honchi ho, hyochi ho: root and branch treatment staging in contemporary japanese acupuncture

7/29/2019 HONCHI HO, HYOCHI HO: Root and Branch Treatment Staging in Contemporary Japanese Acupuncture

1/77

HONCHI HO, HYOCHI HO:

Root and Branch Treatment Staging in

Contemporary Japanese Acupuncture

by

Robert Hayden

submitted April 2, 1996, in fulfillment of major paper requirement

(A572 Major Paper Completion)

Midwest Center for the Study of Oriental Medicine, Racine, WI and Chicago, IL


2/77

Table of Contents

Introduction......................................................................................................................4

Part I: Survey of Paradigms and Clinical Approaches

Paradigms .....................................................................................................................10

! Five-Phase ..........................................................................................................10

! Eight Extraordinary Vessels ................................................................................12

! Biorhythmic/Stem-Branch ...................................................................................13

! Other Paradigms .................................................................................................15

Clinical Approaches .......................................................................................................16

! Approaches to Diagnosis of Root condition ........................................................16

! Methods of Assessment ......................................................................................16

! Systems of Feedback .........................................................................................21

! Approaches to Treatment of Root Condition .......................................................21

! Tools and Techniques ..........................................................................................21

Part II: Comparison of Styles: Toyo Hari & Manaka

Toyo Hari ........................................................................................................................23

Paradigm---Five Phase/ Four Sho Model ......................................................................24

Root Treatment ..............................................................................................................25

! Approaches to Diagnosis ....................................................................................26

! Assessment of Root Condition (Sho Determination) ..........................................26

! Feedback systems.....28

! Approaches to Treatment .28

! Tools and Techniques ...31

2


3/77

! Assessing Treatment 34

Supplemental (Branch) Treatment ..34

! Methods ..35

! Midnight-Noon 35

! KiKei 37

! Naso & Muno .38

Yoshio Manaka ..40!

Paradigm---Multi-Model 41

Root Treatment 43

! Approaches to Diagnosis ..43

! Assessment of Condition .43

! Feedback systems ..48

! Approaches to Treatment .48

! Choice of Method .48

! Tools and Techniques .49

! Assessing Treatment 51

Supplemental (Branch) Treatment ..51

! Methods ..51

Conclusion .53

Appendices

Comparison of Point Selection of Meridian Therapy Founders ..57

Comparative Symptomology of Extraordinary Vessels 62

Bibliography .74

3


4/77

Introduction

! An important concept in acupuncture is that of Root and Branch (Chinese: Ben-

Biao). These words that can have a variety of meanings, and be applied to a variety of

situations. For example, concepts of pathophysiology, body areas, or clinical events

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 patients 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

with which the practitioner identifies him- or herself.

! 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

important and is usually the initial event in treatment.

! We aim to show that:

-Root treatment is important

-It usually occurs first in the staging of the treatment

-It uses different diagnostic criteria than the branch treatment

-It uses different treatment methods than the branch treatment

4


5/77

-It is usually monitored and measured against some criteria to be judged effective

-It may itself be subdivided into stages

! The paper is divided into two main sections. First is an overview examining the

paradigms, diagnostic and treatment techniques commonly associated with root

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

clinical approaches developed by two of the most prominent Japanese acupuncturists of

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,

from the book Acupuncture, A Comprehensive Text, which is a translation of the

Shanghai CTCM textbook:

! In Chinese Medicine, emphasis is placed upon distinguishing the relative

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

reversed. Occasionally, both may be treated simultaneously, or one treated exclusive of

5


6/77

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 support the normal, since the expulsion of the abnormal

Qi from the body depends primarily upon the organisms ability to resist disease.

! Helpful comments from Denmei Shudos excellent Japanese Classical

Acupuncture: Introduction to Meridian Therapy, in which he quotes other sources:

!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)

! (Root treatment) is the treatment in which the imbalances in the meridians,

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

rendered according to the...complaints of the patient by treating localized

areas. (Fukushima, 1979)

! (Root treatment) is the correction of imbalances in the meridians by using the

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

treatment is performed simultaneously in accordance of the symptoms by directly

6


7/77


8/77

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)

! Yoshio Manaka provides an excellent definition of root treatment in his

posthumously published work, Chasing The Dragons Tail:

-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

the rest of the treatment.

-Specific factors, such as individual and constitutional differences, can be taken into

consideration.

-It requires some simple, verifiable diagnostic confirmation.

-Such checks allow selection of points for patients who are otherwise difficult to

diagnose by other means.

-The method of treatment can de decided for incipient diseases that are beyond

detection by means that depend on symptoms.

-Problems and imbalances can be detected and treated at preclinical or functional

stages before a pathology becomes evident. In ancient China, there was a tradition that

the superior physician treated diseases before they occurred.

! While it is difficult to generalize about Japanese acupuncture, given the vast

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


9/77

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

needling accomplished its objective.

!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

skin in general, disappearance of abnormal palpatory findings such as pressure pain,

increase in circulation to the extremities and in digestive motility, and subjective

improvements such as relief from symptoms in the patient. He continues, The

immediate, subtle response of the body to needling sends a very important message to

the practitioner about the correctness of the treatment.

! Even if we accept Shudos 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

philosophies. It is important to note the scope of acupuncture practice in Japan, and to

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


10/77


11/77

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) .

! Among those schools in Japan that claim adherence to classical principles,

perhaps none is as widely known as the Meridian Therapy movement, founded in the

1930s and 1940s in Tokyo. Traditional medicine had been largely supplanted by

modern theories of anatomy and physiology which had been introduced in Japan by the

Dutch as early as the seventeenth century . An acupuncturist and philosophy scholar

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

journalist-turned-acupuncturist Shinichiro Takeyama; the three of them are considered

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

and because it presents a systematized and self-contained system of acupuncture

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

of this particular conceptual system it occupies a prominent place since it appears to be

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


12/77

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

indeed, it is arguable, to the art of acupuncture as a whole - is the concepts it introduced

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

16, about which more will be said below.

! 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 doesnt fit well with the eight guiding criteria, and is largely discarded

as an anachronism, a pseudo-mystical historic curiosity no longer relevant to the

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

of the principles of Five-Phase dynamics.

12


13/77


14/77


15/77


16/77


17/77

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

grouping of symptoms is found through looking, listening and questioning, it is very

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.

! Pulse diagnosis is less commonly used in Extraordinary Vessel Therapy (KiKei

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

practitioner whose diagnostic framework and treatment protocols are outlined in

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


18/77

positions at the superficial level. She apparently uses this method exclusively, and no

mention is made of anyone else who has adopted her innovations .

Palpation of the abdomen (Hara) and meridians

! Among practitioners of Meridian Therapy, the prototype for abdominal diagnosis

comes from the Nan Jing, Difficulty 16 (see diagram). Most practitioners of Meridian

Therapy follow some variant of this scheme.

! 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.

The navel is the starting focus.

18


19/77


20/77


21/77


22/77


23/77

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

symptom-control tool for Yoshio Manaka, to be used only at the conclusion of 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

needles may be routinely used) becomes a supplementary technique in Meridian

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

each with its own unique methods for root treatment.

Part II: Comparison of Styles: Toyo Hari & Manaka

Toyo Hari

! The Toyo Hari Gakkai (East Asian Acupuncture Medical Association) was

founded in 1959 by Kodo Fukushima, a student of Inoue. Fukushima, blinded during

the Pacific War, had originally formed the organization for blind Meridian Therapy

practitioners. The methods he and his association developed were based on extremely

delicate and refined techniques of examination (largely palpatory) and needle

technique. As the association continued to grow, sighted members were trained in

23


24/77

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

Meridian Therapy movement was founded by sighted practitioners, blind acupuncturists

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

is perhaps not representative of other Meridian Therapy associations, but it is

nonetheless a fascinating system with which the author is well acquainted. A basic

overview with some specific examples follows.

Paradigm---Five Phase/ Four Sho Model

! The primary paradigm in Toyo Hari, as in other schools of Meridian Therapy, is

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


25/77

Other paradigms, such as Extraordinary Vessels, may also be used, but are assigned a

secondary role in the hierarchy of therapeutic methods.

! 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

imbalance is always defined in terms of a deficiency of a yin organ or meridian...the yin

organs or meridians have a tendency to become deficient, and the Yang organs and

meridians to develop excessive conditions. From these patterns of deficiency of the

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

will be of little avail.

! 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

a Japanese pronunciation of the Chinese Zheng): Symptoms are the manifestation of

disease and represent the condition of the body. Akashi is of a higher level. It is the

25


26/77


27/77

-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

tonification or dispersion with appropriate needles in an appropriate quantity. Determine

the patients constitution; decide what kind of needle to use; what kind of stimulation and

how much; how many points to treat.

-In addition to five-phase diagnosis, you must determine if they are of Yin or Yang

constitution. Look at the pathology...is it Yin or Yang? Old or New? Slowly-developing or

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.

Determine the Sho based on these findings.

-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

circulation of the Ki-Ketsu (Qi and Blood) of the body.

27


28/77


29/77


30/77


31/77

Tools and Techniques

! As Shozo Takahashi-sensei, vice-president of the Toyo Hari Medical Association,

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

in diameter, and 25-40mm in length), characteristically made of silver and sometimes

gold. In contrast to the techniques used in the PRC, which are aimed at eliciting a

strong sensation of distension or soreness (called deqi or obtaining Qi) by deep

insertion and pronounced manipulation, the Toyo Hari practitioners advocate subtle

techniques in which the needle is manipulated in ones consciousness as much as with

ones 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

needle is withdrawn in a strictly prescribed manner according to the findings gleaned

during selection of Sho.!

! All one really needs when treating patients is a needle and one s 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

formation of a good oshide is considered crucial, especially during tonification. 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


32/77


33/77


34/77


35/77

speeds up the process...In terms of the overall care of the patient...its value is far less

significant than that of Fundamental Healing.

! 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

than local treatment.

Methods

Midnight-Noon (ShiGo)

! ShiGo (Chinese: Zi Wu) is a system of point selection based on the circadian

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:

3-5 a.m.: Lung

5-7 a.m.: Large Intestine

7-9 a.m.: Stomach

9-11 a.m.: Spleen

35


36/77

11 a.m.-1 p.m.: Heart

1-3 p.m.: Small Intestine

3-5 p.m.: Bladder

5-7 p.m.: Kidney

7-9 p.m.: Pericardium

9-11 p.m.: Triple Burner

11 p.m.-1 a.m.: Gallbladder

1-3 a.m.: Liver

!When opposite sides of the diagram are combined, a Yin-Yang/hand-foot

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

meridians are paired thus:

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


37/77


38/77


39/77

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

distending sensation of TCM acupuncture, a warming sensation in the affected area or

meridian is considered a positive sign. As in other techniques in Meridian Therapy,

strong needling is avoided and is considered detrimental to proper treatment.

! 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 treatment anymore. It has become a whole-body treatment, a complex micro-

system of acupuncture in which virtually any complaint may be addressed.

! 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

curiously shaped needles designed to stroke or scratch the cutaneous meridians

(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


40/77


41/77

practiced these modalities from 1960s 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

medicine as he could, and evaluated each according to his own research.

! As he went on in his career, he gravitated more to the subtle methods of those he

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 primitive

information system in the body that has embryological roots, but is masked by the more

advanced and complex control (regulation) systems... cannot be explained by

neurophysiology because it manifests and is manipulated clinically with minute stimuli or

influences that cannot be clearly said to affect the nervous system... we feel it is a

biological system as yet undiscovered by biologists and anatomists.

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

the use of magnets and other polarity agents in acupuncture.

Paradigm---Multi-Model

! Manakas model is based on a number of paradigms, refined by his own

research. The Extraordinary Vessels were of particular importance, especially during

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


42/77

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

applied in a whole-body approach that Manaka adapted from master moxibustionist

Sawada. Unusual treatment methods, such as shining colored LED lights on five-phase

points or applying sonic stimulation at various frequencies to different meridians, were

also routinely employed.

! Manakas clinical protocol is lengthy and involved; Stephen Birch has noted that

it may be done in 45 minutes, if youre brisk . Manaka

s protocol is constructed in five

steps, the first three of which he considered the root treatment and the remaining two

the supplemental treatment.

! The protocol can roughly be charted as follows:

Step One:

Treat the Yin (front) side of the body

Paradigms:

Extraordinary Vessels; Polar Meridian Pairs; Biorhythmic Methods; Taiji Moxibustion

Methods:

Mainly Ion Pumping Devices (see below)

Step Two:

Treat the Yang (Back) side of the body

Step Three:

Treat the Meridian-Sinew imbalances

Paradigms:

42


43/77

Related Back-Shu points (Step Two); Reactive points along Yang Meridians

Methods:

Kyutoshin (Needle Moxa); Fire Needle; Moxibustion; Sotai exercise

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

abdomen. Manakas Mu points would be pressed, and the Extraordinary Vessel

configurations would be tested. Reactive Mu points that appeared in polar meridian

combinations would be confirmed with palpation of relevant areas on the gastrocnemius

muscles. Any findings regardless of paradigm could be confirmed by positive o-ring

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

the three commonly-used methods outlined above could be employed. Another

possibility would be the Taiji moxa treatment developed by Sawada and refined by

Manaka.

Treatment staging I: Root Treatment (Steps 1, 2 & 3 )

Approaches to diagnosis

Assessment of Condition

! In his book, Chasing the Dragons Tail, Manaka offers this explanation of akashi

(or Sho, as described above) as opposed to diagnosis in the modern biomedical sense:

43


44/77

! Akashi is a collection or pattern of signs and symptoms that center on a

treatment adaptation or method. Thus, depending on what treatment method is

selected, the akashi will be different, where in Western biomedical terms, several cases

might all be the same disease entity, regardless of treatment possibilities.

! Akashi can be said to depend on the intentional consciousness with which we

observe the patient... However, this makes the akashi dependent on the style,

experience sensitivity, and ability of each practitioner.

! In Manakas 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

reactive Mu point combinations, along with a system of palpation of reactive zones on

the gastrocnemius muscles (see Table).

Manakas Mu Points

Lungs - LU 1 to LU 2 area

Percardium - PC 1

Heart, Pericardium - CV 17

Heart - KD 23

Heart - At the sides of CV 14

Liver - LV 14 to GB 26 (esp right subcostal)

Gallbladder - GB 24 to GB 29 region

Stomach - Beside CV 12 (including ST 21)

Spleen - GB 26 to SP 21 region

44


45/77

Kidneys - KD 16 (occasionally GB 25)

Triple Warmer - ST 25 (or slightly lateral)

Upper Warmer - CV 17

Middle Warmer - CV 12

Lower Warmer - CV 5

Small Intestine - ST 26 (or slightly lateral)

Large Intestine - ST 27 (or slightly lateral)

Urinary Bladder - KD 11

45


46/77


47/77

! 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

Extraordinary Vessel pattern, step Two would follow thus:

! -Yinqiao Mai-Ren Mai, kyutoshin (moxa-needle) on UB 23 and/or 25

! -Yangqiao Mai-Du Mai, kyutoshin on UB 27 and/or 28

! -Yinwei Mai-Chong Mai, kyutoshin on UB 18 and/or 20

! -Yangwei Mai-Dai Mai, kyutoshin on UB 19 and/or 22

!-Cross-Syndrome, kyutoshin on UB 18 and/or 27, 25, 23

All of these may be supplemented or supplanted by points of pressure pain.

! 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

examination typically reveals the following associated with organ patterns:

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

22, and problems in the left shoulder.

Lung problems often result in shoulder and intrascapular tension, as well as stooped

shoulders and upper back.

Kidney problems often manifest as lumbar problems from UB 23 to 52.

! 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


48/77

Feedback systems

! Feedback in this style is largely gauged through the relief of pressure pain or

tightness in the previously palpated abdominal or gastrocnemius zones. Omuras o-ring

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

the imbalances in the meridian-sinews have been corrected.

Approaches to treatment

Choice of Method

! Manakas 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,

extraordinary vessel therapy, or biorhythmic treatments has provided the greatest

effectiveness and utility.

48


49/77

! Step One treatments, as noted above, are chosen primarily from Extraordinary

Vessel or Polar Meridian pair models; barring clear indications of either of these,

biorhythmic open points or Sawada/Manaka Taiji moxibustion treatments may be used.

Taiji moxibustion, as practiced by Manaka, would consist of tiny direct moxa on CV-12,

ST-25, CV-4 or CV-7, TB-8, Manakas 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, Manakas 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. Birchs

translation of the term Keiraku Chiryo, implying a five-phase paradigm) alone as

constituting proper root treatment; the channel sinew, extraordinary vessel, or

biorhythmic treatments would all be seen as supportive treatment.

! In this way, Manakas 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.

Tools and Techniques

! In Manakas 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

of tonification and dispersion.

! Step one treatments are generally done with ion-pumping devices, instruments

invented by Manaka himself. There are three varieties, developed over time. The

49


50/77

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

seconds to accomplish their mission.

! 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


51/77

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

Metal, black for Water, and orange for Source points.

! 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

Sotai system developed by Keizo Hashimoto .

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,

and sometimes one or the other is eliminated.

Treatment staging II: Supplemental (Branch) Treatment (Steps 4 & 5)

Methods

! Manaka referred to his branch methods as symptom control; sometimes the

root treatment would provide sufficient relief, and further treatment would be

51


52/77


53/77


54/77

involved are so subtle, one must be able to increase one s perceptivity in the clinical

context.

! Didactic approaches from Japan, such as the Toyo Hari associations 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.

!Mark Seem, in his book Acupuncture Imaging, notes ...the tremendous

importance of Kiiko Matsumotos own work in this country, as she tries to engage

American practitioners in...a phenomenological approach...intervening in terms of the

patients own present condition whether or not it fits some preconceived clinical

syndrome or pattern...When a practitioner probes the patients body very carefully,

showing that he knows where to palpate, this reinforces the patient s own internal

knowledge and awareness that her signs and symptoms are all connected to the same

underlying imbalance...

! An understanding of Japanese methods is not only advantageous for the student

and educator; longtime professionals may gain new insights and benefits as well. As

the practice of acupuncture turns more towards complementary medicine (with

consequent time constraints), more efficient methods of assessment may be needed;

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


55/77


56/77

physical therapy cage in which many earnest practitioners find themselves. Perhaps

further scientific research will bring us closer to Manakas X-signal hypothesis, or a

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

here as the art continues to evolve.

56


57/77


58/77


59/77


60/77


61/77


62/77

Appendix II

Comparative Symptomology of Extraordinary Vessels

REN MAI

Manaka: Gynecological problems; hemorrhoids; asthma; bronchitis; lung problems;

neurosis; toothache; ear, nose and throat problems.

Nagatomo: Emphysema; catarrh; asthma; lower abdominal diseases; skin diseases.

Bachmann: Respiratory tract diseases; lower abdominal diseases; diabetes; eczema;

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

lower abdomen; general pain; diarrhea; constipation; urinary incontinence, anuria or

hematuria; general gynecological disorders; birthing difficulties; special circulatory

problems particular to women; nervous disorders; hemorrhoids; anal prolapse; cold or

hot feet; kidney diseases; general lack of vigor.

Shanghai CTCM: Pathological symptoms of the Yin channels, especially Liver and

Kidneys; uterine disorders; infertility; urogenital disorders; leukorrhea; irregular menses;

colic.

Feit/Zmiewski: (repletion) menstrual disorders; vaginal discharges; male urogenital

disorders; head and neck pain; abdominal distension and pain; mouth and tongue

abscesses. (depletion) pruritis; heaviness of loins and lumbar area; shan qi pain.

62


63/77


64/77


65/77


66/77

YANGQIAO MAI

Manaka: Whiplash; epilepsy; speech disorders; shoulder pain; lumbar pain; unusual

sweating; trigeminal neuralgia.

Nagatomo: Any bleeding problem; stroke; hemiplegia.

Bachmann: Any skin bleeding disorder; edema; swelling; CVA; hemiplegia; tinnitus.

Fukushima: (see Du Mai)

Shanghai CTCM: Eye diseases; tightness and spasms along lateral leg muscles with

flaccidity of medial leg muscles; lumbar pain and stiffness.

Feit/Zmiewski: (repletion) General weakness of Yin organs and functions 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

improve at night; fatigue, lassitude or weakness during the day.

YANGQIAO MAI (palpation)

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

GB-29 and UB-36; UB-62; GB-21.

66


67/77

CHONG MAI

Manaka: Heart problems; neurosis; stomach problems; gynecological problems; cold

feet; liver/gallbladder problems; problems of anus.

Nagatomo: Painful diseases of the abdomen or chest; non-fixed rheumatic symptoms.

Bachmann: Pain that moves; late menses causing suffering of the heart and

palpitations that lead to insomnia; intestinal spasms.

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;

abdominal distension or pain; pain, cramping, palpitations or upward flushes on the

sides of the abdomen (Spleen) or around the umbilicus (Kidney); nausea or vomiting;

diarrhea; constipation; bleeding affiliated with the stomach, kidneys or large intestine;

gynecological diseases; endocrine disorders; menopausal ailments; hemorrhoids.

Shanghai CTCM: Gynecological disorders; male sexual disorders including impotence;

abdominal pain; colic.

Feit/Zmiewski: (repletion) Weakness of abdominal organs; menstrual block or

irregularity; ! insufficient lactation; nervous or motor atony; impotence.

(depletion) Lower abdominal spasms or pain; prosatitis; urethritis; orchitis; seminal

emission; metrorrhagia, menorrhagia; hematemesis.

CHONG MAI (palpation)

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),

SanInKyo (SP-6) and KoSon (SP-4).

67


68/77


69/77


70/77

disorders; distension of the ribs and lower abdomen; general pain; coldness and pain in

the lower back; irregular menses; abnormal vaginal discharge.

Shanghai CTCM: Fullness in the abdomen; irregular menstruation; leukorrhea; lumbar

pain; weakness and motor impairment of the lower limb.

Feit/Zmiewski: (repletion) Superficial repletion of Yang channels; lumbar and loin pain;

pain in lower extremities; weakness of shoulders and upper extremities on opposite

side; weakness of opposite eye, breast or ovary. (depletion) Cold or heaviness or

weakness in lumbar and loins; white vaginal discharge; uterine prolapse; abdominal

distension; pain and inflammation in opposite shoulder, upper extremity, eye, breast or

ovary.

DAI MAI (palpation)

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;

Gallbladder meridian, particularly GB-41; UB-23.

YANGWEI MAI

Manaka: Dizziness; headache; whiplash; sweating problems; trigeminal neuralgia;

fatigue; eye and ear problems.

70


71/77


72/77

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

combined with HT-7 or PC-6, depending on specific symptoms.)

GOKOKU / KANKOKU (LI-4/ST-43)

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

diseases; acute emotional disorders.

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)

and Ashi SanRi (ST-36).

TAISHO / TSURI (LV-3/H-5)

Symptomology: Symptoms along the course of the meridians; vertigo; Alzheimers

disease; emotional disorders; eye afflictions; disorders of the endocrine system; thoracic

or flank pain and distension; muscle cramping; sweling; coldness; lack of motivation.

72


73/77


74/77


75/77


76/77

Papers

Birch, Stephen. Dr. Manakas Yin-Yang Balancing Treatment (Parts 2 & 3), North

! ! American Journal of Oriental Medicine, Vol. 2, No. 3, March 1995, p 4-6;

! ! Vol. 2, No. 4, July 1995, p 5-7

Kuwahara, Koei. If You Dont Try to Fix it, it Fixes Itself North American Journal of

! ! Oriental Medicine, Vol. 2, No. 5, November 1995, p 22-25

Manaka, Yoshio. Japanese and Chinese Acupuncture: Similarities and Differences,

! ! North American Journal of Oriental Medicine, Vol. 1, No. 2, November

! ! 1994, p 5-9

Nakada, Koryo. Basic Needling Techniques of Toyo Hari North American Journal of

! ! Oriental Medicine, Vol. 2, No. 4, July 1995, p 24-26

Romano, Augusto. Toward your own style of acupuncture, American Journal of

! ! Acupuncture, Vol. 20, No. 2, 1992

Shima, Miki. Looking Forward, North American Journal of Oriental Medicine, Vol. 2,

! ! No. 5, November 1995, p 5

Van der Poorten, Nancy. A Visit by Dr. Iriye to Toronto, North American Journal of

! ! Oriental Medicine, Vol. 2, No. 5, November 1995, p 35

Other Sources

Shima, Miki. JAAF Video Series: Mysteries of the Needle, Japanese American

! ! Acupuncture !Foundation, Corte Madera, CA, 1992

Stephen Birch lecture at AAAOM convention, Austin, TX, 1990 (unpublished audio tape)

76


77/77

honchi ho, hyochi ho: root and branch treatment staging in contemporary japanese acupuncture

Documents