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. 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.
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 ).
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. 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.
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. 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.
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. 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. 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.
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.
