Shudo Denmei Translated by Stephen Brown Eastland Press, Seattle, 2003 Paperback, 274 pages, price £24
(Reviewed by Marion Fixler, EJOM Vol. 4 No. 3)
Shudo Denmei has compiled a points book with a difference, distilling and sharing his clinical experience spanning over four decades and offering something new to all practioners, young and old! This is not a comprehensive reference book, as extensive in its material as for example A Manual of Acupuncture1. Instead, this book concentrates on those points which Shudo has found to be most useful clinically. Written in the first person, with considerable humour, humility and honesty, it is both accessible and informative and makes enjoyable reading. Shudo does not limit his case examples to those patients who have only been treated successfully; he also cautions the reader by openly discussing cases where the condition has worsened: a phenomenon rarely seen in print.
Shudo Denmei is a renowned Japanese acupuncturist and a key proponent of meridian therapy. This system of Japanese acupuncture is based on the classical principles of five phase theory as outlined in the Nan Jing. Shudo's first book Introduction to Meridian Therapy2 is an excellent introduction to the theory and practice of this subject. The main emphasis of Finding Effective Acupuncture Points is on points which effectively treat specific conditions as part of the branch treatment. So, although this new book can be seen as a valuable complement to Shudo's first book, with its references to meridian therapy diagnosis (where root treatment concentrates on the primary yin channel imbalances), it will be equally useful to practitioners from all acupuncture traditions.
The book is divided into three main sections. In the first section, Shudo reviews literature examining the existence and definition of acupuncture points. This is a fitting introduction to the subject and one that is often taken for granted and left unexplored. He discusses the different depths at which points can be found and how best to palpate them. I find this an interesting subject as among the acupuncture traditions I have studied, there are many different approaches to needling and depth of needling.
In the next section, which forms the main body of the text, acupuncture points are covered, which are ordered in areas of the body. This is by no means a comprehensive list of points. Instead, it includes the points Shudo uses in his own practice. He has given each point a three star rating, indicating the importance he gives each point.
For each point, the Japanese and Chinese name is given (but not the English translation) and the classification of points is not listed, although often mentioned in the ‘discussion' section. A number of alternative point locations are described, which helps the reader to understand the emphasis on palpation. Interestingly, certain points have varying locations depending on the symptoms treated. In some instances, Shudo has developed alternative locations altogether (e.g. his iliac crest point). Also included are specific uses of points identified by famous Japanese practitioners, in particular, the renowned moxibustionists, Sawada3 and Fukaya4, for example, using direct moxibustion on reactive upper Du mai/Governing vessel points for nervous disorders.
The indications listed are quite brief in many instances and are probably confined, once again, to the conditions for which Shudo uses each point. Actions are not included, as these are usually based on more recent TCM terminology and would not be relevant within the context of meridian therapy.
The distinguishing feature of this book is the information on palpation techniques. Historically, acupuncture in Japan developed separately from herbal medicine and was more closely associated with massage. As these were both in the domain of blind practitioners for a time, this resulted in a greater emphasis on palpation as a diagnostic tool. Finding the 'alive' point is an integral part of Japanese acupuncture systems5. Shudo emphasises the importance of finding this reaction, to ensure effective treatment. Very light palpation will reveal puffiness and tension, indicating the presence of a pathogenic influence (jaki/xie qi) or as described in ling shu Chapter one, 'the guest is at the gate'. When a patient is ill, the qi at the relevant point can be palpated and distinguished more easily, says Shudo.
For each point, a detailed description of what to feel for is included. This includes indurations, depressions, spongy areas, tension and hardness in the muscle fibres as well as tender points. Shudo not only describes what to feel, but also how to feel for it; what fingers to use and in what direction to palpate. He includes an interesting pinching technique that I have previously only encountered in the diagnosis and treatment of disturbances in the sinew channels using direct moxibustion. Palpation is also central to the practice of direct moxibustion6 in Japan and many of the points include useful information on moxibustion indications.
Under each point, there is a discussion section in which Shudo gives anecdotal examples of his experience of using the point, including how his own medical conditions were treated. This informal style is both entertaining and candid, as it includes some cautionary tales of over-stimulation or wrong treatment and their resulting consequences. This degree of openness is humbling, as echoed in Shudo's modest revelation that it took him thirty years before he felt the arrival of qi! He adds, reassuringly, that for most practitioners it may only take five to ten years.
In the final section, Shudo discusses the range of needling techniques he uses. Under each point, he also discusses the appropriate needle depths and angles. This can vary from contact needling on the skin surface or very shallow (Japanese style needling) of 1-2mm, to depths of up to 50mm. The needle gauges in particular are very fine, Shudo often uses Japanese No.0 or 0.1 or No.17. The fineness of the needles used emphasises his skill as a practitioner, particularly when he describes specific needle sensations. Guide tubes were originally developed in Japan and are commonly used with such fine needles.
In this section, Shudo concentrates on the importance of reaching the correct depth in order to get the arrival of qi. He differentiates this from obtaining qi (or de qi); the former being what the practitioner feels, the latter, what the patient feels. The arrival of qi is felt at the needle tip as a resistance; if the needle goes beyond this depth or if there is no resistance, then the therapeutic effects will be lost. He describes needle sensations travelling to the area he wants to effect, which can be quite a distance away - for example from the interscapular area up to the head and neck.
Shudo Denmai's book on acupuncture points is a refreshing departure from standard point location texts. Its accessible and informal style makes it an enjoyable read, as well as a valuable reference book in the clinic. It stimulates the practitioner to explore different ways of working in areas where skills are often taken for granted, including the location and needling of acupuncture points. Through the depth of Shudo's expertise, we can expand our own understanding of different approaches to treatment, whatever system of acupuncture we practise.
References 1. Deadman, P., Al-Khafaji, M., with Baker, K. (1998). A Manual of Acupuncture, Journal of Chinese Medicine Publications. 2. Denmai, S. Translated by Brown, S. (1990). Introduction to Meridian Therapy, Eastland Press. 3. Sawada Ken (1877 – 1938). 4. Fukaya Isaburo (1900 – 1974). 5. In the Toyohari system of meridian therapy which I practise, the actively 'alive' point is identified and confirmed by positive pulse changes when the point is touched. This is agreed by the consensus of the group during study sessions. 6. Direct moxibustion involves burning extremely small cones of moxa on the skin (from thread size to half rice grain size). 7. 0.14mm (42#) and 0.16mm (40#) respectively
Marian Fixler Marian Fixler is a Senior Lecturer at the University of Westminster in London where she teaches point location. She has been in practice since 1991 and in recent years has specialised in Japanese acupuncture.
