Needle Stimulation
The needle should be rotated without any lifting and thrusting movement. In general the more a scalp area is stimulated the better is the result, the Chinese recommending that the needle be rotated manually at a frequency greater than 200 times per minute for about five minutes. This should be repeated two or three times during a twenty to thirty minutes period of treatment. Many Chinese use electrical stimulation over the scalp areas, the stimulator being used at high frequency (about 3000Hz), and maximum tolerable intensity, for about twenty minutes. When the scalp is stimulated the patient often feels a burning sensation in the scalp and a dull, numb or distended feeling in the relevant area.

Selection of Scalp Areas
In order to know which scalp areas should be stimulated a clear neurological diagnosis must be made. The contralateral area is usually stimulated, but better results seem to be obtained if the area is stimulated bilaterally.

III. The Indications for the Use of Scalp Acupuncture

Routine medical management should always be carried out first, and if scalp acupuncture is indicated then it should be used to aid recovery and deal with the chronic sequelae.

Cerebro-vascular Accidents
Scalp acupuncture is particularly useful in all types of strokes, whether the origin is cerebral thrombus or a cerebral haemorrhage. Do not start scalp needling for at least a week after the stroke; scalp acupuncture increases the blood flow to the damaged area of the brain and local cerebral bleeding may be increased if it is used too early. Scalp acupuncture can be started up to two years after the onset of a stroke, with beneficial results.

Prescription
Use the relevant scalp area; if there is motor pathology in a specific area then use the relevant motor area. This rule applies to all pathology, therefore a clear neurological diagnosis of which area(s) is affected is essential.

The contralateral area on the scalp must be used but, in general, better results are obtained if the affected area is stimulated bilaterally.

Treatment
Sometimes strokes respond very quickly, but not always. It may be necessary to give several courses of scalp acupuncture. As with all types of acupuncture keep treating the patient as long as there is improvement, and then give a few more treatments to consolidate. Each course involves about eight treatments and there should be a gap of at least a week between courses. The treatments should be given daily or every other day.

Severe Head Injuries
Follow the same rules of treatment and prescription as for cerebro-vascular accidents. Scalp acupuncture is particularly useful for reducing chronic muscle spasm. Treat after routine medical treatment when the patient's condition is stable.

Intracranial Inflammation
After routine medical treatment is completed, and the patient's condition is stable, treat the areas that are damaged. Follow the same rules for treatment and prescription as for cerebro-vascular accidents.

Extra-Pyramidal Disease
Chorea and paralysis agitans are the main extra-pyramidal diseases. The most important scalp area is the chorea-tremor area. Parkinson's syndrome responds better than Parkinson's disease. Follow the same rules for treatment and prescription as for cerebro-vascular accidents.