Constitutional Facial Acupuncture: The New Protocols

We are presently experiencing a quantum evolution in our perceptions of the aging process, which involves the elimination of outmoded ideas about what it means to be elderly. This paradigm shift has been facilitated by half a billion Baby Boomers¹ worldwide who have provided a powerful stimulus for a collective change to the ‘face of aging’. This is not the previous silent generation, but an outspoken, entitled demographic, which, by force of their sheer numbers, is amending existing conscious and unconscious social contracts.

Around the globe, there are unprecedented numbers of people who regard themselves as middle-aged; in fact, the population of individuals over 50 years of age is the largest in recorded history. With dramatic advances in Western medical technology and a parallel expansion of consciousness about the effectiveness of alternative strategies to promote and maintain optimum health, these high functioning people expect to live longer than their parents, with a level of vitality and enjoyment that would have been considered unrealistic by previous generations.

The impact of this revolution is also beneficial to younger generations, who are observing the Boomers as they actively reject pre-existing beliefs about health, beauty, creativity and vitality being the exclusive property of the young. These trailblazers are pursuing natural, holistic, and less invasive approaches to maintain a youthful appearance without sacrificing their wisdom and integrity. They adhere to a concept of beauty that embraces the totality of their experience, keeps them productive, and authentically transforms body and spirit.

As acupuncturists, we stand poised to address the concerns of all our patients, both the elder ones and the young, who, already primed by popular consensus, fear old age as a time of decline and illness. Metaphorically, we can function as a bridge, straddling both worlds of Western medicine and other complementary disciplines.

The Three Levels of Constitutional Treatment

The Jing

This level targets the Eight Extraordinary meridians, hereditary factors and their relationship to the endocrine system.

For example, Dai Mai, GB 41 Zulinqi and SJ 5 Waiguan, regulates migraines caused by menstrual imbalances. TheYang Wei Mai affects the nervous system via the Gallbladder and Liver meridians, and the points on the cranium, while theDai Maiaffects the hormonal system. Liv 13 Zhangmen, the frontMuof the spleen, and influential point ofZang, is important because ‘unemployed sex hormones are neutralized in the Liver.’² Severe migraines often occur as a result of excess gonadotrophic hormones.

The Eight Extraordinary Meridians are considered to encode fundamental hereditary aspects of the individual, what Oriental medicine terms theJing; thus, employing them in the context of a facial acupuncture treatment can have profound impact upon both the visible and implicit symptoms of the aging process, promoting healthy aging, greater quality of life and harmony.

The Ying

The Ying level, which targets post natal Qi and utilizes the Twelve Regular Meridians, is the second constituent of Constitutional Facial Acupuncture’s three pronged constitutional approach.

While traditional Chinese medicine (TCM) diagnostics focus on qi, blood and fluids to address this level, I also integrate it with the Five Elements and their interaction with the pathology of the Twelve Regulars.

This particular constitutional treatment is based upon Japanese acupuncture:

The Liver and Gall Bladder signs and symptoms usually are more pronounced on the right side of the body. The patient may have weight issues, hepatitis, cirrhosis, or a fatty liver, and additionally manifest addictions to alcohol and drugs, including prescription drugs.

Hormonal headaches involving the pituitary gland originate at UB 2 Zanzhu, with complaints of intense pain behind the eyeballs. With the involvement of the Gall Bladder, one sided migraine headaches may ensue. There may also be tendinomuscular spasms, tics and temporomandibular joint dysfunction (TMJ). Shoulder pain is reported at UB 43 Gaohuangshu, which is the outer Pericardium Shu.

Nagano Sensei’s Obesity Treatment

Treatment Points:	Liv 14 Qimen, St 27 Daju, Ren 6 Qihai and GB 26 Daimai
Locations:	Liv 14 Qimen is 4 cun lateral to the midline in the 6^th intercostal space.
	St 27 Daju is located 2 cun below the navel, 2 cun lateral to Ren 5 Shimen Stone Gate Ren 6 Qihai is on the abdominal midline, 1.5 cun below the navel GB 26 Daimai is located directly below the end of the 11^th rib where Liv 13 Zhongmen is located, at the level of the navel
Needling Protocol:	All points are needled bilaterally except for GB 26 Daimai, and Liv 14 Qimen. Needle Liv 14 Qimen on the right side, pointed laterally between the ribs, with a 10-15 degree insertion, and GB 26 Daimai on the left side, angled toward the back. St 27 Daju and Ren 6 Qihai are needled at a 90 degree angle. Use direct moxa after needling.
Indications:	Abdominal obesity; Fat metabolism imbalances; Abdominal and hypochondriac distention and pain; Damp heat; Constitutional toxins in the Dai Mai It regulates the uterus; irregular menses, dysmenorrhea, uterine prolapse and cramps; Resolves damp heat issues, such as leucorrhea; Treats abdominal pain and hernia; Pain in the lumbar area and hypochondria Pincer grasp the waist at GB 26 Daimai, between your thumb and fingers, with your non dominant hand; Locate the internal obliques muscle, which feels like a tight band next to the waist area; Palpate it by rolling the bands between your fingers. This will make your patient aware of the tightness of this long, fan like muscle. They may feel a local twitch, or a jump referring up the muscle, but not necessarily. Continue to hold the internal oblique muscle and needle transversely downward, 0.5-1 cun, toward the massage table, with a 36 34 gauge, 40 mm or longer, needle. Needling in this fashion will not puncture the peritoneum. Do not needle toward the waist, but downward through the muscle; When the trigger point releases, the patient usually experiences a wave like sensation, flowing up and down the entire muscle; If the muscle is very tight on one side of the body, first needle the other side; this will release the tense side; Massage arnica gel or cream into the area, and inform your patient that they may experience muscle soreness, such as they would after a strenuous workout
Comments:	This Japanese acupuncture protocol indicates that only the left GB 26 Daimai is to be treated. This is most likely due to the Wood Element hara reflex, which is palpated only on the left side of the abdomen. Only the right Liv 14 Qimen is indicated because the Liver organ is on the right side of the body. In Sensei Nagano’s experience, patients lost weight after they were treated with direct moxa every day. Patients with a fast pulse lost 10 pounds a month without regaining the original weight.

The Wei Level

The Wei Level releases the exterior and is within the purview of the tendino-muscular meridians (TMM). These particular vessels are referred to as tendino-muscular because they travel in the depressions and planes between the muscles and the tendons.

Tight tender, trigger, motor or ‘ashi’ points are identified through an assessment of the patient’s symptoms, and through palpation. It is possible to release a tight waist with tension localized around the GB 26 Daimai area.

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“Wandering Skirt” Syndrome

This syndrome relates to the Belt Meridian, the internal oblique muscles and issues of bloat, obesity and other imbalances, manifesting around the waist. The patient has the attendant Shaoyang emotions of frustration, anger, with an inability to make a decision, and a tendency to stuff these damp viscous feelings under their belt. Since one of the TCM indications for the Dai Mai is a subjective feeling of sitting in cold water, the patient may also have a Kidney imbalance, and will lack courage.

“Wandering Skirt” Syndrome can be used with patients who have been in an automobile accident and complain of low back pain, with difficulty rotating their spine to one side of the body. This technique also temporarily ameliorates lower back pain due to kidney stones.

Muscle:	The internal obliques are a fan shaped abdominal muscle, whose fibers range from vertical to diagonal to horizontal. All the muscle fibers meet at the inguinal ligament, and the iliac crest of the lower spine. They flex and rotate the spine and trunk to the same side of the body.
Treatment point:	GB 26 Daimai is directly below the free end of the 11^th rib where Liv 13 Zhangmen is located, at the level of the navel.
Indications:
Signs and symptoms:	The indications for both trigger and motor points are similar. Imbalances include fibrocystic nodules or tightness near GB 26 Daimai and the pubic bone, difficulty flexing and bending the spine to the same side, lower back pain, an imbalance of the right and left sides of the body when standing for long periods of time or walking for hours. It also increases the intra-abdominal pressure for urination and defecation.
Trigger point palpation:	The trigger point, when needled with the pecking technique, may elicit a jump or twitch within the muscle.
Trigger point needling technique:

Facial Needling: The Expressive Muscles

After the constitution has been addressed, the face can be treated with the origin and insertion of the muscles.

The Origin and Insertion of Muscles

The origin of the muscle is the beginning of the muscle, because it is usually attached to the bone. This origin anchors the muscle, and it is needled first in Constitutional Facial Acupuncture treatments. This fixed attachment permits the insertion of the muscle to move and make facial expressions.

The insertion of the muscle attaches to the skin or muscle fibers, and is needled after the muscle origin. The insertion attachment supports muscle movement in making facial expressions, and allows the face to be mobile and flexible.

The expressive movement of the facial muscles is an interplay between the origin and insertion of the muscles, which pulls the skin in the direction of a facial expression when a person laughs, smiles or frowns. This interplay is similar to the balance between yin and yang in Oriental medicine. Wrinkles are formed cross fiber or transversely to the fiber direction of the muscle involved.

Each muscle has a specific function, range and direction of motion, associated emotion and specific wrinkles formed by repetitive and habitual movements.

Forehead Wrinkles and Tension

According to Western medicine, the frontalis muscle raises the forehead in fright, shock and surprise, and wrinkles the skin on the forehead horizontally.

Emotions:In Chinese medicine, raising the eyebrows and wrinkling the forehead is a sign of disturbed Shen characterized by fire and heat rising to this part of the face.

Forehead Lines and Tension

Lines and wrinkles. Many years after prolonged stress or a traumatic event, people still habitually wear their fright and surprise on their foreheads, etched there in the form of horizontal lines, wrinkles and muscle tension. These muscles are referred to as myotatic units because they both insert into the scalp and synergistically affect muscle movement. Therefore, the bellies of the frontalis and occipitalis muscles function in tandem with each other, and any contracture or habitual wrinkling of the forehead can cause tension, headaches and pain in the occipital and cervical areas of the head and neck.

Since all the Yang meridians rise up to the face and head, especially the UB, Gall Bladder and Stomach meridians, which traverse the forehead area, it is important to anchor and ground the Yang constitutionally before needling. This prevents unwanted headaches, hot flashes, hypertension, anxiety, shallow breathing and disturbed Shen.

Unresolved trauma can lodge in the forehead from an event that happened many years prior to their initial Constitutional Facial Acupuncture treatment. Being aware of this stored muscle memory is very important for the efficacy of facial acupuncture treatments.

Frontalis:	Raises the eyebrows in fright or surprise and wrinkles the forehead
Emotions:	Fright, shock, surprise; disturbed Shen
Origin:	In the epicranial aponeurosis, at the level of the coronal suture
Insertion:	In the skin of the frontal region above the eyebrows
Needling:	15 mm; 40 or 38 gauge (#1 or #2 Japanese), 0.2 0.3 cun

Conclusion

Facial acupuncture seemingly targets only the visible signs of aging, and consequently is often labeled as cosmetic by the general public and many acupuncturists.

However, with a strong constitutional component, this modality effects long term change in the patient’s general health. It also ameliorates significant dermatological issues, if used with topical herbal masks, poultices, creams, natural cleansers and essential oils. Cleansing and hydrating the face is paramount for effective treatments, and the addition of the jade rollers, gem discs, and hydrosols makes this approach more effective. It also creates a safe and nurturing atmosphere in which your patients can relax, allowing them to experience a transformative ritual.

¹ Current estimate for the worldwide Baby Boomer population is 450 million. Source: http://trendwatching.com/trends/boomingbusiness.htm, quoting MIT Agelab.

² Low, Royston, The Secondary Vessels of Acupuncture: A Detailed Account of their Energies, Meridians and Control Points, Harper Collins, New York, NY, 1984 (out of print).

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