FACIAL

ENHANCEMENT
ACUPUNCTURE

Clinical Use and Application

PAUL ADKINS
PHOTOGRAPHS BY ROGER DUTTON
Figures 1.1 and 3.1–3.7 have been purchased and adapted from iStockphoto.com
in accordance with their Standard Licence.
Figure 1.1 © iStockphoto.com/LindaMarieB.
Figures 3.1–3.6 © iStockphoto.com/ariwasabi.
Figure 3.7 © iStockphoto.com/Gangliulo.
Figures 4.1–5.14 are reproduced with kind permission from Roger Dutton.
All photographs have been edited and enhanced by Stacey George.

First published in 2014

by Singing Dragon
an imprint of Jessica Kingsley Publishers
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and
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Copyright © Paul Adkins 2014

Photography copyright © Roger Dutton 2014

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ISBN 978 1 84819 129 7

eISBN 978 0 85701 103 9
CONTENTS

DISCLAIMER

ACKNOWLEDGEMENTS

PREFACE

1.
INTRODUCTION TO FACIAL ENHANCEMENT
ACUPUNCTURE

1.1
The Five Elements

1.1.1
The Wood Element


1.1.2
The Officials of the Wood Element

1.1.3
The Wood Element Facial Patient

1.1.4
The Fire Element

1.1.5
The Officials of the Fire Element

1.1.6
The Fire Element Facial Patient

1.1.7
The Earth Element

1.1.8
The Officials of the Earth Element


1.1.9
The Earth Element Facial Patient

1.1.10
The Metal Element

1.1.11
The Officials of the Metal Element

1.1.12
The Metal Element Facial Patient

1.1.13
The Water Element

1.1.14
The Officials of the Water Element

1.1.15
The Water Element Facial Patient

1.2
The History of Facial Acupuncture

1.3
Modern-Day Treatment Comparison

1.4
The Development of Facial Enhancement Acupuncture

1.4.1
The Muscles of the Face

1.4.2
Lines and Wrinkles

2.
EXPECTED RESULTS OF FACIAL ENHANCEMENT
ACUPUNCTURE

3.
ACUPUNCTURE POINTS USED IN THE MAIN PROTOCOL

3.1
The Aggressive Energy Treatment (AE Drain)

3.2
Acupuncture Points on the Feet and Legs

3.3
Acupuncture Points on the Hands and Arms

3.4
Acupuncture Points on the Head and Forehead

3.5
Acupuncture Points around the Eyes

3.6
Acupuncture Points on the Jaw

3.7
Acupuncture Points on the Front of the Face

3.8
Acupuncture Point on the Chin

3.9
Acupuncture Points to Treat the Neck

3.10
Auricular Acupuncture Points for Facial Enhancement Acupuncture

4.
STEP-BY-STEP GUIDE TO THE FACIAL ENHANCEMENT
ACUPUNCTURE PROTOCOL

4.1
Contraindications

4.2
Preparation

4.3
Step-by-Step Guide to Facial Enhancement Acupuncture

4.3.1
Initial Grounding Treatment

4.3.2
Needling the Legs and Feet

4.3.3
Needling the Hands and Arms

4.3.4
Needling the Head and Forehead


4.3.5
Needling the Ears

4.3.6
Needling the Eyebrow Area

4.3.7
Needling the Jaw

4.3.8
Needling the Front of the Face

4.3.9
Needling the Chin

4.3.10
Treating the Neck

4.3.11
Treating Wrinkles


4.3.12
Applying Serums and Creams

4.4
Facial Enhancement Acupressure Massage

4.4.1
Massage Stage 1

4.4.2
Massage Stage 2

4.4.3
Massage Stage 3

4.4.4
Massage Stage 4

4.4.5
Massage Stage 5


4.4.6
Massage Stage 6

4.5
Finishing the Treatment

5.
ADVANCED FACIAL ENHANCEMENT TECHNIQUES

5.1
Jade Gua Sha

5.1.1
About Gua Sha

5.1.2
The Gua Sha Facial Massage

5.2
Jade Rollers

5.2.1
About Jade Rollers


5.2.2
Step-by-Step Jade Roller Facial Massage

5.3
Dermal Rollers

5.3.1
About Dermal Rollers

5.3.2
How Skin Needling Works

6.
TREATING SPECIFIC FACIAL ISSUES

6.1
The Acupuncture Meridians and their Role in Facial Enhancement
Acupuncture

6.2
Sagging Facial Muscles

6.3
Eye Bags and Dark Circles

6.4
Age Spots and Skin Discolouration

6.5
Acne

6.6
Eczema

6.7
Rosacea

7.
FACIAL ENHANCEMENT ACUPUNCTURE CASE STUDIES

7.1
Case Study 1: Jane, Aged 58

7.2
Case Study 2: Petra, Aged 35

7.3
Sample Case Studies

8.
MARKETING FACIAL ENHANCEMENT ACUPUNCTURE

8.1
Marketing to Existing Patients

8.2
Attracting New Patients

8.3
Online Marketing

8.4
Memberships

8.5
Branding

8.6
Top Ten Marketing Tips for Facial Enhancement Acupuncture

GLOSSARY

RESOURCES


REFERENCES

LIST OF FIGURES

Figure
1.1
The face and neck muscles

Figure
3.1
The location of the head and forehead points

Figure
3.2
The location of the points used around the eyes

Figure
3.3
The positioning of the jaw points

Figure
3.4
The location of the points used on the front of the face

Figure
3.5
The location of Ren 24

Figure
3.6
The location of the points used on the neck

Figure
3.7
The location of the auricular points 1–18

Figure
4.1
Demonstrating needling at Yin Tang

Figure
4.2
Demonstrating needling in the hairline at BL6

Figure
4.3
Demonstrating needling at GB14

Figure
4.4
Demonstrating needling at the Extra forehead point

Figure
4.5
Demonstrating needling at the auricular point Shen Men

Figure
4.6
Demonstrating needling at Yuyao and the intradermal needling
technique using wide grip tweezers

Figure
4.7
Demonstrating the eyebrow needles in place

Figure
4.8
Locating the first jaw point and tucking the skin beneath the jaw
bone

Figure
4.9
Demonstrating needling along the jaw line

Figure
4.10
Demonstrating how to needle the Extra cheek point

Figure
4.11
Demonstrating needling at ST4

Figure
4.12
Demonstrating needling at LI20

Figure
4.13
Demonstrating needling at ST3

Figure
4.14
Demonstrating needling at SI18

Figure
4.15
Demonstrating needling at ST2

Figure
4.16
Demonstrating needling at Ren 24

Figure
4.17
Demonstrating needling at SI17

Figure
4.18
Demonstrating needling at Ren 23

Figure
4.19
Demonstrating needling at ST9

Figure
4.20
Demonstrating intradermal needling at the ‘number elevens’

Figure
4.21
A close-up of intradermal needling in a forehead line

Figure
4.22
Demonstrating intradermal needling in the forehead lines

Figure
4.23
Demonstrating the intradermal needling technique at the base of
the nasal labial fold

Figure
4.24
Demonstrating intradermal needling along the nasal labial fold

Figure
4.25
Demonstrating intradermal needling on the ‘crow’s feet’

Figure
4.26
Demonstrating intradermal needling along the top lip, chin and
the bridge of the nose

Figure
4.27
Placing thumbs above Yin Tang to begin the facial massage

Figure
4.28
Sliding both thumbs across the forehead

Figure
4.29
Using a circular motion at the temple

Figure
4.30
Using the middle fingers to massage the forehead with continuous
strokes

Figure
4.31
Begin by placing your thumbs at LI20

Figure
4.32
Sweep down the nasal labial fold

Figure
4.33
Applying pressure to point ST4

Figure
4.34
Continuously stroking the chin in an upwards direction using
each thumb

Figure
4.35
Begin with thumbs placed at ST9

Figure
4.36
Gently sweeping the thumbs up the neck

Figure
4.37
Finishing the stroke from ST9 beneath the ears

Figure
4.38
Holding the tension on the cheeks up towards the ears

Figure
4.39
Placing both hands, with fingers touching at the centre of the neck

Figure
4.40
Sweeping upward strokes on the neck area

Figure
5.1
Using gentle pressure to sweep the jade Gua Sha stone from the
neck to the ear

Figure
5.2
Working on the nasal labial fold

Figure
5.3
Massaging the forehead lines with the tip of the Gua Sha stone

Figure
5.4
Rolling the jade roller from the ear to the mouth

Figure
5.5
Moving the jade roller across to focus on the nasal labial fold

Figure
5.6
Using the large jade roller to massage the neck

Figure
5.7
Rolling the large jade roller up and down the side of the eye

Figure
5.8
Turning the large jade roller 90 degrees to roll up to the eye

Figure
5.9
Sweeping the large jade roller across the face

Figure
5.10
Using the small jade roller to roll across the nasal labial fold

Figure
5.11
The small jade roller is used on the chin area

Figure
5.12
Targeting the top lip area with the small jade roller

Figure
5.13
Rolling the ‘crow’s feet’ with the small jade roller

Figure
5.14
Using the small jade roller to smooth the ‘number elevens’
DISCLAIMER

The techniques and methods described in this publication are based on the
author’s knowledge and personal experience and no guarantees can be made as
to their accuracy or success. The author can take no responsibility whatsoever
for the results of any treatment that someone decides to carry out after reading
this publication. In no circumstances should the information contained in this
book be used as a guide for medical practice or purpose. If a medical condition is
suspected, then you are advised to consult a medical practitioner, particularly if
you are on orthodox medication.
ACKNOWLEDGEMENTS

This book has been made possible by the love, support and encouragement of so
many people.
First, I want to acknowledge the help and support of my partner Stacey
George. Without her editorial assistance, design work and expertise in research,
this book would not have come together on time, if at all. She is an
accomplished Feng Shui practitioner and Chinese astrologist and I am sure has
many of her own books to write.
Also, I would like to thank Julie George for her role as our model for the Step-
by-Step Guide. Her patience was greatly appreciated. These photographs were
all taken by a very good friend, Roger Dutton. His dedication and skill with the
camera is second to none.
I would also like to extend thanks to my three great children who I am so
proud of, and my fantastic parents who have always been there for me and
encouraged me to set my sights high.
I would like to acknowledge and thank all of the staff and my fellow students
who attended the College of Traditional Acupuncture in Leamington Spa,
England. I have been honoured to have been taught by some of the finest minds
in Five Element Acupuncture and without their support and encouragement I
would not be publishing this book today.
My appreciation goes to my demonstration patients and the students who
undertake my courses. You continue to inspire me with your enthusiasm for
Facial Enhancement Acupuncture, which vastly helps the continual progression
of the protocol.
My thanks go to Jessica Kingsley Publishers for their faith in me and their
help with this publication.
Thank you, everyone, for your assistance, and I hope this book justifies your
support.
PREFACE

I first started my journey into acupuncture in the year 2000 at the age of 40,
quite late compared to many other practitioners. My entire working life was
previously involved in sales and marketing, of one type or another, so studying
acupuncture was a whole new departure for me.
I studied Classical Five Element Acupuncture at the CTA College of
Traditional Acupuncture in Leamington Spa, England, and gained an honours
degree as well as my licence to practise. When I was first looking at acupuncture
as a subject to study, I was not aware of the differences between styles and it
was purely through luck and good fortune that I picked this form. I was
immediately drawn to the Chinese Five Elements; I could instantly see how
everything about them made such good sense, both from an acupuncture point of
view and also in daily living.
From my early days in practice, I was always interested in facial and/or
cosmetic acupuncture and the possibilities that it can offer for improvements to
the skin’s structure and facial suppleness. I started by experimenting with
different facial points and looking at the results that could be achieved by their
application. I was amazed at how, with continuous use of some points, the facial
muscles could be trained, very similar to having a work-out in a gym. This
change in the face remained for quite some time after treatment. The target was
then to try to maintain these results long term.
With my Five Element Acupuncture training, I was fortunate to be able to
incorporate body points into my treatments which helped to endorse and
maintain the facial work that I was carrying out. I was also able to use my
experience in this area to maximise the overall health and wellbeing of the
patient, so that the effects were more far-reaching than appearance alone. As the
treatments progressed, I began to use other needle techniques that would
encourage the stimulation of collagen in the face and help to reduce fine lines
and wrinkles. This combination of treatments resulted in a very powerful form of
acupuncture, specifically developed for the face; this is what we call Facial
Enhancement Acupuncture (FEA).
FEA continues to develop and is now practised in many countries throughout
the world, with acupuncture practitioners attending our workshops and online
courses on a weekly basis. However, it does not stop there; I am still making
advancements in FEA and looking at new forms of needling for the face. These
include techniques like Micro Needle Therapy (MNT), laser therapy and other
forms of collagen induction.
I originally wrote The Pocket Guide to Facial Enhancement Acupuncture in
2006; this book was very well received, but covered only the basics of a FEA
treatment. For some time, I have been looking forward to writing a far more
comprehensive publication and I hope this is it; this book should cover all the
basic information that an acupuncturist wanting to learn facial acupuncture needs
to know.
This is by no means the end of the story; in fact, we are only just getting
started. I am still amazed on a daily basis by the power of acupuncture, and
facial acupuncture is no exception. FEA will continue to develop and I am
excited about the prospects for its future.
CHAPTER 1

INTRODUCTION TO FACIAL
ENHANCEMENT ACUPUNCTURE

As a Classical Five Element Acupuncturist, this form of treatment influences all

that I do. You may already be familiar with the Chinese Five Elements of Wood,
Fire, Earth, Metal and Water. Perhaps you are a practitioner of Five Element
Acupuncture. However, there is no need to worry if you are not – knowledge of
this style of acupuncture is not required to carry out a Facial Enhancement
Acupuncture treatment. Having said that, I would like to give you a brief
introduction to the Five Elements and show how they might be able to help you
when treating a patient, be it for a conventional acupuncture session or a
Facial Enhancement Acupuncture treatment.

1.1 THE FIVE ELEMENTS

The basis behind a Five Element Traditional Diagnosis is to try to work out
which Element is your patient’s Causative Factor (CF); this is the Element that
remains with them from birth, or early childhood, for the rest of their life. The
CF represents a person’s underlying imbalance and once you have determined
this Element, you can tailor your treatment plans with this in mind. In my
experience, this additional information should help you to achieve some
remarkable results.
Five Element practitioners diagnose a patient’s Element by using four key
factors: emotion, colour, odour and the sound of their voice. And, as we will see,
the Five Elements of Wood, Fire, Earth, Metal and Water are also associated
with, amongst other things, the organs of the body and the seasons. These
correspondences extended to flavours, as outlined in this extract from the most
significant book in the history of Chinese medicine, the Nei Jing ( Nei Ching) or
The Yellow Emperor’s Classic of Internal Medicine:

 Hence if too much salt is used in food, the pulse hardens, tears make
their appearance and the complexion changes. If too much bitter
flavour is used in food, the skin becomes withered and the body hair
falls out. If too much pungent flavour is used in food, the muscles
become knotty and the finger and toe nails wither and decay. If too
much sour flavour is used, the flesh hardens and wrinkles and the lips
become slack. If too much sweet flavour is used in food, the bones
ache and the hair on the head falls out. (Veith 1972, p.141)

Salt is the flavour of Water, bitter relates to Fire, pungent is associated with
Metal, sour is linked to the Element of Wood and sweet correlates to Earth. This
excerpt alone demonstrates how knowledge of the Five Elements can reveal a
direct correlation to the condition of the skin and appearance.
Now, obviously I cannot explain in a few paragraphs what takes many years
to learn, but I would like to give you a short taster of the Chinese Five Elements
and how they may be incorporated into a Facial Enhancement Acupuncture
treatment. You might then decide to explore the Five Elements further and in
greater depth.
According to Taoist theory, the Five Elements were born of Yin and Yang and
in turn they gave birth to the Ten Thousand Things. Many would say that this
subject is a life-long study but, if this ancient classic is anything to go by, it is
one well worth dipping in to for matters of longevity:

This knowledge of the Tao and the workings of Yin and Yang was
considered even strong enough to counteract the effect of age. Thus we
find it said in the Nei Ching that ‘Those who have the true wisdom
remain strong, while those who have no wisdom grow old and feeble.’
(Veith 1972, p.17)

To begin, let us look at each of the Five Elements individually.

1.1.1 THE WOOD ELEMENT

Spring is the season of the Wood Element, the time of rising Yang energy,
creativity and birth:

Simple and fresh and fair from winter’s close emerging,

As if no artifice of fashion, business, politics, had ever been,
Forth from its sunny nook of shelter’d grass – innocent, golden, calm as the
dawn,
The spring’s first dandelion shows its trustful face.
(Whitman 1888, p.375)

The spring is the time when we look forward to the coming year with optimism
and excitement, or rather we should, if our Wood Element is in balance. This
season is all about fresh starts and new things bursting into existence; it is seen
in the plants and the trees around us and the wildlife coming to life after the long
sleep of winter. We should be starting to make plans for the future now, putting
to rest memories from the past and looking forward with optimism:

Spring is the time of birth and regeneration. The burst of activity

which surges out of the stillness of the winter has no equal elsewhere
in the year; there is an energy and dynamic force abroad which brings
life and vigour to everything. (Worsley 1998, p.1.2)

The spring can be a very lively and noisy time with people starting to go about
their business and planning for the new year ahead. The animals are beginning to
show more activity in the fields, as the spring lambs bounce around. It is
generally a time when things start to happen after the shutdown of the winter
months. The gift of this season is the optimism and chance to look to the future.
It brings to us an opportunity to start again, to put failure behind us and take a
fresh approach to life. Obviously, this only works if we are in balance. If we are
suffering from an imbalance during this season, we will find it very hard to plan
or look forward; we will have no energy, no drive and no ambition. If we have
no vigour, then we can become depressed and anxious; these are all signs that
something is not right.
Spring is linked with the Wood Element because of the prospects for growth
and development. If a tree is not nourished and given a chance to grow, then it
will wither and die, very much like the Body and also the Spirit of a person who
is suffering from an imbalance. Again, like a tree, we must be able to bend and
be flexible, adapting to things that may come our way. We must stay strong and
rooted, but supple enough to give a little, should the need arise:

And so the tree grows according to its destiny, in harmony with the
seasons, in constant battle with the natural forces. As it grows strong,
the winds and weather do it less harm. The tree maintains enough
flexibility to sway in the wind, yet stays firmly rooted in the ground.
(Herrmann 2000, p.180)

The Wood Element will show itself as someone who is well motivated and
organised, someone who is a scrupulous planner; perhaps they might be self-
employed or a director of a company, a person used to having life mapped out
ahead of them. They are people who like to be pushed and their abilities tested
and stretched. A Wood Element will be totally dedicated to anything that he or
she pursues. This may be to do with work or the family; it can be taken literally
to the point where that person would lay down their life for that cause. If we
look at an historical example, we could see this devotion in Joan of Arc who,
being so totally dedicated to what she believed in, became a martyr.
The spring is truly a time for inspiration, when everything looks more positive
than perhaps at any other time of the year. This is the time when we can achieve
and get things done:

My beloved spake, and said unto me, Rise up, my love my fair one,
and come away. For, lo, the winter is past, the rain is over and gone;
The flowers appear on the earth; the time of the singing of birds is
come, and the voice of the turtle is heard in our land; The fig tree
 putteth forth her green figs, and the vines with the tender grape give a
good smell. Arise, my love, my fair one, and come away. (Song of
Solomon 2:10–13, King James Version)

The emotion that is linked with the Wood Element is that of anger or lack of
anger. When a Wood Element is in balance, this emotion will not necessarily be
portrayed as the usual idea of anger, but perhaps more as a forcefulness of
wanting to get things done, not tolerating laziness or sloppiness. Whereas a lack
of anger will come across as someone who is very timid, and they may appear to
have had the stuffing knocked out of them.
The sound that relates to this Element is that of shouting and patients with a
constitutional imbalance may have a clipped or loud voice:

The voice of thunder is heard and through the Spring Equinox, the
yang makes its victorious rise more visible. Celebrations are in the
making and everyone is excited, pushed on with a slight feverishness.
The songs of the workers rise in harmony with this awakening of
spring. These are the aspects of the second month: the Awakening of
Insects and the Spring Equinox. (Larre 1994, p.28)

The Yin and Yang of this can be seen in the patient who may struggle to be
heard.

1.1.2 THE OFFICIALS OF THE WOOD ELEMENT

Within each Element there are organs, also known as Officials, which process,
store and distribute vital energy. Their functions are very specific and it is this,
rather than the physical properties of each, that works to maintain life.
The Wood Element has two Officials: the Liver and Gall Bladder. They can
be likened to the architect and the site foreman on a building site: one makes the
plans and the others make the decisions on how to put these plans into progress.

Liver
The Liver is the ‘Official of Planning’; this manifests itself in the Body, Mind
and Spirit. We must all have a plan, be it long term or short term; otherwise we
would lack direction and meander aimlessly. The Liver Official is always
evident in a Wood Element as they are very serious planners. They usually have
everything mapped out to the finest detail; they will also have a contingency
plan prepared for those times when things do not go quite as they expected. A
Wood Element in balance will have all the angles covered. When things are
planned to this degree, it can give us the peace of mind to be able to relax, as we
know we have all eventualities under control.
The Body has many contingency plans of its own that spring into action when
they are required. When we cut ourselves, a plan is launched that begins to clot
our blood. There are many plans that are in place, which release hormones into
our system when our reserves are becoming depleted. Another example of a
plan, this time solely in women, is that of the menstrual cycle. This is a plan that
is regular when we are in balance; as soon as we suffer an imbalance these plans
go out of the window and the menstrual cycle can become irregular or can even
cease.
The Liver carries on planning for our futures and without this service we
would flounder and lose direction. This Official also gives us the power to be
flexible; when things do not quite go to plan, the Liver will give us the
adaptability to change them. When there is an imbalance, any change of strategy,
such as this, would be devastating and we would not be able to cope. The ability
to plan is more important than ever to our Spirit; we need to be able to look to
the long term and we want to be able to realise the goals that we have set for
ourselves. Without this capacity to organise our lives and look ahead, it could
almost feel as if we have no reason to exist.
The Liver is the Official responsible for managing the flow of Qi and also
Blood. An imbalance would emanate in the Mind as an inability to move
forward, a feeling of being stuck in the same place and eventually becoming
stagnant, as nothing is moving. On a more physical level, an imbalance may
show in the form of anaemia or some other blood disorders. It may also be
evident in poor circulation, as the blood is not flowing freely to the extremities
of the body. This in turn can cause poor joint conditions and arthritis. Also the
nails on the fingers and toes usually show signs of being in a poor condition;
these are obviously at the extremities and not receiving the circulation that is
required.
Gall Bladder
The gall bladder weighs 3 liang and 3 chu, is 3 ts’un long and lies
within the shorter leaf of the liver... It can hold 3 ho of liquid essence
(bile). The gall bladder’s spirit is Lung Yao ‘splendor of the dragon,’
its epithet is ‘the stately and the radiant one,’ and its shape is that of a
hybrid of turtle and snake. (Wallnofer and Von Rottauscher 1965,
pp.82–84)

The Gall Bladder is the ‘Official of Decision Making and Judgement’. It is the
Official that converts the plans into actual decisions; it excels in making choices.
Of course, if this Official is suffering from an imbalance, then the opposite
applies and decisions will be very difficult to make.
Our whole existence involves decision making on one level or another. On the
physical side, for every movement that we make, a decision has to be made as to
which direction, or how much weight, or when can that arm or leg move. That is
why people whose Gall Bladder is not functioning correctly might show signs of
movement disabilities or stiffness of the joints. Obviously, decision making is
more evident in a Mind situation, and without this Official functioning to its best
capability, the person will stagnate and be unable to make any decisions – they
will flounder without any direction or purpose. They may also resort to being
very judgemental about others; they will have a fixed idea of how they think
things should be and there is no room for reason or discussion over the matter.
The Gall Bladder is one of the most influential Officials in the body,
becoming involved with all of the others; it directs and organises the rest: ‘In
Chinese medicine the Gall Bladder is said to be the only Official who works
with pure essence; all of the others either store or come into contact with
polluted or dirty energy’ (Worsley 1998, p.10).
Western medicine sometimes removes the Gall Bladder in cases of disease
and the patient can live a normal healthy life, but if that is the case, why do we
have the organ in the first place? From this perspective, the Gall Bladder carries
out the function of storing bile, which it regulates to the Small Intestine. Without
the Gall Bladder the bile still flows to the Small Intestine, but in more of a drip-
feed manner, rather than a regulated flow. Personally, I think I will try to retain
my Gall Bladder. This decision follows what I, and medical doctors, considered
to be a recent Gall Bladder issue. I had been experiencing some considerable
pain under my ribs in the area of the Gall Bladder and after some treatment with
acupuncture and adjustments to my diet I paid a visit to the doctor. They agreed
with the diagnosis and I was sent for various scans and tests. The curious thing
was that during the whole time I was suffering with the pain, my decision-
making process had gone to pieces; a ‘headless chicken’ comes to mind – I could
not make a decisive decision about anything.
Following the scans and regular acupuncture, my Gall Bladder had settled
down and I felt quite strongly that, given the choice, I would not want to part
with mine and face a life of indecisiveness.

1.1.3 THE WOOD ELEMENT FACIAL PATIENT

‘The amazing ability of the liver to regenerate following partial resection or
injury is unique, especially because the highly differentiated functions of the
organ are totally maintained’ (Papadimas et al. 2012, p.1). The qualities of
regeneration held by the Liver are so important, especially from the perspective
of ageing.
One thing that we can be sure of when we see a Wood patient for a Facial
Enhancement Acupuncture treatment is that they would most likely have done
their homework; they will know what they are looking for and will have
everything planned to the finest detail. There should be no problems with this
patient making a decision, unless of course they are out of balance and, if that is
the case, perhaps some general acupuncture should be the first course of action.
One of the main symptoms in a Wood Element can be poor circulation, which
means blood is not flowing freely to the extremities. This could manifest in the
face and the skin; it may look dull and lifeless and there may be signs of age
spots and discolouration. A Wood patient would definitely benefit from the
circulatory stimulation that a Facial Enhancement Acupuncture treatment would
bring to the skin.

1.1.4 THE FIRE ELEMENT

The Fire Element is linked to early summer, south and the colour red: ‘Insects
dart and buzz continually until the air itself seems to be in motion, while
butterflies duck and rise like flames. Through it all, light and heat bear down
with an intensity that sears the senses’ (Reichstein 1998, p.52). This is the time
of maximum Yang and the Fire Element CF will carry echoes of this in what is
likely to be a passionate, friendly, enthusiastic and compassionate nature. The
sun, at its zenith at this time of the year, fills us with warmth. The Fire Element
has the power to transform things and this season has that quality: ‘The term
“fire”...also means “to transform”...the yang Qi are in charge and the ten
thousand beings undergo change and transformation...’ (Rochat de la Vallee
2009, p.71).
Often with a rosy or red complexion, the Fire person’s dominant emotion is
joy. Like the emotion of anger for Wood, this can manifest at either extreme as
an excess of joy or a lack, leading to sadness. Problems in relationships can also
derive from an out-of-balance Fire Element, either from not letting others in or
by being too open, without determining whether someone is trustworthy.
A Fire CF is likely to be naturally tactile, flirtatious and at times inappropriate
in what they say. When they are in balance, they can be happy, playful, great
communicators and full of genuine laughter. It is then that this Element has the
ability to truly listen to the needs of people in their lives.

1.1.5 THE OFFICIALS OF THE FIRE ELEMENT

Unlike the other Elements, the Fire Element has four Officials: Heart, Small
Intestine, Pericardium and Triple Heater.

Heart
The Heart is the ‘Supreme Controller’ and that is exactly what it does; this
Official should be protected at all costs. All of the other Officials are likened to
the ministers in a court, who take their orders and allotted duties from the Heart.
The Western medical view of the Heart is very important, but it is only really
considered to be a pump. The Chinese perspective is far greater; you rely on
your Heart to instruct the other Officials in the tasks that they should carry out,
but these can only be the wishes and desires of the other Officials.
The Heart is also the home to our Shen. This is our Spirit. When our Shen is
strong, this will show in our whole presence, the way we act and conduct our
lives. Governing the distribution of Blood throughout the body, the Heart, when
its flow is strong, will reach every corner of our physical being:

Shen...is Yin in character and said to correspond to the mind. It is

responsible for complex mental, emotional and spiritual feelings and
affecting areas like consciousness, mental activities, memory, thinking
 and sleep. It receives its input from the senses, thus the events outside
the body are directly related to a change in Heart rate. (Herrmann
2000, p.213)

The other view of the Heart is that of the Official of love and other emotions.
This is very clear when traumas and feelings are evident. We are always hearing
how the Heart was broken or how someone has given their Heart to someone.
The Heart may be the Supreme Controller, but it is also very vulnerable to attack
from the emotions and needs to be protected at all times.

Small Intestine
The Small Intestine is known as the ‘Official Who Separates Pure from the
Impure’. It is the Sorter.
The Stomach passes on the rotted and ripened food to the Small Intestine,
whose role is to extract the pure Qi energy and then pass on the waste to the
Large Intestine for disposal. This sorting helps to maintain a pure Mind and
Spirit. If this Official is not functioning properly, it may become evident, in
extreme cases, in depraved or degrading behaviour. The Small Intestine’s link to
Fire is that this Element helps to warm the positive Qi energy, to give warmth
and joy to our lives.
There may be times when things seem confused and in a mess; this can be a
sign that the Sorter is not working correctly. On a physical level, the Body can
then become sluggish and slow; it becomes bogged down with bile and rubbish
that is not being sorted by the Small Intestine. The stagnation of waste within the
Body can show in the symptoms of a tummy ache, especially in children, or as
pains, such as in the lower back. If this Official is not functioning properly, it
can lead to stagnation or pollution not only of the Body but of the Mind and the
Spirit too.

Pericardium
Also known as the ‘Circulation Sex’ and the ‘Heart Protector’, it protects the
Supreme Controller from insult and injury. The Heart is so busy organising the
other Officials that it does not have the time to watch its own back. That is
where the Pericardium comes in; it is the bodyguard to the Heart.
The Heart Protector stands in the way when we suffer from physical or mental
shocks:

The Heart Protector’s role should not come as a surprise to us since

there are many parallels in nature around us of the same function. The
bees protect their queen with millions of workers, so that she can be
allowed to do her work without fear of invasion and attack. Herds
gather themselves around their leader, and fend off threatening attacks.
(Worsley 1998, p.11.3)

Triple Heater
The Triple Heater, also known as the Sanjiao or Triple Burner, is the ‘Official in
Charge of the Three Burning Spaces’ within the main trunk of the Body. The
interesting thing about the Triple Heater is that it is the only Official that does
not manifest itself in any particular organ. It has a title, but no form as such; it is
still an immensely important Official within the system. The main job of the
Triple Heater is to maintain an even balance of heat across the three main areas
of the Body; this sustains an even climate for each of the other Officials to
perform at their optimum level. The nickname for this Official is the Heating
Engineer; picture him running around your system maintaining the organs’
output and reliability. If this Official becomes out of balance and too much heat
accumulates, this can cause lethargy and laziness. Also, the Mind and Spirit start
to overheat and we lose our tempers and patience. If it goes the other way and
we begin to freeze, then things will eventually grind to a complete stop.
This Official also monitors the conditions that are around us; either in the
climate or those that we may subject ourselves to, like hot baths or cold drinks, it
then adjusts our Body’s thermostats to suit.
So, although this Official has no form, its presence is felt throughout the
Body; if it is sick and not performing its duties properly, then the whole system
of Officials will cease to work correctly.

1.1.6 THE FIRE ELEMENT FACIAL PATIENT

‘Facial complexion, which is a direct reflection of blood circulation, is also a
major external indicator of heart function’ (Reid 2001, p.55). Therefore, the
Heart is indicated when the face shows excessive redness or, where there is a
lack of Fire, an extremely pale complexion.
 The Heart also houses the Shen and, as this links to the emotions, when
troubled this can have an effect on stress levels and a patient’s sleep. We all
know how sleep deprivation (SD) can affect the way we look and feel, and a
2010 article collected data that shows why this may be happening:

...reduction of sleep time seems in many ways to affect the

composition and integrity of various systems. The SD causes an
increased production of glucocorticoids, which may alter the integrity
of the skin. In addition, the SD causes deregulation of the immune
system, which consequently may also affect the integrity of collagen
fibres. (Kahan et al. 2010, p.536)

We can see that the Fire Element out of balance can manifest in insomnia, which
clearly can have a direct effect on the skin.
The emotion for Fire is joy and the sound is laughter. The focus of a Fire CF’s
treatment may even be around the fine lines and wrinkles that have formed from
all that smiling. Like the sun, a Fire Element CF may like to be centre of
attention. There is an underlying vulnerability that sees them hankering for
compliments. This craving could be a driving force for them seeking treatment
to enhance their appearance and is something that may come to light during the
initial consultation.

1.1.7 THE EARTH ELEMENT

The Earth Element is linked to late summer, the time of declining Yang.
Traditionally, it is seen as the central pivot for the other Elements: ‘The
exceeding beauty of the earth, in her splendour of life, yields a new thought with
every petal’ (Jefferies 2010, p.64).
An Earth Element is a person who is used to serving others. It is something
they do without complaint and they are at their happiest when they are helping
people with one thing or another. This rushing around looking after other people
could lead to a feeling of emptiness, or being unfulfilled in one’s self, because
all of their energy and time is taken up by other people. This lack of fulfilment
may manifest itself in an Earth Element as an eating disorder – a need to eat in
order to give themself some attention. Although they would be eating, it would
not necessarily be for the reasons of nutrition, but more than likely as a need to
do something for themselves. This would probably lead to excessive eating and
digestion problems, with a feeling of being bloated – an Earth Element may
show signs of heaviness or lethargy.
Another sign of an imbalance in an Earth Element is for them to go to
extremes of one form or another. They may become obsessed with cleanliness or
with how they look, or they may go completely the opposite way and let their
appearance and standards go altogether, not taking any interest in themselves at
all. For some, these feelings go back to when they were children and their
mother was always making sure that they were constantly clean, neat and tidy:
‘The Earth Element nourishes us as our Mother, feeding and supporting us,
giving us the ability to care for ourselves and others’ (Worsley 1990, p.21). Of
course, if this nurture was lacking in childhood, it can lead to a constant search
for this kind of attention. When we understand this, it is not hard to see how the
emotion associated with Earth is that of sympathy. This need can be excessive or
there can be a complete lack of compassion.
We are all made up of the Five Elements and, although you may not consider
your patient’s primary CF to be Earth, you may recognise a little of this Element
in their make-up. For example, they may feel that they are always taking on
other people’s problems or worrying about others and what might happen if they
do not help them. There is often a fear of letting others down and, for an Earth
Element, this can feel as if they are carrying a large weight across their
shoulders, which stops them from walking upright and grinds them down. It is
important for those with an Earth CF to realise that they can still care about
people, but they need to take time to look after themselves too.

1.1.8 THE OFFICIALS OF THE EARTH ELEMENT

The Earth Element is all about nourishment and nurturing, about taking on board
food and digesting and distributing it around the Body. This is done by the two
Officials – the Stomach and the Spleen. As well as nourishing the Body we must
also look after the Mind and Spirit equally.

Stomach
We must always be looking to digest as much knowledge as we can in order to
keep the brain as active as possible. By absorbing this information, we are
making ourselves feel secure and able to cope with problems. So, it is
understandable that, when an Earth Element is out of balance, this can also affect
the Mind. There will, of course, be the more obvious physical symptoms, but it
will affect the Mind in similar ways to the Body. When the latter is not working
correctly, the Stomach can feel knotted up and not able to receive any more
nourishment. It is in this same way that the Mind and the Spirit can feel
overwhelmed and unable to take any more in. It can become confused and
discard information in a similar manner to the Stomach rejecting things when it
is not right. These are all symptoms which demonstrate that both the physical
and mental aspects of an Earth Element are not in balance.
The Stomach is referred to as the ‘Official of Rotting and Ripening Food and
Drink’; it digests the food that it receives and also controls the creation of waste
by-products. We have observed that when something is out of balance it can
affect the Mind as well as the Body. Someone with a Stomach imbalance may
have a very vacant look about them, and they are unable to digest any facts or
information that may be provided; this information will have to be condensed
and fed to them in small sections so that they are able to take these facts on
board. If too much information is thrown at them, they will show signs of
confusion and also anxiety.

Spleen
The products processed by the Stomach, either nutritious or waste, are
transported throughout the body by the ‘Official of Transportation and
Distribution’ – the Spleen. If there is a breakdown or imbalance in these
Officials, then the whole cycle of creation and distribution breaks down, thus
creating problems throughout the whole Body and Mind. Both the Stomach and
Spleen are integral to the wellbeing of all of the other Officials throughout the
body. In his book In the Footsteps of the Yellow Emperor (Eckman 1996, p.78),
the author refers to ancient Chinese beliefs that the Stomach and Spleen Officials
should be strengthened as a basis for all other treatments. If the distribution
system is not functioning smoothly, then food and by-products will not be
distributed and they will rot and cause blockages throughout the system; these
Officials must be allowed to transport and distribute efficiently in order to
maintain an even balance:

Some readers may think that the image of a road haulage system does
 not do justice to the wisdom and beauty of this system of medicine, but
in truth there is no better example from our daily lives than this. When
food has been harvested, stored, or brought to market, it has to be
taken to where it is needed as soon as possible or it will rot. Exactly
the same applies within the body, mind and spirit. (Worsley 1998,
p.13.7)

As with the Stomach, a similar distress can manifest itself when the Official of
the Spleen is imbalanced. The Spleen is the transporter and, if this function is not
working smoothly, worry and stress can set in, which can cause as much of a
problem as a physical slow down or blockage in the Body.
From my studies of the Earth Element and its Officials, it has become clear
that they are integral to the efficient running and maintenance of our Mind, Body
and Spirit. The Stomach is the furnace that keeps our engines well stoked and
full of power and energy – both for our physical wellbeing and to keep our Mind
and Spirit alert. The Spleen provides the means for transporting this energy
around our system to all the areas that require this stimulation. It seems evident
that we would not be able to carry on with a healthy and rewarding existence if
either of these Officials were not working correctly. Therefore, it must be in all
of our interests to maintain a balance here before we can even look at other areas
of our wellbeing.

1.1.9 THE EARTH ELEMENT FACIAL PATIENT

A deficiency in the Spleen will be indicated by sagging skin and a loss of tone to
the face as this organ relates directly to the flesh: ‘The Spleen controls the flesh’
and ‘flesh that is particularly flaccid or drawn, reflect imbalances in the spleen
function’ (Reichstein 1998, pp.105–106).
The Earth Element from a Facial Enhancement Acupuncture perspective is
very interesting. Earth Elements can be obsessive about their appearance, so may
be unrealistic about their expectations of what might be achieved by a facial
treatment. This needs to be taken into consideration when you are discussing the
expected results. When we look at the other side of an Earth imbalance, the
patient may let themselves go and have no interest in how they look or what
might be done to improve their skin or their appearance. The problem with this
imbalance, of course, is that the patient is very unlikely to seek help through a
Facial Enhancement Acupuncture procedure.

1.1.10 THE METAL ELEMENT

The Metal Element is linked to autumn, the time of rising Yin. Metal is about
connection, inspirational quality and purity. Autumn is considered to be the time
of winding down, getting together a storehouse ready to see you through the
winter. If you do not get the reserves together in autumn, then it will be a very
difficult winter to get through. It is also a time of reflection, when one looks
back and perhaps takes stock of things and issues that have happened in the past.
It can be a period when a person may paint or put their thoughts on paper and
want to leave a more permanent record to pass on to their children and family.
This can sound a little bit sombre, but it is not like that at all. Autumn is also the
time when nature has a last burst of colour and energy, as the trees and plants
give an exhibition of wonderful hues:

Autumn in New England brandishes the changes of the season. Leaves

turn vibrant colors, signifying the point of a cycle wherein all things
begin to conserve and store themselves inside for nourishment, while
externally life seems to be fading. (Connelly 1975, p.64)

The related emotion for this Element is grief. Those who experience a Metal
imbalance may lose their judgement about when to let go and will often suffer
from symptoms such as diarrhoea or constipation. The latter extreme can
manifest in the Mind as an inability to let go and look forward; this person will
always be thinking of what has gone before and perhaps what might have been.
Like trees in autumn, they need to release their fruit and let it drop to the ground.
What they are doing is hanging on and this fruit is rotting and causing them an
imbalance.
It is very true that this time of the year is a period for reflection and we may
all find ourselves looking back and contemplating whether the year has lived up
to our expectations. It is very hard not to dwell on the past, but this is really
wasted energy unless we can change our perspective of those events in order to
move forward. What we need to do is look to the future and be positive in our
attitudes, which is sometimes easier said than done.
 Metal is attributed with discernment and quality and also purity; this can be
likened to the rich minerals and ore that are found within the earth, which in turn
can be processed to extract precious metals such as gold. These types of qualities
in a person are something very special to have. They will come across, perhaps,
as a perfectionist or as someone who wants things done properly and in order.
They will likely be outspoken about their beliefs and have very high ethical and
moral views:

When minerals or ore are purified in intense heat, they give us the
most precious substance, such as gold and diamonds. Yet often not
only heat is needed for this process, but pressure, intense pressure that
forces them to contract. The humorous remark that a diamond is just a
piece of coal is perfectly accurate. They are both the same mineral i.e.
carbon, yet one has been under heat and pressure and contracted
infinitely more than the other. Similarly air in our lungs changes under
pressure; some oxygen is removed, the air we breathe out is
condensed. (Hermann 2000, p.107)

Air is also linked with the Element of Metal and obviously this is one of the
greatest gifts that we have, as without it there would be nothing. Air is what
gives us life and vitality and what feeds our lungs. We must be continually
looking for that clean, fresh air that we require to develop and go forward. We
do not want to become bogged down with impure and stale air, which can be
likened to the old memories and feelings from our past that may stop us
progressing.
As we have discussed, a Metal Element is very pure and inspirational,
someone who is organised and straightforward. As Earth relates to the mother,
Metal is associated with the father, which speaks of authority and respect. This
CF is likely to see things as cut and dried and would not want to see a ‘do not
care, do it tomorrow’ type of attitude. You could sum it up by saying that you
know where you stand with a Metal Element. Therefore, a challenge to someone
of this Element would be disorganisation and irresponsibility; they would find it
very difficult to tolerate scruffiness. Of course, as we have seen with each of the
Elements, an imbalance could result in the other exaggeration, where someone
could lose their self-esteem and become completely unkempt.

1.1.11 THE OFFICIALS OF THE METAL ELEMENT

When we focus on the Metal Element, we need to look at the two Officials of the
Lung, known as the ‘Official Who Receives the Pure Qi from the Heavens’ and
the Large Intestine, which is recognised as the ‘Official of Drainage and Dregs’.
These Officials are interrelated, as one brings goodness and vitality into the
Body and the other expels the waste and by-products from the Body: ‘The
functions of the Officials of the Metal Element are in many ways the easiest to
follow; they share a great many similarities with the physical functions of their
equivalent organs in Western physiology’ (Worsley 1998, p.14.1).

Lung
The Lung is of the greatest importance to us. It is the first sign of life when we
are born and it is also the last sign when we pass away. It takes the energy from
the outside of the body to the inside. It acquires what sustenance it needs from
the air it has inhaled and then expels what it does not need when it exhales. The
Lung Official then circulates this vital energy throughout the Body, Mind and
Spirit. It breathes fresh air and life into our whole being and it also gets rid of the
stale and tainted air that resides within us. However, we do seem to take even the
act of breathing for granted. We have to eat, drink and breathe to survive, but we
would soon panic if we could not find some food or water to consume. And yet
we can go for days without this nourishment, but we can only survive for a
matter of minutes without air.
Do we really take much notice of the air that we take into our lungs? As a
society we are always polluting what we take in. We inhale cigarettes, either by
choice or secondarily by the environment that we find ourselves in. We are
forever breathing in pollution from cars and factories and yet we often do not
seem to think twice about the consequences. If, however, we eat one too many
cream cakes, then it is as if the world has come to an end! Diving was a regular
hobby of mine and, despite not participating in a dive for a few years, I keenly
remember the renewed sense of appreciation it gave me for the capacity of my
lungs:

As soon as he leaves the surface and descends, a diver is exposed to an

 increasing partial pressure of nitrogen. At the same time the effects of
nitrogen narcosis begin. At shallow depths the effects are mild, but as
he descends the effects increase, altering his awareness of events and
his own behaviour. The danger in nitrogen narcosis lies mainly in the
effect it has on the diver’s awareness. Like a drunk who refuses to
believe he has had too much to drink, a diver with nitrogen narcosis
may not accept that there is anything the matter with him. (Anon.
1991, p.100)

The Lung Official is crucial to throwing away rubbish as it expels the carbon
dioxide that builds up in our bodies. This pollutant is harmful and deadly and it
is very important that it is removed from our systems.

Large Intestine
The other Official associated with the Metal Element is the Large Intestine. The
Large Intestine is the ‘Official of Drainage and Dregs’. It is responsible for
getting rid of unwanted material that can cause blockages and problems when
things are not running smoothly. Of course, this also applies to the Mind and
Spirit; if things are allowed to build up and are not cleared out on a regular basis,
then they will rot and become stale. This can lead to the Mind and Spirit
becoming clogged up and not able to move forward.
This Official is the dustman for all of the other Officials. When it is working
properly and on time, then the rubbish is cleared away and everything can flow
efficiently. If we think back a few decades to the refuse collector’s strikes in the
UK, we can remember the devastation that was caused as the rubbish began to
build up in the streets for many weeks. The danger of disease became very
serious and eventually society would have ground to a halt. This is what happens
to the Mind, Body and Spirit if this Official is not functioning correctly.
Eventually everything will seize up and stop working. Even when it eventually
starts performing as it should, there will be a backlog to clear up. Therefore, a
complete balance may take some time to achieve.

1.1.12 THE METAL ELEMENT FACIAL PATIENT

I consider the Metal Element one of the easiest to recognise in a prospective
Facial Enhancement Acupuncture patient. The skin is often referred to as the
‘third lung’ and most skin disorders are related to an imbalance in this Element.
The Nei Jing states that ‘The Lungs are connected with the skin’ (Veith 1972,
p.140).
Also, as the ‘Official of Drainage and Dregs’, if the Large Intestine is
imbalanced, this could manifest as spots and acne or general poor skin quality.
The skin is generally the first place to show any signs when there are toxins or
impurities in the Body, so this patient would benefit from treating the Lung and
Large Intestine points as well as the Facial Enhancement Acupuncture treatment.
Dry skin can also point to an imbalance here: ‘Dry Evil is caused by
insufficient moisture in the air and is particularly damaging to the lungs. It
prevails in autumn and is associated with the Elemental energy of Metal’ (Reid
2001, p.71).
Although, these symptoms may superficially indicate a primary imbalance, it
is important to remember that not everyone who exhibits skin disorders of this
kind will automatically be classed as a Metal Element CF. We are each made up
of all of the Five Elements and they have a complex effect upon one another, so
these issues may be an indication of an imbalance at another point in the cycle.
This nuanced approach will require a much more in-depth study than we are able
to explore here but, if this has not formed part of your acupuncture background,
it is enough for now to be aware of these Elemental relationships.
Perfection is attributed to this Element and a prospective facial patient with an
imbalanced Metal CF may well be on a quest to achieve this. It is all the more
important to address this in the initial consultation and manage their expectations
carefully.

1.1.13 THE WATER ELEMENT

The Water is linked to winter, the time of maximum Yin, but its power cannot be
underestimated:

Under heaven nothing is more soft and yielding than water.

Yet for attacking the solid and strong, nothing is better;
It has no equal.
The weak can overcome the strong;
The supple can overcome the stiff.
Under heaven everyone knows this,
 Yet no one puts it into practice.
Therefore the sage says:
He who takes upon himself the humiliation of the people
is fit to rule them.
He who takes upon himself the country’s disasters deserves
to be king of the universe.
The truth often sounds paradoxical.
(Tsu 1972, ch.78)

The type of character that first springs to mind when thinking about a Water
Element is one of the guys in the classic movie Easy Rider. A rebel image
conjures up the type of person that does not want to stay in one place for too
long and is always looking to move on – someone who does not conform and
stands out from the crowd.
If you can call it a gift, then it would be that a Water Element is a free spirit;
any obstacle that confronts them is easily worked around, like a river finding its
way around obstructions or boulders in its way. When balanced, they adapt to
the shape that contains them, which, on the flip side, can indicate a need for
boundaries, lest the Water overflows and loses control, using up their reserves.
In fact, the persona of a Water Element sounds like a very cool and attractive
one to have, a bit of a James Dean figure, a person that is hard to pin down, who
is perhaps on a different wavelength to the majority of people, but who risks
depleting their Essence:

Water itself is naturally elusive and resists definition. It can hold any
shape, and yet cannot itself be grasped and held once and for all. It
appears to have boundaries, and yet will find a passage around any
dam or obstruction wherever it can. (Worsley 1998, p.6.1)

The emotion associated with the Water Element is that of fear, or lack of fear.
This feeling can be traced back many years to when farmers would have built up
their stores of grain and crops to last over the barren winter months. There was
the fear that if this was not done, then there would be no food left come the
spring. This fear is still evident today in Water Elements who, during the winter,
are very conscious to conserve things and are frightened of the consequences if
they do not. A farmer would be very careful to make sure that he conserved as
much water as possible, so that there would be enough supply for the dry season
to follow.
Take time to observe the relentless persistence of Water to get to where it
wants. This is a feature that you can see if someone’s Water Element is
balanced; they will be persistent in what they do and not give up: ‘Over time it
can wear away the hardest rock and make it smooth’ (Hicks and Hicks 1999,
p.180).
Notice the smell. Each Element has an odour and Water’s is putrid. The sound
that is linked to the Water Element is that of groaning. This is very evident when
you are taking a walk along the beach: the sea has that relentless groaning sound,
one minute quiet and then a groan as the wave reaches a peak and breaks – a
similar sound to a train. Finally, the taste associated with Water is salty, and of
course you can taste this on your tongue very easily when you are near to the
sea.

1.1.14 THE OFFICIALS OF THE WATER ELEMENT

These two Officials really do exactly what it says on the tin! They deal directly
with the Water Element. Between them they govern the major aspects of our
vital fluids. They are of the greatest importance to the whole of the Body and
other Officials, as none of them can function without Water.

Kidney
The Kidney Official is known as the ‘Official Who Controls the Waterways’.
This, however, may be a little misleading as the Kidney does far more. Ancient
Chinese philosophy believed that the Kidney Official was the storehouse for
ancestral energy that was passed on to each generation; it was the seed of life
that was handed down.
The Official takes some of the Qi energy from our consumption of food and
air and compiles it as a reserve. This supply can be called upon when we have
heavy physical or mental tasks to cope with. A part of the Kidney Official is the
Ming Men. This is responsible for warming the Essence of the Kidney, and it is
also a very important part of the Official as it is a warmer for all of the Body’s
organs.
The Essence that we have mentioned is called the Kidney Jing. This is derived
from both pre-and post-Heaven Essence. The pre-Heaven Essence is inherited
from our parents at conception. It can be gradually depleted throughout our
lifetimes unless it is conserved well. The post-Heaven Essence is taken from
food and nourishment and can be replenished.
The function of Kidney Jing in our bodies is to do with the basis of growth
and development; deficiency can result in stunted growth or retardation and bone
and teeth problems.
Kidney Jing is also the basis of our constitutional strength and the production
of bone marrow, which fills the brain and the spinal cord. The pathology of
someone with deficient Kidney Jing will be that of someone who is always weak
and prone to constant infections.

Bladder
The Bladder is the ‘Official Who Controls the Storage of Water’ and it is the
reservoir of the Body, Mind and Spirit. This is the reserve that we draw from in
the winter when things are running low. If this is lacking, then things can start to
go wrong in all three aspects.
As well as being a reservoir, the Bladder is also charged with disposing of the
impurities found in our urine; if these are left to build up and not disposed of,
this can eventually pollute our whole being.
So, if the Bladder is out of balance, it may not be able to keep its fluids within
its boundaries. This may manifest as incontinence and cystitis-type infections.
The Bladder is one of the few Officials that is similar in its description of use in
both Chinese and Western medicine. It is also the longest meridian on the body
with 67 points. The Bladder and the Kidney need to be looked at in the context
of equal importance: ‘The Kidneys are rulers over the winter. Kidneys and
Bladder are related and have to be treated as one in acupuncture’ (Wallnofer and
Von Rottauscher 1965, p.90).
These two Officials of the Water Element need to be dealt with the greatest of
respect, as they are responsible for a huge amount of water in the body – in fact,
according to Masaru Emoto in his book The Hidden Messages in Water, ‘the
average human body is 70 percent water’ (2004). That is a large volume of fluid
that needs retaining and managing, so these organs need to be in the best of
condition.
1.1.15 THE WATER ELEMENT FACIAL PATIENT
From a an emotional point of view, a Water Element patient looking at a Facial
Enhancement Acupuncture treatment might express irrational fears, perhaps
about growing old or the ageing process in general. They may be frightened by
the prospect of so many needles and potential risks, so they will need more
reassurance than most. Alternatively, they will exhibit a complete lack of fear
and will seem unfazed. They may have even chosen to have this type of
treatment because it is unconventional and appears daring. Whether terrified or
unperturbed, you can be sure that, once they have begun, they will be determined
to see the course of treatment through.
As we have seen, the Kidneys house our inherited energy or Essence. When
this is strong, we will ‘grow old gracefully’, and if it is weak, ‘old age may
arrive prematurely’ (Hicks and Hicks 1999, p.181) It is clear to see that
strengthening and maintaining the Kidney Jing can help retain vitality and
youthfulness.
The Bladder is also an important meridian in facial acupuncture, as the
channel passes over both the head and face. This Official helps to expel
impurities from the Body, so, again, similar to the Metal Element, there may be
skin conditions such as greasy skin or blackheads that become evident when this
Element is out of balance.

1.2 THE HISTORY OF FACIAL ACUPUNCTURE

At the beginning of the twentieth century, 1024 prescriptions left by medicine
men were unearthed from the Mogoa Grottoes at Dunhuang situated along the
Silk Road in China: ‘Most of the manuscripts are from the Sui or Tang dynasties
and give a variety of prescriptions’, including literature about dermatology, and
the ‘experts were also attracted by a considerable number of cosmetic recipes
such as facial creams, hair tonics and shampoos’ (Feng and Zheng 1994, p.96).
These findings show evidence of China’s long-held beauty tradition, but the
practice of skin rejuvenation stretches back well before the arrival of the Sui ( AD
589–618) and Tang ( AD 618–907) Dynasties. For instance, the Shan Hai Jing or
Classic of Mountains and Seas was written during the Warring States period
(475–221 BC) and finalised during the Western Han Dynasty (206 BC– AD 9). It
detailed many herbal preparations for skin problems and anti-ageing. Birrell’s
translation identifies some of these solutions, such as the fat from a goat-
antelope that could be used to cure chapped skin and ‘a bird on this mountain
named the wagtail... It is effective for wrinkles’ (Birrell 1999, p.13).
Believed to be authored in the Eastern Han Dynasty ( AD 25–220) the Shen
Nong Ben Cao Jing or ‘The Divine Farmer’s Materia Medica’ was another well-
known compilation detailing Chinese herbal medicines. Many of the
preparations are recommended to slow ageing and prolong life and there are
those, such as ‘Bai Zhi’, that offer skin rejuvenating properties: ‘It promotes the
muscles and skin and moistens and makes [the skin] shiny. It can be used to
make a face cream’ (Yang 1998, p.58)
The desire for skin enhancing seems clear and there is evidence that the
acupuncture points of the face have been used for many years in Chinese
medicine. The Zhen Jiu Jia Yi Jing or ‘The Systematic Classic of Acupuncture
and Moxibustion’ was completed a few years before the arrival of the Western
Jin Dynasty ( AD 265–317) by Huang-fu Mi ( AD 214–282). This is one of the
most influential books ever written on acupuncture as not only did it gather
together information from the ancient Ling Shu, Su Wen and Ming Tang, but it
also detailed acupuncture points, the channels and the clinical applications of
treatment. Nine types of needle were introduced, including one specifically for
treating the skin: ‘The skin is associated with the lung and hence with a person’s
yang. Therefore, in treating of (the skin) the arrowhead needle (chan) is
employed’ (Yang and Chace 1994, p.162). The text discusses facial complexion
and the condition of the hair as an indication of potential disease, due to
particular imbalances in the body.
It is widely held that the Chinese empress, and the emperor’s concubines, as
far back as the Song Dynasty ( AD 960–1279) received acupuncture to aid
rejuvenation and specifically promote anti-ageing: ‘A remarkable blossoming of
acupuncture occurred under this dynasty. We owe this period the famous Bronze
Man, the founding of a faculty of acupuncture and the printing and distribution
of drawings and important works’ (Soulie de Morant 1994, p.12). It was certain
that huge advances were made during this dynasty and ‘the Song emperors took
a personal interest in acupuncture studies’ (Soulie de Morant 1994, p.840).
Wang Weiyi wrote some of the most notable books of the time and was charged
by Emperor Ren Zong, who reigned from AD 1023–1064, with the task of
studying ‘the method of needles and moxa and to have a statue cast as a model’
(Soulie de Morant 1994, p.840). Drawings were also made to pin down what was
known about the points. The Emperor wanted the practice of acupuncture to be
standardised and Wang Weiyi’s Bronze Man was a valuable teaching aid. The
model detailed the points of the face and could be used as a means to educate
students about disorders of the skin and balancing the body to prolong life and
the signs of ageing:

Before the exam the model was covered with a thick layer of wax,
which was then allowed to set so that the holes at the position of the
acupuncture points could not be seen. The hollow interior of the model
was then filled with water. A student would be told about a case and
asked how he would treat it using acupuncture. After describing which
points he would use and why, he was asked to locate them on the
model and told to insert them, through the wax and into the hollows
below so that, when the needles were removed, water would flow out.
(Kidson 2008, pp.17–18)

The Emperor’s endorsement would have seen the practice flourish and he, and
his entourage, would no doubt have had a vested interest in the advancements of
acupuncture available at the time.
The Ming Dynasty ( AD 1368–1644) saw further development in cosmetology
when Li Shi Zhen, one of the most highly regarded Chinese physicians in
history, wrote the classic Cao Gang Mu or ‘Materia Medica’: ‘Linking chapters
to specific facial features, Li Shi Zhen addressed the unique treatment
requirements of the eyes, nose, lips, teeth and hair, as well as the more
overriding issues of complexion and wrinkles’ (Zhang 2006, p.7). Related
beauty techniques using jade rollers are also deemed to have their origins in this
era. China’s Forbidden City, built during the Ming Dynasty, is said to display
them as part of the Emperor’s bedroom necessities in the Imperial Palace.
Following this lengthy tradition, with its surge in popularity in the 1970s,
acupuncture started to take its place in the West and interest grew as to the
various benefits that could be obtained from treatment. (Meng, Xu and Lao
2011). In my experience, acupuncture points, both on the body and also the face,
have always shown very good results in treating many conditions of the skin and
also the facial muscles, particularly in the case of stroke patients and those
demonstrating other muscular problems.
Acupuncture has been used to promote longevity, enhance the skin and
reverse the signs of ageing for centuries. However, it is probably only in the past
few decades that acupuncture points of the face have been used in any sequence
with the goal of providing a full facial acupuncture treatment. The cosmetic
acupuncture protocols, as we recognise them today, are now practised around the
world. I am sure that they will continue to evolve and develop, but their roots
will remain in the foundations of acupuncture established many hundreds of
years ago.

1.3 MODERN-DAY TREATMENT COMPARISON

The results that are most expected from a facial acupuncture treatment are a
smoothing of the skin and reduction in fine lines and wrinkles. From a Western
point of view, at the time of writing, the nearest comparison would be with a
Botox® treatment.
Botox® is one of the commonly used trade names for the neurotoxic protein
called Botulinum toxin type A that is produced by the bacterium Clostridium
botulinum (Benedetto 1999). As its name suggests, ‘Botulinum toxin is one of
the most poisonous substances known’ (Barbano 2006, p.E17). However, once
the same toxin is isolated and purified, it can be used for cosmetic purposes. The
protein can then be used to treat such things as brow furrows, wrinkles and areas
of the face like the nasal labial fold. The procedure involves a small amount of
the diluted toxin that is injected into the area in question; this has the effect of
freezing the muscles in order to prevent the wrinkle or crease forming. The
Botox® protein acts by blocking the nerve impulses that contract the facial
muscles; if the muscles can no longer contract, then the wrinkles will soften and
become less pronounced. The effects of Botox® are not permanent and will
generally only last for up to six months, after which time repeated treatments
would then be required to prolong them.
As we mentioned earlier, we must remember that Botox® or Botulinum toxin
is a poison. One way to get botulism is to eat something containing the
neurotoxin produced by the bacterium Clostridium botulinum. A very serious
symptom is paralysis, which in some cases can go on to become fatal.
Obviously, the amounts that are used in a cosmetic procedure are diluted; there
would be very little chance of any such effects, when administered by a
professional. Still, we need to remember that Botox® is a toxin and it carries a
number of potential side-effects.
Botox® and similar types of facial treatments are always going to prove
popular with the public. They offer a quick fix and will give an instant outcome,
and unfortunately contemporary society is one in which people expect results
straight away. Facial acupuncture is a far more subtle, yet natural, approach to
working with the face and, if your patients can be persuaded to wait a little
longer for the results, I am sure they will be impressed. I have also found that as
people’s awareness grows and they begin to consider carefully what they are
putting into their bodies, they become more switched on to a more natural
approach to anti-ageing. Facial Enhancement Acupuncture offers this safe,
holistic alternative.

1.4 THE DEVELOPMENT OF FACIAL ENHANCEMENT

ACUPUNCTURE
So, although facial acupuncture can obtain similar effects to modern-day
treatments, it is not a new idea. Despite having very little written about it in
English, we can see that it is likely to have been in use for at least a millennium.
With this ancient heritage in mind, I feel that we need to think of facial
acupuncture, or cosmetic acupuncture as it is also known, as simply another
form of acupuncture, an extension of what an acupuncturist already does.
As a Five Element Acupuncturist, I look after my patients by treating their
Mind, Body and Spirit. By focusing on their face, I see this as an add-on to my
existing acupuncture services.
I began to develop Facial Enhancement Acupuncture after considering the
locations of the acupuncture points on the face and their positions, with
reference to the facial muscles. I remember looking at one of my anatomy books,
when I was studying, and thinking: ‘Stomach 9 (ST9) is a fantastic point used in
Five Element Acupuncture as a “Window of the Sky” point.’ Combined with its
location, with reference to the muscles of the neck, I began to question how
needling this point might affect them. There are, of course, so many other
acupuncture points with prominent positions on the face and yet the majority I
would generally not use in my day-to-day acupuncture practice; points such as
Stomach 3 (ST3) and Stomach 4 (ST4). Then we have the wonderful points
around the eyes such as Bladder 2 (BL2) and Triple Heater 23 (TH23); these are
great points that help with so many eye conditions. So, combining all of these
points into a protocol means that we get to use these fantastic points each time
we carry out a treatment.
Facial Enhancement Acupuncture quickly became an integral part of my own
practice. I started to monitor the results that I was achieving using facial points
and also developed different needle techniques to achieve results in other areas,
such as targeting fine lines and wrinkles. It soon became clear that regular use of
these facial points would have a profound effect on the facial muscles and
achieve results that far outweighed my original expectations. My Facial
Enhancement Acupuncture treatments now include various body points and
auricular points that I have included in my protocol over the years. These
additional points, although not situated on the face, can have a profound effect
on your patient’s appearance. The treatment plan is always evolving and I am
continually looking at new points or techniques that will improve the overall
Facial Enhancement Acupuncture treatment experience.
Facial Enhancement Acupuncture has grown rapidly and to date I have trained
acupuncturists in over 30 countries worldwide and this is still growing year on
year. It is a very simple concept and, aside from its holistic benefits, works on
two main areas: the muscles of the face and the lines and wrinkles of the skin.

1.4.1 THE MUSCLES OF THE FACE

To begin, we will look at the muscles of the face. We can divide this into five
simple muscle groups. With each of these sections, the technique is the same; we
are stimulating these muscles by using our acupuncture needles. Think of the
facial muscles going to the gym; we are giving each muscle a work-out by
stimulating it with our needle.
These muscle groups are easy to remember: Eyes, Nose, Mouth, Jaw, and
Neck. If we take a look at these five groups, we can see the muscles in relation
to the face and visualise our point locations accordingly.

Eye Muscles

•
Corrugator supercilli: Pulls the eyebrows together in a frown and is often
paralysed with botulinum toxin (Botox®) to prevent development of
wrinkles.


•
Frontalis: Raises the eyebrows.

•
Orbicularis oculi: Narrows the eyes to a squint.

•
Procerus: Pulls the eyebrows down and together.

See Figure 1.1.

Nose Muscles

•
Depressor septi: Depresses the nostrils.

•
Levator labii superioris alaeque nasi: Flares the nostrils.

See Figure 1.1.

Mouth Muscles

•
Buccinator: Helps form the cheeks to blow a kiss.

•
Depressor anguli oris: Makes the lips grimace.

•
Depressor labii inferioris: Makes the lips pout.

•
Levator labii superioris: Opens the lips.

•
Mentalis: Wrinkles the chin.

•
Orbicularis oris: Helps the lips form a shape to whistle.


•
Platysma: Pulls the corners of the mouth together.

•
Risorius: Helps the mouth form a grin.

•
Zygomaticus major and zygomaticus minor: Lift the mouth to smile.

See Figure 1.1.

Jaw Muscles

•
Masseter: Clenches the teeth together.

•
Temporalis: Raises the lower jaw when chewing.

See Figure 1.1.

Neck Muscles

•
Sternocleidomastoid: A pair of muscles running down either side of the
neck, which help to lift and rotate the head.

See Figure 1.1.

 FIGURE 1.1 THE FACE AND NECK MUSCLES

We will cover the points used in a Facial Enhancement Acupuncture treatment in

Chapter 3. For now, it is important to recognise that, by stimulating the
acupuncture points on and near to these muscles, we will be affecting the overall
appearance and tightness of the face.

1.4.2 LINES AND WRINKLES

The second main part of a Facial Enhancement Acupuncture treatment addresses
the problems of fine lines and wrinkles. These become evident in most areas of
the face as we get older, but can also be caused by excess sun and environmental
conditions.
The technique we use for dealing with these areas is to use acupuncture
needles directly into the line or wrinkle; this action creates a very small wound
to the face which the body then endeavours to repair. As it does this, the body
produces natural collagen and wound-healing properties which fill out the line,
and with continued treatment the line or wrinkle should gradually fade. This
same technique can also be successfully employed on age spots and old acne
scars; in fact, any area of the face that requires collagen induction will benefit
from the insertion of acupuncture needles into the area.
When I first developed Facial Enhancement Acupuncture, I used small
intradermal needles to work on lines and wrinkles and we will cover the use of
these needles later in the book. As technology develops and my experience of
needling the face has grown, I am now looking at additional methods of
addressing these areas. These make use of tools such as lasers and dermal rollers
within the practice of Micro Needle Therapy. We will take a closer look at the
latter new system as we progress, but we must always be aware that Facial
Enhancement Acupuncture as a treatment protocol will continually develop as
our expertise in this field grows.
I am sure that as your practice and use of Facial Enhancement Acupuncture
advances, both you and your patients will be amazed at the results that can be
achieved. Remember, however, that this is not a treatment that garners
immediate results; a course of treatment is necessary, with regular maintenance.
This will give your patients long-term sustainable results, which have been
achieved totally naturally. What could be better than that?
CHAPTER 2

EXPECTED RESULTS OF FACIAL

ENHANCEMENT ACUPUNCTURE

As soon as I mention Facial Enhancement Acupuncture to someone, either a

friend or a prospective patient, you see their eyes light up and the majority reach
for the neck and jowl area, expressing their excitement at the prospect of a
facelift. That is all well and good and it is great that people are so enthusiastic,
but we do need to make it clear to prospective patients that facial acupuncture is
not a facelift, at least not in the context of what they might consider one to be.
To understand a patient’s expectations of a traditional facelift, we need to
examine what exactly a facelift does.
A facelift, technically known as a rhytidectomy (literally meaning the surgical
removal of wrinkles), will usually involve the abstraction of excess skin from the
face and a tightening of the underlying tissues. This kind of invasive procedure
to the patient’s face and neck will carry the risks that any surgery would have.
With Facial Enhancement Acupuncture, we are working more to stimulate the
muscles of the face and also to aid the production of natural collagen in the
dermis. Targeting the muscles in particular will have an overall lifting effect but,
with all the best intentions in the world and the most skilled acupuncturist, it is
very unlikely that you will be able to achieve the results that would be attained
by a surgical facelift. Therefore, it is very important to stress to your patient
exactly what the treatment is you are offering and the expectation of results that
can be achieved.
The secret of a successful and beneficial Facial Enhancement Acupuncture
treatment is to manage the patient’s expectations. When you first meet your
patient, you will carry out a full consultation and it will soon become clear to
you what they are looking for. From this first visit, you may find that their
expectations are probably very unrealistic for the type of treatment that you are
offering.
No matter how competent an acupuncturist you are or how experienced with
carrying out facial acupuncture treatments, the reality is that most goals that
patients are looking to achieve with a treatment will be beyond the reach of
Facial Enhancement Acupuncture. I have found that the vast exposure to
celebrities in the media can often result in very high expectations from patients.
The trend for digitally enhancing images in magazines can also give unrealistic
aims.
Having said all of that, I am not suggesting that Facial Enhancement
Acupuncture will not provide your patients with some impressive results,
because it most definitely will. It is important to remember to manage your
patient’s expectations; if you do this successfully, they will not be disappointed
and you will have a happy patient who will return for further treatments.
When you first talk to your patient, ask them to describe to you what they
think about their appearance. What would they like to change if they possibly
could? Ask them to show you the area of the face that they are not happy with
and make a note of their comments. You can look back after a few treatments
and assess the progress that has been made. One thing that will quickly become
apparent is that people will soon forget what they originally talked about, so it is
always useful to be able to check back in the file and see what areas of the face
you were targeting with your treatment.
When I have conducted consultations in the past, on a number of occasions it
has become clear that the patient’s expectations from the treatment are going to
be more than we can accomplish with facial acupuncture. Using your skills as a
therapist, you might determine from your consultation that the patient has deeper
issues going on, perhaps emotionally rather than physically. These deep-rooted
problems may have prompted them to look into changing their appearance. I
would recommend discussing this further with your patient and deciding the
appropriate line of treatment to take. It is well worth bearing in mind that,
whatever results you might achieve for that patient, they are unlikely to be happy
if there are underlying issues surrounding their need to alter the way they look.
Let us assume that you have carried out your consultation with your patient
and they have outlined a few areas of the face that they would like to improve
upon. What realistic results can be achieved by using Facial Enhancement
Acupuncture? One of the most dramatic improvements that patients often report
back to me is that the quality of their skin is vastly improved, even after only the
first treatment. This is not surprising as we are directing a lot of Qi energy to the
face. When you add the stimulation effect of the needles, this is improving
circulation and blood flow to the skin’s surface. This can, in turn, reduce redness
and improve the overall definition of the skin. Another noticeable improvement
is the reduction in puffiness of some areas of the face.
The two main areas of the face that are mentioned the most in a consultation
are the lines between the eyes at the bridge of the nose and also the line that runs
from the corner of the mouth to the edge of the nose – the ‘nasal labial fold’. If,
as a practitioner, we can do something about these, then we will have many
happy patients. Facial Enhancement Acupuncture is very successful at reducing
the appearance of lines in these two areas and you will find that, on most
patients, they will achieve a very dramatic reduction in the line depth and
severity after a few treatments.
Another area of the face that I am asked if I can improve is the eyes,
especially drooping eyebrows, which tend to drag a person’s face down. Facial
Enhancement Acupuncture can be really effective in helping to lift a patient’s
eyebrows and we will cover the specific points that help to do this in Chapter 3.
So far we have been able to offer the patient improved skin quality and texture
and also been able to reduce the depth and severity of lines on the forehead and
to the side of the mouth; we have also been able to address the problem of
drooping eyebrows.
The other area of concern to patients is often the jowls that we previously
mentioned. This is probably one of the hardest areas of the face to treat, as so
much can depend on other factors such as the patient’s weight or general facial
structure. If we look at the fat components of the cheek, we will see that there
are two distinct overlapping fat compartments that are above and below the
mandible bone. The mandibular septum separates the jowl fat in the cheek from
the fat in the neck (Reece, Pessa and Rohrich 2008). What we can do with Facial
Enhancement Acupuncture is start to try to tighten the muscles in the face and
the neck in order to reduce the appearance of the jowls. It is surprising how
effective this can be and, although it will never achieve the results of a surgical
facelift, it might be all that is needed to improve this area of your patient’s face.
In my clinic we have patients who come for a one-off treatment, perhaps in
the build-up to a special occasion, and others who make Facial Enhancement
Acupuncture a regular part of their beauty regime. With the latter, you should
notice a very dramatic improvement in the appearance of any lines on the face
and also the general tightness of the skin. With regular follow-up maintenance
sessions, there should be no reason why this improvement cannot be sustained in
the long term.
Of course, we must not forget that there are lots of other facial issues that we
can address using traditional acupuncture. Your patient may express concerns
about dark circles under their eyes or perhaps swelling around them and eye
bags. These are all constitutional issues that we can tackle using acupuncture
points of the face and the body. We will look at some of these conditions and
treatments in Chapter 6 and you can consider their additional use in your
treatments.
A one-off session is an ideal way to experience a Facial Enhancement
Acupuncture treatment, but to obtain the best long-term results I would advise a
course of ten treatments at weekly intervals. This can then be followed by
regular one-month to six-weekly maintenance treatments. This treatment plan
will give your patients the optimum results and endurance to the improvements
that you have made.
To recap, it is of the upmost importance that you should manage your
patient’s expectations of their treatment. If you can do this successfully, you will
have a satisfied patient.
CHAPTER 3

ACUPUNCTURE POINTS USED IN THE

MAIN PROTOCOL

3.1 THE AGGRESSIVE ENERGY TREATMENT (AE DRAIN)

The AE Drain, as taught by J.R. Worsley, is a treatment protocol that is used in
Five Element Acupuncture to clear an accumulation of unhealthy Qi energy
from a patient’s system. This build-up of Aggressive Energy (AE) can have an
external or internal cause and the Yin organs usually trap the heat from this
resulting stagnation. In many of the ancient texts, it is thought that a build-up of
Aggressive Energy can be extremely debilitating or even life-threatening.
The lineage of Five Element is thought to be an oral tradition dating back to
the practitioner Liu Wan-Su ( AD 1110–1200) and preserved in Taiwan. As Peter
Eckman describes in The Footsteps of the Yellow Emperor, the concept of AE
was brought to Europe by French acupuncturist Jacques Lavier from Taiwan,
where he studied with Wu Wei-p’ing in the 1950s: ‘whose treatment protocol
calls for draining the AEP’s (Back Shu Points) of the Zang Organs involved,
prior to energetic balancing’ (Eckman 1996, pp.147–150). This point is further
elaborated:

Li Dong-yuan, during the same epoch as Liu Wan-su, recommended a

similar protocol – treating the Back Shu Points of the Zang Organs for
any condition resulting from the penetration of environmental Evil Qi
secondary to a deficiency of central Qi. (Yang and Li 1993 in Eckman
1996, p.150)

I like to use this protocol each time I see a new patient in the clinic and before
we embark on a course of treatment. One AE Drain is usually sufficient to begin
with, but sometimes we may have to go back and repeat the procedure later in
the patient’s course of treatment if problems do not appear to be clearing.
The following Back Shu points are used for clearing Aggressive Energy:

•
BL13 Lung Shu

•
BL14 Pericardium Shu

•
BL15 Heart Shu

•
BL18 Liver Shu

•
BL20 Spleen Shu


•
BL23 Kidney Shu.

Also, we need to use a couple of test needles that are inserted level with, or just
outside of, the Bladder meridian. If Aggressive Energy is present, you will see
redness around the base of the needles; this redness is also called erythema. The
colour that emerges around the Back Shu points should be a darker red than at
the test needles. This will confirm that your needle positions for the Back Shu
points are correct. See Section 4.1 for the full AE Drain protocol.

3.2 ACUPUNCTURE POINTS ON THE FEET AND LEGS

LIVER 3 TAI CHONG (SUPREME RUSHING)
Location: Between the first and second metatarsals on the dorsum of the foot.

Element: Wood.

Functions: Spreads Liver Qi and Blood, also relieves pain. Subdues Liver Yang
and calms anger.

Applications: Headaches, hypertension, eye problems, genital and

gynaecological problems.

Liver 3 (LV3) is known as a Source point and each of the acupuncture meridians
has its own. I have heard Source points likened to a main station on a train line.
They are high-concentration points that provide access to the main meridian
system.
LV3 has many uses in Chinese medicine, as outlined, and is a powerful point.
It is a particularly useful point for feelings of being stuck. When needling LV3,
there is usually a very strong sensation which can be felt in the foot and
sometimes through the length of the leg along the Liver meridian.

STOMACH 36 ZU SAN LI (LEG THREE MILES)

Location: 3 cun below Stomach 35 (ST35), one finger width lateral from the
anterior border of the tibia. (See Glossary for a definition of cun measurement.)

Element: Earth.

Functions: Restores balance to Qi, harmonises the Stomach, strengthens the

Body and Spleen and enhances immune function.

Applications: Indigestion, stomach pain and vomiting.

Stomach 36 (ST36) is a very important point; enriching for Mind, Body and
Spirit. Having this point needled often produces a strong sensation that
sometimes travels down the leg. Most acupuncturists consider ST36 as a point
that they would use for digestive issues; it is indeed a universal point that I
would use for any condition from diarrhoea to heartburn. I would also consider
using ST36 when the system needs a boost. Of course, if your patient lacks
energy, this will often manifest in the face. The Stomach channel begins on the
face and, according to a 2012 study, ‘suspended moxibustion over Zusanli (ST
36) has a very significant increase in temperature at the forehead, around the
nose, at the corners of the mouth, and at the cheeks and lips’ (Yang et al. 2012,
pp.397–403).
The Stomach channel descends from the face to the feet and ST36 is
commonly used as an anaesthetic point, as we will discover in the next section.
And, according to the theory of Tsang Fu Chinglo, ‘Where the meridian passes,
there is healing’ (in Anon. 1974, p.77).
ST36 is also a He-Sea point, one of the connecting points found at the elbows
and knees. Not only that, it is a strong Earth Element point responsible for
nourishment and feeding the other organs of the body. Therefore, it is considered
to be a significant point for general patient wellbeing.

SPLEEN 9 YIN LING QUAN (YIN MOUND SPRING)

Location: In the depression, distal and dorsal to the medial condyle of the tibia.

Element: Earth.

Functions: Expels dampness, strengthens the Spleen, restores balance to bodily

fluids.

Applications: Menstrual problems, urinary retention, knee pain, chronic yeast

infections and candida.

Spleen 9 (SP9) is a Water He-Sea point on an Earth channel. It is a very

important point on the meridian for transportation and nourishment around the
body, often used in conjunction with ST36. The Spleen is responsible for
sending fluid up to the lungs, which in turn disperse the moisture to the skin. As
a Water point, SP9 can be particularly useful in reducing swelling and oedema.
This channel opens at the mouth and, when healthy, the lips will be red and
moist: The ‘Spleen’s brilliance is manifested in the lips’ (Su Wen in Kaptchuk
1983, p.59).

GALL BLADDER 41 ZU LIN QI (FOOT ABOVE TEARS)

Location: In the depression distal to the junction of the fourth and fifth
metatarsals on the lateral side of the extensor digiti minimi tendon.


Element: Wood.

Functions: Spreads stagnant Liver Qi, clears Fire and extinguishes Wind, clears
vision and sharpens hearing.

Applications: Eye diseases, eye redness and swelling, headache and vertigo.

Gall Bladder 41 (GB41) is a Shu-Stream point, which is where the Qi pours

through the channel. GB41 is used in a Facial Enhancement Acupuncture
treatment purely for its benefit of helping the eyes. This is a great point for
clarity when the eyes appear cloudy or unfocused.

STOMACH 44 NEI TING (INNER COURTYARD)

Location: Between the second and third toes at the edge of the interdigital skin
at the dividing line between red and white flesh.

Element: Earth.

Functions: Regulates and harmonises the Stomach and intestines, regulates Qi

and stops pain.

Applications: Dysfunctions of the five sensory organs (e.g. toothache),

peripheral facial paralysis, frontal headache and stomach pain.

Stomach 44 (ST44) is a Ying Spring point, where the Qi trickles down the
meridian. A very important use of ST44, in the context of a Facial Enhancement
Acupuncture treatment, is its ability to improve the complexion. It is ‘indicated
for heat disorders affecting the upper portion of the channel in the face and head
as well as clearing heat and damp-heat from the intestines’ (Deadman 1993,
p.34). When used in conjunction with Large Intestine 4 (LI4), ST44 can help to
expel Wind from the face.
By using GB41 and ST44 on the feet, we are also aiming to ground the Qi,
whilst so much attention is given to the face and head.

3.3 ACUPUNCTURE POINTS ON THE HANDS AND ARMS

Acupuncture anaesthesia is a subject that fascinates me and, during the Facial
Enhancement Acupuncture treatment, we employ a few anaesthetic points on the
hands and arms to help patients with the needle experience. Most patients who
have a FEA treatment do not find the needles to be too much of a problem at all;
however, I have found that patients are a lot more comfortable when anaesthetic
points are used during the session.
Various studies have been written about acupuncture as an anaesthetic and
what has been published makes for very interesting reading. Much of the
research that influenced this aspect of my protocol was documented in the
1970s, which we will come to later. However, I have also chosen to highlight
some studies in the 1990s, which have continued to provide evidence of the
benefits of using acupuncture for anaesthesia. The first two research papers
demonstrate how electroacupuncture (EA) is being used for this purpose.
In 1996, 59 patients were split into two groups to undergo a colonoscopy with
either electroacupuncture analgesia or meperidine analgesia. Meperidine is an
opioid drug commonly used for this type of procedure. The acupuncture points
used in the study were ST36 and Stomach 37 (ST37) on the right, and the
auricular point Shen Men on both sides. The needles were inserted ten minutes
before and retained throughout the colonoscopic examination. The conclusion
was that ‘the analgesic effect of elecroacupuncture and meperidine is the same
but EA has fewer side-effects’ (Wang et al. 1996, pp.13–20).
Another study, published in 1999, compared the results of electroacupuncture
to the pharmacological product alfentanil during oocyte aspiration for in-vitro
fertilisation. Both the acupuncture and alfentanil were combined with a
paracervical block (PCB). LI4, Triple Heater 5 (TH5), Stomach 29 (ST29), Du
Mai 20 (DU20) and ST36 were attached to EA and others with manual
stimulation:

In conclusion, this study has shown that EA is as good an anaesthetic

method as alfentanil during oocyte aspiration. The women in this study
were positive to the idea of using EA. We therefore suggest that EA
may be a good alternative to conventional anaesthesia during oocyte
aspiration. (Stener-Victorin et al. 1999, p.2483)

Finally, a 1992 study compared acupuncture at ST36 and LI4 to epidural

anaesthesia in appendectomy. Eighty patients with appendicitis were divided
equally, with one group receiving epidural anaesthesia and the other receiving
acupuncture only. Both groups performed well during the surgery; however,
what was interesting was that the acupuncture group fared better in terms of
associated signs:

There were less respiratory depression, hypotension, cardiac

arrhythmia and less amount of liquid infusion needed than that of the
epidural block during operation. Furthermore, in the group of
acupuncture anesthesia, the intestinal gas excreted earlier, the
analgetics and antibiotics administered were less and the rate of the
wound infection were reduced after operation. (Sun, Li and Si 1992,
pp.87–89)

LI4 forms part of the Facial Enhancement Acupuncture protocol, in part for its
use as an analgesic. According to Acupuncture Anesthesia, LI4 is ‘used in all
types of acupuncture anesthesia surgery’ and ‘the area for pain relieving is very
strong’ (Anon. 1975, p.202).
I selected two other points on the arm, based on their documented anaesthetic
effects: Triple Heater 8 (TH8) and Pericardium 4 (PC4). I first read about the use
of these points for lung surgery in The Principles and Practical Use of
Acupuncture Anaesthesia (Anon. 1974), whilst studying, and the discovery made
a big impression. What astounded me was that, in the 1960s, doctors and
surgeons of the Peking Tuberculosis Research Institute had managed to reduce
the 40 needles, used for anaesthesia to remove parts of the lung, to only one.
This single needle was used to deeply penetrate the arm in order to stimulate
both TH8 and PC4: ‘Two hundred and one of the operations were performed
with anaesthesia from a single needle, and 98.5 percent of these were successful’
(Anon. 1974, p.277). Practitioners found that TH8 ‘is highly effective in
nullifying pain’ and PC4 ‘functions like a sedative’ (Anon. 1974, p.279). This
was witnessed in 1974 by ten Canadian anaesthetists who visited China to view
acupuncture analgesia first-hand: ‘The most dramatic exposition was the use of a
single needle, stimulating San-Yin-Loh (TB-8) and Hsi-men (EH-4), and
providing analgesia for thoracotomy’ (Spoerel 1975, p.363).
During Facial Enhancement Acupuncture, we are obviously not performing
anything near as invasive as opening the chest cavity; these points are
particularly relevant to this type of surgery due to the region of the meridians.
Nor are we, you will no doubt be relieved to hear, needling through the arm.
However, we are using these points for their general analgesic and sedation
effects and because they may help to ‘calm the heart and secure the spirit’
(Anon. 1975, p.198).
Acupuncture anaesthesia is a vast subject and if, like me, you find this subject
of particular interest, more of the research can be found in my first book, The
Pocket Guide to Facial Enhancement Acupuncture (Adkins 2006). However, all
of these studies serve to demonstrate that if acupuncture can achieve such a
response as to provide pain-free procedures such as these, imagine what can be
done by using similar points in a Facial Enhancement treatment. There should be
no reason why anyone should experience any discomfort during a FEA session.
The points on the hands and arms that I have chosen for their analgesic effects
follow. As you can see from the studies I have selected, aside from LI4, which I
would always recommend, this list is not exclusive for analgesia but, in my
experience, these points have always benefited the patient during treatment.
Other points that can also be utilised for this purpose will be covered in the
section dedicated to auricular points in Section 3.10.

LARGE INTESTINE 4 HE GU (JOINING THE VALLEY)

Location: In the webbing of the thumb and index finger at the highest spot of
the muscle when the thumb and index finger are brought together.


Element: Metal.

Functions: The point for all facial symptoms, disperses wind and suppresses
pain.

Applications: Can reduce headache pain, toothache, shoulder pain and also
alleviates pain and inflammation of the hand, wrist, elbow, shoulder and neck.

LI4, in combination with LV3, is a famous ancient formula called the ‘Four
Gates’ and is used for alleviating pain and stress. It is a very powerful method
and balances the body’s Qi, opening circulation throughout the meridians. Like
LV3, LI4 is also a Source point and is indicated for many conditions. When
needled, LI4 often produces a strong sensation or ache.
The Large Intestine meridian travels up to the face, so almost any symptom
related to that region calls for this point. There is evidence that by needling LI4
in healthy volunteers, the blood perfusion volume of the bilateral acupuncture
areas of the face are effectively increased (Wang et al. 2012). Studies such as
this demonstrate why LI4 is such an important point in the Facial Enhancement
Acupuncture protocol.

TRIPLE HEATER 8 SANYANGLUO (THREE YANG CONNECTION)

Location: On the dorsal plane of the forearm, 4 cun above the transverse wrist
crease, between the ulna and radius.

Element: Fire.

Functions: Needled through to PC4 in acupuncture anaesthesia, eases pain and

removes blockages.

Applications: Toothache, voice loss, deafness, hand and arm pain.

As outlined in the section on acupuncture anaesthesia, Triple Heater 8 (TH8) is

used in conjunction with PC4 as an anaesthetic point.

PERICARDIUM 4 XI MEN, HSIMAM (GATE OF QI RESERVE)

Location: Between the palmaris longus and flexor carpi radialis, on the link
line between Pericardium 3 (PC3) and Pericardium 7 (PC7), on the inside of the
arm 5 cun above the transverse crease of the wrist.

Element: Fire.

Functions: Needled through the arm from TH8 in acupuncture anaesthesia,

alleviates pain, clears heat from the Qi and calms the Shen.

Applications: Stops vomiting, heart pain, palpitations, coughing blood, pain of

the elbow and arm.

PC4 is used as an analgesic point with TH8. Known as an Accumulation or Xi-

Cleft point, PC4 is where Qi and Blood gather.

3.4 ACUPUNCTURE POINTS ON THE HEAD AND

FOREHEAD
DU MAI (GOVERNOR VESSEL) 20
BAI HUI (ONE HUNDRED MEETINGS)
Location: On the dorsal midline, 5 cun posterior to the anterior hairline on the
crown of the head.

Functions: Calms the Spirit, soothes the Liver, raises Yang, benefits the head
and counters prolapse.

Applications: Headache, heaviness of head, dizziness, tinnitus, nosebleed, poor

memory and lockjaw.

The Du Mai channel is often translated as the Governor Vessel and DU20 is the
highest acupuncture point on the body. I have heard this point referred to as
‘Upright Pillar’: a point where a patient would hang from a golden thread, which
would keep them upright when they have the weight of the world on their
shoulders. We are using DU20 in the context of a Facial Enhancement treatment
to lift the face and to also relax the patient.

YINTANG (HALL OF IMPRESSION)

Location: Midpoint between the medial end of the eyebrows. See Figure 3.1.

Muscle: Procerus.

Functions: Calms the Spirit.

Applications: Frontal headache, sinus and eye issues and insomnia.

Yin Tang is an Extraordinary (Extra) point but, unlike other Extra points, it is
found on the Du Mai channel. Many people describe its location as being in the
region of the ‘third eye’.
As one of my favourite points to use for many treatments in the clinic, Yin
Tang has a noticeable calming and relaxing effect on the patient. I have often
likened it to closing the open windows on a computer screen, as the often busy
mind of the patient quickly starts to shut down. Using this point towards the
beginning of the facial acupuncture treatment is an effective preparation for the
rest of the needling. It also activates the procerus muscle, opening up the area
between the eyebrows.

BLADDER 6 CHENG GUANG (LIGHT GUARD)

Location: 1.5 cun lateral to the midline, 2.5 cun within the anterior hairline. See
Figure 3.1.

Element: Water.

Functions: Enhances eyesight, alleviates pain, clears the head and eliminates
wind.

Applications: Headache, glaucoma and dizziness.

Bladder 6 (BL6) is a point that is rarely used as its main functions are to clear
the eyes.
In a Facial Enhancement Acupuncture session, we use BL6 purely for its
location, although, when looking at anti-ageing as a whole, enhanced eyesight is
a particularly good side-effect from using this point.

GALL BLADDER 14 YANGBAI (YANG WHITE)

Location: 1 cun above the eyebrow, directly in line with the pupil. See Figure
3.1.


Muscle: Frontalis.

Element: Wood.

Functions: Alleviates pain, enhances eyesight, expels wind and benefits the
head.

Applications: Eye disease, headaches, facial paralysis, vertigo, drooping of the

eyelid and deviation of the mouth.

Gall Bladder 14 (GB14) is a very good point for pain of the head and to benefit
the eyes, in particular for sagging eyelids. It can also be used in cases of facial
paralysis and has been chosen in many studies researching the treatment of
Bell’s Palsy using acupuncture: ‘Bell’s palsy is an acute peripheral unilateral
facial weakness or paralysis with an as yet unknown cause’ (Xia et al. 2011,
p.1). At the time of writing, a study has just been published highlighting the
positive effect of De-Qi for patients with early-onset Bell’s Palsy: ‘De Qi is an
internal compound sensation of soreness, tingling, fullness, aching, cool, warmth
and heaviness, and a radiating sensation at and around the acupoints’ (Xu et al.
2013, p.1). Points included GB14, ST4, Stomach 6 (ST6), Stomach 7 (ST7) and
Triple Heater 17 (TH17) on the affected side and LI4 on both sides. Six months
following treatment, it was found that acupuncture with De-Qi ‘improved facial
muscle recovery, disability and quality of life among patients with Bell palsy.
Stronger intensity of De-Qi was associated with better therapeutic effects’ (Xu et
al. 2013, p.5).
These recent findings are encouraging for the specific treatment of Bell’s
Palsy and for facial acupuncture in general, especially as half of these points are
used in the Facial Enhancement Acupuncture protocol. Up until now, I have
mainly limited De-Qi to the body points as, due to the many facial points
involved, there was a potential for the treatment to be overwhelming if all points
were needled in this way. A proportion of the points used have also been
selected, in the most part, for their location and work with the underlying muscle
group. To a certain extent, I will be aiming to achieve De-Qi for related points
depending on the requirements of the patient and the specific facial issue they
are looking for me to work upon. However, in light of this new research, I will
certainly explore this in even more depth. It is important to remember that any
protocol is organic and must continue to grow and develop for optimum results
to be achieved. Despite Facial Enhancement Acupuncture already garnering
effective results in my practice and for those trained in the protocol, acupuncture
is a life-long study. I look forward to continuing to maximise the results of the
treatment and reporting my findings in future publications.
Returning to GB14, the many studies for facial paralysis utilising this point
unilaterally demonstrate its use for lifting the facial muscles. This is what we are
aiming to achieve when using GB14, as it is located on the frontalis muscle,
which is responsible for lifting the eyebrow. The method for needling GB14
outlined in Chapter 4 will demonstrate this muscle training technique.

FOREHEAD POINT
This is an additional point that I use in the protocol. Located approximately 1.5
cun (2.5cm) above Yin Tang, this point is used for reducing forehead tension, as
well as lines and wrinkles in that area. See Figure 3.1.

 FIGURE 3.1 THE LOCATION OF THE HEAD AND FOREHEAD POINTS

3.5 ACUPUNCTURE POINTS AROUND THE EYES

BLADDER 2 ZAN SHU (COLLECT BAMBOO)
Location: In the depression at the medial end of the eyebrow. See Figure 3.2.

Muscle: Frontalis and corrugator supercilli.

Element: Water.

Functions: Clears heat, eliminates wind, enhances eyesight and alleviates pain.

Applications: Eye diseases, sinusitis, headache, neck pain and stiffness.

Bladder 2 (BL2) is a really good point for benefiting the eyes and also the
sinuses; we are using it predominantly as a lifting point to raise the medial end
of the eyebrow. The underlying muscle is the corrugator supercilli, which is
responsible for the vertical frown lines on the forehead. Targeting this point
helps to tighten the muscle to prevent these lines from forming.

YUYAO (FISH WAIST)

Location: Directly above the pupil in the eyebrow. See Figure 3.2.

Muscle: At the top of the orbicularis oculi, where it meets the frontalis.

Functions: Enhances eyesight, activates the vessels, relaxes tendons and reduces
oedema.

Applications: Oculomotor paresis, eye tics and eye disease.

Yuyao is an Extra point that is located in the middle of the eyebrow. We are
using this point to help raise this area. Interestingly, Yuyao was reported by the
Shanghai First College of Medicine as an anaesthetic point for use in minor
surgery to the forehead, eyebrow and temple regions (Anon. 1975). This can
only serve to continue to lessen any discomfort that may otherwise be felt when
we work more closely on these parts of the face.
TRIPLE HEATER 23 ZHU KONG (SILK BAMBOO HOLLOW)
Location: The lateral end of the eyebrow, in the depression on the supraorbital
margin. See Figure 3.2.

Muscle: Orbicularis oculi.

Element: Fire.

Functions: Enhances eyesight, alleviates pain, expels wind and clears heat.

Applications: Eye diseases, eye tics, one-sided headache, toothache, deviation

of the face and eye.

Triple Heater 23 (TH23) is another acupuncture point that can be used to benefit
the eyes. Here, we are using this point to lift the lateral end of the eyebrow and
raise drooping eyelids.

 FIGURE 3.2 THE LOCATION OF THE POINTS USED AROUND THE EYES

3.6 ACUPUNCTURE POINTS ON THE JAW

JAW POINTS
These are six Extra points that I use on either side of the mandible to tighten the
jaw line.

Location: Find Stomach 5 (ST5) Da Ying (Great Welcome), which is 1.3 cun
anterior and inferior to the corner of the jaw, on the front edge of the masseter
muscle. The first point is directly below ST5, with one point approximately 1.5
cun either side. See Figure 3.3.

Muscle: Platysma.

 FIGURE 3.3 THE POSITIONING OF THE JAW POINTS

3.7 ACUPUNCTURE POINTS ON THE FRONT OF THE FACE

CHEEK POINT
This is another Extra point that I have chosen for its capacity to tighten the cheek
area.

Location: Approximately 1–2 cun above ST5, then 1 cun back towards the ear
and into the cheek muscle. See Figure 3.4.

Muscle: Masseter.
STOMACH 4 DICANG (EARTH GRANARY)
Location: 0.4 cun lateral to the corner of the mouth, directly below the pupil.
See Figure 3.4.

Muscle: Orbicularis oris, risorius and zygomaticus major.

Element: Earth.

Functions: Expels wind, activates the channel and alleviates pain.

Applications: Facial paralysis, deviation of the mouth, toothache, neuralgia and

night blindness.

Stomach 4 (ST4) often lies at the base of the nasal labial fold. We are using ST4
purely for its location at the side of the mouth as we are angling it up into the
underlying zygomaticus major muscle, responsible for raising the smile.
ST4 is also a common point used for facial paralysis and was selected for the
aforementioned study into treating Bell’s Palsy.

LARGE INTESTINE 20 LINGXIANG (WELCOME FRAGRANCE)

Location: Level with the lateral part of the nasal wing in the nasal labial fold.
See Figure 3.4.

Muscle: Levator labii superioris.

Element: Metal.


Functions: Opens the nasal passages, expels wind and clears heat.

Applications: Deviation of the mouth, facial paralysis, rhinitis, nosebleed, facial

oedema and facial itching.

Large Intestine 20 (LI20) is a local point for swelling, paralysis and itching of
the face. The point is located at the top of the nasal labial fold, which covers the
levator labii superioris muscle. Points along the Large Intestine channel are used
to detoxify and improve the complexion.

STOMACH 3 JU LIAO (GREAT CHEEKBONE)

Location: Directly below the pupil on the lower border of the ala nasi. See
Figure 3.4.

Muscle: Levator labii superioris and levator angular oris.

Element: Earth.

Functions: Enhances eyesight, expels wind and activates the channel.

Applications: Mouth and eye deviation, sinus pain, swelling of the lips and
cheeks and facial paralysis.

This point is used in conjunction with LI20 and Small Intestine 18 (SI18) to
shape and contour the cheek area. The levator angular oris is a muscle that
underlies the levator labii superioris and this is triggered when needling, helping
to lift the face.

SMALL INTESTINE 18 QUANLIAO (CHEEKBONE CREVICE)

Location: In the depression below the zygomatic bone, directly below the outer
canthus. See Figure 3.4.

Muscle: Zygomaticus major.

Element: Fire.

Functions: Alleviates pain, activates the channel, returns to correct position and
relieves cramp, expels wind and reduces swelling.

Applications: Facial paralysis, facial cramps, deviation of the mouth and eye,
facial pain and toothache.

Small Intestine 18 (SI18) is used in conjunction with ST3 and LI20. Aside from
its outlined functions and applications, needling this point has an effect on the
zygomaticus major muscle in order to lift the face.

STOMACH 2 SI BAI (FOUR WHITES)

Location: In the depression of the infraorbital foramen, 1 cun directly below the
pupil. See Figure 3.4.

Muscle: Orbicularis oculi.



Element: Earth.

Functions: Enhances eyesight, clears heat and expels wind.

Applications: Eye diseases, headache, night blindness and deviation of the
mouth and eye.

Stomach 2 (ST2) is located on the orbicularis oculi muscle. Locate the point,
gently press your finger to it and tightly squeeze your eye shut. This muscle is
responsible for closing your eyelid, but you will feel how the skin is drawn in
around the eye and forehead. It is this action that gradually forms crow’s feet
around the eye. We needle this point to lift the top of the cheek and to benefit the
eyes.

 FIGURE 3.4 THE LOCATION OF THE POINTS USED ON THE FRONT OF THE FACE

3.8 ACUPUNCTURE POINT ON THE CHIN

REN MAI (CONCEPTION VESSEL) 24 CHENG JIANG (RECEIVING
FLUID)
Location: Below the middle of the lower lip, in the depression of the
mentolabial fold. See Figure 3.5.

Muscle: Between orbicularis oris and mentalis.

Functions: Reduces oedema, alleviates pain, activates the channel and its
vessels, benefits the face, clears heat, calms the Spirit and expels wind.

Applications: Deviation of the mouth and eye, purple lips, swelling of the face,
dry mouth, sweating, facial pareses and acute toothache.

According to the famed Chinese physician Li Shi Zhen, the Ren channel
‘became the ocean or controller of the yin meridians’ and at Ren 24 it meets with
‘the du mai, large intestine and stomach meridians; then circles around the lips
on the inside of the mouth, divides and passes up to chenqi [ST-1] where it ends’
(Li Shi Zhen 1570 in Matsumoto and Birch 1986, pp.27–28). This demonstrates
how needling this point can have a beneficial effect on the front of the face. It is
also the only Yin point on the whole of the face, which could indicate its
function to cool things down.

 FIGURE 3.5 THE LOCATION OF REN 24

3.9 ACUPUNCTURE POINTS TO TREAT THE NECK

When treating the neck using Facial Enhancement Acupuncture, there are a few
conditions that you can address using your acupuncture needles. Patients will ask
you if it is possible to help with the sagging muscles in the neck. Some will refer
to it as a ‘turkey neck’, which to my mind is not a nice description.
What you will find, as you work with more patients, is that the neck area is the
place that starts to show ageing more than many others. When you look at the
celebrities who have had thousands of pounds’ worth of plastic surgery carried
out, it is very often the neck that gives the game away. The points that I have
outlined will all help to tighten the neck muscles and improve the overall
appearance of this area. If the patient has a lot of lines around the neck, which
may also extend down to the upper chest area, then this might be a candidate for
using the dermal roller or dermal pen that we will explore in more detail in
Section 5.3.

SMALL INTESTINE 17 TIAN RONG (HEAVENLY APPEARANCE)

Location: In the depression between the angle of the mandible and the anterior
border of the sternocleidomastoid. See Figure 3.6.

Muscle: Sternocleidomastoid.

Element: Fire.

Functions: Reduces oedema, enhances hearing, descends rebellious Qi and

benefits the neck and throat.

Applications: Tinnitus, deafness, acute throat inflammation, asthma, goitre and

asthma.

Small Intestine 17 (SI17) helps to reduce swelling in the region of the neck.
Deadman and Al-Khafaji also suggest that it can be used for swelling of the
cheek (1993, p.34). In Five Element Acupuncture, SI17 is known as a ‘Window
of the Sky’ point. This is a point that many regard as one of a selection of ten
that have a connection with the Mind and Spirit of a patient. Therefore, it should
help to balance and calm everything down. The translated name ‘Heavenly
Appearance’ certainly seems quite apt for what we are trying to achieve. In the
context of a Facial Enhancement Acupuncture treatment, we are using it to
tighten the neck.

TRIPLE HEATER 17 YI FENG (WIND SCREEN)

Location: In the depression between the mastoid process and the mandible,
behind the earlobe. See Figure 3.6.

Muscle: Sternocleidomastoid.

Triple Heater 17 (TH17) is not used directly in the treatment; it is listed here for
its location. The Step-by-Step Guide in Chapter 4 will demonstrate how we
needle up to this point from SI17.

REN MAI (CONCEPTION VESSEL) 23 LIAN QUAN (ANGLE SPRING)

Location: In the depression superior to the hyoid bone, on the ventral midline.
See Figure 3.6.

Functions: Descends Qi, benefits the tongue and alleviates cough.

Applications: Throat disorders, mouth ulcers, lockjaw and dryness of the

mouth.

Ren 23 is a central point on the neck and targets the suprahyoid muscles.
Working with this point is part of the tightening and lifting process we are
aiming to achieve in this area.

STOMACH 9 RENYING (PEOPLE WELCOME)

Location: 1.5 cun lateral to the upper side of the laryngeal prominence, on the
front side of the sternocleidomastoid muscle. See Figure 3.6.

Muscle: Sternocleidomastoid.


Element: Earth.

Functions: Regulates Qi, alleviates pain, clears heat and benefits the throat and
neck.

Applications: Asthma, hypertension, hypotension, throat inflammation and
swelling, tonsillitis, headache.

Stomach 9 (ST9) is a very interesting point and warrants an in-depth look at how
powerful a point it can be. Like SI17, in Five Element Acupuncture, ST9 is
known as a ‘Window of the Sky’ point.
I have always considered ST9 to be a highly important point to use in a Facial
Enhancement Acupuncture treatment, not simply because of its location on the
neck, but also because of its power to open up the face and improve the
complexion. This is very clearly highlighted by Wei Lushang and Xiao Fei in
their article for the Journal of Chinese Medicine in May 1997. It was noted that
in using ST9 for patients with facial paralysis, as well as improvements to the
paralysis, there was also a dramatic enhancement to their complexions and the
smoothness of the skin’s surface. Their research also showed that patients who
suffered with problematic cerebral blood supply found that their ‘complexions
became lustrous and their eyes brightened’ (Lushang and Fei 1997, p.18).
Doctors Wei Lushang and Xiao Fei also made studies into the effects of
needling ST9 to improve particular skin conditions. Their results were quite
astounding. In the case of chloasma, which is typified by a discolouring of the
facial skin – for example, yellowish brown or coffee coloured patches – there
were very dramatic reductions in its appearance after a few treatments. And, in
some cases the condition completely cleared after a course of ten sessions using
ST9 (Lushang and Fei 2007).
Another complaint that I am asked about frequently is acne and how
acupuncture can help. Acne is a condition caused by over-secretion of the
sebaceous glands, which can block the pores and cause break-outs (see Section
6.5). Needling ST9 on a regular basis has been found to be fairly effective in
restricting the production of the sebaceous glands and has improved the acne
over a course of treatments (Lushang and Fei 2007).
Generally, it has become apparent to me that ST9 is one of the most powerful
acupuncture points at our disposal, which may be why we are often instructed to
use it with caution. However, due to its many benefits, I feel that it is a point that
we should consider using more frequently.

STOMACH 13 QI HU (QI DOOR)

Location: 4 cun lateral to the midline, at the top of the chest directly beneath
Stomach 12 (ST12) and the lower side of the clavical. See Figure 3.6.

Element: Earth.

Functions: Unbinds the chest, relieves breathing problems and descends

rebellious Qi.

Applications: Pain in the chest, asthma, wheezing, stiffness of the neck and
vomiting blood.

Stomach 13 (ST13) and the following point, Gall Bladder 21 (GB21), are to be
viewed as optional additions, as not all patients will require treatment on their
necks. ST13 is a point used for treating the lungs; if the lungs are working freely,
tension to the neck muscles will be reduced.

Note: Needle with extreme caution as deep insertion carries a substantial risk of
lung puncture.
GALL BLADDER 21 JIAN JING (SHOULDER WELL)
Location: On the high point of the trapezius muscle, at the point of greatest
tenderness. See Figure 3.6.

Element: Wood.

Functions: Alleviates pain, regulates Qi, activates the channel, clears heat and
expels wind.

Applications: Neck pain and stiffness, shoulder and back pain, breast pain and
prolonged labour.

GB21 is located on the high point of the trapezius muscle, and is a powerful
valve for unblocking energy. When the smooth flow of energy is achieved in this
area, the neck becomes less tense and Qi flows freely:

So strong is the action of Jiangjing GB-21 in descending qi that Gao

Wu, in the Ode of Xi-hong, says ‘When you needle Jiangjing GB-21
you must needle Zusanli ST-36. If this is not done, the qi will not be
regulated.’ (Deadman, Al-Khafaji and Baker 2001, p.439).

ST36 forms part of the Facial Enhancement Acupuncture protocol and Gao
Wu’s words demonstrate the benefit of needling the feet and legs, before
beginning work on the face and upper body in this treatment.

Note: Contraindicated in pregnancy.


 FIGURE 3.6 THE LOCATION OF THE POINTS USED ON THE NECK

3.10 AURICULAR ACUPUNCTURE POINTS FOR FACIAL

ENHANCEMENT ACUPUNCTURE
Auricular acupuncture, or ear acupuncture as it is also known, uses similar skills
to traditional acupuncture, but with acupuncture stimulation limited to the
external ear. When I studied Five Element Acupuncture, we did not cover any
auricular practice in our studies; most of my research has been undertaken over
the last few years. Since then I have discovered some very powerful treatments
using points on the ear.
Traditional acupuncture has been practised for over 2500 years, at least, and
ear acupuncture is thought to have been around for the same length of time,
albeit without the same notoriety. Auricular therapy has a long history of use in
China. It was mentioned in the most famous of ancient Chinese medical
textbooks, the Nei Jing: ‘This ancient Chinese document was very specific about
the needling of particular auricular points for the balancing of functional
disorders related to a particular channel system’ (Ken and Yongqiang 1991).
Auricular acupuncture owes a lot of its current popularity to the late Dr Paul
Nogier, a French physician from Lyon. He is credited for research and
development of auricular acupuncture since the 1950s and has even been
nicknamed the ‘Father of modern auricolotherapy’ by the Chinese (Gori and
Firenzuoli 2007, p.14). He famously ‘drew a chart of ear points that was mapped
from the shape of an inverted fetus’ (Chen 2004, p.3). This microsystem meant
that by stimulating points on the ear, the whole body could be treated.
Following on from this concept, we can look at various auricular points that
will have some bearing on our Facial Enhancement Acupuncture treatment.
Many acupuncturists who I know and have worked with are not that familiar
with the points of the ear, unless of course they are auricular specialists. These
points are some of the most powerful and many practitioners achieve fantastic
results with their patients by only using these points. In fact, there are many
successful acupuncturists who run only auricular clinics. There are several fine
publications specialising in auricular acupuncture and they all seem to feature
very accurate diagrams showing the many points on the ear. It may be worth
purchasing a large Nogier wall chart for your clinic; this will give you an instant
reference when deciding which point you should choose.
Personally, I will always use the point Shen Men left, then right for every
FEA treatment that I perform. It is an effective point to use in combination with
classical points like Yin Tang and DU20 for relaxation and calming. Also, in
conjunction with this, I will choose to use another auricular point that would
correspond with a particular area of the face that I am keen to work on. For
example, if I am interested in improving the area around the eyes, then I might
consider auricular points that relate to this.
Some of the points that I have found to be most successful, alongside Shen
Men, are the points Mandible, Eyes, Cheek and Mouth. However, you will be
able to use the initial consultation to gauge which area to focus on for each
particular patient. My advice for any auricular points would be to research them
and see what points work for you and then incorporate them into your own
treatment protocol.
When needling auricular points I like to use a 15mm (length) × 0,20mm
(thickness)/36 (gauge) needle, I find it advisable to use a sterile swab to clean
the ear prior to this. This area can be very vulnerable and must be scrupulously
clean before you begin.
Listed below are a few auricular points that could work well in a Facial
Enhancement Acupuncture treatment. See Figure 3.7.

 FIGURE 3.7 THE LOCATION OF THE AURICULAR POINTS 1–18

1. SHEN MEN
Like its counterpart on the body, Shen Men is a powerful point for calming the
Spirit. It can also be used as an analgesic in combination with the three
constitutional anaesthetic points. It should be needled first, before selecting a
follow-up point.

2. MOUTH
Relates to mouth issues (e.g. cold sores).

3. FOREHEAD
This point is often used for headaches, but in this context can be employed for
enhancing the forehead.

4. EYE
Can be used for improving vision and brightening the eyes.
5. TEMPLE
As you can guess, Temple is used specifically for headaches in this location.
However, it can also be used to focus on this area of the face.

6. CHEEK
This point is also known as Face and is used for cases of facial paralysis and
working with the facial muscles. It is recommended for treatment involving this
part of the face, so it would be a useful point to include, particularly for lifting
the cheek.

7. MANDIBLE
Also known as Jaw, this can be selected to target jowls.

8. NECK
Again, relating directly to its name, this point can be used to relieve tension in
the neck.

9. HEART
This point has some correlation with Shen Men.

10. LUNG
As the Lung governs the skin, either Lung 1 (LU1) or Lung 2 (LU2) can be used
to improve the complexion. Anyone presenting with skin rashes, rosacea or acne
could benefit from this auricular point.

11. SYMPATHETIC
This is a pain-relieving point, so it would combine nicely with LI4, PC4 and
TH8.

12. SUBCORTEX
This point is known for its anti-inflammatory effects and can reduce swelling.
Therefore, it will help the face to calm down during the treatment. It is also a
point used for acupuncture analgesia, so it would work well with the anaesthetic
points and boost the effects.
13. ZERO POINT
‘Zero Point is thought to have a powerful influence in treating various conditions
including pain, sedation, addiction treatment, and inflammation’ (Frank and
Soliman 1999, p.13). This point is also deemed to bring the whole body back
into balance, and this homeostasis will be beneficial not only for how your
patient looks but for how they feel too.

14. RELAX MUSCLE

An auricular point that literally does what its name suggests and relaxes the
patient’s muscles. This can be beneficial for patients who are struggling to
unwind and really enjoy the treatment.

15. ENDOCRINE
This system in our bodies is responsible for the secretion of hormones into our
bloodstream. So, where skin issues are caused by hormonal imbalances, this
point can be used help address this. Also, when the Endocrine system is working
efficiently, it will slow down the ageing process and assist in retaining our
vitality as we get older.

16. SPLEEN
In Section 3.2 we discussed how the Spleen sends fluid up to the lungs and they
then disperse moisture in the skin, so this point can assist with hydration.
Choosing the Spleen point on the ear can also help to tone the flesh, as discussed
in Section 1.1.9.

17. KIDNEY
This organ relates to the ageing process as the Kidney governs all stages of
development. If your patient has bluish eye bags, you may like to try this point
as the Kidney is often linked to this problem.

18. LIVER
The Liver is linked to the eyes and we can use this point to directly improve this
area and decrease dark circles.
CHAPTER 4

STEP-BY-STEP GUIDE TO THE FACIAL

ENHANCEMENT ACUPUNCTURE
PROTOCOL

4.1 CONTRAINDICATIONS
The training acupuncturists are given ensures that we take a thorough patient
history before we commence treatment. This is also crucial when conducting a
cosmetic acupuncture treatment and I provide a free 15-minute initial
consultation to determine whether someone is able to undergo the procedure and
to describe what they can expect from a course of Facial Enhancement
Acupuncture.
The first thing to consider would be whether the patient has recently had more
invasive cosmetic treatments such as microdermabrasion, laser resurfacing or a
surgical facelift. I would also check to see if they have had recent Botox® or
fillers. It would be possible to work on areas that have not been injected;
however, I like to wait at least three months before carrying out Facial
Enhancement Acupuncture in these cases.
From a health perspective, I would refrain from performing a cosmetic
acupuncture treatment if a person suffers from chronic migraines, uncontrolled
high blood pressure or diabetes, has cancer, is actively trying for a baby,
pregnant or breast-feeding, has had a pacemaker fitted, during a cold or flu,
during an allergic reaction or if someone has a problem with excessive bleeding
or bruising.
Sometimes it is possible to treat the patient’s current health problems and then
re-evaluate them at a later date to establish if they are now able to receive Facial
Enhancement Acupuncture.
As with any Five Element Acupuncture treatment, I am always conscious to
look out for any indications that may need me to refer the patient to a medical
practitioner and the same applies with my facial procedure. If at any time I am
aware of the symptoms or conditions of an illness that cause me any concern,
then I will always refer the patient to a medical consultant.

4.2 PREPARATION
Before you start your Facial Enhancement Acupuncture treatment, and even
prior to your patient arriving at the clinic, make sure that you are well prepared
and have your supplies ready. You will need cotton wool and cotton buds and
also some cleanser to remove any make-up or just to cleanse your patient’s face
before you start the facial treatment. We will go into more depth in Step 4.3.4 of
the treatment protocol, but it is recommended to have some skin-numbing cream
and arnica on hand. Tweezers are also necessary for insertion of the intradermal
needles.
Like any traditional acupuncture treatment, you will need to be able to access
your patient’s feet, legs, hands and arms, so that you can use the constitutional
acupuncture points before you start working on the face. These points will be
used to ground and relax the patient in order to make the treatment as
pleasurable as possible.
The amount of time that you set aside for FEA treatment is entirely up to you
and you will get this down to a fine art once you have carried out a few sessions.
Personally, I like to allow at least two hours for my first treatment, as we will
need to carry out an in-depth initial consultation and we will be adding in a
clearing or detox protocol. Subsequently, my sessions are 75 minutes, but I
allow an hour and a half, so that the patient has time to relax and not feel rushed
following the treatment.

4.3 STEP-BY-STEP GUIDE TO FACIAL ENHANCEMENT

ACUPUNCTURE
4.3.1 INITIAL GROUNDING TREATMENT
How we start a treatment is very much down to the preferences of the
practitioner. Before we embark on a series of treatments it is important that we
perform some sort of detox or clearing treatment on the patient. (This clearing
treatment is usually only performed on the first visit.)
Because of my Five Element background and training, the obvious choice for
me would be to perform an Aggressive Energy Drain on the patient. See Section
3.1 for more on this protocol.
BL13, BL14, BL15, BL18, BL20 and BL23
To begin, make sure that your patient is comfortable, as it can take some time for
the AE to clear. You will need to insert the needles at the points listed bilaterally
and very superficially. At this stage, do not needle BL15, the Heart Shu point;
this point should be needled on its own after testing for AE on the other points.
Also, remember that we need to use a couple of dummy needles that are inserted
level with, or just outside of, the Bladder meridian, after the main Shu points
have been needled. This ensures that the Shu points are correct, as the redness
should be less pronounced at the control points.
This stage of treatment depends on how long the redness takes to completely
clear or ‘drain’.
The needles for the AE Drain should be retained until the erythema around the
needles has cleared. If very little or no redness appears, then retain the needles
for a few minutes and then remove.
I would encourage you to try to get into the routine of performing an AE
Drain for the first treatment when you take on a new Facial Enhancement
patient. If you feel things are not progressing very well during the course of
facial treatments, it may be worth repeating the AE Drain to make sure all
energy is clear. As a Five Element practitioner, I am very familiar with this type
of treatment. However, depending on your background, you may wish to utilise
your own protocol for draining AE, detoxing or clearing.
Remember to make your patient fully aware, during their initial consultation,
that you will be using body points, as they may only expect facial treatment.
Once any AE has been cleared from a patient, you should see a dramatic
response to treatment and a vast improvement in their Mind, Body and Spirit.
This will form the optimum basis for further treatment.
Again, depending on your school of acupuncture, I would take the patient’s
pulses and also investigate their general health condition before starting the
treatments.

4.3.2 NEEDLING THE LEGS AND FEET

LV3, ST36, SP9, GB41 and ST44
These points provide an ideal base for the patient before we begin work on the
face, they should be needled every treatment. I always start to needle the points
on the patient’s feet and legs first. These points are designed to give a good
grounding for the treatment. They are retained throughout and are the last
needles to be removed.

Needle size: 25mm (length) × 0,16mm (thickness)/40 (gauge).

Technique: Bilaterally and with slight tonification.

4.3.3 NEEDLING THE HANDS AND ARMS

This step utilises the anaesthetic nature of the selected points.

LI4, PC4 and TH8

Needle size: 25mm (length) × 0,16mm (thickness)/40 (gauge).

Technique: Bilaterally. It is important to achieve De-Qi. Always use LI4 as it

forms part of the Four Gates treatment and has so many benefits. I mostly use
PC4 and TH8 when a patient seems particularly nervous or jittery about the
treatment and will benefit from extra sedation. These two points are situated on
meridians that run into the chest area; this has a calming effect on the patient’s
respiration and helps them to relax during the procedure.

Note: LI4 is contraindicated in pregnancy.

4.3.4 NEEDLING THE HEAD AND FOREHEAD

Before we begin the facial needling, it is important to make sure that the skin is
totally clean of any make-up and dirt. I would recommend a natural cleanser that
does not contain chemicals.
If, despite using the points indicated for their anaesthetic properties, your
patient is particularly sensitive to the facial needles, it might be worth
considering the use of a mild anaesthetic cream. Lidocaine 5% can be applied to
the areas of the face you will be paying particular attention to. This is similar to
the cream that tattooists use in their studios. It needs to be applied at least 30
minutes prior to the facial needling and any residue should be removed before
treatment commences. Use a disposable spatula, or similar tool, to apply the
cream and try to avoid contact with your fingers at this stage, as much as
possible. You can, of course, if you prefer, carry out the treatment without any
cream; there is very little pain or discomfort due to the needles inserted during
Section 4.3.3 and most of my treatments are done this way.
My needle preference has always been metal handles for traditional
acupuncture. However, for facial work, I recommend plastic-handled needles as,
due to their light weight, they remain more upright in the face, even with shallow
needling. As the number of needles in use increases, the face is still accessible.
This is helpful when we come to using the intradermals, as it will give you much
more room to work on the face.
When conducting a Facial Enhancement Acupuncture treatment, it usually
pays to stand or sit at the back of your patient, working over the top of their head
and face. By needling from this position, you will always be using a lifting
technique as you needle towards yourself. By continually using this technique,
you will get into the habit of lifting the patient’s face as you work.

DU20
Needle size: 25mm (length) × 0,16mm (thickness)/40 (gauge).

Technique: Evens.

Angle: 90 degrees perpendicular to the scalp.

Yin Tang
Use gentle stimulation upon insertion.

Needle size: 15mm (length) × 0,20mm (thickness)/36 (gauge).

Technique: Tonification.

Angle: Posterior, at approximately 75 degrees.

See Figure 4.1.

 FIGURE 4.1 DEMONSTRATING NEEDLING AT YIN TANG

BL6
Needle size: 25mm (length) × 0,16mm (thickness)/40 (gauge).

Technique: This point is needled as you pull back on the patient’s forehead. Pull
the skin gently towards the rear of the head and then insert the needle. You are
effectively pinning back the scalp using this method. Needle bilaterally, using
evens technique.

Angle: Posterior, at approximately a 45-degree angle to the scalp.

See Figure 4.2.

 FIGURE 4.2 DEMONSTRATING NEEDLING IN THE HAIRLINE AT BL6

GB14
Needle size: 15mm (length) × 0,20mm (thickness)/36 (gauge).

Technique: When needling this point, do so bilaterally and use your other hand
to pull back on the forehead. This will have the effect of pinning back the
eyebrows. If you have needled this point correctly, the side that you have just
needled will remain lifted when you take your other hand away. This is an
effective combination with the intradermal needling you will carry out in Section
4.3.6 to raise the eyelids. Needle bilaterally, using evens technique.

Angle: Posterior and approximately 75 degrees from the forehead.

See Figure 4.3.

 FIGURE 4.3 DEMONSTRATING NEEDLING AT GB14

Forehead Point
Needle size: 15mm (length) × 0,20mm (thickness)/36 (gauge).

Technique: Needle with an upwards motion.

See Figure 4.4.

 FIGURE 4.4 DEMONSTRATING NEEDLING AT THE EXTRA FOREHEAD POINT

4.3.5 NEEDLING THE EARS

At this stage of the Facial Enhancement Acupuncture treatment, we will also
consider the use of some auricular points to support the treatment. I always
include Shen Men, but you might also include points such as Mandible or
Cheek. Your choice of ear points will be based on your initial consultation and
will likely differ from patient to patient, depending on their requirements and
your assessment. See Section 3.10 for details of auricular points that you may
like to select. See Figure 4.5.

 FIGURE 4.5 DEMONSTRATING NEEDLING AT THE AURICULAR POINT SHEN MEN

4.3.6 NEEDLING THE EYEBROW AREA

The next three points are needled using 6mm intradermals. It is best to insert
them with tweezers. The type I recommend are those with a slanted tip and a
wide handle grip. I find that these are the best to master this technique. By
raising the eyebrows in this step, we will naturally lift the eyelids too. When
needling any of the three eyebrow points, do not be afraid to lift the brow as
much as possible; you need to be achieving a ‘startled’ look when you have
finished inserting the needles.

Yuyao
Needle size: 6mm intradermal.

Technique: To needle this point, lift the eyebrow as you do so and pin it in
place. This Extra point is one of the most sensitive points that you will needle on
the face, so extra care needs to be taken when working in this area.


See Figure 4.6.

FIGURE 4.6 DEMONSTRATING NEEDLING AT YUYAO AND THE INTRADERMAL NEEDLING
TECHNIQUE USING WIDE GRIP TWEEZERS

BL2
Needle size: 6mm intradermal.

Technique: Lift the medial end of the eyebrow with the forefinger of your other
hand and needle with the intradermal, pinning the brow in an upward direction.

See Figure 4.7.

TH23
Needle size: 6mm intradermal.

Technique: TH23 this should be tackled in exactly the same way as the previous
two points, again raising the brow as the intradermal needle is inserted.

See Figure 4.7.

 FIGURE 4.7 DEMONSTRATING THE EYEBROW NEEDLES IN PLACE

4.3.7 NEEDLING THE JAW

This technique is chiefly used for working on the patient’s jowls. At this stage it
might be worth mentioning needle technique. As a Classical Five Element
practitioner, I was trained to needle without the use of guide tubes and, to date,
this is my preferred needle technique. However, after years of carrying out facial
treatments, it has become my experience that the whole treatment is less
sensitive for the patient when using guide tubes for 25mm needling. This is
particularly noticeable when treating the jowl area. I have found that patients
find this technique more comfortable and it is easier to perform this next
‘pinning’ method.

Location: First, locate point ST5 and choose a point directly below it and one
point symmetrically either side of this needle. Effectively, you will have three
points under the mandible bone at approximately 1.5 cun distance between each
point. These are not acupuncture points


Needle size: 25mm (length) × 0,16mm (thickness)/40 (gauge).

Technique: Apply downward pressure and tuck the skin under the jawbone as
you needle the midpoint; you are pinning the flesh under the mandible bone.
Repeat this procedure with the points either side. Needle the jaw in this way on
both sides of the face. Over time, this part of the treatment will train the muscles
in the jowl to tighten and encourage a more angular shape to the patient’s jaw
line.

See Figures 4.8 and 4.9.

FIGURE 4.8 LOCATING THE FIRST JAW POINT AND TUCKING THE SKIN BENEATH THE
JAW BONE

 FIGURE 4.9 DEMONSTRATING NEEDLING ALONG THE JAW LINE

4.3.8 NEEDLING THE FRONT OF THE FACE

Cheek Point
Location: Again, locate point ST5 and palpate above this point approximately
1–2 cun in measurement, then 1 cun back towards the ear and into the cheek
muscle. See Figures 4.8 and 4.9 for the location of the point.

Needle size: 25mm (length) × 0,16mm (thickness)/40 (gauge).

Technique: Needle this Extra point with insertion towards the ear. When
needled correctly, there should be a ‘grabbing’ sensation as the needle enters the
cheek muscle. If this is achieved, you will notice how the area we are working
on tightens up almost immediately. This is a very important point that can give
very dramatic results, so it is worth practising your needle techniques on this
point. Needle bilaterally.

Angle: Approximately 45 degrees to the cheek.

See Figure 4.10.

 FIGURE 4.10 DEMONSTRATING HOW TO NEEDLE THE EXTRA CHEEK POINT

ST4
Needle size: 15mm (length) × 0,20mm (thickness)/36 (gauge).

Technique: Working with the ‘smile’ muscles and using the opposite hand to
which you needle, pull up on the side of the mouth with your forefinger and
insert a needle upwards. Ensure that you lift the point as much as possible before
needling. Again, needle bilaterally, with evens technique.

Angle: 45-degree angle to the face.

See Figure 4.11.


 FIGURE 4.11 DEMONSTRATING NEEDLING AT ST4

LI20
Needle size: 25mm (length) × 0,16mm (thickness)/40 (gauge).

Technique: Needle bilaterally and using evens technique. This is the first point
that we use to begin to lift and shape the cheek.

 FIGURE 4.12 DEMONSTRATING NEEDLING AT LI20

ST3
Needle size: 25mm (length) × 0,16mm (thickness)/40 (gauge).

Technique: This is the second point used to shape the cheek area and it is
needled perpendicularly and bilaterally, using evens technique.

See Figure 4.13.

 FIGURE 4.13 DEMONSTRATING NEEDLING AT ST3

SI18
Needle size: 25mm (length) × 0,16mm (thickness)/40 (gauge).

Technique: The third location forming the triangle of cheek-sculpting points.

Needle bilaterally, using evens technique.

See Figure 4.14.

 FIGURE 4.14 DEMONSTRATING NEEDLING AT SI18

ST2
Needle size: 15mm (length) × 0,20mm (thickness)/36 (gauge).

Technique: Evens and needled bilaterally.

See Figure 4.15.

 FIGURE 4.15 DEMONSTRATING NEEDLING AT ST2

4.3.9 NEEDLING THE CHIN

Ren 24
Needle size: 15mm (length) × 0,20mm (thickness)/36 (gauge).

Technique: Evens.

See Figure 4.16.

4.3.10 TREATING THE NECK

I generally use the first three points during every treatment that I perform. ST13
and GB21 are optional and are added to the protocol when the patient wants
particular attention given to their neck area.
SI17
Needle size: 25mm (length) × 0,16mm (thickness)/40 (gauge).

Technique: This technique is very effective for tightening the neck muscles.
When needling this point in a facial treatment, needle in the direction of (not
under the skin) point TH17, behind the earlobe. If the patient has excess skin
there, pinch the flesh together as you needle and implement this step with
extreme caution. This is a vulnerable part of the neck and must be needled with
great care. Aim to achieve a ‘grabbing’ sensation. When needled correctly, the
muscles will be taut and there will be a significant improvement to the
appearance of the neck area. Needle bilaterally with an evens technique.

Angle: 45 degrees.

See Figure 4.17.

FIGURE 4.16 DEMONSTRATING NEEDLING AT REN 24

 FIGURE 4.17 DEMONSTRATING NEEDLING AT SI17

Ren 23
Needle size: 25mm (length) × 0,16mm (thickness)/40 (gauge).

Technique: This point is listed here due to its location on the neck, although I
tend to needle this point whilst working on the jaw points, as it is in the same
area and it seems a natural progression. Ren 23 should be needled with an evens
technique.

See Figure 4.18.

ST9
Needle size: 25mm (length) × 0,16mm (thickness)/40 (gauge).


Technique: Tonification and bilaterally.

See Figure 4.19.

ST13
Needle size: 25mm (length) × 0,16mm (thickness)/40 (gauge).

Technique: Tonification and bilaterally.

Note: Needle with extreme caution.

GB21
Needle size: 25mm (length) × 0,16mm (thickness)/40 (gauge).

Technique: Tonification and bilaterally.

Note: Contraindicated in pregnancy.

FIGURE 4.18 DEMONSTRATING NEEDLING AT REN 23

 FIGURE 4.19 DEMONSTRATING NEEDLING AT ST9

4.3.11 TREATING WRINKLES

Treating lines and wrinkles on the face using Facial Enhancement Acupuncture
is an effective part of the protocol and one that should give good results after a
minimum of three treatments. The same intradermal needling technique can be
used on forehead lines and also areas such as the nasal labial fold, which runs
from the side of the nose to the corner of the mouth.
The latter, along with the ‘number elevens’ (lines between the eyes at the
bridge of the nose), are two of the most commonly requested areas of the face
that I am asked to treat. Known as glabellar frown lines, the ‘number elevens’
are formed by the movement of the underlying procerus and corrugator
supercilli muscles. Sun exposure and genetics are a cause, along with too much
frowning. This may sound odd, but many of us have jobs that involve staring at a
computer screen all day and even the fine needling we perform as acupuncturists
requires a lot of concentration. Of course, we all grow older and, as we do, the
collagen and elastin production in our skin reduces.
Other areas that benefit from treatment can be the ‘crow’s feet’ lines around
the eyes, although I prefer to call them the starburst lines! And, of course, the
lines that appear across the forehead can be especially deep on some patients,
depending on their exposure to the sun and the elements.
From my experience, it is possible to make a difference to any of these areas
using facial acupuncture, but obviously some parts of the face will respond
better than others. If the line is particularly deep, it may take a lot more than
three treatments to have any profound effect. Having said that, providing you
and your patient are prepared to work on the area over a course of time, you will
start to see some quite dramatic results.
Obviously, the ageing process plays a huge part in getting wrinkles, but why
is this?
As we age, our facial bone structure starts to shrink; couple this with the loss
of collagen and elasticity in the face, add in gravity and what we have as a result
are wrinkles. Genetics are always going to be a factor in how we age, but there
are many external factors that contribute to the speed at which this happens. A
major cause of wrinkles that I often come across is, of course, sun damage. This
was highlighted in a 2010 study, which examined the skin of participants who
had been exposed to the sun for a large proportion of their life through a nearby
window, due to their occupation or activities:

Significant differences were observed in clinical scores for wrinkles,

skin roughness assessed by fringe projection on the cheek, and skin
heterogeneity assessed with spectrocolorimetry on the cheekbone.
Other differences were observed for skin hydration, as well as skin
laxity, which tended towards significance. (Mac-Mary et al. 2010,
p.277)

The sun will affect people in varying ways depending on the amount of melanin
that they have in their skin.
Smoking is a well-known major factor that causes wrinkles on the face, and it
can be very evident on the top lip of those who have smoked for a number of
years. It is, however, not solely the repetitive action of smoking that adds to the
lines and wrinkles, but what the cigarette is doing to the body and the pollutants
in tobacco smoke. An interesting study carried out in 2004 was the first to
examine whether there was an earlier need for cosmetic surgery in smokers. A
questionnaire was sent to 517 patients who had undergone blepharoplasy (upper-
eyelid correction) due to valid dermatochalasis or ‘baggy eyes’: ‘The smokers
underwent surgery an average of 3.7 years earlier than the ex-smokers and 3.5
years earlier than the never-smokers’ (Deliaert et al. 2012, p.853).
Ideally, if my patient has made the decision to stop smoking and would like
me to help, I will work with them using traditional acupuncture before
commencing with a course of facial acupuncture.
It is so often overlooked, but one of my top ten anti-ageing tips is simply to
drink enough water. Loss of hydration can affect the skin in many ways, such as
flakiness, tightness and dryness. Dry skin is particularly more prone to fine lines
and wrinkles.
Drinking sufficient water is also important for removal of waste from the
body. If the volume of fluid is decreased, then the body finds it much more
difficult to remove toxins. This can result in the body attempting to expel them
through the skin, which can in turn exacerbate conditions such as eczema and
acne. I always recommend that my patients maintain an adequate intake of water
throughout the day.
So, how much is adequate? The recommended daily amount of water is eight
glasses a day, but that has been subject to a lot of criticism. As with everything,
we are all unique, and different people may require varying levels of water
depending on the local climate, activity, type of job, age, sex, weight, food
intake and alcohol and so on.
I am able to use the information derived from the initial consultation to
establish whether a couple more glasses a day may benefit my patient’s health
and their skin. One suggestion could be that your patient drinks enough to ensure
that their urine is mostly clear.
Personally, I use a distiller in my clinic, as I believe this is preferable to tap
water. So, the quality of water is important to think about too.
As acupuncturists, looking at our patient’s diet and lifestyle will already be
integral and these skills can be incorporated into your cosmetic treatments,
ensuring we are always working from the inside out.
So, we have looked at the potential causes and how we can help to prevent
deep lines and wrinkles forming. However, we will now concentrate on the
method for needling the lines and wrinkles that our patients are looking for us to
treat.

Intradermal Needling
Needles: 6mm intradermal.

Technique: We will be using tweezers to insert these needles, as we did for the
three eyebrow points. Remove the intradermal needle from its individual
packaging with the tweezers. You will need to practise holding the intradermals
with the tweezers. The first time you use them it will feel a little strange, but
once you have carried out a few treatments they will become second nature.
When the appropriate number of intradermals have been inserted into the
target line, they need to be left in position for at least 20 minutes. During this
time a redness or erythema will appear around the needled area. This shows us
that the treatment is working.
When you remove the intradermals with your tweezers, it is always worth
having a cotton bud on standby to help extract the needle. Sometimes, you will
find that the intradermals tend to grab the skin and you will need to put a little
pressure at the base of the needle to help with its removal. By doing this you will
also help to prevent bruising.
After treating any areas with intradermal needles, you will usually see some
improvement after a minimum of three treatments. A course of ten treatments is
recommended for optimum results, followed by maintenance treatments every
few months. The latter will help to prolong the effects of the initial treatments
and ensure the fine lines and wrinkles remain diminished.

NUMBER ELEVENS
Begin with the lines in between the eyebrows at the bridge of the nose. Look at
one of the lines that you want to needle; you will need to open the line up by
using two fingers of the opposite hand that you are needling with. We want to
insert the needle into the base of the line; if you visualise the line or wrinkle as a
narrow canyon, the needle needs to go right into the bottom of the canyon. Insert
the intradermal needles at a 45-degree angle to the skin; the needles should be
spaced at about 2mm intervals. The direction of the needle is not overly
important, but on these ‘number elevens’ I still try to work in an upward
direction. If we are looking at a line approximately 2.5cm in length, we should
be trying to insert at least ten intradermals. The needles should be inserted to a
depth that is comfortable to the patient. This need not be the full depth of the
needle shaft; however, try to maintain the 45-degree angle as you needle. See
Figure 4.20.

 FIGURE 4.20 DEMONSTRATING INTRADERMAL NEEDLING AT THE ‘NUMBER ELEVENS’

FOREHEAD
Again, you will need to insert your needles at a spacing of 2mm and work across
the line from one end to the other. This is one of the rare occasions when we are
not needling in an upward direction. When needling the forehead lines, we are
attempting to insert as much of the intradermal needle shaft into the skin and
along the line as possible. Aim to maintain a 45-degree angle from the forehead
as you needle. Be patient. The more intradermals you can insert into the line, the
better the overall outcome. See Figures 4.21 and 4.22.

FIGURE 4.21 A CLOSE-UP OF INTRADERMAL NEEDLING IN A FOREHEAD LINE

 FIGURE 4.22 DEMONSTRATING INTRADERMAL NEEDLING IN THE FOREHEAD LINES

NASAL LABIAL FOLD

The nasal labial fold between the corner of the mouth and the side of the nose
can be treated in exactly the same way. Again, make sure that the line is opened
up, so that you can needle directly into the base of it. Practise opening the line
with the forefinger and thumb of one hand as you needle with the other. This
makes the insertion of the intradermals a lot easier than when the skin is loose.
Spacing of the intradermal needles should be approximately 2mm apart and
again I would needle in an upward direction. See Figures 4.23 and 4.24.

FIGURE 4.23 DEMONSTRATING THE INTRADERMAL NEEDLING TECHNIQUE AT THE
BASE OF THE NASAL LABIAL FOLD

 FIGURE 4.24 DEMONSTRATING INTRADERMAL NEEDLING ALONG THE NASAL LABIAL
FOLD

CROW’S FEET
When working around the eyes, we need to take extra care as this area can be
very sensitive and we do not want to needle too close to the eye. From
experience, if there is any chance of bruising, this is the most likely area where it
will happen. If you do bruise the patient, do not panic. Have some arnica cream
on hand and apply this to the skin as soon as the bruise appears.
Using your usual technique of opening up the line with one hand, insert the
intradermal needle gently into the line around the eye. As always, try to maintain
a 45-degree angle from the skin and insert the needles towards the eye. See
Figure 4.25.

 FIGURE 4.25 DEMONSTRATING INTRADERMAL NEEDLING ON THE ‘CROW’S FEET’

TOP LIP
This is another area that is very popular for treatment. Patients very often
complain about the lines that appear here which, as we discussed earlier, are
often, but not always, caused by smoking. Using the intradermal needles is a
very effective way of addressing these lines, but this area can be particularly
sensitive. The anaesthetic points that we have needled should be sufficient but, if
a lot of work is required in this area, it may be appropriate to apply the
anaesthetic cream before you commence the protocol to assist with this.
After needling the top lip area, you can then take a little more time to address
any other fine lines and wrinkles, such as those on the chin and across the bridge
of the nose. See Figure 4.26.

 FIGURE 4.26 DEMONSTRATING INTRADERMAL NEEDLING ALONG THE TOP LIP, CHIN
AND THE BRIDGE OF THE NOSE

HOW IT WORKS
The action of using the intradermal needles is two-fold. First, by inserting the
needle, we are creating a very small injury to the skin. The body then produces
collagen that repairs this injury and, due to the location of the needle insertion,
this will start to fill out the line. Second, we have created a number of small
perforations in the skin along the line that we are treating; these perforations will
remain open for a short while, which will give us the opportunity to apply skin
rejuvenating serums and moisturisers that will be absorbed into the upper layers
of the dermis.

4.3.12 APPLYING SERUMS AND CREAMS

Remove all of the needles inserted from Steps 4.3.2–4.3.11 in reverse to the
order they were inserted. Use the tweezers to remove the intradermal needles
and gently press down on the skin with a cotton bud as you remove each one, to
prevent bruising. Retain the needles in the hands, arms, feet and legs; these will
be removed at the end of the treatment (see Section 4.5).
We now have a small window of time to apply any serums or moisturisers to
the area in order to maximise the benefits of the treatment; these will be
absorbed into the skin in the area that you have needled and aid in the skin’s
rejuvenation process. Of course, there are many serums and moisturisers on the
market that all profess to improve the quality of the skin, but my serums of
choice would either be a hyaluronic acid serum, with pantothenic acid (vitamin
B5) and/or a retinol serum. These are applied with a dropper and are
concentrated, so they need to be used sparingly and gently massaged into the
face following treatment. Allow the serums to sink into the skin, before moving
on to the next step.

Hyaluronic Acid
This sounds like the last thing you would want to administer to a patient’s face,
but it is actually extremely gentle and is ‘naturally present in the skin as part of
the extracellular matrix and as a component of collagen’. John and Price go on to
say that it also ‘acts as a ground substance of the dermis, and is also a
component of joint fluid, vitreous of eye, disc nucleus, and the umbilical cord’
(John and Price 2009, p.226).
One of the most significant properties of hyaluronic acid is ‘its capacity to
bind huge amounts of water (1000-fold of its own weight)’ (Jiang, Liang and
Noble 2007, p.437). As this is a natural molecule, which decreases as we age, it
is one of the reasons that skin becomes dry and joints stiffen. Applying this to
the face after needling greatly improves absorption and allows the hyaluronic
acid to penetrate the dermis more deeply. Due to its massive hydrating capacity,
this, in turn, provides additional moisture which works to plump and smooth out
the wrinkles.

Pantothenic Acid
This is also known as vitamin B5 and is often found alongside hyaluronic acid in
readily available serums for external use. This water-soluble vitamin is one of
the three components of Coenzyme A occurring naturally in the body.
Dr Lit-Hung Leung investigated vitamin B5 for the treatment of acne vulgaris.
Participants were asked to take an extremely high dose daily and also apply a
topical solution which contained pantothenic acid. Within only two to three
days, there was a visible reduction in facial sebum secretion and the condition
was found to be under control after eight weeks. The other facial benefit was the
shrinking pores:

The pore size becomes noticeably smaller within 1–2 weeks, very
often much sooner. Like sebum excretion, the pores will continue to
shrink until the skin becomes much finer, giving the patient a much
more beautiful skin. (Leung 1997, p.106)

This study demonstrates the beneficial effects of pantothenic acid for acne
sufferers and, although we are only applying it topically, vitamin B5 will still
have a beneficial effect on the patient’s skin.
We discussed in Section 4.3.11 how we are making very tiny injuries when
we needle the skin, which will encourage collagen induction to plump the
wrinkles. Pantothenic acid is widely known for its wound-healing properties as it
‘aids in the production of the lipoproteins of the skin, hastening its healing time’
(Sharma et al. 2011, p.1520). This is why I choose to apply this vitamin as part
of a serum that contains hyaluronic acid. After all of the intradermal needling we
have carried out, this acts as a natural hydrating and healing part of the
treatment.

Retinol
Also known as vitamin A, retinol has some key functions in the body relating to
embryology and vision, through to immunity. Aside from these important roles,
it is well known as an active ingredient in skin creams and serums. A 2007
randomised, double-blind, vehicle-controlled study evaluated the effectiveness
of topical retinol in improving naturally aged skin: ‘Topical retinol improves
fine wrinkles associated with natural aging. Significant induction of
glycosaminoglycan, which is known to retain substantial water, and increased
collagen production are most likely responsible for wrinkle effacement’ (Kafi et
al. 2007, p.606).
A biologically active cosmeceutical such as all-trans-retinol (containing 0.3%
retinol) is recommended and needs to be applied sparingly. While vitamin A is
important to the body, it can be toxic in high doses and can also have a drying
effect, so, if using retinol, you may want to include hyaluronic acid serum to
lock in the moisture.

Note: Facial Enhancement Acupuncture is contraindicated for patients actively

trying for a baby, pregnant or breast-feeding (see Section 4.1 for
contraindications) and retinol should not be applied in any of these cases.
Vitamin A is also not recommended for patients undergoing skin peeling
procedures or taking medication prescribed for acne.

4.4 FACIAL ENHANCEMENT ACUPRESSURE MASSAGE

Many students on my courses have asked me whether the massage part of my
treatment protocol is that important. Of course, it is entirely up to you as a
practitioner as to which elements you choose to include in your treatments.
However, my advice would be to include a massage of one type or another that
will provide a conclusion to the treatment. I cannot profess to be a qualified
masseur, but it has been worth my time and effort to investigate ways of
improving this aspect of the treatment. If you spend some time investigating
what works for you, then I believe it will be time well spent.
When you start to look into facial massage as a subject in its own right, you
will find that there are many books written on the topic and many practitioners
specialising in this form of treatment. Working with the facial muscles of a
patient using massage has, for a long time, been recognised as a way of delaying
the ageing process and improving the patient’s facial appearance. If you then
consider that with acupuncture we are working with those same muscle groups,
but to a far greater depth than just massage, then it is hardly surprising that we
should be getting such good results.
My patients really enjoy their facial massage and it also provides an
opportunity for me to analyse their face and plan what I would like to work on at
their next treatment session. I will go through a few of the massage techniques
that I use and then leave it up to you to do your own investigation. What I am
about to describe here should be enough to get you started.
Before we start on the facial massage, we need to make sure our patient is
happy and relaxed. This should be a pleasurable experience for them and not just
a rushed procedure at the end of a treatment protocol. Using acupressure points
during the massage also gives the added benefit of helping to lift the face and
benefit the work that we have already achieved with the needles.
 It is very important to use a good-quality base cream when you are massaging
the face. Your fingers need to be able to move freely across the skin and not drag
at any point. Do not be afraid to use some pressure on the face. From experience,
patients prefer some gentle pressure during a massage, rather than a delicate
tickling-type sensation. I use a natural anti-inflammatory cream with vitamin E
for the facial massage. This can be applied once any serums you have chosen to
use have had a little time to sink into the skin. The anti-inflammatory helps to
promote skin healing following needling and the vitamin E nourishes the skin.
An alternative might be to use a natural collagen-based cream to further boost
the collagen-induction aspects of the treatment. Alternatively, you may already
prepare your own aromatherapy creams and would prefer to work with these.
I have broken my signature Facial Enhance massage down into some very
easy steps. Feel free to mix them up and add in anything of your own, but it is
always important to have a basic structure to what you are trying to achieve. I
can honestly say that if you take your time with this part of the treatment
protocol, it will cement the good work that you have done with the needles and
you will end up with some remarkable results.

4.4.1 MASSAGE STAGE 1

Begin your facial massage by gently placing both thumbs on a point
approximately 1.5 cun above Yin Tang. Apply a gentle rocking motion in this
position, along with upward pressure. Then, after a few seconds, gently slide
both thumbs outwards towards the edges of the forehead. As you do this, apply a
gentle amount of pressure to smooth the brow lines and any forehead lines or
creases. See Figures 4.27 and 4.28.

FIGURE 4.27 PLACING THUMBS ABOVE YIN TANG TO BEGIN THE FACIAL MASSAGE

 FIGURE 4.28 SLIDING BOTH THUMBS ACROSS THE FOREHEAD

Once you have massaged the forehead a few times using this technique, let your
thumbs come to rest on your patient’s temple area, just above the end of the
eyebrow. Now, applying a gentle pressure and using a circular motion, massage
this area for a few seconds. See Figure 4.29.

 FIGURE 4.29 USING A CIRCULAR MOTION AT THE TEMPLE

4.4.2 MASSAGE STAGE 2

Using the second finger of your right hand, apply pressure to the middle of your
patient’s left eyebrow at the point Yuyao. Gently slide your finger towards the
top of the patient’s forehead, lifting the eyebrow as you do so. As your finger
reaches the top of the forehead, do exactly the same with the middle finger of
your other hand. Continue with this relatively quick motion, one after another for
a few seconds. By doing this you will stimulate the muscles in the forehead that
raise the eyebrows. Move to the right side and repeat. This same technique is
very effective when used on the area above Yin Tang, in between the eyebrows.
Use a gentle pressure to smooth this area towards the hairline. See Figure 4.30.

 FIGURE 4.30 USING THE MIDDLE FINGERS TO MASSAGE THE FOREHEAD WITH
CONTINUOUS STROKES

4.4.3 MASSAGE STAGE 3

Using the thumbs of both hands, position the pads of the thumbs directly on
acupuncture point LI20. Apply some gentle pressure on this point for at least ten
seconds and then softly smooth the nasal labial fold from top to bottom using the
thumb. See Figures 4.31 and 4.32.

FIGURE 4.31 BEGIN BY PLACING YOUR THUMBS AT LI20

 FIGURE 4.32 SWEEP DOWN THE NASAL LABIAL FOLD

4.4.4 MASSAGE STAGE 4

While we are at the corner of the mouth, following Stage 3, apply upward
pressure to pressure point ST4 for approximately ten seconds. See Figure 4.33.
Using a similar amount of pressure as used on ST4, at this stage we need to
apply downward pressure on points ST3 and SI18. Use the tip of the fingers and
apply the pressure for approximately ten seconds; these points are great for
shaping the cheekbone area.

 FIGURE 4.33 APPLYING PRESSURE TO POINT ST 4

4.4.5 MASSAGE STAGE 5

We now turn our attention to the area just below the bottom lip. We are going to
be stimulating the pressure point Ren 24. Using both thumbs and a gentle lifting
and stroking action, massage this point by alternating from one thumb to the
other for a few seconds. See Figure 4.34.

FIGURE 4.34 CONTINUOUSLY STROKING THE CHIN IN AN UPWARDS DIRECTION USING
EACH THUMB

Move your hands down to your patient’s neck and position both thumbs either
side of pressure point ST9. Now, with long gentle sweeping strokes, massage the
patient’s neck from ST9 up to just below the ears. See Figures 4.35, 4.36 and
4.37.

FIGURE 4.35 BEGIN WITH THUMBS PLACED AT ST9

FIGURE 4.36 GENTLY SWEEPING THE THUMBS UP THE NECK

 FIGURE 4.37 FINISHING THE STROKE FROM ST9 BENEATH THE EARS

4.4.6 MASSAGE STAGE 6

Using the thumbs, and also the fleshy part at the base of the thumbs, apply
pressure to your patient’s face directly below the eyes at ST2 and then move to
the side of the ears. Carefully pull back on the patient’s cheek towards the ears
and hold the tension for ten seconds. Repeat this three times on both sides. See
Figure 4.38.
To bring the facial massage to an end, use both hands to apply long upward
sweeping strokes to your patient’s neck. Keep contact with your patient at all
times as this makes them feel secure and the massage is more relaxing. See
Figures 4.39 and 4.40.

FIGURE 4.38 HOLDING THE TENSION ON THE CHEEKS UP TOWARDS THE EARS

FIGURE 4.39 PLACING BOTH HANDS, WITH FINGERS TOUCHING AT THE CENTRE OF
THE NECK

 FIGURE 4.40 SWEEPING UPWARD STROKES ON THE NECK AREA

Finally, massage in a good-quality moisturiser. Again, the choice of moisturiser

is entirely up to you and warrants some research. However, I would recommend
sourcing a product that is perfume-and paraben-free. You may be treating some
patients with sensitive skin and a gentle, yet potent, high-quality cosmeticeutical
will be less likely to cause a reaction. Your treatment results will also be
enhanced by using a cream with premium ingredients. I use a natural, hydrating,
pro-collagen moisturiser, at this stage, which contains retinyl palmitate (vitamin
A derivative). I find this the perfect finish for my treatment as it helps to lock in
moisture and promote collagen synthesis.

4.5 FINISHING THE TREATMENT

The full Facial Enhancement Acupuncture protocol is now complete and you can
set about removing the final needles that you inserted in Steps 4.3.2 and 4.3.3.
Leave your patient to relax for a few minutes, as they have received a
somewhat intensive treatment. There has been a lot of facial work carried out
and their skin should look vibrant, but they will be able to appreciate the effects
more fully within a few hours once their face has completely settled down.
Encourage your patient to refrain from touching their face, where possible,
immediately following their treatment, to ensure the skin remains clean after the
needling.
CHAPTER 5

ADVANCED FACIAL ENHANCEMENT

TECHNIQUES

5.1 JADE GUA SHA

5.1.1 ABOUT GUA SHA
Gua Sha is an East Asian treatment which generally uses quite a vigorous
rubbing/scraping technique. It is mainly used in China on the patient’s back, for
detoxification purposes or for various sprains and injuries throughout the body.
Gua means ‘to scrape or scratch’ and Sha is the resulting redness or rash
(Nielsen 1995, p.43).
We are going to be using a Chinese jade Gua Sha stone to massage our
patient’s face and to help our serums and creams penetrate the skin more deeply.
The first thing to mention is that, to be accurate, my technique is not considered
a true Gua Sha technique, in the sense of those practised for thousands of years.
The original Gua Sha method uses much more intense stimulation along the
acupuncture meridians and clears areas of stagnation on a patient’s body. This
treatment is fairly strong and creates the redness on the patient’s skin that we
have described. Obviously, we do not want to use this type of technique on the
face, which would be too sensitive for authentic Gua Sha. The facial version that
we use requires extreme care, as the skin on the face is far more delicate. Used in
this way, it is a lovely, relaxing part of the treatment that can again be used
across the cheeks, around the eyes, on the forehead, the nasal labial fold and the
fine lines around the mouth.
When working on the face, I use a jade Gua Sha stone, mainly because of its
cooling properties. My stone of choice is a beautiful, smooth piece of jade that is
carved in such a way that it fits into the various angles of the face. This means
that I can use the stone to massage the areas that I might struggle to get to using
hands alone. However, Gua Sha is often practised with regular day-to-day
objects such as spoons or coins. The best way to use the stone is to combine it
with a good-quality cream that nourishes the skin and enables smooth movement
of the tool. The important thing to remember when using Gua Sha on the face is
to make sure the pressure that you apply is enough to help the serums and
creams penetrate the skin, but not too heavy that it is an uncomfortable
experience for the patient.

5.1.2 THE GUA SHA FACIAL MASSAGE

If you opt to include Gua Sha in your treatment, I would recommend adding it in
before the facial massage outlined in Section 4.4. First, apply a liberal amount of
your serum of choice (for instance, hyaluronic acid) to the areas of the face that
you intend to massage. Allow this to sink in and then apply some massage cream
to the same areas; this cream is what will allow the Gua Sha stone to move freely
over the face (see Section 4.4 for further information about massage cream).
Use the large smooth edge of the stone in long sweeping strokes to massage
from the neck right up to just below the ears. See Figure 5.1.

 FIGURE 5.1 USING GENTLE PRESSURE TO SWEEP THE JADE GUA SHA STONE FROM
THE NECK TO THE EAR

Aside from this, I do not sweep the stone in any particular direction. For
instance, when I concentrate the tool on the nasal labial fold, I use it within the
fold itself, beginning with a gentle rocking motion and building to more circular
sweeping strokes along the line. See Figure 5.2.

 FIGURE 5.2 WORKING ON THE NASAL LABIAL FOLD

As I work along each line, I am using the Gua Sha stone almost like an eraser,
but with a gentle circular motion to work the cream into the lines and wrinkles.
See Figure 5.3.
I have found that the best results with this technique can often be found on the
‘crow’s feet’ around the eyes. There are, however, no set rules or actions to
using facial Gua Sha. As a practitioner, you need to practise your skills to
achieve a pleasurable massage for your patient. My only comment is always to
concentrate on massaging in an upward direction as, at all stages, we are
attempting to lift the patient’s face. What you are trying to do is encourage the
muscles under the skin to tighten and, in turn, raise the face and reduce the lines.
Also, you are aiming to get the energy moving in the face, as this has benefits for
the circulation. A 2007 study found that Gua Sha ‘increases microcirculation
local to a treated area’ (Nielsen et al. 2007, p.456). You will find that, with only
very mild rubbing, the skin may redden. That is the Sha appearing and this will
settle down within a couple of minutes. As long as you are using only a light
pressure, the skin will respond well and your patient will feel very relaxed.

FIGURE 5.3 MASSAGING THE FOREHEAD LINES WITH THE TIP OF THE GUA SHA STONE

To keep my jade Gua Sha tool scrupulously clean between patients, I use a
disinfecting jar. These are commonly found at hairdressing salons and are used
to disinfect scissors, combs and so on. I keep this jar in my clinic room, so that
my patients can see that the jade rollers, tweezers and Gua Sha stone, which we
are using throughout their treatment, are all perfectly clean.

Gua Sha is an add-on to the Jade Roller Facial Enhancement Massage treatment
and I usually dedicate around 5–10 minutes to this technique. Many of my
patients have been very impressed by the treatment as it is soothing, yet works to
tighten the whole face. Combining Gua Sha with a Facial Enhancement
Acupuncture treatment can provide even more evident results.

5.2 JADE ROLLERS

5.2.1 ABOUT JADE ROLLERS
Jade, which the Chinese have exalted for nearly 4000 years as their
‘Jewel of Heaven,’ is still, even in the West, the mystery stone of the
ages. (Zara 2001, p.9)

It was my privilege to discover these rollers a few years ago and I have been
using them in my cosmetic acupuncture treatments ever since. Jade rollers are
not only lovely things to use but they are also very pleasing to the eye; they have
a luxurious feel to them and are steeped in hundreds of years of history: ‘For
many centuries before or after Confucius (551–479 BC), jade was considered to
be of supernatural origin, and to contain the essence of life, virtue and eternity’
(Lyons 1978, p.6).
Usually, a set of jade rollers will comprise two different-sized rollers,
although I have seen some rollers that are double-ended, with a large roller at
one end and a smaller one at the other. My rollers of choice are the two separate
rollers. The larger one is for use on the forehead and cheeks; it is also ideal for
use on the neck. The second roller, which is quite a bit smaller, is great for
working on the top lip and around the nose.
A huge benefit of using the jade rollers is that, as a ‘side-effect’ of treatment,
many of my patients find that sinus problems they have been suffering from are
diminished. Not only that, but because we are spending time rolling the face and
neck, this aids lymphatic drainage, resulting in the body expelling a build-up of
toxins: ‘The lymphatic vascular system is essential for lipid absorption, fluid
homeostasis, and immune surveillance’ (Wang and Oliver 2010, p.2115). So, by
rolling these lymph vessels and encouraging healthy flow, it can have a positive
effect on overall health. This is one of the reasons that the Jade Roller Facial
Enhancement Massage is so effective at reducing puffiness and oedema.
We have often heard of splashing cold water on our faces to close the pores,
and the cooling jade is an ideal tool for achieving a similar effect following the
treatment. As a result, I recommend adding the jade roller massage at the end of
Section 4.4 (the Facial Enhancement Acupressure Massage) and before you
moisturise the face.

5.2.2 STEP-BY-STEP JADE ROLLER FACIAL MASSAGE

I always begin with the large roller and, gently, with a little pressure, roll from
the ear to the mouth and back again for approximately ten strokes on both sides
of the face. See Figure 5.4.

 FIGURE 5.4 ROLLING THE JADE ROLLER FROM THE EAR TO THE MOUTH

Move the roller up the face and repeat the same technique, ensuring you roll
right on to the nasal labial fold. See Figure 5.5.

 FIGURE 5.5 MOVING THE JADE ROLLER ACROSS TO FOCUS ON THE NASAL LABIAL
FOLD

Next, begin to work on the neck, rolling from the lowest part of the neck, over
the jaw and up to the ear in one long stroke. Always roll using upward strokes to
lift this area and repeat on both sides. See Figure 5.6.

 FIGURE 5.6 USING THE LARGE JADE ROLLER TO MASSAGE THE NECK

Then move to the eye area and carefully roll up and down by the side of the eye
over the ‘crow’s feet’ approximately ten times. Turning the roller 90 degrees,
roll in the opposite direction. See Figures 5.7 and 5.8.

FIGURE 5.7 ROLLING THE LARGE JADE ROLLER UP AND DOWN THE SIDE OF THE EYE

FIGURE 5.8 TURNING THE LARGE JADE ROLLER 90 DEGREES TO ROLL UP TO THE EYE

Finally, use the large roller to sweep across the front of the face, repeating the
same method as before on both sides. See Figure 5.9.

 FIGURE 5.9 SWEEPING THE LARGE JADE ROLLER ACROSS THE FACE

Switching to the smaller roller enables you to work more thoroughly on the nasal
labial fold. Roll back and forth across the line approximately 10–15 times on
both sides. See Figure 5.10.

 FIGURE 5.10 USING THE SMALL JADE ROLLER TO ROLL ACROSS THE NASAL LABIAL
FOLD

At this stage, you can roll across the chin approximately ten times, where you
needled at Ren 24. See Figure 5.11.

 FIGURE 5.11 THE SMALL JADE ROLLER IS USED ON THE CHIN AREA

The smaller roller also enables you to get into the top lip area, where you can
push the creams into the lines that form around the mouth. Roll back and forth
across each side of the area for approximately ten strokes. See Figure 5.12.

 FIGURE 5.12 TARGETING THE TOP LIP AREA WITH THE SMALL JADE ROLLER

Next, move on to the eye area. We have already covered this section using the
larger roller which massages this area as a whole, but we can really target the
fine lines around the eye by using the small roller to gently traverse the ‘crow’s
feet’. See Figure 5.13.

 FIGURE 5.13 ROLLING THE ‘CROW’S FEET’ WITH THE SMALL JADE ROLLER

Finally, tend to the ‘number elevens’ and forehead lines by rolling up and down
the area. Concentrate on the centre to begin with and continue the technique
outwards across the forehead on either side, making sure to cover the whole
expanse of the forehead from eyebrow to hairline. See Figure 5.14.
This completes the Jade Roller Massage and your patient should feel very
relaxed following this stage of the treatment. Remember, if you have added this
step into your treatment plan, this is the time to finalise the massage by applying
moisturiser.

 FIGURE 5.14 USING THE SMALL JADE ROLLER TO SMOOTH THE ‘NUMBER ELEVENS’

5.3 DERMAL ROLLERS

5.3.1 ABOUT DERMAL ROLLERS
Micro Needle Therapy (MNT) or Dermal Rolling (also known as dermarolling,
dermarolling, skin needling and collagen induction therapy) is based on some of
the same principles as facial acupuncture. This puts acupuncturists in the perfect
place to consider offering this treatment in their practice.
The dermal roller is a plastic-handled tool with a rotating head that is covered
in up to 200 micro needles. The top-quality rollers use titanium needles and the
needle length for the rollers can vary from a fraction of a millimetre up to 3mm
in length. My needle length of choice for facial treatments is a 1.5mm dermal
roller. These rollers are sterile and disposable, intended for one-time use on your
patient. Alternatively, you can opt to use a dermal pen, which is the latest
development in this treatment sector. This is a tool that can be fitted with sterile,
disposable needle heads. The electronic device can then be used to glide gently
across the skin, whilst the vibrational movement vertically pierces the skin with
the tiny micro needles.
Micro Needle Therapy should be looked at as an add-on treatment to your
Facial Enhancement Acupuncture and, as such, full training in the use of dermal
rollers should be attained before performing this treatment in your clinic.
Therefore, this section will simply aim to provide information about this area of
skin needling and how it can benefit your patients.

5.3.2 HOW SKIN NEEDLING WORKS

We have all injured ourselves in one way or another in the past and probably
noticed how the wound or injury heals very quickly, usually leaving stronger
tissue than before. This is the body’s own healing mechanism, creating new
collagen to repair itself. Just like in the intradermal needling technique, this
intricate process is the basis behind MNT; we are creating the smallest of
injuries to the face and letting our body do what it does best and heal the
wounds. The only difference with the dermal roller or dermal pen and an
acupuncture needle is that by the time we have completed an MNT treatment we
have created over 2000 miniscule injuries that instantly begin to repair and
rejuvenate. This repair and renew process is what makes MNT such an exciting
development in natural cosmetic treatments.
Combine the effect of the small injuries to the face with the ability to
introduce high-quality moisturisers and serums to the lower layer of the dermis
of the skin and you have an all-round facial treatment that will provide
impressive results. Due to the increased collagen production, the effects will
continue to improve in the weeks and months after the treatment.
Many people have asked me to provide comparisons with MNT and other
facial procedures. MNT is considered to be a ‘nonablative’ treatment that
provides the same results as ablative treatments such as microdermabrasion and
chemical peels. Benefits include rejuvenating ageing skin and diminishing the
appearance of common skin conditions such as indented scars, large pores and/or
uneven skin tone, but the method involved is different: ‘As opposed to ablative
laser treatments, the epidermis remains intact and is not damaged’ (Aust et al.
2008, p.1421). The aim of this type of treatment is to induce new collagen
production without the need to remove this outer layer of skin.
The topmost layer of the epidermis is known as the stratum corneum. It was
viewed for many years as a dead layer of skin, but its intrinsic role as a barrier
against dehydration, foreign bodies and UV radiation are now well established:


Continued basic science and clinical research coupled with keen

clinical observation has led to more recent recognition and general
acceptance that the stratum corneum completes many vital ‘barrier’
tasks, including but not limited to regulating epidermal water content
and the magnitude of water loss; mitigating exogenous oxidants that
can damage components of skin via an innate antioxidant system;
preventing or limiting cutaneous infection via multiple antimicrobial
peptides; responding via innate immune mechanisms to ‘cutaneous
invaders’ of many origins, including microbes, true allergens, and
other antigens; and protecting its neighboring cutaneous cells and
structures that lie beneath from damaging effects of ultraviolet
radiation. (Del Rosso and Levin 2011, p.22)

It is clear that it is preferable for this layer of skin to remain intact, which is not
the case in ablative therapies, which smooth out fine lines and scars by removing
the epidermis and injuring the dermis. The downside is that these more invasive
techniques result in a thinner epidermis being formed with less protection than
before. This means that the skin is more vulnerable to the factors that lead to the
reduction of collagen originally.
There is, of course, a place for ablative treatments, such as for
hyperpigmentation, tattoo removal and acne reduction. Although skin needling
is, in my view, a more effective way of reducing scars and treating ageing skin,
MNT is particularly effective for improving acne scarring:

Overall 36 out of the total of 37 patients completed the treatment

schedule and were evaluated for its efficacy. Out of these 36 patients,
34 achieved a reduction in the severity of their scarring by one or two
grades. More than 80% of patients assessed their treatment as
‘excellent’ on a 10-point scale. No significant adverse effects were
noted in any patient. (Majid 2009, p.26)

Also, a study entitled ‘Acne Scarring Treatment Using Skin Needling’ published
in 2008 had similar findings. Notably, all 32 patients who undertook the study
had smoother skin after eight weeks following only the first treatment and it was
concluded that the ‘reduction in severity grade of acne scars before and after
CIT, should be considered significant’ (Fabbrocini et al. 2009, p.878).
The wound healing process is complex, but Fabbrocini et al. (2009) go on to
discuss a new hypothesis that skin needling with a high-quality device does not
‘create a wound in the classic sense’; however, ‘the final result is a deposition of
new collagen in the upper dermis’. This summary explains the concept more
fully:

The wound healing process is cut short, as the body is somehow

‘fooled’ into believing that an injury has occurred. According to this
new theory, bioelectricity (also called ‘demarcation current’) triggers a
cascade of growth factors that stimulate the healing phase. When
microneedles penetrate the skin, they cause fine wounds. Cells react to
this intrusion with a demarcation current that is additionally increased
by the needles’ own electrical potential. (Fabbrocini et al. 2009, p.878)

So, in short, collagen is produced in the dermis at various stages of the healing
process and continues to be laid down in the weeks and months ahead. This
natural process has the effect of plumping out facial scars and fine lines and
wrinkles, as well as helping to shrink the pores. This all occurs without
damaging the protective barrier of the outer layer of skin, making it, to my mind,
a preferable cosmetic procedure to more invasive methods.
The second key benefit of Micro Needle Therapy is the dramatic increase in
absorption of topically applied creams. The micro needles temporarily open up
miniscule channels, allowing serums and creams to by-pass the barrier properties
of the stratum corneum and penetrate to the underlying dermis. This is one of the
main advantages of the treatment; however, it greatly demonstrates why we need
to ensure the use of only high-quality, professional topical products following
needling, whether for MNT or Facial Enhancement Acupuncture.
CHAPTER 6

TREATING SPECIFIC FACIAL ISSUES

The main Facial Enhancement Acupuncture protocol will suffice for most facial
issues, as it is working on a number of levels. However, should you wish to add
to this to optimise the improvement of specific conditions, I have included some
follow-up points that can be used.
First, let us take another look at the meridians of the body and how they relate
to the face.

6.1 THE ACUPUNCTURE MERIDIANS AND THEIR ROLE IN

FACIAL ENHANCEMENT ACUPUNCTURE
REN CHANNEL

•
Regulates the body’s Yin energy.

•
Used to treat lifelessness in the face.

DU CHANNEL


•
Regulates the body’s Yang energy.

•
Helps to treat internal organ conditions.

•
Reduces swelling.

•
Clears heat.

LIVER CHANNEL

•
Beneficial for the eyes.

•
Liver Qi stagnation can cause facial discolouration, dark circles and age
spots.
GALL BLADDER CHANNEL

•
Works with the Liver meridian to promote Qi and blood flow to the face.

HEART CHANNEL

•
Excess Heart Fire can result in facial redness.

•
A dull complexion can relate to Heart deficiency.

•
Houses the Shen; relates to emotions, calms the mind, improves sleep,
lessens stress and anxiety, all of which can lead to better skin.

SMALL INTESTINE CHANNEL

•
Imbalance can lead to impurities manifesting (e.g. acne).

PERICARDIUM CHANNEL


•
Protects the Heart.

TRIPLE HEATER

•
‘The upper burner distributes fluids as a vapour over the entire body – it
moistens the skin’ (Hecker et al. 2005, p.247).

STOMACH CHANNEL

•
Packed full of Qi and Blood.

•
Promotes healing.

•
Smooth flow of Qi will reduce puffiness, swelling and oedema.

SPLEEN CHANNEL


•
Transporter of food Essence and fluids; aids the facial muscles and
complexion.

LUNG CHANNEL

•
Governs the skin.

•
Responsible for opening and closing of the pores.

•
Useful for treating acne.

LARGE INTESTINE CHANNEL

•
Responsible for fluids.


•
Eliminates toxins.

•
Important organ for skin quality.

BLADDER CHANNEL

•
The longest meridian passing both head and face.

KIDNEY CHANNEL

•
Responsible for the reproductive system.

•
Used to treat signs of premature ageing.

6.2 SAGGING FACIAL MUSCLES

As we age, our skin loses its firmness and elasticity; this is evident in our
physique, as well as facially. What do we do about it? Well, if we are keen, and
able to stick at it, we exercise and go to the gym regularly to try to tighten up
those sagging muscles. We need to do exactly the same for the face; this can be
achieved with facial exercises or we can try Facial Enhancement Acupuncture.
This treatment gives the muscles of the face a work-out and also simultaneously
stimulates the Qi to help with circulation. The resulting production of collagen
helps to bring back some elasticity into the face.
Many of the facial points in the protocol have been selected, in part, for their
relation to the underlying muscles. If you have established that facial sagging is
the main focus of the treatment, you may like to add in this ‘propeller’ technique
on the cheek.

Needle size: 15mm (length) × 0,20mm (thickness)/36 (gauge).

Technique: In addition to the Cheek Point used in the protocol, choose an ashi
point on the cheek. An ashi point is an unnamed acupuncture point chosen for its
sensitivity and location. Palpate to find an area where you can feel the band of
muscle running across the cheekbone. Insert the needle into the point and twirl
the needle in a clockwise direction, but with an action similar to winding up a
propeller on a rubber-band aircraft. What we are attempting to do is to catch the
facial muscle with the needle and tighten it with the twirling action. If this
technique is administered successfully, you should find a lot of tension on the
needle as you do this. Needle this point bilaterally. To remove the needle, it is a
case of pulling back on the needle and gently unwinding the needle in an anti-
clockwise direction; it can then be safely removed.
If you have a patient with significant facial sagging, it might be appropriate to
use two or three of the skin tightening points on either side of the face.

6.3 EYE BAGS AND DARK CIRCLES

When we are treating a patient’s eyes and the surrounding area, we also need to
look at the constitutional points that we might be able to use in order to improve
the appearance. Many patients come to me complaining of eye bags and a
general puffiness under the eye. According to Traditional Chinese Medicine
(TCM), all diseases that relate to the eye are closely linked to the Liver, as this
meridian opens at the eyes. In Five Element Acupuncture, the Liver is the organ
that is responsible for the smooth flow of Blood and Qi in the body. If this organ
is out of balance, then there is a very good chance your patient will be stuck,
perhaps congested and unable to move freely. This might, in my opinion, result
in stagnation and consequential dark circles around the eye. In order to release
this congestion and have the Qi flowing smoothly again, I would look at treating
the Liver Source point LV3. This is a point that we are already using in our
Initial Grounding Treatment as part of the Four Gates treatment, alongside LI4. I
would pay particular attention to these points and tonify them at the end of the
treatment, as LI4 will further help to reduce any swelling or oedema.
The partner organ of the Liver is the Gall Bladder and both meridians are of
the Wood Element. One of my favourite Gall Bladder points for anything eye-
related is GB41 ‘Foot Above Tears’. What a perfect name, which sums up
exactly what it can do. Already in use as part of the main protocol, this in
combination with LV3 is recommended for anything that involves stagnation of
the eye.
ST44 is one of the first points that we needle and it is a great point to help
clear stagnation. If it is immediately apparent on your first consultation that this
eye condition is of concern to your patient, then I would definitely not omit
ST44 from your Initial Grounding Treatment.
Bluish eye bags can be a sign that the Kidney channel is affected and fluid is
being retained. KI3 is a Shu Stream point, and these ‘points of the Yin channels
are the primary point on each channel for regulating and harmonising their
respective zang, and may therefore be considered as the single most important
point of their respective channel’ (Deadman 1993, p.36).
BL1 has to be needled slowly and with extreme caution, due to its location,
but it can aid with fluid retension around the eye and other eye issues.
We already use ST2 during the protocol and this will help to reduce swelling
to the lower eye by moving Qi and Blood to the area. Auricular points that can
be added are, of course, the Eye and also Spleen for its role as the transporter of
fluids.

6.4 AGE SPOTS AND SKIN DISCOLOURATION

‘Surrounding the Dragon’ is a technique that can be used for treating age spots
and patches of hyperpigmentation. I absolutely love the description of this
treatment; it actually sums up what we are trying to achieve so descriptively.
Using 6mm intradermal needles, insert them so that they point towards the age
spots/discolouration. The number of needles will vary, depending on the size of
the target area, so you will need to use your judgement here. The main priority is
to ensure that the area is completely surrounded. These needles can then be left
in for the duration of the treatment and removed along with the other facial
needles.
This technique helps fade age spots or discolouration by encircling the area
with needles and thus redirecting the Qi underneath the damaged tissue, often
caused by sun exposure, and ultimately outwards in a bid to regenerate the skin.

6.5 ACNE
Acne affects millions of people worldwide and is considered to be ‘the most
common cutaneous disorder in the Western World’ (Goldberg and Berlin 2012,
p.8). If someone presents with acne, I would generally begin with a course of
Five Element Acupuncture treatment. However, there are general points that you
could try to improve the condition based on Traditional Chinese Medicine
principles. Acne is often attributed to the Lung–Large Intestine channels and the
Spleen–Stomach channels. We have touched upon the subject of acne in earlier
chapters and explored how the point ST9 could be utilised to treat overactive
sebaceous glands (see Section 3.9) and how the application of pantothenic acid
serum could improve acne and open pores (see Section 4.3.12). Retinol serum
could also be applied to the skin. As it has a drying effect, however, care needs
to be taken when using vitamin A. It should not be administered to those taking
prescribed acne medication or anyone who is trying to conceive, is already
pregnant or breast-feeding.
When the acne is caused by a hormonal imbalance, perhaps exacerbated
during the menstrual cycle, the Endocrine auricular point can be used to help to
balance the system. We have established the connection of the Lung meridian in
connection with the skin, so I would also consider using LU5, a He-Sea point on
the arm and the He-Sea point of the Large Intestine LI11, for its widely known
benefits for skin issues.
The Spleen governs digestion and transportation, so stagnation in this channel
may result in blemishes. Consider using the Spleen point on the ear to help the
free flow of Qi along this meridian.
It is also possible to locate points around the infected area using the
‘Surrounding the Dragon’ technique outlined in Section 6.4.
6.6 ECZEMA
This dry skin condition, also known as dermatitis, is characterised by red, scaly
and itchy skin that can vary in severity from person to person, especially as it
comes in many different forms: ‘In many developed countries over one-fifth of
the population are affected by one or more atopic allergic disorders’ (Sheikh
2002, p.14).
The skin of an eczema sufferer doesn’t produce as much oil or fat as those
without the condition. This lack of protection sees channels opening up because
of the inability of the skin to retain water.
As both a Classical Five Element Acupuncturist and Facial Enhancement
Acupuncturist, I am often called on to help with eczema on the body and I have
also found that facial eczema can be particularly distressing to patients. The
premise behind both traditional and facial acupuncture is that it is holistic, so we
are aiming to balance Mind, Body and Spirit in order to help settle the problem. I
would therefore tend to treat constitutional body points, before I begin to target
specific areas.
I believe that how we look is very much related to how we feel, and eczema
can be particularly debilitating due to the accompanying itch, which can be quite
painful and lead to the skin splitting and bleeding. I would certainly suggest that
a patient visit their doctor or dermatologist, particularly if their condition has yet
to be diagnosed. What is very encouraging is that recent studies, such as ‘Effect
of Acupuncture on Allergen-Induced Basophil Activation in Patients with
Atopic Eczema: A Pilot Trial’ by Pfab et al. (2011), have been examining the
successful reduction of itch intensity following treatment with acupuncture.
Apart from BL6 and BL2 on the head and face and the AE Drain that we can
choose to perform at the patient’s first treatment, we do not use any other
Bladder points during the treatment. This is due to the fact that, as the meridian
runs down the back and the back of the legs, it is not an easy channel to access
whilst your patient is having facial acupuncture. However, there are a couple of
points that may be worth tonifying at the start of treatment in this case. BL17 on
the back and BL40, a He-Sea point on the back of the leg, are commonly used
for itching skin.
‘Family studies say that atopic disorders result from a complex interplay
between genetic and environmental factors’ (Sheikh 2002, p.16). And, like many
conditions, the triggers can vary, so diet may be a factor or stress may result in a
flare-up. Your patients may also find that climate could play a part or household
allergies. Stress seems to be a common trigger for many of my patients and they
find that the acupuncture helps in this regard. There have been many studies
carried out that highlight the role acupuncture can play in reducing anxiety and
one, albeit small, study, focusing on a single acupuncture point H7 (Shen Men),
found an average 44 per cent reduction in stress (Chan et al. 2002, p.74). The
Shen Men auricular point is needled bilaterally every treatment and this could be
used to garner the same effects.
The Facial Enhancement Acupuncture protocol will aid with general
inflammation and swelling as many of the points included are indicated for this.
Again, I would suggest LU5 and LI11 could be tried for their relation to skin
conditions.

6.7 ROSACEA
Rosacea is characterised by ‘two clinical components: a vascular change
consisting of intermittent or persistent erythema and flushing and an acneiform
eruption with papules, pustules, cysts, and sebaceous hyperplasia’ (Arndt and
Hsu 2007, p.174). If you are a sufferer, or you have treated patients with rosacea
in your own practice, you will know how this chronic skin condition can affect
self-esteem and confidence.
Often, rosacea strikes in middle-age, as redness on the nose, cheeks, forehead
and chin. Patients will experience different triggers and the most common seems
to be sun exposure, closely followed by emotional stress. As practitioners, we
regularly advise on lifestyle factors, so it is worth your patient trying to
determine what may be exacerbating the condition. We can help to balance the
Body, Mind and Spirit and, as for other skin conditions, I would focus on my
Five Element Acupuncture training to help address this issue. That said, I have
had good success with rosacea from my Facial Enhancement Acupuncture
protocol alone, as I find that it really activates the Qi in the face and helps to
clear the skin. Depending on your patient’s response to the initial protocol, LU5
and LI11 could also be added to your treatment plan to see if this boosts the
effects.
If your patient has already established their triggers, it is important to find out
whether they may be related to any of the creams you choose to use during a
facial treatment. That is another reason for sourcing cleansers, serums and post-
treatment creams that are beneficial and suitable for sensitive skin.
With four subtypes of rosacea (Erythematotelangiectatic, Papulopustular,
Phymatous and Ocular), it is important to take your usual in-depth consultation
and to discuss the realistic expectations about the outcomes of treatment
depending upon their particular condition. The beauty of acupuncture is that it
accepts that everyone is different and ensures that we maintain the holistic
experience that this truly wonderful practice provides.
CHAPTER 7

FACIAL ENHANCEMENT
ACUPUNCTURE CASE STUDIES

7.1 CASE STUDY 1: JANE, AGED 58

This case study that I would like to share with you is for one of my first Facial
Enhancement patients. Jane came to me when she was in her late fifties, married
with no children. A typical middle-aged lady, Jane was experiencing a few
difficulties in life and wanting to get rid of some of the lines that had appeared
over the years.
When we first talked, I could see that there was a lot more to Jane than just
someone who wanted to try to turn back the clock; things went a lot deeper than
that. I could tell there were issues of self-worth and also self-esteem that went
back many years. During that initial consultation, it became obvious to me that
this lady needed more help than just getting rid of a few of those lines.
You may be reading this and thinking, ‘What has this got to do with facial
acupuncture and helping reduce the signs of ageing?’ Well, at this stage, not a
great deal. However, as we go into greater detail, I hope that you will see the
relevance of this case study in the context of facial acupuncture.
Jane had not experienced an acupuncture treatment before and was relatively
new to alternative therapies in general. There was a very deep sadness to Jane
that would take some time to get to the bottom of and, I hoped, help with. We
carried on with our initial consultation and discussed the reasons why she had
sought out cosmetic acupuncture as a treatment. It emerged that Jane had been
unhappy about how she looked for quite a long while. I asked her to describe
how she saw herself and what she would like to improve, if she could.
If we analyse how Jane looked, we can then consider how we might be able to
help using Facial Enhancement Acupuncture. Her skin quality was reasonably
good, with no visible oily patches or dry areas. She did have a lot of lines around
the corners of the mouth and also on the top lip. Also evident was a loss of
muscle structure around the mouth and chin, which gave the impression of a
sagging mouth with deep lines vertically at the sides.
There was very little evidence of lines around the eyes and the ‘number
elevens’, above the nose, were not too deep. There were a few furrows across the
forehead, but again these were not that pronounced.
Generally, for a woman in her late fifties, Jane looked very good, perhaps just
showing the usual signs of ageing. My overall impression, though, was still of
this deep sadness and a general greyish colour to the whole face.
I decided that the best course of action would be a few Five Element
Acupuncture treatments before we embarked on a course of Facial Enhancement
Acupuncture. This was definitely a good plan, as it later emerged that Jane had
gone through, and was still going through, quite a few personal difficulties. I was
sure that we would be able to help with a course of acupuncture.
Let us fast-forward a couple of months. In a nutshell, I had established that
Jane’s Causative Factor (CF) was Metal. There was a lot of grief there and she
was struggling to let go of things. Following ten acupuncture treatments working
with her on all levels, both physically and emotionally, I was so glad that we
decided to take this option. The sadness that was apparent at our first meeting
had started to subside and the pallid colour had begun to lift. I felt that we were
in a much better position now to embark on a series of Facial Enhancement
Acupuncture treatments.
We had talked earlier about the patient’s lack of muscle tone around the
mouth. This is a very difficult area to improve dramatically, as the face has a
pronounced sunken look to it after that amount of muscle wastage. We planned
an initial course of ten Facial Enhancement Acupuncture treatments at weekly
intervals, followed by regular maintenance treatment every six to eight weeks.
The patient responded really positively to the facial treatments, especially as
she had experienced Five Element treatment and was feeling a great deal better
after her course of regular acupuncture. Consequently, the Facial Enhancement
Acupuncture treatments went very well and there did seem to be a marked
improvement in the general appearance of the skin; the fine lines across the
forehead were also reduced. As I first thought and explained to the patient, it was
difficult to make a marked impression in the area around the mouth, but there
did seem to be an improvement in the fullness of the face there and the patient
was very pleased with the results.
Jane was a perfect example of a Facial Enhancement Acupuncture patient who
needed a little bit more than just cosmetic treatment, and in the end I was really
pleased to be able to help her on so many levels, other than just her appearance.
To this day, Jane is still a regular patient at my clinic and she continues to have
monthly Five Element Acupuncture treatments, plus a Facial Enhancement
Acupuncture treatment every couple of months. Over the period of time that she
has been having these treatments, she still feels that there are improvements to
her face. She is a great fan of the treatment and, most importantly, she feels
better too.

7.2 CASE STUDY 2: PETRA, AGED 35

Petra is a young lady who came to me a couple of years ago wanting help with
her acne.
My first impressions of her complaint were that it did not seem too severe but,
obviously, when something is of concern to the individual, then in their eyes it
sometimes seems more problematic than it actually might be.
Generally, her skin looked to be in very good condition; the main problem
were the raised cheek areas that were showing some old acne scars and also
some current spots that were very red.
After a traditional diagnosis, the first course of treatment was an Aggressive
Energy Drain (see Section 3.1). This was used to balance the patient, before
carrying out facial treatment.
Following the initial consultation, it was again decided to treat this patient’s
Metal Element. Therefore, I selected Lung and Large Intestine points as a
constitutional treatment, alongside the Facial Enhancement Acupuncture
protocol. This would help to eliminate any toxins that had built up in the system.
Note: This detoxification process could appear to exacerbate the problem for
a few days, so it is important to explain that this may be the case, but reassure
your patient that this will soon calm down.
A good way to treat a patient suffering with active acne would be to perform a
treatment comprised of some additional constitutional points, combined with
facial points. To begin with, I used a treatment called ‘Surrounding the Dragon’;
this is a treatment where we use acupuncture needles in ashi points circulating
the offending area (see Section 6.4). I inserted the needles around the acne and
not into the blemishes themselves and slightly angled towards the offending
area.
The aim of this treatment is to promote healing to the skin that we are
concentrating on, targeting the body’s own healing energy into the condition. A
noticeable improvement in the patient’s acne condition was seen after three
treatments. This was as a result of the constitutional treatment using the Metal
points and also the ‘Surrounding the Dragon’ treatments.
Along with the additional treatment for the patient’s acne, I also carried out
the full Facial Enhancement Acupuncture protocol. Because this patient had
existing acne scars from previous breakouts, it was decided that I would try to
help to erase these marks by using intradermal needles directly into the scars.
The aim of the treatment was to stimulate collagen production in the skin that
was affected by the scarring and plump out the pitted scars.
Once the active acne was under control and after closer examination during
the treatments, it was decided that the patient would benefit from Micro Needle
Therapy (MNT) treatment using dermal rollers to help further reduce the acne
scarring. The MNT has the same effect as the intradermals, but is ideal when
there is a larger area to treat.
The results of the MNT treatment were dramatic and, after a couple of
treatments, with six weeks in between, there was a significant reduction in the
appearance of the scars.

7.3 SAMPLE CASE STUDIES

I have included a selection of short case studies based on a typical initial Facial
Enhancement Acupuncture treatment. These are general outlines and even
patients exhibiting the same facial issues will often vary in the type of treatment
carried out and the expected results. Every individual is different and we must
always bear this in mind when forming our treatment plan. These studies are
here to provide a basic guideline as to how you can successfully tailor your
treatments centred upon your patient’s unique requirements.

PATIENT 1
Treatment focus: Forehead and mouth.

Techniques used: First, I used the grounding and anaesthesia points and
followed with those on the cheek and jaw; the patient had pointed out that they
wanted particular attention paid to the mouth area. I achieved a nice pulling and
tucking effect with the use of point ST4 and the Extra points under the mandible
bone. I then moved on to the points on the front of the face to include ST3 and
SI18. Next, I used the ‘Surrounding the Dragon’ technique on the forehead
around some age spots and areas of discolouration. The whole treatment was
finished with a facial massage, paying particular attention to the forehead by
using the Chinese Gua Sha technique

Expected results: Using the ‘Surrounding the Dragon’ technique on a regular

basis should result in a distinct improvement in age spots.

PATIENT 2
Treatment focus: Vertical lines between the eyebrows and horizontal lines
across the forehead. Moderately dry skin.

Techniques used: The treatment started with the grounding, as well as the
anaesthesia, points. The patient complained of tension in her neck, so I included
the points ST13 and GB21. The skin felt very taut when I needled the Cheek and
Jaw points and I was able to get a good lift on the eyebrow area. All Face and
Cheek points were inserted comfortably. I used the ‘Surrounding the Dragon’
points primarily on the forehead. The vertical lines between the eyebrows were
treated with intradermal needles and this was also the case with the horizontal
forehead lines. After the treatment I used hyaluronic acid on the whole face, but
focusing on the vertical and horizontal lines.

Expected results: With continued treatment and the use of the hyaluronic acid,
we should see a dramatic reduction in the intensity of the brow and forehead
lines. The skin should also become less dry, due to the hydrating qualities of the
hyaluronic acid.

PATIENT 3
Treatment focus: Red complexion.

Techniques used: I used the Four Gates and some cooling points to help with
the patient’s high blood pressure, LI11, LV2, DU20 and also ST9 later on. I then
followed the full Facial Enhancement Acupuncture protocol. After I needled the
legs and hand points, I decided to use Shen Men and Sympathetic auricular
points. I worked on the eyebrow points and found this to be a sensitive area, so I
think I will use numbing cream there for future treatments. I then moved on to
the points on the front of the face. I used the intradermal needles on the only
deep lines running from the nose to the corners of the mouth.

Expected results: ST9 is a useful point for taking heat and redness out of the
face. After a few treatments you would expect the redness in the face start to
subside.

PATIENT 4
Treatment focus: Dark pigmentation beneath the eyes.

Techniques used: For the grounding treatment I used Shen Men, ST44, LV3
and GB41. I added the Point Zero auricular point and then performed the full
facial treatment protocol.

Expected results: Immediately after treatment, the patient’s eyes should look a
lot brighter. The use of Wood points, Liver and Gall Bladder will have a
profound effect on the eyes.

PATIENT 5
Treatment focus: The skin is not overly wrinkled, but the patient complains of
saggy jowls.

Techniques used: The patient’s pulse was a little fast, and she said she gets
anxious before any procedure. I began with the auricular points Shen Men and
Point Zero and she soon began to relax. I used all of the points in a Facial
Enhancement Acupuncture procedure, but made a conscious effort to really
work on the points under the mandible bone. I added Mandible as a third
auricular point to help strengthen this area.

Expected results: Needling the jaw area is a bit tricky at first, but with a little
practice you can achieve a very tight area beneath the jaw line. With continued
treatment there should be a dramatic improvement on the jowl area.

PATIENT 6
Treatment focus: Around the eyes.

Techniques used: This was a new patient, so to start this treatment protocol I
first carried out an Aggressive Energy Drain. Following this I needled the Four
Gates points. I moved on to the auricular points of Shen Men and the Eye point,
followed by DU20 and BL6, and continued with the full Facial Enhancement
Acupuncture protocol. I then inserted the intradermal needles at the eyebrows. I
focused on the ‘crow’s feet’, inserting intradermal needles on both sides at a
spacing of a couple of millimetres. I then performed a Jade Roller Massage,
placing specific emphasis on the eye area with the smaller roller.

Expected results: A patient’s eyes are often noticeably better following Five
Element Acupuncture but, following the full facial protocol, this is often
amplified. After only one treatment, I regularly see a great improvement around
the eyes, but also in the eyes themselves and in their clarity.

PATIENT 7
Treatment focus: This patient wanted me to focus on her cheeks and jaws and
around her eyes where ‘crow’s feet’ were forming. Her cheeks were somewhat
red and beginning to lose firmness.


Techniques used: I needled the Four Gates, Shen Men and the auricular Cheek
point. This time, I chose to needle the anaesthesia points PC4 and TH8,
achieving De-Qi. The patient had very little experience of acupuncture and was
concerned about the possibility of pain and discomfort. The combination of Shen
Men and Yin Tang also helped the patient to feel very calm. The cheek was my
focal point for this patient so I needled these points with an upward direction.
After checking that the patient was comfortable, I moved on to the eye area, and
used intradermal needles in the crow’s feet. As usual, I left the intradermal
needles in place for 20 minutes and after that I proceeded to carefully remove the
needles, starting with intradermals and facial needles and ending up removing
LV3 as the final needle.

Expected results: The cheeks may seem more red initially following treatment,
but this should decrease and be replaced by a lighter complexion colour. The
patient’s cheeks should appear less swollen and the skin more taut.

PATIENT 8
Treatment focus: Normal to dehydrated skin, enlarged pores, brown spots. The
patient also has wrinkles and fine lines in between the eyebrows, in the nasal
labial fold and on the top lip.

Techniques used: I started as usual with an AE Drain, followed by the Four
Gates point and continued with the other constitutional body points. The patient
complained of very dehydrated skin. This should improve dramatically by using
the Facial Enhancement Acupuncture protocol. I used the intradermal needles on
the lines around the eyes and also along the nasal labial fold. Thirty minutes
before needling the top lip lines, I decided to apply some skin-numbing cream as
this particular area can be very sensitive. I applied hyaluronic acid, with
pantothenic acid to lock in moisture and help to shrink the pores. There was a lot
to focus on for the initial treatment and I will wait to see the developments
before adding in the ‘Surrounding the Dragon’ method to tackle the age spots.


Expected results: There should be a dramatic improvement in skin quality, due

to the increased circulation to the face. After only a few treatments there should
be a great improvement on the lines around the eyes and the nasal labial fold.

PATIENT 9
Treatment focus: This patient has been having Botox® for ‘crow’s feet’ and
‘number elevens’. The appointment was scheduled three months following the
patient’s last Botox® session, as an alternative to having the more invasive
treatments.

Techniques used: I made some diet and lifestyle recommendations as the

patient had complained of general unhealthiness and diet issues. Many of the
Facial Enhancement Acupuncture points can aid detox, such as LI4, LV3, GB41,
ST36, SP9, Yin Tang and DU20. Alongside Shen Men, the auricular points I
selected were Liver and Eye, and I added in Large Intestine to help the
detoxification process. I focused on the areas that the patient had received
Botox® for and also for eye bags. I also used intradermal needles in the ‘number
elevens’ between the eyebrows and the ‘crow’s feet’. There was noticeable
erythema in these areas following needling.

Expected results: A general softening of the lines on the face should occur but,
because of the effects of the Botox®, it will take a few treatments to have any
lasting result.

PATIENT 10
Treatment focus: Facial sagging, loose skin in the cheek and also around the
jaw area.

Techniques used: I needled the constitutional body points and I chose to use a
few more auricular points with this patient. Shen Men, of course, but also
Mandible, Cheek and Spleen for its relation to the toning of the flesh. I used the
‘propeller’ technique described in Section 6.2, to help tighten up the cheek
muscles and spent time using the ‘pinning’ method (see Section 4.3.7) to tighten
the skin beneath the jaw.

Expected results: The patient should see an initial lifting effect after the first
treatment, although they will need a few more sessions to really gain benefit
from the treatment.

PATIENT 11
Treatment focus: Lines around the mouth.

Technique used: Because of the quantity of lines around the mouth, it was
necessary to use in excess of 50 intradermals just in this one area.

Expected results: There should be some change within approximately three

treatments, but I would also recommend introducing some sessions of Micro
Needle Therapy every 4–6 weeks. Used in combination with regular FEA
treatments, this should see dramatic results in this area.

PATIENT 12
Treatment focus: Overall complexion and forehead lines.

Techniques used: I needled the Four Gates and the body points, omitting the
anaesthetic points as this was a regular patient who is not sensitive to needling. I
then proceeded with the facial protocol. I used intradermal needles for the
forehead lines and selected the Forehead auricular point. The overall complexion
of the patient should naturally improve by the use of the Facial Enhancement
Acupuncture protocol. The facial needles generate a lot of Qi and this is
circulated throughout the face, resulting in an improvement in complexion and
reducing open pores. I applied retinol serum to the face and used the Gua Sha
stone to push it into the skin.

Expected results: The improved Qi energy and blood flow that the needling to
the face promotes should see a rapid improvement to the complexion within
approximately three treatments.

PATIENT 13
Treatment focus: Facial scar and active acne.

Techniques used: I carried out the full Facial Enhancement Acupuncture

protocol. The patient had an old scar on her face and I used the ‘Surrounding the
Dragon’ technique. I chose not to opt for Micro Needle Therapy to treat this, as
the patient had active acne that needed addressing and this would not be
recommended in relation to Dermal Rolling. In addition to this, I made sure that
I needled ST9 and also selected LU5 and LI11 to help the skin. I applied
hyaluronic acid serum, with pantothenic acid to help the infection.

Expected results: The ‘Surrounding the Dragon’ technique can significantly

reduce the appearance of a scar over a period of approximately six treatments.
The acne can get worse initially, due to the detoxification process. However, it
should then begin to improve to the point where we can use MNT to further
plump out the pitted scar.

PATIENT 14
Treatment focus: Old acne scars.

Techniques used: Whilst it was important to carry out a full Facial

Enhancement Acupuncture treatment on this patient, it was also deemed
beneficial to carry out a series of dermal roller treatments that would directly
help to reduce the appearance of the acne scars.

Expected results: The dermal roller can be used as stand-alone treatment, but it
is also a valuable tool when used in combination with the Facial Enhancement
Acupuncture treatment. On this particular patient, it would be envisaged that a
vast improvement would be evident after approximately six treatments, carried
out at 4–6 week intervals.

PATIENT 15
Treatment focus: Sagging eyebrows and eyelids.

Techniques used: First, I carried out an Aggressive Energy Drain with this
patient; this was followed by the Four Gates treatment. I decided to apply some
numbing cream to the eyebrows as this area can be very sensitive. Once the
numbing cream had taken effect, I needled points BL6, GB14 and the three
intradermal points that lift the eyebrow. The rest of the Facial Enhancement
Acupuncture protocol was carried out and the needles left in place for 20
minutes.

Expected results: An improvement to the eyebrows should be evident after

approximately three treatments, which should also affect the eyelid. I would
envisage that this would improve even more over a full course of ten treatments.


CHAPTER 8

MARKETING FACIAL ENHANCEMENT

ACUPUNCTURE

The subject of marketing is something that is very close to my heart, having

spent many years in a sales and marketing career before I discovered I was far
happier sticking needles in people.

Joking apart, this background did set me up with some knowledge of

how I might be able to attract patients to my clinic and also, more
importantly, keep them as regular patients in my practice.

My emphasis with marketing and patients has always been focused on patient
retention.

It is so important to make sure that your patients come back to you on

a regular basis and that you have offers and services that will attract
them.

A very simple way to achieve this, and something that you might do
already, is always to make sure that at the end of a patient’s treatment
you rebook them for a follow-up.

This could be in a week or even three months’ time.

As long as you get a date booked in the diary, you can relax, as you
know you will be seeing that patient again.
There is nothing worse, in my mind, than a happy patient going away
and saying they will be in touch or they will see how things get on.

Of course, you cannot hold a patient down and not let them out until
they rebook, but there is nothing stopping you having the diary ready
and suggesting some dates.

The other side of this issue is when you have a cancellation.

There is nothing that can be done to change this, but when it happens,
ensure that you try to get into the habit of making a new booking as
soon as they cancel.

If they telephone and leave a message, the same applies.

It never does any harm to return the call or send an email expressing
your concerns that they are okay and to suggest booking a date for
their appointment in the future.

If, as a practitioner, you maintain constant contact with your patients and keep
an efficient diary, you should always have a healthy and busy practice.

We will review some of these tips later and organise them into some
user-friendly reminders to help jog your memory.
Of course, the main idea behind this chapter is to help you market facial
acupuncture and to bring prospective patients into your practice; the same
methods and techniques can be used for any type of acupuncture or business.

It is simply a case of tailoring them to suit your current need.

Let us break down the subject of marketing into some bite-size chunks
that we can take in more easily.

8.1 MARKETING TO EXISTING PATIENTS

This is probably the most overlooked but most accessible opportunity to add
business to your practice.

Think about every patient that you treat.

Obviously they are happy with the service that you have given them;
otherwise they would not be a regular patient.

During the time that you have been seeing them you will have built up
a sound knowledge of their background and personality.

More importantly, they will trust your abilities and judgement.

So, before you even start to think about an advertisement in the paper,
start talking to your regulars.

Ask them questions.

Would they like to try a facial acupuncture treatment?

Perhaps you might like to offer them a special discounted treatment as

a thank you for being a loyal patient.

Have some discount vouchers printed and give them to patients to

pass on to friends and relatives.

This is a good way to spread the word.

Another effective method of advertising to your regular patients is to organise

an open day or evening where you will be demonstrating the new treatments and
answering any questions about what you have to offer.

Remember old or lapsed patients; I am sure you have a filing cabinet of files
for patients who have not been to your practice for a while.

With a new treatment to offer, this provides a perfect opportunity to

rekindle some interest and get them back in to see you.

Of course, they may also have friends or relatives who may be keen to
try acupuncture, so put together a professional letter along the lines of:
‘It has been a while since we saw you at the clinic, so we would like
to let you know about some exciting new developments that I am sure
will be of interest.’

Remember to include some discount vouchers too.

You can be very daring in your marketing to existing patients; it can take
some bravery on your part, but it can also bring long-term dividends.

Perhaps take a look at your patient database and list your top 50
regular patients.

Then produce a card or email that thanks them for their continued
support and offer them a free facial acupuncture treatment.

There is a possibility that you may get a few joking responses: ‘So
you think I need something done with my face?’

However, remember that anyone can benefit from Facial

Enhancement Acupuncture, young or old, male or female.

This type of marketing is extremely powerful; if we look at it more

carefully, you are thanking one of your most loyal patients by offering
them a free treatment.

Depending on your treatment charges, this could be to the value of

£100.

Obviously, this free offer does not cost you this amount, but your
patient does not see this; they only see the free £100 treatment.
 It might go against your business ideals to be giving away treatments, but do
not look at it as giving something away; look at it as an investment in your new
business.

These 50 patients are the core of your business; they will spread the
word and, more importantly, they will rebook if they like the
treatment that you provide.

And that brings me nicely into the next step of using your existing patient base
to its full.

Introduce a ‘refer a friend’ scheme.

You could set up a system that rewards your patients when they
introduce a new patient to your clinic – perhaps a discount off of their
next treatment for every new patient they introduce.

Printing some referral cards can be a simple and effective way of

marketing your practice.

Whilst you are having these printed, you could also opt to produce some
patient loyalty cards.

These are a great way to retain your patients and also introduce them
to your new treatments.

One suggestion might be to stamp the patient’s card every time they
have a treatment and then, as a bonus, the tenth treatment could be a
free facial acupuncture treatment.

This is a great way of keeping your patients loyal and also thanking
them for their continued custom.

8.2 ATTRACTING NEW PATIENTS

This section is particularly relevant to practitioners just starting out, but can
apply to anyone seeing a dip in trade or for general maintenance of your diary.

There are so many ways that you can attract new patients to your clinic; the
main thing is to think about who you are trying to attract and not to waste money
on general advertising that, in my experience, very rarely works.

When thinking of Facial Enhancement Acupuncture, a certain client

stream will initially come to mind.

Who might like to try facial acupuncture, perhaps as an alternative to

other facial procedures?

Approach a few local hairdressers in your area – see if they might be

interested in advertising your facial treatments to their clients.

You can reward them for displaying your leaflets, perhaps with a
commission for anyone they send your way.

They might even like the idea of you doing a demonstration evening
for their clients.

Further down the line, you may even find an establishment with a
spare room that you could rent on a regular basis and offer onsite
treatments directly to their clients.

Obviously, facial acupuncture is for both sexes, but of course it is only natural
that it is going to appeal to women more than men.

Do some research into groups and organisations in your area that cater
mainly for women; these could be organisations like the Women’s
Institute or other groups that meet on a regular basis.

I have found that groups such as these are always looking for speakers
at their meetings and this is a great opportunity to gather 20 or 30
women in one place to talk about your subject.

The prospect of talking to a hall of 30 people might not be for you, but try not
to dismiss the idea too quickly.

In general, they will only require you to speak for 30–45 minutes and
that is not too long to talk about a subject that you are knowledgeable
and passionate about.

From my experience, you do not need any fancy props or projectors.

I simply take along a few needles so that I can dispel the myths and
then I talk about acupuncture and how it can help.

I then let the audience ask a few questions and before you know it
nearly an hour has passed.

Make sure you have plenty of leaflets on hand and also take along
your diary, as some people will want to book an appointment there
and then – make sure you are ready to take those bookings.

Leaflet drops are another way of getting the word out.

In my experience, they are generally more successful than newspaper

advertising, but not as good as regular talks and more direct
marketing.

Leafleting can get the word out very quickly, but do not expect a huge
response.

The odds are very low when it comes to this type of marketing; I
usually look at perhaps a 2 per cent response rate.

So, for every thousand leaflets, I would expect to get 20 new patients.
However, by making your leaflets more attractive and aiming them at
a specific sector of the public, this should help to improve the take-up
odds.

It is also important to have a clear ‘call to action’ on your flyer,

perhaps with a code so that you know exactly how successful your
campaign has been.

A well-designed, targeted leaflet, with an offer, is more likely to be

pinned to a noticeboard or fridge, rather than finding its way straight
to the dustbin.

Leafleting should be part of an overall marketing campaign and should not be

your sole method of attaining new business.

Coupled with other forms of direct marketing, it can be a powerful

tool to build your brand locally.

We should not overlook other forms of media, such as local radio and, of
course, television.

The latter can be difficult to get on to, but local radio is a very realistic
option for your marketing.

We all have nearby stations that may be interested in hearing from

you.

They all have time spots to fill and would be really interested to hear
about what you do.

Of course, you cannot just use the radio to advertise, unless you pay
for airtime, but what you can do is use any airtime that you do get to
spread the word and create awareness of what you are offering.

An effective way of introducing yourself to radio stations and also getting free
coverage in newspapers is to produce a press release.

A press release is a simple and concise document that informs the

reader of something new and/or something that they might find
interesting.

There are many websites that can help you to produce a press release
and it really is a worthwhile thing to do.

Journalists are always on the lookout for items with a difference or

that have relevance to topics in the national news.

By sending your press release to the radio stations and also local
newspapers, this could achieve airtime or editorial that could be worth
a lot more than some paid advertising.

People like to hear from and deal with experts in their field and, after all, that
is what you are.

You have trained for years to do what you do and continue to gain
experience treating your patients in your clinic.

As well as the talks and lectures to groups, you might also like to
consider writing short pieces for local magazines and community
newspapers.

Again, this is not a direct form of advertising, but a way of drip-

feeding awareness to people and letting them know what you are
offering and where they can go to benefit from your expertise.

8.3 ONLINE MARKETING

The benefit of being in practice these days is the access we all have to the
internet and social media.
We can communicate with hundreds if not thousands of potential new
patients at the click of a button.

As a basic requirement, I would recommend that every practice has its own
website, even if it is only a basic one-page site that you can add to as the practice
grows.

Make sure that your website tells people exactly what you do and
where they can find you.

You also need to ensure that your contact details are clear and easy to
see, so that potential patients can readily book an appointment to see
you.

This may sound obvious, but it is surprising the number of websites I

have come across that have not considered this.

Also, your website should be a place of information and not just

somewhere to advertise your business.

You want visitors to keep coming back to your site on a regular basis
and they will only do this if the site is interesting and offering new
information.

Nothing is worse than an old site that displays the same material; it is
beneficial to keep the site as fresh as you can.

Make sure your website address is displayed on all of your literature and
business cards; it needs to become the focus of your business – the place that
tells people what is happening and keeps them updated with the latest
developments.

You could also incorporate or link your own blog page to your
website.
I am sure you are familiar with blogs and may already write your own
but, for those who are not, a blog is where you write about a variety of
topics online.

Subjects could be acupuncture or yourself, right through to

developments in your clinic or the services that you offer.

Again, it is more of a tool to provide information and resources than a

direct sales aid, but it will help to develop and build your profile,
which can direct business to your practice.

There is a vast array of social media avenues to explore, too many to mention
here.

For my clinic, I predominantly use Facebook, Twitter and LinkedIn.

We have gradually gained a good following on Facebook and our

Twitter account is linked to this.

Social media can be time-consuming to maintain, but it is also very

immediate and gets your message in front of an audience that has
chosen to connect with you.

This provides a distinct advantage over other types of marketing.

As long as you are using it to engage with your community rather than
solely to promote your business, I believe it can be a great addition to
your marketing strategy.

My advice would be to aim most of your posts at providing

information and resources to your audience, rather than direct selling.

One of the most rewarding benefits of your website or social media platform
is to gather information about your existing patients and also potential new
patients for your clinic.
Make sure that every visitor to your website or Facebook page has the
opportunity to leave their email address as a minimum; also let them
know that by leaving their details you would like to keep them
informed of your services and any special deals that you might be
offering.

By making it clear to visitors that it is your intention to send updates

and news about your business, you should not have any problems in
using the information that you collect for marketing to this database.

One of the best ways of doing this is to produce a newsletter, perhaps monthly
or quarterly.

Use this as a chance to tell potential patients what has been happening
at the clinic and any exciting new developments that are occuring.

Of course, remember to provide your readers with resources and

information.

It is not all about selling.

Your newsletter should be giving people information of value that

they find interesting, that they want to share with their friends.

It should be engaging, so that your audience will want to read more

and receive future issues.

You may wish to provide an incentive to encourage people to sign up to your

newsletter, such as a free guide, ebook or some top tips related to health and
wellbeing that you have written.

Many of the email marketing companies have a facility for automated

emails that can be sent out when someone chooses to add themselves
to your mailing list.
8.4 MEMBERSHIPS

It is all well and good having a brilliant website and engaging social media
communities, but how do people find you in the first place?

An effective website will have search engine optimisation in place and

will climb to the first page of Google or other well-known search
engines for relevant terms.

You can also set up pay-per-click advertising campaigns that will

direct people to your website or within Facebook, for example.

This can be an effective method of promoting your online presence,

but you will need to have a realistic budget in place and regularly
quantify the results to get the best out of your campaigns.

However, some people will still prefer to find practitioners through a

trusted network or professional body and will look to these registers to
find a qualified practitioner first.

As a traditional acupuncturist based in the UK, I am a member of the British

Acupuncture Council and potential patients can find me through their website.

You may practise Western medical acupuncture or auricular

acupuncture or you may be a physiotherapist who has undertaken
training in acupuncture.

Each of these modalities will have their own societies or regulating

bodies and I have listed some of those that are located in the UK in
the resources section.

Membership of a site pertaining to your training can lend weight to your

profile and reassures potential patients of your qualifications.

There is a cost involved, and some of my colleagues have chosen to

opt out of such groups, but from a personal perspective I have found
membership to be beneficial to my practice.

One of the major assets of these associations is that they provide a hub
of information about the service that you are offering, building
awareness of what you practise and enabling potential patients to
discover more about acupuncture and how it can help them.

The member areas also often provide the opportunity to talk with
fellow practitioners about your business and the profession as a
whole.

In the UK, there is now a network specifically for facial acupuncture and
Micro Needle Therapy.

I recognised that there was a gap in the market for acupuncturists

specialising in this type of treatment and, in 2008, I founded Cosmetic
Acupuncture UK.

This professional network is open to acupuncture practitioners who

have undergone additional training in cosmetic acupuncture.

A sister-site for Five Element Acupuncturists, The 5 Element

Acupuncture Network, was created in 2012 (see Resources).

Making your website available on these sites, and other related directories, not
only links potential practitioners straight to your business but also helps your
website’s rank in the search engines, as they favour highly relevant backlinks.

8.5 BRANDING

The best way to bring all of these marketing ideas together, especially the
website and the social media aspects, is to develop a brand for your business.

A branding gives your business an identity that potential patients can

recognise and relate to.

Branding covers everything from your business logo, through to the colours
that you use on your printed literature and website.

Your logo is important, but it does not need to be anything too grand;
it might even just be your own name written in a style and colour that
people will remember.

The key is to create a uniform look that flows through all of your
stationery, such as your business cards, flyers, letter head and
advertising.

This should then tie into your online presence, which will give a look
and feel that endorses your professional skills.

Good branding will give potential patients confidence in you and how
you operate.

With any of these ideas that I have put forward, there is no need to employ
expensive companies to develop things.

Of course, you can invest in this if you choose, but these ideas can
also be implemented by the individual.

With a little thought and imagination, you will be able to put forward
a brand and image that you can be proud of.

8.6 TOP TEN MARKETING TIPS FOR FACIAL

ENHANCEMENT ACUPUNCTURE

The tips and ideas that I have outlined to help with the development of your new
facial acupuncture business are simple but, when put together, can be very
powerful at attracting new business.
The ideas can be used in whole or in part, but my advice would be to
employ as many of the suggestions as possible.

If you do that, I can almost guarantee that you will have a full diary
now and into the future.

I have broken my marketing tips down into a few easy stages below that
summarise the suggestions that I have made.

Some options will depend on your budget, but many simply need an
investment of your time.

In that respect, there is absolutely nothing to lose by giving some of

these ideas a try and I am sure that you will be pleased by the results
that can be achieved.

1.

Introduce a ‘refer a friend’ scheme or loyalty card for existing

patients.

2.

Run a clinic open evening to introduce facial acupuncture.



3.

Carry out a targeted leaflet drop for facial acupuncture.

4.

Approach local groups to do talks.

5.

Produce a facial acupuncture press release and send it to local radio,

newspapers and magazines.

6.

Develop or improve your website.

7.

Set up social media accounts, such as Facebook and Twitter.



8.

Look into adding your contact details to relevant online directories or

becoming a member of a professional body, network, society or
association.

9.

Start a practice newsletter.

10.

Develop your practice branding.

GLOSSARY

Acupuncture: An ancient Chinese treatment/medical technique based on the

principle that there are pathways called meridians relating to internal organs and
systems, running throughout the body. Vital energy or Qi flows along the
meridian lines and there are points along these channels that can be stimulated
by the insertion of fine sterile, disposable needles to clear blockages. Points are
selected for the treatment of various disorders or to alleviate pain.
Aggressive Energy Drain: Treatment protocol used to clear an accumulation
of unhealthy Qi energy from a patient’s system.
Anaesthesia: Loss of bodily sensation, specifically loss of the feeling of pain.
Analgesia: An inability to feel pain.
Ashi Point: Tender spots that can be used as acupuncture points.
Auricular: Relating to the ears.
Blood: Dense fluid that has been affected by Qi energy, flowing both through
the vessels and the meridians, nourishing Body, Mind and Spirit.
Body, Mind and Spirit: If one of these three connecting factors is out of
balance, it can affect the others.
Channels: See ‘Meridians’.
Cun Measurement: A Chinese measurement denoted by the width of the
knuckle of the thumb or the space in between the distal and proximal inter-
phalangeal joints of the third finger. 1.5 cun is measured by the width of first and
second fingers together. All four fingers together demarcates 3 cun.
DE-Qi: The sensation felt when stimulating an acupuncture point.
Evens Technique: Method where the acupuncture needle is inserted with no
stimulation.
Extra Point: Extraordinary acupuncture point that is not attributed to a
particular channel.
He-Sea Point: Connecting points found at the elbows and knees.
Intradermal Needle: Small 3mm or 6mm acupuncture needle used for fine
work.
Jing: The Essence. Kidney Jing, derived from both pre-and post-Heaven
Essence, is related to growth and maturation.
Meridians: Channels of energy that run throughout the body.
Qi: Vital energy believed to circulate around the body in currents.
Shen: The Spirit. Heart Shen governs the emotions.
Shu-Stream Point: Where Qi pours through the channel.
Source Point: A high-concentration point that provides access to the main
meridian system.
TCM: Traditional Chinese Medicine.
Tonification: Stimulation of the acupuncture point by turning the needle
clockwise to boost it.
Xi-Cleft Point: Where Qi and Blood gather.
Ying Spring Point: Acupuncture point where the Qi trickles down the
meridian.
RESOURCES

www.facialenhance.co.uk
Facial Enhance, the home of Facial Enhancement Acupuncture, providing
information, latest developments and details of upcoming masterclasses and
workshops.

www.learncosmeticacupuncture.com
Facial Enhance online courses, including Facial Enhancement Acupuncture,
Micro Needle Therapy and jade roller study options. Paul Adkins’ training
options including comprehensive study material and HD videos, resulting in
certification and a listing as a practitioner on the Facial Enhance website.

www.cosmeticacupunctureuk.com
Cosmetic Acupuncture UK Network.

www.5Elementacupuncture.co.uk
The 5 Element Acupuncture Network.

www.acupuncture.org.uk
British Acupuncture Council, the UK’s main regulatory body for the practice of
traditional acupuncture

www.bawma.co.uk
British Academy of Western Medical Acupuncture, training medical doctors and
nurses to practise Western medical acupuncture.

www.medical-acupuncture.co.uk
The British Medical Acupuncture Society. Western medical training for
healthcare practitioners.

www.aacp.uk.com
Acupuncture Association of Chartered Physiotherapists.

www.auricularacupuncturecollege.com
The college of Auricular Acupuncture. Ear acupuncture study options.

www.facebook.com/facialenhancementacupuncture
Facebook page for Facial Enhance.

www.twitter.com/facialenhance
Twitter page for Facial Enhance.

www.5elementwebdesign.co.uk
Website design for therapists.
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version="2005-1" xml:lang="en">

Cover

Title

Copyright

Contents

Disclaimer

Acknowledgements

Preface

1. Introduction To Facial Enhancement Acupuncture

1.1 The Five Elements

1.2 The History of Facial Acupuncture

1.3 Modern-Day Treatment Comparison

1.4 The Development of Facial Enhancement Acupuncture

2. Expected Results of Facial Enhancement Acupuncture

3. Acupuncture Points Used in the Main Protocol

3.1 The Aggressive Energy Treatment (AE Drain)

3.2 Acupuncture Points on the Feet and Legs

3.3 Acupuncture Points on the Hands and Arms

3.4 Acupuncture Points on the Head and Forehead

3.5 Acupuncture Points around the Eyes

3.6 Acupuncture Points on the Jaw

3.7 Acupuncture Points on the Front of the Face

3.8 Acupuncture Point on the Chin

3.9 Acupuncture Points to Treat the Neck

3.10 Auricular Acupuncture Points for Facial Enhancement

Acupuncture

4. Step-By-Step Guide to the Facial Enhancement Acupuncture

Protocol

4.1 Contraindications

4.2 Preparation

4.3 Step-by-Step Guide to Facial Enhancement Acupuncture

4.4 Facial Enhancement Acupressure Massage

4.5 Finishing the Treatment

5. Advanced Facial Enhancement Techniques

5.1 Jade Gua Sha

5.2 Jade Rollers

5.3 Dermal Rollers

6. TREATING SPECIFIC FACIAL ISSUES

6.1 The Acupuncture Meridians and their Role in Facial Enhancement

Acupuncture

6.2 Sagging Facial Muscles

6.3 Eye Bags and Dark Circles

6.4 Age Spots and Skin Discolouration

6.5 Acne

6.6 Eczema

6.7 Rosacea

7. Facial Enhancement Acupuncture Case Studies

7.1 Case Study 1: Jane, Aged 58

7.2 Case Study 2: Petra, Aged 35

7.3 Sample Case Studies

8. Marketing Facial Enhancement Acupuncture

8.1 Marketing to Existing Patients

8.2 Attracting New Patients

8.3 Online Marketing

8.4 Memberships

8.5 Branding
8.6 Top Ten Marketing Tips for Facial Enhancement Acupuncture

Glossary

Resources

References