The Treatment of Pain Through Chinese Scalp Acupuncture

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19 The Treatment of Pain Through Chinese Scalp Acupuncture

Jason Jishun Hao, DOM, MTCM, MBA, Linda Lingzhi Hao, DOM, PhD

Chinese scalp acupuncture is a contemporary technique combining traditional Chinese needling methods with Western medicinal knowledge of various representative areas of the cerebral cortex. Scalp acupuncture has been proved to be an effective technique for treating acute and chronic pain due to central nervous system disorders ranging from phantom pain and complex regional pain, to strokes and multiple sclerosis. The scalp somatotopic system appears to manifest the convergence of the central nervous system and the endocrine system. The scalp somatotopic system seems to operate as a miniature transmitter-receiver in direct contact with the central nervous system and endocrine system. By stimulating those reflex areas, acupuncture can have a direct effect on the cerebral cortex, cerebellum, thalamo-cortical circuits, thalamus, hypothalamus, and pineal body. Its unique neurologic and endocrinal composition makes the scalp an ideal external stimulating field for internal activities of the brain. Using a small number of needles, scalp acupuncture can often produce remarkable results almost immediately, sometimes taking only several seconds to a minute to complete.

Acupuncture, an oriental therapeutic technique, can be traced back more than 2500 years, summarizing centuries of Chinese experience in preventing and treating disease. Throughout its long history, acupuncture has continued to evolve its own unique traditional medicine, forming many new and different methods by embracing newly developed knowledge and technology. Current developments in acupuncture include new acupuncture points and new techniques such as electric and laser acupuncture. One of the most important advancements that ancient Chinese acupuncture has made in the past 60 years has been to create scalp acupuncture by integrating Western medicine into its traditional needling techniques.

Scalp acupuncture is well-researched natural science and incorporates extensive knowledge of the past and the present. Years of clinical experience have contributed to the majority of discoveries and developments in scalp acupuncture. This modern system of acupuncture has been formally explored since the 1950s in China, but treatment by needling the scalp and knowledge of scalp acupuncture has been traced back to early civilization. In the first Chinese medicine book, The Emperor’s Internal Medicine described the relationship between brain and body in physiology, pathology, and treatments. Citations of acupuncture treatments on the head are also found throughout classical Chinese literature.

Around 1950, various famous Chinese physicians introduced Western neurophysiology into acupuncture fields and explored the relationship between the brain and human body. Although there were several hypotheses, it took acupuncture practitioners roughly 20 years before they accepted a central theory that incorporated brain functions into the Chinese meridian theories. Dr. Jiao Shunfa, a neurosurgeon in Shanxi province in China, is the official recognized founder of Chinese scalp acupuncture.1 Starting in 1972, he systematically undertook the scientific exploration and charting of scalp correspondences for the first time in more than 2500 years of acupuncture history. Dr. Jiao combined a modern understanding of neuroanatomy and neurophysiology with traditional techniques of Chinese acupuncture to develop a radical new tool for treating the central nervous system. At the time, scalp acupuncture was primarily used to treat paralysis and aphasia due to stroke. Dr. Jiao’s discovery was investigated, acknowledged, and formally recognized by the acupuncture profession in a national unified acupuncture textbook, Acupuncture and Moxibustion in 1977.

In 1987, scalp acupuncture began to gain international recognition at the first International Acupuncture and Moxibustion Conference held in Beijing. In 1989, Dr. Jason Jishun Hao brought scalp acupuncture to the United States. Since then, Dr. Hao has trained hundreds of acupuncture practitioners and treated thousands of patients with disorders of the central nervous system in the United States. After its introduction in the United States, the techniques and applications of scalp acupuncture have been expanded and developed through further research and experience. Studies and research on scalp acupuncture continue to show positive results in treating the disorders of the central nervous system.2

Scalp acupuncture is different from traditional acupuncture in its fundamental theories, locations, stimulation techniques, and patient’s responses. Scalp acupuncture treats and prevents disease through the proper insertion of needles into scalp areas. It is accompanied by different manipulations to regulate and harmonize the functional activities of the brain and body, as well as to restore and strengthen the functions of the body, organs, and tissues.

Scalp acupuncture is based on a reflex somatotopic system organized on the surface of the scalp. Scalp acupuncture consists of needling areas versus points on the skull according to the brain’s neuroanatomy and neurophysiology. Unlike acupuncture, where one needle is inserted into a single point, in scalp acupuncture needles are subcutaneously inserted into whole sections of various zones. These sections are the specific zones through which the functions of the central nervous system, endocrine system, and meridians are transported to and from the surface of the scalp. From a Western perspective, these areas correspond to the cortical areas of the cerebrum and cerebellum, which are responsible for central nervous system functions such as motor function, speech, and balance (Figs. 19-1 and 19-2).

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Figure 19-1 Cerebral cortex, side view.

(Courtesy Jason Jishun Hao.)

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Figure 19-2 Cerebral cortex, top view.

(Courtesy Jason Jishun Hao.)

In clinical practice, acupuncture treatments are typically based on highly individualized philosophical constructs, and the practitioner has a wide amount of discretion on the type of points and techniques. Therefore, even when treating the same complaint, the method of treatment chosen by one practitioner can vary significantly from another. Scalp acupuncture, on the other hand, applies more of a Western medicine approach in which patients with the same diagnosis usually receive similar types of treatments. In various cases, scalp acupuncture has not only been proved as a more effective treatment for many diseases in the central nervous system, it is also more easily accessible, less expensive, entails less risk, can yield quicker responses, and often causes fewer side effects than some Western treatments.

In a recent study by the author, scalp acupuncture was used to treat seven patients with phantom limb pain at Walter Reed Army Medical Center in Washington, D.C.3 After only one treatment per patient, three of the seven patients instantly felt pain relief and showed significant improvement, whereas three patients showed some improvement, and only one patient showed no improvement (see later). Because of the limited numbers of patients, this needs to be replicated on a larger scale. It nevertheless shows the potential efficacy of scalp acupuncture in treating phantom pain.

The technique of scalp acupuncture is systematic, logical, and relatively easy to understand and practice. The techniques introduced in this chapter can be performed even if one has little acupuncture experience. Scalp acupuncture treatment can be used as the primary approach or as a supplement to other acupuncture modalities. Scalp areas are frequently used in pain management, especially pain caused by the central nervous system such as phantom pain, reflex regional pain, and residual limb pain. Scalp acupuncture is also often used in the rehabilitation of paralysis due to stroke, multiple sclerosis, automobile accident, and Parkinson disease. It has been proved to have effective results in treating aphasia, loss of balance, loss of hearing, dizziness, and vertigo.

In the West, although scalp acupuncture has been known for some time, the technique has been taught and used only sparingly. Only a handful of books with scalp acupuncture as the main emphasis have been published. With such little information available, it is almost impossible to apply this technique in practice. In the West, most healthcare practitioners are familiar with acupuncture for pain management. However, scalp acupuncture, as a tool for paralysis rehabilitation, is a relatively new concept. Even now, it is not surprising for a Western physician to claim that it is a coincidence if a patient recovers from paralysis after acupuncture. Therefore, there is an urgent need for Chinese scalp acupuncture to be developed, studied, and expounded by modern science and technology. Much more research needs to be done on scalp acupuncture so that its potential can be fully explored and utilized.

Scalp acupuncture can provide solutions in situations where Western medicine solutions are limited or entail too much risk. This chapter will show the scope of scalp acupuncture in treating many kinds of diseases. This research is derived from many years of clinical experience and can be used as the foundation for future clinical practice and research.

Location and Indication

Precise location of Chinese scalp acupuncture areas requires identification of two imaginary lines on the head. The anterior-posterior line runs along the centerline of the head. The midpoint of the skull is located at the midpoint between the occipital protuberance and the glabella, midway between the eyebrows. The second line, the horizontal line, runs from the highest point of the eyebrow to the occipital protuberance. Where this line intersects the anterior hairline defines the lower point of the motor area (Fig. 19-3). In patients without a definite hairline, an alternative method for locating this point is to draw a vertical line up from acupuncture point ST-7 until it intersects the line from the brow to the occipital.

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Figure 19-3 Lower point of the motor area.

(Courtesy Jason Jishun Hao.)

Motor Area Location

The motor area is located on the projective area of the scalp corresponding to the precentral gyrus of the frontal lobe. The motor area is located in a strip beginning at the midline at a point 0.5 cm posterior to the previously located midpoint of the head, along the anterior-posterior line.4 The motor area runs from this point obliquely down to the point where the eyebrow-occipital line intersects the anterior hairline (Fig. 19-4). The line of the motor area determines the angle and location of several other areas, such as the sensory area and chorea and tremor area.

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Figure 19-4 The motor area runs from this point obliquely down to the point where the eyebrow-occipital line intersects the anterior hairline.

(Courtesy Jason Jishun Hao.)

The motor area of the cerebral cortex controls and adjusts intersectional body movements. One side of the cerebral cortex controls contralateral muscles of the body in the level below the neck. One exception is that most head and face muscles are bilateral. The size of the motor gyrus of the cerebral cortex is associated with complexity and accuracy of body movement. A larger representative area equates to greater complexity and accuracy. The motor gyrus is depicted as an upside-down human body image. For example, the upper part of the gyrus controls the lower limbs, whereas the middle part of the gyrus controls upper limbs, and the lower parts control head and face movement.

The motor area is divided into three regions according to the homunculus projection.5 In order to correctly locate those three regions, the whole motor area is first equally divided into fifths. Then three regions are measured as Upper one-fifth region, Middle two-fifths region, and Lower two-fifths region. The Upper one-fifth region is used to treat contralateral movement dysfunction of the lower extremity, trunk, spinal cord, and neck. The Middle two-fifths region is used to treat contralateral movement dysfunction of the upper extremity. The Lower two-fifths region is used to treat bilateral movement dysfunction of the face and head. These areas are used to affect the contralateral side of the body. The direction of needling is usually from the upper part of the area downward, penetrating to the entire area.

Motor Area Indications

Indications to apply needles in the motor area are: paralysis or weakness in the face, trunk, or limbs caused by stroke; multiple sclerosis; traumatic paraplegia; acute myelitis; progressive myotrophy; neuritis; poliomyelitis; post-polio syndrome; periodic paralysis; hysterical paralysis; Bell’s palsy; spinal cord injury; traumatic brain injury; and brain surgery.

Among the disorders mentioned earlier, the most common problems are generally paralysis due to stroke, multiple sclerosis, and traumatic injury. When treating a thrombosis and embolism stroke, scalp acupuncture treatment should begin as soon as possible. When treating a hemorrhagic stroke, scalp acupuncture treatment should not be performed until the patient’s condition is stable, typically at least 1 month after the stroke. Although stroke can be treated at any stage, the greatest response to treatment will be for strokes occurring less than a year prior to scalp acupuncture. The longer the duration of the impairment, the more gradual the improvement will be. With long-term cases of impairment, expectations need to be realistic, although some patients will occasionally surprise practitioners. Improvement is rare for patients with a long history of paralysis that has led to muscular atrophy, rigid joints, and inflexibility.

When treating chronic progressive diseases like multiple sclerosis and Parkinson’s, the results from treatment are sometimes temporary. Results may last for hours, days, weeks, or months, but ongoing follow-up treatments will be necessary. However, when treating paralysis from either stroke or trauma, the improvements of movement are often permanent.

Although each part of the cerebral cortex has its own functions, it is relative to our understanding of brain functions. When one area is impaired, the impaired area can recover to a limited extent. In addition, by employing proper stimulation, other areas can compensate for the impaired area. This may be the answer to explaining the mechanism of scalp acupuncture in treating cerebral cortex impairment. Generally speaking, paralyzed extremities are targeted by treating the opposite site of the motor area in the scalp. For instance, if a patient has paralysis of the right leg and foot, needles should be inserted into the patient’s left side of the scalp motor area. However, for patients undergoing brain surgery or with an injury where part of the brain was removed, needling should be on the same side of the scalp as the side of the paralyzed limb.

For treating motor dysfunction, place the needles and rotate them at 200 times per minute for 2 to 3 minutes every 10 minutes for a total of 30 to 60 minutes. More difficult cases require longer treatment times. For the best results, the patient should feel something in the reference area: tingling, movement, twitching, heat, cold, and so on. After stimulating the needles, begin passive and active movement of the affected limbs. It is helpful to have the patient walk, with or without assistance as indicated, between stimulations. Initially, the treatment should be twice a week until major improvements are achieved, then once weekly, then every 2 weeks, and then spaced out as indicated by the patient’s condition.

Sensory Area Location

The sensory area is located on the projective area of the scalp corresponding to the post-central gyrus of the frontal lobe. The sensory area is one of the most commonly used in Chinese scalp acupuncture. It is located parallel to the motor area, 1.5 cm posterior to the motor area (see Fig. 19-4).

The sensory area of the cerebral cortex controls and adjusts sensation in the opposite side of the body. One side of the cerebral cortex controls contralateral sensation of the body in the level below the neck. One exception is that most of the sensation of the head and face are bilateral. The sensory gyrus, like the motor gyrus, is also distributed as an upside-down human body image. That means the upper part of the gyrus controls the lower limbs; the middle part dominates the upper limbs; and the lower part controls head and face movements.

The sensory area is also divided into three regions according to the homunculus projection. These are the same proportions as discussed for the motor area: the Upper one-fifth, the Middle two-fifths, and the Lower two-fifths. These zones follow the same distribution, with the lower extremity, trunk, and neck in the Upper Zone, the upper extremity in the Middle Zone, and the face and head in the Lower Zone. These areas are used to affect the contralateral side of the body. The direction of needling is usually from the upper part of the area downward, penetrating the entire area.

Sensory Area Indications

Indications to apply scalp acupuncture to the sensory area are: abnormal sensations of face, trunk, and limbs that are either hyposensitive or hypersensitive including pain, tingling, numbness; and loss of sensation in the contralateral side of the body. The following disorders have shown positive results when treated by scalp acupuncture: loss of sensation or pain from stroke and traumatic injury, numbness and tingling from multiple sclerosis, phantom pain, complex regional pain, residual limb pain, trigeminal neuralgia, temporomandibular joint dysfunction (TMJ), migraine headache, cluster headache, shingles, pain in the neck, shoulder, back and lower back, sciatica, gout, plantar fasciitis, fibromyalgia, neuropathy, and paresthesia. In general, abnormal sensations of an extremity are treated by choosing the opposite site of the sensory area in the scalp. For instance, if a patient has pain in the right leg and foot, the left side of the sensory area in the scalp should be needled. However, for patients having brain surgery and an injury where part of brain was removed, needles should be placed on the same side of the scalp as the affected limb. For example, a patient with numbness in the left leg and foot, would be treated with needles on the left side of the scalp’s sensory area.

Scalp acupuncture produces excellent results for pain, numbness, and tingling. Many patients show significant improvement during initial treatment. Scalp acupuncture results in much quicker effects compared to other modalities of acupuncture, such as in the ear, hand, or body. Some patients felt improvement just a few seconds or a few minutes after their scalps were needled.

As with the motor area, the Upper one-fifth of the sensory area is used to treat abnormal sensation and pain in the lower extremities, trunk, back, chest, and neck. The Middle two-fifths is used for the upper extremities. The Lower two-fifths is used for problems with the face and head, including migraines, headaches, trigeminal neuralgia, toothache, and TMJ.

Additional Areas of the Cortex

Tremor and Chorea Area

The tremor and chorea area is located on the projective area of the scalp corresponding to the basal ganglion area. This gyrus has important motor-adjusting functions that closely involve stability of voluntary movement and the control of muscular tension.

The Chorea and Tremor Area is located parallel to the motor area, 1.5 cm anterior to the motor area (see Fig. 19-4). It runs 4 cm and starts 1 cm anterior to the Midpoint at its upper point. This area is always needled bilaterally and is used for any involuntary motor activity. This is the primary area for the treatment for Parkinson’s disease, tremor, shaking of the head, body, or extremities, and chorea. This area is also very effective for treating patients with muscular tension and tightness in any part of the body. The direction of needling is usually from the upper part of the area downward, penetrating to the entire area.

Vascular Dilation and Constriction Area

This area is also parallel to the motor area, 1.5 cm anterior to the chorea and tremor area, or 3 cm anterior to the motor area (see Fig. 19-4). This area is also always needled bilaterally and can be used for essential hypertension, cortical edema, and other autonomic vascular dysfunctions. The direction of needling is usually from the upper part of the area downward, penetrating the entire area.

Vertigo and Hearing Area

This area is located over temporal lobe in the lateral side of the head. It is on the horizontal line and totals 4 cm.6 It starts 1.5 cm superior to the apex of the auricle of the ear at its middle point, and extends 2 cm anterior and 2 cm posterior to the middle point (see Fig. 19-4). This area is also needled bilaterally and can be needled in either direction. This is a very useful area for treating vertigo, dizziness, Meniere disease, tinnitus, hearing loss, and hearing hallucination.

Speech I Area

There are three speech areas. Speech I area is located in the posterior third of the gyrus frontalis inferior over the frontal lobe, and controls groups of muscles for speech and phonation. Speech I area corresponds to Broca’s speech area of the frontal lobe, which controls the muscles of the tongue and mouth that form speech. Speech I area overlaps the lower 2/5 40% of the motor area (see Fig. 19-4). The major indication for Speech I is in the presence of motor aphasia after stroke or brain injury, where the muscles of speech and vocalization have been paralyzed. This area is needled bilaterally for motor aphasia. The direction of needling is usually from the upper part of the area downward, penetrating the entire area.

Speech II Area

This area lies over the reading and comprehension part of the parietal lobe, and is located by finding the parietal tubercle. From the parietal tubercle, run a line parallel to the anterior-posterior line 2 cm posteriorly. Using this as the starting point, the Speech II area runs 3 cm in length, parallel to the anterior-posterior line (see Fig. 19-4). This area is used bilaterally for nominal aphasia—the inability to name objects. In this disorder, the patient can describe an object, but cannot produce the noun. The direction of needling is usually from the upper part of the area downward.

Speech III Area

This overlies Wernicke’s area of the temporal lobe, and overlaps the posterior half of the vertigo and hearing area. It lies on the same horizontal line 1.5 cm superior to the apex of the auricle but begins at the midpoint of the vertigo and hearing area directly above the auricle and runs 4 cm posteriorly (see Fig. 19-4). It is used bilaterally for treatment of expressive aphasia, where the patient can articulate words, but the words don’t make sense. The direction of needling can go either from the left part to the right or from right to left side, penetrating the entire area.

Praxis Area

This is an area used uncommonly. Starting from the parietal tubercle, the praxis area joins three lines, one running straight downward, and the other two at a 40-degree angle anterior and posterior to the vertical line (see Fig. 19-4). This area is used for apraxia—the inability to execute certain fine motor activities such as buttoning a shirt.

Vision Area

The vision area is located over the occipital lobe on the posterior aspect of the head. It starts on a horizontal line at the level of the occipital protuberance. The vision area starts at a point 1 cm lateral to the occipital protuberance and runs upward for 4 cm, parallel to the anterior-posterior line (Fig. 19-5). The vision area is often needled bilaterally. Unlike other scalp areas in Chinese acupuncture, the vision area must be needled from the top down. Needling from below upward incorrectly has the risk for causing injury to the medulla. Indications for needling are vision loss due to stroke or brain injury, visual field loss, visual hallucination, and nystagmus.

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Figure 19-5 Stimulation area, back view.

(Courtesy Jason Jishun Hao.)

Balance Area

The balance area is located over the cerebellum. It starts on a horizontal line at the level of the occipital protuberance. The balance area starts from a point 3.5 cm lateral to the occipital protuberance and runs 4 cm inferiorly (see Fig. 19-5).

Both the vision and balance areas are needled bilaterally. These are the only areas that must be needled from the top down. Indications for needling the balance area are disequilibrium, cerebellar atrophy, cerebellar strokes, multiple sclerosis, Parkinson’s disease, ataxia, and loss of balance due to traumatic brain injury.

Foot Motor and Sensory Area (FMSA)

The foot motor and sensory area is the most commonly used one in Chinese scalp acupuncture. It has broad-ranging effects on both motor and sensory functions. The FMSA is located parallel to the anterior-posterior line, 1 cm lateral to the midline beginning at the level of the midpoint of anterior-posterior line and running 4 cm posteriorly (Fig. 19-6). The foot motor and sensory area gets its name from including both the motor area and the sensory area in the region of the foot on the homunculus.

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Figure 19-6 Stimulation area, top view.

(Courtesy Jason Jishun Hao.)

Although it is useful for motor and sensory problems of the feet, the foot motor and sensory area has a much broader effect and is used for a wide-ranging collection of symptoms. Because the area overlies many endocrine glands, such as the pituitary gland and adrenal gland, it not only affects the central nervous system but also regulates the endocrine system. That is why the FMSA can treat many kinds of different disorders. The foot motor and sensory area is usually needled bilaterally, either from the front part of the area to the back part or vice versa. However, it is relatively easier if the direction is from front to back.

Indications for needling the foot motor and sensory area are: paralysis of the leg or foot, restless leg syndrome, pain in legs and feet including gout, neuropathy, plantar fasciitis, reflex sympathetic dystrophy or complex regional pain, fibromyalgia, phantom pain, residual limb pain, numbness and tingling in legs and feet, pain in the neck and shoulders, incontinence of urine, bedwetting, incontinence of stool, irritable bowel syndrome, impotence, premature ejaculation, decreased libido, infertility, prolapse of the uterus, amenorrhea, dysmenorrhea, abnormal uterine bleeding, psoriasis, neurodermatitis, shingles, attention deficit hyperactivity disorder (ADHD), posttraumatic stress disorder, postconcussion syndrome, poor memory, poor concentration, emotional disturbances, and mental retardation. Avoid needling the Foot Motor and sensory area in pregnancy because there is a theoretical risk of inducing uterine contractions.

Internal Organ Areas

The internal organ areas are located on the front of the head. The location of internal areas is based on clinical experience versus anatomy and physiology as known in Western medicine. These scalp areas are not used often because traditional body acupuncture produces excellent results.

Head Area

The head area is located on the midline at the forehead, running from the hairline 2 cm superiorly and inferiorly (Fig. 19-7). This area is used for treating mental and emotional disorders, such as insomnia, poor memory, poor concentration, anxiety, and depression.

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Figure 19-7 Stimulation area, front view.

(Courtesy Jason Jishun Hao.)

Thoracic Cavity Area

This is located half the distance between the stomach area and the midline, running from the hairline 2 cm superiorly and inferiorly (See Fig. 19-7). This area is used for treating asthma or tachycardia.

Stomach Area

This is located on the midpupillary line from the hairline 2 cm superiorly (see Fig. 19-7). This area is used for treating stomach pain and discomfort in the upper epigastric region.

Liver and Gallbladder Area

The liver and gallbladder line descends onto the forehead for 2 cm along the midpupillary line (see Fig. 19-7). This area is used for treating costal pain and rib pain due to hepatitis, gallstone, and shingles.

Reproductive Area

This area starts at the frontal corner of the hairline, running 2 cm superiorly (see Fig. 19-7). It is useful for treating menstrual cramps, bleeding, and urinary tract infections.

Large Intestine Area

This descends onto the forehead for 2 cm along the reproductive line (see Fig. 19-7). The area can be used in cases of diarrhea or constipation.

Needle Techniques

Insertion of the Needle

The needle should be inserted by using the free hand technique instead of a guide tube, which is a popular insertion technique in the West. This is because of the special anatomy of the scalp consisting of five layers: skin, connective tissue, aponeurosis, loose areolar tissue, and pericranium. In Chinese scalp acupuncture, a 30 to 36 gauge stainless steel acupuncture needle with a length of 1.5 inches is placed in the loose areolar tissue layer beneath the aponeurosis and above the pericranium. To place the needle correctly, hold the needle with the nondominant hand. Place the tip at a 15 to 25-degree angle to the skin. Use the dominant hand to quickly pierce the skin and thread the needle through the loose areolar tissue layer for the entire length of the needle, 1 to 2 inches deep.

The proper angle, depth, and speed of inserting needles reduces sensations of pain and discomfort significantly. While the needle penetrates the skin, the practitioner’s fingers will have a sense of slight tightness at first. When the needle reaches the loose areolar layer, the practitioner’s fingers will feel the tightness disappear or reduce. Once the layer becomes looser, the needle will smoothly push deeper, with little or no resistance. At this time, push the needle to the designed depth as quickly as possible. It only takes 1 to 2 seconds for an experienced practitioner.

Manipulation

Once the needle is in the correct position, the needle is stimulated with manual manipulation. Grasp the handle of the needle between the thumb and the distal interphalangeal joint of the index finger. By moving the index finger and keeping the thumb stationary, you can twirl the needle at a rate of 200 to 400 times per minute. Rotate clockwise and counter-clockwise with amplitude ranging from 360 to 720 degrees. In other words, make 1 to 2 turns in each direction. Rotate needles every ten minutes for 2 to 3 minutes.

Electronic stimulation may be used to replace hand stimulation. It can strengthen the stimulation and improve the therapeutic effect for the novice who cannot rotate needles at the minimum of 200 times per minute. If this method is chosen, a pair of needles is connected to the electronic stimulator. For scalp acupuncture the negative lead form the stimulating device is connected to the secondary area, and the positive lead is connected to the primary stimulating area on the scalp. The recommended frequency is in the 3 to 4 Hz range—approximately equal to 200 times per minute. The ideal intensity should be at the level that the patient can feel without causing any pain. The duration of the electrical stimulation is ten to twenty minutes.

Timing and Frequency of Treatment

The needles are stimulated for approximately 2 minutes and restimulated at 10-minute intervals over the course of treatment. Most treatments of scalp acupuncture last 30 to 45 minutes. In China and other Asian countries, patients are usually treated every day if they are in the hospital. Cost of acupuncture in Asia is inexpensive compared to Western countries and it is very convenient for acupuncture treatments when patients are in hospital. According to the authors’ experience, two or three treatments per week are cost efficient and effective for patients who are not hospitalized; these patients can recover as quickly as if they are treated every day.

Withdrawing the Needle

Needle removal is accomplished with one swift motion by pressing down the hair around the needle with one hand. Meanwhile, hold the needle between the thumb and index finger of the other hand. Rotate the needle gently to make sure it is loose, then withdraw it quickly. After that, press the needling area with a dry cotton ball for a short while to prevent bleeding. Because of the scalp’s rich blood supply, the needled sites bleed more frequently on removal of the needle than at other body sites. It is therefore important to press the needled site a little longer and recheck it after removing the cotton ball.

Contraindication and Precaution

It is inadvisable to apply scalp acupuncture on any scalp area where there is infection, ulcer, tumor, or postoperative skull defect. Also it is inadvisable to treat an infant whose fontanel has not yet closed. The same contraindications hold as for other acupuncture. Do not use scalp acupuncture on patients with a tendency to hemorrhage, or on those with severe hypertension, high fever, or an acute stage of cerebral hemorrhage.

Clinical Applications and Case Studies

As mentioned earlier, scalp acupuncture is highly effective for managing many types of pain, based on 37 years of experience and studies in China, as well as the authors’ own 27 years of practice. This section will present those disorders that have outstanding results from treatment by scalp acupuncture.

Phantom Limb Pain, Residual Limb Pain, and Complex Regional Pain

Phantom limb pain, residual limb pain, and complex regional pain are common symptoms for patients with limb injuries and/or amputations. Several studies have shown that approximately 70% to 80% of patients develop pain within the first few days after amputation. Phantom limb pain is the term for abnormal sensation perceived from a previously amputated limb.7 Patients may feel a variety of sensations emanating from the absent limb. The limb may feel completely intact despite its absence. Patients often describe their pain as burning, squeezing, cramping, prickling, shooting, or stabbing sensations. Residual limb pain is believed to come from injured nerves at the amputation site. Residual limb pain is often associated with phantom limb sensation and pain, and may be related in etiology. Complex regional pain is a “chronic pain syndrome with severe pain, changes in the nails, bones, skin, and an increased sensitivity to touch in the affected limb.” The former term for this was reflex sympathetic dystrophy.

Several theories have been proposed regarding the cause of phantom limb pain. An understanding of the mechanisms underlying phantom pain is likely to lead to new and logical types of treatments. Some studies have indicated that phantom pain might originate in the brain. Other areas of the brain fill in when the area of the brain that controlled the limb no longer has a function after amputation. There is a reorganization of the primary sensory cortex, subcortex, and thalamus after amputation. The reorganization of the sensory cortex is currently considered to be responsible for phantom limb pain.

Conventional medicine has provided limited help in alleviating these types of pains. Acupuncture, on the other hand, is becoming a more popular method of treatment for acute and chronic pain. It ranks high among nonmedical treatments such as transcutaneous electrical nerve stimulation, vibration therapy, biofeedback, hypnosis, massage, physical therapy, and electroconvulsive therapy.

Scalp acupuncture has been proved to be the most effective technique for treating central nervous system damage. This treatment is indicated when there is phantom limb pain, residual limb pain, complex regional limb pain, postconcussion syndrome, or posttraumatic stress disorder. In these cases, scalp acupuncture is superior to needling on the body, ear, or hand.

The areas recommended for scalp acupuncture are: sensory, leg motor and sensory, tremor, and motor area. The foot motor and sensory areas are the primary locations to treat limb pain. The sensory area is an important treatment location. The Upper one-fifth of the sensory area is unilaterally selected to treat opposing leg and foot pain. The Middle two-fifths of the sensory area is unilaterally selected to treat opposing arm and hand pain. The Lower two-fifths of the sensory area is bilaterally selected to treat facial and ear pain. Tremor areas are classified as secondary locations to treat limb pain and are bilaterally selected to treat spasm pain on either or both sides. Proper manipulation techniques are crucial to obtaining the desired results. The needles are usually retained for 30 to 45 minutes with stimulation every 1 to 2 minutes using a rotational technique every 10 minutes. The patients are often treated two to three times a week, depending on the degree of pain.

Although there are certainly other acupuncture techniques, such as on the ear and body, scalp acupuncture is a more effective method; it results in more rapid and often immediate pain relief. Scalp acupuncture was applied to treat seven patients with limb pain at Walter Reed Army Medical Center in Washington, D.C. on February 11 and 12, 2006. After only one treatment for each patient, three of seven patients instantly felt pain relief and showed significant improvement, three patients showed some improvement, and only one patient showed no improvement. The subsequent cases are from treatments at Walter Reed Army Medical Center.

Case Report 1—Phantom Pain

Several months after both legs were amputated, the patient still felt severe phantom pain. Various types of medication provided little relief. The pain interrupted his sleep and caused loss of emotional control. The patient described severe painful tingling sensations in both his feet, with his right foot more painful than the left. As soon as he underwent scalp acupuncture treatment, the patient started to feel heat sensations in both his legs, followed by a tingling almost like an electrical sensation in his toes. Five minutes later, his phantom pain diminished considerably. After ten minutes passed, his phantom pain had completely disappeared. The patient was worried that the pain might recur after the needles in his scalp were removed. He insisted on sitting in the room for a period after he finished the treatment. He was happy to leave the treatment room without any phantom pain 2 hours after his first scalp acupuncture treatment.

Case Report 2—Residual Limb Pain

This patient experienced severe residual limb pain in his right stump immediately after surgery 5 months previously. He described the chronic pain like the presence of “a wire tight up his leg” with spasms that resulted in an intolerable state of pain. Scalp acupuncture was applied at the foot motor and sensory area, and Upper one-fifth sensory area. Fifteen minutes after four needles were inserted in his scalp, followed by stimulation of the needles by the clinician, the patient felt a numb and tingling sensation in his leg. After this, the sensation of tightness in the leg began to lessen. After 5 more minutes, the tight leg spasm and pain were nearly gone.

Case Report 3—Complex Regional Pain

After being shot twice in each leg during a battle in Iraq, this patient suffered from severe complex regional pain in his right leg. His right leg and foot were so sensitive that even the lightest touch or contact from a thin blanket or a sock would induce pain so severe that the patient could hardly tolerate it. The patient lost his ability to stand and walk because of sensitivity of the right foot.

As soon as the needles were inserted in his scalp, the patient experienced a “water bubble-like sensation.” First the sensation moved from his right hip to his leg, then to his foot and toes. Five to eight minutes later, his leg and foot pain started to diminish and he was able to make contact with his leg and toes with little discomfort. The patient was so excited to feel the results that he continued to touch his leg and toes to verify that they really were better. He was asked to try to put a sock on his right foot and he did so without showing pain or discomfort. The patient then proceeded to take a short nap. At the follow-up visit the next day, the patient was lying on the bed with both socks on. He had very little pain and was much less sensitive than before. He was able to walk with almost no pain after four needles were placed in his scalp. Each step he took brought on applause from observers.8

Although few scientific investigations have directly assessed the efficacy of scalp acupuncture treatment in limb pain, this study at Walter Reed Hospital, showed that the patients instantly felt effectiveness with only one treatment. Scalp acupuncture treatment for pain relief is accessible and safe; it is less expensive than pain medications and has fewer side effects. In the future, it would be helpful to conduct controlled studies of effectiveness of such treatment. Scalp acupuncture not only benefits patients with limb pain, but also significantly contributes to our understanding of phantom pain. Scalp acupuncture may help investigators to discover the mechanisms of phantom limb and residual limb pain and could lead to the discovery of further advancements in pain management.

Stroke

Stroke is the third leading cause of death in the United States, after heart attack and cancer, and it is a leading cause of adult disability. Stroke patients must receive emergency treatment with Western medicine. It is important to identify a stroke condition as early as possible because patients who are treated earlier are more likely to survive and become less disabled.

Stroke survivors usually have some degree of sequelae of symptoms depending primarily on the location in the brain involved and the amount of brain tissue damaged. Disability affects about 75% of stroke survivors, and it can affect patients physically, mentally, emotionally, or a combination of all three elements. The symptoms of stroke depend on the type of stroke and the area of the brain affected. They include paralysis, weakness or abnormal sensations in limbs or face, complex regional pain, aphasia, apraxia, altered vision, problems with hearing, taste, or smell, vertigo, disequilibrium, altered coordination, difficulty swallowing, and mental and emotional changes.

Because each side of the brain controls the opposite side of the body, a stroke affecting one side of the brain results in neurologic symptoms on the other side of the body. For example, if the stroke occurs in the motor area of the right side of the brain, the left side of the body may show weakness or paralysis. Although there is no cure for stroke, most stroke patients now have a good chance for survival and recovery. When stroke patients pass the acute stage, they should start rehabilitation as soon as possible. Stroke rehabilitation is the process by which patients undergo treatment to help them return to their normal life as much as possible by regaining and relearning the skills of everyday living such as speaking or walking. These treatments include acupuncture, physical therapy, occupational therapy, speech and language therapy, and massage.

Scalp acupuncture has been found to have a very good effect on the sequelae of stroke, including hemiplegia, aphasia, complex regional pain, and abnormal sensations in the limbs. Many patients treated with scalp acupuncture at our clinics have shown some immediate improvement from their initial scalp acupuncture treatment. Numerous studies in China over the past three decades have shown that scalp acupuncture is effective in relieving the sequelae of stroke, especially for paralysis. Thanks to advanced stroke research and brain imaging technology, physicians continue to gain a new understanding of how the brain can adapt after stroke to regain its ability to function. New research suggests that normal brain cells are highly adaptable and can undergo changes not only in function and shape but also changes that allow them to take over the functions of nearby damaged cells. As a result, scalp acupuncture is geared toward stimulating and restoring affected brain tissue or retraining unaffected brain tissue to compensate for the lost functions of damaged brain tissue.

In patients with paralysis or weakness of limbs, the scalp areas for motor, sensory, and speech functions should be treated. If paralysis is in the upper limb, the Upper one-fifth of the motor area should be chosen; if in the leg and foot, the Middle two-fifths of the motor area should be the choice; and if in the face, the Lower two-fifths of the motor area should be selected. If there is reflex sympathetic dystrophy, tingling, numbness, or other abnormal sensations in the leg and foot, arm and hand, or face, use the Upper one-fifth sensory area, Middle two-fifths sensory area, and Lower two-fifths sensory area, respectively. The chosen insertion area should be the opposite of the affected limb. For example, if there is paralysis in the right arm, the left Middle two-fifths motor area should be selected. Speech I area is effective for patients with expressive aphasia; speech II area is for nominal aphasia; and speech III is for receptive aphasia. Rotate needles at least 200 times per minute with thumb and index finger for 1 to 3 minutes. The doctor should twirl the needle as vigorously as the patient can tolerate; and have the patient move the affected limb actively and passively. Repeat the stimulation every 10 minutes. During the treatment, patients may have some or all of the following sensations: hot, cold, tingling, numbness, heaviness, distention, or sensations of water or electricity moving down the affected limb. Those patients usually respond and show improvement more quickly. However, those who do not have such sensations could still have immediate positive results. Keep the needles in for 30 to 45 minutes. The patient is given two to three treatments per week, and a therapeutic course consists of 10 treatments.

There are many different acupuncture techniques to treat paralysis. Although scalp acupuncture has the fastest response, other techniques are necessary for a fuller recovery. According to the individual’s condition, recovery time can be accelerated by combining scalp acupuncture with regular body acupuncture, electric acupuncture, and moxibustion (a traditional Chinese medicine technique that involves the burning of mugwort, a small, spongy herb, to facilitate healing), as well as physical therapy and massage. Regular acupuncture treatment has been found to have a positive therapeutic effect on the recovery of movement of hands, fingers, feet, and toes. In treating unilateral paralysis of the limbs, tradition says to select more points from Yang Ming channels because Yang corresponds to movement and agility, and Foot Yang Ming/stomach controls the functions of the muscles. Commonly used points are LI-4, TW-5, LI-11, LI-14, and LI-15 for upper limb paralysis; and UB-60, UB-57, GB-34, ST-36, and GB-30 for lower limb paralysis. Although more Yang Ming points are used for paralysis, points from Yin channels, especially Taiyin and Jueying channels, should not be ignored. Yin corresponds to nourishing muscles and tendons; and those points from Yin channels have positive results for pronounced stiffness and contraction of the limbs. Commonly used points are Lu-5 and P-6 for upper limb and Sp-6, Sp-9, Sp-10, and Li-8 for lower limb.

Electrical stimulation is helpful if the practitioner has difficulty performing the rotation of the needle more than 200 times per minute. It is suggested that only two of the scalp needles be stimulated at any one session, or the brain can become too confused to respond. For electrical stimulation in body acupuncture, fewer than four needles should be stimulated in each limb. Best results are achieved when applying low frequency with high intensity. Moxibustion can enhance the therapeutic results of scalp acupuncture, especially for older or weaker patients. The practitioner should consider scalp acupuncture as the primary approach, rather than a complementary approach to the patient with paralysis.

Case Report 4—Stroke

Maria, a 69-year-old female, was waiting at her home for a scalp acupuncture treatment. Maria was partially paralyzed on her left side after her first stroke 6 years ago. She had a second stroke 3 years later, and she now suffered from aphasia. Her daughter reported that the entire left side of her body was completely paralyzed; and that she had severe spasms and pain in her left arm and leg that caused her enough agony to scream frequently. After her second stroke, Maria had twenty body acupuncture treatments that resulted in little response or improvement. On examination, the patient’s mind was clear when responding to the questionnaire. Although she could make sounds in response to questions, her speech was unintelligible. Maria’s left limbs showed no positive movements at all. They were very stiff and tight, and she could hardly be moved by another person. Her tongue was red with a little coating, and her pulse was wiry and thready.

Maria had a positive response to her first scalp acupuncture treatment. After the needles were inserted in her scalp, the spasms, stiffness, and tightness in her left arm and leg showed immediate improvement. Her left limbs became looser, and her daughter was able to move Maria’s leg and arm up and down with little resistance. Maria’s eyes were full of tears as she answered questions with a clear and strong voice. She said, “Thank you so much doctor. I am so glad that I can now speak very clearly again.” Several minutes later, Maria was able to move her left leg and her left arm by herself. She was able to pull and push her left leg so strongly that the doctor was encouraged to ask her if she would like to try walking. She did not hesitate and said with a clear voice, “Yes. I would like to try.” While she was walking back and forth in her room exercising her leg with the assistant helping, she kept saying, “Thank you, thank you so much for this miracle.” In this case, the hemiplegia was caused by cerebral hemorrhage, which has the worst prognosis for the sequelae of stroke, compared to cerebral embolism and cerebral thrombosis. After cerebral hemorrhage, the patient should get acupuncture treatment as soon as his or her condition is stable. The earlier the patient gets treatment, the better the prognosis will be.

Fibromyalgia

Fibromyalgia is a chronic disorder characterized by diffuse or specific pain in muscles, ligaments, tendons, joints, or bone. Also, patients experience multiple tender points and fatigue. Fibromyalgia affects more females than males. Symptoms and signs can vary depending on stress, physical activity, weather changes, or even the time of day. Common symptoms and signs include widespread pain and stiffness, fatigue and sleep disturbances, heightened sensitivity of the skin, headache and facial pain, irritable bowel syndrome, weakness of limbs, muscle spasms, and impaired concentration and short-term memory.9 The degree of symptoms may also vary greatly from day to day with periods of flare-ups or remissions.

Fibromyalgia often starts as a result of some mental or physical trauma, major surgery, or disease. Symptoms are often aggravated by unrelated illness or changes in the weather. The cause of fibromyalgia is still unknown. One theory states that patients with fibromyalgia have a lower threshold for pain because of increased sensitivity in the brain to pain signals. Other theories include abnormalities of the autonomic nervous system, changes in muscle metabolism, injury, infection, psychological stress, or hormonal changes. There is no universal cure for fibromyalgia in Western medicine. In general, treatment emphasizes minimizing the symptoms and improving general health.

Scalp acupuncture has a very good track record for treating fibromyalgia. Many patients have shown significant improvements with just a few treatments in our practice. Effective areas for fibromyalgia are sensory, tremor, foot motor and sensory, and head area. For both the sensory area and tremor area, needles should be inserted bilaterally. The practitioner should choose secondary areas based on symptoms in Western medicine and patterns in Chinese medicine.

A good technique is to put one needle on the Shenmen point on the ear to help patients relax and reduce the sensitivity of the needle insertion and stimulation of the scalp. Use as few needles as possible in the scalp, and rotate them at least 200 times per minute with thumb and index finger for two minutes. The doctor should twirl the needles as gently as possible in the beginning so that the patient can tolerate the intense sensations, and then gradually increase the intensity of the stimulation. Repeat stimulation every 10 minutes.

During treatment, patients may have some or all of the following sensations: hot, cold, tingling, numbness, heaviness, distention, or the sensation of water or electricity moving along their spine, legs, or arms. Tell patients before the needles are inserted that these sensations are normal, and patients who experience some or all of them usually respond and improve more quickly. This lends encouragement to patients to come back for additional treatments; however, it is important to also convey to patients that if they do not have such sensations, they could still have immediate, positive results. Retain the needles in place for 25 to 30 minutes. Initially, treatment should be given two to three times per week. After a few weeks, it can be spaced out to once a week and then twice a month. The patient should be treated about once a month thereafter, if a remarkable improvement is obtained. A therapeutic course consists of 10 treatments.

It is very helpful if other acupuncture methods are added to scalp acupuncture treatments as adjunct therapies. The selection of body acupuncture points should be individualized based on the differentiation of patterns in Chinese medicine. For instance, Li-3, GB-34, and Li-14 are used for liver stagnation Qi, and Ki-3, Ki-6, and Ki-7 for deficiency of the kidneys. Cupping is another valuable method for patients with fibromyalgia. The area for cupping is around the gallbladder meridians because pains that patients with fibromyalgia normally have are located on the area that GB energy is distributed. The most frequently used points on the gallbladder meridians are GB-20, GB-21, GB-30, GB-31, GB-34, and GB-41. In late stages of fibromyalgia, the kidneys are often affected. Therefore, the points to reinforce the kidney are usually very helpful, such as Ki-3, UB-23, and GV-4.

In addition, fibromyalgia often becomes worse with stress: it may be physical, emotional, or psychological. Therefore, the internal organ areas in scalp acupuncture that function to relieve anxiety, irritability, worry, or depression should be combined with the foot motor and sensory area for the best results.

Case Report 5—Fibromyalgia

Judy, a 48-year-old female came to our clinic in Santa Fe, New Mexico in the summer 2002. Judy was diagnosed with fibromyalgia in 1998. Previously, she had been a physically active young woman. She participated in many exercises and sports, such as aerobics, skiing, jogging, and hiking. For the last 10 years, these activities had to stop because the pain in her neck and back made simple tasks such as washing the dishes nearly unbearable, much less exercise. Her legs hurt so severely that even walking a short distance left her in tears. Every morning when she woke up, her neck was so stiff and painful that it was impossible for her to turn her head. The pain became progressively worse and spread through other areas of her body. She began to gain weight and feel depressed. She started to have more discomfort including insomnia, fatigue, mood swings, poor memory and concentration, and either diarrhea or constipation. Her immune system was so weak that she caught flu or colds frequently. Although she received many kinds of therapy, Judy showed little improvement. Some physicians seemed to be tired of hearing her time-consuming complaints. Examination showed that she had a red tongue with a thick white coating and teeth-marks, and her pulses were thready and wiry.

Judy had a different experience during her first scalp acupuncture treatment. She felt her body totally relax and fell deeply asleep just a few minutes after the needles were inserted in her scalp. She felt completely at ease when she woke up and said as she was leaving, “I am looking forward to my next treatment.” After only six treatments, her pain and stiffness were reduced by about 70%. She woke up renewed instead of feeling as if she had not slept at all. She also no longer felt the searing pain in her neck, back, and legs that used to bring her to tears regularly. By the tenth treatment, Judy had achieved significant improvement over insomnia and fatigue. She was thrilled to start exercising again and hoped to resume many of the physical activities she had once loved. She told friends, “I cannot find the words to describe how much scalp acupuncture has changed my life.”

Before scalp acupuncture, Judy had lost all hope of ever having her old health back, but after 20 treatments, Judy hardly experienced any pain . She had lower back pain occasionally but it was manageable; and receiving scalp acupuncture treatments every 4 to 6 weeks kept the pain under control. She said she was also glad to be able to live without painkillers anymore, and did not need to rely on drugs just to get through the day. In addition to pain relief, Judy reported that her immune system was stronger than ever, and she rarely suffered from colds or flu since receiving scalp acupuncture treatments.

Restless Legs Syndrome

Restless legs syndrome is a neurologic movement disorder characterized by abnormal sensations in the legs, and an uncontrollable urge to move them to relieve these unpleasant feelings. The sensations are often described as antsy, electrical creeping, itching, pins and needles, pulling, tugging, painful, or like insects were crawling inside the legs.

The abnormal sensations and urge to move can occur in any part of the body; however, the most cited location is the legs. Any inactivity such as lying down or sitting can trigger those sensations and the subsequent urge to move. Movement usually brings immediate relief but it is often only temporary and partial. Most patients find that the symptoms are less noticeable during the day and more pronounced in the evening or night. The exact cause of restless legs syndrome is still unknown. Generally, it is a lifelong condition for which there is no cure in Western medicine.

Scalp acupuncture has positive results with restless legs syndrome, and it usually produces immediate beneficial responses in the initial treatment. Significant and complete reduction of restless legs syndrome has occurred in approximately 85% of people receiving scalp acupuncture in our clinics. Although the norm has been that symptoms gradually disappear with each treatment, it is not uncommon for some patients to experience the symptoms worsening during their treatments. If restless legs are not well controlled by scalp acupuncture alone, patients may experience better results when combining treatment with body acupuncture. Commonly used points are Li-3, GB-34, Sp-6, and UB-18. However, for patients with severe restless legs, it is not advisable to use body points in their legs. If patients constantly move their legs while needles are inserted, this could cause severe leg pain and muscle spasm.

The effective locations to insert needles for restless legs syndrome are foot motor and sensory area, tremor area, and Upper one-fifth sensory area. Foot motor and sensory and tremor areas should be inserted with needles and stimulated unilaterally. Rotate the needles at least 200 times per minute with thumb and index finger for 1 to 3 minutes. The doctor should twirl the needles as vigorously as the patient can tolerate and repeat this stimulation every ten minutes. During the treatment, some patients may feel their restless legs becoming relaxed and feel less of an urge to move them. Or some patients may experience their tremors becoming a little more severe. Those patients with some or all of these sensations usually respond and improve more quickly. However, those who do not have such sensations could still have immediate positive results. Retain the needles for 25 to 30 minutes; the treatment is given two to three times per week; and a therapeutic course consists of 10 treatments.

Case Report 6— Restless Legs Syndrome

Sue, a 72-year-old female, was referred to our clinic in Albuquerque, New Mexico by her primary care physician. She had suffered from restless legs syndrome for more than 15 years. Because Sue felt her legs creeping and burning, she could not keep them still during the day or night. Her restless legs became even more pronounced at night to the point that she had to move around constantly to diminish her discomfort. She had difficulty falling asleep and staying asleep, resulting in severe fatigue and exhaustion. Her condition also caused depression, poor appetite, and constipation. She had a red tongue with a thin yellowish coating; and her pulses were thready and wiry.

Sue was very calm as the doctor inserted four needles in her scalp. A few minutes after treatment began, she told the doctor that there was a warm sensation moving from her head down to her legs. After that, she was able to relax her legs and keep them still, which she had not been able to do for years. The abnormal sensations in her legs also showed some improvement, and she was able to tolerate these feelings. She was amazed to find that her legs stayed still for the entire 30 minutes of treatment, which she never could have done without scalp acupuncture.

At the second treatment, Sue said she had hardly needed to get up the past several nights. She did not have to walk around at night to ease the strange sensations in her legs since the first treatment. She also stated that her sleep was better, she had more energy, and the depression was gradually improving as well. Her poor appetite and constipation were unchanged, however. Needles were inserted in stomach areas as well as other scalp areas during her second treatment. By the third treatment, Sue said, “I can sleep through the night now because my legs do not bother me anymore.” By the sixth treatment, Sue was very happy to report that she had not had any restless legs symptoms for several weeks, and her appetite and bowels had returned to normal. Sue was now sleeping well, and she was joyful that she had a lot more energy. Examination showed that her tongue had become light red with a thin white coating, and her pulses had changed to soft. She did not need further acupuncture and started to really enjoy her senior years.

Multiple Sclerosis

Multiple sclerosis (MS) is a progressive disease of the central nervous system in which communication between the brain and other parts of the body is disrupted. There are multiple scars on the myelin sheaths, which comprise a fatty layer surrounding and protecting the neurons of the brain and spinal cord. Myelin allows for the smooth, high-speed transmission of electrochemical messages between the brain, the spinal cord, and the rest of the body. When myelin is destroyed or damaged, the ability of the nerves to conduct electrical impulses to and from the brain is disrupted, which causes the various symptoms of MS. Approximately 300,000 people in the United States and 2.5 million people worldwide suffer from MS. It primarily affects adults, with age of onset typically between 20 and 40 years, and is twice as common in women than in men. The effects of MS can range from relatively benign in most cases to various degrees of disability. However, the symptoms for some are devastating. Symptoms and signs of MS vary widely depending on the location of the affected myelin sheaths. Common symptoms may include numbness, tingling or weakness in one or more limbs, partial or complete loss of vision, double or blurring of vision, tremor, loss of balance and mobility, unsteady gait, fatigue, and dizziness. Some patients also might develop muscle stiffness or spasticity, paralysis, slurred speech, dysfunction of bladder or bowel, depression, and cognitive impairment. MS is unpredictable and varies in severity. In some patients it is a mild illness, but it can lead to permanent disability in others. In the worst cases, patients with MS may be unable to write, speak, or walk.

MS can occur either in discrete attacks or slowly over time. Although the functioning of systems may resolve completely between episodes, permanent neurologic problems usually persist, especially as the disease progresses. Many risk factors for MS have been identified, but no definitive cause has been found. Currently, MS does not have a cure in terms of conventional treatments but a number of therapies can be used to treat the disease symptomatically.

Scalp acupuncture has been proved to have the most success in the treatment of MS and other central nervous system damage when compared to other acupuncture modalities including the ear, body, and hand. Scalp acupuncture not only can improve the symptoms, the patient’s quality of life, and slow the progression of physical disability, but also it can reduce the number of relapses. Scalp acupuncture treatment for MS has had much success in reducing numbness and pain, decreasing spasms, improving weakness and paralysis of limbs, and improving balance. Many patients also have reported that their bladder and bowel control, fatigue and overall sense of well-being significantly improved after treatment. Recent studies have shown that scalp acupuncture could be an effective modality in controlling MS. Scalp acupuncture often produces remarkable results after just a few needles are inserted.10 It usually relieves symptoms immediately, and sometimes it takes only several minutes to achieve remarkable results.

Scalp acupuncture areas may be chosen according to the patient’s particular symptoms. The primary acupuncture areas for patients with motor problems such as paralysis, weakness of limbs, or abnormal sensations in limbs, including tingling, numbness or pain, are the motor area and the sensory and foot-motor areas. Those areas should be inserted with needles and stimulated unilaterally or bilaterally, according to the patient’s manifestations. Select the balance area or dizziness area of the scalp, respectively, depending on which symptom the patient manifests. The tremor area of the head should be chosen if patients have limb spasm. Many patients had a quick positive response in controlling urine and bowel functions when the foot-motor and sensory areas are stimulated.

Rotate the needles at least 200 times per minute with the thumb and index finger for 1 to 3 minutes. The needles should be twirled as vigorously as the patient can tolerate and repeated every 10 minutes. During treatment, some patients may have some or all of the following sensations: hot, cold, tingling, numbness, heaviness or distention, or the sensation of water or electricity moving along the spine, legs, or arms. Those patients with some or all of these sensations usually respond and improve more quickly. However, those who do not have such sensations still could have immediate positive results. Keep the needles inserted for 30 to 45 minutes. The treatment should be administered two to three times per week and a therapeutic course consists of 10 treatments. There are many different acupuncture techniques to treat MS. Although scalp acupuncture has the fastest track record for improving symptoms, other techniques are also necessary for further improvement. Regular body acupuncture, electric acupuncture, and moxibustion, as well as physical therapy and massage, can combine with scalp acupuncture to speed the time of recovery.

Case Report 7—Burning and Stabbing Pain

A 52-year-old female received scalp acupuncture treatment at National Healthcare Center in Albuquerque, New Mexico. After the first symptoms occurred in January 2007, the patient was finally diagnosed with MS in in August of that year. Although various types of medications were provided, she experienced little improvement. The patient described severe burning and stabbing pain throughout her whole body that interrupted her sleep and caused loss of emotional control. She also had occipital headaches and loss of balance that made her unable to walk or turn around. The examination revealed that she could not stand still if her eyes were closed; and she could not turn around, stand on one leg, or walk from toe to heel. The movements of touching her nose and touching both index fingers together were accomplished slowly and only with great effort. Her tongue was red and somewhat purple, with a thin white coating. The pulse was wiry and thready.

As soon as she underwent scalp acupuncture treatment, she started to feel the sensations of energy moving down her lower back, followed by heat sensations in her feet. Three minutes later, the burning and stabbing pain diminished considerably. She felt only some of those sensations in her right hip and abdominal area. After 12 minutes had passed, the sensation of burning and stabbing in her entire body had disappeared almost completely, except for some mild sensations in her abdomen. The patient was so excited to feel such dramatic results that she could not wait to test her movements. She was very surprised to find that she had no problem standing with her eyes closed, standing on either leg with the other one raised, walking in a straight line, and turning around without loss of balance. Also, she could now touch her nose and touch her index fingers together like a normal person. By the end of the treatment, her occipital headache had disappeared as well. This patient was happy to tell other MS patients that she felt like a “normal” person physically and emotionally after only one scalp acupuncture treatment.

Case Report 8— Paralysis

A 55-year-old female in a wheelchair received scalp acupuncture treatment. After the first symptoms occurred in 1990, the patient finally was diagnosed with MS in 2002. Both of her legs had started to become weak and heavy in the 1990s. Within 3 years, she was almost paralyzed and finally could not walk at all. The examination revealed she could not stand up straight due to the weakness in her legs, and she was unable to lift her right foot, so she had to drag it behind her when walking. Her tongue was red with a thin white coating; and her pulses were thready and wiry, with weak pulses in the kidney positions.

After four needles were inserted in her scalp, the patient experienced some tingling and electrical sensations in both of her legs. Five minutes later, she felt the urge to move both legs. After exercising her legs by bending and extending them, she was able to stand up straight and walk, free to lift both her feet almost normally. Although it took a lot of effort, she was amazed to be able to walk. At first she needed two people to assist her, then only one person, and finally she was able to walk by herself.

Case Report 9—Dizziness and Vertigo

A 60-year-old female received scalp acupuncture treatment. After the first symptoms occurred at age 20, the patient was finally diagnosed with MS in 1994. Her major symptoms were dizziness and vertigo accompanied by temple headaches that gradually became worse over the next 7 years. Sometimes her vertigo was so severe that she felt as if the whole room was spinning violently, which caused her to fall down easily even when she was just standing. Her quality of life was completely diminished and she had to spend whole days flat on her back with her eyes closed to avoid any movement of her head. The onset of dizziness and vertigo were exacerbated whenever she changed her position in bed or even slightly moved her head.

A few years before, the patient had received more than 15 acupuncture treatments from various doctors but experienced little improvement. On examination, it was found that her tongue was red with a thick white coating and she had wiry and thready pulses. After two needles were inserted in each temple, the patient reported that she felt some weird sensations in her head that she did not know how to describe. As the doctor stimulated the needles in her head, she was able to explain that it felt like a curtain in front of her eyes had opened. These sensations made her mind clear and her temple headache disappeared. Soon after, her vertigo and dizziness diminished significantly. She moved her head upward, downward, to the left and to the right, testing whether her dizziness and vertigo really were gone. Finally, she announced, “I believe I do not have any dizziness and vertigo anymore. And this was only my first scalp acupuncture treatment!”

Although MS still is an incurable disease of the central nervous system, scalp acupuncture provides an important alternative treatment approach for improving many MS symptoms and the patient’s quality of life. It slows or reverses the progression of physical disability and reduces the number of relapses. By directly stimulating affected areas of the central nervous system, scalp acupuncture has shown more effective results compared to other acupuncture techniques. Our treatments showed that many patients had instant improvements after only one scalp acupuncture treatment. The treatments also demonstrated that scalp acupuncture for MS is accessible and safe; it appears to be effective with few side effects. Scalp acupuncture not only benefits patients with MS, but also significantly helps us to better understand the mechanisms that cause the condition. It may guide us to the discovery of new effective treatments and hopefully to a cure for this disease.

Conclusion

Chinese Scalp Acupuncture has been proved to be effective, safe, and inexpensive for central nervous system disorders. This is based on 37 years of empirical evidence and study in China. Many more people in the United States are seeking acupuncture treatment to alleviate their pain. Therefore, it is increasingly helpful for acupuncturists, physician acupuncturists, and Doctors of Oriental Medicine to have a working understanding of scalp acupuncture and its clinical application. Although there have been many hypotheses and research reports on scalp acupuncture for rehabilitation of paralysis and pain management in the Western medical literature over the past 38 years, there is still a long way to go in uncovering the mystery of the mechanisms of scalp acupuncture.

Drs. Jason Jishun Hao and Linda Lingzhi Hao have been teaching, researching, and practicing scalp acupuncture for 28 years. They studied with and were tutored by many famous professors, including Jiao Shunfa, the founder of scalp acupuncture, Shun Shentian and Yu Zhishun—all outstanding professors and researchers on scalp acupuncture in China for many years. Their successful cases of using scalp acupuncture have been reported in several newspapers and journals including “Stripe” published by Walter Reed Army Medical Center, “The New Mexican,” “Albuquerque Journal,” “Acupuncture Today,” “China News of Traditional Chinese Medicine,” and “Alternative Therapist.”

The authors hope that acupuncture practitioners, teachers, and students will benefit from the knowledge and experience imparted in this chapter. It is intended to serve as the basis for further teaching, practice, and research. For more detailed information on scalp acupuncture please see the authors’ new book, Chinese Scalp Acupuncture, that will be published on November 2011 by Blue Poppy Press in Boulder, Colorado. They can be contacted by visiting their website www.scalpacumaster.com or call their clinic in Albuquerque, New Mexico at 505-822-9878.

References

1. Jiao Shunfa. Head Acupuncture. Bejiing: Forign Languages Press; 1993. 17-22

2. Frank Lampe, Suzanne Snyder, Jason Hao. “DOM: Pioneering The Use of Scalp Acupuncture to Transform Healing”. Alternative Therapies. MAR/APR. 2009;15(2):62-71.

3. McMillan Brett B. “Easing the Pain, Acupuncture Program Looks to help Relieve Discomfort of Troops”. Stripe. February 17, 2006:1.

4. John O’Connor, Dan Bensky. Acupuncture A Comprehensive Text. Seattle: Eastland Press; 1981. 498-501

5. Hal Blumenfeld. Neuroanatomy Through Clinical Cases. Sunderland, Massachusetts: Sinauer Associates, Inc; 2002. 28-29

6. Van Heertum Ranalk L., Tikofsky Ronald S. Functional Cerebral SPECT and PET Imaging, 3rd ed. Philadelphia, PA: Lippincott William & Wilkins; 2000. 62–63

7. Orhan Arslan. Neuroanatomical Basis of Clinical Neurology. New York: The Parthenon Publishing Group Inc; 2001. 335

8. Jason Hao, Linda Hao. “Treatment of Phantom Pain by Scalp acupuncture”. Acupuncture Today. September, 2006;7(9):10-11.

9. Shi Lingzhi, Hao Jishun. Treatment of Fibromyalgia by Eight-needle Penetrating Techniques”. Chinese Journal of Information on Traditional Chinese Medicine. Feb 2005;12(2):64.

10. Jason Hao, Linda Hao. “Treatment of Multiple Sclerosis By Scalp Acupuncture. Acupuncture Today. April 2008;9(4):12-13.

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