Abstract: Objective We first observe the clinical effect of “Six acupoints for treating tinnitus” in the treatment of tinnitus patients with spleen and stomach deficiency, and then adopt a longitudinal study on the treatment of tinnitus with acupuncture by using fMRI which investigates their brain effect mechanism. Methods We select 65 tinnitus patients that were diagnosed with chronic, moderate to severe tinnitus(THI≥38 points)and have spleen and stomach deficiency according to TCM syndrome differentiation. These patients were admitted to the Department of Otorhinolaryngology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese medicine from August 2020 to January 2022. In addition, patients were randomized into an observation group(the “Six acupoints for treating tinnitus” treatment group)and a control group(the basic treatment group). The former group was receiving communication puzzle-solving and acoustic therapy. The latter group was treated with acupuncture at “Six acupoints for treating tinnitus”(twice a week, for five weeks)in addition to the basic treatment. After treatment and follow-up period(two-time points: 1 month and 3 months after the treatment), we employ THI and PSQI to assess the improvement of clinical symptoms in these two groups. Finally, we make a comparison study by adopting ALFF, ReHo, and FC as data analysis methods to compare the changes in brain functional activities before and after acupuncture at “Six acupoints for treating tinnitus” in tinnitus patients with spleen and stomach deficiency. Results Compared with control group, the scores of THI and PSQI in patients with chronic tinnitus in observation group were significantly reduced(P<0.05). Compared with those before treatment, the scores of THI and PSQI in both groups were significantly decreased after treatment(P<0.05). The total effective rates at the end of treatment, 4 weeks, and 12 weeks after treatment in observation group were 90.63%, 87.50%, and 87.50%, respectively. Nevertheless, those in control group were 75.76%, 72.73%, and 66.67%, respectively. To put it differently, the clinical efficacy in observation group was more significant than that in control group. The ALFF values in the right putamen nucleus and right insula, and the ReHo values of the right fusiform gyrus and the right lingual gyrus were decreasing after acupuncture treatment of tinnitus patients in the observation group. Functional connectivity analysis showed that the functional connectivity between the right putamen nucleus and the right frontal gyrus, the right angular gyrus, and the left paracentral lobular decreased after treatment when the right putamen nucleus was set as the seed point. Similarly, the functional connection strength between the right lingual gyrus and the left medial superior frontal gyrus or left superior frontal gyrus decreased after treatment when the right lingual gyrus was used as the seed point. In observation group, the change of ALFF value in the right putamen nucleus was positively correlated with PSQI score(P<0.001). Conclusion “Six acupoints for treating tinnitus” acupuncture treatment has a more significant effect on improving the severity of tinnitus patients, reducing tinnitus loudness, and relieving concomitant symptoms. The decrease in the functional connection between the putamen nucleus, the lingual gyrus, and the prefrontal cortex after acupuncture treatment may be the important central regulation mechanism of “Six acupoints for treating tinnitus” acupuncture in the treatment of tinnitus patients with spleen and stomach deficiency.

Key words: Tinnitus, Acupuncture, Functional magnetic resonance imaging, Six acupoints for treating tinnitus, Spleen and stomach deficiency