Wrist Ankle Acupuncture Book

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Hi everybody,

I want to take this chance to announce that the Wrist and Ankle Acupuncture book is now available in Amazon store from less than 2 dollars (Amazon sellers does not allow me to give it for free, I am sorry gays). If you add my demo videos on my youtube channel , and also take a look into my WAA site , then you will have all what you need to perform this incredible technique.

Also I want to let you know that next november we will be meeting for a course in Barcelona, and in february 2017 (11-12th) in Basel (Switzerland) for the english version. 70% practice with supervision, because remember that this technique must be 100% accurate! I will be with you all.

Any question? Feel free to e-mail me:



WAA protocol for the pathology of the back.

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I submitted this article for the Chinese Medicine Digital Magazine, which I really encourage you to subscribe. I hope this will help you more to effectively treat your patients with this technique.


WAA protocol for the pathology of the back.

The purpose of this article is to clarify how to manage patients suffering from back pain, from the simplest approaches to the most complex cases which are presented in the clinical practice. Also focusing on the main treatment  points and secondary protocols to achieve the best results in the least time.

To treat any clinical manifestations of the spine with WAA, we need a diagnosis as accurate as possible. It is not enough to just identify what kind of pain, or where the pain is, we should also think about what is the underlying cause that these symptoms originate from, which brings us to the question, what about the secondary issues? Or the cause which has triggered the problem.

For example, when a patient complains  that they are suffering from neck pain and numbness in their right arm and after consulting your clinical records you see that the cause is a herniated disc. This raises the question what is behind all this? Consider this example:  perhaps it was due to a whiplash injury or it might have been started after a long period of stress. This point is particularly relevant when explaining the different secondary points of the protocols.

Beyond the protocols. Discovering the underlying issues.

We have direct and indirect factors:  knowing what is actually causing the pain and inflammation to the patient is crucial to achieve 100% of the expected recovery. Depending on the causes that the practitioner considers to be primary and secondary, you are then able to apply secondary points to the standard protocol.  This is how versatile WAA is to work with, in your own clinical practice which can be adapted to your own particular diagnosis of the patient.

Some of the most frequent causes which must be considered are:

  • Emotional stress
  • Bulging disc
  • Bruxism, TMJ
  • Structural compensation
  • Visceral influences
  • Trigger points
  • Twelve channel theory


High level of mental activity over a long period, causes the muscles of the neck to be held too tight, and the lumbar muscles too week. The excessive demand of cortisol combined with excess of acidity in the tissues, as well as lack of nutrition from oxygen leads to cervical pain and spasm.

Bulging disc.

The example of the disc herniation in the patient, shows us that we must look beyond the evidence. In the same manner, when we observe an affected sacra-coccyx area, which could have been compensated for by the readjustment of the cervical vertebrae. By analyzing what conditions are the root of the pain and functional disability to the patient, you can then decide the best approach to the treatment.


Missing teeth, maintained levels of stress, or not dealing with emotions, etc. TMJ disease is suffered by one third of the population. We should also consider those that are not yet diagnosed, or are affected by TMJ without bruxism. We can affirm, that the cervical pain is difficult to be completely resolved without first addressing, or at the same time, TMJ problems. For chronic tension in the masseter, or the temporomandibular joint affected, or poor oral occlusion.

A dental problem can cause sustained tension on the scalene and the sternocleidomastoid muscles, which can also play a role in maintained tightness throughout the whole cervical area. It is because of this that you will have to treat these secondary zones.

Structural compensations.

Right to left, upward to downward and viceversa. Postural and structural imbalances as a primary factor – due to chronic respiratory disease or digestive problems for example – which cause altered positions of the spine, and also cause excessive cervical curvature, to give an example. If this imbalance of curvatures in the spine, has been causing back pain since childhood, and the herniated disc is merely secondary and opportunistic, then the diagnostic of bulging disc may well be of little clinical relevance. Then these exaggerated lordosis and kyphosis, could block our success of the treatment, and would be considered when deciding upon the treatment.


As previously explained, some osteopaths point out the importance of any kind of visceral disease. As to say, patients who have suffered from hepatitis, or gall bladder cysts are prone to having right C3 slipped via frenic nerve, and also can suffer from migraines, trapezius spasms for example. Also in women with pelvic inflammation, which is reflected in the lower back area, and in the neck zone.

Trigger points.

Where the secondary pain, or the pain with less intensity, or where the tenderness is (trigger points) leads us to the following main points. A lot is said about this technique, and I agree with Travell and Simons postulates theories.

Channel theory.

Twelve main acupuncture channels, could serve as a secondary approach to WAA.  I want to stress the importance of choosing the patients own WAA diagnose as a primary treatment, and the channel theory as a secondary tool.

In this way, the main points to treat spine pathology, is by adding secondary points in response to the other source. When the judgment is concise and correct, the effect will be observed in seconds. That is how the practitioner will know whether or not he is pointing the right point or not. Results with WAA are a question of one to five seconds, and can be tested prior to the needling.

We should address the treatment of the patients symptoms at the first stage of the needling process, and then consider the underlying cause, the direct origin, and its treatment when the first two or three needles are not being as effective as they are supposed to be. Or whenever your patient is improving and then one day stops, then you can add your second points to the main ones.

Where do we needle first? When do we needle secondary points?

The main manifestation of pain, will point out the main points for the treatment. Where it hurts most, is the first thing that you want to know. Where injured, according to the patient, and especially where it hurts now, right at this moment. Ask the patient how he feels the pain before needling, or how much his arm can move upwards for example, and then needle one point and ask him again: “how is it now?” In fact, I like to call this technique the “how is it now technique” so this is what you do once and again in the clinical practice.

The underlying cause, from your own point of view, is the second thing to consider in Wrist and Ankle Acupuncture. The secondary points that you will add when needed to the main ones. This is the second stage in the treatment. For example: for treating neck pain, the first thing I consider, is using the upper zones: point upper 5 bilateral. When the pain is on the right side, I will start needling the upper5 right area, point upper 5 right, and on the other hand, when the pain is on the left side, my first choice is to needle the upper5left area, point upper 5 left.


 It is not suffice only to needle the right side, and I will have to add the left side, either in the first session, or when the treatment blocks are a reinforcement, in subsequent sessions.

In almost all cases (needling of?) the 5 bilateral upper zone is needed,

Due to the compensation of back pain on one side which has consequently caused stress on the other side, when you needle the opposite side of pain, many patients have reported to us: “Finally the pain is gone, I have finally noticed definite improvement“.

In any chronic neck pain the question you should ask the patient is,

Do you clench your teeth at night, do you have bruxism?

Aboard bruxism and TMJ with zones upper 3 or 4.

Which are useful points for addressing this kind of condition.  Add the emotion protocol if needed.

The Stress Management Protocol, consistent in points upper1 and 5 bilateral, in alternate sessions, or before boarding directly the treatment of the neck pain, can be useful to solve permanently affected cervical area, with chronic involvement of mandibular spasm or tightness.

Add upper bilateral 1 and 5 points, for emotions and stress.

To relieve the stress caused by dental misalignments, the zones upper 1 and 2ipsilateral or bilateral may be useful for treating dental disorders, and thus help chronic neck pain.

Teeth with upper 1 and 2. 

Whenever they are in a nervous state, with excess levels of stress, we must assess upper 1 bilateral.

Points upper and lower 1 bilateral can address by themselves: pain and stress.

When there are multiple body aches or pain perception seems exaggerated for the accurate diagnosis of the patient, we think about stimulating the upper areas, we then regulate the nervous system and the widespread pain. Thus the treatment protocol would be for most of these cases: upper points 1 + 5.

We must take into account also the upper 6 points: to address the structure, spine and marrow, vertebral disorders, which constantly provoke local muscle spasm and compensation in the lower body. The lower body structurally blocked, for example by a herniated disc or a vertebral blockage,or nerve impingement, will cause local muscle spasms, and a mechanical compensation in the upper body. Treating upper and lower bilateral areas at the same time is highly effective and thus needling zone 5 and / or 6 bilateral superior simultaneously,  will be helpful, and we then mobilize the patient by doing a type of “serpentine danceto release blocked articular connective tissue structures. This treatment is done for twenty minutes and just this protocol alone is very effective. Again some therapists add at the same time or after this, some other techniques based for example on microsystems.

Other secondary points that have to be considered are:  zones upper 2 and 4. Zone 2 as it is the contralateral to zone 5. And the zone 4 as part of the releasing effect on lateral neck muscles.

Reminder:  the areas upper 5 are the first ones to think about. Ipsilateral or bilaterally.

Those guidelines are for our first approach to the treatment. And the ScratchTest is helpful to first determine which of these areas need auxiliary points, and whether they will be really effective for the treatment of neck pain or not. VIDEO or PIC.


We are going to test the neck muscles, check for right joint functionality and mobility. Then decide what area to apply, and add other secondary points if necessary. We need to establish our roadmap in the treatment. Using only the essential points, and adding secondary sites when treatment stacks, or when we are no longer getting a therapeutic result session to session.

It is known that treatment of lower regions support the treatment of the upper part of the body. Even more effective when comparing the utility of the stimulation of the upper points over the bottom. In this way we can add the lower 5 points, which release the low back muscles, hip and buttocks, which are very important over the cervical and scapular balance. In this case we must remember, to mobilize the lower body simultaneously as we treat it with lower points, as well as mobilizing the cervical damaged area. As is to say,to treat the cervical area we can add the lower regions, and complete mobilization in this case is useful to unlock the sacroiliac or hip. And then affect positively and direct on the upper part thanks to effect of the WAA stimulation points, and indirectly releasing sinews and joints of the lower body.

We could also add as a strategy, remote trigger points in the back.Then we want to soften these sore spots,having punctured the zone which covers the area where this trigger point is. Some therapists add at the same time neuromuscular therapy, dry needling, cupping, intradermal, thermie, etcetera.

What are the first points to needle and in what direction are we going to needle them?

When the patient has cervical pain which runs through the hand, it leads us to ask whether we should use zone 5 or 6, or even both as a first approach. And whether to needle the proximal first or the distal.

When neck pain predominates, we will start needling proximal. When the numbness or pain in the hands or fingers predominates then distal puncture should be done in the first place.


Wherever there is irradiation to the arm, upper 6 areas must be taken into account. However initially we must remember that always the upper 5 points are our first choice. And the next area in the case of nerve irradiation will be certainly the upper 6. If the pain or numbness predominates in the hand, then needle is inserted distally first, and if we don’t get instant results, then needle the proximal. Then it is still needed when we apply the upper 6. First to the hand or cranial direction, depending on the predominance of the symptoms.

Finally if numbness or paresthesia is in the palmar part, which is often the case, I value add points upper 2 distally. There are not usually as effective as 5 points,but sometimes can make a difference.

Few patients do not improve significantly and immediately when proceeding with this step by step protocol

Clinical case.

Ivan, 61 years old. He worked in the market, selling fish. A highly virulent Zoster, which had not been treated with antivirals,  caused an intercostal neuralgia, with an inability to raise his left arm, swelling and numbness in the hand, and the loss of ability to close his hand and bend the third and fourth fingers. Severe pain that kept him awake for three nights. Treatment: Upper 5 directed to the hand. Immediately he recovered part of the sensitivity, and he could grip his hand. Then remained the third finger, which didn’t reach the full flexion yet. Upper point 6 was added and kept for 30 minutes. A slight additional improvement was experienced. Using points 5 to proximal and distal, and also point 6 to distal, for a period of two months, twice or three times a week, was enough to completely solve the problem. After the second treatment he could sleep the whole night thanks to the absence of pain. The third week the functionality of the hand was completely restored. After the fourth week, the shoulder pain still did not allow him to raise his arm. After a month of physical rehabilitation he recovered completely. Ivan returned for a check up three months after, showing no sign of relapse, and he went back to his job and could “forget this nightmare”.


Upper back pain: upper 5 + upper 6/4 or + lower 5/6

Nerve irradiation: upper 5 (proximal or distal needling) + upper 6

Fighting the Low Back Pain.

Despite of the severity of the case, we are going to take into consideration the same main principles applied to the neck area. What are the causes, primary and secondary approaches, and combination of points. I want to stress the difference as previously mentioned, that the upper points help the lower zones, but not as much as the powerful lower points. It is needed then, to obtain the maximum results with the lower points. Adding upper 5 or upper 6 generally, for unblocking the cervical area if needed, or the upper bilateral 1, for multiple pains, generalized pain, or excessive sympathic perception of the pain. That is why for the damages of the entire spine, or when there is lower back and also neck pain, simply needle or start with the lower ones. In these cases the patient often wonders why we have not not added anything else in his arms or his neck. I explain to them that with the lower points they will notice improvement not only in the lower back, but also in the neck. Then they will mobilize the cervical and lumbar zones simultaneously. And only when the cervical area needs an extra boost will I add the upper points.

In case of sciatica, or herniated disc, we must discriminate whether it is a real pinch, or a strained muscle, or maybe the psoas muscle contracting, or for example it might be another trigger point. Pelvic inflammatory disease in women is also of importance, as well as urether irritations. As said, overall for the lumbar part, think immediately  in points lower 5 or 6 bilateral as our first choice. Then we should add lower 2 for gynecological and urological related problems.

When the primary cause of the lower back pain, is a digestive distress, or a pancreatic problem, ovaries or uterus, it is useful to add lower 1 or 2 points, after having exhausted the effectiveness with lower 5 and 6 points.

Whenever there is irradiation to the leg, the main area immediately becomes the lower 4. The first step in the treatment  will most certainly be this lower 4 point. Even when everything points out to other zones. First of all needle lower 4 and make the decision as to whether or not you need to add extra points, or wait for at least five to ten minutes before extra needling.  If nerve irradiation is predominant, needling only lower 4 of the leg concerned is enough to set in motion the recovery process. This is because its main indication is: nervous disorders, motor or sensory disturbances of the lower extremity. Therefore, this point alone can be effective enough and even definitive in the management of sciatica or any problem derived from the spine or lumbosacral plexus when it irradiates to the lower extremity.

When symptomatic manifestation is in the foot, the needle will be located distally, and proximally for the other locations (the rest of the limb).

Clinical case.

Ruth, 82 years old. Herniated lumbar disc L-5-S1. Diabetes. She took anti-inflammatory medication and had rehabilitation without success. Bilateral sciatic pain constantly. Treatment: Bilateral 5-6 lower points. Improves immediately after the insertion, the rotation and flex-extension movements are now pain free.

One session a week and on the third session we added lower 4 instead of the lower 6. Then we saw a one hundred per cent improvement. Six sessions more as a control, and we also saw that her reducing sugar levels were significantly maintained (I have seen this often with the lower zone 5. The stimulus on the adrenals or by symptomatic improvement, leads to an increase in the amount of daily physical activity).

Now a year later, its totally controlled, no relapse, and she is leading a normal life, even dancing in the village festivals!

Some highlights on the lower 5 and 6 points:

Lower 5: it covers the lateral side of the lower extremity, which affects all the (major/main/large) muscles in the leg, near the hip and sacroiliac joint, which are responsible for most of the indirect manifestations in the lower back. This point is also, in my experience, one of the most powerful of the twelve points of this acupuncture technique.

Lower 6: consider when there is undoubtedly a spinal block, or disc problem, and when this is really the cause of the symptoms to finally take control of the problem.

It should be punctured after point 4 or point 5 have been used – even after the contralateral point 5 -. In some cases of sacral pain, zone 6 could be our first choice to provide good results. However, the association of lower 5 still remains essential to rapidly improve the patient. In my experience it is not as effective as one would expect, except when the origin of the pain (we are not talking about the origin of the disease, the scans findings, but the source of the pain, which is different) is spinal or vertebral.

How often should I come back for treatment?

To determine the frequency with which we must address the pathology of the back, regardless of the severity, we should decide whether or not it is an acute or chronic problem:

  • For the acute, when it has been less than a week that the patient has been suffering, or if it is a relapsing chronic problem in a hyperalgesic phase:
  • First week: we will perform three consecutive sessions; even four or five treatments in a row when possible.
  • Second week we will schedule three to five sessions, but at least two sessions are needed .
  • Third week: if there is still an acute condition, apply one or two sessions to complete the treatment.

In a few cases it is necessary to add more control sessions. Common ambulatory treatments, are necessary in just one or two sessions as a whole, and it is probably enough. In sports medicine, for example a lumbar sprain can be addressed in just one week, even when there is a pulled muscle which has been confirmed by ultrasound. Severe cases need those extra sessions.

  • In chronic cases, we will conduct one session per week, for a maximum of eight to ten sessions. The maximum efficiency is expected in this period, and as a reference we may need up to five sessions to start observing improvement (when we undertake daily sessions). Usually the improvement appears in the first or second visit to the clinic. The follow up is once a week to avoid relapses,and keep this basis until the pain is gone for at least two weeks, or until the improvement stops.

The treatments should be thirty minutes long, which is still more than sufficient to treat both acute and chronic problems. In immobilized patients, hospitalized or at home, when they can not move due to intense pain and suffering, it may be necessary to retain the needles for up to several hours, provided they are controlled, and sufficiently aseptically covered under existing Health protocols, and protected from the natural movement of the patient during that time period. If the patient observes a great and quick improvement, we must warn the person in charge,so they should be instructed how to remove the needles, and check that the patient does not do tasks such as climbing stairs, bathing, cooking, or operate hazardous machinery as one wrong move could trigger a sudden and unexpected severe pain when the needle is still inserted, putting the patient at risk of  sudden reaction to this pain (falling, or dropping a pan when cooking, or a drill, for example).

When the treatment is prolonged for a month or more, the patient may adjust to the stimulation and the effectiveness may decrease. In these cases I have found  Zonal Scratching for a few sessions (three or four days) to be very effective, and the application of needles in the upper arm and thigh areas, and later if necessary, returning to the usual protocol.

In post-chirurgical treatments it is useful to improve the pain control and inflammation and promote healing, reducing the risk of infection and control anxiety: puncture should be applied from the recovery room, or as soon as possible. Keeping the needles in over a period of 24 hours, without completely removing them and reinserting the needle every 12-24 hours to increase the therapeutic efficacy.  This has been shown in laboratory studies to be useful on the analgesic effectiveness over long periods. It should be extended in such cases as special care implementation in immune or compromised patients with coagulation deficits, diabetes or severe psychiatric disorders.


Lower back pain: lower 5 + lower 6

Nerve irradiation: lower 4 + lower 5 + lower 6

Final remarks.

It is essential that the patient does not change the medication he is taking, or the amount of activity he does on a daily basis. It is the only way to get a quick and successful improvement by both the therapist and the specialist physician, and the patient rehabilitation program.

It is an excellent treatment when combined simultaneously with rehabilitation, physiotherapy, osteopathy, massage therapy, or cupping. It is not recommended to combine it with traditional acupuncture techniques at the same time, as it can inhibit recovery when you combine one technique with another. However it is well combined with microsystems techniques, and application of intradermal needles into WAA acupuncture points between sessions (maximum 4-5 days between sessions).

Joseph Carri

Lic. Acup., Lic. TCM

Associate professor Master in Acupuncture, ULleida




Find other articles in my other blog http://wristandankleacupuncture.blogspot.ch

Wrist and Ankle Acupuncture in pregnant women

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Wrist and Ankle Acupuncture is safe during pregnancy?

STUDY: no side effects in 417 pregnant women treated with acupuncture in a total of 3152 treatments.
Kvorning Ternov et al. Pain Medicine 2001;

Another study on low back pain in pregnancy, use points prohibited by Chinese tradition, and is not reported any side effects. Obstetrics et Gynecologica Act. 2006, 85:12-19
Decrease of pregnant women’s pelvic pain after acupuncture: A randomized double-blind controlled study. Irene Lund, Thomas Lundeberg, Lena Lonnberg, Elisabeth Svensson.

Therefore, there is no evidence that lower zone 2 may have a contraindication.


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