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Acupoint Injection Therapy Poney Chiang and Scott Richardson

 

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

Good afternoon, everyone. Welcome to this Week’s American Acupuncture Council’s Live, Facebook podcast show. My name is Poney Chiang your host for today, I’m coming to you from Toronto Canada. I’m an engineer’s vacation pro provider from Newark radiant.net. Today. My special guest is Dr. Scott Richardson, who is joining us from Denver, Dr. Scott Richardson, and is a doctor of acupuncture and Oriental medicine who competed his master’s and doctorate degree from Pacific college, went into medicine in San Diego while attending Pittcon. He was able to study abroad. I changed to university in China, and later did some apprenticeships in connects in Taipei Taiwan. He’s an NCCR credentials, acupuncture, CU provider. He has lived in Colorado since 2012. We have served as the vice president, president and letters that have a chair of the agricultural association of Colorado. He worked on the legislation that put acupuncture, injection therapy written into the scope of practice for Colorado acupuncturist.

He teaches acupoint injection therapy at Colorado school of TCM and in various institutions around the world. He’s the owner of Denver acupuncture and sports medicine, and prolotherapy of Denver, where you continue to see patients with a wide variety of concerns. Thank you for joining us, Scott. Absolutely. So the reason why I wanted to, uh, interview an expert in acupuncture point ingestion is because this is something that more and more patients asking about and more and more jurisdictions in the, in the West and in Europe and in North America are starting to explore. For example, the Ontario in Canada, where I’m located, we are currently unable to do daily injections. However, we are working on a doctoral class of a, of a, of licensure and we’re exploring things like injection therapy as a potential scope of practice. I personally think that is going to be super powerful and super beneficial for our patients. So I can’t wait to have this conversation with you Scott today. Can you tell us, how did you get interested in point injection?

Sure. And like you said, it’s really important to make sure that you are aware of what you’re able to do within your own state or jurisdiction. if you are unclear then, you know, contacting your local governance board would be a good way to make sure. but, uh, this is really an amazing tool that we have within a TCM. again, like you said, I started my program, I learning out in, uh, San Diego that Pacific college of Oriental medicine. I moved to Colorado in 2012 and that’s where I first got exposed to acupoint injection therapy. I studied from Michael Young, pretty much that first year, uh, within a few months of moving there. and then just took off from there. I’ve also studied with, Jeff Harris out of Bastyr university. Andrew Taylor who’s also up in Canada is an amazing teacher. I’ve studied with him and, and even had him come out to Colorado to teach some advanced classes. but, uh, it’s been an amazing tool to add to my practice and to help my patients.

Wonderful. And, can you tell us for those of you are, those of us are not familiar with it a little bit about the history of acupuncture point injection and what is it exactly

Sure. And this is something that I’ve been kind of been a hobby of it I’ve been trying to find more literature, more research about how this all started and what has been injected traditionally. from what I’ve been able to understand, this really started, around the 1940s or even pre 1940s, when China started experimenting with doing and they were actually herbal formula injections, they would do single herb extracts or herbal formula injections. And a lot of times they would use it for things like flu influenza. and then it kind of expanded from there and has continued to be used in China quite a bit, including with, uh, some of the SARS outbreaks. it is something that has been around, for quite a long time and within the, and I’m going to mess up the name, it’s the Shanghai acupuncture compendium.

I believe the Shanghai acupuncture texts, uh, within that textbook, they actually talk about, acupoint injection therapy, substances that can be used where it can be used and how to use it. And so, uh, that was a required reading for our text. And, uh, I think a lot of people, or a lot of schools use that text and it’s something that is part of that tradition, substances that can be used again in China. A lot of times they’ll be using herbal extracts and even herbal formulas. in the United States, I am not aware of any FDA regulated facilities that are doing single herb extracts or herbal formula extracts. A lot of what we’re using are homeopathic formulations. Hiebert is one of the companies, that is local here in Colorado. they have, uh, a very, they have five main formulas that they sell, here in the United States. But again, uh, internationally, they have a wide range of homeopathic formulas. heal is another very popular one. If you’re familiar with Traumeel for acute injuries, they actually make an injectable form of true meal. So when you have bruising swelling, when you have a localized heat, you can use that formulation to help to speed the recovery and it works amazingly well.

can you give us a sense of what type of situations would you, uh, would you think about acupuncture in, in point injection therapy compared to quote unquote standard acupuncture? And a lot of it is a case by case

Spaces, and I am really hoping that as this starts becoming more mainstream, especially here in North America, we can start doing more research to figure out, you know, when is this better than doing acupuncture by itself? and when is acupuncture, going to be just as effective? one of the, research studies that was recently done, this came out of, uh, North Carolina university. There’s a medical doctor that was doing, procedures to try to do injections for back pain. And he was doing it on mice. And one of the things he was finding is by doing it on mice, he had a high rate of injuring the nerves or the spine. And so he wasn’t getting good results. He is not a TCM practitioner. He didn’t practice acupuncture before this study, but he found out about you before he doesn’t call it that.

But he found out about an acupuncture point behind the knee, and he started doing his injections there and he got amazing results with his, uh, research trial. he went on to later state that, uh, doing an injection at an acupuncture point can last 100 times longer than doing traditional acupuncture alone. So it’s a situation where we can have longer lasting results, and do it in a shorter amount of time. now when to do it versus when not, it can be a little bit more tricky. And again, a lot of that comes with personal experience. I do a lot of sports medicine. so when I have an athlete that comes in with a chronic muscle, not a, an area of tissue, that’s just not recovering. I go in, I needle it and it’s not releasing. one of the benefits I see with acupoint injection therapy is that I can go in and hydrate locally at that muscle tissue.

what does that mean in terms of TCM? I am literally adding in fluids or in fluids to that local area to help it to and recover, common solutions, uh, a 5% dextrose. It’s a sugar water, very easy to use, as something that is a sugar that’s sweet. I see that as, as a spleen tonic, another very easy, uh, thing to, to get ahold of is normal saline saline as assault. it’s a kidney tonic, as a mineral, it clears heat as something just as simple as normal saline into a hot localized area. It can help to clear heat out of that area. And again, can be very effective. you know, we don’t have to get overly complicated again with yin deficient patients or in deficient patients. It works extremely well on adding those that nourishment adding, helping to tonify the spleen to nourish the muscles and sinews. and it’s something that, uh, is a great way to either use standalone or in conjunction with an acupuncture treatment.

Oh, okay. So it sounds like not only is it using for that a chronic problem that you’re nourishing like a year influenza, like blood, the red blood for the seniors, when there’s actually something acute you can use, like something like sailing to actually combine with the injection to get an immediate results. I didn’t know that that’s really powerful.

Absolutely. And, and I I’ve, I’ve done it a couple of times. I, I I’ve had patients come in where they’ve gone to their doctor, they had a cortisone shot. and one patient, she spent over $1,800 on this cortisone shot because she didn’t have insurance to cover it. So she had to pay $1,800 out of pocket. She came into my clinic, we did one shot, uh, and she immediately felt relief. it wasn’t a cure, but immediately felt relief and felt benefit at less than one 10th. The cost of seeing her, her dog. Right.

That’s fantastic. Not to mention, you know, there’s some recent research showing that there’s actually a long term, uh, wear and tear associated with the stair usage injection of cortisone injections, the knee. Right. Yeah. so can you give us an example of a particular case in your own practice, private practice that was particularly memorable that you felt, you know, I probably wouldn’t have gotten this resolved if I didn’t practice acupuncture, injection therapy, something to just kind of wet our appetite a little bit.

Sure. And again, I do a lot of sports medicine, and so a lot of what I’m seeing are muscular skeletal conditions, had a patient come in with frozen shoulder. and so, uh, had very limited range of motion, had trouble even just going into the rotator cuff and needling some of those muscles. our first treatment we, we did, Eastern, and we were going into subscap. and then kind of like an [inaudible] 10. Sometimes I call it OSI nine and a half house. as I 11 area, and we were doing some East them to try get to those muscles to release and help. We saw some improvement. There are some reduction in pain. The second time she came in, I actually did an injection and it was, again, very simple. It was normal saline, 5% dextrose and B12 combined. and we injected into the subscap and there were multiple trigger points all throughout that area.

So, I wouldn’t necessarily say it was a heart one because we were aiming specifically for that muscle, but going in hydrating the muscle. And then we did a couple more again [inaudible] when she got off the table, after that second treatment, she had noticeable improvement about 20 degrees range of motion improvement. just following that injection, the next 24 hours, she got another about 5% range of motion, uh, after the treatment, but it was something where again, it was kind of a, she was definitely a yin deficient patient. but going in and hydrating, nourishing those muscles, we were able to get significantly better improvement than just doing our first acupuncture and Eastern treatment.

Yeah. And was the patient impressed?

Oh yeah. And she loved it. Cause sometimes especially when the muscles are chronically tied and they can’t get that relief, getting that nourishment in there, you get that, uh, that satisfaction. I mean, not so many times that like, yes, that’s what I needed. And, and, uh, a lot of times I’m seeing that I can use less number of treatments and get faster recovery with them.

I know that, there are some people that are a little bit more, conservative when it comes to, uh, uh, embracing new new techniques or perceived new techniques on that I’m hearing is may not actually be dine you. uh, but for those people that, that, uh, do you have a, an encouragement for them, they will have, why would I, why should I acupuncturist and learn this? How would this be able to allow them to do things or take care of their patients better than they were otherwise?

Well, and I think that this is one of the areas where us as acupunctures can really help to, benefit the medical community. Uh, when we go through our training, uh, four years master’s program, we’re required to have a minimum of 660 supervise clinical hours and 700 didactic hours learning how to puncture the skin in a safe and effective manner. Other medical professions don’t have this type of training. I worked inside of a family practice for about eight years and the PAs were constantly coming to me, asking me how to do an injection on a different area of the body because they couldn’t get the needle in and knees. I can’t tell you how many times I’ve seen a provider, tried to inject a knee with the leg straight out. and so I think that, as a profession where we, have much training on how to do this safely and effectively, uh, the patients appreciate it because it’s much safer.

but then as far as being TCM, again, we’re still applying those same principles that we learn, you know, fluid deficiency, yin deficiency, heat, excess deficiency, all or these things are, are what we apply to our treatment protocols. And then again, learning where we inject, you know, can we combine the properties of what we’re injecting to the therapeutic properties of the point that we’re injecting? So a common example I bring up is, you know, if we use the Harare point on the kidney channel and inject water there, you know, can we have a stronger effect than if we’re just needling there? B12, I consider B12 a blood tonic. you know, it actually helps in the production of red blood cells. So if we use a B12 injection at the influential point of blood, you know, can we have a stronger therapeutic effect then, you know, if they’re just popping B12 pills and, and, and trying to, you know, eliminate symptoms that way.

so I think with our training, we really have a strong foundation that we can provide these types of techniques. like you mentioned, with cortisone, we can provide safer solutions to people where they are lasting more longterm, uh, without a lot of the side effects. A lot of what we do in our profession is to help to facilitate that healing in the body, make the person stronger after our treatments with minimal side effects. and so, yeah, I think that this is a perfect addition, for people to learn about and train with. And, you know, again, if this is something that’s not currently in your area or your jurisdiction, uh, reach out to your local, association and, and see what steps need to be taken to, to help get this in there.

Hmm. Yeah. I like, I like what you have to say about that because, obviously, uh, as decent practitioners, we have a competitive advantage. We can apply what we injecting to the point specific functions that you inject into. So that’s, that’s a scope of practice that, that, uh, the other professionals can do. But what I hadn’t realized was that we’re actually better at putting needles into their joint and a new joint because I do it all the time, large intestines and the theme that she end or something 35, we’re really good at that. Hopefully we can, we can, you know, deliver the substance more effectively. And so, and this way it’s kind of building on the skills that we’ve already had. It’s not really relearning anything. We actually going to be able to pick this up faster than, a comparable, uh, biomedical, uh, practitioners to injections. the, can you, you know, give it down, you got to excite as though.

And do you mind if I share another story real quick? Oh, of course. Yeah.

So I was, uh, I was teaching at CSTC and this was our first time that we were doing live classes after we were shut down for Corona and, you know, same type of thing, that one, I had three hours to go over clean needle technique. And by the way, injections are a part of clean needle technique. Again, we have all these, competencies that we already go through to show that we’re safe and effective, but had a three hour class and the last 45 minutes or so is when the students really get to start trying this out and injecting. And again, this is a, an acupuncture student, and they’re testing this out. He did an injection at bilateral, bladder 23, and then y’all tongue sway on, on the opposite of the effected side and started moving it around and immediately had relieved. And so this is, you know, again, uh, an acupuncture student, that’s starting to play around with this and can already see how there’s benefit to this just from doing, you know, his traditional acupuncture classes and how, you know, again, with our training, we just build on that to get better results. And I, I just love it. I get excited as well. I think it’s fantastic.

Can you, I know, you know, obviously we haven’t learned how to do injections and, and a, I hope to do that in the very near future. but are there any lessons you learned little curls or advising you give us, like using the approach of acupuncture, injector, maybe, or assessment, whatever that you think would be able to be, that we would benefit from looking at the body or approaching the patient the way you do

Well. And, and again, I always try to get people to build on the, on the tools that they already have, you know, feeling the pulse and seeing if this is someone who feels like their fluid division or the tongue usually is my biggest assessment tool. And right now it’s difficult because, uh, you know, we’re not looking at patients tongues, but if you see a yin deficient tongue, that’s one of the big, indications for me of saying, okay, this is something that could benefit from using an acupoint injection therapy. if you feel a really thin pulse, then, you know, B 12 is something that’s readily assessable to help to build the blood. And again, use those on, yin channels or blood building points to help to amplify that effect. I am not a huge fertility. Specialtist a specialty person. I generally will refer out to them, but, again, it’s a going stray, I’m doing acupoint injection therapy over to going Shea and, and, uh, spleen six.

there’s lots of ways where we, again, take what we learn from our schools, what we practice, what we see, and then this can help to accentuate that. And, you know, again, assuming that the MD, the scientists that I mentioned at the beginning of it, he was able to validate that, you know, we can have a stronger stimulation lasts 100 times longer without having to need leave needles in for a long period of time or doing intro normal intradermals and having the patients take that home. but, uh, yeah, I, I get excited about it and I, I do, I see people just pick it up. I, I do the same time. I use guide tubes and I know studying in China guide tubes, you’re not supposed to use them, uh, freehand dealers pick this up very quickly, but, I do the same, uh, muscle memory doing injections as I do with guide tubes and, and, yeah, it, it works well.

I, something pop into my mind, about, uh, people that have some concerns about practicing injection, you know, is it TCM or NY? I wanna, I want to just mention that when, uh, back when I was a student, had a teacher that told me that, uh, told me, told me these fantastic stories, but as soon as to me out there, the doctor who made it easy and physician code of conduct, and that the person that document that 13 goes points just in case, uh, you know, the name of the case, our listeners and [inaudible] was really a role model about sincerely. I would say he was very embracing of different styles approaches. He was the one that brought peer visitor Kerbal materia Medica into TC. So he didn’t care. It was Chinese medicine, or not as long as somebody help people. I mean, he also dabbled in a lot of our chemical and spiritual practices, as long as you can help people.

So I had teachers that would tell me, you know, I bet you if, since I was alive today and he had access to point injection therapy, he probably would have used it as well. Okay. So, uh, that, that was always a story that I thought was, you know, helps me feel comfortable. I don’t know about other people, but it helps me feel that it’s okay to, to use new new techniques because, just because Chinese medicine is not, uh, no longer merely a classical textual medicine, it doesn’t mean that it hasn’t had a history of always evolving. I want to finish with, a question. That’s a really big question. I know it’s probably not going to be something we can cover in the span of today’s little interview, but a lot of us are, living in a jurisdiction where we are not able to, we are not yet able to practice injection on our patients. And I know you have a lot of experience with that. So is there some general, I know this is a lot of work. It probably takes a lot of time, but, you know, we have to start somewhere, right. So if you don’t start in, it’s never going to happen. So give us some advice on how, how you help transition your state from a state that that was not part I could punch his scope of practice into the wine that is now almost well known for being able to do that

Well. And a lot of it is building bridges. And, and again, the best thing that you can do is work with your state association, then build that, uh, that network within other associations. And that’s going to take a lot of education. That’s going to take a lot of reaching out. so we ran our bill in 2015, and we were lucky because we had a letter from our regulatory agency saying that it was their opinion that we could do, injections within our state. And that had been there, I believe since 1999. and so when we went to the, our state medical society, we were able to say, we’ve been doing this for a while. There haven’t been complaints. There haven’t been adverse events. but one of the big things is being able to communicate to medical providers, what it is that we want to do and why this is something that’s in our scope of practice.

You know, again, emphasizing how much training we have on being able to puncture the skin safely and effectively, uh, being able to educate them in a way that they understand that this is part of traditional Chinese medicine that, you know, we’re not trying to do injections so we can do, you know, Kenalog or pharmaceutical, injections, where we’re trying to use this from a healthy, safe aspect so that we can continue that tradition of TCM as it relates to our patient. And then using this tool to continue with those diagnosis and protocols. When generally you educate the different communities on what you’re trying to do, that you’re trying to use substances that are safe, that you’re not trying to do again, pharmaceutical or, or, you know, cortisone, Kenalog, uh, these types of injections. They’re generally very supportive because again, your MD, they’re not going to be doing, you know, a B12 shot.

You know, they’re not going to be doing these types of things. And so if we can take that population and we can help, or if we can help with these chronic pain patients in a way that we’re not using opioids or addictive substances, then they see this as a benefit. again, in Colorado, when we ran this bill, we sat down our state association, which, uh, at that time I was president of, we sat down with our medical society. I had a binder of over 300 pages of research and trials and everything that I handed to them. And we sat there and we answered all their questions. And the end result was that our state medical society officially supported this bill to help us put this in writing in our scope of practice. so talking with other States, the biggest thing you can do is to educate the other associations on what it is you’re trying to do, what substances you’re trying to use, and inform them on the training and the expertise we have in this field. And again, generally when that’s done in a collaborative and informative manner, then they see this as a positive thing and are willing to help with it.

Thank you for that. What encouragement and guidance, you know, uh, I’m inspired. I, I want, I want my jurisdiction to be able to do this kind of a procedure so that we can help our patients to the most of our ability. So to finish up, would you be able to tell us where we can get more information about nutrition P O L and how we can stay updated on your teaching schedule? Sure. And so I have a website where I have a few different types of classes that I teach. I have an introduction class. I have a class that’s specific to muscular skeletal conditions and, uh, trigger point injections. and then I briefly go into some of the cosmetics I’m using natural substances to fill in fine lines and wrinkles, and to give the population a, an alternative to Botox and, and some of those other kind of toxic chemicals.

my website that has my education classes is prolotherapy of Denver. so that’s www.proloden.com. and then on the upper right hand side, I have a tab for education and that’s where I keep my classes up to date. Great. Thank you very much. And even if you’re not somebody that sees a lot of athletes, I mean, but wheel, which I keep punches, doesn’t see a lot of pain, right. So if you, maybe if you’re more inclined to do stuff for aesthetic cosmetic stuff, you just heard everyone from Skype, you can also apply this to great results for, for rejuvenation, okay. For longevity anti-aging practices. So I like to thank you once again, Scott your time with us and share your knowledge and experience with us and to our listeners. I hope you enjoyed that. And that was very informative for you. Please. Don’t forget to join us next week. Our host for next week is Matt Callison and Brian Lau. And, and I thank you everybody for your attention. And, uh, if you have any questions, don’t feel free to post them. And if you found this, little interview useful, maybe let your colleagues know about it may be, uh, show some love. And, and, uh, and I look forward to speaking to everybody very soon. Thank you. Stay safe and stay strong. Thank you.

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Dr. Virginia Doran

AAC Modern Language, Ancient Knowledge

Hello, I’m Virginia Doran. And this week’s show title is modern language, ancient knowledge using acupuncture research to communicate acupuncture’s evidence. The guest today is Sandro Graca, who is just doing amazing things for this field. We really need to thank him and people like Mel hopper, Koppelman, who are doing things through the evidence based acupuncture, uh, organization, and other things. Sandro originally from Portugal, though, he graduated from the Irish college of TCM.

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He’s a fellow with a bar and practices in Dublin fertility medicine at the Sims clinic. He’s also a member of evidence-based acupuncture board and is an avid and a speaker and promoter of acupuncture research. Additionally, he teaches at the Northern college of acupuncture in New York and UK, and sits on the board of the obstetrical acupuncture association. So Sandro, thank you for being a guest. Thank you for having me here. It’s a pleasure to be here with you having a chance to chat and thanks to the American acupuncture council for having me.

It’s a pleasure. Yeah. And we all want to thank the American Acupuncture Council for so generously, you know, supporting these shows and producing them. Um, so I wanted to start by asking, how did you get into research? It’s not a path everybody takes in acupuncture. Yeah. It’s um, I suppose it’s a, it’s a follow on from the acupuncture, right? The, um, and it’s funny when you, when you asked me that my brain was like, Oh, a few years ago, people used to ask me and we all used to this in the clinic. How’d you get into acupuncture in the first place. And now it’s, how do I get into, um, to research? And actually the answer is pretty simple. And I, I started reading the papers after qualifying and, you know, you read all the books and you’re in college and you have your teachers and you start practicing in the clinic. And eventually

It just led to my field being, you know, more into, um, acupuncture for fertility and pregnancy. And I just started to read papers, you know, studies that were out. And at the time, I honestly, I didn’t know how to, or you know, that there was a way of reading them. I would just jump straight into the methods.

Well, that’s encouraging because for a lot of us, it’s a challenge too. We haven’t had sufficient training in school to really read and analyze research papers.

It’s, it’s a different, it’s a different language, isn’t it? And then, you know, it’s a different language, but here I am, you know, from Portugal and studying Chinese medicine in Ireland. So I guess I’m missing the different languages. Right. But, but yeah, I would just, you know, initially it would be like, what you’re saying it is, it is, it is a more complicated language. Like academic writing is different and from what we’re used to from a book, for example, and I was just, yeah, I was just jumping to that method section because I wanted to see what points they were using for the studies and almost like a compare and contrast on what I was using in the clinic as well.

So why do you think acupuncture’s should be research literate even if they don’t plan to use it and they just intend to be a practitioner clinical practitioner.

Yeah. So, so kind of like the same principle. So first of all, to keep up to date and there’s, there’s that, there’s that difference between, you know, how much do you need to know about research and do you just want to be able to read and know how to read it and interpret the paper and get the, I suppose, the juice from the paper, or are you really interested in doing research because that’s way further down the line, right? So for, for a practitioner in the clinic and independent of specializing in one particular field, or, or just being more general practitioner, just to keep up to date, because, you know, unfortunately, you know, books are written, it could be five years plus before there’s a second edition of that book. And in terms of getting like what’s up to date, you know, getting it from from research is the quickest way to, um, to learn, you know, and to keep up to date and then you start getting into, you know, why, and, and really why it matters for the profession as well.

And not just for the individual is because of trying to learn how to use that language and whether we want it or not. The reality is that for most of the other medical fields, they understand that language. They like to communicate in that language. And they like to use research for argument, you know, argumentation between people, right? So learning how to, again, get the information from it and know how to use it, you know, get familiar with the language just means that you will be able to then communicate with people. I I’ll give you one very quick example. And it’s like, I’m very practical in terms of telling people why and giving them examples. If you’re going to be talking to someone, it being a new patient, just a member of the public, a consultant, or even a healthcare policy maker. If you’re going to talk to them about what you do, if you have that chance of like the five minutes, you know, golden ticket to tell them what you do, if you use terminology that we would use to one another, because we’re both practitioners, they don’t understand it. Right. And sometimes people think about this and go like, Oh, but it’s what we do. And if you’re good at explaining, and I always say, no,

Know your audience,

Think about how you felt during the first day in TCM school. Think about how you were during that first week, during that first month with all the different terminology, you know, there was she and Shen and jingle. It, it, it was all new to you. And it took you a little bit of time to understand the concepts, to get, you know, it’s a new way of looking at things, right? It’s like a new reality. It’s like the new lens to look at it. Right. You only have five minutes with these people. They don’t know the terminology, but there’s other terminology that they’re familiar with. Right. And if you use that, you just going to engage with them and you’re going to be able to communicate with them.

Makes sense. Absolutely. I always don’t, it’s like, don’t explain it in Chinese medical terminology because you know, for a lot of people they’re not going to understand, and they’re either going to think you’re trying to fool them or they’re going to think, Oh, that’s very poetic, but it sounds like gobbledygook, you know, talk to them at the level they’re at. So if it’s a doctor using research language, if it’s just a lay person, you know, keeping it scientific, but simple enough for them to understand.

Yeah. There’s different levels, right? Unlike again, if we go to the different levels and the extreme of like the healthcare policy maker, a lot of the times healthcare policy makers don’t even come from a medical background that could be from a law background. So not only that person might not have the medical background, they definitely don’t have your own medical paradigm background because they’re not TCM. They’re not even, you know, biomedical, how are you going to communicate with them? Right. So I always say like, as you pointed out, you know, it’s have that in your head about know your audience. Who are you talking to? You might only have a few minutes if you’re talking to another practitioner. Absolutely. I love talking about the classics. I love talking about Chinese medicine. Love talking about acupuncture, use the terminology with your colleagues, but when you’re talking to other people, they might not know it and you’re just going to, you’re going to lose.

Right. Right. Now, what would be your advice for starting into some sort of knowledge of research literacy? Like where would somebody start assuming they didn’t have a good program in school for that practice?

Yeah. You know, this is the, this is the lecture in me. Can just go, you have to practice more. Um, yeah, it’s true. I it’s difficult because you know, a lot of the times you don’t even, you don’t even learn it in school as such like the basic research skills of, you know, where to find the papers, how to go about finding them. And then there’s the whole thing about, you know, what’s the quality and how do I know that this is a good paper or not? And I would say, just start and get to it. So go online. Pub med is the easiest way to do it. It’s free, you know, indexes, most of the papers there. And again, think about the levels and think about the steps. There’s, you know, whenever, whenever we hear the word research, we’re thinking about, you know, lab coats and run the mice control trials.

And, you know, for those, and, you know, can look at the pyramid and think that you’re all the way up the top of the pyramid, but, you know, think about lower down the pyramid because it needs that space too. So, you know, start reading about case studies case reports, learn how you learn, what are the different types of studies that go up that pyramid of evidence and get familiar with it because there is, it’s really difficult to jump ahead and think that you just, you have to read all the RCTs. It’s difficult. It’s like trying to learn how to drive in a Ferrari, you know, get your little binder car first and get familiar with it. And then once you’re, once you’re more comfortable, then you get your next car and so on and so on. So pub med will be my first recommendation, you know, Google scholar as well.

Um, the results from Google scholar, just because it includes more stuff. And it just it’s a lot like there’s chapters of books and books and stuff like that. I prefer pub med. And I would always say to colleagues, start there and look at, you know, different years, different publications, you will start to know as well. You might have a particular author that you read the book from college or that, you know, from before and just try and follow and see what other publications that particular author has and, and just practice really, you know, it’s it’s, you gotta get used to it. It’s a different language, but again, look, we’re TCM practitioners. We are used to different languages, right. We can study Chinese medicine. So yeah, practice scholar would be the key ones.

I was surprised when you really encouraged, uh, when we spoke yesterday about, uh, practitioners doing case reports that that really filled a need. I just thought I didn’t really see the value in it until you explained it to me.

I think that, you know, it’s, it’s a big passion of mine and with evidence-based acupuncture, both Mel and I have spoken about this before in public and in our own work and trying to how to approach this in a way to, again, having those five minutes and getting people involved with us. And I always mentioned too, when, when I’m doing my presentations, I always say that I love to put it out there because that’s, you know, the standing on the shoulders of giants and you see something and you try to improve on that and build up on that. But it always breaks my heart a little bit to see that you read the research paper and independent of the results you look at who was doing the treatment, who was doing the acupuncture. And a lot of the times it’s not acupuncturist.

Right, right.

Why, you know, why can’t I get involved in this? Why can’t we as a profession? You know, it should be us doing this. So again, thinking about the different steps and jumping ahead and thinking that, you know, someone is going to arrive with a bunch of money and get us to do a big, huge RCT. Yeah. Let’s keep our fingers crossed and hope that that’s going to happen, but probably won’t. So let’s start somewhere else. And that was something that recently we started to put that together and get that point across of let’s build that bottom of the pyramid of the case studies and the case reports and just write them and write them according to the guidelines. So you can go online and you can find it’s care, hyphen, a statement, care, hyphen statement.org, and you can get the guideline. It’s like a roadmap that you follow those, you know, those guidelines, those principles to write your case report, that’s where the name comes from.

Just kind of keep it in your head it’s care because it’s for case reports, CA R E. Yeah. So, um, you know, research, we love acronyms. It’s amazing. And, but, but it’s, it’s going to, a lot of the times it’s going to turn people’s head because it’s like a case studies case reports are at the bottom of the pyramid. But last year I was doing a day, it was a pre symposium lecture in a, in Portugal. And that came about, and I just had those few seconds when someone asked a question in the audience about a case reports and I was like, but hang on a minute, look at the pyramid. It doesn’t matter how much you look at the top of the pyramid. If the bottom of it is not strong and full, the whole thing is going to collapse. It’s like the house, right?

So for us to be thinking that as, as starting in research and has not having enough funding and all that start aiming and thinking about our CTS, I think in my opinion, that it’s just going to take a lot of energy and we’re just not going to get there. Let’s get familiar with the case studies and the case reports. And look at the time that we’re going through right now, where there’s, the virus is going around. There is no time for RCTs. There is no time for huge literature reviews and studies. We’re going on case reports, we’re going on case studies, right until the month start building up. And then you start putting that amount of work together. And eventually there will be trials, right? Right. We can do this. Right. We have the guidelines. It doesn’t matter how much training you had in school.

You’re doing this all the time. You’re treating patients, you’re in clinic, you’re treating patients, you’re taking notes, put those notes into those guidelines, start producing case studies, start putting case reports out there, you know, try and get them published. You know, you get your name out there. It looks good on your CV. And eventually you just start building up that bottom of the pyramid and Hey, some of those case studies and those case reports might end up being a pilot trial. They might end up being an RCT at some stage, you know, fingers crossed. Yeah.

How can a practitioner, uh, incorporate the knowledge from the existing literature in their practice?

Well, I’ll give you a very, very, again, an example that was like, wow. So if I can’t remember exactly how many years ago, but a few years ago in Australia, when the legislation changed, one of the things that came out for the acupuncturist is that they couldn’t do any direct advertising of any kind. So they couldn’t even, it’s almost like they can’t even talk about what they do. Right. And, and yeah, you know, it’s a bit like I do this, but I can’t tell you anything. And you know, there’s different levels of advertising, right? So that, wasn’t the point of it. The point was what some practitioners then started to develop and credit to the first person I heard saying, and then using it this way, it was Deborah bets. And she was like, well, you can’t talk about what you do, but you can talk about the research that is out there.

Right? So instead of writing on your website about what you do, and these are the conditions that you see, and then having hassle with people saying, Oh, you can’t say this. You can’t say that. Why don’t you start talking about the papers that are out there and start saying something like, Hey, here’s a paper from the study and 2019. And Hey, there were 10 people. It was a small trial, but isn’t it funny that even from that small trial, they found that blah, blah, blah. And at point they can’t come to you and say that, Oh, you can’t write that because it’s advertising because you’re saying I’m not advertising. I’m just talking about what they found from the paper.

Yeah. There’s always a work around isn’t there.

I shouldn’t be saying this life. Yes. But you know what I mean? Like if you’re reporting and if you’re talking about stuff that is in the study, number one, you’re informing the public. So you can use that as a training for you for when you’re talking to the person in the clinic, you can use it for your website. Right. You can use it for your blog. You can use it for your social media and, you know, for the public it’s information, you’re not selling that, Hey, come to my clinic because I do this. You’re just saying, I’m an acupuncturist. Here’s what, you know, a study from last year, I found about acupuncture and this, I do this type of acupuncture in my clinic, you know, work with us. Um, that would be, you know, that would be kind of like the main thing also remember, and I keep saying this all the time, stay up to date, right. If there is, you know, you’re doing, you’re doing

Well these days, that’s hard. There’s so much coming out.

Exactly. Right? Like even with research, it’s tough sometimes because there’s so much coming out, but you know, don’t stay in the same place and, you know, I know want to be critical, but you know, it’s not the same points all the time, the same people all the time, it’s everyone is different. And there’s been times when something comes out of a research paper that I go, wow, I actually, I never thought of it, but that’s actually a very good idea to use that particular point prescription for this. Or even not with a point prescription, even with the timing of the treatments, you know, recently there has been a lot of stuff that came out about dosage and considering that, you know, maybe once or twice a week might not be enough for some conditions. Maybe we leave three times a week for condition X. Right. So it’s not about, it’s not about read on the paper and change your practice. It’s about read it on the paper and think about it.

Yeah. I think some of the viewers might be wondering, is there a fast track to learning acupuncture reasons literacy? Well, I know the answer to this. I’m just wanting to hear your response

That look ideally, and this again, going towards what we are exploring with evidence-based acupuncture and what we would like to do. And we’ve done some lectures on this already is just trying to have, start with the basics. Right. And I really mean it. Like, it’s not about trying to teach someone to do RCTs, start with basic research skills and try and talk to the colleges to see can that be incorporated as part of the curriculum. And I know like I’ve been at these meetings and I know that the first thing that the college director is going to say is we don’t have the time we don’t the budget. You know, if you’re going to add something else to the curriculum, what are you going to take? I understand that, but let’s work together. You know, let’s try and find a little bit of space. And, and I can’t say too much about a paper that I’ve been involved with recently and it’s not published yet, but it’s fascinating stuff in terms of how we can get the colleges involved, you know, the associations involved as well. You know, we already have the associations, you know, some of them pushing for practitioners to do ethics CEO’s and to doing, you know, practice CU like proper stuff in terms of ethics and safety, maybe there’s room to incorporate something to do with basic research skills as well.

Right. And, and, and updating it for your, you know, CU or yeah, absolutely.

Absolutely. You know, so, you know, trying to talk, I know it’s very early days to be talking about this, but it would be something that we would really like to explore. And hopefully I’ve been in touch with, with the main authors on that paper. And they did allow me to just say, keep your eyes out for four days, it’s going to be published soon. And hopefully we can engage in this conversation and just say, in my opinion, I think there are a lot of people are just thinking about research as doing research. And I think that we need that little bit of education and say that first, let’s talk about knowing how to find it as you ask, and then how to read us, you know, out to get some points from it. You know, I don’t mean acupuncture points, but points from the paper in terms of how, you know, dosage, what are they doing?

How are they doing it? And ultimately if this doesn’t convince people, ultimately the goal is I, we, as the BA Mel would say the same thing, we would like acupuncturist to be doing the research. We would like to be involved in the design of the trials, right? Because it’s, I’m not the kind of guy to be on the outside saying that that’s wrong and that should change. And the kind of guy that goes, I’ll, I’ll go in and get stuck in and let’s see, can we change it? And I think that the first steps would be that, you know, involve the colleges involved, the associations journal clubs, you know, online education and start, start small, start with the first steps of learning.

Hmm. Now for some people who don’t have access through an institution, uh, they, they may not be able to get anything but abstracts, especially for certain papers. Um, you know, talk about the difference between an abstract and the full text and, uh, why it’s important. If you can to get the full text,

It’s a lot of the times you will hear this, that, you know, you can find a lot of the times they can find the, the, the abstract, you know, the index paper on pub med. And then if you search on Google scholar, you might find the full paper. So when I gave you the example of how I started looking at research, a lot of the times that stuff doesn’t come up on the abstract, you know, abstracts are really condensed in terms of the word count because of publication and to start what you’re, if you’re just starting and you’re reading only the abstract, you’re actually missing out on the, on the, the important thing and kind of like what helps you to build your own confidence, which is go to the method section and see what points were they using? How long were they treating for?

What were they checking for baseline, you know, checkups? Like what were, what did they want to see on the patients first? And then how many months later were they doing and what were they doing again? That sort of information comes up the paper. Sure, absolutely. Yeah. Yeah. So, yeah. So you have, even from, you know, if you go up in that pyramid again, we look at things like, you know, who was the person doing the acupuncture, um, what, what type of training they had and for how many years, a lot of the times, you know, this is encouraged to come up on the paper as well. And if you read the abstract, you’re, you’re missing out on that. You know, the abstract is a little bit like the poster for your movie, right. How they got there, right. It’s just going to tell you the start, like the context of, you know, the context of the story, and then the happy ending for the story, right? That’s your abstract and what you’re missing out from the other one, one of the things that you hear a lot from, and I know, you know this, but for people listening is that it’s very rare that someone actually reads a paper from start to finish. Right? You tend to go through the results first.

Okay.

The results first, then you go like, Oh, I want to read a bit more about this. And then, you know, you come to normally the methods, you know, just to see what way they were, what they were using. So it’s, it’s not something it’s not bedtime reading.

No, unless you want to use it for insomnia.

I mean, like, it’s not something that I’m going to read this now and I’m going to get 20 papers and I’ll read them in one day. It’s not like that. You know, I, I would really encourage look at authors that you like in your field and it’s more than like that they have something published and just start reading about it. And for sure read the full paper because it’s, it’s inside. You’re going to get these gems.

Yeah. Is there anything else you want to leave us with,

Um, roll up your sleeves and let’s go, and let’s this look, I like to focus on the positives and I like to encourage people to do things. And that’s how I got, you know, how I got stuck in doing things. And a lot of the times there is this attitude towards research and using the language of science, which we actually have as part of the, the slogan for EBA. And I always say to everyone, look, if it wasn’t for changing the language and adapting the language, I wouldn’t be here. And a lot of my colleagues wouldn’t be here because what was there in terms of Chinese medicine had to be translated. A lot of, you know, this, a lot of the stuff that got to Europe was actually translated from French right into French first. Right. And when I got super enthusiastic about Chinese medicine, the first book that the college got me, like the first big book, the college got me to read was Giovanni’s book, you know, and the great late Giovanni, my church, he took all that knowledge and took all that Chinese medicine and a lot of Chinese writing too.

And put it in that book. And the version that I got first from the college was actually a Portuguese translation. So it was translated again. Right. And yes, we acknowledged that some things are going to be lost in translation is why you go back to the classics and you learn more and you go a little bit deeper changing that now into the language of science is just going to allow for more people to get stuck in. Otherwise you would have to know Chinese to do Chinese medicine. It would never get to the point where I got interested in it and I was reading it. It would never get to the point where I move and I get to study Chinese medicine in English as well. It’s a different language. It’s not changing anything. It’s just changing the way that you’re explaining it to someone else.

So don’t be afraid of the language of science. Don’t be afraid of research. There’s different levels. Read about it, find out a little bit more about it and Hey, get in touch with us having a space occupant. We’re happy to help. And you’re part of a program at the Northern college where there, there is more emphasis on research, right? Yeah. True. Yeah. The Northern college of acupuncture has started that, um, the online MSC. So it allowed for people from all over the world to actually come together and do that. And, you know, the pleasure of being part of that program. And they asked me to stay on and lecture on the program as well. So yeah, the, um, the online MSC, I can tell you, for example, the last it that I was teaching, there was someone in that cohort. Two is from South Africa. There was someone from New Zealand finding the times for everyone be online at the same

Time. And yeah, it’s, it’s fascinating. And it’s fascinating. The amount of work that people that gone through that, you know, practitioners have gone through the, the courses I’ve been able to do quickly, like a colleague of mine was able to create, create something from nothing based on just the, you know, it was one of his ideas from, from the MSC for, for a project for it and took ideas from the MSC, took ideas from EBA and created this new wing in the hospital for treatment. And, you know, based on acupuncture and Chinese medicine and the potential, you know, it’s there, you, you can do it. Like, I didn’t know how to do it either. And it’s just like going to school and learning again. So every one of the Northern college, it is really like being, it’s like my second family and I love them all dearly.

And there’s people from that college involved in research all over the world. So it’s fascinating. It’s a great school. And despite the, there’s always been an emphasis on research with Richard Blackwell. And, um, and yet when I taught there, you know, in person, I was impressed with their clinical skills, more than many schools that I’ve taught at. So, um, they’ve really stuck, struck a good note there on the balance between something like that, didactic and the clinical. So yeah, I recommended the names, you know, you mentioned a couple of names, but people will be familiar with the names from there and you know, it’s, it’s a, it’s a, it’s a second family. Really. I love it. Yeah. Well, thank you so much. Thank you for having, um, you know, we’ll do it again. We’ll get Mel on here too. She’s got time. And, uh, next week our get us, our, our new hosts is Chen Yen. So be sure and catch that and you can find me on luminous beauty.com and, uh, we’ll see you all very soon. Thanks.

[inaudible].

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Brian Lau and Matt Callison

AAC Neurophysiology and Acupuncture Brain Lau, Matt Callison & Michael Corradino

Click here for transcript.

Hello everyone. Thank you very much for joining us. My name is Matt Callison and with me is Dr. Brian Lau we’re with the Sports Medicine Acupuncture Certification program. We’re lucky enough to be able to have this, this sports podcast with the American Acupuncture Council. So we want to give a big shout out to the American Acupuncture Council. Thank you very much. We have a great opportunity today that we can invite a number of top speakers in the sports acupuncture field. And today we have Dr. Michael Corradino, he’s the creator and founder of neuropuncture. It’s the only complete neuroscience acupuncture system that we have here in the United States. He has been clinically practicing acupuncture for 25 years has been traveling the world, teaching a system and researching neuroscience acupuncture for the past 15 years. He’s been involved in groundbreaking electrical acupuncture research, and as a published author in this field.

And from what we understand, he’s actually working on his third book. Michael. Welcome. Thank you so much for joining us. Really appreciate it. Welcome, Michael. Thank you guys so much. It’s a real incredible honor. Thank you. Well, um, should we just jump right into the first topic? Sure, sure. So what we discussed was let’s, let’s get into a talk a conversation about neurophysiological mechanism of acupuncture. Why don’t you go ahead and take it, Michael. All right. So I think on this particular topic, I think it’s important to kind of plant the little, little flag right here of acknowledging that the language of our medicine, um, being, you know, from 2,500 years ago was our ancient predecessors and founders of our medicine, observing physiological phenomenon and putting it in the language and terms that they had at that date. And that, um, the, unfortunately I believe the very strong, unfortunate, uh, mistranslations of energy and meridians.

And I know that a lot of our professional professions liked to use that was who was, was really, you know, mistranslated by Soulié de Morant, who was not a physician. I think that’s very clear to make that point because in my travels to China, uh, you know, there’s strong documentation of physicians from Germany, America, and France that traveled to China in the 16 hundreds in the physicians, when they looked at the classics, understanding anatomy, physiology, pathology clearly really translated jingluo, and mai and qi more as breath as qi and pathways and channels and networks and actually points they translate as neurovascular nodes. So when you put the physician hat on as a, as a physician, I think that the neurophysiology understanding of acupuncture was kind of side routed because the energetic model, but today using 20th and 21st century medical sciences, we can absolutely understand the physiology of acupuncture. I think a lot of the groundbreaking research with functional MRIs clearly denotes that we are modulating the nervous system. We can target specific regions of the brain specific receptors with electrical frequencies and different hand techniques, which is measured by frequencies. And we transmit signals along, uh, the neuropathways that then communicate with the entire body because, you know, brain being the CPU, um, you know, uh, I teach five main neurophysiological mechanisms and I think they really clearly do explain all of acupuncture’s clinical phenomenon today. Awesome. Awesome.

Alright, we’ll set. Brian, do you have anything to add? Yeah, well, you know, and, and, um, the work we do in sports medicine, acupuncture, I think, uh, you know, Michael, you probably look much more from the neurological aspect than we do though. Of course, we do take a lot of, um, consideration of the neurology jiaji points, and we’ll get into those in a little bit, uh, of course, motor points, we’ll get into those in a little bit, but one of the influences of, of mine, um, in the last several years and, uh, and I think speak for Matt, maybe he’ll agree with this is some of the work, uh, from, uh, the, the, um, physio from Italy, Luigi Stecco, and he has a very, um, fascial, you know, kind of, um, myofascial, uh, mechanism, but also, you know, his, his work is called myofascial techniques or something like that, myofascial therapy, but he, uh, initial terminology they use was neuromyofascial, because you know, he’s looking at how the fascia

Communicates mechanical pull, um, and helps, uh, um,

Through that mechanical pull helps inform proprioceptors in that area. Uh, you know, that there’s, it’s really a mechanical stimulation that, that informs those proprioceptors, and then that

helps in terms of coordinated movement, helps certain muscle groups work together,

Uh, to be able to fire and then the antagonist to be able to relax. And there’s a communication network that is some degree is the brain, but it’s really,

His view is a little bit of the mechanical,

Uh, communication that is really driving that stimulation. It’s a little bit more of the fascial aspect. I think you’re a little bit more in the neurology aspect. I don’t know if the two necessarily are exclusive, but it’s an interesting, interesting perspective.

Yeah, that’s true. That’s a good point. Um, and as we know, it’s that there’s no real segregation with the human body, right? I mean, you’ve gets all interconnected. So with the nerves, I think we can probably say that those nerves are a big part of the channels, but that’s not the only part of the channels. Right? So with the neural stimulation that is going to be affecting every cell in the body, no matter where you end up putting the points, there’s always going to end up being a change. So that’s the fantastic thing about neurophysiological aspect. So I mean, adding the different frequencies and the different waves onto the needle itself is going to be obtaining a number of different rewards or penalties sometimes. Exactly. Unfortunately, you know, you can still treat the excess and the deficiencies using electric stimulation. And so it’s, it’s, it’s fantastic.

I love this topic. It’s a good one, Michael, back to you. Um, I would like to definitely, I like what Brian was saying. I don’t think there are not connected as Matt just clearly stated the fascia nervous system, because there’s been some real strong research that supports the fascial being indicated with acupuncture, but the fascia won’t be able to transmit some of those signals without neural innervation. So I think there is an absolute, you know, connection there and that, uh, again, you know, in my, uh, my research, I think that the neurophysiology really just really powerfully, powerfully empowers the practitioner when they understand that. Yeah, absolutely. On all levels, right? Your primary channel channels, your sinew channels, your luo channels, it’s all being affected. Absolutely. This is good. This is actually a good segue into points unless Brian, that you wanted something that

Actually I was curious about, um, you know, when you’re through your perspective in your work, when you’re needling points, especially, you know, the in acupuncture, we have a lot of primacy of the, the transporting points and xi-cleft and luo-connecting points and the points below the elbow and below the knee, when you’re working with those points, are you then thinking of what nerves being stimulated is that sort of your, your first sort of go to, in terms of the effect you’re trying to achieve

100% Brian that’s exactly. Then, you know, I, you know, the classics actually state that, right? That, that, that the qi and the pathways get closer to the surface from the elbows in those joints below. And that shows actually that we have more clear access to those nerves. We can use an example using luo and source points, like a LU7 LI4 both on the radial nerve, right BL58 and KID3, you got the tibial and sural bifurcations of the sciatic and peroneal nerve. So I think they do lie and they do definitely communicate. They modulate each other. Um, when we’re looking at points, um, again, I look at, you know, neurovascular nodes, NIH came out with this wonderful study where they used an invisible marker and they had a, I think we’ve got like 10 practitioners mark and locate a point, then needle it, and then stimulate and took a function MRI of it, and what they found out was that none of the practitioners found the point the same way or the same location. So that’s not a point, right? It’s more of a unit or region, but there is differences from on the same nerve, different regions. Right. And that’s been confirmed as well, like P6 or P5. They actually different regions that affects on the brain. So there could be a nerve, but the, your locations, but they’re not points. Yeah, that’s it.

I have a very, um, been very curious about that. Is there something

Unique about the various,

You know, stream points are jing-river points. Is there something unique about those points neurologically, like, do some of them tend to

Correlate with branches where the nerve branches, or is it really just point by point? Obviously there’s something unique in terms of how they affect physiology. Right. Is there something anatomically that’s, that’s something that you’ve observed that’s unique about them? LI4 to LU 7 has that. Oh, I’m sorry for interrupting. Was that question for Michael? I’m sorry, go ahead buddy. Oh, it’s just whoever. Yeah, no, Matt, I think you’ll be able to probably answer this better. You both can do this, but check this out. Okay. So we know the daqi sensations has about seven main class main classical sensations. You guys are all familiar with spinal anatomy of the spinothalamic tract, right. And there’s three of them, the anterior, posterior, and lateral. There’s also the spinocerebellar tract that brings up transmissions from the exterior. And how can we affect those spinocerebellar tracts for balance and proprioception is through the points on the wrist or the river points, because those tend to actually target more of the spinocerebellar tracts. So Brian, to your answer, I think yes, there can be these points that do maybe affect certain spinal tracts different than other ones. And that’s based on the receptors you’re stimulating and where they’re located. Yeah. That’s really interesting. Brian. I think what I understood you say, Brian is their actual physical conduit going from one nerve to the next, like for example, xi-cleft, no, I’m sorry, Like a source and luo combination. Is that where you’re talking about Brian?

I guess I was thinking, you know, I’ll, I’ll use, uh, jing well points. I would assume jing well points being where they are, that they’re at the termination

of various cutaneous nerves.

And that would seem like a pretty consistent of how that affects, um, in terms of, uh, communication back into the central nervous system

is kind of what Michael was speaking at. But I guess what I’m wondering is if the jing well points are at termination of, of certain, um, cutaneous nerve pathways,

Other nerves, do you tend to see a correlation that there may be at a bifurcation of the nerve? Or is that really not… Is that really more of a point by point. Well, I do know that perfect example again, right. Using the luo and source of large intestine four and lung seven, you know, that’s great for upper respiratory things. We know that’s the radial nerve goes into the brachial plexus, the cervical eight nervous part of the brachial plexus and those nerves do affect the lungs. So you do see, I think those correlations just like bladder 58, kidney 3 surreal tibial, or a peroneal tibial running up into the low back, helping out with low back pain and then any visceral muscular reflexes, which I’m sure we’ll go over with the huatuojiaji points. I see some correlations to that. We have a video on YouTube channel that shows the interdigital nerve, that branches off of the radial nerve and it goes right in toward LI4.

So we saw that. Yeah, it’s is so much fun. We saw that. So we saw that connection, but then in our cadaver dissections, we looked at other sources of luo anatomical areas to see if there was a branch like that. And we couldn’t quite find it. And this is where we hypothesize that is probably more of a going from nerve to that fascial plane that connects to that point. And then you have that mechanical aspect. I don’t know, but you know, it’s just kids, we’re just loving what we’re doing. So we’ll check out the next cadaver, see what we can find. Absolutely. I mean, when I was there for your cadaver, I’ll bring it up. We get to the motor points, but you guys just do phenomenal cadaver work and dissection work, and I’m really impressed. And I know that we’ll talk about it well that, you know, we’ll, we’ll talk about when we get to the other stuff.

Definitely pleasure to hang out with, do you as well that’s for sure. Thank you. Should we get into the motor points? Sure. All right. Okay. Um, well, something that I’ve been researching for a long time is the, the neurophysiological location of the motor point located on the skin and then going deeper to see where that motor entry point actually is. So there’s different names for the motor point. Some people call it a neuro muscular junction, which can be a motor point. That is from what I know of as being an internal motor point. The research that I’ve been working on would be where the actual motor nerve enters into the muscle itself. Some people call that the neuromuscular junction. That’s not my understanding of it. That would actually be the motor entry point. Then the nerve would then branch off and go into proximal, neuromuscular junctions, and then still branch travel along into distal intramuscular, junctions, or muscular junctions.

So yeah, I mean, this is something, these, these points become Ashi points that have been treated for thousands and thousands of years. And, um, very, very useful as we know, to be able to treat these and mixing these with acupuncture points, acupuncture points, many of them are acupuncture points. Exactly. And also many of them are our notable Ashi points. So by treating these in a, in a, in a system we’ve seen that it can be able to relax the myofascial systems and change posture and such. Now what’s something that we haven’t actually done, which in the seminars that we have, Michael. in SMAC, but people ask questions about, do you apply electric stim to certain things. I do use electric stim on some, but only probably about 10%. This is why I refer my class to you, to your program. And that’s what I refer the neuromuscular section of mine to you, Matt.

I swear to God, I tell all my practitioners. You want to really dive into this, go to the master, go to Matt, trust me. Well, they both compliment each other, you know, each other very well. Absolutely. Hey, if I can add some to that, you know, when we were dissecting and I was doing that when we were working together, man, you know, I have a picture of it, of the dissection of that neuromuscular junction that you were able to dissect right down to that junction. So we were able to do that with what scalpels, our hands and our eyes. So going back again, knowledge, knowledge, and I don’t think that it would behoove. I think it would behoove us to not think that maybe our ancestors had some of that understanding as well. Yes. They definitely SAW those wonderful nerves, activating the muscles and put some of this together. You know, it might have got lost in translation a little bit, but man, Matt, you impressed me so much when you went right down and you nailed it, man. I mean, that was beautiful. It was really incredible. I got lucky. Thank you for that. I appreciate it.

Like that’s a common misconception about dissection. You know what I mean? The weights of the organs are in the classics. There’s a lot of anatomical description in there and how much of how much information is lost too, and how much of the information didn’t carry forward and books that maybe got lost along the way. So I think it’s a, it’s obvious that there was dissection going on an exploration of anatomy and how well that, how, how deep that understanding was, it’s hard to say, but it seems like it’s pretty, pretty solid.

Yeah, absolutely. So when they were doing the dissections, like Huatuo, my hero. Can you see him over my shoulder here? My inspiration, my leader, there was ever a person that I would like to be able to have met, it would have been Huatuo, right. I would have liked to have sat down with tea with Huatuo and Galen from the Roman empire, that we’re at the same time, 188 AD. Galen knew the afferent and effernet nerves, Huatuo knew the spinal segments, man let’s have tea or maybe Italian wine with them. Do you think they would have gotten along. I don’t know. Yeah. Right. Two empires. Right? Yeah. Funny, funny. Yeah. Well, what you’re saying, Michael, when they were doing dissection centuries ago and they saw it, we call it nerves, they were calling it channels and collaterals and the main nerves and the tributaries branch off from that and innervate the body. Absolutely. Absolutely. Okay. So Michael, you want to, you want to lead off with Huatuo points and why you love them so much.

Ooh, gosh. These are, you know, when we get through this section, neuro puncture, I, when I first came across this, I, you know, it just, I just dropped the microphone. I was like, are you kidding me? Like this was just such a beautiful explanation of our back shoe points and how powerful they are. And in short, the huatuojiaji points created by Huatuo discovered by him. It’s not a coincidence that they line up viscerally with the motor or the muscular visceral reflex that’s in the spinal segment. So when you needle into the muscle and there’s also a cutaneous visceral reflex, you’re, you’re affecting these inner motor neurons in the spinal cord and you can absolutely affect this rule change and that’s been proven and it is just amazing. And the only thing that we do a little differently is we now know through, again, the great anatomy biomedicine.

We know now that there’s not just one segment per organ, right. They might have three or four and we can really maximize that effect on the visceral function by having those deeper understanding. But man, they are just, it’s incredible what he did. That’s right. That’s why I always joke when you see images of him, his forehead is so big because his brains are so hard, right? Yeah. Way ahead of his time. Brian, is there anything that you want to add to the huatuojiaji points? Well, you know, they’re just the reflex and that segmental relationship between, uh, you know, I think most acupuncturists know this, but maybe not all. Cause it’s, it’s kinda spotty, the anatomy understanding that’s taught at school, but you know, it’s the same through the sympathetic division of the nervous system, the same branch that goes out and innervates the liver or innervates, depending on which segments you’re at, innervates the various viscera to give sympathetic nervous system information to regulate those organs at that same segmental relationship are the ones that send that posterior dorsal rami, the medial branch of it into the huatuo, and then the lateral branches into the, uh, internal and external back shu line.

So, I mean, it’s really a segmental relationship between those, those viscera, those organs, the muscles and the skin of the back. And then, uh, in that coming up through the lamina for the huatuos and then the outer ones for the, uh, the back shu points. And then of course, you know, wrapping around that same pathway and then coming into the innervating the front mu points. It’s very, it’s it’s neurology. Yeah. I mean, it’s, it’s like under, so you can understand it so much better when you can see that neurology, when you can open up Netter and look at those cross sections and see the relationship between those nerves and how they would, uh, sort of have an influence on those various points front mu, back shu points. hutuojiaji points. Yeah. I mean, yin yang therapy, the classical needle technique utilizes that.

It was Yin Yng therapy was front mu and back shu. So front mu point and the back shoot point, wow. By adding the Huatuojiaji points, you can see because it is the same nerve pathway. It’ll just emphasize that needle technique. It’s useful to see a cross section, I think like in thoracic spine to be able to see how the dorsal primary rami goes up to the huatuojiaji, goes to the inner bladder line, goes to the outer bladder line and the anterior Rami of that spinal nerve goes to the sympathetic ganglion, which as we were discussing stimulates the organs. Right. So, and this has all been proven, then that same nerve goes all the way around to the front mu point, right? So you can see if there’s going to be pathology, it will be facilitated. Therefore, all of those points along that spinal segment can be very, very tender.

If we could be able to take ourselves in a small little car and actually drive from the dorsal primary rami, you can actually make it to the anterior rami, so hello to the sympathetic ganglion, make a u-turn and go all the way back that intercostal nerve and say hello to the front mu point. Yeah, absolutely. That’s amazing. And there’s also, you know, I mean, Ren 12, right, having such a great effect on digestion. If you were a needle that properly, I believe you’re actually splitting both dermatomes of seven and eight. So you’re getting liver spleen, gallbladder, stomach, pancreas, just by Ren 12. But I think that’s why that front mu is such a great point for the middle jiao, right. And when you line that up with dermatomes and our front mu points, it really does show those connections that were found, again, you know, a hundred AD, which is just incredible. Michael, I have a question for you, how I’m sorry, Brian, go for it, buddy.

So, um, uh, at one point I think there was some, some questions on this about needling Huatuo points and why I particularly like, the back shu points are great, but the Huatuo points being that they’re so protected by the laminae, um, you know, even over the thoracic region, you can, you can needle them as long as you understand, and you can palpate correctly. And you know, maybe with the exception with somebody who has really severe

Scoliosis and you might lose sight of those angles, but if somebody’s

Spine and you have good palpation

And it’s, they’re very safe to needle, cause you can go perpendicular and that’s

protect by the laminate as long as you’re at that 0.5 cun. Um, you know, I know some people do angle. I don’t know Michael, how you do it. Some people angle perpendicular is how we teach it too, though. I think you get a good result, needling it angled, too. But the point is that the points are very protected and you don’t have to be

Afraid of depth. Again, assuming you have the palpation and you were taught properly how to needle it. Brian, go ahead and plug the YouTube video that we have with that. Oh yeah, yeah,

Yeah. We have a, um, so we did a dissection, um, and we cut out. It is in the thoracic region. What was it about T7.

We’ve done it five or six times, but the video that’s that’s on YouTube I think is that T8 or T7Yeah. So it’s in that

thoracic region and we dissected a triangle from like, if this is a spine, a triangle out, I’m covering like three range of three levels, something like T7, T8, T9. And then we cut the skin away and then the subcutaneous tissue and then the first, you know, the lower traps, first muscle layer and piece by piece so that you can fold, you know, like a book, you can, you can fold the skin back, you can fold the subcutaneous tissue back. You can fold the first muscle layer, a second muscle layer all the way to the deep paraspinals and eventually seeing the lamina. And then you can see where the needle goes, you know, putting the needle in and then folding those layers back and seeing the target tissue. Awesome. Yeah. Sports, medicine, acupuncture, YouTube sports medicine acupuncture, YouTube watch Huatuojiaji video. It was a bit of work to do the dissection.

Remember guys, when we were, when we were working together, we did, I did the upper back like that and we pulled the skin, Yeah, that’s right, the trap, the rhomboid, and then the paraspinals. We put the needle, I think we use the 40 or 50, you know, length needle and we’re just tapping and there was, there was room. So you can really show that depending on the patient. But that was, that was so excellent. I loved that. I think our acupuncture field would, would, would take off if we add more dissection as part of the standard training, I know it’s expensive and that’s really where the trick comes in. That’s where we’re going, right, Ggentlemen? We’re trying to be able to do in both of our programs is to educate the acupuncture field with the cadaver dissection is that we do in your program.

The neuropuncture, and in our program, sports medicine acupuncture. So it’s great. And also other ones that we have, Matt, I did have something that I thought you might want to add something to. And that is, um, and I know we don’t have a ton of time left, but I don’t think it will take long, this idea with the Huatuojiaji points and, uh, the, um, affecting the muscle therefore affecting the neurology, affecting the skin, but also the facet joints, and I know that’s a big part of the sports medicine acupuncture program in terms of the first module. If you wanted to add anything to that. Um, the location of it and then different needle techniques at different target tissue. Okay. So if we’re thinking about the movement of the facet, so, you know, for fixations, vertebral fixations. so you’re wanting me to talk about vertebral fixations and needling the facets?

Is that what you’re saying? No, not necessarily needling the facet, but for vertebral fixations and movement as a facets and how that relates to the neurological aspect, too. I’m not following you. I’m sure you’re trying to dig something out of me from a conversation that we had, sorry for being so dumb. So why don’t you take it over and all, you know what you’re talking about? In Sports Medicine Acupuncture, we also look at the, um, the movement of the vertebral facets. It’s in the first module. And we assess when, when the facets, when the joints are moving, when the spinal joints are moving or not moving and how that, um, you know, we a whole protocol, I don’t know if we have time to go in into the protocol now, but, um, that can relate when we’re working in vertebral fixations of the neck, it can relate to injuries in the arm, low back. It can relate to injuries of the lower extremities, but, but you know, a lot of times practitioners are also working with, um, visceral problems and they’re doing various mobilizations in combination with

huatuojiaji point needling, in combination with distal points,

In combination with the whole thing, they’re also going in and doing tuina mobilization to return mobility to those facets, which has a really big impact on digestive problems and really a lot of different things.
Yeah. I would say that’s probably one of the biggest successes that we’re having with that. Thank you for dumbing that down. Now I can join you. I didn’t ask it really well, I guess. Now that I understand that I’ll say we know we do very similar work in neuropuncture, as well. I’ve been taught traditional Chinese bone setting, and I teach that to my certified members. And that’s exactly a great combination with huatuojiaji for visceral or peripheral injuries due to those nerves. Absolutely. Yeah. That’s a great combo. Fixated vertebrae or subluxed vertebrae are obstructions in the channel particularly the du mai. And so when you got obstructions in that du mai, it’s going to offset the rest of the channels. Absolutely. So getting that vertebrae back into place, however you do it, a forceful manipulation or mobilizations, movement therapy, all that it’s going to be important. I mean, that’s how the Chinese do it, right? So they would go from acupuncture to taiji, qigong exercises, their physical therapy. Yup. Yeah. Hey, you guys, we’re already at 1o:28. Anything else that you want to say real quick before we give our, thanks again, say goodbye.

I would just say that if our practitioners and our listeners, um, open their hearts and their minds to what we’re saying and do a little best investigating and check us out, they’re going to really have a deeper understanding, learn a language to communicate and really get, I think quite, you know, you know, just amazing clinical outcomes. And that is just, that’s the bottom line. And we started with neurophysiology of acupuncture and everything we just said, and the discussion we had just eliminate all that, even bring it in historical relevance. I think that’s just cements it back in and galvanizes it. Yeah, absolutely. Yeah. I second the motion with that, for those people that are interested in what we were discussing and it really excites you. Yeah. Please check out both programs and just see which one’s the best fit or both of them. Absolutely. Because Michael’s a great guy.

As you can see super knowledgeable, he’s a hell of a practitioner and his protocols work. So that’s something that you want and you need to be able to have that in your, in your main focus of practice and also different things. Do you put in your back your back pocket? So when you’re actually practicing yourself, you remember when Michael taught you and that can get you out of a lot of problems are very, uh, are very treatment or assessment or treatment oriented. Absolutely. I think we have to do our little goodbyes now because it’s 10 29. So I’m Matt Callison. I’m the president of the sports medicine acupuncture certification program. My colleague and dear friend, Brian Lau, go ahead, Brian. Okay. I’m a faculty of sports medicine acupuncture certification, and a practitioner in Florida, along with Michael, though we’re in different cities and thank you very much, Michael Corradino. And I really appreciate you. Yeah, it was really, really nice. We want to thank you. Thank the American acupuncture council again for having us next week. Stay tuned for Virginia Doran. She’s going to be with us in the American acupuncture council. So that’d be something to check out. Um, again, you guys thank you very much. It was a lot of fun. It’s fun. You guys are awesome. I appreciate it. Very honorable. OK, take care. Bye. Thanks guys.

Poney Chiang Thumb

Strategies for post-COVID-19 infection associated neurological dysfunctions

Click here to download the transcript.

Click here to download the slides.

Hi, welcome to this week’s live show brought to you by American Acupuncture Council. I’m your host for today, Poney Chiang, coming to you from Toronto Canada. I’m a continuing education provider, and if you’d like more information about me, you can find it on the title slide.

Today, I’m going to talk to you about strategies for dealing with neurological complications and neurological symptoms as a direct result of patients that have unfortunately been afflicted with COVID-19. And there’s actually a growing amount of literature in this area and since my interest and expertise in the area of neurology and acupuncture, naturally this is a area that I’m very passionate about. So I’d like to show you some of the readings and research and strategies that are applied in my own clinic.

The first paper that we’re going to look at comes to us directly from [Wuhan 00:01:43]. This paper was published in just March, and it is a retrospective observational study conducted from three different centers. So these patients were tested positive for COVID in the month of January and February this year, and there were a total of 200 plus patients. And they were all assessed by neurologists, and their neurological manifestations were categorized into three different subtypes.

The first type is called the central type, and the central nervous system type gives you symptoms such as headache, impaired consciousness, if you can have an acute cerebrovascular disease, that’s another word for stroke, and you can have ataxia and seizures. The second type of classification is peripheral nervous system symptoms. And the most famous one that you may have already heard about is lack of smell or lack of taste. And sometimes there can be vision-related impairment as well. The third type of dysfunction is have to do with skeletal muscle injury. So patients would complain about pain. Those of us that know people who have been infected with COVID will tell you it’s like a flu like none other. You’re just hit with it. Your entire body hurts. I even had a friend tell me that it feels like shards of glass in his joints. That’s how painful it is. Okay?

So those are the three main neurological classifications. And as I said, this is a study of 214 people. And what the research found was that 36% of these patients all exhibited neurological symptoms. And what was interesting is that those with more severe infections, defined by having more poor respiratory status, which was in this case 41% of the patients in this study, they were more likely to develop neurological problems. So somehow, the harder you’re being hit by this disease, the more likely you’re going to have neurological symptoms. Just so you have a breakdown of roughly the proportions of the three different classifications I mentioned, about 25% of these patients had central nervous system symptoms. About 10% of the patients had peripheral nervous system symptoms, and another 10% or so have muscular skeletal symptoms. So, you can see why this is something that we as acupuncturists should be aware of because oftentimes patients with CMS and peripheral nervous and now of course muscle-related problems, want to come to us for support.

Of the central nervous system symptoms, the most common ones were headache and dizziness. Whereas, in the group for the peripheral nervous system, the most common symptoms were impaired taste, which is called dysgeusia, and impaired smell which is anosmia. And a patient who had muscle injury as compared to those who had no muscular pain symptoms, were found to have higher C-reactive protein levels and higher D-dimer levels. C-reactive protein is a marker for systemic inflammation in the body. So, patients who had more inflammation in the body was more likely to have muscle pain. And D-dimers is a breakdown product that the body makes when blood clots have been broken down, which is indirectly a measure of how much coagulation there is in the body.

So in other words, those with more coagulation, think in terms of [T-blastocysts 00:05:26] and TCM, those with C-reactive protein, indicative inflammation, thinking in terms of blood heat in TCM. These patients are far more likely to develop muscle injury related symptoms. Now, I want to emphasize that neurological symptoms is not just limited to the central nervous system. We mentioned it’s the peripheral and there’s the musculoskeletal. So I don’t want you to have an impression that show COVID patients are more, are oft being afflicted with strokes. Okay? That was the picture that was being passed around in the early stages when we didn’t know what was happening. But now we’re seeing, it seems to be that they are more likely to develop central nervous system symptoms, such as acute cerebrovascular disease like stroke, but it’s not the entire spectrum of neurological symptomologies that these COVID patients have.

So, as an example, in the Wuhan study, there are six patients out of only 200, only six patients out of 214 had acute cerebrovascular disease. And two of them actually arrived at the ER with sudden hemiplegia, paralysis, weakness of one side of the body, but they did not have many COVID symptoms. That is to say, no fever, no cough, no anorexia, no diarrhea. And they were only found to be suspected of having COVID from CT scans of the lung that found there’s some lesions. And then they were subsequently tested with PCR based assays to confirm that they had indeed were infected with COVID. So this is important because one, we need to realize that patients may never have gone to the hospital because they’re afraid of going to the hospital because they were going to get COVID, you can contract COVID in a hospital, they may have neurological symptoms and they will go to the community for care, even though they are positive and not because they’re, but being asymptomatic positive.

Another interesting finding was that some patients that did present with fever and headache were presented to neurologic ward in Wuhan, and they were initially positive-negative. So either their viral titers were high enough to be detected by the assays, or it was a false negative. And then only when the symptoms really started come on like coughs, and the dyspnea, then they were retest [inaudible 00:08:00] found to be positive. So that’s important to keep in mind as conditions that we need to be aware of. Possibly the patient come to us with neurological symptoms, but may actually be symptom negative, but in fact positive COVID patients.

So in summary, from this paper, they found that all the patients that had neurological problems, tend to have lower lymphocyte counts, white blood cell counts, which is indicative of some level of immunosuppression, and therefore, they are more likely, for mechanisms that scientists are still starting to study, more likely to be afflicted with central nervous system symptoms.

And now patients who have more severe infections, meaning worse outcomes with their respiratory integrity, have higher D-dimer levels. That, again, it’s a measure of how much coagulation there was in the patient’s body, and this can explain why those with more severe infection, meaning more worse lung function, having more D-dimers, are they more likely to develop occlusion or clot-type of strokes.

[inaudible 00:09:16] reminder that the authors of this paper wanted to show us is that… I put this in red, in quotation, that during the epidemical period of COVID-19, when seeing patients with neurological manifestations, physicians should consider the COVID-19 infection as a differential diagnosis. You want to avoid the late diagnosis or misdiagnosing and prevention of transmission. So this is an important wisdom for all of us to take to heart as practices start to open and you’re seeing patients with neurological issues. You might want to gently remind them to go get tested, because it’s possibly that they could be positive and just be asymptomatic.

Now, a group in Spain replicated this type of study, but this time with a larger n size of 841 patients, and this time around with a larger sample size, they actually found that close to 60% of COVID-positive patients now presented with neurological symptoms. And this was data collected across two different institutions.

And Harvard, okay, I don’t want to be an alumnus, not all neurological symptoms associated with COVID are struck. If you look at these numbers here, only 11 out of 840 actually presented with ischemic stroke and three presented with hemorrhagic stroke. So that’s only 14 out of 840.

The mean time of occurrence was approximately 10 days after the development of the COVID symptoms. So they started having stroke 10 days later after personally having a cough, [inaudible 00:11:07] a fever and as such. And again, there was a very strong correlation between those that who had the stroke, in other words, the cerebrovascular disease, and those with higher D-dimer levels, meaning that’s the byproduct of the breakdown [inaudible 00:11:23] in the body. So in other words, no surprise, more [inaudible 00:11:26] in their body, more likely to have a stroke presentation.

Now on this side, we’re looking at a paper published in Germany, and this paper was a attempt to summarizing the amount of ischemic stroke that was being seen in patients with the COVID from three different countries. As in first column you can see from the United States, second column from China.

So this China column is actually the paper I just presented from Wuhan. And then another paper, which I’m not presenting today, is of n size of 206 from Singapore. And what I wish to point out, is that you can see the number of people having strokes in relation to the total [inaudible 00:12:22] positive number of COVID patients. It’s relatively small. Now they all have associated risk factors that we know of: have they been hypertensive, being obese, be having diabetes mellitus. These are predisposed youth to more higher incidents or infection in this diseases.

And what these researchers have found was that, in the overall picture, if you look at the type of stroke, that the patients are having, there is a preference or a more heavily weighted manifestation of large artery occlusions in contrast to small vessel types, in contrast to blockages in their heart or cardiac embolisms. Okay.

So even though the number of strokes that COVID patients have is not very high, and it really depends on the severity of the infection, it depends on how much D-dimers they have, if they were to get a stroke, based on the limited amount of data we have to date, it appears that there is a preponderance towards large artery occlusion type. And now let’s take a look at the outcome of these patients.

In China, of the 11 people that had stroke-related presentations, four of them died. In Singapore of the five people, three of them died. In the United States, none of them died, and they were then subsequently sent to ICU stroke units we have, or went to go home. So we can potentially, as acupuncture, be seeing these patients that are being sent back to the community for rehabilitation purposes.

Now, I want to talk a little bit more about this large party ischemic stroke. This paper that was talking about the five people from the United States is summarized in this tabulated form in the next slide. So this is a paper that was published in “The New England Journal of Medicine”. And this is physicians in New York were noticing that, “Wait a minute, young people are getting strokes. This is not expected.” So if you look at the first row, you can see the patients one through five. These are patients that are under the fifties. Most of them actually in their thirties or early forties. Young people should not be getting stroke. So even though I said repeatedly, that strokes are not the most predominant type of neurological symptoms in patients with COVID, it is kind of sad and devastating that these can affect young people. And not all of them had the risk factors we talked about, such as hypertension and diabetes. Look at the second, third row here.

Medical history and risk factors for stroke, there was none, these people had none, undiagnosed … One of them has undiagnosed diabetes and some of them have hypertension, but some people had no symptoms whatsoever. A lot of them weren’t even on any medication. So relatively healthy people, young people can get this.

So another thing I wanted to bring to your attention, is look at the symptoms that these patients present. So they present with hemiplegia, loss of consciousness. They can have difficulty speaking, or they can have altered sensation. They can have something called gaze preference, issues to do with the eyes, we’re going to go … and also hemianopia, which is also a vision [inaudible 00:16:47] symptom. We’re going to talk a little bit more about the visual aspect of stroke and have some strategies you can deal with that in the upcoming slides.

If you look at the vascular territory, the ones that the strokes involve, you’ll see that it is affecting the internal carotid, infecting the middle cerebral artery. Most of them are affecting middle cerebral artery with one exception here, here is affecting posterior cerebral artery. I’m going to also talk a lot about that. It means that patient that have stroke, these large vessel type of strokes, tend to be getting it in the internal carotid and its derivative, such as the middle cerebral artery.

Let’s look at the symptoms of these patients. So some patients have cough, headache and chills in the first column, patient one. Patient two has no symptoms. Patient three had no symptoms. Patient four was tired, that’s it. Other than that, no fever, no cough. I want to just stress upon you, maybe you want to take this into consideration when you screen patients, whether you accept these type of patients in your clinic or not. If somebody comes in with neurological symptoms needing help and this developed in the last two, three months, it could very possibly be asymptomatic COVID patients who’ve had this, and they’ve never had a reason to go get tested because they had no symptoms. So it’s up to you whether you want to open up your clinic to help these type of patients, or maybe request they’re tested before that you’re able to help them, et cetera.

So a little bit more about this large occlusion, artery type of occlusion. What is it exactly? [inaudible 00:18:40] saw some embolization of atherosclerotic debris. So if you think about plaques inside your blood vessel and embolization means these plaques have become free, dislodged. Usually they originated from the common or internal carotid artery in your neck, the common carotid artery divides into internal, external. I’m going to show you some pictures about that in a moment. Sometimes it can actually come from the heart itself, the vessels of the heart and they become dislodged. The large vessel ischemic strokes that develop are most likely to affect the medial cerebral artery territory.

In other words, the symptoms, the neurological symptoms the patients are going to manifest, are going to be whichever part of the cortex that the medial cerebral artery supplies. So this is why it’s important to know the anatomy, knowing which part of the vessels are more likely to be affected in COVID stroke type of patients, we can then predict what is the most likely type of symptoms or neurological dysfunctions that this patient going to have based on the vascularization of relevant function area, corresponding function areas in the brain.

So this is just a quick review of the circulation of the brain. What you see here in the center is the circle of Willis that we all learn about in school. What I love about this slide is that they color coded it as such that in purple, I’ll call the posterior circulation, and it’s called posterior circulation because comes from the vertebral artery in the back. If you look at the patient on the right side over here, VA stands for vertebral artery. Whereas the green shade, called the interior circulation, which subsequently divided into anterior cerebral and medial cerebral, also, ICS stands for internal carotid artery. These green ones come from … so you’ve color coded over here, comes from the carotid, common carotid artery, which divides into ECA, CCA is the common carotid artery, which divides into ECA for external carotid artery, this goes round the face, outside your skull and then the internal carotid artery, which as you can see is now green, and then goes into the brain and divides into enter in medial carotid artery.

So here is the picture of the internal carotid artery label over here, this big one over here in green, the biggest one, the biggest cross-section green. You can see it divides into anterior … the anterior cerebral artery, ACA over here. Then going left and right laterally, this one here is the middle cerebral artery.

So patients are most likely to have clots in here before the division, or somewhere in the neck here. Or after the internal carotid has bifurcated into the middle cerebral artery, you can have occlusions in the middle cerebral artery.

So now we’re going to take a look at where the middle cerebral artery supplies. So this is a very nice picture that shows you in a color coded manner different areas of the brain compartmentalized, based on its source of vascularization. So on the bottom here, you can see A, this is turquoise color, A part. These all supply the interior cerebral artery, it’s not relevant to our discussion. All the P part, all the red parts are all supplied by the posterior circulation. That’s also not relevant to what we’re talking about here. All the yellow ones, labeled N, shows us where the middle cerebral artery supplies.

So as you can see, it supplies a large portion of the lateral surface of the cortex, both the frontal, the parietal, and even the temporal lobe. So it is a very important area. If you look at the cross-section over here, you can see here’s the internal carotid artery and it divides into … this tiny little guy here is the anterior cerebral artery, and then it divides into common carotid artery. So patients with COVID are most likely having large vessel strokes, what that means is that most likely cause is in here before bifurcation, or in here in the middle cerebral artery. Why is it not in the interior? Because the interior is small. So therefore it doesn’t qualify as the large vessel type.

Now, as you can see, the middle cerebral artery then divides and wraps upwards to cover the parietal lobes and wraps downwards here to cover that the temporary lobes. So here’s a side view of this side here, very beautiful picture, I love this picture. You can see that if the occlusion is happening in the common carotid or middle cerebral, then all of these [inaudible 00:23:49] are going to be shut off. That means all the neuro cortical areas that are in this region are going to be hypoxic, and therefore going to go show [inaudible 00:24:00]

Now what’s in this area. If you remember your scalp acupuncture, there is the sensory line, the motor line, and that’s in relation to the central sulcus. So, where is the central sulcus? The central socket is in here. Okay. There’s just most promise sulcus over here. So interior that to the motor [inaudible 00:24:23], that is a somato sensory. So this means that somebody who suffers with a middle cerebral artery stroke is going to have sensory and motor dysfunction.

Okay. And even though the medial part, which is the blue “A” part, this is the region that’s more where the lower extremities are located, even though it is not part of the middle cerebral artery distribution, there is some overlap. So you can still expect patients to have lower extremity problems. And I’m of course, referring to the homonculus map, along the central sulcus, where if you recall the medial one-fifth is supposed to be the lower extremity, the middle two-fifth would be the upper extremity, and the lateral one-fifth would be the face.

So let’s approximate that on the picture here on the top right, in this area over here would probably be the lower extremity around here. Around here, would be the upper extremity. And when you get down to the park, closer to the Sylvian fissure over here, which separates the parietal lobe and the temporal lobe, you’re going to get closer to the facial areas. So these patients can obviously expect facial drooping, facial motor deficit, upper extremity, and to some extent, low extremity also.

Now I’m going to take a little segue now and talk about what other things are involved other than just the occlusion. There’s something that is called SIC, which stands for Sepsis Induced Coagulopathy. So this means it is a coagulation of blood clot that’s induced by having a bloodborne infection. So scientists now know how the virus gets into our bodies, through a type of receptor and uncertain cells called ACE2 receptors. “ACE” stands for Angiotensin Converting Enzyme. And these type of cells I’ve found on lung cells. So no surprise COVID is primarily an upper respiratory airway disease. It’s found in the small intestine. So perhaps this can explain why some patients have gastrointestinal symptoms with this disease. It’s found in endothelial cells, meaning these are the lining cells of your blood vessels in the dyadic system.

So now we can see how this actually can attack the vascular system and lead to severe vascular events. And it’s found in smooth muscles in the brain. So no wonder people can develop neurological central member system symptoms as a result of this infection. Now I’m no expert on the complicated receptor cascade that regulates the inflammation and coagulation in the body. So I’ll just summarize it for you: it’s two types of receptors are known to activate cardio-protected or neuro-protected effects inside the body. Now, when COVID-19 infects us through ACE2 receptors, it depletes the receptors. Meaning whichever function that these receptors are supposed to do physiologically can no longer be accessed. So what this means is that our body is in a less, or more compromised cardio-protected in your particular state, leaving us one type of receptor to act unopposed thinking about Yin and Yang regulation.

So what is one activating? A swine type of receptor, ultimately results in cascades, sickening cascades, that activate genes that lead to inflammation, and coagulation, and even hypertension’s that embody. So, as the cognition is not bad enough, now you have high blood pressure – you’re more likely to cause a stroke, right? So it is because this virus has the taste for these two receptors that is supposed to be neuroprotective for us. But, as a consequence of these receptors being also found in the brain, it’s a double whammy. You are now set up for inflammatory and coagulatory disaster.

Now scientists are proposing different ideas of how this lead to damage to the brain. We now know that there is more inflammation in the body, because of the unopposed ACE1 cascades inside the body. But what that inflammation does, is that it can actually lead to damage, or breakdown of the blood brain barrier. So the bumping barrier is a very delicate piece of barrier inside our body. And if it is broken down because of inflammation, that spells doom. What happens is then the inflammatory cytokines in your body, now can cross the blood brain barrier, and reach the central nervous system. So it’s, it’s just bad on top of that. You may have heard about cytokine storms that happen in this patient is actually your body’s immune response. That is hyper immunity response towards the virus that is actually causing damage to tissues and organs that certainly can also affect the brain now ,because it’s got causing breakdown of the blood brain barrier.

So I think that’s really interesting information about the neuro-physiological mechanism. How this virus affects us and it gives us a epidemiological appreciation of how this disease can manifest in neurological ways. Now I’m going to share with you some of my ideas about how we can help these type of patients using areas in my research that I’ve done about the peripheral nervous system and the [inaudible 00:30:54] system. This is a map called a Brahman area map where the different processes of the brain had been compartmentalized based on different functions. I showed that here, just as a quick reference for you, because in my upcoming slides, I will be talking a little bit about some of these areas.

So one of the most common peripheral nervous system functions was Anosmia, which is loss of smell and Ageusia, or hypergeusia, which is loss of taste. So how can we possibly help patients with this? First of all, we need to say the [inaudible 00:31:38] nerve one, which is our olefactory nerve, is way deep inside the brain. It’s not accessible. And unfortunately the olfactory cortex is also not accessible. It’s not posting up to the surface in the brain for us to be able to affect it through scalp cap acupuncture. If you go back to the previous slide, you’ll see that olfactory is a dark orange. The dark orange is actually area 34.

Okay, so if you see this, this is actually in the midline. This is the lateral surface, this is the midline. So it’s actually on the inside of the temporal lobe. It’s not accessible, to too far in for acupuncture, [inaudible 00:32:11] . So what can we do? Fortunately, we have points that have been passed down that are supposed to have some effect on the nose and sense of smell. That’s over, located on the midline of the scalp. But let’s take a look at the new anatomy and see if it actually makes sense based on what we know about the new anatomy of the nerve supply for the nose. I want to talk about the anterior ethmoid nerve, which is actually from the opthalmic division V one of cranial nerve five. And, let’s take a look at that.

So, anterior ethmoid nerve, here’s the ganglion of the trigeminal nerve and there’s, there’s your V one, V two and V three. So as part of the V one, you have this nerve here that branches into the posterior ethmoid, anterior ethmoid, see how it goes and makes it a little hole in the foramen, in the back of the eyes. So from here, it goes into the cranial vault. I’m going to give you a different view at the next slide here.

So it comes out of these foramens over here and these nerves actually supply the meninges. So here’s the interior meningial branches and anterior ethmoid nerve, that supplies the meninges. But, because this cross section is horizontal, you don’t appreciate how high up this innovation goes. So this next picture shows you that the opthalmic division of V one and specifically the anterior ethmoid nerve, innovate this bony membrane called the falx cerebri along the midline.

And, it gives credence to the notion that these points that have been passed down to us, global area 20, all the way to 23, 24, which is on the midline, or which is innovated by the anterior ethmoid nerve, can possibly affect this nerve. So, what’s the big deal about affecting these nerves? Well, this anterior ethmoid nerve not only just innovates the meniges, these same nerves or branches now innovate the nasal cavity and septum. So as you can see here, the anterior ethmoid nerve, after it innovates the meninges up here, comes very close to the olfactory ball, by the way. So, we don’t currently don’t have permission to confirm this, but normally what we know about the nervous system, oftentimes there are communication branches that might be able to affect the cranial nerve of one olfactory nerve.

But, even if it doesn’t, this nerve, has an external branch that goes outside the [inaudible 00:34:59] of skin, but an internal branch that innovates the septum and also the nasal cavity. So this nerve gets information about the amount of mucus or dryness there is in the nasal cavity, and, presumably, your nervous system can regulate the amount of moisture in your cavity. And, we know that dry nose is related to, mucus member is needed, moisture is needed for fragrance particles to adhere, and therefore more likely for us to detect the smell. Perhaps by modifying the internal conditions of the nasal cavity, even though we’re not affecting the cranial nerve one directly, we are making it more favorable for the cranial nerve one to actually be able to detect smells and fragrances. I thought it was pretty crazy that these points that we learned on the anterior aspect of the midline of the scalp, to do with the nose, actually has hard cranial nerve-related explanations for how they can affect the nose.

Now, a couple of case. The gustatory cortex is something that is accessible. So, the gustatory cortex is actually Brodmann area 43. It’s a tiny, tiny little area, basically at the junction of the Sylvian fissure and the central sulcus. So you can see here, this part here is the central sulcus. So, anterior to that is a motor, posterior is a motor sensory. If you continue all the way down, where the motor sensory and the temporary lobe meets, that’s Brodmann area 43, which is the gustatory cortex.

And, based on the MRI research that I’ve done, and talked about it elsewhere, we have a chance to affect this area, but it requires a special needle technique, called a cross threading technique, where you would thread down from global area five and thread anteriorly from global area six, and that will allow you to cross intersect of over Brodmann area 43, which is a gustatory cortex. So if you’ve reviewed the vascularization of the middle cerebral artery, and with the parts that it affects, you can see why it would affect the taste, because that’s the gustatory area is part of the middle cerebral artery domain. And, therefore can explain why patients with COVID may have loss of taste, if they developed central nervous system type of symptoms.

Now, another way we can possibly affect the taste is using nerves called lingual nerves. And, these lingual nerves ara a branch of the mandibular division of the trigeminal nerve. So remember, the trigeminal nerve has three divisions, the mandibular is V3. Now, even though this is, strictly speaking again, a sensory nerve, it is not responsible for taste. In fact, the tastes of the anterior third of the tongue, as the comments here are written down for you, is supplied by the facial nerve. So, just sensation is supplied by the lingual nerve, but the taste, special sense taste, it’s essentially beneficial there. However, the facial nerve relies on the lingual nerve to convey its nerve fibers back to the brain. So, this is the reason why patients who have damage in the lingual nerve, either due to dental procedures and whatnot, can oftentimes cause them to feel like there’s a metallic taste in their mouth, or a foreign taste, or a lack of ability to taste.

And, so fortunately for us, we have acupuncture points located right below the tongue to affect these lingual nerves, and that’s the extra points Gingy [inaudible 00:39:01] . So, puncturing these points, even though it doesn’t affect the special sense directly, it provides conveyance of the special sense nerve fibers back to the brain, which might be able to help to receive more signal about taste to the brain. Now, early on, patient people also published ocular motor dysfunctions associated with patients who have COVID-19. Two different research groups have presented information how these patients may develop ocular motility deficits or ocular motor palsies. And, even though the case number is not very high at this point, again, you’ve got to think about this. People who present with either of the issues, and if they’re asymptomatic, are not going to be sent to isolation or sent to the infectious diseases.

They’re going to be going to the neurologist, or even in this case, ophthalmologist. By the way, the first doctor in China who blew the alarm on the COVID-19 was an Asian ophthalmologist. So, don’t let the fact that these cases don’t seem very high dissuade you, because it might simply be a case of lack of reporting. So in any case, how may we as acupuncturists help patients who are suffering Oculomotor Palsy, possibly as a consequence of having neurological dysfunctions from COVID infections?

I need to briefly introduce you to something called a frontal eye field. The frontal eye field, we talk of the Brodmann areas, right? It’s located in Brodmann area 6, so you can have a look at that in the map in a moment. And what happens is that this part of the brain is responsible for controlling rapid changes in your eyes in the left and right direction. It’s called saccadic movements. So patients who have dysfunction in this areas of the brain, affecting this area of the brain, may manifest inability to have rapid eye movements. This is also called contralateral horizontal conjugate gaze palsy. So if you recall, the American paper show you the five different patient cases. One of the symptoms that they had was gaze preference. Okay? It’s because they are lacking the ability to see both sides so they have a preference for one side.

Now, how does this affect the parts of the brain that actually controls cranial nerves III, IV, and VI, that actually is responsible for the eye movement? Based on tractology or connectivity studies, neurologists have found that the frontal eye field actually makes connections with the midbrain, where these cranial nerves can make the eyes form.

So again, these midbrain structures and cranial nerves are too deep for us to get affect directly. But pressed indirectly through the cortical connections, neurocortical connections, we can have a fighting chance to affect ocular motor systems. I’m going to show you my research about this. You’re looking at the correspondence of the scalp and the cortex, specifically operators 16. And I was really cool about this and I love the chorus, but that when, when the Eastern West converged gallbladder 16 in Chinese is more strong. It means I window. Hello? The name is telling you that this point can do with the vision and that it actually correspond to frontal eye field, based on modern research, is just too good to be true. So where is this specific to this front IFU in humans? A lot of research in animals suggest that it’s in Brodmann eight, but we now know that’s incorrect.

It’s in problem in six. And so where is that? If you look at the yellow data line, it’s where the superior frontal sulcus meets the precentral sulcus. So here’s the central sulcus, okay. Where we divide the motor sensory and there’s an OMP. So, and then you have the premotor area or the pieces of gyrus right in front of that, it’s called a precentral sulcus where the precentral sulcus meets the superior frontal sulcus. This is superior frontal sulcus there. This one over here look other broken is the inferior frontal sulcus. So in a case where the front end superior from this office meets the precentral sulcus. Now the bird side view superior frontal sulcus meets the precentral sulcus. This area is where Brodmann six or prefrontal sorry the frontal eye field is located. And we have a point called LAR 16, which is just right in this area. If you thread it, if you’re familiar, scalp acupuncture along the Meridian, you will cover this area beautifully. And therefore you will be able to affect from the eye field and affect ibogaine and movements.

I’m going to just finish up with a case that I recently saw of a showcase. I tongue in cheek, call it the case of shotgun at time of Corona. And this was an 86 year old male patient who in early April, he, he and his family cannot be exactly sure exactly. When, where he started have developed slurred speech. Now he has the risk factors such as hypertension, diabetes, mellitus, and other non directly related symptoms. And nursing does comorbidities such as them freaking urination as a result of enlarged prostate. He’s had a history of Bell’s Palsy in his forties. Now several weeks before he had a stroke, he has some poor sleep. So it’s not sure whether that sleep was related to that’s just a coincidence or related to poor sleep having caused hypertension poorly managed by any case, he was admitted to the hospital for one night.

And because of symptoms was start to already showing signs of very fortunate men or already showing signs of improvement. He was discharged the next day. And, and which is atypical should typically, when you have a symptom of stroke, you are in the hospital for very longer. Not sure this is change in policies is dependent on the fact that there’s some lack of resources and the staffing during this time of COVID that the patient, since it was not life threatening was sent back home, by any case in addition to star specie also presented with left sided arm and leg paresis, and he felt extremely tired. I remember one of the symptoms, one of the only symptoms that, one of the five Americans that had the show with just lethargy, right? There’s no other covert, listen to this, man didn’t have any respiratory problems’ fever and such, but it doesn’t mean he’s not positive.

And for all the research that we’ve seen so far and the family noticed that ever since having a stroke is, can seem to have Mark and the aged. And, is just complaining about tiring all the time. He has a dark tongue okay a dark purple tongue [inaudible 00:46:46] that we talked about things like coral coding, which means a lot of phlegm cold phlegm inside of the body, which is we know cold, also contributes to [inaudible 00:46:58], right? So the pictures are triangulating quite nicely, unfortunately this is actually a family friend of my receptionist, and because the clinics closed due to mandating to be closed because of public health policies, he’s unable to make an acupuncture appointment with me or with anybody.

So it wasn’t until we will reopen on June 2nd, he was able to get his appointment. And so on the very first day that I was back on June 6th, he saw me for acupuncture and to date, we’ve had four sessions so far, and I’m happy to say that the results have been quite favorable after one treatment he said that his left leg, which is the afflictive site actually now feel stronger than in his right side. Okay. So patients, maybe there’s a little bit of a, a good patient and practice rapport there, maybe a little bit of psychological effect, but Hey, I’ll take it. And, but so far there’s no change in the arm strength just yet, which is actually expected those of us that have experience doing neuro rehab know that arm loss of function or paralysis is harder to regain than leg paralysis. But by the end of the fourth session, patient Ashley left the treatment room without taking or, quote unquote, needing his cane. So presumably that is indicative that his legs felt so strong that he forgot that he needed the cane.

So, that’s the latest case I can share with you all. I don’t know for certain that it is a case of COVID, but I’m using extreme PPE precautions, and I am suggesting that this case should go get tested despite being asymptomatic. So I thank you very much for your attention. And if you have any questions, just message me. If you like this presentation, don’t forget to tell your colleagues, don’t forget to let others know about it. And if you enjoyed it, show us some love. Thank you very much.

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Dr. Virginia Doran

AAC-Beyond Heart 7: Alternative Approaches to Insomnia Repair

Click here to download the transcript.  Click here to download the slides.

Hi, I’m Virginia Doran, your host for another edition of, To The Point. Very generously produced by the American Acupuncture Council. Today, my guest is Daniel Bernstein. He’s been a licensed acupuncturist in New York city since 1995, and around 2008, he started specializing in insomnia. And this year, 2020, he came out with a book called, Rewired for Sleep: The 28-Day Insomnia Repair Program. And he’s soon also to release a book dedicated to practitioners called, something like beyond hard seven alternate strategies for treating insomnia.

I think you’ll find it very interesting, and it’s something if you don’t have yourself, certainly some of your patients do, especially at this time. So Dan, please welcome, and tell us about your approaches to insomnia, because I know it goes beyond just TCM. Tell us what you think as practitioners we ought to know.

Great. Thank you so much, Virginia. I really appreciate you inviting me to share what I have gathered over the years. And thanks also to the American Acupuncture Council for setting this all up. It’s a great service that you all do. And yes, I’m Daniel Bernstein. I’ve been a licensed acupuncturist since 1995. I have a practice Blue Phoenix Wellness in New York city. And again for the last 12 years or so, I’ve been focusing on sleep and sleep related issues. In February of this year, I was pleased to release a book and I’m going to bring it up, here it is. It’s called, Rewired for Sleep: The 28-Day Insomnia Repair Program.

I’m just going to go to this quote here, which is, “Put your thoughts to sleep, do not let them cast a shadow over the moon of your heart. Let go of thinking.” And I love this quote by the Persian poet Rumi, because, as someone who’s patients are often caught in the crossfire of self-talk when they’re trying to sleep, this quote sings to me, it has an elegance to it that calms my heart down and puts me almost into a meditative state as it is. So I’m going to go on here. Let’s go to the slides please.

And I’m assuming we’re at the slides. So that’s the quote I was talking about, “Put your thoughts to sleep, do not let them cast a shadow over the moon of your heart. Let go of thinking.” Today’s goals are going to be pretty simple. We’re going to talk about the importance of sleep, why healthy sleep matters, treating insomnia, an overview. We’re going to talk about a case history. I’m going to talk about mind traps, is what I call them. And then I’m going to show you all a simple exercise that I show to my patients who have a hard time sleeping.

So, how sleep has changed. This healthy sleep means sleeping eight hours nonstop. And in my first go around with the book, I wanted to do a comprehensive, even exhaustive book on treating sleep issues, including acupuncture strategies, herbs. And instead I wrote a book that was targeted for the lay person, but that acupuncturists can use as a template for helping their patients get a good night’s sleep. Now I’m working on the second one.

And while I was doing research for that book, I began to question what healthy sleep is? Among the ideas that we take for granted right now, is a belief that in order to be fully rested, we’re supposed to sleep continuously for seven and a half, eight, eight and a half hours a night. But this idea that we’re supposed to sleep continuously is really a recent one. And it’s a construct of the industrial revolution. It wasn’t until a vast numbers of people had a report for work at eight o’clock in the morning, that the idea of sleeping eight hours through the night even existed.

You see before that, what was common, was people had first sleep and second sleep. Okay? And in that more natural cycle, a person might wake up at one o’clock in the morning or two or 2:30, and use that in between time, they’d get up and they might feel feed livestock. They might talk, they might meditate. They might eat something and then gently and easily go back to sleep. So this recent idea that we need eight hours continuously and that anything else is frankly wrong, implies that if our sleep patterns stray from the norm, we’re somehow failing at sleep, okay.

Now what that does is, it creates an immediate anxiety. If I wake up 2:30 in the morning, and I think I’m supposed to be sleeping, kicks in some cortisol. It feels like I just drank two cups of espresso and I’m off to the races. So one of the things I tell my patients is, it’s okay if you wake up. In fact, you can just say to yourself, it’s okay if I don’t sleep, you can get up and you can rummage around for 10, 15 minutes. I tell them that they can actually, just do a little odds and ends and then naturally and easily go back to sleep.

When did they start saying that it didn’t have to be uninterrupted?

When did they say that it had to be interrupted? You’re saying.

I hadn’t heard that before, that it doesn’t matter. I know in certain cultures, people have their siesta, you traditionally have a nap in the afternoon and therefore you’re…

Right. So, you’re asking, when did people say that?

Yeah, I just wondered, where you’ve seen that as a resource or if that’s a standard.

That it need not be eight hours you’re saying?

Or that it need not be uninterrupted.

Well, as I said, historically, it has been such that people did not necessarily need eight hours sleep. That uninterruptedly, it was common. My resource was the New York times. And it is talked about by Cervantes and Don Quixote, where he talks about Pancho, censor, all eight hours in without problem. But he would get up in the middle of the night and rummage around and then go back to sleep. So it’s part of the historical norm. Certainly people who worked in farms and such would understand that it was all part of the larger cycle. Does that answer the question?

Yeah. Can people go into deeper levels of sleep if they are sleeping for shorter periods at a time?

Well, an hour and a half is typically a REM cycle, typical four stage cycle. So if you’re sleeping three hours, then you’ve completed two stages and then you can go back and sleep another two or even three cycles. So yes, as long as you’re working within an hour and a half cycle of the REM cycle, you’re good. It’s just, it’s something people don’t get enough of those cycles in. So in other words, for them, they might get only two cycles in. And so they’re feeling depleted.

I have another question. Are you a proponent of people taking naps? Because some people seem to believe in it. Some their bodies just don’t really work that way. They feel better, not taking naps, some people it’s-

Sure. I am a proponent of somebody knowing their body enough to know what works. I know I’ve had gotten some patients who came from a Cognitive Behavioral Therapy or CBT, which often uses restrictive sleep, not allowing naps, making sure people get in bed a particular hour and out of bed at a particular hour as a way of retraining the body. I’m not a fan of that. But as for naps, I think everybody’s just different. And the body changes. Some people can never take naps, and then 20 years later, all of a sudden they nap beautifully. So, we’re capable of changing our circadian rhythms in that way.

So, and we’re talking about circadian rhythms, they’ve been thrown off by artificial lighting, of course street lights were boon to society and culture, but they also meshed with the pineal gland. And suddenly we were no longer going to sleep at dusk and waking up at dawn. So that was totally out of the window. So that on top of recently, having our iPhones, our tablets, our computers at night, adds another layer of messing with the pineal gland.

So these things have really tended to mess with that most curious organ, the brain. Some sleep facts. Okay. So 44% of Americans report having insomnia, for half of them, the conditions chronic. That’s an interesting thing, because half the people with sleep issues have slept poorly for a long time. They’ve tried every drug under the sun, they’ve done sleep nitrous, they still can’t sleep. Whereas the other half, the acute insomnia sufferers, for them it’s more situational. Okay. Maybe a loss of a job, the death of a loved one, too much responsibility and it’s situational.

And the good news for them is that, it’s easier for them to go back to normal sleep, usually, sometimes not. Over 9 million Americans are addicted to sleep aids. That’s an incredible number. And the tragedy is that most doctors, almost every patient I’ve ever had, I asked them, did your doctor tell you that after 21 days you would be addicted? And to a person, they said no, but that is the simple fact that, after 21 days a person’s, whether it’s Lexapro, Ambien, any of those drugs that are used for sleep, then the person then has to get off that drug, and they are no longer on top of that.

I asked doctors, are sleep aids, risk restorative? Do they actually help the person recuperate? Usually I got a blank stare or a shrug shoulders. It was like, I don’t know. What we do know is that sleep aids, do not take a person past stage two. So this gets us into talking about the stages of sleep. Okay. So stage one is basically, the drowsiness you feel when you’re about to or you’re watching TV. Stage two is like a power nap. Stage three is where all the action is. The restorative stage of sleep, or our brain waves are slow, your body’s busy fortifying your immune system. You’re building tissue and preparing your body for the next day.

This is where also you can add muscle mass. If you’re reaching level three, then the body can add muscle mass. Stage four is REM sleep. This plays an integral part in processing, learning, and memory. And also as a response to stress. So given the stress levels we’ve got these days, it’s a wonderful thing when we get to dreaming. Personally, I think melaton gets a bad rep. Sometimes people talk about job, all these lucid dreams.

And it’s like, yeah, that means you’re actually getting to REM sleep. That’s a good thing. So if you can handle it, I’m not a proponent of knowledge on it, but I also don’t knock it, because a lot of people do. So acupuncture and herbs and self care are bridges to healthy sleep. So that is the response. I wanted to put this in here, it’s maybe a little self serving, but it’s regards to what’s going on with COVID right now.

Okay. This is a quote from Dr. Matthew Walker, author of, why we sleep. “Natural killer cells are critical components of the body’s immune system response, serving as the first line of defense against cancer cells, microbes, and other potential threats. A single night of poor sleep can impair natural killer cells activity by as much as 70%. In the short term, this can put us at risk for developing acute illnesses colds and flu, but in the longterm, it increases our risk for much more serious threats.” And so this is where I say, make sleep a really important part of your practice, because we’re doing so much more than just helping people sleep, we’re really, not only we are increasing their metabolism, we’re really helping their immune system.

That right now is so crucial. And the opposite is well, what happens with lack of nourishing sleep? Well, depression, anxiety, diminished learning, diminished immune system, toxins remain in the body. Nutrients, not going to their intended muscles, an increase in hormones that break down muscle. I believe that’s the catabolic hormones and an increase in the hormones that make us want to eat, which I guess are gremlin. We call it gremlins, but I know it’s not. So treatment strategies. Oops.

I have a question Dan.

Yes.

You miss some sleep, say, normally you get seven, eight hours sleep. And then because of whatever reason, it may not even be insomnia, it might be travel or whatever, you get four or five hours sleep. Can you make up those hours or is that the little bit of damage to the body that can’t be redone?

I think it’s an interesting question, because science tells us, no, you cannot make up that sleep. That is what sleep scientists tell us. But I think it is a two dimensional way of looking at it, because somebody who’s really not taking care of themselves and they lose those eight hours, that’s going to mess them up. However, somebody is really doing self care, perhaps they’re meditating, maybe doing two gong, maybe eating, well, it sort of gets, I would say, absorbed in the greater good. So, theoretically, technically, no, but that’s a soft no. And I would say that if we’re taking care of ourselves, then it’s not a big deal.

So, getting 10 hours the next night, won’t…

That’s what they tell us. That’s what science tells us. They may find something else out next year, but I don’t worry about it. I’ve certainly lost a lot of sleep, I take. So maybe it’s just deluding myself, but I’d to believe that it all comes out in the wash as long as we’re doing self care.

How did you get into focusing on insomnia or sleep patterns?

Sure. Well, briefly, I had my own sleep issues. I went through a bunch of stuff around 1990, that put me on high anxiety, insomnia, and I went to acupuncture and it helped a lot. There was insomnia in my family, and it took me years to really see that, that I often would wake up in the morning and my mother would be in the dining room, finishing a dress that she’d spent all night working on. And so, it was a pattern of insomnia there in my family and I saw it up close. And so I do believe that, it’s a cliche almost to say, the work we do sometimes as healing our own wounds.

I think there’s a certain truth to that. And whether that is true for me or not, I don’t know, but I do find it interesting going back over many years and seeing that it was something that used to be… It would make me feel weird, because on one hand, you had this very productive mom and she’d make this dress, on the other hand, part of me was like, my God, she’s been up all night and that can’t feel too good. So whether it plays into it, I don’t know, but I think it is interesting.

So, treatment strategies. Over the longer term, helping patients sleep and to be participants in that sleeping process brings greater than success than nearly, and I won’t say merely acupuncture and herbs, because we can definitely get people sleeping again. But as we all know, we go in and out of balance, okay. It’s part of the human condition. And so as we go out of balance, people then start sleeping, not so well again.

And so in my treatment practice, I like to teach them simple stuff, diaphragmatic breathing, what can be better than just teaching somebody who breathes from their chest, to start breathing from their belly? That’s like 50% of everything, right? If they’re open to it, Qi Gong, use of magnets and Japanese tiger warmers. I have that in my book, acupressure, Yintang, Anmian, kidney one, pericardium six, kidney six, the standard sleep points.

And I just tell them to just either use the moxa with tiger warmer or acupressure. At the end, I have complimentary tools for self repair, including an exercise I’ll get into later called the five, five and five. This is Yogi. This is my nemesis. He’s my cat. And essentially he’s also, his attitude is the way most of my patients look when I first suggest that they can actually start taking care of themselves. So I thought, I think we all have patients like Yogi.

And cats have problems with insomnia.

Definitely strange. They definitely have oddball sleep issues. And the beautiful thing about when I work with patients, is if they go for it, when I first suggest they can actually help themselves, the beautiful part is that, if they do, they start getting a sense that they’re not victims, okay. It opens up all sorts of possibilities for that person. I mean, they’re going from, I’m doomed to, what can I do next? Maybe I can quit smoking. Maybe I can lose those 10 pounds. Let’s work on those things too.

And it’s my belief that the more aware our patients are, that they have this ability, the more they see the value of the subtle, yet powerful work that we do. So I don’t believe it’s like, well, they won’t need us later if they’re able to help themselves. No, that means that they will, instead of being 3% of the populous coming to acupuncture, it will be 30% or 50%. And I think it does help to help people, help themselves. Thank you, Yogi. So insomnia is not a disease, it’s a symptom, treat the root and that’s the theme for today.

We know that Western diagnosis tells us a little, and we also know that the main organ systems involved in Chinese medicine or the heart and the liver to a lesser degree, the kidney, the spleen, and perhaps the gallbladder. Okay. And often we see mixed pathologies, perhaps heart yin deficiency with Liberace stagnation. And so we treat those things that we see, and they’re all incredibly valuable.

I would suggest that before we treat what we see, when it comes to sleep, a root treatment is really important. And so unless, we treat the deeper energetic issue involved, the patient will have a much harder, getting better. So some of the root treatments are five elements, eight extraordinary vessels. I call it Kiiko style. Okay. I studied, as did Virginia. We both studied with Kiiko Matsumoto, and she does a lot of root treatments, adrenal deficiency, sympathetic dominance, blood stagnation, all of it is root treatments and then going on to symptom based treatments.

I believe that Dr. Tan’s balanced style is really a combination, as some others are calling doctor, master Tong as well, are a combination root and branch treatments, because they’re rooted in the i-ching and in the five elements. So, treating the extraordinary vessels. And by the way, give me five minutes, if I’m getting dangerously close to going over my 20. So a quote from the Nan Jing, and it talks about the extraordinary vessels being a root treatment. And the ones that are most involved with sleep are Yin and Yang Qiao and the Yin Wei.

The Qiao’s are involved with opening and closing the eyes. And this gets into, it’s not how many hours we sleep, but how rested we are when we wake up. I get people who sleep eight hours and are exhausted. They tell me, I feel I just ran a 10K, while I was sleeping and other people sleep four hours and feel incredible. So it’s clearly not always about time, the distinction is one that’s made clear by Dr. Hamid Montakab in his book, acupuncture for sleep.

He talks about differentiating the quality of sleep versus the quantity of sleep. And we can use the extraordinary vessels as regulators of that sleep. So if it’s an issue of the person, simply not being able to sleep enough, not being able to keep their eyes closed, either theoretically or metaphorically, or literally it tends to be a Qiao issue. And what we want to do, is we may palpate kidney eight, which is the Xi-Cleft or the Qiao. And if it’s tender and everything lines up, then we may treat the Qiao. We may drain UB-62, tonify Yin Qiao.

We may add points to that, since it’s around the kidneys, kidney 27 points, along the kidney channel. However, if there’s more an emotional issue and perhaps a person’s exhausted, emotionally wrung out, they’re anxious, depressed, lethargic. These are all symptoms that the Nan Jing refers to in talking about Wei issues. So, that’s an issue of depth, meaning they’re not sleeping deeply enough. And so, we look to the ways.

And so the way that we look at that is we may palpate kidney nine, which is the Xi-Cleft of the Wei channel, the Yin Wei. And if that’s tender and we look to which one is the most tender, is it the right or left? We needle that, and then we continue treating the Wei channel. So the opening point of the Yin Wei, pericardium six, and we couple that with spleen four. Again, I talk here about, verifying that Yin Wei is the correct treatment, aside from the fact that they’re typically depleted, depressed, wrung out.

Certainly Dr. Manaca used to use the Wei to start a treatment almost constantly. If you read, chasing the Dragon’s tail, he used the Yin Wei a whole lot. So then we may needle PC-6 and spleen four bilaterally, and this is the root treatment, let the patient rest for 15 minutes. At that point, we may expand the treatment in modular fashion. Some people believe in just letting the entire treatment be the root treatment and that’s okay. Certainly it’s the five elements, we see that whether an aggressive energy treatment or external dragons, that treatment is a full treatment in their root treatment.

I have no problem with that. I typically check the pulses and, go from there. What else did I want to say about that? Yeah, I always found it interesting. Let me go back to this, excuse me, considering that the heart is the emperor, I always thought it odd that why is it that there is not a heart point on the extraordinary vessels? You’d think that that would be, top of the list there. And so I went back and I see that a lot of Japanese acupuncturists do not treat the heart typically, they will go to the pericardium and protector of the heart, and certainly points along the pericardium are crucial for sleep, anxiety, palpitations, heat, all the heart stuff.

So for me, opening the Yin Wei, is such a powerful way to begin treating someone who’s having those issues. So let me continue here to, Marianne, this is a case for Yin Wei and Buddha triangle. 38 year old woman, complained of waking up during the night, agitated, palpitations, feeling heat, et cetera. My voice is going. So I’m going to keep it simple. As you can see, those are the fairly often seen pulse tongue, palpatian issues that lead us to believe that it’s a fire and water disharmony, repletion above, vacuity below. Water is not nourishing heart.

So there’s heat above. And so one option is more of, I’ll call it a TCM style. Certainly it’s a wonderful treatment, heart seven, heart six, which does clear heat. Pericardium seven for palpitations and insomnia. Yin Tang, which is a great sleep point, CV-17, heart, et cetera, et cetera. So it’s a terrific treatment. My tendency is, if I were to go that route, I might start with a year, Yin Wei or another would treatment and then go to that. Option two, go to the root treatment, open the Yin Wei, followed by Buddha’s triangle.

So, we start on the dominant hand, pericardium six on the opposite foot, spleen four. Now what I would do often, is expand that to Buddha’s triangle. So I might start first with just the two points, and then I’d expanded to pericardium six, heart seven and long nine, which is also a root treatment. However, I don’t think you can go wrong with it. And then I would add contra-laterally. Some people believe in just those three points and they make a perfect triangle on the wrist. I to add liver four, spleen six and kidney three contra-laterally.

And that is a beautiful treatment. It really handles insomnia, anxiety, palpitations, dream disturbed sleep, and it’s a full treatment. Another one since I promised that I would give them tan treatment, I’m just going to add another one for Fir-Water disharmony, that comes from the playbook of the balance method, Dr. Tan, which is a Shao Yin/Shao Yang treatment. And this goes to heart three and heart seven on the right, gallbladder 34 and 41. And then the left side, we’re treating kidney three and kidney 10 and triple burner three and triple burner 10.

And I’ve used this and it’s a good treatment. It’s an effective treatment. You have to keep doing it. You really need to see the patient for this. You need to see patient like twice a week. It’s true for all. I mean sleep is not an easy fix. Okay. I like to joke that since Sim Yao talked about, that he’d rather treat 10 men than one woman, because of the plumbing. And I to say that as he was leaving, he muttered that I’d rather treat 10 women than one insomnia patient, because they’re paying him my gallbladder 30. I don’t know if that’s true or not, but we move on.

Where does triangle protocol come from?

I think it’s part of the five elements universe, that is where I saw it originally and I couldn’t swear to it. So I hope a lot of 5E people don’t bite me on the neck for claiming it’s part of them. But I do use it as part of that, because I do believe it’s a beautiful… To me it’s a crossover between five element and balance method, it’s got a lot of stuff going for it. I didn’t get into it, but I also will add to that, sometimes again, contra-laterally, Yang points to those two, right hand, left foot. I will add, typical as to Richard Tan, I’ll do a right foot, Yang points, left hand Yang points, depending on the secondary stuff that needs to be treated.

So, herb formula for Marianne would be, Tian Wang Bu Xin Dan. Okay. That is typically for people with heart and kidney issues that wakes them up, their palpitations. They can’t sleep, they have heat issues. And just to differentiate that, let’s say from something that’s just more kidney, like Jo bi di wang wang, that’s more kidney or something that is more blood based. That would be Suan Zao Ren Tang. The Suan Zao Ren Tang is terrific, because it also addresses heat issues. But again, it’s more blood rather than Yin deficiency, which I think Marianne was presenting with.

Again, some food cures, asparagus, chicken egg, wheat, if you want to go the Chinese formula style, banana, bamboo shoot, these are all for Yin deficiency. And then finally I gave Marianne some homework. In this case, it was the five, five and five exercise. Before we get to it. Actually, I’m just going to skip it over, we may be running out of time. Yes. Or how are we doing?

I think they’re pretty self explanatory those.

Yes. Okay. So basically I treat the sleep-disordered mind a lot, and it falls into those five categories, distractions, daily regrets, real life problems, overwhelms, things I didn’t do yesterday and things I won’t be able to get done tomorrow. And then finally disconnecting from phone, computer and TV. So one of the treatments that I like to do is, and it’s so simple. It’s called the five, five and five. Okay. It helps unwind the sympathetic nervous system and it takes 15 minutes. Okay.

Basically for five minutes I have the person write down regrets, resentments fears, overwhelms clogging their mind, all this stuff that we typically start churning at night. We’re great during the day, but when we close our eyes, they start unfolding. So I tell them, spend five minutes and no more, then fold the paper, place it aside and say, out loud. “These are tomorrow’s problems.” For five minutes, close the eyes and gently massage Yintang, whatever you wish to do. I like Yintang. And at the same time, I’d tell the person, imagine that you’re in a garden, a rain forest, someplace where you feel safe, it could be in your little den.

And then for the last five minutes, I tell them to become mindful of breath. And so these are ways that we open them up to the idea of meditation without having to call it meditation. So just follow the path of your breath with your mind, down into your lungs, back up through your nostrils and just keep doing that for five minutes. And so these are, I feel stress free ways of getting someone to begin the process of unwinding the sympathetic nervous system and engaging their parasympathetic nerve system at night.

And then finally, I use something called autogenic training, and it was invented by a German cardiologists in 1931, who frankly was tired of seeing his patients dying. So he invented a calming technique that would reduce their levels of stress. It’s an eight week program. And it really helped in the way that no other Western method had, using a version of a progressive muscle relaxation.

And so I have that on my website, which is rewiredforsleep.com. If you go to the Explorer page, you’ll see that, and I think three other recordings, that’s all free to listen to. And well, I mentioned before the exercise and rewired to give for the sleep disorder, I think any acupuncturist wanting to provide their patients with tools to combat insomnia, anxiety, stress, and PTSD can really benefit from it as well for their patients and for themselves.

Have I missed anything? So, finally, I have already popped my little book. I’ll do it one more time. Rewired for Sleep: The 28-Day Insomnia Repair Program. It’s available on Amazon in both digital and paper. And if you’d to know when the next book is coming out, please feel free to email me at daniel@bluephoenixwellness.com. I’m going to say one last, thank you to American Acupuncture Council and to Virginia for allowing me to visit and give my little talk. Thanks again.

Thanks Dan. It was really lovely having you and I’m sure people will get a lot of benefit from this book, practitioners and patients.

Thank you. Thanks.

All right, so we’ll see you all soon. Thanks for tuning in, again, I’m Virginia Doran, luminousbeauty.com , and sayonara.

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