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Volume 6, Number 15 (March, 1999) NAJOM

movement Yanagiya began was a return to methods. Abdominal diagnosis exhibited
Keiraku Chiryo the classics but using a critical evaluation significant developments as it too became
Japanese Meridian method that combined study group investi- simplified and systematic.4,18 Needling tech-
gations with trial-and-error-type clinical in- niques evidenced a major shift, as efforts at
Therapy vestigations. As Ogawa has described, it reproducing and repeating needling meth-
Pragmatic in Theory with was basically a pragmatic and empirical
approach that used minimal theory. 13 The
ods described in the historical literature led
to the routine use of extremely delicate
Clinical Sophistication theories and methods that emerged repre- needling techniques.4,18 Some even devel-
sented a solid base that was applicable and oped and then specialized in non-inserted or
by Stephen Birch effective in clinical practice and which contact needling to produce their treatment
avoided the overly theoretical elaborations results.4,17,19
Keiraku Chiryo or Japanese meridian/chan- that had harmed acupuncture earlier in Japan. The major changes that emerged during this
nel therapy was virtually unknown outside Anyone looking back into the historical time (1930s-1940s) led to a simplification
of Japan ten years ago. In the last ten years literature on acupuncture is naturally led to of theory with an elaboration and sophisti-
it has established a place for itself in the US, the Nanjing of circa 100 AD.2,13 This is cation of technical skills. The basic theo-
Australia and Europe. It has generally been where Yanagiya and colleagues Sodo Okabe, retical model that remained was empirically
received with open arms by those who have Keiri Inoue found a natural focus. This is based. It is sufficient to guide clinical prac-
studied it, and is being taught in postgradu- clearly the most important of the early acu- tice and could be agreed upon after critical
ate workshops or training programs in these puncture texts from China.21 It described a evaluation through clinical practice and study
places. Its reception is not on the scale that simple model of Qi circulation in the twelve group investigations. I would venture to
TCM took hold in the US in the early 1980s. channels as the basis of what acupuncture suggest that future medical historians look-
There are several reasons for this. focuses on. It described this simple model ing at the development of the Keiraku Chiryo
(1) since it is Japanese and not Chinese, it is with a systematic use of five phase and yin movement in Japan might see it as a turning
typically not viewed as being as legitimate yang theories . Unschuld describes this book point in the development of acupuncture
by Occidentals.2 as the landmark text in the development of based on traditional methods. There is no
(2) it has had to make room for itself in the theory of systematic correspondence record of such a systematic and clinically-
already established TCM-saturated markets.2 upon which the practice of acupuncture and based investigation approach before, mak-
later herbal medicine was based.21,22 The ing what was achieved quite unique. The
(3) in the US the licensing exams are almost
text also describes a number of other inno- diagnostic skills of pulse and abdominal
exclusively based on TCM information, forc-
vative concepts and methods that have been palpation appear to have been very impor-
ing all schools to teach that model.2
influential into the modern period: the sys- tant in this process as these diagnostic meth-
(4) TCM is very biomedical in its logical tematic use of radial pulse diagnosis; ab- ods were used as feedback tools. For exam-
structure and model.12,22 and therefore is dominal diagnosis; treatment principles that ple, knowing which pulse qualities indicate
easily acceptable to Occidentals since it is are at the core of the use of five phase theory a better condition allowed study groups to
already familiar. Keiraku Chiryo on the in clinical practice; the use of needles alone test various methods and ideas. Those that
other hand is strictly East Asian in its logic to regulate and correct the circulation of Qi could be agreed upon as producing the de-
and model, and therefore not as acceptable in the twelve channels with what appear to sired changes would then be tested in clini-
since it is not very familiar to Occidentals.12 be relatively delicate needling techniques; cal practice. If improved clinical results
However, despite these restrictions, its the mu points, the five phase-shu point cor- were found, this would be taken as confir-
growth is notable, and like its TCM forerun- respondences. mation of the consensus opinions from the
ner, it has the potential to greatly expand in study groups. This feedback through body
After exploring and testing these important
popularity in these countries. In anticipa- responses and clinical practice was prob-
developments and methods in the Nanjing,
tion and encouragement of this trend, I ably the most important tool these clinicians
Okabe and Inoue developed a systematic
thought it useful to write a little about the had. It is probably evidenced to a greater
and simplified approach to using traditional
nature and development of Keiraku Chiryo. degree in the Toyohari Association (which
diagnostic methods guided by an extremely
Additionally, I want to try to explain why started in 1959) than in any other group. The
pragmatic interpretation of a few key con-
many of us who have studied it have found clinical and technical sophistication of this
cepts and treatment principles in the Nanjing,
that it is more like the acupuncture we thought group is quite remarkable. The feedback-
especially Nanjing 69.4,13,18 This simplified
we were going to study before we started study method is called the Kozato method
approach found four basic patterns which
studying acupuncture. after its inventor, Katsuyuki Kozato.5
when treated with appropriate needling tech-
Keiraku Chiryo was essentially born out of niques appeared to produce significant Today there are a number of Keiraku Chiryo
a backlash to excessively restrictive gov- changes in patients.4,6,13,14,17,18 Associations and related movements. After
ernment policies and pressures. The Meiji the original group, headed by Sorei
What remained was just enough theory to
Restoration had greatly restricted acupunc- Yanagiya, Sodo Okabe and Keiri Inoue, had
guide clinical practice so as to produce good,
ture in terms of who could practice, and formed, the early study group became the
repeatable clinical results. The emphasis
regulations, several decades later, elimi- Nihon Keiraku Chiryo Gakkai in 1948.10
was placed squarely on practical, clinical
nated all traditional concepts and methods Later new groups began to emerge under the
methods. A considerable sophistication of
from the curriculum of acupuncture training umbrella of this organization. For example,
diagnostic and treatment methods devel-
programs.2,13,15,18,23 This government inter- Bunkei Ono helped establish the Tohokai,
oped. Six position pulse diagnosis has be-
ference created a reaction through individu- Meiyu Okada the Meishinkai, Kodo
come quite systematic and even a highly
als such as Takeshi Sawada and Sorei Fukushima and Katsuyuki Kozato the
developed art, especially in some groups
Yanagiya. The backlash became an effort to Toyohari Igakukai. As these new groups
such as the Toyohari Association where it
clarify the historical literature to find what evolved, some of their members helped es-
lies at the core of the clinical and training
was useful in the Twentieth Century. The tablish yet further organizations. Many of
NAJOM Volume 6, Number 15 (March, 1999)
these changes were fueled by technical in- does not match the reality of practice. All thing, but I am generally not in the habit of
novations and refinements and some by those wonderful theories seemed irrelevant denying my experiences, rather I seek to
political process. Bunkei Ono developed as as we strove to puncture the nervous system find explanation for them, as is human na-
many as nine different draining techniques;17 with heavy painful needling methods. Also, ture. Through the clinical study methods of
and Kodo Fukushima's group, five different in retrospect, I have realized that TCM was Manaka11 and use of the Kozato method in
draining techniques.4 Kodo Fukushima in- easily accepted because it is so biomedical the Toyohari Association, I have been able
sisted that the interpretation of the restrain- that it was very familiar. Since that time I to directly experience phenomena that clearly
ing cycle relationships to the primary four have always found overly theoretical mod- match the explanatory models each uses. In
patterns be based on clinical observation els of practice somewhat suspect. Addition- both cases, the explanatory models closely
rather than a strict dogma of five phase ally, after studying with Tin Yau So, Yoshio match what is observable and experienced.
theory.4 Also, as has happened throughout Manaka, Kodo Fukushima, Toshio Yana- Thus, for me at least, the simple models they
the history of acupuncture,2 skilled clini- gishita, taking workshops with or observing use are quite satisfactory. We even have
cians have developed new methods, techni- in the clinics of practitioners such as Denmei scientific evidence of the reliability of the
cal improvements and/or personal, unique Shudo, Meiyu Okada, Bunkei Ono and oth- Toyohari diagnostic methods and judg-
or idiosyncratic approaches to the practice ers, it became evident that many highly ments.1 However, when explanatory mod-
of Keiraku Chiryo, so that even within each effective clinicians with a lot of clinical els stretch beyond the demonstrable and
of the different organizations or groups, experience tend to use very simple theoreti- experiential realm, they become like all
there has been a blossoming of new ap- cal models. They all achieve their results other theories, objects to study and ques-
proaches and ideas. Within the Keiraku with highly trained hands guided by these tion, and perhaps believe in. In the absence
Chiryo Gakkai for example, there are now simple models. In short, I have been very of experiences pertaining to a particular
many practice models developed by leading impressed by the straightforward and intel- theory I don't find the theory useful or nec-
practitioners such as Ikeda,7,8,9 Ogawa,12 lectually honest approach of theoretical sim- essary. I am unaware of any such demon-
Shudo,19 etc. plicity, coupled with skilled hands, experi- strable phenomena in the realm of TCM or
According to Somei Okabe15,16 and Takayo- ence and intuition. I believe that it is this TCM-like models of practice, and thus find
shi Ogawa,13 during the last ten years or so, which makes Keiraku Chiryo increasingly their complex theories interesting but not
some Keiraku Chiryo practitioners have been popular outside of Japan. In TCM-domi- appealing, as I have no direct experiences
questioning whether the basic model that nated countries, where the complex theories that help to justify using them.
had been developed and used for five dec- of TCM increasingly seem irrelvant to good It is for the above reasons that I find Keiraku
ades is sufficient. The new models emerg- clinical practice in acupuncture, and where Chiryo and especially Toyohari to be, more
ing out of this questioning incorporate more the clinical techniques seem to violate the satisfying and more like what I thought
theoretical approaches, principally it seems, traditional theories of Qi circulation regu- acupuncture was supposed to be before I
to be able to explain the development of lated by needling techniques, what is miss- started studying it. I think others who have
symptoms, and vary treatment accord- ing is a system that uses a very practical studied Keiraku Chiryo have some of the
ingly.7,8,9,10,15,16 We find in the writings of approach coupled with a theoretically ap- same feelings. However, I hope Keiraku
Masakazu Ikeda and Somei Okabe the in- propriate model. It seems to me that Keiraku Chiryo does not become burdened with the
corporation of ideas and models that had Chiryo supplies this. But if Keiraku Chiryo need to be increasingly biomedical in ap-
previously been more in the domain of herbal starts introducing precisely those aspects pearance. I worry that hands-on clinical
medicine.7,8,15,16 These practitioners are de- that are increasingly being found to be irrel- training and skills will be increasingly sac-
veloping models that incorporate TCM-like evant or less appealing, how will this affect rificed to the illusion of truth in increasingly
ideas, such as distinguishing hot-cold, inter- the success and appeal of Keiraku Chiryo? complex theories. I think that the first line
nal-external. Okabe calls this new approach I have learned at least six distinctly different of the Dao De Jing said it best: “The dao that
“reconstructed meridian therapy”,15 but this ways of practicing acupuncture. Why should can be spoken of is not the eternal dao”. We
process of change has not finished yet, as at I believe any one person's explanatory model really don't know what is going on, so why
present, “a whole variety of approaches are over another? Now we have more new pretend that we do. We are in the business
vying for a place within the Meridian explanatory models. As a scientist, I would of treating patients. The more elaborate the
Therapy arena”.13 It thus seems that Keiraku like some evidence that allows me to make theories become, the more complex the di-
Chiryo is in the throes of a phase of change a decision about which models I will use. I agnostic processes. The more complex the
and growth as it adapts again to new politi- think good clinical results show that the diagnoses, the more difficult to help our
cal and cultural pressures. I find the fact that practice works, but do not contribute real patients. I believe the motto should be: keep
some meridian therapists are now introduc- evidence that helps me decide which ex- it simple!
ing these elements into their models inter- planatory models to believe or use, since A simple model coupled with rigorous
esting but somewhat disturbing. each system seems to produce clinical re- hands-on training is the best approach. With
It is clear to anyone who can research the sults. Thus good clinical results do not the exception of, for example, the Keiraku
nature and origins of acupuncture that TCM themselves help in the decision of what Chiryo models of the Toyohari Association
is a poor relative of “Oriental medicine”. model to believe and use. There is also an or Denmei Shudo, this is precisely what is
Indeed, as Ogawa and Unschuld have ar- absence of scientific studies that could at- lacking in Western acupuncture education.
gued, it may not even be “Oriental medi- tempt to answer questions about how to Partly out of fascination with theory and
cine”, so biomedically dominated is its ap- decide which models of traditional theories partly because of a dearth of hands-on train-
proach.12, 22 When I was first studying TCM, to use. Because of this, I feel that we must ing with highly experienced clinicians and
it seemed to be a wonderful set of theories look elsewhere for evidence. I have come to teachers, most training programs in the West
quite unlike anything we have in the bio- accept that if I can experience something have emphasized the theoretical models.2
medical model. But when exposed to the then I at least have a starting point for Also, as a parallel to the transformation of
extremely harsh needling techniques, it understanding and investigation. I may Chinese medicine in China during the last
quickly became evident to me that the model wish to question an explanation of some- five decades, we find other Asian as well as
Volume 6, Number 15 (March, 1999) NAJOM
most Western groups, who study acupunc- 3. Ferringo B. (1996). An interview with Stephen Rinsho Nyumon. Yokosuka, Ido no Nippon
ture basically seeking to explain their Birch. Orient Med. 5, 3/4, 17-26. Sha.
biomedically-rooted view of health and dis- 4. Fukushima K. (1991). Meridian Therapy; 18. Shudo D. (1990). Japanese Classical Acu-
ease with a construct of traditional Chinese Tokyo, Toyo Hari Medical Association. puncture: Introduction to Meridian
theories.12,22 The need to find a rational 5. Fukushima K. (1994). Keiraku Chiryo Therapy; Seattle, Eastland Press.
explanation for the development of symp- Genron, Vol II Tokyo, Toyo Hari Medical 19. Shudo D. (1997). Looking forward. N Amer
toms has root primarily in Western culture; Association. J Orient Med 4, 11, 4.
it is quite novel to traditional Chinese and 6. Honma S. (1949). Keiraku Chiryo Kouwa. 20. Unschuld PU. (1985). Medicine in China: A
Yokosuka, Ido no Nippon Sha. History of Ideas. Berkeley, University of
Japanese cultures. Explanation of the de-
7. Ikeda T, Ikeda M. (1991). Zo Fu Keiraku California Press.
velopment of symptoms was always rather
Kara Mita Yakuho to Shinkyu. Volume 5. 21. Unschuld PU. (1986). Medicine in China:
approximate and generally quite vague in Imahari City, Kampo In Yo Kai. Nan Ching the Classic of Difficult Issues.
traditional acupuncture models.12,22 There Berkeley, University of California Press.
8. Ikeda M. (1997). Point selection for root
have always been numerous competing, treatment. N Amer J Orient Med 4, 10, 16- 22. Unschuld PU. (1998). Chinese Medicine.
sometimes-accepted, sometimes-rejected 20. Brookline, Paradigm Publications.
models of the development of symptoms 9. Ikeda M. (1997). Point selection for branch 23. Yanagishita T. (1998). An acupuncture with
and disease in acupuncture.2 The rise or fall treatment. N Amer J Orient Med 4, 11, 12- system wide application. N Amer J Orient
of different explanations usually have little 15. Med 5, 12, 6.
to do with clinical results and more to do 10. Kaneko E. (1998). About the traditional Japa- Stephen Birch, BA, LicAc, PhD is the Director,
with cultural and political changes.2,20,22 The nese acupuncture association. N Amer J Ori- International Branches of the Toyohari Asso-
biggest advantage of traditional forms of ent Med 5, 13, 33-34. ciation. He has practiced acupuncture since
acupuncture, and Keiraku Chiryo in par- 11. Manaka Y, Itaya K, Birch S. (1995). Chasing graduating from acupuncture school in 1982.
ticular, is that by using their simple models the Dragon's Tail. Brookline, Paradigm Pub- He studied acupuncture extensively in Japan
and methods we have a very flexible ap- lications. with Yoshio Manaka and senior Toyohari in-
proach for handling even the most complex 12. Ogawa T. (1996). Comparison of TCM and structors. He has coauthored six books on acu-
patients, “simplicity is the keynote in the meridian therapy. N Amer J Orient Med 3, 6, puncture, focussing on Japanese acupuncture,
6-11. most recently: Chasing the Dragon’s Tail with
root treatment method”. 11 The more com- Manaka and Itaya, and Japanese Acupunc-
plex the differentiation of patterns becomes, 13. Ogawa T. (1998). The current situation and
future direction of Japanese acupuncture. N ture with Junko Ida. He has co-authored a
the more difficult it is to apply and justify seventh book about acupuncture to be released
Amer J Orient Med 5, 14: 7-10.
the methods.11 this year: Understanding Acupuncture. He
14. Okabe S. (1974). Shinkyu Keiraku Chiryo.
References Tokyo, Kobunsha.
has a PhD focussing on acupuncture research
methods, making additional contributions to
1. Birch S. (in submission). Preliminary inves- 15. Okabe S. (1998). Introduction to traditional the field with his work in research. He currently
tigations of inter-rater reliability of tradition- Japanese acupuncture (meridian therapy). N practices in Holland with his wife, where they
ally based acupuncture diagnostic assess- Amer J Orient Med 5, 13, 9-13. are running training programs in Japanese acu-
ments. 16. Okabe S. (1998). Introduction to meridian puncture and Toyohari. He is also the Chairper-
2. Birch S, Felt R. (in press). Understanding therapy (apart 2). N Amer J Orient Med 5, son of the non-Japanese branches of the Toyohari
Acupuncture. Edinburgh, Churchill 14, 2-6. Association, and first recipient of the prestig-
Livingstone. 17. Ono B. (1988). Keiraku Chiryo Shinkyu ious Kodo Fukushima prize.

Shiatsu AD