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Thoughts on Using Chinetsukyu in Meridian Therapy

By Robert Hayden, L.Ac.

Although Meridian Therapy is based on supplementation and drainage of vephase points using needles, moxibustion plays an integral role in the treatment as well. I did not understand this fully until I began to watch treatments by master practitioners, and then began to incorporate more and more moxibustion into my own practice. As most readers of NAJOM are aware, numerous methods of moxibustion exist. However, most of the practitioners with whom I've studied routinely use just two types: direct moxibustion with very small pieces of moxa, and chinetsukyu. This article will explore the latter type, chinetsukyu. Method Chinetsukyu is usually translated as "heat perception" or "sensing heat" moxibustion. A at-bottomed cone of medium-grade moxa is fashioned, placed on the skin and ignited. The therapist then allows it to burn until the patient indicates that the desired amount of heat is felt, whereupon the burning cone is removed from the skin. The size of the cone may vary. Junji Mizutani mentions the cones as being the size of an azuki bean(8). Kodo Fukushima describes it as being the size of the tip of the little nger(2). Masakazu Ikeda gives dimensions of 1 cm at the base and 1 cm high(3). I have personally seen larger cones used, and I tend to use a variety of sizes depending on the location of the point and the effect I want to elicit. The method of chinetsukyu used in Meridian Therapy is associated closely with Keiri Inoue(2). Mr. Ikeda told me the method is sometimes called "Inoue-style chinetsukyu"(5). Commonly some medium is used to ensure that the burning cone does not roll off once it has been placed on the skin. Often this is done with water, either moistening the bottom of the cone or the skin itself. I have also seen sesame oil used for this

purpose(5). Indications Chinetsukyu is used mainly as a local or supportive treatment, though it has a fairly broad range of indications. Chinetsukyu is commonly used for points which manifest pressure pain (2)(7), as well as tightness, heat, or swelling (6)(7). Ikeda mentions: "When heat stagnates in certain areas to cause pain (as with inammation) it becomes necessary... to remove the heat. The simplest approach would be to use chinetsukyu". (4) Contraindications Chinetsukyu can burn the skin if used improperly. Use extreme caution on people who are not able to properly sense the amount of heat. This includes people with diabetic or other types of neuropathy, as well as elderly people. People who have difculty articulating their sensations, such as infants, should be treated with careful attention. This last category includes unconscious or semiconscious people; I personally have had people fall asleep while the cones are burning, only to be awakened with a start by the heat. It pays to keep an eye on their face or breathing and not just on the moxa. In any case, once the moxa smoke appears to be circulating around the bottom of the cone, remove it at once. Always check the skin surface for redness before reapplying the moxa. Supplementation and drainage Since Meridian Therapy is based on root treatment using supplementation and drainage of meridians, it is only natural that these concepts nd their way into supportive treatments, such as moxibustion, as well. An interesting disagreement among sources occurs around the subject of supplementation and drainage. For Ikeda, drainage may be looked at as "cooling" the point (this is based on Su Wen 54). Chinetsukyu's "Effect ... is to warm up the skin surface and facilitate the release of yang qi to remove heat and also to soften up indurations." He concludes that chinetsukyu is actually contraindicated for vacuity cold conditions (4). Fukushima mentions that it "...principally results in a sha (draining) effect", but mentions that supplementation is possible by "removing the cone... when the patient rst notices a warming sensation."(2) This view

apparently comes from Inoue himself. Once when asked about chinetsukyu, Inoue believed that chinetsukyu is effective for a replete condition in a meridian, but went on to state that experimentation was being done (in conjunction with an unnamed practitioner in Nagasaki) to achieve supplementing effects as well. He elaborated:

"Normally with chinetsukyu, rst it feels warm and then it feels hot. For vacuity conditions the cone should be removed when it feels warm, before it gets hot. For a replete condition in the meridian, there is no warm sensation, and it feels hot all of a sudden. The initial warm sensation is not felt especially on inamed areas. For replete conditions, apply one cone per point, and for vacuity, apply ve warm cones."(6)

In Toyohari, drainage is specic to the removal of Ja Ki (pathogenic Qi), whether internal or external, and hot and cold are not such a consideration when applying chinetsukyu. In the clinics of the Toyohari practitioners which I observed, chinetsukyu is used quite liberally in conditions which Mr. Ikeda would consider it contraindicated. It is often used for supplementation as well as drainage (2) (10) (14). Interestingly, Ikeda himself specically recommends at least one clinical use of chinetsukyu for a cold pattern (frostbite, usually Liver Vacuity Cold Pattern) and some of his case histories mention using chinetsukyu although the pattern was one of vacuity cold (3), which seems to indicate that he applies the technique more exibly in the clinic. I might also mention that Ikeda tends to use cruder moxa than that of many Toyohari practitioners, which would also lend itself to a more draining type of heat stimulation(5). Applications of Chinetsukyu Root Treatment In the root treatment, chinetsukyu may be used to drain essential points (especially cleft or connecting points) on replete Yin or Yang channels(3)(14). Chinetsukyu can also be used on abdominal diagnostic areas which show reaction, or to

facilitate the circulation of Ki in the abdomen. Areas which are tight or show uid accumulation are better suited for draining methods, whereas areas that are accid on the surface are supplemented. Pulses which are difcult to read may be claried by supplementing CV12, ST25, and CV6. In his seminar last year in Hawaii, Ikeda sensei performed a demonstration treatment in which the subject was a Liver Vacuity pattern with Lung Heat. His point selection of choice was LV4 and K7, however he noted that the K7 area was abnormally stiff, so he suggested chinetsukyu to loosen the tissue. Branch Treatment Chinetsukyu has a broad range of symptomatic applications. A few of them follow. General guidelines are as indicated above. Look for redness, heat, tightness, accumulation or pressure pain for draining-type chinetsukyu and depressions or accidity for the supplementing type. Mr. Ikeda mentions that in cases of spontaneous pain, or Ki level pain, chinetsukyu is well suited. In this, he notes similarity to contact needling. In addition, he mentions instances where chinetsukyu accompanies or follows retention of needles. An example of these methods comes from his recommendations on treating Katakori (shoulder stiffness): "When there's spontaneous pain in the shoulder do wei qi tonication (contact needling) only. Never apply pressure. In meridian points in the chest area where pressure pain appears, kori will actually also spontaneously form on these people. This used to be commonly known as "kenpeki". It's good to do contact needling on the chest points. If there's heat use chinetsukyu. If there's pain retain needles at LU1 and LU7, also at hard points on the abdomen retain needles and do chinetsukyu." (4, p126) Ikeda's case histories show him making frequent use of chinetsukyu for a wide variety of ailments. Some conditions that he mentions are trigeminal neuralgia, joint pain (knees, shoulders, elbow and wrist), acute lumbar pain, phlebitis, heart conditions, and abdominal pain.

Following are some miscellaneous applications of chinetsukyu treatments, from a variety of sources: For high fever, DU14, up to 20 cones. (14) K2 for otitis media. (10) For diarrhea, CV8 or four points around the navel. For Kikei (Extraordinary Vessels) Treatment, two cones are burned on the master point, one on the coupled point. (9)(14) For any chronic problem, apply chinetsukyu to Pigen. (1) Sinus problems, Yintang and LI20; place a handkerchief over the nostrils and mouth to avoid inhaling the smoke. The patient should hold the handkerchief in place while the moxa is burning(14). Inoue Keiri recommended chinetsukyu around the nose, interscapular and low back, SI16, DU12, UB12, UB19, UB20, followed by sanshin (scatter needling, or quick contact needling).(12) For contusion,1st stage-2nd stage, or bruising from needle or for residual needle pain. (10)(14) K7 for menstrual pain (13), UB52 for dysmenorrhea in young women.(12) On the Naso area (around ST12), for any problem of the upper body. (14) Edward Obaidey recommends using chinetsukyu in pregnancy: UB14, UB17 during the period between 4-6 months, and UB14, UB15 from 10 months to birth. One can use CV17 post partum for poor lactation, also GB21, UB14, UB15, UB43, UB44. (11) Adjacent to post-surgical incision sites or post-herpetic sites. (14) Also very effective for mosquito bites. End of treatment After a particularly vigorous symptomatic treatment, I will frequently use chinetsukyu to nish off the treatment and rescue the pulse quality; this is something that is done often in Toyohari. In general I nd that the pulse becomes more soft and relaxed with supplementing chinetsukyu. Sometimes with this technique, the patient does not actually feel the heat, but a denite positive change occurs in the pulse. The pulse can be monitored or, after one has gained some experience, the proper amount can be judged more or less by one's intuition(9). Generally the amount of the cone burned for this technique is 70% or less(10).

In closing, I'd like to offer some personal observations. Chinetsukyu is a very simple, easily-learned yet powerful technique which can be employed throughout the treatment and even taught to patients to perform at home. The effects are somewhat different than direct moxibustion, and to me, each has their proper place. However, there are times -- for example, this past Summer when temperatures in Chicago reached over 100 degrees Fahrenheit -- when chinetsukyu was just plain easier to administer than direct moxa. So I do occasionally use them interchangeably. Currently my favorite moxa to use is "Unryu" or "Cloud Dragon" grade moxa, which is a little more pure than Wakakusa. I actually received a box by mistake, but I tried some and found it burns at a very comfortable temperature with less annoying smoke than other grades of moxa that I've used. I have clients who like chinetsukyu very much, and for them the treatment seems incomplete without it. One practitioner whose clinic I visited in Tokyo observed that it seemed more to him like a "service" than an effective adjunct to treatment. As much as I don't like to disagree with my elders, I personally have seen many cases where application of chinetsukyu was indeed just the thing to turn a so-so treatment into a good one. (My thanks to Stephen Brown for his help with some of the more difcult translation) References 1 Stephen Birch & Junko Ida, Japanese Acupuncture, A Clinical Guide, Paradigm Publications, 1998 2 Kodo Fukushima, Meridian Therapy, Toyohari Medical Association, 1991 3 Masakazu Ikeda, Dento Shinkyu Chiryoho (Traditional Acumoxa Treatment Methods), Ido no Nihon Sha,1996 4 Masakazu Ikeda, NAJOM #10 & #11 5 Masakazu Ikeda, Private notes from Hawaii 1999 6 Keiri Inoue, transcription of lecture, Keiraku Shinryo (Meridian Needle Therapy), December 1998 7 Keiraku Chiryo Gakkai, Nihon Shinkyu Igaku (Japanese Acumoxa Medicine), 1997

8 Junji Mizutani, NAJOM #5 9 Kazuto Miyawaki, Private notes, Osaka 1996, Seattle 1997 10 Koryo Nakada, Private notes, Tokyo 1997, Boston 1998 11 Edward Obaidey, NAJOM #11 12 Denmei Shudo, Private notes from Hawaii 1999 13 Akihiro Takai, Private notes from Tokyo 1996 14 Toyo Hari class handouts (Koei Kuahara et al) 1995