Episode 206: Chronic Pain, Migraines, Brain Injuries – Acupuncture & Functional Neurology

with Dr. Ayla Wolf

If you suffer from chronic pain, migraines, ongoing concussion symptoms, or really anything related to neurology, you’ll definitely want to check out this conversation with Dr. Ayla Wolf.

Dr. Wolf blends the paradigms of functional neurology, Chinese Medicine, and acupuncture to bring a unique healing perspective to her patients. By looking at people in real time, rather than just a snapshot of their conditions, she’s able to analyze and apply differential diagnoses to treat the whole, connected system of the brain and body.

On Today’s Episode of A Healthy Curiosity:

  • What functional neurology is and how it looks in a Chinese Medicine setting
  • Why things can get missed when looking at patients in specialized silos
  • How the dynamic nature of the nervous system can affect neurological exams
  • What the research says on the cumulative effects of acupuncture treatments
  • Some insight into how herbs can interact with the immune system of the brain

Dr. Ayla Wolf is a Doctor of Acupuncture and Oriental Medicine specializing in neurological disorders, concussions and traumatic brain injuries.  She is a faculty member of the Carrick Institute of Clinical Neuroscience and Rehabilitation, and teaches doctoral program courses in neurology as an adjunct faculty of the AOMA Graduate School of Integrative Medicine, and American College of Traditional Chinese Medicine. She is an international speaker and educator on functional neuroanatomy, neurophysiology, neurological exam techniques, and neuro-rehabilitation utilizing acupuncture and Chinese medicine. She also teaches advanced courses on the management of patients with concussions and TBI.


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Welcome to A Healthy Curiosity. The podcast that explores what it takes to be well in a busy world with self care strategies from Chinese medicine, functional medicine, Ayurveda, neuroscience, and beyond I’m your host, Brodie Welch, licensed acupuncturist and transformation catalyst here to support you on your journey of health, happiness, and personal evolution.

Welcome to today’s show really quickly before we get rolling today, I have a really important announcement. If you’re listening in real time, election day is nearly upon us here in the United States, and there has never been a more important election in our lifetimes. The fate of democracy itself may well hang in the balance.

So I wanted to start off today’s show by encouraging you to please, please vote, vote early. If you can. Trump and his cronies are actively engaging in voter suppression and misinformation because they know it’s the only way that they can win is to repress voter turnout. And that includes making it difficult to vote.

Casting doubt on vote by mail, and generally demoralizing people around whether or not voting will even matter in hopes that we will surrender our power rather than show up to cast a ballot. Don’t be fooled. If you care about democracy, if you care about saving the affordable care act, which Trump and their whole Hoboken are trying to get rid of, if you care about human rights for LGBTQ people, if you support the black lives matter movement, living wages help for people in small businesses hit by COVID and the pandemic, and not just major corporations.

If you believe that we should have clean air and water and policies driven by science and common sense, please cast your vote for Joe Biden and calmly. Joe Biden was not my favorite or even my 15th favorite candidate in the primaries. But to quote a cartoon that’s been circulating online. He is our lifeboat and now is not the time to quibble over the size and shape or color of said, lifeboat.

We need to get on it. And then we can help steer it in the direction that we want it to go. Even if you think that they’re both evil and that who cares, if it’s the lesser of two evils, the lesser of two evils is still way, way, way less evil. When we’re dealing with an incompetent narcissist who’s in over his head and acts as though he’s above the law.

So please vote for Joe and Camila and encourage your friends and family who might be thinking of sitting this one out to do the same. It matters. Thanks for listening. And now on to today’s. Welcome to A Healthy Curiosity. I’m your host Brodie Welch, licensed acupuncturist and health consultants,. Today’s episode is for you.

If you suffer from chronic pain migraines, if you’ve had a concussion, if you’ve got anything really related to neurology going on. You’re going to want to listen up with me. Today is a colleague Dr. Ayla Wolf, who is a doctor of Oriental medicine and acupuncture, specializing in neurological disorders, concussions and traumatic brain injury.

She’s a faculty member of the Carrick Institute of clinical neuroscience and rehabilitation. She teaches doctoral program courses in neurology and as an adjunct faculty of the AOM, a graduate school of integrative medicine and the American college of traditional Chinese medic. She’s an international speaker and educator on functional neuroanatomy, neurophysiology, neurological exam techniques, and neuro rehabilitation using acupuncture and Chinese medicine.

She also teaches advanced courses on the management of patients with concussions and traumatic brain injury. Dr.Ayla Wolf. Welcome. And thank you so much for being here today. I’m excited to talk to you. Same. Thank you for having me. I’m sure there are a lot of people out there who have no idea that Chinese medicine has any possible relationship with things like concussions and traumatic brain injuries.

Although we’re kind of widely known for treating pain and migraines. There’s some really great research about that. And so we see a lot of that in our practice. How is it that you. Got into this very specific niche. I definitely didn’t start out with that. I started out specializing in fertility and women’s health and getting into a lot of functional medicine training on how the endocrine system works and all the different areas that feed into it.

So. I kind of started out with this functional medicine mindset of looking at how is everything connected and what are, what is this concept of, you know, having functional ranges, as opposed to, you know, what we would call more of these wider lab values that we often see on people’s charts and there to bring people who might already be lost into the conversation that, that you’re talking about functional ranges, as it as like an optimal range, as opposed to just.

Yeah, something that that is like, quote unquote within normal. Right. Exactly. So when we get our lab results, you know, we get these numbers that are our values, and then we get the range that the lab says is a normal range. But within the world of functional medicine, we can appreciate that. We need to look at those numbers a little differently, and that sometimes those normal ranges are maybe a little too broad.

And that even if you fall within that range, you may still not have optimal health. And that there are still things that can be done to bring people back into a more optimal, optimal level. So that was the mindset that I already had. And when I had my own concussions, I’ve I’m, I love sports and I love trying new things.

And so I’ve done a lot of martial arts over 15 years, lots of mountain biking, snowboarding wakeboarding, then. So I’ve had a number of concussions and I felt like. I had gone about 50% of the way into getting better, but I was still having symptoms and turn up a lot of brain fog. Like that was really kind of the thing that was bothering me the most, but definitely my circadian rhythms were, or off, I was having trouble sleeping, having a lot of brain fog, becoming more and more sensitive to a lot of different foods.

So developing what I would say is like, worse than that. Food sensitivities. So I decided to literally make a 180 in my life and decided to go back to school, to get my doctorate degree in acupuncture and Chinese medicine, with the intent of studying how acupuncture can improve brain function and what, what is acupuncture actually doing?

When it comes to the brain, is it improving blood flow to the brain? Is it changing neuro-transmitters is it affecting the immune system and the brain? Know what, what does acupuncture actually doing? Because it has a long history of being used for things like stroke, recovery, for example. And so obviously it’s having a major impact on.

Different motor circuits in the brain and the ability to change motor output and to help people recover and regain function, following strokes. And that’s where a lot of the research has been. And there hasn’t been a whole lot of research focused on the topic of acupuncture and traumatic brain injuries.

It’s mostly been on spinal cord injuries and then on stroke. And so I went into this doctorate program wanting to actually. Contribute to the research and to say, you know, what, what can acupuncture do to improve somebody’s brain function? And how would we go about studying that? And in the process of asking these questions and designing a pilot study, looking at cerebral blood flow and acupuncture, I was introduced to the Carrick Institute, which is an incredible institution that teaches what a lot of people would call functional neurology.

And so I think before I go any further, maybe we should just talk about what is functional. Yeah. That seems like a really good tangent and especially like, what is functional neurology in general? I will point out to longtime listeners that we had an episode with a functional neurologist a few years ago.

We’ll have a link to that in the show notes, but specifically also what that looks like in a Chinese medicine center. Absolutely. And that’s, that’s been my super fun journey for the last five years, for sure. And when, when I explained to people kind of for the first time, if they’re not familiar with functional neurology, I do like to put it into that context of when we look at this idea of functional medicine, we’re understanding the functional medicine focuses on how is everything connected?

You know, how is the health of the gut. Impacting brain function, for example, and understanding that these systems are connected or understanding, how does stress impact the nervous system? Um, how does trauma influence pain? You know, we, we’re always looking at this. How, how are things connected and understanding.

Where can we jump in to, to possibly make a change and improve somebody’s function based on all of these different factors of, of diet, of lifestyle, of stress, of sleep, of genetics, uh, you know, all of these things, what kind of exposure to chemicals people have had? We’re always paying attention to the big picture and understanding that we have to look at that big picture.

To, to get that 360 degree view of what’s happening with this one particular patient, because everybody has a different background, different genetics, different stress levels, different levels, uh, experiences of trauma. And that all is important to pay attention to with functional neurology. It’s the same perspective it’s it’s looking at.

How is it all connected and. A great example of that is the connection between the vestibular system and the autonomic nervous system. And our autonomic nervous system controls the output of what we often consider the kind of subconscious functions that we don’t pay attention to, like breathing and heart rate and blood pressure, things like that.

Well, when somebody has of the stipular imbalance that the stipular system. Fires so quickly into the autonomic nervous system that if there’s a vestibular imbalance that can drive all kinds of autonomic. Functions, including problems with a heart rate, maybe Taki cardia, someone’s heart suddenly beating too quickly or driving anxiety or driving drastic changes in blood pressure.

And so once you start diving into functional neurology, you learn about how all the different systems feed into each other. And so when you have a patient say with a brain injury or a concussion, and they have all these different symptoms, You’re not confused by the system, the symptoms, you understand that through your neurological testing, if you find out there is something going on with the vestibular system.

Then you start to see how that’s playing into a lot of their autonomic symptoms and you can kind of trace back to what we need to correct the specific color imbalance to actually improve these other complaints of tacky, cardia, or blood pressure problems or anxiety or chronic nausea or things like that.

So in other words, like that perspective means that you really are treating the whole system, as opposed to thinking about how do we just affect the heart rate or, oh, like maybe this person needs to manage stress that those may be pieces of the, of the, of the puzzle, but really understanding the vestibular component impact on the autonomic nervous system is critical.

Yeah. And in a system of medicine like we have now, People often get stuck into silos of, well, if you have a heart condition, you go see a cardiologist, but maybe that cardiologist isn’t paying attention to. The fact that somebody had a brain injury or the fact that they have a vestibular imbalance, or if somebody has a gut issue, maybe they go to a GI specialist who also is not necessarily paying attention to oh, well, all of these food sensitivities started to happen after they got their concussion and maybe that’s something happened.

With the way that the insular cortex is communicating with the brainstem, which is communicating with the Vegas nerve, which isn’t communicating with the gut. So when we go to specialists who aren’t looking at it from a functional perspective or from. Full 360 degree lens things get missed. That makes a lot of sense.

It certainly is. As, as we look at it in Chinese medicine, that all systems are connected, functional medicine shares that strategy. And so it just, it just seems smart to look at the whole picture. Yeah. And the other piece of that is that time and time again, I have to remind myself to be really aware of the fact that our nervous system is such a constantly dynamic changing system in the sense that if I have a patient come in, who comes in for an initial exam and I do my neurological exam.

If they came in and it was, you know, 9:00 AM in the morning and they had a great night’s sleep that night, their neurological exam is going to be completely different than if they were coming in for their initial exam. After they worked all day. After a stressful day of work, they’re tired, they’re fatigued.

Maybe they didn’t sleep great the night before, or maybe something stressful happened. Their entire neurological exam could be different based on just those factors of time of day and how fatigued they are. And so there’s always this idea of you’re really looking at people in real time and you’re having to always take into account all these immediate factors of, you know, have they eaten, do they have low blood sugar, but did they, um, did they work all day?

You know, these things are so important. And so they can’t look at people in these kind of snapshots, you know, because those snapshots really. Or just that they don’t tell us what’s going on both all day, all day long, or as far as like a circadian rhythm type of functionality either. Yeah, definitely.

There’s I think that’s a great reminder to those of us who are practitioners that we, that the slice of the person’s life that we’re exposed to is just this tiny little snapshot of, of their world. And hopefully as we get to know our people over time, Picture gets filled out a bit more in a way that helps us be better diagnosticians.

But yeah, so, so many things change moments, a moment as we’re constantly trying to adapt and create homeostasis, I wanted to circle back to your original. What got you into this question? That what, what is acupuncture actually doing with the brain? You mentioned blood circulation, you meant, you mentioned immune function.

Can you share with us a little bit about the, what acupuncture has to do with the. Definitely. And what has been really exciting is the process of doing a neurological exam and having these objective findings. And when I say neurological exam, I’m including ocular motor aspects. So how smoothly can somebody follow a target that’s moving horizontally left to right versus vertically up and down.

What is somebody’s ability to accurately? Um, interpret sensory input. For example, if I’m doing a graph, a Statia test and drawing letters on somebody. POM or their foot, are they able to determine what letter I’m drawing? And, and so it’s this idea of we’re looking at sensory input. We’re looking at how the brain is interpreting the information, and then we’re looking at the motor output.

Um, so doing a lot of gait analysis, a lot of motor analysis, a lot of balance and vestibular analysis, proprioceptive awareness, ocular, motor functioning, autonomic nervous system testing, you know, What is someone’s heart rate doing when they’re laying down versus when they go to stand up, are they, is their system responding appropriately to that change in gravity and that movement and looking at, you know, what is the blood pressure doing?

What is the heart rate doing? What are their pupils doing when they go from laying down to standing? So we’re collecting all of this information on all these different systems in the brain, and then. Creating an understanding of perhaps what systems are not working so well. And for the case of chronic pain, that’s a great one where the parietal lobe is where we have a map of different body parts.

And when people have chronic pain, in a sense, we can say that in certain cases, the map of that body part in the brain is not as. Precise and accurate. It’s not, it’s no longer in high definition. You know, it gets a little blurry and because of that, people then lose their, their sensory input from the area and they lose the motor output to that area in the sense that it’s no longer optimal, so different functional tests can kind of pick up on the fact that there might be some parietal lobe decompensation happening.

And what’s amazing is that you can then do acupuncture and see. The improvements in those neurological exams. And so what I love about functional neurology and applying it to a Chinese medicine practice is that you’re gathering all this objective information and you’re gathering all these biomarkers of function and you’re seeing where there’s a loss of function, and then you’re doing your treatment and you’re immediately retesting and you’re seeing gains in function.

Based on your neurological exams and it can happen that fast. It happens that fast, very often. And I think when we go back to the pulse, like we, you know, we love feeling people’s pulses well that you can’t feel someone’s pulse and say, oh, your parietal lobes not working so well. Right, right. It doesn’t the pulse doesn’t give us that information, but just like we would feel a patient’s pulse and then maybe do an acupuncture point and then go back to the pulse to see if it shifted.

It’s the same concept only instead of feeling the pulse, I’m doing these other functional examination. With this idea that in the parietal lobe where we have these maps of the different parts of the body, that so that we can, we can navigate the world and have a sense of where we are in space and what’s going on with the different parts of the body and that when we have chronic pain that it’s like, it’s this out of focus image.

And. I can really relate to that. Cause I had chronic back pain for a good, like, I dunno, 15 years or so that wasn’t, I don’t believe like led by my brain, but certainly it was the kind of thing where, where. I think I was hurting myself over and over again, doing yoga without mirrors, because it’s like, what I thought was alignments or a level of hips or things like that really weren’t at all.

And it was only after having to quit entirely and change up my routine. So I was like in a, I was in a bar studio or there are mirrors all around. I was, I had this awareness of like, wow, what I think is my lunge or what I think is this position of, of spinal alignment actually, isn’t at all. And like, no wonder I’ve been tweaking myself over and over again.

And that, that idea, even though it anyways, so th this idea makes a lot of sense to me that when we can increase the communication between the part of the body that’s hurting and the brain we’re able to. Increase that relationship in that dialogue between those two areas so that we are moving from kind of this low definition, blurry map to a higher definition, one, which can not only be, uh, you know, we, we know of course acupuncture can moderate pain levels with adenosine level.

It has all these sort of neurotransmitters that help us perceive pain differently. But also it just the fact that we are we’re, we’re helping the body communicate. Yeah. And if you think about the way that the somata sensory cortex is laid out in the brain, the low back actually has very little real estate in that area.

And we’re vert compared to say the hands. And I think that is one of the reasons why chronic low back pain is kind of the number one version of chronic pain that we see. Because it doesn’t have a lot of representation in thus medicine, Sri cortex. And if you think about, you know, these very, very fine needles that you’re inserting into the back, you’re now giving somebody very specific proprioceptive input in dif all these different points in the low back.

And in my mind, the way that I see that is that you are in a sense of remapping the back in the brain by giving people all these little teeny, tiny things. With your needles. I think that I’m reminded of just like in the intake process, asking people, well, where are you feeling your back pain? And they gesture in this incredibly vague way, you know, like in a space that takes up like three feet of, you know, of diameter of, of a circle of like, oh yeah, it hurts like all the way from here to here.

And it’s the kind of thing where like, yeah, that it can be. It can move around. It can be this when, when asked to kind of literally put their finger on it, it can be very difficult to find. Right. And then oftentimes a sign that it’s getting better is when that pain really does start to localize to a much more defined, smaller area.

Yeah. Yeah, exactly. And that’s it. And then of course, it’s, um, it’s easier to hit a target when that target becomes more clearly in view. All right. And the other piece of the chronic pain thing that we haven’t talked about yet, is it acute pain really does kind of reside pretty exclusively in terms of the local injured area communications.

That’s a matter of sensory cortex and the pridal lobe, but then when you get into chronic pain, all of a sudden we do bring in these other art areas of the brain that, that, that some people just refer to as the pain neuro matrix. And that actually includes the hippocampus and the amygdala. And the anterior singular cortex.

And when you’re bringing in the hippocampus, you’re bringing in the, essentially the memory of pain. And so it’s almost like people’s brains are just remembering the pain over and over and over again. And so that’s dysfunctional. And then with the amygdala, you’ve got, you know, the more of these emotions, the negative emotions.

You know, fear, panic, anger, things like that. And so now you’ve got an emotional component tied into the fact that you’re experiencing chronic pain, and then you have the anterior cingulate, which is where we perceive suffering. So then you’ve got this, you know, actual visceral sense of, of suffering that gets pulled into the conversation and cause chronic pain network.

Th the fascinating thing is that functional MRI research has shown that certain acupuncture points and the cumulative effects of multiple acupuncture treatments. Kind of creates a different conversation happening within all of these areas of the brain that make up the pain neuro matrix. And so the way that I like to describe the differences, like let’s say you’ve got all these areas of the brain and there’s, they’re, they’re all shouting at each other.

And that shout is this feeling of pain and suffering. And if with acupuncture, it’s almost like you’re piping. Calm relaxing music on top of the shouting. And so instead of only being able to hear the shouting that’s happening between these areas, you’re you, you’re hearing something different and something that’s actually much more pleasant.

And before I’m imagining like the memory of pain saying, like, remember this, you don’t want to do this again. It was really painful that last time. Oh. And, and when we’re in pain, we’re really. Life is really hard and we’re isolated and it’s frustrating. And so the amygdala gets involved and there’s this perception of suffering and like all these voices.

Holy cow. Right. So I’ll make cut, turning the volume down on that, down on the voices. Yeah. This episode is brought to you by the coaching division@brodywelch.com could have five to 10 minutes daily practice, and five phone conversations really change your life. They did for my client, Amanda. Uh, high powered doctor, mother, and activist, who is struggling with chronic stress and low self-worth.

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So this gets into, I know that there are some sort of approaches to pain management that really address the emotional aspects, right. That the fact that our emotions and our physical pain can be processed similarly in the brain or in the, in the, in the same section. And, and is that part of your approach?

Do you encourage people to. To either look at their pain differently or sends a different message to their body about like being safe or being, um, like how, how do you get someone to stop going to the past if they have then had an accident or a trauma or something where, where there’s legitimate reason for the body to want to guard that area or to feel those.

I do pay close attention to it, but that’s also where I like to pull in other providers who can offer some kind of therapy in regards, specifically to the trauma. So whether that is EMDR, I, that I love EMDR and I, that is usually my go-to. Um, but also things like neurofeedback. And I think that’s where it is really important to kind of create a team of people.

Some people can pro can use acupuncture to help them kind of process through trauma. I personally like to refer those patients out to have additional help because I don’t see myself as a trauma practitioner in the sense of like, that’s not what I want to focus on. Like I’m focusing on optimizing the functioning of the nervous system and when there’s trauma, I see that as a huge roadblock and I like to.

That’s why I said like send people off to EMDR because I feel like that is really specific for dealing with trauma. Whereas I feel like acupuncture. I think, I, I guess I see myself as trying to do too many other things I need, I need someone else to just focus on the trauma piece and someone who does that probably, you know, for that that’s their specialty.

It makes a lot of sense. And there’s plenty of acupuncturists who, who specialize in creating that sense of safety and. People work through emotional trauma out there. And at the same time, that’s a, that’s a big ask if you’re also doing all this other functional neurology, all of these different components that you’re focused on, um, makes a ton of sense for those people.

Listening. EMDR is eye movement, desensitization and repatterning and, um, yeah, I also, I also love referring people out for that as well. You mentioned a moment ago that the idea of. That treatments tends to build on themselves and that as someone undergoes this process of, of acupuncture treatments, that, that it’s not a one and done situation, right.

That there is that there is some research actually, that, that shows that the impact of multiple treatments in a row. Could you speak to that a little bit? Yeah. There, there are. Quite a few good studies that have shown in terms of looking at functional MRI imaging that have shown the acupuncture really does have a cumulative effect in terms of changing neuroplasticity.

So I see, I see the brain in chronic pain as having negative neuroplasticity, meaning neuroplasticity in the way that all those areas that we talked about are shouting at each other. So it’s, it’s become plastic, but not. And in order to remind the brain that it should be doing something different. So in order, this is kind of like if you’ve got all this areas of the brain that are shouting at each other and you do acupuncture, you’ve got to kind of keep doing it to remind those areas to quiet down.

Right. Every day it’s like, Hey, it’s nap time. It’s time to quiet down. And then over time you can create more of that plasticity in a beneficial way where after reminding those areas to quiet down and quiet down, quiet down, finally, they kind of remember, oh, okay. We need to stay quiet. Instead of continuously going back to our high volume.

Yeah. And that’s a lot of how most of us build our treatment plans with our patients is we, we have maybe a tight orbit around treatments a couple of times a week, maybe at first, and then stretching that orbit out until the body, I think can remember the suggestion that we were trying to give it. And sometimes people just graduate entirely.

And a lot of times for, for chronic conditions, it can be really helpful to have that periodic reminder of that the volume can be turned down. Exactly. I’d love to hear more about migraines. I was, this is something that we as acupuncturists see a lot of and our practices and a lot of people, especially women deal with fairly regularly and can be quite debilitating.

So I’m curious what you can share with us about treating migraines. Yeah. I, one of the things that I really like to, to talk about is the fact that migraines should, in a sense, be looked at as. Almost a sensory processing disorder. And the research is showing that people that have migraines, that there are certain parts of the brain that are, that are hyper excitable.

And not just when they’re having the migraine, but actually in between migraines. So you can look at certain pathways of the brain as in a sense, being upregulated. To create more hyperexcitability and a sense that they’re firing too much when they shouldn’t be. And that includes the trigeminal system.

Which is actually a very complicated system because we have our trigeminal nerve, which has three branches that cover the face. And then we’ve got the trigeminal ganglion that those nerves all feed into. And then we’ve got the trigeminal nuclei in the brainstem, and we actually have trigeminal nuclei that are in the midbrain.

And the ponds, which is in the lower brainstem and then also into what we call the trigeminal cervical complex, which is in the spinal cord, kind of the level of C1 and C2. And then you’ve got the lesser occipital nerve and the greater occipital nerve in the back of the head that also feed into that trigeminal cervical complex.

So you’ve got all the sensory input from the front of the face, the top of the head, the back of the head. All feeding into this trigeminal cervical complex. And then that is going up, you know, crossing over, going up in the thalamus and then up into higher core areas of the brain to transmit basically information on pain in the face and the head.

So that whole system can become dysregulated in the sense that there’s too much information in a sense it’s a chronic pain pattern, right? It’s like it’s too much pain, constantly being experienced and filtered through that trigeminal system. And on top of that, you’ve got other areas of the brain that have become dysregulated like the hypothalamus.

And so that’s why, you know, with people skip a meal, it can be a trigger for a migraine because the hypothalamus is really important in regulating hunger levels and blood sugar regulation. And then you’ve got the thalamus that is gaining a lot of information. And if that’s dysregulated, you’ve got the light sensitivity and the sound sensitivity.

And so there’s just all of these different areas. That are dysregulated in migraine that creates this really complex situation. And. What I loved was the fact that there was certain research studies looking at the use of acupuncture and they were using functional MRI imaging. And they were looking at what they call these, um, low amplitude fluctuations, where they’re looking at different nuclei, like the ones I just talked about.

And they’re looking at how often they’re fighting. And they found that the acupuncture points on the body. So not even on the head, nowhere near the spine or the head, but points just on the body could actually modularly and regulate different areas in the brainstem that are associated with my. And so I just love, you know, people always have that, that question of what I have a headache and you’re sticking a needle in my foot.

Like, you know, how does that work? And so he is up here, right? And so I just love that. We actually now have really good science that gives us explanations for why a point in the foot might actually improve a headache. And it’s not magic. Because it’s, it could literally change the conversation happening in a system within that trigeminal system.

That’s become dysregulated. Yeah. It’s not magic. It’s a map, right? Yeah. I’m curious if you have particularly favorite points, as you talked about sort of discovering these points on the body that can affect parts of the brain, or it might, there might these be points that we’re already familiar with as practitioner.

I have developed, um, some favorite points. And in terms of neurology, one of my favorite points has really become, do 26 and in the case of migraines and when you’ve got facial pain and I do in terms of testing, I will do touch and then pinwheel testing on the three branches of the trigeminal nerve. And from a interpretation perspective, like how do you interpret the findings of a pinwheel test?

If somebody has a peripheral nerve injury or inflammation, for example, a Bell’s palsy that’s affecting, you know, one side of the face, you can run a pinwheel along all three branches of the trigeminal nerve on that side of the face. And the patient would probably say, oh, that feels a doll. I can barely feel it.

So when you get somebody who says, there’s a difference between the left and the right in all three branches, you’re usually thinking there’s something going on with the peripheral nerve. But when you test and a patient tells you like, oh, well the left forehead feels sharper, but the right cheek feels sharper.

Or the, the, you know, the right forehead feel sharper. And then the right job feels sharper when you run that pinwheel, if really it’s only one or two out of three branches that are different, you’re usually thinking of some kind of dysregulation centrally, and time and time again, when I’m working with people with migraine.

That’s what I see in my pinwheel testing of the trigeminal nerve branches on the face. And what I love is the fact that I can do do 26 and then with the needle still in 15 seconds later, I can go back and retest with my pinwheel and everything feels equal from right to left. It’s like, awesome. Yeah.

You’ve completely equalized the input in that trigeminal. With just do 26 for like, you know, needling it for, um, you know, doing a little bit of a pecking technique for all of three seconds. And this point for those who might be curious is located just underneath the nose, like on the midline. And I learned that as, as being famous for re reviving people from fainting or, um, like drowning or just helping people to regain consciousness.

Yeah. And that’s another thing that I love about Chinese medicine is that you learn that when you’re in school, but then you don’t really learn the science behind it. And that was one of the things that I just came to understand through my own learning of how the nervous system is wired. And according to the system of stroke rehab that they’re practicing in Tianjin.

The way that they need we’ll do 26 is that they’ll actually needle it until the eyes start to water. And if you think about that, the watering of the eyes is coming from cranial nerve seven. So if you’re needling the phase you’re creating and your needle and do 26 and you’re needling it enough to make the eyes water, what that means.

Is that you’ve stimulated the nerve strong enough that it’s fired into the brainstem and created enough activity in the brainstem to create activation of cranial nerve seven, to then make the eyes water. And so then if you realize that what we just did is we created activity in the brainstem and when people are in a coma that reticular activating system in the brain.

It has been shut down. It’s not firing. And so if you create activity in it enough that you see tiering in the eyes, well, you just lit up that reticular activating system. And if you do that strongly enough, you could wake somebody up. I love that it’s it’s so it makes so much sense that we can take, we can take it on faith that for thousands of years, this particular point has been shown to have this particular effect.

And then. It’s kind of gone into hyperdrive with in the past few decades, right. With research of figuring out exactly why that is that what, how empirical observations over and over again, that which, which is of course the basis of any science is observing and noticing a repeatable pattern. And we can then understand it through the lens of, of modern neuroscience to really fully get why this point does.

Yeah. And there was another passage in, um, the Hong D nudging that talks about bringing people out of a coma and it talks about using a straw and blow. Air into somebody’s ear. And when I, again, it was like, that would have made no sense to me before I had gone on to study neurology and neuroscience. But when you study the vestibular system, you know, you realize that if you there’s something called a warm air caloric, it’s a test that they use to measure.

The connection between the, the stipular system and the ocular motor system. Because when you stimulate certain semicircular canals, they’re yoked certain eye muscles that then move the eyes in a predictable fashion. And so they will literally, you can put warm air into somebody’s ear to activate the vestibular system.

And knowing that, that the stipular system fires into the autonomic nervous system and fires into the brainstem, it’s like, oh, well, okay. So these people are blowing warm air into the ear again, to try to activate the vestibular system. To activate the brainstem to try to bring somebody out of a coma.

Like, I mean, yes, it’s incredibly rudimentary, but it’s also brilliant. Yeah. Well, exactly. Because cause really like what else are you going to do? You know? Or just like in, in a right, you live in, you know, 1000 BC, you don’t have technologies right. At that point. Um, it, is it really ingenious that, that.

That’s something that, that people discovered way back then getting into, like to the concussion and traumatic brain injury. You’ve painted a really great picture of how you go about diagnosing that, like this is in fact what’s going on and how you’re treating kind of in real time, you’re performing these tests.

You’re, you’re putting in needles. You’re you’re reassessing. Some of these tests. What else do people need to know about, like, if someone out there has had a concussion or is dealing with long-term brain injury, what, what could you say to sort of demystify the process? Cause obviously you’re not needling directly into people’s brains, but just what, what could you say to get that person on board?

Well, if we look at the SIM, you know, the common symptoms of a concussion, we can start to say that people. Fall into certain categories where it’s, in one sense, I’ve had patients who have had a concussion and their main symptoms are, are more cognitive in nature where suddenly they’re having trouble focusing.

Their attention has been affected. Their cognitive endurance has been affected. Maybe they used to be able to drive a car for 12 hours. Now, if they’re in the car for more than 30 minutes, they get tired. Or they used to be able to work on the computer for eight hours a day. And now it’s like, they can’t do that anymore.

So you’ve got people that fall into this cognitive. Then you have people that can fall into more of a pain category where let’s say they now have daily post-traumatic headaches, or they used to have migraines once a month. And now they’re having them 15 times a month, or you’ve got people that are now falling into a category of autonomic dysfunction, where they’re having a lot of dizziness and nausea and problems regulating their heart rate and your blood pressure.

So you’ve got to first really have a deep understanding of. How has this individual patient presenting what is their, what we would call kind of phenotypical expression of their brain injury. And then from there, we start to look at, well, what can acupuncture do for that person? So if I’ve got somebody.

Showing up with more of this cognitive issues. I really want to pay more attention to the frontal lobe and the temporal lobe. And then I look to, you know, the acupuncture points that have not only the historical kind of precedent for using, but also the modern research. So we can look at, say an acupuncture point, like stomach 36.

And it’s like, well, we’ve got research that shows with pet scans and looking at blood flow changes in the brain that when you do stomach 36, You increased cerebral glucose metabolism in the frontal lobe. And so I can start to actually tailor my acupuncture treatments based on. What that per individual person is coming in with.

And if it is more of a, you know, cervical component where they had a concussion, there was also some whiplash and there was a huge cervical input driving their headaches and driving their chronic pain and maybe even driving their dizziness. Well, then I’m going to do a lot of work locally on the neck to address the cervical spine and the cervical trauma.

That’s driving a lot of their symptoms. And I think it’s that. Differential diagnosis that needs to happen in order for people to really get good quality care. That that is specific to what they’re dealing with. I really appreciate that you emphasize the importance of differential diagnosis, even within Chinese medicine.

It’s still, uh, you know, not all brain injuries are alike. Not all migraines are alike, not all chronic pain is a like, and being able to see how it presents in a given individual allows us to tailor our treatments to that individual. I’m wondering if you work with herbs? I do. I do. And I, I see herbs as in my own personal journey was really about.

You know, learning Chinese medicine kind of by itself and then learning functional neurology by itself, and then learning how to apply functional neurology into a Chinese medicine clinic and how the two can be seamlessly intertwined together. And then I felt like the third part of that journey was now looking at how Chinese herbs are changing brain function and bringing in kind of the neuroscience of herbal medicine into how do you help these people.

And so that’s been my journey, um, is really integrating, you know, these three different legs of acupuncture. Chinese herbs and neuroscience, and then learning how to just seamlessly start to blend everything. And so your herbal approach wouldn’t be necessarily all that different from another acupuncturist in terms of like diagnosing and using the herbs as an extension of your diagnosis.

Well, I think that. It is a lot of additional training that goes into understanding the immune system in the brain and understanding the connection between the microglia in the brain. And in a sense, this dysregulation of producing inflammatory cytokines. The idea of, you know, what does say dampness in the brain look like or damp heat in the brain, or what is phlegm in the brain and what the, you know, what herbs actually have a larger impact on crossing the blood-brain barrier and getting into the brain.

So there’s, it kinda needs to be, uh, definitely. Track, you know, it’s not what we ever talked about as your basic training and school on how to use herbs. I think there’s a lot of additional education that, that needs to go into it when you’re looking at those types of things. And this is something that you teach.

Um, yes, I’m, I’m one of the courses that I’m working on right now is actually this specific topic. I can’t wait. I can’t wait for that one. Um, cause yeah, I treat, I treat a lot of people with brain fog and a lot of people who have that kind of what I think of as like the bugs on the windshield right there, their perception is they have a sense that it is.

It is not accurate. And so a lot of times we think about the points and herbs that affect phlegm, misting the mind, right? Or the, this idea of yeah. Dampness, which a lot of times, of course, brain fog can certainly be related to food allergies, food sensitivities, the gut brain access for recognizing that in Chinese medicine, the connection between the spleen or the gut and the mind, the intention, the, our ability to formulate a clear intention and to see clearly that, that, that.

Long been a tradition in Chinese medicine. And so it’s the thinking, thinking about it that way. Can you drop any clinical pearls for, for those of us who practice with herbs about what we might need to know about the immune system of the brain specific. Well, one of my favorite herbs is long chin Scoodle area because it’s, I’ve been paying attention to the research on this earth for, for five years now.

And what’s really great is that research that was older looking at. Function and its specific effects on the microglia like that, that research has been continuously redone and you know, it’s like more and more people have been building on it. And they’re all getting kind of the same feedback is that there are certain herbs that do seem to have specificity to the microglia, as opposed to say, you know, if you took a huge, big, long list of herbs that we know, maybe address inflammation, it’s not to say that every single herb on that list.

Couldn’t necessarily target the microglia in the brain. So that makes a lot of sense that herbs herbs are kind of have these reputations as guiding to different parts of the body. And you know, most of us who, who have learned about Hong chain as, as this bitter cold herbs that clears heat and dries dampness, we might not necessarily like, I don’t remember anything about the brain and wonky.

Right. Yeah. So a lot of these herbs that we learn about, we don’t learn about in the context of neurology. Yeah. Um, so, and again, that’s just one example of, of an herb that actually has a lot of really specific research on it. What I’m really excited about is a company called way labs. And they’re actually based just down the road from where my clinic is.

And the lead researcher who formulates their herbal products. Uh, her name is Dr. Sarah Lee, L I, and she’s a genius and she has formulated lots of. What I would call neurology specific formulas that talk about regulating the microglia and draining dampness from the brain. And like with, with different herbal formulas of theirs, they’ll kind of give the Chinese medicine differential diagnosis of what it’s doing, but then they go into all of the neuroscience behind it.

And I just love how seamlessly she is dancing between TCM and. Neuroscience and biochemistry. Oh, it sounds like she’d be an excellent guest on this show to reach out. I’d love that one last question. I know we are short on time here, but I got to get this in while I have you here in this conversation, and that is a brain issue.

As a concern for lots of people, all timers disease. I’m wondering if you have any advice for people who might be have that as a standout concern about what people should be doing, either acupuncture or lifestyle or diet or whatever, whatever, um, piece of, of knowledge you could share about Alzheimer’s prevention.

Sure. And I love you put me on the spot with a son, cause we didn’t talk about us ahead of time. And, and I spent all weekend reading some fascinating papers as I was working on my, uh, course that I mentioned earlier. My understanding based on again, research that’s being published literally in 2020 is that these amyloid plaque accumulations that everybody is talking about, those are more of an end product of dysfunction.

It’s not to say that they’re not something that needs to be treated or you don’t. It’s not that you don’t need to go after them, but it’s important to realize that that’s, that’s a by-product of dysregulation of lipid metabolism and immune function in the brain. So it’s kind of like cholesterol. Like it’s not necessarily the problem.

It’s just there, wherever there is a problem in the cardiovascular system. So it’s not so much. This cholesterol down. It’s not like we need to target the amyloid plaque because this is the cause, but it’s there. It’s, uh, it’s, it’s a long for the ride it’s there and it might even be the result of whatever’s going on.

Yeah. It’s, it’s a by-product that then causes its own problems, but it’s not the beginning of the pathology. And so what we really need to. Do in terms of the people are young and they’re trying to understand, like how can I prevent this from happening keeping like blood sugar levels regulated and keeping those hemoglobin A1C levels really healthy that’s that’s key.

Like blood sugar regulation is key and live in metabolism is key, which means that a healthy liver and a healthy gallbladder are key. So in terms of prevention, People need to be exercising. They need to be making sure that their inflammation levels are low. Their CRP levels are low. Uh, their hemoglobin A1C is in a super healthy range.

Um, they need to make sure that their liver and their gallbladder are working really well and that they’re able to absorb fats and processed fats that they’re avoiding all of the trans fats and processed food and inflammatory foods. So it does really, again, come back down to the importance of super healthy lifestyle.

Such a great place to leave it. So there’s yeah. Cause yeah, there is a lot that we can do preventatively and it’s, and it’s not rocket science, it’s the same stuff. That’s going to be preventative. We healthy in pretty much every system of the body. So thanks for sharing that with us. Um, on the fly. Yeah. Dr.

Ayla Wolf, where can people connect with you if they are interested in learning more? I’ll make sure to have this link in the show notes, but for people who are just want to get in touch, what’s the best way to do that. I have two different websites. My, my teaching website. Acupuncture neurology.com. That’s where I post my live courses and my online courses.

I’ve got specific ones that focus on concussions and migraine and all of those things, even Parkinson’s. And then I’m constantly trying to update and add courses to my library there. If people want to contact me more on the patient practitioner side, my clinic website is healing response. Neuro doc.

Wonderful Dr. AylaWolf. Thank you again so much for sharing. So generously of your knowledge and I’ve, I’ve learned a lot. I hope that everyone else listening has as well. Thanks so much for being here today. Thank you for having me. Thanks for listening today. To check out the show notes, get on my email list or drop me a line.

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