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Segmental Acupuncture

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Josh regularly, pursues high level trainings in cranial and visceral manipulation and has profound understanding of the interplay between the nervous system internal organs and musculoskeletal system.

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

Hi, my name is Poney Chiang from Toronto Canada. I teach continuing education courses from neuromeridian.net. Uh, welcome to this week’s live Facebook podcast show for the American Acupuncture Council. My guest for today is Josh Margolis. Joshua has been practicing manual medicine and bodywork since 1995 and acupuncture in Chinese herbal medicine since 2001 from 2005 to 2009. He was a faculty at the academy of Chinese culture and health sciences in Oakland. And yeah, I keep on change here to medicine in college in Berkeley, teaching anatomy, orthopedic acupuncture, advanced channel theory and pain management. Currently Joshua is on staff at the osteopathic college of Ontario and teaches in the doctoral program at several bay area acupuncture colleges. Additionally, he teaches segmental acupuncture and manual therapy of courses for acupuncturists throughout the United States. Josh regularly, pursues high level trainings in cranial and visceral manipulation and has profound understanding of the interplay between the nervous system internal organs and musculoskeletal system. In Joshua’s years of practice in the bay area, he has gained a diverse, loyal following comprise of professional musicians, dancers, yogis restauranteurs, athletes, and as well as children, the elderly and those with severe chronic illnesses, he has been practicing art from a Copia in Santa Rosa, California in 2011, as a pleasure for you to, for me to be able to have this chat with you today. Joshua welcome.

Thanks for having me here.

And, um, uh, are you joining us today from Santa Rosa right now?

Yeah, Santa Rosa, California. Yeah. It’s morning time here.

So I have been hearing really great, wonderful things about your courses. And I look forward to view a study with you in person, hopefully sooner rather than later. Um, so this is why I wanted to, um, use my spot for a guest today to steal all your secrets. I want to, I want to pick your brain and hear what is it that you do? What influences you like brings you? What makes you, you passionate about what you do? So let’s start by, um, telling us a little about, about yourself. I know I already give an in in-depth introduction, but you know, who, or what influenced you the most, would you say as far as, uh, practicing clinically speaking?

Well, I’ve always had my foot kind of into two worlds. Uh, I don’t that are not the domain. So, uh, and I used to feel like I put on two hats. Those are the two worlds being manual therapy and acupuncture, and I’ve always felt I had to kind of put two hats on and be like, okay, now it’s anatomy time and I’m going to do osteopathy. And now it’s acupuncture channel time and I’m going to do some kind of distill acupuncture, ear acupuncture. So, you know, I got pretty quick at, at, uh, switching my hats back and forth. Um, but of, you know, uh, thinking about how to integrate those things has been kind of an ongoing question for me. Uh, the, those two hats. So there’s been a couple key influences along the way. Um, Michael Kuchera who is, uh, an osteopath, I think he’s in, uh, Kirksville.

Uh, he wrote some great books on, uh, osteopathy for internal medicine, uh, disorders, and it really talks a lot about segmental organization and how you can, uh, exterminate you from external stimulus, uh, affect the internal processes. Um, and on a, another from the acupuncture side, uh, C Chan Gunn Chan Gunn, uh, really with the intramuscular stimulation and that concept of taking motor points and acupuncture or a trigger points and going back to the spine and treating the spine first and looking at that as maybe, uh, a more centrally mediated problem that, you know, partially maintained at the spinal cord level. Um, those two were really big in, uh, kind of my early, early career, uh, and continuing on. Um, there’s so many, there’s so many and Carol Levitt, uh, from the Czech Republic was a physician who really turned me on to, uh, functional, uh, musculoskeletal assessment and looking more beyond, you know, beyond what is sort of broken, but more how, how does movement happen and how can we coordinate movement?

And that has really influenced my acupuncture, uh, as well as manual work. And then, you know, researchers like you pony, to be honest, because, uh, you know, you’re taking that, looking at, uh, acupuncture, meridians and points through two lenses and, and really doing the research and the background work, um, and that, you know, that, that sort of legacy from Joseph Long and, and the others from the sort of Toronto medical acupuncture to unity, um, have been, uh, uh, a real influence to me. I was lucky enough to study with a medical acupuncturist, uh, early in my, in my career in that. So I’ve always been, uh, most of my professional life and very interested in that interplay and understanding, uh, kind of how, how things work, not just what works for what, right. I’m sure

For you, it’s the same as it is for me. The, the excitement is being able to find the similarities and find the anatomy and it, and it used to have medicine actually independently validate each other. There you find, uh, you know, oh, this is that same thing in the nature thing. And I say exactly about this anatomy, and then it just, uh, you know, you can have, I’m sure we can have a lot of decals and about all these, like, oh, how did these ancient people know like this anatomy, you know, um, so Russo, I’m glad that we, uh, like-minded because I know, um, you bring kind of the best of both worlds and that’s what I like to do also. Um, so tell me about, um, segmental acupuncture. Uh, I see that you’ve been teaching quite a bit of workshop about them. I know that’s probably a very in depth topic. Could you just, you know, give us with the coleslaw version of, uh, give us a sense of what is segmental acupuncture? How is it different from, um, you know, like, uh, a, a TCM approach, for example?

Yeah, that’s a great question. Um, I mean, the key thing is to understand that our tissues remember where they came from. So during embryologic development, you know, our, our tissues, uh, migrate off of, uh, you know, essentially a segmented worm type of, uh, uh, you know, our embryo is kind of a segmented worm and our tissues literally travel off that in different segments, but when they travel, they drag their nerve supply along with, um, so during that, during development and then on into, you know, birth and adult life, those connections stay, uh, PTEN the, you know, the segmental, the body doesn’t forget its segmental organization. Even if those tissues might’ve migrated quite far away from the original segment. And, you know, you have the, you know, the germ layers, dermatome, myotome, and sclera tome. And so now people are talking about the viscera Tom or the Interra tome for the internal organs, but essentially you have the skin, the muscles and the bone sensation.

Um, those, those might not overlap perfectly, you know, the muscles move in a different way than the dermatome moves and works in a little different way than the sclera tone. So, uh, we can access all these different layers and these different laborers can have their own ridiculously related pain too. You can have that sclerotomal pain, you know, with, uh, with, uh, someone who has a nerve, uh, nerve root injury that might be like this deep aching, hard to pinpoint just sort of pervasive pain, or you can have that more superficial dermatome pain burning, uh, you know, sharp, oh, kind of electric type sensation. So, you know, understanding that kind of, I find it’s very, very helpful. Um, another thing, uh, to, to understand key points regarding that, um, concept that the nerves have been dragged along is that, um, everything in, uh, in a segment influences everything else in a segment for good or for ill.

So that means that, uh, if you injure something in a segment, then it facilitates, it lowers the threshold for irritation, for other structures that share that same, uh, Embry logic, uh, source that seems segmental source. Um, so that, that’s a really key concept to understand, and that can help us develop, uh, distal type treatments are not always distillable. You might be treating appendicular really for, uh, for a trunk problem, or you might be treating actively for, uh, a peripheral problem, but, uh, that, uh, that those relationships has really stayed at stay active. And you can, you can, neuromodulate quite strongly, uh, using these inputs. So for example, like I, I’m very into, uh, periosteal pecking, uh, that’s real popular in the, in the, uh, British medical acupuncture world, uh, Felix man, and, uh, um, Cummings, uh, I think, uh, they, you know, that that approach is incredibly effective for modulating.

The whole segment. You can have a person who has, you know, a terrible rotator cuff injury, and then you heck the periosteum along the greater CA uh, treater tubercles or the humerus. Uh, and then, uh, you can change how the entire myotome behaves, uh, quite quickly, uh, very, very effective, very, very interesting. So, you know, the key being the non, uh, nociceptive inputs, uh, into the, into the segment, uh, will, uh, beneficially affect all the other structures. And, and also, you know, consequently, if there’s an injury that will negatively affect all the other structures that share that same sick mental intervention. So, you know, things like an injury to the sake of spring to the SSI joint, for example, could, can mimic sciatica, you know, [inaudible], uh, dermatome. So, you know, they might have a sclerotomal injury of the ligaments and the, and the, uh, periosteum and, uh, bone, but dogs are gonna feel the sensation, maybe along the S one S two dermatome, uh, you know, their heart disease coming down, the T1 T2 dermatomes, that’s more of a autonomic related segmental, uh, phenomenon or liver disease can show up sometimes in the C3 four, cause the capsule of the liver is innervated by the phrenic nerve.

So you can get liver disease. People can feel that right sided, neck and shoulder pain. These are just some very classical examples, but are relevant to, to assessment, uh, and understanding, uh, potential origins of things. Um, you know, I’m, I’m not going to go too long on this, but another concept that’s pretty awful here that overlays is the osteopathic consent concept of the facilitated segment, um, where, uh, through prolonged irritation or, uh, enough of an initial insult that the segment will itself will just become irritated and stay in an irritated state. And that, what that means is that the threshold for irritation for, to, to cause, uh, tissues to respond is becomes lower. Um, the, uh, reaction may be higher and, uh, you know, to the extent that even a non what should be a non painful stimulus might, might, uh, read as painful in, uh, to, to the body.

So these are all, uh, you know, assessable, uh, for us as, as acupuncturists doing physical medicine, doing physical assessments, we can see signs of all of this. So, you know, there’s something we call it, the red sign and osteopathy where you drag your fingers. Uh, so vigorously along the pair of spinal tissues, kind of along the Quato druggie points, um, you know, 2, 3, 4 times. And you’ll see at a segment that is, uh, more facilitated, more, uh, active, uh, irritated that you’ll have, uh, extended red response. Uh, you’ll see, pin will stay red, uh, you’ll find pseudo motor activity, uh, muscle shortening tenderness, uh, and perhaps, uh, Teebo like motion dysfunctions, uh, at these segments. And these are mostly autonomic signs and they’re probably autonomically. Uh, they seem to be autonomically mediated. So, uh, a lot of what we can do is then look back at a chart for, you know, sympathetic, uh, innervation in particular.

And, uh, you can learn a lot about what’s going on. Uh, there’s been some research that really shows that these pair of spinal signs show up before internal medicine, uh, disorders are, uh, measurable often that, you know, as the Oregon is inflamed and irritated, it’s sending back, uh, signals that it’s in trouble. And then that facilitates the segment. So, you know, we have, uh, so Maddow visceral and this row of somatic reflexes in the body, as well as some ADOT some ADOT and, uh, this were visceral reflexes, but from the acupuncture standpoint, a lot of what’s interesting are the interface between the Soma, our musculoskeletal system, our muscles joints, uh, cutaneous nerves, and internal body. And we’re starting to be able to map this, uh, pretty, pretty well. There’s been a, uh, osteopaths really researching this, uh, trying to validate, um, osteopathic, uh, uh, therapy theory and, um, uh, you know, things that people are noticing clinically, right?

We’ve been collecting clinical data for, you know, clinicians on our patients for a long time, but to start to understand that a little more with the science behind that. So they’ve been looking at that for, you know, 120 years now or something like that, but we can see these things in Chinese medicine, like the moon shoe points are very closely related to segmental innervation. Some of them are pretty precise and some of them are a little off like the small intestine and bladder points are more probably affecting the parasympathetics to the, to those organs rather than the FedEx small intestine much, but certainly the bladder and the uterus and so on using them like Bali out on the lower, the lower shoe points, the mood points are pretty, pretty, pretty well, uh, line up, uh, with very few exceptions, uh, segmentally, um, you know, things like spleen six, we can understand a little bit more about what we’re doing, and then there’s all these, you know, various techniques that have come out of, uh, mostly Western medical acupuncture, um, that are, are very helpful for us in the clinic. So that’s, uh, maybe a longer answer than you were looking for, but

No, that’s good. It’s important to lay the foundations. Right. Um, so the, the, the facilitation that you described does a work both as a lot of this, I be so sematic. Um, so that there’s some, if you have a chronic elbow issue that can lead to its corresponding segmental, glandular, or organ dysfunction, or like, you know, somebody who has a chronic organ issue when being more predisposed to certain types of joint or muscular movement disorders, um, that does that theory apply in both directions.

Yeah. That’s a great question. And yes, it does. Um, any, any irritant, you know, of enough, either severity like intensity or time will eventually have the potential to, uh, facilitate a segment. So when you go somato visceral, um, usually that’s, uh, like say you have like an upper back restriction, which could affect your, uh, cardiac function. There was like some cardiac chiropractors did a study and I’m sorry, I cannot find the study anymore. But I remember reading this study where they showed that there was a correlation between forward head posture and cardiac disease, for example, so tension in those upper, you know, 3, 4, 5, 6 thoracic vertebra and lack of movement, lack of nourishment seemed to affect cardiac function, have a interrelationship to cardiac. Um, and you can see it the other way. So, you know, someone has, uh, like heart disease. They’re going to potentially have more medial elbow pain because you’ve got that T1 T2 dermatome.

There’s going to be a, uh, there’ll be more easy. It’ll take less to injure that area. It won’t necessarily become like allogenic, except for in a more like severe case where you may have ongoing, uh, pain, like in head zones, for example, uh, and whatnot. But yeah, it’s, that’s important that concept that, uh, the somatic visceral, visceral sematic, it goes both ways. The work of, uh, uh, Akio Sato or Saito I, Japanese researcher, he wrote a great paper, like in 1997, that summarized kind of all that, all that stuff. Uh, and then, um, Myron Beale and Louisa burns are osteopathic researchers. Who’ve done a lot of work on the, on, on that, the sort of somatic and some out of visceral reflexes. There was a lot of literature on it actually. Um, but the Seto work is particular. It’s interesting because he was particularly looking at like, what happens if he massages little parts of like a rat and then looking at their autonomic nervous system and what was happening in like gastric motility, uh, bladder and those kinds of things. He, he did a lot of study on that. Him and his group did a lot of studies on that kind of thing. And I did the paper from 97 is sort of his retirement paper that covers all of his other videos. So the basic idea from the one,

Yeah. Uh, I wanna, I want to touch on what you talked about with the frame that phrenic nerve and its relationship to the capsule around the liver. Um, just as a reminder for everybody, because when I found out about that, that I was like, it was like a mind blowing emoji, like, uh, I, uh, when I thought about that, like, you know, the phrenic nerve innervates, the diaphragm, the diaphragm is in the TCM hypochondriacal region. And we also associate that liver she’s technician, right? So there’s a connection to the diaphragm and the FedEx nerve and the signs and symptoms there, but she’s stagnation. And now you have like actual anatomical basis to explain that the friend in there for some reason, get sensory information from the capsule and deliver. So the state of the tension, you know, Chinese person talks about like softening deliberate as a course of treatment.

The state of the tension of the liver through this capsule somehow is information that the phrenic nerve needs. And presumably that sensory input has there creates a reflexive, um, motor output to control the contraction of the, of the diaphragm. So it’s really, really beautiful that like, there is a connection between the liver and liver moving the cheese, you know, the, the, the, uh, the extradition we have in Chinese medicine. Yeah. So I, I, and now that’s related to like, you know, cervical radicular, apathy issues at the, you know, the upper cervical area and it’s associated with dermatomes and upper back. Um, it’s, uh, it’s just, you know, so exciting. Um, do you notice patterns like that? You know, like you can run a TCM and the patients, all of us all have like neck problems or something.

Yeah. Oh, certainly. I mean, certainly more like classical kind of distal acupuncture type techniques. You see all kinds of things that are sort of beyond the segmental thing and the, you know, like how did they figure out these interrelationships, like, you know, liver three improves blood flow at the brachial plexus. So yes, it works for neck problems. Right. But, you know, that’s a super segmental thing. Yeah. And the, and, you know, and you see the overlap with, as you mentioned with the liver, right. The C3 four, you know, you’ve got the super cool vicular nerves, you know, that’s a segmental relationship. So, you know, if the diaphragm or, uh, the liver at C3 four gets irritated, then there’s a potential to send hypersensitized C3 and four, which is, uh, you know, this whole, this whole region. So that kind of dive from attic or that, uh, trapezius pain that everybody sees often as related to, uh, some kind of liver congestion.

Okay. Interesting. So it’s all coming together. [inaudible] everyone has the richest, the nation, everybody has tight trapezius muscles. Right. So it can not be, um, I want you to discuss about German layers and, uh, do you use that, um, embryological concept and the way you select points or the way you assess a problem? How does that, how, how does that apply clinically?

Yeah, so, you know, the germ germ layers, dermatome, myotome, and sclerotomal, uh, just briefly those, those are the layers of, um, Misa term, he’s a normal development. So that’s what goes to make the dermatome goes to make the dermis. So the under deeper layers of the skin, uh, the myotome goes on to make the muscles that, and the sclerotomal goes on to make the, um, the, basically the spot, the spinal column and the ribs. Um, they, we do use the term sclerotomal a little more broadly in the adult, we know, refers to ligaments and bones, uh, and their innervation, but, uh, it’s so it’s used a little differently. The other two terms stayed pretty, pretty, uh, pretty, uh, uh, consistent. Um, but anyway, you know, one, one thing about using those different layers as these tissues migrate, you know, remember what I said earlier that the segment, uh, is continues to be interrelated and because tissues migrate it kind of different rates and different amounts, you may find that the dermatome and less Clariton don’t line up.

So someone may like have a broken phone, but you may be able to access the dermatome, uh, somewhere along the way. Um, or you may be able to access the myotome. You know, there’s a Hilton’s law, right? The, the, uh, that the, uh, basically muscles crossing a joint, uh, share fibers with the joint itself and with the, you know, overlying skin. So, uh, you can, you can access at any level to affect all the other levels. So, you know, that’s, that can be a really effective now, you know, thinking again, as general set mentally, you can go back to treat axially or peripherally for a problem. So if someone has a, I talked about shoulder problems earlier, right? So most shoulder, most of the shoulder, the glenohumeral joint is C5 C6, right? That covers pretty much the majority of the medial C4 on the, um, superficial bits and the skin.

But you could go back, uh, if someone had like a shoulder replacement surgery or frozen shoulder or whatnot, you could go back and look at the, uh, you could go back and look at like, see four or five and six at the neck, and you could treat the, uh, something I find is helpful is doing like a periosteal pecking on like C5, C6, uh, at the articular pillar can really neuromodulate the whole, that whole shoulder quite effectively. Uh, you could do that if you don’t do pecking and don’t have training in that are not interested in, you know, a stronger stimulation like that. You might just needle them all Tiffany in the neck, you know, do some deep repair of spinal noodling. Uh, you can run electrical stem, all those things are really effective for effecting, uh, sort of axial to peripheral. Um, you know, and then that goes both ways.

So if someone’s having C5, C6, right, C6 is kind of the, um, crisis point, uh, for the, uh, neck, right. Most mobile vertebra. And then it’s connected to C five or C seven, which already, which is one of the least mobile cervical vertebra. Um, and then T1, which of course has the ribs. So it’s more fixated. So there’s a sort of maximum movement, minimal movement right next to each other. And those time zones kinda ended up having problems. So you can, you could modulate C5 C6 on the, uh, C5. It like the greater tubercle of the humerus and C6 is more of the upper condoms or, uh, some parts of the posterior shaft of the humerus if you wanted to pack, but you could also look, okay, you can say C6, right, C6, you make a six, I don’t know if that’s coming out as a six, but, you know, in the old, uh, you could treat that dermatome only, you know, with like large intestine four or, you know, other other points that are related.

Um, so, you know, the germ layers, uh, I think are helpful, mark, conceptually, I haven’t found a way to go, like, you know, this is this and that, you know, like myotome is better for this, or dermatome is better for this, or sclerotomal, except for that, I would say sclerotomal stimulation is more effective for that really stubborn pain yeah. Pain that just won’t budge. And because there’s a lot of sympathetic innervation, uh, at the periosteum, uh, that kind of stimulation is really helpful if there’s like, uh, a, uh, some sort of autonomic piece and, you know, innovation is incredibly important. Um, and, uh, for everything including trigger points, right? You can feel a trigger point in if you know how you don’t even have to press the muscle. Cause there’s a pseudo-motor effect. There’s often a temperature difference. So, you know, every, almost every pain condition is going to have some change in the autonomics. And so if you, if you know how to look for that, that’s, that’s kind of a key to the assessment related to that, because your rotation at like a sclerotomal level, like a sprained ankle or a chronically sprained ankle is going to affect that whole segment. So you’re able to treat that, maybe that question.

Yeah. Um, just for our listeners, um, when Josh is talking about to a motor, you were talking about like, uh, the sweating, um, regulation of, uh, autonomic nervous system, right? Yeah. Yeah. So you’re able to is training, uh, palpate the, the, um, uh, the poor to the skin, um, in the vicinity of the trigger point and be able to diagnose, diagnose, uh, financial and point, even without having to push down to get that Asha tender feeling, just fine, touch alone, you’re going to start noticing some changes. Um, so this is, yeah, this is, this is really a very interesting, I, I, um, I, you know, everybody dermatomes in the mountains very well known third toast, you know, that started as the least well researched, but as, um, kind of the secret weapon in a way to be able to have that understanding, I would love to be able to combine those layers together and be able to treat, um, you know, cry problems from a different perspective.

That’s really, really interesting that you’ve had a lot of experience kind of seeing when to use which layer for which type of problem. Um, I also found it very interesting that like ligaments and, um, and, uh, and the attendants are, uh, part surely from the scotoma as well, because in Chinese medicine, they always talk about gene group, seniors and bone together as a binary. They don’t really separate those terms, um, you know, differently. So it’s interesting that those they share same, um, type of term, uh, German, um, innovations. Um, that’s finished up with the clinical Pearl. Um, uh, I heard that you have a lot of success in you. Um, I guess I’m very consistent results really inside a car. Is it possible for us to give, you know, give our viewers and listeners advice so that we can become more proficient in treating, um, such a debilitating problem as Sika?

Yeah, sure. Um, for a really acute sciatica, um, if there’s too much, uh, like muscle for boarding and spasm in the back or piriformis, uh, whether it’s, uh, radicular or a piriformis syndrome, these same approaches will, will be effective. Um, I often will use, uh, just the Bajan points, um, that, that when you get, uh, for really acute problems along the, and this is nothing new for Chinese medicine fans, um, really acute problems, the further away you are from the actual site often is more effective and like stimulating the cutaneous nerves, they’re the gene Wells or the, or the, the, uh, yang spraying points tends to be more effective for that really very hot acute pain. Um, I find you get a more complete, uh, regulation of the whole system. So I often will just for the first couple of visits at someone’s, you know, the people will get like brought in by their family member or, you know, couldn’t drive themselves to the clinic.

Um, those people I tend to use like often, uh, maybe kidney seven, especially if I can get a tibial nerve, you know, like, uh, if I can get a sensation down to the heel or to the toes when I, when I manually regulate it, those are usually my line of first, uh, first input, you know, maybe, uh, uh, like lingo.by something up there up higher, just to, you know, because sick mentally, uh, in terms of like gate control theory, if, if you, if you stimulate something at a higher level than the problem that does have an additive effect, it’s not as good as like treating the right segment, but, you know, your even 5% more is a lot for someone who can’t move, you know, so, so I do add some points that are higher up, um, but then for more chronic or, uh, pain, or if the muscle boarding’s not too severe, I often use, uh, Craig pins, which is, uh, is a, um, medical acupuncture technique where basically you needling along the bladder or the Pato judgy line make a central module encompassing the segments that are involved.

Uh, you can go higher, make it more like a profusion, include the autonomic levels, but you just do the sensory motor level. So say Attica is primarily S one S two. So you really need to focus on the sacrum. You might go up as high as T 12 a to L two, to cover those autonomics, but then we’re going to add, uh, local points as appropriate. So glute, max and piriformis, both of them, you know, primarily, uh, you’re getting like L five S one S two, uh, glute max. I think you get a little lower as well, but the, um, those are totally related to the Syns towed to dermatome problem that the person’s feeling pain they’re having. And then you can then add, uh, points like laying ho or, uh, which is like a posterior gallbladder 34 it’s sometimes called and, uh, and a bladder 40 to get the peroneal nerves and the, the, uh, tibial nerves as well.

So, you know, I, you don’t, you can be very flexible in terms of how you, how you do this, but each module goes at kind of a higher frequency usually. So, you know, it might be one to two Hertz, centrally, uh, two to four Hertz in the gluteus Maximus piriformis, and maybe, uh, like four to 15 or even higher, if you’re doing, um, sensory nerves, uh, down the leg way, sometimes bladder 60, or kidney three, you can, uh, kidney or kidney six, you can get more of the sensory fibers down there, uh, with a higher frequency, maybe as high as a hundred Hertz. Um, but I find that this works well.

I’m going to ask a question for the benefit of the listeners, because I know they’re going to want the specifics. So for the platform that you mentioned for the two sag example, um, would you be doing electrical stimulation there too? And what if so our frequency?

Yeah, the phone, if I tend to use, um, I tend to use a higher frequency. I can use like a hundred, sometimes 200 times even 500. Um, I, I do it either two ways, depending on kind of either position of the patient or their own squeamishness either. We’ll put it on like a high-frequency with like one to two Hertz. So it just goes back and forth so that they get,

Uh, connecting electricity between the web spaces. Is that how you’re doing it, um, for web spaces? So you’d be connecting needles together, or,

Yeah. So what I do is I take, I’m trying to get the camera oriented, uh, it’s backwards area area. So, you know, what I do is I get into all the web spaces and then I tend the needle. So I take all four [inaudible] and I put one clip on there. If I’m using, if I’m using the ITO, I might do that at, um, I might do that at like, with the black one, because the black leads a little stronger, stronger uneven, uh, stem, so that, because I’m in more sites, I might need a little stronger stimulation. And then I usually wire it up to like kidney kidneys, seven ish, but kidney seven is where I personally seem to get the tibial nerve, most distal, tibial, nerve, most reliable I’ll hook those like, like that. And I would generally use a high, um, if the, if the patient is able to crank it up themselves, get seven, there’s still a fair amount of motor.

So if I’m doing that, you know, you don’t want to at a high, at a hundred Hertz, they’re just like not comfortable. So if I’m doing sensory only, I might clip it like two buff on one param and just get one, you know, to the medial, to, and the lateral to do at a high, high frequency, or I’ll clip it at a lower frequency. And I include kidney seven as part of it. Um, and have that, even if they have a slight motor contraction, and then if I’m doing high, I give them the box and let them turn it up. And if I sometimes I’ll do a, my, I use pantheons mostly. And so they have the option to run like an alternating, like one to two Hertz or, and then like a hundred Hertz. So it goes back and forth. So they don’t accommodate to the, um, they don’t accommodate to the stimulation.

Um, again, just a little more detail because otherwise where they’re going to ask the questions. So you are doing the baffle on the effect of the size, same side as the sciatica, right? Or are you doing both sides? Counter lateral?

I often will do both sides. I mean, I immediately, you know, it’s enough to do the one side, but you get some Asian, you know, if you’re having more, any less to the segment, then that’s better for the you’re going to get a better outcome. So that’s where a lot of them like treating the left to do for the right and on up to the down, all that sort of Neijing, uh, links, shoe talk, uh, comes from, you know, really.

And the last question to summarize the protocol. How long do you use the electrical steam that you mentioned? High-frequency so in the order of a hundred Hertz, but how long do you do it for,

I do it for really hot static. I like to do a full 20 minutes. I really, I want to, I want to overwhelm that segment with non nociceptive input. I mean, to the extent that they can stand it. So if they’re able to turn it up themselves, that tends to actually work better because it could be accommodation and then they keep raising it and accommodation, and then I might run to hurt somewhere else in the body, one to two Hertz just to help with the beta endorphin release, but you know, like a large intestine for stomach 36, something, someone somewhere else, uh, you know, stomach 36 is great. It’s part of the peroneal nerve part of L L five. So that’s gonna relate to the sciatic symptoms. So, you know, you can, you can use your logic, whether TTM or from like a neuroanatomical standpoint.

That’s amazing. I can’t wait to try it tomorrow. And, um, so, um, unfortunately all the time we have her today, um, if we would like to step study more with you, is there, are there any resources or any contact that you have, um, for our listeners to the viewers?

Yeah. Um, on the east coast, uh, I’m working with the, uh, Dow collective and that’s a D a o-collective.com. That’s with, uh, Doty, uh, Chiang and pony and teach with them as well. So that’s exciting. Um, and, uh, the other place to find me is on Facebook. That’s where I keep most of my classes updated and that’s, um, uh, facebook.com/omt Lac. So that’s oh, as, and then, and then this is Mary T as in Tom, then Lac licensed acupuncturist, uh, OMT is osteopathic pathic manual therapy. So that’s my thing. And then the other way is to, you know, reach out to, yeah, I’m pretty fine to on the web and I can put you on my mailing list.

Yeah. Awesome. Thank you very much for sharing your experience and wisdom with us. Unfortunately, that’s all the time we have today. I’d like to thank all the, uh, other viewers and listeners for joining us, and don’t forget to join us next week. Uh, our guest for our hosts for next week is Matt Callison and Bri.an Lau. And, um, thank you once again and have a wonderful rest of the day.

Are Vaccines Mandatory for Acupuncturists?

What’s happening, what’s mandatory, what’s mandatory. What’s not mandatory. What can I do? What do I have to do? And who can tell me to do it? So let’s go to the slides and let’s talk about what is mandatory and requirements for an acupuncture provider.

Click here to download the transcript.

Hi everyone. This is Sam Collins, your coding and billing expert for acupuncture and the American Acupuncture Council Network and information network, as well as the insurance company, of course, and welcome to another edition of, to the point and how to make sure your practice is doing well. This time, the topic is not going to be on coding and billing, not this week because obviously with a lot that’s going on very timely because we’re now getting close to October is what’s going to go on with vaccines. What’s happening, what’s mandatory, what’s mandatory. What’s not mandatory. What can I do? What do I have to do? And who can tell me to do it? So let’s go to the slides and let’s talk about what is mandatory and requirements for an acupuncture provider. As far as vaccines are concerned, do I have to get one and who can tell me to get one?

So you want to think about who can mandate, well, several things. There can be a mandate by the government, whether it be the federal, it could be the state, even local. You might have a city or a county. And then of course also private businesses may do so as well. So we have to remember, let’s look at, to see who is doing it, what they’re saying we have to do, and whether or not there’s going to be compliance for it. Because one of the things that’s occurring is a lot of people have gotten misinformation about who’s doing, or when they’re saying it, who they actually are including. So let’s start work first with this misinformation and misinterpretation. So you’ll see here in July 6th, the office of the alphas of legal council mandated that they said, no, we can do vaccine mandate. So there’s nothing constitutional.

We can say, oh, well I have a private citizen, right? And so forth. Well, we have a lot of rights, but do you have to wear a seatbelt? You know, do you have to wear a motorcycle helmet in some areas? So it’s that type of thing. So be careful if someone’s saying they can’t do it, they can, we have to look at, are they mandating it for us to do it? So let’s go here and let’s talk about federally, what’s happening for Medicare. So you’re going to see here at president Biden, you know, back a few weeks ago, made this big statement about Medicare, that Medicare is mandating it and they have to in federal and everyone was up in arms like, oh my God, is it going to have to be something we have to do? Well, they made a mandate that it said, yes, the key is, does that include acupuncturist?

Who does it include? And it’s often says facilities and people wonder what’s a facility. Well, facility generally is going to be a facility that provides services within it, such as a hospital, skilled nursing, that type, not generally individual provider offices. So with that said, what about the Medicare part under the federal? Does that apply well currently, of course. And I’m sure you’re well aware. Can an acupuncturist join Medicare? No. So that means absolutely not. Now a quick note, is there a bill right now to get acupuncture, to be part of Medicare? Yes. So make sure you’re supporting it. But as of now, there is no mandate for acupuncturists to even be in Medicare. So we want to be careful. That’s not part of it. There is a mandate that for Medicare facilities and providers, hospitals, that doesn’t include individual providers fee for service providers. So let’s just say you are working in a Medicare facility like within a hospital or a big clinic there you might be.

But for most of us, we’re working in private offices. So even if we were in Medicare, we wouldn’t have to, in fact, look here, it says a spokesperson directly. And this was just a week ago. This regulation does not directly apply to physician’s offices. If these are considered regulated under the provider specific Medicare health and safety regulatory provision, generally referred to as a condition of participation. In other words, in simplest terms as an individual provider, even if you were treating Medicare patients in a private office, you do not have to have a vaccination. So the federal rule actually does not apply to everyone. Now, if you are a medical doctor working in a hospital, yes. If you’re a nurse working in a hospital, if you’re an acupuncturist working in a hospital and there’s a few of you, that could be, but so long as you’re working in a private office, absolutely not.

So that being said, let’s talk about the conclusion of this and really what it means. Acupuncture providers can’t even join Medicare. So the, the mandate really doesn’t match. The only way it would, as I mentioned, would be if you were working inside one of those facilities. So again, from the federal level, nothing to worry about as far as a federal mandate for an acupuncture provider to do a vaccination or have a vaccination. And remember when they’re saying vaccinations, they’re also referring to also staff. So let’s talk about another federal plan. I’m sure many of you have heard or seen the VA made an announcement that they’re going to require vaccinations. And so here is on July 26th, they said the department of veterans affairs, making vaccines mandatory to all VA health personnel, including physicians, dentists, podiatrists, optometrists, and even went so far as to say anyone doing veteran administration through the VA choice program.

And so of course, everyone’s like, oh, what does this mean? Is this something that it’s going to be mandatory for me? And of course they had to make a clarification because everyone were all upset. Like, no, and you’ll see here. It says, and this is something the VA has posted. They are not requiring community providers, which is where acupuncturists fit. If you are working in your office as a community provider on a standard episode of care, where they refer a patient, there is no requirement for you, whether you belong to the Optum on the east coast or try west on the west coast. Now they do say they strongly recommend that you should have the vaccine, but there is no mandatory requirements. So both on the federal level of Medicare, the federal level of the VA, there is no requirement for vaccinations unless you’re working within a facility doing those services.

So by example, there are acupuncturist who work in the VA hospitals, or work in the big VA centers for those acupuncturist. If you work there, you will be vaccinated as every provider within that. Heck if you’re a janitor in those types of facilities, you are going to have to do, um, a vaccination. Well, let’s move the next step. What about state rules can states make that happen? So the first one I’ll point out here is for California. Now this is just an example of one for California. The department of health first came out and said they issued a mandatory vaccine for offices. And of course, everyone was like, what lost their mind going crazy? And I always will say, make sure that you understand the full rule read in detail. You’ll notice here. They made it mandatory. But however it says, we have exemptions which include acupuncture offices.

And in fact, this includes all types of facilities that are not covered under this order. So this means acupuncture offices. And of course all the rest of these meaning chiropractic as well as natural paths and almost every individual office occupational therapy, okay. Optometry offices, podiatry offices, physical therapy places. So in other words, it’s really, again, kind of going back to the facility areas, not the individual providers, again, facilities. So California does not have a mandatory facility for you even first days. If you work at a theme park, some people that if I’m a theme park nurse, I have to do it. So pretty much exempt except facility. So I will go back to kind of California followed the mandate of the federal government, which said facilities. However, we have to be careful. Some states are pushing it. So by example here, what about the state of New York?

Well, New York has made a mandate that says as of August 25th, their regulations include a broad vaccine mandate for New York health care facilities. So again, I want to use this term broadly and say facilities. And so here are the emergency regulations apply to each of the following types of categories in the state of New York, which is going to be general hospitals, nursing homes, okay. Diagnostic and treatment centers, including without limitation, community providers and birthing centers, again, big places. And then along with that certified home agencies and so forth, but I will highlight again, home health in person hospices, but this does not include acupuncture, adult care. So notice again, kind of the facilities area of this. That is where it applies. But while California New York don’t what about the state of Washington? Now, Washington is a bit different now you’re thinking, well, Sam, I’m not in one of those states.

What I’m going to implore you to do is make sure to check your state. There’s only a few that are, but definitely Washington is making an issue Washington as had a proclamation by the governor that on August that they’re requiring it. And within this, this means that you are mandatorily required to have vaccinations. And it has to be by October 18th. So this status includes again, acupuncture offices. It includes every employee providing healthcare. So it means everyone in your office, which means this is going to be difficult. Every one of us has to be within this. And it does mean acupuncture providers are included. So Washington’s going to be a bit tough. Now, are there exemptions you might be able to have absolutely. There can be exemptions, but it’s mostly religious exemption. So I would be careful, I would say, make sure, make sure that you verify within your state.

Cause I’m going to tell you for Washington right now, they’re pushing the issue. Now what’s going to be interesting is how are they going to enforce it? Are they going to require each licensee to send information? And they may, well, what if you don’t send it, could they suspend your license for a while? Possibly. So something I would look at well beyond the state of Washington there, again, as I mentioned, there’s exemptions, but I want to highlight Oregon is doing the same thing. Oregon is requiring it by October 18th, as well with no exemptions other than religious. So again, know your state. So if we go down just the west coast, Washington, Oregon, yes, California, no New York says no, at least for us, but you’ve got to be careful. So again, on a state level, if your state is enforcing it, please look at your licensing board, make sure, check with legal counsel to make sure am I in a position where I’m willing to fight back on this or do I just have to get the vaccination?

That’s gonna be a tough choice for some obviously, well, let’s move on to the next thing here. If the healthcare provider works in a healthcare setting, they must register request accommodations for the operator, which means, again, be careful of these exemptions. If your staff says that they can’t be there certainly could be healthcare concerns that do it. If they have a healthcare issue that doesn’t allow them, but be very careful. Am I really doing things that are vaccinated? It says if an individual does not qualify for an accommodation, they must get vaccinated. And notice it says, testing, not allow. There are some states that will say, Hey, no vaccine, but get tested. California is doing that. But of course that means for us, it doesn’t matter. Cause it’s not a requirement. But if you’re working in a facility, they would require this testing. So others are pushing back.

Well, what’s the next place. Okay. So we went from state and I get I’m an employee to look at your own state. What about local employers? Can they do it? According to legal side, a private company is allowed to mandate vaccines. You know, kind of private company mandate a lot of things, dress code, and otherwise in the United States, you’ll see here in the second box, mostly our employers and employees are at will. And this employment means you can be dismissed for anything, which could be, Hey, you relate to times this week, but if you won’t get vaccinated, so it becomes one of those ones. If local is doing it, meaning an employer, they could enforce it. Now could you try to bring a lawsuit? I’m sure you could. But in the, between of the lawsuit, would they allow you to continue working? Probably not. So I want you to be very conscientious of knowing within the rules of what is having to be done.

I’m not finding for us, that’s going to apply as much because you’re the employer. But let’s say you’re employed by someone. What if you work in an office where you’re with an MD or a chiropractor or anyone else and they mandate, Hey, we want you to have that. Well, I’ll give you an example. Take a look at this. Does Disneyland. If you work for Disney, can you have facial hair? Do you know up into 2000 at Disneyland, you could not have even a mustache. Even though Walt had a mustache, Disneyland wanted to be clean cut and no one could have facial hair. So that meant if you wanted to grow a beard, you can, you’re just not working for Disney. And so Walt had one, but up into 2000, you could have a very small trimmed mustache. Now the rule is you can have facial hair, it’s allowed, but notice what they say.

Employees are allowed to have beards as long as they’re kept shortened and trim. So what I’m bringing this up for is that always understand who has the right to do it as an individual. Do you have a right to say, I don’t want to do something. Sure. But that could mean you don’t have a right to like come into the business. For instance, could you say, I don’t want to wear clothes and go into a store or I don’t want to wear a shirt. Let’s not even go that far to just say no clothes at all. And we all know that no shoes, no shirt, no service. So the same thing applies. What I want to make sure is I hope most of you were on board with this, but I will tell you many of you have not. And I’m going to ask you, where are you getting your information?

This is the webpage of the American acupuncture council network. And I want you to see, I put it in red here talking about federal vaccine mandates do not include acupuncture offices. We’ve put in three times this. So if you haven’t already go to the American acupuncture council network page, go to the new section and sign up for our newsletter. Cause we keep you constantly updated as to what’s going on. And I want to just as a little tease, do you see that one I highlighted in blue? It says ICD 10 updates happen. October 1st include new new codes for back pain. How many of you were aware of that? So a week from Friday new codes for back pain, are you on top of that? The American acupuncture council, we’re here to be your resource, the network, especially seminars, our network service. If you don’t have a place to get this information correctly, you’re going to be lost.

Remember the internet is not your friend when it comes to this information because there’s just as much bad information come to the trusted resource, go to our site. If nothing else, at least get into the new section. Because if you don’t, we’re going to have some problems. Please make sure you’re always set to understand what’s new, what’s changed. And we’re always that resource. So be careful. Do I have to get a vaccine on a federal level? No VA level, no. Some states, yes. I gave just a few examples. So make sure, and of course, if you work for someone, it could be from them. If you need to know more information about that, we are the place to go. So what I’m going to say to all of you is thank you very much. If you want the resource go to our website, it’s just simple AC info network. We’re going to help you. We do continue education and much more than that. And for next week next, our host will be Poney Chiang. Remember the American Acupuncture Council is always your resource. And if you don’t have the right information, you’re likely not getting paid. And of course we want you to get paid. See you next time, everyone. Thanks for being with me.

How to Setup Your Website to Attract New Patients

“So I have some very special guests that are joining me here today, and we’re gonna be talking about how to set up your website to attract new patients.”

Click here to download the transcript.

Hi folks, Jeffrey Grossman here. And thanks again for joining us with another installment of a live broadcast from the American Acupuncture Council, bringing you some great information, um, business building and marketing and coding and all these great things streaming to you live. So I have some very special guests that are joining me here today, and we’re gonna be talking about how to set up your website to attract new patients. And with me today, we are going to have, um, the, uh, the team from our sister company called Acu perfect websites. We’re gonna have Ben Thibert and Ken Moorhouse that will be joining us to answer some of those questions that have come in over the years around, you know, attracting patients to your website. So thank you, Ben. Thank you, Ken, for joining me here today.

Thanks Jeffrey. Thanks for every for having us. Thank you, AAC.

That’s awesome. Good, good. So, um, you know, a lot of practitioners are, you know, they just assume they can just put a website up there and just, you know, and just attract patients in these, uh, throngs of patients just started streaming into their door and that’s pretty much further from the truth. And so I kind of want to get some clarity, you know, that you guys can share based upon the fact that you work with hundreds of acupuncturists, you build a hundreds of websites every single month, you’re, you’re managing these services for them. And, um, you know, so you’ve, you’re, you’ve got your finger on the pulse literally. Um, and, um, you know, I think that it would be great to kind of share some of this insight into some of this information with, um, our members. So one of the first questions that I’ve heard over the past, and you probably, you guys probably hear about it too, because I think a lot of our clients come over from other companies to join our S um, so what are some important things that people miss when they’re doing their own website on services like Squarespace and Wix?

Yeah. So I think one of the most important things to think about when you’re building your website is content. Uh, content is what drives traffic to your website. So when you write content about TCAM and acupuncture and the different conditions that you treat people in your community will have access to that, if you set up your website correctly. So content is still king, uh, bill gates coined that term back in 1996, and he was talking about the future of the internet and sure enough content is still king on the internet. So it’s really important that you write good quality content on your website, and that can be blog posting. We’ll talk a little bit about, and you can also talk about landing pages as well. So in terms of blog posting, you want to write some content about TCM and acupuncture and how it can help conditions and be sure that when you’re writing your content, doesn’t have to be very long, 600 words will suffice, but you want to have a good quality post that talks about the condition, your location, how you help people in your community with those conditions and what modalities you may use.

So that’s a really good, good way to start attracting traction and getting people to visit your website. Uh, the other part of that is also landing pages are really important. Uh, Ben, did you want to talk a little bit about landing pages?

Yeah, just content in general. Um, one thing that we see is, you know, Google doesn’t rank sites based on how they look, it’s all based on what’s on the site and the content. So you could have a beautiful website, but if you don’t have the content on your homepage or your about page, that matches what people are searching for it, you’re not going to get ranked. You’re not going to get people to your website. Um, I mean, having a good looking website is, is important, but not in Google’s eyes. Um, so it’s important to have, you know, like on your homepage, for example, you want to make sure you list all the, um, services you provide. You want to list the main conditions that you treat. So when people are searching for acupuncture for back pain, you know, it’s going to come up. Um, it was one thing we see missed a lot is people will have, you know, maybe their mission statement or some, you know, quote that they like on the homepage, but they don’t have any information about what they do or what they offer, or even sometimes where they’re located, people miss that.

So you want to make sure you have all that stuff that Google is going to pick up and use to rank your site, uh, in your content, across all your pages, put your address. It was basic. It seems like it’s basic stuff, but it’s amazing how many people, it’s hard to find where they’re located or what their phone number is. If like dig through all their pages to find it. Um, that’s something that’s missed a lot. And, um, like as Kay mentioned, landing pages, that’s where you can get, get a little more detailed. So you can kind of use your homepage to list your general overview of what you do, what you offer. Um, but if there’s a specific service that you provide or a condition that you treat that you wanna really focus on and you can create a whole separate page for that, and that’s just called the landing page. So for example, if you focus on anxiety, you can have a whole landing page that talks about how acupuncture can help with anxiety, the different treatments that you offer, kind of your, your plan that you, when someone comes in to treat anxiety. But the important thing is to have a separate page that has all your good keywords in there that Google’s going to pick up and use to rank you for different, different conditions.

I think. Yeah, I think, I think that’s a big thing that people overlook is they just assume that they have a pretty looking website and that is just going to be the patient attraction tool for them, but having content with specific meta-tags and alt tags and title tags. I mean, that stuff that you know is what is, what, what you guys do. It’s what you guys focus on, which isn’t what a lot of practitioners do, um, in that way. But like when, when Google, when people like type in acupuncture, you know, back pain, Seattle, all of that information should be part of the content on some level, right?

Yep. Yeah. We could talk a little more about the meta-tags too. So it’s one thing that we see miss a lot is someone does their website on Squarespace or something, you know, even if they have great content on there on the page itself, um, we’ll see that their, their title tag for the page is just the word home or, you know, something really generic, but that the title tag is one of the most important meta-tags, that’s what Google uses to actually list your site in the listings. So each page use your title tag, and that’s what shows up when you search in Google, those are the title tags for each page. So you need to make sure that you have all your information in your title tag, that, you know, you have to keep it short. And I think it’s something like 60 characters. Um, but you want to have, you know, your business name and your city, and if your business name doesn’t include the word acupuncture, you want to make sure that you have, you know, have that in there as well. So you are targeting acupuncture in your city, in your title tags. That’s when we see missed a lot as the title tags aren’t set and it’s something has to go and manually do when you’re in Wix and Squarespace, you have to go and set those for each page.

To your point to Jeffery, all tags are sort of treated the same way as any time. If you have an image that you upload to your website, make sure you have a good description of that image, and also include some of that information. Some of the keywords that we’re talking about, your city, your location, and then a description of the image. And that really helps that with SEO and Google ranking, right?

I think a little bit into, I was gonna mention that that’s a big part of the, we’ll talk a little bit about ADA compliance too. And, um, accessibility and L tags are a big part of that, but go ahead, Jeffrey.

So, so as far as title tags, clarification on that, the title tag is the title of whatever content piece you’re putting out, whatever blog posts you’re putting out. Right.

It’s the title of that page? Um, yeah, so right. Yep. Okay.

And then, and then as far as pictures go, Ken, that’s a really good point because a lot of people just pick up pictures like, oh, me at the beach, right. Or whatever that is, or me doing moxa or me doing cupping, but like, it’s, you know, I mean, if someone puts up a picture of cupping, it should be like, Jeffrey’s acupuncture clinic, Seattle cupping. Right. That should be yeah.

Treating patient with capping or something similar to that effect. Yeah,

For sure. Yeah, because that all plays into like getting search when, when the search engine crawlers are out there, they’re like those search, not only the title tags, but the, the, the other alt tags in the photos, which is, I think I would, you know, I never knew that until I started, you know, you guys started jumping into the websites, informing us around that. So, um, cool. Um, and, um, so what is another question is like, what’s the best way for practitioners to reach more prospects in their community? Like how can they get out there and be more forward facing? So people when they are searching that they’re found?

Yeah. I think the number one thing that people miss as a practitioner is setting up their Google, my business account. Um, so if you go to google.com/business, uh, you can create a listing, uh, inside of Google and Google will, uh, rank your website better when you create that listing. And what it does is essentially it tells Google what you do, the services you offer, and also verifies that you’re actually a real business. And that’s really important to get a better ranking in search results. And also to, it allows you to appear on Google maps, which is really important because your patients will go to Google maps to try to seek you out. And part of Google maps includes reviews and reviews are really important. So if you think about going to a restaurant and a, you choose a five-star restaurant, uh, that, uh, that your peers have reviewed at five stars versus a one-star restaurant, you want to be part of that, that community that Google is putting in front of you. Um, and that’s through Google my business. So, uh, Google my business is really important, uh, way of getting in front of your community and making sure that you’re ranking well for some of the conditions and, uh, the modalities that we mentioned earlier

And Google my business it’s free. Right. There’s no cost to getting that set up.

Sure.

Right. Yeah. Yeah. There are a lot of third-parties that I’m sure a lot of people have gotten calls from, uh, you know, solicitors calling and saying, Hey, we’ll set up your Google business for you for, you know, X amount of dollars, hundreds of dollars. Uh, but it is free through Google if you do it yourself. Um, and a lot of times too, um, Google will, you know, use the yellow page listings to auto-generate your Google business listing. Um, but it’s, you know, usually lacking a lot of content. It’s just the basic. So you, even, if you have one up there, you want to make sure that you go to google.com/business and claim the listing. If it exists already, I go through the verification process and then you have full access to put all your information and make sure your hours are up to date. Um, you know, during COVID, you can, you can list your specific COVID changes that you have on your listing, um, and also have access to the reviews.

So you can interact with your views that come in. Um, that’s one thing that is important is, you know, you want to make sure that you’re encouraging your patients to leave reviews and then that you are going in there and actually responding to the reviews and interacting with them. And that shows Google that you’re, you know, not only have a lot of patients coming in, cause they leaving reviews for you, but you’re actually being proactive and using your listing and responding to both positive and negative reviews, hopefully all positive, but you can still go in and just say, thank you to people who leave reviews. Um, and that’s something that Google notice and, you know, if you’re really active with your listing, Google, you’ll start bumping up in the, in the ranks, especially if you’re in a competitive area where there’s, you know, dozens of, of competitors trying for that top, top, the top three spots on Google maps, those are the really important spot to get to because that’s where you show up kind of on the first page, when you search something that shows like just a couple map results, when you search, you know, you want to be great if you can get up in that top three spot.

So reviews will help a lot with that.

Yeah. Because these days, people don’t really scroll past the first page when they do a Google search. And you know, the first thing that shows up there are I think, paid ads and then sort of the map, you know, like the map listings and then, then other other generic rankings. Is that right?

Yeah. That’s one thing that, you know, a lot of people coming to us thinking that there’s a quick way to click one button to get to the first page of Google. And you know, it it’s a process, especially if you’re in a competitive area. Um, if you’re in a smaller town, you can see it as possible to get up to the first page within, you know, a month or so. But if you’re in a competitive market, it’s going to take time to build that, that ranking up and get to the first page or two. Um, but the, the easy, quick way to do get it to the first page is through the ads. And I mean, it definitely is a cost involved. Um, it can get expensive doing Google ads, especially in a, in a big market, but that’s really the only way to guarantee to get to the top spot immediately,

Right. By paying for the ads, hiring someone to run the hours they’re doing limit yourself. Right. And then around that, there’s so many different parameters that you’ve got to abide by in order to, you know, make sure you’re not stepping on their term terms of service or terms of use around that. Um, cool. Um, yeah. So Google, Google maps will help people get found. Google reviews are really important. Is there anything else that you can think of that is another good way for practitioners to, you know, have be found online?

Yeah, I think it just really is to summarize everything like Google my business is great and setting it up, but we have to also remember that Google loves fresh content, right? So if you’ve got a website that you’ve built and it looks great and it just goes dormant because you’re not adding fresh content to it related to the service that you provide, then most likely it will drop in organic ranking. So you’ve got the paid advertising, you’ve got the map and then you have the organic, you want to get into that organic space, the first page of Google. And that’s what takes time. So writing good quality blog posts about, um, your, your practice and the conditions you treat is really important. You got to keep feeding, Google that content, and the more you feed it, the higher you will rank compared to a site that doesn’t post anything. So that’s really what drives your ranking. Um, and then there’s some other, other, other factors that we talked about, like all tags and metatags, I want to,

Another thing I want to mention too is, um, you know, if you’re, especially, if you’re starting out and your site’s new and you’re starting at kind of from square one, you’re buried in the listings. Um, and it’s gonna be hard to get people organically to go onto your site. They’re not going to find you on the fifth page of Google. So one of the important things to do when you’re first starting out is to find other ways to get traffic to your site. So that’s through, you know, if you have a social media following, you know, you can start putting your blog posts onto social media. So people click through to your website. Um, if you have like a, you know, a newsletter list, sending out newsletters that link out to your website, um, even just first starting out, just sending your website to friends and family and have them visit because Google will see the traffic started picking up and that’ll say, oh, you know, people are getting to this website. This must be important enough to move up the rankings a bit. It must be relevant. Um, so that’s one thing that I think sometimes people miss, you know, if you build your website and it’s brand new and it’s sitting on the fifth page of Google, you know, you gotta find other ways people to get to the website first, before it can, you know, start moving up to the first page or so.

Cool. Um, okay. Um, another thing that I’ve heard in the past, and maybe you guys can shed some light on this is the fact that it’s important to have your website be mobile ready in order to, is that helpful for rankings at all or anything like that?

Oh, absolutely. Um, and it it’s something that it seems like it’s becoming more standard now. It is, it is the standard. So we see it less and less of people not having a mobile ready site, but we do still do see it. So, you know, having a mobile radio site super important, if people are searching for businesses, they’re doing it from their phone in 90% of the time. Um, so you want to make sure your website is mobile friendly because Google will tell if it’s not, and then they will lower your rank on mobile searches if you’re not mobile friendly, um, cause they want the sites that are easy to use to are the first ones that are popping up. So that’s super important to be mobile readily mobile ready. Um, you can search on Google and Google has its own mobile ready test. You can go and plug in your website and it’ll tell you if it’s coming back as mobile friendly or not.

Um, and then the other thing is, um, having SSL security is really important. That gives you that little lock icon in your browser that shows that you’re secure. Um, that’s pretty much standard at this point, it’s it? You know, it’s every host should have it an easy way for you to get that. Um, Google’s even say not secure if you, if you don’t have the SS SSL security on your site. And that just gives people peace of mind when they’re sending con your contact form through or messaging you. So yeah, mobile friendly and SSL are super important to have. And at this point, if you don’t have it, then you’re kind of behind the times.

Okay. Yeah. And you could tell, like, there’s a big difference between the way a website loads, that’s mobile friendly versus a website that is not mobile friendly. Cause I mean, some of the sites that, that, that you guys have worked on, literally like there’s a button, a big button, you just click to call, click to schedule, you know, click to send a message, right. I mean, let’s just seem super efficient.

Yeah, absolutely. It’s important to make it easy. And then one thing that we can also mention too, is, you know, having your website get found is one thing, but you want to make sure that it’s easy to use once people get there, you want to make sure that it’s easy. You want to have this really strong call to action. So when someone gets to your site, they know what to do next they know to contact you. They see a big contact us button. One thing you can do is, you know, go to your website and see how long it takes you to find the button, to see, to make an appointment or to call it. And if it takes more than two or three clicks, then you probably need to make it a little easier for people to find because people will give up quick and move on to the next thing. If it’s not easy to use or easy to find what they want.

Yeah. And it’s also important to put that call to action closer to the top of the page so that people don’t have to scroll down to get to it. And you want to make sure it’s front and center. And like Ben said, two or three clicks to get the, take the person down the path that you want them to go down is the, is the key. So go to your website and check it out and see how long it takes you to contact yourself. So

Right. Or what call to action you have like available on your site. It’s like, you know, you need to have a schedule. Now, call me now, download this free report now and all this stuff like right front and center. So if people don’t schedule with you right away, what’s the next action that they can then take to, you know, communicate or reach out to you or just stay in your loop.

And one thing, one thing you can do is, you know, contact, uh, you know, maybe, uh, an elderly relative or patient and have them go and test your site. Hey, is this, can you, can you find how to do this? Somebody who’s, doesn’t ha hasn’t been to your site. Maybe it’s kind of not super tech savvy and to see if it’s easy for them to, to navigate and navigate the site and get to what they want. Because if you, if you’re in there everyday working on it, it’s easy for you. Cause you know, everything is, but sometimes you kind of forget that other people don’t have the, the prior knowledge to know everything is like you do. So can I seeing some fresh eyes on your site and see if it’s easy to use? That’s important. Okay,

Cool. Cool. Okay. So, um, well I think that those are all the main questions that I have for you. Is there anything else that you guys would want to share?

Yeah, I think one thing that we, uh, we’re going to talk a little bit about just because it was a kind of, uh, came up this year as a ADA accessibility. Um, it’s one thing that, you know, beginning of the year, there were a lot of kind of reports of practitioners getting, getting sued for their website, not being accessible, um, mostly out of California. Um, so, you know, what’s one thing that we looked at a lot this year is, you know, making sure that our sites are, are as compliant as they can be. Um, you know, we got extra tools in there for, for accessibility, but just to talk about a few things, if you’re doing the site yourself to, to look for, um, the important thing with ADA accessibility is, you know, one of the, one of the most important things is making sure that your website is, is usable with just a keyboard without a mouse.

Um, and that’ll kind of mimic to what if people don’t have feel using like, you know, voice commands to use a website. You want to make sure that everything is accessible. So you can go, go and test your site and make sure that you can, you know, for example, navigate through your menu with just your tab key and your space bar, um, making sure you can get to pages, just using your keyboard. Uh, that’s an important thing to do. Um, you mentioned alt tags before in images. Um, if someone’s blind and using a screen reader to go through your website, you want to make sure that all the important images are, have the descriptive alt tag, um, behind them. So if you, someone can actually see the screen, it’ll describe what the image is. So, you know, patient receiving acupuncture or something on, on, uh, on the acupuncture picture. So that’s really important. That’s one of the thing that people get dinged. As you know, they’ll run through the website using a screen reader and to see if it’s broken or not. And that’s kind of as a red flag, if, if your site is not easy to use with a screen reader or a keyboard, um, anything else you wanted to add to that kin?

Yeah, I think the other part of that is screen readers is being aware of your heading tags. So your heading tags are basically the different sections of a page and Screenagers need to be able to determine what those sections are. So if you have a section about what is acupuncture and then some information, and then the next section is what about what is a moxibustion that kind of thing? Things a headings are important. Part of ADA accessibility, and like Ben said, active, perfect websites includes, um, the accessibility testing, making sure that your site is built correctly to meet some of the most of the requirements. And, uh, you know, it’s, we, we try to do our best to, to guide you along the way. If you want to make changes yourself, we give you the tips and tricks on how to make sure that when you’re uploading content or adding images, how to make your content ADA accessible so that you don’t get dinged by any, any of the ADA lawyer stuff that’s going on right now in California.

Cool. And one last thing,

I’m sorry, man. I was going to say Daniel, if anyone, you know, feel free to contact us, we’re happy to, you know, take a look at your website. We do have an evaluation available. Um, yeah. So feel free to reach out if you have any questions about this, we’re happy to go in more detail with you. Um, you know, actually look at your website.

Yeah. So there’s, so if you guys want a free website evaluation, um, there is a link right now, that’s up on the screen and, uh, I guess, uh, once you sit, once you go to that page, you submit your site and Ben or Ken or, or Ian, or reach out to you and, and take the next steps to evaluate your website. Um, and one thing that’s, I think really important to get across is the fact that a lot of times when you work with Wix or Squarespace, you’re actually, the practitioner is actually working on and building and updating and doing the website and upkeeping it and doing it all themselves. Whereas what you guys do like day in, day out, you guys are doing all that for the, our clients. Right, right, right.

He didn’t go to acupuncture school to become a web tech builder. You’re eight. So that’s what we’re here for. We take that off of your hands and it frees up more of your time so that you can treat more patients, you can attract more patients to, through our service, which is great. So that’s why we’re here. We’ve been building websites since 2011. So we’ve been going for 10 years now has been a great ride. So

It’s actually Ben’s baby, but don’t kill anyone, right? Yeah. Uh, so other than the evaluation is, is that the,

Yeah, just go to that school. I go to that site, um, you know, they’ll have our other links there for signing up for a free trial. If you want to try us out, uh, the free trial is really easy. You just give us your information, we’ll set up a new site for you. Even if you already have an existing one, we’ll set it up at a temporary address. You can kind of just see how it is, you know, click around, see how it works and you know, be ready to go. If you want to make the switch and make it all easy. We do all the tech stuff for you. Now. You don’t have to be knowledgeable in any of that. We’ll try to make it as easy as possible.

Yep. And one last thing. So you just mentioned switch. So a lot of people are scared to switch over because they think it’s a daunting, massively, huge thing to do so, but like that’s what you do. Like you literally do that, right?

Yeah. We do it in a way. So there’s no downtime. We’ll build your whole new site kind of at a temporary page, so you can see it, make sure you approve it. Everything, once everything’s in place, then it’s just a quick little switch at your domain name and everything goes live and there’s no downtime. So we walk you through all the steps that you need and do all the do as much as we can from our end to keep all the tech stuff out of your hands. So you can just get to work.

Sounds good. Well, thanks guys for, um, you know, joining me here today and sharing some insights and wisdom with, uh, the AAC and those that are watching here. Um, next week you can join, uh, Sam Collins is going to be here and he’s going to be, uh, talking about some great things, um, on, uh, billing and insurance. So comeback then other than that, thanks guys again for joining us. Thank you. The AAC for, uh, allowing me to bring, um, you know, some guests onboard to share some insight and some wisdom. So thanks everybody. Take care. Bye Ben. Bye Ken. Bye. Thanks Jeffrey.

Staying Out of the Negative Gap Trap

So where the mind goes, the Qi or chi follows what you focus on, becomes a reality. So this is really about where you choose to put your intention.

Click here to download the transcript.

I want to thank the AAC for inviting me back, um, to their live stream, to the point my name’s Lorne Brown, um, a little background, I’m a CPA, a certified professional accountant. I’m a doctor of traditional Chinese medicine. I’m also a clinical hypnotherapists. I’m trained in psych K um, rapid tribes, transformational therapy, the Mercer of pure technique. And I’m the founder of healthy seminars.com offers continuing education, um, for acupuncturists as well as the founder of acrobatics wellness center. The first and I guess longest serving integrated fertility clinic in British Columbia, Canada. And I’m the author of this book missing the point. Why acupuncturists fail? Um, I want to, um, have a discussion with you about, um, ignoring or getting stain out of the negative gap trap. This trap is where, um, you lose your confidence. You feel frustrated, you feel depressed. And so, um, I promise you that for this lecture, um, I always like to set the intention. I hope to one day be remembered as the guy that keeps everything really simple, powerful, and effective. And I started his quote here is make everything as simple as possible, just not simpler. Um, and that idea, the risk of being too simple is that you may ignore it or dismiss it all together, but I will do my best to keep this simple, because I don’t like to do complicated, but yet powerful and effective.

So where the mind goes, the Qi or chi follows what you focus on, becomes a reality. So this is really about where you choose to put your intention. That is the key. And I like to use the idea of, um, the missing the tile syndrome, um, concept here. And so in missing the tile syndrome, the idea here is you have this beautiful, um, tapestry, this beautiful let’s think of our, our ceiling has been hand painted. There’s a million tiles and every tile has been beautifully hand painted. However, unfortunately in the corner of the ceiling, one tile has cracked and half of it has fallen. And because of that, the museum has closed the exhibit and notice it as worthless. And this is this idea that you have 999,000 beautiful tiles. But if you focus on that one damaged tile, then it becomes worthless to close the exhibit.

Um, I like to say when again, where the mind goes, achieve follows, what you focus on becomes your reality. So if you have nine good things happening and one bad and you focus on bad, then you suffer. Life is not great. Vice versa that if you have nine, not nine bad things happening and good, and you focus on that one, good, then life becomes great. And so it’s really about which Wolf you’re going to feed a, where are you going to put your attention? Where the mind goes? The chief follows what you focus on becomes reality. And I’m sure many of you who, who drive or purchased a vehicle in your life have probably had this experience that once you’ve decided on a vehicle that you like, all of a sudden, you see more of that make and model, and maybe even color of that vehicle, that car on the road.

It’s not that there’s any more of that car on the road. It’s just that that’s become your focus. And that’s what gets percolated up from your subconscious to your conscious mind. And you start to notice that you start to notice it more. These opportunities were always there. These vehicles were always there, but now that you’ve put a bit of focus there, you start to notice it more. And so this is how life happens. You start to experience, notice that, notice things more, this becomes the life you live, and this is why you could live in suffering and stress, or you can live in joy and gratitude keyword. There is, it’s a choice. Um, I really enjoyed a book called minding the gap and it was by, um, Dan Sullivan. He’s a coach and I really liked his metaphor. So I want to share my version of it, um, in this idea and how to stay out of this gap.

The gap is where you do not want to be. Um, he, he gives us idea that you set sail basically, and you untie your, your boat from land. And as you said, sail, you look out to the horizon. Now you gotta remember the horizon is a mental construct. There is no place where the sky and the ocean meet or in sky and land meat. It’s just a mental construct, but that’s where you set your target out. Um, those are those big audacious goals. That’s what you say, your target. When you leave the land on your sailboat and after 24 hours of sailing, you, you go down and retire at night. You have a nice sleeper below. When you wake up to your dismay, you notice that the horizon is just as far today as it was yesterday. And if you keep just focusing on horizon, then over a period of time, this can lead you to a lack of confidence, frustration, and depression.

So the antidote for this, the solution is to look backwards, to look behind you and notice how far you have come each day. And that’s the issue for a lot of driven people is they’re constantly focused on their long-term goals are focusing on that horizon, but they’re not stopping each day to do gratitude, to be grateful for what they have, where they have come. And so the gap is from the gap is the area from where you are today to where you want to be. That’s the gap. But what we have to remember is there’s also a position from where you are today and where you’ve come from, and this idea of, of practicing daily gratitude, where you look for things that you can be grateful for. It basically forces your mind, your brain to search for the last 24 hours of what has been going well for you.

And this is the antidote to staying out of the gap and enjoying life more. Uh, there’s this quote that if you cannot feel gratitude, then you cannot be happy. And so, so many of us still suffer, even though you have material possessions, I’m talking about the people that have, you know, if I, if I just have this, then I’ll be happy. Well, they have this, but yet they still don’t find the joy in their life. And the key quote here is if you cannot feel gratitude, then you cannot be happy. And I will say I was one of those people, very driven, um, that kept on achieving, but never finding that fulfillment. It was always short-lived. And I’ll talk more about that. And again, the key here is to state of gratitude and the solution is daily practice of gratitude. And let’s talk a little bit about how gratitude works as well from a scientific perspective.

Um, remember that this is your free will, gratitude is a choice. And it’s one of those things that I like as a mind hack. I like to do mine tax. And again, I’m always looking for these simple things. So what I’ll do is I’m just going to read a little bit, um, from some research here. Um, so again, on gratitude, um, many of us are always looking toward external factors. We’re always looking outside of ourselves to experience joy and happiness. When really it’s all related to internal work. This is a lot of the stuff around conscious work that many of you may have been exposed to. This is something science is just starting to grasp as well as shown by research out of UCLA mindfulness awareness research center. According to them, having an attitude of gratitude changes, the molecular structure of the brain keeps gray matter functioning.

It makes us healthier and happier when you feel happiness, the central nervous system is affected. So your whole autonomic nervous system changes, which many people say is the subconscious mind, the autonomic nervous system, you are more peaceful, less reactive and less resistant. Now that’s really a cool way I’ve taken care of your well-being. Now I suspect when you’re practicing gratitude, I suspect that you’re going into, um, alpha brainwaves. So when you’re in high tech high beta brainwaves, that’s that state of stress overwhelm anxiety you’re suffering at that time is that nice, um, state of detach relaxation. And when you’re an alpha brainwaves, basically you become resourced. And again, through research, what they’re noticing is that when we’re in this state of gratitude and in the state of alpha brainwaves, we now are able to access more of our mind that is normally not normally available to us in particular.

They say the research that we’re able to access more of that creative mind. And so when you’re in that stress response in high beta, you’re likely focusing on the problem. And when you go into gratitude, it has a shift in perception, and it takes you from focusing on the problem to now focusing on the solution. And that’s when, when you get into gratitude and alpha brainwaves, you now are in inspired thought, and that’s when one of these solutions inspired thoughts pops into your mind for what you can do. And you get really excited about I’m just going to read another little line here from some of the research. Um, scientists have discovered that feelings of gratitude can actually change your brain. So they’re measuring things and seeing the brain structure changes, synopsis that fire together wire together, and feeling gratitude can also be a great tool for overcoming depression and anxiety, more important now than ever.

Right? Furthermore scientists have discovered that the heart sends signals to the brain, your thoughts and feelings of gratitude create a physiological response in your body. So if you want to feel happy, practice joy and gratitude. If you want to feel happy, practice joining gratitude, it’s not going to be this relationship. Or when you make this so much money or you have this health, that’s going to make you happy. It is an internal experience. And remember, it’s not happiness. That brings us gratitude is gratitude. That brings us happiness. And so if you practice a daily, um, basically if you cannot feel gratitude, you cannot be happy. You can not feel happy. And so the idea of practicing gratitude daily is, um, you revisiting the past 24 hours and some people will find this a challenge by the way, but that’s okay. That’s just showing you that you’re not practiced at gratitude. And it’s taken a little bit of effort to get those wires to fire, right? Those synapses to fire. Last little piece from this research in short practicing gratitude seems to kick off a helpful self perpetuating cycle in your brain, perfect momentum, right? Counting your blessings now makes it easier to notice and count them later. And the more good you senior life, the happier, more successful your life becomes.

So in Shawn anchor’s book, he’s an author on the happiness advantage. He talks about a study where they take people that are basically, um, uh, you know, think of negative and positive. Um, people I’m losing the thought of the word. That’s not the word that he used in the book. Um, but it just, I just lost my head and normally it does it, but it, it, it will be okay still with the exercise that we’re going to do. So he has two groups of people, um, and one group, um, they’re, uh, both groups actually are asked to count how many images they see in the magazine and it’s timed. And this was a magazine made for the study. And what they notice is the, um, people that, um, I’m going to call it negative again, negative thinking, right? Things don’t go well for the victim thinking versus the people that are lucky enough, good things happen to them.

Um, the ones that were in the negative thinking group, they took longer to complete the exercise, then the positive mindset group. And that’s not the terms of use by the way, but it will work for what we’re doing. Now. What was interesting is they all had identical. So what’s the time difference. And in each magazine, there was an image and right under the first image, it said, um, if you’re reading this to finish this exercise, now go to the second to last page. And so on the second to last page, it said, show this line to the supervisor and collect $250. So these people would look at the picture, read this, flip it and hand it in. But there was a whole group of people that went picture, missed it, picture, picture, picture, and it took longer. This is that idea that I mentioned about seeing your make and model of the car on the road, where the mind goes, the chief follows what you focus on, becomes a reality.

There’s only so much information. The conscious mind can take five to seven bits of information. Your subconscious is a supercomputer. And so if you’re in that negative mindset, it’s only going to percolate up to you. That’s matching what you want. Like when you’re looking for that car, all of a sudden, you’re now noticing that car. So if you are of a positive mindset, that gratitude, you start to see more opportunities. They saw that line right away and were able to collect $250 by completing the exercise quickly where the other group were not able to read that line. They opportunities are always there. It’s there for everybody. So what’s the difference. The difference is what have you put your focus on? And gratitude is a way to start focusing on opportunity and what’s going well in your life. And when you do that, you start to notice more. And because you were experiencing that, it’s an inner experience. You’re enjoying life. And they’ve shown that it’s happy people that become successful. It’s not successful. People become happy, happy people become successful.

And there’s that quote, successful. People are happy, happy people are successful. We often think if I get this, then I’ll be happy. And that is not how it works. Pleasure is temporary success. That kind of success, material successes, pleasure is, is only temporary. And it puts you in a vulnerable state as well, because you’re always needing an external environment to be a certain way for you to feel a certain way. And in conscious work, this is about inner work and that you’re feeling good despite the external environment. So that’s a skill. Can you deny the five senses and what’s happening now, um, and bring up that feelings of joy and like attracts like, and this is how happy people do become successful. So happiness is more about the joy and striving for your potential than the actual end result. So enjoy the journey versus focusing on the destination idea.

So it really is less about the external world. I’m John anchor, again, the happiness advantage and before happiness, it was two books. Uh, one of the studies that he looked at is they looked at wanting to raise success rates and happy, uh, when you try to raise success rates. So in corporations that try to raise success rates. So profit margins, um, revenue, you know, on the material side, they saw happiness would flat line, but yet when they raised happiness inside these organizations, success would rise dramatically, educational and financial. And so again, happy people become successful in same thing for your organizations, happy organizations become successful.

So it’s a cause and effect. And we can take this from a Newtonian level to a quantum level. So on the Newtonian level cause and effect, we are using the external environment to make ourselves feel gratitude. So we’re looking at what has happened. So in that gap, minding the gap exercise, we’re looking behind us and in the last 24 hours, what can I be grateful for? Um, that’s cause and effect, and that’s on a Newtonian level and it’s very beneficial. And that’s where the research is has been done on the causing effect is kind of a quantum idea where you’re starting to feel gratitude in advance of what you desire and want before it’s actually manifested. And this is more beyond the scope of our discussion today. Um, but in that quantum level, you are now, um, using your imagination to create what you want in your life and you’re causing the effect.

And so, you know, um, to, you know, to, if you want to be healthy, then start to feel whole and complete, right? If you want to be happy, then start to feel joy and gratitude in advance of what you see physically, right? And so that’s causing the effect and that’s a quantum level idea that people talk of and that I love. And that’s more on a manifestation level. And today we’re really focusing on cause and effect where you’re looking at, what you can be grateful for, what I invite you to do now, while you’re listening to this, this is really simple. Um, but I would invite you to take a moment and write down three things that you’re grateful for. Oh, this was the part I, you know, it’s, I’m going to share this now. Cause I didn’t add this to the slide with the Shawn Achor lecture, um, research that he talks about, where they looked at those two groups of people where they looked at the magazine, this is very key.

So I’m glad I remembering this. Now it kinda ties it in together. So a quick, quick summary in that study, one group took much longer than the other because they missed it where it said, go to the supervisor and collect two 50. They miss that opportunity and just focused on the pictures. What they did is they took the pessimist. That was what it was pessimists and optimists. That’s how they kind of define the groups. So they took the pessimist group and they got them to write down for 21 days, three things that they can be grateful for three original things. And so every day they would write, not think, but write down three things that they be grateful for. And what they notice is not only did they see changes in the brain structure, so the brain wired differently, but these people started to feel more optimistic and start to notice more good things happening in their life that like attracts like, and so this is something that can be learned.

So wherever you’re at now, I would suggest, and I do this for my patients all the time. I suggest a gratitude practice. I’m going to actually tell you what I do is I recommend and a really nice book. So I buy more of the expensive books, too, a nice leather bound book. This one has like a strap to it. So if you can see that, so some people do a little hill Roy, but I do it on a nice binder because these are your gratitude, your, your joy, uh, books. So it’s, it’s precious. I’m giving it the respect, right? It’s precious. So it’s in a nice expensive book. And each day I write three original. Now the key to this is to take your time, write something you’re grateful for. What’s gone well in the last 24 hours or more. And write that down and allow yourself to feel the gratitude.

It’s the feeling that’s key. If you just write three things down, but you don’t bring up the feelings of gratitude. It won’t be very beneficial. That feeling is chemistry and the body feelings are chemistry, right? And so, and this has an effect on your electrical and hormonal nervous system, right? And so you want to bring up the feelings of gratitude. This is key. And if you have something that every time you think about it, it brings gratitude. You’re a welcome to write that down each day, but now you need four things because it has to be three original each day. So if you want to carry something forward or more than one thing forward, that is fine, but you need three original things. Now what happens if it’s difficult, then be grateful that it’s difficult because if it, if you were super great at it and you’re still suffering, um, that’s unfortunate, right?

Because what else can we do? And there’s lots of we can do if you’re finding it difficult, that is feedback that you don’t have that wiring for gratitude, because if it’s wired, it’s instant, it’s easy. Like you can just bang, bang, bang, and really feel it. Then, you know, it’s worried. Cause that subconscious is like a super fast super computer. So it would be easy and fast. If it’s not easy, then you are now building those synapses. Right? So time you think about it, you’re wiring your brain differently. Like we saw in that study that Shawn anchor quotes in his book, they noticed after 21 days that the brain changed and they felt more optimistic. They noticed more gratitude. They were experiencing more joy in their life. And so write three things down. I recommend an a, an, a book, the research didn’t do it based.

You do it in your head. They didn’t do it on your iPhone notepad, um, or on a sticky note. Um, I recommend a nice book and sometimes I sit back and I reread these things. I go back and I reread, um, what I put for gratitude. And I kind of have two practices, the Newtonian one where I look at what I’m grateful for in my life. And then the quantum level of cause and effect. I share to be grateful for things that have not manifested yet, but I believe we’re going to her. I’m convincing myself. They’re going to start to really imagine and dream that. And gratitude is powerful because gratitude is a form of receivership. When you are thankful when you were receiving something, um, or have received something you’re grateful, you’re thankful. So gratitude puts you in that, to that receiver, um, state.

Um, and that’s kind of basically what I want to share about how to stay out of the gap in today’s world, um, with the media and social media usually bombarding you with unfortunately negative thought patterns. Um, it’s really important for your mental health to develop practices like meditation and daily gratitude to really calm that nervous system, to take you from that high beta stress and anxiety and overwhelm into that alpha detach relaxation, right? To take you from that sympathetic fight or flight survival mode into parasympathetic, the rest and digest, um, system and your body will thank you for it. And these are just really simple mind hacks. So gratitude helps you stand in the gap by thinking about what has gone well in the last 24 hours is still healthy and okay to have to be looking into the horizon. It’s great to dream big.

Um, two things I would add to that, remember to keep looking where you’ve come from. That’s key. Otherwise it’s easy to fall into this gap of frustration and lack of confidence and depression and, um, causing effect, not only having the horizon, these big goals, but taking time to imagine, to meditate, to dream what it would be like if it was fulfilled now not thinking how you’re going to do that. I didn’t say that. Just thinking if it was happening now, what your dream is, if it actually has occurred, what would be different? How would you feel? How would you behave? How would you act? And you’re training your body, your autonomic nervous system, which I understand to believe is your subconscious system. Um, you’re training it and it now has that expectation. And then these opportunities start to show up in your life to help you materialize that in the physical plane here.

So thank you again for tuning in. Um, if you like these kind of topics and talks, I suggest you check out my book missing the point and, um, you can check out my website, um, Lorne brown.com. It has links to, um, where to get my book. It has links to my website that I found in healthy seminars where you can great, great con continued education for PDA and use. It also has, um, uh, a library there of our past 10 years of lectures and links to my clinic. So you can check all that out. And I want you to know the next week you want to tune into, to the point with AAC. Cause we got Jeffrey Grossman from acupuncture, media works, and he always has great business pearls to help you grow your practice. Thank you for listening. And I’d love to hear your feedback in the chat.

PTSD – Post Traumatic Stress Disorder Tsao-Lin Moy

What is post-traumatic stress or post-traumatic stress syndrome? Like what does it look like from a Chinese medicine lens? Right. We’re going to cover what it is, what is pandemic fatigue recognizing and treating it in our patients and also recognizing it in ourselves.

Click here to download the transcript.

No. Hello and welcome. And I’d like to thank the American Acupuncture Council for, uh, putting these talks on, on these platforms of Facebook, Twitter, YouTube, Instagram, and so many more. Um, my name is Tsao-Lin Moy. I am an acupuncturist and Chinese medicine practitioner with a brick and mortar practice in New York city union square. And so today we’re going to be talking about post-traumatic stress disorder, post-traumatic stress syndrome. And so we’ll go to the slides. Okay. What is post-traumatic stress or post-traumatic stress syndrome? Like what does it look like from a Chinese medicine lens? Right. We’re going to cover what it is, uh, what is pandemic fatigue recognizing and treating it in our patients and also recognizing it in ourselves. And then I’ll go over a few tips, uh, and, uh, treatment strategies that you can use with your patients and also to, for yourself. Right.

Um, so what is post-traumatic stress disorder? Well, it is defined as a psychiatric disorder. They can occur in people who’ve experienced or witnessed trauma events, such as natural disasters like Katrina or Sandy. Uh, what we’re seeing right now, a serious accident, a terrorist attack, war violence of physical violence, sexual violence. And this is based on, um, the American psychiatric associations definition. Right now we’re looking at seven to 8% of the us population, uh, will have, uh, post-traumatic stress at some point in their lives. Hey Cindy. Um, and 3.6% of us adults each year, um, are diagnosed with it. It’s a particular diagnosis, but we have to look at what happens before you get the diagnosis, right? Um, and, and then this case twice as many, it’s twice as high for women and also, you know, for teens. And we see a lot of that going on right now.

Um, this diagnosis requires exposure to an upsetting traumatic event. It’s often associated with something called combat fatigue, and a lot of veterans have this, and this is a statistic, 23% of veterans of Iraq and Afghanistan, um, are, have been diagnosed with PTSD or PTSS, uh, 30% of veterans from Vietnam. And this is something that is continuing to, to grow. And it’s something that’s really important that we start to address and can be addressed really well with acupuncture and Chinese medicine. And so here quick, there is an opportunity for us as Chinese medicine practitioners to really be of service. So what is this in the PTSD or PTSS is a form of Shen disturbance, right? And Shen is the idea of this dynamic interplay of the five mental and spiritual aspects of ourselves. These are housed in, we called the zone or the yin organs and are expressed in the form of our emotions.

Um, I’m not going to go over what the emotions are because I know all of you, um, have learned this in foundations, right? Um, but this is also sign when someone is experiencing something like post-traumatic stress, it’s a sign that the Shen is disturbed and is not going back into a state of balance. So there’s something that is preventing the natural inclination to move towards homeostasis. And this is through, this could be a physical experience or something emotional. Although I say everything we experience is in our body. So there is the we address what is the physical right? Um, so when the Shen is in order, the person’s ability to navigate the world with resilience and cultivate health and wellness is achieved. So it’s not to say that we don’t get upset and it’s not to say that we don’t get stressed and really stressed what’s happening is, is that the inability to self-regulate has been disrupted at a very deep level.

What we also are looking at is something called pandemic fatigue. And I put this in here because over time, us as practitioners and we see it with physicians, um, we are experiencing a situation in which we have to be vigilant all the time that we’re helping people. And we have all of these health issues that are really focused on staying healthy. And so what happens is, is we start to get really exhausted just from the situation. So as an acupuncturist, Chinese medicine practitioner, as practitioners, we’re also healers. So I want to put this forward. We’re not just, you know, mechanical and we work with energy medicine and the energy of others. So what’s really important is that we have to take care of ourselves. Um, and, uh, what we recommend to our patients is also that we need to really like look at, to do for ourselves. And oftentimes we forget, yeah.

Need to be the model. So what do we know for sure about, uh, PTSD and PTSS, all it’s kidney and heart liver and spleen. These are really, uh, two things that I’ve seen and witnessed. Um, there are many more, um, combinations, but with something like, uh, post-traumatic stress, stress plays such a major role. And it, by tapping into our adrenals, it affects the kidney cheat and the shock trauma affects the kidney essence affecting the brains. We look at the brain is an extension, the brain, uh, the spinal cord and the brain are really part of the kidney essence. And then in turn that brain and mind, you think the mind is housed in the heart, but also the extension goes through that physical the brain as well. So we look at the emotional disturbance, the chemical shifting, uh, PTSD and PTSS is not just a simple heart and a kidney heart disharmony, but it also involves a multitude of the symptoms.

So it really important when a and what I’m talking about is very specifically, we can recognize that the, the adrenals and the stress are, are really at the root of it, but then what’s happening. Is that the way it manifests starts to affect all different other parts of our body. And then we look constitutionally of the individual and also what their history is and then how that plays a role. And so though we may see all this in our patients, right? We can see like, oh, this person has this happening and that happening. We oftentimes are missing it in ourselves and we end up burning ourselves out.

So one of the things about PTSD and PTSS is that it changes our brain and body chemistry. So these changes result in the overstimulation, and this is Western stuff, the amygdala, which is that emotional survival response, the underactive aspect of the, which is the hippocampus, the hippocampus, uh, that what is an increases in stress hormones, and that affects our ability to move forward. So we often get these flashbacks, it affects the kind of memory aspect, and also in, um, it’s ineffective, we call the ineffective variability, which means that there are elevated stress hormones, and those interfere with self-regulation and we get the systemic decline. So we’re looking at, there’s an inability for the body to actually go into the parasympathetic, which is the rest and digest. And if we look at that from a Chinese medicine, we’re looking at the body needs to have the yin and the yang, right. And if we can’t go into the time of kind of cooling down and resting, then what happens is we’re always more young and more manic and we get this exhaustion.

So some of the symptoms of post-traumatic stress or post-traumatic stress syndrome are that these intrusive thoughts, worry, repeating thoughts. Uh, I look at distressing dreams that tells me a little bit more, that there’s like a liver thing, uh, flashbacks, um, you know, even feeling that, you know, they, people that they feel they’re reliving something, right. Uh, or in this case, what I look at, like I put in my notes communing with spirits, because you’re actually kind of involved in a situation that may be in the past and there isn’t really a person there, but you’re engaging, right. And this is really, you start to engage, let’s say the spirit world. Um, the other thing is avoidance avoiding reminders of an event, what to drawing from people or places and activities, um, avoid thinking about an event, not sharing feelings, right. And then there’s an aspect that I put in here too, is toxic positivity.

Um, or we, we also call it spiritual bypass is another term. And that is, is that everything’s great. Everything’s wonderful. Um, or towards others, we can be this way when they’re sharing their feelings, that we kind of tell them, oh, look on the bright side. Right. And, and this is, uh, also like something that we have to look at within ourselves that maybe we’re avoiding those difficult conversations and being able to get present. Right. And that’s something as a practitioner that, uh, kind of checking out is, is going to be also kind of a sign that we’re in this stress situation ourselves. Um, we look at alteration in cognition and mood, so negative thoughts and feelings, a lot of pessimism, um, you know, distorted beliefs, right. And also detaching from others, um, alteration in arousal and reactivity. So we start to look at reckless behavior, um, emotional outbursts, self-destructive behaviors, um, more vigilance, a lot of sleep problems.

And one of the things, uh, across the board, which I’ve noticed is that, um, people have had problems with sleep. Uh, so here is a little infographic of, you know, some of the things that people are experiencing, a lot of emotional, you know, outbursts, uh, frustration overwhelm, uh, just that feeling of, uh, not being able to deal with anything. And again, uh, what I do want to say is this is normal. We’re in, when you’re in a situation which is extreme in which we are in, in the way that we are now, there’s an aspect of self preservation and coping.

Now, sometimes this coping mechanism to the stress trauma is not necessarily beneficial over the long period, right? So the discomfort of trauma triggers our coping mechanisms from a state of fight or flight or freeze, right. In an effort to dull the pain to run away and to numb it. So examples of this are a lot of stress eating, a lot of junk food. So binging on junk food, like a lot of comfort food. Um, and this is something where with a, if somebody has this propensity, we’re looking at the day underlying, maybe have before, even a little stomach and spleen imbalance. Um, then we look at alcohol addiction, a lot of the addiction to medications now during the pandemic. And, uh, well, we’re still in it, uh, that in February, from February 15th to March 15th, 2020, there was like a 67% increase or 38, but I’m not to like look at the stats, um, in, uh, the prescription for anti-anxiety medication.

Right. And so that is a lot of these benzos do have addictive properties, but we, we, we need to cook to cope. There was also a study of an increase in alcohol use of new moms or women with children under the age of five. And so we start to look at, you know, how is somebody coping? And really this is a kind of medicine that, uh, you know, people are searching for. What do they know? Right. In other cases, there’s an increase in violence and angry outbursts. Now this, we look at liver gallbladder issues, right? Like any kind of, any kind of emotion that we’re unable to express is going to actually show up eventually in the form of some kind of stagnation, um, heat, inflammation, and anger, right. And also this is very normal, you know, we’re in situation, that’s very frustrating. The problem then becomes later on when we can’t get out of it.

And that becomes the pattern. Uh, the other thing is, is that if there is an underlying trauma that wasn’t resolved and that all also shows up a lot, when people come in for acupuncture and Chinese medicine, right, they they’ve tried other things and something is not working that there, the longer that they’ve had this experience, that the emotions and there’s much more going on then, um, that let’s say their initial accident, right. There’s more emotion that stuck with it. And then that is also hooking in and later on, that can show up. Uh, one of the, the activities also is extreme prepping, hoarding, food, toilet paper, um, exercising and dieting. Uh, we saw a lot of that. Uh, this is, uh, goes along lung and large intestine kind of controlling, right. Hoarding, controlling that metal energy, uh, another disassociation kind of checking out. And this is kind of like the Shen has gone to walk in and say, we want someone like, how are you doing?

Oh, I’m fine. Really in all this chaos, uh, it’s actually important that someone, you know, kind of acknowledges that things, you know, things are difficult and they’re getting through it. But the response that I’m fine is kind of really like, uh, I don’t know, uh, to me that says something like, Hmm, I don’t know, avoidance, uh, susceptibility to conspiracy theories like aliens and chip devices. So this is also a small intestine we’re looking at really, uh, inability to shift from what’s clear and unclear. Right? And that, that also ties into also fear. You know, when there’s a lot of fear of the unknown what’s going to happen is it’s going to trigger many different responses within, um, within ourselves and in our patients that then they can become very susceptible to things that, you know, something that they might’ve thought Ben seems to become a reality. And again, this is part of, um, not being so present, but actually, uh, going somewhere else, right. In terms of what, what is happening.

So do you know anybody that’s hoarding toilet paper? This was actually one of the responses that helped, uh, people to feel they’re in control that they’re actually doing something. So when someone starts hoarding or having certain kinds of behavior, it is a coping mechanism. It’s a, it’s a way for them to feel in control. And does this kind of like look at, uh, you know, what’s going on for that person. So they may, they may not say it, but, uh, this is like an indication that, you know, something may be gone, something else may be going on. Um, and so you’ll go, so why topic? Well, the topic is because if we don’t already have a form of this, post-traumatic stress, we’re on track to getting it because we’re living through very challenging and chaotic times much of which we have no control over. We’re witnessing a lot of death, uh, climate change, disasters, fires, flooding, and, um, the ravages of war and politics, having our lives up ended and having to pivot now.

And also what I want to say is the news cycles and social media, right? So much of the, the, the definition that was in one of the earlier slides about, you know, reliving, traumatic events, um, thoughts over and over again, that what’s happening is, is in our news cycles. We’re actually kind of seeing the same thing over and over and over again. So as an individual who might, who’s resilient, um, it’s hard to manage your thoughts when you keep getting exposed to social media. And so one of the things that I suggest, or the news, right, the news, the news likes to, um, be sensational in order to get the call it clickbait to get clicks. Uh, but what happens is, is that once you kind of see it, it’s very hard to unsee it and it taps into our other than conscious, right. And it kind of like works up, works us over.

And so really important is to clear the cookies on your electronic devices. So, and be careful of what you’re searching for, right? Because then all of a sudden you’re going to get a lot of that content. So the symptoms of, uh, PTSD PTSS Shen disturbance are a Shen disturbance and they reflect this disruption of the function of definitely the liver, you know, cause maintaining that free flow of Chi because when she and blood are in harmony, the mind is also at ease. And so this is also an indication of like where you want to look to when you can, you want to treat and help someone. Um, kidney essence is being drained. We know cause the brain, um, part of the brain is being affected. Um, there’s also that deficiency of heart blood, uh, people experiencing a lot of palpitations. Um, I, I highlighted or bolded insomnia because that is really like a big thing that, um, people are experiencing, um, both with a hyperactivity of heart fire on the mental restlessness.

Um, the, the issues are, if you’re not getting sleep and again, that’s that rest and digest, it is going to affect your information. And it’s also going to affect your mind. Right? Poor sleep is attributed to memory loss and long-term illness like dementia and Alzheimer’s. And if patients, one of the things that, uh, to look at, if your patients are not responding to treatment, uh, as you would say, Hmm, there’s something else going on. They’re not really healing. Then you have to really look at there’s something more and to look at the emotional component to being addressed.

So treatment strategies really need to address, uh, the stress cycle. Okay. So got a question about sleeping as a coping mechanism, right? Yes. Is like to get sleep, but you know, if there’s too much sleep, what can happen is that’s also like a kind of adrenal fatigue, right? Like all of a sudden, boom, somebody has been overstressed like with chronic fatigue or with fibromyalgia that they’re just, their energy is shocked, right? So adrenal, adrenal fatigue, or when your adrenals are shot, you’ll also like sleep a lot. But the key thing is, is that, are you getting a restful sleep, right? Because if you’re not waking up, uh, refreshed, then we also know you’re not getting those deeper levels of sleep. And that means you’re only get your cycles are off. Uh, and also like too long being asleep is also, you do build up a toxicity, right?

So over 10 hours of sleep is not better. There, there is that window of sleep. So sleeping is great. Uh, but also you want to get quality sleep, which means that your nervous system goes into that yin aspect. Right. Uh, so treatment strategies, well, I like the ear acupuncture and ear seeds, right? A lot of research in treating post-traumatic stress disorder, um, in, in, uh, is being used in the military. Right. And also used in addiction. And the beauty of either ear acupuncture or ear seeds is that they’re very simple. Right. And I like you put in some ears seeds and the patient can actually stimulate them, uh, points that I suggested, like Shen men, zero points sympathetic, then you can decide liver lung, like add a few other ones based on what you’re seeing in that patient. Right. Ear seeds are excellent because then later on they can, the patient can press them.

Uh, I’ve also used like the little, uh, the hand, uh, magnets, the Korean hand magnets, I guess they will. And on something like PC six, because not only does that help with anxiety and nausea, right. It’s easy for someone to access and, and to do right. So important that you’re going to give your patients some things that they can do on their own. Right. Because that is something that allows them to be in control. Right. And to be aware of that, they need to address their stress and you, and you give them resources. Moxibustion um, I actually prefer in these cases, moxa to needling, right. So if somebody is pretty startled and they’re, they’re overstimulated that you really want to cut there, there’ve been drained. You kind of want to add in something. And so a little bit of moxa, um, and less needling, right.

Cause then you’re piercing their, their defense. Right. And then that could be even like too much for somebody. So, uh, classic points like CB six CV, 12 stomach, 36 spleen six. So that’s more like central key, definitely. On the back, you would do 14, do 12, these help with the nervous system. And also that’s the meeting point of young, uh, do for right. The main men we’re looking at, uh, this is the gate of light, like on the gates of life, you know, when you’re stressed out or your, your, your kidney essence is draining, you really want to be able to route the person. So bladder, and then outside bladder point 52 more for spiritual, right. Or one more spirit point and then the six flowers. So you’re really like looking at helping that person consolidate their energy. Right. We don’t need to manipulate too much like, oh, they’ve, you know, this point for that, you just think about constitutionally helping them to get back into a place of balance, essential oils.

This is something also, they have essential oils have psychoactive properties. You can also miss that, have them massage them on certain points. I won’t get into. There’s like a whole, they’re all types of kinds of protocols. Um, but essential oils, uh, because they’re psychoactive, they go directly to the brain and can affect the chemistry. And that’s, this is a tool that can help your patients, um, when they’re feeling stressed or just to kind of have a, a, uh, you know, vapors or, um, a mist of it to really help them to, um, have a calm environment. They’re also great for children, right. Children experienced a lot of stress and often they can’t say it, they may act out right, and they’ll have tummy aches and, and, uh, other kinds of, of problems. Right. And they pick up our vibration, right. They’ve got their mirror neurons.

So if we’re stressed out, they’re going to pick it up. And then what I do recommend is something like Vetivar or bergamot. And this is, uh, in research, they, it shows that it has a similar effect as valuable in terms of calming, right. And also lavender is always like a natural, uh, uh, soothing and calming central oil. And you can get like lavender pillows and things like that. I think, uh, patients, they love, they love it, right? They love it. You can have little gifts, self massage. Uh, so in Asia for anyone who’s listening, if you’re Asian, it’s, it’s very common practice. Even as when I was a child, uh, to learn to kind of do massage techniques, especially on your parents’ back, you know, uh, little, little hands or walking on their, their back, uh, and, uh, you know, to learn how to do this.

And, and you do it in the home, uh, so you can teach your patients to massage their own feet, maybe stimulating kidney one, uh, they can also use one of those stimulation balls. You know, the kind of like helps to, uh, treat the entire body through the bottom of the foot, right. It’s also going to help with sleep. You can also massage a little bit of essential oil at the bottom of the feet. Um, I also, uh, like to teach my patients to press, you know, down the, the stomach channel, right. Stomach 36 all the way down. So there’s a stomach channel because that’s also the same idea is we want, you know, the, your central achie or nutritive cheek, um, your digestion, and that’s going to help to nourish the whole body. You’re you on cheat also liver three, nourishing your liver, helping with the smooth flow of, of cheap teas.

Um, there are so many teas out there. I suggest to my patients to kind of switch up caffeine, cause people want to be alert. Uh, stress can actually cause people to be really sleepy, right. Or to like really be overwhelmed, like dealing with, uh, a stressful situation. You actually burn a lot of energy and then have difficulty concentrating. Um, so, uh, offer having someone take tea, it has half the caffeine, but also, um, T is delivers a slow, an even amount of caffeine. And this is due to its chemical composition, which is actually great. I mean, there’s a lot of, there’s a history of the difference between, uh, coffee and tea and the idea in terms of the industrial revolution and being able to focus and be more productive. Right. Um, and that has to do with caffeine. Uh, what I have discovered is this is something that you can look up con a T uh, there are some over the counter and the health food stores. Uh, it is a very interesting herb. It’s a succulent from South Africa, natural serotonin uptake, inhibitor, meaning, uh, allows more serotonin to circulate. Um, so you feel better and, uh, stimulates the endocannabinoid system, uh, meaning immune. And then it’s also very empathic genetic. So you feel, you know, it’s at heart opening, you feel much better, and this is something that you can buy in the health food stores. And if you want, you can contact me and I can tell you different ones that I’ve looked at.

Okay. Another connecting with nature, what kind of mindfulness practice, um, and essential oils that you recommend, uh, bergamot, uh, the, uh, recommend vet D bear and Vermont, right? Those have the, if you look there’s research on those, uh, that, that shows that as the similar effect on the brain as taking Ballmer, right? So you smell it and you feel calmer, right. Um, so, uh, connecting with nature, having a mindfulness practice. So mindfulness practice, that’s a whole other, you know, it’s a very big topic, some kind of meditation or gratitude, uh, but also, you know, post-traumatic stress is very disruptive to the whole system at its deepest level. And so something there needs to be something great to feel that there’s something greater than right. Which is, which is that feeling with meditation, more connected to the world, right. Instead of, uh, uh, retracting or contracting.

Um, and one of the things is, is nature. So nature has a vibration, it sustains life, right? There’s a vibration of plants. There’s a vibration of the earth. And so things like gardening, or actually physically connecting barefoot to the earth or grass, or even sitting under a tree, what happens is, is our body is naturally going to go to synchronize with the vibration. And so we, and this gets back to us, right. Uh, when we are in a place of calm, we are so great for our patients. And I, and I know that they come and they say, wow, how are you? So calm? I always feel good when I come and see you. Right. And what it is is when you’re in a place of calm, you’re very stable. And then they have, it’s like, you’re like a beacon and a place of stability for them to feel like everything is going to be okay, which is why it’s very important that take care of yourself also.

And the other thing, um, before I conclude is I want to say that less is more so when dealing with, uh, post-traumatic stress, uh, less is more individuals are already overwhelmed and overstimulated, which is why I said like, okay, maybe some magnets, uh, that they can do on their own as well after being treated, uh, you know, to, to little things, simple shifts to ease them out of that cycle. Right. So they can feel that they could do a little thing that they’re in control of. They’re not given a ton of, of, uh, homework, because then that’s just like a whole other thing to deal with. And I think it’s really important that, uh, people can actually, uh, have these resources that you’re gonna teach them and show them. Of course, there are many more, uh, you can, uh, work with, uh, different kinds of recipes and foods to, to help them, you know, so something that’s simple, right.

And so that they can cultivate, uh, health and wellness and longevity and resilience for themselves. So this is the conclusion. Um, and let’s see, I hopefully I would like you to make sure that you join us next week, where we’re going to have Lorne Brown, uh, coming and, uh, he’ll be giving a wonderful talk. And again, I would like to thank the American acupuncture council for, uh, having these talks on. And I hope that, uh, they were interesting for you. I would love your comments and please, um, let me see, where would I please share the reference? Okay. Um, okay. There is going to be a transcript and a replay. Uh, so, uh, if, uh, or you can contact me and I can talk to you more about, you know, some of the essential, some essential oils, right. Um, that’s a whole other topic. All right. And, okay. So thank you. And I hope to see you next time.

Communicating with Confidence

I think the first thing that I would say is that, my experience is that most people are not skeptics or, you know, this kind of, what I call these official pseudo skeptics. So people who spend a lot of energy trying to debunk things like acupuncture.

Click here to download the transcript.

Hello and welcome to another edition of To The Point. Very generously produced by the American Acupuncture Council today. I’m very excited. My guest is the well-known and beloved Mel Hopper, Koppelman, and Mel, for those that don’t know is the executive director of evidence-based acupuncture, an international nonprofit organization dedicated to improving public health through better information about acupuncture’s considerable evidence base. Uh, she completed her masters of science and acupuncture at the Northern college of acupuncture in New York in 2012, and has kind of taken the world of acupuncture by storm since then. Uh, she also has a second master’s of science in nutrition and functional medicine, uh, from the university of Western states in Portland, Oregon, she’s published numerous articles about acupuncture and she practices at her clinic Harbor, integrative health in Bristol, Rhode Island. Uh, so now, you know, so many of us know a little bit about acupuncture research, want to know more and also want to be able to communicate it to both the public and other medical professionals. Um, you know, what do you do when there’s a skeptic that says, oh, well, is the acupuncture just a theatrical, but they, the slave hour or something, you know, how do you retort these, you know, what kind of answer reply, and if you could give us some science to base it on so that we’re, we’re ready when that happens again.

Thank you. Thanks for that question. And thank you so much for having me on, um, I really appreciate it. And to the American Acupuncture Council. Um, yeah, so this is a great question. And one that comes up a lot. Um, I think the first thing that I would say is that, um, my experience is that most people are not skeptics or, you know, this kind of, um, what I call these official pseudo skeptics. Uh, so people who spend a lot of energy trying to debunk things like acupuncture. Um, and so most of the time people, um, that we might come across in different contexts may just be unaware, um, uh, that what of what acupuncture is or how it might help them. Um, and we can talk a little bit about some of the, um, scientific evidence that can help support that. If we’re talking to the public, mostly the public wants to know if we can help them.

Um, and that’s, that’s what I find. So, you know, I have this issue, will you be able to help me? And, and often they’re not going to need a, like a pub med reference bibliography in order to, to convince them, um, although sometimes that can be helpful if a patient or a client needs some support for communicating what they’re doing to other people. Um, that said, if we are speaking to medical professionals, and if we’re speaking in different contexts than having, um, referenced to the, uh, considerable evidence-based can be very useful. Um, and so the first thing that I’ve found, um, is that most, um, you know, depending on the context, most medical practitioners are simply unaware of how much evidence acupuncture has, um, which is a lot. Uh, so I think at last count, um, Cochrane had sequenced something like 14,000 studies, um, of acupuncture, which is more than for chiropractic more than for physiotherapy,

Right? Yeah. And somehow this, this is not out in the public or it hasn’t caught on somehow.

Right? I mean, things are definitely improving since I started, um, since I trained and then started communicating about it. But, you know, one thing that I really would love people to understand, and I was just having a chat about this with, um, Sandra Grassa who’s the, of [inaudible] working really hard at it. Yes. The global acupuncture community, um, really wonderful, um, intelligent guy. Um, and we were talking about how most people don’t realize that once the evidence is there and it’s strong and it’s repeated that doesn’t necessarily mean that it’s a treatment that’s going to be recommended in guidelines. And once the treatment is recommended in guidelines and acupuncture, um, one study found over 1200 recommendations for acupuncture in different guidelines. And, um, this was outside of China and Southeast Asia. So this was in north America, Australia, uh, you know, uh, Australia, New Zealand, Europe, you know, that, um, to my reading that may make acupuncture one of the most recommended treatments. Full-stop so it’s really, yeah.

Oh, I just wanted to interject that. Um, some people might not understand the context of the word guidelines that you’re how you’re using it. Can you explain what you mean by

That really great question. Um, so guidelines, um, will be produced by, it could be a government funded organization frequently, or let’s say a medically medical specialty group. And so there’s a group of experts who come together to review, um, all of the best quality evidence for a treatment for specific conditions to decide what they’re going to recommend. Um, so in the UK, there’s an organization, um, that’s abbreviated as nice. And so for the UK, this organization, nice will produce guidelines. Um, basically saying what doctors in the NHS should be offering, um, in, in other countries that works, it works differently. The United States, um, usually it’s a medical specialty groups will have different guidelines, also. Um, different government organizations will have guidelines. And so what most people don’t realize is that just because official guidelines recommend a treatment such as acupuncture doesn’t mean that, that it automatically gets implemented.

Um, so as an example, um, in the UK, the nice guidelines recommended acupuncture very strongly, um, for the prevention of chronic migraines. It was the second line recommendation, um, after trying a pharmaceutical and I never came across a doctor who was aware of that or who recommended it and patients weren’t aware of it either, even though it was within their constitution to be able to access it. And so, um, but on the, on the other hand, the guidelines had a weak recommendation for Botox, uh, by company called Alligan, which had much less evidence for its effectiveness applied to a lot fewer people, but how their GaN had actually taken the time to put together a hundred page document on how to implement the treatment in the UK. It trained up doctors. And so patients were very easily able to access Botox for migraines, um, on the NHS.

And so the difference there, wasn’t a matter of evidence because acupuncture had more and better evidence. It wasn’t a matter of the recommendations being there because the recommendations were stronger for acupuncture than for Botox. It was a matter that, um, I think many people, including the acupuncture profession, um, in various countries might assume that there’s an automatic, uh, once that recommendation is there, then people will have access and practice in the practitioners will know about it and they’ll be recommending it. And, you know, our doors will be flooded and that’s simply not the case. And so, um, you know, circling back to what you said before is that, you know, people, uh, you know, there is so much evidence for acupuncture and comparatively more evidence for acupuncture than other modalities that may have a stronger branding or people are more aware of, but we just, um, we need to do more perhaps to communicate it. So that’s in the consciousness of the public and the healthcare decision-makers

So public relations campaign.

Yeah. Well, this is it. Um, you know, yeah. Public relations campaign. And I know, um, you know, Matt Bauer at the acupuncture now foundation, he has thought a lot about that and about how to implement that and what the funding would look like for that. Um, the role that the evidence-based acupuncture, um, plays is by summarizing the evidence so that it’s available to be used by, let’s say, um, a public relations campaign, because what different organizations in different countries have found the hard one expensive way is that, um, reading and interpreting and communicating evidence about acupuncture is a really specialist skill. So you can spend, if you’re an organization, you can spend a lot of money on hiring really good PR people that doesn’t necessarily mean that they have the expertise to be able to get across some of the nuances, um, that involve, you know, what we do and how we’re studying.

Hm. So what do you think is the best way to go about this?

Well, yeah, no, I mean, that’s, that’s, that’s a nice question. Um, you know, I think one is first for us to have a better and maybe more accurate understanding of what the challenges are. So when I went to college, uh, for my MSC, um, I guess, you know, over a decade ago now, um, at that time, you know, most of the, the writing and information that was discussing acupuncture in terms of science was written by, by skeptics, by people who basically did not like the look of what we were doing, didn’t understand what we were doing. Um, and just, just thought it was stupid and wanted to tell people not to. And there wasn’t really any other kind of scientific or evidence-based perspective to counter it. So if you were, you know, kind of, uh, an educated, but not medical Joe public, and you wanted to know what the deal was, you really, you, you had either these, um, medical doctor skeptics saying that it’s a theatrical procedure, or you have acupuncture websites that talk about changing and yang, which people might not understand.

And so it might put you off a bit. Um, and so when I went to school, the message that I was getting from my, um, faculty was that there wasn’t much, it wasn’t much evidence for acupuncture because it wasn’t funded and because it was difficult to study, and I believe that they were just believing the skeptics. And when I started to kind of look, you know, look at what the skeptics were saying, and I was really, um, unimpressed with the strength of the arguments. I was like, kind of hoping that it would be like just some really good criticisms of what we did. And I found it was really weak and really not well thought out. Um, and then when I started doing a really basic literature review, I found like loads of studies and systematic reviews and tons of evidence. And so the first problem, um, to, to overcome was to help acupunctures know that what we do actually has a strong evidence base.

So that was, I understand the first problem. And then the second problem I would say is that, you know, research in all fields, especially in medicine is produced far faster than anyone can read it. And so, you know, within the profession, there is often still this kind of idea. Like we need more research that may be partially true. I’m not saying, I’m not saying we should stop doing research on acupuncture, but we, I think even more need people to, uh, to find, read, summarize, and communicate the research has already been done. So that’s the second problem is, is like kind of becoming aware of what’s there and getting out to the practitioners and to people who are working on policy and who were working with legislators at the state and national level. Um, and then the third thing, you know, is doing that. So you can get it into the guidelines and that is happening, right?

So, um, in the UK, the most recent, nice guidelines, um, for chronic pain that would publish in April, 2021, recommend acupuncture for any kind of chronic pain. It’s a very high recommendation. It’s incredible, it’s unprecedented. Um, it’s a really strong recommendation. It’s a really big deal because not only does that affect, uh, the, the population of the UK, if we can help the implementation. Um, but also other countries look to the nice guidelines to inform their policy. So, you know, getting into the guidelines. And then, um, I think the next that next piece is like us realizing that we need to do the implementation is not automatic at all at all. So in fact, you know, having, um, acupuncture rec recommended, uh, in Medicare guidelines here or in, um, the, uh, like joint commission, which is the organization in the United States that regulates all hospitals like over 20,000 hospitals, um, they have guidelines saying that non-pharmaceutical treatments must be offered as a first line of care to kind of prevent unnecessary opioid problems. Um, and they include acupuncture at the top of that list, but that does not then translate into automatically having an acupuncturist in every hospital at all. So we need, um, so, so my first thing is we need to do, uh, I think a good job of testing our assumptions of what the real problems are and making sure that we’re identifying the problems and then kind of solving them in a way that makes, um, the most, the most sense. Um, so that’s, that’s, uh, that’s how I would solve that.

Would it make sense instead of just trying to promote it to the public, these kinds of things, uh, to try to educate the doctors because through them, they w you know, they’ll be referring and then patients will become educated.

Yeah, that’s a, that’s a great question. Um, you know, I, I don’t know how much of the people who watch this are an international audience versus a US-based audience. Um, okay. Cause there’s, um, there are, you know, quite a few geographical considerations in terms of who’s paying for it. Um, so, you know, when, when, uh, the patients or clients themselves are able to make their own decisions, then you, um, you know, then you’re educating them and letting them know that you can help them solve their problems. Um, if we’re working through insurance, you know, and acupuncture is increasingly included on insurance plans, um, in the United States in different places. Um, but certainly I think the big thing, you know, I’ve had conversations with colleagues and one of their, you know, what questions they have about communicating with doctors about acupuncture, what a lot of them said was eating, getting them to care, uh, that it exists, like getting, getting them to show up to a meeting.

And so what that brings up to me is that we want to be really savvy about, like, thinking about what are the problems of the person or organization that we’re talking with that we can help solve. So, like, you know, doctors shouldn’t care that we’re, acupunctures just because we’re acupuncturists. Like what, why should they care? Well, let’s understand what their problems are and what they can. So, and what’s really beautiful about how acupuncture works and evidence-based for acupuncture. And I don’t think this is coincidental is that the evidence for acupuncture’s effectiveness is wrongest the conditions, the wishes, there are the least effective and safe options in conventional medicine.

Hmm. So we know that acupuncture works and there seems to be a resistance to the Western medicine based from adopting it. And it is often marginalized as alternative medicine. Can you speak about that?

Um, sure. I mean, that, that’s, uh, a, well, I mean, a couple of things like that, there’s different ways that we can look at what that means. Um, sometimes skeptics or critics will say something like there’s no like real medicine and alternative medicine, there’s just medicine that works and medicine that doesn’t work. And so, uh, from that perspective, I would say, well, you know, acupuncture is clearly medicine that works by the standards that are set forth for studying an intervention for a variety of conditions. And I do want to step back and say that if we’re talking about a treatment for a condition, it’s not, nothing is really, uh, ever framed in science that it either works or it doesn’t work. It’s really a question of, uh, what is the condition and what is the population and what is the intervention and compared to what oh, okay. So, uh, and there’s like a really, um, uh, big, uh, compared to what, um, thing that we need to bring to this discussion. On the other hand, um, in certain

Those kinds of comparative studies are, are, are important for validating acupuncture, uh, or to, uh, a prescription drug or another modality.

Yeah. So there’s, um, that’s a really good question. So for folks who are watching, you might not come across this before. Um, there’s a number of common ways that interventions are studied. And so most commonly, especially for pharmaceuticals, they’re studied, um, in a double-blind placebo controlled trial, where we’re trying to really control the environment in a very artificial way and remove all these different, um, variables. So we can study the medication and that’s standard for, um, for any treatment that doesn’t involve the practitioner doing anything and just handing over something to be taken. Uh, but it doesn’t, it’s not an appropriate design for any sort of, um, like kind of treatment that involves the practitioners. So for sample like surgery, you know, you can’t do a double blind placebo controlled trial and surgery. You can do sham controlled, which we can talk about, but, um, you can’t blind the surgeon, you can’t do sham controlled therapy, you can’t do sham control.

So anytime the practitioner is guiding the treatment, the practitioner, um, will, will know about it. So it’s just not the appropriate design for that type of Mo of modality. And then, um, on the other hand, you can compare a treatment such as acupuncture to what else is on offer. And really, you know, neither of those designs, I just mentioned, uh, placebo controlled versus kind of a real world, uh, effectiveness study. Neither one of these is right or wrong, good or bad. They just answered different questions. And the questions that patients have, and that clinicians have is I have a patient in front of me who has this problem, what are the options? And what’s the best option for this patient. So they’re comparing it to what else is on the table. So the study design that answers that question is what’s called a pragmatic study that measures acupuncture against, uh, the other things available. So that’s what that does sort of makes it makes sense.

So I first became aware of you on social media with your, um, work with Wikipedia. Can, you know, you had such brilliant responses to the pseudo skeptics, and I know it wasn’t just with Wikipedia. Can you tell people a little bit about that and you know, what you’ve done and where that situation is now?

Sure. Um, that’s a really good question. And it’s, it’s one, I know I’m glad that we’re bringing it up because this is one of the most common things that gets mentioned, uh, by acupuncturists and practitioners in any form is like, okay, well, Wikipedia is the, uh, encyclopedia that anyone can edit. And if you go look at the article on acupuncture, to be honest, I haven’t checked for a little while. Cause it, uh, it doesn’t change too much. Um, they don’t, they don’t have nice things to say about acupuncture at all. Um, and they don’t include, you know, the various Cochrane systematic reviews that show that acupuncture is more effective than sham or effective than usual care. They don’t include the guideline studies. They don’t include all these things. Um, and so, you know, what’s the deal. Why don’t, you know, why don’t we just end it?

Why don’t we do something with it to deal with their bias? You know? Yeah. So, um, you know, editing Wikipedia is something that, you know, I was part of a acupuncture research, um, group back. I was in the UK at London, south bank that meant, um, every so often. And it was a project that we identified, like, we need to do something about this. This is nuts. Um, but, um, you know, and, but various, uh, people, uh, very, um, very noble worthy people have tried and failed to edit that page. And so I decided to go on as an experiment just to see what the deal was. And so, um, this was actually quite a few, this was back in 2016. Um, and so I registered as an editor and I learned enough about the rules of the game to make sure that I didn’t break any rules so that there was been no grounds for, you know, there being any problem. Um, and acupuncture is one of the top 10 most contentious pages on with the piece.

What about COVID,

Um, possible, but it doesn’t have the history. So, um, you can even, you can kind of look back and see the number of edits. I mean, I can only imagine there’s thousands and thousands of pages of conversation. A lot of it not very civil about what’s on that page. Um, so it gets, so you’re not even allowed to come on as an editor and start editing. Um, you have to kind of earn your stripes, but you can participate in the discussion. So I entered, I joined that discussion. I was, uh, respectful. I did not break any rules and I simply provided a very standard references, Cochrane, systematic reviews, you know, talking about different things. Um, and within a week I had been banned as an editor forever. Um, yeah, they, they accused me of something called sock puppeting, which is when an editor is banned and then comes back under a new name.

So they were basically an, I kind of went and looked at the person that they were accusing me of being, and it was interesting. Um, I can assure you that I’m not her because her, uh, her only Wikipedia page that she ever wrote, it was on, uh, Korean pop. Um, that’s, that’s not me. I have like plausible deniability, like, um, that song came out years ago. I was like the last one to hear about it. So yeah, so we’re not the same person. Um, what we had in common is that we were, um, up on the research and was able to reference it in a, in a valid way. So we were basically just you report faithfully and accurately and fairly reporting the science. Um, and that’s why they thought I was hurt, which is a little bit sad. Um, more recently, Larry Sanger who’s one of the co-founders of Wikipedia, um, has spoken out on really, you know, when, when Wikipedia was initially founded, it was really, um, central part of it was, um, a neutrality policy so that that anybody could edit it and that it would reflect a plurality of views.

And, uh, he is pointed out how it very soon veered from that course. And now, you know, there’s like huge companies that really control that content. Um, in the case of the, of the acupuncture page, the individuals that I was, you know, being banned by, or being named cold by, or being criticized by, um, these were really early adopters of Wikipedia editing. So a certain personality and they, none of them have medical backgrounds and none of them have research backgrounds. Um, they’re mainly they have pharmaceutical backgrounds, um, in this case, I don’t think so. Um, I’ve never found evidence to support that. Um, but, um, but certainly they have a specific point of view that does not come from, um, a deep understanding of the subject matter. Um, and that they’ve been effective at kind of keeping us all out. Um, at one point, you know, we did, um, start a, uh, a kind of a petition and a movement to kind of call attention to the towel. Crazy. This is it’s, you know, acupuncture is recommended by governments all around the world and it’s included on health insurance. I mean, at this point, as I said, it’s really not alternative medicine in that way. Um, and we were not able, they just listed by their, their neutrality policy. So

It sounds like you tried to confuse them with the facts

I did. I w it was too easy. Um, so yeah, so, so for those, you know what I understand, I mean, the, um, unfortunately Wikipedia is the single most referenced website in the world for medical information by doctors, not just the public. And so, um, that’s just, you know, kind of, unfortunately, a sign of the times these days is that we do have these kinds of centralized nodes of information that don’t necessarily reflect. Um, you know, that can often reflect a certain point of view. That’s not necessarily, um, in line with public’s best interest or at least, you know, in the case of acupuncture, just being able to here’s some information about it and not just a, you know, kind of a one-sided view.

Yeah. Well, is there anything you want to lead us with, uh, you know, whether it’s the direction of things are going or, you know, a particular place to reference studies or whatever, whatever you’d like to, uh, think would be helpful?

Uh, yeah, no, that’s a great question. Um, a couple, a couple of things. One is, you know, I mentioned that sometimes acupunctures, um, can refer to as an alternative medicine in a way to discount it and to, um, to, um, to basically say that it doesn’t have an evidence, but on the other hand, sometimes it gets lumped in with all wonder if that’s a Larry singer Wikipedia call it. Um, so sometimes it gets lumped in into this like kind of alternative medicine bucket and it gets undifferentiated. So it’s like, oh, you know, alternative medicine, like natural medicine, you know, massage and hung me up at the acupuncture. And, and, and it gets kinda lumped into this undifferentiated bucket and the danger there can be, as you know, that there can be an increasing awareness of the, um, unintended side effects of pharmaceuticals and people trying to find alternatives.

But, um, there, you know, what we can do for people can be really diluted if we get lumped into that bucket, because acupuncture has an incredible amount of evidence. And so, and it, and it is also a system of medicine or, you know, it’s part and parcel of the system of medicine, um, and of itself. So that’s a little bit of a danger that we want to be aware of is that we want an increase. Um, I guess, um, we, we want to be available for people who want an alternative, but also understand that we’re not kind of just like a wishy washy touchy, feely, um, system, um, not, not to disparage any of those things, which, you know, I been training in and I go see, and they’re helpful as well. Um, so that’s, that’s one thing I would say, just to be kind of aware of that, that pitfall, you know, what we find with acupuncture is now that the evidence is so good, um, a lot of different professions want to use it.

And so, you know, we need to again be mindful of, um, you know, where our true challenges are and how we address those skillfully. Um, Ellen had a question about how to educate patients. And so this may be, um, is a kind of good thing to come back. It’s like the, you know, first is be really aware of your audience and who you’re speaking to and what your intention is and what their needs are. Um, so, you know, depending on where you’re located in the, um, like background of your patients, some may want research and evidence. Um, often I find that comes from a fear of seeming foolish, you know, not to kind of psychoanalyze anyone, but people would just want to know that there’s not enough that they enjoy it and that, or that they feel better. They want to know that there’s, that there’s evidence some, just find it interesting.

Um, and many, you know, really just want to, um, to know if you can help them. And I think Al asked the question before, yes. About researcher testimonials. And I think, um, you know, I’m, I’m not a marketing guru, but I think testimonials and, and, um, kind of pro social proof probably is the more influential, well, I mean, a good place to look at it from a political, I mean, that’s a good we’re testing it. And the pharmaceutical ads don’t tend to emphasize uh evidence-based to emphasize couples skipping around and smiling. So, um, that’s, I think they’ve done their research on what works. So that kind of told me that they’ve done their marketing research. Yeah. But wiling is more effective to get people to purchase then, um, then, then lots of systematic reviews

Because not all testimonials are real. I tend to trust the research more than I do testimonials.

Yeah. And that’s, I think, uh, my understanding there is that that’s why you see a move towards testimonials that are more difficult to fake. So if you can get a video testimonial from a patient, it’s kind of, you can tell that that’s not an actress or an actor, um, and we’re, or people using their real names, um, that, so that social proof is going to have more value. And I think that really just on a psychological unconscious level that does have more, um, you know, it’s almost like people need the, some people need the research in order for them to stay for the conversation or to be open to the conversation so that when they see the social proof, um, they’re, they’re, they’re, um, you know, which is different than a patient kind of coming across acupuncture. And then we just, you know, presenting tons of systematic reviews at them.

Um, I think what we know from a marketing research and psychology is that the social proof is probably gonna have more of an impact, but we want to, we want to just at the top, down in the bottom up, so the bottom up is you, um, influencing, uh, you know, people let it, I should say, letting people who we can, who might benefit from our services know that we’re there and that we can help them. But at the same time, we also want to make sure that if we have systems of healthcare that are being paid by different government institutions, that, that, that awareness is happening on that level as well.

Sure. Oh, is that a multi-faceted approach? Well, thank you so much. I really appreciate you coming on. Cause you know, it’s nice sunny summer day. So, um, you know, w we can talk again soon and go into some more specifics and thank you everybody for watching. And next week we have as a host Tsao-Lin Moy. So I hope you’ll tune in to see her. And again, thank you to the American Acupuncture Council and, um, Virginia Doran of luminous beauty.com this season. Thank you.