Disclaimer: The following is an actual transcript. We do our best to make sure the transcript is as accurate as possible, however, it may contain spelling or grammatical errors.Due to the unique language of acupuncture, there will be errors, so we suggest you watch the video while reading the transcript.
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Today I would like to show a side bending exercise I give with patients frequently in the context of treatment of low back pain, especially when the facet joints and the QL is involved.
Disclaimer: The following is an actual transcript. We do our best to make sure the transcript is as accurate as possible, however, it may contain spelling or grammatical errors.Due to the unique language of acupuncture, there will be errors, so we suggest you watch the video while reading the transcript.
Hi, this is Brian Lau. I’m with Jingjin Movement Training, also an instructor with Sports Medicine Acupuncture Certification Program. So thanks to American Acupuncture Council. I always appreciate doing these webinars. A lot of fun to get together and share some information with you. Today we’re going to be referring back to the last presentation I did.
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We talked about the internal pattern, talked about the Zhui Yin and Xiao Yang channels in general. We looked at it in relationship to rotation. We even looked at a rotation exercise. Today I would like to show a side bending exercise I give with patients frequently in the context of treatment of low back pain, especially when the facet joints and the QL is involved.
It’s a great exercise, great to add to your repertoire when treating patients. It’s actually a great exercise to do for your own health. You get a twofer, you get something you can practice for yourself if you don’t have a good side bending exercise, but then something you can use to, to, as part of the treatment.
So it’s an exercise that patients can do at home, yes, but as much as anything, I use some equipment for this. is it’s an exercise that I do after treatment to supplement the treatment to help open the tissue that I worked on with acupuncture manual therapy. So let’s go to the presentation.
We’ll start going over some some introductory information, a little bit of anatomy, and then we’ll look at the movement. Let’s talk about the quadratus lumborum, not the only muscle in the low back that causes low back pain by any means, but it’ll be a little bit of the star of the show for today.
And this exercise can work for a lot of different things, but when the QL is involved, it’s a really great exercise specifically for QL. Type pain. So this is the trigger point referral pattern of the quadratus lumborum. You can see some of the trigger point referrals can be out to the gallbladder channel, along the side, even to the greater trochanter.
They can wrap around to the liver channel. Sometimes the deeper fibers can go towards the SI joint or glute area. But by and large, it’s gallbladder and liver distribution. Now it’s interesting to me because I see, and we’ll look at a brief picture in a moment with the anatomy, I see that the liver, I somborum is part of the liver sinew channel which is a little higher up than the channel is classically described.
We’ll talk about that briefly. But interestingly also is liver V as a distal point, I do treat it locally local treatment is extremely important when you’re working with low back pain when the QL is involved. But as a distal point, liver V, the low connecting point, is a very useful point that becomes very reactive with QL pain.
And it’s interesting that this low connecting point treats this muscle that has a referral both to its its Xiao Yang partner, the gallbladder channel refers to the gallbladder channel, but it also refers to the liver channel. So its referral seems to be between those two those two related channels and the low connecting point would make sense that it would become reactive in that case.
So let’s look briefly at the QL anatomy. This is from Matt Callison’s Motor Point Index. He also has it in his Sports Medicine Acupuncture text. A great book if you don’t have it. This shows the iliac crest attachment, the 12th rib attachment, but also fibers that are going to transverse processes.
It’s a very complex muscle, multi layers. There’s actually three layers of the quadratus lumborum. We did a class on this that’s available on Net of Knowledge, and we talked about all these layers and different fascicles. It’s an interesting muscle. to spend a little more time on that we don’t have time today, but just to highlight that it does have attachments on those transverse processes and the 12th rib and the iliac crest.
It communicates with the multifidi muscles that also attach to the transverse processes and those muscles then go to the spinous processes. So this exercise we’ll be looking at would work those muscles too, but what really I want to highlight in this image in addition to the QL is the facet joints.
We’ll come back and talk about those in a second, but you can see them really well on this illustration. This is where the main movement happens from vertebra to vertebra. Facet joints are also called zygopaphyseal joints and these can be pain generators themselves. When there’s pain associated with a QL, multifidi, and or, and it’s often a and the facet joints this will be a really good exercise to complement it.
So the facet joints of the spine have a coupled relationship between side bending and rotation meaning that they both they, when they do one or the other, they do both. So when you’re side bending, there’s also a rotation component when you’re rotating the individual vertebrae can side bend.
And in particular, the lumbar region has limited rotation just by design. The facet orientation has limited rotation. So we’re going to be doing side bending to really exercise and move those facet joints. So if there is facet joint pain, moving the facets will help open that tissue up and help desensitize that tissue.
But when you’re moving the facets and sidebending, you’re also stretching and contracting, depending on which side you’re sidebending to. Stretching and contracting the quadratus lumborum, and you’re somewhat activating the multifidi also. So nice to know that these coupled relationships exist because really a good comprehensive program will include both sidebending and rotation.
We’re going to look at sidebending today. Here’s the liver sinew channel, so classically it ends at the groin, following up the adductors, adductor longus, pectineus, adductor brevis, gracilis, adductor magnus in my mind is part of the liver sinew channel, it’s more posterior, has a different fascial plane that it lives in, but we’re going to be looking more at those anterior adductors.
I also have in the list the lower portions of the channel, including the flexor digitorum longus, which is what you’d be needling into if you need a liver 5. So that would be affecting that fascial plane. And classically that ends at the groin, but if you follow that fascial plane up, it goes into the psoas, the iliacus, and the QL, all part of that plane, even though we access the QL from the back, it’s much more of a central muscle.
It’s on the fascial plane of the adductors. That would follow really all the way up to the diaphragm. So you can take that channel, in my opinion, up to the diaphragm. But QL is a big player in that and common cause of low back pain. So it’s important to understand these pathways. So liver organ itself has a particular movement that’s going to play into this.
So we looked at rotation at the last webinar I did with the American Acupuncture Council. So in the transverse plane, there’s a rotational movement of the liver in relationship to the diaphragm and the organs around it, like the stomach in particular, kidneys too. There’s a movement in the sagittal plane where it’s tilting forward, tilting back.
Those are going to be exercised much more with rotational type exercises. I want to look at this frontal plane movement. So the frontal plane movement, the liver moves in relationship to the left ligament that holds it up to the diaphragm. And as you side bend to the left and that liver flares up, you want it to be able to move in relationship to the tissues around it, like the transverse colon, the stomach, et cetera.
Then it can also rotate down so it can have a movement in that frontal plane that we’re going to be really highlighting in the rotation exercise. So you’re going to be stretching and contracting the QL, you’re going to be mobilizing liver, you’re going to be opening and closing the facet joints.
It’s important to do sidebending activities because they are underutilized and they’re extremely important for low back health and liver health. Alright, real brief, I’m not going to go into a lot of needle technique for the QL, it takes a little bit more time than I have here today, but I just wanted to highlight a couple directions that you could look at if you’ve had some training with the liver I mean with the liver sinew channel with the QL.
I can needle through this fibrous part of the thoracolumbar fascia where all the abdominal muscles meet, at least all their fascial compartments meet. And then it separates into fascial compartments that wrap around various aspects around the erector spinae and between QL. This is called the lateral raffae.
It’s the lateral seam of the abdominal muscles before they separate into various layers of the thoracolumbar fascia. So I can angle a needle into that. Sometimes that tissue is pretty reactive in and of itself. And that’s my target tissue. Or I could go through that and touch the QL. If I’m trying to needle the QL, I usually just go straight lateral, parallel with the table of the person was lying prone.
If they’re lying sideline, it would go straight towards the table, perpendicular to the table. So there’s some instructions here. If you go back and watch this, you can freeze here and look at those. I, again, this isn’t an instructional webinar on needling that. I just want to give some highlights real quickly here.
I’m palpating into that lateral raffae. So you can see I have about a 30 degree angle or so towards the table. So I’m at the edge of the iliocastalis lumborum advancing the needle into that lateral raffae. Maybe I touch the iliocastalis lumborum. Maybe I touched the quadratus lumborum. Maybe I’m in that fascial seam, which is my target.
And I think what happens is when I hit that fascial seam and engage that, it’s gonna pull on whatever structures it needs to. But it’s just a very reactive place and I needle the lateral raphe quite frequently based on palpation. If my goal is to needle the QL, I’m going to go more parallel to the table, directly cross fiber to the QL or needle it sideline.
I’ll have the leg extended to help depress the ileum on that side and then go straight down towards the table. This is my preferred way of needling the QL if I want to cross fiber the QL, but I might do it prone if I want to combine it with other points, for instance. All right I have some of these types of exercises, including this exercise, but I want to redo the video.
I have it on my YouTube channel, JingJin Movement Training, there’s a QR code there. I haven’t put short samples of those on my Instagram page too, so you can follow that if you’re interested in more information. But I want to now go and show some instruction for this particular exercise that you can use in your treatments.
So I’m going to exit out, and I’m going to back up, so give me just a moment.
Alright, so let’s initially, minimize something, sorry. Let’s talk about equipment first of all. So I’m going to show you two things that I use for this. This is a product called, from a company called StickMobility. StickMobility. StickMobility. com So I like the, I really think this is a solid product. I have them.
I, it comes in a set of two of these. This is a six foot one. I’m not super tall. If you’re taller, I’d get the seven foot one. So I’m about five eight. This one’s going to work for the exercise I’m going to show you quite well. But if you’re six foot tall or something like that, I would go ahead and get the seven foot tall one.
It marks them pretty well on the webpage. So it comes with two of these and it comes with a shorter one. I will say they’re a little pricey. So if you’re not going to use them a lot, I paid 180 for them. That was before greenflation or whatever we want to call it. So they’re probably, I haven’t, I meant to check before the webinar.
They’re probably 200 or 220 or something like that. Now it’s worth it. If you’re going to use them a lot, they’re very solid. They’re not going to break on you. For this particular exercise though especially if you’re going to give it to patients, I think it works just fine with PVC pipe. So with this PVC pipe, I put a little chair stand, whatever these are called that goes on the ends of the legs of the chair.
So I put those on the end because I wanted to be able to grip the floor so that this works out pretty well. These are just little rubber stoppers but the PVC pipe’s pretty strong. So this would be, I don’t know, 10, 15 or something like that. It takes you a little time. You have to go get it and find the appropriate stoppers for it, but it works out just fine.
So I’m going to use the stick mobility one since I have it, but this would be perfectly fine. I’ve never had a problem. PVC pipe’s pretty strong. I’ve never had a problem with that breaking. But I guess that is a consideration if you have a professional product, maybe from a liability standpoint. So maybe in your own office it’s worth having these, but if you’re going to give it to patients and they’re not willing to buy something that’s 200 and they’re only going to do this one exercise, I think the BBC pipe would be a really adequate way of doing it.
But you can also just give this in your office as a complement to the treatment, even if they don’t do it at home, at least they’re engaging that tissue that you just addressed with the acupuncture. So let’s get this set up. I want this to be somewhere about a foot away from my side of my foot. I don’t know, maybe with the metatarsals, doesn’t really matter.
It’s somewhere along the side of the foot, about a foot away. This exercise is easier the farther I move it away. But you’ll see as I go into side bending, if I have it too far away, it’s going to slip. So I need to have it close enough to where it grips. So that’s going to be a little bit of a challenge.
If it’s too hard, you need to move it away. But if you move it away too far, it’s not going to work so well. So about a foot is a good happy medium. So I’m going to put the Stick down. I’m gonna get my arm about at a 90 degree angle at the elbow. I’m gonna reach up, palm facing forward. So if I open my palm up, it’s facing forward.
Grab around. This is where if I was too tall, I’m gonna be like this. I’m not gonna be able to get my head under when I go to do side bending. So it needs to be high enough up to where I’m comfortable. Okay, so I want my chest to turn slightly Towards the bar, and what I’m going to do is I’m going to push out with the lower arm.
I’m going to let the top arm straighten, and I’m going to turn my chest forward. So that’s the position. I need to turn. So I’m pulling with the top arm, but I’m not pulling with the elbow. I’m pulling with the shoulder blade. And then I’m pushing out and extending out. So you can see it gives a really nice stretch all the way through the spine.
For Especially the lumbar spine, very complimentary for working with facet type pain and QL type pain. Come out of it slowly, I can turn my chest back, forward, and relax. So it does take a certain amount of strength for this. This one’s not overly, requires a lot of strength. It’s somewhat also positioning and learning how to use your whole body.
People mostly are trying to use the arms and it’s very difficult for them to push. I’ll show you how I assist them and help them in a second, but part of it is learning how to turn the chest and side bend into the, how to pull with the shoulder girdle without pulling with the arm. That’s going to shorten everything.
I need to pull my scapula back on that side, push the arm out on the bottom one, and then just lean and let it start to bend through the torso. Okay, I’ll show it on the other side and then I’ll show you how I help patients with it. So again, set up about a foot away, arm down, out about hip level, we’ll say about a 90 degree angle thereabouts, maybe slightly lower.
You can adjust it as you go for comfort, palm facing forward. Behind the bar, behind the stick, grab a hold, face my chest towards the bar, or at least in that direction. So I’m rotated in this case to my right, I don’t know if that’s going to show up because sometimes things get a little weird imaged on the webinars, but I’m facing to my right.
This is my right hand at the lower portion, and then I need to turn my chest forward. So I’m turning slightly to the left. Project, pull
the shoulder blade back, my left arm on my top arm, push out with my bottom arm, let everything side bend,
and slowly turn back when I’m ready, and there you go. So how I help. So let’s say I’m back on this side.
Patient can’t really do, first of all, the most often what they’re doing is they’re going to bend the top arm because they’re trying to pull. They need to learn how to let the lats lengthen, let that arm straighten, turn the chest. So it’s a little bit of a difficulty. So imagine I have a patient who’s struggling with this activity here.
I could be on the other side. I usually brace this with my foot and I help them. I’m not just pulling them through it. But I’m giving them some assistance and guiding them, let your top arm straighten, okay there you go, and then I’m helping pull them. Now, once they get into the stretch as far as they can get, I don’t want to just let go when they come out of it.
So I’m pulling, guiding them through it. Their chest is facing forward. Okay, so let’s come out of it. I’m slowly letting up as they turn their chest forward, especially if they have back pain. I don’t want it to be a very jarring activity where they’re in a somewhat compromised position and they just let go.
So I’m helping guide them through it. They don’t have to go as far as I went. Maybe they just go a little bit. Maybe they just get to here. But if I can help pull enough to where Pulls on this top arm, they’re going to start to get that stretch down through the lats, and then also into the QL. Highlight the movement.
I would definitely do it on both sides. So if it’s a lot of pain, maybe they only get this far, but usually this feels good for them. So if it is causing a lot of undue pain, I might come back to it in another treatment, but usually it feels good, feels therapeutic, it feels helpful. It feels like it supplements the treatment.
Same thing. I’d get them set up on this side, chest angled slightly towards the direction of the pole, turn the chest forward, push out, and that same thing. I might be over on this other side, guiding them, giving them some help, making sure they feel stable, guiding their positioning, let that top arm straighten.
Let everything stretch, giving them, coaching them through it, and giving them some guidance, helping them find the maneuver. So using the stick makes it really much more effective. Some people do a side stretch, which is great, nothing wrong with it. Or they might do something with the hands overhead, no problem.
Really nice, You can do a lot of the same types of things. There’s a windmill exercise I do, reaches through nice mobilization. I don’t like this one as much for back pain because of the rotation until they get a little bit more farther along the treatment and they can comfortably go in rotation without causing pain.
So there’s other ways of doing it, but the stick is a really guided way that you can work with patients. You can give them that assistance. You can take them through the process. In a little bit more controlled way. And to be honest, having that arm pulled and stretched from the stick really makes the stretch much more easy to access and takes them into it in a much stronger way.
So it’s a simple bit of equipment, even especially if you just got the PVC pipe. We’d recommend at some point, splurging and getting the stick mobility. I think they’re a really good product, but they are a little pricey. But it’s nice to have maybe the PVC pipe one also in your office so you can show patients and give them some recommendations for what to do in their at their own house when they’re practicing that.
But it, like I said, even just doing it that one time after treatment is part of the treatment. That’s how I view it. So I think you can take that same approach. All right. I think that covers the main information that I wanted to cover for this. Give it a go. Like I said, I have some videos on my YouTube channel, JingJin Movement Training.
I’ll make a point to get a new video up with this from different angles so you can see it and review it. But you can also review it from the webinar. That is on American Acupuncture Council’s Facebook page. It’ll also be on my YouTube channel. And if you wanted to go back and look at the rotation exercise I did, those will be at both of those places also, and it’ll give you a complimentary exercise for rotation that’ll also work.
The internal pathways quite nice. So thanks again for American Acupuncture Council. Look forward to seeing you guys at another time.
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Today, we’re going to be looking a little bit at the liver channel. In particular, we’re going to look at the internal pathway, talk a little bit about some of the anatomy, and we’re going to then look at a therapeutic exercise that’ll help work rotation, liver channel primarily,
Disclaimer: The following is an actual transcript. We do our best to make sure the transcript is as accurate as possible, however, it may contain spelling or grammatical errors.Due to the unique language of acupuncture, there will be errors, so we suggest you watch the video while reading the transcript.
Thanks for tuning in today. I’m Brian Lau. I’m with Jingjin Movement Training. I also teach with Sports Medicine Acupuncture certification program. I want to thank American Acupuncture Council for having me back. Today, we’re going to be looking a little bit at the liver channel. In particular, we’re going to look at the internal pathway, talk a little bit about some of the anatomy, and we’re going to then look at a therapeutic exercise that’ll help work rotation, liver channel primarily, but really all of the Jueyin channels and the Xiaoyang channels.
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That would also include, obviously, gallbladder, Sanjiao, pericardium, and liver, but we’ll highlight the liver channel, that’ll be the focus of the webinar. So let’s go ahead and go to the PowerPoint, and we’ll jump into some anatomy, and then we’ll look at a movement that will work some of this anatomy.
So this image right here is showing my interpretation of the liver sinew channel. We’ll maybe talk a little bit about the sinews, but I want to go into the next slide, and we’ll go right into the liver channel itself. So many of you are familiar with this image from Dedman’s Manual of Acupuncture, or you’re familiar with other images possibly.
So just to highlight the internal pathway here we have the external pathway, acupuncturists are all very familiar with that, probably familiar with the internal pathway, but the external pathway, we have points. So we have a little better sense of the anatomy. Liver 13 would be actually a motor point, motor innervation for the external obliques.
Liver 14 would also be on the region of the external obliques, more at the attachment site. But let’s look at this little internal pathway. and discuss some of the potential anatomy for that. These internal pathways can be a little bit more vague. So I’m going to go to an image, a couple images actually from Netter’s Atlas of Anatomy, fantastic anatomy atlas.
So in Netter’s Atlas, here we have inside the abdominal cavity. So peritoneum’s removed. What we’re seeing is the liver reflected back. So you can see the little hook here, grabbing the liver, pulling the liver back. And what they’re trying to highlight. What Nutter is highlighting in this image is the lesser omentum between the liver and the stomach.
It’s a ligament that holds the liver to the stomach, allows for a particular amount of movement, but keeps some positioning of those organs intact. So I see that this lesser omentum is part of that internal pathway of the liver. Topography wise, it makes sense. It matches the topography fine, but if you open up in dissection and go inside of that Lesser Omentum, then I think it really gives a clear indication or at least a hint at what Deliver Channel is all about.
And that’s what we’re looking at here. We have the contents of the Lesser Omentum. We have the Hepatic vein, we have the portal vein, and then we also have what I think is really important to understanding the liver pathway and the liver channel itself, is we have a branch of the vagus nerve. In my view, and probably others the liver, Being a general, directing where the blood goes, is really about autonomic nervous system functioning.
Particularly, you could argue that it’s about the parasympathetic rest and digest portion of the autonomic nervous system. Very active at night, the blood returns to the liver at night, it returns to all these vessels inside the liver, these capacitance vessels that holds and stores a whole lot of blood.
Blood moves very slowly through that, they’re more full. At night, when we’re not moving, it’s more under the control of the parasympathetic nervous system. But it’s also really autonomic nervous system regulation, telling the body to give blood to the digestive organs, or do I want to give blood to the skeletal muscles because I’m out playing football or doing martial arts or something like that?
It’s where am I in my phase of activity? So it’s really about regulation between those. Now, we think of the liver oftentimes from pathology, which is more sympathetic overload, but in its health and most obvious function, it’s really more about that rest and digest, the most yin, the quietest portion of the nervous system.
And lo and behold, inside this lesser omentum, we have the branch of the vagus nerve. I would posit that this gives us a hint that internal pathway is following the vagus nerve or has something to do with the vagus nerve. I’m not saying it’s necessarily the entirety of the pathway, but it has something to do with that pathway.
So we’re going to look at a movement in a little bit, and I want to be able to move this region, or at least over time of practice of this movement. I want that to move the liver. and move the liver in relationship to the stomach to be able to exercise the contents in the lesser omentum. So just a real brief summary of movement of the liver.
The liver itself has movement in context of these ligamentous structures like the lesser omentum, in context with the diaphragm, of course, also. So the liver moves in the frontal plane. It moves up and down, follow, I’m gonna turn it over to Jim to talk about the the BAPT program.
The original BAPT program was designed in response to the COVID 19 pandemic to provide a way for the medical population to provide the needs of their bystanders to provide the necessary medical care. back and forth. We’ll look at that when I’m standing in a bit. And then it kind of moves in the sagittal plane, a tucking under type motion and a tilting motion.
So those are the motions we’re going to be really highlighting in this rotation exercise. So if you’re doing rotation and you’re letting that rotation wind through the body, it’s going to start to mobilize the liver, mobilize structures like the lesser momentum, and it’ll really complement Both for your own health, but if you’re treating patients and giving them exercises, it’ll really complement any treatments you’re doing for the liver channel, whether it’s musculoskeletal or internal type work, it’s good to have them be able to exercise these internal portions of the channels.
All right. So when we’re doing these rotations, like I mentioned, it’s sometimes you have movements that work a channel, but by and large, functional movements. We’re looking at networks, and when we’re looking at side bending and rotation, we’re looking at the Zhui Yin, Xiao Yang network. So all of these channels have something to do with rotation, and if that rotation is going through the pelvis, through the spine, through the shoulder girdle then we’re having both the arm channels and the leg channels of these Zhui Yin and Xiao Yang channels exercised.
So it’s really more of a functional network that we’re going to be exercising, but I’m highlighting the internal pathway of the liver channel. So just a couple images here, all of these are showing some aspect of either rotation or side bending with the exception of the middle image, which is really more about extension.
I put this one in here for a particular reason, because even when we’re doing activities like Tai Chi, like this is showing push hands or Tai Chi movement we’re stabilizing the lateral side of the body and the medial sides of the body. So to be able to have this nice posture and express the strength that would come from engaging the back and pushing forward we need to be stable, as the weight drops into the front leg, we don’t want that front, in this case, the left hip to rock up, or we don’t want the other hip to rock down.
We want to have a certain amount of stability from side to side. So this one is using the stabilizers and it is using this Joanne Xiaoyang Network. But to do it, it’s not an active movement that you see like you do in this gymnastics ring movement where you can see an obvious side bending or any of these rotational type movements.
So that’s why I put that one in there, but all of them feature some aspect of rotation or side bending, all featuring that Zhui Yin Shao Yong network. So we’re going to be looking at some pelvic movement, so using the liver channel, at least the sinews, pectineus would be one of those muscles, using the Shao Yong channels, piriformis and the lateral hip rotators.
To create and guide rotation of the pelvis, we’re going to be using the external obliques on the liver channel to help with torso rotation. Internal pathway of the, or at least internal portions of the liver sinew channel, QL, and the psoas will be active. Pericardium channel creates a sling around the body, that’s going to be active.
So really gallbladder channel is going to be active. We’re using those channels primarily, but I want to come back to that idea of exercising the internal pathway to complement treatments or to complement and help our own health. So this is showing some of the complex movements that happen between the two sides of the innominate bone, the pelvic bones.
Those also, when you’re walking, they’re going through a rotational type movement. And this is from a study that kind of highlighted those movements. We don’t need to get in the weeds with that. That’s very complex. That could be its own 20 minutes. Might not even be enough time, but its own its own webinar.
But just to highlight that when we’re doing types of movements like walking or turning, that there’s a discrepancy from side to side as one side does something, the other side does something different, we’ll look at that when I’m standing. All right, and that’s an image highlighting some of the, not just the pelvic movement, but how what happens in the pelvis relates to what happens in the ribcage.
So you can see in this boy running, the pelvis has a rotational and twisting type motion. The rib cage in this case has an opposing opposite action. So what’s happening on the right side of the pelvis is mirrored on the left side of the rib cage, but sometimes you can do rotation and have it mirrored on the same side.
The important thing to highlight is that lower rib cage and where the liver is, where the diaphragm is going to relate. It’s going to respond to what’s happening in the pelvis. So when we’re doing this rotation exercise. I want to look at how that winds from the pelvis up into the lower rib cage out into the shoulder girdle.
If you want to learn more about this, you can check out my YouTube channel. I have a lot of movement from a channel perspective movement exercises on there, Tai Chi, Qi Gong, some other types of calisthenic exercises, all from the lens of the channel perspectives, looking at it from the channel movements.
It’s called Jing Jin Movement Training. You can also check out my Instagram page. There’s a link or at least a QR code for each of those. All right, so I’m going to step back and we’re going to start looking at some of the exercises now. So I’ll get a little more back so you can see me more fully.
Let me just get something else out of the way. All right, so this is one exercise that I use a lot for myself. I give to patients also. It’s going to highlight that rotation in the pelvic girdle. It’s going to highlight that rotation In the lower rib cage, it’s going to highlight that rotation in the shoulder girdle, almost like a towel that’s being wrung out.
I want to have a wringing type motion that works throughout the whole body, so I can exercise that entire channel. I want to start with my stance about shoulder width. Maybe almost pelvis would be a really, a good marker. Maybe the outside of my pelvis could almost fit to the inside of my feet. So about a pelvic width stance would be good.
You can make it a little narrower, you can make it a little wider, but somewhere, I don’t want it to be super wide in this particular exercise. So somewhere about pelvis width, right? So I’m going to start with just a pelvis, so you can highlight that. I’m going to put my hands on my ASIS. This is not the motion, I just want to set the stage for it.
And I want to turn. Just to about 45, turn. As I turn, the pelvis is going to pull on the thighs, so there might be a little rotation, but I don’t want to lose form in my thighs. I don’t want my knees to cave in. I want to keep a certain amount of architecture in the knees. It’s okay if the legs move, it’s okay if the knees move a little bit, but I want to keep somewhat of an openness between the two knees.
I’m just turning, almost as if I’m a playing card at this point. So my ASIS facing 45, my shoulders are facing 45. So I’m not really moving yet in the torso, I’m just moving the pelvis. So even from the get go, there’s a little bit of movement in the pelvis. One side pulls back into a posterior tilt. One side moves into an anterior tilt.
You don’t have to do that. Should just happen once the pelvis loosens up. If you’re working with patients, sometimes they’re stiff and that has to take some time to manifest. But if they’re just getting a genital turn, they’re starting to exercise that movement from side to side, that contralateral movement of the pelvis.
All right, next phase, once I turn 45, I want to continue to turn, pulling through with the rib cage. So pelvis goes, Ribcage continues, as if I’m bringing my chest towards the side wall. Okay, so now let’s look at the full movement with that in mind. One arm up, one hand down, turn,
open the chest. So this hand pulls back to the tailbone.
Relax the torso, turn, open the chest. Relax the torso, turn, open the chest. Real briefly, I’m going to turn to the side so you can see from a different angle. So as I turn This hand, I want to let it pull back, turn my chest. So my chest is almost facing forward now. That’s going to depend on flexibility. I don’t want to torque myself past where I can comfortably move, but that’s the idea is I want to turn past where my pelvis can turn, open the chest, shoulder girdle moves,
soft, gentle. It’s not a real big deal with this exercise, but it can be very useful to do on a regular basis.
Okay. So facing forward again. I want to highlight a couple more things, and then maybe show it, and then I think we’ll be good. So as I turn, opening the chest, it’s as if somebody’s reaching through, pulling, So I want to turn fully to where this area moves. When I come to the other side, turn, move. So I want that whole lower ribcage to pull through so somebody’s reaching through.
See if you can see that as I’m doing the motion.
Might help with it is it might seem like there’s a little bit of a stand up at the end. Chest is bowed and soft. As I turn through, I get taller. Turn, move. Get taller, turn, get taller. So that getting taller is where you start working the lower rib cage and start working the internal pathway of the liver channel.
So that’s it. It’s a simple exercise. I want to get a full turn, but I don’t want to tense my body up and make a big to do with it. I’m just turning the hips, turning and opening the chest. That’s going to help my shoulder girdle open and just the gentle Once I get comfortable with it, then I can speed it up a little bit if I want to go faster.
But I would start small and start slow and get the pathway. Down, get the feeling down before trying to add speed.
I will get a video up on my channel for this. I might go from different angles, you can see it a little bit more. But I think from just that, it’s something to get started with. This is an easy exercise, easy for patients to do. It’s a little bit of coordination with it. It can take a little practice for people a little guidance.
You just want to watch them and see that they’re doing it in a very balanced way. But it offers a lot without too much difficulty, so I think it’s very applicable for a lot of people. You can do it seated also. Just keep in mind when you’re seated that you wouldn’t have access to as much turning of the pelvis.
So if I, if this area was fixed, I wouldn’t want to pull myself around. I wouldn’t want to pull my shoulder girdle around. You get the movement. I would still want it to be small ribcage turning in relationship to the pelvis so you don’t have as far to go in a chair, but it is applicable, it is something you can modify into a seated position.
It’s a good chance to work the liver channel, and it’s helpful for a lot of musculoskeletal, back pain, that kind of stuff, but really anything that’s involving that channel. Yeah. Thanks to American Acupuncture Council. It’s really enjoyable for me to come out and show some of these exercises, look at the pathways, to get a chance for us to feel movement in those channels.
And maybe we’ll check out side bending next time in the next webinar, and we’ll go over some some applications for patient exercises there for your own therapeutic benefit. So thanks again, and I look forward to seeing you guys next time.
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So is there a way? To request or to get an increase in a PPO rate, because if you think of it, they never do it, but is there an opportunity to do yeah…
Disclaimer: The following is an actual transcript. We do our best to make sure the transcript is as accurate as possible, however, it may contain spelling or grammatical errors. Due to the unique language of acupuncture, there will be errors, so we suggest you watch the video while reading the transcript.
Greetings, my friends. This is Sam Collins, the coding and billing expert for acupuncture and for you, but the profession as a whole. Thank you, American Acupuncture Council, for the opportunity. But let’s get into it. What’s going on, particularly for the first of the year? You’re always thinking business, money, pricing, and many of you have joined these HMO slash PPO plans and may have been in them for years and are noticing them.
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I’m getting paid the same thing, year after year, and at some point that becomes unsustainable. So is there a way? To request or to get an increase in a PPO rate, because if you think of it, they never do it, but is there an opportunity to do yeah, I will certainly say I’ve had offices that have had success in getting rate increases for PPOs, but there’s a way to do it that I think will lend to potentially having more success.
This is no guarantee, but potentially more success in getting a rate increase. So let’s go to the slides. Let’s talk about that. What things do we need to do? To help ourselves request a rate increase and really get one, it comes down to making sure you create really a value opportunity about your office.
I want you to write a letter to them and request specifically an increase, but by writing a unique value proposition that makes your practice stand out. Maybe where you’re located. Okay, it might be an underserved area. Those types of things are helpful, but more than anything, always go by what’s your status within the plan.
Show your value. I’m sure many of you have heard of the company ASH or one similar, and you can rise in status from Tier 1 to Tier 6. Obviously, the higher tier status you have, The more prestige you have in the plan, and that creates more of a value. They want to keep those higher performing providers, and if you are one of those, that certainly makes it much, much better.
You want to also focus in on your utilization. Bear in mind, we do understand these plans raise your tier by not over utilizing care. That doesn’t mean you shouldn’t do the care that’s necessary, but be mindful, they’re not expecting everyone should get 20, 30 visits. They’re expecting, actually, an average of about 8 visits per patient.
And what that means is, you’re going to have some patients that you might see 20 times. They need it. There should be a balance with maybe seeing some of them two times, so that average comes in. Realize, don’t let one patient plan set it up, but the average over time. And if your numbers are lower, you can show that.
You would point out, heck, my average is six, let’s just say. You want to also highlight, what about the number of providers that might be in the region? Some areas are very underserved. Particularly now with the viability of acupuncture, the VA and all these things, they’re looking for providers. And if it’s an underserved area, that’s going to help.
But even if it’s over served, if you will, there’s a lot of providers. Where do you stand out? Your availability, your location, your hours. Your languages you speak. What if you have multiple languages? I would highly recommend if you have multiple languages spoken in the office, it should be brought up.
Do you speak Spanish? Do you speak Tagalog? I mean think of any type of language. It’s gonna be helpful to create access because that’s very important these PPO plans always creating access. Make sure you also point out their value Compared to other existing contracts. Other plans you’re part of, but I would start with Medicare and Workers Comp.
My goodness, even Medicare for two sets? When you look at the Medicare rate, it allows 70. Workers compensation is usually a percentage of that. Usually anywhere from 120 to as much as 200 percent of Medicare. So therefore, you want to start to use that to say, how is it a PPO thinks they’re sustaining when they don’t even meet the value of Medicare?
And Medicare is the low end. ASH is going to pay many acupuncturists 40 to a visit, which is literally one set, even for Medicare. And if there’s two sets for Medicare, you get 70. So it’s probably unsustainable, and it’s not reasonable, really. Because you have to look at inflation and cost of practice.
Don’t be afraid to bring up about your own specific issues in your practice. What does cost more? Certainly, when you first started practicing, your rates have increased. I’m looking at rates of rent now, which are through the roof. Could that be sustained? Look at gas, the cost of phone and internet, all those things are part of a practice and cost.
So you have to make sure that you’re creating all of that with the window to show your value and unique value to that plan of how you’ve helped people. Don’t be afraid to get a few testimonials from patients of how you’ve helped them. Make sure there are ones too that the patients didn’t have something where they needed hundreds of visits to.
But nonetheless, those types of things are going to be helpful because an insurance company has a vested interest. and making their clients Happy. You want to show that’s what your job is and what you have done. So here’s a way to focus that. This would be the highlights of how to put together some type of proposition or letter to the carrier.
And you can point out, I’ve been a panel provider since say 2015. For some of you, it might even be longer. I support the development of managed care in acupuncture because it helps to standardize documentation, promote evidence based care, and create greater accessibility. We want people to have access to get acupuncture.
We do. But we’ve got to make sure in doing so, we have to have a reasonable amount that’s paid to us to sustain it. You’ll highlight to them there’s been no significant change in reimbursement from your plan, and I’ve been a member for decades maybe. These days, I’ve increased costs. Staff salaries, rent.
Think of the work we have to do now with electronic health records, electronic billing. All the costs that are there. A lot of these plans require you to bill electronically. That doesn’t happen for free. Therefore, that’s got to be brought in. Software contracts and so forth. Not to mention your rent and the other things that go with maintaining your practice.
And frankly, the cost of other things. Cost of gowns. Cost of needles. It’s all increased. You’ll highlight to them, my overhead is nearly four times of what it was when I enrolled with you. My average cost of seeing the patient now is 41 a visit before there’s even a profit. So some of these plans are paying as little as 40.
So you got to think, wait a minute, if my cost is 41 and I’m getting 40, does this make any sense? No. Can you imagine every business just exactly makes what their actual costs are? You can’t stay open. There’s just no way. So this level of reimbursement is not a sustainable model, and while being on the plan to create a greater volume of patients, there’s still a limitation.
Let’s face it, an acupuncture visit is typically 30 to 45 minutes. How in the world can you sustain a practice where you’re getting paid? Less than 80 for an entire hour of work, maybe an hour and a half, and then going to be able to maintain that practice to be open. Think of just what you’re paying per square foot.
In some ways, I would argue we might be better off working at Starbucks or Panda Express, considering some of those places pay 40, 000 to 80, 000 a year. For a full time worker. Come on, as a healthcare professional, they can’t have rates that are at least sustained at that level. So you want to start to point out that hypocrisy by pointing out the rates for your insurance have increased to allow the plan to remain solvent.
I get that. Has insurance companies increased the rates to their insurance every year? I know and I redo my insurance every September. There’s been an increase every year I’ve been in there. However, are providers part of this increase? Isn’t it interesting how insurance companies typically say we’ve had to increase the rates because of the increase in cost.
And I agree, there’s an increase in cost. Where isn’t there an increase in cost? What provider is still getting the same, paid the same amount they have for years? So in reality, the provider costs are flat. Yet, they get all these raises to do what? Now maybe that’s to cover drug costs and all that, but at the end of the day How could they say we’re part of an increased rate when they’ve not paid us any more money?
They’re thinking you just can see more people. How could we see more people if it takes that much time? So it’s unreasonable for providers to bear this cost with no consideration, while the plan has increased their premiums and the adjustments in pay to their workers. If you work for these plans, I bet many of them, if not everyone, get some type of adjustment yearly, 2 to 3 percent.
I’m looking at least for that. I would think if you haven’t had one in a while, what about a 10 or 20 percent jump for this year? Because to sustain it in this way at some point just cannot be sustained. In my observation, healthcare services are the cornerstone of this business and have been left out.
I’m requesting if you’re getting per diem or even if it’s per service, a certain request over that, which will allow me to continue to welcome these patients to my office in the future. Because without an increase, I will no longer be able to sustain the relationship. Let’s be reasonable. It just won’t.
In fact, I’ve had a lot of offices that realized that it was a sum negative and they’ve dropped out. And this is someone I spoke to last week. This is not an exaggeration. They pointed out that they dropped out of one of these plans and they first were very panicked because they thought, Oh my God. And they go, Oh my God, Sam.
In the first two months, they lost 30 percent of the patients. But here’s what they realized. They lost 30 percent of the patients, but that only equals 6 percent of the revenue. What does that tell you about this plan? How bad it is? All this work and emphasis. Maybe it’s not worth it. And this is something that you have to start to look at as a business decision.
There’s nothing wrong with being part of these plans if they’re at a sustainable rate. But if they’re not, maybe it is time to move on. And this is what we look at. If they can’t sustain it, then let’s move elsewhere. Don’t be afraid to make a move. Don’t be afraid to request. Because at the end of the day, the power is with the providers if we wield it.
And don’t be afraid that ultimate power is your patient. And if that patient is still coming in without the plan and paying a fair rate, why would I push for this thing where I’m getting paid 25, 30? So do be careful, but I’m not saying not to request, not to do it, but at least this way you’ll know where you stand.
And if they’re treating you that poorly, maybe it’s time to move on. Don’t be afraid to break a relationship that relationship does not have mutual parts that are beneficial to both sides. And that rate increase to us, I think is important and without it, maybe we can’t stay there. So don’t be afraid.
I wish you well, as always, the American Acupuncturist and myself are always there to help our service. The network is a place where you can go and work with me one on one to really write up a protocol like this. I really wish you all well, continue a good practice and enjoy what you do.
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Disclaimer: The following is an actual transcript. We do our best to make sure the transcript is as accurate as possible, however, it may contain spelling or grammatical errors.Due to the unique language of acupuncture, there will be errors, so we suggest you watch the video while reading the transcript.
Hello. I am, , Moshe Heller. , and I am from Moshen Herbs on one hand and also representing Jingshen Pediatrics, which is a, , , organization that, , teaches, , , classes on. Pediatric treatments in, , in ACU with acupuncture. , and I’d like to thank the American Acupuncture Council for having me today and, , helping me host this.
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, very interesting talk about the concept of yin fire in pediatrics. So, , let’s start, , can we. Turn on the slides. Okay. So, , , I’m gonna be talking about this idea of yin fire. , and before I actually, , would like to discuss that, I wanted to, , bring your attention to the idea. That, , comes from, , pediatric acupuncture.
And, and I’m going to, , talk about, , this for a second before we go into yin fire. And that is, , an , , , , a concept that actually comes from Julian Scott, , from his book of the treatment of, , pediatrics in with acupuncture, , that there are five. Common patterns of disharmony in children. , and the reason I’m pointing, , to this idea is that there’s some, , , correlation or there’s some,
Similarities between the ideas that he kind of presented, , presents, , in his book and the concept of yin fire. And we’ll see how that correlates in a little bit. But, , I want to remind to kind of discuss these five patterns as, , as, , as sort of like a a, an introduction. So these five patterns include, , a regular spleen G deficiency, , type.
, and that’s the, , , usually, , seen in a deficient type. . , patient, , pediatric patient. , usually they’ll have digestive issues similar to the same concept of having a spleen cheat deficiency in, , your adult, , patients. And that, that I don’t, I. I think I don’t need to, , explain too much. , hopefully everybody knows that.
, the other pattern, the next pattern is a lingering pathogenic factor, and that comes from the idea that children are more susceptible to pathogenic factors and. More so they are more susceptible to having these pathogenic factors linger and continue to influence them, , further than just, than, , the initial invasion.
The other three. The next one is called hyperactive kidney deficiency, hyperactive spleen, G deficiency and accumulation disorders. So these three are the ones I want to kind of point out because there are, , similar in, in that there, there is this kind of. The similar idea of yin fire, where you have a doll, , or a a, a rooted deficiencies condition that creates, , excess like symptoms.
And that’s at the root of yin fire. And that’s why I wanted to point out these, , three, , patterns. Also the hyperactive. Kidney deficiency and the hyperactive spleen deficiency both. At the root, , you will see signs of spleen deficiency are classical signs of spleen deficiency, coupled with a lot of behavioral excess meaning, , difficulty falling asleep.
Being hyperactive in their, in their behavior. , , kids that seem very, , , excessive and sometimes difficult to control. Although, , at the, at the core, they are presenting with a spleen deficiency, signs and symptoms, the accumulation disorder. Is classically according to, , Julian Scott, more of an belongs to an excess type.
But really I’ve seen a lot of accumulation disorder in my office that are deficient. Patients with the accumulation or these, these kind of accumulation of dampness and in particular, , that, , manifests as. , excess signs and symptoms. So I just wanted to, , give that as a, as a introduction, , to the, the idea of, , of yin fire because I think it’s not totally foreign or it’s not completely new, , in that type of thinking.
But, . Let’s talk about yin fire and, , just wanted to point out that, , the concept of yin fire was, , , discussed first by, , li Don Yan, , who wrote the book, , the P Lung in 1249. . In there. You know, we all know that, , li Donan was this, , , famous Chinese doctor who, , developed the idea of the spleen and stomach stu , school, meaning that he believed that a lot of, .
, disorders or most disorders were created or stem from this, , spleen, chief acuity. , and, , and , and in his discussions he discussed the idea of yin fire, which is, , again, , this idea of spleen vacuity at the core and then having. Which we’ll discuss, , what that means in a little bit. , and this idea of Li Donan was discussed, , and debated in many, I import by many important Chinese doctors throughout the years.
. And actually has gained more attention in today. I hear a lot of practitioners talking about Ian Fire. , not, , you know, recently and a lot of, , lectures and, and discussions, which is, , very interesting. And, , the reason I think it’s becoming very popular is because it’s actually. Can be an explanation for many chronic diseases, , or disease that are a mixture of a mixed pattern of excess and deficiency, , in combination.
And we’ll see how that works. , well in, in, in a, in a little bit. , but it’s, it’s, it’s actually, , although you see all these. Excess signs in, in the forefront because the, those are more, , clear. , the right treatment principle is a principle of strengthening and resolving the, the, the main, core idea of this deficiency that’s causing the excess like symptoms that are not really excess.
So, , I’m going to, I, I brought this excerpt from, , from the p , which is the opening, , , con, , , paragraph, , sort of defining what Yin fire is, and it’s, , translated by Lorraine Wilcox, , , which, , provides a very. Good translation in this. You can find, , her article about this, , translation very easily.
, , so let me, , read this, , because I think it’s really important to understand what is said here. So, . , and it starts by talking of, , saying this, if eating and drinking becomes irregular or cold and worth, warmth are inappropriate, the spleen and stomach becomes damaged. So the first sentence we see that the causes of this imbalance, the causes of this balance of, of, of, of the damage of spleen and stomach come from.
, diet basically says it’s either diet, , or inappropriate exposures to, , warmth and cold. , and the diet is, is, is really a very important, , aspect of that. And we have to, . , to, , you know, I, I wanna point out, , before moving on, that, that is, , at the core of, , the treatment pri principles.
When I see, when I recognize infire diet is one thing, I have a very long discussion with my patients, with the parents and the, the children, depending who I’m treating. , about regulating diet and not so much. Not as much as, , I put as, as much as emphasis on. The scheduling and how you eat and, , enough, , chewing and not swallowing, , your food, but chewing it and giving it time and having, , and eating in regular schedule, , as part of this kind of healing of the spleen and stomach.
So this is a very important aspect that, , that we need to pay attention to. Then he goes on on saying, or joy, anger, anxiety, and fear can also consume original qi, or it’s called, he names it as Yuan qe. And here we have to be. And , Lorraine also, , . , points out that when he, , when he call what he calls Yuan Chi, we have to be careful not to, , confuse that with what we call yuan kidney Yuan or Yuan Source.
It’s a different, this Yuan Chi is very much associated with what we might call the chin chi or the clear chi that comes out of. Digestion, right. So, , after, , Gucci is derived from the, the, the, the food and drink it is. Trans and it is connected with the, the, the, , the, the chio, the chi of the air. , it becomes this kind of, , yuan qi and it actually, , is associated with the lower Jiao.
So it’s, , it comes, it’s connected also with some, , of the kidney. , . Kidney. So, , it stems from the lower jaw and goes up to the upper. So, . That’s the Yuan Chi that we’re, we’re, we’re talking about in this case. Once spleen and stomach chi has declined and original Q has become insufficient, the only thing that is abundant is the pathological fire in of the heart.
So in a sense, this, , clear q, , allows the balance or allows the, the, the balance between. , that and heart fire. So once they are declining, , the fire in the heart becomes, , pathological. And this is, this heart fire is yin fire, which arises in the lower J and connects with the heart through its system.
So, , this whole system has to do with the relationship of the pericardium and the Tial fire and, , and it is associated with this kind of movement of qi. And so I. Of, of movement, of qi up and down and, , in our body. And therefore, , a lot of this yin fire is associated with stagnation, stagnation of qi.
So we’ll see that also in a little bit. So Minister Fire Min, minister Fire is the fire of the Lower JAO and the bau. There’s a whole discussion what BAU means, , which we won’t go, go into. , . And once that Tal fire is this, it is the thief of original Qi fire cannot coexist with the original qi. One of them will become victorious and the other will be defeated.
So we see this kind of mechanism that’s, , that’s described, which is . Which I want to sort of, , , in the next slide, I’ve sort of created this, , visual, , , presentation of it. , if we have the lower, middle and upper levels here, , this TAL fire should be, , coming down from the heart and placed.
, under the, , under the pot, if you say, of the spleen and stomach. , So the yanchi, , is also arises from here and, , and is in part of the process. But if the menstrual fire, , is misplaced, it creates, , more heat. If you can imagine this kind of menstrual fire as being the fire under the pot, if the fire is sitting aside from the pot, it brings up, , heat that harass, that can harass the heart.
And so, you know, as the spleen and stomach, , supposed to, , raise the spleen is supposed to bring up the chi to the chest and the stomach riping and rotting and, . It is supposed to connect with the lung chi to create Gucci. And then this is sort of the source of our postnatal chi and also the source of having a very strong and balanced ying chi and way chi.
, so as we can see here, this is all, , once this, there’s an imbalance here. It affects our ability to. , have a balanced immune system. It has, , a, a, a a very, it will affect the mechanisms of our own energy so that it will be very imbalanced and, , and, , if we understand this path of mechanism, we can understand and, , and see it in our patients much clearer.
So I want to just, , also point out that throughout these discussions and development, there’s actually a lot of, . Different. So, yin fire is not one thing. It’s actually a concept. And, , and, and in an article in the JCM, the Journal of Chinese Medicine, , called, , an Introduction to Chinese Medicine Concept of Yin Fire by Sean Randen.
, he writes this, , it’s a, it’s a great article and I, , would recommend reading it. , but he talks about this. The concept of Yen Fire has been discussed and debated through the history of Chinese medicine, and he brings this, , modern auth author from 2007, Leo Tu, who classified Yen Fire, according to four different categories.
. One. , the one of them is the, , what we, he calls occlusive exclusively Q deficiency, , yin fire as described by Lee Donan, you know, in his, in his book. That’s. Currently discussed, but he brings three more aspects of that. One is more, , , issue of XY and mostly this kind of XY cold, xin cold that, , actually the cold creating fire.
So he, , talks about the sea and fire created. From kidney cold. So this, again, this, we, you know, we can see this concept of dull , patterns. So a mixed pattern, cold and heat or deficiency, and what seems like excess. Also, , the other one he discussed is called Kidney in Deficiency, creating Fire. That’s a more classical part of that, but as it as this, if this fire is harassing the heart, that’s when we see yin fire in this case.
And the third one has to do with liver, gallbladder cheese stagnation causing depressive. Heat or fire, , also harassing the heart. So again, I just wanna point out in by this, , is that there’s a broader concept of yen fire other than just, , what we’ve just discussed.
So this is the end of part one of, , the concept of yin fire in pediatrics in part two. I’m going to be speaking about how does yin fire manifest in pediatrics more specifically.
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Today’s talk focuses on facial motor points. Last time, if you missed part one, I talked about using facial motor points for cosmetic applications. And today we are gonna be talking about so cosmetic applications like, Crow’s feet or frown lines.
Disclaimer: The following is an actual transcript. We do our best to make sure the transcript is as accurate as possible, however, it may contain spelling or grammatical errors.Due to the unique language of acupuncture, there will be errors, so we suggest you watch the video while reading the transcript.
Hi, my name is Michelle Gellis and I am an acupuncture physician who teaches facial acupuncture classes internationally. Today, I will be presenting part. Two of a lecture on using facial motor points for facial concerns, and if you would please go to the first slide.
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This is a list of the different classes that I teach. They are all recorded and on my website, and today we will be going over some of the. Topics that I cover in treating neuromuscular facial conditions and some of the advanced techniques from my facial acupuncture class.
Today’s talk focuses on facial motor points. Last time, if you missed part one, I talked about using facial motor points for cosmetic applications. And today we are gonna be talking about so cosmetic applications like, Crow’s feet or frown lines. But today I am going to be talking about using facial motor points for a couple of different types of neuromuscular facial conditions, and the two that I’m going to discuss today are Bell’s Palsy and Ptosis.
But first I wanna review quickly. What is a motor point? If a muscle. Is not functioning properly. Using an acupuncture needle and putting it into the motor point of the muscle is like a reset switch and it will bring the muscle back into normal functioning. Because on our face, the skin is attached to the muscle.
Using the motor points on the face can help the face to not only look, differently getting rid of tension and wrinkles and lines and folds, but it can also help the face to function properly so that if someone has some sort of a neuromuscular facial condition, using the motor point can help to resolve that.
A motor point is different than a trigger point. A trigger point is like a knot in a muscle, whereas a motor point is, so if this is your peripheral nerve, you have your sensory nerve, and then you have your motor nerve, and the motor point is where the motor. Attaches into the muscle. It is the most electrically excitable part of the muscle where the motor nerve is attached.
The face has two nerve branches that are in charge of the functioning and the sensory of the face. So we have the trigeminal nerve, which is. The fifth facial nerve CN five, and that takes care of sensation. And also mastication, it connects to your massacre, the facial nerve which is CN seven, cranial nerve seven.
Helps the functioning of the face, so your facial expressions and also taste. So you can see the two different nerves. We have the facial nerve and the trigeminal nerve. And the trigeminal nerve has the ophthalmic branch, the maxillary branch, and the mandibular branch, and the facial nerve has five.
Branches, the temporal zygomatic, bcal, the mandibular branch, and then the cervical branches which go down to the platysma.
The first neuromuscular condition we’re going to talk about is Bell’s Palsy and. Be’s palsy is the most common cause of facial paralysis that you will find in your treatment room, that you’ll see in your treatment room typically, and it’s a disruption of the facial nerves, and it can result in facial paralysis, weakness, drooping, inability to keep the eyelid open or closed.
You can patients can get unusual taste sensations, hearing loss, ear pain and normally the symptoms get at their peak within 48 hours and can last for several weeks up through a lifetime.
Palsy is typically in Western medicine. It’s typically thought of as a result of a virus and, mostly it is seen in individuals between the ages of 15 and 60, although I have seen patients as young as two in my treatment room with Bell’s Palsy, and it usually follows some sort of a viral infection.
It is seen. In a very large number of pregnant women and Western medicine treats it with drugs such as Acyclovir. And also usually so the acyclovir is an antiviral, and then frequently they will give some sort of a steroid to help with any inflammation. So the first thing you would do is an exam protocol, and in order to ascertain which of the muscles is not.
Functioning properly. So you would look at, for example, the frontals. The way you would determine if that is working properly is you’d have your patient raise their eyebrows, close their eyes, and you’re going to be looking for any disparity between the two eyes. Have them smile, and this is going to let you know how the zygomaticus major and minor.
Functioning the orbicularis, orus, the lator muscles, and ZOS. Et cetera, et cetera. So you’re gonna go through the exam of the different facial muscles and you’re going to look for any disparity, and then you will know which muscles to treat, and then within that muscle group. Where the different motor points are, and fortunately for us, the motor points on the face, most of them are either on an acupuncture point or they’re right between a couple of acupuncture points.
So it makes it easier for us to find them because the muscle, the face does have a lot of muscles.
So the first motor point that we would use if someone could not pull their eyebrows together and frown would be the motor point for the corrugator muscle, which is just lateral to bladder two.
The next, as I mentioned the frontals that raises the eyebrows and the motor point for that is gallbladder 14. So you would treat the affected side for the orbicularis oculi. This can help with. Closing the eyelids, and that can sometimes be a problem. People with Bell’s Palsy, they have to take their eyelids shut and the motor points.
There’s two for each eye, and one is between Sania 23 and gallbladder one, and then the other is the extra point Q Hoag, which is right on the orbital Ri. It’s between stomach two and gallbladder one. The next is the motor point for the Zygomaticus major, and that is SI 18, and you’re going to needle into the muscle, but not through the muscle.
The Zygomaticus minor helps to elevate the lip and the motor point for that is between stomach two and stomach three. For the levator Labii Superioris, the motor point is between LI 20 and stomach two, and the levator labii Superioris helps to elevate the lip individually as if snarling the Tallis, is on either side of Ren 24 and it is a half soon lateral to Ren 24, and this helps to elevate and protrude the lower lip.
So in addition to ascertaining which muscles you’re going to treat. If you were treating a condition such as Bell’s Palsy, you also would want to do a full body treatment. And so you would do your TCM diagnosis and look for the pattern and treat the underlying pattern. In the case of Bell’s Palsy, it is either blood stagnation, a lung wind invasion, or a spleen chi deficiency.
And then you would do local points and motor points on the face where the person has the deficiency. In addition to any body points, posis is another neuromuscular facial condition that. You will see commonly in your treatment room, and it can affect one eye or both eyes. It’s when the eye lids are not opening fully.
Everyone has a little bit of ptosis, but it can happen as we age. Some people are born that way and for others it can happen after some sort of an injury or even an illness. And this these are different levels of ptosis. This is slight ptosis, very slight ptosis. And this is due to aging. And then this is more severe ptosis.
I already went through all of this. There are many different causes of ptosis again people, sometimes people get ptosis when they have cluster headaches and, some sort of brain injury as I mentioned injury. A brain injury, spinal cord injury can cause ptosis as well. The motor points that you would use ver posis are the orbicularis oi, and also the frontalis can help the major muscle that’s involved.
Is the levator muscle, but there is no motor point for that. There is a way to treat it with cosmetic threading techniques, but I cover that in my cosmetic classes. When you’re looking at posis of the upper eyelid, it’s either a deficiency of spleen. And kidney or and or spleen deficiency with wind phlegm or oh, I’m sorry.
Let me back up a step. The slide is confusing. The it’s either a spleen deficiency with wind phlegm. Or a deficiency of spleen and kidney. And so the, you would do your differential diagnosis based on what the symptoms are, and then you would treat the underlying symptoms accordingly, as well as using the motor points.
This is information on how to find me if you are interested in. More information. You can follow me on Instagram or join my Facebook group, facial Acupuncture and my website for all of my recorded and live classes I do teach internationally is facial acupuncture classes.com.
I wanted to say thank you for today for coming, and thank you to the American Acupuncture Council for giving me this opportunity to spend some time teaching you.
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