As I promised in my response to this facebook post by the good people over at Crane Herbs, here are my thoughts on treating fibromyalgia with acupuncture:
In almost every case of fibromyalgia that I have treated, I have found strong lines of tension and a number of active points at the base of the occiput and along the midline over the cervical vertebrae. I recommend you examine this area carefully. When you are palpating, allow your search area to extend to the Gallbladder lines along the occiput, and to the HuaTuo lines along the neck.
Palpate very gently, using light short strokes with the pad of your finger. You are feeling for active points that feel like small depressions. At first, do not actively try to find the points, just try to feel the differences in the skin quality. If you palpate with this mindset and keep your finger relaxed, you will not have trouble finding the active points. If you stiffen your finger and palpate with the mindset of seeking out the points on the neck, you will feel very little. Once you have found the points, change your palpation method and make small circles to define more precisely the characteristics of the points. Often they will feel soft, “empty” and slightly spongy, and will have a light buzzing sensation that you will feel when you rest your fingertip lightly in the center of the depression. Keep your pressure very gentle while you are doing this. If you press deeply or cause any pain, you will cause the area to tense up. This will activate the Wei Qi in the area and make the active points will become more difficult to find and treat.
Insertion into these points has to be very shallow. If you are skilled at using a Teishin or Enshin, these tools are excellent for treating the active points you find. If you are using an inserted needle, use the highest quality and thinnest needle you can. A Seirin #00 would be the lowest quality needle I would recommend for this purpose. Those of you who have studied needle technique with me, I recommend Call and Response in the direction of the dominant Vector, with a target depth of about 1 mm. Those of you who have not studied with me, I recommend you learn and use Shudo Denmei’s wonderful Super-Superficial Technique. It is not the technique I use, but it is lovely, I think it should work quite well with the treatment points I have described, and a description is available on the web. You can read about it here: http://www.najom.org/essays/Shudo_Tx_of_Depression.doc
The local treatment of the area works well when combined with a root or constitutional treatment. I suggest that you keep your root treatment as simple as you can. A minimalist approach in this case helps your client focus more on the work being done on the neck. I have found that too many body needles can distract from the benefits of the local in this case. Do not rush working with the local area – the changes you make at the neck points will provide the bulk of the relief for the client.
I have found that how you position your client is also important in this treatment. What is most important is to keep the back and neck totally relaxed. If your client is uncomfortable and feels the need to lift his or her head up or tense the back and neck, it will make things difficult. Prone works well if the face-rest is comfortable. A massage chair is often a better choice for some clients. If neither is possible, try positioning the client sitting comfortably at the side of the table and leaning forward, resting on several pillows and the top of the table. Before you start examining the neck, gently feel the muscle tension in the neck and back. If the muscles are loose and the client feels relaxed, it will probably be fine.
If client position is difficult, and if you are skilled in Open Hand Acupuncture, Craniosacral Therapy, or another form of hands-on work that allows you to treat meridian and point disharmonies with your hands alone, here is another way I treat fibromyalgia: Place your client supine, and apply a simple root treatment with your needles. Seat yourself at the head of your client, and do whatever you need to do to ease into your treatment connection. Once you are “in,” use your hands to examine and release along the bones and muscles, and at the acupuncture points in the above-mentioned areas. Work lightly and take as much time as you need within your style of work to release the neck well. As with the needle technique, deep pressure into the neck or head will make treatment more difficult and will most likely not produce the desired results.
If you have any questions about what I have written here, please feel free to e-mail me, or to post comments below. I have treated many clients over the years with these methods, and have found the results to be excellent.
Sunday, January 31, 2010
Friday, January 29, 2010
I Ching in a Nutshell
I received a request for more information about the upcoming I Ching classes. Here are my thoughts on the I Ching in nutshell. Feel free to contact me if you have specific questions.
The I Ching is THE book on Yin and Yang, and a vital textbook for acupuncturists who wish to better understand exactly how Yin and Yang work beyond the basic correspondences, at very complex levels of organization. The first class in February will focus on a small group of Hexagrams, which we will cover in detail. Participants will receive the tools they need for continuous, meaningful study of the I Ching. At the second class in March we will build upon what we learned in the first class, and discuss the remaining Hexagrams.
Why is studying the I Ching important for acupuncturists? In the treatment room, this information can be used to improve diagnostic understanding, to appreciate the choices your clients make within a larger framework of the changes going on in their lives, and to clarify the healing arc that will best serve your client.
The Yin and Yang balance of any situation can be interpreted meaningfully in several different ways. The empahsis of this class series is practical applications of the I Ching. Participants will be shown not just one way to work with the I Ching, but ways to understand it on a deeper level, so they will be able to easily develop their skills and find their own connection to the movements of change. At the end of these classes, participants will have a very firm understanding of the different ways that Yin and Yang are interpreted and used, and will be able to analyze any event they encounter into complex patterns of Yin and Yang (Hexagrams).
The I Ching is THE book on Yin and Yang, and a vital textbook for acupuncturists who wish to better understand exactly how Yin and Yang work beyond the basic correspondences, at very complex levels of organization. The first class in February will focus on a small group of Hexagrams, which we will cover in detail. Participants will receive the tools they need for continuous, meaningful study of the I Ching. At the second class in March we will build upon what we learned in the first class, and discuss the remaining Hexagrams.
Why is studying the I Ching important for acupuncturists? In the treatment room, this information can be used to improve diagnostic understanding, to appreciate the choices your clients make within a larger framework of the changes going on in their lives, and to clarify the healing arc that will best serve your client.
The Yin and Yang balance of any situation can be interpreted meaningfully in several different ways. The empahsis of this class series is practical applications of the I Ching. Participants will be shown not just one way to work with the I Ching, but ways to understand it on a deeper level, so they will be able to easily develop their skills and find their own connection to the movements of change. At the end of these classes, participants will have a very firm understanding of the different ways that Yin and Yang are interpreted and used, and will be able to analyze any event they encounter into complex patterns of Yin and Yang (Hexagrams).
Monday, January 25, 2010
Monday Mission: Season 1, Episode 4
Your Monday Mission for this week, should you choose to accept it, is to pay attention to your Breathing with every needle you insert this week. Breath is often ignored during actual practice. However, it is a vital part of the needling process and, if used well, will make your needles and therefore your treatments more effective.
There are many diferent ways to use Breath in acupuncture. But the most important thing to remember for most people is TO breathe! It is all too common that we lock our legs, lean forward from the waist, and hold our Breath while we quickly insert the needle before moving on. For this week there are two parts to the exercise:
First, check in and make sure that you are breathing the entire time you are working. If you catch yourself holding your Breath, STOP, take a moment to focus, relax, and Breathe deeply at the tableside in a comfortable position. When you are able to Breathe freely again, and only when you are able, proceed with your insertion and technique. Take as long as you need with each client to do this. One needle inserted with good Breath is worth at least three that are just tapped in, so you will not be losing any time with this important exercise. Over the week, you will find that you will be better able to maintain a nice, slow, deep Breath with every insertion.
Second, and only if you can do the first part above, try to make your Breath a little deeper and fuller with each insertion. Explore how luxurious one single Breath can be, and how long it can seem to last. Savor each Breath as much as possible, spending an eternity in a moment with each point. Do this second part only when you can maintain even and full Breathing throughout each treatment. There is no sense rushing ahead - you will only be cheating yourself out of the benefits of the exercise.
In your journal, keep track of what comes up, and when you have difficulty Breathing in your clinic. Sometimes stopping your Breath is a sign that you are not valuing yourself and your work as fully as you deserve. Sometimes it happens only in the presence of certain clients, or when needling certain points. If it happens repeatedly with some clients, think about what is similar among all the clients and how you feel when they are with you in the treatment room (notice I did not say "when you are with them in the treatment room" - own your space!). If it happens with specific points, see if you are contorting your body to reach those points and whether a shift in your stance might open up your Breathing more.
Again, stay with this one as long as you feel you need. Working well with the Breath is one of the most under-appreciated and under-used methods of dramatically improving your treatment results. Remember that this Mission is not a race. It is better to finish the Mission well than finish it quickly. If you go into next week with this one, or even into the week after, you can pick up the next exercise when you are ready.
There are many diferent ways to use Breath in acupuncture. But the most important thing to remember for most people is TO breathe! It is all too common that we lock our legs, lean forward from the waist, and hold our Breath while we quickly insert the needle before moving on. For this week there are two parts to the exercise:
First, check in and make sure that you are breathing the entire time you are working. If you catch yourself holding your Breath, STOP, take a moment to focus, relax, and Breathe deeply at the tableside in a comfortable position. When you are able to Breathe freely again, and only when you are able, proceed with your insertion and technique. Take as long as you need with each client to do this. One needle inserted with good Breath is worth at least three that are just tapped in, so you will not be losing any time with this important exercise. Over the week, you will find that you will be better able to maintain a nice, slow, deep Breath with every insertion.
Second, and only if you can do the first part above, try to make your Breath a little deeper and fuller with each insertion. Explore how luxurious one single Breath can be, and how long it can seem to last. Savor each Breath as much as possible, spending an eternity in a moment with each point. Do this second part only when you can maintain even and full Breathing throughout each treatment. There is no sense rushing ahead - you will only be cheating yourself out of the benefits of the exercise.
In your journal, keep track of what comes up, and when you have difficulty Breathing in your clinic. Sometimes stopping your Breath is a sign that you are not valuing yourself and your work as fully as you deserve. Sometimes it happens only in the presence of certain clients, or when needling certain points. If it happens repeatedly with some clients, think about what is similar among all the clients and how you feel when they are with you in the treatment room (notice I did not say "when you are with them in the treatment room" - own your space!). If it happens with specific points, see if you are contorting your body to reach those points and whether a shift in your stance might open up your Breathing more.
Again, stay with this one as long as you feel you need. Working well with the Breath is one of the most under-appreciated and under-used methods of dramatically improving your treatment results. Remember that this Mission is not a race. It is better to finish the Mission well than finish it quickly. If you go into next week with this one, or even into the week after, you can pick up the next exercise when you are ready.
Monday, January 18, 2010
Monday Mission: Season 1, Episode 3
Your Monday Mission for this week, should you choose to accept it, is to continue working at paring down the number of points you needle in each session. For this week, pay attention to your techniques - whatever techniques you use in your treatments with the style you practice. The focus of this week will be on the physical movements of the hands. Try to take a fresh look at the way you needle, and make every movement as strong, agile, and eficient as you can make it.
An easy way to pare down the number of points you use, for most people, is to pay better attention and make better use of your technique. As technique improves, you will often not need as many points to get the results you want.
In addition, this is an excellent week to PRACTICE your needle skills when you are not treating clients. Adding fifteen minutes a day of practice to really hone your form will pay off by next Monday. If you are working through these exercises with a Mission Buddy, set a time to get together and critique each other's physical technique. Look for places where your parter is holding tension in his or her body, or where the movements seem sluggish or the focus begins to wane. Having another set of eyes and honest feedback can be a big help. If you are working through the exercises alone, write down what you find when you look closely at your needlework. Are your fingers at the most efficient angle with the needle handle? Do you feel in control the whole time? If not, at what point in the technique do you lose control of the needle? Where do you feel tension in your body? Keep track also of any emotional responses that come up, directions that your Mind wanders, lack of clarity in your Intention, and so forth.
If you were not able to use your average number of needles on the bulk of your clients last week, see if you can get a little closer this week. If you were able to do so, try to shave off one more needle on average this week.
An easy way to pare down the number of points you use, for most people, is to pay better attention and make better use of your technique. As technique improves, you will often not need as many points to get the results you want.
In addition, this is an excellent week to PRACTICE your needle skills when you are not treating clients. Adding fifteen minutes a day of practice to really hone your form will pay off by next Monday. If you are working through these exercises with a Mission Buddy, set a time to get together and critique each other's physical technique. Look for places where your parter is holding tension in his or her body, or where the movements seem sluggish or the focus begins to wane. Having another set of eyes and honest feedback can be a big help. If you are working through the exercises alone, write down what you find when you look closely at your needlework. Are your fingers at the most efficient angle with the needle handle? Do you feel in control the whole time? If not, at what point in the technique do you lose control of the needle? Where do you feel tension in your body? Keep track also of any emotional responses that come up, directions that your Mind wanders, lack of clarity in your Intention, and so forth.
If you were not able to use your average number of needles on the bulk of your clients last week, see if you can get a little closer this week. If you were able to do so, try to shave off one more needle on average this week.
Friday, January 15, 2010
I Ching: Understanding Yin and Yang
February 6-7, 2010
Come and spend a weekend developing a well-structured, personal connection with the I Ching, or Book of Changes. We will explore the role of the I Ching as the catalog of possible combinations of Yin and Yang in all phenomena. You will leave this class with a sound understanding of the foundations of the I Ching and clear guidelines for ways to deepen your knowledge of this classic.
We will review the rules that govern Yin and Yang, and show how these rules apply to increasingly complex patterns. The Ba Gua, or Eight Trigrams, will be explored in great detail. We will also look closely at on 16 Hexagrams that allow you to unlock the meaning of all the others, and practice methods of using the I Ching that enable you to directly analyze your own choices and gain insight into your own personal connection with the movements of Yin and Yang all around you.
This class is open to anyone interested in a deeper understanding of the I Ching. No prior training or experience is required.
12 CEU/PDA points
Class held from 9:00-4:30pm at Sage Acupuncture, 62 Massachusetts Avenue, Lexington, MA 02420
Your tax-deductable investment: $295 ($250 for students)
Class size is limited to ensure individual attention and plenty of Q&A, so don’t delay, register today!
Come and spend a weekend developing a well-structured, personal connection with the I Ching, or Book of Changes. We will explore the role of the I Ching as the catalog of possible combinations of Yin and Yang in all phenomena. You will leave this class with a sound understanding of the foundations of the I Ching and clear guidelines for ways to deepen your knowledge of this classic.
We will review the rules that govern Yin and Yang, and show how these rules apply to increasingly complex patterns. The Ba Gua, or Eight Trigrams, will be explored in great detail. We will also look closely at on 16 Hexagrams that allow you to unlock the meaning of all the others, and practice methods of using the I Ching that enable you to directly analyze your own choices and gain insight into your own personal connection with the movements of Yin and Yang all around you.
This class is open to anyone interested in a deeper understanding of the I Ching. No prior training or experience is required.
12 CEU/PDA points
Class held from 9:00-4:30pm at Sage Acupuncture, 62 Massachusetts Avenue, Lexington, MA 02420
Your tax-deductable investment: $295 ($250 for students)
Class size is limited to ensure individual attention and plenty of Q&A, so don’t delay, register today!
Tuesday, January 12, 2010
Change in Format
I have changed the format of the Monday Missions. Instead of putting the dates in the titles, I will be heading them with "Season" and "Episode." Each Season will encompass a different larger topic, with the Episodes offering suggested exercises that build on each other. This will make it easier for people who arrive later to this part of the blog, allowing them to join in with Mission Buddies at the start of the most recent Season, rather than having to all the way back to the beginning and catch up.
Monday, January 11, 2010
Monday Mission: Season 1, Episode 2
Your Monday Mission for this week, should you choose to accept it, is to try to use your average number of points in more of your treatments, and force yourself to be more efficient in your point selection based on Actions and Effects. For this week, try to make your average number the maximum number of needles you insert. So if you found that 13 was your average number of needles, for example, try not to use more than that for any treatment this week. If you need to insert more, that is fine – the needs of your client will, of course, take precedence over the Monday Mission. So if you put your 13 in and decide that you have to put 4 more in the ears, or 3 more for the local treatment, or 20 more because it is appropriate for the treatment, go ahead and do so.
What I recommend you pay close attention to this week is the situations where you want to put in only a few more points than your calculated average. Such cases happen all the time, and are excellent ones to look at more closely after hours. Take home the files for the clients you wanted to add only a couple more points. Grab your copy of Deadman’s, or whatever other point book you prefer, and spend some time trying to see if you can make the point combination you selected for treatment a little tighter. Perhaps you are using two points to do the job that one could? Spending 15 minutes going over one case in this way can give you a tremendous amount of insight into old habits you may still be holding onto in how you choose points, but which no longer serve you. Be creative, think outside the box, and find a way to shave off those last few points from your treatment. Write the adjusted prescription in the client file (or use one of those 3M sticky notes). The next time you see that client, try the new prescription instead.
And when you try the new prescription, don’t check your critical thinking at the door! Check in with the pulse, the abdomen, or palpating the Meridians to get a sense of how well the adjusted point list is working. You may decide that some more points are, in fact, necessary. More often than not, though, you are likely to find that the new prescription works better. We all hold onto certain ideas about what points are “supposed” to do that do not actually hold up in the application of our own clinical style. This is an opportunity to say, “Hmmm… Large Intestine 4 and 20 are supposed to be good for sinus congestion, but I find that Large Intestine 6 alone does a better job!” And when you find such things out, congratulations! You have just used your Monday Mission to make your practice a little more effective, and a little more in-sync with who you really are as a practitioner and the unique gifts you bring to your treatments!
Try to do this practice every day this week. If you cannot do every day, go to the book twice this week. Every little bit helps, as long as it fits into your lifestyle. Keep notes of what you find. Talk it over with a Mission Buddy. Or post a comment below! This is an individual process for everyone, but we all learn from each other.
What I recommend you pay close attention to this week is the situations where you want to put in only a few more points than your calculated average. Such cases happen all the time, and are excellent ones to look at more closely after hours. Take home the files for the clients you wanted to add only a couple more points. Grab your copy of Deadman’s, or whatever other point book you prefer, and spend some time trying to see if you can make the point combination you selected for treatment a little tighter. Perhaps you are using two points to do the job that one could? Spending 15 minutes going over one case in this way can give you a tremendous amount of insight into old habits you may still be holding onto in how you choose points, but which no longer serve you. Be creative, think outside the box, and find a way to shave off those last few points from your treatment. Write the adjusted prescription in the client file (or use one of those 3M sticky notes). The next time you see that client, try the new prescription instead.
And when you try the new prescription, don’t check your critical thinking at the door! Check in with the pulse, the abdomen, or palpating the Meridians to get a sense of how well the adjusted point list is working. You may decide that some more points are, in fact, necessary. More often than not, though, you are likely to find that the new prescription works better. We all hold onto certain ideas about what points are “supposed” to do that do not actually hold up in the application of our own clinical style. This is an opportunity to say, “Hmmm… Large Intestine 4 and 20 are supposed to be good for sinus congestion, but I find that Large Intestine 6 alone does a better job!” And when you find such things out, congratulations! You have just used your Monday Mission to make your practice a little more effective, and a little more in-sync with who you really are as a practitioner and the unique gifts you bring to your treatments!
Try to do this practice every day this week. If you cannot do every day, go to the book twice this week. Every little bit helps, as long as it fits into your lifestyle. Keep notes of what you find. Talk it over with a Mission Buddy. Or post a comment below! This is an individual process for everyone, but we all learn from each other.
Monday, January 4, 2010
Monday Mission: Season 1, Episode 1
Your Monday Mission for this week, should you choose to accept it, is to discover the true average number of points you needle in your clients this week, and also the maximum number of points you needle. How to do this? Keep a piece of paper on hand with the date written at the top. Every time you treat a client, take a moment to count the needles you have put in, and write that number down. Also write down your client’s initials, in case you want to check something about that specific case later. At the end of the week, add the number of needles up, and divide by the number of treatments. That is your average. Then note the top three numbers of needles you inserted during the week. That gives you an idea of your maximum.
This week we are just gathering information that you will need to go forward. Next Monday we will build on this week’s work, and we will begin exploring how very useful it can be to know your average and maximum needle use for each client. When the week is over, if someone asks you, “How many needles do you use during a treatment?” You should be able to say with confidence, “About ___ on average, and usually no more than ___.”
This week we are just gathering information that you will need to go forward. Next Monday we will build on this week’s work, and we will begin exploring how very useful it can be to know your average and maximum needle use for each client. When the week is over, if someone asks you, “How many needles do you use during a treatment?” You should be able to say with confidence, “About ___ on average, and usually no more than ___.”
Mission Possible
This blog post will self-destruct in 5 minutes… bum bum Bum Bum bum bum Bum Bum BA DA BUM… BA DA BUM…
Starting in 2010, I will be starting a new feature on the blog: the weekly Monday Mission. Everyone works with different styles and has a different flow in the clinic, and the goal here is to help you develop confidence in your unique gifts and skills so you can become the best acupuncturist you can be. In essence, you will become just like those super agents from Mission Impossible. As we say in our clinic, “Healing is possible,” so every Monday we will have a Mission Possible. And, no, we will not need the Master of Disguise for these missions.
Each Mission is a suggestion for you to follow in your practice, which will hopefully give you some new insights into how you work, and increase your awareness of little details in your practice that you can modify to make your treatments more efficient and effective. The Monday Missions will build on each other over time, so if you are new to the blog, I recommend you start at the beginning and take your time going through the various exercises. Do not be in any hurry to get through the Missions. Go at your own pace, even if it means you spend longer than a week on each one. Over time, you will notice that you will be happier in your work, and your clinical efforts will feel more authentic and more “You.”
For best results, I also recommend you find a way to record, review, and share what you notice in terms of clinical results, any personal resistance that comes up, and any new ideas that are sparked by these exercises. One approach is to get a journal and keep notes. Another idea is to find a Mission buddy – a co-agent if you will – with whom you can work through the weekly entries and discuss what comes up for each of you. You can also feel free to post your experiences on the blog. There is a lot of room here for comments, and I would love to hear from you.
VIEW THE MONDAY MISSIONS
Starting in 2010, I will be starting a new feature on the blog: the weekly Monday Mission. Everyone works with different styles and has a different flow in the clinic, and the goal here is to help you develop confidence in your unique gifts and skills so you can become the best acupuncturist you can be. In essence, you will become just like those super agents from Mission Impossible. As we say in our clinic, “Healing is possible,” so every Monday we will have a Mission Possible. And, no, we will not need the Master of Disguise for these missions.
Each Mission is a suggestion for you to follow in your practice, which will hopefully give you some new insights into how you work, and increase your awareness of little details in your practice that you can modify to make your treatments more efficient and effective. The Monday Missions will build on each other over time, so if you are new to the blog, I recommend you start at the beginning and take your time going through the various exercises. Do not be in any hurry to get through the Missions. Go at your own pace, even if it means you spend longer than a week on each one. Over time, you will notice that you will be happier in your work, and your clinical efforts will feel more authentic and more “You.”
For best results, I also recommend you find a way to record, review, and share what you notice in terms of clinical results, any personal resistance that comes up, and any new ideas that are sparked by these exercises. One approach is to get a journal and keep notes. Another idea is to find a Mission buddy – a co-agent if you will – with whom you can work through the weekly entries and discuss what comes up for each of you. You can also feel free to post your experiences on the blog. There is a lot of room here for comments, and I would love to hear from you.
VIEW THE MONDAY MISSIONS
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