Abstract
BACKGROUND: Post-stroke central facial paralysis (CFP) is a common post-stroke complication that affects the quality of life. The current conventional treatment has limitations in efficacy and safety. As a traditional medical therapy, acupuncture and moxibustion have shown potential in the treatment of facial paralysis, but the differences in efficacy of different acupuncture methods are still lacking a systematic comparison. OBJECTIVE: Compare the efficacy differences of different acupuncture methods or combined methods in treating CFP with acupuncture alone. METHODS: The system retrieved randomized controlled trials (RCTs) published in Chinese- and English-language databases through 1 January 2026. The eligible literature was screened. The risk of bias was evaluated using the RoB2 tool, and a network meta-analysis was conducted using the random-effects model within the framework of frequency analysis. The primary outcome indicators included total effective rate (TER) and facial disability index (FDI). Due to the different efficacy assessment criteria used in the original studies, the TER analysis was stratified according to the House-Brackmann (HB) grading standard and the "Chinese Traditional Medicine Disease Syndrome Diagnosis and Therapeutic Effect Standards" (Traditional Chinese Medicine [TCM]). The efficacy of the intervention measures was ranked using the Surface Under the Cumulative Ranking (SUCRA) curve value, and the quality of evidence was evaluated using the Confidence in Network Meta-Analysis (CINeMA) tool. RESULTS: A total of 22 RCTs were included, involving 1,888 patients and 8 types of acupuncture intervention measures. Based on the HB criteria, 9 studies showed that acupuncture combined with conventional treatment (AandCT, SUCRA = 0.84), acupuncture combined with traditional Chinese medicine (AandTCM, SUCRA = 0.73), and penetrating acupuncture combined with moxibustion (PNTandMT, SUCRA = 0.68) ranked the top in improving TER. Based on the TCM criteria, 10 studies showed that fire needle (FN, SUCRA = 0.82), acupuncture combined with traditional Chinese medicine (AandTCM, SUCRA = 0.79), and scalp acupuncture (SA, SUCRA = 0.78) ranked the top. Regarding FDI improvement, 15 studies showed that botulinum toxin type A combined with acupuncture (BTTAandA, SUCRA = 0.90), cupping combined with acupuncture (CandA, SUCRA = 0.81), and the penetrating needling technique combined with moxibustion (PNTandMT, SUCRA = 0.79) had the best efficacy. The heterogeneity test showed low heterogeneity across the studies, and no significant publication bias was found in the analysis. Evidence quality evaluation showed that approximately 70% of the evidence was of moderate or higher quality. CONCLUSION: Different acupuncture therapies have their own advantages in improving central facial palsy after stroke: based on the HB criteria, acupuncture combined with conventional treatment or traditional Chinese medicine has better effects; based on the TCM criteria, fire needle and head acupuncture perform well; in terms of improving patients' subjective function, botulinum toxin type A combined with acupuncture has a prominent advantage. The selection of acupuncture points centers on Hegu, Dicang, and Jiaqu, etc. The results of this study support acupuncture as a safe and cost-effective complementary therapy for clinical use, but future studies should further standardize the system for evaluating efficacy and conduct high-quality research to verify its long-term efficacy.