Efficacy of acupuncture combined with various traditional Chinese medicine therapies for peripheral facial paralysis: A systematic review and network meta-analysis

Background and purpose: This meta-analysis aimed to evaluate whether acupuncture combined with other traditional Chinese medicine (TCM) therapies is more effective in the treatment of peripheral facial palsy (PFP) than acupuncture alone. Methods: Eight databases were searched until May 2025. Two independent reviewers extracted relevant data on study characteristics and used the Cochrane Risk of Bias Assessment Tool 2 (RoB2) to assess the risk of bias of the included studies. Results: 266 articles were included. Results showed that compared with acupuncture alone, acupuncture combined with tuina and cupping (surface under the cumulative ranking curve (SUCRA) = 99.33%) was the most effective intervention for improving the overall effective rate; acupuncture combined with topical application of TCM (SUCRA = 90.61%) was the optimal approach for enhancing facial nerve function (House-Brackmann (HB) scale); acupuncture combined with herbal fumigation and steaming therapy (SUCRA = 80.40%) was the best intervention for improving social function (Facial Disability Index - Social Function (FDIS)) in patients with facial paralysis; acupuncture combined with pricking blood (SUCRA = 87.62%) was the most effective method for improving physical function (Facial Disability Index - Physical Function (FDIP)) in patients with facial paralysis; and acupuncture combined with cupping and pricking blood (SUCRA = 86.90%) was associated with the lowest incidence of adverse reactions. Conclusion: This study showed that interventions such as acupuncture+tuina+cupping, acupuncture+topical application of TCM, acupuncture+herbal fumigation and steaming therapy, and acupuncture+pricking blood are all associated with facial nerve recovery and demonstrate superior efficacy compared with acupuncture alone.