Gentle Neoclassical Japanese

Approaches for Sensitive and

Traumatized Patients
Bob Quinn, DAOM, L.Ac.
Net of Knowledge 4/2020
 A poem to set the stage

● You have traveled too fast over false ground;


Now your soul has come, to take you back.

● Take refuge in your senses, open up


To all the small miracles you rushed through.

● Become inclined to watch the way of rain


When it falls slow and free.

● Imitate the habit of twilight,


Taking time to open the well of color

That fostered the brightness of day.

● Draw alongside the silence of stone


Until its calmness can claim you.

● Be excessively gentle with yourself.

● JOHN O'DONOHUE

● Excerpt from the blessing, 'For One Who is Exhausted,' from John's books:

Benedictus (Europe) / To Bless the Space Between Us (US)
 AOM as three-legged stool

● First leg: Scholarship

● Second leg: Cultivation

● Third leg: Manual skills

 Our goals in this module

● Define trauma

● Learn some practices/exercises that can develop sensitivity in our hands

● Go through a basic look at what occurs in trauma and how to understand sensitive patients

● Look at the work of Stephen Porges, Ph.D. and the implications of his Polyvagal Theory

● Look at the Kaiser ACEs research

● Look at what defines highly sensitive patients

● Establish a rationale for gentle work

● Survey of a few techniques and strategies from Japan that can be used to good effect with both
sensitive and traumatized patients; Miyawaki’s 8EV

● Hands-on practice of techniques

 Some quotes to set 

context for our work today

● Singular and particular detail is the foundation of the

sublime. William Blake

● What we perceive is structurally inseparable from what

we think. Owen Barfield

● The question is not what you look at, but how you look
and whether you see. Henry David Thoreau

● All physical forms are transforms of messages. Gregory

Bateson
 Relevant quotes from Johann
Wolfgang von Goethe

● My way of seeing is itself a thinking, my thinking a way

of seeing.

● The human being is the best and most exact scientific

instrument. …

● Nature also speaks to other unrecognized and unknown

senses which lie even deeper to known senses.

● He who seeks after cause and effect makes the great error.
They are one and the same thing. (The alternative view is
the concept of “mutually arising phenomena.”)
 My basic assumptions on 

dose in treatment

● It can’t be the case that all patients need the same level of stimulation. (or even
approximately the same)

● Traumatized, and most highly sensitive, patients are in a state of hypervigilance

and poorly suited for strongly stimulating therapies.

● If this is true, and we want to do the best for our patients, then we need to be
prepared to adjust our stimulation level—perhaps radically—AND to use other
techniques, e.g., teishin, sesame seed moxa, gentle bodywork…

● The same patient on different days might need quite different levels of
stimulation.

● More is possible with gentle work than is commonly believed or accepted.

● All acupuncture styles require dedication to learn, though some might look
simpler than others, e.g., it looks easy to use a teishin—it is not.
 My assumptions on tx of the
sensitive and traumatized

● Both groups require tx with “kids’ gloves”

● In both cases the nervous system is in a state of

excitation, so that strongly stimulating therapies are
usually a poor choice

● The quality of our touch, our voice, our facial

expression are key tools in successful tx of these two
groups—we need to use hand-voice-face to
communicate safety

● “Less is more” These patients are easily over-treated

 More on voice-facial expression-touch

● We want to use a voice with prosody (an Earth-

element quality)

● Our facial expression should be softly focused and

communicate safety and social engagement

● Our touch can’t be the type of touch that simply

looks for ah-shi points; instead our touch has to be
the very soul of gentle (gentle here does NOT mean
only superficial exploration, but is more the quality
of our touch)
 Touching the “Space Between”

● This “space between” is an ideal level we can reach

in our palpation
● It is more an attentional “phase shift” than an actual
physical layer
● We touch lightly, then we engage in this phase shift
and our perception moves to a slightly deeper level

● We know we are at the “space between,” because the

quality is entirely other; it is softer, more engaged,
gentler, and it communicates with the whole
 Under-investigated questions
in AOM
● Why do patients not return for follow-up treatments? Do we
know their reasons? (OCOM numbers from ten years ago)

● How much treatment does a given patient need to achieve the

ideal outcome?

● What does too much treatment (over-treatment) look like?

(PCOM anecdote)

● How many needles should we use? What gauge? How deep?

How do we know our treatment has provided the ideal?

● Is it enough to simply follow the guidelines our books list?

What is the alternative?
 Insights from Buckminster Fuller

● “Synergy is behavior of the whole unpredicted by behavior of

the parts"

● Morewithlessing aka ephemeralization

● “There is nothing in a caterpillar that tells you it is going to

become a butterfly”

● “Rashness is the faithful, but unhappy, parent of misfortune”

● ** Fuller referred to himself as an “anticipatory design

scientist;” received 47 honorary doctoral degrees in his life!!
The importance of the neck

● FM Alexander saw the neck as “the primary control,” i.e., it establishes the
relationship between head and torso, and human movement depends on this

● Zhu Ming-Qing: “All Americans over 50 have neck problems, even those who say
they don’t.” (This is the famous scalp acupuncturist.)

● In the Nei Jing the head relates to heaven, the torso to earth—thus making the neck
the connection between heaven and earth—(”Heaven and earth have to be put
together or this world never becomes home.” Fr. Richard Rohr)

● Moshe Feldenkrais saw movement as originating in the lower abdomen-pelvis-hip

(koshi) but given direction by the neck

● All the blood, fluids, nervous signaling crucial for the brain has to get through that
narrow neck—all this can be constrained by chronic muscular tension, poor postural-
movement habits

● The vagus nerve is at its most superficial level over part of the SCM (connection to
Polyvagal Theory); here we have our best chance to improve vagal tone
 Gleanings from 

Stephen Porges, Ph.D.,MD

● Polyvagal Theory—rethinking the parasympathetic

nervous system (myelinated vs unmyelinated fibers)
● Importance of voice tone and facial expression (and
touch) in conveying engagement and safety (and by
extension, touch)
● After trauma “is it safe?” dominates patients’ thoughts
● Social engagement as part of the function of PNS
● The sense of “neuroception” – scanning the environment
constantly for safety---this is an unconscious process!
● https://www.stephenporges.com/bio
 The importance of the diaphragm

● According to both Funamizu Sensei and Shimamura

Sensei, trauma will always cause a dysfunction in
the diaphragm and breathing

● Example of a towel grabbed and twisted in the

middle—the effect is felt in all four corners
(Shimamura Sensei)

● Importance of BL-17 area in trauma tx

● Focus on the breath (Dan Bensky, Peter Yeats, Alice

Whieldon)
 Strategies to release the diaphragm

● Yin Wei Mai (PC6-SP4)

● Chong Mai (SP4-PC6)

● ST Qi Line Treatment

● Yang Wei Mai (TB5-GB41)

● Retained needles near BL17 and/or LI10 level TW

● Supine “Four Corners” breathing

● Abdominal fascial release Sotai

 “Four Corners” breathing

● Hold contralateral shoulder-hip (~GB27—~LU1-2) lightly

● Make phase shift to the “space between”

● Tell patient to simply feel their weight on the table

● Coach them to ALLOW their breath to lengthen the spine,
widen the ribs

● Track patient’s breathing; relax your own breathing

● You can use this to dx what is going on in the paraspinal
muscles for later direct tx
 Why a body-centered focus for
sensitive and traumatized patients?

● Palpation easily filters out patients’ biases and

delivers information that they have not nuanced for
you, i.e., the body cannot lie to you (anecdote from
Funamizu Sensei’s visit to NUNM)
● Gives your hands a chance to communicate safety,
compassion, competence, confidence, i.e.,
communication in touch is always two-way

● Palpation (e.g., pulse, forearm, abdomen, channels)

provides immediate feedback so that treatment can
be adjusted accordingly
How do we actually define trauma?

● A person’s response to actual or perceived threat of

death, violence, neglect, injury, or oppression.

● Can be through experiencing an event directly, or

witnessing an event that someone else endures, or
vicariously through listening or via media exposure.

● Anything at all can retrigger a patient (smells, TV

news, the trauma of a friend…)

● Helplessness and terror are the core wounds of

trauma (what are the implications of this for tx?)
 A traumatized person…

● Will tend to have difficulty descending their qi (anxiety is an

ascending qi phenomenon)

● Will tend to have an exaggerated startle response

● Will likely display mood swings (don’t take them personally)

● Experiences anxiety, irritability, panic, depression

● Will tend to have a greater degree of muscle tension, especially

in the upper body

● Has difficulty sleeping

● Will be sensitive to light, sounds, rapid movements

 How common is trauma?

● Kaiser Study on ACEs (Adverse Childhood Experiences)

1995-97
● 17,000+ participants in 2 waves of data collection (SoCal)
● Almost two-thirds of study participants reported at least
one ACE; more than one in five reported 3+ ACEs.
● ACEs are linked to more frequent chronic health
problems (e.g., cancer, diabetes…), mental illness, and
substance misuse in adulthood.
● ACEs are common across all populations, but some
populations are more vulnerable to experiencing ACEs
because of the social and economic conditions
 How were ACEs defined?

● Parents with substance abuse issues

● Parents with mental health challenges
● Physical, emotional, sexual abuse in the home (or threat
thereof)

● Divorce or separation
● Physical neglect
● Homelessness
● Parents, family members in prison

● Suicide in the family

 ACEs Family Health Questionnaires

● The male version of the questionnaire:

● https://www.cdc.gov/violenceprevention/
acestudy/pdf/fhhmlorna.pdf

● The female version:

● https://www.cdc.gov/violenceprevention/
acestudy/pdf/fhhflorna.pdf
 ACEs Health Appraisal Questionnaire

● Male version:

● https://www.cdc.gov/violenceprevention/
acestudy/pdf/haqmweb.pdf

● Female version:

● https://www.cdc.gov/violenceprevention/
acestudy/pdf/haqfweb.pdf
Where do the impacts of ACEs play out?

● HIV STDs

● Cancer, diabetes

● Alcohol, drugs, unsafe sex

● Lower education status, occupation, lower income

● Unintended pregnancy, complications in birth

● Depression, anxiety, suicide, PTSD, TBI, burns,

fractures
 Ongoing ACEs data collection

● Behavioral Risk Factor Surveillance System ACE Data

● Many states are collecting information about Adverse

Childhood Experiences (ACEs) through the Behavioral
Risk Factor Surveillance System (BRFSS). The BRFSS is an
annual, state-based, random-digit-dial telephone survey
that collects data from non-institutionalized U.S. adults
regarding health conditions and risk factors. Since 2009,
42 states plus the District of Columbia have included ACE
questions for at least one year on their survey.
 Principles of trauma-informed care

● Safety (this includes you, your manner, your staff,

the physical set-up of your waiting room, tx rooms)
● Transparency and trustworthiness (be true to your
word)
● Choice (tx options not forced on them)
● Collaboration and mutuality (be more a coach-
teammate than a savior)

● Empowerment (give them homework and help them

make positive lifestyle choices)
 Our first tx goal: “The Intermediate,”
i.e.,patient resiliency

● Jacob Needleman writes of “the intermediate,” a

halfway point between everyday functioning and
enlightenment

● We borrow it here to designate a point halfway

between ANS frozen-shutdown-traumatized mode
and total healing when some resiliency returns

● This is the initial goal, a start of the healing journey

● Healing via neuroplasticity is possible

 Gentle treatment keys

● Be clear on your starting point (baseline measures) using

pulse, forearm, abdomen, channel palpation, shen in eyes,
color, sound of voice…
● Recheck periodically throughout the tx to see what has
changed and to what degree
● Light touch, soft hands; move slowly, deliberately
● Dan Bensky’s idea of “vector of engagement”
● Do not doubt the power of the gentle---if you genuinely
believe strong, forceful needling is the only real medicine,
then you are unlikely to have success offering gentle
treatment, i.e., what we think-believe is important
 Gentle treatment techniques

● Contact needling (hundreds of techniques)

● Sanshin/sesshokoshin

● Half-rice moxa
● Polarity strategies, e.g., zn-cu discs w/8EV and other
points

● Gentle bodywork (e.g., qigong tuina, cranial-sacral…)

and movement work

● Stroking with facial teishin, chokishin, Yoneyama

zanshin…
 Strategies for descending the qi

● Chong mai - using SP-4, PC-6; or LR-3, PC-6

● Yin wei mai – using PC-6, SP-4

● “St Qi Line Treatment” of Nagano-style (according to Li Shi-

Zhen, these 3 points ST-36, 37, 39 activate the Chong mai)

● Direct moxa LI-11, St-36, TB-4, LU-5

● Elbow to wrist stroking on all 6 arm channels with chokishin or

enshin or Yoneyama zanshin (very light touch)

● Restore integrity of ming men to anchor the qi (many strategies

in herbs, e.g., fuzi formulas, and acu-moxa, e.g., salt moxa on
CV-8)
 Some Shimamura Sensei ideas for tx

● If pt depleted due to long-term PTSD or other emotional stress, we

need to focus our tx on the torso, because the body gathers the
available energy toward the center

● Use ST 24, 25, 27 combination with BL 20 21 22 23 to build pre- and

post-natal qi (this is from the Sawada style) 27is for pre; 24 is for post;
25 is the pivot, as is BL22

● If little qi present, use LI4 (clock opposite source point to KD); LI10-11
for weak immunity

● For yang depletion do direct moxa on right BL 67; also BL53

● Release tension T2 – T7 for emotional issues (various ways)

● For deficient heat rising to the head needle right SI3 for 3 minutes to
vent the heat
 How to do the sanjiao harmonizing 

qigong tuina technique

● One hand under neck (pt is supine), the other on

lower jiao; open and close laogong with the breath to
start
● Move neck hand to upper chest
● Move upper chest hand to middle jiao
● Move lower jiao hand to BL40, and middle jiao hand
to lower jiao; do both side BL40

● Connect BL40 to KD1 to finish; both sides done

ipsilaterally
 Why a focus on the neck?

● Toyohari naso treatment

● ** Porges and focus on vagus---this nerve runs superficially

over the SCM muscle

● Dr. Bear’s sanshin techniques in the neck

● Enshin stroking downward or with facial teishin

● Neck as “connection between heaven and earth” (head as

heaven, and torso as earth)

● FM Alexander – neck as “primary control”

● Moshe Feldenkrais – neck as giver of direction to movement

 More on the neck & face/scalp

● The muscles of facial expression c/t vagus nerve function

● The skin of the face is controlled by the trigeminal nucleus in the brainstem where the ANS
control center is

● Connection between senses (eyes, ears, nose) and trauma experience as a rationale for working on
them directly

● “Intimacy” of touching the face

● Dr. Hiroshi Nagata,, MD and his facial points for chronic conditions

● On scalp at least stroking through the hair back to GV-20 and possibly tx si shen cong (Four Alert
Spirits)

● Nagano-style use of GV 20 needled forward and then ah-shi point between GV 23 and mid-
forehead (feel for depression)

● Assessing how tight the scalp is and looking for soft or depressed points as possible treatment
locations (Funamizu Sensei)
 Key elements of facial stroking
for PTSD and trauma

● Start at chin and lightly stroke to in front of the ear.

Then from under nose also over to the ear. These
strokes can be repeated a number of times.

● From temples and forehead stroke horizontally to

the hair line

● Stroke lightly over the eye lid as well

● After the face is done, use the pointed end and comb
it through from the anterior hairline (with a
following hand) back to GV 20
How to hold the facial teishin
Various facial teishins
 Neck sanshin with teishin

● Use thumb and index fingers to gently create slight

skin tension by separating
● On the tense skin between your fingers touch the
teishin lightly (light as a feather)
● Move randomly over SCM and scalenes
● On especially tight points you can linger until tense
tissues soften

● This works best if done very lightly, but there is a

range of pressure possible
How to Hold Teishin for
Sanshin on Neck
Various styles of teishin
 How to form oshide; one-point
tonification, e.g., for ST Qi Line tx
 Three lines

● Imagine the fingers meeting on the teishin can connect a

bit more strongly on an upper line, a middle line, or a
lower line. The lower line would be closer to the patient’s
skin

● The fingers meet more slightly more strongly on the

upper line for tonification (a sense of adding in)

● The fingers meet more slightly more strongly on the

lower line for sedation ( a sense of pulling xie qi out)

● The fingers meet more slightly more strongly on the

upper line for even technique (neither tonify nor sedate)
 8EV treatment in trauma

● 8EV cover a broader, less specific terrain

● Manaka and Miyawaki systems using polarity

agents (zn-cu discs, (+) (-) poles of magnets, ion
cords, thumb-pinky) followed by direct moxa

● Deeper, almost primal, feel to the 8EV

● Profoundly relaxing

● (See separate handout on 8EV)

 Polarity tx of 8EV

● Our thumb goes on the master point

● Pinky on the couple point

● Very light touch

● We will perceive a subtle motility that is at first

chaotic; when it settles into a periodic, regular
rhythm, we can remove our touch and recheck
abdomen, pulse, symptoms

● Follow then with moxa (see other slide)

 How to use moxa in 8EV
treatment

● Master point gets moxa first, then couple point, e.g., SI-3,
then BL-62 for Du Mai

● Master point receives more than couple point

● Possible ratios 5:3 (typical); 3:2 or 2:1; a cycle can be
repeated if symptoms are still a problem, e.g., pain

● Can be done alone, or after needles, or after polarity tx

● Any type of moxa suffices, but Miyawaki uses sesame
seed-sized cones

● Other ways of heating the points are acceptable (devices)

 How to locate points for the
8EV

● The locations can vary significantly in the Miyawaki

8EV system

● We use pulse quality changes to find points (pulse

will soften, sink, slow, become more integrated when
we are on a good point)

● The points should have a feeling of “otherness” to

them

● We mark our location with a marker so that our

moxa is precise
 A word on dose in acupuncture

● Manaka Dose Model – tough challenge to determine how

much treatment a person needs
● Example of Portland cancer patient
● What overtreatment looks like
● Curricula leave this issue largely unexplored (E. Talcott
research)
● Modern urban dwellers as significantly different from
those of earlier times (thus needing different types of
treatment---Jeffrey Dann, Ph.D.’s idea)
● Examples of patients who received minimalistic tx
 Sensitive patients

● Like those patients who need a lower medication dose

than others, these patients need less acupuncture than
others

● What we have covered in terms of techniques for

traumatized patients apply here as well

● Many sensitive patients have trauma in their background

● We need to check in with pulse and other markers again
and again to make sure we do not do too much

● We have to be willing to give “fake treatment” to these

patients once they have reached their tx threshold
 ST Qi Line tx as core strategy for descending
the qI and rebuilding post-natal qi

● Idea of Nagano Sensei

● Story of Shimamura Sensei and his current version
● How Li Shi-Zhen’s ideas on the 8EV enters the story
● Connection of ST 36 37 39 to Chong Mai
● If this tx does not significantly shift the pulse, then it
means LR13 is blocked (usu just one side)

● Nei Jing: “All counterflow belongs to the Chong

Mai.”
 How to find good ST Qi points

● Find the St Qi Line; the energy here will be a bit denser.

● Locate area of luster change on the line near St 36 37 39

● At that area of luster change find a depression or a kori

(nodule)

● Use that as your treatment point; use contact needle or

teishin

● Use a reference point to let you know when to come off

the point
 One possible treatment flow

● Thorough assessments to establish baseline measurements (pulse, abdomen,

forearm, channels, san jiao, tongue, others…)

● Abdomen contact needling 3X

● Five phase adjustment points, e.g., LR-8, KD-10 if LR-KD pulses both weak

● ST Qi line tx (ST-36, 37, 39)(teishin, then direct moxa)

● Sanshin in SCM and scalenes

● Facial-scalp teishin treatment

● Possible 8EV treatment

● Direct moxa (CV-12, 6, TB-4, ST-36, LI-11)

● Tx of back shu points (5-20 minute retention)

 Other helpful therapies

● TRE – Trauma Releasing exercises

● Shan Ren Dao – “Path of the Virtuous Human”

● Somatic Experiencing

● Dream work (give a few examples)

● Anat Baniel or Feldenkrais work

● Various types of psychotherapy, including those with

a somatic component
 Resources

● NAJOM – North American Journal of Oriental Medicine –

Japanese styles only covered

● Book of Dr. Bear (website)

● Stephen Porges (books, Youtube videos, website)

● Peter Levine (books, seminars, website)
● Bessel van der Kolk (books, seminars, website)
● Teishin book soon to be published by Blue Poppy by Bob Quinn
and Daniel Silver)

● Trauma Releasing Exercises (TRE) (various trainings-Jim Gillen

in PDX)
 Where to purchase tools

● www.onkodoclinic.com (Navajo tools)

● www.culia.net
● www.acuartistry.com
● www.bluepoppy.com (Arnon’s tools)