Sunday, May 8, 2011

Famous Chinese Physicians of the Past


Pien Ch'iao
(Bian Que;
ca. 500 B.C.)

Tsang Kung
(Cang Gong;
ca. 200 B.C.)

Chang Chung Ching
(Zhang Zhongjing;
150-219 A.D.)

Hua To
(Hua Tuo;
110-207 A.D.)

Wang Shu-Ho
(Wang Shuhe;
180-270 A.D.)

Huang Fu
(Huangfu Mi;
214-282 A.D.)

Ko Hung
(Ge Hong;
281-341 A.D.)

T'ao Hung-Ching
(Tao Hongjing;
452-536 A.D.)

Ch'ao Yuan Fang
(Chao Yuanfang;
550-630 A.D.)

Sun Ssu-mo
(Sun Simiao;
581-682 A.D.)

Chien Chen
(Jian Zhen;
683-763 A.D.)

Wang Tao
(Wang Tao;
ca. 702-772 A.D.)

Chien Yi
(Qian Yi;
ca. 1032-1113 A.D.)

Liu Wan-su
(Liu Wansu;
1120-1200 A.D.)

Chang Tzu-Ho
(Zhang Zihe;
1156-1228 A.D.)

Li Tung Yun
(Li Dongyuan/Li Gao;
1180-1252 A.D.)

Chu Tan-Chi
(Zhu Danxi/Zhu Zhenheng;
1280-1358 A.D.)  

Li Shih-Chen
(Li Shizhen;
1518-1593 A.D.)

Wang K'en T'ang
(Wang Kentang;
1549-1613 A.D.)

Wu Yu-Hsing
(Wang Youxing;
1582-1652 A.D.)

Chang Chin Yueh
(Zhang Jingyue;
1583-1640 A.D.)

Yeh Tien Sian
(Ye Tianshi;
1690-1760 A.D.)

Wang Chin Ren
(Wang Qingren;
1768-1831 A.D.)

Wu Shang Sian
(Wu Shangxian;
1806-1886 A.D.)

Current Issue: TCM and Infectious Disease

 In traditional Chinese medicine, the first reference to infectious disease appeared in Huang Di Nei Jing (Yellow Emperor's Inner Classic) compiled in the first or second century C.E.
Lastly, many of the bitter and cold herbs and formulas used to treat these warm and hot diseases are recognized today to have remarkable antibiotic effects. These observations are made and published approximately 200 years before the discovery of bacteria and other micro-organisms. Wen bing (warm disease) theories accurately described the origins and transmission of epidemic disease, and the importance of the immune system in relationship to the pathogens. Wen bing (warm disease) theories revolutionized and significantly influenced the theory and practice of traditional Chinese medicine, changes that persist even today.
Prevention of Infectious Disease
One of the fundamental concepts in traditional Chinese medicine is that "superior medicine prevents disease, and inferior medicine treats disease." Prevention of infectious disease is certainly no exception since bacteria and virus tend to adversely affect those who have weakened or compromised immune systems. Many herbs and formulas that tonify wei (defensive) qi have been shown to have marked effect to boost the immune system. Examples include:
Classic formulas with immunostimulant effect:
  • Shi Quan Da Bu Tang (All-Inclusive Great Tonifying Decoction)
  • Ren Shen Yang Ying Tang (Ginseng Decoction to Nourish the Nutritive Qi)
  • Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction)
  • Si Jun Zi Tang (Four-Gentlemen Decoction)
  • Yu Ping Feng San (Jade Windscreen Powder)
Herbs with immunostimulant effect:
  • Dong Chong Xia Cao (Cordyceps)
  • Ren Shen (Radix et Rhizoma Ginseng)
  • Dang Shen (Radix Codonopsis)
  • Huang Qi (Radix Astragali)
  • Bai Zhu (Rhizoma Atractylodis Macrocephalae)
Treatment of Infectious Disease
Traditional Chinese medicine consider infectious disease as wen bing (warm disease) and treat it with heat-clearing herbs. Many of these herbs are confirmed to have remarkable antibiotic effects, including antibacterial and antiviral. In addition to traditional diagnosis and treatment, the following herbs and formulas may be considered to more precisely target and treat infectious disease.
Classic formulas with antibiotic effect:
  • Yin Qiao San (Honeysuckle and Forsythia Powder)
  • Huang Lian Jie Du Tang (Coptis Decoction to Relieve Toxicity)
  • Long Dan Xie Gan Tang (Gentiana Decoction to Drain the Liver)
  • Pu Ji Xiao Du Yin (Universal Benefit Decoction to Eliminate Toxin)
  • Ba Zheng San (Eight-Herb Powder for Rectification)
Herbs that have antibacterial effect include:
  • Bai Tou Weng (Radix Pulsatillae)
  • Chuan Xin Lian (Herba Andrographis)
  • Huang Lian (Rhizoma Coptidis)
  • Hu Zhang (Rhizoma et Radix Polygoni Cuspidati)
  • Huang Bo (Cortex Phellodendri Chinensis)
  • Huang Qin (Radix Scutellariae)
  • Ku Shen (Radix Sophorae Flavescentis)
  • Pu Gong Ying (Herba Taraxaci)
  • Shan Dou Gen (Radix et Rhizoma Sophorae Tonkinensis)
Herbs that have antiviral effect include:
  • Ban Lan Gen (Radix Isatidis)
  • Da Qing Ye (Folium Isatidis)
  • Jin Yin Hua (Flos Lonicerae Japonicae)
  • Lian Qiao (Fructus Forsythiae)
  • Ye Ju Hua (Flos Chrysanthemi Indici)
In Western medicine, the discovery of antibiotic drugs is one of the major breakthroughs in modern medicine. It enables doctors to effectively treat many different types of infections. Unfortunately, decades of abuse and misuse have led to growing problems of bacterial mutation and resistance. At this moment, many of these "super bugs" can only be treated with the newest and most potent antibiotic drugs, and unfortunately, many of them have potent side effects as well. Due to the number of antibiotic drugs, and the various species of micro-organisms, it is beyond the scope of this article to discuss the benefits and risks of each individual drug. As a category, antibiotic drugs are extremely effective against most types of bacterial infections. The key points are to select the correct antibiotic drug with least potential side effects, and make sure that the patient finishes the entire course of therapy.
In traditional Chinese medicine, herbs and herbal formulas are also extremely effective for treatment of various infections. In fact, most modern pharmaceutical drugs were originally derived from natural sources, including penicillin [the oldest antibiotic] and gentimicin [one of the most potent]. One of the main benefits of using herbs is their wide spectrum of antibiotic effect, with indications for bacterial and viral infections. Furthermore, most of these herbs are extremely safe, and do not have the same harsh side effects as drugs. Therefore, when treating patients with bacterial or viral infections, it may be beneficial to use the herbs noted with confirmed antibacterial and antiviral effects.
In summary, both drugs and herbs are effective to treat mild to moderate cases of bacterial infections. However, because drugs are more immediately potent and can be prescribed with more laboratory precision (via cultures and sensitivity tests), they are more appropriate for life-threatening infections, such as meningitis or encephalitis, or mutant strains of bacteria, such as beta-lactam-resistant Staphylococcus aureus and methicillin-resistant Staphylococcus aureus (MRSA). On the other hand, use of herbs is far more effective than drugs for treating certain viral infections, such as the common cold and influenza, as drugs are essentially ineffective for these conditions. Most importantly, herbs are much gentler to the body and safer than drugs. In other words, herbs treat infection without damaging the patient's underlying constitution. This allows the patient to recover faster, and become more resistant to secondary or re-current infections.
References

  1. Gilbert D, Moellering R. and Sande M. The Sanford Guide to Antimicrobial Therapy 1999. 29th Edition. Antimicrobial Therapy, Inc. Hyde Park, VT USA.
  2. W Yu-Xìng, also known as W Yòu-K, 1580's – 1660's (exact dates of his birth and death are unknown).
  3. Yè Guì, also known as Yè Tin-Shì, 1666 – 1745.
  4. Wú Táng, also known as Wú J-Tng, 1758 – 1836.
  5. Wen Re Lun (Discussion of Warm and Hot Disorders) by the apprentices of Ye Gui between 1745 to 1766.
  6. Wen Yi Lun (Discussion of Epidemic Warm Disease) by W Yu-Xìng in 1642.
  7. Wen Bing Tiao Bian (Systematic Differentiation of Warm Disease) by Wú Táng in 1798.
  8. Bei Ji Qian Jin Yao Fang (Thousands of Golden Prescriptions for Emergencies) by Sún Sí-Mio in the middle of the 7th century.
  9. Chen J. Chen T. Chinese Herbal Formulas and Applications, 2009. Art of Medicine Press. City of Industry, CA USA.
  10. Zhong Yi Fang Ji Xian Dai Yan Jiu (Modern Study of Medical Formulae in Traditional Chinese Medicine) 1997;652-654.
  11. Guo Wai Yi Xue Zhong Yi Zhong Yao Fen Ce (Monograph of Chinese Herbology from Foreign Medicine) 1992;14(2):52.
  12. Zhong Yi Fang Ji Xian Dai Yan Jiu (Modern Study of Medical Formulae in Traditional Chinese Medicine) 1997;520-521.
  13. Zhong Cheng Yao Yan Jiu (Research of Chinese Patent Medicine) 1981;12:28.
  14. Zhong Xi Yi Jie He Za Zhi (Journal of Integrated Chinese and Western Medicine) 1990;12:22.
  15. Chen J. Chen T. Chinese Medical Herbology and Pharmacology, 2004. Art of Medicine Press. City of Industry, CA USA.
  16. Shang Hai Yi Yao Za Zhi (Shanghai Journal of Medicine and Herbology), 1988; 1:48
  17. Zhong Yao Xue (Chinese Herbology), 1998; 729:736
  18. Zhong Xi Yi Jie He Za Zhi (Journal of Integrated Chinese and Western Medicine), 1985; 5(8):487
  19. Biol Pharm Bull, 1977; 20(11)-1178-82
  20. Xin Yi Yao Xue Za Zhi (New Journal of Medicine and Herbology), 1979; 6:60
  21. Chen J. Chen T. Chinese Herbal Formulas and Applications, 2009. Art of Medicine Press. City of Industry, CA USA.
  22. Zhong Cheng Yao (Study of Chinese Patent Medicine) 1990;12(1):22.
  23. Hu Bei Zhong Yi Za Zhi (Hubei Journal of Chinese Medicine) 1981;4:30.
  24. Zhong Yao Yao Li Du Li Yu Lin Chuang (Pharmacology, Toxicology and Clinical Applications of Chinese Herbs) 1991;(1):5.
  25. Chen J, Chen T. Chinese Medical Herbology and Pharmacology. City of Industry, CA: Art of Medicine Press, 2004.
  26. Zhong Yi Yao Xin Xi (Information on Chinese Medicine and Herbology) 1987;6:31.
  27. Chen J. Chen T. Chinese Medical Herbology and Pharmacology, 2004. Art of Medicine Press. City of Industry, CA USA.
  28. CA, 1948; 42:4228a
  29. Zhong Yao Xue (Chinese Herbology), 1998, 178:179
  30. Zhong Hua Yi Xue Za Zhi (Chinese Journal of Medicine), 1958; 44(9):888
  31. Zhong Xi Yi Jie He Za Zhi (Journal of Integrated Chinese and Western Medicine), 1989; 9(8):494
  32. Zhong Yao Xue (Chinese Herbology), 1998; 556-558
  33. Zhong Yao Da Ci Dian (Dictionary of Chinese Herbs), 1977: 2032
  34. Zhong Yao Xue (Chinese Herbology), 1988; 137:140
  35. Zhong Yao Xue (Chinese Herbology), 1998; 148:151
  36. Zhong Yi Yao Xue Bao (Report of Chinese Medicine and Herbology), 1991; (1):41
  37. Xian Dai Shi Yong Yao Xue (Practical Applications of Modern Herbal Medicine), 1988; 5(1):7
  38. Zhong Cheng Yao Yan Jiu (Research of Chinese Patent Medicine), 1987; 12:9
  39. Zhong Yao Xue (Chinese Herbology), 1998; 174:175
  40. Shan Xi Xin Yi Yao (New Medicine and Herbology of Shanxi), 1980; 9(11):51
  41. Shan Xi Xin Yi Yao (New Medicine and Herbology of Shanxi), 1980; 9(11):51
  42. Zhong Hua Yi Xue Za Zhi (Chinese Journal of Medicine), 1962; 48(3):188

Current Issue: Complex Cases: Tips for Navigating A Sacred Terrain

Have you ever had a case that felt so big you weren't sure how to wrap your brain around it? The challenge may have been diagnosis oriented: a progressed and debilitating autoimmune disorder, a degenerative neurological disease or metastatic cancer.
There are many reasons why a case can feel daunting. We all have patients who push the envelope of our expertise and require that we expand the way we work. If you have ever felt overwhelmed by such a case, you are not alone. Patients like this pop up in everybody's practice. They don't discriminate against the new practitioner either. Those of us who have been practicing for decades run into them head-on also. No matter how much you revere your teachers, even they need to partner up with humility and new strategies when it comes to tough cases.
I am going to share some of the tools that I have come up with to help me navigate this difficult terrain. Perhaps some of these ideas will be helpful to you. I will take on a case if I feel I have a real shot at being successful with it. I don't put that responsibility only on my own shoulders, though. I like to split it with a patient. Here is how I divide that responsibility.
At the first session I do my diagnostic work and come up with what I call an "energetic profile," the condition of my patient's qi, the snapshot, the diagnosis. After I share my findings I send them home to seriously think about their budget for healing the condition.
Their Budget Determines Outcomes
I tell my patient that healing their condition is a project that will take time and money and is an investment in their future. Rather than pushing for higher levels of commitment than my patient can make as I spend months trying to get results, I find out what they can put into their healing up front.
My budgets are made up of three things: dollars, hours and miles. How many dollars does the patient have per day, week or month to invest in healing the problem they are presenting? How many hours do they have per day, week, month and how many miles will they travel to get well? The answers vary tremendously and give me the foundation I need to build an effective treatment protocol or to tell them that I am not the best person to work with them. When I have clarity about their level of participation I can better asses the likelihood of getting results with the resources they have available. I don't want to be badgering a patient to do more and I don't want to fail because I can't get results with the amount of commitment my patient can make.
Some patients have lots of dollars to devote to a problem but not very much time. These folks are highly committed making the money they then use to heal. On the other hand, some people with fewer financial resources may have more time to contribute. This is not always the case and one is not generically better than the other. It's just good to know what I have to work with and find the advantages in every circumstance.
A patient's budget doesn't have to be static and can change by the week or month. Parents may need to have different budgets when children aren't in school, for example, or if they lose a job. I may be able to work with the changes if I have an idea of what they will be and can prepare for them. But surprises in patient involvement don't work well with complex cases so I always ask my patients to give me notice of budget changes well in advance.
I include miles in the budget because I need to know if I can send someone to a physician, healing center or seminar out of town. One of my favorite homeopathic physicians is in Oregon. Is my patient willing to fly there if I feel that this particular ND would be helpful? The Hoffman Quadrinity process, (Hoffmaninstitue.org) is the most brilliant seminar I have ever sent patients to if they need to learn about how childhood experiences and trauma influence their health and body-oriented lifestyle decisions. These seminars are in 15 countries around the world, including the U.S. Will a patient fly to Napa Valley, Calif. to experience this life transforming opportunity? I have many examples of this nature. My favorite foot surgeon is in Arizona, my favorite integrative medicine hospital is in Philadelphia, etc. Miles could also refer to how far a patient will go locally. If they rely on public transpiration can they get themselves to the physical therapist who specializes in their condition but is 20 miles away or should we stay more local?
Upon examination of a budget I may see that a patient doesn't have the resources to see me as often as I consider necessary. I may decide to offer them a lower rate to allow for my greater involvement or I can become a monthly or quarterly advisor, a manager of sorts. I assume the role of the less frequent, but consistent team organizer whose network of resources helps maximize a patient's limited resources.
Set Realistic Expectations
When a patient gives me their budget I can give them better time estimates and appropriate expectations. One strategy, that has never failed me, is that of informing a patient that their body takes time to "show" results and that they need to commit to coming for a minimum of six treatments before they expect to see any improvement. "If you aren't comfortable doing that, let's not get started," I tell them. Much of what we do is below the surface. It may take many treatments before a seriously ill patient improves to such a degree that they notice benefit from your work. The first few weeks or months may not feel any different to them. By telling my patient that the healing rate is dependent upon his or her own body's ability to metabolize our work I take the inappropriate expectation of speeding up the process. I have never needed six sessions for patients to notice results but I still like to give the process this lengthy window. The longest I have needed was five sessions and that was with a severely qi and blood stagnant elderly gentleman. Stagnation takes a while. When patients get results in less than six sessions they get excited about our progress rather than frustrated with how long it took to start feeling better.
Give Little Jobs
When someone is severely ill they want to do something between sessions that will help them get better. This is empowering and uplifting to their spirits while gently supportive of your work. Because their energy is severely compromised they are likely to tire, feel pain or overwhelm relatively quickly, so it is best to make those jobs small. Have one appointment with a specialist, walk for five minutes a day or every other day. Supplement and herb dosages must be small too.
Handing someone ten bottles of herbs, nutrients and homeopathics early in the treatment process and suggesting multiple dosages a day may backfire. Remember, our medicine works under the premise that you give a patient dosages in proportion to what they can metabolize, not in alignment with what they need. The body's need level is high in severe illness but its absorption and utilization ability is generally low. Give the body less and be patient. This is the way of our professional ancestors. Low dosages that build over time help big problems go away at an appropriate pace. This yin method of healing is important when undertaking the major transformation required in cases of this nature.
Remember the Sanctity Herein
Working with heavy duty, complex cases can keep you up at night thinking these cases are rewarding and an opportunity to dive deeply into the beauty of OM. Its richness shows up in many subtle and unique ways. I am reminded of the genius in this medicine, the generations of effort that have gone into its creation and refinement, when I unravel a complex puzzle of energetic syndromes over the course of years. I recall the first time a patient smiled at me, seven months into the course of treatment. After 25 years, eight surgeries and continual worsening from rheumatoid arthritis, she felt better enough to smile. And the deep sighs expressed by a patient whose severe diaphragmatic spasm had kept her from breathing deeply for over a decade. It is the details that first express the light of our medicine.
I hope you come to enjoy the challenges that are inherent in treating patients with severe illness. As your work has impact, layers of energetic disharmony dissolve into the body's beautiful music and harmonious vitality. Life hungers for itself. Life yearns to flow into and regenerate itself. It's a miracle to behold and an honor to participate. May we all be blessed in such sacred undertakings.

Current Issue: Scope and Standards for Acupuncture: Dry Needling?

Legislative scope and standards of practice are major elements that define a profession. Clarifying these two areas for the field of acupuncture and Oriental medicine is important because of emerging legislative arguments that are mixing the logics of scope and standards - to the possible detriment of society. Let me explain.

Scope of Practice and Acupuncture
Acupuncture is an incisive and invasive procedure involving the subcutaneous application of a needle. Further, the needle is applied to a variety of tissues for various therapeutic affects. There can be bleeding or bruising. Acupuncture may also refer to a professional discipline, which includes other practices of healing that involve diagnosis and the delivery of a treatment plan. The procedures of the discipline include but are not limited to manual therapies, scraping, and use of physical agents such as cupping (negative pressure) scraping, mechanical devices, heat, cold, air, light, water, electricity, and sound in the aid of diagnosis or treatment. Some states include herbal medicine and nutrition in the scope of practice for acupuncture. Licensing scope provides autonomy, but also liability and culpability. For some of these reasons and more, safe and effective practice requires comprehensive education.
The procedure of acupuncture may have a variety of descriptors including trigger point dry needling, manual trigger point therapy, intramuscular dry needling, intramuscular manual therapy and intramuscular stimulation. Contemporary practices also involve the injection of therapeutic substances into an acupuncture point. The application of electrical current to the needles may be called electro-acupuncture or percutaneous electrical nerve stimulation or PENS.
Medical acupuncture and biomedical acupuncture are also forms of acupuncture-based upon biomedical thought. There are licensed acupuncture practitioners throughout the range of health professions who think this way. What matters is the way of thinking about acupuncture is not a scope of practice; it is a standard of practice.
Dry needling is a description of acupuncture that relies on a category of points described in Chinese language as ashi points. A reasonable English translation of ashi points is "trigger points," a term used by Dr. Janet Travell in her landmark 1983 book, "Myofascial Pain Dysfunction: The Trigger Point Manual"1. Dorsher et al2, determined that of the 255 trigger points, listed by Travell and Simons, 234 (92 percent) had anatomic correspondence with classical, miscellaneous, or new acupuncture points listed in Deadman et al3.
Other authorities describe dry needling as acupuncture. Mark Seem discussed dry needling in "A New American Acupuncture" in 19934. Matt Callison describes dry needling in his Motor Points Index5 as does Whitfield Reaves in "The Acupuncture Handbook of Sports Injuries and Pain: A Four Step Approach to Treatment"6. Yun-tao Ma, author of "Biomedical Acupuncture for Sports and Trauma Rehabilitation Dry Needling Techniques" describes dry needling as acupuncture and provides a rich historical explanation7. Chan Gunn, sought to create language more readily accepted in the West in a 1980 article8. These examples make it clear that there is a literary tradition in the field of acupuncture that uses the term "dry needling" as a synonym for acupuncture.
In a position paper, Valerie Hobbs states, "It is the position of the Council of Colleges of Acupuncture and Oriental Medicine (CCAOM) that dry needling is an acupuncture technique. It is the position of the CCAOM that any "total body" intervention utilizing dry needling is the practice of acupuncture, regardless of the language utilized in describing the technique"9.
Standards of Practice and Acupuncture
Standards of practice are behavioral and include professional judgment, such as the selection of procedures, diagnostic tools and referrals. Similar is the decision whether to use a trigger point or some other method of point selection. For instance, the decision to use a neuro-anatomical approach to acupuncture in a condition such as sciatic neuropathy by treating at the nerve root as opposed to traditional Chinese medical point functions. That is, it is based upon how the practitioner builds knowledge in the clinic. The way of thinking is not scope and therefore is not subject to the weight of law.
The National Certification Commission of Acupuncture and Oriental Medicine (NCCAOM), uses job task analyses to validate the examination that authorizes acupuncturists to seek licensure in most states. The 2003 job task analysis found that 82 percent of acupuncturists used trigger point needling. This makes dry needling a standard of practice.
In the CCAOM position paper, Hobbs cited a complaint made by a physical therapist in Maryland to the Maryland Board of Acupuncture regarding the use of the term dry needling in chart notes by an acupuncturist9. The PT claimed that the acupuncturist was using language unique to physical therapy. This is a matter of standards of practice, not scope. Language and thought is not controlled by scope of practice codes. This is an attempt to conflate standards of practice (professional judgment or medical thought) with scope of practice: the privilege to perform a procedure. Ultimately, the complaint was dismissed because the procedure was deemed to be acupuncture performed by a licensed acupuncturist.
The Little Hoover Commission, in its 2004 report to the California legislature concluded that, "interactions with other health care providers, including collaboration and referrals, as well as with many members of the public, benefit from the use of common, Western-based diagnostic terminology"10. Acupuncturists who graduate from ACAOM accredited schools are required to complete 30 semester credits in biomedical clinical sciences for acupuncture only education and 34 semester credits for combined Chinese medicine and acupuncture programs11. The objectives tie neatly with the 2004 Little Hoover recommendation.
This commentary should not be considered a recommendation to remove the professional technical languages of Chinese medicine and acupuncture. In my opinion, it is not possible to effectively practice Chinese medicine without the language of the discipline, especially in the context of herbal and nutritional management.
References
  1. Travel J, Simons D. Myofascial Pain Dysfunction: The Trigger Point Manual. Philidelphia, PA: Lippincott Willimas & Wilkins; 1983.
  2. Dorsher PT. Trigger Points And Acupuncture Points: Anatomic And Clinical Correlations. Medical Acupuncture. 2006;17(3).
  3. Deadman P, Al-Khafaji M, Baker K. A Manual of Acupuncture. Kingham, Oxfordshire Journal of Chinese Medicine Publications.
  4. Seem M. A New American Acupuncture: Acupuncture Osteopathy, the Myofascial Release of the Bodymind. Boulder, CO: Blue Poppy Press; 1993.
  5. Callison M. Motor Point Index: An Acupuncturist'sGuide to Locating and Treating Motor Points San Diego, CA: AcuSport Seminar Series LLC 2007.
  6. Reaves W, Bong C. The Acupuncture Handbook of Sports Injuries & Pain. Boulder, CO: Hidden Needle Press; 2009.
  7. Ma Y-t. Biomedical Acupuncture for Sports and Trauma Rehabilitation Dry Needling Techniques. New York: Elsevier; 2010.
  8. Gunn CC, Milbrandt WE, Little AS, Mason KE. Dry Needling of Muscle Motor Points for Chronic Low-Back Pain: A Randomized Clinical Trial With Long-Term Follow-Up. Spine. 1980;5(3):279-91.
  9. Hobbs V. CCAOM Position Paper on Dry Needling 2010.
  10. Acupuncture in California: Study of Scope of Practice Overview of Current Status and Issues to Consider Prepared for the Milton Marks "Little Hoover" Commission on California State Government Organization and Economy: UCSF Center for the Health Professions; May, 2004.
  11. Accreditation Manual: Structure, Scope, Process, Eligibility Requirements and Standards. In: Medicine ACfAO, editor.: Maryland Trade Center Building #3, Suite 760 7501 Greenway Center Drive Greenbelt, Maryland 20770-3514; 2009.

Current Issue: Ways To Market Outside the Box

Recently, I met the human resources assistant for a local manufacturing business which has over 2,000 employees spread out over two locations - both within 15 minutes of where I live and work.
As I thought about what to bring - ear seeds rather than needles, a few herbal formulas, and lots of business cards - I wondered where all of the other acupuncturists were, and why no one else thought to connect with the human resource departments of big companies with health insurance. While Chinese medicine is an age-old practice, it is still fairly unique to America. In such an up-and-coming science/art, we need to start marketing outside of the box.
Understanding and reaching Our Target Market
Our target audience has changed in the last few years due to the recession.
It used to be that our target market was people with disposable income. Now, there is a whole new batch of people - people who have lost their health insurance as they lost their jobs.
Not only does Chinese medicine promise more, but most of the time, the out-of-pocket expense for someone lacking health care is cheaper than going to a Western medical doctor (except for emergency cases). Let's see how we can creatively and easily connect with these people, and others with insurance, and be busy practitioners.
There are hundreds of careers we could have chosen, but something drew us to Chinese medicine rather than to law or accounting. We might enjoy healing patients in pain, endocrine system disorders (thyroid, fertility, etc.), emotional and chemical disorders (i.e. depression, bipolar, OCD). If you ask 100 acupuncturists how they got into their trade, you might get 100 different stories. That thing that drew you in might be your specialty now. In acupuncture school, we were still trained to treat almost every disorder, but there are one or two things that we are especially passionate about.
Market this passion.
As you treat what you are passionate about, your happiness and energy will grow, and people will want to come to you for your passion. As other problems arise, either for themselves or for their family, they will think of you, and your practice will grow.
Education and Partnerships in your Community
One of the easiest ways for Chinese medicine practitioners to market outside the box is to take the time to educate curious people and prospective, new and current patients. This can happen while on the phone, or in person, and also by providing lectures and writing articles for local papers. Learning how to take the Chinese lingo that we learned in school and translating it into layman's terms is invaluable, and makes what we do much less intimidating to people, and seem less like witchcraft.
Independence can lead to isolation. One way to combat that isolation is to work part-time for another company. While working the health fair that I mentioned above, I was asked to come in for an interview at a local hospital, as they were hiring an acupuncturist part-time. The nurse taking blood pressure happened to be the director and decision maker in this hospital ward, and I had been working next to her all along! I was completely honored when she said, "I knew there was a reason I was supposed to come here today – it was so that I could meet you."
Another way to combat isolation is to create partnerships with healers of other modalities. Even if you have full confidence in your abilities as a practitioner, you never know what will ultimately heal a person, whether it will be your skillful acupuncture techniques, herbal formulas, rolfing, chiropractic, yoga, Western medicine, massage, etc. In terms of a successful practice, the old adage remains: The whole is greater than the sum of its parts. Creating business partnerships with both practitioners and businesses will lead to more success than plowing through the world on your own. Offering specials with others is a great way to broaden your name while creating community.
An example of cross-marketing is to connect with your local yoga studio and offer 10 percent off the first acupuncture treatment for yogis, [and comparably] a free yoga class for all your existing patients. The yoga studio will post the fliers in their space, and you will post theirs in your office space. You will, of course, share the expense of the marketing materials.
Another idea is to offer a discount on multiple services.
For instance, if you have a massage therapist or a nutritionist that shares your clinic space, then offer a discount to try all the services. Selling gift certificates (e.g. all three services for $150 rather than $75 per service) for new patients is ideal. It is not ideal for regular patients who already utilize these services, as it is just a cheaper way for them to get the same services they already use. This is best around the holidays, and should only be used for new patients, or people who are uncertain about trying something new.
ATTEND Health Fairs
Believe it or not, health fairs happen all the time. Health clubs, gyms, health stores, and yoga studios will likely have at least one health fair per year - if not once a month. Start by asking the manager at the places you visit most often to get practice in learning about health fairs, and then branch out to other companies to find out when other local companies host theirs. A list of all the local companies and how many employees they have will be found on your county's website.
Remember to keep your rapport with these companies strong, and follow up with a thank you letter or email to the manager of the event.
Using Online Marketing
In a world inundated with traditional media, many of us have noticed that advertising in local newspapers, magazines, or phone books doesn't have the same effect as it once did.
Let's look at some creative ways to illuminate our names.
I am not fully convinced that it is a fancy website that will draw in business as much as internet marketing. Even once you get your website up and running, it is still a question as to whether or not you will draw viewers to that website. The easiest and most effective question is: how will people find you online? If someone goes to the almighty Google, then mostly what is important is that they can type in keywords such as: "acupuncture" plus your city which draws up your name (or your clinic's name) instantly in their search. Go to: www.google.com/local/add, and add your name to Google maps, and when people search on Google, they will instantly see your name, clinic name, phone number and address in cue. It is the phone call to you that is most important, rather than someone looking at your website. More importantly, Google emails you bi-monthly letting you know how many people typed in your keywords, and searched for you. This gives you instant feedback as to what people are seeking in your neighborhood.
It is monotonous to plow along the business path paving our own way rather than to learn from others, and repeat what is already tried and tested. Find other acupuncturists and healers in your city and create communities. There is no lack of patients to treat. Have fun!

Current Issue: Microcurrent–Light Lymph Drainage for Physical and Emotional Healing

The lymphatic system is the defense network and waterway of the body, and is a primary route for cleansing and detoxifying our blood, kidneys and liver. The lymphatic system defends the body from foreign invasion by disease causing agents such as viruses, bacteria, or fungi.
It also contains a network of vessels that assists in circulating body fluids. These vessels transport excess fluids away from interstitial spaces in body tissue and returns it to the bloodstream. Lymphatic vessels prevent the back flow of the lymph fluid. They have specialized organs called lymph nodes that filter out destroyed microorganisms.
When the organs of elimination – the liver, kidney and intestines – are healthy, the lymphatic system is usually able to do its job well. When these organs become burdened and toxic due to unresolved negative emotions, poor diet, inactivity or other such factors, the lymphatic system can become stagnant. The waters of life are no longer flowing freely. This is a major predisposing factor to chronic pain – physical or emotional.
points for the upper extremity of lymphage drainage Figure 1 showing points for the upper extremity of lymphage drainage. According to Peter Mandel, the founder of the Colorpuncture system, the lymphatic system is also the "psychic buffer" between the conscious and subconscious minds. Stagnant lymph can allow negative and fearful programs in the subconscious to become manifested as chronic pain and disease. This reminds of the Michael Crichton novel "The Sphere," in which scientists investigating an alien craft at the bottom of the Pacific Ocean start experiencing various horrific events as their inner fears and fantasies start coming true and manifesting physically. Turns out that using technology to remove their "psychic buffer" was the alien's way to cause them to kill each other off!
Reinhold Voll, the German pioneer of microcurrent electro-acupuncture taught that many cases of challenging chronic pain cannot be resolved without mobilizing stagnation in the lymphatic system. He discovered a new meridian on the body to address lymphatic healing (see below).
Treatment of imbalances of the kidneys and liver, from a Western or TCM perspective, often requires lymphatic drainage to be fully effective. Kidney "deficiency" - a commonly seen TCM syndrome, may be due to stagnation, i.e., excess in the lymphatic system. That is why moderate detoxification and drainage may actually raise the qi of the kidneys.
Both microcurrent and color light therapies have been shown effective in helping mobilize stagnant lymphatic function. Yellow is the primary color indicated for promoting drainage of the lymphatic system. Red is used on some points to add dynamic Kidney Yang energy to system, while green is used to balance liver function.
This therapy must be used with caution. Clients with chronic health pain and disease and those with strong emotional repression or control can only tolerate gradual opening of their psychic buffer. Start with only a few points per treatment and gradually increase in subsequent sessions.
It is essential that all patients undergoing lymphatic treatment increase their pure water intake, and take a good liquid mineral supplement. Meridian and chakra balancing is highly recommended as an adjunct.
Microcurrent Settings: According to EAV, 2.5 Hz clears edema and varicosities, and 9.2 Hz is effective for supporting kidney elimination. 13 Hz resonates with the lymphatic system. These frequencies may be used with lymphatic drainage. The indicated points may be treated at these frequencies bilaterally @ 50 – 100 µA, adding indicated color light simultaneously to improve results and help address the emotional level as well. Treat for about 30 seconds per set of points.
acu-points for lymphatic drainage Figure 2 showing range of acu-points for lymphatic drainage. One of Voll's great contributions was to map out meridians unrecognized by Chinese Medicine that he used for both electro-diagnosis and treatment. One of the most important new meridians was that of the lymphatic system. Here are the points on the upper extremity (chart).
The Voll Lymph vessel also has a point on the front of the neck that also influences lymphatic drainage when used with yellow light and microcurrent stimulation. This can be treated with other local acu-points as shown in the next diagram. For patients with sluggish Kidney Yang or excessive fear, the posterior points shown can augment lymphatic drainage, mostly treated with Red or Scarlet light and microcurrent.
These microcurrent and color light lymphatic treatments can be excellent adjunctive therapy for the following needs:
  • Chronic pain patients
  • Facial and whole body rejuvenation
  • Weight loss programs
  • Patients dealing with depression or anxiety
  • Some cases of cancer (do not use any pad electrode treatments for cancer patients)
Again, it is vital that patients undergoing lymphatic therapies drink sufficient pure water throughout the process to allow the body to drain off discharged toxins. You need to let them know that there could be temporary uncomfortable symptoms such as fatigue, nausea, headaches or revival of past symptoms through the Law of Cure. This is a principle from homeopathy that states that the healing process of some diseases could cause the patient to temporarily experience symptoms of past diseases in the reverse order in which they originally manifested. This is considered a good sign of deep resolution.
Appropriate Chinese herbal therapy and homeopathic drainage remedies can help minimize these uncomfortable symptoms and speed recovery. The use of simultaneous microcurrent and color light is a very effective means to treat the lymphatic system, as it addresses both the physical and emotional underpinnings of the patient's issues together. This is very appropriate for treating the lymphatic system because it is both a drainage system for the body's tissues and its psychic buffer.

Current Issue: Acupuncturists Stepping Up to the Cancer Challenge

One of the greatest challenges in medicine is treating the cancer patient.
Successful treatment often involves bringing to bear many different modalities to restore health, a multi-disciplinary model followed regularly in Asia - where acupuncture, nutrition, exercise, hyperthermia, and herbal medicine are often combined with the more commonly accepted Western modalities of surgery, radiation, and chemotherapy.
In this interview, Acupuncture Today asks three licensed acupuncturists and NCCAOM Diplomates about their experiences working at CTCA. Dr. Irina Aleynikova, MD, LAc, Dipl. Ac. (NCCAOM) earned her MD at Minsk Medical University in Belarus and her Masters of Oriental Medicine at the Midwest College of Oriental Medicine in Chicago. She practices at CTCA's Chicago center. Jennifer Feingold, LAc, Dipl. Ac. (NCCAOM), PA, earned her Master's degree in Acupuncture from The New England School of Acupuncture and her Bachelor of Science and Physician's Assistant certificate from Hahnemann University. She practices at the Eastern Regional Medical Center, CTCA's Philadelphia hospital along with Dr. Gurneet M. Singh, ND, LAc, Dipl. Ac. (NCCAOM) who earned both her Doctorate in Naturopathic Medicine and her Master of Science in Acupuncture at Bastyr University in Seattle.
AT: How did you come to work at CTCA?
Dr. Irina Aleynikova, LAc, MD: My major paper in college was on the use of Chinese medicine in breast cancer treatment. The dean of the school saw this and recommended that I apply to the Cancer Treatment Centers of America due to my interest in the topic and my prior background as a physician in Belarus. After that, I met with Dr. Ray, a reconstructive surgeon and medical acupuncturist, and he told me about the unique approach at this hospital that integrates complementary alternative medicine to treat cancer. After this meeting, I knew that this hospital would be a great fit for me.
Jennifer Feingold, LAc, PA: While I was working at Great Brook Valley and learning both Western medicine and Eastern medicine with Jeff Satnick, MD who is also a NESA graduate, I was strongly considering attending acupuncture school. Jeff encouraged me to look into Naturopathic School as well before I made my final decision. I went to a Naturopathy conference in Seattle around 1996 or so and there CTCA had an informational booth. I was impressed with their integrative model. I had only been a PA for a couple of years and was already feeling somewhat frustrated with the limitations of Western Medicine. I can still remember the woman's face at the CTCA booth and my positive experience with our conversation. I remember thinking to myself that it sounded like an interesting place to work. Perhaps it was an omen. Fast forward many years later. I moved back to Philadelphia to be close to my mother with her ailing health. A massage therapist acquaintance mentioned to me that he had interviewed at CTCA and had passed on my information. I interviewed and knew it was a special place as soon as I walked in the door. And that's how it all started!
Dr. Gurneet Singh, LAc, ND: How CTCA and I found each other is a bit of a story! I received a phone call from a caregiver of a patient at CTCA, who had researched local Philadelphia acupuncturists and found me. She was interested in learning more about how acupuncture could benefit her husband and wanted to know if I could come to CTCA to treat her husband. I told her that I would like to help and would look into it. I called CTCA and was connected with the Director of the Rehabilitation department at that time. At the same time, the director had been looking for an acupuncturist to initiate the development of the acupuncture program at Eastern. She was contacting local physicians, who were also trained in acupuncture. Included in her search, she contacted the doctors that I was assisting in research at the University of Pennsylvania Medical School and they recommended me. As I learned more about CTCA, visited and interviewed at Eastern, I was very excited about the integrated team, the patient focused model, and the wonderful people I met during my interviews. I knew I was in the right place and was thrilled to start my work here!
AT: What kind of conditions do you treat at CTCA?
Dr. Irina Aleynikova, LAc, MD: At CTCA we treat a variety of conditions such as pain, nausea, vomiting, chronic fatigue, peripheral neuropathy, stress, anxiety, hot flashes and others.
Jennifer Feingold, LAc, PA: The conditions that I treat at CTCA include, but are not limited to; side effects from cancer treatment: Digestive complaints - nausea, vomiting, diarrhea, constipation. Musculoskeletal pain, post op pain, fatigue, anxiety, insomnia, peripheral neuropathy, xerostomia from radiation treatment for head and neck cancers.
Dr. Gurneet Singh, LAc, ND: The majority of conditions that I focus on at CTCA are the side effects of chemotherapy, radiation, and surgery. Some conditions that are addressed routinely include: nausea and vomiting, diarrhea, constipation, anorexia, xerostomia, hot flashes or flushes, nicotine addiction, fatigue, peripheral neuropathy, pain, and stress/anxiety. In terms of pain management, this may be pain directly related to the cancer or associated with the treatment of the cancer. I can also focus on any type of pain issues that may be affecting the quality of life for the patient, such as arthritis, low back pain, knee pain, and headaches/migraines. Furthermore, the benefits of acupuncture definitely extend beyond the physical, and I use acupuncture at CTCA for mood support, stress management, and the promotion of an overall sense of well-being.
AT: Are treatments mainly for symptoms or do you also address underlying issues of constitution and balance?
Dr. Irina Aleynikova, LAc, MD: Here at CTCA, most acupuncture treatments are done in order to alleviate the symptoms caused by cancer; it unfortunately does not do anything to treat the underlying disease. Acupuncture is, however, able to successfully decrease the side effects caused by cancer treatment, such the nausea and vomiting caused by chemotherapy and radiation. Acupuncture is also able to help many patients decrease cravings from trying to quit smoking.
Jennifer Feingold, LAc, PA: Our patients are very complicated medically with multiple medical and emotional issues as well as multiple side effects from their treatment. What I have found works best is to try to always balance their pulse as a root treatment and then needle for the presenting complaint. Using the basics of Japanese Acupuncture and using the pulse to guide me seems to work best for these patients. Sometimes when I am squeezed for time, I will do an auricular treatment based on symptoms alone.
Dr. Gurneet Singh, LAc, ND: The treatment sessions are symptom focused. Our acupuncture treatments are physician directed, meaning that a physician's order is placed by the medical oncologist, the hospitalist, or another physician, such as surgeon and the treatment is focused on the condition(s) listed in the physician's order. I explain to my patients that we are not attempting to treat the cancer with the acupuncture, rather we are focusing our treatments on managing, diminishing, and preventing the side effects of chemotherapy, radiation, and surgery. Although the treatments are not "cancer treatment" focused, it is my hope that the acupuncture does help to support the immune system, as studies have shown. Any support to the immune system is very important as it can inevitably help our patients in their fight.
In addition, during the intake for each patient, I also inquire about digestion, mood, energy, sleep, and pain. Often times, these issues are interconnected and I am able to treat multiple issues within one treatment session.
AT: In how much demand is your work? How many treatments do you perform a year on average at CTCA?
Dr. Irina Aleynikova, LAc, MD: Last year, I performed close to 1,400 treatments, so I would say it is in quite high demand.
Jennifer Feingold, LAc, PA: When I first started at CTCA, there was not much demand for our work. Gurneet and I have done extensive education throughout the hospital for the medical staff, and our demand has grown significantly. I see about 1,200 patients per year there. That is based upon 0.6 full time equivalents. I am there three full days per week. We see on average eight patients per day. It is mostly outpatients and some inpatients.
Dr. Gurneet Singh, LAc, ND: I have been working at the Eastern Regional Medical Center since the Fall of 2006. Being the first acupuncturist here, I had the exciting opportunity to launch and initiate the development of our acupuncture service at Eastern. I have been proud to see how our program has progressed and evolved over the years. In particular, it has been amazing to witness the growth, popularity and demand for our services by our patients over the past four years. On average, I provide about seven to eight treatments per day, including both in-patients and out-patients. I work at CTCA three days per week and I provide approximately 1,125 acupuncture treatments per year. Patients are treated in our out-patient clinic treatment room, in the infusion center while receiving chemotherapy, and in their in-patient rooms.
AT: Do you get to use any moxibustion in your treatments? If so, I assume that would be indirect, yes?
Dr. Irina Aleynikova, LAc, MD: Yes, I use them indirectly.
Jennifer Feingold, LAc, PA: We do not use moxibustion at this time. I hope that we will be able to in the future.
Dr. Gurneet Singh, LAc, ND: We are not using moxibustion at our center. Because many of our patients are very sensitive to different scents, we were concerned about the odor associated with moxa (even smokeless moxa). Additionally, we are not permitted to light anything on hospital grounds, which would be necessary to use moxibustion.
AT: Do you get to use any herbal remedies in your treatments? If so, do you recommend Shih Chuan Da Bu Wan (Ten Flavor Teapills) for treatment of low white blood cell counts? This condition is normally treated in the West with injections of Neulasta or Neupogen.
Dr. Irina Aleynikova, LAc, MD: Although I have a MS in herbology, I do not prescribe herbal remedies because we have a department of naturopathic medicine that deals with the prescription of herbal supplements.
Jennifer Feingold, LAc, PA: In the acupuncture department, we do not use any herbal remedies. However, as you know, we employ naturopaths who use extensive herbal remedies.
Dr. Gurneet Singh, LAc, ND: We do not use any herbal remedies as a part of the acupuncture services at Eastern. When patients begin treatments here, they will meet with a naturopathic doctor, who will conduct a thorough review of all of the supplements that the patient is using. All of the supplements and herbal products that are recommended by our naturopathic doctors are evidence-based, meaning that they have been researched for efficacy and safety.
As a side note, if I am aware that a patient has low white blood cell counts, I will include acupuncture points in the treatment which can help support the immune system, including white blood cells. Also, if a patient is being treated with Neulasta or Neupogen, a common side effect is generalized body pain or achiness, which can be addressed with acupuncture.
AT: Have your patients remarked at all upon their treatments with hyperthermia? If so, what has been their general reaction?
Dr. Irina Aleynikova, LAc, MD: I have not treated patients with hyperthermia, so I am not able to comment on that question.
Jennifer Feingold, LAc, PA: Most patients have been very satisfied with their hyperthermia treatments. I saw one very young adult who was in her early 20s. I treated her for anxiety associated with using hyperthermia. Another that I recall had a lot of fatigue from her treatments. They both did very well and benefitted from including acupuncture in their treatment regimens.
Dr. Gurneet Singh, LAc, ND: I have worked with patients who are also undergoing hyperthermia treatments. I have not noted any complaints of side effects related to hyperthermia that patients wanted me to work on.
AT: What has been your experience of working with other members of the medical staff? Do you feel to be integrated into the team?
Dr. Irina Aleynikova, LAc, MD: Here at CTCA, I feel very integrated into the medical staff. When doctors and nurses see a patient that can benefit from acupuncture treatment, they never hesitate to refer them to me. This is especially true of the pain team and medical oncologists who very frequently refer patients for acupuncture treatment. Doctors are well aware of the way in which acupuncture works and we are able to provide a very integrated approach toward medicine at CTCA.
Jennifer Feingold, LAc, PA: In the beginning when I arrived at CTCA, the medical staff were not familiar with our work and were a bit skeptical. However, over time and with our education and patient feedback, I feel that we are well integrated into the team. We have numerous referrals from the physicians, and we are likely going to expand our department.
Dr. Gurneet Singh, LAc, ND: I can say with 100 percent confidence that CTCA has truly realized, actualized, and implemented an integrated care model. This integrated team approach is one of the main reasons I wanted to join the CTCA family. Each member of the team is valued for the special expertise he or she can contribute to the care and healing of each patient. We work seamlessly together as a unified team to ensure that all the of patient's physical, emotional, mental, and spiritual needs are met with care and respect. We rally around and support our patients to the best of our abilities and strive to surpass the expectations of our patients. I feel that my expertise is respected and valued by patients and my fellow clinicians.
We participate in daily in-patient rounds where clinicians from the different departments including nutrition, naturopathic medicine, acupuncture, mind/body, pain management, rehabilitation, and pastoral care can meet to review the status of each in-patient with the hospitalists and nurses. This provides a forum where each department can be updated on our in-patients and furthermore, each department can determine if they can help address particular issues that each individual patient may be experiencing.
AT: What is your overall impression of CTCA?
Dr. Irina Aleynikova, LAc, MD: CTCA is a very warm and friendly place to work. Doctors, nurses, and all staff members are very compassionate and caring to the patients needs, and we are able to put the patients' needs first at this organization. We all provide a unified effort to ensure the patients' physical as well as mental welfare.
Jennifer Feingold, LAc, PA: My overall impression of CTCA is very positive. Here is an institution that uses conventional cancer treatment as well as treatments that are considered alternative - acupuncture, naturopathy and mind body support. Also, sound nutritional support. They do not just offer lip service. CTCA takes the CAM services very seriously. I have worked in many medical institutions over the years. It is very refreshing to work in a place that is not afraid to step outside of the box and do what is right for excellent sound patient care.
Dr. Gurneet Singh, LAc, ND: I think very highly of the model, mission and values that CTCA upholds and I enjoy my work here tremendously. It has been a pleasure and honor to work at CTCA...first and foremost for our wonderful, strong, courageous, and inspiring patients.
The atmosphere at CTCA is very special and different than other hospitals. As soon as you enter one of our hospitals, this difference is palpable. You walk into a facility that looks more like a luxurious hotel rather than a hospital. You are immediately greeted with friendly smiles and "hellos." The mood is set as a place of healing and you can sense the dedication and compassion from the employees at CTCA.
AT: I understand that its co-founder wanted care-givers at CTCA to treat patients as they would their own mothers, hence CTCA's trademark Mother Standard(R) of care. What does the Mother Standard(R) of care mean for you in your work at CTCA?
Dr. Irina Aleynikova LAc, MD: The Mother Standard(R) is a wonderful care system that treats every patient as an individual rather than a physical problem that needs to be solved. The Mother Standard(R) aims to provide the highest level of care to people that is struggling with a difficult problem in their life, because cancer is not only a physical ailment, but a mental struggle as well.
Jennifer Feingold, LAc, PA: I love the Mother Standard of Care here at CTCA. It means all of the staff are on the same page. I have tried to use the same philosophy in my clinical practice over the years. It is easy to do when one is working solo in a private practice. However, when working in a hospital, there are many other challenges when working with other medical staff. Some staff may not have the patient's best interest at hand at the moment - for varied reasons. It usually is that a staff member wants to just complete a task and may forget about the patient in his or her diligence to complete a given task. With the Mother Standard, everyone in the hospital is on the same page - from the cleaning lady who does not speak much English up to and including our CEO. Everyone knows that the patient comes first and it makes a HUGE difference for the patient and also the staff. Everything flows so well here at CTCA. It is a pleasure to work here. The roadblocks and bottlenecks do not exist as they do in other facilities where I have worked. The energy is very open positive and flowing.
Dr. Gurneet Singh, LAc, ND: To me, the Mother Standard(R) is the ultimate and ideal patient focused care model. The Mother Standard(R) means providing the best care that I possibly can and providing that care with heart and compassion. The Mother Standard(R) holds that each patient is treated as if he/she is a part of our own family and we are expected to give the care that we would give to a loved one. Our patients are the reason that we are here and their journey, health, and comfort are of the utmost importance to us. I feel honored to be welcomed into and included in my patient's lives. Working within this type of model, we become close to our patients, forming memorable connections every day. I am truly touched by my patients' stories and I am inspired every day as I witness their courage, hope, and strength.

Current Issue: Venturing into the World of Pet Acupuncture

The practice of acupuncture offers a variety of scenarios, which make it different from other types of medicine. One strikingly unique setting is in the veterinary clinic.

My first experience with animal acupuncture was typical. In acupuncture school, we were informed that acupuncture is effective for animals as well as humans. We received the information that as with humans, the tongue and pulses are inspected in diagnosis, and then we were shown needles for chickens and horses. These, when compared to the needles for humans, were respectively thinner and shorter in the case of the former and thicker and longer in the latter case. With this foundation, I was confronted by a co-worker who asked me if I could do something to help her dog who was having bad back pain. The dog was a 7-year-old male Daschund. He was unable to urinate without squatting because of back pain. His gait was slightly affected but without tenderness in the legs. My friend was distraught and the dog's struggle was compelling so I agreed to try to help. I concluded that the treatment should follow "normal" protocols for back and hip pain and located the second sacral foramen and placed .5 cun needles bilaterally where I assumed ub-32 would be located. After examining the dog's hind legs it appeared that although the foot is elongated and the animal stands on its toes, the ankle is very clearly defined and k-3 and ub-60 were available for use. Again, using .5 cun needles I chose left side k-3 and right side ub-60. Needles were retained 10 minutes after inserting them with neutral technique.
old lady and dogResults were remarkable.
Upon my removing the needles, the dog which has been lying partially on his side jumped to his feet and scampered about, rushing to the owner's feet excitedly. The dog needed no further encouragement and ran to the stairs after my surprised friend who had reported that stair climbing had become difficult for the dog. Later, she reported that while on their afternoon walk the dog has been able to lift his leg.
The next time a friend's dog needed help it was a 12-year-old female toy Dobermann named Mitzie. The dog was limping in her hind legs from referred pain in the hips. There were no tender spots on her paws or legs but her gait showed frank weakness. The first treatment was with .5 cun needles bilaterally in the second sacral foramen at ub-32. The next points bilaterally were jiaji points at L-2. The needles were retained for 10 minutes resulting in general improvement of her gait.
I scheduled her for a second treatment in three days. When I examined her before treatment there were no tender spots and her gait had improved in strength. I repeated the S-2 (ub-32) and added ub-23 and gv-4. The needles were retained for 10 minutes. After the needles were removed Mitzie showed no signs of discomfort and ran into the yard. I found the second set of points useful every two weeks for a period of two months. During this time the family brought Mitzie to my home for her treatment. Once while I was preparing my needles and talking to the family members, Mitzie barked gently to get my attention and faced me, she then looked at her rear end and at me and at her rear again. The family and I had good laugh and then I obediently proceeded with the obviously appreciated treatment.
After this, further treatments were unnecessary until the dog's passing several months later.
During the time that I was treating Mitzie, my niece's 12-year-old Australian Shepard, Bravo, began having trouble when going on walks. I examined him and found no tenderness on his rear limbs or paws. His gait showed a slight limp and there appeared to be a similarity among the three cases. None of them had been preceded by an incident or injury and they all appeared to be a gradual appearance of difficulty in the performance of daily activities. Bravo was a medium sized dog with long fur and considerably larger than the first two dogs so I treated him with 1 cun needles.
I used a reinforcing technique inserting at s-2 at ub-32 bilaterally, and at l-2 level, at ub-23 retaining the needles for 10 minutes. The response was very good and he continued to improve during several follow-up visits. Once, while I was visiting with his owner, Bravo gave me a reminder similar to Mitzie's - a short bark followed by glances at me and the tail. It was hilarious.
Shortly after I stopped treating Bravo, I began to work as staff acupuncturist at a veterinary hospital. The owner of the hospital had previously seen good results with acupuncture. He scheduled my first appointment with a very difficult patient. This dog was a large nervous Sheperd female who could not stay still and wanted to bite. I had two assistants put the dog onto a table with bolsters and pillows to hold her still and in place. X-rays showed problems in the spine, hips, and front limbs. The doctor and I discussed the reports and examined the X-rays. I selected points that were local to the abnormalities on the X-rays.
In spite of the dog's excitable personality she showed no objection to needles placed bilaterally at t-12, L-4, as well as LI-11 and p-6 on the left foreleg. The needles were retained 10 minutes after reinforcing technique. The results were encouraging and her pain medications were reduced in half. Subsequent treatments were not met with the same level of resistance although some reluctance was always there because of the high strung nature of the Sheperd breed.
The satisfactory response to this first treatment left me encouraged. I was confident in the setting because in comparison to human acupuncture, point location and needle insertion are identical with the exception of the presence or lack of fur.
The next patient's response did nothing to discourage me.
This was a 12-year-old male Yorkshire terrier. The small dog was brought to the hospital wrapped in a blanket. I was told he was unable to stand and had trouble eating and breathing. When my assistant placed the dog on the treatment table his front and back legs splayed out in four directions and he lay flat on his chest. His tongue was lolling out. This appeared to be significant deficiency of the kidney yang and qi. I decided to tonify the kidney qi and raise the kidney yang.
I selected gv-20 ub-15 bilaterally and ub-32 also bilateral. The needles were retained for 10 minutes and each lasered for two minutes with a 670 nm 5mw class IIIa laser. After I removed the needles the dog appeared to be more alert than before and not at all upset by having undergone acupuncture.
The following day, the owner called the animal hospital. She was beside herself with excitement. She had been taking care of her other animals, feeding them when she was surprised by the sight of my patient, Bugsy, walking casually over to the food bowl and eating standing up! The following week I gave Bugsy his second treatment. When he was unwrapped from his blanket he lay flat on the treatment table as before. I inserted the needles in the same locations as the previous treatment and applied the laser. When the treatment was half over, the dog gave a huge shudder and stood up on all fours! This was a surprise to my assistant, myself, the veterinarian and not least of all the owner. I supported the laser acupuncture with a kidney yang tonification herbal formula and repeated weekly treatments. Bugsy stabilized and was able to walk and eat normally at the time treatment was discontinued.
Another extraordinary case was Mikki. The veterinarian told me that there was a cat in the hospital who might benefit from acupuncture. She said that if I wasn't interested they would be likely to euthanize the cat because her high creatinine and blood urea nitrogen indicated significant kidney disease.
Mikki, an obese female tabby was unable to stand and passed very cloudy urine during my examination. My diagnosis was kidney qi deficiency. The treatment plan was to reinforce kidney qi. Because of the cat's size the .5 cun needles were too big so I used 7mm ear needles. Points selected were gv-20, ub-32, ub-60, and k-3. Along with the acupuncture I employed a photon therapy light with a .5 cun dual frequency head of 650 nm red and 940 nm infrared @20mw. This is pulsed @146 hz. The photon light was used on ub-23 and ub-52 for 10 minutes while the needles were retained.
My assistant placed the cat on the floor without removing the needle in gv-20. She stood on all fours and took one step. After she tried another step with partial success we gave her further treatment with the photon light. After 10 minutes on ub-52 the cat was returned to the floor where she took five steps. The next week the follow-up treatment was the same. After I removed the first needles I gave another 10 minutes on the ub-52 point. This obviously sedated the cat and she almost fell asleep. The treatment resulted in improvement. The cat was able to stand long enough to defecate and take one step before its hind leg began to weaken. The owner's enthusiasm was obvious and the next follow-up was scheduled for two days later.
Finally, there was a case which emphasized the significance of the kidney meridian system in treating paralysis in dogs and cats This patient was a 7-year-old female Newfoundland, Bessie, weighing 120 lbs. The dog was in acute renal failure. Since she couldn't walk or eat she was brought to the treatment room on a stretcher. My treatment plan was to reinforce kidney yin, qi, and yang. Since she had long fur I selected 1 cun needles.
These were 32 gague (gold plated to help tonification) inserted with neutral technique (alternating right and left). Points selected were gv-20, k-3 retained for 15 minutes. At this point I added 1.5 cun 32 gague needles in ub-23 and ub-32 for 15 minutes. After all the needles were inserted, I placed the photon led light on ub-52 for a 10-minute cycle. The dog was not upset by the acupuncture and remained on the stretcher. She was taken back to the kennel on the stretcher.
The next day I repeated my treatment on Mikki the cat. I was asked to treat Bessie the Newfoundland for a follow-up. Upon seeing her owner when she was brought back to the kennel, she had gotten up from the stretcher and walked to him! Bessie walked into the treatment room. My assistant led her onto the treatment table. According to the vet she was still in renal failure and not eating. With this in mind I increased the needle retention time to 20 minutes each set and used reinforcing needle technique. I prescribed a dose of rehmania 6 (liu wei di huang wan) in pill form for the evening to improve her appetite and she took a short walk with her owner before returning to the kennel. The next day she had eaten and a few days later I treated her again using the same protocol as in the second treatment. Her mobility was restored but unfortunately her renal failure was too far advanced and eventually terminal.
Treating animal patients is very rewarding. The cooperative and enthusiastic pets and owners and pets respond with relief and gratitude. The animals don't require strong acupuncture and cats don't even try to reciprocate the "puncture" part.
Although acupuncture is the main modality, it can be supported in the veterinary setting with herbal medicine and laser. Almost all common chinese herbal formulas are useful for dogs, cats and horses (the main concern is to adjust dosages according to the patient's weight.)
I have also found that cold laser and infrared photon lamps are a good substitute for moxa stimulation since they are able to penetrate the fur and access the points on the surface as well as boost the effects of individual needles.

Treating Urinary Tract Infections with Chinese Medicine


If you’ve ever had a bladder infection, you’re no stranger to the lightening bolt of pain you feel every time you hit the ole’ litter box to pee. You’re damned if you do and damned if you don’t; it’s going to hurt if you go, but holding it hurts, too.
While what’s going on may seem like a simple bladder infection, in Chinese medicine they’re anything but simple. Like headaches, colds, or back pain, bladder infections (or UTI’s) have a distinct personality. Symptoms can run the gamut from urinary urgency, frequency, difficulty, dribbling, sharp urethral pain, spasms in the lower abdomen, and pain radiating to your lower back.
In Chinese medicine, UTI’s generally fall into a pattern of excess or a depletion. Excess patterns are due to an accumulation or too much of something. Bladder infections that are excess tend to be a combination of dampness (an accumulation of fluids) and heat. The most notable symptom of this kind of pattern is a burning pain during urination. A damp heat UTI can be the result of too much alcohol, hot spicy food, sweets, or poor hygiene.  
UTI’s that are caused by depletion are usually the result of being run down from aging, not sleeping well, poor diet, and…um, too much sex. Living life a little too fully can wear down your Chinese Kidney and/or Spleen to the point that you’re unable to metabolize water or control the mechanism of the bladder very well. The end result can be incontinence or dribbling, dull and achy pain, and a sore lower back.
To further complicate the diagnosis, in Chinese medicine, bladder infections are grouped into six different types:
Heat. This is the typical bladder infection, with sharp, burning pain. You may also run a fever, have constipation, thirst, or a bitter taste in your mouth.
Stony. Okay, this one really hurts with the kind of pain that can bring you to your knees. This is essentially kidney stones, and the symptoms include severe low back or abdominal pain, cramping, difficulty urinating, urinating blood, and passing stones in the urine.
Qi. This is all about your Qi, or energy, and can be either excess or deficient. An excess pattern means that your energy is stagnating and causing symptoms, which include difficult urination, a feeling of fullness or pain in your lower abdomen, and possibly chest tightness or rib pain. A depleted Qi pattern is caused by not having enough energy for your bladder to metabolize water. Symptoms in this case may include a feeling of heaviness in your lower abdomen, dripping or incontinence, possibly a pale complexion, feeling tired, shortness of breath, and an achy lower back.
Bloody. This pattern can also be from either an excess or a depletion, but either way, there will be blood in your urine. An excess pattern is essentially heat causing you to bleed, with symptoms such as urinary frequency, urgency, sharp burning pain, and of course, blood in your urine–usually a fair amount. A depletion can also cause blood in your urine, but there typically won’t be as much blood, or the bleeding will occur over a long period of time. Also, if this pattern is from being depleted, it won’t generally be as sharply painful, but you may feel tired and you may have a weak, achy low back and/or knees.
Cloudy. Like the bloody pattern, this one can come from either an excess or a depletion. The common denominator, however is cloudy or milky looking urine. If caused by an excess, this type will have very cloudy urine with urethral pain and burning. If from a depletion, your symptoms may include dribbling of cloudy looking urine, mild urethral pain, dizziness, ringing ears, and again, a weak or achy lower back and knees. This pattern tends to affect people who have a thin, weak, or depleted body type.
Taxation. This is a total depletion pattern, and comes from overdoing it or being totally wiped out. The symptoms include periodic dribbling of urine, stress incontinence (leaking after jumping or sneezing), fatigue, and an achy, weak low back or knees.
Each type of UTI has a specific method of treatment in Chinese medicine. However, in general, an excess pattern will involve clearing heat and resolving the dampness. This may be done through a combination of acupuncture, Chinese herbs, and food therapy. A common herbal formula for bladder infections is Ba Zheng San, (also called Eight Herb Powder for Rectification). This particular formula works to clear heat and drain out dampness, and in some cases can be used for UTI’s where there is some blood in the urine.
For UTI’s that are caused by being depleted, the first line of treatment may involve Chinese herbs to supplement Spleen or Kidney Qi (energy). Acupuncture and foods chosen to build up your strength may also become part of your treatment. It’s important to remember that it usually takes longer to treat a depletion than an excess pattern. That’s because when you’re depleted, the treatment involves nourishing or rebuilding your body, and this can take time.

The Contraindicated (Forbidden) Points

The following points have been traditionally considered forbidden to use during the nine months of gestation (pregnancy) with any technique. This is due to their oxytocic effect (ability to induce labor by stimulating contractions of the muscles of the uterus).
Forbidden Point

Ghost Points

Ghost Points (Guixue) listed by Sun Si-Miao in the book Qian Jin Yao Fang (Prescriptions worth a Thousand Gold Ducats) for the treatment of psychosis (Diankuang) and epilepsy (Dianxian).
English Name
Point
Ghost Palace DU26
Ghost Convincing LU11
Ghost Fortress SP1
Ghost Heart PC7
Ghost Road UB62
Ghost Pillow DU16
Ghost Bed ST6
Ghost City REN24
Ghost Cave PC8
Ghost Hall DU23
Ghost Hidden REN1
Ghost Official CO11