1-2Vin continuous wave (CW) mode to make the needle slightlyvibrate and keep the mice quiet The needles were retainedfor 20min once a day and the treatment lasted for 14 daysElectroacupuncture practitioner in this study had 10 years ofacupuncture and TCM training and 6 years of experience inacademic and clinical acupuncture

242 Control Groups There were 3 control groups theblank control group saline group and model animal groupAll mice were fixed once a day for 20min without anyintervention

25 Evaluation of FNP Symptoms After electroacupunctureat days 3 7 and 14 of treatment period symptoms wereevaluated by scores of blink reflex vibrissae movement andposition of apex nasi

26 Quantification of HSV-1 DNA HSV-1 DNA in theintratemporal facial nerve geniculate ganglia brainstem andcerebral cortex tissue was quantified after electroacupunctureat days 3 7 and 14 of treatment period

261 Extraction of HSV-1 DNA Tenmice in each group wereanesthetized by intraperitoneal injection of sodiumpentobar-bital (50mgkg) and killed by decollation quickly at days 3 7and 14 of treatment periodThe intratemporal portions of theright facial nerves geniculate ganglia brainstem and cerebralcortex were dissected and preserved at minus80∘C The facialnerves geniculate ganglia brainstem and cerebral cortexwere cut with scissors placed in a sample tube containing200120583L buffer solution and shaken until they were suspendedthoroughly After removing the supernatant and adding 20120583Lproteinase K (20mgmL) the tissue was digested at 56∘C for30min followed by a brief centrifugation and removal ofsupernatant After that 220120583L buffer solution GB was addedand the sample was shaken for 15 sec and incubated at 70∘Cfor 10min followed by a brief centrifugation and removalof supernatant After adding 220120583L absolute ethyl alcoholthe sample was oscillated for 15 sec and mixed thoroughly byvigorous shaking for 15 sec Following a brief centrifugationthis solution was poured into a CB 3 absorbing columnwhich was put in a 2mL collection tube and centrifugedat 9660 g for 30 sec Waste liquid in the collection tube

Evidence-Based Complementary and Alternative Medicine 3

Table 1 Scores in evaluation of FNP during treatment period and at the end of treatment period (119909 plusmn 119878)

Group 119873 At day 3 of treatment period At day 7 of treatment period At day 14 of treatment periodBlinkreflex

Vibrissaemovement

Position ofapex nasi

Blinkreflex

Vibrissaemovement

Position ofapex nasi

Blinkreflex

Vibrissaemovement

Position ofapex nasi

A 10 0lowastlowast 0lowastlowast 0lowastlowast 0lowastlowast 0lowastlowast 0lowastlowast 0lowastlowast 0lowastlowast 0lowastlowast

B 10 0lowastlowast 0lowastlowast 0lowastlowast 0lowastlowast 0lowastlowast 0lowastlowast 0lowastlowast 0lowastlowast 0lowastlowast

C 10 15 plusmn 31 17 plusmn 28 9 plusmn 18 12 plusmn 25 11 plusmn 17 7 plusmn 19 7 plusmn 18 8 plusmn 24 5 plusmn 16D 10 7 plusmn 24lowast 8 plusmn 19lowast 3 plusmn 22lowast 4 plusmn 16lowastlowast 5 plusmn 19lowastlowast 3 plusmn 14lowastlowast 1 plusmn 21lowast 2 plusmn 10lowast 0 plusmn 00lowast

Group A blank control group Group B saline group Group C model animal group Group D electroacupuncture group lowastCompared with Group C 119875 lt005 lowastlowastCompared with Group C 119875 lt 001

was removed and the absorbing column was put back intothe same collection tube After that 500120583L deproteinizedsolution and 700120583L and 500 120583L eluent GW were addedconsecutively and the sample was centrifuged at 9660 g for30 sec after each addition Waste liquid in the collection tubewas removed and the absorbing columnwas put back into thesame collection tube and centrifuged at 9660 g for 2min toremove residual liquid The CB 3 absorbing column was putin a clean centrifugal tube of 15mL and incubated at roomtemperature for 25min Buffer TE of 50 120583L was added to theadsorption film in the center of the absorbing column Thesample was incubated at 60∘C for 25min and centrifuged at9660 g for 2min

262 Reverse Transcription PCR of HSV-1 DNA Syntheticprimers encoding parts of the HSV-1 (51015840-CCACCGAGC-GGCAGGTGATC-31015840 as upstream primer and 51015840-GCC-GACCGCCTGCTCGTGCT-31015840 as downstream primer) andthe 120573-actin gene (51015840-CGTTGACATCCGTAAAGACCTC-31015840as upstream primer and 51015840-TAGGAGCCAGGGCAGTAA-TCT-31015840 as downstream primer) were used for PCR ampli-fication After an instantaneous centrifugation of primersdeionized water was added to make a 100 120583M solutionDeionized water of 380 120583Lwas added in another EP tube and10 120583L upstream primers and 10120583L downstream primers wereadded (400 120583L and 25 pmol120583L) Deionized water was addedto dilute cDNA to a proper concentration The extractedDNA and primers were denatured initially Forty cycles ofamplification (15 sec at 95∘C for denaturation 15 sec at 95∘Cfor renaturation 45 sec at 72∘C for extension)were performedand the sample was extended at 72∘C for 5min and incubatedat 4∘C To test the amplification efficiency and specificity ofprimers standard curves andmelting curves weremade PCRsolution of 24120583L wasmade with 125 120583L SYBR Premix Ex Taq(2times) 05 120583L PCR forward primer (10 120583M) 05 120583L PCR reverseprimer (10120583M) 3 120583L template cDNA and 85 120583L dH

2O and

incubated in a real-time PCR tube Gradient dilution of 2120583Lfor cDNA was added Forty cycles of amplification (15 sec at95∘C for denaturation 15 sec at 95∘C for renaturation 45 secat 72∘C for extension) were performed and the sample wasextended at 72∘C for 5min Fluorescence data for meltingcurve was acquired every 05∘C during a temperature tran-sition from 58∘C to 85∘C Fluorescence quantitative standardcurvewasmade Real-time PCRwere run in triplicate Briefly

mRNA was corrected with 120573-actin via CT (the cycle atthreshold level) The relative mRNA expression of HSV-1120573-actin was quantified according to the formula of 2minusΔΔCTAnalysis of CT was performed using Sequence Detectionsoftware version 123 (Applied Biosystems group)

27 Statistical Analysis All analyses were carried out usingthe Statistical Package for the Social Sciences version 170(SPSS Chicago IL USA) Descriptive statistics including themean plusmn standard deviation (SD) median minimum (min)and maximum (max) were used to present continuous vari-ables One-way analysis of variance (ANOVA) was used todetermine statistically significant differences between groupsof variables with data that were normally distributed Theleast-significant difference (LSD) test was used for homo-geneity of variance whereas Tamhanersquos T2 test was usedfor heterogeneity of variance Hierarchical data was testedwith the nonparametric test to determine differences betweengroups 119875 lt 005 was considered statistically significant

3 Results

31 Results of Melting Curve TheHSV-1 melting curve had asingle peak melting at 85 plusmn 1∘CThis step was replicated sev-eral times The amplified product was the intended product

32 Symptom Relief of Acute Viral FNP Mice Mice in theblank control group and saline group showed no symptomsof FNP and the score for each item in these two groups was 0The scores of blink reflex vibrissae movement and positionof apex nasi in the model animal group and electroacupunc-ture group decreased over time However the scores in theelectroacupuncture group decreasedmore rapidlyThe scoresof blink reflex vibrissae movement and position of apex nasiin the electroacupuncture groupwere significantly lower thanthose in model animal group (119875 lt 005 at day 3 119875 lt 001at day 7 and 119875 lt 005 at day 14 of treatment period) Thedifferences in FNP symptoms among all groups are shown inTable 1

33 Quantity of HSV-1 DNA NoHSV-1 DNAwas detected ineither saline group or blank control group mice HSV-1 DNAwas detected in the model animal group and electroacupunc-ture group However the quantity of HSV-1 was significantly

4 Evidence-Based Complementary and Alternative Medicine

lower in the electroacupuncture group compared with themodel animal group (119875 lt 005 at day 3 119875 lt 001 at days7 and 14 of treatment period) as shown in Table 2 At day7 of treatment period HSV-1 DNA was decreasing in theelectroacupuncture group while HSV-1 DNAwas still highercompared with 4 days prior in themodel animal group HSV-1 DNA in the model animal group was decreasing at day 14 oftreatment period

4 Discussion

The blink reflex score vibrissae movement score position ofapex nasi score and total score were significantly higher inthe electroacupuncture and model animal group than thosein saline and blank control group after modeling whichindicated that the FNP mice model was successfully inducedby inoculation of HSV-1With the development of FNP somefacial nerve function recovered and HSV-1 DNA contentalso decreased in the model animal group These resultsreflect the disease progression of FNP Facial nerve functionrecoveredmore quickly in the electroacupuncture groupThesymptom relief after acupuncture is consistent with clinicaltrials evaluating the therapeutic effects of acupuncture forFNP [20ndash22] In addition HSV-1 DNA quantity in theelectroacupuncture group was significantly lower than thatin model animal group at day 3 At day 7 HSV-1 DNAquantity in the electroacupuncture group was decreasingwhile HSV-1 DNA quantity in the model animal group wasstill higher compared with 4 days priorThese results indicatethat electroacupuncture has therapeutic effects on FNP andpromotes the reduction in HSV-1

41 The Mechanism Underlying Acupuncture to AlleviateFNP Symptoms It has been suggested that the cell-mediatedautoimmunemechanism against myelin basic proteinmay bethe pathogenesis of FNP FNP is an autoimmune demyelinat-ing cranial neuritis and in most instances it is a mononeu-ritic variant of Guillain-Barre syndrome a neurologic diseasewith cell-mediated autoimmune reaction against peripheralnerve myelin antigens In FNP viral infection or the reactiva-tion of a latent virus may provoke an autoimmune reactionagainst peripheral nerve myelin components leading toinflammation and demyelination of the facial nerve [29]During its progression FNP is accompanied by significantelevations in some proinflammatory mediators includingtumor necrosis factor alpha (TNF-120572) interleukin-6 (IL-6)and interleukin-1 beta (IL-1120573) [30] TNF-120572 IL-6 and IL-1120573 are linked with a wide range of inflammatory infectiousautoimmune and malignant conditions [31] The abnormalhigh level of serum TNF-120572 also causes demyelination ofthe facial nerve via inflammation [32 33] Acupuncturesignificantly reduces plasma levels of TNF-120572 in patients withchronic headache [34] and mRNA levels of IL-6 and IL-1120573in rats of lipopolysaccharide-induced fever [35] A recentlypublished study found a new pathway for anti-inflammatorypathway of electroacupuncture Electroacupuncture at thesciatic nerve controls systemic inflammation by inducingvagal activation of aromatic L-amino acid decarboxylase

leading to the production of dopamine in the adrenalmedullaand then the reduction of TNF-120572 [36] By inhibiting the pro-duction of proinflammatory mediators acupuncture mighthelp alleviate facial nerve inflammation and demyelinationand thus promote the repair of the facial nerve to improvesymptoms Overall acupuncturemight have potential benefitfor inflammation in inflammatory and infectious diseasesby regulating the production of proinflammatory mediatorsHowever there is no direct observation to support thatacupuncture could reduce the contents of TNF-120572 IL-6 andIL-1120573 in HSV-1 induced FNP in vivo

42 The Mechanism Underlying Acupuncture to Help ControlHSV-1 Infection

421 Acupuncture Might Help Reduce the Efficiency of HSV-1 Replication and Spread HSV-1 can activate autoimmunepathways including the nuclear factor kappa-light-chain-enhancer of activated B cells (NF-120581B) signaling pathway Evi-dence suggests that HSV-1 can induce a persistent transloca-tion of NF-120581B [37] NF-120581B complexes are bound to inhibitorsof NF-120581B (I120581Bs) in unstimulated cells thereby maintainingNF-120581B in an inactive state The phosphorylation of I120581B bythe I120581B kinase (IKK) complex is involved in the activationof NF-120581B leading to I120581B degradation which releases NF-120581Band then allows it to translocate into the nucleus [38 39]Thepersistent translocation of NF-120581B subsequently increases theefficiency of virus replication [37] The translocation of NF-120581B to the nuclei of infected cells is a necessary componentto prevent apoptosis of host cells during HSV-1 infectionwhich helps HSV-1 evade immunological surveillance andspread effectively in the host [40] Acupuncture can inhibitabnormal NF-120581B expression and activation by inhibiting theNF-120581B signal transduction pathway in host cells [41 42]Thismight help the immunological surveillance and reduce theefficiency of HSV-1 replication and spread However thereis no direct observation to support that acupuncture couldinhibit NF-120581B expression and activation in HSV-1 inducedFNP in vivo which needs to be further studied

422 Acupuncture Might Regulate Immune Response to Elim-inate HSV-1 After HSV-1 infection humoral immunity andcell-mediated immunity will be activated to eliminate HSV-1 In cell-mediated immunity antigen-specific cytotoxic Tlymphocytes a type of T lymphocytes that kill cancer cellsand infected cells are activated to induce apoptosis in virus-infected cells displaying epitopes of foreign antigens on theirsurface Studies regarding the effects of acupuncture on theimmune system show a stimulating effect on cell-mediatedimmunity Acupuncture is able to help in T lymphocyteproliferation [43] After acupuncture T helper lymphocytesa type of T lymphocytes that help in the activity of otherimmune cells and cytotoxic T lymphocytes were significantlyincreased [44 45]The ability of acupuncture tomodulate theimmune response might help the immune system to elimi-nate HSV-1 Therefore acupuncture might have potential tocontrol infection in infectious diseases by activating someimmune pathways and modulating the immune response

Evidence-Based Complementary and Alternative Medicine 5

Table2Detectio

nof

HSV

-1DNAdu

ringtre

atmentp

eriodandatthee

ndof

treatmentp

eriod(119909plusmn119878)

G119873

Atday3of

treatmentp

eriod

Atday7of

treatmentp

eriod

Atday14

oftre

atmentp

eriod

Facialnerve

(2minusCT)

Geniculate

gang

lion

(2minusCT)

Brainstem

(2minusCT)

Cerebral

cortex

(2minusCT)

Facialnerve

(2minusCT)

Geniculate

gang

lion

(2minusCT)

Brainstem

(2minusCT)

Cerebral

cortex

(2minusCT)

Facialnerve

(2minusCT)

Geniculate

gang

lion

(2minusCT)

Brainstem

(2minusCT)

Cerebral

cortex

(2minusCT)

A10

0lowastlowast

0lowastlowast

0lowastlowast

0lowastlowast

0lowastlowast

0lowastlowast

0lowastlowast

0lowastlowast

0lowastlowast

0lowastlowast

0lowastlowast

0lowastlowast

B10

0lowastlowast

0lowastlowast

0lowastlowast

0lowastlowast

0lowastlowast

0lowastlowast

0lowast0lowastlowast

0lowastlowast

0lowastlowast

0lowastlowast

0lowastlowast

C10

1367plusmn216

1182plusmn18

177

3plusmn10

8652plusmn227

1542plusmn271

1418plusmn19

71257plusmn311

652plusmn227

989plusmn14

776

3plusmn12

2677plusmn12

8614plusmn16

3D

1098

4plusmn12

9lowast90

4plusmn229lowast

304plusmn229lowast

217plusmn114lowast

218plusmn213lowastlowast

178plusmn114lowastlowast

104plusmn14

8lowastlowast

217plusmn12

5lowastlowast

071plusmn016lowastlowast

018plusmn021lowastlowast

003plusmn009lowastlowast

005plusmn013lowastlowast

Thequ

antityof

HSV

-1DNAwas

expressedwith

2minusΔΔCT

ofdifferenceratio

ofHSV

-1mRN

AG

roup

Ablank

controlgroup

Group

Bsalin

egrou

pGroup

Cmod

elanim

algrou

pGroup

Delectroacup

uncture

grou

plowastCom

paredwith

Group

C119875lt005lowastlowastCom

paredwith

Group

C119875lt001

6 Evidence-Based Complementary and Alternative Medicine

43The Compatibility of Distal-Proximal Acupoints in Acupu-ncture Treatment for FNP Acupoints compatibility is a keypoint in acupuncture prescriptions which influences thera-peutic effectsThere are many classical acupoints compatibil-itymethods such as yuan-source acupoints and luo-collateralacupoints combination back-shu acupoints and front-muacupoints combination and distal-proximal acupoints com-bination Distal-proximal acupoints combination is oftenused in the treatment of FNP For example Hegu (LI4) inupper extremity and some local acupoints in face are needledin combination Synergistic effects exist among acupointsso acupoint compatibility can strengthen the effectiveness ofacupuncture

The mechanism underlying Hegu (LI4) treating diseasesin the face and mouth remains unclear A morphologicalstudy suggested that the Gasserian ganglion receives theneural projection to Hegu (LI4) [46] Furthermore the nervein Hegu (LI4) has an indirect project to the nucleus of thesolitary tract and the facial nerve has a direct connectionwiththe nucleus of the solitary tract [47] This might be the mor-phological foundation of Hegu (LI4) treating diseases in theface and mouth As to Jiache (ST6) this acupoint is locatednear the subbuccal and marginal mandibular branches of thefacial nerve which provides themorphological foundation toalleviate symptoms of FNP [48] The combination of Hegu(LI4) and Jiache (ST6) stimulates more peripheral nervescompared with needling a single acupoint of them

5 Limitations

There are some limitations of this study Although the mod-eling method in this study is more consistent with the naturalpathogenesis of FNP the model rate is relatively lower thanthat of compressing the facial nerve Additionally this studyshows the potential of acupuncture in triggering a patientrsquosimmunoreaction to further reduce HSV-1 quantity Howeverthis study is insufficient to fully elucidate the mechanismof acupuncture in reducing HSV-1 quantity Future studiesmight be directed toward elucidating this mechanism suchas the relationship between acupuncture and NF-120581B in FNPin vivo

6 Conclusions

Weconcluded that in the treatment for FNP electroacupunc-ture alleviates symptoms facilitates affected nerve recoveryand promotes the reduction in HSV-1 Acupuncture mighthave therapeutic advantages in controlling inflammation andinfection in FNP

Conflict of Interests

The authors declare no conflict of interests

Authorsrsquo Contribution

Hongzhi Tang and Shuwei Feng contributed equally to thework

Acknowledgments

This study was supported by the National Basic ResearchProgram of China (no 2012CB518501) and the ResearchFund for the Doctoral Program of Higher Education (no20105132110003)

References

[1] J Finsterer ldquoManagement of peripheral facial nerve palsyrdquoEuropean Archives of Oto-Rhino-Laryngology vol 265 no 7 pp743ndash752 2008

[2] H C Slavkin ldquoThe significance of a human smile observationson Bellrsquos palsyrdquo Journal of the American Dental Association vol130 no 2 pp 269ndash272 1999

[3] M Shaw F Nazir and I Bone ldquoBellrsquos palsy a study of thetreatment advice given by neurologistsrdquo Journal of NeurologyNeurosurgery and Psychiatry vol 76 no 2 pp 293ndash294 2005

[4] N J Holland and G M Weiner ldquoRecent developments in Bellrsquospalsyrdquo British Medical Journal vol 329 no 7474 pp 553ndash5572004

[5] A G Marson and R Salinas ldquoBellrsquos palsyrdquo Western Journal ofMedicine vol 173 no 4 pp 266ndash268 2000

[6] N A Brandenburg and J F Annegers ldquoIncidence and riskfactors for Bellrsquos palsy in Laredo Texas 1974ndash1982rdquo Neuroepi-demiology vol 12 no 6 pp 313ndash325 1993

[7] Q D Yang Neurology Peoplersquos Medical Publishing HouseBeijing China 2002

[8] C A J Prescott ldquoIdiopathic facial nerve palsyrdquo Journal ofLaryngology and Otology vol 102 no 5 pp 403ndash407 1988

[9] B Lorber ldquoAre all diseases infectiousrdquo Annals of InternalMedicine vol 125 no 10 pp 844ndash851 1996

[10] C Atzema and R D Goldman ldquoShould we use steroids to treatchildren with Bellrsquos palsyrdquo Canadian Family Physician vol 52pp 313ndash314 2006

[11] S Axelsson S Lindberg and A Stjernquist-Desatnik ldquoOut-come of treatment with valacyclovir and prednisone in patientswith Bellrsquos palsyrdquoAnnals of Otology Rhinology and Laryngologyvol 112 no 3 pp 197ndash201 2003

[12] J Schirm and P S J ZMulkens ldquoBellrsquos palsy and herpes simplesvirusrdquo Acta Pathologica Microbiologica et Immunologica Scan-dinavica vol 105 no 7ndash12 pp 815ndash823 1997

[13] K K Adour J M Ruboyianes P G von Doersten et al ldquoBellrsquospalsy treatment with acyclovir and prednisone compared withprednisone alone a double-blind randomized controlled trialrdquoAnnals of Otology Rhinology and Laryngology vol 105 no 5 pp371ndash378 1996

[14] S Murakami M Mizobuchi Y Nakashiro T Doi N Hatoand N Yanagihara ldquoBellrsquos palsy and herpes simplex virusidentification of viral DNA in endoneurial fluid and musclerdquoAnnals of Internal Medicine vol 124 no 1 part 1 pp 27ndash301996

[15] Y Furuta S Fukuda S Chida et al ldquoReactivation of herpessimplex virus type 1 in patients with Bellrsquos palsyrdquo Journal ofMedical Virology vol 54 pp 162ndash166 1998

[16] C G Jackson and P G von Doersten ldquoThe facial nerve currenttrends in diagnosis treatment and rehabilitationrdquo MedicalClinics of North America vol 83 no 1 pp 179ndash195 1999

[17] K K Adour ldquoOtological complications of herpes zosterrdquoNeurology vol 35 no 1 pp S62ndashS64 1994

Evidence-Based Complementary and Alternative Medicine 7

[18] N Hato H Yamada H Kohno et al ldquoValacyclovir and pred-nisolone treatment for Bellrsquos palsy amulticenter randomizedplacebo-controlled studyrdquoOtology ampNeurotology vol 28 no 3pp 408ndash413 2007

[19] K Kawaguchi H Inamura Y Abe et al ldquoReactivation ofherpes simplex virus type 1 and varicella-zoster virus andtherapeutic effects of combination therapy with prednisoloneand valacyclovir in patients with Bellrsquos palsyrdquoThe Laryngoscopevol 117 no 1 pp 147ndash156 2007

[20] F R Liang Y Li S G Yu et al ldquoA multicentral randomizedcontrol study on clinical acupuncture treatment of Bellrsquos palsyrdquoJournal of Traditional Chinese Medicine vol 26 no 1 pp 3ndash72006

[21] Y Qu ldquoClinical observation on acupuncture by stages com-bined with exercise therapy for treatment of Bell palsy at acutestagerdquo Chinese Acupuncture and Moxibustion vol 25 no 8 pp545ndash547 2005

[22] Y Li F R Liang S G Yu et al ldquoEfficacy of acupuncture andmoxibustion in treating Bellrsquos palsy a multicenter randomizedcontrolled trial in Chinardquo Chinese Medical Journal vol 117 no10 pp 1502ndash1506 2004

[23] H Takahashi N Hato N Honda et al ldquoEffects of acyclovir onfacial nerve paralysis induced by herpes simplex virus type 1 inmicerdquo Auris Nasus Larynx vol 30 no 1 pp 1ndash5 2003

[24] N Honda N Hato H Takahashi et al ldquoPathophysiology offacial nerve paralysis induced by herpes simplex virus type 1infectionrdquo Annals of Otology Rhinology and Laryngology vol111 no 7 pp 616ndash622 2002

[25] T Sugita S Murakami N Yanagihara Y Fujiwara Y HirataandTKurata ldquoFacial nerve paralysis induced by herpes simplexvirus in mice an animal model of acute and transient facialparalysisrdquo Annals of Otology Rhinology and Laryngology vol104 no 7 pp 574ndash581 1995

[26] S Murakami N Hato M Mizobuchi T Doi and N Yanagi-hara ldquoRole of herpes simplex virus infection in the pathogenesisof facial paralysis in micerdquo Annals of Otology Rhinology andLaryngology vol 105 no 1 pp 49ndash53 1996

[27] H Takahashi Y Hitsumoto N Honda et al ldquoMouse model ofBellrsquos palsy induced by reactivation of herpes simplex virus type1rdquo Journal of Neuropathology and Experimental Neurology vol60 no 6 pp 621ndash627 2001

[28] S G Yu and Y Guo Experimental Acupuncture ShanghaiScience and Technology Press Shanghai China 2009

[29] A Greco A GalloM Fusconi CMarinelli G FMacri andMde Vincentiis ldquoBellrsquos palsy and autoimmunityrdquo AutoimmunityReviews vol 12 no 2 pp 323ndash328 2012

[30] M Yilmaz M Tarakcioglu N Bayazit Y A Bayazit MNamiduru and M Kanlikama ldquoSerum cytokine levels in bellrsquospalsyrdquo Journal of the Neurological Sciences vol 197 no 1-2 pp69ndash72 2002

[31] M Apostolaki M Armaka P Victoratos and G Kollias ldquoCel-lular mechanisms of TNF function in models of inflammationand autoimmunityrdquoCurrent Directions in Autoimmunity vol 11pp 1ndash26 2010

[32] C Larsson C Bernstrom-Lundberg S Edstrom and TBergstrom ldquoTumor necrosis factor-120572 response and herpesvirusinfection in Bellrsquos palsyrdquo The Laryngoscope vol 108 no 8 part1 pp 1171ndash1176 1998

[33] A V Delgado A T McManus and J P Chambers ldquoProductionof tumor necrosis factor-120572 interleukin 1-120573 interleukin 2 andinterleukin 6 by rat leukocyte subpopulations after exposure tosubstance Prdquo Neuropeptides vol 37 no 6 pp 355ndash361 2003

[34] H J Jeong S H Hong Y C Nam et al ldquoThe effect of acupunc-ture on proinflammatory cytokine production in patients withchronic headache a preliminary reportrdquoThe American Journalof Chinese Medicine vol 31 no 6 pp 945ndash954 2003

[35] Y S Son H J Park O B Kwon S Jung H Shin and S LimldquoAntipyretic effects of acupuncture on the lipopolysaccharide-induced fever and expression of interleukin-6 and interleukin-1120573 mRNAs in the hypothalamus of ratsrdquo Neuroscience Lettersvol 319 no 1 pp 45ndash48 2002

[36] R Torres-Rosas G Yehia G Pena et al ldquoDopamine mediatesvagal modulation of the immune system by electroacupunc-turerdquo Nature Medicine vol 20 no 3 pp 291ndash295 2014

[37] A Patel J Hanson T I McLean et al ldquoHerpes simplex virustype 1 induction of persistent NF-kappaB nuclear translocationincreases the efficiency of virus replicationrdquo Virology vol 247no 2 pp 212ndash222 1998

[38] M S Hayden and S Ghosh ldquoSignaling to NF-kappaBrdquoGenes ampDevelopment vol 18 no 18 pp 2195ndash2224 2004

[39] N D Perkins ldquoIntegrating cell-signalling pathways with NF-kappaB and IKK functionrdquo Nature Reviews Molecular CellBiology vol 8 no 1 pp 49ndash62 2007

[40] M L Goodkin A T Ting and J A Blaho ldquoNF-kappaB isrequired for apoptosis prevention during herpes simplex virustype 1 infectionrdquo Journal of Virology vol 77 no 13 pp 7261ndash7280 2003

[41] X R Zhang XWang C L Sun et al ldquoExpression of NF- KB inspinal ganglia of CIA rats and therapeutic action of acupunctureJiaji pointsrdquo Modern Journal of Integrated Traditional Chineseand Western Medicine vol 16 no 11 pp 1460ndash1462 2007

[42] L Zhou H X Zhang Q Wang et al ldquoEffect of scalp acupunc-ture on the expression of NF-JB mRNA COX-2 mRNA andtheir proteins in rats with acute cerebral ischemia-reperfusioninjuryrdquo Acupuncture Research vol 34 no 5 pp 304ndash308 2009

[43] M Bianchi E Jotti P Sacerdote and A E Panerai ldquoTraditionalacupuncture increases the content of 120573-endorphin in immunecells and influences mitogen induced proliferationrdquoThe Ameri-can Journal of Chinese Medicine vol 19 no 2 pp 101ndash104 1991

[44] F Petti A Bangrazi A Liguori G Reale and F Ippoliti ldquoEffectsof acupuncture on immune response related to opioid-likepeptidesrdquo Journal of Traditional Chinese Medicine vol 18 no1 pp 55ndash63 1998

[45] BWu ldquoEffect of acupuncture on the regulation of cell-mediatedimmunity in the patients with malignant tumorsrdquo AcupunctureResearch vol 20 no 3 pp 67ndash71 1995

[46] X H Jing H Cai B Lu et al ldquoStudy on morphologicalfoundation of point LI 4 treating diseases in the face andmouthrdquo Chinese Acupuncture and Moxibustion vol 23 no 2pp 109ndash110 2003

[47] S l Chen Z G Jin X H Jing et al ldquoMorphological study onthe afferent pathways of ldquoHegurdquo point and mouth-face regionrdquoAcupuncture Research vol 29 no 3 pp 217ndash221 2004

[48] Z Xu ldquoAnatomic basis for the treatment of facial paralysis bydicang-through-jiache acupuncturerdquo Shanghai Journal of Acu-Mox vol 27 no 4 pp 35ndash37 2008

Submit your manuscripts athttpwwwhindawicom

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Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

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Behavioural Neurology

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Disease Markers

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Parkinsonrsquos Disease

Evidence-Based Complementary and Alternative Medicine

Volume 2014Hindawi Publishing Corporationhttpwwwhindawicom

2 Evidence-Based Complementary and Alternative Medicine

[23] In this study we established a mouse model of FNPinduced by HSV-1 infection [24ndash27] The purpose of thisstudy was to investigate the effects of electroacupuncture onthe alleviation of symptoms and content of HSV-1 in FNPmice

2 Materials and Methods

21 Animals We used 4-week-old Balbc mice (185ndash205 g)purchased from Chengdu Dashuo Biological TechnologyCompany for this experiment All mice were maintained inLaboratory Animal Center of Chengdu University of TCMand cared for in compliance with the Guideline for AnimalExperimentation at Ehime University School of Medicine

22 Virus Inoculation and Groups Mice were randomlydivided into three groups an FNP model group (119899 = 156)saline group (119899 = 30) and blank control group (119899 =30) The KOS strain of HSV-1 was prepared in Vero cellsand plaque-titrated at 67 times 107 plaque-forming units (PFU)per milliliter Mice in the FNP model group were generallyanaesthetized with intraperitoneal injection of sodium pen-tobarbital (50mgkg) and the posterior auricular branch ofright facial nerve was incised by 2mm and inoculated with25 120583L virus solution (17times106 PFU) on a 2mmtimes 3mmgelatinsponge whichwas placed in the notchThen the incisionwasclosed In the saline group normal saline solutionwas appliedinstead Nothing was used on the mice in the blank controlgroup Animals were returned to their cages upon completionof the procedure

23 Evaluation of FNP Model The model was evaluated byscores of blink reflex vibrissae movement and position ofapex nasi daily after the virus inoculation [27] The blinkreflex was evoked twice by blowing air onto the eye throughan 18-gauge needle with a 5mL syringe The degree of blinkreflex was graded on a 0 to 2 scale (0 no difference betweentwo sides 1 the blink reflex was delayed compared with theunaffected side 2 the blink reflex disappeared completely)Vibrissae movement was observed for 30 s and scored on a 0to 2 scale (0 no difference between both sides 1 the vibrissaemovement was weaker than that on the healthy side 2 thevibrissaemovement disappeared completely)The position ofthe apex nasi was scored on a 0 to 1 scale (0 the position isin the middle 1 the position is to the unaffected side) Thetotal score was defined as the sumof all scoresWhen the totalscore was 3 or 4 points we recognized that the FNP modelwas established

Only mice that developed a transient and homolateralFNP after the primary infection were used for the followingexperiments Ninety mice (58) developed FNP exclusivelyon the same side as the inoculation and 60 FNP model micewere randomly divided into two groups an electroacupunc-ture group (119899 = 30) and a model animal group (119899 = 30)

24 Experiment Procedures There were four groups with30 mice in each Group A blank control group Group B

saline group Group C model animal group and Group Delectroacupuncture group

241 Electroacupuncture Treatment Group Based on previ-ous study [22] two frequently used acupoints Jiache (ST6)and Hegu (LI4) were selected The location of the twoacupoints was found according to Experimental Acupuncture[28] with both Jiache (ST6) and Hegu (LI4) on the paralyzedside Both acupoints were punctured 3ndash5 mm in depth Elec-troacupuncture was given by a G6805 after fixing the mice(Qingdao Xin Sheng Industrial Co Ltd Qingdao China)The filiform needles were sterile Hwato acupuncture needlesfor single use 25ndash40mm in length and 030mm in diameter(Suzhou Medical Supplies Factory Co Ltd Suzhou China)The stimulation frequency was 3-4Hz and intensity was 1-2Vin continuous wave (CW) mode to make the needle slightlyvibrate and keep the mice quiet The needles were retainedfor 20min once a day and the treatment lasted for 14 daysElectroacupuncture practitioner in this study had 10 years ofacupuncture and TCM training and 6 years of experience inacademic and clinical acupuncture

242 Control Groups There were 3 control groups theblank control group saline group and model animal groupAll mice were fixed once a day for 20min without anyintervention

25 Evaluation of FNP Symptoms After electroacupunctureat days 3 7 and 14 of treatment period symptoms wereevaluated by scores of blink reflex vibrissae movement andposition of apex nasi

26 Quantification of HSV-1 DNA HSV-1 DNA in theintratemporal facial nerve geniculate ganglia brainstem andcerebral cortex tissue was quantified after electroacupunctureat days 3 7 and 14 of treatment period

261 Extraction of HSV-1 DNA Tenmice in each group wereanesthetized by intraperitoneal injection of sodiumpentobar-bital (50mgkg) and killed by decollation quickly at days 3 7and 14 of treatment periodThe intratemporal portions of theright facial nerves geniculate ganglia brainstem and cerebralcortex were dissected and preserved at minus80∘C The facialnerves geniculate ganglia brainstem and cerebral cortexwere cut with scissors placed in a sample tube containing200120583L buffer solution and shaken until they were suspendedthoroughly After removing the supernatant and adding 20120583Lproteinase K (20mgmL) the tissue was digested at 56∘C for30min followed by a brief centrifugation and removal ofsupernatant After that 220120583L buffer solution GB was addedand the sample was shaken for 15 sec and incubated at 70∘Cfor 10min followed by a brief centrifugation and removalof supernatant After adding 220120583L absolute ethyl alcoholthe sample was oscillated for 15 sec and mixed thoroughly byvigorous shaking for 15 sec Following a brief centrifugationthis solution was poured into a CB 3 absorbing columnwhich was put in a 2mL collection tube and centrifugedat 9660 g for 30 sec Waste liquid in the collection tube

Evidence-Based Complementary and Alternative Medicine 3

Table 1 Scores in evaluation of FNP during treatment period and at the end of treatment period (119909 plusmn 119878)

Group 119873 At day 3 of treatment period At day 7 of treatment period At day 14 of treatment periodBlinkreflex

Vibrissaemovement

Position ofapex nasi

Blinkreflex

Vibrissaemovement

Position ofapex nasi

Blinkreflex

Vibrissaemovement

Position ofapex nasi

A 10 0lowastlowast 0lowastlowast 0lowastlowast 0lowastlowast 0lowastlowast 0lowastlowast 0lowastlowast 0lowastlowast 0lowastlowast

B 10 0lowastlowast 0lowastlowast 0lowastlowast 0lowastlowast 0lowastlowast 0lowastlowast 0lowastlowast 0lowastlowast 0lowastlowast

C 10 15 plusmn 31 17 plusmn 28 9 plusmn 18 12 plusmn 25 11 plusmn 17 7 plusmn 19 7 plusmn 18 8 plusmn 24 5 plusmn 16D 10 7 plusmn 24lowast 8 plusmn 19lowast 3 plusmn 22lowast 4 plusmn 16lowastlowast 5 plusmn 19lowastlowast 3 plusmn 14lowastlowast 1 plusmn 21lowast 2 plusmn 10lowast 0 plusmn 00lowast

Group A blank control group Group B saline group Group C model animal group Group D electroacupuncture group lowastCompared with Group C 119875 lt005 lowastlowastCompared with Group C 119875 lt 001

was removed and the absorbing column was put back intothe same collection tube After that 500120583L deproteinizedsolution and 700120583L and 500 120583L eluent GW were addedconsecutively and the sample was centrifuged at 9660 g for30 sec after each addition Waste liquid in the collection tubewas removed and the absorbing columnwas put back into thesame collection tube and centrifuged at 9660 g for 2min toremove residual liquid The CB 3 absorbing column was putin a clean centrifugal tube of 15mL and incubated at roomtemperature for 25min Buffer TE of 50 120583L was added to theadsorption film in the center of the absorbing column Thesample was incubated at 60∘C for 25min and centrifuged at9660 g for 2min

262 Reverse Transcription PCR of HSV-1 DNA Syntheticprimers encoding parts of the HSV-1 (51015840-CCACCGAGC-GGCAGGTGATC-31015840 as upstream primer and 51015840-GCC-GACCGCCTGCTCGTGCT-31015840 as downstream primer) andthe 120573-actin gene (51015840-CGTTGACATCCGTAAAGACCTC-31015840as upstream primer and 51015840-TAGGAGCCAGGGCAGTAA-TCT-31015840 as downstream primer) were used for PCR ampli-fication After an instantaneous centrifugation of primersdeionized water was added to make a 100 120583M solutionDeionized water of 380 120583Lwas added in another EP tube and10 120583L upstream primers and 10120583L downstream primers wereadded (400 120583L and 25 pmol120583L) Deionized water was addedto dilute cDNA to a proper concentration The extractedDNA and primers were denatured initially Forty cycles ofamplification (15 sec at 95∘C for denaturation 15 sec at 95∘Cfor renaturation 45 sec at 72∘C for extension)were performedand the sample was extended at 72∘C for 5min and incubatedat 4∘C To test the amplification efficiency and specificity ofprimers standard curves andmelting curves weremade PCRsolution of 24120583L wasmade with 125 120583L SYBR Premix Ex Taq(2times) 05 120583L PCR forward primer (10 120583M) 05 120583L PCR reverseprimer (10120583M) 3 120583L template cDNA and 85 120583L dH

2O and

incubated in a real-time PCR tube Gradient dilution of 2120583Lfor cDNA was added Forty cycles of amplification (15 sec at95∘C for denaturation 15 sec at 95∘C for renaturation 45 secat 72∘C for extension) were performed and the sample wasextended at 72∘C for 5min Fluorescence data for meltingcurve was acquired every 05∘C during a temperature tran-sition from 58∘C to 85∘C Fluorescence quantitative standardcurvewasmade Real-time PCRwere run in triplicate Briefly

mRNA was corrected with 120573-actin via CT (the cycle atthreshold level) The relative mRNA expression of HSV-1120573-actin was quantified according to the formula of 2minusΔΔCTAnalysis of CT was performed using Sequence Detectionsoftware version 123 (Applied Biosystems group)

27 Statistical Analysis All analyses were carried out usingthe Statistical Package for the Social Sciences version 170(SPSS Chicago IL USA) Descriptive statistics including themean plusmn standard deviation (SD) median minimum (min)and maximum (max) were used to present continuous vari-ables One-way analysis of variance (ANOVA) was used todetermine statistically significant differences between groupsof variables with data that were normally distributed Theleast-significant difference (LSD) test was used for homo-geneity of variance whereas Tamhanersquos T2 test was usedfor heterogeneity of variance Hierarchical data was testedwith the nonparametric test to determine differences betweengroups 119875 lt 005 was considered statistically significant

3 Results

31 Results of Melting Curve TheHSV-1 melting curve had asingle peak melting at 85 plusmn 1∘CThis step was replicated sev-eral times The amplified product was the intended product

32 Symptom Relief of Acute Viral FNP Mice Mice in theblank control group and saline group showed no symptomsof FNP and the score for each item in these two groups was 0The scores of blink reflex vibrissae movement and positionof apex nasi in the model animal group and electroacupunc-ture group decreased over time However the scores in theelectroacupuncture group decreasedmore rapidlyThe scoresof blink reflex vibrissae movement and position of apex nasiin the electroacupuncture groupwere significantly lower thanthose in model animal group (119875 lt 005 at day 3 119875 lt 001at day 7 and 119875 lt 005 at day 14 of treatment period) Thedifferences in FNP symptoms among all groups are shown inTable 1

33 Quantity of HSV-1 DNA NoHSV-1 DNAwas detected ineither saline group or blank control group mice HSV-1 DNAwas detected in the model animal group and electroacupunc-ture group However the quantity of HSV-1 was significantly

4 Evidence-Based Complementary and Alternative Medicine

lower in the electroacupuncture group compared with themodel animal group (119875 lt 005 at day 3 119875 lt 001 at days7 and 14 of treatment period) as shown in Table 2 At day7 of treatment period HSV-1 DNA was decreasing in theelectroacupuncture group while HSV-1 DNAwas still highercompared with 4 days prior in themodel animal group HSV-1 DNA in the model animal group was decreasing at day 14 oftreatment period

4 Discussion

The blink reflex score vibrissae movement score position ofapex nasi score and total score were significantly higher inthe electroacupuncture and model animal group than thosein saline and blank control group after modeling whichindicated that the FNP mice model was successfully inducedby inoculation of HSV-1With the development of FNP somefacial nerve function recovered and HSV-1 DNA contentalso decreased in the model animal group These resultsreflect the disease progression of FNP Facial nerve functionrecoveredmore quickly in the electroacupuncture groupThesymptom relief after acupuncture is consistent with clinicaltrials evaluating the therapeutic effects of acupuncture forFNP [20ndash22] In addition HSV-1 DNA quantity in theelectroacupuncture group was significantly lower than thatin model animal group at day 3 At day 7 HSV-1 DNAquantity in the electroacupuncture group was decreasingwhile HSV-1 DNA quantity in the model animal group wasstill higher compared with 4 days priorThese results indicatethat electroacupuncture has therapeutic effects on FNP andpromotes the reduction in HSV-1

41 The Mechanism Underlying Acupuncture to AlleviateFNP Symptoms It has been suggested that the cell-mediatedautoimmunemechanism against myelin basic proteinmay bethe pathogenesis of FNP FNP is an autoimmune demyelinat-ing cranial neuritis and in most instances it is a mononeu-ritic variant of Guillain-Barre syndrome a neurologic diseasewith cell-mediated autoimmune reaction against peripheralnerve myelin antigens In FNP viral infection or the reactiva-tion of a latent virus may provoke an autoimmune reactionagainst peripheral nerve myelin components leading toinflammation and demyelination of the facial nerve [29]During its progression FNP is accompanied by significantelevations in some proinflammatory mediators includingtumor necrosis factor alpha (TNF-120572) interleukin-6 (IL-6)and interleukin-1 beta (IL-1120573) [30] TNF-120572 IL-6 and IL-1120573 are linked with a wide range of inflammatory infectiousautoimmune and malignant conditions [31] The abnormalhigh level of serum TNF-120572 also causes demyelination ofthe facial nerve via inflammation [32 33] Acupuncturesignificantly reduces plasma levels of TNF-120572 in patients withchronic headache [34] and mRNA levels of IL-6 and IL-1120573in rats of lipopolysaccharide-induced fever [35] A recentlypublished study found a new pathway for anti-inflammatorypathway of electroacupuncture Electroacupuncture at thesciatic nerve controls systemic inflammation by inducingvagal activation of aromatic L-amino acid decarboxylase

leading to the production of dopamine in the adrenalmedullaand then the reduction of TNF-120572 [36] By inhibiting the pro-duction of proinflammatory mediators acupuncture mighthelp alleviate facial nerve inflammation and demyelinationand thus promote the repair of the facial nerve to improvesymptoms Overall acupuncturemight have potential benefitfor inflammation in inflammatory and infectious diseasesby regulating the production of proinflammatory mediatorsHowever there is no direct observation to support thatacupuncture could reduce the contents of TNF-120572 IL-6 andIL-1120573 in HSV-1 induced FNP in vivo

42 The Mechanism Underlying Acupuncture to Help ControlHSV-1 Infection

421 Acupuncture Might Help Reduce the Efficiency of HSV-1 Replication and Spread HSV-1 can activate autoimmunepathways including the nuclear factor kappa-light-chain-enhancer of activated B cells (NF-120581B) signaling pathway Evi-dence suggests that HSV-1 can induce a persistent transloca-tion of NF-120581B [37] NF-120581B complexes are bound to inhibitorsof NF-120581B (I120581Bs) in unstimulated cells thereby maintainingNF-120581B in an inactive state The phosphorylation of I120581B bythe I120581B kinase (IKK) complex is involved in the activationof NF-120581B leading to I120581B degradation which releases NF-120581Band then allows it to translocate into the nucleus [38 39]Thepersistent translocation of NF-120581B subsequently increases theefficiency of virus replication [37] The translocation of NF-120581B to the nuclei of infected cells is a necessary componentto prevent apoptosis of host cells during HSV-1 infectionwhich helps HSV-1 evade immunological surveillance andspread effectively in the host [40] Acupuncture can inhibitabnormal NF-120581B expression and activation by inhibiting theNF-120581B signal transduction pathway in host cells [41 42]Thismight help the immunological surveillance and reduce theefficiency of HSV-1 replication and spread However thereis no direct observation to support that acupuncture couldinhibit NF-120581B expression and activation in HSV-1 inducedFNP in vivo which needs to be further studied

422 Acupuncture Might Regulate Immune Response to Elim-inate HSV-1 After HSV-1 infection humoral immunity andcell-mediated immunity will be activated to eliminate HSV-1 In cell-mediated immunity antigen-specific cytotoxic Tlymphocytes a type of T lymphocytes that kill cancer cellsand infected cells are activated to induce apoptosis in virus-infected cells displaying epitopes of foreign antigens on theirsurface Studies regarding the effects of acupuncture on theimmune system show a stimulating effect on cell-mediatedimmunity Acupuncture is able to help in T lymphocyteproliferation [43] After acupuncture T helper lymphocytesa type of T lymphocytes that help in the activity of otherimmune cells and cytotoxic T lymphocytes were significantlyincreased [44 45]The ability of acupuncture tomodulate theimmune response might help the immune system to elimi-nate HSV-1 Therefore acupuncture might have potential tocontrol infection in infectious diseases by activating someimmune pathways and modulating the immune response

Evidence-Based Complementary and Alternative Medicine 5

Table2Detectio

nof

HSV

-1DNAdu

ringtre

atmentp

eriodandatthee

ndof

treatmentp

eriod(119909plusmn119878)

G119873

Atday3of

treatmentp

eriod

Atday7of

treatmentp

eriod

Atday14

oftre

atmentp

eriod

Facialnerve

(2minusCT)

Geniculate

gang

lion

(2minusCT)

Brainstem

(2minusCT)

Cerebral

cortex

(2minusCT)

Facialnerve

(2minusCT)

Geniculate

gang

lion

(2minusCT)

Brainstem

(2minusCT)

Cerebral

cortex

(2minusCT)

Facialnerve

(2minusCT)

Geniculate

gang

lion

(2minusCT)

Brainstem

(2minusCT)

Cerebral

cortex

(2minusCT)

A10

0lowastlowast

0lowastlowast

0lowastlowast

0lowastlowast

0lowastlowast

0lowastlowast

0lowastlowast

0lowastlowast

0lowastlowast

0lowastlowast

0lowastlowast

0lowastlowast

B10

0lowastlowast

0lowastlowast

0lowastlowast

0lowastlowast

0lowastlowast

0lowastlowast

0lowast0lowastlowast

0lowastlowast

0lowastlowast

0lowastlowast

0lowastlowast

C10

1367plusmn216

1182plusmn18

177

3plusmn10

8652plusmn227

1542plusmn271

1418plusmn19

71257plusmn311

652plusmn227

989plusmn14

776

3plusmn12

2677plusmn12

8614plusmn16

3D

1098

4plusmn12

9lowast90

4plusmn229lowast

304plusmn229lowast

217plusmn114lowast

218plusmn213lowastlowast

178plusmn114lowastlowast

104plusmn14

8lowastlowast

217plusmn12

5lowastlowast

071plusmn016lowastlowast

018plusmn021lowastlowast

003plusmn009lowastlowast

005plusmn013lowastlowast

Thequ

antityof

HSV

-1DNAwas

expressedwith

2minusΔΔCT

ofdifferenceratio

ofHSV

-1mRN

AG

roup

Ablank

controlgroup

Group

Bsalin

egrou

pGroup

Cmod

elanim

algrou

pGroup

Delectroacup

uncture

grou

plowastCom

paredwith

Group

C119875lt005lowastlowastCom

paredwith

Group

C119875lt001

6 Evidence-Based Complementary and Alternative Medicine

43The Compatibility of Distal-Proximal Acupoints in Acupu-ncture Treatment for FNP Acupoints compatibility is a keypoint in acupuncture prescriptions which influences thera-peutic effectsThere are many classical acupoints compatibil-itymethods such as yuan-source acupoints and luo-collateralacupoints combination back-shu acupoints and front-muacupoints combination and distal-proximal acupoints com-bination Distal-proximal acupoints combination is oftenused in the treatment of FNP For example Hegu (LI4) inupper extremity and some local acupoints in face are needledin combination Synergistic effects exist among acupointsso acupoint compatibility can strengthen the effectiveness ofacupuncture

The mechanism underlying Hegu (LI4) treating diseasesin the face and mouth remains unclear A morphologicalstudy suggested that the Gasserian ganglion receives theneural projection to Hegu (LI4) [46] Furthermore the nervein Hegu (LI4) has an indirect project to the nucleus of thesolitary tract and the facial nerve has a direct connectionwiththe nucleus of the solitary tract [47] This might be the mor-phological foundation of Hegu (LI4) treating diseases in theface and mouth As to Jiache (ST6) this acupoint is locatednear the subbuccal and marginal mandibular branches of thefacial nerve which provides themorphological foundation toalleviate symptoms of FNP [48] The combination of Hegu(LI4) and Jiache (ST6) stimulates more peripheral nervescompared with needling a single acupoint of them

5 Limitations

There are some limitations of this study Although the mod-eling method in this study is more consistent with the naturalpathogenesis of FNP the model rate is relatively lower thanthat of compressing the facial nerve Additionally this studyshows the potential of acupuncture in triggering a patientrsquosimmunoreaction to further reduce HSV-1 quantity Howeverthis study is insufficient to fully elucidate the mechanismof acupuncture in reducing HSV-1 quantity Future studiesmight be directed toward elucidating this mechanism suchas the relationship between acupuncture and NF-120581B in FNPin vivo

6 Conclusions

Weconcluded that in the treatment for FNP electroacupunc-ture alleviates symptoms facilitates affected nerve recoveryand promotes the reduction in HSV-1 Acupuncture mighthave therapeutic advantages in controlling inflammation andinfection in FNP

Conflict of Interests

The authors declare no conflict of interests

Authorsrsquo Contribution

Hongzhi Tang and Shuwei Feng contributed equally to thework

Acknowledgments

This study was supported by the National Basic ResearchProgram of China (no 2012CB518501) and the ResearchFund for the Doctoral Program of Higher Education (no20105132110003)

References

[1] J Finsterer ldquoManagement of peripheral facial nerve palsyrdquoEuropean Archives of Oto-Rhino-Laryngology vol 265 no 7 pp743ndash752 2008

[2] H C Slavkin ldquoThe significance of a human smile observationson Bellrsquos palsyrdquo Journal of the American Dental Association vol130 no 2 pp 269ndash272 1999

[3] M Shaw F Nazir and I Bone ldquoBellrsquos palsy a study of thetreatment advice given by neurologistsrdquo Journal of NeurologyNeurosurgery and Psychiatry vol 76 no 2 pp 293ndash294 2005

[4] N J Holland and G M Weiner ldquoRecent developments in Bellrsquospalsyrdquo British Medical Journal vol 329 no 7474 pp 553ndash5572004

[5] A G Marson and R Salinas ldquoBellrsquos palsyrdquo Western Journal ofMedicine vol 173 no 4 pp 266ndash268 2000

[6] N A Brandenburg and J F Annegers ldquoIncidence and riskfactors for Bellrsquos palsy in Laredo Texas 1974ndash1982rdquo Neuroepi-demiology vol 12 no 6 pp 313ndash325 1993

[7] Q D Yang Neurology Peoplersquos Medical Publishing HouseBeijing China 2002

[8] C A J Prescott ldquoIdiopathic facial nerve palsyrdquo Journal ofLaryngology and Otology vol 102 no 5 pp 403ndash407 1988

[9] B Lorber ldquoAre all diseases infectiousrdquo Annals of InternalMedicine vol 125 no 10 pp 844ndash851 1996

[10] C Atzema and R D Goldman ldquoShould we use steroids to treatchildren with Bellrsquos palsyrdquo Canadian Family Physician vol 52pp 313ndash314 2006

[11] S Axelsson S Lindberg and A Stjernquist-Desatnik ldquoOut-come of treatment with valacyclovir and prednisone in patientswith Bellrsquos palsyrdquoAnnals of Otology Rhinology and Laryngologyvol 112 no 3 pp 197ndash201 2003

[12] J Schirm and P S J ZMulkens ldquoBellrsquos palsy and herpes simplesvirusrdquo Acta Pathologica Microbiologica et Immunologica Scan-dinavica vol 105 no 7ndash12 pp 815ndash823 1997

[13] K K Adour J M Ruboyianes P G von Doersten et al ldquoBellrsquospalsy treatment with acyclovir and prednisone compared withprednisone alone a double-blind randomized controlled trialrdquoAnnals of Otology Rhinology and Laryngology vol 105 no 5 pp371ndash378 1996

[14] S Murakami M Mizobuchi Y Nakashiro T Doi N Hatoand N Yanagihara ldquoBellrsquos palsy and herpes simplex virusidentification of viral DNA in endoneurial fluid and musclerdquoAnnals of Internal Medicine vol 124 no 1 part 1 pp 27ndash301996

[15] Y Furuta S Fukuda S Chida et al ldquoReactivation of herpessimplex virus type 1 in patients with Bellrsquos palsyrdquo Journal ofMedical Virology vol 54 pp 162ndash166 1998

[16] C G Jackson and P G von Doersten ldquoThe facial nerve currenttrends in diagnosis treatment and rehabilitationrdquo MedicalClinics of North America vol 83 no 1 pp 179ndash195 1999

[17] K K Adour ldquoOtological complications of herpes zosterrdquoNeurology vol 35 no 1 pp S62ndashS64 1994

Evidence-Based Complementary and Alternative Medicine 7

[18] N Hato H Yamada H Kohno et al ldquoValacyclovir and pred-nisolone treatment for Bellrsquos palsy amulticenter randomizedplacebo-controlled studyrdquoOtology ampNeurotology vol 28 no 3pp 408ndash413 2007

[19] K Kawaguchi H Inamura Y Abe et al ldquoReactivation ofherpes simplex virus type 1 and varicella-zoster virus andtherapeutic effects of combination therapy with prednisoloneand valacyclovir in patients with Bellrsquos palsyrdquoThe Laryngoscopevol 117 no 1 pp 147ndash156 2007

[20] F R Liang Y Li S G Yu et al ldquoA multicentral randomizedcontrol study on clinical acupuncture treatment of Bellrsquos palsyrdquoJournal of Traditional Chinese Medicine vol 26 no 1 pp 3ndash72006

[21] Y Qu ldquoClinical observation on acupuncture by stages com-bined with exercise therapy for treatment of Bell palsy at acutestagerdquo Chinese Acupuncture and Moxibustion vol 25 no 8 pp545ndash547 2005

[22] Y Li F R Liang S G Yu et al ldquoEfficacy of acupuncture andmoxibustion in treating Bellrsquos palsy a multicenter randomizedcontrolled trial in Chinardquo Chinese Medical Journal vol 117 no10 pp 1502ndash1506 2004

[23] H Takahashi N Hato N Honda et al ldquoEffects of acyclovir onfacial nerve paralysis induced by herpes simplex virus type 1 inmicerdquo Auris Nasus Larynx vol 30 no 1 pp 1ndash5 2003

[24] N Honda N Hato H Takahashi et al ldquoPathophysiology offacial nerve paralysis induced by herpes simplex virus type 1infectionrdquo Annals of Otology Rhinology and Laryngology vol111 no 7 pp 616ndash622 2002

[25] T Sugita S Murakami N Yanagihara Y Fujiwara Y HirataandTKurata ldquoFacial nerve paralysis induced by herpes simplexvirus in mice an animal model of acute and transient facialparalysisrdquo Annals of Otology Rhinology and Laryngology vol104 no 7 pp 574ndash581 1995

[26] S Murakami N Hato M Mizobuchi T Doi and N Yanagi-hara ldquoRole of herpes simplex virus infection in the pathogenesisof facial paralysis in micerdquo Annals of Otology Rhinology andLaryngology vol 105 no 1 pp 49ndash53 1996

[27] H Takahashi Y Hitsumoto N Honda et al ldquoMouse model ofBellrsquos palsy induced by reactivation of herpes simplex virus type1rdquo Journal of Neuropathology and Experimental Neurology vol60 no 6 pp 621ndash627 2001

[28] S G Yu and Y Guo Experimental Acupuncture ShanghaiScience and Technology Press Shanghai China 2009

[29] A Greco A GalloM Fusconi CMarinelli G FMacri andMde Vincentiis ldquoBellrsquos palsy and autoimmunityrdquo AutoimmunityReviews vol 12 no 2 pp 323ndash328 2012

[30] M Yilmaz M Tarakcioglu N Bayazit Y A Bayazit MNamiduru and M Kanlikama ldquoSerum cytokine levels in bellrsquospalsyrdquo Journal of the Neurological Sciences vol 197 no 1-2 pp69ndash72 2002

[31] M Apostolaki M Armaka P Victoratos and G Kollias ldquoCel-lular mechanisms of TNF function in models of inflammationand autoimmunityrdquoCurrent Directions in Autoimmunity vol 11pp 1ndash26 2010

[32] C Larsson C Bernstrom-Lundberg S Edstrom and TBergstrom ldquoTumor necrosis factor-120572 response and herpesvirusinfection in Bellrsquos palsyrdquo The Laryngoscope vol 108 no 8 part1 pp 1171ndash1176 1998

[33] A V Delgado A T McManus and J P Chambers ldquoProductionof tumor necrosis factor-120572 interleukin 1-120573 interleukin 2 andinterleukin 6 by rat leukocyte subpopulations after exposure tosubstance Prdquo Neuropeptides vol 37 no 6 pp 355ndash361 2003

[34] H J Jeong S H Hong Y C Nam et al ldquoThe effect of acupunc-ture on proinflammatory cytokine production in patients withchronic headache a preliminary reportrdquoThe American Journalof Chinese Medicine vol 31 no 6 pp 945ndash954 2003

[35] Y S Son H J Park O B Kwon S Jung H Shin and S LimldquoAntipyretic effects of acupuncture on the lipopolysaccharide-induced fever and expression of interleukin-6 and interleukin-1120573 mRNAs in the hypothalamus of ratsrdquo Neuroscience Lettersvol 319 no 1 pp 45ndash48 2002

[36] R Torres-Rosas G Yehia G Pena et al ldquoDopamine mediatesvagal modulation of the immune system by electroacupunc-turerdquo Nature Medicine vol 20 no 3 pp 291ndash295 2014

[37] A Patel J Hanson T I McLean et al ldquoHerpes simplex virustype 1 induction of persistent NF-kappaB nuclear translocationincreases the efficiency of virus replicationrdquo Virology vol 247no 2 pp 212ndash222 1998

[38] M S Hayden and S Ghosh ldquoSignaling to NF-kappaBrdquoGenes ampDevelopment vol 18 no 18 pp 2195ndash2224 2004

[39] N D Perkins ldquoIntegrating cell-signalling pathways with NF-kappaB and IKK functionrdquo Nature Reviews Molecular CellBiology vol 8 no 1 pp 49ndash62 2007

[40] M L Goodkin A T Ting and J A Blaho ldquoNF-kappaB isrequired for apoptosis prevention during herpes simplex virustype 1 infectionrdquo Journal of Virology vol 77 no 13 pp 7261ndash7280 2003

[41] X R Zhang XWang C L Sun et al ldquoExpression of NF- KB inspinal ganglia of CIA rats and therapeutic action of acupunctureJiaji pointsrdquo Modern Journal of Integrated Traditional Chineseand Western Medicine vol 16 no 11 pp 1460ndash1462 2007

[42] L Zhou H X Zhang Q Wang et al ldquoEffect of scalp acupunc-ture on the expression of NF-JB mRNA COX-2 mRNA andtheir proteins in rats with acute cerebral ischemia-reperfusioninjuryrdquo Acupuncture Research vol 34 no 5 pp 304ndash308 2009

[43] M Bianchi E Jotti P Sacerdote and A E Panerai ldquoTraditionalacupuncture increases the content of 120573-endorphin in immunecells and influences mitogen induced proliferationrdquoThe Ameri-can Journal of Chinese Medicine vol 19 no 2 pp 101ndash104 1991

[44] F Petti A Bangrazi A Liguori G Reale and F Ippoliti ldquoEffectsof acupuncture on immune response related to opioid-likepeptidesrdquo Journal of Traditional Chinese Medicine vol 18 no1 pp 55ndash63 1998

[45] BWu ldquoEffect of acupuncture on the regulation of cell-mediatedimmunity in the patients with malignant tumorsrdquo AcupunctureResearch vol 20 no 3 pp 67ndash71 1995

[46] X H Jing H Cai B Lu et al ldquoStudy on morphologicalfoundation of point LI 4 treating diseases in the face andmouthrdquo Chinese Acupuncture and Moxibustion vol 23 no 2pp 109ndash110 2003

[47] S l Chen Z G Jin X H Jing et al ldquoMorphological study onthe afferent pathways of ldquoHegurdquo point and mouth-face regionrdquoAcupuncture Research vol 29 no 3 pp 217ndash221 2004

[48] Z Xu ldquoAnatomic basis for the treatment of facial paralysis bydicang-through-jiache acupuncturerdquo Shanghai Journal of Acu-Mox vol 27 no 4 pp 35ndash37 2008

Submit your manuscripts athttpwwwhindawicom

Stem CellsInternational

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

MEDIATORSINFLAMMATION

of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Behavioural Neurology

EndocrinologyInternational Journal of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Disease Markers

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

BioMed Research International

OncologyJournal of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Oxidative Medicine and Cellular Longevity

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PPAR Research

The Scientific World JournalHindawi Publishing Corporation httpwwwhindawicom Volume 2014

Immunology ResearchHindawi Publishing Corporationhttpwwwhindawicom Volume 2014

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ObesityJournal of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Computational and Mathematical Methods in Medicine

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Research and TreatmentAIDS

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Gastroenterology Research and Practice

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Parkinsonrsquos Disease

Evidence-Based Complementary and Alternative Medicine

Volume 2014Hindawi Publishing Corporationhttpwwwhindawicom

Evidence-Based Complementary and Alternative Medicine 3

Table 1 Scores in evaluation of FNP during treatment period and at the end of treatment period (119909 plusmn 119878)

Group 119873 At day 3 of treatment period At day 7 of treatment period At day 14 of treatment periodBlinkreflex

Vibrissaemovement

Position ofapex nasi

Blinkreflex

Vibrissaemovement

Position ofapex nasi

Blinkreflex

Vibrissaemovement

Position ofapex nasi

A 10 0lowastlowast 0lowastlowast 0lowastlowast 0lowastlowast 0lowastlowast 0lowastlowast 0lowastlowast 0lowastlowast 0lowastlowast

B 10 0lowastlowast 0lowastlowast 0lowastlowast 0lowastlowast 0lowastlowast 0lowastlowast 0lowastlowast 0lowastlowast 0lowastlowast

C 10 15 plusmn 31 17 plusmn 28 9 plusmn 18 12 plusmn 25 11 plusmn 17 7 plusmn 19 7 plusmn 18 8 plusmn 24 5 plusmn 16D 10 7 plusmn 24lowast 8 plusmn 19lowast 3 plusmn 22lowast 4 plusmn 16lowastlowast 5 plusmn 19lowastlowast 3 plusmn 14lowastlowast 1 plusmn 21lowast 2 plusmn 10lowast 0 plusmn 00lowast

Group A blank control group Group B saline group Group C model animal group Group D electroacupuncture group lowastCompared with Group C 119875 lt005 lowastlowastCompared with Group C 119875 lt 001

was removed and the absorbing column was put back intothe same collection tube After that 500120583L deproteinizedsolution and 700120583L and 500 120583L eluent GW were addedconsecutively and the sample was centrifuged at 9660 g for30 sec after each addition Waste liquid in the collection tubewas removed and the absorbing columnwas put back into thesame collection tube and centrifuged at 9660 g for 2min toremove residual liquid The CB 3 absorbing column was putin a clean centrifugal tube of 15mL and incubated at roomtemperature for 25min Buffer TE of 50 120583L was added to theadsorption film in the center of the absorbing column Thesample was incubated at 60∘C for 25min and centrifuged at9660 g for 2min

262 Reverse Transcription PCR of HSV-1 DNA Syntheticprimers encoding parts of the HSV-1 (51015840-CCACCGAGC-GGCAGGTGATC-31015840 as upstream primer and 51015840-GCC-GACCGCCTGCTCGTGCT-31015840 as downstream primer) andthe 120573-actin gene (51015840-CGTTGACATCCGTAAAGACCTC-31015840as upstream primer and 51015840-TAGGAGCCAGGGCAGTAA-TCT-31015840 as downstream primer) were used for PCR ampli-fication After an instantaneous centrifugation of primersdeionized water was added to make a 100 120583M solutionDeionized water of 380 120583Lwas added in another EP tube and10 120583L upstream primers and 10120583L downstream primers wereadded (400 120583L and 25 pmol120583L) Deionized water was addedto dilute cDNA to a proper concentration The extractedDNA and primers were denatured initially Forty cycles ofamplification (15 sec at 95∘C for denaturation 15 sec at 95∘Cfor renaturation 45 sec at 72∘C for extension)were performedand the sample was extended at 72∘C for 5min and incubatedat 4∘C To test the amplification efficiency and specificity ofprimers standard curves andmelting curves weremade PCRsolution of 24120583L wasmade with 125 120583L SYBR Premix Ex Taq(2times) 05 120583L PCR forward primer (10 120583M) 05 120583L PCR reverseprimer (10120583M) 3 120583L template cDNA and 85 120583L dH

2O and

incubated in a real-time PCR tube Gradient dilution of 2120583Lfor cDNA was added Forty cycles of amplification (15 sec at95∘C for denaturation 15 sec at 95∘C for renaturation 45 secat 72∘C for extension) were performed and the sample wasextended at 72∘C for 5min Fluorescence data for meltingcurve was acquired every 05∘C during a temperature tran-sition from 58∘C to 85∘C Fluorescence quantitative standardcurvewasmade Real-time PCRwere run in triplicate Briefly

mRNA was corrected with 120573-actin via CT (the cycle atthreshold level) The relative mRNA expression of HSV-1120573-actin was quantified according to the formula of 2minusΔΔCTAnalysis of CT was performed using Sequence Detectionsoftware version 123 (Applied Biosystems group)

27 Statistical Analysis All analyses were carried out usingthe Statistical Package for the Social Sciences version 170(SPSS Chicago IL USA) Descriptive statistics including themean plusmn standard deviation (SD) median minimum (min)and maximum (max) were used to present continuous vari-ables One-way analysis of variance (ANOVA) was used todetermine statistically significant differences between groupsof variables with data that were normally distributed Theleast-significant difference (LSD) test was used for homo-geneity of variance whereas Tamhanersquos T2 test was usedfor heterogeneity of variance Hierarchical data was testedwith the nonparametric test to determine differences betweengroups 119875 lt 005 was considered statistically significant

3 Results

31 Results of Melting Curve TheHSV-1 melting curve had asingle peak melting at 85 plusmn 1∘CThis step was replicated sev-eral times The amplified product was the intended product

32 Symptom Relief of Acute Viral FNP Mice Mice in theblank control group and saline group showed no symptomsof FNP and the score for each item in these two groups was 0The scores of blink reflex vibrissae movement and positionof apex nasi in the model animal group and electroacupunc-ture group decreased over time However the scores in theelectroacupuncture group decreasedmore rapidlyThe scoresof blink reflex vibrissae movement and position of apex nasiin the electroacupuncture groupwere significantly lower thanthose in model animal group (119875 lt 005 at day 3 119875 lt 001at day 7 and 119875 lt 005 at day 14 of treatment period) Thedifferences in FNP symptoms among all groups are shown inTable 1

33 Quantity of HSV-1 DNA NoHSV-1 DNAwas detected ineither saline group or blank control group mice HSV-1 DNAwas detected in the model animal group and electroacupunc-ture group However the quantity of HSV-1 was significantly

4 Evidence-Based Complementary and Alternative Medicine

lower in the electroacupuncture group compared with themodel animal group (119875 lt 005 at day 3 119875 lt 001 at days7 and 14 of treatment period) as shown in Table 2 At day7 of treatment period HSV-1 DNA was decreasing in theelectroacupuncture group while HSV-1 DNAwas still highercompared with 4 days prior in themodel animal group HSV-1 DNA in the model animal group was decreasing at day 14 oftreatment period

4 Discussion

The blink reflex score vibrissae movement score position ofapex nasi score and total score were significantly higher inthe electroacupuncture and model animal group than thosein saline and blank control group after modeling whichindicated that the FNP mice model was successfully inducedby inoculation of HSV-1With the development of FNP somefacial nerve function recovered and HSV-1 DNA contentalso decreased in the model animal group These resultsreflect the disease progression of FNP Facial nerve functionrecoveredmore quickly in the electroacupuncture groupThesymptom relief after acupuncture is consistent with clinicaltrials evaluating the therapeutic effects of acupuncture forFNP [20ndash22] In addition HSV-1 DNA quantity in theelectroacupuncture group was significantly lower than thatin model animal group at day 3 At day 7 HSV-1 DNAquantity in the electroacupuncture group was decreasingwhile HSV-1 DNA quantity in the model animal group wasstill higher compared with 4 days priorThese results indicatethat electroacupuncture has therapeutic effects on FNP andpromotes the reduction in HSV-1

41 The Mechanism Underlying Acupuncture to AlleviateFNP Symptoms It has been suggested that the cell-mediatedautoimmunemechanism against myelin basic proteinmay bethe pathogenesis of FNP FNP is an autoimmune demyelinat-ing cranial neuritis and in most instances it is a mononeu-ritic variant of Guillain-Barre syndrome a neurologic diseasewith cell-mediated autoimmune reaction against peripheralnerve myelin antigens In FNP viral infection or the reactiva-tion of a latent virus may provoke an autoimmune reactionagainst peripheral nerve myelin components leading toinflammation and demyelination of the facial nerve [29]During its progression FNP is accompanied by significantelevations in some proinflammatory mediators includingtumor necrosis factor alpha (TNF-120572) interleukin-6 (IL-6)and interleukin-1 beta (IL-1120573) [30] TNF-120572 IL-6 and IL-1120573 are linked with a wide range of inflammatory infectiousautoimmune and malignant conditions [31] The abnormalhigh level of serum TNF-120572 also causes demyelination ofthe facial nerve via inflammation [32 33] Acupuncturesignificantly reduces plasma levels of TNF-120572 in patients withchronic headache [34] and mRNA levels of IL-6 and IL-1120573in rats of lipopolysaccharide-induced fever [35] A recentlypublished study found a new pathway for anti-inflammatorypathway of electroacupuncture Electroacupuncture at thesciatic nerve controls systemic inflammation by inducingvagal activation of aromatic L-amino acid decarboxylase

leading to the production of dopamine in the adrenalmedullaand then the reduction of TNF-120572 [36] By inhibiting the pro-duction of proinflammatory mediators acupuncture mighthelp alleviate facial nerve inflammation and demyelinationand thus promote the repair of the facial nerve to improvesymptoms Overall acupuncturemight have potential benefitfor inflammation in inflammatory and infectious diseasesby regulating the production of proinflammatory mediatorsHowever there is no direct observation to support thatacupuncture could reduce the contents of TNF-120572 IL-6 andIL-1120573 in HSV-1 induced FNP in vivo

42 The Mechanism Underlying Acupuncture to Help ControlHSV-1 Infection

421 Acupuncture Might Help Reduce the Efficiency of HSV-1 Replication and Spread HSV-1 can activate autoimmunepathways including the nuclear factor kappa-light-chain-enhancer of activated B cells (NF-120581B) signaling pathway Evi-dence suggests that HSV-1 can induce a persistent transloca-tion of NF-120581B [37] NF-120581B complexes are bound to inhibitorsof NF-120581B (I120581Bs) in unstimulated cells thereby maintainingNF-120581B in an inactive state The phosphorylation of I120581B bythe I120581B kinase (IKK) complex is involved in the activationof NF-120581B leading to I120581B degradation which releases NF-120581Band then allows it to translocate into the nucleus [38 39]Thepersistent translocation of NF-120581B subsequently increases theefficiency of virus replication [37] The translocation of NF-120581B to the nuclei of infected cells is a necessary componentto prevent apoptosis of host cells during HSV-1 infectionwhich helps HSV-1 evade immunological surveillance andspread effectively in the host [40] Acupuncture can inhibitabnormal NF-120581B expression and activation by inhibiting theNF-120581B signal transduction pathway in host cells [41 42]Thismight help the immunological surveillance and reduce theefficiency of HSV-1 replication and spread However thereis no direct observation to support that acupuncture couldinhibit NF-120581B expression and activation in HSV-1 inducedFNP in vivo which needs to be further studied

422 Acupuncture Might Regulate Immune Response to Elim-inate HSV-1 After HSV-1 infection humoral immunity andcell-mediated immunity will be activated to eliminate HSV-1 In cell-mediated immunity antigen-specific cytotoxic Tlymphocytes a type of T lymphocytes that kill cancer cellsand infected cells are activated to induce apoptosis in virus-infected cells displaying epitopes of foreign antigens on theirsurface Studies regarding the effects of acupuncture on theimmune system show a stimulating effect on cell-mediatedimmunity Acupuncture is able to help in T lymphocyteproliferation [43] After acupuncture T helper lymphocytesa type of T lymphocytes that help in the activity of otherimmune cells and cytotoxic T lymphocytes were significantlyincreased [44 45]The ability of acupuncture tomodulate theimmune response might help the immune system to elimi-nate HSV-1 Therefore acupuncture might have potential tocontrol infection in infectious diseases by activating someimmune pathways and modulating the immune response

Evidence-Based Complementary and Alternative Medicine 5

Table2Detectio

nof

HSV

-1DNAdu

ringtre

atmentp

eriodandatthee

ndof

treatmentp

eriod(119909plusmn119878)

G119873

Atday3of

treatmentp

eriod

Atday7of

treatmentp

eriod

Atday14

oftre

atmentp

eriod

Facialnerve

(2minusCT)

Geniculate

gang

lion

(2minusCT)

Brainstem

(2minusCT)

Cerebral

cortex

(2minusCT)

Facialnerve

(2minusCT)

Geniculate

gang

lion

(2minusCT)

Brainstem

(2minusCT)

Cerebral

cortex

(2minusCT)

Facialnerve

(2minusCT)

Geniculate

gang

lion

(2minusCT)

Brainstem

(2minusCT)

Cerebral

cortex

(2minusCT)

A10

0lowastlowast

0lowastlowast

0lowastlowast

0lowastlowast

0lowastlowast

0lowastlowast

0lowastlowast

0lowastlowast

0lowastlowast

0lowastlowast

0lowastlowast

0lowastlowast

B10

0lowastlowast

0lowastlowast

0lowastlowast

0lowastlowast

0lowastlowast

0lowastlowast

0lowast0lowastlowast

0lowastlowast

0lowastlowast

0lowastlowast

0lowastlowast

C10

1367plusmn216

1182plusmn18

177

3plusmn10

8652plusmn227

1542plusmn271

1418plusmn19

71257plusmn311

652plusmn227

989plusmn14

776

3plusmn12

2677plusmn12

8614plusmn16

3D

1098

4plusmn12

9lowast90

4plusmn229lowast

304plusmn229lowast

217plusmn114lowast

218plusmn213lowastlowast

178plusmn114lowastlowast

104plusmn14

8lowastlowast

217plusmn12

5lowastlowast

071plusmn016lowastlowast

018plusmn021lowastlowast

003plusmn009lowastlowast

005plusmn013lowastlowast

Thequ

antityof

HSV

-1DNAwas

expressedwith

2minusΔΔCT

ofdifferenceratio

ofHSV

-1mRN

AG

roup

Ablank

controlgroup

Group

Bsalin

egrou

pGroup

Cmod

elanim

algrou

pGroup

Delectroacup

uncture

grou

plowastCom

paredwith

Group

C119875lt005lowastlowastCom

paredwith

Group

C119875lt001

6 Evidence-Based Complementary and Alternative Medicine

43The Compatibility of Distal-Proximal Acupoints in Acupu-ncture Treatment for FNP Acupoints compatibility is a keypoint in acupuncture prescriptions which influences thera-peutic effectsThere are many classical acupoints compatibil-itymethods such as yuan-source acupoints and luo-collateralacupoints combination back-shu acupoints and front-muacupoints combination and distal-proximal acupoints com-bination Distal-proximal acupoints combination is oftenused in the treatment of FNP For example Hegu (LI4) inupper extremity and some local acupoints in face are needledin combination Synergistic effects exist among acupointsso acupoint compatibility can strengthen the effectiveness ofacupuncture

The mechanism underlying Hegu (LI4) treating diseasesin the face and mouth remains unclear A morphologicalstudy suggested that the Gasserian ganglion receives theneural projection to Hegu (LI4) [46] Furthermore the nervein Hegu (LI4) has an indirect project to the nucleus of thesolitary tract and the facial nerve has a direct connectionwiththe nucleus of the solitary tract [47] This might be the mor-phological foundation of Hegu (LI4) treating diseases in theface and mouth As to Jiache (ST6) this acupoint is locatednear the subbuccal and marginal mandibular branches of thefacial nerve which provides themorphological foundation toalleviate symptoms of FNP [48] The combination of Hegu(LI4) and Jiache (ST6) stimulates more peripheral nervescompared with needling a single acupoint of them

5 Limitations

There are some limitations of this study Although the mod-eling method in this study is more consistent with the naturalpathogenesis of FNP the model rate is relatively lower thanthat of compressing the facial nerve Additionally this studyshows the potential of acupuncture in triggering a patientrsquosimmunoreaction to further reduce HSV-1 quantity Howeverthis study is insufficient to fully elucidate the mechanismof acupuncture in reducing HSV-1 quantity Future studiesmight be directed toward elucidating this mechanism suchas the relationship between acupuncture and NF-120581B in FNPin vivo

6 Conclusions

Weconcluded that in the treatment for FNP electroacupunc-ture alleviates symptoms facilitates affected nerve recoveryand promotes the reduction in HSV-1 Acupuncture mighthave therapeutic advantages in controlling inflammation andinfection in FNP

Conflict of Interests

The authors declare no conflict of interests

Authorsrsquo Contribution

Hongzhi Tang and Shuwei Feng contributed equally to thework

Acknowledgments

This study was supported by the National Basic ResearchProgram of China (no 2012CB518501) and the ResearchFund for the Doctoral Program of Higher Education (no20105132110003)

References

[1] J Finsterer ldquoManagement of peripheral facial nerve palsyrdquoEuropean Archives of Oto-Rhino-Laryngology vol 265 no 7 pp743ndash752 2008

[2] H C Slavkin ldquoThe significance of a human smile observationson Bellrsquos palsyrdquo Journal of the American Dental Association vol130 no 2 pp 269ndash272 1999

[3] M Shaw F Nazir and I Bone ldquoBellrsquos palsy a study of thetreatment advice given by neurologistsrdquo Journal of NeurologyNeurosurgery and Psychiatry vol 76 no 2 pp 293ndash294 2005

[4] N J Holland and G M Weiner ldquoRecent developments in Bellrsquospalsyrdquo British Medical Journal vol 329 no 7474 pp 553ndash5572004

[5] A G Marson and R Salinas ldquoBellrsquos palsyrdquo Western Journal ofMedicine vol 173 no 4 pp 266ndash268 2000

[6] N A Brandenburg and J F Annegers ldquoIncidence and riskfactors for Bellrsquos palsy in Laredo Texas 1974ndash1982rdquo Neuroepi-demiology vol 12 no 6 pp 313ndash325 1993

[7] Q D Yang Neurology Peoplersquos Medical Publishing HouseBeijing China 2002

[8] C A J Prescott ldquoIdiopathic facial nerve palsyrdquo Journal ofLaryngology and Otology vol 102 no 5 pp 403ndash407 1988

[9] B Lorber ldquoAre all diseases infectiousrdquo Annals of InternalMedicine vol 125 no 10 pp 844ndash851 1996

[10] C Atzema and R D Goldman ldquoShould we use steroids to treatchildren with Bellrsquos palsyrdquo Canadian Family Physician vol 52pp 313ndash314 2006

[11] S Axelsson S Lindberg and A Stjernquist-Desatnik ldquoOut-come of treatment with valacyclovir and prednisone in patientswith Bellrsquos palsyrdquoAnnals of Otology Rhinology and Laryngologyvol 112 no 3 pp 197ndash201 2003

[12] J Schirm and P S J ZMulkens ldquoBellrsquos palsy and herpes simplesvirusrdquo Acta Pathologica Microbiologica et Immunologica Scan-dinavica vol 105 no 7ndash12 pp 815ndash823 1997

[13] K K Adour J M Ruboyianes P G von Doersten et al ldquoBellrsquospalsy treatment with acyclovir and prednisone compared withprednisone alone a double-blind randomized controlled trialrdquoAnnals of Otology Rhinology and Laryngology vol 105 no 5 pp371ndash378 1996

[14] S Murakami M Mizobuchi Y Nakashiro T Doi N Hatoand N Yanagihara ldquoBellrsquos palsy and herpes simplex virusidentification of viral DNA in endoneurial fluid and musclerdquoAnnals of Internal Medicine vol 124 no 1 part 1 pp 27ndash301996

[15] Y Furuta S Fukuda S Chida et al ldquoReactivation of herpessimplex virus type 1 in patients with Bellrsquos palsyrdquo Journal ofMedical Virology vol 54 pp 162ndash166 1998

[16] C G Jackson and P G von Doersten ldquoThe facial nerve currenttrends in diagnosis treatment and rehabilitationrdquo MedicalClinics of North America vol 83 no 1 pp 179ndash195 1999

[17] K K Adour ldquoOtological complications of herpes zosterrdquoNeurology vol 35 no 1 pp S62ndashS64 1994

Evidence-Based Complementary and Alternative Medicine 7

[18] N Hato H Yamada H Kohno et al ldquoValacyclovir and pred-nisolone treatment for Bellrsquos palsy amulticenter randomizedplacebo-controlled studyrdquoOtology ampNeurotology vol 28 no 3pp 408ndash413 2007

[19] K Kawaguchi H Inamura Y Abe et al ldquoReactivation ofherpes simplex virus type 1 and varicella-zoster virus andtherapeutic effects of combination therapy with prednisoloneand valacyclovir in patients with Bellrsquos palsyrdquoThe Laryngoscopevol 117 no 1 pp 147ndash156 2007

[20] F R Liang Y Li S G Yu et al ldquoA multicentral randomizedcontrol study on clinical acupuncture treatment of Bellrsquos palsyrdquoJournal of Traditional Chinese Medicine vol 26 no 1 pp 3ndash72006

[21] Y Qu ldquoClinical observation on acupuncture by stages com-bined with exercise therapy for treatment of Bell palsy at acutestagerdquo Chinese Acupuncture and Moxibustion vol 25 no 8 pp545ndash547 2005

[22] Y Li F R Liang S G Yu et al ldquoEfficacy of acupuncture andmoxibustion in treating Bellrsquos palsy a multicenter randomizedcontrolled trial in Chinardquo Chinese Medical Journal vol 117 no10 pp 1502ndash1506 2004

[23] H Takahashi N Hato N Honda et al ldquoEffects of acyclovir onfacial nerve paralysis induced by herpes simplex virus type 1 inmicerdquo Auris Nasus Larynx vol 30 no 1 pp 1ndash5 2003

[24] N Honda N Hato H Takahashi et al ldquoPathophysiology offacial nerve paralysis induced by herpes simplex virus type 1infectionrdquo Annals of Otology Rhinology and Laryngology vol111 no 7 pp 616ndash622 2002

[25] T Sugita S Murakami N Yanagihara Y Fujiwara Y HirataandTKurata ldquoFacial nerve paralysis induced by herpes simplexvirus in mice an animal model of acute and transient facialparalysisrdquo Annals of Otology Rhinology and Laryngology vol104 no 7 pp 574ndash581 1995

[26] S Murakami N Hato M Mizobuchi T Doi and N Yanagi-hara ldquoRole of herpes simplex virus infection in the pathogenesisof facial paralysis in micerdquo Annals of Otology Rhinology andLaryngology vol 105 no 1 pp 49ndash53 1996

[27] H Takahashi Y Hitsumoto N Honda et al ldquoMouse model ofBellrsquos palsy induced by reactivation of herpes simplex virus type1rdquo Journal of Neuropathology and Experimental Neurology vol60 no 6 pp 621ndash627 2001

[28] S G Yu and Y Guo Experimental Acupuncture ShanghaiScience and Technology Press Shanghai China 2009

[29] A Greco A GalloM Fusconi CMarinelli G FMacri andMde Vincentiis ldquoBellrsquos palsy and autoimmunityrdquo AutoimmunityReviews vol 12 no 2 pp 323ndash328 2012

[30] M Yilmaz M Tarakcioglu N Bayazit Y A Bayazit MNamiduru and M Kanlikama ldquoSerum cytokine levels in bellrsquospalsyrdquo Journal of the Neurological Sciences vol 197 no 1-2 pp69ndash72 2002

[31] M Apostolaki M Armaka P Victoratos and G Kollias ldquoCel-lular mechanisms of TNF function in models of inflammationand autoimmunityrdquoCurrent Directions in Autoimmunity vol 11pp 1ndash26 2010

[32] C Larsson C Bernstrom-Lundberg S Edstrom and TBergstrom ldquoTumor necrosis factor-120572 response and herpesvirusinfection in Bellrsquos palsyrdquo The Laryngoscope vol 108 no 8 part1 pp 1171ndash1176 1998

[33] A V Delgado A T McManus and J P Chambers ldquoProductionof tumor necrosis factor-120572 interleukin 1-120573 interleukin 2 andinterleukin 6 by rat leukocyte subpopulations after exposure tosubstance Prdquo Neuropeptides vol 37 no 6 pp 355ndash361 2003

[34] H J Jeong S H Hong Y C Nam et al ldquoThe effect of acupunc-ture on proinflammatory cytokine production in patients withchronic headache a preliminary reportrdquoThe American Journalof Chinese Medicine vol 31 no 6 pp 945ndash954 2003

[35] Y S Son H J Park O B Kwon S Jung H Shin and S LimldquoAntipyretic effects of acupuncture on the lipopolysaccharide-induced fever and expression of interleukin-6 and interleukin-1120573 mRNAs in the hypothalamus of ratsrdquo Neuroscience Lettersvol 319 no 1 pp 45ndash48 2002

[36] R Torres-Rosas G Yehia G Pena et al ldquoDopamine mediatesvagal modulation of the immune system by electroacupunc-turerdquo Nature Medicine vol 20 no 3 pp 291ndash295 2014

[37] A Patel J Hanson T I McLean et al ldquoHerpes simplex virustype 1 induction of persistent NF-kappaB nuclear translocationincreases the efficiency of virus replicationrdquo Virology vol 247no 2 pp 212ndash222 1998

[38] M S Hayden and S Ghosh ldquoSignaling to NF-kappaBrdquoGenes ampDevelopment vol 18 no 18 pp 2195ndash2224 2004

[39] N D Perkins ldquoIntegrating cell-signalling pathways with NF-kappaB and IKK functionrdquo Nature Reviews Molecular CellBiology vol 8 no 1 pp 49ndash62 2007

[40] M L Goodkin A T Ting and J A Blaho ldquoNF-kappaB isrequired for apoptosis prevention during herpes simplex virustype 1 infectionrdquo Journal of Virology vol 77 no 13 pp 7261ndash7280 2003

[41] X R Zhang XWang C L Sun et al ldquoExpression of NF- KB inspinal ganglia of CIA rats and therapeutic action of acupunctureJiaji pointsrdquo Modern Journal of Integrated Traditional Chineseand Western Medicine vol 16 no 11 pp 1460ndash1462 2007

[42] L Zhou H X Zhang Q Wang et al ldquoEffect of scalp acupunc-ture on the expression of NF-JB mRNA COX-2 mRNA andtheir proteins in rats with acute cerebral ischemia-reperfusioninjuryrdquo Acupuncture Research vol 34 no 5 pp 304ndash308 2009

[43] M Bianchi E Jotti P Sacerdote and A E Panerai ldquoTraditionalacupuncture increases the content of 120573-endorphin in immunecells and influences mitogen induced proliferationrdquoThe Ameri-can Journal of Chinese Medicine vol 19 no 2 pp 101ndash104 1991

[44] F Petti A Bangrazi A Liguori G Reale and F Ippoliti ldquoEffectsof acupuncture on immune response related to opioid-likepeptidesrdquo Journal of Traditional Chinese Medicine vol 18 no1 pp 55ndash63 1998

[45] BWu ldquoEffect of acupuncture on the regulation of cell-mediatedimmunity in the patients with malignant tumorsrdquo AcupunctureResearch vol 20 no 3 pp 67ndash71 1995

[46] X H Jing H Cai B Lu et al ldquoStudy on morphologicalfoundation of point LI 4 treating diseases in the face andmouthrdquo Chinese Acupuncture and Moxibustion vol 23 no 2pp 109ndash110 2003

[47] S l Chen Z G Jin X H Jing et al ldquoMorphological study onthe afferent pathways of ldquoHegurdquo point and mouth-face regionrdquoAcupuncture Research vol 29 no 3 pp 217ndash221 2004

[48] Z Xu ldquoAnatomic basis for the treatment of facial paralysis bydicang-through-jiache acupuncturerdquo Shanghai Journal of Acu-Mox vol 27 no 4 pp 35ndash37 2008

Submit your manuscripts athttpwwwhindawicom

Stem CellsInternational

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

MEDIATORSINFLAMMATION

of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Behavioural Neurology

EndocrinologyInternational Journal of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Disease Markers

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

BioMed Research International

OncologyJournal of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Oxidative Medicine and Cellular Longevity

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

PPAR Research

The Scientific World JournalHindawi Publishing Corporation httpwwwhindawicom Volume 2014

Immunology ResearchHindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Journal of

ObesityJournal of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Computational and Mathematical Methods in Medicine

OphthalmologyJournal of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Diabetes ResearchJournal of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Research and TreatmentAIDS

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Gastroenterology Research and Practice

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Parkinsonrsquos Disease

Evidence-Based Complementary and Alternative Medicine

Volume 2014Hindawi Publishing Corporationhttpwwwhindawicom

4 Evidence-Based Complementary and Alternative Medicine

lower in the electroacupuncture group compared with themodel animal group (119875 lt 005 at day 3 119875 lt 001 at days7 and 14 of treatment period) as shown in Table 2 At day7 of treatment period HSV-1 DNA was decreasing in theelectroacupuncture group while HSV-1 DNAwas still highercompared with 4 days prior in themodel animal group HSV-1 DNA in the model animal group was decreasing at day 14 oftreatment period

4 Discussion

The blink reflex score vibrissae movement score position ofapex nasi score and total score were significantly higher inthe electroacupuncture and model animal group than thosein saline and blank control group after modeling whichindicated that the FNP mice model was successfully inducedby inoculation of HSV-1With the development of FNP somefacial nerve function recovered and HSV-1 DNA contentalso decreased in the model animal group These resultsreflect the disease progression of FNP Facial nerve functionrecoveredmore quickly in the electroacupuncture groupThesymptom relief after acupuncture is consistent with clinicaltrials evaluating the therapeutic effects of acupuncture forFNP [20ndash22] In addition HSV-1 DNA quantity in theelectroacupuncture group was significantly lower than thatin model animal group at day 3 At day 7 HSV-1 DNAquantity in the electroacupuncture group was decreasingwhile HSV-1 DNA quantity in the model animal group wasstill higher compared with 4 days priorThese results indicatethat electroacupuncture has therapeutic effects on FNP andpromotes the reduction in HSV-1

41 The Mechanism Underlying Acupuncture to AlleviateFNP Symptoms It has been suggested that the cell-mediatedautoimmunemechanism against myelin basic proteinmay bethe pathogenesis of FNP FNP is an autoimmune demyelinat-ing cranial neuritis and in most instances it is a mononeu-ritic variant of Guillain-Barre syndrome a neurologic diseasewith cell-mediated autoimmune reaction against peripheralnerve myelin antigens In FNP viral infection or the reactiva-tion of a latent virus may provoke an autoimmune reactionagainst peripheral nerve myelin components leading toinflammation and demyelination of the facial nerve [29]During its progression FNP is accompanied by significantelevations in some proinflammatory mediators includingtumor necrosis factor alpha (TNF-120572) interleukin-6 (IL-6)and interleukin-1 beta (IL-1120573) [30] TNF-120572 IL-6 and IL-1120573 are linked with a wide range of inflammatory infectiousautoimmune and malignant conditions [31] The abnormalhigh level of serum TNF-120572 also causes demyelination ofthe facial nerve via inflammation [32 33] Acupuncturesignificantly reduces plasma levels of TNF-120572 in patients withchronic headache [34] and mRNA levels of IL-6 and IL-1120573in rats of lipopolysaccharide-induced fever [35] A recentlypublished study found a new pathway for anti-inflammatorypathway of electroacupuncture Electroacupuncture at thesciatic nerve controls systemic inflammation by inducingvagal activation of aromatic L-amino acid decarboxylase

leading to the production of dopamine in the adrenalmedullaand then the reduction of TNF-120572 [36] By inhibiting the pro-duction of proinflammatory mediators acupuncture mighthelp alleviate facial nerve inflammation and demyelinationand thus promote the repair of the facial nerve to improvesymptoms Overall acupuncturemight have potential benefitfor inflammation in inflammatory and infectious diseasesby regulating the production of proinflammatory mediatorsHowever there is no direct observation to support thatacupuncture could reduce the contents of TNF-120572 IL-6 andIL-1120573 in HSV-1 induced FNP in vivo

42 The Mechanism Underlying Acupuncture to Help ControlHSV-1 Infection

421 Acupuncture Might Help Reduce the Efficiency of HSV-1 Replication and Spread HSV-1 can activate autoimmunepathways including the nuclear factor kappa-light-chain-enhancer of activated B cells (NF-120581B) signaling pathway Evi-dence suggests that HSV-1 can induce a persistent transloca-tion of NF-120581B [37] NF-120581B complexes are bound to inhibitorsof NF-120581B (I120581Bs) in unstimulated cells thereby maintainingNF-120581B in an inactive state The phosphorylation of I120581B bythe I120581B kinase (IKK) complex is involved in the activationof NF-120581B leading to I120581B degradation which releases NF-120581Band then allows it to translocate into the nucleus [38 39]Thepersistent translocation of NF-120581B subsequently increases theefficiency of virus replication [37] The translocation of NF-120581B to the nuclei of infected cells is a necessary componentto prevent apoptosis of host cells during HSV-1 infectionwhich helps HSV-1 evade immunological surveillance andspread effectively in the host [40] Acupuncture can inhibitabnormal NF-120581B expression and activation by inhibiting theNF-120581B signal transduction pathway in host cells [41 42]Thismight help the immunological surveillance and reduce theefficiency of HSV-1 replication and spread However thereis no direct observation to support that acupuncture couldinhibit NF-120581B expression and activation in HSV-1 inducedFNP in vivo which needs to be further studied

422 Acupuncture Might Regulate Immune Response to Elim-inate HSV-1 After HSV-1 infection humoral immunity andcell-mediated immunity will be activated to eliminate HSV-1 In cell-mediated immunity antigen-specific cytotoxic Tlymphocytes a type of T lymphocytes that kill cancer cellsand infected cells are activated to induce apoptosis in virus-infected cells displaying epitopes of foreign antigens on theirsurface Studies regarding the effects of acupuncture on theimmune system show a stimulating effect on cell-mediatedimmunity Acupuncture is able to help in T lymphocyteproliferation [43] After acupuncture T helper lymphocytesa type of T lymphocytes that help in the activity of otherimmune cells and cytotoxic T lymphocytes were significantlyincreased [44 45]The ability of acupuncture tomodulate theimmune response might help the immune system to elimi-nate HSV-1 Therefore acupuncture might have potential tocontrol infection in infectious diseases by activating someimmune pathways and modulating the immune response

Evidence-Based Complementary and Alternative Medicine 5

Table2Detectio

nof

HSV

-1DNAdu

ringtre

atmentp

eriodandatthee

ndof

treatmentp

eriod(119909plusmn119878)

G119873

Atday3of

treatmentp

eriod

Atday7of

treatmentp

eriod

Atday14

oftre

atmentp

eriod

Facialnerve

(2minusCT)

Geniculate

gang

lion

(2minusCT)

Brainstem

(2minusCT)

Cerebral

cortex

(2minusCT)

Facialnerve

(2minusCT)

Geniculate

gang

lion

(2minusCT)

Brainstem

(2minusCT)

Cerebral

cortex

(2minusCT)

Facialnerve

(2minusCT)

Geniculate

gang

lion

(2minusCT)

Brainstem

(2minusCT)

Cerebral

cortex

(2minusCT)

A10

0lowastlowast

0lowastlowast

0lowastlowast

0lowastlowast

0lowastlowast

0lowastlowast

0lowastlowast

0lowastlowast

0lowastlowast

0lowastlowast

0lowastlowast

0lowastlowast

B10

0lowastlowast

0lowastlowast

0lowastlowast

0lowastlowast

0lowastlowast

0lowastlowast

0lowast0lowastlowast

0lowastlowast

0lowastlowast

0lowastlowast

0lowastlowast

C10

1367plusmn216

1182plusmn18

177

3plusmn10

8652plusmn227

1542plusmn271

1418plusmn19

71257plusmn311

652plusmn227

989plusmn14

776

3plusmn12

2677plusmn12

8614plusmn16

3D

1098

4plusmn12

9lowast90

4plusmn229lowast

304plusmn229lowast

217plusmn114lowast

218plusmn213lowastlowast

178plusmn114lowastlowast

104plusmn14

8lowastlowast

217plusmn12

5lowastlowast

071plusmn016lowastlowast

018plusmn021lowastlowast

003plusmn009lowastlowast

005plusmn013lowastlowast

Thequ

antityof

HSV

-1DNAwas

expressedwith

2minusΔΔCT

ofdifferenceratio

ofHSV

-1mRN

AG

roup

Ablank

controlgroup

Group

Bsalin

egrou

pGroup

Cmod

elanim

algrou

pGroup

Delectroacup

uncture

grou

plowastCom

paredwith

Group

C119875lt005lowastlowastCom

paredwith

Group

C119875lt001

6 Evidence-Based Complementary and Alternative Medicine

43The Compatibility of Distal-Proximal Acupoints in Acupu-ncture Treatment for FNP Acupoints compatibility is a keypoint in acupuncture prescriptions which influences thera-peutic effectsThere are many classical acupoints compatibil-itymethods such as yuan-source acupoints and luo-collateralacupoints combination back-shu acupoints and front-muacupoints combination and distal-proximal acupoints com-bination Distal-proximal acupoints combination is oftenused in the treatment of FNP For example Hegu (LI4) inupper extremity and some local acupoints in face are needledin combination Synergistic effects exist among acupointsso acupoint compatibility can strengthen the effectiveness ofacupuncture

The mechanism underlying Hegu (LI4) treating diseasesin the face and mouth remains unclear A morphologicalstudy suggested that the Gasserian ganglion receives theneural projection to Hegu (LI4) [46] Furthermore the nervein Hegu (LI4) has an indirect project to the nucleus of thesolitary tract and the facial nerve has a direct connectionwiththe nucleus of the solitary tract [47] This might be the mor-phological foundation of Hegu (LI4) treating diseases in theface and mouth As to Jiache (ST6) this acupoint is locatednear the subbuccal and marginal mandibular branches of thefacial nerve which provides themorphological foundation toalleviate symptoms of FNP [48] The combination of Hegu(LI4) and Jiache (ST6) stimulates more peripheral nervescompared with needling a single acupoint of them

5 Limitations

There are some limitations of this study Although the mod-eling method in this study is more consistent with the naturalpathogenesis of FNP the model rate is relatively lower thanthat of compressing the facial nerve Additionally this studyshows the potential of acupuncture in triggering a patientrsquosimmunoreaction to further reduce HSV-1 quantity Howeverthis study is insufficient to fully elucidate the mechanismof acupuncture in reducing HSV-1 quantity Future studiesmight be directed toward elucidating this mechanism suchas the relationship between acupuncture and NF-120581B in FNPin vivo

6 Conclusions

Weconcluded that in the treatment for FNP electroacupunc-ture alleviates symptoms facilitates affected nerve recoveryand promotes the reduction in HSV-1 Acupuncture mighthave therapeutic advantages in controlling inflammation andinfection in FNP

Conflict of Interests

The authors declare no conflict of interests

Authorsrsquo Contribution

Hongzhi Tang and Shuwei Feng contributed equally to thework

Acknowledgments

This study was supported by the National Basic ResearchProgram of China (no 2012CB518501) and the ResearchFund for the Doctoral Program of Higher Education (no20105132110003)

References

[1] J Finsterer ldquoManagement of peripheral facial nerve palsyrdquoEuropean Archives of Oto-Rhino-Laryngology vol 265 no 7 pp743ndash752 2008

[2] H C Slavkin ldquoThe significance of a human smile observationson Bellrsquos palsyrdquo Journal of the American Dental Association vol130 no 2 pp 269ndash272 1999

[3] M Shaw F Nazir and I Bone ldquoBellrsquos palsy a study of thetreatment advice given by neurologistsrdquo Journal of NeurologyNeurosurgery and Psychiatry vol 76 no 2 pp 293ndash294 2005

[4] N J Holland and G M Weiner ldquoRecent developments in Bellrsquospalsyrdquo British Medical Journal vol 329 no 7474 pp 553ndash5572004

[5] A G Marson and R Salinas ldquoBellrsquos palsyrdquo Western Journal ofMedicine vol 173 no 4 pp 266ndash268 2000

[6] N A Brandenburg and J F Annegers ldquoIncidence and riskfactors for Bellrsquos palsy in Laredo Texas 1974ndash1982rdquo Neuroepi-demiology vol 12 no 6 pp 313ndash325 1993

[7] Q D Yang Neurology Peoplersquos Medical Publishing HouseBeijing China 2002

[8] C A J Prescott ldquoIdiopathic facial nerve palsyrdquo Journal ofLaryngology and Otology vol 102 no 5 pp 403ndash407 1988

[9] B Lorber ldquoAre all diseases infectiousrdquo Annals of InternalMedicine vol 125 no 10 pp 844ndash851 1996

[10] C Atzema and R D Goldman ldquoShould we use steroids to treatchildren with Bellrsquos palsyrdquo Canadian Family Physician vol 52pp 313ndash314 2006

[11] S Axelsson S Lindberg and A Stjernquist-Desatnik ldquoOut-come of treatment with valacyclovir and prednisone in patientswith Bellrsquos palsyrdquoAnnals of Otology Rhinology and Laryngologyvol 112 no 3 pp 197ndash201 2003

[12] J Schirm and P S J ZMulkens ldquoBellrsquos palsy and herpes simplesvirusrdquo Acta Pathologica Microbiologica et Immunologica Scan-dinavica vol 105 no 7ndash12 pp 815ndash823 1997

[13] K K Adour J M Ruboyianes P G von Doersten et al ldquoBellrsquospalsy treatment with acyclovir and prednisone compared withprednisone alone a double-blind randomized controlled trialrdquoAnnals of Otology Rhinology and Laryngology vol 105 no 5 pp371ndash378 1996

[14] S Murakami M Mizobuchi Y Nakashiro T Doi N Hatoand N Yanagihara ldquoBellrsquos palsy and herpes simplex virusidentification of viral DNA in endoneurial fluid and musclerdquoAnnals of Internal Medicine vol 124 no 1 part 1 pp 27ndash301996

[15] Y Furuta S Fukuda S Chida et al ldquoReactivation of herpessimplex virus type 1 in patients with Bellrsquos palsyrdquo Journal ofMedical Virology vol 54 pp 162ndash166 1998

[16] C G Jackson and P G von Doersten ldquoThe facial nerve currenttrends in diagnosis treatment and rehabilitationrdquo MedicalClinics of North America vol 83 no 1 pp 179ndash195 1999

[17] K K Adour ldquoOtological complications of herpes zosterrdquoNeurology vol 35 no 1 pp S62ndashS64 1994

Evidence-Based Complementary and Alternative Medicine 7

[18] N Hato H Yamada H Kohno et al ldquoValacyclovir and pred-nisolone treatment for Bellrsquos palsy amulticenter randomizedplacebo-controlled studyrdquoOtology ampNeurotology vol 28 no 3pp 408ndash413 2007

[19] K Kawaguchi H Inamura Y Abe et al ldquoReactivation ofherpes simplex virus type 1 and varicella-zoster virus andtherapeutic effects of combination therapy with prednisoloneand valacyclovir in patients with Bellrsquos palsyrdquoThe Laryngoscopevol 117 no 1 pp 147ndash156 2007

[20] F R Liang Y Li S G Yu et al ldquoA multicentral randomizedcontrol study on clinical acupuncture treatment of Bellrsquos palsyrdquoJournal of Traditional Chinese Medicine vol 26 no 1 pp 3ndash72006

[21] Y Qu ldquoClinical observation on acupuncture by stages com-bined with exercise therapy for treatment of Bell palsy at acutestagerdquo Chinese Acupuncture and Moxibustion vol 25 no 8 pp545ndash547 2005

[22] Y Li F R Liang S G Yu et al ldquoEfficacy of acupuncture andmoxibustion in treating Bellrsquos palsy a multicenter randomizedcontrolled trial in Chinardquo Chinese Medical Journal vol 117 no10 pp 1502ndash1506 2004

[23] H Takahashi N Hato N Honda et al ldquoEffects of acyclovir onfacial nerve paralysis induced by herpes simplex virus type 1 inmicerdquo Auris Nasus Larynx vol 30 no 1 pp 1ndash5 2003

[24] N Honda N Hato H Takahashi et al ldquoPathophysiology offacial nerve paralysis induced by herpes simplex virus type 1infectionrdquo Annals of Otology Rhinology and Laryngology vol111 no 7 pp 616ndash622 2002

[25] T Sugita S Murakami N Yanagihara Y Fujiwara Y HirataandTKurata ldquoFacial nerve paralysis induced by herpes simplexvirus in mice an animal model of acute and transient facialparalysisrdquo Annals of Otology Rhinology and Laryngology vol104 no 7 pp 574ndash581 1995

[26] S Murakami N Hato M Mizobuchi T Doi and N Yanagi-hara ldquoRole of herpes simplex virus infection in the pathogenesisof facial paralysis in micerdquo Annals of Otology Rhinology andLaryngology vol 105 no 1 pp 49ndash53 1996

[27] H Takahashi Y Hitsumoto N Honda et al ldquoMouse model ofBellrsquos palsy induced by reactivation of herpes simplex virus type1rdquo Journal of Neuropathology and Experimental Neurology vol60 no 6 pp 621ndash627 2001

[28] S G Yu and Y Guo Experimental Acupuncture ShanghaiScience and Technology Press Shanghai China 2009

[29] A Greco A GalloM Fusconi CMarinelli G FMacri andMde Vincentiis ldquoBellrsquos palsy and autoimmunityrdquo AutoimmunityReviews vol 12 no 2 pp 323ndash328 2012

[30] M Yilmaz M Tarakcioglu N Bayazit Y A Bayazit MNamiduru and M Kanlikama ldquoSerum cytokine levels in bellrsquospalsyrdquo Journal of the Neurological Sciences vol 197 no 1-2 pp69ndash72 2002

[31] M Apostolaki M Armaka P Victoratos and G Kollias ldquoCel-lular mechanisms of TNF function in models of inflammationand autoimmunityrdquoCurrent Directions in Autoimmunity vol 11pp 1ndash26 2010

[32] C Larsson C Bernstrom-Lundberg S Edstrom and TBergstrom ldquoTumor necrosis factor-120572 response and herpesvirusinfection in Bellrsquos palsyrdquo The Laryngoscope vol 108 no 8 part1 pp 1171ndash1176 1998

[33] A V Delgado A T McManus and J P Chambers ldquoProductionof tumor necrosis factor-120572 interleukin 1-120573 interleukin 2 andinterleukin 6 by rat leukocyte subpopulations after exposure tosubstance Prdquo Neuropeptides vol 37 no 6 pp 355ndash361 2003

[34] H J Jeong S H Hong Y C Nam et al ldquoThe effect of acupunc-ture on proinflammatory cytokine production in patients withchronic headache a preliminary reportrdquoThe American Journalof Chinese Medicine vol 31 no 6 pp 945ndash954 2003

[35] Y S Son H J Park O B Kwon S Jung H Shin and S LimldquoAntipyretic effects of acupuncture on the lipopolysaccharide-induced fever and expression of interleukin-6 and interleukin-1120573 mRNAs in the hypothalamus of ratsrdquo Neuroscience Lettersvol 319 no 1 pp 45ndash48 2002

[36] R Torres-Rosas G Yehia G Pena et al ldquoDopamine mediatesvagal modulation of the immune system by electroacupunc-turerdquo Nature Medicine vol 20 no 3 pp 291ndash295 2014

[37] A Patel J Hanson T I McLean et al ldquoHerpes simplex virustype 1 induction of persistent NF-kappaB nuclear translocationincreases the efficiency of virus replicationrdquo Virology vol 247no 2 pp 212ndash222 1998

[38] M S Hayden and S Ghosh ldquoSignaling to NF-kappaBrdquoGenes ampDevelopment vol 18 no 18 pp 2195ndash2224 2004

[39] N D Perkins ldquoIntegrating cell-signalling pathways with NF-kappaB and IKK functionrdquo Nature Reviews Molecular CellBiology vol 8 no 1 pp 49ndash62 2007

[40] M L Goodkin A T Ting and J A Blaho ldquoNF-kappaB isrequired for apoptosis prevention during herpes simplex virustype 1 infectionrdquo Journal of Virology vol 77 no 13 pp 7261ndash7280 2003

[41] X R Zhang XWang C L Sun et al ldquoExpression of NF- KB inspinal ganglia of CIA rats and therapeutic action of acupunctureJiaji pointsrdquo Modern Journal of Integrated Traditional Chineseand Western Medicine vol 16 no 11 pp 1460ndash1462 2007

[42] L Zhou H X Zhang Q Wang et al ldquoEffect of scalp acupunc-ture on the expression of NF-JB mRNA COX-2 mRNA andtheir proteins in rats with acute cerebral ischemia-reperfusioninjuryrdquo Acupuncture Research vol 34 no 5 pp 304ndash308 2009

[43] M Bianchi E Jotti P Sacerdote and A E Panerai ldquoTraditionalacupuncture increases the content of 120573-endorphin in immunecells and influences mitogen induced proliferationrdquoThe Ameri-can Journal of Chinese Medicine vol 19 no 2 pp 101ndash104 1991

[44] F Petti A Bangrazi A Liguori G Reale and F Ippoliti ldquoEffectsof acupuncture on immune response related to opioid-likepeptidesrdquo Journal of Traditional Chinese Medicine vol 18 no1 pp 55ndash63 1998

[45] BWu ldquoEffect of acupuncture on the regulation of cell-mediatedimmunity in the patients with malignant tumorsrdquo AcupunctureResearch vol 20 no 3 pp 67ndash71 1995

[46] X H Jing H Cai B Lu et al ldquoStudy on morphologicalfoundation of point LI 4 treating diseases in the face andmouthrdquo Chinese Acupuncture and Moxibustion vol 23 no 2pp 109ndash110 2003

[47] S l Chen Z G Jin X H Jing et al ldquoMorphological study onthe afferent pathways of ldquoHegurdquo point and mouth-face regionrdquoAcupuncture Research vol 29 no 3 pp 217ndash221 2004

[48] Z Xu ldquoAnatomic basis for the treatment of facial paralysis bydicang-through-jiache acupuncturerdquo Shanghai Journal of Acu-Mox vol 27 no 4 pp 35ndash37 2008

Submit your manuscripts athttpwwwhindawicom

Stem CellsInternational

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

MEDIATORSINFLAMMATION

of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Behavioural Neurology

EndocrinologyInternational Journal of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Disease Markers

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

BioMed Research International

OncologyJournal of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Oxidative Medicine and Cellular Longevity

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

PPAR Research

The Scientific World JournalHindawi Publishing Corporation httpwwwhindawicom Volume 2014

Immunology ResearchHindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Journal of

ObesityJournal of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Computational and Mathematical Methods in Medicine

OphthalmologyJournal of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Diabetes ResearchJournal of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Research and TreatmentAIDS

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Gastroenterology Research and Practice

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Parkinsonrsquos Disease

Evidence-Based Complementary and Alternative Medicine

Volume 2014Hindawi Publishing Corporationhttpwwwhindawicom

Evidence-Based Complementary and Alternative Medicine 5

Table2Detectio

nof

HSV

-1DNAdu

ringtre

atmentp

eriodandatthee

ndof

treatmentp

eriod(119909plusmn119878)

G119873

Atday3of

treatmentp

eriod

Atday7of

treatmentp

eriod

Atday14

oftre

atmentp

eriod

Facialnerve

(2minusCT)

Geniculate

gang

lion

(2minusCT)

Brainstem

(2minusCT)

Cerebral

cortex

(2minusCT)

Facialnerve

(2minusCT)

Geniculate

gang

lion

(2minusCT)

Brainstem

(2minusCT)

Cerebral

cortex

(2minusCT)

Facialnerve

(2minusCT)

Geniculate

gang

lion

(2minusCT)

Brainstem

(2minusCT)

Cerebral

cortex

(2minusCT)

A10

0lowastlowast

0lowastlowast

0lowastlowast

0lowastlowast

0lowastlowast

0lowastlowast

0lowastlowast

0lowastlowast

0lowastlowast

0lowastlowast

0lowastlowast

0lowastlowast

B10

0lowastlowast

0lowastlowast

0lowastlowast

0lowastlowast

0lowastlowast

0lowastlowast

0lowast0lowastlowast

0lowastlowast

0lowastlowast

0lowastlowast

0lowastlowast

C10

1367plusmn216

1182plusmn18

177

3plusmn10

8652plusmn227

1542plusmn271

1418plusmn19

71257plusmn311

652plusmn227

989plusmn14

776

3plusmn12

2677plusmn12

8614plusmn16

3D

1098

4plusmn12

9lowast90

4plusmn229lowast

304plusmn229lowast

217plusmn114lowast

218plusmn213lowastlowast

178plusmn114lowastlowast

104plusmn14

8lowastlowast

217plusmn12

5lowastlowast

071plusmn016lowastlowast

018plusmn021lowastlowast

003plusmn009lowastlowast

005plusmn013lowastlowast

Thequ

antityof

HSV

-1DNAwas

expressedwith

2minusΔΔCT

ofdifferenceratio

ofHSV

-1mRN

AG

roup

Ablank

controlgroup

Group

Bsalin

egrou

pGroup

Cmod

elanim

algrou

pGroup

Delectroacup

uncture

grou

plowastCom

paredwith

Group

C119875lt005lowastlowastCom

paredwith

Group

C119875lt001

6 Evidence-Based Complementary and Alternative Medicine

43The Compatibility of Distal-Proximal Acupoints in Acupu-ncture Treatment for FNP Acupoints compatibility is a keypoint in acupuncture prescriptions which influences thera-peutic effectsThere are many classical acupoints compatibil-itymethods such as yuan-source acupoints and luo-collateralacupoints combination back-shu acupoints and front-muacupoints combination and distal-proximal acupoints com-bination Distal-proximal acupoints combination is oftenused in the treatment of FNP For example Hegu (LI4) inupper extremity and some local acupoints in face are needledin combination Synergistic effects exist among acupointsso acupoint compatibility can strengthen the effectiveness ofacupuncture

The mechanism underlying Hegu (LI4) treating diseasesin the face and mouth remains unclear A morphologicalstudy suggested that the Gasserian ganglion receives theneural projection to Hegu (LI4) [46] Furthermore the nervein Hegu (LI4) has an indirect project to the nucleus of thesolitary tract and the facial nerve has a direct connectionwiththe nucleus of the solitary tract [47] This might be the mor-phological foundation of Hegu (LI4) treating diseases in theface and mouth As to Jiache (ST6) this acupoint is locatednear the subbuccal and marginal mandibular branches of thefacial nerve which provides themorphological foundation toalleviate symptoms of FNP [48] The combination of Hegu(LI4) and Jiache (ST6) stimulates more peripheral nervescompared with needling a single acupoint of them

5 Limitations

There are some limitations of this study Although the mod-eling method in this study is more consistent with the naturalpathogenesis of FNP the model rate is relatively lower thanthat of compressing the facial nerve Additionally this studyshows the potential of acupuncture in triggering a patientrsquosimmunoreaction to further reduce HSV-1 quantity Howeverthis study is insufficient to fully elucidate the mechanismof acupuncture in reducing HSV-1 quantity Future studiesmight be directed toward elucidating this mechanism suchas the relationship between acupuncture and NF-120581B in FNPin vivo

6 Conclusions

Weconcluded that in the treatment for FNP electroacupunc-ture alleviates symptoms facilitates affected nerve recoveryand promotes the reduction in HSV-1 Acupuncture mighthave therapeutic advantages in controlling inflammation andinfection in FNP

Conflict of Interests

The authors declare no conflict of interests

Authorsrsquo Contribution

Hongzhi Tang and Shuwei Feng contributed equally to thework

Acknowledgments

This study was supported by the National Basic ResearchProgram of China (no 2012CB518501) and the ResearchFund for the Doctoral Program of Higher Education (no20105132110003)

References

[1] J Finsterer ldquoManagement of peripheral facial nerve palsyrdquoEuropean Archives of Oto-Rhino-Laryngology vol 265 no 7 pp743ndash752 2008

[2] H C Slavkin ldquoThe significance of a human smile observationson Bellrsquos palsyrdquo Journal of the American Dental Association vol130 no 2 pp 269ndash272 1999

[3] M Shaw F Nazir and I Bone ldquoBellrsquos palsy a study of thetreatment advice given by neurologistsrdquo Journal of NeurologyNeurosurgery and Psychiatry vol 76 no 2 pp 293ndash294 2005

[4] N J Holland and G M Weiner ldquoRecent developments in Bellrsquospalsyrdquo British Medical Journal vol 329 no 7474 pp 553ndash5572004

[5] A G Marson and R Salinas ldquoBellrsquos palsyrdquo Western Journal ofMedicine vol 173 no 4 pp 266ndash268 2000

[6] N A Brandenburg and J F Annegers ldquoIncidence and riskfactors for Bellrsquos palsy in Laredo Texas 1974ndash1982rdquo Neuroepi-demiology vol 12 no 6 pp 313ndash325 1993

[7] Q D Yang Neurology Peoplersquos Medical Publishing HouseBeijing China 2002

[8] C A J Prescott ldquoIdiopathic facial nerve palsyrdquo Journal ofLaryngology and Otology vol 102 no 5 pp 403ndash407 1988

[9] B Lorber ldquoAre all diseases infectiousrdquo Annals of InternalMedicine vol 125 no 10 pp 844ndash851 1996

[10] C Atzema and R D Goldman ldquoShould we use steroids to treatchildren with Bellrsquos palsyrdquo Canadian Family Physician vol 52pp 313ndash314 2006

[11] S Axelsson S Lindberg and A Stjernquist-Desatnik ldquoOut-come of treatment with valacyclovir and prednisone in patientswith Bellrsquos palsyrdquoAnnals of Otology Rhinology and Laryngologyvol 112 no 3 pp 197ndash201 2003

[12] J Schirm and P S J ZMulkens ldquoBellrsquos palsy and herpes simplesvirusrdquo Acta Pathologica Microbiologica et Immunologica Scan-dinavica vol 105 no 7ndash12 pp 815ndash823 1997

[13] K K Adour J M Ruboyianes P G von Doersten et al ldquoBellrsquospalsy treatment with acyclovir and prednisone compared withprednisone alone a double-blind randomized controlled trialrdquoAnnals of Otology Rhinology and Laryngology vol 105 no 5 pp371ndash378 1996

[14] S Murakami M Mizobuchi Y Nakashiro T Doi N Hatoand N Yanagihara ldquoBellrsquos palsy and herpes simplex virusidentification of viral DNA in endoneurial fluid and musclerdquoAnnals of Internal Medicine vol 124 no 1 part 1 pp 27ndash301996

[15] Y Furuta S Fukuda S Chida et al ldquoReactivation of herpessimplex virus type 1 in patients with Bellrsquos palsyrdquo Journal ofMedical Virology vol 54 pp 162ndash166 1998

[16] C G Jackson and P G von Doersten ldquoThe facial nerve currenttrends in diagnosis treatment and rehabilitationrdquo MedicalClinics of North America vol 83 no 1 pp 179ndash195 1999

[17] K K Adour ldquoOtological complications of herpes zosterrdquoNeurology vol 35 no 1 pp S62ndashS64 1994

Evidence-Based Complementary and Alternative Medicine 7

[18] N Hato H Yamada H Kohno et al ldquoValacyclovir and pred-nisolone treatment for Bellrsquos palsy amulticenter randomizedplacebo-controlled studyrdquoOtology ampNeurotology vol 28 no 3pp 408ndash413 2007

[19] K Kawaguchi H Inamura Y Abe et al ldquoReactivation ofherpes simplex virus type 1 and varicella-zoster virus andtherapeutic effects of combination therapy with prednisoloneand valacyclovir in patients with Bellrsquos palsyrdquoThe Laryngoscopevol 117 no 1 pp 147ndash156 2007

[20] F R Liang Y Li S G Yu et al ldquoA multicentral randomizedcontrol study on clinical acupuncture treatment of Bellrsquos palsyrdquoJournal of Traditional Chinese Medicine vol 26 no 1 pp 3ndash72006

[21] Y Qu ldquoClinical observation on acupuncture by stages com-bined with exercise therapy for treatment of Bell palsy at acutestagerdquo Chinese Acupuncture and Moxibustion vol 25 no 8 pp545ndash547 2005

[22] Y Li F R Liang S G Yu et al ldquoEfficacy of acupuncture andmoxibustion in treating Bellrsquos palsy a multicenter randomizedcontrolled trial in Chinardquo Chinese Medical Journal vol 117 no10 pp 1502ndash1506 2004

[23] H Takahashi N Hato N Honda et al ldquoEffects of acyclovir onfacial nerve paralysis induced by herpes simplex virus type 1 inmicerdquo Auris Nasus Larynx vol 30 no 1 pp 1ndash5 2003

[24] N Honda N Hato H Takahashi et al ldquoPathophysiology offacial nerve paralysis induced by herpes simplex virus type 1infectionrdquo Annals of Otology Rhinology and Laryngology vol111 no 7 pp 616ndash622 2002

[25] T Sugita S Murakami N Yanagihara Y Fujiwara Y HirataandTKurata ldquoFacial nerve paralysis induced by herpes simplexvirus in mice an animal model of acute and transient facialparalysisrdquo Annals of Otology Rhinology and Laryngology vol104 no 7 pp 574ndash581 1995

[26] S Murakami N Hato M Mizobuchi T Doi and N Yanagi-hara ldquoRole of herpes simplex virus infection in the pathogenesisof facial paralysis in micerdquo Annals of Otology Rhinology andLaryngology vol 105 no 1 pp 49ndash53 1996

[27] H Takahashi Y Hitsumoto N Honda et al ldquoMouse model ofBellrsquos palsy induced by reactivation of herpes simplex virus type1rdquo Journal of Neuropathology and Experimental Neurology vol60 no 6 pp 621ndash627 2001

[28] S G Yu and Y Guo Experimental Acupuncture ShanghaiScience and Technology Press Shanghai China 2009

[29] A Greco A GalloM Fusconi CMarinelli G FMacri andMde Vincentiis ldquoBellrsquos palsy and autoimmunityrdquo AutoimmunityReviews vol 12 no 2 pp 323ndash328 2012

[30] M Yilmaz M Tarakcioglu N Bayazit Y A Bayazit MNamiduru and M Kanlikama ldquoSerum cytokine levels in bellrsquospalsyrdquo Journal of the Neurological Sciences vol 197 no 1-2 pp69ndash72 2002

[31] M Apostolaki M Armaka P Victoratos and G Kollias ldquoCel-lular mechanisms of TNF function in models of inflammationand autoimmunityrdquoCurrent Directions in Autoimmunity vol 11pp 1ndash26 2010

[32] C Larsson C Bernstrom-Lundberg S Edstrom and TBergstrom ldquoTumor necrosis factor-120572 response and herpesvirusinfection in Bellrsquos palsyrdquo The Laryngoscope vol 108 no 8 part1 pp 1171ndash1176 1998

[33] A V Delgado A T McManus and J P Chambers ldquoProductionof tumor necrosis factor-120572 interleukin 1-120573 interleukin 2 andinterleukin 6 by rat leukocyte subpopulations after exposure tosubstance Prdquo Neuropeptides vol 37 no 6 pp 355ndash361 2003

[34] H J Jeong S H Hong Y C Nam et al ldquoThe effect of acupunc-ture on proinflammatory cytokine production in patients withchronic headache a preliminary reportrdquoThe American Journalof Chinese Medicine vol 31 no 6 pp 945ndash954 2003

[35] Y S Son H J Park O B Kwon S Jung H Shin and S LimldquoAntipyretic effects of acupuncture on the lipopolysaccharide-induced fever and expression of interleukin-6 and interleukin-1120573 mRNAs in the hypothalamus of ratsrdquo Neuroscience Lettersvol 319 no 1 pp 45ndash48 2002

[36] R Torres-Rosas G Yehia G Pena et al ldquoDopamine mediatesvagal modulation of the immune system by electroacupunc-turerdquo Nature Medicine vol 20 no 3 pp 291ndash295 2014

[37] A Patel J Hanson T I McLean et al ldquoHerpes simplex virustype 1 induction of persistent NF-kappaB nuclear translocationincreases the efficiency of virus replicationrdquo Virology vol 247no 2 pp 212ndash222 1998

[38] M S Hayden and S Ghosh ldquoSignaling to NF-kappaBrdquoGenes ampDevelopment vol 18 no 18 pp 2195ndash2224 2004

[39] N D Perkins ldquoIntegrating cell-signalling pathways with NF-kappaB and IKK functionrdquo Nature Reviews Molecular CellBiology vol 8 no 1 pp 49ndash62 2007

[40] M L Goodkin A T Ting and J A Blaho ldquoNF-kappaB isrequired for apoptosis prevention during herpes simplex virustype 1 infectionrdquo Journal of Virology vol 77 no 13 pp 7261ndash7280 2003

[41] X R Zhang XWang C L Sun et al ldquoExpression of NF- KB inspinal ganglia of CIA rats and therapeutic action of acupunctureJiaji pointsrdquo Modern Journal of Integrated Traditional Chineseand Western Medicine vol 16 no 11 pp 1460ndash1462 2007

[42] L Zhou H X Zhang Q Wang et al ldquoEffect of scalp acupunc-ture on the expression of NF-JB mRNA COX-2 mRNA andtheir proteins in rats with acute cerebral ischemia-reperfusioninjuryrdquo Acupuncture Research vol 34 no 5 pp 304ndash308 2009

[43] M Bianchi E Jotti P Sacerdote and A E Panerai ldquoTraditionalacupuncture increases the content of 120573-endorphin in immunecells and influences mitogen induced proliferationrdquoThe Ameri-can Journal of Chinese Medicine vol 19 no 2 pp 101ndash104 1991

[44] F Petti A Bangrazi A Liguori G Reale and F Ippoliti ldquoEffectsof acupuncture on immune response related to opioid-likepeptidesrdquo Journal of Traditional Chinese Medicine vol 18 no1 pp 55ndash63 1998

[45] BWu ldquoEffect of acupuncture on the regulation of cell-mediatedimmunity in the patients with malignant tumorsrdquo AcupunctureResearch vol 20 no 3 pp 67ndash71 1995

[46] X H Jing H Cai B Lu et al ldquoStudy on morphologicalfoundation of point LI 4 treating diseases in the face andmouthrdquo Chinese Acupuncture and Moxibustion vol 23 no 2pp 109ndash110 2003

[47] S l Chen Z G Jin X H Jing et al ldquoMorphological study onthe afferent pathways of ldquoHegurdquo point and mouth-face regionrdquoAcupuncture Research vol 29 no 3 pp 217ndash221 2004

[48] Z Xu ldquoAnatomic basis for the treatment of facial paralysis bydicang-through-jiache acupuncturerdquo Shanghai Journal of Acu-Mox vol 27 no 4 pp 35ndash37 2008

Submit your manuscripts athttpwwwhindawicom

Stem CellsInternational

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

MEDIATORSINFLAMMATION

of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Behavioural Neurology

EndocrinologyInternational Journal of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Disease Markers

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

BioMed Research International

OncologyJournal of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Oxidative Medicine and Cellular Longevity

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

PPAR Research

The Scientific World JournalHindawi Publishing Corporation httpwwwhindawicom Volume 2014

Immunology ResearchHindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Journal of

ObesityJournal of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Computational and Mathematical Methods in Medicine

OphthalmologyJournal of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Diabetes ResearchJournal of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Research and TreatmentAIDS

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Gastroenterology Research and Practice

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Parkinsonrsquos Disease

Evidence-Based Complementary and Alternative Medicine

Volume 2014Hindawi Publishing Corporationhttpwwwhindawicom

6 Evidence-Based Complementary and Alternative Medicine

43The Compatibility of Distal-Proximal Acupoints in Acupu-ncture Treatment for FNP Acupoints compatibility is a keypoint in acupuncture prescriptions which influences thera-peutic effectsThere are many classical acupoints compatibil-itymethods such as yuan-source acupoints and luo-collateralacupoints combination back-shu acupoints and front-muacupoints combination and distal-proximal acupoints com-bination Distal-proximal acupoints combination is oftenused in the treatment of FNP For example Hegu (LI4) inupper extremity and some local acupoints in face are needledin combination Synergistic effects exist among acupointsso acupoint compatibility can strengthen the effectiveness ofacupuncture

The mechanism underlying Hegu (LI4) treating diseasesin the face and mouth remains unclear A morphologicalstudy suggested that the Gasserian ganglion receives theneural projection to Hegu (LI4) [46] Furthermore the nervein Hegu (LI4) has an indirect project to the nucleus of thesolitary tract and the facial nerve has a direct connectionwiththe nucleus of the solitary tract [47] This might be the mor-phological foundation of Hegu (LI4) treating diseases in theface and mouth As to Jiache (ST6) this acupoint is locatednear the subbuccal and marginal mandibular branches of thefacial nerve which provides themorphological foundation toalleviate symptoms of FNP [48] The combination of Hegu(LI4) and Jiache (ST6) stimulates more peripheral nervescompared with needling a single acupoint of them

5 Limitations

There are some limitations of this study Although the mod-eling method in this study is more consistent with the naturalpathogenesis of FNP the model rate is relatively lower thanthat of compressing the facial nerve Additionally this studyshows the potential of acupuncture in triggering a patientrsquosimmunoreaction to further reduce HSV-1 quantity Howeverthis study is insufficient to fully elucidate the mechanismof acupuncture in reducing HSV-1 quantity Future studiesmight be directed toward elucidating this mechanism suchas the relationship between acupuncture and NF-120581B in FNPin vivo

6 Conclusions

Weconcluded that in the treatment for FNP electroacupunc-ture alleviates symptoms facilitates affected nerve recoveryand promotes the reduction in HSV-1 Acupuncture mighthave therapeutic advantages in controlling inflammation andinfection in FNP

Conflict of Interests

The authors declare no conflict of interests

Authorsrsquo Contribution

Hongzhi Tang and Shuwei Feng contributed equally to thework

Acknowledgments

This study was supported by the National Basic ResearchProgram of China (no 2012CB518501) and the ResearchFund for the Doctoral Program of Higher Education (no20105132110003)

References

[1] J Finsterer ldquoManagement of peripheral facial nerve palsyrdquoEuropean Archives of Oto-Rhino-Laryngology vol 265 no 7 pp743ndash752 2008

[2] H C Slavkin ldquoThe significance of a human smile observationson Bellrsquos palsyrdquo Journal of the American Dental Association vol130 no 2 pp 269ndash272 1999

[3] M Shaw F Nazir and I Bone ldquoBellrsquos palsy a study of thetreatment advice given by neurologistsrdquo Journal of NeurologyNeurosurgery and Psychiatry vol 76 no 2 pp 293ndash294 2005

[4] N J Holland and G M Weiner ldquoRecent developments in Bellrsquospalsyrdquo British Medical Journal vol 329 no 7474 pp 553ndash5572004

[5] A G Marson and R Salinas ldquoBellrsquos palsyrdquo Western Journal ofMedicine vol 173 no 4 pp 266ndash268 2000

[6] N A Brandenburg and J F Annegers ldquoIncidence and riskfactors for Bellrsquos palsy in Laredo Texas 1974ndash1982rdquo Neuroepi-demiology vol 12 no 6 pp 313ndash325 1993

[7] Q D Yang Neurology Peoplersquos Medical Publishing HouseBeijing China 2002

[8] C A J Prescott ldquoIdiopathic facial nerve palsyrdquo Journal ofLaryngology and Otology vol 102 no 5 pp 403ndash407 1988

[9] B Lorber ldquoAre all diseases infectiousrdquo Annals of InternalMedicine vol 125 no 10 pp 844ndash851 1996

[10] C Atzema and R D Goldman ldquoShould we use steroids to treatchildren with Bellrsquos palsyrdquo Canadian Family Physician vol 52pp 313ndash314 2006

[11] S Axelsson S Lindberg and A Stjernquist-Desatnik ldquoOut-come of treatment with valacyclovir and prednisone in patientswith Bellrsquos palsyrdquoAnnals of Otology Rhinology and Laryngologyvol 112 no 3 pp 197ndash201 2003

[12] J Schirm and P S J ZMulkens ldquoBellrsquos palsy and herpes simplesvirusrdquo Acta Pathologica Microbiologica et Immunologica Scan-dinavica vol 105 no 7ndash12 pp 815ndash823 1997

[13] K K Adour J M Ruboyianes P G von Doersten et al ldquoBellrsquospalsy treatment with acyclovir and prednisone compared withprednisone alone a double-blind randomized controlled trialrdquoAnnals of Otology Rhinology and Laryngology vol 105 no 5 pp371ndash378 1996

[14] S Murakami M Mizobuchi Y Nakashiro T Doi N Hatoand N Yanagihara ldquoBellrsquos palsy and herpes simplex virusidentification of viral DNA in endoneurial fluid and musclerdquoAnnals of Internal Medicine vol 124 no 1 part 1 pp 27ndash301996

[15] Y Furuta S Fukuda S Chida et al ldquoReactivation of herpessimplex virus type 1 in patients with Bellrsquos palsyrdquo Journal ofMedical Virology vol 54 pp 162ndash166 1998

[16] C G Jackson and P G von Doersten ldquoThe facial nerve currenttrends in diagnosis treatment and rehabilitationrdquo MedicalClinics of North America vol 83 no 1 pp 179ndash195 1999

[17] K K Adour ldquoOtological complications of herpes zosterrdquoNeurology vol 35 no 1 pp S62ndashS64 1994

Evidence-Based Complementary and Alternative Medicine 7

[18] N Hato H Yamada H Kohno et al ldquoValacyclovir and pred-nisolone treatment for Bellrsquos palsy amulticenter randomizedplacebo-controlled studyrdquoOtology ampNeurotology vol 28 no 3pp 408ndash413 2007

[19] K Kawaguchi H Inamura Y Abe et al ldquoReactivation ofherpes simplex virus type 1 and varicella-zoster virus andtherapeutic effects of combination therapy with prednisoloneand valacyclovir in patients with Bellrsquos palsyrdquoThe Laryngoscopevol 117 no 1 pp 147ndash156 2007

[20] F R Liang Y Li S G Yu et al ldquoA multicentral randomizedcontrol study on clinical acupuncture treatment of Bellrsquos palsyrdquoJournal of Traditional Chinese Medicine vol 26 no 1 pp 3ndash72006

[21] Y Qu ldquoClinical observation on acupuncture by stages com-bined with exercise therapy for treatment of Bell palsy at acutestagerdquo Chinese Acupuncture and Moxibustion vol 25 no 8 pp545ndash547 2005

[22] Y Li F R Liang S G Yu et al ldquoEfficacy of acupuncture andmoxibustion in treating Bellrsquos palsy a multicenter randomizedcontrolled trial in Chinardquo Chinese Medical Journal vol 117 no10 pp 1502ndash1506 2004

[23] H Takahashi N Hato N Honda et al ldquoEffects of acyclovir onfacial nerve paralysis induced by herpes simplex virus type 1 inmicerdquo Auris Nasus Larynx vol 30 no 1 pp 1ndash5 2003

[24] N Honda N Hato H Takahashi et al ldquoPathophysiology offacial nerve paralysis induced by herpes simplex virus type 1infectionrdquo Annals of Otology Rhinology and Laryngology vol111 no 7 pp 616ndash622 2002

[25] T Sugita S Murakami N Yanagihara Y Fujiwara Y HirataandTKurata ldquoFacial nerve paralysis induced by herpes simplexvirus in mice an animal model of acute and transient facialparalysisrdquo Annals of Otology Rhinology and Laryngology vol104 no 7 pp 574ndash581 1995

[26] S Murakami N Hato M Mizobuchi T Doi and N Yanagi-hara ldquoRole of herpes simplex virus infection in the pathogenesisof facial paralysis in micerdquo Annals of Otology Rhinology andLaryngology vol 105 no 1 pp 49ndash53 1996

[27] H Takahashi Y Hitsumoto N Honda et al ldquoMouse model ofBellrsquos palsy induced by reactivation of herpes simplex virus type1rdquo Journal of Neuropathology and Experimental Neurology vol60 no 6 pp 621ndash627 2001

[28] S G Yu and Y Guo Experimental Acupuncture ShanghaiScience and Technology Press Shanghai China 2009

[29] A Greco A GalloM Fusconi CMarinelli G FMacri andMde Vincentiis ldquoBellrsquos palsy and autoimmunityrdquo AutoimmunityReviews vol 12 no 2 pp 323ndash328 2012

[30] M Yilmaz M Tarakcioglu N Bayazit Y A Bayazit MNamiduru and M Kanlikama ldquoSerum cytokine levels in bellrsquospalsyrdquo Journal of the Neurological Sciences vol 197 no 1-2 pp69ndash72 2002

[31] M Apostolaki M Armaka P Victoratos and G Kollias ldquoCel-lular mechanisms of TNF function in models of inflammationand autoimmunityrdquoCurrent Directions in Autoimmunity vol 11pp 1ndash26 2010

[32] C Larsson C Bernstrom-Lundberg S Edstrom and TBergstrom ldquoTumor necrosis factor-120572 response and herpesvirusinfection in Bellrsquos palsyrdquo The Laryngoscope vol 108 no 8 part1 pp 1171ndash1176 1998

[33] A V Delgado A T McManus and J P Chambers ldquoProductionof tumor necrosis factor-120572 interleukin 1-120573 interleukin 2 andinterleukin 6 by rat leukocyte subpopulations after exposure tosubstance Prdquo Neuropeptides vol 37 no 6 pp 355ndash361 2003

[34] H J Jeong S H Hong Y C Nam et al ldquoThe effect of acupunc-ture on proinflammatory cytokine production in patients withchronic headache a preliminary reportrdquoThe American Journalof Chinese Medicine vol 31 no 6 pp 945ndash954 2003

[35] Y S Son H J Park O B Kwon S Jung H Shin and S LimldquoAntipyretic effects of acupuncture on the lipopolysaccharide-induced fever and expression of interleukin-6 and interleukin-1120573 mRNAs in the hypothalamus of ratsrdquo Neuroscience Lettersvol 319 no 1 pp 45ndash48 2002

[36] R Torres-Rosas G Yehia G Pena et al ldquoDopamine mediatesvagal modulation of the immune system by electroacupunc-turerdquo Nature Medicine vol 20 no 3 pp 291ndash295 2014

[37] A Patel J Hanson T I McLean et al ldquoHerpes simplex virustype 1 induction of persistent NF-kappaB nuclear translocationincreases the efficiency of virus replicationrdquo Virology vol 247no 2 pp 212ndash222 1998

[38] M S Hayden and S Ghosh ldquoSignaling to NF-kappaBrdquoGenes ampDevelopment vol 18 no 18 pp 2195ndash2224 2004

[39] N D Perkins ldquoIntegrating cell-signalling pathways with NF-kappaB and IKK functionrdquo Nature Reviews Molecular CellBiology vol 8 no 1 pp 49ndash62 2007

[40] M L Goodkin A T Ting and J A Blaho ldquoNF-kappaB isrequired for apoptosis prevention during herpes simplex virustype 1 infectionrdquo Journal of Virology vol 77 no 13 pp 7261ndash7280 2003

[41] X R Zhang XWang C L Sun et al ldquoExpression of NF- KB inspinal ganglia of CIA rats and therapeutic action of acupunctureJiaji pointsrdquo Modern Journal of Integrated Traditional Chineseand Western Medicine vol 16 no 11 pp 1460ndash1462 2007

[42] L Zhou H X Zhang Q Wang et al ldquoEffect of scalp acupunc-ture on the expression of NF-JB mRNA COX-2 mRNA andtheir proteins in rats with acute cerebral ischemia-reperfusioninjuryrdquo Acupuncture Research vol 34 no 5 pp 304ndash308 2009

[43] M Bianchi E Jotti P Sacerdote and A E Panerai ldquoTraditionalacupuncture increases the content of 120573-endorphin in immunecells and influences mitogen induced proliferationrdquoThe Ameri-can Journal of Chinese Medicine vol 19 no 2 pp 101ndash104 1991

[44] F Petti A Bangrazi A Liguori G Reale and F Ippoliti ldquoEffectsof acupuncture on immune response related to opioid-likepeptidesrdquo Journal of Traditional Chinese Medicine vol 18 no1 pp 55ndash63 1998

[45] BWu ldquoEffect of acupuncture on the regulation of cell-mediatedimmunity in the patients with malignant tumorsrdquo AcupunctureResearch vol 20 no 3 pp 67ndash71 1995

[46] X H Jing H Cai B Lu et al ldquoStudy on morphologicalfoundation of point LI 4 treating diseases in the face andmouthrdquo Chinese Acupuncture and Moxibustion vol 23 no 2pp 109ndash110 2003

[47] S l Chen Z G Jin X H Jing et al ldquoMorphological study onthe afferent pathways of ldquoHegurdquo point and mouth-face regionrdquoAcupuncture Research vol 29 no 3 pp 217ndash221 2004

[48] Z Xu ldquoAnatomic basis for the treatment of facial paralysis bydicang-through-jiache acupuncturerdquo Shanghai Journal of Acu-Mox vol 27 no 4 pp 35ndash37 2008

Submit your manuscripts athttpwwwhindawicom

Stem CellsInternational

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

MEDIATORSINFLAMMATION

of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Behavioural Neurology

EndocrinologyInternational Journal of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Disease Markers

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

BioMed Research International

OncologyJournal of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Oxidative Medicine and Cellular Longevity

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

PPAR Research

The Scientific World JournalHindawi Publishing Corporation httpwwwhindawicom Volume 2014

Immunology ResearchHindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Journal of

ObesityJournal of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Computational and Mathematical Methods in Medicine

OphthalmologyJournal of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Diabetes ResearchJournal of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Research and TreatmentAIDS

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Gastroenterology Research and Practice

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Parkinsonrsquos Disease

Evidence-Based Complementary and Alternative Medicine

Volume 2014Hindawi Publishing Corporationhttpwwwhindawicom

Evidence-Based Complementary and Alternative Medicine 7

[18] N Hato H Yamada H Kohno et al ldquoValacyclovir and pred-nisolone treatment for Bellrsquos palsy amulticenter randomizedplacebo-controlled studyrdquoOtology ampNeurotology vol 28 no 3pp 408ndash413 2007

[19] K Kawaguchi H Inamura Y Abe et al ldquoReactivation ofherpes simplex virus type 1 and varicella-zoster virus andtherapeutic effects of combination therapy with prednisoloneand valacyclovir in patients with Bellrsquos palsyrdquoThe Laryngoscopevol 117 no 1 pp 147ndash156 2007

[20] F R Liang Y Li S G Yu et al ldquoA multicentral randomizedcontrol study on clinical acupuncture treatment of Bellrsquos palsyrdquoJournal of Traditional Chinese Medicine vol 26 no 1 pp 3ndash72006

[21] Y Qu ldquoClinical observation on acupuncture by stages com-bined with exercise therapy for treatment of Bell palsy at acutestagerdquo Chinese Acupuncture and Moxibustion vol 25 no 8 pp545ndash547 2005

[22] Y Li F R Liang S G Yu et al ldquoEfficacy of acupuncture andmoxibustion in treating Bellrsquos palsy a multicenter randomizedcontrolled trial in Chinardquo Chinese Medical Journal vol 117 no10 pp 1502ndash1506 2004

[23] H Takahashi N Hato N Honda et al ldquoEffects of acyclovir onfacial nerve paralysis induced by herpes simplex virus type 1 inmicerdquo Auris Nasus Larynx vol 30 no 1 pp 1ndash5 2003

[24] N Honda N Hato H Takahashi et al ldquoPathophysiology offacial nerve paralysis induced by herpes simplex virus type 1infectionrdquo Annals of Otology Rhinology and Laryngology vol111 no 7 pp 616ndash622 2002

[25] T Sugita S Murakami N Yanagihara Y Fujiwara Y HirataandTKurata ldquoFacial nerve paralysis induced by herpes simplexvirus in mice an animal model of acute and transient facialparalysisrdquo Annals of Otology Rhinology and Laryngology vol104 no 7 pp 574ndash581 1995

[26] S Murakami N Hato M Mizobuchi T Doi and N Yanagi-hara ldquoRole of herpes simplex virus infection in the pathogenesisof facial paralysis in micerdquo Annals of Otology Rhinology andLaryngology vol 105 no 1 pp 49ndash53 1996

[27] H Takahashi Y Hitsumoto N Honda et al ldquoMouse model ofBellrsquos palsy induced by reactivation of herpes simplex virus type1rdquo Journal of Neuropathology and Experimental Neurology vol60 no 6 pp 621ndash627 2001

[28] S G Yu and Y Guo Experimental Acupuncture ShanghaiScience and Technology Press Shanghai China 2009

[29] A Greco A GalloM Fusconi CMarinelli G FMacri andMde Vincentiis ldquoBellrsquos palsy and autoimmunityrdquo AutoimmunityReviews vol 12 no 2 pp 323ndash328 2012

[30] M Yilmaz M Tarakcioglu N Bayazit Y A Bayazit MNamiduru and M Kanlikama ldquoSerum cytokine levels in bellrsquospalsyrdquo Journal of the Neurological Sciences vol 197 no 1-2 pp69ndash72 2002

[31] M Apostolaki M Armaka P Victoratos and G Kollias ldquoCel-lular mechanisms of TNF function in models of inflammationand autoimmunityrdquoCurrent Directions in Autoimmunity vol 11pp 1ndash26 2010

[32] C Larsson C Bernstrom-Lundberg S Edstrom and TBergstrom ldquoTumor necrosis factor-120572 response and herpesvirusinfection in Bellrsquos palsyrdquo The Laryngoscope vol 108 no 8 part1 pp 1171ndash1176 1998

[33] A V Delgado A T McManus and J P Chambers ldquoProductionof tumor necrosis factor-120572 interleukin 1-120573 interleukin 2 andinterleukin 6 by rat leukocyte subpopulations after exposure tosubstance Prdquo Neuropeptides vol 37 no 6 pp 355ndash361 2003

[34] H J Jeong S H Hong Y C Nam et al ldquoThe effect of acupunc-ture on proinflammatory cytokine production in patients withchronic headache a preliminary reportrdquoThe American Journalof Chinese Medicine vol 31 no 6 pp 945ndash954 2003

[35] Y S Son H J Park O B Kwon S Jung H Shin and S LimldquoAntipyretic effects of acupuncture on the lipopolysaccharide-induced fever and expression of interleukin-6 and interleukin-1120573 mRNAs in the hypothalamus of ratsrdquo Neuroscience Lettersvol 319 no 1 pp 45ndash48 2002

[36] R Torres-Rosas G Yehia G Pena et al ldquoDopamine mediatesvagal modulation of the immune system by electroacupunc-turerdquo Nature Medicine vol 20 no 3 pp 291ndash295 2014

[37] A Patel J Hanson T I McLean et al ldquoHerpes simplex virustype 1 induction of persistent NF-kappaB nuclear translocationincreases the efficiency of virus replicationrdquo Virology vol 247no 2 pp 212ndash222 1998

[38] M S Hayden and S Ghosh ldquoSignaling to NF-kappaBrdquoGenes ampDevelopment vol 18 no 18 pp 2195ndash2224 2004

[39] N D Perkins ldquoIntegrating cell-signalling pathways with NF-kappaB and IKK functionrdquo Nature Reviews Molecular CellBiology vol 8 no 1 pp 49ndash62 2007

[40] M L Goodkin A T Ting and J A Blaho ldquoNF-kappaB isrequired for apoptosis prevention during herpes simplex virustype 1 infectionrdquo Journal of Virology vol 77 no 13 pp 7261ndash7280 2003

[41] X R Zhang XWang C L Sun et al ldquoExpression of NF- KB inspinal ganglia of CIA rats and therapeutic action of acupunctureJiaji pointsrdquo Modern Journal of Integrated Traditional Chineseand Western Medicine vol 16 no 11 pp 1460ndash1462 2007

[42] L Zhou H X Zhang Q Wang et al ldquoEffect of scalp acupunc-ture on the expression of NF-JB mRNA COX-2 mRNA andtheir proteins in rats with acute cerebral ischemia-reperfusioninjuryrdquo Acupuncture Research vol 34 no 5 pp 304ndash308 2009

[43] M Bianchi E Jotti P Sacerdote and A E Panerai ldquoTraditionalacupuncture increases the content of 120573-endorphin in immunecells and influences mitogen induced proliferationrdquoThe Ameri-can Journal of Chinese Medicine vol 19 no 2 pp 101ndash104 1991

[44] F Petti A Bangrazi A Liguori G Reale and F Ippoliti ldquoEffectsof acupuncture on immune response related to opioid-likepeptidesrdquo Journal of Traditional Chinese Medicine vol 18 no1 pp 55ndash63 1998

[45] BWu ldquoEffect of acupuncture on the regulation of cell-mediatedimmunity in the patients with malignant tumorsrdquo AcupunctureResearch vol 20 no 3 pp 67ndash71 1995

[46] X H Jing H Cai B Lu et al ldquoStudy on morphologicalfoundation of point LI 4 treating diseases in the face andmouthrdquo Chinese Acupuncture and Moxibustion vol 23 no 2pp 109ndash110 2003

[47] S l Chen Z G Jin X H Jing et al ldquoMorphological study onthe afferent pathways of ldquoHegurdquo point and mouth-face regionrdquoAcupuncture Research vol 29 no 3 pp 217ndash221 2004

[48] Z Xu ldquoAnatomic basis for the treatment of facial paralysis bydicang-through-jiache acupuncturerdquo Shanghai Journal of Acu-Mox vol 27 no 4 pp 35ndash37 2008

Submit your manuscripts athttpwwwhindawicom

Stem CellsInternational

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

MEDIATORSINFLAMMATION

of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Behavioural Neurology

EndocrinologyInternational Journal of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Disease Markers

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

BioMed Research International

OncologyJournal of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Oxidative Medicine and Cellular Longevity

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

PPAR Research

The Scientific World JournalHindawi Publishing Corporation httpwwwhindawicom Volume 2014

Immunology ResearchHindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Journal of

ObesityJournal of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Computational and Mathematical Methods in Medicine

OphthalmologyJournal of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Diabetes ResearchJournal of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Research and TreatmentAIDS

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Gastroenterology Research and Practice

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Parkinsonrsquos Disease

Evidence-Based Complementary and Alternative Medicine

Volume 2014Hindawi Publishing Corporationhttpwwwhindawicom

Submit your manuscripts athttpwwwhindawicom

Stem CellsInternational

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

MEDIATORSINFLAMMATION

of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Behavioural Neurology

EndocrinologyInternational Journal of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Disease Markers

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

BioMed Research International

OncologyJournal of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Oxidative Medicine and Cellular Longevity

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

PPAR Research

The Scientific World JournalHindawi Publishing Corporation httpwwwhindawicom Volume 2014

Immunology ResearchHindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Journal of

ObesityJournal of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Computational and Mathematical Methods in Medicine

OphthalmologyJournal of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Diabetes ResearchJournal of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Research and TreatmentAIDS

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Gastroenterology Research and Practice

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Parkinsonrsquos Disease

Evidence-Based Complementary and Alternative Medicine

Volume 2014Hindawi Publishing Corporationhttpwwwhindawicom