My clinical trial research was recently published in The Journal of American Society of Acupuncturist. Spring, 2019 Issue titled: Combining Acupuncture with Aromatherapy to Enhance the Treatment of Stress. Access here: https://www.meridiansjaom.com/
The Art of Practice - 6 Simple Ways to Spice Up Your Practice (Published October, 2015)
Over the course of 15+ years of private practice I have realized that there truly is an art to being a continuously successful and completely fulfilled practitioner. Sometimes we get burned out. Sometimes our patients get bored with the same treatment every time they come in. Sometimes we get a patient that our traditional treatments don’t seem to help effectively. So, what do we do? In this article I hope to offer you some ideas.
While I have a steady stream of new patients I also have a solid base of returning patients – my “regulars”. They have been coming to see me every week or every two weeks for years. I have found that for these regular patients it is important to keep the treatments fresh, new and exciting. Luckily for us, practitioners of TCM and alternative medicine, we can be creative and add different things to our treatments to enhance the experience, maintain the transformation in our patients and keep them coming back to us.
Whether you are a brand new practitioner or a “seasoned” one like me (so much better than saying “old”), it is absolutely vital to keep your practice fresh and keep your bag of tricks filled so you can approach all types of situations. By doing so you will not only increase patient satisfaction, you will also increase your own job satisfaction greatly. In this article I share 6 simple and effective things you can add to your treatments and/or practice to prevent burn out and/or stagnation, enhance the over-all treatment experience and increase patient satisfaction:
1. Aromatherapy. I have always used aromatherapy in my practice and patients love it. The easiest way to incorporate this ancient healing technique is to simply add essential oils or aromatherapy sprays onto a cotton ball and place the cotton ball within your patient’s sniff zone while they are receiving a treatment (i.e. place the cotton ball on their chest or under the head rest if they are face down). Then, when the patient leaves after their treatment have them take the cotton ball with them, instructing them to smell the aromatherapy frequently to keep the treatment going through their body. Even though it is a cheap little cotton ball with aromatherapy on it patients will covet it like prized gold and look forward to their cotton balls with each treatment. I once walked a patient to her car and saw a line of cotton balls on her dashboard from prior treatments. For basic aromatherapy you can add lavender to cotton balls to help them relax or try a citrus oil like grapefruit or orange to move Qi and increase energy. It’s simple – we all have cotton balls. It’s effective – efficacy of aromatherapy has been proven over and over again in clinical trials. It is inexpensive – it costs you pennies and pays you back in spades when your patients want to come see you regularly. It has even been proven that adding aromatherapy to an acupuncture treatment increases its efficacy.
2. Cards. No, I don’t mean business cards. I’m talking more about oracle cards or positive affirmation cards. While thought leaders like Doreen Virtue and Denise Linn were some of the first people to come up with these cards, everyone seems to have their own deck and there are decks for all areas of life. Louise Hay has positive affirmation cards, Deepak Chopra has several decks for spirituality, Doreen Virtue has dozens of decks and now Gabby Bernstein, one of our newest thought leaders in personal development, has her own positive card deck “Miracles Now”. There are even little tiny angel notes that have positive affirmations on them that you can have placed in a bowl in your waiting room. Patients can pull one while they are waiting and take it with them as a little positive pick me up.
There are several ways you can use them with your treatments. You can have your patient pull a card before treatment as a way to get them to share what is going on inside them. Perhaps the chosen card reminds them of something they forgot to mention to you or the card really speaks to how they are feeling. So much is revealed in these discussions. You can also use them to provide encouragement. I’d like to share one particular experience I had with using these types of cards. I had a fertility patient who was finishing her third month of treatments as was becoming impatient as she wanted to get pregnant now and didn’t understand why it was taking so long. I asked her if she wanted to pull an angel card from Doreen Virtue’s Daily Guidance From Your Angels card deck. She agreed and after shuffling the cards a bit she pulled one from the middle and it was the “Child” card which reads: “ Your life purpose involves helping children – A child in Heaven is saying ‘I love you’ – Pregnancy or adoption might be part of your life”. She couldn’t believe it and started to cry (I couldn’t believe it either!). Then she said to me: “Hey, are they all Child cards?” inferring that I may have stacked the deck. I went to turn over all the cards and show her that there were 44 different types of cards in the deck and a card fell on the floor between us. I picked it up and we both looked at it. It was the “Have Confidence “card. We both laughed. She felt encouraged and left my office. She conceived 2 weeks later. True story!!
3. Auricular To Go. If you are not already using ear seeds I recommend adding them to your practice even if you just put a seed on Shen Men. I do not provide ear seeds on every treatment or even on the first treatment. I save it to add to future treatments. It can also be something that you can suggest at the end of a treatment. For example: “While you were resting I was thinking that next time you come in I want to give you ear seeds”. Now your patient has more reason to come back. Furthermore, I encourage you to educate your patients that the efficacy of auricular acupuncture has been proven many times. I recently searched PubMed for research articles and found up to 100 studies. One study that I found really interesting used an fMRI to prove the efficacy of acupuncture. You can find it here: http://www.ncbi.nlm.nih.gov/pubmed/24867864. Lastly, you can get rather creative with your ear seeds. There are several options. There are traditional vaccaria ear seeds, essential oil infused ear seeds, silver seeds, gold seeds and the now increasingly popular Swarovski Crystal Ear Pellets. www.earseeds.com has them all.
4. “Happy Tea” Packets. One of the simplest and most profound formulas in TCM is Gan Mai Da Zao Tang. I remember when I was in school a local acupuncture center would serve this formula as a tea in their waiting room and call it: “Happy Tea”. And, it really does make us happy by calming our Shen and soothing our Liver Qi. I have little packets of “Happy Tea” in a large mason jar in my office. I give out single use packets to patients as little giveaways/gifts. Using Microsoft Word I created a simple little label with instructions on how to make the tea at home.
The single use giveaway packets cost you about $0.75 after you buy the three herbs for the formula in bulk. Like the aromatherapy, this patient giveaway/gift pays off in spades. Patients love to try Chinese Herbal formulas especially if they taste as good as this one. If patients really love your “Happy Tea”, sell the packets in your office. You can also use this formula as a kind of “gateway” formula to warm them up for more advanced formulas in the future.
5. Gemstones. I honestly grew up thinking I was one of only a few people with a strong liking for gemstones. Well, I was wrong. So many people love, and are attracted to, gemstones. Gemstones are energetic just like many facets of our medicine so they are a perfect complement to a TCM practice. Now, I don’t always use gemstones in my treatments. Rather, I pull them out in order to add something new to my treatments for my regulars or for a patient that really needs an outside-of-the-box treatment. Sometimes after a treatment I will tell a patient “I sometimes incorporate gemstones into my treatments. On your next visit I’d like to add some gemstones if you are up for it”. If you do this your patient is excited and already looking forward to their next treatment with you as they know that they get to try something new. Another thing that is important when adding gemstones is to tell the patients why you are doing so. For example: “I am adding Rose Quartz to help heal your heart or to help promote a sense of calmness in your body”. I have been amazed at how many of my patients love having gemstones added to their treatments. With gemstones you can be basic or elaborate because there are as many stones as they are single herbs in our Materia Medica. For a real basic gemstone addition you can have your patient hold rose quartz in their left hand while being treated (the left hand is considered the receiving hand). Rose quartz is considered the Universal Stone of Love. It nourishes the Heart, Spirit and Shen. It is great for recharging and opening the heart to Universal love. You can also place chunks of rose quartz on acupuncture points or chakras. Amethyst is another great healing stone and has been used by many cultures in healing practices to balance the body, calm the mind, heal grief, promote emotional balance, ease stress, encourage tissue regeneration and much, much more. Like the rose quartz, you can have the patient hold a piece of amethyst in their left hand or place it on points or chakras. Gemstones also make for an inexpensive and fun giveaway/patient gift. For example, you can use rose quartz or amethyst in a treatment then give your patient a small stone to take home. Small pieces of these stones cost as little as $0.10 to $0.25. A very little investment for a big reward. Like the cotton ball with aromatherapy, you would be surprised how much your patient will value this tiny little stone.
6. Healthy Food Giveaways. We can educate our patients on proper nutrition, recommend they drink a lot of water after a treatment and/or suggest that they go out and buy specific foods and/or supplements but the likelihood that they will actually follow our advice and go drink a bunch of water or buy quinoa or chia seeds can be slim to none with many patients. What I like to do is have what I call “healthy food giveaways” in my office. I believe that if our patients have a taste of what we are recommending they are more likely to go out and buy it for themselves. A few simple and fairly inexpensive healthy food giveaways are:
a. Chia Seeds. I have a large bag of organic chia seeds in my office along with small zip lock baggies. I can send a patient home with a “sample” of chia seeds to try. I can also place some chia seeds in a water bottle while they are getting their treatment and send them home with chia seeds in water. For flavor I sometimes add an Emergen-C pack to the water-chia combo. Once they try chia seeds and like them, they are more likely to go buy them for themselves and receive the super benefit of having more Omega 3’s and fiber in their diet.
b. Emergen-C and Mineral Supplement Packets. I always have a few of these in the office. They are great to send patients home with or even have them drink while they are in the office. These cost about $0.30 when you buy a box.
c. Bottled Water. In addition to a larger water dispenser I like to have single bottled water for patients to take home after treatment, especially after receiving cupping. That way I know they are getting hydrated and flushing out toxins.
d. Go Qi Berries. Like the chia seeds I give little zip lock baggies of Go Qi berries to patients and tell them to try them by adding to hot water, tea or oatmeal. Sometimes I even steep some berries in hot water while they are getting treated and send them home with puffed up Go Qi Berries in warm water. This is a great Blood tonic and way to get your patients to try them.
e. Raw Gan Cao – These are great for the onset of external attacks, slight sore throat or just feeling a bit “out of it”. Gan Cao is so harmonizing and mild that I have little sealed baggies of Gan Cao that I will give to patients and tell them to steep the sticks in hot water and sip throughout the day, making sure to re-fill the mug of hot water and re-use the same sticks for a few steeps. You can also steep some Gan Cao in hot water while they are getting treated and have them go home sipping it.
f. Healthy Fast Food. I have single serving bags of anti-oxidant trail mix (Trader Joes brand). The mix just includes almonds (Vitamin E), Walnuts (great brain food and Omega 3’s), cranberries (antioxidant). These are perfect for patients who consume a lot of junk food. You can introduce them to a more healthy type of fast food for busy, eating on-the-go lifestyles.
Well, there are just six ideas. However, the possibilities to enhance your treatments and keep them fresh and more exciting are nearly endless. I didn’t even begin to explore ideas like adding sacred geometry or simple Qi Gong postures to your treatments.
If you are still finding yourself burned out from private practice, do yourself, and your patients, a favor by working hard to relieve that burnout. It really affects you and your patients in a negative way. Find ways to recharge your own batteries and stay passionate about your chosen field. Here are just a few ideas to get you thinking: Start your own health related or TCM product line. I used to make myself aromatherapy sprays to use in practice and patients loved them and kept asking me to make them a spray. As a result I ended up making an entire product line. It is also very easy to create an herbal liniment or therapeutic product line and put your name or practice name on the label. Just going through the creative process of developing products or unique services can prevent burnout and stoke the fire of your passion for this medicine and helping others. Maybe you are not into creating a product line. How about receiving training in a synergistic modality such as Feng Shui, Chinese Face Reading, Fertility, Facial Rejuvenation, The Tapping Method, Reiki, or even Shamanistic Healing? When you feel ready you can begin to add these modalities to your treatments. It has been said that variety is the spice of life and we know from TCM that spice can be very helpful in treating stagnation. Prevent stagnation and burnout for yourself and your patients. Keep your treatments fresh and exciting. I hope you have found this helpful. Be well. Be happy. Be successful!
Incorporating Aromatherapy into Your Practice (Published Nov. 2011)
Like Chinese Medicine, aromatherapy has been around for thousands of years. Ancient cultures from all over the world have used various forms of aromatherapy ranging from the burning of incense to utilizing the extracted oils from various plants, herbs and flowers. These ancestors used aromatherapy because they understood the healing properties of essential oils and the aromas that come from them. This article aims to provide a general understanding of how aromatherapy works and ways in which you can incorporate aromatherapy into your practice.
Since many of us are familiar with the term “aromatherapy” it is interesting to first explain where this term originated. Back in the late 1920’s, French chemist Rene-Maurice Gattefosse was severely burned in a laboratory experiment. It is said that he applied lavender oil on his burned flesh and discovered that not only did his pain and swelling reduce significantly, but the wound healed rapidly and almost miraculously. It was around this time that Gattefosse began a life-long exploration into this healing modality and coined the term “aromatherapie” (basically referring to the use of essential oils for treating the body, mind and spirit).
Generally, aromatherapy can be applied in three ways: Direct application to the skin, inhalation and internal consumption. In all three scenarios the properties of the essential oils, which constitute “aromatherapy”, travel through the body and eventually go to the brain where they have both physiological and psychological effects.
When applied to the skin, the essential oils are absorbed and enter into the lymphatic system, which then circulate into the blood stream, making their way into the brain. Similarly, when essential oils are inhaled or ingested, they are absorbed into the mucous membranes of the respiratory tract, lungs and/or gastrointestinal system, transferred into the blood stream, and make their way to the brain. Inhalation of essential oils also utilizes the body’s olfactory system which processes the smell, sending a signal to the limbic system of the brain. The limbic system is directly connected to the parts of the brain that control heart rate, blood pressure, breathing, memory, stress levels, the balancing of hormones and the processing of emotions and memories. For these reasons, it is evident that aromatherapy can have a very powerful effect, both emotionally and physiologically.
We can also look at aromatherapy from a TCM point of view. Lavender (Lavandula Angustifolia) and Grapefruit (Citrus Paradisi), two very common essential oils used in aromatherapy, can serve as good examples. Lavender is spicy and sweet, has a cooling nature and affects the Lung, Liver and Pericardium. Two of the major functions of lavender are to promote the smooth flow of Liver qi and calm the shen. Grapefruit is spicy and bitter, has a slightly warming nature and affects the Lung, Stomach and Gallbladder. Major functions of grapefruit include regulating the flow of Liver qi and breaking up qi, food and phlegm stagnation. With their positive influence on qi, just using these two essential oils would be a good start to incorporating aromatherapy into your practice.
So, now that we have a basic understanding of aromatherapy, healing mechanisms of same and two essential oils which we can start to use immediately, how can we specifically incorporate this powerful, ancient healing modality in our practice? Here are a few simple and extremely effective ways:
Diffuse essential oils in your waiting/reception areas and/or treatment rooms. You can buy special plug-in diffusers designed to slowly release essential oils based on your desired strength (i.e. from light to heavy scent). You can also use a small tea-light oil/scented wax burner that does virtually the same thing
without the need of electricity or batteries.
#2. ACUPUNCTURE POINTS
You can place drops of essential oils onto acupuncture points prior to needling or in lieu of needling. If you chose this technique, it is extremely important that you dilute certain essential oils before doing so as some oils can burn the skin. Lavender is an example of an essential oil that is safe to place on the skin directly.
#3. SPACE SPRAY
You can make an aromatherapy spray by placing drops of essential oils into a bottle (preferably dark colored glass) filled with spring water. Similar to making an herbal formula, you can chose one essential oil or create a blend based the individual make up of each essential oil and the desired therapeutic outcome. For a one ounce bottle, eight to ten drops of essential oils is sufficient. You can spray over the patient during treatment or between patients in the treatment room.
#4. EYE PILLOW
Many eye pillows come infused with aromatherapy. However, if you do not possess one of these, you can easily make one by lightly spraying essential oils onto a folded Kleenix tissue and placing the Kleenix tissue onto the eyes of your patient. Instructions on making an aromatherapy spray are given above.
#5. COTTON BALL
Place a few drops of an essential oil or essential oil blend onto a cotton ball and place it on the patient’s chest, near the face, during a face-up treatment. This way the patient is able to receive the aromatherapy while they are having an acupuncture treatment. If they are face down, place the cotton ball on a chair under their nose so they can receive the aroma. When the treatment is over, you can give them the patient the cotton ball to take with them, directing them to continue smelling it throughout the day. You can also give a cotton ball to patients that become extremely relaxed from a treatment and feel “out of it”. Saturate a cotton ball with a few drops of an uplifting essential oil like grapefruit and have them inhale a few times before leaving your office and have them take the cotton ball home with them so they are alert as they drive away and go about their day.
Add drops of essential oils into your massage oil and apply to specific channels of the body or even to the UB channel where we find the back shu points. For eight ounces of massage oil, ten to fifteen drops of essential oils is sufficient. This method is preferred over inhalation for patients that have sinus problems or impaired olfactory systems which may inhibit the processing of inhaled aromas.
These six methods are just a few ways in which you can incorporate aromatherapy into your practice. With hundreds of essential oils, each having their own properties and specific actions on the body, the application of aromatherapy is almost endless. This article is simply an introduction into aromatherapy and only scratches the surface of a much deeper body of knowledge. Many workshops and books offer a more in-depth understanding of this modality as well as additional ways in which you can incorporate its use. Hopefully with just the few tips provided herein, you can find ways to integrate aromatherapy with your treatments and thereby achieve higher levels of efficacy and patient satisfaction.
Combining Aromatherapy with Acupuncture - it Makes Science and Scents (Published Nov. 2014)
Acupuncture and aromatherapy are two individual modalities that have been used for thousands of years to successfully treat a gamut of conditions and diseases. But what happens when they are combined together in one treatment? Is the treatment session more effective? Is there no difference at all? Does it merely increase patient satisfaction and comfort? I set out to answer these questions in 2011 while obtaining a doctoral degree in acupuncture and Oriental medicine. Here I will share with you what I discovered and suggest that yes, combining aromatherapy with acupuncture can make a treatment more effective.
Let’s begin this discussion the same way I began my research - by asking the question: “What is something that nearly all patients complain about?” The answer is: Stress. Stress is something that affects every one of us in one way or another, especially our patients. Some may even take it further and suggest that stress is the underlying cause or root of the majority of conditions we treat.
Many of us know from personal experience that we can effectively reduce stress with acupuncture treatments. In fact, this notion has been proven through multiple studies and a great deal of clinical research. But what if we add aromatherapy to an acupuncture treatment which is aimed at reducing stress levels? Will the addition of aromatherapy reduce stress even more? To determine this, I ran a clinical trial comparing the efficacy of reducing stress levels from acupuncture treatment alone to a treatment session where acupuncture was combined with aromatherapy.
In the early days of gathering research for my clinical trial I was immediately surprised that I could not find a single published study or clinical trial on the combination of aromatherapy with acupuncture. Rather, I found three trials wherein acupressure was combined with aromatherapy but none where acupuncture was combined with aromatherapy. Here was an opportunity to enter uncharted territories.
Selecting a study design for my trial was the next step and I chose to perform a randomized, double-blind, placebo-controlled pilot study. At the time I remember several people asking me: “How can you have a placebo when performing a trial on aromatherapy?” “You either smell something or you don’t, right?” Well, it turns out that many of the previously performed trials on aromatherapy which elected placebo controlled trial designs simply utilized spring water or alcohol as a placebo. In many of these studies saturated cotton balls were placed on the chest area near the study participant’s nose. The cotton ball either contained aromatherapy (the intervention) or spring water (the placebo). Therefore, I decided to adopt the same deliver method and water-based placebo for my trial.
For the acupuncture portion of the trial, I created a point protocol that was made up of acupuncture points that had all been previously proven to reduce stress. The protocol included: Liver 3 Tai Chong, Large Intestine 4 He Gu, Stomach 36 Zu San Li and Yin Tang M-HN-3. This protocol provides a simple and effective stress reducing treatment. Next, I formulated an aromatherapy blend of essential oils, each of which had also been proven to reduce stress levels. The blend included: Ylang-ylang, rose, grapefruit, and lavender all-natural essential oils. From here I had to select study participants, preferably a demographic with inherently high stress levels.
Fortunately, finding study participants was an easy task for me as I was, at the time, the off-site supervisor at an in-house drug and alcohol rehabilitation facility for women. Under my supervision, acupuncture students would provide treatments to the patients that resided at the center, many of which were court-ordered to be there, had their children taken away from them and/or were required to be there for up to 18 months. Believe me when I tell you these women had high stress levels. So, with approval from the center’s corporate headquarters, I recruited thirty (n=30) women to be study participants. I acted as the primary researcher/acupuncturist and a prior student of mine, who was subsequently waiting acupuncture licensing, was my amazing research assistant who administered the aromatherapy, conducted all the paperwork and helped me manage the trial.
The thirty participants were randomly assigned to either Group A (n=15) or Group B (n=15). While all thirty participants began the six week trial and completed at least two treatments, by the end, only fourteen had completed the entire 6-week trial with Group A containing six (n=6) participants and Group B eight (n=8). High participant attrition was a reflection of participants having to appear in court or tend to sick children, thereby missing a treatment session. The trial had a strict policy that if a participant missed a single treatment session, they would be removed from the trial. Unfortunately, due to this policy and the demands on this particular participant population, we lost more participants that we had anticipated. In retrospect, perhaps a trial length of only four weeks or a study design that allowed for one missed treatment may have yielded higher outcomes. Nonetheless, we ended up having an adequate number of participants and sufficient data to provide results.
Each week, for six consecutive weeks, participants came in for a 30-minute treatment session. All participants received the exact same acupuncture treatment from the same primary researcher/acupuncturist (me). Every acupuncture treatment protocol was exactly the same using these points: Liver 3 Tai Chong, Large Intestine 4 He Gu, Stomach 36 Zu San Li and Yin Tang M-HN-3. After needles were inserted, I left the room and the research assistant would come in and administer the aromatherapy by spraying the contents of either Bottle A for Group A or Bottle B for Group B on a cotton ball and placing the saturated cotton ball onto the participant’s chest near their nose. The cotton ball would remain on the participant’s chest as they rested during treatment. After 30 minutes the research assistant would return and remove the cotton ball from the patient’s chest and room before I would return and remove the needles. The rooms were aired out between treatment sessions and neither I nor my research assistant knew which bottle contained aromatherapy or spring water, thereby ensuring the closest thing as possible to a double-blind placebo controlled trial design.
To measure stress level, two instruments were used: The Perceived Stress Scale (PSS) and the SF36, both of which are nationally recognized instruments for measuring stress levels and quality of life, respectively. Participants completed both surveys prior to beginning the trial and after the sixth treatment session. The following table provides a summary of the trial results:
As you can see from the results, both groups received benefit from the treatments. The aromatherapy group and the placebo group both experienced an increase in quality of life (SF36 survey scores) and a decrease in stress levels (Perceived Stress Scale scores). However, the data revealed evidence that Group A had better results compared to Group B. In fact, despite the small sample size, statistical significance was achieved from the before and after scores of the SF36 Survey.
Given these results, can you guess which group received the real aromatherapy with their treatments and which group received a placebo? Yes, Group A received the real aromatherapy intervention and Group B received a placebo of spring water.
This trial proved two things that I find exciting for our profession: (1) It confirms that acupuncture is effective in reducing stress levels; and (2) It provides strong evidence that combining aromatherapy to an acupuncture treatment may increase efficacy. Furthermore, these results lead us to several questions on which to ponder. What if we combined aromatherapy with acupuncture in treating pain, headaches, high blood pressure, weight loss, diabetes, anti-aging, prevention and/or fertility? There are so many areas for further exploration. It is my hope that my findings will not only lead to future trials and research centered around the efficacy of combining acupuncture with aromatherapy but that more practitioners will consider incorporating aromatherapy into their practice.