1

AcupunctureMasterPoints– Dr.PaulJaskoviak Oklahoma- 9/24/2016

ACUPUNCTUREMASTERPOINTS

PaulA.Jaskoviak,,DC,Dipl.Med.Ac.,FIMA,DCRC,DACAN,CCSP,FICC

AcupunctureExperience

CurrentPositionDeanofPostgraduateDivision,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)

2

AcupunctureMasterPoints– Dr.PaulJaskoviak Oklahoma- 9/24/2016

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

3

AcupunctureMasterPoints– Dr.PaulJaskoviak Oklahoma- 9/24/2016

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

4

AcupunctureMasterPoints– Dr.PaulJaskoviak Oklahoma- 9/24/2016

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

5

AcupunctureMasterPoints– Dr.PaulJaskoviak Oklahoma- 9/24/2016

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

6

AcupunctureMasterPoints– Dr.PaulJaskoviak Oklahoma- 9/24/2016

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

7

AcupunctureMasterPoints– Dr.PaulJaskoviak Oklahoma- 9/24/2016

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.

8

AcupunctureMasterPoints– Dr.PaulJaskoviak Oklahoma- 9/24/2016

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.”

THEEND