Walking the Path of Neoclassical Japanese Meridian Therapy
By Bob Quinn
“…A condition of complete simplicity
Costing not less than everything…” T.S. Eliot
In early 1999 I enrolled in a certificate program in Japanese therapies in Seattle. A few months before I had graduated from a TCM college and was clear that the style of acupuncture I had learned there was not for me. I had little confidence I could produce good therapeutic outcomes using the tools I had been given. My forte was in the sensitivity of my hands, and so I wanted training in a palpation-based approach to treatment that was classically rooted. My hope at the time was that Japanese Meridian Therapy (MT) would fit the bill. It is now 13 years later, and I would like to share some insights gleaned as I look back over these early years of MT practice. I will also cover some of the key aspects that set MT apart from the dominant TCM style.
First, an important clarification: There is no such thing as “Japanese acupuncture,” aside, that is, from acupuncture performed by citizens of Japan. There is a wild plethora of styles practiced in Japan today, and finding a common thread woven throughout would be an impossible challenge. Everything in the world of acupuncture in North America is found in Japan, and much, much more. MT itself wears many masks. There are six main schools of practice in the MT world, but this breaks down further actually into 28 distinct styles (this, according to the scholarship of Dr. Shuichi Katai). Perhaps a quarter of the acupuncturists in Japan practice MT.
Why in the title of this article is MT described as “neoclassical” and not “classical”? Acupuncture in Japan came close to dying out altogether in the early part of the 20th century. At the end of the Edo Period (1603-1868) the Japanese government in its mad rush to modernize was willing to throw out everything traditional. Acupuncture as well was pulled into this vortex of change. Almost overnight every structure in society was catapulted into the modern era. It was only through the inspirational efforts of a small group of students and practitioners that this ancient art was saved. Protests erupted against the government’s attempt to outlaw the practice of acupuncture, and the government eventually backed down. However, now officials unsympathetic to traditional medicine controlled the curriculum. As a result “stimulation therapy” replaced classical channel theory and techniques.
After some years of this modern curriculum acupuncture in Japan was a walking corpse. Luckily a few motivated individuals located some old masters willing to train them in the genuine art of acupuncture. In addition they formed study groups and poured over the classical texts, with a particular focus on the Nan Jing. This back-to-the-classics movement saved the day for acupuncture in Japan. (It is interesting to note that a somewhat similar back-to-the-classics movement is now in its infancy in the US and China).
Because the continuous thread of acupuncture tradition in Japan was in large measure interrupted and then reestablished, it seems best to refer to it as a neoclassical style of acupuncture. There are other reasons as well, notably that many practitioners of MT also incorporate modern, non-classically inspired insights in their treatment thinking. So, in that sense it is not, strictly speaking, an exclusively classical style of practice. For my part I am quite happy with this openness to the new. Alan Watts, the late, great popularizer of Asian philosophy, often spoke of an obsession with the classics (not medical classics in his case) as comparable to focusing on the acorn while ignoring the oak tree. I find that hard to argue with, though it must be pointed out, that if one wants to understand oak trees, acorns are certainly a necessary part of the exercise.
We often describe ourselves as practitioners of the healing arts, and I have often wondered about the relationship between art and medicine. I believe we can clearly see that relationship between MT and wabi-sabi, a particular aesthetic in Japan. Many people are vaguely familiar with wabi-sabi. The Japanese are used to being asked to explain it—and they rarely succeed, simply because it is so elusive a concept. I have always been drawn to this view of beauty. A year ago while reading a few books on wabi-sabi I realized there were many correlations-resonances with MT. Wabi-sabi is built on a foundation of simplicity, restraint, asymmetry, naturalness, close-to-the-earthness, and it paradoxically contains elements of both joy and melancholy; through it all runs a deep acknowledgment of impermanence.
To appreciate wabi sabi’s view of beauty we have to first unlearn our own culture’s definition of beauty—this is a bit similar to a character in a fairy tale waking from a spell. This need for unlearning applies equally well to MT; to learn to appreciate the beauty of MT we must first unlearn much of what we assume is universally true in acupuncture. At the very least we must be willing to question some of our dearly held assumptions, particularly concerning our beliefs about the level of stimulation required in an acupuncture treatment.
One key aspect of wabi-sabi that we see emphasized in MT is that insignificant and easily-passed-over details are raised to the center of attention. As an example, in a wabi-sabi painting a lone branch of a tree might be the sole focus, leaving the rest of the canvas empty. Similarly a newcomer to MT is often surprised that a tiny palpatory finding on a channel can take on great significance, and can indeed become the focal point of treatment. This is wabi-sabi in its essence.
Another feature of wabi-sabi is its embrace of asymmetry. In art this is reflected in objects that exhibit obvious distortions. Warped, rough raku tea bowls are an example of this aesthetic. In the TCM style of acupuncture, points are typically needled bilaterally—that is to say symmetry in treatment is preferred. This is not generally true in MT. Here the thought is often expressed that if the patient’s body is imbalanced, treating both sides will only perpetuate the imbalance. Instead great care is often taken to determine which side is better to treat and which side to leave alone.
The wabi-sabi preference for the rough-hewn and simple (read, imperfect) over the artistically perfected has its correlate in acupuncture as well. The elaborate theories of Chinese medicine (the correlate to the refined, perfected object of art), if they cannot be demonstrated practically, are not favored. Instead a very simple and practical orientation has replaced it—an acupoint might be treated simply because of how it feels, not because of some theory about what its functions are. If an idea or theory cannot be shown clinically to have an immediate, demonstrable effect, it is not easily sold to a MT audience. This clinical effect might appear quite slight to an outside observer (e.g., a small nodule—one that might seem to present no problem to the patient—disappearing as a result of a technique would be accepted as proof that the technique in question is worthwhile). MT acupuncturists see their job as the regulation of qi and blood in the channels and collaterals—period, end of story. Quite simple, just as in wabi-sabi.
Wabi sabi’s vision of the beautiful is disarmingly simple. Hold in your mind an image of a crude, black iron teapot on an old piece of barn wood in a plain peasant hut; contrast it now with an image of a perfectly proportioned porcelain teapot on a pressed, white silk table cloth on a highly polished table in a beautiful room. This illustrates so much of the embrace of simplicity that is through and through part of wabi sabi (and MT). Can acupuncture be that simple that we orient ourselves according to yin-yang and the five phases? Consider the quote below from Zhang Jingyue:
“When diagnosing and treating disease, we must first of all differentiate between yin and yang. This is simply the most important principle of medicine. If the physician correctly differentiates yin and yang, the treatment will never be accompanied by side effects. All of the myriad ways of practicing medicine, therefore, can be summed up in two words: yin and yang, and that is all there is to it! There is the yin-yang of symptoms, there is the yin-yang of pulses, and there is the yin-yang of herbs.” Zhang Jingyue, noted Ming dynasty physician. (Fruehauf, 2007, p.52)
This is akin to a Christian understanding that the core of his faith is expressed in Jesus’ commandments: Love the Lord God above all else and love your neighbor as yourself. If a person can live these two teachings successfully, he can certainly claim that he is a serious practicing Christian, even if he knows little else of Christian theology. In similar fashion, if an acupuncturist can practice her art with an understanding of and sensitivity to yin-yang and the five phases, she can practice effective medicine. This simplicity is the core of MT and also wabi-sabi. No argument, by the way, is made or implied here that it is undesirable to master the detailed theories of Chinese medicine, only that effective treatment is possible based completely on a basis of profound theoretical simplicity coupled with a heightened sensitivity. Would the Christian in the above example be better off if he knew more deeply the details of Christian theology? If he still managed to genuinely live the tenets of Jesus’ teachings, he would certainly not be worse off. We can say that for sure.
The great architect-mathematician-futurist-poet-designer R. Buckminster Fuller (he referred to his work as “comprehensive anticipatory design science”) coined the word “morewithlessing,” which he also referred to as “ephemeralization,” to capture the importance of gaining always the maximum output with the minimum input. This is the attitude in MT; our medicine is an attempt at an ephemeralized acupuncture. In MT the needles themselves are minimalistic, as is the depth of insertion. We use 38-44 gauge needles and typically insert 1-6mm, occasionally deeper, and at times the needle does not even break the skin barrier. Many surface, non-insertive techniques are used to good effect. For the needle-phobic patient these effective, gentle techniques are a godsend.
One is faced continually in MT with the question: How much treatment (stimulation) does this patient truly need? The belief is that it is not helpful to stimulate beyond this ideal minimum. Consider this analogy: If you are feeding a guest, it is not useful to force more food on him than his stomach can accommodate. So it goes with acupuncture. We likely, according to the view of many senior Japanese acupuncturists, are frequently over-treating our patients. We should at least consider this possibility and investigate a bit in our own clinics.
Chapter 69 of the Nan Jing outlines a key feature of MT practice, specifically the rationale for starting our work with a “root treatment”. In MT an effective root treatment is seen as by far the most important aspect of the therapy we offer our clients. Three points are made in this key chapter (see Paul Unschuld’s Nan Ching p.583) that are relevant to this idea of “root treatment”:
1) In the case of depletion, supplement the respective channel’s mother
2) In the case of repletion, drain the respective channel’s child
3) First tonify, then disperse
So, to start treatment we need to identify the core deficient channel(s), and then treat them using the mother phase channel. These deficiencies are most likely to be found on the yin channels. After this root deficiency is dealt with the treatment can move on to identifying the most prominent replete channel(s), which we expect to find on yang channels. These are drained using either the child point on that channel or the luo point.
My own experience of the MT root treatment is that it is every bit as important as the masters say. Coming from a TCM background I was not trained to expect the five phase strategies to actually work as well as they do. TCM does not generally orient its treatments in any systematic way towards utilizing five-phase thinking. The changes that can occur in the pulse from the root treatment needles barely inserted are nothing short of astounding. And the pulse is not the only change we find from this gentle root treatment; symptoms also can shift dramatically.
In my doctoral program a survey of North American acupuncturists was mentioned. Less than 10% of the respondents reported use of moxa in their practices. Probably most of those who use moxa are using the indirect form of it in which a smokeless pole is held close to acupuncture points. For a MT acupuncturist it would be unthinkable to not use direct moxa. (Our word “moxa” derives directly from the Japanese “mogusa”). Needles do something that moxa cannot do, and moxa has an action that needles cannot duplicate. They go together in MT like noodles and broth—one can eat noodles alone without broth, and one can drink broth without noodles, but they are much better combined. In fact in Japan one earns a separate license in moxibustion. The little moxa that is taught in North American TCM schools does an injustice to an important art, and we can thank MT practitioners (as well as other Japanese styles) for keeping this art alive.
One finds that, as with acupuncture, the MT moxa dose is usually miniscule compared to the type of direct moxibustion taught in TCM colleges. Half rice-sized (or smaller) pieces of highly refined mugwort is used in MT. This high-grade of mugwort burns much cooler than the cheaper, green version; it is also much more expensive, costing these days about $1.40 per single gram. In this way the strength of the stimulation is generally kept quite comfortable. There are numerous other moxa techniques employed as well.
Role of Palpation
If one could speak of a common thread running through the various styles of acupuncture practiced in Japan, it would likely be the emphasis on careful palpation. The philosopher Alan Watts said: “Attention is selection.” The literary great William Blake wrote: “Singular and particular attention is the foundation of the sublime.” These two quotes carry a sense of what is actually happening as we palpate our patients. When we select just a few from the myriad of possible palpatory findings to pay particular attention to, we are engaging our patient in a process of giving meaning to phenomena that most other practitioners pass over as insignificant—but are findings insignificant simply because they escape our normal gross level of scrutiny? After years of engaging patients in this hands-on process of talking to their bodies, I am no longer surprised when it enters the realm of the sublime. There is simply something almost magical about informed touch and what it can accomplish in a treatment.
Certainly touch is itself highly therapeutic, especially when delivered by hands with an evolved sensibility. I have often reflected on why Chinese medicine has so quickly been licensed in almost all of the 50 states while naturopathic medicine, which has been here much longer, has no legally defined scope of practice or licensure in even 20 of the states. Could it be because Chinese medicine practitioners actually touch all of their patients and do not just talk to them? At its most basic level, to insert a needle requires that patients be touched. The Japanese MT practitioners go much further though. For them a highly evolved “conversation” with the surface of the body is engaged. Patients are fascinated by it and impressed when tight-tender areas disappear, when cold areas warm, when dry, rough areas become moister and smoother, when nodules soften and shrink—and, most importantly, when they feel much better, even at times, transformed!
To build palpatory skill into our hands takes long years of focused practice, much longer than one would at first imagine, and the journey actually never ends. Our hands can always become more sensitive. The dedication required to acquire hands with a refined sensitivity is much like what is required in meditation practice. Lately I have been reading the poetry of Muso Soseki, a 12th century Zen monk. His satori poem captures the essence of this journey:
Many year dig ground
Seeking blue sky
When one reads the Nan Jing and the Shang Han Lun it is clear that careful palpation of the patient’s body was a part of the medicine in the Han Dynasty. Why this important skill died out in China is a bit of a mystery. In Japan these Han medical classics took root about 350 years after the end of the Han Dynasty. Over the ensuing centuries this art of palpation evolved into a sophisticated system of diagnosis and feedback. Abdomens, channels and radial pulses are all assessed with a sensitivity that, when practiced by a master, is truly extraordinary. Much more trust is given to these findings than, say, patient reported symptoms, or lack thereof. For instance, even if there are no reported lung symptoms, if a MT acupuncturist discovers a significant palpatory finding on the LU channel, say at LU 5, she will likely treat it somehow. The understanding is that these subtle findings our hands detect are the body “speaking” in its own unique language.
Observers of MT treatments are often amazed as at the degree of attention that is paid to the abdominal assessment. Just as there are sho (patterns) spoken of in the pulse readings, there are also abdominal sho. Specific findings in the abdomen tend to confirm a focus on particular channels. Some practitioners in Japan have also discovered abdominal sho for the eight extraordinary vessels. The depth of palpation in the abdomen can vary quite significantly from one MT style to another. Some barely touch the skin, while others go in an inch or more. Just as immediate changes in the pulse are expected, so also can we continually check back in with the abdomen to assess how well our treatment is progressing.
Many US acupuncturists incorrectly reserve structural concerns for the sports acupuncture specialists. The thinking appears to be that structural distortions are not significant concerns unless a patient complains about them, but nothing could be further from the truth! The Japanese, with their cultural focus on refined skills and presentation arts (tea ceremony, flower arranging, Zen art, archery…), have a unique sensibility for form. That this then plays a role in their acupuncture should come as no surprise. Dr. Hashimoto Keizo brought this eye for structure into a movement-bodywork system called Sotai. Many MT practitioners know a little of his system. Kiiko Matsumoto included a chapter on Sotai in her Hara Diagnosis Reflections on the Sea, and Stephen Brown translated Dr. Hashimoto’s book into English. Beyond bringing a few Sotai movements into a MT treatment, the needles themselves can be used to make significant structural shifts. Jeffrey Dann, Ph.D., in his Koshi-Balancing system has advanced the art of using unbelievably minimal stimulation (1 mm depth insertions) to gain significant structural shifts.
In this article I have attempted to share some observations of what has struck me in these early years of MT practice as worthy of mention for a North American audience dominated by TCM training. Luckily for anyone whose interest I have piqued there are now many resources available (see endnotes). The best is likely the North America Journal of Oriental Medicine (najom.org). An inexpensive CD-ROM of all past issues can be purchased; it is a treasure trove of clinical tips and thought-provoking material. Many of the teachers I list in the endnotes teach regularly in the U.S.; it is much more useful to have contact with a good teacher than with a good book when one is learning manual skills.
Fruehauf, Heiner (2007). Classical Chinese Medicine: An Introduction to the Foundational Concepts and Political Circumstance of an Ancient Science. Portland, OR: self-published—I love this little book. If you are familiar with Heiner Fruehauf’s work as it has appeared at times in The Journal of Chinese Medicine or on his website www.classicalchinesemedicine.org, you will want to read this gem.
R. Buckminster Fuller wrote many books, all of which deserve reading. If I had to recommend just one it would be Humans in Universe, written together with Anwar Dil.
There are many books available on wabi-sabi. My favorites are Wabi Sabi The Japanese Art of Impermanence by Andrew Juniper and Wabi-Sabi for Artists, Designers, Poets & Philosophers by Leonard Koren.
Paul Unschuld’s translation of the Nan Ching (1986, University of California Press) is the most scholarly we have to work with. I recommend every acupuncturist read it at least once.
There are now available many books on MT and other gentle styles of Japanese treatment. Rather than list the many books, let me simply list key authors (in no particular order) and recommend all of their books: Shudo Denmei, Kiiko Matsumoto, Ikeda Masakazu, Stephen Birch-Junko Ida, Kouei Kuwahara, Miki Shima, Shoji Kobayashi, Stephen Brown.
The original article can be found here.
We are very grateful to Bob Quinn for offering his article for reprint by the Jade Institute, and to Michael Max for permission to use this article that was first printed at the Junkyard Daoist. For more interesting articles by Michael Max and a variety of authors, check out www.junkyarddaoist.com
Bob Quinn graduated from the Oregon College of Oriental Medicine (OCOM) with a master’s degree and then in 2007 with his doctorate in Chinese medicine. He was a member of the first cohort in the U.S. to graduate from a fully accredited doctoral degree program in Oriental medicine. He supervises the Clinical Internship Rotation at the National College of Natural Medicine (NCNM) and also regularly teaches several courses on acupuncture, herbal medicine, and Asian Bodywork.
A writer as well, Dr. Quinn has contributed articles, case studies, book reviews, and interviews to professional publications such as the North American Journal of Oriental Medicine and The Journal of Chinese Medicine, along with monthly columns in community papers for the public. Bob has a private practice in SE Portland and is co-founder of TJM Seminars: www.pdxtmjseminars.com