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Qigong Exercises for Low Back Pain – Brian Lau

Anatomy. Specific for the low back. That’ll give us a little bit of focus when we go into the movement.

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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.

Hello. Welcome. Thanks for coming. Thanks for taking the time outta your day to attend, and as usual, it’s always a pleasure to do these webinars with the American Acupuncture Council. So thank you to American Acupuncture Council for having me back. So you might be able to tell that I’m leaning, or excuse me, kneeling here.

And that is because pretty soon I wanna be standing and showing some some Qigong movement. Hopefully if you’re at a place that you can get up and do it along with me, that’d be great. So better to be a little bit interactive with it than just standing and watching or sitting and watching. So feel free to get up.

I’ll try to orient the instruction around the idea that you’re gonna be at taking part with me. But I do have a few things to cover first and we’ll look at a couple things. A couple things. Anatomy. Specific for the low back. That’ll give us a little bit of focus when we go into the movement. So let’s go to the PowerPoint and then we’ll go ahead and start that.

The picture here of the image is from eight pieces of brocade. We’re gonna be looking at four of the eight movements of eight pieces, bro of brocade. Each of these movements really could be quite good for the low back, but I picked four that are representative. of certain concepts that I wanna show.

Maybe we’ll get to four of those. Maybe we’ll just get to three of ’em. We’ll see how time goes, but I’d like to get to all four of these. So let’s look at a couple things anatomy wise first. So what we’re gonna focus on with the low back, it’s a pretty comprehensive, pretty big region, lots of structures.

I wanna focus on a particular part of the thac lumbar fascia. So thac, lumbar fasha. If you look at anatomy illustrations, that’s that diamond shape structure that sits in the low back usually illustrated in white, which is a fossil structure. If you’re doing dissection, it all looks the same.

But for illustrations they really highlight that diamond shaped thera lumbar fasa. , which looks like a sheet Thac. Lumbar faia is an asis, which means it’s a wide flat tendon, but those illustrations don’t quite highlight the multi-dimension, multi-layered quality of the thoraco lumbar fasa.

We wanna zoom into a particular part of the thoraco lumbar fasa called the Lateral rap. So let’s look at that structure on this illustration. I have my pointer here, so I wanna highlight this portion of the Thoraco lumbar fasa. That sits over on top superficial, maybe I can say posterior to the erector spinna.

So here’s the erector spinna muscle group part of the urinary bladder channel as we start talking about the channels. So that layer of the thac lumbar fasa is what you’d see in the illustrations. That diamond shape structure is what sits over the erector bna, but there’s another component of it that goes deep to the erector bna between it.

and the quadratus lumbo. So there’s names to all this. We don’t have to get too Huang up on that. That’s the posterior lumbar fascia that sits on top of the erector spinna. It’s the middle lumbar fascia that sits between the erector spinney and the quadratus lumbo. There’s another layer that goes in front of anterior to the quadratus lumbo.

Some models talk about three layers of that Tharco Mumbar faa. I think most of the direction it’s going now is that. More anterior layers considered a different fossil layer. It’s different embryologically. So I kinda like this two layer model of the one that’s superficial to the erector bna in between the erector bna and the quadri lumbar very deeply integrated with both of those muscles.

So the lateral rap is that seam, that meeting point where those two layers come together, or I guess if you’re in a three layer model where those three layers come together, but we’ll stay with the two layer model. So there’s the lateral rap. It’s at that lateral edge of the Quadra slum in the erector spin aid.

Deeply integrated with both of those muscles. If we follow that fossil structure going more around the body, that links up with the abdominal layers, especially the internal obliques and the transverse sub Dominus wraps around to the front forms another seam where those fossils layers come together.

This is referred to as a semi lunar line. Just lateral to the rectus abdominus part of the stomachs in new channel. So rectus Abdominus, deeply integrated with the lateral rap and deeply integrated with these two structures that are part in, in linked with the lateral Rafa urinary bladder sinu channel, the quadri slum part of the liver and kidney Sinu channel.

So a lot of channels going on. We’ll come back to that and look at it. But I just want you to have an appreciation at this moment for how this lateral rap communicates with a whole ton of structures in the low pack, a pivotal point. It’s like a lever that everything attaches to and communicates through and helps coordinate movement, helps the body know when the quadri alarm contracts.

The rectus of Dominus knows that, and it can link its contraction, link, its activity with it. So all of those structures can work together through the lateral Rae, through the mechanical pole of the lateral Rae. So we’re gonna look at movement to highlight that, but let’s look at a quick video that’ll show some palpation, some acupuncture ideas, some manual therapy ideas.

So for those acupuncturists who are wanting to link maybe some prescriptive exercises for their patients, With their acupuncture and manual therapy treatments, this will help with that. So we’ll go over, look at a video and then we’ll come back and start doing some movement.

Palpation of the low back can be complex. One of the key unifying structures to consider with palpation is the thoraco lumbar fasa. , especially a region within it where the abdominal fasha wraps around and joins with the lateral rae.

The lateral rap is a fasci seam at the lateral edge of the erector spin in the quad slum. From here, the fascia splits and goes superficial to the erector spna, and the other layer goes between the erector spna and the quad slum. It’s a pivotal part of the fassal system of the low back as it moderates forces such as side bending, rotation, inflection, and extension.

Start by finding the lateral edge of the ilio costal luum. This will be your window into the lateral press on the lateral edge of the ilio costal towards the quads.

From here I can palpate more superficially towards the erector, spiny, or change my angle and press towards the quad slum. I’m looking for areas of maximum tension. I can press towards the 12th rib or press down towards the iliac attachment again, looking for regions of maximum tension.

At the lateral, I can mobilize by lifting and decompressing, or I can press and de rotate the tissue. I can also apply a shearing force either up or down

for acupuncture. I need to transition from my palpating hand to my needling hand. I need to press and find the region of maximum tension. Assess the angle, put the needle in the exact angle, and then advance the needle to the depth that I was palpating.

I can use a lifting and thrusting technique until I find the region right there where there is a ation.

You can also palpate partial structures in the front of the body as they relate to the low back. The fasha from the abdomen wraps around to connect with the lateral in the back, but it also continues as it wraps around to the front to the semi lunar line. And then a portion of that fasha wraps over the rectus of Dominus and another portion of the fasha dives deep to the rectus of Dominus.

From the semi lunar line, I can press into the rectus abdominus and feel for Todd Bands within this muscle. I can move slightly up palpating across the bands of the rectus Abdominus, looking for areas of maximum tension.

I’m also looking for regions that might refer back into the low back.

From the semi lunar line, I can press into the rectus of dominance, feeling for depth, transition from palpation to the needle, and then advance the needle in the same angle to the depth that I palpated. And there was a culation.

Due to its strong foal connection, reducing tension of the rectus of dominance will translate to reduced tension in the back since the wraps around and unites at the lateral.

All right, so let’s look at some movement for that. We’re gonna be looking at, like I said, four movements from eight pieces of brocade. Maybe we’ll run outta time and just do three movements. There’s three main ones I wanna cover, but we might get to a fourth one. But I want you to have this idea that we’re working with the channels when we’re doing particular movements, when we’re doing more expansive movements where the body’s opening.

Lifting and stabilizing. In the core, we’re primarily using the shall the tie y and shao yin channels. I guess for low back we’d be primarily looking at urinary bladder and kidney in channel. But for this first movement, we’ll also be using small intestine and heart sinu channels, especially small intestines in you channel.

So we’re using whole body exercises to really zero into this area of the lateral Rafa and improve back health. We also wanna do some compressive forces using the, a lot of the abdominal movement. So y young Ming Tain channels specifically for low back. We’ll be thinking about the stomach and spleen sy channels, and then the Shell Young Jok channels are gonna have much more to do with rotation and with side bending movements.

So we have some expansive aspects, some compressive aspects some rotational movements and some side bending movements. All to be able to work. Paul on the fasha, Paul on various muscular structures, the Paul on the fasha of the lateral rap, and improve that communicating and supporting nature of that structure.

These are something that I work quite a bit with in Zoom class. I teach eight pieces of brocade and some other Qigong and strengthening type exercises. So if it’s something you’re interested in, feel free to get in contact with me about that. We’ll be covering at least a good portion of those movements here.

So last thing and then we’ll go to movement is I do have a series of online classes that I teach with Matt Callison as part of the sports Medicine acupuncture certification, but also just the some some smaller classes on actually the Quadra Andor, which covers a lot of this information that we’re talking about in the lateral rap.

We also have a class on the, so ads. Both of those ha are. Linked and will be some crossover information from what we’re covering today. Not as much the Qigong movements, but some of the anatomy and the acupuncture manual therapy ideas. So I think I’m done with the PowerPoint. I’m gonna move it.

We’ll go and get set up for some movement. Gimme just a second. And there we go.

All right, so I’m gonna back up, get into position. So we’re gonna start with, let’s start with a movement. It’s actually the second move in eight pieces of brocade, and it is called Drobo and Shoot Hawk. It’s gonna highlight much more of this opening, expanding aspect where we’re stabilizing and getting a lot of core strength.

This movement, innate pieces of brocade actually specifically is discussed as working with the kidneys. So we wanna get a lot of movement in the low back so that the kidneys can roll and move along the SOAs, which is what they do, but it’s also gonna start opening. And expanding that lateral rapha on both sides.

So we’re gonna start this movement in a wider stance or stance. There’s gonna be a lot of aspects of compression to give us full range of movement, so we can come outta that compression and expand. Just to give you a quick summary of that, or maybe you can try this with me. You can put a hand on the lower ribcage, another hand on the low lower Dion, just below the belly button.

And I wanna have this sense that those two come together, which means I need to tuck my pelvis under a little bit and bring my ribcage down so that there’s a compression. If I were to look at that from the side, I’m not leaning forward, I’m compressing. So that’s position one. Then as I come out of that and start to expand, I want to lift the chest, neutralize the position of the pelvis as I’m opening and as I start opening the hands, which I’ll look at in a second, there’s gonna be a tendency for the pelvis to go into an anterior tilt.

So I have to support with my kidney sinu channel, part of the core structures of the body to keep the pelvis neutral, keep the expansion, keep the decompression of the spine. So position two, we’ll look at it with the arms in a second, but it’s expanded. So we’re going from a compressive position to an expanded position.

So primarily using in the urinary bladder and the kidney channels to expand. So I’m gonna come back to facing the camera. Hands are down. I’m gonna compress. Hands are gonna come up the midline. One hand towards the opposite shoulder, almost like a boxing position. Then I wanna open like I’m drawing a bow open, pull the chest open, chest faces forward.

Elbow of the straightening arm faces down, so I have to externally rotate, broaden the chest, straighten the body. Hands come in, compress

and back up. Go to the other side. Compress hands come up the midline, hand to the opposite shoulder, like I’m drawing a bow open. I have to expand, lift the chest. Turn the elbow down towards the floor, open the chest, straighten the body,

hands in and back up

again. We’ll go a little faster this time. Hands up the center line of the body opposite shoulder. Straighten the body, pull the chest open, drop the elbow, broaden the chest. Everything’s straight, hands in

and back to neutral. So the diaphragm actually attaches to the lateral rfa. At least it has fossil communication. So let’s see if we can put breathing into it. So I’m gonna start here. Neutral. Inhale

hand to the opposite shoulder. Exhale, pull open.

Elbow faces down.

Inhale, hands come in.

Exhale, expand.

Inhale.

Exhale, helps you create force. Open, expand, lift, chest open, inhale, everything comes together.

Exhale. All right, quick thought about the breathing, and then we’ll move on to another move. So you might find the opposite of what I said. So breathing, I don’t get too Huang up on. I know it’s talked about a lot in Qigong. It’s definitely important for low back health because things like the rated slum, lateral rap are deeply integrated with the diaphragm.

Interestingly enough, in some places you can get your 12th rib removed, completely cosmetic, creates a streamlined waste. Some people go, I think you can get it done in Mexico and not recommending it. But the idea when you do that is they cut the rib at the spine, tease the fibers away, and pull the rib out.

And what you’re left with is that seamless continuation of the quadr and the diaphragm. . They don’t have to cut the diaphragm and cut the QL and sew ’em back together. They’re already together. You just have to tease the fibers away from the bone, bring the rib out, not recommending it. But I want you to understand that, to have an idea of how integrated those structures are.

So breathing’s important, but breathing’s also really tied into our core. So if we don’t have the tone in the transverse sub dominance, maybe it feels odd to have that inhale when I’m compressing. and that exhale as I’m expanding. So maybe you have the opposite. No problem. The idea that you’re linking the breathing to the movements good.

Over time, you might find that it changes and you can have it more like I’m telling you in this particular demonstration. But the breathing can be flexible, so you want it to feel natural. All right, so draw, bow and shoot Hawk. We have that opening expansion. Everything’s lifted. Elbows down, so we’re engaging at the shoulder, but we have a lot of movement in the low back to be able to work with the low back pain patients.

Let’s look at another move. This is the sixth move in eight pieces of brocade. It’s called turn head and sway tail. This one will have a lot of rotation and it one of the key movements that we will have for a lot of people with low back pain sake. Reac joint pain. Just multiple types of low back pain facets, trigger points in the quadri slum trigger points in the rectals, pna, et cetera.

It’s gonna involve much more of our liver sinu channel and our gallbladder sinu channel. So those rotational aspects are very pivotal. Pivotal for a lot of low back movement. I’m gonna keep this horse stance. You might find a little narrower works for you. I need to bring myself down. Hands on the knees, if that’s challenging for you.

You can be up a little higher, but I’m gonna be down at the knees. My fingers are on the inside of the thigh. Thumbs on the outside of the thigh. I can spend a moment to get the back comfortable. I have that hollow body curved back. I’m not leaning forward, so my hole from the pelvis up to the spine’s curved.

Okay. First thing is I want to turn my whole body hips low back up through the chest, shoulder girdle. So turn, lift the chest. Imagine I have a little beam that I have to get under here and I have to roll under that beam compress turn. Lift the chest up under that beam. I have to let the spine curve duck under lift.

Chest up. Common mistake. Is I’m just turning my shoulders and cranking the neck around. I wanna turn at the hips. If I’m doing it correctly, I should feel one knee slide forward just a little bit. As this hip opens up, this other knee pulls back. I keep the structure, I’m not collapsing, but there’s movement in the legs as one turns that’s gonna transfer to a turn in the legs.

So we’ll go back down. We’ll do it again. Keep that in mind. Do you wanna turn the hips, turn the spine, turn the torso and ribcage, turn the shoulders. So it’s equal turn coming all the way up the body. If you do it properly, you should even feel it in the feet. You should feel that rotation. Drop into one arch, lift the other arch, and then as you go the other way, it changes.

So again, we’re gonna come down

spine’s, curved. I have a hollow body. I can warm up, get comfortable in that position. Fingers on the inside of the thighs, thumbs on the outside. Something I need to get under, like a beam or something. So I can duck under that. Turn from the hips. Turn from the low spine, lift the chest. Rise. Part of me stays down.

Another part of me comes up underneath.

Turn

left

underneath. Turn

left.

under turn lift. So this one in eight pieces of brocade, they actually talk about working on the lungs, which it does. Also, if you look at the upper body, you can talk about that another time, but I’m thinking of that rotation and how that’s integrating with the low back. All right, so turn head and sway.

Tail challenge of that one is leg strength. You have to work on it to where you’re comfortable in that position, but really an excellent move for low back problems. Next one. Let’s look at, this is actually the first move of eight pieces of brocade. This is called two hands, left to heavens. We’re not in a horse dance.

We’re gonna be shoulder width stance.

Hands are gonna be overhead, so I’ll be reaching up. So I’ll give you an idea of where I’m going with that. Not much happens with the lower body. I can start with my hands out. This one works with the San organ. So we’re looking at triple burner san gel, but it also works quite a bit with the gallbladder sy channel, as you’ll see.

So hands curve up. My whole spine is slightly hollow.

Point the hands towards the ceiling. Lift the chest optional as I can come up on my toes. Fully stretch up. Hold for a second. There we go. And then back down.

Turn to the side. Her bend to the side. My chest faces forward.

So definitely stretching the lateral on the side that I’m bending away from back up. Now I’ll compress the lateral on that same side that it was stretching a second ago. Obviously stretching on the other side.

Back up.

Chest relaxes, spine bows, chest rises. Okay, do it a few times, but let’s look at where people tend to. Get a little off on this move sometimes if they don’t have the flexibility to pull the chest back to pull the shoulder blades back in particular, I should say. Then when they go to rotate, they turn so they turn what should be a side bend into flexion, A different move.

I wanna keep the chest facing forward and side bend. If I need to compromise the straight arm position, no problem. I can have my arms down. That might help me keep my arms open, my shoulder blades together. But I want to get up as high as I can comfortably without distorting the move. So you want nice, clean side, bend stretch.

Stretch. So it’s like fabric being pulled. The minute you start going into deflection, then you lose that. Okay, so hands down,

exhale.

Inhale, chest lifts.

Keep the chest lifting. Exhale, fully stretch. You don’t have to straighten the arms. That’ll be individual. Then down,

exhale, side bend.

Inhale back to the center.

Exhale, side bend.

Inhale back to the center.

Chest relaxes

and up. One more time. Inhale, compress everything slightly curved. My hands are going up only because my chest is going up. Chest is rising. Chest is rising. Exhale up on the toes. You don’t have the balance for that. No problem. You can skip that part. Inhale. Back to the center. Chest open, neck, relaxed,

exhale, side bend, stretching all the way through the hip to the feet.

Inhale to the center

and exhale.

Back up.

All right, so we had draw, bow, and shoot hawk. Working a lot with the tissues, a lot of movement in the low back to work on the structures we’re talking about, but there’s also mobilization of the kidneys as we bend forward, straighten up, those kidneys are able to rise and fall and we get a nice little massage on the kidneys.

Very important for back health. We had that turning one turn, head, sway tail. A lot of movement in our liver. Also really deeply integrated with the low back lateral rap, quad slum. So there’s a lot of rolling and moving of the liver. I guess we could say. The other side also the spleen, not sure with webinars, sometimes you get a mirror image.

So this is my left side spleen, this is my right side. I’m not sure if it’s s playing that way on your screen. . So a lot of movement mobilization of the liver side bending. We also get a lot of mobilization of the liver and spleen cuz the liver’s able to rise up, the liver’s able to come down. So lots of movements with structures that are deeply integrated with the low back.

This next one really works a lot with the stomach. So this is separate heaven and earth one hand down. , one hand points up. My wrists are on the midline. I can only get up so far where my chest is up before I need to change, and I can change just by letting the hand turn towards the opposite side. This hand pushes down.

This one turns a little bit and back down. Chest bow slightly. Spine curves, chest opens as my hands pass.

Exhale, stretch. Inhale together.

Exhale, open and stretch.

Inhale

And exhale. Okay, we’ll do a couple more times, but I wanna show something. So it’s like a washing machine for the stomach. As one hand moves, they get this little kind of movement through the center to help mobilize and turn the stomach integrated with the abdominals, integrated with the low back. So as the hand lifts a little bit more, that’s gonna pull the ribcage up.

As the hand pushes down, that’s gonna push the ribcage down. So I get a little bit of side bend, but I’m not side bending, so to speak. Just pulls me into a little bit of a position of slight expansion on one side, closing on the other side, then neutral. So don’t side bend, but just let the ribcage move. So as I get farther up and I continue to stretch, I get that little bit of expansion on one side, little bit of compression on the other side, and I’m able to move the lower ribcage, move the stomach, move the 12th rib, move the lateral expands on one side,

compresses on that same side as it starts to expand on the other side.

Okay. One more time each side. Chest bows. Chest opens,

chest bows, chest opens.

Chest. Those chest opens.

All right, very nice. So all four of those exercises move the low back in a different way. None of ’em are extraordinarily. Stretchy we stretch pretty decently on that. Two hands lift, the heaven, the side bending, but they’re mostly just moving. It’s like a stretch, compress, stretch, compress, engaging structures, relaxing structures, engaging structures, relaxing structures.

Those are the types of things that really help. create a gentle mobilization of the low back in a way that really improves the flexibility, elastic elasticity, and ability to stabilize for the fossil system. Especially things like the lateral rap that are so integrated with the front of the body, with the back of the body, with the core of the body.

With the rib cage and with the pelvis. So it’s of a lever in some ways that helps integrate movement between all of those structures. And we wanna be able to take it inflection, extension, side, bending, rotation, so each of those offers a window into one of those particular movements so we can be holistic in our movement of the low back and improving health of the low back.

All right, I think we’re good. Good timing. Four more moves, maybe another time. But also, like I said, I have some Zoom classes. You’re welcome to, to come into those. If you’re interested, just shoot me a message. But those four movements I thought were really key for low back health, simple to apply, easy to give to patients.

I work with them quite a bit. I use ’em myself. They’re great exercises. So thanks again to the American Acupuncture Council. And maybe another time we’ll cover the next four moves.

The Acupuncture Wow Factor – Lorne Brown

And so the Wow factor that I’m talking about is for your patients to have a shift on your table and experience a shift so that they are able to relax and therefore have the trust and confidence to follow your treatment plan.

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Again, thanking the American Acupuncture Council for this opportunity to share with you my colleagues. My name’s Lorne Brown. I’m a doctor of traditional Chinese medicine. I’m a clinical hypnotherapist. I’m also a C P A. I’m a certified professional accountant, and I wanted to talk about the acupuncture Wow factor.

And I’m gonna set my intention that this will be simple and yet powerful and effective. That comes from the Einstein quote that make things as simple as possible but not simpler. Meaning let’s make it simple so we, it’s easier to implement, but we don’t make it so simple that it loses its effectiveness.

And also my intention is to do a small sound bite here. So you can just take one concept or one idea and run with this in your practice. I have found that sometimes the things that. Help practitioners be the most successful, are the most obvious, but yet they’re not obvious until somebody brings it to your attention, to your awareness that you’re like, oh yes, I want to intentionally do this.

And so the wow factor that I’m talking about is for your patients to have a shift on your table and experience a shift so that they are able to relax. and therefore have the trust and confidence to follow your treatment plan. Now I’m gonna unpack this for us, and I’m gonna talk about this from, I guess materialistic and quantum level here.

So when we have resistance, then we block flow and receptivity things that happen for us in life. And you’ve probably experienced this, where sometimes you just have flown receptivity, synchronicities are happening and things just seem. Easier. They just happen and flow for you as if there’s these invisible hands coming down from the heavens and opening up doors you did not know existed.

You’re probably also aware where you’re putting effort and more effort and the more effort you do, it just seems the higher things get and things just aren’t easy and there is no flow. And on a quantum or spiritual level, when we have resistance, we are blocking. This receptivity and flow, we have a beautiful term for this in Chinese medicine is called cheese stagnation.

In conscious work, I often hear it call as resistance or friction. And this ties into our patient’s ability to heal because the body has this beautiful, innate ability to heal. And I see my role as a practitioner, as a facilitator, I’m not healing, I. The person in front of me. We are learning more and more through really cool research.

Again, quantum physics level research, that it seems to be that it’s the patient’s need that determines the healing. And we as practitioners have to be that clean vessel. But we are the facilitator and even our nervous systems, our parasympathetic nervous systems, our subconsciouses. They’re syncing up.

They’re doing this through FMR, F M R studies where they can see that the nervous systems are syncing up beyond our conscious awareness, and there’s a healing, an exchange of information that happens. And we use our needles sometimes to do that exchange for information. So the wow factor for us now, I want to unpack this and go back into this patient’s innate ability to heal.

That if they have resistance, they’re not sure if you can help them. They’re not sure if it’s worth their money. There’s that trust issue. Do I really believe this? Does acupuncture work? Work? You know what the skeptics are saying, what conventional medicine’s saying? , all this can get into their psyche and disrupt their ability to receive and have flow.

So disrupt that innate ability to heal because that placebo impact, which has such a bad rap placebo, is not inert. We know this in 30% of Western trials, sorry, in Western. Random controlled trials. Sometimes it’s common that 30% and up to 90%, but it’s common 30% they attribute to placebo. From a Chinese medicine perspective, or at least from my perspective, what we are doing is engaging the individual’s capacity to heal.

They have this innate ability to heal. It’s amazing how we try to dismiss this, but I guess from our materialistic perspective, from conventional medicine, we have that ego that we’re doing the healing , but really it’s the individual. They take the medicine and through that medicine, they incorporate it in heal or through our needle or through our communication.

The healing process starts the acupuncture wow factor to allow the resistance to be lowered. So the patient is in that state of receptivity and flow to really accelerate and accentuate the innate ability, heal. That healing process comes from them feeling an a, an experience, a shift on the table. And so I’m gonna give you at least two examples here, and I’m thinking of recent lectures on healthy seminars.com, where I hosted in one week, both Pony Chung and David Uler.

It’s actually pronounced Oiler, but spelled Uler . David Uler, you probably know him if you read his name, but David Oiler and Pony Chung and their style of acupuncture gives the patient this incredible shift. On the table that even if they don’t have resolution on the table in that one treatment, which is, let’s be honest, it’s we don’t get that resolution for chronic conditions in one treatment.

But because they experience that shift, they now have that ability to have trust and confidence to follow your treatment plan. And it’s been my experience in my own clinical practice using their style of treatment and also call my colleagues that. Patients then leave the treatment room and book their 12 to 15 treatments in that two to three month period because of the experience they had on the table.

So when I talk about shift, let’s bring up David Jeweler first as a concept, and then I actually have a video demonstration that I have with Pony Chong that I’ll share with you with David Yuler. He does palpation based acupuncture. He study with Kiko, Matsumoto and her teacher, and it’s a really cool style of somatic acupuncture where you’re palpating tender spots on the body and based on those tender spots, those are called reflex zones, you needle other areas to release the tender spot.

And by doing so, that experience for the patient is an aha moment. So I’m gonna share a story with you, for example, and I’m gonna do the David Oiler idea of palpation, how this works in the treatment room. But here’s one of my. Own clinical stories and I’m gonna share one about Shen disturbance that David shared recently in his lecture.

This woman came to me after two, two months post C-section delivery of her baby, and she had poor quality of life because of the incredible lower abdominal pain that she had since the birth of her child. And she went to back to the surgeon, the gynecologist. They ruled out any infection they ruled out.

anything left inside and they just said, there’s nothing going on there. There’s nothing they can do. Obviously, she didn’t want to take high dose or pain meds because she’s breastfeeding. She had saw massage. They had referred her for some physio for post-surgical to help. Nothing had helped over those.

Two, two months. She came to my practice. She knew of me because I actually was the practitioner that helped her with her infertility, and I guess we have branded ourselves so well at fertility that because she wasn’t trying to get pregnant, she didn’t think to come back to my clinic until later say, do you think you can help me with this?

It didn’t even dawn on her that maybe this is something we can help. . And so she came into my practice with her lower abdominal pain and right away I thought about the tsu. And for those that are not familiar with that term, it’s basically a reflex zone for blood stasis. And when you have this, it can wreak havoc in the body.

Cause remember, it’s a system and we have a serious stagnation. It inf it interferes with the flow and receptivity. And I press down on her tsu and she’s oh. Like incredible pain. And so after pressing in on the tsu, I go to the distal points that are used to relieve that. It’s just two acupuncture points.

And I hold my little device, just the tube of the needle actually. And I try different angles on liver four and asking her as I palpate, does this reduce this pressure? Pain? And she goes, oh, you’re not pressing as hard. So she thought I was trying to fake her out because. She went from like a 10, outta 10 to two outta 10, and I said, I’m pressing the same.

How about you press so you take my hand and you push down? So she took my hand and pushed down while I used the handle of the tube. No pain. So I go ahead and I needle those points. I also noticed that her immune reflex was really sensitive, so I did the immune points and a week later I did follow up with her and she was immediately at that treatment.

90% relief. So she had 90% relief immediately after that treatment, and one week following, she still had 90% relief from that treatment. That’s where somebody like that now refers anybody and everybody to the practice and any plan that I would have for her. She is more relaxed, as in con, has the confidence trust in me.

One is she had relief in her symptoms, but I’ll share with you that even if the symptoms aren’t relieved, when they experience the fact that I can palpate an area, a reflex zone and then needles somewhere else, and then that zone is gone, they see that it’s doing something and it gives, it inspires them to now follow your plan.

In his course also, he talked about the reflex zone and the sternum for anxiety and shen disturbance. And there’s points that we do on the back for this. And there’s points that we do distally for firepoint on the pericardium and heart channel. We test the fire points to see if they’re tender as well.

And then we use metal and water points. To relieve that. And again, when patients come in and they’re really anxious, so the difficult trusting cuz they’re sympathetic. They’re sympathetic, is on high alert, that means can’t trust, right? They’re rarely cautious, paranoid, almost really feeling worried and anxious, palpating the sternum and it’s tender for them.

And then going and touching reflex zones on the back. And then if that relieves it, great. If not, then I go to the fire points on the palm and then I check the acupuncture points. And if that relieves it, you can just see the melt on the table. So that’s my example as a shift on the table. And so learning styles by like David Yuler is a way to really grow your practice.

Now, I was trained as what I call a barefoot doctor or Zg Fu acupuncturist, which I think many of you have been trained as well, meaning like if you have blood deficiency, it’s stomach 36, it’s red 12, it’s spleen six, bladder 17. Really? These are my herbalist, acupuncture herbalist from China teaching me acupuncture and.

Because I host healthy seminars. I’ve had the privilege and the opportunity to witness different styles of acupuncture and realizing that there is a really deep history and style of acupuncture more than how we were trained in TCM schools, where you can get really good results. and also there’s that impact on the table.

And so David Oiler is one of those examples of studying with him and being able to just palpate some points, relieve them right there, that first treatment in 20 to 30 minutes with that treatment, and then they continue on for their condition because they’ve seen such an experience of that. Plus, they also are getting resolution for what they’ve come in for.

Let’s talk about Pony Chong. Another style of acupuncture and where they’re in common is he shows a shift on the table. And in the video that we’re gonna bring up is from a lecture he did recently in our community library. And what he’s demonstrating is he’s doing a, an acupuncture point, spleen 12, and he talks about.

In the Canon and the classics, just where it travels on the Sinu channel and how it impacts what muscles, what ligaments went tendons basically in modern day. So he can treat certain conditions in the lower extremities and he’s going to needle the point. And then he tests the point with a pointer plus, and he does this because of two reasons.

One is when you. Test it. It lets you know you’re in the right place, cuz I’ll share that sometimes we always have the right intention. This is where I think SPLEEN 12 is on this individual based on landmarks. But Pony has shown through his style of acupuncture that it’s reproducible, that you can be really precise based on reading the description of what this acupuncture point does on a muscle skeletal level.

And seeing that muscle shift or move or fsic. When you touch it with a pointer Plus from the patient’s perspective, it is a wow factor because they know where their pain is in whatever their leg, and when you put a needle in and it co and they feel that sensation going down, that whole muscle, they now have the confidence that you are in the right spot.

The second reason it’s so important that I went on a quick tangent there about the patient’s experience is sometimes we have the right intention of where we think the point is, but points actually drift. They’re not. The same based on the book location on every individual, there’s a little bit of drifting and pony style of acupuncture.

Teaching shows you that you can actually get exact and know that you’re in the right spot by testing the needle. And I have to share when I use this in my practice, sometimes I have to reinsert the needle two or five times to get it. But now you get better results because originally my intention was this is the right spot for this point, but I can test and show whether I’m really in that spot or not.

This is also gonna be important for research to make research reproducible. Now we know we’ve given them the right acupuncture point for where it is in their body, and so this wow pa factor is crucial in having patients relax. So lowering the resistance, having confidence and trust to follow your treatment plan because they experience a shift, that first treatment, not let’s treat you for the next.

10 or 12 treatments and see if there’s a shift, and then we’ll reassess they believe after that first treatment. So let’s bring up the video. I’ll share with you the first five seconds, the volume’s low or 10 seconds, and then it kicks in. And this is just a discussion that I was having with Pony in one of his community lectures while he was demonstrating this idea of testing a point and how the patient experiences this.

So please bring up that video now.

And pony, this is what I mentioned in our introduction. If you could just go back to that video for a moment. Okay. That when patient experience a shift on the table and in this case when needle, when pony needles, the point and then he stimulates it with his pointer plus the structure of the leg. The muscles watch the leg move in the bottom left eyes, watch the leg move.

Confirming he’s in the right location cuz it wouldn’t move he was in, if he was in the correct. Two things happen. One is he has now accurate needle location because we have good intention and we say we’re putting it in SEN 12. We put the intention, but PONY is showing that there’s an actual real spleen 12 for each individual, and it can drift a bit from how it’s described in the book and based on the person.

And he’s confirming that he has reached spleen 12 based on what he’s seen in the leg. So a for effectiveness preciseness. Two is the patient is seeing what’s happening, she’s late leg and it just her leg gives them the confidence and trust to then pretends machine on the needle lake move. And that’s why I invite you to check out PONIES courses in the library and then really do a deep dive and he has those courses on demand so you can learn how to do this in your practice.

Thanks. No problem. Yeah. Thank you for Lorne. Thank you for mentioning the way intentioned to, that’s something I emphasize a lot when I teach the course is that we taught that, okay, you have to have good intention, right? And then, and your intent drives the cheat. Okay? And so drives the, your cheap, but also to the needle.

You drive the patients cheat. But that’s pretty much the end of the education. I got an intention, it just. But extreme attention’s the same. But the way I see it now, based on my experience in all my research, is that there’s a different intent for each specific point, and now you can predict and agree on that intention if you understand anatomy.

So for example, here, screen 12, the anatomy is the femoral neurovascular bundle. So the intention that we, when I have, when I come to Neil’s point, is that I want. This to activate the quadricep muscle, and if I apply electricity to that, it’ll activate all the quadrant muscle in the new extent. Okay? So it could be a sensory nerve in, in which case we know what that nerve travels, the duchess sensor should be felt to that area.

It’s not a guess word. You should know exactly what that intent for that specific point should be. and know if you got it or not, based on whether it moves what it should, ghost by sensation where it is. So then your intent is actually very clear and precise and it’s not just assuming that intents the same, it’s not just all heavy achy sensation e everywhere, anywhere.

Okay. But also coming back to, to like the buy-in the wow factor, patients are gonna remember. The times that you don’t succeed. But when you, if you tell them, okay, I’m needling this, I’m checking this. I’m, they don’t know what’s what they’re supposed to see, right? Only you know that. But you tell them that I’m, the reason I’m doing this, I’m checking to make sure I’m precise, but you stimulate it.

You tell them, you may feel a sensation going down the top of your quadricep. You might feel a little contraction in your muscles and quadricep. And if you say that and you try it, and if it’s one of those, one of those times that you succeed, they feel that’s instant. Because that’s pro, that’s in a way prophecy, prophesize what’s gonna happen.

And then it actually happened. More average mortal human beings don’t have the ability to prophesize. So that makes you different, that you can do something and make it happen. Exactly what you said, it’s gonna happen. They’re not gonna remember if it doesn’t happen, but they damn remember it when it does.

And that is the wow factor that Lorne is talking about before their. You’re even done treating them. It’s the first treatment. They haven’t solved the result yet. They’re already asking, do you treat this for my brother? Do you treat this with that? Okay, this is from my personal experience.

So I like his term, the prophecy. So you’re prophesizing for the patient and then they experience it. And that is a wow factor. And like he said, can you treat this? Can you treat this for my family members? Because you’re able to predict what they’re going to experience. And so from a practitioner with integrity intention, you’ve got the accurate point.

So you, you want the results, so you know you have the accurate location and then. From the patient’s perspective, they’ve experienced this prophecy on the table, which gives you that guru status and why some practitioners are constantly looking to fill their practice. And like others, like my practice, I usually have a two to three month wait list because of that Wow.

Factor on the table. And then when you learn from like a David Oiler, Or Red Yuler, but pronounce Oiler or Pony Chung. They give you language too to help with the prophecy. So going back to David’s talk where I mentioned he, for anxiety, he’ll palpate the typical area on the sternum. And when I go and palpate these reflex zones and they’re tender, and then I needle elsewhere, and then those reflex zones go away.

That’s the prophecy, cuz I’m telling them that if we can remove the blockages in the body that are preventing the innate ability to heal, if we can lower the resistance and bring back chief flowing, your body will start to heal regardless of the Western diagnosis. I just gotta remove some of these disturbances in your biofield and that is why I think.

To my colleagues that studying with Pony and David or having that wow factor where a patient experiences your prophecy in the treatment room cuz they experience the shift is important. And the last thing I wanna share for a wow factor, or just what I have found in my 20 plus years, sometimes complicated cases come in.

And I have to remind myself that it’s not my job to fix the patient, and if all I do is listen, really listen and let them know I hear them, then the healing process starts as well. Remember that there is something, and we’re this is being studied, that we know that there’s communication through our facial expression, our eyes, pheromones, and even biophotons light and packets of energy that are.

Transmitting between us that we now know that there’s information being exchanged. And what we’re noticing is that when somebody feels really seen and heard, that lowers their resistance as well. They start to relax, the flow starts to come back, and the healing response is engaged. And so really taking time to listen to your patients.

Let it Showing compassion that you understand and get what they’re going through with is really important as part of the healing process. So really making that time to hear them feel, understand, they feel understood. That lowers the resistance, and again, on a unconscious level, not something that you’re doing or they’re aware of, something is happening between the two of you.

Something has been triggered and there is an exchange of information. Add onto it when you do your treatment and you can prophesize that. When I palpate here. Anywhere there’s certain, there’s points all over the body and they’re tender. And I needle elsewhere, and that tenderness goes away. Then we have lowered the disturbance, the resistance in the body, which will support its healing.

I will share that when I was at the Society of Acupuncture Research Conference, one of the presenters there shared her research where they have. Shown a, what’s the word? They have shown that when there’s organ issues that down distally in the fascia that there’s disturbances. So tender points or even nodules or gunness happens.

So they’re sharing that this is happening. And when I heard this research, it made me think of David Oilers palpation based acupuncture style, because that’s their style is going along the channel and palpating these points. And if they’re. Tender. Then there’s other points to needle, to reli to relieve that tenderness.

And what I suspect is happening is we’re lowering the disturbance in the body, the resistance, and therefore the channel flow becomes free. And then the organs become healthy and the organism us become healthier, and so I just wanted to share that with you. Lectures by both Pony and David are available on healthy seminars in the community library.

They also have C E U proof courses on healthy seminars.com in that area as well. and a good way to just find out what I’m up to. If you like this Quantum idea and biophysics, do check out just my website, Lorne brown.com. Then you can see information about my practice management book. You can hear about my Conscious Fertility podcast, things that are doing at Healthy Seminars.

I created that website cuz I like to do a lot of things. And I decided to create that website so you can find everything in one place. So Lorne brown.com is to just go where everything is, aggravate is collected, and then healthy seminars.com is where the continued education, the community library, the mentorship, and the online learning is for healthy seminars.

So I hope what I shared with you is simple. For you and you’ll find it powerful and effective. It’s been my experience, my colleagues, and for the patients. They have found it powerful and effective. And I wish you the best of luck in your practice. I do believe we need more prosperous acupuncturists because we need more of people like you working in the C communities to help heal our community.

Cuz the world needs lots of healing and this starts with healing ourselves. Obviously. I want to thank the American Acupuncture Council again for this opportunity. To share some of my clinical and business pearls with you.

Are You Practicing in a Vacuum? Nell Smircina

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Hello, and welcome to another episode of To The Point. I am Dr. Nell with American Acupuncture Council. Thanks so much for having me, and let’s go to the slides.

Hey, we’re gonna be talking a little bit about this idea of practicing in a vacuum, and we pose this as a question, are you practicing in a vacuum? But I feel pretty confident with the experience that I’ve had in this industry to let you know. You might be. We are mostly sole proprietors. We’re thrust out of school and pushed into being small business owners.

A lot of times the mechanism of practice setup is, all right how do I figure out how to afford to rent one room and then scale to two rooms, and when do I get to a. Point where I could bring on an admin assistant or an office manager or another practitioner, and sometimes we don’t even have the time or the bandwidth to look at strategy around this.

And what often ends up happening with this mechanism of getting into practice. We forget about all of the resources around us. The resources that we could be leveraging outside of the four doors of our treat or the four walls of our treatment room, and really say to ourselves, all right, like, how do I leverage these resources around me to grow my business, to be more successful, to welcome more patience and.

To even have resources available that I don’t have to create on my own, whether it’s marketing collateral education resources for patients or for other providers. And so we’re gonna talk a little bit about those industry resources that we should be leveraging today. So first, we have to address the misconceptions here.

Again, we have our tunnel vision. , we’re focused on patient care. We’re trying to figure out how to afford everything and how to grow and how to scale. So a lot of times this mindset that there’s no infrastructure already set up, can creep in. Maybe we’re only familiar with our school. or the school alumni network, if your program even has a viable alumni network available to you.

And so we don’t think about what’s already there, what’s already set up that we can be leveraging. There’s also a lot of confusion around regulation versus advocacy. So what are these different players in the game and how do we fit into that equation? And this idea of limitations to involvement with that.

So we might see these big groups out there and think, oh, we’re divorced from them. They’re so far away. They’re a regulatory agency, or they deal with advocacy and that feels a little too far from. Me and my practice. And just to tell you that’s not true. There are definitely ways to be involved.

And we actually did another show specifically around leveraging advocacy for your business. And you can tune into that one as well and take a listen. Let’s look at first, who are these main players to get a little oriented to our industry and then we can talk about how we’re leveraging them. So the Council of Colleges actually was the creator of Clean Needle Techniques.

So we all had to do that in order to get into internship to then go ahead and get licensed or get our national board certification. And this is actually a collection of. School leadership. So schools join the Council of Colleges. And so in addition to issuing the Clean Needle Technique certification, they also gather multiple times a year, have different committees, and they’re looking at what are common issues that schools are experiencing.

We have had school closures just in the last few years. We’re probably gonna continue to see some consolidation. . So we wanna make sure we’re really tuned into what’s happening on an education level and what goes hand in hand with that is acom. So the Accreditation Commission for Acupuncture and herbal medicine, they’re actually linked up with the Department of Education who oversees what they do, and then they go and accredit the different schools, our education and.

Institutions. This allows for things like financial aid to happen so that we have an infrastructure set up where students can come in and get that federal financial aid support. If we didn’t have that accreditation, that wouldn’t be available to us, and that would really stall a lot of things in our industry.

There’s opportunities to be involved with them. You can be a site visitor. You can serve on their board of commissioners as well. Council of Colleges, if you’re involved with the schools, you can be a part of Council of Colleges and serve on one of their committees and help influence how the more minute details of education and school initiatives are happening.

And then everybody’s familiar with N C A O M. . Even in California, people are getting N C O M certified. So this is really those minimum standards. When we’re looking at getting into practice. For most states, they require these N C O M exams for licensure and a lot of states, Also require you to re-certify every four years.

Now, NCCM has a ton of resources. They have a provider directory. You can look on their website for different continuing education for your PDAs. You could be a PDA provider and be marketing yourself and your courses through them. So even though these are more Organizations that develop standards and are more regulatory in nature, there are still opportunities within them and still resources available to you even if you’re just in private practice.

And I wanna briefly note the difference between regulatory and advocacy or associations. . When I was the president of ciso, which is a state association in California we would get calls all the time for people thinking that we were the acupuncture board who issues licenses, who does the exam, who regulates the profession in California.

And so there are different agencies. We talked about standards and more the regulatory, but then you also have these advocacy organizations. And so a regulatory board who’s issuing your license. Their responsibility is to protect the public, not to advocate on behalf of the profession. So it’s important to be knowledgeable about where are our advocacy resources and how do we go ahead and leverage them.

So here are some really exciting big players in the advocacy, and I like to say advocacy slash. Fun stuff and awareness for the profession. Because some of these organizations, their primary initiative is advocacy and some of them, they’re just doing really good work that help elevate our profession.

And then they have great resources for us as well in private practice. The biggest one we wanna think about is American Society of Acupuncturists. That’s our National Trade Association. You have states like state associations like Selma, like the North Carolina Association, the DC Association, they are all members.

Of asa. So it’s a federation style organization. So states get voting rights and everybody’s an equal player, and that council of states is really powerful and they get to decide different initiatives that happen from a national level. I do have the pleasure of serving on the board for asa. We just had an awesome conference.

We were just on Capitol Hill talking about. Garnering support for our Medicare bill so that we can direct bill Medicare as providers. So there’s a lot of good work that’s being done at a federal level. And if you go on as a’s website, if you join a committee, if you are involved in your state association, who’s a member of asa, you get a ton of benefits.

There are one pagers that you can send to other medical providers explaining acupuncture. There are templates for advocacy in your state. So if you’re interested in going and speaking to your representatives, looking at a one pager and saying, Hey, how do I need to prepare? How do I find my representatives?

These types of things. These are resources that are available to you as well as like deals, discounts for different vendors in the industry. And then you have the Society for Acupuncture Research. I was also just at their conference last weekend, and this is an international organization, however really strong in the state.

So they had the conference in New York and they’re another organization that has. Tons of resources for you. You can go on their website, you can become a member. You can have access to different databases. See the incredible amount of research that our profession is involved in and how that works and the resources here for you and your practice.

You can easily have access to that research. Sometimes patients are gonna wanna know that information. Sometimes other providers wanna know that information. And seeing how this is done on a global level, it is a little bit different in the states than how other countries practice. And that global and cultural awareness is really important, especially today.

And I did throw on here e b a evidence-based acupuncture. I recently at the SAR conference met one of their board members and I was asking him, what’s the difference here? Because there seems to be a lot of overlap with the research and the good work that’s. Being done. Evidence-based acupuncture is like a little more a little more patient friendly, a little more lay person friendly.

So if you want like quick fact sheets that you can give to anyone, that’ll speak to people in a way that they can understand. Stand, even if they’re not familiar with research or acupuncture, they’re a great resource for you. And so a lot of these things are going to make your practice life easier because you’ll have resources to pull from so you’re not reinventing the wheel.

You don’t have to create a one pager for yourself about how acupuncture works for other medical providers. You get to download it from one of these organizations who’s already done it in a really easy and professional way. And I also like to put APA on here, American Herbal Products Association.

This is an organization that is a lot bigger than just our profession. They do have a Chinese medicine, like a Chinese herbs committee. But as a broader aspect, they’re really involved staying on top of what’s going on with F D A regulations how would this trickle down effect impact our profession?

And so even just getting on their mailing list and seeing what they’re up to, a lot of these quick updates will come out through them. When something around herbal medicine happens. So if there’s a press release that comes out or an adverse event they’ll probably have knowledge about it and be sharing that information in a really tangible way so that you get the entire story.

So let’s talk about, again, back to that vacuum effect. Is that what’s happening? Did. Maybe coming into this conversation you thought, oh no, I’m aware, , I’m not practicing in a vacuum. Were you aware of all these organizations? Are you aware of the resources available to you? Are you reinventing the wheel when you don’t need to be?

I hope that after this really brief 11 minutes that you’ve had a little bit more of an introduction to not only the resources available to you, but the ways that you can get involved. All of these organizations that I’ve mentioned have additional opportunities and some of them. Are revenue generating opportunities, ways that you could go and implement your skillset beyond private practice to help some of these organizations.

some of them are volunteer based, some of them are putting out resources for you. But regardless of that situation, please take the time to look into them, research them, see that they can help you with your marketing, with your collateral, with things that you would be spending your time and energy doing.

And also the networking that you get through this, going to these different conferences, hopping on their different. Portals, seeing the discounts and deals that are available to you. You’re not alone in practice. There are plenty of organizations here for you. We do have an infrastructure built in this industry that we need to strengthen and get more involved in.

And of course, I like to put AAC as this last resource for you. A lot of the opportunities that I’ve been introduced to were introduced to me through AAC. And so whether it’s your following on Facebook, Book you’re calling us up and saying, oh hey, like I have this issue. We’re always here to help. I’m always here to help and so please feel free to reach out with any additional questions.

Thank you all so much for being here, and do not forget to tune in next week for another episode of To The Point.

In Search For The Best Liability Insurance For Acupuncturists – Consider These Tips

It is crucial to exercise due diligence to get the best liability insurance for acupuncturists. If you still have to decide on your options, perform comprehensive research before you pick up the phone to accept any deal from an insurance provider.

And to help you get better results in your search for the best liability insurance for acupuncturists, consider these tips:

Research the types of liability insurance available: Liability insurance can come in different kinds, such as general liability, professional liability, and malpractice insurance. You need to identify and understand the differences between these insurance options and determine which one(s) you need as an acupuncture practitioner.
Make sense of the coverage limits: The limit is the maximum amount a liability insurance provider will pay for a claim. The goal is to get a coverage limit that is high enough to protect you in case of a large claim. Therefore, figure out the number and act accordingly.
Include the deductibles in your decision: The deductible is the amount you pay from your pocket before your insurance provider starts covering costs. Make sure that the deductible is an amount you can afford.
Evaluate the acupuncture insurance company’s reputation: Perform thorough research about its reputation by reading through reviews and ratings from other acupuncture practitioners. Choose an insurance provider that is well-known for giving excellent service and support.
Consider the other benefits: Some insurance policies come with added benefits, including – but not limited to – legal assistance or risk management services. These can be so helpful should there be a claim.
Seek advice from a professional: Consider seeking help from an insurance broker or a professional with expertise in liability insurance for acupuncture. They can provide expert advice and help you find the best policy for your needs.
Put quotes from different insurance providers side-by-side: Shop and get quotes from multiple acupuncture insurance providers. Scrutinize coverages, deductibles, and premiums of prospective policies to find the best one for your specific requirements and budget.

Are you looking for the best liability insurance for acupuncturists? Consider including the American Acupuncture Council in your list of prospects.

Contact us at (800) 838-0383 for inquiries.

Michelle Gellis’ Top 10 Facial Acupuncture Points

I am going to be talking to you about my top 10 facial acupuncture points.

Click here to download the transcript.

Hi, my name’s Michelle Gellis, and today I am going to be talking to you about my top 10 facial acupuncture points. I am a licensed board certified acupuncture physician, and I teach cosmetic and facial acupuncture classes internationally. Can you go to the first slide? Great.

So when I’m talking about my top 10 facial acupuncture points, these are both for cosmetic purposes, but some of them have spillover into treating neuromuscular facial conditions as well. So the first point I wanna talk about is and you might be wondering, what does this have to do with facial acupuncture?

When you needle shen men, it helps to calm your patient, which is. great when you’re going to be putting needles in their face, and it also relaxes the face itself when we think about our face and our face aging. We might think it’s a good thing to tighten up the facial muscles, when in reality the facial muscles when they’re tight and constricted, then the skin will wrinkle.

So you really want the face to be relaxed when you’re going to work on the face. So my first favorite facial acupuncture point is ear chan men.

My next favorite point when working on the face is gallbladder 41. And gallbladder 41, although it is on the feet, it helps when you are doing cosmetic and facial acupuncture in a couple of ways. Most importantly is it helps to keep your patient grounded because when you’re bringing a lot of energy up to the face and the neck and the head, you wanna make sure you counter that with some grounding points.

So this is always the first body point I put in when I’m doing cosmetic acupuncture. It also helps to relax the liver and spreads chi throughout the liver and the gall bladder channels. And this will help if your patient is very frustrated or angry because frustration and anger can cause a lot of constriction in the forehead and cause lines between the eyebrows.

My next favorite point when doing cosmetic and facial acupuncture is stomach 36 and stomach 36 is probably my most favorite acupuncture point of all of the points if I had to pick one. And the reason for this is, , it covers so many different things. It’s the chicken soup point for acupuncture, and it helps to infuse all of the gifts of the earth to all of the meridians.

It’s a sea of nourishment point, which is really important when you’re working with the skin. You wanna make certain that all of the. Food and drinks that you take in get digested properly, get into your bloodstream and are spread throughout the body. It also helps to tonify chi and blood, which can become deficient as we get older.

We can get blood deficient and chi deficient and by needling stomach 36, it helps tonify the chim blood. . It also helps to fortify the spleen, which is really important because as we get older and the spleen becomes weaker and not as efficient, we can have sagging. So the spleen holds things up and it also is very much integral with.

Creating nice, healthy blood. So holding things up and making sure that our blood is healthy are two of the spleen’s jobs. So by needling stomach 36, you’re fortifying the spleen and the next. Important thing about Stomach 36, which should have been its own bullet, but it calms the spirit. And when you’re doing cosmetic acupuncture, you want your patient to be nice and calm.

My next favorite facial acupuncture point, which is also on the body, is large intestine four, and this is a command point for the face. So I would never do cosmetic acupuncture without needling large intestine for, and it also allows us to get rid of impurities. Not just on a physical level, but also on a mental level.

So really clearing out all of the impurities on a body mind, and spirit level. I. Next is small Intestine six, and the name for small intestine six is nourishing the old. So if you think about where small Intestine channel runs, it runs right up the neck and then up. In front of the ear and it can help with sagging jowls and chin and neck.

It activates the entire channel because it is a sheet cleft point, and it also helps to nourish us in the face of old pain and allows us to. Taken all of life’s lessons from past traumas and it, it really calls on some of our ancestral chi as well. . Next is gallbladder 18. So gallbladder 18, in case you don’t know where it is.

So you go to the center of the brow, and that’s gallbladder I’m sorry, the center of the frontals muscle and. , which is in the middle of the brow and that’s gallbladder 14. Then you find gallbladder 15 and you’re going to go back along the gallbladder line until you are in alignment with do 20, so where the gallbladder meridian and do 20 intersect on the head.

This is where gallbladder 18 is, and you can see it here. And this is the occipital frontal. So the gallbladder 18 helps to benefit the eyes and the forehead, and it has a direct action on that super orbital nerve. So that’s this right here. and the super orbital nerve, which is C N six runs along the Galea epi erotica, which links the occipital and frontal bellies of the occipital frontalis muscle.

So when you needle that point, it helps to nourish the eyes, lift the brow, and lift. The forehead as well.

Next is stomach four, and the name of this point is receive nourishment. So stomach four is right at the corners of the mouth and it helps to treat the mouth area. Lip lines, naso, labial, folds that. Run right into this area. It’s also right on the Modis, which connects the lader muscles on the face. The depressor, anguli, ORs, the resources muscle, all of these muscles.

Calm together right here at Stomach four. So by needling this point it helps to relax the depressor, angular ORs, which can pull down on the corners of the mouth and Ma make us look unhappy when we are not

Next. Next is small intestine 18 and the name of this point. Is cheekbone and very appropriately named, and this helps to lift the cheek area. The way that I like to needle it is I come over the cheek and then I will needle straight up, so I’ll. Go over the cheek and I like to use tubes when I work on the face.

So I come over the cheek and then I will needle straight up right underneath the bone and this will help to lift up the cheek area.

Next is Yu and I do a combination of points in order to lift the brow and the eyelid. I’ll use Yu and Sano. 23 and Blood are two together, and I have a little video here for how I would needle.

Like really like this. What I’ll do is I’ll pull up, but for her I would just use the tube and push underneath the brow like that. So again, I’m not on the lid, I’m underneath the brow. And you know why they called us you? Yeah. Don’t you? . Ouch. Yeah. You. Yeah.

So you could see in the video, I like to pull the brow up above the orbital rim, and then I will just push the tube underneath the brow and then push the needle straight up. I use a half an inch needle. I usually put a little anika gel there because the orbit is very highly vascularized and you don’t wanna bruise your patient.

and then I will push it in almost up to the handle. And this really helps, works on the lader muscle and helps to treat you. Yeah. And then by using some supplemental points around the brow and the forehead, it really can help to lift this area because one of the biggest concerns that. My patients have had over the years is that their eyelids are starting to get droopy or their brows are getting droopy, like really like my last favorite acupuncture point for.

Facial and cosmetic acupuncture is Yong, and Yong is great for a lot of reasons, and it’s right there between the brows. This helps if your patient has any lines between like wrinkles, deep furrows between their brows. You can use Yong. and it also helps to relax your patient and spread the chi in this area.

It calms the mind. It calms the patient. So this is a great point. I use it on almost everyone, even if they’re not coming to me for facial and cosmetic acupuncture. So there you have it. My top 10 favorite acupuncture points for facial acupuncture, and you can follow me on social media. Michelle Gellis on Facebook, Instagram.

TikTok and on LinkedIn, and I also have a Facebook group called Facial Acupuncture, and my website is facial acupuncture classes.com. I hope you enjoyed this, and thank you to the American Acupuncture Council for providing me with this opportunity to share this with you.

Worry and Fertility – Dr. Lucas

Today’s topic is worry and fertility, because. One of the main emotions that are fertility challenged patients, or some people call them infertility patients have is worry.

Click here to download the transcript.

Hi, it’s Dr. Martha Lucas here to talk with you today about fertility. I am very happy to be here and want to thank the American Acupuncture Council for sponsoring this webinar. My offices are located in Denver and Littleton, Colorado, but I teach everywhere. And my teaching website is lucas teachings.com.

So let’s go to the slides.

Today’s topic is worry and fertility, because. One of the main emotions that are fertility challenged patients, or some people call them infertility patients have is worry. And as you know from the history of Chinese medicine, emotional conditions can cause physical disease or physical symptoms, and we are the.

When we’re in utero, we are the vibration of our parents, especially of our mother. So there is a reason for an additional reason for the mother to try to get rid of that worry pulse, that worry, that anxious energy. At least when she’s pregnant. But as I will say later, most of the time it doesn’t go away.

Which is why we need to treat her throughout her pregnancy. Because even when the end is having a healthy baby, right? That’s the end goal. Healthy baby. Healthy mother. A long struggle to conceive can take a brutal toll on the couple, the both people involved, women and men who have lived with things like anxiety, worry, sadness, depression, and other emotions that are associated with fertility challenges, they c may even have those patterns.

After the healthy birth. So even seeing the couple or the mother after the birth is important. There is a quotation by Van Golf that says there may be a great fire in our soul, but no one ever comes to warm himself by it. All that pastors by can see is a little smoke. Now we know about the fire within, right?

How many people do we pass by every day that we just see the outside? We have no idea about the raging fire, the raging worry that’s inside of them. They may have a passion or a pain inside that is so great. They feel like they can barely contain it, but we don’t see it on the outside. Now, we as practitioners, Who specialize in treating fertility, know about that raging fire.

All of us know that cousin or aunt who loves kids or a friend of ours, and we see the sadness in her eyes at baby showers, but we don’t really know the depth of that person’s pain. We can see how coworkers light up whenever people talk about their children, but we don’t really know why.

He or she didn’t have any children. In fact, it becomes a little bit of a topic that you’re not really certain how to address or begin talking with people about it. We read something once in a while about. Recurrent miscarriages and we feel sorry for the person, or we felt sorry for the person, but we couldn’t picture anyone who we knew who had lost multiple consecutive pregnancies until, as I said, we are treating fertility challenges and then we know all of these people.

And the fire inside their passion, their desire fire can leave serious damage behind. And it’s hard unless you’re treating it to fully grasp what fertility challenges involved, unless you are dealing with it personally. As I said, the worry we’re gonna talk about doesn’t go away lots of the times when you get pregnant.

One of my fertility patients, Finally, got pregnant, had a healthy live birth, then she got pregnant again. In fact, she came to see me and she said, oh, I was coming to see you because we wanna get pregnant again, but guess what? I’m pregnant already, but I’m worried. And I said, are you worried about having a miscarriage?

Because she had miscarriages already. And she said yes. And again, I still had to deal with that worry, even though. She’d already had a baby, which does not necessarily mean you’re gonna get pregnant again or easily get pregnant or pregnant at all. And I needed to explain to her, are you having symptoms of a miscarriage?

No. Okay, then let’s work on that. Worry. Like I said, many people believe that the end game is have a baby, and if they can just get that prize, all their worries about infertility will go away. But that is not how it is in real life. It’s much, much bigger than that. It the. Experience they’re going through really affects their physical and mental health in insidious and sometimes long lasting ways.

Because struggling to have a biological child is a complicated emotional process and. , it’s an invisible loss, right? There aren’t any rituals for miscarriages. There aren’t any rituals for somebody who gets pregnant and at six weeks they realize, oh, there’s no heartbeat. Or genetically speaking, where this is not gonna be a viable pregnancy.

There aren’t any rituals for that. So these people are experiencing these losses without being able to go through. Hey, I’ve had this loss and I need to grieve, and I need people to grieve with me. Now we can grieve with them, right? And we get them through it. However, There aren’t any formal rituals for it.

And then they start to feel like there’s something wrong with them. I’ve had, and I’m sure you have to, women who had previously had an abortion who feel like, oh, that’s my punishment now my punishment is I’m never gonna get pregnant. That’s of course not true, but because of their.

Feelings about it because of this constant try and lose. Try and lose. Try and lose. What happens is they start to take it internally. They start to think of themselves as a bad person or lose some of their self-esteem. They may also experience shame. And part of shame is why can’t I be happy at my girlfriends?

Baby shower. Because you’re disappointed, because you’re sad, because you’re grieving your own loss, or the potential loss, or the idea that maybe you’re never going to have a biological child, but lots of people envy makes them feel shameful. So there’s that underlay of I can’t be happy for anybody else because I can’t be happy for myself.

And then that goes into worry that they’re going to lose friends. If I can’t show my happiness at my girlfriend’s baby shower, maybe she’s not gonna wanna be my friend anymore. So you can see that their worry about it, their constant thinking about it about. Whether or not they can get pregnant, how are they gonna have to go to a baby shower?

I think we have all heard the stories of, wow, I’m trying to get pregnant, and everybody around me is pregnant. It’s amazing how many patients tell us that, that, yep, am I Another coworker came in today. They weren’t even trying, and they’re pregnant. So it’s just all consuming sometimes. And they also have the worry that their relationship will suffer and relationships have been damaged by reproductive issues because there’s so much pressure to have that biological child.

And that affects intimacy. And this is partly why I always treat the man and the woman. That’s my protocol. I do not only treat the woman. I started doing that years and years ago, because we all know it takes young and it takes yin. And if the young part of the picture is. Over here and out of it.

Then how are we going to succeed? And remember, 40% of the time, reproductive challenges are on the male side. That’s a huge. Piece of percent you can. It would theoretically suggest that your success rate could go up. Success rate, helping people get pregnant by 40% if you treat the male. So find out about and treat the male.

And partly I can tell you in terms of the pressure I’ve had men be very grateful that I’m seeing them because they say they’re a nervous wreck. They’re on call all the time. Their wife is always checking her temperature and her phone app on when she’s gonna ovulate. And it’s just a lot of.

Tension for them. Plus remember the hormones that are involved in if a woman’s gonna get I V F or some fertility clinic treatment and getting hormones, boy oh boy, those can really intensify her emotions so everything can get worse. Anger, worry, depression, all of those can be escalated and. And sometimes your easiest target or your most available target is your partner who is really trying to help you, but can feel a little helpless.

So I’ve even ex, guided couples in how often to have intercourse. Studies show that if you have intercourse every three days, you are going to within three months, hit ovulation at the right time. I’ve had men. Thank me for giving their wife that information because again, they feel pressured to have intercourse.

Too often they are happy. It’s a pleasant experience, but it starts to become unpleasant when they’re on call, when it’s pressure, when it has to happen right now. So then even their intimacy gets in this negative cycle because of the woman’s worry. And men worry about it too, about being able to have that biological child.

And remember about their experience of loss too. Fathers to be, experience a loss of a miscarriage or having to end a pregnancy because of genetic problems and unsuccessful I V F treatment cycles. Remember, they are affected too. They would like to have a biological child. They get this thing done, they, it looks good.

The wife is. Pregnant, every, the woman is pregnant, everything’s looking good, and then it doesn’t work out that way. Remember, they are a part of it too. It is an emotional loss experience for the male of the partner also of the partnership also. So again, it’s, it can be very complex. Then there’s what is called unexplained secondary infertility.

Very nebulous term, right? It starts with the word unexplained, and this is when women have successfully given birth already. , but for some reason they are not able to easily get pregnant a second time. And there are timelines on this, it’s a shock, right? They feel like wait a minute. I got pregnant so easily the first time.

Why isn’t it happening now? Why shouldn’t I be able to have another baby? Why is this happening? Why won’t my body do what it’s supposed to do? So there’s not only the first time trying to get pregnant, but also. Future times can be affected by fertility challenges and you need to obviously look at everything, health conditions, surgeries what did they have, a previous C-section, and maybe there’s some scar tissue there.

Looking at all of that for the second time around. and research has also shown that women dealing with fertility challenges have depression and anxiety levels similar to those who are suffering with cancer, H I V and heart disease. And through our work, we can help resolve that worry. And also I consider it a trauma.

I consider these losses, this journey a part of trauma. The fertility struggle has. Traumatic. Traumatic impact. Now, some people don’t think it deserves the label trauma because it isn’t life threatening, but it is fulfilling, life threatening. It is having a happy life, living a life threatening. So I feel like there is no problem with.

Treating fertility challenges, especially when there are a lot of losses as though the person has been traumatized. In fact, there are research scientists and psychologists who feel like the word trauma or the idea of trauma should be expanded to include psychological and emotional responses, not only physical.

Threats or the physical threat of life. So these people are experiencing a Ma major shift in their life. They are planning a major shift in their life that sometimes isn’t working out for them. They are exposed to constant reminders of their condition or of the fact that they can’t seem to get pregnant from everyone, from family members, coworkers, friends, medical, the people that they go to for their medical treatments and other, and pregnant women.

I think that. We can truly believe that fertility challenges affect how you see yourself and the world along the way. A lot of women have so much worry and so much doubt that they just feel like they can’t even trust themselves, that this kind of doubt and experience is just a part of who they are.

They’re just always gonna leave live in a. State of worry, a constant state of worry. And as I said, this does not turn off when they become pregnant. It does not turn off when they hear that heartbeat. It’s a pattern in their body and they, we are gonna help them get past it. using acupuncture and sometimes herbs they’re always bracing themselves, right?

They’ve gone through fertility treatments that didn’t work. Some have failed adoption attempts. That’s also a traumatic experience for women. They’re bracing themselves all the way through their ivf, sometimes through a C-section, so they, you might think they’re invincible and a lot of people do. I think.

Feel like these women are invincible cuz look what they’ve been through. But that’s not true. They are extremely delicate inside and they are always thinking the other shoe is gonna drop. They are pregnant, but they are always waiting for something bad to happen with that pregnancy.

And even women who have a child after the child is born still feel like. Guilt over, oh, I have this baby finally. Or is something gonna happen to this baby because of that worry that they went through sometimes the years of their fertility treatments. So it’s that constant rollercoaster and unfortunately sometimes it’s off the rollercoaster and you’re still in defeat.

Plus, of course, these women, these worried women very often and something to pay attention to with your fertility patients, they very often deal with postpartum depression because again, even though it seems like the golden ring is that live healthy birth, It doesn’t take away the patterns of worry that they had while they were going through all of their treatments.

We need to be aware of that, a after our patient has their babies. So what has all this got to do with worry? In this picture of the right pulse side, so the right positions, you can see that worry earth is in that middle position there. And worry makes the energy go backward toward the kidneys.

Now, as you know for if you’ve heard me talk about pulse diagnosis, my system before the kidneys, and we know this, the kidneys fund everything, so we really don’t need a perverse movement going back toward the kidneys, but that’s what worry does to your digestion. So that’s one of the problems with worry is that it wrecks the Earth’s spleen stomach position and sends it back toward the kidneys.

The part that I talked about with trauma, the trauma can empty that earth sector. That’s what a trauma pulse feels like. These are, this is where unresolved, that continuous cascade of worry and other. Emotions that come with the experience. Leave the pulse, the earth, spleen, stomach, our digestive, our nurturing center can become empty.

In fact, it can be so empty that under your finger, it feels almost like that arrow, like it’s sucking down. This person is so needy and empty that their, literally, their earth is sinking. And then you’ll notice in the lung, large intestine position, I put a little arrow just to remind you that the positions flow through each other like those little sine waves on top of the line.

If earth is empty, Then there is no energy going to the large intestine in the lung. So you’re gonna have an out of balance lung, large intestine pulse. And as earth and metal make the immune system so that whole, those two whole sectors are liable to be empty and out way outta balance.

Now, as you can imagine from me showing you those, Pulse when Earth is not working, when earth is empty, when Earth is going back toward the kidneys, when digestion isn’t working, this person is not making good quality energy. They cannot make good quality blood, which. We’re trying to create a warm, fertile environment, a blood filled environment in the uterus, but they’re not making good quality blood.

Their ability to nurture themselves decreases because Earth is how we nurture ourselves. Digestion, working well is how we make our energy, make our blood, nurture ourselves, keep ourselves alive, and then their immune system can also suffer well. We don’t really need them catching frequent colds or that sort of thing.

Having bad allergies, having skin problems. We don’t need to add immune system problems onto their fertility challenge. And as I said, their skin might suffer. They might start to have hair loss. That is because partly that spleen, stomach sector, that earth sector is not moving into the lung large intestine.

So the immune system is suffering. The skin is suffering, the hair is suffering. And they basically just are losing their core, right? The where would be under my middle finger, the core, nothing is flowing from the kidneys into the earth, into the long, large intestine. So again, we, that’s a major part of treating fertility.

That’s why I always tell my students, treat digestion on every fertility patient because, They have to make good quality energy, make good quality blood, have enough blood to flow to the uterus, have a good solid immune system, and the only way they’re gonna do that is if we can keep their earth, their spleen, stomach, sector of the pulse strong.

Now the second pulse picture I showed you, which was the earth sector going down, that, as I said, is related to old trauma patterns. Now this could be. Worry from childhood sometimes I treat an awful lot of trauma. I treat an awful lot of people who today’s issues are because of what happened way back.

Because your pulses remember everything. They’re your Rosetta stone. So all that stuff is in there. Even if your conscious mind has blocked it out, your subconscious mind and your energetic body has those patterns in there. So I will ask them, do you feel like you worried as a child? and then you can say other things like, did you feel like your life was outta control?

Now, as kids, almost all of our lives are outta control. Let’s face it, we don’t have any control. Our parents control everything. But that’s different than worrying that your parents are gonna get a divorce or worrying that your dad who’s an alcoholic is gonna make it home alive without having an accident.

Worry like that, is going to. Create some sort of old trauma and it can lead these people to feel like their body’s outta control. So that again, would show up as a very deep, empty earth, spleen, stomach pulse, old trauma that is unresolved. Now the beauty of acupuncture is we can recycle that old trauma pattern into.

back into the digestion, back into nurturing the spirit, back into flowing through the kidneys. So like the infinity symbol here, that is the beauty of acupuncture for treating trauma. We can make that. Infinity symbol happened. The pulses from both sides connected to each other. That’s what good health is, that infinity symbol, all of the organ systems communicating with each other, flowing from side to side, everyone getting a continuous flow of energy rather than what I showed you with the spleen, stomach sector going back and forth, or just frankly being empty.

Now one way to accomplish getting the organ systems connected is using the low points. Now I know, I don’t do what I call prescription Chinese medicine. I follow the pulses and I do what the pulses tell me to do with the patient. However, sometimes you do need to connect things like the kidney low, if the, we use that kidney low.

If we s. We think the person is seeing an emotional vent as the worst possible thing that could ever happen to them, thereby leading to fear and sometimes paralyzing fear. All right, these women are afraid they’re never gonna have a baby. That’s their worry. Their worry is, this month is not gonna work.

Next month is not gonna work. I’m never going to have a biological child. So there is. A total acceptance in opening up kidney four to get the kidneys flowing into the other organ systems. Get them supporting the other organ systems.

Some other things are if the patient reacts quickly to everything, they’re, they’ve lost their ability to handle and manipulate their world. Then the stomach is associated with pensiveness and worry. So you can see you can do stomach 40. It’ll help regulate digestion. Spleen four also will help the gut and will help the blood, and it’s the master point of the chok, which is my.

Favorite. Favorite, I think extraordinary, or we’ll say one of my big favorite, extraordinary, I love, love, love the Chong Ma because as it starts in the fire, in the belly, comes up the body, and then encircles the spirit like a lollipop. That’s the vision I give my patients, and then recycles back down a perfect fertility channel.

So spleen four is a great low for you to try heart five. Remember? This person is having a hard time evaluating and articulating their feelings because their main feeling is worry and grief, worry and depression, worry, and anxiety. So this helps them the energetically to help them reevaluate the situation, help them speak to others about the situation.

Remember I said there aren’t any rituals for the losses that happen every month when you don’t get pregnant, however, We can help them with heart. Five. The small intestine low represents redefining. Emotional processes and getting feedback from others and being more accepting of that feedback. So it’s about reprocessing and integrating our emotions.

And the pericardium or heart protector, low, right? P six, PC six, that represents our defense mechanisms and. It can help us get out of those holding patterns and frankly, we might be tempted to go to heart seven when someone is suffering a lot from worry and pensiveness and we wanna nourish their spirit.

But remember, the pericardium might be protecting the heart. So we need to go through the pericardium some sometimes re, as I said, really tempted to go right to the heart, but honestly, sometimes we need to go through the pericardium to the heart, and PC six will help them with their coping mechanisms during these, what are very trying times for them.

Then there’s gallbladder 37 chance to let go of the stagnation of our feelings, illuminating brightness. Nice option for people going through this. And then the liver low. Remember, it’s gonna help when we’re feel like we’re controlled by something else than other ourselves. And they are. If they’re in an IVF clinic who’s controlling them, they feel totally outta control of their own body.

They’re, they might be having negative side effects. They have to do this on this day and this on this day, and this on this day. You can’t create good chi and blood when you’re stuck like that. So that combination is also very nice. Liver five. Gall bladder 37, they’re, they need blood for creation and that’s a part of liver five.

Blood moving for creation and them able to experience their passion, their desire in a positive way. So I wanna thank you very much for watching this. I wanna, again, thank the American Acupuncture Council. I am available to help you with any questions you have. You can go to lucasteachings.com and see course selections.

There’s a contact Dr. Lucas button there. Acupuncture woman is my. Private practice site. There’s a contact Dr. Martha button there, and my email address is dr. M Lucas acupuncture woman.com. Drmlucas@acupuncturewoman.com. If you need, have any questions or would like to talk with me about just anything, Chinese medicine, and next time we’re gonna talk about depression and fertility challenges.

Thank you.