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Pediatrics as a specialty is one of the oldest topics discovered in the Chinese medical literature. Sabine Wilms discusses that as early as the Han Dynasty (206 BC-220 AD), there is mention of pediatric treatments in at least 19 volumes within the Imperial Library, (Venerating the Root, Part 1, 2013). Sun Simiao was a notable author in the early Tang Dynasty (618-907 AD) who emphasized the treatment of children and women above any other medical issue. Qian Yi (1032-1113, Song Dyn.), who is credited as the “Sage of Pediatrics,” recognized that there are unique characteristics of children that distinguish them not as small adults, but as having distinct physiology and pathophysiology that require modified treatments. The earliest documentation of using acumoxa therapy on children was described by Dr. Wan Quan (1495-1585) in the Ming dynasty. He discussed the reality that children can be difficult to needle, making pediatric massage more sufficient to rectify their diseases.
From these early moments in history forward, the movement towards non-needling children was recognized as beneficial, resulting in the creation of new techniques.. The method of shonishin (sho=little, ni=children, shin=needle) started in Japan in the 1700s, and has been popularized by Western practitioners. Shonishin involves gentle scraping and tapping with small copper, brass or stainless steel instruments along the acupuncture channels of the limbs, abdomen, and back of young patients. The act of tapping and sraping ensures a healthy directional flow of qi in a child. Since their body systems are immature, and they are in the most yang phase of life, a rapidly moving, superficial technique is extremely useful. In modern Japan, it is common for TCM hospitals to raise brightly colored flags with animals on them during each month on the emergence of the full moon. The flag raising signals to local parents that it is time to bring their children in for shonishin treatments. This practice acclimates children to treatment when they are healthy, so that when they do fall ill, they are already familiar with the protocol, and are comfortable with the procedure.
The actual practice of treating children in a pediatric clinic is rewarding yet challenging,. The job requires the herculean ability of juggling parental input and opinion, apprehension about their child’s illness, the child’s initial fear, distrust, and curiosity about the novel methods of treatment, and of course, accurate diagnosis. Don’t forget somehow managing to successfully treat a wiggling, small person. Choosing the necessary instruments for treatment is unique to each situation. In my clinic, various techniques are used for treatment in addition to or in lieu of needling, including tui na massage, tuning forks, Manaka hammers, magnets, and shonishin. Most kids are delighted by the variety of tools, and have a great time exploring them while trying to treat their parents during their treatments. However, it’s been recognized that children with the condition of Sensory Processing Disorder (SPD, also called Sensory Integration Disorder-SID), do not always respond favorably to the shonishin specifically, which can be a useful tool for helping determine both the TCM pattern, and also the type of SPD.
SPD/SID is a comorbid condition that may present with any of the autism spectrum disorders. In 2009, a study by Ben-Hasson, Carter, & Briggs-Gowan suggested that possible risk factors for developing SPD were premature gestational age (less than 36 weeks), low birth weight, maternal stress, illness or medication use during pregnancy, lower socioeconomic status, and living with a single parent. The general presentation of SPD deals with external sensory input. The input is overwhelming and disorganized to the child, who is unable to clarify what information is essential for their attention and response, and what is irrelevant background information or noise. For example, when you are listening to a teacher lecture, the normal response is to ignore the sound from the air vents above and listen to her voice. A child with SPD cannot isolate the imperative input; the result of this internal chaos can manifest as adversity to touch, sounds, smells, tastes, textures, and vigilance to maintaining an orderly space around her/himself, all of which are reflective of hyperactive response. The opposite, or hypoactive response presents with craving strong, stimulatory sensations, textures, and movement. Additionally, it has been found that children with SPD have a range of mental-emotional concerns, from anxiety (hyperactive, or hyper-sensitive to everything) to aggression (hypoactive, because they are trying to elicit strong reactions from those around them).
This disorder also falls under the categorization of ADD/ADHD, although this is a slight misrepresentation according to Carol Kranowitz, in her seminal book, “The Out of Sync Child,” (2006). There are overlapping elements of the two conditions that are suggestive of either SPD/SID or ADD/ADHD, but there is too much reductionist interpretation of these coinciding signs and symptoms to make an accurate diagnosis. This lack of accuracy results in medicating the child for ADD/ADHD, perhaps in lieu of receiving appropriate therapy for SPD.
Dr. Jean Ayres, an occupational therapist, first discussed SPD about 40 years ago. Within the treatment paradigm of OT, the strategy is to always offer sensory information that is steady, consistent, and firm, depending on whether the child’s tendencies are hyperactive or hypoactive. In the hyperactive case, the child is overwhelmed with sensory information, indicating that treatment needs to be done with firm pressure, in a darker room, and small space. These conditions reduce the amount of concurrent sensory distraction, allowing the neurological system an opportunity to quiet and calm down. The specific types of treatment in the TCM clinic would include firm tui na techniques, Manaka hammer on specific acupoints that correspond to diagnosis (as long as the sound is not distressing), and use of tuning forks on acupoints. In contrast, the hyporesponsive child needs much more sensory input, so quick, rapid and lighter techniques would be appropriate, along with movement of both patient and practitioner around the treatment room (i.e. sitting on the floor during treatment). In the hypoactive case, shonishin would be a well tolerated technique to add, but since it is performed with gentle, surface techniques on the skin, it is tremendously uncomfortable for the hyperactive presentation, as these children are almost uniformly averse to light pressure and touch.
In most cases, the family is not aware of which type of SPD their child has, but the practitioner will discern fairly quickly what is distressing, and ideally will stop that activity during the treatment. You can use this shonishin information to your benefit when trying to identify the TCM pattern.
While the action of treating children is fairly easy, determining the pattern is often elusive. Solely focusing on the sense organ most affected, the pattern of element out of harmony or organ system imbalance will be nearly impossible to distinguish. The types of sensitivities are as varied as the senses: visual, auditory, taste, texture, proprioceptive, and olfactory. Children exhibit varying degrees of sensitivity to one or all of these sensory cues. Additionally, there may be inconsistency in their sensitivity, for instance, a child with proprioceptive imbalance who always bumps or trips over objects may be quite adept and coordinated when engaging in focused sporting activities. Closely observe the reaction to shonishin, since this a clear objective collection of data, and this information will yield a better clinical perspective.
In this author’s experience, there are a few standard recognizable patterns of symptoms, when identified can indicate the most appropriate and comfortable treatment options.
Hypersensitivity to Touch – Tactile Defensiveness
If Qi & Blood are circulating poorly, then the surface of the body is more open and exposed, which can not only permit the Six Excesses to enter, but also allows external stimuli to discomfort to the child.
Hyposensitivity to Touch – Under-responsive
TCM Pattern(s): Heart & Liver Fire, Phlegm-fire harassing the Shen
The internal heat in these children is evident in their outward behavior, but usually will also present with long, red, pointy tongues, with or without thick coat.
Poor Tactile Perception & Discrimination
TCM Pattern(s): Lung vacuity, Kidney vacuity
There can be more fear-based living in these children, which clearly points to Kidney/Heart vacuity, but the lack of coordination and “bodily structure” suggests that the Metal element can be weak.
Melanie Katin, MSTOM, LAc has been on the faculty of Pacific College of Oriental Medicine (PCOM) NY since 2006, and has a private practice in NYC, where she focuses on pediatrics and auto-immune cases. She can be reached via her website at: www.melaniekatin.com]]>
Katy visited our center with a seemingly disparate collection of symptoms that were causing her distress. She described a pattern that was episodic in nature and involved abdominal bloating, belching, acid reflux, loose stools, shallow breathing, and palpitations. A cardiologist had ruled out serious heart disease and she’d been offered beta-blockers for what had been diagnosed as pre-ventricular contractions (PVCs) and occasional tachycardia. A gastroenterologist had found nothing remarkable on endoscopy, apart from a small hiatal hernia, and Katy had been given a prescription for antacids for the acid reflux. Her internist had diagnosed her with panic attacks and suggested a combination of talk therapy and medication. Katy was grateful for each intervention, but remained convinced that all her symptoms had one root and so, looking for a deeper solution, she decided to try Chinese medicine.
Her symptoms could be the result of any number of patterns in Chinese medicine, ranging from the Five Element diagnosis of Wood invading the Earth and not generating Fire, to the zang fu pattern of spleen qi deficiency with liver qi stagnation leading to heat in the upper jiao harassing the heart. Counter-flow in the chong meridian was also a possibility. Like Katy, I was keen to get to the root of her problem rather than simply treat her symptoms.
Bio-medically, I felt as if her pattern could be explained by looking closely at the vagus nerve. One of the 12 pairs of cranial nerves, the vagus nerve is also called the wandering nerve because it meanders in a zigzag pattern from the brain and its fibers spread to the tongue, pharynx, vocal chords, lungs, heart, stomach, and intestines. As a major nerve of the parasympathetic system, it slows the heart rate and stimulates bowel activity.
It plays a key role in the mind-body connection and, in particular, the way that the heart responds to emotions. It is also one of the mechanisms by which the stomach and intestines are affected by stress. Many of the patients I treat for IB who have the classic symptoms of Wood invading Earth have a vagus nerve that is either under or over performing. Likewise, the Five Element pattern of Wood not generating Fire correlates to the way the vagus nerve links the heart and gallbladder anatomically. The chong meridian links the heart and stomach in a way that is also similar to the path of the vagus nerve.
Because the vagus nerve supplies motor parasympathetic fibers to every organ from the neck down to the second segment of the transverse colon (except the adrenal glands), its effect can be far reaching. Stress can raise the body's level of epinephrine and norepinephrine, which stimulates the sympathetic nervous system to over-ride the parasympathetic nervous system, of which the vagus nerve is the main component. When the vagus nerve is affected in this way, people can experience palpitations, tachycardia, or premature ventricular contractions (PVCs). These are extra, abnormal heartbeats that begin in one of the heart's two ventricles. Patients describe vagus nerve induced palpitations as a thud, a fluttery sensation, or a skipped beat. The sensation varies depending on the point during the heart's normal rhythm that the vagus nerve fires. In many cases, this becomes a vicious cycle where the anxiety caused by the missed heartbeat further exacerbates the fight between the sympathetic nervous system and the parasympathetic nervous system, leading to more palpitations.
Gastrointestinal bloating, indigestion, loose stools, shortness of breath, and hiccups can also be caused by an overstimulation of the vagus nerve, because branches of the nerve innervate the GI tract, diaphragm, and lungs.
So how does the vagus nerve get irritated in the first place? Any kind of GI distress can put pressure on the nerve and irritate it, with a hiatal hernia being a frequent culprit. Poor posture along with muscular imbalances can also cause the vagus nerve to misfire, as can excess alcohol or spicy foods. Stress can inflame the nerve, along with fatigue and anxiety.
So what is the best way to get the nerve to calm down? In my practice, one of the best solutions I’ve found for patients suffering this combination of gastrointestinal distress and heart palpitations is the Gallbladder Divergent Channel. It separates from the regular Gall Bladder Channel at the greater trochanter, then curves around the hip joint, then goes to the external genitalia, where it joins the Liver Divergent Channel. It then travels up the flank to enter deeper into the body at just below the ribs where it connects the Gall Bladder to the Liver and then travels up to connect with the Heart. It then flows from the esophagus to the mandible, near the mouth. From here it disperses over the face, connecting to the eyes before joining the regular channel again at the outer canthus.
In this way, the Gall Bladder Divergent Channel further cements the Gall Bladder’s relationship with both the Heart and the Liver. Many of the patients who present with symptoms of an irritated vagus nerve have what could be described as a Gall Bladder and Heart Complex in Chinese medicine. This traditionally has been a diagnosis used to describe a collection of symptoms such as esophagitis, hiatal hernia, gastritis, insomnia, palpitations, fearfulness, being easily startled, chest fullness, and a bitter taste in the mouth. In these patients I’ve found that accessing the Gall Bladder Divergent Channel can bring almost immediate relief. I usually use the separating and convergent points of the channel GB 30 and GB 1, along with GB 34, LIV 3, PC6, SP 4, LIV 14, and UB 19.
How can patients suffering from an irritated vagus nerve help themselves? Here’s the advice I give my patients, with one caveat: Because these symptoms can be caused by so many disorders, I always refer my patients to their MD to rule out more serious pathologies before giving self-help suggestions.
As for Katy? She felt better after her first two treatments. With some lifestyle adjustments, she was able to maintain her good health, having finally found an explanation in both Eastern and Western medicine for what had been a confusing symptom pattern.
Jill Blakeway, MSc, LAc is the Clinic Director of the YinOva Center in New York City. She makes frequent appearances on national television and in the print media and is the author of two books on women’s health.]]>
We are presently experiencing a quantum evolution in our perceptions of the aging process, which involves the elimination of outmoded ideas about what it means to be elderly. This paradigm shift has been facilitated by half a billion Baby Boomers1 worldwide who have provided a powerful stimulus for a collective change to the ‘face of aging’. This is not the previous silent generation, but an outspoken, entitled demographic, which, by force of their sheer numbers, is amending existing conscious and unconscious social contracts.
Around the globe, there are unprecedented numbers of people who regard themselves as middle-aged; in fact, the population of individuals over 50 years of age is the largest in recorded history. With dramatic advances in Western medical technology and a parallel expansion of consciousness about the effectiveness of alternative strategies to promote and maintain optimum health, these high functioning people expect to live longer than their parents, with a level of vitality and enjoyment that would have been considered unrealistic by previous generations.
The impact of this revolution is also beneficial to younger generations, who are observing the Boomers as they actively reject pre-existing beliefs about health, beauty, creativity and vitality being the exclusive property of the young. These trailblazers are pursuing natural, holistic, and less invasive approaches to maintain a youthful appearance without sacrificing their wisdom and integrity. They adhere to a concept of beauty that embraces the totality of their experience, keeps them productive, and authentically transforms body and spirit.
As acupuncturists, we stand poised to address the concerns of all our patients, both the elder ones and the young, who, already primed by popular consensus, fear old age as a time of decline and illness. Metaphorically, we can function as a bridge, straddling both worlds of Western medicine and other complementary disciplines.
The Three Levels of Constitutional Treatment
This level targets the Eight Extraordinary meridians, hereditary factors and their relationship to the endocrine system.
For example, Dai Mai, GB 41 Zulinqi and SJ 5 Waiguan, regulates migraines caused by menstrual imbalances. TheYang Wei Mai affects the nervous system via the Gallbladder and Liver meridians, and the points on the cranium, while theDai Maiaffects the hormonal system. Liv 13 Zhangmen, the frontMuof the spleen, and influential point ofZang, is important because ‘unemployed sex hormones are neutralized in the Liver.’2 Severe migraines often occur as a result of excess gonadotrophic hormones.
The Eight Extraordinary Meridians are considered to encode fundamental hereditary aspects of the individual, what Oriental medicine terms theJing; thus, employing them in the context of a facial acupuncture treatment can have profound impact upon both the visible and implicit symptoms of the aging process, promoting healthy aging, greater quality of life and harmony.
The Ying level, which targets post natal Qi and utilizes the Twelve Regular Meridians, is the second constituent of Constitutional Facial Acupuncture’s three pronged constitutional approach.
While traditional Chinese medicine (TCM) diagnostics focus on qi, blood and fluids to address this level, I also integrate it with the Five Elements and their interaction with the pathology of the Twelve Regulars.
This particular constitutional treatment is based upon Japanese acupuncture:
The Liver and Gall Bladder signs and symptoms usually are more pronounced on the right side of the body. The patient may have weight issues, hepatitis, cirrhosis, or a fatty liver, and additionally manifest addictions to alcohol and drugs, including prescription drugs.
Hormonal headaches involving the pituitary gland originate at UB 2 Zanzhu, with complaints of intense pain behind the eyeballs. With the involvement of the Gall Bladder, one sided migraine headaches may ensue. There may also be tendinomuscular spasms, tics and temporomandibular joint dysfunction (TMJ). Shoulder pain is reported at UB 43 Gaohuangshu, which is the outer Pericardium Shu.
Nagano Sensei’s Obesity Treatment
Liv 14 Qimen, St 27 Daju, Ren 6 Qihai and GB 26 Daimai
Liv 14 Qimen is 4 cun lateral to the midline in the 6th intercostal space.
St 27 Daju is located 2 cun below the navel, 2 cun lateral to Ren 5 Shimen Stone Gate
Ren 6 Qihai is on the abdominal midline, 1.5 cun below the navel
GB 26 Daimai is located directly below the end of the 11th rib where Liv 13 Zhongmen is located, at the level of the navel
All points are needled bilaterally except for GB 26 Daimai, and Liv 14 Qimen. Needle Liv 14 Qimen on the right side, pointed laterally between the ribs, with a 10-15 degree insertion, and GB 26 Daimai on the left side, angled toward the back. St 27 Daju and Ren 6 Qihai are needled at a 90 degree angle. Use direct moxa after needling.
This Japanese acupuncture protocol indicates that only the left GB 26 Daimai is to be treated. This is most likely due to the Wood Element hara reflex, which is palpated only on the left side of the abdomen. Only the right Liv 14 Qimen is indicated because the Liver organ is on the right side of the body.
In Sensei Nagano’s experience, patients lost weight after they were treated with direct moxa every day. Patients with a fast pulse lost 10 pounds a month without regaining the original weight.
The Wei Level
The Wei Level releases the exterior and is within the purview of the tendino-muscular meridians (TMM). These particular vessels are referred to as tendino-muscular because they travel in the depressions and planes between the muscles and the tendons.
Tight tender, trigger, motor or ‘ashi’ points are identified through an assessment of the patient’s symptoms, and through palpation. It is possible to release a tight waist with tension localized around the GB 26 Daimai area.
“Wandering Skirt” Syndrome
This syndrome relates to the Belt Meridian, the internal oblique muscles and issues of bloat, obesity and other imbalances, manifesting around the waist. The patient has the attendant Shaoyang emotions of frustration, anger, with an inability to make a decision, and a tendency to stuff these damp viscous feelings under their belt. Since one of the TCM indications for the Dai Mai is a subjective feeling of sitting in cold water, the patient may also have a Kidney imbalance, and will lack courage.
“Wandering Skirt” Syndrome can be used with patients who have been in an automobile accident and complain of low back pain, with difficulty rotating their spine to one side of the body. This technique also temporarily ameliorates lower back pain due to kidney stones.
The internal obliques are a fan shaped abdominal muscle, whose fibers range from vertical to diagonal to horizontal. All the muscle fibers meet at the inguinal ligament, and the iliac crest of the lower spine. They flex and rotate the spine and trunk to the same side of the body.
GB 26 Daimai is directly below the free end of the 11th rib where Liv 13 Zhangmen is located, at the level of the navel.
Signs and symptoms:
The indications for both trigger and motor points are similar. Imbalances include fibrocystic nodules or tightness near GB 26 Daimai and the pubic bone, difficulty flexing and bending the spine to the same side, lower back pain, an imbalance of the right and left sides of the body when standing for long periods of time or walking for hours. It also increases the intra-abdominal pressure for urination and defecation.
Trigger point palpation:
The trigger point, when needled with the pecking technique, may elicit a jump or twitch within the muscle.
Trigger point needling technique:
Facial Needling: The Expressive Muscles
After the constitution has been addressed, the face can be treated with the origin and insertion of the muscles.
The Origin and Insertion of Muscles
The origin of the muscle is the beginning of the muscle, because it is usually attached to the bone. This origin anchors the muscle, and it is needled first in Constitutional Facial Acupuncture treatments. This fixed attachment permits the insertion of the muscle to move and make facial expressions.
The insertion of the muscle attaches to the skin or muscle fibers, and is needled after the muscle origin. The insertion attachment supports muscle movement in making facial expressions, and allows the face to be mobile and flexible.
The expressive movement of the facial muscles is an interplay between the origin and insertion of the muscles, which pulls the skin in the direction of a facial expression when a person laughs, smiles or frowns. This interplay is similar to the balance between yin and yang in Oriental medicine. Wrinkles are formed cross fiber or transversely to the fiber direction of the muscle involved.
Each muscle has a specific function, range and direction of motion, associated emotion and specific wrinkles formed by repetitive and habitual movements.
Forehead Wrinkles and Tension
According to Western medicine, the frontalis muscle raises the forehead in fright, shock and surprise, and wrinkles the skin on the forehead horizontally.
Emotions:In Chinese medicine, raising the eyebrows and wrinkling the forehead is a sign of disturbed Shen characterized by fire and heat rising to this part of the face.
Forehead Lines and Tension
Lines and wrinkles. Many years after prolonged stress or a traumatic event, people still habitually wear their fright and surprise on their foreheads, etched there in the form of horizontal lines, wrinkles and muscle tension. These muscles are referred to as myotatic units because they both insert into the scalp and synergistically affect muscle movement. Therefore, the bellies of the frontalis and occipitalis muscles function in tandem with each other, and any contracture or habitual wrinkling of the forehead can cause tension, headaches and pain in the occipital and cervical areas of the head and neck.
Since all the Yang meridians rise up to the face and head, especially the UB, Gall Bladder and Stomach meridians, which traverse the forehead area, it is important to anchor and ground the Yang constitutionally before needling. This prevents unwanted headaches, hot flashes, hypertension, anxiety, shallow breathing and disturbed Shen.
Unresolved trauma can lodge in the forehead from an event that happened many years prior to their initial Constitutional Facial Acupuncture treatment. Being aware of this stored muscle memory is very important for the efficacy of facial acupuncture treatments.
Raises the eyebrows in fright or surprise and wrinkles the forehead
Fright, shock, surprise; disturbed Shen
In the epicranial aponeurosis, at the level of the coronal suture
In the skin of the frontal region above the eyebrows
15 mm; 40 or 38 gauge (#1 or #2 Japanese), 0.2 0.3 cun
Facial acupuncture seemingly targets only the visible signs of aging, and consequently is often labeled as cosmetic by the general public and many acupuncturists.
However, with a strong constitutional component, this modality effects long term change in the patient’s general health. It also ameliorates significant dermatological issues, if used with topical herbal masks, poultices, creams, natural cleansers and essential oils. Cleansing and hydrating the face is paramount for effective treatments, and the addition of the jade rollers, gem discs, and hydrosols makes this approach more effective. It also creates a safe and nurturing atmosphere in which your patients can relax, allowing them to experience a transformative ritual.
Note: excerpts have been taken from Mary Elizabeth Wakefield’s Constitutional Facial Acupuncture, © 2014, by Elsevier Ltd.
1 Current estimate for the worldwide Baby Boomer population is 450 million. Source: http://trendwatching.com/trends/boomingbusiness.htm, quoting MIT Agelab.
2 Low, Royston, The Secondary Vessels of Acupuncture: A Detailed Account of their Energies, Meridians and Control Points, Harper Collins, New York, NY, 1984 (out of print).]]>
There is a rise in the incidence of mood disorders. Depression, anxiety, panic attacks, rage, eating disorders, substance abuse, and many more are becoming common. There are also moods secondary to complaints, such as the fear and anxiety that may accompany a diagnosis like cancer or infertility; the disappointment of training for an event, only to get an injury; the difficulty of living with conditions like pain, insomnia, and trauma. There are also everyday concerns for our finances, reputation, relationships, family and friends, the environment, and more. Practitioners are not immune from difficult moods. In addition to their own concerns they are also seeing, hearing, and feeling their patients’ and co-workers’ as well. While we are making interesting progress on many fronts to a better understanding of moods through modern medicine and psychology, the incidence of mood disorders continues to rise.
Can we learn anything helpful by going back over our literature and looking into the ways our ancestors dealt with moods? In the Huang Di Nei Jing, Shang Han Lun, and other early texts, we read many passages around the theme that if we fail to follow certain things in one season, we are likely to develop problems in the following. Or, if exposed to certain harmful climatic or dietary influences, we will more likely experience unpleasant symptoms in the future. This year at Pacific Symposium, in my workshop, we will examine some representative passages and explore the views inherent in them. The above examples suggest a view that symptoms and moods arise out of certain causes and conditions. If we can better understand the relevant causes and conditions, we can learn to cultivate those that lead to more positive mood states and avoid the conditions that lead to negative states. This leads to not just treating the arising moods, but also their sources. There are many other interesting and clinically helpful views inherent in our early texts.
By using my own case histories, we will cover what practitioners need to know to be more effective with patients who are deeply distressed. We will cover how to interview; key points in diagnosis; some old formulas revisited; some favorite point combinations and their uses; moxa and other techniques, and self help practices. For example, Bai He Tang is the core formula of the four classic bai he decoctions mentioned in the Jin Gui Yao Lue, or the Essentials from the Golden Cabinet chapter on 'Lily disease'. This is one of the most enigmatic syndromes. The text is brief, offering little explanation, but describes a patient who is depressed, does not like to talk, and is confused about what they want. They complain of feeling cold, then not cold, feeling hot and then not hot, craves food at one moment and then doesn’t want to eat, and they are taciturn and vague. I have found that many patients with chronic fatigue and post-viral chronic fatigue present this vagueness when trying to describe what they are feeling. This formula has helped.
We will cover several cases, each describing some commonly seen clinical conditions, anxiety, anger, rage, depression, PTSD, abuse, and eating disorders. Through the cases we can see how to modify interviewing and examination, possible formulas and points to use, and other techniques that helped. We will cover how to create the conditions for your patients to safely explore what contributed to their moods and to cultivate other conditions more likely to lead to positive moods.
From each of the cases we can also learn something of how we are affected by our patients and ways to take care of ourselves. We may find some of the same treatment strategies useful for ourselves. Knowing our own moods and the role we play in the therapeutic relationship is also important for our own health and our effectiveness as practitioners.
As practitioners we are also experiencing moods. Just as our patients are subject to conditions that influence their moods, so are we. It can be helpful to know the conditions that influence our own moods and shape how we practice. Some of the conditions include the following:
As helpful professionals we listen to patients’ stories of difficult diagnoses, depression, anger, fear, pain, trauma, or other issues and we may absorb some of this emotional residue. If we do not have ways to digest or process these stories, we may develop secondary trauma and/ or compassion fatigue.
Secondary trauma and compassion fatigue are not burnout. Burnout is more related to the daily stressors of the job. Secondary trauma and compassion fatigue are directly related to what we absorb of our patients’ stories and experiences.
Secondary trauma may occur when issues that patients bring to us are similar to issues we may have encountered in our lives.
Compassion fatigue may occur when issues patients bring to us begin to exhaust our ability to work effectively. We reach the limit of what we can tolerate.
Signs of secondary trauma and compassion fatigue may include any of the following:
In the workshop we cover more signs and symptoms and explain each one.
In order to maintain ourselves, it can be useful to know some of the interpersonal and intrapersonal mechanisms we engage in with patients. We will explore the therapeutic relationship looking at ways of relating that confuse us and cause us to misunderstand or be drawn in to unproductive exchanges.
From our own tradition, we know that cultivating reflection and self-awareness can help practitioners to listen attentively and better be able to accomplish the following:
We can develop the conditions that lead to a “not taking up” state of mind. “Not taking up” is learnt from reflecting on how we fuel our experiences. What we are seeing is not a self, but a way of perceiving and structuring our experience as if there is a self. We can see the way we structure our experience as belonging to us, identifying us, as defining us. All of our relationships are colored in this way. Not taking up is not taking up a way of self-structuring. Our medicine teaches that we are an aggregate of five phases in flux, not something fixed. We can establish the conditions for ourselves of gentleness, curiosity, and permission, which leads to unlearning fixed notions. We see into the patterns and forces that have shaped us. We are freeing ourselves from them.
Greg Bantick, BAc, MTOM originally began training and practicing in 1975. He helped found one of Australia’s first teaching colleges. He has studied in England, Japan, China, and the U.S. where he spent 20 years teaching and in senior academic positions at Pacific College of Oriental Medicine (PCOM) and the Seattle Institute of Oriental Medicine (SIOM). He is now practicing in Brisbane, Australia. Find out more about Greg at www.menla.com.au]]>
What is a marriage? Two people joining together to be more than either one alone. Of course, that’s just one aspect of a marriage. In addition to the union of two people, we use the term “marriage” to describe other types of joining, such as a marriage of form and function, marriage of words and art, or the provocative William Blake title of The Marriage of Heaven and Hell. This article discusses the marriage of acupuncture and psychology.
A relatively new branch of psychology has emerged in the past few decades, generically known as Energy Psychology. This specific psychology utilizes some of the understandings and principles of acupuncture married to some concepts and processes of psychology. As psychologists and authors of this article, we are certainly limited in our understanding and application of the processes and nuances of acupuncture, yet sufficiently versed in psychological processes to utilize certain aspects of acupoints and meridians to boost the effects of psychological interventions.
Three Main Waves in Psychology
Clinical psychology is primarily focused on understanding and treating patterns of thought, emotions, and behaviors that are either maladaptive or limiting a person’s life. Over more than a century, the field of psychology has experienced the flow and ebb of different approaches to helping people overcome problems in those areas. There have been three main evolutions in the field of psychology as well as many subsets and offshoots, but below is a brief description of the three great movements.
What is Psychoanalysis?
Psychoanalysis, one of the earliest forms of psychotherapy, aims to bring basic human drives into conscious awareness and to resolve conflicts between conscious and unconscious, or repressed material in the form of mental or emotional disturbances, such as anxiety and depression. Psychoanalysis and psychodynamic therapies seek to help patients understand their defense mechanisms such as repression, denial, and projection. In addition to fostering insight, they use therapeutic interventions such as dream analysis and free association to words and images.
What is Behavioral Therapy?
Another evolution of psychology is the Behavioral Therapy movement which is based on the belief that behaviors can be measured, trained, and changed. Behavioral Therapy considers that all behaviors are acquired through conditioning. Conditioning develops through a person’s interaction with their environment, including observing the behavior of others. One of the key interventions of behavioral therapists is Operant Conditioning, which is a method of learning or changing behaviors which uses rewards and punishments for targeted behaviors.
What is Cognitive Therapy?
Cognitive psychology is concerned primarily with a person's thought processes. Cognitive therapists examine how thought processes influence how a person understands, interprets, and interacts with the world around them and the future. It’s in sharp contrast with behavioral theory, yet many psychologists merge the two theories to form what is called cognitive-behavioral theory or CBT. CBT has become a standard of practice for many psychological conditions including anxiety and depression and posits that behaviors are the direct result of internal thoughts and core beliefs, which can be controlled and changed. For example, a person who perceives a small setback in an exaggerated way may see the loss of a job as catastrophic, and will feel and behave according that perception. They may shut down and not even look for another job, believing that their prospects are dismal. A shift in thought about that job loss to being a minor life event will allow the person to recognize their own strengths and resources and act accordingly (such as search for a new job).
While this is not a comprehensive overview of the evolution of modern psychology, we offer this “fly-by” to set the stage for another evolution that is Energy Psychology.
A New Wave has Formed: Energy Psychology
Around the mid 1980’s, a prominent psychologist, Roger Callahan, had contact with several colleagues including chiropractor, George Goodheart and psychiatrist, John Diamond as well as acupuncturists whose names are lost to this history. Over the course of a decade, these innovators discovered a process that incorporated elements from kinesiology, acupuncture, and psychology that provided a remarkable method for rapidly resolving fears and phobias.
Dr. Callahan had an employee, Mary, who worked at his home in the desert town of Indian Wells, California. Mary was visibly frightened of water and gave wide berth to the swimming pool in Callahan’s back yard. One day, as an experiment, Callahan asked Mary to tap on an acupuncture point directly beneath her eye on the high cheekbone while she viewed the pool from a distance. This point was Stomach 1 and Callahan theorized that because her symptom of fear was largely experienced as distress in the gastrointestinal area that it might provide some relief.
In fact, it did provide Mary with some relief. Gradually, self-applying pressure to that specific acupoint by way of continual tapping, Mary was able to move closer and closer to the pool, something she’d never done before. Finally, after many days and many applications of this process, she was able to touch the water and thus functionally overcome her morbid fears of water. This led Callahan to further explore the possibilities of combining self-applied acupressure with a psychological process of exposure, either directly or in imagination.
Psychology and Traditional Chinese Medicine Meet
Psychiatrist John Diamond, who authored several books including, Life Energy, and Your Body Doesn’t Lie, described his exploration of the connection between the meridians and specific emotions. He posits that the stomach meridian is associated with contentment and calm on one end of a continuum and disappointment and disgust on the other. Diamond does not address medical issues with the meridians and focuses primarily on emotions, temperaments, and personality factors associated with specific meridians. For example, he associates the kidney meridian with sexual indecision and the large intestine meridian with guilt and self-worth. He used processes of testing muscle strength while pressing or touching certain acupoints to determine, in his words; “…the effects of nearly all stimuli, physical or psychological, internal or external, on the human body…most importantly for our purposes, each meridian is also associated with a specific negative and a specific positive emotional state.”
The point is that Diamond, who influenced Callahan,along with others, began to codify a system of using meridians and their beginning and end acupoints for treating emotional distresses across a wide spectrum, from anger and anxiety to regret and shame. This system represents a significant departure from CBT. A variety of treatment protocols emerged from Diamond and Callahan’s explorations and formulations, including our own which we call Emotional Self-Management (ESM). ESM is detailed in our book, Instant Emotional Healing: Acupressure for the Emotions, published by Random House.
An Alphabet Soup of Techniques
Over the past 20 years, a number of clinical studies and anecdotal evidence has accumulated for the effectiveness of a number of what has come to be broadly called Energy Psychology (EP) methods. These appear as an alphabet soup of acronyms such as TFT, EFT, ESM, TAT, HBLU, and many others. Thought Field Therapy (TFT), Callahan’s iteration, was one of the first to gain clinical traction and was streamlined by a non-clinician, Gary Craig, who first used TFT for himself then modified the system Callahan developed so as to be more user-friendly. Craig disseminated his method dubbed, Emotional Freedom Techniques (EFT) and made it available to clinicians as well as the general public at low or no cost. Thus, EFT became the most widely recognized version of EP. Over the past two decades, refinements have been made in some cases, as with our ESM, to include energy corrective processes called Reversal Corrections.
Acupunturists Enter Energy Psychology
Tapas Fleming, one of the earliest acupuncturists to enter the EP arena, developed her own version called Tapas Acupressure Technique (TAT). The Association for Comprehensive Energy Psychology (ACEP) currently has about half a dozen acupuncturists as members. ACEP has become the trade group for therapists, coaches, and clinicians of all disciplines who are interested in or currently using one or another EP method.
All of the various forms of Energy Psychology (EP) methods and their taxonomy are to vast to explain here, but the research has largely been on Emotional Freedom Technique in one or another form. Psychologist, David Feinstein, has been the most prolific published writer on the theory and mechanisms of action of all EP methods. In his 2012 article in the Review of General Psychology, a peer-reviewed American Psychological Association journal, he found 51 published articles on some aspect that would qualify as EP with 36 of those studies systematically measuring outcomes of multiple treatments while using some form of tapping on acupoints. We conducted one of those published studies, which focused on claustrophobia. In our study, we measured psychological factors of state vs. trait anxiety, physiological measures of EEG, EMG, heart and respiration rates, and a measure of electro-conductance within the meridians using Motoyama’s Apparatus for Meridian Identification (AMI). We compared a treatment group of claustrophobic individuals with a group of non-claustrophobic individuals and found both clinical improvement (less fear) as well as changes in several physiological measures after a single 30-minute treatment (Subtle Energies & Energy Medicine, Vol. 14, No.3).
How Do Energy Psychology Methods Work?
The marriage of psychology and acupuncture continues to evolve and one of the most likely explanations for the mechanism of action for the reduction of emotional distress has been put forth by Feinstein. He offers that “Imaging studies showed that the stimulation of certain points with needles reliably produced prominent decreases of activity in the amygdala, hippocampus, and other brain areas associated with fear. In almost all EP acupoint stimulation protocols, the physical procedure is done simultaneously with the mental activation of a psychological problem or desired state. In this sense, energy psychology with PTSD and other anxiety disorders is an exposure technique” (Review of General Psychology, Vol. 16).
What Does the EP Future Look Like?
In a not too distant future, we envision that more acupuncturists will blend their skill-sets with psychological principles to address uncomplicated cases of phobias, anxiety, and depressive disorders, just as they already assist patients in quitting smoking, weight loss, and other quasi-psychological problems. Some licensed acupuncturists have already pursued counseling and advanced psychology degrees to marry what they know about the body with what they’ve learned about the mind to create elegant mind-body healings. This is a trend that we hope will continue.
Peter T. Lambrou, PhD is in private practice as a licensed clinical psychologist, specializing in anxiety, work stress, and emotional management. He is the author Self-Hypnosis: The Complete Manual for Health and Self-Change, which has been translated into 14 languages, and Stop Your Panic Attacks Now.He is also co-author along with Dr. George Pratt, of the books Hyper-Performance: The A.I.M. Strategy for Improving Your Business Potential, the award-winning book, Instant Emotional Healing: Acupressure for the Emotions, published by Random House and their most recent book, Code to Joy: The 4-Step Solution to Unlocking Your Natural State of Happiness, from Harper Collins. Dr. Lambrou is past Chairman of Psychology at Scripps Memorial Hospital in La Jolla California, where he continues on the Psychology Executive Committee. Dr. Lambrou is a clinical member of the Association for Psychological Science, and he is Diplomate in Behavioral Medicine.
George J.Pratt, PhD is a licensed clinical psychologist with a private practice in La Jolla, California where he specializes in psychotherapy, hypnotherapy, behavioral medicine, performance enhancement, and corporate consulting. In addition to co-authoring books with Dr. Lambrou, he is also co-author of A Clinical hypnosis Primer, Expanded and updated. Dr. Pratt is past Chairman of Psychology at Scripps Memorial Hospital, La Jolla, a Diplomate of the American Board of Medical Psychotherapists; the American Academy of Pain Management; and the American College of Forensic Examiners. He is also a member of numerous professional organizations including the American Psychological Association and is in Who's Who in America.]]>