I. Overview: Tourette syndrome Tourette syndrom (TS) is a complex chronic neuropsychiatric disorder of childhood and adolescence, first reported by Itard in 1825 and first described systematically by Gilles de laTourette in 1885 Itard first reported it in 1825 and Gilles de laTourette first described it systematically in 1885. The disease mostly occurs from 4 to 12 years of age, 90% before 10 years of age, and is characterized by uncontrollable recurrent, rapid, purposeless, involuntary single or multi-part muscle contractions, such as eyebrow squeezing, eye blinking, forehead wrinkling, nose contraction, crooked mouth, corner of mouth twitching, shoulder shrugging, head shaking, neck twisting, limb or trunk twisting, etc., involuntary vocalization or cursing, and swearing. It can be manifested as simple muscle twitching or complex involuntary movements. It is often accompanied by inattentiveness, obsessive-compulsive ideas and movements, emotional and behavioral abnormalities, and poor academic performance. The prevalence is 0.05% to 3%, with a male to female prevalence ratio of 3:1 to 8:2, with males being more common. In recent years, there has been a significant increase in the incidence of the disease [1]. Second, the etiology and pathology: the etiology of this disease is complex. Some scholars believe that the disease is mostly caused by various causes of basal ganglia lesions and abuse of anti-psychotic drugs, while trauma is a common trigger. By analyzing the etiology of 83 confirmed cases, Wu Lijiang [2] et al. concluded that the possible etiologies are: ① the cases in this group were effectively treated with dopamine receptor blockers, which supports the theory of central neurotransmitter dopamine receptor blockade according to most scholars [Microsoft China 1]; ② 9 cases had a family history of twitching, which was considered to be related to genetics; ③ 20 cases of neonatal hypoxic-ischemic encephalopathy and 5 cases of traumatic brain injury, which were considered to be related to brain injury (iii) 20 cases of neonatal hypoxic-ischemic encephalopathy and 5 cases of traumatic brain injury, considered to be related to brain injury; (iv) 4 cases of children’s fear of going to kindergarten and 5 cases of parental divorce, considered psychiatric factors as predisposing factors; (v) 8 cases with a history of encephalitis, presumed that these infections were related to the disease. golden (1978) considered TS to be a manifestation of repressed and defiant personal desires, and certain psychological treatments could lead to symptom relief, thus considered the disease to be related to psychiatric factors [Microsoft China 2]. shapiro ( Wassman (1978) and others reported a genetic association with the disorder. Sweet (1973) found 70.8% EEG abnormalities in 22 cases of TS, thus suggesting that the disorder may be the result of organic damage to the central nervous system. Balthasar (1957) found an abnormal cell type in the dopamine-rich cell population of the striatum in an autopsy of a patient who died of TS, and this abnormal cell type may be a consequence of the injury and is the pathological basis of the disease. Cholen et al. suggested that the syndrome is the result of the interaction of genetic, neurophysiological-behavioral and environmental factors during the development of children [Microsoft China 3][5]. Another [33], through history tracing, physical examination and cervical spine radiographs in 30 patients with TS, found that all patients had a history of head and neck trauma, physical examination and radiographs of the neck suggested an abnormal position of the upper cervical segment, especially the circumflex joint, and lateral radiographs showed straightening of the physiological curvature of the cervical spine or segmental straightening; high tone of the rhomboid, sternocleidomastoid, scapularis raphe, rhomboid and rhomboid muscles in the back of the collar with pressure pain, pressure pain in and around the thoracic 4~7 spinous process, interspinous process and radiating to the shoulder. Clinical manifestations: l. Age of onset: 1 to 12 years old. Course of disease: slow progression, with fluctuating symptoms, ups and downs. 2. Sudden, rapid, involuntary, repetitive, purposeless, stereotyped, and transient muscle twitches. The twitches include simple motor twitches and complex motor twitches. 2.1 Simple motor twitches Nodding, head shaking, blinking, grinning, pouting, nose twitching, eyebrow squeezing, shoulder shrugging, hand shaking, abdominal twitching, kicking, spinning, etc. cannot be restrained (disappears during sleep), gradually aggravated, one after another, and a new set of symptoms will appear when one set of symptoms disappears, continuously. In severe cases, the whole body twitches. 2.2 Complex motor twitching is characterized by the sudden appearance of coordinated and complex movements that seem to have a purpose. The twitching may include hand clapping, hand movement before writing, chopstick pointing before clamping a dish. When walking, squatting or kicking before walking, walking in a circle before walking, stamping the feet, tilting or turning the eyeballs upward, jumping on the feet. 2.3 Vocal twitching Simple vocal twitching: sound in the throat, gurgling, “snoring”, involuntary sudden loud shouting or animal-like sound, throat clearing, dry coughing, sucking nose, gasping, whistling. Complex vocal tics: involuntary chattering, obscenities, cursing, imitative language, repetitive language. Obscenities (coprolalia) often occur in early adolescence. shapiro (1978) reported that 60% of patients with TS [Microsoft China 4] had obscenities. Obscenities are to be distinguished from cursing due to anger, which occurs without any corresponding stimulus, mostly in the form of loud and sudden, sometimes indistinct pronunciation. Some patients simply repeat the same obscene words and phrases over and over in their minds without actually making a sound, called mental coprolalia. Children are subjected to teacher criticism and parental chastisement, stressful partnerships, isolation, and irritability. Adults are often subjected to sarcasm and discrimination, and thus avoid socializing and participating in various social activities. 3, obsessive-compulsive disorder The incidence of children with Tourette’s syndrome combined with obsessive-compulsive disorder is >28% to 67%, which is manifested by obsessive-compulsive ideas and compulsive behavior. Repeatedly appear stereotypes and behaviors. For example, they may feel uncomfortable with their neck and need to turn it, or they may feel uncomfortable with their feet and need to kick them to make them comfortable. Compulsive ideas include compulsive suspicion, compulsive memories, compulsive associations, etc. Compulsive behaviors are forced calculation, forced hand washing, forced ritual actions, etc. 4, attention deficit hyperactivity disorder Children with tic disorder are often combined with hyperactivity and inattentiveness. 5. Learning difficulties The incidence of learning difficulties in children with Tourette’s syndrome is 24% to 50%. Children with Tourette’s syndrome have difficulty concentrating due to frequent twitching episodes, and discrimination and ridicule from teachers and classmates can make them bored with school. Tic disorder itself can also cause visual and perceptual impairment, reduced visual-motor skills and impairment in reading, calculation, writing and language. Anxiety and depression can be associated with anxiety, depression, withdrawal behavior, social interaction disorders, and other mood disorders. Diagnosis and differential diagnosis 1, diagnosis Diagnosis mainly relies on the medical history and clinical special symptoms, not difficult to diagnose. However, this disorder is often accompanied by some psychological and behavioral symptoms, which can confuse the diagnosis and lead to errors. The DSM-IV diagnostic criteria are listed below for reference only: (1) Multiple muscle twitches and more than one vocal cord twitch occur during the disease period, both of which may not occur simultaneously (twitching refers to sudden, rapid, repetitive, stereotyped, non-rhythmic muscle movements or vocal cord vocalizations). (2) Twitching can occur almost daily, several times a day (often in paroxysms), or intermittently over the course of a year but never without twitching for more than 3 consecutive months. (3) The disorder causes significant distress and annoyance, or causes significant social, work, or other disruptions. (4) The onset of the disorder is before the age of 18 years. (5) The disorder is not due to the direct effect of a substance (e.g., stimulants) or a physical illness (e.g., after Huntington’s disease or viral encephalitis). 2, differential diagnosis (1) rheumatic chorea caused by rheumatic infection, often with joint and cardiac lesions, mostly seen in children. Involuntary movements are dance-like movements of large amplitude, non-stereotypic, not controlled by will, and hypotonia. There may be increased blood sedimentation, increased anti-“O” and effective anti-rheumatic therapy, which may help to differentiate. (2) Huntington’s chorea, also known as chronic progressive chorea. It usually starts in adulthood and is an autosomal dominant disorder with degeneration of the basal ganglia and cerebral cortex, characterized by progressive choreiform movements and dementia, so it is not difficult to differentiate. (3) Myoclonus is a type of seizure with seizure characteristics, each lasting for a short period of time, mostly accompanied by impaired consciousness. EEG is abnormal. Anti-epileptic drug treatment is effective. The course and prognosis of TS is chronic, with fluctuations and intermittent occurrences that can last for several years. The tic symptoms usually improve or remit after adolescence, but only a small percentage of patients persist into adulthood or even for life. Follow-up studies have shown that half of the patients recover completely, about 2/5 patients have partial improvement of symptoms, and only about 5% continue into adulthood. Chinese medicine recognizes the disease: Chinese medicine believes that the cause of the disease is congenital and acquired. The congenital factor is the lack of endowment, such as genetic factors that cause genetic defects, birth injuries that cause head injury, difficult birth, birth asphyxia or cesarean delivery can make the child endowment abnormal; acquired factors include viral infection, head trauma, liver qi stagnation, emotional discomfort, phlegm fire, environmental changes, excessive excitement, etc., due to the combined effect of congenital and acquired factors, resulting in the imbalance of yin and yang, yin does not control yang, yang agitation and movement. Children are “infantile yin and yang”, they grow rapidly and need the most precious yin essence, once the yin is insufficient, they will show hyperactivity of yang and develop symptoms. The tic-obscene syndrome is mainly caused by liver, wind, phlegm and fire, which is closely related to liver, spleen and kidney. Treatment: The application of acupuncture in the treatment of this disease has made great progress, with good efficacy and no side effects, which are summarized below. 1, acupuncture therapy Wu Lianzhong et al [6] identified and took acupuncture points for the treatment of tics and obscenities syndrome in 156 cases: Yangming heat accumulation type of points such as Nei Ting, Quchi, Bi Li and Sibai, Nei Ting, Quchi and Bi Li used the lifting and inserting diarrhea method, and Sibai used the bird pecking diarrhea method, so that the needle sensation is transmitted downward. Inadequate medulla oblongata type of acupuncture points such as mute gate, Lianquan, Shenmen, and Fuyao, etc. Shenmen and Fuyao use the twisting and tonic method; mute gate deep pricking 1.5-2 inches, the upper extremity of the electric sensation that the needle is released; Lianquan with a bird pecking technique, so that the local blocking and swelling sensation. Acupuncture once a day, stay for 30 min, treatment for 2 weeks for a course of treatment. After acupuncture treatment, 114 cases were cured, 30 cases were controlled, and 12 cases were invalid, with an overall efficiency of 92.3%. The healing rate was 81.08% and 66.7% for the Yang Ming heat accumulation type and the medullary sea deficiency type, respectively, with the former being significantly higher than the latter (P0.05), but the difference in the healing rate was significant (P