Objective By clinical observation, the clinical efficacy of facial acupuncture guided by fascia and meridian sinew combined with balanced acupuncture in the treatment of acute peripheral facial paralysis was discussed. Methods Patients with peripheral facial paralysis were randomly divided into observation group and control group. There were 36 cases in each group, and the control group was treated with ordinary acupuncture. However, the observation group was treated with balanced acupuncture combined with facial acupuncture for 2 weeks after treatment. The clinical efficacy of the two groups was evaluated, comparing the scores of facial nerve function and facial nerve paralysis symptoms between the two groups. Results The results showed that the total effective rate of the observation group was 75.00% higher than that of the control group 47.22% (P＜0.05). Conclusion The balance needle combined with the facial needle guided by fascia and meridian theory can effectively improve the facial nerve function of patients with acute peripheral facial paralysis and reduce facial muscle injury and facial muscle injury and effectively improve its symptoms and signs. It is helpful for further improving the clinical therapeutic effect and shortening the course of treatment.