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The Role of Biofilms in the Induction and Maintenance of Latency (伏)


Hi, I’m Virginia Doran hosting another episode for, to the point, generously hosts, hosted and produced by the American Acupuncture Council. Today. My guest is Brandon Horn. He’s going to speak on the role of biofilms in the induction and maintenance of latency and, uh, being that I live in a very chick ridden area.

Click here to download the transcript.  You can download the PPT slides here.

I’ve come to learn a lot about biofilms and, uh, certainly they influence other diseases, but I think it will be valuable for you across a host of different conditions that you might be treating. So, uh, Brandon is a real Renaissance man, and, uh, I can’t even really, uh, get into all his, um, bio, but you could go and see that low to center.com. Um, he’s been a senior student of Jeffrey UN for years. He’s has a doctorate of philosophy in classical Chinese medicine, uh, from American university of complimentary medicine in Los Angeles.

Uh, he’s been a licensed acupuncturist since 2000 and, uh, he has many specialties in fertility, rheumatology, pediatrics, uh, he’s published, um, in books and in articles, um, many times and various subjects. And I think it’d be very interesting for you if he has a healthy seminars, uh, course on, uh, optimizing ovarian reserve. And there’s really just so many, uh, things as he’s done, I’d be talking for quite a long time to tell you all that. So without further ado, I would like to introduce Brandon and if I left something important out brand the pizza, let me know. Um, but otherwise I’ll hand it over to you, Brian. Brandon. Okay. You hear me okay? Yes. Okay, great. Um, so thank you, Virginia. Uh, and, uh, just more thank you and the AAC for inviting me to, um, to speak with you today. Um, so, uh, I originally, as you noted, wanted to present some information on code for you guys, but I’m not allowed to, because I was told that Facebook has decided to pull down people’s accounts. If they’re disseminating information about Coda, that’s not from an official source. Uh, at any rate I’ve been presenting a series on latency, uh, at international,

Uh, integrative Chinese medicine conference in Australia. Um, and this, um, uh, these talks are now available@aucm.online, if you want to pursue today’s lecture further. So, um, I’ll get into as much detail as we have time for. Um, but there is a resource available if you want more. So, um, we’re going to talk about biofilms today, which is apparently not on Facebook sensor list, uh, yet, uh, but biofilms are quite fascinating. And really when you begin to study microbiology, I, you start to understand the details of what the, uh, the ancient doctors were observing and what they’ve been describing for millennia.

So, all right. Um, uh, I’m taking slides straight out of, uh, one of the talks that I gave called managing microbial resistance. And again, this is available in full@acm.online, uh, for those who want to hear the full lecture, because biofilms is only one part of the lecture and I had to cut it down a bit to fit within a half an hour. Um, so in that lecture, we’re talking about latency or lurking pathogens as some people call them. Uh, and this is more from the perspective of bacteria in this particular lecture because different pathogens have very different ways in which they form and maintain latency. And also our weight. She responds very differently as well. So from a big picture, bacterial latency perspective, we have, uh, three major players, uh, here. Um, these are the persisters, the persister organisms, the biofilms and the in time microbial resistant organisms.

So these groups of organisms are all on a spectrum of latency, uh, that we’ll look at in the net. But, um, first I’d like to briefly review the origins of latency in Chinese medicine, for those of you who are not necessarily familiar with the concept. Um, so in Chinese, uh, the term we use for latency or for lurking is cool, uh, and this has been popularized or revived in some ways, uh, in TCM from the, uh, from the one thing school, right? But the origins of this concept of latency are much older than that. Uh, the earliest mentions go all the way back to the majoring and chapters three and five of the N, which States that when one is harmed by cold in the winter, one will suffer a warm disease in the spring.

So what that’s saying is that, yeah,

But you really get cold in the winter and then you’ll end up with a one being in the spring. It’s really giving us this concept that, uh, infection and disease are not the same thing, meaning that you can be infected asymptomatically. Um, but that asymptomatic infection does not mean that you’re off the hook, right? So this is important. Uh, it has very important ramifications with disease etiology, and particularly with how we approach diseases. So for example, in another topic that Facebook loves to sensor, we find that these vaccines are designed to induce latency either immediately, which is in the case of live vaccines or upon contact with a pathogen as is the case with most of the other vaccines that we have. And we know for example, that vaccinating, uh, if you take, for example, for testis, uh, that prevents you, assuming that it works, it prevents you from becoming symptomatic with, for testis, but it does not prevent infection with four to tele pertussis.

However, uh, what the nagging is telling us is that you can contract the pathogen asymptomatically, but later on, you’re going to manifest the disease in a different way, right? So pharmaceutical companies, uh, they don’t like to look up for that kind of problem because it rains in on their profit parade. Uh, but fortunately there are a few researchers that have noticed these kinds of problems and published about them, but bad things tend to happen to their careers, uh, at any rate, as they say, trust science, uh, but not necessarily scientists. Alright, I’m done with politics. Uh, the second, the second thing,

An example of that, you know, uh, could you give an example of the, uh, of this latency?

Uh, yeah. I’m going to give you lots of examples. Yeah. So the, you know, we’re going to talk about a whole spectrum of latency in a minute. I have some slides on, so, okay. So, um, anyway, the second thing, uh, that it’s telling us is that, uh, environment is primarily responsible for this change in packaging, from being asymptomatic to transforming into a disease, right? They say, it said, one thing happens in winter. The next thing happens in the spring. This is environment. Um, there are other things here as well in terms of discussing people’s constitution, uh, and things like that. But that’s a little more involved in the uptime for right now. Sorry about that. Uh, the main point here is that Chinese medicine has understood this idea of a hidden pathogen or asymptomatic infection, uh, or subclinical infection, if you want to call it for millennia.

And so in Chinese medicine school refers to any kind of infection that can hide or take on a dormant state, uh, or that can resist being expelled by the body. Now. So this gets to your question here a little bit, or well now from then aging, how we can differentiate different kinds of latencies. There’s latent, cold, latent heat, latent down and Layton wind. And then the one being school added really latent fire. But for this particular lecture, the most important are latent cold, latent heat and latent dam. Um, really latent fire and wind are all under latent heat for young faculty, right. Um, so at any rate to give you some idea of how this is important, uh, within microbiology have a kind of a spectrum of what Chinese medicine really calls a fool. And these are again from Leighton close to Laden heat. And of course in between cold and heat is damn right. We’re yin and yang meat, uh, is damp now, uh, what the spectrum is describing is both phenotypical alterations of the organisms. So this would be a cold pathogen transforming you to like heat pathogen, for example, or it could be describing the environment that the pathogen is in, and these concepts are related, but when we’re discussing biofilms themselves, we’re talking both about the environment of the biofilm, as well as the pathogen mix. Uh, so biofilms as the earth element, uh, contain the entire spectrum from cold, uh, to eat.

So what exactly are biofilms? Well, um, biofilms are basically these kinds of small fortresses. Uh, if you want to think about them, that pathogens build to protect themselves from our way T and to allow them to persist in our bodies without having to worry about the immune system. So basically they are one of the main methods of latency within our bodies. Uh, and in my opinion, this is why sensimilla thought slam was a major part of disease. And he was right. It turns out that up to 60% of all human infections are believed to be caused by biofilms. That’s all human infections. And 80% of bacterial diseases are believed to be caused by biofilms. And when we look at the chemistry of biofilms, how we see that they’re essentially what they are. Is there a matrix of biopolymers that are, as I say, highly hydrated.

So in other words, they’re full of water, right? So polymers are just like, uh, they’re technical, they’re repeating chain of molecules. So it’s kind of like if you take Legos and you just use the Legos to build, you know, the same size and the same pieces to build the kind of more complicated structure, um, that’s essentially what you have. And they’re also again, highly hydrated. And so you see that from a chemistry perspective, these bio polymers that make up the outer coating of the biofilms R and D data, right. But polymers of course, can be very tough substances. So like plantain. So we think of like, so if you think of some polymers, things like PVC is a poem, right? Or even natural polymers, like rubber or hemp and so forth. So they can be very difficult to break down. And one more point here that I want to make is that biofilms are made of our sessile organisms.

And that means that these are organisms that are attached to the biofilm. So when the organisms are swimming around, we call them planktonic. But, um, these are just different phenotypes that the same organism can become and organisms that are in this particular phenotype that we call a sessile state respond very differently to antibiotics and to the immune system, then planktonic organisms do. Um, however, almost all of the literature that you read about with earth, they matter, or this antibiotic or whatever, killing XYZ bacteria, these are done when they’re in new planktonic state and not when they’re in necessitate state. So these may actually have no effect on the organism when it’s expressing assessable phenotype. So for example, in a biofilm, and this is another reason why it’s really hard to kill a biofilm organisms for a candidate.

Okay. So here you have a couple of images of what a biofilms look like a close up, and you can see it, it really is plenty, uh, in some ways. So I like these images because it’s similar to what you can feel impulses, uh, or when you palpate. Right? So a lot of what Jeffrey UN for example, refers to as bands or some of these phlegm modulations that aren’t obviously lymph nodes or something, uh, or these calcification type things, or what Kiko Matsumoto, if any of you follow her cause gummies or crunchies, these are really a lot of times, these are the effects of biofilms on tissue and both Jeffrey and Kiko. I’ll break these down. And they’d like to use moxibustion as well, which we have a slide on the minute Jeffrey, like salsa using WashDOT go doesn’t really use croissant to my knowledge.

Um, so, uh, so we saw that the photograph of the surface of a biofilm, but inside the biofilm, it’s a little different. So inside of a biofilm, we basically have three layers under the surface. So you can think of it as kind of like a three story house or something, right. In some ways. So at the top layer, you have the, uh, it’s full of and blood kind of like, you know, like young men, right. Uh, and then you have the next layer that is high in substrate and low in oxygen. So that’s the shallow young layer. That’s where Dan pathogens that have to use fermentation for energy, right? Because it’s low in oxygen, that’s where there’s a live right in that layer. And then finally you have the third layer, which is low and substrate and low in oxygen. Uh, and this is where you have the persister cells or the, what we call in Chinese medicine, these cold pathogens.

Right. Um, so what you see here is that, uh, w um, you get sort of multiple phenotypically the States within one biofilm. And what that means once again, is that it’s really tough to kill, right? So even if you remove the surface and you expose the bacteria to the immune system or to antibiotics, then the persister cells are still going to survive, and eventually they’re going to become planktonic again, and then they can reinfect you again. And this is why we need to think longterm, you can’t just treat symptomatically. And once the symptomatic, the symptoms are gone, then you stop treating because the pathogen is going to remain latent, and it’s going to pop up somewhere else as a different kind of disease, or it can pop up in the same place as well. So you get rid of, let’s say, you get rid of the person’s knee pain or whatever, but really you just, you know, release pathogen.

And then six months later, it’s growing on the person’s neck or their spine. And then you end up with another kind of disease that you don’t necessarily correlate with that this is really a micro biological reality of divergent channel theory. If you have any of you follow jeopardy, uh, you might have some of the other teachers teaching at divergent channels. Um, so to treat biofilms, uh, we should perse take a look at how they’re formed. Uh, and then we’re going to discuss a little bit of some of the approaches we can use to treat them. So, um, the, with the formation of biofilms, of course, it’s going to first start with, uh, adhesion right at first has to, uh, adhere to a surface. And, um, so, uh, once that happens, then it’s going to attach, uh, and then grow the biofilm on it. So this first stage is really in the CI level, uh, because the initial adhesion is done through electrostatic or vendor walls, uh, interactions, which if you’re not familiar with the band or walls forces, they’re basically like what, you know, geckos use the stick to the ceiling or, or to the wall or something like that.

Um, but yeah, that’s what they use. So at any rate, because this is the cheat level, we can use cheese to prevent adhesion. And so we can really look at things like cheese gong, or like using East them, if you’re not, you know, if you think she goes to esoteric for you use East them, or you can alter the pH various pH altering strategies work, uh, hydration is also very helpful. Uh, all of this can disrupt biofilms from forming. I also have a list of herbs here as well. So things like green tea, which of course they, you know, they use in Chinese restaurants to clean the grease off the glass tables, uh, you know, cause it’s really good at breaking down, uh, you know, dampness, right. Uh, it’s also, um, uh, there’s cranberry, which is popular for preventing UTIs and it also helps prevent the formation of biofilms as well. Um, and also keep in mind, there are different methods that different bacteria use to form biofilms. So these herbs aren’t going to necessarily work on all biofilms, but certainly they do help with many different times.

Okay. So then after, uh, after we have the initial sort of, uh, adhesion then attachment, so once they’re together, then they have to start, uh, binding. Right. So then we start, uh, physically binding, right. Um, so, uh, at any rate, once that happens, then that’s what we consider to be more at the blood level, right? So we need to use herbs because it’s something more structural, more physical. So we need to use herbs that break up blood stagnation or blood spaces to prevent formation at this state or to break things down at this stage. So I just put up, you know, herbs with studies here, but of course you can use the regular wounds. You know, now not applying is, is particularly effective for this space, by the way. Um, but you should be careful with that. Not all finances is actually quite strong.

Um, okay. So once it’s anchored, uh, then the start to collect on it so they can call, uh, we basically call that swarming, right? Everything just starts swarming towards it. And there are some herds listed here that we can use to inhibit the sort of swarming function. Uh, and then as they’re swarming and gathering into a community, uh, then they need to communicate. So this is done towards, uh, by something called forum sensing, which I discuss in detail in the main lecture, but I, here are a list of herbs that interfere with that process. So quorum sensing is also very important when we’re dealing with antibiotic resistant organisms, which are different than biofilms, and these require different strategies than just, you know, dealing with biofilms. So then we have that the, uh, outer coating the EPS, uh, so inhibition of the formation of EPS. So these are some strategies for, uh, breaking down the biopolymer or the phlegm, uh, as we discussed. So again, I know all of, you know, which herbs treat land in Chinese medicine. So I only listed herbs here that has studies on them directly inhibiting, uh, the EPS formation. Uh, but of course you can use other herbs that, you know, uh, deal with phlegm as well.

And finally, after the biofilm is formed, uh, it eventually gets too crowded. And at some point, uh, at bursts open and we call that the dispersal stage. Uh, so it can be stimulated also by environmental factors like extreme temperatures, uh, pH extremes, dietary changes, and so forth. So of course, you know, saunas can cause dispersal as can dietary supplements, uh, and of course verbal medicines can as well. Uh, and so this is one of the prime causes of the so-called, you know, healing crisis, uh, where all of a sudden these latent pathogens get released, and then you need to deal with them. They’re no longer latent. They’re spreading. Again, this is divergent channel theory, where if you’ve studied with Jeffery yang, he talks about how you have two or maybe three approaches when you’re dealing with chronic pathogens. And one is the maintenance, uh, I mean the general approaches one is to maintain latency or induce latency.

And the other is to stimulate the pathogen to come out of latency and then expel it from the body. Now, of course, it’s very difficult to permanently rid yourself of the pathogen, but it can help to reduce the pathogenic load on the body if it’s using too many resources to maintain latency. So you only have so many, uh, you know, jail cells, so to speak. And if you don’t clear out your jail cells, there’s not going to be any room, a room for new criminals that are coming, right. So, you know, I mean, that’s really kind of how it is. So here’s some herbs and so forth here that I’ve listed that can help inhibit dispersal. And some of these actually are counterintuitive because traditionally we’ve used cold to maintain latency, but hearing you see garlic and onions and cinnamon bark, uh, those can inhibit biofilm dispersal.

Of course, you know, these studies keep in mind, these are usually done in vitro, meaning in a test tube or in a Petri dish or something. And, you know, it can behave very differently when it’s in vivo or when it’s in the body. Right? So for me, when I’m trying to inhibit dispersal, which may be, if I know my patient is going into some extreme conditions, or if they are going through something really stressful, or maybe they’re having a current healing crisis, then I don’t use garlic. I’m, you know, I’m recommending things that are cooling and cold. So from here, you can see things like cactus and apples and leafy greens and so forth, things like that. Of course, you know, cinnamon bark you can use in small doses to actually pull things back into latency, but that’s, you know, that’s another discussion in general as a general concept, cooling and cold is what I use. Like [inaudible] soup for those of you who’ve studied some of the classical medicine. Yeah.

Recommend the patient, do things to kind of open the detoxification pathways, something like glutathione or something so that their detoxification of this, of whatever they have, um, makes it easier, a smoother, less cathartic list, you know, uh, Herxheimer reaction at all.

Yeah. So I actually, uh, I don’t go there right away. So this will be sort of an individual thing for each patient, but as a general proposition, it’s, it’s not actually a lot of people like to detoxify. Um, but that’s really, usually not the, in my opinion, that’s not the correct strategy to start with the correct strategy to start with is to make sure that all of your exits are open, right? So you want to make sure that the person’s vowels are moving well. You want to make sure that their urination is going well. They’re able to sweat, you know, these types of things, because you can do as much, you know, detoxification as you want. And that’s just like taking a bathtub and trying to clean it without much water. You know, you just got one without the drain being open, even if you have water, right.

You’re just going to switch it around and it’s not really going to do much. So you first have to make sure that all the exits are going smoothly. So if the person’s constipated or they have dry stools or, you know, these types of things and you need to correct, I recommend correcting that first, anytime you’re doing any of this stuff, um, and then you can get in, or a person needs glue to buy on, or a person needs, whatever. You know, I, I am actually as much as I talk about all this Western stuff, you know, I am at part a on herbalist and acupuncturist first, and that’s always my go to initially and I do functional medicine types of things and types of testing. I do it frequently, but these are things that I do for people where they’re, it’s more remote oftentimes. So I don’t have to check their pulses necessarily, or I can use it also as a, you know, if what I’m doing in the herbal medicine, isn’t working well enough for the person sensitive. So that’s kind of,

I think we’re actually saying the same thing. Yeah. The Goodwill line just opens up the liver so that it can detoxify more smoothly, um, as you know, but anyway, yeah. It’s just interesting to hear your approach.

Yeah, exactly. So you, you can open up the liver, but, but it still has to get out of the body. Right. So that’s all I’m saying is that I would agree to, you know, that this is, you know, you’re assuming step one is done. So, um, so for treatment then biofilms, since that’s this, this slide, we can talk about that a little bit. Um, the approach then. So this is just kind of a general idea of where you first ensure that the body strong enough to handle the breakdown of biofilms and this release of latency, and then next you attack the matrix, right? So after the person’s strong enough, then you go after the matrix of the biofilms and you can use some of the strategies that we talked about that caused biochem this first. So like saunas or jumping into a frozen Lake, or getting beaten by a tree branch.

These are the kind of Russian methods, but at least there’s a sauna at the end. So that’s good. And then finally you need to sort of clear the pathogen out and then loop back to step one until you no longer get symptomatic after step two. So you’re going to keep going through the cycle that as soon as the symptoms over time, they’re going to be less and less as you’re clearing things out. Um, so let’s take a look at the different stages. We’re actually not going to talk much about the first stage because that’s just standard TCM. Pretty much everyone is trained and you know, how you, uh, strengthen the body and blood and made sure that they’re strong enough for this. Um, so then the second thing is that, uh, we’re going to attack the matrix. So other than the, uh, environmental manipulations that I just mentioned, uh, we work primarily with the aid extra channels on this eye and the low channels for this stage.

And really if you’re looking at biofilms, low channels are the primary way to treat these because biofilms, again, as we mentioned, they’re, um, most oftentimes, uh, present as phlegm and his blood stagnation and the channel system that deals with phlegm and blood stagnation on the low channels, right? So you can use a guash Shaw on the bandit areas, or you can use needles and moxa to break that down. Uh, those are also very effective from the, uh, eight extra channel perspective. Uh, we work with young way Maya as the primary channel, and then secondarily, then we can work with [inaudible] ciao. And I guess you need some of that extra power or whatever, then possibly you’ll tap into Duma as well, but it’s more the diet and Yung chow for this. So now, as, as I mentioned moxibustion before, um, so here’s a slide on that.

It’s very useful for breaking down biofilms and there has been research in this area in terms of temperatures, not in terms of moxibustion directly, but in terms of temperatures that biofilms begin to break down with. So then we can look at what temperature the moxa gets up to, right? And this of course is going to also depend on the blend that you’re burning. So you can check the temperatures if you want with those laser thermometers, if you’re a metal type and you need to have those exact numbers, but basically you want the area of the tissue that you’re trying to break down to hit 50 degrees centigrade, which is about 122 degrees Fahrenheit. Um, but for me, I use centigrade for this not to be fancy, but just because it’s easier to remember. Uh, so I use that. So 50 is your target for biofilm breakdown, uh, and 60 is where your skin burns.

So the sweet spot is between 50 and 60 degrees Celsius. And as you can see here, a moxibustion can get you there. Um, but keep in mind that the temperature at the surface of the skin is not the same as the subacute temperature, subcutaneous temperature. Um, so what I find to be the most effective personally is using Chico style of doing direct moxibustion on the needle itself, you know, meaning, meaning that you, you insert the needle and then you’re putting the moxibustion at the border of the needle, uh, and the skin, uh, right. And you put a little burn cream on there for those of you who aren’t familiar with that. And then you do the small rice grain boxes on top and keep going. Um, if you use needle moxa, what happens is it typically is going to cool off too much, uh, by the time it gets to the biofilm, uh, unless you’re using a particularly hot mocks that formula you’re burning it for a particularly long time, then you might be able to get enough there.

Um, so, uh, I’m not going to discuss during the pathogen so much because that’s, you know, there are many ways to do that. I tend to use low channels a lot in these that really the most for clearing and verbally, once these things are active, you can use your standard things. Your Shanghai online formulas are one big strategies, depending on what your, you know, what you’re trying to do at that point. Um, so, uh, here in this slide, um, I just wanted to bring up this a caution that when you release late, I can see it can spread and it can cause widespread problems that can be serious. And as you see here, it can disseminate into the blood, which means that it could cause sepsis, right? If the patient isn’t strong enough to clear it out. So, uh, again, my recommendation is to go slowly, but sometimes, you know, we don’t have a choice because someone gets sick, someone gets a fever and then bang, it starts to pause, disperse a little biofilms.

And these are where you get a lot of secondary bacterial infections to a primary viral infection, like say a cold or flu, or that other thing that shall not be named that some people are taking as it for my son. Uh, so if you’re aware of this, we can employ some of the acupuncture and herbal strategies as a prophylaxis. Um, now, uh, some of the practitioners, particularly natural paths or some functional medicine, practitioners love to use a lot of anti biofilm substances. And I would really caution against being overly aggressive with those, because unless you know how to monitor pulses again, you’re only going to know something is happening otherwise, if the patient’s symptomatic, but these things can spread asymptomatically as well. And then they can go places that are less than ideal, right? Your body put them in a particular place, perhaps on purpose.

And then we, you know, then they can start spreading the places your body didn’t want. So if you check pulses, then you’re much less likely to run into a problem, but if you don’t check pulses, then I think it’s best, uh, personally to err on the side of just moving slower, uh, to release the, uh, latency. So again, these are all, uh, citations to, uh, articles and, uh, uh, in the NCBI. So you can follow up that, yes, fever, induced, biofilms do release a new Macaca. Uh, and this has been shown to result in bacterial dissemination and sepsis, for example. So this is not just Chinese medicine docking. This is also, you know, what’s been confirmed in medical research. I mean, non Chinese medicine, medical research, I personally relied more on Chinese medicine. Vertical research is much more, um, uh, much more accurate, but that’s a whole nother discussion.

So lastly, um, I just want to mention that biofilms are everywhere in our environment or they’re on your showers. They’re already here, they’re all over the place everywhere. I, and also everywhere in our bodies and some of them are actually beneficial. So just like if we take too many phlegm resolving herbs, we can damage our yen. If we remove biofilms too aggressively, we can end up compromising our health rather than helping. Um, so here’s one example of biofilm syrup, the lower jaw that protect the body from other pathogens. So here you see that lactobacillus form may fit protective layer. Uh, the biofilm basically in the email, you’re a genital system that provides protection against bacterial infections and the vaginal cells are completely covered with, uh, healthy biofilms. And that’s a good thing. So I think that’s pretty much it. Uh what’s that, that’s great. Yeah. Okay. Yeah. And so I just want people to know that they can, the full presentation is available talking about the persister organisms, a little more detail on biofilms, but I’m also talking about the antibiotic resistant organisms themselves and how to approach those. Um, that’s available at AUC, um, dot, uh, online, uh, and it’s only three hours, so it’s not like you have to watch it for two years, um, by some of my other ones.

Okay. Well, I want to thank you all for tuning in and next week, the guests will be [inaudible] and, uh, he’s always interesting. And, uh, again, thanks to the American Acupuncture Council, um, Virginia Doran of luminousbeauty.com. And we’ll see again, soon all right. Thank you. Thank you, Brandon.

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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.


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.


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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.


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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