Dr Wang Ruihua (left) treats an autistic child by moxibustion at Ruijing Hospital. [Shanghai Daily]

Locked in his own little world, six-year-old Tom Sun sits quietly in a small hospital chair, wearing a very peculiar traditional Chinese medicine "hat" that is intended to treat his autism.

A few needles are placed in acupuncture points on his closely shaved head.

He seems quite oblivious to it all, including the moxibustion, or burning of mugwort herb inside the small (10cm x 5cm) hollow cylindrical bamboo tube "hat" with holes to release the smoke.

Sun has been receiving this therapy, and other treatment, for four months at home.

His mom, Diana Liu, says it seems to help because during recent thunderstorms the boy was not terrified and screaming.

Sun's mother has placed a picture book on his lap and squats beside him, showing him pictures and trying to get him to read the characters.

Though he looks normal, Sun does not speak or reach out for his mother and seek her hugs and kisses.

When he was three years old, Sun was diagnosed with autistic-spectrum disorder, a pervasive developmental disorder. There are different types and severities of autism and in all of them the patient withdraws to a greater or lesser degree and lacks communication and emotional connection skills.

His mother quit her job and has been searching for treatment for him since then.

Four months ago, she contacted Dr Wang Ruihua, of Ruijin Hospital, who for the past 12 years has been studying and treating autism by moxibustion, a TCM treatment involving application of burning moxa, usually mugwort herb, to acupuncture points.

He does not claim it's a cure but says patients show some improvement.

Autistic children lack interest in the world and other people and are immersed in their own reality, playing alone, sometimes just rocking back and forth. They have difficulty learning, of course. Some become violent.

Autism has not been researched extensively in China, but it is not rare, says Dr Wang who estimates there are around 1.5 million child patients, and many more unreported cases. Most known cases are in urban areas.

There are around 8,000 child patients in Shanghai, says Dr Wang.

Most children cannot be diagnosed until they are two or three years old, around the age when they should begin to speak and express themselves.

"Many autistic children were thought at first to be just late in acquiring speech or simply introverted," says Dr Wang, "but actually their brains didn't develop together with their body growth."

These children usually have a poor sense of space, motion, language, logic and communication, some may be hyperactive and exhibit symptoms such as eating things other than food.

The exact causes of autism are not known, but there are theories involving heavy metal poisoning, a mother's bad mood during pregnancy, genetics and problems with some kinds of inoculations.

Wang says most treatments in Europe and the United States involves a mix of therapies tailored to individuals, including physical therapy, behavior training, communication, supplements, diet and so on.

"But in TCM, doctors focus more on reinforcing what the kids lack," says Dr Wang.

TCM holds that autism is an inborn problem of slow development of shen (spirit/brain), he says, "and this problem is believed to be caused by deficient primary energy that the child is born with."

Everyone is born with a given amount of original energy. This energy is a major source of brain growth, according to TCM, and without sufficient energy, children cannot develop their shen, just as they cannot grow tall without enough nutrition from foods.

A pregnant woman's troubled moods, fatigue, poor nutrition or illness can all cause birth defects and energy deficiencies in their babies, says Wang.

"Since these children lack energy, we have to help them make it up," he says. The best time for this is from the ages of two to six, before the peak growth period from seven to 16 years, when a great amount of energy is urgently needed.

Energy in the heart and kidneys is considered the most important source of shen development, while other organs also aid the development of the brain.

Determining the exact area of deficiency and compensating is crucial in treating autism. Otherwise, imbalanced internal energy may aggravate autism.

Taking the pulse is a common way to locate the problem, and behavior is another indicator, says Wang.

Autistic kids with deficient energy in the lungs are usually depressed and sad; those low in kidney energy are usually timid and lack willpower; those with little spleen energy are often constipated and may eat things such as paper, uncooked rice or dangerous objects like nails.

Sun is a typical case of deficient energy in the kidneys. He used to wet the bed a lot, and has always been a timid, especially afraid of loud sounds.

"Many boys love firecrackers; but for my son, they are monsters," says Liu, Sun's mother. This year's Spring Festival was a family nightmare. Sun screamed and shivered at the noise and refused to go out.

There are other TCM autism treatments like eating herbal medicine soup and acupuncture. But Dr Wang prefers moxibustion, as it stimulates children less and is easier to carry out, even for parents with no professional TCM background.

Dr Wang invented his own moxibustion tool with the aid of an expat financial sponsor from Britain, John Pistilli. It is a hollow bamboo tube-like tool with a moxa holder inside. Moxibustion can be carried out safely without burning the skin.

Moxibustion is a traditional TCM treatment that uses burning moxa (mugwort and other herbs) to warm acupuncture points and thus induce a smoother flow of blood and energy.

Herbs added to the moxa can also travel through the energy channels and function at target points. This method requires less precision than acupuncture.

"I don't suggest parents come to the hospital often," says Dr Wang. "They can treat their kids right at home where the kids feel safer and more comfortable. That may contribute to a better outcome."

First, Dr Wang diagnoses the problem and teaches parents how to apply moxibustion treatment on certain acupuncture points. Children should be treated every day for one or two weeks before the next consultation.

Each treatment takes 40-50 minutes.

Dr Wang adds special yin jing yao (energy channel-guiding medicine) to the moxa to help the medicine reach the target area of the brain more precisely.

For example, yu jin (radix curcumae) helps guide the herb to the liver meridian, while rush (marsh reeds/rushes) helps guide the herb to the heart meridian.

Comprehensive treatment also involves herbal medicine, behavior training and stimulation of peripheral nerves, like brushing the fingers with brushes.

Dr Wang sets five goals for his patients - acquiring the ability to repeat words, initiate language use, think logically, communicate with others, and adapt to society.

Almost all of Wang's patients, around 100, can now repeat words, he says, and about 30 have apparently recovered this ability in a short time.

The other goals are far more difficult to achieve, Dr Wang says.

Just getting kids to concentrate is a huge task and adapting to society is a very distant goal.

"I don't expect my son to recover completely, like a normal child," says Sun's mother. "I just want to make life relatively easier for him."

After four months of treatment, she sees some progress. During last weekend's thunderstorms, Sun ran to the window to see what was going on instead of screaming as he did when he heard Spring Festival firecrackers.

British Expat Backer with Moxie

A British expat, John Pistilli, has given financial support to Dr Wang in developing his moxibustion therapy and device for autism.

Pistilli, who works in the financial field, tells Shanghai Daily that Wang's moxibustion therapy and device are "very exciting" because they are simple, apparently effective and can be used by many ordinary people to help their children.

No one claims it can cure autism.

Pistilli, who is not a doctor, says he met Dr Wang about five yeas ago through a friend.

"I saw how Dr Wang treated children and I thought it was amazing because most Western doctors consider autism is incurable," he says. "But through Dr Wang's treatment almost all the kids have shown some improvement."

Dr Wang does not claim to "cure" autism but says his therapy has shown encouraging results.

Pistilli says he saw a Chinese boy from Beijing who was suffering from severe autism. "A few months later he was communicating and hugging his mother. He was totally changed," says Pistilli.

So he wanted to help.

One doctor can treat only a limited number of people, he notes, "but with this convenient device, thousands of people can use it themselves to help their own children."

Maximizing TCM with Moxibustion

Moxibustion is one of the oldest forms of Chinese traditional medicine. By burning moxa - mugwort and other TCM herbs - and focusing the heat on acupuncture points, it can help reinforce and activate the flow of qi and maintain general health.

It can also be used to treat specific ailments and pain.Traditionally moxa was burned directly on the skin over acupressure points along key meridians. Because of pain, burning and scarring, this method is seldom used today.

A skilled practitioner can do it safely, however, by placing burning moxa on a piece of ginger, salt or other material on top of the skin. In this way it heats but does not burn. This takes great skill.

TCM practitioners these days generally use indirect moxibustion. It involves burning a moxa or herb stick an inch or more above the skin over the acupuncture point. In this way the heat is targeted; the heat also opens the pores so the herbal smoke penetrates the skin and enters the bloodstream.

Indirect moxibustion also can be combined with acupuncture. In this method acupuncture needles are inserted and the moxa is burned above the needles. Thus the heat is also transferred precisely through the needles to the acupuncture points.

Other moxibustion tools have been developed, such as Dr Wang's bamboo tube.

(Shanghai Daily September 1, 2009)