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OklahomaAcupunctureTechnique
11/20/2016
Dr.PaulJaskoviak 1
ACUPUNCTUREMASTERPOINTS
PaulA.Jaskoviak,,DC,Dipl.Med.Ac.,FIMA,DCRC,DACAN,CCSP,FICC
Acupunctureexperience •Currently
• DeanofPostgraduateDivision,TexasChiropracticCollege
PublishedtworesearchmanualsinAcupunctureatNUHS
TaughtfirstAcupunctureCourseofferedbyaChiropracticCollege
EducationinChina,andstudiedvariouswaysofusingacupunctureincludingJapanese,Korean,andChinesesystems
StudiedunderWuWeiPing,Amaro,andothers
TestifiedthroughouttheUS
My patientPaula….
Science-Basedvs.Yin/YangandFiveElementtheory Howtoexplainacupuncturetoyourpatients
• Science- based• Traditional• Oriental• ForcenturiesintheOrientacupunctureconsistedof:• Specificpointstimulation• Physicalmodalities(suchasheat,coldandmassage)• Counseling(psychotherapy)• Herbalism(nutrition)
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ThebasicsofClassicalOrientalDiagnosisandthecausesofdis-ease
1) Internalfactors– notlivinginaccordancewiththeprinciplesoftheTAO:PREDISPOSED– thisisanimbalanceintheprotectingchi
2)EffectedbyoneoftheTenExternalFactors– thisisanimbalanceinthemeridians:toomuchortoolittleenergy(anexcessoradeficiencyofchi):climate,emotions,excessfoodanddrink,physicallabor,unregulatedsexualactivity,epidemics,wounds/bites,worms/infestations,poisons,heredity.Onlyeffectsanalreadyweakbody.
Alldiseaseiscausedorassociatedwithadisturbedharmonybetweentheyinandyang.Ifyangbecomesdominantinanorgan,theorganbecomeshyperactive;ifyinbecomesdominantinanorgan,thentheorganbecomeshypoactive.
3)SymptomsExcessofenergy– pain,inflammation,hyperactivityorhyperfunctioningDeficiencyofenergy– edema,conditionsofbodyorgans
Scientificbasisofacupuncture
• AcupunctureintheSuccessfulTreatmentofLeukoderma – AmJ.Acupuncture,Vol8,No.3,July-September1980• RevolutionaryNewPainTheoryandAcupunctureTreatmentProcedureBasedonNewTheoryofAcupunctureMechanism– AmericanJournalofAcupuncture,Vol.11,No4,October– December1983• Long-LastingReductionofBloodPressurebyElectroacupuncture inPatientswithHypertension–MedicalAcupuncture,Vol.27,No.4,2015• AnalgesiceffectonprimarydysmenorrhealtreatedwithconventionalandshamacupunctureatSan-yin-jiao (SP6)– Zhongguo ZhenJiu2016Apr;35(4):318-22• EffectofZusanli (ST36)Electroacupuncture atTwoFrequenciesontheBioavailabilityofTc-SodiumPertechnetate andonLabelingofBloodConsituents inRats – J.AcupunctureMeridianStud2009:2(2):135-146
• Electroacupuncture atBilateralZusanli Points(ST36)ProtectsIntestinalMucosalImmuneBarrierinSepsis – Evidence-BasedComplementaryandAlternativeMedicine,Vol.2015,ArticleID639412
• PCacupoint stimulationforpreventionofpostoperativenauseaandvomitinginpatientsundergoingcraniotomy:studyprotocolforarandomizedcontrolledtrial– byFengandLi
PainControl– Endorphinsandenkephalins
• Endorphins:• 100timesmorepotentthanmorphine
• First– stimulateaspecificsite:• Thestimulationofspecificsites(orcombinationsofsites)sendsanimpulsetothebrainstemthat
triggersthereleaseofacomplexmolecule:Beta-lipotrophin/ACTH• Basedonthesite/orcombinationofsites– oneormoreofseveralreactionsaretriggered:
• Increaseordecreaseshormonallevels(maleorfemalehormones)• Increasesordecreasescortisone• Increasesordecreasesprostaglandins(associatedwithacuteinflammation)• Andfinally– releasesover200kindsofendogenousendorphinswhichtendtobesitespecific
• L-Tryptophanisaprecursortoendorphinproduction• Endorphinscirculateinthebloodstream,cerebrovascularfluidandgastrointestinaltractforupto3
dayswithapeakwithin30-45secondsoftreatmentcommencement.• Pomeranz hasconductednumerousresearchstudiesdocumentingendorphinproduction
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Intriggeringendorphins– locateatriggerpointoran“Ahshi”point- Stimulationoccurswithaneedleorwithasmalldiameter
electrode;3-5pps;motorstimulation- Treatmenttimeis20-30secondspersite
Enkephalin- largemyelinatednervefibersoftheskinhaveaninhibitoryeffectonthesmallpainbearing
fibersthatenterthesamesegmentofthespinalcord
-Enkephalins blockoutpain– thisoccurswithhighvolttherapyat70-90pulsespersecondgenerallywithintensitytopatientperception(sensorylevelsofstimulation)withpadplacementdirectlyoverthesiteofthepainORwithinterferentialtherapyin
whichcasepadplacementisaroundthesiteofthepainand80-100pulsespersecond
TypesofpointsTherearemanydifferenttypesofpoints,e.g.Localpoints,AhShipoints,tonification andsedationpoints,horarypoints,connectingpoints(luo),intersectionpoints,accumulationpoints,cardinalpoints,miraclepoints,moxa points,thermalreflexareas,internalpointsandamphotericpoints(alarm,association,source,akabane,masterpoints)
Locatingacupuncturepoint– TheHumaninch:Tsun orPouce
• Basedonthepatient’shand(males– left,females– right).Patient’shand.
• Usedtolocateacupuncturepoints• Thedistancebetweenthetwocreasesofthephalangesformedwhenthesecondormiddlefingerisbent.Fen– decimalpartofthehumaninch.
AhShipointsandlocalpoints
• Ahshi pointsareliterallytriggerpoints– thesearethemainpointsoffocusinDryNeedling• Localpointsarepointsinlocalareathataretreated
Masterpoints
• Masterpointsareexamplesofamphotericpoints• 2-3timestheenergythatotherpointshave• Methodofstimulationofthesepointsisgenerallyirrelevant• LI4• ST36• SP6• LU7• LV3• GB20• BL54
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LI4HoKuHegu/Hegu
PhysiologicalEffects
• Painintheupperextremityheadandneck• Analgesia– lowerjaw• Promotesdrainage,stagnation
RecentstudiesfromtheJournalofOrofacialPainshowedthatthestimulationofHeGu (LI4)significantlyreducedmyofascialpainofthejawmuscles[2].ArecentCochranesystematicreviewonacupunctureinmigraineandtension-typeheadachessuggestsstimulationofacupoints asaneffectiveandvaluableoptionforalleviatingmigrainesandtension-typeheadaches[1].
• References• Schiapparelli P,AllaisG,etal.Acupunctureinprimaryheadachetreatment.Neurol Sci.2011May;32Suppl 1:S15-8.
• ShenYF,YoungerJ,etal.Randomizedclinicaltrialofacupunctureformyofascialpainofthejawmuscles.JOrofac Pain.2009Fall;23(4):353-9.
Combiningpointschangesthephysiologicaleffectsofthepoints
• Examples:
• LI4andST36• LI4andSP6• LI4andLI11• LI4andLV3
LI4andST36
• Gastrointestinalcomplaints• Theorderofneedleinsertionmaymakeadifference• Thefrequencyutilizedmakesadifferencewithelectricalstimulation• Thesideoftreatmentmaymatter• Eventhelengthoftimeeachpointisstimulatedmaymakeadifference
LI4andSP6- GynecologicalComplaints
LI4andLI11
• Dermatologicalissues• Treatmentisbilateral
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LI4andLV3
• Majorsedation
ST36ZsusanliZu SanliTsu sanli
PhysiologicalEffects• Kneepain/lateralaspectoftheknee• Gastrointestinalconditionse.g.diarrhea,constipation
• Orderofneedleinsertionmatters• Nauseaandvomiting• Stressandfatigue• Healthpromotionandlongevity• Painonthelateralaspectoftheknee• Majortonification pointforthebody• hiccups• Bilateraltreatmentofthispointeffectsthecellularelementsoftheblood;somestudieshavedemonstratedincreasedwhitebloodcount(duringinfections)andincreasedredbloodcountincasesofanemia.InonestudyST36andSP6wasmoreeffectiveinraisingleukocytesthanWesterndrugs
• Researchshowselectro-acupunctureresultswithP6(HC6)incasesofhypertension• Whenneedling,don’tstandinfrontofthepatient
Research
• TherearemanystudiesconductedwithZu SanLi(ST36)inthescientificliterature.Inneuroimagingstudies,stimulationofZu SanLi(ST36)hasbeenshowntoaffectthelimbicandparalimbic systemsinthebrain[2]whichmayaffectthebody’sresponsetostress[3].TheJournalofAutonomicNeurosciencealsopublishedanarticlethatshowedthatboth Nei Guan(P6) andZu SanLi(ST36)usedtogetherhaveaneffectongastrointestinalmotility[1].
• References• YinJ,ChenJD.Gastrointestinalmotilitydisordersandacupuncture.Auton Neurosci.2010Oct28;157(1-2):31-7.Epub 2010Apr3.
• FengY,BaiL,RenY,WangH,LiuZ,ZhangW,TianJ.Investigation ofthelarge-scalefunctionalbrainnetworksmodulatedbyacupuncture.Magn Reson Imaging.2011Sep;29(7):958-65.Epub 2011May25.
• Pavao TS,Vianna P,Pillat MM,MachadoAB,BauerME.Acupuncture iseffectivetoattenuatestressandstimulatelymphocyteproliferationintheelderly.Neurosci Lett.2010Oct22;484(1):47-50.Epub 2010Aug13.
SP6SanYin Jiao
PhysiologicalEffects• CrossroadsofthethreeYinMeridians:Spleen,Liver,andKidney
digestivegynecologicalemotionalconditions
• Menstrualproblemse.g.irregularmenstruation,dysmenorrhea,amenorrhea,infertility• Nocturnalemissions,enuresis,dysuria• impotence• Generalizedbodyedema• Abdominaldistention• Masterpointforcirculation….Forindividualsthatbruiseeasily,coldfeet,andvaricoseveins
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Research
Spleen6iscommonlyusedforurologicalandpelvicdisorders,insomnia,andmenstrualcramps.
Effectsonlaborpainwithacupressure:improvelabor,managelaborpain,andshortendeliverytime
• WongCL.LaiKY,Tse HM,EffectsofSP6acupressureonpainandmenstrualdistressinyoungwomanwithdysmenorrhea,ComplementTher Clin Pract.2010May:16(2):64-9,Epub2009Nov14• EffectsofSP6AcupuncturePointStimulationonLaborPainandDurationofLabor….Iran
LU7Lieque
PhysiologicalEffects
• Goodforlocalizededemacausedbymusculoskeletalproblemsespeciallythoseofanacutenature,e.g.asprainedankle• Asthma:Lu7istreatedinconjunctionwithpointsonthekidneyandstomachmeridianswhicharelocatedonthecheck– overtheanatomicallungs(pointsonthechestandbackmaybeconsideredlocalpoints).Fewdistantpointsarefoundinanyformulas,howeverLI4isanexception– andthispointisknownto“decongest”• Needleinsertionshouldbetowardthewrist
GB20Fengchi
PhysiologicalEffects
• Suboccipital headaches• Painandstiffnessintheneck• Conditionsinvolvingtheparasympatheticnervoussystem(restanddigest;feedandbreed)• Paralysis,twitching,tremors,numbnessanddizzinessandvertigo• Seizures,memoryissues• Mayeffectconditionsinvolvingtheeyes,e.g.blurredvisionandredpainfuleyes• Tinnitus,nasalcongestion,andrunnynose• Whenusingneedles,angletowardoppositeeye…shallowinsertion
LV3Taichong
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PhysiologicalEffects
• Thispointwillrapidlydetoxifythebody….Angleneedletowardheeloffootabout½“deep• Neurologicalcomplains,e.g.Parkinson’s,MS,depression,epilepsy,infantileconvulsions• Weaknessnumbnessandpaininthelowerextremities;difficultiesinwalking• Majorsedationpoint– especiallyforthelowerpartofthebody• Migraineheadache• Drugrehab• Usecareintreatingifpatienthasepilepsy,isondrugs,orisintoxicated• Needlesshouldbeangledtowardtheheel
BL40/someoldertextslistasBL54WeiZhong
PhysiologicalEffects
• Paininthekneejoint• Meniscalorarthriticpainintheknee• Sciaticpainthatradiatestotheknee• Bendkneepriortoneedleinsertion
ManagingmusculoskeletalcomplainsPhaseOne• AcuteInflammatoryPhase• Thisphasemaylastforupto72hours,dependingontheseverityoftheinjuriesandconstitutesanon-specificreactioninvolvingbothcellularandhumoralelements• Swelling,redness,warmthandpain• Muckle hasemphasizedtheprominentpartplayedbyprostaglandinsinthemechanismofbothpainproductionandincreasedcapillarypermeability• Managemet:cold,antiprostaglandins,TNS,encephalinandendorphins• Localanddistantpointtreatment;alongwithLU7forlocalizededema;andGB20-21torelaxmusclespasmintheupperextremityandGB34inthelowerextremity.LV3detoxifies.
Phase2
• Healingphase• Thisstagemaylastfrom48hoursonupto6weeksandischaracterizedbythesynthesisanddepositionofcollagen
• AccordingtoVanderMeulin,“therepairoftissueisonlypossiblewhenthewoundhasbecomeclean”andmacrophagesaremobilizedfreelyintheremovalofcellulardebris,erythrocytesandthefibrinclot
• Thegoaliscollagensynthesiswithanemphasisonthequalityofthecollagen• Management:Createmovement,heattherapies,e.g.ultrasound,diathermy,hotpacks• Acupuncture:LocalpointscombinedwithST36– themajortonification pointofthebody
Phase3
• TheRehabilitativeorRemodelling Phase• Thisphasemaylastfrom3weeksto12monthsormore(Franketal.)andisaperiodinwhichcollagenisremodeledtoincreasethefunctionalcapabilitiesofthetendonorligamenttowithstandthestressesimposedonit.
• Thedistinctionbetweenphases2and3islargelyoneofincreasingthequantityofcollagenduringtherepairphaseandofanimprovementinthequality(orientationandtensilestrength)inthelatterphase.
• Thehighlyorganizedappearanceofnormalligamentsubstancehasnotbeenapproachedbytheremodeledscarevenafter40weeksofhealingandthereisanapparentplateauinscarcollagenconcentrationatjustover70%ofnormal.Inshort,collagenisdeficientbothincontentandqualityatleast40weeksafterinjury.
Reference:Acutesofttissueinjuries– areviewoftheliterature,JohnKellett,MedicineandScienceinSportsandExercise,Vol.18,No5,1986.
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Shoulder,Elbow,wristandhand
• Treatlocalpoints– addpointsbaseduponsymptomatology• Incasesofdecreasedmobility– treattriggerpointonoppositesideandcreatemovement
HipJoint
• Treatlocalpoints– addpointsbaseduponsymptomatology• Incasesofdecreasedmobility– treattriggerpointonoppositesideandcreatemovement
Knee,ankleandfoot
• Treatlocalpoints– addpointsbaseduponsymptomatology• Incasesofdecreasedmobility– treattriggerpointonoppositesideandcreatemovement
DryNeedling
• Aterm– apparentlycoinedbythePhysicalTherapists– inanefforttosecuretherighttoutilize“acupuncture”• Triggerpointdryneedlingtargetsthetightpointswithinmusculartissuethatproduceandreferpain• AccordingtotheAPTA,“Dryneedlingisaskilledinterventionthatusesafiliformneedletopenetratetheskinandstimulateunderlyingmyofascialtriggerpoints,muscular,andconnectivetissuesforthemanagementofneuromusculoskeletalpainandmovementimpairments.”• “Thepracticeofacupuncturebyacupuncturistsandtheperformanceofdryneedlingbyphysicaltherapistsdifferintermsofhistorical,philosophical,indicative,andpracticalcontext.Theperformanceofmoderndryneedlingbyphysicaltherapistsisbasedonwesternneuroanatomyandmodernscientificstudyofthemusculoskeletalandnervoussystem.Physicaltherapistswhoperformdryneedlingdonotusetraditionalacupuncturetheoriesofacupunctureterminology.”
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