**7.1 Depression**

*Acupuncture - Resolving Old Controversies and Pointing New Pathways*

depression, anxiety, insomnia, etc. [13, 18–20].

the information to allow the executive functioning.

phy (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)

**6. Mechanism of scalp acupuncture**

the harmony of Yin and Yang.

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,

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 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

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, magnetoencephalogra-

**40**

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 provide conclusive evidence [37].

## **7.2 Anxiety disorders**

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.

#### **7.3 Schizophrenia and psychotic 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].

### **7.4 Insomnia**

Insomnia and sleep disorders are common mental health problems that have been always overlooked. Poor sleep quality could adversely affect the quality of life and deteriorate mental status. The use of acupuncture and scalp acupuncture may benefit insomnia patients, according to recent systematic review literatures. Since the current results of the clinical studies are promising and consistent, the use of acupuncture may be encouraged as an adjunctive therapy in insomnia [15]. We are expecting more high-quality evidence supporting especially the use of scalp acupuncture in the treatment of insomnia in the near future.

## **8. Contraindication of scalp acupuncture**

The contraindications of scalp acupuncture include infants with unclosed cranial fontanelles and sutures. Patients with cranial infection, ulcer, or scars on scalp are not advised to perform scalp acupuncture. Patients with past history of epilepsy or seizure should be comprehensively evaluated by the therapists before receiving treatment. Patients extremely anxious toward needles should be handled with care. Appropriate counseling and encouragement will be useful in building a good rapport between therapist and the parent. Possible side effect of scalp acupuncture includes discomfort or mild pain by the needle, emotional distress during the treatment sessions, bleeding, sleep disturbance, and increased hyperactivity.

### **9. Summary**

Scalp acupuncture deserves greater concerns on its application on mental disorders. It has advantages over conventional individualized body acupuncture in clinical practice, and its effect could be objectively observed. Evidence from neuroimaging, biochemical investigations, and clinical trial has been supporting the use of scalp acupuncture on patients with mental disorders. We see great potential in scalp acupuncture to play an important role in alleviating or even preventing mental health problems in the future. Nonetheless, there is an urgent need for quality trials to provide definitive evidence to support the use of scalp acupuncture for various mental disorders.

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**Author details**

provided the original work is properly cited.

Chuen Heung Yau\* and Cheuk Long Ip

\*Address all correspondence to: annyau@hkbu.edu.hk

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

PSD-95 postsynaptic density-95 protein

TCM traditional Chinese medicine WHO World Health Organization

SPECT single-photon emission computerized tomography

© 2019 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/ by/3.0), which permits unrestricted use, distribution, and reproduction in any medium,

School of Chinese Medicine, Hong Kong Baptist University, Hong Kong
