TITLE: Functional Neuroimaging and Acupuncture

ISSUE DATE: November 12-15, 2000
LAST NAME: Jie-guang
NAME: Sun
NATIONALITY: Hong Kong
ADDRESS: Rm204, 2/F, chow yei ching Bldg, The University of HK.
ABSTRACT: abbreviation
B-1.
TITLE: Functional Neuroimaging and Acupuncture
AUTHOR(S): JG SUN, V Wong, ES Yang, QY Ma
ABSTRACT:
Introduction: Acupuncture is a treatment technique developed by practitioners of Traditional Chinese Medicine(TCM) thousands of years ago and has been performed in China for a long time. The method of healing is to promote recovery using the body's homeostatic systems by needling specific anatomical sites on the body surface. Tongue Acupuncture (TA) is a new technique developed by Sun JG that shared the same theory of traditional acupuncture. It is done by needling specific site on the tongue instead of the body surface.
Functional neuroimaging techniques have been used to study the biophysical and biochemical processes of human brain for many decades. Among them, positron emission tomography (PET) and functional magnetic resonance imaging (fMRI) techniques are widely used in neuroscience community as the major non-invasive tools to study human brain functions. PET is favorable for its quantitative results while fMRI provides high spatial and temporal resolution images and could readily incorporated in current clinical system. In our studies, fMRI was used as an index of brain function to study the neuronal recovery of brain-disordered patients after tongue acupuncture. 18F-fluorodeoxyglucose (FDG) PET was used to study the change in glucose metabolism during acupuncture procedure. We have demonstrated, for the first time, that tongue acupuncture would increase glucoses metabolism and would effect on brain plasticity. This study has also proven that the advanced functional neuroimaging techniques could be directly applied to the studying, monitoring, and verification of the acupuncture treatment process.
Methods: In 1999 April-2000 August, we recruited patients with neurological diseases whose disabilities had been static with conventional Western treatment for TAC treatment. The outcome was assessed objectively with clinical, functional, and neuroimaging (fMRI/PET) modalities.
Results:[1] Stroke Project [N=25] adults with stable stroke for >2 years (4 weeks twice daily TAC) - There was statistically significant improvement in the following measures: National Institute of Health Stroke Scale (p<0.0001), Edinburgh Stroke Scale (p<0.0014), hemiplegic hand muscle power with dynamometer (p<0.0001), Barthel's Activities of daily Living index (p<0.05) and modified Rankin Scale 9p<0.05). fMRI showed reactivation of the contralateral hand motor cortex in some.
[2] Cerebral Palsy Project [N=15](8 weeks daily TAC) - There was statisticaly significant improvement in functional independence measure of children (p<0.05). fMRI showed reactivation of contralateral hand motor cortex in hemiplegia, and reactivation of feet motor cortex in spastic diplegia.
[3] Cortical Visual Impairment Project [N=5] (consecutive daily TAC for 40-120 weeks) - There was improvement in visual acuity, functional level of vision, visual evoked potential. FMRI showed reactivation of visual cortex in 2 patients. [4] PET Project: More than 20% activation of the superior temporal gyrus (auditory cortex) and calcarine /precuneus gyrus in occipital lobes (visual cortex) were detected in 2 healthy subjects after 3 daily TAC treatment. The activation was statistically more significant with real time electrical TAC in addition to TAC.
Discussion: Our study had demonstrated the efficacy of TAC in improving neurological disabilities. Objective evidence of brain plasticity was demonstrated even in aged patients with stable stroke. Even children with cortical blindness of 5-14 years duration had shown partial recovery of visual function, though with intensive courses of treatment.
Conclusion: Functional Neuroimaging techniques are useful in objectively demonstrating brain plasticity with TAC. The quantification of glucose activation in the brain with repeated TAC courses in patients should be evaluated along with clinical parameters.
Keywords: tongue acupuncture, fMRI, PET, stroke, cerebral palsy, cortical visual impairment

ACUPUNCTURE THESIS
THE FIFTH WORLD CONFERENCE ON ACUPUNCTURE
KS-0103 LOCATION SEOUL

TITLE: CLINIC STUDY OF TONGUE-ACUPUNTURE THERAPY OF PARALYSIS AGITANS

ISSUE DATE: November 12-15, 2000
LAST NAME: Jie-guang
NAME: sun
NATIONALITY: Hong Kong
ADDRESS: Rm204, 2/F, chow yei ching bldg, the university of HK
ABSTRACT: abbreviation
B-2.
TITLE: CLINIC STUDY OF TONGUE-ACUPUNCTURE THERAPY OF PARALYSIS AGITANS
AUTHOR(S): Sun Jie-guang, Sun Xue-ran, Zhang Xiao-bing, Ma Tie-ming
ABSTRACT:
Introduction: Paralysis agitans is also called Parkinson's disease and the disease of extrapyramidal system, characterized by the agitans of extremities, muscle rigidity, and hypomotility. This disease is frequently occurred to men of 50-60 years of age. The cause of this disease is now clear yet. It is generally considered that this disease is caused by undue low concentration of dopamine in extrapyramical system, thus causing degeneration of pallidal globus and black substance.
Methods:
1. General Data
of 105 cases of primary paralysis agitans, 73 men, 32 women; 5:43-50 years old, 66:50-59 years old, 34:over 60-years old; course of disease 6 months-12 years.
2. Observation of curative effect of paralysis agitans
Tongue acupuncture is used, acupuncturing Son's tongue points: Mingzhong, Tiankui, Ganhe, Chunzhong etc, using the tongue-acupuncture apparatus. 5 days is a course of treatment. The following course of treatment is after two days. 105 cases of paralysis agitans were treated by tongue-acupuncture, with total effectiveness 96.19%. 28 cases were cured, 41 cases were treated with obviously effect, 32 cases were with effect and only 4 cases were without effect.
Results: To further compare the curative effect of tongue-acupuncture with that of other acupuncture on paralysis agitans, we take 42 cases of body-acupuncture as control group, comparing the curative effect of above two groups according to patient's condition and phases, see table 1. In light of x2 examination, there is not notable difference between the 2 groups(P>0.05).

Table 1 Comparison between tongue-acupuncture group and body-Acupuncture group according to patient's condition and phases
Group Number of cases 1st phase 2nd phase 3rd phase 4th phase
Case % Case % Case % Case %
t.a. 105 25 23.81 51 48.80 22 21.00 7 6.67
b.a. 42 12 28.57 17 40.48 10 23.81 3 7.14
t.a=tongue acupuncture; b.a.=body-acupuncture
The main points for body acupuncture are Baihui, Fengfu, Fengchi, Yintang, Hegu, Taiching, Taixi, Sanyinjiao, subordinating points according to symptoms, 5 days is a course of treatment. All cases take 6 courses of treatment.

Group
Number of
Cases Recovery Obvious effect Effective
Case % Case % Case %
t.a. 101 28 26.67 41 39.05 32 30.48
b.a. 18 0 0 4 9.52 14 33.3
Table 2 Comparison of curative effect between tongue-acupuncture and body-acupuncture
t.a=tongue acupuncture; b.a.=body-acupuncture
It is clear from table 2, that according to x2 examination, there is notable difference between above 2 groups in curative effect (P<0.01), namely the curative effect of tongue acupuncture groups is far better than that of body acupuncture group.

Conclusion: Tongue acupuncture came out before long, but got attention from many doctors with its notable curative effect and obtained satisfied results. The patients usually take L-dopa, Artane...........the effect of these drugs is reduced with prolongation of time and the poisonous and side effects are strong. Tongue acupuncture is easy to operate without any poisonous and side effect, producing an instant effect and reducing, even dispense with above drugs with progression of treatment.
Key Words: Paralysis agitans/ Parkinson's disease/ Tongue Acupuncture/ Body Acupuncture

ACUPUNCTURE THESIS
THE FIFTH WORLD CONFERENCE ON ACUPUNCTURE
KS-0104 LOCATION SEOUL

TITLE: CLINICAL RESEARCH ON TREATING PSEUDO-BULBAR PARALYSIS WITH TONGUE PUNCTURING

ISSUE DATE: November 12-15, 2000
LAST NAME: Jie-guang
NAME: Sun
NATIONALITY: Hong Kong
ADDRESS: Rm204, 2/F, chow yei ching bldg, the university of HK
ABSTRACT: abbreviation
B-3.
TITLE: CLINICAL RESEARCH ON TREATING PSEUDO¡ªBULBAR PARALYSIS WITH TONGUE PUNCTURING
AUTHOR(S): Sun Jie Guang, Liao Ning Labouring Sun Xue-ran
ABSTRACT:
Introduction:
Adapt tongue puncturing in micro-needling method to treat 125 cases of pseudo-bulbar paralysis including 89 male, 36 female from 40 to 78 years old of which the course 29 are within 3 months, 96 are over 3 months. For its original coming on disease, 64 cases are of multi-coming on cerebral infarction and cerebral atrophy, 45 are pure multi-occuring cerebral infarction, 16 are cerebral atrophy and other diseases.
Treating method: puncture MingAn, TianGu, GuanZhu, Zhen Jie, TianKui, RunZe, DiCheng, MingHe, WenAn, TongSu, XuanGen, etc. tongue puncturing points with small needle. Match the points according to diagnosis, 5 times are one course.
Results & Discussion:
125 cases of pseudo-bulbar paralysis have been treated with tongue puncturing method, of which 79 cases (63.2%) have been cured completely, 36 are of obvious effect (28.8%), 10 are effective (8%), total effective rate is 100%. Obviously improve 23 cases of orignal coming-on diseases (18.4%), 98 cases of it have been improved (78.4%), 4 cases are ineffective (32%). Within the one course group, there are 57 cases, of which 19 cases have been recovered (33.33%), 28 of obvious effect (49.12%), 10 effective (17.54%). In the group with 2 or above 2 courses, there are 68 cases, of which 60 cases have been recovered (88.24%), 8 cases of obvious effect (11.76%). There exists obvious difference between the two groups, and the result of 2 or above 2 courses group is better than that of the one-course group (P<0.01). There are 29 cases whose courses for getting the disease are within 3 months, of which 22 cases have been recovered (75.86%), 6 of obvious effect (20.69%), 1 effective (3.45%) after treatment. There are 96 cases whose courses getting the disease are above 3 months, of which 57 cases have been recovered (59.38%), 30 of obvious effect (31.25%), 9 effective (9.38%) after being treated with the method. No obvious differences exist between the two groups. That shows the treating result is not influenced by the course to get pseudo bulbar paralysis. For the patients who have been punctured for more than 2 months, 58 cases have been investigated, no recurring appears within 2 to 4 months; 3 cases show slight symptoms between 5 and 6 months; but the recurring of pseudo¡ªbulbar paralysis is 0. That's to say, the treating result is rather good.
Conclusions:
Based on holographic theory, the author thinks the channels and collaterals, vital organs, head and body as well as limbs all have its related reflecting points or areas on tongue. Observing tongue's change to diagnose disease is a very key method, so is tongue puncturing to treat diseases. Pseudo¡ªbulbar paralysis is apoplexy involving kidney, heart, spleen. While tongue puncturing just treats disease through clearing channels by adjusting the functions of kidney, heart and spleen.
Key Words:
Tongue Acupuncture/ Pseudo-Bulbar Paralysis/ Cerebral infarction/ Cerebral atrophy

ACUPUNCTURE THESIS
THE FIFTH WORLD CONFERENCE ON ACUPUNCTURE
KS-0105 LOCATION SEOUL

TITLE: Randomized Control Trial of using Tongue Acupuncture in children with Autistic Spectrum Disorder

ISSUE DATE: November 12-15, 2000
LAST NAME: Chun-nei Virginia
NAME: Wong
NATIONALITY: Hong Kong
ADDRESS: Rm112, New Clinical Bldg, Queen Mary Hospital, Hong Kong
ABSTRACT: abbreviation
A-1.
TITLE: Randomized Control Trial of using Tongue Acupuncture in children with Autistic Spectrum Disorder
AUTHOR(S): V WONG, JG Sun, XR Sun, W Wong
ABSTRACT:
Introduction: Traditional Chinese Medicine approach to Autism Spectrum Disorder (ASD) is a more holistic, approach. We aim to improve the overall functional independence in the children by the effect on behavior, communication and cognition with an innovative method, Tongue Acupuncture(TAC).
Methods: TAC was conducted as a double-blind randomized controlled trial on 30 children with ASD. The children were randomly assigned to the treatment group with 40 sessions of TAC or control group with continuing their current behavioral and educational approach over a course of 8 weeks. We used 7 standardized outcome measure for comparison. This included: Childhood Autism Rating Scale (CARS), Ritvo-Freeman Real Life Scale(RFRLS). Aberrant Behavior Checklist, Reynell Language Developmental Scale, Preverbal Communication Scale, functional independence measure for children (WeeFIM) (mobility, self care and cognition). Parental Stress Index and Clinical Global Impression Scale(CGIS).
Result: The treatment group had statistically significant improvement in the following outcome measures: RFRLS: the mean difference in score ¡¾SD of the treatment group was 0.152¡¾0.192 and control group was 0.022¡¾0.26(P value = 0.005); WeeFIM: the mean difference in score of treatment group in mobility was 11.867¡¾8.417 as compared to control group was 1.0¡¾1.780(P=0.0002);self care domain, the mean difference in the treatment group was 4.933¡¾6.147 as compared to control group of 0.5385¡¾1.854(P value=0.0071);and cognition domain, the mean difference in treatment group was 8.533¡¾6.534, and for control group was 1.462¡¾2.025(P value=0.0004).
Discussion: Our anecdotal clinical experience for patients with learning disability and ataxia also showed that there were specific acupoints on the tongue which improve cognitive function and ataxia respectively. Improvement in alertness, attention and emotional state of a child through "starting-up" with TAC to acupoints rich in neural networking to the frontal cortex through the brainstem and cerebellum may explain the improvement in the child's awareness of drooling. Thus, by a mechanism of re-networking of the "brain systems", plasticity of the brain is evident in various functional disability.
Conclusion: We observed the overall improvement in intellectual quotient and communication abilities in these children rather than just pure behavioral improvement, Even the teachers who were blind did find improvement in children in terms of behavior, communication skills and also higher intelligent quotient, have more imaginative-draw better, more coherence in their composition and writing up of stories, and become more initiative. In future researches, we still need to assess other parameters, such as factors contributing to efficacy, the intermediate and long term efficacy, and whether repeated courses of TAC are necessary. We are currently trying to document objectively, using functional Magnetic Resonance Imaging (fMRI) and Positron Emission Tomography (PET), the specific function of specific acupoints in normal subjects in order to prove the philosophy of TCM.
Key words: Traditional Chinese Medicine/ Tongue Acupuncture
Autism Spectrum Disorder (ASD)/ Children

ACUPUNCTURE THESIS
THE FIFTH WORLD CONFERENCE ON ACUPUNCTURE
KS-0106 LOCATION SEOUL

TITLE: Pilot Study of Efficacy of Tongue Acupuncture in Neurologically Disabled Children with Severe

ISSUE DATE: November 12-15, 2000
LAST NAME: Chun-nei Virginia
NAME: Wong
NATIONALITY: Hong-Kong
ADDRESS: Rm112, New Clinical Bldg, Queen Mary Hospital, Hong Kong
ABSTRACT: abbreviation
A-2.
TITLE: Pilot Study of Efficacy of Tongue Acupuncture in Neurologically Disabled Children with Severe Drooling Problem
AUTHOR(S): V Wong, JG Sun, XR Sun, W Wong
ABSTRACT:
Introduction: Tongue Acupuncture (TAC) is an innovative acupuncture technique. There are at least 40 acupoints on the tongue which are linked through the 14 meridians to various organs and viscera. Specific acupoints were documented to subserve various functional domains of the human body. Clinical efficacy of acupuncturing the surface or base of the tongue in specific acupoints proved the efficacy in improving various functional modalities in patients with chronic neurological disorders, including pseudobulbar palsy and motor disability in stroke and cerebral palsy. Our own clinical experience of >20 years with this technique had demonstrated its efficacy and safety. This study aimed to assess the efficacy of TAC in an objective manner in children with severe drooling problem.
Methods: We conducted a pilot project as an intent-to-treat study in a cohort of 10 children (aged 2-18 years) with neurological and/or cognitive disability having serve drooling problem. These children had such severe functional disability that they failed to comply with conventional oral motor stimulation programme or behavior modification treatment. A course of TAC was performed on a daily ambulatory basis to 5 acupoints in the tongue (3 on the surface and 2 on the bottom) for a total of 30 sessions by one of the authors (JGS). The children were not sedated during the acupuncture treatment. Each acupuncture lasted for less than 15 seconds. We used standardized outcome measures of drooling to assess the efficacy of TAC at baseline and after a course of treatment. The assessors were blinded to any treatment given.
Results: Pre-and post-treatment data was analyzed with Wilcoxon matched-pairs signed-rank analysis. Statistically significant improvement was noted in 3 outcome measures. The mean Visual Analog Scale (VAS) decreased from 6.6%(pre-TAC) to 4.67(post-TAC) (p=0.002); the mean Drooling Quotient(DQ) decreased from 14.016%(pre-TAC) to 8.335%(post-TAC)(p=0.0078); and the mean Drooling Score (DS) decreased from 7.4(pre-TAC) to 4.4 (post-TAC)(p=0.002).
Discussion: Tongue Acupuncture (TAC) is an innovative technique invented to improve functional disability of patients with chronic neurological disorders. This pilot study using objective outcome measures of the severity and frequency of drooling had demonstrated its efficacy as an alternative treatment for patients with neurological disability.
Conclusion: Thus, TAC is indicated one of the treatment options for patients with persistent drooling. TAC can be tried either before or after failing oromotor stimulation programme; or if the patients are not suitable candidates for behavioral modification treatment due to serve cognitive disability. TAC can definitely be tried before embarking on surgical maneuvers on the salivary glands.
Key words: Drooling,
Cerebral palsy,
Children,
Tongue Acupuncture(TAC),
Traditional Chinese Medicine(TCM)