A 65-year-old retired woman first visited in early 2018. She had experienced depression and anxiety for about 10 years, and intermittent, predominantly one-sided involuntary facial twitching and spasms for 5 years. The spasms were clearly aggravated by stress, fatigue, and emotional fluctuation, and eased with rest. She had previously taken Chinese herbal medicine and received routine acupuncture for several months. Her sleep and mood improved significantly, but the facial spasms hardly changed. Because twitching affected her daily social life and self-image, she sought further care.
On examination, intermittent spasmodic twitching was observed on the affected side, involving the orbicularis oculi, zygomatic muscles, and orbicularis oris. The neck and upper back were generally tight and stiff. Multiple tender nodules and taut bands were palpated in the upper trapezius, levator scapulae, and splenius/upper cervical muscle groups. In the facial spasm area, several tender micro-nodules (ranging from rice-grain to soybean size) were palpable; pressing them could trigger or intensify twitching and reproduce a sore, aching discomfort. Her tongue was pale with a white greasy coating; sublingual veins were markedly distended (+++); the pulse was wiry, thin, and slippery. She did not have a recent CT/MRI report available and denied previous imaging showing a mass lesion or brainstem pathology. Routine blood pressure and blood glucose were essentially normal, and electromyography was not performed.
The working diagnoses were: Western medicine—hemifacial spasm; TCM—spasm syndrome with wind-phlegm obstructing the collaterals, with liver constraint generating wind and phlegm-stasis binding; Mini Ren-SNAN Acupuncture findings—dominant myofascial trigger points in the neck and upper back, forming a continuous abnormal high-tension chain from the neck-shoulder girdle to the skull base and facial expression muscles, with superficial nodules within the spasmodic facial muscles as a localized micro-structural lesion.
Treatment: Mini Ren-SNAN Acupuncture was performed using a sterile, single-use mini-blade needle (0.35 mm × 25 mm), with insertion depth controlled within subcutaneous tissue and superficial muscle layers, generally under 10 mm. Treatment began in the prone position with systematic palpation from the neck to the upper back, focusing on taut bands and tender nodules in the upper trapezius, levator scapulae, and splenius/upper cervical muscles. Shallow anti-nodule release was performed along the direction of muscle fibers using gentle lifting-thrusting and short fan-shaped micro-release. The patient was then treated in the supine position; tender micro-nodules in the orbicularis oculi, zygomatic muscles, and orbicularis oris were located, and the blade edge was kept parallel to muscle fibers for shallow micro-release, with careful avoidance of vessels and nerves throughout. Each treatment lasted about 10–15 minutes, 1–2 times per week, with an initial course of three sessions.
After the first treatment, the patient immediately felt her neck and upper back become lighter and more relaxed. The frequency and intensity of facial twitching decreased noticeably, and she reported whole-body relaxation with improved sleep that same night. After three treatments, hemifacial spasm episodes had essentially disappeared; only occasional mild twitching occurred during emotional stress and no longer affected daily life or social interaction. At 3–6 months follow-up, there was no obvious relapse, and her mood and sleep remained more stable than before.
Discussion: This case had been treated for years mainly as an emotional or neurological regulation problem. While that approach improved sleep and mood, it overlooked the key, treatable physical drivers: a persistent neck-to-skull-base high-tension chain and palpable micro-nodules inside the spasmodic facial muscles. Chronic cervico-shoulder fascial tightness can maintain traction and irritation around the skull base; when pressing a facial nodule reliably reproduces twitching, it often signals a local structural “switch” that fuels abnormal firing. Mini Ren-SNAN Acupuncture addressed the issue in the order that matters—reducing upstream traction first and then releasing the local nodular lesion—so mechanical irritation drops and the spasm loses its driver. For many long-standing hemifacial spasm patients, careful hands-on assessment can reveal what scans do not show, and targeted release can be a turning point when other therapies stall.
Suggest to the patients who are suffering from this issues: If your facial twitching has lasted for months or years and worsens with stress or fatigue—especially if you also feel chronic tightness in the neck and shoulders, or you can find tender “knots” on the face that trigger pulling or twitching when pressed—don’t just live with it. Book an appointment to meet Dr. Guojian Huang to discuss your condition and whether Mini Ren-SNAN Acupuncture may be suitable for you. Appointment link: https://ankang.cliniko.com/bookings#service