Category Archives: Blog

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.

Click here to download the transcript.

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

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.

Click here for the best Acupuncture Malpractice Insurance

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.

Get a Quick Quote and See What You Can Save

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.

Click here for the best Acupuncture Malpractice Insurance

Get a Quick Quote and See What You Can Save

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

An acupuncture malpractice insurance quote gives you more than a premium estimate. It helps you understand exactly what protection you’ll receive if a claim or lawsuit arises. It is important to note that policies can vary in coverage limits, legal defense benefits, exclusions, and optional endorsements. Meaning to say, apart from price, there are several factors to consider before picking a policy. Looking beyond the price means you choose a policy that fits the way you practice.

For new practitioners, getting a quote also provides a better understanding of the insurance requirements that many employers, clinics, and state licensing boards expect.

What to Look for in Your Coverage

As mentioned above, not every malpractice policy offers the same level of protection. Before making your decision, review the policy details carefully. Consider whether the policy covers services such as herbal medicine, cosmetic acupuncture, or other treatments you provide.

You’ll also want to know how claims are handled, what legal defense benefits are included, and whether additional coverage options are available as your practice grows.

In other words, the goal isn’t simply buying insurance—it’s protecting your professional reputation and financial future.

A Quick Checklist Before You Request a Quote

Use this checklist to help compare your options:

Review the policy’s liability limits.
Ask which treatments and services the policy covers.
Find out if legal defense costs are included.
Check whether discounts are available for new or part-time practitioners.
Ask how claims are managed and who provides legal support.
Compare the insurer’s experience with acupuncture-specific malpractice claims.

Taking a few extra minutes to ask these questions can make a significant difference if you ever need to rely on your policy.

Why Many Acupuncturists Choose the American Acupuncture Council

The American Acupuncture Council (AAC) has specialized in protecting acupuncture professionals for decades. Since 1972, AAC has focused exclusively on acupuncture malpractice coverage, offering insurance programs designed specifically for the profession rather than general healthcare policies. Its liability programs include a variety of coverage options and limits, backed by experienced claims support and risk management resources.

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?

Click here to download the transcript.

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.

Click here for the best Acupuncture Malpractice Insurance

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.

Get a Quick Quote and See What You Can Save

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

Click here for the best Acupuncture Malpractice Insurance

Get a Quick Quote and See What You Can Save

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.

Click here to download the transcript.

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.

Click here for the best Acupuncture Malpractice Insurance?

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.

Get a Quick Quote and See What You Can Save

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.

Click here for the best Acupuncture Malpractice Insurance?

Get a Quick Quote and See What You Can Save

Bad Google Review

Let’s talk a little bit about something that I’ve gotten a lot of questions about. Let’s talk about, what if I get a bad Google review?

Click here to download the transcript.

Greetings, friends, colleagues. This is Sam Collins, the coding and billing expert for acupuncture for you, for the American Acupuncture Council, and of course, for my AAC network members. Let’s talk a little bit about something that I’ve gotten a lot of questions about. Let’s talk about, what if I get a bad Google review?

Click here for the best Acupuncture Malpractice Insurance

Let’s go to the slides. Let’s get into that. What if someone puts an online statement about you that’s false, bad, inflammatory, you name it? Let’s be careful. What if you do get a bad Google review? The first thing to do not let your emotion run away. When a patient makes a complaint or something less than flattering on an online platform, our immediate visceral response, of course, is going to be a little bit of anger because it is our integrity, and I do understand that.

Get a Quick Quote and See What You Can Save

But you have to take a moment, take a breath, start to understand what’s going on and how to respond because no one’s ever going to have 100% good reviews. I’ve been to a lot of services and places that I think, “How did this person write a bad review?” Everyone’s experience is different, but remember, there’s a lot of reviews.

Here’s where we have to be careful. You are a healthcare provider. You are bound by HIPAA regulations, so be very careful. When the patient even identifies themselves and discusses their treatment, you should never, regardless of what they’ve done, even confirm the reviewer is a patient Don’t even get into it.

I saw that when you came today. No. You got to make sure that you do not discuss diagnosis, treatment, appointments, billing, or outcomes, nothing that I would identify them. So for the most part, it would be a very generic response, of course. Now, obviously, factual inaccuracies by revealing protected health information.

You may think that wasn’t true.” You can’t correct it. Again, you’ve got to always remember, your greater violation will be the issue of protected health information. You may have a much bigger lawsuit against you than just someone saying, “I didn’t like the office.” Be careful. Do not engage in any type of argument or back and forth.

It’s not worth it. It’s like arguing religion, politics. You’re not going to win that. So be careful. Always think of, “What is my best practice?” You get a bad review, you should have thousands of good reviews. Make sure they’re there. Make it available. Encourage reviews. Aid patients in making access. Maybe not the first visit they’ve come, but after a few, get a lot of reviews going.

I think something that a person can go through and see that there’s, hundreds of reviews, and you’ve got one or two that are bad, oh, come on. You ever been to a restaurant that was fantastic, but there’s still a couple of bad reviews because they didn’t like the waitress, or there was too long of a wait?

It’s a good restaurant. That’s why there is a wait. Now, sometimes the best practice is no response at all. But if a review is negative but not defamatory, okay. What if the reviewer is angry and likely to continue the dispute? Not worth it. You can tell by the way they’ve done it. They’re trying to prompt you a little bit.

And realize a response may draw more attention, and y- all of a sudden now, instead of there being that one response, you’ve got lines of responses, ’cause it’s gone back and forth, and they’re taking it even further. Realize often just putting something in there that just says, “We would love to address this with you.

Please, give us a call or reach out to us,” may be the best response. Prospective patients are more influenced by a pattern of reviews than a single review. I know that’s true for me. I don’t think I’ve ever not chosen something, oh, there was one bad review. I’m looking for a pattern. If I see a bunch, now I’m concerned.

But realize, never argue or be defensive. Never. Never. You’re never gonna win that. De-escalate it. Make them come to your side. When you choose to respond, first thing you do, take a breath Breathe in and think, “Okay, what’s the best way to respond?” Maybe give yourself a little time. Don’t respond right away.

Take some time. Keep your response brief, professional, and frankly, just generic. Being calm and generic will reflect well, as potential patients can see that the office remains professional even when you’re criticized. You ever see someone that when they’re being criticized, when they have a measured response, you’re like, “Ooh, wow.

That’s the type of person that I want to be.” I want you to be that way ’cause that’s what your patients are looking for. I don’t want a doctor that’s off the hinges. Now, what about someone that re- reported something that’s just false? Okay, demonstrably just way out of line. Preserve screenshots, okay? And then obviously check the platform policies.

Realize most are not gonna remove something. They really aren’t. Now, maybe something exceptionally defamatory, maybe, but I find most people have tried, they pretty much won’t, so that’s why I say always bury it. If you are going to say anything about, “I’m gonna sue,” or anything like that, please don’t do that until you’ve consulted legal counsel.

You don’t wanna make any statement you don’t already know the answer to. I’ll give an example. Both my son and daughter are attorneys, and when they’re in court, the one thing they’ve always told me is they never ask a question they do not already know the answer to. So before you start to make any statements about, “I’m going to sue you,” better make sure, “Do I have standing, and can I actually sue?”

Chances are probably not anyway. But I get it, because it’s your integrity. So make sure you stay calm, but also make sure your staff understands, too, because sometimes your staff is defensive for you. And remember, designate who’s gonna respond to these. Are you going to allow staff, or is it gonna be the doctor only?

Make a rule that no employee may disclose any patient information online under any circumstance. They’re not responding probably at all, but they have to follow the same rules, that responses should be approved by designated management, meaning by you. But again, I’m still gonna go back, should be us. And then when legal counsel should be consulted.

Before you make any statements, “Eh, is this something maybe I want some legal counsel.” Maybe you wanna check with your malpractice carrier. Remember, American Acupuncture Council does protect you for when there’s lawsuits against you or when patients… I’m not saying they’re gonna defend you for a bad review.

But should that person turn into something legal, they will be there to help you, and they are there to help. I will say responding to a bad review requires a calm, prompt however, and professional reproach. Your primary goal is not to argue, but to show potential customers, ’cause this one’s probably gone anyway, that you’re attentive, empathetic, and committed Focus on commitment to service and next steps to contact you directly.

Make sure they’re aware, “Oh, no, I- here’s how you get in touch with us.” More though, have a lot of other reviews. What I see too often is reviews get old. When you get a new patient or someone that’s come in that’s been helpful, encourage them. I know I certainly like to. If I’ve had a good service, I love to give them person a review.

Realize that is part of what we do in society now with the way we have online platforms. Give yourself a chance for that. The American Acupuncture Council, myself, we’re here for you. Network members, you’ve ever run into this, please contact me. Let’s do a one-on-one Zoom. If you’re not a member, think about it, because we’re really gonna be able to help you.

But wholeheartedly, we want to make sure you’re successful. Your practice is always gonna have challenges. We’re here to meet those challenges. Until next time, my friends.