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The Scope and Opportunity of Oncology Acupuncture

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Hello, everybody. I am Dr. Yair Maimon, and I would like first to thank the American Acupuncture Council for hosting this show. Today I will focus on something which is very close to my practice and my experience, which is oncology acupuncture. In the last years, I can say there’s been an amazing opportunity for acupuncture because there is so much evidence and because we can do so much for oncology patients. So the whole field of oncology has been opening up. I’ve been practicing all my life, also in hospital setups and being a head of oncology, integrative oncology acupuncture departments. So I can see both from my practice, I can see from the response of the other oncologists and regular medical care that is seeing more and more the importance of acupuncture in this field.

It’s almost hard to believe how much we can help in oncology. I can just tell you it just now I’ve seen a patient, I’m still just after my clinic, she came with so much pain. She has a sarcoma in her lower abdomen that was just removed. Recently. She came all kinds of hunched in with her husband and I said just lie down, and I just need column four, stomach 37, stomach 39, and waited a few minutes. And then she started to look at me and said, “Wow, this is the first time in days that I’m back to my power, back to myself,” and this kind of changes, especially in oncology, because the patients are very deficient. They’re very weak.

We’ll talk more about the indications that we see. They’re responding both extremely well, they’re able to tolerate their cancer, their treatments, cope better with the disease emotionally and mentally. So to me, this has been an amazing kind of journey, which I didn’t really plan, but I saw how much I just found myself doing oncology acupuncture is … Actually, especially because about almost 20 years ago when I started, everybody were afraid of treating oncology with acupuncture. I was in China, saw the amazing results and went back and started to treat patients. And since then, I’ve been treating a lot of oncology patients, doing a lot of research. If you’re interested, you can read my research. I have more than 20 peer reviewed publications, most of it around the oncology, but also around other areas. So in this talk, I would like to speak about the opportunity and the scope of oncology acupuncture, because the scope is quite remarkable. So, I will start with the slideshow, please.

First of all, the reason there is so much awareness about oncology and the field of acupuncture is because we get more and more evidence. The amount of evidence is even … I think even people are practicing Chinese medicine and not aware to the amount of evidence of the effectiveness and the safety that oncology acupuncture has. So, first I’ll say just some words about evidence, because when people say evidence, they always expect human studies, comparable studies in human, but the world of evidence, I just want to point out, is actually based also on clinical experience. It’s based on patients and patients’ report. And also obviously the best external evidence that we can have, by peer review by different studies that were done. Oncology is one of the really robust area where there’s more and more studies that are repetitively showing their effectiveness.

When we’re talking about studies, we’re talking about the pyramid of evidence, and in the top of the pyramid there is systemic reviews. Under this, there is the randomized controlled trials, then there’s cohort studies case reports. So, all of these are building the evidence that is trusted in Western medicine. And one of the things that we have to understand that the higher we go on this pyramid, the strongest the evidence of what we are showing and what we are knowing. So for us, it’s really translating then what we know in the clinic, which has been known for years to be effective, into a scientific kind of objective and reflection. So I just want to point out that if there is enough randomized clinical trial, you can do a systemic review. It means you can take a lot of trials together and look at them from above and see if a field is effective.

From a scientific point of view, it’s a very kind of robust and high way to look at Chinese medicine. So I decided to start and we’ll talk about especially the amount of studies that are in oncology acupuncture, also to show you there’s quite a lot of studies in the acupuncture overall. I just recently looked, there’s 32,000 studies in PubMed and I think around about … I can estimate around 1400 studied just in cancer care. That’s quite a lot more than usually people would think there is.

When I want to talk about the scope, I would like actually to show one of the quite recent, it’s only been around for a few years, one of the systemic review of the effectiveness of acupuncture on related therapies, [inaudible 00:07:05] acupuncture, and it’s an overview of systemic reviews. So this is like, if we talk about systemic reviews, this is even one above it, and it was published in one of the publications of Nature, Scientific Report. We have a very high level looking at effectiveness of a field and on the scope of a field.

Let me explain. This is the overview of systemic reviews. This is this paper that I’m going to present. It looks on systemic reviews, which is based on individual studies. So, if there is enough individual studies let’s say on nausea and vomiting, they do a systemic review. Enough studies on pain, they do a systemic review on the studies on pain. In this one there’s been enough systemic reviews, so it overviews them. In this study, they took 23 systemic reviews, which included almost 250 individual research studies and about 17,000 people who have been involved in these individual studies.

So, this is kind of quite a big pyramid to look at the way acupuncture is effective in oncology. So we are looking really at the top of the top of the pyramid, really this kind of tip of the pyramid. We look at 23 systemic reviews, which is looking at almost 250 individual research. Most of them are actually randomized clinical trials, and it looks on a population of 1700 cancer patients.

This is the type of scope that they’re looking at. So there is enough research. It doesn’t mean that everything reached the level of saying, okay, the evidence are extremely conclusive, but there is enough research in these areas and that shows you the scope of acupuncture in cancer care. So, if you look at fatigue and by the way, if fatigue is one of the most common. Almost all cancer patients suffer from fatigue, either chronically or at some period, and acupuncture is extremely effective in relieving fatigue. This in itself is a phenomena. And then reducing those and vomiting, but also in leukopenia. These three I marked in red here, because in this systemic reviews, they found out that these three indications have enough scientific rigorous studies to show the effectiveness. So just these three are quite impressive. So we see the effect in fatigue. We see nausea and vomiting, which is related to a lot of chemotherapies and other therapies that patients are getting. And also sometimes for the cancer itself, if they’re in the digestive system, and to reduction of leukopenia, white blood cells.

I’ve done extensive research in herbal medicine for leukopenia and in neutropenia. So, Chinese medicine is very good in really protecting and invigorating the bone marrow, which is producing the white and red blood cells. Then cancer related pain and pain is accompanying many cancer or cancer treatments. Hot flashes. We’ll talk about hot flashes in this show or in this lecture. Hot flashes is side effect, especially for gynecological cancer and breast cancer, because many of these patients are receiving anti-hormonal therapy and suffering from severe hot flashes, which are really every part of it. But this is just a good example. And I’ll talk about it more extensively later. It’s really reducing the quality of life, and sometimes to the point where patients want to stop the anti-hormonal therapy, which has its own effect, because the quality of life is diminished.

Then hiccups. I had a few cases of hiccups that nothing stopping it and believe me if you have hiccups all the time, it’s a real terror. So this is like … and the acupuncture can stop it just usually within a treatment or two. They’re quite rare, but if there are, remember that acupuncture is very effective. Improving patient general quality of life management, management of the xerostomia, which is the dryness of mouth, especially from radiation. There’s many studies on this. Acupuncture is one of the effective treatment for that and large intestine too, which I extensively also lecture about studying of the large intestine, too. It’s actually been proven to increase the salivation in the mouth and it’s good, not just for cancer, all of it. Also, when you learn how to treat it, you also learn how to treat it in other patients that suffer from these symptoms. The same with shortness of breath.

Lymphedema actually hasn’t shown up to be extremely good, but was studied extensively. This is where the lymph system is not working well, especially for patients with breast cancer, that some of their lymph nodes were removed, so they have this kind of [inaudible 00:12:46] edema and lymphedema, so they tried acupuncture for it. I generally don’t treat lymphedema, but it was part of what they reviewed in this study. Then general improvement of physical wellbeing. So, you can see quite a lot of indication that there is a lot of studies. Like I said, the top ones are the ones that there is enough evidence to say that we can conclude that this intervention, which is acupuncture, is helpful, but the scope is actually what we see in the clinic and the scope is what you see coming up more and more in different research.

One of the most important things is safety, and acupuncture has been strongly proven safety, and here is a study of 1700 people that says that there is no serious side effects that were reported in any of the studies. So, acupuncture could be considered as a very safe complementary in cancer care. When we’re talking about any intervention to medical system, then there’s two concerns, efficacy and safety. And definitely for safety, we are winning. There’s more studies on safety actually, but this study is just a great example, which is specific for cancer care, showing the level of safety that acupuncture has. To us maybe it’s obvious, but if you communicate with the medical community and you can say this word, we have proven safety, it is very meaningful. That’s what I find acupuncture is now, and especially in the United States has been practiced more and more in different medical centers and hospitals, and it provides today the knowledge and ability to treat oncology patients. I think it’s a great opportunity for acupuncturists and I’ve been extensively teaching courses and specialization all around the world and in the States. If you’re interested, probably follow my website and see when a course is coming soon and if it’s interesting for you.

Even when we look at the NCI, the National Cancer Institute, I can say overall acupuncture has been reviewed in a very positive way. You have to read it always because it’s updating, changing. I’ve been following this webpage so I can see there is always the work there, but just for the scope also they’re stating that cancer patient is using acupuncture and they’re giving you the scope from pain management to nausea, vomiting, fatigue, hot flashes, dryness of mouth. Neuropathy is another big field which has been proven that acupuncture is helping neuropathies, these kind of pains and lack of sensations that patients get, especially from chemotherapy and especially from different taxanes and other chemos. If it’s become chronic, it is a really debilitating condition and acupuncture is one of the best thing to help it and also help to recover from it to prevent a chronic state. There’ve been a lot of studies on the neuropathy.

Anxiety. The whole field of anxiety and the whole field of emotional side, this is very close to my heart and practice. To me, acupuncture is a transformative medicine. It can really transform on the very deep level how patients to get in touch with their Shen, with their spirit. And one of the worst thing that follows cancer patients is fear. It’s understandable for a certain period, but it’s definitely taking away one’s power from getting healed and even the opposite. When there is a lot of fear, to me, the prognosis is not good. I see very difficult patients with difficult cancers in very difficult stages. When I see no fear there, I know they will do well. Even if they won’t live full span of whatever we can say about life, they will have a better quality of life and they will exceed usually what is expected. In my clinic, we’ve been looking at many patients and we recall there is a lot of what you call exceptional patients. I think exceptional patients, a lot of them, are due to this connection of Shen to the body and that’s where healing is really coming from.

So, acupuncture has been studied for anxiety, depression, but also general wellbeing and also sleep. So obviously if the Shen is disturbed, the sleep is difficult. So this is from the NCI. You can go, there is more evidence there. This is just for the scope of this lecture. I’m more talking about scope or opportunities. We don’t go deep into all their research projects and all the research that we have. And even they’re showing the laboratory animal studies on different aspects of cancer care and they show that acupuncture has a very strong effect on the immune system, on immune regulation.

Immune modulation is really the key thing. If you help the immune system to reach a better balance, you are helping another also pathway of treating cancer, helping another way of patient to avoid secondary infection, to deal better with their medication if they’re taking. You’re preventing a lot of other potential side effects. Now we are seeing different pathways, how acupuncture is affecting immune system and in animal models there’s been a lot of studies that has been out there, but there’s also a few studies in humans. One of them is from Dana-Farber Hospital. That was part of Harvard Medical Center that was published by Weidong a few years ago, but we see more and more studies coming up on the effect of acupuncture on immune system and obviously I, a lot of time, combine with herbal medicine or specific formulas which I am studying.

From the JCO, the Journal of Clinical Oncology, again if you want to talk about scope, especially with oncologist or medical team, you have to quote very reputable journals. This is definitely a very reputable journal. It has a lot of studies on acupuncture, surprisingly. This was a systemic review of acupuncture, not the one I liked the best, but again some papers you like the design more than others, but again it’s a good review and you can see more showing the scope. So again, most of the things that we talk about are coming up, but there is prolonged postoperative ileus, which is another area of study. A lot of patients, and especially cancer patients, undergo surgery. And because of the anesthesia, there is lack of bowel movement. So acupuncture can really increase bowel movement. And that’s also what I find in the clinic. We have a very strong effect on bowel movement and a lot of patients are suffering from constipation because of their antiemetic medicine or because of their cancer or other disturbances, especially lack of appetite, which is sometimes the killer because people are really dying from malnutrition.

So, acupuncture has very strong effect on the justice system. So I brought also the scope, to show the scope from different studies. So this is a systemic review before I’ve shown systemic reviews and also the NCI view on that field. So you can see from many different directions, what we call conventional points of view. It’s quite surprising how acupuncture is accepted and is looked into the science that we can see by now. Even when I looked at clinicaltrial.gov, where you register clinical trials, there is almost 150 registered trials on oncology acupuncture. So there is a vast amount of effort in proving the efficacy of acupuncture in oncology and even some phase three trials. Phase three means … Usually a trial will go from a pilot, phase one, phase two. That’s randomized clinical trial. Phase three means there is enough people to compare between two groups, usually placebo and real or control and real.

And after a phase three trial, in Western medicine, it’s almost a level of this is what patients should get. So this is like beyond any doubt that this intervention is proven effective and that’s when we talk evidence. So we see that acupuncture is moving up in oncology acupuncture in phase three trials and this is a very interesting. I’m actually now in the midst of taking all the trials that we have until now and putting it into a book, which is evidence based oncology acupuncture. It will summarize the trials, but not just would summarize, but also would show the acupuncture points and what we can learn from different trials, if there’s interesting acupuncture points that we use. And also the frequency. I think many times we have to understand the frequency of treatments and when we don’t see good results, a lot of time it relates either to the frequency of treatment, the design of the trial.

So we are now kind of compiling, me and a colleague of mine, Dr. [inaudible 00:23:13], are compiling all the current and the good trials to see what we can learn from them as far as points and the evidence and then also that you can show … learn for yourself, but also show people who are in regular medical care the amount and kind of depth of studies in oncology acupuncture. I want to go to one trial. I like it very much. Also the people who did it, to me, very active at the SIO, which is the Society of Integrity of Oncology, both in their clinical practice, in their acupuncture. We have a special acupuncture group there and a research group and Eleanor Walker, she’s the head of the department of radiation oncology in Henry Ford Hospital in Detroit, and she carried a few trials with her team. They’re very good team there.

This is not … It’s one of the what we call older, if there is such few years as older, but actually it’s not true. It’s still very relevant. I like the trial, and I like that the design and also what we can learn from it. So I would like to share with you this trial and some points that we use, so maybe there’s some take home message from here. There have been few trials on the same idea of the reduction of hot flashes, and especially the reduction of hot flashes in cancer patients is important because it’s very common, especially in breast cancer and other gynecological cancer, especially if they’re hormone sensitive, to give this patient anti-hormonal therapy, and this anti-hormonal therapy creates different side effects.

The main one is hot flashes. The other one is joint pain. Both have been shown to be effectively treated by acupuncture. Many patients are stopping their treatment, this anti-hormonal treatment, which is designed to prevent reoccurrence of their cancer because of the side effects. So we are both increasing their quality of life, but also allowing them to adhere to the treatment, which is important for them. And so in this trial, although not big, but they’re interesting, they did what we call it head to head trial. So, they compared venlafaxine, which is an irregular SNRI drug. Here we call it Effexor, so I’ll call it Effexor, comparing to acupuncture. So it’s a head to head, drug intervention compared to acupuncture intervention. So you’re looking which one is more side effect, which one is better. But interestingly enough, they also follow this trial a year later. So, this was 12 weeks. So for 12 weeks, patients receive either acupuncture or venlafaxine and they looked at different outcomes and they measured it also and followed one year later. So, after 12 weeks, both were stopped and then they’re following up the effect, if there is any of the effect in the group of the acupuncture or of the venlafaxine.

So the results, especially immediately after when they administered both the acupuncture and the drug, both groups had significant decrease in hot flushes, so both were effective, so they had less symptoms and better quality of life. The first thing is acupuncture was as effective as venlafaxine, so that’s quite impressive. But two weeks after the treatment, when they stopped the both acupuncture and the drug, there was an increase in hot flashes in the venlafaxine group, but not in the acupuncture group. So, in the acupuncture group there was still a effect of the treatment also two weeks after the it was stopped, while in the drug, once you stop the drug, you stop the effect. Which carries always a lot of thought about acupuncture, because acupuncture is a curative medicine. It’s not a palliative. So it doesn’t just affect that the moment that you are given the treatment. It changes something in the body, allowing it better healing mechanism.

And when we look deeper at the result, venlafaxine had a lot of adverse effects. So there was nausea, dry mouth, dizziness, anxiety. There’s a lot of symptoms that patient that took it experienced. While with the acupuncture, there was no negative side effects, even the opposite. They had some additional benefits like increase in sex drive in some women and most reported improvement in their energy, clarity of thoughts, a sense of wellbeing. This is from the real article, so this is a good reflection on the total effect that we see from acupuncture, which is different than drugs. Again, for us, an acupuncturist, people who do Chinese medicine, it’s obvious. But believe me, to see this kind of results in a trial, in a high reputable journal, it is very impressive and to me, it’s the beginning of a change. Beginning of a change that the scope of our medicine and the effectiveness are viewed in a different way.

That’s why I’m I call this a lecture the scope, but also the opportunity. Once you see more and more respect to this form of medicine, there’s a greater opportunity for us, both to effect patient, and to enter into a best care. And to me, the best care is always integrity of care. So the conclusion, acupuncture is appeared to be equivalent to the drug therapy in these patients. It is safe. Again, we see safety, effective and durable. Treatment for vasomotor symptoms, which means hot flushes secondary to longterm anti-estrogen hormone used in patients with breast cancer. So, this kind of summary, this kind of a conclusion in this type of journal, it’s definitely meaningful and meaningful to the whole profession. Now let’s look at the points they use. I mean, nothing outstanding, but they did a good design, which means they gave … Some points were all the acupuncturists used and some were like secondary points that the practitioner could choose a point according to the condition.

And to me, this is a much better design of trials than fixed points because we know acupuncture, we don’t give the same treatment to all the patients. We adjust and we do personalized medicine. So if you do a trial, you can take this aspect out and suddenly create a fixed treatment and just hope that it’s always worked. I can talk about it quite a lot. I think in herbal medicine, some things we can do. In acupuncture, certain places maybe a little bit. But overall a better design is a design like this, which is closer to real life and closer to good acupuncture when we are able to adjust and tailor the treatment to the patient. So they use different points. I kind of group them in my own way. The grouping is my grouping in the article is just a list and explanation.

So when there was more Yang, probably more Heat, they added Du-14, especially if there’s a lot of Heat in the patient. Or Du-20 to [inaudible 00:31:56]. If there mores Qi complaints, then use stomach 36, Ren-6 and Lung-9. And I put Hun, but a lot of mental side and difficulty in sleeping can be treated through the Hun. I extensively teach about the Hun and palm and how they interact, and I think it’s a core understanding of how to use points in Chinese medicine. So gallbladder-20, liver-3 for pains and for Hun and for the liver, and for the Shen, pericardium-7 and heart-7. So this is the points that they could choose one point out of this in order to make a personalized approach. It was carried for 12 weeks at the beginning, for the first four weeks, twice a week, and then another, I think, four weeks, once a week.

So this is kind of completing a good … I think 12 sessions is a good period to have a sustainable change. And I mean sustainable, when they looked at one year later there was still difference obviously between the group and still many women that got this 12 week treatment are experiencing the benefit of it and also in general wellbeing. So, I think this is impressive. Again, there’s more trials, but if you want to follow me, you will see me talking about more trials and more possibilities how to treat oncology patients. But I think it is showing the scope, showing the opportunity and really strengthening this, that we can feel very confident about the effect of acupuncture and especially in this group of patient and for these kind of conditions.

So I would like to finish up with one of my mentors, Father Larre. I was lucky to have two very good mentors along my studies and really to take us a bit above just research, but into the worth of acupuncture in the 21st century, in the words of Chinese medicine in this century, especially with Western medicine on one hand is very developing, but on the other hand, I think there is a great need to integrate with what we are doing in there’s a great need for what we can provide to patients. “By returning to the classical roots of Chinese medicine, we can make a truly significant contribution to the medicine of the future.”

And to me, combining the medicine that we are doing that comes from an ancient roots with the modern medicine and its ability also to look at in a kind of objective way, where we are effective or not effective. That’s why I’m carrying a lot of research. And I have my own lab and we look even on a cellular level and we look at different biomarkers. All this it’s strengthening what we are seeing in the clinic and all this is helping to create a better future medicine. So to me, whatever we are doing is key and important.

Thank you for joining the show and I will just wish you all the best of health, especially in these times. Be well and safe and healthy. Thank you very much for watching it. All the very best.

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COVID-19 Documents for the Practicing Acupuncturist

The American Acupuncture Council has made available the following documents so you are well prepared to continue to serve as many patients as possible during the COVID-19 Pandemic. Feel free to click on any and all of the images below to download each of the below.

Stop the Spread

Office Safety

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Caring for Patients

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Palpation in Assessment and Treatment

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Hello, I’m Brian Lau. Welcome. I’m here today with Matt Callison. We’re both with AcuSport Education. Also here today with Chad Bong. Many of you know Chad Bong. He’s one of the founding members of the Sports Acupuncture Alliance. There’s been three summits so far. Chad, you can let us know about the state of any upcoming ones. We’re in the midst of COVID-19 pandemic, so I believe that’s on hold. But we’ll have a chance to chat about that.

Chad’s also the host of PinPoint Performance Podcast. Just had a recent edition out with Jamie Chavez. I was interviewed for that. That’ll be coming out in a little bit. I think Matt’s been a past guest of that also. Whitfield Reaves, a bunch of other really great educators have been a guests of that podcast. Chad, do you want to say anything about the upcoming summits or possibilities of that?

I don’t know. We’re a little nervous about trying to get a hundred people in a room in our current state.

Yeah, sure.

So I don’t know. We have a lot of decisions to make with that. So as things start to get clear, maybe as a vaccine comes out, then we’ll be able to set it down the line. But it’s a big project. I was very thankful we didn’t have one set for this spring because-

Yeah, timing is not good for your live.

… I couldn’t have imagined having canceled something like that. So I’m glad that that worked out in our favor, but I’m a little nervous about setting one up right now. So we’ll see what the future holds there. But we’ll definitely keep with the podcast. We have a fair amount of them recorded-

Great.

… so we’ll be able to be turning some of them out every two weeks.

Awesome.

Yeah. So, Chad, just a little bit of background. Chad, you have a Master’s in Exercise Science.

Correct.

Also a massage therapist, studied massage therapy. A graduate of Southwest Acupuncture College. You’ve taught at a number of schools, Southwest, you’re currently at the WON Institute, and you’ve taught at Tri-State College of Acupuncture.

Yes.

Then in addition to that, of course you teach a lot of continuing education classes. So many folks who are listening might have attended some of those-

Possibly.

… or highly recommended to attend at some point in the future when we’re back doing live stuff.

Yeah, I definitely prefer the live stuff because I like the hands-on stuff, like what we’re talking about today, the palpation stuff. I don’t know how you teach that over the internet. Although I have to teach that over the internet because The WON is on 100% online classes right now.

Yeah, sure.

In the next couple of weeks here, I have to start teaching, three, four-hour classes on palpation.

Yeah. We’re going to be doing some online stuff with palpation, too.

It’s going to be tough.

It’s tough, but it challenges you in a different way. It brings out some sides that puts the spotlight on and makes you observe a little bit more. I mean it’s good to be positive about it. But I agree. Ideally, there’s no substitution for palpation live.

Yeah. I can’t put my hand on their hand and help them feel what they’re trying to feel. Once you teach this stuff for long enough, you can place your hand on top of somebody else’s finger and feel what they’re feeling through their fingers.

Sure.

So you can be like, “Not that thing right there, that thing right there.” You just can’t do that over the internet. So at least I haven’t figured that out yet.

Hey, Brian. I was looking at our list for the introduction for Chad, and it looks like there’s one line here. So Chad’s also a licensed acupuncturist and he’s completed Whit Reaves’ apprenticeship program. You also co-authored a book with Whit, right?

I helped with his book.

Yeah. So maybe that’s a good segue to go into your article from coracobrachialis that you just spoke about with Lhasa. I think it was last week or two weeks ago. Do you want to segue right into that, Chad?

Sure, we can move into that. So I did a coracobrachialis. We’re trying to put out some information for people during the COVID thing here. So I tried to pick something that I think just gets missed sometimes, I think, that other acupuncturists send me patients for that, for whatever reason, they haven’t figured out or haven’t gotten.

So that’s where we got into the coracobrachialis. It’s an interesting one as far as the palpation stuff because it’s an important muscle to be able to palpate not only the tissue of the muscle, because it’s not super easy to palpate the coracobrachialis versus the short head of the biceps without some practice. Then you also have to really know where that whole neurovascular bundle is that’s sitting right underneath it.

So when you do go in there, the needle, you’re not whacking away on that. Although I know some acupuncturists who purposely hit things like that, but I’m not one of them.

So I think it’s important to really be able to feel the difference between tissues. A pulse would be a real easy one to feel there. Then feel the septum in between the short head of the biceps and the coracobrachialis.

Then we’ll find bony landmarks, the coracoid process, and having some way to think through that, and then be able to see where the muscle ends and where the muscle begins and being able to continue that line down so you can feel the tissue all the way I think is important. So I think that’s pretty good into this whole idea of palpation.

Yeah. The discussion of that, what you were pointing out, is something that I note quite a bit working with acupuncturists, and I think this makes sense. We learn points and we learn an anatomy of points, whether that’s specific muscular anatomy or just bone landmarks and palpation and feel for indentation.

So I think acupuncture is often, understandably so, thinking points and they lose sometimes sight of that real estate of the muscle attaches from here and travels through this region of the arm or whatever structure you’re palpating, and thinking of it as a space and a region and relationship from this muscle to another muscle where the neurovascular bundle is all of those things together. It’s easy to lose sight of when you’re used to feeling for individual points. So I know what-

I agree. If I think back to acupuncture school, it was just like you learn all of this stuff, but it’s just this one point and this is another point and another point. It’s not all of the tissue in between and what all that tissue feels like and the depths of the tissue and the three-dimensionality of the body, being able to think about the body in more than just the surface area. You can get to the same spot inside the body from different angles, different points.

Yeah, sure.

Going back to the coracobrachialis, wouldn’t you guys agree that sometimes coracobrachialis strains seems like it’s a bicipital tenosynovitis. It’s easy to go to a bicipital tenosynovitis when, in reality, it’s actually a coracobrachialis strain.

So that’s where palpation comes in. It’s so important to understand what you’re feeling. Is it really the bicipital tendon and you cross-fiber that? If that doesn’t really cause the pain, then go deeper into the coracobrachialis, especially after some resistance, so you can feel it pop up. So palpation is everything in assessment. It’s what builds a treatment protocol, right?

I find it very important. I bring in the whole massage therapy world to it. Although my concept on palpation and feeling and tissue has evolved quite a bit from what I would have just called myself a massage therapist versus after going through acupuncture school and spending all of that time working with Whit and just getting much more specific and precise with what I’m doing palpation-wise. Whereas in the beginning of massage school, it’s just sliding strokes.

Yeah, sure.

You don’t get quite so precise. But, over time, I think if you keep practicing, you get super precise.

Yeah, yeah. Whit’s very big into palpation, thank goodness, because palpation is a missing link in our training in school, that’s for sure. So with palpation, I mean, isn’t it a lifetime skill also? I mean we should continue to learn all the time, especially the more that you actually consciously know about anatomy. The more that you can actually see anatomy and know what the underlying structures are, then you can start to actually see it in their palpation. So it seems to me that it’s just a lifetime skill development.

Yeah. I think like most things, the deeper you go into it, the bigger the hole is. So you can just keep learning more and more. I sat down and wrote some notes about things that I wanted to talk about during this thing, and building your anatomy base to understand where all of those tissues are. Then, on top of that, building the palpation base.

Both of those are endless processes, things that you could go on learning for the rest of your life, the details of anatomy. I think my anatomy is pretty good, but I know there’s people out there who know their anatomy better. I think I could spend a lot more time with cadavers and ultrasound and things like that and try to develop my feel and the view of this tissue even better. So I think there’s always room for learning.

Sure.

Then palpation, I have students in the beginning, when I first started with them, do the thing where you put a one-inch piece of thread underneath sheets of paper and then they palpate it. People, when they begin, maybe can feel that under 15, 20, maybe a really good person might get 40 in the beginning. But if you keep practicing, you can get up near a hundred sheets of paper with that little piece of thread under there and you’ll be able to find it.

So just developing that sense so that when you feel something different in the tissue, you can start to feel the actual differences in texture, which is really what I’m looking for is changes in texture in the tissue that I’m trying to feel to be able to tell that there’s something different going on in that specific spot.

Wouldn’t you say that then you could also quantify to excess, deficient, damp, hot, cold, which would then set up your needle technique and also your application of acupuncture and moxibustion, right? So if it feels real excess, we’re going to be feeling it with palpation and then needling it as a reducing method. So palpation is … It’s so incredibly deep. Hey, Chad. I think you and I have been bogarting this, and we haven’t been letting Brian speak.

Oh, no, I’m good. [crosstalk 00:11:37].

You’ve just to jump in, Brian.

Yeah, yeah, yeah.

It’s a first come first serve show here.

Yeah. I do want to segue a little off of Chad giving tips because I had a few thoughts for this podcast of giving maybe some tips. We don’t have a ton of time to go into that, but we can talk about some guidelines or tips since that is an area within the acupuncture profession that could be improved on. You already gave a tip basically, was increasing sensitivity by having some method that you can start to add sheets of paper and feel through those sheets of paper to where you have greater and greater depth that you’re feeling through.

Yeah. If you want to talk about how, I think somebody could get better and better at palpation. First, I think you have to have a basis in anatomy, right?

Yeah, sure.

I think we all have. We’ve all been thinking about anatomy a lot. I think you need to learn that base so you can understand what tissues you’re trying to feel. Then I think you should build on that with learn what all the functions are, learn where the major neurovascular bundles are going through things, and maybe learn the functions of those muscles by practicing your manual muscle test, so that you can see what those muscles are actually doing.

Then you’re building multiple brain connections where you’re not just trying to memorize, “Oh, the biceps does elbow flexion,” you’re actually doing the elbow flexion or you’re having somebody else do the elbow flexion while you resist them.

So I think building your anatomy base, and thinking of it from small to big. Don’t just like, “I’ve got to learn all of the anatomy.”

Yeah, sure.

Just put pieces on top of pieces, layer it. But then once you have the … And I think you should do some range of motion stuff in there so you can see how people move. Then start feeling things. Really, the more different types of bodies, the more different tissue you feel, the better idea you’re going to have on what this tissue should feel like and what is different about the tissue?

Watch the students going through the three semesters of palpation stuff with me, and in the beginning, they can tell their auto-muscle and that’s about it. By the end, they’re like, “Is it that thing or is it that thing?” which is cool to watch the progression with them. Is that what you’re looking for?

Yeah. Well, I mean I have one. We were mentioning the coracobrachialis when you mentioned that doing a contraction to bring that muscle up. A tip that I often teach when I’m talking with students about a little bit more certainty for what they’re palpating is, yes, you can get the muscle to come up by a certain action, but you can be a little bit more precise on what action you use.

Coracobrachialis is a great example because it does really two major actions, but one of them, shoulder flexion. Well, it’s also right next to the bicep. So if you put your finger and span down and get on what you think is the coracobrachialis and have the person do shoulder flexion, it’s not going to tell you a whole lot because it’s going to contract, the biceps are going to contract. And what am I feeling? I don’t know. But if you recall that it also does adduction, [adeduction 00:00:14:46], adeduction is a much better-

Horizontal.

Horizontal adeduction. But also just straight adduction. That’s going to-

It tends to position your arms in, I guess, but-

Yeah, but that’s going to bring it up a little bit more different. It’s going to differentiate it a little bit more from the biceps just based on the action that it’s doing.

Yeah, a mechanism of injury, like, for example, you see usually this injury with people doing too many pushups or bench press or something like that. What else refers to the anterior shoulder, though? Doesn’t the lower motorpoint, which is also the same location of a trigger point of infraspinatus? [crosstalk 00:15:19].

It definitely refers to the front of the shoulder. The story I told at the beginning of the coracobrachialis thing, that’s what I thought it was. I pushed on her infraspinatus, I felt around back there, and I found a spot that just referred right to the front of her shoulder. So I was like, “Well, there we go. This is our thing.” She was a backstroke swimmer. So I was like I’ll treat her. Infraspinatus is the main concept muscle-wise, and this’ll get better pretty quickly, and it didn’t.

Don’t you hate that?

It doesn’t happen that often, but, well, it does.

Did they get somewhat better?

I learned something, though, right? I learned something by having her not get better. She didn’t get better basically.

At all. At all. Okay.

A couple of times actually. So I did some work on the infraspinatus and I did some work on the biceps and the deltoid, and I just wasn’t getting anywhere. Then, finally, I was like, well, I’m going to try the coracobrachialis. Once I needled the coracobrachialis, the next time she was 90% better when she came in. Then she was back to swimming. She’d missed swimming for years, basically, as far as competitive swimming.

How do you needle the coracobrachialis? We teach it as needling the motor innervation [ju pi 00:00:16:36], which is one tsun below [jan ayling 00:16:39]. How do you needle it?

So I’ll come pretty close to there. I’ll find it off of the coracoid process and then palpate out, making sure I’m on the right line by … People can see me, right?

Mm-hmm (affirmative).

Making sure I’m on the right line by coming and finding it in here, and then palpating all the way up here and then needling going out and down. But not super deep. You just want to get through whatever you happen to be under there, either the anterior delt or a little bit of the pec major. But, again, all of that neurovascular bundle there is sitting behind the coracobrachialis there. So you’ve got to be a little bit careful.

So I’ll needle it there, but you can also get into it inside the arm here, which is what I talked about when I did the coracobrachialis presentation. But here you really have to know your palpation, right?

Yeah, sure.

You have to be able to separate … I don’t know if you can see my screen right now, but if you do a light flex, you can see that septum in there. If you flex it a ton, it’ll just go away and it’ll just feel like the bicep.

But you can get this little space right here, but then you have to know right behind it. In this position, inferior to it is that whole neurovascular bundle. You can feel the brachial artery right there. So you’ve got to make sure you don’t hit that thing.

But this would be by palpation in here to see if I can find a spot that’s really interesting. Then I’d usually get two needles into it. You don’t have to needle deep. That muscle is basically right at the surface, so you don’t have to go crazy, again because you want to be careful of all the neuro stuff back there.

Then I would just get two needles into that tissue, some light e-stims just until either the patient feels it or you see a little tiny bit of a twitch. Then if you have needles in up here and needles here, you might see these needles moving and these needles moving, if you have a light twitch going on.

Brian, how do you like to palpate it?

Well, I use the motorpoint ju pi quite a bit. But like Chad mentioned, I sometimes do look for trigger points, or ashi points, a little bit more inferior. I don’t discuss that as much with people just because it takes a lot of set up in terms of students. It takes a lot of set up, and there is a little bit more risk. You have to be a little more mindful of the palpation.

But, yeah, I do sometimes needle it in that more inferior aspect. I do find that that’s a pretty common area of congestion. I also do a lot of manual work in that area. I probably more frequently do manual work at that part of the muscle than I do needling it and separating the coracobrachialis.

This is where it comes really having the palpation skills there because you can separate it from the septum. It can create a lot of congestion in that septum between the biceps and the triceps and being able to open that septum up.

Something else that we do when we teach … Chad, you probably know that we use a lot of models with sinew channels. The coracobrachialis is on the pericardium sinew channel, palpating it and then going and needling either a point like [piece X 00:19:44] or something. But in that case, I’d probably go with another muscle on the pericardium sinew channel like the pronator teres, maybe pronator quadratus, and see, when you go back and return to palpation, if that diminishes. Usually it’ll be about by 50% that you can diminish some of the sensitivity to palpation from a distal point. It doesn’t mean you won’t needle it locally, but-

So I’m glad you brought that up because David Legge, in his book, he basically puts it on the lung channel.

Yeah, that’s great.

And I was like I don’t necessarily agree with that. So I’m glad I got somebody else on my corner here [crosstalk 00:20:20] pericardium.

Yes.

It’s all opinion, of course, right?

Yeah, I mean you’re trying to decipher some pretty ancient language that’s been translated.

It’s in a different myofascial bag than the lungs, the lung channels. Yeah, it’s different.

Yeah, I agree.

Yeah, we have the biceps on the lung channel and then how that relates down the arm, the pericardium on the … I mean coracobrachialis on the pericardium channel. I think we have a video where we do on a cadaver specimen, where we have a needle in the … I don’t think this is up on our YouTube channel, but the needle in the coracobrachialis motorpoint and pronator teres motorpoint.

I forget now which one we turned and wrapped, but more aggressive than you do on a person. This isn’t a technique demonstration, but turning the needle to where it really, really grabbed a hold of the tissue. Obviously it’s a cadaver specimen, so there’s no sensation.

But you really want to get the needle stuck and then pull and see if it transmits force. I think it was from coracobrachialis down to pronator teres. You pull on coracobrachialis and you’ll see that [crosstalk 00:21:26].

You saw them both move.

Yeah.

That’s pretty cool.

Yeah.

Now we needled it the way that we needle it in SMAC, which is supposed to meet at the bicipital tendon, going in at an angle distal into that area, into the innervation site, which is common area for strain in that region. It seems like going from what Chad was showing, going from the medial intermuscular septum, in between the bicipital septum, going that way. It seems like we’re just going to the same spot, but at two different angles.

Like I said, it’s a 3D thing. We’re working from three dimensions. So you wanted tips. I think a great tip is for people who … The first time you’re trying to work on a muscle or find a muscle is to break open the Motorpoint Index book and be like, okay, ju pi is right here. So I know that I’m all on that muscle if I go to this point, or at least I’m really close to it depending on some other person’s anatomy. But I’m right on this muscle. So you could find that spot.

Even if you’re not a motorpoint needling person, or if you are, but at least it gets you on the muscle so you can start in a spot that’s in a good spot, and then you can palpate from there. It’d be a good way to find, say, like a popliteal muscle or coracobrachialis or something like that. Just use the Motorpoint Index wording and description of the location to find the actual point on the muscle, I think, is a great way to go about it.

Well, gosh, since we’re talking about that, you might as well go ahead and get the Sports Medicine Acupuncture Textbook because the images have not just individual, but it’s grouped together. So you can see the motorpoints all together. Thanks for that, Chad. That was a nice segue, buddy.

No problem. Anytime.

Yeah, and I think it’s important to see it in relationships too, because it’s good when you’re learning anatomy to see that isolated muscle on a skeletal structure and get a clear picture of where it attaches to and where it lives, but then to be able to see it in relationship to the other structures … Because that’s going to be more like when you’re actually going to palpate because you have to differentiate between blood vessels and other muscles and just the whole picture.

Yeah. I think it just helps people who don’t have quite the palpation background to find a certain spot, but then we also know like, okay, that’s a relatively safe spot to put a needle essentially, is into where the motorpoint is marked out. So you have both a point that’s relatively safe to put a needle in and it gets you on the muscle. So I think it’s a good way to learn where each of these muscles are and where there’s points you could access them as you go about learning this stuff.

Now I want to bring one thing up, is that, remember, our founding fathers really didn’t know the anatomy so well. There is some literature that does show they had … They were doing dissections, for sure. But the anatomy knowledge is not like how it is today.

So not knowing the underlying anatomy then gives the practitioner so much of a feel of what’s happening in the skin over the muscle itself. How well can you move the skin of an acupuncture point or a motorpoint or a lesion or something? How well does that skin move over that muscle or adhere to it because of the skin ligaments and the subcutaneous tissue onto the fascia profunda?

So there’s so many different things that can be developed just by not knowing the anatomy, but by going by what’s happening within the skin. I think that’s how we started, right?

Sure.

Then with dissection then came more anatomy and such, because we’re feeling for excess and deficiency, and I already talked about all of that. But I think that was really quite traditionally was how it began.

I’m sure it was just, again, layers on top of layers of learning over a long time for our [inaudible 00:25:23].

Matt, I just saw a question come in about the name of the book you mentioned.

Oh, great. Awesome. Thank you. It’s called Sports Medicine Acupuncture. If you go to SMAtextbook.com, SMAtextbook.com, there’s information about it. Thank you very much for that.

Yeah, and I guess we can mention Whitfield Reaves’ book. Chad, you had some interaction with that book also, if you wanted to mention that, because another great resource for acupuncturists who are transitioning into a more orthopedic or sports model.

Yeah, the Acupuncture Handbook of Sports Injuries and Pain. Yeah, it’s a great concise book about 25 really common injuries that people … If you’re going to work in sports injuries kind of world, those are the injuries, the 25 of the most common injuries, you’re going to see. So it lays out a really simple way of going about treating those injuries. I’m not a very good [crosstalk 00:26:29].

Yeah, more and more resources are out there now for sports and orthopedic-based acupuncture, which is great. I think there’s more on the horizon, too. So it seems like it’s a really growing field right now.

Yeah, the amount of people who are into this and posting things that they’re trying has grown exponentially since we started.

Hey, guys, there’s only about four minutes left. Is there anything that you want to wrap up with or any other questions that we can be able to take?

I think-

I can give one quick … We’re on some tips. This is an easy tip and it won’t take long. But when we’re palpating muscles, also being able to effectively palpate bone is quite important. What I frequently see when I’m teaching palpation is people tend to go in very quick and jab you when they’re palpating for bone. Just a general tip is when you’re doing it to use a flatter surface.

If you’re using your fingertips and you’re trying to palpate the coracoid process, you can’t really tell if you’re on the head of the humerus, if you’re on the coracoid process. You’re on maybe attachments that can feel hard if you go in too quick.

Whereas if you come in and match the shape of the bone, it has like a little hook. So if you can get your finger around that little hook and get more surface on the bone, and also wait a little bit of time and let that density of the bone … As the tissue softens around your hand, that density of the bone really comes to your hand more. It’s a really good strategy for palpating bone.

Then once you’re on that, you can do a little back and forth movement to get a little more clarity to it. But bone palpation, I find for a lot of people who are not really taught outpatient well, they’re too quick, too quick on the point of their finger. So just imagine how much information … You can’t really bring in as much information on a point as you can on a flatter surface.

Yes, I would-

[crosstalk 00:28:26]. Go ahead, Chad.

I would carry that into muscle as well.

Sure.

I mean, if you go in there really quick, the people are just going to tense up. They’re going to have constant pain, especially if you’re working on bigger muscles, if you use a bigger surface, like I’ll use a fist or an arm or something like that. Then I’ll just find something I’m interested in and just keep working into a smaller thing so then I eventually get down to my finger or something.

But you can feel a lot of very interesting things that you might miss with just a finger with a wider surface on, say, a bigger muscle. So don’t forget to do that. And work your way in. So you can put a lot of pressure on a human being if you work your way in there slow. If you go in fast, they’re just going to jump off your table.

Yes, I agree. Something that I’ve said for a long, long time is if you use a number of different anchors, following up with what you just said, Chad, but specifically your pericardium nine, because, in my mind, what works for me is that allows intuition to come up. It seems like I get a lot of messages when I feel with my pericardium nine finger. Maybe that’s just [Mattism 00:29:29], but I believe that’s actually fairly true for a lot of people.

Yeah. I have people practice with all their fingers, like figure out what finger works for you.

It works better than the elbow, that’s for sure.

I don’t know, man. You can train an elbow pretty well.

Yeah, I agree.

That’s true.

I agree.

That’s true.

I agree.

My elbow sensation 20 years ago was nothing. I could tell I was on a human body. But, no, man, I can feel a ton of stuff. It’s just because I’ve used them a lot to find things. That doesn’t mean I’m using them to cause an immense amount of pressure on somebody. But on big areas, a forearm shaft, a shaft of your ulna, you can find a lot of stuff with it.

Yeah.

Hey, I know we don’t have a ton of time, but there are a couple of reoccurring questions refining palpation, and two that I’ve seen come up quite a bit is palpation on people who are obese, because it can create a little bit more challenge. I mean I’ve worked with plenty of obese people that had just great muscle tone, very easy to palpate, and some very thin people who had very … Very difficult to palpate. But, generally, generally, it’s much more difficult to palpate people who have extra weight. Any tips or thoughts on that?

Matt?

Sure. Move it to the side as much as you can, knead it as much as you can, and also put the patient into a position to allow gravity to move the subcutaneous fat out of the way. For example, if you want to go to the lateral side of the body or into the obliques or something like that, instead of having them being supine, have them roll to the side so you can have that tissue with gravity move out of the way. Different tips like that is fine, but it takes a while. It will start to melt, but it takes time to do that.

Yeah. I think there’s different levels of connective tissue inside adipose tissue, too. So I think there’s a difference in how some of these things are going to feel. Some of it’s pretty easy to move through, some of it’s more difficult to move through.

Retinacular cutis.

Yeah.

Again, it’s practice. That’s why I say you need to try on a lot of bodies. You can’t just practice on one person because, yeah, you’ll get good at palpating that person, but you need to practice on all shapes and sizes of people to really get good at this skill.

Yeah. Having done a lot of dissection, you get to see, with people who are obese, how much subcutaneous fat there is, but also how much internal visceral fat there can be. Even when you’re seeing what you’re doing, sometimes differentiating structures on a cadaver specimen can be very difficult with people who are obese.

These are all great tips, but at some level you just have to do your best and understand that it’s inherently more challenging. That’s why sometimes people who are more obese, sometimes they don’t do certain surgical procedures because it’s … I mean this is when you’re in there seeing things. It’s hard to differentiate.

Now imagine you can’t see anything and you’re going in with your hand trying to differentiate the structures. It’s harder. You just have to understand that it’s harder. But [crosstalk 00:32:38].

But it can be [inaudible 00:32:38] a lot of stuff.

Sure. But you have to also understand that, at some capacity, with some people that you just have to do your best and feel your best and trust that you’re on the right structure. If you are in a risky area, maybe choose not to do those certain points that you can’t safely differentiate where you’re at and needle safely.

Definitely.

Yeah. Now the palpation is followed by needling. Then the needling density also helps, wouldn’t you say?

Yeah.

So then if you’re palpating … Are we still on the obese, I guess?

Yeah.

I mean this is a whole another podcast or webinar.

Sure.

Yeah, it is. [crosstalk 00:33:17].

You’re talking about density of tissue when you’re dealing with a needle. That’s a whole … Like we could talk about another half an hour, probably an hour, about just how a tissue feels and how you need to learn that when you’re practicing your needle. What does it feel like to go through fat? What does it feel like to go through fascia? What does it feel like to go through muscle, both healthy muscle and not healthy muscle? You talked about like you could diagnose somebody off of palpation with excess, deficient, whatever. You could do the same thing with a needle.

Absolutely. Absolutely. That would be fun to do. That’d be a fun discussion to have.

Yeah.

I’m ready.

Well-

You guys, it’s 10:33. So another question or … Yeah.

It doesn’t matter to me.

We’ll also be looking at questions on Facebook and can answer those via written responses. But I think we’re probably about ready to wrap up.

All right. Some closing comments. Chad, I just want to say thank you very much for doing this with us. That was really, really fun. It’s always great to get your insight on this. Also, so, Brian, it’s great always being with you as well.

Yeah, of course.

Let’s make sure that next week that you stay tuned to this because you’ve got Yair Maimon that’s coming in. If you have not had an opportunity to be able to listen to him, he is a brilliant speaker, a real bright light. He’s an excellent person to tune in with. He’s got all kinds of different insights with acupuncture and traditional Chinese medicine. So I hope you enjoy that. Brian, anything else that we need to say, thanking American Acupuncture Council?

Yeah, thanks to American Acupuncture Council, of course. We’ll be back then in a few weeks down the road for some more discussion of orthopedic and sports acupuncture.

Yeah, this is a topic that Brian and I hit on the podcast that we did. So if you’re interested in this, stay tuned for when we release Brian’s podcast, because Brian gets into his thought process on this a little bit more in the podcast.

Awesome.

I agree.

That’s great. When is that podcast, Chad?

I don’t know.

Okay.

We have a pretty big queue of podcasts right now.

Yeah, yeah, yeah. The one with Jamie Chavez, there was a little discussion on palpation, too. It wasn’t the centerpiece of the whole thing. It covered a lot of topics, but there’s a little bit in that also.

Josh, our goal is we get into it a little bit more, because he’s more of a bodyworker. You, we got into it quite a bit because you’re more of a bodyworker, too. So those are probably the two biggest ones we talked about palpation stuff.

Got you, okay.

Josh is … I don’t know when we’re going to release that either, but it’s coming to PinPoint.

Okay. Yeah, I was about to say I hadn’t heard his yet, but that’s why.

Yeah.

All right.

Thanks, guys.

All right, thanks very much, and we’ll see you next time.

See you.

Okay, bye bye.

Bye bye.

We done, Brian?

AAC-Telemedicine and Facial Acupuncture-diagnosis & treatment strategies

Click here to download the transcript.

Hi, everyone my name’s Michelle Gellis. I am an acupuncture physician and I teach facial acupuncture classes internationally. I would like to thank the American Acupuncture Council for giving me this opportunity to present a webinar to all of you, on how we can best support our patients, our cosmetic patients, our neuromuscular facial patients now through telemedicine and also once we start opening up, how we can continue to support our patients safely in our treatment rooms if we’re doing any points on their face. So this is one example of how we can actually work on someone’s face. This was me teaching a class… A portion of the class was watching me do some face lifting techniques that are unique to what I teach, and I’m going to talk about that in a moment.

I found this cartoon which I thought was very fitting and it’s supposed to be someone doing long distance acupuncture, and I thought during this time it would be funny… not funny, but many of us have found ourselves trying to kind of scramble figure out how are we going to support our patients if we are in a place where we can’t treat them, and especially if you specialize in cosmetic acupuncture or you have any patients who are new or current patients who have any sort of neuromuscular facial condition, how can you help them? This is a slide from one of my classes and what it is, is a quote from Coco Chanel and she’s saying that from birth until age 25 you have the face that your mother gave you. From 25 to 50 you have your own face that you create, and then from 50 on you have the face that you deserve. I put this slide into this presentation because so many of us are missing that care that we’re used to getting from outside, whether it’s for our bodies, for our faces, for our skin, for our hair, many of us and our patients are used to going outside for these services. I’m in Maryland in the USA and here everything is completely shut down and has been, we’re on week eight now of complete shutdown.

So there are ways that we can support our patients during this time. Telemedicine is actually a wonderful way that you can support your patients, not just with needles like you normally would but there are methods that you can use to help them physically, emotionally… And I’m going to go through a few of those possibilities with you. One of the most important things to think about when you’re thinking about treating the face is how the face is connected to the rest of the body, and when you’re treating the outside you’re treating the inside. So by treating a person’s face you’re treating all of them, and the same goes for if you’re doing body points it also helps to treat their outside.

In my classes I teach a full body protocol for facial acupuncture. It’s not just working on the face which will help if you’re doing cosmetic acupuncture, you can kind of get around… work around some of the things that maybe you’re used to doing by providing some of that full body work. Additionally, now is a great time to do a telemedicine intake for your new patients. Assuming that some of us will be opening up, it’s coming up in the next few weeks coming into summer, really getting prepared so that when you do see your new patients you can limit or reduce the amount of time that you have to spend doing the face to face intake, I’m going to talk about that as well. How can you support your existing facial patients, whether or not they have a neuro condition like bell’s palsy, trigeminal neuralgia, stroke, Ms ptosis. Any condition that affects them here there are things that you can do now to get… to set the stage for when they do come in. Chinese medicine is uniquely suited to help our patients body, mind, spirit and so we really are at quite an advantage over some other modalities.

As I said I’m also going to talk a little bit about what we can do when we do open. So I touched upon that a lot of our patients who are used to getting different services, whether it is their Botox or filler or their lasers or peels, or just a facial amongst other things they have not been able or they are still not able to have these services, but there are things that we can do to help them and any of you who are on social media, know the myriad of jokes that have been going around people and their inability to care for themselves saying they can’t wait. The first thing they’re going to do is get their hair done or their nails done.

So this kind of points to that. So telemedicine in general is great because it does give us an opportunity to work on some skills that maybe we would have never spent a lot of time developing for those patients who are afraid of needles, don’t like needles. It’s a nice, safe way for us to be able to practice our art. Our patients are not… for many of them not taking really good care of themselves right now. So you can speak to them during telemedicine about what’s going on with you as far as yourself care. Have you increased your alcohol consumption? Have you been following your regular hygiene routine? Are you getting enough sleep? How is your stress level? And all of these are very much a part of what your regular telemedicine sessions can be. I’m a Worsley trained five element acupuncturist. So a big part of my background and my training when I’m working with my patients, whether they’re my cosmetic patients or my pain patients is too check in with them about all of their systems to see how they’re going, and certainly you can do that through telehealth.

The reason why I… part of the reason why I was able to really make the jump from in-person to a telemedicine for cosmetic purposes is that the… so the skin on our face is the only place on our body where our muscle is attached to skin. So you can move the skin on your face and what this means to us as practitioners when we’re doing a session like this, we can look at our patients faces and we can see the different signs of their emotions. We can diagnose them constitutionally… and I’m going to break this down in a moment, but all of these emotions will get launched in the face. Since telemedicine is done through a camera, you have a unique opportunity really to look at your patient’s face and diagnose them that way. People are dealing with a lot of emotional issues, loneliness, isolation, fear, grief, people. Parents are having to homeschool their kids.

There’s a lot of over nurturing that’s going on for people that are in families, a lot of togetherness and in some cases there’s a lot of anger and frustration. So all of this is going to show up right here and this is all going to help you with your diagnosis. Also, really talking to them about what’s going on and giving them some self care skills, self-nurturing skills some of which you already know and some of which you might need to be a little creative as far as how can you take your skills whatever they are meditation or [qigong 00:12:44] and deliver those things to your patients. As far as offerings, speak to your patients about their nutritional habits, lifestyle support, are they getting enough exercise? What are the eating? What are they drinking? And as far as actually caring for their skin, you can teach your patients acupressure.

So for your current and your new facial patients, it can be acupressure on facial points and it can also be some body points that affect the face. So anything that you might be needling you can teach them some acupressure, and what I’ve done is I’ve just taken charts and highlighted or circled things, either taken a picture, scanned it and sent it to them. And then the next time I meet with them I’ll do a little training session with them, I’ll ask them how it’s going. I check in from week to week and it really keeps you engaged with your patients, and it makes them know that you care. So facial cupping, if you’ve never done facial cupping before I have a website where all of my live lectures are recorded, they’re all CEU recorded webinars and I teach facial cupping.

I also have a live stream class coming up, I was supposed to be teaching it in London. It is the first weekend in June and all that information is on my website, it’s facialacupunctureclasses.com and part of that class is a facial cupping. So this is what a facial cup looks like and it’s relatively easy to teach your patients how to do facial cupping and also facial Gua sha. The Gua sha tools I like look like this, and I’m going to talk a little bit more about those in a second. Also, micro needling is something that you can train them to do at home with a Derma roller as well. Any of my live stream classes are also recorded as well, I did want to mention.

I put this picture of myself… This is me teaching. I do make a lot of jokes when I teach our time is limited here so I’m going to keep the jokes and stories to an absolute minimum, but I put this picture up because you can see the lines on my face and those are very typical or someone who smiles and laughs a lot. When I’m teaching I go through all the different lines and what they mean and where they come from but I’m going to give you guys just a quick overview right now, and things that you can talk about with your patients or just use them as your own diagnostic tools. So on the left here is more of a picture of the different areas of the face and the organs that they correspond to, and this picture on the right is from Lillian Bridge’s book Face Reading, and I actually don’t… I personally don’t teach either one of these, I have a recording of one of my friends who is licensed to teach her class.

I have a section of that, that I include on Chinese face reading but there are a lot of different types of lines on the face that you can use when you’re diagnosing. There are a five element tools if you know five element acupuncture or if you’re interested, I go over a lot of this as well but looking at your patient’s facial color, the sound of their voice and the overlying emotion these are things that you can actually do with your patient through telemedicine. If the camera or their lighting isn’t good, they can take a picture of themselves with their cell phone and send it to you, and you can get a better idea of their color. You can also do tongue diagnosis and this can give you more information, same thing have them take a photo and compare it. Although you cannot feel their pulse, you can certainly get an idea of the pulse rate.

So if they’re wearing one of those Apple watches or whatever, whether it’s their pulse is slow or fast and if they don’t have a device, one of those Fitbits then you could just ask them to feel their pulse and count it for you. There are a lot of physical signs of aging that you can use through telemedicine to help diagnose what’s going on with your patient. If I have time I’ll get back to all of these, but I just wanted to put some of these up. These are slides from… I think they’re in their first module of my recorded webinar about diagnosis, and some liver and gallbladder lines. Some signs of kidney out of balance, [spleen 00:19:27] deficiency and then all the different facial lines and signs of aging and what they mean. These are things that you can look for when you are diagnosing your patient through telemedicine.

So, that’s a lot about diagnosis now What about treatment? What can you actually do for your patient? Well, by treating their spirit you’re going to treat their face, right? If someone is stressed it’s going to show up on their face. If someone is angry it’s going to show up on their face. If someone is fearful… if they’re grieving all of this is going to show up right here. So using ear seeds and teaching your patient… I have one of these little ears that I use and I’ll show my patient where to put the ears seeds, and then I’ll give them a diagram of the ear and I’ll put little dots. You can… here’s a great point for relaxation and then there were actually points right on the ear lobe that treat different areas of the face, the endocrine system to help with their complexion can help to balance their hormones. I’ve had patients call me their hair’s falling out, their face is breaking out. So the ear seeds can be great and they can even put them on acupuncture points. If they’re home they’re not going out which a lot of us aren’t, they could just put the seeds right on points. As far as the cupping and Gua sha, you can either take one of my webinars, you could… as long as you credit me you could use some of the pictures from that.

You could draw a picture for your patient and just show them it’s relatively easy and just because your teaching them doesn’t mean they’re not going to come to you afterwards. Because they will enjoy having you do this to them much more than doing it to themselves, but just teaching them some simple facial cupping, some facial Gua sha, how to really use the Gua sha tools and learning how to prescreen your patients for whose a candidate is important.

So I do recommend that you get trained, you don’t just try to wing it. There are some pictures from some of my classes and some acupressure that your patients can do. If you have current cosmetic patients and they’re contacting you going, “I got to get in, I got to get in.” You can teach them some acupressure on different points on their face that they can use to help to stimulate some of these points, and these are some common points that I use in my classes, and also some distal points that would be part of a facial acupuncture protocol. I found this picture online, I liked it because it was color coded and it made it easy to share with my patients. Of course, herbs are something that you can recommend for acne, rosacea, different cheek deficiencies, blood deficiency, stagnation any of these things are going to show up on the face. Puffy eyes, redness.

Any sort of skin condition usually can be helped through herbs, and I am not an herbalist so I’m not going to go into a lecture. There are prescriptions and formulations that can help with different skin conditions. As far as micro needling you can get a microneedle device. I sell them through AcuLift skincare, my company the AcuLift Derma roller and Lhasa has them, but you can buy them sell them to your patients or ask your patients to get one. These are great when you are practicing for your patients to use them between treatments or during this time when they’re looking for a really low tech way to treat their skin. It’s roller with titanium needles and it doesn’t damage the skin at all, it’s very gentle and they could just roll it on their skin. It stimulates collagen and elastin, and it can really go a long way to keep their skin looking good. When they’re at home you could teach them how to use it and again these are safe.

They are approved by the American Acupuncture Council, the AcuLift brand is approved by AAC for use in the treatment room. It is the only brand that is approved by AAC, and they can be used if their hair is falling out, you can use it on your scalp to help to stimulate blood flow, reduce [inaudible 00:25:14] excess testosterone, balance the hormones in the scalp. They’re great for pitted scars, acne scars and a lot of other things and I teach microneedling as well.

I don’t want to spend a lot of time on all this. You can go to my website and look up all of this. I want to make sure I have time for once you open. So I have noticed that a lot of people are going back to work in the next couple of weeks. So one of the big questions is, what do you do once you reopen? If your patient is supposed to be wearing a mask, how are you going to treat their face? Well, there are a few options.

So first when you think about a mask, there’s really only a certain part of the face that a mask covers, right? So if your patient is wearing a mask, the areas that you’re going to have difficulty reaching will be anything around their lips or kind of the gel area. So doing points like stomach 8, [inaudible 00:26:42], gallbladder 2 which you can still reach, and distal points, large intestine four, stomach 36, stomach 40. These points will all help the lower [Hussey 00:27:01] points will help to access this area of the face. Also, using Dr. Tan, if you use Dr. Tans you can do body imaging and you can treat their body.

So even if they are wearing a mask of course you can still treat everything here, and you can do ear points, you can do scalp acupuncture and these can all work to treat all of this, and then using some of your other tools of some of these other points can help with the rest.

So some of the… one of the skills that I teach in my class is using… utilizing the auricular muscles and doing submuscular needling, and this also helps to lift the face. Even if your patient is wearing a mask, you can still access these as well as doing points along the gallbladder 18, which works on the galea aponeurotica up which connects the occipital and frontal bellies of the occipitofrontalis muscle. These are all things that really work to lift the face. What about if you’re trying to… if you are practicing five element, and you need to do some entry exit points on the face? Well, you can access all of them actually except LI20, and in that case you would go down to the next accessible point, which was large intestine 18 which is in line with stomach nine and right behind the SCM.

Lastly, some other alternatives if you feel comfortable having your… if you’ve check their temperature and you screen them thoroughly, and they are asymptomatic and you are wearing a mask and a face shield depending on what the regulations are in your state, you could have them remove their mask or move their mask and treat their face that way, and the last thing is I did find this face shield if you could see here on the right. It was designed for estheticians to be able to treat their clients. It’s a giant sneeze guard and when I first I saw it I thought it was a joke, but I just ordered one. So we’ll see how it goes but again it’s a possibility because if you have on a mask and a face shield, you’re safe but you also want to protect your treatment space. If your patient did cough or sneeze, that it wouldn’t be spread throughout the treatment space.

So again a lot of the stuff I talked about was for cosmetics, but definitely for your neuro patients utilizing body points… any points you can access and I also have a two part webinar on treating neurovascular facial conditions, and a big part of treating a lot of these conditions is scalp acupuncture and body points with some facial points incorporated in. So, that is the end of my lecture and I want to thank the American Acupuncture Council for giving me this opportunity to share everything that I shared. If you have any questions you can go to my Facebook group which is Facial Acupuncture, I’m also on Instagram Facial Acupuncture. I have a Facebook page, Facial Acupuncture classes and my website where you can also write to me is facialacupunctureclasses.com and next week we will… AAC will be hosting Matt Callison and Brian Lau. So, that should be a great lecture and I want to thank all of you for your time, and I’ll be more than happy to answer your questions as best as I can. Thank you so much.

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Acupuncture Liability Insurance: COVID-19 Safety Tips For Clinics

The COVID-19 pandemic has affected many companies from different industries. That includes the acupuncture sector. Many already have scaled their operation down to their skeletal workforce. The goal is to improve the level of protection versus this health emergency.

As an acupuncture liability insurance provider, we would like to reiterate that it is our goal to keep supporting our clients in any way possible most especially in these challenging times. So, in this post, we want to give some tips about good practices that every acupuncture clinic should consider implementing.

The following will help protect acupuncturists, their staff, and clients from COVID-19.

Opting to virtual consultations – With the help of modern technologies, acupuncturists can make use of virtual consultations. They can use video conferencing for case assessment. Of course, patients should still receive appropriate, evidence-based advice and guidance. Managing any health issues such as pains or disorders should not be a hassle in spite of distance consultation.

Practicing physical distancing – If there is a need for an in-person consultation or during treatment, physical distancing should be followed. This practice should be part of the ‘new normal’ while the medical community is still working to find a COVID-19 cure.

Wearing facemasks, PPEs – While on duty, the use of a mask and other necessary personal protective equipment should be considered. Along with proper handwashing, doing it can help improve the level of protection against COVID-19.

Choosing cashless payment – Instead of paying cash, acupuncturists may require clients to pay cashless. They can opt to go for electronic transactions, credit cards, debit cards, as well as using online payment platforms.

Of course, acupuncture liability insurance coverage should be part of the minimum requirements in running a clinic these days. This is to ensure that acupuncturists, in their practice, are protected from liability lawsuits even during this time of the COVID-19 pandemic.

For liability insurance inquiries, contact us at (800) 838-0383.