Intervention group

In this group of patients, we will give the same treatment as the control group. At the same time, on this basis we will give acupuncture treatment. (1) Head acupuncture treatment. Acupoint selection: Baihui, Sishencong, Shenting, and Benshen, with mental behavior symptoms, plus Neiguan and Shenmen. Refer to the sixth edition of acupuncture for acupoint positioning. Operation method: generally take a sitting position, depending on the condition, you can also use the supine or lateral position, using Huatuo brand 0.30 mm diameter, 25-mm-long needle (Suzhou Medical Supplies Factory Co., Ltd.). The needle is about 30° from the scalp, twist the needle diagonally along the selected acupuncture point, the depth of the acupuncture is suitable to reach under the cap-shaped aponeurosis, and twist continuously for 2–3 min quickly, and then connect GM-101 type acupuncture instrument, continuous wave, tolerated by the patient as a degree, changed to sparse and dense wave after 15 min. Remove electroacupuncture after 30 min and continue to retain the needle for 1 h; during needle retention, twist the needle every 30 min. Once a day, five times a week for 4 weeks. (2) Moxibustion treatment. Acupoint selection: Shenting, Baihui, Shendao, Fengfu, Xinyu, and Ganshu. Operation: use mild moxibustion. First, assist the patient to take the prone position, fully expose the moxibustion site, and then place the moxa stick into the moxibustion device head, aim at the acupoints of Shenting, Baihui, Shinto, Fengfu, Xinyu, and Ganshu, wait for the local skin to be red, have a warm and comfortable feeling, last for 30 min. Adjust the height of the moxibustion head in time according to the patient’s feelings, observe the patient’s local skin color, and avoid blisters caused by excessive temperature, five times/week for 4 weeks.

We will use sterile disposable stainless steel needles of 0.25 mm diameter, 25 mm or 40 mm long and 0.30 mm diameter, 50 mm or 70 mm long, depending on the acupuncture points. In addition to the main acupuncture points specific for the treatment of PS CI, the TCM physicians will be allowed to make minor adjustments to the acupuncture points in view of the differing constitution of the patients as per the holistic treatment philosophy of TCM. Therefore, the number of needles to be inserted per subject per session will differ. The needles will be inserted from 0.25 to 1 in. deep depending on the acupuncture points. After eliciting the de qi response, the needles will be left in place for 30 min. The needles will be stimulated manually every 10 min. The acupuncture treatment will consist of a total of 10 sessions (or 2 courses) in total. Each course of treatment will consist of 5 acupuncture sessions held over 2 weeks, each session lasting 30 min. The patient will have a break of at least 3 days and up to 1 week in between each course of acupuncture. TCM physicians will document components of treatment and adherence in standardized logbooks.

The anatomical location of each acupuncture point is as follows: Baihui is located in the middle of the top of the head, in the cap-shaped aponeurosis; around it, there are left and right superficial temporal arteries and veins anastomotic network, as well as the branches of the greater occipital nerve and the frontal nerve. Sishenchong is also located in the galea aponeurosis; it is surrounded by occipital arteries, veins, superficial temporal arteries, venous top branches and supraorbital arterial and venous anastomotic nets, great occipital nerve, auricular cervical nerve, and supraorbital nerve branches. Shenting is located at the junction of the left and right frontal muscles; it is surrounded by frontal arteries and veins, as well as frontal nerve branches. Benshen is in the frontal muscle; it is surrounded by supraorbital arteries, veins, supraorbital nerves, and superficial temporal arteries and veins. Neiguan is located between the palmar longus tendon and the flexor carpi radialis tendon. Its deep part is the pronator; it is surrounded by the median forearm vein, the median artery, the anterior arteries and veins between the bones, and the inner and outer cutaneous nerves of the forearm. There are median nerve trunk and anterior interosseous nerve distribution. Shenmen is located between the flexor carpi ulnaris and the superficial digita flexor muscles, and the deep layer is the deep digita flexor; underneath it is the ulnar artery passing through; it is surrounded by the medial forearm cutaneous nerve.