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The “Perfect Formula” to Attract Quality Prospects

 

 

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Disclaimer: The following is an actual transcript. We do our best to make sure the transcript is as accurate as possible, however, it may contain spelling or grammatical errors.  Due to the unique language of acupuncture, there will be errors, so we suggest you watch the video while reading the transcript.

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Evidence-Informed Acupuncture Practice

 

 

And so today we’re going to be talking about the importance of evidence-based practice. Or evidence-informed practice, which means it’s coming out of a lot of the research, which the exciting part about that is that we’re getting from the other aspect, the more Western scientific model.

Click here to download the transcript.

Disclaimer: The following is an actual transcript. We do our best to make sure the transcript is as accurate as possible, however, it may contain spelling or grammatical errors.  Due to the unique language of acupuncture, there will be errors, so we suggest you watch the video while reading the transcript.

Hello and welcome today’s episode of the American Acupuncture Council live stream. My name is Tsao-Lin Moy. I am a licensed acupuncturist and herbalist with a brick and mortar practice in union square in New York city. I’m very excited. Today to be welcoming Sandro Graca and very grateful to the American Acupuncture Council for putting these livestreams on now a quick Al Sandro is a licensed acupuncturist and lecture and research.

Is he’s done. He’s writing lots of papers about in particular women’s reproductive health, which is extremely important because not enough is done for women’s health. And he is also an avid speaker. And he is the director of evidence-based acupuncture and a fellow at the American board of Oriental reproductive medicine, and S and also the society for acupuncture research.

And so today we’re going to be talking about the importance of evidence-based practice. Or evidence informed practice, which means it’s coming out of a lot of the research, which the exciting part about that is that we’re getting from the other aspect, the more Western scientific model. Is now really recognizing, the benefits there’s like more concrete evidence and information.

And so we’re really looking at integrative medicine, or this is the, this is what we’ll be bridging that helps to bridge, understanding and better practice. So thank you so much, Sandra, for being. Thank you so much for asking me, inviting me to be here and asking me to do this talk. It’s always a pleasure to talk about.

I love research, but more so, it’s a pleasure because I get to contribute towards the future of our profession. Absolutely. We really need, we really and this is for the, for the public. Because we’re looking at what’s happening is, Medicare is going to be covering a lot of insurance companies are covering or not covering because there is, where’s the evidence.

And this is an area that it just benefits everyone. And if somebody is on the fence, About I don’t know if it works that here. We’ve got some great studies. And again, we were talking before the break about the one with carpal tunnel and I’m so very excited to see your presentation Sandro.

Yeah, thank you so much. I think that’s a really good point. And one of the things that I would mention is that there are actually different ways of using this information and different ways of using research. So one of them is, as you said, just having that you know the language to be able to talk to other people about what we do because not everyone knows what we know or loves acupuncture and Chinese medicine as much as we do.

So they might not have that language. But if we have another language to be able to communicate with them, then it just becomes a little bit easier to have that interaction and to get the ball rolling in terms of communication. And also, as you said, with the policymakers, obviously, But another aspect that I will bring up on my presentation as well is going to be that fact of the more you write about what you do in your clinic, because that’s research too, reporting, what do you do?

And the results you’re getting in your clinic. You’re contributing to the literature and you’re leaving something there for not just the people around us now, but also for the future for others to read what we’re doing in the clinic and taking that a step further. Absolutely mean, what would we be doing? What would we do without the sew-in aging or the link shoe, or, the golden cabinet or all of those things where this is very traditional practitioners, we’re recording all of their cases.

And then from that, tome of information gathered. That they were getting results that then ended up being prescriptions and points to use that they could pass down. This is thousands of years, so there’s no reason why, we shouldn’t be continuing to contribute. And then with modern science to take advantage of, that aspect of.

Yeah, absolutely. Yeah. Yeah, I’ll talk a little bit about those different aspects during my presentation. So if we’re okay to go and then I’ll obviously I’ll leave a little bit at the end as well for us to talk about it, but I’ll show you how I try to put those together. Hopefully what do you will take from this and thinking about my main role, in terms of research with evidence-based acupuncture and being that idea of ancient medicine, modern research, and the evolutionary thinking that hopefully for all of us to continue to carry our perfection forward, this is almost like a little bit of a disclosure as well.

So what I do, as you said, I’m on the board of directors of evidence-based acupuncture, I’m a fellow of the born. And on my, for full disclosure to pay jobs. I am a lecturer at the Northern college of acupuncture, and I’m also a researcher on the Cochrane review group for acupuncture, for IVF. My main work is and research and passion is on PCLs polycystic ovary syndrome.

And I am a member of the SRM of Astra and the androgen excess society for PCLs. So that’s really the. My passion lies. And I want to say big, thank you. And this is not just a, a token of gratitude. This is really a big, thank you for you inviting me to be here because I’m a doer. I like to put the M get my feet down and could do some work.

And this is a paper that came out only. Last month was the end of March that was finally published. And this is a survey of clinical practice. And this is really asking the practitioners what they’re doing, how they are doing. Really proud of this is my first author paper as well. And working with such a great, an amazing group of people that are, really motivates me and to do more.

So what this says, and this is why I’m really saying a big, thank you, is that practitioners that were in the survey actually said that they favored knowledge obtained from webinars and conferences. Ah, nice webinar talking about research. So I hope that this reaches as many people as possible and the message for our side, because as I was talking just before we started, I don’t spend as much time in the clinic anymore.

The message for academics and clinician researchers is to hear what the practitioners are saying and saying that they still want this dissemination of knowledge. They want to know about this, but beyond those traditional publications on the journals and stuff like. They do want to know more about research literacy and special interest groups, like for example, da Borum or the obstetrical acupuncture association that I’m connected with as well and the AAC as well.

Like it’s the associations needing to link with the practice. Just a quick acknowledgement, because again, we like doing this and TCM and here I am saying that I would not be here if it wasn’t for the passion for research from professor Ian McPherson, who unfortunately is no longer with us.

And he’s there with the person who was my supervisor for my MSC. That’s Dr. Lara McClair. And I just want to say that yeah, Lara was spot on when she wrote that for Hughes retirement. When she said that he inspired thousands of us to become researchers, that I’m really proud to be one of those and to continue that work.

And obviously Dr. Mike Armour, who we saw the name on that publication there, who’s really helping me. And in this new career, for as a researcher. So I’ll start this with a little story and. Because my granddad was a great storyteller and I always look at Dr. Leon hammer and think about the great stories that he always shares with us.

And this really connects and links for me in terms of research and why we’re doing this rather than just being in clinic and keep doing the same thing over and over again. So he wrote this paper in 2002. So that’s 20 years ago. And look at how relevant that is. He started with the paper could be some not, but a small story.

And he said a little girl once asked her mother why she cut off the end of the roast before putting in the oven. And the mom said because that’s the way that my mother, your grandmother used to do it. We’ll have to ask her. So off they go to grandma’s house and only to find out that grandma actually did it because her mother had.

So the three generations are to go over to great-grandma’s house. And I love his wording was there to seek the wisdom of the ages. And when they posed the question to the great grammar and the great grammar just said, why? Dear the pan was too small. So that story just continues and it’s a great article.

If you have the time to read it, it’s amazing. And he just talks about that. Chinese medicine needs a new pond for a roast that has grown since ancient times in size and in shape and what we can talk about now, he says then at the end there about the. Pulse is no longer a sign of internal cold in our time is a sign of overworking nervous system.

And I always think about this and going, this was written in 2002. How would this tide pools will be described in 20, 22 after all that has happened recently? So it’s really interesting to see that sometimes. And this is no disrespect to our practice, but some is there. More cases that we’re just doing things because that’s what we were told.

And then when we asked the people who told us they were doing it as well, because that’s what they were told. So that’s what really motivates me. And at the time when I was getting this information together, I would, as I was at a webinar, there you go with Elizabeth and she said this is word by word, what she said, Chinese classical medicine is not yet finished.

We have to continue to edit it. And I thought, huh, that’s really interesting. And bearing in mind like me. So I’m Portuguese. I speak English. I know a little bit of Chinese from learning. Elizabeth Tasha is French. So she’s speaking in English and she’s talking about Chinese medicine as well. So for me, the language is very important and she said that it’s not to invent, but to discover new ways to express, it’s not because it’s not in the classics that it’s not interest.

And then this was the sentence that really, I was talking to her, like emailing back and forth after this webinar, because I thought this was really interesting. There are a lot of things that we are yet to develop. If we want to continue to practice a living medicine and not a dead. And again, I really liked language and that really stayed with me.

And this is the work that I was already doing, and that I’m really passionate about doing now, because it depends on how we see things, order and chaos could be different in different ways that when they are in front of you, So I do love the classics. I read them when I was studying and I still do when I have the time, you always go back to them, but now I just do more work in research and I love research.

And I think that it’s really important for the continuity of our medicine. And just like Elizabeth Kasha said to continue to practice this Olivia. So you might be wondering, and if you’re one of those purists that would say that, no, this is, ancient medicine. We need to stick with the ancient medicine.

I thought that too, and I was able to see things from a different perspective and I always bring up this study because it, I came across this just by pure accident. And again, it’s just one of those things Dr. June mouse was involved in this, as you can see in the name. And it just really caught my eye because when considering barriers for occupants to use.

And bearing in mind, this is a hot topic, right? Like it’s breast cancer survivors. So it’s really, it’s charged and it’s emotional. And I would always think that the main thing would be because I don’t use acupuncture because it interferes with the treatment that’s that was my perception would be, that would be the top thing.

So when I started reading the paper and realizing that lack of knowledge about acupuncture was actually the main reason why these people weren’t getting acupuncture was just mind blowing. And knowing that interfering with the treatment, not based on science, the side effects, painful, difficult time finding an acupuncturist.

I thought, I always thought those were going to be way up higher. I did not think that lack of knowledge was going to be an issue. And since it is, then we need to get this information and try to make sure that people know about acupuncture, but that they know about it from reliable sources. And if we can’t communicate with them in terms of the classics and old language that is harder for them to understand, let’s bring a language that it’s easier for them.

So that’s I want to like interrupt you just for a second about the cancer research, because I mean our the information okay. That is one of the very, if I remember correctly, the th the evidence and the efficacy of acupuncture for nausea. From chemotherapy, that was one of the burbs studies for nausea, for pregnancy and chemotherapy.

That was really validating okay, this is why acupuncture works. So the surprise that in the area among, breast cancer, that is still not this is a great thing to do that, it’s a, non-drug, it’s, easy to. Very it’s not going to injure you in any way.

That’s the surprising is that it can really help simple, very simple thing to be doing to help somebody. But so you can see how important it is that to language is, so this is going to be teamwork, right? So it’s going to be the patient needs to know the clinicians that are already looking after that patient.

They need to know as well. Practice. I think that we all have to be ambassadors for our medicine, for sure. Yeah. Yeah. And we need to, and once we are called up to be on that team, we need to be able to talk to them because if they ask us, what did you just do? What treatment was that for that particular patient, we need to use a language that they can understand this.

Otherwise, they still won’t know what, when damn cheap Schwab, they won’t know what that means. So how would you want to work with someone that you can’t understand? So it’s being part of the team and what language you’re using to make sure that people can go actually allowed something here.

I always say this on my presentations in we do the. Practitioners graduated and they start going into their own practice. And what they do. I always say that do not ever let any patient leave your clinic without them knowing a little bit about what you did, because you don’t want them to go and talk to someone else and go, Hey, I went for acupuncture and it was brilliant.

And that person is going to ask him, oh, acupuncture, I’ve heard about that. What did they do? Oh, I don’t know. I was just lying there and they put in some needles. I don’t know what kind of advertising. It’s not really, that’s not really great word of mouth. Is it? I was lying there at then. It’s, people, patients that are informed make better decisions about their health, right?

Yeah, absolutely. Yeah. So that’s really good. And thanks for bringing that up because that’s one of the aspects. So that was a little bit of about. How it relates to our practice and to the people around us. So more specifically now I’ll give you an example of B for me, how it’s start. Was I looking at points or IVF?

So I was getting people into the,

and Nick and they were going, and I remember clearly the very first time of looking at a re what’s, this thing, all about this, Paul, all those protocols. Points are to use this right? So it helped us. And it was interesting for me, need to go. It wasn’t available in the classics in this detailed way for this specific issue that is so recent.

And this kind of gotten me thinking and from then on, it was like, okay, so what else is actually been written and in research and what else can I, what other information can I get from these papers as well? And to take that con the continuous from the policy protocol and how things changed here we are.

Now, all these nipples protocol was published in 2002. Here we are now in 2019 with a systematic review and meta now. Telling us more about three or more treatments, the use of a modified protocol. We know the C MoPTA credenda migraine. The acupuncture protocol is even more used now and how we’d adjust to the changes on the IVF procedures as well, because the IVF procedures now are not the same as they were when the policy protocol was designed.

So again, it’s a living medicine, so we’re all learning from it. Yes, exactly. Am I just want to point out that, protocols are. So really a guide. They’re not because of course each we’re still practicing patient centered medicine. And, radically personalized. And so this two ideas about the idea of improving blood circulation, calming the nervous system down, right?

So those are these points elections, but they’re not the only thing. And then there are many practitioners that do, assist with reproductive, with the IVF protocols, et cetera, et cetera that are going to tail. To their patients and use some, maybe all maybe less. But yeah.

So with protocols, I like, okay, it’s not with everyone. It’s got it. We still have to personalize treatments. Absolutely. Yeah. And I’ll show you a good example of that then towards the end. Cause I have one again, because I have more experienced with the IVF side of things and how important it is to have, as you said, like that protocol, that set of ideas, but then how.

Also work with that and add more related to that person in front of you. So just to summarize, and I will talk a little bit more about these points, just more specifically, but research literacy. So knowing about research, why is it important if anyone was to ask you. Through the main points that I would say to someone best practice.

So we spoke about this just now, knowing what is being done, what has changed, what are other peoples in other parts of the world doing and how is it working for them? So in other words, is it informing my practices? Professional credibility. When you’re talking to someone, if you’re able to talk to them in a language that they understand, it’s easier to have a conversation.

So it’s not taking anything down from the classics or from Chinese medicine. Language is just adopting that if I was speaking Portuguese only because I was in Portugal, we wouldn’t be able to have this conversation. If the classics weren’t translated from Chinese into English. We wouldn’t be able to read them when we were in college and we wouldn’t be having this conversation.

So it’s the credibility of, oh, I understand what you’re saying. And we’re having a conversation and then linked with that is engaging with other healthcare practitioners, because we want to be part of that team that is looking after the patients. And that is pretty much how evidence-based acupuncture was born.

By the way evidence-based acupuncture was something that was set up by a medical doctor who did acupuncture. And in his own words, it was just getting the same question all the time when he told people to in his office and they say, oh, I think you should get acupuncture. People who go but you’re a medical doctor and you’re telling me to go and get acupuncture.

Do you believe in that? I knew would always say the same thing. It’s nothing to do with belief. It’s to do with it works. So I’m telling you to go learn. Belief has nothing to do with this conversation. So the EBA has this one sentence thing that you see on the website and on our forum. It’s the goal is to construct a successful evidence-based explanation, and that will help us to communicate.

Acupuncturist evidence effectively and support the public clinicians and healthcare policy makers. And that’s really important because those people are the ones that will decide what type of medicine and who gets to work, where, and that is using the language of science. The healthcare policy makers was something that we added more recently in the last few years.

And it’s been really interesting for me to look at that group specifically because. They might not have any medical background at all. They might be coming from a law background or, anything else, not necessarily a medical background. So not only they wouldn’t know about what we would call biomedicine or Western medicine, they definitely would not know from Chinese medicine eater.

So really important to have a language that we can talk to them about. And that’s because the public. And these, everyone is reading stuff from all the way from, as you were saying, these great papers coming out in terms of acupuncture for cancer. But the other side of the spectrum has stuff that is not accurate at all.

And we just can’t change it because it is the way it is. So there’s a big wide spectrum of information that these people are accessing. And I would prefer them to get this information from us. I added a slide because he asked me to, because he wants to talk about this one. And I really liked this one and seeing the stuff that came out of acupuncture research that is so much part of our day-to-day life.

And that’s sometimes we might not even realize that it came about because of acupuncture, research, neuro imaging research, you were talking about the. The paper and talking about how MRIs have been used and gave us so much information about what’s happening inside our brain, when we’re getting acupuncture biomedical knowledge of connective tissue, Penn level Lily Helaine Lowe’s event, like a it’s all, acupuncture is definitely so fascinating that as it looking to see how it works, they find so much more and it actually does advance.

The Western medical model. It’s yeah. So you see it adds onto it. Yeah. Insights into therapeutic encounters. Again, professor you McPherson wrote a lot about this as well and how, and even, yeah, Vitaly not, but I’ll put this out there as well, how the encounter actually matters. And that should account for when you’re doing the research tens machines, the anti-nausea wristbands, all of this stuff is there because of this work that is being done.

Hooray to us, and the new thing that you seeing more and more the comparative effectiveness research in terms of really trying to get that pragmatic approach to what we do in clinic and trying to put that into what is happening in research as well, and the amount of stuff that is out there.

And again, I won’t go on too much about this because we all know about this. John puts this amazing stuff together, compiles all this information. There’s almost 16, probably. Now this was in February 16,000 of Cochran’s central register of controlled trials. We should not discard this information.

We should use it. And that information is of good quality. This is something that we hear every once in a while about there’s a lot of research, but is it of good quality? We now have information showing that it is it’s the last 20 years. Yeah. Twice to fold higher rate than biomedical research.

The quality of that research is better as well. It has improved on journals and we have the papers to prove it as well. So this is good information to have on your website and to have on under your belt when you’re talking to other people. If they say, oh, there is stuff written, but it’s not a good quality.

Actually let me show you. And this is, I always go back to this amazing sentence that John said when we had our conference about the research is out there, but who’s reading it. And I guess that this is why I’m here doing this with you. And this is why we have our goal with EBA to get people, to talk with different languages and understand different languages and ultimately whatever floats your boat acupuncture.

So I’m asking you to be the change, you all listening to this, you and I say this, that you spend more time in clinic than I do. So you matter. And here’s the example that I was saying to you about the IVF work. So we’re looking at this from 2012, the Delfi consensus put together. So this is asking practitioners about information, about what you’re doing in the clinic for your IVF treat.

That information is, can even see that Shane Littleton was involved in this professor. Carline Smith’s name is Derek says on grant. Anyway, the names you’ll recognize the names anyway, but this was asking to practitioners, tell us what you do in the clinic. All that information goes towards an RCT. It doesn’t always have to be an RCT, this group is really reliable and really good at putting this research together.

They were able to put it in RCT together. That goes into a secondary outcomes of that RCT. So more information from that in terms of anxiety and quality of life for women undergoing IVF. And sometimes the clinics are really interested in this quality of life, anxiety for those people going through IVF.

Then all that information that started with the clinic remember goes into a systematic review and meta analysts. That gives us a lot of information. All of that goes into information for the Cochrane review, which is more likely to be something that, again, healthcare policymakers and medical people will be reading about that.

Remember how it started with that email in your inbox. Hey, do you have five minutes? Do you have 10 minutes to help us out with this? So what I want to say is that, if acupuncture is helping with anxiety over IVF, then. It’s obviously going to also help with anxiety over climate change, anxiety, over whatever anxiety.

And we see, move that there is this opioid crisis for pain. Acupuncture is great for pain. It’s great for helping people get off of addiction. But also if it’s great for anxiety, then we’re also gonna be looking at the future where so many people are on anxiety medication. Which are also very addictive.

And so just by, I’m just like adding into this. Just because one research area is about they’re a little more granular. The information then, gets applied in other areas as well, which is a very easy bridge, especially when it’s addressing those biomed those Mo biological mechanisms, that are showing up for things like anxiety, depression, and all of that. So this is a really big. And a good add on to that would be also to say that if you are, which I’m going to go into now auditing your clinic and showing and putting out there what’s happening in your clinic, you might actually be finding new trends you are now seeing in clinic a lot more patients complaining with X condition compared to what you were before.

And once you write about that, maybe someone in. Austria is going to go. Oh, actually it’s funny. You mentioned that because I’ve been noticing that too. And then someone in New Zealand is going to go, oh wow. It’s not just me. These guys also noticed that, right? Oh, there’s definitely, I’ll tell you in my practice over the last couple of years, anxiety and sleep problems.

And then looking at other research, there was, increase in writing of prescriptions for anxiety medication. Like even looking outside of. Who’s coming in your office, you start to see other, trends that are in the media and being reported, you start to look at, oh, cause I look at it when a patient comes in, I’m having a sleep pro and I’m like, wow, it’s all happening.

And then all of a sudden you see so many people. Are experiencing having these things. And once it that’s what I was saying. Once you start, if you keep this in your clinic only no one will know. Then you’re going to beat the best, kept secret. If you find a prescription that is really good for that particular condition, and you don’t tell anyone again, let’s go back to the beginning and think, is this a living medicine?

Is that going to, is that going to be the secret from your practice? And no one will ever know. So I know I’m exaggerating, but I’m just giving the example of why it’s important to audit your clinic. Just show what you’re doing and how you’re doing it. And then when you look at the outcomes, you might be helping practitioners all over the world to access.

Improve the type of treatment that they’re giving to their patients. So on-screen now there’s just a few examples of how you can do it. My mom, a lot of people know about it and a lot of people use it, which is great. There’s one which is online now in the U S you might’ve heard about it because I can track are actually involved in the study going on in the Northwest as well.

So yeah, you will hear more. About them because they’re online. So it’s just a little bit easier to collect this information from the patients as well. So that would be my thing. And for those who are interested in getting to know more about how to collect that information, then write it down in a case report.

And here’s what you have to do. Basically just look up. Care, which is case reports and then start collecting the data from your clinic. There’s actually more specific into Chinese medicine. It’s called Karch. And a lot of people will know about it even for N of one trial. So when you have just a one person this information is out there, but I would go back to what John Weeks would always say, it’s out there, but who’s reading this right.

I’m always in there. I’m in there. Yeah. Yeah, jumping in and I go if this herb is doing that, I’m going to look in the other categories. And I also look at the foods, what’s in the food medicine, there’s so much there. So this is really, I’m really excited about, you talking about.

Big point of interest for me, because it’s important that, a lot of practitioners may not do continuing education or, they may get a little bit I don’t know, stale with their treatments. And so I think this is important, very important to be up to date on what’s out there and also really again, to be in back.

For our medicine to be able to talk about it intelligently. Now, when I was in school, we didn’t have as much, I was in school, graduated 20 2002. So over 20 years ago there wasn’t a lot that was out there. There was the IVF study coming out of Germany. There was the study for the nausea and I think there were still working on the.

Down at NIH, right? So there wasn’t really a lot. And then you’d have to have things well, actually coming out of Japan, there were things, but they’d have to be translated. So what we have now, and also the internet was, very much in its infancy. This is, it’s so accessible for practitioners to do that and good good clinical practice.

To double check. Yeah. And this is we didn’t, people are going to be watching this and thinking that we arrange this, but we didn’t, and this is a great segue into this because what’s on screen now. It’s only part of the slide and I, this is actually a sentence from the paper itself that I’m going to show you.

And it’s something that adds on to exactly what you’re saying and what still to this day. And I hope that this will help to change that. Turns people against acupuncture research a little bit while clinical trials provide valuable data about if efficacy of interventions, findings often do not translate into clinical.

That’s something that you see and you hear, I would say that too, like maybe 10, 15 years ago, but then after learning and after doing my MSC and getting more into research, I don’t anymore. And talking about the timescale that you are giving this sentence is out of this paper that has just been published recently by a good friend of mine.

Beverly Devela. She collected information over 15 years. 15 years of information. Now, anyone can come from anywhere saying that, oh, there’s not enough evidence about acupuncture, or there’s not enough for us to base our decisions. That’s 15 years of information right there and published for everyone to see.

So in looking at this and saying these are sentences from the paper itself and that key punchline on, in day-to-day clinical. Practice not appears to be a safe, effective intervention for breast cancer survivor. This is really important for us to know and to have this, to be able to say straight away.

Actually, and what I’m going to emphasize too, is the beauty of doing the research is we also have thousands of years of, knowledge about the, how it was used. So we’re not, it’s not just being made on. We’ve got these, it’s not made up something it’s really based on, okay, this is what they say, this is what was going on.

And this is why they continued to do these practices. Now we can take that and look at it. So this is the point. So it’s the only 15 years ago, 15 years. Thousands of years of evidence that’s in, in these records and then really looking at them. So it is actually like we’re doing like a little bit of a retrospective, right?

Look at everything that’s been done and then designing. Different kinds of research based on what’s showing up in, in health for us and how, and like how we can actually use this and integrated with what I consider like the traditional model, right? Like where that fails.

There are these other things, and there’s no reason why we can’t do both. It’s not an either or and it’s and again, as you, we see that a lot of the acupuncture then informs better practices in a Western medicine model, like areas for growth. Yeah. Yeah. And this is again very timely for you to say this because I’m going to give you the two examples, just because we spoke about a discount at the end of the presentation.

This is just out in the last couple of weeks. Good friend of mine. Good colleague, Dr. Mathias, zoom or Martinez works. Mathias is a medical doctor who was also trained in TCM. He works in oncology and. And he wrote this case report about what are the patients? So this is like debunking a bunch of stuff against occupants in one paper right there, right?

Is a medical doctor trained in TCM who uses it in the oncology setting. And as now published a case report, which I’m asking you to do more and more showing the difference in one patient between getting acupuncture. This is one treatment, just one treatment. The difference between getting one treatment of acupuncture and the oncologist.

Like amazing stuff. And I just put another one because again, to link it back to the states as well and see, cause people would be familiar with this they’re obscene and Valerie, Valerie actually sent me a message before this. So if she’s watching hi and yeah, just publishing a case report and showing what’s happening in your own setting.

Again, hospital setting, acupuncture being used and how it’s helping the patients, but it needs to come from you. It doesn’t have to be a big, huge RCT a case report will do with. So here’s my plea and my punchline and my please. And then you can stop and you don’t have to listen to me anymore begging you to write research.

So here’s a time I’m V I’m more visual. So I like this and this makes sense to me. So I hope it makes sense to you as well. We started with the classics. All of this was written. Back in the day we read them. We learned about them in school. The first book that I read about Chinese medicine when I started studying in Portugal was Giovanni’s book translated from Chinese, some Chinese terminology there as well.

It all starts to make sense. Then you go into what brought me into research occupants or research the book. And again, the names they’re amazing. Rosa Schneider just, really inspirational for everyone. That’s how I started. And that’s what I read about. And it becomes the classical book now in terms of where it all started.

Now we have all this information going into Cochrane reviews and going into research and starting to be part of the research literature. My question then is who is writing tomorrow’s classics because yesterday’s classics have been. But in 200 years, in 2000 years, when they look back, what are they going to say?

That those guys in 2022, what were they writing about? What were they doing in their clinics? So this is why I’m asking you. To do it and to please make it your turn now of writing the stuff that you’re doing in the clinic and telling more and more people so that we can adjust and adapt the trials as well into being more like what you do in your own.

So that’s the end of my presentation and my begging for you to write what you’re doing. Oh yeah. I, and I have to say, I love that book. I actually have four different copies of Sue and aging and link shoe because each translation is slightly different. And I also had the pleasure of studying some with Elizabeth shot, the LA she’s amazing sense of humor.

And what I would say is that it’s also important to reread the classics, especially after you’ve been practicing, because then when you read it again, you go, oh, so a lot of this is you need to read over and over because and research and read papers because you’re at one level as a practitioner and then you get some experience and then you go back and then you can catch the deeper meaning and then also apply it.

So it’s always, so this is not, it’s like review, do that retrospect review again. Go back and you’re like, oh, wow. I didn’t know this before. And our information comes from many different places. I find my patients are fantastic for reporting stuff back to me which is also important.

So what I want to ask you Sandra, how what can we do to help you? Can we where can we find you? How can we follow you? Listen to more of the stuff that I have to say. Ah, yeah, I wasn’t expecting that. Yeah. Okay. So look as an individual, obviously it’s my pleasure. And it’s my passion to to the research side of things.

It’s just how I get to write. So some people would write books for example, which are very valuable. I, that my passion is that, writing these papers and putting it out. Sharing this information with people. So on a personal level I’m working in research. I’m I love lecturing. I love teaching.

I love learning from the students as well. So people can find me, Sandra grass online that they will be able to find more information about me. And the main work that I would do that would be more visible than for people would be through evidence-based occupants. And. Thankfully, we have a lot of people helping and supporting it’s a nonprofit organization.

So evidence-based acupuncture.org is where people can go and check it out. We have a forum as well, so we don’t do discussions on social media anymore. And we just take that to a private place where we can all talk as practitioners and as colleagues and outside of the eyes. Are there any. Censorship of social media type thing.

And without any distracting voices, either from the outside, so just for us to talk on the farm and share ideas and yeah, EBA connect is the way that people help and support the work that we do with EBA. Awesome. Awesome. Fantastic. Thank you so much. For coming on and sharing all this great information and also really helping people to really keep their practice from going stale.

And then also, be better practitioners, better, clinical practice. And then, this is how we bridge to other professions and become part of the team. And keep keep us professional, right? Yeah. Share what you’re doing in the clinic. Like it’s amazing.

I really appreciate the opportunity of coming here and being able to talk about this. I know I speak a bit too fast when I get excited about it. But it is really I’m learning so much every time. To find out from other people in their clinics, what they are doing and how can that influence? You said it yourself.

The study was from Germany and then you were reading it and then someone else, the paper I showed you, the survey of practice was actually in Australia and New Zealand, and now it’s everybody else in the world is reading it. Mathias wrote that paper from the hospital, the oncology. In Austria and now everyone is reading it.

So I think that it’s really important for us to stand proud of what we do and, have it on our websites. Haven’t, especially have it published and be able to talk about it in terms that other people can understand. And as I said, like the case reports would be, as you can see, the example would be the best way to put it out there and publish it for everyone.

Awesome. Thank you so much. Okay, so here we go. Hopefully you will join us next week. We are going to be having Jeffrey Grossman will be coming on and presenting for the American acupuncture council. And all right. And again, thank you for the American Acupuncture Council for putting this production on.

 

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Treatment of Radiation Side Effects in Cancer Patients

 

 

Hi today we are going to talk about the treatment of radiation in TCM and this is quite an unusual topic, but we are, it’s one of the topics that we are getting a really great results, both in the treatment.

Click here to download the transcript.

Disclaimer: The following is an actual transcript. We do our best to make sure the transcript is as accurate as possible, however, it may contain spelling or grammatical errors.  Due to the unique language of acupuncture, there will be errors, so we suggest you watch the video while reading the transcript.

Hello, everybody. And welcome. I would first like to think the American Acupuncture Council to put up this presentation for all of you. And I would like to start with the presentation. I hope you’re all. Hi today we are going to talk about the treatment of radiation in TCM and this is quite an unusual topic, but we are, it’s one of the topics that we are getting a really great results, both in the treatment. And also even in the research that we are following up. Radiation therapy also known as radiotherapy is one of the most common treatments.

In cancer. Almost half of the cancer patients will get radiation therapy. Although, there’s so many advancement in the treatment of cancer, different drugs, et cetera, radiation therapy is just continuing to develop and be there as the, one of the major modalities that are used the cancer care.

And how does it work? Basically radiation is a very high frequency of radiation, which is used and it works in two ways. One, it has a direct effect and direct effect of radiation. It damages the DNA in the cell by producing more and more free radicals, but it is also a. Eh, a larger indirect action by producing the whole area of more free radicals, which are damaging more cancer cells and much less healthy cells.

So this can also give some kind of additional effect to the radiation. When we look at the radiation, we are actually looking at the very high frequency res. If you look here, you see the size of J regular Ray radio radiation. And as we move along, you can see the side that the radiation that we are using in x-rays is here.

And in gamma rays, we are even going to a much smaller size, but x-ray the size. And the frequency of radiation is extremely high, and this will help to understand the effect in Chinese medicine. And one of the side effects of radiation is here. As you can see here in the picture, like a person that is radiated for neck, a very common area for neck cancers or for women with breast cancer.

So you can see the redness appearing there, and this will help us also later to understand the effect of radiation in Chinese medicine. And the side effects of radiation are very much dependent on the doses. The area of which is radiated and also the sensitivity of the surrounding tissues or organs.

And today, the radiation is very exact. So there is less damage to surrounding tissues in the past, there was much greater damage and the radiation side effects, first of all, the main one is really this heat, but there’s also fatigue. And there is some diffused feeling of not of being ill, not being yourself.

Sometimes headaches obviously on the skin, they can be in DEMA inflammation, like in his trunk. So sander. And if the radiation is like to the throat, to the mucus area, then there can be mucositis or dry mouth or dry dryness, wherever the radiation is directed at, the radiation can be directed to any place in the.

The very common thing we see in the clinic is radiation to an in throat, in their throat cancers, but also to the head and to the breast, obviously for breast cancer. But radiation can be done to any tumor. The side effects let’s look at them for a minute from the Chinese medical point of view, the way we view them.

So as you can see, it’s a very stressful. And small frequency of a phrase that penetrates deeply and they’re causing dryness. First of all, dryness to the fluids and dryness to the fluids over a long period of time in Chinese medicine, we’ll create in deficiency, which means a long-term thirst and a longterm inflammation, either the local or even more general.

Radiation in itself is toxic heat. And I think this is one of the key issues when we are teaching oncology acupuncture now to treat and diagnose patient with a TCM in oncology. Toxins is one of the main things we have to consider, because this is a new parameter, a new pathogenic factor, which is not very much obviously mentioned and then aging and the classical Chinese medicine.

So to understand toxins and its effect is one of the key factors. We have a combination of toxins and. And toxins and heat. We’ll also create some cheat deficiency. And if after a long period of time, even Jing deficiency, this deep penetration of the Ray goes deep inside the cell. And obviously also to the DNA of the cell.

But if Chinese medicine we’ll talk about this going deep into the gene level. And so this is the main factors that we are seeing in the. And this is the pathology in Chinese medicine. So first of all, it’s toxic. It is the nature of the x-ray. We see the dryness in many different area. It can be either superficial to.

Dryness or can be deeper. And then we’ll talk about the fluid and fluid production, like on the land, in this and the stomach, which are involved in Flint production. If it’s a very strong radiation, we’ll see in the efficiency, as we talked before, especially if it’s for a larger area, Xi deficiency is a classic and the two deficiency can also extend even four months after the treatments and locally we can see.

And which can affect like the tender masculine Meridian in the area that is being radiated. And we look at the supply of the tender muscular Meridian to the area, the classical combination of points, which are addressing this pathology. So large intestine elect will help to take the heat and it’s a young midpoint, so it will also help to cool.

And also GB 14 is actually for head radiation or neck radiation. It’s when they all the young meridians are joining will help to take the heat out. The excess young for drugs. Again, we’ll use points on the young meaning stomach for the foreign, large intestine. Two, both of them are water points and they’re in reaching back the fluids for inefficiency.

We can add kidney the six and if the radiation is over a long period of time or area with many bones, then we can add gallbladder 13. Which is the viewpoints and for bone marrow and some other kidney points depends on the radiation area. If there’s a general chief efficiency, we’ll do stomach 36. If it’s deeper, we’ll go to the seas and use stomach 30 and, or Lang nine, the gain to help to rebuild back the cheap.

For local area, we’ll use more local effected points, team end points. So let’s give you a kind of a general idea how I will treat the radiation and how we are treating radiation. And when we are teaching them college acupuncture, we start with some general prescription and go into many other options of treating.

One of the very interesting research that was done because there’s many high quality research, which are showing that acupuncture is good, especially for dryness of the mouth of the radiation for patients with head and neck cancers and this dryness. Extreme, and it’s very debilitating and it really create a extreme suffering to this patients.

Imagine that on top of having radiation and having a throat cancer or mouth. Your mouth feels like it’s desert, there’s no saliva or free for the production and because there’s been many evidence that acupuncture is good for it. There was one really interesting research that they want to share with you.

And it’s, they looked in functional MRI on patient. It’s actually not patients. There were just volunteers. I know Gary Dan from Memorial Sloan Kettering, he did this research, so we took volunteer. And punctured them a large intestine to, and looked in functional MRI and the amount of saliva produced and and the real comparing to placebo.

So this was the use of the occupancy was at the large intestine to comparing to a non occupant tree point, just on the side of. And this design is quite a interesting, because they did this time acupuncture, some got the real acupuncture, some got the sham acupuncture. Actually they did the crossover. So this.

People who were in the research in the beginning either got real or shy and then crossed over. And what was compelling was the mechanism, the functional MRI, and also the amount of saliva, the results were quite unusual. And you can see that the patient, whenever they are this, in this respect, the people who are examined when the large intestine two was punctured the area in the.

Which is to do with the saliva production was got more blood and you could see it in there. It was activated, comparing to the placebo point where there was no specific area in the head, in the factional MRI. And as far as salivation, they put the cotton ball in the mouth of this patient. And. Wait it before and after the puncturing of either the real large intestine two or the placebo, and this was very significant higher amount of saliva where large intestine two was punctured.

So it’s one of these beautiful research which shows you how a point. Both has a physical effect and potentially some mechanism of action, how it is working. So the conclusion of the study was that acupuncture in large intestine, two was associated with neuroma activation in the brain, but also was correlated to more saliva production.

I love this research because a lot of time, even as an acupuncturist, we would laugh to see this correlation between the city. What we know and the real finding, and that’s the beauty of research that you can actually look at it finding. Cause what it means. It has a lot of other ramifications than just supporting people with.

And dryness in the mouth due to radiation. It also means that this point is effective to many other conditions of dryness in the mouth. For instance, your grin, which is an auto immune disease, which the mucous membranes that had drying up any other dryness of the mouth which is stemming from different disease or even from in the efficient.

That we see, like for women, with menopausal people who get up at night and have to drink water. So we can use this point in additionally, maybe to kidney six and other points that they discussed to help with this dryness. And why is it working? And that’s, to me, the beauty, and as I say, I teach a lot. I am cology acupuncture.

You’re all welcome. If you’re interested in this field to do join us teaching and. It’s one of the things that we see this strong effect of acupuncture on different side effects in cancer patients. And we can understand why when we look both into research and we look into the Chinese understanding of the point.

So a lot of interesting people, too. And always been a water point and the large intestine Meridian goes to the mouth, as we know, and it’s a young Ming Meridian, and it was indicated for dryness in the mouth, but also for two sakes and for throat pain 2000 years ago. Now we can see the evidence, how it works and we can utilize it also with more confidence, looking at the risks.

But also understanding more how occupant you can help for patients with cancer. I’m on this beautiful project. When we draw the points with my two colleagues about the human needs, key from Poland, Dr. Babish Kaminski and Annie yell from Israel. And this is just an example of the drawing of the large intestine in Meridian and large intestine two.

And this is just to add to the beauty and understanding of the water production. Eh, around this point, another optional points actually see between 83 and another point, which helps in producing saliva and generally enrich the body fluids in the body. So as we know, large, interesting too, is both a water point is in spring point.

So it has a lot of different Chinese, eh, indication. So both reduce here. Young meaning points like large intestine in stomach of both helping to reduce it, helping to replenish fluids and in a deep way, even to strengthen the kidney and through the internal docs of the same chow. So despite, as you can see as a very large options in helping patients with dryness, But specifically also to treat radiation other points because we are on the treatments of radiation, which are very good for the neck and the patients who have neck and throat cancers is also maybe Lang 11, the Firebird.

And you can use lung five or alleged. This 18 is a local point again, to gain back this Floyd and reduce the heat and the toxic heat, even bleeding a point like large intestine 11, if there is a very stubborn and acute throat pain and a pain in the throat after a day. This was a little bit about acupuncture and the use of acupuncture and the, also the proof for acupuncture points and why acupuncture works so well for ideation, I did also more than 15 years of research into one formula.

And one of the things that we tried this formula, and when we combine it with radiation there is always a few. That herbal medicine, especially willingly they’re fear with radiation. And what we know from this formula, it’s called LCS. One, one is that it’s not that it’s not interfering, but it’s actually working through the same mechanism of actually producing more free radicals.

And also we have proven how it’s kills cancer cells. And does it affect. When we tried it with radiation, and this is a publication that we publish this in one of the very reputable journal. With my colleagues here. And my last colleagues is professor Berger, who is the head of the oncology services in the hospital that just to work Sheba hospital.

So it’s a very interesting publications, which is showing actually the twin. We take this formula here. We showed it the different cancers here. It’s for example, breast cancer in prostate cancer. Because if you actually have a look, you can see the blue line is just radiation alone. And on the side you see the amount of cancer and that is killed.

So the lower you go is the hundred percent of cancers are killed. So this is the, just the radiation. It’s. That the amount that we are using here is killing around 50% of the cancer cells. When we are adding the formula in small dose, it kills much better when we are adding it in higher doses, it much better, but even five.

So this isn’t for example, for breast cancer cells, and this is for prostate cancer cells. So what we see actually in this experiment that we published it, the formula is not just helping him killing cancer cells, but it’s actually even having a synergic effect. Definitely not interrupting. And there’s the whole debate of using herbal medicine together with radiation.

Definitely anything which reduce the amount of free radicals you shouldn’t use with radiation vitamin E for example, vitamin a. But actually it was this herbal formula. This we’ve been researching, we’ve shown not just that it’s not interfering, but it’s actually potentially adding to the radiation effect.

And that’s what we see because it’s similar. We know that the mechanism of action, so we can explain even why. So I’m advocating for people who are using radiation also to use this formula. So we have that. We have acupuncture, we have herbal medicine. All helping patients, oncology patients. So in this presentation, I talked about acupuncture stressing about the, also the mechanism of flagging this thing, do it, how it helps in radiation and other points.

You have quite a nice selection of points that you can use for patients in radiation and the herbal medicine LCS 1 0 1 or protective veil. Is it called? So you have already, I think even from this way, Some key component in ideas of how to help patients with the radiation, especially for the, they can throat.

But generally, if you’re interested in courses, you can look at it the same academy, there is much more information and quite a lot of free information about it. So I hope you enjoy this presentation and I’m wishing you all the best of. And from Shane to Shen thank you. On Friday, we’ll be Tsao-Lin Moy presenting on this channel.

So you will come to watch it. So keep healthy and safe and all the very best buy for me.

 

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Microneedling Benefits for Your Practice 

 

 

Click here to download the transcript.

Disclaimer: The following is an actual transcript. We do our best to make sure the transcript is as accurate as possible, however, it may contain spelling or grammatical errors.  Due to the unique language of acupuncture, there will be errors, so we suggest you watch the video while reading the transcript.

Hi, my name is Michelle Gellis and I am going to be speaking to you today about the benefits of microneedling for acupuncturists. I wanted to say thank you to the American Acupuncture Council for this opportunity, and we’re going to go to our first.

Over here. As this is a picture of me, for those of you who don’t know me and today as I mentioned, we’re going to be talking about the benefits of microneedling and micro needle noodling. What it is the use of tiny needles to beautify the skin. And this can be like a microneedle pen or a microneedle Derma roller, and, or what’s called a hydro roller or a Hydra needle, which is a little device where you put liquid in and you.

Infuse it into your skin directly. So all of these different devices are very modern ways of beautifying the skin, but they are based on the Chinese principles of using needles to beautify the skin, which is something that’s been done for thousands of people. And it is not just so it is preventative as well as it is restorative.

And it doesn’t just work on the outside. Microneedling if done by an acupuncturist will work on the inside as well. The principles and the practice of microneedling is almost identical to practices that we already have of either circling the dragon to treat a scar or some sort of just chromia in the scan or.

Intradermal needles or a seven star hammer, like a plum blossom needle for things such as hair loss and other skin concerns. And seven star hammers are used in Chinese medicine to treat blood stagnation, neuropathy, scars, and alopecia, but we can do the same thing with some of these other more modern.

Devices. So here is a photograph of a, what we call a dark spot or a liver spot. And Yeah, little wrinkles that might form around the lips or in the nasal labial area. Typically we will take small intradermal needles and insert them with tweezers, superficially to bring blood and Xi to the area. We can also thread larger needles and doing things like this helps to release.

Stagnation, any sort of fascial adhesions, which can cause the skin to fold and wrinkle and help to encourage the growth of healthy cells. So these are things that we can do with regular acupuncture needles. But this can also be done with a Derma roller or with a micro-needling pen. And this will mimic the, these are modern ways of mimicking some of these ancient techniques.

When I teach microneedling in my classes, I do. So as part of a holistic TCM practice, I incorporate my five element. I’m a traditionally trained five element acupuncturist, and I incorporate it as part of my. Overall system of health and wellness. So I do my diagnosis either your five element or TCM Dyke neurosis, and then you would use body points to help to build the cheap yen blood move stagnation, move, stagnant, fluid, stagnant sheet, stagnant blood.

And this is all in service of treating the outside because in order to treat the inside, you have to treat the outside and vice versa in order to treat the outside, you have to treat the inside. Here is a map of the face. And one of the principles of our medicine of course, is the connection between our skin and our internal organs.

And this is actually mapped out on the face as a microsystem where different parts of the face, when you treat them, it affects. Different organ systems.

So what are some of the things you might use microneedling for in your treatment room for a cosmetic. Purposes, it can be used for fine lines, acne scars, loose skin, and large pores, crows feet, lip wrinkles, any sort of dark spots or melasma things like stretch marks and even hair restoration. Many people have suffered post COVID hair loss and microneedling can help them.

So how exactly does it work and what does it do? From a Western standpoint, when you puncture the skin, when you make little holes in the skin, your body is stimulated to build its own collagen. Plus if there’s any products you’re using, like I showed this little Germa stamp here. The Hydrus stamped.

You can put fluid in here and infuse it directly into the skin. If you are, even if you’re just Derma rolling, or if you’re using a microneedle pen, you put your products on and then when you. Use these needling devices, these microneedling devices, it helps to infuse it because many of the products that we use, we put them on our skin and they never get absorbed.

So what are some of the benefits of microneedle Lang versus maybe some of the Western treatments, some of the more invasive treatment. That people are having done, whether it’s fillers or toxins, such as Botox with microneedling this very little downtime, it’s very low risk. It’s very effective.

There are many clinical studies many clinical studies that have been done. If you go to my website, which I’ll show you at the end. If you go to my website, you can see many articles that I’ve linked to and blog posts that I’ve written on this. So it’s very low risk. It’s very effective and it allows your body to produce collagen.

Naturally it can help with stretch marks, acne scars can decrease hair loss, encourage new hair growth. Like with eyebrows. As we get older, we lose the tails on our eyebrows can help with. Wrinkles on the neck and within cosmetic acupuncture, the neck can be a really difficult area to treat. So when you’re dealing with the neck, those fine lines around the lips crow’s feet.

So areas that would require a lot of small needles, the microneedling devices can address those. It is not painful or most cases it’s not painful. And the results last a long time. So the needles create these little micro channels and then a micro channel stimulate a healing response and collagen and elastin are produced.

And when that happens, the skin becomes firmer. Any depressed scars, start to gradually. Diminish, and this will help to smooth the wrinkles over time. You can do microneedle laying on your face, your neck, your scalp, your stomach, your thighs, your arms, pretty much anywhere on the body. You don’t want to do it inside the orbital rim on the red part of your lips or Ani, any mucus membrane.

So here’s just a little refresher. Here is a cross section of scan. And when we’re microneedling, we are just working right in this top layer here, the epidermis and the collagen induction therapy. As I mentioned, works on the wound healing responses. There is this all. Inflammatory reaction that happens.

And then the body recognizes it’s been injured and it makes nice new, healthy skin. So here’s a, just an example. This would be with a Derma pen, but it looks very similar with a Derma roller dermis stamp and you can see how it creates temporary little. Micro wounds or microtraumas, and then the body heals itself.

So if you’re already doing cosmetic acupuncture, like what are the differences and what are the similarities? So with micro needle, Lang you’re working very much on the skin level, the fine lines, any depressed scars, you don’t want to go over raise scars. With the nano needle. So there are little nano needles that you can get for the microneedle pen, which you actually can use inside the orbital rim and on the red part of the lab.

And the results happen fairly quickly. There’s a little downtime depending on how deep you go. And then the results are very long lasting up to five years with cosmetic acupuncture, your really working with the underlying causes of aging. You’re going much deeper till the muscle, the fascia you’re working with the blood and the cheek.

And it’s much better for the sagging skin jowling and your patient is going to need 12 to 24 treatments with microneedling. It’s four to six treatments and there’s no downtime with cosmetic acupuncture. So what can you expect? This is someone before treatment, during treatment and after treatment, they really should just be a little pink.

Like they have a sunburn, there should be no bleeding. Germer rolling. However can be done in your office. Or you can sell your patient a Derma roller and. Have them take it home and with proper instruction, they can do self care between treatments, which is really great. So here are some before and after pictures of a microneedle laying, this was with the microneedle pen.

So here are acne scars, and then you can see these fine lines around the crow’s feet around the eyes. And this is actually a picture of me. This was before I had done any microneedling on my eyebrows and this was after. And you can see not only is my entire brow thicker, but I have new growth in here where I didn’t have much of anything going on before.

And I don’t have any eyebrow pencil or eyebrow mascara going on here. You can see my eyebrows now. So I’ve been microneedling my eyebrows for about six months now. And I started to notice a change after about eight weeks. It was quite astounding. How do you set up your pricing? Let’s say you were already doing microneedling.

You already know all of this stuff, but you’re not quite sure about pricing and maybe how to market it. So the way that pricing is set up, typically with microneedling is. You’re going to charge per session. And depending on where in the country you are treating is how you would market your per session treatment and your packages.

Now one way that you can find out, what is a good price where you live is to maybe call some of the Medi spas and see what they’re charging. The caveat to that is I always do full body acupuncture along with my microneedling. So I put the body points in and I put, if I’m going to use numbing cream, I put the numbing cream on.

And then I come back in and take the numbing cream off and I do my microneedle. And so my patients tend to be on the table for about a half an hour. And so you want to price accordingly? Taking into account the fact that you are giving them an acupuncture treatment as well. And also depending on where you’re practicing in the country, you have to check with your local acupuncture board and make sure it’s okay for you to do packages, but you can also do a package because most people are not going to be satisfied with treatment until they’ve had at least four treatments spread out once a month.

Some other pricing options are to maybe only do the brows. Some people only want their mouth area done. Now with microneedle Lang you could do someone’s brows and then give them a. Cosmetic acupuncture treatment afterwards with the mouth area. What I have done with my patients who have a lot of lip wrinkles instead of using a lot of intradermal needles is I’ll put the numbing cream on I’ll do their body point.

And then I do any lifting points, points around the eyes, forehead, things of that nature. And then I come back in, take all the needles out in the fairs, take off the numbing cream and I do the microneedle and around the mouth, you can also just do neck and chest. You can do the back of the hands.

Microneedling is very effective for the back of the hand. And I don’t know if you can see my hands I’ve been, I am right now as of this recording, I am 60 and I hit don’t have any of those dark spots on the back of my hands. And I credit it all to microneedling because I started out many years ago when I was in my four days doing a Derma rolling on the back of mine.

Whatever CRM I used on my face, I put her on the back of my hands and then I would roll it in and then I would wash my face and it just helped everything absorb. So the vitamin C serum that I used really got absorbed very well. And I really feel like it’s helped my neck and the back of my hands and my overall.

Skin health doing the DerMarr walling. And then during the past year, I’ve started microneedling all myself with the microneedle pen as well. Also you can do knees and elbows, which Or another place where people tend to age along their elbows around their knees. And if someone has stretch marks, so these can be like standalone treatments and you can just decide how much you want to charge.

I’ve given you an idea of what I charge in my treatment space. And but you want to check around and see what’s going on with. As far as the microneedle pens, what you want to look for in a device is something that has a minimum of 14,000 RPMs. And that’s the speed. So when you’re turning it on, they have.

I could get my camera here. They have different levels and whatever speed you set it at when it’s at the highest speed, it should be a minimum of 14,000. This one goes to 18,000. Also, you want to look for that? The tip is a bayonet tip, which means that instead of just a little point of tip, it has a couple of connectors that you can put right in, turn it having a pen that comes with a couple of batteries is great.

And then if the battery does. Being able to screw it off and have a plug-in attachment is wonderful as well. Look at the warranty and make sure that the settings are easy to read that there’s a guide on it. And that you can tell. Where you’re setting the needle depth. So you’d be able to easily adjust and see the needle depth and also.

That it comes with a good user’s manual product support. And ideally it should have some marketing material that come with it. So you don’t have to go through the process of printing out brochures, coming up with information for your website, et cetera. And training, making sure that you get properly trained on whatever device you’re using is very important as well.

And so this is just talking a little bit about the side products. When you’re looking at products, you want something that is organic, so it doesn’t have chemicals in it. You will have patients that are vegan. They’re not going to want animal products or something. That’s vegan, something that’s easily absorbed.

And has properties that brighten the skin, nourish the skin, won’t clog the reporters, something that reduces inflammation, the products that I use have arnica and CBD. And and you want some after-care products for after you’ve done the treatment? I have arnica and aloe. Product that I give to my patients.

And then you want it to be slippery if it’s not slippery enough that you’re going to get drag on your device. This AccuLift skincare is my company, and I mentioned you can go to my website. AccuLift skincare.com for. Information on microneedling in general, you don’t have to be a customer.

There’s many blog posts and many pieces of information about microneedling in general. And I also teach cosmetic acupuncture classes. This is my website, facial acupuncture classes.com. All of my classes are recorded and they. Carrie CE use. I think that is my last slide. Next week we have Yair Maimon and he will be presenting for the American Acupuncture Council.

And I want to thank AAC again for having me on again, and I will see you again next time.

 

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Limits to Acupuncture Sets Per Visit

 

 

Click here to download the transcript. 

Disclaimer: The following is an actual transcript. We do our best to make sure the transcript is as accurate as possible, however, it may contain spelling or grammatical errors.  Due to the unique language of acupuncture, there will be errors, so we suggest you watch the video while reading the transcript.

Hi everyone. This is Sam Collins, your coding and billing expert for acupuncture and the American Acupuncture Council. With another episode to always make sure that you’re on point and making sure your practice is continuing to thrive and to grow our role with the American Acupuncture Council and my service, the network is to always help.

Be the best it can be in implementing the care for your patients and ultimately being paid. One of the things that comes up and I’ve had this question quite a bit from members is there some sort of limit to the amount of acupuncture I may provide someone and that’s a question, certainly some people think do what can I only do two, can I do four?

What is my protocol? Is there some sort of. That I must follow and in a way, yes, but in a way, no. So let’s talk about that. Let’s go to the slides. Let’s talk about what’s going do the type of acupuncture you’re gonna do and what are the limits. So from here, you can see just my basic information, there’s our website, my email address for those that need some extra help, but let’s talk about the care of.

Let’s talk about what is reasonable or what is necessary and what I’d say that always comes back to as a medical necessity. So I’d say the limits to acupuncture more than anything is going to be, what does the patient need? What does it medically necessary? Let’s define that here’s a statement from Cigna Insurance specifically on their acupuncture policy, which by the way, just recently updated.

And it says medical necessity decisions must be based upon patient presentation, including diagnosis severity. And documented clinical findings. So in other words, the more severe the case, obviously the more severe the diagnosis, the more care they might likely need. So you’ll see here, they’re not really putting a limit per se.

What they also indicate is that an individualized treatment, meaning frequency, duration, and so forth is appropriately correlated with the clinical findings. So again, it goes back to severity. So when someone says to me, Sam, is it okay? I do four sets. I’m going to say it can be. But it’s gotta be, is that’s what’s needed it.

I would be careful of a being something that’s based on my style that everyone gets four sets, no matter what. It should be based on what the patient needs. Let’s give one more. Let’s take a look at what Aetna says, and this is Aetna’s clinical policy bulletin, which has also just been republished again, but for 2022, and it says this acupuncture services are considered medically necessary.

Only if there is a reasonable expectation that acupuncture will achieve measurable improvement in the patient’s condition and is reasonable for a predictable period of time. In other words, we’re showing we’re making the patient better. So I’m trying to highlight here is that. They don’t really give a definitive that you can or cannot do whatever is necessary.

In other words, could some patients get better with two, maybe three or even four? Here’s something that came out and we’ve had a lot of offices gotten letters like this. Here’s one from the company empire, which is out of New York, but this is an Anthem company. And we’ve seen this across the U S of course I teach seminars all over and you’ll see here at.

The review indicated your average utilization of acupuncture sessions of what hour are greater or what are greater for personal one-on-one time is greater than what we consider the average of providers. So right there, they’re saying, oh, you’re doing an hour. That’s greater than the others. Now you’ll notice it.

Doesn’t say you can’t do it. It just says, because you’re doing more. They’re trying to say why they’re questioning it, but notice what it says here. We are aware of many factors that may impact the coding of your acupuncture services. So they’re indicating if it is with, for I know someone who treats post-surgical, that is her absolute specialty.

That’s all she does is referrals. Post-surgical patients. She goes, Sam, I generally sometimes do two hours. She’s doing six, seven sets on these patients. But when you think. These are post-surgical patients, lots of severe pain. So would that be reasonable? If they were questioning this, you’re going to just have to be able to respond.

It’s reasonable based upon the severity and need. So is there an absolute artificial limit while in some instances there is. You’ve probably seen something, what they call the medically unlikely edits MUE it’s often termed and you’ll see here. This is the United healthcare is promotion of it. I won’t say promotion, but their indication of it.

This is set up on a federal level and it says this, it says in accordance with the code descriptions and or the centers of Medicaid, Medicare services, meaning medical. Guidelines that CMS national coding initiative, it says the following are, the service limits are as follows. And you’ll notice the initial set is one.

Of course, how many more sets can you have than the first set? The first set is always one, but notice the additional sets all indicate two. So in other words, the amount of sets per this guideline says there’s going to be three pre-visit. I will tell you a lot of carriers have adopted this. I’ve seen this, not just with, I seen it with Cigna plans as well, where they’re pushing these three set part based on this medically unlikely edit.

Now you might look at this and think, wow. Are they picking on our profession? Not really because every profession, chiropractors, physical therapists have limits just like this. And you’ll notice here, I’ve just given a quick list of common codes. Obviously I put acupuncture, chiropractic notice for acupuncture.

The one. The initial two additional chiropractics, only one. And then you’ll notice certain therapies. Like by example, if we moved down to massage, you’ll notice they allow up to four, meaning once you’ve over one hour, they’re going to say no, and these are kind of artificial limits, but they’re just saying they don’t feel that often.

It would be reasonable to do much more than that. So now the issue becomes, if I’m billing insurance, am I limited to this? In a way, it’s what the insurance may cover. They may only cover that many. Can you do more? So let’s say you’re an out of network provider and the patient has a policy where it only pays for three.

Could you still do four and be paid for four? You could, but not by the insurance company. The insurance company is going to pay three who would pay the. The patient. So you have to be willing to make sure informed the patient. Your plan allows a maximum of three. However, for your case, I believe we need four and here’s the additional charge.

That’s if you’re out of network, here’s the downside. What if you belong to an insurance? So let’s say you belong to United as a provider. You will be limited to three. And if you do a fourth, absolutely. You can do a four. But you will not be paid for it and you can not collect from the patient. Cause remember when you join an insurance, you’re abiding by their rules, which means if they allow three, that’s the maximum that we can do for reimbursement.

If you do more go right ahead. There’s no additional money. So you have to make sure beyond these plans. When you join an insurance, you now will become beholden to these rules. If you don’t belong to the plan, you can tell the patient, this is what your insurance covers. This is what we need. And so therefore you do, what’s medically necessary.

Obviously people want to use insurance and we want to give them the best access, but maybe it doesn’t always cover everything. As we’ve all witnessed. How many of you have been to a doctor and you’ve had to pay substantial money out of pocket or things weren’t covered because your plan didn’t cover.

What do you do? You pay out? Here’s one. This is tri west. Now try west. Remember is on the west coast. Basically Texas and west of Texas that handles the VA. And you’ll notice they follow the same thing, one initial and two followup. So you’re seeing this also for the VA side federal plans obviously, and realize that’s also for Optum, which is part of United.

So to answer directly for some plans, there is a limit of. That’s payable. That doesn’t mean you can’t do more. It just means your limit for payment is three. Which means if you’re in network, you’re stuck with three, but if you’re out of network, can you build a patient for additional you’ll notice the anthems didn’t fall that I’m going to always say, treat what you need to do for your patient.

Treat the patient. Not insurance. Remember insurance is nothing more than an eight and never feel fully trapped into it. You’re going to let someone know here’s what your coverage covers. Here’s what we need to do. Here’s the difference provide what is necessary for your patients. So if you need to do four sets, do four, but if you’re in United health care, you will be limited to three.

So be conscientious of following through and understanding different plans and understand what your rights. In the sense when you’re in network or out of network, remember when you’re out of network, it’s up to you to charge what you feel is reasonable and the patients can choose or not choose to get it.

But bottom line is you are not limited unless you belong to something. When you belong to something like the VA, oh, they can say three are United. And so I will say the medically unlikely edits is there. If you go to a massage there. And they want to do two hours, but the plan only pays for who’s going to pay for the additional hour.

We, as the patient or the patient would, so same idea here. What I want you to take away from this is do what’s medically necessary, do what your patient needs, but just be careful understanding when you belong to a plan, there can be limits. And that limit is three to give you a little history of it.

Pre 2019, it was actually for manual. And three for electro and post 2019, they removed it and went down to three. Now the good news to that is I would suggest that many patients, I know me and myself as a patient, I’ve often not gotten much more than a 30 minute, maybe 45 minute. I’ve never had an hour treatment and I’m not saying anything wrong, but I think most patients can respond.

So we want to treat what’s adequate and be careful if you’re doing an hour. And here would be my question to you. Does the patient really need the hour? Are you just doing extra because you’re not busy enough and I’d sometimes be careful of that. Be careful of having a patient that you overdue, just because you feel like you want to throw everything at it.

Be. Be mindful, be helpful. What’s your patients they’re looking for is a response to care whether it’s going to take 30 minutes or an hour. So don’t put yourself in the realm of limiting, but also bear in mind. What is my cost benefit ratio? And remember, benefits are continuing to increase. Take a look.

And the benefit of 2022, it says Aetna will add acupuncture as a standard benefit in new and renewing commercial health plans in 2022. So everyone who has a commercial Aetna plan will be covered. Now, this doesn’t mean some of the federal ones, but all the commercial ones will cover, which means greater access.

Now will Aetna limits you to three sets? I’ve not seen them. I will say Optum United. But not Anthem and Aetna bear in mind, again, medical necessity. What comes down to, we want patients, we want access, give them the best help and understand do what is medically necessary. We’re always here to help remember the American Acupuncture Council, specifically the Network, not the insurance side.

The network is here to help you. I can become part of your own. Where you can call me, email me, fax me. We even do monthly zoom meetings. Take a look at our site, take a look. It’s very reasonable and as well as always gives you access, have an expert on your staff. Always reach out to us, go to our site. And I’m going to say to all of you.

Thank you. Continue success. Peace. Be with you, my friends catch you next time. Oh, and don’t forget, they’re going to bring it up on the screen. There is another show this Friday, and it’s going to be Michelle Gellis please tune in. We’re always here to help take care of everyone. Seeing that.

 

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A Proprioceptive Acupuncture Technique at Extrapoint Chonggu

 

 

Click here to download the transcript.

Disclaimer: The following is an actual transcript. We do our best to make sure the transcript is as accurate as possible, however, it may contain spelling or grammatical errors.  Due to the unique language of acupuncture, there will be errors, so we suggest you watch the video while reading the transcript.

Hello, everyone. Thank you very much for attending our American Acupuncture Council webinar presentation. My name is Matt Callison. I am here with my esteem colleague, Brian Lau. I thank you. That. We’ve got a really fun topic today. It’s a proprioception at Extra Point Chonggu. Brian, can we go ahead and go to that first hetero slide?

Let’s get this slide.

So we’re going to be discussing is a needle technique for Extra Point, Chonggu, which is actually just one portion of a treatment for a upper cross syndrome posture. The upper cross syndrome posture, which we’re going to be elaborating here in just a little bit can lead to a multitude of different injuries.

And today is very short presentation. We’re gonna be. We’re going to be lecturing about how to actually needle this particular point and stimulate these lower cervical area that usually has a proprioceptive deficiency from this particular posture of a Ford, had an upper cross syndrome. So let’s go ahead and I think jump right into upper cross syndrome so we can discuss that.

So this term upper cross syndrome was coined by Vladimir Yonda close to 40 years ago. He is an osteopath in specializing in rehabilitative medicine, and he coined this term basically from looking at his patients that have a very unique type of posture that we actually see in our practice. And you as well, commonly, I would say every single.

It is looking at a forward head posture of a plumb line, increased thoracic kyphosis. So you can see that upper back really starting to curve without forward head. That’s going to lead to a number of different postural imbalances and agonist antagonist. So Bladimir, Yonda when he saw this, he actually coined this term is looking at it as a cross.

So you can see that the pectorals in purple here, the pectorals are going to be in a locked short position. Pulling on that humerus, making the humerus internally, rotate, collapsing the chest. Now going through that, you can see the next purple would be the neck extensors. Now those neck extensors are locked short, but they’re actually with through evolution, looking at portions of these neck, extension extensors are going to be locked short, and some of them will actually be locked long.

The longer part let’s say the lower cervical aspect of. That posture you’ll see that the neck extensors would be more in a lengthened position because of the forward head. Then the upper cervical region, the neck extensors actually be in a shortened position. So a little bit more on that with the next slide and just a little.

So that’s the purple aspect. Those are your locked short muscles. Now you’re locked long muscles will be, if you can see where the increase thoracic kyphosis would be your rhomboids, your middle trapezius, your lower trapezius, those muscles be very weak, allowing scapular, protraction, as well as that increased thoracic kyphosis.

Now, if we look on the Antar aspect of the body, you see the neck flexors. So it’s the deep neck flexors in particular that are going to be. Locked long or inhibited posture. If we look at the sternocleidomastoid, which will also be a neck flexor, that’d be more in a locked short position. So you have your general upper cross syndrome, but there’s also going to be just some variabilities within those muscle groups that will be locked long and locked.

So the point, the takeaway here is to look at as today’s presentation is that lower cervical region will be usually proprioceptive deficient in that forward head posture. It’s a lengthened area. So we’re going to use an acupuncture needle to try to reestablish some of that proprioception combined with an exercise to bring that forward, head back to neutral position.

Let’s look at a couple of models here. Let’s go to the next slide. There’ll be. So zeroing in on this upper cross syndrome or a common posture that lengthens the lower cervical region. So you can see how the head is really quite forward, but then it’s going to compress the tissues of the upper cervical region.

So if you could take two fingers and just put them right there at gallbladder 20, and once you have that, just simply start to look toward the ceiling. You might tilt the head back just a little bit. That’s called Qapital extension. So that’s different than cervical extension. Cervical extension is when you have all of the cervicals moving capital extension.

When you had your fingers there, gallbladder 20, you might have flipped those muscles. Just move just a little bit. When you’re looking up, that’s going to be looking at the upper neck extensors, especially the suboccipital triangle. And when those muscles get really quite taut that can lead to a number of different types of headaches, nerve and syndrome.

So the third occipital nerve, the greater occipital nerve, the suboccipital. Lots of different injuries that can occur from this particular posture. So you can see what the, both these models, if they got increased thoracic kyphosis, the head goes forward as a compensation for that forward head. The person’s just going to tilt their heads slightly upwards so they can see the horizon.

And that’s going to cause that capital extension and a number of different injuries. Now Brian’s going to go ahead and show a video that he did of himself to explain this a little bit more. Brian, do you want to take that away?

Yeah, sure. Videos just showing the relationship between the shoulder girdle movement, the scapular movement and the.

So there’s a ton of sinew channels that act on the position of the scapula and the movement of the scapula, not a ton, but there’s several. And we can go through them, but really, I just wanted to highlight in this video, how the spinal movement links with those scapular movements and the tie into what we’re seeing in these images here, before we go into the video, these models, as you see, have increased thoracic.

So their spine in that thoracic region and the upper, or excuse me, lower cervical region. The spine is stuck in flection. So we’re going to look at the relationship between the flection and extension components of the spine and how that relates to the scapular movement. Pretty short video. It’s an Instagram video.

It’s going to be on our Instagram channel or Instagram page. So it’s a minute long Instagram. Doesn’t give you a lot of time for these things, but it’s very brief. So let’s give it a look at. Okay there. We’re going to look at the relationship of the spine to the shoulder blade movement using this resistance band.

So as I go from protraction retraction, that movement likes to occur. As the spine comes out of flection, the cervical spine starts drying back and pact traction. That the spine will want to go into election retract. Buying comes out of flection, cervical spine throughout the back. Many people have a forward head posture.

So the spinal movements not coordinating with the entire movement of the body that sets them up for injury in the cervical spine angle, her girdle potential job problems, headaches. So they need to learn how to get rod, that surgical site back to encourage the entire.

all right. I’m gonna go back here for a second, a fun thing about filming things is you notice aspects that you wouldn’t notice otherwise. I had my mic here on the shirt. So when my head goes forward, of course, I go a little ways away from the. But I was acutely aware of how different my voice was and I was strained.

My voice became when I went into that forward head posture. So that was quite interesting, but yeah, just also noticing the the difference tension in the extensor suboccipital reason and how that sets you up for a whole host of different potential problems. But with that video you might notice the scapular movement and how much activity there, there occurs in the rhomboids lower trap.

It was mentioning those structures that are pulling the scapula back and retraction. So that can get us thinking about ways of treating this beyond just the technique we’re going to be highlighting. And I think Matt’s going to get into that on the next slide here. Okay. Okay. Thanks, Brian. That was good.

So just as an overview, what we’re looking at is just a portion of that upper cross syndrome, the increase thoracic kyphosis, which are going to, it’s going to have a lock long and weakened and. Rhomboids middle trapezius, lower trapezius. The head is going to be forward, which is going to be a lengthening of those lower cervical vertebra.

Then you have a shortening of the upper cervical tissues. So in this image, the head is neutral. Now, if we look at, if we can be able to take that head and just move it forward, we can start to see a little bit more of how. Lower cervical vertebrae going forward and how it would be great if there was a way for us to actually pull that lower segment of the cervical vertebra and all of the tissues that are highly appropriate, receptive your deep paraspinal muscles, your supraspinous ligament, your interspinous ligament, and encourage that to be able to come back while the person’s.

He is trying to strengthen the rhomboids, the lower trapezius, the middle trapezius, and add proprioception add sheet to that particular part of the. So I would say probably about 15 years ago. So I started playing around with this needle technique with the exercise and the combination is pretty profound.

And this is the reason why we wanted to share that with you today. Again, the takeaway here is this is one portion of the needle techniques or the points that we’d be using and the exercises that we’ll be using for upper cross syndrome. And Ford had an increased thoracic hypothesis, but it is a Pearl.

This is a big point. This is a great technique to be able to use. So it’s underneath the C6 vertebra. You’re inserting the needle through the skin, through the superficial fascia, the adipose tissue, and then the first tissue of resistance that you’ll feel would be the supraspinous ligament. Now, once you go through that, supraspinous ligament than the.

Long and wide interspinous ligament is going to be the next issue of resistance that you’ll feel with that acupuncture needle on most people, it’d be probably about, just about a one inch needle insertion, which is completely safe. You’re very far away from the spinal cord. Some patients when they’re laying on the table prone, it’s difficult to get to that C6 area because maybe they have a lot of tissue in the area or are just increase extension for some patients.

Some practitioners like to lower the head. To be able to open up that neck personally, as a patient. I don’t care for that very much. Having my head drop down a little bit. Doesn’t feel very good to me. Usually what I’ll do for patients is just to put a pillow underneath the chest and that’ll open up the neck.

So as a practitioner, just take your finger or two fingers and start feeling underneath that C6 vertebra separating the tissue so you can get an idea. On how to be able to put that needle up underneath the spinus process of C6 and get through those a formation, a four mentioned tissues. Once you get into that interspinous ligament, which is about, like I said, about an inch deep propagate Xi, and it may take a while actually for that patient to get to you because of the lack of appropriate.

Now, remember this is also going to be combined with other points for example, the wrong point motor point, the middle trapezius rotor point, the lower trapezius motor point you could use GB 20. There’s a number of different points that we can use depending on the patient’s case. So once you’re able to get an established Che at Extra Point Chonggu, then what we’ll do.

We’ll wrap the tissue around the needle by twisting the needle in one direction until the needle starts to get stuck. Once it’s stuck, then we’re gently going to start to pull that tissue back posterior where alongs. So we want that tissue to go back it’s lengthened because of the forward head position.

We want that tissue to go back at the same time as the. Doing an exercise, the prone and neck protraction exercise. So let’s go to the next slide there. Be

all right. So as that person is elongating that lower aspect of the cervical spine, bringing him back into extension, you’re pulling up with the needle so they can start to get an understanding of raising that lower cervical part of their body up toward the. They’re going to slowly just start to tuck their chin a little bit.

So that starts to get rid of some of that capital extension. And they set up this exercise by lowering and squeezing the scapulas together. Then engaging the middle trapezius, the rhomboids and the lower trapezius. So this is an exercise that you would do after all of the needles have been taken out with the exception of Extra Point, Chonggu.

Brian, is there anything that you wanted to add to that before we jump right into the video to show them. Yeah, you’ll you’ll see this a little bit on the video coming up that the tendency for the people who really need this technique in particular, the tendency, when people start to lift their chest by engaging the rhomboids middle lower traps they’re really tied into the idea, not even consciously, but just their body’s kind of stuck in it in a particular position to where they want to arch their neck.

And exaggerate the neck position that we’re trying to get them out of. It’s just something that’s very difficult for people who really need this technique. It’s difficult for them to find that movement where they both retract the scapula and bring the, draw the cervical spine back and lengthen that posterior portion of the cervical spine, especially the upper cervicals.

And now of course, the technique is designed to help with that, to help give them a signal and encourage them. But you have to look at the. And make sure that they’re not going further into capital extension, like trying to lift a lift up and going further into capital extension. So you have to coach them.

Now, the good news is the technique helps give a little cue and coach them at the same time, but sometimes verbally coaching is necessary. And you’ll see an example of that coming up. Yeah, that’s a really good point. A lot of people will go into that capital extension just because they’re used to doing that.

So thanks for saying that, Brian, by coaching the person, just to tuck their chin a little bit, that helps with it. Now, this technique also is useful. If you didn’t want to needle it by just pinching the tissue of Chong GU and lifting that. But it’s not as successful in my own opinion as actually using a stainless steel needle, going into the interspinous ligament propagating sheet.

To me, that’s the changing proprioception far better than just actually just lifting up that skin. Cool. All right. So let’s, and again, you’re in the blue channel, right? With the needle you’re in the do channel, you’re in the ligamentous tissue and you have a lot more sway on it. So you’re ready for the video.

Yes.

super supplies.

Squeeze caplets together, race together and relax everything. So bring these guys to be a backbone because you put this together

for me and agree this.

all right. That video is up on our YouTube channel by the way. So if I noticed the birds are a little aggressive, they’re mad in your background, they’re making some noise and it might not have heard anything. This sounds a little put out by that, but we do have that up on our YouTube channel. If you wanted to check that out sports medicine acupuncture, and you can do that.

Oh, sorry, Brian, are you finished? Can I go? Okay. This was a recording that we just did in New Jersey to finish the 2019 2022 smack program. It was three years because of the smack of sorry for him because of the COVID. So we just finished this. This was a module for neck, shoulder, and upper extremity. This is one of the techniques that we’re using now.

Remember, we’re also going to be needling the other points as well, and that helps with proprioception. So the person gets an idea on how to be able to lower and squeeze the scapulas together. So that’s great. That’s, this is a really wonderful technique to be able to use. We’re going to be teaching this class again here in San Diego and that’s coming up in June four days and that will be wrapping up completely of the 2022.

So also what we’re going to be teaching with this is a wonderful myofascial technique that Brian has introduced into the program that works extremely well for that particular posture and opens up the tissue. Great mile fast, mild fascial technique to use after all the needling. Brian do want to take it away.

Yeah, sure. So this is a seated technique. It’s a interactive between you and the patient. So first and foremost, you want the patients sitting in a position that is going to help facilitate change in the body. So you don’t want to just slouching though. I am starting a little slouch. So if you look at the picture, there’s three images, the one in the left most image once you have the person stacked on their sit bones, you’re going to take your Louis kind of knuckles.

I usually use just the flat kind of inner phalanx of two fingers. And you’re going to place that approximately I’m not being really exact on any location, really, whatever real estate you can get in that upper cervical spine. And you want to allow the patient to drop their chest and go into the Capitol extension.

Why am I doing that? I’m doing that so that the tissue shortens and I can get a good investment of the tissue. I can hook, I can engage the fascia. I can sink into the fascia and then you’re coaching the patient to start a lift. The sternum, descend the scapula by engaging the rhomboids lower. And drawing the cervical spine back.

So they’re a long gating, the the posterior part of the cervical region, especially those lower cervical structures that we’re trying to to engage. So they’re doing that while you’re descending and gliding through the tissue. So again, just initial setup, they drop the, they exaggerate the posture, so you can get a hook on the tissue.

And then as you’re drawing that tissue down, And elongating, they’re doing the movement, bringing the cervical spine back and opening the chest. So you’ll see that in the technique, these just give you the kind of rundown and the instructions for that. But let’s look at the video.

this technique is a combination between the manual work that you’re doing and also the movement of the patient. So you want to coach them with the movement, first of all, so have them drop the chest. And serve a call extension. So that’s going to be the starting position, starting them with bad posture.

And then they lift the chest and the length and the posterior cervical spine. So they start an extension with the chest dropped and then lift the sternum, like in the back of the neck, the chin comes in. Many times patients will have a difficult time doing that. When they go to lift the sternum, the loss of go more into extensions and some patients you have to coach them to the movement of this technique is really a big part of it to starting them.

And this position is it let’s come back to neutral. I’m going to gently place my fingers up towards the occiput. Just any area of the cervical spine that I have access to. I’m going to take them into the starting point. That will shorten the tissue. It allow me to get a purchase of the tissue and now it’s a pin and they start to come out of that and I’m stretching the tissue in the posterior cervical spine associated with urinary bladder.

Edgington.

and another pass maybe slightly lateral or slightly medial is again, place your fingers on the deck. Take them into the starting position. That allows me to get a hook last meeting the hold of the tissue, because it’s in a short position now, as I bring the tissue to known where they come out of that position, lifting the sternum, bringing the chin, like the need of the posterior part of the neck.

And I can take it all the way down through the upper part of the thoracic spine.

all right. So this is a supine version. I guess time to the seated extensor technique. So in this one, we had the patients who I’m limited the ability for them to be as involved in it, by dropping the chest, by lifting the head. So it takes away a little bit of the re-education aspect, but at the same time, there are next, a little bit more relaxed or they’re in a more neutral position that way.

I can still take them into capital extension with them in capital extension. I can sink into the tissue pretty close to the occiput. And as I bring the tissue down and start spreading downward, I can bring their neck back into a neutral position. So it’s a little more passive on the patient’s arm and the seated.

so it might be appropriate if there was currently neck pain, that they were having a harder time in the seated position, or if you just don’t have time to put them into a seated position or to use the time of their place,

the two movements. With the hand where you’re bringing them in to flection

lengthening the posterior part of the neck. The other one with the other hand, simultaneous where you’re spreading downward descending, the aging.

So a question about how many times, or how long would you do this technique? It’s a short technique, two passes, three passes. You don’t need to do it really more than three passes. If I were to doing multiple passes, I would probably move slightly lateral or slightly medial and cover the same region but tissue that’s slightly medial to the first pass or silent lateral to the first.

These are short techniques. There are supplement to the acupuncture. They don’t need to be something you spend a lot of time with something else, especially with the seated technique that might not be apparent is when I was following the person, as they went into a kind of exaggerated drop chest capital, a extension I’m not cramped.

I’m not digging my hand in as deep as I can. I’m really just following it’s more of a pivot point is you’re guiding them and following you’re not trying to force them into that position. So I’m not using a lot of pressure. By doing that, I get a hook on the tissue and the pressure really comes from when they start coming out of that position.

So you don’t need to use a whole, a strong ton of pressure with it. It’s a pretty gentle. There’s four, so they’ll feel it, but it’s not anything that you’re driving them in or trying to sorta mobilize the spine by doing it. So it’s more just following, Hey, Brian. I also saw that same question about the needle techniques.

So I think I’ll go ahead and address that as well. Do you want to go to the next slide? Just so people can see that information?

There we go. It’s just has our information that you do, but general, we have a lot of these videos up there. We also post them on our Instagram account and Facebook page. So all sports medicine acupuncture. If you searched for that, you’ll find it. And then our webpages there. So to address the question about how often are you using the Chung goo lifting technique?

Until the patient actually has a really good command of the movement of going into prone, neck retraction. Once they have that, then you can go ahead and stop now. So we addressed this needling technique as basically for that forward head, but you can also use. This 0.4 disc problems, cervical disc problems.

Also, if there’s going to be tenderness to just in that local area, there’s an Oscher point. You can also just go ahead and needle that without actually the lifting technique is for when you see that forward head posture. But again, this point could be used for a number of different types of local injuries.

Brian, is there anything else that you want to add before we had. Just as the bounce off what you said. Yeah. It’s used when they’re, when they have that forward head posture. It might also be used when you say use that neck extension exercise that we highlighted and the person’s really struggling and they can’t figure out how to coordinate that movement to bring that portion of the spine back.

It’s very difficult. And actually I was teaching, I teach some online Teagan classes that was covering this today because there are people that do that very thing when they go to open the chest. Arched the neck up and you try to coach them and they have a very difficult time finding that region.

So it’s appropriate aseptic technique. It gives that a pointer to this tissue bring this back, without using words, they can feel that the noodle kind of pulling that region is oh, that’s what you’re asking me to do. You’re asking me to bring that back. It’s just, it becomes very clear.

It’s like a spotlight on that region. So yeah. Just use it, use the technique, but you might use it when you’re seeing people struggle with particular instruction that.

The guys that wraps it all up. If you have any questions whatsoever for Brian or myself, or you’re interested in the program or any of our classes and information, there’s our contact information that was there in those notes. Thank you so much for attending. Really appreciate it. I remember next week also, Sam Collins is going to end up being here.

I thank you again for the American Acupuncture council. And we’ll see again next, next month. Yes. Thanks everyone. Thanks everybody.