Category Archives: Techniques and Protocols

AAC-Beyond Heart 7: Alternative Approaches to Insomnia Repair

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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.

Yes.

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 rewiredforsleep.com. 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 daniel@bluephoenixwellness.com. 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, luminousbeauty.com , and sayonara.

See you.

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The Scope and Opportunity of Oncology Acupuncture

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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COVID-19 Documents for the Practicing Acupuncturist

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

Stop the Spread

Office Safety

Informed Consent

Caring for Patients

Palpation in Assessment and Treatment

Click here to download the transcript.

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

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

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

Yeah, sure.

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

Yeah, timing is not good for your live.

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

Great.

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

Awesome.

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

Correct.

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

Yes.

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

Possibly.

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

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

Yeah, sure.

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

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

It’s going to be tough.

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

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

Sure.

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

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

I helped with his book.

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

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

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

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

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

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

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

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

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

Yeah, sure.

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

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

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

Yeah, sure.

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

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

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

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

Sure.

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

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

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

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

You’ve just to jump in, Brian.

Yeah, yeah, yeah.

It’s a first come first serve show here.

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

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

Yeah, sure.

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

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

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

Yeah, sure.

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

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

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

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

Horizontal.

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

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

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

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

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

Don’t you hate that?

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

Did they get somewhat better?

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

At all. At all. Okay.

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

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

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

Mm-hmm (affirmative).

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

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

Yeah, sure.

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

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

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

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

Brian, how do you like to palpate it?

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

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

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

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

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

Yeah, that’s great.

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

Yes.

It’s all opinion, of course, right?

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

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

Yeah, I agree.

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

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

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

You saw them both move.

Yeah.

That’s pretty cool.

Yeah.

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

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

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

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

No problem. Anytime.

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

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

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

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

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

Sure.

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

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

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

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

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

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

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

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

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

I think-

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

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

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

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

Yes, I would-

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

I would carry that into muscle as well.

Sure.

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

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

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

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

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

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

Yeah, I agree.

That’s true.

I agree.

That’s true.

I agree.

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

Yeah.

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

Matt?

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

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

Retinacular cutis.

Yeah.

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

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

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

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

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

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

Definitely.

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

Yeah.

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

Yeah.

I mean this is a whole another podcast or webinar.

Sure.

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

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

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

Yeah.

I’m ready.

Well-

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

It doesn’t matter to me.

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

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

Yeah, of course.

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

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

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

Awesome.

I agree.

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

I don’t know.

Okay.

We have a pretty big queue of podcasts right now.

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

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

Got you, okay.

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

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

Yeah.

All right.

Thanks, guys.

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

See you.

Okay, bye bye.

Bye bye.

We done, Brian?

AAC-Telemedicine and Facial Acupuncture-diagnosis & treatment strategies

Click here to download the transcript.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

(silence).

The Science Behind Promoting Digestive & Cardiopulmonary Balance with Acupuncture

Click here to download the transcript.

– Hi, I’m Virginia Doran, your host for this episode of “To The Point” very generously produced by the American Acupuncture Council. Today our show is called A Fresh Perspective on Zu San Li, Stomach 36, and Neiguan, Pericardium 6. The science behind promoting digestive and cardiopulmonary balance with acupuncture. And I am so honored and pleased that we have as our guest today, Narda Robinson. Narda has a very interesting history and approach with this. She has a Bachelor of Arts from Harvard, Radcliffe, a Doctorate in Osteopathic Medicine, a Doctorate in Veterinary Medicine and Masters Degree in Biomedical Sciences. She’s a Fellow of The American Academy of Medical Acupuncture, Vice Chair of the American Board of Medical Acupuncture and a former member of their board of directors. She has launched the first Integrative Medicine Service at Colorado State University and for eight years has directed Colorado State University’s Center for Comparative and Integrated Pain Medicine. She’s taught a variety of scientifically-based continuing ed courses ranging from medical acupuncture and massage to botanical treatment and photo medicine. She’s a leading authority on Scientific Integrated Medicine from a One Health perspective, having over two decades of practicing, teaching and writing about integrative medicine approaches in both veterinary and human osteopathic medicine. She’s the founder, CEO and Lead Faculty and Course Director for the CuraCore MED and CuraCore VET based in Fort Collins, Colorado. And she’s also the author of a most wonderful book called “Interactive Medical Acupuncture Anatomy”. It’s very comprehensive. She has a very interesting neuroanatomical and evidence-based approach. So I don’t know how she’s done that all in just a couple of decades because it’s really quite formidable her accomplishments. So for anybody who hasn’t seen it or who can possibly get it and now that you’re home staying in place, you might actually have time to read it. I really recommend the book. You can find it on Amazon and see some excerpts there, as well as if you search on Google, you’ll see some highlights from it as well. It really adds to our field by putting a lot of the scientific point-based research altogether with the points in, it’s a book of points basically, and explains with a really comprehensive describing of the neuro, not just neuroanatomy, of all the anatomy that contribute to the points and how that actually affects the uses of it, and basically verifies what we’ve learned from, you know, classical sources. So, I guess how I found the book was a student took my class and he was an osteopath and he came up on a break and he said, “Oh, you have to see this book.” And I was kind of like, “Yeah, yeah, whatever,” he was new at it and I just didn’t expect much. And then he showed me, I was like, “Oh my gosh.” And then I had to buy it. It’s not an inexpensive book, but with the work that’s in it and the information that has been assembled all in one place like that, it’s very valuable book, I really recommend it. It can be used however you think about things, but it can help verify things for your patients and the field of Western medicine. So without further ado I’d like to introduce Narda, and give it to her to explain this from her experience and knowledge which is formidable. So Narda, thank you very much for being here.

– Thank you, thank you Virginia, it’s great to be here. We’ll be talking about, Zu San Li and Neiguan and while I am presenting a big focus on the points themselves, I am going… In clinical practice of course we use other points that are mandated or suggested by the patient’s presentation. So this is though is an opportunity to see how some of the mainstay approaches or the mainstay points such as Stomach 36 and Pericardium 6 work from a neuroanatomic perspective. So as you can see here on the left, we have Pericardium 6 in the forearm and Stomach 36 here on the pelvic limb. And just in a different form here is the individual with a different view of the hand so of course when we move around the point locations change, here’s Stomach 36, in just part of the larger context because when we again want to use these clinically for something like Stomach 36 we might want to treat knee pain, we might want to treat pain in the calf, we might be addressing immune function. But if we are working with something for digestion from my scientific neuroanatomic connective tissue approach, I am going to be interested in how stimulation of this point, whether we’re using needling, pressure, heat, laser, whatever it is, how is that going to affect internal organ function? Because I think that that is one of the perplexing ideas from Chinese medicine where we can say it balances Yin and Yang or moves Qi, but we also have information now on exactly how this is going to affect internal organ function. So the objectives for today are three. We’re gonna review some of the Chinese medicine indications and mechanisms for these two points, we’re going to identify key neuroanatomic connections between each of the points and areas of the spinal cord and, or brain. And describe how knowing the structural underpinnings, which was everything my book was about, but of these two specific points, how we can link that directly to the physiologic outcomes that happen from needling, which I as a clinician, as a veterinarian and an osteopathic physician, I appreciate knowing how the points are going to influence my patient and to know that there’s quite a bit of scientific background and backing for what I’m expecting to see. And I will talk as we go forward about how to search for scientific literature so that when you want to come up with papers that substantiate what you’re doing, that you can see how easy it is to do that. So with the images that I use in this, if they are not from Shutterstock photos that I have it mentioned here, so this is from TCM Wiki. But just looking at the stomach channel as a whole, we can see that there is often described in the Chinese medicine kind of literature, a divergent branch that goes to the organ after which it’s named. I mean I learned acupuncture from I mean a variety of perspectives. The Chinese component, the French energetics, the scientific approach, neuroanatomic connective tissue. So I had that as a background. And so this idea suggests that you have energy or Qi going into the stomach somehow and hence the stomach line is a name. And that maybe the idea from that would be that, okay, you stimulate Qi and somehow there’s a branch that takes that to the organ. But what I’m going to add to that is the knowledge about the actual structures that we can dissect and feel and test that give us objective understanding of what these sites of stimulation will do. So again, this is one of the images from my book and it’s with all the different layers on. Because what happened was this was from the Visible Human Anatomy Database and there were computer animators that put it all back together so that as I was photo editing for 15 years, I could add in muscles or take away muscles and just see vessels and nerves or organs or things like that. So by starting with the points on the surface and then going down and removing the skin layer from photo editing, then I could see the different structures that I would be stimulating as an acupuncturist, plus using neuroanatomic information from other sources as well. But this is Stomach 36, as you would see with the skin gone. And the description being on the anterior aspect of the lower leg, three cun below Stomach 35 which is up here in green and one finger breath from the anterior crest of the tibia, which we can also look at as a tibial tuberosity right here. And this is a cross section which I really appreciated learning by dealing with these cross sections, learning the different depths of muscles and fascia and vessels and nerves once you go into the skin, both from a safety perspective as well as a tissue activation perspective. So here on the left, I have cross section through Stomach 36 and I’m showing that, sometimes I’ll say cranial tibialis ’cause that’s what the terminology is as a vet, but the anterior tibial, and it points to how at least in an individual like the person that made up the Visible Human Database was, how far in depth we can go where it’s safe versus when we start to get into other structures. But the point of this slide being that research has shown also that we have all the different muscle afferents available to us at the point. So groups one, two, three and four, which have different levels of myelination and whether they are mechanoreceptors, so transmitting information about light touch or vibration or the subtle activation from an acupuncture needle or nociceptors, so they don’t have any myelin and they’re more conveying pain. So typically what we are thinking about as far as Stomach 36 for indications are have to do a lot of times with digestive things; gastric pain, vomiting, abdominal distension, diarrhea or constipation. But then some mood-based things, even epilepsy or depression or insomnia. Then of course local things for the knee pain or we have leg weakness or paralysis, maybe even a fibular or used to be called peroneal nerve injury. So just coming into acupuncture, one might think, “Okay, how does one point do all these things?” And so that’s what I loved in the process of those 15 years of putting this book together. Coming from a standpoint of just really relying on the Qi in the Chinese medicine approach with some of the scientific background in there. But then seeing as I would start with the neurologic connections local at the point and then put together where they hit in other reflex zones within the central peripheral or autonomic nervous system. It to me explained the effects that were these conventional indications. And so it didn’t leave anything more for me to wonder about. But just to review that the point Zu San Li changes to Leg Three Miles when we convert that to English, which has a lot of different interpretations that we don’t have time to go into. But the Chinese medicine description is that it will tonify Qi and blood, harmonize and strengthen the spleen and stomach, strengthen the body as a whole, and the Wei Qi raises Yang, calms a Shen, activates the meridian, stops pain. Okay, so that’s quite a bit of complexity there. And so what can we start to see? So–

– You know I always say that Stomach 36 does everything except wash windows.

– Yeah, yeah, that’s good. Or like with laser therapy, sometimes when we lecture, talk about it treats everything but death. So I guess maybe you could, I mean you say it tongue in cheek, but that’s a good point, Virginia, yes. So with Helene Langevin’s work, from the ’90s that the needle-tissue interface has been described as, as you see here being able to wind around the collagen that’s in that connective tissue, and then with that we are deforming fibroblasts which is activating their metabolism, causing them to make all kinds of changes through their structure function, just alterations, but there are also nerves in the vicinity. So while we are doing some connective revisions or interactions causing some fascial relaxation, even several centimeters away, there’s also that profound effect which is on the nerves which is neuromodulation. And that will get us into some of the analgesic effects and some of the autonomics or the parasympathetic, sympathetic or the digestive system, the Yin-Yang general balance. And then just taking this from a website talking about modulation, like what is modulation? Well, it is putting in your own signal that is going to interface with what is already there. And so you are modulating or you are changing the status, the resting tone of what that organism is going through. So that when there’s an imbalance, we can come in with our somatic afferent stimulation, meaning on the surface, the somatic afferent, the afferents, the nerves are coming into the nervous system equation and then we are stimulating it initially, but the body is going to respond with a modulating effect. So we are relying on the intrinsic healing mechanisms, self-maintaining mechanisms of the body to take our input, our somatic afferent stimulation with the needling and do what it normally does, bring it back to normal. So it’s like, “Oh yeah, right, this is what normal is.” And we’ll talk about how that happens. And it’s comprised of some neurotransmitter shifts, whether peripherally or in the spinal cord or in the brain, and then other things that happen with larger brain networks. For the analgesia or the pain relieving approach, we can distill some of it down to what happens from our input. So not a pain causing, that’s where having a nice gentle approach with acupuncture is so important where we’re subtly manipulating the needle and that is going to activate the mechanoreceptors preferentially. And what that means, so those receptors respond to light touch or vibration. Think of just a nice gentle soothing electroacupuncture. These are thicker well myelinated fibers that are important in pain control when they get to this dorsal root ganglion. So they’re the good guys. I mean the ones that convey, they’re also good guys ’cause they convey information, or tissue deformation. But let’s say you had some kind of pain elsewhere or if you needle too aggressively, that is sending information through these other types of fibers, the nociceptors. So we really wanna touch or inputs in the way I teach is to be gentle and well-received. There are gonna be some responses in the dorsal horn of the spinal cord that connect to that hand in this case. And those light touch receptors, the mechanical receptors, I think through the next side we’ll see the gate control idea of pain. They can help shut down pain influencers that are coming into that same location in the spinal cord. Of course the big complexity of the whole thing with acupuncture analgesia is that we’re gonna be affecting the whole brain and different pain networks and the thalamus and limbic system, all kinds of areas with our acupuncture analgesia. But just to distill it down right now we have those three initial areas that we’re concerned about. This is just an expansion of that spinal cord dorsal horn area where if we have acupuncture here, they have skin massage. If we just say that’s acupuncture, acupressure done gently that we’re bringing that information through these mechanoreceptors, the well-myelinated mechanoreceptors coming in here. And they are helping to block the pain impulses from on that same ultimate neuron that’s going to come up and then send impulses to the brain. So that’s just a peripheral way to block the pain impulses. This is a Stock photo. This is not necessarily how I would approach knee pain ’cause I would be tailoring it to the exact expression and location. But in general, this is electroacupuncture and I’m bringing that in because here’s Stomach 36 more or less. And they’re doing a typical four treatment before needling approach around the knee, and took it up to electroacupuncture. So if we look at knee pain, how is Stomach 36 participating in that? Well, there’s some local pain shutting down, so peripherally, but then there’s also going to be affects, I like to consider all the anatomy that’s being affected, but we don’t have really time to go into that much here. But there’s also even for knee pain going to be impulses that are going into the spinal cord so that ascending to the spinal cord and brain that are also going to be pain alleviating. And so that’s important to know from a neuroanatomic perspective ’cause we can reinforce that with points on the back and the spine that will help shut down pain information that’s being communicated in the relevant levels of the spinal cord and really reduce what we call peripheral sensitization of nerves that are going to the knee. But it’s never really knee pain. It’s we, I as an osteopath and a veterinarian, I mean we look at the whole body and what are the compensatory biomechanical alterations? Where are the myofascial restrictions? It’s really a whole body kind of thing that in clinical appreciation. But if we’re talking about digestion, one of the things that we can be aware of is that Stomach 36 afferent information is coming into the cord at the sort of the lumbosacral junction. And so when impulses arrive into the cord, there’s something called somatovisceral and visceralsomatic reflexes that we’ll look at as the next slide. Then there’s another component that goes to the brain that will cover. But seems a little bit confusing here. But let’s say we have a dysfunctional viscous, so a problematic organ in on our belly somewhere and that is sending afferent pain impulses into the cord. If those go unabated then we could get tenderness to palpation. This is the whole rationale with the diagnostic exam with the Back-Shu and Front-Mu points. So that is crosstalking with somatic or muscles, skin and subacute areas so that we get essentially spinal reflexes that are originating in a viscera of viscous. And then having a somatic presentation where we can go along the back and find tenderness to palpation and think, “Okay, is that local on the back “or is that from something inside?” And we put that together with the whole patient presentation. So there are lots of reflexes like that to consider whether we’re coming from a viscous and going into the muscles or we would come from the muscles and the external. So if we’re doing a treatment and we are involving low back points, then through these reflexes working the other way, somatovisceral reflexes, we can help to shut down some of that internal pain. So that is why I would use those baby back points in addition to a Stomach 36, I’d be palpating and seeing what’s involved. But here are typical bladder points that are associated with the spinal nerves that in my framework that somatic afferent stimulation is being picked up by the spinal nerves going into the spinal cord and having repercussions there as well as going to the brain. But if we’re talking about where’s that impulse from Stomach 36 coming, then we talked about local peripheral nerve effects very briefly ’cause of not much time and then spinal cord effects and reflexes. But then we’re gonna go up to the brain and this is really what explains a whole bunch of Stomach 36 effects. There’s a little site in the brain stem in the medulla called the nucleus tractus solitarius. Here’s just the brain stem looking at that. And the interesting thing about this brain stem center is it sits side by side with this vagus nerve, which is actually longer than this. And the vagus nerve is what is covering, you know that’s doing most of our parasympathetic nervous system. So versus the sympathetic system, which is fight or flight, this is more you’re vegging out, restorative, calming down kind of thing. And so it has effects that are going to balance out that fight or flight sympathetic system. So it’s gonna slow your heart rate, it’s going to help digestion flow and all the secretions from the gland, stimulate bile release, help regulate blood glucose, help you with elimination and digestion and all that. And for the cognitive effects, I mean, vagus nerve stimulation, so this parasympathetic medic effect is so good that it’s like they implanted vagus nerve stimulators for things like depression and epilepsy and different things. But it’s like we have the ability with Stomach 36 and some other points to actually give parasympathetic benefits because of these long loop reflexes that we now understand. And these are… So the nucleus track, the solitarius is one of the two main somatoautonomic convergence sites. What do we mean by that? This is where the somato, so the somatic input from Stomach 36 is going to join at this site in the brain stem called the nucleus tractus solitarius with inputs from the vagus nerve. So 80% of the vagus nerve that’s coming into the brain, which we just saw a bit ago, is afferent information. So the brain really needs to know a whole bunch of information about what’s going on elsewhere. And so that is coming into this site, the nucleus tractus solitarius along with information from the body of which the Stomach 36 has a nice big connection there. And then it’s like this operator here. So if she’s the nucleus tractus solitarius, she’s getting information from the Soma, which could be Stomach 36, and the viscera, which is your guts and things, and then making decisions. So, what she has to do is, well what she does, who knows how this all happen, but it because of her side-by-side connection to the vagus nerve, the nucleus tractus solitarius can up or down regulate vagal nerve output. So that means if you have constipation, you can change it and the vagus nerve can change its activity so that it speeds up digestion. So this is a structural piece of how, might call it Yin-Yang balance, but it’s how our body keeps things stable. Our temperature, our blood pressure relatively, we have these real estate centers in our brain that are in command of doing all this and keeping us alive on a day-to-day basis. And it’s really very amazing that we know this and that we can have pathways with acupuncture to deal with it. So Stomach 36 for GI problems. It’s that homeostatic balance whether we’re dealing with the long loop reflexes to the brain stem or and the lumbar segments as well. So it’s a way that we can understand how even disorders like this, which is our representation of inflammatory bowel disease. When the nucleus tractus solitarius is not doing its thing, then there is a, and with its parasympathetic effects for the vagal nerve, then things can get out of balance. And when the sympathetic nervous system, the fight or flight area takes over too much, then we get a pro-inflammatory state. So not just fire or too much Yang but its actual inflammatory state and if it’s going to affect the GI track, then we can get an inflammatory bowel condition. So by having Stomach 36 in there, then we are pushing the balance of the body to a parasympathetic level, calming things down. So if you just go to pubmed.gov you can do, see this as well. And all I did was I did Stomach 36 and NTS for nucleus tractus solitarius. And you can see various research articles, you can select for free full text if you want so that you can get this whole article for free. It’s online shopping. You don’t have to take out your credit card. So there are so many studies that support this idea that it’s a great way to move forward and to be evidence-based with acupuncture. So we just have a few minutes and just–

– You want to, I don’t know how much you have to speak about Pericardium.

– Okay

– Do you want, anything else to, you wanna discuss about Stomach 36 and do Pericardium 6 another time? Or do you wanna move on?

– No. I think we can show like that there’s another point that has similar effects.

– Okay.

– But I think we’re good. Because it has a different brain stem center for the most part and a different, I don’t know, just clinical applications. So Neiguan, Pericardium 6, again, instead of just thinking maybe there’s an energy connection there, we can look at here and its proximity to the median nerve and indication. Some of which overlap. So the nausea, vomiting piece, that’s because the fibers from the median nerve, from PC6 ultimately go to a very nearby center in the brain stem. It’s called the rostral ventrolateral medulla. But a lot of fibers go there. But some of them go to the nucleus tractus solitarius, which for me explains the GI piece here. But otherwise we’ve got cardiopulmonary indications and we can see how Chinese medicine explains it. But if we look at the science and begin again at the site, just like with Stomach 36, we know that there’s muscles and tissues and fascia and bones and here’s a cross section and especially that median nerve is nearby. But when we get to the rostral ventrolateral medulla, which is not far from the nucleus tractus solitarius, we it… that site is more concerned with cardiac, just antiarrhythmic effects and the pulmonary influences. That’s why it’s this master point for the chest. And so we look at a paper like this, for example, “Cardioprotective effects “of transcutaneous electrical acupuncture point “stimulation on perioperative elderly patients “with coronary heart disease” showing that just to cut to the chase here, that electroacupuncture at PC6 and PC4 can reduce postoperative troponin concentration so limiting heart damage and change the autonomic balance to a much improved state. And PC4 makes sense here because that was right along the median nerve if you saw that in the picture from my book before. It’s median nerve stimulation that hooks up to long loop reflexes in the brain. Here’s “The effectiveness of PC6 acupuncture “for the prevention of postoperative nausea “and vomiting in children” Again, just seeing that yes, there are brain stem connections and that is what helps us understand how physiologically, how anatomically we’re put together so that we can understand that you stimulate here and you get effects kind of body-wide or internally, and we’re not sticking needles in organs. To me it helps to really understand this wiring diagram. So the key points of all this are the anatomy or structure and physiology or function are inextricably interrelated. It’s with architecture and it’s with acupuncture and anatomy. So the more we know about the anatomy of the acupuncture points and their physiologic effects, that’s how we can better understand what the Chinese acupuncturists from way back when and Japanese and whoever else was doing acupuncture back then. They might’ve described it using metaphorical language, but if so inclined one can also understand a lot of it now scientifically. And that then informs my needling protocols, because I can take what my hands say, what my heart says and what my mind says and make treatment protocols that are very tailored to my patient based on what I feel, what I know and just a certain level of intuition but not having to have just a belief somewhere, but really having a clear expectation with objective endpoints that I can rely on. So with that , I am ready for any further questions or if you’d like, you can email me at narda@curacore.org.

– Yeah, I think, I don’t know, Alan, you can tell us if there’s any questions or if we’ll leave that for after the show. But there’s just so much you’ve presented . That’s why I couldn’t look up at the camera. I was like, my eyes were glued to the slides. Well I think we’ll, in this case, I hope you can come back another time because I feel like we’ve just touched on the surface of something’s really interesting. Some people will ask questions and they can be addressed after the show. Thank you again for coming and thank you to the American Acupuncture Council and to all our viewers and hope to see you next time. All right, bye now.

– Bye bye.

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