Volume 11, Number 4 | Winter 2016

Clinical Report 1 (Acupuncture)
Dropped Head Syndrome

hospital, and diagnosis of “dystonic dropped head”
was determined. With joint diagnosis with theMasanori Takashi1) and Katsuhiko Arai2)
1) Tokai University Oiso Hospital,
2) Tokai University School of Medicine

DroppedHeadSyndrome

istheclinicalcondition where the neck drops in the sitting or
standing at rest position, and was reported by
Gerlier in 1887 for the first time１ ). This condition
has been observed in Parkinson’s disease, multiple
atrophydegeneration,(MSA),

amyotrophicspinocerebellar
lateralsclerosis,

cervical spondylosis, myopathy, myasthenia gravis,
and hypothyroidism. Moreover, dopamine-agonist
and DPP-4 inhibitor have gained attention as
causal agents.
In

thisto increase cervical muscle force was sought.
However, symptoms fluctuated between better andworse depending on the season, and the patient

Introduction

systemdepartment of rehabilitation, palliative treatment

case,

clear

cause

could

not

be

ascertained and rehabilitation was carried out
under the diagnosis of “dystonic dropped head.”
However, recovery of symptoms was up and down,

noticed that dropping head increased to more thanten times a day by June of the same year. Droppingneck occurred more frequently in the afternoon, but
decreased when a hot pack was applied before therehabilitation training. However, sinuous sensationand sharp pain occurred around the GB-21 肩井during training, and disrupted exercise therapy.
Subsequently, the physical therapist suggested
combining the use of eastern medicine treatment,
and the patient then visited an acupuncture clinic.
Overall body symptoms: Heartburn when sweets
are eaten. It is possible to eat but no appetite.
Heavy sweating (occurring when neck discomfort
appears), frequent urination, and urination once atnight.

so acupuncture and moxibustion therapy were

[Past history] Follow-up at the local medical clinic

suggested by a physical therapist, and we provided

for hypertension over the past 10 years.

such treatment.

[Present status] 139cm height, 37kg weight, bloodpressure 132/71mmHg. Sinuous induration in[Case] 73 year-old woman

abdominal trapezius muscle, especially near the[Chief complaint] Dropped head
[Prsent illness]

Neckflexion“kensei” was observed. Neck dropped forward 45°,
anddiscomfort

appeared in October X-1. From December, shebegan experiencing dropped head especially when
walking and visited a local orthopedics clinic.
However, since cause could not be ascertained,
follow-up observation was carried out. Shoulder

neck rotation are R45°, and L50°.
Sunken pulse, Tongue dark red and slightly coated.
[TCM diagnosis]
Deficiency of Qi and blood stasis, and descent of Qi
in the Middle Heater

stiffness increased, and the patient visited the[Therapeutic principle]

neurology department at a general hospital.

Tonify Qi and activate blood, Tonify Qi in the middle

However, cause could not be ascertained, so inheater

January X, she was referred to the neurology
department of this hospital for examination. Thecause could still not be ascertained even at thisThe Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

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Volume 11, Number 4 | Winter 2016

[Acupoint selection] LI-4, CV-6, ST-36, SP-6, BL-20,[Course]BL-23 (all reinforcing treatment), GB-21 (reducing

Second session: No feelings of fatigue wastreatment)

experienced after the previous treatment. During

Used needles: Seirin-made sterilized acupuncture

treatment, when GB-21 was warmed by electricneedle, length1cun6fen, No.1 and No.3

moxibustion after acupuncture, the patient said
she felt a tingling on thesurface. Hence warming GB21 was discontinued, and onlyacupuncture was performed.
Third session: At this time,
the patient felt that “kikai”
was hot. This was considered
to indicate decreased defense
function of Qi, LU-9 and CV17 were added in order totonify defense Qi, and inattempt to tonify lung Qi anddefense Qi.
Fourth session: Frequency ofdroppingheadchangedslightly. However, shoulder stiffness remained, so[Explanation]
Tonifying Qi was attempted by combining ST-36

heating was attempted again. The patient said it

and g LI-4 2) and CV-6 3) which functions to regulate

felt good and that induration loosened up.

the mechanism of Qi (strengthening the spleen,

Fifth session: The sinuous feeling of GB-21 began

tonifying the kidney, regulating Qi) of the lowerto decrease. Stimulation of the shoulder finallyburner and tonifies source Qi, was added to tonify

began to show results. Acupuncture of the GV-20

while activating Qi. Since CV-6 has kidney

was carried out in order for Qi to accumulate in thetonifying function, this combination tonifies source

upper region. The reinforcing method was carriedQi.3) Elevating was attempted after sufficient

out in order to elevate the Qi, by points

tonification. Moreover, tonification with twirling

arrangement of LI-4, ST-36, and GV-20 6）

was added on SP-6, to tonify the blood which is

From here, elevating the Qi in the middle heatermother of Qi.4) In addition, purgation with lifting

was added to the medical principle.

and thrusting was applied to GB-21, and to improve

Sixth session: No change.

blood circulation for a smoother Qi route.5)

Seventh session: Sweating of the neck decreased.
Before treatment, sweating and wetness occurredfrom the neck to the back shoulder, but was nolonger

14

present.

Frequency

The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

ofdroppedneckVolume 11, Number 4 | Winter 2016

decreased, and the patient said she could exercise

Reference

until the afternoon.

1) Gerlier: Une epidemie de vertigge paralysant Rev.

Eighth session: Recently the patient has anappetite (has a sense of hunger), and does notexperience heartburn even after eating sweets.
Tenth session: Frequency of dropped neck has
become several times a day. Frequency of urination
was also reduced.
Twelfth session: Experiences dropped neck only
before bedtime.

Med, Suisse Rom., 7: 5-29, 1887
2) LI Shi-zhe: Clinical Elaboration of the CommonShuPoints,

P178-179,

People’s

MedicalPublishing House Co., LTD, 1991 (in Chinese)3) LI Shi-zhen: Clinical Elaboration of the CommonShuPoints,

P797-798,

People’s

MedicalPublishing House Co., LTD, 1991 (in Chinese)4) Acupuncture Treatment, p24-25, China Press of
Traditional Chinese Medicine, 2005 (in Chinese)

Fourteenth session: The patient no longer has toconsciously hold up her head, and the sinuous
feeling of the shoulder disappeared.

5) Dictionary of acupuncture points, p285－286, Toyo
Gakujutsu Shuppansha, 1986
6) LI Shi-zhen: Clinical Elaboration of the Common
Shu Points, P192, People’s Medical Publishing
House Co., LTD, 1991 (in Chinese)

Discussion:
This case was diagnosed as dystonic dropped
head due to neck muscle contraction. As a result ofdetermining this condition as dropped neck due todecreased Qi in the middle heater and induration
due to Qi deficiency and blood stasis, the symptoms*This case report was inserted in “The Journal ofKampo Medicine” (Japanese Edition) Vol.61 No.4.
and translated into English with some additionalchanges.

could be significantly improved. Two causes for theappearance of pain (tingling) on GB-21 肩井 on thesecond visit, could be determined. One reason wasstagnant heat caused by shoulder induration
worsened due to Qi deficiency and blood stasis, andthe other was considered to be caused by a decreasein defense function of Qi due to Qi deficiency.
However, according to conditions on the fourth visit,
discomfort experienced on the second visit wasconsidered to be a reaction to the defense function,
not due to stagnant heat, but Qi deficiency ofexterior. In other words, heating stimulation was
too strong.
The author considers that “descent of Qi in themiddle heater” means a decrease in all supporting
power in many clinical conditions. For example, inthis case, a reduction in the supporting power of theskeletal muscle is thought to be within this range.

The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

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