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The Science Behind Promoting Digestive & Cardiopulmonary Balance with Acupuncture

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– Hi, I’m Virginia Doran, your host for this episode of “To The Point” very generously produced by the American Acupuncture Council. Today our show is called A Fresh Perspective on Zu San Li, Stomach 36, and Neiguan, Pericardium 6. The science behind promoting digestive and cardiopulmonary balance with acupuncture. And I am so honored and pleased that we have as our guest today, Narda Robinson. Narda has a very interesting history and approach with this. She has a Bachelor of Arts from Harvard, Radcliffe, a Doctorate in Osteopathic Medicine, a Doctorate in Veterinary Medicine and Masters Degree in Biomedical Sciences. She’s a Fellow of The American Academy of Medical Acupuncture, Vice Chair of the American Board of Medical Acupuncture and a former member of their board of directors. She has launched the first Integrative Medicine Service at Colorado State University and for eight years has directed Colorado State University’s Center for Comparative and Integrated Pain Medicine. She’s taught a variety of scientifically-based continuing ed courses ranging from medical acupuncture and massage to botanical treatment and photo medicine. She’s a leading authority on Scientific Integrated Medicine from a One Health perspective, having over two decades of practicing, teaching and writing about integrative medicine approaches in both veterinary and human osteopathic medicine. She’s the founder, CEO and Lead Faculty and Course Director for the CuraCore MED and CuraCore VET based in Fort Collins, Colorado. And she’s also the author of a most wonderful book called “Interactive Medical Acupuncture Anatomy”. It’s very comprehensive. She has a very interesting neuroanatomical and evidence-based approach. So I don’t know how she’s done that all in just a couple of decades because it’s really quite formidable her accomplishments. So for anybody who hasn’t seen it or who can possibly get it and now that you’re home staying in place, you might actually have time to read it. I really recommend the book. You can find it on Amazon and see some excerpts there, as well as if you search on Google, you’ll see some highlights from it as well. It really adds to our field by putting a lot of the scientific point-based research altogether with the points in, it’s a book of points basically, and explains with a really comprehensive describing of the neuro, not just neuroanatomy, of all the anatomy that contribute to the points and how that actually affects the uses of it, and basically verifies what we’ve learned from, you know, classical sources. So, I guess how I found the book was a student took my class and he was an osteopath and he came up on a break and he said, “Oh, you have to see this book.” And I was kind of like, “Yeah, yeah, whatever,” he was new at it and I just didn’t expect much. And then he showed me, I was like, “Oh my gosh.” And then I had to buy it. It’s not an inexpensive book, but with the work that’s in it and the information that has been assembled all in one place like that, it’s very valuable book, I really recommend it. It can be used however you think about things, but it can help verify things for your patients and the field of Western medicine. So without further ado I’d like to introduce Narda, and give it to her to explain this from her experience and knowledge which is formidable. So Narda, thank you very much for being here.

– Thank you, thank you Virginia, it’s great to be here. We’ll be talking about, Zu San Li and Neiguan and while I am presenting a big focus on the points themselves, I am going… In clinical practice of course we use other points that are mandated or suggested by the patient’s presentation. So this is though is an opportunity to see how some of the mainstay approaches or the mainstay points such as Stomach 36 and Pericardium 6 work from a neuroanatomic perspective. So as you can see here on the left, we have Pericardium 6 in the forearm and Stomach 36 here on the pelvic limb. And just in a different form here is the individual with a different view of the hand so of course when we move around the point locations change, here’s Stomach 36, in just part of the larger context because when we again want to use these clinically for something like Stomach 36 we might want to treat knee pain, we might want to treat pain in the calf, we might be addressing immune function. But if we are working with something for digestion from my scientific neuroanatomic connective tissue approach, I am going to be interested in how stimulation of this point, whether we’re using needling, pressure, heat, laser, whatever it is, how is that going to affect internal organ function? Because I think that that is one of the perplexing ideas from Chinese medicine where we can say it balances Yin and Yang or moves Qi, but we also have information now on exactly how this is going to affect internal organ function. So the objectives for today are three. We’re gonna review some of the Chinese medicine indications and mechanisms for these two points, we’re going to identify key neuroanatomic connections between each of the points and areas of the spinal cord and, or brain. And describe how knowing the structural underpinnings, which was everything my book was about, but of these two specific points, how we can link that directly to the physiologic outcomes that happen from needling, which I as a clinician, as a veterinarian and an osteopathic physician, I appreciate knowing how the points are going to influence my patient and to know that there’s quite a bit of scientific background and backing for what I’m expecting to see. And I will talk as we go forward about how to search for scientific literature so that when you want to come up with papers that substantiate what you’re doing, that you can see how easy it is to do that. So with the images that I use in this, if they are not from Shutterstock photos that I have it mentioned here, so this is from TCM Wiki. But just looking at the stomach channel as a whole, we can see that there is often described in the Chinese medicine kind of literature, a divergent branch that goes to the organ after which it’s named. I mean I learned acupuncture from I mean a variety of perspectives. The Chinese component, the French energetics, the scientific approach, neuroanatomic connective tissue. So I had that as a background. And so this idea suggests that you have energy or Qi going into the stomach somehow and hence the stomach line is a name. And that maybe the idea from that would be that, okay, you stimulate Qi and somehow there’s a branch that takes that to the organ. But what I’m going to add to that is the knowledge about the actual structures that we can dissect and feel and test that give us objective understanding of what these sites of stimulation will do. So again, this is one of the images from my book and it’s with all the different layers on. Because what happened was this was from the Visible Human Anatomy Database and there were computer animators that put it all back together so that as I was photo editing for 15 years, I could add in muscles or take away muscles and just see vessels and nerves or organs or things like that. So by starting with the points on the surface and then going down and removing the skin layer from photo editing, then I could see the different structures that I would be stimulating as an acupuncturist, plus using neuroanatomic information from other sources as well. But this is Stomach 36, as you would see with the skin gone. And the description being on the anterior aspect of the lower leg, three cun below Stomach 35 which is up here in green and one finger breath from the anterior crest of the tibia, which we can also look at as a tibial tuberosity right here. And this is a cross section which I really appreciated learning by dealing with these cross sections, learning the different depths of muscles and fascia and vessels and nerves once you go into the skin, both from a safety perspective as well as a tissue activation perspective. So here on the left, I have cross section through Stomach 36 and I’m showing that, sometimes I’ll say cranial tibialis ’cause that’s what the terminology is as a vet, but the anterior tibial, and it points to how at least in an individual like the person that made up the Visible Human Database was, how far in depth we can go where it’s safe versus when we start to get into other structures. But the point of this slide being that research has shown also that we have all the different muscle afferents available to us at the point. So groups one, two, three and four, which have different levels of myelination and whether they are mechanoreceptors, so transmitting information about light touch or vibration or the subtle activation from an acupuncture needle or nociceptors, so they don’t have any myelin and they’re more conveying pain. So typically what we are thinking about as far as Stomach 36 for indications are have to do a lot of times with digestive things; gastric pain, vomiting, abdominal distension, diarrhea or constipation. But then some mood-based things, even epilepsy or depression or insomnia. Then of course local things for the knee pain or we have leg weakness or paralysis, maybe even a fibular or used to be called peroneal nerve injury. So just coming into acupuncture, one might think, “Okay, how does one point do all these things?” And so that’s what I loved in the process of those 15 years of putting this book together. Coming from a standpoint of just really relying on the Qi in the Chinese medicine approach with some of the scientific background in there. But then seeing as I would start with the neurologic connections local at the point and then put together where they hit in other reflex zones within the central peripheral or autonomic nervous system. It to me explained the effects that were these conventional indications. And so it didn’t leave anything more for me to wonder about. But just to review that the point Zu San Li changes to Leg Three Miles when we convert that to English, which has a lot of different interpretations that we don’t have time to go into. But the Chinese medicine description is that it will tonify Qi and blood, harmonize and strengthen the spleen and stomach, strengthen the body as a whole, and the Wei Qi raises Yang, calms a Shen, activates the meridian, stops pain. Okay, so that’s quite a bit of complexity there. And so what can we start to see? So–

– You know I always say that Stomach 36 does everything except wash windows.

– Yeah, yeah, that’s good. Or like with laser therapy, sometimes when we lecture, talk about it treats everything but death. So I guess maybe you could, I mean you say it tongue in cheek, but that’s a good point, Virginia, yes. So with Helene Langevin’s work, from the ’90s that the needle-tissue interface has been described as, as you see here being able to wind around the collagen that’s in that connective tissue, and then with that we are deforming fibroblasts which is activating their metabolism, causing them to make all kinds of changes through their structure function, just alterations, but there are also nerves in the vicinity. So while we are doing some connective revisions or interactions causing some fascial relaxation, even several centimeters away, there’s also that profound effect which is on the nerves which is neuromodulation. And that will get us into some of the analgesic effects and some of the autonomics or the parasympathetic, sympathetic or the digestive system, the Yin-Yang general balance. And then just taking this from a website talking about modulation, like what is modulation? Well, it is putting in your own signal that is going to interface with what is already there. And so you are modulating or you are changing the status, the resting tone of what that organism is going through. So that when there’s an imbalance, we can come in with our somatic afferent stimulation, meaning on the surface, the somatic afferent, the afferents, the nerves are coming into the nervous system equation and then we are stimulating it initially, but the body is going to respond with a modulating effect. So we are relying on the intrinsic healing mechanisms, self-maintaining mechanisms of the body to take our input, our somatic afferent stimulation with the needling and do what it normally does, bring it back to normal. So it’s like, “Oh yeah, right, this is what normal is.” And we’ll talk about how that happens. And it’s comprised of some neurotransmitter shifts, whether peripherally or in the spinal cord or in the brain, and then other things that happen with larger brain networks. For the analgesia or the pain relieving approach, we can distill some of it down to what happens from our input. So not a pain causing, that’s where having a nice gentle approach with acupuncture is so important where we’re subtly manipulating the needle and that is going to activate the mechanoreceptors preferentially. And what that means, so those receptors respond to light touch or vibration. Think of just a nice gentle soothing electroacupuncture. These are thicker well myelinated fibers that are important in pain control when they get to this dorsal root ganglion. So they’re the good guys. I mean the ones that convey, they’re also good guys ’cause they convey information, or tissue deformation. But let’s say you had some kind of pain elsewhere or if you needle too aggressively, that is sending information through these other types of fibers, the nociceptors. So we really wanna touch or inputs in the way I teach is to be gentle and well-received. There are gonna be some responses in the dorsal horn of the spinal cord that connect to that hand in this case. And those light touch receptors, the mechanical receptors, I think through the next side we’ll see the gate control idea of pain. They can help shut down pain influencers that are coming into that same location in the spinal cord. Of course the big complexity of the whole thing with acupuncture analgesia is that we’re gonna be affecting the whole brain and different pain networks and the thalamus and limbic system, all kinds of areas with our acupuncture analgesia. But just to distill it down right now we have those three initial areas that we’re concerned about. This is just an expansion of that spinal cord dorsal horn area where if we have acupuncture here, they have skin massage. If we just say that’s acupuncture, acupressure done gently that we’re bringing that information through these mechanoreceptors, the well-myelinated mechanoreceptors coming in here. And they are helping to block the pain impulses from on that same ultimate neuron that’s going to come up and then send impulses to the brain. So that’s just a peripheral way to block the pain impulses. This is a Stock photo. This is not necessarily how I would approach knee pain ’cause I would be tailoring it to the exact expression and location. But in general, this is electroacupuncture and I’m bringing that in because here’s Stomach 36 more or less. And they’re doing a typical four treatment before needling approach around the knee, and took it up to electroacupuncture. So if we look at knee pain, how is Stomach 36 participating in that? Well, there’s some local pain shutting down, so peripherally, but then there’s also going to be affects, I like to consider all the anatomy that’s being affected, but we don’t have really time to go into that much here. But there’s also even for knee pain going to be impulses that are going into the spinal cord so that ascending to the spinal cord and brain that are also going to be pain alleviating. And so that’s important to know from a neuroanatomic perspective ’cause we can reinforce that with points on the back and the spine that will help shut down pain information that’s being communicated in the relevant levels of the spinal cord and really reduce what we call peripheral sensitization of nerves that are going to the knee. But it’s never really knee pain. It’s we, I as an osteopath and a veterinarian, I mean we look at the whole body and what are the compensatory biomechanical alterations? Where are the myofascial restrictions? It’s really a whole body kind of thing that in clinical appreciation. But if we’re talking about digestion, one of the things that we can be aware of is that Stomach 36 afferent information is coming into the cord at the sort of the lumbosacral junction. And so when impulses arrive into the cord, there’s something called somatovisceral and visceralsomatic reflexes that we’ll look at as the next slide. Then there’s another component that goes to the brain that will cover. But seems a little bit confusing here. But let’s say we have a dysfunctional viscous, so a problematic organ in on our belly somewhere and that is sending afferent pain impulses into the cord. If those go unabated then we could get tenderness to palpation. This is the whole rationale with the diagnostic exam with the Back-Shu and Front-Mu points. So that is crosstalking with somatic or muscles, skin and subacute areas so that we get essentially spinal reflexes that are originating in a viscera of viscous. And then having a somatic presentation where we can go along the back and find tenderness to palpation and think, “Okay, is that local on the back “or is that from something inside?” And we put that together with the whole patient presentation. So there are lots of reflexes like that to consider whether we’re coming from a viscous and going into the muscles or we would come from the muscles and the external. So if we’re doing a treatment and we are involving low back points, then through these reflexes working the other way, somatovisceral reflexes, we can help to shut down some of that internal pain. So that is why I would use those baby back points in addition to a Stomach 36, I’d be palpating and seeing what’s involved. But here are typical bladder points that are associated with the spinal nerves that in my framework that somatic afferent stimulation is being picked up by the spinal nerves going into the spinal cord and having repercussions there as well as going to the brain. But if we’re talking about where’s that impulse from Stomach 36 coming, then we talked about local peripheral nerve effects very briefly ’cause of not much time and then spinal cord effects and reflexes. But then we’re gonna go up to the brain and this is really what explains a whole bunch of Stomach 36 effects. There’s a little site in the brain stem in the medulla called the nucleus tractus solitarius. Here’s just the brain stem looking at that. And the interesting thing about this brain stem center is it sits side by side with this vagus nerve, which is actually longer than this. And the vagus nerve is what is covering, you know that’s doing most of our parasympathetic nervous system. So versus the sympathetic system, which is fight or flight, this is more you’re vegging out, restorative, calming down kind of thing. And so it has effects that are going to balance out that fight or flight sympathetic system. So it’s gonna slow your heart rate, it’s going to help digestion flow and all the secretions from the gland, stimulate bile release, help regulate blood glucose, help you with elimination and digestion and all that. And for the cognitive effects, I mean, vagus nerve stimulation, so this parasympathetic medic effect is so good that it’s like they implanted vagus nerve stimulators for things like depression and epilepsy and different things. But it’s like we have the ability with Stomach 36 and some other points to actually give parasympathetic benefits because of these long loop reflexes that we now understand. And these are… So the nucleus track, the solitarius is one of the two main somatoautonomic convergence sites. What do we mean by that? This is where the somato, so the somatic input from Stomach 36 is going to join at this site in the brain stem called the nucleus tractus solitarius with inputs from the vagus nerve. So 80% of the vagus nerve that’s coming into the brain, which we just saw a bit ago, is afferent information. So the brain really needs to know a whole bunch of information about what’s going on elsewhere. And so that is coming into this site, the nucleus tractus solitarius along with information from the body of which the Stomach 36 has a nice big connection there. And then it’s like this operator here. So if she’s the nucleus tractus solitarius, she’s getting information from the Soma, which could be Stomach 36, and the viscera, which is your guts and things, and then making decisions. So, what she has to do is, well what she does, who knows how this all happen, but it because of her side-by-side connection to the vagus nerve, the nucleus tractus solitarius can up or down regulate vagal nerve output. So that means if you have constipation, you can change it and the vagus nerve can change its activity so that it speeds up digestion. So this is a structural piece of how, might call it Yin-Yang balance, but it’s how our body keeps things stable. Our temperature, our blood pressure relatively, we have these real estate centers in our brain that are in command of doing all this and keeping us alive on a day-to-day basis. And it’s really very amazing that we know this and that we can have pathways with acupuncture to deal with it. So Stomach 36 for GI problems. It’s that homeostatic balance whether we’re dealing with the long loop reflexes to the brain stem or and the lumbar segments as well. So it’s a way that we can understand how even disorders like this, which is our representation of inflammatory bowel disease. When the nucleus tractus solitarius is not doing its thing, then there is a, and with its parasympathetic effects for the vagal nerve, then things can get out of balance. And when the sympathetic nervous system, the fight or flight area takes over too much, then we get a pro-inflammatory state. So not just fire or too much Yang but its actual inflammatory state and if it’s going to affect the GI track, then we can get an inflammatory bowel condition. So by having Stomach 36 in there, then we are pushing the balance of the body to a parasympathetic level, calming things down. So if you just go to pubmed.gov you can do, see this as well. And all I did was I did Stomach 36 and NTS for nucleus tractus solitarius. And you can see various research articles, you can select for free full text if you want so that you can get this whole article for free. It’s online shopping. You don’t have to take out your credit card. So there are so many studies that support this idea that it’s a great way to move forward and to be evidence-based with acupuncture. So we just have a few minutes and just–

– You want to, I don’t know how much you have to speak about Pericardium.

– Okay

– Do you want, anything else to, you wanna discuss about Stomach 36 and do Pericardium 6 another time? Or do you wanna move on?

– No. I think we can show like that there’s another point that has similar effects.

– Okay.

– But I think we’re good. Because it has a different brain stem center for the most part and a different, I don’t know, just clinical applications. So Neiguan, Pericardium 6, again, instead of just thinking maybe there’s an energy connection there, we can look at here and its proximity to the median nerve and indication. Some of which overlap. So the nausea, vomiting piece, that’s because the fibers from the median nerve, from PC6 ultimately go to a very nearby center in the brain stem. It’s called the rostral ventrolateral medulla. But a lot of fibers go there. But some of them go to the nucleus tractus solitarius, which for me explains the GI piece here. But otherwise we’ve got cardiopulmonary indications and we can see how Chinese medicine explains it. But if we look at the science and begin again at the site, just like with Stomach 36, we know that there’s muscles and tissues and fascia and bones and here’s a cross section and especially that median nerve is nearby. But when we get to the rostral ventrolateral medulla, which is not far from the nucleus tractus solitarius, we it… that site is more concerned with cardiac, just antiarrhythmic effects and the pulmonary influences. That’s why it’s this master point for the chest. And so we look at a paper like this, for example, “Cardioprotective effects “of transcutaneous electrical acupuncture point “stimulation on perioperative elderly patients “with coronary heart disease” showing that just to cut to the chase here, that electroacupuncture at PC6 and PC4 can reduce postoperative troponin concentration so limiting heart damage and change the autonomic balance to a much improved state. And PC4 makes sense here because that was right along the median nerve if you saw that in the picture from my book before. It’s median nerve stimulation that hooks up to long loop reflexes in the brain. Here’s “The effectiveness of PC6 acupuncture “for the prevention of postoperative nausea “and vomiting in children” Again, just seeing that yes, there are brain stem connections and that is what helps us understand how physiologically, how anatomically we’re put together so that we can understand that you stimulate here and you get effects kind of body-wide or internally, and we’re not sticking needles in organs. To me it helps to really understand this wiring diagram. So the key points of all this are the anatomy or structure and physiology or function are inextricably interrelated. It’s with architecture and it’s with acupuncture and anatomy. So the more we know about the anatomy of the acupuncture points and their physiologic effects, that’s how we can better understand what the Chinese acupuncturists from way back when and Japanese and whoever else was doing acupuncture back then. They might’ve described it using metaphorical language, but if so inclined one can also understand a lot of it now scientifically. And that then informs my needling protocols, because I can take what my hands say, what my heart says and what my mind says and make treatment protocols that are very tailored to my patient based on what I feel, what I know and just a certain level of intuition but not having to have just a belief somewhere, but really having a clear expectation with objective endpoints that I can rely on. So with that , I am ready for any further questions or if you’d like, you can email me at narda@curacore.org.

– Yeah, I think, I don’t know, Alan, you can tell us if there’s any questions or if we’ll leave that for after the show. But there’s just so much you’ve presented . That’s why I couldn’t look up at the camera. I was like, my eyes were glued to the slides. Well I think we’ll, in this case, I hope you can come back another time because I feel like we’ve just touched on the surface of something’s really interesting. Some people will ask questions and they can be addressed after the show. Thank you again for coming and thank you to the American Acupuncture Council and to all our viewers and hope to see you next time. All right, bye now.

– Bye bye.

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Telemedicine Guide: A Low Back Case Study Matt Callison & Brian Lau

Hello and thanks for joining us today. This is the first of a series of webinars that we’re going to be doing discussing issues, topics, and featuring guests in sports and orthopedic acupuncture.

I’m here with my colleague, Matt Callison. Many of you probably know Matt. Matt’s been around for a long time. He’s sort of a fixture, especially in the sports acupuncture community. Many of you probably know him from various articles and books that he’s written. Matt is the President of AcuSport Education. He’s also the President of Sports Medicine Acupuncture Certification. He’s recently published his lifelong, really, work, it’s been over multiple decades of work, the Sports Medicine Acupuncture: An Integrated Approach Combining Sports Medicine and Traditional Chinese Medicine. Really a monumental amount of work, so a lot of congratulations goes to Matt. It’s going to be a game changer for the field. It’s so nice to see such important work coming out in field.

So, I’ve been working with Matt, initially as a student, when I took the program Sports Medicine Acupuncture Certification. Then I was asked to teach in 2014, quite an honor for me. Fortunately, despite the fact that the program is an incredible program, Matt gave me a lot of flexibility to also add and integrate information that I had coming from my field in structural integration, also in my work with qi gong and tai chi and tendon changing.

We worked to integrate a lot of work to build a model for the channel sinews. I’ve written quite a bit about the channel sinews. We feature a lot of that work in the Sports Medicine Acupuncture Certification.

We’ll start today. Matt’s going to set us up and discuss the case study for low back pain.

Brian, thank you very much, but the honor is mine just to be able to work with you, seriously. You are not only a brilliant academic, but you’ve got that combination of a true clinician and also an academic, so it’s great to be able to call you my friend as well.

Can we start the slides? Why don’t we actually go to the first slide here. Let’s talk about a quick, brief history of what we’re about to see here. This webinar is an abridged version of a blog article and also an accompanying video that shows highlights of our experience with developing, designing, and working through some of the logistical issues of a telemedicine consultation.

Initially, the information in this article and video that you can find on the Sports Medicine Acupuncture website, www.sportsmedicineacupuncture.com, blog article and also video in the April issue. It was initially intended to be presented as a live webinar, so this was like a trial run for us. We wanted to have a live webinar that contained the content for students and graduates of the SMAC program. It was intended to be a review of the recently completed module two, which was the low back, hip, and groin, held in New Jersey, which was right before actually New Jersey closed its door and the COVID-19 shutdown.

Our intention with this is try and be able to show practitioners how to apply some of the principles taught in SMAC and also our experience through telemedicine format, which was brand new for us. We wanted to go through the logistics of it and help practitioners to learn from what our mistakes and what was the best way of setting up patients, lighting, making sure the patient has consent forms, preparing the space for the patient. All of those categories that you see in the bullets here is in that article with explanation as well.

Now, the reason why we decided to publish this trial run was because the surge of demand for telemedicine consultations, we decided just to get it out there. When you do see the video, I really apologize because, like we said, this was a trial run. It was not intended to go public, and I just got out of bed. I don’t think I brushed my teeth. I have bed head. You can tell that this was a rough run for us. Brian, he’s always beautiful looking, so I’m not going to apologize for him at all with that.

Yeah, my hair looked about the same in this one as it did in this test.

What you’re about to see now, this next slide is going to be a video. The blog article and video contains us observing a patient with low back pain, which is something that practitioners could go ahead and do, asking her to perform static and functional assessments so that we get a working hypothesis of her injury and eventually develop a diagnosis, a virtual diagnosis, really.

Then, we can develop an acupuncture and motor point prescription for self-massage acupressure, and then prescribing corrective exercises based on her postural anomalies that we saw through the assessments.

Again, this short webinar is going to be the highlights of what you can find on the video and on the article. Should we go right into the video? Yeah, let’s do that.

Yeah.

It feels like here.

Okay.

And, that kind of feels bilateral.

That’s good.

[crosstalk 00:06:23]

That’s like a facet joint sign, okay.

When I walk, it’s more here.

Yeah.

And then it could even go straight in here. This whole line even here and it goes into this ischial tuberosity.

All right, so with that, listening to the patient, describe this. Brian do you want to go ahead and share our thought process with that?

Yeah, I mean of course she’s just said a few words, she kind of gave a pathway of where the pain is. A couple of simple things. But you should already be starting to think what could be causing the pain, where is this next pain site coming from? And we haven’t tested yet, we haven’t done anything to rule out things or we haven’t done anything to confirm ideas. But already just from the body language, how she was saying it spreads across the back, that’s a very typical sign of facet joint injury. The referral that she was showing down, maybe not lumbar disc involvement, based on just going down to the behind, but we should definitely rule it out and check for it. Thoracolumbar junction syndrome is a common injury that’s becoming more common. Based on the pathway of pain as you’ll see in the coming up slides, that could be an issue. Sacroiliac joint injury could be an issue and also soft tissue strain. So again, we have to rule these out or confirm them, but they’re just preliminary thoughts based on her explanation of the pain.

Okay, good. So the postural observations. We observed the patient in a static and also functional positions. In the static position we asked the patient to move from left and right, so we could see the lateral view, look at the posterior view, look at the anterior sides. Just trying to gain as much information as possible. From there we surmised that the patient had the following postural disparities. She has, what would look like a bilateral anterior pelvic tilt, it was greater on the right. Slight posterior tilt of the ribcage. An anterior hip shift that we’re going to be talking about a little bit more real soon here and it’s relevance to qi and blood deficiency and kidney qi deficiency.

On the posterior view we could surmise that she’s got an elevated right ilium, also known as a left pelvic tilt. We could also see a left tilt of the L4-L5 vertebrae, which really helped to confirm the elevated ilium. Additional postural imbalances to check in the second and third office visit could be looking at the head, the scapula, the knee the feet positions and also the possible contributions to overall postural and myofascial imbalances.

Because this is a telemedicine conference, it was a little challenging to look at the entire picture, but we want to be able to see as much as we possibly could and design a protocol for her so we can get her out of pain. And like we said we can look at the other aspects on the second and third visit.

Brian we’ve got a video coming up here. Let’s go ahead and show that and do you want to chat afterward?

Sure.

What I see is an anterior hip shift.

Yeah, me too.

I see a possible pelvic rotation to the right.

A little bit of the ribcage coming back, it’s not extreme, but a little bit of the kidney qi, qi and blood deficiency posture.

I agree. Should we look at her other side?

Sure. Yeah more noticeable this side is the traction.

What I see is-

So, first of all the video clip doesn’t show the whole picture, because this was our first chance to look at her from the side view. And if you caught this Matt was talking when I was talking, that was maybe he did the recording, but not just this moment. So when we did the recording, the first time lining up sometimes you don’t see things correctly and now we have the added challenge of having a video camera and maybe the angle not being set up properly. Matt mentioned it looks like there was a right rotation to the pelvis as if the pelvis is turning and looking to the right. But as we switched over to the left, if that video would have played longer you would’ve heard us say, “No it actually looks like a left rotation.” And all the other assessments we’re doing later on we confirm that left rotation. Pelvis looking to the left.

The other main thing we’re talking about is this anterior hip shift where, if you look at this images on the screen now, especially the second image. Second and third you really see it, but the second image is the most like patient you’ll be working with. The hip is shifting anterior to a line that’s dropping through gallbladder 40. This anterior hip shift can have multiple implications, but when the ribcage starts going backwards, that’s consistent with people who have signs and symptoms of kidney qi deficiency, qi and blood deficiency. Matt presented on this information at the Pacific Symposium before, we can’t go into the whole details in the time frame that we have today, but each of these postures have a strong correlation with the various zang organ pathologies that are listed underneath them.

So this patient was most like, maybe not as severe as number two, but most like the kidney qi, qi and blood deficiency posture. I think we can go to the next slide, unless you wanted to add something to that, Matt?

Yeah, something real quick. When you see postures like this, you can pretty much predict what the tongue and the pulse is going to end up being, which is really a great thing. That helps the practitioner to direct their questioning to what organs could be contributing to this type of posture. This was a lot of research, I started in 2010, I presented at 2011 symposium and also in 2019. We talk about it in a module in the SMAC program, it itself is its own webinar for sure.

We asked the patient to show us her tongue and lighting was a big issue with this. When there was poor lighting, you can’t be able to see the tongue very well, so she was able to move her device closer to a window and we were able to see… Now obviously this is a screenshot from the video, so you can’t see it very well, but when you look at the video, that’s online at the website you can clearly see a pale tongue, teeth marks qi and blood deficiency in that tongue. Also, what’s helpful, if you have a white card you could put that card right next to the tongue, it gives a little color differentiation as well. Let’s go to the next slide. Brian you want to go for that?

Yeah, so I’ll just follow up to the tongue. The rest of the video is going to be focusing on posture, focusing on orthopedic evaluation, functional tests, that kind of stuff, which in enough themselves are testing the channel sinews. But if this was a full evaluation, and the video doesn’t reflect this, because it was really set up as a webinar for a review for low back and hip injuries. As Matt said you’d be asking questions based on multiple things that we were looking at, so looking at a full picture. We’re going to go back now to look at some of the indications that we saw from where she had pain. We both didn’t think that there was lumbar disc involvement with it, but it’s good to be thorough and rule it out.

We have the patient get on the floor and do a straight leg raise. Normally in clinic you would do this to the patient, but she was able to bring her leg up, it was negative. We asked her to do a passive one, which is more like the test you would do clinically, if the practitioner was doing it and again it was negative, but it was good to rule out that there didn’t seem to be any signs of lumbar disc involvement based on straight leg raise.

And if, by chance this was going to be a positive test, the practitioner would need to guide the patient through the different steps of straight leg raise. All right so let’s go to the next one.

Okay, so we were thinking that, with this particular video that you saw and with information that’s coming, facet joint injury seemed like it was going to be more the primary pain generator. Again, we’re just on a working hypothesis right now. We asked the patient to perform lumbar extension, because the facet joints usually get aggravated with extension. Because she has a bilateral anterior pelvic tilt, she’s already going to have a jamming of those facet joints. So the picture is really starting to make sense.

There’s two common body movements when describing facet joint pain that patients will commonly do. One is you’ll see there on the left where a fist or some kind of indication there at the spine and also that body language of starting at the spine and then going out lateral. So I believe we’ve got another video that we can watch to go see more information.

Matt, before you switch that. Just to highlight, also Matt mentioned the bilateral anterior tilt, also the elevation of the right ilium that she gets into when we look at the postural assessment. But you can see it in both those views, I would start to side bend the lumbar spine to the right and also approximate those facets on the right, which is primarily where she was describing the pain.

Yeah, good, thanks Brian. Okay, ready video?

Can you go into extension please? Does that cause pain?

Yeah, a little bit.

And where’s the pain?

Right there.

Can you go into extension please-

Okay, she already did. I have it on loop. All right, so she indicated, so we’re kind of leaning more toward facet joints. So let’s use some more examinations that can aggravate the facet. Do you want to talk about stork standing Brian?

I’ll let you continue with it, because it’s kind of a similar theme to the extension.

All right, so a stork standing test. You’re going to have to describe to your patient how to perform these tests, and this particular one because it requires balance is to have them close to a wall or a chair of course would be very useful. In stork standing test you can see how she’s going into lumbar extension and also rotation. This particular image on the left is aggravated the pain. Now here, what’s really interesting, she didn’t take her fist and put it into the spine at all, she actually went lateral. Where she’s indicating there is giving us a lot of information. So let’s go to the next slide and Brian we can start chatting about that and then set the sinew channels. Or maybe we should just say it now, do you want to describe the three sinew channels there that can be-

Yeah, so in the Sports Medicine Acupuncture Certification program we talk about… First of all we have a very developed model of the channel sinews and when you look at the descriptions or you look at images and there’s a line across the body, it doesn’t give the precise anatomy, we’re working on a model to really hone in on what particular structures are in which channel.

So when she points to an area like this, you might be pointing to the iliocostalis lumborum, that would be on the urinary bladder channel, part of the continuous myofascial plane up the body, from foot to head. Maybe deeper, because she’s also at the attachment of the quadratus lumborum at the top end. The quadratus lumborum would be on a continuous myofascial plane which is part of the liver sinew channel. And there’s also a plane of tissue that’s coming up through the quadriceps and up through the abdominals and to the side and into and wrapping around to the back, which forms a seam where all the fascia come together, that’s called the lateral raphe. And that’s affected and part of the stomach sinew channel. So there’s really three potential sinew channels that this one little spot can be pointed op based on the precise location in the back.

So this helps a lot because the practitioner’s now starting to think about those three different channels and what acupressure points that we can be able to use. Xi-cleft, luo points, for example. In order to be able to move qi and blood. Brian, I just noticed that we’re kind of running behind, because we love talking about this so much, but it’s such a short webinar. So I’m going to fly through these next four, and then we’ll get you back up on that rotation, is that all right?

Okay, sure.

So here we’ve got the injury assessment. If you look at the image on the left, these are lumbar facet joint referral patterns. So this is where the actual facet joint itself, when it’s degenerative can be able to have its own referral patterns. You can see she’s indicating the areas of L3-L4, L4-L5, possibly L5-S1. Knowing these patterns, we’re really starting to go down the road of this injury coming from facet joint, having postural imbalances which lead to myofascial sinew channel imbalances.

In addition, is that her tracing going into the gluteal area and also toward the greater trochanter, it could be thoracolumbar junction syndrome. The assessment for this is for the practitioner to actually be there on site and trying to be able to provoke that thoracolumbar junction syndrome pain by doing some mobilizations of the spine. We can’t do that, obviously so we have to try to be able to see it. When we had her go into a lumbopelvic rhythm, what we noticed on the image to the right, you can see the thoracolumbar junction of T11-T12, L1-L2 kind of pops up a little bit. It actually goes into extension. When she was moving into trunk flexion, that part of her spine actually didn’t move as well, and popped up. That could be a sign of a possibility of instability in the region, causing thoracolumbar junction syndrome. We put that into our back pocket as part of the assessment.

The practitioner can also examine the sacroiliac joint with various functional exams. We weren’t thinking it was going to be SI joint, but we might as well. We ran her through a number of different examinations for the sacroiliac joint. Practitioners that are experienced with this, you know that these particular examinations can also provoke pain in other places. Your idea’s trying to provoke pain in the sacroiliac joint, and see if that’s going to be positive, but each one of these exams also caused other pain that was indicative of possibly facet joint or hip joint problem.

And actually I don’t think it did cause SI joint pain, specifically.

Yeah, none of them did. The lower image on the right is Gillet’s test, which is a video that we’re going to show you right now. This is an easy one for a practitioner to do with a patient. Let’s show you this Gillet’s test, you’ll see that it’s positive on the left.

You really see the elevated ilium om the right, so lateral tilt of the pelvis. You can see L4-L5 tilting to the left. And then coming back to midline around L3?

Yeah that’s what it looks like. It doesn’t seem to go up really high.

Uh-huh (affirmative). So, Lily can you weight bear on one leg and then on the opposite leg, raise it at least 90 degrees, slowly. A little bit higher. Okay, thank you and down. Yeah there it is. So you could see that left hip innominate bone raising up. Brian do you want to take it from here?

Yeah, so the Gillet’s was positive on the left, the PSIS wasn’t able to drop down when she brought the hip into flexion. That does show that there is a jamming of the SI joint. We’re moving on now to looking at rotation. Rotation would just be a functional test. There would give us some ideas of imbalances of the channel sinews in the body, but it could also suggest things like thoracolumbar junction syndrome.

We’ve confirmed through postural assessment that she had a left rotation of the pelvis, the pelvis is turning to the left. It’s very typical then that the torso would start turning back towards the right. We have a seated test to be able to confirm this. Because if she has the torso turning back to the right, the tissue shortens in a way that allows her to turn more easily to the right, and it starts to pull on that shortening of tissues and the abdominal obliques as she turns to the left.

You can see as she turns to the right she has greater range of the motion. As she turns to the left she is not able to turn as far. The patient mentioned herself that she felt like she couldn’t turn as far to the left. That indicates a right rotation of the trunk in relationship to the pelvis. There are certain tissues that are associated with that shortness.

The other test on the right where she has her hands out is starting to involve more of the lats. As she turns to the left, the right latissimus dorsi has to lengthen, and she has limited range of motion, she should be able to turn about 80 to 90 degrees. Then we have her cross the left ankle over the right knee, which starts to engage the glutes and multiple things could happen. In her case she was able to turn a little bit more, suggests an inhibition of the glute max. Those tissues, the lats to the contralateral glute max communicate with each other through the thoracolumbar fascia and they can form a sort of sling through the body that can have dysfunction.

So we have shortness in the right lats, there’s actually shortness in the left lats too, which you don’t see because in the still she’s not turning in that direction. Then there’s suggestion of inhibited glute max. I think we can go to the next one.

Good. So the diagnosis and what we’ve found so far with the patient is, because of her posture and also from the TCM differential diagnosis questioning that we do not have on the video, something that practitioners can go ahead and do of course, looking at the zang organs. Kidney qi and qi and blood deficiency is her posture and also her tongue did support that as well. The questions that we had supported that as well. Long term knee pain and so on and so forth. I don’t want to go into this because our time is flying by as my light source just flew by.

Here we are. So let’s just go back. So we’ve got a right elevated ilium and myofascial channel imbalances. If it’s alright you can see that this image on the right is an anterior view, what we’ve been showing you is a posterior view. There is a particular combination of locked long abductors and locked short abductors. Locked long adductors, locked short adductors. With liver jingjin and gallbladder jingjin that has its own protocol, not only with acupuncture, but also with corrective exercises. Brian I know we could talk about this all day, but we have to keep moving.

Okay.

Brian do you want to do this one?

So this is just reviewing what we just talked about, really. That there’s rotation, the pelvis going to the left so that would mean your right ASIS is forward and the whole pelvic structure is turning to the left. And then the torso is coming back to the right. You can almost see at liver 13, the left side going down to about gallbladder 27 on the right, towards the ASIS on the right. That line from left to right ASIS is shorter than it is from the right liver 13 to the left ASIS. That shows that shortening in the obliques and that kind of tightening and screwing, and like a jar tightened too much it starts to put compression into the trunk and into the spine. So we want to unwind her with the exercises and acupressure. Also, with self-massage you want to untwist that jar if it’s too tight.

Brian wouldn’t that this is a common finding to have a pelvic rotation, also a trunk rotation?

Yeah. When the pelvis is rotated to the left, it’s unlikely that the person’s going to be working and steering themselves over to that direction. So somewhere it’s going to come back to midline, most often the trunk. If things are really locked up I guess it could be the neck, or somewhere else, but it’s more often than not it’s going to be the trunk that starts to come back on midline. It’s just part of the way that the body finds balance when there’s injury that caused imbalance, overuse or whatever it is. It’s just the way the body gets itself oriented back to the front.

This is a common posture found in low back pain. Next, here we go. Bilateral anterior pelvic tilt, more on the right. That tells us point prescription gallbladder 39 and a half and liver 4, which we really need to be able to get to soon here. We’ve got possible thoracolumbar junction syndrome. I talked about earlier, watching the lumbopelvic rhythm, seeing that thoracolumbar junction pop up, not moving smoothly in the lumbopelvic rhythm. We’re looking at a L2 to L4 region facet joint from the patient’s description of the pain and also the referral pattern and worse with extension. Actually flexion makes it better and alleviates some of the pain, so we can put that in our back pocket as far as giving corrective exercises.

The treatment plan protocol with this, putting it all together. Of course strengthen kidney qi and systemic qi and blood with this, we’ve got to be able to do this so that we can be able to hold the treatments. Otherwise, the patient just won’t hold the treatment, we’ve got to build the internal to help the external. We need to balance the postural deviations. By balancing the posture deviations it’s going to help with the pulley lever system, the musculoskeletal system, but it would also decrease the amount of internal torsion of the organs. Let’s think about also what postural disparities do to the internal organs. Decrease pain in the UB, stomach and gallbladder jingjin of the low back. That’s what we saw from the assessment.

The treatment protocol, we’re going to give acupressure prescriptions. There are ways of doing acupressure, you can find some suggestions that we have in the blog article on sportsmedicineacupuncture.com. Dietary recommendations we normally can do this. Chinese herbal medicine, let’s make sure that we can send the patient the Chinese herbs. Corrective exercises which we have the patient go ahead and do, we watch them do the exercises, make sure they’re performing them. And also qi gong exercises would be wonderful to be able to show the patient. I’m going to give a little highlight to Brian here. He’s teaching, three times a week, some really wonderful qi gong classes. If you wanted more information on that anatomyofthesinewchannels.com. You can actually have your patient go to that, it’s excellent I’ve been doing it with him for a long time, it’s really great, Brian’s an excellent teacher with this.

Oh thanks, Matt. It’s sinewchannels.com but the blog is called Anatomy of the Sinew Channels, but I don’t think that will bring it up, just sinewchannels.com will have the schedule on it. Thanks for mentioning that.

Let’s go into the acupressure point protocol. You want to start that off?

These are based on the assessment that we had, so gallbladder 41, San Jiao 5, is on the left. For multiple reasons you could think about for the channel sinews, but specifically for the Gillet’s test. Those points will change a positive Gillet’s. We do this in sports medicine acupuncture of course with needles, where we’ll do it just to highlight this where somebody has a positive Gillet’s, we put those points in and it changes instantly. That’s the good news, the problem is those by themselves, you take them out or you have the person massage them and they got it changed and they walked around for a second and came back. The positive Gillet’s will often come back. So by themselves these points have an influence on the movement of the sacrum and the movement of the SI joint, but it needs to be reinforced with a full, comprehensive treatment. It’s going to be part of the treatment, nonetheless.

I’ll go ahead and take the next one too Matt, we have kidney 3 and kidney 4. In this case you want to massage that whole region and affect the kidney low channel, because that goes through the region of the facet, it’s probably having a strong effect on the deep lumbar multifidi muscles. That can be a really good combination to reduce pain in the facets, also with the kidney qi and qi blood deficiency signs, this would be a good combination, working with that aspect too. Particularly on the right, but we have the bilateral because we weren’t able to in and palpate and put our finger right on, let’s say it was a facet in L3 or L4 that’s causing the pain, we weren’t able to go and confirm that with palpation. So we just went ahead and included that bilateral in this treatment.

I’m not sure if we’re still live or not, because it’s after the time left, so I don’t know if just you and I are doing this or if everybody’s still there. I don’t know. We’ll try to fly through this as fast as possible, because I know we’re very strict on time here.

We’re on still.

Oh, okay. Spleen 3, stomach 4 being the source or luo point combination which helps with the abdominal muscles. UB 58, liver 5, stomach 40, as we know luo points that can be able to move qi and blood through those channels when we saw the patient indicating with her fist on the lateral aspect of her back, looking at the iliocostalis, the lateral raphe tissue and the quadratus lumborum. We’re looking at the luo points there to try to be able to change that pain pattern.

Using gallbladder 39.5, which is located halfway between 39 and 40, in addition to liver 4, does decrease the innominate bone of an anterior pelvic tilt. That’s been shown numerous times, we’ve got a YouTube video on that and there’s a whole story behind that, how I was able to come up with that. Another day, another story.

You’ve got a classic point combination to be able to tonify qi and blood, calm the spirit and also move liver qi there from the liver 3, spleen 6, P6, stomach 36, LI 10. Yoga tune up balls are excellent to be able to have your patient get them. The link for them is going to be in the contact, it’s the very last slide of this presentation. We can also have that person do some massage with yoga tune up balls there, or a foam roller if you’d like. Also, having do yoga tune up balls or a foam roller on the piriformis motor point, bilateral will help to set the structure well.

Matt, I know we don’t have a lot of time, I just want to mention this will take a second, one thing. That resource it’s in the slide, but the blog post which really has the full case study on sportsmedicineacupuncture.com, and the video on our YouTube channel has the full case study, the full video. And all of those resources are listed both on the YouTube video in the description, but also in the blog posts. I think that’s what people will have… You won’t be getting the slides for the presentation, because this is very truncated, better off to look at the old blog posts, it has all the information.

Excellent, that’s a good point, thanks Brian. The corrective exercises for the initial visit. We prescribe the exercises to prioritize the patient’s postural imbalances that’s contributing to the pain. The patient had disparities which was a bilateral anterior pelvic tilt that we saw, an elevated ilium, which is going to offset the lumbars and increase facet joint jamming with an anterior pelvic tilt. And also the pelvic and the trunk rotation, we need to be able to try to be able to change that as fast as possible.

These exercises help to balance the structural deviations by activating the biao-li pairs, the internal external pairs of UB and kidney, liver and gallbladder and spleen and stomach. This is in our thought process, not only by prescribing exercises to the core and to postural anomalies or dysfunctions, but what’s happening with the myofascial sinew channels and how they communicate.

As discussed previously, also having the patient apply acupressure massage to the suggested points prior to the exercise helps the proprioceptive signaling. How do we know that, because we do that in the SMAC program. We see that consistently by using intradermal needles on points and how it changes the exercise before and after, dramatically. That’s a big one, have your patient perform these right before the exercises, that would be really good.

Here are some of the exercises that we were giving. The exercise on the left here is figure for a cross-over which is an excellent exercise to work on the liver and the gallbladder sinew channels and decrease that elevated ilium. The center image is a foam roll on some ashi points on the lock sure glute medius side, excess, localized gallbladder sinew channel. And then strengthening the weakened gallbladder sinew channel on the opposite side with some clam shells. This is not all the exercises, this is just a highlight. All of the exercises for this particular patient is in the blog article on the website, so there you can be able to see the whole thing, again this is just the highlights.

Brian do you want to say anything real quick before we go-

No, I think we’re probably getting close to time. I think that’s the last slide just real quick on the prognosis.

The prognosis, make sure in the follow up visits is in the next few days that they’re doing the exercises correctly. You want to make sure that the posture and the orthopedic and the functional exams are hopefully about 20 to 30 percent better. It’s a positive sign, also when the patient is not tracing that referral pain. They’re not doing that body language of tracing down her buttock or into the greater trochanter. Maybe it’s just going to be more localized in the back. So it’s not peripheralization, it’s now centralization which is a much better sign.

Make sure that they’ve received herbs in the mail, make sure they’re doing the dietary changes, are they doing their qi gong exercises that Brian has…

I know we’re flying through this real quick, we didn’t have very much time, but we have to go ahead and say thank you very much to the American Acupuncture Council for hosting this webinar, we really appreciate that. And also to Lesley Spencer that took a lot of time with the video and putting it all together. Brian to you as well, this was not a one day feed, this was not a two day feed or a week. We put a lot of work into this and we really hope that it helps practitioners to gain some insight to be able to help their patients during this very challenging time. Brian?

Thanks Matt, and we have the guests coming next week?

Virginia Duran?

Virginia Doran, yes. So tune in next week for that and we will be back then in a few episodes and probably with a guest and we’ll be looking at some more topics within the sports and orthopedic acupuncture world.

I want to say one more thing, there’s a lot of digital formats that are out there, platforms that you can be able to use for telehealth, telemedicine. Unified Practice subscribers, they have one that’s brand new, they’ve worked out all of the kinks, it’s actually working really well and it’s free to Unified Practice subscribers. So you might want to check that out. Zoom is a popular one, it’s got really nice features, but if you’re already a subscriber to Unified Practice you might want to go ahead and just give them a jingle and contact them and see what they have.

Thank you everybody, we really appreciate all your time.

Yes, thank you.

Okay, bye-bye now.

Not sure if people are still on, but if they are, then these resources are found on the webpage blog.

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Neuro-scientific Posturology – Poney Chiang and Annette Verpillot

Hi, welcome to today’s Facebook live [inaudible 00:01:08] show for American Acupuncture Council. My name is Poney Chiang, your host for today, and I’m coming from Toronto, Canada. I’m a continuing education provider, and acupuncture practitioner and herbalist. Today it is my honor to have the opportunity to interview our special guest for today, Annette Verpillot. Annette is a founder of a company called Posture Pro, a health company specializing in restoring the brain body connection. She’s a Canadian entrepreneur, therapist, public speaker and internationally recognized posture specialist.

Annette has developed some of the world’s most advanced rehabilitation and injury prevention techniques, and she teaches this method called Posture Pro to professionals in various fields. Her unique posture evaluation system is recognized throughout the world for eliminating chronic pain, increasing strength and improving sports proficiency. Through her teaching, speaking and research, Annette tackles global health issues and trains professionals to have a lasting impact on clients and patients. Thank you very much for joining us today, Annette.

Thank you so much Poney, for having me on the show. It’s a true honor and pleasure.

Can you tell us where you’re joining us from today?

I’m located in Montreal, Canada. You and I are not too far away from each other.

It’s only five, seven hours drive maybe.

Yeah, I prefer taking the plane. But yeah, it’s fairly close.

Yeah. So the reason why I wanted to invite you to our show today is that I understand that you have a very special way of addressing posture. And what fascinated me about your method is that you incorporate a lot of application of the understanding the peripheral nervous system, the central nervous system, and even using cranial nerves as such. Would you be able to tell us how did you become interested? Were you always interested in posture aspects or interested in neurological things?

Yeah. I come from a family of neurosurgeons that from France moved to Canada at the time when I was much younger. So I was raised in a medical environment where I would always listen to my aunt and uncle talk to my father about the latest in neuroscience. I was always very much interested in the medical field. I recently found a book of myself, a book that they had asked us to draw a picture of yourself of where you saw yourself in the future. And in this book I wanted to be a surgeon, a neurosurgeon, and then I found the picture. It was actually really quite funny. So I’ve always been, I guess indirectly involved, not really realizing it in the world of neuroscience, of course through my family.

But at the same time I was always very much involved in movement in sports and very quickly became aware of the aspect of movement and performance, and of course injury because I could remember my father saying to me, at the time I made it to the Games of Quebec, and he was like, you can’t go to this because the ultimate goal is for you to make it to the Olympics. This is how it starts, and by the age of 30 your body will be ruined. And I remember not being very sad about this because he literally interrupted the whole process. But now that I think back, I guess the myth of movement, and training, and athleticism and injury go hand in hand.

May I ask a what was your area of focus specialization in sports?

The 100 meter sprint was my specialty. No one can catch me.

Very impressive. I know it’s a very diverse, and broad and in depth topic, can you tell us a little bit about Posture Pro?

Yeah. So Posture Pro opened its doors in 2004. The idea was to combine training with rehabilitation. At the time I had studied different types of rehabilitation therapies to be able to accommodate my clients. I myself went through some injuries while I was training. I’ve always been involved in fitness and trainings as far as I can remember, and for me was something that was very important to be able to try to address injury. So of course I naturally learned rehabilitation methods and techniques to be able to apply them with my clients in practice. Very quickly realized that working manually was only providing temporary results, not really understanding why that was actually happening and kind of following the flow that everybody does. They teach us to do A, B, C, D when you find that there is different types of local problems, but I guess that part of the problem that eventually I came to realize was that they were not really telling us why the problem existed to begin with. So the cause behind the symptoms that we are taught to manage. So, a quick Google search kind of got me going on the way, and then associating myself with different professionals and specialists in their fields, really some of the best in their field as far as rehabilitation, to try to combine all of this knowledge together to create what we call today the Posture Pro Method.

Can you tell us a little bit about the approach or the rational in it, how is it different or what makes it more effective, for example?

Yeah. So combining the knowledge of neuroscience, and biomechanics and movement all together, but also the knowledge of how the brain develops in the first place in human beings and working with a method that allows us to kind of connect which brain part, brain, body connection parts are broken is what I find makes our method unique. We work on what we call specific sensory receptors. Yes, we do work with the eyes, obviously the cranial nerves that innovate the eyes. But where I think our strength lies is in all the links that we make within those different cranial nerves and the symptoms that we’re seeing in clinic with our clients, but also the fact that we address one component that I think is the missing link in most therapies, which is the weight bearing surfaces of the clients that we’re working with.

We never really take into account, I mean in North America when we talk about the feet, we tend to think of feet specialists or podiatrists, but in reality what we’re looking for is the way that this person learned how to walk in the first stages of their lives, which we know is ultimately between zero to 12 months of life, and the postural strategies then that the clients will then develop and the links between the symptoms that they’re presently experiencing, the posture that they have today and the brain connection or the broken brain connection, if I may say, that they are living with which are creating the symptoms that we are seeing in our practice on a daily basis. And this holds true for children as well as adults.

So there’s a lot of emphasis on the information inputs coming from the feet. You mentioned about the vision. What are some of other important inputs that you take the time to assess or provide exercises for?

Yeah. So another really interesting link is the position of the mandible, the position of the jaw, and how the actual stomatognathic system will develop how the motor acted, the tongue posture, if you wish, nasal breathing, all of that complex has the potential to influence head posture, position of the head on the shoulders, which will challenge your center of gravity. The ultimate goal for us, what makes us human as humans is the fact that we’re bipedal, and fighting this we’re constantly fighting against gravity. And how we fight gravity ultimately will dictate how much energy we have throughout our day. So for example, someone who has what dentists call a class two occlusion, which is where the upper teeth of the maxillary will cover the lower teeth by more than one third, this will bring about, how can I say, the mandible will move up and back pushing the head forward.

And this would be a permanent state of disequilibrium that the client would be living with, which we can very easily imagine how this can cause lower back pain. But there’s also missing teeth, there’s also tongue posture and there’s also many other links that could be made within the TMJ in itself. As well we work with pathological scars. This is any type of surgical intervention that someone may have had. We treat it with either essential oils or with laser therapy. Would love to learn about acupuncture. I know that acupuncture is absolutely phenomenal when it comes to pathological scars. But where we try to make the link is again with the symptoms that the client is experiencing and whether or not the scar is actually creating a postural, a muscular imbalance in the context of the session.

That’s very interesting. So you mentioned the tongue posture. Most of our listeners are acupuncturist, and we actually really love to diagnose each other’s tongue and our patients’ tongues. I think they would be very interested to be able to add a dimension of postural analysis from the tongue. You also talked about equilibrium. I was wondering if the vestibular or the years come into play in this system, or is more focused on jaws and other inputs?

No, we do absolutely consider the vestibular, the vestibular ocular reflex. But what we’ve tend to see is when we actually realign someone’s posture by working on their feet, we really always start with the two extremities, the sole of the feet, the eyes. Is there anything going on with the jaw? If there is, we must neutralize it. We like to work by process of elimination. What’s causing what? Is it the feet, is it the eyes? But we know that ultimately all of these sensory receptors together have the potential to affect our posture and our stability. So what we’re going to try to basically, how can I say, what we’re going to try to determine is, is the client clenching even? Are they excessively stressed? We know that stress is psycho-emotional. When I’m stressed, I’m going to clench my teeth. But some clients who are doing this or patients who are doing this on a daily basis are not fully aware of the negative impacts that this can have, not only on their posture, on their hormone production, but on all of the different physiological systems of the body, really.

Right. Fascinating. That’s definitely something, clenching and a tight muscles of mastication, temporalis muscles. Those are actually a lot of things that acupuncturists see on a daily basis. So I think there’s definitely a lot of opportunity for an acupuncturist to employ some of this diagnostics, perhaps even use that to not just reduce the stress and the pain, but actually improve posture from that. As you know, acupuncturists is kind of well known for treating pain, and now there is actually more of a movement in the acupuncture community where we’re trying to start to use acupuncture to affect neurological issues. So Parkinson’s diseases and stroke rehabilitation. And obviously there’s a lot of gate problems in these visuals, postural problems in these individuals. So that’s really why I became interested in your work. Could you help our fellow listeners understand how might your work or being an expert in posturology make them better at what they’re doing?

Yeah. Well I mean, as you know, Meridian’s is kind of like an energy highway that flows within our body, and if we look at the way that someone’s posture has developed, and I put the emphasis on this, because understanding how someone developed their postural strategies from the get go is a really important factor in determining where they are at today. So I’m not an acupuncturist, but it’s very easy to imagine and understand if someone has a forward displacement of their center of gravity, a lower shoulder, a rotated pelvis, vertebraes that are in a subluxed state 24/7, poor body posture, I mean in that context, can poor body posture affect the energy flow within our body? We know that it can affect many other factors from our sympathetic to parasympathetic, to our circadian cycle, digestion, blood flow, stress, and of course energy within our bodies. So I think there would be many benefits of incorporating the Posture Pro Method with any type of therapy, but also Meridian therapy and acupuncture because it will simply just enhanced and double the therapeutic effect. If someone’s posture is better aligned, you’re actually giving them the chance to be able to fully recuperate and tap in into that healing process that they have within themselves, and of course the natural flow of energy that we all have within us.

I’m just going to sprinkle a little bit of Chinese medicine terms for the benefit of our listeners. For us, we talked about points around the neck that are called window to the sky points. These points directly affect psycho and emotional presence and awareness in health. So you imagine how problems in your neck can actually cause psycho emotional issues. For acupuncturist thinking in terms of those points around the spine called the back shoot points which affect individual organs. So if you are having subluxations or you’re having abnormal curvatures, it would affect the energy aspect of the bladder Meridian or affect those back shoot points and they can actually cause internal somatovisceral problems. So I think knowledge of this posture analysis comes hand and hand with acupuncture, and I think there’s a lot of things to be excited about, about how we can actually combine these knowledge to actually improve our ability to help patients, both physically as a posture aspect, but also internal viscerally. Because after all, the nervous system is [inaudible 00:16:49] and she controls all of our autonomic systems also.

If I may just add to to what you just said, I very much appreciate the description that you just gave. So within this complex as we know, and again, from the method that we’re working with, if there’s a crossbite, for example, or poor breathing habits that have been acquired since the beginning of life, or eyes that are not tracking properly through the cranial nerves within the brainstem, we know that just these two components alone can affect the stability of our suboccipitals and C1 and C2, which hence can this have an impact on the energy flow? And as you’ve just explained, my guess is is that it can. So if we’re starting from the perspective that you can’t build a house on a crooked foundation, so trying to align structure as quickly, and as fast and as best as possible, 24 hours a day, seven days week, so this work is actually being done without you having to think about it when you work with a brain based approach. And then incorporating any other types of therapy, like acupuncture, is always at a greater benefit to the patient.

What you just mentioned gave me a couple of more ideas I want to share with our listeners. Eyes for Chinese medicine practitioners have very much to do with the liver and has to do something to call wind and movement. So isn’t it interesting that by analyzing eye movement, which we are basically looking at its connection to the liver and wind. So you can see how there’s a lot to the ancient teachings about how eyes have to do with wind, because by analyzing eye movement you have the entire ability to assess a nervous system, which a lot of nervous problems are due to wind, but also relationship to coming and going and movement issues. Tongue. Again, back to the eyes. Eyes are supposed to be where is the spirits or the from Shen emanates. So you can have added tools to assess the patient’s state of Shen and spirit.

Their tongue is supposed to be the opening of the heart. And so by looking at the tongue posture, you have an indirect way of gauge into the Chinese business date of the heart’s health. So these are all the thing that’s [inaudible 00:19:14] and I’m really looking forward to finding out and learning more about this from you. Now, I know you have a lot of experience working with athletes, working with people with chronic pain, and even children and developmental problems, people with central nervous system problems, and I would love to hear all your experience. But because of limitation of the time we have today, could you just share with us with one maybe from recently that you’ve seen that was really highlighted to the power of this method? Something that’s really meant a lot to you personally as a therapist, you’re really able to transform somebody. Or something’s just really neat and something that was very cool that even surprised you for so many years of practice. Just a story. Basically just tell us a story, we want a nice story.

Oh, I have many stories to tell you. What I love about the Posture Pro Method is that there is not a week that goes by where I don’t have shivers on my arms because we realize that we’re actually changing the lives of people. And when I say, we like to use the hashtag changing lives, is when you give someone the ability to be able to regain their pain free living and live a life free of pain so that they can enjoy their lives, that for me is the ultimate reward. The case that I could think of, the first case that I sat on for a long time was when I got contacted by someone called Diane Murphy, and this is going back maybe over 10 years. And she left a message at Posture Pro saying, I’ve just recently been diagnosed with Parkinson’s disease stage one. I’ve tried everything, I’m desperate, please can you help?

And this was really the first case of Parkinson’s disease that I would ever encounter in my practice. And not knowing how far I can actually push the nervous system and really being afraid of the unknown, I didn’t respond to her call for three weeks. After the third week, I said to myself, Annette this is silly. Face your fears. The worst thing that can happen is that nothing happens and so be it. But at least try. And I did try. And I’ve put the video on my YouTube channel of that first consultation originally. Well, obviously the full consultation was recorded, but we trimmed it down to five to six minutes. Was the most rewarding moment that I ever had. You could hear Diane saying how her entire symptoms in the session completely disappearing. And funny enough, what did it the most for her was a scar that she had in her lower back.

So we proceeded in correcting the foot, we worked with the eyes, we actually looked at the jaw. We’re going through this in the video, we’re going through this step by step as we’re explaining what’s happening. But what really worked for her was, so we had to do all of that first, and then lastly we looked at the scar. I said to her, Diane, do you have any scars? And she goes, yes, I had lower back surgery years ago. And just by working on the scar she was like, her testimonial was overwhelming. I mean, I could not express it more how she was so verbal and expressive. So that was really one of the most ooh ha moments for me in my practice. And I’m lucky enough to say that these moments have followed and continued to follow every week of my life and in practice here. So this is, again, I’m so grateful to be on your podcast because ultimately I think that everyone should have the right to know what is out there and choose the best therapy treatment for themselves and for their loved ones really.

Thank you. That was a great, very heartfelt story. Unfortunately, due to time limitations we have to wrap up real soon. Could you give us a little appetizer or a little bit of amorous goose, a little bit of teaser, something that, I don’t know it’s very complicated or if it’s even possible, but something that is a little technique or something like that we might start to incorporate and to get us to see the power of posturology?

Yeah. So doing simple eye exercises as I demonstrated in my Ted Talk, which consists of doing simple circles and trying to converge, trying to focus on a specific target as your eyes are moving in 360 degrees. Some people find that very challenging. If they feel dizzy while they’re doing it, simply just pull away the finger and continue doing those eye exercises. This a great way to start working out your eyes on a daily basis. And quite frankly, I think it should be incorporated in for everyone. Regardless of the context, I think everyone should work out their eyes in the morning when they wake up.

I think I’ll also add to that, being aware of whether or not you clench your teeth. I love to have people become aware, just awareness of whether or not the teeth are in constant contact by putting red dots on the wall, and when you see the dot in that moment, you will say to yourself, are my teeth touching? And if they are, simply taking a moment to just stop whatever you’re doing if you can, position your tongue on top of your palette, hold it there with your lips closed and breathe for one minute. I think that doing those two things already is a great way to calm your parasympathetic, your sympathetic system down. Tap into parasympathetic, give yourself a break, disconnect. And of course if you retrain your eyes, you’re also retraining your muscular system.

Thank you very much. So if people out there would like to learn more about your methods and your teachings, where can we go to find out more about this information?

Our website is posturepro.co, and we’re very active on social media. We post daily tips, and specifically before and after cases on our Instagram channel, which you can find us very easily at @posturepro. Same address for Facebook.

Great. Thank you very much for joining us today, it’s been an absolute pleasure.

Thank you so much, Poney. It was a pleasure meeting you.

I look forward to studying with you soon in the very near future.

God bless.

Thank you.

Bye-bye.

Bye.

Using Chinese Herbs in the Various Stages of Toxic-Heat Invasion

Hi, I’m Virginia Doran, your host this week for To The Point, a show very generously produced by the American Acupuncture Council. We had another show scheduled for today, but considering the time that we’re living in right now with COVID-19, we decided to have another guest, and that is someone that many of you will be familiar with, Jake Fratkin. He’s going to talk about Chinese herbal treatment in different stages of the virus and various practical tips of products that are available from various sources. And he’s been an educator, an author in the field for decades, and practices out in Boulder, Colorado.

Many accomplishments, too many to list here, maybe he will enlighten us, or you can see on his website. And because there’s so much information to cover, I want to turn it right over to him. So, Jake, please inform us practitioners of your ideas for Chinese herbal treatment for this virus.

Okay, I’m ready to talk. Am I on? I’m on. You can hear me. Okay, so hi, everybody. I want to thank the American Acupuncture Council for inviting me. It was kind of short notice, but I’m happy to share the information that I’ve been pursuing about how to address the various stages of the virus with Chinese herbal formulas or herbal products. Now some of you out there do raw herb customizing or work with powders and do raw herb customizing, and so about the half the information or more is going to be directed to you, because you have the ability to customize formulas to patients at the various stages.

If you don’t customize formulas, you have two choices, one of them is to get herbal products that are already made and we’re going to talk about, or to ask one of the companies that does make formulas like Crane, and Lotus, and Mayway, that they’ll make the formulas up for you to give to your patients, so that’s one caveat there. We have a lot of groundwork to cover. I am certainly not going to go into detail, but the whole PowerPoint lecture that you’re going to see can be downloaded off my website. You’ll see it. If you go to my website you’ll see it in the lower right-hand corner, the way to download the lecture notes from this lecture. So that’s what we’re going to do.

And that’s called fratkin.com?

No, it’s at the end of the lecture, but it’s drjakefratkin.com.

Okay.

D-R, no period. Okay, let’s get started.

And you know, we want to just remind our viewers if you don’t have Chinese herbal training then you shouldn’t be doing this. You will want to do everything in accordance with your license in the states where you live or licensed in. And we’re not curing, and we want to be very careful not to state or misinform our patients that we are curing.

Yeah. The COVID-19 virus is very patent-protected by the FDA. You can’t advertise that you’re treating COVID-19. You can’t mention the words, because they will go after you, so I’m just calling it toxic heat invasion and working at it from there. I don’t know if my PowerPoint’s up because on my screen I can’t see what’s exactly up. I don’t see my face yet.

They’re not up yet.

They’re not up yet. And is my face up on the screen, or no?

Allen says they are up, but I don’t see them yet.

Yeah, you have the yellow box around you, but I don’t. So I don’t know if my face-

He says we’re up.

So I want to get my face up. I want to get the PowerPoint up. So let me know when you see the PowerPoint, Virginia.

Okay.

Do you see it? No.

No.

No. Okay, let’s just start it now.

Allen, you see it, but we don’t.

Okay. In general, the worst is going to come starting in about two weeks. Some of you may be seeing corona patients right now. I am over the phone. Everything I’m doing is by phone, webinar, phone consultation, and then I’m working from the material to send people herbal products. Now the way I work is I combine herbal extract powders. I use extract powders, and when I make a formula I make 100 grams. So I never like to make a formula that has more than 10 or 12 ingredients in it, 12 would be my max just because in 100 gram mix, you just can’t get the strength of enough herbs if you go more than 10 or 12 herbs. In a decoction you can put in 20 or 30 herbs, they don’t care, you just add it to the pot.

Virginia, do you see my face or no?

Yeah.

You do? [inaudible 00:06:30].

He’s saying that the audience can see things that we can’t.

Okay. All right. So I’m working with 100 gram powders and the formulas that I’m going to show are very large, they’re huge formulas, 15, 20 herb formulas, so I really recommend that if you have training in Chinese herbs, don’t give the whole formula unless you’re going to do raw soup decoction, which most of you don’t do. If you’re going to do powder extractions, then you have to whittle down the suggested 15 herbs or so into 10 or 11 herbs or so. So that’s up to you. I would not go the full formulas that they’re recommending unless you’re doing raw herb. If you don’t do powders or custom, then you default to the products.

Now, we’re going to have some products to offer, they’re not going to be as strong as these other formulas. Virginia, do you see my PowerPoint up?

Yes.

Okay, good. So these things come from two sources from China, one is Guidance for Coronavirus Disease. This is a wonderful, 140-page manual. It’s actually available on eLotus down here. I think they have a download so you can see the whole thing. Which if you’re a raw herb prescriber, there’s a lot of notes in there I’m not including, so you might want to get that document. The other document is what John Chen and Lori Hsu did, which is called, How COVID-19 is Currently Treated in China. So there’s two Chinese sources we’re working with here.

The first group is called Medical Observation Period. There’s been no lab confirmation of COVID. This is where people suspect, they have a couple symptoms, they’re not sure. So we divided those into two groups, not we, the Chinese. One is fatigue with GI upset, so there’ll be some diarrhea, there’ll be some abdominal cramping. There may or may not be fever. There’s fatigue. The formula of choice is Huo Xiang Zheng Qi Pian. These are, if you go to my book, this book which we’ll talk about, it has all the manufacturers of any formula, so it says Huo Xiang, it’ll name every manufacturer that makes it. Another phase will be-

Including American brands?

Yeah. It’s mostly, in this book there’s only GMP formulas.

Okay.

It’s only products made, pretty much put together in America, or they’re GMP otherwise. So the other one is fatigue with fever. We can’t get any of these recommendations that they’re talking about, but they’re very similar to one of these three, Gan Mao Ling, Zhong Gan Ling, or Yin Qiao. If you are not familiar with those, my book will talk about them in detail. Now for what they call confirmed or highly suspected cases, they throughout, they have this foundation formula so I can’t see… yeah, it’s hard to see the ingredients there, hard to see the ingredients. Can we move the pictures over a little so-

No, we can see.

Oh, okay, okay. So the lung-clearing detox soup is kind of like a foundation formula that they will use in all cases, mild to severe, but this is too many herbs. You have to reduce them according to how much heat you see and how much dampness you see. So this is really going to be an interplay between heat, between dampness, and between toxic heat. So toxic heat are herbs that go after viruses, and regular heat is heat in the qi, so for example Shi Gao is used a lot to bring down fever. So in this stage there’ll be coughs, there’ll be maybe some dampness. And then, of course, kind of a foundation there, Xiao Chai Hu Tang. If you’re going to work with products, probably the best combo here is Xiao Chai Hu Tang, mixing it with something called San Ren Tang, and not a lot of people have San Ren Tang, so I think you can mix it with Huo Xiang Zheng Qi Pian, Xiao Chai Hu Tang and Huo Xiang.

But as you’ll see when I go back to my other references, you always want to give toxic heat herbs, so you can always use these Gan Mao Ling, Zhong Gan Lings as part of it. Yin Qiao’s not strong enough, but it’s helpful in other ways.

I just want to ask a question here. Some people are getting it or at least starting with more of a wind cold damp scenario.

Yeah. Yeah, yeah. We go into that.

Okay.

Okay. So now in the early stage where it’s mild, there’s two presentations that I’ll show, cold dampness into the lungs, and the second one is damp heat into the lungs. So for cold damp they’re using this formula. Again, if you’re making it, really reduce it. You can’t put all these into a 100 gram bottle, there’s no way. They recommend Ephedra in all these cases, Ma Huang, which we cannot get in this country, so I’m substituting Cinnamomum, Gui Zhi, instead. This will reduce heat, it’ll dispel wind, and it will clear damp, so it’s a good general formula, cold dampness affecting the lungs. There’s maybe slight fever, it’s not real bad. There’s some cough, the chest is tight. The key symptom is nausea, nausea. So if there’s nausea, we think that there’s a damp accumulation and the stomach qi is not descending, so this formula addresses that.

If you’re going to do it with product, you use Huo Xiang Zheng Qi with something called Jing Fang Bai Du, which is in my book. For the heat stage, still the difference isn’t the fever, but now their body’s very achy. You have headache, you’re achy. There’s a dry cough, maybe a sore throat. The mouth is dry, the chest is tight, again, nausea. The stools could be loose or constipated. So this one is more cooling with herbs like Huang Qin and Lian Qiao, Qing Hao, Ban Lan Gen. So now we’re really starting to address the heat toxins, the viral toxins, Isatis, Ban Lan Gen, Forsythia, Lian Qiao, plus you also have a Xiao Chai Hu Tang basis in there with Chai Hu Huang Qin. For products, can use Xiao Chai Hu Tang with either Gan Mao Ling or Zhong Gan Ling for that stage. This is early, still considered an early stage.

In the general stage, now this is the bigger stage, it’s not hospital-level, but this is where people are sick. So this stage is called damp toxin, stagnating the lung. The fever is now starting to go up. The cough is getting more. There’s difficulty breathing. The abdomen is uncomfortable. The tongue will probably start to be more red with a slight yellow coat, but not always. Tongue doesn’t always, tongue confirms, but it doesn’t rule out. If the tongue is not red or not greasy it doesn’t mean they don’t have this, it just means it hasn’t shown on the tongue yet, so don’t require the tongue to confirm. But if it does confirm, then more power to you. The pulse is more rapid and slippery due to heat. Again, they’re using Ma Huang, again I’m substituting.

Now we’re addressing cough with Xing Ren and getting heat out of the lungs, Shi Gao, so there’s still an attention to dampness. If you have to go with products, you want to use Huo Xiang Zheng Qi, but now we’re going to use Qing Zao Jiu Fei, or things like that. I’ll talk about this stage a little bit in a minute. Cold dampness, no fever or very low fever, but again you have this cough and chest tightness and nausea. But the tongue is not red, the pulse is not rapid. And we give this, which is much more addressing cold and dampness, and again here we can use Ban Xia Hou Po Tang with Ge Gen Tang or Gui Zhi Tang. Ge Gen Tang and Gui Zhi Tang will push out the wind cold, Ban Xia Hou Po will neutralize the phlegm and dampness.

All these are on these notes which you can download from my website. Now when it gets really severe, this is the stage people want to go to the hospital. In two or three or four weeks, the hospitals are not going to take everybody. There’s going to be someone at the door saying, “Okay, you, not you.” It’s because they don’t have the beds. They don’t have the beds. Here the fever is high. This is the lung blocked by epidemic toxin. This is where the viral toxin really cranks, and this is usually seven days after their first symptom, after their first symptom of feeling fatigue and achy. After about seven days it’ll crank, and you’ll get a high fever with redness, a harsh cough because the heat now is going into the lung.

There may be some sticky phlegm, there may not. Very hard to breathe, painful to breathe. Dry mouth, there may be damp symptoms such as nausea. Now a lot of these Chinese formulas come out of Wuhan and Hubei, very damp place. Now if you live in the East Coast, that’s going to relate to you. I live in a very dry area in Colorado. We don’t see that much, we just don’t see that much dampness, but here they’re very sick. Now we have high fever, harsh cough. This is the recommended formula. They’re still trying to get rid of wind cold with Ma Huang and Xing Ren, but they’re moving again to Shi Gao. It’s a very similar formula. If there’s constipation, you work with the Da Huang, and here we can use Chai Ge Jie Ji Tang combined with Bai Hu Tang and Liang Ge San.

I talk about who has these products later. Flaring heat in the qi and yin is beyond just the lungs, this is very high fever. People will be trying to get into the hospital, but there are going to be people turned away from the hospital, and this kind of has a Bai Hu Tang foundation, Shi Gao, Zhi Mu. They’re using Shui Niu Jiao, which you’ll only get if you’re a raw herb herbalist. I think you can get this by powder form. Okay. They have cooling herbs, Xuan Shen, Lian Qiao, and Huang Lian, Lophatherum and Zhu Ye will bring down systemic heat. So if you have fever, this Zhu Ye is an important herb and Shi Gao is an important herb. You’ll see on the raw herbs that they’ll be going 30 to 60 grams in a decoction. That’s a lot. That’s a lot.

We’ll never approximate that in a extract powder, you’ll never get that much. But I would, on an extract powder, do at least 12 grams of Shi Gao. Here we would use Bai Hu Tang with either Gan Mao Ling or Zhong Gan Ling or one of the other anti-viral formulas that I’m going to talk about.

Critical stage, you’re not going to see this. This is where they’ve collapsed, they’ve collapsed. They’re not going to survive without a ventilator. The TCM people are recommending the combination of Ren Shen and Fu Zi for collapsed yang and qi, Shan Zhu Yu to bring it into the body. You won’t be seeing these patients. They’ll be in the hospital or dead.

Now my recommendations for illness with fever, you want to use heat toxin herbs. You want to use Wu Wei Xiao Du, and here’s the availability. This is everybody that carries that product. This is how my yellow book is organized. I’ll take a formula, I’ll say, who’s got it? So an asterisk means it’s based on, it’s a variation on a theme. Chuan Xin Lian is very good anti-viral, it’s a three-herb combo of Isatis, Ban Lan Gen, and Andrographis, Chuan Xin Lian and Tara Xacum, Pu Gong Ying. These are all the people that have it. Gan Mao Ling, here’s who has it. Zhong Gan Ling, here’s who has it. But there are a lot of products that are in my book that people don’t know about. All of these are anti-viral, all of these products.

I put asterisks in the ones that I think are stronger and more appropriate. Okay, Seven Forest has a lot of these products. They have Patrinia 7, Paris 7, so on. But all these companies, and then Golden Flower has Viola Clear Fire, it’s a great, great product. But all these are good, and they’re just heat toxin herbs, so you add this into what you’re doing. Let’s say you’re on a Huo Xiang stage, but you want to get the heat toxins, the virus, you really have to default to one of those or one of these. Those are very important to combine heat toxin herbs with the more classical formulas.

Lung fire, this is a painful, barking, dry, harsh cough. Qing Zao Jiu Fei is helpful, Huang Lian Shang Qing is helpful, and Qing Fei Yi Huo is very helpful. American-made products, Seven Forest has two products, Bellamcanda 15 and Stemona, they’re very good for heat. I have a product called SVP Lung. It’s good, it sort of like medium. And then here’s the codes, if I said GC it means Guang Ci Tang, if I said GF, it means Golden Flower, so on. These products can be found at Crane, Golden Needle will have them, other distributors will have all of them. But-

And what are you hearing about availability with the demand?

Don’t know. It’s not yet running out, but it will be. That’s why if you have a raw herb pharmacy or extract granule pharmacy, you can work with that. I had trouble getting some extract granules from my supplier so I went to another supplier and was able to get what I wanted. You can either stock up, or you’re going to reach a point where you’re just out of herbs. eLotus, that’s John Chen’s and Tina Chen’s group, Evergreen, they translated numerous articles from China for treating COVID-19. This is that link, or you just go to their website, eLotus.

And they have a wonderful hour and a half free presentation about it, when-

Oh, yeah. Yeah, yeah. So this sums up their information. So they took a document called How COVID-19 is Currently Treated in China, they translated it. They divided that into four phases, prevention, influenza, pneumonia, and recovery. So I’m just summing up their stuff here because they give a lot more detail, but pneumonia prevention number one, they had this formula. Influenza phase, they said patent medicine you can combine Ge Gen Tang or Chai Ge Jie Ji Tang. I would combine it with one of the anti-viral formulas based around Gan Mao Ling. Flu formula number one with headache, with dry throat. These are not strong enough in my mind. They’re good, but I would combine them with a strong heat toxin formula that we just talked about.

Then toxic heat attacks the lungs, they give a recommended formula. This is a good formula, I like this formula. Damp cold in the lung, it’s not going to be acute. I mean, it might be. It’s a difficult differentiation here, because when they’re feverish, you think everything is heat, but here there’s more of the damp side, the distension, nausea, diarrhea. Remember in China, they have a lot more damp presentations than they have in most places in America, but that’s their recommended formula. With this again, you could default to Huo Xiang Zheng Qi or Ban Xia Hou Po Tang.

I understand that the testing of people’s lungs who had severe cases of it, they found like thick, rubbery, congealed phlegm blocking the airways. So yeah, phlegm is really important to treat.

Pneumonia phase, this is a special phase. It’s kind of a Shaoyang stage with accumulation of damp. Herbal formulas you can use are Xiao Chai Hu Tang, San Ren Tang, or Gan Lu Xiao Du. Pneumonia phase, again it’s Xiao Chai Hu Tang with some, it’s sort of like what you see up here but in a customized formula. Finally, damp heat, another pneumonia formula. You download this, print it out, keep this as your reference. Now these are smaller formulas, so you can just make this just like it is, changing these doses here for soup. You have to adjust that for 100 gram bottle if that’s what you’re doing.

Toxic stagnation, this is where there’s a lot of fever, here’s the formula. You’ll have to look at it and look at it closely. This is the end-stage abandonment. You won’t see this, this is definitely in the hospital or dying. These patent medicines you cannot get anymore in the United States. I had them in my original patent medicine book, An Gong Niu Huang and Zi Xue San for fever that’s killing you. And you can get them in Chinatown, but you’re not going to get them from any of the GMP-type distributors.

This last phase is just collapse. It’s ginseng Ren Shen and Aconiti Fu Zi. There is a recovery phase, and they’re basically recommending Sha Shen Mai Dong Tang as a recovery formula. That’s available. A lot of people have it. Here is if you customize it, that’s how you would do it. All right. So all those products that I mentioned, they’re in my book. You can see who’s got it, you can see what’s the applications, what are the contraindications, what’s the historical origins, and so on. I guess that’s about it.

The handout notes are available from that link, which is drjakefratkin.com/toxic-heat-invasion/. But if you go to my site, it’ll be on there. All right. Virginia, any questions?

I really want to thank you for putting this together on such short notice and bringing your expertise. Your original patent book was the first book I read on Chinese herbs in the early ’90s before I studied it in-depth and it was really invaluable, and now I’m glad to see that you have another, more in-depth version. You really contributed a lot to the field, so I want to thank you for that, as well as what you’ve done for the show and what you’re doing right now.

Only one thing I want to say about this book. I made the mistake of not calling it essential Chinese patent medicines because it’s just about products that are available in our country, so there’s 133 classical formulas, and 83 modern formulas. These modern formulas, people who just study the classics have missed out on what China’s been doing since 1950, which is developing a lot of new products. The best ones have come out as patent medicines, so there’s 83 of them in this book that are GMP. Everything in this book is GMP. They’re GMP in China, but then usually a lot of them are tested when they come to this country. I can guarantee you they’re clean. There’s no heavy metals, there’s no pharmaceuticals, and so on.

And a lot of companies sell these, and so you want to look at this document and stock up on what you think you’re going to need, okay? All right. Thanks for your time. I hope this was helpful, and I want to really thank American Acupuncture Council for sponsoring these shows and for giving me an opportunity to talk and share my information. And it’s not mine, I just compiled it, I just compiled what’s out there.

And for people who do have an hour and a half to watch John Chen’s webinar, it’s really useful, and he gives some research studies behind things. And he talks about how, for practitioners, it’s really early-stage and recovery that we are probably best apt to treat and most likely to be treating. But it’s good to know this, because as you say, if the hospitals are full, people will be desperate for something. So I’m grateful, and thank you again to the American Acupuncture Council, and we will see you again soon.

Slides: https://aacttp.click/ov7

Understanding How Chinese Medicine Affects Immunity Yair Maimon

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Telehealth – Coding, Documenting and Compliance of Telehealth

Hi, everyone. This is Samuel Collins, your coding and billing expert for acupuncturists. Specifically, the American Acupuncture Council’s Insurance Information Network and Malpractice. Today’s program, as you’re probably aware, is going to be one that’s very important considering the crisis we’re going through right now, and on telemedicine. Is it something appropriate? Is it something we can code? And how do we do it? Well, of course we have to make sure, first of all, that we are getting ourselves together. Because of course our patients are changing, can they come into the office? So without further ado, let’s get to the slides. Let’s make sure we’re understanding what’s going on for telemedicine.

So you’ll see here on this first slide, I’ve got my email address and of course take a look at our website, the American Acupuncture Council Insurance Information Network, which is AACinfonetwork.com. But here you can see a teleconference call. Now on the left side here you’ll notice this picture, a woman opening her tongue, doctor observing. So what can we do? Well before we get fully there, let’s talk a little bit about making it a little bit light. I’m not always required to see patients online, but when I do, it’s a 99243, that is the code of course for the 30 minute visit online. But it could be for of course the diagnosis of Z03.818, which is the encounter for observation for a suspected exposure to other biological agents to be ruled out, which of course could be COVID-19.

Now again, that’s not something you’re going to be treating for, but of course this is why now many patients can’t come in. So what are the diagnosis for COVID-19? Just to make sure everyone’s aware of the diagnosis under ICD10 is U07.1. And of course if it’s just for observation, Z03.818. Now of course we’re not going to be seeing patients for that, or you won’t be seeing patients for that, but likely for the conditions that you’re already treating for, but they cannot come into the office, maybe they’re in a high risk group. Certainly it’s not something that you have to close your office per se, if there’s a person in acute or severe pain. Certainly you should be helpful to them, but make sure of course you’re using all the safe practices.

That being said, let’s talk about telemedicine. It is a patient initiated service with a physician, or as I underlined here, or other qualified healthcare professional, which would fit an acupuncturist, for the evaluation, assessment and management of the patient. In other words, an ENM code. It’s not intended for the non evaluative electronic communication simply of test results, scheduling of appointments, or communication that doesn’t involve an ENM. In other words, consider it, it’s like an office visit but just done online. You would be doing all the same things of discussion with your patient: history, exam and so forth. So essentially this is an ENM visit, simply in a non-direct face to face manner, but through electronic communication. Basically doing the patient’s history, evaluation, medical decision making, and counseling.

Patients must be under your care and likely under your care for acute or chronic pain, and how to manage without direct treatment. You might have a patient that cannot come in but they’re having a severe episode of back pain. What are we going to do to help them? Well, this is the point. You can do it via the phone or virtual, meaning through your computer or tablet, to make sure to evaluate the patient and give them instructions how to help themselves.

What would this include? Well, here’s an example of a self management of a patient that you all likely do or would do face to face. Talking to the patient about how to rest and reduce strenuous activities; changing their ergonomics and posture; appropriate exercises including Tai Chi, Qi gong, yoga; stress management or meditation; joint protection; weight loss; self massage; self acupressure; maybe the use of hot or cold packs or relieve discomfort. Educate the patient about the causes, what things they can avoid, and then potentially about brief use of supports if necessary in the acute stages to limit motion. In other words, the same recommendations and things you would do face to face without care.

So in other words, simply put, this is a patient you are helping, just doing it online, doing it without physically touching or hands on the patient. So telemedicine, the patient must be an established patient. It can’t not be a new patient, someone you’ve never seen before, but it can be an established patient that has a new condition. So the problem may be new to the provider, but it must be an established patient. And it must be initiated on a HIPAA compliant secure platform, typically. That would be something where you’re going to use obviously some sort of secure platform. But however, due to this recent COVID issue, they have made a mandate that providers may use simple communication through phones or tablets with simple services like Skype or FaceTime. In fact, it was recommended by the centers of Medicaid and Medicare Services yesterday that patients that are of an older age probably should just get their grandchildren or children to come over and then use their phone or tablet for them. So don’t be afraid to initiate in that way as well.

Now what are the codes? Okay. So for online digital evaluation of a patient, which means you’re going to do some type of virtual visit, the first code is 99421, that is online digital evaluation management service for an established patient for up to seven days of cumulative time during a seven day period, for five to 10 minutes. So in other words, it’s the entire time up to a seven day period. So this might be several communications with a patient within seven days, and the time would be cumulative. But it certainly could be just for one, if it’s only one within that time. You’ll notice the codes are relatively simple, in that one is for five to 10 minutes, one is for 11 to 20 minutes, and one is for 21 minutes or more. So simply put, once you get over 21 minutes, then it’s just a 99423, and this would be again, the accumulative time for each patient. And again, it’s online, meaning through some type of virtual platform.

These are patient-initiated services for the assessment and management of the patient. They’re not intended for non-evaluative communication for test results. I want to be clear, it’s not for a patient where you’re calling and saying, “Hey, your test results came back,” but literally just like you would do on a regular visit. The patient had an ENM within the last seven days, these codes cannot be used for that problem. So if you saw a patient yesterday, this part of it would be counted as part of that visit. It’s not till after seven, which I believe we’ll see a lot of this because of the time that’s extending for patients that would’ve had an appointment, this certainly is going to fit, particularly if it’s just initiating here.

So certainly keep in mind if you saw the patient the day before and a phone call the day after, or a virtual visit, that would not count towards this. But for a patient within or after a seven day period, and again it’s cumulative time. If the inquiry is about a new problem, certainly if that’s no problem, and it can be sooner than seven days. So, so long as that is a new condition. And I would question, even though a patient may be initiating right now, they’re dealing with some new issues because they cannot come in. So certainly I think this is going to fit. And we might see a nonissue of that seven day period. The issue here is that it’s simply a visit with the patient that’s done on an online platform to address their concerns of how you may help them.

Obviously you’re not going to be able to do direct treatment, but the things you can do to help them, and maybe it might even be to get them in, and of course if it is to get them in within a 24 hour period again, that wouldn’t count because it goes towards a visit, but certainly for a patient that can’t be seen or a person in a high risk group, obviously that is mandated to stay home.

Now again, to count the times for these codes, start the seven day clock when the physician first performs a persona’ review of the patient’s question. Add the time for the review of the relevant patient records and data interactions or the clinical staff to the problem. So in other words, what this is including is the time you may take to review the records before that phone call starts. Now I would be careful, I would certainly say, don’t tell me you spent a half hour reviewing records, but certainly a few minutes would count. And this would include communication with the patient by digital means that doesn’t fall under another ENM code, meaning it’s not with a phone call. This is going to be the online. It includes decision-making, assessment, management by those in the same group practice as well. So again, if you’re in a group setting, that could work.

What I want to emphasize here though, is that it is simply the doctor doing an ENM. And when I say doctor, I mean the licensed acupuncturist doing an ENM with that patient just simply online. And that means the documentation would fall into the same way. So for the medical record, the guidelines just direct you to keep permanent documentation, either electronic or hard copy. And to make this simple, simply document like you would any other visit, as if the patient were in the office. Make notes, put the time down, obviously, the time you started and ended. You do not need to record the phone call, but you would record the visit in the same manner. So take the same type of copious notes you would as with any other visit.

Now what else can we do besides a virtual visit? Well there’s the telephone evaluation and management service, which certainly could be useful as well. And this is provided by the physician or established acupuncturist to an established patient. And again, I want to make sure that we see that’s established patients for this, not a new patient. Now it could be an established patient you have not seen in six months. And if they’re calling for a problem, then of course you can see them. It’s simply just not for the new patient. Now this services, again not within the previous seven days of the first visit, or the last visit, and it can’t lead to an appointment within 24 hours. So that’s something you’ll see kind of uniquely here for the telephone visit, is that it cannot be the result of the phone call is to come in for treatment. This is literally for the patient to manage at home, not come in within the next 24 hours or next available appointment.

So what are the codes here? 99441 is for five to 10 minutes, 99442 is 11 to 20 minutes, and 99443 is for 21 to 30 minutes of medical discussion. So again, this is going to be that discussion with the patient, essentially, again, an ENM visit where you’re discussing with them the history of the issue, evaluating their outcome, what can they do at home, this is what this is going to be used for.

Now, one thing about these codes though is that you have to document them properly in the sense that I want everyone to note here at the bottom, the place of service is not 11 as you normally would do on a claim. The place of service would be 02, which indicates a telemedicine visit. So again, if the patient’s in the office, it’s 11. If you go to a patient’s home to do a treatment the place of service is 12, but if you’re doing a telemedicine visit, the place of service is 02.

But now one thing I’m sure everyone’s concerned with is, what would be an appropriate charge for these codes? Well, I really can’t give you what your charge should be, because of course everyone’s going to vary as to the location. But what I can help you with is the relative value unit. The relative value unit is the value comparison of one code to the other, or a ratio. So what I put here at the top is the relative value of manual acupuncture, which has a relative value of 1.05. Now for our intents and purposes, let’s just say it’s approximately a value of 01. So now when you look at these other codes, you’ll notice all their RVUs are broken down to 0.43, 0.86 and so forth.

So in a simple term, think of it, it’s a ratio. If you were charging whatever you’re charging for acupuncture, roughly 99421 would be about 40% of that. 99422 would be about 86%, and so on. So again, just think of it as a simple ratio. So by example, if someone were charging probably $70 for manual acupuncture, the relative price for a 99421 would be 40% of that, or about $28. So again, just keep it really simple. We want to make sure, of course, that acupuncturists are available to patients who are managing their chronic pain, who are managing many issues that they otherwise would not get help for. You could be the person that really gives them a good sense of feeling of assuredness that you’re there for them to give them even just stretches, how to use hot packs, maybe it’s even dealing with some of the herbal consult that you’ve had.

What I want to make sure is that we’re doing a good job and continuing to help our patients in this time, and make sure they’re aware that you’re available. There would be nothing wrong with sending something out to your patients to let them know that you are available, potentially in the office for appointments, but also online and it will be covered by insurance. Ultimately, we want to make sure you’re doing well. The American Acupuncture Council is your resource, and I’m going to make sure that anyone that’s listening that’s of course a member of my network, you’re welcome to give me a direct call or email so I can help you with these.

Of course, if you’re not in the network, I apologize for that, but we do offer a service for it. You may want to see that we upcoming seminars that will allow you to, with some help, and the seminars will be virtual as well. But please take a look, we have more information on our website, to go to our Facebook page or to our Instagram account to take a look there. We’re here for you. The American acupuncture council is your partner. Your success is our success, and we’re your partner to make sure your practice continues to thrive even during this time. Next week’s post will be Virginia Duran. And until then, this is Sam Collins, the coding and billing expert for the American Acupuncture Council, and I wish you all well and be safe.