INTRODUCTION TO SCALP ACUPUNCTURE

1. Characteristics of Scalp acupuncture a) A special needling technique. b) Combines TCM with the anatomy, physiology and functions of the cerebral cortex and the nervous system. c) The purpose of scalp acupuncture is: To promote Qi and blood circulation Strengthen the bodys resistance Eliminate pathogenic factors Regulate Yin and Yang Unblock the passage of energy via the meridians All of the essential Qi of yin and yang organs rises to the head The head is the seat of the Essential Brightness 2. Principles of the development of Scalp Acupuncture a) The acupoints or lines (Areas) distributed on the skin of the scalp correspond to their respective areas on the brain. b) The stimulation areas and standard lines are close to the brain lesion areas or the control center. c) The meridian and collateral circulate to the scalp. The meridians are connected to the brain directly or indirectly. d) The Qi and blood of the Zang-fu organs circulate to the brain. THE MIRACULOUS PIVOT states: 12 meridians, 365 acupoints, their blood and qi all run upward to the head on the mouth, eyes, ear, nose and brain. All meridians connect to the eyes and join the brain. The meridians circulating to the head and their acupoints. There are eight meridians circulating up to the head. They are Du meridian Bladder meridian Gallbladder meridian Stomach meridian Liver meridian Sanjiao meridian Yangwei meridian Yangqiao meridian 1) Du meridian Runs to DU 16 (Fengfu) at the nape of the neck where it enters the brain. 2) Bladder meridian

Ascends to the forehead and joins the Du meridian at the vertex and a branch runs to the temple. From the vertex, it communicates with the brain. 3) Gallbladder meridian Ascends to the corner of forehead and curves downward to the retroauricular region, GB 20 (Fengchi). 4) Liver meridian After passing the throat, it connects with the eye system, then runs further upward. It emerges from forehead and meets the Du meridian at the vertex. 5) Stomach meridian Ascends in front of the ear, follows the anterior hair line and reaches the forehead. 6) Sanjiao meridian A branch which originates from the chest, runs upward, emerges from the supraclavicular fossa, ascends the neck and runs along the posterior border of the ear to the corner of the anterior hairline. Then, this branch turns downward to the cheek and terminates in the infra-orbital region. It runs from the retro-auricular region and enters the ear. 7) Yangwei meridian Once it reaches the forehead, it turns backward to the back of the neck where it communicates with the Du meridian. This meridian connects with all yang meridians and dominates the exterior of the whole body. 8) Yangqiao meridian After it passes over the shoulder it ascends along the neck and the corner of the mouth. Then it enters the inner canthus at UB 1, runs along the bladder meridian to the forehead, and meets the Gallbladder meridian at GB 20 (Fengchi). This meridian governs and coordinates the Yang meridian on the lateral aspects of the head and brain As mentioned above, many of the regular meridians pass to the head and brain. We can therefore conclude that by puncturing specific areas and acupoints on the scalp we are able to treat the diseases. There are 35 acupoints on the hair-bearing area of the head. Eighteen of these acupoints are related to the treatment lines in scalp acupuncture. The acupoints on the scalp and their indications directly affect the areas or lines of scalp acupuncture. We therefore have to review the following acupoints locations and indications.

Du- Du 24 (Shenting), Du 22 (Xinhui), Du 20 (Baihui), Du 21 (Qianding), Du 19 (Houding), Du 18 (Qiangjian), Du 17 (Naohu), Du 23 (Shangxing) UB- B3 (Meichong), B5 (Wuchu), B6 (Chengguang), B7 (Tongtian), B8 (Luoque), B9 (Yuzhen), B 10 . GB- GB4 (Hanyan ), GB6 (Xuanli), GB7 (Qubin), GB8 (Shuaigu), GB 9 (Tianchong), GB13 (Benshen), GB 15 (Toulinqi), GB 16 (Muchuang), GB 17 (Zhenying) SJ- SJ 20 (Jiaosun), ST- ST8 (Touwei), Extra 6 (Sishencong) THE ANATOMY OF THE SCALP The scalp can be divided into five layers. Each layer possesses certain characteristics that help in understanding its importance in the practice of scalp acupuncture. The five histological layers of the scalp can be learned by using the spelling S-C-A-L-P (scalp), which is composed of the initial letter of each layer. 1) Skin : Thick tissue, fine and close, hair bearing area extending from the top of the neck muscle at the back of the head to the forehead and eyebrows at the front of the head and extending down over the temples to the ears and zygomatic arches. It includes sweat glands, sebaceous glands, lymphatic vessels, and rich blood supply which all communicate (anastomose) with each other, especially on the hyperdermic area. The vessel wall is closely adhered to the fibrous tissue and does not constrict easily after damage. For this reason, this area is prone to bleeding. Fortunately the healing ability of the scalp is strong. 2) Connective Tissue (or Superficial Fascia or Hypodermis): Fibro-fatty tissue contains thick and big fibrous bunches and adipose tissue, firm and tenacious, fine and close connective tissue with numerous arteries and veins forming free anastomosis. This area is prone to easy bleeding. Nerves of the soft tissue run through this layer. Needles generally encounter great resistance in this tense area. It is difficult to manipulate the needle within this layer. 3) Aponeurosis (or Galena aponeurotica and occipito- frontalis muscle): The occipito-frontalis muscle consists of occipital and frontal bellies, separated by an aponeurosis into which both are inserted.

The galena aponeurotica lies over the vertex between occipitalis and frontalis bellies. The skin of the scalp is firmly bound to these muscles and to the galena aponeurotica (epicranial aponeurosis). 4) Loose Connective Tissue (or Subaponeurotic space): It is a thin layer of loose areolar connective tissue. Bleeding and infection in this layer is easily spread. This layer is named the dangerous area. In severe cases, infection may spread to the bone or to the intracranial area leading to cranial osteomyelitis and intracranial infection. 5) Pericranium ( periosteum) : It is rather loosely attached to the bone but firmly attached to the suture (immovable joint on the scalp). In this area bleeding and infection beneath the pericranium cannot spread.

THE NERVE AND BLOOD SUPPLY OF SCALP The blood supply of scalp: The scalp is supplied by external carotid artery and internal carotid artery. The occipital artery, posterior auricular artery, and superficial temporal artery are derived from external carotid artery. Supratrochlear artery and supraorbital artery are derived from internal carotid artery. All these arteries anastomose with one another. The junction of forehead and temple, above the lateral end of eyebrows, is the area where it anastomoses. All the arteries are attached to the deepest layer of the dermis. The nerve of the scalp: The nerves of the scalp run with the arteries. Vertex and posterior area are supplied by greater occipital nerve and third occipital nerve. Posterior auricular area is supplied by the lesser occipital nerve. Temporal area is supplied by auricular-temporal & zygomaticotemporal nerves.

MAJOR TYPES OF SCALP ACUPUNCTURE

The treatment lines and the stimulation areas are not acupoints. These lines and areas are located on scalp. There are currently several different lines and areas used by the practitioners. Jiaos and Standard lines are more commonly used by the practitioners. I. JIAOS HEAD ACUPUNCTURE: Areas correspond to areas of the cerebral cortex and with its functional locations. Main location method: o First set up two basic lines, and 16 stimulation areas can be defined in relation to two basic lines. Manipulation method: o Rapid inserting, rotating and withdrawing the needle Used for the treatment of neurological conditions and 40 kinds of different diseases. II. FANGS SCALP ACUPUNCTURE: The supine and prone pictures of the human body on the scalp. A prone picture with the head to the forehead and the limbs stretched on the scalp. Manipulation method: o Rotating method Used for the treatment of neurological conditions and eyes diseases. III. ZHUS TREATMENT OF THE HEAD POINTS Zones are based on the location of the acupoints, channels, collaterals and the theories of Zang-Fu organs. The Du channel is the center line, and Du 20 is the center point. Nine treatment zones are located. Manipulation method: o Chouqi and Jinqi methods in combined with the breathing exercise, long retention of needles. Different clinical diseases and severe diseases, such as hemiplegic and emergency cases. IV: INTERNATIONAL STANDARD LINES Based on the TCM theories and meridians. Acupoints are used to locate lines Manipulation method: o tonification or purgation with the needle along or against the direction of channel. Mainly it uses to treat neurological diseases and others.

JIAOS SCALP ACUPUNCTURE

The areas of the scalp correspond to the functional location of the cerebral cortex. Method of location: To find the stimulating areas, it is necessary to mark some lines on the scalp. 1. Midline of head (Anterior median line): This line is drawn from Glabella (midpoint between the eyebrows) to the lower border of the external occipital protuberance. 2. Eyebrow-Occipital line (Supraciliary-occipital line): This line connects the tip of the external occipital protuberance to the midpoint of upper border of the eyebrow. Based on these two lines, sixteen stimulation areas can be defined. The sixteen stimulation areas are actually lines. It is important to remember areas are measured in centimeters and not cuns in this method. The stimulation area location, functions and their relationship corresponds to brain or cerebral cortex. 1. MOTOR AREA This area corresponds to the anterior border of precentral gyrus of the cerebral cortex. Location: The upper end lies on the anterior-posterior median line 0.5 cm behind its midpoint. The lower end lies at the intersection of the supraciliary-occipital line and anterior border of temple. The connecting line of these two points is the motor area which can be divided into five sections. Indications: This area is divided into five equal parts: Upper 1/5: to treat paralysis of the lower extremity of the opposite side (contra lateral). Middle 2/5: to treat paralysis of the upper extremity of the opposite side (contra lateral). Lower 2/5 (includes Speech I): to treat facial paralysis, motor aphasia, dripping saliva, diseases of mouth and phonation disturbances. [Types of Aphasia Sensory Aphasia (Wernickes aphasia): Fluent and rapid speech, no comprehension of spoken or written languages. Motor aphasia (or expressive aphasia or Brocas aphasia): Broken Speech, understands but cannot articulate appropriately. Combination aphasia: Combined sensory and motor aphasia. Nominative aphasia: Inability to name objects, even very ordinary ones. It is caused by lesion of the angular gyrus, can be treated by using Speech area #2.]

2. SENSORY AREA This area corresponds to the anterior border of postcentral gyrus of the cerebral cortex. Location: Parallel to and 1.5 cm posterior to the motor area. Indications: This line can be divided into five equal parts: Upper 1/5: treats opposite side low back pain, leg pain, numbness, abnormal sensation or feelings, occipital headaches, stiff neck, neck pain, and tinnitus. Middle 2/5: treats opposite side upper extremity pain, numbness, and abnormal sensations of upper limb. Lower 2/5: treats numbness and pain of the contra-lateral side of the head and face.

3. CHOREA AND TREMOR CONTROLLING AREA This area corresponds to the external pyramidal bundle of the brain. Location: Parallel to and 1.5 cm anterior to the motor area. Indications: Used to treat involuntary movement and tremors of opposite side extremity. 4. VASCULAR DILATION AND CONSTRICTION AREA Location: Parallel to and 1.5 cm anterior to the chorea and tremor controlling area. Indications: Treats primary (essential) hypertension and cortical edema. (Cortical edema- Patient with brain vessel diseases who have suffered from paralysis of the extremity combined with edema. It is not related to the heart, liver, kidney or malnutrition it may be caused by brain cortex damage.) 5. VERTIGO AND HEARING AREA (Dizziness and auditory area) This area corresponds to the upper border of superior temporal gyrus Location: A horizontal line 4 cm in length and with its midpoint 1.5 cm directly above the tip of the auricle. Indications: Treats ipsilateral dizziness, auditory vertigo, Ipsilateral tinnitus, diminished hearing, cortical hearing impairment and auditory hallucination. 6. SPEECH # 2 AREA This area corresponds to the Angular gyrus.

Location: A line 3 cm in length and parallel to the anterio-posterior median line. Downward from the point 2 cm besides the parietal tuber. Indications: Nominative (anomic) aphasia. 7. SPEECH # 3 AREA Location: A horizontal line which goes 3 cm backward/posterior from the midpoint of the dizziness and auditory area. Indication: Sensory aphasia 8. APPLICATION AREA (Voluntary movement area) This area corresponds to the Supramarginal gyrus. Location: Three lines, 3 cm in length each, drawn from the parietal tubercle. The middle line goes toward the center of mastoid process. The second line is to the front of middle line and the third posterior to the middle line. Together they make a 40-degree angle with the middle line. Indication: Aprexia*(syn. parectropia) (*Aprexia: The patient is unable to execute a voluntary motor movement despite being able to demonstrate normal muscle function. Aprexia is not related to a lack of understanding or to any kind of physical paralysis but is caused by a problem in the cortex of the brain.) 9. MOTOR AND SENSORY AREA OF FOOT Location: A parallel line of 3 cm in length on the vertex. The line is 1cm parallel to the anterior-posterior median line and from the midpoint goes backwards or posterior 3cm. Indications: Contra lateral lumbago, leg pain, numbness and paralysis. Nocturnal urination of child. Increased frequency of urination, cortical dvsuria, cortical urinary incontinence paralysis, nocturnal enuresis. Combine with genital (reproductive) area to treat frequency and urgency of urination present in acute cystitis. Increased thirst, diuresis due to diabetes mellitus. Impotence, emission and prolapsed uterus, prolapsed anus Combine with intestine area to treat allergic (irritable) colitis, or diarrhea. Combine with thoracic cavity area to treat oliguria due to rheumatic heart diseases.

Combine with sensory area upper 2/5, to treat hyperplasia syndrome of cervical and lumbar vertebrae. Contact dermatitis and neurodermatitis. Frequent micturition, difficult urination and incontinence of urination caused by the functional disturbance of Para central lobule due to cerebral arteriosclerosis with deficiency of blood supply in the anterior cerebral artery and cerebral thrombosis. This is called cortical frequent urination, cortical difficult urination and cortical incontinence of urine, respectively.

10. VISION AREA (Optic area) This area corresponds to the occipital lobe, lateral area of brain Location: A parallel line of 4 cm in length 1cm parallel to the anterioposterior median line. This line is located lateral to external occipital protuberance and upward from the level of the external occipital protuberance. Indications: Treats cataracts and the cortical impairment of vision 11. BALANCE AREA This area corresponds to the hemisphere of the cerebellum. Location: A vertical line of 4 cm in length and 3.5 cm beside anterioposterior median line or 3cm lateral to the external occipital protuberance. This area line runs downward from the level of external occipital tuberosity. Indications: Treats imbalance caused by the injury of the cerebellum. 12. STOMACH AREA Location: A 2 cm vertical line which goes upward from the level of anterior hairline. The line runs parallel with the anterio-posterior median line and directly above the center of the pupil. Indication: Pain from acute and chronic gastritis. Discomfort or pain in the abdomen. Pain due to ulcer of stomach and duodenum 13. LIVER AND GALLBLADDER AREA Location: A 2 cm line extending downward/anterior from the stomach area and parallel with the anterio-posterior median line. Indications:

Pain in upper right quadrant of the abdomen due to liver and gallbladder disorders.

14. THORACIC CAVITY AREA Location: A 4 cm vertical line right between the anterior-posterior median line and the stomach area. The line is 2 cm above/anterior and 2 cm below/posterior to the anterior hairline. Indications: Allergic asthma, bronchitis. Angina pectoris, chest pain, rheumatic heart disease and paroxysmal supraventricular tachycardia (also effective to some extent to treat shortness of breath, edema and oliguria). 15. REPRODUCTION AREA Location: To locate draw a 2 cm vertical line upward from the frontal corner (angle of forehead) in parallel with the anterior-posterior median line. This line is lateral to the stomach area and at a distance equal to that between stomach area and thoracic area. Indications: Functional uterine bleeding. Used in combination with both side of the motor-sensory area of the foot to treat frequency of urination and urgent urination due to acute cystitis Extreme thirst, polyuria, increased intake of water intake due to diabetes mellitus. Impotence, enuresis and uterine prolapse. (Combine with leg motor sensory is for the treatment.) 16. INTESTINE AREA Location: A 2 cm vertical line extending further downward from the reproductive area. Indication: Pain in the lower abdomen. (The above stimulation areas are named according to the organs they treat as when these area are punctured , the patient will get the sensation on that corresponding area with some therapeutic results.)

THE STANDARD LINE SCALPACUPUNCTURE

The standard line is located on the scalp and is based on TCM theory and acupuncture. There are fourteen main standard (MS) lines. They are as follows: 1. MS 1 (Middle line of forehead) Location: 1 cun long from DU 24 (Shenting) straight and downwards along the meridian. Indications: Epilepsy, mental disorder, and diseases of nose. 2. MS 2 (Line I lateral to forehead) Location: 1 cun long from UB 3 (Meichong) straight and downward along the meridian, close to the inner cantus. Indications: Bronchitis, bronchi-asthma, angina pectoris, insomnia 3. MS 3 (Line II lateral to Forehead) Location: 1 cun long from GB 15 (Toulinqi) straight and downward along the meridian. Indication: Acute and chronic gastritis, peptic ulcer, liver and gallbladder diseases.

4. MS 4 (Line III Lateral to forehead) Location: 1 cun long from the point 0.75 cun medial to ST 8 (Touwei) straight and downward lateral to the MS 3 Indications: Functional uterine bleeding, impotence, enuresis, prolapse of uterus, and urine frequency 5. MS 5 (Middle line of vertex) Location: A line from Du 20 (Baihui) to DU 21 (Qianding) along the midline of head. Indications: Leg and foot diseases such as paralysis, pain and numbness. Nocturnal enuresis. Polyuria from cortex, anal prolapse, nocturnal urination of child. Hypertension, and vertex headache 6. MS 6 (Anterior oblique line of vertex-temporal) Location: From Qianshengchong (1 cun anterior to DU 20) to GB 6 (Xuanli) Indications: This line can be divided into five equal parts.

Upper 1/5, to treat opposed side paralysis of lower extremity. Middle 2/5, to treat opposed side paralysis of upper extremity Lower 2/5, to treat center facial nerve paralysis, motor aphasia, diseases of the mouth and cerebral arterial sclerosis 7. MS 7 (Posterior oblique line of vertex-temporal) Location: From DU 20 (Baihui) obliquely to GB 7 (Qubin) Indications: This line can be divided into five equal parts. Upper 1/5, to treat opposed side abnormal sensation of lower extremity. Middle 2/5, to treat opposed side abnormal sensation of upper extremity. Lower 2/5, to treat abnormal sensation of head and face.

8. MS 8 (Line I Lateral to vertex) Location: 1.5 cun lateral to middle line of vertex, 1.5 cun long from B 6 (Chengguang) along the meridian. Indications: Lumbar, leg diseases such as paralysis, numbness, pain etc. 9. MS 9 (Line II Lateral to vertex) Location: 2.25 cun lateral to middle line of vertex, 1.5 cun long from GB 17 (Zhengying) along the meridian. Indications: Shoulder arm and hand diseases, such as paralysis, numbness, and pain. 10. MS 10 (Anterior temporal line) Location: From GB 4 (Hanyan) to GB 6 (Xuanli), within the hair line from the corner of forehead to hair line anterior to the ear. Indications: Peripheral facial nerve numbness, migraine and motor aphasia. 11. MS 11 (Posterior temporal line) Location: From GB 8 (Shuaigu) to GB 7 (Qubin), on the temple, directly superior from apex of the ear. Indications: Migraine headache, deafness, tinnitus and vertigo

12. MS 12 (Upper-middle line of occiput) Location: From DU 18 (Qiangjian) to DU 17 (Naohu) the middle vertical line from external occipital protubercle. Indication: Eyes diseases. 13. MS 13 (Upper-lateral line of occiput) Location: 0.5 cun lateral and parallel to upper-middle line of Occiput. Indications: Vision problem such as cortical disturbances, cataract and near sightedness. 14. MS 14 (Lower-lateral line of occiput) Location: 2 cun long from B9 (Yuzhen) straight downward, inferior to the external occipital protubercle, 1 cun lateral to the external occipital protubercle vertical line From B9 (Yuzhen) to B 10 (Tianzhu) Indications: Imbalance from diseases of cerebellum, and occipital headaches.

TREATMENT LINES, MERIDIANS AND ACUPOINTS

The treatments lines of scalp acupuncture pertain to the meridians, which as you know circulate up to the head separately. This is the basis for selecting lines and areas and making prescriptions with scalp acupuncture in the clinic. Du meridian: The following line pertains to the Du meridian MS 1, MS 5, MS 12 This line crosses the Du meridian MS 6, MS 7 The nine meridians that cross the Du meridian are Ren meridian, hand-Yangming, foot-Yangming, hand-Taiyang foot-Taiyang, hand-Shaoyang, foot-Shaoyang, Yangwei, and footJueyin Bladder meridian: The following line pertains to the bladder meridian MS 2, MS 8, MS 14 This line crosses the bladder meridian MS 6, MS 7 The meridians that cross the bladder meridian are foot-Shaoyang, Du meridian, hand-Taiyang, hand-Shaoyang, footYangming, foot-Shaoyin, Yangqiao, and Yinqiao.

Gallbladder meridian: This line pertains to the Gallbladder meridian MS 9, MS 10, MS 11, MS 3 This line crosses the Gallbladder meridian MS 6, MS 7 The meridians that cross the Gallbladder meridian are foot-Yangming, hand-Shaoyang, foot-Jueyin, hand-Taiyang, foot-Taiyin, hand-Jueyin, Du meridian, and Yangwei Stomach meridian: This line relates to the stomach meridian MS 4 The meridians that cross the stomach meridian are hand-Yangming, foot-Taiyang, Du meridian, foot-Shaoyang Ren meridian, Chong meridian, Yangwei and Yangqiao meridian.

Comparison between Jiao and Standard line scalp acupuncture. Jiao

Thoracic area Stomach, LV, GB area Reproductive area Motor area Sensory area Foot motor sensory area Vertigo hearing area Vision area Balance area

Standard line
MS2 (I lateral to forehead) MS3 (II lateral to forehead) MS4 (III lateral to forehead) MS6 MS7 MS5, MS8 MS11 MS12, MS13 MS14

ZHUS SCALP ACUPUNCTURE

There are eight treatment zones in Zhus scalp acupuncture. Locations are based on the twelve channels. The naming of the zones is based on names of the acupoints and anatomical names of the scalp bone. Each treatment zone has its own therapeutic effect and indications. 1. EDING ZONE Location: 0.5 cun on either side of the line joining Baihui (Du 20) to Shenting (Du 24). The zone is 1 cun wide. It belongs to the Du channel and the bladder channel of footTaiyang. Functions: Calms the mind and soothes the fright. Calms the heart. (front 2/4) Treats sore throat, regulates the lungs and soothes the chest disorders. Revives the patient from unconscious state. (Front 1/4). Regulates the stomach and cleans the intestines (from 3/4). Regulates the gallbladder and disperses the stagnant liver Qi Reinforces the kidneys to promote diuresis. Regulates menstruation. Ascends Yang to restore its astringent function (back 1/4). Indications: Eding zone is used to treat diseases on the Yin side of the body, such as diseases of the face, chest and abdomen. Eding zone can be divided into four parts: Front 1/4 is for the diseases of the face, throat and tongue Front 2/4 is for the diseases of the chest and upper Jiao, heart, lung, bronchi and diaphragm. Used for chest pain, stuffiness of the chest, palpitation, cough asthma, etc Front 3/4 is for the diseases of the upper abdomen, and middle Jiao, liver, gallbladder, spleen, stomach and pancreas. Used for biliary colic, gastritis, Stomach ulcer and dysfunction of digestive system etc Back 1/4 is for the diseases of lower abdomen and lower Jiao, bladder, prostate, urethra, perineum and reproductive organs. Used for kidney stone, retention of urine, incontinence or urine, prostatitis, etc.

2. EPANGZONE Epang Zone I Location: A zone 0.5 cun anterior and posterior to Toulinqi (GB 15) and 0.25 cun lateral to it on either side. It belongs to the gallbladder channel of foot-Shaoyang. Functions: Dispersing the stagnated liver Qi to pacify the stomach. Regulating the gallbladder to clean the intestine. Indications: Acute diseases of the middle Jiao. The diseases of the spleen, stomach, liver, gallbladder, and pancreas. Epang Zone II Location: A zone of 0.5 cun anterior and posterior to Touwei (St 8) and 0.25 cun lateral to it on either side. It belongs to the stomach channel of foot-Yangming. Functions: Reinforcing the kidney to promote diuresis. Regulating menstruation and restoring astringent function Indications: Acute diseases of the lower Jiao. The diseases of the kidney, bladder, reproductive system etc 3. DINGNIE ZONE Location: 0.5 cun on either side of the line joining Qianding (Du 21) to Touwei (St 8). It belongs to the Du channel, the bladder channel of foot- Taiyang and the gallbladder channel of foot Shaoyang. Functions: Dredging the meridian passage. Strengthening the tendons and relieving pain. Indication: Diseases of dyskinesia and dysesthesia. Effect is remarkable for the diseases of central dyskinesia and central dyskinesia and dysaesthesia. The zone can be divided into three equal length parts: Upper 1/3 can treat diseases of the lower limbs. Middle 1/3 can treat diseases of the upper limbs. Lower 1/3 can treat diseases of the face and side of the head.

(Inserting needles from Qianding (Du 21) to Touwei (St8) can treat diseases of dyskinesia, such as weakness or paralysis of limbs. Inserting needles from Touwei (St 8) to Qianding (Du 21) can treat diseases of dysesthesia of limbs, such as pain, numbness etc.) 4. DINGZHEN ZONE Location: 0.5 cun on either side of the line joining Baihui (Du 20) to Naohu (Du 17). The zone is 1 cun wide. It belongs to the Du channel and the bladder channel of foot-Taiyang. Function: Circulating and smoothing the Qi of the Du and bladder channel. Reinforcing the kidney. Improving eye sight. Relieving pain. Indications: Diseases on the Yang side of the body. The zone can be divided into four equal parts from upper to lower. They can treat diseases of the head, neck, back, lumbar region, sacrum and perineum. Treats cervical hyperosteogeny, cervical spondylopathy, pain of the lumbar region and back, lumbar muscle sprain etc. 5. FRONT ZONE OF DINGjlE Location: A zone of 0.25 cun on either side of the line joining Tongtian (B7) to Baihui (Du 20). It belongs to the Du channel and the bladder channel of foot-Taiyang. Function: Dredging the meridian passage and relieving pain. Indication: Diseases of the hip joint and buttock. Such as sciatica, pyriformis injury etc. 6. BACK ZONE OF DINGJIE Location: A zone of 0.25 cun on either side of the line joining Luoque (B 8) to Baihui (Du 20). It belongs to the bladder channel of footTaiyang and the Du channel. Function: Dredging the meridian passage and relieving pain. Indications: Diseases of the shoulder joint and neck, such as injury to the shoulder joint, arthritis, cervical vertebra pain etc.

7. .NIEQIAN ZONE Location: 0.5 cun on either side of the line joining Hanyan (GB 4) to Xuanli (GB 6). It belongs to the gallbladder channel of foot-Shaoyang. Function: Circulating channel Qi of the Shaoyang channel and the facial area. Indications: Migraine, Kinetic aphasia, peripheral facial nerve paralysis and diseases of mouth. 8. NIEHOU ZONE Location: 0.5 cun on either side of the line joining Tianchong (GB 9) to Jiaosun (SJ 20). It belongs to the gallbladder channel of foot-Shaoyang and the Sanjiao channel of hand-Shaoyang. Function: Circulating Qi of the Shaoyang channel. Treats dizziness and diseases of the ear. Indications: Migraine, dizziness, deafness, tinnitus.

SCALP ACUPUNCTURE TECHNIQUES

Needle: 1-1.5-cun (Gauge 30 or 32) stainless steel filiform needle with short handle, so as to be convenient for manipulating needles and retaining needles. On some patients Gauge 28, 1.5 - 2 cun is used. Preparation before puncture: Carefully inspect and select the needle, if needle is damaged (broken tip, loose handle, rusty, marks of damage, or bent) avoid using it and discard it. Practice: Good skills can reduce the puncture pain and improve the therapeutic effects. The practice includes the strength of fingers, the skill to insert the needle, the needle manipulation movement, the skill to twist the needle. You can use gauze or thick layer paper or cotton to practice quick puncture, deep insertion, withdrawal and twisting the needle.

Posture of the patient: The patient should be put in a comfortable position, which makes it easy for the practitioner to accurately locate and stimulating areas or lines. Sitting or any other position is selected depending on the patients situation. Patients who suffer from the disease of Zang-Fu organs, patients with the history of fainting, extremely weak patients, and patients who have difficulty sitting up can be treated with either a lying or supine posture. If sitting posture or standing posture is selected, it is important the practitioner should be facing the patient. It makes it easier for the practitioner to locate the area or line accurately. Sterilization: At present, sterile disposable needles are used. The treatment areas or lines must be wiped with 2% iodine, and then followed by 70% alcohol. The practitioners fingers should be sterilized routinely with 70% alcohol cotton balls. Insertion and withdrawal: Following are methods for needle insertion: The common method The method of inserting needles along with the nail pressing the skin is usually used. Then, press besides the stimulation area or line (acupoint) with the nail of thumb of left hand, hold the needle with the right hand and keep the needle tip closely against the nail, then insert the needle into the areas or lines. Insertion of the needle: avoid the hair-follicle so as to as to reduce pain. Rotating the needle obliquely while inserting the needles. Withdrawing the needles: Before withdrawing the needle, manipulate the needle again. When withdrawing the needle, press the skin around the point or area gently and lift it rotating the needle slowly to the subcutaneous level, then withdraw it quickly. Press the puncture point for a while with a sterile cotton ball to prevent bleeding. *(This technique, apart from its low efficiency, also had the drawback of causing much discomfort to the patients.) Three-quickness acupuncture technique It is a fast insertion, fast twirling and fast withdrawal of the needle method-----so called three-quickness acupuncture technique Quick insertion, quick manipulation, and quick removal of needles.

Angle and depth of insertion: In order to insert the needle into the subaponeurotic space, after inserting the needles quickly push into the skin; the best angle of insertion is about 15-30 degree. The depth of insertion should be about 1 cun. Retaining the needle: Retaining the needle means to keep the needle in place, so as to strengthen the therapeutic effect of scalp acupuncture. Course of treatment: Chronic diseases: The treatment will be given every two days, ten treatments as one course. The next course of treatment will begin at the interval of 10-20 days. Acute diseases: The treatment course may vary from 3 to 10 treatments. Longer time to retain the needles and manipulating the needles at intervals can be applied to control the disease. After the diseases are relieved, treatment may be given daily or every two days. Manipulations Twirling method (Jiaos method in stimulation area): The needle is twirled 200 time/min for 1-2 minutes, or 400 time/min at most, and then it is retained in the scalp for 5-10 minutes or up to 30-40 minutes. The manipulation should be repeated twice after intervals of 5-10 minutes, and then the needle is withdrawn. Quick manipulation of the needle can generate a stronger stimulation in the patient and better therapeutic results may be obtained. Tonification or Purgation on the standard line: Tonification is a slow puncture in and fast withdrawal. Reducing is a fast puncture and slow withdrawal of the needle. For the tonification method, the tip of the needle should be positioned along the direction of the meridian. For the purgation method the needle is positioned against the direction of the meridian. Chouqi and Jinqi method: Chouqi: After the needle is inserted beneath to the subaponeurosis, slowly thrust the needle about 1-1.5 cun deep horizontally. Then lift the needle quickly with strong force, without letting the body of the needle move, or it may move no more then 0.1 cun outward. Repeat many times until the arrival of qi and the desired effect is achieved. Jinqi: After the needle is inserted beneath the subaponeurosis, slowly thrust the needle about 1-1.5 cun deep horizontally then thrust the needle quickly with strong force, but the body of the needle

should not move, or it may move no more than 0.1 cun inward. Repeat many times until the arrival of Qi and the desired outcome is achieved.

NEEDLE SENSATION (OR ARRIVAL OF QI) WITH SCALP ACUPUNCTURE

Types of needling sensation Signs of needling sensations o The common needling sensations include: a hot feeling, numbness and or spastic-like feeling. The hot feeling may appear in 80 percent of the patients. o The original symptoms of numbness, coolness, spastic sensations, and pain maybe relieved or disappear during the process of scalp acupuncture. o Some patients cannot detect the needling sensation and yet the treatment can produce the desired therapeutic results. The Areas and Types of Needling Sensation o Most patients experience sensations that may reach the contra lateral limb. o In a small number of patients, this sensatory conduction goes to the ipsilateral limbs while some patients may feel this in their whole body. o Sometimes, the sensatory conduction is limited to a local area such as a joint or muscle o Needling sensation may appear after a few seconds up to several minutes; some may appear several hours after the needles have been removed Involuntary movement reaction: o The limbs may move involuntarily, for example, a diseased limb may be lifted up involuntarily, automatically extend and stretch. o Automatic movement of internal organs, such as cough, peristalsis of the stomach and intestines may increase. Perspiration in the face or the extremities: Some patients may have sweat on the face and extremities (palm) on the opposite side. Sometimes the sweat may even drip. Temporary exacerbation of symptoms Some patient will notice their symptoms or signs increasing during needling stimulation. But this phenomenon will disappear a few minutes after the needles are removed.

The main factors in the arrival of Qi: There are several factors that can influence the arrival of qi. Precisely locating the stimulation area or line on the scalp bears directly on the results. Proper manipulation: Cooperation with the breathing exercise (* Scalp acupuncture in combination with the breathing exercise can enhance and strengthen the therapeutic effect.) THE PRINCIPLES FOR THE LINE AND AREA SELECTION The treatment lines should be selected according to their functions and differentiation of syndromes. The place of insertion should be decided on the basis of the disease site: For diseases above the neck, the same side lines or areas can be selected for needling. For diseases below the neck, the opposite side lines or areas should be selected according to the rule for the contra lateral needling. According to the Yin and Yang theory of TCM. If the disease site is on the Yin side, the tip of the needle should be pointed to the yin aspect. If the disease site is on the yang side, the tip of the needle should be pointed to the yang aspect. (*To distinguish the yin and yang aspects of the line according to DU 20 (Baihui). Anterior to Du 20 belong to a Yin aspect and posterior to DU 20 belongs to a Yang aspect.) According to the affected areas of the body. For disease affecting only a limb, a site is selected on the contra lateral side of the head. Diseases affecting the bilateral limbs are treated by stimulating sites on both sides of the head. Diseases of the internal organs or those which are systemic in nature (such as hypertension or urticaria etc.) are treated by stimulating sites on both sides of the head. The diseases which are difficult to distinguish as being one sided or the other (such as vertigo etc.) is treated by stimulating both sites on the head.

INDICATIONS CONTRAINDICATIONS AND PRECAUTIONS Indications: Brain diseases and their complications, pain of internal organs, skin diseases, some peripheral disease and genital urinary diseases. Acupuncture anesthesia. Contraindications: Needles should not be applied to the area on the vertex of infants when their fontanels are not closed, and retaining the needle is forbidden for the infants. It is not advisable to apply scalp acupuncture to a place where the scalp has an operation wound, scar or tumor. It is no advisable to apply scalp acupuncture to a scalp with severe infection, ulcer or trauma. If a patient is stressed, fatigued or hungry, scalp acupuncture may not be applied or carefully applied to avoid fainting.

THE TREATMENT OF COMMON DISEASE (Samples)

Treatment of nervous system diseases Stroke patient with paralysis The patient is in a coma due to the hemorrhage in the brain. The patient needs to be treated to stop the bleeding by a physician do not use acupuncture at this stage. The acupuncture treatment can be started once the patient is out of coma and the condition is stable. If the patient is in the hospital, scalp acupuncture can be applied once a day or every other day for 10-15 days as one course. The following areas or lines can be used for treatment On the opposite side: motor area, sensory area, foot motor-sensory area MS 5 middle line of the vertex MS 6 Anterior oblique line of vertex-temporal MS 7 Posterior oblique line of vertex-temporal MS 8 Line 1, lateral to the vertex MS 9 Line II lateral to the vertex For the feet motor-sensation areas, MS 8, and MS9 you can use both sides to get better needle reaction and the feeling may be on one side or both sides. For paralysis or numbness on the extremities, combine with regular acupuncture therapy

Different Consciousness states 1) Light unclear mind (Confusion state): Mild confusion states are common, especially among elderly patients, including the trauma of major surgery. Inappropriate response to question, can only answer some simple questions, but not the complicated, decreased interaction with environment. Patient may be less active and disoriented. 2) Lethargic: Drowsy, a condition of abnormal drowsiness or temporary loss of all or part of sensation or motion, lacking energy, slow or slow moving, falls asleep quickly. Once aroused, can answer some simple questions. 3) Coma: This is a severe disturbance of the mind, and can be divided into three different degrees of severity. In none of the three states can the patient can be awakened. a) Light coma: some reaction to strong stimuli, such as pain. Respiration, blood pressure and heartbeat are normal. b) Intermediate coma: decreased reflex, pathological reflex like Babinskis sign, respiration and heart function lightly disturbed, incontinence or retention of bladder and bowels. c) Deep coma: absence of reflexes (all deep and superficial reflexes disappear), heart and vascular functions are disturbed. 4) Delirium: Mostly seen with high fever or toxicity of patient. Sudden onset. Lasting for hours or days, rapid mood swings, fear, and suspicion. Slurred or rapid and manic speech and hallucinations are common. Sleep-wake cycle may be disturbed Intracranial infections A patient in an acute stage has to be treated by internal medicine in a hospital. After the patient wakes up and their symptoms are stable, if the patient has paralysis, numbness or aphasia. Select the area or line as Stroke patients. If a patient has aphasia use the Speech #III or Speech # II, MS 10 (anterior temporal line) Combine with regular acupuncture for paralysis, numbness or atrophy of the extremities Treatment course: QD for 10-15 days as one course, then after an interval 5-7 days, then start another course, if the patient needs more therapy.

Parkinsons disease, tremor and chorea disease Stimulation area: Chorea tremor area. If it is a semi-Chorea disease use the opposite side. Line MS 14 (lower-lateral line of the occiput) Headache Vertex pain: MS 5 middle line of vertex both sensation upper 2/3 area. Forehead-temporal area pain: Sensory lower 2/5 Occipital headache: Lower-lateral line of occiput Migraine MS 10 Anterior temporal line, MS 11 Posterior temporal line Sciatica Opposite side or both sides Sensory area upper 1/5, Foot motorsensory area MS 7 posterior oblique line of vertex-temporal upper 1/5 MS 2 line I lateral to forehead. During treatment you can ask the patient to work or move the lesion side of their legs and thighs Combine with regular acupuncture on the lesion side. Neurological diseases Tinnitus, vertigo and Menieres disease The Vertigo-hearing area MS 11 Posterior temporal line Skin diseases Neurodermatitis, Urticaria, Pruritus The area, or line used depends on the disease and the lesions. Skin pruritus: Sensation area upper 2/5 (both), foot motor-sensory area (both) MS 5 middle line of the vertex, MS 8 Line I lateral to the vertex Neurodermatitis: One side disease: Opposite side upper 3/5 sensory area, foot motor-sensory area Both sides: Both sensory areas upper 3/5 and Foot motor-sensory area Urticaria: Both sensory areas upper 3/5