General Characteristics of Meridian Therapy

by Robert Hayden, Dipl. Ac.

Background Meridian Therapy is a style of acupuncture which was developed in Japan in the mid-1930's (about the same time as what's known as TCM was being formulated in China). During the modernization of Japan that began during the late nineteenth century, traditional East Asian medicine (which had come to Japan from China via Korea around the fth century, C.E.) was suppressed in favor of medicine which was based on the Western model. In the 1910's and 1920's a revival of Kampo (traditional herbal medicine, largely based on the Shang Han Lun) sparked at least one acupuncturist, Sorei Yanagiya, to reexamine the classical texts of acupuncture. Others became interested and studied with Yanagiya, most notably Sodo Okabe and Keiri Inoue. These two were largely responsible for the formulation of Meridian Therapy. Theoretical Foundations Meridian Therapy is based primarily on the earliest classics, the Huangdi Nei Jing Su Wen, the Huangdi Nei Jing Ling Shu,and, most specically, the Nan Jing. At its foundation, it is theoretically concise.
The primary paradigm is that of the Five Phases 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 (kyo), and the Yang organs and meridians tend to become excess (jitsu). From these patterns of deficiency of the Yin organs associated with the Five Phases come the four Sho (Chinese: Zheng) or patterns.

Lung Sho: Lung and Spleen Deficient Spleen Sho: Spleen and Heart (Pericardium) Deficient Liver Sho: Liver and Kidney Deficient Kidney Sho: Kidney and Lung Deficient (Note that there is no Heart Sho. This is because the Heart itself will rarely be deficient, and if it is, consequences are so serious that acupuncture therapy will be of little avail.)

This model makes for an extremely exible and pragmatic system. The treatment is essentially built into the pattern. It is perhaps not surprising that, during the years since Meridian Therapy was rst developed, there have been practitioners who found this model too conning and have sought to extend it theoretically.

Diagnosis Diagnosis in Meridian Therapy is equal to determining the pattern. For this, the classical Four Examinations are used.
1. Looking: General assessment, determine the patient's overall constitutional state, look at the five colors on the face and cubital area, etc. 2. Listening/Smelling: Listening to the quality of the patient's voice, listening for the Five Tones, determining the Five Odors, etc. 3. Questioning: Current complaint(s), questions related to specific complaint(s), relevant medical history, general symptoms, determining the Five Tastes, determining presence of Internal or External factors, etc. 4. Palpating: Palpation of the pulses (pulse quality and sixposition comparative pulse diagnosis),abdomen (hara) and meridians.

Of these, the Palpating examination is the most important. The sho should be determined through a synthesis of these factors, but the nal determination of the pattern is ultimately weighted in favor of the palpatory ndings, most notably the pulse examination.

Palpation is emphasized not only in determing the pattern, but also in point location (locating "live points" as opposed to location strictly based on anatomical landmarks). Palpation (particularly of the pulse) may also be used as a means of feedback to judge the quality and appropriateness of one's treatment.

Treatment Treatment is effected with the use of acupuncture and moxibustion. It generally proceeds in at least two stages:
1. Root Treatment Based on the pattern, its aim is to resolve the fundamental imbalances in the Yin and Yang organs and meridians through tonification and dispersion Point selection is primarily based on Nan Jing chapter 69: Lung Sho: LU9, SP3 Spleen Sho: SP3, P7 Liver Sho: LV8, K10 Kidney Sho: K7, LU5 These are standard point combinations, though point selection may vary based on a number of factors. What is consistent is the use of Five Phase points in these particular combinations of meridians. needles used are extremely thin (#00 - #2 gauge), and insertion is extremely superficial (generally less than 2 mm), with no needle sensation (deqi or hibiki). 2. Branch Treatment Based on the presenting complaint(s), its aim is to alleviate symptoms using tonification and dispersion. Point selection is primarily based on palpatory findings along the affected meridian or body area, and/or points that have been shown empirically to affect the presenting complaint(s). needles used may be thicker (#2 gauge or heavier), and insertion may be deeper, occasionally will evoke needle sensation (deqi or hibiki). Often involves supplementary methods: Moxibustion (okyuu), direct or indirect Bloodletting (shiraku)

Temporary implantation and retention of intradermal needles(hinaishin or empishin) etc.

It is worth noting that even during the Branch Treatment, the intensity of stimulation is generally very comfortable.

Developments Meridian Therapy is not monolithic. There are many different streams of thought coming from a common pool of Nan Jing-based theory. Major variations on this theme have been developed by, among others, Kodo Fukushima's Toyo Hari association and Masakazu Ikeda's Kampo Inyokai. The Toyo Hari association was originally conceived as a study group for blind acupuncturists. As a result, their primary emphasis is on very subtle palpatory skills. Their needling tends to be very light, with non-inserted, or contact needling (sesshokushin) a characteristic feature. Another strong characteristic of Toyo Hari is that the pulse is used as a system of feedback for virtually all phases of the treatment, and is the standard by which a successful treatment is judged. Theoretically, Toyo Hari has extended the four-pattern model to a hierarchy of primary and secondary patterns along the control cycle. An example would be treatment of a single patient for both a Lung Deciency Sho (primary) and a Liver Deciency Sho (secondary). This is contrary to standard Five-Phase theory, which states that two meridians in a control cycle relationship cannot be decient simultaneously. Masakazu Ikeda is a practitioner of Kampo as well as Meridian Therapy (in Japan, only medical doctors and pharmacists may prescribe herbal medicine). As a result, he has extended the theoretical parameters of Meridian Therapy by the addition of elements from Shang Han Lun theory. His Lung Sho, for example, includes subsets of Taiyang or Yangming excess, and his Spleen Sho includes a Yangming excess subpattern as well. He also includes some control-cycle

combinations into his pattern repertoire, for example simultaneous deciency of Kidney and Spleen. Thus, some of his material may be familiar to practitioners and students of TCM. There are theoretical differences from standard TCM theory, however, and his point selection and technique are much more sophisticated, similar in some ways to that of the Toyo Hari association. (Note: some of the differences between these two streams of Meridian Therapy may be seen in their abdominal patterns.) In addition to these, there are numerous other associations and hundreds of practitioners of Meridian Therapy. Some do straight four-pattern, root-branch types of treatment while others may combine elements of other systems, such as Extraordinary Vessels (kikei hachi myaku). The theoretical construct on which Meridian Therapy is founded has proven to be quite exible to adaptation, in addition to its clinical utility.

Conclusion This is of necessity a brief introduction to Meridian Therapy. For further information, it is recommended that one reads Denmei Shudo's excellent Introduction to Meridian Therapy or Kodo Fukushima's similarly titled Meridian Therapy, which specically outlines the Toyo Hari style.
The opinions expressed in this paper are solely those of the author, and are not necessarily those of any other person or organization. Any errors, omissions, misunderstandings or delusions are mine alone. Text and images 1998 Robert Hayden.