Honora's Farewell Blog

“…won't you celebrate with me

what i have shaped into a kind of life?”

   –Lucille Clifton

Dear Friends and Colleagues,

It’s a little difficult for me to believe, but today I come to the end of my tenure here at Blue Poppy. The company is, I believe, in good hands to continue the work Bob and I began over 30 years ago to help our profession succeed. Though there may be things left undone, I surrender the weight of them to those who follow me!

I haven’t much more to share with you (after all, I’ve blogged and lectured and written continuously for that last decade and more), but I do want to thank everyone who has taken the time to read my books or my blogs or attend my classes, workshops, and webinars. I’ve been blessed to have a good career, most of the time doing things I enjoyed with people I liked. If you got a tip or two along the way that helped you be a more effective clinician or a more successful businessperson, I’m satisfied that it was not all just hot air.

Before I ride into the next sunset, I want to thank anyone and everyone who helped me in my career. So many kindnesses from colleagues who set up a class for me, bought a book, attended an event, or believed that what I had to share was valuable! Especially I want to thank my co-workers at Blue Poppy, without whom the work I did would have been impossible, not to mention lonely. I wish them all success and happiness; I’ll miss the collaboration and camaraderie.

Last, I’d like to thank my business and life partner, Bob Flaws, from whom I learned the medicine and whose tireless work for our profession is still the foundation upon which the edifice of Blue Poppy stands. His contribution cannot be overstated in my estimation.

Final thoughts. I believe that at the end of the day (or the end of our lives) we won’t remember much about what we owned, what cars we drove, or how much we spent on our wardrobe. (We’ll be lucky if we can remember anything at all if we live long enough!) The only things that will matter are who we helped, what we gave back, and how much we loved and shared in our short visit to this small and beautiful planet.

So please don’t be lazy, pay attention, share when and what you can, and smile, laugh, love as much as possible.

Happy trails,

Honora Lee Wolfe

Why Do Patients Leave Our Care Before They Got Better? Part #3

When patients have money issues, we may think there is no way to keep them in our practice. But perhaps we need to think more creatively about this. There may be several ways you can give these patients more affordable options so that they will keep coming. Here are a few ideas.

1. Time of service discounts

Some practitioners only take cash for services rendered, which means that you have one price for all everyone. If, however, you are billing insurance or any type of 3^rd-party payers, it is legal to offer a time-of-service discount or 10-15%. Why? If people pay you at the time of receiving services, you don’t have to do any further paperwork or send out any billing, which requires time and expense for your office. In that case, most states allow you to give patients who pay you up front a discount for making your life easier.

2. Sliding scale payments

If you wish to go to the trouble, you can create a sliding scale similar to what is used by organizations such as Planned Parenthood, which charges fees based on your income-per-household. You may choose to require some type of proof for the discount, or take people at their word.

3. Package deals

In Colorado, we are allowed to give package pricing, as long as there is a signed statement that the patient understands they can get any remaining fees returned to them if they discontinue services prior to using up the total amount. This is a good deal for patients and has the advantage of giving you a larger of income amount up front. Then it’s up to you to do such a good job that the patient wouldn’t think of leaving before all the services are rendered!

4. Clinic “membership” discounts

One clinic I have worked with locally, offers a 15% discount for all services if you become a member of their clinic. What this implies is that the patient will get at least one treatment per month for being a member.

5. Monthly payment schedule with a credit card

If the person says they can only afford $XX per month, but you know they need more treatment, they can give you a credit card to bill over however many months are necessary at an agreed upon rate per month. Get this in writing and signed by both you and the patient!

6. Bill something to insurance

Does the patient have insurance and you have not explored whether they have acupuncture benefits? Insurance patients typically are willing to take more treatments more often than those who are paying on their own.

7. Partial trades

Does the patient have a skill or service that would be useful to you? Explore what you could do outside the world of cash. You will be surprised at how often a patient could trade you something that you want or need outside the cash economy.

8. Space treatments further apart

As a last option, you can suggest spacing treatment further apart, unless you think that will cause the whole treatment plan to be ineffective for the patient. You might also consider switching to herbs-only treatment if that is less expensive.

There are eight options for working with patients who complain about your prices or their inability to pay. You don’t always have to lose a patient because of financial limitations if you can be creative!

Final advice: There are lots of things you can do to improve your patient communication and education, clinic and business operations, and creative financial options, in order to keep more patients who walks in the front door from getting a couple treatments and then walking out the back!

Last but not least, maintain your interest and passion about the medicine and about helping patients heal! Keep learning and keep improving your clinical skills. Do your best with each patient, every time. Patients can feel that and instinctively know this! Make them believe they’d be crazy to be seeing anyone else!

Good luck and best success in your practice.

Thanks for reading.

Why Do Patients Leave Our Care Before they Got Better, Part #2

In the first installment of this blog, I wrote about patient communication and education. It’s my personal belief that everything about how we run our business is also a very powerful aspect of our communication with patients. As such it is more subtle, often non-verbal, communication which makes it more difficult to “teach” but possibly even more powerful than the things we write or say out loud.

What do I mean by office-operations-as-unspoken-communication? Pretty much everything! This includes things as diverse as how (and whether!!!) the phone is answered, how easy or difficult it is to get an appointment, the quality and ease-of-use-and-understanding of your patient paperwork, ease of finding your office, ease of use of your website, whether you run your clinic on time, your bedside manner, the lighting and décor or your rooms, efficiency of check in and check out process, to the cleanliness of the bathrooms. The better you do at all of these, the more satisfied your patients will be with your services. It might even make your treatments work better because all these things are part of placebo effect. Let’s talk about a few of these in more detail.

Phone communications

People in our profession who’ve heard me speak about business know that I have a pet peeve about how poorly we do, in general, with this service to our patients. Without whining too much let me say two things:

1. The lion’s share of the people who are making any serious money in this profession are not answering their own phones.

2. People expect that professional, “real” medical services will be open for business during regular hours. Nothing says dilettante or “playing doctor” more loud and clear than a message about how you’ll get back to them soon and their message is important to you.

3. If you were to become one of the clinics that has it’s phone answered every time someone calls, you’d be in the minority and you’d be more likely to be successful simply because you are open for business and people can get hold of you.

Efficiency of your check-in/check-out

People want to be greeted by a friendly face, sign whatever they need to sign, not wait too long to actually see the clinician, be able to get water or tea, pay their bill quickly and be on their way. Inefficient management of your reception services: no one there when they come in the office, paperwork that cannot be found or is not ready to fill in (best if they can download from your website), paper not loaded into the credit card machine, lights that don’t work, scattered and disorganized operations, running out of toilet paper or facial tissues, all these things indicate to people that the business is not well run. If the business is poorly run, how do they know they can trust any other aspect of your work (like your treatments, for example)?

Cleanliness

In our world, people expect any type of medical office to be spotless. That includes bathrooms, carpets, walls, windows, equipment, everything. Period. This is really not optional.

Ease of getting an appointment

This goes back to phone service, but may also involve your website and email communications. If I want an appointment, but I want to ask you a question first, or I want an appointment today, I need someone to answer the phone or get back in touch with me within minutes of my leaving a message, or answer my email within an hour of when I sent it. If this is not happening in your clinic, you’re going to lose patients. People should not have to work at getting in touch or getting in to see you. In fact, landing on your treatment table should be in every way possible, as easy as sliding down a greased pole and landing on it before they knew what happened!

Décor

There is an entire chapter on this subject in Points for Profit, but just to reiterate, the basic idea for décor in your clinic is one of a few options:

• either knock the socks off your chosen niche of patients, or at least make them feel that the entire place is “all about them” in some way.

• go for a classy, simple, appealing to everyone haven where anyone could relax and be comfortable

• make your space very community oriented, with bulletin boards, announcements about your volunteer activities, offer your space for community meetings, food co-op pickup and drop-off, and generally make it homey in a community oriented way.

No matter what else, keep it clean, clean, clean.

All the above things go into making sure your business approach is patient centered and totally easy and comfortable to interact with. Make sure these are NOT reasons why patients stop care before you decide, together that it’s time.

Next time…Part 3 of this blog: What Payment Options can you offer your patients so they don’t quit for financial reasons?

Why Do Patients Leave Our Care Before They Got Well…and What Can We Do About It? (Part 1)

We’ve all had it happen. A patient comes in once or maybe even a half dozen times. Then they break their next appointment or don’t make one at all and never come in to our clinic again. They don’t return our calls or emails.

What happened here? Of course there could be many possibilities and it may have nothing to do with you at all. But chances are it comes down to a few things we could all do differently to lower the number of disappearing patients. Here are my ideas on this subject and I hope they resonate with you or offer you some food for thought.

I believe most patient disappearance comes down to three things: poor office-patient communication and education, poor business and office management, or inflexible pricing and payment options. Here are some ideas on how can you improve?

Improving office-patient communication and education

To keep a patient for the long haul, we need to do our utmost to make sure that patients see, hear, and understand all our communication with them. Firstly, this is important when educating patients about the necessity of getting a full course of treatment, however many you believe are required to get the patient well using acupuncture. With herbal therapy this may translate into how many weeks or months of herbs you believe they will need to take.

Secondly, signage in your clinic can go a long way toward explaining things about our medicine as well as what you specifically offer to patients and to your community. You can and probably should have “did you know” type signs about various conditions that you like to treat. For example if you like to treat insomnia, a simple sign that says “Did you know that sleep disorders are the most common diseases in the US today? Acupuncture and Chinese medicine can provide quick and effective help for many patients who suffer with sleep disorders. Ask for information for a friend or family member today.” can be effective at educating your patients about the broad scope of conditions that you can treat and about which they did not know. Also, signs that offer your services as a speaker for your patients’ groups and affiliations, signs that let patients know about your volunteer activities, and signs that offer free or reduced price treatments in exchange for participation in a fundraising or volunteer activity all let your patients know that you are a community participant and care about something before your front door. All this kind of information all should be on your website or company Facebook page.

Third, your written educational materials should be easy-to-read and understand. Be wary of using the word “qi” when speaking to patients or writing educational flyers or website copy. We are not even able to translate this word accurately into English. I suggest discussing ideas that Westerners can understand, like balancing your nervous/endocrine/ system, improving your immune response, engaging the body’s innate ability to heal itself, improving organ function, helping the body overall back to proper homeostasis, as better approaches to helping patients understand something about what we do. Always write copy for brochures and your website for the first time reader who knows nothing about acupuncture and Asian medicine.

One friend of mine always schedules an extra 30-45 minutes into her first appointment with a patient. This time is spent allowing her and her patient to get to know each other a little, doing extensive and planned patient education, as well as making sure the patient understands and agrees to a specific financial arrangement with the clinic. In her case, that may mean having her assistant check on insurance benefits while she is working with the patient, it may be creating a payment plan or agreeing on a treatment schedule that will work clinically but also be workable for the patient’s budget. She loses very few patients before their care with her is complete. She says her goal is to keep every patient for life.

Finally, I suggest bonding calls and reminder calls (or texts or emails), as well as semi-regular email and snail mail communications. A bonding call is done within 24 hrs of a first appointment and treatment. It allows you to answer any questions that may have come up in the patient’s mind, reassure them that you are there for them and really concerned about their care, and allows you to nip most problems of perception or misunderstandings in the bud very quickly. Reminder calls or texts are self-explanatory, but they will cut down your no-shows and most people appreciate these. (Who among us has never forgotten an appointment just because of the busy-ness of life?) You can use an opt-in email newsletter to stay in touch with patients, but mostly make this type of communication about cool things you are doing in the community (especially if they can participate), classes you are offering, the discount of the month, a book review, a video of you teaching a seasonal qi-gong exercise or preparing your favorite seasonal recipe. Think fun, light-hearted, community-centered. 

As for snail mail, I think the best use of it is to send a birthday or “thinking of you” card now and again, but one that has a specific, hand-written message in it instead of just signing your name. For example, “Dear ____, Here’s hoping this card finds you well and thriving. I saw that your birthday is coming up and it occurred to me that I recently attended a seminar where I learned a new type of treatment for your condition. If you ever have a recurrence of symptoms and would like to discuss it, please don’t hesitate to give me a call. Meanwhile, stay well and enjoy your birthday.  PS. Did your son get into one of the colleges he had applied to?”  You get the idea here. Keep it friendly, short, and specific to their life in some way.

There are many more suggestions about effectively managing patient communication in Section 2: Chapter 13 of the new and updated edition of Points for Profit (10/2013)

Next time…Part 2 of this blog: What Does Your Office Management Communicate to Patients?

Handouts for October 3rd 2013 Webinar on Treating Pain

 

-->

Get Better Results When Treating Pain

with Honora Lee Wolfe

Copyright, 2013

THE Basic Statement About Pain

Where there is free flow, there is no pain;

 where there is pain, there is no free flow.

Most Common Patterns Associated with Pain

1.Qi stagnation in the local area

2. Blood stasis in the local area

3. Qi & blood vacuity leading to the lack of nourishment of the sinews & vessels

4. Damp or damp heat inhibiting the flow of qi & blood to and through the sinews and vessels

5. Yang vacuity leading to cold congelation and    blood stasis in the channels & sinews

When treating pain/disease with acupuncture and herbal formulas together one should...

Combine root tx with branch tx for the best results.

• Root tx are based on viscera & bowel; qi & blood; fluids & humors; yin & yang pattern discrimination. (often herbal)

• Branch tx are channel-based, based on channel & network vessel pattern discr. and on palpation. (often acu-moxa)

In Chinese medicine in general,

…all treatment methods can be divided into Bu fa and Xie fa

Bu fa means supplementing methods

Xie fa means draining methods

Best General Acupoints for Pain

LI 11 for all upper body pain (with LI 4 for more power.)

UB 60 & GB 34 for all lower body pain

Add Xi (Cleft) points for more power; add electricity, as strong as the person can handle, on these.

Four Bars for head, neck, torso pain.

Related specific ear points.

Bodywork & Pain

In cases of blood stasis or recent trauma, deep tissue work at the site of the pain is often counter-productive.

Bodywork distal to the injury can be helpful to open the channels and free the flow of qi and blood.

Lighter bodywork on an injury after major healing has occurred is useful.

Bodywork in conjunction with moxa on old injuries may be quite helpful.

Use liniments with these treatments for best results!

Acupoint selection

§For moxibustion, use mostly ah-shi points in trauma conditions

§When using moxa as your local or branch treatment, you might choose tender points on related channels as your root treatment

§E.g., for right side shoulder pain on the yang ming channel, moxa ah-shi points in the area of LI 15, needle the same points on the opposite side, and use thread moxa or gold needles on relevant points foot yang ming and foot tai yin as a root treatment.

Bleeding in pain cases

1. Fever (replete yang, not yin vacuity type) (i.e., full, fast pulse, red tongue, full/replete heat symptoms)

2. Sore throat  (replete yang, wind heat common cold or flu, not vacuity symptoms)

3. Musculoskeletal pain which is stabbing or biting, site specific, and recurrent

4. Musculoskeletal pain which is dull and constant but worse with movement

5. Headaches or eye pain of a replete yang nature

6. Itching

7. To reduce swelling caused by stasis of blood and stagnation of qi

8. Numbness or pain with numbness

9. Vomiting caused by stomach heat

10. Emergency resuscitation

11. When there are clear signs of blood stasis such as varicosities or spider nevi veins, especially for pain conditions on the same channel

External therapies

§Pastes & plasters (gao)

§Wines (jiu) or tinctures (ding ji)

§Powders (fen)

§Oils (you)

§Washes (shui fen)

§Compresses (shi fu)

§Medicinal baths (yao yu)

§Fumigation (yan xun liao fa)

External therapies for pain from Blue Poppy

Shao Lin Dee Dat Jow

§Radix Angelicae Sinensis (Dang Gui)

§Radix Ligustici Wallichii (Chuan Xiong)

§Radix Cyathulae (Chuan Niu Xi)

§Lignum Sappanis (Su Mu)

§Flos Carthami Tinctorii (Hong Hua)

§Flos Caryophylli (Ding Xiang)

§Radix Auklandiae Lappae (Mu Xiang)

§Resina Olibani (Ru Xiang)

§Lignum Santali Albi (Bai Tan Xiang)

§Fructus Foeniculi Vulgaris (Xiao Hui Xiang)

§Alcohol

Functions:

§Moves the qi & quickens the blood

§Disperses swelling & stops pain

Indications: Recent closed injuries with swelling and pain     

      

External Therapies: Dragon’s Blood

§Sanguis Draconis (Xue Jie)

§Lignum Pini Nodi (Song Jie)

§Resina Olibani (Ru Xiang)

§Resina Myrrhae (Mo Yao)

§Radix Et Rhizoma Rhei (Da Huang)

§Flos Carthami Tinctorii (Hong Hua)

§Lignum Sappanis (Su Mu)

§Radix Pseudoginseng (San Qi)

§Camphora (Zhang Nao)

§Borneolum (Bing Pian)

§Alcohol

Functions:

§Quickens the blood & dispels stasis

§Disperses swelling & stops pain

Indications: Recent closed injuries with marked ecchymosis

External therapies: Green Willow Liniment

§Flos Carthami Tinctorii (Hong Hua)

§Radix Aconiti Carmichaeli (Chuan Wu)

§Radix Aconiti Kusnezoffii (Cao Wu)

§Radix Angelicae Sinensis (Dang Gui)

§Semen Pruni Persicae (Tao Ren)

§Herba Ephedrae (Ma Huang)

§Pyritum (Zi Ran Tong)

§Semen Strychnotis (Ma Qian Zi)

§Ramulus Cinnamomi Cassiae (Gui Zi)

§Radix Auklandiae Lappae (Mu Xiang)

§Resina Myrrhae (Mo Yao)

§uncooked Rhizoma Zingiberis (Sheng Jiang)

§Alcohol

Functions:

§Moves the qi & quickens the blood

§Warms the channels & frees the flow of impediment

Indications: Wind cold damp impediment

External therapies: Three Angels Liniment

§Cortex Phellodendri (Huang Bai)

§Rhizoma Atractylodis (Cang Zhu)

§Radix Achyranthis Bidentatae (Niu Xi)

§Caulis Trachelospermi (Luo Shi Teng)

§Caulis Lonicerae Japonicae (Ren Dong Teng)

§Radix Angelicae Dahuricae (Bai Zhi)

§Radix Angelicae Pubescentis (Du Huo)

§Radix Angelicae Sinensis (Dang Gui)

§Radix Et Rhizoma Rhei (Da Huang)

§Camphora (Zhang Nao)

§Borneolum (Bing Pian)

§Alcohol 

Functions:

§Clears heat & eliminates dampness

§Frees the flow of impediment & stops pain

Indications: Wind damp heat impediment

External therapies: Sprain Ointment

§Radix Et Rhizoma Rhei (Da Huang)

§Herba Lycopi Lucidi (Ze Lan)

§Lumbricus (Di Long)

§Fructus Gardeniae Jasminoidis (Zhi Zi)

§Pasta Acaciae Catechu (Er Cha)

§Resina Olibani (Ru Xiang)

§Borneolum (Bing Pian)

§Sesame oil

§Beeswax

Functions:

§Quickens the blood and dispels stasis

§Clears heat, disperses swelling & stops pain

Indications: Recent sprain or closed injury characterized by redness, heat, swelling, and pain

External therapies: Stop Pain Tincture

§Flos Carthami Tinctorii (Hong Hua)

§Rhizoma Nardostachydis (Gan Song Xiang)

§Alcohol

Functions: Moves the qi, quickens the blood, stops pain

Indications: For the symptomatic relief of any pain

External Therapy:

1. Herbal Sports Massage Oil

Moves qi and quickens the blood to stop pain in sports injuries

2. Dr. Bob’s Oil and Pain Stick

Same formula as Po Sum On with peppermint and cinnamon essential oils, for temporary relief of muscle pain

Internal Formulas: Kidney Mansion Formula

Shu Di, Shan Zhu Yu, Gou Qi Zi, Tu Si Zi, Du Zhong, Xu Duan, Bu Gu Zhi, Ba Ji Tian, Niu Xi, Gu Sui Bu, Wu Jia Pi, Dang Gui, Chi Shao, Chuan Xiong, Ren Shen

Tx Patterns: liver-kidney vacuity with  blood stasis and wind damp evils.

Tx Conditions: Chronic low back pain, post-menopausal osteoporosis

For mostly aging patients with chronic low back pain.

Internal Formulas: Impediment Magic Formula

Yi yi ren, Qiang huo, Niu xi, Cang zhu, Mu gua, Xiang fu, Wu yao, Fang ji, Qin jiao, Dang gui, Ru xiang, Mo yao, Tao ren, Hong hua, Di long, Gui zhi, Su gen, Gan cao

Tx Principles: Dispels wind, scatters cold, and eliminates dampness, quickens the blood, frees the flow of the network vessels, and stops pain

Tx Conditions: For chronic, enduring bi due to wind, cold, damp and blood stasis in the network vessels.

For long term use, you may need to add something more to help the formula be more easily digested

Internal Formulas: Dang Gui & Anemarrhena Formula

Dan gui, Dang shen, Bai zhi, Cang zhu, Zhu ling, Ze xie, Zhi mu, Huang qin, Yin chen hao, Ku shen, Ge gen, Qiang huo, Fang feng, Sheng ma, Gan cao.

Tx Patterns: For wind damp heat bi with spleen qi vacuity and liver qi

Tx Conditions: This pattern combination is often seen in rheumatoid arthritis, lupus eryth., fibromylagia, and chronic fatigue (CFIDS)

The dampness here is internally engendered due to spleen deficiency

Experiential Tidbits:           

1. With scar therapy, check which direction of applied pressure on the scar makes the related pain worse or better and insert needles in the direction that makes the pain better. Then go over the scar with a Tiger warmer.

2. Bleed an ear point for immediate pain relief. Any related ear point can be used; find one that is sore.

3. Acute Ankle Sprain - bleed point of worst pain; needle same spot on opposite side with deep, Chinese style needling.

4. Check for vascular spiders around the tail bone and sacrum if there is chronic sciatica, piriformis syndrome, neck tension, or back pain.  If you find them, bleed them.

5. For chronic chest pain where blood stasis plays a role, use Ion Pumping cords with black clip on Per 6 and red clip on GB 34 or Sp 4, whichever is more tender.

6. For chronic one-side low back pain, use Black clip on Bl 23 and Red clip on GB 29 or 34, whichever is more tender. Try the same side first and recheck painful spots. Switch to unaffected side if the painful spots do not improve.

7. Chronic Sciatica - Black Clip on GB 30, Red clip on Ki 1 or Bl 60, Green clip on a point 1 cun lateral to Bl 40. On GB 30 use a long needle Chinese style inserted in the direction that the pain shoots. Must insert needle at the same angle that the pressure elicits pain. Spark the black needle every five minutes...leave all needles for 20 minutes. Add moxa at the end of the treatment.

What to try if treatments are unsuccessful

1. Akabane testing/stimulation

2. Ear needles

3. If there are any purple/black veins, if there has been surgery, or if the pain is fixed and stabbing, consider bleeding one or two points

4. Pay more attention to treating the root.

5. Reexamine the patient’s pulse and tongue and go back over what questions you asked to see if you overlooked any factors that may contribute to the condition.

6. Go over self-care techniques with the patient if you have not already done so.

7. Find out if their work habits have changed or if their work-related stress levels have worsened.

8. Suggest dietary changes to support your root treatment.

And finally….

Combining root therapies with branch therapies always gets better results.

Using external and internal herbals together with your acu-moxa treatments is usually more effective than either one alone in pain conditions.

Good Luck and Best Wishes for Success!

Notes for My Webinar on Skin Diseases

Thanks for attending my Webinar on September 26th. I hope you got a few useful pieces of information from the presentation.
Here's the notes from the presentation.

 

Skin Conditions: Internal and External Formulas plus Acupuncture work Best

with Honora Lee Wolfe

Copyright 2013 • All rights reserved.

What is easy about skin conditions is…

•You can see them! Which makes them easier to pattern discriminate, and…

•You can tell how you are doing immediately as a clinician!

•The patterns and treatments are logical based on the morphology of the lesions.

Wai Ke and Nei Ke

•Dermatology is classified as a group of diseases in the “wai ke” or category of diseases occurring in or on the exterior or outside of the body.

Skin Disease Mechanisms

•Heat

•Toxins

•Wind

•Dampness

•Dryness

•“Chong” or insects/parasites

•Blood stasis

Pattern Discrimination of  Dermatological Conditions

•Redness = heat

•Purple red = heat toxins &/or stasis heat

•Dark red = depressive or stasis heat

•Blisters &/or suppuration = dampness

•Purulence = heat toxins

•Scaling = dryness

•Pigmentation & lichenification = stasis

•Itching = wind

•Heat = heat

•Pain = stasis

Therapies that can be helpful

•Macerated wet herbs

•Herbal pastes

•Resolvant powders

•Ointments

•Tinctures

•Medicated oils

•Compresses

•Washes

•Medicinal baths

•Fumigation

•Moxibustion

•Cupping

•Body and ear needles

Acu-Moxa Therapy

To clear heat from whole body: Da Zhui (GV 14), Qu Chi (LI 11)

To course the liver & resolve depression: Tai Chong (Liv 3), He Gu (LI 4)

To clear heat & resolve depression: Xing Jian (Liv 2)

To clear heat from the blood aspect: Xue Hai (Sp 10), Wei Zhong (Bl 40)

To fortify the spleen & supplement the qi: Zu San Li (St 36), San Yin Jiao (Sp 6)

To seep dampness: Yin Ling Quan (Sp 9)

To nourish the blood: Ge Shu (Bl 17), Gan Shu (Bl 18)

To quicken the blood: Xue Hai (Sp 10)

To quiet the spirit: Shen Men (Ht 7)

To stop itching: Shao Fu (Ht 8)

Treat once per day or at least 2X per week for one month. Then treat once per week as needed.

“Eczema” the most common skin condition

Strictly speaking, Eczema is not one disease, but a group of diseases

1. Atopic eczema

2. Contact dermatitis

            A. Allergic contact dermatitis

            B. Irritant contact dermatitis

3. Seborrheic eczema

4. Varicose eczema

5. Discoid eczema

In U.S., 15 million have some form of eczema

10-20% of world population affected by eczema in childhood

Not contagious • No known WM cure

Atopic Dermatitis

•Most common in infants and young adults

•In U.S., 10% of infants have AD

•3% of total population

•50% of patients affected throughout life

•Hereditary

•Increased genetic sensitivity to allergens, & excessive immune reactions

•Atopic describes a tendency to excess inflammation of the skin, linings of the nose & lungs

•Closely linked to allergic rhinitis & asthma

Nutritional Supplementation

•B complex for dry, itchy skin

•Beta-carotene to promote moisture retention

•Vitamin C as natural antihistamine

•GLA (gamma-linoleic acid) as anti-inflammatory

•Quercetin (bioflavonoid) to prevent allergic response

•Zinc often deficient in people with E, especially if taking longterm steroids

The Main CM Disease Mechanisms of AD

•Spleen vacuity (leads to dampness)

•Liver depression (leads to heat)

•Wind heat, blood heat

•Yin-blood-fluid vacuity malnourishment

•Blood stasis

Simplified, the most commonly seen are:

•Wind heat type: Erythema, no suppuration

•Damp heat type: Suppuration

•Wind dryness type: Lichenification, dryness, scaling  

About Psoriasis

•A non-contagious, chronic skin disease of unknown etiology

•Most researchers agree it is an immune-mediated disorder with a strong genetic component.

•An estimated 4% of the U.S. population or more than seven million Americans suffer from psoriasis.

•Incidence of psoriasis rises to 28% if one parent has this condition and to 68% if both parents suffer from psoriasis.

•May occur at any age, but most patients do not show signs till their 20s, with an average age at diagnosis of 28.

•Somewhere between 150,000-260,000 new cases of psoriasis are diagnosed per year in the U.S.

CM and Psoriasis

•In Chinese medicine, psoriasis is thought to be due to heat toxins in the blood damaging the blood and body fluids and, therefore, secondarily causing dryness and stasis.

•The Tx Principles are, therefore, to nourish and quicken the blood, moisten dryness, clear heat, and resolve toxins

•There are many possible internal formulas to use for this condition depending upon the specific pattern combination the patient present

Formulas & Diet for Psoriasis

•Huo Xue San Yu Tang, Bai Bi Tang, Gui Zhi Tang Jia Jian, Bei Xie Shen Shi Tang Jia Jian, Huang Lian Jie Due Tang Jia Jian, Sheng Xuan Yin, Long Dan Xie Gan Tang jia Jian, Mai Wei Di Huang Tang, Er Xian Tang Jia Jian

•Low-fat low-calorie diet reduces inflammation; avoid alcohol to clear heat from the liver.

•Include Fish oil as an anti-inflammatory and as many anti-oxidants as possible.

Basic Principles for Using External Remedies in CM Dermatology

1. Primarily treat the tips or branches with external remedies

2. Do not use oil-based remedies for wet, suppurating lesions

3. Use water or alcohol based remedies or powders for wet, suppurating lesions

4. Use oil-based remedies for dry, nonsuppurating lesions

5. Determine the relative proportions of the disease mechanisms at work & then choose 2-3 medicines for each mechanism

6. Use medicinals known to be empirically effective when applied externally

7. Feel freer to use inferior grade medicinals when treating externally

Blue Poppy External Remedies

•Acne Tincture clears heat, dispels wind and resolves toxins

•Antifungal Ointment clears heat, resolves toxins, disperses inflammation and stops itching

•Clear Heat Ointment (Si Huang Gao) clears heat, resolves toxins, disperses swelling and stops pain (infected lesions that are hot to the touch)

•Cut & Sore Ointment, clears heat, resolves toxins, moves the blood and stops pain, engenders new flesh

•Eczema Ointment clears heat eliminates dampness, dispels wind and stops itching in wind damp heat eczema

•Herpes Zoster Ointment clears heat and eliminates dampness, courses wind and resolves toxins

•Jade Dew clears heat and cools the blood, disperses swelling and resolves toxins in herpes simplex

•Psoriaquell Ointment nourishes and quickens the blood, moistens dryness and clears heat

•Psoriasis Tincture dispels wind and clears heat, eliminates dampness and resolves toxins, kills parasites, and stops itching.

Anti-fungal Ointment

•Oil and beeswax plus Shi Gao, Hua She, Qing Dai, and Huang Bai

•For chronic dry eczema or dry fungal skin conditions such as ringworm.

•Clears heat, resolves toxins, disperses inflammation and stops itching

Eczema Ointment

•Oil and beeswax plus Da Huang, Huang Bai, Cang Zhu, She Chuang Zi, Bai Zhi, Ku Fan, and Tian Hua Fen

•For wind damp heat eczema

•This formula moistens dryness sufficiently to keep the other ingredients fro damaging fluids.

Psoriaquell Ointment

•Dang Gui, Zi Cao, Da Huang, Lu Hui Zhi, Bing Pian in a veg oil, beeswax and vitamin A, D, & E base.

•For blood heat psoriasis with dry, red lesions and silvery scaling

•Do not use in cases of wet, suppurating psoriasis.

White Pearl

•Mu Li, Huang qi, Dang Shen, Fu Ling, Shan Yao, Pei Lan, Bai Xian Po, She Chuang Zi, Bai Zhu, Fang Geng, Dan Pi, Zi Cao, Jing Jie, Jiang Can, and zhi Gan Cao

•Treats spleen qi xu resulting in a defensive qi insecurity with easy invasion of wind complicated by dampness, heat, toxin, and blood stasis manifesting as chronic hives, eczema, or psoriasis

•Can be used for any skin conditions that presents with these patterns

Little Pearl

•Ren Dong Teng, Shan Zha, Shen Qu, Mai Ya, Fu Ling, Bai Zhu, Bai Bian Dow, Yi Yi Ren, Chen Pi, Ma Chi Xian, Bai Mai Gen, Dan Pi

•Specifically for pediatric eczema due to spleen qi xu with damp heat and possible food stagnation. This eczema will be damp, itchy, and possibly weep

Final Advice for Tx Skin Conditions

1. Check your pattern discrimination

2. Check that your medicinals are appropriate for the pattern

3. Check the dosage

4. Add an external remedy if not using one

5. Check that external remedy is correct if using one

6. Be sure patient is adherent to diet & lifestyle modifications

7. Check for other aggravating factors possibly overlooked before

8. Consider adding acupuncture

Get publicity (and more patients) for doing good in your community

by Honora Lee Wolfe, Dipl.Ac.

One of the best ways to call attention to yourself and your services is to either organize or participate in activities that contribute to your community in a positive way. You don’t need to spend a great deal of time or money on a project that will make the news.  For most of these, it would have an even greater impact to get more than one practitioner involved. That way, “acupuncture” and not just you, get a boost from the activity. So ask your colleagues to get involved and make sure the media knows about what you’re doing. Here are some ideas.

Get every acupuncturist in your community to collect in their clinic:
    1. toys for the local family shelter at Holiday time
    2. food for the community food share
    3. $$ for a local charity drive

Make sure your patients are involved in this effort. Create signs for your treatment rooms and your waiting area. Once you have collected everything, make sure you send out a Press Release to all the local media with a headline such as “Local Acupuncturists Donate 500 New Toys to Local Battered Women & Family Shelter” or whatever. Make sure that every acupuncturist involved gets their name in the Press Release.

Need more patients? Offer free or greatly reduced fee acupuncture one day per week for people who have lost their jobs (up to three treatments maximum). Do this on your least busy day of the week or during your least busy hours. That helps insure that no one scams you because working people probably cannot come on Wednesdays from 11 AM- 3 PM. Do you think these people might become paying customers once they get a new job?? Do you think they will tell their friends? You bet they will. (You can take this idea and do the same thing for the annual “Great American Smoke Out”... i.e., free stop-smoking treatments.)

Join together with some other businesses to sponsor a trash pickup or a graffiti cleanup campaign.  Get a local paint store to donate some paints that were “mis-tints” and get some high school students to help with the painting. Everyone gets good publicity and who knows how many people at the paint store or at the high school (parents, teachers, counselors, administration) will become your patients!

Got old inventory of herbs and vitamins or other products? Get a tax write-off by donating them to the Guatemala Acupuncture Project, Bobbi Aqua’s free clinic in Banda Ache www.gentlebirthsbali.org, or to a free clinic on a Native-American reservation.

Sponsor a little-league team or girls soccer team.  You get to put your name on the back of the t-shirts and all the parents know who you are.

Work with a local nursery to create a tree-planting or flower planting weekend at a local park, along a specific street, around a school playground, or to reclaim a vacant lot. Get as many other businesses (especially acupuncturists) involved as you can.  This is also a great photo opportunity and you may make the 5 o’clock news!

Organize a neighborhood crime watch with other businesses in your area. Get help from the local police department.

Whenever you create any community activities such as these, make sure the local media knows about it as far in advance as possible. This qualifies as “good news”, which is something we could all use more of in our lives. Even the media people may become your patients.

If you cannot find the juice to create your own community event, join in on ones that someone else is creating.  This at least gives you the opportunity to meet new people and tell them about the wonderful benefits of our medicine.  Either way, make sure to send a thank you card to anyone you work with on such projects and be sure to include your business card. Remember, everyone is someone’s patient at some point.  Why shouldn’t they be yours?