Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder that is characterized by a lack in social interactions, restricted interactions, and repetitive behaviors (Sun et. al 2019). There are two main categories of autism: natal and regressive autism. Natal autism is when the child displays abnormal behavior and speech delay early on, around 1 years old, while regressive autism is when the child develops normally in the first few years and starts to lose previously acquired skills upon the onset of symptoms of autism (Ming et. al 2012). Currently, there are many classical western treatments for ASD, with the most popular being largely behavioral such as Cognitive Behavior Therapy (CBT) and Applied Behavior Analysis (ABA). However, with the growth in ASD cases throughout the years, far more families are turning to Complementary and Alternative Medicine (CAM) to treat ASD. They are perceived to be safer and cheaper than conventional treatments such as ABA and CBT which can cost $150 an hour and up to $50,000 a year. One CAM practice that is gaining momentum in the western culture and continued to be heavily practiced in China is Traditional Chinese Medicine (TCM) which has been around for around 5,000 years. Compared to western medicine, which has been around for around 2,000 years, TCM defines ASD differently in terms of symptoms, etiology, and treatments. In TCM, the symptoms of ASD are reflected in Wu Chi which contains five kinds of retardations: slowing in standing, walking, hair growth, tooth growth, and speech, dullness (dementia), mutistic, soliloquy, fetal toxicity, infantile metopism, and five weakness (flaccid head, nape, hands and feet, muscle, and mouth) (Cai et. al 2015). On the other hand, western medicine speculates that the etiology of ASD stems from genetic, environmental, and neurobiological factors. TCM theorizes ASD as an insufficiency of the brain which is related to the heart, spleen, kidney, and liver along with a deficiency in qi (energy) and essence and blockages in the affected organs (Cai et. al 2015). In order to treat ASD, TCM practices seek to unblock and nourish the heart, tonify the spleen and kidney, build the brain (Cai et. al 2015). These methods cultivate qi and essence in the heart and kidney which cures the main symptoms of a disease (Zhang 2010).
In this paper, I will explore the extent that Traditional Chinese Medicine is effective in treating children under 18 with ASD by focusing on the patient’s improvements in regards to verbal skills (language and communication). To better understand the mechanisms of specific TCM practices, I will be analyzing the effectiveness of three types of TCM treatments: herbal medicine, acupuncture, and qigong. Along with clinical results gathered from studies and articles, I will also include an interview with my acupuncturist, Dr. Miao, who is treating autistic children. This will give more targeted insight into CAM treatments for ASD that are safer than conventional pharmaceutical treatments.
Throughout the years, studies have documented the benefits of herbal medicine towards treating ASD along with other disorders such as Alzheimer’s disease, ADHD, and Anxiety Disorders. With the increase use of CAM, more families are looking into herbal medicine as a treatment option because it is directly derived from natural products and pose fewer side effects compared to synthetic drug counterparts.
Herbal medicine functions on the principle of “monarch, minister, assistant and guide” where the monarch drug is the key ingredient, the minister drug promotes the monarch drug to exert therapeutic effects, the assistant drug strengthens the effect, and the guide drug directs other ingredients to work on the affected parts (Cai et. al 2015). Each drug or ingredient in the prescription has its own specific effect and together they target and treat the affected areas. One herbal medicine example that has shown multiple benefits is Ukgansan, which is composed of 7 different types of ingredients. Studies have shown that it treats children’s liver dysfunction, inhibits hypersensitivity and hyperactivity through anti-inflammatory effects and neurogenesis. Thus, preventing behavioral abnormalities while also improving neuroplasticity signaling, many of which are symptoms of ASD (Lee et. al 2019). Not only does this herbal concoction ease social manifestations of autism but addresses the neurological aspects of this developmental disorder.
It was reported that there are 23 prescriptions still used to treat ASD and many have reported positive improvement of the patient’s symptoms (Cai et. al 2015). Out of the frequently used concoctions, there were five that were especially effective in treating inflexible tongue, unclear pronunciation, and speech problems: Hu Gu Pill, Bu Zhong Yi Qi decoction, Liu Wei Di Huang Pill, Si Ni Bei, and Chang Pu Pill (Cai et. al 2015). In a study conducted by Li Dexing, he used Hu Gu Pill to treat a child who had verbal problems and after three months of medication, the child could speak more clearly than before and after six months, the child was able to communicate fluently (Cai et. al 2015). Similarly, Gu Mingming used Liu Wei Di Huang Pill and Chang Pu Pill to treat a six-year-old child with speech problems and after a month of medication, the child could speak more fluently and after three months, the child recovered (Cai et. al 2015). Apart from these four herbal medicines, the other more frequently used ones (Jia Wei Wen Dan, Chai Hu Gui Zhi Long, Gu Mu Li, and more) were more effective in improving hyperactivity, hypersensitivity, and sensory problems (Cai et. al 2015). In another review that investigated ten randomized controlled trails (RCTs), all of them explored herbal medicines complementary to conventional therapy or as an adjunctive therapy and almost all of them reported a significant improvement in general ASD composite scores. This shows that herbal medicine is significantly effective in improving the overall symptoms of ASD with no specificity on verbal skills even when paired with conventional therapy. Looking more closely at the ingredients, it was reported that the most frequently use ones, Panax ginseng and Poria cocos, were targeted towards improving abnormal behaviors and had sedative pharmacological effects (Bang et. al 2017). The natural ingredients derived from herbs that act as a sedative can have a more mild and calming effect compared to western synthetic sedatives that often inhibit both motor and neurological functioning. Within these parameters, herbal sedatives would be more useful for treatment of autism.
Overall, there are only a few specific types of herbal medicine that are effective in treating the verbal impairments of ASD while the more commonly used ones have a pattern of treating abnormal behaviors and hyperactivity. These clinical results are especially important for children who have behavioral problems are already involved in some sort of behavioral therapy as these studies and reviews show that herbal medicine has significant improvement when paired with conventional therapy. There were also little to no adverse effects, making it much safer especially when compared to conventional medicine such as risperidone that has reported side effects of weight gain. While herbal medicine is effective in treating the overall symptoms of ASD, there are few concoctions that are significantly effective at treating verbal and communication problems.
The most popular form of TCM used for treating ASD is acupuncture and it is gaining momentum in mainstream Western medicine. According to TCM theory, acupuncture helps to regulate the flow of qi through meridians to correct the imbalance of energy and restore internal homeostasis (Wang et. al 2019). There are 12 regular meridians and 8 supplemental ones that are symmetrical and divided into yin and yang (Ming et. al 2012). The meridians connect the organs to the surface of the body and acupuncture regulates the balance of the organs’ functions via qi and blood by stimulating the acupoints related to the affected organs (Ming et. al 2012).
However, using the concepts of neurobiology in western medicine, a possible mechanism for acupuncture as a treatment for ASD is mainly related to the regulation of neurotransmitters which are disturbed in people with ASD. Studies have also shown acupuncture to be connected to the modulation of expression and activation of brain derived neurotrophic factor which are involved in the pathophysiology of ASD (Lee et. al 2018). It is established that acupuncture stimulates the secretion of the endogenous opioid endorphin but recent studies also show that acupuncture may also stimulate the release of serotonin and dopamine which are neurotransmitters that are related to emotional behavior, appetite, and drive (Cheng 2014). Apart from treating the core symptoms relating to language and social problems, acupuncture can also regulate and improve diets and behavioral issues which are also common symptoms of ASD. Studies have shown that acupuncture has positive and healing effects for Parkinson’s Disease and Alzheimer’s Disease which are also neurological disorders that have neurotransmitter abnormalities and neuronal apoptosis. In addition to treating neurological disorder, acupuncture is more frequently used to treat musculoskeletal conditions and pain such as arthritis, neck pain, and etc.
In a recent clinical trial conducted by Chuenheung Yau, 68 children were split into natal autism, displaying autistic symptoms early on, and regressive autism, losing previously acquired skills upon onset of symptoms of autism. These children were given a scalp acupuncture for 15 weeks for a total of 30 sessions. The results show that the most significant improvements in both groups was in verbal communication and social interactions, with a larger improvement in children at a younger age (Yau et. al 2018). A similar study was conducted by Virginia Wong and Wenxiong Chen in which they compared the effect of electro-acupuncture (EA) and sham electro-acupuncture (SEA) on 55 children under 18 with ASD. The EA treatment was most effective in improving language comprehension and language reception and parents, who were blinded to the treatments, also reported an improvement in language reception (Wong et. al 2015). Additionally, in an interview with my acupuncturist, Dr. Miao, who is currently treating two children with ASD, she stated that after two weeks, both children’s parents and teachers reported an improvement in language skills and verbalization. Lastly, in a review of 27 clinical studies, there were 3 studies that measured verbal skills and all of them reported a significant improvement in communication and language (Ming et. al 2012). The other 24 studies with or without simultaneous behavioral therapy that measured the composite ASD scores also all reported improvements in ASD symptoms along with reports of superior effects using acupuncture compared to conventional treatments (Ming et. al 2012).
Through the clinical results and my interview with Dr. Miao, acupuncture shows extremely promising effects in improving the verbal and language skills of children with ASD. The improvements in verbal skills were especially noticeable in the electro-acupuncture clinical trial conducted by Chuenheung Yau and the scalp acupuncture clinical trial conducted by Virginia Wong where they reported that the biggest improvements made were in the language and communication skills. Along with improvements in verbal skills, there were also significant positive effects in improving social skills and behavior which may have been a result of the simultaneous behavioral therapy or other conventional treatments as many studies investigated acupuncture as a complementary therapy or adjunctive treatment. These improvements can further be explained on a cellular basis with the release of neurotransmitters such as endorphins, serotonin, and dopamine that regulate pain, mood, behavior, and appetite. The effects of these neurotransmitters are connected to the improvements shown in behavior and social interactions when acupuncture is paired with conventional treatments.
Qigong Sensory Treatment (QST)
Qigong Sensory Treatment (QST) contains two concepts: qi, the vital energy of the body, and gong, the cultivation of qi (Weintraub 2001). A possible explanation for the mechanism of QST is that the emitted qi can help open barriers to qi flow which helps to balance the qi in the patient (Weintraub 2001). QST is a set of massages composed of 12 patting, shaking, and pressing movements applied to 12 areas of the body that is targeted towards normalizing the sensory issues which can reduce the symptoms of ASD related to social development and interactions. In recent years, this hands-on therapy has documented benefits for ASD as well as other neurological disorders, in particular Parkinson’s Disease which has symptoms displaying body tremors, rigidity, reduced range of motion, and more. Other than neurological disorders, QST has shown to also treat other health problems such as cardiovascular diseases, pain, hypertension, and asthma (Weintraub 2001).
Currently, more families are considering QST massages for treating children with ASD because studies have shown that parents are able to learn and effectively treat children with ASD using QST massages (Silva, Gabrielson et. al 2011). This makes QST a more safe, cheap, and convenient alternative to conventional treatments such as CBT or pharmaceuticals.
According to the TCM theory, ASD results from the closure of sensory orifices, preventing the brain from receiving information from the outside world for normal development and learning. Thus, QST treats ASD by targeting the improvement of sensory and self-regulatory impairment which underlies social and language delays (Silva, Gabrielson et. al 2011). These findings indicate that QST can treat bodily manifestations of autism such as GI issues in addition to neurological disturbances. This holistic treatment is unique compared to ABA or CBT options which only deal with behavioral aspects of autism.
In a clinical trial comparing home QST program (parent-delivered therapy), dual QST program (parent and professional-delivered therapy), and control treatment for children under 18 with ASD, results show that there were significantly larger improvements in children treated under the dual QST program while there were smaller improvements in children treated under the home QST program (Silva, Gabrielson et. all 2011). Comparing the treatment effects between the home and dual QST program, both treatments show a significant improvement in sensory impairment and self-regulation and small improvements in verbal skills (Silva, Gabrielson et. al 2011). Similarly, in a systematic review investigating the effectiveness of QST in treating children with ASD, results show that 36% of the improved ASD symptoms were in sensory impairment along with a significant improvement in composite ASD scores and sensory regulation scores (Silva, Ayres et. al 2011). This shows that sensory impairment is a major symptom of ASD along with the core symptoms of language and social problems as the biggest improvements made in sensory impairment contributed to an improvement in the severity of ASD. The decrease in severity and improvement in sensitivity further allows children with ASD to better receive other forms of treatment that involves the senses such as acupuncture in order to achieve greater improvements in other core ASD symptoms. These trials show that QST significantly improved sensory problems, though it was still impaired at the end of the trials. However, with longer treatment periods, QST shows extremely promising results in fully treating sensory impairment to be near normal functioning.
While the main improvements were in sensory impairment and sensory regulation, there were also small improvements made in language acquisition and verbal skills. These verbal improvements are an indirect result of the sensory impairment improvements that normalize the circulation of blood and qi to the skin as well as touch and pain responses (Silva, Ayres et. al 2011). Biologically, the sense of touch is known to inform structural brain development where the development of the internal body image in the sensory cortex is dependent on the role of skin (Silva, Ayres et. al 2011). The internal body image would then help organize sensory information relative to self and the world, making it important for social development (Silva, Ayres et. al 2011). Thus, QST seeks to normalize the sensory information from the surface of the body to help promote brain development and treat the symptoms of ASD associated with it: sensory impairment, language reception, and social interactions. This can have important implications for children with ASD that suffer from hypersensitivity to touch, light, or noise. QST can also treat children with different levels of severity as it is a therapy via the skin which requires no language abilities like behavioral therapy.
Conclusion and Implications
In conclusion, TCM treatments show promising results in improving the overall ASD symptoms, making it a safer and cheaper alternative to conventional medicine and pseudoscience, such as hyperbaric oxygen therapy or viral therapy, for treating ASD. Looking more specifically into the effectiveness of the three different TCM treatments at improving verbal skills, acupuncture is significantly effective in improving language acquisition and comprehension as well as social skills while frequently prescribed herbal medicines mainly improved hyperactivity and QST targets sensory impairment and regulation.
Even though acupuncture is the best choice for treating language acquisition and verbal problems, studies have shown that combining all three treatments (acupuncture, herbal medicine, and QST) together may show even stronger improvements in multiple ASD symptoms due to each treatment targeting different symptoms. For families looking towards TCM as an alternative treatment for ASD, combining the different TCM treatments may show the best overall results. However, when looking for TCM treatment options, families should be cautious and aware of fake treatments that do not target the affected areas such as sham acupuncture or ineffective herbal medicine concoctions.
Despite TCM’s results of improving multiple ASD symptoms, there are also many criticisms towards TCM and the effectiveness of it. Critics often argue that there is no real physiological evidence of qi and meridians. Though there have been a handful of trials investigating the effectiveness of TCM for the treatment of ASD, the evidence is often lacking and poor quality to reach a solid conclusion. Thus, there needs to be more high-quality and randomized research and trials completed in this area to fully understand its mechanisms and effects. Further, TCM treatments are largely specific to individuals unlike western medicine that have well-defined causes and treatments to diseases and disorders. This makes drawing conclusion from large groups extremely difficult, if not impossible. It also makes it harder to produce a systemized set of TCM treatments for ASD. However, recently in 2019, the World Health Organization (WHO) formally approved a chapter on TCM in the influential global compendium for the first time. This is a groundbreaking step towards more extensive research into the biological and molecular effects of TCM in an attempt to better understand it in terms of western medicine. This also gives doctors a look into new perspectives and alternative treatments for their patients resulting in more families considering TCM, in particular acupuncture, for treating ASD.
Abo Almaali HMM, Gelewkhan A, Mahdi ZAA. Analysis of Evidence-Based Autism Symptoms Enhancement by Acupuncture. J Acupunct Meridian Stud. 2017;10(6):375‐384. doi:10.1016/j.jams.2017.09.001
Bang M, Lee SH, Cho SH, et al. Herbal Medicine Treatment for Children with Autism Spectrum Disorder: A Systematic Review. Evid Based Complement Alternat Med. 2017;2017:8614680. doi:10.1155/2017/8614680
Cai, JL, Lu JQ, Lu G, et al. Autism Spectrum Disorder Related TCM Symptoms and TCM Herbs Prescriptions: A Systematic Review and Meta-Analysis. North America Journal of Medicine and Science. 2015;8(1), 29-130.
Cheng, Kwokming James. “Neurobiological Mechanisms of Acupuncture for Some Common Illnesses: A Clinician's Perspective.” Journal of Acupuncture and Meridian Studies, vol. 7, no. 3, June 2014, pp. 105–114., doi:10.1016/j.jams.2013.07.008.
DeFilippis M. The Use of Complementary Alternative Medicine in Children and Adolescents with Autism Spectrum Disorder. Psychopharmacol Bull. 2018;48(1):40‐63.
Lee B, Lee J, Cheon JH, Sung HK, Cho SH, Chang GT. The Efficacy and Safety of Acupuncture for the Treatment of Children with Autism Spectrum Disorder: A Systematic Review and Meta-Analysis. Evid Based Complement Alternat Med. 2018;2018:1057539. Published 2018 Jan 11. doi:10.1155/2018/1057539
Lee SH, Shin S, Kim TH, et al. Safety, effectiveness, and economic evaluation of an herbal medicine, Ukgansangajinpibanha granule, in children with autism spectrum disorder: a study protocol for a prospective, multicenter, randomized, double-blinded, placebo-controlled, parallel-group clinical trial. Trials. 2019;20(1):434. Published 2019 Jul 15. doi:10.1186/s13063-019-3537-7
Liu C, Li T, Wang Z, Zhou R, Zhuang L. Scalp acupuncture treatment for children's autism spectrum disorders: A systematic review and meta-analysis. Medicine (Baltimore). 2019;98(13):e14880. doi:10.1097/MD.0000000000014880
Ming X, Chen X, Wang XT, Zhang Z, Kang V, Zimmerman-Bier B. Acupuncture for treatment of autism spectrum disorders. Evid Based Complement Alternat Med. 2012;2012:679845. doi:10.1155/2012/679845
Silva LM, Schalock M, Ayres R. A model and treatment for autism at the convergence of Chinese medicine and Western science: first 130 cases. Chin J Integr Med. 2011;17(6):421‐429. doi:10.1007/s11655-011-0635-0
Silva LM, Schalock M, Gabrielsen K. Early intervention for autism with a parent-delivered Qigong massage program: a randomized controlled trial. Am J Occup Ther. 2011;65(5):550‐559. doi:10.5014/ajot.2011.000661
Wang, C., Lee, Y., Wu, M. et al. Trends in the utilization of acupuncture among children in Taiwan from 2002 to 2011: a nationwide population-based study. BMC Complement Altern Med 19, 328 (2019). https://doi.org/10.1186/s12906-019-2753-8
Weintraub M. Qigong and Neurologic Illness. Alternative and Complementary Treatments in Neurologic Illness. 2001;15, 197-200.
Wong VC, Chen WX. Randomized controlled trial of electro-acupuncture for autism spectrum disorder. Altern Med Rev. 2010;15(2):136‐146.
Wong VC. Use of complementary and alternative medicine (CAM) in autism spectrum disorder (ASD): comparison of Chinese and western culture (Part A). J Autism Dev Disord. 2009;39(3):454‐463. doi:10.1007/s10803-008-0644-9
Yau CH, Ip CL, Chau YY. The therapeutic effect of scalp acupuncture on natal autism and regressive autism. Chin Med. 2018;13:30. Published 2018 Jun 15. doi:10.1186/s13020-018-0189-6
Zhang J. A review of autism spectrum disorders (ASD) from A perspective of classical Chinese medicine (CCM). J Tradit Chin Med. 2010;30(1):53‐59. doi:10.1016/s0254-6272(10)60014-3