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SYNOPSIS OF SCALP ACUPUNCTURE

by Subhuti Dharmananda, Ph.D. and Edythe Vickers, N.D., L.Ac., Institute for
Traditional Medicine, Portland, OR

THE NATURE OF SCALP ACUPUNCTURE

Scalp acupuncture is one of several specialized acupuncture techniques
with a specific body location, taking its place alongside ear, nose, hand,
foot, and wrist/ankle acupuncture. The more general acupuncture therapy
is often called body acupuncture.
Although the scalp has numerous traditionally-identified acupuncture
points along several of the major meridians (notably the stomach, bladder,
gallbladder, triple burner, and governing vessel), modern scalp acupuncture
differs from traditional acupuncture therapy. There are three basic features
of scalp acupuncture that differentiate it from body acupuncture:
1.
Treatment zones have been mapped onto the scalp that are associated
with body functions and broad body regions. The zones include a few
standard acupuncture points, but the treatment principle for point
selection is usually not based on the traditional indication for the point
or associated meridian. In general, within a defined zone, the forward
part of the zone (nearer the face) is used to treat the upper body, while
the rear portion of the zone is used to treat the lower body. Functional
zones, such as sensory, memory, and motor, are usually located at the
back and sides of the scalp.
2.
In scalp acupuncture, the needles are to be inserted within a thin layer
of loose tissue beneath the scalp surface, at a low angle of about 1530
degrees, involving an insertion distance of about 1 cun [the cun is a
variable unit of measure based on body size; about one inch for an
adult]. Standard acupuncture of scalp points normally involves
subcutaneous insertion up to a depth 1/2 cun or less (about 0.30.5
inches for an adult) at a high angle of 6090 degrees.
3.

For scalp acupuncture, the needles are to be subjected to rapid

stimulation, which may be carried out in a variety of ways, including

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pulling/thrusting, twirling, and electro-stimulation.

Standard
acupuncture applied to scalp points usually involves less rapid
stimulation or moxibustion as the main stimulation technique. When
using manual manipulation in modern scalp acupuncture, it is common
to stimulate the needles for 23 minutes at a time, with a rest period of
510 minutes between stimulations.
The fundamentals of scalp acupuncture therapy were reviewed by Lu
Shoukang, of the Beijing College of Acupuncture, Moxibustion,
Orthopedics, and Traumatology, in the Journal of Traditional Chinese
Medicine (1). According to this review, the technique is predominantly a
small-needle therapy in which shu points in the scalp are treated. Shu
points refer to stream points where the qi of the internal organs is
infused. In the system of body acupuncture, there are 5 shu points (one for
each element) on each of the 12 meridians (below the elbow or below the
knee) plus the back shu points, which are each located in the vicinity of one
of the internal organs. According to the theory of channels and collaterals,
shu points in the head can be used to treat diseases of the whole body.
Lu claims that more than 80 diseases are currently treated by this
therapeutic method, which is particularly effective in treating disorders of
the central nervous system and various acute and chronic pain syndromes.
He mentions specific examples: neurasthenia, anxiety neurosis, and other
psychological and psychosomatic disorders, periarthritis of the shoulders,
ischialgia, pain in the back and loin, painful heels, and other pain
syndromes, hemiplegia, aphasia, senile dementia, and other brain disorders.
During the 1970s, scalp acupuncture was developed as a complete
acupuncture system. Three major contributors to the development of this
system, Jiao Shunfa, Fang Yunpeng, and Tang Songyan, each proposed
different diagrams and groupings of scalp acupuncture points. For
example, Jiao divided the scalp points into motor and sensory areas, Fang
into writing (speech) and reading (memory) centers, and Tang into upper,
middle, and lower burner areas. Several different methods of needling were
proposed. Jiao advocated rapid twirling with penetrating and transverse
needling; Fang favored the slight twirling method and oblique needling;

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while Tang recommended long-duration needle retention with superficial

stimulation of the needles, using the lifting and thrusting method.
Thus, scalp acupuncture is not really a single system, but a multiplicity of
systems still in development, with a 30-year history of practical
experience. A standard of nomenclature for acupuncture points has been
developed (adopted in 1984 and reconfirmed in 1989), indicating 14
therapeutic lines or zones based on a combination of the thoughts of the
different schools of scalp acupuncture. However, it is often necessary to
carefully review the zones relied upon by an individual practitioner, as few
have adopted the unified pattern.
As Lu states in his article, Professor Zhu Mingqing (who had been
associate professor at Lus department in Beijing before emigrating to the
U.S.) has developed a popular version of scalp acupuncture. In recent
years, Zhus scalp acupuncture has been a craze in Japan, America, and
China. As a school of scalp acupuncture therapy, Zhus method is actually
derived from the standard scheme [adopted in China] and based on the
clinical experience of Zhu Mingqing. In Zhus scalp acupuncture, 8
therapeutic zones are used [actually, 9 zones], and the manipulation is
characterized by forceful, small-amplitude lifting and thrusting of the
needle, associated with massage [of the body part to be affected] and
physical and breathing exercises. In fact, the therapeutic zones in Zhus
scalp acupuncture are determined on the basis of the standard scheme.
Dr. Zhus father was an acupuncturist who worked on scalp acupuncture,
and Zhu has been working as an acupuncturist since graduating from the
College of Chinese Medicine in Shanghai in 1964. He served as assistant
director of the Scalp Points Research Group of the Chinese Acupuncture
Association from 1987 to 1989. Since coming to the U.S., he has worked
closely with Dr. Eva Munwu Chau, former president of the California
Acupuncture Association. In 1991, Zhu established the Chinese Scalp
Acupuncture Center of the U.S.A. in San Francisco, and, in 1992, he
published an English-language book on his methods: Zhus Scalp
Acupuncture (2), now out of print. He currently provides treatments for
several neurological disorders at Zhu's Acupuncture Medical & Neurology

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Center, in San Jose, California (see Appendix 2 for more on Zhus

experiences in the U.S.).
Dr. Zhu traces the origins of modern scalp acupuncture to the work of
Huang Xuelong, who in 1935 introduced the concept that there is a
relationship between the scalp and the cerebral cortex. Several
acupuncturists pursued this line, seeking points and zones on the scalp that
would treat diseases of the brain. Initial results of clinical work indicated
that acupuncture applied to the scalp had good effect on diseases that were
associated with cerebral damage, such as stroke. Its applications were then
extended to virtually all other diseases, but a focus on nervous system
disorders is still dominant. Other physicians in China trace the acceptance
of scalp acupuncture as a new system to the development of ear
acupuncture, which is also thought to be especially useful for neurological
disorders due to the location of needling at the head.
ZHUS SCALP ACUPUNCTURE
According to Dr. Zhu, Baihui (GV-20) is the basis for all of the scalp points.
Quoting from the Ling Shu: The brain is the sea of marrow. Its upper part
lies beneath the scalp, at the vertex, at point Baihui. The points Chinese
name indicates that it is the great meeting place (literally: hundred meetings).
Traditionally, this point is treated to stabilize the ascending yang; it is also
needled in order to clear the senses and calm the spirit.
The Governing Vessel enters the brain at point Fengfu (GV-16). The
external pathway of the Governing Vessel is used to divide the left and
right sides of the scalp. The left side governs qi and the right side governs
blood. Needling of the left side has a greater impact on disorders of the left
side of the head and neck, but of the right side of the body below the neck,
and conversely.
In Zhus system of acupuncture, there are three main zones (designated the
Eding zone, Dingzhen zone and Dingnie zone) subdivided into a total of 11
portions, and three secondary zones, each divided into two portions
(designated Epang 1, Epang 2, front zone of Dingjie, back zone of Dingjie,
Niehou and Nieqian). The zone names are simply based on anatomical

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descriptions. Following is a review of the primary scalp acupuncture zones

(See Appendix 1 for a picture of the zones).
Eding Zone
Ding refers to the top of the head, and E (pronounced uh) refers to the
forehead. The Eding zone runs from the forehead to the top of the head.
This is a zone that runs along the governing channel, covering a narrow
band from a point 1/2 cun in front of GV-24 (at the forehead/scalp border)
back to GV-20. The width is 1 cun and the length is 5 cun. The Eding zone
governs the yin side (front) of the body, running from the perineum (GV-20
area of needling) to the head (GV-24 area of needling). The zone is
divided into four regions.
Eding 1 is the anterior quarter of the region, extending from GV-24
forward by 1/2 cun. This region is used to treat the whole head and neck
region. The effects of treatment in this region include calming the spirit,
opening the orifices, arousing the mind, and brightening the eyes. To treat,
insert the needle along the side of the zone that corresponds with the side of
the head or neck that is affected. That is, although treatment usually
includes one needle in the center of the zone (along the GV line), if the
problem is on the right side of the head or throat, place the needle on the
right side of the zone. For example, treating blurred vision in the right eye,
place one needle in the right side of the Eding 1 zone or insert the needle at
the center of the zone and direct it to the right side of the zone. The
direction of needling is usually towards the face.
Eding 2 is the second quarter of the zone, extending from GV-24 to GV22. This region is primarily used to treat disorders of the chest region. The
functions include opening the chest and regulating qi, opening the lungs,
stopping wheezing, and calming the spirit. If the problem is on one side of
the body, needle the side of the zone on the opposite side (contralateral).
Eding 3 is the third quarter of the zone, extending from GV-22 to GV-21.
This region is primarily used to treat disorders of the middle burner (including
treatment of acute appendicitis). The functions include stopping vomiting and
diarrhea, regulating the liver qi, and regulating the gallbladder. To treat, use
the contralateral side.

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Eding 4 is the last quarter of the zone, extending from GV-21 to GV-20. This
region is used to treat the lower burner and the lower limbs. The functions
include regulating the menses, strengthening the kidneys and promoting
urination. Needle on the contralateral side; if the disorder is central, as in
bladder dysfunction, needle the central line of the zone or both sides. The
direction of needling is usually towards the back of the head.
As described above, Zhu follows the principal that if the disorder affects
the left or right side of the body, then treatment that is intended to affect the
head or neck is done on the same side of the zone as the side of the disorder
(ipsilateral), but if it is below the neck, then the needle is placed on the
opposite side of the zone. This approach has been followed by many scalp
acupuncture specialists in China. However, a few researchers claim that
clinical evidence does not support the need to treat one side or the other;
rather, one can alternate sides on subsequent days. At this time, there is
probably insufficient data to demonstrate that one or the other approach is
significantly better. Alternate side needling might be better tolerated by the
patient when daily needling is used. For those following Zhus technique,
treating one side according to location of symptoms would be consistent
with his extensive clinical experience.
Dingzhen Zone
Zhen (pronounced jun) refers to pillow, and indicates the back of the
head. The Dingzhen zone runs from the top of the head to the back of the
head, between GV-20 and GV-17. The zone is 1 cun wide. It governs the
spine, the yang aspect of the body (back). It can be divided into 4 regions,
equally spaced from each other. This region is mainly used for pain.
Dingzhen 1 (starting at GV-20) governs the back of the head and the neck.
Dingzhen 2 governs the vertebrae C-7 (seventh cervical, base of the neck)
through T-10 (10th thoracic).
Dingzhen 3 governs the vertebrae T-10 through L-5 (fifth lumbar).
Dingzhen 4 (ending at GV-17) governs the sacrum and coccyx. Needling
here is painful, so it is rarely used.

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The Eding and Dingzhen zones together form a central line from the front
to the back of the scalp. In mapping the zones to the body structure, this
line represents a continuum from head to abdominal base repeated twice,
first covering the front of the body (the more frontal points) and then the
back of the body. The meeting point of the two zones, GV-20, can be used
to treat the entire body, depending on the aim of the needle.
Dingnie Zone
Nie (pronounced nyeh) refers to the temple. The Dingnie zone runs from
the center top of the head to the temple, at an angle (aiming to the
cheekbones). It is located on a line from GV-21 to 1/2 cun anterior to ST8. The zone is 1 cun wide. It can be divided into 3 equal parts, and each
part is used as a representation of a body region that can be treated within
the zone.
Dingnie 1 governs the lower limbs. The homunculus for this zone looks
like a person is kneeling with their foot and thigh on top of each other (near
GV-21), and their knees pointing towards ST-8. This zone does not
include the hip joint.
Dingnie 2 governs the upper limbs. The homunculus for this zone like a
person with their elbows bent. The elbow zone is near the region between
Dingnie 1 and 2. The upper arm (not including the shoulder) and wrist are
mapped near the intersection between Dingnie 2 and 3.
Dingnie 3 (near ST-8) governs the head. It covers motor-sensory
problems. This zone is rarely used as it can be painful to needle; Eding 1 is
usually used instead.
Mapping from the frontal hairline back, the top of the body is forward.
Also, the sensory zone is toward the forward part of the Dingnie zone,
while the motor zone is toward the back of the Dingnie zone. Needling of
this zone may include insertion from GV-21 towards ST-8 or in the reverse
direction.
Epang Zone

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Pang (pronounced pong) means along the side. The Epang zone is a
series of short segments along the border of the forehead/scalp on either
side of the central line. This zone is actually comprised of short and
narrow segments running from the top of the forehead into the hair zone.
Epang 1 is used to treat acute diseases of the middle burner. It is located
1/2 cun on either side of GB-15. The zone is 1/2 cun wide.
Epang 2 is used to treat acute diseases of the lower burner. It is located
halfway between GB-13 and ST-8. The zone is 1 cun long and 1/2 cun
wide.
This mapping of the body runs from the center line (GV, the Eding zone
governing head and throat) to the side, progressing from head to middle
warmer to lower warmer.
Dingjie Zone
Jie (pronounced jeah) refers to being closely bound to something: this is
a zone adjacent to GV-20. Dingjie has a front zoneDingjieqianand a
back zoneDingjiehou. Qian (pronounced chian) means forward, and
hou (pronounced how) means back. The Dingjie zone is a set of four
short segments arrayed from the top of the head to the front and back sides
of the head. These are short lines radiating forward and back to the sides
from GV-20, the meeting spot between the end of the Eding zone
(corresponding to the genital area) and the beginning of the Dingzhen zone
(corresponding to the head and neck). The front Dingjie zone treats an area
of the body just above that treated by the end of the Eding zone, and the
back Dingjie zone treats an area just below that treated by the beginning of
the Dingzhen zone.
Front Zone of Dingjie: This zone is located on a line from GV-20 to BL-7.
This area is used to treat the hips and inguinal area.
Back Zone of Dingjie: This zone is located on a line from GV-20 to BL-8.
It is used to treat the area above the scapula, the upper trapezius region.
Nieqian and Niehou Zones

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Nie (pronounced nyeah) refers to the temple. The Nieqian (meaning

forward temple) zone is near the temple, above and to the front of the
sideburn, while the Niehou (meaning back temple) zone is set back from
the temple (over the top of the ear). The zones at the sides of the head are
rarely used because the needling tends to be painful.
Nieqian Zone: This zone is located on a line from GB-4 to GB-6. It is used
to treat shaoyang disorders (those that are deemed half-inside and halfexternal in nature, and those affecting the liver/gallbladder areas, such as
hypochondrium and sides of the chest), side-of-the-face problems,
menstrual-related migraines.
Niehou Zone: This zone is located on a line from GB-9 to TB-20. It is
mainly used to treat diseases of the ear.
MAPPING OF THE BODY WITHIN THE ZONES
The Dingnie zones, which extend at angles towards the front of the head
(from GV-21 to ST-8 on either side) from the central Eding zone, overlap
the central zone. The mapping of body parts to the zones places the foot at
the beginning of the Dingnie zone (at GV-21) and the head at the end of the
Dingnie zone (at ST-8): Dingnie zone #1 is used for treating the legs;
Dingnie zone #2 is used for treating the arms; Dingnie zone #3 is used for
treating the head. However, because Dingnie zone #3 is more painful to
needle and, because treatment of the head is adequately accomplished in
the Eding zone #1; Dingnie #3 is seldom used by Dr. Zhu.
To visualize the mapping, imagine a person squatting down with arms bent,
placing the elbow on the knee, with the hand by the shoulder. The
beginning of Dingnie #1 is at the base of the foot, this overlaps with the
upper thigh due to the squatting position, and then it maps upward to the
knee; the zone then continues up the arm from the elbow towards the hand
and shoulder, including the forearm in that same space (Dingnie #2);
finally, it follows up the head (Dingnie #3). The foot location of the
Dingnie zone #1 extends all the way to the far side of the Eding zone (the
Eding zone runs along the governor vessel; the zone covers 1/2 cun on
either side of GV; when needling Dingnie to treat the foot, the point of the
needle, threaded into the scalp, rests at the junction of the beginning of

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Dingnie zone #1, where it meets the far side of Eding. Therefore, the
needle enters the scalp behind the Dingnie zone. Dingnie zone #1 does not
include the hips, and Dingnie zone #2 does not include the shoulder girdle;
to treat those parts of the body, Dr. Zhu relies primarily on the Dingnie
zones. Aside from the standard zones, palpation of the scalp for tender
points helps Zhu to identify the specific needling sites within the selected
zone. The Eding zone is the most frequently used of the scalp zones, with
the Dingnie zones being used additionally for treating affected limbs.
When treating a neurological problem that affects the extremities, the
needles are directed, along a zone, towards the opposite extremity. Thus,
for example, if the left leg is affected, the needle will be directed outward
along Dingnie #1 on the right side of the scalp. Only for problems of the
head and neck is the needling done on the same side of the scalp as the
disorder. For disorders that are not specific to a body location, such as
hypertension or epilepsy, needling may be done on both sides of the zone.
If the disorder to be treated is associated with a degenerative disease
involving a kidney deficiency syndrome (common in elderly patients and
those with chronic, degenerative diseases), then Eding zone #4 is usually
needled. A typical needling pattern is: one needle in the center of the zone,
and one needle on either edge of the zone, about 0.5 cun apart from the
central needle; for a total of 3 parallel needles in the zone, with the central
needle leading the other 2 by about 0.5 cun, producing an arrow formation;
the outer 2 needles are directed towards the part of the zone that
corresponds to the kidney, while the inner needle is directed toward the part
of the zone corresponding to the genitals.
Dr. Zhu sometimes uses a crossing technique for needle positioning,
mainly in treating cases of severe pain. He selects a zone site for treatment,
and inserts one needle along the zone and then inserts a second needle
perpendicular to that one, going across the zone and crossing over the first
needle. As an example for right-knee pain, a needle is first directed along
Dingnie #1 towards the left temple, and then a second needle is inserted
across that one. The second needle is stimulated by the draining method.
In cases of quadriplegia, another crossing technique is used. The first
needle is inserted across the zone (e.g., from the left part of the zone to the

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right part of the zone, at about a 45 degree angle), and then a second
needle, crossing over the first (e.g., from the right part of the zone to the
left part of the zone). In some cases, a series of cross-over needles are
inserted along the length of a zone (this may incorporate as many as 3 pairs
of needles).
THE NEEDLING TECHNIQUE
The needle size often mentioned in Chinese texts for scalp acupuncture is
26, 28, or 30 gauge, which is suitable for rapid twirling techniques. For
Zhus needle stimulation technique (thrust and pull method), a somewhat
finer needle gauge of 32 or 34 is suitable for most cases, and the insertion
length is approximately 1 cun. A 30 mm (1.2 inch) needle with a wound
head is thought to be the best. The needle must be long enough so that it is
not inserted up to the handle, but short enough that there will not be any
bending during insertion and manipulation. The angle of insertion is
typically 1525 degrees. The patient should not feel pain, though there are
some rarely used scalp points along the sides of the head, mentioned above,
that typically produce pain.
The needle is inserted along the practitioners nail pressing the skin. Press
besides the treatment zones with the nail of the thumb and first finger of the
left hand, hold the needle with the right hand, and keep the needle tip
closely against the nail. By avoiding the hair follicle, one can minimize
pain during insertion. The direction of needling is usually based on the
mapping of the body within the zone being treated: the needle is aimed
(along the line of the zone) toward that portion of the zone most closely
corresponding to the area of the body that is affected by the injury or
disease.
Although the distance from the skin surface to the skull is very short, there
are several tissue layers: the skin, hypodermis, galea aponeurotica and
occipito-frontalis muscles, subaproneurotic space, and pericranium. The
subaproneurotic space is a loose layer of connective tissue that is ideal for
penetration during scalp needling: the needle slides in smoothly and does
not cause pain, yet the desired needling sensation is strong. If the angle of

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needling is too shallow, the needle will penetrate the skin and muscle layers
and it will be difficult to get a smooth insertion.
Upon inserting the needles, stimulation is applied for 12 minutes (see
below for stimulation technique). The needles are manipulated again after
intervals of 1015 minutes, for 12 minutes each time, throughout the
duration of the patient visit, which may be as long as 23 hours.
Sometimes, the interval between needle stimulation sessions is longer due
to insufficient staff time when there are numerous patients, but usually
within 30 minutes.
The needles should remain in the scalp for a minimum of 4 hours (except
for treatment of acute symptoms, in which case, 0.51 hour is sufficient)
and up to a maximum of 2 days. However, for children and weak adults,
the time of retention should be shorter. Dr. Zhu generally prefers longterm needle retention of 12 days; this is in contrast to the method of Jiao
Shunfa, who advocated removing the needles after the basic
manipulations. At Zhus clinic, the scalp needles are often left in place
when the patient leaves, and are not removed until the next visit, which is
2448 hours later. At that time, new needles are inserted at different
points. If several parts of the body are affected by the illness or injury, the
points selected may be rotated through a cycle aimed at treating each of the
different body parts.
There are two basic needling methods for manipulating the qi, designated
jinqi and chouqi, that have been elucidated by Dr. Zhu. Both are based on
ancient techniques and involve a rapid, short distance movements. Jinqi
(jin means move forward) is a tonifying, thrusting method. Thrust the
needle quickly with violent force, but the body of the needle doesnt move,
or no more than 0.1 cun in. Following the thrust, the needle is allowed to
settle back to its original position. Chouqi (chou means to withdraw) is a
sedating, reducing method. It is based on forceful movement and a lifting
motion. Lift the needle quickly with violent force, but the body of the
needle doesnt move, or no more than 0.1 cun out. Again, after the pull,
the needle settles back to its original position.

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Lu Shoukang mentions in his article that he prefers using the smallamplitude, forceful lifting method, rather than the twirling method, because
it saves the operator effort and gives the patient less suffering. He
describes his preferred method as follows: When inserted to a certain
depth (about 1 cun), the needle is forcefully lifted outwards or thrust
inwards. The direction [angle] of lifting or thrusting is the same as that of
the insertion. The outward and inward force exerted on the needle should
be sudden and violent as if it is the strength from the whole body of the
operator. The lifting and thrusting amplitude should be small, no more
than 1 fen [1/10 cun]. After lifting and thrusting continuously for three
times, the needle body is sent back to the original place (about one cun) and
significant therapeutic effects will be obtained after the maneuver is
repeated for 23 minutes.
For the majority of neurological disorders, the tonification technique (jinqi)
is used, with a series of rapid, very small-amplitude, in-out needle
movements. The emphasis is on the forward movement, then allow the
needle to naturally pull back to the starting position. In cases of pain
syndromes, the draining method (chouqi) is used, with the same kind of
rapid, limited distance movements, but with the emphasis on outward
movement, then allowing the needle to settle back in to the starting position.
During the stimulations, it is important for both the practitioner and the
patient to focus on the breath (this is an aspect of qigong therapy that is
incorporated into the treatment). There should be no talking during needle
stimulus: all attention is on the needling and its effects. The mental focus is
on directing the breath to the body part that is to be affected.
Regarding repetitions of the stimulus, Zhu says: Repeat many times until
revival of qi and effect is achieved. He usually does not specify a
manipulation duration, but rather bases the duration on observed response.
He claims that by using the small amplitude manipulation method rather
than the twirling method, one has the advantages of large amount of
stimulation, saving effort, less pain sensation, and strong needling
sensation, yet the therapeutic effects are achieved quickly. The method is
also easy to master, though success may depend on the qi of the
practitioner when utilizing the forceful but small amplitude manipulations.
Dr. Zhu does not rely on moxa, due to the problems associated with large

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amounts of smoke in the group treatment setting and lack of adequate

ventilation at the Neurology Center. He does use heat lamps to provide
heat to an affected body part, when it is deemed valuable.
The affected part of the body is to be moved during needle stimulation. If
the person cannot make the movement on their own, then the patient will
visualize moving the breath to the affected part and, when possible, an
assistant will move the body part. After the needle stimulation, the patient
is encouraged to continue the movements. In cases where the legs are
involved, the patient walks, if possible (several patients at Zhus clinic
would walk around the block, others might walk the length of the room).
Dr. Zhu expressed the belief that a function of scalp acupuncture is to
improve or re-establish the connections from the central nervous system to
the peripheral nervous system. The sending of signals between these two
parts of the nervous system during treatment is critical. The intention of
the patient to move the affected body part (or the mental practice of moving
the breath to the body part) sends signals from the central nervous system
to the periphery, while actual movements of the body part send signals
back from the periphery back to the central system.
Before withdrawing the needles, Zhu recommends manipulating the needle
again while the patient performs breathing exercises. When it is time to
remove the needles, press the skin around the point with the thumb and
index finger of the left hand, rotate the needle gently and lift slowly to the
subcutaneous level. From there, the withdrawal should be rapid, and the
punctured site should be pressed for a while with a dry cotton ball to avoid
bleeding.
Body points are sometimes used as an adjunct to the scalp acupuncture
therapy. Dr. Zhu uses relatively few body points (typically 13, if any), but
emphasizes obtaining the qi sensation with propagation of qi sensation
towards the affected part. Examples of body points are ST-36 for lower
limb weakness, or LI-11 or GB-20 for arm weakness. If a body part
affected by disease or injury involves very localized pain or spasm, Dr. Zhu
might use body points primarily for local treatment (rather than somewhere
else along a meridian affecting the area), and usually with deep needling.
Body points are sometimes selected because of failure to obtain the desired

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qi reaction when using scalp points. The body needles are also retained
during the full length of the patients long scalp acupuncture treatment, for
up to two hours, not just 2030 minutes as is often the case with standard
acupuncture therapy.
In most cases, treatment is given every day (at least 5 days per week) for 1
2 weeks, then every other day for another 12 weeks, followed by twice per
week treatment for as long as necessary. The frequency of treatment may
be adjusted according to the severity of the condition and rate of
improvement. According to Lu, for best results in treating hemiplegia due
to stroke, scalp acupuncture should initially be performed twice per day.
For other chronic conditions, daily treatment or every other day treatment
is recommended for the initial therapeutic plan, to be followed-up by less
frequent treatments once progress has been made.
CONCLUDING NOTES
It is evident that after 30 years, scalp acupuncture is still evolving in its
techniques and applications. In America, Dr. Zhu and his students have
developed the techniques to suit the Western patients (see Appendices 2, 3,
and 4). In reviewing the Chinese literature (see Appendix 5), one can draw
certain general conclusions. Most authors suggest that utilizing scalp and
body acupuncture together is a valuable method. The recommended
frequency of treatment is high, from once or twice per day to once every
other day, with a course of treatment typically involving 1012 consecutive
sessions, followed by a break of 24 days, sometimes 57 days. Needle
insertion, manipulation, retention, and removal are approached with
differing techniques. An expressed concern is to minimize pain for the
patient and also to make the procedure practical for the acupuncturist.
Thus, the frequently-mentioned method of rapid needle twirling may be
replaced, in some cases, by other methods (including electrical stimulation)
because of the potential for causing pain for the patient and fatigue and
irritation for the acupuncturist. At least one study compared the efficacy of
twirling (manual and machine-aided) and electrical stimulation and the
conclusion was that both were useful. The twirling method with large
needles remains a common practice in China.

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In all cases, it is considered important to obtain an appropriate needling

sensation (not pain); often, this is to be accomplished by utilizing needle
manipulation at least two to three times in the course of a single session
(for 23 minutes each time). The manipulation is usually rapid, with
frequency of twirling in the range of 150300/minute or electrical
stimulation reported in the range of 150700/minute. Total duration of
needle retention in most cases is 2045 minutes, though some patients are
sent home with needles in place (as Dr. Zhu recommends), for retention of
several hours up to a maximum of 2 days.
Indications for scalp acupuncture include virtually all the usual indications
for body acupuncture, but the main applications are stroke, paralysis, pain,
and emergency situations (Zhu has published a book regarding the latter: A
Handbook for Treatment of Acute Syndromes by using Acupuncture
and Moxibustion (3), which includes scalp and other acupuncture
techniques). Contraindications for scalp acupuncture include very high
blood pressure (220/120), heart disease, infection, post-operative scars in
the acupuncture zone, some cases of pregnancy (mainly habitual
miscarriage), persons who are extremely nervous, and infants whose
fontanels have not closed.
In a report from Harbin (18), several aspects of scalp acupuncture for
stroke patients were commented upon, which largely match the
methodology and interpretation expressed by Zhu:
1.
The needle runs in the layer of loose connective tissue between the
galea and the pericranium.
2.
The response of getting qi is more importantly measured by
observing an improvement in movement or sensation of the affected
part of the body rather than a needling sensation like the one that is
generated when the affected parts are directly needled.
3.
Scalp points are especially effective because they are close to the part
of the body that is affected, namely the brain.
4.
Prolonged stimulation time, with rapid needling speed, gives better
results. For example, constant needle twirling [the stimulation method
more often used in China] for 3 minutes gave superior results to
constant twirling for half a minute.

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5.

The effect of scalp needling is to stimulate the cerebral cortex; it can

reverse the imposed inhibitory mechanisms on nerve function, revive
cells that are not completely destroyed, and enhance the function of
nerve cells that are subjected to ultra-low oxygen levels.

In general, Chinese clinical reports indicate a high degree of effectiveness;

cases and situations leading to better or poorer outcome have been
elucidated. In America, there is less tendency to provide daily
acupuncture, which might reduce the effectiveness. Given the general
unfamiliarity with acupuncture, there is more likelihood of patients waiting
to try acupuncture as a last resort rather than a first effort, so that the
chances of improvement are more limited. The scalp acupuncture
technique taught by Dr. Zhu has been used at ITMs An Hao Natural
Health Care Clinic in Portland to treat a multiple sclerosis (see Appendix
3 for protocol details), peripheral neuropathy, migraine headache, and
Bells palsy. Good results were attained in cases where body acupuncture
had not been sufficiently effective.

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APPENDIX 1: Zone Charts

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Acupuncture Zones in Zhus Acupuncture.

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APPENDIX 1, continued: Zone Charts

Acupuncture Zones Based on Motor/Sensory, Speech/Hearing, and

Other Divisions
(not used in Zhus acupuncture system).

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Appendix 2: Dr. Zhus Work in America

Dr. Qingming Zhu opened his neurology clinic for scalp acupuncture
therapy in Santa Cruz, California in October, 1997, after offering his
services for 6 years in San Francisco. Santa Cruz is a small beach town
about 85 miles south of San Francisco that supports an acupuncture
collegethe Five Branches Institute. The neurology clinic shares space in
the same building as the college, serving also as a training center for
acupuncture students. Another acupuncture clinic is also in the same
building, staffed by several experienced Western practitioners, and
provides the more standard variety of acupuncture therapy. Although Zhu
has learned English, his work is aided by a translator who can speed up and
clarify the communications. Still, many of his house calls are made without
this help.
While Zhus work has gotten some favorable press, his efforts at helping
those with neurological problems remains an uphill battle. In California,
medical insurance generally covers the cost of acupuncture, but insurers
have repeatedly refused to pay for other medical expenses associated with
Zhus work, such as special exercise equipment developed for those with
paralysis, herbal treatments, and extended physical therapy. The main
hospital in neighboring San Jose, after initially letting him work on inpatients, has since refused to continue such permission, viewing his
techniques unfavorably, despite the overwhelming support of those
receiving the treatments. Medical doctors have scoffed at his claims to be
able to help quadriplegics by scalp acupuncture.
His clinic is a small facility with one main room, having a dozen chairs for
patients to sit on while receiving scalp acupuncture, and a pair of curtainedoff segments of the room for beds so that patients can receive acupuncture
while lying down. There is a small office, which often turns into a
treatment room, and one small private treatment room off the office. At
this facility, about 20 patients visit each day, staying for 23 hours: after
the needles are inserted, Zhu stimulates the needles from time to time. The
room becomes quite crowded as most of the patients come with helpers.
The clinic is usually open only 45 hours a day; much of the rest of Zhus

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long and grueling work day is spent making home visits to those who are
so severely impaired that they cant travel to the clinic. He also teaches at
the college.
His treatment technique relies almost exclusively on scalp acupuncture,
sometimes using a dozen or more needles in the scalp at one time for the
more severely debilitated patients. Although the needling is sometimes
painful, he has adapted the treatment so that even babies and young
children accept it. Zhu rarely prescribes herbs, but primarily relies on
frequent scalp acupuncture therapy (daily or every other day). He has a
few patent remedies available at his clinic and has access to crude herbs for
making decoctions, or preparing topical applications, from the college
pharmacy.
Zhu treats a wide range of neurological problems, including cerebral palsy,
epilepsy, injury-induced paraplegia, multiple sclerosis, and post-stroke
syndrome, as well as disorders that seem to fall beyond the ability of
neurologists to pin them down with a name. The results of Zhus work are
somewhat difficult to elucidate. With the absence of support from the
community of neurologists who could provide detailed monitoring, and the
limited assistance available during patient treatment (which doesnt permit
careful documentation of the cases), the extent and nature of the responses
are not well established. At Zhus clinic, patients report notable
improvements compared to their earlier conditions. In a few cases of
quadriplegia, Dr. Zhu is using a video camera to illustrate the extent of
changes in patient capabilities. For more information on Dr. Zhu and his
clinic, write: Zhu's Acupuncture Medical & Neurology Center, 100
O'Connor Drive, Suite 20, San Jose, CA 95128, or call Five Branches
Institute (831-476-9424).

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APPENDIX 3: Scalp Acupuncture Protocol for Multiple Sclerosis

The following protocol was developed by Dr. Edythe Vickers, based on the
teachings of Dr. Mingqing Zhu, and is being used at the Institute for
Traditional Medicine.
1.

If the primary lesions are in the brain, insert needle in Eding Zone 1,
needling along the GV line towards the face. This is intended to
improve vision (e.g., to relieve optic neuritis) and increase mental
clarity. If the primary lesions are in the neck, then insert the needle in
Dingzhen Zone 1, which governs the neck.
2.
Insert needle from Eding Zone 3 to Eding Zone 4, needling along the
GV line towards the back of the head. This is intended to tonify the
kidney/liver system that is weak in nearly all persons with multiple
sclerosis. If the patient is suffering from a bladder disorder (typically,
there is inability to completely empty the bladder, and there may also be
incontinence; many individuals rely on a catheter), then needle only
within Eding Zone 4. This latter treatment is the same as selected by
Chen and Chen (4) for treatment of enuresis.

3.

Use two additional needles to complete the treatment. For persons

who are not highly symptomatic, the two needles may be placed parallel
to the needle in Eding Zones 3 and 4, about 1/4 inch on either side of the
central needle. This will enhance the tonification of the liver/kidney
system and strengthen the legs, bladder, and abdominal organs. For
persons who have weakness, tingling sensation, or other disorders
affecting the arms and hands, needle instead Dingnie Zone 2, with the
needle aiming towards the face (towards ST-8). If the problem affects
one side of the body, needle the opposite side of the scalp, but if it
affects both sides, needle both sides of the scalp. For persons with
weakness and numbness in the legs, use Dingnie Zone 1, with the
needle towards the GV-21. For persons with aching and numbness in
the shoulders, needle the Dingjie Zone. Again, needle either one side
or both sides, as appropriate.

Use the thrusting technique (jinqi) in most cases, as this will tonify the
deficiency. The manipulation should be carried out until the patient notices
a change in their condition. When treating the arm or leg scalp zones, have

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the patient attempt movement of the body part while the needle is
manipulated. For bladder disorders, have the patient breathe deeply (to the
lower abdomen, Dan Tian), which should focus attention on the area being
treated and help to produce a warming sensation. When treating Eding 1
(for the eyes), have the patient gently rub their palms over the eyes.
If an effect is not noted (clarifying of vision, change in sensation or
strength in affected limbs) within about 3 minutes of manipulation time,
check that the needling location and needle placement are correct; if
correct, it may be necessary to try the lifting method (chouqi) instead,
especially if there is pain. It may also be valuable to treat body points, such
as ST-36 and GB-34 for the legs and LI-4 and LI-11 for the arms. Once a
response is noted, the needle manipulation can be ceased. Patients with leg
weakness should attempt to walk for a few minutes. After about 15
minutes (from the previous manipulation), the needles should be
manipulated again. At the end of the third manipulation, the patient will be
instructed to retain the needles for a period of several hours, up to two
days, and then remove the needles themselves or with the aid of someone
who can assist them. The needles used for body acupuncture are removed
at the end of the in-clinic treatment session.
Appendix 4: Treatment Method at Vitality Center
Holly Gahn, L.Ac., O.M.D., has been using scalp acupuncture for several
years and currently practices at Vitality Center in Lake Forest, California.
She described her basic treatment techniques as follows, indicating that
there are a number of other procedures that she may utilize to complete the
treatment:
Treatment Course. On the first day, the patient is treated in the morning
and in the evening; for the next nine days, the patient is treated once daily.
Then, treatment continues at the rate of three times per week until the
condition has resolved or the patient has reached what appears to be the
maximum level of improvement.
Point Selection. The motor, sensory, balance, vision, and speech areas are
utilized as appropriate. For unilateral paralysis, use the contralateral side,
but use bilateral treatment of the zones for bilateral paralysis. In cases of

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generalized brain damage (as occurs with anoxic brain damage), Zhu's
Eding zone is used predominantly, along with GV-24 and UB-3 bilaterally.
If the patient's scalp becomes sensitive to needling, as might occur with
frequent needling of the same zone, it is helpful to alternate (from one
treatment to the next) between the motor and sensory points and the Eding
zone.
Needling Procedure. Needles are inserted one cun obliquely into the
subaproneurotic space. Needles point downwards and are angled off
towards the affected limb. It is stimulated by small-amplitude, lift and
thrust technique at rapid frequency (200 times per minute if possible).
Body needles are also inserted, using standard procedures. Both the scalp
and body acupuncture needles are retained for 2030 minutes and
stimulated every 23 minutes during this time.
Neuromuscular Re-education. Immediately after the basic needle
treatment, the body needles are removed, but the scalp needles are
retained. The patient is taken through a series of exercises while the scalp
needles are being stimulated simultaneously. If the patient is comatose or
otherwise unable to perform these, the practitioner (or assistant) performs
the otherwise passive motions for the patient. The patient, all the while, is
encouraged to try to think about doing the exercises, to visualize it, to
visually watch the movements (if possible). Verbal encouragement is even
given to those who are comatose. As soon (in the treatment course) as the
patient is able to perform the movements, they are encouraged to do so,
even if the movement is slight. Electrostimulation may be utilized
(frequency is 200/minute) in place of manual stimulation. As they become
stronger, the practitioner adds resistance to each exercise (weights can be
added), thus requiring the patient to apply greater strength (and, in some
cases, more muscle groups) to the task. The effort put forth by the patient
is of utmost importance.
For Comatose Patients. Needle PC-8 and KI-1 bilaterally plus GV-26.
The needles should be stimulated strongly (manual) for 10 minutes. Then
add PC-6 and SP-6 with strong stimulation before proceeding to needle the
rest of the body and scalp.

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APPENDIX 5: Commentaries and Clinical Observations from the Chinese

Literature
1. About needling techniques and duration.
For peripheral facial paralysis, Cui Yunmeng (7) suggests using a .38 mm
needle and a 75 mm length. The needle is twirled at a speed of 200 times
per minute. Needles are retained for 2030 minutes, being twirled twice.
Needling is done in the facial motor area of the scalp, on the same side as
the affected part.
For treatment of hemiplegia, Wang, et al., (6) give extensive details
regarding point selection (a combination of scalp and body points).
Acupuncture is given once daily for 40 minutes, with 10 days as one
treatment course, and a rest of 3 days between courses. After insertion, the
needle is twisted for 5 minutes at a speed tolerable to the patient who is
advised to exercise the limbs as best he can. Electric acupuncture is then
used at a frequency of 150200 pulses/minute for the head points and 100
pulses/minute for the body points.
Lu Shoukang (1) says that: In scalp acupuncture there are many types of
manipulation. The common one is the rapid needle-twirling method, that
is, after being inserted to the lower layer of the galea aponeurotica, the
needle is tightly held by the thumb and index fingers, and rapidly twirled
for about 200 times per minute. This manipulation requires a high
frequency and continuous movement and lasts 23 minutes each time.
Within half an hour, the manipulation should be done 23 times. Owing to
the fact that by this method the needle often twines the muscular fibers and
causes pains, it is not well accepted by the patient. Furthermore, the
metacarpophalangeal joint of the operator fatigues easily. For this, the
finger twirling is replaced by electric twirling, in which the patient is given
pulse electric stimulations with dense and loose waves and a current
intensity tolerable by the patient.
For the treatment of post-stroke syndrome, Pang Hong (9) reports the
following method, based on the teachings of K.Y. Chen: Scalp acupoints
were needled with the reinforcing or the reducing method as indicated. For
reinforcement, the filiform needle was inserted at an angle of 1530 degrees

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to the scalp, slowly and forcefully to beneath the aponeurosis. Pressure was
applied to the point for one minute, and the needle was quickly withdrawn
after a retention of 10 minutes. For reduction, the manipulations were
similar, except that after 10 minutes of retention the needle was withdrawn
slowly, when the skin formed a mount around the retreating needle. For
either reinforcement or reduction, the needling took 15 minutes, including
the 10 minute period of needle retention. Courses of treatment were 10 daily
sessions, with efficacy appraised after three courses. He went on to
comment that: For the promotion of myodynamia and motile functions, the
method of slow-rapid reinforcing-reducing was significantly better than the
method of flat twisting. The application of reinforcing and reducing
manipulations would shorten the therapeutic course, promote the therapeutic
efficacy, and decrease the rate of disability. The method of slow-rapid
reinforcing-reducing in scalp acupuncture had the advantages of causing less
pain and inducing proper occurrence of the needling sensation; therefore, it
was well received by the patients. With regard to the selection of points,
Pang Hong claims that: For the treatment of apoplexy, the selection of
acupoints on either the healthy or the affected side makes no difference in
therapeutic efficacy. In his clinical work, he treated both sides, alternating
sides from one session to the next.
In a teaching round on apoplexy (10), Professor Guo describes his technique
for scalp acupuncture: Size 28 needles are commonly used, usually of the
length of 2 cm. First, locate the upper point of the motor area, and with the
left hand fixed on it, insert the needle obliquely towards the lower point at an
angle of 15 degrees with the skin surface. Holding the needle with the right
first three fingers, insert the needle quickly until it reaches the loose cellular
tissue beneath the scalp. Then turn the needle horizontally with respect to
the skin surface, and push it to a depth of about 1.5 cm. Twist and rotate the
needle but never lift and thrust it. Hold the needle between the medial
surface of the terminal part of the right index finger and the palmar surface
of the terminal part of the right thumb. With repeated extensions and
flexions of the interphalangeal joint of the index finger, one rotates the
needle in one direction till it turns two rounds and then in the other direction
for another two rounds. One may rotate this way 200 times for one minute,
repeat rotating 510 minutes later, and retain the needle till 30 minutes after
the insertion (including the time of rotating). With rotating of the head of

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the needle, the patient usually reports the feeling of local heat, numbness,
and tics. There may sometimes be radiation of such feelings to contralateral
and homolateral limbs. In general, therapeutic effects are achieved with
mere appearance of local needling feeling; nevertheless, still better results
will be had if the feelings radiate to the limbs. You may produce all the
needling feelings with electrical stimulation. To do this, one inserts a 1 cun
needle into the upper point of the motor area and pushes it horizontally
towards the lower point, and then insert a 1.5 cun needle at the division point
between the upper 1/5 and middle 2/5 [of the motor area]. With these
needles connected to corresponding electrodes in the electroacupuncture
apparatus, one then passes electricity, often in a frequency of 3/sec
[180/minute] with a tolerable intensity for 20 minutes.
Qu Hong and his colleagues (8) described their scalp acupuncture
technique for treating pseudobulbar paralysis as follows: A filiform needle
was rapidly inserted for a depth of 11.5 cun in the direction of the
motor/sensory area, followed by rapid twistings for 0.51 minute until the
appearance of the needling sensation. The needle was retained for 40
minutes, with small amplitude twistings for another 0.51 minute before
withdrawal....Practice has shown that needling on the motor and sensory
areas simultaneously, and on the affected side and the healthy side
simultaneously produces better curative effects. In light of the experience
of Professor Shi Xuemin, the authors adopted deeper insertion of the
needles both on the scalp and on the body. Retention of the needles
enhanced vasodilation of the cerebral vessels to increase cerebral
circulation more than simple twistings of the needles for the recovery of
nervous functions. The authors therefore lengthened the needle retention to
40 minutes.
Liu Chunhui and Wang Ying (11) reported on their experience of treating
acute apoplexy during a medical visit to Yemen. For scalp acupuncture,
they reported that: The needles were twirled once every 10 minutes at a rate
of 200 times per minute, followed by retaining them for 30 minutes. The
patients were asked to exercise the limb during the needle manipulation.
The manipulation was applied every 10 minutes and acupuncture (body plus
scalp) was administered each morning and afternoon for a treatment course
of 12 days, with an interval of 3 days between courses (using 16 courses).

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Wu Chengxun (12) reported on using three techniques of needle

manipulation. Manual twirling was done with a frequency of 200500
times per minute and the twirling was performed every 35 minutes; a
needle twirling machine was applied at a frequency of 300 times per
minute and applied in the same fashion; an electroacupuncture device was
used with a frequency of 500700 waves per minute, with continuous
stimulation for 10 minutes. After the stimulations were applied, needles
were retained for several minutes so that the total duration of needling was
25 minutes. The treatment was performed daily for 12 days, and then a rest
period of five to seven days was allowed before resuming another course of
12 days treatment. With a total of 1228 cases of hemiplegia so treated, it
was determined that there was no significant difference in the outcome for
the three methods of stimulation.
Ji Nan and colleagues (13) used scalp and body acupuncture to treat
sequelae of stroke and cerebral injury, claiming improvement in all but 3 of
128 patients, with treatments deemed markedly effective in 42.8% of the
total group. Needles were inserted, as appropriate to the condition being
treated, into zones designated motor area, sensory area, vasomotor area,
and speech zones I, II, and III. For paralysis, they used the method of
treating the side opposite the affected limb. The scalp needles were
connected to a therapeutic instrument which delivered sparse and dense
waves over an interval of twenty minutes for each session. For each
session 1 or 2 scalp areas and 24 body points (such as ST-36, LI-10, LI11, LI-15, GB-34, or SI-9, getting qi and then allowing 20 minutes
retention) were treated. Sessions were once daily for 10 days as a course of
treatment, applying 2 courses as the standard.
Zhang Naizheng (14) described treatment of tremor artuum in 35
individuals using a combination of body points and scalp acupuncture.
Regarding the latter, he stated: The dancing tremor controlling region was
chosen; needling was done once per day, 10 days for a course of treatment,
with an interval of four days between courses, lasting 4 courses. Using a
26 or 28 gauge, 5 cm long needle, the squeeze-holding method was used
for insertion; the angle of insertion was 30 degrees, and the needle was
rapidly twirled with a small scope of movement, about 200 times per

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minute for 2 minutes, and then retained without twirling for 5 minutes; this
procedure was repeated three times and then the needle was removed.
Zhang Mingju reported (15) on treatment of 296 cases of hallucinations
using scalp acupuncture. The method used was point-through-point
needling, with the needles inserted at an angle of about 15 degrees with the
scalp and running from GV-19 to GV-20 (the Dingzhen 1, which affects the
head); auxiliary treatment locations were needled by similar method,
starting at the selected point and then needling through to the next point
(examples: GB-17 to GB-16; TB-19 to TB-17). Needles were twirled and
agitated for 13 minutes. When the needling sensation is felt is the best
time to channel qi to the locality of the disease. Needles were retained for
13 hours. Acupuncture was performed daily, and 10 sessions constituted
on therapeutic course. After the first course, acupuncture was performed
every other day, with 10 sessions constituting the second therapeutic
course. If still necessary, acupuncture was performed twice weekly, with
10 sessions constituting the third therapeutic course. By this method, 71%
were cured and 19% markedly improved.
Zhang Hong reported (16) on treatment of 76 cases of senile urinary
incontinence. Body and scalp acupuncture was used, with scalp points
picked in the leg motor and sensory area (1 cm lateral to GV-20,
corresponds to Eding 4) and reproduction area (Epang 2). Electrical
stimulation was adopted, with a frequency of about 200 pulses per minute,
with the intensity limited to the patient's tolerance. Needles were retained
for 30 minutes. Treatment was given 5 times per week, with 10 treatments
constituting one course, with an interval of one week between courses.
After 12 courses, half the cases were cured, and 20 others markedly
improved.
2. About needling pain and needle sensation
Lu Shoukang observes (1): In scalp acupuncture, the needle is usually
inserted by the penetration needling along the skin. Since the scalp is rich
in nerves and blood vessels and is more painful than the limb when
punctured, the needle insertion should be rapid and kept away from the hair
follicles and the tip of the needle should be sharp. After insertion, the

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needle body should be rapidly pushed to the lower layer of the galea
aponeurotica that is the loose connective tissue to allow the needle to be
manipulated freely to cause less pains. In order to strengthen the
stimulative sensations, the point-through-point method is used, that is, the
needle penetrates several points at the same time. Sometimes the method
of two needles punctured to each other is used. For instance, one needle is
punctured from qianding [GV-21] to baihui [GV-20] while the other needle
from baihui to qianding, both along the midline of the vertex.
Chen Zaiwen and Chen Ling (4) described treatment of enuresis in children
with scalp acupuncture. It was mentioned that: For scalp acupuncture, the
selection of acupoints needs to be accurate and the manipulation mild to
avoid unnecessary pain which might dispose the child unfavorably to
acceptance of the treatment. The authors choice was a 3032 gauge
filiform needle, 1.5 cun in length. It was desirable to insert the needle
rapidly through the skin in a vertical direction and then the needle was bent
to an angle of 30 degrees to the skin to be pushed forward, preferably under
the epicranial aponeurosis. A stronger stimulation often brought about
better curative effects. Although the authors reported good clinic effect of
scalp acupuncture for enuresis, it was said that: Owing to the needling
pain, only 59 cases [out of more than 100] were willing to accept the
treatment for a complete course [10 to 15 sessions, undertaken either every
day or every other day] or longer.
3. About the effectiveness of scalp acupuncture in clinical practice
In a general review of acupuncture therapy (5), it was said that: Clinical
reports of 2,917 cases of hemiplegia treated in 34 units [clinics] reveal an
effective rate of 94.5%, with 58.9% markedly improved....Observation of
the graphic [EEG] changes of amplitude, decrease of frequency, decrease
of the angle of the main peak, deepening of the valley of the wave indicate
that scalp needling dilates blood vessels, improves vascular elasticity,
reinforces cardiac contraction, and increases cerebral blood flow.
A problem with claimed effectiveness rates for scalp acupuncture is that
there is rarely a control group (or one that is well-matched) to help sort out
improvements that might occur spontaneously or due to other therapeutic

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measures (such as ordinary physical therapy) that might be undertaken.

However, there may be some benefit to examining the disorders that have
been treated by this method and the extent of improvements, whatever the
cause, that were noted during the treatment period.
In the article by Chen and Chen regarding enuresis treatment (4),
effectiveness was moderate (only 9 out of 59 were cured), but it was said
that: It seemed to be a general rule that older children were apt to have
better curative results; treatment in the afternoon seemed to be better than
in the morning, and a longer time of needle retention was better than short
time needle retention....A stronger stimulation often brought about better
curative effects.
In an article on scalp acupuncture for hemiplegia (6), Wang and his
colleagues reported that of 110 cases, 29 were essentially cured, with
mobility of limbs recovered. They state that: Analysis of the 110 cases
showed that the location, number and extent of the cerebral lesions
correlated closely with the therapeutic effects, and early institution of the
acupuncture treatment led to better results....Among 29 cases that were
essentially cured, most involved lesions in the external capsule or cerebral
lobes, with some single lesions in the internal capsule or brain stem.
However, the 5 ineffective cases had mostly multiple lesions in the basal
ganglia, the brain stem, and cerebral ventricles.
In an article by Cui Yunmeng (7), scalp acupuncture for facial paralysis
was described. It was reported that 71 out of 100 cases were cured, using
540 treatment sessions, given once daily.
In a report on pseudobulbar paralysis (8), Qu Hong, Ren Liping, and Guo
Yi describe their results of combining scalp acupuncture and body
acupuncture: The treatment was effective in all 28 cases. 19 cases (68%)
were cured and 9 cases (32%) were markedly effective. The shortest
course of treatment was 4 sessions and the longest 4 courses [40
sessions]....The patients in this series were all difficult cases of
pseudobulbar paralysis refractory to western and Chinese drugs. The good
therapeutic effects indicated the superiority of this modality.

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A study by Wan Zhijie and colleagues on the mechanism of action of scalp

acupuncture (17) indicates that cholinesterase is inhibited and, at the same
time, muscle force of the extremities is increased. Further, microcirculation
is notably enhanced. In treating hemiplegia, a single treatment (about 25
minutes, including insertion, three sessions of 3-minute twirling with two
5-minutes breaks, and withdrawal of the needles) muscle strength in upper
and lower extremities improved by about 20%, whole blood cholinesterase
was reduced by about 15%, and speed of blood flow through nail bed
capillaries increased by over 30%. These changes slowly reverted after
treatment to reach pretreatment values after 24 hours, confirming the need
for daily scalp acupuncture therapy.
Two reports on aphasia (inability to speak) were presented in the Shanghai
Journal of Acupuncture and Moxibustion. In one report, from the
Guangdong Provincial Hospital, 72 cases of stroke-caused aphasia were
treated and evaluated (19). The zones selected were from the speaking
zones (from a different set of zones than used in Zhus scalp
acupuncture). After applying the needles and getting the qi reaction, the
needles were hooked up to an electroacupuncture device and stimulated for
20 minutes (once per day). In addition, body acupuncture was applied
(mainly GB-20 on one day and GV-16 on the alternate day, with some nonstandard, extra points). Those needles were stimulated for about 20
seconds and then retained for 30 minutes (once per day). After 30 days of
treatment, 46% of the patients showed marked improvement, and another
50% showed some improvement. In the other report (20), from the Central
Hospital of Shantou City (also in Guangdong), aphasia in nine children
ages 16 months to 14 years was treated. The causes were numerous,
including viral encephalitis and meningitis. The speaking zone was treated
as the main therapy, and as an adjunct a treatment comprised of needling
GV-20, GV-24 and the four points of Sishencong (Extra-6) were treated.
Three needles were used in the speaking zone, they were twirled rapidly for
two minutes, then connected to an electroacupuncture device and
stimulated for 30 minutes (at 14 Hz). Treatment lasted from 421 days. Of
the 9 patients treated, 4 were reported recovered and 2 improved.
According to the content of these reports, compared to Zhus techniques
there is shorter duration of individual treatments, reliance on

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electroacupuncture as stimulation, and no mentioned focus on patient

breathing or movements during treatment (e.g., for aphasia, Dr. Zhu
needles Eding zone #1 and has the person try to count from 1 to 10, say
their address, sing, etc., to use both voice and memory).
4. About the mechanism of action for stroke
In a study of scalp acupuncture applied immediately following a stroke
(21), it was reported that both thromboxane B2 (TXB2) and 6-ketone
prostaglandin F10 (6KP) levels in the blood plasma were affected. These
biochemicals are the stable metabolites of substances involved in platelet
clumping: thromboxane A2, which induces clumping of platelets and
contraction of arteries, and prostaglandin I2, which inhibits platelet
clumping and inhibits formation of arterial atheromas (by reducing cell
proliferation).
The physicians treated 20 patients who had suffered a stroke within the
prior 10 days. For scalp acupuncture, the major areas selected were the
motion zone and the diastole-systole zone. Body points were also
needled; alternating from one day to the next between treatment of yang
meridians (points would be selected from LI-15, LI-11, LI-4, TB-5, GB-30,
GB-34, GB-39, or UB-60) and treatment of the yin meridians (points would
be selected from HT-1, LU-5 PC-6, SI-13, SP-6, or LV-3). The scalp
needles were strongly stimulated with twirling at 200 times per minute for
23 minutes, and followed by the lifting maneuver to get the full qi
reaction. Body points were stimulated less, but it was important to get a qi
reaction. Needle retention was for 30 minutes, with electrostimulation used
after getting the qi reaction. Treatment was carried out for 6 consecutive
days, followed by a 1 day rest, as one course of treatment, for a total of 4
courses (one month). Drugs that might affect thromboxane or
prostaglandin levels were discontinued prior to the study.
It was shown that stroke patients had higher plasma TXB2 levels and lower
plasma 6KP levels than healthy persons. After performing acupuncture on
the stroke patients, the TXB2 levels declined and the 6KP levels rose. The
changes were statistically significant, though the parameters did not reach
the levels of healthy patients. The improvements in TXB-6KP levels were

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interpreted as a biochemical manifestation of harmonizing yin and yang.

The authors thought that the effect of acupuncture was mediated by the
cerebral cortex and the nervous humoral system.
REFERENCES
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3. Zhu Mingqing, A Handbook for Treatment of Acute Syndromes by Using
Acupuncture and Moxibustion, 1992 Eight Dragons Publishing, Hong Kong.
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5. Jiao Guorui, An introduction to the study of acupuncture and moxibustion in China,
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relation to CT findings, Journal of Traditional Chinese Medicine 1993; 13(3): 182
184.
7. Cui Yunmeng, Treatment of peripheral facial paralysis by scalp acupuncturea
report of 100 cases, Journal of Traditional Chinese Medicine 1992; 12(2): 106107.
8. Qu Hong, Ren Liping, and Guo Yi, Combined application of scalp and body
acupuncture in the treatment of pseudobulbar paralysis, Journal of Traditional
Chinese Medicine 1991; 11(3): 170173.
9. Pang Hong, 52 cases of apoplexy treated with scalp acupuncture by the slow-rapid
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10. Ji Xiaoping, Teaching round: Apoplexy, Journal of Traditional Chinese Medicine
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13. Ji Nan, et al., A study on the mechanism of acupuncture therapy in the treatment of
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Chinese Medicine 1987; 7(3): 165168.
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14. Zhang Naizheng, Clinical research on 35 cases of tremor artuum treated by body
needling plus scalp acupuncture, Chinese Acupuncture and Moxibustion 1996; 2:5
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15. Zhang Mingju, Treatment of 296 cases of hallucination with scalp-acupuncture,
Journal of Traditional Chinese Medicine 1988; 8(3): 193194.
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