Q&A: Post Tx report, Following Paul at LMC, Ax modification.

Hello Paul and Pat,

I am writing for a few reasons. 

One, I just want to extend my thanks again for last weekend. After a year of knowing this system, but not really knowing it - I am so grateful to have had the experience to deepen my knowledge and more important my understanding of AA.

Two, I also wanted to send a follow-up to the treatment I received. My arms feels the same, however - my low back, and in my QL's right around, ZhiShi (Ub52), the spot of stagnation that has been there since before the land of time is at least 60% better, if not more. That is really great. What I found to be the most amazing of them all is - last night i was cleaning out my fridge, and realized my brain has been working much better. Clearer thoughts, making connections between A and B versus just being like yes, that is A and that is B. This had been happening since Monday and continued through today - I could give lots of examples, but I will keep  it short. I couldn't put my finger on why the sudden change - and then I realized, it must have been the treatment on Sunday. So, that is really really neat - it is nice to have my brain functioning at a higher capacity!

Three, I would like to figure out a way to keep studying AA even though I am down in Savannah. I have been drawing grids each day and practicing the measurements (and you are correct, it is amazing how much faster the math gets with even just a few days of practice). There was mention of some possible 3 or 5 day shifts at the hospital. I would like to know more about this - and maybe I can fly up to study and follow for a few days? I have many ideas in my own head about how I can do this, but I would like some feedback for what you are offering for people to continue to study under you - especially since I am not in NYC. 

Fourth, I did an AA treatment today on one of my patients. (It was not for one of the protocols we learned, sorry for disobeying). I treated for blood stagnation leading to cold toes on the right side. As well as Kd Xu and Lv Yin Xu.  I also attempted to treat for macular degeneration. This is a patient I have been treating for awhile and she was open to me trying. Her vision has gotten severely worse recently, and I felt it was worth a try based on what I learned this weekend - and everything I have read and re-read about AA. Patient is female, 88 years old. Pulse, choppy, forceful. Tongue - Pale, thick yellow coat (MJ and LJ), SLV +1, 

Here is what I did, and in the order that I did them:

1. half way between Ren 12 and Ren 13, and halfway between Kd and Ren bilateral - SCS - to pinpoint the eyes.

2. Ren 12 - Deep - harmoinze sp

3. Ren 4 - Deep - harmoinze kd

4. St 24 - Medium - guide qi and blood above - bilateral

5. St 26 - Medium - guide qi and blood below - bilateral (using YM, full of qi and blood to send to lower part of body, and using the next closest yangming point to the umbilicus and below. 

6. Ab6 - SCS - bilateral - to pinpoint the toes

I then went back and slightly adjusted the eyes - and checked each point. 

There was a huge difference in the warmth in the toes, and all of her pain went away in her feet both after needling and after 30 minutes of retention and removing the needles. Her vision also sharpened. There was not as much change in the vision, but the fact that there was any I was excited - (and also surprised). I know the real difference will be if the treatments can last in the feet and the eyes stay even just slightly better until next treatment. I just wanted to share my experience, and more importantly my gratitude for your sharing this system in the US, and all of the work you have done studying yourself. 

With gratitude, 

Jen Marks.



Jen,

First, thank you allowing me to share your email and respond to you here. I think your experience from treatment and the clinical case is a good starting point for discussion on needling considerations in BMAA.

In regards to your treatment, the points used were: RN 12, 10, 6, 4 (all D), RN 10above & R9 above (S), KI17 (bi, M), ST24 (bi,M), KI17 below/lateral (S), Ab7 L & KI13 L (M). I did try to locate the source of your arm pain (cervical & thoracic) and I thought I had when you said the area decreased when you were on the table after RN 10 above. The fact there was no change when you got up means I didn't find the source of it. I did, however, make a decision that while I wanted to reduce the pain for you, it was not going to be a priority. Treating you on a constitutional level was more important.  I modified the cervical spondylosis formula, using the "returning qi to the source" formula RN 12, 10, 6, 4 (all D), instead of the heaven - earth combination. Along with the KI13 & Ab7, I was focusing on supplementation of the kidney. The mental clarity and reduction of back pain are a clear result of this.

As for the patient you treated, first, please don't try to find the eyes on tortoise and needle them. It is not safe. The way to treat the eyes is to bring qi and blood to them. Use CS VBA as the base formula. You said the pulse was forceful. If so, she may have enough qi & blood to treat both the eyes and toes at the same time. But be careful over time.  Your use of ST26 is right on! Add ST 27 if it is not enough.

We can definitely continue the conversation and learning through this forum. Pat and I are discussing the times for an intensive and when the next L1 & 2 will be. We'll email and post as soon as we decide.

You were a pleasure to have in class. I would say it was great to have someone to laugh at my jokes, but I think you were laughing in between them as well!

Be well,

Paul

Post-Stroke Patient: Interesting Case Using BMAA

11/1/2013

Patient complained of inability to move RUE below the elbow and inability to move right foot from ankle to toe.  Both limbs on right were very cold to the touch. Patient evidenced zero mobility in hand during movement testing. Patient stroke history over one month and already received two weeks of acupuncture treatment (not abdominal acupuncture) along with conventional medicine care and physical therapy, but no change in RUE or R foot.

Tongue: Dusky, stasis spots on inside, Center cracks, greasy in back with grey coat and slv dark and thick.  Stasis marks and a white spot in the LU area.

Pulse: 85 bpm.  Wiry. 

Dx: Windstroke with LU and HT Qi Def, and Liv wind.

Tx:  RN 12, 10, 6, 4, KI 17, 13, St 24,  Ab7

Right: Ab 1, Ab2,  St 26,  Ab4, Ab6, St 27 above

Post-tx: SIGNIFICANT change in temperature noted in both arm and leg from shoulder to fingertips and from thigh to toes.  Hand went from "arctic chilly" to "equatorial heat." Arm temperature change not as obvious but improved.  Pt. also had ability to grasp lightly with right hand evidencing ability to move following Tx.

Three days later patient showed further ability to move hand. Patient continues to undergo acupuncture treatment and rehabilitation therapy.

Abdominal Acupuncture: An Introduction

Original Article published on Acupuncture Today: A Comprehensive Introduction to Abdominal Acupuncture 

Acupuncture Today Article (Shortened from the original below)

Abdominal Acupuncture Course Info

By Paul Ryan 

The Beijing Medical Research Institute of Bo’s Abdominal Acupuncture 

American Abdominal Acupuncture Medical Association

East-West Integrative Wellness

Abstract 

     This article introduces Bo’s Method of Abdominal Acupuncture. It discusses its discovery, the basic theory, method of application and current status in China. It also summarizes the clinical research and teaching methodology of the system invented by Dr. Zhi-yun Bo. 

Key words: abdominal acupuncture, microsystems, cervical spondylosis, Shenque Channel System 

The Beginnings 

     One morning in 1972, Dr. Zhi-yun Bo was treating a patient suffering from intense low back pain and sciatica that resisted improvement despite all the acupuncture techniques in Dr. Bo’s repertoire. At 23 years old, Dr. Bo was already surrounded by several apprentices and feared a loss of respect from not being able to mitigate the patient’s suffering. A sudden inspiration reminded him that the Governing Vessel and the Conception Vessel are paired in a biao-li (Internal-External) relationship, and this moved him to try CV4 and 6. What he discovered was that within five minutes the patient’s pain disappeared. Moreover, it never returned after only this one treatment. He repeated this point combination on several patients with similar conditions and was surprised to find the same results every time. 

Basic Theory 

     From his experience that morning Professor Bo began a 30 year exploration of the points of the abdomen that led to the discovery of what he believes is the Prenatal or Congenital Channel System that radiates from the umbilicus. He calls this system the “Shenque Channel System” (SCS) because Shenque (CV8) is the Chinese term for the umbilical acupoint. The SCS is the network of pathways that transports Qi and Blood from the mother to the fetus during gestation. Normal fetal development relies on the transportation and modulation of these essential substances from the mother before the fetus’ own Zangfu Organs produce them themselves. After birth, when the umbilical cord separates from the infant, this system gradually integrates with the new, Postnatal System whose Qi and Blood come from the Zangfu Organs generated from Food Essence. The SCS manifests as bands of points radiating from CV8. Because of its shape, it is likened to a tortoise and thus is called, “The Miraculous Tortoise”. (see figure 1) 

Figure 1: Miraculous Tortoise: Shenque Channel System (printed with permission from BMRIBA) 

     All parts of the body can be found in this system and it is frequently used for musculoskeletal pain problems. An important characteristic of this system is that it is found very close to the surface of the abdominal wall. Needles penetrating this system often lie on the surface of the abdomen with the tip just penetrating the skin. (The traditional 14 Channel or Postnatal System is slightly deeper in the adipose tissue.) Interestingly, the SCS possesses a strong capability to modulate the flow of Qi and Blood of the whole body and often the effects of needling it are instantaneous. 

Dr. Bo also discovered that needling deeper into the abdomen -- the adipose and muscle layers -- he was able to quickly harmonize the Zangfu Viscera. His clinical experience showed him that the layout of the Organs matched that of the Post-Heaven Eight Trigrams (Ba Kuo) of the Book of Changes and he used the ancient diagram to summarize his clinical experience and establish a second system: The Zangfu Organs System (see figure 2). 

Figure 2: Ba Kuo chart of Zangfu Organ System (printed with permission from BMRIBA) 

     

     Because most of the Organs or their biao-li pair resides in the abdomen, needling the Zangfu Organs system can readily affect all the Viscera. This is an advantage over using distal points on the extremities to achieve the same results because it is not always easy for transmission of the stimulation from distal points to reach the Organs, especially when there is a node-block higher up along the pathway which may require protracted periods of manipulation or additional needling in order to release the block. 

Application 

     At first glance, Bo’s Method of Abdominal Acupuncture (BMAA) might appear as just another microsystem. But “megasystem” might be the more appropriate description. It combines needling the Prenatal channel system (Heaven level), the points of the Postnatal System and Extraordinary Vessels on the belly (Humanity level), and the Zangfu Organs System (Earth Level) establishing a multidimensional, comprehensive therapeutic system that harmonizes the Viscera generating Qi and Blood, opens the regular 14 Channels and Extraordinary Vessels, and pinpoints the anatomical locations of the problem to achieve an immediate, substantive and enduring healing effect. Furthermore, by using needles with gauges between 0.22 and 0.16, and with light manipulations and shallow insertion, it is virtually painless. 

     While Prof. Bo discovered all the levels of his system using Chinese medicine theory, intuitive explorations and trial and error, he was able to organize his knowledge into a rational, even partially quantifiable therapeutic system. Integrating ideas from surgical procedures, he manualized the application protocol in order to decrease learning time for students, to improve efficacy, and to increase reproducibility in clinical trials. Some of attributes of his system include: 

1. Standardization of point locations and locating methods: points are located using a combination of anatomical landmarks and cun-ratios; they are measured by ruler and marked with a pen. 
2. Manualized needle insertion/manipulation procedure: practitioners stand on the right side of the patient and insert needles from top to bottom, deep to shallow, inside to outside. Likewise, needle length and gauge are standardized based upon patient size and weight, deficiency or excess condition, and type of disease. 
3. Standardized point formulas: Dr. Bo developed over 20 pattern-based, disease-focused, standardized point formulas for the most common diseases seen in acupuncture clinics. 
4. Integration of Western Diagnostics: the physical exam is used for musculoskeletal problems and stroke recovery; biomedicine tests are consulted for internal medicine conditions; and when appropriate, objective testing before, during and after treatment is used to assess clinical efficacy. In this way, western techniques and technology are integrated into BMAA’s diagnostic model. 

The creation of standardized point formulas is based upon their effectiveness in over 30 years of clinical experience. These formulas are supplemented with additional points to individualize them for specific patients and can be combined for more complex cases. For example, for treating cervical spondylosis with nerve root compression, presenting with pain in the neck and shoulders and numbness in the hands, the points CV12 and 4 are used to generate Qi and Blood from the Spleen and Kidney (govern muscles and bones); K17 and 18 bilaterally are used to relax the muscles of neck and free the nerve roots; ST24 bilaterally is used to guide Qi and Blood into the upper extremities (Yangming: copious Qi and Blood); and the Superior Wind-Rheum point (Ab1) and Superior-Lateral Wind-Rheum point (Ab2) are used on the affected side to pinpoint numbness affecting the hand(s) while dispelling wind and dampness from the Channels. Depending on the location of nerve compression, the location of K18 can be adjusted or additional points like point Superior-CV10 can be used. 

Current Usage and Status in China 

Known in China simply as Abdominal Acupuncture, BMAA made its academic début in 1991 by winning an acupuncture and tuina techniques competition organized by the Shanxi Regional Ministry of Health. Dr. Bo formally introduced the innovative, therapeutic system to the public in 1992. In 2007, it was recognized as a professional subcommittee under the China Acupuncture and Moxabustion Association.[1] In China and Europe it is herald as a “safe, painless, highly effective acupuncture method with rapid results.” It can treat a wide range of conditions, and is currently being used in all areas of health care management (e.g. disease prevention, clinical medicine and rehabilitative medicine). Indications include: orthopedic problems of the neck, shoulder, back and four extremities, degenerative bone and joint disease, rheumatoid arthritis and sciatica; internal medicine problems such as upper respiratory infection (cold/flu), bronchitis, coronary artery disease, hypertension, acute and chronic gastritis, cholecystitis, dyspepsia, diarrhea and constipation; neurological conditions including headache and migraines, bell’s palsy, trigeminal neuralgia and cerebrovascular disease; gynecological problems such as menopausal syndrome, uterine fibroids, dysmenorrhea, irregular 

menstruation, amenorrhea; and difficult to treat diseases like Parkinson's, insomnia, depression, diabetes mellitus, eye diseases, obesity, deafness and tinnitus.[2] 

In Beijing, many acupuncture doctors, department heads and professors at the Sino-Japanese Friendship Hospital, Huguosi TCM Hospital, Xuanwu District Hospital, Dongzhimen TCM Hospital and the Chinese-Western Medicine Integration Hospital (zhong xiyi jiehe yiyuan) are using BMAA. In Shanxi, Tianjin and Xinijiang, Dr. Bo's apprentices run BMAA stroke recovery centers using this therapy as the primary treatment. And there are BMAA specialty clinics in Shanxi, Guangdong and Guangxi to name a few places in the 10 provinces it is used. 

Because of Dr. Bo’s success in treating several staff members of the Guangdong First Provincial Hospital of Traditional Chinese Medicine in Guangzhou (Canton) who suffered from necrosis of the trochanter as a side effect from treatment with steroids for SARS infections, the greatest acceptance of BMAA is in Guangdong. It is the principle method used in the First Provincial Hospital’s Traditional Medicine Center and the department heads of cardiology, gynecology, emergency medicine, acupuncture, orthopedics and the traditional medicine center are all his apprentices. In all the departments and several of the centers across China clinical studies are ongoing. 

Current Research 

Because BMAA has both retained traditional Chinese medicine theory and integrated diagnostic and standardized application practices of biomedicine it has been widely accepted by acupuncturists both domestically and internationally. Its standardized application makes it easier to do clinical research with BMAA than with traditional acupuncture.

According to a systematic review following a search using a Chinese academic search engine, CNKI, [3] Wang et al. found that from 1999-2007, 214 articles have been published on BMAA in China, including 96 clinical trials of which 62 used comparative treatment for control groups.[4] A breakdown of the clinical trials and related parameters is in figure 3. Year Item 1999 2001 2002 2003 2004 2005 2006 2007 Totals No. of articles 1 5 8 8 14 26 21 13 96 No. of diseases 1 4 8 7 8 19 13 11 71 Total no. subjects 88 631 506 1468 1112 2251 1701 977 8734 No. articles chosen for China research core periodicals 0 1 3 3 6 2 5 2 22
Figure 3: No. of articles published on BMAA 1999-2007 and relevant parameters adapted from article Wang, 2008.  *No no-treatment groups were applied.  **By “randomization” it is meant that patients coming in for treatment for a particular disease are randomly assigned to the BMAA treatment or a comparative treatment group.  Figure 4 includes a partial list of diseases studied in trials or clinical observation.

Disease  No. of articles  Disease  No. of articles  Disease  No. of articles  Disease  No. of articles  Herniated Lumbar Disk  22  Cervical spondylosis  30  Knee osteoarthritis  8  Stroke recovery  17  Adhesive capsulitis (frozen shoulder)  6  Lateral epicondylitis  2  Steroid induced necrosis of trochanter  2  Uncomplicated obesity  7  Irregular menstruation  4  Chronic pelvic inflammatory disease  3  Menopausal syndrome  3  Postpartum urine retention  1  Insomnia  7  Depression  3  Vertigo  3  Chronic fatigue syndrome  1  Migraines  8  Herpes zoster induced neuralgia  1  Primary facial m. spasms  2  Bell’s palsy  6  Cerebral palsy  2  Peripheral neuropathy from DM  1  Cerebral atrophy  1  Meniere’s disease  1  Tourette’s syndrome  1  Pseudo-globular paralysis  2  Hepatic cirrhosis with peritoneal effusion (ascites)  1  Chronic Urticaria  1  Efficacy is reported to be between 70-90%, with 90% of the results reporting efficacy above the 90 percentile. (See figure 5)  (Sorry, can't upload chart) Of the 74 musculoskeletal diseases studied, 30 were for cervical spondylosis with nerve root compression. Of those, 22 used comparative treatment control groups and efficacy is reported to be over 90%. Among the 22, a multi-site study was conducted in 2005 at three hospitals in which 300 subjects meeting inclusion criteria were randomized into BMAA and traction therapy treatment groups. The report from this study indicates that traction therapy was found to “improve local blood circulation and relieve symptoms but lacked stable, long-term, curative effects which lead to frequent relapses,” while the cure rate for using BMAA reached 91.5% (complete remission within 10 treatments and no return for three months) and an efficacy rate 98%.[5] (The BMAA formula used for cervical spondylosis in this study was the same one described above.)  More Studies: Cervical Spondylosis and Cerebral Vascular Infusion NIH Listed Abstract Abdominal Acupuncture Course Info bmaa@ewiw.org About Dr. Bo  Dr. Bo Zhi-yun is heir to a family lineage of Chinese medicine. His father, at 84, enjoys the status of being one of the most renowned physicians of Chinese medicine in Shanxi province. Dr. Bo himself is the youngest of the “100 Venerable Doctors of Chinese Medicine” recognized by the State Administration of Chinese Medicine and the Chinese government. Dr. Bo is a full professor at the Guangzhou University of Chinese Medicine. He conducts research and provides clinical instruction to the staff at the First Guangdong Provincial Hospital of TCM in Guangzhou when he is not teaching in Beijing or abroad.  che_fuzhen@126.com  About the Author  Paul Ryan, MS L.Ac., has been studying, practicing and teaching Chinese medicine in China full-time the past 13 years. He is the first American to graduate with a master’s degree from the Beijing University of Chinese Medicine in acupuncture (2004), started studying with Dr. Bo in 2005 and became his only Western apprentice in 2007. Currently, he works with Prof. Bo teaching and translating for BMAA courses and provides clinical guidance to BMAA clinics in China. bmaa@ewiw.org