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Effectiveness Of Yamamoto New Scalp
Acupuncture (YNSA) For The Relief Of Pain Of
The Locomotor System: An Open,
Prospective, Topometrically Controlled Study
Thomas Schockert, MD
Professor Günter Schumpe, MD
Claudia Nicolay, MS
ABSTRACT
Background Patients treated with Yamamoto New Scalp Acupuncture (YNSA) often experience long-term relief from symptoms.
Objective To evaluate the effectiveness of YNSA for the relief of pain of the locomotor system.
Design, Setting, and Patients Prospective series of 104 German patients with severe movement-associated pain who were treated with a single application of YNSA via basic points and Y points selected according to the palpation results of a neck diagnosis. Depending on the duration of topometry, the needles were left in position for 3-9 minutes. A topometer was used to record patients' movements by an external computer-controlled ultrasonic emitter with an accuracy in the millimeter range. The participants described their subjective sensation of pain before and after treatment via a visual analog scale (VAS) for pain. All patients were interviewed by telephone a few weeks later to document the success of the treatment.
Main Outcome Measures The speed of YNSA efficacy and its enduring effects, the complaints for which it is particularly effective, and whether YNSA is suitable for emergency application.
Results All together, 93.3% (n=97) of the patients regarded a single, brief application of YNSA as effective. The average VAS score before YNSA was 63/100; afterward the average was 19/100. A total of 50% of the patients (n=52) stated that they experienced complete relief of symptoms subjectively and by using the VAS. A total of 43.3% of the patients (n=45) experienced some relief after YNSA. Seven patients did not subjectively experience any effect. A total of 58.5% (n=55) of the patients experienced both objectively measurable (topometry) and subjectively stated relief or complete elimination of symptoms (on VAS), lasting from 1 hour to 382 days. Overall movement after YNSA remained constant in topometric measurements for 35.1% (n=33). Overall movement for 6.4% (n=6) measured topometrically was worse after YNSA than before.
Conclusions YNSA can be an effective treatment especially for pain of the locomotor system and can provide subjective improvement for most patients. Due to its ease of application and its reliability, YNSA is particularly well suited for use in emergency treatment since a good long-term effect can be achieved by leaving the needles in position for just 3-9 minutes.
KEY WORDS
Yamamoto New Scalp Acupuncture, YNSA, Locomotor System, Topometry, Pain
INTRODUCTION
We regularly encounter apparent instantaneous phenomena that are otherwise only found in neural therapy after Huneke; immediately after Yamamoto New Scalp Acupuncture (YNSA) treatments, many patients experience long-term absence of symptoms. These observations were the motivation for studying YNSA in more detail.
Methodology of YNSA
YNSA is a special form of traditional acupuncture based on a somatotope of the scalp. In the same way as for auricular or mouth acupuncture, the total organism is projected onto a defined area on the scalp. The locomotor system is situated on either side of the boundary between forehead and hair; the internal organs are represented by Y points on both sides of the temple region. Scalp acupuncture distinguishes a Yin somatotope on the front of the scalp and a Yang somatotope on the rear. With the aid of special Japanese neck diagnostics, the related Y therapy points in the temple region are identified by means of pressure-sensitive points in the neck region. As a representative of every meridian, there is a pressure point on the neck and a related treatment point in the temple region. If, for instance, the kidney point on the neck is pressure-sensitive, a needle is applied to the associated Y point in the temple. If the needle in the temple region is correctly positioned, the pressure sensitivity on the neck disappears successively; thus providing an immediate verification of the correct positioning of the needle.
Study Questions
We designed a study to determine the efficacy of YNSA for pain of the locomotor system and also sought to determine if permanent relief or even elimination of symptoms can be achieved by a single treatment. We were curious about the speed of YNSA's effects and how long the relief or elimination of symptoms lasts. We also studied whether the effectiveness of YNSA is dependent on the needles remaining in place for 20 minutes, and whether YNSA is suitable for application in emergency treatment.
METHODS
Advertisements in the specialty journal Naturarzt and the daily newspaper Bonner Generalanzeiger1,2 targeted patients with severe movement-related pain. The study was performed purely for scientific reasons and did not receive financial support from any source. All the measurements were performed at the Institute of Biophysics and Biomechanics in the Orthopaedic Department of the University of Bonn, Germany, by a scientist who had no experience with acupuncture prior to this study. Because the technical observer had not been trained in acupuncture, he did not know whether active or placebo points were being used. All patients gave their consent verbally before treatment started.
In this study, only active points were used. All the patients were treated by acupuncture on a single occasion and, without exception, by the same physician who had been trained by Dr Yamamoto.3-8
Real-time Ultrasonic Topometry
Complex issues in diagnosis and progress control within the framework of training, therapy, and rehabilitation require an objective and reproducible measuring technique covering as many functional parameters as possible. This method must consider both the evaluation of the performance of the individual (isolated) articular muscles as well as the movement sequences involving several joints. To record the geometrical position of body points in space by the measuring technique, the measuring principle of running time measurements, TR, of ultrasonic pulses between spatially separated ultrasonic transmitters and ultrasonic receivers, was applied. Multiplying the running time, TR, by the temperature-related speed of sound, vt, yields the distance covered by ultrasound, D1. If in this way, 3 distances, D1,2,3, from an ultrasonic transmitter to 3 ultrasonic receivers located at fixed distances from each other in space are measured; then the location of the transmitter in relation to a predefined coordinate system (X,Y,Z) can be determined. A 4th receiver is fixed in a defined relation to the other 3 to verify the measured data. The correctness of the individual measurements can be verified by the 4th redundant measurement. If the measurement is repeated several times during 1 period, the transmitter can be moved during this period, thus enabling a movement trace of the transmitter to be calculated. The measuring system permits measuring frequencies, F, from 1-100 Hz. The resolution achievable during measurements with the ultrasonic topometer depends on the measuring period within which the data are recorded. This data acquisition time is 1/100,000 of a second (10 µs). For comparison, in optical systems, this corresponds to an image repetition frequency of 100,000 images per second or a camera shutter speed of 0.00001 s. Within this period, a point moving at a speed of 125 m/s covers just 1 mm. The measuring accuracy is therefore sufficient to record a moving transmitter with an accuracy of better than 1 mm. The topometer can cover a measuring space of at least 5 x 4 x 3 m; the resolution of the individual transmitter pulses being independent of the distance from the receiver. Since human bodily movements never exceed these velocities, with the exception of some movement sequences in certain sports, the transmitters can be attached to certain body points to record the body positions with this accuracy.
The dimensions of the ultrasonic transmitters are so small (diameter: 1-1.5 cm, height: 0.5-1 cm, weight: 2-3 g), they can be attached to the human body without difficulty. The transmitters do not influence a person's sequence of movements. Furthermore, the transmitters have a largely spherically symmetrical emission of the pulsed wave (± 558) so that rotation of the transmitters about their axis of symmetry does not lead to a falsification of the measured data. Up to 12 transmitters distributed over various locations on the patients can be recorded simultaneously. This is sufficient to identify the patients' specific medical problems and to detect improvements to the locomotor system brought about by rehabilitation measures. These data can also be used to calculate moments of rotation, accelerations, and velocities which have been used to measure the success of certain forms of rehabilitation.3-5
Criteria for Evaluating the Topometry
Posture Angle
The posture angle shows changes in patient mobility. In the recording, pain is indicated by disturbed, not sinusoidal, movement curves at the time of the change of posture. Measurements were made of the respective changes in the angle of the individual transmitters.
Angular Velocity
The angular velocity provides information about coordination ability.
Angular Acceleration
The angular acceleration provides information on how much force a person must exert for a movement. The angular acceleration therefore represents muscular strength plus gravity. If the angular acceleration alone has changed, then an improvement in the dynamics of the movement can be assumed; however, this is not visible to the eye. Only the measurement can detect such a positive change.
The parameters of posture angle, angular velocity, secondary movements, and angular acceleration must be evaluated in a differentiated manner. The information provided depends on the harmony and the reproducibility of a movement.
Harmony of the Movement
The harmony of the movement is the parameter providing the greatest amount of information since a sinusoidal, fluid harmonious movement approximates most normal or physiological movement.
Secondary Movements
Secondary movements are an expression of unsteady sequences of movement distorted by pain, and of movements perpendicular to the sequence of movement. For example, when rising from a seated position, patients throw their arms forward to gain momentum or bend their upper body forward to an unphysiological extent. Or when the patient is asked to rotate the cervical vertebrae, a sideways movement of the cervical vertebrae unintentionally occurs as a secondary movement. The more secondary movements that occur, the further removed the patient is from a physiological, harmonious movement.
Reproducibility
The reproducibility of a movement corresponds to the ease with which the patients move. Factors for a lack of reproducibility include lack of strength, lack of practice, pain, uncertainty, and control problems related to the cerebellum.
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Figure 1. VAS (difference) and relief/disappearance of symptoms
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Figure 2. VAS (difference) and topometry (overall evaluation)
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Visual Analog Scale (VAS) for Pain
The VAS enables patients to adjust a red slide in a white visual field to subjectively represent their sensation of pain on a scale between "no pain" (the red bar is withdrawn completely from the window) and "most intense pain" (the red bar completely fills the window). On the reverse of the VAS, hidden from the patient, the therapist can read off the person's subjective assessment in figures on a scale between 0-100.9-11
Inclusion and Exclusion Criteria
Patients who took part in the study were experiencing severe pain associated with movement or pain that was increased by movement. Patients with movement-related muscular pain were included because the movements most painful for the patients had to be recorded by topometry before and after the treatment for comparison. Patients who had been treated with Marcumar or who experienced pain only at rest were excluded. Patients with headaches were excluded because headache cannot be recorded topometrically.
Implementation of the Experiment
In this study, diagnostic and therapeutic controls were performed with the aid of neck diagnosis. In addition to the Y points, the so-called base points in the boundary between the forehead and hair were also used. In this case, the needle was applied to the maximum point of a pressure-sensitive region in the associated treatment area. Without exception, all the patients were treated just once by needle acupuncture. The needles remained in position for 3-9 minutes, i.e., the length of time required to perform the topometric control measurements.1,2,7,8,10
After their case histories had been discussed, all patients were requested to demonstrate the movement that caused them the most pain. Some of the patients had their pain intensified and provoked, for example, by placing weights in their hands to increase the pain of frozen shoulder before performing the movement, or fixing gonarthrosis weights on their feet making it more difficult for them to move their lower legs when seated. This was intended to create the most realistic possible "everyday conditions," to simulate load pain, and to authentically experience pain when lifting, carrying loads, or bending over. After the painfully limited movement had been assessed, the observer fixed the ultrasonic transmitter in a suitable position by using strong Velcro fastening. To rule out measuring errors as much as possible, he performed all the measurements himself. Before starting the therapy, all patients indicated their acute pain during movements by means of the VAS.
YNSA was performed after the 1st topometric measurements. All patients were treated in a seated position. The new points of Yamamoto New Chest Acupuncture and the points in the pubic area were not used to avoid repeated undressing and dressing. The 2nd topometric measurements were performed after the therapy and then the patients reported outcomes using the VAS. The treatment was then concluded and the needles were removed again. Depending on the duration of the topometric measurements, the needles remained in position for 3-9 minutes. A few weeks or months after the therapy, the patients were interviewed by telephone concerning their subjective state of health. It was not possible to contact all the patients within the same period of time. Furthermore, only 1 interview was performed so that the values presented here on relief and elimination of symptoms merely indicate a lower estimate of the true duration of successful therapy.
RESULTS
A total of 104 patients, including 103 experiencing pain, took part in the study. There were 64 women (61.5%) and 40 men (38.5%); patients ranged in age from 17-87 years. The majority of patients (n=52 [50%]) complained of pain in the lumbar region. Twenty (19.2%) experienced pain in the cervical vertebrae, 12 (11.5%) had hip problems, 8 (7.7%) had shoulder pain, and 7 (6.7%) had knee complaints. The frequency of pain in the thoracic vertebrae, ankle, and wrist was less than 2% each.
Study patients expressed their sensation of pain before and after therapy by means of a VAS. Average VAS values were 63/100 points before treatment and 19/100 points afterward. The difference in the mean before/after values was -44 points and the median of the difference was -45 points. A t test comparison for paired random samples yielded the mean of the intraindividual differences (after-before) of the VAS values that differed significantly from 0 (type I error, a<.001).
Relief and Elimination of Symptoms
Seven patients (6.7%) did not experience any relief. A total of 45 patients (43.3%) reported relief and 52 participants (50%) reported freedom from symptoms for different periods of time after a single session of scalp acupuncture lasting 3-9 minutes. The maximum period of relief of symptoms reported was 113 days and of freedom from symptoms, 382 days.
Topometry as an Objective Evaluation Criterion
In the objective measurements, movement was worse for 6 patients (6.4%) and remained the same for 33 patients (35.1%). Fifty-five patients (58.5%) experienced an objectively measurable improvement. For 10 patients, it was not possible to perform a topometric evaluation due to their severe pain; 2 patients were not able to perform the movements in such a manner that they could be evaluated for the measurement. Technical problems resulted in the loss of data for 8 patients (8.5%). Nevertheless, these patients' subjective VAS scores were available.
Topometric Evaluation
The 6 topometric evaluation criteria were assessed in a differentiated manner. The criterion providing the greatest amount of information was harmony of movement. To obtain the rating, "better," in the overall assessment ("better"/"same"/"worse"), the patient's sequence of movements must have clearly improved in at least 2 categories. For 55 patients (58.5%), it was possible to objectively establish an improvement in movements after a single acupuncture treatment. The result of the ultrasonically controlled recording of the sequence of movements was regarded as the "same" if only 1 assessment parameter displayed a positive change. Patients whose movement curves remained identical before and after acupuncture were also considered to be the "same." A deterioration in the topometry was identified either if movement patterns had occurred in which the harmony was poorer, or if several evaluation criteria displayed a deterioration. This would include, for example, an increase in secondary movements or a lack of precision in the reproduction of the movement.
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Figure 3. Recording of the Posture Angle in Case Report
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The figure shows the recording of the posture angle and serves to assess the harmony and reproducibility.
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Figure 4. Movement Before and After Acupuncture
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The velocity of the movement sequence before (gray line) and after (black line) acupuncture.
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Figure 5. Movement Acceleration
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Representation of movement acceleration before (gray line) and after (black line) acupuncture.
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Patients who reported no improvement in their symptoms (n=7) had on average an improvement of 20 points in the VAS score (95% confidence interval [CI], -2 to 43) (Figure 1). Patients who experienced some relief (n=45) specified an improvement of on average 40 VAS points, i.e., twice as many (95% CI, 34-46). Patients who experienced no symptoms for at least 1 day (n=52) had an even higher average improvement in their VAS values (50 points; 95% CI, 44-56). The difference between these 3 groups was significant with respect to their VAS values (analysis of variance with linear contrast, P=.01). A comparison of the 2 subjective parameters, VAS and disappearance/relief of symptoms,(yielded good agreement (i.e., the greater the improvement in a person's symptoms, the greater the difference in the VAS values). The VAS values before acupuncture did not differ among the 3 groups.
As shown in Figure 2, the greater the difference in the VAS values, the greater the improvement in the patients' symptoms measured by topometry. Those patients whose condition was "worse" according to topometry (n=6) still had an average improvement on the VAS of 21 points (95% CI, 7-35), although this improvement is even more apparent in the other 2 groups (topometry "same" [n=33], average improvement = 33; 95% CI, 29-46 and topometry "better" [n=54], average improvement = 50; 95% CI, 45-56). In this case as well, the analysis of variance with linear contrast revealed a significant difference among the 3 groups (P<.01). The VAS values before treatment did not differ between the 2 topometry groups "same" and "better." The VAS values in the topometry group, "worse," were on average lower than in the other 2 groups. However, there were only 6 patients in the "worse" group.
Case Report
Before acupuncture treatment, a 60-year-old woman with polyarthrosis and Guillain-Barré syndrome complained of pain in her shoulders and upper arms and reported tingling paresthesia after several movements of her arms.
The VAS score before therapy was 88. The patient was treated at Y and base points on both sides of the scalp. After therapy, the VAS score was 0. The patient reported freedom from symptoms for 78 days, and relief of symptoms for 104 days. In the subsequent telephone follow-up, the patient said she had been able to perform movements that were impossible for a long time. In the topometric assessment, backward abduction and adduction of the right arm was observed. The diagrams (Figures 3-5) show a clear improvement in angular velocity and angular acceleration. The reproducibility and harmony of the movement also improved perceptibly after YNSA. Subjective assessment and topometry were in agreement in this case.
DISCUSSION
The effectiveness of YNSA determined objectively by real-time ultrasonic topometry was 58.5%: 55 of 94 evaluable patients experienced objectively measured relief or elimination of their symptoms, which was also subjectively recorded on the VAS. This freedom from symptoms lasted a maximum of 382 days (in the case of pain due to a prolapsed intervertebral disk). The single application of YNSA was considered effective as recorded on the VAS by 93.3% of patients. One caveat is that patients who were willing to take part in the study may have had a positive attitude toward acupuncture and also positive expectations of therapy.
The results presented here were achieved using a single application of acupuncture with the needles left in position for 3-9 minutes. The result of the treatment does not depend on the needles remaining in position for 20 minutes. Therefore, it is recommended that this approach should be used by emergency medical services. Because the needles remain in position for such a short period, it is not necessary to monitor the patient's circulation and/or respiration as may be done with intravenous analgesics. In the majority of the participants, YNSA brought immediate subjective relief or elimination of pain, which continued for a considerably longer period than the effect of an analgesic applied intravenously. In the case of 2 men, dysregulation of the circulation occurred during the application of YNSA. One of them had a previous cardiac condition and the other, who collapsed on application of the needles, had been persuaded (by his wife) to take part in the study. Both participants recovered well without any negative consequences. Thus, YNSA therapists should be able to apply any emergency medical treatment that may be required.
New research findings on so-called pain memory, which is generally established in patients with chronic pain, provide reasons why a single, short-term application of YNSA can effect elimination of symptoms lasting 382 days.12 None of the currently approved analgesics is capable of erasing a pain memory. Even analgesics from the opioid group that have a central effect are probably unable to erase a pain memory. The application of so-called counterirritation methods such as transcutaneous electrical nerve stimulation, physical stimulation (heat or cold), or acupuncture are known to inhibit pain beyond the duration of the actual stimulation for hours or days. YNSA seems to be a therapeutic method capable of erasing pain memories rapidly and sustainably. It seems doubtful whether patterns of movement that have been learned incorrectly can be erased from the brain and replaced by new physiological programs. The topometric recordings seem to confirm this. The observation that after acupuncture treatment, the movement patterns of 6 patients worsened in the topometric recordings indicates that acupuncture appears to have a certain effect on motoricity. This deterioration might be a so-called initial deterioration as can be observed after the administration of homeopathic remedies. The reason for this phenomenon is not known.
CONCLUSION
With the aid of topometry, it is possible to objectively determine and carefully document the success of acupuncture treatment for patients with back and joint pain. Would it not be advantageous if treatment and technical observation, including documentation, were undertaken by different persons? The undoubtedly purely coincidental (and successful for physician and patient) therapy of, for example, pollinosis or asthma within the framework of the model project, cannot be properly documented by topometry.
How effective would the treatment have been if, for example, it had been applied by Dr Yamamoto? Namely, how dependent on the therapist is scalp acupuncture? Our study results should be a motivation for further research.
ACKNOWLEDGEMENT
I want to thank Toshikatsu Yamamoto and Reza Schirmohammadi for imparting their medical knowledge.
REFERENCES
- Yamamoto T, Schockert T. Folgen von Schlaganfall und Schmerzen lindern. Naturarzt. 2000:8.
- Yamamoto T, Schockert T. Mit Schädelakupunktur Schmerzen erfolgreich behandeln. Link: http://www.ynsa.net. Access verified June 4, 2003.
- Schumpe KG. Bewegungsmessungen von Körperpunkten und ihr Aussagewert bezüglich der Körpergelenke. VSI-Berichte. 1991;882:569-581.
- .Schumpe KG. Die Aussagekraft von Ganganalysen am Becken-Bein-Skelett. Z f Orthopädie. 1981;3:306-314.
- Schumpe KG, Morscher E. Ganguntersuchungen und funktionelle Wirbelsäulenvermessungen mittels eines neu entwickelten Echtzeit-Ultraschall-Topometers (EUST) in der Orthopädie. Enke. 1979:69.
- Schumpe KG, Schockert T. Effizienz der Yamamoto neue Schädelakupunktur (YNSA) bei Schmerzen am Bewegungsapparat; eine topometrisch kontrollierte Studie [abstract]. Dtsch Z Akupunktur. 2001:245f.
- Yamamoto T, Yamamoto H. Yamamoto New Scalp Acupuncture. Japan: Springer; 1998.
- Yamamoto T. Neue japanische Schädelakupunktur. Chun-Jo. Freiburg/ Breisgau: 1985.
- Huskisson EC. Measurement of pain. Lancet. 1974;2:1127-1131.
- Kampik G. Propädeutik der Akupunktur. Hippokrates. 1998;276, 359.
- Neugebauer E, et al. Schmerzmessung und -dokumentation. Anästhesiologie Intensivmedizin. 1993;12:391-397.
- Sandkühler J. Schmerzgedächtnis – Entstehung, Vermeidung und Löschung. Dt Ärzteblatt. 2001;42:B2343.
AUTHORs' INFORMATION
Dr Thomas Schockert specializes in General Medicine, Acupuncture, and Naturopathy, and has a private Naturopathy practice in Nideggen, Germany.
Thomas Schockert, MD*
Am Eisernen Kreuz 2c
52385 Nideggen, Germany
Phone: 0049/2427/902424, 902425 (Fax)
E-mail: thomas-schockert@gmx.net
Professor Günter Schumpe is a Physician and Physicist, and Head of Research at the Surgical Centre/Orthopedics Dept and Scientific Dept: Biomechanics/Biophysics at the University of Bonn, Sigmund-Freud-Strasse in Bonn, Germany.
G. Schumpe, MD
E-mail: umc908@uni-bonn.de
Claudia Nicolay is a Research Fellow at the Institute for Medical Biometry, Informatics, and Epidemiology at the University of Bonn in
Bonn, Germany. Ms Nicolay has an MS in Statistics, specializing in Medical Biometry, Clinical Studies Planning/Analyzing.
Claudia Nicolay, MS
E-mail: nicolay@imsdd.meb.uni-bonn.de
*Correspondence and reprint requests
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