Mechanism of Qihuang needle therapy in the management of tic disorders: a clinical trial protocol.

Background: Qihuang needle therapy is a newly developed acupuncture therapy to treat tic disorders in clinical practice. However, the mechanism to reduce tic severity remains unknown. Changes in intestinal flora and circulation metabolites are perhaps the potential pathogenesis of tic disorders. As a result, we present a protocol for a controlled clinical trial using multi-omics analysis to probe the mechanism of the Qihuang needle in managing tic disorders. Methods: This is a matched-pairs design, controlled, clinical trial for patients with tic disorders. Participants will be allocated to either an experimental group or a healthy control group. The main acupoints are Baihui (GV20), Yintang (EX-HN3), and Jueyinshu (BL14). The experimental group will receive Qihuang needle therapy for a month, while the control group will receive no interventions. Expected outcomes: The change in the severity of the tic disorder is set as the main outcome. Secondary outcomes include gastrointestinal severity index and recurrence rate, which will be calculated after a 12-week follow-up. Gut microbiota, measured by 16S rRNA gene sequencing; serum metabolomics, assessed via LC/MS; and serum zonulin, assessed by enzyme-linked immunosorbent assay (ELISA), will be used as biological specimen analysis outcomes. The present study will investigate the possible interactions between intestinal flora and serum metabolites and the improvement of clinical profiles, which may elucidate the mechanism of Qihuang needle therapy for tic disorders. Trial registration: This trial is registered at the Chinese Clinical Trial Registry (http://www.chictr.org.cn/). Registration number: ChiCTR2200057723, Date: 2022-04-14.

Case report: Tongdu Xingshen acupuncture for a patient with persistent vegetative state after herpes simplex virus encephalitis.

Introduction: A persistent vegetative state (PVS) can be caused by traumatic or non-traumatic brain injury. PVS is a complex clinical condition with numerous complications. Nursing care, medical treatment, and comprehensive rehabilitation are necessary to improve the outcomes of PVS. However, the prognosis remains unsatisfactory. Acupuncture therapy has been used as a rehabilitation strategy to treat patients with PVS in China, showing better results in the recovery of consciousness, intellectual capability, and motor function. Case description: We present the case of a 4-month-long PVS after herpes simplex virus encephalitis (HSVE) in a 3.5-year-old boy who underwent Tongdu Xingshen acupuncture integrated with Western medicine and rehabilitation. The patient regained consciousness post-treatment. His intelligence and motor function gradually recovered after seven treatment sessions. Conclusion: Tongdu Xingshen acupuncture is a potential complementary therapy to optimize clinical outcomes in PVS.

[Effect of acupoint catgut embedding therapy on joint attention and social communication in children with autism spectrum disorder: a randomized controlled trial].

OBJECTIVE: To compare the clinical effect on the joint attention and social communication in children with autism spectrum disorder (ASD) between the combined treatment of acupoint catgut embedding therapy with rehabilitation training and the simple application of rehabilitation training. METHODS: A total of 60 children with ASD were randomized into an observation group and a control group, 30 cases in each one. In the control group, the routine ASD rehabilitation training was adopted, including conductive education, speech training and music therapy, once a day. In the observation group, on the base of the treatment as the control group, the catgut embedding therapy was applied to Shenting (GV 24), Baihui (GV 20), Shenmen (HT 7) and the optic area (the point of scalp acupuncture), once a week. In the two groups, the treatment for 4 weeks was as one course, at the interval of 1 week between the courses. A total of 3 courses of treatment were required. The social domain of the autism treatment evaluation checklist (ATEC) and the autism behavior checklist (ABC) were adopted to assess the therapeutic effect of the two groups. RESULTS: After treatment, the scores of each item of the social domain in ATEC and the scores of ABC (feeling, communication, physical movement, language and healthy behavior) were all lower than those before treatment in the two groups (P<0.01). The scores of each item in the observation group were lower than those in the control group after treatment (P<0.05). CONCLUSION: The combined treatment of acupoint catgut embedding therapy with the rehabilitation training effectively improves in the joint attention and social communication. The therapeutic effect of this combined treatment is better than the simple application of rehabilitation training.

[Effect of acupoint thread-embedding therapy on the sitting ability of ataxia children with cerebral palsy].

OBJECTIVE: To investigate the effective of acupoint thread-embedding therapy for ataxia children with cerebral palsy. METHODS: A total of 70 ataxia children with cerebral palsy and a Gross Motor Function Measure (GMFM, Dimension B) score of <35 were enrolled and randomly divided into thread-embedding group and control group, with 35 children in each group, and 2 children in the thread-embedding group were lost to follow-up. The children in the control group were given routine rehabilitation treatment, including physical therapy, spleen-strengthening, kidney-nourishing, and Governor Vessel-regulating massage, vibroacoustic therapy, and scalp acupuncture, and those in the thread-embedding group were given thread-embedding therapy at the acupoints of Jianyu (LI15), Jianliao (SJ14), Tianzong (SI11), Tianshu (ST25), and HuatuoJiaji points (C4, L1 and L4) in addition to the treatment in the control group, with 6-8 acupoints selected each time, once a week. Each course of treatment was 4 weeks, with an interval of one week between two courses of treatment, and the children were treated for 3 courses. Level of sitting scale (LSS), incurvation reflex, and GMFM score were recorded to evaluate the improvement in sitting ability and clinical outcome. RESULTS: Both groups had significant improvements in LSS, incurvation reflex, and GMFM (Dimension A and B) score after treatment (P<0.01), and the thread-embedding group had significantly greater improvements than the control group (P<0.01). The thread-embedding group had a significantly higher overall response rate than the control group (90.9% [30/33] vs 68.5% [24/35], P<0.01). CONCLUSION: In addition to routine rehabilitation treatment, acupoint thread-embedding therapy can effectively suppress primitive reflex in ataxia children with cerebral palsy and significantly promote their sitting ability, and therefore, it is an effective acupuncture treatment method for ataxia children with cerebral palsy.

[Effects of scalp acupuncture on brain injury in premature infants with different months of age].

OBJECTIVE: To explore the clinical efficacy differences of scalp acupuncture on brain injury in premature infants with different months of age. METHODS: According to the corrected months of age, 90 cases of premature infants with brain injury were divided into a group A (3 through 6 corrected months of age), a group B (7 through 9 corrected months of age) and group C (10 through 12 corrected months of age), 30 patients in each one. Based on the conventional early intervention, the infants in the group A were treated with scalp acupuncture at Zhiqizhen, motor area; the infants in the group B were treated with scalp acupuncture at Zhiqizhen, motor area and foot motor sensory area; the infants in the group C were treated with scalp acupuncture at Zhiqizhen, motor area, foot motor sensory area and balance area. All the treatment was given once every other day, and totally 30 treatments were given. The Alberta infant motor scale (AIMS), development quotient (DQ) of each function indexes in Gesell developmental scale (GDS) were observed before and after treatment; the clinical efficacy of each group was compared and the correlation between clinical efficacy and months of age was analyzed. RESULTS: Compared before treatment, the total score of AIMS and DQ of each function indexes of GDS were all improved in the three groups after treatment (all P<0.01). After treatment, the differences of total score of AIMS and DQ of each function indexes of GDS among the three groups were significant (P<0.05, P<0.01), and the results in the group A were higher than those in the group B and the group C (P<0.05, P<0.01). The total effective rate was 96.3% (26/27) in the group A, which was higher than 89.7% (26/29) in the group B and 83.3% (25/30) in the group C. The correlation analysis indicated less months of age was significantly corelated with better efficacy (P<0.05). CONCLUSION: Scalp acupuncture has superior improvement on the recovery of brain damage in premature infants, especially for those with 6 months of age or less.

[Study of optimal parameters of scalp electroacupuncture for rehabilitation effect on children of cerebral palsy].

OBJECTIVE: To analyze the effect difference of wave, intensity, time and treatment frequency by orthogonal design so as to explore the optimal parameters of scalp electroacupuncture (EA) for rehabilitation effect on children of cerebral palsy. METHODS: Ninety children of cerebral palsy were assigned into 9 groups by orthogonal design, 10 cases in each one. The acupoints were bilateral excitable area, foot motor sensory area, speech two area, speech three area, balance area, and intelligent nine acupoints, including Shenting (GV 24), Sishencong (EX-HN 1), and bilateral Benshen (GB 13) and Touwei (ST 8). EA was applied at bilateral excitable area and speech three area. We designed an orthogonal experiment with four factors and three levels. We studied wave (sparse wave of 2 Hz, density wave of 100 Hz, sparse and density wave of 2 Hz /100 Hz), intensity (1 mA, 2 mA, intensity based on tolerance), time (10 min, 20 min, 30 min), frequency (once a day, once every other day, twice a week). The Gesell developmental scale was used to evaluate the developmental quotient (DQ); and gross motor function measure (GMFM), motor function before and after treatment. RESULTS: The optimal parameters for DQ and GMFM were 2 Hz/100 Hz, 20 min, once every other day. . CONCLUSION: The optimal parameters for cerebral palsy may be 2 Hz/100 Hz, 20 min, once every other day.

[Acupuncture based on nourishing spleen and kidney and dredging the governor vessel for motor function and ADL in children with spastic cerebral palsy].

OBJECTIVE: To compare the effects of acupuncture based on nourishing spleen and kidney and dre-dging the governor vessel (GV) combined with rehabilitation and simple rehabilitation for children with spastic cere-bral palsy. METHODS: One hundred and twenty patients were randomly assigned into an observation group and a control group, 60 cases in each one. Physicotherapeutics and hand function training were used in the control group for 3 sessions with 20 d at the interval, 20 times as one session, once a day. Based on the treatment of the control group, acupuncture of nourishing spleen and kidney and dredging GV was applied in the observation group for 3 sessions with 20 d at the interval, 10 times as one session, once every other day. The acupoints were Baihui (GV 20), Fengfu (GV 16), Shenzhu (GV 12), Zhiyang (GV 9), Jinsuo (GV 8), Yaoyangguan (GV 3), Mingmen (GV 4), Pishu (BL 20), Shenshu (BL 23), Zusanli (ST 36) and Sanyinjiao (SP 6). Gross motor function measure (GMFM), Peabody developmental fine motor scale and activities of daily living (ADL) scale were observed before and after treatment in the two groups. RESULTS: After treatment, the scores of GMFM and Peabody fine motor were apparently improved compared with those before treatment in the two groups (P<0.01, P<0.05), with better results in the observation group (both P<0.05). The total effective rate in the observation group was 76.7% (46/60), which was obviously better than 65.0% (39/60) in the control group (P<0.05). CONCLUSIONS: Acupuncture based on nourishing spleen and kidney and dredging the governor vessel, as an assisted method for children with spastic cerebral palsy, can effectively improve gross and fine moter functions and activities of daily living.

[Scalp acupuncture for epileptiform discharges of children with cerebral palsy].

OBJECTIVE: To explore the effect of scalp acupuncture for children with cerebral palsy whose video-electroencephalogram(VEEG) showed epileptiform discharges. METHODS: A total of 184 children with cerebral palsy whose VEEG showed epileptiform discharges or those combined with epilepsy were randomly assigned into a combination group (99 cases) and a rehabilitation group (85 cases). All the cases were treated with the original antiepileptic drugs. The conventional physical training and massage were applied in the rehabilitation group for 3 courses with 20 d at the interval, once a day, 5 times a week and 15 times as one course. Based on the treatment as the rehabilitation group, scalp acupuncture was used in the combination group for 3 courses with 15 d at the interval, once the other day and 10 times as one course. Shenting (GV 24), Benshen (GB 13), Sishencong (EX-HN 1) were selected as the main acupoints, combined with motor zone, foot motor-sensory area, balance zone,and temple-three-needle etc. Clinical onset and VEEG results were observed before and after treatment. RESULTS: After treatment in the combination group, 27 cases improved; 47 cases had no effect; 25 cases aggravated. While in the rehabilitation group, 11 cases improved; 46 cases had no effect; 28 cases aggravated. There was no statistically significance between the two groups (P>0.05). As for the cases with epilepsy onset in the combination group, 8 cases improved; 4 cases had no effect; 4 cases aggravated. In the rehabilitation group, 4 cases had no effect; 7 cases aggravated. The result in the combination group was better than that in the rehabilitation group (P<0.05). As for the cases with epileptiform discharges in the combination group, 19 cases improved; 43 cases had no effect; 21 cases aggravated. In the rehabilitation group, 11 cases improved; 42 cases had no effect; 21 cases aggravated. There was no significance between the two groups (P>0.05). CONCLUSIONS: Scalp acupuncture therapy does not increase the risk of onset or epileptiform discharges in the children with cerebral palsy combined with epilepsy or epileptiform discharges. Scalp acupuncture combined with rehabilitation is better than simple rehabilitation for thosewith cerebral palsy and epilepsy onset.

[Analysis on factors for effects of motor function of cerebral palsy children assisted by acupuncture-Retrospective analysis with 520 cases attached].

OBJECTIVE: To analyze the effects of motor function of cerebral palsy children by the adjuvant therapy of acupuncture and its factors retrospectively. METHODS: Five hundred and twenty cerebral palsy children in hospital (from January 2005 to December 2014) who meet the criteria were selected through Doctor Workstation of our hospital. The cases were divided into groups according to the type of cerebral palsy, gestational age, complication, treatment time and age. Based on the physical rehabilitation, all the patients were assisted by acupuncture. Scalp acupuncture was used at Zhiqizhen (seven-intelligent needles), motor area, foot-motor-sensory area, etc. Body acupuncture were mainly at the governor vessel and yangming meridians of hand and foot. Treatment was given once every other day for eight months. Effects were evaluated by gross motor function classification system (GMFCS) and gross motor function measure (GMFM). RESULTS: ① GMFCS:after eight-month treatment, the total effective rate of children with spastic cerebral palsy was superior to those of mixed type and involuntary movement type[77.9% (300/385) vs 60.3% (38/63), 56.9% (41/72), both P<0.01]. The total effective rates of the above three types with gestational age from 37 to 42 weeks were better than those of the corresponding types with gestational age (P<0.01, P<0.05). The efficacy of children with mental retardation and language disorderwas higher than that of epilepsy and hearing disorder (P<0.01, P<0.05). The total effective rates of patients in the three types with the age of 1-2 were better than those of the corresponding types with the age of 2-4 (all P<0.05). ② GMFM:after three-month and eight-month treatment, the GMFM scores of the three types were increased in different degrees (all P<0.01), and after eight-month treatment, the score of the spastic type was increased more obviously than those of the other two types (both P<0.01). CONCLUSIONS: The motor function of cerebral palsy children can be improved assisted by acupuncture, and the effect may be related to treating time, cerebral palsy type, gestational age, complication and age.

[Impacts on adductor muscle tension in children of spasmodic cerebral palsy treated with acupuncture at the three-spasm-needle therapy].

OBJECTIVE: To explore the effective therapeutic method for reducing adductor muscle tension in the children of spasmodic cerebral palsy. METHODS: One hundred and forty cases of spasmodic cerebral palsy met the inclusive criteria were randomized into an observation group and a control group, 70 cases in each one. In the control group, the conventional physical therapies (Bobath therapy and lower extremities therapy) and scalp acupuncture (seven-intelligent needles, motor area, sensory area, foot-motor-sensory area and balance area) were adopted. In the observation group, on the basis of the treatment as the control group, the three-spasm-needle therapy was applied to Jiejian, Xuehaishang and Houxuehai. The physical therapies were given once every day, acupuncture was given once every two days, the treatment of 20 days made one session. There were 15 to 20 days at the interval among the sessions and 3 sessions were required totally. Separately before and after treatment, the modified Ashworth scale was used to evaluate the adductor muscle tension, and measure the adductor muscle angle, and D and E regions of gross motor function measure (GMFM-88) were adopted for clinical efficacy evaluation. RESULTS: After treatment, the scores of the adductor muscle tension were decreased to different extends in the two groups (both P<0.01), the adductor muscle angle was increased as compared with that before treatment (both P<0.01) and the scores of D and F regions in GMFM-88 were all improved (all P<0.01). The efficacy in the observation group was more significant than that in the control group (all P<0.01). CONCLUSION: The three-spasm-needle therapy effectively reduces adductor muscle tension and improves the range of motion in hip joint, independent walking, running and jumping abilities in the children of spasmodic cerebral palsy.

[Treatment of autism with scalp acupunctur].

OBJECTIVE: To verify the efficacy on autism treated with scalp acupuncture for regaining the consciousness and opening the orifice in children. METHODS: Seventy cases of child autism were divided into an observation group (30 cases) and a control group (40 cases). In observation group, the cases were treated with scalp acupuncture for regaining the consciousness and opening the orifice, in combination with music therapy and structure education method. Scalp acupuncture was applied to intelligent nine needles (frontal five needles, Sishencong (EX-HN 1)), affection area, heart and liver area, once a day, at the interval once every one week. Totally, 60 treatments made one session. In control group, music therapy and structure education method were applied simply. Clancy Autism Behavior Scale, Childhood Autism Behavior Scale (CARS), Autism Behavior Checklist (ABC) and Gesell Developmental Scale (social adaptive behaviors and language development) were adopted to assess the scores before treatment and after 1 session of treatment. RESULTS: After treatment, the scores in Clancy Autism Behavior Scale, CARS and ABC were lower apparently in observation group as compared with those before treatment (all P < 0.01), and the scores in Clancy Autism Behavior Scale and ABC were lower than those in control group (both P < 0.01). In observation group, the scores of social adaptive behavior scale and language development scale were improved obviously after treatment (both P < 0.01), which were all higher than those in control group (both P < 0.01). In observation, between the group aged from 4 to 6 years and the group aged from 2 to 3 years, the value differences in Clancy Autism Behavior Scale, ABC and social adaptive development scale did not present statistical significance in group comparison before and after treatment (all P > 0.05). CONCLUSION: Scalp acupuncture for regaining the consciousness and opening the orifice can significantly improve the efficacy on autism, effectively relieve child autism symptoms and enhance the intelligence, language ability and social adaptive ability. Moreover, the efficacy cannot be impacted by child's age.

[Progress in researches on the specificity of acupoints].

In the present paper, the authors introduce the development of researches on the specificity of acupoints in morphological structure (nerves, blood vessels, musculotendons, connective tissues, etc), biophysical characteristics (electricity, sonics, photology, thermology, electromagnetism), pathological response, and effectiveness. However, the aforementioned researches are basically at the stage of phenomenon-observation, some key factors influencing acupoint specificity and the underlying mechanisms have no definite or lack convincing results. Further studies should aim at those acupoints for some effective diseases (or symptoms) of acupuncture by using multiple modern scientific techniques. Some key scientific issues about the biophysical characteristics, pathological responses, efficacy, and combination regularity of acupoints should be solved reasonably. Moreover, theoretical models about acupoint specificity should be established for developing the theory of acupoint learning.