Dr. Xuelong Huang, the Earliest Founder of “Scalp Acupuncture-Zones Therapy”

Abstract

Background:

There were controversies in academic circles regarding who was the founder of Scalp Acupuncture (SA), while Dr. Yunpeng Fang or Dr. Shunfa Jiao claimed themselves as the earliest founder and some believe that SA was founded by Dr. Xuelong Huang (Huang) in the 1950s.

Aim:

To investigate Huang and his acupuncture practice and research, to uncover the history of Huang’s contribution to SA therapy.

Methods:

Huang and his SA therapy are introduced and discussed in five aspects, including the transformation from a local traditional scholar in the late Qing Dynasty to an expert in acupuncture-moxibustion, the formation of scalp acupoints and acu-zones, clinical indications, multiple stimulation modalities, and clinical experience.

Results:

The fact is that in the 1950s, Huang was the first to develop SA therapy. Its theoretical basis is that the 14 Channels and the brain are a sole system: when divided, they are demonstrated as 14 Channels, and when combined, the Channels are all unified in the brain. The longitudinal stimulating line (acu-zones) is located on the scalp above the sagittal suture, centered at the Baihui (DU20) acupoint, and with the other scalp acupoints on the Governor Vessel (Du Mai). The horizontal stimulating line (acu-zones) is formed with the acupoints Naohu (DU17), Yuzhen (BL9), and Naokong (GB19). Both lines form a shape of “丄”. The stimulating modalities include single-point needling, one needle piercing through two or multiple acupoints, moxibustion, and plum-blossom dermal needling (extensive shallow acupuncture). When acupoints on the head are selected, the local scalp zones of the “cerebral cortex” directly underneath are often introduced first, and then based on the indications recorded in traditional classics such as A-B Classic of Acupuncture and Moxibustion. Huang’s SA accumulated extensive experiences. His stimulation does not have to be limited to single-acupoint and more focus on acu-zones, and there are many stimulating modalities adopted; therefore, Huang’s method can be called “scalp acu-zone therapy.” In the 1970s, “SA therapy” rose again under the first advocacy of Dr. Yunpeng Fang, and many SA “schools” formed, such as Fang, Jiao, Tang, Lin, Zhu, and many more. The promulgation of international standards for SA in the 1980s marked the formal acceptance of SA by international acupuncture societies, it has been incorporated into the Channels and acupoint system of traditional Chinese medicine.

Conclusion:

Starting by Huang, the main operating method of all schools of SA is using needles to penetrate acupoints on the scalp instead of stimulating every single acupoint, and the stimulating methods are becoming more and more diverse, it is suggested to change the term “scalp acupuncture” to “scalp acu-zones therapy” for reflecting the real clinical practice.

INTRODUCTION

That acupuncture focused on the scalp and formed a microsystem was first named “head acupuncture” or “head acupuncture therapy” by Dr. Yunpeng Fang in 1970 and was renamed “scalp acupuncture” (SA) or “SA therapy” in 1976.^1–3 Later, many other doctors, including well-known Dr. Shunfa Jiao, adopted both the terms and used them interchangeably.^2–4 There were controversies in academic circles regarding who was the founder of SA, while Fang or Jiao claimed themselves as the earliest founder.^2–4 Among them, some believe that SA was founded by Dr. Xuelong Huang (Huang, in short) in the 1950s.^5–7 However, due to limited research available on Huang over the last decades, there is a lack of detail on the process of Huang’s development of SA therapy, as well as the theoretical basis, stimulating location, and method or modalities. Based on the available literature, we have introduced and discussed Huang and his SA therapy in five aspects, with the hope to uncover the history of Huang’s contribution to SA therapy.

AN OLD-STYLE SCHOLAR IN THE LATE QING DYNASTY TURNED INTO A WELL-KNOWN ACUPUNCTURIST

Huang lived in an era of great changes in China. His life was full of legends from a local old-style scholar in the late Qing Dynasty to a well-known acupuncturist in modern China.

Huang (alias: Zhuhua, Yuelong; nickname: Cizai,1877 AD–1962 AD, 85) was born in Huangdahu Village, Huxi Town, Dongyang City, Zhejiang Province. He was awarded “Xuecai,” a first-level scholar title after he had passed the county examination in 1899, in the 25th year of Emperor Guangxu stage in the late Qing Dynasty. At that time, Western-style schools had just started to be established. In 1905, at the age of 28, Huang enrolled in the Teacher Training School affiliated with the Zhejiang College of Higher Learning (currently, Zhejiang University), the highest institution in Zhejiang Province at that time, with a 1-year schooling. ⁸ In 1908, he was admitted to a high-level class in the program of Natural Science at Zhejiang Provincial Two-Level Normal School (now Hangzhou Normal University). There were a total of 328 students majoring in Nature Science. The primary-level class was for the training of elementary school teachers, while the high-level class was for middle and high school teachers. The so-called natural science was the general name of disciplines such as animals, plants, minerals, physiology, and hygiene. Therefore, Huang was one of the earliest college graduates in China. He studied science ⁷ and graduated in June 1910. After that, he successively served as a teacher in the secondary school and the normal school—as a doctor for the secondary school in the counties of Jinhua, Taizhou, Chuzhou, and Dongyang (and also as a principal in a secondary school), respectively.^6,7 He was once a military doctor in the National Revolutionary Army. ⁹

Huang did not believe in traditional Chinese medicine (TCM) in his early life, because of his Western-style educational background, especially since he had been strongly influenced by his teacher Dr. Shuren Zhou (well known as Lu Xun, a leading figure of modern Chinese literature) in physiology and anatomy. Zhou learned Western medicine in Japan and later became a famous writer with a strong anti-Chinese medicine attitude in the last century. However, after more contact with traditional Chinese doctors, Huang started to dabble in Chinese medicine in 1927 at age 50, studied Yellow Emperor Internal Classics (Huangdi Neijing), and discussed Chinese medicine theory frequently with Dr. Jialan Jin, a well-known Chinese medicine doctor in East China. ¹⁰ In 1931 at age 54, Huang heard that acupuncture could treat and even cure difficult-to-treat diseases. Out of curiosity, he studied acupuncture together with his younger brother, Mr. Yunlong Huang. “First study acupuncture, then study moxibustion,” he recalled. ¹¹ According to the “Alumni Directory” published in the Journal of Acupuncture and Moxibustion (JAM) in 1935, on December 6, 1934, he joined the China Acupuncture and Moxibustion Research Society (CAMRS, an acupuncture school and a research institute under the name of “society”), to study acupuncture under the guidance of Dr. Dan’an Cheng (Cheng, in short), the most famous acupuncturist and acupuncture educator in China at that time.^12,13

The profession of acupuncture and moxibustion had been weakened to the status of “folk medicine” after Emperor Daoguang’s ban on acupuncture and moxibustion in Imperial Medical Academy and Hospital (Tai Yi Yuan, due to “not being appropriate to serve the monarchs”) in 1822 and the government of the Republic of China advocated Western medicine only and abolished TCM from 1912 to 1949. ¹³ Cheng founded the CAMRS in Suzhou, China, in 1929, which is the earliest acupuncture academic research institution and school in contemporary China. It was also the earliest correspondence education institution for acupuncture and moxibustion. In 1933, the JAM, the earliest professional journal of acupuncture in China, was published. From 1934 to 1935, Cheng went to Japan to investigate the development and the research status of acupuncture and moxibustion. After returning to China, he founded the Chinese Acupuncture Institute and Acupuncture Sanatorium (hospital) in Wuxi, China, based on the research and teaching institute CAMRS. In 1937, CAMRS was transformed into the Chinese Institute of Acupuncture Medicine. The school was destroyed during the Japanese army’s bombing, and the teaching and journal publications were interrupted significantly during the war. In 1950, Cheng re-established the CAMRS and the JAM and invited Huang (73 years old) to serve as the vice president of CAMRS, concurrently as the editor-in-chief of the JAM. In 1952, the JAM was renamed Acupuncture Medicine, with Huang as the editor-in-chief and a contributing author.

In 1954, the Department of Health, Zhejiang Province, summoned Huang to Hangzhou, Zhejiang’s capital city, to teach acupuncture and moxibustion to a class of Western-trained physicians. At the same time, he served as a special-appointed physician by the Hangzhou Hospital (the predecessor of the Zhejiang Provincial Hospital of Chinese Medicine). In July 1956, he was invited to work as a researcher at the Zhejiang Institute of Chinese Medicine. In July 1957, he was appointed as one of the earliest four professors in the Zhejiang Provincial School of Chinese Medicine Further Training (the predecessor of the Zhejiang University of Chinese Medicine). He was an editorial board member of the Zhejiang Journal of Chinese Medicine (ZJCM). In the spring of 1958, he resigned from his job and returned to his hometown, to practice Chinese medicine. In 1962, he, unfortunately, suffered from a stroke and died half a year later, at the age of 85. ¹⁴

Huang had read many TCM classics, especially in acupuncture-moxibustion. With his profound knowledge of Chinese literature, biology, and physiology, he devoted himself to the exploration of traditional acupuncture and moxibustion theories and clinical applications. To clarify the mysteries of traditional acupuncture and moxibustion with modern medical theories, he read many modern medical books, such as Systematic Anatomy, Neuroanatomy, and Euclidean Internal Medicine, and made a lot of excerpt notes. Huang wrote many papers clarifying traditional acupuncture with modern medical theory. In 1950, Huang compiled and published them in a book, titled The Art of Slaying the Dragon. ¹⁵ His book Acupuncture and Moxibustion Therapy and Physiological Effects was published in 1953 and was revised and republished in 1954. ¹⁶ These two books embody Huang’s major academic thoughts and, therefore, were highly valued and praised by the acupuncture and moxibustion community. Huang also published papers in journals such as New Chinese Medicine and ZJCM. Another book, The Interpretation for the Classics of 14 Jing (Channels), was not published in time, and his original article was lost during the Cultural Revolution.

Huang’s SA Stimulation Regions

Huang is proficient in the theory of Jing Luo (which means Channels and Networks, now mistranslated as meridians in the western countries, i.e., the invisible energy lines) and has an in-depth understanding of the functions of the cerebral cortex. He used physiological anatomy as a footnote to the Jin Luo theory and acupuncture therapy to prove that the Jin Luo theory had a scientific basis. Huang proposed in Acupuncture and Pavlov that the Jin Luo “are divided into fourteen, and when combined they are all unified in the brain.” ¹⁵ Combining the Jin Luo and the brain provides an important theoretical basis for creating the SA.

Huang was good at using acupoint Baihui (DU20) clinically and got the nickname “Huang Baihui” (Baihui, literally, with two meanings: one is an acupoint which means “all Channels meet there,” alludes that acupoints are the brain-specific; another, means the person knowledgeable and “can treat everything with a good result”). DU20 is a very commonly used acupoint in clinical practice. It was first seen in A-B Classic of Acupuncture and Moxibustion (259 AD) (Zhen Jiu Jia Yi Jing). ¹⁷ The reasons why Huang made good use of this acupoint may be as follows: the first, the book Classic of Nourishing Life with Acupuncture and Moxibustion (1120 AD) (Zhen Jiu Zi Sheng Jing) records that “Northerners use moxibustion on newborn babies’ on this acupoint for preventing babies’ possible convulsions in the future.” ¹⁸ The Baihui-moxibustion method with moxa cone is still used in the Dongyang region where the Huang family lived 800 years later. According to Collections of Zhejiang Modern Academic Experience on Acupuncture and Moxibustion ⁶ , published in 2002, “at that time, scars from moxibustion wounds can still be found on many local people’s top heads, especially those over 40 years old.” ⁶ The second, Song Dynasty’s Classic of Nourishing Life with Acupuncture and Moxibustion (1120 AD), mentioned that “there are four most important acupoints in the human body for emergency use, all ‘four hundred and four diseases’ can be cured. One of these acupoints is Baihui.” Baihui acupoint can be used for many diseases or disorders and has a good therapeutic effect. Third, The Spiritual Pivot (Lingshu, Chapter Jingmai) says, “The Bladder Channel of Foot-Taiyang…the straight one goes from the top of the head to connect the brain.” “Top,” many annotators believe, is Baihui acupoint. The book Lei Jing Tu Yi (1624 AD) said, “Not only the Channels of Governing and Foot-yang meet here, but also the Channels of both Hand- and Feet-Shaoyang and both Hand- and Feet-Jueyin all meet there.” ¹⁹ Huang believed that the Baihui point is closely related to the brain. Huang further inferred that “Baihui is the center point of the sensory area and motor area of the whole body, and is the crown of all points, underneath the acupoint is the central sulcus of the brain. In front of the central sulcus is the whole-body movement zone. The area post to the central sulcus is the whole-body sensory zone.” Therefore, “the stimulating of Baihui can, indeed, invigorate the whole body’s senses and Movement.” ²⁰

In clinical practice, in addition to the DU20 acupoint, he also attaches great importance to the Qianding (DU21), Houding (DU19), Qiangjian (DU18), and Xinhui (DU22) acupoints located above the sagittal suture. He believes that Baihui can be applied to all symptoms from multiple disorders and diseases, adding one or two points at the anterior and posterior parietal scalp region at the sagittal suture line to improve the acupuncture effect. Huang calls the Qiangjian (DU18) “Little Baihui.” ²⁰ Considering underneath Qiangjian (DU18) inside the skull is the visual cortex of the occipital lobe, he believed that in addition to treating headaches and neck stiffness, it also can be used to treat eye disorders, dizziness, or vertigo. Considering underneath the Houding (DU19) is “the outer layer of the occipital lobe of the brain, which is the higher visual center.” It is mainly used to treat “bad wind” (such as migraine, stroke, etc.), dizziness and the disorders with unclear vision. Huang also called the Xinhui (DU22) point “Big Baihui.” ²¹ In the article “My Opinions on the Study of Some Channel Points,” the Naohu (DU17) was added to the list. ²¹ There was a picture of “the bird’s eye view on the top of the head” in the paper, which included the Xinhui (DU22, Big Baihui), Qianding (DU21), Baihui (DU20), Houding (DU19), Qiangjian (DU18, Little Baihui), Naohu (DU17), and many others.

Huang added Shangxing (DU23) and Shenting (DU24) points in his article “How to Use Baihui-related Points on the Sagittal Sulcus line (above the falx cerebri of the Brain)” published in 1954. ²² In this way, the stimulation point area extends forward and backward, respectively, from the sagittal suture line on the scalp and becomes with the Governing Vessel (Du Mai) as the longitudinal axis. He also believed that since the occipital lobe of the brain has a visual cortex, in addition to Houding (DU19) and Qiangjian (DU18), the Yuzhen (BL9) 1.3-cun adjacent to the Naohu point (DU17) in the occipital region can also treat “pain in the eyes and can’t see far.” The Naokong (GB 19) 2.25-cun beside Naohu (DU17) can be used to treat “vision poor” and “eye and nose pain.” They all can “get a physiological explanation (through the cortex functional zone underneath the acupoints).” In this way, the Yuzhen point on the Feet-Taiyang Channels on both sides of the Naohu acupoint and the Naokong point on the Feet-Shaoyang Channels on both sides of the Naohu acupoint are included in the treatment stimulation region, thus forming a transverse acupoint zone with Yuzhen (BL9) as the focused points. Huang’s SA stimulation region is mainly composed of the Governing Vessel (Du Mai), Feet-Taiyang, and Feet-Shaoyang Channels’ points, which are arranged in a “丄” shape. The descriptions of Huang’s scalp stimulation region above laid the foundation for the re-emergence of SA in the 1970s, especially, the hypothesis of Jiao’s SA and his SA stimulating zones.^1,3–5

Huang’s SA and Its Clinical Indications

Huang treated the 14 Channels and the brain as a whole system. He believed that “the Channel acupoints are closely related to the cerebral cortex.” In this way, the Channels, acupoints, and the cerebral cortex are connected. At the same time, it is also believed that “the impulses sent by the cerebral cortex can affect many systems at the same time, and cortical activation can also activate many endocrine organs.” ²³ Therefore, Huang believed that “stimulating Baihui region can indeed promote endocrine activities” because the pituitary gland is the “king of endocrine glands” and is very sensitive to temperature changes caused by the acupuncture stimulating at local of Baihui (DU20), Qiangjian (DU18), and other related points; therefore, the SA proposed by Huang would treat not only outer body (such as limbs) diseases or disorders but also visceral diseases or disorders.

Huang believed that there is no absolute precise positioning at the cerebral cortex that regulates visceral function. Therefore, he said that acupuncture stimulation is not necessary to be limited to a specifically single acupoint at the scalp. DU20 can be adopted, and the location can be forward or backward; there is no need to be rigid about the exact Baihui’s original location. Both sides of the falx cerebri under the sagittal sulcus are the related cerebral cortex. If multiple points at the midline are stimulated appropriately, the cerebral cortex can be activated more efficiently. ²⁴ The impulses from a particular cerebral cortex area can affect many systems at the same time, therefore, all points discussed above at the sagittal sulcus line and above the two hemispheres of the brain, such as DU21, DU19, DU23, and DU18 should be used, in addition to DU 20 at a doctor’s discretion. He said that “whenever there is a disease in the internal organs, Baihui (DU20, and related points discussed above) should be used, especially in diseases with a pain condition.”

Huang creatively set an acupuncture protocol that combined the SA at Baihui (DU20) and related acupoints, with the traditional Channel points to enhance the curative effect. ²³ For example, “Shenshu (BL23) is the reactive (tender) point of kidney-disease,” during treatment for the kidney disease, BL23 and DU20 acupoints can be adopted and stimulated; for the palpitation treatment, DU20, Xinshu (BL15), Shenmen (HT7), and the like can be adopted and stimulated; for hemoptysis and hematuria, DU20 can be used with Geshu (BL17), while BL17 is a special acupoint for blood disorders. DU20, DU21, DU19, and other points at the sagittal sulcus line, combined with Feishu (BL13), Fengmen (BL12), and the like, are used in treating asthma and cough. So-called Spleen in TCM is related to the pancreas function; therefore, stimulating points such as DU20 plus Pishu (BL20) can promote the secretion of the pancreas; stimulating DU20 can promote the discharge and regulation of bile, and therefore, it can be used in conjunction with Ganshu (BL18) and Danshu (BL19), the liver’s and gallbladder’s acupoints; stimulating the stomach such as Zhongwan (RN12), the reactive point of the stomach, plus DU20 at the same time can promote digestion better. He also said that stimulating the precentral gyrus may promote stomach and gallbladder movement. ²³ For digestive system diseases, DU20 can be used not only for gastric ulcers but also for all other stomach diseases. DU20 can be used not only for digestive system diseases but also for neuropathy, burning neuralgia, hypertension, autonomic nervous system diseases, and many more.

Except for the treatment of outer body (limb) diseases, in Huang’s papers, DU20 can be found to treat dizziness and needle-fainting; DU18 can be used for treating headaches, neck stiffness, dizziness, and vertigo; DU19 was mainly used to treat “bad wind” (migraine or stroke) and dizziness. Overall, Huang’s discussion of the SA theory is not much in detail, however, Huang believed that one-third of the cerebral cortex is exposed and two-thirds forms the sulcus wall. The central sulcus of both brain hemispheres is approximately 70° from the sagittal sulcus. “Every part of the human body, including the sensory and motor activities, centers on the brain cortex. Its location is from bottom to top. The cortex underneath DU20 is the center point of the whole-body motor and the whole-body sensory zones. In front of DU20 are DU21, DU22, DU23, and DU24, and behind DU20 are DU19 and DU18 acupoints. These acupoints are all located on the sagittal sulcus line, and underneath both sides of the sagittal sulcus are all connected to the different functions of the cerebral cortex. If such points are stimulated, they will particularly affect all functions of the cerebral cortex, especially the sensory and motor functions. Therefore, SA stimulation has a therapeutic effect on limb movement and sensation” ²³ . He said, needling DU20 and Fengfu (DU16), if the patient has a strong sensory connection, the soreness and tingling will radiate directly to each end of the upper and lower extremities, such as fingers and toes. Therefore, DU20 can be applied to all outer body (limb) symptoms or conditions; points either front or back of DU20, such as DU21 or DU19, can also be used to strengthen their regulating effect. “(Stimulating the scalp regions above) the optical zone above the occipital lobe is for vision (improvement), and the auditory zone at temporal lobe is for hearing (improvement).” ²³ If such regions are not used, other parts of the scalp also can be used for substitution. He said DU20 and its surrounding area can be used for regulating the temperature and treating various fevers as SA can modulate the function of the hypothalamus. It shows that Huang had a clear understanding of the functional distributions of the cerebral cortex. However, he did not mechanically select acupoints according to the functional distributions on the cerebral cortex, that is, he did not set up stimulation areas such as the motor zone and sensory zone, as Jiao does.^3,4 This is because Huang believes that the various functions of the cerebral cortex are overlapping and “mosaic-like.” ²⁵

Huang used DU20 and other acupoints (he named them Big Baihui, Little Baihui, etc.) at the sagittal sulcus line (actually, it can be called the Baihui line) very frequently; therefore, he got the nickname Huang Baihui.

Multistimulating Methods Adopted by Huang’s SA

Huang attached great importance to the stimulation methods of the Baihui acupoints on the scalp. He believed that “the dose and the duration of the needling stimulation should be paid close attention by Acupuncturists.” ²³ He believed that acupuncture therapy’s stimulation fully depends on the activation of peripheral nerves, the auto-modulation of visceral nerves, and the regulatory nature of the cerebral cortex, and then exerts its effectiveness so that the internal and external parts could restore their inherent functions. For this purpose, Huang used many methods or techniques in his clinical practice, such as traditional single acupoint acupuncture, multiacupoints penetrating needling, dermal needling (multineedles, shallow, and multiple needling), moxibustion, fumigation, and so on methods.

Huang’s traditional single-acupoint acupuncture

Huang advocated light (minor) stimulation in acupuncture, that is, shallow needling and light moxibustion. His idea is to let many “subthreshold stimulations” accumulate, to play a therapeutic role. He firmly believed in the effectiveness of light moxibustion or shallow needling of DU20 and other related acupoints. ²³ He once published an article “Shallow Needle and Light Moxibustion” to discuss it in detail. ²⁶ In his article “On Acupuncture Operation,” Huang believed that needles should “enter the skin quickly and enter the flesh slowly.” As for the needle stimulating technique, Huang believed that “there are different opinions (methods). It can be found that every opinion has its specific insights and can be effective. There is no need to stick to anyone.” “Scholars can consider and adopt (a proper method) according to the degree of deficiency or excess (in each specific patient), or use a moderate and even speed stimulating (so-called Zi-wu pounding mortar method, Dr. Fan notes: it means quickly upper-down a needle a few times and then remove it) to compromise.” ²⁷

Huang’s multiacupoints penetrating needling

Needle penetration through multiacupoints along the skin, also known as the “acupoints penetration style of acupuncture,” is one of the acupuncture techniques. It is listed here to distinguish it from the traditional single acupoint acupuncture by each needle. Since the soft tissue of the scalp is shallow, SA is often used in this style of technique, and Huang frequently adopted it. Therefore, when adopting DU20 as a key acupoint for the treatment of a migraine, Huang first used a long needle penetrating (headache) ipsilateral SJ23 (Sizhukong) to GB8 (Shuaigu), ST8 (Touwei) to GB5 (Xuanlu), and one side of GB20 (Fengchi) to another side of GB20. Then, needled (headache) contralateral LI4 (Hegu) and LU7 (Liejue), and finally the moxibustion was used on DU20. He claimed this style of treatment would achieve a good effect. ²⁸ It is generally believed that the “acupoints penetration style of acupuncture” first came from the “Yulong Song,” an ancient acupuncture textbook. In the song, when treating “hemi-lateral and full-head wind”(currently, migraine), the author mentioned using a longer needle to penetrate from TE23 (Sizhukong) along the skin to the rear and reach GB8 (Shuaigu), one needle pieces and stimulates two acupoints. Huang reformed it and punctured from GB4 (Hanyan) along GB5 (Xuanlu) to GB6 (Xuanli), from the upper to lower, and then retreated the needle to GB4, and slightly backward, pieced to GB8; therefore, one needle can piece three acupoints. He once published a paper “On One Needle and Two Acupoints” to discuss this topic. ²¹ Thirty years later, Dr. Keyan Chen advocated and promoted SA, and Dr. Guirong Dong’s “Baihui penetrating to Taiyang (DU 20 to EX-HN5)” ²⁹ and others, ³ all followed Huang’s experience.

Huang’s dermal needling

Dermal needling therapy uses a special tool installed with five, seven, or even more short needles for shallow-stimulating soft tissue, especially the skin and its related parts, such as “plum-flower needling,” “seven-star needling,” and many more. It was popular during the 1950s. At that time, doctors believed that the stimulation caused by the dermal needling was much lighter than that by traditional body acupuncture. Huang proposed using dermal needling to “puncture the entire surface of the skull” to treat diseases. ²³

Huang’s moxibustion

Huang proposed that the effectiveness of moxibustion is triggered by artificial inflammation caused by warm stimulation or skin-burning injury. He considered that the cerebral cortex plays a major role in the temperature or injury perception of the skin. Moxibustion on the skin would cause a change in temperature or injury perception of the skin, which can indeed affect brain function. He believed that direct-moxibustion acupoints such as DU20 would be the strongest. ²³ In the ancient book, A-B Classic of Acupuncture and Moxibustion, ¹⁷ Dr. Huangfu proposed that moxibustion at DU20 can only be used for 15 min (five Zhuangs) and it is forbidden at DU18. Some ancient doctors opposed using moxibustion at the head too much, because “it will cause loss of the spirit if the moxibustion time is too long during one treatment” (book Xiao Pin Fang, or called Formulary of Trifles). ³⁰ Dr. Weiyi Wang (in the book Illustrated Manual of Acupuncture Points of the Bronze Figure) mentioned that “when moxibustion is applied to the top of the head, it should not be applied more than seven Zhuangs (Dr. Fan notes: about 21 minutes), as the skin on the top of the head is thin.” ³¹ Dr. Jizhou Yang even specially wrote in Zhenjiu Dacheng: “On the head could not be given moxibustion too long time.” ³² Huang proposed that for ordinary illness, the moxibustion time can be 3–5 Zhuangs (10–15 min), while for chronic and “stubborn” illnesses or disorders, moxibustion can be used for 30 min because such conditions need a higher dose in fighting with moxibustion fire. To relieve the burning pain of moxibustion, Huang used to apply local anesthesia to the treatment area. He mentioned that “intradermal injection of 0.5% to 2% procaine solution, half a milliliter to one milliliter,” this method “has no impact on the efficacy of moxibustion,” and “the dose of local anesthesia used is very low, and there is no need to worry about its side effects.” The aim of that local injecting of a small amount of procaine is pretty much like Dr. Travell’s local injecting of procaine after the injecting needle’s needling (so-called dry needling, a type of acupuncture). ³³

Huang’s other techniques

Huang also combined acupuncture and moxibustion in clinical practice, and there are two methods. The first method is to directly use moxibustion around the needle after inserting and leaving the needle in place. “The combination of mechanical and warm stimulation should double the effect. It is stronger than burning the needle tail,” he said. However, a warm needle (burning the needle handles) may be better for those afraid of pain. ²² The second is to acupuncture first and then moxibustion on the same acupoint (after the needle was removed). [Dr. Ye comments: that is the “warm needle” in “Treatise on Febrile Diseases” (On Cold Damage)]. Huang believed that these kinds of mechanical and warm stimulations “can enhance the stimulation power.”

Clinical Experience

As for clinical experience and case studies, Huang’s records are relatively scattered but very distinctive. His clinical works were documented in the book Acupuncture-moxibustion Therapy and their Physiological Effects ¹⁶ and the journal Acupuncture Medicine. ³⁴

When Huang introduced the acupoints on the scalp, he often introduced the corresponding area of the brain cortex under them. Then he discussed the main treatment protocols from ancient medical books, such as A-B Classic of Acupuncture and Moxibustion, ¹⁷ and his own clinical experience. For example, when introducing the acupoint DU17 in “The Effects of the Medulla Oblongata,” he first introduced that the medulla oblongata is (inside of the skull) exactly under the DU17; he said “(the medulla oblongata) has the respiratory center, heartbeat center, vomiting center, sweating center, sugar regulation center, blood vessel expansion-contraction center, and many more” and “the heart’s adjusting center (the vagus nerve centers) is on each side of the medulla oblongata, connected by fibers.” Then he cited the main effects of DU17 in A-B Classic of Acupuncture and Moxibustion^16,17: “for spasms, blurred vision, puncturing the Naohu (i.e., DU17)” (Volume 7, Part 4 ¹⁶ ); “heavy-head and pain on the top of the head, blurred vision, coldness in the ‘brain’ (Dr. Fan notes: head) caused by wind, not warm even with heavy clothes, sweating, and aversion to the wind in the head, puncturing the Naohu” (Volume 7, Part 2 ¹⁶ ); “epilepsy, bone pain, dizziness, madness, mouth spasms, and with animal roaring sounds, puncturing the Naohu” (Volume 11, Part 2 ¹⁶ ); “muteness, inability to speak, puncturing the Naohu” (Volume 12, Part 3 ¹⁶ ). Regarding DU18 (“rear fontanelle,” Xiaobaihui), he said, “the Qiangjian (i.e. DU18) is located at a depression directly superior to the external occipital protuberance. Underneath DU18 is the higher visual center called the occipital lobe. The main therapeutic effect of DU18 is for blurring, dizziness, and vertigo with or without spinning, which is particularly important except for headache and stiff neck (Moxibustion is prohibited).” “The Houding (DU19) which is near DU18, is mainly used to treat the bad spasms, blurring, and dizziness.”

Huang’s clinical case studies were rearranged and published by the current authors in a literature journal in Chinese language ³⁵ recently.

DISCUSSION

Dr. Xuetai Wang was the Chairman of the World Federation of Acupuncture-Moxibustion Societies. He said in the preface of Scalp Acupuncture Therapy that, in the late 1950s, the acupuncture medical community was inspired by auricular acupuncture diagnosis and treatment and began to pay attention to the correspondence between the scalp (or say, hair-covered area) and various parts of the body. Through clinical practice, repeated verification, summary, and sublimation, SA therapy with the theoretical characteristics of a microneedling system integrating the whole body into the local was gradually formed. ³⁶ The person mentioned in this preface is Dr. Yunpeng Fang, a well-known acupuncturist in Shaanxi. In 1958, Fang started to explore “needling the functional regions on the surface of the scalp projected of the cerebral cortex, to treat systemic diseases as a new clue.”^1–3 In 1970, he treated patients in the Weinan region, Shaanxi Province, and actively promoted this therapy. According to the recollections of grassroots medical staff in Weinan, the Shaanxi Provincial Health Department once sent a special team to “conduct an investigation.” After confirming the facts, a special section on “SA” was documented in the provincial annals. It is clear that the rise of “SA therapy” was first advocated and promoted by Dr. Fang based on Huang. Soon, SA therapy formed many schools such as Fang, Jiao, Tang, Lin, and Zhu.^3,36 In the 1980s, Dr. Xuetai Wang examined SA with the vision of a strategist and formed the “National SA Research Collaboration Group” (NaSARC Group). At that time, a known acupuncture researcher, and deputy chief physician Dr. Keyan Chen, served as the leader of the NaSARC Group. ³ Therefore, “to standardize the scalp acupuncture sites, the NaSARC group, following the requirements of the Chinese Acupuncture Association, invited relevant experts in 1983. In the spirit of seeking common ground while reserving differences and the principle of aligning with meridians and acupoints, after sufficient discussion and joint summary, the “International Standardization Scheme for Scalp Acupuncture Sites” was formulated. It was adopted at an international conference convened by the World Health Organization (WHO) in 1989. The WHO publicly announced this standardized SA nomenclature in 1991. ³⁷ The advent of the international standard for SA marked the inclusion of SA into the meridian-acupoint system in TCM. Among these SA schools, Fang’s “Fu Xiang” is like a human miniature lying on the sagittal suture. Its body stimulation area on the scalp is similar to Huang’s stimulating acupoint area. The difference between the two is that Huang did not subdivide the stimulation points, while Fang not only subdivided the stimulation points but also added upper and lower limb stimulation points on the coronal suture and lambdoid suture. Jiao adopted Huang’s theory (hypothesis) and further elaborated, his method has many followers. ³ Tang further divided Fang’s human miniature into two miniatures: supine and lying yin and yang. ³⁸ Lin developed the acupuncture areas of the “quiet area” and “new area of the cerebellum.” ³

The same needling method of these acupuncture schools is scalp needling with multiacupoint penetrating needling. As Huang’s various stimulating methods are rediscovered and discussed, scalp stimulation methods will also become more diverse. Therefore, it is recommended to change the name of “scalp acupuncture therapy” to “scalp acupoint therapy” to facilitate clinical reference and development.

It is noted that except for being very effective in SA’s clinical practice, such as Jiao’s SA and others, there is a significant limitation in Huang’s SA theory which hypothesized that stimulating the scalp area directly above the cortex’s zones to treat disorders or diseases. ³ Apparently, there is no specific direct neural or other anatomy structure connection existed between the needling area of Huang’s SA and the cerebral cortex’s functional area^3,39 except for the possible reflecting adjustments of cerebral blood flow (CBF) through trigeminal or occipital nerve distribution area stimulations. CBF is significantly increased by stimulating specific scalp acupoints, areas, or nerves innervating the scalp, which parallels the instant or long-term improvement of symptoms of disorders or diseases. ⁴⁰ More and more studies focused on functional (f) magnetic resonance imaging (MRI) have been used to explore the mechanism of SA. One of the fMRI studies showed that, after needling the DU20, compared with preacupuncture, the brain areas being activated were the left postcentral gyrus and right precentral gyrus and the brain area being deactivated were bilateral middle temporal gyrus and cerebellum. When the DU20 was stimulated by electroacupuncture, compared with preacupuncture, the brain areas being activated were the bilateral postcentral gyrus, bilateral precentral gyrus, right superior temporal gyrus, bilateral lingual gyrus, right insula, left calcarine, and the brain area being deactivated were bilateral precuneus and cerebellum. ⁴¹ It demonstrated that SA’s effects on the brain are complicated, related to multiple regions, not only limited to the cerebral cortex, and different stimulating doses may result in different effects.

AUTHORS’ CONTRIBUTIONS

M.Y. and A.Y.F. initiated the project and conducted the study selection and data extraction. M.Y. drafted the first article in Chinese. A.Y.F. revised and drafted the second version in English. A.Y.F., M.Y., H.W., and Z.H. revised and finalized the article.