Professional Documents
Culture Documents
by
Robert Hayden
Midwest Center for the Study of Oriental Medicine, Racine, WI and Chicago, IL
Table of Contents
Introduction......................................................................................................................4
Paradigms .....................................................................................................................10
! Five-Phase ..........................................................................................................10
! Biorhythmic/Stem-Branch ...................................................................................13
! Feedback systems……………………………………….....…………………………28
2
! Assessing Treatment …………………………………………………………………34
! Methods ………………………………………………………………………………..35
! Midnight-Noon …………………………………………………………………………35
! KiKei ……………………………………………………………………………………37
Paradigm---Multi-Model ………………………………………………………………………41
! Methods ………………………………………………………………………………..51
Conclusion …………………………………………………………………………………….53
Appendices
Bibliography ………………………………………………………………………………….74
3
Introduction
Biao). These words that can have a variety of meanings, and be applied to a variety of
can all be subdivided into root and branch. The present study will focus mainly on the
latter, specifically, the way in which acupuncturists in Japan treat what they see as the
root of a given patientʼs problem. The treatments are prioritized in such a way that there
exist specific divisions and guidelines for each stage of a single patient encounter.
These guidelines vary with the practitioner, and are often dictated by the association
! The purpose of this paper is to show how the Japanese view the concept of Root
and Branch within the context of clinical practice - which is, after all, the major concern
of the pragmatic Japanese - and to show the root and branch treatments as an orderly
and consistent staging of clinical events, each of which must be satisfactorily completed
according to certain (often palpatory) criteria before proceeding to the next stage. While
opinions differ as to the proper proportions of root versus branch stages, most
practitioners with any classical background will concur that the root stage is very
4
-It is usually monitored and measured against some criteria to be judged effective
! The paper is divided into two main sections. First is an overview examining the
patterns”. This section will briefly review a variety of paradigms as they are used
clinically in Japan. Major exponents of the various schools will be noted, though some
who may not fit into one or the other may be excluded (Akabane, for example). This list
will of course be limited to practitioners whose styles and ideas have been described in
English-language texts. It should be noted that the emphasis of the paper is on those
schools that acknowledge the classics as a major influence, and not on those schools
that seek a purely “scientific” approach. Second is a more detailed examination of the
the twentieth century, Yoshio Manaka and Kodo Fukushima . Appendices follow.
! First, let us consider some points of view on the meaning of root treatment. First,
importance of the Root and Branch. In terms of disease, the first to be contracted is
considered to be the Root, and later complications the Branch. Between the Organs and
their pertaining channels, the former are considered the Roots and the latter the
Branches. Points on the limb are Roots, those on the trunk and head are Branches.
Sometimes the Root is treated before the Branch, but at other times this sequence is
5
the other. Generally an acute illness is treated first, a chronic illness second, Exterior
disease first, Interior complications second. However, the more general balance
between the normal and abnormal forces in the body must also be taken into account.
For example, if the Normal Qi is particularly Deficient, i.e., the body is very weak, the
most immediate concern is to ʻsupport the normalʼ, since the expulsion of the abnormal
Qi from the body depends primarily upon the organisms ability to resist disease.”
! “Root treatment is performed in accordance with the pattern of the disease, and
symptomatic treatment in accordance with the symptoms of the disease. The first
priority is to correct the abnormal relationships of deficiency and excess among the
meridians. To do this we must determine the overall picture of the disease known as the
pattern by identifying and analyzing those relationships of deficiency and excess among
the meridians and organs that are abnormal, and those that are not.” (Yamashita, 1971)
which are the essence of the disease, are corrected by tonification and dispersion using
the five-phase points and five essential points. Symptomatic treatment is the treatment
essential points on the four limbs in accordance with the primary pattern, which is
derived from the various diagnosis and analysis of the symptomology. Symptomatic
6
Tonifying or dispersing reactive points or acupuncture points [resulting from]
imbalances.! There are, of course, cases in which the symptoms are relieved by root
most situations these two treatments are equally important and necessary. (Takeyama,
1944)”!
! Shudo emphasizes the importance of both root and symptomatic treatment. “No
unnecessary...The only real difference between meridian therapy and the conventional
body energetically before the specific symptoms are treated...The distinctive feature of
meridian therapy is that root treatment comes first...There are considerable differences
treatment. Some believe that root treatment takes care of 70-80% of the
treated separately with symptomatic treatment. Finally, some practitioners believe that
root and symptomatic treatment are of equal value... The concepts of root and
symptomatic treatment were redefined with the advent of meridian therapy. The classics
mention treatment of the root (honji/ben zhi) and treatment of the manifestation or
branch (hyoji/biao zhi), but this is generally just a matter of emphasis, rather than two
therapy because the majority of practitioners in Japan are only concerned with
symptoms and the stimulation of tender points. Since root treatment in acupuncture is a
7
unique approach introduced with meridian therapy, it is naturally presented as the more
important aspect of treatment. All practitioners of meridian therapy agree that root
treatment comes first, and symptomatic treatment second.” (all italics mine)
“-As the procedure performed first, it serves to clear the way for the procedures that
follow. When successful it can be sufficient in itself, and at the very least, it simplifies
-Specific factors, such as individual and constitutional differences, can be taken into
consideration.
-Such checks allow selection of points for patients who are otherwise difficult to
-The method of treatment can de decided for incipient diseases that are beyond
stages before a pathology becomes evident. In ancient China, there was a tradition that
array of approaches developed there since the Second World War, it is fairly certain that
each acupuncture association has developed its own “root style”, with its own diagnostic
requirements and treatment techniques. The majority of Japanese schools use more
gentle treatment methods than their PRC counterparts, and often it is necessary to have
8
a system of feedback to monitor the progress of therapeutic events. It is not uncommon
that the root treatment requires confirmation of efficacy before the treatment is allowed
to proceed to the next step, i.e., the practitioner must pass a sort of “test“ before
entering the next “grade”. As Shudo explains it, “After the root treatment...is completed,
there must be some way to determine if the desired effect has been achieved. In root
treatment, unlike symptomatic treatment, relief from symptoms is not the primary
indicator of success. Nonetheless, after tonifying a point, one still needs to know if the
! These he sums up into various indications, having to do with the relative balance
between pulse positions and changes in pulse quality, changes in the abdomen and the
immediate, subtle response of the body to needling sends a very important message to
! Even if we accept Shudoʼs assertion that the present emphasis on root treatment
began with the meridian therapy school, we shall see that the concept has spread
outside their stylistic boundaries to a wide range of different practitioners and their
realize that the present paper will only hint at the diversity of techniques and models
that are found there. In many cases, the various practitioners involved will adapt each
others methods.
9
! In the first part of our exploration into concepts of root treatment, we will examine
acupuncture, namely those of the Five Phases and of the eight Extraordinary Vessels.
These two theoretical models have preoccupied much of the Japanese view of root
treatment since the Second World War, and are present in many forms of acupuncture
today. In addition, we will note other paradigms that have been more or less discussed
Paradigms
! In the Japanese acupuncture literature that has come to the West, it is striking for
the student educated in most U.S. acupuncture colleges to note the absence of the
TCM paradigm (i.e., the eight guiding criteria or Ba Gang Bian Zheng) in favor of
concepts of pathophysiology and therapy hardly taught in most schools here. While
each paradigm is enormous enough in it own right to merit at least one full-length book
on the subject, for our purposes a quick mention of each in the context of contemporary
bibliography.
Five-Phase (GoGyo)
is long and controversial; its influence on virtually all aspects of Chinese thought is
enormous and outside the scope of this work. Its application in medicine dates to at
10
least the Huang Di Nei Jing Su Wen , and it is the model of choice for what is probably
the most classically-oriented of all styles of acupuncture in Japan today, Keiraku Chiryo
(Meridian Therapy) .
perhaps none is as widely known as the Meridian Therapy movement, founded in the
1930ʼs and 1940ʼs in Tokyo. Traditional medicine had been largely supplanted by
modern theories of anatomy and physiology which had been introduced in Japan by the
named Seisuke Yanagiya (also known as Sorei Yanagiya) was dissatisfied with the
prevailing Westernized methods being practiced at the time and sought an approach
that was more grounded in classical theory. He began to attract students. Two of them,
Fukuji Okabe (also known as Sodo Okabe) and Keiri Inoue, joined forces with
to be, along with Yanagiya, the founders of the Meridian Therapy style .
! The classics they used were primarily the Huang Di Nei Jing Su Wen, the Huang
Di Nei Jing Ling Shu, and, most prominently, the Nan Jing. The Nan Jing was made the
basis for the clinical practice of Meridian Therapy, Shudo says, because of its antiquity
treatment”. Paul Unschuld, perhaps the most prominent Nan Jing scholar writing in
English, calls the work “the mature classic of systematic correspondence. In the history
the only work we know of that combines a high degree of innovative thinking with a
consistent - in the Chinese sense - body of thought.” . The clinical procedures outlined
11
in the Nan Jing were largely based on the Five Phase paradigm, and made extensive
use of the Five Transporting points ; thus their prominence in Meridian Therapy.
! Perhaps the greatest contribution of the Nan Jing to Meridian Therapy - and
regarding radial pulse diagnosis. The idea that the pathophysiology of the organs and
meridians could be determined largely from the radial pulse revolutionized the practice
of medicine in China and continues in some form in virtually all systems of acupuncture
extant today. So, too, the treatment principles revealed in Difficulty 69, from which
developed the “four-needle” technique and other point selections derived from it. This is
the “mother-child” principle, which is the foundation of not only the Meridian Therapy
associations, but others such as various Korean and European schools. A third strong
Nan Jing influence in Meridian Therapy is the abdominal mapping based on Difficulty
! It is perhaps worth noting that this model, though very influential in Japan and
other parts of Asia, has fallen out of favor in the PRC. In the U.S., many schools today
barely teach this paradigm, which at one time was central to the practice of
acupuncture. It “doesnʼt fit” well with the eight guiding criteria, and is largely discarded
practice of Chinese medicine. Thus, it is not well understood by many (if not most) of
those who have graduated from acupuncture schools in this country. In Japan,
however, extremely sophisticated principles of point selection and treatment have been
developed and used with outstanding clinical results; these reflect a deep understanding
12
Eight Extraordinary Vessels (Ki Kei Hachi Myaku)
! In a manner similar to the Five Phases noted above, the Eight Extraordinary
Vessels paradigm (C: Qi Jing Ba Mai, J: Ki Kei Hachi Myaku) has a long history, though
far less defined than that of virtually any other aspect of acupuncture meridian theory .
Cohesive writings regarding methods of diagnosis and treatment began to emerge only
during the Ming period. A notable development was the concept of “jiaohui” points,
sometimes translated “meeting” or “master” points. These are points on the extremities
that, while not necessarily lying within the vessel trajectory itself, are seen to “control” or
“open” the particular vessel. Furthermore, these eight points are combined into four
pairs of points, and thus four pairs of vessels, which are seen to treat a more or less
wide variety of conditions. These point pairs are as follows: L-7 is combined with K-6,
SP-4 is paired with P-6, GB-41 is paired with TB-5, and SI-3 is combined with UB-62.
! Though often used singly or in combination with other points unrelated to the
Extraordinary Vessel paradigm, these point pairs became in some schools of thought
entire treatments in themselves. Their use in twentieth-century Japan has been almost
inextricably linked with the concept of “polarity agents”, i.e. treating the master point and
composition . Examples of this range from tonifying and dispersing needle techniques
to north and south poles of magnets to needles coated with different metals; this creates
a “gradient” effect similar to a battery. In some cases, devices have been invented
solely to treat these four pairs of points; more about these will be said later. It is worth
noting that, though it makes use of more “scientific” theory, this technique is so
13
prevalent in Japan that it has been adopted by even the staunchest of traditionalists,
biorhythmic acupuncture reached its zenith of development during the later Ming period.
Several forms are being somewhat revived today, both in Japan and in the PRC. In
Japan, the major proponent was Yoshio Manaka; since his demise, his disciples have
apparently continued using these methods in addition to the others described above.
! Briefly, the methods Manaka employed center on the concept that certain points
become “open” or particularly active at certain times during various cycles of one, ten,
or sixty daysʼ duration. The daily cycle is based on the meridian circuit described in the
Ling Shu (the so-called “Chinese clock”); the points that are open are the tonification or
dispersion points (“mother” and “child”) described in the Nan Jing. The ten-day cycle
cycle of the Five Phases, and uses the points associated with the Five Phases and the
Yuan-Source points. The sixty-day cycle (“Eight Methods of the Mysterious Turtle” or
Ling Gui Ba Fa) is formulated by a complex series of calculations based on the Chinese
calender, and is associated with the Latter-Heaven sequence of the Eight Trigrams of
the I Ching; the only points that appear in the cycle are the eight jiaohui points of the
Extraordinary Vessels.
! The “Chinese clock” is also the basis for Manakaʼs “polar meridian pairs”, which
are Yin-Yang meridians on opposite sides of the clock: for example, the Heart meridian,
14
active between 11 a.m. and 1 p.m., is paired with the Gallbladder meridian, active
between 11 p.m. and 1 a.m.. An associated method used by the Toyo Hari association is
called ShiGo; it is based on the same meridian pairings, but used in a different way. A
Other Paradigms
! Though Five-Phase and Extraordinary Vessel models make up a large part of the
classically-based or integrated systems are being introduced to the West. One example
out of many is Tadashi Iriye, a revered master and teacher of noted acupuncturist Miki
diagnosis and treatment , and is the developer of his own kinesiological technique, the
! Other systems barely exposed in the body of translated literature include those of
moxibustion master Takeshi Sawada and his disciple, the noted classical scholar Bunshi
Shiroda, as well as the equally revered moxibustionist Isaburo Fukaya. Kobei Akabane,
Japan, wrote several works that remain untranslated into English, and fascinating
systems such as the traditional Shaku-Ju school have been only superficially explored if
15
Clinical Approaches (diagnosis-treatment)
Methods of Assessment
palpation), the palpatory exam is, among virtually all Japanese practitioners, the most
important. Different schools emphasize different aspects of palpation: just what one
presses at what depth in what order, etc., is not at all uniform across the spectrum of
palpation, or “hara diagnosis”, there is little consensus between styles, as we shall soon
see. One may look for generalities, such as overall tone, shape and degree of moisture
in the skin; or probe for very specific findings in certain locations, such as the classical
emphasized heavily in the Meridian Therapy schools and marginally or not at all in the
styles of Manaka or Ito. Palpation of the extremities, usually in the context of meridians
or meridian points, is generally used, though again there is some disagreement about
the amount of pressure and even the location of points or meridians. Points that are
Pulse Diagnosis
! Radial pulse diagnosis, as stated earlier, was a major contribution of the Nan
Jing. The pulse scheme partially delineated in Nan Jing 18, in particular, became the
foundation for what has become known as “six-position” pulse diagnosis. Briefly, the left
16
and right wrists are divided along their length into three sections, with the middle section
usually centered somewhere in the proximity of the styloid process of the radius. These
are the “six positions”. In addition, the pulse may be divided into Yin and Yang areas
according to the depth to which one presses when palpating. Thus, the twelve
meridians may all be examined from the palpable portion of the radial artery. In
addition, the arrangement of the positions makes it relatively easy to detect imbalances
along the generating and controlling cycles of the Five Phases, further contributing to its
status as the “root” examination in Meridian Therapy. Shudo cites Sodo Okabe, who
gives a further interpretation of root and branch in the four examinations: “Pulse
diagnosis is the root and the other examinations are the branches. Even if a certain
difficult to put them in a uniform pattern [without pulse findings]. ... In meridian therapy,
pulse diagnosis is the foundation and all other findings are secondary.”
Chiryo); although some theorists have devised methods for finding disturbances in the
Extraordinary Vessels from pulse palpation, many practitioners contend that a workable
system has yet to be found . One notable exception is Michi Tokito, a modern Japanese
Extraordinary Vessels by Matsumoto and Birch. Tokito operates within the now-
standard six-position pulse scheme; however, she concentrates largely on the left and
right proximal positions at the depth of the Yin meridians. She compares the balance
between them, and decides on one of two patterns of Master-Coupled point pairs, one
of which is further differentiated by the balance between the left and right middle
17
positions at the superficial level. She apparently uses this method exclusively, and no
comes from the Nan Jing, Difficulty 16 (see diagram). Most practitioners of Meridian
! One example of variation comes from the Toyo Hari association, a large
organization of Meridian Therapy practitioners, about which more will be said in part II:
Abdominal diagnosis (fukushin) is based on Meridian Therapy theory. The tone of the
abdomen is noted, and palpation is to find the presence of Kyo or Jitsu, warmth or cold.
The luster or dullness of the skin is noted. The left palm lightly touches the abdomen.
18
*CV-7 to CV-12 = Spleen diagnosis area
*GB-24 to SP-16 right side = Lung diagnosis area; same area left side = Lung
comparison
pulse finding; it is a vitally important component of the diagnostic process, but not one
presses is generally superficial; though diagnosing diseases of the Blood level may
require deeper pressure, and some adjunct methods (such as Extraordinary Vessels
19
! In contrast to the light touch employed by most Meridian Therapy practitioners,
the style of Yoshio Manaka uses sensations of pressure pain or tightness in assessing
the condition of the patient. Manakaʼs abdominal configurations are reflective of his
employed in root treatment have different abdominal configurations, and oneʼs findings
during the abdominal examination indicate the choice of paradigm in treatment. Details
! Palpation may also include meridian palpation to assess the deficiency or excess
condition of the five-phase points, though some schools use distal point palpation to
may indicate Extraordinary Vessel treatments, but is usually used to assess and treat
Yang meridian points during the second or third step of his treatment plan, in addition to
! Some practitioners use reflex areas discovered during their own long clinical
experience, and which are unique to their own practice. Consider Mr. Osamu Ito,
bone manipulation led him to develop palpatory schema of the knee and sacrum to
diagnose and confirm the Extraordinary Vessel imbalances in his patients; this method
is apparently limited to his own practice, and is based in no other Oriental medical
source.
20
Systems of Feedback
elicited, most Japanese styles monitor treatment by repeating parts of the examination
to see if any changes have taken place. Thus, the pulse may be rechecked, the hara
that the root treatment is indeed achieving its goal. Whatever is emphasized during the
examination is likely to be the focus of feedback assessment: so the pulse will be the
proof of the patientʼs improvement in a Toyo Hari clinic, whereas in Manakaʼs hospital
the abdomen or o-ring test is used to indicate success in the first stages of treatment.
Ms Tokito is also likely to recheck the pulse, as well as the relative tension of the
use his own palpatory zones or leg lengths to confirm the efficacy of the therapeutic
events.
acupuncture, the Japanese have developed a dazzling array of clinical tools and
techniques with which to render an effective treatment. Needles are fashioned from or
21
Nagatomo and Gerhard Bachmann) has become influential in Japan. These principles
complementary metals placed on the skin; one prominent example is Osamu Itoʼs work
with his “PIA” or “Ito magnets”, which are bipolar pairs of magnets with complementary
metals (copper and zinc, or gold and aluminum) embedded in the magnet face. Ito was
work with “polarity agents”, most notably the “ion-pumping cords”, the use of which will
be described later.
! A common phenomenon is the use of very specific instruments and methods for
each stage of treatment. These will vary from school to school; often the same
techniques will be utilized and defined differently between schools according to their
acupuncture in Japan identifies itself with its own “root style” or primary diagnostic and
treatment framework (which may or may not be based whole or in part on any number
of classical texts or traditions), for which it researches and develops very specific
techniques and implements. There are practitioners, for example, for whom bloodletting
would be considered a “root treatment”, and those who use primarily cutaneous
techniques such as tapping or warming the surface of the skin over meridians or
specific zones. Each association then adds techniques for “supplemental treatment”
based on the vast array of root techniques developed by these various associations.
The Toyo Hari association, for example, will use paired copper and zinc in a fashion
similar to the M-P advocates; however, this method is considered supplementary and
not part of the root treatment, for which silver or gold needles are used with very specific
22
techniques unique to the Toyo Hari. Similarly, the intradermal needles (hinaishin)
developed by Akabane and used by him as the primary method of treatment become a
treatment. The direct moxibustion that forms the sole method for the treatments of
Sawada (though, curiously, not for the style that has evolved bearing his name, in which
Therapy and Manaka styles, and is not used at all in other systems, such as those of Ito
or Tokito. The Toyo Hari association has even developed a method which combines
direct moxa with M-P principles, though, again, it is not considered part of the root
treatment.
! In the next section, we will examine more closely two approaches to treatment
staging, each with its own definitions of which stage constitutes root and branch and
Toyo Hari
! The Toyo Hari Gakkai (East Asian Acupuncture Medical Association) was
the Pacific War, had originally formed the organization for blind Meridian Therapy
practitioners. The methods he and his association developed were based on extremely
23
these methods. The organization is now well integrated, and has begun to grow
overseas as well.
! The Toyo Hari method differs from other Meridian Therapy schools in several
respects; these are in many ways related to the origins of the association. Since the
wishing to study this material encountered obstacles in a system that was not designed
for them. Fukushima and other founders of the Toyo Hari association at first developed
their own methods of learning until they could be integrated more fully into the Meridian
Therapy movement. In this way, their theories and methods, though similar to and
largely inspired by those of Yanagiya and especially Inoue, for example , grew into an
emphasis on clinical research and didactic methods that set them apart and are very
much responsible for the strength and flexibility of the organization today. In recent
times, unique theories, such as Sokoku harmonization, and even entire subsystems of
acupuncture, such as Naso therapy, have emerged from the Toyo Hari Gakkai. In this, it
nonetheless a fascinating system with which the author is well acquainted. A basic
that of the Five Phases. It is imbalance in the Five Phases that is seen as the cause of
morbidity in humans, and it is this imbalance that is addressed in the root treatment.
24
Other paradigms, such as Extraordinary Vessels, may also be used, but are assigned a
! In the process of diagnosis and treatment, special attention is paid to the state of
the Yin Meridians, and the pathology associated with them is generally though to be one
of vacuity. As Shudo states, “...in this school of acupuncture the basic pattern of
organs or meridians have a tendency to become deficient, and the Yang organs and
Yin organs associated with the Five Phases come the four Sho (Chinese: Zheng) or
“patterns”. The Sho number four rather than five because of a view that the Heart itself
will rarely be vacant, and if it is, consequences are so serious that acupuncture therapy
! The four Sho are the foundation of Meridian Therapy theory; without them, one
may not properly treat with acupuncture. Shudo elaborates: “The four basic patterns in
meridian therapy are the simplest expressions of the most common and fundamental
types of imbalances in the meridians, all of which involve deficiency of Qi. One or
another of these basic patterns can be utilized in every clinical situation... The
assumption which underlies meridian therapy is that all imbalances, no matter how
complex, initially begin with a deficiency in one of the Yin organs that is reflected in its
corresponding meridian.”
! Fukushima, using the Japanese alternate term akashi (instead of “Sho”, which is
disease and represent the condition of the body. Akashi is of a higher level. It is the
25
fundamental nature of the disease and represents the goal of its treatment. Akashi is an
symptoms of the patient... (it) is a holistic interpretation of the disease and contains the
in ki (qi)and ketsu (blood), identified through the kyo (deficiency) and jitsu (excess) of
the meridians. Ho and sha techniques are applied with hari (acupuncture) and okyu
(moxibustion) to correct these imbalances. This process constitutes true East Asian
Approaches to diagnosis
26
-In the first step of Sho selection, one considers the Yin or Yang constitution of the
patient, Yin or Yang nature of the disease, and selects appropriate techniques of
the patients constitution; decide what kind of needle to use; what kind of stimulation and
-In addition to five-phase diagnosis, you must determine if they are of Yin or Yang
Quickly-developing? Yin diseases are often inapparent, while Yang diseases are often
apparent.
-In the second step, one collects signs and symptoms and correlates them to the twelve
meridians.
-Finally, pulse diagnosis is used to determine the primary pattern or Sho. Palpate the
pulse, hara and the meridians. By now you already have some sense of what to look for.
-It is very important to follow all these steps in order to correctly determine Sho.
! !
! Signs and symptoms are largely derived from the symptomology described in the
Ling Shu. They are not very different from those described in modern TCM texts, but
they become weighted in terms of their importance by the subsequent step of the
diagnosis. Thus, the diagnostic process is not simply counting up how many symptoms
are those of the Spleen, Kidney or whatever; and the state of the body fluids or
substances is not of great concern. What is being addressed is the quality and
27
! Complicating the process is the fact that methods continue to be developed in
Toyo Hari; it is a dynamic process rather than a static system etched in stone. A key
development in the evolution of Toyo Hari was the concept of Primary and Secondary
Sho, or “Sokoku Control” needling. This came during years of clinical application of
Five-Phase theory in which patterns would present that were seen to be contrary to the
“rules of treatment” formulated during the early years of the Meridian Therapy
movement. !
Feedback systems
are lightly stroked in the direction of their circulation while the pulse is checked. A
positive response, i.e. normalizing pulse, confirms the diagnosis. It is worth noting that
this same method may be employed in locating the exact point to be treated. In fact,
the pulse is checked routinely during the decision making process in much the same
way as the o-ring or other tests are performed in the field of applied kinesiology.
Approaches to treatment
Point selection
! Root treatment point selection in Meridian Therapy is based on Nan Jing 69; it is
the “Mother-Child” scheme. The standard tonification point patterns for the four Sho are
as follows:
28
• Lung Sho: LU9, SP3
The point selection may be altered as necessary; sometimes specific symptoms may
require alternate points, as described in Nan Jing 68 (for example, jing-river points may
be selected in cases involving coughing or dyspnea). Phase energetics may also play a
hand in more complex selection schemes. However, the principle of tonifying the
mother Phase of the affected meridian is rarely violated. The perceptive reader may
notice the substitution of Earth points for Fire points in the Spleen Sho, and the
substitution of LU-5 for the more “orthodox” LU-8 in the Kidney Sho. The former is to
avoid tonifying the Fire phase , while the latter seems to be an empirical choice .
Sokoku Control, based on unilateral patterns of needling. Briefly, the primary pattern is
needled on one side of the body (usually the stronger or asymptomatic side), the
secondary on the other. The basic point selection for the primary pattern is the same as
the standard four Sho; the secondary pattern treatment point is often simply the Yuan-
29
! Once the primary and secondary Yin meridian imbalances have been addressed,
the pulse is reassessed, and the state of the Yang meridians is examined. Tonification
and dispersion is then applied to those Yang meridians that are deficient or excess. In
theory, this should fit into a neat Five-Phase scheme (e.g., in a Lung pattern, the Lung
and Spleen are deficient and the Large Intestine and Stomach are excess), but, in
practice, one treats what is “under oneʼs fingers” without regard to theory. The point
selection in treatment of the Yang meridians, too, is far more based on pragmatic
any of the Five-Phase points which are reactive (i.e., tight, edematous, tender, etc.).
30
Tools and Techniques
said in conversation with the author, “technique is everything in Toyo Hari” . In general,
the techniques rely on very delicate manipulation of fine needles (usually .16 or .18mm
gold. In contrast to the techniques used in the PRC, which are aimed at eliciting a
insertion and pronounced manipulation, the Toyo Hari practitioners advocate subtle
oneʼs fingers. The needles are often not inserted (i.e. they do not penetrate the
epidermis) but are held with the tip either just touching or slightly above the skin. Even
in more dispersing techniques where the skin is broken, the needle rarely reaches a
depth of more than a few millimeters. Needles are seldom left in situ; once the “arrival
of Ki” (C: Qi dao, J: Ki itaru) is felt - by the acupuncturist rather than the patient - the
! All one really needs when treating patients is a needle and oneʼs own two hands.
The right hand, called sashide, holds the handle of the needle and is used to insert and
manipulate. The left hand, called oshide, holds the tip of the needle and is used to
stabilize the needle and keep the Ki from leaking out. Both are important but the
thumb and index finger are brought together in an “o” shape; the profile should be flat
and there should be as much contact as possible between the very tips of the thumb
31
and index finger. The needle tip may be just barely seen between the tips of the two
fingers. When placed on the skin, there should be no gap between the fingertips
notes taken by the author during the course of his Toyo Hari training.
1) Ho (tonification) is achieved with Left-Right pressure, ie. the fingertips of the oshide
must press against each other to seal the point so that no Ki escapes during needling.
Amount of Left-Right pressure during needling varies with the individual patientʼs
constitution, but the important thing to remember is that the oshide must be tightened
when the needle is withdrawn, so as to close the hole to prevent leakage of Ki, and, with
2) Sha (dispersion) is done with downward pressure, i.e. the oshide presses down into
the skin as the needle is being withdrawn in order to expel the evil Ki in the meridian.
HO Technique:
-Rub the area gently with left index finger to locate the point
-Bring the tip of the needle to rest lightly alongside the left index fingertip
-Apply Left-Right pressure on oshide: 70% for weaker patient, 30% for stronger patient
-Apply slight downward pressure with the needle and rotate it back and forth slightly
-When the arrival of Ki is felt, apply 100% Left-Right pressure and quickly remove
needle
32
-Recommended needles: 0.8-1.3 cun, #1 or #2 silver needle
-EXTERNAL EVILS are differentiated into two types: Fujitsu & Genjitsu.
1. Fujitsu Pulse is related to Ki; it is Floating and Rapid, indicates febrile condition"
-#3 silver or stainless needle, angled against meridian flow, 1-2 mm depth
-Lift and thrust slightly, withdraw needle with downward pressure “as if pushing out pus”
-Hold handle more tightly, lift and thrust and rotate with relatively large amplitude
-When resistance at the tip lessens, press down harder and slowly withdraw needle
! In addition to these basic techniques, there are a group of techniques which are
in between Ho and Sha; these address the modern problem of Kyo Ja, or “deficiency
evil”, pathology that arises from Phase imbalances which are seen in patients who are
overall so deficient that standard Sha techniques would cause more harm than good.
Again, they are differentiated by pulse type, and include elements of both Ho and Sha
techniques.
33
Assessing treatment
and abdomen. Pathological qualities noted in the pulse will begin to normalize; a pulse
that was noted during the initial examination as sinking will begin to rise, a floating pulse
will begin to sink, a slow pulse will accelerate, and a fast pulse will slow down.
Differences between individual positions may become less apparent, and the pulse
overall should become smoother and more defined. The abdomen itself may begin to
normalize, and temperature and texture differences are likely to even out. Even the
! In addition, the patient should feel relaxed and comfortable, and any pathological
changes in the face or skin should resolve. The skin should take on an added luster;
signs of over-treatment include excessive moisture of the skin. If this occurs, needle
thus: “Targeted Healing is a system for the direct treatment of the local afflictions
Fundamental Healing will eventually result in the removal of all the symptoms...but
certain complicated cases...may require a long period of time to cure. Targeted Healing
34
speeds up the process...In terms of the overall care of the patient...its value is far less
! I feel it is further necessary to comment upon what the Toyo Hari training
methods call “supportive treatment”, and to differentiate this from the more commonly
held notion of branch treatment as “local”. While it is true that supportive treatment
targets symptoms and that the goal is the elimination of same, the treatment is often as
not conducted upon locations remote from those where the symptoms may be found.
Thus (as noted above) the branch treatment in Toyo Hari may employ the same
methods used by other associations as a root treatment. In addition, the affected body
areas themselves may be treated in a more standard “local” treatment. The majority of
methods outlined below more closely match the definition of supportive treatment rather
Methods
Midnight-Noon (ShiGo)
rhythm of the the twelve meridians as outlined in the Ling Shu. The cycle is said to
begin with the Lung meridian at 3:00 a.m. and progress through the meridian circuit as
follows:
35
11 a.m.-1 p.m.: Heart
meridian pair is created. For example, 3-5 a.m. is the time designated for the Hand
Taiyin Lung meridian. This would be combined with the opposite time on the clock,
namely 3-5 p.m., which is the active period for the Foot Taiyang Bladder meridian. The
Lung-Bladder
Large Intestine-Kidney
Stomach-Pericardium
Spleen-Triple Burner
Heart-Gallbladder
Small Intestine-Liver
! Problems affecting a given meridian may be treated by needling its ShiGo paired
meridian, i.e., for pain along the Heart meridian, the Gallbladder meridian would be
treated. The most common indications for ShiGo treatment are either symptoms that
recur during a specific time (patient awakes every night at 2 a.m., for example) or
36
symptoms that occur along the course of a specific meridian. Some practitioners also
use it for organ-specific symptoms, such as treating the Bladder meridian for acute
asthma.
! The methods used generally employ a thick #30 gold needle (non-inserted);
direct moxa (15-30 times) or gold pressballs may also be used. Luo-connecting points
or Xi-cleft points are routinely selected, depending on reactivity. For problems restricted
to one side, the opposite side is treated; so, for pain in the right elbow that runs along
the Large Intestine meridian, left K-4 or K-5 would be treated. For bilateral pain or
organ problems, the most painful side is treated. For symptoms occurring at a specific
time, the patient may be given instructions to apply moxa or finger pressure to the
! ShiGo was originally utilized in the Toyo Hari system only for acute emergency
situations. Often the procedure is done before the standard root treatment. Recently,
the Toyo Hari association began to investigate this technique in the treatment of chronic
ailments, and the results so far look encouraging, especially with chronic asthma.
KiKei
treatment, and often use it for a specific symptom or set of symptoms. The methods
used are strikingly familiar to those acquainted with M-P school techniques: originally
gold and silver needles were used, but currently dime-sized discs of copper and zinc
are taped to the master and coupled points on opposite sides of the body, or north and
37
south magnets are used in their place. Moxa may also be used for home treatment: five
cones for the master point and three for the coupled point. One example from the
authorʼs experience: a patient with signs and symptoms indicating a Kidney Sho. The
patient, among other complaints, was developing a goiter; after the root treatment of the
Kidney Sho, tonification or dispersion of various Yang meridians, and various local
treatment techniques, the patient was instructed to use magnets or moxa on K-6 (north
or 5 cones) and L-7 (south or 3 cones). It was explained to the patient that this was “for
! In Meridian Therapy, the section on KiKei mentions that the therapy was added to
the Toyo Hari repertoire in 1972; this is certainly late enough to admit the profound
influence of the M-P school and Yoshio Manaka (who is mentioned in the KiKei section
of this book). The Toyo Hari association, however, has added two new point
combinations (for a total of six) to the KiKei point formulary. In addition to the standard
point pairs (see section above), Toyo Hari added LV-3 + H-5 and LI-4 + ST-43.
Symptoms and palpatory signs for all the KiKei point combinations may be found in the
appendix following.
! Naso and Muno are supportive treatments, performed around the clavicle and
symphysis pubis respectively. Naso is employed for pain or dysfunction above the
waist, including neck, chest, shoulders, upper limbs and back. Any problem below the
waist may be addressed by Muno. As they are taught today, they may be used for
internal problems as well (such as treating respiratory or gastric problems with Naso,
38
and intestinal or urogenital problems with Muno). They are essentially the same
procedure: knots or lumps in the tissues are palpated, a needle is inserted until it
reaches the knot, manipulated until the knot loosens, withdrawn and another knot in the
area is sought. The Toyo Hari categorize the various lumps according to the degree of
hardness, and correspondingly harder needles and techniques are employed for each.
Needle sensation along the meridian may be felt here, but in contrast to the cramping or
! Naso itself has grown and developed over time into a unique system which
strongly corresponds with the Sho. Clinical research has indicated reflex zones which
may be palpated to confirm the Sho, and/or treated to extend the Root treatment still
further. Originally viewed as roughly correlating to the muscle meridians in the neck
area, they are increasingly being refined to the extent that Naso can hardly be called a
! Local areas themselves are often treated by fast and light “touching
needle” (sanshin) techniques, and other types of implements such as the rounded
needle (teishin, which may be used in diagnosis and root treatment as well), and
(zanshin, enshin, shonishin) are routinely employed in the clinic. The Toyo Hari
association also uses other techniques more familiar to other Japanese styles, such as
39
direct moxibustion, microbleeding, intradermals, and needling into various empirical
encompass a fairly broad range of modalities; yet, their concept of root treatment is very
strictly defined, limited to the five-phase paradigm. This seems to present no real
obstacles to clinical success, given that the parameters of supportive treatment are a bit
more open. I have heard it said that Fukushima himself, at least towards the end of his
career, relied almost entirely on root treatment ; this stage of clinical procedure is
certainly given heavy emphasis in the Toyo Hari training program. As the organization
continues to grow, it is likely that the repertoire of treatment options will grow with it.
However, the original spirit of classical five-phase root treatment is fundamental to the
philosophy of the Toyo Hari Gakkai. It is unlikely that this will change.
! In the next section, an overview of a much broader style of clinical procedure will
Yoshio Manaka !
! Yoshio Manaka (born April 23, 1911; died November 20, 1989) was perhaps the
best-known figure in Japanese acupuncture. Stephen Birch has called him “ the
painter, sculptor, author, and a “true renaissance man”. He graduated medical school
and went on to get PhD in physiology in 1930ʼs. An army surgeon during the war, he
spent last years of war in prison camp in Okinawa. He studied East Asian medicine,
acupuncture, moxibustion and Kanpo (herbal medicine) on his own, and exclusively
40
practiced these modalities from 1960ʼs on. He founded Manaka hospital in Odawara,
Japan in 1945 and was its director until his death in 1989. Thus, he had resources to
experiment and collect data to test his theories. He studied as many styles of traditional
studied, and developed his own unique paradigm to explain the profound effects such
methods could elicit. This he called the “X-signal system”; he described it as a ʻprimitive
information system in the body that has embryological roots, but is masked by the more
influences that cannot be clearly said to affect the nervous system... we feel it is a
Manaka developed devices to affect this system without stimulating the nervous system;
the most famous and widely used of these is the “ion-pumping cord”, described in
greater detail below. It is worth noting that his work in this field has influenced most of
Paradigm---Multi-Model
the initial developments of his approach. Later, he began to add the “polar meridian
pairs”, i.e. the hand-foot -Yin-Yang pairs formed by opposing meridians on the “Chinese
clock” (see above section on ShiGo). Musculoskeletal imbalances were framed in the
41
context of the “meridian sinews” (jing jin). He developed indications for each paradigm,
and treated according to what he found. If the findings were inconclusive, he had a
paradigm for that too. The biorhythmic “open point” could be treated, or moxa could be
Sawada. Unusual treatment methods, such as shining colored LED lights on five-phase
! Manakaʼs clinical protocol is lengthy and involved; Stephen Birch has noted that
“it may be done in 45 minutes, if youʼre brisk” . Manakaʼs protocol is constructed in five
steps, the first three of which he considered the root treatment and the remaining two
Step One:
Paradigms:
Methods:
Step Two:
Step Three:
Paradigms:
42
Related Back-Shu points (Step Two); Reactive points along Yang Meridians
Methods:
Manaka observes that Step Two and three often overlap, as their goals are similar.
! The examination would generally begin with palpation, usually starting with the
test. If both polar meridian findings and Extraordinary Vessels findings occurred during
the examination, the more appropriate of the two paradigms would be determined; step
one treatments generally used only one paradigm. If no positive findings occurred and/
or the examinations were otherwise inconclusive, biorhythmic open points from any of
possibility would be the Taiji moxa treatment developed by Sawada and refined by
Manaka.
Approaches to diagnosis
Assessment of Condition
! In his book, Chasing the Dragonʼs Tail, Manaka offers this explanation of akashi
(or Sho, as described above) as opposed to diagnosis in the modern biomedical sense:
43
! “Akashi is a collection or pattern of signs and symptoms that center on a
selected, the akashi will be different, where in Western biomedical terms, several cases
observe the patient... However, this makes the akashi dependent on the style,
! In Manakaʼs style, the main method of assessment is palpation, and the primary
site of palpation is the abdomen. Manaka determined his own set of Mu-Alarm points
for the various Zang-Fu (see Table), as well as zones of reactivity for the various
Extraordinary Vessel pairs (see Table). The polar meridian pairs are indicated by
Manakaʼs Mu Points
Lungs - LU 1 to LU 2 area
Percardium - PC 1
Heart, Pericardium - CV 17
Heart - KD 23
Gallbladder - GB 24 to GB 29 region
Spleen - GB 26 to SP 21 region
44
Kidneys - KD 16 (occasionally GB 25)
Upper Warmer - CV 17
Middle Warmer - CV 12
Lower Warmer - CV 5
Urinary Bladder - KD 11
45
46
! The pattern selected for Step One usually sets up the rest of the procedure
through Steps Two and Three. Points on the back would be selected which strongly
correspond to the assessment for step one. For example, if Step One were an
! Step Three generally hinges on examination of leg and arm lengths and
muscular imbalances on the sides of the spine. If these are present, further
• With Liver problems, the paravertebral muscles on the right between UB-17 to 20 may
be tight or swollen; problems with the right shoulder and left low back may appear.
• Problems of the Spleen may show paravertebral problems to the left, from UB-18 to
• Lung problems often result in shoulder and intrascapular tension, as well as stooped
! Often step three could be completed with a simple exercise combined with direct
moxa or fire needle to UB-18 (the Liver Shu, as the Liver controls the sinews).
47
Feedback systems
! Feedback in this style is largely gauged through the relief of pressure pain or
test is also employed. This is an applied kinesiology test, developed by Yoshiaki Omura
MD, in which the patient holds their right index finger and thumb tips together in an “o-
ring” shape while the left index finger touches a diagnostic point on their own body. The
therapist attempts to separated the fingers in the o-ring and gauges the resistance given
by the patient to this action. The test is considered “positive” when the resistance is
weaker than usual. A number of points may be tested this way, and in certain cases the
presence of pathology may be evident only with this technique. Stretching exercises in
step three would begin and end with range-of-motion tests to gauge the extent to which
Approaches to treatment
Choice of Method
! Manakaʼs view of root treatment was fairly broad: “Treatments that take
advantage of the signal system are considered root treatments. Treatments utilizing
channel characteristics, five-phase points and extraordinary vessels are root treatments.
Treatments that harmonize Yin and Yang are also root treatments.” “In our experience,
for root treatment, selecting from classical channel therapy, channel sinew therapy,
48
! Step One treatments, as noted above, are chosen primarily from Extraordinary
Vessel or Polar Meridian pair models; barring clear indications of either of these,
Taiji moxibustion, as practiced by Manaka, would consist of tiny direct moxa on CV-12,
ST-25, CV-4 or CV-7, TB-8, Manakaʼs own 3-yin crossing point (above SP-10), K-7,
LV-3, LV-4, GV-12, GV-20, UB-18, UB-20, UB-23, UB-32, UB-52, GB-31, GB-34, GB-40.
! As is evident from the above quote, Manakaʼs definition of root treatment was far
more open and encompassing than that of the Meridian Therapy schools. As we have
seen, the Toyo Hari Gakkai would consider the classical channel therapy (Mr. Birchʼs
! In this way, Manakaʼs “root treatment” concept could be spread over three stages
of clinical events, so step Three of a five-step plan is as much a “root treatment” as step
one.
! In Manakaʼs system, tools are generally more important than techniques; this is
especially true in the first step of treatment, in which the polarity agents do the work that
in other systems would be accomplished with manipulation of the needle or other forms
! Step one treatments are generally done with ion-pumping devices, instruments
invented by Manaka himself. There are three varieties, developed over time. The
49
oldest, ion-pumping cords, were developed during the second World War to treat burn
victims, but their use in subsequent years has been confined to the field of acupuncture.
They consist of one or more pairs of cords of thin copper wire, each with an alligator clip
at either end. The clips are partially covered in colored rubber; one clip is black and the
other red. The red clip contains a germanium diode which allows the current to flow in
only one direction. As Manaka states: “Theoretically, attaching the positive and
negative clips of an ion cord to two needles...will create a polarity between the needles
and electronic and ionic currents will begin to flow inside the body” . The needles to
which they are attached are inserted shallowly (2-3 mm) with no manipulation. They are
retained for ten to twenty minutes, after which the abdominal reactions should improve.
! Newer (and costlier) alternatives which use no needle insertion and save
considerable time are the ion beam apparatus and the electrostatic adsorbers. The ion
beam consists of a small electronic box into which two small cylindrical coaxial
conductors are plugged; the conductors, also colored red and black, conduct very weak
negatively and positively charged electrical current (“beams”). They are touched to the
relevant points for twenty to sixty seconds to produce the desired effect. The
electrostatic adsorbers are metal rods with built-in ceramic capacitors, connected by a
cord and also designated red and black; the device “withdraws static electrical charges
that are caught or stored in body tissues” and redirects them via a diode similar to the
ion pumping cords. Again, they need only be touched to the skin for twenty to sixty
! Alternative Step One modalities include the use of colored lights and pens on the
five phase and source points; these may be used to confirm diagnoses (repalpate after
50
applying colors) or to treat, in some cases. Briefly, the colors used follow the classical
five-phase associations: green/blue for Wood, red for Fire, yellow for Earth, white for
! Step two treatments are done with kyutoshin, moxa-needle. Back-shu points
relevant to the akashi (for example, UB-18 for cross-syndrome or Liver-Small Intestine
polar meridian pair) are needled and moxa is burned on the handle of the needle. This
is the most common technique for step two, although moxa is not always used. Step
three is accomplished with the fire needle (Chinese: Fa zhen) or direct moxa, utilizing
simultaneous stretching of the affected meridian or specific exercises chosen from the
Assessing treatment
! Treatment may progress from step one to step two when the abdominal reactions
noted during the diagnostic process are reduced or eliminated. A positive o-ring test
may also confirm that the treatment has achieved its purpose. As noted above,
distinctions between steps two and three are often blurred, as their goals are similar,
Methods
root treatment would provide sufficient relief, and further treatment would be
51
unnecessary. In general though, the supplemental methods would be added to make a
complete treatment.
! Manakaʼs symptom control methods were too numerous to detail; some of his
more common methods will be mentioned here. Manaka often used what he termed an
“isophasal” approach, selecting points that resonated with each other; often he would
apply intradermals (hinaishin) on corresponding points on the body, hand and ear. For
UB-18 point on the hand (according to the Tae Woo Yoo system of Koryo Hand
Acupuncture ), and on the Liver point of the ear (usually according to the Chinese map,
though sometimes Nogier points would be used). More typical applications of Japanese
techniques, such as direct moxibustion for specific symptoms, were often employed. In
stubborn cases, Manaka might have used TCM points and methods in symptom control,
or bloodletting; even scalp needling and barefoot doctor acupuncture were used on
occasion.
! Step five, finally, would concentrate on home therapy, whether exercise, diet or
home moxibustion or Hirata zone therapy . The patient would be given instructions on
how to apply these therapies, sometimes with innovative variations, such as using a
the use of Manakaʼs wooden hammer and needle, which is also used as an alternative
to the fire needle in Step Three. Briefly, the rounded tip of the wooden needle is placed
against a relevant point and the needle is tapped lightly with the wooden hammer in
which have an effect on various meridians. For example, a toothache could be treated
52
by tapping LI-4 at 108 beats per minute, as that is the rate described by Manaka as
Conclusion
! In Japan, as we have seen, the definition of precisely which methods and models
constitute root treatment and which are purely symptomatic is largely dependent on
oneʼs personal ideas or on the ideology of the association one chooses to join. The
definitions of the Toyo Hari Gakkai, and most of the Meridian Therapy associations, are
rather narrow in scope; yet this does not hinder their ability to treat effectively, given the
grow as these organizations strive to expand their research activities and their
membership). The view of Manaka, as well as the organization he helped found, the
scientifically integrated organization than the traditional Meridian Therapy schools and
one that includes other famous modern practitioners such as Miki Shima and Tadashi
Iriye), is that the definition of root treatment is much broader and allows one to be quite
creative in oneʼs diagnosis and treatment. Yet the goals remain very similar: a holistic
approach is generally applied before addressing specific complaints, and the energy of
the body must be balanced properly before any real lasting results can be achieved.
! As interest in the myriad of Japanese styles grows in this country, the practice of
acupuncture will doubtless incorporate some of their key elements. Palpation, perhaps
the most notable feature of Japanese diagnostic practices, will become more important,
as will other non-verbal clues to the condition of the patient. Because the methods
53
involved are so subtle, one must be able to increase oneʼs perceptivity in the clinical
context.
! Didactic approaches from Japan, such as the Toyo Hari associationʼs Kozato
method, can lead to new ways in which to teach acupuncture in this country. The
Japanese emphasis on “hands-on” training enables the student to feel the subtle
differences in tissues and gain the tactile understanding crucial to effective point
location, for example. Learning the methods of feedback can help to discriminate core
issues in treatment and keep the therapy on track, instead of “chasing symptoms”.
importance of Kiiko Matsumotoʼs own work in this country, as she tries to engage
patientʼs own present condition whether or not it fits some preconceived clinical
showing that he knows where to palpate, this reinforces the patientʼs own internal
knowledge and awareness that her signs and symptoms are all connected to the same
underlying imbalance...”
and educator; longtime professionals may gain new insights and benefits as well. As
the empirical palpatory styles of Japan offer ways to rapidly combine assessment and
treatment virtually at the same time. As a greater variety of people curious about
acupuncture begin to seek treatment, the practitioner can only benefit from cultivating
54
approaches to adapt to those who are needle-phobic, or others for whom the more
! As was noted earlier in this paper, the dizzying variety of approaches in Japan
have only recently (and thus incompletely) come to light in the U.S.; there exist many
fascinating and potentially useful methods that have yet to be introduced here. Even
approaches which have been fairly well exposed in the English-speaking world such as
Meridian Therapy have many varying ways of diagnosis and treatment; for example,
Bunkei Ono, Meridian Therapy master and founder of the association known as Toho
Kai, has developed a variety of special techniques not found among those of other
Meridian Therapy organizations, only the Toyo Hari Association, highlighted in this
paper, is currently beginning to expand into the United States. Denmei Shudo has
lectured in this country several times. It is through the work of Kiiko Matsumoto, her
erstwhile writing partner Stephen Birch and his wife Junko Ida (both of whom studied
with both Manaka and Fukushima), Shudo disciple and translator Stephen Brown and
his colleague Junji Mizutani (who produce the North American Journal of Oriental
Shima, and others that more systems of diagnosis and treatment will be brought to the
West.
! The practice of acupuncture in this country can only benefit from further exposure
to these clinical methods. The Japanese emphasis on prioritizing treatment towards the
holistic reintegration of the body processes rather than focusing on more symptomatic
concerns may help acupuncture in the U.S. reach new levels, beyond the “Oriental
55
physical therapy” cage in which many earnest practitioners find themselves. Perhaps
similar validation of the subtle, intangible effects of acupuncture and moxibustion that
seem at once unprovable yet impossible to deny. What is certain, though, is that
Japanese styles, with their respective Roots and Branches, are becoming more a part
of Oriental Medicine in North America and will make their unique imprint on practitioners
56
Appendix I
Sorei Yanagiya
MRDN 1. HO 2. SHA
phase on the engendering cycle) point of the affected meridian is combined with the
same-phase point of the “mother” meridian to tonify the deficiency. The controlling point
affected meridian is combined with the same-phase point of the “controlling” meridian to
disperse the relative excess. This pattern is uniform throughout the four Sho here.
Sodo Okabe
MRDN 1. HO 2. SHA 3. HO
LIVER LIV-8, K-10 LU-5 GB-43
SPLEEN ST-36, SP-2, H-7 LIV-1 SP-6, ST-41
LUNG LU-9, SP-3 H-7 ST-36, LI-11
KIDNEY K-7, LU-8, LU-5 SP-4, K-3 UB-67
57
! Okabeʼs logic is more complex. In the Liver Sho we see first the standard four-
needle combination of LV-8 and K-10. This is followed by the “son” (representing the
phase following an excess meridian on the engendering cycle) or dispersion point of the
Lung meridian, which represents the controlling phase. Then, in the third step, GB-43,
the “mother” point of the Gallbladder meridian (the YinYang paired meridian of the
Liver), is tonified. This suggests that Okabe tended to think in terms of the phase as a
! The second example, Spleen Sho, begins with tonification of ST-36, which is the
Earth point of the Yang Earth meridian (as well as a good overall tonification point),
followed by a variation of the four-needle scheme. SP-2, the mother point, is tonified,
along with HT-7; this latter point deviates from the standard four-needle plan in that it is
the Earth point (in this case the “son” point, as well as the Source point) of the “mother
meridian” rather than the same-phase (in this case Fire) point. This is followed by
dispersion of the same-phase point of the controlling meridian, LV-1, a standard four-
needle application. The third step begins with SP-6, presumably as a general
the Spleen and Liver channels, it could also be said to have a harmonizing effect on
those two meridians (as well as the Kidney meridian, which also intersects there). This
is followed by ST-41, the mother point for the Stomach meridian. Again, Okabeʼs aim
that, again, HT-7 is substituted for HT-8. Note also that the deficient meridians
themselves are not dispersed (e.g., LU-10 is not dispersed, as in the standard four-
58
needle scheme), and the overall process is geared toward tonification. The third step
again tonifies the Yang paired meridians of the Lung and Spleen; LI-11 is the mother
! Finally, the Kidney Sho begins with standard four-needle technique, except that
LU-5 is added (or perhaps substituted, the reference sources are not clear on whether
all or just some of these points would be treated); the combination K-7 and LU-5 is a
popular one in Meridian Therapy. The dispersion phase here is the only one of the four
Sho to include a point on the deficient meridian itself; the fact that it occurs in the Kidney
Sho strikes this author as curious, as the Kidney is seen as always deficient and never
excess in Meridian Therapy. Finally, UB-67 is tonified; it is the mother point of the
Keiri Inoue
MRDN 1. HO 2. SHA
LIVER LV-8, K-1 (LV-5, K-4) ST-45, LI-11, LI-4 (ST-40, LI-6)
SPLEEN SP-2, P-7 (SP-4, P-6) UB-65, GB-43, GB-40 (UB-58, GB-37)
LUNG LU-9, SP-5 (LU-7, SP-4) GB-38, SI-3, TB-4 (GB-37, TB-5)
KIDNEY K-7, LU-5 (K-4, LU-7) SI-8, ST-41, ST-42 (SI-7, ST-40, H-3)
! Inoueʼs logic is even more sophisticated. He maintained that the Yin meridians
tended toward deficiency, and as such should not be dispersed; while the Yang
! In the all of the Sho treatments here, he first treats the mother point of the
affected meridian. Then he selects the point representing the phase of the deficient
59
meridian on the mother meridian itself (which coincides with the “son” point). Thus, in
the Liver Sho, he pairs LV-8, the Water point on the Wood meridian, with K-1, the Wood
point on the Water meridian. This pattern is consistent throughout the four Sho. One
may note also the substitution of the Pericardium meridian for the Heart meridian in the
Spleen Sho; this was to avoid treating the Heart directly. In addition , or as a
substitution, he would treat the Luo-connecting point of the two meridians to further
enhance the tonification process. This is also consistent throughout the four Sho here.
! It is the dispersion step that constitutes perhaps the most Byzantine aspect of
Inoueʼs treatment strategy. It was perhaps through pulse patterns that Inoue decided
that the Yang pairs of the controlling-cycle meridians were to be dispersed; this logic
can also be found in Toyo Hari rules of treatment, for example . In any case, points on
both the Yang paired meridian of the controlling as well as controlled cycle would be
! Specifically, in the Liver Sho, LI-11 (mother point of the controlling Yang meridian)
and LI-4 (Source point of the controlling Yang meridian) are dispersed; ST-45 (son point
of the of the controlled Yang meridian) is dispersed as well. The Luo points may also
be added to reinforce the dispersion. This same scheme is repeated in the Spleen Sho:
GB-43 and GB-40 (mother point and Source point of the controlling Yang meridian) are
dispersed, as is UB-65 (son point of the controlled Yang meridian). Similarly, the Kidney
Sho: ST-41 and ST-42 (mother point and Source point of the controlling Yang meridian)
are dispersed, as is SI-8 (son point of the controlled Yang meridian). The Lung Sho
here differs slightly in that both the Yang Fire meridians (Small Intestine and Triple
60
Burner) are dispersed, presumably to counter the overacting cycle. So, SI-3 (mother
point of one of the controlling Yang meridians) and TB-4 (Source point of the other
controlling Yang meridian) are dispersed, as is GB-38 (son point of the controlled Yang
Denmei Shudo
MRDN 1. HO 2. SHA
LIVER LIV-8, K-10 SP-3, SP-5; GB-37; UB-58
SPLEEN SP-3, P-7 LIV-1; GB-37, GB-40, GB-43
LUNG LU-9, SP-3 LIV-1, LIV-2; GB-38; P-8, H-7; SI-4; LI-4; ST-40
KIDNEY K-7, LU-5 SP-3, SP-4
! Shudoʼs point selections for tonification here are common in Meridian Therapy.
The Liver Sho and Lung Sho follow standard four-needle formulae. The Kidney Sho is
the same as that of the Inoue example. The Spleen Sho is a common adaptation of the
four-needle technique: Earth points are used to avoid indirectly tonifying the Fire phase,
and the Pericardium is used in place of the Heart, as in the Inoue example.
! The dispersion points are not all treated; rather, Shudo explains, these are the
most likely points to be dispersed in each particular Sho. In reality, Shudo would usually
for example in the Spleen Sho, points on the Gallbladder meridian (such as GB-37,
GB-40 or GB-43) may be tonified to control the excess of the Liver, if one does not wish
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Appendix II
REN MAI
tumor.
Fukushima: (with Yinqiao; Nin/In-kyo) Symptoms along the courses of the meridians;
tooth and gum pain in the front of the mouth; coughing; asthma; phlegm disorders;
epigastric pain; nausea and vomiting; distension and pain in the epigastrium, middle or
Shanghai CTCM: Pathological symptoms of the Yin channels, especially Liver and
colic.
disorders; head and neck pain; abdominal distension and pain; mouth and tongue
abscesses. (depletion) pruritis; heaviness of loins and lumbar area; shan qi pain.
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REN MAI (palpation)
Fukushima: “...can be thought of as the Lung Meridian. Its diagnostic points vary greatly
with the type of illness involved and must therefore be located by applying pressure to
Manaka: Pressure pain or reaction may be found on: the whole length of the Ren Mai
from CV-1 to CV-22; in particular, below and above the umbilicus, with a band of tension
on the midline above the umbilicus; Lung meridian, especially LU-1 and LU-7.
YINQIAO MAI
cramps; uterine bleeding; late labor; leukorrhea; prostatitis; impotence; bladder spasms;
constipation.
Shanghai CTCM: Eye diseases; tightness and spasms along medial leg muscles with
flaccidity of lateral leg muscles; lower abdominal pain; pain along the waist to the
corresponding tension of Yin organs and functions; aggravations that worsen at midday
and improve in the evening or are worst at sunrise; migraines; congestive headaches;
tightness and spasms along medial leg muscles with flaccidity of lateral leg muscles;
diurnal epileptic seizures; watery eyes; heavy sensation of eyelids or inability to open
63
eyes; hypersomnia. (depletion) Aggravations during the night; nocturnal headaches,
Fukushima: “...can be thought of as the Kidney meridian. Its diagnostic points are
JinGei (ST-9), KetsuBon (ST-12), KoShin (K-8), ShoKai (K-6) and NenKoku (K-2).”
Manaka: Pressure pain or reaction may be found on: the Ren Mai, particularly when the
area ! below the umbilicus is weak or has less tension than the area above the
umbilicus; back muscles are jitsu while abdominal muscles are Kyo; weakness of the
abdomen with areas of tension around the umbilicus, K-16, GB-29 (ASIS), K-11, CV-2;
ST-12; ST-9; Kidney meridian between ST-12 and K-8, especially K-8; K-6 and K-3.
DU MAI
Manaka: Epilepsy; fatigue; spine and neck problems; neurosis; insomnia; superficial
Nagatomo: Rheumatic arthritis of the spine; inflammation of the joints; neuralgia; head
Bachmann: Rheumatic arthritis of the spine; inflammation of the joints; neuralgia; head
Fukushima: (with Yangqiao; Toku/Yo-kyo) Symptoms along the course of the meridians;
pain in the top or back of the head and the back of the neck; apoplexy accompanied by
paralysis or speech disorders; general disorders of the eyes, ears or nose; trigeminal
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neuralgia of the second or third branches; tooth and gum pain; swollen or sore throat
accompanied by sore points along the Du Mai in the back of the neck; Taiyang disorders
such as headaches, chills, anhidrosis, and systemic pain; Yang Kyo: fatigue,
hemorrhoids; epilepsy.
Shanghai CTCM: Stiffness and pain along the spine (obstructed Qi); heavy sensation in
the head, vertigo, shaking (deficient Qi in the channel); mental disorders (Wind in the
channel); febrile diseases; Qi of the channel rushing upward to the Heart produces
Head slumping forward; walking with rounded shoulders; lack of physical and mental
DU MAI (palpation)
Fukushima: “...Can be thought of as the Small Intestine Meridian. Its diagnostic points
vary greatly with the type of illness involved and must therefore be located by applying
Manaka: Pressure pain or reaction on: the Du Mai from GV-1 to GV-20, particularly the
upper back and GV-3, GV-4 and GV-20; the Small Intestine meridian, especially SI-3.
65
YANGQIAO MAI
Manaka: Whiplash; epilepsy; speech disorders; shoulder pain; lumbar pain; unusual
Bachmann: Any skin bleeding disorder; edema; swelling; CVA; hemiplegia; tinnitus.
Shanghai CTCM: Eye diseases; tightness and spasms along lateral leg muscles with
corresponding tension of Yang organs and functions; aggravations at the end of the day
and at night; nocturnal congestions, pains or crises; tightness and spasms along lateral
leg muscles with flaccidity of medial leg muscles; nocturnal epileptic seizures; dry or
itchy eyes; restless sleep or insomnia. (depletion) Aggravations during the day that
Fukushima: “...can be thought of as the Bladder meridian. Its diagnostic points are
FuBun (UB-41), KoKo (UB-43), IChu (UB-40), ShoZan(UB-57), FuYo (ST-19), and
BokuShin (UB-61).”
Manaka: Pressure pain or reaction may be found on: ASIS; alongside the cervical
vertebrae; around SI-9 and SI-10; K-11; the Bladder meridian, especially between
66
CHONG MAI
Bachmann: Pain that moves; late menses causing suffering of the heart and
Fukushima: (with Yinwei; Sho/In-i) Symptoms along the course of the meridian; swollen
and sore throat; chest or heart pain or discomfort; epigastric pain; general pain;
sides of the abdomen (Spleen) or around the umbilicus (Kidney); nausea or vomiting;
diarrhea; constipation; bleeding affiliated with the stomach, kidneys or large intestine;
Fukushima: “...thought of as the Spleen meridian in the legs and feet and the Kidney
meridian in the chest and abdomen. Diagnostic points are KiSha (ST-11), KoYu (K16),
67
Manaka: Pressure pain or reaction may be found on: K-16 and around the umbilicus;
ST-11; the Spleen meridian between ST-11(sic) and SP-6, particularly SP-6 and SP-4;
ST-30; K-1.
YINWEI MAI
stomach problems.
Nagatomo: Symptoms similar to those of the Chong Mai, but with less emphasis on
Bachmann: Symptoms similar to those of the Chong Mai, but with less emphasis on
pain; weakness in the heart; palpitations from fear; phobias; easily upset; talks a lot;
borborygmus; no appetite and weight loss with stabbing pain in the intestines at the side
Feit/Zmiewski: (repletion) All deep pulses stronger than superficial ones; repletion of
dyspnea; (with external depletion) weakness of homolateral shoulder, upper arm and
hand, and contralateral lower extremity. (depletion) All deep pulses weaker than
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pain in homolateral anterior shoulder, upper arm and hand, and contralateral lower
extremity.
diagnostic points are TenTotsu (CV-22), KiMon (LIV-14), FukuAi (SP-16), DaiO (SP15),
Manaka: Pressure pain or reaction may be found on: subcostal regions; CV-22; the
Pericardium meridian in general, PC-6 in particular; the Kidney meridian from CV-22 to
K9, particularly the abdomen and K-9; the areas from SP-13 to SP-15.
DAI MAI
elbows, wrists, hips knees, ankles; muscular pain of the neck, head, and general
muscle pain; menstrual pain or gum pain associated with weakness or fatigue.
Fukushima: (with Yangwei; Tai/Yo-i) Symptoms along the course of the meridian;
headache accompanied by edema; general eye and ear afflictions; trigeminal neuralgia;
tooth and gum pain in the sides of the mouth; dizziness; Meniereʼs syndrome;
spontaneous sweating; night sweating; alternating chills and fever; liver and gallbladder
69
disorders; distension of the ribs and lower abdomen; general pain; coldness and pain in
Feit/Zmiewski: (repletion) Superficial repletion of Yang channels; lumbar and loin pain;
weakness in lumbar and loins; white vaginal discharge; uterine prolapse; abdominal
distension; pain and inflammation in opposite shoulder, upper extremity, eye, breast or
ovary.
Fukushima: “...can be thought of as the Gall Bladder meridian. Its diagnostic points are
ShoMon (LIV-13), TaiMyaku (GB-26), GoSu (GB-27), YuiDo (GB-28) and KyoRyo
(GB-29).”
Manaka: Pressure pain or reaction may be found on: K-16 or around the umbilicus in
general; the Dai mai, including LIV-13, ST-25, GB-26, GB-27, GB-28 and GB-29;
YANGWEI MAI
70
Nagatomo: Mainly any pain on one side of the body (e.g. migraine, neck pain); joint
inflammation; symptoms similar to Dai Mai but more Yang in nature (inflammation, etc.).
cramp; eye tick; retinitis; poor circulation; hypotension; rapid pulse; arteritis; blepharitis
Shanghai CTCM: Chills and fever; vertigo; muscular fatigue, stiffness and pain; pain
Feit/Zmiewski: (repletion) General repletion of all Yang channels; fever; headaches with
heat symptoms; symptoms that worsen with violent weather such as thunderstorms;
pains or skin problems during weather changes; articular pains, especially in wrists and
ankles; mumps; diarrhea. (depletion) General lack of body heat; loss of energy and
Fukushima: “...can be thought of as the Triple Heater meridian. Its diagnostic points are
KenSei (GB-21), TenRyo (TB-15), KyoRyo (GB-29), YoRyoSen (GB-34), and YoKo
(GB-35).”
Manaka: Pressure pain or reaction may be found on: ASIS; TB-5; the Gallbladder
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Additional Toyo Hari KiKei Combinations
(NOTE: In addition to the classic Extraordinary Vessel combinations, the Toyo Hari
Gakkai has added two point combinations to it s Extraordinary Vessel treatments: LI-4 is
combined with ST-43, and HT-5 is combined with LV-3. Occasionally LV-3 will be
Symptomology: Symptoms along the course of the meridians; growths and abcesses on
the face, neck, arms or back; stye or pinkeye; inflammation of oral mucosa; swelling and
pain in teeth and gums; sore throat; stomach pain and distension; diarrhea; skin
Palpation:“GoKoku point is affiliated with the Large Intestine meridian. Its diagnostic
points are GoKoku(LI-4), OnRu (LI-7), KenGu (LI-15), TenTei (LI-17) and GeiKo (LI-20).”
“KanKoku point is affiliated with the Stomach meridian. Its diagnostic points are
KanKoku (ST-43), ShoKyu (ST-1), ShiHaku (ST-2), KetsuBon (ST-12), TenSu (ST-25)
disease; emotional disorders; eye afflictions; disorders of the endocrine system; thoracic
or flank pain and distension; muscle cramping; sweling; coldness; lack of motivation.
72
Palpation: “TaiSho point is affiliated with the Liver meridian. Its diagnostic points are
“TsuRi point is affiliated with theHeart meridian. Its diagnostic points are TsuRi (H-5),
73
Bibliography
Acupuncture Texts
Hashimoto, Keizo, with Yoshiaki Kawakami. Sotai, Balance and Health Through Natural
Johnson, Larry. Magnetic Healing and Meditation, White Elephant Monastery, San
! ! Francisco, 1988
Li Shi-Zhen. Pulse Diagnosis (Bin Hu Mai Xue), translated by Hoc Ku Huynh and G.M.
Liu, Bing Quan. Optimum Time for Acupuncture, Shandong Science and Technology
Manaka, Yoshio, and Ian Urquhart. The Laymanʼs Guide to Acupuncture, Weatherhill,
Manaka, Yoshio, with Kazuko Itaya and Stephen Birch. Chasing The Dragonʼs Tail,
Matsumoto, Kiiko, and Stephen Birch. Five Elements, Ten Stems, Paradigm
----. Hara Diagnosis; Reflections on the Sea , Paradigm Publications, Brookline, Mass.,
! ! 1988
74
Omura, Yoshiaki. Acupuncture Medicine, Its Historical and Clinical Background, Japan
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---. Medicine in China: Nan Jing, The Classic of Difficult Issues, University of California
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Yoo, Tae Woo. Koryo Sooji Chim: Koryo Hand Acupuncture vol 1, Eum Yang Mek Jin
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Papers
Birch, Stephen. “Dr. Manakaʼs Yin-Yang Balancing Treatment (Parts 2 & 3)”, North
Kuwahara, Koei. “If You Donʼt Try to Fix it, it Fixes Itself” North American Journal of
! ! 1994, p 5-9
Nakada, Koryo. “Basic Needling Techniques of Toyo Hari” North American Journal of
Shima, Miki. “Looking Forward”, North American Journal of Oriental Medicine, Vol. 2,
Van der Poorten, Nancy. “A Visit by Dr. Iriye to Toronto”, North American Journal of
Other Sources
Shima, Miki. JAAF Video Series: Mysteries of the Needle, Japanese American
Stephen Birch lecture at AAAOM convention, Austin, TX, 1990 (unpublished audio tape)
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Lecture notes and private conversations during the course of authorʼs Toyo Hari
Private interviews with Stephen Brown, L.Ac., Augusto Romano, L. Ac., and David
77