针刺疗法治疗周围性面瘫的临床研究进展

Clinical Research Advances in Acupuncture Therapy for Peripheral Facial Palsy

摘要: 周围性面瘫(PFP)是因面神经核或核下病变导致的同侧面部表情肌不同程度运动障碍性疾病。是临床最常见的颅神经疾病之一，具有起病急、后遗症发生率较高的特点。是针灸临床常见优势病种之一，以一侧面部表情肌运动障碍、额纹变浅或消失、眼睑闭合不全、口角歪斜等为主要表现，严重者可遗留面肌痉挛、联带运动、鳄鱼泪等后遗症，影响患者容貌、语言、进食及心理社会功能。近年来，针刺治疗PFP的临床研究不断增多，研究内容由单纯的疗效观察逐渐拓展至针刺方法优化。现有研究普遍认为，针刺可改善面神经功能，缩短病程，提高临床有效率，且急性期、静止期及时介入可能较恢复期后介入更具优势。然而，目前研究仍存在样本量偏小、随机和盲法实施不足、疗效标准不统一及机制研究与临床结局衔接不够等问题。针刺治疗PFP具有独特的治疗时机和临床优势，本文系统梳理了近年来针刺干预PFP在介入时机、分期治疗策略、毫针要素、电针参数及特殊针法等方面的临床研究进展，以期为临床针刺精准治疗PFP、提高治疗有效性和针对性提供研究方向。

Abstract: Peripheral facial palsy (PFP) is a disorder characterized by varying degrees of motor dysfunction in the facial muscles on the same side, caused by lesions involving the facial nerve nucleus or its subnuclear components. It is one of the most common cranial nerve disorders clinically, marked by acute onset and a relatively high incidence of sequelae. PFP is also one of the key conditions where acupuncture demonstrates significant therapeutic advantages. The main clinical manifestations include motor impairment of the facial muscles on one side, diminished or absent forehead wrinkles, incomplete eyelid closure, and deviation of the mouth corner. In severe cases, patients may develop long-term complications such as facial muscle spasm, synkinesis, and crocodile tears, which affect appearance, speech, eating, and psychosocial functioning. In recent years, clinical research on acupuncture treatment for PFP has increased significantly, with studies expanding from simple efficacy observation to optimization of acupuncture techniques. Current evidence generally supports that acupuncture can improve facial nerve function, shorten disease duration, and enhance clinical effectiveness. Early intervention during the acute and static phases appears to be more beneficial than delayed intervention in the recovery phase. However, existing studies still face limitations, including small sample sizes, inadequate randomization and blinding, inconsistent outcome measures, and insufficient integration between mechanistic research and clinical outcomes. Acupuncture for PFP offers unique timing advantages and clinical benefits. This article systematically reviews recent advances in acupuncture interventions for PFP, focusing on optimal timing, stage-specific treatment strategies, needle parameters, electroacupuncture settings, and specialized needling techniques, aiming to provide guidance for precise and targeted acupuncture therapy to improve treatment efficacy and specificity.