SYNOPSIS OF SCALP ACUPUNCTURE
by Subhuti Dharmananda, Ph.D. and Edythe Vickers, N.D., L.Ac.,
Institute for Traditional Medicine,
THE
NATURE OF SCALP ACUPUNCTURE
Scalp acupuncture is one of several specialized acupuncture techniques
with a specific body location, taking its place alongside ear, nose, hand,
foot, and wrist/ankle acupuncture. The
more general acupuncture therapy is often called body acupuncture.
Although the scalp has numerous
traditionally-identified acupuncture points along several of the major
meridians (notably the stomach, bladder, gallbladder, triple burner, and
governing vessel), modern scalp acupuncture differs from traditional
acupuncture therapy. There are three
basic features of scalp acupuncture that differentiate it from body
acupuncture:
1. 1.
Treatment zones have been mapped
onto the scalp that are associated with body functions and broad body regions.
The zones include a few standard acupuncture points, but the treatment
principle for point selection is usually not based on the traditional
indication for the point or associated meridian. In general, within a defined zone, the
forward part of the zone (nearer the face) is used to treat the upper body,
while the rear portion of the zone is used to treat the lower body. Functional zones, such as sensory, memory,
and motor, are usually located at the back and sides of the scalp.
2. 2.
In scalp acupuncture, the
needles are to be inserted within a thin layer of loose tissue beneath the
scalp surface, at a low angle of about 15–30 degrees, involving an insertion
distance of about 1 cun [the cun is a variable unit of measure based on body
size; about one inch for an adult].
Standard acupuncture of scalp points normally involves subcutaneous
insertion up to a depth 1/2 cun or less (about 0.3–0.5 inches for an adult) at
a high angle of 60–90 degrees.
3. 3.
For scalp acupuncture, the
needles are to be subjected to rapid stimulation, which may be carried out in a
variety of ways, including pulling/thrusting, twirling, and
electro-stimulation. Standard
acupuncture applied to scalp points usually involves less rapid stimulation or
moxibustion as the main stimulation technique. When using manual manipulation
in modern scalp acupuncture, it is common to stimulate the needles for 2–3
minutes at a time, with a rest period of 5–10 minutes between
stimulations.
The fundamentals of scalp acupuncture therapy
were reviewed by Lu Shoukang, of the Beijing College of Acupuncture,
Moxibustion, Orthopedics, and Traumatology, in the Journal of Traditional Chinese Medicine (1). According to this review, the technique is
predominantly a small-needle therapy in which shu points in the scalp are treated. Shu
points refer to “stream” points where the qi of the internal organs is infused. In the system of body acupuncture, there are
5 shu points (one for each element)
on each of the 12 meridians (below the elbow or below the knee) plus the back shu points, which are each located in
the vicinity of one of the internal organs.
According to the theory of channels and collaterals, shu points in the head can be used to
treat diseases of the whole body.
Lu claims that more than 80 diseases are
currently treated by this therapeutic method, which is particularly effective
in treating disorders of the central nervous system and various acute and
chronic pain syndromes. He mentions
specific examples: neurasthenia, anxiety neurosis, and other psychological and
psychosomatic disorders, periarthritis of the shoulders, ischialgia, pain in
the back and loin, painful heels, and other pain syndromes, hemiplegia,
aphasia, senile dementia, and other brain disorders.
During the 1970’s, scalp acupuncture was
developed as a complete acupuncture system.
Three major contributors to the development of this system, Jiao Shunfa,
Fang Yunpeng, and Tang Songyan, each proposed different diagrams and groupings
of scalp acupuncture points. For
example, Jiao divided the scalp points into motor and sensory areas, Fang into
writing (speech) and reading (memory) centers, and Tang into upper, middle, and
lower burner areas. Several different methods of needling were proposed. Jiao advocated rapid twirling with
penetrating and transverse needling; Fang favored the slight twirling method
and oblique needling; while Tang recommended long-duration needle retention
with superficial stimulation of the needles, using the lifting and thrusting
method.
Thus, scalp acupuncture is not really a
single system, but a multiplicity of systems still in development, with a
30-year history of practical experience.
A standard of nomenclature for acupuncture points has been developed
(adopted in 1984 and reconfirmed in 1989), indicating 14 therapeutic lines or
zones based on a combination of the thoughts of the different schools of scalp
acupuncture. However, it is often
necessary to carefully review the zones relied upon by an individual
practitioner, as few have adopted the unified pattern.
As Lu states in his article, Professor Zhu
Mingqing (who had been associate professor at Lu’s department in
Dr. Zhu’s father was an acupuncturist who
worked on scalp acupuncture, and Zhu has been working as an acupuncturist since
graduating from the
Dr. Zhu traces the origins of modern scalp
acupuncture to the work of Huang Xuelong, who in 1935 introduced the concept
that there is a relationship between the scalp and the cerebral cortex. Several acupuncturists pursued this line,
seeking points and zones on the scalp that would treat diseases of the
brain. Initial results of clinical work
indicated that acupuncture applied to the scalp had good effect on diseases that
were associated with cerebral damage, such as stroke. Its applications were then extended to
virtually all other diseases, but a focus on nervous system disorders is still
dominant. Other physicians in
ZHU’S
SCALP ACUPUNCTURE
According to Dr. Zhu, Baihui (GV-20) is the basis for all of the scalp points. Quoting from the Ling Shu: “The brain is
the sea of marrow. Its upper part lies
beneath the scalp, at the vertex, at point Baihui.” The point’s Chinese name indicates that it is
the great meeting place (literally: hundred meetings). Traditionally, this
point is treated to stabilize the ascending yang; it is also needled in order
to clear the senses and calm the spirit.
The Governing Vessel enters the brain at
point Fengfu (GV-16). The external pathway of the Governing Vessel
is used to divide the left and right sides of the scalp. The left side governs
qi and the right side governs blood.
Needling of the left side has a greater impact on disorders of the left
side of the head and neck, but of the right side of the body below the neck,
and conversely.
In Zhu’s system of
acupuncture, there are three main zones (designated the Eding zone, Dingzhen zone
and Dingnie zone) subdivided into a
total of 11 portions, and three secondary zones, each divided into two portions
(designated Epang 1, Epang 2, front zone of Dingjie, back zone of Dingjie, Niehou and Nieqian). The zone names are simply based on anatomical
descriptions. Following is a review of the primary scalp acupuncture zones (See
Appendix 1 for a picture of the zones).
Eding Zone
Ding refers to the top of the head, and E (pronounced “uh”) refers to the
forehead. The Eding zone runs from the forehead to the top of the head. This is a zone that runs along the governing
channel, covering a narrow band from a point 1/2 cun in front of GV-24 (at the
forehead/scalp border) back to GV-20.
The width is 1 cun and the length is 5 cun. The Eding zone governs the yin side (front) of the body, running from
the perineum (GV-20 area of needling) to the head (GV-24 area of
needling). The zone is divided into four
regions.
Eding 1 is the anterior quarter of the region, extending from GV-24 forward by
1/2 cun. This region is used to treat the whole head and neck region. The effects of treatment in this region
include calming the spirit, opening the orifices, arousing the mind, and
brightening the eyes. To treat, insert the needle along the side of the zone
that corresponds with the side of the head or neck that is affected. That is, although treatment usually includes
one needle in the center of the zone (along the GV line), if the problem is on
the right side of the head or throat, place the needle on the right side of the
zone. For example, treating blurred
vision in the right eye, place one needle in the right side of the Eding 1 zone or insert the needle at the
center of the zone and direct it to the right side of the zone. The direction of needling is usually towards
the face.
Eding 2 is the second quarter of the zone, extending from GV-24 to GV-22. This
region is primarily used to treat disorders of the chest region. The functions
include opening the chest and regulating qi, opening the lungs, stopping
wheezing, and calming the spirit. If the
problem is on one side of the body, needle the side of the zone on the opposite
side (contralateral).
Eding 3 is the third quarter of
the zone, extending from GV-22 to GV-21. This region is primarily used to treat
disorders of the middle burner (including treatment of acute appendicitis). The
functions include stopping vomiting and diarrhea, regulating the liver qi, and
regulating the gallbladder. To treat, use the contralateral side.
Eding 4 is the last quarter of
the zone, extending from GV-21 to GV-20. This region is used to treat the lower
burner and the lower limbs. The functions include regulating the menses,
strengthening the kidneys and promoting urination. Needle on the contralateral
side; if the disorder is central, as in bladder dysfunction, needle the central
line of the zone or both sides. The
direction of needling is usually towards the back of the head.
As described above, Zhu follows the principal
that if the disorder affects the left or right side of the body, then treatment
that is intended to affect the head or neck is done on the same side of the
zone as the side of the disorder (ipsilateral), but if it is below the neck,
then the needle is placed on the opposite side of the zone. This approach has been followed by many scalp
acupuncture specialists in China. However,
a few researchers claim that clinical evidence does not support the need to
treat one side or the other; rather, one can alternate sides on subsequent
days. At this time, there is probably
insufficient data to demonstrate that one or the other approach is
significantly better. Alternate side
needling might be better tolerated by the patient when daily needling is
used. For those following Zhu’s
technique, treating one side according to location of symptoms would be
consistent with his extensive clinical experience.
Dingzhen Zone
Zhen (pronounced “jun”) refers to pillow, and
indicates the back of the head. The Dingzhen zone runs from the top of the
head to the back of the head, between GV-20 and GV-17. The zone is 1 cun wide.
It governs the spine, the yang aspect of the body (back). It can be divided
into 4 regions, equally spaced from each other. This region is mainly used for
pain.
Dingzhen 1 (starting at GV-20) governs the back of the head and the neck.
Dingzhen 2 governs the vertebrae C-7 (seventh cervical, base of the neck) through
T-10 (10th thoracic).
Dingzhen 3 governs the vertebrae T-10 through L-5 (fifth lumbar).
Dingzhen 4 (ending at GV-17) governs the sacrum and coccyx. Needling here is painful, so it is rarely
used.
The Eding
and Dingzhen zones together form a
central line from the front to the back of the scalp. In mapping the zones to the body structure,
this line represents a continuum from head to abdominal base repeated twice,
first covering the front of the body (the more frontal points) and then the
back of the body. The meeting point of
the two zones, GV-20, can be used to treat the entire body, depending on the
aim of the needle.
Dingnie Zone
Nie (pronounced “nyeh”) refers to the
temple. The Dingnie zone runs from the center top of the head to the temple, at
an angle (aiming to the cheekbones). It
is located on a line from GV-21 to 1/2 cun anterior to ST-8. The zone is 1 cun
wide. It can be divided into 3 equal parts, and each part is used as a
representation of a body region that can be treated within the zone.
Dingnie 1 governs the lower limbs. The
homunculus for this zone looks like a person is kneeling with their foot and
thigh on top of each other (near GV-21), and their knees pointing towards
ST-8. This zone does not include the hip
joint.
Dingnie 2 governs the upper limbs. The
homunculus for this zone like a person with their elbows bent. The elbow zone is near the region between Dingnie 1 and 2. The upper arm (not
including the shoulder) and wrist are mapped near the intersection between Dingnie 2 and 3.
Dingnie 3 (near ST-8) governs the head.
It covers motor-sensory problems. This zone is rarely used as it can be
painful to needle; Eding 1 is usually
used instead.
Mapping from the frontal hairline back, the
top of the body is forward. Also, the
sensory zone is toward the forward part of the Dingnie zone, while the motor zone is toward the back of the Dingnie zone. Needling of this zone may include insertion
from GV-21 towards ST-8 or in the reverse direction.
Epang Zone
Pang (pronounced “pong”) means along the
side. The Epang zone is a series of short segments along the border of the
forehead/scalp on either side of the central line. This zone is actually comprised of short and
narrow segments running from the top of the forehead into the hair zone.
Epang 1 is used to treat acute diseases of the middle burner. It is located
1/2 cun on either side of GB-15. The zone is 1/2 cun wide.
Epang 2 is used to treat acute diseases of the lower burner. It is located
halfway between GB-13 and ST-8. The zone
is 1 cun long and 1/2 cun wide.
This mapping of the body runs from the center
line (GV, the Eding zone governing
head and throat) to the side, progressing from head to middle warmer to lower
warmer.
Dingjie Zone
Jie (pronounced “jeah”) refers to being closely
bound to something: this is a zone adjacent to GV-20. Dingjie
has a front zone—Dingjieqian—and a
back zone—Dingjiehou. Qian
(pronounced “chian”) means forward, and hou
(pronounced “how”) means back. The Dingjie zone is a set of four short
segments arrayed from the top of the head to the front and back sides of the
head. These are short lines radiating
forward and back to the sides from GV-20, the meeting spot between the end of
the Eding zone (corresponding to the
genital area) and the beginning of the Dingzhen
zone (corresponding to the head and neck).
The front Dingjie zone treats
an area of the body just above that treated by the end of the Eding zone, and the back Dingjie zone treats an area just below
that treated by the beginning of the Dingzhen
zone.
Front Zone of Dingjie: This zone is located on a line from GV-20 to
BL-7. This area is used to treat the hips and inguinal area.
Back Zone of Dingjie: This zone is located on a line from GV-20 to
BL-8. It is used to treat the area above the scapula, the upper trapezius
region.
Nieqian and Niehou Zones
Nie (pronounced “nyeah”) refers to the
temple. The Nieqian (meaning forward temple) zone is near the temple, above and
to the front of the sideburn, while the Niehou
(meaning back temple) zone is set back from the temple (over the top of the
ear). The zones at the sides of the head
are rarely used because the needling tends to be painful.
Nieqian Zone: This zone is located on a line from GB-4 to GB-6. It is used to treat shaoyang disorders (those that are
deemed half-inside and half-external in nature, and those affecting the
liver/gallbladder areas, such as hypochondrium and sides of the chest),
side-of-the-face problems, menstrual-related migraines.
Niehou Zone: This zone is located on
a line from GB-9 to TB-20. It is mainly used to treat diseases of the ear.
MAPPING
OF THE BODY WITHIN THE ZONES
The Dingnie zones, which
extend at angles towards the front of the head (from GV-21 to ST-8 on either
side) from the central Eding zone, overlap
the central zone. The mapping of body
parts to the zones places the foot at the beginning of the Dingnie zone (at GV-21) and the head at the end of the Dingnie zone (at ST-8): Dingnie
zone #1 is used for treating the legs; Dingnie
zone #2 is used for treating the arms; Dingnie
zone #3 is used for treating the head.
However, because Dingnie zone
#3 is more painful to needle and, because treatment of the head is adequately
accomplished in the Eding zone #1; Dingnie #3 is seldom used by Dr.
Zhu.
To visualize the mapping, imagine a person
squatting down with arms bent, placing the elbow on the knee, with the hand by
the shoulder. The beginning of Dingnie #1 is at the base of the foot,
this overlaps with the upper thigh due to the squatting position, and then it
maps upward to the knee; the zone then continues up the arm from the elbow
towards the hand and shoulder, including the forearm in that same space (Dingnie #2); finally, it follows up the
head (Dingnie #3). The foot location of the Dingnie zone #1 extends all the way to the far side of the Eding zone (the Eding zone runs along the governor vessel; the zone covers 1/2 cun
on either side of GV; when needling Dingnie
to treat the foot, the point of the needle, threaded into the scalp, rests at
the junction of the beginning of Dingnie
zone #1, where it meets the far side of Eding. Therefore, the needle enters the scalp behind
the Dingnie zone. Dingnie
zone #1 does not include the hips, and Dingnie
zone #2 does not include the shoulder girdle; to treat those parts of the body,
Dr. Zhu relies primarily on the Dingnie zones. Aside from the standard zones, palpation of
the scalp for tender points helps Zhu to identify the specific needling sites
within the selected zone. The Eding zone is the most frequently used
of the scalp zones, with the Dingnie zones
being used additionally for treating affected limbs.
When treating a neurological problem that
affects the extremities, the needles are directed, along a zone, towards the
opposite extremity. Thus, for example,
if the left leg is affected, the needle will be directed outward along Dingnie #1 on the right side of the
scalp. Only for problems of the head and
neck is the needling done on the same side of the scalp as the disorder. For disorders that are not specific to a body
location, such as hypertension or epilepsy, needling may be done on both sides
of the zone.
If the disorder to be treated is associated
with a degenerative disease involving a kidney deficiency syndrome (common in
elderly patients and those with chronic, degenerative diseases), then Eding zone #4 is usually needled. A typical needling pattern is: one needle in
the center of the zone, and one needle on either edge of the zone, about 0.5
cun apart from the central needle; for a total of 3 parallel needles in the
zone, with the central needle leading the other 2 by about 0.5 cun, producing
an arrow formation; the outer 2 needles are directed towards the part of the
zone that corresponds to the kidney, while the inner needle is directed toward
the part of the zone corresponding to the genitals.
Dr. Zhu sometimes uses a “crossing” technique
for needle positioning, mainly in treating cases of severe pain. He selects a zone site for treatment, and
inserts one needle along the zone and then inserts a second needle
perpendicular to that one, going across the zone and crossing over the first
needle. As an example for right-knee
pain, a needle is first directed along Dingnie
#1 towards the left temple, and then a second needle is inserted across that
one. The second needle is stimulated by
the draining method. In cases of
quadriplegia, another crossing technique is used. The first needle is inserted
across the zone (e.g., from the left part of the zone to the right part of the
zone, at about a 45 degree angle), and then a second needle, crossing over the
first (e.g., from the right part of the zone to the left part of the
zone). In some cases, a series of
cross-over needles are inserted along the length of a zone (this may
incorporate as many as 3 pairs of needles).
THE
NEEDLING TECHNIQUE
The needle size often mentioned in Chinese texts for scalp acupuncture
is 26, 28, or 30 gauge, which is suitable for rapid twirling techniques. For Zhu’s needle stimulation technique
(thrust and pull method), a somewhat finer needle gauge of 32 or 34 is suitable
for most cases, and the insertion length is approximately 1 cun. A 30 mm (1.2 inch) needle with a wound head
is thought to be the best. The needle
must be long enough so that it is not inserted up to the handle, but short
enough that there will not be any bending during insertion and
manipulation. The angle of insertion is
typically 15–25 degrees. The patient
should not feel pain, though there are some rarely used scalp points along the
sides of the head, mentioned above, that typically produce pain.
The needle is inserted along the
practitioner’s nail pressing the skin.
Press besides the treatment zones with the nail of the thumb and first
finger of the left hand, hold the needle with the right hand, and keep the
needle tip closely against the nail. By
avoiding the hair follicle, one can minimize pain during insertion. The
direction of needling is usually based on the mapping of the body within the
zone being treated: the needle is aimed (along the line of the zone) toward
that portion of the zone most closely corresponding to the area of the body
that is affected by the injury or disease.
Although the distance from the skin surface
to the skull is very short, there are several tissue layers: the skin,
hypodermis, galea aponeurotica and occipito-frontalis muscles, subaproneurotic
space, and pericranium. The
subaproneurotic space is a loose layer of connective tissue that is ideal for
penetration during scalp needling: the needle slides in smoothly and does not
cause pain, yet the desired needling sensation is strong. If the angle of needling is too shallow, the
needle will penetrate the skin and muscle layers and it will be difficult to
get a smooth insertion.
Upon inserting the needles, stimulation is
applied for 1–2 minutes (see below for stimulation technique). The needles are manipulated again after
intervals of 10–15 minutes, for 1–2 minutes each time, throughout the duration
of the patient visit, which may be as long as 2–3 hours. Sometimes, the interval between needle
stimulation sessions is longer due to insufficient staff time when there are
numerous patients, but usually within 30 minutes.
The needles should remain in the scalp for a
minimum of 4 hours (except for treatment of acute symptoms, in which case,
0.5–1 hour is sufficient) and up to a maximum of 2 days. However, for children and weak adults, the
time of retention should be shorter. Dr.
Zhu generally prefers long-term needle retention of 1–2 days; this is in
contrast to the method of Jiao Shunfa, who advocated removing the needles after
the basic manipulations. At Zhu’s
clinic, the scalp needles are often left in place when the patient leaves, and
are not removed until the next visit, which is 24–48 hours later. At that time, new needles are inserted at
different points. If several parts of
the body are affected by the illness or injury, the points selected may be
rotated through a cycle aimed at treating each of the different body parts.
There are two basic needling methods for
manipulating the qi, designated jinqi
and chouqi, that have been elucidated
by Dr. Zhu. Both are based on ancient
techniques and involve a rapid, short distance movements. Jinqi
(jin means move forward) is a
tonifying, thrusting method. “Thrust the
needle quickly with violent force, but the body of the needle doesn’t move, or
no more than 0.1 cun in.” Following the thrust, the needle is allowed to settle
back to its original position. Chouqi
(chou means to withdraw) is a
sedating, reducing method. It is based
on forceful movement and a lifting motion.
“Lift the needle quickly with violent force, but the body of the needle
doesn’t move, or no more than 0.1 cun out.”
Again, after the pull, the needle settles back to its original
position.
Lu Shoukang mentions in his article that he
prefers using the small-amplitude, forceful lifting method, rather than the
twirling method, because “it saves the operator effort and gives the patient
less suffering.” He describes his
preferred method as follows: “When inserted to a certain depth (about 1 cun),
the needle is forcefully lifted outwards or thrust inwards. The direction [angle] of lifting or thrusting
is the same as that of the insertion.
The outward and inward force exerted on the needle should be sudden and
violent as if it is the strength from the whole body of the operator. The lifting and thrusting amplitude should be
small, no more than 1 fen [1/10
cun]. After lifting and thrusting
continuously for three times, the needle body is sent back to the original
place (about one cun) and significant therapeutic effects will be obtained
after the maneuver is repeated for 2–3 minutes.”
For the majority of
neurological disorders, the tonification technique (jinqi) is used, with a series of rapid, very small-amplitude,
in-out needle movements. The emphasis is
on the forward movement, then allow the needle to naturally pull back to the
starting position. In cases of pain
syndromes, the draining method (chouqi)
is used, with the same kind of rapid, limited distance movements, but with the
emphasis on outward movement, then allowing the needle to settle back in to the
starting position. During the
stimulations, it is important for both the practitioner and the patient to
focus on the breath (this is an aspect of qigong
therapy that is incorporated into the treatment). There should be no talking during needle
stimulus: all attention is on the needling and its effects. The mental focus is on “directing the breath”
to the body part that is to be affected.
Regarding repetitions of the stimulus, Zhu
says: “Repeat many times until revival of qi and effect is achieved.” He usually does not specify a manipulation
duration, but rather bases the duration on observed response. He claims that by using the small amplitude
manipulation method rather than the twirling method, one has the advantages of
“large amount of stimulation, saving effort, less pain sensation, and strong
needling sensation,” yet the therapeutic effects are achieved quickly. The method is also easy to master, though
success may depend on the qi of the practitioner when utilizing the forceful
but small amplitude manipulations. Dr.
Zhu does not rely on moxa, due to the problems associated with large amounts of
smoke in the group treatment setting and lack of adequate ventilation at the
Neurology Center. He does use heat lamps
to provide heat to an affected body part, when it is deemed valuable.
The affected part of the body is to be moved
during needle stimulation. If the person
cannot make the movement on their own, then the patient will visualize moving
the breath to the affected part and, when possible, an assistant will move the
body part. After the needle stimulation,
the patient is encouraged to continue the movements. In cases where the legs are involved, the
patient walks, if possible (several patients at Zhu’s clinic would walk around
the block, others might walk the length of the room). Dr. Zhu expressed the belief that a function
of scalp acupuncture is to improve or re-establish the connections from the
central nervous system to the peripheral nervous system. The sending of signals between these two
parts of the nervous system during treatment is critical. The intention of the patient to move the
affected body part (or the mental practice of moving the breath to the body
part) sends signals from the central nervous system to the periphery, while
actual movements of the body part send signals back from the periphery back to
the central system.
Before withdrawing the needles, Zhu
recommends manipulating the needle again while the patient performs breathing
exercises. When it is time to remove the
needles, press the skin around the point with the thumb and index finger of the
left hand, rotate the needle gently and lift slowly to the subcutaneous level. From there, the withdrawal should be rapid,
and the punctured site should be pressed for a while with a dry cotton ball to
avoid bleeding.
Body points are sometimes used as an adjunct
to the scalp acupuncture therapy. Dr. Zhu uses relatively few body points
(typically 1–3, if any), but emphasizes obtaining the qi sensation with
propagation of qi sensation towards the affected part. Examples of body points are ST-36 for lower
limb weakness, or LI-11 or GB-20 for arm weakness. If a body part affected by disease or injury
involves very localized pain or spasm, Dr. Zhu might use body points primarily
for local treatment (rather than somewhere else along a meridian affecting the
area), and usually with deep needling.
Body points are sometimes selected because of failure to obtain the
desired qi reaction when using scalp points. The body needles are also retained
during the full length of the patient’s long scalp acupuncture treatment, for
up to two hours, not just 20–30 minutes as is often the case with standard
acupuncture therapy.
In most cases, treatment is given every day
(at least 5 days per week) for 1–2 weeks, then every other day for another 1–2
weeks, followed by twice per week treatment for as long as necessary. The frequency of treatment may be adjusted
according to the severity of the condition and rate of improvement. According to Lu, for best results in treating
hemiplegia due to stroke, scalp acupuncture should initially be performed twice
per day. For other chronic conditions,
daily treatment or every other day treatment is recommended for the initial
therapeutic plan, to be followed-up by less frequent treatments once progress
has been made.
CONCLUDING
NOTES
It is evident that after 30 years, scalp acupuncture is still evolving
in its techniques and applications. In
America, Dr. Zhu and his students have developed the techniques to suit the
Western patients (see Appendices 2, 3, and 4).
In reviewing the Chinese literature (see Appendix 5), one can draw
certain general conclusions. Most
authors suggest that utilizing scalp and body acupuncture together is a
valuable method. The recommended
frequency of treatment is high, from once or twice per day to once every other
day, with a course of treatment typically involving 10–12 consecutive sessions,
followed by a break of 2–4 days, sometimes 5–7 days. Needle insertion, manipulation, retention,
and removal are approached with differing techniques. An expressed concern is to minimize pain for
the patient and also to make the procedure practical for the
acupuncturist. Thus, the frequently-mentioned
method of rapid needle twirling may be replaced, in some cases, by other
methods (including electrical stimulation) because of the potential for causing
pain for the patient and fatigue and irritation for the acupuncturist. At least one study compared the efficacy of
twirling (manual and machine-aided) and electrical stimulation and the
conclusion was that both were useful.
The twirling method with large needles remains a common practice in
China.
In all cases, it is considered important to
obtain an appropriate needling sensation (not pain); often, this is to be
accomplished by utilizing needle manipulation at least two to three times in
the course of a single session (for 2–3 minutes each time). The manipulation is usually rapid, with frequency
of twirling in the range of 150–300/minute or electrical stimulation reported
in the range of 150–700/minute. Total
duration of needle retention in most cases is 20–45 minutes, though some
patients are sent home with needles in place (as Dr. Zhu recommends), for
retention of several hours up to a maximum of 2 days.
Indications for scalp acupuncture include
virtually all the usual indications for body acupuncture, but the main
applications are stroke, paralysis, pain, and emergency situations (Zhu has
published a book regarding the latter: A
Handbook for Treatment of Acute Syndromes by using Acupuncture and Moxibustion
(3), which includes scalp and other acupuncture techniques). Contraindications for scalp acupuncture
include very high blood pressure (220/120), heart disease, infection,
post-operative scars in the acupuncture zone, some cases of pregnancy (mainly
habitual miscarriage), persons who are extremely nervous, and infants whose
fontanels have not closed.
In a report from Harbin (18), several aspects
of scalp acupuncture for stroke patients were commented upon, which largely
match the methodology and interpretation expressed by Zhu:
1. 1.
The needle runs in the layer of
loose connective tissue between the galea and the pericranium.
2. 2.
The response of “getting qi” is
more importantly measured by observing an improvement in movement or sensation
of the affected part of the body rather than a needling sensation like the one
that is generated when the affected parts are directly needled.
3. 3.
Scalp points are especially
effective because they are close to the part of the body that is affected,
namely the brain.
4. 4.
Prolonged stimulation time, with
rapid needling speed, gives better results.
For example, constant needle twirling [the stimulation method more often
used in China] for 3 minutes gave superior results to constant twirling for
half a minute.
5. 5.
The effect of scalp needling is
to stimulate the cerebral cortex; it can reverse the imposed inhibitory
mechanisms on nerve function, revive cells that are not completely destroyed,
and enhance the function of nerve cells that are subjected to ultra-low oxygen
levels.
In general, Chinese clinical reports indicate
a high degree of effectiveness; cases and situations leading to better or
poorer outcome have been elucidated. In
America, there is less tendency to provide daily acupuncture, which might
reduce the effectiveness. Given the
general unfamiliarity with acupuncture, there is more likelihood of patients
waiting to try acupuncture as a last resort rather than a first effort, so that
the chances of improvement are more limited.
The scalp acupuncture technique taught
by Dr. Zhu has been used at ITM’s An Hao Natural Health Care Clinic in Portland
to treat a multiple sclerosis (see Appendix 3 for protocol details), peripheral
neuropathy, migraine headache, and Bell’s palsy. Good results were attained in cases where
body acupuncture had not been sufficiently effective.
APPENDIX 1: Zone Charts
Acupuncture Zones in Zhu’s Acupuncture.
APPENDIX 1, continued: Zone Charts
Acupuncture Zones Based on Motor/Sensory, Speech/Hearing, and Other
Divisions
(not used in Zhu’s acupuncture system).
Appendix
2: Dr. Zhu’s Work in America
Dr. Qingming Zhu opened his neurology clinic for scalp acupuncture
therapy in Santa Cruz, California in October, 1997, after offering his services
for 6 years in San Francisco. Santa Cruz
is a small beach town about 85 miles south of San Francisco that supports an
acupuncture college—the Five Branches Institute. The neurology clinic shares
space in the same building as the college, serving also as a training center
for acupuncture students. Another
acupuncture clinic is also in the same building, staffed by several experienced
Western practitioners, and provides the more standard variety of acupuncture
therapy. Although Zhu has learned English, his work is aided by a translator
who can speed up and clarify the communications. Still, many of his house calls
are made without this help.
While Zhu’s work has gotten some favorable
press, his efforts at helping those with neurological problems remains an
uphill battle. In California, medical
insurance generally covers the cost of acupuncture, but insurers have
repeatedly refused to pay for other medical expenses associated with Zhu’s
work, such as special exercise equipment developed for those with paralysis,
herbal treatments, and extended physical therapy. The main hospital in neighboring San Jose,
after initially letting him work on in-patients, has since refused to continue
such permission, viewing his techniques unfavorably, despite the overwhelming
support of those receiving the treatments.
Medical doctors have scoffed at his claims to be able to help
quadriplegics by scalp acupuncture.
His clinic is a small facility with one main
room, having a dozen chairs for patients to sit on while receiving scalp
acupuncture, and a pair of curtained-off segments of the room for beds so that
patients can receive acupuncture while lying down. There is a small office, which often turns
into a treatment room, and one small private treatment room off the office. At this facility, about 20 patients visit
each day, staying for 2–3 hours: after the needles are inserted, Zhu stimulates
the needles from time to time. The room
becomes quite crowded as most of the patients come with helpers. The clinic is usually open only 4–5 hours a
day; much of the rest of Zhu’s long and grueling work day is spent making home
visits to those who are so severely impaired that they can’t travel to the
clinic. He also teaches at the college.
His treatment technique relies almost
exclusively on scalp acupuncture, sometimes using a dozen or more needles in
the scalp at one time for the more severely debilitated patients. Although the needling is sometimes painful,
he has adapted the treatment so that even babies and young children accept
it. Zhu rarely prescribes herbs, but
primarily relies on frequent scalp acupuncture therapy (daily or every other
day). He has a few patent remedies
available at his clinic and has access to crude herbs for making decoctions, or
preparing topical applications, from the college pharmacy.
Zhu treats a wide range of neurological
problems, including cerebral palsy, epilepsy, injury-induced paraplegia,
multiple sclerosis, and post-stroke syndrome, as well as disorders that seem to
fall beyond the ability of neurologists to pin them down with a name. The results of Zhu’s work are somewhat
difficult to elucidate. With the absence
of support from the community of neurologists who could provide detailed
monitoring, and the limited assistance available during patient treatment
(which doesn’t permit careful documentation of the cases), the extent and
nature of the responses are not well established. At Zhu’s clinic, patients
report notable improvements compared to their earlier conditions. In a few cases of quadriplegia, Dr. Zhu is
using a video camera to illustrate the extent of changes in patient
capabilities. For more information on
Dr. Zhu and his clinic, write: Zhu's Acupuncture Medical & Neurology
Center, 100 O'Connor Drive, Suite 20, San Jose, CA 95128, or call Five Branches
Institute (831-476-9424).
APPENDIX 3: Scalp Acupuncture Protocol for Multiple
Sclerosis
The following protocol was developed by Dr. Edythe Vickers, based on
the teachings of Dr. Mingqing Zhu, and is being used at the Institute for
Traditional Medicine.
1. 1.
If the primary lesions are in
the brain, insert needle in Eding
Zone 1, needling along the GV line towards the face. This is intended to improve vision (e.g., to
relieve optic neuritis) and increase mental clarity. If the primary lesions are in the neck, then
insert the needle in Dingzhen Zone 1,
which governs the neck.
2. 2.
Insert needle from Eding Zone 3 to Eding Zone 4, needling along the GV line towards the back of the
head. This is intended to tonify the
kidney/liver system that is weak in nearly all persons with multiple
sclerosis. If the patient is suffering
from a bladder disorder (typically, there is inability to completely empty the
bladder, and there may also be incontinence; many individuals rely on a catheter),
then needle only within Eding Zone
4. This latter treatment is the same as
selected by Chen and Chen (4) for treatment of enuresis.
3. 3.
Use two additional needles to
complete the treatment. For persons who
are not highly symptomatic, the two needles may be placed parallel to the
needle in Eding Zones 3 and 4, about
1/4 inch on either side of the central needle.
This will enhance the tonification of the liver/kidney system and
strengthen the legs, bladder, and abdominal organs. For persons who have weakness, tingling
sensation, or other disorders affecting the arms and hands, needle instead Dingnie Zone 2, with the needle aiming
towards the face (towards ST-8). If the
problem affects one side of the body, needle the opposite side of the scalp,
but if it affects both sides, needle both sides of the scalp. For persons with weakness and numbness in the
legs, use Dingnie Zone 1, with the
needle towards the GV-21. For persons
with aching and numbness in the shoulders, needle the Dingjie Zone. Again, needle either one side or both sides,
as appropriate.
Use the thrusting technique (jinqi) in most cases, as this will
tonify the deficiency. The manipulation
should be carried out until the patient notices a change in their
condition. When treating the arm or leg
scalp zones, have the patient attempt movement of the body part while the
needle is manipulated. For bladder
disorders, have the patient breathe deeply (to the lower abdomen, Dan Tian), which should focus attention
on the area being treated and help to produce a warming sensation. When treating Eding 1 (for the eyes), have the patient gently rub their palms
over the eyes.
If an effect is not noted (clarifying of
vision, change in sensation or strength in affected limbs) within about 3 minutes
of manipulation time, check that the needling location and needle placement are
correct; if correct, it may be necessary to try the lifting method (chouqi) instead, especially if there is
pain. It may also be valuable to treat body points, such as ST-36 and GB-34 for
the legs and LI-4 and LI-11 for the arms.
Once a response is noted, the needle manipulation can be ceased. Patients with leg weakness should attempt to
walk for a few minutes. After about 15
minutes (from the previous manipulation), the needles should be manipulated
again. At the end of the third
manipulation, the patient will be instructed to retain the needles for a period
of several hours, up to two days, and then remove the needles themselves or
with the aid of someone who can assist them.
The needles used for body acupuncture are removed at the end of the
in-clinic treatment session.
Appendix
4: Treatment Method at Vitality Center
Holly Gahn, L.Ac., O.M.D., has been using scalp acupuncture for several
years and currently practices at Vitality Center in Lake Forest,
California. She described her basic
treatment techniques as follows, indicating that there are a number of other
procedures that she may utilize to complete the treatment:
Treatment Course. On
the first day, the patient is treated in the morning and in the evening; for
the next nine days, the patient is treated once daily. Then, treatment continues at the rate of
three times per week until the condition has resolved or the patient has
reached what appears to be the maximum level of improvement.
Point Selection. The
motor, sensory, balance, vision, and speech areas are utilized as
appropriate. For unilateral paralysis,
use the contralateral side, but use bilateral treatment of the zones for
bilateral paralysis. In cases of
generalized brain damage (as occurs with anoxic brain damage), Zhu's Eding zone is used predominantly, along
with GV-24 and UB-3 bilaterally. If the
patient's scalp becomes sensitive to needling, as might occur with frequent
needling of the same zone, it is helpful to alternate (from one treatment to
the next) between the motor and sensory points and the Eding zone.
Needling Procedure.
Needles are inserted one cun obliquely into the subaproneurotic
space. Needles point downwards and are
angled off towards the affected limb. It
is stimulated by small-amplitude, lift and thrust technique at rapid frequency
(200 times per minute if possible). Body
needles are also inserted, using standard procedures. Both the scalp and body acupuncture needles
are retained for 20–30 minutes and stimulated every 2–3 minutes during this
time.
Neuromuscular Re-education.
Immediately after the basic needle treatment, the body needles are
removed, but the scalp needles are retained.
The patient is taken through a series of exercises while the scalp
needles are being stimulated simultaneously.
If the patient is comatose or otherwise unable to perform these, the
practitioner (or assistant) performs the otherwise passive motions for the
patient. The patient, all the while, is
encouraged to try to think about doing the exercises, to visualize it, to
visually watch the movements (if possible).
Verbal encouragement is even given to those who are comatose. As soon (in the treatment course) as the
patient is able to perform the movements, they are encouraged to do so, even if
the movement is slight.
Electrostimulation may be utilized (frequency is 200/minute) in place of
manual stimulation. As they become
stronger, the practitioner adds resistance to each exercise (weights can be
added), thus requiring the patient to apply greater strength (and, in some
cases, more muscle groups) to the task.
The effort put forth by the patient is of utmost importance.
For Comatose Patients.
Needle PC-8 and KI-1 bilaterally plus GV-26. The needles should be stimulated strongly
(manual) for 10 minutes. Then add PC-6
and SP-6 with strong stimulation before proceeding to needle the rest of the
body and scalp.
APPENDIX 5:
Commentaries and Clinical Observations from the Chinese Literature
1. About needling techniques and duration.
For peripheral facial paralysis, Cui Yunmeng (7) suggests using a .38
mm needle and a 75 mm length. The needle
is twirled at a speed of 200 times per minute.
Needles are retained for 20–30 minutes, being twirled twice. Needling is done in the facial motor area of
the scalp, on the same side as the affected part.
For treatment of hemiplegia, Wang, et al.,
(6) give extensive details regarding point selection (a combination of scalp
and body points). Acupuncture is given
once daily for 40 minutes, with 10 days as one treatment course, and a rest of
3 days between courses. After insertion,
the needle is twisted for 5 minutes at a speed tolerable to the patient who is
advised to exercise the limbs as best he can.
Electric acupuncture is then used at a frequency of 150–200
pulses/minute for the head points and 100 pulses/minute for the body points.
Lu Shoukang (1) says that: “In scalp
acupuncture there are many types of manipulation. The common one is the rapid needle-twirling
method, that is, after being inserted to the lower layer of the galea
aponeurotica, the needle is tightly held by the thumb and index fingers, and
rapidly twirled for about 200 times per minute.
This manipulation requires a high frequency and continuous movement and
lasts 2–3 minutes each time. Within half
an hour, the manipulation should be done 2–3 times. Owing to the fact that by this method the
needle often twines the muscular fibers and causes pains, it is not well
accepted by the patient. Furthermore,
the metacarpophalangeal joint of the operator fatigues easily. For this, the finger twirling is replaced by
electric twirling, in which the patient is given pulse electric stimulations
with dense and loose waves and a current intensity tolerable by the patient.”
For the treatment of
post-stroke syndrome, Pang Hong (9) reports the following method, based on the
teachings of K.Y. Chen: “Scalp acupoints were needled with the reinforcing or
the reducing method as indicated. For
reinforcement, the filiform needle was inserted at an angle of 15–30 degrees to
the scalp, slowly and forcefully to beneath the aponeurosis. Pressure was applied to the point for one
minute, and the needle was quickly withdrawn after a retention of 10
minutes. For reduction, the
manipulations were similar, except that after 10 minutes of retention the
needle was withdrawn slowly, when the skin formed a mount around the retreating
needle. For either reinforcement or
reduction, the needling took 15 minutes, including the 10 minute period of
needle retention. Courses of treatment
were 10 daily sessions, with efficacy appraised after three courses.” He went on to comment that: “For the promotion
of myodynamia and motile functions, the method of slow-rapid reinforcing-reducing
was significantly better than the method of flat twisting. The application of reinforcing and reducing
manipulations would shorten the therapeutic course, promote the therapeutic
efficacy, and decrease the rate of disability.
The method of slow-rapid reinforcing-reducing in scalp acupuncture had
the advantages of causing less pain and inducing proper occurrence of the
needling sensation; therefore, it was well received by the patients.” With
regard to the selection of points, Pang Hong claims that: “For the treatment of
apoplexy, the selection of acupoints on either the healthy or the affected side
makes no difference in therapeutic efficacy.”
In his clinical work, he treated both sides, alternating sides from one
session to the next.
In a teaching round on
apoplexy (10), Professor Guo describes his technique for scalp acupuncture:
“Size 28 needles are commonly used, usually of the length of 2 cm. First, locate the upper point of the motor
area, and with the left hand fixed on it, insert the needle obliquely towards
the lower point at an angle of 15 degrees with the skin surface. Holding the needle with the right first three
fingers, insert the needle quickly until it reaches the loose cellular tissue
beneath the scalp. Then turn the needle
horizontally with respect to the skin surface, and push it to a depth of about
1.5 cm. Twist and rotate the needle but
never lift and thrust it. Hold the
needle between the medial surface of the terminal part of the right index
finger and the palmar surface of the terminal part of the right thumb. With repeated extensions and flexions of the
interphalangeal joint of the index finger, one rotates the needle in one
direction till it turns two rounds and then in the other direction for another
two rounds. One may rotate this way 200
times for one minute, repeat rotating 5–10 minutes later, and retain the needle
till 30 minutes after the insertion (including the time of rotating). With rotating of the head of the needle, the
patient usually reports the feeling of local heat, numbness, and tics. There may sometimes be radiation of such
feelings to contralateral and homolateral limbs. In general, therapeutic effects are achieved
with mere appearance of local needling feeling; nevertheless, still better
results will be had if the feelings radiate to the limbs. You may produce all the needling feelings
with electrical stimulation. To do this,
one inserts a 1 cun needle into the upper point of the motor area and pushes it
horizontally towards the lower point, and then insert a 1.5 cun needle at the
division point between the upper 1/5 and middle 2/5 [of the motor area]. With these needles connected to corresponding
electrodes in the electroacupuncture apparatus, one then passes electricity,
often in a frequency of 3/sec [180/minute] with a tolerable intensity for 20
minutes.”
Qu Hong and his colleagues (8) described
their scalp acupuncture technique for treating pseudobulbar paralysis as
follows: “A filiform needle was rapidly inserted for a depth of 1–1.5 cun in the
direction of the motor/sensory area, followed by rapid twistings for 0.5–1
minute until the appearance of the needling sensation. The needle was retained for 40 minutes, with
small amplitude twistings for another 0.5–1 minute before withdrawal....Practice
has shown that needling on the motor and sensory areas simultaneously, and on
the affected side and the healthy side simultaneously produces better curative
effects. In light of the experience of
Professor Shi Xuemin, the authors adopted deeper insertion of the needles both
on the scalp and on the body. Retention of the needles enhanced vasodilation of
the cerebral vessels to increase cerebral circulation more than simple
twistings of the needles for the recovery of nervous functions. The authors therefore lengthened the needle
retention to 40 minutes.”
Liu Chunhui and Wang
Ying (11) reported on their experience of treating acute apoplexy during a
medical visit to Yemen. For scalp
acupuncture, they reported that: “The needles were twirled once every 10
minutes at a rate of 200 times per minute, followed by retaining them for 30
minutes. The patients were asked to
exercise the limb during the needle manipulation.” The manipulation was applied every 10 minutes
and acupuncture (body plus scalp) was administered each morning and afternoon
for a treatment course of 12 days, with an interval of 3 days between courses
(using 1–6 courses).
Wu Chengxun (12) reported on using three
techniques of needle manipulation.
Manual twirling was done with a frequency of 200–500 times per minute
and the twirling was performed every 3–5 minutes; a needle twirling machine was
applied at a frequency of 300 times per minute and applied in the same fashion;
an electroacupuncture device was used with a frequency of 500–700 waves per
minute, with continuous stimulation for 10 minutes. After the stimulations were applied, needles
were retained for several minutes so that the total duration of needling was 25
minutes. The treatment was performed
daily for 12 days, and then a rest period of five to seven days was allowed
before resuming another course of 12 days treatment. With a total of 1228 cases of hemiplegia so
treated, it was determined that there was no significant difference in the outcome
for the three methods of stimulation.
Ji Nan and colleagues (13) used scalp and
body acupuncture to treat sequelae of stroke and cerebral injury, claiming
improvement in all but 3 of 128 patients, with treatments deemed markedly
effective in 42.8% of the total group.
Needles were inserted, as appropriate to the condition being treated,
into zones designated motor area, sensory area, vasomotor area, and speech
zones I, II, and III. For paralysis,
they used the method of treating the side opposite the affected limb. The scalp needles were connected to a
therapeutic instrument which delivered “sparse and dense waves” over an
interval of twenty minutes for each session.
For each session 1 or 2 scalp areas and 2–4 body points (such as ST-36,
LI-10, LI-11, LI-15, GB-34, or SI-9, getting qi and then allowing 20 minutes
retention) were treated. Sessions were
once daily for 10 days as a course of treatment, applying 2 courses as the
standard.
Zhang Naizheng (14) described treatment of
tremor artuum in 35 individuals using a combination of body points and scalp
acupuncture. Regarding the latter, he
stated: “The dancing tremor controlling region was chosen; needling was done
once per day, 10 days for a course of treatment, with an interval of four days
between courses, lasting 4 courses.
Using a 26 or 28 gauge, 5 cm long needle, the squeeze-holding method was
used for insertion; the angle of insertion was 30 degrees, and the needle was
rapidly twirled with a small scope of movement, about 200 times per minute for
2 minutes, and then retained without twirling for 5 minutes; this procedure was
repeated three times and then the needle was removed.”
Zhang Mingju reported (15) on treatment of
296 cases of hallucinations using scalp acupuncture. The method used was point-through-point
needling, with the needles inserted at an angle of about 15 degrees with the
scalp and running from GV-19 to GV-20 (the Dingzhen
1, which affects the head); auxiliary treatment locations were needled by
similar method, starting at the selected point and then needling through to the
next point (examples: GB-17 to GB-16; TB-19 to TB-17). Needles were twirled and agitated for 1–3
minutes. When the needling sensation is
felt is the best time to channel qi to the locality of the disease. Needles were retained for 1–3 hours. Acupuncture was performed daily, and 10
sessions constituted on therapeutic course.
After the first course, acupuncture was performed every other day, with
10 sessions constituting the second therapeutic course. If still necessary, acupuncture was performed
twice weekly, with 10 sessions constituting the third therapeutic course. By this method, 71% were cured and 19%
markedly improved.
Zhang Hong reported (16) on treatment of 76
cases of senile urinary incontinence.
Body and scalp acupuncture was used, with scalp points picked in the leg
motor and sensory area (1 cm lateral to GV-20, corresponds to Eding 4) and reproduction area (Epang 2). Electrical stimulation was adopted, with a
frequency of about 200 pulses per minute, with the intensity limited to the
patient's tolerance. Needles were
retained for 30 minutes. Treatment was
given 5 times per week, with 10 treatments constituting one course, with an
interval of one week between courses.
After 1–2 courses, half the cases were cured, and 20 others markedly
improved.
2. About needling pain and needle sensation
Lu Shoukang observes (1): “In scalp acupuncture, the needle is usually
inserted by the penetration needling along the skin. Since the scalp is rich in nerves and blood
vessels and is more painful than the limb when punctured, the needle insertion
should be rapid and kept away from the hair follicles and the tip of the needle
should be sharp. After insertion, the
needle body should be rapidly pushed to the lower layer of the galea
aponeurotica that is the loose connective tissue to allow the needle to be
manipulated freely to cause less pains.
In order to strengthen the stimulative sensations, the
point-through-point method is used, that is, the needle penetrates several
points at the same time. Sometimes the
method of two needles punctured to each other is used. For instance, one needle is punctured from qianding [GV-21] to baihui [GV-20] while the other needle from baihui to qianding, both
along the midline of the vertex.”
Chen Zaiwen and Chen Ling (4) described
treatment of enuresis in children with scalp acupuncture. It was mentioned that: “For scalp
acupuncture, the selection of acupoints needs to be accurate and the
manipulation mild to avoid unnecessary pain which might dispose the child
unfavorably to acceptance of the treatment.
The author’s choice was a 30–32 gauge filiform needle, 1.5 cun in
length. It was desirable to insert the
needle rapidly through the skin in a vertical direction and then the needle was
bent to an angle of 30 degrees to the skin to be pushed forward, preferably
under the epicranial aponeurosis. A
stronger stimulation often brought about better curative effects.” Although the authors reported good clinic
effect of scalp acupuncture for enuresis, it was said that: “Owing to the
needling pain, only 59 cases [out of more than 100] were willing to accept the
treatment for a complete course [10 to 15 sessions, undertaken either every day
or every other day] or longer.”
3. About the effectiveness of scalp acupuncture
in clinical practice
In a general review of acupuncture therapy (5), it was said that:
“Clinical reports of 2,917 cases of hemiplegia treated in 34 units [clinics]
reveal an effective rate of 94.5%, with 58.9% markedly improved....Observation
of the graphic [EEG] changes of amplitude, decrease of frequency, decrease of
the angle of the main peak, deepening of the valley of the wave indicate that
scalp needling dilates blood vessels, improves vascular elasticity, reinforces
cardiac contraction, and increases cerebral blood flow.”
A problem with claimed effectiveness rates
for scalp acupuncture is that there is rarely a control group (or one that is
well-matched) to help sort out improvements that might occur spontaneously or
due to other therapeutic measures (such as ordinary physical therapy) that
might be undertaken. However, there may
be some benefit to examining the disorders that have been treated by this
method and the extent of improvements, whatever the cause, that were noted
during the treatment period.
In the article by Chen and Chen regarding
enuresis treatment (4), effectiveness was moderate (only 9 out of 59 were
cured), but it was said that: “It seemed to be a general rule that older
children were apt to have better curative results; treatment in the afternoon
seemed to be better than in the morning, and a longer time of needle retention
was better than short time needle retention....A stronger stimulation often
brought about better curative effects.”
In an article on scalp acupuncture for hemiplegia
(6), Wang and his colleagues reported that of 110 cases, 29 were essentially
cured, with mobility of limbs recovered.
They state that: “Analysis of the 110 cases showed that the location,
number and extent of the cerebral lesions correlated closely with the
therapeutic effects, and early institution of the acupuncture treatment led to
better results....Among 29 cases that were essentially cured, most involved
lesions in the external capsule or cerebral lobes, with some single lesions in
the internal capsule or brain stem.
However, the 5 ineffective cases had mostly multiple lesions in the
basal ganglia, the brain stem, and cerebral ventricles.”
In an article by Cui Yunmeng (7), scalp
acupuncture for facial paralysis was described.
It was reported that 71 out of 100 cases were cured, using 5–40
treatment sessions, given once daily.
In a report on pseudobulbar paralysis (8), Qu
Hong, Ren Liping, and Guo Yi describe their results of combining scalp
acupuncture and body acupuncture: “The treatment was effective in all 28
cases. 19 cases (68%) were cured and 9
cases (32%) were markedly effective. The
shortest course of treatment was 4 sessions and the longest 4 courses [40 sessions]....The
patients in this series were all difficult cases of pseudobulbar paralysis
refractory to western and Chinese drugs.
The good therapeutic effects indicated the superiority of this
modality.”
A study by Wan Zhijie and colleagues on the
mechanism of action of scalp acupuncture (17) indicates that cholinesterase is
inhibited and, at the same time, muscle force of the extremities is increased.
Further, microcirculation is notably enhanced.
In treating hemiplegia, a single treatment (about 25 minutes, including
insertion, three sessions of 3-minute twirling with two 5-minutes breaks, and
withdrawal of the needles) muscle strength in upper and lower extremities
improved by about 20%, whole blood cholinesterase was reduced by about 15%, and
speed of blood flow through nail bed capillaries increased by over 30%. These changes slowly reverted after treatment
to reach pretreatment values after 24 hours, confirming the need for daily
scalp acupuncture therapy.
Two reports on aphasia (inability to speak)
were presented in the Shanghai Journal of Acupuncture and Moxibustion. In one report, from the Guangdong Provincial
Hospital, 72 cases of stroke-caused aphasia were treated and evaluated
(19). The zones selected were from the
“speaking zones” (from a different set of zones than used in Zhu’s scalp
acupuncture). After applying the needles
and getting the qi reaction, the needles were hooked up to an
electroacupuncture device and stimulated for 20 minutes (once per day). In addition, body acupuncture was applied
(mainly GB-20 on one day and GV-16 on the alternate day, with some non-standard,
“extra points”). Those needles were
stimulated for about 20 seconds and then retained for 30 minutes (once per
day). After 30 days of treatment, 46% of
the patients showed marked improvement, and another 50% showed some
improvement. In the other report (20),
from the Central Hospital of Shantou City (also in Guangdong), aphasia in nine
children ages 16 months to 14 years was treated. The causes were numerous, including viral
encephalitis and meningitis. The
speaking zone was treated as the main therapy, and as an adjunct a treatment
comprised of needling GV-20, GV-24 and the four points of Sishencong (Extra-6) were treated.
Three needles were used in the speaking zone, they were twirled rapidly
for two minutes, then connected to an electroacupuncture device and stimulated
for 30 minutes (at 14 Hz). Treatment
lasted from 4–21 days. Of the 9 patients
treated, 4 were reported recovered and 2 improved.
According to the content of these reports,
compared to Zhu’s techniques there is shorter duration of individual
treatments, reliance on electroacupuncture as stimulation, and no mentioned
focus on patient breathing or movements during treatment (e.g., for aphasia,
Dr. Zhu needles Eding zone #1 and has
the person try to count from 1 to 10, say their address, sing, etc., to use
both voice and memory).
4. About the
mechanism of action for stroke
In a study of scalp acupuncture applied immediately following a stroke
(21), it was reported that both thromboxane B2 (TXB2) and 6-ketone
prostaglandin F10 (6KP) levels in the blood plasma were affected. These biochemicals are the stable metabolites
of substances involved in platelet clumping: thromboxane A2, which induces
clumping of platelets and contraction of arteries, and prostaglandin I2, which
inhibits platelet clumping and inhibits formation of arterial atheromas (by
reducing cell proliferation).
The physicians treated 20 patients who had
suffered a stroke within the prior 10 days.
For scalp acupuncture, the major areas selected were the “motion” zone
and the “diastole-systole” zone. Body
points were also needled; alternating from one day to the next between
treatment of yang meridians (points would be selected from LI-15, LI-11, LI-4,
TB-5, GB-30, GB-34, GB-39, or UB-60) and treatment of the yin meridians (points
would be selected from HT-1, LU-5 PC-6, SI-13, SP-6, or LV-3). The scalp needles were strongly stimulated
with twirling at 200 times per minute for 2–3 minutes, and followed by the
lifting maneuver to get the full qi reaction.
Body points were stimulated less, but it was important to get a qi
reaction. Needle retention was for 30
minutes, with electrostimulation used after getting the qi reaction. Treatment was carried out for 6 consecutive
days, followed by a 1 day rest, as one course of treatment, for a total of 4
courses (one month). Drugs that might
affect thromboxane or prostaglandin levels were discontinued prior to the
study.
It was shown that stroke patients had higher
plasma TXB2 levels and lower plasma 6KP levels than healthy persons. After performing acupuncture on the stroke
patients, the TXB2 levels declined and the 6KP levels rose. The changes were statistically significant,
though the parameters did not reach the levels of healthy patients. The improvements in TXB-6KP levels were
interpreted as a biochemical manifestation of harmonizing yin and yang. The authors thought that the effect of
acupuncture was mediated by the cerebral cortex and the nervous humoral system.
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December
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