Acupuncture for Japanese Encephalitis: Points and Therapy

Epidemic encephalitis B (abbreviated as JE) is an acute infectious disease of the central nervous system caused by the Japanese encephalitis virus.

When a mosquito carrying the Japanese encephalitis (JE) virus bites human skin, it can infect the individual. However, not all infected individuals develop the disease; most remain asymptomatic, a condition known as inapparent (subclinical) infection. In a very small number of infected individuals, due to compromised immune function or a high viral load with strong virulence, the JE virus can penetrate the blood-brain barrier and invade the central nervous system, leading to pathological lesions.

The pathological changes primarily involve extensive acute inflammation of the brain parenchyma, affecting structures from the cerebrum to the spinal cord. The most severe lesions are found in the cerebral cortex, basal ganglia, diencephalon, and midbrain, followed by the cerebellum, medulla oblongata, and pons, with the spinal cord being the least affected. Gross observation reveals congestion of both the meninges and brain tissue.

Edema; in severe cases, hemorrhage and softening foci may be observed. Microscopically, there is extensive perivascular infiltration of lymphocytes and monocytes, neuronal degeneration and necrosis, formation of softening foci, and diffuse proliferation of microglial cells.

1. Diagnostic Points

This condition predominantly affects children under 10 years of age. However, in recent years, there has been a trend of increasing cases among adults. The epidemic season is mainly in July, August, and September.

Clinically, based on the severity of symptoms, it can be classified into four patterns:

(1) Mild Type

Body temperature ranges from 38°C to 39°C. The patient remains conscious, with possible mild headache, drowsiness, and vomiting. The course of the illness lasts 5–7 days.

(II) Moderate Type (Common Type)

Fever between 39°C and 40°C, headache, pronounced vomiting, lethargy or occasional convulsions, positive meningeal signs and pathological reflexes, weakened or absent superficial reflexes. The disease course lasts 7 to 14 days.

(3) Severe Type

Body temperature above 40°C, unconsciousness, recurrent or persistent convulsions, superficial reflexes absent, deep reflexes initially hyperactive then absent, early-stage meningeal irritation signs prominent, pathological reflexes positive. The disease course can last 2–4 weeks or longer. During the recovery period, severe neurological and psychiatric symptoms are common, and some patients may develop sequelae.

(4) Extremely Severe Type

Body temperature rapidly rises above 40°C, accompanied by deep coma, persistent convulsions, early pupillary changes, and central respiratory failure and/or circulatory failure. Even with aggressive resuscitation, severe sequelae often remain.

A minority of patients still have sequelae in the mental and nervous systems (such as aphasia, dementia, mental disorder, paralysis, deafness, epilepsy, and tonic spasm of the limbs) after 6 months from disease onset.

1. Blood picture: Total white blood cell count is elevated, typically 10,000–20,000/mm³, with neutrophils increased to over 80%.

**2. Cerebrospinal Fluid (CSF):** Pressure is mildly elevated. The appearance is clear or slightly turbid. The white blood cell (WBC) count is mildly increased, ranging from 50–500 cells/mm³ (50–500 cells/µL), and in a few cases may exceed 1000 cells/mm³ (1000 cells/µL); it can also be normal. The differential count shows predominantly neutrophils in the early stage, shifting to lymphocytes in the later stage. Protein is mildly elevated, glucose is normal or elevated, and chloride is normal.

3. Serological examination:

**(1) Complement Fixation Test:** It demonstrates high specificity and sensitivity, but early positive results are uncommon. The positivity rate increases significantly after three weeks and may persist for approximately one year. Therefore, in clinical practice, a four-fold rise in antibody titer in paired sera is considered positive. For a single serum sample, a titer of 1:2 is regarded as suspicious, while a titer of 1:4 or higher is considered positive and aids in diagnosis.

(2) Hemagglutination Inhibition Test: Hemagglutination inhibition (HI) antibodies appear on day 5 after disease onset, peak during the second week, and persist for over one year. This test can be used for clinical diagnosis and epidemiological investigation. A four-fold or greater rise in antibody titer in paired serum samples is considered positive and confirms the diagnosis.

**(3) Specific IgM antibody test:** Specific IgM antibodies appear on the 4th day after infection and peak within the 2nd to 3rd week. It is currently used for the early diagnosis of Japanese encephalitis.

2. Treatment

(1) Acupoints

1. **Motor Area**: This corresponds to the projection of the precentral gyrus (primary motor cortex) of the cerebral cortex onto the scalp. The upper point is located 0.5 cm posterior to the midpoint of the anterior-posterior midline (the line connecting the glabella to the most prominent point of the external occipital protuberance). The lower point is located at the intersection of the eyebrow-occipital line and the anterior hairline at the temple. The line connecting these two points defines the Motor Area. – The upper 1/5 of the Motor Area is indicated for contralateral lower limb paralysis. – The middle 2/5 is indicated for contralateral upper limb paralysis. – The lower 2/5 is indicated for contralateral central facial palsy, motor aphasia, drooling, and speech articulation disorders.

2. Sensory Area: This area corresponds to the projection of the postcentral gyrus (primary sensory cortex) of the cerebral cortex onto the scalp. It is located posterior to the Motor Area, on a line parallel to and 1.5 cm behind the Motor Area. – The upper 1/5 of this area is indicated for contralateral low back and leg pain, numbness, paresthesia, as well as pain in the occipital and nuchal region and tinnitus. – The middle 2/5 of this area is indicated for contralateral upper limb pain, numbness, and paresthesia. – The lower 2/5 of this area is indicated for contralateral facial numbness, migraine, trigeminal neuralgia, toothache, and temporomandibular arthritis.

(II) Methods

The principle of acupoint selection is primarily based on symptomatic points. For example, in cases of hemiplegia of the lower or upper limbs, drooling, and tongue paralysis (lingual paresis), acupuncture is applied to the upper 1/5, middle 2/5, and lower 2/5 of the motor area and sensory area.

The patient is seated. After selecting the acupoints, use a 30-gauge, 1.5-cun filiform needle to needle the healthy-side points. Perform routine local disinfection. Insert the needles using the “relay needling” method (continuous stimulation along the meridian) at each point. Retain the needles for 1 hour, twisting them once every 20 minutes. The treatment is administered once daily, with 10 sessions constituting one course. A 5-day rest is taken before the next course of needling.

Appendix: Acupoint Ligation Therapy (Xuewei Jiezha Liaofa)

Primarily indicated for patients who have developed muscle atrophy for more than three and a half months.

1. Acupoints

For the upper extremities, select LI15 (Jianyu), LI11 (Quchi), and PC6 (Neiguan); for the lower extremities, select BL24 (Qihaishu), BL37 (Yinmen), and ST36 (Zusanli) or SP6 (Sanyinjiao).

2. Methods

The patient is positioned prone or in a lateral recumbent position. Each time, select one acupoint on the affected upper limb and one on the affected lower limb. Mark the acupoint locations with gentian violet. The practitioner washes hands, wears sterile gloves, performs a large-area routine disinfection of the skin surrounding the acupoints, and drapes with a sterile fenestrated towel. Use 5 ml of 0.5% procaine for subcutaneous infiltration anesthesia around the acupoint. Make a 0.5 cm small incision down to the subcutaneous layer with a sharp scalpel. Insert a mosquito hemostatic forceps into the incision (acupoint) to perform blunt dissection and deep massage. Thread a size 1 catgut suture onto a large curved suture needle, insert it from one side of the incision into the deep muscle layer or down to the periosteum, and exit from the opposite side of the acupoint, about 2 cm apart. After withdrawing the needle, hold both ends of the suture and pull back and forth in a sawing motion about ten times for stimulation. Then insert the needle back into the incision through the original skin puncture point, tie a surgeon’s knot (not too tight), and cut the catgut with curved scissors. Use a small skin needle with 0 silk thread to place one suture at the midpoint of the incision, approximate the skin, cover with sterile gauze and adhesive tape. Change the dressing after 3 days, remove the sutures after 7 days, and perform the second group of treatments 15 days later. After completing the third group, observe for 3 months; discontinue if ineffective.

III. Commentary

Japanese encephalitis is an acute infectious disease with rapid onset and rapid deterioration. In general, acupuncture treatment is not recommended during the acute phase. After the fever subsides and the condition stabilizes, scalp acupuncture can be applied early. The author has used scalp acupuncture to treat over 50 such patients, all of whom started acupuncture after stabilization. For those who cannot…

Patients who can eat orally recover relatively quickly. However, some patients with tongue paralysis require nasal feeding. With acupuncture, most patients can resume oral feeding within 10 sessions, and can also achieve early recovery of paralyzed limb function, reducing the incidence of intractable sequelae. For those who have developed sequelae resulting in hemilateral limb muscle atrophy, acupoint ligation therapy (using catgut embedding for stimulation) may be applied three months after the onset of stroke to promote muscle recovery. Patients should be advised to engage in appropriate physical exercise both during treatment and after basic recovery to strengthen their constitution and facilitate early rehabilitation. Given that the condition of stroke is complex and variable, acupuncture should only be performed after careful evaluation, ensuring that the patient’s condition is stable, in order to avoid any adverse consequences arising from the procedure.

Acupuncture Points for JE Fever Reduction: A Targeted Approach

Japanese encephalitis (JE) is an acute viral infection of the central nervous system transmitted by mosquitoes. The disease often presents with high fever, headache, and neurological deficits. In traditional Chinese medicine, JE is categorized under “warm diseases,” and acupuncture is employed to clear heat and reduce fever. Specifically, acupuncture points for JE fever reduction include Dazhui (GV14) and Quchi (LI11), which are known for their antipyretic effects. Stimulation of these points activates descending inhibitory pathways, modulating the hypothalamic thermoregulatory center. Clinical evidence suggests that early application of these points can lower body temperature, reduce inflammatory cytokine levels, and prevent hyperthermia-induced neuronal damage. This approach complements standard antiviral therapy, particularly in resource-limited settings where advanced cooling methods are unavailable. The precise selection of points based on syndrome differentiation enhances the