Introduction to Medical Acupuncture January 7-9, 2011 Johnson City, TN Dr. Carlos A. Suarez MD, DABMA ~With~
Scott Fitzpatrick, RES, Dipl OM
Introduction to Medical Acupuncture January 7-9, 2011 FRIDAY 6:00-6:30 PM 6:30-8:30
Registration Acupuncture History from Ancient China to US today
Introduction to Chinese Medicine EBM How does it work? Needle Shock/Adverse Effects Microsystems: The Ear DEMO on a patient/ yourselves/videos Questions/ Adjourn
SATURDAY 7:30-8:00 AM Registration and Breakfast 8:00-10:00 Upper Limb Command Points, Governing Vessel and Conception Vessel, SHU and MU 10:00-12:00
PRACTICE #1: POINT IDENTIFICATION UPPER LIMB/SHU AND MU
12:00-1:00
Lunch on your own
1:00-2:00
Tongue and Pulse ( by Scott Fitzpatrick, LAC )
2:00-4:00
Lower Limb Command Points, Treatment with Needles, Principal Meridians
4:00-6:00
PRACTICE #2: POINT IDENTIFICATION LOWER LIMB/ PRINCIPAL MERIDIANS, NO ELECTRICITY
SUNDAY 7:30-8:00 AM Registration and Breakfast 8:00-10:00 SELECT TREATMENTS FOR COMMON PROBLEMS:
Anxiety Four Gates Great American Malady and Five Elements Fatigue Local Pain, Itch and Burn Tendinomuscular Meridians
OTHER TREAMTENTS:
Cupping and Scrapping HUI and SEAS MISCELANEOUS and Acupuncture Sources 10:00-12:00
PRACTICE #3: PRACTICE TREATMENTS
12:00-1:00
Lunch
1:00-3:00
PRACTICE #4: GROUP PRACTICE THEORY
3:00-5:00
PRACTICE #5: N->N+1
Conference Instructors and Planning Committee: Carlos Suarez, MD, DABMA (Dipl. American Board of Medical Acupuncture) North Bend Medical Center, Bandon Clinic, Coos Bay, Oregon Scott Fitzpatrick, RES (Rehabilitative Exercise Specialist), Dipl. OM (Oriental Medicine), East Tennessee Acupuncture Clinic, MSHA Indian Path Hospital, Kingsport, TN Credentialed at Holston Valley Hospital, faculty appointment ETSU Quillen College of Medicine; Specializes in sports medicine, pain medicine and infertility Beth Fox, MD, MPH Associate Professor and Residency Program Director, ETSU Family Medicine, Kingsport Family Practice Center, Kingsport, TN Christine Newell Kwasigroch, M.Ed., Ph.D. Senior Program Planner, Office of Continuing Medical Education, Quillen College of Medicine, East Tennessee State University, Johnson City, TN
Continuing Education Credit: CME Credit Quillen College of Medicine, East Tennessee State University designates this live activity for a maximum of 18.0 AMA PRA Category 1 Credits™. Physicians should only claim
credit commensurate with the extent of their participation in the activity. Nursing Credit As an Accreditation Council on Continuing Medical Education (ACCME)-approved provider, the CME credit offered during this educational activity is accepted by the ANCC, AACN and the NCCPA for recertification. CME Certificates By submitting the ‘Request for Credit Form’ (which is part of your Conference Handouts,) or by signing the sign in sheets, credits will be added to your online TRANSCRIPT, which is maintained in the ETSU Office of CME. You may print your transcript online from our website, http://www.etsu.edu/cme. Go to ‘For Learners’ ‘Transcript of Your Earned Credits’. Please allow 2 weeks from the conference date before accessing your transcript. Check with the Registration Desk for information on how to access and print your transcript, or to see an example transcript, or call our office, 423-439-8027, with questions.
Disclosure Information East Tennessee State University’s Quillen College of Medicine, Office of Continuing Medical Education (OCME) holds the standard that its continuing medical education programs should be free of commercial bias and conflict of interest. It is the policy of the OCME that each presenter and planning committee member of any CME activity must disclose any significant financial interest/arrangement or affiliation with corporate organizations whose products or services are being discussed in a presentation. Each of the following speakers and conference planners* have completed a disclosure form indicating that they or members of their immediate family have NO financial interest/arrangement or affiliation that could be perceived as a real or apparent conflict of interest related to: (a) the content of this activity or (b) the supporters involved with this activity:
*Carlos Suarez Scott Fitzpatrick
Beth Fox *Chris Newell Kwasigroch
Commercial Support Disclosure: It is the policy of the Office of Continuing Medical Education at East Tennessee State University’s Quillen College of Medicine to disclose all Commercial Supporters of this educational activity from which educational grants were received. No commercial support has been received for this program. The Syllabus with Presentations is available as a pdf document on our website: http://www.etsu.edu/cme
The materials, products, procedures, and opinions presented at this continuing medical education activity are being made available by East Tennessee University’s Quillen College of Medicine for educational purposes only, and while they reflect the viewpoint or approach of the presenter and/or technical exhibitor, they are not to be attributed to East Tennessee State University’s Quillen College of Medicine. This material is not intended to represent the only, or necessarily the best, method or procedure appropriate for the medical situation, but rather is intended to present an approach, view, statement, or opinion of the authors/presenters and/or technical practitioners which may be helpful or of interest to other practitioners. Before prescribing any medication, primary references and full prescribing information should be consulted. East Tennessee State University’s Quillen College of Medicine does not endorse any products or the content of any presentation or exhibit. CME Educational Conference Planner: Christine Newell Kwasigroch, M.Ed.-M.F.T., Ph.D. 423-439-8074
[email protected] If you have questions, concerns, or comments about this activity, please contact: Barbara J. Sucher, M.B.A., Associate Dean for Continuing Medical Education
[email protected] or 423-439-8081
Quillen College of Medicine Office of Continuing Medical Education (CME) offers educational programs for Physicians, Nurse Practitioners and Physician Assistants, as well as for other health care providers in NE Tennessee, SE Kentucky, SW Virginia, and Western North Carolina.
Mark Your Calendar for these upcoming events: 7th Annual Primary Care Research Day
When: February 19, 2011 Where: Stanton Gerber Hall, VAMC, Johnson City, TN What: A day long meeting of presentations and informational sessions on primary care research activities in the region Learning Objectives: • Summarize health-related research being conducted in the region • Summarize how local research findings can be applied in practice settings • Identify personally relevant health-related issues and determine how they might be investigated and addressed • Seek out opportunities to collaborate with other health professionals Who should attend: Primary Care and Specialty Physicians, PAs, NPs; Public and Allied Health practitioners; Pharmacists; Residents, medical and nursing students; and others with an interest in Primary Care research Credits: 4.5 AMA PRA Category 1 Credits
***
New Horizons in Cardiovascular Health for Primary Care Providers
When: February 25-26, 2011 Where: The Millennium Centre, Johnson City, TN Who should attend: Primary Care Physicians, PAs, NPs; ER physicians, Cardiologists, Pediatricians, Public and Allied Health practitioners, residents, medical and nursing students, and others with an interest in cardiovascular health Credits: 5.25 AMA PRA Category 1 Credits
***
4th
Annual Southeast Student Wilderness Medicine Conference
When: March 5-6 (Sat-Sun), 2011 Where: Stanton Gerber Hall, and Winged Deer Park, Johnson City, TN What: Lectures, team-based scenarios and skills-building Learning Objectives: • Demonstrate increased awareness of medical problems unique to the wilderness and remote environments • Prevent, diagnose and manage illnesses or injuries in remote locations • Promote increased awareness of safety and accident prevention in remote/rural surroundings • Demonstrate skills applicable to wilderness medicine Who should attend: Primary Care Physicians, PAs, NPs; ER physicians and EMTs; residents, medical and nursing students; and others with an interest in rural and wilderness medicine Credits: 8.0 AMA PRA Category 1 Credits
As a result of participating in this workshop, attendees should be better able to: Describe and discuss the underlying fundamentals of acupuncture Identify strong Chinese meridian points Use Meridian points in clinical practice for diverse treatments Confidently and securely 'needle' patients Perform simple and effective pain, anxiety and energy treatments
Introduction to Medical Acupuncture
January 7‐9, 2011
Introduction to Medical Acupuncture Johnson City, TN January 7‐9th 2011
Objectives: After attending this workshop, you should be able to: • Describe and discuss the fundamental ideas underlying Acupuncture. • Confidently and securly ‘needle’ patients. • Perform simple yet effective pain, anxiety and energy treatments. 1/5/2011
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Day 1 Objectives • • • • • • • •
Acupuncture history Introduction to Chinese Medicine Evidence that it actually works How does it work? How does it work? Needle Shock/Adverse Effects Microsystems: The Ear introduction DEMO on a patient/ yourselves/videos Questions/ Adjourn
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Introduction to Medical Acupuncture
January 7‐9, 2011
First things first! • What is it? • Acupuncture is the procedure of: • Inserting • Manipulating needle(s) into point(s) on the body
For pain or Tx.
• The earliest written record of acupuncture is the text Shiji and Neijing. 1/5/2011
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China • China: Stone Age, pressure or heat to certain points on the body to provoke a healing response. • Beginning with stone needles (bian stones), then bronze, iron and currently stainless steel, acupuncture has been used to stimulate the body's ability to heal itself. 1/5/2011
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History: Origins in China • Nei Jing ( Yellow Emperor’s Inner Classic ): Han Dynasty: 2nd Century BC. • Nan Jing ( Classic of Difficulties ): 1st and 2nd Centuries AD. Channels and etiology of diseases, illness and therapeutic needling.
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China • Zhen Jiu Jia Yi Jing ( Comprehensive Manual of Acupuncture and Moxibustion ): In 282 AD, was the first text to speak only of acupuncture and moxa. • Acupuncture knowledge flourished between the Han and the Ming Dynasty ( 200 BC until 1644 AD ). • During this time period a compendium was written. The name? 1/5/2011
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China • Zhen Jiu Da Cheng: Or Da Cheng. This was a compendium of Acupuncture and Moxibustion that was taken to Europe and Asia. Asia
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Introduction to Medical Acupuncture
January 7‐9, 2011
Origins in Asia • Over the millennia, acupuncture and Oriental medicine spread throughout Asia and developed into many schools of thought in different parts of China Korea Japan and different parts of China, Korea, Japan and Southeast Asia. • There are many acupuncture schools native to these countries.
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Disseminated to Europe • 17th to 19th century: Portuguese, French, Dutch and Danish missionaries, traders and physicians travelling and working in China and Japan, took this knowledge back home ( at first in Latin ). this knowledge back home ( at first in Latin ) • The Da Cheng was the first book to be translated into French in the early 20th Century.
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Introduction to Medical Acupuncture
January 7‐9, 2011
Europe • Early 1800’s: There was a big flurry of primitive acupuncture experimentation by physicians in France, Germany, England, Italy, Sweden and the USA Sweden and the USA. • This flurry would not return to Europe until the early 1900’s and in the USA until the 1970’s. 1/5/2011
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Europe • Soulie de Morant: French diplomat, worked in China from 1901 to 1917. He published articles in French from Chinese and Japanese Medical Texts and on his return taught Clinical applications of Acupuncture to French applications of Acupuncture to French physicians. • During the 1950’s in Post War Europe, both Acupuncture and Western Medicine Co‐ developed. 1/5/2011
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History: Acupuncture in the US • Came in with Chinese immigrants starting in the 19th century, mostly for heavy work in the West Coast. • Initially only treated their own kin. • Not for general public. • Of course, no titles or work permits! 1/5/2011
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James Reston • Journalist • Went with President Nixon to China in 1971 . First visit of a US president to China after the cold war started. • Had appendicitis dx. Had appendicitis dx • Had a surgery done with only acupuncture as analgesia and a local xylocaine injection to skin. • …. And no pain! • When he returned home… he wrote an article about acupuncture, bringing it into mainstream. 1/5/2011
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USA • Consensus NIH 1997 : Acupuncture is being "widely" practiced —by thousands of physicians, dentists, acupuncturists, and other practitioners—for relief or prevention of pain and for various other health conditions. • 2007 National Health Interview Survey: 3.1 million U.S. adults and 150,000 children had used acupuncture in the previous year in the USA. • Between the 2002 and 2007 NHIS, acupuncture use among adults increased by approximately 1 million people. 1/5/2011
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USA • On March 28, 1996, acupuncture needles were reclassified by the Food and Drug Administration from, "Class 2, experimental" devices to "Class devices to Class 1, Approved 1 Approved". • Acupuncture needles are now considered general medical instruments, similar to scalpels or forceps. 1/5/2011
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Opening of Acupuncture Schools • Acupuncture and Oriental medicine is now licensed in 32 states and the District of Columbia. , p y • Over 15,000 non‐physician licensed acupuncturists are estimated to be practicing in the United States and almost that many students are currently enrolled in an acupuncture college. • It is the fastest growing health care profession. 1/5/2011
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Non‐Physician acupuncturists • Are regulated and evaluated by The National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM), established in 1982. • The mission of the NCCAOM is to establish, assess, and promote recognized standards of competence and safety in Acupuncture and Oriental medicine for the protection and benefit of the public. 1/5/2011
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Medical Acupuncture • Began in the USA in 1987. • By a group of physicians who were graduates of the "Medical Acupuncture for Physicians" f h "M di l A f Ph i i " training programs sponsored by UCLA School of Medicine.
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AAMA: American Academy of Medical Acupuncture
• Began in 1987 • The AAMA is the sole physician‐only professional acupuncture society in North America accepting members from a diversity America, accepting members from a diversity of training backgrounds. • Physician members represent all of the disciplines of medical acupuncture currently practiced in the United States and Canada. 1/5/2011
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ABMA: American Board of Medical Acupuncture
• The ABMA was established on April 26, 2000. Was created as an independent entity within the corporate structure of the AAMA. • Mission of ABMA: to promote safe, ethical, efficacious medical acupuncture to the public by maintaining high standards for the examination and certification of physician acupuncturists as medical specialists. 1/5/2011
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ABMA • Responsible for our tests • To be a diplomate: • Training >300 hours of training ( at least 100 hours of practice ) over 2 years experience hours of practice ), over 2 years experience needling patients. Over 500 patients treated. • Pass a comprehensive exam ( given once a year ) • Present 10 cases • Gain the title DABMA. 1/5/2011
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Fellow of the AAMA • On top of DABMA: – 1 Research paper published – Or 10 hours of CME given • You get a title of FAAMA
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Currently • 539 DABMA’s • 110 FAAMA’s
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At the end of this course… • We will go over this information again… • And allow you to know what reputable courses are held in the USA to learn h ld i h USA l acupuncture.
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You will learn… You can help with chronic diseases such as ♦Pain Syndromes ♦Fibromyalgia ♦Chronic Fatigue Syndrome ♦Anxiety/Depression ♦IBS ♦... 1/5/2011
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Have you seen a similar patient? • John Doe, Age 44 wm • Symptoms: – Difficulty Concentrating – Irritable, insomniac I i bl i i – Fatigue – “Contractions” Spasms – Explosive Headaches
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John Doe • PMH: H/O Alcohol and drug use… now at AA and NA. • H/O Withdrawal seizures • Has tried: Phenobarbital, tegretol, Keppra, H i d Ph b bi l l K Valium, Dilantin, Thorazine, Haldol. SSRI helped for 1 to 2 years. Not anymore. • Western Dx: Migraines, Seizures, Epilepsy, Personality disorders. 1/5/2011
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John Doe • Neurologist: Tension State, psychomotor epilepsy, Migraine Headache, Cerebral deficit?
ST ++ HT LR/SP
‐ LU
++ LR
‐ SP
‐ KI
++ TH
HT
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DX? • RISING LIVER FIRE: This explains Headache, Insomnia, irritability , spasms. • Af After 1 needle treatment: Patient was able 1 dl P i bl to REST, have a good night sleep • No contractions and Calm: First time in 15 years 1/5/2011
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Introduction to Chinese Medicine • Acupuncture developed well over 2 millennia. It mainly was based on treatment responses and adaptation to social situations. • The language used is a language of an AGRARIAN SOCIETY. It describes how MAN FUNCTIONS HARMONIUOSLY WITH THE UNIVERSE. 1/5/2011
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John Doe • Neurologist: Tension State, psychomotor epilepsy, Migraine Headache, Cerebral deficit? il Mi i H d h C b l d fi it?
ST LR/SP
++ HT
‐ LU
++ LR ++ LR
‐ SP
‐ KI
++ TH
HT
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Introduction to Chinese Medicine It involves the influence of the following external elements: t l l t 1. Wind 2. Heat 3. Damp 4. Dryness 5. Cold 1/6/2011
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Introduction to Chinese Medicine It also describes our responses to internal extremes: t 1. Anger 2. Excitement 3. Worry 4. Sadness 5. Fear 1/6/2011
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HEART Heat Excitement Summer Fire SOUTH LIVER Wind Anger Spring Wood EAST
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SPLEEN Damp Worry Indian Summer Earth CENTER
KIDNEY Cold Fear Winter Water NORTH
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LUNG Dry Sadness Fall Metal WEST
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Introduction to Medical Acupuncture
January 7‐9, 2011
Introduction to Chinese Medicine It involves the influence of the following external elements: 1. Wind 2 H 2. Heat 3. Damp 4. Dryness 5. Cold 1/5/2011
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Introduction to Chinese Medicine It also describes our responses to internal extremes: 1. Anger 2 E i 2. Excitement 3. Worry 4. Sadness 5. Fear 1/5/2011
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HEART Heat Excitement Summer Fire SOUTH LIVER Wind Anger Spring Wood EAST
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SPLEEN Damp Worryy Indian Summer Earth CENTER
KIDNEY Cold Fear Winter Water NORTH
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LUNG Dry Sadness Fall Metal WEST
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Introduction to Chinese Medicine The classical anatomy of acupuncture consists of: • Energy Channels called MERIDIANS that transverse the body. • They are named after organs. These MERIDIANS Th d f Th MERIDIANS will sometimes encompass and most of the times extend the organ’s realm of influence by adding functional, energetic and metaphorical qualities. 1/5/2011
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Introduction to Chinese Medicine For example: • KIDNEY: Supervises bone, marrow ( bone and brain ), joints, hearing, hair, will and motivation. motivation • SPLEEN: Not the useless organ as in western medicine. Supervises digestion, blood production.
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Introduction to Chinese Medicine • Qi (Vital Energy or Life Force) Qi is the vital energy or life force that flows through the body's Meridians, Yin Yang organs, and is responsible for moving the blood. It has got a myriad of subtypes. yp • Qi can transform, transport, hold, raise, protect, and warm. • Qi also has a normal flow or direction of movement associated with each Yin and Yang organ: is frequently translated as "energy flow". 1/5/2011
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Qi • When Qi is low: All body functions require Qi: Digestion, elimination, immune reactions, etc. • Th The most classic symptoms for Qi l i f Qi deficiency is d fi i i fatigue, weakness, shortness of breath, low voice and poor appetite.
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Yin and Yang • Two opposites, yet complement each other. Difficult to decide when one starts and the other ends
Which is which? 1/5/2011
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Yin and Yang • YIN and YANG: too much of either one is bad. • The ideal is a balance of both. • The The hot Saharan desert for example is an example hot Saharan desert for example is an example of extreme Yang • The bitter cold Antarctica is extreme Yin.
• Neither is desirable!!! 1/5/2011
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• Yin and Yang need to be in balance. If they are not, then disease will appear. • Tao represents balance between Yin and Yang. • There are states of maximum Yang ( top ) and g( p) maximum Yin ( bottom ) and intermediate steps that have both Yang and Yin. • Both are tightly connected and cannot exist one without each other. 1/5/2011
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Yin and Yang in a person • In man, both Yang and Yin coexist. • The head is Yang with respect to the feet, but Yin with respect to the heavens. • The feet are Yin with respect to the head, but g p Yang with respect to the earth. • The abdomen is Yin, while the back is Yang (frontal structures are Yin, back structures are Yang). • The skin is Yang, while internal organs are Yin (internal structures are Yin, external structures are Yang). 1/5/2011
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Which is which?
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In a normal State…
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What happens if there is YIN DEFICIENCY? The body cannot balance the fire ( Yang ). Hot, dry and thirsty Aversion to heat Aversion to heat Constipation ( dryness ) Dry body fluids, red cheeks, dark and concentrated urine night sweats. 1/5/2011
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What about YANG Deficiency? Yang: Metabolic activity of the body that produces heat. Cold Feeling LOW YANG th ill b fl id LOW YANG: there will be fluid collection (swelling ). No circulation of fluids. The patient will prefer hot drinks, will be fearful of cold, will have cold limbs, diarrhea, discharge of bodily fluids, edema. 1/5/2011
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Circulation of Qi • Qi circulates on the meridians: Yang to Yin and then from Yin to Yang on a circular and endless movement through the day and the night. • On the body, the down‐flowing Yang Channels ( BACK ) connect with the up‐flowing Yin Channels ( FRONT ) at both fingertips and toetips. 1/5/2011
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Shen and Jing • Shen: Mind. Manifests in the eyes, housed by the heart. If disturbed, can’t sleep. Anxious! • Ji Jing: Essence. You have “Inherited Jing” NOT E Y h “I h i d Ji ” NOT RENEWABLE ( Pre Natal ) and “Renewable Jing” ( Post Natal breath and food ). • Stored in Kidney. When it is lost you get FATIGUE! 1/5/2011
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Blood • Blood ( Xue ):Dense vital substance, flows through the vessels to moisten and nourish the Yin Yang organs, the tendons and muscles, the skin and the sensory organs the skin, and the sensory organs. • Blood houses the Shen (Mind). Stored by liver, governed by heart and controlled by spleen.
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• Low Blood: Symptoms can include dizziness (not enough blood to fill the brain), scanty menstruation, insomnia, dry skin and hair. • Stagnant blood: Pain
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Other Chinese Medicine Principles… When a Chinese Medicine Practitioner evaluates a patient he/she will observe and examine for the following symptoms: • YIN or YANG YIN or YANG • HOT or COLD This will help the practitioner • EXCESS or DEFICIENCY To formulate a diagnosis • INTERIOR or EXTERIOR • WET or DRY 1/5/2011
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HOT vs COLD Cold
Hot
Pale face
Red or flushed face
Feeling cold
Feeling warm
Cold limbs, cold hands
Warm hands, warm body
Fear and avoidance of cold
Aversion and avoidance of heat
Wears more clothes
Wears less clothes
Absence of thirst
Thirst
Wetness or dampness in body
Dryness in body
Preference for warm drinks and foods
Preference for cold drinks and foods
Slow movements
Quick and active movements
Withdrawn manners
Active, and “out there”
Curls up
Restless, agitated
Body secretions are clear, watery, odorless
Body secretions are yellow, strong and foul odor
Pain is worse with cold
Pain gets worse with heat
Pain gets better with warmth
Pain gets better with cold
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Hot vs Cold • Relevance: • HOT: Goes with Excess. • Needs to be dispersed, not stimulated. Needs to be dispersed not stimulated • COLD: Goes with Deficiency • Needs to be stimulated: Heat, electricity, Moxa. 1/5/2011
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Excess vs Deficiency Deficiency
Excess
Symptoms of chronic disease
Acute disease
Diseases tend to be less intense, less sharp and less critical
Diseases more intense, sharper and critical
Pain is dull and diffuse
Pain is sharper, severe and localized
Weakness on chest and abdomen
Fullness of chest and abdomen, with pressure Pain feels better with pressure or after Pain feels worse with pressure or after eating eating Body is underactive Body is hyperactive 1/5/2011
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January 7‐9, 2011
HOT vs COLD Cold
Hot
Pale face
Red or flushed face
Feeling cold
Feeling warm
Cold limbs, cold hands
Warm hands, warm body
Fear and avoidance of cold
Aversion and avoidance of heat
Wears more clothes
Wears less clothes
Absence of thirst
Thirst
Wetness or dampness in body
Dryness in body
Preference for warm drinks and foods
Preference for cold drinks and foods
Slow movements
Quick and active movements
Withdrawn manners Withdrawn manners
Active and “out Active, and out there there”
Curls up
Restless, agitated
Body secretions are clear, watery, odorless
Body secretions are yellow, strong and foul odor
Pain is worse with cold
Pain gets worse with heat
Pain gets better with warmth
Pain gets better with cold
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Excess vs Deficiency Deficiency
Excess
Symptoms of chronic disease Symptoms of chronic disease
Acute disease Acute disease
Diseases tend to be less intense, less sharp and less critical
Diseases more intense, sharper and critical
Pain is dull and diffuse
Pain is sharper, severe and localized
Weakness on chest and abdomen
Fullness of chest and abdomen, with pressure Pain feels better with pressure or after Pain feels worse with pressure or after eating eating Body is underactive Body is hyperactive 1/6/2011
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WOMAN #1
WOMAN #2
Cough, low grade fever, SOB Dx: Lung infection
Cough, low grade fever, SOB Dx: Lung infection
RECEIVES ATB
RECEIVES ATB
Gets better
Doesn’t get better
Excess Condition
Deficiency Condition: The problem is not the bug
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PROBLEM: Weak immune system.
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The 4 Deficiencies • Qi deficiency: For ALL BODY FUNCTIONS: All body functions require Qi: Digestion, elimination, immune reactions, etc. Sx of Qi deficiency is fatigue, weakness, shortness of breath, low voice and poor appetite. • Blood deficiency: Blood is also thought to flow through the meridians nourishing, maintaining and moisturizing the organs (including hair and skin ). Sx: dizziness (not enough blood to fill the brain), scanty menstruation, insomnia, dry skin and hair. 1/5/2011
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• Yang deficiency: Yang produces heat. If there is no Yang, there is COLD feeling. Yang makes fluids circulate, so if there is little Yang, there will be fluid collection (swelling). The patient will prefer hot drinks, will be fearful of cold, will have cold limbs, diarrhea, discharge of bodily fluids, edema. • Yin deficiency: Sx: hot and dry. Other symptoms would be thirsty, aversion to heat, constipation (dryness), dry body fluids, red cheeks, dark and concentrated urine, night sweats.
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WOMAN #1
WOMAN #2
Cough, C h low grade fever, SOB l d f SOB Dx: Lung infection
Cough, C h low grade fever, SOB l d f SOB Dx: Lung infection
RECEIVES ATB
RECEIVES ATB
Gets better
Doesn’t get better
Excess Condition
Deficiency Condition: The problem is not the bug PROBLEM: Weak immune system.
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Dry vs Wet Wetness
Dryness
Feeling of heaviness, stickiness
Dryness of skin, hair, mouth, throat, lips
Heaviness of head Heaviness of arms and legs Oppression of chest Body secretions white or clear
Reduced or absent secretions
Wetness in lungs produce cough with Wetness in lungs produce cough with abundant sputum.
Dryness in lugs produces dry coughs with Dryness in lugs produces dry coughs with little or no sputum
Loss of appetite
Localized accumulations of fluids: edema, skin swelling, vaginal discharge
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Interior vs Exterior Interior
Exterior
Chronic Illness
Acute Illness
Gradual Onset
Sudden Onset
Deap Weak Pulse
Strong Superficial pulse
Deep pain
Myalgia
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Dry vs Wet Wetness
Dryness
Feeling of heaviness, stickiness
Dryness of skin, hair, mouth, throat, lips
Heaviness of head Heaviness of arms and legs Oppression of chest Body secretions white or clear
Reduced or absent secretions
Wetness in lungs produce cough with abundant sputum.
Dryness in lugs produces dry coughs with little or no sputum
Loss of appetite
Localized accumulations of fluids: edema, skin swelling, vaginal discharge
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Uses of Acupuncture PAIN MANAGEMENT ( NIH 1997 ) 1. Lumbosacral pain 2. Headache and craniosacral pain 3. Perioperative pain 4. Osteoarthritic pain 5. Cervical Pain
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Uses of Acupuncture Pain cont’ 5. Tennis Elbow 6. Musculoskeletal pain 7. Pain of organic lesions 8. Pain of malignancy
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Uses of Acupuncture General Medical Problems 1. Nausea from surgery and Chemo. 2. Acute and chronic asthma 3. Dysmenorrhea 4. Head trauma and CVA sequelae. 5. UTI 6. Bowel function 1/5/2011
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EBM and Acupuncture • The development of the evidence base for acupuncture was summarized in a review by researcher Edzard Ernst and colleagues in 2007. • Systematic reviews conducted between 2000‐2005: The effectiveness of acupuncture of acupuncture remains a a "The controversial issue. ... The results indicate that the evidence base has increased for 13 of the 26 conditions included in this comparison”. • For 7 indications it has become more positive (i.e. favoring acupuncture) and for 6 it had changed in the opposite direction." 1/5/2011
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• It is concluded, that acupuncture research is active. The emerging clinical evidence seems to imply that acupuncture is effective for some but not all conditions. Edzard Ernst
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The most researched… • Acute Low back pain: Insufficient evidence for or against either acupuncture or dry needling, though for chronic low back pain acupuncture is more effective than sham treatment but no more effective than conventional and alternative treatments for short‐term pain relief and improving function. However, when combined with other conventional therapies, the combination is slightly better than h conventional i l therapy h alone. l • Chronic LBP : A review for the American Pain Society/American College of Physicians found fair evidence that acupuncture is effective. • In vitro fertilization: There are both positive and negative reviews regarding the effectiveness of acupuncture when combined with in vitro fertilisation. 1/5/2011
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• Post Operative Nausea and Vomiting: A Cochrane Review: Acupuncture effective in reducing them with minimal side effects, though it was equal to the effectiveness of preventive antiemetic medications. • Another Cochrane Review concluded that electroacupuncture can be helpful in the treatment of vomiting after the start of chemotherapy, but more trials were needed to test their effectiveness versus modern antivomiting medication. • Neck pain: Acupuncture is more likely to be effective than sham treatment and offers short‐term improvement compared to those on a waiting list. Idiopathic headaches: Show evidence to respond, though the evidence is not conclusive and more studies need to be conducted. 1/5/2011
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• Migraine: Acupuncture was associated with slightly better outcomes and fewer adverse effects than prophylactic drug treatment. • Osteoarthritis of the knee: Shows EBM with both positive and negative results. The Osteoarthritis Research Society in 2008 concluded that acupuncture may be useful for treating the symptoms of osteoarthritis of the knee. • Fibromyalgia: A systematic review of the best five RCT available concluded that there was insufficient evidence to support the use of acupuncture in the treatment of the symptoms of it. 1/5/2011
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Cochrane Has concluded there is insufficient evidence to determine whether acupuncture is beneficial, often because of the paucity and poor quality of the research, and that further research is needed: • Asthma, Bell’s Palsy, Cocaine Dependance, Depression, Dysmenorrhea, Epilepsy, Glaucoma, Insomnia, IBS, RA and OA, Schizophrenia, Smoking Cessation, Acute Stroke, Tennis Elbow and Vascular Dementia. 1/5/2011
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How does it work? • Traditional Version: • 12 Organs/Meridians that interact one with each other. • 6 are parenchymal 6 h l and 6 visceral or d6 i l transporting. • PATHOLOGY happens when a disharmony is created. There might be a Qi flow disruption, blood flow disruption or metabolic disruption. 1/5/2011
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Medical Acupuncture for Physicians How does it work? A Few Theories 1. Conduction of electromagnetic signals: Acupuncture channels are strategic conductors of electromagnetic signals. 0.5‐1 CUN: Less resistance/MORE ELECTRICAL CONDUCTION and PROPAGATION Speed at acupoints Tc99 ( FRENCH ): 1.7 cm/s Others: 0.1 cm/s 2. Activation of opioid systems: Several types of opioids may be released into the central nervous system during acupuncture treatment, thereby reducing pain. Pomeranz 1970’s. Beta endorphin, Enkephalins, Dynorphins
2 Systems Low frequency HIGH INTENSITY Slow onset analgesia Generalized effect Continues after stimulation Continues after stimulation Cumulative effect Endorphin dependant Naloxone inhibits effect 1/5/2011
High Frequency LOW INTENSITY Rapid onset analgesia Segmental effect Active only during Active only during stimulation No cumulative effect Monoamine dependant (NE/S ) Naloxone doesn’t inhibit effect
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2 Systems Low frequency HIGH INTENSITY Sl onset analgesia Slow t l i Generalized effect Continues after stimulation Cumulative effect Endorphin dependant Naloxone inhibits effect 1/6/2011
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Low frequency 2‐4 Hz Skin Spinal Cord p Midbrain Brain Conscience
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High Frequency LOW INTENSITY R id onset analgesia Rapid t l i Segmental effect Active only during stimulation No cumulative effect Monoamine dependant (NE/S ) Naloxone doesn’t inhibit effect 78
High Frequency >70Hz Skin Spinal Cord p Midbrain
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Low frequency 2‐4 Hz Skin Spinal Cord Midbrain Brain Conscience
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Medical Acupuncture for Physicians 3. Changes in brain chemistry, sensation, and involuntary body functions: Studies have shown that acupuncture may alter brain chemistry by changing the release of neurotransmitters and neurohormones. Examples: Serotonin, Norepinephrine, Acetylcholine,Dopamine, GABA, Substance P Substance P FUNCTIONAL MRI’s: Decrease in signals from Hippocampus and amygdala ( Limbic system : MEMORY, EMOTIONS and ANXIETY/FEAR: )
Medical Acupuncture for Physicians 3. Direct CNS stimulation to sensation, immune reactions, sympathetic and parasympathetic systems.
4. Bimetallic Effect. THERMOCOUPLE EFFECT OF KELVIN‐THOMAS describes a gradient along KELVIN‐THOMAS describes a gradient along the length of a homogenous conductor with a temperature gradient produced by the ends of the conductor at different temperatures
Introduction to Medical Acupuncture
Medical Acupuncture for Physicians Bimetallic Effect
6. Gate theory: • In this theory, there exist two main nerve fibers: A‐beta and C nerve fibers. • A‐beta nerve fibers are large, fast conducting, and have a low volt threshold. • C nerve fibers are small, slow conducting, and have a high volt threshold.
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Medical Acupuncture for Physicians Bimetallic Effect
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Introduction to Medical Acupuncture
Substancia Gelatinosa
Acupuncture stimulation
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Local effect • Release of spasm/Fascia Release • Breakup of fibrosis • Stimulation of blood flow • Muscle contraction/relaxation • Gate theory 1/5/2011
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Adverse effects? • The (FDA) regulates acupuncture needles for use by licensed practitioners • N Needles dl be b manufactured f d and labeled dl b l d according to certain standards. For example, the FDA requires that needles be sterile, nontoxic, and labeled for single use by qualified practitioners only. 1/5/2011
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Adverse Effects • Estimates of adverse event :671 to 1,137 per 10,000 treatments, generally minor. • 2010 systematic review concluded that acupuncture has been h b associated d with h deaths, d h most commonly due to pneumothorax. • It states that with adequate training, fatalities can be avoided. 1/5/2011
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Adverse Effects • Nerve injury • Brain damage or stroke: deep needling at the base of the skull • Pneumothorax from deep needling into the lung • Kidney damage from deep needling in the low back • Haemopericardium: needling over a sternal foramen • Terminating pregnancy with the use of certain acupuncture points that have been shown to stimulate the production of adrenocorticotropic hormone (ACTH) and oxytocin • Transmission of infectious diseases: with unsterilized needles and lack of infection control 1/5/2011
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Needle Shock! • “A vasovagal reflex that manifests as lightheadedness, general malaise, cold perspiration, nausea, and, in extreme situations loss of consciousness situations, loss of consciousness”. Joe Joe Helms • Happens in young, fit, healthy males at the 1st or 2nd visit. • Mostly if the needles are placed in the upper back with the patient sitting. 1/5/2011
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Needle Shock Helms' suggested treatment includes: 1. Removing the needles 2. Lying the patient down 3. Maintaining verbal communication to allay patient anxiety 4. Tonify points: GV 26, ST 36 (Tsu San Li), and LI 4.
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Microsystems Represent the whole body on a limited space Practical to treat Several types…! Hand ( Korean ), Scalp ( Chinese and Japanese ), Ear, etc. • Sounds strange to you? • • • •
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The Ear • Auricular acupuncture is a diagnostic and treatment system based on normalizing the body's dysfunction through stimulation of ear points. points • France 1950: Paul Nogier first presented his observations of the somatotopic correspondences of the ear and is considered the Father of modern ear acupuncture. 1/5/2011
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The Ear • Theory: Due to the ear’s origins from groups of pluripotent cells ( embryo’s ecto, meso and endoderm cells ) contains information from the whole organism and creates regional organization centers representing different parts of the body. centers representing different parts of the body. • Stimulation of a reflex point in the ear seems relieve symptoms of distant pathologies. • Modern research: Use for analgesia and anxiety related disease, while tobacco dependence and other substance abuse still need confirmation. 1/5/2011
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The Ear • Dr Nogier :Concept of an inverted fetus map on the external ear. • He developed this theory after noticing that some patients attending his clinic had a small scar from a burn on part of their ear scar from a burn on part of their ear. • On inquiring into this, he was told that a very small area of their ear had been cauterized by a certain Madame Barrin for treatment of sciatic pain—a treatment that they proved very rapid and effective. 1/5/2011
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The Ear • Nogier then mapped his points. • His first great insight was the recognition of the homunculus, ‘the man in the ear’, the representation and anatomical correlation of the inverted fetus in the ear. • Points on the body, for example the knee, corresponded precisely with the fetal representation of the knee in the auricle • His study was translated to French and then reached China! 1/5/2011
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Acupuncture treatments time? • Should remain usually for 10‐15 minutes on… • On certain “heat” or “pain” conditions may stay longer. l • Very debilitated and ill patients should only get short periods of acupuncture… and always with tonification. 1/5/2011
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What to expect? • Relaxation – Patient might get sedated • Patient might get “HYPER”, especially after the first treatment. fi • Patient can get needle shock… please be vigilant!!!
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What to do? • NO EXCESS: food, activity, sex, drinks, drugs… • Try to rest for 36 hours… timeframe for a whole loop of Qi h l l f Qi circulation. i l i • “No bamboo shoots”
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Demo on Yourselves! • Shoes off! • Socks off! • Localize the space between the first and the second metacarpals and metatarsals. • Follow instructor’s prompts! 1/5/2011
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This treatment is called 4 gates • The upper needles are placed on an acupuncture point called Large Intestine 4. • Th The lower needles are placed on a point called l dl l d i ll d Liver 3. • Both of these points are considered …
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We will practice 4 gates later… For now let’s suffice that it is a good: 1. Balancing treatment. 2. First treatment regardless of complaint. 3. “Quick and dirty” treatment (full day of patients). 4. Great treatment for headaches, toothaches, etc. 1/5/2011
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Introduction to Medical Acupuncture Meridians Upper Limb
Introduction to Medical p y Acupuncture Day 2 Point Review Head, Neck, Upper Limb, Command Points
Meridians Upper Extremity
Objectives Day 2 1. Go over the 12 meridians plus Governing and Conception Vessels. 2. Go over SHU and MU POINTS. 3 G 3. Go over Lower Limb Command Points, L Li b C dP i Treatment with Needles, Principal Meridians, N‐>N+1. 4. Practice Point location and simple circuits.
January 7‐9, 2011
Introduction to Medical Acupuncture Meridians Upper Limb
Don’t Forget!
Command Points • All Points between knees and toes and between elbows and fingers and fingers
January 7‐9, 2011
Introduction to Medical Acupuncture Meridians Upper Limb
LUNG: ZANG
Lung • Starts at LU1 at: On the upper lateral chest, 1 cun below LU 2, level in the first intercostal space, 6 cun from the midline of the chest. MU. • Ends at LU11 at: On the radial side of the thumb, 0.1 cun distance from the corner of the nail bed. Use: This distance from the corner of the nail bed Use: This point can be good for removing excess energy and can have a calming affect. TING POINT, which are usually only used in emergencies such as fainting or more severe acute problems because they are painful areas to needle.
January 7‐9, 2011
Introduction to Medical Acupuncture Meridians Upper Limb
Function • The lung meridian governs the lungs and breathing. • The The lungs are very sensitive to emotional lungs are very sensitive to emotional feelings and turmoil. When people are experiencing excessive sadness and grief, this can lead to imbalances and illness in the lungs.
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Introduction to Medical Acupuncture Meridians Upper Limb
Important Points • LU7,8,9*: Energy moving Points: Use for: Asthma, Coughing, Chest Pain, Phlegm. • LU‐7 Use: This point is a powerful lung point used to get rid of excess cold and wind. dt t id f ld d i d Location: 1.5 cun above the transverse crease of the wrist, superior to the styloid process of the radius.
• LU1 MU POINT LUNG: Use: This is an alarm point and is usually tender and sensitive when respiratory problems are present. Location: 6 cun lateral to anterior midline level with the 1st intercostal space, 1 cun below LU 2. Caution: needle oblique to avoid lungs. • LU‐2 Use: Regulates Lung, good for asthma. Location: g g g 6 cun lateral to the anterior midline below the clavicle in the depression medial to the coracoid process. needle oblique to avoid lungs. • LU1 and 2: For Lung tonification. Cough, asthma, pneumonia, etc.
January 7‐9, 2011
Introduction to Medical Acupuncture Meridians Upper Limb
January 7‐9, 2011
Introduction to Medical Acupuncture Meridians Upper Limb
Large Intestine: FU
Large Intestine • Starts at LI1: Use: heat, pain, stagnation, for eye and ear pain and inflammation, toothache, headaches. Location: 0.1 cun posterior to the corner of the nail on the radial side of the index finger. TING POINT. • Ends at LI20: at the At the midpoint lateral to the border of the ala nasi, in the nasolabial groove. Loss of smell or taste, nasal discharge, any nose a/or sinus issues, nasal polyps, rhinitis, sinusitis, allergies.
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Introduction to Medical Acupuncture Meridians Upper Limb
LI20 LI19
LI4
LI1
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Function • The main function of the large intestine and its meridian is to process waste and pass it through the body. • When there are blockages in the large intestine meridian they often manifest as intestine meridian, they often manifest as digestion and abdominal trouble because these processes are closely tied together. • Used locally for Head and Neck pain and Shoulder/Elbow pain.
Important Points • LI4: This is one of the most used points in acupuncture and it is a very important analgesic point. • This point is often used in treating pain and can be treating pain and can be used to treat pain in all parts of the body, specially the head. • It also promotes the flow of energy in the upper body. Location In the middle of the 2nd metacarpal bone on the radial side.MASTER POINT
• LI11:At the lateral end of the transverse cubital crease midway between LU 5 and the lateral epicondyle of the humerus. For: Tennis Elbow point and funtionally for diarrhea. LI15: Anterior and inferior to the acromion Anterior and inferior to the acromion in in • LI15: a depression found with the arm abducted. Shoulder pain. • LI19/20: Local Points. For Sinus congestion.Nasal polyps, sores. Nosebleed
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Introduction to Medical Acupuncture Meridians Upper Limb
January 7‐9, 2011
Introduction to Medical Acupuncture Meridians Upper Limb
Triple Heater or Warmer or San Jiao: FU
Triple Heater ( San Jiao ) • Starts at:TH‐1 Location: 0.1 cun posterior to the corner of the nail on the ulnar side of the ring finger. TING POINT. Use: Locally. • Ends at: TH23 Location: In a depression at the lateral end of the eyebrow. Use: Eye pain, redness, swelling, twitching, drooping eyelid. • Organ without an organ
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Function • The triple heater meridian gets its name from having 3 heating sections. • Th The job of the Triple Heater Meridian is to j b f h Ti l H M idi i regulate the flow of energy in these three regions.
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Functions • TH is used for: Tinnitus, temporal headaches, shoulder, pain a/or inflammation in the throat. • Eye diseases E di
Important Points: • TH5:Location: 2 cun above TH 4 between the radius and the ulna. Use: Headache, migraines in any area especially with stiffness or pain in the posterior and lateral aspects of the neck. the posterior and lateral aspects of the neck. • Local: Upper limb disorders including the elbow, forearm, wrist and hand. MASTER POINT. Sympathetic switch.
• TH14: Location: On shoulder, posterior to LI 15, in a depression inferior and posterior to the acromion when arm is abducted. Local for Shoulder pain • TH17‐21: Local for ear disease. • TH23: Local for eyes and temporal headaches
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Introduction to Medical Acupuncture Meridians Upper Limb
January 7‐9, 2011
Introduction to Medical Acupuncture Meridians Upper Limb
Master of the Heart or Pericardium ZANG
Master of the Heart ( Pericardium ) • Starts at: MH1. Location: 1 cun lateral to the optimal nipple in the 4th ICS. Use: fullness of the chest, headache, blurred vision. MU POINT. • Locally: Breast disorders, insufficient lactation • EEnds at: MH9. Location: 0.1 cun d MH9 L i 01 posterior to the corner i h of the nail on the ulnar side of the middle finger. (*discrepancy ). Use: clearing heat in the Heart. Stiff tongue, speech disorders, especially those arising after a stroke. Restoring consciousness. TING POINT.
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Introduction to Medical Acupuncture Meridians Upper Limb
Function • The pericardium provides the heart with physical and emotional protection from damage and disruption by excessive energies generated by the other organs, such as anger from the liver fear from the kidneys and grief from the liver, fear from the kidneys, and grief from the lungs.
Important Points • MH6: Location: 2 cun above the wrist crease between the tendons of palmaris longus and flexor carpi radialis. Use: • Chronic Heart symptoms from Qi y p Q stagnation. g • Opens and relaxes the chest, chest tightness, asthma, angina ( R/O MI !!! ), palpitations. • Insomnia, mania, nervousness, stress, poor memory. • Nausea, seasickness, motion sickness, vomiting, epigastric pain. • Carpal Tunnel Syndrome.
• MH7: Location: In the middle of the wrist . Use: Cooling heat that is effecting the Heart of a deficient or excess nature. For hot flashes. • Carpal Tunnel Syndrome.
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Introduction to Medical Acupuncture Meridians Upper Limb
MH6
MH7
Heart: ZANG
Heart • Starts at: HT1: Location: In the center of the axilla on the radial side of the axillary artery. Use: cold, numbness, pain in shoulder or arm. Frozen shoulder. Pain a/or distention of the upper thoracic area. • Ends at: HT9: Location: 0.1 cun posterior to the corner of the nail on the radial side of the little finger. TING POINT: clear heat and obstruction from the opposite end of the channel (eye pain , redness, mouth ulcerations, sores ). Restore consciousness ‐ heart attack, stroke. Emergency heart attack point ‐ strong stimulation.
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Function • 'King' of the organs. The Internal Medicine Classic states: 'The heart commands all of the organs and viscera, houses the spirit ( SHEN ), and controls the emotions.' • When the heart is strong and steady, it controls the emotions; when it is weak and wavering, the emotions rebel and prey upon the heart‐mind, which then loses its command over the body.
Important Points • HT3: Location: With the elbow flexed, between the ulnar end of the cubital crease and the medial epicondyle of the humerus. Use: • Pain, numbness, tremors, stroke. • Spirit disorders from phlegm: epilepsy, depression, anxiety, nervousness, poor memory, fuzzy thinking. • Treats: redness of the eyes, mouth ulcerations. T d f h h l i • HT7: Location: At the wrist crease, on the radial side of the flexor carpi ulnaris tendon, between the ulna and the pisiform bones. Use: Emotional issues:insomnia, excessive thinking., anxiety, mania, nausea, panic, excessive fear. Heart palpitations from any etiology as well as irregular heart beat, pounding heart, angina.
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Introduction to Medical Acupuncture Meridians Upper Limb
HT7
HT3
Small Intestine
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Introduction to Medical Acupuncture Meridians Upper Limb
Small Intestine: FU • Starts at: SI1:Location: 0.1 cun posterior to the corner of the nail on the ulnar side of the little finger. Use: TING POINT : for eye redness, earache, tinnitus, sore throat, stiff tongue. • Ends at: SI19: Location: Anterior to the tragus and d h d posterior to the condyloid process of the mandible, in a depression formed when the mouth is opened. Use: Ear problems of any etiology, inflammation, tinnitus, hearing loss.
SI19
Function • The SI receives partially digested food from the stomach and further refines it. Moves the impure wastes onwards to the large intestine for elimination. • Controls the more basic emotions, such as 'broken heart'.
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Important Points: • SI3: Location: When a loose fist is made, at the ulnar end of the distal palmar crease proximal to the 5th metacarpal phalangeal joint at the junction of the red & white skin. Use: Pain in the scapula, and arm. Stiff neck, cervical strain/sprain, pain of the back or neck. / Occipital headaches, combine with local points. Night sweats, eye redness, inflammation, visual dizziness, earache, tinnitus. • Calms the spirit.
• SI9,10,11: Local points for pain. • SI18: Location: below the outer canthus of the eye in a depression on the lower border of the zygoma. Use: Gathering Point TMM, Yang LE.
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PRACTICE: Points to find • Master Points and Local points • • • • • •
LUNG: Lung 7,8,9,11,1,2 LARGE INTESTINE: 1 4 11 15 19 20 LARGE INTESTINE: 1,4,11,15,19,20 HEART: 1,3,7,9 SMALL INTESTINE: 1,3,9,10,11,19 MASTER OF THE HEART: 1,6,7,9 TRIPLE HEATER: 1,5,14, 23
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Introduction to Medical Acupuncture Governing Vessels
Governing Vessel and p Conception Vessel Two midline meridians
Governing Vessel
GV20 and GV 24.5
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Introduction to Medical Acupuncture Governing Vessels
Governing Vessel – DU MO • Starts : The channel starts midway between the tip of the coccyx bone and the anus . GV1 • It then flows upward inside the spinal column to the nape of the neck, and ascends to the vertex. Along the forehead, it descends to the nose bridge, then to the lips. • Ends at: Ending at the labial frenulum inside the upper lip. GV26 • Responsible for: Uniting Qi of Yang Organs: Sea of Yang. • Important Points:
GV 1 INDICATIONS 1. Diarrhea.. Hemorrhoids.. Prolapse of rectum. Constipation. LOCATION: Midway between the tip of the coccyx and the anus. Locate the point in prone position. GV 4 GV 4 INDICATIONS 1. Leukorrhea. 2. Impotence. 3. Stiffness of the back. Lumbago. Low back pain or sprain. Sciatica. LOCATION: Below the spinous process of the 2nd lumbar vertebra.
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Introduction to Medical Acupuncture Governing Vessels
GV 20 Function: MENTAL/EMOTIONAL Mental disorders, CVA, dizziness, shock, insomnia, seizures. Prolapse of rectum, prolapsed anus Hemorrhoids. • Location : 7 cun above the posterior hairline, on the midpoint of the line connecting the apexes of the two auricles.
Meet GV24.5 YIN TANG • Third Eye Point. "Directly between the eyebrows, in the indentation where the bridge of the nose meets the forehead." • Calms the body to relieve nervousness. Calms the body to relieve nervousness • “The Valium Point”. • Frequently combined with GV20. Electricity 2 Hz.
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Introduction to Medical Acupuncture Governing Vessels
GV20 and GV 24.5
• GV 26 Mental disorders seizures (infantile convulsion coma , shock , hysteria sychosis The dead reviver! • LOC Below the nose, a little above the midpoint of the philtrum.
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Introduction to Medical Acupuncture Governing Vessels
Stimulate for fatigue • GV4: Ming Men: Gate of life. • Stimulation will: Increase Kidney Yang. • Stimulate: GB25 to BL23 ++ add GV4, BL52 for more effect. ff • Super ming men with BL22
Conception Vessel‐ REN MO
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Introduction to Medical Acupuncture Governing Vessels
Conception Vessel • Starts at: Midline between the anus and the scrotum in males and between the anus and the posterior labial commissure in females. CV1. • It ascends anteriorly to the public region. • Ends at: Depression in the center of the mentolabial groove CV24 • Responsible for: Uniting the Qi of all YIN MERIDIANS.
• CV 3 INDICATIONS: 1. Enuresis.. Retention of urine.. Irregular menstruation.. Leukorrhea.. Seminal emission. Uterine bleeding. Prolapse of uterus. LOCATION: On the anterior midline, 4 cun below the umbilicus, 1 cun above the upper border of symphysis pubis.
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Introduction to Medical Acupuncture Governing Vessels
• CV 4 INDICATIONS 1. Enuresis.. Dysmenorrhea.. Leukorrhea.. Prolapse of uterus.. Irregular menstruation.. Seminal emission. Frequency of micturition. Retention of urine. Amenorrhea. Uterine bleeding. Postpartum hemorrhage. Hernia. Urinary tract infection. Nephritis. P l Pelveoperitonitis. Functional uterine bleeding. it iti F ti l t i bl di Spermatorrhea. Impotence. 2. Diarrhea.. Lower abdominal pain. Lower abdominal pain. Dysentery. Round worms in the intestinal tract. LOCATION: On the midline of the abdomen, 3 cun below the umbilicus. • CV5: Similar to CV3 and 4.
• CV8: DO NOT NEEEDLE. Heat with Moxa or lamp only • CV 12 INDICATIONS: 1. Abdominal distention.. Vomiting.. Gastric pain. Regurgitation. Diarrhea. Gastritis. Gastric ulcers. P l Prolapsed stomach. Acute intestinal obstruction. d t h A t i t ti l b t ti Stomach ache. Diarrhea. Constipation. Indigestion. MU for STOMACH LOCATION: On the midline of the abdomen, 4 cun above the umbilicus.
CV 14 INDICATIONS: 1. Vomiting.. Regurgitation. Difficulty in swallowing. Nausea. Stomach ache. Hiccough. 2. Pain in the cardiac region and the chest. Palpitation. Angina pectoralis. MU for Heart. Palpitation. Angina pectoralis. MU for Heart. LOCATION: On the midline of the abdomen, 6 cun above the umbilicus.
January 7‐9, 2011
Introduction to Medical Acupuncture Governing Vessels
CV 17 INDICATIONS 1. Pain in the chest.. 3. Asthma. Bronchial asthma. Bronchitis. MU for Master of the Heart Master of the Heart. LOCATION: On the midline of the sternum, between the nipples, level with the 4th intercostal space.
January 7‐9, 2011
Introduction to Medical Acupuncture Governing Vessels
Stimulate for fatigue and pelvic pain • • • •
Dan tien: CV3,4,5 Always stimulate! Will learn this later! And Practice.
January 7‐9, 2011
Introduction to Medical Acupuncture Shu Mu
SHU MU Meridian Circuit Very simple and powerful
Shu and Mu systems • • • •
Very important. Address organ problems directly. Simple protocol. Not for pain: For function
Back Shu Points T3 Lung T4 Master of the Heart T5 Heart
T9 Liver T10 Gallbladder T11 Spleen T12 Stomach L1 Triple Heater L2 Kidney L4 Large Intestine S1 Small Intestine S2 Bladder
January 7‐9 2011
Introduction to Medical Acupuncture Shu Mu
January 7‐9 2011
Back Shu Points Lung
BL 13
Urinary Bladder
BL 28
Large Intestine
BL 25
Kidney
BL 23
Stomach
BL 21
Pericardium
BL 14
Spleen
BL 20
Triple Heater
BL 22
Heart
BL 15
Gall Bladder
BL 19
Small Intestine
BL 27
Liver
BL 18
Front Mu Points Lung Master of the Heart Heart
Liver Gallbladder Spleen Stomach
Kidney
Triple Heater Small Intestine Bladder
Front Mu Points Lung
LU 1
Urinary Bladder
CV 3
Large Intestine
ST 25
Kidney
GB 25
Stomach
CV 12 CV 12
Pericardium
CV 17 CV 17
Spleen
LR 13
Triple Heater
CV 5
Heart
CV 14
Gall Bladder
GB 24
Small Intestine
CV 4
Liver
LR 14
Introduction to Medical Acupuncture Shu Mu
Examples? • Work on Energy or fatigue? • Work on Kidneys: • Electricity from GB25 ( MU ) to BL23 ( SHU ) • ( Usually 2 Hz x 10‐12 min )
Good Diagnosis? • • • • • • • •
Put a needle in each Shu of the solid Organs: Bilaterally. BL13 Lung BL15 Heart BL15 Heart BL18 Liver BL20 Spleen BL23 Kidney And observe…
January 7‐9 2011
Introduction to Medical Acupuncture Shu Mu
Asthma? • Needle : LU1 ( or LU2 ) to BL13 • Electricity 2Hz • X10‐12 minutes • Will Present 2 “Extra Points” for asthma:
January 7‐9 2011
Introduction to Medical Acupuncture Shu Mu
At both sides of T1 • At 0.5 CUN: Dingchuan • At 1 CUN: Chuanxi • At 1.5 CUN: BL11
DING CHUAN Chuan Xi
How about IBS? • Mu Point for Spleen: LR13 to Shu Point for Spleen: BL20 • Mu Point for Large Inestine:ST25 to Shu Point for Large Intestine: BL25 for Large Intestine: BL25. • May add a CV12 with heat as a local point.
January 7‐9 2011
Introduction to Medical Acupuncture Shu Mu
January 7‐9 2011
Introduction to Medical Acupuncture Final Pulse and Tongue
PULSE AND TONGUE DIAGNOSITIC BASICS SCOTT FITZPATRICK, DIPL.O.M., RES EAST TENNESSEE ACUPUNCTURE CLINIC
CLINICAL USEFULNESS • CHINESE DOCTORS HAVE DOCUMENTED THE PRESENTATION OF PULSES AND TONGUES FOR GREATER THAN 1000 YEARS. “THE YELLOW EMPEROR’S GUIDE TO INTERNAL MEDICINE” WAS ORIGINALLY COMPOSED AS A TREATISE OF INTERNAL MEDICINE, BETWEEN THE YEARS OF 2697‐2657 BC. WITH THE ONSET OF THIS JOURNEY, THE DOMUNENTATION OF THE USEFUL ASPECTS OF THE PULSE AND TONGUE AS SOURCES OF INSIGHT TO THE HUMAN BODY BEGAN TO ACCUMLUATE……
WHERE TO START PULSE
TONGUE
• PALPATE RADIAL ARTERY, GENTLY……. • USE INDEX, MID AND RING FINGER • LET PULSE COME TO YOU!!!!!!! • EVALUATE BY ADDING AND SUBTRACTING PRESSURE AT EACH POSTION
• OBSERVE COLOUR, SHAPE, SIZE, COATING, CRACKS AND ANY IRREGULARITIES • OBSERVE BODY AND COATING OF TONGUE INDEPENDANTLY • OBSERVE DISCOMFORT OF PATIENT WHILE EXTENDING TONGUE
January 7‐9, 2011
Introduction to Medical Acupuncture Final Pulse and Tongue
ANATOMICAL CORRELATION PULSE
TONGUE
• DIAPHRAGM UP IS MOST DISTAL PORTION • UMBILICUS TO DIAPHRAGM IS MIDDLE PORTION • UMBILICUS DOWN IS THE MOST PROXIMAL PORTION
• DIAPHRAGM UP IS THE DISTAL TIP • UMBILICUS TO DIAPHRAGM IS MIDDLE PORTION • UMBILICUS DOWN IS THE BACK OF TONGUE
PULSE LOCATIONS • LEFT • (DISTAL) HEART/SI • (MID) LIVER/GB • (PROMIMAL) KIDNEY (PROMIMAL) KIDNEY YIN/BLADDER, PROSTATE
• RIGHT • (DISTAL) LUNG/LI • (MID) SPLEEN/ST • (PROXIMAL)KIDNEY (PROXIMAL)KIDNEY YANG/ ESSENCE
• SUPERFICIAL LOCATION IS FIRST LISTED
INTERPRETING PULSE • ANATOMICAL REGION AND ITS RELATIONSHIP TO PULSE LOCATION • STRENGTH: INCLUDING FORCE, SPEED, VOLUME AND REGULARITY VOLUME AND REGULARITY • DEPTH AND LOCATOIN OF PULSE AND ITS RELATION TO THE INTRENSIC AND EXTRENSIC FACTORS • OTHER OBJECTIVE FINDINGS THAT WOULD EFFECT YOUR ABILITY TO INTERPRET PULSE
January 7‐9, 2011
Introduction to Medical Acupuncture Final Pulse and Tongue
COMMON TERMS • WIRY, FORCEFUL, FLOATING, CHOPPY, HESITANT, SOFT, SCATTERED, ANCHORLESS, EMPTY, THREADY OR THIN, DEEP, SUPERFICIAL, KNOTTED, SLIPPERY, PINGING OR PAINFUL, INTERMITTENT, JUST TO NAME A FEW….
WHAT I FEEL • STRESS, ANXIETY, PAIN, PROSTATITIS, INSOMNIA, GI DYSMOTILITY AND PAIN, , , , CHRONIC AND ACUTE UTI, PREGNANCY, CAD, FATIGUE, MENSTRUAL CYCLES, HOT FLASHES, CANCERS, PROXIMITY TO PASSING………..AND PACEMAKERS!
WHEN I USE PULSE DIAGNOSIS • WHEN A PATIENT HAS BEEN DETERMINED TO BE “MEDIACLLY NORMAL” BUT BELIEVES SOMETHING IS WRONG. • WHEN A PATIENT HAS DIFFICULTY WHEN A PATIENT HAS DIFFICULTY ARTICULATING OR DIFFICULTY INTERPRETING DISEASE • WHEN I FEEL WE ARE MISSING SOMETHING • WHEN I AM CHOSING AN APPROPRIATE FORMULATION FOR A PATIENT
January 7‐9, 2011
Introduction to Medical Acupuncture Final Pulse and Tongue
TONGUE EVALUATION • • • • • • •
COATING BODY THINKNESS STRENGTH COLOUR RELATION TO ANATOMICAL REGION ABNORMALITIES
COMMON TERMS COATING
BODY
• DRY, DAMP, GREASY, MOSSY OR FURRY, SCALLOPED, AND COLOURS: WHITE, YELLOW, GREY BLACK GREY, BLACK
• PINK, PURPLE, RED, TEETH MARKS, THIN, TREMBLING, FLACCID, DEVIATED, CRACKED PALE CRACKED, PALE • NORMAL TONGUES ARE NOT “GEOGRAPHICAL”
PEARLS • TONGUE BODY INDICATES DEEP CHRONIC CONDITION OF BODY, COAT INDICATES ACUTE CONDITION • PULSES ARE LIKE SNOWFLAKES, NO TWO ARE PULSES ARE LIKE SNOWFLAKES, NO TWO ARE THE SAME…………………….. • PULSES AND TONGUES CAN BE DIFFICULT TO INTERPRET AND DEFINE, CAN BE ENIGMATIC AND EMPERICAL, LEAVING A LOT TO THE EXPERIENCE AND CONFIDENCE OF THE DOCTOR…….
January 7‐9, 2011
Introduction to Medical Acupuncture Final Pulse and Tongue
PEARLS CONTINUED… • WE ARE NOT TRYING TO FIX ANYTHING, WE ARE TRYING TO HELP THE BODY HELP ITSELF…….. • TAKE THIS KNOWLEDGE, MAKE IT YOUR OWN, TAKE THIS KNOWLEDGE MAKE IT YOUR OWN AND BE ON YOUR WAY………… • YOUNG DOCTORS DIAGNOS VERY SUPERFICIALLY, OLD DOCTORS DIAGNOS VERY DEEPLY……………… • LET US NOW PRACITCE AND SHARE!!!!!!!!!!!!!!
THANK YOU FOR SHARING YOUR TIME WITH ME www.easttnacupuncture.com
[email protected] 423‐230‐0005 Please contact me with questions
January 7‐9, 2011
Introduction to Medical Acupuncture Meridians Lower
Introduction to Medical p y Acupuncture Day 2 Point Review Lower limb, Command Points
Don’t Forget!
January 7‐9, 2011
Introduction to Medical Acupuncture Meridians Lower
Command Points • All Points between knees and toes and between elbows and fingers and fingers
Spleen: Zang
Spleen • Starts at SP1: Location: On the medial side of the big toe. 0.1 cun posterior to the corner of the nail.Use: Any Bleeding Issues from SP Deficiency ‐ reckless bleeding, hemorrhage, blood in the urine/stools Emotional issues of worry ‐ worried urine/stools. Emotional issues of worry ‐ worried dreams, depression. • Ends at SP21:Location: Mid‐axillary line in the 6th inter‐costal space. Great LUO of the Spleen.
January 7‐9, 2011
Introduction to Medical Acupuncture Meridians Lower
Function • The function of the spleen organ‐energy system includes the pancreas. p y • The spleen directly influences and is reflected by the tone and condition of muscle tissue. Weak limbs and muscular atrophy are indications of deficient spleen energy.
Important points • SP4:Location: In a depression distal and inferior to the base of the 1st metatarsal bone at the junction of the red and white skin. Use:severe abdominal a/or epigastric pain, dysentery, food poisoning, GYN masses, fibroids, cysts, irregular menstruation. • SP6:Location: SP6:Location: 3 cun 3 cun directly above the tip of the medial directly above the tip of the medial malleoulus on the posterior border of the tibia. Use: Tonify Yin and Blood, all Spleen disorders. Digestive disorders, prolapse, irregular, menstrual cycle, amenorrhea, dysmenorrhea,bleeding disorders, Insomnia, palpitations, and other anxiety related emotions. Dizziness, hypertension. • Intersection point of the SP, LV and KD (3 leg yin meridians)
January 7‐9, 2011
Introduction to Medical Acupuncture Meridians Lower
• SP9: Location: On the lower border of the medial condyle of the tibia in the depression posterior and inferior to the medial condyle of the tibia. (or) On the lower border of the medial condyle of the tibia on level with the tuberosity of the tibia. Use: SP 9 will drain damp from the lower warmer. Chronic yeast infections, candida. Medial Knee Pain. • SP21: Location: On lateral side of the chest and on the mid‐axillary line in the 6th inter‐costal space. Use: Mentioned classically that when this point is deficient, all the joints are flaccid, and when excess, pain all over the body. Thoracic pain tx. Tx for cough, chest oppression, shortness of breath.
January 7‐9, 2011
Introduction to Medical Acupuncture Meridians Lower
January 7‐9, 2011
Introduction to Medical Acupuncture Meridians Lower
Stomach: FU
Stomach • Starts at ST1: Location: Below the pupil, between the eyeball and the infraorbital ridge. Use: Any eye issue. • Ends Ends at: ST45: Location: 0.1 cun at: ST45: Location: 0 1 cun posterior to the posterior to the corner of the nail on the lateral side of the 2nd toe. Use: Release heat ,headaches, toothaches, facial pain, TMJ, breast pain. Agitation , insomnia w/heat signs ‐ calms the spirit.
January 7‐9, 2011
Introduction to Medical Acupuncture Meridians Lower
Function • The stomach is called the 'Sea of Nourishment'. • It is responsible for providing the entire system with postnatal energy from the digestion of food and fluids.
Important Points • ST1‐8: Local Points face, teeth, TMJ. • ST25:MU point for Large Intestine. Location: 2 cun lateral to the umbilicus. Use: All intestinal issues ‐ constipation, diarrhea, distention, pain. • Connects the Upper and Lower burners. • ST36:Location: one finger width lateral from the anterior border of the tibia. Use: Arguably the strongest point in the body. All issues involving the Stomach a/or the Spleen: Abdominal pain, diarrhea, gas, bloating, indigestion, etc. • breast problems, lower leg pain. • Support Lung function in cases of asthma, wheezing, dyspnea. • Psychological disorders ‐ PMS, depression, nervousness.
ST1‐8
ST36
ST25
January 7‐9, 2011
Introduction to Medical Acupuncture Meridians Lower
• ST40: Location: 8 cun below ST 35, one finger width lateral to ST 38, two finger widths lateral to the anterior border of the tibia. Use: Resolve Phlegm.Issues with the lower limbs involving pain, swelling, numbness, weakness, etc.
January 7‐9, 2011
Introduction to Medical Acupuncture Meridians Lower
January 7‐9, 2011
Introduction to Medical Acupuncture Meridians Lower
Liver: ZANG
Liver • Starts at: LR1. Location: On the lateral side of the the big toe, 0.1 cun from the corner of the nail. Use: Ting Point ‐ loss of consciousness, Uterine/Menstrual bleeding from excess or deficiency. • Ends up at: LR14. Location: On the mamillary line, directly below the nipple, 4 cun lateral to the AML in the 6th ICS. Use: Subcostal tension, chest/rib pain, LR overacting on the LU (cough, SOB). MU for LR. • Hepatitis, gallstones. • Anger, irritability, headaches, neck and shoulder pain.
January 7‐9, 2011
Introduction to Medical Acupuncture Meridians Lower
Function • The liver controls the peripheral nervous system, which regulates muscular activity and tension. • The inability to relax is often caused by liver dysfunction or imbalance in Wood energy. • Liver energy also controls ligaments and tendons.
• Liver function is reflected externally in the condition of finger‐ and toenails and by the eyes and vision. Blurry vision is often a result of liver malfunction. of liver energy can cause intense • Obstruction of liver energy can cause intense feelings of frustration, rage, and anger, and these emotions in turn further disrupt liver energy and suppress liver function, in a vicious self‐destructive cycle.
Important Points • LR2:Location: On the dorsum of the foot between the 1st and 2nd toes, proximal to the margin of the web at the junction of the red and white skin. Use: Generally, clears LR Fire ‐ extreme irritability, red / y / g face/eyes/tongue. • Clears Heat from the Lower Burner ‐ burning urination. • Lack of Qi flow to the extremities (cold hands/feet).
January 7‐9, 2011
Introduction to Medical Acupuncture Meridians Lower
• LR3:Location: On the dorsum of the foot in a depression distal to the junctions of the 1st and 2nd metatarsal bones. Use: • LR Qi Stagnation / LR Yang Rising : headaches, dizziness, canker sores. • Eye issues ‐ blurred vision, red, swollen, painful eyes. • Menstrual issues :‐ dysmennorrhea, amenorrhea, PMS, breast tenderness breast tenderness. • LR attacking ST/SP ‐ nausea, vomiting, constipation, diarrhea w/ undigested food. • Calming point ‐ anger, irritability, insomnia, anxiety. • With LI 4, four gates treatment ‐ powerfully effects the flow of Qi and Blood in the body.
• LR13: Mu for SP. Location: On the lateral side of the abdomen below the free end of the 11th rib. Use: • Assist with SP Deficient signs esp. from the LR invading the SP ‐ pain and distention of the abdomen, vomiting, constipation, diarrhea (or alternating), bloating, undigested food in the l ) bl d df d h bowels. • Hui Point of the Zang ‐ tonify all Zang organs.
January 7‐9, 2011
Introduction to Medical Acupuncture Meridians Lower
January 7‐9, 2011
Introduction to Medical Acupuncture Meridians Lower
Gallbladder: FU
Gallbladder • Starts at: GB1. Location: 0.5 cun lateral to the outer canthus of the eye in a depression on the lateral side of the orbit. Use: LR Yang/Heat Rising effecting the head ‐ headache, eye problems, similar to Taiyang which is used more. • Local Tx. • Ends at: GB44. Location: Location: 0.1 cun E d t GB44 L ti L ti 01 posterior to the corner of the nail on the lateral side of the 4th toe. Use: • Insomnia especially with nightmares ‐ LR/GB heat rising to effect the HT (fullness below the heart). • Issues with the sense organs (eyes, ears, nose, mouth, tongue)
January 7‐9, 2011
Introduction to Medical Acupuncture Meridians Lower
Function • It secretes the pure and potent bile fluids . • The common tension headache is caused by obstruction in the gall‐bladder meridian, which runs up over the shoulders and back of the neck to the top of the head and forehead. Such headaches are usually accompanied by neck and shoulder tension. • The gall bladder governs decisiveness.
Important Points • GB1‐20: Local Points. Use: Depends on what structure they are close to. • GB13: Location: Location: 0.5 cun within the hairline of the forehead at the outer cantus level. Use: Gathering Point Yang arm TMM.
• GB20: Location: In a depression between the upper portion of the sternocleidomastoid muscle and the trapezius, level with GV 16. Use: Neck pain. • GB21: GB21: Location: On the shoulder directly above Location: On the shoulder directly above the nipple at the midpoint of a line connecting GV 14 and the acromion at the highest point of the shoulder. Neck, Shoulder pain.
January 7‐9, 2011
Introduction to Medical Acupuncture Meridians Lower
• GB22: Location: On the midaxillary line when the arm is raised below the axilla in the 5th ICS (directly below HT 1). Use: Gathering Point TMM. Yin of arm. • GB25: Mu for KI. Location: On the lateral side of the abdomen on the lower border of the free end of the 12th rib. Use: Resolves: diarrhea (esp. watery/cold), bloating abdominal distention bloating, abdominal distention. • Diuretic point ‐ urinary retention, difficult urination, edema. • Uterine stones ‐ assists passage.
January 7‐9, 2011
Introduction to Medical Acupuncture Meridians Lower
• GB34: Location: In a depression anterior and inferior to the head of the fibula. Use: Hui of the tendons ‐ useful for treating soft tissue anywhere in the body, contracture, cramping, pain, spasm, weakness, numbness, paralysis.Sciatica • All disorders of the lateral regions of the body. • Cholecystitis, hepatitis, jaundice, nausea, vomiting, bitter taste in mouth, gallstones. • LR attacking SP ‐ LR ki SP counterflow fl Qi: nausea, vomiting, Qi ii indigestion, IBS • GB40:Location: Anterior and inferior to the external malleolus in a depression on the lateral side of the tendon of extensor digitorum longus. Use: Local Point.
January 7‐9, 2011
Introduction to Medical Acupuncture Meridians Lower
January 7‐9, 2011
Introduction to Medical Acupuncture Meridians Lower
Kidney: ZANG
Kidney: ZANG • Starts at: KI1 Location: Foot plantar aspect, 1/3 to 2/3 distal. Use: descends rising LR fire and excess LR Yang, headaches, tinnitus, chronic sore throat, insomnia, palpitations, loss of consciousness. TING POINT. KI1’: 0.1 CUN nail bed, medial th toe. aspect of the 5 p • Ends at: KI27 Location: In depression on lower border of clavicle, 2 cun lateral to the midline. Use: open and relax the chest, asthma, constricted breathing, cough, tonify KI deficiency in adrenal exhaustion, fatigue, lowered immunity, local for neck a/or jaw pain.
January 7‐9, 2011
Introduction to Medical Acupuncture Meridians Lower
Function • The kidney is regarded as the body's most important reservoir of essential energy. • The kidneys control sexual and h kid l l d reproductive functions , which the Chinese regard as a major indicator of health and immunity.
• The kidneys are responsible for filtering waste metabolites from the blood and moving them onwards to the bladder for excretion in urine. • The kidneys, particularly the adrenal glands, are especially vulnerable to damage from excessive stress and sexual abuse. In the Chinese view, such damage is a major cause of immune deficiency, low vitality, and sexual impotence.
January 7‐9, 2011
Introduction to Medical Acupuncture Meridians Lower
• The kidneys control the bones and nourish the marrow ( bone and CNS ). Therefore poor memory, inability to think clearly, and backache are all regarded as indicators of impaired kidney function and deficient kidney energy. • Kidney vitality is reflected externally by the condition of head and body hair and is associated condition of head and body hair and is associated with the aperture of the ears. Tinnitus (ringing ears) is thus a sign of kidney dysfunction. The kidneys are the seat of courage and willpower, and therefore any impairment in kidney energy results in feelings of fear and paranoia.
Important Points • KI3: Location: In depression midway between the tip of the medial malleolus and the attachment of the achilles tendon, level with the tip of the medial malleolus.Use: This is a helpful point for many urogenital disorders and helps strengthen and balance the energy in the kidney meridian. • KI10: Location: at the medial side of the popliteal fossa when the knee is flexed, between the tendons of semitendinosus and semimembranosus muscles. Use: clear damp‐ heat in the lower warmer, urgent/difficult urination, genital pain/itching, uterine bleeding.
January 7‐9, 2011
Introduction to Medical Acupuncture Meridians Lower
Bladder: FU
January 7‐9, 2011
Introduction to Medical Acupuncture Meridians Lower
Bladder • Longest! • Starts at:BL1. Location: In a depression, 0.1 cun above the inner canthus of the eye. Use: Eye pain, strain, redness, swelling, itching, twitching, blurry vision, etc. • Ends at:BL67. TING POINT. Location: 0.1 cun posterior to the corner of the nail on the lateral side of the little toe. Use: Clears pain a/or stagnation from the opposite end of the channel: headache, eye pain, sinus pain, etc. • Use with moxa to adjust breech fetal position (generally indirect moxa for 10‐20 minutes 1x/day).
Function • The bladder is responsible for storing and excreting the urinary waste fluids passed down from the kidneys. • As an organ the bladder has only this function, but as an energy system the bladder is but as an energy system the bladder is intimately related to the functions and balance of the autonomous nervous system ( sympathetic and parasympathetic trunks of the autonomous nervous system • .
January 7‐9, 2011
Introduction to Medical Acupuncture Meridians Lower
• The sympathetic system will cause tension and pain along the spine and its periphery. This tension and pain may be relieved by stimulating the flow of energy along the spinal branches of the bladder meridian. • Such stimulation induces total relaxation by switching the autonomous nervous system over to the restful, restorative parasympathetic mode
Important Points • BL1,2,10: LOCAL • BL11: HUI BONE . Location: 1.5 cun lateral to GV 13, level with T1. Use: Useful with any bone or problem such as osteoporosis, arthritis, inflammation, sensation of heat in the bones, etc. Useful adjunctive point to fh i h b U f l dj i i effect the lungs in cases of infections, colds a/or flus or asthma related conditions. • BL13,14,15,18,19,20,21,22,23,25,27: BACK SHU POINTS. Will be d/w later!
January 7‐9, 2011
Introduction to Medical Acupuncture Meridians Lower
• BL40:Location: Midpoint of the transverse crease of the popliteal fossa, between the tendons of biceps femoris and semitendinosis. Use: As the Lumbar Command Point, useful for all lumbar related issues: acute low back pain, sprain, muscle spasms, etc. • Good local point for leg and/or knee pain. p p • BL60:Location: In a depression between the tip of the external malleolus and the achilles tendon. Use: Main point for pain anywhere along the spine (BL40 may be used more for pain in the middle of the spine). • Main point for chronic low back pain a/or problems of pain a/or numbness in the lower limbs. • Main point for headache and other excesses effecting the head. • Induce labor or promote discharge of a retained placenta.
January 7‐9, 2011
Introduction to Medical Acupuncture Meridians Lower
January 7‐9, 2011
Introduction to Medical Acupuncture Meridians Lower
Points to memorize Master and Local Points • • • • • •
BL1, 2, 10, SHU, BL40, 60, 67 KI1, KI1’, KI3, KI10, KI27 LR1 3 13 14 LR1, 3, 13, 14 GB1, 13,20, 22, 25, 34, 40, 44 ST1, 25, 36, 41, 45 SP1, 3, 6, 9, 21
January 7‐9, 2011
Introduction to Medical Acupuncture Principle Meridians
Principal Meridians The Basics first!
• Command Points: Between hand and elbow and between toes and knees. • MOST IMPORTANT POINTS TO MOVE ENERGY MOST IMPORTANT POINTS TO MOVE ENERGY • NON COMMAND POINTS
Introduction to PM • 4 meridians that are related to each other. Energy circulates in a loop. • When Qi gets disrupted: YOU’ve got a problem: Fatigue pain swelling problem: Fatigue, pain, swelling. • The answer is: Make it flow well again. • 2 upper extremity meridians ( one yin one yang ) coupled with 2 lower extremity meridians ( one yin and one yang ).
January 7‐9, 2011
Introduction to Medical Acupuncture Principle Meridians
Shao Yin – Tai Yang
Shao Yin Tai Yang • Use it for: • Increase Energy • Tai Yang SI and BL Represents the very back of the Yang the Yang. • Should be used for central Back Pain, neck pain. Knee pain. • Shao Yin: Stimulate for energy and support of KI. • Dispel Anxiety.
January 7‐9, 2011
Introduction to Medical Acupuncture Principle Meridians Shao Yin – Tai Yang NÆN+1 For Back Pain HT3 or HT7 SI3
BL40 KI3
BL60
Jue Yin – Shao Yang
Jue Yin – Shao Yang • Shao Yang: GB Represents the side of the body: • Example: shoulder pain, hip pain, lateral headache, etc. • Jue Yin: LR related problems, wind problems, headaches, anger. • THE MH and TH portions: Useful to balance emotions.
January 7‐9, 2011
Introduction to Medical Acupuncture Principle Meridians
Jue Yin – Shao Yang
MH6
TH5
GB34
LR2 or LR3 GB40
Tai Yin‐ Yang Ming
January 7‐9, 2011
Introduction to Medical Acupuncture Principle Meridians
Tai Yin – Yang Ming • Yang Ming is the most anterior Yang… for anterior pain! • M Most important role is with digestion! You i l i i h di i !Y have: SP, LI, ST • Lung is used for lung and phlegm problems.
Tai Yin‐ Yang Ming
LI4
LU7 SP9
ST36 SP6
January 7‐9, 2011
Introduction to Medical Acupuncture Treating with Needles
Treating with Needles g gy Making the energy move!
The N‐‐‐‐‐>N+1 Principle
Acupuncture Needles • ACUPUNCTURE NEEDLES are ideal instruments due to their physical properties. • COMPOSITION: stainless steel shaft with a spiraled handle of copper, bronze, or alloy
Acupuncture needles • Typical needle is 1 to 8 cm long, 0.30.4mm in diameter or 28 to 26 gauge. • S Some off them th come with ith a tube t b to t place l them, some others come without them.
January 7‐9, 2011
Introduction to Medical Acupuncture Treating with Needles
NEEDLE IN DISPERSION • This gradient reaches equilibrium in 10-15 minutes. • Dispersion is used in conditions defined as problem of excess,, such as acute strain ap or sprain. • The needle inserted, allow reaction to take place, often produces local erythema of skin, reaches equilibrium as erythema clears.
January 7‐9, 2011
Introduction to Medical Acupuncture Treating with Needles
NEEDLE IN TONIFICATION • Manipulation of the needle manually. • Indicated in “deficiency states,” chronic or d f dysfunction ti states. t t • May be also tonified by heat, manual manipulation or electrical stimulation.
French add‐on: If you put 1 needle • You will generate local agitation.
If you place 2 needles • Will equilibrate: Second needle in circuit gives agitated equilibrium.
January 7‐9, 2011
Introduction to Medical Acupuncture Treating with Needles
If you place 3 needles • This will generate an energetic movement: • Third needle in circuit leads to dynamic equilibrium, thus flow within the meridian. • THIS IS A SIMPLE ENERGETIC TREATMENT. • For this movement you only need to insert needles on the affected limb or area to make the energy flow.
Example • Pain in internal Ankle • What Point?
KI3
January 7‐9, 2011
Introduction to Medical Acupuncture Treating with Needles
• You go: • Below 1: Ki1 or Ki2 • Above 2 needles: KI7,KI10
N‐‐‐ÆN+1 • N represents # of needles. • NÆN+1: Represents direction of flow of energy from f the th PM with ith least l t number b off needles to larger number.
For example • You want to move energy from YIN TO YANG for back pain: • N=1 N 1 • One needle on Yin, two on Yang. Thus the movement of the circuit is to Yang.
January 7‐9, 2011
Introduction to Medical Acupuncture Treating with Needles
SI3
BL40
KI3
Another Example • You want to energize a fatigue person! • You want to move energy to YIN! • N=1 at Yang • N+1 ( 2 ) at Yin… thus, the movement is to YIN.
KI10 BL40
KI3
January 7‐9, 2011
Introduction to Medical Acupuncture Treating with Needles
What is the plan? • Get the energy to move • This can be done within one meridian • Or within one principal meridian.
Meridian Energy movement • Say you have back pain: • Which Meridian?
January 7‐9, 2011
Introduction to Medical Acupuncture Treating with Needles
Bladder, Right? • Tai Yang right? • • • • •
So you go: KI3 BL40 BL60 For an N=1
PM system?
N=1
BL40 KI3 BL60
January 7‐9, 2011
Introduction to Medical Acupuncture Treating with Needles
January 7‐9, 2011
N=2 SI3 HT3
BL40 KI3 BL60
HT3
HT3
SI3 SI3
BL40
KI3 BL60
BL60
BL40
Introduction to Medical Acupuncture Treating with Needles
How about IBS? Diarrhea? • PM Couple?
Tai Yin Yang Ming Schematics N=1
LI4
ST36
SP6
Tai Yin Yang Ming Schematics N=2 LI4
ST36
LU7
SP9
SP6
January 7‐9, 2011
Introduction to Medical Acupuncture Treating with Needles
January 7‐9, 2011
LOCAL TREATMENT CV12: MU STOMACH ST25: MU LARGE INT.
ST25: MU LARGE INT.
LR13: MU SPLEEN
Meridian Treatment CV12 LU7
ST25 LU7 LI4
LR13
LI4
SP9 ST36
ST36 SP6
How about Stress? Or Headaches? Or Shoulder/Elbow pain? • PM couple?
Introduction to Medical Acupuncture Treating with Needles
January 7‐9, 2011
Jue Yin Shao Yang Schematics N=1 TH5
GB34 LR3 or LR2
Jue Yin Shao Yang Schematics N=2
TH5 MH6
GB34
GB40 LR3
Local Treatment TAI YANG
GB14 GV24.5
• LI15
TH14
LI15
Introduction to Medical Acupuncture
January 7‐9, 2011
Principal Meridian
MH6
MH6
TH5
TH5 GB34
GB40
GB34
LR3
LR3 GB40
GB34
Introduction to Medical Acupuncture Anxiety
ANXIETY TECHNIQUE AND FOUR GATES Day 3
Objectives Day 3 • Learn simple, yet very effective short treatments for: • Anxiety, energy, pain, muscle spasm, etc. • Get used to the needles. G d h dl • Make proper treatment plans to treat common problems. Use the plans to treat the patient.
Anxiety Technique • Simple, yet effective. • Use for acute anxiety or even chronic. • Please Please use variant for elderly or debilitated use variant for elderly or debilitated patients.
January 7‐9, 2011
Introduction to Medical Acupuncture Anxiety
January 7‐9, 2011
GV20
HT3
LR3
Note • On the original protocol you leave all needles to dispersion. • On a first modification: • Use GV20 to GV24.5: Use 2 Hz. U GV20 GV24 5 U 2 H • AGAIN: NOT FOR WEAK PATIENTS.
Variation • Add: MH7, LR2, HT7 • Even stronger input. • Add: KI3 to KI10 at 2Hz: In order to STOP depleting the patient.
Introduction to Medical Acupuncture Anxiety
GV20
January 7‐9, 2011
HT3
HT7
MH7
LR3 LR2
4 GATES • LR3 and LI4 Bilaterally • Use: ‐ This combination often is used to promote general qi l i circulation and relaxation i l i d l i and often is used as part of a larger acupuncture point prescription.
Introduction to Medical Acupuncture Anxiety
• Good Starting point. • Good Quick and dirty. • Use a lot for headaches with LOCALS. Use a lot for headaches with LOCALS.
4 Gates for Headaches • Regular protocol: • Add: GV20‐24.5 2 Hz • Add: Tai Yang Point
January 7‐9, 2011
Introduction to Medical Acupuncture Local Pain and Itch
Local Pain, Itch and Burn Protocols Day 3
So, the protocol: Idea: Move Energy AWAY from the problem! 1. Surround your problem with needles 2. Place your “MOVING ENERGY NEEDLES” according to the nearby Meridians so as to get di h b M idi the Energy AWAY from the problem. 3. You may use 15 Hz electricity to help moving Energy
Protocols are similar
January 7‐9, 2011
Introduction to Medical Acupuncture Local Pain and Itch
So, why all three? • Pain, itch and Burn most of the times indicates at least some criteria of an Excess condition. • What you do with Excess conditions is DISPERSE THEM. • The way you disperse is: 1. Apply needles surrounding the area 2. Move the Qi. 3. Bleed the TING point associated with the Meridian.
January 7‐9, 2011
Introduction to Medical Acupuncture Local Pain and Itch
Dispersing! To disperse needles even more: • Buy Peppermint Oil: Cooling oil. Dab the needles with it to further cool them down. dl i hi f h l h d • Use Alcohol and dab is with cotton on needles.
A word of caution! On an elderly or debilitated patient: • DO NOT ABUSE THE TIME YOU DISPERSE as you may deplete the patient from his VITAL d l h i f hi VITAL ENERGY ( QI ). Do not go above 15 min OR you may want to tonify KIDNEYS first!
Two Needle technique • Quick and Dirty treatment. • Not really acupuncture but more Electrical Si l i Stimulation and local dispersion. d l l di i
January 7‐9, 2011
Introduction to Medical Acupuncture Local Pain and Itch
FIRST NEEDLE TO BONE
Example SECOND NEEDLE TO TENDON/MUSCLE
Two needle technique 1. First needle to bone 2. Second needle to muscle 3. Stimulate for 30 min with high frequency: 30Hz++. 30H • You may want to use a limited meridian moving protocol too. 4. Extremely useful for a BUSY day at the office.
Local pain: Superficial Energetics
January 7‐9, 2011
Introduction to Medical Acupuncture Local Pain and Itch
Superficial Energetics It works because you release fascia! Local Effect Not quite Acupuncture! You fill up the pain area with THIN and SHORT You fill up the pain area with THIN and SHORT needles. • Do not Stimulate! • May leave for longer periods of time as it is less deep. • May use Alcohol for better dispersion. • • • •
January 7‐9, 2011
Introduction to Medical Acupuncture Cupping and Scraping
Cupping and Scraping Day 3
Cupping • Cupping is a form of traditional medicine found in many cultures worldwide It involves worldwide. It involves placing cups containing reduced air pressure (suction) on the skin.
• The cupping procedure commonly involves creating a small area of low air pressure next to the skin. • The cups themselves can be various shapes including balls or bells, and may range in size d i i from 1 to 3 inches (25mm – 75mm) across the opening. • Plastic and glass are the most common materials used .
January 7‐9, 2011
Introduction to Medical Acupuncture Cupping and Scraping
• The low air pressure required is created by heating the cup or the air inside it with an open flame or a bath in hot scented oils, then placing it against the skin. • As the air inside the cup cools it contracts and cools, it contracts and draws the skin slightly inside. • Vacuum can be created with a mechanical suction pump acting through a valve located at the top of the cup..
• They may be used by themselves or placed over an acupuncture needle. Skin may be • Skin may be lubricated, allowing the cup to move across the skin slowly.
• The skin may be lanced before placing the cup so that the vacuum draws fluids, primarily blood, into the cup as part of the treatment.
January 7‐9, 2011
Introduction to Medical Acupuncture Cupping and Scraping
• Depending on the specific treatment, skin marking is common after the cups are removed.
Cupping • Goal: To generate blood flow/lymph flow. TCM: circulate stagnant blood and qi (vital energy) in muscles and other soft tissues of the body. • For initial presentation of cold and flu. These techniques draw the pernicious influences to the surface of the body where they are more readily dispersed. • For: Muscle spasm and pain.
Scraping or GUA SHA • Shirt off . • Apply a small amount of massage oil ( We use Traumeel or Arnica Homeopathic cream ) Homeopathic cream ) to AREA to treat. • Start to scrape the skin of the AREA to treat. Avoid sharp objects. • We use a Chinese soup spoon.
January 7‐9, 2011
Introduction to Medical Acupuncture Cupping and Scraping
• The Skin will turn red. • Almost straight away very small, red dots of blood will begin to appear just below the skin surface skin surface. • This happens over the points of most tenderness. • Scrape for about 5‐10
January 7‐9, 2011
Introduction to Medical Acupuncture Tendinomuscular
Tendinomuscular Meridians Day 3
Tendinomuscular meridians • They circulate through the superficial aspect of the 12 Principal Meridians on the body. • Associated with muscles, tendons and ligaments of the body No connection to ligaments of the body. No connection to interior organs. • USE: Deal with ACUTE and SUBACUTE pain, swelling, burns, etc.
How do they work? 1. STIMULATE TING POINT ( LOCATED IN THE PM corresponding to pain/burn area ). 2 USE LOCAL POINTS SURROUNDING AREA 2. USE LOCAL POINTS SURROUNDING AREA 3. USE GATHERING POINT for the area involved.
January 7‐9, 2011
Introduction to Medical Acupuncture Tendinomuscular
Example: Tennis Elbow 1. TING POINT:
2. LOCAL POINTS:
3. GATHERING POINT:
GB13
LI4
LI11
LI1
Yang Upper Gathering Point • For the following Meridians: • LARGE INTESTINE LARGE INTESTINE • SMALL INTESTINE • TRIPLE HEATER
GB13
January 7‐9, 2011
Introduction to Medical Acupuncture Tendinomuscular
January 7‐9, 2011
Yang Lower Gathering Point • For the following meridians: SI 18
• Bladder Bl dd • Gallbladder • Stomach
Yin upper Gathering Point • For the following Meridians: H • Heart • Master of the Heart • Lung
GB22
Yin Lower Gathering Point • For the following Meridians: • Liver Li • Kidney • Spleen CV2
Introduction to Medical Acupuncture Tendinomuscular
Example: • Ankle pain ( lateral ). • TING: • Local: • Gathering:
January 7‐9, 2011
Introduction to Medical Acupuncture 5 Element and Great American Malady
Five Element Theory and Great American Malady Protocol y Day 3
Theory • The five element theory is needed for you to understand this very simple treatment, THE GAM or Great American Malady.
FIVE ELEMENT THEORY • A huge “type” of acupuncture. • There is a school that deals with ONLY this type of acupuncture. • For complex and multiproblem F l d l i bl task solving. k l i • NOT FOR PAIN, although it may aid in pain. • NOT FOR ANXIETY specifically although it might aid it.
January 7‐9, 2011
Introduction to Medical Acupuncture 5 Element and Great American Malady
Five Elements Theory HEART/ SMALL INTESTINE
SPLEEN/STOMACH
LIVER/GALLBLADDER
KIDNEY/BLADDER
LUNG/LARGE INTESTINE
HEART/SI FIRE HEART/ SMALL INTESTINE SUMMER HEAT JOY LIVER/GALLBLADDER LIVER/GALLBLADDER
SPLEEN/STOMACH SPLEEN/STOMACH EARTH
WOOD
MOUTH
HARVEST
SPRING
TISSUE: VESSELS
DAMPNESS
WIND
WORRY
ANGER
MOUTH
EYES
TISSUE:MUSCLES
TISSUE: TENDONS KIDNEY/BLADDER WATER
LUNG/LARGE INTESTINE
WINTER
FALL
COLD KIDNEY/BLADDER
DRYNESS LUNG/LARGE INTESTINE
FEAR
GRIEF/SADNESS
EARS
NOSE
TISSUE: BONE
TISSUE: SKIN
January 7‐9, 2011
Introduction to Medical Acupuncture 5 Element and Great American Malady
SHENG AND KE CYCLES
SHENG AND KE CYCLES • SHENG: Generative cycle. WOOD GENERATES FIRE, FIRE GENERATES EARTH ( as ASHES ), EARTH GENERATES METAL, METAL GENERATES WATER WATER GENERATES WATER, WATER GENERATES WOOD. • KE: Control Cycle. Water controls Fire ( or puts out fire ), Wood controls Earth ( or invades it ), Fire controls Metal, Earth controls Water and Metal controls wood ( or cuts it! ).
Example of SHENG CYCLE PROBLEM • For example let’s see how the Earth phase gets disturbed by the environment!
January 7‐9, 2011
Introduction to Medical Acupuncture 5 Element and Great American Malady
POOR EATING, STRESS: HEART/ SMALL INTESTINE
SPLEEN/STOMACH bloating, gas, di h diarrhea
LUNG/LARGE INTESTINE Asthma, sinusitis Due to increased dampness
Another Example • Let’s see the typical case of an anxious, stressed out executive with neck and shoulder pain, headaches and anger issues with explosive behaviour explosive behaviour. • He also has bloating and frequent diarrhea and GERD.
HEART/ SMALL INTESTINE Explosive Red Eyes Insomnia
LIVER/ GALLBLADDER Anger Headaches Neck and Shoulder
KIDNEY/ BLADDER Fatigue Exhaustion
SPLEEN STOMACH Bloating Diarrhea h GERD
LUNG/LARGE INTESTINE
January 7‐9, 2011
Introduction to Medical Acupuncture 5 Element and Great American Malady
So, how do we treat? 1. SEDATE THE AREAS OF EXCESS 2. STIMULATE AREAS OF DEFICIENCY 3. MAKE USE OF THE KE CYCLE TO CONTROL EXCESSES OR DEFICIENCIES.
HEART/ SMALL INTESTINE
HT7 or 3 SEDATE ( ‐ ) SPLEEN STOMACH
LIVER/ GALLBLADDER
LR2 or 3 LR2 or 3 SEDATE ( ‐ )
KIDNEY/BLADDER
KI3 to KI10 STIMULATE (++ )
LUNG/LARGE INTESTINE
LI11 to ST25 STIMULATE (++)
Great American Malady • Treatment not only for the US. • This treatment will work in most people living our current modern life. We have already seen the treatment: • We have already seen the treatment: • LR2 or 3: ‐ • HT3 or 7: ‐ • LI11 to ST25: ++ • KI3 to KI10: ++
January 7‐9, 2011
Introduction to Medical Acupuncture Fatigue
Fatigue Protocol Day 3
Several Ways to do it! • FRONT: • Through KI channel • Through LOWER DANTIAN • BACK: • Through MING‐MEN
Generalities • All of these treatments can be used to: • 1. Augment your treatment or • 2. Be a PRE‐TREATMENT to increase energy, which, will be circulated on a immediately continuing treatment. Specially important in the elderly! You need to have energy to circulate it!
January 7‐9, 2011
Introduction to Medical Acupuncture Fatigue
Kidney Channel Use: • KIDNEY 3 to KIDNEY 10 • Electricity 2Hz. Time: 10 min. • These can actually be accessed through front or back! • You may substitute KI3 by Spleen 6.
DAN TIAN ( LOWER ) • Needle CV3,4,5 • Stimulate with: MOXA, Electricity and/or heat and/or heat. • DO NOT LEAVE IN DISPERSION!!! • No more than 10‐15 min.
January 7‐9, 2011
Introduction to Medical Acupuncture Fatigue
DAN TIAN • The word dantian translates as cinnabar fields, or elixir field. • The dantian in the lower abdomen is said to be the residence of primordial qi, or the yuan qi, the energy that each person receives from their parents.
Ming Men • The name of GV4! • The name of a treatment too! • At the level of L2 A h l l f L2 • At the sides: BL23 ( SHU KIDNEY ), BL52 • Further to the sides: GB25: MU KIDNEY!
BL23: SHU for Kidney
GB25: MU for Kidney
GB25: MU for Kidney
January 7‐9, 2011
Introduction to Medical Acupuncture Fatigue
January 7‐9, 2011
Treatment • GB25ÆBL23 2Hz BL23 BL22
• Or: GB25
• GB25Æ BL22/23 2Hz
BL23 BL22
GB25
Introduction to Medical Acupuncture Ear Acupuncture
EAR ACUPUNCTURE PROTOCOLS Day 3
Equilibration Protocol • Use master points… • Recommended: Buy a point finder! Buy a point finder!
Quit Smoking Points • These are the points on the EAR: • Shen Men KI • Sympathetic LR • Lung ST • Kidney • ST • LR LU
January 7‐9, 2011
Introduction to Medical Acupuncture Ear Acupuncture
Quit Smoking Protocol • Patient needs to DECIDE HIMSELF TO QUIT. • Set a Quit date. • YOU NEED TO MAKE HIM HAVE A PSYCHOLOGIST pp for support. • Day 0: AM Tx. No tobacco • Day 1: PM Tx • Day 2‐7: Open. Patient may come as often as he likes. • Day 8 and 22: Repeat Tx. • 5 to 6 weeks: Repeat Tx.
Battlefield Acupuncture • • • • • •
Developed by Dr. Niemtzow. Extremely strong protocol. Tested in the Armed forces. Quik onset Doesn’t last long YOU USE SPECIAL NEEDLES.
January 7‐9, 2011
Introduction to Medical Acupuncture Ear Acupuncture
January 7‐9, 2011
Introduction to Medical Acupuncture Misc
Miscellaneous Day 3
How do you? • Stimulate a needle? • • • •
1. Heat: Heating lamp 2. Moxa: Another form of Heat 3. Electricity 4. Twiddle the needle!
Heating Lamp
January 7‐9, 2011
Introduction to Medical Acupuncture Misc
Moxa
Electricity
January 7‐9, 2011
Introduction to Medical Acupuncture Misc
Twiddle needle!
How do you SEDATE? 1. Leave the needle alone! 2. Apply alcohol 3. Apply a cooling essential oil: Peppermint or lemongrass.
January 7‐9, 2011
Introduction to Medical Acupuncture Resources, Courses and Needles
Acupuncture Resources, Courses Needles and Gadgets g Day 3
First, let’s see courses… • Acupuncture for Physicians Wilson Memorial Regional Medical Center 33‐57 Harrison Street Johnson City, NY 13790 (607) 763‐ 5334 • Acupuncture Integrative Medicine Program Tri‐State College of Acupuncture 80 Eighth Avenue, Ste 400 New York, NY 10011 (212) 242‐2255 Director: Mark D. Seem, PhD, LAc • The Art and Science of Acupuncture: Basic and Advanced University of Miami PO Box 016960 (D‐79) Miami, FL y ( ) , 33101 (305) ( ) 243‐4751 • Medical Acupuncture at Downstate SUNY Downstate Medical Center 450 Clarkson Ave, Box 1244 Brooklyn, NY 11203 (718) 270‐ 4563 Director: Tsai C. Chao, MD • Medical Acupuncture for Physicians Helms Medical Institute 2520 Milvia St Berkeley, CA 94704 (510) 649‐8488 http://www.hmieducation.com Director: Joseph Helms, MD, FAAMA • Acupuncture for Physicians Harvard Medical School Department of Continuing Education Boston, MA (781) 391‐7518 ext 240
About needles • Depends on what you want to treat! • If you want to treat piriformis syndrome, you need LARGE needles. METAL HANDLE!! • So size wise: S i i • 1 inch: Delicate areas: NECK • 1.5 inch and 2 inches: MOST OF THE BODY • 3 inches and even larger: HIP and BUTTOCK
January 7‐9, 2011
Introduction to Medical Acupuncture Resources, Courses and Needles
About quality • Chinese: Poor quality ( KINGLI )…. BUT CHEAP!!!: 4‐5$ a box of 100 needles. • Japanese: Superb steel. BUT EXPENSIVE: 11‐ 15$ a box of 100 needles. THERE ARE MANY “ IN BETWEEN”. GOAL: The needle shouldn’t hurt going in!
With Tubes and without! • Depends on your preference and if they exist! • I prefer them with tube. I f h ih b
January 7‐9, 2011
Introduction to Medical Acupuncture Resources, Courses and Needles
What do you need to set up a small practice? • Treatment tables: http://www.livingearthcrafts.com/ • Paper rolls/towels • TIMER: Keep a record of treatment length! TIMER K d f l h! • Music • Acupuncture Charts for décor/Bamboo plants • Medicare/ TRICARE/ALL INSURANCES self payment forms.*
Where to buy needles? • Lhasa OMS: www.lhasaoms.com • Go Acupuncture: www.goacupuncture.com
January 7‐9, 2011
Introduction to Medical Acupuncture Resources, Courses and Needles
What do you need to set up a small practice? #2 • Infrared Heat, Moxa Rolls, Ear stimulator/Finders • Electrical Stimulators
January 7‐9, 2011
Introduction to Medical Acupuncture Resources, Courses and Needles
Coding and Insurance • MEDICARE RECOGNIZES 4 SPECIFIC CODES FOR ACUPUNCTURE: • 1. 97810: Acupuncture first 15 min • 2. 97811: Acupuncture next 15 min 2 97811 A 15 i • 3. 97813: Acupuncture with electricity 15min • 4. 97814: Acupuncture with electricity +15min
• • • • • • •
1. 97810: Acu first 15 min: 60$ 2. 97811: Acu next 15 min: 50$ 3. 97813: Acu with electricity 15min: 80$ 4. 97814: Acu with electricity +15min: 70$ 5. 97016: Cupping: 25$ 6 97014 El 6. 97014: Electricity without needles: 25$ i i ih dl 25$ 7. 97026: Infrared Heat: 25$
• SO A USUAL TREATMENT: 3+4+7: 175$ for about 30‐45 minutes.
January 7‐9, 2011
Introduction to Medical Acupuncture Resources, Courses and Needles
You can always code: • 99213 or 99214 on TOP of your acupuncture code. It is considered a NON REIMBURSED procedure by MEDICARE and most East Coast Insurances. Insurances • Use a ‐25 modifier as any other procedure. • If MEDICARE: Use Medicare WAIVER with a ‐ GA modifier.
Medicare Waiver form • Google: Advanced Beneficiary Notice It mentions: • PROCEDURE NAME AND CODE • THE ASSURANCE THAT THE PATIENT WILL BE HELD RESPONSIBLE TO PAY IF INSURANCE DOESN’T.
TIPS • Start needling right away… otherwise YOU WILL FORGET! • Start doing simple treatments! Gain confidence in yourself! confidence in yourself! • Once convinced, try taking a full course ( 300 hours ). • When you don’t have a clue: Refer out to an experienced practitioner!
January 7‐9, 2011
Introduction to Medical Acupuncture Resources, Courses and Needles
January 7‐9, 2011
Introduction to Medical Acupuncture Resources, Courses and Needles
TIP #2: Advertisement • Before you advertise BEGIN with your own regular patients! • They are your best source of advertisement almost for free! • ASK THEM: If there is any pain? Anxiety? Offer a first treatment for free! THEY WILL COME BACK!
TIP #3:PRICING • For CASH PAYING ONLY: • Be sure to ask how much your competitition charges… ! h ! • MEDICARE CAN MAKE THINGS COMPLICATED!
TIP #4: YOUR PRACTICE • BE SURE YOU HAVE EXPLORED A PATIENT’S DIAGNOSIS WELL. • Example: 20 yo patient with a history of headaches… DO A FULL MEDICAL WORK UP.
January 7‐9, 2011
Useful webpages: http://www.acupuncture.com http://www.YinYanghouse.com References: 1. American Academy of Medical Acupuncture: www.medicalacupuncture.org/ 2. Acupuncture Energetics: A Clinical Approach for Physicians by Joseph Helms. Medical
Acupuncture Publishers; 1st edition (1995) 3. Point Locations and Functions by Alejandro Elorriaga Claraco, Amoy Ng, Joseph M. Helms; Medical Acupuncture Publishers, (http://bookmooch.com/s/point+locations+and+functions; http://bookmooch.com/s/alejandro+elorriaga+claraco+amoy+ng+joseph+helms; http://bookmooch.com/s/Medical+Acupuncture+Publishers ; (2000)
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