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Root and Branch Treatment Staging in

Contemporary Japanese Acupuncture


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
Table of Contents


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

! 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


Comparison of Point Selection of Meridian Therapy Founders ………………………..57

Comparative Symptomology of Extraordinary Vessels …………………………………62

Bibliography ………………………………………………………………………………….74


! 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 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

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

-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

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.”

! Helpful comments from Denmei Shudoʼs 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

Tonifying or dispersing reactive points or acupuncture points [resulting from]

imbalances.! There are, of course, cases in which the symptoms are relieved by root

treatment alone. In such cases, symptomatic treatment is unnecessary. However in

most situations these two treatments are equally important and necessary. (Takeyama,


! Shudo emphasizes the importance of both root and symptomatic treatment. “No

authority on meridian therapy claims that treatment of localized areas is

unnecessary...The only real difference between meridian therapy and the conventional

approaches to acupuncture in Japan is that root treatment is performed to balance the

body energetically before the specific symptoms are treated...The distinctive feature of

meridian therapy is that root treatment comes first...There are considerable differences

of opinion regarding just how important root treatment is relative to symptomatic

treatment. Some believe that root treatment takes care of 70-80% of the

symptoms...others believe that while root treatment corrects imbalances of Qi in the

meridians, it is not immediately effective in ameliorating the symptoms...{which must be}

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

distinct aspects of treatment. Root treatment is emphasized so much in meridian

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

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 Dragonʼs 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


-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

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 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 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

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.

! In the first part of our exploration into concepts of root treatment, we will examine

two of the most common paradigms in contemporary practice of traditional Japanese

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

in the extant translated literature on this subject.

Part I: Survey of Paradigms & Clinical Approaches


! 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

Japanese practice is warranted. Recommended reading on each may be found in the


Five-Phase (GoGyo)

! The history of the Five-Phase (Chinese: Wu Xing, Japanese: GoGyo) paradigm

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

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

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

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

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 “doesnʼt 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.

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

its coupled point with materials or techniques of dissimilar, unequal or “opposite”

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

prevalent in Japan that it has been adopted by even the staunchest of traditionalists,

though often only when treating the Extraordinary Vessels .

Biorhythmic/Stem-Branch (Un-Ki, ShiGo)

! A collection of therapeutic methods based on the principles of Chinese astrology,

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

(“Midnight-Noon Flowing and Pooling” or Zi Wu Liu Zhu) is based on the generating

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,

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

more detailed discussion can be found later.

Other Paradigms

! Though Five-Phase and Extraordinary Vessel models make up a large part of the

traditional diagnostic paradigms in Japan, there are important practitioners whose

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

Shima, who has a wealth of interesting techniques based on divergent meridian

diagnosis and treatment , and is the developer of his own kinesiological technique, the

“Iriye Finger Test”.

! 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,

creator of the intradermal needle that revolutionized the practice of acupuncture in

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

at all in the West.

Clinical Approaches (diagnosis-treatment)

Approaches to diagnosis of Root condition

Methods of Assessment

! Of the classical four examinations (visual, auscultation/olfaction, inquiry,

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

acupuncture practice in Japan. Even in the uniquely Japanese method of abdominal

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

Mu points (which may themselves have alternative locations between practitioners) or

other points which elicit pressure pain or other abnormal findings.

! Classical pulse examination, one of the “two pillars” of Chinese diagnosis, is

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

important in one style may be ignored in another.

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

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

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.

*CV-7 to CV-12 = Spleen diagnosis area

*CV-14 & CV-15 = Heart diagnosis area

*GB-24 to SP-16 right side = Lung diagnosis area; same area left side = Lung


*The flanks from GB-26 to GB-29 = Liver/Gallbladder diagnosis area

*CV-7 to CV-2 = Kidney diagnosis area

! In Meridian Therapy, the abdominal examination is used generally to confirm the

pulse finding; it is a vitally important component of the diagnostic process, but not one

that may stand alone, as in some other Japanese styles.

! As in other palpatory aspects of Meridian Therapy, the depth to which one

presses is generally superficial; though diagnosing diseases of the Blood level may

require deeper pressure, and some adjunct methods (such as Extraordinary Vessels

therapy) may need even more.

! 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

investigative nature and his multiparadigmatic way of thinking; different models

employed in root treatment have different abdominal configurations, and oneʼs findings

during the abdominal examination indicate the choice of paradigm in treatment. Details

of Manakaʼs hara configurations may be found in Part Two of this paper.

! Palpation may also include meridian palpation to assess the deficiency or excess

of the meridians themselves. In Meridian Therapy, it is primarily used to check the

condition of the five-phase points, though some schools use distal point palpation to

choose adjunct methods such as Extraordinary Vessel therapy. In Manakaʼs style, it

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

symptomatic points to be treated.

! Some practitioners use reflex areas discovered during their own long clinical

experience, and which are unique to their own practice. Consider Mr. Osamu Ito,

whose magnetic treatments are outlined in Extraordinary Vessels. His experience in

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


Systems of Feedback

! In contrast to the treatment methods of TCM-style acupuncture, where efficacy of

treatment is thought to be dependent upon the amount of needle sensation (“deqi”)

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

repalpated, reactive points reexamined, or kinesiological tests repeated to demonstrate

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

sternocleidomastoid muscles, to determine the treatment progress. Osamu Ito would

use his own palpatory zones or leg lengths to confirm the efficacy of the therapeutic


Approaches to treatment of Root condition

Tools and Techniques

! In contrast to the limited number of implements routinely employed in TCM-style

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

plated with various metals, based on their classical associations or on modern

electromagnetic research. An entire school of acupuncture created around the use of

complementary pairs of metals (the so-called “M-P” or “Minus-Plus” school of Tsugio

Nagatomo and Gerhard Bachmann) has become influential in Japan. These principles

have stimulated a variety of non-invasive procedures utilizing magnets or

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

a student of Nagatomo, and Nagatomo himself was influenced by Yoshio Manakaʼs

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

treatment-staging methods. Stephen Birch has remarked that each association of

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

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


! 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

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.

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, “ 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

fundamental nature of the disease and represents the goal of its treatment. Akashi is an

abstraction derived from an interpretation through meridian theory of the complex

symptoms of the patient... (it) is a holistic interpretation of the disease and contains the

practical information that determines how to conduct the therapy.”

Treatment staging I: Root Treatment

! In Meridian Therapy, Fukushima describes root treatment (here translated as

”Fundamental Healing”) thus: ”Fundamental Healing involves the application of ho

(tonification) and sha (dispersion) needling correct imbalances in the 12

meridians...The patientʼs illness must be interpreted holistically in terms of imbalances

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

medicine. It is Fundamental Healing based on ʻrebalancing meridian kiʼ that makes

Meridian Therapy a unique and outstanding medical discipline.”

Approaches to diagnosis

Assessment of Root Condition (Determination of Sho)

! The diagnostic process, or determination of Sho, proceed in three orderly steps:

! 1. Choose the treatment method

! 2. Analyze symptoms according to the twelve meridians

! 3. Select the primary meridian by pulse diagnosis. This is the Sho.

-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 it Yin or Yang? Old or New? Slowly-developing or

Quickly-developing? Yin diseases are often inapparent, while Yang diseases are often


-In the second step, one collects signs and symptoms and correlates them to the twelve


-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.

! 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

! A key in diagnostic confirmation is meridian palpation; the meridians diagnosed

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:

• Lung Sho: LU9, SP3

• Spleen Sho: SP3, P7

• Liver Sho: LV8, K10

• Kidney Sho: K7, LU5

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 .

! As mentioned earlier, Toyo Hari makes use of a unique concept known as

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-

Source or Luo-Connecting point of the Sokoku meridian (see table).

! 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

concerns; the points needled are generally Yuan-source, Luo-connecting, Xi-cleft, or

any of the Five-Phase points which are reactive (i.e., tight, edematous, tender, etc.).

Generally only one point per meridian is needled.

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 oneʼs consciousness as much as with

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

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 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

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

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

themselves, nor between the fingertips and the skin.

! The following description of techniques used in the root treatment is based on

notes taken by the author during the course of his Toyo Hari training.

The most basic ideas behind Toyo Hari technique:

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

it, deterioration of the pulse (as well as the patientʼs condition).

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

-Right hand lightly grasps the needle handle

-Bring the tip of the needle to rest lightly alongside the left index fingertip

-Form the oshide

-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


-Recommended needles: 0.8-1.3 cun, #1 or #2 silver needle

SHA Technique (general):

-Use thicker needle; #2-#5 silver or stainless

-Locate point, bring needle tip to oshide

-Manipulate, apply downward left-hand pressure and remove needle

-Sha Technique is further classified according to:

" 1. type of Jitsu (external or internal)

" 2. particular pulse quality

-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”

2. Genjitsu Pulse means pathogen is on Ketsu level; it is Sinking and Wiry

-#3 stainless needle placed against meridian flow, push in 2-3 mm

-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


Assessing treatment

! Assessing the effects of treatment involves basically a reexamination of the pulse

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

shape of the navel may become more symmetrical.

! 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

treatment should stop and corrective measures may be applied.

Treatment staging II: Branch Treatment

! The second stage of clinical procedure, or branch treatment, is called “Targeted

Healing” in the translation of Fukushimaʼs Meridian Therapy. This is contrasted with

“Fundamental Healing” or root treatment, described above. Fukushima describes it

thus: “Targeted Healing is a system for the direct treatment of the local afflictions

accompanying a patientʼs illness. The strengthening of Vital Energy through

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

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.


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


3-5 a.m.: Lung

5-7 a.m.: Large Intestine

7-9 a.m.: Stomach

9-11 a.m.: Spleen

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:


Large Intestine-Kidney


Spleen-Triple Burner


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

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


! 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

relevant point at the time when the symptoms occur.

! 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.


! In contrast to other styles in which Extraordinary Vessel therapy (KiKei Chiryo) is

used as the primary treatment, Toyo Hari practitioners employ it as a supplemental

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

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

the goiter” specifically.

! 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 & Muno

! 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,

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

direct moxibustion, microbleeding, intradermals, and needling into various empirical

points commonly used in Japan.

! As we have seen, the methods of treatment utilized by Toyo Hari Gakkai

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

be attempted: this is the style developed by Dr. Yoshio Manaka.

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

archetypal Japanese acupuncturist”; he was both scientist and classical scholar, a

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

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

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 ʻprimitive

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.


! Manakaʼs 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

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.

! 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

the supplemental treatment.

! The protocol can roughly be charted as follows:

Step One:

Treat the Yin (front) side of the body


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


Mainly Ion Pumping Devices (see below)

Step Two:

Treat the Yang (Back) side of the body

Step Three:

Treat the Meridian-Sinew imbalances


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


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. Manakaʼs 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


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

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:

! “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 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

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

the gastrocnemius muscles (see Table).

Manakaʼs 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

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

! 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).

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. Omuraʼs 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

! 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,

extraordinary vessel therapy, or biorhythmic treatments has provided the greatest

effectiveness and utility.”

! 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, 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

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, 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


Tools and Techniques

! 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

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

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

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)


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

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

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

example, a Liver problem might warrant an intradermal on UB-18, on the corresponding

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


! 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

blow-dryer and cardboard shield in place of warming moxibustion. Another innovation is

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

time to a metronome. The metronome is set to specific speeds, determined by Manaka,

which have an effect on various meridians. For example, a toothache could be treated

by tapping LI-4 at 108 beats per minute, as that is the rate described by Manaka as

affecting the Large Intestine meridian. In some cases, assistance is needed.


! 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

variety of methods used in supportive treatment (the applications of which continue to

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

Shinkyu Topology Gakkai (“Acupuncture and Moxibustion Topology Association”, a more

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

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


! 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”.

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

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

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

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

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

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...”

! 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

approaches to adapt to those who are needle-phobic, or others for whom the more

aggressive methods brought to us from the PRC are odious.

! 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

associations. Though famous in Japan, he is virtually unknown here. Of the various

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

Medicine, or NAJOM, an excellent publication highlighting mainly Japanese styles), Miki

Shima, and others that more systems of diagnosis and treatment will be brought to the


! 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

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

further scientific research will bring us closer to Manakaʼs “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.

Appendix I

Point Selection for Standard Sho: Comparison of Meridian Therapy Founders

Sorei Yanagiya


LIVER LIV-8, K-10 LIV-4, LU-8

SPLEEN SP-2, H-8 LIV-1, SP-1

LUNG LU-9, SP-3 H-8, LU-10

KIDNEY K-7, LU-8 SP-3, K-3

! Yanagiyaʼs point selection outlined here is identical to the “four-needle” technique

taught in most schools of acupuncture. Here the “mother”(representing the preceding

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

(representing the “controlling” phase on the controlling or overacting cycle) of the

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

! 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

whole being deficient or excess.

! 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

tonification of the Spleen, as it is without five-phase association; as a crossing point for

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

appears to be an overall tonification of the Earth Phase.

! The Lung Sho is a fairly standard application of four-needle technique, except

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-

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

point, and ST-36 is preferred here over ST-41.

! 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

paired Yang channel.

Keiri Inoue

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

meridians tended toward excess, and as such should not be tonified.

! 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

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

dispersed. As an example, deficient Yin Wood requires dispersion of Yang Metal

(controlling) and Yang Earth (controlled).

! 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

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

meridian). Again, the Luo points may be added or substituted.

Denmei Shudo

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

disperse points according to the presence of tenderness or induration. In some cases,

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

to directly disperse Yin meridians.

Appendix II

Comparative Symptomology of Extraordinary Vessels


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;


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;


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.

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

points along the entire meridian.”

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.


Manaka: Urinary problems; gynecological problems; cold feet; intestinal problems.

Nagatomo: Peritonitis; hepatitis; nephritis (related to hypoxia or acidosis).

Bachmann: Insomnia; chronic pharyngitis; intestinal poisoning; jaundice; menstrual

cramps; uterine bleeding; late labor; leukorrhea; prostatitis; impotence; bladder spasms;


Fukushima: (see Ren Mai)

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

genitals; hernia; leukorrhagia.

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

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

eyes; hypersomnia. (depletion) Aggravations during the night; nocturnal headaches,

cramps or convulsions; insomnia.

YINQIAO MAI (palpation)

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.


Manaka: Epilepsy; fatigue; spine and neck problems; neurosis; insomnia; superficial

invasion of e.p.f. (Taiyang syndrome).

Nagatomo: Rheumatic arthritis of the spine; inflammation of the joints; neuralgia; head

and neck pain; emotional problems.

Bachmann: Rheumatic arthritis of the spine; inflammation of the joints; neuralgia; head

and neck pain; emotional problems; overexcitement; nervous breakdown; lack of

concentration; insomnia; melancholia; lethargy; epilepsy.

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

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,

spontaneous sweating, night sweats; Alzheimerʼs disease; lack of mental clarity;

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

colic, constipation, enuresis, hemorrhoids, functional infertility.

Feit/Zmiewski: (repletion) Opisthotonos; back pain; stiffness of the spine; headaches;

hallucinations; jing-shen disorders; eye pains; hyperexcitability; seizures. (depletion)

Head slumping forward; walking with rounded shoulders; lack of physical and mental

strength; weak personality; hemorrhoids; sterility; impotence.

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

pressure to points along the entire meridian.”

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.


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.


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).”

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.


Manaka: Nervousness; heart problems; palpitations; psychological problems; insomnia;

stomach problems.

Nagatomo: Symptoms similar to those of the Chong Mai, but with less emphasis on

pain; palpitations; difficulty breathing; phobias.

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;

forgetful; easily excited; excessive emotional sympathy; suffering in the chest;

borborygmus; no appetite and weight loss with stabbing pain in the intestines at the side

of the abdomen or around CV-15 with cold or exhaustion.

Fukushima: (see Chong Mai)

Shanghai CTCM: (not listed)

Feit/Zmiewski: (repletion) All deep pulses stronger than superficial ones; repletion of

thoracic organs; heart pains; hypertension; delirium; nightmares; thoracic oppression;

dyspnea; (with external depletion) weakness of homolateral shoulder, upper arm and

hand, and contralateral lower extremity. (depletion) All deep pulses weaker than

superficial ones; depletion of thoracic organs; timidity or fear; apprehension; nervous

laughter; emotional depression; hypotension; weak respiration. (with external repletion)

pain in homolateral anterior shoulder, upper arm and hand, and contralateral lower


YINWEI MAI (palpation)

Fukushima: “...can be thought of as the Heart Constrictor (Pericardium) meridian. Its

diagnostic points are TenTotsu (CV-22), KiMon (LIV-14), FukuAi (SP-16), DaiO (SP15),

FuSha(SP-13) and ChikuHin (K-9).”

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.


Manaka: Coldness or achiness in lower back; gynecological problems; menstrual

problems; problems in lower abdomen.

Nagatomo: Any joint pain; neuralgia; menstrual pain; toothache.

Bachmann: Rheumatic arthritis or neuralgia of the joints, toes, fingers, shoulders,

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

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


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


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.


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

fatigue; eye and ear problems.

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.).

Bachmann: Headache; joint inflammation; migraine; neck pain; gingivitis; writerʼs

cramp; eye tick; retinitis; poor circulation; hypotension; rapid pulse; arteritis; blepharitis

(swelling along eyelid); oversensitivity to seasonal change; thrombosis; skin

inflammation; eczema; pimples; skin swelling; irregular breathing; hemoptysis; epistaxis;

stuttering; ankle sprain; bedwetting; heartburn.

Fukushima: (see Dai Mai)

Shanghai CTCM: Chills and fever; vertigo; muscular fatigue, stiffness and pain; pain

and distension in the waist.

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

physical strength, especially during snowy or rainy weather.

YANGWEI MAI (palpation)

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


Manaka: Pressure pain or reaction may be found on: ASIS; TB-5; the Gallbladder

meridian between GB-29 and GB-21; GB-34 and GB-35.

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.)


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).”


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

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

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

Palpation: “TaiSho point is affiliated with the Liver meridian. Its diagnostic points are

Taisho (LV-3), ReiKo(LV-5), KyokuSen (LV-8), and KiMon (LV-14).”

“TsuRi point is affiliated with theHeart meridian. Its diagnostic points are TsuRi (H-5),

ShimMon (H-7), ReiDo (H-4), and KyokuSen (H-1).”


Acupuncture Texts

Fukushima, Kodo. Meridian Therapy, A Hands-on Text on Traditional Japanese Hari

! Based on Pulse Diagnosis, Toyo Hari Medical Association, Tokyo, 1991

Hashimoto, Keizo, with Yoshiaki Kawakami. Sotai, Balance and Health Through Natural

! ! Movement, translated by Stephen Brown and Richard Held, Japan

! ! Publications, Tokyo, 1983

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.

! ! Seifert, Paradigm Publications, Brookline, Mass., 1985

Liu, Bing Quan. Optimum Time for Acupuncture, Shandong Science and Technology

! ! Press, Jinan, PRC, 1988.

Manaka, Yoshio, and Ian Urquhart. The Laymanʼs Guide to Acupuncture, Weatherhill,

! ! New York/Tokyo 1972

Manaka, Yoshio, with Kazuko Itaya and Stephen Birch. Chasing The Dragonʼs Tail,

! ! Paradigm Publications, Brookline, Mass., 1995

Matsumoto, Kiiko, and Stephen Birch. Five Elements, Ten Stems, Paradigm

! ! Publications, Brookline, Mass., 1983

----. Extraordinary Vessels, Paradigm Publications, Brookline, Mass., 1986

----. Hara Diagnosis; Reflections on the Sea , Paradigm Publications, Brookline, Mass.,

! ! 1988

Omura, Yoshiaki. Acupuncture Medicine, Its Historical and Clinical Background, Japan

! ! Publications, Tokyo, 1982.

Seem, Mark. Acupuncture Imaging, Perceiving the Energy Pathways of the Body,

! ! Healing Arts Press, Rochester, VT, 1990.

----. A New American Acupuncture, Acupuncture Osteopathy, The Myofascial Release

! ! of the Bodymindʼs Holding Patterns, Blue Poppy Press, Boulder, CO, 1993

Shanghai CTCM. Acupuncture, a Comprehensive Text, translated by John OʼConnor

! ! and Dan Bensky, Eastland Press, Seattle,1981

Shudo, Denmei. Japanese Classical Acupuncture, Introduction to Meridian Therapy,

! ! translated by Stephen Brown, Eastland Press, Seattle, 1990

Unschuld, Paul. Medicine in China, A History of Ideas, University of California Press,

! ! Berkeley, 1985

---. Medicine in China: Nan Jing, The Classic of Difficult Issues, University of California

! ! Press, Berkeley, 1986

Veith, Ilza. The Yellow Emperorʼs Classic of Internal Medicine (Revised Edition),

! ! University of California Press, Berkeley, 1966

Wu, Jing-Nuan. Ling Shu; the Miraculous Pivot, Taoist Center, Washington D.C./

! ! University of Hawaii Press, Honolulu, 1993

Yoo, Tae Woo. Koryo Sooji Chim: Koryo Hand Acupuncture vol 1, Eum Yang Mek Jin

! ! Publishing Company, Seoul, 1988.

Zmiewski, Paul, and Richard Feit. Acumoxa Therapy, A Reference and Study Guide,

! ! Volume 1, Paradigm Publications, Brookline, Mass., 1989


Birch, Stephen. “Dr. Manakaʼs 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 Donʼt 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)

Lecture notes and private conversations during the course of authorʼs Toyo Hari

! ! training, 1995-96 (Lectures by and conversations with Akihiro Takai,

! ! Toshio Yanagishita, Shozo Takahashi, Koryo Nakada, Koei Kuahara,

! ! Stephen Birch, Junko Ida)

Private interviews with Stephen Brown, L.Ac., Augusto Romano, L. Ac., and David

! ! ! Fuselier, L.Ac., by the author