10.3 Scalp Acupuncture: Systems, Stimulation Areas, Technique, and Indications
Key Takeaways
Jiao Shunfa's scalp acupuncture maps cortical functions onto the scalp; the motor area runs from 0.5 cm behind the midpoint of the midsagittal line to the temporal hairline.
The motor area is divided into thirds by function: upper fifth for the opposite leg and trunk, middle two fifths for the opposite arm, and lower two fifths for the face and speech.
Scalp areas treat the opposite side of the body: a left-hemisphere stroke with right-sided weakness is treated on the left side of the scalp.
Needles are inserted obliquely and advanced along the scalp under the galea, then twirled rapidly or electrically stimulated while the patient moves the affected limb.
Avoid open fontanelles, scalp infection, and the unstable acute phase of intracerebral hemorrhage, and press firmly after removal because the scalp bleeds easily.
10.3 Scalp Acupuncture: Systems, Stimulation Areas, Technique, and Indications
Quick Answer: Scalp acupuncture needles specific zones or lines on the scalp, mainly for neurological conditions. The best-known system, from Jiao Shunfa (China, early 1970s), projects functional areas of the cerebral cortex onto the scalp. The motor area treats paralysis on the opposite side of the body. The sensory area lies 1.5 cm behind it, and the chorea-tremor area lies 1.5 cm in front of it. The WHO standardized 14 scalp lines (MS 1-MS 14) in 1989. Needles are inserted obliquely, advanced along the scalp, and stimulated rapidly while the patient moves the affected limb. The main indications are stroke sequelae, aphasia, tremor, vertigo, and pain.
The Main Systems
| System | Origin | Key idea |
|---|---|---|
| Jiao's scalp acupuncture | Jiao Shunfa, Shanxi, early 1970s | Functional areas over the corresponding cerebral cortex |
| WHO standard scalp lines | WHO standard nomenclature, 1989 | 14 lines (MS 1-MS 14) defined by traditional points |
| Zhu's scalp acupuncture | Zhu Mingqing | Zones based on channel theory, with specific techniques and patient movement |
| Yamamoto New Scalp Acupuncture (YNSA) | Toshikatsu Yamamoto, Japan, 1973 | Somatotopic points mainly around the hairline |
Jiao's Stimulation Areas
Two reference lines are used: the midsagittal line from the glabella to the external occipital protuberance, and the eyebrow-occipital line from the midpoint of the eyebrow to the protuberance.
| Area | Location | Indications (opposite side unless stated) |
|---|---|---|
| Motor area | From 0.5 cm behind the midpoint of the midsagittal line, running obliquely to where the eyebrow-occipital line meets the temporal hairline | Paralysis. Upper 1/5: leg and trunk. Middle 2/5: arm. Lower 2/5: face, including motor aphasia (speech area I) |
| Sensory area | Parallel line 1.5 cm behind the motor area | Numbness and pain, divided in the same thirds |
| Chorea-tremor area | Parallel line 1.5 cm in front of the motor area | Tremor and chorea, as in Parkinson's disease |
| Vertigo-auditory area | 4 cm horizontal line centered 1.5 cm above the ear apex | Vertigo, tinnitus, hearing loss |
| Speech areas II and III | Lateral parietal and above the vertigo-auditory area | Nominal (word-finding) aphasia and receptive aphasia |
| Foot motor-sensory area | Paramedian lines near the vertex | Leg paralysis, numbness, and pain; also urinary frequency |
| Visual area | Occipital, beside the midline | Cortical visual disturbance |
| Balance area | Occipital, lateral to the visual area | Ataxia and balance disorders of cerebellar origin |
Selected WHO Scalp Lines
- MS 5, middle line of the vertex: from Du 20 (Baihui) to Du 21 (Qianding). For low back and leg disorders, urinary problems.
- MS 6, anterior oblique line of the vertex-temporal: from Du 21 (Qianding) to GB 6 (Xuanli). The motor line, used for paralysis.
- MS 7, posterior oblique line of the vertex-temporal: from Du 20 (Baihui) to GB 7 (Qubin). The sensory line, used for numbness and pain.
Technique
- Part the hair, locate the area, and clean the scalp with 70% alcohol.
- Insert a 1-1.5 cun filiform needle quickly at about 30 degrees, then lower the angle and advance it along the scalp in the loose layer under the galea aponeurotica.
- Stimulate by rapid twirling without lifting and thrusting (Jiao described roughly 200 rotations per minute for 1-2 minutes), or with electrical stimulation.
- Have the patient actively or passively move the affected limb, or practice speech, during stimulation.
- Retain the needles, often for 15-30 minutes or longer, restimulating periodically.
- On removal, press firmly for a minute, because the scalp is very vascular.
Indications
- Stroke sequelae: hemiplegia, numbness, and aphasia, during recovery after the patient is medically stable.
- Movement disorders: tremor of Parkinson's disease (chorea-tremor area), ataxia (balance area).
- Dizziness and vertigo, tinnitus: vertigo-auditory area.
- Pain and numbness: sensory area.
- Other neurological conditions such as multiple sclerosis, cerebral palsy, and the effects of brain injury, as part of a medical team plan.
Example Prescriptions
| Condition | Areas (Jiao system) | Notes |
|---|---|---|
| Right hemiplegia after a left-hemisphere stroke | Left motor area (segments for the affected limbs), left sensory area if numbness | Move the right limbs during stimulation |
| Motor aphasia (difficulty speaking) | Speech area I (lower two fifths of the motor area) on the dominant side, usually the left | Practice counting or naming aloud during stimulation |
| Parkinsonian tremor | Chorea-tremor area on the side opposite the tremor, or both sides | Combine with body points such as LR 3 and GB 34 |
| Vertigo and tinnitus | Vertigo-auditory area, both sides | Combine with GB 20 and SJ 17 |
| Nocturia or urinary incontinence | Foot motor-sensory area, both sides | Add body points such as Ren 4 and BL 23 |
| Ataxia from a cerebellar lesion | Balance area, both sides | Practice walking or balance tasks during stimulation |
Treatments are often given daily or every other day for a course of about 10 sessions in Chinese hospital rehabilitation, then reviewed. Electrical stimulation is often used to save the practitioner's hands during long twirling. Use it at a comfortable intensity, and follow the electroacupuncture precautions in Section 11.7.
Precautions and Contraindications
- Infants with open fontanelles: do not needle over the fontanelle.
- Acute stroke: a patient with new stroke symptoms needs 911, not acupuncture. Scalp acupuncture is started once the patient is medically stable. With intracerebral hemorrhage, wait until the condition has stabilized.
- Scalp infections, wounds, or skin disease at the site.
- High fever, severe heart failure, or very weak patients: avoid strong stimulation.
- Treat patients lying down or well supported, because strong stimulation can cause fainting.
A patient recovering from a left-hemisphere ischemic stroke has weakness of the right arm. Which scalp area is most appropriate?
The upper fifth of the right motor area
The lower two fifths of the right sensory area
The left vertigo-auditory area
The middle two fifths of the left motor area
Where does Jiao's chorea-tremor area lie in relation to the motor area?
1.5 cm in front of and parallel to the motor area
1.5 cm behind and parallel to the motor area
Directly on the midsagittal line
On the earlobe
During scalp acupuncture for post-stroke hemiplegia, what should the patient be asked to do while the needles are stimulated?
Hold completely still with the eyes closed
Actively or passively move the affected limb
Hold the breath during each twirl
Lie prone with the face down
A family brings a 66-year-old man to the clinic because his right face and arm became weak and his speech slurred 40 minutes ago. They ask for scalp acupuncture. What is the correct response?
Call 911 now; scalp acupuncture can be considered later, once he is stable
Begin scalp acupuncture in the left motor area immediately to limit the damage
Treat the right motor area now and recheck his speech in 30 minutes
Apply moxibustion to Du 20 and observe
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