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1 1 B U L L E T I N O F C L I N I C A L DR. HOLMES KEIKOBAD MBBS, DPH, Dip Ac NCCAOM, LAc Editor in Chief & Clinical Director CAROL ANDRADE PHD LAC Editor & Creative Director Copyright ACU-FREE.COM LLC ALL RIGHTS Published by ACUFREE.COM INC

2 2 TERMS OF USE This Bulletin can be studied only as a download from its home on the web page It is permissible to download a copy to your computer for your own personal use. Making hard copies for distribution in any way without written permission violates Federal Copyright Laws creating a liability which could result in steep fines and worse. If you want a colleague to be informed of the publication of issues on a regular basis, request them to send an to that effect to ceus@acu-free.com or for sporadic access, simply have them access the web page It is not legal to excerpt material, in part or whole, to teach, or include this material in any form in a course or any other medium. If you wish to do so legally through reprints with authorship and copyright respected, send your request by to ceus@acu-free.com and we will gladly consider it. If you are a State Acupuncture Association, you may get a hard copy of the Issue mailed to you free of cost. To receive that send an to ceus@acu-free.com making the request and inputting full details of your organization. We really go to great lengths to research and write expert discussions and acu-free.com to get the Bulletin INC. to All you, rights free reserved. of any cost or encumbrance. Respect for our requirements not only keeps you safe from copyright infringement legal problems, but also maintains your standards as a professional. You can help us incredibly by making certain the Terms of Use are respected. In every sense of the word, Acupuncture is everyone s heritage. This Bulletin continues to guard and expand that great wisdom. With best wishes Dr. Holmes Keikobad Editor in Chief Published by ACUFREE.COM INC

3 3 In This Issue Page 2 Terms of Use Pages 4-11 Heel Pain Main Article: a detailed discussion Pages The Diagnostic Dilemma Special issues in Diagnosis and Treatment Page The Healing Power of Gardens Introductory Article on Natural Healing Methods Page 17 Distance Learning Courses NCCAOM & State Re-Certification (Advertisement) Page 18 Contact Information & Refer a Friend Whatever you will seek you will find, and therein lies the rub Faramoush the Forgotten Published by ACUFREE.COM INC

4 4 Heel Pain Dr. Holmes Keikobad Preamble This is a common condition you may frequently see in your clinic, and one may think this a case of, almost certainly, a calcaneal spur: a bony hook like growth on the ventral aspect of the calcaneum. But by and large, it is not, and is very likely instead, a case of plantar fascitis. To make matters more interesting, fascitis would imply an inflammation of the fascia of the foot, but there is none here. What occurs in fact is a non specific, generic irritation which passes by the name of inflammation. So the most likely non-traumatic cause reported for heel pain is, a non specific inflammation, [read irritation], of the plantar fascia in the foot. In the writers experience, this irritation can be anything from ill fitting shoes, a job which puts strain on the foot, congenital flat feet, (except for people of African descent for which normal healthy feet are without the arch), an old injury, anything which places pressure on one side of the body more than the other, such as a scoliotic spine, disparate shoulder - hip levels etc. The foot The is a complex mechanical structure containing: 26 bones 33 joints more than a hundred muscles, tendons, and ligaments Which is to stay when you walk or stand or jog, you are poised on two feet, 52 bones joined together with 66 joints, slung together by 200 plus muscles, tendons and ligaments. Such a finely poised mechanism needs care, so that one must walk, sit, jog and stand in a manner which respects its intricacy, and inbuilt balance. Civilization has taken this fine mechanism and confined it to a container made of leather, plastic or canvas. This may have, for women, an inordinately high heel, or for men, thick soles. This may be fairly confined, with added insoles, thick socks in wintry weather. It becomes clear why the feet experience fatigue, even injury, over the years, and registers non specific fascitis of the plantar fascia, the primary tendinous support in the foot. Published by ACUFREE.COM INC

5 ED Structure of foot This is best studied from 3 vantage points: ES ER V Ÿ Superior Ÿ Lateral Ÿ Medial And by arbitrarily dividing the foot into 3 approximate sections: T S R Ÿ Anterior 1/3rd [A] Ÿ

5 5 ED Structure of foot This is best studied from 3 vantage points: ES ER V Ÿ Superior Ÿ Lateral Ÿ Medial And by arbitrarily dividing the foot into 3 approximate sections: T S R Ÿ Anterior 1/3rd [A] Ÿ Middle 1/3rd [B] Ÿ Posterior 1/3rd [C] IG H Medial malleolus L R Arch of the foot which is always located medially A L B L C A O M L Calcaneum. E E R F U C Phalanges of Great toe Metatarsal of Great toe A C C Prominence of navicular bone under which point Kidney 2 is located. To feel it in your foot, first locate medial malleolus, then slide down finger about 2 inches, and the forwards for about an inch; the prominence you feel is the navicular bone. t Here is an odd question. h Can you assess the quality ACU-FREE.COM Of Kidney Qi fromig what iscopyright visible in this foot? Answer LLC ALL RIGHTS r below. y p o C ANSWER: There is good K Qi because the area around point Kidney 3 is level. If there were a Deficiency, a prominent hollowed trough would appear. Published by ACUFREE.COM INC

6 6 Bones in the foot Superior aspect Bones in sector A: Phalanges [PH] Metatarsals [MT] Bones in sector B: Cuboid [CB] Navicular [NV] Cuneiform [CN] Bones in sector C: Talus [TL] Calcaneum [CL] Note: Phalanges: there are 3 in each toe except in Great toe which has only 2 3 cuneiform bones are seen here, medial, middle and lateral The blue dot is the protuberance of the navicular under which is point K 2 In case you treat by elemental Patterns, then: PH Bones will be ruled by Kidney Fascia, ligaments and tendons by Liver In a confirmed case of plantar fascitis one will tend to reinforce Liver Wood Qi, which is Liver Yin, which can also be Liver Blood. Copyright acu-free.com LLC. All rights reserved C A B CL TL CB NV CN MT Published by ACUFREE.COM INC

7 7 Bones in the foot Try your hand at recapitulating the bones. Its OK to refer the previous page. Once you are fluent with that then on next page you will try to identify bones entirely without any guidelines: C CL A B TL CB NV CN MT PH Published by ACUFREE.COM INC

8 8 Bones in the foot 1. Name the 3 sectors when considering bones in the foot. 2. Name the bones of the foot as marked in this figure. C A B Published by ACUFREE.COM INC

9 9 Pathogenesis of heel pain If the cause is plantar fascitis the genesis is as explained. Follow panels from 1 to 4. - Bottom of Foot - 1 Fascia anchored at heel and at the metatarsals, see panel 2 4 heel pain of plantar fascitis 3 the fascia has superior to it all the muscles, tendons, ligaments and joints in the foot and acts as a natural protective barrier as well as support. When there is abnormal pressure on the foot as with flat feet, the maladjustment shows, or with occupational overload etc, the fascia experiences additional strain. This transmits to the attachment in the heel causing the typical heel pain, see panel 4 2 Fascia anchored at metatarsals so that there is a springing action to support the foot, see panel 3 Published by ACUFREE.COM INC

$When you examine the bones for fracture or a structural compromise begin systematically from posterior to anterior 1/3rd: Talus, calcaneum > navicular, cuneiform > cuboid > whichever metatarsals and$

10 10 In this plate look at the prominent cuneiform [CN] articulating with the metatarsal for the great toe [MT]. Posterior to that is the navicular [NV]. Next see the tell tale 2 phalanges of the Great toe [PH]. That makes it the left foot medial aspect. When you examine the bones for fracture or a structural compromise begin systematically from posterior to anterior 1/3rd: Talus, calcaneum > navicular, cuneiform > cuboid > whichever metatarsals and phalanges are visible. TL CL MM NV CN See the plantar fascia and how it extends from the calcaneum to the phalanges. Heel pain in this condition is felt at the attachment of this structure with the calcaneum. Follow the sequence of the pull on the fascia [1 to 4] previous page, and work that into this plate. Heel pain CB FSC MT PH Published by ACUFREE.COM INC

11 11 Plantar fascitis - Facts Less inflammatory and more degenerative Occurs in two million Americans a year or 10% of the population over a lifetime Commonly associated with long periods of work-related weight bearing Associated with a high body mass index Increased probability of knee pains, especially among runners Diagnosis - establish these Usually by clinical examination alone Far less frequently, radiographs, diagnostic ultrasound and MRI Pain on rising in morning from bed, better by activity Intense with the first steps of the day Difficulty bending the foot so that there is decreased dorsiflexion of ankle Pain on causing passive dorsiflexion of toes Felt on the underside of the heel on and around calcaneus No immediate history of trauma sprain or strain Differential diagnosis - exclude these Pain of bony spur [X-Ray confirms spur] Ball-of-foot pain [more at anterior aspect of foot] Metatarsalgia [dull pain or numbness in the metatarsal region] Capsulitis, inflammation of a joint capsule Injury or sprain Degenerative changes in joints of foot Osteoarthritis of joints of foot Treatment Western Medicine: stretching, night splints, physical therapy, orthotics, anti-inflammatory medications and surgery in refractory cases. Traditional Medicine: Ruling profile - tendons, fascia, ligaments ruled by Liver Wood Aggressing element - Metal Strategy - step 1: reinforce Metal; step 2: Harmonize Wood Points for step 1: Reinforce: [all these points on right side] Lung 9, Large Intestine 11, Lung 7, Urinary Bladder 13 Points for step 2: Even movement: [all these points on left side] Liver 3, Gall Bladder 41, Gall Bladder 34, Urinary Bladder 18 Local points: Reinforce Stomach 44, Liver 2, Kidney 3, Urinary Bladder 60 Ear points: [all points on affected side] Massage ear till ruddy, place Points Foot, Liver, Lung. After removing needles place seeds. Published by ACUFREE.COM INC

12 12 The Diagnostic Dilemma Dr. Holmes Keikobad How should a diagnosis be worded? If there is Damp Heat in Stomach Rising to Throat, should it be named that on the case sheet, or should one opt for the Western Medicine descriptor, Tonsillitis? There is a pronounced trend to bring in Western Medicine parameters in one manner or another, into classical acupuncture practice, with the result that the sanctity of the Art is compromised. 1. Etiology Vs each of these conditions in the Western model: Sore throat - infection Toothache - infection, tooth decay Earache- infection; impacted wax Pain of sinusitis - infection; deviated septum obstructing nasal drainage 2. Etiology Vs each of these conditions in the Traditional model: Damp Heat from Stomach Rising 3. How would one Traditional etiologic factor cause so many varied pathologies? The Damp Heat has chosen on several directions to rise, towards throat, gums, ear, sinuses. 4. Damp Heat Rising. Where can this come from? Stomach 5. What could be causing Damp Heat in Stomach? Undigested food Stomach - Spleen Disharmony Liver Oppressing Stomach A Kidney Xu Deficient Fire 6. How would one in the Western model treat each condition? Sore throat - infection - antibiotics Toothache - infection, Copyright tooth decay ACU-FREE.COM - antibiotics, LLC teeth ALL repair RIGHTS Earache- infection; impacted wax - antibiotics, ear cleaning Pain of sinusitis - infection; deviated septum obstructing nasal drainage - nasal lavage, antibiotics, local surgery Published by ACUFREE.COM INC

13 13 7. How would one treat by Traditional Medicine? Undigested food - Harmonize Stomach so Excess Damp is allayed Stomach - Spleen Disharmony - Harmonize Earth Liver Oppressing Stomach - Reinforce Liver, Harmonize Stomach A Kidney Xu Deficient Fire - even out Kidney Qi 8. Can one further simplify this approach? For first two conditions - Harmonize Earth For third condition - Reinforce Liver & Harmonize Stomach For fourth condition - Even out Kidney Qi [use even movement on K channel points] One can work to further simplify the treatment by understanding the dynamics which caused the condition. But the point is, Traditional approach works with energetics while the Western model, with structure. Granting both are worthwhile in their own places, the point arises, what model should be the ideal one in a Traditional practice? One might ask, would it really matter? The short answer is, yes; the structuralist Western model uses medications to reestablish the marred matrix, while the Traditional one uses Qi Energy to reestablish the harmonious Qi matrix. If you use the Traditional model in establishing diagnosis, you have an energetic pattern on your hands where Qi has become in Disarray. If you will treat this you will work to reestablish the Qi Harmony which existed before the illness. If on the other there are places where you use the Western model in establishing diagnosis, you have a structural anomaly at hand where the substantial matrix has become in Disarray. If you will treat this you will work to reestablish the structure which existed before the illness, which is to say resort to medications. In a double diagnosis it seems one may use Traditional diagnosis but label the illness with Western Medicine labels. This might be necessary for insurance claims, or keeping records readable by non TCM personnel. Over time you may veer away from Traditional enunciation to the colloquial one and risk losing sight of the true Copyright diagnostic ACU-FREE.COM philosophy. LLC ALL RIGHTS Or you may in spite of what is recorded in History stay with the mind set of the Traditional healer. Which is easy, because the Path is filled with footsteps of great healers and thinkers over very many centuries, the Gracious Nameless Ones who never lost sight of the energy that creates both illness and well-being. Published by ACUFREE.COM INC

14 14 The Healing Garden Carol Andrade PhD LAc In this article, we will be investigating the healing power of nature as it has existed forever on planet earth, especially in a particularly old and constant form: the garden. This has a direct relationship to so many of our healing arts, as acupuncturists, herbalists, food healers, and adherents of Feng Shui. Throughout my time as a healer, I have always attempted to have offices, no matter where I was working, that overlooked green vegetation, water features, or natural waterways, and if possible walking paths where patients and their families could walk or sit before or after their sessions. Published by ACUFREE.COM INC I consider this a very important part of the healing process, neither superficial nor decorative. When I find a patient sitting and just staring out the window at a the scene that I have provided who simply says I could sit here forever, as many have, I know that I have provided a sanctuary, a refuge, a respite from the turmoil of the world. It is in this environment, both outer in form and inner in response that healing begins. That is why many times when I teach healing, I take people to nature-filled places like Hawaii. So many healers get off the plane and exclaim what a wonderful site for a healing center, and only later realize, with much chagrin, that their statement is redundant. It already is a healing center. If they build a building or add an office with that intent then they are lucky, but the real healing is just being there, surrounded and immersed in nature. Gardens, whether natural or handmade, go on for miles or bend from a single flower pot toward a sunny window in the center of the city. Large, small, grand or humble they reflect and heal through contemplation of nature, of which we are a part. There are three levels of gardens that we will be exploring in these articles: 1. Making a garden 2. Maintaining a garden 3. Passing on a garden to someone else 4. Gratitude for those who have passed a garden on to you. John Muir, the great American Copyright naturalist, ACU-FREE.COM planted a garden LLC that ALL RIGHTS I have enjoyed every time I have gone to San Francisco. Carefully cultivating on what would seem a less than possible tract of land all sand at the edge of the ocean, a hundred years later I now walk through some of the most towering ferns and exotic walkways on planet Earth. I thank him every time I go.

15 So what part of the world most needs the healing gardens now? One of the earliest known words for garden is from the Persian pairidaeza or paradise.

15 15 So what part of the world most needs the healing gardens now? One of the earliest known words for garden is from the Persian pairidaeza or paradise. The Persians are famous for their walled gardens filled with roses and jasmine, and platforms from which to view the moon, to meditate to find inspiration for art, music, and poetry. The Alhambra, perhaps one of the most beautiful gardens I have ever walked through, is on gentle rolling hills in Spain, contains no figurative work, but is filled with geometric patterns that flourished all over the Mediterranean and came from North Africa with the Moors. The Cupolas, pavilions, hallways of trees and pools of water supported the explorations of mathematicians, healers, philosophers, great herbalists and students of spirituality. Published by ACUFREE.COM INC I am particularly choosing the greatest gardens from places which so many only consider the source of war and destruction because the earth remembers other avenues of human creation, and if we listen carefully, we too will remember the earth which has no nation states, but is continuous, and once fullblown and unbound was only garden. Whilst fountains and flowing water are a common feature around the Alhambra, they are particularly prevalent in the Palacio de Generalife.

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vertebral discs Anatomy of spine, shoulder and hip girdles Structural acu-free.com weaknesses in INC. skeleton All rights reserved.

between 5 elements The 50th Difficult Issue The Back Pain Elemental Pattern Conditions which require surgical intervention Diagnosis in Western

16 16 A d v e r t i s e m e n t Ads appear only on this page so your reading pleasure is not interrupted. SALE! 15 ceus/pdas for $149. Go to acu-free.com or us at: ceus@acu-free.com ACU-FREE.COM, the sponsors of this Bulletin, offer expert distance learning courses created by the same team which authors many of the articles in the Bulletin. Courses accepted with NCCAOM & approved in AK AR FL GA ID IN MA ME MD MT NC NH NM RI TX & most States. AZ accepts NCCAOM. Check out specific approval. Most Workbooks are delivered by , some by Priority USPS at no extra cost! Treating Low Back Pain 25 CEUs/PDAs Published by ACUFREE.COM INC 25 CREDITS - $ NCCAOM CA MA MD & Most States - downloaded same day. Send Quiz by and get Certificate same day by . No extra cost Course Content 4 Parts, 82 pages Topics include: Demarcation of back pain Curves in spinal cord Structure of vertebrae Inter vertebral discs Anatomy of spine, shoulder and hip girdles Structural acu-free.com weaknesses in INC. skeleton All rights reserved. Risk factors;* Back pain in Western Medicine Role fallen arches and shoulder-hip differences in back pain Qi Transfer System Relationships between 5 elements The 50th Difficult Issue The Back Pain Elemental Pattern Conditions which require surgical intervention Diagnosis in Western Medicine & Traditional Medicine Signs and Symptoms in Traditional Medicine Tongue profiles; face color signs Reading X-Rays Copyright and MRI scans, ACU-FREE.COM actual patients. LLC ALL RIGHTS Includes treatment Discussion on neck and shoulder pain & sprain of back Check out many other courses earning credits: or call TRU.SELF Images ACU-FREE.COM LLC ALL RIGHTS

17 17 To close this Bulletin and return to our web site, click on the left-pointing arrow at the upper left hand corner of your browser. To receive Bulletins at a new or a preferred address, click here To refer the Bulletin to a colleague, click here Certification & Mailing Center 1712 N McAllister Ave Tempe AZ USA Toll free TRU.SELF < > Web site Fax Published by ACUFREE.COM INC

Basics of 5 Element Diagnosis Part II

Basics of 5 Element Diagnosis Part II To SUBSCRIBE or change your email, click here: http://www.acu-free.com/prefs.html 1 Bulletin of Clinical Acupuncture & Natural Healing Volume IX Issue 214 Jul 2013 1 DR. Homi J E Kaikobad MBBS, DPH Dip