1. Tobacco Cessation Protocol Doris Hubbs, MD, FACP April 27, 2013

2.  Traditional diagnosis: Inspection Auscultation and Olfaction Inquiring Palpation

3. Wall Street Journal: April 24, 2013

4. Wall Street Journal, April 24, 2013

5.  Traditional diagnosis: Inspection of face, body, and especially the tongue: S: tongue size and shape C: tongue color and coating U: tongue underside (true color) M: tongue markings and moisture

7.  Principal meridians (and internal organs) are reflected on specific tongue areas kidney GB- stomach -spleen-liver Heart -lung

8.  Color Light red or pink: normal Red: abnormal heat Pale: yang deficiency or blood deficiency Purple tongue: stasis Tongue Color can be affected by food or natural pigmentation

9. PALE TONGUELIGHT RED TONGUE

10. Need good lighting, preferably natural light For adequate inspection of color

11. LIGHT RED TONGUERED TONGUE

12. DARK RED TONGUEPINK TONGUE

13. PINK TO LIGHT REDUNDERSIDE : TRUE COLOR

14. THICK TONGUE NORMAL FULL SIZE TONGUE SLIGHTLY SWOLLEN EDGES

15. SWOLLEN EDGES THIN TONGUE?

16. “HAMMER TONGUE”LONG TONGUE

17. UNEVEN COAT NORMAL THIN, WHITE MOIST COAT

18. YELLOWISH, THICK, DRY COAT WHITE COAT “WITHOUT ROOT”

19. NOTE TEETH MARKS AND RED TIP LOOK FOR VENOUS CONGESTION

20. LIGHT REDDARKER RED

21. LESS SWOLLEN; FEWER CRACKS TEETH MARKS REMAIN; BUT TIP OF TONGUE BETTER

22. KI 3 AND SP6 CONNECTED WITH4 HZ ELECTROTHERAPY TO LU 5

23. COAT IS LESS PEELEDTIP IS LESS DENTED

24.  “Quivering” ..\power point presentations 042713\tongue quivering..\power point presentations 042713\tongue quivering

25.  Traditional diagnosis: Inspection of face, body, and especially the tongue: S: tongue size and shape C: tongue color and coating U: tongue underside M: tongue markings and moisture

26.  Traditional diagnosis: Inspection Auscultation and Olfaction Inquiring Palpation

28. Ear (auricular) Hand Scalp (Tongue)

30.  Hand acupuncture: Korean, Chinese,  Scalp acupuncture: Japanese, Chinese,  Ear acupuncture: French, Chinese,

31. ENTIRE BODY ON HANDALL MERIDIANS ON HAND

32. POSTERIOR BODY ON HANDANTERIOR BODY ON HAND

33. CHINESE SCALP ACUPUNCTURE JAPANESE SCALP ACUPUNCTURE

34.  Stroke Rehab  Difficult pain conditions  Neurodegenerative disorders

35. FIND THE MOTOR AREA& THE SENSORY CORTEX

37. AARP BULLETIN APRIL 2013ACUPUNCTURE FOR PAIN

43.  Anxiety  Substance abuse (detox protocols): NADA Protocol  Nausea and GI sx  Pain Specific points Battlefield Acupuncture Protocol Many more conditions can be treated

44. Needle the ear point associated with the part of the body in pain

45.  Observe abnormal ear markings, discolorations, abnormal skin  Palpate for tenderness at specific points  Use electrodermal point finder to locate regions with low skin resistance (high skin conductance)

47.  Acupressure with seeds or pellets  Acupuncture needles: Short needles, 15 mm (0.2 mm) ASP needles (stay in for 1-2 days) Electroacupuncture Laser stimulation

49. FOUR POINTS FOR ANXIETY INSERTED IN “SHOULDER POINT” OF EAR

50. Four ASP gold needles in the autonomic pt., LI, SI, stomach pts. Patient felt better and less nauseated immediately afterwards.

56.  National Acupuncture Detoxification Association Protocol  Works for withdrawal of opiates & other  Shen Men  Autonomic Point  Lung 1 or 2 (use the more reactive)  Liver  Kidney

58.  Five ear acupoints in specific order:  Cingulate gyrus  Thalamus  Omega 2  Point zero prime  Shen men  For acute pain

59. FIVE EAR POINTS USING ASP GOLD SEMI- PERMANENT NEEDLES

60. 5 EAR POINTSMILITARY IS USING THIS

61.  PATIENTS  All Failed Western Pain Medications  A. 40 y/o M Sciatic LBP 10/10 4 weeks TX: 1/10 F/U: 3 days 9/10  B. 52 y/o M Shoulder Bursitis 7/10 1 month TX: 0/10 F/U: 10 days: 2-3/10  C. 36 y/o F 5 years Elbow and Leg Pain 7/10 TX: 1/10 F/U:8 days: 3/10  D. 43 y/o F 9 years TMJ 4/10 TX: 0/10 F/U: 2 days 5/10

62.  E. 77 y/o F 10 months Fibromyalgia 6/10 pain TS: 2/10  F/U:2 days: 3/10  F. 24 y/o F 5 years Carpal Tunnel bilat 4-5/10 TX: 0/10  F/U:4 days: 4/10  G. 21 y/o F 2 years TMJ 4/10 TX: 1/10 F/U: 2 days: 2/10  H. 78 y/o F 7-8 years Left Hip/DJD pain 8/10 TX: 2/10  F/U:3 days: 1/10  I. 50 y/o F 17 years Fibromyalgia Pain 9/10 TX: 0/10  F/U: 5 days: 6.5/10

63. December 2011

64. Developed by Dr. Helms et al.

65. ATP 6 EAR POINTS IN SPECIFIC ORDER  Targets auricular areas that correspond to parts of brain hurt by stress/ trauma  Thought to help balance or normalize brain dysfunction caused by stress/ trauma Helms, et. Al., HMI Auricular Trauma Protocol: An Acupuncture Approach for Trauma Spectrum Symptoms, Medical Acupuncture, Vol.23:4, 2011.

66. ATP 6 EAR POINTS IN SPECIFIC ORDER Use regular or ASP needles (or press tacks or pellets) Leave needles in for 30-120 minutes  Used successfully for: PTSD Pain Acute/chronic conditions Military or civilian Helms, et. Al., HMI Auricular Trauma Protocol: An Acupuncture Approach for Trauma Spectrum Symptoms, Medical Acupuncture, Vol.23:4, 2011.

67.  The tongue can be valuable for diagnosis  The radial pulse can be important for diagnosis but is more difficult to master  Auriculotherapy is one type of microsystem acupuncture that is relatively easy to use  Other microsystems of acupuncture include (Korean) hand acupuncture and Japanese and Chinese scalp acupuncture

68.  More than one protocol available for decreasing withdrawal symptoms  Body acupuncture and ear acupuncture  Does NOT keep the person from smoking or buying cigarettes  Only helps with the w/d symptoms: craving, irritability, nervousness, etc.

69.  Quit cigarettes the night before (day 0)  Day 1: give full treatment protocol  Day 2 or 3: repeat full tx protocol  Open door for ear protocol for 1 st wk  Day 8: give full tx protocol  Week 3: repeat full tx protocol  Week 5 or 6: repeat full tx protocol Modified from Medical Acupuncture for Physicians: A Pocket Clinical Reference Guide (Complied by Carlos Vargas, MD)

70. GB 8, GB 18, (AND GV 20) SP 3 ON EACH FOOT WITH 4 HZ ELECTRICITY

71.  Insert acupuncture needles into GB 8 and GB 18 (both sides of head) SP 3 (both feet and connect electrical stimulation from one foot to the other with 4 HZ) Patient is comfortably semi-reclined and treatment continues for about 45 minutes GV 20 is often added to the acupoints above

72. AURICULOTHERAPY FOR ANXIETY NADA PROTOCOL

73.  Cochrane review of acupuncture for cigarette cessation: no evidence of benefit Acupuncture may improve withdrawal symptoms, but patients need to be committed to stopping cigarettes in order to be successful.

74.  Cigarette protocols and auriculotherapy can be helpful for withdrawal symptoms, including craving, irritability, and anxiety  Patients need to be committed to stop smoking in order to have long term success