Sciatica is a common complaint that brings people into the acupuncturist’s office. And it’s often treated well with acupuncture. But there are times when a situation that seems straightforward is anything but.

When you start to think about how sciatic pain can be an issue of the dai mai, and how the dai mai is involved not only in the structural aspects of pelvic function, but also in the functional flow and health of the 12 main channels, it’s easy to see how what at first glance appears simple can quickly turn complex.

 Listen in for a discussion of the importance of hands on assessment, the way deficiencies lead to excess and why it’s helpful to have palpatory findings that give you feedback on the effectiveness of your treatment.

The medicine of east Asia is based on a science that does not hold itself

separate from the phenomenon that it seeks to understand our medicine

did not grow out of Petri dish experimentation, or double blind studies.

It arose from observing nature and our part in it.

East Asian medicine evolves not from the examination of dead structures, but

rather from living systems with their complex mutually entangled interactions.

It's a qiological I'm Michael max, the host of this podcast that goes in depth

on issues, pertinent to practitioners and students of east Asian medicine, dialogue

and discussion have always been elemental to Chinese and other east Asian medicines.

Listening to these conversations with experienced practitioners that go deep

into how this ancient medicine is alive and unfolding in the modern clinic.

Hello and welcome back to chia logical.

I'm delighted today to be sitting down with my friend, Laura Christiansen.

Laura is one of those unusual kinds of practitioners who drinks

from a number of different Wells.

And more importantly has a way of tying seemingly stray threads together.

She pulls from the work of Kiku.

Matsumoto the work of master dong and the subtle sensing and palpation as taught

by the engaging vitality folks, chip chase, Margaret Jenkins, and Dan Penske.

Today, we are sitting down for a discussion about something many of us

acupuncturists see on a regular basis.

In fact, it's one of the biggest pains in the butt that comes into our clinic.

That's right today, the topic is sciatica.

Laura.

Welcome to qiological.

Hi, my sciatica is perking up, perking up.

How perfect is that?

Yeah, so, you know, while back you and I were talking, uh, I think it was,

you know, between one of the classes or something that we were taking together and

somehow the discussion came to sciatica.

And you said something to the effect of some godly on large number of people that

you see like a quarter of your patients or something are dealing with sciatica.

I think a half a half.

And I thought, well, I see a fair amount of sciatic or, you know, in

my practice here, but that's a lot of sciatica and I was thinking, wow, you're

the person to get onto the show here to talk about that half the people.

Is it just that you're a specialist in this and everybody knows if you got

a pain in the butt, go see Laura, or is it something about the place where

you live, the kinds of people you see, why do you think you see so much?

? Well, it started a long time ago, like 15 or 20 years ago when I

didn't know everything I know now.

And apparently I did a good job with a few people and they told more

people and you know how that works.

I think when I first started out, you know, all I had was

my essential TCM education.

Including a lot of local needling.

So, you know, that's where we were.

And I, uh, always have enjoyed doing palpatory acupuncture and figured out a

lot of stuff just through that, on my own.

So I think people tell people, I also know that my clinic is really

popular with people over 60 and I've had other acupuncturists say really,

because apparently other people's clinic are not populated by that group.

And again, I think I just got started with people in the later stages of life

and they tell each other, I also think they have more health problems and

more money to spend on health problems.

So they tend to be around.

And a fair number of my clients are the kind of people who have never

been to a doctor in their lives.

Or who just don't trust Western medicine at all.

And many of them are farming people and they really believe

in natural healing methods.

So I think as people age, they just have more, uh, lumbar spinal pathology

and lots more chronic musculoskeletal distortions from work and age.

And so they have sciatica.

That's how we got here.

Well, where is it that you practice it?

You're seeing so many farmer type people I'm in Iowa city, Iowa,

which ironically is a university town of about 85,000 people.

And there are only about 40 acupuncturists in the state and 10 of them are

in Iowa city and I got the farmer.

Bunch of the clients.

Okay.

You started out, like, we all start out, you know, walk them through that gate of

TCM and using that TCM thinking often a lot of local points, that sort of thing.

We're going to get into some more details about how you do this, but

what I'd like to begin, where I'd like to begin is what are some things that

you used to believe about treating sciatica that you don't believe anymore?

Well, I would say that my initial thoughts about treating sciatica were

more strongly influenced by my friends who are chiropractors then than by

anything I learned in school, especially.

And so I started to think about just the musculature of.

The low back.

And I took an orthopedics course actually from Alon Marcus a long time ago.

And I was just doing kind of local musculoskeletal treat the muscle

that spastic and make it settle down kind of acupuncture, which works.

Okay.

But of course, you know, there are always those few cases where you

need all the low back and you end up with the person going into crisis.

And that was very surprising and embarrassing to me.

And I recognized that needling the structure where you believe

the pathology is, is really not the best option in general.

It took me about 10 years to finally come to believe what they told us

in school, in order to treat the front, treat the back in order to

treat below, treat above, et cetera.

I just didn't believe in.

I don't know why 5,000 years of medical history just didn't

come through, but now I do.

So that's, I think the biggest, you know, it's funny, you say 10 years

down the road, you start to get a handle on it in a different way.

And yes, we, we do learn these things in school, but still, it seems we need to get

a certain amount of experience under our own hands, a certain amount of experience,

really seeing it happen or not happen or making it worse in clinic ourselves before

things really begin to gel before some of those little axioms or little things that

our teachers taught us, you know, these little one-liners, that seems so simple.

We come back to it later and go, uh, yeah.

Now I see what's going on here that, um, I don't know.

I don't know if there's a way to speed that process up or not.

Well, the thing about me also is that I went to school in 1982.

And I was in the fifth graduating class at the first acupuncture

school in this country.

And we really didn't have any textbooks.

Well, Dan Bensky, his book came out during our second year, but we mostly

had teachers who had been trained by Dr.

So, and they didn't really know this stuff either.

They were trying to figure it out.

And so it was also, it was only a two year program and we had no clinical year.

And so we did do clinical observations and little, you know, I was a moxa

slave for a bit, actually with Ted Kaptchuk, but nobody's gave us the

real wisdom of 40 years of practice.

And so many of my classmates who are still in practice.

Now I'm sure have developed a lot of really wonderful wisdom as have I,

and I didn't even practice acupuncture until I had been graduated for nine

years, because I did not think that my training had properly equipped

me to actually treat patients.

So I, I did another career for a while, and then only because people begged me,

I began doing acupuncture at that time.

So, you know, it's very different from people who go to school now and have a

three or four year program and so many textbooks and special ed specialist

specialization in their training.

So I think that made a very big difference as well.

You didn't really have clinic in the way that people have clinic today.

You learned about this, you got to observe people, but in terms of doing

treatments with supervision, that was not part of the curriculum when you were in.

No.

Okay.

There wasn't even any acupuncture licensing anywhere

there wasn't an NCAA AOM exam.

It was the wilderness, the wilderness.

Okay.

So you and the people, you know of your, let's say generation, you know, um,

generation of, of, of acupuncturists in this country, a lot of what you had

to learn, you learned it in clinic.

So, but we're going to get into some more details here in a moment, but

especially for those people that might be new to acupuncture, even those of us

that have been in practice for awhile.

Can you give us a little insight or some of your thoughts on just

how we can pay attention to our clinical experience in such a way.

That, that we can really know what's helpful in harvest that, and we can

really know what's not helpful ideally early on, and how to pivot from that

into something that's more helpful.

How, in other words, how do we learn from our own experience?

Well, I think that the biggest problem that a lot of acupuncturists

make is that they claim to theory and ignore the obvious.

And so, as you and I have discussed many times, we have so much theory

and we have so many different ways to look at any particular scenario.

And we can really wrap ourselves up in knots, thinking about how to

describe this problem and strategizing a treatment that would please our

supervisor in clinic and all of that, but what we tend to not pay attention to.

Is our palpatory findings.

And sometimes even the report of the patient, sometimes we don't do

a good job of interviewing patients.

And so we, I think it's easy for us to get stuck in theory and not

stay in touch with the present.

And so I think another little confusion is that to treat problems that are

musculoskeletal one really must be doing meridian-based acupuncture.

And we need to kind of set aside the whole liver deficient blood

kind of TCM idea, because it's not necessarily going to lead us to the

best treatment outcome for those cases.

Did that answer your question?

It helps.

Oh, we use, what do we need to say?

So the other thing is that I started.

Feeling around on people's bodies.

Very early on, I had been trained by Kiko Matsumoto in my second year of acupuncture

school and she was fairly new in this country and she taught us some things that

she doesn't teach anymore, but for sure, she taught us to feel around on the body.

And she taught us this idea that an acupuncture point is not in a

fixed location, that the points move around and that they show up

where they show up on this day.

And it may not be in that location tomorrow.

And so there was right from the beginning of my education and emphasis on learning

to feel where points are with my fingers.

And I had been trained as a cellist, and I think that I had a high degree

of palpatory sensitivity from that.

As well, so it always appealed to me to do palpation.

So I always enjoyed feeling around on people's low backs and their glutes to

see what's going on and where is the pain?

And if I push on this thing, you know, does it make that other thing better?

So I was kind of already in that exploration.

And when I came back well, after about, well, 10, 12 years of practice, I stumbled

into a seminar with Kiko Matsumoto again.

And when I watched the way that she worked, I said, this is the.

I got to learn this stuff because she has such an accurate way of evaluating

not only the musculoskeletal disturbance, but the whole clinical picture

based on abdominal palpation and the evaluation of specific distal reflex.

All right.

How about re ground this a little bit and something sort of clinical.

So let's say someone comes in, they've got, they come in there

and they got a bit of a limp.

It looks like the limp is on the right side.

They come in, they report, you know, whatever they report.

How would you begin to do your actual assessment and figure

out for yourself beyond what the patient has to say about this?

What would you do?

I mean, what are you feeling for?

Where do you feel?

What kinds of, what kinds of things are you looking for?

How do you make sense with your hands?

I'm a very lazy acupuncturist.

Well, anybody who treats a large number of patients has to find efficient

ways to get things done, right?

So I resort to two or three basic evaluations that I tend to repeat.

And it's not only for sciatica patients, it's for all patients with any pain.

So now that patient who appears to be limping on the right, I don't assume that

their problem is on the right first of all, um, because the palpatory findings

may not match the, the way the patients behaving, but I do a very simple pelvic

analysis where I have the patient lying supine and I palpated the ASI S bilateral.

And then I palpated at about gallbladder 26 bilaterally.

And so the ASI S you can either paint palpate right on the very tip of the

bone, or you can go around to the inside surface where you're actually pressing

on the iliac and I'll compare right.

And left first touching the most external pur true grunts of the ASI.

Cause people, if you reach in and, and palpation, palpating, iliac is

on somebody you've never met before.

It's a little touchy.

Yeah.

That gets a little intimate.

So I'll say I'm going to just test your pelvis here.

And first I test the very tip of the ASI S and then compare right in left.

And then I moved, then I say to the patient, now I'm going to move to the.

And I just palpated on the inside surface of that ASI S and I'm expecting one

side to be more tender than the other.

And in about 97% of cases, that's true.

And I note that I have a little sketch of the thorax on every treatment notes

page and I mark, where I find tenderness.

Then I moved to gallbladder 26 ish, and I do the same thing I press in and ask the

patient, which side is more tender, right?

Or left.

Now on the gallbladder 26 exam, I can also feel very clearly that

one side is usually more resistant to my palpation than the other.

So most often the gallbladder 26 tenderness is opposite.

The ASI S tenderness.

And so this tells me that there's what I call a pelvic towards.

And that means that on the side where the ASI ES is tender the quadratus lumborum.

And so as our short, and so when the QL and so us are short, it ratchets up the

back of the, of the pelvis and moves it closer to the lowest rib on that side, on

the opposite side, where gallbladder 26 is tight or tender, that system is just

responding to what the other side did.

So we have this twisted pelvis and the chiropractors test this all the time

and what they measure is leg length.

So they have the patient usually in lying prone and they will look at which

heel is more extended than the other.

And then the more extended leg would be on the side where the QL is short.

For, for a, an anatomical reason that I can't at the moment explain.

So that's my first test on everybody.

Even if it's carpal tunnel syndrome, migraine, neck pain, ankle sprain, it

doesn't matter because if the pelvis is in this distorted presentation, we do

not have a good flow of meridians from the feet to the head and the hands.

And this is all about the dynamite.

And if so, you can think about the dime I, as this sort of connector,

like around a sheaf of wheat, where if that loop is crooked, You're

going to see all the sheets, the wheat straws be kind of cockeyed.

So we want to get that dime.

I, as well-organized as possible.

Now I have to say there are a couple of cases that tend to be a little bit

difficult and one is where people's pain and tenderness on the pelvic exam.

If it's exactly bilaterally symmetrical, those patients are very difficult to help.

It's almost as if their body needs to remember how to move.

They're very static, but in the majority of patients, we're going to

have this asymmetrical presentation.

And I actually think an asymmetrical presentation and the pelvis is normal.

I think that it is part of how nature gives us the inertia to move and

walk this very small pelvic tilt.

It makes us want to move, makes us want to adapt, but under situations of stress

that pelvic tension gets exacerbated.

And that's when the QL gets very, very short on one side.

So let's see, I don't know where I am at the moment where it's a dime

I and the dye can cause all kinds of issues, uh, with the other channels.

If things are kinked up, when you're treating, I mean, we're

going to stay with sciatic here.

Will you often look first to get that diamond to open up?

Yes.

So the way that I work on this is straight out of Kiko Matsumoto world.

I will usually treat kidney nine on the side where the HSIs has

tender and kidney seven on the side where gallbladder 26 is tender.

So.

One of the things that we know about this whole system is that there is a

relationship between adrenal physiology or just stress and this short QL.

And so as pattern, and I think in the chiropractic world, there's

quite a lot of discussion about that.

And of course, kidney 16 is on, is kind of on the dime.

I, so kidney 16 is a palpatory assessment point for adrenal physiology

and some chiropractic thinking.

So I believe that it is largely due to people's adrenal kind of overload that

this QL and so as can become short.

So even just day-to-day stress when it's out of bounds, we'll set people up.

For a short QL and start this whole pattern off.

So there's an interaction between structure and general

physiology right there.

So you're really seeing these kidney points and you're seeing the adrenals

and the kidneys as being sort of the root of a lot of these pelvic distortions.

Yes.

Well, there's another interesting problem with this and that is that

when you think about how the pelvis is working, one of the things that

we must constantly do is manage the pelvis relationship to gravity, right?

And so the pelvis needs to be always within a certain range level.

And how do we do that?

We do that first of all, with our footstep.

With the way that we hold our weight on the soles of our feet,

both in standing and in walking.

And so interestingly, it's the, the muscles of an e-version an

inversion of the feet that will kind of be involved in this, right?

Because inversion we're, it's the, it's the kind of the kidney

bladder pare that manages that as well as the gallbladder Meridian.

Right.

So, you know, if you consider the gallbladder Meridian running up and

down the sides of the body and through the dime, I, I think of the gallbladder

Meridian as like sides of the letter H and the dime I is the crossbar of the H.

So Dima is really.

Major structural facet here, but kidney and bladder Meridian are

acutely managing this pelvic rotation.

And so if you think about the trajectory of the kidney Meridian,

of course, it, it enters the pelvic floor right at the perennial them.

And then of course flows up in through the iliacus and the psoas.

So as we use our feet to manage ourselves in gravity, that whole kidney,

so as iliac a system is being, uh, modulating by foot strike and is also

sending information down to the foot.

So there's this whole feedback mechanism.

And then of course, the bladder Meridian, where people get so many symptoms in

the low back sort of ends up being the recipient of the, of whatever

dysfunction in the kidney system is.

Does that make sense?

Yes, it does.

I'm curious, you're talking about inversion, eversion of the feet,

the way that we hold ourselves up with our feet, the way we

walk our foot strikes, all that.

Do you find that if people change the way they walk and not just like change the

shoes, but change how they place their feet or change, bring some attention

to how they, they move their gate.

Do you find that that can make a difference in, in their

recovery or likewise in a, the problem getting even worse?

I don't think that people can change their.

I think that the gate is so automatic.

And so sort of programmed, you know, the cerebellum is involved with this

and the appropriate receptors all over the body, particularly at the junction

between the, the Atlas, the C1 and the occiput, sort of the top end of this

system, you know, that surface is covered with more proprioceptive receptors

than any other location in the body.

And so I think that the foot strike pattern is very unchangeable by intention,

and many, many things contribute to it.

For example, injuries, if you've broken a toe, if you've sprained an ankle,

if you've broken a wrist, any kind of major injury will end up causing sort

of permanent changes in foot strike.

So I don't think that people can really change it by, by trying and also, you

know, I think that shoes are a huge issue.

I had a guy come to see me with sciatica once who I knew that he walked with

his feet, very strongly turned out.

I had known the guy for 15 years, and the last time he came to see me,

he was just in terrible pain and I treated him and he wasn't responding.

And I finally looked at his shoes and the outside of each heel was so worn down.

It was unbelievable.

And I said, how long have you been wearing those shoes?

And he said, well, about five years, but my father-in-law wore

them for 10 years before that.

So, you know, there's just so, so much of course is given by the shoe.

And sometimes when people start getting better, they need to buy

new shoes or they need to get new.

Minors or new orthotics.

And so, so I don't think that trying is making a very big difference for

people, but I think what we have to do is begin to kind of unravel

the very automatic stuck rigidified mechanisms in that whole system.

And so when we're doing acupuncture, what I think we're doing is

removing layers of adaptation.

You know, this, what I'm talking about is adaptation.

So you break, let's say you, you break a part of your foot at one

point, or you have plantar fasciitis, then you're going to walk funny.

Or those people who end up in a boot.

I'm sure you've seen them.

They they've had plantar fasciitis.

The doctor puts them in a boot.

Now they've got that one leg there, lifting it up and hoisting it around and

clomping around with that thing, which is injuring their low back their SSI joint.

And they're also getting their glute medius on the opposite side is

getting really strong because they're picking up that leg all the time.

And so, you know, that's one of those cases where the fix

actually makes the problem worse.

So I think we have to kind of peel away the layers of the onion and these cases.

And we have to gently encourage the pelvis to remember how to be more

vulnerable, how to be more responsive.

And sometimes that means we have to work at the occipital area.

Sometimes the wrist.

I mean, it could be almost anything, but for sure, we're always working

on the kidney and the dynamite.

So it sounds.

Your main thing is getting the pelvis to open up, free

up, get more emotion into it.

And if there's more emotion in it, it will self correct.

Because there's like room to maneuver.

Yeah.

That would be a fair assessment.

Yeah.

One of the findings in these people, if, if they have a very strong,

um, ASI as tenderness on one side, the area that is described as the

anterior border of the gastrocnemius on that same side, down on the leg.

Yeah.

I mean, you have to think the anterior border of the gastrocs, where is that?

So that is Kikos location for kidney nine and it is superior

to the textbook location.

So what I find is that in people who have a very tortured.

They actually develop quite a lot of, um, dense muscle tissue, the myofascial

system in that kidney nine area kind of spanning from like kidney eight, up

toward kidney 10 on along the gastric, that system gets very, very dense.

You know, it's like a myofascial thing that has to be loosened up.

And so I think that the presence of a needle in that, that medial gas rock

really helps sort of break up the Stacey, uh, in the kidney Meridian

there by just, you know, electro, chemical and mechanical needs.

So helping the kidney Meridian function better is critical in these

cases because it gets very stuck.

You know, if you've got a tight muscle at kidney nine, you're going to have

weird foot geometry as a response to.

So I'm always working on that kidney Meridian, for sure.

No, this is interesting.

I think about, uh, some of like the dome sure.

Acupuncture and, you know, often they'll talk about using

channels of the same name.

So quite often I see people come in, they've got sciatica.

It's that classic.

They it's sort of in the low back, but it's mostly around gallbladder 30.

It goes down the side of the leg.

It's clearly a shaoyang issue.

And this is, this just seems to me like a great example of using the shalion same

name, same level to treat the shaoyang.

Right.

Well, you know, in the balance method, of course, that's, that's all there.

And for me, I guess, I don't really think that way so much.

So here's another layer of this whole conversation.

When in my studies, one of the things that I have been presented with is the concept

of something called Don chin weakness.

And we see these patients all the time and they can present with

low back pain and sciatica and so on or almost anything else.

But the palpatory findings in these patients is very clear.

And one of them is they will have a little sort of divot at the superior edge of

the umbilicus, like a little V-shaped notch pointing up into the Linea Alba.

And it's like at CV nine.

And so there's this weakness at CV nine and that same patient often will

have a, either slight or profound weakness at . And not often as much

at CV six, but CB four can be very.

Either flacid or just sort of sunken in.

And so if you have this patient with this Don chin week, the thought in my mind

is that the vessel that is the pelvis, that is the Don Chen is not strong enough

to contain, um, the energy that is the kidney, you know, Don 10 being men energy.

And what I also have learned is that the body will do anything to

protect Don Chan being men, right?

Like this whole system that I'm talking about, kidney is.

We're talking about that L two level of the spine, which

is the source of everything.

And so all of these weird pelvic shifts and foot strike patterns and everything

else is the way that the body has adapted to attempt to protect L two.

And so the system will give up a lot to try to protect L two.

So we want that L two segment to be very strong and also able

to give, to sort of be flexible.

So we have to be both strong and flexible.

So, you know, the posterior of the system of this vessel and the

anterior of the system, like CV for that whole center is kind of the,

the access from front to back around, which the pelvis is organizing itself.

Is this something that like in traditional TCM terms, you would call

it kidney deficiency or do you see classic signs of kidney deficiency?

Yeah, this is all kidney deficiency.

And so when I do Lum lumbar pathology treatments, I'm not

just going to treat kidney nine, kidney seven on the opposite side.

I almost always use kidney 16 also and kidneys 27.

So then I'm really supporting that whole.

System, which also is Chung my, by the way.

So I think about the relationship of Chung, MEI and dime.

I also hear like Chung my is this core that is so related

to two Ming men and then die.

My is sort of the hula hoop or the gyrus, you know, it's like a gyroscope

it's that the dynamite is, is creating balance within which the Chung MEI

and Ming men system can be contained.

Yeah.

Well, when I think of that, my, I mean, it's really the

centralist of the central vessels.

Yes.

Because it's anterior to the spine.

And if you think about, you know, we, we learned from, in

our engaging vitality course that these retro peritoneal structures.

Uh, you know, that's where I think of the Chung Maya being.

So as is like Chung my, in my mind.

And then QL is more like bladder Meridian, cause it's posterior.

So you see all these balancing pairs, right?

You see Chung balancing the bladder Meridian, or, you know, Dima, it's

all like this overlapping system of layers and structures and they

all must move toward balance for the symptom of sciatica to go away.

So if all we're doing is saying I'm going to do Meridian based acupuncture and

the pain is on the gallbladder Meridian.

So I'm going to do gallbladder, you know, if I were a dunk style or, uh, yeah.

Dunk style purist, I'd be doing like gallbladder 40, 41, 42, you know?

And so that's my dime.

I, you know, on the opposite side I do my kidney points.

Yeah, but I think we have to be able to palpate with our hands, the Don ShaoYin

and evaluate how it is improving.

So you should see a change in your palpatory findings

as you're doing the needles.

Exactly.

I think week after, well, first of all, within the course of a session, for

example, that kidney nine and gallbladder 26 finding will reduce instantaneously.

And when I put that kidney nine in on the side where the ASI is tender and I

read palpation, the ASI is the patient always says, wow, how did you do that?

And then I go, yes.

And then I do kidney seven on the opposite side.

And then I re palpate gallbladder 26 and they say, wow.

So the patient now their awareness has contacted the fact that we have.

Unlocked the pelvis so that it can be key begin changing.

So that's good.

Yeah.

They're already aware that something has shifted, you know, it's so funny.

I don't know.

You'll probably get this question too.

I suspect a lot of is to what patients will ask us.

They'll go, well, how do I know I'm getting better?

Which to me is always such a bizarre question.

You're living in your body.

How would you not know?

But anyone who's practiced for any length of time knows that people miss

all kinds of things about themselves.

Well, and of course, you know, every one of us who's done acupuncture, no matter

how long has experienced the fact that patients come back for their, for their

follow-ups and they say it still hurts.

And when I'm really burned out, I feel like all day, every day people

are telling me I haven't helped them.

And I have to actually go to the trouble.

Well, let's just go back here and see exactly what has changed and ask for

specific questions and say, does the pain go as far down your leg as it did before?

Oh, no, it doesn't.

It used to go down to my foot.

Now it only goes down to my knee.

Great.

And how about this pain in your, in your glute?

Is this still is tenders?

It was last week.

Oh no, actually it's moved.

So I think we have to show the patient that they're better because as, as we all

know, even in our own bodies, it's easier to pay attention to what still hurts than

to notice what's not hurting anymore.

It's really hard to pay attention to something that's not present.

Yeah.

So, so the other thing is that when I do the Don ShaoYin weakness

treatment, I usually use points on the side of the pelvis, like

gallbladder 29 and some other things.

And then when I go back and repel, pate, the abs.

People will often say, oh, that CV nine point is doesn't

seem as weak as it was before.

Or that CV four point feels not as loose as it was before.

And, and I'm detecting very subtle changes, but I do want to see the Don

ShaoYin sort of filling up and I want to find the container more robust.

Otherwise I don't think they can hold the treatment as well.

So the more years I do abdominal evaluation, the more I can sense things.

And oftentimes I can sense things that patients can't feel.

So you probably have patients say this as well, right.

Something really hurts.

And they say, all right, doc, load me up with needles, make this thing go away.

We both know that overtreatment is not helpful.

In fact, it can be, you know, as big a problem as is not doing

enough treatment, maybe a more so.

Do you find when you get this week, dantien pattern that you want to go

easier on a patient in terms of needles.

You want to be more careful.

You want to be more cautious about the amount of, uh, stimulation you give them.

Well, you know, that's a very interesting subject because I, I study, I always

study at two ends of a continuum.

I always study extremes.

And so one of my teachers right now would say, no, no, no, you can do five needles

or six or eight needles in each extremity.

Don't worry about it.

That's one extreme.

And the other extreme, you know, this is dong style.

A lot of dome style teachers say, do overlaps.

So, you know, you're going to address the problem with four or

five needles in each limb, always targeting that same mirror of the.

Those junk style teachers might say, oh no, you're not going to waste your client.

But then our teachers in the, in gaging vitality world would say,

you never want to use more than three needles in a treatment.

Well, I don't know.

What would they say?

Never use more than three.

Would they say use just the right amount?

Well, they might say use just the right amount, but I know if

they saw the treatments I do, they would shake their heads.

So I do think for sure that putting a lot of needles in the lumbar is going

to be over-treating this type of person, especially if they have a lot of Don Chen

weakness, like I've been talking about.

And so when I do treat the lumbar in these patients, I tend to use more ton

of, I use a tonifying points, like call butter 25 and I use bladder 52 alone.

On the side where the short quadratus lumborum is, and that's kind of

a, a little bit of a throwback to some of Matt Collison's work.

He, he puts a long needle.

Seventy-five millimeter needle in the QL, starting from gallbladder 25 and needling

transversely through the QL towards L two.

I used to do that a lot and I really don't anymore.

Now I just use a short needle, a 30 millimeter.

And, um, so I tend to do kind of two tonifying points on that, on

the side where the QL is tight.

And then on the opposite side, which is usually the symptomatic side, not always,

I use a series of needles just along the sacral border, where the glutes attach

into the sacrum and those needles are very shallow and they're your transverse

and they needle towards the feet.

So I just do a row of needle.

Right.

They go down in a little diagonal row and starting, usually I start

at the, at the tip of the sacrum and work my way up toward the PSIS.

And so those needles tend to release the glute and the piriformis a bit.

I think that that's actually not a very weakening treatment.

I think it supports the kind of untwisting of the pelvis and having gallbladder

25 in there, you know, is really nice and stabilizing to the Don ShaoYin.

So I think the kidney would love that.

Wouldn't it?

Yeah.

And, uh, I do a variety of different things on the back of the legs.

Some days I use Kikos econ treatment where I do bladder 60, 58 and 39.

And that's kind of an echo of the dong style idea as well.

Other times I don't put any needles in the backs of the legs.

It just sorta depends.

Certainly the weaker patients, I don't do as many needles.

So I decided how many needles to use on the back, depending

on the patient's strength.

Oh, by the way, I always treat front and back on 95% of my patients, especially

with this type of problem, of course, the other great, great, great one for

any lumbar pathology is state waters.

That's the governing vessel.

I can never remember the numbers 15 and 16 on the occipital protuberance

north of the north of the little chip.

So, so that would be something I would use pretty commonly as

a support for the lumbar spines.

I always want to be supporting the lumbar spine in these cases.

And I don't think that that like state waters, I don't think that over

treats people because it's so distal.

Do you see distal points as being more moving or less moving?

Well, I think some are really moving and some are more ton of.

So, I don't know.

I don't have a static idea about that because I've often heard the idea that

the more distal you go, it's like using a lever it's like the longer the lever is

the more oomph that you can get out of it.

Well, so, you know, of course when we're at school, we learned that the more

disappoints or more cooling, right.

So in that way you might think they're stronger, but like, in some of the

dunk style thinking you would palpate for tenderness on a distal Meridian,

like bladder Meridian, for example.

So you're going to palpate along the bladder, Meridian bladder,

65, 64, 63 62 61 60, maybe 59.

And you're going to choose the most tender point because

that's sort of the live point.

Is that a strongly moving point or not?

I think of it more as.

Uh, reflux, that's active just like when we palpate for

tenderness in the ear, for sure.

If I palpate a Meridian and it feels dense and like, there's not

a lot of movement in the tissue.

Like I palpate kidney Meridian a lot.

I palpate gallbladder, I palpate triple burner a lot.

And so if I find density in a myofascial zone, that to me is tissue

that is not allowing Xi to move well.

So I'm thinking more in a mechanical sense there of disrupting

stagnation by needle and right.

Would you needle into those dense areas or would you would yes.

As opposed to like needling somewhere else to try to get it, to open them,

go back and check and see how it feels.

You just go right into that density.

I don't think that needling along the Meridian in another location

usually loosens those up very much.

I mean, maybe it's just not how I work.

But yeah, I just, I mean, part of me is still a good old orthopedic, you know,

sort of trigger point acupuncturist.

Yeah.

I'm blending, blending, blending.

Now there's certain points that have a ton of flying property

that really need to be respected.

Right.

So I would never do aggressive needling on kidney three, for example, because

that's, first of all, patients have that electric sensation that they hate, but I

never want to dissipate energy in a point that already feels soft and yielding.

So kidney three never gets in my book, strong acupuncture.

Let's see what other points are like that liver three, again, I'm

not going to dissipate that energy because that needs to be respected.

So especially in, in Meridian points, I, I think of them more as supportive.

And young Meridian points.

I think that they do tend to get kind of tied up in knots, you know,

remember that principle that the weaknesses in the yen meridians give

way to excesses in the young meridians.

So I would tend to more dissipate excess in a young Meridian.

So I'm going to palpate for density on the gallbladder and the bladder Meridian.

So I'd be treating the bladder Meridian and the calf sometimes if

it's really dense I'll needle along that and try to make it softer.

And I get instantaneous results, gallbladder, Meridian as well, especially

in people that have like a really tight, uh peroneus we're going to find some

density there that if we can loosen it up, it's going to make that, that letter

H have a lot more ability to bend.

Sideways, I call this the hula hoop system.

So when patients say, what are you doing?

I say, oh, we're fixing your hula-hoop control system.

So that done.

Yeah, the diamond and the gallbladder Meridian.

That's our hula hoop control system, you know, with the

kidney Meridian on the inside.

Yeah.

And so, yeah, we want to be able to move that hula hoop in every

different range and control it.

And you want to have a strong center to it as well.

Right.

And see, that's why people get piriformis syndrome.

It's so obvious if you think about it that way.

And you know, more than half of our patients complaining of sciatic, neuralgia

have a compression of the piriformis and glute medius on the sciatic nerve.

They may not, or they may have pathology.

You know, but just ignoring the lumbar pathology, gallbladder 30 and 29

become tight as the system is trying to stabilize itself in the face of weakness.

So you tonify that weakness and the system can relax a little, right?

So as we strengthen the Don Chan, as we strengthen the vessel, the container

that the pelvis is, and we free up the kidney Meridian a little bit, improve

the flow in the kidney Meridian, then the gallbladder 29 30 complex can settle down.

It doesn't have to be called in to stabilize the system.

It's already working over time.

Yeah.

Now there's a whole nother level of problems that I haven't talked about yet,

which is, you know, lumbar pathology.

And somebody said everybody over the age of 50 has.

Okay.

So, and probably everybody over the age of 50 has some amount of degeneration of

intervertebral discs in the lumbar spine.

And those of us who spend our day standing at acupuncture tables are

right up right there among them.

So when the patient comes in with her MRI interpretation, I'm very interested to see

what the radiologist said, you know, am I dealing with lateral foraminal stenosis?

Am I dealing with Fossette arthropathy?

Am I dealing with central canal stenosis?

And do I have disc herniations?

So in my experience, disc herniations, more, they normally

will get better on their own if they're treated conservatively.

And I think this is the opinion in the chiropractic clinic.

But central canal stenosis is a condition that just gets worse.

It's a rigid suffocation of the connective tissue that wraps the cauda equina and

the lumbar spine, and it narrows and squeezes those nerves before they even

get outside the center of the spine.

So that's a pretty hard pathology to have in the mix, but lateral

foraminal stenosis, where the disc has degenerated to the point where

that opening between the upper and lower vertebrate is closing down.

Now that little hole getting smaller and smaller, and also being filled

with osteophytes and inflammation, that nerve root your rotation

is very provocative to the body.

I mean, not only is it just an irritation of the nerve, but the, but

the lumbar spine and the musculature there is going to go into a guarding

pattern to try to protect that.

And then the worst pathology perhaps is the Fossette joint arthropathy,

which will project pain to the surface right over the top of it.

And that pain is going to show up and Ridge rigidified

location in the erector spinae.

So those psychiatric nerve roots coming out from the lumbar spine can, can be

getting irritated by an awful lot of bony pathology and then muscular tension where

the lumbar paraspinals are just rigidified the system to try to protect it.

So the lumbar spine is just going to go into a more rigidified state to try

to keep anything bad from happening.

And, you know, that's, nature's way of working.

So, you know, how much can we change that in those patients is a big question of.

Well, it raises the question for me too.

If you have an area of the body, you were talking about the, uh,

lateral nerve roots coming out.

And if, if there's some problems there in the body, rigidified around it to try

to stabilize it and protect it, loosening that area up, our attempt to loosen it.

Would that actually be helpful?

That might actually, that might actually make it worse in some ways,

or open them up to deeper injuries.

That's exactly right.

And that's why for those patients with really severe pathology in

the lumbar spine bones, when you do strong local needling, you

really risk exacerbating that.

And I was taught by one teacher who had me use a 30 gauge seventy-five

millimeter Siron or 60 millimeter series.

At the Watteau points, needling all the way down to touch the transfers process.

And yeah, you can get in there and work on those erectors PNA, and maybe you can even

needle into the multifidi and rotatores, but I don't know what I'm doing.

If I'm mechanically disrupt trigger points in the erector spinae, am I

making that lumbar more unguarded in a way that's going to increase pathology?

I don't know.

And I've had two or three cases where after that kind of aggressive

needling, people got much more unstable.

And so we cannot aggressively needle.

These, these very pathologic low backs in less, a lot of other things

are in place that help the dontcha.

Be more of a stronger vessel, right?

So this is where yoga is so critical for improving foot strike for improving foot

mechanics and from improving just the whole health of the bladder Meridian.

And I'm not talking about this big, hot yoga with a lot of flow.

I'm talking about concerted very carefully done ion Gar with lots of

adaptations for these older patients, we've got to strengthen the Dutch yen

before we get in there with big fat, long needles and try to break things apart.

Yeah, well, you know, this is a classic example of deficiency leading to excess.

Right?

Exactly.

And it makes sense because if there's deficiency that the most extern, the

most exterior layers of the system are going to become more rigidified

because again, the whole purpose of this thing is to protect the Dante.

And the container has become is going to become more and more

rigid to protect the Don JueYin.

And we have to respect that.

And so, you know, there are a lot of teachers who are going to say in

those cases, we're going to use a lot of moxa on governing vessel points

and, you know, mocks on G before.

And I've done a fair amount of OCU in the past.

I don't always do it now, but, or even, you know, the Korean moxa box

on the, on the backside and the belly, both for strengthening the container.

It's just those ancillary therapies become so important and probably herbs as well.

Yeah, it makes sense.

We'll, I'm looking at the time and I can't believe that an hour

has gone by already time flies.

Yeah, I know, but it is.

Well, we just may have to bring you back for part two at some point.

Um, cause I do try to keep these to an hour or any.

Closing thoughts that you'd like to leave with our listeners before

we wind this thing down today?

Well, I'd say that I think everybody can benefit from doing more palpation

of the musculature of the low back and the hips and the belly.

And just beginning to make some record in the chart, some graphic

reflection of the findings and repeating that week after week after week.

So we can see how these cases evolve.

That's a really important source of objective information, much

more important than pulse.

And Taiyang in my opinion.

So, um, that's, I think where most of us can really increase

our ability to do a good job yeah.

That in writing it down is so helpful.

Cause I find.

If I write stuff down, I start to actually build up a vocabulary for

making sense of what I'm feeling.

It's really helpful.

Even if I don't necessarily understand it, sometimes I'll feel things

and I'll go, I'm feeling this.

What does it mean?

I don't know what it means, but I know I'm feeling this well,

and I love doing it in pictures.

I love making a sketch because it's quicker than a narrative to.

Great.

Well, Laura, thank you so much for your time today.