In the 2023 Guidelines for the Treatment of Facial Nerve Palsy, which were revised for the first time in 12 years, recommendations were made for two clinical questions regarding acupuncture and moxibustion: 1) Is acupuncture and moxibustion effective for early recovery from paralysis (acute phase) and 2) Is acupuncture and moxibustion effective for reducing symptoms of sequelae (chronic phase).　This paper describes the purpose of the guidelines, the process of creating them, the CQs for paralysis, and the use of the guidelines; the evidence for rehabilitation and the role played by certified rehabilitation instructors from the Japanese Facial Neurology Society; and the evidence for acupuncture and its role in treating paralysis.　In the future, the role of acupuncturists will be to work closely with medical institutions to understand the stage of paralysis, and to provide acupuncture and moxibustion treatment and self-care guidance according to the stage of the disease.

There is little common understanding among acupuncturists regarding the poor prognosis for peripheral facial paralysis, evaluation methods, precautions during treatment, including acupuncture and moxibustion treatment. Cooperation among relevant occupations is also a major issue. Currently, the treatment of paralysis is focused on how to minimize sequelae during the recovery process of paralysis in cases with poor prognosis. The goal is to prevent sequelae and improve patient quality of life (QOL). For that purpose, it is important to understand the guidelines for medical treatment of paralysis, and like other medical staff, the acupuncturist should provide appropriate medical examination, treatment, self-care guidance, etc., and cooperate with other medical specialists. We hope that this seminar will provide a common understanding of the pathophysiology and evaluation methods of paralysis, precautions for acupuncture and moxibustion treatment, and a consensus of clinical research and the future possibility of using acupuncture and moxibustion in the treatment of paralysis.

This paper introduces the 2023 guidelines for the treatment of facial nerve palsy, which have been revised for the first time in 12 years, mainly related to acupuncture. The purpose of this study is to assist medical professionals in selecting appropriate evaluation and treatment for paralyzed patients. In this revision, the two clinical questions on acupuncture and moxibustion are recommended: (1) Is acupuncture effective for early recovery from paralysis (acute phase)? Both have been reorganized from "not recommended" to "weakly recommended". Regarding these results, several systematic reviews have been published in which acupuncture intervention can be expected to be more effective than conventional treatment (control) in recovering from paralysis in the acute phase and reducing sequelae such as contracture and stiffness in the chronic phase. Among them, it is suggested that prevention and reduction of aftereffects in particular contribute to the improvement of quality of life. Acupuncture and moxibustion treatment and guidance on self-care are also considered to be the role of the acupuncturist.

[Objective] Peripheral facial paralysis with sequelae (PFPS) reduces the quality of life (QOL) of patients. However, not much information is available on acupuncture treatment (AT) for PFPS. We report a case of a patient with PFPS whose sequelae and QOL were successfully improved by a combination of medication, physical therapy (PT) and AT.[Case] A 42-year-old woman. Her chief complaint was facial tightness, facial asymmetry, and synkinesis.[History of present illness] Left paralysis developed in November X-1, and Bell's palsy was diagnosed. Yanagihara Score (YS) was 6 points. She received intravenous steroid treatment during hospitalization for 9 days after second week after onset. In addition, she was given facial nerve decompression on January 24, X. but there wasno change. Subsequently, she visited the Department of Otolaryngology-Head and Neck Surgery, The University of Tokyo on 24 April. Electroneurography was 4%, YS was16 points and synkinesis was found. AT was started from May 29, X. [Acupuncture treatment] We performed AT on muscle for facial expression for contractural reduction. Also, weinstructed self-care techniques such as massage, open-eyelid exercise, individual muscle strengthening exercise and matters that require attention in everyday life. AT was performed 19 times, once every one to two weeks.[Assessment and Progress] Measurements of YS, synkinesis, synkinetic potential (SP), Facial Clinimetric Evaluation Scale (FS) were evaluated at about 7 and 15 months after onset. YS (point) changed from 24 to 34, synkinesis changed from (++) to (+), SP did not change, FS (point) increased from 41 to 57.[Discussion and Conclusion] Treatment for PFPS is limited and reduces QOL. We added regular acupuncture treatment to medication and PT for PFPS. As a result, we were able to relieve sequelae, contributing to improvement in the quality of life. It is suggested that AT might have efficacy for PFPS.