The Potential of the Head as a Treatment Zone
Roundtable discussion chaired by Susuki Ikuo

(Participants: Kajima Ikuo, Sai Gyoumei, Inoue Etsuko)

Translated and reprinted with special permission from the Spring 2004  (Vol. 20, No. 1) issue of Shinkyu Osaka Journal

Chairman: I am Susuki Ikuo, and I will be serving as the chairman. I myself never just do focused needling on the head, but since I studied with the late Shirota Fumihiko at the Nissan Tamagawa Hospital, I often read the books by Shirota Bunshi. In his books, he used cranial points all the time so I assumed that this was standard practice. In the clinical study groups, which I lead, however, I often hear comments like “I’ve never treated the head, or I’m scared to do it, or I don’t know how to do it.”

By treating the head, sometimes things that could not be changed by treating the body shift dramatically, so it can be very helpful clinically to know about it. Today I would like to hear your ideas about acupuncture/moxibustion treatment of the head in a way that even beginners can understand. Please begin with a self-introduction.

Sai: I studied rehabilitation for a year at the Osaka University Medical School Orthopedics Clinic as an exchange student from China in 1989. In this time I studied for 3 months at a rehabilitation hospital, Bobath Hospital, as well as one month each at the Osaka Workman’s Compensation Hospital, Hoshioka Kosei Hospital, and the National Rehabilitation Hospital in Saitama Prefecture. Since then I have been working for 12 years at the Kamiyama Hospital primarily treating stroke and orthopedic patients.

Kajima: I have been in practice about 25 years. I started out with the common approaches, but I just didn’t find any method that really impressed me and I was fortunate to come across a special approach in my search. My first encounter with cranial acupuncture was through Ensanshin.  I used Ensanshin for about ten years for alopecia. An by coincidence when I was presenting case histories of alopecia patients in the first WFAS Congress in Beijing, Dr. Zhu Mingqing did a presentation on Dr. Zhu’s Scalp Acupuncture.  Ever since then I’ve kept in touch with Dr. Zhu, and three years later I began promoting his work by inviting Dr. Zhu to Japan.

I have been doing scalp acupuncture for about 14 years. Basically I’ve been using scalp acupuncture to aid the recovery of stroke patients. Especially because of the different medical environment in Japan from China, I can’t do early stage treatment two weeks after the stroke, and I can only see patients six months to a year after the stroke. So I have been developing by treatments to adapt to the situation in Japan blending Dr. Zhu’s Scalp Acupuncture with rehabilitation techniques. But actually it is an uphill struggle to get it widely accepted. I myself have given presentations in conferences and held seminars, and even though people listen with interest, few acupuncturists have the will to put it into practice. It is a specialized technique after all, and it may be difficult for many acupuncturists to follow this method because of their level of training. We need a better educational system, or have more clinical research. Otherwise, I feel this great method will never take hold in Japan. I’d be happy if I could use this opportunity to introduce some features and applications of cranial acupuncture to further peoples understanding.

Inoue: I have been in practice for a rather long time, but I must admit that I haven’t done so much clinical work. I am hoping to listen and learn from what the others have to say.

Chairman: The treatment and stimulation of the head is different from that on the rest of the body. I think the head is indispensable as a treatment site, but if one doesn’t know anything about it, one has no idea of it’s features,  then you won’t know its effects or when to use it. Unless one knows about these things, one is not likely to think about using this approach.

Cranial acupuncture is safe and effective.

Sai: Needling the head may seem scary to the general public, but actually it is the safest place to needle. The head has the skull, which makes it impossible for the needle to go deeply. Needling the arms or legs without skill can cause pain in the muscles, and in the thoracic area it is possible to cause pneumothorax. Patients may be afraid at first, but it feels great once they get used to it and they get to like it.

Chairman: So you are saying that it’s safe, but even if there is no problem with adults, in children there are fontanels and dangerous places aren’t there? Until what age must we be careful about cranial acupuncture?

Sai: This is almost no problem at all after three years of age. If the child is under 3, there is no problem with needling the temporal region.

Chairman: In the occipital region there is GV-15. What about that?

Sai: When needling GV-15, it is best to posteriorly flex the neck slightly or have a pillow under the head. There is some danger of insertion into the medulla oblongata when the next is anteriorly flexed, so it is dangerous to needle deeply with a large needle.

Kajima: Basically scalp acupuncture is almost all horizontal insertion. The needle goes in 2 or 3cm along the scalp, so it is almost impossible that it would go inside. The issue, however, is infection. I think that we need to be more careful than other parts about disinfection of the skin when it comes to the head.

Chairman: What do you recommend for disinfection.

Kajima: The best thing is to disinfect the insertion area with a surgical disinfectant like isodine. Or at least, more than just alcohol, one should use several disinfectants. The needles should of course be disposable.

Chairman: Even if one uses just alcohol, it has to be done very thoroughly, right?

Kajima: That’s right.

Sai: Yes, on the scalp, the hair is quite dirty. There are many germs on hair, so in the beginning one must soak the scalp as if to wash it, and wipe it repeatedly with a cotton ball soaked in alcohol. It should be left for 2 to 3 minutes to let the alcohol soak in and kill the germs. Also ask patients to come after shampooing, as much as possible. Cleanliness is essential.

Chairman: Have you actually had any problem with the disinfection being insufficient?

Kajima: I have never heard of an actual problem. I have treated over 700 cases, but I haven’t had any problems.

Sai: I’ve done a lot of scalp acupuncture myself, but there is no problem if one is very careful about disinfection.

Kajima: The skin of the scalp especially has a lot of fat, so just swabbing quickly will not remove the sebum (sebaceous excretions) of the scalp. Sometimes germs are mixed into the sebum, or dandruff is mixed in with sebum and adheres to the skin. So the conditions on the scalp are different from skin on other parts of the body, so one must be careful.

Inoue: Aside from that, there are no issues with safety, are there?

Kajima: I don’t have any other issues.

Chairman: We don’t hear much about such things, do we?

Inoue: Maybe just subcutaneous bleeding.

Kajima: There is no subcutaneous bleeding either. With the scalp, if there is any bleeding, it all comes out. It is very unlikely that any bleeding will remain inside.

Sai: The scalp may bleed when the needle is removed, but it stops when it is swabbed. Patients with cerebral embolisms who take aspirin or other blood thinner bleed easily.

Kajima: The scalp tends to bleed more than other parts of the body. Especially those who have high blood pressure tend to bleed, but this is rather like blood letting, and it sometime serves to stabilize the blood pressure.

Chairman: You have a point. Some patients who bleed after removing the needles often have high blood pressure.

Sai: With scalp acupuncture, the blood pressure goes up briefly in those with high blood pressure, but it goes down after that. This is true of other types of acupuncture, and the blood pressure goes up briefly in the beginning but it goes down soon after.

What is scalp acupuncture?

Inoue: This is a very basic question, but please explain the difference between scalp acupuncture on acupuncture the points of the 14 meridians.

Kajima: This is generally known as a “microsystem,” and there is auricular acupuncture and hand acupuncture in which the whole is compressed into a part. These are traditional approaches that have existed in China. Just as they invert a fetus to create correspondences in auricular acupuncture, there have been systems in China where the whole body was placed over the entire scalp.

One more thing, the scalp acupuncture that first came into Japan, the system of Dr. Jiao Xunfa, had correspondences between the scalp and the functional areas of the brain. This physiological map was overlaid right onto the scalp, and the areas of the precentral gyrus and postcentral gyrus were divided into the motor and sensory areas. This was completely adopted from the Western medical perspective. This was blended with other maps, and the basic scalp acupuncture map of the WHO was created. Dr. Zhu Mingqing combined the points of the 12 meridians with Western medical map of Dr. Jiao Xunfa. So even if we say scalp acupuncture, there are many varieties.

I started using scalp acupuncture around 1990, but when I was in acupuncture school the scalp acupuncture map of Dr. Jiao Xunfa was not in our text. I just saw it once on a copied page, and I was interested. But it actually never became popular in Japan. The reason I became interested in Dr. Zhu Mingqing’s scalp acupuncture was not just because “needling the scalp is effective.” In addition to needling of the scalp, especially when there is physical handicap due to a stroke, the rehabilitation exercises are also applied. I found the idea of stimulating both the head and the affected local area very refreshing. I felt that this might be a useful approach for Japanese patients within physical therapy system who were recovering at home and in a state where they couldn’t do exercises on their own.

There are many names including cranial acupuncture and scalp acupuncture, but if you look at them closely they all are based on different ideas. One more thing, in the case of Dr. Jiao Xunfa’s scalp acupuncture or scalp microsystems that came before, they are not integrated with basic TCM theory. This is true for auricular acupuncture too but when you refer to an auricular point there is no relation to the 14 meridians. So you can’t come up with a treatment principle based on Oriental medicine. The meridians do pass through the head, and the head is where Yang Qi collects in Oriental medical theory. In this sense it can be integrated, and it can be effective to treat the scalp together with the body. There are many possibilities.

Inoue: There must also be characteristic insertion techniques for the scalp.

The standard is horizontal insertion.

Kajima: There is only 3 to 4mm until the needle hits the skull with vertical insertion into the head. In the sense of general technique to stimulate a point, this might be fine. Especially for Dr. Zhu’s scalp acupuncture, however, the site of stimulation is not a point but a band or treatment area. In Dr. Jiao Xunfa’s scalp acupuncture these areas are indicated as lines, so horizontal insertion is the standard instead of vertical insertion. The needle is placed along the line in the loose connective tissue between the scalp and the skull. In this sense it is basically the same as the traditional technique of threading a needle.

Chairman: It seems that in cranial acupuncture the stimulation tends to go directly to the brain. The brain governs the whole body, and under its control various sense organs function and diseases occur. It seems that adjusting this in the right way can adjust the body and bring a cure.

Keep the stimulation light and comfortable.

Sai: The head from an Oriental medicine perspective is where the Qi of the 14 meridians gathers. The Yang meridians of the legs originate in the head and the Yang meridians of the arms go up to the head. Branch meridians of the Heart and Liver meridians go up to the head. From a Western medical perspective, the cranial nerves originate in the head. In terms of clinical application, there is meridian differentiation, eight principles differentiation, and anatomical correspondences.

Dr. Jiao’s scalp acupuncture originated from Western medical ideas, so it seems to be effective for musculoskeletal and nervous system diseases. Dr. Zhu’s scalp acupuncture combines both Oriental and Western medical ideas, so it seems to have a broader application. In my practice I use Dr. Jiao’s scalp acupuncture for musculoskeletal and nervous system diseases. I use Dr. Zhu’s scalp acupuncture for internal medical, surgical, or gynecological diseases.

Dr. Jiao uses the high-speed rotation technique. Dr. Zhu uses the Deqi technique that moves Qi. I have my own technique in which I slowly rotate the needle and advance it with the exhale and withdraw it with the inhale. I keep the amount of stimulation light, at a comfortable level. I don’t do strong stimulation. In Dr. Jiao’s method rotation and strong stimulation is applied. This is good when the patient is unconscious or with very acute conditions. Once the patient recovers, I avoid strong needle rotation. It hurts. Strong stimulation is good in the beginning, but once they are better you have to back off on the stimulation. Japanese patients are sensitive and they will not tolerate it.

Inoue: Even if the same area, or the same points were used, would you say that there is a difference in the effect according to the technique?

Sai: There is a great difference in the effect when the manipulation or technique is different.

Kajima: In Dr. Jiao Xunfa’s method, after the horizontal insertion, high speed rotation is applied continuously. Dr. Zhu’s uses the lifting and thrusting technique, and the lifting is the foundation. The lifting and thrusting technique for needles on body points is usually a larger stroke, but in scalp acupuncture the movement is a minute pulling motion about 1mm. The movement is pretty fast too.

It depends on the practitioner, and it’s hard to say whether the technique has to be that way. The point is the originators use these techniques, and I learned directly from Dr. Zhu. In the ten years since that time my technique may have changed some.

Chairman: When it comes to stimulation of cranial points, if you get a good point, the effect is instantaneous when you needle it, isn’t it?

Kajima: Yes.

Use electro-stimulation for paralysis.

Sai: Aside from needle techniques, there is electro-stim. I use it often for musculoskeletal conditions and paralysis of the limbs after a stroke.

Chairman: What amount of time and what frequency do you use?

Sai: A pulse rate of about once a minute, and I apply it for 15 to 30 minutes. When stimulated slowly like this, it feels good; it’s a pleasurable sensation. I change the pulse rate in the middle. I start out with a rate of about once a minute and then switch to about 120 times a minute. If it’s the same, it causes fatigue or the sensation is dulled.

Chairman: How do you differentiate the frequencies such as 1Hz, 60Hz, or 100Hz?

Sai: There is a pain relieving effect when frequencies between 120 and 200Hz are used, but sometimes it causes a muscle spasm. That is why for paralysis or pain in the arms or legs must be treated at a low frequency. It’s better when it is slower than the heart rate. I apply electro-acupuncture on the head, arms, and legs for stroke patients with hemiplegia to get a harmonic vibration to create a new nerve feedback to improve the paralysis. It feels good when the frequency is just right.

Chairman: So do you decide the frequency by asking the patient how it feels?

Sai: The electro-acupuncture that’s usually taught suggests a higher frequency, but I feel that it is safer and more comfortable if it’s slightly slower than the heart rate. I haven’t actually experimented to see which is better.

Chairman: In cases of tinnitus, when electro-acupuncture is applied on the head, sometimes the ringing in the ears disappears at a certain frequency between 60 and 100Htz. Isn’t that so?

Sai: Yes. The frequency varies from patient to patient.

Chairman: So you are saying that in any case there is no problem if the frequency is comfortable to the patient. What about situations where electro-acupuncture is indicated and where it is not? Is there a way to differentiate?

Sai: With paralyzed patients it works better to use electro-acupuncture. It is better not to use it when doing a meridian diagnosis or the patient has an internal disease. This is true for systemic (entire body diseases). It’s better not to use electro-acupuncture. Conversely electro-acupuncture has a local effect. Strokes are the exception in that electro-acupuncture is applied on the arms and legs to create a nerve feed back, or otherwise as stimulation to increase muscle strength.

Chairman: Could you tell us in practical terms which diseases or what conditions are indicated for cranial acupuncture? Please tells us any stories about how “we can use it.”

The indications for treating the head

Sai: Cranial acupuncture is best for dementia. During the time I worked in the hospital I treated many elderly patients. Patients with serious dementia in their 80 and 90s have lots of white dandruff in their scalp in the beginning. Their cells are aged and dysfunctional. With scalp acupuncture the scalp gains luster, their blood pressure stabilizes, and they become more alert. Acupuncture and moxibustion treatment of the cranial area is good for preventing dementia and strokes. It is also effective for treating diseases all over the body.

It has a pain relieving effect for musculoskeletal disorders. For example when there is pain on the right, there is an immediate effect when a needle is threaded from GV-20 to the left Sishenzong point. Last year a professional soccer player of Osaka injured his right foot and walked into my clinic with a cane. I did some acupuncture on his head and the pain stopped and he was able to walk without a cane.

Also the head is the center of mental activity, isn’t it? Modern society is full of stress and there are many mental disorders including depression, epilepsy, and schizophrenia. Points on the head like GV-20 are good for relieving mental stress and treating mental disorders. For insomnia I use TB-17 and GB-20. This is also very effective for restless children who have a difficult time with their studies. Moxibustion on GV-23 is effective for atopic dermatitis, rhinitis, and hay fever.

Chairman: So you are saying that it’s good for aging, strokes, dementia, musculoskeletal pain, and mental disorders.

Sai: It is also said to be good for aiding a child’s mental development.

Chairman: How is it for ear, nose, and throat diseases?

Sai: It is good for dizziness. One of the common issues seen by ear, nose, and throat specialists is dizziness. There is also a lot of cervical syndrome in middle aged and elderly patients. Dizziness with neck and shoulder tension that is not accompanied by tinnitus is often related to the cervical vertebrae. GB-20 and BL-10 are very effective for this. Sometimes it gets better the moment the needle is inserted.

Chairman: Applying direct moxibustion repeatedly on GV-20 when one is feeling dizzy and the head is spinning will stop the dizziness. Tinnitus can also be treated with moxibustion on GV-20.

Sai: I don’t know because I haven’t treated diabetes or cancer, but for patients who don’t respond after various methods are attempted sometimes experience surprising effects when you needle the cranial area once. This January a female patient came to see me who had surgery for lumbar disc herniation and ten days later her legs were paralyzed after taking a bath. When I put needles in the motor area of the scalp immediately she felt like there was an electrical current in her arms and legs. After the second treatment she was able to walk without a cane.

Chairman: A current? Was it a Deqi sensation?

Sai: Yes. Suddenly she felt like blood was flowing in her limbs. Right after that she was bale to move her arms and legs and walk without a cane. So it is worth trying scalp acupuncture when you can’t get results with any other treatment.

Chairman: Otherwise, sometimes there are people who are sensitive all over their body and it’s impossible to even touch them, but their head is insensitive and doesn’t fee a thing. In cases like this treating the cranial area often removes the hypersensitivity in their body.

Release of muscle tension

Kajima: In my clinical experience I find basically the same thing as Dr. Sai. The indications are as he said, but speaking more personally in paralysis of the central nervous system like strokes, of course it is a spastic paralysis. The muscles become contracted and one cannot relax them. Scalp acupuncture is the most effective way to release this spasm. More than needling points on the arms or legs, retaining needles for ten minutes in the head releases the tension beautifully.

And this effect is not limited to stroke patients. It is good for pain associated with muscle tension, and pain with movement like frozen shoulders. It works to put needles in the head and have the patient move. There is a strong pain relieving effect. It releases the muscle tension and relieves the pain. This effect is clearly far greater than needling body points.

Relax mental tension.

Kajima: I’m an acupuncturist, but I also do psychological counseling. Once when I counseled a young lady with extreme anxiety suffering from fear of interacting with others, the first two forty-five minutes sessions she was so tense she could hardly say anything. After she got used to me, using her neck and shoulder tension as an excuse, I talked her into doing just one needle each in GV-20 and Dr. Zhu’s temporal zone, and they were barely inserted. In just ten minutes her tension decreased and she began to talk. It really has an incredible effect of facilitating relaxation.

Another benefit of cranial acupuncture is that it can be applied right along with body points. So the head can be needled as the body is being needled. One more thing is the feedback, which Dr. Sai spoke about earlier. One can get a feedback going between the cranial zones and the affected area that actually has the symptoms. And this correlation can be established both from a meridian and neurological perspective.

For instance, with the needle in the head active and passive movements can be initiated as movement therapy in the problem part. If there is paralysis in certain muscles, they can be stimulated directly with things like electro-acupuncture. So one can approach a problem from both ends –both the head and the local area.

In my practice I don’t limit myself to scalp acupuncture, but when the effects aren’t forthcoming with regular acupuncture, adding just a little scalp acupuncture usually brings some change.

Chairman: Spastic paralysis often becomes worse when one treats the local area because the muscle tension only increases. It is convenient if one knows that treating the head will release the spasm. I myself needle GV-20 when I am feeling tired and irritable, and it works pretty well.

Sai: I also often put one needle in my head when I’m feeling tired. Patients sometimes ask me, “Doctor, are you OK with that needle in your head?” Needling the head relieves fatigue and makes you more alert.

Chairman: It’s important to show people, isn’t it? In my acupuncture and moxibustion practice I often utilize the autonomic reflex or spinal reflexes. I feel that these reflexes are inhibited and the effect is diminished, however, when the condition of the brain isn’t good. It’s the same things as distracting a person when the tendon reflexes don’t occur in order to bring them out. When the head is full of all sorts of things, it seems that the response to stimulation is inhibited. I think that needling the head to remove some of the inhibition makes the acupuncture work real really well.

According to stories I’ve heard, Shirota Bunshi used to start with a few small needle in points like GV-20 or BL-2 for about five minutes before starting to treat the body. I think doing some pre-treatment on the head in this way increases the response and efficacy of treatment.

Sai: Human beings are animals, so we have the natural healing capacity of animals, don’t we? But human beings alone have on overdeveloped cerebral cortex and the individual will has become strong, so there is a tendency for the natural healing power to be suppressed. For example: why does a stroke patient have spastic paralysis?  Why are the tendon reflexes exaggerated? The pyramidal system, which controls voluntary movement, is damaged, so that the primitive reflexes have an exaggerated reaction.

It is possible that we overuse our brains on a daily basis and are mentally exhausted and we suppress our natural healing ability with our willful behavior. In order to counteract this tendency they suggest various methods such as yoga and meditation so that the autonomic nervous system is regulated and there is greater relaxation and circulation. Cranial acupuncture can have the same effect very quickly.

Chairman: One time, someone asked me to treat a dog that could no longer stand and was drooling. Its eyes were askew and its head was turned to one side. I think it had a stroke. When I felt down his spine, there was a depression on the GV channel (around GV-12 and GV-4 in a person). I did moxibustion on those points and the dog stood up right afterward. I had the owner shave the hair over those points and had him apply stick-on moxibustion every day. I was really surprised that in about one month, the dog was almost back to normal.

Also once there was a 3-month old golden retriever that seemed very quiet. Come to find out it had many diseases and was ailing. It seemed like it might die if we didn’t do something. So, I did moxibustion on the point that corresponds to GV-12 on a human being. The next day, that little dog was jumping around like a normal puppy. So acupuncture and moxibustion really work well on animals, don’t they? And they work well on children, and also on adults who are simple, or uncomplicated people. After all, it could be that (overactivity of) the brain reduces the body’s natural response and blocks (suppresses) the effect of the acupuncture and moxibustion. Also, acupuncture on the head works quite well for symptoms like hemorrhoids and pain in the genital area.

Inoue: You said that cranial acupuncture regulates the autonomic nervous system. In this respect, I’ve read that Dr. Shirota said GV-20 is a sedative point and tends to make the parasympathetic system dominate, while GV-22 and 23 on the front of the head make the sympathetic system dominate and that is why they work well for asthma and hay fever. Do you feel that there are special points, or areas with specific effects?

Sai: In my experience points on the frontal area have a sedative and pain relieving effect. I use points on the frontal area and the occipital area for stress reduction and mental disorders.

Kajima: I don’t get much sense that acupuncture points have specific effects. Unlike drugs, I don’t think there is anything like this place for sympathetic dominance and that place for parasympathetic dominance.  If the patient’s condition is one side of normal, the native self-healing ability that is aided by acupuncture stimulation is something that takes it back toward the normal range. So what happens is that the tension that is inhibiting the self-healing ability is removed, and as a result things go back toward normal whether the abnormality is in the direction of the sympathetic or parasympathetic system. Giving the same treatment to different patients should yield the same results. But it doesn’t make sense that there are two points just a few centimeters apart and one affects the sympathetic system and the other affects parasympathetic system.

Chairman: When you treat the head, more than learning specific points, is it better to think about scalp areas and look carefully for reactive points, or is it better to learn which points to use for which conditions?

Kajima: There are points that are especially effective for certain symptoms, aren’t there? Often patients say that there is pain behind their eyes. Treating Taiyang sometimes doesn’t relieve this pain very well. I discovered a point on the cranium by accident that is extremely effective for this symptom. So there are points that are especially effective for certain things.

Chairman: In that case, can one find a reaction?

Find reactive points on the head.

Kajima: The point is more tender.

Chairman: Can one find them by careful palpation?

Kajima: First there is an abnormal feeling in the scalp overall. This is edema of the scalp. The scalp is thick and boggy. Or otherwise the scalp is extremely tense and the scalp feels hard and as if it were glued on to the skull. It’s one or the other. The area around indicated points are extremely hypersensitive. Not only are they tender, sometimes even moving the hair feels very uncomfortable. This kind of abnormal sensitivity is found not only in stroke patients, but even relatively healthy people. Patients who hold tension in their neck or shoulders almost always have areas of the scalp that are insensitive and hypersensitive.

Chairman: So these areas are abnormal, so insensitive areas can be treated as well as sensitive areas, right?

Kajima: That’s right.

Chairman: Then one can palpate points and reactions on the scalp by looking for edema, hardness, and hypersensitivity, which includes tenderness.

Sai: There is also itchiness.

Chairman: So itchiness is a finding too?

Sai: Itchiness is an abnormal finding. And aside from edema, areas of the scalp that are very thin are also points. Acupuncture points are abnormal points on the body. So you can’t find these abnormal reactions unless you palpate the body and scalp carefully.

For example,the effect of LI-4 on facial pain and the effect of ST-36 on stomach pain are not related to cold or hot syndromes. These effects are related to the meridians. Meridian Therapy and Kampo herbal medicine are different. They use LI-4 to treat colds from wind cold or wind heat. ST-36 can be tonified or dispersed to get effects. With Kampo herbs on the other hand, Ginseng is just a Qi tonic, and it can only tonify. Huanglian clears heat, and it can only disperse.

Acupuncture points are biphasic in that they can be used to tonify or disperse. The differentiation and treatment in Kampo herbal medicine is different from that of acupuncture/moxibustion. In acupuncture/moxibustion finding abnormal points is the most important thing.

Tonification and dispersion are a result.

Kajima: There seems to be a split in the apprehension of disease states and the theory acupuncture/moxibustion in Japan today. By differentiation of syndromes some think in terms of tonifying a deficient pattern or dispersing an excess pattern and treat the organs or meridians this way. They decide in their head what to do in advance. But even if someone is deficient overall, for example, there are some deficiencies and excesses depending on the meridian and points. So if the acupuncture is done according to the condition of the points, the result will be the necessary dispersion or excess and balance will be achieved.

The meridians are the pathways for the circulation of Qi and Blood, and there is only repletion or insufficiency in this flow. It’s stagnation, repletion or insufficiency. If it is stagnated, needling the stagnated place will restore flow. Once flow is restored, the Qi and Blood flow from where there is plenty to where there is little. Needling upstream of the stagnation where there is plenty is dispersion, and needling downstream where there is little becomes tonification. In the schools they do teach that this point is for tonification and this one is for dispersion, but in actual practice you need to know where it is stuck. If one has a clear understanding of repletion and insufficiency, I don’t feel there is any particular reason that one needs to think about dispersion (and tonification) at a particular point.

Chairman: I remember once when a beginner asked Dr. Shirota Fumihiko “Is that dispersion or tonification.” He responded, “You can use any technique and do anything, but if the result is tonification you have tonified.” For example bleeding is apparently dispersion, but if the result is to tonify the patient, that technique was tonification. You decide from the results. You don’t decide by the technique.”

Sai: We are all of exactly the same opinion. The technique of tonification and dispersion differs from practitioner to practitioner. You can’t say whether strong stimulation is dispersion or tonification. Sometimes strong stimulation is dispersion, but for someone with paralysis in the four limbs strong stimulation is tonification. For hypersensitive people, even light stimulation on the arms and legs can become dispersion. The amount of stimulation for tonification and dispersion differs by the patient and the condition. It is not fixed. I think that the best effect is obtained when I do acupuncture if the patient says it feels the best. This amount of stimulation must not be exceeded, but it must not be too little. I ask the patient’s body whether it is appropriate or not. The patient’s body is the barometer. Generally it is better to stimulate lightly. We can adjust the amount of stimulation by seeing how the patient responds.

Chairman: When it comes to acupuncture/moxibustion, give the body some stimulation and the body will utilize it and respond according to what suits it, so in one sense even if one makes a little mistake some results can still be obtained. Assuming there is a dispersive treatment, even if you do it on a deficient patient, the body says, “This won’t do,” and pushes in the opposite direction. So doing dispersion for a deficient patient sometimes unexpectedly produces very good results. Of course, there are also times when it doesn’t work out that well.

Tonification and dispersion are not weak and strong stimulation.

Kajima: There is quite a bit of confusion concerning tonification and dispersion, especially Japan overall, and even in China recently it’s being stereotyped. I think this might be a problem. They teach that weak stimulation is tonification and strong stimulation is dispersion, but this is a lie. It’s not about weak or strong stimulation.

Sai: I agree.

Kajima: For very strong deficiency, one needs tonification with strong stimulation. For light excess, one needs dispersion with light stimulation. Tonification/dispersion and light and heavy stimulation are completely different things. Somehow this has become misconstrued in Japan.

Also even the same diagnosis and treatment is different between acupuncture/moxibustion and herbal medicine. Many people don’t understand this. It became a point of discussion before in a different journal. Does BL-20 serve as tonification or dispersion for someone who is Spleen deficient? It depends on the reaction (at the point). If there is strong Qi stasis at BL-20, unless dispersion is used the situation cannot be resolved even in cases of Spleen deficiency. But in herbal medicine, the whole body is in a deficient condition called Spleen deficiency, so it must be tonified. They ignore the reactions at the meridians or points.

Because they stereotype the techniques, the desired results cannot always be obtained. Our work as acupuncturists is to observe (palpate) the condition of the meridians and points and regulate the repletion/insufficiency and circulation in the circulation of Qi, Blood, and Fluids. So whether the body is deficient or excess as a whole, what we need to do is to normalize any meridians and points that are found to be abnormal. That is why it is wrong to think that someone has an excess condition from the diagnosis and must be treated only with dispersion.

Chairman: I once treated a person who had extremely soft and deficient lower abdomen. The practitioner who treated him before me did a lot of direct and warming moxibustion for some time but the patient didn’t improve. I tried the same thing but he showed no sign of improvement. He just happened to have fullness and discomfort in the costal region, and since what I was doing wasn’t working, I worked on relieving the tension in the costal region. His abdomen firmed up with this change in strategy.

Kajima: So the Qi was stuck above and did not descend.

Chairman: That’s why, when there is a deficiency, somewhere there is excess. I think it often happens that the deficiency improves when the excess is relieved effectively.

Sai: I would like to add that GB-20, GV-20 and Taiyang are effective for high blood pressure. The blood pressure goes down especially for those who are not taking medication to control blood pressure. It depends on the symptoms, however, whether a person can go off blood pressure medication.

Chairman: So the main reactions to look for on the head are edema, hardness, hypersensitivity, itchiness, and abnormal sensations, right? I have learned that to locate points on the head points that become depressed with light pressing or where the finger comes to a stop are Tsubo (active points).

Dr. Shirota Bunshi has written something to this effect. Most of my point location is based on this, but what do you think about locating points in the depression?

The key to treatment is protrusions and depressions.

Sai: The (active) acupuncture points are found in the high places and the low places, the places that are tight or slack, and the places that protrude or are depressed. Needling such protrusions and depressions in the lumbar area is very effective for the treatment of low back pain. This principle of point selection applies to other diseases as well.

Chairman: In the case of the head, they are the protruding or depressed points, right?

Sai: Yes, those are the best points.

Kajima: This is not limited to the head.

Sai: It’s true for the whole body.

Kajima: If the meridians circulate and we pictured it as the flow in a river, when there is a blockage somewhere, it will protrude upstream of this. This is excess. Downstream there is insufficient flow so it becomes depressed. So the depressed places are deficient, and the protruding places are excess. This is a reactive point, not in the whole body, but in the location of the meridians depending on whether there is a lot or a little Qi and Blood. So this is of course, becomes a point for treatment. There is an obstruction in the middle. This phenomenon is not limited to the scalp, but applies to the skin all over the body.

Sai: That’s right. Students often ask things like “Why are you needling there? Is it the point BL-23?” The points used in clinic differ from those in textbooks from time to time. Points change, and seasoned practitioners seek them out.

Inoue: So not only Japanese, but Chinese acupuncturists also emphasize findings on the body surface like that?

Sai: That’s not quite true. This is something I learned from treating many patients. Just one look and you get a sense of it from the complexion, tension in the skin, and abnormal appearances. I apply acupuncture and moxibustion to the places that are depressed or protruding, tense or slack.

Kajima: You can tell just by looking can’t you?

Sai: I used to work in a hospital so I had to see and treat a lot of patients in a short time. So I take a quick look and treat right away. I learned to treat quickly and get quick results.

Kajima: The meridians are pathways for Qi and Blood right? When we think about the function of Qi, it has a warming and moving property. The moving property is the ability to make fluids and blood flow. When these substances stagnate, it’s natural that fluids collect and cause edema. Of course areas of the body become undernourished if they are deficient and the skin becomes thin (depressed). And due to its warming property, when Qi stagnates, its natural that the skin temperature goes up in these places.

Not only on the scalp, but also on the back, we generally treat those places that are protruding or have indurations, don’t we? This is all an attempt to relieve the symptoms that come from the excess condition of Qi stagnation, wherever Qi is stuck. The places where the skin temperature is low, the skin is thin, or the muscles are soft are all deficient places. If we get the Qi to travel from excess places to deficient places, the excess places are dispersed and the deficient places are tonified.

By removing the one place that is stuck in the middle, we perform both tonification and dispersion. This is a fundamental principle in the meridian theory. This principle was forgotten over time, and people began to fall into thinking that the stimulation of points was the only effect. This only causes a difference in thinking. Thus when the Spleen meridian is excess for instance, the Spleen meridian is supposed to be dispersed at certain points. The point, whether it’s on the body surface, scalp, or torso, is at the protrusion or depressions caused by abnormalities in the flow of Qi. And this is a result of a decline in the moving properties of Qi, which leads to abnormal amounts of fluids. And high or low skin temperatures are abnormalities that result from the warming properties of Qi.

When nutrition is lacking the skin becomes rough, and when there is too much it becomes greasy and symptoms of excess naturally appear. And this is seen in terms of changes in the pathway of the meridians rather than in specific points. All you have to do is find where it is blocked and open it up. This is basic not only to scalp acupuncture, but to acupuncture for the whole body.

Sai: In clinic, it is not sufficient to treat based on pulse diagnosis alone. The pulse changes somewhat when a person lies down. It is no use to get a change in the pulse when the symptoms are unchanged. One must use the Four Exams to diagnose comprehensively.

Kajima: The Meridian Therapists in Japan, with the exception of a few practitioners, do not distinguish between the meridians and the Zangfu. There is no basic differentiation between Zangfu symptoms and meridian symptoms. They don’t have a flexible view of using of meridians to heal the Zangfu, or understand the meaning of reactions on the meridians. So, even if they find a Spleen deficiency in the pulse and treat it, there is no real change because there are no Spleen symptoms.

Sai: Even if you go to their study groups, the teacher may be very good, but the students don’t get good at it.

Kajima: The leaders of the group have a intuitive grasp of it, but they aren’t transmitting this knowledge. Or should I say, they haven’t organized it so it’s learnable. They just lecture on interpretations of classics, and it seems like they don’t delve deeply into what meridian therapy is really about.

Chairman: They call it Oriental medicine, but they do seem to focus too much on the minutia.

Sai: Their the actual clinical practice is different from the things that are written about it in journals and books.

Kajima: It is different.

Chairman: It’s better if people wrote articles about their actual practice even if it becomes a bit messy.

Kajima: When you write about it you are required to have some theoretical soundness for things like why you selected a certain point. In clinical practice, however, there is an experiential aspect and if one wrote about all that some readers might get confused.

Sai: There are things that cannot be described in words, and it’s hard to express everything that is felt.

Chairman: It might be good if people would write their impressions or thoughts separately as a footnote or something. Now I would like to get some case studies or advice for those who are thinking, “I might incorporate cranial acupuncture in my practice.”

Use No. 2 or 3 gauge needles and rotate them slowly.

Sai: When a needle is inserted into the scalp, it is inserted horizontally at an angle of 15 to 20 degrees. I like to use No. 2 or 3 gauge needles. I have my own method of manipulating the needle. While the patient is exhaling I twist the needle clockwise with my thumb, and while inhaling I twist the needle counterclockwise with my thumb. For tonification I emphasize the exhalation and the clockwise movement, and for dispersion I emphasize the inhalation. I manipulate the needle slowly and keep it comfortable.



Also, when I needle the Sishencong points, I vary the direction of the needles by the disease. For pain in the left leg or foot, I thread the needle from GV-20 to the right Sishencong point. This is a pretty effective method for pain.

Chairman: So the Sishencong points can be used for pain?

Sai: Yes. For leg or low back pain you can thread the needle from GV-20 to the Sishencong point on the healthy side. GV-23 is effective for rhinitis. Treating tender points along the Gallbladder meridian on the scalp is very effective for eye strain.

Inoue: There is a point called “window of the eye” (GB-16) isn’t there?

Sai: GB-16 has the name “window of the eye” and is known as a point to treat eye problems. The points BL-10, GB-20, and TB-17 are effective for dizziness.

Inoue: Do you insert the needle vertically into BL-10?

Sai: With the patient prone, the needle is angled slightly downward, but it’s vertical. Never needle this point with the patient seated. BL-10, GB-20, and TB-17 are effective for auricular, cervical, and cerebral vertigo. But it’s not effective when the needles are too superficial. I insert between 5 and 10mm. Do not apply strong stimulation.

I generally use Chinese needles, but I often use Japanese needles as well. I usually start with one Seirin disposable needle in either GV-20 or GV-14, and then I use a plastic tube to insert Chinese needles. GV-20 and GV-14 facilitate the flow of Qi in the Governor Vessel. The treatment results are better when the flow is enhanced.

Kajima: I also needle horizontally when I treat the scalp. I used to use short Chinese needles for this purpose, but since it is hard to obtain needles like this in Japan, now I use 30mm No. 5 Seirin needles.

The reason I use No. 5 needles is because, as Dr. Sai just mentioned, thin needles are difficult to insert and actually increase the discomfort. It is really less pain for the patient when a thicker needle with some heft is inserted quickly and smoothly. This also increases the effect of insertion. I mostly retain the needles, but one of the features of the Dr. Zhu’s scalp acupuncture is to apply some tonification and dispersion. The idea is to scatter the Yang qi and increase the flow for patients such as those with a stroke with an accumulation of Yang qi in the head. The tonification and dispersion is accomplished by lifting and thrusting techniques.

Dr. Zhu Mingqing uses a different name for this. He calls the thrusting Jinqifa (advacing Qi) and the lifing Zhuqifa (extracting Qi). The lifting is like using a syringe to draw out fluids, where it is pulled out slowly. The thrusting is like pressing slowly when using a syringe. This is the basic technique, and the thrusting Jinqifa (advacing Qi) and the lifing Zhuqifa are unique expressions used in scalp acupuncture but these are based on the lifting and thrusting tonification sedation methods found in the basic textbooks of Chinese acupuncture. The main difference between scalp acupuncture and that on the body is that the needle is inserted into the loose connective tissue between the of periosteum the cranium and the galea aponeurosis.

Needle carefully so as not to hit the periosteum.

Kajima: Pain is caused when the angle of the needle is too steep and the needle runs into the periosteum. Also it’s possible to cause a hematoma, so one must be careful to insert the needle horizontally and avoid hitting the periosteum. When the needle is moved roughly in this area, it scratches the periosteum and this could leave residual pain or a hematoma. There is some risk of this. As Dr. Sai has Said, needle manipulation on the scalp should not be done roughly. The rule of thumb is to keep the movements slow and at a low amplitude as much as possible. If the needle is moved in and out 5mm to 1cm, this will scratch the periosteum, so keeping the amplitude of movement as small as possible is the secret in Dr. Zhu’s scalp acupuncture.

Those who are overly tense psychologically, and those who are unstable should be treated on the head even if they don’t have any symptoms in the head. Mental relaxation and stability is essential for increasing the effects on the physical body. So I insert needles 2 to 3mm in points like GV-20, GV-21 and GV-24, just enough for the needle to stay in horizontally or diagonally. Also when I counsel those who have phobias about being around people, those who are under great psychological stress, I insert needles in the head just as with cranial acupuncture. I retain the needles for about an hour as I counsel them.

Have patients do movements with needles retained.

Kajima: Also in cases of musculoskeletal disorders, I retain some needles in the scalp and direct patients to move. The movements are different depending on the problem, and also the movements are different for stroke patients because it depends on the stage and the aim of treatment. It is primarily range of motion movements, or otherwise I use parts of the Bobath Hospital protocol. So I have the patient do active movements using different combinations of movements.

 

For pain associated with tension, such as low back pain with difficulty in bending forward, I use the cranial occipital zone (a band one to one half a unit from the Governor Vessel on either side from GV-20 to GV-17). I treat the occipital zone on the left when the low back pain is on the right.

In Dr. Zhu’s scalp acupuncture the needle is pointed downward and manipulated as the patient is asked to bend forward. The patient stops where the pain begins and the needle is manipulated in that position, also the practitioner hits the muscles lightly, and then the patient is asked to bend forward some more. Usually the patient who couldn’t bend forward due to the pain is able to bend forward farther. The treatment proceeds in this way.

Frozen shoulders is treated in a similar way, but I won’t go into detail because it would just be a lecture on Dr. Zhu’s scalp acupuncture. People can read the textbooks on this technique. There is a zone for the treatment of the shoulders, and a needle is inserted in this zone and the patient is instructed to move their arm. In this way, the basic approach in Dr. Zhu’s scalp acupuncture is to use scalp acupuncture in conjunction with movement of the area that has the problem.

Needle up to the periosteum for eyestrain.

Kajima: Once in my clinical practice I discovered a scalp zone that was highly effective for reducing eyestrain. I’ve been using this zone ever since and teaching it. It works well when there is extreme tenderness in the coronal suture (between the frontal and parietal bones) in line with the pupil. I use the short needles for scalp acupuncture and insert the needle at a steeper angle of about 45 degrees so that it runs into the periosteum. This creates a sensation in the area that radiates toward the face. When the needle is retained this way for 15 minutes, patients say that their vision has become clearer, or the heaviness in the back of their eyes has lifted. I get such clinical effects quite consistently. Of course, this point alone will not treat all eye problems so I give a whole body treatment based on the differentiation of the cause of the eyestrain. The above point is even more effective when it is added as a symptomatic approach to complement the treatment.

Inoue: So you don’t use a guide tube, do you?

Kajima: I don’t use a guide tube for scalp acupuncture. Using a guide tube inevitably causes the angle of insertion to be too great. You can’t use a guide tube to insert at an angle of 3 degrees. Actually there is less pain if you begin without an insertion tube and just press the needle in.

Moxibustion is used often.　

Chairman: When I needle the cranium, I do superficial needling on the points that are tender, and I leave between 5 and 10 needle in the head. Then there is a sense of release from the neck down through the body, so it seems ideal for stress and tension in the neck and shoulders. It works the same way no matter who does the treatment. That is about it for my needling of the head, and all the rest of my treatment is moxibustion.

The good thing about moxibustion is that, as long as you apply moxibustion on the point palpated with your fingers, you don’t have to worry about being within 1 or 2mm, not to mention half a millimeter. It works no matter who does it. When it comes to moxibustion, the treatment point is not a pin point. The thing about moxibustion is that it works fairly well even if a novice does it. Of course the quality of the heat stimulation varies (with experience).

The area around GV-20 works well for dizziness and ringing in the ears. It is also effective for pain and various symptoms on the opposite end of the body like the sacral region, the coccyx, perineum, and anus. Symptoms that cannot be relieved by treating the local area can be relieved quite well by treating the opposite end of the body. Also this point is good for patients with hypersensitive Governor Vessels. It relieves the tenderness they have when the spine is touched. It really relieves hypersensitivity in cases where the sensory nerves are overexcited.

When treating the local area is not effective for pain conditions like low back pain, adding direct moxibustion on GV-20 sometimes has an immediate effect. I feel that adding GV-20 to the treatment for pain conditions is probably beneficial.

Otherwise, this is mentioned in Shirota Bunshi’s books, but when one half of the body feels strange and there is some hypersensitivity or discomfort, one can palpate tender and reactive points on the lateral cranium on the same side. These reactive points are around GB-17, GB-18, and BL-7. Abnormalities in one half of the body often resolve when acupuncture or moxibustion is performed on these reactive points.

In cases of nasal diseases there are reactions between GV-23 and 22. When this point is not effective, you can often find an effective point by palpating on either side around BL-5. 

Another interesting point is GB-16. It is good for eye diseases because it’s name means “window of the eyes.” Nevertheless, for some reason I have found it to be effective in four or five cases of paralysis in the leg from cervical syndrome or a stroke. When pressing GB-16 with such patients in the seated position they are able to raise their leg off the table, and otherwise those who couldn’t raise their leg with me applying resistance on their leg with my hand are able to do so. In this way, I’ve found that treating this point increases strength in the iliopsoas mucle. I’m sure it doesn’t affect only the iliopsoas mucle, but that is the only motion I have tested, and by applying moxibustion on GB-16 I’ve gotten the results of improved walking ability and ease in raising the foot, along with less tripping.

GV-15 is effective for speech disorders.

Chairman: I’ve used GV-15 effectively for patients with with ALS who have difficulty in talking and those with bulbar paralysis from multiple thromboses. The improvement is immediate. Sometimes GV-15 works, and sometimes GV-16 works better, and at other times GB-20 or the scalene muscle point works better. In any case, GV-15 is effective for symptoms of bulbar paralysis and speech problems for many people, and there is an immediate improvement in speech. The disease may progress later and the speech problem may return, but swallowing becomes easier and the patient is less likely to choke. If this approach could be used for the prevention of aspiration pneumonia, it would be valuable because it will increase life span.

Other important points are TB-22, BL-10, and GB-20. If you pin point TB-22 (which I locate slightly posterior) just right, just pressing the point will make the patient’s vision clear up. It relieves eye strain when an intradermal needle is placed in this point or when moxibustion is applied. It also moistens dry eyes, and relieves itching for those with allergies and itching around the eyes. BL-10 and GB-20 are not exactly cranial points, but I once applied moxibustion on these points for a patient with glaucoma, although I didn’t know this at the time. The patient had ocular pressure of 24 - 25 for over a year, but it went down to 14 – 15 in about four treatments and he was able to go off the medications. Although it wasn’t quite as dramatic a reduction, I’ve had several other patients whose ocular pressure went down.

Retinitis pigmentosa can be alleviated?

Chairman: I had a patient with the early stages of retinitis pigmentosa who I instructed to apply moxibustion on BL-10 at home.  Colors became clearer for this patient and letters became bigger and easier to see. Also this patient became able to see a little in a relatively dark place.  I had two or three cases of blindness due to retinitis pigmentosa, where treatment of points around BL-10 and GB-20 enabled them to see some light, even though they were still blind. For BL-10 and GB-20 also, I tend to locate them 1 or 2cm above the standard locations. You can find great indurations and tenderness.

BL-9 is not a point that I use very often, but once when treating a patient with bad eyes with extreme tension in the neck, shoulders, and interscapular region, I decided to try this point that is on the opposite side of the head from the eyes. The interscapular tension released on the spot.

The other day, one of my students had an interesting case. It was a woman who was about 32 weeks pregnant. She had a history of miscarriage

and she was hospitalized in the early and middle stages of her pregnancy. Her belly had become large and felt like it was dropping a bit, and she had excruciating pain in her pubic bone. He told me that he was thinking of giving a little treatment on the pubic bone. I advised him as follows: “The patient tends to miscarry so it’s better to leave the bottom end alone. Look for points on the on the median line in relation to the Conception Vessel, like GV-23 and 20. GV-20 is good for coccyx and hemorrhoid pain so the same principle could work if you find points a bit more anterior.” The pain went away as soon as he needled GV-20 and 21. He Said that her pain mostly resolved with two or three treatments.

Does anyone have any stories to share about something interesting that happed in their practice?

Sai: Last March I was asked by a friend from Kyoto University to make a house-call for a patient who was unconscious with a cerebral hemorrhage after a bout of morning sickness. The cerebral hemorrhage happened in November 2002 and the MRI and CT scans showed a hemorrhage in the right hemisphere. She remained unconscious after two surgeries, and her mouth couldn’t be opened and she had contracture in all four limbs. She was hospitalized in a hospital specializing in neurosurgery. Even the most advanced medical technology could do nothing more. I went to treat this patient in the hospital at the request of her family, and the hospital consented to this.

I began mostly with scalp acupuncture, and as I visited and treated this patient day after day, gradually her eyes began to open and after a month and they were able to get her to drink some tea. Her family and attending physician we flabbergasted. We are continuing with the treatments six months after she has been discharged, and now she is able to eat on her own. She still has speech impediments and serious paralysis in her legs so we are continuing with the treatments.

Five years ago, I also went to treat a stroke patient in a vegetative state regularly for a year at a certain university hospital. The patient never regained consciousness, but his body temperature, breathing, and overall physical condition has been better maintained. Even in cases of serious strokes, I think we can save many patients if they could be treated with acupuncture and moxibustion in the early stage.

There is hope even for patients with intractable symptoms.

Kajima: Both the scalp systems of Dr. Jiao Xunfa and Dr. Zhu Mingqing depend on treatment in the early phase. They begin treating within two weeks after the stroke and complete the treatment after two months. In Japan all acute stroke patients are held in hospitals so we can’t treat them. Dr. Sai has a relationship with universities so he can get access, but in normal acupuncture clinics we only get patients six months to a year, or even five years after the stroke. In these cases of course, the results are very limited. Once Dr. Zhu Mingqing came to Japan for a while to give me clinical instruction, but at that time he became angry saying that such chronic patients could not be helped. So there is a basic difference in the medical situation between Japan and China.

Nevertheless, that doesn’t mean it’s hopeless, because there are many patients who have not gotten adequate results from neurosurgery and neurologists, and have been abandoned by the rehabilitation department with incomplete recovery. I am thinking about some approach that might work in these cases. In textbooks of stroke rehabilitation it says that there is no more improvement after 8 months in the legs, and after 14 months in the arms, but I think there is a possibility that we can prove this wrong. In fact, I’ve had cases where there was some improvement with patients five years after the stroke. This may be an exceptional case, but I once got a patient to stop using a prosthetic device on the lower leg ten years after the stroke.

Also aside from strokes, I treated a patient with bilateral spastic paralysis due to a brain injury from an auto accident. He had to use canes in both hands to walk, and we got to a place where he could walk without a cane. Cases like this are not that rare with scalp acupuncture. Patients can move better as long as we can balance the tension in their body. It might seem miraculous from the Western medical viewpoint that says there is no more change after 6 months to a year, but the body has the ability to recover in some way so as long as the (therapeutic) environment is improved.

Chairman: A while back I read some case histories in Shirota Bunshi’s book Shinkyu Chiryo no JisSai (The Practice of Acupuncture and Moxibustion). There were many cases of hemiplegia of five to ten years that become much better, even though it took six months to a year. It may be called intractable symptoms, but sometimes you really don’t know until you give it a try.

Sai: Stroke patients usually can’t receive early and extended treatments necessary because the effects of acupuncture and moxibustion are not well known and many can’t afford to pay out of pocket for the treatments. If insurance were to cover it, many more patients could be saved. This is a different topic, but if you do cranial acupuncture dark hair will begin to grow in two or three months.

Continuous scalp acupuncture makes hair darker.

Kajima: Yes, it does make hair grow.

Sai: Hair on the scalp increases when scalp acupuncture is performed two or three times a week for three months. Acupuncture also improves luster in the scalp and keeps the scalp from aging. Also there is a preventative effect when stroke patients with residual symptoms continue to receive acupuncture.

Inoue: Is this a unique effect of scalp acupuncture that can’t be obtained from acupuncture on other parts of the body?

Sai: I think it’s a special effect of cranial acupuncture.

Kajima: There is a famous technique for acupuncture on the body for strokes called Seino Kaikyo (revive brain, open orifices) method of Dr. Shi Xuebin. There are acupuncturists in Japan who have studied under Dr. Shi Xuebin and practice this method but this also doesn’t work unless it’s done in the early phase. As far as I know, the Seino Kaikyo method has little effect six months after the stroke. Scalp acupuncture, however, continues to have an effect.

Sai: And one more thing, it’s not an ordeal to receive scalp acupuncture. The original Seino Kaikyo method uses strong stimulation and is painful, so it’s hard for patients to endure.

Kajima: Japanese patients can’t handle it, and it can’t be kept up.

Sai: I did this methods once, and the patient was able to walk, but when I told the patient I would do it again the patient got angry saying that “You torture Japanese.” I was shocked. I did my best to help the patient, but I realized that the stimulation was too much and this method wouldn’t fly.

It has positive effects on alopecia.

Inoue: So of course scalp acupuncture is effective for alopecia.

Kajima: Of course.

Sai: That’s right.

Kajima: In my case, I specialized in treatment for alopecia before I got into scalp acupuncture. You use the same points on the head, but sometimes when I’m treating the patient for something else their white hair begins to become darker, or the hair gets thicker. This happen quite often.

Chairman: There are many ways to stimulate hair growth like applying chemicals or liquid nitrogen. The main thing is to stimulate the scalp and improve local circulation. Inserting needles directly into the scalp to cause minute injuries, or doing moxibustion to make small burns with moxibustion is a direct method of increasing circulation. It’s simple to do and not that expensive, and I think it’s a very good approach. Conditions like alopecia areata respond very well.

Kajima: I am quite confident about treatment of strokes and other basic brain disorders using scalp acupuncture, but one reason this method is not spreading is because it’s hard to get the access to hospitals that handle such cases in Japan. Another thing is the level of acupuncturists. Those who know only and acupuncture and moxibustion can’t give good treatments. After all, to treat strokes it takes some knowledge of rehabilitation, and an ability to give appropriate instructions in exercises.

Sai: When I first came to study in Japan, I learned the Bobath protocol at the Bobath Hospital. The Bobath protocol is a neurological facilitation method using rehabilitation exercises. Acupuncture and moxibustion directly stimulates the nerves and meridians, and has a stronger effect than the Bobath protocol. Also the effect appears faster.

The effect can be increased by the combining with the Bobath protocol.

Kajima: The Bobath protocol, among all the facilitation methods, is one which gives stimulation from the distal parts to the brain using specific exercises and then actually stimulating the nerves that are involved in those exercises. On the other hand, scalp acupuncture stimulates the brain via the scalp, so it is stimulation from the brain to the distal parts. An effective feedback system is possible only when you apply both these approaches. The usual classical rehabilitation methods that simply work with movements have only a small effect. A good combined effect can be achieved with scalp acupuncture only with facilitation methods. So I ended up using the Bobath protocol myself.

Chairman: Could you give us a few cases where you’ve had great success using cranial acupuncture points.

Kajima: Just like Dr. Sai, I’ve had success with stroke patients who have had difficulty moving their limbs. We always see patients long after their strokes, and there was one man in his seventies who had a stroke ten years ago, and I began treatment with the understanding that the chances of recovery would be slim. He had spasticity in his leg and his foot was stuck in supination and dorsiflexion. He couldn’t put weight on his foot this way, so he was always wearing a orthodic device that held his ankles in 90 degrees flexion. After I gave him a treatment, he was able to move his toes. The ankles were fixed and didn’t move at all, but since his toes began to move just a bit, I thought his condition just might improve, so I had him remove the orthodic device and put needles in and started having him do exercises putting weight on his feet. We began with shifting his weight onto the foot, and as we repeated doing this weight shifting with scalp acupuncture treatments, we were able to create a condition where he could release the tension in the ankle joint. We repeated this treatment and after a while I had him put his affected foot forward and shift his weight forwards and back. This gradually stretched his Achilles tendon and gastrocnemius muscle, and he became able to flex his ankle. Eventually he was able to walk without his orthodic device or a cane. This was ten years after his stroke. I reported on this case a long time ago, but the doctors didn’t believe it. They Said that’s impossible. But such miraculous things actually do occur.



But if you were to ask if such effects could be obtained for all stroke patients ten years later, I would say it’s unlikely. In the above case, the range of motion was secured for ten years by his orthodic device. He was a patient who could manage on his own, and he managed his leg and mobility so the joint didn’t go into contracture. Even if it’s just three years after a stroke, it’s very difficult to reverse (loss in ROM) if there is contracture in the joint. This is structural damage to the joint so the joint will not regain mobility not matter how much you relax the muscles. In this sense, the above case is exceptional.

The precision is required in scalp acupuncture. Inoue: I often hear that when it comes to scalp acupuncture precise needle insertion within a couple of millimeters is required, but is this really the case? If so, what could one do in the way of practice to get such precision?

Sai: This need for precision is not limited to scalp acupuncture. All acupuncture points are within a couple of millimeters. The effect may even depend on 1mm difference. I think points like LU-7 and SI-6 especially are within a few millimeters. In my practice I try to get the needle within a few millimeters as much as possible.

Chairman: Can’t those who can’t get the exact point start by getting on the right line?

Sai: Yes, you can get it on the meridian line. There is no effect if you miss the meridian.

Inoue: Do you ask the patient whether the needle is on the right point?

Sai: Yes, that’s right. I adjust the angle, depth, and location of the needle during the treatment based on the change in the patient’s symptoms. I try to get the best possible results from each needle.

Chairman: It is good to insert the needle in relation to the improvement in the pain with certain movements or increased range motion.  It is good to change or reconsider the treatment based on the feedback of results.

Sai: That’s right. We adjust the needling based on the results.

Chairman: So you are saying that the location and technique is good when there is a good result?

Sai: Yes.

Locate the appropriate points.

Kajima: This is not just true for scalp acupuncture, but there is usually a needle sensation when I needle body points, but students often can’t get any sensation when needling the same point. The students often ask what is the difference, but there are two things. The first is whether the point location is appropriate. It is important for the licensing examination that the point location is according to the textbook, but for clinical work there also has to be some reaction. I don’t treat points that don’t have a reaction, so it all depends on whether one can develop a sensibility to grasp these reactions precisely. One must be able to feel with the fingertip something that is different around the point described in the textbooks, such as indurations, tension, or slight difference in the resilience of the skin.

Usually the middle of the tip of the index or middle finger touches the point first, so probably a point close to the middle of the nail comes up against the skin. I have students mark the point with a pen, and then I have them put their oshide (supporting fingers) on this, place the tube and needle inside, and insert a needle to see if they can hit the point precisely.Unless people practice their basic point location and needling techniques, they can’t hit the points they should be able to hit. The important thing is practice.

Chairman: I often use intradermal needles, but with intradermal needles the insertion point can be adjusted by 0.1 or 0.2 to 0.3mm. If I place an intradermal and the symptom doesn’t change, it often improves when I move it slightly. It becomes practice when you confirm changes and effects as you give treatment. Anyone can learn to do this if they practice for about a year.

Sai: If you adjust your needling according to results, you gradually improve and you hit rate goes up.

Chairman: It might actually be harder to hit the pin point inserting a needle with a tube.

Kajima: As long as the basic needling technique is correct, you might be 1 or 2mm off, but the needle will pretty much start above the point. It’s just a problem when the supporting hand is lax, the pinching pressure is uneven, the tube is not placed vertically on the skin, or the needle is just pushed in. The problem recently with disposable needles is that people place the needle and tube on the point first before creating the base with their supporting hand. It’s no wonder that people miss the point when they have sloppy technique like this.

This is why the traditional basic needling techniques have to be taught carefully. I am about to give my students a practical exam. I will mark a needle pillow with a red pen and the students will lose points unless they get the needle right into that point. Anyone can practice this kind of thing. It doesn’t take many months and years. Six months would do it.

How long does the effect of treatment last? Inoue: I have heard that the effect is short-lived with special needling techniques like scalp acupuncture and ocular acupuncture. To make up for this, do you use things like intradermal needles to extend the effect with supplemental methods between treatments?

Sai: I use intradermal needles.

Kajima: It’s not that the effect is short-lived with special needling techniques, but rather the effect doesn’t last because the root treatment is inadequate. Does this mean special needling techniques are always branch treatment? Not necessarily. Even scalp acupuncture can be used for root treatment. It is a biased view to regard it as only branch treatment. The reason the effect doesn’t last is because the basic condition of the body is not improved and only the apparent symptoms are treated. This issue is the same whether it is scalp acupuncture or regular acupuncture.

Chairman: When you give a complete treatment and the effects don’t last, the best thing to do is to increase the frequency of treatment.

Sai: This happens with all methods. It’s not only scalp acupuncture that has short effects. The same is true for regular acupuncture. The maximum effects are felt three to five hours. Then it gradually diminishes.

Chairman: When a good condition is maintained, the effect of the treatment also gradually lengthens. When patients tell me “The effect lasts one or two days only,” or “the effect lasts for only three days, what should I do?” I tell them “Why don’t you come in on the third day.” It seems that there is this fixed idea that acupuncture should be performed once a week. If treatments are given every other day, or once every two or three days it can actually reduce the total amount of time and number of treatments.

Sai: In China they give treatments everyday until the patient gets well. In Japan they only give treatments once a week so it’s much harder to get people well.

Rehabilitation exercises at home are necessary.

Kajima: Even with Dr. Zhu’s scalp acupuncture, in China they give treatments three days in a row and then rest one day. This is possible because they are treating patients in the hospital. In China they use extended needle retention, and leave the needles in the scalp for 24 to 48 hours. This would be impossible in Japan where patients go home on the train.

This is why, unless patients set aside time to do exercises at home even on days they don’t come for treatments, there is little effect. What is common to patients who don’t get effects is that they don’t do rehabilitation exercises at home. This is why there aren’t much results. Scalp acupuncture alone is not enough to get good results.

Sai: In Japan patients tend not to do rehabilitation exercises at home. They are glad to do it when they come to hospitals. When I used to work in a hospital and gave acupuncture to stroke patients who were getting early stage rehabilitation work, they got better quickly and their hospital stays were shortened.

Kajima: It would be ideal if we could do that.

Chairman: To induce labor I have expectant mothers apply moxibustion on SP-6 every two hours. But if people don’t know about this and apply moxibustion only once a week or once every few days, they may wonder why it doesn’t work. With pain from cancer, for example, you have to treat over and over if the pain persists. Otherwise you can insert a needle horizontally and tape it down with a large piece of tape, have the patient hook it up to electrostim machine and leave it on 24 hours, adjusting the level on their own. This can be done at home, and it’s very useful to know.

Kajima: There are many things in this world where people just go along with an idea without going to the effort to verify the effect.

Inoue: There may even be cases where treatment is required several times a day.

Sai: Depending on the disease, I give treatments every day, or even several times a day. Sometimes I give treatments that last a few hours. Stroke patients seem to respond to treatments where needles are retained for a few hours each day. The best results are obtained with asthma when acupuncture is given before the asthma attack. Also it is Said that it’s best to do preventive treatments three months before the onset of asthma. The successful treatment of disease depends on timing and frequency. This is an issue we need to continue to study and investigate.

Inoue: Thank you. I appreciate all the time you have taken to share valuable information.

Chairman: Please continue your good work.

END

translated by Stephen Brown

 

Susuki Ikuo (Chairman)

Born in 1960. Graduated Ibaragi University School of Agriculture in 1983.

Graduated from the KokuSai Shinkyu (acupuncture/moxibustion) College in 1984 and started to work in the Oriental Medical Section of the Tamagawa Hospital. He opened his own practice in 1997. He became the head of the clinical medicine study group in 1998 and started publishing the journal “Rinsho Igaku Dayori.” He became a non-regular faculty at the Ryogoku Acupuncture College from 2002.

Kajima Ikuo

Born in 1957. Graduated from the Meiji Shinkyu (acupuncture/moxibustion) College in 1979. Started working at the Japan-China Clinic in 1984. He opened his own practice in 1990. Graduated from the instructors training program at the Meiji Shinkyu College in 1997 and became a non-regular faculty at the Ikuoka Acupuncture College.

Sai Gyomei Born in 1957. Graduated from the TCM College of Jiangxi, China in 1982.

Became an instructor at the TCM College of Jiangxi in 1983. Sent to Osaka University Medical School Orthopedics Clinic as an exchange student from Chinese government in 1989. Studied in the Anesthetics Department of Osaka University Medical School from 1991. Started practicing at the Kamiyama Hospital in 1992. Graduated from the Osaka Shinkyu (acupuncture/moxibustion) College in 1995. Inoue Etsuko Born in 1951. Graduated from the KanSai University with a degree in psychology. Graduated from the Osaka Shinkyu (acupuncture/moxibustion) College in 1977 and became an instructor at this college. Opened her practice, the Inoue Clinic in 1986. Joined the editorial staff of Shinkyu Osaka in 1988.