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Why PI? Worth It or Not – Michael Coates

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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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Hi, I’m Michael Coates of Personal Injury Made Easy, and I’d like to thank the American Acupuncture Council for allowing me the honor of presenting to you on personal injury So this is part of a series on personal injury, but today’s topic, we’re gonna talk about why PI. We’re gonna talk about the pros and the cons, what providers that do really well in this kinda what, how they’re shaped, and other ones that don’t do so well, and we’ll also talk about some common myths.

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So the first thing I wanna hit to, into is about why personal injury, ’cause whether you should be in this or not, and I know that a lot of you have either experienced it in the past, and you may have had a very bad experience and a bad taste in your mouth, maybe from a law firm you dealt with or a particular patient.

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And I wanna try to have you rethink and have a new perspective. You also may be someone who has maybe dabbled in personal injury, just not done a lot. Maybe you’re a little frustrated, you feel overwhelmed or it’s out of your normal skill set. And the last would be the griddles, the grizzled veterans, those who have really have a, a solid personal injury segment, but I wanna make you better.

So let’s first talk about why PI or why to expand personal injury. So the first thing about personal injury that I think is maybe the best for the chiropractic and also the acupuncture base, and even for physical therapy, as I call them, the CAP providers, is about that you can bill your full out-of-network rates.

So when you think about a business and a practice, you also wanna think about your patient mix. Not all patients are profitable. Sometimes it takes a lot more patients to make the same amount of money as it does on a single patient, and that’s one of the beauties of personal injury, is that one PI patient, when you’re paid your 100% of your full out-of-network rates, can make up for a handful of in-network pers- or in-network patients, and also for a number of cash patients.

So that’s the first major benefit. The second one, which I find very valuable for your segment, is because it, you can bill for things that insurance would deny. So when health insurance wants to deny for laser procedures or the things that you really believe are medically necessary, are gonna help your patient, PI allows you to bill for it, and you’re gonna get paid for it, and that’s really significant.

The next area I would say is like what Warren Buffett said on investing. He always said, “Invest your money and your time and your resources by following the money.” So where is the money going in healthcare? It certainly isn’t going to normal healthcare reimbursements because healthcare reimbursements in the insurance industry have been cut in half, and a lot of medical costs have doubled.

But the one area you’re gonna find that there’s more investment in is personal injury. All you’ve gotta look is at the minimal auto policy benefits and the minimum insurance coverage in whatever state you’re in, and most of your states have had an increase or will be having an increase. So California, for example, went from 15,000 per each patient walking in the door to 30,000 behind them So that means it doubled, and a lot of states have gone way up.

So more money is being invested into personal injury to pay, of course, obviously it’s gotta pay the attorney, it’s gotta pay all of you, and it’s gotta pay the patient. But that’s a real benefit. But there’s more than just money when I say benefits or profits. So here are some other ones that I think are really fantastic for personal injury.

One is you’ve got no financial paperwork you really have to get on your patient because it’s the personal injury matter that would be satisfying your bill. So you’re really not having to chase patients. Now, sometimes you do, sometimes that occurs, but the primary aspect of PI is you’ve got an attorney who generally has a fiduciary duty to watch your financial back when they receive monies.

Even if their own client says, “Send me the doctor’s money,” wink, “I’ll pay him,” they’re not supposed to. In fact, if they do, it could be a violation of state ethics laws and other problems they’ve gotten into. So you have to hold it for you. So that’s a real benefit when you don’t have to chase patients and someone’s protecting your financial interest.

Also, it’s a great gateway to new patients. A lot of people have never heard of the magic of what you do. You know how good it is, but they’ve never experienced your medical specialty ever before. But you have the opportunity now here to wow them on how good it is, what you do, and what your profession is.

You get to educate that patient on the value, not just for them seeing you for PI, but for all the things you do. So that turns PI also into a great feeder to all of your practice segments. So that’s why I say when you’re growing a P- a PI practice, it’s not just growing personal- a personal injury segment, it’s using PI to grow all of your practice segments, and I think that’s a huge advantage.

So another really great advantage is medical, the medical lien area is a very collaborative one. So it’s not just you. There’s usually a healthcare team that is treating your patient. Now, usually because, let’s say you’re the chiropractor, you are the quarterback generally of that team. It is the only industry in this entire country where chiropractic is the number one lead medical specialty, just that one.

And for say for those in acupuncture, you’ve never even had that usually before, so it gives this whole new area to get into. But on chiropractic, being that healthcare team quarterback, you’re the one really guiding the referrals, and when you’re referring out or someone’s referring patients to you, it needs to be someone on lien, or if you’re in a letter of protection state, that will take it on LOP.

So that’s an advantage. In fact think of it this way. Every time you may have gotten a settlement notice from a law firm, and you’ve asked them to lay out all the settlement amounts, the attorney fees, costs, and all the lien holders, and the amount to their client that’s going, so you can make an evaluation of how much you should get paid, guess what you should be looking at?

the listing of all those medical lien holders. ‘Cause when you do, you now know in your community who is taking it on lien. It’s a great one to reach out to, to say, “Hey, let’s look about maybe collaborating.” But you’ve got to vet them first. Of course, you want really competent, good providers as part of your lien network, and you want to have that in the can, so when you do have to refer out to specialists, they’re there.

But what I’m getting to is that there’s a lot of peers that maybe doubt the efficacy of what you do, and they shouldn’t. It’s because just a lack of knowledge. So when you engage in the lien area, you have a chance to educate them also on how get it– good it is of what you do and how you do it, and you have someone else telling them, your patient Also their patient.

So that’s a great extra advantage. So there’s so many things that I think that are so pro– good about YPI, they outweigh the benefits. If we looked– outweigh the negatives. If we looked at the negatives, some of that’s gonna be obviously you have to wait to be paid, right? And it could be either months, it could be years.

Then again, going back to a positive, there is the fast cash options in personal injury. That would be MedPay, which most policies have, unless you’re in a no-fault state. For those states, you’ve got PIP, personal injury protection. Now, those are both auto policy benefits. They’re given for prompt care, they get prompt payment.

Now, attorneys do tricks and stuff, and we’ll talk about that later in the series. But in the end, it’s something really important to realize you can get paid on a monthly basis for you as a reha- rehabilitation professional, and that’s fantastic. You don’t have to wait. So you’ve got to learn how to identify when it exists.

You have to learn how to properly submit, and you have to learn when attorneys try to hijack it or maybe take fees out of it, how to address that so that doesn’t occur. So that’s fantastic, even though to offset the downer that I had. Now, of course, you are gonna be dealing also in an area that you get pushback.

Now, you don’t get people in insurance that are trying to sometimes degrade you or degrade what you do. It’s just the way that insurance tries to delay, deny, devalue, and defend. That’s what the attorneys do too, but they do it a lot more aggressively and forcefully. Why? They’re warriors.

They’re advocates. This is what they do for a living. Not just the attorneys, but a lot of the law firm staff. Back when I was first a defense attorney in my earlier years of course, everybody in law firms, whether on my side or the plaintiff side, all had law clerks and paralegals, so trained in the law.

They understood the law. That’s not today’s environment. All are– they are as a lien specialist is someone that follows a protocol the law firm sets, and they generally try to pay you less. But there are easy ways to work around that. You just have to learn. So that, again, is the beauty of this. And I think that personal injury’s just gotten this bad rap from prior bad taste in the mouth, like bad medicine going down, and it’s just from a lack of knowledge A lack of skill development and a lack of support for you.

Now, the great thing is all of you, you’ve got me to support you on whatever it is that you’re doing. So a little bit about me. I speak, teach, and coach around the country. I help providers in every state. All the state laws are generally unique in PI. I deal with really all medical specialties. And in the end, it’s trying to right the ship.

I think that medical providers have been used and abused, where first the attorneys are looking for themselves. They then try to make their clients happy enough so they will refer them or be happy and not slam them on Yelp. And so unfortunately, a lot of times they try to make the burden fall on you, the medical provider.

But that’s why I’m here, to help guide you along. And part of that guiding is this. When I say what is it that makes a good provider and a, maybe one who struggles more in this, and that’s learning how to be a value driver. What do I mean by a value driver? You al- are always to remain neutral as to the outcome of a PI case.

You’re there for the healthcare of your patient, and you’ve gotta stay in your lane. However, when you learn how to do personal injury right, you become a value driver to your patient, to your peers that you may be referring to or referring to you, and also to the law firms. That includes what are the things that could harm a PI case?

What are the things that when you put them in your documentation, it helps, as I call it, and we’ll talk again more later in the series, storytelling documentation, focusing on the ADLs, the DUDs, and the loss of earning. The other thing that, that’s so key when I talk about what works really great is when you can get across that value to an attorney early on in a case.

One of the biggest areas of tax that the law firms have to deal with for you, aside from poor documentation, and that is rampant in this area, I’m gonna make you better in this series. But one of the areas is of attack that the adjusters always do to the attorney, and it rolls downhill, is that you overtreat and overbill.

Now, usually you don’t hear about that till the case is already over. So a lot of times it’s a red flag. It’s not really the truth. But imagine this, if you could help the attorney support your fees and your billing before, when you’re first treating a patient, so that when they’re dealing with the adjuster, they cannot allow the adjuster to drop your bills, your fees, and lower them.

Because what does that do? That increases the value of every case. Because one of the, the tricks when I was, of course, being an insurance defense attorney is lower the value of the bills, lowers the settlement offer that we’ve gotta deal back and forth with them, and we save money, right? By you being, making yours more solid, you’re taking that kind of trick away, and it’s fantastic.

So that increases settlement value, and that’s just you holding firm to solid fees, but you gotta learn how to do that. And I do find there are providers that don’t do this area right, and they do improperly set fees too high. They have something different for personal injury versus other things. And in the end, realize you’ve got one fee schedule across, right?

We’ll talk about that more in process of the next one, but it’s really important to understand it. Okay, the, the other side of the coin is when you have proven the value, shown the value, they’ve gotten better results, obviously it makes it easier to get paid, right? From the good firms Even when you’ve got the good ones, I think you’ve got to realize that personal injury is an industry of pushback.

Insurance pushes back a little bit like, “Where’s the paperwork? You didn’t have the right code.” But in personal injury, the pushback is gonna be our client said they didn’t show these days or they didn’t get these treatments or you billed too high or your per office visit is way too high you’re way past Medicare, all these things they try to throw at you.

So in the end, what you want to realize is that those are tricks and traps and you got to learn how to spot them and then to address them. So those that learn how to do it well do really well. Those who don’t know what they’re doing get so overwhelmed and being the healer mindset that you have, you generally give in and I find it disappointing that a lot of you in your profession are so happy when you get paid half your bill.

Why is that? Are you not worth what you bill? If you are, I believe that in the cap side, chiropractors, acupuncture, and even physical therapy, that you should be getting paid 100% of your bill 80% of the time, or if you did a blended rate, because not all are winners, it’s at 80% for your medical specialty. So use that as a barometer, and there are– And it’s being done all the time.

So when the four-minute mile was broken, everybody else could do it. That’s what I’ve been doing in helping people in personal injury for medical providers. At the same time, they get more patients. So the other thing, our, maybe let’s address a few common myths. So some common myths out there in personal injury that I want to hit today are that MedPay is okay to be held by the attorney, and that’s not correct.

MedPay, as I was saying, has been for prompt payment. And what– The same thing is happening with PIP, by the way, which is less but still happening far too often than as what I see around the country. So when you get that, you have to first be able to identify it, and you want to make sure to make the proper professional pushback demands of attorneys to get paid back.

And remember I talked about an industry of professional pushback? They are being pushed back on by adjusters, defense attorneys, judges and juries even sometimes. So they’re not new to being pushed back. It’s how you push back. Do it professionally. And when you can learn about the facts that matter, have enough of the law to where you can be dangerous to know.

You’re not there to be an attorney, but once you can assert facts and law, that makes you also someone that the good attorneys want even more. And why? Because in the really good cases, they may go to trial. Less than 3% of cases actually go to a jury trial, but a lot of them position to that, and that’s where d- adjusters and defense attorneys say, “Do we settle or do we go forward to try?”

And the better that the expert is, the better that the treating physician is, the more likely we need to settle. So when you learn how to stand for your fees and your bills and can support it, when you’re treating properly, when you have the storytelling documentation when you then push back, the good firms say, “I want that doctor.”

That means they’re gonna hold up well at a deposition. They’re gonna hold up well at trial. They know what they’re doing So with that, we’re gonna wrap up for the t- today on this first session. I hope you learned a few things. You see a little bit of the overall, and the way to look at the rest of the series is this.

We’re gonna hit three segments. We’re g- And I think it’s three segments that build any medical practice, and that’s processes, systems, you know that well, but there’s unique systems in personal injury. The next is being properly paid, not just MedPay and PIP, but how to out-negotiate law firms, the trusted ones to get paid more, but also the really difficult ones, and how to protect your staff or for your staff to do it better.

And the last is growth. And like I said, it’s growing not just a personally injury segment, including how to be a better value driver, but it’s how to use PI to grow all your practice segments, and it’s gonna be fantastic for you because this really is the high-profit highway. That’s what personal injury is.

And with that said, I’d like to thank the American Acupuncture Council for their support in allowing me to present to you this wonderful series.

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How OBBBA Will Affect Patients and Reimbursement

what’s happening with what’s called the One Big Beautiful Bill So let’s go to the slides.

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Hey there. Greetings, friends and colleagues. This is Sam Collins, the coding and billing expert for chiropractic and acupuncture. We’re combining today a little bit because we’re gonna work talking about chiropractic and acupuncture combined on what’s going on or what you’re gonna be looking forward to, if you will, with what’s happening with what’s called the One Big Beautiful Bill So let’s go to the slides.

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Let’s talk about that to make sure everyone has a good understanding. The reason why I want to bring this up now is I’ve recently gotten a lot of questions from my network members and others asking, “Hey, Sam, how is this going to affect me?” And I wanna be- make sure that we’re being proactive and not reactive to what’s going on.

So what is this One Big Beautiful Bill Act? How’s it going to affect us? What makes a difference to us? Really what the One Big Beautiful Bill Act is, as related to healthcare providers, are the changes affecting healthcare insurance, if you will, whether it’s gonna be through Medicaid or through the exchange.

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So it’s more so gonna be an effect on the workflow that you have to do in tightening up are they insured or are they not. So the impact for providers is gonna be about insurance verification. This is really going to be mostly about people with marketplace plans. That’s the one they get through the marketplace.

Many people have them. And of course, anyone through Medicaid. Now, remember for California providers, we call that Medi-Cal, but it’s one in the same. It’s gonna really make a difference because, as you’ve probably noticed in the news, it’s gonna change eligibility. So it’s gonna require much more frequent verifications, and there’s gonna be some retroactive issues with it as well that someone may appear to be active, and then it’s taken away.

So here’s really what I wanna make sure. What if you say, “Hey, Sam, I don’t do a lot of Medicaid or none at all. I do mostly cash.” Then this doesn’t affect you at all. But if you’re dealing with people in the marketplace or Medicaid, it does. So most healthcare offices will have minimal effect unless you’re treating those types of patients.

So keep in mind, a lot of times when you’re hearing a lot of this hyperbole in messages, it often gets you panicked, thinking, “What do I need to do right now?” That’s why I say slow down and let’s look at it. Here it’s gonna be the Medicaid one. So it’s primarily on coverage, and let’s make sure too that I’ve seen some things about this that people say it’s gonna change how you bill.

It is not gonna change how you send a claim. It only impacts the coverage itself. So it’s not gonna impact coding or how claims are submitted, but primary coverage eligibility. So we’re gonna have to put a lot more pressure on us and the patient to what is or is not gonna be covered. This is really gonna begin next January, but I think it’s best to start getting used to now following through to make sure, does my system work through it?

Whether you’re using a Vality or something through your clearing house, you wanna have somewhere that can easily verify what’s going on with a patient because you’re gonna have to make sure that these people are still eligible. Why? There’s gonna be changes to eligibility. As you’ve probably heard in the news again, there’s gonna be eligibility changes based upon is the person able-bodied and working?

Are they doing volunteer service? So there’s gonna be a lot more verification. I think a lot of people will lose their plan, gain it back, and you’ll go back and forth, and it’s gonna make it very frustrating. So the bottom line is more patients may lose Medicaid eligibility during the course of care. I’m not even talking at the beginning, but during the course, you’re thinking, “Oh my God, what a hassle.”

This is why many of you say doggone it, that’s why I don’t take insurance.” In fact, I’ll let you in on a secret. In my dad’s practice when him and I were together, we took very little. In fact, my dad saw it as a charity. In fact, sometimes my dad would say, “It would be better to treat these pa- patients for free than all the administrative work,” which I’m not so sure he was wrong.

Bear in mind, though, some Medicaid plans for chiropractic and acupuncture can pay quite well, and in fact are the lifeblood of many practices. So we wanna make sure that you’re ready for that. More patients may lose their eligibility, so therefore eligibility verification has become important, done regularly.

I’ve had some people argue it should be done every visit, but I would say probably at least monthly or sooner because there may be changes that all of a sudden they’re saying it’s eligible now.” Two weeks later it no longer is. The risk of claim denials due to coverage termination is gonna be my big issue.

We wanna make sure that when someone comes in, as you’re well aware with the No Surprise Act and giving a good faith estimate, patients should be aware of what their charges are. So I think it’s gonna change how we as offices begin to make sure these patients understand if their insurance is not in effect, that’s not our fault We’ve done the best job we can to make sure that their coverage is there.

However, we’re warning them, “Your coverage may not be intact,” and as such, they would be personally liable. Therefore, they’re signing some type of financial agreement or otherwise to make sure that we’re not left holding the bag, because the truth is, I would rather not treat you and not get paid than treat you and not get paid.

So we’re gonna do a little bit more verifications, making sure it’s in line and patients understand their responsibility. So you’ve really got to conduct eligibility reviews more frequently. Now, they’re saying here generally every six months rather than annually. I would say maybe even quarterly for some, and some people may lose it retroactively.

So what may have been good through, say, March, all of a sudden for the next quarter is not. So retroactive Medicaid coverage will be reduced to one month, meaning that sometimes it could be as quick as one month it’ll be a turnaround. They used to have it where there’d be a three-month grace period. Now it’s only gonna be one month.

As a result, implement routine eligibility verifications. I’m gonna suggest if you’ve not already taken advantage of the electronic way through Availity or other systems, you really should. They’re minimal to no cost. In fact, Availity for the most part is free. But through other plans, there’s ways of getting that information.

Getting on the phone and calling, ineffective. You’ve really got to do it as an online part. If you’re a network member with me, reach out. We can go through what things you need to do. Bottom line is this: it’s not just Medicaid, though. It’s gonna be the marketplace or the exchange plans, and they impose stricter benefits on that.

I’ve just recently saw a lot of people have lost their benefits, so make sure, is it active? All we need to know when someone comes in, our job is to give you really good care. Insurance is their contract, and while we’re gonna do our best to make sure it’s covered, I want every patient understanding Our office has done the best job to verify your insurance.

However, we cannot guarantee coverage. You ever notice that when you contact an insurance, they always say this, “This is not a guarantee of coverage”? We’re gonna have to start doing the same thing. We’re not beholden to your insurance. If your insurance doesn’t cover, you have to understand your personal liability, and if they’re not ready to take personal liability, that’s fine, then we won’t accept them as patients.

Again, I go back to I’d rather not treat you and not get paid. So I wanna make sure there’s a good way of looking at this, saying, “Okay when is this policy effective? When’s the change date?” Because we have to make sure we’re gonna have potential issues where patients may experience more frequent coverage lapses.

They may lose coverage in the transition and have to be self-pay. Insurance card changes, plan changes. Here’s what the bottom line is. We’re gonna have to be more adept at verifications. It’s not as hard as you think. They’ve put so much stuff online to verify whether the person is eligible. Just plug in their ID number and you’ll see when is the effective date.

If we are proactive with that, I think we’ll run into far less problems. So really, what do you wanna start to do now? Now, just be aware. If you’re not doing much of this, I’m not really that concerned. You may say I may have a few people.” But bottom line is verify their eligibility regularly. Now, some will say before every visit.

I’m not sure I’m ready to go that far, but being if you’ve got an efficient system, that may work. Update financial policies. Make sure your patients understand their financial requirements in your office. Make sure you have a good, clear financial agreement. There’s nothing worse than someone coming saying, “Oh, everything is covered,” and when it’s not covered, they don’t wanna pay.

Remember, you’re not an attorney office. This is not one of these contingency things. If your insurance doesn’t pay, there’s no charge. Oh, no, that’s not how this works. Patients have to be understanding of their responsibility. Also, make sure you’re insu- obtaining their current insurance cards more frequently.

I would check quarterly, not just waiting for first of the year. Have you had any updates? Now, if someone’s coming in regularly, if there’s any updates, they probably make you aware. But if someone’s not been in a while, always say, “Hey, can we see your latest card?” Because a lot of times people get a new card, and they forget to tell you like, “Oh, I thought it was all the same.”

And strengthen your good faith estimate It’s very important patients understand their costs, just like we do. Don’t be afraid to be the office that we’re here to give you good care, but there’s an expectation of payment. And of course, if it’s not covered, could we put them into a self-pay plan, a prepaid plan, or even deal with a hardship?

Absolutely. But just be aware that this may change some coverages. Again, if you’re doing very little of it, may not affect you much. But realize we’re always here to help because you need to establish payment plans and coverage loss situations. What are we gonna do? If you don’t already work with me, as some of you are network members, work with me.

We’ll help you set that up. We already have some in- set up for you. Train your staff also, recognizing if they’re Medicaid eligible or they have marketplace, that has there been any recent changes? Has something changed with their job or whatever the case may be. Also, monitor your state Medicaid fees, because Medicaid fees in some states, really poor, but in other states, pretty good.

So this is something you’re gonna balance the type of practice you have, thinking of volume. It becomes more difficult if you are a type of practice that you spend a lot of time with patients, particularly in an acupuncture setting, there may not be as much value for you. So it’s something to consider whether or not is this a value to your practice or is it not.

The overall impact, it projects that it’s gonna indicate significant numbers of individuals that are currently covered under Medicaid or marketplace may lose coverage, so we wanna make them aware. But here’s the thing. As a chiropractic practice or an acupuncture practice, we are the most nimble at keeping things affordable.

Do you think most people can pay cash going into a medical practice? Absolutely not. What about coming to you? I think we do a good job as professionals at making things affordable, so don’t be afraid to put them into self-pay, prepaid, things where you can discount. My goodness, if you’re in California, you can offer a very large cash discount.

Know what your state allows. In Florida, you can do a prepaid monthly plan. So understand what your different states allow. Again, I would say reach out to me so we can make sure to set yourself up to make this be a benefit to your office, not something that’s a downer. Providers, the primary concern is not changes to coding and billing, but rather insurance patient coverage.

And if it’s not covered, put them into cash. Not a big deal. Eligibility verifications, financial responsibilities, make sure patients are clear. Just like when you go to purchase something, it’s the same thing. That part is the professional part. Make sure patients understand what they need. As always, we’re here to help.

If any of you have any concerns, reach out to me through H.J. Ross or American Acupuncture Council. If you’re a network member, we’re there to really help. We can do a one-on-one Zoom. Realize there’s some changes happening for documentation, very specifically for acupuncture. We’re having seminars this month, July 16th and the 23rd.

I hope to see you. But if not, keep a look for me online. We’re always here to help everyone. Best wishes.

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Acupuncture Malpractice Insurance Quote

What Every Practitioner Should Know Before Choosing Coverage

Running an acupuncture practice means caring for patients while also managing the responsibilities of a healthcare business. And here’s the truth that every acupuncturist should know: Even when you follow established standards and communicate clearly with every patient, unexpected claims can still happen. That’s why many practitioners request an acupuncture malpractice insurance quote before opening a clinic, renewing a policy, or expanding their services. Taking time to compare coverage now can help you choose the best offer and avoid costly surprises later.

Why Getting a Quote Is Worth Your Time

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A Quick Checklist Before You Request a Quote

Use this checklist to help compare your options:

Review the policy’s liability limits.
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If you’re comparing providers, requesting an acupuncture malpractice insurance quote from AAC is a practical place to start. Our team can explain available coverage, answer your questions, and help you find a policy that fits your practice and budget.

ADHD, the Gut Microbiome, and Chinese Medicine

Research on the ADHD gut microbiome is expanding, but the clinical meaning remains unsettled. Studies suggest that some people with attention-deficit/hyperactivity disorder have differences in gut microbial composition, immune signaling, or gastrointestinal symptoms. These findings do not prove that dysbiosis causes ADHD or that changing the microbiome will reliably improve core symptoms.

In this presentation, pediatric Chinese medicine practitioner Moshe Heller discusses the gut-brain connection through the lens of Chinese medicine. He relates digestive function, the Earth element, phlegm, dampness, and Shen disturbance to patterns that may appear in children with attention, activity, sleep, emotional, and digestive concerns. For acupuncturists, the practical value is not a new stand-alone treatment for ADHD, but a framework for evaluating the whole patient while staying within an evidence-informed, collaborative plan of care.

What the ADHD gut microbiome research shows

The gut-brain axis describes bidirectional communication among the gastrointestinal tract, nervous system, immune system, endocrine signaling, and microbial metabolites. This is a biologically plausible area of ADHD research because neurodevelopment, inflammation, diet, medication exposure, sleep, stress, and gastrointestinal function can interact.

Recent reviews report differences in particular bacterial groups or microbial metabolites between some ADHD and control populations. However, results are inconsistent. Studies use different ages, diagnostic criteria, diets, medications, sequencing methods, and outcome measures. Some find microbial differences; others do not find significant associations with ADHD presentation or symptom severity.

The most responsible interpretation is that the microbiome may be one factor within a complex biopsychosocial condition. It is not an established diagnostic biomarker, and no specific microbiome profile currently confirms or excludes ADHD.

Research on probiotics and other microbiome-directed interventions is also preliminary. Small trials have reported possible changes in gastrointestinal symptoms, emotional regulation, or selected behavioral outcomes, but reviews continue to describe the evidence as limited and heterogeneous. Clinicians should not imply that probiotics, elimination diets, fecal microbiota transplantation, or herbal products are proven treatments for ADHD.

How Chinese medicine frames digestion, attention, and behavior

Heller’s presentation uses the Earth element as a clinical metaphor for transformation, nourishment, and stability. Within traditional Chinese medicine, Spleen and Stomach function may be considered when a child presents with poor appetite, loose stools, fatigue, fogginess, worry, sleep disturbance, phlegm, or difficulty sustaining attention.

He discusses three broad pattern concepts:

Spleen qi deficiency with dampness: fatigue, poor concentration, digestive weakness, loose stools, heaviness, or a “foggy” presentation.
Heart-Spleen deficiency: fatigue with poor sleep, anxiety, reduced appetite, pallor, dream-disturbed sleep, or difficulty settling.
Phlegm-heat disturbing the Shen: agitation, impulsivity, excessive speech or movement, irritability, poor concentration, and possible signs of heat or phlegm.

These are traditional pattern descriptions, not biomedical subtypes of ADHD. They should not be presented as equivalent to a psychiatric diagnosis, microbiome test result, or proven disease mechanism. Their value lies in organizing an individualized Chinese medicine assessment that also considers sleep, digestion, emotional regulation, medication effects, diet, family stressors, and other comorbid concerns.

What current evidence says about acupuncture for ADHD

Systematic reviews have reported potentially favorable findings for acupuncture, including acupuncture used alongside medication or compared with conventional treatment. Yet confidence in those results is limited by small samples, inconsistent controls, inadequate blinding, variable outcome measures, and risk of bias.

The National Center for Complementary and Integrative Health states that there is insufficient evidence to draw firm conclusions about the efficacy or safety of acupuncture for ADHD in children and adolescents. That position should guide patient communication. Acupuncture may be considered as an adjunctive, individualized supportive therapy, but it should not be marketed as a replacement for evidence-based diagnosis, behavioral treatment, school support, psychotherapy, or medication when indicated.

Practical guidance for acupuncturists

A useful integrative approach begins with scope, screening, and coordination rather than a promise to “treat ADHD through the gut.”

Confirm appropriate evaluation. ADHD diagnosis requires a qualified medical or mental health assessment. Symptoms can overlap with anxiety, trauma, sleep disorders, learning disorders, autism, mood disorders, hearing or vision problems, and medication effects.
Track functional outcomes. Use concrete goals such as sleep onset, stool regularity, appetite, classroom participation, emotional recovery, family stress, or treatment tolerance. Do not rely only on a parent’s global impression.
Coordinate care. With consent, communicate with the child’s pediatrician, psychiatrist, therapist, school team, or other treating professionals. Standard ADHD care commonly includes behavioral interventions, parent training, school-based support, and medication based on age and clinical need.
Document claims carefully. Record the traditional pattern diagnosis separately from the biomedical diagnosis. Avoid charting or advertising that dysbiosis caused the patient’s ADHD unless a qualified clinician has established a separate gastrointestinal diagnosis.
Use pediatric consent and assent. Explain the procedure in developmentally appropriate language, obtain guardian consent, seek the child’s cooperation, and stop when the child withdraws assent or cannot tolerate treatment safely.

Herbal medicine and microbiome safety

The formulas discussed in the video—including Shen Ling Bai Zhu San, Gui Pi Tang, Wen Dan Tang variations, Ban Xia Hou Po Tang, and Xiao Jian Zhong Tang—belong to traditional prescribing systems. Their inclusion in a lecture is not a recommendation for unsupervised use or a standardized ADHD protocol.

Pediatric herbal prescribing requires an individualized assessment, age-appropriate dosing, product-quality review, medication and supplement reconciliation, allergy screening, and knowledge of state scope-of-practice rules. Practitioners should consider potential herb-drug interactions, contamination or adulteration, hepatic or renal vulnerability, and the possibility that gastrointestinal symptoms require medical evaluation.

Do not advise families to stop stimulant, nonstimulant, psychiatric, or sleep medication without the prescribing clinician. New severe abdominal pain, persistent diarrhea, weight loss, blood in stool, dehydration, marked behavioral deterioration, suicidal thinking, psychosis, or other urgent symptoms require prompt medical or emergency evaluation.

Clinical takeaway

The gut-brain axis offers a promising research framework, and Chinese medicine provides a longstanding method for integrating digestive, emotional, sleep, and behavioral findings. Neither framework currently establishes that microbiome treatment or acupuncture can correct the underlying cause of ADHD.

For acupuncturists, the strongest application is careful pattern differentiation, realistic goals, conservative claims, coordinated care, and attention to digestive or sleep complaints that may affect a child’s functioning. Used this way, Chinese medicine can contribute to a broader patient-centered plan without overstating the evidence.

Explore more AAC education: Visit the American Acupuncture Council blog for additional clinical education, practice support, and risk-management resources for acupuncture professionals.

References

National Center for Complementary and Integrative Health. ADHD and Complementary Health Approaches.
National Institute of Mental Health. Attention-Deficit/Hyperactivity Disorder: What You Need to Know.
Centers for Disease Control and Prevention. Treatment of ADHD.
Liu Y, et al. A narrative review of research advances in gut microbiota and attention-deficit/hyperactivity disorder in children. Front Psychiatry. 2025.
Brown AA, et al. Associations of the gut microbiome and inflammatory markers with ADHD and co-occurring symptoms in young adults. Sci Rep. 2025.
Ang L, et al. Acupuncture for treating attention deficit hyperactivity disorder in children: a systematic review and meta-analysis. Medicina. 2023.
Zhao FY, et al. Integrating acupuncture into the management of ADHD in children and adolescents: a systematic review. 2025.

Educational disclaimer: This article is intended for licensed healthcare professionals and students. It does not provide medical advice, establish a standard of care, or replace diagnosis and treatment by an appropriately qualified clinician. Acupuncture and herbal medicine laws, scopes of practice, and documentation requirements vary by jurisdiction. Practitioners should use independent clinical judgment, obtain appropriate consent, coordinate care, and follow applicable laws and professional standards.

The Face, Emotion, and the Qi Connection

“The face is the mirror of the soul.” But what if the relationship goes much deeper than that?

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Hi, everyone. My name is Michelle Gellis, and I am an acupuncture physician. I would like to thank the American Acupuncture Council for this opportunity to talk to you today

I want to talk to you today about something I think about every single time I work on a patient’s face. We’ve all heard the expression, “The face is the mirror of the soul.” But what if the relationship goes much deeper than that? What if the face isn’t just reflecting our inner world, but actually shaping it?

Today, I want to explore what I call the emotional feedback loop of the face, the bidirectional conversation between our expressions, our nervous system, our organs, and our qi. I want to show you why this matters profoundly, both as acupuncturists and as people living in a world that is increasingly interfering with that loop.

Let’s start with the Western research, because it’s very fascinating, and it directly validates what Chinese medicine has understood for thousands of years. In psychology, there is something called the facial feedback hypothesis. The basic idea is this. Your facial expressions don’t just communicate your emotions to the world, they actually generate emotional states within you.

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The face sends signals back to the brain. It is not a one-way street. This idea goes back to Charles Darwin. In my book, Treating the Face, I talk about research that was done And by Charles Darwin, and it really gained momentum in 1988 when researchers Strack, Martin, and Stepper conducted a now famous experiment.

They asked participants to hold a pen between their teeth, which forces a smile, or between their lips, which prevents smiling. Those holding the pen in their teeth rated cartoons as significantly funnier. They were smiling without knowing it, and their brains responded accordingly. A large international study published in Nature Human Behavior, nearly four thousand participants, nineteen countries, found that when people deliberately mimic a smile, it amplifies and even initiates feelings of happiness.

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Think about what this means clinically. The muscles of the face are not just motors for expression. They are afferent transmitters sending information back to the brain, back to the nervous system, back to the organs. When we activate the corrugator muscles, the muscles that are between the eyebrows, we don’t just look concerned, we begin to feel concerned Now here’s where it gets really interesting for our purposes as practitioners.

Botulism toxin, known by the brand name Botox, Dysport, Xeomin, works by paralyzing the muscles of facial expression. Researchers have used this as a natural experiment to study what happens when you interrupt that feedback loop, and the results are striking. When people see a happy or angry face, they unconsciously mimic that expression.

But Botox prevents that muscle reaction, and it scrambles the brain’s ability to interpret other people’s emotions. In one study People who were using Restylane, which is a filler, not a muscle paralyzer, read emotions with seventy-seven percent accuracy. Botox users, only seven– seventy percent. We don’t just see someone else’s expressions, we mirror it micro-muscularly, and that mirroring is how we understand what they feel.

If you paralyze the muscle, you lose part of your emotional translation system. Research also found that Botox to the crow’s feet, those little laugh lines on the sides of your eyes, was associated with increased depression scores and reduced emotion recognition. Freeze the muscles of a real smile. So you only get those when you’re smiling really big, like a genuine smile, and when you freeze them, you reduce the feedback that tells your brain you are experiencing joy.

There is a paradox here, though. If you use Botox in the globu-ellar lines between the eyebrows, it can actually reduce depression because you can’t frown deeply, and they receive less negative feedback associated with worry and sadness. So in some cases, Botox reduces depression, but it also reduces the full range of emotional experience.

It creates what I like to call emotional flattening. If you lose the lows, you also are gonna lose some of the highs, and you lose your ability to fully read the people around you. As acupuncturists, we need to know that when we’re treating patients, if they’ve had these sorts of injections, it can affect them.

Their facial feedback system has been altered, and we can discuss that with them gently and professionally and from a deep place of knowledge. Now, I want to bring this to something even more fundamental. This isn’t just about adults choosing cosmetic procedures. This is about how we develop emotionally as human beings from the very beginning of life.

When children are very young, newborns, they are going to show a preference for their mother’s face within hours of being born. Newborns only hours old have been found to copy facial expressions, making an O with their lips or sticking out their tongues. This is remarkable because they’ve never seen their own face.

They are not learning through language. They are learning through instruction. They are learning through mirroring through the face. Research published in Scientific Reports found how much a mother’s– how much a mother mirrors her baby’s face in the first two months, and the mirroring that goes on between the mother and the child and how much mirroring occurs actually shapes the baby’s developing neural pathways and their ability to process expression for years to come Mirror neurons may be central to this process.

When we observe an emotional state in someone else, the mirror activity occurs in our own emotional center. We feel a version of what they feel through our face. So think about what happens in a family where expression is habitually suppressed. When parents chronically hold tension in their jaw, guard their brow, tighten around the eyes, children are literally learning to hold these same patterns in their own faces, and those muscular patterns are sending feedback to their developing nervous systems, shaping how they experience and regulate emotions for decades.

This is not abstract. This is psychology, and it is something Chinese medicine has always understood. In the Chinese medi– in Chinese medicine, the face is never separate from the whole person. Every zone of the face reflects organs. Every line, every color, every area of tension, it tells a story about the internal landscape.

The brow, the corrugator, the procerus belong to the liver. Chronic furrowing here reflects constraint of liver qi, the holding in of frustration and anger that has nowhere to go. And as Western research now confirms, that muscular tension is not just a symptom. It is perpetuating the emotional state.

It is feeding it back into the system. So this is not just carrying a meat suit around. The expressions that we hold back here are going to have an effect on the health of our organ systems. The area around the mouth, the obicularis oris, the depressor anguli oris, these all belong to our ability to feel joy and express joy.

And if these muscles have been paralyzed, then we cannot fully express joy. And if someone has experienced loss, chronic sadness, unexpressed grief, we can see this here also through the large intestine channel. The corners of the mouth will pull down, and that downward pull is sending information back to the nervous system.

Something’s wrong. Something’s been lost. What we are looking at when we look at the face is not just age. It is the history of a person’s emotional life written in their muscle, fascia, and qi. And what makes facial acupuncture so profound and so different from anything else we do is that we are intervening in that feedback loop.

We are releasing the muscular holding patterns that have been perpetuating emotional states, sometimes for decades. We are restoring the flow of qi through the channels that govern the emotional experience and helping the face and therefore the whole person In part two, we are going to go deeper into specific techniques on how to work with these patterns clinically I would like to thank the American Acupuncture Council again for this opportunity to speak to you today and make sure to check out part two

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Myofascial Point Combinations with UB 60 – Brian Lau

Today we’re gonna look at a little bit of the anatomy of the bladder sinew channel, and specifically in relationship to bladder 60, like a sphere of influence of bladder 60.

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Hi, I’m Brian Lau. I’m with Accu Sport Education sports medicine acupuncture program. And I always appreciate coming in with the American Acupuncture Council, so thanks for having me. Today we’re gonna look at a little bit of the anatomy of the bladder sinew channel, and specifically in relationship to bladder 60, like a sphere of influence of bladder 60.

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So we’ll look at using that point of course, but then applying it or at least syncing it, linking it with other points in the sinews. So something that would be along what you would think of as the bladder channel, but then we’ll draw out the full sinew channel course and look at how it relates to some of the other structures off the primary channel, but more along the sinew channel.

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Let’s start with that. We’ll go to the slide and we’ll start looking at the first bit of information. So this is a image of bladder 60. So it’s just showing, of course everyone knows the location of bladder 60 between the lateral malleolus and the Achilles tendon halfway. But just a summary of some of its actions.

It clears heat and lowers yang, so particularly when there’s tension rising up the bladder channel, and you think of stress and being at work and everything, shoulder’s rising and the whole back line rising. Pacifies wind and leads down excess. That’s pretty similar to the first action in some ways in terms of how it plays out in this situation.

It activa- activates the entire bladder channel and alleviates pain. A lot of pain indications for this point. Relaxes the sinews and strengthens the lumbar spine, and then it promotes labor. So just a quick note while we’re on this image is you can note the course of the sural nerve. So this point would be in a location that would stimulate the sural nerve.

The sural nerve is branches off of both the tibial branch of the sciatic nerve and the common fibular branch. They come back together, but then it travels down, pretty much down the midline along the bladder channel shifts over to the lateral side. So when you, when needle bladder 58, you’d be stimulating that and then down along the course of the bladder channel.

So this would be stimulating that. It’s nice to know the target tissue and some expectations of where that qi sensation would go. Because this is a cutaneous nerve, it would supply sensation down the foot, so you could expect to see some traveling sensation along the bladder channel from that But if we look at the bladder sinew channel, that k- helps us draw out some of those actions and indications.

This illustration is showing sort of two levels, or two layers of the bladder sinew channel. When we do dissection in the program, we do a three-day dissection. This would be on day two, where we start to, to look at the posterior aspect of the body. And if I were to remove skin and adipose, that’s what we would do in a dissection process, the very first structures we get to would be what we see in this box here on the back, which would be the latissimus dorsi, trapezius.

Those are gonna be the most superficial structures. Glute max. And that’s our superficial bladder sinew channel. It’s a lot of what we see as these branches in Deadman’s illustration coming off of the main channel. So it highlights these lateral branches that wrap around to the front of the body.

We’ll come back and look at the front in just a second. But if I were to remove this layer reflect back that layer, then I would get to what would be along the main course of the channel, erector spinae, sacrotuberous ligament, hamstrings, et cetera. A lot of these link at the thoracolumbar fascia.

It’s multilayered, so that’s our linking point between the superficial and deep layer. This will be the subject of the day. If I were to continue from a dissection standpoint, the next layer past the deep bladder channel layer would be the kidney channel sinew channel layer. So that would be our sort of progression, but we’ll stop at the bladder channel today.

So back to the branches. This is where I think a lot of the influence of Bladder 60 is not so much on the main channel, a little bit for sure, but primarily on these branches. So the latissimus dorsi, trapezius, which branch off of the thoracolumbar fascia, the glute max, which branches off of the thoracolumbar fascia.

But if I were to look at the latissimus dorsi, that comes to the front of the arm to the bicipital groove and kind of shares fascia

with the pectoralis major. So it links into the front of the chest and then follows up the SCM. The platysma would also be part of this and into the facial muscles. I don’t have that in the illustration, but you can see this link of the latissimus dorsi, pectoralis major, sternocleidomastoid.

So some areas in the front of the body, which a lot of us don’t really think about with the bladder channel. But with the bladder sinew channel, there is some linkages into the front of the body So here’s another illustration that shows that from the side, labels it. But we have the a lot of, not all of them, but many of the indications of Bladder 60.

So let’s think of those indications from the perspective of this these lateral branches. So clears heat, lowers yang, pacifies wind, and leads down excess. That would include things like headaches. Headaches are a big one for Bladder 60. Visual dizziness bursting eye pain in the upper teeth. A lot of these would correlate with headaches, with Bladder 10 area, so into the semispinalis capitis.

But if we were to broaden out, especially the SCM, the sternocleidomastoid would contribute to things like visual dizziness. It can be a component when there’s trigger points in that. It can be a component of positional vertigo. Of course, headaches. Headaches are a big one. We’ll look at the referral pattern for this in a second.

But headaches it can create a lot of referral into the face area and link with facial issues, both pain and other conditions, even things like Bell’s palsy to some extent. So it can contribute to or at least link with facial pain particularly. Pain in the upper teeth, it can refer into that area also.

So SCM is one of our big links for that. Upper trapezius too. We’ll look at some referral patterns for the upper trapezius. The kind of goal that I want to highlight is that trigger points are becoming increasingly more considered with in medicine in general, but particularly in the acupuncture world.

And many of us, I teach trigger point classes trigger point needling classes within Acusport education. And I just see it with when I teach, when other people teach, is that there’s a tendency to shift away from our TCM when we start looking at more medic- more Western medical language and thought processes and stuff.

So I always like to remind back into the channel system and link with distal points and not lose sight of the channel theory when you start doing more orthopedic or or Western sort of type approaches. And trigger points is somewhere in between. A lot of the language nowadays is Western, but of course, it parallels a lot of what we learn in Chinese medicine.

So not like a complete divergence or anything. So that’s the goal is I want to consider when I’m needling local points like in the sternocleidomastoid trigger points, I might link it with Bladder 60 in particular instances So another indication, relaxes the sinews, strengthens the lumbar spine, activates the channel and alleviates pain.

Stiff neck, goes hand in hand with what we were looking at, but trapezius can be a big component of that also. Contraction of the shoulder and back. Upper trapezius is gonna be one of our big links for that. Fullness of the chest, we can note that the pectoralis major is part of that lateral branch, so that can definitely create a lot of pain and sensations in the chest area.

Heart pain that radiates to the back, and then the other one would be sacral pain and coccyx pain, which is a big one. So we’ll look at the glute maximus. Last indic- action, I should say, but there’s some indications there of course too, is that promotes labor. And I’ll just highlight and not really focus on it much past this, but if I can create some stimulation in this region of the chest, pectoralis major, that’s gonna have an influence on the breast, and oxytocin, which would contribute to promoting labor.

So putting out oxytocin would be, if there’s stimulation in that breast area, that’s… Even if it’s distally, that’s going to have the body put down, put out oxytocin, and that’s gonna start the labor process when the person’s close to it. So just a consideration there so here’s the sternocleidomastoid trigger point referral patterns.

I highlighted some key points around the SCM. Though if you’re needling trigger points, sometimes with palpation, you might be a little off these points, but these are good starting places to consider with the SCM. And just to note that the SCM has a referral into the frontal area, a…

in the eye and cheek area. I’m not sure if I’d be thinking of bladder 60 for this referral. I might be thinking more stomach channel point, stomach 41. Maybe a different day we’ll look at stomach 41 and how it links. Into the ear, I might be thinking San Jiao 3. So the SCM’s a complicated muscle.

There’s multiple channel relationships to it. But what I do wanna highlight is that kinda occipital region. So when there’s that occipital pain and palpating the SCM starts to bring that referral, and it’s “Oh, yeah, that, that feels like my headache,” that would be my consideration particularly for bladder 60.

So when I go to needle, I can just palpate and needle according to what I’m palpating. But I would say San Jiao 16 is a really common point that I use, particularly from the back end of it. So I would thread not perpendicular, but I would thread that needle through the back fibers of the SCM. A little bit more superficial, I might get the sternal head.

If I go a little deeper, I’ll get the clavicular head. So depending on how close to the surface you wanna be, into the muscle at least, but how close to the surface of the muscle versus deeper in the muscle will get different fibers, so you can change the angle of that. That’s a very common approach I do.

Gallbladder 12 would be up at the attachment. 20 would… You can angle it into the SCM or the traps or just straight in. SI 16, I don’t needle that region as much but it’s sometimes reactive there. Stomach nine, I would, again, angle into the muscle. Stomach nine’s a really useful location. Lower fibers, even something like stomach 11, but I don’t find those areas become as reactive.

I do wanna highlight the external jugular vein. So the external jugular vein, which wouldn’t be a big deal if you hit it, it’d just cause a bruise. We don’t wanna cause a bruise. It’s better not to hit it, better to know and look for it. But it’s not, overly gonna be damaging to the person. It’s more cosmetic at that point.

People don’t want a big bruise on their neck. But at the same time, if we can avoid it, better to avoid it. But you can note that it starts and runs behind the SCM. It crosses superficial to the SCM, and then it goes anterior to the SCM. So I particularly like San Jiao 16 in that area ’cause it’s behind the external jugular vein, and I have pretty good access to the muscle without worrying too much about the external jugular vein.

Stomach nine, also on the anterior surface, very good. So those are common areas of insertion. But, you might modify the location. You don’t have to be strict with the location of any of these when there’s SCM strain, it’s nice to note how much fascial communication there is with the pectoralis major.

Clavicular head in particular for the clavicular head of the SCM, clavicular head of the pec majors lung one would be a consideration. But really just trigger points along the whole pectoralis major can help reduce tension into the SCM, especially if people are desk workers and they’re spending a lot of time closing the chest, driving, desk, pretty much a lot of what we do on a day-to-day basis.

People tend to get overactive in that pectoralis major. Even the lats, serratus major, those would be considerations to contribute. If I were linking bladder 60 with the SCM, maybe some points in the pectoralis major lats, these would be starting to build a little bit more of a comprehensive treatment So trapezius is another big one.

Trapezius is multiple channel relationships also. We have gallbladder 21, gallbladder channel, gallbladder 39 is really useful to reduce tension in the upper trapezius. San Jiao points have an effect on it. There’s a lot of channels that converge at the trapezius, but the bladder channel, especially that sinew channel coming up the body is one of those, one of those channels.

And again, I can think it kinda correlates to that pulling up tension in the back when we have stress, and we’re busy and, we wanna have that area descend down and drop. We don’t want that excess to rise. So those would be a consideration for bladder 60 if that seems to be the correlation.

But again, that occipital referral. So this is showing the lower trapezius trigger points and some other, like mid-fiber trigger points and the referral into the occipital region. So a very common often missed area with headaches. When I am assessing for this, I might kinda spread even just with a finger spread, oops, spread through the lower trapezius kind of in the direction that my cursor’s going, from a downward lateral direction cross fiber, and sometimes you’ll even see little local twitch responses.

This is a pretty superficial insertion. You have to kinda thread right into the muscle. So if you’re not used to needling the trapezius in this this region, you do have to know that it’s a fairly thin region. There’s not a whole lot of tissue, especially for people who are thinner. There’s not a lot of adipose in this area, so and the muscles are fairly thin in this area, so there’s not a whole lot of space before you get to the rib cage.

So there is a little bit of pneumothorax risk if you don’t know how to needle this area properly. But I usually thread through a feeling with my finger. I can feel the fibers, and I’m gonna advance the needle through those fibers, an oblique, almost transverse angle. Too transverse, and you’re just going through the skin, but it’s still a relatively oblique transverse.

But even San Jiao 15, gallbladder 21, these are all points you could consider linking. Bladder 10 would be more… And it’d go through the upper traps, but it’d be more in the semispinalis capitis. That would be, of course, a really useful local point for that occipital head pain. But yeah, the lower trap’s one that is frequently missed.

So this is a composite of some of the pain patterns from the trapezius in general, and I would be thinking more of that kind of coming up the bladder channel occipital referral for bladder 60 more than I would for the kinda classic gallbladder channel distribution. I would kinda think gallbladder 39 for that among other choices that I might go with that one.

That would be my pain referral that I would be looking at. So that occipital pain would be the big one. And again, you could link it with other muscles, pec major, lats, other things like that And then the final one we’ll discuss for today is glute max because this is a big component of many sacral pain and coccyx pain type patterns, and that would be the influence of bladder 60.

So this shows from Travell’s book some of the referral, along the sacrum, especially that attachment site. Sacral type pain, coccyx pain. So the Xs, these… I think the current editions of her book doesn’t include these Xs, ’cause there could be trigger points anywhere in the muscle. I kinda like the Xs that showed her clinical experience of where, this region when there’s trigger points, how it would tend to refer there.

But I think the modern editions, they take away the Xs ’cause these trigger points can refer anywhere in the muscle along these distributions. But I still think there’s some value in the Xs personally. And they correlate to certain regions of acupuncture points, bladder 35, especially for that coccyx pain.

36, anywhere along that line, actually, there can be trigger points in those lower fibers. That can be a big component of coccyx pain. But any of these points could influence coccyx pain or b- sacral pain. Bladder 54 would be in the main region of one of the motor entry points, as w- as with gallbladder 30.

And the black l- circle here represents more just kind of attachment trigger points. I, I don’t off the top of my head know of any point there, but I didn’t look that closely with it. But I just think of it as an common area of attachment trigger points. So yeah, just a quick run-through of the the channel.

But particularly the influence, sphere of influence of bladder 60. And I think the idea is linking it with those local points and adjacent points. Pec major, SCM, trapezius, lower trapezius fibers if there’s occipital pain, glute max with the sacral and coccyx type pain. Those would be really good starting places.

Learning more myofascial trigger point techniques can be great, but then we wanna bring it back into our channel system. All right. So I think that is, wraps it up for today. So we’ll look at some maybe next time, some more anatomy, go through some of the channel related anatomy.

I think it’s a really good way to review channels and think about them a little differently if you didn’t have this type of approach when you were learning the medicine. So again, I always appreciate and thank American Acupuncture Council for having me, and I will see you next time.