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Understanding How Chinese Medicine Affects Immunity Yair Maimon

Hi, everybody. Good evening and, I hope, very healthy evening to all of you. My name is Yair Maimon. I’ve been practicing Chinese medicine for over 30 years. I’m very lucky because I’ve been involved both as a practitioner all these years, practicing also in private practice, but also in the health system and in hospitals. I’ve been teaching all around the world. I live in Israel, but I’m used to frequently travel, now a bit less lately. Also, I’ve been researching, so I was very fortunate to have my own research center in several hospitals and the last one also a laboratory center.

One of the areas that I’ve been deeply researching and had interest in was the immune system. Actually, my main interest is very extreme. One is the shen and the relationship of the body to the shen. The other one is the body, cancer, and immunity. As far as immunity, I’ve been researching especially herbal medicine and different herbal combinations and their effect on the immune system. As we know, we are now in a very challenging time. The key in this challenging time is actually the immune system and the immune response and immunity overall.

In this lecture, I would like to touch on this topic more from a Chinese point of view, but also from a research and one of my research that has been just accepted for publication two days ago and have a better understanding on how Chinese medicine affects immunity and how Chinese medicine could be a key player, actually both in strengthening immunity and helping it to deal with pathogens and really, any pathogens, but also viruses and bacteria. This also we are seeing in research, in our clinical experience. I think it’s a good opportunity to go deeper and look at the current situation we are facing from a Chinese medical point of view and deepen our Chinese medical understanding.

I would like to start, first of all, with some relevance to our times, to try to take it from, again, as I said, a different angle. There’s many angles that have been all the time on the news that everybody be talking about. If you look at it from Chinese medical point of view, we are looking at a struggle between two forces. This is the best way to start to address the situation and address immunity and the immune response.

We are looking traditionally at zheng qi, which is the upright qi, which is the summary of all the body’s ability to keep its vitality, and xie qi, or bad qi, which is pathogens that are trying to invade the body, so constantly in life, we have this struggle between these two forces. This struggle is quite interesting because on both sides, we have qi, so we have the same phenomena that we are addressing, but from a different point of view. Chinese medicine doesn’t just look at the body. It looks at the Universe. It looks at how things are functioning.

Qi can be of different natures and here, we look at the body’s qi, which is the zheng qi, and the xie, the bad qi, which is trying to invade the body and take over. This is like a key aspect to this struggle. I would like to put in a chart which, again, takes it a bit deeper into the conflicts we are facing now. On one hand, we have zheng qi. Zheng qi also can represent the immune system, but also something which is deeper, the vitality. From a Western point of view, we’ll talk also about the immune response, the antibodies that the body produces, so this is our immunity.

Then we have the pathogens. As we know, we have different types of pathogens. The pathogens can be damp, can be heat, can be cold, and, by the way, the same, for example, virus can manifest differently in different individuals according to their preexisting condition. For us as a clinician, it’s very important because if we help to clear the preexisting condition, let’s say damp, we know fat people or people with diabetes will have a much stronger response to a viral infection, especially the current one. If there is too much heat, again because this virus is very hot, the heat will even go faster. I think if there is something common, it’s the toxic part, if we look at all this type of invasions.

Then if we look at the zheng qi, the immune qi, or if we look at the body, we have three options. I’m putting it as a large category, but obviously, in the clinic, it helps us to guide an individual case, which can be a mixture or can be not always all straightforward. We have either a good zheng qi, a good immunity, slightly weak immunity, or somebody with a weak immune system. By the way, since I’m treating a lot of cancer patient and I specialize in treatment of cancer, we see a lot of patient with weak immunity, not just due to their disease, but also due to the medicines they are taking. Also, people with autoimmune disease will take chemotherapy or other intervention, Western intervention, that will weaken their immunity, even that initially, they are not with weak immunity, they are now in a state of weak immunity and weak zheng qi.

Then we have a pathogen. In this respect, the pathogen is strong. That’s what we see. If the immune system is good and the pathogen is strong, there can be total healthy response, so people can stay healthy even if the pathogen is strong. If the pathogen is slightly weak and the xie qi is strong, the pathogen is strong, then we’ll get a mild disease. Everything soon will be translated to acupuncture points into clinical usage.

The main problem we have that when the zheng qi, the immune is weak and the pathogen is strong, then we get very fast, serious disease. Fast means also that there is the nature of toxins and wind and heat will dampen it, so this is the condition which is actually in the hub of the problem we are facing now.

Now if we look at clinical approach, then when the immune system is good, you can mildly tonify it, take some herbs. I’ll talk later about my herbs that you can take, but you actually don’t need to do anything. I have hundreds of people calling me, say if your immune system is good, probably you don’t need to do much. You can do something. People, one of the problem is a psychological problem, so a lot of times, when you take something, you also feel psychologically better. Or if you have a purposefully designed prescription which is good for you to keep your health, definitely this is one of the things I’ll advocate, so in this respect, you tonify the immune system or that’s the strategy [inaudible 00:08:40].

In the second stage, when the immune system is weak and the pathogen is strong, actually, what you need to do is to take the heat out, is you need to focus on the pathogens because when you eliminate or reduce the toxicity or the heat or the damp of the pathogen, then the body’s immunity can pick up and can give a good fight and then eventually go out with … You don’t deteriorate into serious condition.

Obviously, the most complicated situation is the worst and the most difficult is the third case, where the immunity is weak. Then you need to tonify or strengthen the immunity and, at the same time, to reduce the pathogen, so you’re kind of doing a dual approach or a dual strategy approach, which is very possible from Chinese medical point of view, but it will require a more complex or more complicated approach or complex approach also, as far as herbs, as far as the acupuncture points that we choose.

Let me take it to a clinical situation. I’m looking at the curve, but from a different point of view. The curve has this area where there is a place for prevention because … Sorry. I’ll just go back to this. When there is a possibility of prevention because here, if the immune system will be good in this area, probably disease will not develop or will develop very mildly. The person will not feel it, so there’ll be some antibodies build up. There’ll be some immune response, but there will be no disease. The second is when there is a full-blown disease and then again, we are treating very differently. The third situation is actually when there is a cure from the disease, when somebody is over the acute phase, the active phase, and is in the curative and getting back to normal situation.

In these three situations, we will use different points. I’ll just illustrate it with some points like from the lung du mai or some of you may use it as a GV or from the stomach or large intestine meridians. If we look at the lung meridian, for prevention, I’ve put lung 9. The yuan [inaudible 00:11:12] the line the earth points to tonify the yuan qi. Yuan qi is closely linked to wei qi. Actually, the way wei qi is build is all the time with interaction of pre-heaven and post-heaven qi. We’ll touch on it a bit later or I will go deeper in other situations.

From the du mai, I will take du 4, the Ming men, again to tonify the yuan qi and stomach 42, the yuan point of the stomach, which also will have a strong effect on both tonifying the stomach, but also enhancing the body fluids and alleviating a tendency for dampness, etc., so all of them will be kind of tonifying the yuan qi and through this, the wei qi and keeping the [inaudible 00:12:00], keeping the zheng qi in large intestine four again, the yuan qi or the large intestine.

When there is a disease phase and there is a lot of heat and a dramatic response in the body, then from the lung, we can take lung 10, the water part, sorry, the fire part, and reduce the heat in the lung. From the du, we take du 14, where all the yuan are meeting and, again, helping to reduce this acute heat building up situation in the body. From the stomach, stomach 44, the water points that will also help to reduce the heat and again, we are doing here a yangming treatment of stomach and large intestine using large intestine 11 and both of them together reducing heat. It’s a strong reduction of heat and increasing or building back some fluids in the body and helping the body to deal with the pathogen.

In the curative stage, we’ll use lung 7, which is the lu point, which will, again, help to eliminate the residue of the pathogens, du 12, which we’ll discuss in a minute, the body pillar, beautiful point to build up immunity and to build up back zheng qi. Stomach 36 we’ll talk a lot about it also later and about research when stomach 36 was used to build up, again, the zheng qi, the correct qi, from many different aspects, and amazing combination stomach 36 and large intestine 10 both the san li points to build up white blood cells and strengthen the body. You can see how three different strategies, three different usage of acupuncture points, are utilized here in order to achieve the best effect in the clinic when we are facing different situation. Obviously, you can cross use points depending on the situation and when on the patient and also, as the patient goes along, obviously, we change our strategy.

Just a word about du 12. Du 12 is called body pillar. It’s just on the line of bladder 11, which is the zhu point of the lung, and bladder 42, which also a very good point to strengthen the lung and the immunity, so all this three points being affecting the lung and the qi and the zheng qi in the body are very important for immunity.

The interesting things about especially du 12 that has this dual action. On one hand, it clears heat from the lung, so when there is heat, it helps to clear the heat, but it also pacify wind and tonify the lung and wei qi. Acupuncture overall has this capacity to be modulating, on one hand reducing excess and, on the other hand, building the deficiency. That’s, I think, the strength of acupuncture, especially because we live in the world is striving for balance. If we have a point that allows the body to reach this balance in a better way, then definitely, especially if we look at immunity and the way the immune system work and modulate itself, it’s a very effective point.

Its indication will have heat in the chest, dyspnea, so there will be difficulty in breathing, sudden cough, etc. You can also actually use even cupping around this area to help people if they have a cough and difficulty breathing and heat in the lung, so all these points can be star points to use.

It’s called body pillar, so I think it needs name. We are studying deeply the names, as well. It kind of tells about this zheng qi, about holding strongly to body and the body’s ability to fight. If you have a strong back, you can easily fight a disease, so body pillar brings the body back this pillar and this upright situation like the zheng qi. It’s also very good in allergies and, especially, allergies when there is stuck heat in the body and there’s lingering pathogenic factors in the body.

This column is also nicely linking between Heaven and Earth, so it’s kind of helping us to stand erect. You know if you want to stand erect, you kind of just straighten this area of the body, opening your chest and moving up this area where this point is. This shows good immunity, but also good stand as a human between Heaven and Earth, having this pillar, which is a human pillar.

I want just to bring something about the history of Chinese medicine. Li Shi Zhen, from the Ming Dynasty, was a famous doctor who wrote the Bencao, which has almost 1800 herbs in it. It’s amazing book about treating disease. At this point, there was a pandemic, as well, and he was one of the first one to point out that during the plague, disease comes through the mouth and nose. In the West, it was discovered maybe 200 or 300 years later. As we know, this is the key to prevent pathogens to go in. To us, it’s obvious, but it took ages in human history. As we know, the most effective part about Western medicine is hygiene, always has been. Chinese medicine has also long history and one of the first one to point out that the entry points of disease would be through the openings in the face.

This is interesting. I mean, I find it interesting that this year started in February is the metal year, yang metal year and, as we know, yang is metal. It’s not just it’s a yang metal, so there is a strong dynamic of yang. I’m not the greatest astrologist in Chinese medicine, but I find it, again, just interesting to see that [inaudible 00:18:16] the hexagram from this year is built from thunder and wind, so everything is about these kind of changes that are coming quickly that are affecting the lung that are to do with extreme situation that move extreme, like the rat. It’s just interesting to note on another aspect, which is some closely or some relevance to Chinese medicine.

One of the prescriptions that were heavily … We get now a lot of research from China and I do believe that by the end of this pandemic, we will be able to analyze better and understand better the role of Chinese medicine in treating a new disease. I believe that there will be breakthroughs as far as both treating immunity and helping recovery, but also preventing deterioration of disease. That’s what we are seeing now from China, so I thought I’ll bring the most famous prescription.

I like it because it shows the complexity of Chinese medicine. You see it’s a huge prescription, qing fei pai du tang. It’s made from different subscripts, prescriptions, so I kind of put it in colors. Ma xing shi gan tang is the first herbs here. Then wu ling san is these herbs, so this wall is more for the shortness of breath, the cold, the cough, and eliminating pathogens from the lung. Shen gan ma huang tang, this is the next one. It’s indicating it again more for phlegm in the lung. Xiao chai hu tang is more for kind of this ShaoYang syndrome, the nature of not just a regular invasion through the [inaudible 00:20:10], but the ShaoYang area. Then some additional herbs to clean and remove toxins. I think we should watch very carefully and deeply the effect of herbal medicine in helping patients during a disease and helping them from deteriorating into severe stages.

We talked a little bit about things that are relevant to our time. I would like to go deeper into immunity and Chinese medicine because the immune system it quite unique. It is a system. I call it it’s orchestrating life. When you talk about immunity, hormonal system, neurological system, they’re all Western terminologies. They’re not Chinese, but they’re talking about a system, about something which is orchestrating, something which is making sure everything is working together. The immune system is actually the most complex one and truly, it needs a lot of time to get to understand it.

It’s different than local systems like if we talk stomach, spleen in digestive system and lung, respiratory, urinary, so here we are talking about local xiang fu kind of engagement in the processes of changing water and food into our qi. Here we are talking about and orchestrating large system that is multifaceted, that has a lot of different aspects that we need to consider when we want to understand it fully.

One of the things we can look at from a three dimensional point of view because we have the wei qi, actually wei and ying qi. We have the jing qi and actually jing and yuan qi, but also the shen qi. Shen qi also means our emotions and the way we feel in ourself and in the world. As we know, the immune system is very much closely related to the mental, to emotional, and to the inner connection to the shen. Many times, especially with acupuncture in the clinic, if you put the right point for the person to enhance the shen qi, sometimes especially for prevention, it will be the key point to strengthen their immune system. When we study immune system, we need to study this threefold kind of situation or threefold co-enhancing qis that are all the time interplaying in the body. Especially when we’re teaching from a healthy point of view, we are looking to enhance wei qi, jing qi, and shen qi on a regular basis in order to prevent disease.

When we look at causes of disease and the way they relate to the different qis, we can see that external disease, I’ll put it also the Heaven, Earth, man model, but external pathogens more relate to wei qi. Internal pathogens more to the ying qi that flows in the channels, and the lack of communication with one’s dao, the lack of being centered in one’s self to shen qi. They’re all interrelated and they’re all part of what we will call immunity.

When we come to treatments or to treat the wei qi, the lung will be the main xiang fu and to eliminate pathogen, we’ll use also different systems like tendinomuscular meridian, divergent meridian. For jing qi, we’ll use more the kidney. For internal pathogenic factors, maybe also external meridians. For the shen qi, the heart and we’ll look also deeper on trauma and how it affects or weakens or distract the shen qi. We’ll look at special points to do with traumas. This is like the complexity of Chinese medicine when we talk about immunology. In Western immunity, we’ll talk about adaptive and innate immunity and actually my research, herbal research was really in innate immunity, which is really the part of us, the first line of defense against viruses.

Wei qi is one of the strongest qi. It’s a very dynamic yang qi. Also, when we look at the Chinese character, on both sides, we have this xing, like wu xing, like in the five elements, like left and right foot walking, so we have some dynamic movement forward, and in the center, again the phonetic qi, but also like a strong movement. Ying qi moves more in the channels. The wei qi actually moves between the muscles and the channels. That’s why it’s very good to enhance sweating when you want to tonify the wei qi and so you actually need different herbs and different suggestion to enhance the sweating. With the sweating, the wei qi comes up.

A good point that I mentioned before, bladder 42 in line with bladder 13 and GV 12 that we talked about. I think the most amazing thing about this point it’s also good for deep exhaustion of lung. There’s been research published in Japan that shows it actually [inaudible 00:25:29] on these points can strengthen and makes the white blood cells, like they increase the count of white blood cells, so [inaudible 00:25:38] on this point is very advisable way to increase immunity on a daily basis.

Since I deal a lot with compromised immune patients, I will touch also on this topic a bit. From a wei qi point of view, we want to tonify the lung and zheng qi, so points we discussed, GV 12, bladder 13, lung 9, stomach 36 is good combination for. For jing qi, we’ll go deeper to ren mai, CV 4, and stomach 30, which is both where the chong mai emerge, but also, it’s part of the Sea of Nutrition. It’s a very strong point. For the marrow because I’m dealing a lot of patients with bone marrow and marrow suppression and these patients needs different care and I teach worldwide, especially oncology acupuncture among other things, so we go over deep in understanding the marrow and how we can tonify the marrow, for example, with chong mai, with gallbladder 39, which is the wei point for the gallbladder. If you are interested in studying further both immune system or oncology, you’re always welcome to go to my website and probably it will direct you to different places.

The last thing I would like to touch on is on some herbal formulas which can be useful for our times and also a little bit of our own research. I’ll do it through ren shen, ginseng, because ren shen is a very unique herb. We know the ginsenosides. We know some active ingredients in it, but we also know its different types, so ren shen as we know, the regular ren shen tonifies qi. There’s also yuan qi and deeply tonifies the vitality of the body. When we treat it to be red like hong ren shen or Korean ginseng, then it’s more tonifying the yang. Need to be careful with people who have already too much heat in their body or high blood pressure.

Xi yang shen is American ginseng. It’s a very different nature. It actually tonifies the yin. Ci wu jia is Siberian ginseng. It’s not ginseng, but it has the word ginseng, so I put it here. It’s very adaptogen. It’s very good also to help with stamina and to sustain situation when you need stamina. Obviously disease and a difficult disease is one of them, but also for people are doing sport, extreme sports, etc, or just tired, so ci wu jia, or Siberian ginseng, will be very kind of immunomodulating adaptogen. Generally ren shen is adaptogen, so we can use it in different situation.

I personally like more formulas than single herbs. Chinese medicine is based on complexity and understanding complexity and using formulas. Yu ping feng san will be the most simple, but also the most beautiful formula. Yu ping feng san, if you look at it, to me, some formulas are almost like the same as acupuncture prescription. They’re almost like a song. It’s like you have these different parts of the choir playing together to create the beautiful harmony, so it has huang qi, which works strongly on the lung the qi, and bai zhu also. It dries the dampness, but also works on qi and spleen qi, so you have the lung and spleen working together, and fang feng, which again stimulates, but also good for the beginning of wind cold, wind heat. It’s a classical prescription that can be modified.

Then there is two formulas that we’ve been studying this one for now almost 20 years and this one, I think, for about 10 years. This one we just recently got the approval for publication. Its last study took almost five years and almost 20 year to finally approve a publication in the good journal, so it’s a kind of long distance running if you do research and you want to publish in a good paper. That’s what it takes. That’s what it needs. I’m happy to be on the spot. I think there’s no shortcuts in research and definitely if you want to achieve something meaningful.

What we have been studying, here we are looking at white blood cells, so when you have the white blood count, when you go and you have your white blood count in Western medicine, you will see that under the white blood cells, leukocytes, you will have five types, very interesting from Chinese point of view. We like the number five. In our research, we are specifically looking at the neutrophils and on the lymphocytes and then subtypes of lymphocytes because they are the one that are key factors in viral, in bacterial infection and prevention.

The subcategory of the here again we see them, but we see them divided into two types, the leukocytes, but the subcategories of the lymphocytes are the most interesting ones, especially the T cells, T-helper cells, and the natural killer cells. When we do study in the lab, we take the blood of patients and also volunteers. We compare both. We take from cancer patients. We take from our staff, friends, whoever is willing to donate a little bit of blood to us. Then actually take sometimes month to three months to work on their blood with the herbs to see how the herbs are affecting it. In our last research, we specifically look at the T, T-helper cells, and the natural killer cells and the neutrophils.

We look at herbal medicine, specifically the formula we were studying and specifically the formula that we were studying the way we kind of I can say adjusted it and concentrated it affected it. By the way, one of the good thing about research is you can play. You can change. You can modify and see which modification works the best, both in the clinic and then you can check it later in the kind of environment of the laboratory that the conditions are the same, so you repeat it and repeat it and so I’m very fortunate that I could do this work, as well.

This is how it looks in the lab. In the lab, you kind of go through a specific assay where you take the white blood cells and you take the neutrophils. You can isolate them from the lymphocytes and then you can look at there at CD69. It’s a special kind of addition you can use. Then you can look at activation. Here we look this is like the control, how active it is comparing to little bit of formula comparing to more formula. We see that the more we are increasing the formula, the more the neutrophils are active, so we see dose dependent, time dependent manner, which means there is something very active in it. That’s how it looks on patients and we did many patients checking out their blood.

It’s [inaudible 00:33:16] so we take their blood to the lab and then we are checking it outside of their body. That’s their normal neutrophil activation and so you can see they are different on each patient. This patient are more cancer patient, so it’s extreme, so it’s lower than the norm. Then you can see once we are adding the LCS102, when we are adding, we call it now Tonix, Tonix-R formula. It activates dramatically comparing to the control their neutrophil activity, so you see this will be the norm and you can see how much it gets more active on that patient.

This here we look at natural killer cells, the natural killer that’s like their name. They are born to kill. They are looking at bacteria. They are looking also on cells, also on cancer cells, the deformed cells, and they are killing them. That’s their job in the body. Again, we are comparing here on the same patient that’s the control. That’s their blood, the activation of the natural killer, and then when you’re adding the LCS102 or the Tonix, Tonix-R. We can see it gets more active and, again, it’s individualized, so in each patient we see a different response. That’s normal. That’s normal with herbs.

This is the ingredients in Tonix-R, so we have poriae, ganoderma, and cordyceps, three mushrooms. They are very researched mushrooms. We are using specific subtypes of them. Then they show significant effect on immunity. From Chinese point of view, they also reduce dampness. They’re also tonifying different aspects of qi. Then for additional herbs, astragalus, atractylodes, lycium, and ligustrum, which, again, further have shown in different research to have immunomodulation effect in increase fatigue, mental function, blood sugar level, leaving enhanced blood sugar level, and liver and kidney function.

This is the formula we have been using. The Tonix-R is one of two in the research that just got accepted for publication. The other formula, LCS101, we are more checking on cancer patients undergoing chemotherapy and the first one, the LCS102, the Tonix was also for healthy people. I use it now. This formula is more for people with undergoing chemo or with suppressed immunity or people with history of cancer or the need of cancer care.

Then again we’re looking at a larger picture, so we need a randomized clinical trial. We look at the red blood leukocytes and, specifically, neutrophils on these patients and then we’re showing that we’re actually protecting the bone marrow. Bone marrow means the jing, so in Chinese medicine, protecting bone marrow is a deep implication in many level. You see people sometimes are undergoing chemo, they go older quite fast, so the jing is reduced. This one we published specifically on the immunomodulating effect. We published at OncoTarget and Therapy also quite a few years ago. This is the second formula and, again, we look at the T activation and natural killer cells activation.

This is the herbs in the formula. You can always look in all the publications, so you don’t need to worry about it. It’s on every publication on this formula or you can always go to my website, which is just my name dot com. Then you will be directed to research and to all the herbs in the formula. We show the further effect just because we’ve been researching for many years in more than seven research centers, including cooperating with Miami Children Hospital, with researcher from MD Anderson. The last publication is actually with one of the renown professors from Harvard Medical School, so we’ve been collaborating worldwide and with different researchers to produce research that shows the multifacet effect of a formula in Chinese medicine.

To me, that’s the beauty of formulas, so in a sense, this formula, to me, can be like a pioneer to other people in the West and to study formulas and their multifacet effect. In this respect, we show the effect to the protection that they top, a little bit about the immunity that I talk about also, a lot of effect on anticancer effect. We look deeper into the … This was in the lab, but we look at the mechanism of action, so we kind of have a better understanding of how a complex formula is working and what’s its potential in human care.

To finish up with immunity and acupuncture points, I would like to introduce stomach 36. This is a beautiful painting. I’ve been doing this project with some colleagues of mine, [Abatos Komininski 00:38:35], Dr. Abatos Komininski from Poland and Ron [Yael 00:38:38] from Israel with amazing painter from Poland [inaudible 00:38:42] where we paint the meridian. This is the stomach meridian. We paint the points. We kind of try to illustrate the nature of the point, so this is stomach 36. You see the three different aspects of the stomach. Actually, this is the three avenues and then sources of yuan qi and the [inaudible 00:39:00]. It’s an Earth point, so we kind of look in deeper into this. We’re looking into the names of the point, one step deeper the alchemy of the poin and lis, one of it’s understanding, it’s cultivating a field of land like on an eight village family kind of, so it’s very much to do with self-sustainability and the ability to produce all the food you need. San has also caused Heaven and Earth, talks about the three aspects of the origin of the yuan qi in the san jiao, etc., so it has different meanings.

We know this point has many effects on the body. It harmonizes stomach, but again, it has this kind of modulation effect because it also can resolve dampness. Its strengths in the zheng qi and yuan qi. It helps to nourish and tonify qi and blood and yin even, so it’s a magical point. For that reason, we have been looking at different research on immunity. I’ll give a webinar, I think tomorrow. A friend of mine will give a webinar. I’ll moderate it. I mentioned him, Dr. Abatos Komininski, specifically on the research, just specific the research and the mechanism of action of acupuncture in modulating and working on immune system.

Here I want to point out there’s been a summary of research with acupuncture point that has been studied both in human and animals and, as you can see, stomach 36 is one of the most researched points both in animals you see 25 studies and 14 studies in human. There’s been a lot of studies on the effect on this point and even kind of trying to understand the mechanism of action, how tonifying this point will affect enhancing natural killer cells in the body through the avenue of the brain and the central nervous system.

I’ll end up with some combination of stomach 36, so qi you can combine it with lung 7, bladder 42, GV 12 that I mentioned. For yuan qi with san jiao 4, the yuan qi, the one point of the san jiao, which would be warmer, and CV 4, and for zheng qi with kidney 27, the last point on the kidney, and lung 9, so this would be also interesting combination for qi, yuan, and zheng qi. I want to leave you with different potential clinical abilities.

I’m going to give a series of webinars actually starting from I think the dates are different, so like two weeks from now. It’s called To Serve & Protect, a bit kind of known thing and so you can go look into it at TCM.AC if you want more information.

If you want to understand better immunity, so immunity is made out of three things. It made out of the shen qi, the body’s qi, and also the jing qi and what you bring to the world in order to keep yourself in great vitality.

Lastly, to say when you’re choosing a point the resonates with the patient’s inner heart and heaven, this is where healings come from. Then you touch the real depth of the person. I will leave you with quoting one of my mentors, Father Larre. “By returning to the classical roots of Chinese medicine, we can make a truly significant contribution to the medicine of the future.”

Thank you very much. Thank you for watching and wishing you the best of health and healing. This is also I want to thank the American Acupuncture Council for hosting this show. I will end this slide and say a few other words of welcoming the next show, so thank you very much and all the best.

Next week on the show, there is Poney Chiang, so don’t miss him. I hope you enjoyed it. Again, I want to thank the American Acupuncture Council for hosting it and allowing us all to enjoy this. Thank you very much. Be safe and healthy.

Please subscribe to our YouTube Channel (http://www.youtube.com/c/Acupuncturecouncil ) Follow us on Instagram (https://www.instagram.com/acupuncturecouncil/), LinkedIn (https://www.linkedin.com/company/american-acupuncture-council-information-network/) Periscope (https://www.pscp.tv/TopAcupuncture). Twitter (https://twitter.com/TopAcupuncture) If you have any questions about today’s show or want to know why the American Acupuncture Council is your best choice for malpractice insurance, call us at (800) 838-0383. or find out just how much you can save with AAC by visiting: https://acupuncturecouncil.com/acupuncture-malpractice-quick-quote/.

Acupuncture Business Insurance – The Options To Consider Buying

All companies, regardless of industry, need some level of protection to keep running. If you are running an acupuncture clinic, getting acupuncture business insurance is necessary. It provides several benefits. For instance, it can take care of the expenses in case you have to deal with a legal battle against a patient filing a lawsuit. It can also help compensate your worker who is, for the meantime, not able to work, stemming from a work-related injury. In other words, acupuncture business insurance can help get a heavy burden off your shoulder.

Now that you’ve learned how important it is to have insurance for your acupuncture business, it pays to know the options so that you know how to make the most out of its benefit.

Here are some insurance options to consider:

General Liability Insurance – This is the most common but a comprehensive one – a type of insurance that any acupuncture business should consider investing their money in. It provides protection from the risks of bodily injury, damage to property, medical payments, legal defense, and personal injury. In case of facing a lawsuit for malpractice, a general liability insurance policy helps compensate for the associated legal fees as well as for possible damages.

Professional Liability Insurance – Another type of insurance that acupuncturists should consider obtaining. Professional Liability Insurance protects you and your reputation in case someone claims your professional services caused him harm. If a patient sues you based on a negligence claim, this insurance takes care of your legal fees and your possible settlement.

Workers’ Compensation Insurance – It protects your workers should they become injured while at work. Apart from a worker’s medical bills (and lost wages if they go on vacation for recovery), it can also cover disability or death benefits stemming from a work-related accident. Because of its usefulness, most states oblige companies to carry workers’ compensation insurance for both part-time and full-time employees.

Commercial Property Insurance – You may also consider getting commercial property insurance, which is for giving protection to your acupuncture equipment, office furniture, computers, office supplies – items that can be vulnerable to calamities such as hurricanes and fire.

For more inquiries regarding acupuncture business insurance, contact us at (800) 838-0383.

Telehealth – Coding, Documenting and Compliance of Telehealth

Hi, everyone. This is Samuel Collins, your coding and billing expert for acupuncturists. Specifically, the American Acupuncture Council’s Insurance Information Network and Malpractice. Today’s program, as you’re probably aware, is going to be one that’s very important considering the crisis we’re going through right now, and on telemedicine. Is it something appropriate? Is it something we can code? And how do we do it? Well, of course we have to make sure, first of all, that we are getting ourselves together. Because of course our patients are changing, can they come into the office? So without further ado, let’s get to the slides. Let’s make sure we’re understanding what’s going on for telemedicine.

So you’ll see here on this first slide, I’ve got my email address and of course take a look at our website, the American Acupuncture Council Insurance Information Network, which is AACinfonetwork.com. But here you can see a teleconference call. Now on the left side here you’ll notice this picture, a woman opening her tongue, doctor observing. So what can we do? Well before we get fully there, let’s talk a little bit about making it a little bit light. I’m not always required to see patients online, but when I do, it’s a 99243, that is the code of course for the 30 minute visit online. But it could be for of course the diagnosis of Z03.818, which is the encounter for observation for a suspected exposure to other biological agents to be ruled out, which of course could be COVID-19.

Now again, that’s not something you’re going to be treating for, but of course this is why now many patients can’t come in. So what are the diagnosis for COVID-19? Just to make sure everyone’s aware of the diagnosis under ICD10 is U07.1. And of course if it’s just for observation, Z03.818. Now of course we’re not going to be seeing patients for that, or you won’t be seeing patients for that, but likely for the conditions that you’re already treating for, but they cannot come into the office, maybe they’re in a high risk group. Certainly it’s not something that you have to close your office per se, if there’s a person in acute or severe pain. Certainly you should be helpful to them, but make sure of course you’re using all the safe practices.

That being said, let’s talk about telemedicine. It is a patient initiated service with a physician, or as I underlined here, or other qualified healthcare professional, which would fit an acupuncturist, for the evaluation, assessment and management of the patient. In other words, an ENM code. It’s not intended for the non evaluative electronic communication simply of test results, scheduling of appointments, or communication that doesn’t involve an ENM. In other words, consider it, it’s like an office visit but just done online. You would be doing all the same things of discussion with your patient: history, exam and so forth. So essentially this is an ENM visit, simply in a non-direct face to face manner, but through electronic communication. Basically doing the patient’s history, evaluation, medical decision making, and counseling.

Patients must be under your care and likely under your care for acute or chronic pain, and how to manage without direct treatment. You might have a patient that cannot come in but they’re having a severe episode of back pain. What are we going to do to help them? Well, this is the point. You can do it via the phone or virtual, meaning through your computer or tablet, to make sure to evaluate the patient and give them instructions how to help themselves.

What would this include? Well, here’s an example of a self management of a patient that you all likely do or would do face to face. Talking to the patient about how to rest and reduce strenuous activities; changing their ergonomics and posture; appropriate exercises including Tai Chi, Qi gong, yoga; stress management or meditation; joint protection; weight loss; self massage; self acupressure; maybe the use of hot or cold packs or relieve discomfort. Educate the patient about the causes, what things they can avoid, and then potentially about brief use of supports if necessary in the acute stages to limit motion. In other words, the same recommendations and things you would do face to face without care.

So in other words, simply put, this is a patient you are helping, just doing it online, doing it without physically touching or hands on the patient. So telemedicine, the patient must be an established patient. It can’t not be a new patient, someone you’ve never seen before, but it can be an established patient that has a new condition. So the problem may be new to the provider, but it must be an established patient. And it must be initiated on a HIPAA compliant secure platform, typically. That would be something where you’re going to use obviously some sort of secure platform. But however, due to this recent COVID issue, they have made a mandate that providers may use simple communication through phones or tablets with simple services like Skype or FaceTime. In fact, it was recommended by the centers of Medicaid and Medicare Services yesterday that patients that are of an older age probably should just get their grandchildren or children to come over and then use their phone or tablet for them. So don’t be afraid to initiate in that way as well.

Now what are the codes? Okay. So for online digital evaluation of a patient, which means you’re going to do some type of virtual visit, the first code is 99421, that is online digital evaluation management service for an established patient for up to seven days of cumulative time during a seven day period, for five to 10 minutes. So in other words, it’s the entire time up to a seven day period. So this might be several communications with a patient within seven days, and the time would be cumulative. But it certainly could be just for one, if it’s only one within that time. You’ll notice the codes are relatively simple, in that one is for five to 10 minutes, one is for 11 to 20 minutes, and one is for 21 minutes or more. So simply put, once you get over 21 minutes, then it’s just a 99423, and this would be again, the accumulative time for each patient. And again, it’s online, meaning through some type of virtual platform.

These are patient-initiated services for the assessment and management of the patient. They’re not intended for non-evaluative communication for test results. I want to be clear, it’s not for a patient where you’re calling and saying, “Hey, your test results came back,” but literally just like you would do on a regular visit. The patient had an ENM within the last seven days, these codes cannot be used for that problem. So if you saw a patient yesterday, this part of it would be counted as part of that visit. It’s not till after seven, which I believe we’ll see a lot of this because of the time that’s extending for patients that would’ve had an appointment, this certainly is going to fit, particularly if it’s just initiating here.

So certainly keep in mind if you saw the patient the day before and a phone call the day after, or a virtual visit, that would not count towards this. But for a patient within or after a seven day period, and again it’s cumulative time. If the inquiry is about a new problem, certainly if that’s no problem, and it can be sooner than seven days. So, so long as that is a new condition. And I would question, even though a patient may be initiating right now, they’re dealing with some new issues because they cannot come in. So certainly I think this is going to fit. And we might see a nonissue of that seven day period. The issue here is that it’s simply a visit with the patient that’s done on an online platform to address their concerns of how you may help them.

Obviously you’re not going to be able to do direct treatment, but the things you can do to help them, and maybe it might even be to get them in, and of course if it is to get them in within a 24 hour period again, that wouldn’t count because it goes towards a visit, but certainly for a patient that can’t be seen or a person in a high risk group, obviously that is mandated to stay home.

Now again, to count the times for these codes, start the seven day clock when the physician first performs a persona’ review of the patient’s question. Add the time for the review of the relevant patient records and data interactions or the clinical staff to the problem. So in other words, what this is including is the time you may take to review the records before that phone call starts. Now I would be careful, I would certainly say, don’t tell me you spent a half hour reviewing records, but certainly a few minutes would count. And this would include communication with the patient by digital means that doesn’t fall under another ENM code, meaning it’s not with a phone call. This is going to be the online. It includes decision-making, assessment, management by those in the same group practice as well. So again, if you’re in a group setting, that could work.

What I want to emphasize here though, is that it is simply the doctor doing an ENM. And when I say doctor, I mean the licensed acupuncturist doing an ENM with that patient just simply online. And that means the documentation would fall into the same way. So for the medical record, the guidelines just direct you to keep permanent documentation, either electronic or hard copy. And to make this simple, simply document like you would any other visit, as if the patient were in the office. Make notes, put the time down, obviously, the time you started and ended. You do not need to record the phone call, but you would record the visit in the same manner. So take the same type of copious notes you would as with any other visit.

Now what else can we do besides a virtual visit? Well there’s the telephone evaluation and management service, which certainly could be useful as well. And this is provided by the physician or established acupuncturist to an established patient. And again, I want to make sure that we see that’s established patients for this, not a new patient. Now it could be an established patient you have not seen in six months. And if they’re calling for a problem, then of course you can see them. It’s simply just not for the new patient. Now this services, again not within the previous seven days of the first visit, or the last visit, and it can’t lead to an appointment within 24 hours. So that’s something you’ll see kind of uniquely here for the telephone visit, is that it cannot be the result of the phone call is to come in for treatment. This is literally for the patient to manage at home, not come in within the next 24 hours or next available appointment.

So what are the codes here? 99441 is for five to 10 minutes, 99442 is 11 to 20 minutes, and 99443 is for 21 to 30 minutes of medical discussion. So again, this is going to be that discussion with the patient, essentially, again, an ENM visit where you’re discussing with them the history of the issue, evaluating their outcome, what can they do at home, this is what this is going to be used for.

Now, one thing about these codes though is that you have to document them properly in the sense that I want everyone to note here at the bottom, the place of service is not 11 as you normally would do on a claim. The place of service would be 02, which indicates a telemedicine visit. So again, if the patient’s in the office, it’s 11. If you go to a patient’s home to do a treatment the place of service is 12, but if you’re doing a telemedicine visit, the place of service is 02.

But now one thing I’m sure everyone’s concerned with is, what would be an appropriate charge for these codes? Well, I really can’t give you what your charge should be, because of course everyone’s going to vary as to the location. But what I can help you with is the relative value unit. The relative value unit is the value comparison of one code to the other, or a ratio. So what I put here at the top is the relative value of manual acupuncture, which has a relative value of 1.05. Now for our intents and purposes, let’s just say it’s approximately a value of 01. So now when you look at these other codes, you’ll notice all their RVUs are broken down to 0.43, 0.86 and so forth.

So in a simple term, think of it, it’s a ratio. If you were charging whatever you’re charging for acupuncture, roughly 99421 would be about 40% of that. 99422 would be about 86%, and so on. So again, just think of it as a simple ratio. So by example, if someone were charging probably $70 for manual acupuncture, the relative price for a 99421 would be 40% of that, or about $28. So again, just keep it really simple. We want to make sure, of course, that acupuncturists are available to patients who are managing their chronic pain, who are managing many issues that they otherwise would not get help for. You could be the person that really gives them a good sense of feeling of assuredness that you’re there for them to give them even just stretches, how to use hot packs, maybe it’s even dealing with some of the herbal consult that you’ve had.

What I want to make sure is that we’re doing a good job and continuing to help our patients in this time, and make sure they’re aware that you’re available. There would be nothing wrong with sending something out to your patients to let them know that you are available, potentially in the office for appointments, but also online and it will be covered by insurance. Ultimately, we want to make sure you’re doing well. The American Acupuncture Council is your resource, and I’m going to make sure that anyone that’s listening that’s of course a member of my network, you’re welcome to give me a direct call or email so I can help you with these.

Of course, if you’re not in the network, I apologize for that, but we do offer a service for it. You may want to see that we upcoming seminars that will allow you to, with some help, and the seminars will be virtual as well. But please take a look, we have more information on our website, to go to our Facebook page or to our Instagram account to take a look there. We’re here for you. The American acupuncture council is your partner. Your success is our success, and we’re your partner to make sure your practice continues to thrive even during this time. Next week’s post will be Virginia Duran. And until then, this is Sam Collins, the coding and billing expert for the American Acupuncture Council, and I wish you all well and be safe.

Personalized Chinese Medicine Logic or Magic? Yair Maimon

Hi everybody and welcome to the show, The Spark and Evidence of Acupuncture. I am Yair Maimon. I would like to thank the American Acupuncture Council for providing the space and broadcasting this show to you. It’s quite a unique show and I will explain why. I’m very fortunate. I’ve been practicing Chinese medicine for more than 30 years, and in the last 20 years working more closely with oncology patients, so caring very much on how Chinese medicine affects cancer and immune system. Immune system specifically now at this time has another potential or understanding the effect of Chinese medicine on the immune system, especially because of the outbreak of Corona has another interest of how we as humans can protect ourself from viruses. I’ll try to touch it. It wasn’t in my original show, but since part of the research is about immunity, and especially in native immunity, we’ll be able maybe to expand on this burning issue of the Coronavirus and its spread. Welcome to the show. I would like to start with the slides.

As I say, I have this daily dilemma as an acupuncturist, and also working in a hospital, of looking at personalized medicine, because eventually we know that the best for us will be to prescribe a personal formula to a patient. Western medicine has the advantage of researching one molecule or one agent and seeing placebo versus real, seeing if it effective or not. In Chinese medicine, in a way, each person is a whole world and to each patients we are providing a specific medicine. The question is, can we actually test it? That’s why I call this lecture Personalized Chinese Medicine, Magic or Logic? Because if we can put some logic into it, I think we are moving into the next potential of Chinese medicine and integrating Chinese medicine, especially herbal medicine, which is very difficult to integrate into regular medicine. I’ll touch on it a bit. As I say, this is my daily quest and also interest to have Chinese medicine available to patients within the regular system, and definitely for cancer patient or patients who are in a great need that can benefit from both medicines, the Western and the Chinese.

As I said, I’m very fortunate. I’ve founded this research center in Sheba Medical Center. Sheba Medical Center was one of the top 10 hospitals, a leader in medical science and biomedical innovation by Newsweek. It was one, not just in the Middle East, but worldwide, so this very innovative hospital with a lot of research facilities. That’s really, I can say my luck is to be able to also have a laboratory and research facilities and good researchers working with me and taking Chinese medicine sometimes one step forward, or challenging the ability to bring science into what we clinically do and validate it. You see the uniqueness on one side. There is, you can see the laboratory and how it looks. On the other side we have the clinical facilities, and that’s where patients get treated.

My interest is both in the research part and that’s where we provided the Tal Center at Sheba Hospital. We provide also the research and the clinical facilities. Also my deep research is in education, because I believe that one of the most needed thing, especially if you’re practicing with cancer patient or different immunological challenging diseases, we need extra knowledge. Knowledge is really the strength. With this thing in mind, is with the dream and the vision to bring this knowledge to everybody. I’m part of the TCM Academy. You can find also some of the lectures and especially a very specific course which is designed for oncology acupuncture that has an online part and offline, and is unique in this way that provides worldwide ability to understand Chinese medicine for oncology in a very kind of unique way. There’s already like 250 people graduating from this course worldwide. It provides a common knowledge to people worldwide.

As I say, Chinese medicine is personalized medicine. It is a challenge. It’s much easier in a way. There’s always a saying that Western medicine is hard to learn but easy to practice. Chinese medicine is relatively easy to learn but difficult to practice. That’s true, because each patient brings us a different challenge. For each patients we are like almost starting from the beginning, building up a personalized approach for him. We know that each person is unique, and therefore personalized approach is the right approach to provide him a good medical care, but even zebras have stripes, but they display individual stripes. As with zebra, the human DNA is 99.9 similar across the population, but this special crossing for the zebra, but also for us being so different for each other, is just 0.1. That allows us to display our individuals stripes and to be different. It’s quite amazing number if you think of it, but there is, as I said, a lot of power, and there is so much in little.

When we do a successful treatment, we look and I put on the gene level and a DNA level, because on the gene we are different. On the Shen, we have something in common, but when we want to provide a specific treatment to a specific patient, then we look at something very specialized and very personalized. That presents a challenge.

I want to prepare the lecture. Actually, it’s a patient of mine, and this is really where the story starts. As you can see, I like to look at it, she had actually a dress or a shirt with a zebra crossing. That’s how I came across to thinking about zebras in this case. She’s a female, 55 years old, a nurse, married with two children, and she has metastatic adrenocortical cancer with metastasis to the liver, lung and bones. I’ve been seeing her for quite a while. After a while, she had a very stable disease, which was like extremely good health, very stable disease for more than four years. She [inaudible 00:08:24] to the Chinese medicine, also in acupuncture, Mitotane and Cortisone, which were the usual care for her in Western medicine, and the treatment I provided her.

Her condition was stable until it started to deteriorate. When it started to deteriorate, I started, because again, it’s quite unique cancer and every patient is unique, so there’s like two concerns. What will be the best formula for her in this deterioration? I did the regular Chinese medicine diagnosis. I used the four pillars of diagnosis: observation, feeling her pulse, palpating her pulse, looking at her, asking her specific questions. Then I had three formulas in mind to right her. I put it here like formula one, formula two and formula three. I wrote almost three different formulas, one based more on my Chinese diagnosis, one thinking more about research, about different herbs that can be more specific for her cancer and for her type of medication that she was taking, and then another formula, which I said, I’m trying to be a little bit more creative, taking what I see in Chinese medicine and research and combining them together into a third formula.

This really was where my debate was, which formula will be most effective for her? Will it be the first one? I put some just few herbs from each formula as an example. Each formula contained more herbs. I had this debate between this formula one, formula two and the third one, thinking which one will benefit her most once her condition got deteriorated. The question is, since I was in and working in a hospital, can I help Western medicine and scientific testing to verify or to assist in this decision making? Can we use Western technology, and especially laboratory technology, to validate or to assist us in the decision making in this respect for the best herbal formula for this patient, and overall, to see if this formula is effective for her or not? I wondered if we can combine the healing and the part of the healing that is so strong in Chinese medicine with the science and the logic of Western medicine. This is the place where I say, is it logic or magic?

In her case, I was able to isolate her natural killer cells from her blood. This is where you see actually the oncologist taking her blood test from her. In the laboratory we can isolate her natural killer cells, her innate immunity, which as I say, this part of immunity also deals with cancer cells on a daily basis, but is also very important in the fight against viral infections. I isolated her cancer cells. We shared the shared operation. From the operation we took part of her growth and we started to grow her cancer cells in our lab. At this point, we are having in our lab two things. One is her part of her immunity system, her personalized immunity system, and we have her cancer cells growing in two different sets.

On this two different preparation, I started to see if we can put different formulas and see how they react, how her immune reacts and how her cancer cells are reacting to the different formulas. Remember, I was debating between these three formulas. This is called ex vivo. We take something from the patient, we grow it outside the body, and we try things on it. There is human research, ex vivo or in vivo. In this case, when we tried the three formulas, this is the result we got. On the first formula, her immune system got stimulated six times more than the control, so her immune system was six times more active than the control one with the first formula. With the second formula, three times more, and with the last formula, as you can see, two times more. We saw a big difference in the way her immune system responded to the different formulas. We have the first one, second and third. You can see the first one is responding in the best way.

Now the second part was looking at her cancer cells. Again, we are looking at the cancer cells and to see the death rate of the cancer cells. The first formula killed 50% of her cancer cells. This is also the same formula that increased her immune system almost six times more. The second one killed 50% of the cancer cells, and the last one 10%. The phenomena that we see, that the same compound with the same amount, the same concentration, on one hand activates the immune system six times more, on the other hand, it actually kills 50% of her cancer cells in the same amount.

We are looking, because it’s a compound, because it’s a formula that has also anticancer herbs and have herbs to increase her immunity, it works on these two arms. This is very unique. Of course, we don’t have molecules or Western medicine that can do this to action. The most interesting things to me is this is the first formula is the formula I prescribed to her just from the Chinese medicine diagnosis, just sitting in front of her, taking her pulse, looking at her tongue, hearing her story, thinking about the nature of her cancer and prescribing.

It was a kind of very great relief to me to see that formula that we prescribed in the clinic, based on our knowledge of Chinese medicine, had such a strong effect and are better than formulas that we are trying to formulate just from our mind and just from based other research or based on other criteria. Here again, the personalized formula that was made for Chinese criterias was the most effective on both arm. It has also great effect on the patient. She looked at it and results and she felt very happy and content that she’s taking something that she knows that effects her both immunity system and cancer.

But with traditional Chinese diagnosis we go even deeper. We also look at the Shen, which is a bit beyond sometimes the normal consideration, definitely of Western medicine. We want also to see how we can affect the spirit in a personalized way, not just the body. From observation, for example, we look at her eyes. As you can see, this as a picture of her eyes. You can see the fear there. It’s not just the fear of cancer. It’s something deeper that has been there all the time. If you think about it, if her cancer is in the kidney and there is a fear, then addressing this part in her will also aid in healing.

That’s definitely have an effect when we choose a point, like if we choose a point for her, I would choose the points on the chest for one of the points, like kidney 23, which called Spirit Seal, which will have a deep effect on helping her to protect her fear and her heart and feeling more, I can say, strong in herself, not just in the ability to deal with cancer and all the difficult issues dealing her, but also deep side in feeling more content and being more one, that the Shen and the gene or the heart and the kidney are uniting in a good way and communicating in a good way. Her ability to sleep, her ability to deal with the challenges she has will come much more from inner strength and inner peace than just from fear.

When there is a lot of fear there, always to me, both the prognosis is not so good, but also that person’s ability to heal are much more limited. Addressing it also in the herbal prescription, using herb like Yuan Zhi, or herbs that are addressing the kidneys and strengthening the kidneys, which have also some kind of deeper aspect. Deeper healing aspect brings us this, I think, this uniqueness of Chinese medicine of being able to see the patient and finding a prescription formula point which are actually matching the person in a very deep way and allowing and creating a deep healing, which and as we know, a human’s potential is much greater than the physical. This allows us to address it.

To me, seeing this result, and we repeated it with more patients, and the same results, always the formula that was prescribed when we see the patient has a much better ability than the other ones that were like speculated, or at least that I was debating. It was one that I felt more comfortable with according to the diagnosis. The other ones, I brought other criterias in but I felt less comfortable. It’s amazing you bring it to the cells and it shows the same. It gives us much more trust in our diagnosis in our medicine. This personally prescribed medicine, I think to me, and I hope to all of us, brings us much better confidence in the medicine and the way we deliver it on a daily basis.

It also validate the concept of holism that is very strongly embedded in Chinese medicine, that we look not just at the body on the physical plane, but we are looking at the complexity of humans, addressing the body, the mind and the spirit in whatever way you can to enable healing. I think this is one of the strong and most important points that we are making dealing in Chinese medicine in the Western world and in Western environment.

But this testing may have further application. One of the further applications that we did was interaction with her chemo. Obviously the result was a great fear, that for herbal medicine, that it will negatively interact with the patient’s Western medicine intervention, and in her case, was especially the chemotherapy. This possibility provide us again to take ex vivo to check if we can take the formula, her cancer cells, and the Western medicine that was prescribed to her, and see if we see any positive, negative or no interactions. Taxol and Gemcitabine were the two herbs that were prescribed to her. We could see that the chemo alone killed 70% of the herbs. Again, we are looking at a certain amount of chemo. This is for Taxol alone, but when we added the herbs, there was additional killing effects, so not just that it didn’t interfere with the Taxol, at least in ex vivo format, it actually enhanced the killing effect.

With Gemcitabine, we saw same, 85%. We were looking at a certain amount of chemo. Then we looked, when we’re adding the herbs, it’s increased. It was added on effect. Everything we look at in the timeline, so we are checking in during the time in a different concentration, but I’m showing you just time. If I’m picking up the easy results to understand, but everything is time-based and concentration-based, but the bottom line, this kind of potential situation in the laboratory allows us also to look at interaction with regular drugs. As we see in this case, as then I’ve seen in quite many cases in my clinic, the interaction has a much more potential positive effect than danger, as a lot of time is feared. This is definitely another way to start to look at it more scientifically.

What about the future of such testing? Because I hope and see the Chinese medicine has much for interaction with Western medicine in different ways. To me, it brings us a much stronger and broader horizon. There is few options. One is optimizing. I did actually, for her, another patient, I took again these cancer cells for example, and tried different herbs, and to see from the herbs I have, which one is killing more and which one less, and then maybe adjusting the formula accordingly, testing it again. We can optimize formulas. We can add or reduce certain herbs. We can look at interaction with chemo or interactions with other agents that the patient are receiving. We can develop a new methodology that maybe can help us in clinical decision making, create a new paradigm.

Especially at the moment, everything is elaborated, takes sometimes days and weeks of research, but soon can be achieved, can be very simple method that can isolate it definitely from the blood, even circulating cancer cells in the blood, and we can immediately or very fast do tests on them. Things that look today a bit futuristic, when we look at technology in a few years, many things will be possible. To me, it’s another paradigm and another way to think about a potential future and potential interaction with technology and Western medicine, and also discovery of new combination, very effective combination. For the last 15 years, I’ve been researching one specific formula, LCS101. If you’re interested, you can read a lot of published research by us on this formula. By now, it’s probably one of the most recent formula in the Western world. We collaborated with people from MD Anderson, from Miami Children Hospital, even the latest collaboration was with one of the good oncologists from Harvard Medical School.

Once we can show science, it’s very easy to collaborate, very easy to discover new combination to see how they are working, how safe they are. I think this give us the potential to make more and more new discoveries. Obviously, if you want to look more at my research, you’re welcome.

Just to end up, I think that one of the best future possibilities is combining the science of medicine with the art of healing. This combination can open a new horizon, both to cancer patient, but also for almost everything that we look on the level of humans. As I said, for example, now there’s this greatest fear from Coronavirus. One of the most important things is that your innate system, your immune system, innate immune system will be at its best. Then Coronavirus will be as every other virus, you either don’t get infected, or if you do, you recover quickly. Chinese medicine definitely has a potential in enhancing immune system. It’s overlooked in this potential. Everybody is looking for immunizations or other means, but I think strengthening the immune system definitely is one of our strengths and one of the things that we can bring back from ancient medicine into humanity today, and to reduce suffering and help also people to be less ill.

We can trust this path of seeing the uniqueness in each patient, because as I said, as a clinician, you always want to bring more trust in what you’re doing. To me, this research, and as I said, we did it on many other patients and the same idea repeated itself.

I would like to finish with my hero, Sun Simiao, and that’s really a sentence that goes with me always, that, “If the heart has no worries, the body has no limits.” It’s an important way to me to finish this lecture. I would like also to thank people at the hospital and people I’m closely working with, especially Zoya Cohen, Noah Samuels and Raanan Berger, who is the head of the oncology department, and the Jacobson family who provided the fund and the ability to do all this research.

I hope this was of an interest to you. If you’ll have any further question, you can always email me or ask me. I think it’s quite unique to see how Chinese medicine can be verified and validated in many ways. We shouldn’t forget that each one of us is unique and has individuals stripe. Thank you very much for watching it. As the last words, I would like to thank again the American Acupuncture Council for providing this platform and providing this show. Next week there will be Lorne Brown having a show on the same platform, so you’re welcome to watch it. All the very best to you. Be well and healthy, and I wish you all the best of health.

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It helps you discover other insurance package inclusion (that you might not know when you do not ask quotes) – Though acupuncturist business insurance quotes are quite similar, there still exists a difference. The difference is what you can negotiate with your prospects for better deals.

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Phlegm – Etiology pathology and treatment Moshe Heller

Hi, my name is Moshe Heller. First I’d like to thank the American Acupuncture Council for hosting this show, and providing this really wonderful platform for writing information.

I’d like to start talking today, and today’s lecture would be, I will talk a little bit about pediatric phlegm, or phlegm in general. I want to just have a short discussion about etiological factors, pathology, and also the treatment. Since phlegm is actually a very, very common thing nowadays because of, as we know, a lot of … The flu is very common and upon us. As disease progresses, I see many children presenting with phlegm presentations in the past few weeks.

Let’s start. I think the slides are on, and you’re seeing it. The first thing I’d like to just talk about is that … Why do children actually have phlegm, or tend to have phlegm? There’s a famous saying that children produce phlegm very easily, and there’s a few reasons for that.

It all starts with the fact that, actually, children are born with very weak spleens. We assume that, at the beginning of their life, they will always have spleen vacuity. That presents with their tendency to have difficulty digesting, also having very soft stools. That’s a normal thing for them, and that’s a very clear sign their spleen is deficient. Therefore, when you have a spleen deficiency, dampness can easily accumulate and therefore transform into phlegm.

Also there’s another saying that the exterior of children is not secure, and they contract pathogens very easily. WHen the child contracts a pathogen, it influences the way that the lung functions, and the spleen. Therefore, also, the end result could be an accumulation of phlegm, or dampness and then phlegm.

There are a few other supportive factors to the production of phlegm, and one of them has to do with … What I see very commonly now is that the feeding schedule is not as … Parents tend to feed babies on what we call “on demand”. Therefore their scheduling of feedings are random, and sometimes cause this eating on various times, and end up a lot of times overeating. That in itself can also cause an issue with or become a burden on the spleen, and therefore produce more phlegm.

Also, as the children grow, and we start to introduce new foods, a lot of times wrong foods can be presented to them. Meaning either they’re too cold or difficult on the digestive system, and that could be because one of the most common thing is introducing fruits earlier on, or too early. As we believe in Chinese medicine, that fruits are cold and therefore can really burden the spleen, also.

There’s also the issue of formula. I think that sometimes the formula is very heavy and is actually over rich, and therefore not so easy to digest. A lot of children, once they’re put on formulas, actually start developing phlegm. It’s a very interesting thing to watch, because we have then the issue of, what to we do if there’s no other sources of food, and we have to look at different formulas as solutions?

I also want to mention one other thing that’s really commonly seen in my office is that a lot of times antibiotics are given inappropriately, meaning that … Antibiotics definitely have a place and a time to be used, and they are very important. Nonetheless, if they’re used inappropriately, they can produce a dampness very easily because of their nature. As we know, from a Chinese medical perspective, antibiotics are cold and bitter, and therefore they are hard on the spleen. If we have a cold condition, and it’s a cold exterior condition, and we give out antibiotics, the end result will be that there will be some phlegm developing, or damp and then phlegm.

How do we diagnose? How do we know that there is phlegm in the body? Sometimes in children the easiest way is that we see it. As we saw in the first picture of the slides, sometimes it’s very visible, but sometimes it isn’t. If there’s no discharge, there are other telling signs that are important to realize.

One thing ends up as a result of this, especially if the phlegm is stuck in the sinuses, the child becomes a mouth breather. A lot of times we’ll see that their lower lip is a little saggy. Especially if they’re trying to concentrate, you’ll see that their lower lip opens and falls down, and it doesn’t shut down. A lot of times it will also result with some more drooling, or a tendency to drool, heavier if they’re at the teething age.

We have this drooped lower lip, and then mouth breathing. Then we can hear them breathing a lot of times. Another telling sign is snoring at night. Snoring at night usually indicates there’s something that’s blocking, and that phlegm is one of the causes of snoring in kids. Mouth breathing, heavy breathing, or snoring at night, those are all really strong signs.

Of course, palpating the lymph glands is a very important diagnostic procedure in children, because if the lymph glands are swollen, that’s a really strong sign that there is some phlegm accumulating, and a very particular type of phlegm, which we’ll talk in a second. Then, also, the actual history itself of the disease. If there’s chronic sinusitis, or chronic ear infection, or tonsillitis, all these are signs that maybe there’s this phlegm that’s lingering, and is a part of the pathology of the disease.

Another thing that’s really important to use as a tool is listening to the lung sounds. That’s something that, if you’re seeing children, you should probably have a stethoscope with you, because listening to the lung sounds can help in your diagnosis, another sign that can help you in the diagnosis of the patient.

For example, if you hear wheezing when you listen to the lung, you know that that is a constriction of the bronchials. That means that there’s Chi stagnation. But, if you hear crackles, crackles are the sounds like little balloons popping, that is a sound that there is phlegm in the lung. I use it as a diagnostic technique. I listen to the lung. If I hear those crackles, I know that I’m going to need to clear phlegm from the lung.

I want to go over two patterns, this is diagnostic patterns, that are very common in children. The first one I want to discuss is accumulation disorders. We discussed this many times before, but I’m just want to remind you that a lot of times accumulation disorders are the reason that children are presenting with phlegm.

What it is is that … It’s like food stagnation in adults, but its difference is that this could be just from either overeating or eating things that are very difficult for them to digest, and then that accumulates in the stomach and creates this heat and phlegm. The heat symptoms manifest with these red cheeks that are there all the time. This is heat rising from the stomach, and you’ll see these little, almost like stop lights, with the two red cheeks. They’re very distinct. It’s a sign that the digestion is a little overheating and stagnant.

Of course, that will also affect their … They’ll be a little more cranky and irritable, and maybe have difficulty falling, or staying, or waking up frequently. These children don’t sleep as well because something’s not digesting well.

Of course, once these fluids go up and stagnate, they can cause phlegm to accumulate. Then you’ll see this green nasal discharge, exactly like you saw in the first picture. Then you’ll probably see cough involved with it that is very rattly, and maybe some slippery coughs. These are all phlegm signs that come from the accumulation disorder.

When we recognize or diagnose accumulation disorder as the source, we always need to think of Si Feng as the treatment points. Of course, Stomach 36, Stomach 25, and CV-12 are also really important to help, and San Jiao 6, which really helps to move the Chi and resolve the blockage in the digestive system. These are all really important points, but the main treatment point will be Si Feng.

Then the formula that you might be considering has to do with helping the digestion. I have a great formula that’s based on Bao He Wan in my new motion line. I have a website that will be at the end of the slideshow. You can log on and look at digest. It’s a really fantastic formula for supporting the digestive system in situations just like that.

The other aspect is lingering pathogenic factors. Lingering pathogenic factor, a lot of times either cause phlegm or are the phlegm itself. When we diagnose lingering pathogenic factors, we usually have three types or three syndromes under that. One is more of a deficient kind that’s a little more rare, and it involves spleen Chi deficiency. The other one is called retention of phlegm, and retention of very thick phlegm.

We’ll go over the last two just to remind you how we diagnose them. When we only have retention of phlegm, usually you’ll see that there’s this recurring infection, and it can be anywhere from the sinuses, to the throat, to the chest, to the ears. There’ll be a lot of phlegm or discharge from the nose, or cough with a gurgling or rattling sound. There’ll be mouth breathing, like we discussed earlier. There’s emotional state where they want things, but they don’t really want them. They’ll say, “I want this,” but when you give it to them, they’ll throw it away. That’s a very typical sign of that. Then, also very choosy, and wanting only sweet or white foods.

Sometimes you’ll see a manifestation of that phlegm on the stool itself. That’s question we have to ask parents. How does the stool look? Does it change color? Have you noticed any changes in … If there’s this glistening, or it’s a little bit shiny, that’s a sign that there’s phlegm in the stool. Then, of course, enlarged lymph glands, which is really a very important sign for the lingering pathogenic factor.

When it becomes thick phlegm, there’s a lot of the same symptoms. A lot of times the thing that triggers me is that, when I ask, when we discuss the illness history with the parents, they’ll always say a sentence like, “Since their illness, they haven’t been really the same.” The underlying mechanism is that the child’s character is altered or really changed. There’s something either subtly or really more significant change in their character.

Then, that’s very typical of that, when we think that phlegm is becoming so distinct that it actually changes the spirit, or changes … With an adult, we’ll say that there’s phlegm blocking the heart orifices, and then the Shen is not as clear. That’s when we start seeing that in children.

A lot of times there’ll be two other signs that I want to say. They’ll have these energy crashes. They’ll suddenly have periods where they just are really cranky, and they only want to really rest. Also it is sometimes associated with intermittent abdominal pain. These are all signs of the lingering pathogenic factor with very thick phlegm.

The treatment, when you recognize that, is combination of four points, Bai Lao, which is an extra point in the back, UB13, 18, and 20. This is the basic protocol. Sometimes I combine it with the Shao Yang combination of Gallbladder 41 and Triple Warmer 5. Also I will palpate UB43. If it feels very full and excess, I might needle that also.

The main form that I use for that is a combination of Xiao Chai Hu Tang. We’ll talk a little bit about Xiao Chai Hu Tang, because it’s not the first formula that you would think for phlegm, but I found it really helpful with many children, especially with children, to resolve phlegm. I guess because [Ban Xia 00:21:00] is in that formula, but it really is a mild way to resolve phlegm. Helps the children resolve it. I’ve used it many times. You can see that, once Xiao Chai Hu Tang is used in its correct formula, you will see a slow drying of that phlegm, and the symptoms are reduced. I really want you to remember Xiao Chai Hu Tang, especially with kids when they have phlegm.

I want to give a case example that I was treating, actually, a few days ago, last week. There’s this two-year-old boy that came to my office that the parents were saying that was experiencing back-to-back ear infections. Again and again, the ear infections would repeat. Also it always comes with fever and pain. The child really is two years, but still is talking already, and expressing pain in the ear. He mostly tugs and pulls on the left ear, but both ears is something that he’s experienced.

His mother says that everything was normal during pregnancy. The delivery was fine. At the end he needed to be vacuumed, but he was healthy otherwise. Around nine months of age, something around then, she had to stop breastfeeding, go back to work. Although she was giving him formula beforehand as a supplement, at around nine months, around that time, formula was a the only thing she was giving, of course and the introduction of solids.

At that time, there was a lot of dairy products that were introduced. That created a lot of wheezing, or he started to have these episodes of wheezing, almost like asthma. Went to the doctor, the doctor gave steroids in a nebulizer, an inhaler. That really calmed the wheezing, as the mother was reporting.

Then, a few months later, he got another really bad cold. Then that developed into an ear infection, and he was given antibiotics. Since then, it’s been repeated ear infections and rounds of antibiotics. Last round of antibiotics was about three weeks ago. He was given Amaxicillin, and he is currently still complaining of ear infection, although there’s no fevers, which the mother was relieved. She took her to the pediatrician a few days before the appointment, and there was still accumulation of fluids behind the ear drum. The doctor was saying that they may need to consider doing ear plug operation. That’s why they were looking for an alternative way to treat him.

The mother was saying that the baby is a very picky eater, and in the last month they were trying to get him off of dairy, because they thought that that could be a problem, and that’s why he’s having the ear infections, which I agreed. We also agreed that, from now on, they should probably stop wheat.

Bowel movements are two to three times a day. The mother thinks it’s pretty normal, and they don’t seem to be too soft or hard. He doesn’t complain of stomach aches. But, his sleep is not good. He wakes very frequently. He drinks a lot of water throughout the night, and also the mother reports that he’s addicted to the pacifier throughout the day. She’s wanting him to stop, or trying to wean him off of that.

On examination, I found submandibular lymph nodes that were positive or enlarged. His finger vein, which is something that I observed, was very dark, which means heat, and wide. That means that the pathogen is strong, and it’s reached the wind gate. It hasn’t really penetrated extremely deep. Therefore we could address it by resolving it on the [Yan 00:26:43] layers. I’ll explain in a second. Also, when I was examining him, it was clearly that his breathing was heavy and he sounded very congested.

Out of that, I was very clear that his diagnosis was that he had what we call thick phlegm LPF. I believe that it had developed from what we might call a food accumulation, or an accumulation disorder prior to that. I needled the points San Jiao 5 and Gallbladder 41. That is a combination I use for ear infections, because when we address the Shao Yang, it opens up the flow of Chi around the ear. That could be, in itself, the treatment for the ear part of the disorder.

I also added Bai Lao UB13, 18, and 20, as we know, because of the lingering pathogenic factor. I also prescribed Xiao Chai Hu Tang. The first days after the treatment, I got a report that the child was sleeping much better, which was I think a very important sign to see.

I’m running out of time, but I wanted to just mention a few formulas that we usually use for phlegm. Including Er Chen Tang, is an important basic formula for phlegm that we know. Sometimes you can combine that with Xiao Chai Hu Tang. I usually think of Er Chen Tang when I see a spleen deficient at the background of the phlegm accumulation. If there’s spleen deficiency at the background, Er Chen Tang is what I would think for.

Ban Xia Hou Po Tang, another really important formula for phlegm. The difference between that and Er Chen Tang is that Er Chen Tang is more spleen-y, and whereas Ban Xia Hou Po Tang is more liver-y. If the spleen is really deficient and is the cause of the phlegm accumulation, then we can use Shen Ling Bai Zhu San. Or, if there’s an accumulation disorder at the background, Bao He Wan is the choice. As I mentioned, you can check my variation of Bao He Wan in the motion herbs website.

There’s other two formulas I just want to mention that is related to cough. Qing Qi Hua Tan Wan is the famous phlegm heat, or sometimes called Pinellia Expectorant. That clears phlegm heat from the lung. That’s when you have a lot of this cough, which is productive with yellow phlegm. But, if there’s more phlegm dryness, we think of Bei Mu Gua Lou San as the formula for resolving phlegm and dryness.

I think that’s about the time that I have for this presentation. Thank you very much for joining me, and I hope we will meet again in our next session.