ACUPUNCTURE TECHNOLOGY SYMPOSIUM2017 WELCOME! · 2017-07-10 · ACUPUNCTURE TECHNOLOGY SYMPOSIUM...

WELCOME!

ACUPUNCTURE TECHNOLOGYSYMPOSIUM2017ACUPUNCTURE TECHNOLOGY

SYMPOSIUM2017

WHY ARE YOU HERE?

WHY ARE WE HERE?

TOO MANY NEGATIVE STATISTICS

Source: Descriptive Demographic and Clinical Practice Profile of Acupuncturists: An Executive Summary from the NCCAOM® 2013 Job Analysis Survey

ACUPUNCTURE TECHNOLOGY SYMPOSIUM

WHAT’S THE STORY?• 70% work fewer than 40 hours in ALL practice activities

• 46% work fewer than 30 hours in ALL practice activities

• SIGN ME UP!


BUT WAIT…• 35% say it’s because they don’t have enough

patients • 25% say it’s because they have a second job • Therefore, 60% can’t make a satisfactory living

as an acupuncturist • Perhaps that’s why 50% of the profession has

been at it less than 10 years.


STUDENT LOAN DEBT• Usually well over $100,000 • Payments over $1,000 • Mathematically, it doesn’t work…


NEW PATIENTS SEEN IN A MONTH


TOTAL PATIENTS SEEN IN A MONTH


TOTAL GROSS PERSONAL INCOME

15.9%


IT CAN BE DONE…• 16% make over $105,000 • AcuGraph users make 35% more than non-users • So let’s talk about money…


ACUPUNCTURISTS ARE SELFLESS• Most common route into Acupuncture starts with Massage Therapy • Pursuing passion, called to serve • Is it wrong to make a living? • Even a good living? • What is money?

THIS IS NOT A MARKETING COURSE…

But it is.


TWO MOST IMPORTANT FACTORS• Connection • Results


CONNECTION• What do your patients see when they walk in? • What first impression do they get?


CONNECTION• What do your patients see when they walk in?

• What first impression do they get?

• Negative stereotypes. Perpetuated?


CONNECTION• Do patients TRUST you? • Do they have CONFIDENCE in you? • Is the visit a POSITIVE experience? • Do they get what they WANT from you?


RESULTS• Do you meet expectations? • Wait, what ARE expectations? • What evidence can you show? • What Matters More: Change or symptoms?

TECHNOLOGY IS KEY


PATIENTS WANT, LIKE AND USE TECH• Dr. Google is your biggest competitor

• It is becoming part of the human experience

• It is becoming the human experience

• In our lifetimes, permanent human enhancement

• Causing health problems (and solving them) • Age of evidence


PATIENTS WANT, LIKE AND USE TECH• Patients EXPECT technology • Fastest, most reliable way to connect

• Immediate trust

• Key to results


LET’S TALK ABOUT RYODORAKU• First Major Advance in Acupuncture Tech (at least

since metal needles!) • First evidence-based approach • Started the whole shift toward “modern” approaches

Wikipedia.com, “Traditional Chinese Medicine” August 2, 2010


The most scientific derivative of TCM practiced in Japan is Ryodoraku ( ), which was developed by Yoshio Nakatani in 1950. It utilizes objective electricity test instruments and direct current stimulation of acupoints instead of subjective interpretation of symptoms and treatment.

INTRODUCTION TO RYODORAKU ACUPUNCTURE

Adrian P. Larsen, DC, FASAAcupuncture Technology

Symposium 2017

�Qi

TCM (TRADITIONAL CHINESE MEDICINE)• Acupuncture • Herbal Therapy • Qigong • Tuina • 8 Principles (Zang-Fu) diagnosis

JAPANESE ACUPUNCTURE• Spread to Japan about 1,500 years ago • Retained many of the spiritual aspects of the

original medicine • Based upon the equal distribution and movement

of Qi through the channels • Balance brings healing

1. Which meridians are out of balance? 2. Which points are needed to restore balance? 3. Where are these points located? 4. What type of treatment will be used?

THE FOUR BASIC STEPS IN MERIDIAN BALANCING

• Pulse Diagnosis • Tongue diagnosis • Muscle testing • Hara palpation • Symptoms Analysis • Ryodoraku

STEP 1: WHICH MERIDIANS ARE OUT OF BALANCE?

WHAT IS RYODORAKU?• Method of evaluating the meridians • Uses electrical resistance measurement at 24 points • Mathematical interpretation • Creates graphical representation of meridian balance • Based on objective evidence (not subject to opinion)

PRACTITIONER BENEFITS

WHY RYODORAKU?• Objective examination • Increased insight into patient’s condition • Easy to learn and perform • Can be done by an assistant • Record of progression

PATIENT BENEFITS

WHY RYODORAKU?• Increased understanding • Increased acceptance • Satisfies reward-seeking behavior • Better treatment • Better results

PRACTICE BENEFITS

WHY RYODORAKU?• Unparalleled marketing power • 35% more practice revenue • Increased efficiency • Objective evidence of need for care • Objective evidence of progress

RYODORAKU HISTORY AND DEVELOPMENT

• 1950: Dr. Nakatani noted areas of altered electrical conductivity on the skin of patients with various diseases.

• Generally in lines following the classical Chinese acupuncture meridians. • He named these points, “ryodoraku” (ryo=good, ‘do=(electro)

conductive, ‘raku=line.)

Since that time, many other books have been published by numerous authors

IN 1977 HE PUBLISHED THE DEFINITIVE TEXTBOOK ON THE SUBJECT


RYODORAKU METHOD• The technique is performed by

measuring electrical skin resistance at 24 representative points.

• 8 of the 12 representative points are Yuan Source points.

Ryodoraku Designation

Equivalent Chinese Point

Type

H1 LU 9 Source

H2 P 7 Source

H3 HT 7 Source

H4 SI 5 Horary

H5 TH 4 Source

H6 LI 5 Fire

F1 SP 3 Source

F2 LV 3 Source

F3 KI 4 Luo

F4 BL 65 Sedation

F5 GB 40 Source

F6 ST 42 Source


RYODORAKU METHOD• Each of the values is plotted on a paper chart.


RYODORAKU METHOD• The chart is calibrated for a 1.4 centimeter ruler to represent the

physiological range.

1.4 cm

• Only bars outside the range are treated.

RYODORAKU METHOD


1.4 cm

• Originally treated with tonification and sedation points only. • Treatment by electrical current applied to needles.

RYODORAKU METHOD


MODERN UPDATES• Standardized on Yuan Source points only • “Splits” are also addressed


AKABANE• The Akabane Method was

developed by Koohee Akabane in 1951.

• Originally used moxa sticks and heat sensation.

• Treatment was applied to the back-shu points.

• Today, electronic methods are used.


AKABANE• Modern Adaptation • Using Moxa Testing


AKABANE• Modern Adaptation • Using Electronic Testing






GERMAN ELECTRO-ACUPUNCTURE

• EAV was developed by Dr. Reinhold Voll in the early 1950’s. • Developed a system with over 850 points (some on

acupuncture meridians, some not.) • Also began testing for allergies, remedies, supplements, etc. • Widely used today; many types of devices on the market. • Many problematic claims • Practitioner bias

(Voll/EAV/EAP/GEA/EDS)


GERMAN ELECTRO-ACUPUNCTURE • Uses indicator rise and drop

as indicators for the type of dysfunctions located

(Voll/EAV/EAP/GEA/EDS)


ARE THEY ESSENTIALLY THE SAME THING?

RYODORAKU • AKABANE • VOLLSimilarities: • All use skin resistance measurement as a surrogate for life force

energy or Qi • Ryodoraku and Akabane use traditional Chinese meridians for

measurement and traditional acupuncture points for treatment

ARE THEY ESSENTIALLY THE SAME THING?

RYODORAKU • AKABANE • VOLLDifferences: • Voll (EAV) does not primarily use the traditional acupuncture

meridians, for either measurement or treatment • The primary purpose of EAV is to prescribe supplements or remedies,

not to do acupuncture


• Ryodoraku is a method of electrically evaluating the acupuncture meridians

• In use for over 60 years • Objective and insightful • Uniquely acupuncture focused

SUMMARY

TIME FOR A SLIDE SHOW!

THE SCIENCE THAT SUPPORTS YOUAcupuncture Technology

Symposium 2017

Adrian P. Larsen, DC, FASA

PART 1: EVIDENCE FOR MERIDIANS

Resistance: • Defined as opposition to the flow of

electric current • Measured in ohms Ω

ELECTRICAL CONCEPTS

Conductance: • A measure of how easily electrical

current flows along a given path • The inverse of resistance • Can be expressed in amperes

ELECTRICAL CONCEPTS

Current: • The rate of flow of electric charge • Measured in Amperes (A) • Milliamp = 1/1,000 Ampere (mA) • Microamp = 1/1,000,000 Ampere (µA)

ELECTRICAL CONCEPTS

• General Skin Resistance: 50K Ω- 15Meg Ω

• Acupoints can be 2-6 times more conductive than surrounding skin

• Can electrically locate meridians to within 5mm (3 studies)

• Resistance changes as much as 60% within 6 seconds of needle insertion

• Meridians demonstrate “capacitance” (store 5x the energy of surrounding skin)

• 15 published studies indicate acupuncture points and meridians have higher electrical conductance than surrounding cutaneous areas.

• 16 additional studies demonstrate that, in certain disease processes, higher or lower impedance can be detected at clinically relevant AP’s but not at clinically unrelated AP’s in the same patients.

• 9 published studies show electrical connections between acupuncture points on the same meridians, on paired or coupled meridians and between theoretically related points.

• A waxing and waning of electrical impedance that correlates with experimentally induced disease and subsequent recovery, at clinically relevant AP’s has been demonstrated in 5 human and animal studies.

MERIDIANS

ACUPUNCTURE MERIDIANS• Lines or channels of energetic flow • Over 635 specific meridians identified

in the literature • Used therapeutically for at least 5000

years • Not (yet) conclusively related to any

anatomic structure

ACUPUNCTURE MERIDIANS


• NOT nerves. • Not neurochemicals. • Not brain chemistry. • Neurovascular bundles, neuromuscular

attachments, nerve endings. • Way too fast. • Way too slow.

FACT VERSUS FICTION

ANATOMIC EVIDENCE

• Most nearly aligned with Fascial system of the body

• (Studied since 2002)


• Vast electromagnetic signaling system so that every cell in the body knows what every other cell is doing

• Cytoskeleton may act as coupled harmonic oscillator sending information from outside of cells all the way into the nucleus and even into the DNA itself

• In proportion to their size, cells set up huge electrical fields across their membranes with a negative polarity inside the cell and a positive one outside the cell

• Collagen arrays (connective tissue) also set up electrical fields that are produced primarily by movement

“The fascia is the ‘context’ for the content i.e. the muscles, bones and organs. It is the universal environment for life. It enwraps each cell, group of cells, tissue, organ and then finally wraps the entire body in a ‘superficial fascia’. We can trace the relationships of the collagen and other fibers of the fascial matrix all the way down to the intracellular matrix.”

—James Oschmann

“The connective tissue and fascia form a mechanical continuum, extending throughout the animal body, even to the innermost parts of each cell. All great systems of the body—the circulation, the nervous system, the musculo-skeletal system, the digestive tract, the various organs—are ensheathed in connective tissue. This matrix determines the overall shape of the organism as well as the detailed architecture of its parts.”

“All movements, of the body as a whole, or of its smallest parts, are created by tensions carried through the connective tissue fabric. Each tension, each compression, each movement causes the crystalline lattices of the connective tissues to generate bioelectric signals that are precisely characteristic of those tensions, compressions and movements. The fabric is a semi-conducting communication network that can convey the bioelectric signals between every part of the body and every other part.”

“This communication network within the fascia is none other than the meridian system of Oriental Medicine, with its countless extensions into every part of the body. As these signals flow through the tissues, their biomagnetic counterparts extend the stories they tell into the space around the body. The mechanical, bioelectric, and biomagnetic signals traveling through the connective tissue, and through space around the body, tell the various cells how to form and reform the tissue architecture in response to tensions, compressions, and movement we make.”

—James Oschman, Energy Medicine: The Scientific Basis

PART 2: ACUPUNCTURE RESEARCH

• Confirmation Bias • Medical Bias • Scientific Model Bias • Mechanism Bias • Sham Problem • Pure vs. Applied

THE RESEARCH IS STACKED AGAINST YOU:

• Acupuncture Is No Better Than A Placebo For Treating Back Pain, Says Report

• Acupuncture Is Theatrical Placebo • Acupuncture Offers No Benefits Over Placebo for Hot Flashes of

Menopause • Another Study Shows Acupuncture is a Placebo Treatment

“UNBIASED” ACUPUNCTURE REPORTING

• Is Acupuncture a Placebo Therapy? • Acupuncture is All Placebo • The Acupuncture Myth • Acupuncture, Magic and Make-Believe

“UNBIASED” ACUPUNCTURE REPORTING

100% Based on “Sham Acupuncture”

Usually suboptimal dose, or improper administration

“Sham Acupuncture”

• Non-needle Sham (inactive TENS, for example) • Needle-based Sham

- Penetrating Needles - Non-Penetrating Needles - At Acupoints - At Non-acupoints

is no better than a placebo for treating back pain, says report.

ACUPUNCTURE

A total of 638 adults with chronic mechanical low back pain were randomized to one of 4 groups:

• Individualized acupuncture • Standardized acupuncture • Simulated acupuncture • Usual (medical) care

DANIEL C. CHERKIN, PHD, ET. AL., 2009:

Daniel C. Cherkin, PhD, et. al., 2009


“Collectively, these recent trials provide strong and consistent evidence that real acupuncture needling using the Chinese meridian system is no more effective for chronic back pain than various purported forms of sham acupuncture.”

Daniel C. Cherkin, PhD, et. al., 2009


“However, both real and sham acupuncture appear superior to usual care.”

DANIEL C. CHERKIN, PHD, ET. AL., 2009:

Agency for Healthcare Research and Quality, 2016

• Opioids • Analgesics • NSAIDs • Muscle Relaxants • Antidepressants • Anti-seizure medications • Corticosteroids • Ultrasound • TENS • PENS • Muscle Stim • Traction

• Taping • Interferential Current • Laser • Heat/Cold • Exercise • Pilates • Tai Chi • Yoga • Psychological Therapies • Multi-discipline Rehab • Acupuncture • Massage • Manipulation

NONINVASIVE TREATMENTS FOR LOW BACK PAIN

Acupuncture vs. No Acupuncture scored highest awarded in all 6 categories: • Pain: Magnitude of effect • Pain: Evidence • Pain: Strength of evidence • Function: Magnitude of effect • Function: Evidence • Function: Strength of evidence

Agency for Healthcare Research and Quality, 2016NONINVASIVE TREATMENTS FOR LOW BACK PAIN

Overall, following a course of at least eight weeks, patients treated with acupuncture suffered fewer headaches compared to those who were given only pain killers. In the migraine study, acupuncture was superior to proven prophylactic drug treatments, but faked treatments were no less effective. In the tension headache study, true acupuncture was actually slightly more effective than faked treatments.

—Science Daily, January 21, 2009

KLAUS LINDE (2 HEADACHE STUDIES)

• Acupuncture added to usual care resulted in 41 in 100 people having the frequency of headaches at least halved, compared to 17 of 100 people given usual care only.

• The frequency of headaches halved in 50 of 100 people receiving true acupuncture, compared with 41 of 100 people receiving 'fake' acupuncture.

• At three months, headache frequency halved in 57 of 100 people receiving acupuncture, compared with 46 of 100 people taking the drug. After six months, headache frequency halved in 59 of 100 people receiving acupuncture, compared with 54 of 100 people taking the drug. People receiving acupuncture reported side effects less often than people receiving drugs, and were less likely to drop out of the trial.

COCHRANE REVIEW, JUNE 2016:ACUPUNCTURE FOR THE PREVENTION OF EPISODIC MIGRAINE

SO IS ACUPUNCTURE JUST A PLACEBO?

• There is no effective placebo for acupuncture because there is no demonstrated mechanism

• With no demonstrated mechanism, you cannot differentiate placebo • There is no way to double blind (patient and practitioner) • Clinical evidence • Anecdotal evidence • Skeptical patients • Positive, unexpected side effects

THE OTHER SIDE…

ANIMAL STUDIES

TWO EFFECTS

0

0.1

0.2

0.3

0.4

0.5

EFFECT SIZE

40%

60%Effect due to context plus sham needling

Effect of true

acupuncture over and above context and shamSame effect size

as NSAID vs. sham

• 90% of benefit of acupuncture over usual care remains after 12 months

• 50% of benefit of acupuncture over sham remains over 12 months

ALSO:

SIZE MATTERS:

Estimated Effect Size Approximate Sample Size Required for a 2-arm Trial

Medium 0.5 170

Small 0.3 468

True vs. Sham

Acupuncture0.2 1052

What Kind of Research? Does acupuncture work?

Why does it work? How should we use it?

ANALYSIS OF 8637 INDIVIDUAL GRAPHSAll the following parameters showed statistically significant improvement across age and gender over the course of 5 visits: • PIE Score • Stability Score • Yin/Yang balance • Number of Splits

CONCLUSIONS:• Acupuncture meridians have measurable electrical properties. • These properties significantly differ by demographic. • These properties change with acupuncture treatment, tending toward

balance. • These changes cannot be attributed to placebo effects. • Greater balance correlates with improved clinical outcomes. • Acupuncture is real.

Skin Conductance at 24 Source (Yuan) Acupoints in 8637 Patients: Influence of Age, Gender and Time of Day

TOP PRIZE HEO-JUN AWARD 2011!


HERPES ZOSTER (SHINGLES)• 9 studies with 945 participants total • Acupuncture plus Moxibustion produced significantly better results for

Herpes Zoster (Shingles) pain reduction than pharmacotherapy


INTERSTITIAL CYSTITIS/BLADDER PAIN• 12 patients received 10 acupuncture sessions each • Statistically significant improvement in pain, urgency, symptoms and

maximum voided volume • Improvements lasted up to 12 months (length of the study)

NECK PAIN


• 34 patients received a single microcurrent treatment to points on the lower back

• 68% reduction in reported pain immediately after treatment

• 35% reduction in reported pain at 48 hour follow up


TMJ PAIN• 9 studies involving 231 total patients • Acupuncture produced significant

decreases in pain when compared to most controls. (A variety of sham and other intervention controls were used)

• Non-penetrating sham was less effective than penetrating sham, and acupuncture performed as well as TMJ splint treatment for myogenous TMD


• 2 cohorts of 50 patients each, operative tooth removal with 10-day follow up.

• Auriculotherapy produced significantly better results than usual care for chewing, anxiety and post-operative analgesic use

DENTAL PAIN POST TOOTH REMOVAL


CHEMOTHERAPY

• 56 patients in 2 groups for 2 weeks • The frequency and duration of nausea, vomiting, abdominal pain, diarrhea,

and quality-of-life scores were significantly better in the acupuncture group than in the usual care group

ASSOCIATED GASTRIC SYMPTOMS IN GASTRIC CANCER

CHRONIC LOW BACK PAIN


• 80 adults with LBP >/= 4/10 were treated with ear acupuncture or placebo, with immediate post-treatment evaluation

• Ear acupuncture produced significantly better results than placebo for pain reduction


EPISODIC MIGRAINE (COCHRANE REVIEW)• The available evidence suggests that adding acupuncture to symptomatic

treatment of attacks reduces the frequency of headaches. Contrary to the previous findings, the updated evidence also suggests that there is an effect over sham, but this effect is small.

• The available trials also suggest that acupuncture may be at least similarly effective as treatment with prophylactic drugs. Acupuncture can be considered a treatment option for patients willing to undergo this treatment. As for other migraine treatments, long-term studies, more than one year in duration, are lacking.


AURICULAR ACUPUNCTURE FOR PEDIATRIC MIGRAINES• 19 patients included, 8-18 years of age • All subjects showed significant

improvement or complete resolution of migraine headache pain

• There were no reported adverse events


VISUAL FUNCTION IN RETINAL DISEASE• 14 patients received body and ear acupuncture in 10 sessions over 5

weeks. A non-acupuncture control group received no intervention • All treated patients showed subjective and objective improvements in

visual function. • Other non-related improvements in sleep, pain and feeling cold were also

noted.


DEPRESSION-RELATED INSOMNIA• Meta-analysis of 18 studies • Acupuncture showed significant

improvements in sleep quality • Acupuncture alone did not show

significant improvements in depression

• Acupuncture combined with western medicine showed significant improvements in both


DIABETIC PERIPHERAL NEUROPATHY• 42 cases treated with acupuncture; 21 treated with sham • 3/6 measures of motor nerves and 2/2 measures of sensory function

improved significantly • Sham group saw no significant improvement


MYOFASCIAL PAIN SYNDROME• Meta-analysis of 10 studies • Significant improvement with acupuncture treatment after a single

treatment and a course of eight treatments. • Significant increase in pressure pain threshold following acupuncture


SLEEP DISORDERS IN PARKINSON’S DISEASE• 22 patients, before and after 8-week treatment protocol of one acupuncture

session per week • The results showed that acupuncture significantly improved quality of

nocturnal sleep, nocturnal psychosis, and nocturnal motor symptoms for Parkinson’s patients


ELECTRODERMAL SCREENINGS OF ASTHMATICS

• 50 asthma patients screened using Jing-well points • All mean meridian conductances were lower for the asthma group • Significant differences in Lung and right Bladder meridians • All but two of the standard deviations of group meridian conductances for

the Asthma group were higher than those for the Healthy group

WITH ACUGRAPH 4


ELECTRODERMAL SCREENINGS OF ASTHMATICS

• These suggest that group measures of electrical conductance at Jing Well points can distinguish asthma from healthy individuals

• The study provides support for the usefulness of meridian energy measurements to assess organ-related dysfunction and for the idea that pathology groups exhibit higher standard deviations i.e. lower quality of regulation

WITH ACUGRAPH 4


EMBROYO TRANSFER FOR IVF• Laser acupuncture before and after embryo transfer beat needle

acupuncture, sham laser acupuncture, and no treatment • Laser acupuncture improves implantation rate for IVF

www.RyodorakuResearch.comMORE STUDIES:

BONUS


EVEN MORE STUDIES (2017):• Long-lasting reduction of blood pressure by electroacupuncture in

patients with hypertension • Reduction in headache symptoms associated with traumatic brain

injury in armed forces veterans • Improvement of symptoms and function in menopausal dry eye

syndrome • Up to 80% improvement in obsessive-compulsive disorder


CHRONIC LOW BACK PAIN• American College of Physicians (ACP) • 148,000 members in countries • Largest medical-specialty society in the world • Now recommend acupuncture for acute, subacute and chronic

low back pain as first line treatment, before drugs


SUMMARY• There is real evidence for meridians and their properties • Numerous studies show acupuncture is effective for a variety of problems • Numerous biases still prevent full acceptance • Mechanism questions prevent medical acceptance • Technology is the best way to sidestep the issue, connect with patients, get

superior results and have a successful practice

Dr. Adrian Larsen

President: Miridia Acupuncture Technology Inc. www.miridiatech.com 208.846.8448

THANK YOU!

ACUPUNCTURE TECHNOLOGY SYMPOSIUM2017 WELCOME! · 2017-07-10 · ACUPUNCTURE TECHNOLOGY SYMPOSIUM...

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