Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder characterized by varying degrees of impairments in language, social interaction, and behavior. Acupuncture has been proven to be an effective and safe treatment. We aim to provide an overview of the clinical research status and efficacy of different acupuncture protocols in the treatment of ASD, systematically review and critically evaluate the existing evidence on the effectiveness and safety of acupuncture in children with ASD. We searched the randomized controlled trials (RCTs) of acupuncture for children with ASD in databases such as China National Knowledge Infrastructure (CNKI), PubMed, and Chinese Biology Medicine disc (CBMdisc) etc. in the past decade, conducted a retrospective summary and evaluated the efficacy of different acupuncture protocols. By observing the changes in the scores of relevant scales before and after treatment, all studies found that both the single utilization and comprehensive utilization of acupuncture therapy have certain clinical efficacy in improving ASD children’s physical and activity participation-related functions such as language, social interaction, and behavioral patterns, and also has efficacy in alleviating comorbidities. This review suggests that acupuncture has certain clinical efficacy in alleviating ASD children’s core symptoms. However, Due to statistical and clinical heterogeneity among studies, it can’t determine whether there’re therapeutic discrepancies between different acupuncture protocols.

• Autism spectrum disorders • Child • Acupuncture • Review

Cheang K, Jiang Y (2026) Clinical Research Progress in Acupuncture Therapy for Children with Autism Spectrum Disorders: A Literature Review. J Neurol Disord Stroke 13(1): 1249.

ASD: Autism Spectrum Disorder; ADHD: Attention Deficit And Hyperactivity Disorder; TCM: Traditional Chinese Medicine; ABC: Autism Behavior Checklist; CARS: Childhood Autism Rating Scale; RBS-R: Repetitive Behavior Scale-Revised; PEP-3: Psychoeducational Profile Third Edition; ASRS: Autism Spectrum Rating Scales; Gesell: Gesell Developmental Schedules; SRS: Social Responsiveness Scale; GSI: GI Severity Index (GSI); ATEC: Autism Treatment Evaluation Checklist; Glu/GABA: Serum Ratio Of Glutamate and Γ-Aminobutyric Acid ; ETTAA: Encephalopathy Therapeutic Tongue Acupoint Apparatus

Autism spectrum disorder (ASD) is a group of early- childhood-onset neurodevelopmental disorder. It is characterized by deficits in social communication and social interaction, as well as restricted, repetitive patterns of behavior, interests, or activities, and commonly coexists with intellectual disability. Core clinical symptoms include social  disorder,  impaired  social  interaction,  limited or absent verbal communication, mutism, echolalia or repetitive utterances, stereotyped and repetitive motor behaviors, and restricted interests [1]. It is often accompanied by comorbidities such as developmental coordination disorder, attention deficit and hyperactivity disorder (ADHD), sleep disorders, anxiety disorder, depressive disorder, motor problems, obesity and gastrointestinal symptoms etc [2].

Research [3], reported that the global number of ASD cases has reached 61.8 million, making it one of the major diseases of burden among children and adolescents. In 2021, the number of ASD patients in China was approximately 9.0786 million, and the prevalence rate has been rising rapidly in recent years, ASD becoming a widely concerned social and public health issue. Younger age groups are the priority population for ASD intervention. At present, ASD is mainly managed via behavioral, pharmacological, physical, and exercise methods, yet these strategies are limited by inconsistent therapeutic outcomes, interindividual variations in efficacy, and the occurrence of adverse drug reactions [4].

As a conventional external therapy in Traditional Chinese Medicine (TCM), acupuncture can dredge meridians, regulate yin and yang, and strengthen healthy qi to remove pathogenic factors. In recent years, the application of acupuncture in the treatment of ASD has presented different treatment protocols and forms, yielding promising therapeutic outcomes in alleviating the clinical symptoms of ASD children and showing its distinctive merits and potential. Besides, previous studies [5, 6], have provided evidences for efficacy and safety of acupuncture for children with ASD.

By searching databases such as China National Knowledge Infrastructure (CNKI), PubMed, and Chinese Biology Medicine disc (CBMdisc), this paper reviews clinical reports on acupuncture for children with ASD in the past decade. The objective of this study was to review existing research findings and to provide an overview of the clinical research status and efficacy of different acupuncture protocols in the treatment of ASD, aiming to offer references for the clinical application of acupuncture in ASD.

Theoretical basis of acupuncture treatment for ASD

There was no term equivalent to autism spectrum disorderin ancient Traditional Chinese Medicineliteratures, yet there are numerous records of similar symptoms, such as “five retardations” (wu chi), “echolalia retardation” (yu chi), “lack of emotional responsiveness” (shi wu qing), “mental dullness” (bu hui), and “lack of intelligence” (wu hui). Wang Sumei [7], summarizes that ASD falls into the category of emotional disorders in TCM. It is generally believed that the lesion site of ASD is in the brain, involving the five zang-organs, and the fundamental pathogenesis is the impairment of spirit-mind function. Treatment of ASD should be based on yin and yang, centered on the Five Zang, and guided by the correlation of “Five Zang - Five spirits - Five Sensory Organs”. Therapeutic interventions must adhere to the principle of invigorating intelligence, inducing spirit arousal, and opening the orifices, emphasizing on harmonizing yin and yang and regulating the functions of the Five Zang. Modern studies [8-11], indicate that the pathogenesis of ASD is linked to genetic factors, maternal immune activation, neuroinflammation, maternal and early antibiotic exposure, environmental triggers. Nevertheless, the summaries and deductions of clinical research in these domains are insufficiently comprehensive, with numerous limitations remaining. Emerging research [12-17], has demonstrated that acupuncture can elevate the levels of neurotransmitters including oxytocin, arginine-vasopressin, and serotonin at the molecular level, enhance the expression of brain-derived neurotrophic factor (BDNF), optimize neuronal function and plasticity, suppress neuronal apoptosis, mitigate immune-inflammatory reactions, counteract oxidative stress damage, and modulate cerebral energy metabolism as well as Brain-gut axis function. Acupuncture acts via multiple levels and targets ameliorating the corresponding functional impairments associated with ASD, and also addressing comorbidities.

Scalp Acupuncture

Scalp acupuncture is evolved from the TCM zang-fu- meridian theory combined with the theory of functional localization of the cerebral cortex. In TCM, ASD is generally considered the site of pathology is centered in the brain and is predominantly categorized under emotional disorders. Based on the TCM principle “Where the acupoint is located, there lies its therapeutic effectt”, scalp acupoints are considered as key points for treatment of ASD. Study indicate that filiform needling methods stimulate the neural activity and blood circulation of cerebra [18], achieving the therapeutic effect on ASD.

Jiao Shunfa delineated specific scalp acupuncture stimulation zones according to the corresponding correlation between the functional localization of the cerebral cortex and its projection on the cranial surface

[19] Yu et al. [20], selected Touwei (ST8), Shenting (GV24), Baihui (GV20), Sishencong (EX-HN1), Yintang (EX-HN3), Yanyu 1 Area, and Yanyu 2 Area etc. for scalp acupuncture, combined with behavioral therapy for ASD. After treatment, the scores on relevant assessment scale of the combination group, including language communication, social interaction, sensory cognition, and healthy behavior of the pediatric patients were significantly lower than those before treatment and also lower than those in the single behavioral therapy group. It can be seen that Jiao’s scalp acupuncture can improve autistic behaviors such as sensory function, communication function, and motor function of the pediatric patients, and also promote healthy psychological development.

Based on Jiao’s cerebral cortex functional localization areas, Lin Xuejian developed the new theories of the “cerebral cortical silent area” and the “new cerebellar area”. On the basis of using Jiao’s scalp acupuncture treatment protocol, Zhao et al. [21], eliminated the Yanyu 3 Area and added the Lin’s Niesanzhen (Three temporal needle), and all of these three acupoints were punctured posterosuperiorly at an angle of 15–20° to the horizontal line to strengthen the stimulation of the posterior temporal

region, thereby enhancing the storage of receptive language skill and memory. After treatment, both groups showed improvements in social adaptation, language function, social interaction, and Autism Behavior Checklist (ABC) assessments compared with baseline. The Lin’s scalp acupuncture group outperformed the Jiao’s scalp acupuncture group in the improvement of personal social interaction and the ABC assessment, while no significant differences were observed between the two groups in the improvement of social adaptation and language function.

Yu Zhishun [22] established the “Field Theory” by integrating traditional Chinese medicine meridian theory and modern medicine functional localization of the cerebral cortex, and divided the cranial surface into seven therapeutic zones. Yu considers that the stimulation of needles on scalp acupoints can enhance the excitability of cerebral cortical neurons, reactivate the inhibited cranial nerve cells, restore corresponding brain functions effectively, and alleviate clinical symptoms. Liao [23], using Cluster Acupuncture at the temporal, frontal, suboccipital and occipital zones of Yu’s scalp acupuncture on the basis of conventional rehabilitation training. Following intervention with Yu’s scalp acupuncture, the Childhood Autism Rating Scale (CARS) scores of the pediatric patients were lower than those in the conventional rehabilitation training group, demonstrating that Cluster Acupuncture on scalp acupoints can achieve superior therapeutic effects in improving social interaction, perception, language and behavioral functions in children with ASD.

Liu Zhenhuan established the “Pediatric Neurorehabilitation Scalp Acupuncture Therapy” focusing on awakening consciousness, combining with national standardized scalp acupuncture, Jiao’s scalp acupuncture, Jinsanzhen Theory, Lin’s scalp acupuncture, Brodmann’s cerebral functional partitioning and Von Economo’s cerebral functional localization. Huang et al [24], implemented structured training for control group patients, including individual language training, personalized work, and group music game sessions. On the basis of structured training, the experimental group added the “Pediatric Neurorehabilitation Scalp Acupuncture Therapy”, using zhisanzhen, sishenzhen, dingshenzhen, niesanzhen, Heart-Liver Area, Emotional Area and Broca Area. After treatment, the patients showed significant reductions in both ABC and CARS scores compared with the pre-treatment baseline. Furthermore, the experimental group showed greater decreases in the body use and language function subscales of the ABC as well as the total CARS scores than the control group.

Bai et al. [25], preformed sensory integration training 

to the control group. For the experimental group, on the basis of the same sensory integration training, focusing on different symptoms chose different cranial surface projection area and three needles were inserted Naohu (GV17) toward Fengfu (GV16) and both sides Yuzhen (BL9) toward Tianzhu (BL10), using Cluster Acupuncture with prolonged needle retention for 6 to 8 hours. This method acted directly on the frontal, temporal, occipital, parietal and suboccipital regions of the scalp that are associated with ASD. After treatment, the scores of CARS, ABC and Repetitive Behavior Scale-Revised (RBS-R) in the experimental group were significantly lower than the pre- treatment levels and also lower than those in the control group; meanwhile, the scores of the Psychoeducational Profile Third Edition (PEP-3) in the experimental group were significantly higher than the pre-treatment levels and also higher than those in the control group. Thus, it can be concluded that scalp Cluster Acupuncture with prolonged retention significantly improves efficacy, confers distinct benefits in alleviating clinical symptoms, reducing repetitive stereotypies behaviors, and facilitating language development in children with ASD.

In summary, although different schools of scalp acupuncture have differences in selecting acupoints (zones) and manipulation technique, scalp acupuncture treatment mostly selects acupoints (zones) based on the projection positions of the cerebral cortex functional areas on the skull surface, stimulating the functions in corresponding brain regions and exerting the effects of refreshing the mind, tonifying the brain, regulating the spirit, and improving intelligence in TCM theory. According to the understanding and experience of different trials, the therapeutic emphases vary. However, in general, scalp acupuncture, whether used alone or in combination, can improve the core symptoms of children with ASD and enhance the overall therapeutic effect.

Body Acupuncture

In TCM holistic view, the Zang-Fu organs are interconnected and coordinated via the meridian system, jointly sustaining the normal operation of physiological functions such as mental and emotional activities, circulation of qi and blood as well as body fluids, and somatic movements. TCM recognizes that the core symptoms of ASD are essentially the external manifestations of imbalanced Zang-Fu organs functions, disordered circulation of qi and blood, and dysfunction of the spirit. Therefore, regulating the meridians to restore the coordinated functioning of the Zang-Fu organs can effectively alleviate such symptoms.

The “Thirteen Ghost Points” can regulate qi, blood, 

yin and yang as well as regulate spirit and refresh the mind; they were commonly used for treating depressive and mania psychosis in the past, nowadays, their clinical application has been extended to the treatment of various emotional disorders [26]. ASD is a kind of emotional disorder in TCM, Du[27] et al. selected Neiguan (PC6), Shenmen (HT7), Yongquan (KI1) and Xuanzhong (GB39) as the main points on the basis of conventional rehabilitation therapy, and combined with the “Ghost Points” in accordance with pattern differentiation for experimental group. After treatment, in the intragroup analysis, the total score of Autism Spectrum Rating Scales (ASRS) and the subscale total scores, including peer socialization, adult socialization, social/emotional reciprocity, atypical language, stereotypy, repetitive behavior, sensory sensitivity, and attention/self-regulation, were significantly decreased compared with the pre-treatment levels. The aforementioned scores were also significantly lower in the experimental group than in the control group. These results demonstrate that the use of the “Ghost Points” based on pattern differentiation exerts a positive effect on alleviate multiple core symptoms in children with ASD.

Chief Chinese medicine practitioner Chen [28], applied Cluster Acupuncture with elongated needle at the Du Meridian to regulate brain function, based on the TCM theory “The Du Meridian into the Brain” combing the modern anatomical, physiological features of nose brain access of olfactory mucosa, olfactory bulb and subventricular-zone, and no barrier brain regions. The first needle was applied from Shendao (GV11) toward Yaoyangguan (GV3), the second from Zhiyang (GV9) to Dazhui (GV14), the third from Yaoshu (GV2) to Yaoyangguan (GV3) and were inserted Shenting (GV24), Baihui (GV20), Naohu (GV17) and Fengfu (GV16) at a 15° angle to the skin. In addition, adjunct points were chosen according to differentiated pattern. Thereby achieving the effects of unblocking the Du Meridian to refresh the mind, harmonizing the zang-fu organs, and tonifying qi to elevate yang. This acupuncture protocol has showed a certain efficacy in enhancing language and cognitive functions in children with ASD in Chen’s clinical practice.

Bo Zhiyun [29], held that, based on holographic theory, needling the “innate meridian system” in the abdomen can link the “acquired meridian system” and zang-fu organs via the potent regulatory function of its “mother system”, combining modern research of the Brain-gut Aix, pointed out that abdominal acupuncture exerts a direct regulatory effect on systemic qi and blood circulation and zang-fu organ functions. For the treatment of ASD, Bo [30], selected 

abdominal acupoints based on pattern differentiation according to the clinical manifestations in children. For the depression-prone type, Daheng (SP15), Right Upper Rheumatic Point, Qihai (CV6) and Guanyuan (CV4) were selected to regulate the spirit and relieve stagnation. For the emotional development disorder type, Guanyuan (CV4), Qixue (KI13), Daheng (SP15) and Right Upper Rheumatic Point were chosen to harmonize the zang-fu organs and modulate emotional states. For the cerebral dysplasia type, Zhongwan (CV12), Yindu (KI19) and Guanyuan (CV4) were opted to harmonize the zang-fu organs, refresh the mind and regulate the spirit. This therapeutic method has demonstrated a positive effect in palliating children’s emotional state and promoting cerebral development.

Combined use of scalp acupuncture and body acupuncture

Scalp acupuncture focuses on regulating the circulation of qi and blood in the brain, while body acupuncture concentrates on harmonizing the functions of the zang- fu organs. The combination of the two methods can make up for the deficiency of scalp acupuncture that emphasizes the regulation of cerebral functions. In clinical practice, acupoints are selected and combined according to children’s differentiation and symptoms, thereby achieving the goal of harmonizing the brain and zang-fu organs coordinately.

According to the Jin’s Three-Needle therapy school[31], the core pathogenesis of emotional disorders can be attributed to disharmony and dysfunction of the brain spirit, heart spirit, and five zang spirits, leading to disturbance and failure of the spirit mechanism. In TCM therapeutic theory, the selection of acupoint follows the principle that “All needling methods must be based on the Shen(spirit)”, and is guided by the acupoint-combination philosophy of concentrating the brain spirit, regulating the heart spirit, nourishing the five zang spirits, and conducting the spirit. Zhang[32] et al. gave game therapy to the control group, while the observation group received additional acupuncture at Zhisanzhen, Niesanzhen, Sishenzhen, and Naosanzhen to unblock meridians, regulate the spirit, strengthen the brain and improve intelligence, and Matched acupoints with pattern differentiation, including Back-Shu points, Zusanli (ST36), Sanyinjiao (SP6) and others. After 3 and 6 months of treatment, the CARS and ABC scores in the observation group were lower than both the pre-treatment levels and in the control group. Meanwhile, the scores on the Children Neuropsychological and Behavioral Scale-Revision 2016 were increased to a greater degree than in the control group. From this, it can be seen that Jin’s Three-Needle therapy combined with 

game therapy more effectively promoted the improvement of the children’s overall abilities, including language, social behaviors, adaptive ability, fine motor skills, and gross motor behaviors. Previous similar studies [33,34] have found that combined Jin’s Three-Needle therapy can also improve anxiety disorders in children, enhance their self-care ability and quality of life, and significantly improve their intellectual, behavioral, and neurological development.

The Huxiang’s academic school takes the Five- Meridian (referring to the five meridians in the human meridian system, namely the Liver, Heart, Spleen, Lung, and Kidney Meridians) acupoints as core when needling. While selects acupoints, it emphasizes the compatibility of five meridians and the relationships of generation, restriction, restraint, and transformation among the meridians, acupoints, and zang-fu organs. He et al. [35], selected acupoints under the guidance of five meridians compatible theory of Huxiang school, focusing on scalp acupoints including Baihui (GV20), Shenting (GV24), Sishencong (EX-HN1), Naohu (GV17), Benshen (GB13), Fengchi (GB20), and Yamen (GV15). Besides, in accordance with pattern differentiation and the Five-Meridian compatibility principle, additional trunk acupoints were selected as adjunct points. After treatment, the pediatric patients’ ABC and CARS scores were decreased, while the scores of the Gesell Developmental Schedules (Gesell) and the Sign-Significance relation assessment were increased. These results indicate that Huxiang’s acupuncture method can improve behavioral manifestations in children with ASD and enhance their language and cognitive abilities.

Zhang et al. [36], considered that children with ASD present with symptoms such as social disorder, poor language function, and repetitive stereotypies behaviors due to dysfunction of the five zang-organs and failure to nourish the five spirits. Thus, the treatment should focus on regulating the spirit. Based on Yang Jiasan’s “Spirit- Regulating Acupuncture”, Shenting (GV24), Benshen (GB13), and Baihui (GV20) are used to regulate the spirit, refresh the mind and open the orifices. Combined with bilateral Shenmen (HT7), Taichong (LR3), Taixi (KI3), Neiguan (PC6), and Sanyinjiao (SP6), to regulate the deficiency and excess of the five zang-organs, replenish essence and nourishes the spirit, thereby restoring the functional activity of the spirit. Zhu et al. [37], applied Yang Jiasan’s “Spirit-Regulating Acupuncture” to regulate the spirit, tonify essence, and regulate and balance yin and yang. After treatment, the CARS, ABC, and Social Responsiveness Scale (SRS) scores of children with ASD were all decreased, indicating that the Spirit-Regulating Acupuncture exerts a positive effect on relieving the core symptoms and social ability of ASD children.

TCM theory holds that the brain and intestines are interconnected via meridians. Physiologically, the brain marrow relies on the production and nourishment of acquired cereal nutrients. Pathologically, the two influence each other. Recent studies [38,39], have also indicated that the Brain-gut axis is involved in the pathogenesis of various neurological disorders, including ASD. Wu [40], believed that dysfunction of the middle-jiao pivot and impaired transportation and transformation of the spleen and stomach, leading to insufficient produce of source for qi-blood generation and fail to nourish the heart spirit and original spirit. In addition, dysfunction of transmission in the large and small intestines leads to disturbance of qi activity, which disturbs the spirit and results in malfunction of the spirit mechanism, thus presenting various symptoms of ASD. Based on the interaction between the intestines and the spirit, Wu founded the method of “Regulating Intestines to Treat the Spirit”, which can regulate both intestinal and neurological disorders. For the treatment of pediatric ASD, Sishenzhen, Zhisanzhen, and Yanyu 3 Area were used to regulate the spirit and refresh the brain, combined with bilateral Tianshu (ST25), Zusanli (ST36), and Shangjuxu (ST37) to regulate the intestine and activate the brain, so that ensures the generation and nourishment of the spirit, thereby mitigating the clinical symptoms of ASD. After applying the “Regulating Intestines to Treat the Spirit Acupuncture” in children with ASD. Chen [41] et al. found that the CARS and ABC scores as well as the GI Severity Index (GSI) were all decreased, indicating that this acupuncture protocol can effectively alleviate the behavioral and gastrointestinal symptoms of pediatric ASD.

Yang et al. [42], also established a therapeutic strategy of treating the brain and intestine simultaneously and emphasizing spirit regulation based on the Brain-gut axis theory, and founded the “Acupuncture with Intestine- spirit Joint Therapy” for ASD. For scalp acupuncture, Yang selected Baihui (GV20), Shenting (GV24), Sishencong (EX- HN1), and the Emotional Area to regulate the spirit, refresh the brain, improve intelligence and open the orifices. For body acupuncture, chose Linggu, Huozhu, Menjin, and Changmen from Dong’s Extra Points to soothe the liver and strengthen the spleen, regulate the intestine and activate the spirit, combined with rehabilitation training. The children’s post-treatment scores of ABC, CARS, Autism Treatment Evaluation Checklist (ATEC), and traditional Chinese medicine symptom assessment for gastrointestinal diseases all decreased compared with baseline, and the reductions were significantly greater than those in the rehabilitation training alone group. The trail indicates that the improvement in clinical and gastrointestinal symptoms in children with ASD is related to the intervention.

Other needling methods

Other acupuncture methods include hydro- acupuncture, fire needling, auricular pressure method, and thumbtack needle, among others. In the basis of comprehensive rehabilitation training, Zhao et al. [43, used the solution contained 200mg of vitamin B1 and 1mg of vitamin B12, mixed with 100mL normal saline, and administered injections into Ejisanzhen , Anshenzhen, Niesanzhen, Zhenshangsanzhen, Intelligence-Enhancing Three-Needle, and Yanyu I, II, and III Areas with a dosage of 1.0–1.5 mL per point. After treatment, the children’s ABC and CARS scores were both decreased compared with baseline. Moreover, a significant improvement in sensory function was observed as early as 1 month after treatment. These results indicate that rehabilitation training combined with hydro-acupuncture can further enhance the efficacy.

Gong et al. [44], summarized the clinical practice experience of Liu Qingguo and pointed out that pathogenic cold stagnating in the brain orifices is one of the important pathogenesis of ASD. When pathogenic cold obstructs the brain orifices, yang qi fails to diffuse and unblock, leading to malfunction of brain spirit and disturbance of the spirit mechanism, results in abnormal development of cerebral function and functional disorders. The treatment should be based on the principle that “dredge Jue and regulate yang, opening and closing to inspire intelligence”. By virtue of the yang-heat qi of fire needling, it unblocks qi and blood, promotes cerebral development, and regulates the mental function of children. Liu selects Shenting (GV24), Benshen (GB13), Sishencong (EX-HN1), and Baihui (GV20) as the main acupoints to warm yang and open the orifices, refresh the brain and improve intelligence, combined with Shuaigu (GB41), Fengchi (GB20), Toulinqi (GB15), and Tongtian (BL7), or chooses the projection points on the scalp according to modern medical functional brain regions, including prefrontal lobe, temporal lobe, and parietal lobe. Liu’s clinical practice has shown that the core abilities of pediatric patients, such as logical thinking, language expression, and physical movement etc. have been effectively improved.

Xie et al. [45], gave conventional rehabilitation training to the control group, in the observation group additionally combined auricular points pressing, selecting the Liver, Kidney, Heart, and Brain points as the main ear points to replenish essence and fill the brain marrow, soothe the liver and nourish the heart, and selected auxiliary points according to the different symptoms. For patients with language disorders, Mouth and Tongue points were chosen to assist language development; for those with stereotyped 

and repetitive behaviors, the Endocrine, Sympathetic, and Shenmen points were took to promote cerebral and neural development, as well as to soothe the mind and calm the spirit; for those with social disorders, the Brain Stem point was opted to refresh the brain, invigorate vitality, calm the mind and enhance intelligence. The results showed that all scores of ATEC, CARS, and ABC in observation group after treatment were lower than those in the control group, indicating that the combined use of auricular points pressing method in the treatment of ASD has a definite therapeutic effect.

Lin et al. [46], indicated that the Microbiota-gut-brain axis has a regulatory effect on neurodevelopmental disorders, so that ASD can be treated by improving gastrointestinal function by needling Front-Mu points, and observed its impact on comorbid gastrointestinal diseases. Combined with the TCM theory of twelve cutaneous regions, the team used thumbtack needle in Zhongwan (CV12), bilateral Tianshu (ST25), and Guanyuan (CV4) on the basis of conventional rehabilitation training to regulate the middle-jiao, balance the intestinal flora, and thereby improve cerebral function. After treatment, it was found that the reduction in scores of ABC, CARS, Achenbach Child Behavior Checklist (CBCL), and TCM spleen-stomach symptoms in the combined group was greater than that in the simple conventional rehabilitation group. Additionally, the reduction in the serum ratio of glutamate and γ-aminobutyric acid (Glu/GABA) in the combined group was more significant than that in the simple conventional rehabilitation group. It is apparent that compared with simply implementing conventional rehabilitation training, the intervention method of combining Front-mu point thumbtack needles with conventional rehabilitation training has a more significant improvement on the core symptoms and gastrointestinal symptoms of ASD.

Encephalopathy therapeutic tongue acupoint apparatus (ETTAA) is a device for brain disease that combined with traditional Chinese medicine tongue acupuncture therapy, incorporating modern physical therapy techniques such as electric pulse, electric heat, and infrared rays. Sun et al. [47], utilized this apparatus to perform electrical and thermal stimulation on the “Autism treatment area” at the bottom of the tongue, including Naoshu, Naozhong, Naoyuan, Bizhong, in combination with conventional rehabilitation training. After treatment, the CARS total score was significantly reduced and in the treatment group and more significantly than the simple conventional rehabilitation training group, showing that through stimulate points on the tongue have curative effect in the treatment of ASD, it can better enhance intelligence and improve language and communication. Moreover, Sun’s research found that 

ETTAA also exerted improving effects on sleep and motor

disorders comorbid with ASD.

In summary, hydro-acupuncture and fire needling have demonstrated definite efficacy in the treatment of ASD. Compared with filiform needling, auricular pressure method, thumbtack needle, and Encephalopathy therapeutic tongue acupoint apparatus have the advantages of effectiveness, convenience, lesser stimulation, and safety, making them more acceptable to patients.

Comprehensive acupuncture therapy

Comprehensive acupuncture therapy has become a research hotspot in the acupuncture treatment of child with ASD due to its significant synergistic effect.

Wu et al. [48], conducted a study where the control group gave rehabilitation training and acupuncture, while the experimental group received additional massage including pressing, rubbing, and pushing on acupoints such as Chengjiang, Renzhong, Xiaguan, Jiache, Dichang, Jianjing, and Fengchi. The results of the trail show that the scores in the relevant evaluation scales of the experimental group were significantly higher than those of the control group in terms of language barrier recovery level, sensory expression, social communication, and the anxiety and depression scores were significantly lower than those of the control group. The research suggest that acupuncture combined with massage can more effectively accelerate the rehabilitation process of language disorder, meanwhile, improve depression, anxiety, and negative emotions. Similar studies [49,50], have also shown that acupuncture combined with massage is a safe and reliable treatment for improving language expression, sensory, social ability and development in children with ASD.

On the basis of routine intervention, Huang et al. [51], applied in the control group rehabilitation training and a herbal plaster composed of Fructus Lycii, Rhizoma Acori Tatarinowii, Herba Epimedii, Semen Cuscutae and other herbal medicines in the anterior fontanelle to strengthen the brain, replenish the marrow, awaken the mind and open the orifices. Another plaster consisting of Cortex Cinnamomi, Radix Aucklandiae and Flos Caryophylli was used at Shenque (CV8) to regulate qi movement, warm the middle-jiao and improve transportation. In addition to the treatment in the control group, applied extra acupuncture in Emotional area, Yanyu area, Zhiqizhen, Zhijiuzhen and Niesanzhen in combined group. The results showed that the ABC and CARS scores of the children with ASD were decreased after treatment, and those in the combination group were lower than in the control group. The Gesell and PEP-3 scores were increased after treatment, and 

compared with the control group, the combination group achieved remarkably greater improvements in language understanding and expression, cognition, and behavioral characteristics. Acupuncture combined with plaster therapy is effective in relieving symptoms and improving language disorders in children with ASD.

Kang [52], treated children in the control group with simple acupuncture, and patients in the experimental group were additionally treated with auricular point pressing on Heart, Brain, Liver, Kidney, Tongue, and Mouth points. The improvement in the experimental group was meaningfully better than that in the control group in the relevant assessments, it is suggested that the combination of acupuncture and auricular point pressing can effectively enhance the language function, improve the recognition ability of picture words, and social adaptability of children with ASD, alleviate their clinical symptoms ultimately.

Zhao et al. [53], on the basis of acupuncture combined with rehabilitation training in the control group, the treatment group was additionally treated with soaking hands and feet with ‘Anshen Dingzhi Decoction’ or ‘Xingshen Kaiqiao Decoction’, as well as auricular point pressing on liver, Shenmen, and other points. After treatment, the total effective rate of the treatment group was significantly higher than that of the control group, and the ABC score was significantly lower. It is evident that the combined use of acupuncture, traditional Chinese medicine bath, and auricular point pressing has a good effect on improving ASD symptoms.

These clinical researches all show that the curative effect of combined multiple therapies is superior to that of simple acupuncture therapy, and can significantly improve various abnormal behaviors in children with ASD

By enumerating the clinical efficacy of different treatment protocols and forms for ASD, it has been found that both the single utilization and integrated utilization of acupuncture therapy have achieved significant progress in clinical research in recent years, including breakthroughs in treatment methods, efficacy mechanisms, and efficacy evaluation. Moreover, integrated therapy obtains better efficacy than single use of acupuncture, confirming that acupuncture has certain clinical efficacy in improving ASD children’s physical and activity participation-related functions such as language, social interaction, and behavioral patterns, and also has efficacy in alleviating comorbidities.

However, most of current clinical trials has merely 

demonstrated acupuncture is effective in treating ASD. It can’t determine whether there’re therapeutic discrepancies between different acupuncture protocols, including various selection of acupoint and stimulation area, practitioners’ manipulative techniques, and treatment durations. Besides, it’s also remains challenging to conduct horizontal comparisons among acupuncture protocols. Moreover, the majority of treatment protocols employ a combination of acupuncture and rehabilitation training, it hinders the independent evaluation of acupuncture’s net therapeutic effect, making it difficult to assess the efficacy of acupuncture as a monotherapy for ASD. And there is also a lack of objective evaluation criteria for therapeutic efficacy, such as neurotransmitter activity detection. In addition, clinical trials typically feature small sample sizes, primarily focus on short-term efficacy, long-term efficacy has not been sufficiently observed, and there is a paucity of long-term follow-up data. Besides, basic research of acupuncture therapy for ASD are still underdeveloped.

Addressing the aforementioned limitations, future research ought to focus on the following aspects. Firstly, standardize acupuncture protocols and efficacy assessment criteria to improve the reliability and reproducibility of research findings. Secondly, it is essential to improve the research methods and conduct large-sample, multi- center, randomized controlled trails to provide more comprehensive and systematic evidence for clinical efficacy evaluation. Lastly, enhance the observation of long- term efficacy, establish a standardized long-term follow- up mechanism, and conduct continuous tracking of post- treatment symptom changes, efficacy maintenance, and recurrence, aiming to assess the long-term effectiveness and safety of acupuncture in ASD treatment and identify the sustained therapeutic benefits of acupuncture for ASD.

As research progresses further, the standardization and scientificity of acupuncture for ASD will be steadily enhanced. This will promote the widespread implementation of acupuncture in ASD management, and it may evolve into an important component of comprehensive interventions for ASD, offering new prospects for the rehabilitation of ASD patients.

Conflict of Interest

The research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Thanks to editorial manager Elissa Hanna for the invitation.

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