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MENOPAUSE – The Treatment of Hot Flashes in Women

And today I’ll talk on a very unique topic of menopause, on hot flashes, but in a very, I can say, different way, or I would like to highlight different points of how we treat and the potential of treatment of acupuncture.

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

Hello everybody. I’m Dr. Yair Maimon, and I would like, first of all to thank the American Acupuncture Council for putting up this presentation. And today I’ll talk on a very unique topic on of menopause, on hot flashes, but in a very, I can say, different way, or I would like to highlight different points of how we treat and the potential of treatment of acupuncture.

For menopause and especially for hot blood, hot flashes. So let’s put up the slides first. Menopause. It’s to do with transformation. Al always, it’s a time of changes for women. It’s a transformation. And when we talk in Chinese medicine of transformation, it’s always something to do within any yang.

It’s always rooted in this constant transformation of matter into energy and energy into matter. Or we’ll talk about transformation of. And let’s look a little bit about the uniqueness of the way in Chinese medicine, the uru, the womb is understood. If you look at chapter 47 and chapter 33 the simple questions, you’ll see that the UREs is connected on one side with the bowel Ma, with UREs vessel to the heart, and on the other side with the bowel duress channel to the kidneys.

So immediately the UREs is between two very specific organs, the heart and the kidneys. And as the heart and the kidneys will present the water and. Or again, if we go deeper, we can say Matter and energy. And the UREs is a place of creation and of birth between fire and water, or between earth and heaven.

And fire and heart are connected to the she to the spirit, and the kidneys are connected to the jing and the meaning of these two phenomenas, the meeting of Ian Yang are creating. New life, a new possibility of life. So Duru in this way is perceived in a very deep way of connecting heaven, an earth of connecting the heart and the kidneys, and It’s very much related to the earth in Chinese medicine, but also to this two organs which are heart and kidney.

And it means also when we are utilizing acupuncture points, and especially later when we look at some research on hot flashes. So there’ll be some points related to the heart. Like heart seven, the low point of the heart, peric heart seven. And if you look at the kidneys blood at 23, that tonifies the kidney, Kidney three, which is the again, the source points, the un point of the kidney.

So we see all this un points of the. Perricone heart and kidneys and splint six, which is more related to the earth where all the in channels are crossing, and again, has a very closed link to the lower jaw and to dure. So this actually took this points. It’s very common pins, but they’re also been used in research, which I would like later to present, but.

This is another way to show the logic of Chinese medicine, of connecting the fire and the water, the heart and the kidney, and enhancing the, and reducing also side effects of menopausal changes. So menopause, it’s always this movement of transformation of in and young. And we know the cycling woman of every seven years of the cycle in around 49 is the menopause time.

By the way, the premenopause starts much earlier. So many symptoms can be much earlier than the menopause itself. In this lecture, I’m not going to talk on the, about the natural kind of menopausal symptoms and occurrence of symptoms, but more on menopausal symptoms and especially hot flashes which are occurring due to anti hormonal medicine.

Anti hormonal medicine is given. To women who had cancer, and especially cancer, which is sensitive. There is receptors on the cancer cells themselves, which are sensitive to estrogen. And then the treatment is anti-estrogen treatment, especially in different cancers, either gynecological cancer in very common breast.

So endocrine therapy in western medicine applies this anti hormonal medicine, and because the tumors that are hormone related, the, if there is more presence of hormones in the body, there is more tumor growth. So this is the very common, as a saying, breast cancer and in several gynecological cancer.

There’s two major ways of an of endocrine treatment. One is to block the receptors on the cells themself to estrogen. The other one is to stop the production of estrogen. This is a very common treatments like tamoxifen. If you see on the cells, there’s the receptors for estrogen. And the tamoxifen mimic or has affinity in binds to the surface of the cell and therefore the estrogen cannot bind to it and therefore start the growth of especially mutated cancer cells.

So this is the kind of competition idea. It binds to the receptors in the cells, so the oxen and the other one is aromatase inhibitors. The estrogens in order to become estrogen, they’re going through different pathway of changes. One of them is the aromats and when DITs is inhibit, then there’s no production of estrogen.

There’s different ways to block the production of estrogen. This is the very common one with aromatase inhibitor. The bottom line is very similar, is producing in women who are taking anti hormonal medicine. Many side effects of menopause due to this medicines. There’s many common side effects for women who are receiving endocrine therapy.

I, I s. Put here the most common one, like fatigue, hot flashes is a big one. Mood swing, insomnia, sometimes even disturbance in concentration and depression. And there is a whole list of symptoms of menopausal symptoms, which are reduced by the endocrine therapy. This medicines are taken for long time, five years, sometimes for 10.

And many women stop almost 30% are stopping. Sometimes the treatment, even though it can be very useful for them because of the side effects, but acupuncture, Has been shown and there is evidence that it’s extremely effective treatment to reduce side effects, especially hot flashes and joint pain.

In this presentation, I want to talk a little bit about the evidence that we have for acupuncture, reducing the hot flashes, but also enhancing general better wellbeing in this woman. One of the early studies, but still I think one of the very Inspiring studies was head to head study. Women breast cancer women are taking anti hormonal medicine.

Were divided into group two groups. One was receiving acupuncture and the other one was receiving venlafaxine, which is like s nri. It’s really, it’s a light antidepressant drug, but it has also the it reduces also hot flashes, so it’s commonly used also for hot flash. And they measured the outcome.

They gave a certain 12 weeks of treatment. Then the treatment stops both the. Hormonal. They, I had avela vaccine, so both the medicine and the acupuncture was stopped after 12 weeks. After three months, the women didn’t receive any other treatment, and then they looked at the outcome even one year later.

And the acupuncture group did extremely well and the. Obviously you’ll see the Venlo vaccine. As you stop the, as the women stop the medicine the effect was quite immediately reduced and hot flashes were back. You’re welcome to read the full study. I’m just giving some highlights.

So as the results, you can see that both group exhibits significant decrease in hot flashes, depressive symptoms, and other quality of life symptoms. But in the acupuncture group it was the same for the acupuncture in the Vela vaccine. But by two weeks after stopping the treatments, the Vela vaccine group had significant increase in hot flashes where the hot flashes in the acupuncture group remained very low.

So this is very important because we are showing the effect of acupuncture. As a, something that enhances the ability of the body to, to bring itself back to balance. So we are really talking about the quality of the healing qualities of acupuncture which is lacking when you treat sometimes symptomatically, like in this.

And also in the Vela vaccine, it’s also very commonly known as Vix had many adverse effects. There was those in dry mouse dizziness and anxiety with acupuncture group. The opposite. There was no negative effect, but actually there was some additional benefit, even increasing sex drive in some women. And most of them reported improvement in their energy, clarity of thoughts and sense of wellbeing.

So the acupuncture group, No side effects is opposite. Had other benefits comparing to the group that took the vela vaccine? So in conclusion to this research, the acupuncture appears to be equivalent drug to therapy in this patients. But it is safe, effective, it’s a durable for vaso matter.

Vasomotor is this hotline, flashes and secondary for long term is also. Long term use of estrogen and anti hermon estrogen use. The points that they used in this research were quite interesting. So the main points you can see, and I mentioned them before, was bladder 23, kidney three in spleen six. So strengthening the kidney and in enhanced also the all the in channels and the spleen.

And this is the point that. All of the practitioner news, and then there were secondary points that can be a according to TM diagnosis. So the practitioners had some kind of freedom to choose which points are the most beneficial for the patient so they could do a diagnosis, Chinese medicine diagnosis and be more.

Exact on what’s going on with the patient. So if it was more heat and young, they couldn’t do 14 or do 20 with The 14 especially can reduce a lot of heat and especially if the heat goes up to the upper parts of the body. If those cheat deficiency like fatigue, stomach 36, ran six, lung nine, and if there was more disturbances at night Dreams, sleep disturbances goldbar 20 and leave it.

Or more agitation. By the way, many menopausal symptoms are to do with more blood stagnation agitation and if it was more to address the she than per card seven and heart seven. And this is the points we discussed before, and it was for 12 weeks. So four weeks, it was twice a week, and then another eight weeks, once a week treatment.

So the total treatment was for 16 weeks. And I would like to present another research, a larger research with 190 women and they received 10 acupuncture treatment session. And again, both of this research was published in the Journal of Clinical Oncology. It’s a very reputable journal. So it’s in science, it’s not just what you publish, but where you publish it.

So publishing in such a journal has a lot of or additional weight to it. And especially if if you want to present a acupuncture evidence to oncologists or to the medical team, it’s good to quote high reputable journals such as the Journal of Clinical. So this also had a 10 acupuncture session.

So this group was doing as you will see, the choice of diagnosis and points was a bit more diverse than the first research. And this. Quite a few research on that topic I’m just presenting to, and they also followed up for three months and six months post-treatment visits. In both cases, we see its, and this uniqueness that it’s not just the treatment itself, but also when the treatment stops, we can still.

Even half a year and a year later, the effects of treatment. Cause many patients usually ask me, how long, do I need to come for acupuncture? Is it like a life thing? So I say, no. If you’ll come for a series of treatments, then the benefit. Should last long to me actually for many years. Because if the acupuncture was accurate in the diagnosis was good, it has an effect, which is a long term effect.

So again, here, the conclusion that acupuncture is effective integrity intervention which the quality of life and hot flashes for these women they use the much more elaborated. And actually, that’s what I love about this research. A real TCM diagnosis and Chinese medicine is a medicine we don’t just use points per condition, but we are trying to do a deeper diagnosis, understand better.

And different women will have hot flashes depending also on their The condition they came with. So if they came with more in deficiency, there’ll be more the hot flashes on and the quality of life impairment, your de deficiency. So there was a set of points, and here they actually looked at the percentage of the diagnosis.

16% of the women was diagnosed with kidney deficiency. I just highlighted the kidney points like 6, 3, 7, and 10 that they could choose. But obviously also you see here heart six, which is very good for heart and kidney in deficiency if it’s kidney in and young deficiency. Or kidney, liver in deficiency with some young rising then again will be different points.

So there’ll be still the kidney six, Percu seven as a kind. Major points to balance the kidney and percu of fire and water. But we’ll see here additional points like liver three and gold bladder 20 and maybe combination of liver three and large intestine four will to move the stagnation and enhance better levy and liver.

Two to reduce heat from the liver. So you see the point combination here is a different, Oh, sorry. Has a different dynamic including lung seven and kidney six, which is the opening the remi, the channel in front of the body, which is responsible for all the in. And then if it’s kidney and heart disharmony particularly, then you will see this group of points.

There’ll be more kidney points from kidney six to kidney two. Kidney two is one of the interesting points that can take back the heat into the kidneys and enhance the kidneys. So it’s not just reduces heat, but also enhances the kidney young. And additional point we’ll see per card six, hard six, the hard six that we discuss for the in of the heart.

And Percu six with each additional ability also to be the main point of the, in way my balancing all the in. In the body and enhancing the heart womb kind of balance. So also hormonally there will be much more enhancement in, in, in using this points. And additionally in this group, many other points that are to do with enhancing kidney and also relaxing points like on the du mind, CV 15, because the heart is so much involved.

And as you can see, there’s 10% in. Of patients in this group were 36%. So you see most of the patients were of kidney and liver in deficiency, so they were more coming from this group from Flame Studies, Flame of Chita. There were still, it’s very different diagnosis. You’ll see that we’ll have some other points like Stomach 40, splint 10.

So more looking at this dynamic of a phlegm and cheese stagnation additionally to kidney and hard points. And blood stuff is, interestingly enough, there was none in this group, but still in clinic in the when we look at the symptoms, sometimes the symptom. Is also very common and seen commonly.

When we I would like to say that one of my passions is to teach the treatments of cancer patients and especially to treat oncology, acupuncture. And we do a very extensive course at the TCM Academy, and the idea is to teach and give. Tools, but also the skills and the competencies to treat cancer patients and especially cancer patients who are having side effects.

And we combine the three pillars of Western medicine, Chinese medicine, and research and evidence base. Cause when we combine this three pillars, I think then there is a. Clearer understanding both of the sys, the symptom, the ability to communicate with the patients, and the also the medical team that is working with the patients.

And in cancer, it is extremely effective. Extremely effective, but extremely important to understand both the Western medicine and the Chinese medicine differentiation, which. Very relevant to cancer patients. So if you want to know more, you can check up at the TCM Academy website. And this is this extensive oncology acupuncture program which covers, There’s also in the website Ava free stuff, but covers also other ideas like pain, nausea, vomiting, fatigue, and other components which are has so much.

To treat cancer patient and to treat the side effects. So I hope you learned something about the treatment of hot flashes, evidence based behind it. And with this slide I want to wish you all the best of health and from Chantel. She thank you very much for listening and being with us, and again, I would like to thank the American Acupuncture Council for putting this up.

So all the best and thank you so much.

Treating Facial Wrinkles with Intradermal Needling

And today’s topic is going to be Treating Facial Wrinkles with Intradermal Needling. So let’s get started.

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Hi, my name is Dr. Shelly Goldstein. Welcome to the American Acupuncture Council. Thank you so much for having me here today. And today’s topic is going to be Treating Facial Wrinkles with Intradermal Needling. So let’s get started. We think of wrinkles on our face and we think of them as just wrinkles.

But in fact, there are many, types of wrinkles on the face, and they come from many different sources. We can get wrinkles from. Bone changes and over time, all of these changes occur on many different levels. So from the deepest level bone, as we age, bone resource, or starts to break down, bone is the underlying structure of our face.

And so when the bone starts to break down, so do the overlaying structures, including the skin or the surface, which is where the wrinkles. We can get wrinkles from muscle changes over time. We say muscles attenuate, which means they, they get stiff and stagnant and then they create different peaks and values increases in the face.

We can get wrinkles from fat changes. Over time, fat starts to break down and move primarily into the nasal labial fold, or that fold between the edge of the nose and the corner of the mouth and accentuates different types of wrinkling. And then of course, all of those wrinkles show up on the skin. So on top of the wrinkles that occur from the skin level.

Are those deeper wrinkles? So today we’re gonna focus on the wrinkles that we see that appear on the skin from skin changes. The skin is part of the Anta system. The anta system consists of that fat layer, the subcutaneous of the hypodermis. And then on top of that is, Dermal layer, which is the true health of the skin.

Skin cells start at the bottom of the dermis, make their way up to the epidermis, above the dermis, and then they float to the top and they come off. So the true health of the skin and the visible health of the skin reside in the epidermis and the dermal layer, and that is the layer that we’re going to talk about when we talk about intradermal needling.

Intradermal needling is one of many different types of needlings that occur when you go get an injection or a hypodermic shot if they go into the muscle. It’s called intramuscular need. If it’s at the slide slightly into the, that subcutaneous level that’s called subcutaneous needling, intravenous, lev needling goes right into the bloodstream, and then there is the intradermal needling, which goes between the.

Into the dermal layer. So we see on needling too deep is that it misses that middle dermis layer. If you needle too shallow, it stays too superficial at the epidermal level into, if it’s inserted properly, it goes into the dermis and you can actually see it creates a little swelling at the surface.

And that’s how you know if you are into the intradermal needling because you can actually see the surface of the skin popping. Why, intradermal needling into the dermal layer? What’s going on? Basically, and in a nutshell, we’re working in the connective tissue portion of the dermal layer. There are two types of connective tissue in the dermal layer of the tissue.

There’s the papillary layer. Which is that loose mesh work that we can see on the right, and this primarily provides the nutrients to the skin, and then there’s the rec particular level below, which is much thicker, and it provides the density of the tissue or density of that layer, the structure of that layer.

When we think about connective tissue, what are we talking about? The primary components that make up connective tissue are collagen. Collagen is the support system. It’s like the mattress that you lie on. It’s the firm structure that has enough balance in it to allow you to lie comfortably. But it also.

Has enough resilience and tension so that you have support. That’s collagen. It’s the mattress of the germal layer of the tissue and the mattress of connective tissue. In addition to connective tissue and collagen, we have elastic fibers. And as you can see in this slide, it’s a very thin vertical.

Structure and that’s gonna allow the snap or the ability for that dermal or the connective tissue to bounce back. So you lie on the mattress, it sinks in, you get up, it pops back up, and that’s due to the elastin fiber within the connect. Tissue and then also in the connective tissue. We have fibroblast cells.

And fibroblast cells are what stimulate the production of collagen, and then we, It’s all embedded in this aqueous solution of hyaluronic acid. And hyaluronic acid provides the moisture and the ability for cells to float around and receive the nutrients that they need to grow healthy. It’s also what keeps our skin nice and hydrated and moist.

Now as we age, what happens? We age, we start to lose the ability for the cells to mo migrate from the base of the germal layer up through the epidermis, and they lose their vitality. We start to lose the integrity of the collagen and the elastin in those layers. They begin to get disorganized or not line up properly.

We start to lose the VAs, the blood vessels that iva that area and nourish the, area as well. When all of this happens, we start to lose that plumpness, the plumpness of the. The connective tissue and the dermal layer itself. When it starts to, when we lose the integrity of that it starts to dry out, we start losing hyaluronic acid in within that area.

And then we start to see not only as it dries out, but that dermal layer in that epidermal layer start to thin and separate. Creates more dryness. And then as we lose that suppleness of disorganization of collagen, an elastin, we start to see pitting. And you can actually see in this image, you can see the surface of the skin starting to pit.

Sometimes we call that wrinkle. Sometimes we call it skin pitting. For our purposes, There are multiple types of wrinkles. There are fine lines are primarily due. They’re not wrinkles. They’re due to the loss of hyaluronic acid in the tissue or dehydration. And the key is to just drink more water.

We are apply more hyaluronic acid or hydration to the surface of your skin. For our purposes, we are going to look today at shallow wrinkles. Shallow wrinkles, you’ll see in a moment are very superficial wrinkles. When the collagen starts to move up and down, or the elastin starts to snap back we, lose the creases.

So the creases come when we’re activating our muscles or textures of the skin, and then they relax as they, as the shallow wrinkles become more sedentary, they move into deep wrinkle. And this is when we are actually start to see changes in the architecture and integrity of collagen in the skin tissue and, also lattin so it becomes more visible when the faces at Russ and then static wrinkles are are a different type of wrinkle.

They’re actually. Deep wrinkles that have been around for a while. And in this situation actually starts to create damage into the tissue via the loss of elasticity within an elastin within that skin tissue. And then again, this too is visible at when the faces rest. And then we have dynamic wrinkles.

And these have more to do with muscle as opposed to skin create, although they may. Static wrinkles and deep wrinkles and cello wrinkles. When you treat dynamic wrinkles, you actually have to treat the muscle as opposed to the skin. So here’s an example. Here’s shallow wrinkles are on the left. And as you can see in this image, the person on the left or the figure on the left is probably in her thirties.

The middle is probably in there, her fifties and sixties. And then the on the right is, older. Most shallow wrinkles occur earlier in. And as you can see, say particularly in this image starting at the nasal labial full dot full between the edge of the nose and the corner of the Mac, you start to see the creasing there.

You’ll start to see it in between the eyebrows, Ella creasing, and possibly across the forehead. As they move into deeper wrinkles, you can start to see the changes of the architectural changes in the face. You can start to see a deeper creasing between the eyebrows, the nasal labial, fo maybe around the mouth, starting to see a change in the mental crease, which is between.

The chin and the lower lips and the marionette lines, which are between the corner of the mouth and the jaw area. And then as they move into more static wrinkles, they create a number of changes in the architecture of the face. And you can see the visible difference here. In fact, it’s just a progression from left to right and most of it has to do with age and lifestyle.

And diet. What’s interesting about needling at different layers of the tissue, particularly at the epidermal level and the germal level, is the references to it that we’ve seen in the classics, notably the ling shoe over time. In the classics, they talk about numerous, there are numerous discussions about needling guidelines specific to the layers of the face, the skin, the flesh.

The channels around the muscles, and then at the layer of the bone. So there are constant references throughout time about different ways and the importance of kneeling at all of those different levels. Also in the Ling shoe, in chapter one, it says The skin, the flesh, the muscles, the tendons and the meridians occupy different places in the body and that different diseases respond to different methods of treatment.

In chapter seven, it talks about the illnesses. If illness is superficial and needling is deep, it will penetrate and injure the good flesh. If illness is deep and needling is superficial, results will not be obtained. So again, there’s the references to the changes, the importance of needling at different different layers, and then the results that can be obtained when properly kneeling into those different levels.

Intradermal needles is superficial needling, obviously, and it’s sim very similar to Japanese needling technique. We know in Japanese needling technique that the insertion is superficial, that the manipulation, if there is any manipulation occurs at the surface of the skin. We’re not needling for Dutch.

And the needle gauges. The needles themselves are different. They’re very thin, and the length varies, say between a very short needle and say a 30 millimeter, which is like an inch long. When we are needling for the purpose of intradermal needling, what’s going on? There are multiple theories as to why this works.

One that’s the most popular and actually the foundation of say Derma rolling or microneedling, is the fact that when you insert a needle into the surface of the skin, it actually creates a little wound. Wound healing results. When you put something in or you damage the surface of the skin fibroblasts, circle that area and immediately start to stimulate the production of collagen and elastin within that tissue to actually heal the wound from the inside.

This was what we called a wound healing cascade, and which case again? We insert the needle, it creates a micro damage into the surface of the skin or under the surface of the skin. Fibroblasts come in, they stimulate the production of collagen. Collagen starts to line up, as well as elastin into the dermal layer of the skin.

And you can actually see in this image, In the first image, you see where the damage was created, and then you start to see the abundance of fibroblasts building collagen and elastin at the dermal and epidermal layer to start to thicken and to heal this microtrauma. Another theory is in doing so, what we’re doing is actually enhancing not just the collagen, but also the elasticity as well.

So we’re building collagen, building elastin under the skin, stimulated by the trauma that was created by inserting a needle into the surface of the skin. And there’s also something else that’s going on, and that’s called Paso Electric. Collagen is the primary component in connective tissue, which we just learned, and it also is capable of transmitting electrical signals throughout the bottom.

So it has an electric energy, call it, she call it electro Paso. Call it whatever you want, but it creates a vibration or an electricity. that then signals throughout surrounding area. And it’s both mechanical. So inserting in the needle stimulates this Paso electricity. It creates both the mechanical and electrical properties that vibrate out into the surface and connect with other systems.

So when. Insert the needle as a form of an external influence. The electrical current in that tissue created by the collagen radiates out into neighboring structure. It’s a, it’s somewhat the foundation of acupuncture in our culture is creating some type of an energetic that then spreads, not just stays at the center where we’re need.

It begins to spread out throughout surrounding tissue. And in our world, the meridians that, that connected these points. So we need and put the needle in. Intradermal needling, it stimulates that wound healing cascade. It excites that collagen Paso electricity. And it also releases fascial tension, which is the tension that is created by holding that tissue in this stagnant place now for so long.

The slide in this presentation or in this PowerPoint is histological slide. So they take pieces of skin or where there are wrinkles, they put ’em on the slide and, they put them they put a little piece of glass on top of it and they slide it under a microscope and, then you actually get an, a larger image or a magnified image of what’s going on.

So here we see a wrinkle. And it looks like a little divot like this. This is another slide. The wrinkle is actually very, shallow. This would be considered a shallow wrinkle. This is very minor or more minimal wrinkle, moving into a deeper wrinkle. Here’s a deeper wrinkle. You can see it’s not just a, dip or, but more of a plummet, a little deep area.

So that’s a different kind of wrinkle. So as you can see, we’re going to see all different types of wrinkles, and we’re gonna needle them differently as well, depending upon the. The, wrinkle itself. So we can’t really look at a magnifying glass in our practice. We’re not gonna take a slide and put it under my magnifying glass.

So you have to start to train your eye to see what does a wrinkle look like? Is it very shallow? Does it look a little bit deeper? Does it look like it’s petted? And then we’re going to decide how to needle it, and we’re gonna decide which type of needles to. Most of the intradermal needles today are either the straight intradermal needles, the Japanese one, or the press tax.

And they’re good. They don’t give you a lot of flexibility if you, they’re very tiny. You have to use a pair of tweezers if you’re using an intradermal needle and just slide it in. And you get a very short distance of, being able of insertion the press tax. There’s only one way to needle it and it’s down.

So that is somewhat limiting. EUS is a new serum needle and I think it’s a really good needle, and it’s ones that I choose to use. They’re stainless steel needles. They’re triple polished. They’re similar to serum needles. They’re high. The, quality of them is great. They come in a bolt pack of four.

They’re really easy to use and they’re a little bit longer. Some, they range between they’re all about seven millimeters, but then the thickness of them is varies. Different sizes. So depending upon the type of needle you choose you can affect different types of wrinkles. All of them work. It’s just a matter of personal preference.

So I’m gonna show you these slides. So this is a shallow wrinkle, which means it’s going to show up and then disappear. So when the model lifts her eyebrows and cringes her forehead, then you’re gonna start to see them. And I’ve actually had her do this in this image. And so we’re gonna look at these needles.

It’s pretty good. It’s a little blurry, but basically she doesn’t have a lot of wrinkles. And the wrinkles that she does have moose. One way to find out whether it’s a shallow wrinkle list, actually, to have your patient lift their eyebrows, drop them further eyebrows, and see what stays, and see what goes away.

So in this situation, what I’m gonna do is I’m actually gonna spread. The tissue and needle very shallowly into the needle. So in this situation, when you’re spreading the needle it’s a very shallow insertion at the upper level of the dermal level. You open the wrinkle, slide the needle into the surface, and you can line them up because most of these are fairly long needles.

So this is a good technique to use if you’re doing, if you’re treating a very shallow. Let’s see. This is more of a deeper ecstatic wrinkle, and this is the nasal labial fold right here. It’s the different, it’s from the corner of the nose to the sock corner of the mouth. A lot of it has to do with tissue that has fat that has moved down, or gravity muscle attenuation.

Has some effect in it. But in this situation, you’re gonna actually treat the wrinkle itself. Now, it’s hard to spread this because it’s a deeper wrinkle and it’s static. You can see it, it will stay there whether the person is smiling or frowning or either or making any other muscle expression. So rather than trying to spread this, wrinkle, what you’re gonna do is you’re gonna actually grab.

Like this and pinch, and then slide the needle into the crease. So let’s take a look at this. So I’m pinching, it, and slide. Okay. I’ll show you. This is a closer version of it. This is a, and it’s a little bit blurry, but I think you get the image. You’re gonna pinch and slide. Okay. It takes little practice.

It’s almost as if you want to take that area, start further out, pinch it, and let’s do this one more time so that you can see it. You’re pinching, you’re starting f pretty far out. In order to pop it, pop the tissue up so that the only thing that you can actually see is the wrinkle. Perfect. Let’s keep going.

Okay. Now, we’re gonna talk about deep wrinkles for a moment. On top of the changes of the architecture that occur within the derma layer, when A wrinkle has been around for a long time, it starts to affect the tissue around it very similar to that of a. Scar tissue is composed of the same collagen protein as healthy skin tissue similar to this, but because of the trauma or because of the static nature of the wrinkle, the tissue around it starts to change.

So similar to a scar where during tissue healing, the collagen cells group together. Like this and bunch up. This is sometimes what a deep wrinkle looks like. We’re gonna look at one in a minute. The way to treat this is not to slide the needle in because that’s not gonna really break up the tissue is and not to pop it and go into.

Base, but actually to go into the wall of the tissue to start to break up the fibrous tissue that is starting to develop, to create this, that stagnant nature, that depth of, the wrinkle itself. So here we go. Take a look. This is, if you look at the, let’s look up here. This is what we’re gonna treat.

This where the red arrow is. But if you look at, and it’s right here on the large image. Now look at this wrinkle. This wrinkle starts at the, in the lip. It starts at the base of the bottom lip and actually projects all the way down, but right. This is the depth of the wrinkle. This is probably where it started, began to spread.

So here’s where the damage is. Here’s where potential scar damage is, what we’re calling scar damage, but it’s really not a scar. It’s basically tissue that has been in one position for a very, long time. So in order to affect this, we actually need to break this, tissue up and around it. So we’re gonna take.

And I’m gonna needle into the wall. You can either needle from the outside in or you can needle from the inside out, but the object is to actually get into the wall of that wrinkle as opposed to the base of the wrinkle itself.

So just as a recap, we have fine lines. Fine lines are basically due to creases in the skin surface caused by dehydration. And the way to treat it is to enhance water consumption or to apply it or both. We have shallow wrinkles, which have to do with creases that are just beginning, and they change so they’re not stagnant.

Over time, you spread the wrinkles and needle into the crease. We have deep wrinkles where the crease is caused by the beginning of. In a lack of integrity of collagen and elastin in the tissue itself, and they stma, they’re starting to show up and stay there, stay at the face, or stay visible when the face is at rest.

And then we have static wrinkles. And these result from a loss of elasticity, tissue damage, we see that build up or the change in the architecture of collagen elastin around those needle wrinkles. And the treatment is to, the intradermal, kneeling treatment is to needle into the crease of the wall. And then we have dynamic wrinkles, often known as ride tides.

And these develop from repeated facial movements, in which case we need to treat the muscle as well as the. So thank you for today’s presentation. If you have any other questions or want to know more about facial acupuncture or cosmetic facial acupuncture you can visit me@hamptonsacupuncture.com, my website.

You can email me@infohamptonsacupuncture.com or follow me on Instagram at Shellie underscore Goldstein. So thank you again everyone. Thank you, the American Acupuncture Council. It’s always a pleasure to be with you and next week stay tuned for Chen Yen she’s very exciting and a wonderful lecture. I’m sure you’ll enjoy her presentation as well.

Neurology in Acupuncture the European Perspective

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Clarifying Diagnosis in Chinese Medicine

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Sacroiliac Joint Pain: Considerations for Acupuncture Treatment

So let’s go ahead and get that. Pearls these nuggets these wonderful protocols to be able to use for sacred iliac, joint pain and dysfunction.

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Hello, everyone. Thank you very much for attending our lecture on the sacred iliac joint. My name is Matt Callison. I’m here with my colleague, Brian Lau. Hi, thank you very much to the American acupuncture council for having. Brian. And I were talking about the upcoming module two low back hip and groin for this sports medicine acupuncture certification program.

That’s in September. And we’re thinking about different ideas of what we could be able to present. Because sacred iliac joint pain that would be presented at September and November is so prevalent with many people with different lifestyles. And we thought it would be a good idea to share with you some of our experiences.

As experiences at different points and different things that we can be able to use for releasing sacroiliac joint pain and dysfunction. What we’re doing is actually just going to be providing you in this short period of time, just a slice of the pie of things that can be used to help to reduce pain and the sacred early, actually, there is quite a few more things that you have to take a look at, but that would end up taking quite a few days to be able to go through all of that.

So let’s go ahead and get that. Pearls these nuggets these wonderful protocols to be able to use for sacred iliac, joint pain and dysfunction. So the next slide there, if we could. Go to is it’s such a crazy common injury for people and it can be able to come and go can actually really be recalcitrant for a number of different people as well is sacred iliac, joint pain, and the sacroiliac joint and the tissue surrounding that is usually the innocent bystander.

If from the different postural and muscle imbalances that are causing a total. Our torsion, a strain within the post here, sacred iliac ligaments, and also the that are just over that sacred iliac joint. So the sacroiliac joint does have a very small amount of motion, but again, it’s the innocent bystander from different pelvic imbalances and muscle.

And with those muscle imbalances come channel imbalances. And with that then comes challenge bounces within the associated channels. So this is something for us to be able to take a look at as an acupuncturist. Let’s go ahead and present some real gems here that we can be able to instantly take pain away from the sacroiliac joint and not just needling local.

So the next slide, please.

This is a bit of an overview, so we could use the innovations of L four L five at the Wachovia, Josh G points as well as you be 31 and 32. You be 33 would also be a choice. That’s just easier to find. You’d be 31 at 32 Bali out points. So this would be where we could actually affect the. We’ll also talk about points along the internal pathway of the call bladder that can be used as its own separate treatment protocol as well.

And of course, local needling in the sacred iliac joint region. And the reason why I say not into the sacroiliac joint is because it’s very difficult to get an acupuncture needle into that small little crevice of the sacred iliac joint. It’s something that I think as professionals, we should never say.

To anyone that were actually neatly into that joint, we would actually need some kind of digital imaging in order to guide us to go in there. So it’s just important that we have our language straight, especially if we’re going to be discussing to medical doctors or chiropractors or physical therapists, we’re stimulating the tissue around the Secor iliac joint, helping to decrease pain.

Then after that, we’ll get into some important motor points and also some tissues like the sacred tuberous ligament that are associated with the urinary bladder and kidney. So let’s go ahead and start right off. I think the next slide, please. This is a repaid. This is some, these are some points that you can use consider when you are needling locally underneath that PSIS for the sacred iliac joint pain is the innervation site to that joint.

So walk to a jig points at L four L five needle, those bilaterally as usually for the past. For needling, those points also, you be 31 and 32. I don’t really need all those bilaterals, but you could normally I would be needling just the side of the effected SSI joint. So you’d be 31 and 32 good combinations with local needling that you can use that in addition to, let’s go to the next slide point combination here of gallbladder 29, which is. Motorpoint or the superior motor point for the tensor fascia Lata. You can also use gallbladder 30, or I prefer the piriformis motor entry point. And I’ll discuss why in just a second. That would be with your SIJ needle technique and then also do one.

So why are we using this point combination? Let’s take a look at the internal pathway. So that image on the right, this is from Royston Lowe’s book of secondary or ordinary. I think it’s called secondary to. Printed in the 1980s, you can see from gallbladder 29, Brian, I don’t know if you’re have a cursor, if you could be able to point that out.

So gallbladder 29 on the hip there, we can see from that primary branch 29 will then go to gallbladder 30. That’s as we know into the buttock region, there’s an internal pathway that goes from gallbladder 29 down deep across the PSIS and communicate. Seemingly with the steak really act joint and its tissues, because the next point is that it communicates with, as you be 31 30, 2 33 and 34, the Bali alpha points, then that internal pathway goes down to two one, which is really quite interesting when we look at the pelvic floor.

So we’ll have a quick discussion on that, which is a very quick from that do one. Then the internal pathway arises and goes back up to the surface at gallbladder 30. This is the reason why we could use gallbladder 29, where the internal pathway begins before it goes to the sacroiliac joint. We could also use do one would be a good choice because of the ligament that had a cost to Jill ligament is the seam of the left and right pelvic floor.

So it has a lot of communication within that region. We could also use gallbladder 30 there because that’s where the internal pathway comes up and arises at gallbladder 30 personally, I prefer to use the piriformis motor entry point in this case, the reason why is because of its influence within that region has a really strong stabilizing effect for the sacrum itself.

When I’m using gallbladder 38, I’m actually thinking about trying to stimulate that sciatic nerve when there is true. SIADH. So I’m using that for a little different purpose or also with ease and gallbladder 30, just on a side note, it’s an excellent point for tonifying chia. Something to be able to mock up, you can use that with 36.

So back to the sacroiliac joint pain, gobbler 29, where the internal pathway exits from gallbladder 30 is where it comes from the deep, after going to the Bali Al points and the secretary iliac joint region to do one resurfaces at gallbladder 30. So you could use that point or the piriformis motor entry point.

That’s a nice combination. And you would tie in those needs. Those local needles around that area with gallbladder 41 is sad. Job five being the master income fluent points for the diamond mine young way has a strong effect on the civic really act joint that we demonstrate quite a bit with Gillette’s test in the smack pro.

All right. So that’s a standalone. However, you could use that with the L four and L five watch OCI points, or you’d be one and you to help tie in that internal pathway and also the innovation. It’s a solid treatment. So let’s go into, I think the next one, Brian is going to take over and start talking about the urinary bladder and kidney.

Yeah. So this would just be a, something to consider an add into the treatment. If we just get an overview of the urinary bladder and kidneys and new channels, translation for the sinew channels. We have a partial list on the left for the urinary bladder. So a new channel and a partial list on the right for the kidney sinew channel.

I say partial, cause it’s only taking us up to the lumbar spine. These channels would continue. But I’m just glancing at that image. We can notice a couple things. First of all, the urinary bladder sinew channel is going to go posterior region through the glute max hamstring tendons. We’ll talk about a couple other structures, but they’re going to form and unite at the posterior.

Part of the sacrum with the posterior sacred iliac ligaments. So that’s something right there. So it’s going to have an influence on the sacred iliac joint. Through the posterior second is really act ligaments, the kidneys, send new channels, going to dive deeper, anterior to the sacrum, to form the ligaments on the anterior portion of the sacred.

So those channels run fairly close to each other, running up the leg and thigh, and then diverged at the pelvis. Kidney channel can be sending a channel going into the pelvic floor, anterior to the sacrum urinary bladder, posterior to the sacrum. And they’re going to have quite an influence on the balance of the sacrum.

So we’re not going to necessarily have to treat every structure listed in. But we’ll highlight a few specific ones and we can look right now and notice on the left, we have the sacred tuberous ligament as part of the urinary bladder sinew new channel. This is the ligament that goes from the issue of tuberosity to the sacrum, a major structure that supports the sacrum.

So if I’m bending forward, that’s going to prevent my sacrum from basically popping out of the joint. It’s a very supportive structure on the sacrum, the piriformis part of the urinary bladder send you to. Blue max, which would be important. We’re not going to talk about it as much today, but we’ll highlight that line from the hamstrings, especially the biceps for Morris into the sacred tuberous ligament, and influenced also by the piriformis.

And then one last structure on the urinary bladder is one that would not be super obvious for a lot of people is Fronius long in the prone in general, the peroneal group, it’s very lateral. It looks like it’s on the gallbladder channel. It’s a lateral branch of the urinary bladder sinew channel. I’m going to put my cursor on it and run up through here.

The gallbladder channel would run just anterior to this. So this is a lateral bland branch of the. Urinary bladder channel. It’s going to go up to the fibular head and then link very strongly with the biceps for Morris. And then up through there and to the sacred tuberous ligament and the posterior sake really act ligaments.

That’s a key structure that we’re going to be working on that whole line in this. And we’ll talk about that in this presentation. And then the kidney send new channel. Just isolate one structure and that’s part of the pelvic floor, which has a big influence on the sacred iliac joint. That’s the issue of Cox.

So let’s move forward and look at those. Brian, yeah. Can you go back to that slide? I just want to offer one thing. I remember something that you and I have taught in the past when we’re talking about acupuncture as an assessment. So when the patient is laying prone and you can palpate underneath that PSIS and they have a certain amount of pain when you’re palpating in that region.

It’s usually the peroneus long as sometimes it’s the biceps for Morris, but it’s also the protein as long as it’s a real go-to muscle to go ahead and treat that motor entry point and see if that’ll decrease. The SSI joint pain usually does by a good 50%. So remember that combination, the Proteus longest the biceps femoris, and of course, going into this particular tuberculous.

But the peroneus longus is one point that can really take a lot of pain away from the sacred iliac joint, which is wonderful to be able to do so you can see patients have a lot of confidence. You as a practitioner, when you use one needle and you decrease their pain substantially. Thanks, Brian.

Yeah, sure. Yeah. This would functionally would really help support the SSI joint during gait, cause as you’re walking in heel strike, those muscles would start firing and help help. Whole mechanism that supports and pulls down and blocks, maybe that’s the right term, but supports stabilizes.

That’s sort. I was looking for help stabilize the sacred iliac joint, especially in running and walking type activities. So it’s really tied into the balance of the sacroiliac joint closure of the joint. That’s awesome. That’s great. Performance and sacred tubers ligaments are are ones that we’ll look at a lot.

And this slide This is a complex topic. When we get into the movement of the sacroiliac joint, I’m not going to go into super detail with it. Cause you have to, if you’re interested, you can look up nutation and counter nutation. It’s a long process to describe it and it can get very bogged down in the mechanics.

But simply speaking as you’re walking and running, you have one leg going forward and one leg going back in the innominate bones follow that there’s going to be a rotary rotation type motion in the denominator. You can picture the leg that’s swinging back is going to influence one that side. Let’s say, it’s my right leg.

That’s swinging back. This is going to influence that right side into an anterior tilt the pelvis. Whereas the leg that moves forward the forward leg is going to influence the innominate bone on that side of a D my left side in this case is going to go into a posterior tilt. And then as the gait changes in the leg switch, that’s going to go back the other way.

There’s going to be this kind of rotational type aspect through the innominate bone. That’s going back and forth. And even just from the get-go, you’ll notice with people that there is going to be a cemeteries in that. And maybe one side, it goes really easily. And the other side, not so well. So that’s going to set up the potential for things like say curly act, joint pain.

The sacrum has a particular movement in that rotation that is helped and supported by the guy wires of the parapharmacy and sacred or tumors. That’s going to prevent the sacrum from just being locked to that innominate bone movement. And it’s going to create this nutation and counter nutation motion this swaying and nodding of the sacrum.

And that’s what kind of creates the sacred joint movement. It’s a very small movement, but it’s an important movement. So we’re there to help support and guide the sacrum and its movement within that rotary movement of walking and. So it’s very important in the balance and stability and movement of the sacroiliac joint.

Because these are such key structures that holding onto the sacrum and supporting the sacrum and guiding the sacrum, it makes sense to make those part of the treatment. Paraform MIS via treating via the pair of farmers, motor entry point and the sacred tuberous ligament are very key structures that you can just include in treatment for Sacre iliac joint pain, but.

Ways you can use assessment to help determine when they’re going to be most effective manual muscle test postural findings. There’s a test for the sacred tuberous ligament that we use that we help feel for when it’s over bound and preventing and locking the movement. So those can help guide it, but they’re really key structures for this whole dynamic.

So let’s talk about piriformis motor point. This is from from Matt’s book the motor point, you actually having both the sports medicine acupuncture book, but also the Motorpoint index for the location. That point is halfway between you’d be 53 and you’d be 54. That’s how it’s described in the motor point index.

But easier to teach when we’re teaching this motor point for location is to find the PSIS. Let me get the cursor there. Find the borders of the PSIS lower border, upper border medial lateral get right in the middle of the PSIS. That’s going to be one of your points. Next point is going to be where’d my cursor go.

There we go. It’s a little hard to move on this due to, we know we’re due to his and draw a line between middle Brian. Yeah. Do we have a video for this next? It might be easier just to watch that video because the cursor is having a harder. Okay. Yeah, we can do that. Yeah. It’s hard to control the cursor cause it’s a kind of a small window, so yeah.

And it just describes it in the video. So let’s just go for that. Okay. We’ll do so I think it’s the next slide. Yeah,

we’re looking at the lateral side of the hip and identify the piriformis and loader entry. So first let’s go ahead and feel for due to then also for PSI. So we’ll take three fingers. I feel for that PSIS superior Porter, inferior border medial Porter, lateral border. And I just arrived for the middle of that.

PSIS I feel duty. Yeah, from the middle of the PSIS to do too, we’re going to divide that in half. So there’s a line drawn from the middle of the PSIS to due to being the hiatus of the sacrum. Divide that in half on that line. Okay. So then now this point, the halfway point, you’re now going to go perpendicular to the line until you feel the edge of the sacrum from the edge of the sacrum.

We’re now going to follow that line, just continue. One more SU identifying the PSIS inferior border fingers, medial border superior border, and lateral border go right into the middle. Take the other hand to the sacral Cox show injunction, which would be due to the hiatus of the sacred and the PSIS the highest of sacrum.

Divide that in half. There’s going to be a line here. So divide that. From that line now drop perpendicular line paid out till you feel the edge of the sacrum from the edge of the sacrum. Just one more soon out and you’ll then locate the piriformis. Motorpoint approximately one sort away from the lateral border around the sacred.

This was soon.

Next slide. Alright, so you guys, the continuation of that video actually does show the needle going in, but it’s just it’s a perpendicular needle with a three-inch, going into the depth about two inches. For those people that have studied with us before, that this is also the piriformis motor point is an empirical motor point that softens the urinary bladder 10 region.

So it’s really quite useful with a cervicogenic headaches when needling for sacred iliac, joint pain, and dysfunction. So always a good idea to needle bilaterally the period before. When you’re using manual muscle testing, it’s very common to have one piriformis be weak, and then the other one would actually be strong or a locked short position.

So it’s always good idea to be able to needle both piriformis. Brian, you wanna just keep going on the secretary of this ligament or do you want to keep take over.

All right. So in combination, as Brian was talking about earlier is the guy wires for the sacrum would be your sacred tuberous ligament. And also by that a performance, we just covered now with the sacred tuberous ligaments, a very prominent, dense tissue, easy to find just off of do to. So if you divided due to, and the issue of tuberosity in half and did a cross fibers for your cross fibering, where that ligament is, it’s a very.

Ligaments about the size of your pinky. Very dense. However, it does have some flexibility. So when you find some Oscher points within that region, you can see it. The red arrow that’s on the left is going to perpendicular with the sacred tuberous ligament. That’s how you want to palpate it. That’s how you want to needle it.

Usually in the middle sections where you’re going to find some Osher points I’m using an inch and half. You might need three and she knows depending on the size of the person’s bum but it shouldn’t happen to two or two and she will usually go right in that area. Needling that bilateral late is usually a good idea with sacred iliac joint pain as well.

Now there’s going to be another muscle, the next slide part of the pelvic floor being the issue of Cox and GS muscle, the issue of Cox GS Brian, let’s see if we can get the cursor. I know it’s really channel. To do that, that right-hand side, that issue is going to be located under the sacred tuberous ligament.

So you can see the cutaway on the right hand side of the image. And the cutaways, you can see the sacred tuberous ligament and also the sacred spinus ligament and where the pointer is right now is the underlying issue of Cox a G as part of that pelvic floor. So the same way that you would needle the sacred tuberous ligament going right into that dense ligament, if you took a three inch needle and threaded that up underneath the sacred tuberous ligament scraping, basically the.

Of it. The needle would probably be brushing against the sacred spinus ligament as well. The next tissue is going to be an issue of Cox and GS. This is a game changer for sake, really act joint pain. And there’s a number of different reasons why we need them in this muscle as well for the lower ciao complaints.

But for right now, let’s just keep on the sacred iliac joint. You can consider the issue of Cox, of GS as part of the pelvic floor and also Guidewire to help to stabilize. So needling the district Cox, a gas is very safe. However you can see that caution is advised on the left-hand side there. This technique really should be needled by experienced practitioners with excellent knowledge of anatomy.

You need to have really good command of your needle technique and know where the point of the needle is going at all times with this. Inadvertently go too far internal, you could affect internal organs. And that would not be a good idea whatsoever because of the risk of infection. This is a wonderful point to be able to use for just for experienced practitioners only.

All right. What do we have next? We’ve got now the local needling, right? The local needling for the sacroiliac joint pain in the secure sacroiliac joint region has been around for decades. There’s different ways of going about needling it, the way that we teach it in the smack program is to get the upper two thirds of that sacred iliac joint, where mostly where the pain is and divide that into four quarters.

From that PSIS the medial border. You move out just medial, just about once someone may be three quarters of a stone in order to take a finger to press underneath the PSIS, which is the roof of the sacroiliac joint. So that finger is going to go just underneath that. PSIS toward the secretary iliac joint, and you’ll divide that into four different vectors or four different angles.

So it always good to ask the patient does vector. How does that feel? That better be as you move down a little bit, how does that feel? Vector? See, it should move down just a little bit more. How does that feel? And of course, vector D and they’ll tell you let’s see, they’re going to be, what’s common.

It’s usually a and C could be B and D. So whatever those are you go ahead and take your inch and half needle and start threading that underneath the PSIS in the direction of the CIC. Really? Actually, there’s a great local. Technique to be able to use in combination with the other points that we have used, or at least some selection of different points that we’ve have talked about.

Great to be able to combine these needle techniques. After all the needles have been pulled out with the following myofascial release technique. This is something that we teach in our sinew channel myofascial techniques, class. This is also another game-changer to help, to reduce the tension within the tissues of the sacred early actuate and also the glute Maximus.

Brian, do you want to take it away? Now? We have a video for this one. It’s a pretty simple technique. I’ll let the video show it, but it’s, I’m working on the boundaries, the borders and attachment sites at the sacrum. It’s an easy technique just as loosen that a lateral border of the sacrum and help free the sacroiliac joint.

And you can modify it based on somebody in a posterior tilt or an anterior tilt. You can basically. Bring the leg up and you’ll see this in the video. It can like a crawl position to help bring that more anterior tilted pelvis into a posterior tilt and influence it out of that position pretty well.

Or you can move in the other direction for somebody in a posterior tilt to influence that and take it more into an anterior position. We’ll see that in the video.

so we’ll be working on the attachment. So the glute Maximus, especially the sacral attachments and just the spreading and moving softening the attachments along this. Very nice technique. We can adapt the technique to somebody who has a posterior and anterior tilt. This model. We have an anterior tilt, but I’m an exaggerate.

The anterior tilt. You can imagine with that, that it’s going to be much more effective if I move that tissue away from the sacrum. Yes. But also downward and help encourage more posterior. Or they took the pelvis. Conversely, if somebody has posterior tilt your pelvis under. And in that case, if you were working in that same direction, it’s going to encourage them more into a posterior tilt than the RDR.

So it would make more sense to come from a different angle and help lift the tissue to help encourage more anteriority to the pelvis. So we can adapt that general direction, but in both cases are moving the tissue away from the sacrum, either away and down lateral and down or lateral enough. So we’ll start with.

Lateral and downward, is that a little bit at the edge of the table? My side is towards her, so I can gently let my body sink in for them tissue using the elbow. Also a little bit of the proximal hole. Now I go right to the sacral attachments, think perpendicular and then spreads slightly lateral just to distract the tissue away from the sacrum and inferior.

I might have the. Gently and slowly tuck the pelvis under just the small movements, adequate

relax, slightly downward, another area of the tissue and under move, that movement that you’re doing, you can help them talk, but all of us under.

They generally talk under

pass.

I’m from instances you might, especially with an anterior tilt, you might add to the technique I put in the patient into sort of a crawl position. And you can see in this position, that’s going to encourage even more of a posterior tilt the pelvis so it can do similar technique. You’re comfortable.

Cellular technique with them in this position. And the position itself is going to encourage more of a posterior tilt

and I might hold a little longer in this particular position.

All right.

We have a QR code here for the new program that just started. We’ve the sports medicine acupuncture has been going on. This is jeez, what cycle is this mat now? 13, 14, but this is a updated version of it where we’ve added significantly to the. So for more information you can access the QR code.

That class has just started. I just actually returned from San Diego two days ago. So I’m still on California time. But that was for not for this, but the class just started this past month for module one module two will be in. You can start at any time, low back hip and pelvis. It’s a really pocket one.

It’s great. Yeah. It’s starting in September.

And Matt, why don’t you talk about this? Sure. Yes. So we are crazy enough to be able to put on a symposium because the field needs it. So ACA sport education we’ve gotten together, we’ve decided that the field really needs to be able to have a sports orthopedic acupuncture type of supposedly. So it’s something that should be happening hopefully every single year.

We’ve got a great speakers. This is going to be coming up in March 30th, April 1st in 2023. I’m here in San Diego. If you want any information there, just go to sew as education.com. So app as is the acronym for the title of the simple. The civic sports and orthopedic acupuncture symposium or so, so as education.com the next slide, I’m not going to get into all these introductions.

You guys can go ahead and check that out. Check that out. That’s also going to be on. So as education.com, theme is going to be mild fascial assessment and treatment. We’ve got some great people here. I can’t wait for this symposium. This is going to be a lot of fun. We also have recordings through loss of OMS.

That’s going to be available. Under the online CE use 75% of the smack program is going to be online, is online. And Brian and I are also working on an acupuncture anatomy series. You see there on the upper left. So as major and quadrant slump, And then if you want, if you like the way our education is, then you know, this get connected, we’ve got Facebook, we’ve got YouTube, our sports acupuncture Facebook page is really quite popular.

That’s a great one. To be able to ask some questions, you get a lot of knowledgeable people that are trying their best to be able to give their experiences with it. It’s a good Facebook feed as for sure. Brian, is there anything you want to add to that? Nope. I think. Okay, so next week, Sam Collins for me here.

Oh, that’s right next week. Sam’s going to be here. That’s awesome. Thank you so much to the American acupuncture council for having us, it’s really wonderful. Brian, it’s always a pleasure to be able to be hanging out with you and talking about medicine. It’s great. Thanks very much. So then we’ll see you next time.

Thanks everybody right. Bye. Bye.

Facial Acupuncture for Treating Drooping Eyelids (ptosis)

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Hi, Michelle. Gellis here. I want to thank you for attending this AAC live presentation and thank you to the American Acupuncture council as well. Today, I am going to be talking about treating. I chose. And for those of you who don’t know me, I teach cosmetic and facial meaning neuromuscular acupuncture classes internationally.

So the topics for today are going to be how some possible techniques for treating eye TOSA. Looking at the etiology from an Eastern and a Western perspective and then different treatment techniques, including submuscular needling motor points. And I’m not going to get into scalp, acupuncture and cupping, but those are some other treatments that can be used.

To treat I ptosis. So what is ptosis of the eyes? I chose this is when the muscles that raise the eyelid and there are a few of them. So there’s the levator muscle and the superior tarsal muscles. And in some cases also the frontalis muscle, when these muscles are not strong in. One or both of the eyelids can droop.

So testers can affect one or both eyes. It can be congenital. It can be cause through disease or injury. It’s more common in the elderly as the eye muscles begin to weaken and deteriorate. And here are some pictures of different degrees of eyelid ptosis. So in this person here on the top left, it’s very mild and in the person right below them both of the eyelids are what is referred to as hooding, meaning the.

Eyelid itself is eclipsing the part of the eye that allows us to see, and this again, can happen with old age. It can happen due to disease or injury in the middle photo. We have a slightly. More pronounced degree of eyelid ptosis, and then in the photo on the far right. Someone who has severe ptosis.

And so I am going to go into, again, some of the etiology and treatment for the varying degrees of islet. So Don damage or trauma to the eye can happen through injury or anything that damages the third cranial nerve, which is the ocular motor nerve, which controls this muscle. If someone has Bell’s palsy stroke they something like this can happen from a brain tumor, even conditions like diabetes or my skin you gravis can cause ptosis of the another cause common cause of ptosis is Horner syndrome and that is a.

Nerve damage that occurs in the face and the eyes. And in that case, it most likely wouldn’t just be the eyelids, other sorts of brain injuries, spinal cord injuries cancer can cause harm. Syndrome and ptosis cluster headaches can also cause ptosis what a cluster headache is a severe headache that has a frequent pattern for a period of time.

And then it will go into recession from a cheese TCM perspective. Ptosis is due to a congenital deficiency. Either a deficiency of the spleen or the kidney or balls or an obstruction of the collaterals by wind flam, leading to some sort of malnourishment of the upper eyelids. When we’re looking at doing body points to.

TOSA is from a TCM perspective where you would differentiate between the spleen kidney deficiency with wind flam and points on the stomach. Bladder and spleen meridians are typically used in that instance. And some of the manifestations for. The deficiency of spleen and kidney is it’s typically bilateral.

There might be some soreness and weakness in the lower back and the knees, poor appetite, loose stools, and the tongue body would be pale with a white coating, deep, weak pulse. And so the treatment principle would be to reinforce the spleen, warm the kidney. And I’ve listed some possible points that you can do, and you might want to add in let her 20 and 25 use a mocks that are really tonify the spleen and the kidneys.

And then the explanation is listed here below.

for us spleen. Whoops, sorry for a spleen deficiency. With when phlegm, the manifestations would be more of a swelling and numbness in the upper eyelids, possibly difficulty moving the eyeball. Numbness of the limbs fatigue, poor appetite here, your tongue would have a pale body with a white and sticky coating.

The pulse is going to be soft and thready, and the tree treatment principles would be to reinforce the spleen and resolve the phlegm. And the primary points are listed. And then the explanation. For why you would do each one of these points is listed below. If we have time at the end, I’ll come back to this, but I’m always mindful of time when I’m doing this live presentations.

For a scalp acupuncture, I had mentioned that you can treat. Eyelid ptosis with scalp acupuncture. We don’t have time for a whole scalp acupuncture lecture, but needling the lower two fifths of the motor area on both sides. And. For doing motor point. So facial motor points, you could do the motor points for the and those are two motor points.

It’s the extra point show how, and you would do an oblique absurd insertion. And there’s also a motor point halfway between gallbladder one and Sanchez 23. Again, you would do an oblique insertion also for the corrugator because the corrugator muscles work in conjunction with the eyebrows and the eyelid.

So treating the corrugator muscle. By doing the motor point that is just lateral to bladder too. And also treating the motor point for the front desk. Because as I mentioned, the frontallis, which is which are these muscles right over your eyebrows, the frontallis raises the eyebrows. So doing the motor point for the frontallis, which has gallbladder 14.

And again, a bleak insertion, and you can also do facial cupping and guash Shaw gently around the orbicularis ocular a little bit inside the orbital Ram. You can even stimulate the acupuncture points, all the acupuncture points around the eye, stomach to gallbladder one, the X per point. Ladder to you?

Yeah. Sanjay 23. So gentle cupping, gentle guash Shaw stimulating the point. We’ll all work on the ambiguous virus. Oculus. And if you choose, you could even use a Derma roller around the outside of the eye area. You never Derma roll inside the orbital rim, but really stimulating that area can be very beneficial.

So I mentioned these three points, bladder to you yell and Sangyo 23 when I needle them, especially with you. Yeah. I will lift the brow up out of the way and I will needle straight. Yeah. Under the eyebrow and for you. Yeah. If you go in line with the pupil, as opposed to the center of the eyebrow, if you go in line with the pupil, you can catch the edge of the levator muscle Azure noodling, and it really helps to lift this entire area.

I think I have a video.

Let’s see if I can get this sleigh, like really this. What I’ll do is I’ll pull up, but for her, I would just use the two and push underneath the brow like that. So again, I’m not on the lid on underneath the brown. Okay. Where they call this you yet? Don’t you? Yeah.

So those of you who don’t know me I do teach cosmetic acupuncture classes, which is what all of these other points are. And I incorporate this in my cosmetic acupuncture classes because as we age for many people, the drooping eyelids is very much a concern. And I realized the video is a little jumpy, but a few go to my social media.

I have a lot of these short little videos. I do a facial acupuncture tip of the week. So you could see it a little more smoothly than than you just did,

like really another. That can be very beneficial is gallbladder 18. This is not a widely used point, but it is a fabulous point for treating the eye area. If you look at this drawing from a medical textbook, this shows right here, the supra orbital nerve, and. This runs right along the Gallia up and erotica, which links the subtle and frontal bellies of the occipital from talus muscle gallbladder 18 is in line with do 20.

And so do 20 is here. The bladder line is here and then gallbladder. The way you can find it is you go to a gallbladder 14 and then 15, and you’re going to follow it straight back till you get to 18 noodling. This affects the entire occipital frontalis muscle and helps to open up the eye area.

So I had talked about the motor points for the , which is the muscle that goes all around the outer side of the orbital rim here. And the two motor points of. Between gallbladder one and Sanjay 23. And then the extra point Q ho. And you would treat only the affected eye. If both eyes were affected, you would treat both eyes, but if it’s just one eye that was affected, you would just treat the one eye.

And here is a picture of gallbladder 18. You can see it is in line with do 20 and it is right along the gallbladder line. Another point. That I will thread actually is I start at bladder four and the way you find bladder four is you go to bladder two, you go straight up to bladder three, and then you are going to come over at 1.5 soon to.

Bladder for. And when you were at bladder for you thread, a long, the scout all the way back to ladder six. You can use a half inch needle or a one inch needle, but this added in with the other points here. Whoops. I have a little delay here. So if you add these points, gallbladder 14 and Gulf letter 15 all together,

along with some of these motor points and you leave them in for about 20 minutes or so, what I do is I would leave the points and I might include. Some scalp acupuncture and with the scalp acupuncture, you would come in every 10 minutes or so and stimulate the needle. Then you would take the face points out, continue to stimulate the scalp point.

Cause you want to leave that in for about 30 minutes and try to get your patient to lift their lid. And sometimes it helps. If you’re doing scalp acupuncture to have them sitting up, you hand them a mirror and have them really focus on lifting up their eyelids. If they can see in a mirror, it helps to connect the brain to the muscle group.

Once the noodles come out, then you would do your. Cupping and Guam Shaw and Derma rolling. And I also sell my patients a set of cups and I teach them how to use the small cup and the facial wash shot tool. And. That way in between treatments, they can be working on these muscles. It’s a great way to reinnervation the muscle to re educate the muscle.

Obviously your patients can not be needling themselves at home. Teaching them to work, these muscles at home can be. Very beneficial. And so the order would be you put in the body points, right? You’re going to treat the underlying condition. Then you’re going to do any points around the eyes and scalp.

And then once the eyes. Come out, continue with the scalp points, have them work the muscles, then the cupping and GWAS Shaw, and then the German walling.

This was a patient of mine. She was actually young. Sorry. She was actually young. She had come to me for. She was going to be getting married and she had ptosis of her left eyelid, her entire life. And she was concerned because when she got tired, It became more pronounced. It was more noticeable and she suspected, or if she was sick, it would become more pronounced and more noticeable.

And she was very concerned that moving forward that the day of her wedding in all of the wedding photo, That she would have this one, very droopy eyelid. So she came to me for about three months before the wedding. And. Worked very much. He had very deficient kidneys. I spoke to her about getting proper rest and drinking.

Plenty of water treated. Her kidneys, did a lot of work. And what I would do is I would do the points on her back. Lots of mocks, a heat lamp. Then I would turn her over. I would do the body points on the front of her body and treated her. Eyelids. And after about six treatments, she really started to notice a difference.

And then by the end of three months, the treatments were holding to the point where I only saw her from time to time and you can see the after photo. This was a close-up actually from one of the. Photos a day of the wedding. She did it before she put her makeup on her. Eyelid had opened up and she was very happy.

Think so worried about time. I talk really fast. Let’s go back to the beginning and I just want to run through the diagnosis. A little more thoroughly and then wrap it up. So for the actual points that you would use, if someone had a deficiency of spleen and kidney, the primary points would be the eye points that.

I spoke about, so gallbladder 14 bladder to tie on, which I didn’t mention. You could also do gallbladder one. You yell Joe 23, very gently manipulated, do 20 stomach, 36 spleen, six, kidney seven. And then the explanation is. Bladder 20 and spleen six reinforced the spleen and tonify that she bladder 23 warms the kidney yang, especially with moxa stomach 36 and do 20 reinforced.

She raised the yang and can help to lift things that are sunk in. Gallbladder 14 bladder to Ty young and you yeah. Are all local points. They helped to nourish the upper light eyelid and strengthen the local muscles for the spleen deficiency with wind phlegm, the primary points would be gallbladder 14, bladder two.

Ty young you. Yeah, again, so a lot of the same local point do 20 Sanchez, 23 and stomach 36. Again, spleen nines, blend three and stomach 40. So stomach 36 helps to reinforce the kid, the stomach chew spleen nine spleen three, reinforced the spleen and remove dampness stomach. 40 helps to transform phlegm, do 20 dispels the wind and gallbladder 14 also promotes a nourishment of the.

Upper lip. So I think that is everything. I don’t recall if we can do Q and a, but I don’t see any questions popping up. So I am just gonna conclude. This talk today. And next week we have Matt Callison and Brian Lau presenting live. And if you missed any part of this, or if you’re interested in seeing any of the other AAC, Facebook or Instagram live shows, they are available on YouTube and on the AAC.

So thank you again for coming and I look forward to seeing you again. .