Stephen Birch & Junko Ida Paradigm Publications 1998,Massachusetts Paperback, 344 pages, £26.95
(Reviewed by Marian Fixler, EJOM Vol. 3 No. 4)
Japanese Acupuncture: A Clinical Guide is an invaluable practical guide to the richness of techniques that can be found under the umbrella of Japanese acupuncture systems. It is a foundation volume on Japanese acupuncture practices with further publications to follow. This book will enable the practitioner to apply a wide range of techniques which can only serve to enhance any acupuncture practice. It gives the reader an introduction to a number of the different paradigms that exist in Japan and which are becoming increasingly accessible on this side of the Atlantic, due to the extensive teaching of the authors, currently based in Holland. For readers interested in exploring these systems in more detail, the book can be read alongside other texts which offer a more theoretical framework, written and translated by the authors.(1)
Although it is primarily a text on Japanese acupuncture techniques, the practical nature of the book lends itself to practitioners from all traditions, who wish to incorporate these techniques into their existing practices. It will also give new insights into the refinement and extension of their application to those practitioners already familiar with them.
The book begins with a brief history of the development of acupuncture and moxibustion practice in Japan. This maps the course of Japanese acupuncture from its initial importation from China in 562 C.E, through periods of relative inactivity, to its resurgence in the 1500's, with the development of its own unique approaches.
Specific characteristics that differentiate Japanese from Chinese acupuncture are explored with reference to the practical aspects of these traditions. In particular, the development of the shinkan guide tube, has become a part of western acupuncture practice due to the packaging of disposable needles. However, the guide tube was developed in the 1680s, by the prominent blind practitioner Waichi Sugiyama, who opened the first blind acupuncture school. The guide tube has a particular function for controlling depth of insertion (which is often extremely shallow) and for the use of extremely fine needles, both common to Japanese acupuncture traditions. The book explores the political influences that led to the emergence of the tradition of blind practitioners, and the separation of acupuncture from herbal practices. Both these factors have had a significant influence on the development of acupuncture with its emphasis on palpatory techniques as central to diagnosis and treatment, and the emphasis on channel-based systems of diagnosis. In a country where there is also a separate licence for moxibustion practitioners, it is easy to see how these techniques were developed and practised to a more sophisticated level.
The book emphasises the similarities between Japan and the West with regard to an industrialised rather than agricultural society, thus advocating the appropriateness of the Japanese techniques of gentle needling with very fine needles and with very little stimulation to the needs of our patients. My own experience and the feedback from patients certainly supports this preference.
Before launching into the individual techniques covered, the book gives an introduction to some of the main approaches to treatment within the pluralistic Japanese acupuncture traditions. The emphasis is primarily on the Meridian therapy tradition of Keiraku Chiryo and its further development within the Toyohari school and Yoshio Manaka's Yin Yang Channel Balancing therapy system. We are given an overview of how the channel system can be disrupted with an outline of the complexities of the interactions and correspondences existing within the channel system with reference to circadian rhythms, qi circulation, correspondences between arm and leg channels and between yin yang channel pairs. Diagnosis is based primarily on palpatory findings from the pulse and the abdomen, with the above correspondences forming the basis of treatment methods. This chapter can only serve as an introduction to these systems of diagnosis, and offers a context for the utilisation of the techniques that follow. Both the systems referred to, have a structured step by step protocol that addresses the Root condition (honchiho or ben) first and then the Branch (hyochiho or biao). The main detail in this book is on the techniques that treat the latter.
The chapter on palpation emphasises this fundamental aspect of diagnosis within the Japanese paradigms. As treatment often consists of very superficial needling to a depth of as little as 1-2mm with no further stimulation of the needle, exact point location becomes paramount and can have a profound effect on the effectiveness of treatment. The book describes how this accuracy can be developed with the same pragmatic approach that runs through the whole of this text. Palpation provides not only a tool for diagnosis, but also a feedback system to evaluate the effectiveness of treatment.
The chapter on needles and needling refers to the nine types of needles described in the Huang Di Nei Jing Ling Shu. The needles used within Japanese acupuncture reflect this diversity, incorporating some beautiful implements that could pass for modern pieces of jewellery. Many of these needles, which include zanshin (conical shaped needle), enshin (rounded tipped needle) and teishin (small rounded tipped needle) are used within the paediatric tradition of Shonishin acupuncture. This involves a range of non-insertive needling techniques not dissimilar to some tuina practices of rubbing, tapping, stroking and pressing, as gentle ways of stimulating the channels. The book has an extensive range of photographs depicting all the techniques described and their methods of application.
The non-insertive needling method using teishin needles from the Toyohari tradition, is elaborately described with its emphasis on forming the oshide (a rounded closed structure of the fingers) with the left hand, which has the role not only of anchoring the needle at the point, but also of gathering the qi. A challenging concept to the most liberal TCM practitioner, this approach is firmly rooted in the teachings of the Nan Jing, which says in Chapter 78 'Those who know how to apply the needle rely on their left hand; those who do not know how to apply the needle rely on their right hand'.
Each chapter covers a different technique and begins with a historical description of the development of each technique and its application in clinical practice. Next, there is a comprehensive step by step guide to the practical considerations, the precautions and any contraindications. This is accompanied by a series of photographs depicting each step of the process and where helpful, additional diagrams. This pragmatic approach instils confidence in the practitioner and encourages the practice of each technique - practise, practise, practise being the emphasis on mastery of each skill; the patience this requires is something that here in the West we are not always very good at!
Many of the techniques covered should be familiar to most students and practitioners, such as moxibustion techniques and cupping. In addition to this, there are chapters on intradermal needling, press tacks and press spheres, bloodletting and the unique Japanese wooden hammer technique developed by the renowned practitioner, Yoshio Manaka (co-author of Chasing the Dragon's Tail). The detail of information is in many cases more extensive than I have encountered in other similar texts. The rich array of techniques within each of these categories reminds the reader of the many approaches available to adapt to the individual needs of patients. We learn about the application of direct moxa (okyu) from thread size to half rice grain size and that moxa can be used in an extensive range of conditions as the primary form of treatment. The indications described illustrate the saying 'When a disease cannot be treated by needling it should be treated with moxa', (Ling shu Ch. 73) indicating the effect of moxa as a stronger form of stimulation for moving qi and Blood. There is a wealth of treatment strategies and helpful clinical tips, such as using chinetsukyo moxa cones on abdominal points to clarify pulse readings.
The techniques of intradermals, press tacks and press spheres are compared and contrasted, with suggestions for when each is more appropriate. The emphasis with all these techniques is on the continuation of the treatment stimulus between sessions. Once again, this is approached with great pragmatism regarding advice to patients. Interesting strategies are described, such as Manaka's isophasal treatments, using intradermals on local points, plus the corresponding auricular point and the hand point (from the Korean tradition).
The chapter on bloodletting reminds us that bloodletting was probably the earliest form of acupuncture with references in the Nei Jing Su Wen (Ch. 20). This is often not taught in schools due to the issues of safety. The authors not only describe an extensive range of bloodletting techniques, but are highly aware of the issues of safety and sterilising procedures. These techniques have been shown to be effective even in such unexpected cases as low blood pressure and anaemia, thus emphasising that these techniques ultimately regulate blood flow by invigorating and moving the blood and releasing stasis.
A common theme that runs through these and all the chapters, is the importance of dosage and the adaptation of each technique to individual patient needs. The importance of an assessment of the energetic condition of patients and adapting the technique accordingly is emphasised. This subject is addressed in a more elaborate way than I have encountered before, whether it be with regard to the numerous ways of controlling dosage with cupping or to the number of drops of blood extracted during bloodletting.
The book contains a rich selection of case studies from numerous Japanese practitioners and the authors' own experiences. It can be difficult to follow these if one is not familiar with the system used; however, in many cases the emphasis is on the use of a particular technique as the primary approach to treatment. The book began with a historical outline of the development of acupuncture in Japan and ends with an interesting analysis of current day practice and trends. For example, as many as 35 - 40% of lay acupuncturists in Japan are blind. Japanese Acupuncture: A Clinical Guide is exactly as its name says. As someone who has been studying these systems in recent years, I have found these techniques to not only be an invaluable addition to my practice, but they have enabled me to be a more creative practitioner. This book is one of the most user friendly guides I have come across. Its approach makes you feel as though you are in the treatment room experiencing the techniques first hand. Of course, as with all practical techniques, a hands-on approach to learning is the only way to really accomplish these skills for oneself. This book however, goes further than most to describe the details and considerations in a comprehensive and clear way.
Marian Fixler Marian Fixler is an acupuncturist and senior lecturer at the University of Westminster Centre for Community Care and Primary Health BSc (Hons) Acupuncture course. She works in private practice in London and at London Lighthouse for people with HIV/AIDS. In the last two years she has been training in Japanese Acupuncture systems.
Reference (1) Manaka, Y., Itaya, K. and Birch, S., Chasing the Dragon's Tail and Matsumoto, K. and Birch, S., Hara Diagnosis: Reflections on the Sea.