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The Anatomy of Facial Aging

When we practice, we will start with the Western medical perspective and this lecture we’ll discuss facial anatomy. And then also the morphological changes that occur. The face ages over time.

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Disclaimer: The following is an actual transcript. We do our best to make sure the transcript is as accurate as possible, however, it may contain spelling or grammatical errors. Due to the unique language of acupuncture, there will be errors, so we suggest you watch the video while reading the transcript.

Hi, my name is Dr. Shellie Goldstein. I’m an acupuncturist specializing in cosmetic facial acupuncture. And I would like to thank the American Acupuncture Council for allowing me to be here today. It’s always a pleasure. Today’s presentation is the anatomy of facial aging. This is actually very important, particularly for cosmetic facial acupuncturist, because although we are practicing traditional Chinese medicine we always need to take into account the anatomy of the face and the way that it changes over time.

So this is. Presentation is almost the foundation of our sense skills and being able to get great results. When we practice, we will start with the Western medical perspective and this lecture we’ll discuss facial anatomy. And then also the morphological changes that occur. The face ages over time.

And then we will touch on Eastern medicine, acupuncture strategies for treating the aging face. And throughout my series with the AAC, we will break these down into smaller formats and address them individually. But today is just an overall of what you need to do in order to, and know in order to understand other lectures.

When we think about facial aging, from the perspective of Western medicine, we’re really talking about this biological process that happens with the resulting of a gradual reduction and the structural component cell function and the Chinese medicine. We think more in terms of the G and the energy and the organ systems.

Whereas from a Western perspective, we’re really going to look at the anatomical features of the face. And then the morphological changes that we see as the face ages over time. And when we think about a young phase that has a normal volume, nice and full with very well-defined contours along the jaw line and the cheekbones, that type of thing.

And then as we age these regional facial aesthetics, these units that we’re talking about begin to change. And from a Western medical perspective, those changes are mainly due to a number of factors, a reception of the bone fat tissue changes. Muscle attenuation or the changes that occur with the muscles of the face.

And then the skin gets thinner. The skin gets flacid. It develops elastosis and then we have ligaments in our face that we’ll talk about. And as those shift, they also reposition the soft tissue that it attaches to. When we look at the facial planes, we look at them and two different systems.

We look at them horizontally, and then we look at them vertically. So horizontally, we talk about the upper face, which includes the hairline and the upper hairline to the inner campus area at the top of the eyebrow. And the mid face is referred to from the inner campus plane to right below the nose. The

And then the lower face is considered right below the nose to the jaw area. And then we look at them from a vertical center line as well. So we have the very center, the vertical center line, and then moving out to the center of the pupil is the next vertical line. And then the third vertical line is right in front of the ear lobe.

So we’d go from upper to middle to lower upper face, maybe. Lower phase. And then from the center line, moving out to the center of the pupil and then directly in front of me. And these are fairly standard. There are obviously some changes that occur with different types of faces. So say a Caucasian face may have a narrow or nasal base and a larger tip projection that intercampus area widens at when compared to other faces.

Whereas in Eastern Asian face is going to have a very somewhat weaker facial structure framework. It’s a little more. Delicate. It’s a little wider, a little rounder. The eyebrows are a little bit higher. The lips are a little fuller. The nasal, the bridge is a little bit lower. And then the flaring of the nasal Alia or exists more with an Eastern Asian face.

And then the Malheur prominence in the mid face. This Malheur area. Right along here is more prominent. Lips are more protuberant and then the chin is a little more pushback or receipted for a Latino or Hispanic face. Typically the bises a zygomatic distance right in here is a little wider. The maxillary protrusion is a little wider.

The nose is a little wider and then the chin is a little more receded. And then an African-American faces much has a much broader nasal. I decreased nasal projection. The Bilac by maxillary protrusion exists where the orbital is a little more pro per ptosis, a little bit lower. And then the tissue is a little plumper, a little bit softer.

The lips are a little more prominent and there’s an increase in facial convexity. So there are so much changes, although we’re still dividing them up and along the same trajectories, both horizontally and for. When the face ages it moves from when you think of a young face, it has a very wide, upper number, upper face and upper mid face, and a more narrow and pointed lower face.

And when we look at the younger face, what we see is our eye goes directly to the upper portion of the face. So we look at eyes, we’re looking at a very high cheap, but when we look at a nice wide area and the upper face and the upper mid face, and then as we age, it moves, the weight of the face actually moves.

It drops. LA drops and then turn becomes more medial. So that in this case, as with the aging face, the weight of the face actually moves down. We start to lose, you can see along here, we lose the definition along the dry area. And the weight of the face moves from say upper and outer. So it up and wide to more medially, and.

This creates a lot of changes in the face. Then what are going to look at that right now? We know we have bone and then above the bone, we have soft tissue and in order to really get effective treatment results, we really need to understand the relationship between Eastern medicine. And the biomedical anatomy with regard to the morphological or the psychodynamic facial changes that were time.

So let’s break these down and let’s look at them as they exist from bottom to top. So deep search deep to the surface. We have bone, the basic structure of our face that holds the shape of our. On top of bone, we have muscle on top of muscle. We have fat and then superficially, we have skin. So let’s look at them.

Let’s look at what happens with bone first as we age bone resorbs, which means that it starts to break down and it breaks down from the openings that exist. So for example, the eyes get a little bit wider. The eye socket gets wider. And we’re looking at this boat. This is a CT image of two females. This one on the left.

She’s between 20 and 40. This is someone who is over 65 on the right. And you can see, and the earlier one you can see a nice squared face, open eyes. Here’s the nasal bone and it’s nice and thick and foam. And look what happens over time. The openings start to open up and get white. The F as the face itself starts to get smaller.

So the openings get wider. The skull itself starts to shrink. So it gets smaller. You can actually see it starting to push down. When the skull starts to push down, what happens? You lose the form. So the mid area, the maxillary area get shorter. The mandibular bone, the mandibular area starts to break down too.

It starts to push forward to, you can actually see this rotation, this inward medial rotation of bone that you see changes in dentation. And so we see the height of the face starts to decrease the eye socket, start to expand. You get temporal hollowing. Here’s the temple there starts to break down and get hollow.

And the piriform, this is the nasal pyriform. This is the openings that we were talking about. The nasal pyriform gets wider and we get the resorbtion of the breakdown of the mandible read in here, along the base, the maxilla on the top. And then this causes changes in your teeth, changes of indentation.

It starts to push for. And then the entire face starts to rotate and protrude. And this is what it looks like. What we begin to see as eye sockets, start to increase the nasal pyriform starts to widen the mandible. And here starts to shorten the mandibular length starts to break, to lengthen and shorten as well.

The nose starts to change and the maxillary area right in here, this angle starts to get change. You start to see changes in the height of everything which pushes the teeth. When that happens, this is what so the darker areas is where the bone is starting to break down. What happens to all of the soft tissue on top.

All of that tissue starts to, it has it’s losing its support. It’s losing its underlying foundation. So in even in a healthy tissue, it’s going to start to stag. It doesn’t have the foundation anymore. So it starts to sag and drop and move medially. As we saw. On top of bone, we have muscles. Now the faces unique, the face has two site types of muscles.

It has superficial muscles and it has deeper. The deeper muscles generally attached, like on the body from bone to bone, our bone to muscle and the deeper muscles in the face are primarily located in the mid face, this mid area. And they’re designed to move bone and it’s attachment. So primarily what we’re talking about.

Is the mandible. The mandible is the only loose bone on the body. Everything else is connected. And so the main purpose of the deep muscle muscles of the face is actually to move bone. And it’s primarily for chewing for moving the mandible back and forth and for chewing. Now the muscles on the superficial muscles are a little different.

We call them the muscles of expression are medic muscles memetic, and these muscles are different than the rest of the muscles on the face and the deep muscle the deep muscles of the face and on the body, them a medic muscles are designed to move other muscles and move the skin. So rather than moving both.

Or bony attachments, they’re going to move muscles and they’re going to move school. They’re very flat and you can see them in this cadaver. There here’s a medic muscle right here. There’s one around the eyes. There’s one here in the cheek area. Here’s one right here and then around the mouth and then the participant muscle along the neck and with age rather than atrophy, they attenuate.

So what does that mean? We think of muscles atrophying over time. And it’s mainly from lack of use, but when you think about the muscles of their face, We use them all the time. We use them with our expressions. We use them when we talk, we are eyes they’re opening and closing all the time. We are constantly using the muscles of our face.

So they don’t they don’t really atrophy. They attenuate. And when we see a tango what that means is they get short. So they move, they reduce in their amplitude of movement and they get stiff and straight. And instead of being nice and flexible and moist and resilient, they start to straighten, they start to stiffen, they get stuck or they reduce an amplitude, so they don’t move as well.

And that limited amplitude of these mimetic muscles leads to a more permanent or more contrasting. Position. Whereas we, if you look in an aging person and it looks like their muscles are frozen, they aren’t moving, they aren’t moving back and forth or contracting and relaxing. They’re stuck in their position.

And when these muscles get thinner and tighter and stiffer or straighter the skin on top of them starts to crease our we start developing a facial asymmetry and when we get wrinkles. So a lot of this is combining the changes in structure and the bone plus the changes or the attenuation of the mimetic muscles of the face.

And then we see systemic changes in the integumentary system. The integumentary system is made up of three layers. It’s made up the subcutaneous or the fat layer it’s made up of the dermis, the mid layer. And it’s made up of the epidermis, which is the very surface area of our standards. What we see when we look in the mirror or when we’re looking at.

Let’s start in the deeper layer in the subcutaneous or that fat layer. We have two layers on the body, the face we have the deeper layer and we have a more superficial layer and they look different. You hear in this cadaver, we can see on the on the surface of the the left side, this is the, it’s a little lighter yellow color, and it sits on the surface.

Whereas the deep fat is a little darker in color and it’s deeper underneath the surface of this. Regardless see that as we look at the phase and as we look at the fat in our face, the fat is what provides the structure or the plumping plumpness of. Some people have more than others, as you can see. I don’t have a lie.

But they’re all of these fat pads, we think of them as being all across the face in a uniform position. But in fact, that’s not the case. They are actually separated by ligand implements. So they’re partitioned in sex, sectioned off and held into place with ligaments. As we age changes occur.

And those, the fat we call it descent and deflate, which means that it moves as it breaks down. It starts to lose its form. It lose its integrity and then it moves. And oftentimes it moves under the eye socket. And in this fold between the nose and the corner of the mouth, it’s called the nasal labial fold.

And we see as people get older, This area begins to thick, and it’s not a wrinkle it’s actually partially due to the movement of the tissue and the muscles immediately towards the nasal labial fold. But it can also be due to fat right in here that is moving from the center of the face, into that area.

And it’s also due to just simple loss of fat in the mid-face area, so that we see a flattening or a deflating. In the mid-face area, but then we also have the illusion of being thicker in the nasal Lavia. Also what we see as changes in the upper area, the forehead, the periorbital area, the temporal area.

We start to see a breakdown of fat into this area. And then some of this also lands along the jaw. And that is partially what happens when we start to lose our jaw area are the cut that we see in our general area. We may think that it’s all skin that is starting to fall down. And in fact, some of that may be due to fat, build up along this jaw area that creates that asymmetry from side to side, but also that loss of definition in the jaw area.

On top of the fat layer or the adipose tissue of the deeper areas. We see the dermal layer. The dermal is right here in the middle. And then on top of that is the. And the dermal area is where the health of the cells develop cells begin their growth cycle at the base of the dermal area. And they begin to float up their base.

Then this nutrient of hyaluronic acid and fluid proteins, vitamins, everything that we need in order to create healthy cells occurs on the German. And floats up to the top, moves up to the dermal layer, the epidermal layer, and then spreads off. So not only do we have a number of nutrients and bathing solutions in this dermis, but we also have our our rector Pillai muscles, their muscles that we feel when we get the chills and our, and the hair starts to stand up on our.

I sweat glands, a number of sebaceous oil glands, a number of different vital substances are in the dermal area out of this. It’s composed of a papillary layer, which is a loose meshwork of thin connective tissue. And then the deeper area is the thicker layer of connective tissue. And if you look in this side image, this is connective tissue.

We’ll go into this a little more deeply, but it’s a very loose matrix, a loose structure, whereas the lower areas a little bit. And then on top of that area is the epidermis. The remembering the epidermis is that theory surface layer of the skin it’s made up of a number of different layers, seven different layers.

On the very top are dead cells. They’re filled with keratin. It’s what we slough off and we fully ate our skin. And then as we move deeper to the dermal layer, the cells are a little bit healthier. They’re a little bit plumper. They’re a little thicker. They have a little more, most moisture in them. And then as they move through the dermal cells, move through the dermal layer into the epidermis.

They start to thin out, they start to flatten. They lose their moisture. And then at the very surface is the dead keratin cells. As we age a number of things happen, one is the health of the cells that are floating up from the dermal layer up to the surface, the cell health and the dermal layer starts to change.

We start to lose the water content. They start to be a little thinner, a little drier. So they’re not as healthy as they move up to the surface. Also the structure of the dermis. Remember we spoke about that connective tissue starts to lose its integrity. Collagen and elastin are the main components that hold up the integrity of the dermal layer.

When that starts to become disorganized and break down, we actually lose the integrity of that entire dermal layer. Think of a mattress that’s thick, and as we lie on it over and over, it gets a little bit thinner and. Like we lose the integrity of our mattress. Over time, we lose the integrity of that dermal layer and then cells on the top are thinner.

They are dryer though, less subtle, they’re less plump and the entire area sinks. So here’s the mattress, here’s the sinking of the skin and the mattress. And it looks like their wrinkles been. In fact, it’s just loss of college and loss of integrity and skin aging on the surfaces. Remember that connect that.

In that connective tissue. So connective tissue is throughout fascia is a type of connective tissue and it is the most abundant form of collagen fibers in, in, in the tissue of the skin. There’s fascia on the face, which attaches to the bone, the lining of the one, the periosteum, and it encapsulates and protects the muscles and the deeper layers of.

Tissue. And then there’s a superficial and that superficial, it’s like a thin layer of say sticky film or saran wrap. So it’s a little sticky and it attaches to the muscles and then the muscles attached to the skin. And every time a muscle moves, it causes the skin to move. And that’s how we get our expressions.

And then. All of these are in a horizontal plane and then running in a perpendicular plane are our retaining ligaments. There are a number of different retaining ligaments in the face. Remember they surround and encapsulate fat, but they also are like little plugs. They hold all of the loose tissue.

That’s running in a horizontal plane. They hold it all together. So what happens as they age? They start to attenuate as well. They start to dry out. They start to thicker, they lose their integrity. And as all of the horizontal tissue starts to shift, starts to dry out. Remember turn more immediately the these re retaining ligaments start to move as well.

So again, everything moves medially, and again, we start to lose our Mallory projection, and this is what we. If you look at this is on this end on the, to the left is aging as a young face from the frontal and then side view. As we age, we can start to see shortening in the far ahead, we start to lose or flattening in the mid phase and then loss of definition along the jawline, as you can see.

So let’s look at this. So here is a younger face. Nice to see the height up here. Eyes wide, open forehead. Nice and relaxed. Now look, this is what happens as we start to age, remember everything starts to drop down, move more, more immediately. We develop that nasal labial foam. We develop a long here, the repositioning of fat loss of structure.

Everything starts to fall and then loses it. Here we see this side is a younger face. B is the older face. Can you see how the mid face starts to flatten? We start to see a deeper nasal labial fold. We start to see loss of collagen and elastin, particularly in around the mouth and loss of definition along the job.

I hear it as a. Here’s a younger face. Hirsi is the older face deepening and the nasal labial fold loss of definition. The jaw line, the corners of the mouth start to turn down. This is another conversation about muscles and the effect that muscles have on the phase. Particularly the mimetic muscles.

And then in terms of treatment, how are we going to treat this? We see this changes starting to happen. We see the the changes that are starting to occur. Some that you can change. You can’t really change bone loss. These the, that have already lost some bone. It’s very hard to change, but we can make a.

And we can do that with our acupuncture treatments. So in the link shoe, there are a numerous discussions about needling guidelines specific to the layers of the face, the skin, the flesh between the areas between that flesh and the channels and around the muscles at the local level. In the link shoe, they talk about the skin, the flesh, the muscles, the tendons, and meridians all occupied different places in the body and that different diseases respond to different methods.

And when we talk about diseases in this case, what we’re talking about is. And if illness are aging is superficial, the different needling that we do, it will penetrate and injure the good flesh. If we do not treat it at the superficial layer or we miss it, then we’re not going to get the right results.

So when we treat what we’re treating, as we talk about the superficial layers, we’re talking about the epidermis and the dermis. So when we’re actually treating them, we have to angle the needle in a way that we’re actually treating the epidermis and the dermis. So we’re actually aligning that. Very flat.

When we talk about angle of insertion, what we’re talking about is relative to the skin surface. So we would lay that needle right at the surface of the skin, and we say five to 15 degrees and we can treat the superficial wrinkles. We can treat skin atrophy. Pain. There are a lot of pain receptors in the dermal layer of the skin.

And so we can actually help treat pain by laying that needle in a very superficial layer. We can use it with intradermals. A Japanese style of acupuncture is very good for addressing for our purposes. Introducing. Japanese acupuncture to treat the epidermal and dermal layer of the skin. If we want to move a little bit deeper into the hypodermis or the fat layer, we’re going to angle it a little bit deeper, not much because remembering if you actually place your hand on the surface of your skin, if you push a little bit, you’re already at the bone.

So it’s very superficial, very shallow. So we’re going to angle the needle at a 15 to 20 degree angle. We use it for skin atrophy for any type of fat atrophy or deflating. It’s really good for prevention. For aging on the deeper channels at the muscle. If we want to address the muscle layer, we’re going to name and go that needle on a 45 to 60 degree angle.

Really good for treating muscle attenuation trumps. Muscle trauma or prevention. And then for the bone, we’re going to go right or into treating the meridians. We’re going to go at the angle of the bone, which are the more 90 degree angle. So that’s also great for prevention, any Meridian problem or trauma to the face.

So here’s an example. This is a different protocol or a protocol. This is just an example of how we might use and to the muscles in the neck area at a 45 degree angle. If we’re going to treat the meridians, we might go right into the acupuncture points on the face, a shallow noodling into wrinkles and the, into the dermis and the epidermis treating the muscles, the corrugator muscle.

You can see this deep corgi. Fold, and then 90 degrees into the meridians. And this would be a before and after picture of what you can expect to see, say, and this is a 10 treatment series. So that’s it for today. There again, I have a number of different lectures for you where we take a deeper dive into the individual.

So thank you very much. Again, thank you to the AAC for allowing me to present today. Stay tuned next week for Sam Collins. He’ll be presenting next Wednesday. He’s always exciting. Very interesting to listen to. And see you again. Thank you.

The Many Uses of Gui Zhi Tang

So first I’d like to describe how I see Gui Zhi Tang working and. Last time. I talked about the physiology of the shell hung lawn that I think is encoded into the Shang online.

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Hi, everyone. I’m so happy to be here. And I want to first thank the American Acupuncture Council for inviting me to do this series on Chinese herbal medicine. And last time I spoke about why I’m so sold on classical Chinese medicine in herbal medicine and defined that to mean working with the formulas from the Shang Han Lun and Jin Gui Yao Lue. And today I would like to express some of the principles that I talked about last time with focusing on the formula. And this is such a useful formula. It’s an inexpensive formula easy to take formula and the way we learned about it in our kind of typical TCM education is as a formula that will dispel wind. And we usually think of it as a formula to use for coming down with a cold or what we might call an external influence or an epi. And what I’d like to do is describe how useful it is beyond just a common cold, because quit your tongue is a formula that I use all the time in my practice for a wide variety of disorders. It’s also a very small formula, so it’s easily modifiable. And actually there are many formulas in the Shang Han Lun that are based on grade your tongue. So hopefully besides my main goal is to get people excited about studying classical formulas and working with them. But I also have a goal today of having the listener. Be able to go home and think oh, I can use this formula that you could use it next week for something you may not have thought to use it for. So first I’d like to describe how I see Gui Zhi Tang working and. Last time. I talked about the physiology of the shell hung lawn that I think is encoded into the Shang online. And that it’s really about being right with time. And there’s this kind of circular movement of heaven going around us while we’re here on the earth. And this same circular movement is going on in our bodies. And so great. Your tongue is, one of the first formulas. So I think the first formula would be mentioned in the Shang Han Lun in the Taiyang section. So understanding a little bit about Taiyang it’s this steaming up movement that goes from the middle warmer up to the surface of the body. And right after the tie young movement, it’s. Going up like the sun rising, it hits noon and now it starts going down. And the downward movement is the beginning of the Yangming Conformation. So when we’re, when our Taiyang is functioning it has this really nice steaming up. And if you think about what steam is, it’s young within yen. So when you have steam. You have this kind of fire that’s inside of water and that fire and water are so mixed that it’s actually steam. It’s this water that rises up because of the fire that’s inside of it. And that’s what Taiyang does is the, has a steam that goes up and how all the way to the surface of our body and that steam creates a nice ozone layer of warmth and protection. And when it functions well, we sweat. Normally we have a nice, comfortable body temperature. And what happens in a greater tongue pattern is you usually think of it as like an invasion of wind cold or an invasion of wind. I’d like to suggest thinking of it a little bit differently, that what happens in a Taiyang pattern is that movement of stinks. Going up to the surface of the body. It resolves too quickly. And so that fire and water separate before they’ve really reached all the way to. Surface of our body. So what do you get from this separation that we also would call a Ying Wei Disharmony, meaning the way that’s the warmth inside should be nice and inside the yang so that it brings it all the way up to the surface, but instead they separate. So you get sweating as the yang droplets lose their relationship with the. They come out as sweating and the young that’s lost its relationship with the yang. We get feverishness or flushing up. That’s what the yang way disharmony is in a way it’s like a premature ejaculation, that you want it to take as long as this, before it results, but instead it resolves too quickly and that becomes pathological. So when we give Gui Zhi Tang, we are supplementing the warmth and the fluid in the middle warmer, and we’re slowing down that process. So the steam rises and makes it all the way. To the surface of the body. And in fact, a Gui Zhi Tang pattern can actually treat premature ejaculation. Know we can explain premature ejaculation with the Gui Zhi Tang pattern because it’s a leaking pattern it’s coming out of relationship. So I said that the Gui Zhi Tang comes from the middle warmer, and you look at the ingredients of Gui Zhi Tang. We have gone. So Sheng Jiang and Gan Cao These supplement and warm the spleen we have Da Zao, which replenishes the nutrition in the spleen. So we’ve got this kind of fire inside of a nice juicy herbs. And that starts that steaming process in the spleen and stomach. Now Da Zao also enriches the blood. And so does Shao Yao. So what I’d like to show is that the Gui Zhi Tang formula, supplements the middle in a warm way, and it also supplements the blood and that the warmth in the middle and the good quality warm blood is what then is the foundation for the harmonized Ying and Wei to come all the way up and out to the surface. So really the Gui Zhi Tang is a supplementing formula, supplementing the spleen and also supplementing the blood. And from that replenishment, it then supports that consolidation of the exterior of the body. So by giving wager tone, we’re not just getting rid of a wind pathogen. Really it’s a healthy body, knows how to get rid of a wind path. Rather than just getting rid of the wind pathogen, we’re restoring this function of the body, the function of the body to have really nice harmonized Ying and Wei. So I want to talk first about this flushing up, that happens in a Gui Zhi Tang pattern and what that can look like. It can look like nausea and vomiting. If the flushing up affects the stomach. Then you can have nausea and retching. And that’s why Zhang Zhongjing put Gui Zhi Tang as the first formula in the pregnancy chapter of the Jin Gui Yao Lue for Pregnancy. In early pregnancy. So that’s one little gem I would like to give you is to really think about grade your tongue as a formula that can treat nausea and vomiting in early pregnancy. And it does it, that the reason that there’s the vomiting is because of the Ying Wei Disharmony and it, by putting that way back into the. It then it’s not flushing up anymore. It’s physiologically rising to the top of the body. So that’s one thing that we can treat with Gui Zhi Tang and it’s right in there in the Jin Gui Yao Lue. The other thing I want to mention is When the Ying and Wei separate from each other. It really means that the surface of our body, instead of getting that nice from ozone layer, that separation means that the surface of our body is too open in the Shang Han Lun. It says aversion to wind. And in my opinion the symptoms that are mentioned in the Shang Han Lun are both literal and symbolic. So the wind can mean that you have an aversion to just too much going on. In other words, you get overwhelmed really easily and you feel really hypersensitive. So imagine a patient who comes in and let’s say, it’s a woman and she’s, you can see that she has blood deficiency. You can see from her complexion, from our. Maybe from your abdominal diagnosis and, she’s got blood deficiency and at the same time, she tends to be a little bit cold and then premenstrually, she becomes very sensitive. We usually think of pre-menstrual syndrome as wanting to move the liver cheese. But many of our patients don’t actually fit that pattern and they don’t benefit from formulas like or something like that. There are many of our patients who come in and they experienced, they have premenstrually is they become hypersensitive. They feel very vulnerable. And if you question them one thing I like to ask is. Do you generally flush when you have emotions, like if you’d get embarrassed or if you have to speak in front of a crowd, do you flush easily? Do you sweat easily? In other words, that kind of person, their Ying and Wei tends to separate. And there, many of my patients have been really helped with Gui zhi Tang for PMS. Because of this. So what the Gui zhi Tang then does is it supplements the blood, it nourishes the spleen and it harmonizes the Ying and Wei. And it really creates a sort of ozone layer of protection on the exterior of the body. So people don’t feel so open and so vulnerable and they can handle more. Knowing that pre-menstrual time. Many women just feel like I can’t handle anything. Someone looks at me the wrong way and I just start crying. And Gui zhi Tang is really good for that. We can think of that also for peri-menopause or menopausal types of symptoms, which. The same kind of experience for people. So we can see that this range of grades, your tongue is really is really broad. There are also lots of modifications of Gui zhi Tang. Expand its usefulness in the clinic. A lot of these modifications are mentioned in the Shang Han Lun. So for example, a really favorite modification for me is a formula that’s called Gui Zhi Jia Shao Yao Tang, but the Shao Yao is doubled, so Zhang Zhongjing is telling us you can actually use more Shao Yao if you want to, and so it’s just great. You’re talking about you’re using more Shao Yao. So what happens to this formula that harmonizes the Ying and Wei? If you add. and there’s a couple of things that this formula is so useful for. Not so often I’m increasing the shadow. So what does the show do? And I, here, I’m talking about by shell. So the Shao Yao is a blood nourishing or, and one of the main indicators for me that I might want to double the Shao Yao is. Abdominal diagnosis. So with abdominal diagnosis, if I find that the rectus abdominis from under the ribs down to the navel are very tight for me, that’s almost always a by shout indication. And so in that case, I will have more by show. The other thing that often goes along with this abdominal finding is so common and it will go with a lot of these PMs kinds of women that I was talking about is neck and shoulder tension. We know that the bladder channel and the small intestine in general, they are on the trapezius and. And by show really nourishes the muscles, especially when we have Bai Shao, like we do in your, that becomes , which is for relaxing spastic muscles. And where are those muscles most likely to get really tense in the Gui Zhi Tang pattern. It’s going to be the tie on channels and the upper body, because there’s. Flushing up called? Nobose in Japanese this, when we talk about it in terms of abdominal diagnosis, so there’s flushing up, so it’s going to affect the upper body and then it’s affecting the Taiyang channels of the trapezius and neck. So very often people will say, yes, I, I carry so much tension in my neck and upper back. It’s always tight and painful for me. That’s an indicator for adding increased Bai Shao to Gui Zhi Tang. Very common. The other indicator for increasing the Bai Shao is related to the fact that Bai Shao is also bitter and it’s. And Bai Shao when it hit like bitter, because I’m putting my hand down this way because the bitter flavor descends in the body and by show is cool. So it’s very good for opening up the Yangming and treating constipation. So it treats constipation both because it’s very lightly purging. But also because it relaxes muscles, one muscles, relax. It’s not just that. It’s not like a muscle relaxer that makes all the muscles all Saudi ends up the way that by Bai Shao works to help the muscles. It helps muscles do what they’re supposed to do. So actually helps normal pair of spouses while stopping cramping. So another indication for adding by show is. Person that you’re seeing that feels so vulnerable and sweats easily and flushes. If they also tend to get constipation, you can increase the by show or abdominal pain. No. So in the Shang Han Lun, that’s what it’s for. ? is for abdominal pain. So that kind of cramping can cause constipation. It can also cause abdominal pain. So that’s a modification of Gui Zhi Tang, so easy and easy to remember because it just makes so much sense. Another modification that’s really listed just right after this Gui Zhi Jia Da Huang. Is if the constipation has gone on for more than three days, so it’s really blocked in there, so what happens when you’re constipated is that it sits in there and gets drier and drier, and then it just makes the constipation worse. So if you want to get. Flush just to break that cycle. In other words, it’s a short-term treatment, but you want that flush to be gentle. You want it to be body temperature, Gui Zhi Tang is body temperature. Then you have Gui zhi Tang plus the little bit of the Da huang And it’s a short term just to give the body an enema, except that it’s going in from the other direction, just to flush that out. And often that formula would be followed by Gui zhi Jia Shao Yao Tang. So I hope this is just a little 20 minute talk and there are lots of other modifications of greater time that are equally as elegant. And useful. My hope is that in this short little talk that at least I’ve given you a sense of how great your tongue can work for chronic illnesses and illnesses that have nothing to do with catching a cold just maybe inspired some people to get excited about classical formulas and studying them. Cause it’s such a beautiful way to work with our patients. And it’s beautiful in large part because it’s so effective. So I would like to also let people know that I’m the founder of the whitepinecircle.org. Which is an organization that promotes teaching such as these, and it’s a really, just a wonderful membership organization. So I’d just like to encourage you to check that out whitepinecircle.org. where there’s lots of teachings, just like this. If this excited you. I also teach a. Graduate mentorship program, where we just go through all of these formulas in a way that discusses them relative to these principles of classical formulas. You can find out about whitepineinstitute.org that’s listed right here. And then finally, I would like to, again, really thank the American acupuncture council. This is such a cool thing. They do. I’m offering short teachings just for us to get to know each other in all the wonderful things that are happening in the world of Chinese medicine. And I really appreciate their service to acupuncturists. And I’d also just like to mention that the next talk is going to be Matt Callison and Brian law. So I hope that you are able to attend that one as well. And I just really appreciate your attention to the things that I love so much. So thank you very much.

A Problematic Postural Position: Forward Head and Forward Shoulder

So forward shoulder, um, it’s a, it’s a posture that it seems like it’s becoming more and more common with sitting in front of the computer a lot more than we used to, especially during this COVID time. Um, the propensity for this, for the weight of the head to go forward and the shoulders to go forward is really quite great. And the more that we sit in one position, we know that the muscles and the myofascial tissues are going to adapt to that position.

Click here to download the transcript.

The American Acupuncture Council for having us really appreciate that. I’m excited to get into this information. There’s a lot of great things with, uh, let’s go ahead and get into the first slide please.

Or the next slide. There we go. All right. Thank you. So forward shoulder, um, it’s a, it’s a posture that it seems like it’s becoming more and more common with sitting in front of the computer a lot more than we used to, especially during this COVID time. Um, the propensity for this, for the weight of the head to go forward and the shoulders to go forward is really quite great. And the more that we sit in one position, we know that the muscles and the myofascial tissues are going to adapt to that position. So it’s a lot easier to get into that forward head and for shoulder position. If we maintain that position for hours and hours throughout the day, now it’s usually predicated from what’s happening in the pelvis. So this is the reason why that, that we’re saying this is just one piece of the whole. So, I mean, you have to look at the whole body with this to help afford heading for shoulder, but we want to give you some nuggets that have helped us clinically quite a bit, um, to help alleviate some pain. Uh, Brian, do you want to, uh, say anything before we get in the next slide now? I think jump right into the next slide. All right.

All right. So the Ford had an imbalance in his posture, cannot counteract the forces of gravity, thereby increasing the stress on the muscle skeletal system and perpetuating the aging process. So you can see that red arrow that’d be the force of gravity as the head is going forward of the plum line. Let’s back up a little bit. The plumb line will be measured from the foot going up to the head. You want the plumb line to be in line with gallbladder 40 at the foot, the middle of the knee, the greater truck enter the middle of the hip joint. Then going up spleen 21 region into the chromium, the large intestine 15 region, and then the auditory meatus or the small attest in 19 region. So in this case, you can see that this patient’s head is forward by probably a good two and a half inches.

So for every inch for posture, there’s an increase of the weight by 10 pounds. Imagine what’s happening to the upper thoracic region and the lower cervical region and being elongated and polling quite a bit, trying to be able to maintain their proper positioning. But in this case, they’re really struggling because there’s so much weight pulling forward. This can increase the aging process significantly the longer that it ends up lasting. I mean, there’s a host of injuries that can occur from Ford head for shoulder. Brian, let’s go ahead and think about this. We’ve got thoracic outlet syndrome. You’ve got lower cervical spondylosis in the 40 plus age group. That’s increasing, um, nerve impingement. What else? Brian, with the sport headaches would be a big one. Yeah, that’s true. Brutal scapular nerve and traffic could be a big one there. Gosh, a chromatically vicular joint strain is something sternoclavicular joint strength is there, uh, with the pectoralis minor being a shortened position and the anterior scalings being in a shortened position. There’s your nerve entrapment sites for thoracic outlet syndrome. So, you know, with this for shoulder, it goes down the upper extremity chain, the head of the humerus. Sorry, go ahead.

Oh, go ahead. Yeah. The one worth mentioning also is the, uh, uh, when we’re going to be covering more in detail later is a lot of shoulder injuries, especially tendinopathies.

Yeah. So with this, we’re going to talk quite a bit about the functional anatomy of the Ford headed for shoulder, and then flip hats, put a different hat on blending, the two hats actually, and get into this new channels. So again, back to this Ford head and Ford shoulder, this is just one segment of what’s happening with the body. You’ve got humoral internal rotation, and then it’s going to affect the radio ulnar joint proximal, and also distal. So there’s a lot of things to be able to look at. So we’re just, again, just talking about one piece of the whole hair. Can we get to the next slide

While you’re doing that? Matt it’s worth mentioning that the head itself is 10 to 12 pounds. So an additional 10 pounds for every inch forward is pretty significant in terms of the amount of load that puts on the upper back and shoulder girdle and all that.

Yeah, absolutely. Absolutely. So Fort headed for shoulder is one component of something called upper cross syndrome, which Dr. Vladimir Yonda was the one that coined that term. Um, he noticed that a lot of patients in this particular posture, he would document the muscle imbalances that are, that are contributing and holding that posture as well. Now in the 1960s, this was a Latin Marianna in the 1960s, but also Dr. George Goodheart, who was another pioneer in posture and also muscle imbalances, both these guys actually in the 1960s. Talk a lot about the different types of Muslim balances, not only in the upper cross syndrome, but also in lower cross syndrome in the upper extremity and also the lower extremity. These two pioneers are, or actually the, um, major contributors to where we actually have a lot of manual muscle testing today. And manual muscle testing is becoming much more popular than it was in the 1960 seventies, or when I first became an acupuncturist in the 1990s, um, is becoming much more popular and these guys influenced that substantially.

So it was really quite interesting too, when you look at this paragraph here, that Dr. Vladimir Yonda, he thought of it as actually being more of the deficient muscle, the lengthened muscle that was perpetuating a lacrosse syndrome and the muscle bounces and Dr. George Goodheart was actually considering that be more of the shortened muscle is what’s causing the upper cross syndrome. So interesting glamor Yana thought it was more as the deficiency that, that made the excess and the Dr. Goodheart thinks it’s the excess that’s creating the deficiency, both work mean that these are both great pioneers, both actually work quite well. All right, so let’s go to the next slide. So your upper cross syndrome, uh, you’ve got with a Ford head and the Ford shoulder, if you look at the box on the upper left shorten overactive cervical extensor. So that means the upper extensors are really the biggest ones that are going to be shortened and active.

The suboccipital triangle, hence the reason for causing nerve entrapment of the lesser occipital nerve or the third occipital nerve, uh, developing trigger points when the suboccipital muscles causing muscle tension type headaches, um, a whole host of different injuries can, can occur in that area. And then below that you’ve got lengthened inhibit rom boys’ middle and lower trapezius. So those would be in a locked long position, a stretched out position, and you can see how the back shoe points of the heart and the lung here are going to be greatly affected the pericardium as well. So that’s going to be an elongated position, putting stress on those back shoe points. Then on the other side, you’ve got your shortened and overactive pectoral. So that pectoralis minor is going to be pulling excessively on the core court process, inhibiting the muscles on the other side, which are the wrong boys in the middle and the lower trapezius. Then you’ve got your LinkedIn inhibited, deep neck flexors, including the middle and anterior scaling. Hence the reason why you get thoracic outlet syndrome many times or many times, you see thoracic outlet syndrome with people with postures like this. Brian, do you want to say anything?

Yeah, sometimes the, um, the, the neck flexors, I would also include, uh, the longest call lion and longest capitus the deepest, deepest cervical flexors, which are, um, create neck flection, but they are, they’re a big stabilizer and we’ll get, this is a little foreshadowing, but, uh, from a Cindia channel perspective, those would be part of the kid decent new channel. So, um, kind of speaks a little bit to the kidney cheat and how that sort of loss of kidney cheese starts to cause that the, that depression and that, um, dropping of the head in the forwardness of the head.

Yeah. Good point. Yeah. Excellent.

Excellent. All right, let’s go to the next slide. So we’ve talked about this slide before.

This is some research that I did it starting in 2010, um, and presented it, I think in 2011 Pacific symposium, and also 2019, it’s looking at different types of posture and their relation to Zong, uh, uh, TCM patterns. So what I noticed is that with looking at, from the lateral view, certain postures would come in and they would have certain types of Azzam signs and symptoms. For example, the guy on the left, you’ve got spleen lung and kidney deficiency, and you can see how the lungs in this type of position in this position are having a difficult time expanding the diaphragm’s going to be constricted. I mentioned earlier that the tissues around the bladder, I’m sorry, the lung and the heart back shoe points will be elongated and struggling. Um, let’s see what else we’ve got compression caged is going to be affecting this and also the liver, and it is positioned the thoracolumbar fascia. The deep layers around the renal fascia will also be restricted inhibiting some of the kidneys, the kidney, but these people themselves will often come in with spleen, lung and kidney type of deficiencies. Brian, do you want to add anything to that?

Uh, no. I think you gave a good summary how it’s not just the muscle imbalance, but how it’s also affecting the internal organs and the space for the internal organs to do their proper function.

Hmm. So which ones out of, out of these spots,

Figures, Brian, which ones can you see have that forward head and forward shoulder type Fox?

Sure. Yeah. So the type one, the first one is the most obvious. And especially with the plumb line, as Matt was mentioning with the plumb line, going through GB 40, coming up through the greater trocanter, um, through the acromion, you can start seeing the shoulder going forward and you can really see the head going forward and the type one, the type two is there, but it’s a little, uh, um, maybe obvious it’s obvious if you look at it, but with the plumb line, there’s a little bit of a trick to it. And you notice how forward the greater trocanter is from the plum line. You know, this, uh, this patient and the type two. And for that matter of the type four posture have an anterior hip shift. So there’s, the hip is as moved forward and then their rib cage is starting to tilt back posterior.

So in some ways their, their head looks a little bit more aligned according to the plumb line and their shoulder looks a little bit more aligned according to the plumb line. But if you were to kind of imagine tilting the rib cage back into position, you know, to, to kind of line the rib cage up in, in a straight line, you would start to see with that, you know, uh, if you did that, how much the shoulder and that hadn’t been forward in relationship to the rib cage. So, um, there’s a definitely a big relationship between the pelvis and the head and shoulder position for those, those type two and type four ones in particular. But it’s, it’s a, if you adjusted, you definitely see the forward head in the forward shoulder, though. It’s a little different flavor from the type one. Yeah.

That’s interesting because if you do end up changing one segment of that, of that disparity, the compensation comes out somewhere it’s like Brian was saying, if you tilted that ribcage here for you brought those hips back to the plumb line, actually physically did that. You would see the compensation above and the forehead and for children. It’s great. Now an increase to type twos. You look at type four and you can see that the greatest rural Cantor is even farther forward, which is causing more of a poster tilt to the rib cage. And the shoulder is posterior to the plumb line, but it’s the same thing. If we brought those hips back, you would see a really far forward head and also afford shoulder. So somebody like this could be coming in with thoracic outlet syndrome or, or such, um, from the muscle imbalances within forehead and for shoulder in upper cross syndrome, the slide three and a type three and type five. I don’t see it as much, possibly type five. What do you think?

Yeah, they’re not as obvious. I mean, the head is forward on type three, but it’s really, that whole body is shooting forward. So it’s not, um, as much of the obvious head and shoulder forward. Yeah. Yeah. Okay.

Excellent. All right. So then, uh, what’s the next I Brian, you want to take?

Yeah, yeah. And Matt, uh, I will nevermind. Um, your audio is a little distorted. You might want to turn your phone off to have a little extra bandwidth, but I’ll be chatting here for a second and give you a moment anyways. So, um, we kind of alluded to this in the previous, uh, the previous slide where we have multiple examples of a forward head and forward shoulder, but I kind of used the term flavor, you know, that, that the farthest one on the left, the type one posture had us at quote unquote different flavor than the type two, which had that obvious posterior tilt to the rib cage and, um, had a different interaction of how things related to each other, but both, ultimately they both had a forward, um, shoulder and forward head. So if we wanted to kind of start assessing that variation from patient to patient, one way we can start to look at is the, um, is the position of the scapula, uh, and notice, uh, that it varies from patient to patient with this forward shoulder.

So a blanket term would be scapular protraction. Um, so scapular protraction, the shoulder blades are going wider and they’re usually tilting forward. Um, but when you start breaking down from patient to patient, you can start to see that there’s variation on tilts shifts and rotations. Um, so just to give a quick terminology, if the shoulder blade itself moves away from the spine, we might call that protraction. It’s an element of protraction, but we can be more specific and call it a lateral shift. You know, it’s shifted lateral retraction. It might shift medial and come closer to the spine. Um, if it tilts forward, we would call that an anterior tilt. So in that case, the top of the shoulder blade, the, um, SSI 12 region is facing forward. Um, it could also rotate around the rib cage. So we might call that a medial rotation cause the, the shoulder blade spacing more medial. So just, uh, based on where it’s moving, if it’s moving medial, moving lateral up down, et cetera, we can, uh, call based on shifts and tilts. So we’ll see an example of this on the next slide. So let’s go ahead and go to the next slide.

So this patient, we have, we could again call it a scapular protraction on the right side, but it’s different than some other people might manifest with scapular retraction. So if you look at the medial border and you were to kind of draw a line along that medial border, you’ll see that the medial border comes closer to the spine, uh, as it goes inferior on the right side in particular notice, the right side is what I’m talking about. So the whole scapula is in, we could call it downward rotation, but if we were to use this terminology of tilts and shifts, it’s a lateral tilt. The top of the, the scapulas facing lateral and the scapula is also moved a little bit away from the spine. So it’s a lateral shift. We’d have to look from the side, um, to see about if it’s tilting forward. It probably is. So it’s a likely anterior tilt, but that, uh, from this, this perspective is a little harder to see, but I think we will see that in the next, uh, slide. We’ll get another view for a different patient.

Hey Brian, can you go back? I’m sorry, can you go back to the last slide please? Um, just to keep in context, what we had with the previous slide. So this would also be immediate rotation of a scaffold, correct?

Medial rotation yet the immediate rotation. Uh, if it’s going around the rib cage, we can say that’s a lateral shift, cause it’s definitely moving away from the spine, but the scapula will start following the rib cage. So you could also describe that component of a medial rotation for sure, because you can kind of picture it the more it goes lateral. The more of the scapula is following the sort of, uh, border of the rib cage. It’s going to start turning and facing inward facing medial. So yeah, I would agree a lateral shift and a medial rotation.

So the anterior aspect of the scapulas is facing immediately. Okay, great. Yeah. Thanks Matt.

All right. So now to the next slide, and again, we could call this a younger, uh, gentlemen here, we could refer to this as a scapular protraction, but it’s a little different, a little different that, um, look than the previous patient. And really what you see is the strong anterior tilt. You can kind of notice that with the inferior border of the scapula, which is poking out in relationship to the top of the scapula. So it’s a, um, kind of highlights a little bit more of the shortening of the pectoralis minor muscle in the whole scapula tilting forward. We’d have to look at him from the back. He might have a little bit of a, um, a lateral shift to the scapula. I don’t recall from seeing previous images. Um, we don’t have it in this PowerPoint, but he didn’t this particular patient didn’t have a really obvious lateral shift. If I remember Matt, do you remember that

It was more of the superior shift in Andrew scapular tilt was more, but he did have scapular protraction on this right here.

Yeah. Yeah. But it’s manifesting a little bit more, is that, is that anterior tilt that anterior tilt component is, um, a little bit more prominent, but why is this important? What’s, what’s the importance of it. It starts to set a picture for which tissues are involved. And, um, if, if you look at it from which, which muscles in which structures are shortened, uh, and which ones are lengthened, it starts to also paint a picture, which send you a channels are involved. So, um, anything else on this one, Matt, before we, yeah,

Yeah, I think, um, for those people that don’t really know the muscles very well as if this is the pectoralis minor image, that’s on the right. So you can see if those fibers shorten their attachment sites, how it’s going to be pulling on that core court process, creating that anterior tilt now with an anterior tilt, the superior medial border of the scapula also raises up a little bit. So in that case, if you thought about what possible injury could be taking place here, the levator scapula, um, and that where it attaches to the superior medial border, as we know, has a lot of mild fascial adhesions in that tissue Guber is basically, I mean, it just feels so very, very rough and some people actually complain of pain in that region. So we could needle that section and that would give good relief for a little bit, but until we actually start working on that enter shift and the Petraeus minor shortening, we won’t be able to help out the elevator scapula and have it be pain-free

[inaudible] treating the effects, not the cause necessarily. Yeah. So we can go ahead and go to the next slide. So this is a little bit of a summary. So we have, uh, some, uh, scapular protraction that have more emphasis on that anterior tilt and that pec minor shortening. So we’ll give you a heads up that the pectoralis minor is part of the lung sinew channel. Um, also we have shortening in the upper fibers of the serratus anterior, also part of that lung sinew channel. And then that’s kind of counterbalanced, especially by the lower trapezius, also the middle trapezius and rhomboids, but we’ll, uh, kind of focus on the lower trapezius, which is there to stabilize against that sort of, um, pull from the pectoralis minor. That’s going to pull the scapula into an anterior tilt. The lower traps are there to sort of stabilize and hold the scapula in place and keep it from being pulled forward from the pectoralis minor.

So this is a very common muscle imbalance between these two, uh, internally and externally related channels, send new channels and muscles where the pectoralis minor gets overactive lock short into a shortened position, holds the scapula into an anterior tilt, uh, tends to pull it a little bit more into, uh, a lateral tilt. So kind of downwardly rotating the scapula, whereas the lower trapezius becomes inhibited and fails to counteract that. So we have an imbalance between these two related channels of the lung and the large intestine channel. So that’s important for local treatment, but of course, important for distal treatment also.

Yeah, that’s great. So the distal treatment, because the Petraeus monitor is going to be, fascially connected to all of the mild fascial tissue on that lung sinew channel all the way down to the wrist. We can use many acupuncture points or to change that mild fascial tension. So not just treating locally, but also adjacent and distal to signal the myofascial gene June, what we’re trying to do. So by treating the TCM, bialy internal and external relationships here, um, it’s just, it’s pretty amazing what can happen when you soften tissues so far away and signal while you’re trying to be able to do when our founding, our founding forefathers were just absolutely brilliant to be able to come up with such associations. And, and we’re just talking about it in a different way. This is great. We will be going over acupuncture points in a little bit.

Yeah. All right. So next slide. So then this particular, uh, example, now we have a little bit more of the emphasis on the lateral shift, you know, the movement of the scapula away from the spine. And, uh, with that, you’re going to see a little less, sometimes a little less of that anterior tilt. So it speaks a little bit more to a different set of tissues, the serratus, anterior, especially the middle and lower fibers of the straightest anterior and the rom points. So those become imbalanced. And in the system that we teach in sports medicine, acupuncture, this is part of the pericardium send new channel. The serratus anterior, um, is, is a big part of that, but the straightest anterior, it goes. And if you kind of notice in this illustration, it becomes a little bit faded because it’s going underneath the scapula. So it goes underneath, uh, it should say anterior to the scapula between the scapula and the rib cage.

And it attaches to the medial border of the scapula, right at the place that the rhomboids attach. So they really create one continuous, uh, myofascial sling. It’s almost like it seemed if you can kind of picture that, that sling that has like a seam along that medial word of the scapula. So it’s, it’s, it’s kind of anchored at that medial border of the scapula, but it’s a continuous sling. Um, and sometimes that’s referred to as the Rambo’s rate of sling, uh, for those who’ve paid attention to, uh, anatomy trains in the work of Tom Myers, he uses that terminology of thrombosis rate of slang. And we see that as a part of the pericardium sinew channel. So it’s a little bit more of that influence of that channel versus the lung and large intestine as a new channel and balance.

Yeah. [inaudible]

Of the scapula.

Oh, I’m sorry for, I’m sorry for interrupting Brian, go ahead and finish what you’re saying. No, that’s it. I finished. Okay. Here’s my audio better now? Yeah, much better. Okay, good. Uh, what was I saying? Yeah. On the cadaver, it’s fascinating to see the thrombosis rate is sling how the straightest anterior and the rom Boyd fibers just interdigitate. It is really one tissue, like so many other tissues in the body, but it’s keeping context of what we’re talking about now. It’s amazing to see how it’s just one line of Paul on that. Yeah. Fantastic. Oh, also something else now, even though we’re putting the pericardium channel or the pair of, even though we’re putting the serratus anterior into pericardium and also lung there’s a gray area with that in smack, we will often demonstrate that by needling the motor innervation points of the straightest, anterior, for example, ribs three through seven or so, you can even do four through six we’ll change a lung pulse.

So it is influencing the internal Oregon. For sure. If you have a patient that’s coming in that has asthma, common cold, a C D something like that, feel the pulse. If you would treat the motor entry points of this rate, anterior that pulse will definitely get better and change. So you are influencing what’s happening with those lungs. Just something to think about when you do have a patient like that. Yeah. It’s going to help the lungs to expand the rib cage, to expand by getting any kind of tension or lack of proprioception within us. Right. Of center. Sorry, Brian, go ahead. We’re going to say, yeah,

I was just, just commenting on what you’re saying that this radius anterior definitely when it’s, uh, restricted we’ll we’ll stop breathing well, we’ll prevent a really good solid fall inhale.

Yeah. Yeah. And it’s fun how fast it changes the pulse, you know, intuitively the body is all right. We can just keep going on this. We better get going. We only have one minute pink. Okay.

Yeah. So, so the, this was kind of painting a picture. You know, it’s a little bit of a simplification because things can be both, you know, you can have both that anterior tilt and the lateral shift, but, but generally when you look at patients one’s predominant or oftentimes at least one’s more predominant. And if we go back to those, uh, the, the, um, TCM patterns and postures, the type two person that we see kind of replicated here on the right with the posterior tilted ribcage. Again, if you were to tilt that rib cage back, you’d notice how much of an anterior tilt of the scapula we have here. You can see that from the illustration, she kind of resembles more of that, right. Illustration where the rib cage is tilting back. The pelvis is shifted forward. The scapula is almost straight up and down, but if we were to adjust the, um, the rib cage, you’d see in relationship to the rib cage in relationship to those tissues that are holding it in into a particular balance, that it’s a pretty strong anterior tilt of the scapula that tends to correspond much more with, uh, kidney deficient, postures, um, and kind of a lack of stability from, uh, the kidney channel sort of holding and stabilizing the body.

That’s a whole nother topic, but, um, but there’s this, there’s a strong correlation with this type of posture with various types of kidney deficiency that you saw from the five fosters that Matt was highlighting earlier. So there’s a relationship between the lung and the kidney channel and this type of posture you saw with the boy, even who had that little bit of a posterior tilt to the rib cage, very, uh, versus, uh, I’m ready to go on, unless you wanted to say something else about that, Matt.

Um, I think maybe just a little bit like another demonstration that we do in smack to see how the pelvis and his position is related to kidney cha. Um, we have, uh, people go ahead and stand up and partner up and feel each other’s, uh, kidney pulses on the right and left hand side. And the kidney pulse is going to be the weakest, the patient, or the practitioner will slowly go ahead and just do anterior poster, pelvic tilts, not enough to get the heart rate up. So it’s going to change that Paul’s, but just very slowly going to an anterior and posterior pelvic tilt, changing the fashion and the position of where the kidneys are. So then by doing that eight, 10, 12 times the kidney pulse actually starts to come up, which is pretty amazing. And it’s so significant. It happens almost every single time, but this demonstration, we, we do frequently in the smack program. And also, I think I did a civics symposium one time. It’s pretty amazing to be able to see that. So what’s the next slide.

So same idea with channel relationships, that more lateral shift of the scapula, um, oftentimes with a little bit of an upward rotation, um, but when you start seeing more of a lateral shift and that sort of rounding of the arms, uh, that often goes in corresponds with, uh, multiple things, but especially spleen channel deficiency. And you can see with this type one posture, as Matt mentioned, how that’s kind of compressing the spleen and, um, the organ itself is being compressed, but the posture and the tissues associated with that posture, um, the tissues associated that sinew channel are involved with the pericardium and spleen relationship. So, you know, you might consider distal points, multiple things, but something like splitting for pericardium six might be a component of the, um, the treatment protocol for this doesn’t have to be, but that’s something that comes to my mind. Whereas the previous one, you might consider something like lung seven, kidney six, or, you know, other other kidney and the lung channel points for the previous, uh, person versus a spleen and pericardium channel point for this one. So we’re going to talk more about points, but just kind of think that, you know, start, start making those connections now. And when we’ll get into that at some point in combinations,

This is great. All right. So with the pericardium and spleen, and also the kidney, the lung, the lung and large test in relationships, the straightest anterior with the pericardium and lung, these imbalances can create a numerous amount of injuries. And we’ve already talked about a few, let’s go to the next slide and see what actually happens to the children.

Yeah. So, um, as much as we can have a whole bunch of injuries that we could focus on, uh, we talked about muscle tension, headaches and spondylosis, and a whole, whole bunch of things. But, um, but we’re gonna kind of give an example related to the, um, the shoulder position, shoulder movement and, uh, tendinopathies. So Matt, do you want to talk about this one?

Sure. What scaffolding humor, rhythm,

The, the humorous,

And also the scab will have a rhythm as the person’s going into shoulder abduction. So when you have process of proper muscle balancing, then that scapula will go ahead into a rotation as the head of the humerus is coming up. Now, if there’s going to be imbalanced with that scapula, if the lung large intestine that roof or the chromium right here is going to not be as strong, it will end up actually coming down into a downward rotation, a budding the head of the humerus, that particular scenario is probably, you probably see that more times than not with shoulder problems is the inability for the, for the scapula to upwardly rotate and allow the head of the humorous to move freely within that joint. It’s the abutting of the head of the humerus against the chromium impinging, the superspinatus tendon, the capsule of bicipital long head tendon making insertional type of strains. Um, there’s, there’s so many different types of injuries that can occur with us. So balancing these muscles and the sinew channels is going to be really imperative, followed by some kind of exercise prescription, which, um, I believe it was last month or the month before that, that Brian and I have a podcast, right. That we talked about this.

Yeah. I said both. We talked about fab lab last two, two webinars, I believe. Hm, Hm. Yeah. You know, it’s interesting

Too, with this cause we don’t have there much time left is that we talked about mostly what’s happening with the scapula, but the head of the humerus with a forward shoulder position. In fact, you can just do this yourself. If you sit up and you have your shoulder go forward, your human starts to internally rotate. And that’s just the way that it starts to move, causing more muscle imbalance within the rotator cuff between the heart and the small intestine Jean chin. So it just keeps on going. We just don’t have enough time in this 30 minutes to be able to talk about that. So let’s go to the Brian D anything else go for the next slide? No, no, I think that’s good.

This is a severe case of shoulder impingement spinner, but you can see in this x-ray as the person going to the shoulder abduction, the rotator cuff muscles are not pulling that head of the humerus down into the joint. And it looks like the scapula stabilizers, the lung and larger tests and Jean, Jen, and also the pericardia are not lifting ASCAP properly into upper rotation. The greater tubercle that humorous is hitting the chromium and the fact that it looks like it’s been doing it for an awfully long time. Cause you can see it, the superior aspect of the humerus, like a rough mountain range edge there. I don’t know if you can see that I don’t have a cursor without I can be able to do this, but at the very top of that humorous in the black, you see a very rough edge and it looks like that’s probably from necrotic tissue or a lot of overused banging into their chromium. This person was in some pain for quite a long time. Let’s talk about some acupuncture points that we can use for forehead and for shoulder Brian. Yep. Sounds good. Next slide please.

All right, go ahead, Brian, go ahead. Well, the points are going to be based on the particular injury, obviously. So is it going to be periscapular pain? Is it going to be levator scapula insertional pain? Will it end up being super spine Natus tendinopathy or maybe bicipital tendinopathies. So depending on which injury is going to predicate, what local points that you have or the adjacent points we want to needle the Watteau G points bilaterally, that’s going to be level with the innervated tissue. So, um, kneeling a C4 through C6, which the C is not on there. My bad, sorry guys. So the Watchers Joshy points of C4 through C6 needling, the pectoralis minor motor point motor entry point, which would be best if you were actually shown how to be able to do that. So we don’t create a pneumothorax if you’ve never done it before. Um, the rhomboids, the middle and the lower trapezius motor entry points would be good to get that communication between the Petraeus minor and the trapezius. And of course the straightest, anterior ribs, three through seven, another muscle that would be best shown how to be able to do those motor entry points. Because if you obvious reasons, if you don’t actually need all that muscle and go to the intercostal space, you could cause some damage with that. So if you’re unfamiliar with anatomy very well, you don’t want to needle these motor entry points.

Yeah. I mean, it just, it’s not three through seven. Like all of them, you wouldn’t necessarily, wouldn’t be needling. Serratus. Anterior is read three, four, five. So you’re picking the more restricted one or two, uh, um, regions, you know, slips of this radius. Anterior, that’d be a lot of needling for, um, you know, for all, all of those, those lips. True.

But we are immediately two to three, sometimes four, depending on the case

And the persons that you want to cover, the distal points Bryant. Yeah. So, um, flexor carpi radialis motor point is a really, uh, excellent, um, uh, motor quieter motor entry point that will soften the pectoralis minor. So in combination is great, but if you’re not comfortable with needling, the pectoralis minor, it is, it is good to learn that in a classroom setting. Uh, just so you do it safely and don’t cause damage to people, but the flexor carpi radialis is a little bit easier of a tissue to, um, to work with if you haven’t been trained to do pec minor. So it’s going to have an effect on pec minor for sure. Uh, other points along the lung and large intestine channel would be, uh, indicated, uh, L I six would be the sheet cleft wine of the large intestine channel would be a really useful long seven would be an excellent point.

Brachioradialis is, uh, brachioradialis is kind of associated with both lung and large intestine, but, but it’s, um, but it’s definitely a, uh, large intestine channel point. That’s going to influence that portion of the channel. Um, protonate or Terry’s Motorpoint would be more for, um, pericardium sinew channel. So if it has more of that lateral shift and again, serratus, anterior is difficult to needle for some people, if they haven’t been trained for inner Terese would be a really excellent, uh, in, in addition or, or just a needle in that one as part of a comprehensive treatment would be good. And then P six, um, for obviously for the pericardium channel. Yeah.

It doesn’t have to be all of these points. You guys, it’s just, we’re just giving you some points to be able to choose from, um, the brachial radialis motor entry points. We could do large intestine, 11 that’s that could connect large intestine lung that’s the upper point. And then lung six, the sheet cleft point is also going to be a motor entry point for the brachioradialis. So points that you can be able to use to be able to communicate upper into the gene gin. Um, just to kick out a little bit more when you were talking about the flexor carpi radialis my mind went to that, um, cadaver dissection that we did on that last specimen. So thank you very much for this donor, continuing to help us learn quite a bit, um, how you showed the really strong connection between the biceps and the flexor carpi radialis and for that lungs in you. That was fantastic. It was great.

Um, the, um, sorry, I don’t have time to go into it, but the connection is the muscle itself attaches flexor carpi ulnaris, uh, flexor flexing carpi flexor carpi radialis attaches to the medial. Epicondyle definitely not on the lung channel distribution, but it has a fibrotic structure from the biceps called the last fibrosis. Sometimes it’s called the bite sip app and neurosis that links the flexor carpi ulnaris with the biceps, which is part of the lungs, then you channel. And then from there short head into the pectoralis minor, and it’s a really strong link. So we talked about how the rhombus rate is slinging on the rhomboids will, will interdigitate also here with the straightest anterior. When you look at the cadaver specimen, you’ll see the pectoralis minor come up to the court court process and just factually bind right with that bicep. Also the, uh, the biceps short head.

So it’s just one continuous tissue onto that coracoid process is fascinating to see the connections at the same layers anyway. So we’re kicking geeking out on that, um, which is crazy. So should we get into a video? You want to introduce the video Brian or the myofascial release, what we’re doing here? So this is a, uh, a pectoralis minor stretch. It’s pretty simple technique. You can do it with the person in a prone position and the video will walk you through it really good to do after treatment. I guess you could make an argument if you’re doing facedown treatment and then turning the person over and doing face up treatment that you might do it in the, uh, after you take the needles out, um, from the face down position and before you turn them over. But generally speaking, we teach these to do after treatment. So the video should run through everything. So we’ll go ahead and go into the next slide.

So this technique, it’s a passive stretch of the pectoralis minor. You’re going to use both hands, one hand, covering the scapula, especially covering the inferior angle of the scapula. The other hand reaches underneath and hooks around the coracoid process. So you have to have contact with the coracoid process and you’re falling to the inferior border of the coracoid process. So with the one hand pushing down, kind of in a direction following the lower trapezius, it’s almost like you want your hands to be the lower trapezius in terms of function, by pushing the scapula inferior angle down and lifting at the coracoid process to give a stretch to the pectoralis minor. When I say lifting, I’m not lifting straight up, that’s going to lock the scapula and kind of limit movement. But lifting is really more in some ways, following the angle of the lower trapezius and lifting headboard, cranial and slightly towards the ceiling, while you press the other hand down and you want to picture the fibers of the pectoralis minor are getting longer and you can hold for however long you feel is appropriate and changing angles slightly to get different fibers. Pec minor has a third, fourth, and fifth rib attachments. So different angles we’ll get different fibers of the pec minor.

So the video is longer than the technique needs to be just because it was showing the setup. It’s kind of a subtle technique. You don’t have the right line of Paul. You don’t get as much benefit from it. Yeah. And feels so good when that technique is applied. That technique is great at, in a combination of acupuncture, myofascial work, and then doing the stretch. It really helps with the four shoulder quiet, big buckets that Ford shoulder’s gonna go right back into place. If the person goes back to their desk and doesn’t do their exercises, do the opposite movement and a host of different movements that can be able to help open up that chest. Well, Brian, is there anything else that you want to say we’ve gone over our time again, thank you very much for hanging in there, guys. I hope this was useful for you, Brian. Anything else that you want to be able to say? Um, no. No. Uh, I think, uh, the technique is you’ll, you’ll see if you wanted to reference that in recordings, that is going to be at one of the techniques that we’re going to have in a class upcoming class. That’ll be a webinar in March. So we’ll have a lot of different techniques like that and kind of combining some myofascial release with acupuncture.

Awesome. Awesome. Cool. So I want to thank American Acupuncture Council again. Thank you, Brian. It’s always nice hanging out and doing these things with you. Next week, Sam Collins is coming in to be able to discuss the billing and coding for insurance. He’s always great for, uh, providing the latest updates, which is really important in these ever-changing times. Um, so thanks again, everybody really appreciate it. And, uh, we’ll see you again next month, right?

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Acupuncturist Malpractice Insurance: Addressing Health Issues in children; Integration of Chinese Medicine to Western Medical Practice

In this post, we are sharing useful insights from a recent Live Event by Dr. Sam Collins of the American Acupuncture Council, with his guest, Dr. David Miller. Their discussion revolved specifically about addressing health issues in children of all ages and the things that acupuncturists can do in order gain more traction in the western medical practice.

Here’s the gist of that discussion:

Why communication is so important. Not all patients who come to your clinic are willing to undergo treatment if they are not familiar (if not fully aware) of the process and their benefits. However, with good communication skills, a practitioner can build reputation and patients begin to trust. It is imperative to send your message across to your patient and right communication is key – to develop a more personal relation with the patient, which makes them more open to new treatment even if the method veers away from conventions .

Why you should be familiar with state laws. Every state has its rules and regulations that are unique to them, which is why it is important that medical practitioners operating in a particular state should be familiar with laws in that area. This holds also true when it comes to acupuncture and the Chinese medicine in general. There are states that allow the integration of Chinese medicine into the western medical practice, but there are also states that impose steep regulations concerning this treatment approach. When you know the local laws, rules and regulations, the chances of your practice being hampered by possible conflict with the law become minimal.

Why go for an integrated, holistic approach in treating children. When making an assessment on children’s health (and eventually addressing the possible health issue), the approach should be holistic. They may complain about back pain, but you should also check the possible underlying issues. For instance, there might also a problem with digestive functions, respiratory issues (e.g. asthma), sleep issue, among others. Such approach is quite common in Chinese medicine, and as an acupuncturist, giving importance to this holistic approach yield positive result.

Why educating doctors about the Chinese medicine is helpful. The discussion also gave highlight on how important it is to educate doctors if you want to integrate acupuncture to western medicine. It put emphasis on the fact that some doctors has little to no knowledge about acupuncture; educating them opens a lot of opportunities, including the expansion of Chinese medicine to the western practice. And the plan of action to carry out process? You need to consider a number of things, including: sending a letter, giving them specific types of cases and their results, asking for a letter of consent (should their patients come to your clinic to seek alternative treatment).

Why establishing presence in the community is important for your practice. Again, the reason why there are still a lot of practitioners who are having a second thought to incorporate Chinese medicine to the western practice is simply the lack of awareness on its benefits. This is why an acupuncture practitioner should reach out to the community. This can help build trust and recognition as you will have an opportunity to introduce this approach to them – with proof of its effectiveness. You can do that using different techniques such as joining in state associations, volunteering, giving lectures – campaigning through grass roots education.

Here’s the link to the live event video: https://www.youtube.com/watch?v=eMF2PXNuXSY

And for your need of chiropractic malpractice insurance, contact ChiroSecure today at: (866) 802-4476

The AAC Pledges to Raise $300,00 for Acupuncture Research