Search JIM Advanced Search

Journal of Chinese Integrative Medicine ›› 2011, Vol. 9 ›› Issue (6): 605-610.doi: 10.3736/jcim20110605

Special Issue: Acupuncture & Moxibustion

• Original Clinical Research • Previous Articles     Next Articles

Relieving pre-exam anxiety syndrome with wrist-ankle acupuncture: A randomized controlled trial

Shi Shu1, Tong-ming Li1, Fan-fu Fang1, Hou-luo He1, Qing-hui Zhou2, Wei Gu1, Shuang Zhou1()   

  1. 1. School of Traditional Chinese Medicine, Second Military Medical University, Shanghai 200433, China
    2. Department of Traditional Chinese Medicine, Changhai Hospital, Second Military Medical University, Shanghai 200433, China
  • Received:2011-04-24 Accepted:2011-05-17 Online:2011-06-20 Published:2011-06-15
  • Contact: Zhou Shuang

Background: Pre-exam anxiety syndrome is a common condition occurring in pre-exam students and directly affects their examination performance and physical state. Wrist-ankle acupuncture has significant therapeutic effects in treating mental disorders and may also relieve the symptoms of pre-exam anxiety syndrome.
Objective: To assess the therapeutic effect of wrist-ankle acupuncture on pre-exam anxiety syndrome.
Design, setting, participants and interventions: A total of 60 students who met the inclusion criteria of pre-exam anxiety syndrome were enrolled from a university in Shanghai and they were randomly divided into treatment group and control group. There were 30 cases in each group, and no case failed to follow-up. In the treatment group, wrist-ankle acupuncture was adopted to point upper 1 bilaterally (impression between flexor carpi ulnaris tendon and ulnar margin), and there was no requirement for Deqi (arrival of qi). In the control group, sham acupuncture was adopted. The treatment was applied 3 times totally in both groups one week before the exam, once every other day, each time with the needles retained for 30 min.
Main outcome measures: The therapeutic effects were compared between two groups. Before and after 3 treatments, Sarason Test Anxiety Scale (TAS) and Expectation and Treatment Credibility Scale (ETCS) were measured and evaluated.
Results: The therapeutic effect experienced by the treatment group was better than that of the control group (P<0.05). There were no statistically significant differences in TAS and ETCS before treatment between the two groups. The scores of TAS after treatment in two groups were higher than those before treatment (P<0.05, P<0.01). There were statistical differences in TAS absolute difference and TAS relative difference between the two groups and the treatment group had better results (P<0.05, P<0.01). After treatment, patients in the treatment group had higher scores in ETCS than those in the control group (P<0.05, P<0.01). No adverse reaction was reported.
Conclusion: Wrist-ankle acupuncture can relieve the symptoms of pre-exam anxiety syndrome significantly, and this therapy is highly safe.

Key words: pre-exam anxiety syndrome, wrist-ankle acupuncture, acupuncture-moxibustion, randomized controlled trials


Figure 1

Flow diagram of randomized trial of two groups"




[1] Zhang J . The study of coping with text anxiety: retrospect and prospect[J]. Ji Chu Jiao Yu, 2010,7(6):50-55
张佳 . 应对考试焦虑研究的回顾与展望[J]. 基础教育, 2010,7(6):50-55
[2] Ao TX, Zhao ZY . Related application research on pre-exam nervous syndrome[J]. Jilin Sheng Jiao Yu Xue Yuan Xue Bao, 2010,6(26):17-19
敖天侠, 赵志瑜 . 考试焦虑的相关应用研究[J]. 吉林省教育学院学报, 2010,6(26):17-19
[3] Tang RQ . Intervention methods for the pre-exam nervous syndrome of middle school students[J]. Kao Shi Zhou Kan, 2010,6(39):11-12
唐睿奇 . 谈中学生考试焦虑的干预方法[J]. 考试周刊, 2010,6(39):11-12
[4] Chen KZ . Wrist-ankle acupuncture regionalism and distribution of fourteen meridians and their curative effects[J]. Zhongguo Zhong Yi Yao Za Zhi, 2004,2(2):99-101
陈克中 . 腕踝针区域划分与十四经分布、疗效探讨[J]. 中国中医药杂志, 2004,2(2):99-101
[5] Wang XP, Yan GQ, Wu JP . Clinical observation of insomnia treated with wrist-ankle acupuncture: a report of 32 cases[J]. Zhen Jiu Lin Chuang Za Zhi, 2000,16(2):10-11
王宪平, 阎国卿, 吴晶萍 . 腕踝针治疗失眠32例临床观察[J]. 针灸临床杂志, 2000,16(2):10-11
[6] Li L, Wu MX, Guo YJ . Clinical effects of wrist-ankle acupuncture on tension headache: a report of 30 cases[J]. Fujian Zhong Yi Xue Yuan Xue Bao, 2004,14(4):23
李俐, 吴明霞, 郭毅坚 . 腕踝针治疗紧张性头痛30例[J]. 福建中医学院学报, 2004,14(4):23
[7] Group for National Infrastructure of Genetic Resource for Diseases. Technical regulation for collection of information about environmental risk factors for mental disorders. (2009-03-22)[2009-04-01]Chinese
中国人类遗传资源平台项目组. 精神障碍性疾病环境危险因素采集规范(讨论稿). (2009-03-22)[2009-04-01]
[8] Sarason IG. The test anxiety scale: concept and research. In: Spielberger CD, Sarason IG. Stress and anxiety(Vol. 5)[M].Washington D. C: Hemisphere Publishing Corp, 1978: 193-216
[9] Chen YB. Diagnostic and effect evaluation standard of traditional Chinese medicine syndromes[M]. Nanjing: Nanjing University Press, 1994: 66
陈佑邦 . 中医病证诊断疗效标准[M]. 南京: 南京大学出版社, 1994: 66
[10] Bedell JR, Marlowe HA. An evaluation of test anxiety scales: convergent, divergent, and predictive validity. In: Spielberger CD, Vagg PR. Test anxiety: theory, assessment and treatment[M]. Washington D.C.: Taylor and Francis, 1995: 35-45
[11] Wang CK . Test report of test anxiety scales in undergraduate students[J]. Zhongguo Xin Li Wei Sheng Za Zhi, 2001,15(2):96-97
doi: 10.3321/j.issn:1000-6729.2001.02.011
王才康 . 考试焦虑量表在大学生中的测试报告[J]. 中国心理卫生杂志, 2001,15(2):96-97
doi: 10.3321/j.issn:1000-6729.2001.02.011
[12] Lao L, Bergman S, Hamilton GR, Langenberg P, Berman B . Evaluation of acupuncture for pain control after oral surgery: a placebo-controlled trial[J]. Arch Otolaryngol Head Neck Surg, 1999,125(5):567-572
doi: 10.1001/archotol.125.5.567
[13] Zhang XS, Ling CQ, Zhou QH. Practical therapeutics of wrist-ankle acupuncture[M]. Beijing: People’s Medical Publishing House, 2002: 13-18
张心曙, 凌昌全, 周庆辉 . 实用腕踝针疗法[M]. 北京: 人民卫生出版社, 2002: 13-18
[14] Li FQ, Zhang WH, Zhao Y, Yang B . Mechanism discussion on acute lumbar sprain treated with wrist-ankle acupuncture[J]. Henan Zhong Yi, 2008,28(10):68-69
doi: 10.3969/j.issn.1003-5028.2008.10.042
李芳琴, 张卫华, 赵阳, 杨斌 . 腕踝针治疗急性腰扭伤的机理探讨[J]. 河南中医, 2008,28(10):68-69
doi: 10.3969/j.issn.1003-5028.2008.10.042
[15] Hu X, Ling CQ . Biomechanical mechanism of wrist-ankle acupuncture in relieving pain[J]. Zhongguo Zhen Jiu, 2004,24(5):361-363
胡侠, 凌昌全 . 腕踝针止痛机理的生物力学观[J]. 中国针灸, 2004,24(5):361-363
[16] Lao LX . Recommendations for enhancing the quality of traditional Chinese medicine clinical research reporting[J]. J Chin Integr Med, 2004,2(6):402-406
劳力行 . 提高中医药临床研究报道质量的建议[J]. 中西医结合学报, 2004,2(6):402-406
[17] Su JT, Zhou QH, Li R, Zhang J, Li WH, Wang Q . Immediate analgesic effect of wrist-ankle acupuncture for acute lumbago: a randomized controlled trial[J]. Zhongguo Zhen Jiu, 2010,30(8):617-622
苏江涛, 周庆辉, 李锐, 章杰, 李伟红, 王琼 . 腕踝针对急性腰痛的即时镇痛作用: 随机对照研究[J]. 中国针灸, 2010,30(8):617-622
[18] Zhang QG, Gu KB, Wang D, Zhang HJ . Treatment of tobacco dependence with wrist-ankle acupuncture: a report of 30 cases[J]. J Chin Integr Med, 2004,2(6):444
张庆光, 顾克斌, 王东, 张惠鹃 . 腕踝针治疗烟草依赖30例疗效观察[J]. 中西医结合学报, 2004,2(6):444
[1] Maria T.Chao, AlexandraChang, SanjayReddy, James D.Harrison, JosephAcquah, MiriaToveg, TrilceSantana, Frederick M.Hecht. Adjunctive acupuncture for pain and symptom management in the inpatient setting: Protocol for a pilot hybrid effectiveness-implementation study. Journal of Integrative Medicine, 2016, 14(3): 228-238.
[2] Nouran A. Aleyeidi, Khaled S. Aseri, Shadia M. Matbouli, Albaraa A. Sulaiamani, Sumayyah A. Kobeisy. Effects of wet-cupping on blood pressure in hypertensive patients: A randomized controlled trial. Journal of Integrative Medicine, 2015, 13(6): 391-399.
[3] Zhong-liang Liu, Wei-rong Zhu, Wen-chao Zhou, Hai-feng Ying, Lan Zheng, Yuan-biao Guo, Jing-xian Chen, Xiao-heng Shen. Traditional Chinese medicinal herbs combined with epidermal growth factor receptor tyrosine kinase inhibitor for advanced non-small cell lung cancer: A systematic review and meta-analysis. Journal of Integrative Medicine, 2014, 12(4): 346-358.
[4] Zhi-yi Zhou, Ling Xu, He-gen Li, Jian-hui Tian, Li-jing Jiao, Sheng-fu You, Zhi-fen Han, Yi Jiang, Hui-ru Guo​, Hui Liu​. Chemotherapy in conjunction with traditional Chinese medicine for survival of elderly patients with advanced non-small-cell lung cancer: Protocol for a randomized double-blind controlled trial. Journal of Integrative Medicine, 2014, 12(3): 175-181.
[5] Jian Liu, Chuan-bing Huang, Yuan Wang, Gui-qin Xu, Yuan-yuan Cheng, Yun-xia Feng, Lei Liu, Ya-jun Qi. Chinese herbal medicine Xinfeng Capsule in treatment of rheumatoid arthritis: Study protocol of a multicenter randomized controlled trial. Journal of Chinese Integrative Medicine, 2013, 11(6): 428-434.
[6] Tian-zhan Wang, Yu Chen, Yan-ming He, Xiao-dong Fu, Wang Yi, Yan-qiu Xu, Hong-jie Yang, Hong-li Xue, Yi Liu, Xiao-tao Feng, Teng Zhang, Wen-jian Wang. Effects of Chinese herbal medicine Yiqi Huaju Qingli Formula in metabolic syndrome patients with microalbuminuria: a randomized placebo-controlled trial. Journal of Chinese Integrative Medicine, 2013, 11(3): 175-183.
[7] Chung-wah Cheng, Shu-fei Fu, Qing-hui Zhou, Tai-xiang Wu, Hong-cai Shang, Xu-dong Tang, Zhi-shun Liu, Jia Liu, Zhi-xiu Lin, Lixing Lao, Ai-ping Lü, Bo-li Zhang, Bao-yan Liu, Zhao-xiang Bian. Extending the CONSORT Statement to moxibustion. Journal of Chinese Integrative Medicine, 2013, 11(1): 54-63.
[8] Hui Luo, Jian-ping Liu, Qing Li. Methodological issues and suggestions for improvement in randomized controlled trials of Chinese herbal medicine for recurrent miscarriage. Journal of Chinese Integrative Medicine, 2012, 10(6): 604-614.
[9] Ming-xing Zhao, Zhen-hua Dong, Zhong-hai Yu, Shi-yuan Xiao, Ya-ming Li . Effects of Ginkgo biloba extract in improving episodic memory of patients with mild cognitive impairment: A randomized controlled trial. Journal of Chinese Integrative Medicine, 2012, 10(6): 628-634.
[10] Li-xin Ma, Yu-yi Wang, Xin-xue Li, Jian-ping Liu . Systematic review on methodology of randomized controlled trials of post-marketing Chinese patent drugs for treatment of type 2 diabetes. Journal of Chinese Integrative Medicine, 2012, 10(3): 279-292.
[11] Paula de Sousa Fragoso Ana, de Sá Ferreira Arthur. Evaluation of the immediate effects of manual acupuncture on brachial bicep muscle function in healthy individuals and poststroke patients: a study protocol of a parallel-group randomized clinical trial. Journal of Chinese Integrative Medicine, 2012, 10(3): 303-309.
[12] Li Min, Yang Ming-hui, Liu Yi. Effects of Chinese herbal medicine Bushen Huoxue Granule on quality of life of patients with Parkinson disease: a randomized, double-blinded and placebo-controlled trial. Journal of Chinese Integrative Medicine, 2012, 10(3): 310-317.
[13] Liu Jian, Gao Ying, Kan Bao-hong, Zhou Li. Systematic review and meta-analysis of randomized controlled trials of Chinese herbal medicine in treatment of multiple sclerosis. Journal of Chinese Integrative Medicine, 2012, 10(2): 141-153.
[14] Ng Cui-shan, Wang Shan-ping, Cheong Jun-long, Wu Yu-dan, Jia Yong-liang, Leung Siu-wai. Systematic review and meta-analysis of randomized controlled trials comparing Chinese patent medicines Compound Danshen Dripping Pills and Di’ao Xinxuekang in treating angina pectoris. Journal of Chinese Integrative Medicine, 2012, 10(1): 25-34.
[15] Susuana Kuek, Wen-jun Wang, Sui-qi Gui. Efficacy of Chinese patent medicine Tian Gui Capsule in patients with polycystic ovary syndrome: A randomized controlled trial. Journal of Chinese Integrative Medicine, 2011, 9(9): 965-972.
Full text



[1] Hao Li, Ming-jiang Yao, Wen-ming Zhao, Jie Guan, Lin-lin Cai, Ling Cui. A randomized, controlled, double-blind trial of Huannao Yicong capsule in senile patients with mild cognitive impairment. Journal of Chinese Integrative Medicine, 2008, 6(1): 25-31
[2] Dong Yang, Yong-ping Du, Qing Shen, Wei Chen, Yan Yu, Guang-lei Chen. Expression of alpha-smooth muscle actin in renal tubulointerstitium in patients with kidney collateral stasis. Journal of Chinese Integrative Medicine, 2008, 6(1): 41-44
[3] Zhi-chun Jin. Problems in establishing clinical guideline for integrated traditional Chinese and Western medicine. Journal of Chinese Integrative Medicine, 2008, 6(1): 5-8
[4] Guo-hong Yuan, Xiao-jing Pang, He-chao Ma. Synergic effects of Danggui Buxue Decoction in reducing toxicity of cytoxan in tumor-bearing mice. Journal of Chinese Integrative Medicine, 2008, 6(1): 83-88
[5] Jin-zhou Tian, Jing Shi, Xin-qing Zhang, Qi Bi, Xin Ma, Zhi-liang Wang, Xiao-bin Li, Shu-li Shen, Lin Li, Zhen-yun Wu, Li-yan Fang, Xiao-dong Zhao, Ying-chun Miao, Peng-wen Wang, Ying Ren, Jun-xiang Yin, Yong-yan Wang, Beijing United Study Group on MCI of the Capital Foundation of Medical Developments. Guiding principles of clinical research on mild cognitive impairment (protocol). Journal of Chinese Integrative Medicine, 2008, 6(1): 9-14
[6] Daniel Weber, Janelle M Wheat, Geoffrey M Currie. Inflammation and cancer: Tumor initiation, progression and metastasis,and Chinese botanical medicines. Journal of Chinese Integrative Medicine, 2010, 8(11): 1006-1013
[7] Xin-jun Wang, Ling-ling Wang . A mechanism of endogenous opioid peptides for rapid onset of acupuncture effect in treatment of depression. Journal of Chinese Integrative Medicine, 2010, 8(11): 1014-1017
[8] Yan-bo Zhu , Qi Wang, Cheng-yu Wu, Guo-ming Pang, Jian-xiong Zhao, Shi-lin Shen, Zhong-yuan Xia , Xue Yan . Logistic regression analysis on relationships between traditional Chinese medicine constitutional types and overweight or obesity. Journal of Chinese Integrative Medicine, 2010, 8(11): 1023-1035
[9] Bing Hu , Hong-mei An , Ke-ping Shen , Qin Du. Senescence-inducing effects of Chinese herbal medicine Tenglong Buzhong Decoction on human colon carcinoma LS-174-T cells and the mechanism. Journal of Chinese Integrative Medicine, 2010, 8(11): 1048-1052
[10] Tao Wang , Feng Qin. Effects of Chinese herbal medicine Xiaoyao Powder on monoamine neurotransmitters in hippocampus of rats with postpartum depression. Journal of Chinese Integrative Medicine, 2010, 8(11): 1075-1079