Research on the Efficacy of Liu’s Scalp Acupuncture in Treating Attention Deficit Hyperactivity Disorder

LIN SEN¹，, Liu Zhenhuan^2*

1.Henan Zhongjing National Medicine Research Institute, Henan Province, China; 

2. Nanhai Maternity and Children’s Hospital Affiliated to Guangzhou University of Chinese Medicine, Guangdong Province, China)

Corresponding Author: Liu Zhenhuan [email protected]

[Abstract] Objective: To investigate the clinical efficacy of Liu’s Painless Scalp Acupuncture for Children in treating Attention Deficit Hyperactivity Disorder (ADHD). Methods: Sixty children diagnosed with ADHD who visited the Acupuncture and Rehabilitation departments of our hospital between January 2023 and June 2025 were selected. All children received Liu’s Painless Scalp Acupuncture for Children. The Conners Parent Rating Scale (CPRS) and the Swanson, Nolan, and Pelham Rating Scale (SNAP-IV) were used to evaluate therapeutic effects before treatment and after 3 courses of treatment. Adverse events occurring during the treatment process were recorded to assess the safety of Liu’s Painless Scalp Acupuncture for Children. Results: After 3 courses of treatment, the scores on both the CPRS and SNAP-IV showed significant improvement, with statistically significant differences (P<0.05). Conclusion: Liu’s Painless Scalp Acupuncture for Children is a safe and effective treatment for ADHD. It significantly improves the core clinical symptoms of children with ADHD, notably enhancing attention and reducing hyperactive-impulsive symptoms.

Keywords: Liu’s scalp acupuncture; Attention Deficit Hyperactivity Disorder (ADHD); Zhi Qi Zhen (Intelligence 7 Needles); Heart-Liver Area; Emotion Area

Attention-Deficit/Hyperactivity Disorder (ADHD) is a common neurodevelopmental disorder that is typically diagnosed in childhood, with approximately 50% of affected children continuing to experience symptoms into adulthood. Its core features are inattention, hyperactivity, and impulsivity that are not commensurate with the individual’s developmental level, and these symptoms can cause significant impairment in social, academic, or occupational functioning. Medication can help control symptoms to a certain extent, but it does not address the root cause and often comes with significant side effects such as decreased appetite, sleep or mood disorders. Traditional Chinese medicine (TCM) has shown good efficacy in treating this condition^[1]. Professor Liu Zhenhuan has been dedicated to the field of pediatric neurorehabilitation for over 40 years and pioneered the Liu-style painless neurorehabilitation scalp acupuncture therapy. He has extensive clinical experience and has treated many children with cerebral palsy, intellectual disability, autism, ADHD, and language development disorders. He has solved the technical problems of poor compliance and fluctuating efficacy in traditional acupuncture treatment. The Liu-style painless pediatric scalp acupuncture has 3 major characteristics: first, it is characterized by painless needle insertion; second, it is based on the precise localization of the projection areas of language, motor, and cognitive functions on the scalp; third, it involves the formulation of individualized scalp acupuncture treatment plans according to the critical periods of motor, language, cognitive, and psychological behavioral development in children of different ages. Professor Liu has unique experience in treating ADHD and has achieved remarkable clinical results. As a student of Professor Liu, I have summarized his experience in treating this condition with Liu-style painless pediatric neurorehabilitation scalp acupuncture in the course of my clinical observations. I have applied his scalp acupuncture treatment plan in the Acupuncture and Rehabilitation departments of our hospital and achieved good therapeutic effects. The research report on the treatment of ADHD with Liu-style painless pediatric scalp acupuncture is presented below.

1. Materials and Methods

1.1 General Information

Case Selection: Sixty children diagnosed with ADHD who visited the Acupuncture and Rehabilitation departments of our hospital between January 2023 and June 2025 were selected. Among them, there were 38 boys and 22 girls, aged between 6 and 12 years, with an average age of (7.5 ± 2.3) years. According to subtype, 38 were predominantly inattentive, 10 were predominantly hyperactive-impulsive, and 12 were combined type. Informed consent was obtained from the parents of all children.

Inclusion Criteria: The study strictly followed the diagnostic criteria outlined in the “Pediatric Expert Consensus on Early Identification, Standardized Diagnosis, and Treatment of Attention Deficit Hyperactivity Disorder” issued by the Developmental and Behavioral Pediatrics Group of the Pediatrics Branch of the Chinese Medical Association. Symptoms of inattention and/or hyperactivity/impulsivity had persisted for 6 months or more.

Exclusion Criteria: ① Children who had previously taken central nervous system stimulants (e.g., Clonidine) at the time of enrollment; ② Children with chromosomal abnormalities, organic brain diseases, or brain malformations; ③ Children with a history of fainting during acupuncture (needle sickness); ④ Children whose parents had poor compliance and could not adhere to the treatment plan.

1.2 Methods

Basic Protocol: All 60 children received Liu’s Painless Scalp Acupuncture “Intelligence 7 Needles” as the basic treatment protocol. Acupuncture Points: GV-20 ([bǎi huì, Hundred Convergences], located at the intersection of the line connecting the apexes of both ears and the anterior midline, 5 cun directly above the anterior hairline), EX-HN1 ([sì shén cōng, Alert Spirit Quartet], 4 points located 1 cun anterior, posterior, left, and right to GV-20), GV-24 ([shén tíng, Spirit Court], 0.5 cun directly above the anterior hairline), GB-13 ([běn shén, Root Spirit], 0.5 cun directly above the anterior hairline, 3 cun lateral to the midline, bilaterally for a total of 2 points). Painless needle insertion method: The patient was in a sitting or supine position. After routine scalp disinfection, disposable filiform needles (0.30mm × 25mm) were used. The needle tip was inserted at a 30-degree angle to the scalp, penetrating rapidly to the subgaleal layer without reaching the periosteum. Insertion during inhalation was considered to be supplementing and insertion during exhalation was draining. After obtaining qi (needle sensation), the pulling and pushing needle manipulation techniques were applied for 1-3 minutes. Needles were retained for 30 minutes and the manipulation was repeated every 10 minutes during retention.
   

Combined Protocol: For the 12 children with combined type ADHD, the basic “Intelligence 7 Needles” protocol was supplemented with “Spirit Stabilizer 3 Needles”, Heart-Liver Area, and Emotion Area. Acupuncture Points: Spirit Stabilizer 3 Needles: Spirit Stabilizer I (0.5 cun above EX-HN3 [yìn tǎng, Hall of Impression]) and Spirit Stabilizer II (0.5 cun medial to GB-14 [yáng bái, Yang White], bilaterally for a total of 2 points). Heart-Liver Area: Starting directly above the left pupil at the hairline, a 2-cm-long line running upwards parallel to the anterior-posterior midline is the Liver Area; starting at the midpoint between the point directly above the right pupil at the hairline and the anterior-posterior midline, a 2-cm-long line running upwards parallel to the anterior-posterior midline is the Heart Area. Emotion Area: 2 cm lateral to the left and right of the anterior midline, starting 2 cm above the anterior hairline, needle subcutaneously backwards to a depth of 25mm. Operation Method: The Spirit Stabilizer 3 Needles were perpendicularly inserted to a depth of 0.3-0.5 cun, with small-amplitude rotation after obtaining qi. The Emotion Area needle was obliquely inserted along the scalp, with the needle tip directed towards the vertex, to a depth of 0.5-0.8 cun, using an even supplementing-draining method after obtaining qi. Needle retention time and manipulation frequency were the same as for the “Intelligence 7 Needles”.

Treatment Frequency: Treatment was administered every other day. Ten sessions constituted 1 course. A 15-day break was taken between courses. A total of 3 courses (30 sessions) were administered.

Therapeutic effects were evaluated before treatment and after 3 courses of treatment.

1.3 Observation Indicators and Assessment Tools

Conners Parent Rating Scale (CPRS): Developed by American psychologist Dr. C. Keith Conners in 1969 and revised multiple times, it consists of 48 items. Based on 10 specific items most indicative of hyperactive behavior, each item is rated on a 4-point scale (0 = Never, 1 = Occasionally, 2 = Often, 3 = Very Often). The raw score for the Hyperactivity Index is calculated and converted to a T-score by comparing with norms. A higher score indicates more severe symptoms. T-score < 60: within normal range. T-score 60-65: may indicate borderline or mild problems, requiring attention. T-score > 65: generally considered clinically significant, indicating problems likely requiring intervention.

Swanson, Nolan, and Pelham Rating Scale (SNAP-IV): Used to assess the severity of ADHD before treatment and after 3 courses, it primarily covers 3 dimensions: Inattention, Hyperactivity/Impulsivity, and Oppositional/Defiant, each with 9 items. Each item is scored from 0 to 3. The average score for each dimension is calculated and summed. Higher scores indicate more severe symptoms.
   

Scalp Acupuncture Safety Assessment: Adverse events (such as scalp hematoma, pain, and needle sickness) occurring during treatment were recorded. Severity was assessed as follows: Mild: Mild, transient symptoms, requiring no treatment, not affecting daily life or treatment (e.g., slight bruising at needle site, brief pain). Moderate: Obvious symptoms causing some discomfort, may require simple intervention (e.g., pressure to stop bleeding, cold compress), slightly affecting daily life, but not requiring discontinuation of treatment (e.g., larger hematoma, significant soreness/distension). Severe: Serious symptoms causing obvious distress, usually requiring medical intervention, potentially leading to treatment interruption or hospitalization (e.g., needle sickness causing brief loss of consciousness).

1.4 Statistical Processing

Statistical analysis was performed using SPSS 22.0 software. Measurement data are expressed as mean ± standard deviation (x̄ ± S). Comparisons before and after treatment and between courses were conducted using repeated measures ANOVA and t-tests. Count data are expressed as rates (%), analyzed using the chi-square (χ²) test. A P-value < 0.05 was considered statistically significant.

2. Results

1. 1.Comparison of CPRS scores showed that, after 3 courses of treatment, the children’s Hyperactivity Index T-scores significantly improved. See Table 1.

Table 1: Comparison of CPRS Scores Before Treatment and After 3 Courses (x̄ ± S, points)

2.2 Comparison of SNAP-IV scores showed that, after 3 courses of treatment, the children’s SNAP-IV scores significantly decreased.

Table 2: Comparison of SNAP-IV Scores Before Treatment and After 3 Courses (x̄ ± S, points)

2.3 Safety Assessment of Scalp Acupuncture: During the treatment process, 2 patients experienced mild scalp hematomas, which resolved after the local application of a cold compress. No other serious adverse reactions occurred.

3. Discussion

Currently, Attention Deficit Hyperactivity Disorder (ADHD) in children and adolescents is a neurodevelopmental disorder with a global prevalence of approximately 5-7%. The prevalence in Chinese children and adolescents is about 6.26%, yet the diagnosis rate is very low. This phenomenon is common worldwide^[2]. However, due to a lack of effective diagnostic tools and insufficient public awareness of ADHD, many patients fail to receive timely diagnosis and treatment, which may be related to societal under-recognition of ADHD and limitations in healthcare resources^[3]. Furthermore, ADHD often co-occurs with other mental disorders, such as tic disorders, anxiety disorders, and depression, further complicating diagnosis^[4-5]. ADHD typically begins in childhood, is more common in boys, and has a complex etiology resulting from the interaction of genetic and environmental factors. Neuroimaging studies have found subtle differences in the volume, activity, and connectivity of certain brain regions (such as the prefrontal cortex, basal ganglia, cerebellum) in children with ADHD. These regions are responsible for executive functions, attention, and behavioral control. Dysfunction in the brain’s dopamine and norepinephrine systems is considered a core neurobiological mechanism^[6-8]. The severity and profound impact of ADHD make early identification, scientific diagnosis, and standardized treatment crucial for improving the quality of life for affected children and their families. Liu’s Painless Pediatric Neurological Rehabilitation Scalp Acupuncture offers the advantages of painless insertion, comfortable needle retention, and rapid effectiveness.

Professor Liu believes^[9-10] that the key to treating ADHD lies in regulating the spirit and abnormalities in the function of the spirit in the human body are closely related to the occurrence of ADHD. Spirit refers to the capacity to govern vital activities in the human body. Chapter 23 of Huangdi Neijing Suwen [The Yellow Emperor’s Inner Canon: Plain Questions], entitled “Treatise Explaining the 5 Qi”, states: “What the 5 viscera store: the heart stores the spirit, the lungs store the corporeal soul, the liver stores the ethereal soul, the spleen stores reflection, and the kidneys store the mind. This is called what the 5 viscera store.” The spirits stored by the 5 viscera are called the 5 Overcoming Spirits. The 5 Overcoming Spirits are a unified whole but distinct from each other; each has its own physiological functions, and they interact and constrain each other. In a pathological state, if the spirit is impaired, dysregulation of mental and conscious activities easily occurs. During childhood, the “viscera are tender; the [body’s] form and qi are not yet full.” The 5 viscera are not fully developed, their functions are not yet perfected, and the 5 Overcoming Spirits are not yet agile. Once the spirit mechanism becomes abnormal, manifestations such as inattention, excessive movement, emotional instability, impulsivity, cognitive impairments, and learning difficulties easily appear, developing into ADHD.

In this study, the primary acupuncture points used in Painless Pediatric Neurological Rehabilitation Scalp Acupuncture were the “Intelligence 7 Needles”. GV-20 (bǎi huì, Hundred Convergences) belongs to the governing vessel and is the “confluence of the yang channels”. Qibo said: “The true essence of acupuncture must first regulate the spirit”. The core of scalp acupuncture lies in “obtaining the spirit”. Its main functions are to arouse the brain, open the orifices, activate the spirit, sharpen the wits, quiet the spirit, stabilize the mind, calm the liver, extinguish wind, and safeguard the corporeal soul. Stimulating GV-20 (bǎi huì, Hundred Convergences) can allow clear qi to ascend to the head and eyes, increase blood and oxygen supply to the brain, and invigorate the spirit. The EX-HN1 (sì shén cōng, Alert Spirit Quartet) points are located around the vertex, surrounding GV-20 (bǎi huì, Hundred Convergences) on the governing vessel. The governing vessel enters and connects with the brain, and the brain is the “house of the original spirit”. Therefore, stimulating EX-HN1 (sì shén cōng, Alert Spirit Quartet) can have very good effects of calming and quieting the spirit, arousing the spirit and opening the orifices, and sharpening hearing and brightening the eyes. GV-24 (shén tíng, Spirit Court) and GB-13 (běn shén, Root Spirit) are 2 important head points closely related to the spirit. They are located near each other, and their therapeutic effects are highly concentrated on mental disorders and head diseases. They are key points for quieting the spirit and arousing the brain to treat mental, neurological, and psychological diseases. Their effects are synergistic, yet they have different focuses. GV-24 (shén tíng, Spirit Court) acts like a solemn “sedation official”, stationed at the center, directly managing the tranquility of the brain; it is skilled at handling severe mental disturbances and obstructions of the head and sense orifices. GB-13 (běn shén, Root Spirit) acts like a comprehensive “mediator”, freeing the qi dynamic of the liver and gallbladder channels, regulating emotional fluctuations; it is skilled at handling emotional dysregulation and pain along the lesser yang channel pathways. Used together, one central and one lateral, one calming and one regulating, they jointly achieve the excellent effect of quieting the spirit, arousing the brain, opening the orifices, and resolving depression, forming a classic point combination in TCM acupuncture for treating mental, psychiatric, and head diseases. Professor Liu believes that the Spirit Stabilizer 3 Needles, combined with the “Intelligence Seven Needles”, work together to arouse the brain, open the orifices, sharpen the wits, and calm the spirit. Needling the Heart-Liver Zone can calm the liver and nourish the heart, enhancing intellectual activity, while needling the Emotion Zone treats emotional disorders and attention deficits. Needling the scalp areas corresponding to the prefrontal cortex can promote functional arousal and recovery, regulate brain electrical activity, and improve cerebral blood flow velocity. The combined use of these points embodies the treatment concept of “the true essence of acupuncture must first regulate the spirit”. Holistic stimulation of the head acupuncture points achieves comprehensive regulation of the 5 visceral spirits, thereby restoring the balance of the spirit dynamic and improving the core symptoms of ADHD.

After 3 courses of scalp acupuncture treatment, the children’s scores on both the Conners Parent Rating Scale and the SNAP-IV showed significant improvement, indicating that scalp acupuncture has definite effects in treating ADHD. It can significantly improve issues related to learning and conduct, alleviate anxiety symptoms, and regulate emotions. Furthermore, during treatment, only 2 patients experienced mild scalp hematomas, which resolved after local cold compress, with no other serious adverse reactions occurring, proving the safety and effectiveness of Liu’s Scalp Acupuncture.

In summary, Liu’s Scalp Acupuncture is a safe and effective treatment for ADHD, capable of significantly alleviating symptoms of inattention and hyperactivity-impulsivity in affected children.

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Author Profile: Lin Sen, a licensed Traditional Chinese Medicine (TCM) practitioner, graduated from Henan University of Chinese Medicine. Currently, he serves as the vice president of Henan Zhongjing National Medical Research Institute. He is a disciple of Professor Liu Zhenhuan and the 6th-generation inheritor of Yang-Style Acupuncture Point Massage Therapy. Lin is also a national vocational skills appraisal examiner and a standing director of the Pediatric Tuina Professional Committee of the World Federation of Chinese Medicine Societies.

Email: [email protected]; Contact Phone Number: 17737774279