MEDICAL ACUPUNCTURE

Volume 22, Number 1, 2010

# Mary Ann Liebert, Inc.
DOI: 10.1089=acu.2009.0699

Treatment of Neck Pain Using Yamamoto

New Scalp Acupuncture (YNSA)
Ali Shaladi, MD, Francesco Crestani, MD, Stefano Tartari, MD, and Teresa Trombella, RN

ABSTRACT
Background: Cervical pain can be defined as a painful condition of the upper region of the spinal column
affecting the neck and shoulders. The conservative treatment for uncomplicated neck pain includes physical and
pharmacological measures, together with the provision of advice and manual treatment such as mobilization
and manipulation.
Objective: To evaluate the effectiveness of scalp acupuncture in the treatment of neck pain.
Design and Setting: We studied patients with neck pain between June 2007 and January 2008 at Pain Service,
San Luca Hospital, Trecenta (Rovigo), Italy. A prospective questionnaire using a visual analog scale (VAS) and
the Present Pain Index (PPI) was administered.
Patients: We treated 46 patients (29 women and 17 men) with neck pain. Among them were 25 patients with
osteoarthritis diagnosed by radiological examination and 21 patients with myofascial pain syndrome.
Intervention: Patients were treated with only 1 session of Yamamoto New Scalp Acupuncture (YNSA) in the
Basic Points A 17.
Main Outcome Measures: Level of pain at 30 minutes after the session, evaluated with the VAS and PPI.
Results: The degree of reduction of pain was 71% when evaluated with the VAS and 80% with PPI.
Conclusions: YNSA acupuncture was effective in the reduction of neck pain for this group of patients, with
only 1 needle in a single session.
Key Words: Acupuncture, Neck Pain, Yamamoto New Scalp Acupuncture (YNSA)

INTRODUCTION

population. It is estimated that almost everyone has experienced, at one time or another, a form of neck pain that
often spontaneously resolves and that may or may not be
associated with pain in the arms. About 15% of women and
10% of men older than 40 years complain of chronic neck
pain related to working activity.3
Many have tried to classify the origin of pain. The best
method of classification and the more widely accepted is a
diagnostic triad in which patients are categorized to 1 of the
following groups: spinal pathology, neurological involvement, and idiopathic neck pain. In a smaller number of
cases, neck pain is caused by tumors, systemic arthropathies

eck pain is one of the more frequent problems in

clinical practice and is a common cause of disability. It
is a painful condition of the higher part of the spinal column,
between the occipital condilum and the spinous process of
the VII cervical vertebra, and involves the neck, shoulders,
and upper arms.1
Neck pain is second only to low back pain as the most
common musculoskeletal disorder in population surveys
and primary care.2 From an epidemiological point of view,
little is known about the exact incidence of neck pain in the

San Luca Hospital, Trecenta, Rovigo, Italy.

41

42

SHALADI ET AL.

(i.e., rheumatoid arthritis, ankylosing spondylitis), infectious illness, thyroid disorders, obstructive esophagitis, or
gastroesophageal reflux disease.4 In about 95% of patients,
neck pain is caused by trauma, myofascial pain syndrome,
postural pain, and=or degenerative osteoarthritis.5,6
The clinical picture shows cervical stiffness in the more
frequent form, followed by headache, pain, and segmental
paresthesia in the neck, shoulder, arm, forearm, hand, and
fingers.7,8 Treatment of neck pain consists of various
methods with the aim of relieving the pain and improving
quality of life.

METHODS
Patients
We used Yamamoto New Scalp Acupuncture (YNSA) in 1
treatment session and then evaluated pain relief. Our study
took place between June 2007 and January 2008 at Pain
Service, San Luca Hospital, Trecenta (Rovigo), Italy. The
authors, who completed 4 years of postgraduate training
in acupuncture, were the acupuncturists in the study. The aim
and methods of the study were explained to the patients;
voluntary participation was requested and informed consent
was obtained, according to the local and international guidelines. The study was reviewed and approved by the institutional review board of our local health care authority.
Forty-six patients with cervical pain lasting for at least
6 weeks were recruited for the study: 29 women (63%) with
a mean age of 51 years (range 2873), and 17 men (37%)
with a mean age of 57 years (range 3584). Twenty-five
patients (54%) had osteoarthritis diagnosed by radiological
examination, and 21 patients (46%) had myofascial pain
syndrome.9

the thumb and the second finger. When the Liver Point is
stiff, the chosen treatment is in Yin and when the muscle is
soft, the treatment is in Yang. We treated 36 patients with
the Yin method and 3 patients with the Yang method. We
researched the acupoints to treat by palpating the scalp with
the tip of the second finger until we found a hard, painful
point. Then we used a stimulator to refine the location
(Figure 1).
The Basic Points A 17 are situated on a line about
1.5 cun long representing the cervical spine from C1 to C7
with all its elements (Figure 2). The Yin points are situated
in the insertion line of the hair, 0.5 cun (the fingertip of the
index finger), at the side of the median frontal line. The
third cervical vertebra is represented on the hairline. The
Yang treatment was performed on the occipital lambdoid
suture, 0.5 cun at the side of the central point of the occipital
bone.
We used 0.2525 mm Hwato sterile, single-use acupuncture needles (Suzhou Medical Appliance Factory, Suzhou,
China). The needles were inserted to a depth of 10 mm with
an angle of 708; each session lasted 30 minutes. The scalp
side to treat was ipsilateral to the referred cervical pain.
The statistical analysis was calculated using the t test for
paired data.

RESULTS
The reduction of pain was evaluated by the VAS and
PPI before the session and 30 minutes after the session. The
mean baseline VAS was 7 (range, 58) and after treatment
was 2 (range, 05). The obtained reduction was 71%
(P < .001).
At baseline, the mean PPI was 2.5 (range, 24) and after
treatment was 0.5 (range, 02), with a reduction of 80%
(P < .001). None of the patients reported adverse effects.

Outcomes
Pain was evaluated with a visual analog scale (VAS)
measuring 0100 mm on a horizontal line, where 0 means
no pain and 100 the worst pain.10 To be eligible, the patients
mean pain score had to be greater than 40 mm on the scale.
We also used the Present Pain Index (PPI) to quantify the
pain on the basis of the effects on functional capacity; PPI is
a numeric rating scale that includes a list of adjectives, rankordered by the level of pain. In this case, the evaluation of
pain was determined by the physician.11

DISCUSSION
The majority of studies report that the treatment of neck
pain with acupuncture is performed with a mean of 2 sessions a week for 68 weeks; the reduction of the pain ranges

Technique
The patients were evaluated with VAS and PPI before and
after the treatment. They were evaluated with YNSA Basic
Neck Diagnosis Test to choose the kind of treatment, Yin or
Yang. The test is carried out by palpating the Liver Point
in the middle part of the sternocleidomastoid muscle with

FIG. 1.

Stimulator used to locate points.

TREATMENT OF NECK PAIN USING YNSA

43

CONCLUSIONS
It is possible to conclude from this pilot study that treatment with YNSA was effective for this group of patients;
it seems to be a useful method to reduce pain and quickly
improve the movement of the neck, in only 1 session.
However, the pain reduction was evaluated only 30 minutes
after the acupuncture session, so that it is difficult from our
data to establish the long-term duration of the symptom relief. Nevertheless, YNSA is a simple technique and easily
performed without adverse effects.
Further studies are needed to validate these conclusions
and to explain the physiologic mechanism underlying the
acupuncture-induced analgesia in neck pain.
FIG. 2. Basic Points A 17 are situated on a line about 1.5 cun
long representing the cervical spine from C1 to C7.

DISCLOSURE STATEMENT
from 20% to 50%.12 In our study, we obtained a rapid reduction of the symptoms, evaluated with a single session of
30 minutes and a single needle, using the YNSA method.
The pain relief reduction was reported as 71% on VAS and
80% on PPI.
It is difficult to predict how long the relief will last. The
study was carried out to evaluate the immediate response
to a single acupuncture session; our future intentions are a
long-term follow-up of the patients, although our clinical impression is that a series of sessions is needed for
lasting improvement, just as with classical acupuncture.
However, a rapid relief of the pain satisfies and motivates
the patient.
YNSA is a method developed around 1970 by Toshikatsu
Yamamoto13 and officially presented for the first time during the 25th Congress of Riodoraku Japanese Society in
Osaka.14 The word new was added to distinguish it from
the Chinese craniopuncture. The YNSA method is classified
as somatic microsystem as well as other known microsystems (for example, ear, nose, pulse acupuncture).15 The
somatotope of the Scalp Basic Points situated bilaterally in
the frontal area is called Yin, while Yang points line up
bilaterally in the occipital area along the lambdoid suture. These points represent specific parts of the body and
it is possible to locate them by palpating with a rotating
motion on the scalp using the tip of the second finger, or a
pen or special stimulator (Figure 1). The patient can confirm a sensation of pain or discomfort while the point is
palpated.
These sensory points are treated ipsilaterally to the affected side, and the needle is inserted at an angle of 708.16
While Yamamoto currently labels the A line with numbers
from 1 to 8, we still used the older numeration, from 1 to 7
(considering a careful detection of a hard and painful point
of the scalp more important then a numerical classification
of it).

No competing financial interests exist.

REFERENCES
1. Ferrari R, Russell AS. Regional musculoskeletal conditions: neck pain. Best Pract Res Clin Rheumatol. 2003;17:
5770.
2. Nachemson A, Wadidell G, et al. Epidemiology of Neck Pain:
The Scientific Evidence of Causes, Diagnosis and Treatment.
Nachemson A, Jonsson E, eds. Philadelphia, PA: Lippincott
Williams & Wilkins; 2000:165187.
3. Bovim G, Schrader H, Sand T. Neck pain in the general
population. Spine. 1994;19:13071309.
4. Crob D. Surgical aspects of the cervical spine in rheumatoid
arthritis. Orthopade. 2003;33:12011212.
5. Chiu TT, Lam TH, et al. A randomized controlled trial on the
efficacy of exercise for patients with chronic neck pain. Spine.
2005;30:E1E7.
6. Hoving JC, Devet HC, et al. Prognostic factors for neck pain
in general practice. Pain. 2004;110:639645.
7. Bogduk N. Cervical causes of headache and dizziness. In:
Grieve G, Ed. Modern Manual Therapy of the Vertebral
Column. Edinburgh, UK: Churchill-Livingstone; 1986:289
302.
8. Bogduk N. Innervation and pain patterns in the cervical spine.
Clin Phys Ther. 1988;17:113.
9. Simons DG. Muscular pain syndromes. In: Fricton JR, Awad
E, eds. Advances in Pain Research and Therapy. Vol 17. New
York, NY: Raven Press; 1990:141.
10. Jensen MP, Karoly P, et al. The measurement of clinical pain
intensity: a comparison of six methods. Pain. 1986;27:117
126.
11. Scott J, Huskinsson EC. Graphic representation of pain. Pain.
1976;2:175184.
12. White P, Lewith G, et al. Acupuncture versus placebo for the
treatment of chronic mechanical neck pain: a randomized
controlled trial. Ann Intern Med. 2004;141(12):126.

44
13. Yamamoto T, Yamamoto H. New scalp acupuncture. Medical
Tribune, Japan. 2003.
14. Yamamoto T. The effectiveness of Yamamoto new scalp
acupunture (YANSA) on Mibyou condition. Geriatr Gerontol
Int. 2004;4:S223S225.
15. Nissel H. Pain treatment by means of acupuncture. Acupuct
Electrother Res 1993;18(1):18.
16. Feely RA. Yamamoto New Scalp Acupuncture: Principles and
Practice. Thieme Medical Publishers; 2006.

SHALADI ET AL.
Address correspondence to:
Francesco Crestani, MD
Pain Service, Local Health Care, Authority 18
San Luca Hospital
Trecenta, Rovigo
Italy
E-mail: crestanifrancesco@libero.it