Thoughts on Using Chinetsukyu in Meridian Therapy

By Robert Hayden, L.Ac.

Although Meridian Therapy is based on supplementation and drainage of fivephase 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 flat-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 finger(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
inflammation) 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
difficulty 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 find 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 first 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, first 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 inflamed
areas. For replete conditions, apply one cone per point, and for vacuity, apply
five warm cones."(6)

In Toyohari, drainage is specific 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 specifically 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
flexibly 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 fluid
accumulation are better suited for draining methods, whereas areas that are flaccid
on the surface are supplemented. Pulses which are difficult to read may be clarified
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
flaccidity 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 tonification (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 finish off the treatment and rescue the pulse quality; this is
something that is done often in Toyohari. In general I find 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 definite 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 difficult
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