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Acupuncture Malpractice Insurance – Is it the Fascia?

I am obsessed with fascia these days. Fascia is the glue that’s holding us all together.

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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 everyone, my name is Dr. Shellie Goldstein. I’m here in Florida. Today’s lecture is called Fascia. So thank you so much to the American Acupuncture Council for allowing me to be here today and presenting this topic to you. So let’s go to the slides.

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One of the things that has become very obvious to me these days is the synergy of Eastern and western medicine. And I do firmly believe that integrating eastern and western medicine in today’s healthcare system is both multifaceted effort. It’s on both of our parts, Eastern and western practitioners.

It requires collaboration, education, research, and certainly cultural sensitivity. And when we are able to perform these responsibilities the potential is enormous for both patients, but also . For us as well for the patients. It provides a broader range of treatment options and more personalized care.

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And then when we as eastern medicine practitioners begin to understand Western medical concepts we find that not only do the patients benefit, but we do as well because recognizing and understanding these parallels of each of those systems can . Absolutely lead to an enhanced professional collaboration and improved patient care, which is so important today because as Eastern medicine practitioners, this is our time.

This is our time to join Western medical practitioners in an integrative care modality to Bri be to improve the quality of healthcare and to bring forward. A much broader range of treatment options for both the patients and the practitioners as well. That is what brings me to this topic of fascia.

I am obsessed with fascia these days. Fascia is the glue that’s holding us all together. It’s the, from a modern anatomical and physiological. peRspective we see it both as fascia from a Western medical perspective, and in our world as Eastern medicine practitioners, we see it as the concept of Jji or the Sinu channels.

And when we talk about Jji, what we’re talking about is the network of pathways related to both . Muscles, tendons, and all of the other connective tissue that keeps us connected in the body. One is fascia. From a Western medical perspective, it’s a form of connective tissue. It contains collagen fibers, Alaskan fibers, and what we call ground substance.

And so ground substance is what keeps it all together, keeps it nice and moist. So you think about . Fascia is this tactile network of tissue that both surrounds every muscle organ, vessel bone and nerve fiber. But it also connects the horizontal planes from bone to the surface of the skin. So it surrounds and protects, but it also connects and it’s three dimensional.

As you can see of this image, it moves back and forth. It provides the structural integrity, the stability, and the flexibility of our body to move and be fluid in its movement. And it also allows us to move in a multi-directional and multi-dimensional plane so that we, our fluids are, our movements are nice and fluid.

One muscle doesn’t move and then mu another independently find the movement of another muscle so that there’s this schism of muscle contraction. But it’s that fluid movement that allows us to move through the different multi-dimensional planes upward, downward, inside outward, and then running through these planes.

Of fascia are nerves, and in that sense, not only do we have movement, but we have sensation. There are so many nerve endings or nerves that run through the fascial planes that it is almost as sensitive as touch on the surface of our skin. That’s how sensitive and acute our fascial system is. It is both affected by internal muscle activity and external, say, gravity and movement.

And so as these systems come into play, both our muscle contractions and the weight of external bearing systems, uh, it allows that transmission and that dispersion. Of that through the neck fascial network and then also through its visel properties. It helps to move us in one direction or another. So for example, if someone holds onto your arm and pulls, it’s not just your arm muscle that’s gonna pull, but your whole body is going move along with that.

With that pull or with that movement to compensate both movement in one direction and stabilize that movement in ano in another direction. And when we have our body moving in ni in a nice fluid system such as the fascial system, it actually helps to minimize the amount of energy that’s utilized throughout each singular or connected movement.

Fascia protects the integrity of the body and helps prevent or minimize local stress within a specific muscle joint or a bone. For example, if you have tightness in say, one area, it the ability for the fascial network to move and to break through that tightness allows the body to minimize that local stress.

Also to absorb that localized stress and move it through the body to release that, that tension or that stress. Think of it as the Terminator, right? Think of the Terminator Revisited. I. Think of what if the Terminator was just an individual subset of parts and there was this gap filler, this structure that was stayed in, in, in the, in those empty spaces and it just

Filled the space. That’s not what fascia is. Fascia is actually what we’ve been talking about. That ability for this entire elastic contractual signaling, whole body signaling network to move the body in a very fluid dynamic and structure so we can run faster, jump higher, and be more efficient in our movements.

There are multiple types of fascia. There’s superficial fascia. That’s what’s on the surface of our body, and it’s a very loose layer. It’s very wet, and it is made up of fat. Adipose tissue collagen and elastin fibers, and that ground substance or hyaluronic acid keeps that superficial fascia nice and loose and sticky so that its job is to actually attach the superficial and horizontal planes so that you get this smooth.

Flow between the different horizontal layers so that there’s no friction or tension. Its job is more to stabilize and connect these structures, whereas deeper fascia, I. Has much more fibrous and its job is to cover the different structures, bones, muscles, nerves, and vessels, and protect ’em. So it’s job is to actually absorb contraction.

There. If the body, say for example, if you start to fall, the fascia that surrounds the different muscles and tissues will contract right before you, you fall. In order to support the muscles and contain those muscles. So the difference being that the deeper fascia is protective, it’s contracting and it holds everything together, whereas the superficial is more of a connection, so it connects the different layers together.

aLso deep fascia has receptors that signal the sensation of pain, right? You land hard when you fall, and the body absorbs that shock. Feels that sensation sends it to the brain to signal the brain that something is occurring in that particular area, and then the brain can respond accordingly. And then deep deep into the pockets or the cavities of our body.

We have the visceral and the parietal fascia, and again, these are more loose, connective air, irregular tissue. That’s sub, that has that fat and that liquid hyaluronic acid in it and its job is to surround and protect the internal organs. The visceral fascia surrounds the organs and the AAL cavity, the lungs and the heart, whereas the parietal fascia lines the wall area of the pelvis.

Now what’s interesting and what’s most relevant for the conversation that we’re having today is the relationship between what we’re calling myofascial slings. So the myofascial slings are different planes that work together to create mobility and stability. So they are dense bands, as you can see, the superficial front sling, the superficial back sling, the lateral swing, the.

Spiral and the deep front swing. They’re bands that run from the back to the front of the body, shoulder to the contralateral hip, and their job is to play an int integral role in coordinating con control, coordination and control movement sequencing, and the integration or the kinetic movement that involves the transfer of force.

From the upper to the lower aspects of the body and extremities. So think of them as the slings that support and allow movement of the body. What’s interesting for us is these slings are ve are directly related to what we call our gene gen or sinu channels. These are not the Jing low. These are the sinu or muscle channels that are described separately from the jingo.

So the Jing gin channels incorporate the Sinu channels, the channel sinus, the muscle meridians, and the muscle conduits, or tender muscular meridians. They’re found in Theen. In Theen Chapter 43. It says that whey or defensive chi is formed from food or drink. It cannot travel within the vessels, but flows between the skin and the muscles.

It circulates through the chest and remains outside of the channels and vessels. Now Ma, Chicha then takes this information and combines it with the information that’s found in chapter 13 of the Ling Shoe. He says that the connective tissue of the limbs is either muscle or sinew in Chinese medicine.

Fascia in limbs, sinus, or muscles are both called gin. Therefore, muscle gin is the muscle channels inclusive of fascia, cartilage, tendon, and ligaments. And then he says that they’re discussed in chapter 13 of the Ling Shoe called Jin Gin Channel like muscles or muscles of the channels. And then in the link shoe in chapter 13.

The reference that he’s referring to is the statement that the pathology of sinus cause pain, tightness, and fla, acidity, and even impairs movement. So again, there’s this correlation of this band that we call Jji that is specific to movement and the coordination of muscle and tendon movement within the body.

And also founded by the research of Helen l Langevin at the University of Vermont. She suggests an overlap between fascia and the traditional Chinese medicine concept of channels or collaterals. Now she combines Jing Jin and Jing Lo. But ’cause what she’s saying is that she and her colleagues notice that the insertion and the attachments of the muscles and fascia create cleavages or lines that pull like the grain of in wood.

And then she says that the, there are many acupuncture points that lie directly over that area in these fascial cleavages, where the sheets of fascia diverge to separate, surround and support the muscle bundle, similar to the deeper fascia that we’ve been referring to. And then according to Langerman, the yang chi is said to flow in those spaces between the organs, the bones, and the flesh.

Now what’s fascinating is we, as our, and when we think of our Jji channels, we have CH 12 channels, six paired channels, the Ang Sinu, the Young M Sinu, the Young Chao tie in Cha Andan Sin Channels. If you look at the trajectory of those channels, they’re very similar to the fascial slings. So you can see them in, in this image is the similarities be between them.

But then if you look at this image, you can actually see the direct correlation between the specifics of the slings and the superficial lines of the sinu channels. So you see the superficial back and the urinary bladder channels are very similar. The frontline and the stomach channel are, have overlapping similarities.

And then the deep back arm line, the small is correlates with the small intestines in new channel and the hearts in new channel. The superficial back arm line corresponds with the. Triple burner sinu and the large intestine senu channel. And then if you look in the similarities between the lateral line and the gallbladder senu channel, they’re almost identical.

And then again, through the deep front line. We see overlapping correspondences between the liver sinu channel, the kidney sinu channel, the spleen sinu, and the spleen sinu channel. And then again, lastly, the deep front arm line corresponds to the lung sinu channel and the heart sinu channel. And the superficial front arm line is very similar to the pericardium Sinu channels.

So you can see that the planes of these channels very much o overlap with one another. So when we compare the similarities between Jing, Jin, and Fascia, we see that from a conceptual and anatomical and functional perspective, there are certain parallels between the Jji and Chinese medicine and Western medicine.

And that the myofascial system can be observed in their roles as connective tissue networks that support connect and influence body movement. And even though they’re described differently in our medical frameworks, they both recognize the importance of these pathways in maintaining health, um, both in terms of structural support.

In Chinese medicine, we see them in terms of our . Our support, movement and stability of the skeletal system we see in Chinese medicine, the concept of pain and dysfunction are attributed to our blockages or imbalances in the flow of Q and blood. And we know that from our Jing Jinen meridians, they’re thought to be responsible for the smooth circulation of vital energies.

And when there’s an obstruction in the sinew channels, it can lead to musculoskeletal problems, pain, and a decreased s ability to provide support to the body. And then we see the very similarities in Western medicine and western an anatomy. Same recognition of connective tissue that envelops impacts the muscles, the organs, the blood vessels, the nerves and other structures, and that same three dimensional network or support system throughout the body.

And similarly, I. When there are obstructions or disturbances in the myofascial slings in the fascial system, it leads to musculoskeletal problems, pain, and a decreased ability to provide structural support. We also see that similarity in the ability of the Jing gin and fass that. To movement and mechanical transmission.

So the gene gin acts as a conduit for smooth flow of chi and blood throughout the body and supporting that movement. Where is in western medicine, it’s the fascia that facilitates that smooth mood and colliding action. Between the adjacent structures we see there’s this interconnection. So we see in Chinese medicine, we understand that connection between everything, that continuous flow of chi and blood through the meridians and the vessels that are believed to nourish and support the organs and the tissues.

And we also understand that blockages or imbalances in this flow lead to health problems. And then we also correlate that interconnection integration by understanding the com, the emotional component of both pain, but also trauma into those jji affecting the specific organ system separately. Although the JJI does not necessarily refer to the organ systems, we know.

That there is an interconnection and integration in all the body parts with the deeper senses of emotion in our being. And then in Western medicine they think of this interconnection and integration more in terms of movement. But again, we all recognize the emotional component of it. . And then there’s the understanding of the parallel between gin and fascia in terms of pain and the perception of pain.

So we know from our functional MRI studies in that acupuncture’s ability to influence the brain’s activity in regions associated with pain perception, motor control and mood regulation. And we know . That acupuncture has been shown to activate the release of pain relieving endorphins. By modulating these pain perceptions we can, with acupuncture, we can reduce pain, improve mobility, and ease emotional related discomfort.

The same with in Western medicine, they may not use acupuncture, but there is that innate understanding that fascia contains sensory receptors, propria receptors, and neuro. No e receptors at which contribute to the somatic sensation appropriate adoption. In our Chinese medicine, we see pain in terms of B syndrome and we, and from our understanding of the gene gym, they’re not, although they’re not related to individual organs we do know that they.

Pain itself is what flows through the concept of pain or what we call B or painful obstruction syndrome. Pain, soreness, numbness of the muscles and tend tendons and joints. Rose runs through our Jing gym and we know that acupuncture improves and accelerates that flow of QE and blood within the Jing Gen to alleviate B syndrome, ands, restore proper function.

Now, although the a Jing Jin does not have acupuncture points, those acupuncture points lie along the Jing low. But we know that the Jing Jin and the Jing Low run in parallel. So we use the Jing low points. In order to affect the Jing, Jin Meridians and classical treatment strategies will include primarily we think of the Jing well points.

We also know that there are those four meeting points that are organized, the channels, and regardless of there being an arm, a leg or re or upper or lower uh, we know that CV three. Is for the three Li in channels small intestine. 18 for the three young channels. . Stomach eight or GB 13, depending upon the source for the three young channels of the arm and gallbladder 22 for the three yin channels of the arm.

And we also have realized that those anatomical locations of these specific points are similar to the histological nodes and convergent points of different myofascial planes. So there’s a another correlation there. In terms of treatment, we generally use the ASHI points, or those are the points when you palpate someone and they go, ah, , those are our Ashi points.

trIgger points. Those are those discreet local, hyper irritable spots along a band. So although the pain may be felt in a different area, it’s the, that one trigger point is the referral pain that accompanies this musculoskeletal discomfort. Or we use motor points. And motor points are the site where the motor nerve first pierces the muscle belly.

It’s also known as the MEP of the motor nerve point. And so those are those are the points that are very, a little bit larger in diameter. They carry a greater quantity of motor and sensory sensations and so those are great points for treatment as well. Other forms of treatment include cupping, are guhan.

So let me give you an example of what I’m talking about. Here’s a case study, and this is a hypothetical case study of a 47-year-old male patient presenting with a three-year history of plantar fascitis. He complains of excruciating sharp burning pain on the soles of his feet that would come and go.

The right foot was worse than the left and the right hamstringing. Lower back sous and medial head of the gastric Venus were very tight, and then that pain and upon palpation extended to the medial head of the area of the kidney. Now the patient said that he was not aware of any other physical or digestive disturbances, but upon palpation what we find is that, or are looking at his tongue and pulse, that his pulse was wiring and deep in the both proximal positions and tongue pale with red tips.

So what does that tell us? It tells us that although we are treating. The pain it through the jji. And in our situation, given this case study, this is the T Young Sinu channel or what we call the superficial backline from a Western medical perspective. But we also can tell that from his tongue and from his pulse that he has a little bit of underlying kidney deficiency.

So we’re gonna treat the stagnation in the bladder meridian of the TA Yang Sinu channel. That’s our primary treatment. We may support the kidney treat deficiency because as Chinese medicine practitioners, we’re always looking for that under root cause, but the primary treatment. Is the stagnation and the taang sinu channel.

The treatment is to resolve that stagnation in the bladder meridian of the taang channel and then all, and then to the secondarily, we’re gonna nourish kidney chii and chi and blood of the kidneys. So these are points that we might use that would support both the Tay Young Sinu channel treatment and then supporting the underlying kidney deficiency.

And from a Western perspective, what they were gonna do is a very similar thing. So Mo you see a lot of these points. Bladder 40, 60, 56, 57. 67, 37 all are along the bladder meridian, and then we are supporting . The underlying systems with kidney six, liver three, and spleen six. But as a western medical practitioner treating the back line, what I would do is use trigger points or different types of treatments to pressure with pressure to release the that medial gastric muscle so the patient gets treated, he comes back.

A week later are reporting that a significant reduction and there’s a significant reduction in his pain along the under sole area. But he still has some tight calves and a little bit of tightness in the right hip, which would make sense by looking at both the back sling and the CNU channel. So the next two treatments.

We’re going to incorporate the following points, gallbladder 29 34, and these are designed to release the tights around the hips. Again, we’re treating that sling or that’s sin new channel. And then after three treatments, his musculoskeletal problems significantly improved and he was able to mean. Remain pain-free by regular home care treatment.

And then if he were to go for physical therapy or western treatment, they would do a similar thing. They would treat, continue to treat that medial gastric ne emus area with including the antola lateral zone of the leg and the pelvis. So you see the similarity there. With us treating the channels and then in western medical treatments, the slings.

So there’s a lot of overlap here. And again, going back to the similarities of who we are, both from Eastern West and the importance of understanding. Both the Eastern and Western I do believe that we’re in the right time right now to be able to bring the eastern western medicine together and to make a huge difference and improve the health of our patients by offering a lot more opportunity and options.

So thank you so much for today’s presentation. Thank you to the American Acupuncture Council for allowing me to be here. It’s always a pleasure. And have a wonderful day and take care of those slings. All righty, take care. Bye. .

of Eastern and western medicine. And I do firmly believe that integrating eastern and western medicine in today’s healthcare system is both multifaceted effort. It’s on both of our parts, Eastern and western practitioners.

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Acupuncture Malpractice Insurance – Neuromuscular Facial Conditions Part 1

So today’s lecture topics are I’m going to define a neuromuscular facial condition. I’m going to talk a little bit about the theory behind a multifaceted approach, and then I will talk about submuscular needling and scalp acupuncture.

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Hi, my name’s Michelle Gillis. I am an acupuncture physician practicing in Florida, and today I am going to be speaking to you about treating neuromuscular facial conditions. This is part one of a part two presentation. First slide, please.

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So this is just a little bit about me. I am a former faculty member of the Maryland University of Integrative Health, and I am currently on the doctoral faculty at Yo Sound University, and I. I have been teaching facial acupuncture classes internationally since 2005. Here are some publications that I have completed in the Journal of Chinese Medicine.

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So a neuromuscular facial condition is any group of disorders which can cause weakness or pain on one or both sides of your face, you might lose the ability to make facial expressions have . Pain, difficulty eating, drinking, speaking clearly. You can have ear pain, you can lose your sense of taste, smell, it can affect your eyes, your vision.

And you can also have the inability to sense heat or cold or be very sensitive to the heat or cold. What I have discovered over many years in practice is that using a multifaceted approach to treating these conditions, because some of them can be very difficult to treat, and using a multifaceted approach, can yield a more effective treatment than just using one of these modalities or the other.

Some examples of neuromuscular facial conditions is are Bell’s palsy, Ramsay Hunt syndrome, posis of the eyelids, and this can be one eyelid or both eyelids, synkinesis, which is when you’re trying to move one. Part of your face, but another part moves involuntarily. The side effects of a stroke TMJ Trigeminal Neuralgia multiple sclerosis, and there are many others I.

Part one and two of this presentation represents about an hour of what is usually a two-day class that I teach on treating neuromuscular facial conditions.

So the interesting thing about our face is that our face is the only part of our body where the skin is connected directly to the muscles, which is what gives the. Our ability to move the skin on our face without having to move any bones or ligaments or tendons. So here we have an example. We have skin, and then we have muscle.

And as you can see it, the skin is connected directly to the muscle and then down to the bone.

For example, here is a cross section of a part of the cheek, and you can see the skin and then the fat, and then the fascia and invested inside of this fascial layer is the muscle, and then there is deeper fascia and there is the facial nerve.

When treating the face, there are several things that’s, that are important and you wanna make sure you are increasing the blood flow to the area. I. Increasing the qi to the area and also if there’s any fossil adhesions that exist, that you can break these up because all of this can affect how the face moves and the sensations that we feel.

By using a technique called submuscular needling. In some instances it’s intramuscular needling, but submuscular needling can increase the flow of blood and QI to the area can help to break up any fascial adhesions. And if you are thinking in terms of . Cosmetic benefits. It can also stimulate collagen production to the area.

There are several muscles on the face, head and neck that are really conducive to this submuscular needling approach. And they are the auricular muscles, the temporalis muscle, the platysma, the masseter, the anterior digastric. The frontal, the proces, the corrugator, and the levator muscle. We are only gonna speak about a couple of those today.

And the using submuscular needling is part of this. Multifaceted approach. So in addition to Submuscular needling, we’re also going to talk today about scalp acupuncture, and then next time facial motor points, facial cupping and guha and derma rolling.

So here is another cross section of the face. And as you can see, the facial nerve is invested in this it’s called the SMA layer. It is the superficial muscular AERA system, and the nerve can become entrapped. And when that happens the signal that gets to the muscle, which in turn goes out to the skin, which moves the skin on our face, moves, the muscles in our face can become compromised.

So the first muscle I wanna talk about for Submuscular needling is the frontals and. The frontals muscle goes on either side of the eyebrows. There’s one head on one side of the eyebrow and one on the other. And what you would do is you would take, typically I do half inch needles and I would needle underneath the muscle.

And this is what it looks like here.

So when needling the frontals muscle, the way that you isolate the muscle is you ask your patient to raise their eyebrows. Go ahead and raise your eyebrows, okay? And then relax and you can find the border of the frontals muscle and the way that you needle. Is you’re going to go from the origin to the insertion.

So the origin is up here and the insertion is here.

And typically what I do is I will put in. Usually three needles

on the lateral edge, and I will put in two needles. On the medial side, and when you’re needling, what’s important is that the angle of the tube is the angle that the needle’s gonna go in. So if you go like this, it’s going to go too deep. If you go this is going to be too shallow, I use. My thumb or a finger to help to guide the needle.

So you wanna keep your fingers out of the way when you’re actually inserting. That way you can get to the correct depth right underneath the muscle. That’s the lateral side. Then you’re going to do the medial side, and usually two needles. Will suffice and I do the one side and then I do the other side and I’m using half inch needles.

You can use one inch needles depending on how big your patience forehead is.

The next muscle group. That I’m going to demonstrate for submuscular needling is the temporalis. So the frontalis is used to raise the eyebrows, and it’s also indirectly involved in raising the eyelids, the temporalis muscle, which is a large. Very thin, fan shaped muscle that’s on either side of the skull and it also goes in front of the ear.

It helps us with our chewing and it helps to, so it helps to elevate the jaw and it can be involved with conditions like TMJ. It can also cause head. Pain. If it is too tight, it can be involved in trigeminal neuralgia because nerves can become entrapped underneath the temporalis. I. And this is what this looks like.

So here’s the temporalis muscle, and what you would do is take needles and put them all around the outside of the temporalis. And I have a video for that as well.

So for the temporalis muscle. The idea is to find the outline of the muscle and it tends to be a very large muscle. It runs all the way from the back of the skull all the way around the front of the face. And you’re literally going to take the needles and you are just gonna work your way around.

The entire line of the muscle, and depending on how tolerant your patient is you can use, you can really thread like 20 of these into this area. I’m just doing a little demonstration here I want you guys to get an idea of what this looks like. And it doesn’t really matter which direction you’re going in.

What matters is that you’re getting, again, underneath the muscle and that you’re working your way all around the perimeter of the muscle in order to relax it. And they should have a nice little circle around. A muscle when you’re done, and this will really help to relax the temporalis muscle if they have TMJ.

Pretty much anything that affects the face. The temporalis muscle helps to pull the face up. I use this technique sometimes and facial rejuvenation when I teach my facial rejuvenation classes because the temporalis muscle can really lift up the face. I’m just gonna do one more again. I’m using serum one inch.

Needles. So that’s what that looks like.

So for the temper, the next. Technique that I use when I’m treating neuromuscular facial conditions is scalp acupuncture. Now, scalp acupuncture can be used and it is used traditionally to treat a multitude of. Conditions, everything from phantom pain to speech issues, to inability to move a body part.

But when I use and teach scalp acupuncture, it involves issues concerning the face. So when we when we would incorporate scalp acupuncture. We could use this in conjunction with submuscular needling or as a standalone technique, so any conditions that involve the face scalp, acupuncture can be very effective.

I. Especially when you’re dealing with a condition like trigeminal neuralgia where it’s very painful to needle directly onto someone’s face, you can use scalp acupuncture and this will treat the face without having to directly put needles in the person’s face. So here we have a cross section of the scalp.

We have the skin, we have the close connective tissue, and this is very heavily vascularized with lots of nerves. Then we have the aosis. Right below that is the loose connective tissue, and this is where you would want to insert the needle. Right below that is the perran and that is the skull. The good news is that when you’re trying to find the right depth to needle, if you just go down as deep as you can along the bone.

Then ’cause it, you, it is impossible to put an acupuncture needle through someone’s skull bone. You can needle right along the bone and if you get into the loose connective tissue, it will not be painful. If you go into the close connective tissue, you’re going through vessels and nerves, and it can be very painful.

So the thing that can be the most important thing to learn when you’re learning scalp acupuncture is how to measure. So the, you’re basically going to, these are not acupuncture points. These are areas of the. Scalp that affect different areas of the brain. And the way you measure is you’re going to get your horizontal and vertical planes, and then you will find the area of treatment based on that.

So the first landmark is from the glabella to the occipital protuberance, and the glabella is at the midpoint. Of you’re gonna get to the glabella is between the eyebrows and you’re gonna measure back to the occipital perturbance. And this will give you your line this way. And then you are going to find the midpoint, and that is the midpoint of the midline.

And if you go a half a centimeter. Behind the midpoint, that is where you’re going to be drawing a line. Right here. So you’re going to find the midpoint of the eyebrow and also go back to the occipital protuberance. And when you go back 0.5 centimeters, you’re gonna draw a line that intersects just like this, and you’re gonna break this up into three sections.

So the lower two fifths. Is this is where you would needle for concerns of the face? The upper extremities is the . Middle two fifths and then the upper one. Fifth is the lower extremities. So the lower extremities are the legs, the spine, the trunk, and the neck. And the upper extremities is just the arms and the hands.

And this bottom two fifths is the face. So this is the area that we would want to needle.

The technique for needling looks like this.

When you’re needling the scalp, it’s important to angle the needle properly so that it goes into the loose connective tissue. I like using a tube. You can freehand if you’d like, but I find that the tube helps me to guide the needle to the correct depth. I tap the needle in, remove the tube, and then I use my free hand to guide the needle

if the needle is improperly. Your patient should not feel any pain. So you’ll know that you’re into the loose connective tissue. If your patient doesn’t have any pain, when you needle, once the needle is in, you stimulate it gently for 30 seconds just like this. Or you can use electricity.

So that concludes our lecture today. So we covered Submuscular needling and we covered scalp acupuncture. Next time we are going to talk about facial motor points, facial cupping, GU Shaw, and derma rolling, and then some protocols for specific conditions. And I look forward to seeing you next time.

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Acupuncture Malpractice Insurance – An Associateship vs. Starting a Private Practice

And so we’re gonna go over the idea of employment versus private practice. And so I don’t mean just employment as employment in a hospital.

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Hello, and welcome to another episode of To The Point. I am Dr. Nell with American Acupuncture Council. Let’s go to the slides.

So today we’re gonna go over a topic that, again, every time I bring these to you guys, there seems to be a theme where many people are coming to me with these same questions. And so we’re gonna go over the idea of employment versus private practice. And so I don’t mean just employment as employment in a hospital.

We could talk about . Contract work synonymously. Really the idea we wanna dive into is the idea of growing your own business versus being a part of someone else’s business. And what are some of the pros and cons there? What are some of the considerations and things we need to go over? Why this is such an important topic to me is I have done all of these different variations of this.

I’ve done the cash practice, the insurance practice, I’ve done contract work worked in a medical facility, been part of a group practice, . There’s many different ways that you can build your career in this profession, in the clinical space, if maybe this’ll be a future one that we do. Talking about all the other different revenue streams you could potentially have, and ways that you could make impact or be employed in this industry beyond the clinical space.

But today we’re really going to hone into the clinical aspect of this. So with that, what are we thinking about today? What’s the considerations that we wanna have? We wanna talk about the risk reward ratio. . There’s nuances with that. If you’re on your own versus working for somebody else, same thing with costs.

The costs are gonna be drastically different. And even within those two different options, they’re gonna be different cost considerations, and then the benefits comparison, because of course, whatever decision we make, we always wanna be coming from. A really informed place and making decisions out of having substantial information rather than making a decision based on, oh, insurance feels complicated.

I don’t wanna deal with that. Or, I don’t know anything about owning my business, so I’m just not gonna do that. So we wanna look at what’s the benefit for us but also what are those risks, those costs, really the overall considerations that we need to have when making this informed decision. So let’s look at the risks and the rewards of both of these options.

Like I said, in that employment independent contractor piece . First and foremost, you wanna have malpractice insurance. Whether you’re working for yourself or you’re working for somebody else. You are gonna have the flexibility of how you manage risk when it comes to your own private practice.

You’re gonna have a lot of autonomy when it comes to deciding what is your environment going to look like? How am I going to control all these different variables around me? You’re not worried about, . Potentially other providers causing issues or sharing patients. If it’s you get to make the rules, right?

You also get to make decisions around what type of malpractice coverage you’re going to have. The limits. If you are working for somebody else, they are going to make a lot of these decisions. So that environment, if it’s a shared environment, you are not an autonomous entity there. I’ll give you an example.

When I first started my practice in Beverly Hills, I was sharing a medical space. So it was amazing for a new practitioner because I was in an environment with a neurologist, a chiropractor, massage therapy, Ayurvedic care nurse practitioners. Really loved that multidisciplinary approach. However, . We shared a waiting room.

We shared office staff, and even though we were all running our own businesses . When Covid happened, there were certain risks and, rules that were in place. And I got really concerned that, okay, what if these other providers aren’t following the rules? Could I get fined? Could I get in trouble?

And so there is an additional risk at having this multidisciplinary kind of space and not having that autonomy over your own space. Also, if you’re working for someone else let’s say you work at Modern Acupuncture. . They are going to determine what your limits of liability need to be. The the type of policy that you need to have.

They are going to have the setup of their physical space, right? So you are not going to have a lot of decision making power when you are working for somebody else. There are things you can do. Of course, you’re gonna be practicing clean needle technique. . You’re gonna make sure that you keep your risk as low as possible.

But at the same time, there’s only certain things that you can control when it is not your space. The rewards of that though, we’re gonna get into, and some of that has to do with the cost. So let’s look at that. It’s very interesting to me that, over 90% of acupuncturists are sole proprietors.

So running our own businesses going out on our own functioning as entrepreneurs. And yet, like 2% of our education is focused on business training and most small businesses fail within their first few years. . There is something really interesting about how that is set up and certain realities that we need to be aware of with that.

And cost is really one of those. So when you’re looking at the cost of starting your own business now, yes, we are in an industry that has pretty low overhead. We don’t need a lot of expensive equipment to get really dramatic results for patients. We need our needles, we need our basic tools. For CNT, we need a treatment table.

If you’re doing community acupuncture, you might not even need a table. You might need chairs. So there are ways to offset a lot of this cost. You can share space when you’re first practicing. You can rent a room, so you are operating as an autonomous entity, but you’re minimizing the cost of your initial investment in your practice and how that looks.

Obviously if you’re working for someone else, a lot of that might even be taken care of, that already low overhead could get even lower. So I had done an employment agreement with another acupuncturist when I was first starting, and I worked with him two days a week, but. He paid for all of the supplies.

He was, doing all of the insurance billing. He had a scheduling software that he was paying for. He had office staff, so all I was doing was showing up and treating. And so when we think about cost, we also wanna think about what does that mean? For what it’s potentially costing us as well, right?

So if you are operating in your own business, you get to determine what that fee schedule is. You get to determine what your take home from your business is going to be. Whereas if you’re working for someone else, you’ll see a lot of these jobs advertised online and sometimes it is nowhere near what you could make in private practice.

And that’s because. This entity that is employing you or contracting you is taking on not only a lot of that risk, but the cost as well. And so they have to offset that in some way. But I do really wanna talk about the benefits because this is going to look a little bit different depending on not only like what your risk tolerance is, what your interests are, what you genuinely want to spend your time doing.

So like I mentioned with private practice. You get to determine what your fee schedule is. Nobody is making that decision for you. You can do your own market research. You can say, I’m going to have a relationship based practice and I’m going to go out and make friends with other healthcare providers and make sure that I have a ton of referrals coming in and I keep my patients really happy.

You could have a FI high volume insurance practice where you are in network with a lot of companies that are essentially . Pre-qualifying people for you who are on those websites looking and saying, oh, hey, I’m interested in acupuncture. Where is there an acupuncturist in my area? So that flexibility and the autonomy that you will have in private practice is really your major benefit.

You get to make. All of the decisions that for some cannot feel like a benefit at all. Some people, and I would venture to say a lot of people in our industry did not get into this medicine to run a business. They are not interested in being entrepreneurs. That is not, top of mind. It’s that they wanna be incredibly cli, clinically competent, which most acupuncturists are who are licensed and they want to deliver incredible patient results.

And that’s what we like to do, right? The benefit of working for someone else, when you give up some of that autonomy, you get back a lot of that focus on being a clinician. So I loved at that point in my career, when I was first starting out for two days a week to be able to show up in an office and just treat and have a full schedule and never worry about recruiting patients or what the overhead was, or was my, business license renewed.

Did I pay my taxes, did I get my articles of incorporation in ? All of those things were taken off my plate as an employee as a contractor as well. Like I’m not worried about those things. I get to show up and do what I wanna do best. So when we are looking at . The benefit analysis here that is going to be highly individualized depending on who is looking at this.

I personally see so much benefit in running your own business and getting to determine what your marketing strategy’s gonna be. Who are those partners you’re going to bring in? . But a lot of people might not feel that way. I have a provider who works for me in my practice, and she is incredible.

She’s been licensed for 12 years and she, the entire time has only been interested in employment opportunities or contract work because she is very clear that she wants to spend every hour possible in her day. Focusing on patient care and treating patients, and she has absolutely no interest in running a business.

So looking at benefits that is highly individualized. There are certain things that you’re gonna say, oh hey that sounds really good to me. That will not sound good to somebody else. So just like our medicine is so highly personalized, this decision is as well. But I think the important things with this to remember are you have tons of flexibility.

. You get to decide if you want to only run your own business, if you want to work for someone else, if you wanna work with someone part-time. If you wanna have multiple locations, that is a really beautiful thing about not only the personalized aspect of care that we have, but the personalized aspect we can have with our clinical setup and the way we deliver that care.

It’s very important though to know your state laws. So for example in California it is very difficult to contract people. A lot of those laws were built around trying to protect independent contractors like Uber drivers that type of thing. And. The side effects of that have permeated into the healthcare delivery system.

And so you need to be knowledgeable about, okay, am I even allowed to have independent contractors? Am I allowed to be an independent contractor? If I’m an employee, who do I need to be employed by? Another California example you need to be employed by a professional corporation. So if you don’t, your employer doesn’t fall into that category.

They’re not supposed to be employing you as an acupuncturist in that state. So there is nuance there and workarounds for all that too. That’s where the flexibility comes in. That’s where talking to an attorney comes in. That’s where talking to me, letting me guide you and send you to the right people to help with this setup.

And the last thing I wanna end with is that. As a, not only a medical provider, but a provider of acupuncture and traditional medicine who is working in such a highly specialized area of healthcare. yoU are your business. So whether you are, presenting yourself and saying, Hey, like I have my private practice, but I also work here and I work here and I work here many times, we become the brand for our own entity.

People are drawn to you a lot of times, even more so than the medicine. People get very attached to their providers, and so while that provides a lot of . Flexibility. There’s also a ton of responsibility that goes along with that, and I think that’s, I wanna link that back to the risk management piece at the beginning that we really need to be mindful of.

Because even if we’re out there, we’re, posting on our own personal social media, we’re still representing ourselves and our business, whether we are employed or whether we are practicing independently. I love talking about these different options. I’ve been able to help a lot of providers navigate that landscape that’s my happy place.

So please feel free to reach out. We definitely have the risk management piece covered, and don’t forget to tune in next week for another episode of To The Point. Thanks for tuning in. .

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Acupuncture Malpractice Insurance – Weight Loss and Menopause Part 2

this is part two of Menopause and Weight Loss

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Hi, my name is Tsao-Lin Moy, and this is part two of Menopause and Weight Loss. This is a really important thing and what makes Chinese medicine practitioners acupuncturists different from a Western model is we’re not looking to fix them. We’re gonna help them . To get a better grasp on how their body actually works.

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We can help them understand from that perspective of how to get themselves into a place of balance. For, again identifying the constitutional type, the yin and yang within the body constitution plus . What else is going on? How are they eating their environmental stressors? We can’t be there all the time.

So these are things that they’re gonna have to identify and then work with. So body and fluids are really . Believed to be derived from food and drink, and they serve to nourish and warm the muscles and the skin and lubricate our joints, right? And they also surround our brain. This is really like something to not just address with herbs, but really incorporate dietary recommendations.

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So I just wanna give like an example of one of my patients she’s 52. I actually treated her 20 years ago. So I really know what her constitution was when she was younger. Was a very, let’s say lung, large intestine, stomach, spleen type. She had chronic constipation, a lot of weight on below, right?

She was and why I say lung, large intestine is she emotionally was dealing with like trauma from her childhood, like grief, loss of a parent. And then also like holding on to. Things that weren’t really true, but as a child she believed them and she was also very damp ’cause she had a lot of squishy fluid.

So recently she came to see me and after, having kids and then she had moved to the south very damp and hot where she was which was not great for her constitution. So this is also, we look at . Seasonally, you can figure out someone’s constitution also, like how they are seasonally, what do they prefer?

How are they’re a lot better. Some people are perfectly fine in a hundred degree weather and 90% humidity. I’m not one of them. But some people even will need a sweater. They’re very dry and they are always cold and they, so the heat and the moisture they love so working.

So she’s been working a lot and stressing, her main complaint was this weight gain and swelling, right? That she was starting to swell. She was having frequent urination, but she was still . Gaining all of the water. So she, was working a lot high cortisol overall not getting enough sleep.

And especially at night, this is this circadian rhythm. And again, going back to women have a cycle, men too, right? If men don’t sleep. At night, it’s actually really affects their fertility and their sperm production. So we are creatures that need to be much closer to nature.

So when someone’s not sleeping, then we know that’s also, they’re off balance. And so strategy, because she’s in menopause, I was looking, both her yin and yang were diminishing though, not at the same rate. So lots of water. In her body. Am I thinking kidney? Yes. Because of her adrenals.

And also that the jing is depleting and her constitution. But also from a five elements perspective. The water is not nourishing the wood, so she was . Had this liver defic deficiency, right? Because liver is involved with the blood, it’s involved with the uterus reproduction, it’s responsible for the smooth flow of qi and blood and our emotions.

So really, the strategy was like, okay, how can we address this simply, right? Because when the body is in a state of fluctuation, you wanna have a clear direction. To the body. So the more complex a person’s symptoms, then the more simple you want the the treatment to be. The first order is how can I bring this person into balance?

How can I help them so that then their body is going to heal, they’ll balance out, and then they’ll get stronger and they can at the same time make adjustments. So in terms of let’s say the strategy . With acupuncture. So this is where you’re, we’re looking at what methods do we have? We have food, we have acupuncture, we have herbs, we’ve got some cupping.

We’re doing a, we’re checking constitutionally and where the person is, we have teas as well. Okay. So in terms of . The strategy for this person, and I think this is something that is no matter what you can you’re not gonna do any harm with somebody is to look at source points and also shoe points.

So for this patient really my focus was, spleen, spleen three, liver three, large intestine, four combination, like kind of move, get things moving adding in spleen nine or seven for all the dampness. CV nine for that fluid. So fluid accumulation. Also dimmi because a lot of the fluid was below.

So like sitting in water. Kidney seven. Which actually goes to Dai. So really, and then according to Kiko, Matsumoto style, really like looking at stomach chi, which is, finding the points. And that’s around stomach, 36, 37, 39. So really looking at the stomach, the large intestine, small intestine, because we are looking at digestion right now in terms of food.

Warm foods, . For someone who has the damp, we want warm and like gentle dispersing. So I always think of something like a little bit of cinnamon. So that actually increases a little bit of the peripheral circulation and it’s actually warm. It’s also great for someone who might be, have a difficulty with sugar metabolism and maybe even pre-diabetic is, that’s actually something that can be incorporated, in addition. Looking at excellent probiotic with your patients. You also want to look at dietary adjustments. These are absolutely a must and a kind of detoxification support, whether it’s lymphatic. Some different kinds of foods to clear out to help the system release metabolic waste, let’s say.

And also, oftentimes in menopause with lower estrogen, there’s an increase of what is known as the non-alcoholic fatty liver, which is an means that there is this weight gain because the liver is not able to process, right? So everything gets backed up. In terms of formulas, basic formulas, I like ones that are less than 10 ingredients.

And again, because we’re looking at . The perimenopause menopausal state is in fluctuation, so it’s not that stable. So you start adding a lot into the mix. Then what happens is that you’re sending mixed messages. So better to go simple. I love like jwe shaan, right? The shaan for someone who has a spleen, like kinda worrying.

Type of personality Ong or Swan again for yin and blood deficiency. And this is this recent research with Iwe to and Shan Ma Huang, which are very close was actually used for premature ovarian failure they’re looking at. So it also gently nourishes the yin and the blood, and so

Nothing wrong with, possibly adding those formulas if you know your patient and you also know herbs, right? So we don’t wanna just give herbs based on formula based on a protocol only, right? We need to do a good diagnosis. Okay? So in terms of food and diet I cannot, emphasize more.

This is where the gold is. Your patients absolutely must make changes. It’s really if they’re not willing to do that, then it, it be, it’s you’re constantly battling, right? . So things like eating fresh and organic, primarily plant-based, ’cause it’s a lot cooler and nourishing. I didn’t put it in the list, but in season.

And this is also a way to be in the cycle of the season and also have the body go with the season, right? And also the food is much more nutritious because you’re gonna it because it is actually gonna have a higher nutritional value to it, right? No diet drinks or artificial sweeteners.

One of the traps for women that are trying to like they’re trying to lose weight is that they start looking for diet foods and things that are zero calories or fat free and things. But that actually is very problematic because we do need fats and in fact, because. We are becoming yin and blood deficient, that it’s really important that we have fats and eating foods like a bone broth, right?

Or even marrow stews. That are gonna be nourishing. We can add in even the the dots out, the jujube beads. Really looking at more of like kind of medicinal soups and we really. Getting about it too, right? Gluten and dairy can be very inflammatory. And even when my patients say I’m not I’m fine with gluten I really encourage them to maybe

Try to limit certain foods or to do something called food combining. And that’s a strategy where if you’re gonna have a starch, then you eat it with like leafy green or leafy green with an animal protein, but you don’t eat like animal protein with a starch because that changes the absorption and the sugars the way we digest.

Alcohol. And so these are things to look into and I would actually encourage you to try them yourself, right? The best is if you’ve experience, you can also share it. The other thing too is you can decide, Hey, for all of my . Patients that are in their forties, fifties, and going through a change.

Let’s do it together. Let’s do a sleep work on our sleep, let’s work on eating more vegetables and fruits and stuff and really, come up with recipes and stuff to get involved. I think if you’re involved with your patients and you’re excited about it, that you’re gonna have a better outcome for them.

And always the idea is to teach them, right? Alcohol, preferably none. Alcohol is not. Good . It reduces the immune system. It causes inflammation. Actually, yeah. I know there’s maybe some, that’s something that people will have to make a, make decide to do that, right?

There’s plenty of evidence that it’s not really great and can cause inflammation. So why do that? And again, oh, and I mentioned the food combining. Okay. And let’s see where we are. Yes, here’s some wonderful food. One of the things that is really useful is to certain kinds of foods are can help with hormonal health, so things like seeds. One of the strategies for, for the menstrual cycle is something called seed cycling. And then using the four phases of the menstrual cycle to then have flax seeds, pumpkin seeds, sesame seeds.

So these are things that you can actually. And encourage. I would encourage, because again, even though like I showed in the very beginning of the slides that the . Period is ending, the cycle is still going on underneath. And so being able to look at the cycle and nourish according to where the cycle is going to make a difference.

So once you find, it’s like when you find the wave, then you can ride the wave. If you don’t know where you are on a wave, you’re gonna be tumbling and be pulled in the current. Okay. And then, okay, so this last of heart, and this is teaching your patient self-care. Now here’s the thing, consistency and commitment is gonna get a result.

And so I know oftentimes patients say how many times do I need to do it or how long before it will happen? And really everybody is different, but one thing is certain they need to commit to make that commitment and have the consistency and really look at like when do they give up? Sometimes they just give up or it’s too hard, right?

But the thing is you know, that’s where we can help and coach them through and encourage them so little wins. Let’s say they, stop drinking diet. stuff we need to say great, how long are you doing it? Helping with a mindfulness practice, this is a really big thing because stress is going to increase cortisol.

It’s gonna cause sleep problems, it’s gonna cause more problems with weight. It’s gonna interfere with hormonal balancing and emotional stability. And so having a mindfulness practice, . I encourage doing breath work. I do it every morning. I do Wim Hof breathing and I’ve done GR technique. And really what does breath work do?

It helps you with your nervous system but also when you do breath work, it actually pumps your lymph, right? It actually supports your organs, and this is important to get. Of the inflammation and move the fluids. Sleep hygiene again making sure to go to bed at night. Really important is get off of the phones.

Stop with the Netflix and the videos and the Instagram and the Facebook, even though we’re . On Facebook to really stop that because it actually interrupts our brain patterns. It also creates a lot of anxiety and a lot of worry. And then on top of that, we’ve got cortisol and the stress, and that creates more of this like cycle of doom and gloom.

Exercise and movement again to move the chi in the blood. Not overdoing it, but really looking at what is the purpose is to increase the blood flow, tone the muscles. And it could be used as a practice drainage, again with the breath work. But also I encourage teaching your patients how to actually do a little lymphatic massage on themselves or even to get some body work for that.

And then again making the dietary adjustments such as preparing food themselves. And this is something that. You can offer to your patients in your newsletter or in your posts, some healthy recipes. Again, you can decide to do, a campaign maybe in January as we’re coming up on the people making resolutions or even maybe before start, before, since we’re heading into Thanksgiving and Christmas and all the cookies, et cetera, et cetera, to really start creating things as tools for them.

This is the end of the presentation. If you have any questions, please, to put them in the chat and we can get back to you. Thank you.

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Acupuncture Malpractice Insurance – Using the ICD10 Updates for 2024

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Greetings, everyone. The coding and billing expert is here. Sam Collins, the American Acupuncture Council is your partner in success. The network is the other step of that. How do we help you? We make sure you’re getting paid for what you’re doing, and I don’t care if it’s insurance, cash or otherwise. One of the things to get updated on, of course, is diagnosis.

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As you’re well aware, diagnosis actually update every year, but here’s a riddle for you. When do the 2024 diagnosis codes update? You’re thinking, actually they already did diagnosis codes always update on October 1st, the year prior. So really the answer to the riddle is the 2024 diagnosis began October 21st.

Of 2023. What’s important to note though, is yes codes update, but do the codes update that are important to us, meaning the ones that you use regularly. So let’s talk about that. Let’s go to the slides. Let’s talk about what is going on for 2024. In fact, right now, what’s happening with ICD 10? ICD 10 is our coding system.

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It’s what we use to communicate what’s wrong with our patients. Now, you might say, SI, I don’t bill insurance. I don’t need to know a code. You better know a diagnosis. Whether you’re putting the code down or the diagnosis, it should be accurate. So by example, if I were to say someone has neck pain, that would be okay.

What’s another way of communicating that, whether it be a super bill or a 1500 claim form is AM 54 2. realize every code is universal. That I don’t care if you’re in China, if you put M 54 2, they know you mean neck pain. So we always have to use coding to make sure we have the best and most appropriate coding for what is wrong with our patient.

Diagnosis matters. It really is. What is wrong with your patient? Now, some of you might say Sam, I can’t diagnose in my state. If that’s true, although I’ll say some of that’s not quite, someone comes in with pain. You can say they have pain. You’re not differentiating it, you’re just saying pain.

But what diagnosis is what’s wrong with the patient? Why are they there? Now, what I love about acupuncture is the simplicity, but the genius of the simplicity of acupuncture. What does the body always communicate when something is wrong? It always tells us one simple thing, I’m hurting. I’m in pain. I don’t care what you have.

Pain is always gonna be part of that, so keep it simple. Pain is gonna be fine. For the most part though, we can go beyond that. That’s not all what man? Acupuncturists treat lots of things. Like by example, if you’re treating with someone under the insurance eviCore, they’ll pay for strokes. They’ll pay for menopause, they’ll pay for anxiety, depression, anorexia.

So there’s a lot more beyond. Acupuncture now is being recognized to do much more than just pain management, though. Pain management is a very popular thing to do. It’s not all that you do. So have to remember when we’re talking about coverage. Coverage for some insurances may be limited to pain. But it can be, go beyond that.

Here’s a couple of offices that just put up signs in front, and here would be a thing I’d have for you is do people know what you do? Like I drive by an office that says acupuncture. Great. So when you just put that up, what are you expecting? That I know Something that no one’s ever taught me. I. You’re hoping.

So here’s two offices that let people know what they treat. Notice this one is fatigue, stress, tension, anxiety, depression, so on it goes all these conditions. The other one even indicating like Bell’s palsy, start to think of, we’ve gotta educate people what you do, regardless of how you’re getting paid, whether cash or otherwise.

We have to tell them what we do. And every one of these things has a diagnosis. So that way, even if you’re in all cash office, can I give them a Super Bowl with a diagnosis to make sure we can potentially get the best possible payment by example? Here’s for Aetna. This is Aetna current. This is gonna change after first of the year a little bit, but right now you can see this is what Aetna covers.

Now what’s really interesting here, you’ll notice it says these are the codes that Aetna covers if the selection criteria is met. But then it says, not all inclusive. You know what that’s really saying? These are the codes we pay for sure. There’s others, but we’re not gonna tell you. But I would say, look at this and start to pick up.

Notice it says Migraines. So it covers migraines, but if you notice, you dropped out other types of headaches as well. Then back pain, hip pain. In other words, I’ll tell you, they cover pain, but more than beyond that. So it’s a matter of knowing do I have the right code? Here’s what’s happening with ICD 10.

We have to know that diagnosis code has to reflect what we’re seeing. I would say the most common codes, pain symptoms and signs, they’re acceptable. Probably the best payable codes often, but we have to know. Wait a minute, Sam, you’re talking about an update. I know. I. So let’s talk about the updates. Every year there’s an update and as noted, the ones change for this year, October 1st.

Now, frankly, I will tell you I’m very acupunc centric when it comes to this. I really don’t care about things that acupuncturists don’t manage, treat or get paid for. So if you told me something about nephrology, I go that may be an issue, but I’m not gonna worry about that change ’cause it’s not a code I’m probably going to be using.

So this year there were a lot of updates. You’re thinking, wow. We have 73,000 diagnosis codes. Think about that. There’s that many conditions. Yep. Now, let’s be mindful though. How many do you commonly do? I’m gonna say most acupunctures probably code 10 to 15 things. And it’s because we see a lot of the same things, or you specialize.

So we have to make sure are the things that I treat changing. So there are 395 additions, 25 deletions. What has changed that I can see that might affect you? Here’s one. Migraine. It was first on the list for notice. Now we have codes that indicate chronic migraine. And I know you might be thinking, Sam, there’s always been a code for a chronic migraine.

No, there hasn’t. There actually has not. There’s been codes for migraines, never identified as chronic. Now, what does chronic.

Chronic mean. Honestly, from a pure coding standpoint, chronic means a condition that is lasting longer than you would expect for it normally to be gone, or probably in simplest terms, 12 weeks. So a person that’s had migraines off and on for 12 weeks or more. It’s probably chronic. In fact, I would make an argument that most people that get migraines, they’re probably recurrent.

So I’m gonna jump in and say maybe most migraines, unless this is the first time the person ever had it, is probably chronic to an extent. What I’m pointing out there is just a way of coding it. Are you paid for migraines? You bet you are. Now, can you code headache? Instead of migraine? No, I guess you could, but I want you to think for a moment.

Let’s talk about insurances like an As, H or others. If you’re requesting 12 visits for headache, I doubt they’re gonna give it to you. They’re gonna think, come on, it’s a regular headache. Treat ’em a few times. But what if you code a chronic migraine? Does that set up something a little different? Think of a person with simple back pain.

That’s how you say it’s back pain. But they actually have . Disc bulging with radiculopathy. That is painful, but is disc. Disc with radiculopathy more serious? That’s a patient probably gonna treat for months. Here’s the idea. Give me the code that best describes what’s going on with the patient. So is this a big deal?

No, but it’s one to add to your arsenal. How many of you have a common code list? How many of you have been to American Acupuncture Council? Our network seminars, we provide you with a list. Of all the codes that are payable by insurance and in fact that list is further divided into which insurances do pay for some, which ones don’t pay for some, a good way to look.

But nonetheless, this is added to the list. They’re definitely covered. What else has changed for this year? Remember last year, not any big changes, but the year before, remember the back pain code change and you had all that back and forth. I’m gonna give you a quick tip. If you are billing a Medicare Advantage plan.

And your coding back pain, which of course that’s what they cover. It must be M 54 51 or M 54 59. Do not ever use M 54 50 for back pain. When it comes to anything related to Medicare, and I’m not talking just regular Medicare Part B, but I’m talking the advantage plans that pay you directly. This year migraine codes changed, but notice this code for Parkinson’s.

You’re thinking, oh, come on Sam, Parkinson’s. I won’t say acupuncture treats Parkinson’s directly, but what do Parkinson’s patients often have? Painful and stiff joints. Back pain. So I would look at this as being a comorbidity. I’m not treating it directly, but a Parkinson with Parkinson’s may have more need for care.

I’m not saying treating Parkinson’s at all, and I’m not saying I’m really worried about this coach, but should you be aware, will a Parkinson’s patients have some different issues if you’re dealing with an ASH and you’re requesting extra visits. These type of comorbidities are actually what they pay attention to that, oh, I see why this person needs a little bit more.

What about osteoporosis? M 54 51 is a code that indicates back pain. That’s vert, progenic. Might a person with vertebral genic or osteoporosis be part of that? Here’s some new codes for that are gonna be related to the pelvis. Now, again, I’m pointing out, you’re going, Sam. Do I really care about these?

Probably not in the sense of directly, but indirectly. Think of you’re treating the human condition. If it’s manifesting with some pain. There’s always a way to do that. What I’m concerned about though is what were the changes this year? Migraine. So if you don’t have an UpToDate list, you may want to get one.

Come to the American Acupuncture Council, the network. If you’re part of our network, if you come to our seminars, you get it if you have malpractice through us. Thank you. Malpractice is separate. If you come to my seminar, it doesn’t give you malpractice coverage, so we wanna make sure you have the right codes.

In an up-to-date list of information this year, are there any earth shattering changes? No, I would say not, because it doesn’t change codes that you’re already existing, that you’re doing. It’s adding some. So make sure, do I have the right and proper ones to identify what’s going on and what if they’re coming in from someone else and bringing that diagnosis.

I gotta make sure I have an accurate diagnosis and one that’s payable by example. Cigna has a different list in Aetna, which is different from United, which is different from progressive or other types. So keep in mind, know your coding, know where your payment’s coming from, the AC, the network. We’re always here to help you, but here’s one that’s interesting.

This one may not help you much, but this will be a fun one. At parties, there’s a diagnosis for everything. Do you know there’s a diagnosis for being a bad parent? The parent that’s hovers over the person too much that’s always there and always interferes in their life. That’s actually AZ 62.1. I.

A parent who is never there is AZ 62.0. So you can in a way give a person a really bad, or I won’t say a compliment, say something bad about them without them knowing it. But here’s an interesting, whenever you ever have a friend or family member that works in a hospital and they come home and can be like, oh my God, in the emergency room last night, this person came in, you’re not gonna believe what they put inside their body.

There are diagnosis codes for foreign bodies entering a natural orifice. These are all new ones. They’re in the W section. I want everyone to just give me a moment to think. We have a code that talks about you’re putting a battery or a button bat. So a decel or a button battery. A plastic object, A bead, a coin, a toy, jewelry.

And here’s what I find interesting. There’s bottles. But here’s the, I just find glass or sharp glass. And I guess there is a difference. There could be, nons, sharpp, glass. Here’s my point. Coding can be fun. You ever wanna say something bad about someone? There’s a way of coding it. What I’ll point out is there’s codes for everything.

So if you’re seeing something, trust me, there’s a way to code it. What I’m concerned about, is it something that is under acupuncture’s purview? Is it something we get paid for? And if it is, we wanna know it. The American Acupuncture Council, as I said, is your partner. The network is always here to help with that.

I hope to see you at a future seminar. Come January or at any time, become a member. Let me be part of your staff. Go out and do well. I’m wishing you the best. Code changes for this year. Don’t start in 2024. They started in October. Make sure you update your list, everyone. Until next time, take care.

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Acupuncture Malpractice Insurance – Weight Loss and Menopause Part 1

So today I’m gonna be talking about menopause and weight loss. And this is really menopause is, we have a 50% of our population is female, and we’re, heading into a larger . Portion of a population is gonna be over 40, over 50, moving into this phase of life.

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Hi, my name is Tsao-Lin Moy and I’m a licensed acupuncturist and herbalist with a brick and mortar practice in New York City at Union Square. so I’d like to first thank the American Acupuncture Council for having these opportunities to speak about topics of health that are very important to us as practitioners.

And also to our patients. So today I’m gonna be talking about menopause and weight loss. And this is really menopause is, we have a 50% of our population is female, and we’re, heading into a larger portion of a population is gonna be over 40, over 50, moving into this phase of life.

We’ll go to the slides. Okay. So this is weight loss and menopause, like how to help your patients with the menopausal weight game. Lemme go here. Okay, so the key topics that I’m gonna be talking about is we’re gonna do a little review of yin and yang. Really what’s happening. I’m gonna talk about constitution.

I think we often forget to look at our patient’s constitution look at some treatment strategies a little bit about acupuncture, herbs and supplements, and diet, which is gonna be really important. And . Self-care, right? So if your patients are not involved in their health and taking care of themselves when they’re not seeing you or they don’t have homework or something to do, then oftentimes they end up quitting or giving up or just deciding they’re gonna take, drugs or, go on some crazy weight loss diet.

Yin and yang again, is something that is a dynamic balance. It’s not yin or yang. It’s really yin and yang. And women are relatively more yin, right? And in this, picture, it’s, it is the four stages of a menstrual cycle. So women’s biology is actually very cyclical, with, it’s known as a moon phase.

And so even when women stop bleeding, they still have a cycle. And so it’s really important to recognize that women’s biology, . Their cycle is very different from a man’s. It’s not the same. It’s always going through, um, a a blood phase, a yin phase, a chief phase, and then again, into the yang phase, right?

And so even though the bleeding may stop, there is still this phase. And so what often happens is this is a slide that looks at . What is happening with the hormones? So if we look at, pre menopause and we look at post menopause, in the end, both the estrogen and progesterone are going to end up being like the relatively in the same position except for less, right?

So women are relatively more yin, and this is because . It’s part of our physiology is making blood and being able to hold onto life, right? So always as we head towards menopause, we’re looking at, we’re losing the yin part. And so when we have the hot flashes, this is relative yang, but overall both yin and yang are starting to decline.

So the hormonal fluctuations actually cause . The hot and cold flashes, interruption of the circadian rhythm, like sleep interruption of the result of yin and yang kind of trying to stabilize uh, blood deficiency results in more yang excess, but it’s really relative excess. But not like from abundant young, right?

So you can have someone . Who’s hot? A woman will hot flash, but she always gets cold, hands and feet. So we’re really like looking at this kind of circulation. So this is just a little bit of a review. So what happens is this. The dynamic balance becomes a little bit unstable. And so what we can observe is that when this yin declines, it can’t balance the yang.

And that’s that experience, the hot flashes, right? And the night sweats. So losing more of the yin. And eventually though, as you can see in the slide, that the hormones, the yin and yang kind of balance out. But before that, it can be extremely uncomfortable. Now, for menopause complaints, what I’d say hot flashes really at the top.

Weight gain, skin and hair insomnia, usually from the hot flashes. And the ups and downs are also showing. But for the most, what I’ve found, and I’m guessing that. Because there’s the media, because there’s this aspect of we always have to be thin, that when women start to gain weight it’s very upsetting.

wOmen are always trying to lose weight, stay fit, look good, and then as we enter into this particular phase and our body starts to feel a little bit out of sorts, and then all of a sudden what’s happening is this weight gain, and especially around the middle. Weight gain is in general, I would say a sign that there’s something systemically getting blocked or backed up.

There’s also going to be inflammation in the body as weight gain is office excess fluid. It’s often that and fat that will store waste. So when we have metabolic waste or a lot of chemicals, what’ll happen is our body will try, will store it, convert it into fat, and oftentimes it’s going and especially hormonally.

So if as with women are doing fertility treatments and they’re injecting themselves with all kinds of hormones that they tend to gain a lot of weight around the middle. . This is also due to stress, but it’s also due to the fluctuations of hormones. And then there’s this metabolic waste, or we can call it like turbidity, right?

That’s in the system. So one of the things is that you can also be a endocrine problem, such as thyroid. Or fatty liver, which is also metabolic. But for sure we know that this is part of the digestion because this is postnatal, the digestion is gonna be involved, right? So it’s not just diet, but it’s also

The ability to absorb food nutrients and then make the hormones and make the blood, and make the fluids so for the skin and the hair, right? So all of these things, so we’re looking at. We have our jing, or our Jing that we’re born with which is kinda like a blueprint for life.

And then as we develop, our environment is very much a part of affecting, how we develop, right? So we got a blueprint, and then we have the environment, which will give us a range of how tall we’re gonna be. How healthy, like all of those things. But also we’ve got our, genetic makeup that’s there.

And so once we’re born really environmentally, we’re looking at that postnatal cheese. So environment, and then what are we bringing into our body not just food and nutrients, but also, energetically, emotionally, what else is happening for us? And stress is a big issue, right? Because that’s gonna actually affect our our nervous system.

Okay, so a quick overview. Constitutional body types, right? We’ve got yang, we’ve got yin type, damp phlegm, dry, and then we have neutral, so women are gonna be more in the yin and the damp phlegm, and then also neutral. As menopause, like perimenopause starts to come, this is going to show up and be more exacerbated.

In terms of the characteristics. So if we look at, a young body type is gonna be really like sturdy, energetic, that red complexion to. Tend towards like heat preferring cold drinks. So this is they, if somebody who’s tends towards young starts eating a lot of spicy foods, it’s gonna be problematic.

So looking at the constitution of the person. Is gonna be really important because that’s really like that kind of underlying blueprint that they’re born with, right? Something that their constitution. And so always we’re gonna be looking at constitutionally, how is this pattern emerging?

So it’s not just the signs and symptoms where we can say, oh it’s a yin deficiency, it’s blood deficiency. It’s really, we’re like, oh, in a young person or in a yin person, what is that gonna look like? Because that’s gonna, I, that is actually going to direct you towards like how you’re gonna treat that person, right?

Someone who’s very damp and Fleming is gonna be like more watery. But water is inflammation. Even if it’s not hot. We’re looking at, the body is retaining fluid to dilute some kind of inflammation, and over time it can actually get hot. So in, in terms of a strategy, you wanna be careful, someone is cool and damp.

If you heat them up too much, it can actually turn into that damp heat and phlegm, right? And inflammatory conditions. So that’s why going back to the basics and looking at what is their constitutional body type. And from there we’re looking at what is that pattern? It’s emerging for them, not just their, oh, they’re blood deficient.

Yes. But blood deficiency in a particular body type has a different pattern. Although we can still use the same treatments, we might even use the same herbal formulas. We still have to recognize what is the underlying pattern and not just rely on protocols or, or. Really using herbal formulas, like a supplement.

A lot of, practitioners, I would say forget they that they’re, they may have their western mind cap on and or patients think of them as, oh, give me that herb formula again. I really liked it. I felt really good. Which is great. But then we’re looking at

What else can be done? Because maybe they’re not changing their diet, maybe they’re not doing other things unless somebody’s really ill they don’t necessarily need to be on formulas for a really long time. And that’s the determination of what’s a long time. And as we know, it’s very hard to get people to make changes and especially with their diet and lifestyle, but.

This is a really important thing and what makes Chinese medicine practitioners acupuncturists different from a Western model is we’re not looking to fix them. We’re gonna help them to get a better grasp on how their body actually works. I’m gonna stop here and next time there’s gonna be part two where I’m gonna talk about simple methods on how you can treat your patients that are suffering from weight gain and menopause.