Category Archives: Techniques and Protocols

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AAC – TCM multi-targeted approach to cancer care – Yair Maimon

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Hello everybody. I would like first of all, to thank the American acupuncture consult to put up this show. And today I will try to squeeze 15 years of research experience into 30 minutes. So two minutes kind of per year, I’ve been very fortunate to do, uh, in depth research, both in the lab and with patients with actually eventually won a formula of Chinese herbal medicine, which we took all the way from clinical to preclinical studies in order to prove a one thing the Chinese medicine works, but it’s also have evidence. Uh, this, um, research was also chosen to be presented to NASSCO two years ago when there was a TCM, uh, science day. So I was lucky to present it. I called it multi targeted approach because today all the treatment for cancer is targeted, targeted towards cells targeted towards actually a specific parts in the cells or on the outskirts of the cell.

And Chinese medicine offers a very different model and a very different paradigm. Um, most of my research, at least in the recent years were done in a, the center of integrity of medicine in the cancer Institute and cheaper medical center. It’s a huge, it’s a make a hospital. It goes one by Newsweek of one of the best hospitals actually for cancer in innovation. So it’s a mega hospitality. It has like 20,000 cars per day, 1,800 beds. So it’s really big. And as you know today, hospitals serve a lot of patients coming from also from the whole region, but also patients suffering from, uh, Corona and other, uh, acute situations in our oncology ward. We have, we are very lucky to have the center, which has both a clinical part where a patient can feel like they are in a different environment, healing environment. And it’s very unique to us to have also the research part, the research part, which has a proper lab, and it’s actually molecular biology labs.

So we can go deep into the effect of herbal medicine on immune system, on cancer cells and study even mechanism of action. And as I say, I’m fortunate, uh, to be leading this project for so many years, this is by the way, how the Herb’s look. So in the lab when we, uh, um, put them in some solutions. So you can see that they have different colors and different shapes. Um, this is part of the group that is working with me, uh, including, um, we can say faintly Zoe going, um, North Samuels and, uh, actually Steve Melnick from Miami children’s hospital came and visit us. And you could see me here as well, smiling faces. So I want to start the research actually from a very deep point of view of looking at Chinese medicine, because at the beginning we took cancer patients who were undergoing chemotherapy later, we went into looking deeper on Chinese medicine, but when we look at chemotherapy and when we look at its effect in the body, we are actually going to the deepest place.

We are going to the bone marrow and in Chinese medicine, the bone marrow belongs to the kidney and it’s like the most hidden and deep part of the body is the one it produces the immune system and produces the red blood cells. Cause the bone marrow produces eventually bends the red blood cells, the white blood cells and the platelets. And so this deep production house is housed in the most deepest part and sacred part in the body, inside the bones, in the, in a sense it could be anywhere. But if we understand it from a Chinese medical point of view, we are going to very deep essence of the body. And in Chinese medicine, it is the kidneys. So we want, when we want to address a patient, especially patient and they’re going chemotherapy or RAF treatments or having problem with his bone marrow in Chinese medicine, we know we have to think about the bones or about the marrow and in if we translate it to the substances in the body, which thinking we’re talking about gene, and when we look at the production of the gene, it’s the same as Western medicine.

So Chinese medicine already 3000 years ago, going in along the same line of what in Western medicine is discoveries just in the last decades. So the production of blood, we can look at all the blood in Chinese medicine. And when we look at the production of white blood cells, we would think about the cheap and the effect of cheap. So when we are addressing in Chinese medicine, um, and when we want to protect the bone marrow and the production, and when we want to 25 unity, we have this picture in front of us, looking at the gene, looking at the blood and looking at sheep. So in a sense, we are seeing something from the outside, which now we know is happening very deep inside the body. And if I look at the herbal prescription, if I’ll make a herbal prescription for patients, I can also talk about acupuncture.

Then I’ll put some herbs like or herbs that are, tonifying deeply sorry, the, the gene together, maybe with the herb, the tonifies, the bland and Herb’s the, tonifies the cheek Lakeisha and Juan. So this will be a prescription that you see goes into a very deep layers of the body. Tonifies the production house and also it’s product. And that’s unique about Chinese medicine. And that’s what unique about making a herbal formula rather than using one herb or even using one active ingredient, which is the common process in Western medicine and in chemistry. So when we did the research into formula, which we called LCS one Oh one, we looked at its effect on white blood cells, red blood cells, and even deeper into the immune system on neutrophils, especially in patients who are undertaking chemotherapy, that their bone marrow is suppressed. And therefore the production of the cells is reduced.

And the patients are suffering from anemia, leukopenia, and cetera. This research started more than 15 years ago. And as you will see, it has now many publication in very leading journals, medical journals in the world. Actually, one of my research will LCS one Oh two, which may be will continuing. The series was just probably three days ago. It’s a prescription that works only on immunity or mainly on immunity. So if you want to read, it was published at the medical biomed just two days ago, took about seven years. Uh, so, and by now, this formula was researching seven medical centers in Europe, in Israel and in the U S and this gives it a lot of credibility, because if you can repeat the research in different centers with different scientists, it means that whatever your findings are, they’re very valid and they’re considered more valid because if it’s one center, one place producing all the research, there’s always this question who is overlooking at the research, the results.

So by now, if we’ve kind of been involved in research in seven different institutes, um, and two of them in America. So we had the cooperation with MD Anderson, actually our last publication of LCS one Oh one, we had a cooperation with Arbor medical center. I’ll tell you in then with one of the leading oncologists there. And then we did some of the clinical work calls, not the preclinical work in Miami children’s hospital. So there was a collaboration with many different hospitals. Uh, and, uh, as I said, we were very lucky to find researchers to collaborate with us and Sheba medical center is a sister hospital with MD Anderson. So it was also helpful. This is the formula that cover researching 14 Hertz. Don’t worry if you don’t get it, it’s listed all of our research paper. And whenever you want to put dot com, you’ll find all the research that we’ll be talking about safe.

I’ll be brief on some details. Don’t worry, it’s all research published. You can download, or you can just write to me and I’ll answer questions. The very special thing that we found after we finished this whole series of research that Chinese herbal formula have multi effect. As we know it affects the immune system or they also, they, they achieve the body’s strength. It protects against side effects of different drugs. And it tells also in different research that we ran in the lab, a very interesting effect on cancer cells. But the reason I researched this formula and here is also, I can show this effect. Like I’ve put the, the Chinese herbal prescription into three different formats to show that there is a certain amount of herbs, which are addressing the protection or protecting the gene like New Zealand, Z that I mentioned before, the certain Arabs that we are considered that can kill cancer cells like band Juliane or itself.

And there is certain herbs that are more working on the immune system, like punchy, which is very known or by you, I’m using the Chinese names because I’m more used to them. Uh, and this is really where it all started because I’ve seen very good results in my clinic, treating cancer patients. And in the hospital, I was always, I got a very kind of a cold shoulder, especially from the oncologist that don’t cology department. And this was already in my previous hospital that I was working in. And I was asking, why are you so against natural medicine equals even not Chinese medicine? And always dancing was there is no evidence. And when adopted means, if there is no evidence, it means it doesn’t work because, you know, it’s, it’s a nice, safe to word to say, there is no, but evidence also is approved. So there is also more ways to eat.

But I must say that today, we have so much evidence for acupuncture and oncology acupuncture and the lecture about it. And still, you will hear doctors saying there is no evidence, so you need to read about it and find out, but that will be the very common, uh, kind of thing that, that will hear in the oncology department. They did change after all the research we have done. So we have now a total different acceptance and, and we are heard in a very different way because eventually when you bring evidence, then you’re considered when there is no evidence, you are in a different ball game, I can say. So the first research we did exactly like you do as a, um, regular medicine, double blind randomized, we took a breast cancer patient. In this example, we could have taken other, uh, cancers and they were divided randomly into two groups.

And they were given, one group was given LCS one Oh one. The other one was given placebo. That looks exactly the same. And then this patient were undergoing chemotherapy. So it’s about half year for this breast constipation. And then we compare the results, took about five years and another one year to finish up, eh, all the publications that’s the amount of time good research takes. And sometimes longer the results were quite amazing and stunning because when you look at white blood cells, so we are looking at the herbs that were protecting the bone marrow, but also increasing or helping the white blood cells activity. So if we look at the placebo, I’m looking at the one that had a, a leukopenia or under 3000 counting their blood counts. So it was 42% in the placebo, in the real one, 18%. So less than half, which means 80%, 82% of the patient, they didn’t have leukopenia.

Oh, they didn’t have reduction in white blood cells. It’s almost double, uh, if you look at it from that side on the placebo one, and the same went for a model of being under 10. So there group that took the LCS one Oh one 82%, didn’t have the, uh, the reduction in there and didn’t have anemia reduction in the hemoglobin under 10 while 52%, uh, head reduction. Well, no, sorry. 48% had reduction in 52%, not in the placebo. So see, again, it’s more than half of the women in this respect suffered from anemia. So what we are showing is that we are protecting somewhere deeper because if the red blood cells, white blood cells and we’ll be, look at the neutral fields level is protected means we are protecting the bone marrow from the damage of the chemo, and this was the results. And we published it in, in one of the most respectable, um, oncology journal.

So you can see least less than email. It’s the container and less neutropenia. All this is extremely important. And we published it in the Don cologists one of the best peer reviewed the oncology journals. Uh, so this is what we were kind of seeing that we are protecting, but it has a lot of meaning. Cause when you protect the bone marrow and when you reducing leukopenia and uh, in anemia. So first of all, people can, uh, this patient could do well and adhere to their chemo protocols so they could finish it. So they, it’s also part of the effectiveness of the protocol. They have less complicated complication that less potential secondary infection. When you have low immunity and general better quality of life for the quality of life, we did another group of people. And again, we also published it and we are showing that for fatigue, nausea, low appetite, weakness, pain, bowel function, all of this, a patient who took the LCS one Oh one and the better quality of life than expected.

Then we’re looking at the anticancer properties of the formula and republished it. And then we look even deeper. And we saw that this killing effect of cancer cells was selective, which means it was killing cancer cells and not normal cells and even the same as protection. So this selectivity means that when you use normal chemo, it will kill both the good cells and bad cells. When we were using the protective wall, we can so that instead of chemo, it is only killing the cancer cells and not the normal cells. This is like, if we go for a minute to the lab, you can see this is normal cells of a breast. And you can see on the zero to three, four, five, we take the concentration of LCS one Oh one and they’re thriving. And when we take cancer cells here, you see, they’re almost, they’re almost all dead.

So at this concentration, this one are dead, but the normal cells are alive. And the same when we go for colon cancer, prostate cancer, and later we did on a, um, and bladder cancers, lung cancers, and then other types of prostate cancer was actually also the main one. This is how we chose on the chart. And actually this is for prostate cancer. Again, you see the normal cells are reliable. Even if we go up, some of them are thriving while the cancer cells are dying. So it’s a very unique phenomenon of the selective killing. And this was even further. We shown the selective protection between when you take just a chemotherapy like Doxirubicin or five, a few, it will kill both. When we are adding the LCS one Oh one, it will protect almost totally the normal cells and helping killing the cancer cells. And this was published actually with some scientists from MD Anderson and again, a very interesting publication.

So what you saw and tell now is this protection and killing of cancer cells selectively in a, in, in vitro model. And now we look at the immunity, how the same formula affects immunity, and they always ask me, why do you need so many herbs? Why can’t you reduce the number of pallets? They, they kind of nightmare of a lab work. You know, they have so many protein apps, you have hundreds of ingredients in it, but I say, according to Chinese medicine, we have to follow this logic. And that’s why a whole formula, I call it a team can do so many things. And when we look at immunity, we can see deeply that it activates immunity, both T cells, cells and natural killer cells. This the innate immunity is also the one, which is so important to fight with viruses, but it’s also the type of immunity that kills cancer cells or mutated cells on a daily basis.

So we could have shown on human blood that we are activating the natural killer cells, even sometimes 400% more the normal. So very strong activation. What we did also through all this research is realizing that in order to deal well with herbal medicine, you need to bring it to consistency, to batch, to batch consistency. So today we are doing a very special production in order to bring it to batch, to batch consistency. We are concentrating the Arabs in a different way. We are identifying them. We are looking at their biological activity, not just their chemical activity, obviously the cleanliness, as far as residues of, uh, any toxins. And so we had to go very deep into producing something, which is reproducible for research and later on for, uh, also consumer use. So just to kind of give you a glance, we went deeper because always the concern there is interaction with chemo and radiotherapy.

So, and not a publication. We took 10 different kinds of cancer and 10 different types of common chemos. And there was no negative inter interaction in many times, even a positive one. So again, published, you can read it and everything here takes years until it comes up, but I’m very proud of it. And even also in this publication and others, there’s always oncologists. This is the head of the oncology department in Sheba medical center. But then also we have to look at Ray radiotherapy. There’s always this fear that you will use the effect of radiotherapy because you can be using like the oxygen. But we found actually that the formula is working through different mechanisms. Some of them is like ROS reactive oxygen, which is exactly the same, his radiotherapy. So when we look at the combination, when we combine the range of therapy with the LCS one Oh one, and you see the higher rate going the dosage, the more eh, killing we have for the cancer cell.

So the blue bond is only a zero, uh, formula. So it’s only a red, your therapy. You increase the dose of radiotherapy. So I see more and more cancer cells are dying, but still up to here, almost 30 of them are alive with this dosage of the radiation. But when you’re adding the LCS one Oh one, and when you’re adding them in there larger effect, you actually see a synergistic effect. And this, we also tried on almost 10 different lines of cancer consensus to show that it works, uh, on, on many different types of solid cancers. And again, a very good publication on cancer research, clinical oncology journal, one of the leading journals. So kind of to summarize all this, we need, eh, another research in summary that we published about a year ago and this publication was done with our head of the group is professor Rosenfeld from MD Anderson, from sorry, from Harvard medical school that also helped to endorse our science and to look deeper into it.

So we showed all this effect and just to bring it more to the clinic, um, I’ll show some cases how we use it in the clinic. And we have no cases that we are following more than 10, 15, I’ve even 17 years of patients. Some of them are taking the LCS one Oh one for four years for different reason. This is a classical patient. Uh, she started it when she was during treatments and then she continues, uh, also continues more for maintenance and recovery, and then also to keep her healthy during her life. So when she took it during the chemo, there was an increase in white and red blood cells and very minor side effects. This is, has repeated itself many times, by the way, this is the reason, I mean, there were the whole way of selecting the herbs. The formula was done, first of all, in there, like how can st a clinical setup?

And then when I see repeating the results in my clinic, I went to the hospital to check it with evidence-base and then to improve it and, uh, and, and prove you to also, uh, and, and this is, I think that the advantage of Chinese medicine, we see clinical results. So we start from something, we know we are proving what we know, but this proving is important and has later many implication of how we can utilize on a larger scale. Hopefully that’s my dream, that every patient will get regular therapy together with Chinese medicine together with the therapy that can enhance his quality of life can enhance and protect him from how she effects of treatments. So I can say not just Chinese telephone therapy is what we’ll call, um, today in integrative therapy. But I think Chinese medicine is deleting in the integrative medicine, both from the evidence and from what it can offer.

And the example of and a lung cancer patient who started it after surgery. Again, it was very weak after the surgery. It helped him with recovery immediately and elevation of the white blood cells. You had the throat problem and, uh, immediately got better. Uh, some patient, I think it’s, I think it’s also with him, we’ll continue to take it after. And yeah, he was one of them that was even telling me, you know, I’m like after the chemo, after the cancer, I’m on holiday, everybody around here are sick with virus. It was a few years ago, one year ago, not with coronavirus was just flu, but I’m the only one who’s not getting sick. So I think when we tonify the cheek and he was a chief efficiency and a yang deficiency, I also use acupuncture to tonify the lung. And also the point, his case, a lot of lung cancer can have also part of efficiency and some depression and feeling kind of associated with life and owning your documentary.

It will help them very deeply also on this quality of life issue. So, um, the only was telling me, and I’m keeping taking a LCS one, one. Now we call it protectable. And, um, I’m feeling better. This is another interesting case of a woman that I followed 17 years. Uh, she had a metastatic case of breast cancer and, uh, she takes it together with anti hormonal medicine. And as she started to take it two years ago, this was I’m following him around more many years. Uh, there’s a better quality of life. And also her sweat, hot flashes, sleep, everything got better. So she’s actually quite old by now still metastatic. And, um, it feels very well in her case. It was more the gene deficiency and the kidney deficiency also due to age and also due to anti hormonal medicine, which I reduced it even more, um, another case of a pretty static, eh, prostate cancer, metastatic prostate cancer took this formula for over two years in his case.

Also, we are trying to address the gene part of his, uh, uh, of the formula and of his constitution. So he feels less fatigue, better quality of life. He and I really heard it also from other prior patients. It says that they have back there, even their sex drive, the sex drive, which was reduced after chemo. And, uh, sometimes after the disease itself, because it kind of finds the gene and it kind of finds the vitality of the person. So when we use this in the clinic during treatment, as I gave an example, after helping to recover in maintenance, but also in patient with inactive disease. So usually a full dose, two dates in the tablets, I would use it like two tablets, three times a day, six tablets in full dose maintenance. Those usually have like three tablets a day. Health maintenance can be one or two tablets.

And people who have in active disease usually will be nine tablets. Like you can and make it five times more. If you want to think about the row. Herps because usually from five kilos of Moreau, Herb’s, we’ll do one kilo of powder here. We are actually concentrating in even more. So they’re taking quite a lot of herbs a day, uh, as far as quantity, but it’s quantity really matters. And that’s what we showed in the research. It’s time dependent and also dose dependent. So he really concentrating the formula very much just to finish up with the other research. Uh, there’s been quite an interesting research. This one came from Taiwan that, that followed up, uh, 729, uh, advanced breast constipation, and, uh, looked at mortality rate also. And the only two breast cancer patient who, uh, took, um, herbal medicine, um, and it followed them up.

And this was the most common herbs that they use because different prescription, we see, uh, the major three of them also in LCS, one, one, and the conclusion was following this patient, not patient who taking a herbal medicine, comparing to patients who are not taking that. Uh, they say the TCM may lower the risk of death in patients with advanced breast cancer. So this is a very interesting research, uh, um, prospective research, which compared this kind of population in Taiwan, taking her ups, comparing to the one that are not taking herbs. And, uh, it shows the effect or potential effect of herbs in even in, uh, in this respect. So just to finish up, I tried to do to in 30 minutes, I told you 15 years in 30 minutes, but I have to finish up with a dear mentor of mine. Um, eh, who was one of the, I think most of my inspirational people, as far as studying more the, of Chinese medicine and the depth of Chinese medicine.

And he kind of explains that by returning to the classic roots of Chinese medicine, we can make a truly significant contribution to the medicine of the future. And I think this is very true and the more we will see evidence of it, and the more we will see the, um, usage of it in the West and follow up, uh, the more human in humanity will benefit the better health. So just to say about, uh, how it looks when you do research and this, I heard from my colleague, one of the best researcher, a human first son, who is now himself fighting cancer. Uh, but I held it from his lecture. He says like, Gandy, first, they ignore you. Then they laugh at you.

Then they fight you when you get good results, but then you win. So I hope we are on the winning side. And I think Chinese medicine is gaining more and more acceptance. I know we are still not where we want to be, but I hope with more research of colleagues or research like this, we will help to create a significant change in Maine cancer care and this individual patient’s life. So I want to thank you very much. And again, to saying the American acupuncture consult for hosting me and especially in this days, uh, I would like to wish you the best of health and keep safe and all the very best for me. So thank you very much and have a good time.

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AAC 5 Ways To Quarantine-Proof Your Practice

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Hi there, Jeffrey Grossman from Acupuncture Media Works and AcuPerfect Websites. I am really glad that you are here right now. Thank you, the American Acupuncture Council for inviting me back here to do one of their live trainings for you. I appreciate that. And I appreciate what they are doing every week to bring all this information, and wisdom, and insight to the profession, to keep us going forward in these strange and weird times. For those of you that don’t know me, my name is Jeffrey Grossman, and I am the owner and creator of Acupuncture Media Works and AcuPerfect Websites, and also AcuDownloads. And I’ve been helping acupuncturists grow their practice, educate their patients, and keep their patients in care. Since 2002, I’ve been in this industry of helping practitioners. So, I’m really glad that you are here today. Today I want to talk about five ways to quarantine-proof your practice.

As you all know, these are some really strange times that we’re in and none of us expected to be here. None of us even prepared to be here. And as it stands now, we might be going through various lockdowns over the course of the next few years when things like this arise. So, I want to discuss five different ways that you can quarantine-proof your practice, that you can invest time and energy in now, so when it happens again, if it happens again, hopefully it won’t, but you will be prepared and ahead of the game. So, these are some of the things that I’ve been discussing with my mentees in my mentoring group. And I decided that this is information that would be interesting and, I think, important for the rest of you guys to hear about. So, the the first thing that is important to help quarantine-proof your practice is to learn a new skill.

Now, most of you are acupuncturists so all you really might know about is acupuncture, needling, cupping, gua sha, and all of those things that you do inside of your clinic. And they’re all powerful, and they’re all helpful. But it won’t help you to do those kinds of things in the future if you have to do telemedicine, or distance education, or if your practice has to close. So, it’s important to learn new skills that you can use and start to initiate in your practice now so you can cultivate that awareness. So you can cultivate that familiarity with these. And a couple of things that I would encourage you to think about doing is learning the EFT technique, the emotional freedom technique.

Learn how to do some tapping, learn how to do some distant healing. Also, healing with some tuning forks. Possibly, you might want to learn how to do some facial diagnosis that you could be doing over the telemedicine. Also, one of the things that’s really important is to asking better questions. Now, as an acupuncturist, we have some amazing skills as questioning is a part of our diagnostics. But when we are doing telemedicine and remote medicine, we’re going to need to really balance our diagnoses based upon asking better questions.

Also, you might want to learn how to properly share acupressure techniques with your patients. And some of you might be interested in learning about homeopathy. Now, these are all skills that you could learn now that you could be using with remote and telemedicine. You could be hosting online classes about these. You could be doing this process during your telemedicine classes. The other thing that would be really interesting for you to tap into now, during this time, is how to create and teach online classes and trainings. Now, there’s a lot of things as an acupuncturist that you could teach about. And one of the things that really drew me to this medicine back in the late 90s was that, as an acupuncturist, you’re also that of a teacher. And there are so many amazing things that you could be teaching to your patients to empower their health and to empower their wellbeing and to help support them during these times of quarantine, that are happening now and that might happen in the future.

So you could teach about acupressure points to help alleviate stress and anxiety, to improve sleep and possibly digestion. You could even teach about workplace ergonomics. A lot of people are working from home and they might not have specific ergonomics set up correctly for them. Another thing to teach about is TCM nutrition, kitchen remedies. You could teach about congee recipes. Even breathing techniques like Kundalini or Mantak Chia, the six healing sounds to transform stress into vitality, which is an amazing tool and technique that you can be sharing with your patients that help to talk about and educate about the different meridians. Each of the healing sounds that help activate each of those meridians.

Now, when you’re going to be any teaching, you could be teaching through telemedicine like using Zoom or, or you could be teaching via some specific platforms. Now, I’m going to review a couple of quick platforms here for you and you can choose and check out the ones that you might find more interesting depending upon what your needs are. There’s Teachable, there’s Teachery, there’s Thinkific, there’s Google Classroom, which is free, there’s Podia, CourseCraft and Learnworlds. Those are all specific platforms that you could be using to teach your class. One thing that you might be interested in, something that’s happening in some of my mentoring group, is some of the mentees are putting together online trainings on specific acupressure points. They’re offering them for free to their patients and then charging a small fee for access to these classes and hosting them on a platform like Teachable or Thinkific.

And the beautiful thing about these platforms is that they are an all-in-one solution. They host the videos for you. They will play the videos, you can add downloads that people can access. And also, you’ll be able to email patients through those platforms as well. So, it’s important for you, as a practitioner, to move beyond your skillset from treating inside the clinic, to moving outside into the world of tech. And I know that many practitioners are not very tech-savvy, and I get that. I totally understand it. Fortunately, I am. I’ve grown up in this world of tech and I’m very tech-savvy. And that’s why we do websites for acupuncture. That’s why we have a lot of digital online programs and trainings for acupuncturists. But I encourage you all to really cultivate that tech side of you and cultivate that side of you that is comfortable in this realm of doing online videos or online trainings, or even putting on courses for your patients.

Now when you do have any of these courses, some of them could be live, sure, that’s fine. Or they could be prerecorded, which gives you the option to edit them and perfect them as you will. The other thing that I would really encourage you to do is to diversify your income. And one of the ways to do that is to set up your online store. For those of you that have a website, there are definitely a lot of plugins that you could be employing on your website that create a shopping cart for you. So, what should you sell? Well, you could sell your own products. Many of you are gifted in creating herbal remedies or poultices or other topicals. So you could sell your own products in your website store. You could sell another practitioner’s products on your website store. You could do herbal consultations and sell herbal remedies through your online store, or even hook up with companies like Emerson Ecologics, and having a wholesale account with them and sell some of their supplements through your online store.

You could sell aromatherapy, you could sell ointments and other topicals, but I definitely want to encourage you to really diversify your income. And if you’re not already selling anything other than just acupuncture in your clinic, you should tap into adding to your income by selling other products. One way that I’ve been working with some of my clients is in helping them cultivate their herbal remedies in their clinics, helping them manage their process through doing herbal consultations through the internet, through telemedicine, and then making some recommendations. And then having people buy the herbs through their website store. Also, a lot of these stores allow you to dropship for you.

So you don’t even have to carry any product. So, when you get set up to sell some products through your website store, you could do it in a few ways. One, you can open up wholesale accounts. You could have dropshipping where the order’s made through your website, and then it is automatically dropshipped from the herbalist or the herbal company to your patients. You could also set it up where there’s an affiliate arrangement. Where, let’s say, you’re working with another practitioner. And if you sell their product, you get a small commission based upon that sale. Something to also make sure that you have, is you have a shopping cart on your website, you have an order page on your website. And if you can’t do that, the least that you could do is set up a direct link to a wholesale account for the products. And for those of you that have WordPress websites, it’s easy to embed some products on there with links that link out to other shopping carts.

Ultimately you’d want them to add the materials to a shopping cart on your website. That might be a little more robust than a lot of the websites that you guys have, but that is one way to help you quarantine-proof your practice. There’s a couple of different types of software that you could be using on the back-end to create a shopping cart. One of them that’s really great is WooCommerce, W-O-O commerce, Shopify, BigCommerce, Cart66 Cloud, and WordPress EasyCart. Those are really simple cart softwares that allow you to put and embed a shopping cart on your website very easily.

And the fourth thing that I encourage you to do during this time is to audit and improve your website visibility. So what to do? Now, during this time of quarantine, when you’re home, you might have a lot of time on your hands. And I would encourage you to take this time to audit your website. You want to check your SEO to make sure that your website is updated and that your pages and your plugins are updated on your website. You also want to make sure that you take this time to really update and modernize your design and your website. Make sure that if you are putting out new offerings on your website, like selling products, or hosting telemedicine classes, or teaching a class on acupressure, that there is an “offerings” page on your website that has those new services and offerings that you’re putting out there.

Make sure your blog is updated too. So we’ve spent three months in our homes, and it’s a good time to really focus on really upkeeping your website. There’s no excuse for your website to look like it’s five or six years old, it should be current. That’s the first place people go to when they start thinking about you and your services. Also, the other thing that you want to do is to really tap into social media marketing and promote your website, and your services, and the products that you offer on social media regularly. And make sure that you have a backlink from social media back to your website.

The other things to check while you’re doing this is to make sure that your title tags are set up correctly, your alt tags are set up correctly, and your meta tags. And one thing that I find anytime I do any type of website evaluation or an audit for a client, is that they do not have many calls to action on their website. So I encourage you that when a person hits your website, you want them to take some sort of action. You either want them to schedule with you, to pick up the phone to call you, to set up a telemedicine class with you, to sign up for your acupressure class, or to even just schedule a regular treatment with you. So you’ll need to have multiple call to action buttons on your website. The other thing to do is to make sure that you have videos on your website. Talk about videos about how became an acupuncturist.

What was your road to get you to this moment where you are right now? All right, what kinds of things can you teach your patients that can add value to their life during this time? Make sure your website is mobile-ready, make sure that you have downloadable intake forms, that on your website there is a link to the maps and the directions. Also, make sure that there is a way to capture an email address. So when people visit your website, that if they don’t schedule with you or sign up for a class that you’re hosting or download an ebook that you’re having, that there’s something that you have there that will capture their name and their information. Okay? So, for those of you that are interested, as you know, we build websites for acupuncturists. And if anybody is interested in a free website evaluation to find out what your website is missing, we have a team that is standing by to put together a checklist and go through your website absolutely free.

You can visit this link right here, which is And that will take you to a page where you can submit some information. And my team will go ahead and start conducting evaluations of your website so you can see what kinds of things that you might need to work on during this time to help you quarantine-proof your practice. So go ahead. For those of you that are interested, you can visit And you can just request a free website evaluation there. Absolutely no charge, nothing hidden around that. It’s just something that we do for our clients. And I’ve got a team that is waiting to kind of evaluate your website for you.

And then the last thing that is important for you to do is to make sure that you stay in top-of-mind awareness with your patients. So, couple of ways to do that. Well, before I say that, even though you’re not in practice right now, it’s important for you to have your patients be aware that you still exist and to let them know what you have available to help them to get well, to reduce stress, to reduce anxiety, and to just stay in top-of-mind awareness. So a few things that you should be doing is to email them regularly. I know many of you think that email is bad and that you shouldn’t be doing it, but especially during this time there is a lot of valuable information and content that you could be sharing with your patients and getting in front of them about immune health, or stress reduction, or acupressure techniques.

Another thing to do is to do some direct mail. A lot of people are home right now, and they’re still getting mail. And it’s rare for people to get anything from a healthcare provider. So you can send out a newsletter, regularly, through direct mail. Posting to your social media channels on Facebook and Instagram and Twitter will keep you in top-of-mind awareness. And also, it’s important to make calls to check in. With my coaching clients, I encourage them to make their list of their A-patients and reach out to their A-patients on a regular basis just to see how they’re doing and what’s going on, just to check in with them. Because your A-patients are patients that you love, they know you, they like you, they trust you, you have a really solid relationship with them. And you might not be in their top-of-mind awareness because they’ve got other things going on. But I think if you were to reach out with them and just to check in with them, just to see how them and their family members are doing, it would go a long way in building that trust value with you.

The other thing to do is to schedule regular times to reactivate inactive patients. And you can do this by making phone calls to inactive patients that you haven’t seen in a while. Let them know what your new offerings are. Let them know that you are offering telemedicine, let them know that you are offering some online healthcare consultations, herbal recommendations, nutritional recommendations, or whatever it is that you are offering for them. So, that’s pretty much it. That’s just a quick five ways to quarantine-proof your practice. Again, thank you to the AAC for having me being part of this.

If anyone is interested in a free evaluation, feel free to reach out to us. There will be a link that we’ll be adding here, and we’ll be responding to any comments that you have with regards to wanting a free evaluation. But I just want to encourage you to stay strong and to carry on. These are some strange times, none of us have ever predicted this to be here, but don’t just stagnate and sit there and freeze up and not do anything. You still have a business to run. You still have to generate some type of an income. And there are numerous ways for you to do that, that I covered in today’s training. So, thank you very much for joining me here today. Join us next week when Yair Maimon is going to be joining us on the AAC’s live training. So, if you have any comments, questions, please post them below this video. And I will be sure to respond to them. Take care, stay strong, stay healthy, and we’ll talk soon. Bye-bye.

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Michelle Gellis Thumb

AAC – Treating Cosmetic and Neuromuscular Facial Conditions with Facial Motor Points

Click here to download the transcript.

Click here to download the slides.

Hi, everyone. Welcome this afternoon. I want to thank the American Acupuncture Council for this opportunity to present on treating the face with facial motor points, and I appreciate everyone coming out in the middle of their afternoon or evening or early morning, depending on where you are. If we can go to the slides, little bit about myself, my name’s Michelle Gellis, and I teach cosmetic and neuromuscular facial classes, facial acupuncture classes, internationally. This is a picture of me teaching a class about a year ago in Maryland. What I wanted to talk about today were a couple of things that work with both cosmetic and neuromuscular facial conditions, but before I did that, I did want to talk a little bit about facial acupuncture in general.

When we use the term facial acupuncture, we are talking about a very large topic, so it encompasses anything having to do with a person’s appearance and/or a function of their face so things like wrinkles and sagging skin, and also neuromuscular facial conditions like Bell’s palsy, TMJ, trigeminal neuralgia, stroke, ptosis, and many other facial conditions. Facial acupuncture is actually the largest growing subspecialty in acupuncture right now and so getting trained is something I’m going to talk about in a moment, but it is very important if you are going to specialize.

Facial hair acupuncture can include everything from just needling to using facial cups, gua sha, or doing microneedling on the face, and facial acupuncture is not some new and trendy thing that the Kardashians are doing on social media. Yes, they are and it is really something that has been around a very long time. When they found the emperor and the empresses in their tombs, they had jade gua sha tools and there are records dating back to the Sung Dynasty and even before that of people talking about facial acupuncture throughout history. I have written two publications for the Journal of Chinese Medicine. I’ve written many publications, but to specifically of interest, one is on treating neuromuscular facial conditions with more of a multifaceted approach.

Today we’re going to be speaking about facial motor points, and this is part of a multifaceted approach to treating the face. I’m a classically trained 5-element acupuncturist. I have been teaching at the Maryland University of Integrative Health, formerly the Tai Sophia Institute since 2003, and my second publication was on the importance of clearing energetic blocks prior to doing any facial acupuncture, and links to both of these can be found on my website As I mentioned, there have been quite a few studies on facial acupuncture. I’ve listed a few here, and some of them are pertaining to the cosmetic effects and some of these are pertaining to more of the functionality of the face.

These slides will be available on the AAC site and when I teach my classes, I go over these in a little more detail, but I just wanted to let you see that there actually has been researched done on facial acupuncture. When you’re thinking about your practice and how facial acupuncture can fit in, if you’re just looking at the cosmetic aspects, it’s great because you’re not dealing with insurance. It’s a very reliable stream of cash income. Again, you’re not dealing with insurance. You don’t have to bill the insurance companies, and one thing that we’ve learned during this pandemic is just how much people depend on having other people take care of them for their appearance, and people will spend money on vanity before they will spend money on their health.

If you think about some of the signs, the protest signs for things to open up, they were, “I want to get my haircut. I want to get my nails done.” No one was saying, “I want to go see my doctor or my dentist.” People do spend money on vanity and also, if you learn the neuromuscular foundations of a lot of this, it can open your scope of practice. You can see patients or patients will seek you out because you have this subspecialty or someone who will be known for being able to work on the face. A lot of us, we go to acupuncture school where we don’t spend a lot of time needling the face. We’re not comfortable with it. We didn’t really focus on learning those points.

It opened your scope of practice, will give you a very unique skillset. These are some pictures of me doing some microneedling in a class and some facial gua sha. That’s the benefits for you, for your patients done correctly. A facial acupuncture treatment should include body points and should bring chi and blood to the face, to the muscles, to the skin. Facial acupuncture because it is a full body treatment helps with digestion, immunity, circulation, and all of these things. Everything shows up right here, and it will carry nutrients to your cells and by doing that, it helps to stimulate collagen and elastin production.

Also if you’re using intradermal needles, which are very small needles which require some specialized training to be very effective, it will actually stimulate collagen and elastin production. Again, for your patients, if your patients is having any sort of… This patient of mine had ptosis where one eyelid was lower than the other. You could see her eyelid on our right, but her left was lower than her other eyelid, and she was getting married. She was very self-conscious about it and through treatment, I was able to get the levator muscle to function better and help so that her eyelids were even. On a more cosmetic level, people that have rosacea, facial acupuncture treats the hormones.

We do hormonal points if that’s an issue, and it can help with different skin conditions. This was a student of mine in one of my classes and just during the course of class, I worked on one side of her face and she had a rosacea, and you can see how the rosacea cleared after I had done the facial cupping. People asked me all the time, does facial acupuncture work, and these are just a few of my before and after photos. This person up in the center and the top, she had a scar right in her nasolabial fold and through treatment, the scar softened and ultimately, dissipated.

This person down here in the center, had some dark spots and again, through treatment and some intradermal needles through microneedling and I also work a bit in my classes with skincare, with skincare, I was able to really help her to get some of those dark spots to disappear. This other patient here had a tremendous amount of modeling in her chin, a lot of wrinkling and the corners of her mouth were very much turned down. As you can see in the bottom picture here on her left on our right, that the corners of her mouth, instead of being turned down, they were starting to lift up. With her, I definitely used some motor points, which is the topic of today’s conversation.

Again, another patient. This was actually someone who’d been coming to me for years with wrist pain, elbow pain, shoulder pain on and off. She saw that I specialize in cosmetic acupuncture and she was concerned because she was having some asymmetry where her one brow and lid was coming down a little more than the other. I said, “Just get on the table,” and I treated the left side, and the difference was remarkable just from one treatment. Again, I used motor points in that treatment. Getting trained is important. The American Acupuncture Council does require that if you are doing cosmetic acupuncture, that you get trained by one of their certified providers, and I am one of the few people on their list of people who do training.

The reason for that is because there is special documentation, there are precautions, there are red flags and you really need to prescreen your patients for different contraindications. If someone hasn’t been screened properly and you are doing cosmetic acupuncture, you can bring on things like headaches. If they are prone to high blood pressure, it can raise their blood pressure, and many other things. The other part about training is, as you can see, there are 43 muscles in the face. Many of them are very small and when you’re working with the musculature of the face, you really need to know what you’re doing so that you don’t cause asymmetry, overstimulate a muscle or the nerves and the blood vessels, the capillaries on the face.

Some of them are very close to the surface, and really knowing where they are and how to prevent bruising is important. I’ve made a list of some of the neuromuscular facial conditions that I see most often in my practice. When someone within a 20- to 30-mile radius of where I live is looking up acupuncture for one of these conditions, I’m going to come up because this is something I specialize in. Again, specializing in facial acupuncture can be very beneficial for your practice and when I’m treating any of these conditions, of course, I will treat the underlying condition and I do use a multifaceted approach. Meaning, I use some submuscular needling and facial cupping, some gua sha, some scalp acupuncture, but motor points are a big part of treating neuromuscular facial conditions.

Also when we’re working strictly with cosmetic conditions, if you think about our emotions and how they manifest on the face, really understanding each one of the emotions, either from a 5-element perspective or just from a TCM perspective, how these organs being out of balance, what kind of wrinkles that might cause on the face. Using some of the motor points to really as reset switches, and we’ll talk about that in a second, can really help with things like hooded eyelids, the frown lines, crow’s feet and Bell’s palsy. I found these pictures in a book for artists or sculptors. They are artists, but I love them because they show a face at rest and then four different emotions, which of the facial muscles are used.

As we age, these muscles become not as functional as when we get older. Now some of them get overused, some of them don’t work as well. Some of the muscles that we overuse are going to end up causing lines and sometimes early sagginess on our face. You can see here when someone is showing rage, just how many different muscles are involved, and the same thing with joy. Motor points are something that were discovered actually quite a long time ago. Medical doctors have used them. I found an old medical text, and they were using motor points with hypodermic needles and stimulating them. I’ve listed some of the researchers, some of the people that have done a lot of work in the motor point world and what a motor point is, it’s the most electrically excitable part of the muscle.

When you find the motor point, you can stimulate it, and it is where the motor nerve bundle is… The nerve is actually attached into the muscle. Fortunately for us, many of them are acupuncture points. We don’t have to have a deep knowledge of anatomy in order to find them because we have the acupuncture points as reference points. If a muscle is too flacid, it’s not firing properly and if it’s too tense, it’s not firing properly. By stimulating the motor point, you are helping the muscle to function properly, whether it’s to relax or to get back to doing its job that it should be doing. As I mentioned, many motor points are also acupuncture points, but they are not trigger points or ashi points.

A trigger point is really a sore spot and you press on it or you needle it, and it feels good. It could be like a knot, but motor points are different, and there are motor points on the face. All of them are innervated by the seventh cranial nerve, except for the temporalis and the masseter, and those are innervated by the trigeminal nerve. In order to figure out which motor point you should use, if you looked at those other drawings, there’s arrows going in every direction. You have to understand what the functions of the different 43 facial muscles are.

When I teach my neuromuscular class or I have an advanced cosmetic class, I go through every single one of the emotions or every single one of the issues that might come up with a particular, if someone had Bell’s palsy and which motor point to use, but we are going to talk about a couple of them today. Normally, you just needle straight in or slightly at a slight oblique angle, and you want a needle into the muscle, but not through the muscle. I think I just did this slide this morning. I think this is all of the facial motor points. I’ve got one dot for each. I got a little crowded on one side, so I put some on the other side.

As you can see, there are quite a few facial motor points, and then there are others for the platysma and for the temporalis and also for the SCM, but I don’t have those marked out on here. Let’s talk about a couple, and the first two would be the procerus and the corrugator, and they give you the angry eyes or the frown lines. Here’s the corrugator muscle and the motor point. This brings your eyebrows together. It works in conjunction with the procerus, which is right here, but for the corrugator, the motor point is just lateral to bladder two. For the procerus the motor point is actually Yintang, so it’s easy to find. Again, these two muscles work together to bring the eyebrows together.

Another muscle group is the frontalis, which helps to raise your eyebrows, like if you’re surprised or inquisitive. For each wrinkle just about, there is an underlying emotion and it’s a topic for a whole nother conversation, but I just wanted to bring that up. I could talk about this for six hours so I’m trying to squeeze everything in in a half an hour as much as I can so. The frontalis again causes these horizontal wrinkles. The frontalis is two muscles right here and the motor point is gallbladder 14, and I have a little video. I had needle this on a patient and just stimulated it. You could see that her issue was a drooping eyelid on one side, and the frontalis is connected to your eyebrows so I had needled that.

As you can see, it really woke the muscle up. The orbicularis oculi is something that can be affected if a person has Bell’s palsy or a stroke, and the way you would test for it, can the person close their eyes and open their eyes. From a strictly cosmetic point of view, it is involved and these are called crow’s feet. Here is where the orbicularis oculi is, and there’s two motor points. One is between Qiuhou 23 and gallbladder one, and the other one is the extra point right here, which is more or less between stomach two and gallbladder one. Another motor point and this is something that is important for pursing your lips, bringing your top lip up.

If someone had some sort of paralysis around their mouth, if they put their lips together and they blew out, air would come out. If you or I did it, it would come out evenly, or it wouldn’t come out at all, but if someone had paralysis on one side, the air would only come out on the weak side, and it can also cause lip wrinkles. You can see a picture right here of how all of this works, and the name of the muscle is the mentalis. It makes your lip go down. There’s actually three different muscles that are involved in getting your bottom lip up to your top lip, but it can cause wrinkles on your lower chin and wrinkles all around the lips, and here is a video.

I had a student in class who had had Bell’s palsy years ago, and she said she still could not close her lips completely. I went ahead and needled the mentalis, and I noticed immediately that the muscle started twitching. I stimulated it, and you can see what happens. This was a muscle that wasn’t functioning at all. One of the things that comes up right now during this time, we’re in the middle of a pandemic, and our patients should be wearing masks in our treatment room. There was a lot of questions that have come up. I teach my classes now via livestream webinar, and my students have asked, “Well, how am I going to do my job?” Well, I just started back to work last week, and I gave a lot of thought to I can certainly protect myself, but I want to keep my treatment space protected as well.

The first thing I did was I took a box of surgical masks, and I did a little video. If you go to my Facebook group, I have a Facebook group. It’s called facial acupuncture, or my Instagram is also facial acupuncture. If you go to either one of these, you will see I have hundreds of short demonstration videos, articles and this was I think last week. I just took a surgical mask and so anyway, I have a demo video of how I made this, but I just took a regular surgical mask, cut the elastic, folded it. I use some hemming tape, like seamstress might use, or you might use if you wanted to hem your pants without the needle and thread. I just use the tape on the inside, and then I just reattached the elastic.

You can see the front and the back, and this wasn’t the best version. This was a version that I did. I hadn’t tucked the sides in, but other than LI20 and right around the top and bottom of my lip, if someone is wearing this mask, you can get to their entire face and neck. If they were to cough or sneeze or whatever, it’s still contained under a mask which works. I used one six times last week and I just give it to my patients, and then throw it out. Surgical masks are easy enough to get on Amazon right now. They’re inexpensive too. The next level that I’m working on, I saw this idea on the right, which was designed for aestheticians, and it’s a lucite box. I actually ordered one, but for my purposes, it was too open.

I was concerned that it was just too open, so I’ve actually been working with the manufacturer. I have designed this box on the left. I don’t have a photo of it, until I let them know how many I want. I’m not going to be selling these for profit. I’m going to probably order five or 10 or a hundred, and then just have them shipped to acupuncturists, so they can safely treat their patient’s face. Your patient’s head would go here. There’s holes for your arm. It’s very high up. It’s 15 inches, so your patient doesn’t feel claustrophobic, and I angled this part. When you’re sitting and working on their face, you can lean over and get a little closer. The little dots here, these boxes are actually collapsible.

When it comes in the mail, it’s whatever five pieces, and then you just put it together, and that way you can take it apart if you’re traveling or if you just want to store it, you don’t need it, but it was my extra level of sneeze guarding because a large part of my practice is treating people’s faces. That is my very quick talk on facial motor points, and I am going to open it up for questions. Alan, if you’re there, I don’t know what to do with my slides while we’re doing questions though. I see. Something in the chat box, leave the slides. Okay. I left the slides. No questions. Yeah. If you have questions, you can put them in the comments, and I will answer them later.

If you have questions afterwards, you can just put them in the comments and I can answer them. Okay. Thank you again for tuning in, and you can visit my website, There’s information about my livestream and my recorded webinars, and I want to thank the American Acupuncture Council again for giving me this opportunity. Thank you so much.

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Poney Chiang Thumb

Strategies for post-COVID-19 infection associated neurological dysfunctions

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Click here to download the slides.

Hi, welcome to this week’s live show brought to you by American Acupuncture Council. I’m your host for today, Poney Chiang, coming to you from Toronto Canada. I’m a continuing education provider, and if you’d like more information about me, you can find it on the title slide.

Today, I’m going to talk to you about strategies for dealing with neurological complications and neurological symptoms as a direct result of patients that have unfortunately been afflicted with COVID-19. And there’s actually a growing amount of literature in this area and since my interest and expertise in the area of neurology and acupuncture, naturally this is a area that I’m very passionate about. So I’d like to show you some of the readings and research and strategies that are applied in my own clinic.

The first paper that we’re going to look at comes to us directly from [Wuhan 00:01:43]. This paper was published in just March, and it is a retrospective observational study conducted from three different centers. So these patients were tested positive for COVID in the month of January and February this year, and there were a total of 200 plus patients. And they were all assessed by neurologists, and their neurological manifestations were categorized into three different subtypes.

The first type is called the central type, and the central nervous system type gives you symptoms such as headache, impaired consciousness, if you can have an acute cerebrovascular disease, that’s another word for stroke, and you can have ataxia and seizures. The second type of classification is peripheral nervous system symptoms. And the most famous one that you may have already heard about is lack of smell or lack of taste. And sometimes there can be vision-related impairment as well. The third type of dysfunction is have to do with skeletal muscle injury. So patients would complain about pain. Those of us that know people who have been infected with COVID will tell you it’s like a flu like none other. You’re just hit with it. Your entire body hurts. I even had a friend tell me that it feels like shards of glass in his joints. That’s how painful it is. Okay?

So those are the three main neurological classifications. And as I said, this is a study of 214 people. And what the research found was that 36% of these patients all exhibited neurological symptoms. And what was interesting is that those with more severe infections, defined by having more poor respiratory status, which was in this case 41% of the patients in this study, they were more likely to develop neurological problems. So somehow, the harder you’re being hit by this disease, the more likely you’re going to have neurological symptoms. Just so you have a breakdown of roughly the proportions of the three different classifications I mentioned, about 25% of these patients had central nervous system symptoms. About 10% of the patients had peripheral nervous system symptoms, and another 10% or so have muscular skeletal symptoms. So, you can see why this is something that we as acupuncturists should be aware of because oftentimes patients with CMS and peripheral nervous and now of course muscle-related problems, want to come to us for support.

Of the central nervous system symptoms, the most common ones were headache and dizziness. Whereas, in the group for the peripheral nervous system, the most common symptoms were impaired taste, which is called dysgeusia, and impaired smell which is anosmia. And a patient who had muscle injury as compared to those who had no muscular pain symptoms, were found to have higher C-reactive protein levels and higher D-dimer levels. C-reactive protein is a marker for systemic inflammation in the body. So, patients who had more inflammation in the body was more likely to have muscle pain. And D-dimers is a breakdown product that the body makes when blood clots have been broken down, which is indirectly a measure of how much coagulation there is in the body.

So in other words, those with more coagulation, think in terms of [T-blastocysts 00:05:26] and TCM, those with C-reactive protein, indicative inflammation, thinking in terms of blood heat in TCM. These patients are far more likely to develop muscle injury related symptoms. Now, I want to emphasize that neurological symptoms is not just limited to the central nervous system. We mentioned it’s the peripheral and there’s the musculoskeletal. So I don’t want you to have an impression that show COVID patients are more, are oft being afflicted with strokes. Okay? That was the picture that was being passed around in the early stages when we didn’t know what was happening. But now we’re seeing, it seems to be that they are more likely to develop central nervous system symptoms, such as acute cerebrovascular disease like stroke, but it’s not the entire spectrum of neurological symptomologies that these COVID patients have.

So, as an example, in the Wuhan study, there are six patients out of only 200, only six patients out of 214 had acute cerebrovascular disease. And two of them actually arrived at the ER with sudden hemiplegia, paralysis, weakness of one side of the body, but they did not have many COVID symptoms. That is to say, no fever, no cough, no anorexia, no diarrhea. And they were only found to be suspected of having COVID from CT scans of the lung that found there’s some lesions. And then they were subsequently tested with PCR based assays to confirm that they had indeed were infected with COVID. So this is important because one, we need to realize that patients may never have gone to the hospital because they’re afraid of going to the hospital because they were going to get COVID, you can contract COVID in a hospital, they may have neurological symptoms and they will go to the community for care, even though they are positive and not because they’re, but being asymptomatic positive.

Another interesting finding was that some patients that did present with fever and headache were presented to neurologic ward in Wuhan, and they were initially positive-negative. So either their viral titers were high enough to be detected by the assays, or it was a false negative. And then only when the symptoms really started come on like coughs, and the dyspnea, then they were retest [inaudible 00:08:00] found to be positive. So that’s important to keep in mind as conditions that we need to be aware of. Possibly the patient come to us with neurological symptoms, but may actually be symptom negative, but in fact positive COVID patients.

So in summary, from this paper, they found that all the patients that had neurological problems, tend to have lower lymphocyte counts, white blood cell counts, which is indicative of some level of immunosuppression, and therefore, they are more likely, for mechanisms that scientists are still starting to study, more likely to be afflicted with central nervous system symptoms.

And now patients who have more severe infections, meaning worse outcomes with their respiratory integrity, have higher D-dimer levels. That, again, it’s a measure of how much coagulation there was in the patient’s body, and this can explain why those with more severe infection, meaning more worse lung function, having more D-dimers, are they more likely to develop occlusion or clot-type of strokes.

[inaudible 00:09:16] reminder that the authors of this paper wanted to show us is that… I put this in red, in quotation, that during the epidemical period of COVID-19, when seeing patients with neurological manifestations, physicians should consider the COVID-19 infection as a differential diagnosis. You want to avoid the late diagnosis or misdiagnosing and prevention of transmission. So this is an important wisdom for all of us to take to heart as practices start to open and you’re seeing patients with neurological issues. You might want to gently remind them to go get tested, because it’s possibly that they could be positive and just be asymptomatic.

Now, a group in Spain replicated this type of study, but this time with a larger n size of 841 patients, and this time around with a larger sample size, they actually found that close to 60% of COVID-positive patients now presented with neurological symptoms. And this was data collected across two different institutions.

And Harvard, okay, I don’t want to be an alumnus, not all neurological symptoms associated with COVID are struck. If you look at these numbers here, only 11 out of 840 actually presented with ischemic stroke and three presented with hemorrhagic stroke. So that’s only 14 out of 840.

The mean time of occurrence was approximately 10 days after the development of the COVID symptoms. So they started having stroke 10 days later after personally having a cough, [inaudible 00:11:07] a fever and as such. And again, there was a very strong correlation between those that who had the stroke, in other words, the cerebrovascular disease, and those with higher D-dimer levels, meaning that’s the byproduct of the breakdown [inaudible 00:11:23] in the body. So in other words, no surprise, more [inaudible 00:11:26] in their body, more likely to have a stroke presentation.

Now on this side, we’re looking at a paper published in Germany, and this paper was a attempt to summarizing the amount of ischemic stroke that was being seen in patients with the COVID from three different countries. As in first column you can see from the United States, second column from China.

So this China column is actually the paper I just presented from Wuhan. And then another paper, which I’m not presenting today, is of n size of 206 from Singapore. And what I wish to point out, is that you can see the number of people having strokes in relation to the total [inaudible 00:12:22] positive number of COVID patients. It’s relatively small. Now they all have associated risk factors that we know of: have they been hypertensive, being obese, be having diabetes mellitus. These are predisposed youth to more higher incidents or infection in this diseases.

And what these researchers have found was that, in the overall picture, if you look at the type of stroke, that the patients are having, there is a preference or a more heavily weighted manifestation of large artery occlusions in contrast to small vessel types, in contrast to blockages in their heart or cardiac embolisms. Okay.

So even though the number of strokes that COVID patients have is not very high, and it really depends on the severity of the infection, it depends on how much D-dimers they have, if they were to get a stroke, based on the limited amount of data we have to date, it appears that there is a preponderance towards large artery occlusion type. And now let’s take a look at the outcome of these patients.

In China, of the 11 people that had stroke-related presentations, four of them died. In Singapore of the five people, three of them died. In the United States, none of them died, and they were then subsequently sent to ICU stroke units we have, or went to go home. So we can potentially, as acupuncture, be seeing these patients that are being sent back to the community for rehabilitation purposes.

Now, I want to talk a little bit more about this large party ischemic stroke. This paper that was talking about the five people from the United States is summarized in this tabulated form in the next slide. So this is a paper that was published in “The New England Journal of Medicine”. And this is physicians in New York were noticing that, “Wait a minute, young people are getting strokes. This is not expected.” So if you look at the first row, you can see the patients one through five. These are patients that are under the fifties. Most of them actually in their thirties or early forties. Young people should not be getting stroke. So even though I said repeatedly, that strokes are not the most predominant type of neurological symptoms in patients with COVID, it is kind of sad and devastating that these can affect young people. And not all of them had the risk factors we talked about, such as hypertension and diabetes. Look at the second, third row here.

Medical history and risk factors for stroke, there was none, these people had none, undiagnosed … One of them has undiagnosed diabetes and some of them have hypertension, but some people had no symptoms whatsoever. A lot of them weren’t even on any medication. So relatively healthy people, young people can get this.

So another thing I wanted to bring to your attention, is look at the symptoms that these patients present. So they present with hemiplegia, loss of consciousness. They can have difficulty speaking, or they can have altered sensation. They can have something called gaze preference, issues to do with the eyes, we’re going to go … and also hemianopia, which is also a vision [inaudible 00:16:47] symptom. We’re going to talk a little bit more about the visual aspect of stroke and have some strategies you can deal with that in the upcoming slides.

If you look at the vascular territory, the ones that the strokes involve, you’ll see that it is affecting the internal carotid, infecting the middle cerebral artery. Most of them are affecting middle cerebral artery with one exception here, here is affecting posterior cerebral artery. I’m going to also talk a lot about that. It means that patient that have stroke, these large vessel type of strokes, tend to be getting it in the internal carotid and its derivative, such as the middle cerebral artery.

Let’s look at the symptoms of these patients. So some patients have cough, headache and chills in the first column, patient one. Patient two has no symptoms. Patient three had no symptoms. Patient four was tired, that’s it. Other than that, no fever, no cough. I want to just stress upon you, maybe you want to take this into consideration when you screen patients, whether you accept these type of patients in your clinic or not. If somebody comes in with neurological symptoms needing help and this developed in the last two, three months, it could very possibly be asymptomatic COVID patients who’ve had this, and they’ve never had a reason to go get tested because they had no symptoms. So it’s up to you whether you want to open up your clinic to help these type of patients, or maybe request they’re tested before that you’re able to help them, et cetera.

So a little bit more about this large occlusion, artery type of occlusion. What is it exactly? [inaudible 00:18:40] saw some embolization of atherosclerotic debris. So if you think about plaques inside your blood vessel and embolization means these plaques have become free, dislodged. Usually they originated from the common or internal carotid artery in your neck, the common carotid artery divides into internal, external. I’m going to show you some pictures about that in a moment. Sometimes it can actually come from the heart itself, the vessels of the heart and they become dislodged. The large vessel ischemic strokes that develop are most likely to affect the medial cerebral artery territory.

In other words, the symptoms, the neurological symptoms the patients are going to manifest, are going to be whichever part of the cortex that the medial cerebral artery supplies. So this is why it’s important to know the anatomy, knowing which part of the vessels are more likely to be affected in COVID stroke type of patients, we can then predict what is the most likely type of symptoms or neurological dysfunctions that this patient going to have based on the vascularization of relevant function area, corresponding function areas in the brain.

So this is just a quick review of the circulation of the brain. What you see here in the center is the circle of Willis that we all learn about in school. What I love about this slide is that they color coded it as such that in purple, I’ll call the posterior circulation, and it’s called posterior circulation because comes from the vertebral artery in the back. If you look at the patient on the right side over here, VA stands for vertebral artery. Whereas the green shade, called the interior circulation, which subsequently divided into anterior cerebral and medial cerebral, also, ICS stands for internal carotid artery. These green ones come from … so you’ve color coded over here, comes from the carotid, common carotid artery, which divides into ECA, CCA is the common carotid artery, which divides into ECA for external carotid artery, this goes round the face, outside your skull and then the internal carotid artery, which as you can see is now green, and then goes into the brain and divides into enter in medial carotid artery.

So here is the picture of the internal carotid artery label over here, this big one over here in green, the biggest one, the biggest cross-section green. You can see it divides into anterior … the anterior cerebral artery, ACA over here. Then going left and right laterally, this one here is the middle cerebral artery.

So patients are most likely to have clots in here before the division, or somewhere in the neck here. Or after the internal carotid has bifurcated into the middle cerebral artery, you can have occlusions in the middle cerebral artery.

So now we’re going to take a look at where the middle cerebral artery supplies. So this is a very nice picture that shows you in a color coded manner different areas of the brain compartmentalized, based on its source of vascularization. So on the bottom here, you can see A, this is turquoise color, A part. These all supply the interior cerebral artery, it’s not relevant to our discussion. All the P part, all the red parts are all supplied by the posterior circulation. That’s also not relevant to what we’re talking about here. All the yellow ones, labeled N, shows us where the middle cerebral artery supplies.

So as you can see, it supplies a large portion of the lateral surface of the cortex, both the frontal, the parietal, and even the temporal lobe. So it is a very important area. If you look at the cross-section over here, you can see here’s the internal carotid artery and it divides into … this tiny little guy here is the anterior cerebral artery, and then it divides into common carotid artery. So patients with COVID are most likely having large vessel strokes, what that means is that most likely cause is in here before bifurcation, or in here in the middle cerebral artery. Why is it not in the interior? Because the interior is small. So therefore it doesn’t qualify as the large vessel type.

Now, as you can see, the middle cerebral artery then divides and wraps upwards to cover the parietal lobes and wraps downwards here to cover that the temporary lobes. So here’s a side view of this side here, very beautiful picture, I love this picture. You can see that if the occlusion is happening in the common carotid or middle cerebral, then all of these [inaudible 00:23:49] are going to be shut off. That means all the neuro cortical areas that are in this region are going to be hypoxic, and therefore going to go show [inaudible 00:24:00]

Now what’s in this area. If you remember your scalp acupuncture, there is the sensory line, the motor line, and that’s in relation to the central sulcus. So, where is the central sulcus? The central socket is in here. Okay. There’s just most promise sulcus over here. So interior that to the motor [inaudible 00:24:23], that is a somato sensory. So this means that somebody who suffers with a middle cerebral artery stroke is going to have sensory and motor dysfunction.

Okay. And even though the medial part, which is the blue “A” part, this is the region that’s more where the lower extremities are located, even though it is not part of the middle cerebral artery distribution, there is some overlap. So you can still expect patients to have lower extremity problems. And I’m of course, referring to the homonculus map, along the central sulcus, where if you recall the medial one-fifth is supposed to be the lower extremity, the middle two-fifth would be the upper extremity, and the lateral one-fifth would be the face.

So let’s approximate that on the picture here on the top right, in this area over here would probably be the lower extremity around here. Around here, would be the upper extremity. And when you get down to the park, closer to the Sylvian fissure over here, which separates the parietal lobe and the temporal lobe, you’re going to get closer to the facial areas. So these patients can obviously expect facial drooping, facial motor deficit, upper extremity, and to some extent, low extremity also.

Now I’m going to take a little segue now and talk about what other things are involved other than just the occlusion. There’s something that is called SIC, which stands for Sepsis Induced Coagulopathy. So this means it is a coagulation of blood clot that’s induced by having a bloodborne infection. So scientists now know how the virus gets into our bodies, through a type of receptor and uncertain cells called ACE2 receptors. “ACE” stands for Angiotensin Converting Enzyme. And these type of cells I’ve found on lung cells. So no surprise COVID is primarily an upper respiratory airway disease. It’s found in the small intestine. So perhaps this can explain why some patients have gastrointestinal symptoms with this disease. It’s found in endothelial cells, meaning these are the lining cells of your blood vessels in the dyadic system.

So now we can see how this actually can attack the vascular system and lead to severe vascular events. And it’s found in smooth muscles in the brain. So no wonder people can develop neurological central member system symptoms as a result of this infection. Now I’m no expert on the complicated receptor cascade that regulates the inflammation and coagulation in the body. So I’ll just summarize it for you: it’s two types of receptors are known to activate cardio-protected or neuro-protected effects inside the body. Now, when COVID-19 infects us through ACE2 receptors, it depletes the receptors. Meaning whichever function that these receptors are supposed to do physiologically can no longer be accessed. So what this means is that our body is in a less, or more compromised cardio-protected in your particular state, leaving us one type of receptor to act unopposed thinking about Yin and Yang regulation.

So what is one activating? A swine type of receptor, ultimately results in cascades, sickening cascades, that activate genes that lead to inflammation, and coagulation, and even hypertension’s that embody. So, as the cognition is not bad enough, now you have high blood pressure – you’re more likely to cause a stroke, right? So it is because this virus has the taste for these two receptors that is supposed to be neuroprotective for us. But, as a consequence of these receptors being also found in the brain, it’s a double whammy. You are now set up for inflammatory and coagulatory disaster.

Now scientists are proposing different ideas of how this lead to damage to the brain. We now know that there is more inflammation in the body, because of the unopposed ACE1 cascades inside the body. But what that inflammation does, is that it can actually lead to damage, or breakdown of the blood brain barrier. So the bumping barrier is a very delicate piece of barrier inside our body. And if it is broken down because of inflammation, that spells doom. What happens is then the inflammatory cytokines in your body, now can cross the blood brain barrier, and reach the central nervous system. So it’s, it’s just bad on top of that. You may have heard about cytokine storms that happen in this patient is actually your body’s immune response. That is hyper immunity response towards the virus that is actually causing damage to tissues and organs that certainly can also affect the brain now ,because it’s got causing breakdown of the blood brain barrier.

So I think that’s really interesting information about the neuro-physiological mechanism. How this virus affects us and it gives us a epidemiological appreciation of how this disease can manifest in neurological ways. Now I’m going to share with you some of my ideas about how we can help these type of patients using areas in my research that I’ve done about the peripheral nervous system and the [inaudible 00:30:54] system. This is a map called a Brahman area map where the different processes of the brain had been compartmentalized based on different functions. I showed that here, just as a quick reference for you, because in my upcoming slides, I will be talking a little bit about some of these areas.

So one of the most common peripheral nervous system functions was Anosmia, which is loss of smell and Ageusia, or hypergeusia, which is loss of taste. So how can we possibly help patients with this? First of all, we need to say the [inaudible 00:31:38] nerve one, which is our olefactory nerve, is way deep inside the brain. It’s not accessible. And unfortunately the olfactory cortex is also not accessible. It’s not posting up to the surface in the brain for us to be able to affect it through scalp cap acupuncture. If you go back to the previous slide, you’ll see that olfactory is a dark orange. The dark orange is actually area 34.

Okay, so if you see this, this is actually in the midline. This is the lateral surface, this is the midline. So it’s actually on the inside of the temporal lobe. It’s not accessible, to too far in for acupuncture, [inaudible 00:32:11] . So what can we do? Fortunately, we have points that have been passed down that are supposed to have some effect on the nose and sense of smell. That’s over, located on the midline of the scalp. But let’s take a look at the new anatomy and see if it actually makes sense based on what we know about the new anatomy of the nerve supply for the nose. I want to talk about the anterior ethmoid nerve, which is actually from the opthalmic division V one of cranial nerve five. And, let’s take a look at that.

So, anterior ethmoid nerve, here’s the ganglion of the trigeminal nerve and there’s, there’s your V one, V two and V three. So as part of the V one, you have this nerve here that branches into the posterior ethmoid, anterior ethmoid, see how it goes and makes it a little hole in the foramen, in the back of the eyes. So from here, it goes into the cranial vault. I’m going to give you a different view at the next slide here.

So it comes out of these foramens over here and these nerves actually supply the meninges. So here’s the interior meningial branches and anterior ethmoid nerve, that supplies the meninges. But, because this cross section is horizontal, you don’t appreciate how high up this innovation goes. So this next picture shows you that the opthalmic division of V one and specifically the anterior ethmoid nerve, innovate this bony membrane called the falx cerebri along the midline.

And, it gives credence to the notion that these points that have been passed down to us, global area 20, all the way to 23, 24, which is on the midline, or which is innovated by the anterior ethmoid nerve, can possibly affect this nerve. So, what’s the big deal about affecting these nerves? Well, this anterior ethmoid nerve not only just innovates the meniges, these same nerves or branches now innovate the nasal cavity and septum. So as you can see here, the anterior ethmoid nerve, after it innovates the meninges up here, comes very close to the olfactory ball, by the way. So, we don’t currently don’t have permission to confirm this, but normally what we know about the nervous system, oftentimes there are communication branches that might be able to affect the cranial nerve of one olfactory nerve.

But, even if it doesn’t, this nerve, has an external branch that goes outside the [inaudible 00:34:59] of skin, but an internal branch that innovates the septum and also the nasal cavity. So this nerve gets information about the amount of mucus or dryness there is in the nasal cavity, and, presumably, your nervous system can regulate the amount of moisture in your cavity. And, we know that dry nose is related to, mucus member is needed, moisture is needed for fragrance particles to adhere, and therefore more likely for us to detect the smell. Perhaps by modifying the internal conditions of the nasal cavity, even though we’re not affecting the cranial nerve one directly, we are making it more favorable for the cranial nerve one to actually be able to detect smells and fragrances. I thought it was pretty crazy that these points that we learned on the anterior aspect of the midline of the scalp, to do with the nose, actually has hard cranial nerve-related explanations for how they can affect the nose.

Now, a couple of case. The gustatory cortex is something that is accessible. So, the gustatory cortex is actually Brodmann area 43. It’s a tiny, tiny little area, basically at the junction of the Sylvian fissure and the central sulcus. So you can see here, this part here is the central sulcus. So, anterior to that is a motor, posterior is a motor sensory. If you continue all the way down, where the motor sensory and the temporary lobe meets, that’s Brodmann area 43, which is the gustatory cortex.

And, based on the MRI research that I’ve done, and talked about it elsewhere, we have a chance to affect this area, but it requires a special needle technique, called a cross threading technique, where you would thread down from global area five and thread anteriorly from global area six, and that will allow you to cross intersect of over Brodmann area 43, which is a gustatory cortex. So if you’ve reviewed the vascularization of the middle cerebral artery, and with the parts that it affects, you can see why it would affect the taste, because that’s the gustatory area is part of the middle cerebral artery domain. And, therefore can explain why patients with COVID may have loss of taste, if they developed central nervous system type of symptoms.

Now, another way we can possibly affect the taste is using nerves called lingual nerves. And, these lingual nerves ara a branch of the mandibular division of the trigeminal nerve. So remember, the trigeminal nerve has three divisions, the mandibular is V3. Now, even though this is, strictly speaking again, a sensory nerve, it is not responsible for taste. In fact, the tastes of the anterior third of the tongue, as the comments here are written down for you, is supplied by the facial nerve. So, just sensation is supplied by the lingual nerve, but the taste, special sense taste, it’s essentially beneficial there. However, the facial nerve relies on the lingual nerve to convey its nerve fibers back to the brain. So, this is the reason why patients who have damage in the lingual nerve, either due to dental procedures and whatnot, can oftentimes cause them to feel like there’s a metallic taste in their mouth, or a foreign taste, or a lack of ability to taste.

And, so fortunately for us, we have acupuncture points located right below the tongue to affect these lingual nerves, and that’s the extra points Gingy [inaudible 00:39:01] . So, puncturing these points, even though it doesn’t affect the special sense directly, it provides conveyance of the special sense nerve fibers back to the brain, which might be able to help to receive more signal about taste to the brain. Now, early on, patient people also published ocular motor dysfunctions associated with patients who have COVID-19. Two different research groups have presented information how these patients may develop ocular motility deficits or ocular motor palsies. And, even though the case number is not very high at this point, again, you’ve got to think about this. People who present with either of the issues, and if they’re asymptomatic, are not going to be sent to isolation or sent to the infectious diseases.

They’re going to be going to the neurologist, or even in this case, ophthalmologist. By the way, the first doctor in China who blew the alarm on the COVID-19 was an Asian ophthalmologist. So, don’t let the fact that these cases don’t seem very high dissuade you, because it might simply be a case of lack of reporting. So in any case, how may we as acupuncturists help patients who are suffering Oculomotor Palsy, possibly as a consequence of having neurological dysfunctions from COVID infections?

I need to briefly introduce you to something called a frontal eye field. The frontal eye field, we talk of the Brodmann areas, right? It’s located in Brodmann area 6, so you can have a look at that in the map in a moment. And what happens is that this part of the brain is responsible for controlling rapid changes in your eyes in the left and right direction. It’s called saccadic movements. So patients who have dysfunction in this areas of the brain, affecting this area of the brain, may manifest inability to have rapid eye movements. This is also called contralateral horizontal conjugate gaze palsy. So if you recall, the American paper show you the five different patient cases. One of the symptoms that they had was gaze preference. Okay? It’s because they are lacking the ability to see both sides so they have a preference for one side.

Now, how does this affect the parts of the brain that actually controls cranial nerves III, IV, and VI, that actually is responsible for the eye movement? Based on tractology or connectivity studies, neurologists have found that the frontal eye field actually makes connections with the midbrain, where these cranial nerves can make the eyes form.

So again, these midbrain structures and cranial nerves are too deep for us to get affect directly. But pressed indirectly through the cortical connections, neurocortical connections, we can have a fighting chance to affect ocular motor systems. I’m going to show you my research about this. You’re looking at the correspondence of the scalp and the cortex, specifically operators 16. And I was really cool about this and I love the chorus, but that when, when the Eastern West converged gallbladder 16 in Chinese is more strong. It means I window. Hello? The name is telling you that this point can do with the vision and that it actually correspond to frontal eye field, based on modern research, is just too good to be true. So where is this specific to this front IFU in humans? A lot of research in animals suggest that it’s in Brodmann eight, but we now know that’s incorrect.

It’s in problem in six. And so where is that? If you look at the yellow data line, it’s where the superior frontal sulcus meets the precentral sulcus. So here’s the central sulcus, okay. Where we divide the motor sensory and there’s an OMP. So, and then you have the premotor area or the pieces of gyrus right in front of that, it’s called a precentral sulcus where the precentral sulcus meets the superior frontal sulcus. This is superior frontal sulcus there. This one over here look other broken is the inferior frontal sulcus. So in a case where the front end superior from this office meets the precentral sulcus. Now the bird side view superior frontal sulcus meets the precentral sulcus. This area is where Brodmann six or prefrontal sorry the frontal eye field is located. And we have a point called LAR 16, which is just right in this area. If you thread it, if you’re familiar, scalp acupuncture along the Meridian, you will cover this area beautifully. And therefore you will be able to affect from the eye field and affect ibogaine and movements.

I’m going to just finish up with a case that I recently saw of a showcase. I tongue in cheek, call it the case of shotgun at time of Corona. And this was an 86 year old male patient who in early April, he, he and his family cannot be exactly sure exactly. When, where he started have developed slurred speech. Now he has the risk factors such as hypertension, diabetes, mellitus, and other non directly related symptoms. And nursing does comorbidities such as them freaking urination as a result of enlarged prostate. He’s had a history of Bell’s Palsy in his forties. Now several weeks before he had a stroke, he has some poor sleep. So it’s not sure whether that sleep was related to that’s just a coincidence or related to poor sleep having caused hypertension poorly managed by any case, he was admitted to the hospital for one night.

And because of symptoms was start to already showing signs of very fortunate men or already showing signs of improvement. He was discharged the next day. And, and which is atypical should typically, when you have a symptom of stroke, you are in the hospital for very longer. Not sure this is change in policies is dependent on the fact that there’s some lack of resources and the staffing during this time of COVID that the patient, since it was not life threatening was sent back home, by any case in addition to star specie also presented with left sided arm and leg paresis, and he felt extremely tired. I remember one of the symptoms, one of the only symptoms that, one of the five Americans that had the show with just lethargy, right? There’s no other covert, listen to this, man didn’t have any respiratory problems’ fever and such, but it doesn’t mean he’s not positive.

And for all the research that we’ve seen so far and the family noticed that ever since having a stroke is, can seem to have Mark and the aged. And, is just complaining about tiring all the time. He has a dark tongue okay a dark purple tongue [inaudible 00:46:46] that we talked about things like coral coding, which means a lot of phlegm cold phlegm inside of the body, which is we know cold, also contributes to [inaudible 00:46:58], right? So the pictures are triangulating quite nicely, unfortunately this is actually a family friend of my receptionist, and because the clinics closed due to mandating to be closed because of public health policies, he’s unable to make an acupuncture appointment with me or with anybody.

So it wasn’t until we will reopen on June 2nd, he was able to get his appointment. And so on the very first day that I was back on June 6th, he saw me for acupuncture and to date, we’ve had four sessions so far, and I’m happy to say that the results have been quite favorable after one treatment he said that his left leg, which is the afflictive site actually now feel stronger than in his right side. Okay. So patients, maybe there’s a little bit of a, a good patient and practice rapport there, maybe a little bit of psychological effect, but Hey, I’ll take it. And, but so far there’s no change in the arm strength just yet, which is actually expected those of us that have experience doing neuro rehab know that arm loss of function or paralysis is harder to regain than leg paralysis. But by the end of the fourth session, patient Ashley left the treatment room without taking or, quote unquote, needing his cane. So presumably that is indicative that his legs felt so strong that he forgot that he needed the cane.

So, that’s the latest case I can share with you all. I don’t know for certain that it is a case of COVID, but I’m using extreme PPE precautions, and I am suggesting that this case should go get tested despite being asymptomatic. So I thank you very much for your attention. And if you have any questions, just message me. If you like this presentation, don’t forget to tell your colleagues, don’t forget to let others know about it. And if you enjoyed it, show us some love. Thank you very much.

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Dr. Virginia Doran

AAC-Beyond Heart 7: Alternative Approaches to Insomnia Repair

Click here to download the transcript.  Click here to download the slides.

Hi, I’m Virginia Doran, your host for another edition of, To The Point. Very generously produced by the American Acupuncture Council. Today, my guest is Daniel Bernstein. He’s been a licensed acupuncturist in New York city since 1995, and around 2008, he started specializing in insomnia. And this year, 2020, he came out with a book called, Rewired for Sleep: The 28-Day Insomnia Repair Program. And he’s soon also to release a book dedicated to practitioners called, something like beyond hard seven alternate strategies for treating insomnia.

I think you’ll find it very interesting, and it’s something if you don’t have yourself, certainly some of your patients do, especially at this time. So Dan, please welcome, and tell us about your approaches to insomnia, because I know it goes beyond just TCM. Tell us what you think as practitioners we ought to know.

Great. Thank you so much, Virginia. I really appreciate you inviting me to share what I have gathered over the years. And thanks also to the American Acupuncture Council for setting this all up. It’s a great service that you all do. And yes, I’m Daniel Bernstein. I’ve been a licensed acupuncturist since 1995. I have a practice Blue Phoenix Wellness in New York city. And again for the last 12 years or so, I’ve been focusing on sleep and sleep related issues. In February of this year, I was pleased to release a book and I’m going to bring it up, here it is. It’s called, Rewired for Sleep: The 28-Day Insomnia Repair Program.

I’m just going to go to this quote here, which is, “Put your thoughts to sleep, do not let them cast a shadow over the moon of your heart. Let go of thinking.” And I love this quote by the Persian poet Rumi, because, as someone who’s patients are often caught in the crossfire of self-talk when they’re trying to sleep, this quote sings to me, it has an elegance to it that calms my heart down and puts me almost into a meditative state as it is. So I’m going to go on here. Let’s go to the slides please.

And I’m assuming we’re at the slides. So that’s the quote I was talking about, “Put your thoughts to sleep, do not let them cast a shadow over the moon of your heart. Let go of thinking.” Today’s goals are going to be pretty simple. We’re going to talk about the importance of sleep, why healthy sleep matters, treating insomnia, an overview. We’re going to talk about a case history. I’m going to talk about mind traps, is what I call them. And then I’m going to show you all a simple exercise that I show to my patients who have a hard time sleeping.

So, how sleep has changed. This healthy sleep means sleeping eight hours nonstop. And in my first go around with the book, I wanted to do a comprehensive, even exhaustive book on treating sleep issues, including acupuncture strategies, herbs. And instead I wrote a book that was targeted for the lay person, but that acupuncturists can use as a template for helping their patients get a good night’s sleep. Now I’m working on the second one.

And while I was doing research for that book, I began to question what healthy sleep is? Among the ideas that we take for granted right now, is a belief that in order to be fully rested, we’re supposed to sleep continuously for seven and a half, eight, eight and a half hours a night. But this idea that we’re supposed to sleep continuously is really a recent one. And it’s a construct of the industrial revolution. It wasn’t until a vast numbers of people had a report for work at eight o’clock in the morning, that the idea of sleeping eight hours through the night even existed.

You see before that, what was common, was people had first sleep and second sleep. Okay? And in that more natural cycle, a person might wake up at one o’clock in the morning or two or 2:30, and use that in between time, they’d get up and they might feel feed livestock. They might talk, they might meditate. They might eat something and then gently and easily go back to sleep. So this recent idea that we need eight hours continuously and that anything else is frankly wrong, implies that if our sleep patterns stray from the norm, we’re somehow failing at sleep, okay.

Now what that does is, it creates an immediate anxiety. If I wake up 2:30 in the morning, and I think I’m supposed to be sleeping, kicks in some cortisol. It feels like I just drank two cups of espresso and I’m off to the races. So one of the things I tell my patients is, it’s okay if you wake up. In fact, you can just say to yourself, it’s okay if I don’t sleep, you can get up and you can rummage around for 10, 15 minutes. I tell them that they can actually, just do a little odds and ends and then naturally and easily go back to sleep.

When did they start saying that it didn’t have to be uninterrupted?

When did they say that it had to be interrupted? You’re saying.

I hadn’t heard that before, that it doesn’t matter. I know in certain cultures, people have their siesta, you traditionally have a nap in the afternoon and therefore you’re…

Right. So, you’re asking, when did people say that?

Yeah, I just wondered, where you’ve seen that as a resource or if that’s a standard.

That it need not be eight hours you’re saying?

Or that it need not be uninterrupted.

Well, as I said, historically, it has been such that people did not necessarily need eight hours sleep. That uninterruptedly, it was common. My resource was the New York times. And it is talked about by Cervantes and Don Quixote, where he talks about Pancho, censor, all eight hours in without problem. But he would get up in the middle of the night and rummage around and then go back to sleep. So it’s part of the historical norm. Certainly people who worked in farms and such would understand that it was all part of the larger cycle. Does that answer the question?

Yeah. Can people go into deeper levels of sleep if they are sleeping for shorter periods at a time?

Well, an hour and a half is typically a REM cycle, typical four stage cycle. So if you’re sleeping three hours, then you’ve completed two stages and then you can go back and sleep another two or even three cycles. So yes, as long as you’re working within an hour and a half cycle of the REM cycle, you’re good. It’s just, it’s something people don’t get enough of those cycles in. So in other words, for them, they might get only two cycles in. And so they’re feeling depleted.

I have another question. Are you a proponent of people taking naps? Because some people seem to believe in it. Some their bodies just don’t really work that way. They feel better, not taking naps, some people it’s-

Sure. I am a proponent of somebody knowing their body enough to know what works. I know I’ve had gotten some patients who came from a Cognitive Behavioral Therapy or CBT, which often uses restrictive sleep, not allowing naps, making sure people get in bed a particular hour and out of bed at a particular hour as a way of retraining the body. I’m not a fan of that. But as for naps, I think everybody’s just different. And the body changes. Some people can never take naps, and then 20 years later, all of a sudden they nap beautifully. So, we’re capable of changing our circadian rhythms in that way.

So, and we’re talking about circadian rhythms, they’ve been thrown off by artificial lighting, of course street lights were boon to society and culture, but they also meshed with the pineal gland. And suddenly we were no longer going to sleep at dusk and waking up at dawn. So that was totally out of the window. So that on top of recently, having our iPhones, our tablets, our computers at night, adds another layer of messing with the pineal gland.

So these things have really tended to mess with that most curious organ, the brain. Some sleep facts. Okay. So 44% of Americans report having insomnia, for half of them, the conditions chronic. That’s an interesting thing, because half the people with sleep issues have slept poorly for a long time. They’ve tried every drug under the sun, they’ve done sleep nitrous, they still can’t sleep. Whereas the other half, the acute insomnia sufferers, for them it’s more situational. Okay. Maybe a loss of a job, the death of a loved one, too much responsibility and it’s situational.

And the good news for them is that, it’s easier for them to go back to normal sleep, usually, sometimes not. Over 9 million Americans are addicted to sleep aids. That’s an incredible number. And the tragedy is that most doctors, almost every patient I’ve ever had, I asked them, did your doctor tell you that after 21 days you would be addicted? And to a person, they said no, but that is the simple fact that, after 21 days a person’s, whether it’s Lexapro, Ambien, any of those drugs that are used for sleep, then the person then has to get off that drug, and they are no longer on top of that.

I asked doctors, are sleep aids, risk restorative? Do they actually help the person recuperate? Usually I got a blank stare or a shrug shoulders. It was like, I don’t know. What we do know is that sleep aids, do not take a person past stage two. So this gets us into talking about the stages of sleep. Okay. So stage one is basically, the drowsiness you feel when you’re about to or you’re watching TV. Stage two is like a power nap. Stage three is where all the action is. The restorative stage of sleep, or our brain waves are slow, your body’s busy fortifying your immune system. You’re building tissue and preparing your body for the next day.

This is where also you can add muscle mass. If you’re reaching level three, then the body can add muscle mass. Stage four is REM sleep. This plays an integral part in processing, learning, and memory. And also as a response to stress. So given the stress levels we’ve got these days, it’s a wonderful thing when we get to dreaming. Personally, I think melaton gets a bad rep. Sometimes people talk about job, all these lucid dreams.

And it’s like, yeah, that means you’re actually getting to REM sleep. That’s a good thing. So if you can handle it, I’m not a proponent of knowledge on it, but I also don’t knock it, because a lot of people do. So acupuncture and herbs and self care are bridges to healthy sleep. So that is the response. I wanted to put this in here, it’s maybe a little self serving, but it’s regards to what’s going on with COVID right now.

Okay. This is a quote from Dr. Matthew Walker, author of, why we sleep. “Natural killer cells are critical components of the body’s immune system response, serving as the first line of defense against cancer cells, microbes, and other potential threats. A single night of poor sleep can impair natural killer cells activity by as much as 70%. In the short term, this can put us at risk for developing acute illnesses colds and flu, but in the longterm, it increases our risk for much more serious threats.” And so this is where I say, make sleep a really important part of your practice, because we’re doing so much more than just helping people sleep, we’re really, not only we are increasing their metabolism, we’re really helping their immune system.

That right now is so crucial. And the opposite is well, what happens with lack of nourishing sleep? Well, depression, anxiety, diminished learning, diminished immune system, toxins remain in the body. Nutrients, not going to their intended muscles, an increase in hormones that break down muscle. I believe that’s the catabolic hormones and an increase in the hormones that make us want to eat, which I guess are gremlin. We call it gremlins, but I know it’s not. So treatment strategies. Oops.

I have a question Dan.


You miss some sleep, say, normally you get seven, eight hours sleep. And then because of whatever reason, it may not even be insomnia, it might be travel or whatever, you get four or five hours sleep. Can you make up those hours or is that the little bit of damage to the body that can’t be redone?

I think it’s an interesting question, because science tells us, no, you cannot make up that sleep. That is what sleep scientists tell us. But I think it is a two dimensional way of looking at it, because somebody who’s really not taking care of themselves and they lose those eight hours, that’s going to mess them up. However, somebody is really doing self care, perhaps they’re meditating, maybe doing two gong, maybe eating, well, it sort of gets, I would say, absorbed in the greater good. So, theoretically, technically, no, but that’s a soft no. And I would say that if we’re taking care of ourselves, then it’s not a big deal.

So, getting 10 hours the next night, won’t…

That’s what they tell us. That’s what science tells us. They may find something else out next year, but I don’t worry about it. I’ve certainly lost a lot of sleep, I take. So maybe it’s just deluding myself, but I’d to believe that it all comes out in the wash as long as we’re doing self care.

How did you get into focusing on insomnia or sleep patterns?

Sure. Well, briefly, I had my own sleep issues. I went through a bunch of stuff around 1990, that put me on high anxiety, insomnia, and I went to acupuncture and it helped a lot. There was insomnia in my family, and it took me years to really see that, that I often would wake up in the morning and my mother would be in the dining room, finishing a dress that she’d spent all night working on. And so, it was a pattern of insomnia there in my family and I saw it up close. And so I do believe that, it’s a cliche almost to say, the work we do sometimes as healing our own wounds.

I think there’s a certain truth to that. And whether that is true for me or not, I don’t know, but I do find it interesting going back over many years and seeing that it was something that used to be… It would make me feel weird, because on one hand, you had this very productive mom and she’d make this dress, on the other hand, part of me was like, my God, she’s been up all night and that can’t feel too good. So whether it plays into it, I don’t know, but I think it is interesting.

So, treatment strategies. Over the longer term, helping patients sleep and to be participants in that sleeping process brings greater than success than nearly, and I won’t say merely acupuncture and herbs, because we can definitely get people sleeping again. But as we all know, we go in and out of balance, okay. It’s part of the human condition. And so as we go out of balance, people then start sleeping, not so well again.

And so in my treatment practice, I like to teach them simple stuff, diaphragmatic breathing, what can be better than just teaching somebody who breathes from their chest, to start breathing from their belly? That’s like 50% of everything, right? If they’re open to it, Qi Gong, use of magnets and Japanese tiger warmers. I have that in my book, acupressure, Yintang, Anmian, kidney one, pericardium six, kidney six, the standard sleep points.

And I just tell them to just either use the moxa with tiger warmer or acupressure. At the end, I have complimentary tools for self repair, including an exercise I’ll get into later called the five, five and five. This is Yogi. This is my nemesis. He’s my cat. And essentially he’s also, his attitude is the way most of my patients look when I first suggest that they can actually start taking care of themselves. So I thought, I think we all have patients like Yogi.

And cats have problems with insomnia.

Definitely strange. They definitely have oddball sleep issues. And the beautiful thing about when I work with patients, is if they go for it, when I first suggest they can actually help themselves, the beautiful part is that, if they do, they start getting a sense that they’re not victims, okay. It opens up all sorts of possibilities for that person. I mean, they’re going from, I’m doomed to, what can I do next? Maybe I can quit smoking. Maybe I can lose those 10 pounds. Let’s work on those things too.

And it’s my belief that the more aware our patients are, that they have this ability, the more they see the value of the subtle, yet powerful work that we do. So I don’t believe it’s like, well, they won’t need us later if they’re able to help themselves. No, that means that they will, instead of being 3% of the populous coming to acupuncture, it will be 30% or 50%. And I think it does help to help people, help themselves. Thank you, Yogi. So insomnia is not a disease, it’s a symptom, treat the root and that’s the theme for today.

We know that Western diagnosis tells us a little, and we also know that the main organ systems involved in Chinese medicine or the heart and the liver to a lesser degree, the kidney, the spleen, and perhaps the gallbladder. Okay. And often we see mixed pathologies, perhaps heart yin deficiency with Liberace stagnation. And so we treat those things that we see, and they’re all incredibly valuable.

I would suggest that before we treat what we see, when it comes to sleep, a root treatment is really important. And so unless, we treat the deeper energetic issue involved, the patient will have a much harder, getting better. So some of the root treatments are five elements, eight extraordinary vessels. I call it Kiiko style. Okay. I studied, as did Virginia. We both studied with Kiiko Matsumoto, and she does a lot of root treatments, adrenal deficiency, sympathetic dominance, blood stagnation, all of it is root treatments and then going on to symptom based treatments.

I believe that Dr. Tan’s balanced style is really a combination, as some others are calling doctor, master Tong as well, are a combination root and branch treatments, because they’re rooted in the i-ching and in the five elements. So, treating the extraordinary vessels. And by the way, give me five minutes, if I’m getting dangerously close to going over my 20. So a quote from the Nan Jing, and it talks about the extraordinary vessels being a root treatment. And the ones that are most involved with sleep are Yin and Yang Qiao and the Yin Wei.

The Qiao’s are involved with opening and closing the eyes. And this gets into, it’s not how many hours we sleep, but how rested we are when we wake up. I get people who sleep eight hours and are exhausted. They tell me, I feel I just ran a 10K, while I was sleeping and other people sleep four hours and feel incredible. So it’s clearly not always about time, the distinction is one that’s made clear by Dr. Hamid Montakab in his book, acupuncture for sleep.

He talks about differentiating the quality of sleep versus the quantity of sleep. And we can use the extraordinary vessels as regulators of that sleep. So if it’s an issue of the person, simply not being able to sleep enough, not being able to keep their eyes closed, either theoretically or metaphorically, or literally it tends to be a Qiao issue. And what we want to do, is we may palpate kidney eight, which is the Xi-Cleft or the Qiao. And if it’s tender and everything lines up, then we may treat the Qiao. We may drain UB-62, tonify Yin Qiao.

We may add points to that, since it’s around the kidneys, kidney 27 points, along the kidney channel. However, if there’s more an emotional issue and perhaps a person’s exhausted, emotionally wrung out, they’re anxious, depressed, lethargic. These are all symptoms that the Nan Jing refers to in talking about Wei issues. So, that’s an issue of depth, meaning they’re not sleeping deeply enough. And so, we look to the ways.

And so the way that we look at that is we may palpate kidney nine, which is the Xi-Cleft of the Wei channel, the Yin Wei. And if that’s tender and we look to which one is the most tender, is it the right or left? We needle that, and then we continue treating the Wei channel. So the opening point of the Yin Wei, pericardium six, and we couple that with spleen four. Again, I talk here about, verifying that Yin Wei is the correct treatment, aside from the fact that they’re typically depleted, depressed, wrung out.

Certainly Dr. Manaca used to use the Wei to start a treatment almost constantly. If you read, chasing the Dragon’s tail, he used the Yin Wei a whole lot. So then we may needle PC-6 and spleen four bilaterally, and this is the root treatment, let the patient rest for 15 minutes. At that point, we may expand the treatment in modular fashion. Some people believe in just letting the entire treatment be the root treatment and that’s okay. Certainly it’s the five elements, we see that whether an aggressive energy treatment or external dragons, that treatment is a full treatment in their root treatment.

I have no problem with that. I typically check the pulses and, go from there. What else did I want to say about that? Yeah, I always found it interesting. Let me go back to this, excuse me, considering that the heart is the emperor, I always thought it odd that why is it that there is not a heart point on the extraordinary vessels? You’d think that that would be, top of the list there. And so I went back and I see that a lot of Japanese acupuncturists do not treat the heart typically, they will go to the pericardium and protector of the heart, and certainly points along the pericardium are crucial for sleep, anxiety, palpitations, heat, all the heart stuff.

So for me, opening the Yin Wei, is such a powerful way to begin treating someone who’s having those issues. So let me continue here to, Marianne, this is a case for Yin Wei and Buddha triangle. 38 year old woman, complained of waking up during the night, agitated, palpitations, feeling heat, et cetera. My voice is going. So I’m going to keep it simple. As you can see, those are the fairly often seen pulse tongue, palpatian issues that lead us to believe that it’s a fire and water disharmony, repletion above, vacuity below. Water is not nourishing heart.

So there’s heat above. And so one option is more of, I’ll call it a TCM style. Certainly it’s a wonderful treatment, heart seven, heart six, which does clear heat. Pericardium seven for palpitations and insomnia. Yin Tang, which is a great sleep point, CV-17, heart, et cetera, et cetera. So it’s a terrific treatment. My tendency is, if I were to go that route, I might start with a year, Yin Wei or another would treatment and then go to that. Option two, go to the root treatment, open the Yin Wei, followed by Buddha’s triangle.

So, we start on the dominant hand, pericardium six on the opposite foot, spleen four. Now what I would do often, is expand that to Buddha’s triangle. So I might start first with just the two points, and then I’d expanded to pericardium six, heart seven and long nine, which is also a root treatment. However, I don’t think you can go wrong with it. And then I would add contra-laterally. Some people believe in just those three points and they make a perfect triangle on the wrist. I to add liver four, spleen six and kidney three contra-laterally.

And that is a beautiful treatment. It really handles insomnia, anxiety, palpitations, dream disturbed sleep, and it’s a full treatment. Another one since I promised that I would give them tan treatment, I’m just going to add another one for Fir-Water disharmony, that comes from the playbook of the balance method, Dr. Tan, which is a Shao Yin/Shao Yang treatment. And this goes to heart three and heart seven on the right, gallbladder 34 and 41. And then the left side, we’re treating kidney three and kidney 10 and triple burner three and triple burner 10.

And I’ve used this and it’s a good treatment. It’s an effective treatment. You have to keep doing it. You really need to see the patient for this. You need to see patient like twice a week. It’s true for all. I mean sleep is not an easy fix. Okay. I like to joke that since Sim Yao talked about, that he’d rather treat 10 men than one woman, because of the plumbing. And I to say that as he was leaving, he muttered that I’d rather treat 10 women than one insomnia patient, because they’re paying him my gallbladder 30. I don’t know if that’s true or not, but we move on.

Where does triangle protocol come from?

I think it’s part of the five elements universe, that is where I saw it originally and I couldn’t swear to it. So I hope a lot of 5E people don’t bite me on the neck for claiming it’s part of them. But I do use it as part of that, because I do believe it’s a beautiful… To me it’s a crossover between five element and balance method, it’s got a lot of stuff going for it. I didn’t get into it, but I also will add to that, sometimes again, contra-laterally, Yang points to those two, right hand, left foot. I will add, typical as to Richard Tan, I’ll do a right foot, Yang points, left hand Yang points, depending on the secondary stuff that needs to be treated.

So, herb formula for Marianne would be, Tian Wang Bu Xin Dan. Okay. That is typically for people with heart and kidney issues that wakes them up, their palpitations. They can’t sleep, they have heat issues. And just to differentiate that, let’s say from something that’s just more kidney, like Jo bi di wang wang, that’s more kidney or something that is more blood based. That would be Suan Zao Ren Tang. The Suan Zao Ren Tang is terrific, because it also addresses heat issues. But again, it’s more blood rather than Yin deficiency, which I think Marianne was presenting with.

Again, some food cures, asparagus, chicken egg, wheat, if you want to go the Chinese formula style, banana, bamboo shoot, these are all for Yin deficiency. And then finally I gave Marianne some homework. In this case, it was the five, five and five exercise. Before we get to it. Actually, I’m just going to skip it over, we may be running out of time. Yes. Or how are we doing?

I think they’re pretty self explanatory those.

Yes. Okay. So basically I treat the sleep-disordered mind a lot, and it falls into those five categories, distractions, daily regrets, real life problems, overwhelms, things I didn’t do yesterday and things I won’t be able to get done tomorrow. And then finally disconnecting from phone, computer and TV. So one of the treatments that I like to do is, and it’s so simple. It’s called the five, five and five. Okay. It helps unwind the sympathetic nervous system and it takes 15 minutes. Okay.

Basically for five minutes I have the person write down regrets, resentments fears, overwhelms clogging their mind, all this stuff that we typically start churning at night. We’re great during the day, but when we close our eyes, they start unfolding. So I tell them, spend five minutes and no more, then fold the paper, place it aside and say, out loud. “These are tomorrow’s problems.” For five minutes, close the eyes and gently massage Yintang, whatever you wish to do. I like Yintang. And at the same time, I’d tell the person, imagine that you’re in a garden, a rain forest, someplace where you feel safe, it could be in your little den.

And then for the last five minutes, I tell them to become mindful of breath. And so these are ways that we open them up to the idea of meditation without having to call it meditation. So just follow the path of your breath with your mind, down into your lungs, back up through your nostrils and just keep doing that for five minutes. And so these are, I feel stress free ways of getting someone to begin the process of unwinding the sympathetic nervous system and engaging their parasympathetic nerve system at night.

And then finally, I use something called autogenic training, and it was invented by a German cardiologists in 1931, who frankly was tired of seeing his patients dying. So he invented a calming technique that would reduce their levels of stress. It’s an eight week program. And it really helped in the way that no other Western method had, using a version of a progressive muscle relaxation.

And so I have that on my website, which is If you go to the Explorer page, you’ll see that, and I think three other recordings, that’s all free to listen to. And well, I mentioned before the exercise and rewired to give for the sleep disorder, I think any acupuncturist wanting to provide their patients with tools to combat insomnia, anxiety, stress, and PTSD can really benefit from it as well for their patients and for themselves.

Have I missed anything? So, finally, I have already popped my little book. I’ll do it one more time. Rewired for Sleep: The 28-Day Insomnia Repair Program. It’s available on Amazon in both digital and paper. And if you’d to know when the next book is coming out, please feel free to email me at I’m going to say one last, thank you to American Acupuncture Council and to Virginia for allowing me to visit and give my little talk. Thanks again.

Thanks Dan. It was really lovely having you and I’m sure people will get a lot of benefit from this book, practitioners and patients.

Thank you. Thanks.

All right, so we’ll see you all soon. Thanks for tuning in, again, I’m Virginia Doran, , and sayonara.

See you.

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Yair Maimon thumbnail

The Scope and Opportunity of Oncology Acupuncture

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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