And today I’m going to go over the definition, the etiology, and using facial motor points to treat TMJ. And then in part two, I will go over using scalp acupuncture and submuscular needling to treat TMJ.
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. I’m an acupuncture physician and I teach cosmetic and neuromuscular facial acupuncture classes internationally. I just completed my first book. It is called Treating the Face and it is a comprehensive guide. It’s a hardcover book. It’s a comprehensive guide to treating the face, both for cosmetic and neuromuscular Conditions.
I’m currently on the faculty at Yosan University on the doctoral faculty. And prior to that, I worked at, I was on faculty at the Maryland University of integrative health from 2003 until 2021.
Sorry, I having trouble getting going to the next slide. There we go. So these are the different chapters in my. book and it’s a full color book and some of the images that will be in today’s presentation are from my book. So today we’re going to talk about this is part one of a two part lecture on treating TMJ.
And today I’m going to go over the definition, the etiology, and using facial motor points to treat TMJ. And then in part two, I will go over using scalp acupuncture and submuscular needling to treat TMJ. So what is TMJ? TMJ is short for temporomandibular joint pain. It is also kind of part of TMD is another way of referring to it for temporomandibular disorders, and these are any issues that arise from any jaw pain, jaw problems that come from the muscles surrounding the jaw and can cause problems opening and closing the jaw.
And the temporomandibular joint, or TMJ. for short, is the actual hinge joint that connects the mandible to the temporal bone of the skull. So we’re going to go through, as I mentioned, the definition, and then we’re going to talk about motor points. is the temporal bone right here, and this is the mandible.
And here is the joint that we were discussing. And here’s a blow up of that. So you can see where this condyle goes into the temporal bone and there’s a disc here and there’s various nerves that are attached to it. What can happen through grinding the teeth? or injury or stress, which can cause tension.
People can develop temporomandibular joint pain or TMJ for short.
TMJ can manifest as many different things, not just in the jaw area. People can have pain behind their eyes, different issues with their eyes. They can have limited ability to open their mouth, clenching, grinding. They can have sore teeth. They can get headaches because of the location of the temporal muscle.
They can have issues with their ears, vertigo, dizziness, ear pain neck pain, and of course pain in the jaw and clicking and popping of the jaw. So as acupuncturists, we can do some local treatments with acupuncture and treat the channels that are involved. And so some local points might be stomach five, stomach six, you might treat gallbladder four, SI 19, Sangio 17, Tai Yang.
And then using some distal points, like large intestine 4, which is a command point for the face and jaw. Sand jaw 5, gallbladder 41, which are the master couple point of the young way my. And if they have constrained liver qi and they’re grinding their teeth, you could do liver three and liver four and you can combine some other points such as gallbladder 34, which can help to supplement liver three.
But one of the things that I have found in my practice to be really beneficial when treating TMJ are facial motor points. Facial motor, what facial motor points are, they are the most elect, they’re located in the muscle. They’re the most electrically excitable part of the muscle where the motor nerve bundle is attached.
And specifically, it’s the skin region where the muscle is most accessible to electrical activity. excitement at the lowest intensity. So you can actually measure them. Motor points are not trigger points, trigger points, or tender points, or ashi points, that when you press on them the person is tender.
And fortunately for us, when we’re looking at the face, many motor points are also acupuncture points. When you’re trying to figure out what motor point to use when treating the face, you have to determine what muscles are affected, and then you would look at the motor point on the face. That muscle.
When needling motor points on the face, it’s a good idea to use some ornicogel and a very thin needle. You don’t want to be using a really heavy gauge needle because stimulating the needle could possibly cause some bruising.
Here is an image I took from an old this is an old medical text and they actually outlined all the different motor points on the face and neck. This is from the late 1800s, which I thought was very interesting. Motor points have been used for quite some time. Here is a picture of a nerve and going into the muscles.
So we have the sensory nerve and then we have the motor nerve and the motor point. is, as I mentioned, the most electrically excitable part of that muscle.
There are many motor points on the face. We’re not going to talk about all of them. We’ll just be focusing on a couple, because when we’re thinking about TMJ, the muscles that are involved are going to be the masseter. and the temporalis.
So here’s the temporalis muscle as you can see, and here is the acupuncture point gallbladder A. The motor point for the temporalis is just anterior, it’s one cun anterior to gallbladder A, and you would use a perpendicular insertion. The goal is to go into the muscle, but not through the muscle. The temporalis works with the massetere.
Here’s the massetere to move the mandible up and down and by when a person has TMJ, the temporalis can get very tight and by releasing this motor point, it can relax the entire side of the head and face. and jaw.
Another muscle with motor points that we would use for TMJ is the masseter and here is an image from my book of the masseter and then the it has two motor points and one of them is small intestine, six. And the other one is just below stomach seven, it’s just inferior to stomach seven, and it is level with the earlobe, and you would needle this about a half to one soon deep, because you’re going through the flesh and the fatty area of the face right here.
And this is really wonderful for jaw pain as well. Now this is demonstration of what can happen when you needle a motor point properly. This is not the masseteer or the temporalis, but it was a good display of what happens when you needle a motor point. So, I wanted to show this. Where’s my Ah, there we go.
So this person had had Bell’s palsy and they had a lot of trouble pursing their lips and so this is actually muscle on the chin and you can see when I stimulate the needle, see if I can get that to go again, when I stimulate the needle This is in the mentalis. When I stimulate the needle, how it really jumps, it’s already moving on its own.
And then once I stimulate it, it really causes the muscle to jump.
So next time we are going to talk about other ways of treating TMJ using scalp acupuncture and submuscular needling. And I want to thank the American Acupuncture Council for this opportunity. You can go to facialacupunctureclasses. com and let’s see, I have a slide here. Sorry. You can go to facialacupunctureclasses.
com and you can learn more about some of the classes. That I teach. Thank you so much.
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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.
Hi there, my name is Michelle Grasek. I’m an acupuncturist and a marketing strategist and the host of the Acupuncture Marketing And today we’ll be talking about a new way to think about using Instagram that does not require any new content creation. It is specifically using Instagram for business to business networking so that you can build real connections with other local business owners and expand your Visibility in your community.
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And before we get started today, I’d like to thank the American Acupuncture Council for the opportunity to be here with you. All right, let’s get into the slides. Using Instagram for business to business networking. Today we are going to briefly cover why would we do this, why use this approach, why does it work, and then two specific strategies for building these relationships with other local business owners and collaborating with them.
So why would we take this approach to Instagram? I don’t know about you, but most of the people I know are generally a little burnt out by content creation for social media. As you know, content creation takes time, it takes energy and creativity. And over and over again, that kind of feels like a hamster wheel.
Yes. So if you are feeling kind of worn out by content creation, this is a great strategy. And you have probably noticed in the past year or year and a half that your engagement on your account has gone down. I know that for my own business, Instagram accounts, and for my marketing clients and students, they are reporting that their likes on their posts and their reels has gone way down and so have their views, right?
They are being exposed to way fewer new accounts and even the people who follow them on Instagram are not seeing their posts that often. Okay, so big picture, if you’re experiencing this, you are not alone. It is pretty much across the board. For example, people who were previously getting 50 to 60 likes per reel or post are now kind of struggling to get 5 to 15 likes.
So again, if this is you, you are in good company, but it can be very frustrating to spend time creating content that you feel like No one gets to see, right? Is it effective? So if you need a break from all of that, then this strategy can be a really nice choice. Business to business networking on Instagram is is both a refreshing approach to using Instagram and a refreshing approach to networking.
So why is that? So first of all, it’s a nice approach to Instagram because you can either take a break from content creation or you can scale back the volume of content that you are creating. I know that some of my marketing clients are concerned about stopping content creation altogether for Instagram or any social platform because they’re worried about getting dinged by the algorithm if they don’t create content.
publish new content. So I understand that. If that’s how you feel, it’s all good. You could think about maybe using this strategy and cutting your content creation in half. So if you usually produce two reels a week on Instagram, maybe just do one and then use the time that you would have used to create that other reel for this strategy, for networking, for building connections and collaborations.
So that’s one option. And, or, forgive me. So the other reason that this is a nice approach to using Instagram is that it does leverage all of the content that you’ve created for Instagram in the past. So you’ve probably been creating Posts and Reels for years on your account and when someone lands on your account homepage, they get a really good idea of what your business is about, who you serve, you know, what your values and priorities are, how you can help them just by scrolling through all of your recent posts and reels.
Right? They can get a really good idea of what you’re all about. And so this is really helpful for business to business networking because you are going to engage with other business owners and ask them to collaborate, and they can simply pop over to your account homepage and look through the content you’ve created, and that will give them a great idea of whether you are a good fit to collaborate with them.
Do you match their own values, ideals, and goals, etc. Right? Do they think you’d be good? Partners in this endeavor, whatever it is you’re asking them for, whether it’s an acu yoga collaboration or something totally different. Okay. And this is also a really nice way to think about networking because it’s much lower pressure than traditional networking meetings.
I do find that many, many acupuncturists Of course, not all, but many are introverts, myself included, many of my marketing clients and students are introverts. And for, for the most part, people tend to not like traditional networking meetings where you go and you don’t know anyone and you sort of stand around awkwardly with a drink waiting for someone to talk to you, or you have to insert yourself into a conversation and then introduce yourself.
So, Doing this kind of networking obviously doesn’t require any of that. It simply allows you to build relationships that are genuine at your own pace. So, this is a way to connect with people, potentially in your pajamas from your home. And it’s just much more comfortable for many people, but it’s still equally effective.
And I also like to point out that this approach to networking can be very specific. You get to choose the best business owners or influencers that you’re interested in working with because you’ve, you’ve vetted them and you think a collaboration would be beneficial to both of you. And you can spend your time and energy building a connection with them on Instagram, as opposed to when you go to a traditional networking meeting, you might meet a dozen new people and it could be very varied, right?
Like maybe an insurance salesperson or a real estate agent. And. It’s not that you would never collaborate with those people, but you sort of have to sift through the people that you think would be open to a collaboration and would be a good fit if you’re doing traditional networking, whereas This type of networking is very specific and I think everyone is very busy and if you can fit Instagram networking into your schedule whenever you have a free moment and have it build into Meaningful relationships with a few people instead of superficial relationships with a dozen.
I think most people really appreciate that. So what are these strategies that I keep talking about? It’s actually very simple. Your goal is to connect with real life local business owners. Who you think have an audience who would be a good fit to become your patients. And when I say business owners, I’m also including influencers in this.
It’s sort of interchangeable in some ways. Like some local business owners, they actually have a brick and mortar business. Others are influencers. They might sell something, but really the The main point here is they have a following that you think would be a great fit to eventually become your patients.
They, their following is your target market. Okay. And your goals here are once you’ve made a connection with them to pitch them an idea to collaborate on an event together, or it doesn’t have to be an in person event, whatever ideas you have that are mutually beneficial for the both of you. Or, You can ask someone to come into your office for treatment and do a trade for the treatment and social media exposure.
Okay, so we’ll go more into these strategies, but big picture, this is our goal. And honestly, it works very well. My marketing clients and myself for my practice, we have All countless examples of relationships that we have built with small business owners locally who we never would have met or bumped into in real life, but connected through Instagram and now have these long term, very supportive, collaborative business partnerships or relationships.
Okay, so that’s, that’s what we’re going for here. So I recommend if you don’t have anyone in mind already, and you may, someone that you follow on Instagram, you might say, gosh, I’d love to work with so and so at that yoga studio. We could host this event. It would be fabulous. That’s a great place to start.
Just think about who are the business owners that you admire. Someone where you can genuinely say, I love what you’re doing in the community and I’d love to work together. I think that we have you know, a shared vision or shared goals for our communities and I’d love to work together. If you can say that for real, then you are on the right track and this is probably a good person to try to connect with.
And of course, you also want to make sure that you are choosing people who are local because you want people who can actually come to your clinic, right? So within maybe 45 minutes of your clinic, it’s not that useful to connect with influencers or business owners who are pretty far away because you like, what are the chances that someone who’s five hours away is actually going to come see you for treatment, right?
So that’s not what we’re interested in. We want these people to have followers who are local and who are in your target market. They’d be a great fit to become your patients. Okay. So just thinking about that when you’re trying to decide who are four or five people I’d like to connect with on Instagram.
to build a collaboration. And let’s talk a little bit about influencers. I think we get a bad taste in our mouth when I talk about influencers. I’m talking about nano and micro influencers. So not people with like a million followers. Nano is up to 10, 000 followers. And micro is 10, 000 If you can believe that, they’re still considered micro if they only have 100, 000 followers.
But the idea here is that smaller local accounts, as long as they have an audience who really listens to them, takes their advice, gets good engagement on their account. That’s what you’re looking for, right? And they also are people who would be a great fit to become your patients. So if someone has 6, 000 followers, that’s great, right?
They don’t, they don’t have to have 100, 000. In fact, smaller influencers are more likely to work with you because they have that local connection. And we’ll talk about this in a moment, but I recommend doing a trade for the influencers. Sharing you and your business on their account. Okay. Instead of paying them money to do that.
And again, that’s up to you, but I think that smaller influencers are more likely to accept the gift of a treatment for a trade, than instead of being paid cash, as opposed to like larger influencers are looking for quote brand deals on something much more formal and more money. Okay, so again, you’re just thinking about who would you be proud to work with, whose account would you be proud to be represented on, and who has an audience that is a good fit as your target market.
So some ideas. Who might these people be? Okay, yoga studios are a great fit. I have done some beautiful collaborations with the owner of a low waste specialty shop near me. She only sells things that are plastic free, for example, but she is really into alternative medicine. She’s very supportive of natural health approaches.
So the more you get to know people on Instagram, the Better awareness you have of who’s a great fit to work with and collaborate with, even if they’re not health care providers, right? So don’t limit yourself to just health care providers. Photographers can be fabulous. Photography tends to do really well on Instagram, and so their followers They tend to have a lot of followers and be very engaged.
Lash specialists, artists of all kinds. At my office, we have a wonderful collaboration with a collage artist and some watercolor artists. And then of course you could think about chiropractors, therapists physical therapists, nutritionists, hair salons and estheticians, makeup artists. Those are great choices.
Med spas, they tend to do very well on Instagram. They get a lot of engagement. So try to think outside the box. Again, it’s just, who would you be proud to be associated with? Like who you’d be pleased to be featured on their account and who’s got your target market. So how do you do this? This outreach thing, it’s actually very simple.
There’s two approaches you can take and both, both work well. It sort of depends on your. Maybe your personality and your comfort level with each. So the one approach is what I consider dating before proposing to someone. So I often think of marketing this way that you give your audience the opportunity to get to know you before you say, do you want to buy my stuff?
Right? So in this case, it would look like You know, you would pick a business owner that you’d love to collaborate with, you would follow their account, you would regularly check in on their account for new posts or reels or stories, and you would like all of them and try to comment. So whenever they publish a new reel, for example, you’re liking and you’re commenting.
And I would say try to Ask questions of the business owner in your comments so that you can engage with them right away and they will start noticing if you’re doing this repeatedly. So over time you’ll become pretty familiar to them as someone who enjoys their work and engages with their account and when you’re ready, when you feel comfortable basically, you can shoot them a direct message or private message and then you can more formally introduce yourself and pitch your idea for collaboration like, Hey, my name is Michelle.
I run Ageless Acupuncture in Seneca Falls. I absolutely love what you’re doing and I was wondering if you’d be interested in collaborating. I have a couple ideas. Let me know what you think. I’m so excited to hear from you. Right? So just cheerful, positive. They’re already familiar with you. By and large, people are going to say yes.
And then you can have a conversation and see what sort of collaboration might work well for you. And we’ll talk about collaboration suggestions in just a moment. There’s a million different things you can do. It’s really, the sky’s the limit. It’s up to your creativity. Creativity with this other person.
Okay. And then the other option is just to go right in to their direct messages and introduce yourself and share your pitch. And I have seen this work as well. You know, if your idea is strong enough and beneficial enough for the other business owner, they’re probably going to be interested in answer you because Because it’s interesting, right?
Because they are willing to have a conversation about it. You know, especially if you go about it in a really nice way, where you emphasize how much you, you do enjoy their account and, and the work that they’re doing in the community. And maybe give them some extra reasons why you think working together would, would go well and benefit both of your audiences if you are just diving in with that DM and they don’t know you that well.
But again, I think either of these methods can be very successful. It’s just up to you and your personal preference, how you’d like to connect with them. Regardless of how you go about this, when you are making your pitch for collaborating, make sure you focus your collaboration request on the benefit to the business and their clients or patients and the community that you mutually serve because you’re very likely to have some overlap between the people that you serve, but just angle your collaboration idea from the perspective of all the ways it would be great for them, okay?
For example, you could mention that if you did acu yoga, you would be thrilled to share the class on your, all of your social media and in your email newsletter, so that you’d be exposing them in their business to all of your audience. Naturally, they are going to do the same for you, right? But when you are approaching them, you want to emphasize this aspect of why would this be so great for your business for this reason, or this is one reason.
So really quickly, some collaboration ideas. There’s a lot here. You can take a screenshot if you’d like. Accu Yoga is very, very common. If you wanna collaborate with a yoga studio, you could. Teach a class together, maybe at the community center. You could host a class where they teach something at your office, so you’re giving them a platform to share their expertise with your audience, and they could do the same for you.
You could host a book club together, maybe wellness books, whatever it is that fits for both of your audiences. You could host a pop up event for them or vice versa. I have seen people host weekend wellness retreats because of collaborations that started on Instagram. I mean, some of these ideas make the business owners thousands of dollars because they really get creative and passionate about it and build it out into something so much bigger than they initially imagined.
You could host a fundraiser together for a charity that you mutually support. Themed wellness nights, Valentine’s Day is coming up. It’s a really good opportunity for a themed wellness night. You could do giveaways where you collaborate across both of your Instagram accounts. You could host a networking event together for other wellness people in your area.
The list goes on.
Okay, thank you so much for being here with me today. I hope that you find this Kind of invigorating. Hopefully it is a really refreshing way to look at Instagram and networking. If you have any questions about this, these strategies or marketing in general, you’re always welcome to email me michelle or michelleGrasek.
com. I hope you’ll listen to the podcast, Acupuncture Marketing School, and check out my website for free marketing resources for acupuncturists. Before I go, one last to the American Acupuncture Council. I’m very grateful to be here with all of you today. Thank you.
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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.
Happy New Year and greetings to my friends and colleagues. This is Sam Collins, the coding and billing expert for acupuncture, the American Acupuncture Council, and more notably, you and the profession. I’m here to help you to make sure that you get information that keeps you up to date and moving and there’s nothing better to get knowing what’s going on than let’s get ready for 2025.
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So let’s go to the slides. Let’s talk about are you ready? for 2025? Are you really setting yourself up? Realize this is that first week, so everyone’s back in. Let’s get things ready. Let’s be proactive, not reactive. So the first thing I will tell you to do, you want to start thinking if you’re doing any insurance, but for that matter, even cash, we’ll get into it.
Are you prepared? For insurance, I would say prepare for understanding What’s going on for plans in 2025? Is anything changing? It’s time to go back through to see what’s new for certain plans. Now, keep in mind, if I have one person that works for a company and has insurance A, another patient that comes in from the same company with the same insurance, I don’t have to go through all of that if I do one thorough way of going through that policy on one person, so long as everyone has the same policy.
So the first thing I want to look at is, What’s going on with deductibles? Has there been any changes for 2025? Did it increase, decrease, stay the same? By example, though acupuncturists don’t directly bill Medicare, you’re involved now. The Medicare rates, of course, did make a nice increase. We’ll get into that.
But the Medicare deductible did go up 17 to 257, which means if Medicare went up, might other plans. Yeah, that’s a hit and miss, but check. One thing I’ll point out though, that a lot of times acupuncturists are not familiar with, however, is that deductibles may roll over, meaning that they will not have a new deductible at first of the year if that person saw a doctor in the last quarter, and what this means is, let’s say by example, you don’t go to the doctor at all.
You’re a patient, and in December you go to the doctor, you have a $1,000 deductible, you have to go and you meet that deductible. Then January 1st sits and you’re like, oh my God. I gotta pay the deductible again? I just they don’t punish someone in that way. Most plans will have some type of rollover for a person who’s seen the doctor within the last part of the year.
So it’s worth checking. Often that may not be the case, but it’s worth looking into. So I would check to make sure. Most importantly, We want to know deductible so we can make patients aware of what they’re going to pay. And keep in mind, we also want to check on not just deductible, but what’s happened with any coverage.
Has there been any changes to the benefits? Is the acupuncture benefits better, worse, or the same? By example, a lot of people have said, Sam, I heard that the Medicare Advantage Plans were getting rid of acupuncture. They were not. So long as the person has the standard one that has what we call gosh, I gotta think of the term, but it’s where you’re going to have just a acupuncture benefits that are there all the time.
Realize all plans under Medicare have the regular benefits, meaning, MD supervision, but for those that have routine acupuncture, it will cover for pain management. Look to see if any of that’s changed. Many of them may or may not have it, so always check. Don’t assume. Regular Medicare did not update.
You will still need for regular Medicare Part B medical supervision. Do check though, because this is something that’s occurring with some of these Medicare Advantage plans and others, is the requirements for pre authorization. Many of the Medicare Advantage plans continue to have it, but the ones under United, at least some of the plans, and others under Humana, will require pre authorization, which means they all allow you to do the first visit, but then you have to request more after that.
Not that it’s that hard, it’s all online, but it’s just something to know. You don’t want to bill out assuming it’s being paid and they later say, oh it requires pre authorization, because often they will not do a retro authorization. So do check to make sure what are the coverages, what are the changes, are the number of visits the same.
Are they combined with anything? Is there any limits? And this is something to keep in mind. The limits to acupuncture benefits under insurance are limited to what are they covering under the diagnosis they allow. By example, Cigna has probably a 500 code list of things they cover. Aetna has a list that’s about 25.
So you can see clearly one more that’s going to have a little bit more or possibly more. So know what those plans cover. Don’t assume. Some plans will cover fertility. You want to check to make sure it does it. And here’s my point. Get as much information about beforehand so we can make sure that we understand what’s going on with what are we going to bill and how we’re going to be paid.
Because one thing to look at is what’s going on for fee schedules for this year. And I want to talk about just your common CPT codes. I don’t care about things you don’t do. Most acupuncturists, of course, are going to do exam codes, E& M codes. Acupuncture, of course. And then maybe a handful of therapies.
What I care about are those codes. Here’s some really good news. The relative values For the first set of acupuncture, both manual and electrical have increased substantially. For most of you, if you’re billing the VA, this literally means you’re getting about a 20 percent increase in that allowed rate.
That’s pretty significant, which means that may roll over into other plans because plans that use Medicare, which include VA, Personal Injury Work Comp, et cetera, will be increasing. Now, the downside to this, of course, It’s not going to affect your ASH. It’s not going to affect your Optums. Now, if you’re part of ASH, certainly if you’ve been in a while and you’re a tier six, I will be looking for, have I done a protocol to ask for a raise?
That’s something to be thinking of, but do take a look and think of, wait a minute, how much it’s increased. Now be careful. Relative values tell you what to charge from one code compared to the other. So I want everyone to start a little bit differently. Literally, you’re going to see a large increase. in the first set.
If you want to get more details of that, I’m going to tell you. Come to our seminars with the American Acupuncture Council right at the end of the month. Keep you updated there. If you’re a network member with me, just get in contact with me. I’ll get you set up. But really, this is a significant difference for you, particularly when it comes to things that are related.
VA, of course, but everything else related, which is going to be and so forth, which means prepared to understand. W for this year? What type do we have in place? Make are always aware of your think of what’s the numbe ask beyond if you can hel
Make sure you get something new for the year. Now, if someone’s on an ongoing care plan, they started in December, I’m not concerned, but someone coming in new this year, always have them sign a new and updated financial agreement so there’s no surprise. That’s why we have the No Surprise Act. Make sure they’re aware of what their costs are going to be for what services are covered.
And maybe some services that are non covered. By example, on some ASH plans, they don’t cover massage, which the patient can be charged for. Therefore, we got to make sure they’re aware of it. The bottom line is, just like for you, if you go someplace, you want to know the cost, make sure your patients are aware of their cost as well.
Which means, are you doing anything financially with How do you set up properly for a cash discount? Outside of California and Minnesota you got to be very careful. They allow some big differences but for most states you can make a 5 to 15 percent so if your rates raise up that should be the same thing for cash.
But what about prepays? I do think prepays should be something that every office offers. I’m not going to say it’s absolute that every patient’s going to want one, but I’m going to tell you some patients are. And it’s a good way of creating another revenue stream because people can see it as affordable.
And remember, prepays allow you to discount more than a 5 to 15%. Now what about your assignment of benefits? Remember, patients need to sign a new assignment in the new year. They want one up to date. If you’ve not seen someone in a long time even, Make sure they’re signing a new assignment. What is the assignment?
That just tells the insurance company, pay the doctor. This is something many of you may have gotten letters asking you about that for the VA. Not a big deal. Should always be on file. I would just make it at first of the year. As patients come in, they sign a new assignment January 1. Which means we’re always offering compliance.
Our compliance when it comes to HIPAA. What have you looked there for a while? Have you seen, is my privacy notice up to date? Does it have everything that I do? Which by example, Almost everything is open. What if you say, Hey, I want to make phone calls to remind you about appointments. There’s nothing wrong with that, but in order to do because that may not be private, the patient has to give permission that, oh yes, you can call and leave a message, because that line may or may not be private.
So keep that in mind that if I’ve not done anything to update, have I looked at it? Do I have all the things in place? Do I have business associate agreements? Who am I working with, whether it’s a billing service or an electronic record company? Are they all HIPAA compliant? They should be, but make sure you’ve got things in place protecting ourselves.
Now, what about your office policies? Things that you do in the office. There’s nothing wrong with updating those. And I would say two things to look at. Do you have a no show policy? Some offices like to have those. If a person doesn’t show up, do they get charged? Outside of the VA, you may do so do keep in mind, if you have a no show fee, make sure the patients are made aware beforehand.
What about credit cards? There’s nothing wrong with obviously taking credit cards, debit cards, but can you charge extra? You can, but let’s be careful. It’s not a percentage. You could have a fee that says, if you choose to use a credit card, there’s an additional 1, 2, 5 transaction fee, depending on the amount.
Now, and what I mean by that is, you’re going to charge 5. If they’re only charging 15, that seems a little steep, but what I’m getting to is having a fee. What it has to be a separate from the charges. You can’t say the more you charge, the more of the fee, but there could just be an allowed rate.
That’s allowed so long as patients are told beforehand. Make sure, of course, too, you have consents on file. If you’ve not seen a patient in a while, if you’re seeing them from, an ongoing plan from, November, December to now, I think we’re okay, but if they’re coming in with a new care plan, they need a new consent.
Okay? Make sure also that you have the difference between covered versus non covered. Okay? The patients know what is covered, but what is not covered, I want to make sure they understand that’s going to be out of pocket. They’re going to understand that. I want to make sure if we’re doing cash or prepay, the compliance is we have things on file so that no patient comes back and says, I’m upset because I don’t feel it was fair.
Now you may think I never do insurance. I’m not worried about that. Realize. You can get complaints and other things from the board based on this if a patient makes a complaint. Put things in order. Have them to make sure all the agreements are there. And do remember, it’s always documentation, whether it’s going to be financial agreements or what you’ve done for treatment.
And again, I don’t care cash or insurance. If it is not written down, it didn’t happen. So make sure the documentation has what’s going on. A quick review of what you done. You know what a SOAP note is? The S. A review of the chief complaint. and how the patient is changing as a result of care. Is it better or worse?
In other words, it’s what they’re telling me, subjective. The objective is, what did you find? The tongue was coated. The pulse was wiry. There’s muscle spasm, loss of range of motion. And then your assessment is nothing more than your diagnosis. And then from there, your treatment. So for acupuncture, and this is the area we run into the most problems when we deal with audits.
Remember, if you have insurance through the American Acupuncture Council, you have audit protection. So if you’re audited, they’ll help defend you, but it’s hard to defend because if you don’t document what you’ve done for acupuncture, please make sure you’re documenting the time you spend face to face with the patient, as well as the points of each set.
And remember that 15 minute, or if you will, 8 minute rule that follows. If you’re doing therapies are fine. Just make sure that the therapies are documented properly. What am I doing? Where am I doing it? You can’t just check off if I did infrared heat. But tell me, oh, I did infrared heat to the lumbar spine for 15 minutes.
Again, not very complicated, if you will, but document it in a way that it can be seen when what was done. And again, if it’s timed, make sure time is there. When you’re doing an exam or E& M code, are you making sure that if you’re billing a 99203 or a 202, is that clearly the value? A 202 would mean that you spend at least 15 minutes, a 203, 30, or at least one complaint or multiple complaints with strain and sprain.
Make sure that if you’re billing a code, know why. If you’ve never attended a seminar with me, I’m going to encourage you to go, what is the requirements for E& M? I think a lot of times people really misunderstand that. And I’m going to emphasize time. Acupuncturists do spend a lot of time. Document it.
There’s a value to you. That’s getting you prepared for 2025. Document what you’ve done and ultimately the patient getting better. Your practice thrives off of people understanding and having access to you. The understanding Is this going to help? Then they come in and go, wow, that did. There’s a value to that.
Make sure people understand that. For me, the biggest difficulty for acupuncturists is getting yourself out there. Being prepared for 2025 would be, if I have back pain and I’m looking for an acupuncturist, how am I going to find you? Have you set up a network of people that refer? Does your website do it?
Does the signage in front of your office when I pass by, does it let me know what’s going on? Practices thrive based on, of course, patience. And we thrive based on you. We’re here to be your resource. The American Acupuncture Council, of course, more than the malpractice side, I deal with the network side.
We’re here to help you. One on one, a resource. By example, are you aware of what’s happened with the fee schedules? I’ve given you a little bit of that. What about new codes for phone calls and telemedicine. That’s changing for this year as well. It’s more than what we could do in this short time, but I just want to make you aware, be proactive, not reactive.
I look forward to all your success. I hope to see you all at a future seminar. Until then, my friends take care.
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So why microneedling for acne? Microneedling is something that is historically been used for cosmetic concerns and when you’re thinking about acne and acne scars microneedling, the only thing that it’s been FDA approved for is for treating acne scars.
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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My name’s Michelle Gellis, and I am an acupuncture physician. Hi, my name’s I specialize in facial and cosmetic acupuncture, and today I am going to be doing a presentation, a short presentation, which is part of a longer class that I teach on microneedling for acne and acne scars. So you can go to the first slide.
A portion of this webinar is taken from my book. Let’s see if I can get in the middle. It’s called, thank you. It’s called Treating the Face, and it is a comprehensive guide on treating the face for health professionals. Everything from cosmetic and neuromuscular acupuncture to facial cupping and gua sha.
And there is a chapter on microneedling. So many of the images today are from that. And this is just some photos from the inside of the book. So why microneedling for acne? Microneedling is something that is historically been used for cosmetic concerns and when you’re thinking about acne and acne scars microneedling, the only thing that it’s been FDA approved for is for treating acne scars.
And I’m going to explain that in a moment, but it can also help with acne itself. So what are some of the benefits for microneedling for acne and acne scars? So microneedling can help with the scar itself, it can help with the discoloration, and it can also help with the skin texture. Microneedling will break down the scar tissue.
for the acne scars and it encourages healthy skin regeneration and it helps with the hyperpigmentation, which is a darkening of the skin that can happen when you have had acne. And overall, it will improve the skin tone and the texture making the scars less noticeable. A little bit about acne and there’s different types of acne.
So here is a normal sebaceous gland and hair follicle. And what can happen is the pore of the follicle gets infected with bacteria, and if the skin is healed over it, then you have a white head. If it’s open and oxygen gets to the bacteria, then it becomes a black head. If it gets infected, then you can get this redness around the white head, and If it is inflamed and infected, then you can get a large area of redness, and this is called pustule.
There are also different types of acne scars and boxcar scars. Scars are more of a square shape, ice pick scars are round and deep, keloid scars are raised, and rolling scars are when you have scars that run into one another. What microneedling does is it controls So the little injuries that are, cause when you do microneedling, it stimulates collagen production.
stimulates the skin’s wound healing responses, activating these fibroblasts, and these fibroblasts produce collagen, elastin, and to repair the skin. Microneedling. Also creates little microchannels in the skin, so whatever products you may be using get better absorbed. Here is a picture of a cross section of skin.
Here is the and this is just the epidermis, so the outer layer of the skin. These are all the dead cells on the top. And this is called the stratum corneum, and down here at the bottom, this is the stratum basal, and these are where all the new skin cells are produced. And so when you microneedle, you are both helping the stratum corneum to be exfoliated and you’re reaching down past the keratinocytes down into the stratum basal where the new fibroblast cells create healthy collagen.
So there were many different microneedling devices. There are a dermaroller, which is a non mechanical device where you just roll these little needles on the skin. There’s also a Dermastamp which you stamp onto the skin and you can fill this with serum or different products. And these are really meant for in home use to treat the skin at home.
This is a microneedle pen and this microneedle pen has different speeds for working on different areas of the skin. And it also has different depths. These are little needle cartridges. that connect onto the pen that go into the skin and I offer a four hour training on using a microneedle pen for wrinkles, hair loss and also for acne and acne scars, so how to actually use a microneedle pen.
the pen. So here are some before and after photos of acne and acne scars. This one was microneedling and this one was just using a derma roller. So some of the contraindications are if someone has actual acne. active pustule acne, you don’t want to be microneedling over that. If there’s any sort of infection going on, you don’t want to microneedle over that.
If the person is pregnant, you don’t want to be using a microneedle pen. You could do some derma rolling, but the biggest concern is infection and introducing any sort of infection. So you would want to make You were microneedling with a derma roller or a derma stamp that your device was clean and sterile.
With a microneedle pen, the cartridges are thrown out, but since you’re going deeper, you do run more of a risk of infection. Other contraindications are keloid scars, any sort of bleeding disorder, any sort of skin condition. or if the person is using Retin A or Tretinonin this thins the skin and can be a contraindication.
Other contraindications are if the person has open wounds or cuts, any allergies to any of the ingredients in the numbing agent that you might use or the serum any sort of autoimmune disorder. And, or if they have active cancer or they’re going through radiation therapy.
Some precautions that you would use are to make sure, as I mentioned, that your tools are sterile. And you might also want to do some patch testing, especially if the person has darker skin. And you want to avoid any overly sensitive areas, especially areas where the skin is very thin, the red part of the lips.
inside the orbital rim. As I mentioned do a patch test and avoid any areas where there’s pustule apnea, rosacea, or broken skin. When you’re thinking about different types of skin that might be better suited to microneedling, you want to think about the Fitzpatrick scale. So that’s how dark someone’s skin is.
So darker skin types are more prone to Inflammation sorry, post inflammatory pigmentation. So you would want a patch test if someone has dark skin. And then you would adjust the needle depth and frequency for sensitive or any reactive skin types. So what this boils down to is really doing a thorough consultation to meet the person’s individual needs.
As far as results, typically people come once a month and results are typically seen within three to six treatments. And during the time the person is getting treated, they should avoid using any retinoids, exfoliants, whether it’s a physical exfoliant like a scrub or a chemical exfoliant like alpha or a beta hydroxy acid.
They should not have any exposure to direct sunlight for 48 hours after the treatment. When you’re doing, whether it’s microneedling or dermal rolling, you want to use some sort of a serum when you’re doing your treatment. And then post treatment you want to have something such as aloe, arnica, something that will soothe the skin.
And when you’re treating the skin during the treatment, having something with Peptides, hyaluronic acid, vitamin C, collagen, these are all good ingredients to have when you’re doing the micrometaling. So the hyaluronic acid will hydrate the skin, and it also helps post procedure. The vitamin C helps to brighten the skin, and as I mentioned, you want to avoid any kind of harsh chemicals.
So the first thing that you do is you clean the skin, and then you have to prepare the skin. That might mean putting on a numbing cream if the person wants numbing cream. And then you are going to start in the less sensitive areas. Possibly on the forehead and then work your way down work in different sections.
And this will give, so instead of trying to do the whole face at once, you work in a small area and you don’t wait for the skin to get pink before you go to the next area. Okay. You would treat the area like four times in each direction and then move on to the next area. You can always go back. It is a light to moderate pressure and really the device itself will do the work.
You don’t have to press too hard because that can cause trauma to the skin. And I’m sorry for my slide, really formatted it looks like. Some of the words got cut off.
Typically for acne scars, superficial scars will respond well to depths between 5 to 1. 0 millimeters. Deeper scars like those ice pick scars or the boxcar scars require 1. 5 to 2. 0 millimeter especially if they’re on the chest or the back. I would probably say more 1. 0 to 1. 5 and see how that works when you’re working on the face.
As far as the frequency for active acne, you are going to work every four to six weeks, very shallow depth, and again, don’t treat any active pustules or you don’t want to spread the bacteria. and you want to use an anti inflammatory serum and acne targeted serums and treatments afterwards. If it’s a scar, same thing every four to six weeks, you’re going to go a little deeper depending on how severe the scar is.
And as I mentioned, they should notice a difference within three to six weeks. months of treatment. Once the desired results are achieved, they can come in for maintenance every three to six months to maintain the skin health and they should be doing care at home with products. After the treatment, gentle cleansers, avoid sun exposure, use your serums.
They should cleanse with a mild non fragrance cleanser, and a hydrating serum. So some of the things that might occur afterwards and so redness, swelling, peeling or normal infection is very rare, but it is certainly a possibility. But typically, you get mild redness, peeling, swelling, which subside within 24 to 48 hours.
Something that’s great is if you can combine the microneedling with other therapies, either within the treatment or in the case of acupuncture, you would alternate. So what I do with my patients with acupuncture, is I will give them three weekly acupuncture treatments during the month, facial acupuncture.
Then on the fourth treatment, I will do microneedling. And so I work the microneedling in. Red light therapy can be used or LED therapy can be used, especially the blue light because that helps to kill the bacteria. of the acne and putting these things in combination can really yield the greatest benefits.
It’s very important that you document everything, keep a record of all the treatments, including the needle depth, what products were used, and the client’s symptoms. responses or reactions, and make sure to schedule the follow up so you can monitor the progress. Always use before and after photos so you can document the changes because people don’t always notice the changes.
And then by doing the patient education, you can ensure the best safest outcome for your patient. So this is my social my website is FacialAcupunctureClasses. com. I’m on Instagram and Facebook under my name Michelle Gellis and I hope to see you in class sometime.
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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.
Hi everyone, and welcome. I’m Dr. Kristal Lynn Couture, the Pelvic Accu. My passion is sharing pelvic care with acupuncturists. Around the globe really diving into the sacred medicine of the pelvis and using our unique viewpoints as acupuncturists to treat the pelvis in a holistic manner. This is why I’m so excited that my entire series on the pelvic floor,
and Women’s Health is brought to you by the AAC, the American Acupuncture Council. I just want to take a moment to thank them and share my appreciation and gratitude for the American Acupuncture Council for sponsoring yet another video. In today’s vlog, what we’re going to be chatting about is the pelvic floor and its connection to fertility.
So let’s get into it.
The table of contents for today’s workshop includes chatting about fertility in Western medicine. In order for us to have an interplay with Western medicine as Eastern practitioners, it’s super important for us to have an understanding of what’s happening physiologically in the body. And that means understanding the male and female feedback loops that occur with the body.
the reproductive hormone system. We’re also going to chat about fertility in Chinese medicine, of course. We’re going to get deep into our chat about Tian Gui today, as well as revisit Yin and Yang. We’ll have a look into the differences between Eastern and Western philosophy when it comes to looking at fertility.
within our clients. We’ll also look at the connections or potential connections between the pelvic floor and fertility. And we’ll look at a couple of studies and perhaps ask some questions that could infuse energy into future studies. And then finally, we’ll chat about how to provide support to your clients that are coming in now with potential pelvic floor and fertility issues.
So here we go. Let’s begin with fertility in Western medicine. As I mentioned, in Western medicine, we’re really dealing with the hormone reproductive physiology, which is really determined by the hypothalamic pituitary gonadular axis and the reproductive hormones, of course. There are both positive and negative feedback loops in females and in males.
The stages of conception include the healthy sperm production, high quality egg production, and high quantity egg production, successful transport during ovulation of the egg to the fallopian tubes, transportation of the sperm to the fallopian tubes, and then of course the sperm penetration of the egg, which would yield fertilization, and then finally that implantation of the fertilized egg.
into the thickened uterine lining. Okay. So let’s begin with these feedback loops. They might be a little confusing when we first have a look at them, but the key is to remember that whether a female or a male body, we are looking at this relationship and interplay between positive negati positive feedback loops, which encourage stimulation, and then negative feedback loops, which are the inhibition.
So let’s get our bearings around us. First off, GnRH is gonadotropin releasing hormone. This is released by the hypothalamus to stimulate the anterior pituitary gland. So you’ll see in green on your screen, the hypothalamus followed by the anterior pituitary gland. What happens here? in the first phase is that the pituitary hormone, inter pituitary is going to release luteinizing hormone and follicle stimulating hormone to stimulate spermatogenesis and testosterone secretion by the testes.
Great. Everything is in balance, right? But the body has a natural system. The body is always seeking homeostasis. And this is actually something I learned in school in Western medicine before I learned it in Eastern medicine. The body always wants balance, right? If your ankle is off on one side, your hip eventually is going to go off or your knee in the opposite side, because the body is seeking homeostasis.
Balance. The same is true of hormones. So the body in males has a natural negative feedback loop which halts the overproduction of testosterone and the overstimulation of spermatogenesis. So in this negative feedback loop, what we can see, so that’s marked by the red on the side of your screen, is that we have inhibin and we have testosterone, which are going to inhibit the secretion of GNRH to hypothalamus.
And then the, that will then, of course, inhibit LH and FSH by the pituitary gland. We also do have a little micro, feedback loop, which is that the Leydig cells will also stimulate spermatogenesis within the testes. So this is the basis of what the male feedback loop looks like in relation to hormones.
And we’re really looking here at a quantity game. We’re looking at the perfect quantity and that’s why we’ve got positive in the negative feedback loop. In females, the feedback loop looks similar, but it is slightly more complicated in that we’re not just looking at a perfect quantity, we’re also looking at the cyclical nature and that’s based on what the uterus is doing, right?
So again we have our hypothalamus, we have gonadotropin releasing hormone Then we have the anterior pituitary and then of course in this case we have the ovaries and the follicles and the uterus and endometrium. All are part of this hormone feedback loop, right? The endocrine system. The pituitary, the Gland is going to release LH and FSH, so luteinizing hormone and follicle stimulating hormone, to stimulate several follicles to grow during that follicular phase, right?
Pretty, it’s named pretty aptly actually. So luteinizing hormone, follicle stimulating hormone, several follicles begin to develop within the ovaries. Check. That’s our positive feedback loop in this phase. of the menstrual cycle. The negative feedback loop in this phase is that the dominant follicle is going to begin to produce estradiol, which is the most common type of estrogen in the body.
This can inhibit the GnRH, FSH, and LH production and this is going to cause the endometrium to begin to thicken. So we can start to see how this process is very unique and Very complex interplay of hormones. A lot of things can go awry here. In our next phase, we have ovulation. During the ovulation phase, we’re going to see that we have two positive feedback loops.
Same system is set up, and and in this phase, what happens is that luteinizing hormone and follicle stimulating hormone actually just stimulate that one follicle That is primary to mature. On the other side of the equation, we have the growing follicle continuing to produce that estradiol. And at this phase it begins to stimulate the G-N-R-H-F-S-H and LH production, and then the LH will serve to promote the.
to trigger the ovulation, right? So we can see that this is an overall negative feedback loop becomes a positive feedback loop. In phase three, we’re going back to a positive feedback loop and a negative feedback loop. So luteinizing hormone in this phase is going to stimulate the formation of a corpus luteum from the follicular tissue that is left behind after ovulation.
Okay, so that occurs within the ovaries. The corpus luteum is going to secrete progesterone, so now we have another hormone in play, and we see, if we look at my last presentation, or any of the hormone graphs that are out there, we can see that progesterone peaks at this time in the cycle, right?
When we have progesterone peaking, this is going to then inhibit GNRH, it’s going to inhibit follicle stimulating hormone and luteinizing hormone production. This maintains the endometrium. As the corpus luteum degrades and progesterone declines, this initiates the sloughing of the stratum functionalis.
So we have a basic understanding of these feedback loops. The key that I want you to remember here, even if you don’t have a total understanding of it or can’t remember it throughout the entirety of the cycle, is that This interplay can easily be jostled, right? We can impact the hormones in the body, we know, by stress, by lack of activity, by lack of proper nutrition, right?
So there are so many factors that can impact any of the phases of the body. this cycle and these feedback loops. Excuse me. Sorry about that. So that’s the key and that’s where Chinese medicine comes in to really have an impact because we come in with our needles and they’re like in our herbs and they’re like little lasers to target the exact parts of the body that need extra support.
So let’s just look for one sec at ovulation to implantation, and we can really see in this image, if we look at the ovary and then into the uterus, we can actually really see that this is about an eight to nine day process from the oocyte being produced to fertilization occurring and then migrating through the phases of cell development.
So we go from that first cleavage to the two cell stage, four cell stage, and we develop over time into the eight cell stage. And then we start to see the formation. of the inner cell mass, and we start to see how that blastocyte is immigrated into the wall of the uterus, right? And that, of course, is the implantation.
So again, this is another complex part of what’s happening in the total picture for female fertility. Now, if we have a look at Chinese medicine we’re looking through a whole different lens here, a whole different world. And perhaps the two uniting is the key to creating successful fertility in women and in men.
Ching Hsu, who’s a gynecologist during the Qing Dynasty, emphasized the unique difference between the blood And the menstrual blood. Blood is traditionally known to Ho House the Hun, and to nourish, of course, the tendons, the sinew, the skin, the eyes, and the hair, the Ian Gu or Heavenly Water. is considered to be the menstrual blood, which is derived from the kidney water and the female hormones of estrogen and progesterone.
The liver is the link between the two. Thus, the tonification of the kidneys is what is one of the most important things to consider when we’re working with fertility in Chinese medicine. Now I made a little bit of a graph here to help explain what we have going on. So if we look at this graph, we can see that we have kidney water and the impact of minister fire activates kidney water to become tian gui.
And then we have the link between tian gui and blood with the liver as the communicator between the two and the connection between the two. So let’s talk about minister fire first. Prenatal fire formed at conception on the du and the ren access. So minister fire actually exists before menstruation commences.
Some texts say that it is the kidney yang that turns the tian gui red. It’s just something to play with there. At 14, the ren opens and the chang flourishes, and this is what matures that tian gui. So the minister fire also serves to worm the uterus and balance the yin. which yields potentially conception.
It’s a pretty exciting process when we really look at it from this viewpoint, right? The Ming Men is the root of the Yuan Qi and the residence of both water and fire. The Yin of the five Zhang cannot nourish without it, and their Yang cannot develop without it. Without it. So what we’re saying here is we have this interplay.
Once again, I’m using that term. We have an interplay of water and fire where fire is not trying to overcome water and water is not Extinguishing the fire. And this is really existing within that role of the kidneys. So our system from Chinese medicine and Western medicine, we see some harmonization here, and we also see different and unique viewpoints.
And these different and unique viewpoints play to the physiology and the energy or the nature of the system. And that’s important to consider as we move forth with our chat here. So in my last presentation on menstruation, I shared this slide of yin and yang, and I’m going to share it again here so that we can remind ourselves of how important the yin and yang water and fire balance is within the body as we look at fertility.
So during the menstrual cycle phase, we have yang at its peak and yin at its minimum, then yang and yin cross, they intersect and the follicular phase begins where yin becomes yin becomes prominent Yang starts to become less prominent. And here we have the ovulation phase when each of these is at its maximum.
Then the yin becomes yang, right? And we start to see again, cross or intersect during the luteal phase. The yang begins to rise and the yin begins to fall. When we look at this and blow this up, blow up menstruation, we have During the menstrual phase, we have menstruation. The yang is going to peak and then drop in the qi and blood are going to be moving downward.
We know that, right? Because we have the discharge of menstrual blood or tian guai. The heart is going to be the one who is discharging During this phase, the invigoration of blood is going to be important to move all of the Tiangui out of the system. Next we have the follicular phase. During the follicular phase, the yin and blood in the system, are relatively empty.
Yin grows and crosses yang. And in this phase, the kidney tonification and blood nourishment is really important since we know that we’ve got this emptiness within the system, right? Building back, right? This is a constant Building and releasing. Building and releasing. We have, and there’s two builds and releases.
There’s the release of blood or Tian Gui, and there’s the release of the ovum, Yang and Yin, right? So the, these are really cool to play with this interplay with. So in ovulation, the Chong and the Ren and the Du are going to be fully activated. They’re going to be online. The Yin is going to be at its maximum.
The Qi and the blood are moving upward. In this phase, tifying the spleen to hold the blood is important when we’re thinking about fertility and also strengthening the Chung in the run. Now in the luteal phase, the yang is ra rising relatively rapidly and it’s warming the uterus needs to warm the uterus to prepare for that implantation.
Of the egg, of the follicle, right? The qi moves during this phase, so it’s important to both invigorate qi and blood. Now, what are the differences between western medicine viewpoints and Chinese medicine viewpoints when we’re talking specifically about fertility? In western medicine, we are looking at that endocrine function.
We are looking at the Hypothalamus, GNRH, and those feedback loops into the anterior pituitary and then those feedback loops to the reproductive organs. We’re looking at hormone balance. We are looking, hopefully, at organ function. And then we are looking predominantly at egg function. Quantity and sperm quantity and many of the interventions that western medical fertility doctors provide are to specifically increase quantity of egg and quantity of sperm.
This is a mechanical approach and it is a numbers game. If you’ve worked with clients for fertility, you are commonly seeing labs being run and they’ll look at the numbers being measured. A huge part of this. In Eastern medicine, we have a different viewpoint. We are looking at patterns. We’re looking at that yin and yang balance.
We’re looking at excess and deficiency. We’re looking at heat and cold. We’re looking at interior and exterior factors, right? We’re also looking at system function within the collaboration of the elements and the meridians. Then finally, we start to look at the systems in more specific ways. So we’re looking at the kidney water, the tian gui.
We’re looking at the liver blood. We’re looking through a cumulative and holistic lens. At the whole body and the patterns of the whole body, the entire symptom profile, the entire presentation of the client on the level of body, mind, spirit, and emotions is part of what we’re looking at when we’re trying to establish fertility.
We’re looking at the quality of the foods and the quality of the prenatal gene. So there are some significant differences here. Again, when the two are combined, is the collaboration going to be a unique solution to creating fertility in our modern world? And I think there’s a lot to be said for that. I think that collaboration is the key.
If, and here’s the if we don’t start talking to and educating our clients and our children as a collaborative, not just as acupuncturists, as a collaborative sooner about how they’re taking care of their bodies, what’s happening in their bodies, helping them to understand their own menstrual cycle and their own fertility.
If we are building health before the age of 14, before menstruation even arrives, before the maturation of sperm arrives, then isn’t fertility going to be easier in the first place? I don’t know, just a thought I have. Okay, so our unique perspective in Chinese medicine. The TCM approach to infertility treatment integrates the menstrual cycle as a simple, non invasive, sensitive, motivational, diagnostic tool to understanding a woman’s fertility status.
So that’s the nature that I talk about. It’s the nature of the body is what guides us to determine fertility, which is really about overall health in the system. Let’s chat here about the pelvic floor and fertility. While the pelvic floor And there’s a few studies that indicate this. While the pelvic floor is not likely a cause of infertility, there are seriously a few factors to consider.
One is that if there is pain in the pelvis and tension in the pelvis, One may be less willing to engage in sexual intercourse because of that pain and dysfunction. That pain or dysfunction may put them into strange body positions throughout the day, throughout, their life, but also throughout intercourse.
So again, that can really limit sexual intercourse. the ability for the body to conceive. If there’s pelvic floor dysfunction and dysfunction, I left it broad here because we could think about pelvic floor dysfunction as incontinence for example of bowel or bladder. If someone is experiencing incontinence, it’s going to be very difficult for them to be comfortable with engagement in intercourse, which can make it very difficult to conceive, right?
So there’s an indirect implication of how the pelvic floor can impact fertility here. But now we get a little bit deeper. If there’s congestion or there’s emptiness within the pelvic bowl, I think that can directly impact. Conception, right? There’s blood, which could be stagnation. It could be that the blood is not holding.
It could be that the blood has no motility. If the blood is, if the tiangui, or the blood itself, has stagnation, it’s not holding, or there’s no motility, I think it’s going to be very difficult for one to conceive. If there’s dampness or dryness, again, those fluids are not moving the way that they need to.
And if the fluids are not of high quality and they’re not moving the way that they need to then that can create potentially a block with pelvic floor which can impact fertility. There can be some physiological blocks as well such as accumulations like fibroids, endometriosis, we can have prolapses, there can be Altered spinal segment positioning, or SI joint positioning, and certainly these physiological blocks can also prevent one from being comfortable in the phase of connecting to themselves, connecting to what’s happening in their body, and being open to conception.
When we are in pain, and maybe this is a great research study, I hadn’t thought about that until now. When we are in pain. We are releasing different hormones, right? We are releasing a different set of hormones. So does the body have enough energy to then be at peak while it’s releasing peak reproductive hormone release while it’s working through the release of substance P?
I don’t know. That’s a good one. Injuries to the pelvic bowl are going to be another region. If there’s a trauma, if someone had a fracture, a ski accident, something like that car accident that impacted the pelvis in some way, or the sacrum in some way, that can definitely be a factor that’s going to at least contribute to fertility.
And then of course, energetic blocks. I think energetic blocks are definitely a contribution to fertility and many of those exist within the pelvic floor because the pelvic floor has many sinew connections. It has all of the meridians, most of the meridians running through it. The conception vessel and the governing vessel, which if the CVGV is blocked in general, I think it’s very hard to achieve conception through that state.
And I’ve really found that in my practice. And then finally, the spirit or the emotions. The pelvis is the root of the body. If the root of the body is holding emotions of trauma again, do we have enough energy to then conceive within the body? What does it take? So there’s a couple of studies out there that are sorting, starting to touch upon a connection directly between the pelvic floor, and fertility.
So in this study in BMC Women’s Health in 2024, this is like one of my favorite studies because it’s the first one that really starts to investigate this relationship. So this study for the first time investigates the causal relationship between reproductive factors and pelvic floor dysfunction.
The results suggested a causal relationship between some reproductive factors, but there were significant differences between female genital prolapse and stress urinary incontinence. So we’re starting to see that these physiological factors are impacting reproduction. In another study in alternative therapy health medicine in 2015, there were 13 192 female participants treated in a clinic between 2002 and 2011.
So this was almost a 10 year study, which is pretty amazing. And they had various diagnoses of infertility, including blockages of occluded fallopian tubes, hormone dysfunction, endometriosis. And some of the women were actually going to the hospital. through IVF. So the study was not specific. It was very general.
So we have to keep that in mind as we look at the results. In the intervention in this case, the clients underwent whole body patient centered treatments using protocols of manual PT which focused on restoring the Mobility and motility of the structures that affect the reproductive system. So specifically they worked on those concomitant tissues around the pelvis including, the back, the gluteals, the abdomen, etc.
The manual therapy represented an effective, conservative treatment for women diagnosed as infertile due to mechanical causes, independent of specific etiology. This is another big, important study. Basically, it’s saying that with a very minimally invasive approach, utilizing manual therapy, and no other interventions, utilizing manual therapy, we can impact what’s happening in the structure of the body, which can positively impact fertility.
So that’s an important correlation to consider. But is there some missing data? And I think there is. Unfortunately, there are really no data. Just few studies that link the pelvic floor to fertility, and until this one in 2024, there were almost none that were done on fertility as a whole. Some on interventions, specifically like PT or exercise or acupuncture, but none in direct connection between what is that correlation of pelvic floor dysfunction and fertility or infertility, right?
I think there are some questions. What types of pelvic floor dysfunction are correlated with infertility? What percentage of both males and females with pelvic floor dysfunction are also struggling with their fertility? Does a weak pelvic floor contribute to miscarriage? Likewise, does a tight pelvic floor contribute to miscarriage?
So is pelvic floor muscular dysfunction going to be contributing to one’s ability to hold conception? And are there specific gestational stages during miscarriage that are more likely to be associated with pelvic floor issues? I think these are important parts when we look at fertility and the pelvic floor as a whole.
So what can we do? Here are some pillars of pelvic patency, keeping the pelvic floor in an optimal state of nourishment and function. One is client education, and that is all encompassing. That can include helping the client to understand their body, to understand a little bit about what’s happening to their body.
During the phases of menstruation to help male clients understand what is happening physiologically during ejaculation, educating our clients on conception is really important. This is something that is missing in their childhood, but if they’re coming to see us in their fertile ages and they’re trying to conceive, this is the first line that we can start with is education.
We can also begin to educate them on patterns that we see within their body. If they are drinking smoothies and eating salads every day and they have a cold and damp uterus that’s a contributing factor, right? We understand those patterns. So helping the client to understand the patterns that are going on in their body and alter their nutrition or other factors, lifestyle factors, to help their body, give their body the optimal chance of success.
For healing, that’s a great way to start. Can also begin to educate our clients on posture as well. If we’re talking about mechanical issues within the pelvis that lead to pelvic floor dysfunction, educating clients on posture. And this could be as simple as if they have a desk job that every 20 minutes they stand up Do a little stretch and then sit back down right so that they can be in a place where their spine load is changed and they’re not stuck in a sitting position.
That anterior posterior tilt of the pelvis that they’re stuck sitting in is going to contribute to what’s happening within the pelvic bowl. Breathing. Breathing is so important. Encouraging our clients to get into the diaphragm with their breath, to take intentional breathing, to take intentional breaths is super duper important for the vagus nerve.
And the vagus nerve has fibers that go all the way down. to the pelvic floor. So it’s really important to work in breathing. And the pelvic breath is specific to recognizing that so often when our clients are experiencing leakage in particular, generally speaking, this is true as well. But if we think about leakage as our example, If they’re having leakage, very often it’s on the exhale.
So they are sneezing, coughing, or laughing, and then that produces leakage. Those are in exhale, right? So the pelvic floor is actually functioning in that state, in the reverse pattern of what we want. On the exhale, we want the abdomen, we know this if we’re yogis or therapists in general, we want the abdomen to be coming in.
We also want the pelvic floor to be coming in and out on the exhale. That’s the excretion of air. That’s sending the air into the world, right? That’s the excretion. On the inhale, we want to fill and we want to relax the abdomen. We want to relax the pelvic floor. So encouraging our clients to understand the pelvic breath is very important.
Finally, movement. Movement of qi and blood is particularly important to the health of the pelvis, right? Staying out of phases of stagnation is key and also encouraging our clients to move according to their cycles is really important. At the beginning of one cycle during, the menstrual bleeding phase, the tian gui release phase, it’s important to consider that clients might be a little bit more tired.
They’re not going to be at their peak of exercise during ovulation. They might feel great. They might feel like they can handle more exercise, more weight in the gym, a longer endurance activity, whatever it might be. And that’s okay. And it’s important for them to understand that their body feels different throughout these phases.
And that’s okay. as long as they find some way to move their body. Acupuncture. We are master technicians at working through patterns and helping to resolve the pain. imbalances. So acupuncture can really support our clients in treating those sinews, in opening blocks, and in nourishing the reproductive system in the exact way that it needs based on that presentation.
And of course, dissolving Accumulations is key too. And finally, if you’re into manual therapy, which I am, I love manual therapy. It’s a big part of my practice. Utilizing that manual therapy to help restore balance and establish embodiment. And this, if you’re not trained in pelvic floor work, it doesn’t have to be specific to the pelvic floor.
It can be within those concomitant structures. Don’t downplay working on the abdomen, working on the back, working on the butt, working on the anterior hips. in order to support our clients going through fertility.
Okay, so here’s a little bit about my series with the AAC, the American Acupuncture Council. If you’ve seen me before, you’ve probably seen my pelvic floor intro, as well as my pelvic floor and menstruation workshop coming up soon. We have a workshop on pregnancy. on postpartum and on menopause all in relation to the pelvic floor.
Again, I want to thank you for being with me today and I want to thank the AAC, the American Acupuncture Council, for hosting me through this series and sharing these blogs so that acupuncturists around the globe can get into the sacred medicine of the pelvis. Thank you so much for being with me and I really look forward To seeing you soon, take care.
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