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it is impossible to measure brain activity without an implanted electrode, and it is not safe to perform direct acupoint electrical stimulation in patients with cp. further studies are needed to determine the mechanism of scalp acupuncture treatment in patients with cfs. chinese medicine often invokes the notion of energy. western medicine is now beginning to acknowledge that many clinical syndromes, including those of a chronic nature, can be viewed as the result of disrupted energetic systems [ 18 ]. compared with healthy controls, patients with cfs showed increased limbic-limbic connectivity at rest; the eeg waveforms of these patients were significantly different from those of the controls during resting state [ 19 ]. on the one hand, energy will keep the mind working and body healthy and energized, and therefore we should pay more attention to this factor in brain function evaluation [ 20 ]. on the other hand, patients with cfs suffered from a great deal of physical exhaustion. patients with cfs also present a reduced resistance to fatigue, which is another important factor that affects brain function. fatigue influences the subjective feeling of the patient [ 6 8 ], as well as brain function [ 21 ], and it also affects the energy of the patient’s body. additionally, the increase of brain activity in some of these patients may be directly related to the difficulty in accomplishing daily activities [ 16 ]. therefore, we think that the energy of the patient plays an important role. finally, the traditional chinese medicine theory says that disease has three types of energy: yin, qi, and wei. wei refers to the material energy that is reflected in the physical body. it can be directly treated by the removal of pathological factors, whereas qi and yin are the two main energies used for treatment. as a result of disorder in qi and yin, patients are prone to disease.
further, the chosen points, such as st36, sp6, gv20, bl23, and cv4, were the top five acupoints selected for cfs based on a systematic review [ 20 ]. in addition, previous studies have also reported a better effect when multiple acupoints are stimulated, but this is a controversial issue for cfs and such as in [ 25 ], [ 26 ]. thus, this study will use basic acupuncture only. during the treatment period, a low-frequency alternating current of 0.5 ma will be applied to the needles, and the needles will be retained for 30 minutes each session. for the control group, a routine rehabilitation treatment, consisting of muscle and deep tendon massage, stretching, and behavioural training will be provided, and treatment will last for 30 minutes at a time. a total of four sessions will be scheduled over a two-month period. all assessments will be conducted at baseline, week 4 (treatment 12), week 8 (treatment 24), week 12 (treatment 36) and week 24 (follow-up). the chinese version of the gmfm and fmfm will be used to assess motor function, and the pedi and cp-qol will be used to assess daily activity and quality of life. detailed assessments will be scheduled as follows: the gmfm and fmfm will be collected at baseline and at weeks 12, 24, and 36 for each group. the pedi and cp-qol will be collected at weeks 0, 4, 12, 24, 36, and 24 for each group. all outcome assessments will be performed by a physical therapist who is qualified and certificated. in addition, a trained researcher and occupational therapist will be involved in all outcome assessments. the flowchart is presented in figure 1.