调督和胃针法联合温针灸治疗贝尔面瘫的临床研究进展与疗效预测展望

Clinical Research Progress and Prospects of Efficacy Prediction for Tiaodu Hewei Acupuncture Combined with Warm Needling Moxibustion in the Treatment of Bell’s Palsy

摘要: 贝尔面瘫是临床最常见的急性周围性面神经麻痹，约占全部面神经疾病的60%~75%，年发病率为11.5~53.3/10万，具有较高的发病率与遗留后遗症的风险。针灸是贝尔面瘫重要的中医治疗手段，其中调督和胃针法联合温针灸足三里以“调督振阳、和胃化源”为核心治法，近年临床研究表明其对风寒型周围性面瘫的总有效率可达90%以上，在改善面神经功能、降低面部残疾指数方面具有明显优势。然而，贝尔面瘫的预后受临床表现、神经电生理、局部微循环及中医证候等多维度因素共同影响，不同患者对同一针灸方案的疗效存在显著异质性，现有研究多集中于群体层面的疗效验证，缺乏针对个体的疗效预测工具。近年来，机器学习与多模态数据融合技术的兴起为针灸疗效的个体化预测提供了新路径。本文系统梳理调督和胃针法联合温针灸治疗贝尔面瘫的理论基础与临床证据，总结疗效预测因素的研究进展，并展望多模态数据融合与机器学习在疗效预测中的应用前景与挑战，以期为该疗法的规范化推广与精准化决策提供参考。

Abstract: Bell’s palsy is the most common acute peripheral facial nerve palsy encountered in clinical practice, accounting for approximately 60%~75% of all facial nerve diseases, with an annual incidence of 11.5~53.3 per 100,000 population and a considerable risk of residual sequelae. Acupuncture is an important traditional Chinese medicine (TCM) therapy for Bell’s palsy. Among the various acupuncture approaches, Tiaodu Hewei acupuncture (acupuncture for regulating the Governor Vessel and harmonizing the stomach) combined with warm needling moxibustion at Zusanli (ST36) is based on the core principle of “regulating the Governor Vessel to invigorate yang and harmonizing the stomach to generate the source of qi and blood.” Recent clinical studies have demonstrated that this combined regimen achieves a total effective rate of over 90% for wind-cold type peripheral facial palsy, with marked advantages in improving facial nerve function and reducing the Facial Disability Index (FDI) score. However, the prognosis of Bell’s palsy is jointly influenced by multiple dimensions including clinical manifestations, neuroelectrophysiology, local microcirculation, and TCM syndrome patterns; patients show considerable heterogeneity in their responses to the same acupuncture regimen, and existing studies have focused mainly on efficacy verification at the population level, lacking individualized tools for efficacy prediction. In recent years, the emergence of machine learning and multimodal data fusion techniques has provided a new pathway for individualized prediction of acupuncture efficacy. This article systematically reviews the theoretical basis and clinical evidence of Tiaodu Hewei acupuncture combined with warm needling moxibustion in the treatment of Bell’s palsy, summarizes the research progress on efficacy predictors, and discusses the prospects and challenges of applying multimodal data fusion and machine learning to efficacy prediction, with a view to providing reference for the standardized promotion and precision decision-making of this therapy.