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The Good, the Bad and the Successful in Social Marketing
You might be thinking, "social marketing, don't you mean social media?" No, I mean social marketing. Every day, I keep reading, hearing and learning more and more about the changes happening in social media.
Chiropractic Needs a Lesson in Education
The American Chiropractic Association has launched a campaign, The National Medicare Equality Petition, to enact federal legislation that would achieve full physician status for DCs in Medicare.
Herbal Medicine Continues to Evolve
Product manufacturers, industry partners, distributors and practitioners work as a collective Traditional Chinese Herbal Medicine (TCHM) community to produce high quality TCHM prescriptions that bring low-risk healthcare to thousands of patients everyday.
The Effectiveness of Chinese Medicine in Treating Infertility in the Philippines
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Bring on the Bitters
Out of all the possible flavor choices with foods, such as sweet, sour, salty, and umami (deliciousness), which would you choose first? Bitter, though not as enjoyable, is also a flavor.
Shoulder Rehab: The Gait Connection
Shoulder problems can be difficult to rehab completely for several reasons. The shoulder is made up of several joints that must function together smoothly to provide the extreme mobility that is possible and necessary for many activities.
Immunotherapy: Where Molecular Medicine Crosses Into Holistic Thinking
Immunotherapy, and its promise as a cancer treatment, has been in the news a lot in the last few years, and for good reason. Real shifts are happening in oncology and exciting researchers, clinicians, and patients.
Introducing the Dynamic Chiropractic Digital Edition
In response to the changing habits of our readers, Dynamic Chiropractic is proud to introduce a digital edition of the publication beginning with the July 2016 issue.
Are Herbs Useful for Chronic Pain?
The human nervous system is what makes us special, but our greatest strength also makes us vulnerable: witness the growing incidence of chronic addictions, anxiety, depression, sleep disorders and chronic pain syndromes.
How to Bill Evaluation and Management Codes
Q: I am in need for guidance on how to bill evaluation and management (E&M) codes in addition to acupuncture the same date of service, I have never been paid for an exam when done with acupuncture and I believe I am doing it wrong.
Five-Element Reaches Out to Serve the Community
In 2006, a student at the Institute of Taoist Education and Acupuncture (ITEA) approached the administration about an idea for his senior project.
Acupuncture at a Pain Clinic
Introduction: Pain is the most comprehensive human experience. The experience of pain is associated with the somatic, emotional and social impact. Pain has not only somatic symptoms, but also psycho-social dimension, especially in case of chronic pain.
Day in the Life of an Advanced- Practice DC (Pt. 2)
Let's continue our Q&A with Stephen Perlstein, DC, APC, chair of the New Mexico Chiropractic Association PAC and president of the American Academy of Chiropractic Physicians. Part 1 of this interview appeared in the May 1 issue.
Does Anyone Know You're a Good Chiropractor?
If you had a chance to read the recent article in Time magazine (April 6), you know it provided some good information about the efficacy of chiropractic to the magazine's substantial consumer audience.
2016 Trudy McAlister Foundation AOM Scholars
This year, the Trudy McAlister Foundation (TMF) received a record number of excellent applications for the 2016 scholarship awards and has awarded five scholarships for $2000 each. More information is available on our website: AOMScholarship.org
Case Studies and Answer Analysis for NCCAOM Exam in Foundation of Oriental Medicine
Case studies are very common for acupuncture school students, either in class exams or during taking the national board exam. Most test takers feel they have no idea where they should start and how they should start to analyze those complicated cases.
What Should You Call Your Patients (and What Should They Call You)?
When I walked into the exam room, the new patient looked uneasy, fumbling with his cellphone. He was a huge Polynesian man, probably in his 40s, with unrecognizable island tattoos.
Time for World-Wide Growth
Acupuncture is the organically growing around the world. The legislative body in Quatar has said acupuncture is "okay." The United States has five states to go to have every state recognized and regulated.
F4CP Campaign Addresses Public Misperceptions of Chiropractic
In late 2015, results of the Gallup-Palmer College of Chiropractic Inaugural Report: Americans' Perceptions of Chiropractic were published. The report found that 33.6 million U.S. adults (14 percent) had utilized chiropractic care within the previous 12 months.
Who is Your Ideal Patient?
Being in a healthcare practice requires you to think critically about many things including your equipment, techniques, documentation, financial goals, and the retention of clients and staff.
The Liver: The Official of Planning
The Liver, with its paired Official, the Gall Bladder, belongs to the Element Wood within us. Wood grants us the power of birth – new beginnings, growth, breaking through boundaries and surging forward. It is the vigorous, exuberant energy of the spring season.
Diet, Nutrition and the Context of Risk (Part 2): Food Poisoning
Other than the morbidity and mortality linked to eating too much food, "all-natural" organisms that contaminate our food cause more illness, more hospitalizations and more death than food contaminated by heavy metals, plastics, preservatives, artificial colors, emulsifiers, artificial sweeteners and pesticides combined.
We Get Letters & Email
Another Slap in the Face for DCs; I Know Where to Find the Missing Chiropractic Patients; Clarification on Vitamin D Study.
Treatment of Type 1 Diabetes Mellitus: The Latest Breakthroughs
There are now more than 29 million diabetics in the U.S. and 10% of them have Type 1. The incidence has been increasing in recent years at an epidemic rate.
The Eight Extraordinary Confluent Points
The eight extraordinary confluent points are a very popular set of acupuncture points in the modern practice of acupuncture. They are also called the intersection, meeting, command, opening, master, and the flowing and pooling points of the eight extraordinary vessels.
December, 2006, Vol. 06, Issue 12
The Phrenic Circuit, Part Two
By Dale G. Alexander, LMT, MA, PhD
The Phrenic Circuit provides us with a template to conceive of how the body discharges its tensions by endeavoring to distribute them as widely as possible. These tensions originate internally within the sacs and tubes of organ systems of the body and are eventually expressed, externally, via the musculoskeletal system.1 In part one, it was proposed that most chronic problems related to the cranium, neck, upper back, shoulders, arms, elbows and hands consistently have shown an association to the relationships of the phrenic nerves.2 This article will offer additional anatomical and perceptual relationships for your consideration.
Incorporating some of the feedback from the first article, allow me to note that none of these ideas or relationships should be construed to be provable facts at this time.I apply what produces results for my clients. I am not lobbying for the use of any specific touch technique. Rather, it's my clear intention to invite the reader "inside" the body and to introduce them to the power of perception and intention as part of the process in transformational healing. My writings emerge from a distillation of multidisciplinary theories of philosophical, perceptual, energetic, physiological and anatomical relationships. Additional feedback to the first article reflected that practitioners who actually applied the notions described therein were rewarded with an additional capacity to assist their clients.
I would propose that we all release ourselves from operating "within" or attempting "to prove" absolute cause and effect relationships. Rather, let us embrace the associational and relational correlations that have shown themselves to be repeatedly helpful. Last year's Nobel science award went to two dedicated physicians who had been rebuffed by the medical establishment for more than 30 years in their proposed notion that the bacteria, Helicobacter pylori, is highly correlated to the formation of gastric and duodenum ulcers.
In my experience, chronic problems most often involve multiple sources feeding into a recurring somatic complaint. Obviously physical trauma or repetitive wear and tear of physical activity are slices of the pie. However, when one examines human consciousness in its relationship to anatomy and physiology, many additional slices of the pie have shown themselves to be relevant.
These articles are an exploration of discovering the treasure within each of our clients. What has made the biggest difference for me, as a practitioner, is to place my perception and intention inside of the human body "feeling with my eyes and seeing with my hands" and to expand my perception to include the dimensions of sacred and energetic relationships. I also endeavor to bring to the table simple human common sense.
Let's briefly review. The phrenic nerves originate within the spinal cord from C3 to 4-5. This overlaps the origin of the brachial plexus nerves from C4-T2. This relationship within the spinal cord suggests a "shared circuitry." It's my postulation that the body uses this overlapping within its neural net to distribute the sensory tensions of all the organs and musculoskeletal structures that have even remote connections to this portion of the spinal cord.
"Everything is connected to everything," were the words of a chiropractor who was invited as a guest speaker in my original advanced training with Bill Williams, PhD and Ellen Gregory, PhD, at their Soma Neuromuscular Integration Institute in 1980.3 This phrase made an imprint which resonates even to this day.
Last year's flooding of Hurricane Wilma in the Florida Keys made this even more viscerally clear to me. Just as water finds its way into, around, under or over whatever it can, it has been my experience in working with chronic problems that the electrochemical and electro-magnetic energy of the body can use any portion of the human neural net in its attempt to distribute strain and re-establish some kind of homeostasis. And the punch line is that there appears to exist fairly specific energetic and neural relationships the body uses more frequently. These are the treasure maps for us to follow and improve upon in our collective intention to assist our clients. It has been my clinical experience that the relationships of the Phrenic Circuit are one of these treasure maps.
Let us dive deeper into a review of the basic anatomy. The phrenic nerves are the sole "motor supply" to the diaphragm muscle. There is a separate right and left phrenic nerve, each with its own excursion through the thoracic cavity vitalizing respectively the right and left hemi-diaphragms. Along their descent through the thorax, the phrenic nerves supply sensory branches to the pericardial sac of the heart, the mediastinal/pleural sacs of the lungs and to the subclavius muscles. Once below the diaphragm muscle, they communicate with the celiac plexus through a common phrenic ganglion. Other sensory relationships routinely identified and inferred include the peritoneal sac, the gallbladder, the capsule and the hepatic and falciform ligaments of the liver, the pancreas, both sides of the esophagus and the adrenals.4 Once tied into the celiac plexuses, all the organs below the diaphragm potentially can use this sensory channel to express their tensions. Old-time anatomists commonly described the celiac ganglion and plexus as the "solar plexus" and as an abdominal brain. The point here is that the sensory supply to the phrenic nerves is an extremely open system, not a closed neural loop, and one that intimately shares the spinal cord circuitry of the brachial plexus that provides the neurocirculatory supply for the upper extremities. The Phrenic Circuit does not create anything physiologically, rather it's the conduit for the expression for deeper tensions to be expressed.
I propose that the Phrenic Circuit functions similar to the "canary in the coal mine." This is a phrase from the turn of the century when coal miners would take canaries in cages down into the mineshafts with them, to create an early warning system when their safety was in jeopardy from a buildup of carbon monoxide or natural gas leakage. When the canaries stopped singing, it was a warning to the miners to vacate the underground shaft.
In a similar fashion, the internal organs of the body seek to let us know when their stress levels have reached a threshold of importance. It's like the student who gyrates and excitedly waves their hand in the back of the class endeavoring to be recognized. The inside is signaling through to the outside that something needs attention. The inside is where our consciousness lives and grows, or doesn't, where the biological tenaciousness of the "mind" refuses to operate in present time.5
In the early stages, "that something important," usually relates to our emotional or energetic experience in relation to someone or to a future or past event. We call this "stress." However, the "canary" also can be signaling that dysfunction or disease has begun to progress toward pathology. This suggests that when a symptom of the head, neck, shoulders, arms or hands "just won't go away," it's appropriate for us to refer our clients for a medical checkup.
Currently, most of my clients have been to physicians before contacting me. For a general massage therapist, I would recommend a three session rule. If you have been unable to assist within three sessions at least a 50 percent reduction in their somatic intensity and the profile of their complaints remains unchanged, then send them on to a physician. The following description of "referral patterns" might offer additional guidance.
Let's examine the left and right-sided relationships reflected through the theorized Phrenic Circuit. According to Dr. William Silen's compilation of the experience of surgeons in Cope's Early Diagnosis of the Acute Abdoment, "the significance of constant or intermittent pain in the region of the fourth cervical nerve (the principle root of the phrenic nerves) is still sometimes either not understood or seriously neglected. Pain on top of the right shoulder may be the only signal that an inarticulate liver abscess, threatening to perforate the diaphragm, may be able to produce."6 Dr. Silen enumerates a host of acute and potentially life-threatening ailments we do not routinely see in our offices but that, I propose, often use the Phrenic Circuit in their attempts to be noticed in the early and middle stages of their development.
According to Dr. Jean-Pierre Barral, DO, the developer of the Visceral Manipulation Approach, the gallbladder, liver and the right lung reflect their tensions via the right upper extremity whereas the stomach, pancreas, spleen, heart and left lung reflect their tensions into the left upper extremity. In addition, his many years of clinical experience correlate to the left side of the neck most consistently to gallbladder difficulties and the right side of the neck to liver problems.7
It has been my own clinical experience that early warning signals of diverticulitis attacks often use these upper extremity and cervical referral patterns as well, with the ascending colon referring into the right shoulder while the descending colon usually refers into the left. I also have experienced kidney problems to use this circuitry, especially long-standing sub-clinical kidney infections and clients on the verge of a kidney stone becoming lodged in one of the ureters. However, most commonly in my experience, either kidney will refer its chronic tensions into the low back, the inguinal region and/or into the same-sided hip and most frequently the knee. Additionally, there are presenting anomalies that switch sides. Duodenal ulcers might do this or abdominal adhesions might refer via the pancreatic sensory supply through the phrenic/brachial plexus overlap to the left shoulder or from the transverse colon that is a literal connector between both sides.
I experienced the adhesion example with a female client who exhibited a confusing switching back and forth between the right and left shoulder and neck symptoms, only to discover after an exploratory laparoscopic surgery that she had a 2 centimeter adhesion between the duodenum and the abdominal wall that was referring through both sides of the circuit. Her presenting problem was a constant state of anxiety.
Another case study might further serve to illuminate these relationships. About 17 years ago, while still studying with Dr. Barral, I was working with a client whose right shoulder began to freeze, i.e., progressively began to lose range of motion until he had only about 20 degrees of abduction remaining.
He lost functional use of his right arm for most activities of daily living including his ability to work with his computer. Not good, as he was, and still is, a publisher. He had been diagnosed as having a frozen shoulder and his orthopedist recommended he have his shoulder surgically broken to re-mobilize it. This was a regular client who would see me about twice a month, so I had a perspective from his somatic onset and followed it through to its resolution. I had consistently been using connective tissue, muscle energy, and CranioSacral techniques to mobilize the range of motion of his shoulder along with the visceral touch techniques I learned from Dr. Barral, to mobilize his gall- bladder, liver and to assist in clearing his common bile duct. Nothing worked, but all I had learned about the progression of gallbladder difficulties pointed to it as a bigger slice of the pie.
I begged my client to see his physician and have an ultrasound done of his gallbladder. I have no problem pleading with my clients to seek medical consultation. The test showed he had two rather large gallstones, so big they were unlikely to ever find their way into the common bile duct. His physician told him that removing them was the best course of action but that he could live with them as they were. He selected to live with them. Within a month of his ultrasound and discussion with his physician, we were able to fully re-mobilize his shoulder.
From the beginning of his problem until the eventual resolution and restoration of his shoulder motion, took approximately six months. Obviously, I had yet to create the three-session rule mentioned earlier, however, here was evidence that the body can get used to just about anything. This same case study will be cited and explored further in my next article. The resolution of a presenting somatic complaint does not mean living with something will not affect a client's quality of life or won't possibly contribute to the progression of emerging pathology.
Now, let's explore the dimension of "sidedness" from another perspective. According to Lansing Gresham's The Body's Map of Consciousness, the left side of the human body for both genders reflects our composite of experiences with females while the right side of our bodies reflects our composite of experiences with males.8 One of the most defining elements of our human experience is our gender, how we feel about our own and how we feel about the other. For example, when a male client presents with chronic right-sided complaints, I become curious as to how he feels about himself as a male and the nature of his relationships with his father, brothers or other males in his life. This also includes the absence of male family members through divorce/custody battles, geographic dislocation or death. In contrast, when a female presents with a chronic history of right-sided complaints, I expand to consider not only the possibility of conflicts/trauma associated with males in her life, but also her feelings and the degree of permission she has for assertive expression of her wants and needs. And, of course, for both sexes there often is the wound of not being the gender expected or wanted by one or both parents.
Carl Jung articulated the notion that within females and males there exist conjointly an "anima" and an "animus," both a receptive and a nurturing side and the capacity for confidence in expressing one's competence, skills and abilities.9 We all are challenged to integrate these elements within the process of identity formation throughout the course of our lives, as are our clients.
During sessions with clients, it's my willingness to perceive anything is possible without any preconceptions that allows a quality of touch through which a client might access my library of knowledge and experience. It involves perceptually accessing a space of "not knowing" where clarity through touch might emerge "from within the client," signaling to me the many possible variables relevant to them.
As human beings we are complex. As we turn the facets of the diamond there are many reflections. This article can only serve but to introduce you to some of them. The next time one of your clients speaks to you about chronic problem(s) with their right or left upper extremity or neck, please consider that one of the streams feeding into the Phrenic Circuit might be a contributing factor, that some aspect of the person's sense of self is seeking expression and acknowledgement. Also, please consider exploring the references listed below.
Click here for more information about Dale G. Alexander, LMT, MA, PhD.
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