JAMS324_proof ■ 27 December 2016 ■ 1/7 + MODEL J Acupunct Meridian Stud 2016;--(-):--e-- Available online at www.sciencedirect.com 61 62 1 63 2 Journal of Acupuncture and Meridian Studies 64 3 65 4 66 5 journal homepage: www.jams-kpi.com 67 6 68 7 69 8 70 9 CASE REPORT 71 10 72 11 73 12 74 13 75 14 76 15 A Single Case of Tourette’s Syndrome 77 16 78 17 Treated with Traditional Chinese Medicine 79 18 80 19 Q37 81 20 Min-Hwa Lee* 82 21 83 22 84 23 Q1 DAOM Program of Oregon College of Oriental Medicine, USA 85 24 --- Available online 86 25 87 26 88 27 Received: Aug 14, 2016 Abstract 89 28 Accepted: Dec 13, 2016 The objective of this case study was to investigate the effectiveness of Chinese medicine 90 29 in treating Tourette’s syndrome. Tourette’s syndrome is a childhood- onset disorder that 91 30 is characterized by sudden, involuntary movements or tics. The participant in this study 92 31 was a 33-year-old male who had been diagnosed with Tourette’s syndrome at the age of 9 93 32 years. His major complaints included facial tics, shoulder shrugging, and clearing the 94 33 throat. Using a combination of acupuncture, herbs, Gua-Sha, and lifestyle changes once 95 34 a week for 35 treatments, all the symptoms were reduced by 70%, as reported by the pa- 96 35 tient. In this case, the results indicated that Chinese medicine was able to minimize the 97 36 symptoms of Tourette’s syndrome. Further investigation is needed to support this argu- 98 37 ment. Tourette’s syndrome, which was first described in 1885 by a French physician 99 38 named Gilles de la Tourette, is characterized by facial tics, involuntary body movements 100 39 from the head to the extremities, or vocal tics, and it usually has its onset in childhood. It 101 40 is a neuropsychiatric disorder. The treatment for Tourette’s syndrome is based on phar- 102 41 macological treatment, behavior treatment, and deep brain stimulation. Unfortunately, 103 42 none of these could completely control the symptoms; furthermore, antipsychiatric drugs 104 43 might cause additional side effects, such as Parkinson symptoms, tardive dyskinesia, and 105 44 metabolic disturbances. Finding acupuncture and oriental medicine literature on treat- 106 45 ment of Tourette’s syndrome was difficult, especially that written in English. Some 107 46 research papers that have been translated into English indicated that Chinese herbs 108 47 and acupuncture could reduce the tics significantly. For example, a study by Dr Pao- 109 48 Hua Lin reported the significant effects of using acupuncture and oriental medicine in 110 49 treating 1000 Tourette’s syndrome cases. This case was treated to further investigate 111 50 Q5 the principles of Dr Lin’s study. 112 51 113 52 114 53 115 54 116 55 This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http:// 117 56 creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any me- 118 57 dium, provided the original work is properly cited. * Corresponding author. 119 58 Q2 Q3 120 59 pISSN 2005-2901 eISSN 2093-8152 121 60 http://dx.doi.org/10.1016/j.jams.2016.12.005 Copyright ª 2016, Medical Association of Pharmacopuncture Institute. 122 Please cite this article in press as: Lee M-H, A Single Case of Tourette’s Syndrome Treated with Traditional Chinese Medicine, Journal of Acupuncture and Meridian Studies (2016), http://dx.doi.org/10.1016/j.jams.2016.12.005 JAMS324_proof ■ 27 December 2016 ■ 2/7 + MODEL 2 M.-H. Lee 1 1. Introduction deep brain stimulation, which is used when the conditions 63 2 are too difficult to be treated by other treatments. This 64 3 involves a surgery to install electrodes into the corre- 65 4 1.1. Biomedical perspective sponding brain areas and make a connection with a brain 66 5 pacemaker. A group of researchers from Europe conducted 67 6 Q6 Movement of tics is involuntary therefore patients are un- a long-term follow-up of patients treated with deep brain 68 7 able to control them. In addition, tics come in an urgent stimulation and monitored them for 5e6 years. They found 69 8 form. Some patients say that tics reduce the sensation of an a reduction in severity, and improvements in obsessive 70 9 urge, and they feel that the urge is relieved shortly after behaviors and depression were statistically significant [6]. 71 10 the tics. Sometimes, tics will reoccur. Felling and Singer [1] In their conclusion, they mentioned that the 2-year follow- 72 11 claimed that Tourette’s syndrome is a common and chronic up was more positive than the 5- year follow-up [8]. Third, 73 12 neuropsychiatric disorder, and the presentation of Tour- behavior therapy has been studied to reduce the severity of 74 13 ette’s syndrome includes fluctuating motor and phonic tics. tics. Wilhelm et al [9] led a randomized trial of behavior 75 14 Examples of these include eye blinking or deviation, head therapy for adults. The comprehensive behavior interven- 76 15 jerking, unusual movement of the limbs and trunk, chronic tion included a set of training: psychoeducation and 77 16 persistent cough, ocular tics, etc. [2]. In some cases, it can awareness of tics, competing response training, relational 78 17 combine with other conditions such as obsessi- training, functional analysis, etc. Another study, which 79 18 veecompulsive disorder, attention-deficit hyperactivity utilized the same comprehensive behavioral intervention 80 19 disorder, or drug-induced movements such as akathisia, and functional magnetic resonance imaging to investigate 81 20 dystonia, chorea, Parkinson’s, or antisocial behavior [2]. the behavior treatment of Tourette’s syndrome with regard 82 21 Some argued that tic disorder, another name for Tourette’s to neural change, found a significant decrease in the acti- 83 22 syndrome, and both obsessiveecompulsive disorder and vation of striatal neurons of the basal ganglia from before 84 23 attention-deficit hyperactivity disorder are oftentimes to after the treatments [10]. 85 24 associated with aggressive behavior and low impulse con- 86 25 trol [3]. 87 26 The specific causation remains unknown. However, 1.2. Acupuncture and oriental medicine 88 27 Hallett [4] suggested that Tourette’s syndrome could cause perspective 89 28 the tic sensation due to “defective sensory habituation”. 90 29 He hypothesized the habituation was caused by the tics as a In the studies of traditional Chinese medicine, there are a 91 30 Q7 reward as for urgent sensation. Hallett [4] also described few references regarding Tourette’s syndrome. One of the 92 31 Tourette’s syndrome to be often associated with an auto- authors, Dr Pao-Hua Lin [11], wrote a book, called Tour- 93 32 somal recessive inheritance. No abnormal genes have yet ette’s Syndrome Treated with Chinese Medicine. He also 94 33 been found; however, recent studies indicated that these conducted a clinical study of 1000 Tourette’s syndrome 95 34 Q8 patients showed abnormalities in GABA activities in the patients treated with acupuncture and oriental medicine 96 35 brain. Another genetic research out of the range of geno- (AOM) for his 2010 doctoral dissertation from the Liaoning 97 36 Q9 type 609 Tourette’s syndrome cases. In 2014, a signal gene, University of Chinese Medicine. He mentioned that in the Q12 98 37 Q10 rs2060546, was found near the NTN4 axon. These variants old days Tourette’s syndrome patients were treated by 99 38 are suggested to be associated with the risk of Tourette’s changing their names or the Feng shui of the patient’s 100 39 syndrome alleles [5]. Some reports suggest that it could be houses due to the evil attached to them. Even in AOM, 101 40 the result of a combination of medication, such as lamo- there is no name for Tourette’s syndrome. However, the 102 41 trigine or clomipramine, and infection from Lyme disease Huang Di Nei Jing Su Wen describes it as “.all heat 103 42 Q11 (Singer, MD). Moreover, “an imbalance of neurotransmit- madness and convulsions are fire; all that are easily star- 104 43 ters, especially dopamine and serotonin” has been hy- tled, fearful, as if they’ve lost their mind are also fire” [11]. 105 44 pothesized [6]. Lastly, some stimulants such as Qian YI (ACE 1032e1113), a famous Chinese pedestrian, Q13 Q14 106 45 methylphenidate and dextroamphetamine might trigger the wrote the first existing pedestrian book Xiao Er Zhen Zhi 107 46 syndrome as well. Hue. He summarized four conditions associated with the 108 47 There are several treatments that can control the wind to be either observed or treated. First, if the eyes look 109 48 severity of tics, but further investigation is required in upward, it means the internal heat is rushing up to the 110 49 order to control the symptoms more effectively. First, head. Second, blinking the eyes is associated with liver 111 50 pharmacological treatment is usually indicated for moder- wind, and if the eyes cannot move, then there is heat from 112 51 ate to severe tics. In clinics, nondopaminergic drugs have the eyes. Also, the twitching is due to heat in the heart. 113 52 been used for more than 30 years [7]. However, there are Third, “Ji Jing” (acute fright) is caused by Yang excess and 114 53 side effects such as parkinsonian syndromes, tardive Yin deficiency. Extreme heat induces the twitch.