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Low Back Pain Treatment Protocols – Including DU 1 (Changqiang)

 

 

The point is DU 1. And in my opinion, it’s really quite underutilized. I’ve been doing a lot of research on it just because of the amazing results that you can get when you use DU 1 in combination with other points.

Click here to download the transcript.

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

Hello everyone. Thank you so much for coming to this American Acupuncture Council webinar. My name is Matt Callison. My esteemed colleague, Brian Lau, could not be able to make it. He’s teaching right now. There is a scheduling conflict, so I will be with you before this next 25, 30 minutes or so, discussing a topic that I thought was really quite important.

It’s something that we discuss in the Sports Medicine acupuncture certification program. In the pelvic floor aspect, module two. The point is DU 1. And in my opinion, it’s really quite underutilized. I’ve been doing a lot of research on it just because of the amazing results that you can get when you use DU 1 in combination with other points.

This is also gonna be something that I’ll be discussing in the symposium that we’re. Pacific sports and acupuncture or orthopedic acupuncture symposium coming up in San Diego, March 30th through April 3rd. It’s it’s a big mile fascial point. It makes huge, massive mile fascial changes and it’s a point that I highly encourage for people to to go back and use again.

Many people think about D DU 1 is. Rectal problems or prostatitis or hemorrhoids or something like that. But I highly encourage for people to think about using this point for low back problems, especially chronic low back problems. In the SMACK program, it’s really quite common that people will have low back pains since it’s such a common injury.

I’ll call one of the students up to the front. We’ll talk about their low back pain. It could be a Yon syndrome. It could be sac iliac joint pain. It could be anything that’s affecting their low back and all needle. DU 1, take the needle out and then reassess. They may walk around a little bit and it is often using the 90 percentile.

Reduced substantially. Now of course it’s gonna end up, that pain’s gonna end up coming back just because we’ve only treated one point for about 30 seconds. But the reason why I do that is to show the group that DU 1 is a substantial point to use and it makes Big maas changes an excellent point to use with other acupuncture points for low back pain.

So with that, why don’t we go ahead and get started then Let’s get into the, this first slide here. Again, I’m encouraging using D one into low back treatment pain protocols because of its massive ability to make big changes into the my fascia. All right, so to start with this, we’re gonna talk about the FAS continuum.

This is gonna be some text that’s coming from this article, and you’ll see the reference there at the very bottom, through a scientific review and a comparison of anatomy text. A factual continuum exists between the abdominal. The pelvis being the pelvic floor as well and lumbar wall and such knowledge can improve the understanding of referred pain pathophysiology.

Now, research has shown that deep fascial layers are well innovated and capable of transmitting mechanical forces from a distance. This is outstanding work from Helene Langin in 2002, and she continues to. To publish incredible articles on the efficacy of acupuncture. So what she’s saying is that with mechanical stimulation, like an acupuncture needle, there can be a transmitting of mechanical forces, a signaling along these mile fascial planes for some distance, just like what our founding fathers 2000 years ago knew about manipulating chi and having it actually travel along the channels and the collateral.

This concept of fascial anatomical continuity may have important clinical implications for the treatment of pelvic pain or even lumbar injuries. I thought that was really quite significant. Later in the article, it states lower back symptoms, might find their origin in explanation from pelvic floor disorders.

This new concept could improve the treatment of chronic pain and could lead to an important enhancement of current anatomical knowledge and therapies. They’re being really pretty safe by saying the word could there, from my clinical experience, is definitely a very important thing to be able to treat the pelvic floor, including DU 1 with low back injuries because of the fascial continuum.

In addition to the communication between. Pelvic floor, the abdomen, the multifidi, and the respiratory diaphragm. More in that is just a tick. Let’s go ahead and take a look at some more work of Helene Lango bins

now because the structure. And composition of fascial connective tissue is responsible, is responsive to mechanical stimuli. We propose that acupuncture plays a key role in mechanical transduction signaling, and that’s what acupuncture is. It’s a signaling system, mechanical transduction signaling, and the integration of several physiological functions.

The mechanical stimulation of connective tissue generated by the acupuncture needle manipulation could transmit a mechanical signal to sensory nerves, and as we well. . It absolutely does. Acupuncture needle stimulation that results in the spreading of collagenous matrix deformation and cell activation.

Along fascial connected tissue planes may mediate acupuncture effects remote from the acupuncture needle site, so spreading of collagenous matrix deformation. That’s basically needle technique, inserting the needle and lifting and thrusting being one. And how that can propagate a signal along mile fascial planes as we know them now, what our founding fathers talk about as the channels and the collaterals.

So Helene Lang’s work is pretty outstanding with all of this. So what we’re looking at right now is that we have a connection of the mild fascia and also of the pelvis of the abdomen of the low back, and also respiratory diap. Could we actually go one slide back please. I wanna show you something.

All right, so in this image, and I know the text in there is really quite unclear. That’s actually from the article itself. So it was unclear in the article. And like I said, the reference is right there. I don’t have the ability to point, I don’t have a pointer here, so if you guys could follow me along here, that would be great.

On the right hand side, you can see the abdomen and it’s a greenish turquoise lettering. Around the abdomen. So that’s gonna be scarpa’s fascia. Scarpa’s fascia is gonna be part of the abdomen. Now that green line goes all the way underneath in toward red one and DU 1 area. Now you can see, DU 1 that’ll end up being the A.

So if you take a look at the. A reddish looking text. More on the left hand side, you’ll see the letters acl. ACL is the acronym for Oxid ligament, which is the tissue that we’re gonna be discussing here in just a little bit. That is at DU 1. So you can see here with this representation is that each one of these fascial layers, from the pelvis to the admin to the back and going all the way up to the respiratory diaphragm, communicate with one another.

And this is the important thing is to take away from this is looking at as an acupuncturist, what points can we use for low back pain? It’s just not putting needles into the low back. What else did that? What other tissues does that low back actually communicate? Pelvic floor, abdomen, respiratory diaphragm.

So getting that entire core structure to communicate with one another, using mechanical stimuli of acupuncture along myofascial planes and mechanical transduction signaling. In other words, balancing chi and blood, moving through the channels in order to be able to decrease. All right. Let’s go ahead and skip a couple slides here and we can see where it says core stability, communication in the channels, please.

All right, good. All right, so this is something that I, a slide that I took out of the module two pelvic floor discussion, and I think it’s really quite important just to help to reinforce the communication between the pelvic floor and the other structure. Studies show coordinate a strategy in which all abdominal muscles, pelvic floor and the respiratory diaphragm are cod in order to control the Indo pressure and fascial tension.

They work together. There’s communication with all of these. They work together. Research shows that he, so that should be the stimulation of efferent nerves to the pelvic floor muscles when the pelvic floor muscles were activated. Created a reflex of co contract. The respiratory diaphragm and also the transverse a dominus showing a coordinated communication between these structures.

So again, with transverse a dominus, often being very weak in cases of low back pain, how important it is to be able to treat pelvic floor, the low back, the abdomen, as well as the diaphragm. And many times acupuncturists are like, for example, treating the Watto GI points, you’re gonna be stimulating the multifidi and the multifidi interdigitates itself.

With a trans or subo, we could be treating the diaphragm through U B 17. And in the smack program we talk about stomach 20 as being influential point for the diaphragm, especially on the right hand side. Then also in the pelvic floor, there’s many different points that we can use to affect pelvic floor muscles.

And in this particular presentation, I’m gonna emphasize. Treating DU 1 because it is a core point, a foundational point for the dui, and it does affect many of the mild fascists that we’re discussing. So let’s go to the next slide, and let’s get right into the aox ligament, which is the tissue of the aox ligament.

Tissue of DU 1. So next slide, please.

Oops, I think we went too far. Sorry about that. Can you go. . Yeah. Thank you. So the anaco ligament is also referred to as the postnatal septum. You’ll see that in some of the research page papers. Anaco Rafe, which actually has its own definition, and also the anaco body. So you’ll see all those different terms.

Speaking about the Anaco, Now the acl, that’s what we’re gonna refer to from now on. The ACL, can be described as a myo, fibrous, thick connective tissue located in the midline of the body, in the floor of the pelvis, right?

The ACL connects as a RA tissue with bilateral slings of the levator anti. So a RA tissue is going to be where you have a communication. You have a tissue on one side, tissue on the other side, connected by this tenderness, connective tissue, or also a ra. For example, the later RA in the low back, right next to the quads, lium.

That will then be like the Segway tissue, a RA tissue that connects into the. In this particular case, it’s looking at the aox ligament where D one is as a RA tissue where the bilateral slings, the lava anti, in particular the IOC Oxid, the pubic al and the pub erectile muscles go in and interdigitate right into that aox ligament.

Where DU 1 is located. In addition, the Coxs muscle also has fibers that interdigitate with the acl, which is really quite important. The ous muscle is something that we need in this MAP program all the time for Sacred I problems. So the combination of using DU 1 with the Coxs helps to reinforce that treat.

So on this image here, if you can see on the right hand side, you see the letters acl. That’ll be the aox ligament. So you see the C there. That’s gonna end up being your Coxy. Right next to the CO is the cm. That’s gonna be your Coxid GS muscle. That muscle. The pelvic floor is going in and attaching underneath the coic and it’s going interdigitate itself with the acl, right?

So then you have to the left, almost in the middle of this image is the la so that would be your Lior a I. So those fibers right there are going to be your cubic coxin chill, your pubs, and your ICOs, like I said, which interdigitate with the acl. Where DU 1 is located? All right. Let’s go to the next slide, please.

The anaco ligament has two distinct layers to it, which is something that you can actually try to think about when you’re needling into it. That helps with the depth aspect. So the Anaco Li with these two distinct layers that connect to various faial layers, including the posterior layer of the thac lumbar fascia.

Very important because the thac lumbar fascia is often where pain will be generated around the Yon region and also P gun region. So the anoxic ligament can connect with this poster layer thera, lumbar fascia, as well as internally to the endo pelvic fascia that’s gonna surround the pelvic bowl and the regional organs.

Now this endo pelvic fascia has links to the transverse Alice fascia, which is part of the transverse A. It’s all connected, and this is what my point. So number one, the superficial fibers span this, again, we’re talking about the two different layers here. So the most superficial one, superficial fibers span originating from the fibers of the external anal sphincter or the EASs, right?

So we know about that, and running upwards to the coex is going to be your superficial acl. So when you’re. Palpating this, you’re gonna be feeling that superficial ACL with a deeper palpation. You’ll be pressing into the second layer, which we’re gonna be getting into in just a second. So this superficial layer joins the fashion ligamentous attachments on the poster aspect of the coic and sacrum.

So you can think about that when you have a sacred iliac joint problem, because it’s gonna be continuous. This fascia continuous from the superficial layer going toward the sac iliac joint. And as we talked about earlier, by stimulating with mechanical transduction stimuli or needle technique, very light needle technique, cuz it’s gonna be DU 1, it will still be communicating with other aspects of that fascia.

The superficial ACL joins the SAC tubs ligament, which is gonna be another G wire for the sacrum. Excellent for sac problems. And it continues into the glut maximus, which is a major stabilizer for the low back and posterior layer OFAC lumbar fascia. Extremely important. So let’s now go to the other slide, please.

Let’s talk about the second one. This is now the deeper layer. So the second layer is a deep fiber fibrous band. It’s gonna be, it’s gonna be thicker than the superficial layer originates from the anterior periostin of the cos, right? So the anterior aspect of the coic superficial one is going more.

Superficial aspect of the coic, which then can go ahead and spread. Let’s see if I can do this a little bit better here. So then can go ahead and spread along the ligamentous tissue, the glute maximus, and into the thal lumbar fascia. Let’s go back the D one now, the deeper. Part of the anaco ligament is attaching to the underside of the coy right here, the pre sacral fascia, and that pre sacl fascia directly links into the endo pelvic fascia.

So let’s look at this slide here and we’ll talk about a more.

All right, so then this layer is referred to as the deep acl. The deep ACL directly connects to the endo pelvic fascia and the bilateral slings of the La Vader Antiox. Yep. Like I said, the pelvic floor is gonna be interdigitating with that antiox ligament. This deeper layer is gonna be communicating with the fascia that surrounds the pelvic bowl, holds the organs in place, the endo pelvic fas.

DU 1 is a remarkable point in its ability to communicate with lots of different tissues. All right, let’s go to the next slide if we could. Let’s talk about the function of this ligament. Now in this histological study, the anaco ligament was found to be abundant in smooth muscle and elastin fibers. So what does that mean to us?

When an acupuncture needles going into D one, you’re now tapping into the autonomic nervous system because of the smooth muscle and because it has alast in fibers, we wanna make sure that those elast in fibers are going to actually be up to par, that they’re gonna have still their recoil. Much of the skin in our face has elastin, and with age, obviously it starts to droop.

If we can be able to stimulate these elastin fibers and then provide exercises, for example, keel exercises to help to restore the 10 saity of the anoxic ligament, that’s gonna go a long way in the successful results with low back pain. In addition to lower J is harmonies. So during activity, the anaco ligament will involuntary, shorten and tighten.

It adapts to the. And is responsible for absorbing and transmitting forces generated during movement, and that’s gonna be within that pelvic floor. It also functions to support the pelvic viscera and when the lader anti contracts. The ACL that should be ACL pulls the vagina and rectum forward to maintain urinary and fecal continents.

Weakness of the lava or anti causes sagging of the anticoag ligament, which therefore decreases the A cell support of the pellet floor, which is gonna be very important. This sagging increases the probability of urinary continents and constitutes a predisposition to pelvic organ prolapse. I was at a. A gathering of people, and this was in new.

And we were talking about some different things that people had. And this woman said that she just had a childbirth gave birth to a child, and it was about a year and a half ago, and she said she was still getting some urinary continents with that and, I didn’t have any needles. There was not any acupuncturists where she lives, so I just asked her to go ahead and stimulate, DU 1 numerous times per day when she could in privacy.

And she emailed me back a week later and she said how remarkable it was that her urinary continents completely changed and she’s much better. Just, that’s just with acupoint pressure at DU 1. So again, it’s a very incredible point. Its integrity, D one’s. Integrity is vital and defecation and maintains continence and sexual function.

The antiox ligament is clinical significance as it contributes to maintaining the integrity of the pelvic floor muscles as a dynamic anchor for stabilization. Okay.

All right, so let’s get into the actual location of D one. In the acupuncture books, it’s, there’s two different places that I have seen it located. One location is just underneath the tip of the coex. That’s where some people will put it. I think the better place to put it, and this is where actually you’ll see more of this description is halfway between the tip of the coic and also the anus.

Are the indications, common acupuncture, books, diarrhea, bloody stools, hemorroids, so like rectal problems or lower jaw. Problems. Prolapse of the rectum? Absolutely, because antiox ligament will also be prolapsed. Constipation is a possibility there. Prostitis, and this was interesting. Not all books will have pain in the lower back but some books do, which is quite interesting.

Also you can use this to help with the she in manic disorders. Traditional actions as we know it’s gonna regulate the dui. It’s also gonna regulate the Remi resolves the damp heat that would be part of the diarrhea and such, and it calms the mind. It is an anchoring point, as we know it’s a low connecting point of the dui.

And for traditional acupuncturist, low connecting points, we know helps to open up the channel, right? So when there is pain in the channel, we use the low connecting point and that helps to open up the channel. Decreases pain. It’s also the crossing point, of course, do my with Remi. So it helps to be able to regulate the yin the master of the yin and the master of the young.

There’s a crossing point for the kidney, which makes sense because the kidney is part of that pelvic floor, influential of the pelvic floor. It’s also a crossing point of the gallbladder, which is I found real interesting. And there are some fascial correlations between the pelvic floor and the tensor fascia.

Lata. So think about it when somebody is coming in with L five dermatome sciatic pain, and you do a straight leg graze and you do see that it’s actually gonna be coming from the low back and it’s traversing down the dermatome of the L five, which would be your gallbladder channel. This would be an excellent point to use in addition to your wato Jaji points of L four, L five, tensor, fa, gallbladder 31, gallbladder 34.

Again, DU 1, would be like an opening point, an anchoring point, a signaling point for the rest of these points, DU 1 is an anchorings, a great. DU 1’s a starting point of the dui, obviously, as we know. And so we know that starting points are very powerful, where the kidney y energy emanates outward extending itself along the dui.

So since the DUI controls the Y of the body as we know this point, as the name applies, promotes the body strength and vigor. All right, so personally I like to use acupuncture to DU 1 when they’re in a prone position, and I know many people were taught to use in a sideline position that can work as well. What’s unfortunate about the sideline position? Is that you’re gonna be limited to what points you can include with it because the person’s gonna be in the later recumbent position, whereas the person’s gonna be prone.

It lifts the pelvis up using pelvic blocks. If you’re familiar with using pelvic blocks, it works extremely well. Helps to take away pelvic fascia tension just by reducing the anterior and the posterior pelvic tilts. If you don’t have that, then just a pillow underneath the pelvis will help Substantial.

This is gonna be something that you also wanna talk to your patient about, that this is a point that you want a needle. I find that if you ask the patient to palpate it themselves, they start to understand where you’re gonna be going with that. You can use some information if you like, from this seminar to help to build your case, why you want to go ahead and treat.

DU 1 for this person’s chronic low back pain. It’s always a good idea to have this conversation before you actually start needling them just in case they need to use the restroom and prepare themselves or the area for cleanliness. Okay. So then we wanna locate and treat in the prone position.

Using pelvic blocks is always a really good idea. What I’d like to do is to use this as one of the first points. So I’ll crossfire the aox ligament. I’ll go ahead and locate the coex, and then find the axid ligament I’ll crossfire so I can feel left and right sides right. And then go ahead and press directly right into the anoxic chill ligament and feel for the most tension.

Now the most tension usually is gonna be going superior toward the head, or you can angle it ever so slightly underneath toward the cosics. Now, some people go this way. Some people will go up into this way to get really get that pre sacral fascia and I think that can work. When I’ve done that, I’ve caught, I’ve caused sharp pain more than twice, so that’s something you may wanna consider with that.

I think we’re actually starting to miss too, maybe some of the depth of the two layers of the anaco ligament. So going in toward the head or slightly upward, I find actually makes the best mile fascial change. With this. All right, so perpen needle insertion, three quarters of an inch to an inch and a half is gonna be totally fine, and the reason why is because going from the skin, then you’ve got subcutaneous tissue and that’s gonna be your superficial and your deep fascia, which is highly innovated in that region.

Once you get past that, then you’ll start to feel the actual layer of that, of the acl. From there, go ahead and insert into the ACL into. Thickest most tender spot. Okay, so cautions advised, do not needle past the acl, or an anterior direction to the close proximity of the rectum. This is something that you have to be going way too fast.

For doing that. So you wanna make sure that your palpation tells you where the ACL is and what’s the depth of it going. An inch or an inch and a quarter is totally fine with most people. Not a problem whatsoever.

All right, so let’s look at DU 1 point combinations with this. These are just suggestions, you guys, because of its potential to communicate with many pertinent structures affecting the low back. D ones an excellent point to combine with other low back drawing thigh and abdominal acupuncture points.

So the following’s gonna be some point combinations to choose from. The pharmist motor point is gonna be excellent to use. Usually that usually will have that bilateral for sac iliac joint problems. It’s part of the poster support for the pelvic floor. So DU 1 with the pure performance is useful.

DU 1 with the cos because those fibers do communicate with one another. That can be extremely useful as well. Personally, I don’t use preforms and cos at the same time. It’s just a little bit. Too much for the patient. It just depends on what we’re actually trying to treat. Extra point yon, which we’re treating quite often with low back pain that comes in quite a bit with a iliac crest syndrome or Yon syndrome.

That pain that’s right on top of that iliac crest. Using DU 1 with yon because there’s a direct communication between the superficial layer. Of the antiox ligament and the posterior layer of the thac Colombar fascia where Yon lives. The SAC tubs ligament, again being a G wire for the sacrum. Useful in SAC iliac joint pain.

That also connects with D one, so DU 1 and the sac tubs. Ligament is a nice combination as well. Dew one with go bladder 29 can also be useful. You can still need a Goler 29 in the prone position with blocks on. It’ll just be more of an oblique. Type of angle. And of course when you turn the person over and you’ve already treated DU 1 in the same treatment, you can treat rec ado the transverse ado also the obliques because they help to also signal with DU 1.

So it’s a really nice combination. Is DU 1 as your founding point in addition to the rest of the points, cuz they all communi. All right, so this was a very quick webinar. This hopefully enlightens you a little bit and excites you to be able to use DU 1 and to communicate with your patients why you want to be able to use DU 1.

There are some references, I believe on the next slide. That you’re welcome to go ahead and collect there. This is just something that I’m happy to go ahead and do. There’s a lot more elaboration with needling. DU 1 and practice that’s gonna end up being in the SMACK program, but also, like I was saying, it’s gonna be part of my lecture on March 31st, 2023.

In the So as symposium that lecture is gonna end up being big points that move mild fascia that cha makes mild fascial changes and DU 1 is definitely within that category. Thanks, you guys really appreciate your time. I hope this was really useful for you. And I wanted to thank the American Acupuncture Council for having me.

This was really great and I believe that’s it for now. We’ll see you next time. Thanks everybody.

 

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Yamamoto New Scalp Acupuncture with David Bomzon

 

 

Our show for today is because I became very interested in Yamato’s new Scalp Acupuncture, and I heard great things about it.

Click here to download the transcript.

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

Welcome to this week’s American Acupuncture Facebook Live podcast show. I’m your host, Poney Chiang of neuro-meridian.net. I’m joining you today from Toronto, Canada, and today my guest is David Bomzon. And David is a Chinese therapist and lecturer who specialized in acupuncture in neurological rehabilitation, and is considered to be the leading authority on rehabilitation acupuncture in.

David graduated from the East West College of Classical Chinese based in Tel Aviv, Israel in 2006, and is a former student of Dr. Toshi Kasu Yamamoto, the discoverer of Yamamoto new scalp acupuncture. David. Together with Avi Amir, established the NEMA Center in 2007, which is the largest community clinic in Israel for integrated Chinese medicine, which combines classic Chinese medicine.

Yamamoto New Scalp Acupuncture with Western Medicine. He also established a unique support center at the NEMA Center, which provides continued professional enrichment as well as professional guidance to new graduates and experienced practitioners in the field of complimentary medicine. David is a lead acupuncture in the rehabilitation department in the Benig Zion Medical Center in Haifa.

And David is involved in clinical. Which is investigating the benefit of Y essay in neurological rehabilitation in 2020. Together with Avi David published the book entitled Clinical Handbook of Yamamotos New Scalp Acupuncture. Throughout his career as a therapist, lectures and mentor Deborah has published, has pushed for the integral combination of acupuncture, Chinese medicine, and scalp acupuncture.

And the reason why I’ve invited, To our show for today is because I became very interested in Yamato’s new Scalp Acupuncture, and I heard great things about it. So David, welcome. Thank you for sharing your time with us today and and how are you doing in are you in high far right now?

No. Hello Pony. Thank you for inviting me. I’m I live, I’m not far from my home. I live in the Galilee. I’m 45 minutes commute from. . Okay, great. Can you tell us about Dr. Yamamoto how did he research and discover this form of acupuncture? Dr. Yamamoto is an amazing amazing European amazing person.

I learned a lot from him. He actually started at he special. He didn’t come from the field of acupuncture, and he started actually on the field of anesthesia Anology. He studied anology. He finished in Japan. But in his travels, he traveled to the United States, and then he was in Germany for a couple of years.

Years. But then he, after a few years abroad, he came back to his hometown nana, where he opened the practice and clinic for. Pain management and basically with one of the patients there, he found himself stumbling onto the world of acupuncture. Due to, he says it was an accident, the kind of an accident that he had of a patient that when his patient had a lower back pain with disc and when he looked for an sensitive area to inject the neuro block, he was injecting Lido.

He gave her injection, but he only injected the cell line to the patient. And the next day when the patient came back, he was pretty sure he would be sued for medical malpractice. Cause he only realized in the evening of that day that he never injected any medicine Okay. And act. And actually she came to thank him and say that the pain was gone and she feels amazing.

And that was his first kind of encounter with Acupunc. and then he started studying for himself acupuncture. He was very much influenced by the idea of microsystems. He learned nasal acupuncture or Rico acupuncture, suzu, which is the hand the Korean acupuncture of the hand. And when in 1970, he, when they first published about the GI style scalp acupuncture came out, he went and he studi.

And he started using it in his clinic. He said it took him a while to really specialize and get the results he was looking for with the GL style. And then he basically, if we familiar with the G style, you have the motor and the sensory lines of the area of the ELOs area. And when a patient came to this clinic that was suffering actually from a shoulder pain, like a frozen shoulder.

And actually he had his head when he was looking for the points, he had his hand roundabout here on the patient. And this area is very tender for that patient. And when he pressed down on it, sudden the patient felt some release of in his shoulder and there was more mobility in the shoulder with yours.

That’ll become yamamotos, first point he ever discovered. And then Yamamoto is very curious. Very imaginative and always looking for the, because of the influence by this mirror reflection and the microsystems, he started searching for more points on the area of the scalp for treating different areas in different parts of the body.

And he actually started connecting the dots between the Chinese scalp, acupuncture or even D 24, which is a point that affects the mind. Okay, so D 24, we know it affects the mind. And he said, okay, if I have the mind here and the head, then slowly, if I go down, On my hairline, I’m gonna discover more and more points.

And then he goes to the area of the shoulder, which was the area of C, and slowly discovered 5, 7, 8 points. From that, the whole system developed to about today there’s comprises of about 60 points, I think, which is divided into different somatotypes and microsystems in a large microsystem system.

So that’s how we discover. Okay. You might, you mentioned Somato. Is that one of the underlying principles of wine essay or is it possible to generalize? You mentioned Microsystem any my understanding is that they, there’s actually several microsystems in this system there, several Somato Topes.

Can you comment about just introduce the US to sort the jet the broad strokes of the system. So we have, it’s, Yamamoto always mentions that his system is more of a microsystem. Which is divided into little groups of somato tops, which the first group is like the basic points, which is very as you can see, points that affect the body, like the physical structure of how western medicine sees the human body.

The next group is like brain points, so you can affect, the idea is to affect the brain in some. Some manner, but those brain points do not like that. You don’t match the neuroanatomy of the areas of the bone or the anatomy of the brain. Okay? So that’s the second group. And then you have what’s called the ipson points, which is another group of points, which actually is here is the connection to the organs and the channels.

And then you have cranial nerve points, which is actually a mixture of the Ipsy lung points with the brain points from my. All these just little microsystems that developed with the yours that not necessarily, some of them are on the scalp. He has like a microsystem on the, around the Mals area of the foot, but on the cervical of, sorry, on the spinal cord.

He also has a Soto top, the chest area. But the idea is always looking for different areas to affect different parts of the body. And you really see it in his practice that he’s always trying, Be very open minded and if something doesn’t work, he’s always gonna look for something else. And this is why.

Kept on discovering more and more points. . Okay. What type of patient would you say best benefit from Y nsa? First of all, I forgot to mention that Yamamoto style acupuncture is based on palpation based acupuncture. You have also spread out throughout the body diagnostic areas that tell you which group of points, which points to needle and which areas to needle.

Forgot to mention that. But the patients that benefit from Yamamoto scalp acupuncture, also from clinical research at the Doctor Yamamotos done, and also from research that I’ve been doing in my practice. Mainly, first of all, pain patient. It’s very good instrument for managing pain management. So it’s fantastic for that.

And this is what it was developed for. But also I found, and also Dr. Alo for different types of neurological disorders. It could be stroke, Parkinson’s, like I work also in a Parkinson clinic in the rehabilitation center. We found it very useful. It’s a special point for Parkinson. There’s also multiple sclerosis, any orthopedic car accident or nerve damage to the spinal cord.

So it’s very diverse in treating neurological problems and pain. And in rehabilitation, the advantage is that once you needle little scalp, you can do, the patient is mobile to do his activity or his practice. So actually you’re getting like one plus one is worth two, is two and a half, three.

So that’s the advantages of it. So let me just backtrack a little bit. So it seems like one of the things that’s different is that it’s very how patient informed. And and I’m I’m very pleasantly surprised to hear that Dr. Ya Moto has anesthesiology background and has studied gel style of Chinese scale acupuncture.

I have found that in my encounter with western medical practitioners that have interest in a acupuncture, a lot of times they come from I’m more likely to see anesthesiologists and neurologists. Being more open-minded towards acupuncture because they work the nervous system. They understand pain from a neurological perspective.

And so I’m pleasantly, happy to hear Dr. Yamamoto brings the neurological understanding and perhaps that’s why the system works so well for neurological conditions now. Is it possible for us to give you, give us a little bit more understanding as to. The young public acupuncture might is different than gel style or any other form of c acupuncture that that you’ve encountered?

I know there’s not, there’s probably some similarities. Just for the interest of the listeners who may be interested in learning to teach Yamamoto style, maybe they already learned J style and jazz style. Why should I yet learn another? If you can comment on that.

I’m also familiar with the juice style and GI style. I also use it in the hospital. But I found that one of, one of the things that first of all he always mentions that his system is more of a microsystem. And it’s less like based on the he or the anatomy of certain areas of the brain. If you go words like GI style, if you look, if you go deeper research into GI style even you, I think I watched the video of yours pony that you spoke about, let’s say the core line which has with the pre motor area of the brain.

Yeah. So it’s actually based on the neuro anatomy in general. The. J takes it also to the understanding of a Chinese diagnosis, which is important. And Yamato, if you look at the areas of the points there, like not much of the points in the zones match the neuroanatomy of the brain. , or if maybe if we dig research and found more discoveries about the brain, we’ll see that there is some type of batching of that idea.

So that’s the first difference. The second. The second difference is, so also the needle inside is not usually contralateral or lateral. Usually it’s the side that is chosen is according to the diagnostic zones that are, or in the abdomen or in the neck or in the elbow area. That tells you which side, which points need to be needle.

So that’s also a big difference between the Yamamoto and the Chinese scalp acupuncture method. And also the needle in technique is very different if in the scalp acupuncture, you have to have a thread in motion and then you gotta basically manipulate the needles could be dwelling or even pumping.

Yamamotos style is more acupuncture points. So actually you just, you need all the points perpendicular. , it’s not necessary to stimulate the points. And I once asked the Yamamoto, you need to needle the point, the stimulate the points. No, it’s not necessary to manipulate the points. Cause any movement of the mimics is actually moving the fascia below that the needle in that is actually causing the stimulation that you need.

So that’s one of the, another great big difference between it. So you could say, in some cases for us, whoever starts out, it’s more friendly for the patient until you become very specialized with the Chinese. So that’s very useful for us to know. A lot of the scalp acupuncture systems in particular the Chinese ones require you to have your own TCM or Western biomedical diagnosis.

Sounds like Yamamoto style has its own system of diagnosis. And and I actually. To, like hearing that the kneeling does not require a lot of stimulation and a lot of threading because that generally is a bit more uncomfortable. And if you work with children, let’s say if you work with cerebral policy or autistic children you wanna do it fast.

And just, put the needles in so that there’s less fuss and better cooperation with children. So I can see how the YAMA model style might actually be more practical in, in, depending on the type of patient demographic that you’re working with. Would you be able to give us a a clinical story or something that, you was maybe memorable in your experience applying Yamamoto maybe early on when you started doing this for the first time or in your rehabilitative work right now?

Something that like, really even for me, I practice a long time, but I still get like amazed and find acupuncture miraculous every day. Inspires me, please share with us something of that nature with Yama style that you felt you really changed some patients lives. So the story goes back I’ve been practicing acupuncture from 2007, so three years in Yamamoto from 2009.

And when I started out in my early time years of Yaba motto, I was actually called to come to a house, call on a patient who had a stroke. We’d speaking about five years after the stroke, and he had aphasia, motor aphasia. , and he’s around 80 at that time. And actually what they wanted me to try and treat, they heard that scalp acupuncture is very useful for aphasia and if I could come and try and help him.

So I decided I went to help him. Now, one of the things that the patient. He also had some paralysis of his shoulder, of his upper extremity of, I think it was the, if I remember correct, it was the right side. So if he was standing, his hand was like down here. He could’ve moved more than this of his hand.

So I came to I came to do the treatment and I’d done my diagnosis, I needle. Actually three points. One was like what’s correlated with the cerebrum and the cerebellum points according to, because of the diagnosis. And another point the area of actually the cervical spine. Cause you have the diagnosis.

And I think immediately after about the three needles, I said, okay, let’s see if you can speak. A lot of times the speech takes a long time to impair or improve. So I wasn’t basing myself on the speech. Just move your hand a bit. And he took his hand right up to his mouth and he just bursted out crying, right?

And this was, and I was like trying to keep my cool and say, oh, it works. But I was totally amazed. Like I was blown away, said Wow. And and that was a story with this patient that we just con and. Speaking five years after a stroke that he’s never moved, his hand moved more than maybe two, two to three inches.

Right? And now takes it up to his hand so he could even now attach a prop for him to eat now. , he saw as a mace, like that result. Wonderful. I’ve always like to ask them, my guests to share a couple of clinical pearls or techniques. I know it’s a very complex in depth system, but just to get, our viewers interested, inspired to maybe take up proper training in Yama style someday.

Some give us a couple of tricks that we can apply maybe. This AF today or tomorrow so that we can see and appreciate and admire the power of Yamamoto staff acupuncture. Okay, great. I’ll be thrilled to do so what some of the points, if you don’t wanna use diagnosis, you can use very much symptomatically and they amazing points and they have an amazing result.

The first point is actually what’s called the D point. Is located on the interior hairline. Okay. If you can show me the image. Okay. The first image, Alan sorry. One minute. Something’s knocking loud at the door. I wanna stop them a second. Sorry about this. And he’s saying it’s

And ready. Sorry about this. We’re meant to finish. My son’s calling me. So if you can see the D point here in black, it’s on anterior hairline. It’s very, and it’s about a centimeter above the zygomatic bone, okay? And it’s very powerful point for treating lower back pain or any problem of the lower extremities as well.

So it’s a very good and useful point that you can use in your clinic already. So this is how it easy, you can see the bone structure there. If we go to the next image, Allen you can see this is how it is with the ha of the hairline. So you can see it’s right on the hairline, it’s on the interior hairline and about a centimeter above the zygomatic bone.

And what you wanna do here is look for a very sensitive point and then needle that sensitive point. Okay? So that’s how much, how deep insert. Not not more than not more than a soon. So you’re looking between half a soon about insertion. Okay. Okay. But you can even help, you can even palpate it and push pressure on it and ask the patient to move around.

And if it’s better or the back, you just needle that point. It’s another way you can locate it. So that’s first point. And no simulation, just, and do you retain for, is it in and out or do you retain for some time? 30 minutes minimum. Okay. You can leave it fall per longer. The next point is actually what’s the a point, which is right here just on the line of the bladder channel, bladder three around bladder three area.

If you can see the image here in blue. Which on the line of the bladder three area, which is, let’s say the hairline, that’s gonna be the area of cervical. Cervical three. Four. And if you go about one centimeter up, you’re actually going up towards the head. So the superior part is about the head. And as you go down with that line, you’re going down from cervical one down to cervical eight, which is about a centimeter out of the hair.

And also you look for the most sensitive point on that line and you needle it. And if you need a couple of points, you can needle a couple of points, and that’s very useful for any cervical pain. Okay. Do you how they bilaterally? Just see which side is the most tender. Because we are not using the diagnosis here and we basically using it according to the symptoms, so you need a lot on the side that you have symptom.

For example, if it’s on the left side, you’re gonna need all these points on the left or on the right side. The same with the D point. Okay? And so they’re very useful and I hope you have great success for them and found yourself in charge and enchanted by this wonderful method and this wonderful human being.

Yeah, it sounds like it’s very practical and very easy to apply. And then so I’m gonna look forward to to trying out today. Unfortunately that’s all the time we have. Can you tell us some information about where we can find out more information about you? Do you have a website or social media?

So this is my website ww doma ac.com. So you can found a lot of information there. Also on healthy seminars, I have a online course, so you can go there. You can follow me on Facebook, YouTube, just print my name. And if you take my, I have a a Facebook page, which is actually just the pnima-ac ac and that you’ll get to my Facebook page as.

Excellent. Thank you so much for generously sharing your time with us and being so kind with your, sharing your knowledge and and I look forward to studying Yamamoto style with you in the near future. Hope so soon. So an honor to meet you in person pony, online person, . Yeah. Finally, after so many years, I’ve been following.

The the admiration is mutual. Thank you very much. Okay. Enjoy and what connects soon. Yeah. Thank you. Have a good evening.

 

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Microneedling for Hair Loss

 

 

So what I’m going to talk about is the different topics I’m going to speak about today are the different types of hair loss and how microneedling is within our scope of practice of Chinese medicine, and then how it can stimulate hair growth.

Click here to download the transcript.

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

Hi, my name’s Michelle Gellis. I am an acupuncture physician and I am the founder and president of Facial Acupuncture classes. I would like to thank the American Acupuncture Council for this opportunity to speak to you today about microneedling for hair. Can we go to the first slide?

So what I’m going to talk about is The different topics I’m going to speak about today are the different types of hair loss and how microneedling is within our scope of practice of Chinese medicine, and then how it can stimulate hair growth. And some protocols for microneedling the Scalp. So I teach a one hour CEU class on this topic.

So you you’re getting like a little snippet, but I wanted to do a nice overview for you on microneedling for hair loss. So a little bit about me. Taught at the Maryland University of Integrative Health from 2003 to 2021, and I am currently on the doctoral. I’m on faculty at the doctoral program at Yoan University, and as I mentioned, I have been teaching facial and cosmetic acupuncture classes internationally since 2005.

There are many different types of hair loss and in general terms, some are due to stress or illness and So I’m just gonna go through the like the Western medical differentiations of different types of hair loss, and then we’ll talk about how we differentiate in Chinese medicine, the different types of hair loss.

So in Western medicine we have male and female pattern. This is Androgenetic alopecia, and this is the most common form of hair loss that we see for men. It’s either right on the top here or in the front, and in some cases both. Also there’s telegen. Hair loss where large numbers of the follicles on the scalp stay in the resting phase.

But so we have different phases with our hair growth. Some rests, some grows, and. If we stay in the resting phase too long, your hair falls out, but then new hair doesn’t grow in, and this is typically due to some sort of a hormonal imbalance, thyroid childbirth, or a shock to the system, like a surgery, a fever.

We’re seeing this with covid. People lost their hair with c. Sometimes it is from a vitamin or a mineral deficiency, and so that’s algen. And then there’s antigen, and this is from a medical treatment such as chemotherapy where your hair just suddenly falls out. Almost, it’s almost like it spontaneously falls out due to medical treat treatment.

There can be autoimmune conditions like rat at a rat. Da , I’m having trouble saying it. The slides are small, but that is an autoimmune condition. And tinia cap is ringworm, which is fairly uncommon in Western society, but it does happen. And then there’s scarring, alopecia, and there’s several different categories.

Of this. There can also be hair shaft abnormalities and hypori, which is another type of hair loss in tcm. We divide sudden hair loss. Into four categories, and that would be sudden hair loss due to blood, heat, and wind. And we see this more commonly in adolescents that are tending towards because Adolescents tend towards blood heat, which is going to generate wind, and the signs and symptoms might be some itching, right?

Irritation from the heat. There might be a headache. The tongue is gonna be red with a thin coating, and the pulse is thin and wiry and rapid. As with any. Heat condition and so the treatment is to clear the heat and the wind and we can also have sudden hair loss with a chi and blood deficiency pattern.

this would be after a sudden illness or postpartum because of chi and blood cannot ascend up to the hair. And so the treatment for that will be deify, the chi and blood. . Also, we can have gradual hair loss due to damp heat. Typically this is from dietary type conditions. People have damp heat from eating diet that would generate that in the body.

And the scalp would be greasy and sticky, and you might get some itching and the hair could fall out in clusters. The tongue is gonna be red with a greasy coat, and the pulse will be slippery and rapid, and the treatment would be to clear the dampness and the heat. We can also have a gradual hair loss.

Due to a liver and kidney deficiency pattern, and we see this most likely in middle age. And so this would be the kidney deficiency type of hair loss that is most common, and that would lead to some of the male and female pattern. Boldness that we would see, and the hair will be dull, sometimes yellowish white, and they will have typically typical kidney deficiency patterns, like a sore back knees, dizziness, and red tongue.

The pulse is gonna be thin and rapid, and the treatment would be to nourish the liver and the kidneys. Another reason for hair loss in Chinese medicine would be mental and emotional disorders, such as stress, grief, and worry, which can cause the hair to sin and fall out. When we’re thinking about microneedling in Chinese medicine we tend to think of microneedling as something that is more of a modern technique.

But the Chinese have used needles to beautify the skin for thousands of years. And in Chinese practice it’s referred to as Ma Huang, which translates to beautiful appearance. And so using needles to rejuvenate the skin has been used for Thousands of years. And although the tools that they used and the terminology was slightly different, microneedling, which is also known as collagen, induction therapy, is almost identical to what we might do with a seven star hammer or even when we’re stimulating our channels with a channel roller.

Surrounding the dragon to treat scars and but using a micro needle, derma roller, or a derma pen. And I’ve brought one with me today for you, toc. So this is a ACU lift micro pen. There are many manufacturers of micro needle pens. But these devices you turn them on and they have different speeds that you can set the pen at, and then the there’s a.

Guide right here. And let’s see, I gotta go in the right direction up. And as you can see, as I twist the the little dial, the needles, these little needles where am I? Go, come out, you can see the little needles there. And when the pen is on, they vibrate up and down like this, and they penetrate the skin.

So

when we’re using acupuncture, For to reduce hair loss or to increase hair growth using micro needle pen or der helps to reduce the inflammation that might exist in the hair follicle. It also increases the flow of blood to the skin and to the hair follicles. allows any nutrients that are in your blood to go out to the surface, and it helps to stimulate hair growth.

Acupuncture, full body acupuncture will help to reduce some of the stress, which as we saw is one of the causes for hair loss and acupuncture enhances your immune system. So if part of the reason that your hair is falling, Is because of an immune deficiency or something that’s stressing your immune system.

Doing full body acupuncture along with microneedling can help balance the hormones. Enhance your blood flow, enhance your immune system and allow your hair to naturally grow. Little picture of what it, like a cross section of what it looks like when the needles go in. So what does microneedling.

Actually do. It does two things. One, it stimulates your body’s own collagen production, and hair is made out of collagen and elastin, and it also opens the skin up. So when you do microneedling, , it should be done very superficially. It should not be done very deep. There shouldn’t be any bleeding, and it allows for the absorption of any products that you put.

On your skin. So if you’re using some sort of a hair growth stimulating product and you put it on your scalp, our scalps are pretty thick and it can be difficult for the product to get in. But if you put the product on and then you do the microneedling, it allows it to go down. Pass the outer layer of your scalp and get into where the blood supply is and allows the product to be picked up by your skin.

Here’s a few photos. There have been a lot of studies done, and I’m not gonna go through all of them. I do have a few references and there’s a bunch. My website. So ACU Lift has a website, and on the website there’s information about microneedling and different. Studies that have been done on microneedling, but this is just some pictures before and after pictures for microneedling that were done by a company that makes microneedle pens.

As I mentioned, I’m not gonna read through all of this, but clinical studies that have been done on microneedling and showing how much more effective microneedling. Was then even using minoxidil, which is currently known commonly known as Rogan. And some other studies that were done showing the body points that were used in conjunction with the micro needle pen and.

So you can flip through these as I mentioned on the website, and the protocol is that you would clean your patient’s scalp with either an alcohol spray or some witch hazel. You would let that dry. You can put numbing cream on the scout. And then put a shower cap on it because the heat will help it to absorb.

And you definitely wanna use numbing cream because microneedling, the scalp can be very sensitive. Any, if you’ve ever pulled just like one here, you know how. Sensitive. Our scallops can be once the cap is on with the numbing cream. If you have an l e d one of those l e D lights, you can set that on blue and that helps to kill an bacteria.

And then you. Insert any body points that you were going to use to treat the different conditions that we spoke about. You would wait about 15 minutes. You come back in, you wipe off the numbing cream, and then you put whatever serum you’re going to use. Aiff does make a hair serum. And before you would choose any prescription serums, your I.

Strongly recommend contacting a medical professional eye, the hair serum. I use on my patients that I sell is all organic and vegan and very few ingredients, but it’s all very good, even just on its own to help with hairy growth. And you don’t need to set the pen. Needles too long. So usually what I’ll do is I set it at 0.25 or 0.5, and then you work from the hairline back.

You can either go in a linear direction or you can use a stamping. So you can either stamp or you can work straight back. It really depends on how much hair they. Let’s say it was someone like myself, their hair is thinning a little bit like maybe right here, and you just wanted to get in there and help to stimulate.

You would be better off doing a stamping motion than trying to run the pan. But even if you’re doing a stamping motion, you start at the hairline and you work your way. Back. And after you’ve done that, you, if you have an l e d light, you can put it on red, leave it on there for about five to 10 minutes to allow the serum to really penetrate and for the blood flow to increase and.

Then you would take out your body points and you’re done. I always sell some serum to my patients and tell them to use it twice a day. And I’ve had some really great success with myself and with my patients. Trying to, at this spot me right here I had lost a lot of hair during covid. I don’t know if I was pulling my hair outta my head or what, but had started.

Some hair thinning in that area, and it’s pretty much all grown back now, which is great. So the serum that I’m talking about, can you pull my spot up? It this bottle looks a little larger. I, the bottle itself is I think it’s two ounces but it’s Very easily absorbed light oily serum.

And that’s a picture of the pen. And just real quick, the courses that I offer, I have a facial acupuncture basic certification. I also teach facial cupping in Guacs, Derma Rolling, and skin care microneedling. I teach a two part course on treating neuromuscular facial conditions. I am a classically trained wisely five element acupuncturist, so I have a course, a two part course on the anatomy of expressions about our emotions.

And how our emotions can affect our appearance and vice versa. Also, facial acupuncture, self care for acupuncturists. I have an advanced techniques course for those stubborn to treat conditions. I also have a safety course, and I’ve just added an ethics course so you can meet your se safety and ethics.

Requirements and I also have a comprehensive advanced certificate class, which is self-paced with monthly optional zoom meetings that we do. And there’s also a live hands on component. I do travel. As I mentioned internationally teaching hands on classes you ever get a chance, get it on my website, facial acupuncture classes.com, and I am available on Facebook.

I have a Facebook group for questions and answers and should we open it up for questions here or, If anyone has any questions now, I’m happy to take them. I cannot see the chat window though. Okay. So next time the American Acupuncture Council will be hosting Poney Chaing, and that will be on Friday.

Thank you again to AAC for this opportunity and I hope you’ve found this beneficial.

 

 

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Micro-current For Enhancing Facial Appearance

 

Today’s presentation will be microcurrent for enhancing facial appearance. For those of you who practice cosmetic facial, acupuncture, you’re gonna love this

Click here to download the transcript.

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

Hello everyone. My name is Shelly Goldstein. I’m the doctor of acupuncture and Chinese medicine and licensed in Florida and in New York. Today’s presentation will be microcurrent for enhancing facial appearance. For those of you who practice cosmetic facial, acupuncture, you’re gonna love this. And it’s actually, and then for those of you who practice facial acupuncture of any sort, this is right up your alley.

Today, microcurrent is one of the most rapidly growing ancillary services for facial acupuncturists, but a lot of people don’t really know what it’s about. So here we go. Let’s begin now.

Patterns Microcurrent is what I call low level electrical current for skin and muscle re education. And this is what’s important because many of the ancillary services that we offer, Address the skin level or address the tissue level, but they don’t go down to the muscle level. So this type of service is addressing both skin and muscle.

When we think about the history of Microcurrent, it’s been used for decades. It was been used by acupuncturist, physicians, physical therapists, and chiropractors, and it’s primarily used for. Muscle education and tissue healing. So if you’ve ever damaged muscle damage or muscle strain or pulled a muscle and you go to physical therapy and they put these pads on you, it’s a form of microcurrent.

It’s a little stronger. And the intention of it is to actually heal the tissue, the trauma in the tissue, and reeducate the muscles on that level. What we’re talking about here is just a little bit different. And because we’ve been looking at it for so many years, particularly with patients with Bell’s policy, it started with people being treated with Bell’s Palsy, with low level micro.

And what happened was after they were treated and after the Bell’s Palsy had resolved, they noticed that their fine lines were softer, their face was more lifted, their eyelids were a little bit drier. And this really started the impetus to start exploring various forms of microcurrent for cosmetic treatments and appearance enhancements to lip facial appearance.

Just to give you a little bit of perspective about how this works, when we analyze the face from our perspective, You wanna look at the face in thirds. So the top third is the forehead to the eye to right underneath the eyes. The middle third is from right underneath the eyes to the corner of the nose, and then the lower third is the corner of nose to the chin area.

And in our younger years, when we look at someone, the height of the face or the widest part of the face is at the top of the middle. Third, it’s right below the eyes. You can see it in this image if you look at the triangle. So the base of that triangle is where the height of the, of your appearances.

So when you. At someone what is the upper portion of the face what happens as we age, whether it’s due to gravity, whether it’s due to tissue change, or bone resorption, or bone changes. The tissue begins to drop and the weight of the face moves to the jo area as opposed to the height of the face.

So what happens is when you look at someone with the, who’s older, with that drop, it looks as though the face is heavy, it’s saggy. And oftentimes this is when our patients come in and they say, I look old. I feel old. I, my jaw line is lost in. My cheeks feel flat. I just look old. And that’s what you’re looking at is this organic movement of the weight of the face shifting from the upper aspect to the lower aspect of the faces.

And not only does it move from top to bottom, it moves from the lateral aspect, the corner of the zygomatic area where the cheek bone is. To the middle area. So you would get a deepening of what we call the nasal labial fold, which is that full between the corner of the nose and the corner of the mouth, and the corner of the mouth and the jaw area.

So the weight of the face moves from outer to inner. And then also the forehead starts to shorten, in which case you start to see putting of the eyelid, puffiness underneath the eye. Some of it is organic. It changes within the tissue itself, but some of it is just the redistribution of weight in the face.

And many of those changes occur on multiple levels of the face. So we have the bone changes and starts to change the tissue layer on top of bone on the face. We have muscles. We have two different groups of muscles. On top of the muscle, we have what known as the subcutaneous of the hypodermic layer.

It’s where our adipose tissue is the fat in the face that fills out and gives you volume. So muscles gives your movement to all of the the math, the cheeks, the eyes, and all of the expressions that we make. The hypodermic. So the subcutaneous layer gives you the fat or the plumpness of your. And then the health of the tissue or the health of your skin is really determined by the dermal and dermis and the epidemics cells start at the base of that dermal the orange layer, and float up to the surface of the skin as it reaches the surface.

And in that dermis dermal layer. It’s bathed in hyaluronic acid and nutrients so that they grow healthy and strong and plum. And then as they move to the epidermal layer up to the surface, then they start to slough off and then new cells move their way up. And then all of these layers are surrounded by what is known as connective tissue.

Connective tissue looks like this. It’s sticky. It’s afl. It’s like a sticky film or sarn wrap, and it’s designed to either encapsulate, say the muscles and keep them protected. Or it’s also used to connect, so it can either connect, it can either protect the muscles and surround them and isolate them.

Or it can be used to connect, say the muscles to the more superficial layers of the tissue and then and top the skin, which is why we can see when the deeper, when the muscles of expression move, we talk, we blink our eyes. We smile, we frown. These are all the ability, the muscle’s ability to express themselves on the surface of the skin by virtue of that connective tissue, holding everything together and connecting them.

And collagen, we’ve heard this word a lot. Collagen is the primary component of connective tissue. And what’s unique about. Is that collagen has a mechanical and an electrical property, and it’s that property, the electrical and the mechanical property. That’s the basis for being able to interact with other tissue.

So in the presence of external influences, they can be pressure, they can be vibration, they can be an acupuncture needle going into the surface of the skin when the collagen is altered by any type of external influence that current or that electronic electrical current permeates from the connective tissue throughout.

The other areas of the body and migrates into neighboring structures. And this is how a lot of our ancillary services work. Works in this way, cupping face, cupping works in this way. A number of different services that we use, even acupuncture work by activating the elec, the Paso Electrical effect of collagen.

To create that electrical charge, which then vibrates through the connective tissue into migrating structures. And Microcurrent is another example of how this works. When you. Microcurrent is a vibration. You turn it on, it has a vibratory effect. And in that vibratory effect, it has a number of wonderful functions.

It a, it improves skin tissue circulation. When that happens, skin tone and texture start to change and improve also by going a. Deeper, we talked about the epidermis, the dermis, and then into the deeper fat layers, and then into the muscle. So it starts to move through all of those different layers so it can soften the appearance of fine lines and wrinkles.

And then also it’s used to re-educate muscle activity and interpreting. And this is what you, my current is unique for because a lot of the other service. Like cupping, wash out are primarily for more surface skin, for removing limp from the tissue and for sculpting the tissue, but not necessarily.

Integrating and educating the muscles. So in doing so, by changing the muscle integrity, you can lift and into the cheeks, the lower and the midface muscles. Now, microcurrent is different than tens, the tens that we use. You have needles, you have the little prongs that you put to the needles, and then you turn it on and it causes the muscles to twitch.

This is not what we’re talking. So TENS devices is delivers milli amps of current. This current is designed to blocking messages from the spine to the brain, and that’s why it’s very effective for say, back brain damage. It’s going to help mitigate the pain messages that move from the spine into the brain and help to heal the tissue.

Microcurrent on the other hand, delivers a sub censory micro amperage as opposed to milli amperage. So this current micro amperage is 1000 times less than that of milli amperage current. And when you use this type of current, first of all, the muscles are not gonna twitch. It’s gonna be, and it’s gonna be sub sensory, which means you don’t feel it.

So the current is actually moving into the tissue at a very low cellular intensity. And. Activates or it aligns with that collagen, Paso Electrical current and all of the other currents that we have in our body. So our body is always vibrating. There’s a current that runs through, we may call it Archie, that’s constantly running through our body.

This low level microcurrent actually. And its sub sensory format mimics the body’s own low intensity and this at the cellular level to do a number of things. So here’s what I’m talking about. Here’s the top image is the microcurrent. It’s that low level current. So it’s a very small current that’s moving through the mechanism and into the tissue versus the lower, more charged microcurrent.

Tense machine. Now, when the current moves through this tissue, it goes into the cells and it moves into the mitochondria to activate the Creb cycle. How many of us remember in high school learning about the Creb cycle? The most important aspect of the Creb cycle is to produce at. Triphosphate. Now, Atine Tri Phosphate is like Archie.

It’s what charges the body, keeps it activated, keeps it moving, and keeps us alive. So without atp, we do not exist according to the Western world. When ATP is activated, a number of things happen. It enhances the healthy synthesis of number of proteins. It stimulates the proliferation of fiberblast, or needed to collagen.

And it does it at such a high volume that it actually can increase ATP up to 500%. It can improve the cell wall permeability, and we’ll go into this in just a minute. By 30 to 40%, it increases protein synthesis up to 73% and increases collagen activity up to 60%. These are huge numbers. How does it do it?

First of all, when we produce ATP one, one of the things happens. It creates a the mi, the crib cycle begins. You get the production of atp, and then another couple of things happen. One is it stimulates the activity of the electric transport chain. The electric transport chain is very important for producing the healthy wall of the cell.

But it also helps to boost healthy skin dermal protein development, including collagen and safe development. When we have a cell and when we have the cell wall, there’s a kind of a, some gateway. Which means that there’s a charge that goes back and forth through the cell wall, and you need that fluidity within this cell membrane, not just to pass ions like sodium, potassium, and chloride, but in a bioelectrical potential at this charge as well.

As we age that the tissue of the wall gets heard, it gets damaged, and then we get an imbalance within that bioelectrical potential, which means the cell’s not activating and it’s not doing its job. The body naturally follows the path of least resistance. So in the effort to get that bioelectrical charge into the wall, it’s gonna pass the damage areas and it’s gonna try and get in other places.

And in doing so, it actually damages the cell even more. Microcurrent starts to reverse that process by healing the wall of the cell in order to create and boost that and restore that electrical transport. Also within that Creb cycle and when the activity of the mitochondria, we are also creating an antioxidant effect.

So what do we know about antioxidants? Antioxidants stop cells from oxidizing. If too many cells oxidize, they start to die. So it’s a way of rejuvenating cells and keep them. When we do that, we can heal the tissue. So microcurrent is beneficial for enhancing tissue repair and when tissue repair, when we get a wound a or some type of a physical wound microcurrent is actually beneficial for healing that wound and for our purposes for cosmetic acupuncture, it’s going to improve and reeducate muscle.

I. And this is what we need in order to lift those muscles that we talked about. Start to bring the weight from the base of the chin area all the way up to the top of the chin. It’s not good. Here’s an example. Oops, I’m gonna go back. Sorry about this. I think I’m gone the wrong direction. Oh no.

I don’t wanna do that. Sorry. What you’re gonna need to do is you’re gonna need to reshare that if you can, and then I think we’ll be okay. Okay. Yeah, so just make sure that you have that slide open. Then do share and it’ll be back. Everyone will be very patient. It’ll only take a minute. are did it work while you’re sharing the whole screen rather than just the slide?

So you wanna stop sharing. I’ll help you with. What I’m going to do is help by doing this for a second. So now they can’t see us . And let’s go back to.

Hi, welcome back. Okay, so here’s what happens. Take a look here. You see the microcurrent coming in. It’s. Moving its current into the tissue, and you can actually see the multiple layers, including the orange one. The orange one is the tissue, is the muscle itself. You can actually see the change that occurs.

Now there are some side effects although this is a very low risk treatment. Sometimes let me just say with the side effects are dizziness, headaches, tissue, swelling, pain, discover, redness, bruising, tingling. I have not found these in my practice. But that doesn’t mean that they don’t exist.

Every once in a while, someone may be red, but you can actually just turn the volume down and it’s not in my personal experience, I haven’t. These side effects. There are a few contraindications and precautions. So a contraindication is when not to use it. A precaution is to be aware.

Pregnancy is a precaution. If someone is cleared by their physician, no problem. You, if you are under the age of 18, that’s just because they’re a minor. So that would be a precaution. Active cancer, for me, that’s a contraindication because you wanna deal with the problem first. And then epilepsy seizures, it is current and it’s, but it’s very mild current.

So things like epilepsy, seizures, muscle nerve disorders. You just wanna make sure that’s not something that they’ve had recently or under, or is under control and it should be fine. Reach some facial surgery, filler implants and injections. You just need to wait a couple of weeks after their surgeries, fillers, implants and injections to begin pacemaker or electrical implant device.

Now we’re on the face and it’s a very mild current. So again, that’s not something that. Experience, but it’s in the literature. And then severe acne or inflamed skin as usual, you want, it is current. You are stimulating the face, and so you want to manage that situation or avoid the area.

So again, it’s very space, but you just need to be wise and be a little cautious. It’s a very mild current that you’re buying on someone’s. But the advantages of using it are just tremendous. So if you look at this image, in the remembering the weight of the face, moving from the upper face to the lower face.

If you look on the left where it says baseline, you can see where there’s puffiness and jowling on this image and this woman’s jaw area. And then after 60 days of five minutes of use. So this would be as like retailed as a home treatment, but also you can use it in the office. You will see the jawline begin to lift.

You can see the weight of the face starting to change, moving upwards. It’s actually a little more clear in the sculpted jawline area. You can actually see not just the weight of the face dragging in the jaw area, but you can also see the skin is starting to be creepy and drooping as well. So in this situation, The microcurrent is not only addressing the muscle level, but the tissue level as well.

So this is a really good indication. If you look at the 60 day of all of tightening of the muscles lifting the jaw area, but you can also see the collagen area that has been. Built and building collagen is tightening and lifting skin as well. And then the bottom one is smoother wrinkles, and this is the far ahead area.

And you can actually see the visible changes that occur from forehead, creasing, and lack and diminished creasing after. Microcurrent. So it’s a great treatment to use both in your office, but it’s also really good to use at home too. And there are many different devices that you can use. So the one that it, for those of you who are just starting, you’re interested in microcurrent and you don’t wanna put out a lot of money for it.

New face is a really good way to start. It’s very lightweight. It’s very easy to use. You can use it at home. You can use it in your treatment. You, it has an auto, a charging station that you put it on. I can help you get those. I give you a discount for being a part of the American Acupuncture Council.

For those of you who know you wanna do this, you’re investing in it. There are programs like Biotherapeutics, they’re a wonderful company from was. They have that Suzuki sequencing, which we talked about. It’s microcurrent going into. And to the body and matching the electrical vibration of our body. And this is the key to it.

If your system doesn’t do that, it’s just throwing current at you instead of working with you. This particular instrument is about five to $6,000. And then for those of you who really wanna jump in and know this is what you wanna do, and this is only what you wanna do, or a huge part of what. To do you can spend, 15 to 25,000 pounds.

And then this Casey is the workhorse or the gold standard of microcurrent. But honestly, if you’re just starting, either the new face or the biotherapeutics are really good. Microcurrent machines. And again, if you need help, I can help you do that. So if you have any questions or need additional information about Microcurrent or this lecture, you can contact me at hampton’s acupuncture gmail or at info hampton’s acupuncture.com, or you can watch.

On Instagram as well. So this is a, just an abbreviated lecture about Microcurrent. There are many more out there. And again, I just wanna thank the American Acupuncture Council for allowing me to be here today. And thank you for joining me as well.

 

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Getting A Constant Referral Flow from MDs

 

 

Today we’re gonna talk about probably one of the most common things that I get asked about as an acupuncturist who has grown her practice in a certain way, and that’s MD referrals.

Click here to download the transcript.

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

Hi everyone. I’m Dr. Nell with American Acupuncture Council. So thank you to AAC for having me on the show today. Today we’re gonna talk about probably one of the most common things that I get asked about as an acupuncturist who has grown her practice in a certain way, and that’s MD referrals. So let’s go to the.

Like I said, this is one of the most common things I get asked about. We know that most acupuncturists build their businesses based on referrals. A lot of times that comes from. Patients who are already in your practice who already know, trust you. But there’s always this desire for more referrals, right?

We want to have a constant flow into our practice and really what does that look like? Where are those referral sources coming from? And MDs are a great one. There can be a little bit of intimidation here, but we’re going to go through all of that today and make sure that you walk away with really tangible.

As to how you can get this done quickly and easily.

So you have got this. What does this look like? So again, I told you a little bit about myself. I am with aac, but I’m also first and foremost a practitioner. So I built my practice. Almost solely based on MD referrals. And this was something that felt really efficient for me. As soon as I got a good workflow with it, it worked really well.

So being able to do in-office visits, house calls, get really clear about what type of patient I want into my practice, and then what. MD is to refer to me, is part of the strategy that I employed. So I’ve been on panels with other MDs. A lot of times there’s this thought that, oh MD is an acupuncturist.

Maybe we have to work separately. Maybe we need to stay over here with other allied health providers. That’s simply not true. There is such an interest right now in our medicine and there’s a huge value add that we can have to really any type of medical. And so when I’ve been speaking with other MDs, whether it’s at a symposium, at a conference, on a panel, just as collaborators and peers, we get such incredible feedback about the results that we get for patients.

And so I’m gonna teach you today a little bit about how I employ the strategy throughout my practice.

But first and foremost, let’s address the elephant in the room. Why not? If it’s something that we can be doing, if there’s an interest, why is not every acupuncturist growing their practice in this way? Why isn’t every single MD referring to an acupuncturist? Why isn’t every surgeon saying. We need an acupuncturist to help with post-surgical recovery, or every cardiologist saying, wow, you could help with angina or lowering cholesterol.

Why isn’t this really happening? And so I think first and foremost, we need to address the fears on our end, the things that we can control, right? I’ve heard a lot of times this idea of intimidation, not just about MDs, but. Human nature, approaching a new person. What am I going to say to this person?

How do I get them to buy in? How do I get them excited about what I’m doing in my practice and get them to believe that I can really help them? With their practice as well. And so that fear is first and foremost something that we have to absolutely get rid of today. And we can, cuz we’re going to go through step by step how you can get this done safely, comfortably, and very effectively as well.

But before we go on, What’s the friction? How are we making this difficult and how do we make it easier? So there is a very real and tangible friction there. When it comes to us looking at who we want to approach for referrals. From an MD perspective, and this is coming from MDs I’ve actually spoken to.

So this is not just me pulling things out of thin air or wondering, I wonder if it’s this is actual feedback from other medical doctors. They don’t know you, first of all. There are patients who haven’t had a good experience with acupuncture, and more importantly and more likely MDs just don’t know an acupuncturist.

They don’t know that you’re there. So a lot of times it’s not an unwillingness. On the part of an MD to refer to us. It’s simply I just don’t know any acupuncturists. There’s also a lack of understanding, a lack of education there. Acupuncture versus dry needling. How do we fit into that? Do we do the same things that dry needle layers do?

Can we do dry needling? These are things that MDs have heard about but also need to be educated on. And so if. Don’t know you. They don’t know that there’s an acupuncturist in their area that they can refer to. How are they going to accomplish that? So it is about reducing that friction of making sure that MDs know that you’re there and they understand what you do.

Insurance is another big one that we have to talk about. Patients are accustomed to utilizing their, I. . More importantly though, they’re accustomed to utilizing the same mode of payment. Depending on what healthcare provider they go to, they wanna use the same thing. So for an example, if someone is seeing a cardiologist and they’re paying with their Blue Cross insurance and they get referred to somebody, they’re gonna want it to be somebody who takes their Blue Cross insurance.

That doesn’t mean that you can’t have a cash. Doesn’t mean that you can’t have a hybrid practice. In fact, that’s what I recommend, should talk to Sam Collins about that. But when we’re looking at those referral choices and who we’re going to work with, we need to think about it from the patient’s perspective.

And so there is friction occasionally when you have an MD who is willing to refer to you. But let’s say it’s an MD who is in network with everyone is working with. That’s gonna be a little bit of a roadblock for patients coming in. And it doesn’t mean we can’t work around that or work alongside it, but we first and foremost need to acknowledge it and be aware of it.

And the biggest thing is they don’t know you can meet their needs. , that does not mean that they don’t know the acupuncture works. It doesn’t mean that they haven’t heard of acupuncture before. Even if you’ve, all right I, they know I’m there at this point. They know I’m an acupuncturist.

There is still an innate human need to know what’s in it for me. How can this help me? And that’s from an MD perspective as well. That’s from. A surgeon saying how is this going to help me focus on what I want to do, which is surgery? I don’t wanna walk a patient through the recovery process.

I wanna be able to do surgery and be done with that. So when we’re gonna talk about next is the tangible ways that you can make this happen. One of the things that we’re gonna talk about is reducing that friction, about being really streamlined and targeted with our messaging around how we. The needs of whatever MD we’re talking to at that moment.

So let’s get into it nice and clean and specific. We’re gonna target, connect and follow up. What does this look like? All right. Targeting first and foremost. I do know acupuncturists who have sent out, thousands of letters to every MD in their area. That is certainly something you can do. It’s kinda that shotgun approach, right?

So just a lot of outflow and hope that something comes back. I’m really about efficiency. I know a lot of you that I’ve worked with are about efficiency and. A lot of times you’re running your own show as an acupuncturist, right? You might not have staff, or you have very limited staff, might just be you in the office.

So you need to be really clear about how you’re spending your time, what bandwidth you’re using how much of your cheese is gonna be used up on a project like this. And so if we can get really targeted with the MDs that we wanna work with, then this will be a much more streamlined process and a lot less work.

Let me do this in the form of an example for you. I work with Men’s Health a lot, so if I’m working with middle aged men who are experiencing andropause, I’m gonna say to myself alright. Where is a middle aged man? Normally going for his healthcare at this time when it comes to MDs, likely has a primary care doctor.

Probably has seen a cardiologist or a nephrologist. Kidney issues are very common. High blood pressure is very common at this age and then a urologist because urinary issues, prostate issues are extremely common in middle aged men. So that kind of narrowed my pool already, right? When I’m looking at, okay, I wanna be in middle aged men’s health, that’s who I wanna welcome into my practice.

So now I’m targeting those three types of specialists. Once I’ve narrowed down those three types of specialists, then I’m gonna figure out, okay, how am I connecting with these people? I find them in my area, but how am I gonna do that outreach and really what is my messaging with them? Because that’s incredibly important.

Part of that targeting into connecting approach is knowing that you’ve targeted the right people. Not only are they close by you, because again, if a patient sees someone somewhere, they’re not going to want to go an hour out of their way. So you wanna be really target. Really close close by if possible, least within easy driving distance.

That’s gonna make it an easier sell for the MD to just say, oh, they’re in the same building. That’s the best one. If you’re in a medical building, you can start right there. Very targeted. Who are the specialists that I wanna connect with? Are they close by? So those are two things in targeting.

Another thing is what we spoke about during that friction piece insurance. Do they have a cash practice? Do they have insurance? Do they have a hybrid practice? If they’re taking insurance, what insurance Are they in? Networking. Are you in network with those same those same insurance companies? That is going to matter.

It doesn’t mean that you can’t overcome that with a great value proposition. It just means that it’s something to be really aware of and it’s an additional cell that you are going to give to this MD in this second portion, which is to connect. So when we’re connecting with these very targeted people, what are we doing?

What are we doing when we connect? If you watched one of my previous shows, we talked about introductions and about your elevator pitch, and the main thing I hope you took out of that was that it’s about articulating value to the person you’re talking to. So when you’re connecting with an md, you know you found the right.

They’re close by probably a network with the same insurance company, or they have a cash practice and you have a cash practice, they can send somebody right down the hall to you, right across the street. But what are you saying to them? You need to address meeting their needs. They are humans, just like we are humans and humans wanna know how is this going to make my life easier?

How is this gonna make things better? I would love to sit here and tell you that it is enough to just be able to hand them a thing of research and say, look, acupuncture works. Tell your patients, but if you are looking for not only targeted referrals into your practice, but referrals that continue to come into your practice, there needs to.

An ROI on the other side for that md and that is the God’s honest truth. I’ve seen it with my own eyes. I’ve grown my practice in this way, and so if you can be really clear with how you can help them. I’ll give you another example. I work with a lot of surgeons, do a lot of post-surgical care in my practice, and I will research a surgeon prior to approaching.

Not only on their website and what they say that they do, but also on Yelp, on Google Reviews, looking at what are people complaining about? What do they love? What are the pain points for this doctor that I can address? So you bet. If there is a surgeon whose patients are going on saying, Hey, I really loved them.

They were great. The surgery went well, but I wasn’t so happy about the scar tissue. They didn’t do as good of a job as my friend’s surgery. That’s something you wanna speak to. You absolutely wanna talk about how acupuncture can help with scar tissue reduction. You also have to think about just the innate needs and personality of the MD that you’re approaching.

So again, a surgeon, they wanna cut, they wanna do surgery. They don’t wanna hold someone’s hand through the recovery process. Acupuncturists are great at holding someone’s hand through a recovery process. We are all about recovery. All about regulating the body. So if you can speak to that, if you can tell them that you’re gonna meet those needs that, oh, we can start acupuncture the day after surgery.

We can start it immediately. These are the things that it’s known to do. We’re gonna talk in the follow up about good collateral to have. But if you can speak to the things that you can take off their plate that they don’t wanna do. That is gonna pay dividends for you. On the other end of that, cuz it’s one thing to get an MD to refer to you once to just try it out, to say, oh yeah, I know an acupuncturist.

It’s another thing to get constant referrals into your practice from the same MDs and you have to be meeting their needs and getting them really excited about wanting to refer to you. So that’s the connect piece, making sure that you understand their innate needs and that you’re able to address. And then the follow up.

And this is, arguably the most important point because human nature, we’ve been talking about that a lot today. Human nature is out of sight, out of mind. So not only are you gonna give great results to the patients who are referred to you by MDs, but you’re going to have consistent follow up. And what does that follow up look like?

An initial follow up from a conversation can be in the form of collateral. Again, thinking, how do we make this really easy? How do we reduce the friction? Who am I gonna follow up with? Of course you wanna follow up with the doctor that you spoke to, but a lot of times the. Is who is making decisions in that office?

If a patient comes up and asks the staff a question after they see the doctor. The staff is gonna have a book of referrals or they’re gonna have someone at top of mind. And so being really friendly with not only the doctor but the staff as well, is something that will behoove you. So you can do follow-ups.

Talking to the staff. That’s very easy. If you’re in a medical building in the same area, just pop in and say Hi. I like to give one pagers as collateral and. You need to have an electronic option because a lot of people are not liking paper right now. That doesn’t mean you can’t have your old school brochures and that people don’t still like holding onto something.

But again, reducing friction. How do we make this really easy? And so part of making that really easy is that you’re gonna have multiple options so that it makes it the doctor’s choice or the staff’s choice what’s easiest for them. So I have a very. Clean, easy one pager that goes to surgeons and their staff.

And their patients. And then I have an electronic version as well. The electronic’s also great because you can put links in there. It can link to your website, it can link to research if you want. People don’t wanna read a ton of stuff so you can have a great infographic and. For those people who really wanna read a little bit more, they can click on those different links.

You have a lot of flexibility when it comes to those electronic options. It’s also very easy for the staff to pop that into a patient portal, to send it to them or to shoot it to them. Via email if they’re asking for a recommendation. So we always wanna be thinking not necessarily what’s easiest for me or what I like best as a business owner, but what would a prospective patient like the best?

What would the doctor that I’m interfacing with trying to get referrals into my practice, what would they like best? What would make their life easier? And these are also questions that are okay to ask when you’re in that initial conversation. And part of this follow up is being consistent, so I like to set reminders.

When you have a patient who is referred to you should have a system in place to thank the doctor for their referral. They should be signing a release of medical records so that you can send that doctor a report of their care. Not only, become their colleague and be able to liaise with them about this patient, but let them know that not only are you highly competent, but you’re highly collaborative and that helps reduce friction as well.

That is a concern for other healthcare providers that maybe we’re not gonna be super collaborative, maybe we’re gonna try to steal their patient. If you go requesting their medical records and not providing explanations for. , they might think that, oh, why is this doctor requesting these records and trying to take my patient?

You wanna do everything you can to show how collaborative you are and how excited you are to share in the care of that patient. And so with our documentation, you can very easily send that over to a doctor so they’re in the know about what’s going on with their patient as well. And this gets particularly important when you’re dealing with cases like surgery.

Patients who have been diagnosed with cancer you wanna be extra careful, you wanna protect yourself. We’ve done another show on informed consent, so that’s a conversation, you wanna keep going as well, so you wanna do right by the patients who are referred to you and make sure that you have MEChAs mechanisms in place so you can continue that conversation with the doctor and continue the follow up.

So I told you I like efficiency. We kept it nice and short today. Just wanna end by telling you guys, you’ve got this. This is something that I’ve seen other acupuncturists do. I’ve coached other acupuncturists on how to do this. This is solely the way that I built my practice and I know that you can do this too.

And so I just wanna thank AAC again for having me today and you guys have a very exciting. Coming up next week with Poney Chiang, and if you haven’t caught any of his stuff, I’ve done his stuff live. He is absolutely amazing, knows so much, and so you don’t wanna miss that one.

 

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Know Your Rights When Insurance Co. Asks for Money Back

 

Click here to download the transcript.

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

Hi everyone. Welcome to another episode with the American Acupuncture Council. I’m Sam Collins, the coding and billing expert for acupuncture, the American Acupuncture Council, as well as the profession in general. This episode is gonna deal with a very common question that I get whenever I’m teaching a seminar or doing our network services.

People always ask, Hey, Sam, I got a payment. Now the insurance company is asking for money. What can I do? Is there anything I can do to fight this back? What if they recoup the money? There are many things you can do, and there’s laws and statutes that are on your side. Never assume what they tell you is correct.

Let’s face it, you do an insurance verification, you bill the insurance, they pay it, and then they come back later and say, Hey, we paid you money six months ago. Turns out we shouldn’t have. So let’s take a scenario like that. The insurance company pay. . Then they come back and say, Oops, we shouldn’t have paid because there were visits that were applied towards the whole overall benefit.

Maybe it’s combined with chiropractic, maybe with physical therapy, and now they want it back. What are our rights? What do we do? So let’s go to the slides. Let’s talk about what laws and things protect you in understanding how we have to deal with this. This is not uncommon. Now, I don’t want this to scare you off.

This doesn’t happen a lot, but it happens enough. You have to know what your rights. What are my rights when someone says, We shouldn’t have paid you and we want this back? So here’s a letter and please note everyone, this is a letter from Federal Blue Cross Blue Shield and notice what it’s saying. Dear Billing Department, they’re talking to us directly in regards to the request for repayment for claim.

The request made to you was a voluntary overpayment request. Because you are in network provider, you do not have to pay back any overpayment if the overpayment was discovered 365 days or more after the claim was finalized. So I wanna take a look at this letter and notice what they’re stating here.

They’re stating that they can request an overpayment if you are in network, but not if it’s over 365 days. So notice that’s why the letter says a voluntary overpayment realize most often when an insurance company is requesting a re. they’re doing. So just to see if you’re willing to pay it. So by example, let’s say a policy, as I mentioned, has 20 visits per year.

You verify it and they pay it, and then later they come back six months later, a year later and say, Oops, it turns out the patient already had visits with some other provider. Therefore, we shouldn’t have paid you. Frankly, whose fault is that? You did the proper verification, you bill it, they paid it.

Now they’re saying, Oops, we made a mistake. We want you to pay it back. So notice that’s why this says voluntary. So even though this provider is in network, they’re saying please pay us back. My issue is gonna be no thanks. Why should I pay you back if it’s your mistake? In essence, what they’re saying is, we made a.

And the patient’s benefits weren’t there. Therefore, we want you to pay back our mistake. My rule would be, no, you go to your insured, That’s who you made the mistake with. Cuz essentially what they’re trying to push you to do is you pay them back and now go after the patient. Why would we have to go after the patient if that’s your insured?

That’s where you’ll notice the difference here. Notice it says here, the request made to you was volunt. And because you are in network and it’s over 365 days. So notice now the difference if they had done this within 365 days because you’re in network, they can take it back. This is one of the downsides of belonging to an insurance you give them to right to recoup.

Even when the error wasn’t yours. It was their own mistake. So it’s one of the downsides of being in network. Now, if you were out of network, could you just completely refuse this and say, Actually you could in the absence of fraud, where something you build wrong or maybe they paid you twice, you are under no obligation to refund this.

I’m gonna point you to this is a letter that we use for those in our network, or those that come to a seminar that deals with an insurance company that has paid you and then subsequently wants it back. So notice at the top it says, We received your letter where your company’s requesting re refund the payment, and you reviewed the benefits and nothing here shows otherwise.

So let’s move down here. It says, I feel that you have do not have the right to place this burden upon my office by asking us to correct your error. And this is backed up by Case Law. Notice it says, I would like to bring your attention to cases involving the Federated Mutual Insurance Company, and essentially it says the insurance company is in the best position to know the policy limits and must bear the responsibility of their own mistake.

So again, if you’re out of network and the insurance is asking for this back, understand if they made the mistake and paid more than they should. Maybe there was a deductible, they didn’t apply or they just applied more visits than the plan allows. They have to bear the responsibility for it. And again, case law noting dating back to 1974, so for many of you may not have even been born yet.

The next case goes from here for national Western Life Insurance Company. And it says in the absence of. A healthcare provider is not legally obligated to run refund payments. It receives from an insurer if the insurer subsequently determines they were paid in error. So let’s do this example. You call, the plan says they cover acupuncture.

Great. You bill it, they pay it, and then six months later they say, Oops, it turns out we don’t cover acupuncture. Whose fault is that? You did everything properly. What they’re saying is, pay us back and you chase the patient. My rule would be, You go after your own patient. That’s why that one said voluntary.

You’re under no obligation to pay this. So when you were out of network, , you may completely push back on this with citing these two case laws, because if there’s nothing wrong with the claim, you didn’t bill anything in error. There wasn’t something billed that you didn’t provide, or they didn’t pay you twice.

If someone pays you twice for the same data service, you do have to refund the overpayment of that. But outside of that, the answer is absolutely no. Again, if you’re out of network. Now, why is it different if you’re in. It’s different when you’re in network because part of the contract we sign, when we join these insurances, it literally says in the contract, Should we make an overpayment?

Even if the error was on our side, we can recoup the money. And I’m sure many of you, almost Sam, that’s happened to me before. They just take the money from another patient. They will if you’re in network. If you’re out of network, they should not be because they have no right to that. In fact, the case law stands up, but let’s talk about if you’re in network.

Notice it said one year. Now that’s the federal statute, which is generally equal to what the billing time is. So if the billing time is one year, they have one year to recoup again, if you’re in network. So if you are in network, they can recoup. Within the timeframe of the statute of limitations, and that’s where this is a little bit different from state to state.

So I’m gonna give you a little breakdown here. This has every state, and you’ll notice it can vary from some, That’s one year, 36 months, five years, two years, all the way down to as little as 30 days for some. And some states don’t have any, which to me means it defaults to the federal statute. But always know the statute of limitations.

Just like an insurance. You know how some insurances are? You have 30 days to bill 60, 90, or one. The same thing applies here for a recoupment. The state law will break it down. So is it one year or otherwise? So know your state and whether or not you can push back. My rule would be always send a letter like this in a response when you are out of network.

Even in network, I would use the same protocols, but then follow up with the statute of limitations. Do not be. To push back. The assumption is often you don’t know better and are just gonna pay, cuz we’re afraid of the insurance we’re gonna get in trouble. If they could recoup it in network, they probably would’ve.

So take a look here. Here’s an Aetna claim, and notice what it says As a result of a routine claims payment, we previously notified you that there were some differences between the amount paid and the amount, which you should have been. That’s their own issue. So notice and I highlighted it in yellow, it says, Our records indicate the overpayment as noted on the enclosed document, is not eligible to be offset from future claim payments.

In other words, you’re outta network. So we can’t force you to pay it back, but we’re gonna please say therefore we must request you issue a check or money order payable to us in the amount that’s requested. You know what my answer to that is? No thank. Why would I voluntarily send it? When do they ever voluntarily say, Hey, you know what?

We’re not paying you enough. We’re just gonna go ahead and pay you more. Know your rights. Don’t be afraid to push back when there’s a request for overpayment. Was it truly overpaid? Did they pay you more than you billed? That you would’ve to pay back the amount over what you build? Or if they paid you twice.

But if you’re out of network and they later decide, they didn’t feel they should have paid it too. That’s on them. They should know their own policy. And the Statue of limitation applies for those of you who are in network, just like they put a limit to the time that you can send a. They will have limits to when they recoup.

This is why a lot of providers think maybe I don’t want to be in network, cuz I give them a little bit of power that’s part of that tradeoff. We did this in an earlier talk with you of trading off what is it worth it or not. Now this doesn’t happen enough to where it’s gonna major problem, but it’s something to note within your rights because many times they’ll just send you a letter hoping you’ll pay.

Let’s say you send a hundred of these letters out, maybe 50 of the doctors know the rule. They’re not gonna pay it, but the other 50. That’s an easy way for them to recoup money by simply having people not aware of what their rights are. Notice. These plans aren’t necessarily there for you. Always be able to push back and know where the laws fit.

That’s what we’re here to do. That’s what the American Acupuncture Council is there to do. We always wanna enhance your practice as I do. For those of you who would want to have help, just what we’re doing now where we can deal with this one-on-one via phone or Zoom or otherwise, you may wanna join our network.

Take a look at our site. You can do the QR code or go directly to our site. Remember, it’s aac info network.com. We’re always here. The American Acupuncture is always going to be your resource, your place for help. And remember, first of the year is coming. What’s gonna be changing, lots of things, codes, fees, and otherwise probably time to get to a continuing education seminar with the American Acupuncture Council Network.

I hope to see all of the future date. Until then, best wishes everyone.