Clinical Pearls

Finally - a place for your pearls of wisdom! Pearls are short, practical medical tips submitted by members that may not be widely known but can be used to solve everyday clinical problems. Share tips for successful practice management, or herb, formula, and acupuncture point prescriptions.
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(July 1)

Word Count: 250

Title Tag: Things To Consider Before Purchasing Hydraulic Hose Crimper

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(December 17, 2020)

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(December 17, 2020)

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Added by:   David Dawson
(May 21, 2015)

Spleen 6 'Spleen 6' is widely known as the crossing point of the Spleen, Liver and Kidney channels. One of the books we used (it's been ages ago, so I can't remember what the title was) when learning points listed three other, similar points, which it identified as crossing points of the Leg Yang channels (Gall Bladder 39 - 'Gall Bladder 39'), Arm Yin channels (Pericardium 5 - 'Pericardium 5'), and Arm Yang channels (San Jiao (Triple Burner) 8 - San Jiao (Triple Burner) 8). I haven't seen this information in other books, but the name of San Jiao (Triple Burner) 8, at least, points to a similar overlap. The combination of all 8 points serves to address all 24 circulating channels, and has a broad, gentle full-body-balancing kind of effect. I like to use the combination with one or two other points to add a slight focus (e.g. Heart 7 for anxiety or pain, or Du Mai (Governing Vessel) 20 for fatigue). I've heard the combination called the 'Tai Ji' treatment - which, I suppose, is more or less appropriate.


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(May 8, 2013)

Here is a great formula I learned from "Dr. Yin" (dermatology department) at a TCM hospital in Kunming, China. The formula is specific for a diagnosis of "acne due to Qi Deficiency, Liver Stagnation & Yang Ming Heat": sheng di,30

Mu Dan Pi,15 Chi Shao ,30 Chong Lou,15 Zao Jiao Ci,20 Huang Qin,15 Lian Qiao,15 Dan Shen*,30 Jin Yin Hua,15 Pu Gong Ying,15 Bai Zhi,15 # For excessive Oil, add: Shan Zha,20 Bai Jie Zi,15 Bai Hua She She Cao,15 Wu Gong,#2 * Dan Shen moderates xs male hormone,

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(March 1, 2010)

This isn't a TCM but solution Aztec Healing Clay it is something that patients can pick up inexpensively and in my experience has gotten so great results. Aztec Healing Clay is beneficial for deep pore cleansing of the skin, and can be obtained at any good health food or vitamin store.

Here's how I recommend it's use:

1)Mix the clay in a zip-lock bag with enough water to massage into a paste.

2)Cure in the refrigerator for 2 days. (This improves the absorption of water. Under a microscope, the granules look like tiny shells – curing allows the shells to fill up with water).

3)Take about a ½ cup of the cured clay in your hand. Mix with a little more water and rub hands together until you have a nice warm paste.

4)Spread a thin coat evenly over dry skin until fully covered.

5)Blow-dry with a warm-air hair dryer until the clay dries.

6)Wait 3 minutes.

7)Rinse off as quickly as possible to avoid the skin reabsorbing what the clay has just taken out of your pores.

8)Moisturize ( I recommend a product called Herbal Pearl Natural Skin Care once or twice each day).

The small clay granules act like tiny suction cups which suck the blood to the surface of the skin. Blood circulations seem to go deeper as we age, especially in a dry environment, and the Aztec clay treatment helps to return the blood flow to the surface.

Needle Phobia

Added by:   Jaime Chaves
(April 18, 2009)

The number one question I am asked is "does it hurt". My answer is always "No, although the normal sensations include achiness, soreness, warmth, tingling, etc. which are actually considered therapeutic although not necessary to achieve beneficial results."

Clinical tips: 1. Needle the least sensitive point first (i.e. LI 11-quchi) instead of a highly sensitive point. 2. Avoid saying the word "needle". 3. Avoid showing the patient the needle unless they ask to see it. (Especially the 3" variety) 4. Have them take a breath upon insertion so that they know it is coming rather than being startled which may stagnate qi. 5. Distract them. If the point is generally painful I may ask them a random question such as "what is your favorite color" and while they are thinking about it continue with the insertion. 6. Insert all of the needles first before going back to specific points to acquire de qi. If de qi is acquired at each individual point in sequence the patient may not be comfortable with adding more points along the way. 7. If a point is particularly sensitive stay calm. Do not be so quick to apologize or withdraw the needle. Inform the patient that this is normal and the sensation usually subsides within 30 sec to a minute. Ask them if it is tolerable. If not then pull the needle up 1-3 fen which may reduce pressure on any underlying structures such as blood vessels or nerves. 8. Use thinner needles and fewer points on initial treatments. As the trust builds between practitioner and patient the patient may be more open to stronger techniques in future visits. 9. Have the patient cough on insertion. Research in Europe supports this technique for reducing the perception of pain when being needled. 10. Listen. The patient will tell you either directly or indirectly what they are comfortable with. The beauty of Chinese medicine is that we have multiple treatments for the same disorder. Find the one that resonates with them. (.i.e. local versus distal) and try to be flexible to their needs rather than what you want to do.

“Aculaser” Therapy For Treatment Of

Added by:   Sadashiv Datar
(April 22, 2009)

Objective: To evaluate the effects of “Aculaser Therapy” (Laser Scalp Acupuncture, Pulsating Magnetic Field Therapy, Acupressure and Color Therapy) in children suffering from Multiple Disabilities and associated neurological disorders like Mental Retardation, Hearing Impairment, Speech Impairment, Cerebral Palsy, Visual Impairment, Autism and ADHD In addition to this, to evaluate when this treatment is stopped; is there any regression of the development or reversal of the symptoms. Need For Alternate Therapy • Traditional therapies are time consuming and give limited results • Effective co-ordination of all the conventional therapies is required to bring out desired results. • We are open to new avenues for treatment. • We hope that any new therapy may give better relief to these children. • Develop suitable support treatment program at institutional / school level to achieve sustained improvements • Failure of medical model in rehabilitation process has inspired us to look for alternate therapies

Acupuncture Combination for Dryness

Added by:   J E
(August 14, 2008)

This one is courtesy of Dr. Naiqiang Gu and is great for intestinal dryness, either as an adjunct to or replacement for the usual San Jiao (Triple Burner) 6/Kidney 6.

Stomach 36 Stomach 37 Stomach 39

As Dr. Gu explained it, Stomach 37 is the lower he-sea point of the large intestine, and Stomach 39 is the lower he-sea point of the small intestine. The small intestine governs the jin, or thin fluids, while the large intestine governs the ye, or thick fluids.

Combining Strategies

Added by:   John Donald
(July 10, 2008)

I have found the combination of ion pumping cords with distal point strategies such as the "balance method" to be very effective. You may wish to play around with this idea yourself and see if it improves your outcomes.

One simple place to start is with shoulder pain that is anterior- in the vicinity of the extra point: Jianqian (or Jian Nei Ling) along the lung channel. Tap a 1/2" needle at the local ashi point and tape the black IPC clip to it. Then find the more tender Spleen 9 and tap in a 1/2" needle, taping the red clip to it. Needle stimulation is not necessary. Then I usually add infrared heat to the symptomatic area.

2 points! Works great.

Try the same strategy for other aches & pains too- such as trigger thumb- don't even insert a needle in the thumb joint- just apply a magnet and tape the black clip to it, and run the red clip to the contralateral Spleen 2A and tape to a 1/2" needle there.

I also use this technique for plantar fasciitis and heel spur pain- run IPC cords from the local ashi points to the contralateral hand- choosing points that correspond to the pain location on the foot- such as Mu Guan & Gu Guan for heel pain (depending on whether it's more on the UB or KI channel or both), Heart 8 for Kidney 1 ashi pain, etc.

Try it and let me know how t works for you. Have fun! This is why they call our business a "practice".

Here is a nice link to some balance method reference charts:

The Biomedical Basis of Holistic Acupuncture

Added by:   Andrew Pacholyk
(May 13, 2008)

by Andrew Pacholyk, MS, L.Ac.

Abstract In trying to find ways to unite or just bring closer the mysterious transformational techniques of the East to the reductionism theories of the West, our Western medical science has tried to organize a logical explanation of how the insertion of tiny acupuncture needles can reduce and even dissolve pain in the human form.This research takes a look at the different approaches the Biosciences have attempted in explaining the way holistic acupuncture works in healing. This research will take a look at the biochemical, biomechanical, as well as bio-electromagnetic theories that have been developed in trying to explain the healing aspects of the Ancient Art of Acupuncture.

Keywords Acupuncture, Biomechanical, Biochemical, Electromagnetic, Biosciences, Healing, Meridians, Channels, Traditional Chinese Medicine, Analgesic, Connective Tissue, Cellular Biology, Health, Eastern, Western, Medical, Paradigm, Physiology, Physics.

The Ancient Art of Acupuncture is the needling of specific points along "meridians" or channels that run throughout our body. Acupuncture can be traced back as far as the Stone Age in China, when stone knives and pointed rocks were used to relieve pain and diseases. "These instruments were known by the ancients as "bian" In the Han Dynasty (206 BC to 220 AD) an Analytical Dictionary of Characters "Shuo Wen Jie Zi" describes the character "bian" as meaning a stone to treat disease."(1) Later these stones were replaced by needles made of bamboo and slivers of animal bone, then finally in the Shang Dynasty bronze casting techniques made metal needles possible, which conducted electricity and Qi. This led to the mapping of the meridian system or channels of energy within the body.

Acupuncture remained relatively unheard of until 1974 when James Reston, a reporter for the New York Times accompanied President Nixon on a trip to China where they witnessed an appendectomy and several demonstrations of serious surgeries being performed with acupuncture as the only anesthetic using Acupuncture Anesthesia. Despite many efforts to prove it's efficiency, Western science has never been able to reconcile how Acupuncture works. They can prove "that" it works, but not "how" it works.

Biochemical theories Most of the scientific studies of acupuncture have been centered on the analgesic aspects of pain relief. Acupuncture is definitely effective in treating pain; it works 70% to 80% of the time, far greater than the placebo, which only has about 30% efficiency. (2) The problem with attributing all of acupuncture's effects to the placebo effect, which is based on a "suggestive way" or the fact that one just wants to believe that it works, was the fact that veterinarians in China have used acupuncture successfully to treat animals. (3)

Dr. Bruce Promeranz, working at the University of Toronto, was very involved in research done on acupuncture analgesia. By activating small myelinated nerve f

Added by:   Mridu Verma
(April 18, 2008)

Aloe vera contains over 20 minerals, all of which are essential to the human body. The human body requires 22 amino acids for good health -- eight of which are called "essential" because the body cannot fabricate them. Aloe Vera contains all of these eight essential amino acids, and 11 of the 14 "secondary" amino acids. Several experts recommend drinking aloe vera juice to assure a continuous supply of these ingredients to the body.

It is suggested that one should drink between two to four ounces of aloe vera juice twice daily.

Du Zhong and latex allergy

Added by:   Nathan Anderson
(March 13, 2008)

Use extreme caution in prescribing

Du Zhong to patients who are allergic to latex. The quality of Du Zhong is assessed by the amount of white "stretchy" material between the pieces of bark- the more the better. This "stretchy" material is very similar to latex, and may elicit an allergic response in patients allergic to latex.

Turmeric and Neck/Shoulder Pain

Added by:   Thomas Turpen
(December 6, 2007)

Neck and shoulder pain is perhaps one of the most common conditions that we treat. In my own practice, it is perhaps second only to low back pain or piriformis syndrome. For my patients with neck and/or shoulder pain, I find that one simple herb can dramatically improve my patients' condition--Turmeric.

One of the ingredients in the formula

Juan Bi Tang, turmeric is known as Jiang Huang. It has been proven to reduce prostaglandin formation, and is as effective as NSAIDs without the risk to the liver or kidneys. It has anti-inflammatory, analgesic, as well as antispasmodic effects. Turmeric has a number of side-benefits as well. It has been shown to interfere with viral replication, including viral hepatitis and HIV. It also appears to inhibit carcinogenesis at all stages of cancer formation. In the TCM literature, it has a particularly affinity for the neck and shoulder region.

I have had patients who have taken prescription doses of naproxen, ibuprofen, and even percocet; and they still continued to have pain. When they come in for acupuncture, I also recommend that they go to the local Wild Oats and pick up a bottle of Turmeric standardized extract. I instruct them to Take 1 tablet TID whether or not they have pain. Most of the time they will see significant results within a few days. By combining this with the acupuncture, I have had great success treating even the most difficult neck and shoulder pain syndromes.

Turmeric has been classified as a menstrual stimulant, so it is recommended that pregnant women not take it as it may induce a miscarriage. Turmeric may have an additive effect on platelets, and it decreases the immunosuppressive effect of certain drugs. Therefore, it is wise to avoid the use of turmeric in those taking anticoagulant or immunosuppresant medications.

Herbs for Healthy Blood Sugar

Added by:   Brady Chin
(Rootdown Staff) (December 8, 2007)

Herbal congee is a great way to maintain healthy a blood sugar level in patients with diabetes. Here are two recipes I learned from Dr. Xiong, Dean of the Geriatric Department at the hospital I visited in China: •

Shan Yao 60g, Yi Yi Ren 30g, plus 200g corn. It tonifies Spleen and Kidney qi, and nourishes yin. • Mai Men Dong 15g + Dan Zhu Ye 10g: decoct and add the liquid to 30g rice. After the rice is cooked add 15g Xi Yang Shen and cook for 5-10 minutes more. This recipe nourishes yin and tonifies qi. Other herbs that lower blood sugar include Ren Shen, Huang Qi, Huang Lian, Zhi Mu, Mai Men Dong, Sheng Di Huang, Xuan Shen, Gou Qi Zi, Tian Hua Fen, Shi Gao, Shi Hu, and Ge Gen. Alexa Hulsey, L.Ac. Assistant Academic Dean

Fire Needling!

Added by:   Brady Chin
(Rootdown Staff) (November 21, 2007)

The doctors I observed in the hospital in Chengdu had great success using a combination of fire needling, cupping, and moxa to treat various dermatological conditions. Since fire needling isn’t used in the US, you could substitute bloodletting or 7-star needling instead. The treatment is applied directly to skin lesions such as eczema or dermatitis. Do the needling first, then follow up with cupping, and finish up with a few minutes of moxa. You’ll notice a lot of redness in the area and release of pus or fluids from the skin lesions immediately after the treatment, then a gradual reduction of the lesions. The method is called “yi re yin re” – using heat to conduct heat. The treatment can reduce inflammation, stop itching, and release toxins. For best results, do 1-2 times per week while simultaneously using internal herbs to treat the root of disease (blood heat, excess damp, etc). It works great!

Great Little Trick for Tension Between Shoulder Blades

Added by:   Marc Ryan
(November 14, 2007)

Neck and shoulder tension is one of the most common issues we see because our computer/cell phone/driving culture conspires against our upper backs and necks. Try this simple trick when doing an upper back treatment.

Get 2 towels and roll them so that they create round pillows. Put one under each shoulder between the pectoralis and anterior deltoid muscles (around Lung 1 and Lung 2 areas). This creates a gentle stretch in the front and will relax the rhomboid and levator scapula muscles between the shoulder blades.

Next needle the outer shu points (Urinary Bladder 41 to Urinary Bladder 44) and any ashi points you find in that area. You can also do some cupping or tui na in this position. You're patients will love you unconditionally after this, I guarantee it!


Common Clinical Error's

Added by:   Ray Rubio
(November 13, 2007)

Because so many patient's either scrape or brush their tongues - especially those seeking complementary medicine such as TCM, it is not uncommon to see clinically either a tongue with no coating, or a tongue with coating only in the root. These presentations - if as a result of scraping or brushing the tongue - do not indicate yin deficiency or damp heat in the lower jiao. It simply means the patient couldn't scrape the root of their tongue without gagging.

Also, if a patient has numerous thin cracks in the tongue with no apparent pattern, ask if they wore braces at some time in their life.

Not all oils are equal when cupping.

Added by:   Brady Chin
(Rootdown Staff) (November 8, 2007)

The type of oil used during cupping can make or break the treatment. Woodlock oil is too thin to move cups around on. I prefer a peanut oil base. The high viscosity is perfect for long strokes and gives a nice tight seal.

On the count of two...

Added by:   Brady Chin
(Rootdown Staff) (November 8, 2007)

Inserting needles can be nervewracking for some patients. I like to pull the old "on the count of three" trick on them. First I say I'll insert the needle on three. I then count "one..." and insert the needle on "...two", then finish counting "three". By the time they realize what's happened, the needle is in.

Gag the Gag Reflex

Added by:   Benjamin Satterfield
(Rootdown Staff) (November 7, 2007)

Gagging can be troublesome when you need to do a throat exam. This trick has worked for me many times, in both kids and adults.

Have the patient blow out all the air in the lungs through the mouth. Then ask him or her to open wide and inhale very slowly (preferably through the nose, but the mouth works too if the nose is congested). The patient will not gag as long as he or she is inhaling. Once the inhalation is stopped, the gagging often recurs.

blood pressure monitoring

Added by:   Benjamin Satterfield
(Rootdown Staff) (November 7, 2007)

For patients with hypertension, at-home self-monitoring of blood pressure between office visits is as important as in-office treatment from a doctor. Patients often get lazy in their record keeping, though, especially when office visits are 4 to 6 weeks apart. Instead of asking patients to keep track of their blood pressure for the entire period, I instruct them to bring to the next office visit a record of measurements taken the week before the visit. This helps them remember to check their blood pressure and eases the burden of record keeping.

The same can go for journaling of patient's diets.

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