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Occiput-C1 Fixations and Imbalances in the Channels

 

 

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

Hello everyone. Thank you very much for coming to our presentation. Thank you very much to the American Acupuncture Council for having us. My name is Matt Callison. I’m here with my dear friend and colleague Brian Lau. Thanks for having us. Brian. And I were talking the other day and we were discussing our topic for this particular presentation.

We’ve got the module one presentation coming up for the smack program and it has a lot to do with the T-bar fixations and sacral fixation. How they can contribute to patient’s pain. And this particular one with the occiput and the Atlas is a very important one for acupuncturist to know.

So we wanted to be able to shed some light on this particular fixation and how it can contribute to a number of different injuries. So with without further ado, we’ve got quite a bit to get through. So why don’t we go to the next slide there?

All right. So in the certification program, sports medicine, acupuncture certification program in module one, we look at the role that fatigue and sacral fixations play in the patient’s complaints, including musculoskeletal conditions, but also food. When there’s a table fixations in the thoracic region in this particular presentation.

As I mentioned before, we’re going to introduce the occiput and see one fixation. That’s going to be taking place at the Atlanta occipital. Now this fixation could cause many patient complaints, such as cervicogenic, headaches, muddled, or cloudy thinking neck pain. And, for that matter also it can contribute to job pain, low back pain, and a very interesting so as strain because of the association that this fixation has with bilateral.

So as is that we’re going to touch upon here and just a little bit. So why don’t we get started about what is of the tibial fixation with the next slide? So if a fixation complex is going to be the compression and torquing of one vertebra on top of the other and the locking of the vertebrae together, creating creates a hype boat, mobile, it just fixate those two vertebraes or even three vertebraes that lock together.

Have a lack of mobility within that segment of the spine, which is going to be further restricted with Maya. And also ligamentous adaptations, holding that fixation in place. Now the Fossette choice can be locked into a compression into rotation. It can be tilted to the left and right sides in the sports medicine acupuncture program.

We also discuss how the thoracic vertebrae can be stuck in flat. And also into extension. So if you can take a look here is as if the vertebrae, when it has a compression and torquing, it just locks one on top of the other. And it may not actually look like it’s out of alignment. Many times the vertebraes actually feel like they’re in place, but they end up.

Moving very well. They get stuck with one another that causes a barren motion within the region. And the more chronic that fixation is going to be in place, it starts to then affect the spinal nerves itself. So acupuncture, manual techniques work extremely well to be able to open up these fixations and get more energy to the Zong Fu and also the innervated tissue.

So skeletal system. So what’s on, then let’s go right into that Oxford C1 here. All right. So we’re going to focus on this particular fixation. We’re going to call it the joint from now on just cause it’s a lot easier than saying atlanto occipital joint from the entire presentation. So the skull or the head, it sits right on the superior articular Fossette via the occipital condyles.

Brian, would you be able to show. Where those condos are on the skull and the image on the right. You can see those blue images there that’s on that skull. So then those particular articular areas are going to then fit right into the articulate areas of the Atlas. And you can see there in the cost services, superior articular surface of the lateral mass.

So it’s really quite interesting. The headsets, basically balancing on this very small area on that Atlas. So let’s go to the next slide then.

Now this joint is a small range of motion. That’s going to be approximately 10 to 15 degrees of flection and extension. So that’s going to be the movement of basically nodding. Yes. So it’s the very small movement of 10 to 15 degrees of flection and extension of nodding. Yes. Which is a difference between.

Full cervical flection and full cervical extension. It’s just that small little movement of nodding. Yes. Now some research researchers are going to agree that there’s also a little bit of movement in lateral flection or a lateral tilt of the occiput on the Atlas. And we’re going to discuss that a little bit there too.

When you start to, when we get into the assessment. Now the suboccipital muscles that are located deep to gallbladder 20, and also the semispinalis capitis muscle, especially the superior fibers. They’re going to be primarily responsible for this action. So those are going to be two muscles that we’re going to be definitely treating and linking that with their senior channels.

Let’s go to the next slide. I want to discuss a little bit about how the angle of post. So on the left, you see an image of the four suboccipital muscles that surround Cobb that are 20. So you can see the angle or the line of pull of the suboccipital muscles. They’re going to go ahead and. Tilt the cap or tilt the occiput into extension now on the right, you can see those upper fibers of the semispinalis capitas.

Those will also be tilting the cap or the occiput into extension. So let’s go through that language again. You’ve got cervical extension. But then with that small little movement in the AAO joint, it is capital extension or a little bit of a tilt. If you take your fingers and put them rod over gallbladder 20 on yourself.

And once you’re there, just look to the ceiling, you’re going to have a small little movement of capital extension. So what you’re feeling then is these upper fibers starting to contract. And holding that area in place. So therefore, if you have a posture, let’s go to the next slide there. Brian, we could, if you have a posture where the person’s going to be stuck in capital extension, for example, this image on the far right.

Where the head is basically stuck in the end range of yes or capital extension. Many of our patients who have cervicogenic headaches are clouded thinking low back pain, neck pain, have this particular posture, which on the upper right, that had, is stuck in capital extension. So therefore the AOJ.

Is locked has, and then the soft tissue around that AOL joint actually starts to become adhered and locking that position. But you also have people that we have the end range of. Yes. So you can see on the lower right. That person is going to be more into a flection of that capital. Now that can also be a fixation of the joint and also have muscle and soft tissue balances as well.

So let’s talk about those soft tissue balances, because we’re going to be looking at that for treating with acupuncture. Now, all the tipo fixations, including the fixation of this AOL. It’s going to happen, have the mild fascia imbalances between left and right sides of this, especially apparent with the suboccipital and the semispinalis spinoffs muscles.

So often there’s going to be a lock short muscles, which we can be able to label and treat as an excess on one side of the joint, which is really holding on locking that joint. And then on the opposite side, there’ll be locked long muscles, which we can categorize. As deficient and they’re inhibited their weekend, which is going to predicate needle technique that we’re going to be talking about here in just a little bit.

And that’d be on the opposite side of the choice. Now, this image on the right, this is going to be of the thoracic spine. So you can see there’s going to be locked short Xs on one side and lengthened and deficient on the. For this particular conversation, we’re going to be looking at the upper fibers of the semispinalis capitas and also the suboccipital muscles that we can treat with and also specific needle technique for gallbladder 21 side will be excess and the other side will be deficient.

And this is something that you can often feel just with palpation. And we’ve got a video of this. We can be able to show you here in just a little. So not only are these a local needles that we’re going to be using the extra earn near vessels of small intestine three, and you’ll be 60 to work exception.

To build a help with releasing that occiput and Atlas fixation as well, there’s going to be other muscles that we honestly want to look at and associated channels that we want to look at. That could be actually fixing. The a O joint. And I think we can hand it right over to Brian. So you can get into that.

Brian, are you ready?

Okay I don’t know, Matt, did you mention that inclusion of ? Yeah. At the very end, the extra investors can do my job. Yeah. So we’ll come back to that in a second. Looking at the primary channels associated with it. We have really a combination between the urinary bladder and the small intestine that channel sinew channels.

We’ll go with this new channels. Just to get a quick overview, we’re not going to go through the whole channel for this lecture, but I have it listed here in terms of the myofascial structures that are part of the UV new channel. It’s primarily what you’d expect, running up the posterior part of the body, following the urinary bladder.

But let’s take note of these little branches that sometimes we forget about, if we don’t look at this, the new channels that branch from the primary channel going up and down the back and then wrap around the front and then wrap up to the shoulder. So we’ll get this anatomy in a second, but we can just briefly see this Leticia, this door sigh wrapping around to the PEX and then linking for this lecture.

What’s really important is the Sternocleido mask. And then we have another branch that comes off of this region also and links with the upper trapezius. So that’s one thing. And then the last thing to look at is this binding region that we’ve already discussed at this suboccipital region. So let’s start with the suboccipitals Matt’s already talked about them.

This image is nice because we have a slightly different angle and we can get an appreciation, not only for. The rectus capitis posterior major and minor and the angle they take, but how sharp of an angle. Then we miss out on, when we look at those images that are going straight from the back, we lose track of how much of angle these oblique capitus muscles have.

So that’s nice to see from a slightly different. But collectively, these are going to have a really big influence over the balance of the suboccipital joint and seeing the angle, these muscles take, you can see how imbalances between one side and the next might not just have that extension aspect that Matt’s talking about, but also that ability to sorta have the head not sit on quite straight.

Really key muscles to suboccipitals for the balance of the, of this Atlanta occipital. But also really the balance of the whole urinary bladder send channel. And the tone of that whole urinary bladder send you a channel included also would be the cervical extensors semispinalis capitas.

But then if we go to the the branches that were discussed off the urinary bladder channel, oh, we have the lats into the pecs and then creating a myofascial plane with the sternocleidomastoid is an interesting muscle it’s part of multiple sinew channels. Definitely part of the stomach.

But it has this linkage with the urinary bladder channel. And I’ll give you one indication where you might’ve seen something related to this is when you’ve learned about points and learned about urinary bladder 60. That, that is a common point for headaches. But the description, if you go back and just read the commentary saying Deadman, the description of that often talks about young rising, excess, young, rising up the.

Urinary bladder channel. And the way I interpret that is that tension that rises up to back when people have a lot of St Liberty’s stagnation, a lot of rising liver, young, rising, but it often rises up that urinary bladder channel and everything tenses up, SCM, upper traps, the cervical muscles, the back muscles.

It’s that raising of the shoulders that happens in that scrunching of the neck that happens. So it’s a very typical stress response and these muscles are very involved with. But they’re also because of their mechanical attachments at the mastoid process for the SCM and then the upper traps going all the way up to the EOP, they can also contribute to that capital extension and that discrepancy from left to right.

So their accessory muscles, their muscles, we can also consider as part of a treatment when we’re working with fixations at this region and things that are associated with that. Cervicogenic, headache, cervicogenic. Okay, quickly going through the small intestine, send your channel. We have multiple structures.

We’re not going to get into them all today, but levator scapula is a big one. And that binding region that happens at the upper cervical region, look at an anatomy image of that. Levator scapula actually attaches to C1 through C4 transfers processes. So it has an influence on much of that upper cervical spine, but especially that C1 transverse process.

Be a big contributor to that tilting of the head from side to side, some of the discrepancy in terms of how that’s going to balance, not just a position from a capital extension, but that maybe shortening and raising the shoulders or on one side. And that discrepancy from side to side. So levator scapula is another one that can be a player in this and can be And accessory muscle treating the suboccipitals important.

We’re going to be looking at a technique at gallbladder 20 and semispinalis capitas. Did you be 10, but don’t forget about levator. Scapulae it’s a good one to consider in this whole list. So collectively these two channels are going to meet and have a binding region at that upper cervical spine Atlanta occipital joint region, the suboccipital region.

And collectively are going to be a part of that whole balance of the AAO joint. So here’s a nice image showing that upper fibers of the levator scapula meeting at the transfers per process, and then sharing, communicating mechanical information with the oblique capitus superior and inferior muscles, which are two of the muscles of the suboccipital.

Triangle two of the suboccipital muscles. So they can really work together in terms of balancing, but also become dysfunctional together. All right.

Kind of piety to look at some images. Okay. Yeah, Brian. So let’s get into these and talk about these. I think this is a nice segue into that discussion of the upper trapezius and levator scap as well. So the image on the left, you can see that she’s got a bit of a lateral tilt of her head onto the AOL joint.

You can see how that left ear is slightly lower than right. And this is something also that you see with patients, let’s say, for example, that you’re sitting on a stool and the patient’s sitting on the table right in front of you. Have you ever noticed that it looks like their head’s just not quite on straight.

So there has slightly, just slightly tilted. This is something that you would see on the left and I’ll guarantee you 99 out of a hundred. If you go back and you palpated the gallbladder 20 and the bladder 10. Once I will feel very access and the other side will feel very deficient. Hence something that we’re going to discuss here next is that person will also have bilateral.

So as weakness. So we’ll talk about that here on the next slide, but for right now that image on the left, you can see that they’ve got a little bit that lateral tilt, same thing with the image on the right, this gentleman. You can see his tilt on the right to the levator scapula is going to be in a locked, short position on that right-hand side.

And he most likely has an Oxford C1 fixation as well. So these people could have cervicogenic headaches or any of those aforementioned signs and symptoms that we had. Brian, do you want to talk about the capital extension there on the remaining two? Yeah, I would agree that, the big structures to consider on these ones that Matt talked about would be the suboccipital muscles are so influential on the tone, but it seems to me without having any other information on these patients, you know what they’re coming in with, et cetera, it seems to me like levator scapula would be indicated for those.

Whereas these pictures on the right, I might change my tune if I saw them from the back, but at least from the view, from the side and the success of capitalization, The suboccipitals are going to be involved with that, but I would also be looking at the SCM for both of these these patients.

And it could, it’s going to be the case at one side, it’s going to be shorter and that’s going to contribute to that tilting of the head not being quite on straight. So it would be an accessory muscle to consider along with the suboccipitals and semispinalis capitas, especially if they’re coming in with headaches and it seemed like the SCM was a component of that.

Maybe referring into the frontal region or deep into the occiput STM would likely be involved with that. Maybe even upper traps, all upper traps are in a position where they’re pulled forward. So we’ll be including in this discussion, after looking at some local needle technique, we’ll be including a myofascial technique that you can refer back to those two, right images when we’re talking about that myofascial technique.

And that would be the type of patient that, that the technique we’re going to show with. Yeah, that’s a good point. I would suspect the image on the far left that her left upper fibers of the SCM would also be really quite locked short. The same with the gentlemen on the money. I would think that his SCM on the right.

Yeah, that’s great. Holding this fixation in place. Now you guys, we are zeroing in on the AAO joint for those people that might be looking at the posture on the left images there. Yeah, of course, the elevated ilium and the side bands at the spine and such all of that would have to be addressed.

Which we do in the different modules in the smack program. But right now we’re just zeroing in. Joy joint, how important it is to observe and treat it for different types of signs and symptoms and pain patterns. All right. So the next slide is one is an assessment from applied kinesiology.

So this is George Goodheart’s work, but I’m not exactly sure if it came from him or maybe John PHY in touch for health. I’m not exactly sure which one, but yet with an occiput Atlas fixation at the joint, it will create bilateral. So as weakness. So therefore, if somebody has this muscle that’s in hidden.

And therefore they’re going out and doing extra curricular activity, hiking, doing something above and beyond. You could see how that muscle would be struggling and eventually could actually strengthen. So when somebody has a hip flexor strain, it’s affecting that. So as it’s always a good idea to go up and look at the joint now, since the so as is not going to be stabilizing that lumbar spine as well, being inhibited from a fixation at that AOA joint, it can also create low back.

This is a really great assessment looking at the so as, and then once you correct the AOL joint with acupuncture, and also we’re going to be showing you a little bit of a manual technique that you can use, and also a mild fascia release technique on the upper trapezius that’s affected. You would then go back and check the so as for strength and if it is not bilateral, so as weakness anymore.

So then therefore you’ve done your job with some patients. It might be, then you need lateral weakness, meaning it’s just one. So as that’s weak, that means that the AAO joint is still corrected. Remember with the fixation it’s bilateral. If bilateral weakness turns into unilateral weakness, it then becomes more of a segmental problem or just a localized problem, which we could go ahead and treat the Watteau GS of the high T 12 down to about as well as GB 27 on that particular side in order to be able to turn that.

So as right back on. Cool. All right. So what do we got next here? I will say one quick thing about that. It seems odd, right? The, so as in the occiput C1, there’s not a direct innovation. It’s not like the so has, is getting its innovation from C1. But if you wanted to just look up something called the ocular pelvic reflex it talks about the relationship between the eyes, which have a strong relationship with the suboccipital muscles in terms of turning the head and following eye movement and the pelvic position and really the lower spine position.

So it’s probably a regional. Component that’s communicating between eye movement and stabilization of the spine. And maybe that gets turned off when there’s an occupancy one fixation theory, but it’s really more clinical observation than it is a direct anatomy thing. But that’s what I think it works according to those principles, but that’s something that you teach and demonstrate in the senior channel class.

And it’s really quite interesting. So as fire, when the eyes left or right with that. So that relationship, thanks for bringing that, Brian. That’s good. That’s where it’s like, if there’s somebody seated and you press into the abdomen and you can touch the, so as you often feel that firing slightly, when people look up to the coroner, which suboccipitals will start the fire and you can feel that tone change, like I got my eyes closed and be like, okay, you’re moved.

You moved sometimes you don’t feel it. Maybe those people, you don’t feel it as well. Or you only feel that. Sometimes it’s quite prominent sometimes not so prominent. Maybe the people it’s not really prominent on are the ones with the occiput C1, fixation but you can definitely feel this how, as I’m communicating with that small little eye movement, that’s happening in this small head movement that occurs from that.

All right. Cool. Next.

All right. So when you’re feeling the gallbladder 20 suboccipital region and bladder 10 left versus right. When someone does have an AOL fixation, one side definitely feels more pliable, more deficient. The other side is harder tissue. It’s more dense tissue. It’s usually a bit more painful to palpate.

So with the excess side, what you could do is to go ahead and palpate gallbladder 20, but in three different directions. So from gallbladder 20, if you angle it toward the contralateral gallbladder one, you’re going to be affecting the rectus. Capitis posterior minor and major. If you take your finger from gallbladder 20 and you angle it toward the ipsilateral gall bladder, one is going to be affecting the oblique capita superior.

And then from gallbladder 20, if you angle toward rent 24, you’re putting pressure into the Oakley capitus inferior. So whichever one is actually the most tender or Maven creates a headache is the angle that you want to actually needle from gallbladder 20. If you need a one to 1.1, five inches in any of these directions, it’s going to be totally.

It’s, it is safe to be able to do that. The only one that you want to make sure that you’re definitely kneeling toward the ipsilateral gallbladder. One from gallbladder 22 effectively. Capita superior is one inch to one to 1.5 inches. That’s not an inch and a half. It’s one-to-one. Five suggestible over an inch.

Needling that direction will be very safe. If you do go towards maybe the ear, maybe you’re going too fast. You’re going to be very close to the table, ardor in it’s unprotected region. So we want to make sure that we’re not angling towards or also the ear in that particular case. And then bladder 10, if we can go to the next slide there, which I think it just continues to discuss as go to the next slide.

Yeah, I try to maybe it’s try it again. It’s just stop. Okay. Nope. Here we go. All right. So there we go. So then bladder 10 is going to be the key point for the semispinalis capitas. Now, as we know the way that we were taught as bladder 10 is going to be level with do 15 and gallbladder 20 is level with do 16.

For the last this, so this particular image is from the motor point index that was published and 2000, the year 2000 news I believe was published. And so the information has changed. We have found the actual motor entry point for the semispinalis capitas, the upper fibers at least to be level with deuce 16.

So that means that we’re putting bladder. Level with gallbladder 20 and frankly from my own clinical experience, I think Brian can agree with this as well. Is that treating the upper or the modified bladder 10 level with do 16 and also level with cobbler 20, you get a lot more cheese sensation than you do.

When it’s level with the do 15, but don’t believe me, try that yourself. You guys make sure that you’re needling one soon perpendicular to the table or to the floor going in level with popular 20 and do 16 compared to level with do 15. I think you’ll find, you’ll get a lot more cheese sensation at that particular point.

So the next side is actually showing another view. Semispinalis capitas. You can see how it’s just 20. We’ve modified this and we’re putting it level with gallbladder 20. Everybody got a lot more cheat that way. All right. So the video you’re about to see is going to be needling bladder 10, one inch perpendicular to the floor on one side will be the excess side.

And then on the other side, we’ll end up. Gallbladder 20. So it’s not necessarily going into the three different directions. We’re just needle gallbladder 20 on this particular time, which you can do. But a good idea on the excess side is to palpate those three directions affect that suboccipital triangle.

I think you’ll get better success rate for releasing the AAO joint. This particular video, the audio didn’t turn out very well. So I’m going to go ahead and narrate this as it goes. So Brian, whenever you’re ready, I’m ready.

all right. So we’re going to be looking at, there’s do 16 right there. This is going to be for your a oh, joint fixation do 16. So I’m going to go ahead and palpate on the right-hand side and that feels. Really quite dense there at bladder 10, which we know is going to be about 1.3 soon lateral, that’s going to be the upper trapezius that I’m working my finger through to get to the deeper layer, which is sound mispronounced.

Moving lateral going into gallbladder 20 and feeling the density of gallbladder 20. Now going over to the left-hand side, bladder, 10 more pliable, softer tissue, easier to get in gallbladder 20 more pliable, soft tissue. So there’ll be excess on the right perpendicular to the table of floor going in at bladder.

One inch, you could even go in 1.2, five inches here. I do recommend a deeper needle technique at this particular point to get into that semispinalis capitas and a gallbladder 20 on the right. We’re going to needle just toward the tip of the nose in this case at gallbladder 20. But this would be the area that we could go ahead and pop it to three different directions for the suboccipital triangle in this particular video.

no, on the left-hand side, we want to reinforce this. So this is going to be a shallow needle technique going right into that upper trapezius going in just about a quarter of an inch. No more than a half an inch in that area. A very light CISA station compared to the opposite side, and then a gallbladder 20, the same thing going toward the tip of the nose.

Very light needle sensation here. More of a reinforcing needle technique from clinical experience going in and really wailing on these areas are getting a lot of cheat on areas that are deficient will actually make the person a little bit worse.

So deeper on the right-hand side, more of a reducing needle technique, more superficial on the left hand side, more of a reinforcing needle technique.

This is a video is on our YouTube channel. By the way, I know sometimes streaming the, you can get a little choppy, but if you want it to go back and look at it again, that’s on our channel sports medicine, acute.

All right. This was a really great muscle energy technique for the Suboxone suboccipital triangle muscles. I believe it was developed from Phillip Greenman in the 1940s. He’s a very famous osteopath that has quite a few different books out. It’s a great technique to build. Right after the needling and after the mile fascia work as well you can even use this type of a myofascial technique.

When there isn’t an a O fixation, it just helps to really relax the patient quite a bit. So this is a step-by-step you can see there’s these different slides. That’ll be in your notes here or in this recording here that you guys can be able to check out. It’s basically gently pulling the person’s head into tracks.

And they’re going to look back at you to help to stimulate those suboccipital muscles. And then once they relax, you’re then going to go ahead and just eat a long gait, the head and traction a little bit further. So it is a muscle energy technique where they contract against you. You prevent any kind of movement for about the count of six.

They relax, and then you pull the head chest. Farther. So you’re helping to realign the occiput onto the Atlas. This again, it’s just a, it’s a fantastic mobilization technique.

Here’s the other rest of the instructions. So like Matt said, if you go back and access this recording and you’ll have this, we also have this, I believe in module. Is it module one? Senior channel class or is that going to be module four? It might be module four senior channel class we actually have. Oh yeah.

On a, not a knowledge. Yeah, that’s correct. It’s module four. Okay. All right. So one more technique. And this one will highlight that branch of the urinary bladder send new channel, that’s connecting with the upper traps and the SCM many ways it’s working with the foster. Of that that, that surrounds both the upper traps and the SCM, which are embryologically one muscle, but splits.

So they really have the same fascial compartment, same fascial bag. And this is just taking the fascia and bringing it back. This video has a lot of different steps. We’re going to not watch the whole thing. We’re going to watch just a portion of it. That’s relevant to this discussion. So I’m gonna kinda go a little ways into the video.

Let’s see, that might not be able to, yeah, there we go. Okay.

And same thing. I’m going to be narrating this just for sound aspects. So we’re going to use it as a loose fist and that loose Fest is going to place right on the upper trapezius on that border of the upper trapezius. So we want to put a lot of pressure so much. It’s just enough to get a hook into the two.

And then we’re going to bring the tissue down towards the table back, really bringing the tissue back while the patient rotates their head to the opposite side. It’s like when I learned this technique, I think we use the description of a velvet glove, which kind of is a nice way to think about it.

Do you want a soft pressure? Doesn’t mean it’s not deep. It’s just not pushing into the tissue deep. The next step we can follow up that same fascial compartment up through the. But I’m highlighting is I don’t want to go in front of the SCM with my fist. I want it to be on the SCM. I don’t want to go in front of that border.

Same thing I put in just enough pressure to get ahold of the fascia. If PHP patients are hyperextended like that, I want to use that pull down towards the table to help straighten and elongate the back of the neck. I might even have them bring the chin and a little. And then they rotate while I’m bringing that whole fascial layer back to the almost to the spine as processes as far back as I can reach it while they’re rotating.

So it’s not a lot of pressure into the neck. It’s more about hooking that superficial layer of the cervical fascia and bringing it back. And then I can have them do it again with another pass. When I’m showing there is when they turn, I want them to rotate on an axis and not bend the head to the side.

It’s almost like they have an access or a pole going through the spine that stays straight. So it’s just a very, they should almost feel their hair scraping along the table as they do it. And I’m bringing that whole superficial cervical fascia. So it’s a nice technique to help decompress the back of the neck and elongate that fascia that’s associated with many things, but the occiput C1 area for this lecture let’s create.

So Brian, we’ve got the proverbial hook coming to pull us off the stage right now. We have. Let’s get through this within the next 30 seconds or so. So the new Nepro is forced Mestinon department certification program starting in San Diego here in July. There is the QR code. We’re happy to answer any questions that you guys may have.

And then also in March, end of March of next year, we have a, so as events, the Pacific sports and orthopedic or acupuncture symposium, that is the acronym. So as. And this is going to be based on myofascial pain. We’ve got incredible speakers that are coming, including Dr. Antonio Stecco Dr. Roberta Pratt Rebecca Pratt, our Nielsen, Brian Lau.

I will be there and Bensky, we’ve got a whole, a great list of people that are coming to present. There’s the QR code for? We’ve got a lot of online recordings as well, that we can be able to further your continuing education. That’s going to be through Lhasa OMS here in the United States, Eastern currency in Canada.

And there’s also distributors international for that. You can also follow us. We’ve got YouTube and Facebook and Instagram and Brian, you want to give a shout out for your movement therapy? We’ve been putting together a lot of description of movement associated with the channel sinews. So it’s a not evaluate calisthenics and Qigong Tai Chi, various things, but it’s not about what the exercises are.

It’s really looking at it more from a channel perspective, how you train those channels, wake up those channels and incorporate like really efficient movement, but those channels, and then you can start strengthening. So Jim gen channel sinews movement training a QR code, or you can just do a search for Jim gen movement training, all the other stuff.

We mentioned the sports medicine acupuncture. If you go on YouTube and you don’t have to code with you, just do a search for sports medicine, acupuncture for any of those are fantastic. That’s it. Yeah. Hopefully this was a useful for you. There was some pearls for you guys to be able to crab and help out some patients.

Cause that really is the bottom line. We want to be able to help other people. If you have any questions whatsoever, please reach out to us. We’re happy to be able to answer those questions. Next week. Cholon Moya, who’s going to be coming. I was really happy to be able to hear that she’s actually going to be presenting chose a fantastic speaker and an incredible practitioner.

She’s one of Kiko, Kiku Matsumoto is top students. She took the sports medicine, acupuncture certification. Twice and she’s blending the two things together and she’s just a ball to listen to. She is just a walking dictionary, amazing Tsao-Lin Moy for next week. Thank you very much, everybody. Thank you so much for the American Acupuncture Council.

Happiness. Brian’s always great to hang out with you, buddy, and we’ll see you again soon.

 

AACTTPGELLISHD06242022 thumb

Facial Acupuncture for Treating Drooping Eyelids (ptosis)

 

Click here to download the transcript.

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, Michelle. Gellis here. I want to thank you for attending this AAC live presentation and thank you to the American Acupuncture council as well. Today, I am going to be talking about treating. I chose. And for those of you who don’t know me, I teach cosmetic and facial meaning neuromuscular acupuncture classes internationally.

So the topics for today are going to be how some possible techniques for treating eye TOSA. Looking at the etiology from an Eastern and a Western perspective and then different treatment techniques, including submuscular needling motor points. And I’m not going to get into scalp, acupuncture and cupping, but those are some other treatments that can be used.

To treat I ptosis. So what is ptosis of the eyes? I chose this is when the muscles that raise the eyelid and there are a few of them. So there’s the levator muscle and the superior tarsal muscles. And in some cases also the frontalis muscle, when these muscles are not strong in. One or both of the eyelids can droop.

So testers can affect one or both eyes. It can be congenital. It can be cause through disease or injury. It’s more common in the elderly as the eye muscles begin to weaken and deteriorate. And here are some pictures of different degrees of eyelid ptosis. So in this person here on the top left, it’s very mild and in the person right below them both of the eyelids are what is referred to as hooding, meaning the.

Eyelid itself is eclipsing the part of the eye that allows us to see, and this again, can happen with old age. It can happen due to disease or injury in the middle photo. We have a slightly. More pronounced degree of eyelid ptosis, and then in the photo on the far right. Someone who has severe ptosis.

And so I am going to go into, again, some of the etiology and treatment for the varying degrees of islet. So Don damage or trauma to the eye can happen through injury or anything that damages the third cranial nerve, which is the ocular motor nerve, which controls this muscle. If someone has Bell’s palsy stroke they something like this can happen from a brain tumor, even conditions like diabetes or my skin you gravis can cause ptosis of the another cause common cause of ptosis is Horner syndrome and that is a.

Nerve damage that occurs in the face and the eyes. And in that case, it most likely wouldn’t just be the eyelids, other sorts of brain injuries, spinal cord injuries cancer can cause harm. Syndrome and ptosis cluster headaches can also cause ptosis what a cluster headache is a severe headache that has a frequent pattern for a period of time.

And then it will go into recession from a cheese TCM perspective. Ptosis is due to a congenital deficiency. Either a deficiency of the spleen or the kidney or balls or an obstruction of the collaterals by wind flam, leading to some sort of malnourishment of the upper eyelids. When we’re looking at doing body points to.

TOSA is from a TCM perspective where you would differentiate between the spleen kidney deficiency with wind flam and points on the stomach. Bladder and spleen meridians are typically used in that instance. And some of the manifestations for. The deficiency of spleen and kidney is it’s typically bilateral.

There might be some soreness and weakness in the lower back and the knees, poor appetite, loose stools, and the tongue body would be pale with a white coating, deep, weak pulse. And so the treatment principle would be to reinforce the spleen, warm the kidney. And I’ve listed some possible points that you can do, and you might want to add in let her 20 and 25 use a mocks that are really tonify the spleen and the kidneys.

And then the explanation is listed here below.

for us spleen. Whoops, sorry for a spleen deficiency. With when phlegm, the manifestations would be more of a swelling and numbness in the upper eyelids, possibly difficulty moving the eyeball. Numbness of the limbs fatigue, poor appetite here, your tongue would have a pale body with a white and sticky coating.

The pulse is going to be soft and thready, and the tree treatment principles would be to reinforce the spleen and resolve the phlegm. And the primary points are listed. And then the explanation. For why you would do each one of these points is listed below. If we have time at the end, I’ll come back to this, but I’m always mindful of time when I’m doing this live presentations.

For a scalp acupuncture, I had mentioned that you can treat. Eyelid ptosis with scalp acupuncture. We don’t have time for a whole scalp acupuncture lecture, but needling the lower two fifths of the motor area on both sides. And. For doing motor point. So facial motor points, you could do the motor points for the and those are two motor points.

It’s the extra point show how, and you would do an oblique absurd insertion. And there’s also a motor point halfway between gallbladder one and Sanchez 23. Again, you would do an oblique insertion also for the corrugator because the corrugator muscles work in conjunction with the eyebrows and the eyelid.

So treating the corrugator muscle. By doing the motor point that is just lateral to bladder too. And also treating the motor point for the front desk. Because as I mentioned, the frontallis, which is which are these muscles right over your eyebrows, the frontallis raises the eyebrows. So doing the motor point for the frontallis, which has gallbladder 14.

And again, a bleak insertion, and you can also do facial cupping and guash Shaw gently around the orbicularis ocular a little bit inside the orbital Ram. You can even stimulate the acupuncture points, all the acupuncture points around the eye, stomach to gallbladder one, the X per point. Ladder to you?

Yeah. Sanjay 23. So gentle cupping, gentle guash Shaw stimulating the point. We’ll all work on the ambiguous virus. Oculus. And if you choose, you could even use a Derma roller around the outside of the eye area. You never Derma roll inside the orbital rim, but really stimulating that area can be very beneficial.

So I mentioned these three points, bladder to you yell and Sangyo 23 when I needle them, especially with you. Yeah. I will lift the brow up out of the way and I will needle straight. Yeah. Under the eyebrow and for you. Yeah. If you go in line with the pupil, as opposed to the center of the eyebrow, if you go in line with the pupil, you can catch the edge of the levator muscle Azure noodling, and it really helps to lift this entire area.

I think I have a video.

Let’s see if I can get this sleigh, like really this. What I’ll do is I’ll pull up, but for her, I would just use the two and push underneath the brow like that. So again, I’m not on the lid on underneath the brown. Okay. Where they call this you yet? Don’t you? Yeah.

So those of you who don’t know me I do teach cosmetic acupuncture classes, which is what all of these other points are. And I incorporate this in my cosmetic acupuncture classes because as we age for many people, the drooping eyelids is very much a concern. And I realized the video is a little jumpy, but a few go to my social media.

I have a lot of these short little videos. I do a facial acupuncture tip of the week. So you could see it a little more smoothly than than you just did,

like really another. That can be very beneficial is gallbladder 18. This is not a widely used point, but it is a fabulous point for treating the eye area. If you look at this drawing from a medical textbook, this shows right here, the supra orbital nerve, and. This runs right along the Gallia up and erotica, which links the subtle and frontal bellies of the occipital from talus muscle gallbladder 18 is in line with do 20.

And so do 20 is here. The bladder line is here and then gallbladder. The way you can find it is you go to a gallbladder 14 and then 15, and you’re going to follow it straight back till you get to 18 noodling. This affects the entire occipital frontalis muscle and helps to open up the eye area.

So I had talked about the motor points for the , which is the muscle that goes all around the outer side of the orbital rim here. And the two motor points of. Between gallbladder one and Sanjay 23. And then the extra point Q ho. And you would treat only the affected eye. If both eyes were affected, you would treat both eyes, but if it’s just one eye that was affected, you would just treat the one eye.

And here is a picture of gallbladder 18. You can see it is in line with do 20 and it is right along the gallbladder line. Another point. That I will thread actually is I start at bladder four and the way you find bladder four is you go to bladder two, you go straight up to bladder three, and then you are going to come over at 1.5 soon to.

Bladder for. And when you were at bladder for you thread, a long, the scout all the way back to ladder six. You can use a half inch needle or a one inch needle, but this added in with the other points here. Whoops. I have a little delay here. So if you add these points, gallbladder 14 and Gulf letter 15 all together,

along with some of these motor points and you leave them in for about 20 minutes or so, what I do is I would leave the points and I might include. Some scalp acupuncture and with the scalp acupuncture, you would come in every 10 minutes or so and stimulate the needle. Then you would take the face points out, continue to stimulate the scalp point.

Cause you want to leave that in for about 30 minutes and try to get your patient to lift their lid. And sometimes it helps. If you’re doing scalp acupuncture to have them sitting up, you hand them a mirror and have them really focus on lifting up their eyelids. If they can see in a mirror, it helps to connect the brain to the muscle group.

Once the noodles come out, then you would do your. Cupping and Guam Shaw and Derma rolling. And I also sell my patients a set of cups and I teach them how to use the small cup and the facial wash shot tool. And. That way in between treatments, they can be working on these muscles. It’s a great way to reinnervation the muscle to re educate the muscle.

Obviously your patients can not be needling themselves at home. Teaching them to work, these muscles at home can be. Very beneficial. And so the order would be you put in the body points, right? You’re going to treat the underlying condition. Then you’re going to do any points around the eyes and scalp.

And then once the eyes. Come out, continue with the scalp points, have them work the muscles, then the cupping and GWAS Shaw, and then the German walling.

This was a patient of mine. She was actually young. Sorry. She was actually young. She had come to me for. She was going to be getting married and she had ptosis of her left eyelid, her entire life. And she was concerned because when she got tired, It became more pronounced. It was more noticeable and she suspected, or if she was sick, it would become more pronounced and more noticeable.

And she was very concerned that moving forward that the day of her wedding in all of the wedding photo, That she would have this one, very droopy eyelid. So she came to me for about three months before the wedding. And. Worked very much. He had very deficient kidneys. I spoke to her about getting proper rest and drinking.

Plenty of water treated. Her kidneys, did a lot of work. And what I would do is I would do the points on her back. Lots of mocks, a heat lamp. Then I would turn her over. I would do the body points on the front of her body and treated her. Eyelids. And after about six treatments, she really started to notice a difference.

And then by the end of three months, the treatments were holding to the point where I only saw her from time to time and you can see the after photo. This was a close-up actually from one of the. Photos a day of the wedding. She did it before she put her makeup on her. Eyelid had opened up and she was very happy.

Think so worried about time. I talk really fast. Let’s go back to the beginning and I just want to run through the diagnosis. A little more thoroughly and then wrap it up. So for the actual points that you would use, if someone had a deficiency of spleen and kidney, the primary points would be the eye points that.

I spoke about, so gallbladder 14 bladder to tie on, which I didn’t mention. You could also do gallbladder one. You yell Joe 23, very gently manipulated, do 20 stomach, 36 spleen, six, kidney seven. And then the explanation is. Bladder 20 and spleen six reinforced the spleen and tonify that she bladder 23 warms the kidney yang, especially with moxa stomach 36 and do 20 reinforced.

She raised the yang and can help to lift things that are sunk in. Gallbladder 14 bladder to Ty young and you yeah. Are all local points. They helped to nourish the upper light eyelid and strengthen the local muscles for the spleen deficiency with wind phlegm, the primary points would be gallbladder 14, bladder two.

Ty young you. Yeah, again, so a lot of the same local point do 20 Sanchez, 23 and stomach 36. Again, spleen nines, blend three and stomach 40. So stomach 36 helps to reinforce the kid, the stomach chew spleen nine spleen three, reinforced the spleen and remove dampness stomach. 40 helps to transform phlegm, do 20 dispels the wind and gallbladder 14 also promotes a nourishment of the.

Upper lip. So I think that is everything. I don’t recall if we can do Q and a, but I don’t see any questions popping up. So I am just gonna conclude. This talk today. And next week we have Matt Callison and Brian Lau presenting live. And if you missed any part of this, or if you’re interested in seeing any of the other AAC, Facebook or Instagram live shows, they are available on YouTube and on the AAC.

So thank you again for coming and I look forward to seeing you again. .

 

GWRHDDoran06222022

Ghost Point Treatments

 

Click here to download the transcript.

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.

To the point, generously sponsored by the American Acupuncture Council today. My guest is Leta Herman. And I’m Virginia Duran of Lumina beauty.com. And LE’s gonna talk about the ghost points and her special approach to treating them. Leta was on, I think it was last month on my show. And I don’t know if we need to introduce you again.

Thank you to the American Acupuncture Council for having me on the show. Yeah, I’ve been in practice for, over 20 years in teaching, a lot of different concepts related to alchemy. And so the 13 ghost points are alchemical treatments and we have a teaching a school called alchemy learning center.com.

And so we also have a clinic in Northampton, Massachusetts alchemy healing center.com. But my history is that I’ve been doing this work for a very long time. And I study extensively with Jeffrey UN. Who a lot of this work, I was doing the ghost points before I met Jeffrey UN, but a lot of the work since then, since, early two thousands has been about Jeffrey’s, influence on my work.

Yeah, that’s good. And tell us, or for anybody who doesn’t know or at least your view of the ghost since not everybody uses them and they may not understand them the same way as you. So there are actually quite a few ghost points, 20 ghost points, and they were invented a very long time ago, but sun, which is also a very long time ago, sun, the king of medicine in China, a very famous practitioner decided to put together 13 of.

And these 13, he called the 13 ghost points and he wrote a what’s called the song of the 13 ghost points and owed. That explains how to do this mysterious treat. And it wasn’t, it really was a different kind of treatment and it really was for ghosts or obsessive thinking or any kind of obsession.

And so if you take these individual ghost points that, we all have learned and you just do one or two of them, you’re not really accessing the power of the ghost points. You can do one or two in the mode that. Working with them as a unit of 13, you can even do three is a common way.

People do them two or three of them in a treatment, but you need to understand the deeper ways of working with them, which I call getting into the void of your heart. And so in terms of just how you’re gonna do these points, they’re almost like rich ritualistic points. You have to think about the influence of doism on the treatments.

So those are some things to think about. And so the way that we are working with them is gonna look very different than, modern, classical or TCM type of practices. Do you, is there any kind of energetic flow with them? Like the way Meridian acupuncture looks at things? That’s a really good question.

They’re their own. Yeah, that’s the really good question. The flow isn’t so much aligned with the meridians at all. The flow has to do with things that are more external to a person. How I interact and react to the world would be the beginning of the treatment. And as you walk through the treatment, we’re looking at deeper and deeper issues.

So by the time you get to the last point, which is the identity of a person. You’re talking about the deepest kernel of a person’s authentic self. So you’re you’re beginning at what I like to call the door to your palace due 26 and you’re ending at well, there’s two alternative points.

We can explain that later, but we’re ending at what I like to call the identity of a person. Like when you came into the U in utero and you were a fetus, who was that spirit before you were even born and messed with by life who is that person? Yeah. And so that’s the flow. And do we know why he chose those 13 out of the.

No, we do not know why, from years and years of having treated these points, I do a as I’ve gotten more and more sophisticated, I really see that one leads to the next. And in my more advanced classes, I try to explain this, but it could take, hours for me to go through it.

But so it’s definitely a longer topic, but if you really look at the flow of things, And how things basically, how does like a trauma let’s say you experience a trauma, you were in a car accident. Okay. So now how is that trauma going to infiltrate into you and begin to really mess with you?

So in other words, we know a common. Side effect of having been in a car accident, let’s say you were on the highway every time you’re in that particular situation. Again, your body gets tense, you don’t, you’re looking around. You’re really alert. You’re in hyper drive, it’s like these are common, reactions to having had an accident before.

So how deep does that go? How much does that affect you? And that sort of how this flow of the treatment works. You begin to see that the more serious traumas are going to get in much deeper than. Oh, I had a little accident. I was a little traumatized for a few days. Maybe I was in shock, and then I got over it and I forgot about it.

And I moved on, so not much, or, something that changed your life dramatically. And we all have clients that come in and they’re like, ever since that day I’ve been changed dramatically. And that’s when you start thinking a 13 goes points, treatment would be really fantastic.

. Yeah, I see. What do you sense when you’re doing it? I wanna ask how the, how you do the treatment, but between the differences between these various ghost points and are they all involved with something like a trauma? Are there certain ones that you find seem to be more implicated? It’s certainly not just for trauma because there’s life circumstances that go on for a very long time.

That can be very trauma, like in a life let’s say you have parents who, when you get into your teens they’re just on you all the time. Be like me. I don’t like who you are. That’s very. Traumatizing, you might not consider it like a car accident or sexual abuse know or like trauma, but parental indoctrination or, yeah, there are a lot of things like that maybe in modern society, we wouldn’t think of as trauma.

Just even neglect by a parent. Is something the ghost points would be very helpful with. So you have to expand your horizons on really more. What we’re looking at is the symptom. What is the symptom? The symptom is, obsessive thinking and, or even some kind of entity possession, if you wanna go there.

Definitely I use the ghost points in my practice, mostly for. As I, I said before in our last podcast, anytime someone who is pretty much older than the age of 20 is as you move along in life, you accumulate more of these things. And so we go, oh, I don’t want that to ever happen again.

And every time we say no, that I’m never gonna let that happen again. That means we are on the alert constantly. For any scenario that looks like the previous scenario so that we can make sure it never happens again. Yeah. So that’s a lot of work. It’s exhausting. For, again, for anyone who’s older over the age of 20 I, I used to think the ghost points were really just for extreme cases of psychosis and, extreme O C, D or ex all kinds of things that we see, in our practice mental issues I used to think it was just for that.

And then what happened was I would treat people and their loved ones would say, wow, this person is completely changing, doing so great. I want that treatment and then I started doing it with them and I said, wow, look, it’s more mild with like you or me, if we had it and we’re not having any of those other symptoms.

Of psychosis or mental illness of any type. But these days, a lot of people have at least anxiety, if you think of that as a mental illness. So what we’re looking at is expanding the idea of these points to more of a general population and saying, yeah, not everyone needs that.

Some people are really living pure in themselves. Just really their authentic selves. They’re beautiful selves. They’re just really living who they are and they wouldn’t be a good candidate for this, but the rest of us , who’ve been around a while. We get a little funky and.

Most of the time is cuz we don’t want that thing to happen again. And that’s where the ghost points can really help. So I certainly still do them with people who have been diagnosed with mental illness and that level, but I’m also expanding it to say a lot of us need that right now. And I think in this society, I have seen a huge increase in people who are anxious.

Or depressed then, when I started 20 years ago. So I think it’s just been more and more something that has helped people and that I believe could help a lot more people there. It’s there’s something in the air people are feeling, and they don’t necessarily understand what it is.

And so it’s UNC. Panic or confusion, or could be depression that, is this gonna go on? What’s our future. And yeah, I think it’s very valid. So because you do a much longer, like a four to six hour treatment, can you kinda walk us through it because it’s, I think it’s hard for people to envision.

How do you do the good points in 46 hours? What is it that you’re doing differently? Okay. So imagine, trying to do something radical to help someone in an hour. We all know what the feeling is. When the clinician says time’s up, see you later. And you’re like,

so what we decided to do maybe 15 years ago or more was what if. And this isn’t just for the ghost points. There are other alchemical treatments and even the Worsely treatments like the IDs and the EDS can be done in this format. What we decided to do is say, What if the person could put aside time and space in their life to work on their stuff for the day, we’re not, we only say four to six hours because you really can’t predict, but you gotta give the person a little bit of okay, I should be available between these hours of the day.

Yeah. But what if we said there’s no time limit? What if we said you can tell your whole story in one session? I had a therapist the other day say to me I’ve never, and this is a psychotherapist. She said, I have never. Told my whole story to one person in one sitting in my entire life. And even if nothing else happens from this treatment today, she said that is such a healing and such a gift.

So if not everyone wants to tell their whole story in the ghost pointing treatment, but if that’s what, obviously what she wants, she’s a psychotherapist. But, in terms of what happens if I create a space for you to enter into and to give. Complete attention, complete presence and no judgment, none.

And I allow you to let whatever happens happen. You bring the treatment. I don’t do the treatment. I just facilitate the treatment by walking through this ancient sort of almost like a ritual of points. And as we go through those points, I can talk to you about what each theme is. So each point has a theme.

And as I say what do you think about the door and how you interface with the world? Since that trauma, did it change who you are? And then we begin to have this like really intelligent conversation about. Oh, yeah. Before that, I, when I was a little kid, I used to do things like this and I used to be like really social and now I’m not.

And so what changed that person? And so as you go through theme and you take your time and you don’t switch to a new point until that theme is done until you feel in your. Body mind, spirit that, okay, that’s good. I can move on to the next point, which is a big skill that we teach and how to develop that.

But all of us do that in our Chinese medicine treatments as acupuncturists, when the, the point is done, it’s just a little bit harder if you’re gonna spend an hour on one point . So we take our time and as part of how these treatments were done, traditionally was with music.

And so the idea is to bring in another vibrational component, we have the vibration of the point and the manipulation of the needles. However, you’re doing that. But in terms of how they looked at it now, remember a lot of these were DOIs priests. They did chanting, they played symbols and wood blocks and all kinds of instruments.

And so they would bring music. And so in the modern day, once the technology, now I started this before this was available. Once the iPod technology came out and the idea of shuffling songs and having a large body of music that you can access we now do that. We do it to music and it’s incredibly powerful.

I call it the divine DJ yeah. Oh, that’s funny. With the long treatments, this is something that I do in my own, in regular acupuncture, as well as the facial acupuncture, because I feel like you just can’t do really deep, transformative work. I can’t in a short period. There’s some perhaps that can, but I want to. relax into it and go deeper and deeper.

And I want the patient to have that experience instead of it being this sudden, I want it to be a smooth entry and exit, so to speak of in the treatment. So with you, do you find. Possible to do, cuz realistically it may not be possible for all practitioners to do this.

Maybe their patients can’t afford extended time sessions. How do you work with that? I. That’s a great question. And it’s probably the number one question that practitioners ask me. So when we teach our apprentices how to do these treatments, we start them by doing one point in the session or two points in a session.

And we pick points that from the ghost point, That aren’t going to disregulate a person too much because what can happen? What I love about doing the whole session in one, one day is that as you go through these points, you’re gonna get stirred up a little bit and sometimes a lot of it, and you’re gonna have a lot of things released and it’s nice to wrap it up in that day and to send them off with.

Some things resolved, to really get revolution. And that’s why it takes so long. And then I have them come back the next day or within a week and do a follow up session to make sure that they’re stable and not disregulated by, in some cases opening Pandora’s box. Frankly, if you’ve had a lot of really traumatic stuff in your childhood, it could feel like Pandora’s box.

If that happens, you need to make sure you’re there for them, the next day or the day after. And it can happen that someone feels that way. It’s rare that it’s like really distressing for them. Because again, if you do them together, there’s a resolution, there’s an elegant kind of map of that.

And they usually end up going home feeling like, yes, I feel great. But that’s, again, everyone’s different. And so that’s why I do this, what I call the follow up session that I include in it. So if you’re gonna break it down and say, Hey, I’d like to do the 13 ghost points over a period of time.

And if you wanted to map it out and do that, I’ve done that with people. But the risk you’re taking is that the person’s going to have to go home and deal with those emotions. Yes that may, maybe each point is accessing. And in some cases it’s too much for them. They’re not able to do that on their own.

They don’t have, me in their pocket as they go home going, Hey, it’s okay that you have these feelings. Let’s, the safe container. That I create in the room. Isn’t with them at home, they’ve got their partner, filling up whatever. So let’s say you just wanted to do a few, then there’s a few that I often teach in my webinars that are pretty safe.

So due 26 is my favorite one. And that is called ghost palace, but I like to call it the doer palace because it, it basically is the entryway. How you breathe, how you eat. It’s symbolizing, how things get interface with you. And so if that, one is out of whack in you cause of something that happened and you, and now, like you don’t know, maybe you used to have an open door to the world and now it’s like shut and you’ve got some locks on there and a little people, and you’re just really cautious everywhere you go.

That’s not the true, authentic, you. That’s the trauma that’s made that happen. But however, that’s a point that isn’t really that triggering for people in terms of, some of the deeper points like pericardium eight is later in the treatment. Now that point is for deep part pain. So you have to, so I actually had a person, I was treating the ghost points with over time and we got to this point and the strangest thing happened.

We treated it. And she went home that day and wherever she went that day, people screamed at her like at the gas station, like at the line, getting. She went home and her partner screamed at her. It, her kids and it, and, but here’s the weird thing. When I was doing the point, I wanted to scream at her and I didn’t know where that came from.

That’s never happened to me before, but something in her was evoking from the external world, what she felt and the trauma she had was so significant. Intense probably, I say there’s no hierarchy to paint, but most of the people in the world would’ve said, okay, her turn, she wins she wins that at very unfortunate contest.

And so that she was like the picture of the scream painting, she was like the. In herself. And so when she activated that point, now it, it made people outside of her, like furious with her. They wanted to scream at her. It was very bizarre. So that, , that’s an extreme example, but a lot of ghost points, stories sound really extreme, but there’d one off, that’s that happened once.

So I don’t want you to think. Yeah, sure. Every time we do. I see a couple questions coming in. One is a. You obviously can’t build their insurance. Okay. Here’s the thing I think. Every case is different. And to me, it depends on if you’re doing them in one hour sessions. It’s, as far as an insurance company is concerned, I think it’s just acupuncture.

However you build that. If you’re, if you wanted an all day session, like I would actually recommend, that’s gonna just depend on your insurance company and what they. Say about a long session. Like they might be more open to a two hour session. And maybe you break it up into longer chunks.

Like you were saying, Virginia, maybe you do two hour sessions. That’s enough to at least I would recommend, two hour sessions at a minimum. If you’re gonna, if you’re gonna try to break it up for insurance purposes, I think you might get coverage for that perhaps so while one person asked are the points done?

Bilaterally? Yes. And then also somebody said, where is there something more written about it from you in the way that you’re doing. I like the book it’s through the mystery gate, is it? Yes. Yeah. The book through the mystery gate explains alchemy in general, and we have some case studies that we included in the book in terms of points, we have a ghost points online workshop@thealchemylearningcenter.com and we have an apprent.

and we have classes that are more in general, not just the points themselves. So if you’re thinking, whoever asks this question, if you’re thinking about doing this, I recommend also looking at what I call the becoming and alchemical healer classes that we’re going to be. Having on the site in the future and alive at different times.

So you have to just go check the site out, but those kinds of classes are more about the technique than the physical points, the points you already know, we’re gonna explain them more in the classes, if you wanna take a class in and the ghost points, but the really hard doing that as an online class, we.

It’s always available so you can sign up yeah. At the alchemy learning center.com. And so you wrote on with, I have the transcript from your webinar with Lotus and each point is your teacher. Yeah. You must develop your own relationship with each point. I love that. So I don’t know if there’s anything more you wanna say about.

Or any specifics. So I think what I really think about what I bring to this work, because it’s not like there’s any secrets out there. Like we all know what since emails owed is you can find it online. But what does it mean? And so even when I learned it from my different teachers They explained it more technically, and as we use the points over and over again, so I’m doing two or three of these treatments a week, so I’m really learning.

So they teach me. So over time, for example, calling this the door to your palace was something that I began to feel maybe 10 years ago. So I started saying, oh, wow, whenever I’m doing this point, people wanna talk about this topic. and when I learned what the character meant. For the point. It did.

It does mean that when they say palace for that as a translation, what they’re talking about is the part of the palace where the common people can come in. So it’s the interface of the palace. It’s like a big courtyard or hall where, you know, where everyone gets met, as opposed to later in the treat.

There’s another point due 23, which is called or often translated as hall, you can translate it many different ways, of course, but that hall character is the hall that’s closest to the emperor’s bedroom. So it’s the place where the safest people get entry. . So how does that interact or interface with the pericardium?

Energetic. I think of that. Yes. Think of the heart is a sovereign rule and you have your small official, official at the outer gate. Then you have the pericardium official yes. Regarding the inner gate so that the heart is not, or the sovereign is not burden with all the dramas of life and or people’s dramas.

So is it that kind of. . Yes. So actually there are two pericardium points in the list of the 13 ghost points, and there’s actually a number other of other paracardial points that are ghost points that aren’t in the 13, but the two that are in the 13 are pericardium seven and pericardium eight. And interestingly pericardium seven is playing the role of more that outer level. It’s it? It comes in the treatment at the point where things start to get deeper. But they’re not quite deep yet. So the first Trinity is really about how the trauma on the outer part of you, like, how do I see the world differently now?

How do I interact with the world? I would explain how do I see the world differently? And now how. How do I trust that things are okay? Do I start having am I racked with doubt for the first time? Yeah. About what’s gonna happen out in the world. So those are very external things. And then as we go to the second Trinity points, pericardium seven is the first one.

So you would think that would be a really deep point, but what it is it’s transition. Okay. Now that this is happening all out there. How are my relationships gonna change? How am, how is my heart gonna start to feel about interactions still with the outside world, but it’s that interface that, that pericardium that heart protector function that pericardium seven points about.

And then much later in the treatment, right before the intimacy point we just talked about due 23 is pericardium. and it’s like, where do we store our deepest heart pains, in the void of the heart in, so it’s representative of much deeper issues. So that, that, that’s how now, oddly, there’s no small intestine point in the beginning.

It’s not really it, small inte doesn’t. Ma talks about pericardium six for like breakups and relationships and the, that, those kind of yeah. Traumas. And then he says pericardium seven for men for men makes me, yeah. Okay regarding sex for women. So I, it just made me think do you find a difference that might be attributable to, we know about the differences in pulses between male and female.

Is there any difference you notice with the ghost points between the two sexes? We’re gonna limit it to that. Oh, between the two sexes. I was gonna talk about Perone six of pero seven. Okay. Oh, about that? Yeah, that would be really interesting. I’ll hold that thought. Between the sexes. Other than the physical points, we do a different point for men than women on the ghost.

Hidden. Theme. We do Ren one for men and we do an extra point called you men on women, which is above the clitoris. So that’s, obvi an obvious difference. But other than that, I’d have to think about it because nothing comes to mind about the differences. Like he’s saying. However, Perone six of Perone seven is a really interesting topic because in another treatment that we do in alchemy, which is called, I call the nine heart pains.

Treatment and that we’re going through all the pericardium points in as part of the treatment . And as we get to pericardium, actually we go reverse direction in the pericardium channel, as we do pericardium seven. Now, remember pericardium seven is often translated as burial ground. So what is that person needing to put in the ground?

What do we wanna have a funeral for? Oh, that rape that I had that has plagued my entire life and made me miserable from that day forward. Maybe it’s time to set it aside and bury it in the ground and say, can I put it away? Can I let it go? Can I let it go? So as part of this long treatment of heart pains, we’re working through some, I’m just using a very extreme example.

Of course, then when I get to paracardial, It’s okay, now maybe you successfully put that away. And can you now open your heart? That inner frontier. Can I allow that pericardium now to begin to like a flower begin to transform and open again. So that would be Perone six. And again, that wouldn’t really matter.

Male or female this is a good example of why a longer time, a longer session, a longer treatment is all more viable because we’re running outta time. Yes, according to this program. And I just say about male, female, that I just forgot. That’s really obvious. We start with male on the left and we start with female on the right when you’re treating bilaterally.

So that’s an obvious difference. That might answer somebody’s question. Yes. A little bit. There’s so many, so much more we could say, but thank you so much for doing this, taking your time and It’s just such a fascinating topic love to know more about it. So I wanna also thank the American Acupuncture Council for hosting the show and all the work they’re doing.

And I’m grateful leader for people like you who are exploring the outer reaches in such a beautiful way. Thank you for tuning. Thank you. Thank you for having me. I really appreciate it. Oh, sure. Thank you. Okay, so your website again, alchemy learning center.com and alchemy learning center.com.

Yeah. And you can look at the live event page for, upcoming live streams. Great. And on luminous beauty.com, having some problems with my website, but you can email me if you have a question. So thank you again, and we will see you all soon. Bye. Thank.

 

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Prolo-Acupuncture with Anthony Von der Muhll

 

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As our viewers can see the title of our talk today is Prolo acupuncture, and I’m guessing that stem from prolotherapy, but I’m not sure what that is. So you can tell us what that is.

Click here to download the transcript.

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, welcome to this week’s Facebook podcast show for the American Acupuncture Council. My name is Poney Chiang from neuro-meridian.net. I’m talking to you from Toronto Canada today. My guest is Dr. Anthony Von der Muhll who is joining us today from Al Cerrito, California. Anthony Von der Muhll graduated from the five branch university of TCM, 2002, and founded as Santa Cruz, acupuncture, orthopedic and sports medicine connect in three.

He now practices at the sports acupuncture connected in Berkeley, California. Anthony’s one of very few acupuncture in the United States with extensive experience serving as an expert witness for the California acupuncture board and civil mal. Practice litigations. He emphasizes the highest in safety.

Ethics is sustainability in his classes. He’s the founder of AOM Professional. Has taught certification acupuncture, orthopedics since 2015, he has served as a clinical supervisor at masters in doctoral levels for close to 20 years. And he has taught acupuncture, orthopedics and pain management programs at the doctoral level for.

Numerous, very highly prestigious academic institutions across the United States. I’ve invited Anthony to join us today for interview because he has a lot of experience with the, with orthopedics, but he does something that very few people talk about, which is using acupuncture to increase joint stabilization and increase joint mobilization.

So it is my honor. To have you here today, Anthony, my honor to be here. Thank you very much for the invitation let’s get started. As our viewers can see the title of our talk today is Prolo acupuncture, and I’m guessing that stem from prolotherapy, but I’m not sure what that is. So you can tell us what that is.

And how is pro acupuncture differs when. Yes. Yeah. Great question. Yeah. This name, Prolo acupuncture is basically what I call it. There, isn’t a a defined name for this technique in some classical text, but the technique has its correlates in ancient Chinese medicine. As best we can tell, or at least I can tell from reading descriptions of kneeling techniques, but I happened to learn it through a rather different route, which was another acupuncturist.

Who had studied extensively with I think primarily osteopathic physicians. The acupuncturists I learned from was Alan Marcus, who is now retired who specialized in orthopedics and what he learned from studying with some osteopaths and sports medicine physicians is the technique of probing lax, ligaments, and joint capsule.

To bring about tightening and re stabilization of the joint. And the same technique can also be used to remobilize a joint that is lost range of motions, say through adhesive capitis or joint contractual osteo. Although those are more difficult to treat than a joint that is simply lax in a, in, one or more planes.

And so the derivation of the name again is, proliferative therapy is the term is used by physicians who use this technique. Typically they’re injecting an irritant solution of some sort like Dex or salt water, or sometimes they have cocktail like MSM or Conroy and sulfate and they’re.

But a lot of the effect is actually from just simply the needle itself is the mechanical and various neuromuscular reflexes that occur from. Needling into particular tissue. And so it can be done with a dry needle, an acupuncture needle, a filoform needle, or sometimes occasionally a seven star needle.

Interesting. Are there any indications, counter indications for this type of technique? Yeah. Good question. So the indication is very simple, but it’s not intuitive. The indication is simply a joint that has an abnormality either hypomobility or hyper-mobility in one or more planes, not pain.

And so that I’m emphasizing that at underlining that because we are so wired by our training and education to to think about only pain and to respond to patient’s complaints about pain. But pain is a complex multifactorial phenomenon and there’s all kinds of ways to treat pain. But this is a technique that is very specific to restoring the function and the integrity of joints, which in my clinical experience.

And there’s a lot of, other clinical experience and evidence to support this, that joint hyper mobility or hypo mobility. Can be at the root of a lot of chronic pain and disability. So in some sense, it’s an indirect method, but the benefit of focusing on the joint rather than on pain is that you’re improving structure and function.

You’re not just providing temporary relief for addressing psychosocial factors that contribute to pain, which are important, but. Pain tends to come back until you improve structure and function in certainly in my experience. And so that’s why I gravitated to this technique is that it seemed to have a longer lasting effect on not just symptom relief, but actually bringing somebody back to their full functional capacity in everyday life work, et cetera.

That’s very interesting. Yeah. I I never thought about, stability or instability. Independently from pain. And it’s definitely making me very curious about the your method and your instruction. I’m curious about you mentioned seven star and needles.

So we can use this with our existing toolbox. There’s no special, copyrighted trademark products. I have to buy to, to take these courses. Okay. That’s very cool. Having said that, are there certain tools that you find work better for this. Sure. Sure. That’s a great question. So the one thing that’s a little different from what many of us are, were used to or experienced at say the master’s level training is that in general for probing deep into larger joints, we often used need to use larger gauge needles than some of you might be comfortable with.

And certainly I was comfortable with initially. And I’m talking, for example, a very large joint, like the knee joint, where we can do a lot of good in restabilizing a stretched out sprained anterior crucial ligament. I may use a 24 gauge needle. That’s much thicker than the 32 34 36 that are common in in more superficial acupuncture.

Using, classical locations. But the thickness and the stiffness of the needle are important because I don’t want that needle to bend or worst of all break off inside a joint. And I actually have better control and ability to direct the needle that might sound like it would be much more painful.

And actually repeatedly from both patients and my fellow practitioners to whom I’ve taught this technique, the response is surprisingly, it actually does. It feels different. It’s more like a blunt probe and a little less sharp and pokey than a very thin gauge needle. So it’s not necessarily any more painful.

It’s just different. So what type of a gauge are we talking? That’s at one end of it is a, a very large joint, like the hip or the knee on a large patient. I may need, I may reach for a 24 gauge needle, but more typically I’m using, a 30 gauge needle, a 28 gauge needle on small joints, like the fingers, a 32 or even a 34 will work.

Okay. But a deeper, larger joint needs a stiff. Thicker gauge needle to be both safe and effective in my experience is is the technique completely manual or is there like electrical stimulation in conjunction or depending? Sure. Good question. The answer is no, it doesn’t depend on anything else.

Besides the mechanical probing with your hands electrical stimulation can be useful for a patient who does have a lot of pain at the site of the joint hypermobility or hypermobility, but the essential technique. Itself is one of the reasons I began using it is that it works very fast. Under a minute worth of probing with a needle, and then you can take it out and you’ve accomplished your entire treatment effect.

You don’t need to retain the needle. On a very a joint that is badly sprained with, multiple planes that are hyper mobile. I might spend, four or five minutes, probing around till I get the joint stability I’m looking for. But again, once this is a. There is a, an immediate response that I’m looking for.

I can probe for a minute or so, withdraw the needle and recheck the joint through a manual technique called joint play testing, or end field testing. And I get immediate feedback. It’s oh, it’s either more stable or it’s not, if it’s not, I. Probably just didn’t quite get the angle. Right? Didn’t get the needle into the right location.

I can go back in probe around a little more, but with a little bit of experience, you get very fast and accurate at knowing exactly where to go with the needle and getting that re stabilization, take the needle out. You can move on to the next joint, or you can do something completely different. You can, do GU hour cupping or herbs or, treat a different condition like their I or whatever.

So I do retain the needle though on a patient who is experiencing either a lot of post needling discomfort or is just in severe pain and then I’ll hook up the electrical stem and that will provide some additional, that’ll provide the pain relief, but it doesn’t really, it’s not necessary for the effect on restabilizing or Reil the.

To help our viewers visualize, can you describe a little bit of what you’re doing with your hands? Certain change, intensity you’re feeling for, are pecking, are you going through resistance because most people have not learned this technique and we’re not asking you to teach us, but give us some idea.

What is the technical feel or the sensation that you expect the patients to feel while you’re operating this method? Sure. That’s a great question. So the technique there are basically two methods of physical exam that, that. Guide me to where the needle needs to go. The easiest one that comes, that is you need the least training for essentially is simply palpating the joint for tenderness.

And typically it’s the joint line, the crack or crevice in between two bones that span by ligaments and joint capsule. That’s where the palpation is most instructive. And for example the medial knee, extremely commonly sprained, the medial tryout of MC ACL and medial meniscus palpating along the tibio Foral joint line to find where is it most tender in its medial aspect tells me exactly where I need to go.

And then I will take that needle and I’m often asked a question, what’s the right angle is the angle that you need to get into the tender area. That in occasionally you have to be careful about bypassing a major artery, the hip joint, for example, we have to avoid the femoral artery.

So there’s some safety considerations there, but most joints, most of the time, it’s simply finding the tender aspect of the joint line and inserting directly into it. The second method that allows you to verify whether or not your technique has been effective is what I mentioned earlier. The joint play testing, and probably the best way I can do this actually is the, I’m just.

It’s basically a two handed technique, but I can grab a needle here and give you an idea of how I would do this. For example, say on my own, say I, sprained my thumb. And I wanna restabilize an inter financial joint there. And so I will, and it’s perfectly safe to do this on an uninjured joint, by the way.

So if for some reason, your history and physical exam guide you to a joint that doesn’t need this, you’re not gonna do any harm as long as you follow basic safety procedures of clean needle technique. And like I say, occasionally avoiding a major artery that’s in the area. So I’m gonna take my uninjured thumb here and I’ll show you how this would work.

I can palpate along the joint line, say, oh, ouch. And what I’m really looking for is a patient. I actually watch the patient’s face while I’m doing this. Cause what I’m looking for is reflexive unconscious, involuntary grimacing or wincing, not just them telling me verbally it’s tender, but I want, I’m looking for something like this.

I press in the joint line and they go, oh, Wow. Yeah, that’s it. That’s where it’s really sore. And then this is counterintuitive. I know, but remember, I’m not treating pain here. I’m treating structure and function. I’m gonna go right into that tender area. Will it be sore? Yes, actually. That’s how I know that I’ve got the needle where it needs to go.

Is that the patient says, oh, you’ve got it. You’ve produced my typical symptoms. That’s the bulls. And then I know I’m in an injured ligament because uninjured ligaments in joint capsules, oddly enough, won’t really hurt that much. You’ll feel a little poke as the needle goes through the skin, maybe a little pressure, a little mild achiness, but nothing beyond that.

But when the patient goes, ah, that’s it, that’s the pain I’ve been feeling. I know that the needle is where it needs to be. And then I can probe around a little bit pecking, but it’s not hard pecking, it’s more probing. And then. Like I say, typically within a minute, I can just take the needle out, recheck that joint and it’s rest stabilized.

I see. No, that’s very helpful. Thank you very much. Do you find that there are certain joints that you tend to apply your technique more often than others? Like the, for example, in other words, like other which joints in your clinical practice, do you find the most? Unstable and most able and or, or most hyper mobile.

Yeah. Great question. So the I’ll just mention three joints that really were where I first started using this or that really got my attention. I was introduced to this technique by being a demonstration patient for Alon Marcus. Some gosh. 1520 years ago where he, I was having a lot of chronic low back pain at the time.

And he needle into my posterior SAC, IC ligaments along the SAC IC joint line. And, within a couple minutes of probing around the needle, he took it out. I stood up off the table and I was like, Wow. I have never felt an acupuncture treatment like this. Not only was the pain down in my back, but my entire posture from head to toe felt completely realigned in a way that was more comfortable.

And required less energy and essentially to stay standing and that lasted for a good week or so, and then slowly dissipated. Like all of our acupuncture treatments, it does need to be repeated sometimes, but I was so I, I had felt completely different that I was like, wow, I wanna learn something about this, but the two joints where I’ve actually probably used it the most commonly that where I saw the biggest difference in.

Patient’s clinical outcomes was, number one is the acromioclavicular joint that small little crack in between the clavicle and the AROM which is very superficial, easy to find, easy to needle into safe to needle into as long as you don’t needle immediately towards the lungs. And I began to, I was having a lot of trouble with, chronic rotator.

Shoulder, pain and dysfunction and so on. And I was like, oh, that’s right. There’s that technique that Alan showed me, let me try that on the AC joint. And right away, I started getting, instead of 60%, improvement, et cetera, Mo almost invariably, most of my patients. I found through joint play testing had a loose AC joint that they weren’t even aware of.

It was not painful or symptomatic, but needling into it. Suddenly we got stability of that joint full range of motion in the shoulder. Very often, sometimes there was still some range of motion deficits coming from the GLE humeral joint, but improvements in range, muscle strength. Verified through manual strength testing very frequently, fully restored or greatly improved.

And interestingly neck pain also going down because the upper trapes is attaches to the clavicle. And when that joint is hyper Hoag and not stable the muscles around it, overcompensate and tug on the neck. Wow. One needle, one joint, huge regional effect. Couple of minutes worth of probing. Big difference.

Objectively verifiable that lasts sometimes indefinitely from a single treatment sometimes needs to be repeated a few times, but typically will last for months or years without any repetition. After an effective re stabilization. The other joint I’ll mention very quickly is the ankle similar, easy to treat, easy to.

With effects up and down the biomechanical chain from the hip to the foot improved by restabilizing a hyper mobile ankle joint.

Very fascinating. So it’s you have to, if you’re scaffolding, your foundation is compromised, then your muscles are not gonna properly. Improperly it’s different.

Are. Able to share us with us a inspiring clinical story that you’ve had recently, perhaps your practice or from teaching where it was something that, was very transformative. It made a difference. And wasn’t for this technique. Yeah. Yeah. I’ll mention a patient in her mid seventies that I’m actually currently treating , who a long time ago she was in her twenties.

So 50 years ago was an. Obese large person fell on her from, and sprained her superior tibio fibular joint, a small joint. That’s actually part of the calf, but where the superior part of the fibula articulates with the Tal Condi and also sprained her ankle. So she had a she fell sideways onto the ground with this person falling on Herra her superior tib joint, and her ankle.

And her. Couple of small midfoot joints as well, and has been in somewhat chronic pain ever since in her leg. And it’s affected her back and her neck, et cetera, 50 years ago. And and comes to me. And she happens to be medical professional herself has tried a number of different modalities, nothing really helped.

And I should say, this is why this technique is so important because there isn’t really any other technique that can restabilize a hyper mobile joint. You. Repair and replace it surgically, you can inject cortisone to reduce pain and inflammation, but actually changing the function structure without surgery.

This is really the only thing. Guha cupping manual therapy. Won’t do it. Distal kneeling. Won’t do it. So anyway, so I evaluate her calf and your ankle and go, wow. You’re on your superiority, fib joint and your lateral ankle ligaments. Small joint called the Calkino cuboid joint and the spring ligaments on the medial arch of the foot.

All of these are hyper mobile and stretched out from that single injury because they were never treated locally with this type of technique. About three or four minutes a couple of minutes per joint, again stands up off the table. It’s wow. My leg feels completely D.

And I recheck all the joints. Everything is stable. don’t see her for a month. She comes back in, everything’s still pretty good. The superior tib joint needed a little bit of tune up a little more kneeling, but I didn’t have to treat the ankle or the foot joints again. And then I see her, three or four weeks later and she’s can we work on something else?

Now? My life’s doing pretty good. I can. Yes. I love it when you get that oh, by the way, can you also treat this? And it’s yes. Got it. That’s that was super enlightening. I can’t wait to study with you. So if somebody like me wanted to study with you, where can we find out more information? Sure.

Thank you very much for asking and I’d be happy to work with anyone on this technique. My website is www dot a as in acupuncture, O as an Oriental medicine. And I know this is a been a standard term and I’m in the process of actually changing everything in my notes and eventually my website.

But right now it’s www.AOM, A as in acupuncture, O as in Oriental M as in medicine, professional, all is one word AOM, professional.com. And that’s where you can go for information about live webinars, distance learning classes, and returning to in-person teaching this summer, after a couple years off for the pandemic.

Excellent. Thank you. Once again, I’d just like to thank you for your time on behalf of the American Acupuncture, Acupuncture Council, and and to all our friendly viewers out there. If you have any feedback please comment. And and we would love to hear from you. Thank you very much.

All right. Thank you all for your time too.

 

 

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Cupping – Coding, Billing and Reimbursement

 

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how do I code for cupping? Can I get paid? What is the proper code? Let’s really get into that.

Click here to download the transcript.

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 everyone. This is Sam Collins, your coding and billing expert for acupuncture and the American Acupuncture Council Network. With our other episode on always looking to continue to grow your practice, to give yourself more opportunity, to see people and help people. And as always, I’m going to give you tips on coding and billing and really practice management.

This is a great time to be an acupuncturist, but how do we make sure we’re getting from gaining full advantage to get access to patients and the services we provide? So what I’d like to do with you today is to talk about coding and billing specifically for cupping. This is one that I get this question a lot is that seminar producer, as well as doing our network services, where people call them with questions.

One of the questions I get is, Hey Sam, how do I code for cupping? Can I get paid? What is the proper code? Let’s really get into that. So let’s go to the slides. Let’s take a look. What’s going on with. And how do we do it? What’s the coding and billing. Please note, there is our website. This is the network, not the insurance company, ACM phone network.

Remember we always have updates and news for you there. So what are we looking for? What do we need to do? What is. A cupping as well. Let’s define that cupping as a therapy at ancient form of therapy, where a therapist puts special cups on your skin or a patient skin to create suction.

That suction is to help with circulation, for pain, inflammation, blood flow, and so forth. And of course has become very popular. You’re seeing it all over. Let’s talk about, we know what it’s good for it. How do we use it? But can we get paid for it? Let’s talk about cutting more to define it more clearly.

What I’ve been able to research is that there’s about 10 different types of cupping, and I’m sure some of you might say, oh no, I think there’s five. This is just what I was able to research. And it shows you can have things that they call weaker, like cupping medium or. Moving cupping. I see that commonly needle cupping using moxa or needles with it empty or flash cupping, full bleeding, cupping.

You got to remember that. Is it within your scope for your state, but I’ve seen it used with herbs water and realize the cups can be made of several substances. I generally see some type of glass. I seen some very heavy plastic metals I’ve even heard. I’ve never seen it. I’ve even heard of bamboo.

And that kind of makes sense. What we want to focus on. How do we bill for it? Is there a CPT code that we can use that says it? The first thing we have to remember is whenever you select a code, and this is something that you must always do, you must select a code that accurately describes the service.

Not has to accurately do not be creative. Don’t select a code because it’s like it, like my example, if you were to use. Would you be able to code that as acupuncture? Just because you put seeds on a point, doesn’t make it acupuncture because it’s not needle. So it can’t be it’s gotta be all the way.

So don’t be creative with what you describe, do not select the code that climate is close. Always has to be exact. And within that. If there’s no code for it, there is a code, always. There’s a code called the unlisted code and it can be a modality or a procedure. So whenever you have any service and we’re talking cupping today that doesn’t have a code, that’s going to be the more likely code to use, but let’s take a look at is their way of coding.

It’s I’m going to show you something. I deal with a lot, which is dealing with audits. Many of you are insured with American acupuncture council. And remember if you’re audited who’s there. Remember, if you have American acupuncture council of malpractice, they’re going to help you with audits depending on your policy, anywhere from 30,000 to $50,000 a defense.

And this was one of the cases we had here was an office that had issues with coding. And you’ll take a look. I highlighted in blue. So here it says on 52 claim lines, manual therapy was identified as. In the medical records and reporting of the code 9 71, 4 0 is not appropriate using for the Madame for the modality to indicate as cupping.

So I want to make clear, some people will say Sam, I’m putting the cups on manually and I’m moving them around. So it makes it manual therapy. Nope. That would not make it manual therapy. It’s. And though you’re doing it manually, it doesn’t make it manual therapy. So again, be very careful and you hear a lot of people say, oh, sure.

When I use a cup, Nope, that would not be correct. And I want to make sure you can see this. This is directly from. And again, very clear that it’s not to be used for it. So is there a code for cupping? So if you start thinking of all the codes, infrared heat. Okay. Hot packs, electric stem.

You’ll notice there is no code for cupping. So we want to talk about how to do it. And frankly, let’s be clear. Is it really even a covered service? And I think that’s what I want to focus more on. How do you get. And to get paid for it by insurance. That’s what we have to have a code, but is it a covered service?

Take a look here. This is the VA and I’m sure you’re all familiar with VA claims. The VA is one insurance that will indeed pay for cupping 100%. You’ll notice here and I highlighted it where they indicate the services that can be provided along with your acupuncture. And clearly. Cupping, along with other things, but cupping is there.

So a lot of people look at the codes that are allowed under the VA. And I’ll give you the list here. Here’s the codes that the VA pays for an acupuncturist. Notice it was updated for this year. And you’ll notice that code. I put the blue arrows it’s 9, 7 0 1 6. Now I would say in theory, I think the VA is saying you could use that code.

I don’t think it’s quite correct, but let’s talk about. Should you use it? 9, 7 0 1 6 indicates something that’s called a Vasos nomadic device. And the indication for it is to reduction of a deem after acute injury lymphedema and the use of a pop. So I want to highlight you see this little, long kind of blood pressure cuff goes over the area.

That’s what a visa nomadic devices. It’s a large pressure device that goes over an extremity or part of the body that gets pumped. To prevent a DEMA post-surgical maybe prevent blood clots. It might have vibration to promote circulation and deal with lymphedema. Now I’ve had some people argue that well, could a cup be listed under that?

I would say I can see the argument, but I think this goes against the rule. It has to either fit it or not. I don’t think this would fit it. So I don’t think this is the best choice. And I also don’t think it’s the best choice, because if you use it, I will say the VA will pay it. But the VA Medicare rate is 12 to 1400.

It has a relative value of 0.35, which means it’s about 25% of the value of acupuncture. So again, not a very expensive code, 12 bucks now that’s better than zero, but is that potentially the best code? So remember an application modality, one area Vaser pneumatic says devices that provide external pumping forces to soft tissues to the lower and upper extremities.

And I would say trunk as well. So you would say with cupping, could it fit that definition? I could see you dovetailing it, but I still will stay. It is not the best. Cupping is very popular. You’re seeing it amongst sports and athletes and my goodness, the rock has even had it. And I love what he does because he has moons of followers that if he’s getting cut, the more people are likely to try.

Do I see even the person’s left, had a lot of cups place it’s really popular. It really has efficacy. I’m seeing a lot of additional practitioners from chiropractors to physical therapists that are doing it. So how do we. I mentioned the visa nomadic device. And I said visa, nomadic. I think you can argue it for the VA.

I would never use it outside the VA, but for the VA you could. But I think from a monetary point of view, you’re losing money because it doesn’t pay as well. Using 9 7 0 1 6 will literally get you paid less than 50% of what you would be paid. Otherwise when you use what’s called the unlisted modality code.

Now I want to go back for a second and I’ll go back here and show you. You’ll notice those codes are like, 9 7 0 3 9 and 9 7 1 1 3 9. So you can see they’re all on the list for the VA. In addition tonight 7 0 1 6, but those codes do not have a Medicare value, which means when there’s no value purported by Medicare, they pay at usual and customers.

So what I’m saying to you is simply. If you’re billing, even the VA for cupping, what is the best code to use? It’s going to be the enlist of modality. Whether you want to say it’s unattended or attended. Now here’s the difference. 9 7 0 3 9 says unlisted, modality and modality in this way means something.

You apply to a patient, but you don’t have to be there. Like I know when I’ve had cupping, they placed the. And they leave them there for a bit. I would say that’s an unattended, probably appropriate code, but I’ve also had cupping where the provider is constantly in attendance adjusting and moving them a bit.

That’s going to be more of a procedure or hands-on. So the more hands-on and that you’re spending time with the patient 9 7 1 3 9 would be the better choice if it’s completely unattended 9 7 0 3 9. The difference, just to give an example, if you bill 9 7 0 1 6. They’ll pay a 12 to $14 bill 9 7 1 3 9. I’m going to say payment is going to be between 30 and 45, depending on your area.

So would you rather get paid 10 or 30 or 40? I would opt with the higher one. So how do we code this though, to make sure they know what’s coming says it says unlisted procedure, which means it could be for anything. So you have to indicate cupping on the 15th. Actually, it’s not hard. You’ve all seen a 1500 for here’s an example.

Notice on this line item, it says 9 7 1 3 9. And then in the pink shaded section, right above it, you simply indicate that tells the insurance it’s cupping. Oh, by the way, what if you’re doing moxibustion how would you do that? Actually the same way you would just indicate moxibustion whether it’s fully active.

Or one that it’s unattended. My point here is that coding for cupping, the best code for you would be the unlisted code and indicated this cupping, the VA will cover it. They will pay for cupping. It’s part of the authorization. They will pay it under 9 7, 0 1 6, but at a third of the price. So I think it’s better to use this one.

Now, what about regular? Do regular plans generally cover cupping. The unfortunate answer is no, I’m not finding any type of consistent payment here and there I’ve seen it, but not enough for me to really say yes, it’s covering out. The more likely places to be covered would be personal injury more than likely.

But outside of that, if you go to, gosh, the Cigna, Aetna, the blues general, they’re going to come back and say, it’s experimental investigation, which doesn’t it. From your standpoint, it’s not effective, but you know how insurance companies are without a double-blind study. We’re not going to cover, explain to the patient.

This cupping services is going to be integral to you getting better. We’re going to apply it. This is why, and what we’re doing. And here is the cost. If you show the value and the patient sees the value, they will pay for it and it will be covered. So don’t be afraid to pass it on because if you’re not willing to pass it onto the patient, why bill and insurance, if you’re going to give it away, So I would say, yes, I don’t want to bill for it.

It takes time. It takes effort and it is effective. Quite frankly, I’ve seen some really good responses with muscle injuries that I’ve never seen with other types of modalities. Now we’ll hacky puncture too, but that cupping is really been something I’ve noticed because of the amount of use I’ve seen has really made things work better for patients.

So make it available. Billing wise, what’s the best. Unlisted therapeutic procedure or modality, identify it as cupping and then simply put your price. And when we’re talking just simply price, you’re far better to bill cupping under the unlisted code to the VA. Cause it’s a little bit worth three times the money.

So keep it simple. You know how everybody makes insurance billing hard. You just have to understand the parameters. And that’s what our program with you is to do and realize I do articles and acupuncture today, and this one date back to 2010 and actually talks about it and why I wanted to bring it up today.

That this question though, a lot recently, and it’s because it’s become popular because of the VA. Here’s the thing. You can have me as your. Don’t be afraid to reach out to the network service, because from that I become part of your team where you can call, email me, fax me. However you want to get ahold of me to help you with coding and billing, and frankly get paid my goal to make you better.

I’m your doctor of billing to make your office work better. So go to our side, take a look. I would suggest take a moment to go to our Facebook page AAC. Give us a like there and we always update and put news out. We’re always going to be a resource. The American acupuncture council of course, is your malpractice resource, but will your billing and coding and business to resources as there’s our site, there’s our phone number.

Please reach out to us. Don’t be afraid. My email was at the front end as well. What I’ll say to you all is thank you for the time and next episode, we’re going to have Poney Chiang and again, always go out and be successful. But remember, the success is more about being. Which means being good to your patients, be that person.

And I’ll see you next time. Everyone take care. So what I’d like to do with you today is to talk about coding and billing specifically for cupping. This is one that I get this question a lot is that seminar producer, as well as doing our network services, where people call them with questions.

One of the questions I get is, Hey Sam, how do I code for cupping? Can I get paid? What is the proper code? Let’s really get into that.

 

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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.

Click here to download the transcript.

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.