General Clinical Applications
Traditionally, SA is used to treat cerebral diseases such as paralysis, aphasia, multiple sclerosis, automobile-accident brain trauma and Parkinson's disease. Its effectiveness has also been observed in treating loss of balance, loss of hearing, dizziness and vertigo.7
SA may also be effectively employed for pain and mental health management; and provides preventive benefits against illness by strengthening the immune system. SA is highly recommended for disorders related to the central nervous system and endocrine system.7-8
SA in Clinical Pain Management
Successful clinical results have been observed and reported on SA in managing various pain conditions, such as phantom pain, complex regional pain and residual limb pain.7,26 I have observed instant pain relief in 90 percent of applicable clinical cases with at least 50 percent or more reduction in pain.
The pain conditions treated include shoulder impingement, tibia plateau fracture; postoperative hip pain; tendonitis; neck pain; shoulder pain; lower back pain with or without bulging disc or spinal stenosis; headaches; neuropathy; CRPS; and more. Other than pain, Liu's scalp acupuncture also has demonstrated effectiveness in managing angioedema, anxiety and stress-related mental health conditions.
Clinical Studies on SA For pain management
Clinical studies on SA and pain management are limited, based on PubMed searches using "acupuncture," "pain," "scalp acupuncture" as search terms. With that said, here are some of the research indications for SA based on the available literature to date.
Post-stroke with pain. In a post-stroke study, effective rates for the SA rehabilitation group were superior in both shoulder pain score and functional improvement compared to a body acupuncture group and a medication group.13
Lower back pain. In a randomized, double-blind trial, pain score improved significantly in the SA group compared to the sham group, along with functional status, quality of life and anti-inflammatory tablet intake.14
Migraine headache. In one randomized clinical trial, results showed similar symptom reductions in both the SA and CA [classic acupuncture) groups in terms of pain scale and related symptoms.15
A systematic review of neurovascular headache studies included 16 articles and 535 cases. Meta-analysis showed a significant superior difference between comprehensive acupuncture therapy (SA plus CA) vs. acupuncture therapy alone. This indicates that acupuncture combined with other therapies, such as point injection, scalp acupuncture, auricular acupuncture, etc., were superior to CA alone.16
Postoperative pain. SA's effectiveness in postoperative pain reduction was observed in both animal and human studies.17-18 Clinical trials have showed the potential advantages of using SA for postoperative intestinal cancer pain and total knee arthroplasty.17,19
Labor pain. Bo, et al.,20 reported that labor pain was significantly reduced in the SA group compared to the no-intervention group, including significant differences without adverse effect.
Potential mechanism of SA
The scalp somatotopic zones seem to operate as a miniature transmitter-receiver, directly communicating with the central nervous system and endocrine system; and providing direct effects on the cerebral cortex, cerebellum, thalamo-cortical circuits, thalamus, hypothalamus, and pineal body.7 Evidence of effects or connections between scalp acupuncture points and the brain through different pathways have been observed or recorded21 with EEG.22-23
This data demonstrated objective evidence of the connection between acupuncture points and changes in brain activity, and a possible neurological pathway of scalp acupuncture to brain functional regulation and cerebral disease treatment. Scalp acupuncture's therapeutic mechanisms are waiting to be addressed.
CA vs. SA in Pain Management
SA is quite young, having evolved only over the past 50 years and including newly developed knowledge and techniques with many styles.5 Scalp acupuncture is a contemporary microacupuncture system integrating TCM theory and acupuncture needling methods with Western medical knowledge.
SA has demonstrated its clinical efficacy in treating acute and chronic central nervous system disorders.7 SA is considered to be the most effective method, followed by electroacupuncture, for primary insomnia after reviewing randomized, controlled trials (RCTs) using network meta-analysis.24 Clinicians have contributed to the clearly defined correlation between each of the scalp acupuncture points and their correlation to particular function zones.7,12
Comprehensive studies on scalp acupuncture are limited, especially compared with classic body acupuncture. In PubMed, with a search of "acupuncture," 32,095 results were found as of the time of this writing, while a search of "scalp acupuncture" yielded only 347 results.
There is a long history of treating pain with CA. Most treatment choices among different forms of acupuncture are made based on personal experience, preference and expertise. The similarities, differences and collaboration between CA and SA in pain management remain to be explored.
In pain management, significant intra-individual pain reduction differences have been reported between SA, CA and sham after experimental pain stimuli.25 For migraine headaches, SA and CA have similar effectiveness,15 while SA in combination with CA has superior effects in comparison to CA alone.16 In postoperative pain management studies, SA is as effective as, if not better.17, 18-19
Scalp acupuncture has performed at least similarly or better compared with CA acupuncture in reducing pain, and should be considered as complementary therapy by itself or in combination with CA.
Take-Home Points
Scalp acupuncture has been taught and used in the U.S., and a few SA books have been published in English. High-quality scientific research on SA is needed to further expand the scientific evidence for SA, sharpen the mapping system, identify effective needling techniques, and fully explore its potential and clinical indications.
Editor's Note: Some of the citations in this article are to references presented in pt. 1.
References
13. Zhang HM, Tang Q. [Rehabilitation evaluation on post–stroke abnormal movement pattern prevented and treated with acupuncture and rehabilitation.] Zhongguo Zhen Jiu (Chinese Acu & Moxibust), 2011;31(6):487-492.
14. Hasegawa TM, et al. Acupuncture for acute non-specific low back pain: a randomised, controlled, double-blind, placebo trial. Acupuncture in Med, 2014;32(2):109-115. doi:10.1136/acupmed-2013-010333
15. Rezvani M, et al. Efficacy of Yamamoto new scalp acupuncture versus traditional Chinese acupuncture for migraine treatment. J Altern Complement Med, 2014 May;20(5):371-4.
16. Zhao L, et al. Systematic review on randomized controlled clinical trials of acupuncture therapy for neurovascular headache. Chin J Integr Med, 2011 Aug;17(8):580-6.
17. Ribeiro MR, et al. Yamamoto new scalp Acupuncture for postoperative pain management in cats undergoing ovariohysterectomy. Vet Anaesth Analg, 2017, 2017;44(5):1236-1244.
18. He BM, et al. [Effect of previous analgesia of scalp acupuncture on postoperative epidural morphine analgesia in the patients of intestinal cancer.] Zhongguo Zhen Jiu (Chinese Acu & Moxibust), 2007;27(5):369-371.
19. Chen CC, et al. Acupuncture for pain relief after total knee arthroplasty: a randomized controlled trial. Regional Anesthesia Pain Med, 2015;40(1):31-36.
20. Bo QX, Zhang JX. Observation on therapeutic effect of scalp acupuncture analgesia on labor. Zhongguo Zhen Jiu (Chinese Acu & Moxibust), 2006;26(9):659-661.
21. Wang S, et al. A proposed neurologic pathway for scalp acupuncture: trigeminal nerve-meninges-cerebrospinal fluid-contacting neurons-brain. Med Acupuncture, 2017;29(5):322-326. doi:10.1089/acu.2017.1231
22. Liao F, et al. Characterizing heat-sensitization responses in suspended moxibustion with high-density EEG. Pain Med, 2014;15(8):1272-1281.
23. Chen AC, et al. Mode and site of acupuncture modulation in the human brain: 3D (124-ch) EEG power spectrum mapping and source imaging. NeuroImage, 2006;29(4):1080-1091.
24. Xu H, et al. Efficacy comparison of different acupuncture treatments for primary insomnia: a Bayesian analysis. Evidence-Based Compl Alt Med, 2019: 8961748.
25. Ogal HP, et al. [Variations of pain in the treatment of one classical acupuncture-point versus one point of Yamamoto's new scalp acupuncture]. Anasthesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie, 2002;37(6):326-332. doi:10.1055/s-2002-32231
26. Nissel H. Pain treatment by means of acupuncture. Acupunc Electrother Res, 1993;18(1):1-8.
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