**5. Selection of acupoints in treating mental disorders**

According to TCM theories, acupoints are explicit points located at the surface of our bodies. Each acupoint serves its own function and can be joined together to form meridian lines. The selection and combination of acupoints is the most crucial component in acupuncture therapy. For example, it is understandable that the use of acupoints in treating brain diseases is definitely distinct from those for alleviating pain problems such as back pains. In the treatment of mental problems or brain organic problems, acupoints and scalp lines on the scalp including Baihui, Sishencong, midline of the forehead, lateral line 2 of the forehead and posterior lateral Line of the Vertex are commonly used.

Baihui is located at the vertex of the midline of the head, which is the meeting point from apexes of ears. It is one of the acupoints on the governor vessel (GV). The governor vessel is known to have its passage running from the coccyx upward along the spine into the brain. Under the TCM theory, it is the convergence of all Yang meridians and thus stimulation at Baihui can boost the flow of Qi in all the

Yang meridians, benefits brain development, and enhances intelligence. In modern studies, Baihui has been comprehensively studied and applied in treating a variety of brain diseases and mood disorders such as intracerebral hemorrhage, dementia, depression, anxiety, insomnia, etc. [13, 18–20].

Around the site Baihui locates the acupoints Sishencong. Sishencong is the four points located at 1 cun anterior, posterior, and lateral to Baihui. They are excluded from the 12 main meridians. Sishencong is known for its calming effect as well as tranquilizing excitement in mood. Different directions of needle insertion at Sishencong, such as pointing toward or away from Baihui or toward the side of brain lesion, can bring about different therapeutic effects. In general, it facilitates the harmony of Yin and Yang.

The location of the midline of forehead, also known as Shenting is 0.5 cun above the hairline and within the midline. Similar to Sishencong, it has been used to calm emotions and improve poor memory in theory. Lateral line 2 of the forehead are two acupoints located 0.5 cun above the hairline and directly above the pupils. In reference to anatomy, the midline and lateral line 2 of the forehand are the site of the prefrontal cortex (PFC). There are mainly five functions of PFC, which are executive functions, memory, intelligence, language, and gaze control. Because of the rich cortical and subcortical connection, PFC can initiate and perform goal-directed patterns of behavior, short-term memory tasks, planning, problem solving, etc. [21].

Posterior lateral lines of vertex are two points that are 1 cun next to the posterior Sishencong. It is located at posterior parietal lobe, anterior to the occipital lobe, and posterior to primary somatosensory cortex. Together with the close interconnection with frontal premotor area, it serves as a sensory-motor interface [22]. It receives sensory input from somatosensory cortex, and other regions of the brain integrate the information to allow the executive functioning.

### **6. Mechanism of scalp acupuncture**

Acupuncture for treating brain diseases is never mythical or ritual. It has originated from years of clinical experience and scientific proofs. Scalp acupuncture has proven to bring both functional and structural changes to the brain. Study has shown that scalp acupuncture at Sishencong can significantly decrease the heart rate and blood pressure of the test subjects. It is suggested that it exerts its effect through modulation of autonomic nervous system [23]. Another physiological change induced by scalp acupuncture is the regulation of perfusion in the brain. An alteration of perfusion among brain structures is detected under the inspection of single-photon emission computerized tomography (SPECT) [7, 24]. It is suggested to be the action of vasoconstrictor endothelin-1 (ET-1) [25]. The dysfunction of the brain structures in brain diseases and injuries can be detected and depicted by the probe of abnormal brainwaves [26]. Scalp acupuncture has shown its ability in restoring normal waveforms in healthy and depressed patients [27, 28]. In the long term, acupuncture provokes modulation at cortical structures including orbitofrontal cortex and prefrontal cortex and medial temporal lobes, together with limbic regions of hypothalamus, amygdala, cingulate, and hippocampus. The effects of acupuncture on these structures have been strongly supported by neuroimaging data obtained from electroencephalography (EEG), fMRI, magnetoencephalography (MEG), and positron emission tomography (PET) [29].

Altered catecholamine levels are commonly found in patients with mental illness. The use of scalp acupuncture has been suggest to bring about a surge of neurohormones and neurotransmitters in the central nervous system such as adrenocorticotropic hormone (ACTH), beta-endorphins, γ-aminobutyric acid (GABA)

**41**

*Scalp Acupuncture and Mental Disorders DOI: http://dx.doi.org/10.5772/intechopen.84683*

mental illness.

**7.1 Depression**

provide conclusive evidence [37].

**7.3 Schizophrenia and psychotic disorders**

**7.2 Anxiety disorders**

protein, noradrenaline, and serotonin [30, 31]. Other molecules such as brainderived neurotrophic factor (BDNF), postsynaptic density-95 (PSD-95) protein, and nitric oxide synthase (NOS) also respond to scalp acupuncture, suggesting

There has been a long history of utilizing acupuncture in treating mental health

problems and "mind-related" syndromes in ancient China. However, scientific literatures and clinical trials on acupuncture for mental problems had not been recorded until 1980s. Despite numerous clinical observations and controlled trials that have been made since then, evidences have remain insufficient to draw a definitive conclusion on the general use of acupuncture on psychiatric patients. More high-quality controlled trials with greater sample size and longer follow-up period are clearly needed in order to advocate the use of scalp acupuncture for treating

Depression is the most common mental problem [34]. The disappointing response rate and side effects of conventional medication discourage a proportion of patients from complying conventional treatments. Instead, they turn to CAM treatments, including scalp acupuncture. Meta-analysis has shown possible efficacy of scalp acupuncture on major depressive and bipolar disorders and antepartum and post-stroke depressions [14, 35]. Several studies suggested that the effect of scalp acupuncture is comparable to conventional medication, while a study concluded better outcome in somatization and cognitive process disturbances over antidepressant [36]. Despite various clinical investigations that have been carried out, additional high-quality randomized controlled trials are urgently needed to

Controlled studies have obtained consistent positive results on the use of acupuncture in patients suffering from anxiety disorder. However, most investigations have been focused on preoperative anxiety, generalized anxiety disorder, or anxiety neurosis only, while there is a large vacancy of knowledge about the effect of acupuncture on specific anxiety disorders like panic disorder, phobias, or obsessivecompulsive disorders [13]. A recent meta-analysis advocates the use of acupuncture on patients having post-traumatic stress disorder (PTSD) [38]. It is worth mentioning that a large proportion of studies concerning anxiety have been utilizing auricular acupuncture and body acupuncture, whereas investigations on the use of scalp acupuncture are scarce. We can see a great demand for complementing our knowledge toward the use of scalp acupuncture on various anxiety disorders.

Relatively few studies have been made on the use of scalp acupuncture to psychotic patients. Most studies suggested limited evidence on the use of acupuncture as adjuvant treatment along with antipsychotic medication. However, a general significant improvement in sleep quality and extrapyramidal side effects has been

observed in psychotic patients receiving acupuncture treatment [35, 39].

their possible participation to the mechanism of action [32, 33].

**7. Indication for scalp acupuncture on mental disorders**

#### *Scalp Acupuncture and Mental Disorders DOI: http://dx.doi.org/10.5772/intechopen.84683*

protein, noradrenaline, and serotonin [30, 31]. Other molecules such as brainderived neurotrophic factor (BDNF), postsynaptic density-95 (PSD-95) protein, and nitric oxide synthase (NOS) also respond to scalp acupuncture, suggesting their possible participation to the mechanism of action [32, 33].
