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The Scope and Opportunity of Oncology Acupuncture

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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Understanding How Chinese Medicine Affects Immunity Yair Maimon

Hi, everybody. Good evening and, I hope, very healthy evening to all of you. My name is Yair Maimon. I’ve been practicing Chinese medicine for over 30 years. I’m very lucky because I’ve been involved both as a practitioner all these years, practicing also in private practice, but also in the health system and in hospitals. I’ve been teaching all around the world. I live in Israel, but I’m used to frequently travel, now a bit less lately. Also, I’ve been researching, so I was very fortunate to have my own research center in several hospitals and the last one also a laboratory center.

One of the areas that I’ve been deeply researching and had interest in was the immune system. Actually, my main interest is very extreme. One is the shen and the relationship of the body to the shen. The other one is the body, cancer, and immunity. As far as immunity, I’ve been researching especially herbal medicine and different herbal combinations and their effect on the immune system. As we know, we are now in a very challenging time. The key in this challenging time is actually the immune system and the immune response and immunity overall.

In this lecture, I would like to touch on this topic more from a Chinese point of view, but also from a research and one of my research that has been just accepted for publication two days ago and have a better understanding on how Chinese medicine affects immunity and how Chinese medicine could be a key player, actually both in strengthening immunity and helping it to deal with pathogens and really, any pathogens, but also viruses and bacteria. This also we are seeing in research, in our clinical experience. I think it’s a good opportunity to go deeper and look at the current situation we are facing from a Chinese medical point of view and deepen our Chinese medical understanding.

I would like to start, first of all, with some relevance to our times, to try to take it from, again, as I said, a different angle. There’s many angles that have been all the time on the news that everybody be talking about. If you look at it from Chinese medical point of view, we are looking at a struggle between two forces. This is the best way to start to address the situation and address immunity and the immune response.

We are looking traditionally at zheng qi, which is the upright qi, which is the summary of all the body’s ability to keep its vitality, and xie qi, or bad qi, which is pathogens that are trying to invade the body, so constantly in life, we have this struggle between these two forces. This struggle is quite interesting because on both sides, we have qi, so we have the same phenomena that we are addressing, but from a different point of view. Chinese medicine doesn’t just look at the body. It looks at the Universe. It looks at how things are functioning.

Qi can be of different natures and here, we look at the body’s qi, which is the zheng qi, and the xie, the bad qi, which is trying to invade the body and take over. This is like a key aspect to this struggle. I would like to put in a chart which, again, takes it a bit deeper into the conflicts we are facing now. On one hand, we have zheng qi. Zheng qi also can represent the immune system, but also something which is deeper, the vitality. From a Western point of view, we’ll talk also about the immune response, the antibodies that the body produces, so this is our immunity.

Then we have the pathogens. As we know, we have different types of pathogens. The pathogens can be damp, can be heat, can be cold, and, by the way, the same, for example, virus can manifest differently in different individuals according to their preexisting condition. For us as a clinician, it’s very important because if we help to clear the preexisting condition, let’s say damp, we know fat people or people with diabetes will have a much stronger response to a viral infection, especially the current one. If there is too much heat, again because this virus is very hot, the heat will even go faster. I think if there is something common, it’s the toxic part, if we look at all this type of invasions.

Then if we look at the zheng qi, the immune qi, or if we look at the body, we have three options. I’m putting it as a large category, but obviously, in the clinic, it helps us to guide an individual case, which can be a mixture or can be not always all straightforward. We have either a good zheng qi, a good immunity, slightly weak immunity, or somebody with a weak immune system. By the way, since I’m treating a lot of cancer patient and I specialize in treatment of cancer, we see a lot of patient with weak immunity, not just due to their disease, but also due to the medicines they are taking. Also, people with autoimmune disease will take chemotherapy or other intervention, Western intervention, that will weaken their immunity, even that initially, they are not with weak immunity, they are now in a state of weak immunity and weak zheng qi.

Then we have a pathogen. In this respect, the pathogen is strong. That’s what we see. If the immune system is good and the pathogen is strong, there can be total healthy response, so people can stay healthy even if the pathogen is strong. If the pathogen is slightly weak and the xie qi is strong, the pathogen is strong, then we’ll get a mild disease. Everything soon will be translated to acupuncture points into clinical usage.

The main problem we have that when the zheng qi, the immune is weak and the pathogen is strong, then we get very fast, serious disease. Fast means also that there is the nature of toxins and wind and heat will dampen it, so this is the condition which is actually in the hub of the problem we are facing now.

Now if we look at clinical approach, then when the immune system is good, you can mildly tonify it, take some herbs. I’ll talk later about my herbs that you can take, but you actually don’t need to do anything. I have hundreds of people calling me, say if your immune system is good, probably you don’t need to do much. You can do something. People, one of the problem is a psychological problem, so a lot of times, when you take something, you also feel psychologically better. Or if you have a purposefully designed prescription which is good for you to keep your health, definitely this is one of the things I’ll advocate, so in this respect, you tonify the immune system or that’s the strategy [inaudible 00:08:40].

In the second stage, when the immune system is weak and the pathogen is strong, actually, what you need to do is to take the heat out, is you need to focus on the pathogens because when you eliminate or reduce the toxicity or the heat or the damp of the pathogen, then the body’s immunity can pick up and can give a good fight and then eventually go out with … You don’t deteriorate into serious condition.

Obviously, the most complicated situation is the worst and the most difficult is the third case, where the immunity is weak. Then you need to tonify or strengthen the immunity and, at the same time, to reduce the pathogen, so you’re kind of doing a dual approach or a dual strategy approach, which is very possible from Chinese medical point of view, but it will require a more complex or more complicated approach or complex approach also, as far as herbs, as far as the acupuncture points that we choose.

Let me take it to a clinical situation. I’m looking at the curve, but from a different point of view. The curve has this area where there is a place for prevention because … Sorry. I’ll just go back to this. When there is a possibility of prevention because here, if the immune system will be good in this area, probably disease will not develop or will develop very mildly. The person will not feel it, so there’ll be some antibodies build up. There’ll be some immune response, but there will be no disease. The second is when there is a full-blown disease and then again, we are treating very differently. The third situation is actually when there is a cure from the disease, when somebody is over the acute phase, the active phase, and is in the curative and getting back to normal situation.

In these three situations, we will use different points. I’ll just illustrate it with some points like from the lung du mai or some of you may use it as a GV or from the stomach or large intestine meridians. If we look at the lung meridian, for prevention, I’ve put lung 9. The yuan [inaudible 00:11:12] the line the earth points to tonify the yuan qi. Yuan qi is closely linked to wei qi. Actually, the way wei qi is build is all the time with interaction of pre-heaven and post-heaven qi. We’ll touch on it a bit later or I will go deeper in other situations.

From the du mai, I will take du 4, the Ming men, again to tonify the yuan qi and stomach 42, the yuan point of the stomach, which also will have a strong effect on both tonifying the stomach, but also enhancing the body fluids and alleviating a tendency for dampness, etc., so all of them will be kind of tonifying the yuan qi and through this, the wei qi and keeping the [inaudible 00:12:00], keeping the zheng qi in large intestine four again, the yuan qi or the large intestine.

When there is a disease phase and there is a lot of heat and a dramatic response in the body, then from the lung, we can take lung 10, the water part, sorry, the fire part, and reduce the heat in the lung. From the du, we take du 14, where all the yuan are meeting and, again, helping to reduce this acute heat building up situation in the body. From the stomach, stomach 44, the water points that will also help to reduce the heat and again, we are doing here a yangming treatment of stomach and large intestine using large intestine 11 and both of them together reducing heat. It’s a strong reduction of heat and increasing or building back some fluids in the body and helping the body to deal with the pathogen.

In the curative stage, we’ll use lung 7, which is the lu point, which will, again, help to eliminate the residue of the pathogens, du 12, which we’ll discuss in a minute, the body pillar, beautiful point to build up immunity and to build up back zheng qi. Stomach 36 we’ll talk a lot about it also later and about research when stomach 36 was used to build up, again, the zheng qi, the correct qi, from many different aspects, and amazing combination stomach 36 and large intestine 10 both the san li points to build up white blood cells and strengthen the body. You can see how three different strategies, three different usage of acupuncture points, are utilized here in order to achieve the best effect in the clinic when we are facing different situation. Obviously, you can cross use points depending on the situation and when on the patient and also, as the patient goes along, obviously, we change our strategy.

Just a word about du 12. Du 12 is called body pillar. It’s just on the line of bladder 11, which is the zhu point of the lung, and bladder 42, which also a very good point to strengthen the lung and the immunity, so all this three points being affecting the lung and the qi and the zheng qi in the body are very important for immunity.

The interesting things about especially du 12 that has this dual action. On one hand, it clears heat from the lung, so when there is heat, it helps to clear the heat, but it also pacify wind and tonify the lung and wei qi. Acupuncture overall has this capacity to be modulating, on one hand reducing excess and, on the other hand, building the deficiency. That’s, I think, the strength of acupuncture, especially because we live in the world is striving for balance. If we have a point that allows the body to reach this balance in a better way, then definitely, especially if we look at immunity and the way the immune system work and modulate itself, it’s a very effective point.

Its indication will have heat in the chest, dyspnea, so there will be difficulty in breathing, sudden cough, etc. You can also actually use even cupping around this area to help people if they have a cough and difficulty breathing and heat in the lung, so all these points can be star points to use.

It’s called body pillar, so I think it needs name. We are studying deeply the names, as well. It kind of tells about this zheng qi, about holding strongly to body and the body’s ability to fight. If you have a strong back, you can easily fight a disease, so body pillar brings the body back this pillar and this upright situation like the zheng qi. It’s also very good in allergies and, especially, allergies when there is stuck heat in the body and there’s lingering pathogenic factors in the body.

This column is also nicely linking between Heaven and Earth, so it’s kind of helping us to stand erect. You know if you want to stand erect, you kind of just straighten this area of the body, opening your chest and moving up this area where this point is. This shows good immunity, but also good stand as a human between Heaven and Earth, having this pillar, which is a human pillar.

I want just to bring something about the history of Chinese medicine. Li Shi Zhen, from the Ming Dynasty, was a famous doctor who wrote the Bencao, which has almost 1800 herbs in it. It’s amazing book about treating disease. At this point, there was a pandemic, as well, and he was one of the first one to point out that during the plague, disease comes through the mouth and nose. In the West, it was discovered maybe 200 or 300 years later. As we know, this is the key to prevent pathogens to go in. To us, it’s obvious, but it took ages in human history. As we know, the most effective part about Western medicine is hygiene, always has been. Chinese medicine has also long history and one of the first one to point out that the entry points of disease would be through the openings in the face.

This is interesting. I mean, I find it interesting that this year started in February is the metal year, yang metal year and, as we know, yang is metal. It’s not just it’s a yang metal, so there is a strong dynamic of yang. I’m not the greatest astrologist in Chinese medicine, but I find it, again, just interesting to see that [inaudible 00:18:16] the hexagram from this year is built from thunder and wind, so everything is about these kind of changes that are coming quickly that are affecting the lung that are to do with extreme situation that move extreme, like the rat. It’s just interesting to note on another aspect, which is some closely or some relevance to Chinese medicine.

One of the prescriptions that were heavily … We get now a lot of research from China and I do believe that by the end of this pandemic, we will be able to analyze better and understand better the role of Chinese medicine in treating a new disease. I believe that there will be breakthroughs as far as both treating immunity and helping recovery, but also preventing deterioration of disease. That’s what we are seeing now from China, so I thought I’ll bring the most famous prescription.

I like it because it shows the complexity of Chinese medicine. You see it’s a huge prescription, qing fei pai du tang. It’s made from different subscripts, prescriptions, so I kind of put it in colors. Ma xing shi gan tang is the first herbs here. Then wu ling san is these herbs, so this wall is more for the shortness of breath, the cold, the cough, and eliminating pathogens from the lung. Shen gan ma huang tang, this is the next one. It’s indicating it again more for phlegm in the lung. Xiao chai hu tang is more for kind of this ShaoYang syndrome, the nature of not just a regular invasion through the [inaudible 00:20:10], but the ShaoYang area. Then some additional herbs to clean and remove toxins. I think we should watch very carefully and deeply the effect of herbal medicine in helping patients during a disease and helping them from deteriorating into severe stages.

We talked a little bit about things that are relevant to our time. I would like to go deeper into immunity and Chinese medicine because the immune system it quite unique. It is a system. I call it it’s orchestrating life. When you talk about immunity, hormonal system, neurological system, they’re all Western terminologies. They’re not Chinese, but they’re talking about a system, about something which is orchestrating, something which is making sure everything is working together. The immune system is actually the most complex one and truly, it needs a lot of time to get to understand it.

It’s different than local systems like if we talk stomach, spleen in digestive system and lung, respiratory, urinary, so here we are talking about local xiang fu kind of engagement in the processes of changing water and food into our qi. Here we are talking about and orchestrating large system that is multifaceted, that has a lot of different aspects that we need to consider when we want to understand it fully.

One of the things we can look at from a three dimensional point of view because we have the wei qi, actually wei and ying qi. We have the jing qi and actually jing and yuan qi, but also the shen qi. Shen qi also means our emotions and the way we feel in ourself and in the world. As we know, the immune system is very much closely related to the mental, to emotional, and to the inner connection to the shen. Many times, especially with acupuncture in the clinic, if you put the right point for the person to enhance the shen qi, sometimes especially for prevention, it will be the key point to strengthen their immune system. When we study immune system, we need to study this threefold kind of situation or threefold co-enhancing qis that are all the time interplaying in the body. Especially when we’re teaching from a healthy point of view, we are looking to enhance wei qi, jing qi, and shen qi on a regular basis in order to prevent disease.

When we look at causes of disease and the way they relate to the different qis, we can see that external disease, I’ll put it also the Heaven, Earth, man model, but external pathogens more relate to wei qi. Internal pathogens more to the ying qi that flows in the channels, and the lack of communication with one’s dao, the lack of being centered in one’s self to shen qi. They’re all interrelated and they’re all part of what we will call immunity.

When we come to treatments or to treat the wei qi, the lung will be the main xiang fu and to eliminate pathogen, we’ll use also different systems like tendinomuscular meridian, divergent meridian. For jing qi, we’ll use more the kidney. For internal pathogenic factors, maybe also external meridians. For the shen qi, the heart and we’ll look also deeper on trauma and how it affects or weakens or distract the shen qi. We’ll look at special points to do with traumas. This is like the complexity of Chinese medicine when we talk about immunology. In Western immunity, we’ll talk about adaptive and innate immunity and actually my research, herbal research was really in innate immunity, which is really the part of us, the first line of defense against viruses.

Wei qi is one of the strongest qi. It’s a very dynamic yang qi. Also, when we look at the Chinese character, on both sides, we have this xing, like wu xing, like in the five elements, like left and right foot walking, so we have some dynamic movement forward, and in the center, again the phonetic qi, but also like a strong movement. Ying qi moves more in the channels. The wei qi actually moves between the muscles and the channels. That’s why it’s very good to enhance sweating when you want to tonify the wei qi and so you actually need different herbs and different suggestion to enhance the sweating. With the sweating, the wei qi comes up.

A good point that I mentioned before, bladder 42 in line with bladder 13 and GV 12 that we talked about. I think the most amazing thing about this point it’s also good for deep exhaustion of lung. There’s been research published in Japan that shows it actually [inaudible 00:25:29] on these points can strengthen and makes the white blood cells, like they increase the count of white blood cells, so [inaudible 00:25:38] on this point is very advisable way to increase immunity on a daily basis.

Since I deal a lot with compromised immune patients, I will touch also on this topic a bit. From a wei qi point of view, we want to tonify the lung and zheng qi, so points we discussed, GV 12, bladder 13, lung 9, stomach 36 is good combination for. For jing qi, we’ll go deeper to ren mai, CV 4, and stomach 30, which is both where the chong mai emerge, but also, it’s part of the Sea of Nutrition. It’s a very strong point. For the marrow because I’m dealing a lot of patients with bone marrow and marrow suppression and these patients needs different care and I teach worldwide, especially oncology acupuncture among other things, so we go over deep in understanding the marrow and how we can tonify the marrow, for example, with chong mai, with gallbladder 39, which is the wei point for the gallbladder. If you are interested in studying further both immune system or oncology, you’re always welcome to go to my website and probably it will direct you to different places.

The last thing I would like to touch on is on some herbal formulas which can be useful for our times and also a little bit of our own research. I’ll do it through ren shen, ginseng, because ren shen is a very unique herb. We know the ginsenosides. We know some active ingredients in it, but we also know its different types, so ren shen as we know, the regular ren shen tonifies qi. There’s also yuan qi and deeply tonifies the vitality of the body. When we treat it to be red like hong ren shen or Korean ginseng, then it’s more tonifying the yang. Need to be careful with people who have already too much heat in their body or high blood pressure.

Xi yang shen is American ginseng. It’s a very different nature. It actually tonifies the yin. Ci wu jia is Siberian ginseng. It’s not ginseng, but it has the word ginseng, so I put it here. It’s very adaptogen. It’s very good also to help with stamina and to sustain situation when you need stamina. Obviously disease and a difficult disease is one of them, but also for people are doing sport, extreme sports, etc, or just tired, so ci wu jia, or Siberian ginseng, will be very kind of immunomodulating adaptogen. Generally ren shen is adaptogen, so we can use it in different situation.

I personally like more formulas than single herbs. Chinese medicine is based on complexity and understanding complexity and using formulas. Yu ping feng san will be the most simple, but also the most beautiful formula. Yu ping feng san, if you look at it, to me, some formulas are almost like the same as acupuncture prescription. They’re almost like a song. It’s like you have these different parts of the choir playing together to create the beautiful harmony, so it has huang qi, which works strongly on the lung the qi, and bai zhu also. It dries the dampness, but also works on qi and spleen qi, so you have the lung and spleen working together, and fang feng, which again stimulates, but also good for the beginning of wind cold, wind heat. It’s a classical prescription that can be modified.

Then there is two formulas that we’ve been studying this one for now almost 20 years and this one, I think, for about 10 years. This one we just recently got the approval for publication. Its last study took almost five years and almost 20 year to finally approve a publication in the good journal, so it’s a kind of long distance running if you do research and you want to publish in a good paper. That’s what it takes. That’s what it needs. I’m happy to be on the spot. I think there’s no shortcuts in research and definitely if you want to achieve something meaningful.

What we have been studying, here we are looking at white blood cells, so when you have the white blood count, when you go and you have your white blood count in Western medicine, you will see that under the white blood cells, leukocytes, you will have five types, very interesting from Chinese point of view. We like the number five. In our research, we are specifically looking at the neutrophils and on the lymphocytes and then subtypes of lymphocytes because they are the one that are key factors in viral, in bacterial infection and prevention.

The subcategory of the here again we see them, but we see them divided into two types, the leukocytes, but the subcategories of the lymphocytes are the most interesting ones, especially the T cells, T-helper cells, and the natural killer cells. When we do study in the lab, we take the blood of patients and also volunteers. We compare both. We take from cancer patients. We take from our staff, friends, whoever is willing to donate a little bit of blood to us. Then actually take sometimes month to three months to work on their blood with the herbs to see how the herbs are affecting it. In our last research, we specifically look at the T, T-helper cells, and the natural killer cells and the neutrophils.

We look at herbal medicine, specifically the formula we were studying and specifically the formula that we were studying the way we kind of I can say adjusted it and concentrated it affected it. By the way, one of the good thing about research is you can play. You can change. You can modify and see which modification works the best, both in the clinic and then you can check it later in the kind of environment of the laboratory that the conditions are the same, so you repeat it and repeat it and so I’m very fortunate that I could do this work, as well.

This is how it looks in the lab. In the lab, you kind of go through a specific assay where you take the white blood cells and you take the neutrophils. You can isolate them from the lymphocytes and then you can look at there at CD69. It’s a special kind of addition you can use. Then you can look at activation. Here we look this is like the control, how active it is comparing to little bit of formula comparing to more formula. We see that the more we are increasing the formula, the more the neutrophils are active, so we see dose dependent, time dependent manner, which means there is something very active in it. That’s how it looks on patients and we did many patients checking out their blood.

It’s [inaudible 00:33:16] so we take their blood to the lab and then we are checking it outside of their body. That’s their normal neutrophil activation and so you can see they are different on each patient. This patient are more cancer patient, so it’s extreme, so it’s lower than the norm. Then you can see once we are adding the LCS102, when we are adding, we call it now Tonix, Tonix-R formula. It activates dramatically comparing to the control their neutrophil activity, so you see this will be the norm and you can see how much it gets more active on that patient.

This here we look at natural killer cells, the natural killer that’s like their name. They are born to kill. They are looking at bacteria. They are looking also on cells, also on cancer cells, the deformed cells, and they are killing them. That’s their job in the body. Again, we are comparing here on the same patient that’s the control. That’s their blood, the activation of the natural killer, and then when you’re adding the LCS102 or the Tonix, Tonix-R. We can see it gets more active and, again, it’s individualized, so in each patient we see a different response. That’s normal. That’s normal with herbs.

This is the ingredients in Tonix-R, so we have poriae, ganoderma, and cordyceps, three mushrooms. They are very researched mushrooms. We are using specific subtypes of them. Then they show significant effect on immunity. From Chinese point of view, they also reduce dampness. They’re also tonifying different aspects of qi. Then for additional herbs, astragalus, atractylodes, lycium, and ligustrum, which, again, further have shown in different research to have immunomodulation effect in increase fatigue, mental function, blood sugar level, leaving enhanced blood sugar level, and liver and kidney function.

This is the formula we have been using. The Tonix-R is one of two in the research that just got accepted for publication. The other formula, LCS101, we are more checking on cancer patients undergoing chemotherapy and the first one, the LCS102, the Tonix was also for healthy people. I use it now. This formula is more for people with undergoing chemo or with suppressed immunity or people with history of cancer or the need of cancer care.

Then again we’re looking at a larger picture, so we need a randomized clinical trial. We look at the red blood leukocytes and, specifically, neutrophils on these patients and then we’re showing that we’re actually protecting the bone marrow. Bone marrow means the jing, so in Chinese medicine, protecting bone marrow is a deep implication in many level. You see people sometimes are undergoing chemo, they go older quite fast, so the jing is reduced. This one we published specifically on the immunomodulating effect. We published at OncoTarget and Therapy also quite a few years ago. This is the second formula and, again, we look at the T activation and natural killer cells activation.

This is the herbs in the formula. You can always look in all the publications, so you don’t need to worry about it. It’s on every publication on this formula or you can always go to my website, which is just my name dot com. Then you will be directed to research and to all the herbs in the formula. We show the further effect just because we’ve been researching for many years in more than seven research centers, including cooperating with Miami Children Hospital, with researcher from MD Anderson. The last publication is actually with one of the renown professors from Harvard Medical School, so we’ve been collaborating worldwide and with different researchers to produce research that shows the multifacet effect of a formula in Chinese medicine.

To me, that’s the beauty of formulas, so in a sense, this formula, to me, can be like a pioneer to other people in the West and to study formulas and their multifacet effect. In this respect, we show the effect to the protection that they top, a little bit about the immunity that I talk about also, a lot of effect on anticancer effect. We look deeper into the … This was in the lab, but we look at the mechanism of action, so we kind of have a better understanding of how a complex formula is working and what’s its potential in human care.

To finish up with immunity and acupuncture points, I would like to introduce stomach 36. This is a beautiful painting. I’ve been doing this project with some colleagues of mine, [Abatos Komininski 00:38:35], Dr. Abatos Komininski from Poland and Ron [Yael 00:38:38] from Israel with amazing painter from Poland [inaudible 00:38:42] where we paint the meridian. This is the stomach meridian. We paint the points. We kind of try to illustrate the nature of the point, so this is stomach 36. You see the three different aspects of the stomach. Actually, this is the three avenues and then sources of yuan qi and the [inaudible 00:39:00]. It’s an Earth point, so we kind of look in deeper into this. We’re looking into the names of the point, one step deeper the alchemy of the poin and lis, one of it’s understanding, it’s cultivating a field of land like on an eight village family kind of, so it’s very much to do with self-sustainability and the ability to produce all the food you need. San has also caused Heaven and Earth, talks about the three aspects of the origin of the yuan qi in the san jiao, etc., so it has different meanings.

We know this point has many effects on the body. It harmonizes stomach, but again, it has this kind of modulation effect because it also can resolve dampness. Its strengths in the zheng qi and yuan qi. It helps to nourish and tonify qi and blood and yin even, so it’s a magical point. For that reason, we have been looking at different research on immunity. I’ll give a webinar, I think tomorrow. A friend of mine will give a webinar. I’ll moderate it. I mentioned him, Dr. Abatos Komininski, specifically on the research, just specific the research and the mechanism of action of acupuncture in modulating and working on immune system.

Here I want to point out there’s been a summary of research with acupuncture point that has been studied both in human and animals and, as you can see, stomach 36 is one of the most researched points both in animals you see 25 studies and 14 studies in human. There’s been a lot of studies on the effect on this point and even kind of trying to understand the mechanism of action, how tonifying this point will affect enhancing natural killer cells in the body through the avenue of the brain and the central nervous system.

I’ll end up with some combination of stomach 36, so qi you can combine it with lung 7, bladder 42, GV 12 that I mentioned. For yuan qi with san jiao 4, the yuan qi, the one point of the san jiao, which would be warmer, and CV 4, and for zheng qi with kidney 27, the last point on the kidney, and lung 9, so this would be also interesting combination for qi, yuan, and zheng qi. I want to leave you with different potential clinical abilities.

I’m going to give a series of webinars actually starting from I think the dates are different, so like two weeks from now. It’s called To Serve & Protect, a bit kind of known thing and so you can go look into it at TCM.AC if you want more information.

If you want to understand better immunity, so immunity is made out of three things. It made out of the shen qi, the body’s qi, and also the jing qi and what you bring to the world in order to keep yourself in great vitality.

Lastly, to say when you’re choosing a point the resonates with the patient’s inner heart and heaven, this is where healings come from. Then you touch the real depth of the person. I will leave you with quoting one of my mentors, Father Larre. “By returning to the classical roots of Chinese medicine, we can make a truly significant contribution to the medicine of the future.”

Thank you very much. Thank you for watching and wishing you the best of health and healing. This is also I want to thank the American Acupuncture Council for hosting this show. I will end this slide and say a few other words of welcoming the next show, so thank you very much and all the best.

Next week on the show, there is Poney Chiang, so don’t miss him. I hope you enjoyed it. Again, I want to thank the American Acupuncture Council for hosting it and allowing us all to enjoy this. Thank you very much. Be safe and healthy.

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Personalized Chinese Medicine Logic or Magic? Yair Maimon

Hi everybody and welcome to the show, The Spark and Evidence of Acupuncture. I am Yair Maimon. I would like to thank the American Acupuncture Council for providing the space and broadcasting this show to you. It’s quite a unique show and I will explain why. I’m very fortunate. I’ve been practicing Chinese medicine for more than 30 years, and in the last 20 years working more closely with oncology patients, so caring very much on how Chinese medicine affects cancer and immune system. Immune system specifically now at this time has another potential or understanding the effect of Chinese medicine on the immune system, especially because of the outbreak of Corona has another interest of how we as humans can protect ourself from viruses. I’ll try to touch it. It wasn’t in my original show, but since part of the research is about immunity, and especially in native immunity, we’ll be able maybe to expand on this burning issue of the Coronavirus and its spread. Welcome to the show. I would like to start with the slides.

As I say, I have this daily dilemma as an acupuncturist, and also working in a hospital, of looking at personalized medicine, because eventually we know that the best for us will be to prescribe a personal formula to a patient. Western medicine has the advantage of researching one molecule or one agent and seeing placebo versus real, seeing if it effective or not. In Chinese medicine, in a way, each person is a whole world and to each patients we are providing a specific medicine. The question is, can we actually test it? That’s why I call this lecture Personalized Chinese Medicine, Magic or Logic? Because if we can put some logic into it, I think we are moving into the next potential of Chinese medicine and integrating Chinese medicine, especially herbal medicine, which is very difficult to integrate into regular medicine. I’ll touch on it a bit. As I say, this is my daily quest and also interest to have Chinese medicine available to patients within the regular system, and definitely for cancer patient or patients who are in a great need that can benefit from both medicines, the Western and the Chinese.

As I said, I’m very fortunate. I’ve founded this research center in Sheba Medical Center. Sheba Medical Center was one of the top 10 hospitals, a leader in medical science and biomedical innovation by Newsweek. It was one, not just in the Middle East, but worldwide, so this very innovative hospital with a lot of research facilities. That’s really, I can say my luck is to be able to also have a laboratory and research facilities and good researchers working with me and taking Chinese medicine sometimes one step forward, or challenging the ability to bring science into what we clinically do and validate it. You see the uniqueness on one side. There is, you can see the laboratory and how it looks. On the other side we have the clinical facilities, and that’s where patients get treated.

My interest is both in the research part and that’s where we provided the Tal Center at Sheba Hospital. We provide also the research and the clinical facilities. Also my deep research is in education, because I believe that one of the most needed thing, especially if you’re practicing with cancer patient or different immunological challenging diseases, we need extra knowledge. Knowledge is really the strength. With this thing in mind, is with the dream and the vision to bring this knowledge to everybody. I’m part of the TCM Academy. You can find also some of the lectures and especially a very specific course which is designed for oncology acupuncture that has an online part and offline, and is unique in this way that provides worldwide ability to understand Chinese medicine for oncology in a very kind of unique way. There’s already like 250 people graduating from this course worldwide. It provides a common knowledge to people worldwide.

As I say, Chinese medicine is personalized medicine. It is a challenge. It’s much easier in a way. There’s always a saying that Western medicine is hard to learn but easy to practice. Chinese medicine is relatively easy to learn but difficult to practice. That’s true, because each patient brings us a different challenge. For each patients we are like almost starting from the beginning, building up a personalized approach for him. We know that each person is unique, and therefore personalized approach is the right approach to provide him a good medical care, but even zebras have stripes, but they display individual stripes. As with zebra, the human DNA is 99.9 similar across the population, but this special crossing for the zebra, but also for us being so different for each other, is just 0.1. That allows us to display our individuals stripes and to be different. It’s quite amazing number if you think of it, but there is, as I said, a lot of power, and there is so much in little.

When we do a successful treatment, we look and I put on the gene level and a DNA level, because on the gene we are different. On the Shen, we have something in common, but when we want to provide a specific treatment to a specific patient, then we look at something very specialized and very personalized. That presents a challenge.

I want to prepare the lecture. Actually, it’s a patient of mine, and this is really where the story starts. As you can see, I like to look at it, she had actually a dress or a shirt with a zebra crossing. That’s how I came across to thinking about zebras in this case. She’s a female, 55 years old, a nurse, married with two children, and she has metastatic adrenocortical cancer with metastasis to the liver, lung and bones. I’ve been seeing her for quite a while. After a while, she had a very stable disease, which was like extremely good health, very stable disease for more than four years. She [inaudible 00:08:24] to the Chinese medicine, also in acupuncture, Mitotane and Cortisone, which were the usual care for her in Western medicine, and the treatment I provided her.

Her condition was stable until it started to deteriorate. When it started to deteriorate, I started, because again, it’s quite unique cancer and every patient is unique, so there’s like two concerns. What will be the best formula for her in this deterioration? I did the regular Chinese medicine diagnosis. I used the four pillars of diagnosis: observation, feeling her pulse, palpating her pulse, looking at her, asking her specific questions. Then I had three formulas in mind to right her. I put it here like formula one, formula two and formula three. I wrote almost three different formulas, one based more on my Chinese diagnosis, one thinking more about research, about different herbs that can be more specific for her cancer and for her type of medication that she was taking, and then another formula, which I said, I’m trying to be a little bit more creative, taking what I see in Chinese medicine and research and combining them together into a third formula.

This really was where my debate was, which formula will be most effective for her? Will it be the first one? I put some just few herbs from each formula as an example. Each formula contained more herbs. I had this debate between this formula one, formula two and the third one, thinking which one will benefit her most once her condition got deteriorated. The question is, since I was in and working in a hospital, can I help Western medicine and scientific testing to verify or to assist in this decision making? Can we use Western technology, and especially laboratory technology, to validate or to assist us in the decision making in this respect for the best herbal formula for this patient, and overall, to see if this formula is effective for her or not? I wondered if we can combine the healing and the part of the healing that is so strong in Chinese medicine with the science and the logic of Western medicine. This is the place where I say, is it logic or magic?

In her case, I was able to isolate her natural killer cells from her blood. This is where you see actually the oncologist taking her blood test from her. In the laboratory we can isolate her natural killer cells, her innate immunity, which as I say, this part of immunity also deals with cancer cells on a daily basis, but is also very important in the fight against viral infections. I isolated her cancer cells. We shared the shared operation. From the operation we took part of her growth and we started to grow her cancer cells in our lab. At this point, we are having in our lab two things. One is her part of her immunity system, her personalized immunity system, and we have her cancer cells growing in two different sets.

On this two different preparation, I started to see if we can put different formulas and see how they react, how her immune reacts and how her cancer cells are reacting to the different formulas. Remember, I was debating between these three formulas. This is called ex vivo. We take something from the patient, we grow it outside the body, and we try things on it. There is human research, ex vivo or in vivo. In this case, when we tried the three formulas, this is the result we got. On the first formula, her immune system got stimulated six times more than the control, so her immune system was six times more active than the control one with the first formula. With the second formula, three times more, and with the last formula, as you can see, two times more. We saw a big difference in the way her immune system responded to the different formulas. We have the first one, second and third. You can see the first one is responding in the best way.

Now the second part was looking at her cancer cells. Again, we are looking at the cancer cells and to see the death rate of the cancer cells. The first formula killed 50% of her cancer cells. This is also the same formula that increased her immune system almost six times more. The second one killed 50% of the cancer cells, and the last one 10%. The phenomena that we see, that the same compound with the same amount, the same concentration, on one hand activates the immune system six times more, on the other hand, it actually kills 50% of her cancer cells in the same amount.

We are looking, because it’s a compound, because it’s a formula that has also anticancer herbs and have herbs to increase her immunity, it works on these two arms. This is very unique. Of course, we don’t have molecules or Western medicine that can do this to action. The most interesting things to me is this is the first formula is the formula I prescribed to her just from the Chinese medicine diagnosis, just sitting in front of her, taking her pulse, looking at her tongue, hearing her story, thinking about the nature of her cancer and prescribing.

It was a kind of very great relief to me to see that formula that we prescribed in the clinic, based on our knowledge of Chinese medicine, had such a strong effect and are better than formulas that we are trying to formulate just from our mind and just from based other research or based on other criteria. Here again, the personalized formula that was made for Chinese criterias was the most effective on both arm. It has also great effect on the patient. She looked at it and results and she felt very happy and content that she’s taking something that she knows that effects her both immunity system and cancer.

But with traditional Chinese diagnosis we go even deeper. We also look at the Shen, which is a bit beyond sometimes the normal consideration, definitely of Western medicine. We want also to see how we can affect the spirit in a personalized way, not just the body. From observation, for example, we look at her eyes. As you can see, this as a picture of her eyes. You can see the fear there. It’s not just the fear of cancer. It’s something deeper that has been there all the time. If you think about it, if her cancer is in the kidney and there is a fear, then addressing this part in her will also aid in healing.

That’s definitely have an effect when we choose a point, like if we choose a point for her, I would choose the points on the chest for one of the points, like kidney 23, which called Spirit Seal, which will have a deep effect on helping her to protect her fear and her heart and feeling more, I can say, strong in herself, not just in the ability to deal with cancer and all the difficult issues dealing her, but also deep side in feeling more content and being more one, that the Shen and the gene or the heart and the kidney are uniting in a good way and communicating in a good way. Her ability to sleep, her ability to deal with the challenges she has will come much more from inner strength and inner peace than just from fear.

When there is a lot of fear there, always to me, both the prognosis is not so good, but also that person’s ability to heal are much more limited. Addressing it also in the herbal prescription, using herb like Yuan Zhi, or herbs that are addressing the kidneys and strengthening the kidneys, which have also some kind of deeper aspect. Deeper healing aspect brings us this, I think, this uniqueness of Chinese medicine of being able to see the patient and finding a prescription formula point which are actually matching the person in a very deep way and allowing and creating a deep healing, which and as we know, a human’s potential is much greater than the physical. This allows us to address it.

To me, seeing this result, and we repeated it with more patients, and the same results, always the formula that was prescribed when we see the patient has a much better ability than the other ones that were like speculated, or at least that I was debating. It was one that I felt more comfortable with according to the diagnosis. The other ones, I brought other criterias in but I felt less comfortable. It’s amazing you bring it to the cells and it shows the same. It gives us much more trust in our diagnosis in our medicine. This personally prescribed medicine, I think to me, and I hope to all of us, brings us much better confidence in the medicine and the way we deliver it on a daily basis.

It also validate the concept of holism that is very strongly embedded in Chinese medicine, that we look not just at the body on the physical plane, but we are looking at the complexity of humans, addressing the body, the mind and the spirit in whatever way you can to enable healing. I think this is one of the strong and most important points that we are making dealing in Chinese medicine in the Western world and in Western environment.

But this testing may have further application. One of the further applications that we did was interaction with her chemo. Obviously the result was a great fear, that for herbal medicine, that it will negatively interact with the patient’s Western medicine intervention, and in her case, was especially the chemotherapy. This possibility provide us again to take ex vivo to check if we can take the formula, her cancer cells, and the Western medicine that was prescribed to her, and see if we see any positive, negative or no interactions. Taxol and Gemcitabine were the two herbs that were prescribed to her. We could see that the chemo alone killed 70% of the herbs. Again, we are looking at a certain amount of chemo. This is for Taxol alone, but when we added the herbs, there was additional killing effects, so not just that it didn’t interfere with the Taxol, at least in ex vivo format, it actually enhanced the killing effect.

With Gemcitabine, we saw same, 85%. We were looking at a certain amount of chemo. Then we looked, when we’re adding the herbs, it’s increased. It was added on effect. Everything we look at in the timeline, so we are checking in during the time in a different concentration, but I’m showing you just time. If I’m picking up the easy results to understand, but everything is time-based and concentration-based, but the bottom line, this kind of potential situation in the laboratory allows us also to look at interaction with regular drugs. As we see in this case, as then I’ve seen in quite many cases in my clinic, the interaction has a much more potential positive effect than danger, as a lot of time is feared. This is definitely another way to start to look at it more scientifically.

What about the future of such testing? Because I hope and see the Chinese medicine has much for interaction with Western medicine in different ways. To me, it brings us a much stronger and broader horizon. There is few options. One is optimizing. I did actually, for her, another patient, I took again these cancer cells for example, and tried different herbs, and to see from the herbs I have, which one is killing more and which one less, and then maybe adjusting the formula accordingly, testing it again. We can optimize formulas. We can add or reduce certain herbs. We can look at interaction with chemo or interactions with other agents that the patient are receiving. We can develop a new methodology that maybe can help us in clinical decision making, create a new paradigm.

Especially at the moment, everything is elaborated, takes sometimes days and weeks of research, but soon can be achieved, can be very simple method that can isolate it definitely from the blood, even circulating cancer cells in the blood, and we can immediately or very fast do tests on them. Things that look today a bit futuristic, when we look at technology in a few years, many things will be possible. To me, it’s another paradigm and another way to think about a potential future and potential interaction with technology and Western medicine, and also discovery of new combination, very effective combination. For the last 15 years, I’ve been researching one specific formula, LCS101. If you’re interested, you can read a lot of published research by us on this formula. By now, it’s probably one of the most recent formula in the Western world. We collaborated with people from MD Anderson, from Miami Children Hospital, even the latest collaboration was with one of the good oncologists from Harvard Medical School.

Once we can show science, it’s very easy to collaborate, very easy to discover new combination to see how they are working, how safe they are. I think this give us the potential to make more and more new discoveries. Obviously, if you want to look more at my research, you’re welcome.

Just to end up, I think that one of the best future possibilities is combining the science of medicine with the art of healing. This combination can open a new horizon, both to cancer patient, but also for almost everything that we look on the level of humans. As I said, for example, now there’s this greatest fear from Coronavirus. One of the most important things is that your innate system, your immune system, innate immune system will be at its best. Then Coronavirus will be as every other virus, you either don’t get infected, or if you do, you recover quickly. Chinese medicine definitely has a potential in enhancing immune system. It’s overlooked in this potential. Everybody is looking for immunizations or other means, but I think strengthening the immune system definitely is one of our strengths and one of the things that we can bring back from ancient medicine into humanity today, and to reduce suffering and help also people to be less ill.

We can trust this path of seeing the uniqueness in each patient, because as I said, as a clinician, you always want to bring more trust in what you’re doing. To me, this research, and as I said, we did it on many other patients and the same idea repeated itself.

I would like to finish with my hero, Sun Simiao, and that’s really a sentence that goes with me always, that, “If the heart has no worries, the body has no limits.” It’s an important way to me to finish this lecture. I would like also to thank people at the hospital and people I’m closely working with, especially Zoya Cohen, Noah Samuels and Raanan Berger, who is the head of the oncology department, and the Jacobson family who provided the fund and the ability to do all this research.

I hope this was of an interest to you. If you’ll have any further question, you can always email me or ask me. I think it’s quite unique to see how Chinese medicine can be verified and validated in many ways. We shouldn’t forget that each one of us is unique and has individuals stripe. Thank you very much for watching it. As the last words, I would like to thank again the American Acupuncture Council for providing this platform and providing this show. Next week there will be Lorne Brown having a show on the same platform, so you’re welcome to watch it. All the very best to you. Be well and healthy, and I wish you all the best of health.

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Poney Chiang Thumb

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.

Please subscribe to our YouTube Channel (http://www.youtube.com/c/Acupuncturecouncil ) Follow us on Instagram (https://www.instagram.com/acupuncturecouncil/), LinkedIn (https://www.linkedin.com/company/american-acupuncture-council-information-network/) Periscope (https://www.pscp.tv/TopAcupuncture). If you have any questions about today’s show or want to know why the American Acupuncture Council is your best choice for malpractice insurance, call us at (800) 838-0383. or find out just how much you can save with AAC by visiting: https://acupuncturecouncil.com/acupuncture-malpractice-quick-quote/.

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.

Please subscribe to our YouTube Channel (http://www.youtube.com/c/Acupuncturecouncil ) Follow us on Instagram (https://www.instagram.com/acupuncturecouncil/), LinkedIn (https://www.linkedin.com/company/american-acupuncture-council-information-network/) Periscope (https://www.pscp.tv/TopAcupuncture). If you have any questions about today’s show or want to know why the American Acupuncture Council is your best choice for malpractice insurance, call us at (800) 838-0383. or find out just how much you can save with AAC by visiting: https://acupuncturecouncil.com/acupuncture-malpractice-quick-quote/.