Hello to all of you taking your acupressure TCM inspired course. My name is Justin Laube and I'm an integrative primary care physician in Los Angeles at a center called the Center for East-West medicine, which is at UCLA or UCLA Health, in Westwood in our clinics in Santa Monica, California. In clinic, we use acupressure in our primary care practice as a self-care strategy. Commonly, we use acupressure for patients who come in with anxiety, depression, or other psychological stress. We'll also use acupressure to help patients with pain, whether that's more acute or chronic pain. When we see the patient, we will think similar to other primary care doctors, like internists, family doctors, and even some specialists, to evaluate this problem from a Western or mainstream lens. Next, the main thing is to get through the first step of sorting out, is there something very scary or concerning going on? We'll do a Western workup if needed, meaning labs, full physical exam and history taking, other referrals if needed, and other tests. Along the way as those are going on if they're needed, then we oftentimes will teach patients acupressure approaches to help with their immediate symptoms. There are a number of points that we use, about eight common points on the hands, the feet, the chest and neck that we commonly use because they're commonly used by acupuncturists and in our clinic for chronic or common ailments. Let me give you an example so we can move out of the obstruction. A common patient, I'll call him Steve, so Steve is 35. He is otherwise healthy aside from some sports injuries when he was playing basketball in college and he also is now working as a computer engineer. He comes in with four weeks of increasing neck pain. It's mostly achy, sometimes sharp, a sensation of moving down the arm a little bit but no weakness or numbness in his fingers. It's associated with headaches or he'll get a tension headache, no migraines. When he's seeing me as an integrated primary care physician, I'm listening like any other typical provider, trying to sort out what's going on here and so what I'll do is a physical exam and the history taking. For him, we've ruled out his vital signs are okay. He doesn't have any neurologic abnormalities, he can move his neck full range of motion. Nothing is really flagging as concerning, and so what we add to it as a lot more touch. Touch, meaning palpation or pressing acupoints or trigger points or tender points and we know where they are, because this is a common map. In the neck and shoulder area, this is the trapezius, this is a common point. It's also an acupuncture and acupressure point called GB 21. GB20 is up here, the base of the occiput. We'll usually feel those and if we can elicit or recreate a lot of their pain, then we already are a leg up saying, we know there is a tender areas here. That also gives us a little key as to how to work with this. Because his workup and evaluation initially looked pretty normal, no red flags symptoms, we could proceed with, "Hey, you could try Tylenol, you could try acetaminophen, or you can hold on that, use some heat and we can teach you how to stimulate these points on your own." What we did for him is we recommended a heat pad, we gave him a handout of some basic stretches for his neck and then gave him a handout that included common acupressure points and showed him how to do it. You can use your fingers and so we taught him that, but we found out that acupressure is one form of stimulation, that's through physical touch, but you can also teach someone how to use a golf ball on their foot or their IT van or their chest wall, you name it. Foam rolling, heat, submerging into warm water, all of these are different ways to stimulate an acupoint. As far as your course in acupressure, there's so many different ways to stimulate on different points. There's no specific point for a neck pain, but if you ask a number of acupuncture practitioners, they'll tell you LI4, Large Intestine 4 is a very commonly used point called the four gates of the body here and Liver 3 on the feet. These names sound a little funny for a Westerner because we think of them as organs, but it's part of the language of traditional Chinese medicine, which I'm sure you're learning. Megan had asked me a question as, how do I apply or use the TCM principles in primary care? As of describing, using Large Intestine 4 or Chi, Shen, the blood stasis, this language is challenging for many of my primary care patients. Many are younger in the area and just looking for an open-minded physician. I usually try to use words that they understand. They can understand balance, being imbalanced, out of balance. They can understand generally about flow in their body. They commonly have heard of Yin and Yang and I usually sync that up with the concept of homeostasis, one thing goes up, the other goes down. We have a homeostatic mechanism to maintain our temperature at 98.6 or wherever your set point is. I teach them about Yin and Yang. For Steve, for example, we would talk more about his work as a computer engineer. The second anyone mentions they work with computers, the likelihood of them working in a way that might be out of balance with their intelligent nature is high. Why is that? Well, computers get people to stick and sit down and be stuck in these positions that we were not engineered to live our life like. I can almost guarantee, he's here with his head forward and his body would be out of balance and his brain would be going at 1000 miles per minute as his face and eyeballs are hit with all this electrical energy all day as he is computer coding, even with the best desk, even with the best everything. That would be someone who'd be physically out of balance, very doing energy, maybe very cerebral because of his processing system and I would describe that as this Yang energy, Yang meaning the heat, the sun energy, the day energy that is just ramping up that is quite common for our culture in the West, and I would try to support him towards Yin energy, which is more cooling, grounding, that would be more moon energy and describe it in these naturalistic terms. How would I do that? Acupressure would be more Yin, depending on the stimulation amount, but supporting the body squeezing, touching, slowing down, trying to help him re-balance. The acupressure and the treatments involved in traditional Chinese medicine are more than just take this and you'll feel better. It actually is part of helping them, specifically acupuncture and acupressure to feel their body more, to relax more, breath more, and all of that supports flow and balance which are key for health in traditional Chinese medicine. I wish you well in your course. Thank you.