Many schools of thought have flourished in Japan since Chinese medicine was introduced 1,200 years ago. Unique evolved practice includes abdominal diagnosis and treatment - toxins in the abdomen are declared the source of all human ills - and point location by direct palpation rather than by visual observation of anatomical structures. Rigorous practical application is superior to book learning.
Situated at the very eastern end of the Far East, Japan has been the last place for various continental Asian traditions to arrive. Many sects of Buddhism, Confucianism, and Daoism, for example, have been introduced and have become rooted in Japan over the past 1,200 years. Chinese medicine has also been introduced and practised by the Japanese for at least 1,200 years. Since Japanese traditional physicians are extremely amicable and isolationist among themselves, different groups of practitioners have been able to maintain their practice separately for a long time, and have accumulated an immense amount of medical literature and clinical experience. Since there are so many schools of thought and practice in Japan, it is beyond the scope of this brief article to present a comprehensive portrayal of what is essentially ‘Japanese’ in the history of the Japanese modification of traditional Chinese medicine. The author simply wishes to touch upon some common attributes in how the Japanese have altered Chinese medicine to meet their own needs.
From the eighth century, many Japanese students travelled to China to stay abreast with development of Chinese medicine until the Tokugawa government officially severed diplomatic relationships with China and other foreign countries in 1633. Although it was an abrupt interruption of cultural exchange between the two countries, in retrospect, it turned out to be a great opportunity for Japanese physicians to explore and create new methods of practice which could really meet the needs of their own people rather than simply imitating Chinese methods. The sudden isolation of the country made the Jin-Yuan system the last to be introduced by such physicians as Sanki Tashiro and Dosan Manase around 1545 AD, and although some medical books from the Qin dynasty did trickle down, the Chinese influence was substantially reduced for the following two hundred years.
First, the Shogunate government, controlled by powerful Neo-Confucian bureaucrats, promoted the Jin-Yuan system as the official school of Chinese medicine until the middle of the eighteenth century, when Nagoya Genyi began a movement to return to the classical Chinese medicine. He claimed that, due to its heavily Neo-Confucian character, the Jin-Yuan system was so convoluted and theory-bound that it was neither practical nor effective. Many physicians were strongly influenced by this movement and discarded many theories and concepts of Jin-Yuan medicine that did not prove to be clinically useful for the Japanese.
One of the most talented clinicians of this period was Todo Yoshimasu. He was an adamant critic of the Jin-Yuan system and dedicated his life to promoting the classical medicine. He was also well known for his methods of diagnosis based on the abdominal palpation called ‘Fukushin.’ He claimed that stagnation of toxins in the abdomen was the source of all human ills and that the physician should examine and treat the abdomen. Fukushin was further developed by Bunrei Inaba and Shukko Wakuda by the beginning of the nineteenth century, and is still practised today by a great many practitioners. This particular system of abdominal examination is genuinely Japanese.
As for acupuncture, Waichi Sugiyama may be the most influential in establishing truly Japanese-style acupuncture. Born as a son of a Samurai, he aspired to follow his father’s tradition, but when he later became blind, he abandoned his original intention and became an acupuncturist. He was so greatly talented in the arts of healing that he was appointed to be the first blind acupuncturist for a Shogun, and was subsequently ordered to establish forty-five acupuncture schools for the blind in Tokyo by Shogun Tsunayoshi Tokugawa in 1681. Sugiyama also compiled his famous three official textbooks on acupuncture and moxibustion for the blind to be learned by heart. These books later became the standard texts for two hundred years, during which time acupuncture became the profession for the blind. Even today, half of all Japanese acupuncturists are blind practitioners.
The major emphasis of the professional education for the blind was to teach palpational techniques for diagnosis and treatment. Being deprived of visual observation, the blind students had to rely heavily on pulse diagnosis, meridian palpation, and abdominal diagnosis. Point location and needling techniques also had to be learned without visual assistance. This particular system of clinical training made them extremely sensitive to tactile information from the patient’s body, and also made them very skilful in needling techniques. Thus, after three years of intense training, blind acupuncturists were able to diagnose and treat their patients safely and effectively. This tendency to depend strongly on palpation findings is very prevalent and is another facet of Japanese acupuncture, moxibustion and herbal practice.
In terms of treatment techniques, the blind acupuncturists have placed great emphasis on creating many new excellent clinical techniques to make acupuncture treatment comfortable for the patient. Sugiyama, for example, was the first acupuncturist to invent a needle guide tube after years of clinical trial, which made needle insertion far more comfortable for the patient than the Chinese direct insertion. His style of needling with very fine filiform needles was also very elaborate and exquisite in hand co-ordination resulting in creation of the eighteen needling patterns to elicit various clinical effects. This emphasis on perfection of the ‘art of needling’ is another very Japanese aspect of acupuncture, which is not yet very much appreciated in the West.
The method of point location in Japanese acupuncture and moxibustion is another important matter. Performed by direct palpation rather than by visual observation of anatomical structures, Sugiyama taught his students that acupuncture points are not anatomically stationary and one needs to find effective points by palpation. For example, a skilled acupuncturist would not always needle Spleen 6 at 3 cuns superior from the tip of the medial malleolus, but would palpate the area to locate the most effective point by tenderness or direct perception of ki in the point. Especially, muscle meridian points which exhibit some degree of tightness (called kori in Japanese) may be located differently on every individual patient, and the sensitive hands of an acupuncture master would find the most effective location for needling to disperse the ki stagnation. Based on the author’s 19 years of experience as a teacher in America, the processing of palpational findings is one of the most difficult aspects of Japanese acupuncture and moxibustion for American students to learn.
Another unique aspect of Japanese-style practice is its strong emphasis on direct, intuitive, non-linear and holistic observation of the patient’s condition. Compared to the TCM-style bian zheng, which is a system of diagnosis based on differentiation of patterns by zang-fu, the six pathogenic factors, the eight principles, etc., Japanese practitioners do not appear to care so much about differential diagnosis at all, but rather seem to utilise direct feeling of ki from their patients intuitively and holistically. Pressed for a ‘diagnosis’ an acupuncturist or an herbalist may put a label on the patient’s condition, but they know very well that they are not really treating the label, but the whole person. As a matter of fact, many herbalists would not make a differential diagnosis, but would rather say that the patient’s whole constitution matches such and such an herbal formula, and that is the way they are inclined to make their diagnostic configuration.
In 1984, the author sponsored clinical workshops with many famous acupuncture and herbal masters in Tokyo, and one of the instructors said to the American students, “In my work, diagnosis is treatment and treatment is diagnosis. There is no difference between them.” This statement perplexed the logical and rational mind of the Western students very much, but it exemplifies how advanced Japanese masters feel deeply in their hearts when they are absorbed in the art of healing. They look as if they are diagnosing and treating at the same time, and one cannot really tell which part is the diagnostic section and which is the treatment. Yet, in the workshops they performed beautiful sessions of acupuncture, moxibustion, shiatsu, etc., and patients got better, which looked almost like magic to my American students. One can ask a master questions about his methods and often only get silence in answer. Actually, one of the students in a workshop asked a master whether he was tonifying or sedating a certain acupuncture point. There was a long silence, and then the master finally said that tonification and sedation were only concepts and he did not work in those terms at all. What he was saying was that he does not work in the cause-and-effect frame of conceptual mind, but in intuitive synchronicity with his patients. This is why there is no difference between diagnosis and treatment for him.
The last point that the author would like to make is that the tendency to emphasize actual learning by practising rather than studying from books is very strong, not only in traditional medicine but also in many other traditional arts and religious heritages in Japan. For example, if one is caught with a book in his hand in a Zen temple, he is in trouble, because he is told that Zen can never be learned from a book, but only by sitting in meditation. Acupuncture practice in the traditional setting is very similar to that. Most advanced masters will make their students practice pulse diagnosis, abdominal palpation, needling techniques, etc. over and over again many hours on end. However, excessive conceptual and theoretical discussion is strongly discouraged as a waste of time.
The core of this inclination appears to originate from the way the traditional arts and religion for centuries have been transmitted from a sensei (mentor) to a deshi (student) only within a certain family or a sect. Examples of this kind are numerous - tea ceremony, ikebana flower arrangement, Noh plays, Kabuki acting, etc. to just name a few. They all require years of rigorous practice and the true essence of all these traditions is to make their students very mindful and masterful of every step of the vocation they are pursuing.
In the current Japanese situation, most enthusiastic graduates of acupuncture schools enrol in one of the numerous kais (fellowships) to further refine their healing art, because they do not receive enough individual training at school, and they will probably stay with the same kai faithfully for the rest of their life. They know very well that what they have learned in school is not good enough for actual clinical application and that they need to find a sensei from whom they can directly learn how to heal their patients in a wholesome way. Thus, still keeping the sensei-deshi relationship, many Japanese traditional healing arts are kept alive for future generations.
Miki Shima Miki Shima, O.M.D., Lic Ac. was trained in the Japanese arts of healing and in the I Ching by traditional tutorialship in Tokyo. Dr Shima came to America in 1974, and completed graduate studies at University of Michigan in 1978. He passed the California State Board Examination in 1979, and served on the State Acupuncture Board for 7 years from 1981. He also served as President of the California Acupuncture Association and has been President of the Japanese-American Acupuncture Foundation (JAAF) since 1980. He has taught advanced clinical workshops for the past 15 years on Japanese acupuncture, moxibustion, Kanpo, and the I Ching.) He is the author of Medical I Ching published by Blue Poppy Press.