So we extend the Huatuojiaji points all the way up to C1 on all the way down to alpha. All right. So I think let’s just go right into this video, which is showing the anatomy of the Huatuojiaji points.

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

Hello everyone. Thank you so much for coming to our webinar. My name is Matt Callison. I’m here with my colleague and friend Brian Lau. We’re going to be just, oh, there you go. Huatuojiaji points and spinal fixations. An emphasis of this will be on the middle jaw actually. This is something that is such an important technique that I want to share with acupuncturist.

This is over the last 30 years of clinical practice, just one of the go-to treatments when somebody is having any kind of Zong food type of injuries or Zong food patterns that we want to have a little extra emphasis in that treatment to help out that organ. So we’re going to emphasize the middle job in this particular discussion.

So before we get rolling Brian, is there anything you want to add or should we just go right into it? I will jump in. I will add that. I’m going to be working on some re streaming aspects that we’re doing just so we can get it stream live to our YouTube channel for future webinars, our Facebook page multiple platforms.

So I’m experimenting with some new software. So I’ll probably have a little bit of a backseat today. I might, I’ve been a little. But but I’ll mostly be in the background today. Thanks for handling. It’s exciting that we’re having that live broadcast. So thanks for handling that. All right. Let’s jump into the cadaver warning here.

If we could. So you guys, we are going to have a couple of different cadaver videos just to be able to show some of the dorsal primary, primary nerves and the depth of the Huatuojiaji, the anatomy of the Huatuojiaji points. So in the future, if somebody is watching this recording, you might happen to be at a coffee shop or something for that.

He just wanted to be really mindful of the surroundings that some people may actually end up seeing these cadaver images and it can really be quite upsetting to people. So let’s be really careful of this place. I want to make sure that we don’t offend anyone. But also they are here for you to be able to learn from so you can be able to help your patients.

All right. So let’s jump right in. It’s go to the next slide, if we would. And it’s talk about the definition of the . I believe most of us know that the Huatuojiaji points are 0.5 to one soon. Lateral from the lower border of the spot is process of that particular vertebra. In many texts, you’ll see that the Huatuojiaji points stop at T one.

I’m not exactly sure why that is. However, we’re gonna, we agree with Dan Bensky and John O’Connor in their text acupuncture, a comprehensive. That was first written in the 1980s. And they bring the points all the way up into C1, which makes a lot of sense, because if you have a dorsal Ramiah nerve, which goes all the way up to C one and all the way down to L five, then you’re going to have a walk toe jig point.

And the effect without points can be the same. So we extend the Huatuojiaji points all the way up to C1 on all the way down to alpha. All right. So I think let’s just go right into this video, which is showing the anatomy of the Huatuojiaji points. This will be a cadaver video, and we’re going to be cutting the video a little bit short.

It’s a long video, seven minutes and 46 seconds. It’s a great educational tool, but we’re going to stop about five minutes in so we can save time for the rest of this presentation. Yeah.

So this video is on our YouTube channel too. This one you might want to have access to. It’s really a great resource for looking at down the road.

Yeah. Excellent. So let’s go to video one, please.

Before getting to the cadaver video, let’s take a moment to review the relevant anatomy.

The Huatuojiaji points are located 0.5 to one son from the midline on the posterior aspect of the. For the thoracic region, it is imperative for safety. That the 0.57 measurement is used as a greater distance from the midline increases the risk of causing a pneumothorax, especially with deeper perpendicular needling.

The Huatuojiaji points are also motor points, depending on the depth motor points of different muscles. The most superficial motor points reached or that of the spin Alice, which is the most medial of the erectors being a muscle group, the deeper motor points reached are the part of the transversospinalis muscle group.

This group is frequently referred to as the deep pair of spinals. This video specifically examines the Huatuojiaji point at the level of T nine, starting with the skin and progressing layer by layer through the subcutaneous fat, the lower trapezius, the spinalis thoracic, the deep pair of spinals and ending at the laminate.

The video shows the layers and succession and potential safe needling depth for patients. However we do not advocate deep needling for every condition and assessment of the points and the patients must be considered for safety and efficacy. In some situations, a more superficial needle. Insertion is suggested and other situations, a deeper insertion is desirable palpating for excess and deficiency along with other findings will inform needle technique.

And then. At Accu sport education, we teach proper needling technique and depth for the Huatuojiaji points based on clinical efficacy, patient safety and patient comfort. A thorough understanding of the various layers is vital for proper needling. Let’s now look at these layers on a non chemically treated cadaver specimen.

All right. So with a deeper needling of Watson Georgie point at T nine, let’s look at the layers that we’ll be penetrating. Okay. So we’ve already gone over subcutaneous. There’s the skin subcutaneous fat.

And we have posterior aspect here at T nine. This would be the lower trapezius tissue here would be the participants’ door size. We’ve pulled that back, retracted back

then the next tissue that the needle will be going through at the Watchers yards, you will be the erector spinae. So we take the erector spinae. We retract that back. We go through the erector spinae, the need would then with deeper penetration, go into the deep of spinal muscles, which lie directly on top of the Lamanna.

So the deep needle of walk to a jig point, if it did go to the bone, it would go to the laminate. So this, now this take these deep paraspinal muscles off so we can show the bone.

So continuing with the anatomy, with the walkthroughs, Georgie, as we’ve discussed, we’ve got the skin, we’ve got the subcutaneous tissue. We’ve got the lower trapezius peeling that away the Leticia store side, we peel that away. The needle of the Watchers, as you pointed Tina, it’s not going to affect Leticia store.

So I was moving out of the way so we can see now the deeper layer we’ve got the erector spinae. So the needle would be going through the erector spine as well. We were tracking that back. Okay. So then now you can see here’s the deep pair of spinal muscles. That covers the Lamanna, the deed pair of spinals.

And if we were tracking this back, track that back now is great tissue that you can see

right there. That’s going to be the vertebra. So this would be the last. So the acupuncture needle would be hitting the laminate with a deep insertion. So 0.5 spoons. Okay, great. Thank you. All right. So that gives you a nice in-depth look of what’s happening with the Huatuojiaji points in the safety of the, as you point when you are 0.5 stone away from the lower border, that spine is processed.

It is protected by that laminate. Now what we didn’t see in that video, we’re going to be at the very. Very thin as a hair, the dorsal line. Now this dorsal rabbi nerve is a collateral branch that extends posteriorly from the spinal nerve root, the medial aspect of that dorsal around my intervates, the tissue of the deep pair of spinal muscles and travels all the way up in interface, the skin, all of the watchOS Yashi point.

There’s a lateral branch of this door, ceramide that then intervates the erector spinae at the outer bladder line. So your back shoe points are motor points of that particular level. And then we have a further lateral branch of that same nerve. It’s a collateral branch going into the outer bladder line.

So the dorsal primary is innervating the tissues of the Wachovia. Which would be motor points of the deep paraspinal muscles, the inner flatter line, the back shoot points. And then also the outer bladder line. Let’s take a look at another cadaver dissection that we’ve done so that you can appreciate the innervation of the dorsal primary rabbi at UVA 18, 19 and 20 and special note look at where the innovation site is going to actually be underneath that long, just in this muscle.

Brian, did you want to say something? Yeah. Before the video, maybe just the quick. Summary. So the next one we have what the setup for this cadaver video was, is we took a lot of time. This is a kind of a meticulous process to open up the layer between the erector spinae and the deep para spinal muscles, so that you can start to reflect back the erector spinae.

So in, before all that process, the, that fascia covers everything. It all looks one layer. So you have. Systematically go and tease it away and make it a model basically that you can learn from, instead of it being all intertwined. The fact that the fascia holds everything together and encompasses everything is informative and it gives you information to see how everything’s interconnected, but it’s a little hard to see the different layers.

So that’s the setup for the the video is, as we did take that time to tease away those individual layers. And you’ll see that when you see the video, so context for those who haven’t done. Good. You ready for that? Yep. Let’s do a video too, please.

As we’ve been discussing in the smack program, the Huatuojiaji point, the back shoe points, and also the outer bladder line are innervated by the dorsal primary route. The medial branch of the dorsal primary rabbi, which is a stem that comes right off of the spinal nerve root interface, the tissues of the Huatuojiaji point.

Then there’s a lateral branch that will then Intervate the long dismiss muscle. And there’s a lateral branch that then intervates the tissue on the other low-cost Alice and the outer bladder line. We can use back shoe points when we’re treating the Depot vexations. In addition to Huatuojiaji points to reinforce a stronger signaling system.

When we’re de fixating fatigue, fixations, let’s take a look at urinary bladder 18, 19, and 20. Lift the tissue up. Let me take a look here.

Here we go. Let’s take a look here. We can see a lateral branch right here. We’re right into the, longissimus innovating at you. You’re near bladder 18 coming right down here. Here’s another branch lateral branch. Now coming from going right into the long dismiss innervating urinary bladder 19. The longest-serving.

Back down here now we’ve got T 11, 2 11 coming up, innovating right into the long, just miss urinary bladder 20.

Okay. So I hope you can really be able to appreciate the depth of actually when you’re needling the back shoe points going in a perpetrator. Needle insertion is something that we teach in the smack program. So we can take advantage of as much of that dorsal primary nerve as possible in the innovation, because innovation is going to be on the underside of that long, just a mess.

We want to get into that long dismissal in order to be able to help stimulate the back shoot points, which will also in addition to end up stimulating the sympathetic ganglion. So let’s go ahead and talk about that actually. So from that dorsal primary Ram, I wish we were talking about late, earlier. It was a posterior branch.

Let’s now talk about the intercostal nerve, which is going to be an anterior branch of that spinal nerve root. So in the thoracic region, obviously the anterior branch going, becoming an intercostal nerve, going all the way to the anterior aspect, interface, the tissues of that front. This is the reason why that we find our front move points and the back shoe points on the same level line is because of that thoracic nerve.

Now, if we take a look at the sympathetic ganglion, or if we can go back to that spinal nerve root, so the spinal nerve root then goes into. Just basically telling Newport location of it. So just anterior of the fatigue column, your sympathetic ganglion about sympathetic gangling on then has our branches that are going into most of the organs.

But this is where, what you can see there in your notes as being that young innervation so that the sympathetic nervous system being more than young aspect of it and the of the Vegas nerve actually being more of the UN. Of intervening in those organs. So let’s take a look at the connections between the dorsal primary nerve, the back shoot point, the front move point.

We can see how it’s all the same nerve. And so by stimulating these points, you are affecting the particular organ through the sympathetic ganglion, because it’s all connected classic treatment would be your therapy, which is discussed as your front moon, your back Shu point. But if we add the . In addition to that, we’ll be discussing here in just a tick, the do might as well.

All of that tissue, we use neural signaling because it’s communicating to that particular Oregon as well. Let’s go to the next slide so we can be able to look at a couple of different images. You have described this. So on the image to the left, this is a nice view from Clemente’s book. As you can see the dorsal primary nerve on that image to the left, the dorsal primary.

And then you have that the intercostal nerve then going scrounge to the anterior aspect to the front moot point. So you got a really good appreciation of the continuity of this particular nerve and how it can be able to stimulate with a highly conductive stainless steel needle. The acupuncture. And to be able to propagate Xi and a signal of our intent, then you can see that sympathetic ganglion also within that image of the lab, how it’s an extension and anterior extension of that thoracic nerve in the spinal nerve, this image on the right, you can be able to see also where your Backstreet points are, your Huatuojiaji, your outer bladder line and front crawling along those intercostal nerves between the.

All right. So let’s, now let’s talk about why we want to actually include the Duma with particular cases. So let’s go to the next slide

here. It’s really quite interesting to me is that the different branches? So the different pathways of the Dumas. So we know actually from school that the two miles is going to be traveling along the spot is processed. But there’s also different collateral branches in second branch and third branch of these different pathways for the do mine.

I found it really quite interesting. How, for example, here on the image on the far left the pathway, there is of the third branch of the doom eye and in the drawings of how similar the drawing is to the form. It’s the, being a deep pair of spinal. Innervated by the dorsal rabbi and how interesting that is, how it looks like it could be multiple.

So when our founding fathers are discovering and looking at the the do my through cadaver dissections, I can’t help, but think that when they’re looking at these deep paraspinal muscles and they can see this as being associated as part of the Dumas and not just the points of the doom, my the underneath the spinus processes, but how to do my, can be able to expand laterally to include the wok doji points, which makes a lot of sense, because the super spot is.

And the interest bondage ligaments, which attach from spinus process to spawns process are innovated by the same nerve, the dorsal around that interface, the Huatuojiaji points. So it makes sense to be able to add, do my points to particular areas where you want to be able to have a stronger sensation to at Oregon.

And you look at the image on the right, this is your low collateral. Look how the line of the going extending up from the kidneys themselves, that kind of looks like it could be the same type of fiber direction of the semispinalis, which is going to be part of the deep paraspinal muscles innervated by the dorsal ceramide.

So the similarities are really uncanning in my mind. All right. So why don’t we now talk about when there’s a fixation? So the next slide, please, the VTB fixations are commonly found at the same intervening, stagment of a chronic Zong who? Oregon pattern. For example, if somebody is having, let’s say digestive disturbances, like GERD or any kind of hyperacidity anything like that as effecting that middle jaw, it’s really quite interesting to find a, the Teebo fixation in the same level, that interface, those particular Oregon’s level with the back Shu point.

So what is a sativa fixation? So just to be able to put it really quite simply, it’s going to be where one vertebra we’ll go ahead and tighten on the vertebra above or below. It’s a fixation of the Fossette joints. Normally. Vertebrae we’ll go ahead and move into interdependently. They have motion when they get stuck or fixated, they become actually as one unit.

So in that particular case that can cause wear and tear within the deep paraspinal muscles innervated by the dorsal primary rabbi, and also lead to decreased signaling going into the organ systems themselves, especially with chronic material fixations. So if have the deeper fixation, it’s a stuck area.

It can decrease the amount of she going to the walk doji points to the back point to the front moot point. In addition to the organ itself, we want to be able to make sure that we can try to get rid of this fixation and open up the movement of the chief through the doom. I, what you’ll find with the VTB fixation with palpation is that one side will end up being excess and the opposite side will end up being.

You’ll know this through your palpation, by palpating, the side of the shortened deep pear spinal muscles. That’s holding that vertebra into that locked position. It will feel excess. It will be tight. It’ll be really quite tender. It’ll have some rigidity to it. And then on the opposite side, when you’re palpating, the Huatuojiaji point becomes more pliable.

It’s more open, it’s more deficient. So in my mind, this actually is going to be predicating, a different needle. I’ve been doing this for close to 25 years. So I’ve had a really good eye DM practice of how to be able to needle these particular Beattyville fixations through trial and error and by making patients really quite sore.

So what I did learn is that when you’re on the deficient side is to needle quite a bit, shallower more of a reinforcing needle technique. And we’ll talk about that here in just a little. Let’s go to the next slide and figure out how to be able to actually de rotate or de fixate these particular vertebra.

And Matt, quick question. Can you touch on the role if any, of needling into or stimulating the fascia and these needling techniques? That’s the question on.

Sure which level of the fascia, that’s like for once you get past the skin, you’ve got your superficial fascia and then you’ve got your deep fascia and then you’ve got the fascia that’s separating each one of these muscle layers and because the fashion intertwines into the different muscles themselves I guess I need a little bit more understanding of the question.

Can you answer that, Brian? Yeah, I would maybe need a little up question on it, but I think just to simplify it basically the fascia is going to have the same innovation aspects. So the needles even touching the superficial fascia, it’s going to have an effect on that. If you’re at the lotto level on the medial branch of the dorsal, Rami, if you’re at the back Shu point on the lateral bands on the outer back, Even just in the superficial fascia, it’s going to have an effect on that innovation.

Now, the musculature is going to start to become taught and ropey and irritated, and that’s going to start to become part of the pattern made. Maybe it starts with the food. Maybe . Yeah, digestive disturbance or whatever example we’re looking at. And then those musculature starts getting ropey and knotty.

So I think there’s added value in going deeper than the superficial fascia and going into the level of the myofascia, which is fascia, but also the muscle tissue and effecting the the deep holding patterns in those structures. And of course, if we’re needling the Dumas we’re needling ligaments, which are.

So it’s all part of that innovation aspect. I think something to note on that fascia is that with research that has come out over this last decade is that the refining that the fascia itself is a lot more proprioceptively innervated than muscles themselves. And so that’s part of what the needle technique, how important that is of lifting and thrusting and rotating and getting the mild fascial tissues to wrap around the needle.

Cause that really starts to signal product that hopefully that answered your question. All right.

All right. So just a very simple way of assessing and also mobilizing the thoracic vertebrae is when one thumb is going to end up being on the vertebra above. You just mobilize in a frontal plane and just see if there’s play to the Verdun broad. Does it move or does it stuck for example, like you’re just pressing your thumbs into a brick wall when it doesn’t move and it’s stuck, that’s going to end up being fixated.

That’s going to be the side that you’re going to have a deep needle on. That will be your excess side. So then on the opposite side, we want to make sure that we’re needling more superficial, more of a reinforcing needle to attack. And I think we have a video that actually shows this mobilization right now on TA and Tina and Brian, do I say anything before we show the video?

Yeah, sure. You’ll notice that the videos in portrait mode this video will be up on our Instagram page. If you want to check it out later, we’ll put it up on YouTube too. It’s nice to have reference for it, but it’ll be on our Instagram page for sports medicine, acupuncture. You can check that out.

If you want to watch it later. Of course, it’ll be in the recording of this webinar to all right. So let’s have that video. This video is assessing for a TA T nine Mightybell fixation. I locate the spinus process of TA palpating, the superior and inferior borders so that my thumb placement is in the middle of the spinus process.

Once the location is obtained, I applied the same method to the T nine. Motion palpation is then applied to the spinus process of these vertebrae in the frontal plane. The same method is applied to the vertebrae in the opposite direction, examining for freedom of motion, a lock sensation, or lack of motion indicates of a tibial fixation.

Okay.

Common, you’ll find for TiVo fixations in sets of two and three. So it’s a good idea to needle at also mobilized. And this is what I was discussing earlier, how it’s amazing how well this actually helps your zone food treatment. Alright. So it is very important in my mind, just from creating a lot of soreness with patients, with kneeling deep on both sides and how obvious it is that one side is going to end up being deficient.

So a lighter needle technique for sure. On the deficient side, only a half inch to three quarters of the. It can even be shallower than that if you’d like. And then on the excess side, we do want to get it down to the the deep para spinal muscles. Absolutely. Because that’s going to be the muscle that’s really locking on and holding that burden right into a locked.

So we want an excess or a reducing needle technique at the on the excess side and a reinforcing needle technique on the deficient side. Now let’s discuss needling into the Duma as well to help to reinforce this treatment. So then the next slide. Yeah, wait a minute. Quick thing, just to add to that, Matt.

The deep side, I think you can see the cursor going through. Maybe you get cheap, not so deep. And you can always then put the other needles in and that’s going to start to soften that area and then come back, maybe just before you, you leave the room and let the needle set. Maybe after you put the last needle in and then go a little deeper, cause the tissue or relaxed.

So it doesn’t have to just barrel in right from the start all the way to the deep tissue. Oftentimes it’s not an issue, but sometimes you want to do it in stages. So just to have that heads up.

All right. So what you’re seeing is from that same cadaver dissection that bride did with the videos earlier, how this is a lateral view, the rector spot has been taken off. And this is the deepest view. I’m not sure if you can see that copper handled acupuncture needs. That’s going to be chest underneath the spot is process.

So the needle is going to be inserted into the supraspinous ligament. So we have passed the skin past the subcutaneous tissue, which should have been removed from this particular specimen. And then you have the supraspinous ligament, which is attaching the tops of each one of the spinus processes. Then deep to that is your entire spine is.

That’s a large, broad ligament. So my finger there, the pinky is actually showing the depth of that interest by this ligament in my mind, this is where you’re actually starting to really propagate, do my cheese in this interspinous ligament. So once you start using needle technique at this depth, the patient will often feel the sensation either traveled up or down the spine.

So therefore in my mind, this is really the depth of the Dumas or to be able to see. At do my cheek moving now, importantly, like I said earlier is that these ligaments are highly proprioceptive and they’re innovative also by that dorsal primary nerve. So it’s just another point to be able to increase the signal for your Zog, Oregon patterns, as long for Oregon.

All right. So then what we’ve talked about really is just needling the Huatuojiaji point, the back Shu point, the front move point. Also the doom eye using a potato fixation mobilization. This is really a quick and easy way of getting pretty profound results. There’s a lot more to this. Obviously it’s we have six days discussing actually how to be able to do all of this coming up, module one in the sports medicine acupuncture certification program, that’s going to be starting in July in San Diego.

So this is going to be discuss really quite thoroughly a number of different aspects of it. In addition to look and help your patients go to the next. Is examining their posture and seeing where the Viterbo fixations usually occur. And it’s really quite curious with a lot of patients with organ disharmonies that they’ll have spinal beds, the spinal bed.

And you can see on this image on the left this particular patient was coming in with middle job disharmony lots of different signs of symptoms of acid regurgitation. And and you can see how the elevated ilium. And then you’ve got a spinal then of that lumbar spine and going into the lower to mid thoracic region.

That is usually where you’ll get a BTB. Fixation is where the spinal band then comes back to the do my, now this is going to be the posture of this particular patient. This is the initial office. After the acupuncture treatment. And then also with mild fascia release and reeducation techniques that we teach in this module.

One, in addition to emphasizing different exercises that will help to continue to stimulate your treatment. I may keep mobilizing that spine for the patient to do at home. So these are all things that we’re teaching. Now let’s take a look at the next slide. This is before and after. The first treatment.

So we did the acupuncture treatment as discussed before I did some artifactual work, had to perform some exercises and you can see how the elevated alien from the left of poor treatment is now neutralized. That helps to straighten up the spine. And you can see that his do channels now much straighter.

So that’s going to start taking stress off that middle jaw and on the road to healing for this particular patient. Brian, is there anything that you wanted to say with that? Yeah, just a quick something on this previous slide that both the myofascial and the corrective exercises you notice are movements more in the sagittal plane.

So going flection and extension. So without getting into spinal mechanics, moving in that way, we’ll help D rotate and take the side, bend, soften the side, bends in the spine. So you’d think, just the viewer to look at it without knowing spinal mechanics necessarily, you would think that. You would want to have them do a lot of side bending because of its side bent one way maybe you could sign better the other way, which would help, which would do something.

But this is just another strategy. We get a lot more into it and classes, but that’s why you might notice that it’s a movement in those different planes to balance is fine from a different perspective. Okay. All right. Okay. All right. So we have some contact information on the next slide there.

If you guys have any questions at all, feel free to reach out to us. And I think Brian, if that’s anything else for you, we can give thanks to the American Acupuncture Council so much. This is really fantastic. Thank you. And make sure that you come on back next week cause Sam Collins is going to be back talking about insurance and billing and such.

He’s a real cool. A fun lecture to listen to. Yeah. Sam’s full of energy. Brian, always nice hanging out with you and thank you very much, counsel, and we’ll see you again. Bye.