Full Transcript Introduction to the Balancing Point 0:00 Doctors should be picking all of these things up before they ever run a lab. 0:04 Posture, if I were talking to them and they weren't just kind of lounging in front of their computer, they're attempting to open the back of the spine. 0:12 So if they have a spinal problem, a disc, it's probably on the, If they were sitting kind in a military fashion with their belly pushed forward, 0:20 It would probably be an attempt to the other side of this. 0:23 Again, very telling. 0:25 Hi, and welcome to The Balancing Point. 0:27 I'm Dr. 0:28 John Needers. 0:29 And I'm here to make traditional Chinese medicine, functional medicine and integrative health simple, practical and fun. 0:38 So you can restore balance, boost vitality and enjoy a healthier life every single day. 0:45 Hi there, this is Dr. 0:47 John and I am back with another episode of The Balancing Point. 0:50 This one will be a moderate length, but I think it's pretty fun for you to watch. 0:54 And this has taken from a course that I teach. 0:58 fairly regularly and also I was inspired by a book that my wife gave me. 1:05 Now, when I see a patient, it's usually a three-part exam for me, I have a scribe that's taking notes. 1:12 I will do a general seated visual exam that I'm going to go over with you. 1:16 Then I'll do palpation, which in this case seated is mostly taking their pulses in the Chinese medical way. 1:23 And then we take them into the other room, have them lie down, and we do variety of other exams there.
Three-Part Patient Exam Overview 1:29 Now, occasionally we add orthopedic or gait testing, et cetera, but very, very rarely in my part of the practice, I have several really skilled, 1:40 sports medicine, orthopaedic practitioners in the office that do most of orthopaedics. 1:46 My wife is the acupuncturist for the San Francisco 49ers, St. 1:51 Mary's rugby team, she teaches all over the world. 1:54 She treats athletes from all of the other world, so she's got it pretty well handled. 1:58 So I get to stay in my lane and do what I do. 2:02 Now, when I see a patient, well, before I got to that, my wife gave me this book called Bedside Cardiac Diagnosis done by Henry Marriott. 2:12 And Henry is a cardiologist from the United Kingdom. 2:16 My wife kind of giggled when she gave it to me and she pointed to a particular section and I saw why she giggling. 2:22 He went on a rant. 2:24 Henry was just going on and on about how cardiologists had lost their ability to do bedside diagnosis. 2:34 He said they've gotten too reliant on technology and they miss too many things and their patients suffer needlessly. 2:41 Well, I've gone through that rant many times in front of my wife and she's seen my process, so she knew I'd appreciate this. 2:49 So, gait analysis. 2:51 Now, this doesn't have to be formal. 2:53 In fact, we don't do them, I don' do the formally, my wife does. 2:58 What this involves is I will stand up, walk out in the hallway, and we have a fairly long hallway back to my office, And I'll watch people walk. 3:05 You can tell a whole lot about what's going on in terms of injuries, in term of illnesses, In terms their attitude, whether they're depressed, 3:15 Whether they are happy, etc. 3:17 All these things just watching them walk into your office. 3:21 Then I'm going to shake hands. 3:23 Yay. 3:24 Well, what can you tell from that? 3:27 Do they have any strength? 3:29 Are they weak? 3:30 are they hot? 3:31 or are cold? 3:32 Or are their hands clammy? 3:35 So all of these things that you can tell by a handshake. 3:39 You can get a lot about their attitude also. 3:41 So then from a Chinese standpoint, we have a LOT of advantages that Western medical doctors don't.
Observational Diagnosis: Gait, Handshake, and Facial Clues 3:49 So here we're looking at a map of the different zones on the face that corresponds to different organs. 3:57 There's one of Katherine, my associate's favorite favorite teachers, was a woman named Lillian Bridges who passed away a few years ago who was brilliant 4:07 at this. 4:07 I had a couple patients that I told about Lillion. 4:11 They went up to see her in Seattle. 4:14 She diagnosed exactly what I had diagnosed just by looking at their face. 4:20 And she told them a lot more stuff also about kind of their personal life and things. 4:24 So it can be quite astonishing. 4:28 Again, here are some of those zones. 4:30 You can look back at these at some time. 4:32 And you get these different areas. 4:34 So we look at acne, and sometimes it's the large intestine. 4:38 Sometimes it is the stomach. 4:40 sometimes It's a small intestine, but you can tell what's out of balance just from looking at their face. 4:47 Now, I'm going to follow that up with a dozen, a hundred other tests. 4:51 I am going read their labs. 4:55 I haven't even started yet. 4:56 I hadn't started interviewing them yet and I have all this information. 5:02 Then you've got your eye processing patterns. 5:04 Those of you that have done neuroassociative conditioning or looked at neurocode systems, you know that people when they're accessing their brains in different 5:15 ways will look in difference quadrants or different areas with their eyes. 5:20 So if you ask them a question, what did you have for breakfast this morning? 5:24 And they look up to the left, then they're seeing their breakfast. 5:28 If they looked off to side, to left then, they are talking to themselves actually about their break. 5:36 And so then you can see if they lying, if go from recalled to constructed and then tell you a story, right? 5:42 So again, This can be very helpful. 5:45 And one of the reasons it's helpful is it helps the doctor access their predominant styles of listening. 5:52 It's like if someone speaks Spanish, it is not very effective for me to speak French to them, unless they also know French. 5:59 So I want to be able to their language. 6:03 This is an ear coloration chart. 6:06 I'm not going to go into the details, but looking at the ears and seeing different colorations is very powerful. 6:13 here on this fellow. 6:15 Now you can't see it very well, but There's a line out there, earlobe, okay? 6:23 It's called a diagonal ear lobe creasing, and it's positive correlation to atherosclerosis and coronary artery disease. 6:31 Now, it is not a tremendously high correlation, but there is a correlation. 6:36 Again, I can't point here, if you look at the very apex of this gentleman's ear, you see a big black spot. 6:44 That's the point for high blood pressure. 6:46 If you come down around the back of the ear, you're going to see several other black spots. 6:51 And if you look more in the top, about one third of way down from the tip of your ear you see a white spot and you'll see some more black spot. 7:01 Those are all diagnostic. 7:04 Now here we've got skin tags. 7:07 This is often type 2 diabetes or too much insulin.
Eye, Ear, Skin, and Posture Indicators 7:10 Sometimes it's just genetics. 7:12 And here you see xanthalasia. 7:16 swellings at the upper inner canthus of the eye. 7:20 Now if you see all three of those, if he sees xanthalasia, skin tags, and franksign, those three together, there is a proven positive correlation to atherosclerosis 7:32 and coronary artery disease. 7:34 You see, all 3. Here's corneal arcus, you're staring at your patient. 7:39 or you're the patient being stared at, and you see these white areas around the cornea. 7:45 And that's an indicator generally of very high cholesterol levels that have settled into the vessels. 7:53 Here's thyroid ophthalmopathy or Graves' disease. 7:57 You see how the eyeballs are bulging. 8:01 Probably the classic example of that, it was the actor Marty Feldman. 8:05 He was in Young Frankenstein and a few other movies, and he had very clear Grave's disease eyes, okay? 8:13 Now again, your doctor should be picking all of these things up before they ever run a lab. 8:20 Posture, this person very possibly, you know, if I were talking to them and they weren't just kind of lounging in front of their computer, 8:28 they're attempting to open the back of the spine. 8:31 So if they have a spinal problem, a disc, it's probably on the rear. 8:35 If they were sitting kind in a military fashion with their belly pushed forward, It would probably be an attempt to the other side of spine, 8:44 so again, very telling. 8:46 Okay, you're gonna look at muscular tone and balance, skin quality, pulse oxygen, nails, palms, and then channel palpation of the end channels, 8:56 which I'm not gonna have time to go into today, but. 8:59 These are all things you look for. 9:01 Now, these pictures came out of Wikipedia and they always show the most severe cases. 9:06 If you had nail clubbing like this, you would have already been diagnosed. 9:11 Your doctor couldn't miss this. 9:13 But you see many minor cases of lung clubing, I mean of nail-clubbing, and you can catch it early, like here. 9:19 This is called the shamroth window. 9:21 You can see a little window there. 9:25 a little kind of diamond-shaped window where you can see white between the nails. 9:30 If that disappears, that means there's nail clubbing. 9:34 These are really easy to spot if you look for them. 9:38 I've never had a doctor look at them, so these are small blood clots. 9:42 It's called a splinter hemorrhage because it looks like a Splinter. 9:45 And when I point them out to people, they swear they're splinters, but there is no splinder. 9:50 So these tiny bloodclots, that are getting trapped in these tiny, tiny capillaries in the fingers. 9:57 And this is really about the only place you can see them because you see through the nail and see the clots. 10:05 Now this often infective endocarditis. 10:08 It can also be cancer, et cetera. 10:10 That just means let's look deeper and look quickly. 10:14 Okay, I'll leave these up here. 10:16 I'm not going to go through all of them, but you're welcome to come back and take a look at them. 10:21 But each of these nail and nail bed colors can tell you something. 10:27 So this is a baby with a heart disease. 10:29 You can see the red fingertips. 10:33 Here we've got cyanosis, the blue from very low oxygen levels. 10:38 Here we've got onycholysis. 10:41 Lysis means to break down. 10:43 And you see the nails are, this isn't just typical like biting the nail.
Nail, Hand, and Finger Findings 10:48 This is from psoriasis, or it can be due to a thyroid problem, thyrotoxicosis. 10:54 You don't really see it much, but there are also a couple white spots on the nailed beds, which is usually, not always, usually a zinc deficiency. 11:06 So you want to look at the nail and the nailed bed color. 11:10 So here we've got these alternating lines. 11:15 These are called Mies lines and they can show up if there's arsenic or thallium poisoning and sometimes in kidney failure. 11:23 Fortunately, they are not very common. 11:26 Bose lines, this is much more common, This is a horizontal area of depression, and this is non-specific, but it means something really bad happened. 11:36 Heart attack, stroke, death in the family, something that was so shocking that the body would not put energy into growing fingernails at that time. 11:47 And you can see it. 11:47 I have patients, I'll go through their history. 11:50 but I'll look at their nails and I go, something severe happened to you like six months ago. 11:55 Oh yeah, you know, this and that happened. 11:57 I got in a car wreck and, I was hospitalized, but they hadn't put it on their history, right? 12:02 But the Bose lines don't lie. 12:06 Vertical nail ridging, that can be many different things. 12:09 Again, too many to go into in this presentation. 12:13 And then physical exam of the hands and fingers. 12:17 Heberdeen's nodes, that's where the distal interphalangeal joints, the joints closest to the nails, get swollen and hard. 12:30 Sometimes painful, sometimes not, but that is really a sign of osteoarthritis. 12:36 Ehlers-Danlos, I will pull on people's skin, you know, to see how much stretching and flexibility they have, because most of the patients I see with Ehler's 12:47 Danlos have not been diagnosed by their doctors when I seen them. 12:51 Here's some hypermobility, often associated with ehlers Danlo, but not a hundred percent. 12:58 Dupuytrenes contracture, You can see there on the fourth finger, the ring finger. 13:04 There's a. 13:06 a bump there, which is where the connective tissue has become damaged. 13:11 Dapertrains contracture. 13:13 This is a gene that was passed around the Atlantic around Great Britain, et cetera, by the Vikings. 13:21 That was very kind to them. 13:23 Here you have Osler's nodes. 13:25 Now again, this one's really extreme. 13:27 The one like on the index finger is much more likely to be found. 13:32 This is an immune complex deposition. 13:34 I mean, something's, really messing with your immune system. 13:39 Effective endocarditis is often the cause of a Janeway lesion and these are very subtle. 13:45 It's not like the Oslar's node or like, wow, I can't miss that. 13:49 this ones easy to miss. 13:52 It's almost always missed because doctors don't look at your hands. 13:58 Rheumatoid arthritis, that's obvious. 14:01 Now the art of pulse taking. 14:03 Probably the single most important thing from a Chinese medical perspective is pulse-taking. 14:10 We check three or four positions. 14:12 Some people even check five on each wrist and we look for the depth, the quality, there are 28 pulse qualities. 14:19 So when you multiply that out, got 9 to 15 on each hand and then you've got them on both wrists and you put those together. 14:28 This is an amazing diagnostic tool. 14:34 We'll look at the tongue. 14:35 When we look the top of the Tongue and underside some lingual veins. 14:39 These are Chinese medicine things. 14:42 Tongues diagnosis. 14:42 If this is a female, severe premenstrual syndrome. 14:50 So you see the area in the middle of the spleen and stomach is very depressed. 14:54 It's indented. 14:56 The area on the sides, the liver gallbladder is swollen.
Tongue and Mouth Diagnosis 15:00 That's a sign of an earth-wood disharmony or liver assailing the splen and the stomach. 15:06 And that will cause way, way horrible PMS. 15:10 There's also a little bit of a heart cleft here. 15:12 This person could easily suffer from anxiety. 15:17 This is really a bad one, this is a tongue of a breast cancer patient. 15:22 You see the swelling there, very unusual, but that's a very clear indication. 15:29 Here we have glossitis, that red tongue. 15:32 This can be any number of B vitamin deficiencies, But it can also be from inflammatory bowel disease like Crohn's disease. 15:40 And then you see that horrible patch of Candida there. 15:45 Okay, we had angular chelitis. 15:48 That's where you have redness at the corners. 15:51 That can be caused by anything from anemia to infection. 15:54 Leukoplakia. 15:55 Now your dentist will hopefully pick this up. 15:59 I've never had a doctor look in my mouth. 16:01 And this is a precursor to mouth cancers. 16:06 Gingivitis. 16:07 At the top, you can see the damage. 16:09 The bottom you see when it's cleaned up, very important because gingivitus is one of and maybe the leading cause of heart attacks. 16:19 Way, way, more important than cholesterol. 16:22 And I'm not saying cholesterol doesn't play a role, but gingivitis and gum infections are much more dangerous. 16:29 Then we'll take them in the other room. 16:31 We will do a physical exam. 16:34 Murphy sign. 16:35 So we reach under there. 16:36 You can see that green in their little green place. 16:39 It's the gallbladder. 16:40 We'll have patients breathe in, exhale. 16:42 I'll put my hand up under their ribs, press on the Gallbladder, and if it's hot, they'll scream at me. 16:48 Okay? 16:49 So, we're going to check that. 16:50 And we'll palpate over the liver. 16:53 we are going check for the livers size. 16:55 If I'm suspicious, I will do what's called the hepato jugular sign where We put them at a 45 degree angle. 17:02 We press on the liver and you'll see changes in the blood vessels in their neck. 17:09 Here's a picture, but it's not a very good picture. 17:11 There are lots of very, good videos on this. 17:16 Blood pressure. 17:17 should always be a minimum of both arms. 17:22 Always be minimum a both arm. 17:24 You might want to do all four quadrants if you're suspicious of peripheral vascular problems.
Abdominal, Cardiovascular, and Blood Pressure Exam 17:29 I use just a general electronic measuring device for my general checks. 17:36 And I used a cuff and a stethoscope if I find something abnormally high or to confirm other findings. 17:43 Stethoscope, I'm going to listen to their heart sounds, bronchial sounds and intestinal sounds. 17:48 Now we're getting into things that doctors will do more often, but still. 17:55 It's very rare to do intestional sounds here's the heart map. 18:00 Physical exam, we're going to look for Morton's toe. 18:03 That's where the second toe is longer than the big toe, and here it's called short big toes, but it can actually also be long second toes. 18:13 And that will cause several gait problems over time. 18:17 So it is nice to know it. 18:19 Notice it? 18:20 Mortons neuroma, again named for Dr. 18:22 Morten. 18:24 is actually a calcium deposit that gets around the nerves and you can see it there between the third and fourth toes. 18:35 It's a Calcium deposit and those can hurt like heck. 18:39 Chronic venous insufficiency. 18:41 I'll check every patient's legs and feet to make sure they're not getting vein breakage. 18:48 This is very serious. 18:50 Venous stasis dermatitis. 18:52 Diabetic shin spots. 18:53 Often people don't know they are diabetic, but this is another Symptom, saphenous vein thrombosis. 19:09 Now, I've had patients that had no other symptoms other than a little cramping on the medial portion of their calf. 19:19 I checked them. 19:20 They had an obvious saphanous veins occlusion. 19:24 It feels like a hard pencil. 19:26 If you know what it feels, like you can't really miss it. 19:30 And then we'll do, look for general eye pupillary examination, the stagmas, that's where the eyes bounce back and forth. 19:37 The pupil's accommodation to light and something called a PPR, which is a paroxysmal pupillary reflex. 19:45 Now this I will do when there's a concussion or I suspect a conjunction, but it also can happen from brain stem and tumor issues. 19:53 And the bottom line is when you shine a light into the eye at an angle, so your darkened room, shine the light. 20:01 The pupils should hold the contraction for 30 seconds. 20:04 If they don't, there's something wrong. 20:06 And one of the things that I didn't list here is severe adrenal fatigue. 20:11 The adrenals just aren't providing enough energy to keep the pupils contracted. 20:17 So there is basic eye exam. 20:20 Raglan's test, we do this on most patients. 20:24 If you have a postural change from lying to standing, it should increase the blood pressure by five to 10 points at two minutes. 20:32 Some doctors prefer three minutes, I do it lying down. 20:37 Then I'd do a 30 second standing because I want another thing.
Legs, Feet, and Orthostatic Testing 20:40 I wanna see how the adrenals are responding. 20:43 And then two minute standing. 20:45 Adrenal fatigue, the lower the number, Well, anyway, if they drop, so I get a lot of chronic fatigue patients who their blood pressure will drop 30 to 35 20:59 points when they go from lying to standing. 21:02 That's very, very dangerous and very bad. 21:04 They can get orthostatic hypotension from low blood volume and pass out. 21:10 So there are a couple of things we wanna check with that. 21:13 So that's the end of the presentation. 21:16 These are ways that you can get in touch with our office. 21:19 And I wanna thank you if you sat through all this and start expecting more from your doctor, whoever it is. 21:25 I don't care if it's an acupuncturist, a chiropractor, an MD, start accepting more them and make sure they're really giving you a thorough examination. 21:38 Until next time, be happy. 21:40 Be healthy. 21:41 See you soon. 21:42 Bye-bye. 21:44 Thank you for joining me on The Balancing Point. 21:46 If you enjoyed today's episode, please follow the show, share it with a friend, and leave a review. 21:55 Feeling out of balance? 21:56 Most approaches just manage symptoms. 22:00 Here we get to the root. 22:02 So real healing Real clarity and balance can begin. 22:07 Visit AlamedaAcupuncture.com to learn more, explore our supplements or book a call. 22:17 We'd love to hear from you.
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