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Wear Your Heart on Your Sleeve: Neuro-anatomy of HT-4 to HT-7 – Poney Chiang

Hi, good afternoon. My name is Poney Chiang. I’m a practitioner of acupuncture and traditional Chinese medicine from Toronto, Canada. Welcome to today’s American Acupuncture Council live Facebook podcast show. I’m your host for today. And since this video is taking place on the week of Valentine’s Day, I thought I would do something fun and present something that is heart-related or heart region-related. So, let’s get started with today’s presentation.

The title of my presentation is Wear Your Heart on Your Sleeve. And the subtitle, Neuro-Anatomy of Heart-Four to Heart-Seven. It’s kind of a tongue-in-cheek idea that Heart-Four and Heart-Seven are very close to our wrist, so it’s very close to the sleeve and obviously because it’s Valentine’s Day, I chose to talk about the heart meridian.

The painting you’re looking at is the painting that was done in the year 1900, and it was painted by artist named Edmund Leighton. It is, as you can see, a princess or a fair lady tying a scarf or handkerchief to the sleeve or the arm of a knight. This is supposedly one of the origins behind the English expression to wear one’s heart on your sleeve, which of course means somebody who speaks their mind, somebody has no agenda, who is very direct. What you see is what you get. And here, this knight, by wearing the sleeve from the lady, from the princess, means that he is fighting for the princess’ honor. And therefore, he is identified as vouching or speaking or defending the lady pictured here in the painting.

What we’re going to do first is we’re going to look at the historical development of these points, particularly heart meridian points in the early classics. What I mean by early classics are works around the time of the Han Dynasty or shortly after. So, as you know, the LingShu or the Yellow Emperor’s Classic of internal medicine has two volumes, the plain question, which is the Suwen and the LingShu, which is spiritual pivot. And in chapter 10 the spiritual pivot we learn about the channel theory… And the channel pathways of the different channels on the body. And there is one paragraph that is focuses on the heart channel. Now in this paragraph, on the chapter 10 of the LingShu, entitled Channel Vessel, it says that there is a Luo Channel or what the classic described as a separation.

So if you look at the second bullet under it says “Pathway: the separation of the hand, lesser yin or shao yin is named Heart Five”. And so here we actually have a point identified by its name. Of course then there’s your classic, it would be called Tong Li, the Chinese name of the point instead of heart-five. It says that it’s located one and a half cun from the wrist, separates and course upwards, follow the channel enters into the heart, connects to the tongue root, joins the eye connection and so on and so forth.

Now if you are very good at point location, you might be scratching your head a little bit and wondering, hey, wait a minute. Tong Li, it’s not one point five cun, it’s actually supposed to be one cun from the wrist. So this is an example, a lot of discrepancies we see in the classics at the time of the LingShu, heart-five was actually considered a one point five cun on their wrist, as opposed to the way it is currently taught as one cun from the wrist crease.

But that’s another reason why I’m talking about this. That’s just kind of interesting trivia. I’m introducing to the idea that in the time of the suspicion pivot, we’re starting to have a little bit of introduction to certain points in the heart Meridian, and we know at least our heart file Tong Li is supposed to be in the heart meridian or the hand lesser yin meridian. But you may be surprised that very few points from the heart Meridian are actually recognize by name and location at the time of the yellow in person internal medicine. The only other place that hints at a location of a heart point from the heart Meridian is in the insert chapter 52. The title of that chapter is called Wei Qi as in defensive Qi and there they talk about, if you look at the fourth bullet on the page: the root of the hand shao yin, it’s at the tip of the sharp bone manifest at the back shu.

So here are the top of the hand shao yin, which is the heart meridian and that the root of this Meridian, it’s at the tip of the sharp bone. We modern scholars believe that the sharp bone refers to the pisiform bone in the wrist, in the carpals of the hand which has a bony protrusion and what I want you to notice is that they’ve located this point where we would consider a heart-seven but there’s no mention of shenmen or the name or the Chinese name for heart-seven itself.

And so what that means is that at the time of the Yi Jing, we only have one point for the heart Meridian mentioned by name and location, which happened to even be in disagreement with what is taught later on. And even heart-seven or shenmen, it’s simply just described by location and as names are not mentioned at all.

So that’s only a two out of the nine points in the heart meridian that has been passed down to us today. So the other seven points and not even mentioned by name or location. They don’t actually appear in the knowledge of Chinese medicine textual history until, if you look at the last final bullet in the Jia Yi Jing. This is the meta classic of acumoxa [inaudible 00:07:49] which is probably around the third century.

I put down eight points because heart-seven wasn’t actually mentioned by name. This is why it’s a meta classic where Jia Yi Jing considered the first complete acupuncture manual. There are points that are not described at the time of the of the yellow emperor.

This a nice little zoomed in view of the points on the wrist and the center of the photo is as you can see, heart-four, five, six, seven closely juxtaposed to each other. In fact, heart-seven is right on the crease line. Heart-six said to be half a cun from the crease line, heart-five is one cun from the crease line, and heart-four is one point five cun from the crease line.

And we just saw that even that is disputed because back in chapter 10 where the LingShu, they actually say heart-five is one and a half cun, which is where we look at heart-four today. So the reason why I decided to talk about the heart Meridian points in the wrist. You know obviously you tongue in cheek play on words about the one issue one wears the heart on one’s sleeve and it happens to be Valentine’s day.

But I love examples like this because it really highlights for us the specificity and the lack of redundancy that goes behind how ancient acupuncturists and who I like to call ancient anatomist pass down these points. A lot of people would ask me in my workshops is heart-four or five, six, seven just one point. Because one looks at them as so close and any reasonably educated person would ask that question, why would you have four points? That’s such a tiny little space. Now this is where the brilliance of the ancient acu-anatomist comes in. They pass on these points for very specific reasons is because in fact they are different anatomically. And this is the focus of our presentation today.

Before we jump into very new anatomical, I’d like to just acknowledge William Shakespeare in his work, the Othello at point scene 1. Is this the first textual? A record of the saying wearing my heart upon my sleeve. So there’s a character in the play, Othello’s play, who says that “when my outward action doth demonstrate the native act and figure of my heart in compliment extern, ’tis not long but I will wear my heart upon my sleeve, for daws to peck at”, daws are apparently some kind of Ravens and not what I am.

So if I am not consistent internally and externally I’m not what I seem to be, I am therefore not worthy and deserve to be pecked at by these ravens or and as such. So just in case you were wondering what the expression means and I like to share these kind of food for thought information. It gives a little more context and also helps give us some association when we think about these points.

Now we’re going to jump into the real anatomical and this diagram here comes from Grey’s Anatomy and I would like you to note that there’s two red boxes here on the very top of the page is the ulnar nerve box. And then in the lower box if you read closely, there’s actually two different branches here. One says superficial branch ulnar nerve, the other one says the deep branch of the ulnar nerve. So what I would like you to appreciate is that if you follow the deep branch of the ulnar nerve, you can see that it kind of plunges into the thin arm muscles. And then it actually kicks across towards the left side of the slide, that horizontal branch, that is as also labeled, it’s called deep branch ulnar nerve, it innovates the interior osseous muscles.

These are the muscles that allow you to abduct and adduct the fingers. And it actually makes it all the way into the abductor pollicis muscle. And that’s the muscle that allows you to abduct the thumb. So just another [inaudible 00:12:26] muscle. But because it’s associated with the thumb we call it abductor pollicis instead of interosseous pollicis. So all these branches become important because in a moment we’re going to see how brilliant ancient acupuncturists are in their knowledge of this anatomy and assign different points to each of these specific branches.

So in this video I’m going to show you the needle is inserted into heart-four, and heart-four is assigned the ulnar nerve trunk. Obviously you can stimulate heart, the nerve channel front, I’d say small intestine eight in the elbow, but at that level, the anatomy, it also innovates some wrist extensor muscles. But once you come distally to the level of heart-four it is sort of the first stop before it branches into this deep and superficial branches I just mentioned.

Now because it is superior to the deep motor branch, which I just described, innovates the interosseous muscles, when the electric stimulates that it would stimulate everything downstream of it. So including the superficial branch, which is responsible for the cutaneous sensation of the palmar in the back of the hand, but only for the median one half fingers. Okay, so according to ulnar nerve distribution, but unfortunately because the video cannot demonstrate parasthesia or tingling sensation that the subject is feeling. All we’re going to see is the motor aspect of this mixed nerve trunk at heart-four.

So when I play this video, you’re going to see that there is movement of the fingers. The thumb is moving. In fact, when they sustain a stimulation, what you can see is that there’s an opposition. So the thumb and fingers are coming together by virtue of contraction of the Athena and hypothenar muscles. Sorry, by virtue of the contraction of the hypothenar and abductor pollicis muscles, not the hypothenar muscles. That actually is in fact innovative of the meridian, not the ulnar nerve. I’ll play the video one more time, so you can see. But in addition to the motor aspect you’re seeing with interosseous muscles moving, this subject is feeding tremendous paresthesias or numbness and tingling into the palmar side of the hypothenar and also into the dorsal side of the median one half fingers.

So this color coded image is meant to remind everybody how the ulnar nerve and median nerve covers different terrain in the hand. If I can draw your attention to the left side of the slide, you’ll see the dorsal aspect of the hand. And you can see that in pink, that’s the distribution of the meat of the radial nerve. Now, whereas in green is a distribution of the ulnar nerve. But if you look closely at the dotted line that’s pointing to the back of the hand in the green section, it actually says the dorsal branch. So we haven’t talked about that branch yet. There’s a dorsal cutaneous branch that goes to the back of the hand, but only the one and half fingers. In some people it can be two and a half fingers. Okay. As you can see by the separation where the pink and green separates in the center of the middle finger in this diagram.

Now if I can draw your attention to the right side, now we’re looking at the palmer side of the hand, and you will notice that the palmer side is innovated not by the radial nerve anymore in Brown color. We see that is innovated by the median nerve. So the median nerve is in fact responsible for the palmer innovation, including the palm and fingers of the lateral, three and a half fingers. And then whereas in green you see that the ulnar nerve, if you look at where the dotted line is pointed to the palm, you’ll see that there’s actually two sections. There’s a cross hatch section closer to the heel of the hand that is labeled as the ulnar nerve palmer branch. But when we look at the dotted line as pointing to more kind of the ball of the palm, that is innovative as the ulnar nerve digital branches.

So all in all we have seen palmer branches, digital branches, dorsal branches. Let’s take a look at how these all perfectly super impose on these acupuncture points around the wrist. This slide talks about heart-five and heart-five is also the low point, which means that it’s supposed to connect into an exterior relationship. So the exterior relationship to the heart is there is none other than the small intestine the hand tai Yin. So as a point, it is supposed to traverse from the yin side of the wrist and hand into the yang side of the wrist and the hand going from in other words, the heart to the small intestine or from the shao yin to the [foreign language 00:17:38]. And now what’s very beautiful is that there is exactly a nerve branch of the ulnar nerve that does that.

If you look at the black and white photo on the bottom portion of the slide, you can see on the left side, I have two points as labeled heart-five and small intestine five. The dotted white line on the left side of the photo here represents the outer contours of the ulnar bone. And you can see that the ulnar nerve is labeled in white here with the arrow, is continued into the hypothenar, but on its way to doing that, we have this brand exactly where heart-five is located, where the red dot is on a slide. It branches towards small intestine five in other branches from the yin side to the yang side of the body. So this branch is called the dorsal cutaneous branch and it perfectly satisfies channel theory that is a low meridian point.

This is a dissection. That is from The work that we’d done, the nerves are not naturally yellow like this. They’ve been colored in by an artist to make it more easily visible. And so I want to just start by helping you orientate yourself. You look at the legend on the bottom right, you’ll see that the arrow pointing down is distal. Arrow pointing up is proximal. So imagine this is somebody’s arm pointing downwards and then the ulnar side is actually the right side of the slide and the left side of the slide is the radial side. Let me just help orient you again. This metallic probe you see towards the left side of the wrist here is lifting up the tendon of flexor carpi ulnaris to expose the neurovascular bundle of the ulnar nerve and artery.

In this slide here, C would be the flexor carpi ulnaris muscle. B is pointed to the neurovascular bundle and A is pointing to that [inaudible 00:19:53] branch that is now going to become heart-five. Just as an aside, [inaudible] is actually ultimately bifurcates and becomes small intestine six and small intestine five later on. But that’s beyond the scope of our [inaudible 00:20:08] and discussion for today. If I can draw your attention to heart-six, the arrow heart-six, you’ll see that it is centered over the vessel and we’ll talk more about that. And then heart-seven is on the wrist line.

What’s interesting about the heart-six is that this point has an unusual location. Remember I said these points other than heart-five was just identified by name or location in the special pivot. Points like heart-four, heart-six and seven are not even mentioned by name in the yi jang. So the first time that heart-six ever appears is in the jia yi jang systematic classic and its location is kind of unusual. If you look at the description at the top of the slide I’ve bolded it and highlight it for you in red. It tells us that this point is in the pulse behind the palm, five fen towards the wrist. A fen is a 0.1 cun so, five fen basically means half a cun. But it’s interesting is that is located at a pulse. Now if you can take a look at this black and white photo.

This photograph is taken from the article, The Nerve of Henle: An anatomical & immunohistochemical study for the general hand surgery. And these hand surgeons were interested in finding out more about the anatomy of the ulnar nerve. And you can see it labeled in this diagram here. A, if you look at the left side of the black and white photo, A is the ulnar artery, n is the ulnar nerve. But you see that there’s a star labeled. That star, see how I try for a case on the right side of the photo, that’s actually the branch that goes to the palm and if you remember the colored photo of the distribution of the nerves in the hands, I talked about a cross hash portion around the heel portion of the hand. That’s in fact where those three branches towards the right side goes through.

That’s called a palmer branch. But notice that they’re asterix in addition to the star in this photo and notice how those small branches that represent labeled by the asterix are actually intimately touching the ulnar artery itself. So the significance of this is that the ulnar nerve gives innovations to the ulnar artery. What kind of innovations? Sympathetic innovations, a type of autonomic innovation that controls the smooth muscles of the ulnar artery to control its vasal constriction. And that the classics is the meta classic, we’ve mentioned that this point is in the pulse is telling us that they are more concerned about stimulation of the rich autonomic fibers associated with the artery.

Now it is of no coincidence then that we have learned through pre-occurring experience and knowledge passed on by our mentors that heart-six is one of the most important points to regulate sweating inside of body together with kidney-seven. And why would that be? Because these points are intimately related, associated with the vessels and by stimulating the vessel you are stimulating the sympathetic aspect of the nervous system and sweating is indeed a part of our physiology that is controlled by the sympathetic nervous system. Isn’t that very interesting how the function and anatomy and the historical point locations all perfectly intersect.

The last point is heart-seven. If you look at the color photo on the bottom of the slide here, you’ll see heart-seven clearly labeled. But if you just look a little bit to the right of where heart-seven’s located, you’ll see that there are three branches, right? So the letter C is pointed to two branches that corresponds to the digital branches of the palmer side of the ring, the index and the pinky finger. And then there’s our breads B. That B branch is actually that deep motor branch, the one that actually innovates interosseus muscles.

We saw how stimulation of the the mixed nerve trunk, which contains a sensory and motor aspect. What activate the interosseous and adductor pollicis muscles. So the significance of heart-three or seven, my apologies, is that it is the beginning of the superficial branches of the ulnar nerve. I hope you can see that every single location differ slightly in terms of what nerve has already left the main trunk. So that there is very, very high degree of specificity in the rationale behind why these points are passed down individually and so close to each other.

So I’d just like to finish by giving you a little bit of clinical applications. Anatomy is interesting, exciting, but at the end of the day, that information is to give us more intention, clarity and specificity in our needling. And so we want to talk about how that can be used in a day to day situation. If you are familiar with the type of nerve entrapment called Guyon’s Canal Entrapment. If you look at the picture on the bottom right, it’s also called a handlebar entrapment it’s very common in cyclists that might press the weight of their entire upper body onto the heel of their hand. And as you can see if on the red little lightening symbols, that’s where the pressure and people can feel a nervy electrical sensation. And so if you have some understanding of the… it can differentiate diagnose this type of entrapment.

One way for you to deirritate and improve neural conductance, restore proper neural conductance back into his nerves because it was impeded by pressure. You can needle points like heart-seven, points like heart-four and apply electricity to help deirritate this nerve that has been impinged. One situation that often used the heart-four point for is actually is for restoration of fine motor function. This can happen in patients who have multiple sclerosis. This can happen in patient who has suffered a stroke and they lose the ability to do fine opposition movements and I have found that electrical stimulation of their mixed nerve trunk allows a reactivation of the interosseous muscles and the adductor muscles and hypothenar muscles so that patients can increase their motor control or motor activation of these muscles so that when they do occupational therapy exercises or hand specific fine motor exercises or games, they are going to get more out of those exercises because now the nervous system is firing at it’s optimal efficiency.

Heart-five, it’s name is called Tongli which translates, that’s penetrating interior. It’s traditionally associated with the treatment of aphasia because as you know, the heart orifice is the tongue and the channel theory pathway tells us that heart-five has control and dominance on the heart. But because these points are so close, heart-four to seven, how do you know you actually stimulate heart-five? What if you stimulate heart-seven instead, right? Heart-seven stimulation would feel like palm numbness and parasthesia in the pinky and the ring finger and the palmer side. But whereas heart-five there’s just sensation or parasthesia, ought to feel like numbness and sensation on the dorsal side because of the dorsal cutaneous branch that covers that territory.

So if you are really wanting to use this point to benefit aphasia and tongue and speech and so forth, or to just open the lower vessel, the proper sensation needs to be parasthesia and numbness on the dorsal part of the hand as opposed to the Palmer side of the hand. Finally, heart-seven is called shenmen or a spirit gate, is associated with calming the nervous system. And we already talked about how things like… Points like heart-six because close association to the vessel as very rigid RNI fibers. We saw that how we can conceptualize how that can have effect on sweating, which is a sudomotor response where they get regulated by the automatic nervous system. But similarly heart-seven being able to calm their shenmen, helping insomnia means that by regularly the automatic nervous system is somehow puts the body into a parasympathetic state to improve various type of autonomic dysfunctions.

I want to finish that up this last slide as example of how to use this for a neuro rehab situation. So what you’re still about to see is a patient who has multiple sclerosis at a time that she saw me in the clinic, it’s been about four or five years. She’s developing a lot of spasticities. She has some drop foot happening and upon physical examination we noticed that she was losing fine motor dexterity of her hand. So the top video I will play to you, will demonstrate to you that she’s been instructed to open and close her fingers. The effected side is her right side and then she’s instructed to open and close her fingers. Then she’s going to be instructed to abduct and adduct her fingers. And you can notice that there’s some contracture in the index and middle finger. That’s her attempt to abduct and look at how well the left side works.

The right side cannot abduct at all. And now she’s shaking out her hand because you’d probably be embarrassed. Okay, so just play that one more time so you can just compare for yourself. I’ll stop talking. There’s not much abduction and adduction of the fingers whereas the left hand side is completely normal. And this is important because the deep motor branch of the ulnar nerve is that responsible for the innovation of those interosseous muscles. And so what I did is I put needle heart-four, apply electrical current and because heart-four is the mixed nerve trunk, it will get everything downstream. They’ll get the sensation on the palmer side, on the dorsal side. You’ll get the deep motor branch, you’ll get the supervision branches and immediately after the first treatment and there is that. Now the ability abduct and adduct the fingers is immediately improved.

And that just goes to show you how adaptive are plastic our nervous system is even for something that’s been going on for several years. One treatment, as long as you’re able to have high specificity, you can really do a lot to help these patients. So that’s all I have prepared for you guys today. I hope you enjoyed that. I hope you learn something interesting about the heart points around the wrist and that they are in fact not the same point. They are very, very specific information that ancients have passed down for us. I hope that inspires you to review anatomy. Because I firmly believe that the more you understand neural anatomy, the more specificity you can have with your needling and then the better outcome you can deliver to your patients. Thank you very much everybody for listening. I wish you have a happy Valentine’s Day and don’t forget to join us next week. Our speaker for next week is Sam Collins. Thank you.

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Yair Maimon thumbnail

The Spark and Evidence of Acupuncture


Hello, everybody. My name is Yair Maimon. I want, first of all, to thank the American Acupuncture Council to be kind to put up this show. It’s the first show for me on this platform, so it’s great to be here. I’ve called the show the Spark and Evidence of Acupuncture. Later, you will see why. I think I want to focus the show a lot on the evidence and on the confidence we should have in this medicine, but even more on the spark, I think on the uniqueness of Chinese medicine.

I’ve been a student and an inspirer of Chinese medicine for over 30 years. So it’s quite a while. I’m doing different things. My interest in is on two extremes. One is cancer, where I’m a head of a cancer research institute in the biggest hospital in Israel, in Sheba Medical Center, when I researched the effect of herbal medicine even to the molecular level, both on cancer and the immune system. I’ve published more than 20 peer-reviewed medical journals, so papers. So you can read them up. Although this show, and especially today, will be focused more on acupuncture, but also on the clinical thing.

I’ve been teaching also worldwide, I think, in the last more than 20 years. I have also my own clinical center in Israel, I’m from Israel, where we are about a group of 20 practitioners working together. I must say that, still, the practice is my passion, although teaching and researching all building up the full approach and understanding of Chinese medicine.

So I’m glad to be on this special show and share with you some of my experience, which I hope you will find useful for yourself, for your own clinic today or tomorrow. The idea is really to do a practical and in the same time I hope a little bit magical show. So I’ll put some slides. So please can you put this first slide on? That will be great.

This lecture is called What Do You Do When You Don’t Know What To Do? I chose this topic for a reason. I’ve been practicing, as I said, for 30 years, and I think it’s almost a daily phenomenon, not just for acupuncturist but for any healthcare provider. There is a lot of situation when you don’t know what to do.

So I set up on this small mission of asking colleagues who are at least 15 years in practice. I’ve asked 25 colleagues what they do when they don’t know what to do, and try to conclude something from my experience and other people’s experience. I’ve put it eventually all into one presentation and divided it a bit, I hope, in a special way. I took, I can say, the essence of what my colleagues are practicing Chinese medicine for many years, have kind of were willing to share.

I think, as we know, it is a great clinical dilemma. One of our problems is to move from uncertainty to certainty. We wish sometimes in the clinic we’ll have this kind of crystal ball that can look into the future. If we’ll do this point, this will happen. If we’ll do another point, this will happen. Therefore, let’s choose this one.

But that’s not the clinical reality. We have to take the pulse, check the patients, and then decide upon the diagnosis. What will be the best treatment and the best way to do it? We’d love to be certain. As I say, I put a dice, yes, no, maybe, on each dilemma, but this seems not seems to work.

In western medicine, it’s much easier. As I said, I’ve been all my life also in western medical setups. The thinking is linear, so there’s a much more comfortable solution, like in oncology, one of the fields that I’m excelling in in Chinese medicine and working in Chinese medicine.

In western medicine, eventually there is a diagnosis, there is a protocol, and there is some comfortability about it, which is very different to the way in Chinese medicine, because in western medicine, once you have a diagnosis, you have a protocol, and you proceed in what seems the linear way, which makes the physician comfortable and more feeling certain.

In Chinese medicine, the situation is very different. We’ll look at system, we’ll look at a much wider picture. So for us, there is much more options to make a clinical decision. This is really what the lecture is focusing on. In this kind of what seems to be very open space, how do we make the best clinical decision for patients, especially when we feel that I would say not uncertain, but we feel we don’t really know. We don’t have a final decision of what is the best to do.

I divided this lecture on purpose to three levels, to heaven, man, and earth kind of approach, because in the science of Chinese medicine, we divide things to a number, to one, two. When we reach three, we are really on the place of men on earth and we are on the real dilemma of human life. So in a man situation, we are between heaven and earth making our decisions.

As you will see, when I looked at the three layers of approaching this uncertainty, there will be a different answer. On a heavenly level, there’ll be an answer which more relates to the dao into a path. On a man level, more to the movement, into the qi. And on the earth level, more in material solution. Sometimes we need all of them together. Sometimes we choose one solution to the situation in the clinic. Therefore, we can look at the shen affecting the shen or affecting the qi or affecting the jing.

Each one has a different play in the clinic, and usually we are trying to affect this model, the three layers model, and get the best benefit to the patient. That’s why the shen, qi, and jing are called the three treasures.

When we manage to put them all together, we have a three-dimensional picture of the patient. I always say when you look at the past, then we see all the problems and pains that the patient bring. When we look at the present, we look at their symptoms. But when we look at the future, we look at their healing. So when we can put past, present, and future together in the clinic at one point, we are reaching the depth of treatments and the depths of human experience.

So let’s start with the solution of what do we do when we don’t know what to do in a heavenly level, on the shen level. That means that on that level, we’re allowing a presence of the shen, because for us, shen is one of the five substances in Chinese medicine.

So the spirit to us is not something strange or unreal. It’s a real essence of the body. It’s the most young, the most strong, the most effective, the one that connects us to oneness into the strongest abilities. Therefore, it’s present in the clinic and it’s present in creating healing. It’s definitely one of the key things.

When we are reaching the level of the shen and we don’t know what to do, we listen and we wait. We allow something which we understand is the dao, or the dao or the path of the patient to be present. We do, I think, the most interesting waiting. To me, the Chinese science present I think one of the most mind-blowing idea, is you do nothing. Wu wei means doing a non-doing.

So in a way, when we want to look deeper, we allow this moment of just not being involved, of just being present. In the clinic, it happens many time when I tell … And every practitioner is always … Have this experience. You decide on a certain point, you get to the patient, and you do something else. You realize that this change was exactly what the patient was needed.

So this doing a non-doing, it’s a new concept for us as western people, but it’s embedded in the core of Chinese medicine and Chinese medicine thinking. So on that level, we listen and wait. We allow something of the presence, the presence of the patient, his own path to be there. We’re just waiting.

Waiting is not just a Chinese medical idea because to me wu wei’s the source and essence of Chinese medicine. I took this slide and put also Bion [inaudible 00:10:23], who was a psychologist talking about nonverbal communication, and very much focused on this aspect of just seeing and listening and being present in a nonverbal way, which is strongly affecting the clinical situation. He called this book A Beam of Intense Darkness, because we always talk about light, but actually darkness allows everything to come out and appear in it.

So to me this idea is very strong in the clinic because when I don’t know what to do, I must say my own first thing is just to sit and wait, to put this beam of darkness or to put this endless space and to see what is coming up, and always something will come up.

But this practice, I think it’s one of the best way to start when you don’t know what to do. Instead of convincing yourself, “Oh, there is dampness, there is cold,” or something that you see in the patient and immediately jumping on a diagnosis when, in reality, there is a lot of option at that moment, and we don’t know which one to choose from.

So on the shen level, I think getting this inspiration also from the nonverbal communication, just waiting there, is perfect. I teach a lot what I call one minute diagnosis, because there’s so much we see in one minute. This is the one minute that we allow the whole complexity of the patient just to be present there and us being totally empty and trying to understand and connect and seeing the whole full layers of the patient.

A lot of time in this space, we move from uncertainty to certainty. We move from this deep darkness. Everything is possible into light and into something very specific. This space is a very healing space because in the silent, something comes up. This thing that comes out in the spur of the moment is probably a key for the healing and for the treatment.

A healing environment is very sacred and special. If it allows something happens there, sometimes we know what to do. It’s like almost obvious that this lecture focuses on this space, which is always important to hear, but definitely important when we want to see what’s the most core to the patient at this point when we treat him.

So to summarize this level and the way we can approach it is we start from darkness. We still remain uncertain, and we are fine with it. That’s not always easy to remain fine with uncertainty. We don’t move to certainty. We will use wu wei. We are not doing anything and we are not expecting anything. We’re not putting any pressure.

Then the second step usually comes. There is some movement to light. There is some kind of something that is emerging and coming up. I call it an insight and, a new word in English, enlight. Suddenly something emerging and suddenly we have some certainty in the direction of what to do.

This is really a place when we stay in stillness and something emerge and we approach it or we allow it. To me this level is one of the core levels when we don’t know what to do, and to allow this level in a kind of very, oh, we say almost scientific or didactic or diagnostic way, because we live in the western world. Everything needs to be certain, and uncertainty leaves us a kind of suddenly uncomfortable. I think that allowing this uncomfortable feeling and emerging from it with healing is the key for the level of the shen.

Now we’ll move to the second level, to the level of man. So to the level of man, we move to qi and we move to the movement of qi. In a basic way, when we move to this movement, I got a lot of response from the people I interviewed, and then they realize that a lot of great masters actually created different formulas to what to do and they don’t know what to do, or create different formulas of points that are moving the qi, harmonizing the qi in a very wide way that allows healing.

So when we move to the second level, I actually look upon different masters along the history of Chinese medicine, and I will present some kind of idea from us to tung and maybe even stop with the four command points.

The four command points are very simple and very easy. We can easily understand them. They are each directed to an area. Like we do stomach 36, if there’s something in the abdomen, if there’s something in the head and neck, you do lung seven. If there is a back, especially lower back, bladder 40. If there is something in the face and mouth, you do large intestine four. So you don’t know what to do, but you know these points will guide you to an area or will move qi in an area.

Therefore, it’s a good place to start when you don’t know what to do, because sometimes it’s like peeling an onion. We just move the qi, we peel this first layer, and then something deeper emerges or better clarity comes.

There’s two additional points usually for the four command points. For the chest and the heart, pericardium six. For fainting and collapse, actually also for lower back pain, DU-26. So this will be like a set of point. When you don’t know what to do and you want to move a qi in a certain area in a larger way, this is a good resource to start with in just generally moving the qi.

I looked very deeply at the five points, the 10 needles that Professor Tung suggested, and Miriam Lee, who was one of the first practitioners actually in the States, who was a very, very active practitioner, she saw about hundred patients a day and mainly treating just with this formula. This is the formula that she was using. Very known point, but if we go deeper, very clever point.

I think with acupuncture, we can be very elaborated with points. I’m doing a project, learning the points in depth, but sometimes using a simple point when we know why we are using them is extremely powerful. When we use them all the time, I think we are losing the sense of acupuncture and the fine-tuning of needling. But this lecture more focuses, you don’t know what to do, so this is a very interesting prescription.

It’s not superficial. It allows harmonizing the qi on that level in many ways. So stomach that is six, spleen six, large intestine for large intestine 11, and lung seven are the points of the five points and there’s 10 needles that can be used.

I’ll go very quickly point-by-point to explain how they are combined together. Sometimes we can use the whole five or inner combination, obviously with additional point, a bit like what we do in herbal medicine.

I’ll start with spleen six. Obviously, everybody know and use this points. It’s the meeting of the three yin of the leg. This point, if you look at the combination of them, we’ll see that the sum of the combination will be lung and spleen. We have stomach 36, spleen six. We have large intestine and stomach. So we have TaiYin and we have YangMing. So we have large intestine for large intestine 11 and lung seven. So we have this TaiYin, YangMing combination. We have a specific earth yin and yang combination and metal yin and yang combination. So we have both the qi, the yin qi and the wei qi presented in this combination.

I’ll briefly introduce my two colleagues there, Rani Ayal and Bartosz Chmielnicki. Together, we formed the group called the CAM team. We are producing the special book called The Gate of Life. The Gate of Life book goes deeper into the understanding of acupuncture points with a painter from Poland, Martina [Yankee 00:18:54]. She is painting these points.

Actually, here you can see the whole picture. This is a meridian, so all the meridians are painted. This is the spleen meridian. As you can see, it will start with spleen one and slowly, slowly we go through different points to the point that we are talking now, spleen six, when we have the three yin meeting.

Here you can see them. You can see the three yin women meeting and all the interaction with other meridians, et cetera, and turtle because it’s to do with the deep aspects of yin. I won’t go into all the symbolization, but just to give you this general sense of this book and the points. Probably in future shows, I’ll show some more pictures and going into different less known points and try to explain the dynamic of qi there.

So as we know, spleen six has a very strong dynamic. It both works on postnatal qi, working on the blood and damp. It’s connected with the liver and the kidney. So it will move blood. It will work on yin and jing. So we get a wide variety of effects on the body just using this point, when we don’t know what to do and we … Or we want to affect an area rather than a specific diagnosis. So we are moving from working on a specific diagnosis into affecting a whole area.

It will work on the lower jiao and the energy and everything that’s on the lower part of the body and, specifically this point and especially when combined with the stomach, will also affect especially the dampness in the lower jiao.

So this tung combination, when we look at this point, will be stomach 36 and spleen six working on earth. But not just working on the earth element, but also stabilizing, vitalizing the earth, affecting digestion in a big way, affecting the metabolism of fluids and dampness.

So you can see there’s already inherent combination that works on earth, and another combination that works … So it works on earth and digestion and another combination that works on breathing. Obviously, when we come to life, the first thing we do is we breathe and we need to eat.

So this combination affects this two fundamental aspect of postnatal life, of digestive system, and of the lung system. The combination of spleen six and lung seven will affect breathing and will affect the wei qi. We work also on the RenMai meridian in this respect. So from the tung combination, you can see how wide it is. The same with large intestine four.

I won’t go into each point in too many details because I think some of the points are more familiar, but it’s yuan point, so it’s a command point that affect, as we see, the face and mouth. It’s also a LU point, so it works closely with large intestine four, lung seven. Again, a great combination.

So we’re slowly moving into this tung combination system, and understanding this inner combination of large intestine four and lung seven, like this two command point, releasing also exterior, working on wind, working on the sweat. Our large intestine four and large intestine 11 working on the head, face, also affecting all the orifices and also releasing heat.

So you see how this tung combination, the deeper we go into it, the more and more we see how clever it is and how it affects so many aspects when we don’t know what to do, or sometimes just because there’s a lot of things present, and we want to affect all of them.

So large intestine 11, being in earth and he, uniting point, and taking also heat and affecting deeply the metal and the large intestine. Large intestine 11 and stomach 36 tonifies the qi and blood. It’s the Yang Ming meridian, which is so rich in qi and blood and, with large intestine four, also taking heat out. Again, you can add another points like Du-14 if there is extreme heat. Lung seven, one of the almost last points that I want to present here, again a luo point, opening of the RenMai. In a way, we are even tapping an extra meridian system.

Lastly, we are moving with stomach 36 into this kind of final part of this combination, looking at stomach 36, which is an earth point. But it’s not the normal earth point. It’s an earth point of the earth. I think this is the key of understanding this point.

By the way, this is the picture from our book. It always remind me because when I look at a picture, when I was taught stomach 36, suddenly everybody was saying it’s a three li. If somebody is tired, you puncture this point, and there’s the story. People can walk another three miles, three li. But in reality, the three li have different meanings. One of the li is like a small village that can sustain itself. So three lis is actually three villages that can sustain themselves. It talks about the vitality in this point.

Also, it talks about the three parts, as we can see here, of the abdomen, which are the avenues of the yuan qi that goes to the triple warmer. The three li can also refer to this very deep vitality in the body. But obviously being the earth of earth is the reason why this point is doing so much and it has so many indication, clinical indication.

So we looked at these points, and now I would like to move to the last part. We look at the shen part. We look at moving the qi in a general way, like in one combination, I think, which summarize it nicely and, the last one, through stomach 36, we move to the earth level.

Tapping into the yuan qi, tapping into the earth and the fundamental part of living on earth, because all the elements are surrounding the earth. So whenever we use points of the earth element, especially the yuan source points, we are really helping to stabilize human on earth and we are able to tap on some deep authenticity. We are able to tap on the resource of both qi, blood, and jing to help the patient to recover and regain health.

Stomach 36, that’s the reason why this point is so effective. As I said, it’s the earth of earth. Otherwise, there’s no other explanation why the use of this point is so strong and so critical. Then if you look at all the yin points on the yuan points on the yin meridians, the zang meridian, all of them are earth points and all of them are soul-balancing points.

Again, when we don’t know what to do, yuan points will be the first one we will consider affecting directly the element itself, but also deeply the qi and the yuan qi. Here I’m just showing a simple combination. Liver three, stomach 36, lung nine, all earth point. So we work on this axis. The same way can be heart seven and kidney three with stomach 36, working on the creation axis. So both we can work on the formation or creation axis, just using yuan points, and achieving something very deep.

So to finalize, when we don’t know what to do in the clinic, we can relax. Nothing is under control. It’s a normal situation. But I think if we follow this kind of deep logic of looking at shen, qi, and jing, something unfolds. Then we move from uncertainty to certainty.

So I would like to thank you for watching this. I hope you enjoyed it. Be well. Thank you very much. All the best to you. I want to add maybe some … I can stop the slideshow and maybe just add some final note.

First of all, I want to mention that next week on this show, there’ll be a good friend of mine, Moshe Heller. Also, you can follow the next shows that I will do on the American Acupuncture Council. I hope you enjoyed it. Do write comments. I promise I’ll try to answer. All the very best to you and be well. Thank you very much.

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Best of TCM Research in 2019 – Drs. Doran and Barzilay

 

Hi, I’m Virginia Doran, host of To The Point, generously hosted by the American Acupuncture Council. Today, my guest is Gil Barzilay, and if you haven’t heard him speak, you’re in for a treat. He has a big following internationally, and besides a diploma in Chinese Medicine, he also has studied Chinese and Macrobiotic Nutrition, Kiiko Matsumoto-style Japanese acupuncture and he actually went to college in London at the Imperial College there at the University of London. Has a PhD in from Oxford in Cancer Research and European Medical Biology, post-doctoral fellowship at the Weitzman Institute. He’s got 11 peer-reviewed publications in leading medical journals.

He brings a special dual knowledge in the field of cancer research as well as other kinds of research. He works in Tel Aviv in Israel’s leading complimentary alternative medicine clinic, Rehovot, and he teaches acupuncture, Chinese medicine, research issues all around the world. He’s part of the International Committee of Chinese Medicine, ICCM, which holds an annual conference, which I hear is just fabulous. He also works with the Evidence-Based Acupuncture Foundation and writes regularly, reviews and newsletters.

You can see him on Facebook at DrGilTCM and/or contact him through the ICCM or Evidence-Based Acupuncture. Anyway, without further ado, I would like to introduce everyone to Gil Barzilay.

Thank you, Virginia.

Sure.

What a long introduction. Yeah, that’s all right.

Well, you have a lot of credentials.

Thanks for that.

I wanted to ask you, what makes a good research study in your opinion and why? The studies that you’re going to speak about today, why are those your best of?

Okay. There’s about a thousand, I think, publications that are published on Chinese medicine every year. I get those alerts on Google twice a week. There’s a lot of information, but I think [inaudible 00:03:41] Western medicine research apply for Chinese medicine research without going into the debates, include having randomized controlled studies. So having a control, comparing a compounder to something.

There’s been a lot of debate on sham acupuncture, and I’ve seen some of the speakers that you’ve had before. I’m sure the debate of what sham acupuncture is and whether it should be controlled has been up there, so I’m not going to go into that, but there has to be a good control of some of the subs that have chosen to date had not been in any could control. They have to have a good number of patients. So of course if these Jersey studies are made in China, they sometimes can have thousands that are conducted in North America or in Europe. We’re probably talking about a hundred patient, maybe a few hundred patients.

Also, the third component of whether the study is good or not in my opinion, is having objective and [inaudible 00:04:47]. So we’ve seen a lot of placebo research that has been conducted actually in other universities around the world. One of the ways to better understand whether something works or doesn’t work is having objective and subjective measures. Because when you ask patients only, “Has your quality of life improved?” or something like that, it really depends on the data in the hospital or the clinic, so the answers can be so confusing and really not good enough for measuring the effect of an intervention.

Having a mix of both of them, these are the three that I’ve chosen have these within them.

Mm-hmm (affirmative). You know, I just wanted to interrupt for a second. I’m hearing a reverb. I don’t know, are you hearing it at your end, kind of like an echoing with the technology?

I’m fine. I can’t hear anything.

Well, hopefully the viewer won’t hear it. Okay, good. I guess there’s a little bit of one, but as long as we can still understand you. So tell us about your criteria for a good research study and why these ones are your best.

So, these are the three that I’ve chosen, but I wanted to start with putting things in little bit in a context of where we are now in terms of, not the world we live in, never talk about global warming, but I did want to share some slides. So let’s move into the slides that I’ve created. One second. Have I done something wrong?

Thank you so much for making these slides because it really helps the viewer to anchor that information.

One second. I need to put my glasses… new share.

Oh, I see the slides. Alan sees the slides.

See the slides, but they’re not moving forward.

You can’t see them.

No, I see them, but they’re not moving forward. Oh, now they are. Okay. Okay, no, something’s not working.

I see the title but not the content.

What’s up with the slide?

It says stopped sharing.

Okay.

All right, good.

Now it is on, but okay, let’s see. Okay, so I wanted to put things in context because I wanted to say that one of those things that has been… One second. Not working, yeah, I know. Okay, so one of the things that we’ve seen this year is that of course there’s some things coming about Chinese medicine for the fact that is making it into the clinics with the World Health Organization a categorization of acupuncture as a medicine. Of course that got some good headlines, and then some nasty headlines like the integration of quackery with real medicine.

We have, of course, on the right side you can see Novak Djokovic during the tennis U.S. Open bragging about being treated with acupuncture and the moxa. You see Lady Gaga showing you off her cosmetic acupuncture, but at the same time you have some bad news like Spain planning to ban alternative medicine in health centers. You have an article here that was published the Forbes Magazine that says, “Don’t do this: 156 medical practices that are all failures,” and saying that acupuncture is quackery again. Then you have this silly photo on the bottom right hand that shows guy and says that veterans deserve better than as something that doesn’t work like acupuncture.

On one hand you have some good news, but on the other hand you have some… And some people supporting us like Novak can maybe Lady Gaga and others. On the other hand you have some bad headlines as well. At the same time though, the treatment landscape is really changing. There’s a lot of issues with the opioids, you know it very well, especially in the States, but also in Europe, very high numbers of people dying and if not at least coming to the ER.

But it’s not only the opioids, FDA has put additional box warnings and contraindications on the insomnia medications. You have Xanax, which is now the number two problem after the opioids.

Really?

Yeah, and of course the nonsteroidal antiinflammatory drugs that look like Advil or Neurophin, that look very innocent, but actually increased double and even more than double the chances of having a heart attack. Even more common drugs like Advil and others have have real health issues coming in with them.

That means that people are seeking out alternative. When we have the evidence with research, whether we are really interested in conducting research or not, it can actually support our case with the different organizations and with the health authorities. You can see that treatment guidelines all over are now embracing acupuncture as well when the evidence was solid enough.

You have here the American College of Physicians are clearly stating that acupuncture is one of the treatment options guidelines with clear recommendations on a first and second level that acupuncture should be one of the ways to treat chronic and acute pain. You have NICE, which is the British body of excellence, clinical excellence, recommending that treatment will be given prophylactically for migraines. You have ASCO, you know the American Society for Clinical Oncology in dosing, acupuncture for breast cancer patients.

We have the American College of Rheumatology embracing acupuncture, and now you also have the Adult Stroke Rehabilitation and Recovery using acupuncture. So when you have research, perhaps not all the doctors, perhaps not all the medical community’s aware of it, but when you have evidence bodies and health authorities listen to you, and then they recommend it and may even include it, and I’ve seen throughout this year that several insurance companies in insurance bodies in America have also included acupuncture now as one of the modalities of frequent, so that can only happen when you have good research.

Absolutely.

After all of this introduction, I’m going to go into my top three for this year. So I chose top three that are not within a typical pain and migraine and other areas that we already have enough evidence that acupuncture works and there’s no point in repeating with an additional study that may demonstrate that acupuncture works for pain. We know it does.

I wanted to show some studies that perhaps not everyone is aware that exist, and are pretty solid, and I recommend that people go and read them in full. The first one is a study from Italy that looked at the effectiveness of acupuncture on pain and functional disability for people with rheumatoid arthritis. The studies from a group of medical doctors in Rome, they included 105 rheumatoid arthritis patients that were divided to get either real acupuncture or [inaudible 00:12:53] acupuncture, which I don’t usually like, but they included that. Acupuncture outside meridians or have a wait list, so not receive any acupuncture at all, while at the same time the entire group were continuing with their own treatment, whatever they had already for the RA. Either it was a nonsteroidal drug or a disease-modifying or biologics or any other analgesics that they were getting for their RA.

They received a treatment for three weeks and they were followed for additional four weeks and the points that they use there adjusting people are short of reading the study itself, it was Triple Burner five and Goldwater 39, Hartswean Keeper seven. Just to show you when I was talking about objective and subjective measures, I know this look complicated but it’s actually quite easy to read.

You have in a solid line those who receive real acupuncture, and the dash line, those who receive control acupuncture. You can see that they were doing some auger battery and arm strength as well and quality of life and pain. They were trying to assess pain. They were trying to assess the ability of people to move their hands and to feel pressure and how much pressure they can take on their hands. Of course also asking questions about quality of life. You know all these parameters acupuncture was better than a wait list or sham acupuncture. In fact, they were also looking at the number of swollen and tender joints, and there were also significantly decrease in those who received real acupuncture.

We know that acupuncture is good for lower back pain, for knee pain, whatever. This is one of the few studies that I’ve seen on rheumatoid arthritis, and it’s good also to see that it’s not only the pain but the also the functional, mobility of the patients to do things, to do normal things we do every day. That’s the first study.

Well, that’s good. I was going to ask you to explain to the audience what control acupuncture is. I haven’t heard that.

So control acupuncture, in this case it’s the sham acupuncture. They were asking if you saw on the first slide they were using acupuncture points that were not on the meridians that were relevant to RA. So that’s one of the options. One of the issues, of course, with that type of control or what is called sham acupuncture that we’ve seen in the past it doesn’t work. When you stick a needle in someone, something happens, it talks to the brain and it tells the brain, “Oh my God, you know, something has happened. React.” So just because it’s outside of the Meridian doesn’t mean there’s no reaction. That’s what we’ve seen over the years when the original studies came 30 or 20 years ago with acupuncture, we’re comparing to what they call placebo puncture.

They were comparing to needles that are at two points that are not supposed to be relevant to the disease that we’re talking, but they did actually work in a way. And so all the ones that don’t like us and think that we’re quackery or with some sort of holistic voodoo medicine, we’re saying, “You see, it doesn’t really work.” It works, even when you put needles in a place that shouldn’t work, it does work a little bit. So this whole thing, acupuncture is just not real medicine.

When they moved into doing better controls and/or comparing to people who are continuing to just take their medicine or not receiving any additional treatment, they could actually see the real effect. That’s how, in my opinion, studies should be conducted. But in this group took the double approach. They did a sham control and they did a waiting list as well. In both cases it was working better than either. So that was a good control.

Great.

Okay, so the second study, it’s actually something, and that’s why I put two studies here, but I’m not going to go through both of them, is a phenomenon that we’ve seen over the last almost 10 years. When you do acupuncture to patients who are depressed and are taking SSRIs, the results are faster, better and with less side effects. Some of the reasons from a mechanistic point of view, people have said that if you put needles then since we have seen already the effect that needles do on increasing serotonin levels in the brain, that could relate to that, don’t really understand the [inaudible 00:17:47] of why acupuncture actually helps for patients who are depressed and are already taking SSRI, but that’s effect.

This is a study that was trying to compare manual versus electro acupuncture as an add-on therapy to SSRIs. What they did, it was more than 400 patients. 156 were taking SSRIs only. 161 were receiving manual acupuncture, and 160 patients were receiving treatment with needles, with electro acupuncture. The patients were all on the usual dose of Paxil and Seroxat statin they were taking for six weeks, and the patients received treatment over six weeks with three sessions a week, and they were followed up for an additional four weeks. The points that they were using, you can see here is GV20, the Yintang, GV16, bilateral Goldwater 20, GB14 and bilateral pericardium six and spleen six. When you look at the results, they both showed that manual acupuncture together with the SSRIs or electro acupuncture were both significantly better than SSRI.

At six weeks the response rate for the SSRIs was better. There was an early onset. The level of depression that was assessed is one of the markers as well. Side effects were lower and also the number of patients that had to have their SSRI dosage increased was lower with those who received acupuncture. So acupuncture really does good for patients. I think it’s a good thing to know because I’m pretty sure that there are quite a few acupuncturists that when the patients ask them, “Do treat depression?” or “Is it going to interfere with my therapy that I’m taking now?” The answer is clearly, “No, actually probably it’s going to work better.”

Mm-hmm (affirmative). Now, would it affect the dosage they would need to be taking?

It may affect over time. In this specific study, they actually showed that the number of patients who had to have their SSRI dosage increased over time was less when they received acupuncture, so there was no need to even go and increase your dosage. It’s only one study that actually assessed this. I wouldn’t see that as the key outcome of this study. But the fact that it’s keep on repeating yourself is quite interesting. I think that many people, we’re all very easy sometimes on treating pain because we know it works, but some of the more, life [inaudible 00:20:41] it’s good to know that if a patient or a relative asks, “Does it work with [inaudible 00:20:47] or clear with my therapy?” The answer is definitely not. It may actually even enhance it, and you may even have less side effects.

Mm-hmm (affirmative).

So that’s good news.

Yeah. Definitely.

Okay, let’s go to the third study. This study made a lot of noise in the last year because it was published in JAMA internal medicine, which is a very important journal. It was looking again at acupuncture as adjunct therapy for chronic stable angina. The reason why it caught some attention is because the results were too good or there was a community to relieve. So there was some nasty headlines I’m not going to go into, but if you just Google it yourself, you’ll see some nasty headlines on WebMD and other website of people really unhappy with the results.

Mm-hmm (affirmative).

Yeah.

Antithetical to what it should be. Instead of being happy there was something for patients, they’re more concerned about the political aspects of it.

Well, the thing is that I never really understand it because if the results were choose acupuncture, don’t take drugs, I would have understood it. But actually this studies acupuncture together with the existing drugs. So there’s no competition here. Always saying is, Let’s integrate,” or “Let’s see whether acupuncture actually even improves what the drugs are doing,” because the drugs can only do up to a certain point and they don’t even work very well. [inaudible 00:22:31] we’re not taking off the presses. Don’t worry about it.

[inaudible 00:22:36] pharmaceutical. We’re just suggesting that if you add acupuncture, you can even have better results and your patients will be happier. We’re not taking their job or their sales, but that’s the way it is. Yeah. So these were again, 400 patients. It’s a nice number. They were divided into receiving acupuncture on the disease on meridian. These are [inaudible 00:23:05] bunch on the non-affected meridian sham acupuncture, which was a not real points and no simulation and wait list. In my opinion they’ve done a little bit much [inaudible 00:23:19] after all, but the [inaudible 00:23:22] we had more patients than what they chose to do.

It was four weeks, three times a week, and then six weeks follow up. So that’s a long followup as well. You can see all in all, it’s about four months. And again, no harm to the patients. All received their anti-anginal whichever day were making them ready as recommended by the doctor. So you could be a bigger block. It could have been [inaudible 00:23:57]. So I feel safe.

Yeah.

Now, if you look at the results, you can see here the frequency of angina attacks, and you can see here that the patients who received the real acupuncture and the reduction is significant. [inaudible 00:24:14] well, attack to less those received and none acupuncture. Meridian had also some reduction, but down to 10. Sham acupuncture down to 10, and those who were on the wait list had a reduction of one attack, one and a half attack.

Now, the interesting thing is that, remember that all the patients are continuing to take their anti-angina drugs, but they don’t work. Because you can see they started with almost 14 attacks, and they ended up with about 12. When they had acupuncture, it was halved, so the number of angina attacks you had was down by half.

Like I said, WebMD, [inaudible 00:24:59] it didn’t matter, and you don’t call [inaudible 00:25:06] top cardiologists, Americans in Europe saying that this results are too good to be true. Since this study was not done in America, you never know what happened, who conducted this study and whatever the results were, made up or something. So that’s the way it is.

That’s amazing. That’s a really dramatic one. Yeah. I like that.

Yeah, and that’s a reason perhaps they didn’t like it is that you can see that since since the patients were taking the drug and it didn’t really work, they were seeking additional options, but there are no real additional options. You can go to natural path, you can go to your homeopath or I mean, or acupuncture. That’s about a few of the alternatives. [inaudible 00:26:10] do to drugs obstacle therapies. So yeah, the results are too good to be true, but that’s the way it is.

The reverb was a just occurring a lot. Alan said to ask you if you have a cell phone maybe nearby.

Near? No, no, no, it’s two rooms away from me.

Huh, okay. All right. I have one nearby, but I don’t know that that’s it. I can’t read what… Okay. So you know, with a little bit of time that we have left, can you talk about acupuncture and the research that’s relevant for the opioid crisis that we have. I mean it’s really an epidemic here. It’s so unfortunate and the politics don’t really support the real regulation of the drug companies with the pharmaceuticals that have… Not that that’s the whole root of the problem, but that’s a big portion of it, how it became so big. Can you speak about that from your knowledge?

Yeah, Alan has written something that is important. Cell phones should be off no matter where it is. Okay. It’s off. It really is off. I was a good boy before.

Yeah, so I’m just curious, is there much research for that? Things that we can give to doctors or patients? I mean, there is for pain, but what about addiction?

There is some research on addiction as well, especially the one that was done with veterans in the U.S. with the veterans’ associations and several of them. I think there isn’t enough research that has been done. That’s perhaps part of the problem, because I think in the first few years after the opiod crisis has become such a crisis that the people, you know, the American Physicians Association and others had to react to that and seek alternatives.

The first instance was for an alternative and so acupuncture would be an alternative for treating pain. And that’s correct, and that’s worked. The American ACP and also the American Medical Association, all the other associations, including a bunch of also one of the ways, one of the modalities people will notice. Then only since about 2016 or ’17 you start seeing research being developed and done now on whether [inaudible 00:29:16] in addiction.

We begin to see the results now. The results are interesting and positive, but I think the studies that I’ve seen to date are quite small, and so [inaudible 00:29:32] happy with with. It’s interesting and it’s going in the right direction and perhaps it’s even not even surprising but I don’t think there isn’t enough publications to wave and say, you know, we can also help with coming off addiction.

We can definitely do that and we know we do that, but the research is still, I think, [inaudible 00:30:00] to available. Talked about it.

Is there anything else you wanted to say in conclusion? We’ll have to have you back at another time to talk about things and get that sorted out.

I would just recommend for people to once in a while, I mean if you’re not interested in looking for research or if you don’t know where to look for it or read it, look at for example, the summaries that we are doing the evidence-based acupuncture website, because that has a lot of resources for people who don’t have the time to read or really not interested in research, it’s too complicated. [inaudible 00:30:47] and all of it is okay.

We summarized the highlight and we tried to make it accessible so that every therapist, wherever they are in the world can actually discuss it also with their patients, because we know that when patients sit in our office or lie on the bed with needles, they start asking questions for their brother, sister, mother, son, neighbor, and sometimes it’s beyond what they themselves came for. But there’s a lot of evidence out there and so if you can’t be bothered and that’s totally okay, go for example the DBA website and have a look at that, or look for research courses.

I’m sure there are in America, there’s some online as well and there’s plenty of research around that we can use and convince people. Local hospitals, local clinics. [inaudible 00:31:47] integration. No one is saying that acupuncture is better than drugs or that drugs are better that well. pharmaceutical companies are saying that drugs are better than [inaudible 00:31:58], but I think that if we integrate, it going to work really well. This is where we have integration in all hospitals, it’s really amazing, in oncology, in pain, in orthopedics and some psychiatric.

It’s working quite well. It took 10 or 15 years of fighting with the evidence. So you need to know the evidence for that.

But you know, we owe people like you and Mel Hopper Koppelman and John [inaudible 00:32:31], so many people, I can’t even name them all, but it’s really a gift, what they’re doing for the field, and we need to support that. It’s a really great organization and it’s for the sake of all of us.

So, anyway, thank you so much for coming, even though you’re in Tel Aviv and I’m in Connecticut, but thanks for taking your time to share your knowledge and we’ll hope to have you back again sometime.

Thanks so much for having me.

Yeah, I’ll just say goodbye to everyone. Again, I’m Virginia Duran, your host and my website’s LuminousBeauty.com and Gil Barzilay. You can see by his Facebook, DrGilBarzilay is it?

No, DrGilTCM is the easiest way to find it.

DrGilTCM on Facebook, and of course the Evidence-Based Acupuncture site. So thanks again, and we’ll see you after the New Year. Okay.

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