The Concept Of Meridians From A Systems Perspective

The Concept of Meridians from a Systems Perspective

The Definition of a System

by Manaka Yoshio

Acu-moxa therapy is a medical system that uses the techniques of acupuncture and moxibustion to stimulate a collection of specific points on the body surface in order to treat disease.

This article originally appeared in the 11th issue of Nihon Keiraku Gakkai Shi (The Journal of the Japan Meridian-Flow Society), No.11 (1984). It has been translated and reprinted here with special permission from Nihon Keiraku Gakkai Shi.

A system is a group of components assembled to accomplish a particular aim. For example, an automobile is a gas-powered mechanical system assembled to facilitate travel on roads. Further aims include carrying passengers and cargo, and even racing.

Tsubo or Acupuncture Point? Acu-moxa therapy in Japan is applied to specific tsubo or treatment points. When we refer to tsubo as acupuncture points, we are referring to their characteristic of being located on meridians. Since it is possible to give treatment without reference to meridians, I advocate simply using the term point or treatment point.

The Definition of Meridians The meridians comprise a system of vertically correlated points. One wonders what this systematization was based on. There are related systems, such as the Extra Vessel meridians and Tendino-Muscular Channels.

A Hierarchy of Systems One system can be viewed as a combination of subsystems. Furthermore, several systems can be combined to create a hierarchy of systems. For example, there is a mechanical system/human operated mechanical system/logistical system/theoretical system/mathematical system. Of these systems, the mathematical system is farthest from the practical aspect.

Relationships Between Systems There are systems with no apparent relationship to one another, such as, for example, a mechanical system and political system. Others, such as acupuncture therapy and moxibustion therapy, have a partial relationship. There are systems in which one is a subsystem of another, such as acu-moxa therapy and a treatment system. Even systems with no apparent association can be connected via an interface. For example, a water pump and truck can be combined to create a fire truck.

What are Meridians? The meridians comprise a system which addresses the vertical relationship of points. This is not the only system of its kind. The hardware or physical basis of meridians is as of yet unknown (i.e. it has not been

scientifically confirmed). Meridians are nonetheless known to be very useful as “software.” Situations like this often occur in the realm of technique. An expert angler, for example, knows intuitively where in the river the fish are easiest to catch, or which weather or water conditions are best for fishing. There is not always hardware to back up the software of such know-how. A fairly high level of technique can be developed without any scientific basis as long as one has the ability to perform the appropriate input – output – analysis sequence with a “black box.” Another example of this is the remarkable system of navigational skills sailors relied upon in ancient times to cross the vast Pacific Ocean in tiny vessels.

Variability of the Meridian System It is hard to imagine that the meridian system emerged in complete form as it is depicted in modern-day textbooks. The Yin Yang Eleven Vessel Moxibustion Classic unearthed in China’s Ma Wang Dui tombs, for example, shows no Pericardium Meridian, Six Stages classification, or Five Phases system. And even though it is a relatively unsophisticated system, it must have had practical treatment value in its time. The twenty-third chapter of the Su-wen suggests there was a period when only four categories of meridians or vertical relationships were considered. The posterior aspect of the body was Taiyang, the lateral aspect was Shaoyang, the anterior aspect was Yangming, and all the Yin aspects were categorized as Taiyin. It is hard to believe that all of the many currently documented meridian classifications are being applied as treatment systems. So, there are unutilized aspects of the meridian system.

Root and Branch Treatment There is debate as to whether the terms root and branch are appropriate, but these are nonetheless important aspects of acu-moxa therapy. In TCM, root (ben) and branch (biao) have a variety of meanings, but I define them as follows: • Root treatment: adjusting imbalances in the body as a whole. • Branch treatment: addressing individual symptoms. In the root treatment, a common pattern is discriminated with the aim of balancing the body as a whole and a common point selection strategy is used regardless of the complaint or disease. If the root treatment is fully successful, specific complaints or localized pain are resolved without symptomatic or local treatment. (At least, that is the way it is supposed to work.) Today, both aspects of treatment are considered necessary, like two wheels on an axle.





Root Treatment Systems The aim in root treatment is to correct imbalances, between for example, right and left, top and bottom, front and back, or Yin and Yang meridians. This could be expanded to include other imbalances, including parameters tested in Western medicine, but in the field of traditional medicine, balancing Yin and Yang has been the clearest objective. Balancing the Five Phases has also become a consideration. And, more recently, a system addressing the combination of four oppositions (Eight Principles: Yin/Yang, Deficient/Excess, Interior/Exterior, and Cold/Heat) is widely taught. Any configuration of opposing factors can be the focus of a root treatment system. Since an imbalance is to be rectified, the issue is the variance between two opposing factors. Many factors can be incorporated to create a more complete system. However, it may not be easy to devise a point selection for each and every category. Note: In the Chinese approach to categorizing things as Yin or Yang, there is further division into Greater Yang, Lesser Yang, Greater Yin, Lesser Yin. These are divided in half again to create the Eight Trigrams. The Eight Trigrams become the 64 Combinations. These can be further combined, and thus the system becomes progressively more complex. In my opinion, it is easier to address just eight combinations, rather than 64. A root treatment system can be divided into relatively simple subsystems, each with a simple treatment protocol. It would be most practical if the point location or technique is amended when the protocol proves to be ineffective. The characteristics of a root treatment system are: 1. ���������������������������������������������� It is performed at the beginning of the treatment. This paves the way for the rest of the treatment. If it is successful, the root treatment alone is enough. In any case, it facilitates the treatment that follows. 2. ��������������������������������������������� It addresses the patient's individual characteristics or constitution. 3. ������������������������������������������ It requires several comprehensive, and if possible, simple diagnostic techniques. 4. ��������������������������������������������� Point selection can be made for patients who have not received a Western medical diagnosis or whose diagnosis is uncertain. 5. ���������������������������������������������� Point selection can be made for patients with incipient diseases. 

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6. The ������������������������������������������� “primary contradiction” can be treated even for those with multiple diseases or numerous symptoms. 7. It �������������������������������������������� creates order in the process of acu-moxa therapy and simplifies the learning process. Furthermore, it creates a basis for subsequent treatments. 8. The ����������������������������������������������� number of treatment points can be reduced, and it provides a direction for acu-moxa therapy, which can often become disorganized. 9. ��������������������������������������������� It is most suited to treatment of functional disorders.

Root Treatment Systems in the History of Acu-moxa There is a reliable record of acupuncture and moxibustion treatment systems that do not target individual symptoms, but seek to balance the whole body instead. First of all, the meridians (a system which correlates the vertical relationship of points) are obviously intended as the basis for a root treatment system. In recent years, meridians have been used symptomatically; many texts say that Lung meridian excess has symptoms a, b, and c, and that Lung meridian deficiency has symptoms e, f, and g. Therefore, when there is symptom b and c, the Lung meridian must be dispersed. This is no different than giving indications for individual points. The appeal of working with meridians lies in being able to combine them, rather than treating them individually. This becomes a root treatment system only when meridians on the interior and exterior, the top and bottom, and the right and left sides are combined such that the 12 bilateral meridians are connected vertically and horizontally. We must also consider the Extra Vessels. When the body is divided into the top and bottom, right and left, and anterior and posterior, the dividing line between these aspects is the Dai Vessel (top and bottom), the Govvernor and Conception Vessels (right and left), and the Triple Burner (as the Sea of Yang) and the Pericardium (as the Sea of Yin) (anterior and posterior). The Liver and Gallbladder meridians are extensions of the anterior and posterior dividing line. Thus, the Extra Vessels can be viewed as a root treatment system for balancing the eight aspects (octants) of the body. Unfortunately, the Extra Vessels, like the meridians, are used today primarily as a symptomatic treatment system. Similarly, the Tendino-muscular meridians in the Lingshu (a vertical correlation of points)

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comprise a root treatment system closely associated with Daoyin and Anjiao, gymnastic practices common during China’s Han Dynasty. Today, the Tendino-muscular meridians are viewed as nothing more than a symptomatic treatment system for specific muscular pain. Few practitioners realize what kind of root treatment system it represented in ancient times, and there are no records of it. The system has been abandoned to the empty speculations of annotators and its essence lost. Other systems proposed by ancient practitioners, such as the Fluid and Divergent channels, also address the vertical relationship of points, but their full scope has not been transmitted to us. To this day, new root treatment systems are being developed. The Ryodoraku Regulation Method put forward by Nakadani Yoshio M.D. is an electro-acupuncture version of meridian therapy. But even those who practice Ryodoraku do not seem to consider the overall balancing routine indispensable. There is also the Sympathetic Nerve Stimulation Procedure, a unique needle insertion therapy developed by Ohkubo Tekisai, even though he was not acupuncturist. Although the merits and demerits of his system are debatable, Ohkubo’s concept of treating a limited number of points in the cervical and lumbar regions with the aim of directly stimulating the sympathetic nerve plexus, regardless of the disease, is an extreme example of a root treatment system. One of the most extreme root treatment systems was developed by Hara Shimetaro M.D., who held that the benefits of moxibustion were due only to the stimulation effects of histotoxins resulting from the burns. He therefore considered point selection unimportant and treated all patients at ST-36 and his Eight Lumbar Points. (Dr. Hara, now over 100 years old, is still applying these treatments.) While it might be possible to use such a simple conceptual framework for treatment, this would imply that any artistry in employing acu-moxa root treatment strategies is unnecessary. In treatment, the right/left, top/bottom, and anterior/posterior aspects can be considered as Yin and Yang. Rectifying imbalances between these can be made the priority over local treatments. This makes treatment possible with fewest possible points and the least amount of stimulation.

Yin-Yang Balancing System The method for achieving the above aims are as follows:

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Step 1 Determine the distribution of tender points and the right/left difference, and seek to even this out. Below is a rough classification of tender point distribution: a. One-sided deviation i. left half

ii. right half

b. Top/bottom deviation i. top half

ii. bottom half

c. Cross deviation i. right top half and left bottom half (left twist) ii. left top half and right bottom half (right twist) iii. left bottom half only (incomplete) d. Mixed pattern e. No-tenderness pattern (deficient type) Note: Classifying 100 randomly selected patients in 1982, I found the distribution patterns as follows: (38 males + 62 females = 100). Right half: 18 (11 male, 7 female) Left half: 15 (2 male, 13 female) Bottom half: 2 (2 female) Right top half and left bottom half: 35 (14 male, 21 female) Left top half and right bottom half: 3 (1 male, 2 female) Left bottom half only: 6 (3 male, 3 female) Other: (unclear) 21 (7 male, 14 female)

the Manaka Ion Pumping Cord (IPC). One or two sets are used for a treatment. For example, the deviation to the left half (a) (i) is treated using TB-5 and GB-41 on the right. The deviation of right top half and left bottom (c) (i) is treated using TB-5 and GB-41 on the left and PC-6 and SP-6 on the right. The IPC are applied for about 15 minutes. After this, the distribution of tender points is rechecked. If they have evened out, Step I was successful. If the distribution is still uneven, Step II below is applied. Note: In general, the uneven distribution is equalized by the relatively simple Step I which utilizes two to four points on the arms and legs (Eight Confluent Point treatment). It seems that this treatment usually evens out the tender point distribution in the abdomen. Upon careful examination, however, this equalization or reduction in tender points does not happen all at once or evenly across the board. There seems to be the following patterns of change. 1. Change occurs right after the IPC application is complete. 2. Change occurs gradually within the 15 minutes after the IPC application. 3. Even though there is an overall change and reduction in tender points, some areas of tenderness or the right-left deviation stubbornly persist. These variations are no doubt dependent on the organic causes underlying the pathological manifestation. This information might be utilized in reverse by establishing the probabilities of reduction in tender points and discerning whether the patient’s main problem is functional or organic. Also, when this IPC treatment is applied repeatedly, the pattern of abdominal tender points changes and the patient’s symptoms also tend to change. There are many different ways in which these changes take place, as follows: 1. Symptoms in areas apparently unrelated to the abdomen disappear or are alleviated along with the normalization of the abdomen. 2. In extremely depleted patients who manifest symptoms, the abdomen is soft and weak, and there are no tender points. Nevertheless, there is still muscle tension and tenderness in the back.

Many point selection methods exist to even out the above-listed distribution patterns, but as a very simple approach, my colleagues and I have been using the Eight Confluent Points of the Eight Extra Vessels. We most often use the pairs PC-6 and SP-6 and/or TB-5 and GB-41 and connect the needles to a wire with a diode that directs the current in one direction. This device is known as

3. The tenderness and right/left differences in the abdomen even out after treatment, but eventually reappear. However, the distribution pattern tends to change. 4. Sometimes the abdominal pattern does not change although the symptoms resolve. Therefore, symptom relief is not always related to a change in the abdominal pattern.

While in the strictest sense, abdominal patterns show no necessary correlation to disease, they do provide guidelines for some important aspects of treatment, such as point selection and the degree of stimulation. In this sense, abdominal patterns have the same purpose as pulse findings and even the Four Examinations (looking, listening, questioning, and touching). In clinical practice, it is advisable to confirm how symptoms, especially pain, change after each stage of treatment. Sometimes there is an amazing effect in which a fairly severe symptom disappears without any local treatment at all, and one glimpses the guiding spirit of Chinese medicine, where “the whole governs the parts.” This may be just what is needed to counter the deficiencies of Western medical approaches. Even though modern medicine may be advancing by leaps and bounds, I believe this is one area where traditional medicine has much to offer. Research has shed new light on the autonomic nervous system. The sympathetic nervous system (syn: together or same, pathicus: feel), was originally named with the understanding that a systemic bodily response occurred all over the body in response to stimulus from within and without. More recent findings show that opposite reactions can manifest in certain parts or localized areas. For example, when a thin tube is inserted into a laboratory animal’s spinal canal and then heated or cooled, the sympathetic nerves that control the skin and the sympathetic nerves that control the viscera react in opposite ways. When the tube is warmed, the cutaneous branch is inhibited and circulation increases; meanwhile, the visceral branch is stimulated and circulation decreases, so that the overall blood pressure remains stable. When the tube is cooled, the opposite occurs. When circulation is increased in one part of the body, it concurrently decreases elsewhere to compensate for this. Furthermore, when the active potential of individual fibers in a sympathetic nerve are measured, the opposite activity is sometimes seen in adjacent fibers. This discovery adds a new dimension to our understanding of the activity of the sympathetic nervous system. From the standpoint of acu-moxa therapy, we must pay attention to the following points. 1. As Takagi proved with his study on pressure perspiration reflexes, applying pressure on a particular point on the body surface stimulates perspiration all over the other side of the body. 

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Also, if pressure is applied on a point on the left side of the lower body and on another on the right side of the upper body, this causes cross-pattern perspiration on the right side of the lower body and on the left side of the upper body. Here we can see the “quadrant feature” of the autonomic nervous system. Stimulation for this purpose does not have to be applied broadly. One point is sufficient. Later, Takagi demonstrated that a similar phenomenon occurred with needle stimulation. He also showed that there was a difference in the perspiration effect depending on whether the needle stimulation was applied shallowly or deeply. 2. ������������������������������������������� It may seem strange that a group of tender points on one side of the abdomen, or in a quadrant of the abdomen, can be eliminated just by stimulating a pair of Extra Vessel confluent points. We must bear in mind, however, that the Eight Confluent Points are located on the anterior and posterior aspects of the arms and legs. When these points on the right and left are treated in combination, the key points of the body’s octants are stimulated. I believe that addressing the distribution of tender points in quadrants (rather than the tender points that appear in dermatome layers) is a very important and practical approach for overall balancing with acu-moxa therapy. (Furthermore, we have ample evidence showing that there is also an antagonistic relationship in the octants of the body.) 3. The ���������������������������������������������� majority of abdominal tender points, with the exception of those that seem to originate from organic changes in the viscera, can be eliminated by our simple procedure. Compared to abdominal tender points, however, points associated with Yang meridians tend to be difficult to eliminate by the method described above, which is why Step II is necessary.

Step II In Step I, abdominal tender points (especially the Mu Points on the Yin aspect of the body, and their right-left differences) are addressed. We developed a simple method of equalizing the distribution of these tender points as described above. The meridians on the abdomen, with the exception of the Stomach meridian, are all Yin meridians, and charts show that they end at the clavicle. Some texts explain that these meridians go deep inside of the body at this point. (When Maruyama did his study tracing 

the course of meridians with especially sensitive patients, he found that the sensations along the meridians all terminated in the eyes.) In general, even though the abdomen has Mu Points associated with the Yang meridians, abdominal tender points are more Yin in nature. Thus the purpose of Step I is to balance the Yin aspect. In Step II, the goal is to equalize the right-left differences in tender points on the Yang aspect including the face, back of the neck, and the arms. Below, I will list the points on the Yang meridians that often become tender. If one has the time, however, it is best to palpate the length of each of these meridians. But in practice, there are points where tenderness does not appear often, and points where tenderness appears only in certain positions.Therefore, each practitioner must devise his or her own way to efficiently palpate the meridians. Yang meridian tender points are not as easy to clear up with the IPC method as abdominal points. One approach is to try eliminating each tender point individually. Tender points representing the visceral-somato reflex of a certain organ do not respond to the light stimulation recommended in Step II. These can be addressed later with procedures outlined in steps III or IV. Common Yang Meridian Tender Points • Large Intestine meridian: LI-4, LI-10, LI-11, LI-15, LI-18, LI-19 • Stomach meridian: ST-3, ST-6, ST-7, ST-8, ST-9, ST-11 • Small Intestine meridian: SI-3, SI-7, SI-9, SI-11, SI-14, SI-19 • Bladder meridian: BL-2, BL-7, BL-9, BL-10, BL-11, BL-12

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2. Yin-Yang Polarity (meridian clock) When tender points appear primarily on one side of a Yang meridian, it is good to needle key points on the Yin meridian on the opposite side. (I suggest needling the Source Point first.) The Yin meridian to be needled is on the opposite side of the meridian clock (see below). According to the classical meridian clock, the Small Intestine Meridian is in flux at 2pm, and at 2am the Liver Meridian is in flux (the Small Intestine Meridian is at its lowest ebb). Based on this Yin-Yang opposition pattern, tender points on the Large Intestine meridian (in flux at 6am), can be treated by needling key points on the Kidney meridian (in flux at 6pm). Opposing Meridians on the Meridian Clock Lung

4am

Bladder

4pm

• Gallbladder meridian: GB-2, GB-6, GB-12, GB-14, GB-20, GB-21

Large Intestine

6am

Kidney

6pm

• Governor (Du) Vessel: GV-23, GV-20, GV-15, GV-14, GV-12, GV-10

Stomach

8am

Pericardium

8pm

Spleen

10am

Triple Burner

10pm

Heart

Noon

Gallbladder

Midnight

Small Intestine

2am

Liver

2pm

1. Three Yin, Three Yang Pattern What I call the conjugated meridians (meridians paired by the names of the Six Stages) can be needled together. For example LI-4, the source

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If this does not work, the Manaka three-point connection method can be used. As the third point, a related Governor or Conception Vessel point can be needled. Otherwise, an auricular point can be used. In the case of shoulder pain, for example, the auricular shoulder point can be needled. A very simple and effective method is to use an electro-acupuncture point locator to find the auricular point and then stimulate it with an electrical pulse for 10-15 seconds. Treat both sides in this manner when the tender points appear on both sides.

hour

Numerous tender points appear on the Yang meridians in many configurations with right/left differences. I use two main methods to reduce these tender points.

number

point of the Yangming Large Intestine meridian, can be needled together with a point on the Yangming Stomach meridian. Many possible combinations can be used here. Generally a Source Point and Source Point or Source Point and Connecting Point combination does the trick.

Meridian

• Triple Burner meridian:TB-15, TB-17, TB-20, TB-21

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There are two possible approaches to correcting left/right imbalances on the Stomach meridian (tender points found on one side and not the

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other). The first is to directly stimulate the tender points. If the tenderness is viewed as excess, the points should be dispersed. If it is viewed as deficiency, as Akabane does, an intradermal needle is fixed in those points while the point on the opposite side is dispersed. (Tender points are an issue of deep sensation in the myofascia and tendons. It is possible that the controls of symathetic nerves on the superficial and deeper layers are antagonistic.) There is evidently a need to clear up the confusion around the terms excess and deficiency. The second approach to correcting left/right imbalances on the Stomach meridian is to treat the opposite polarity of the octants, viewing the opposite sides as polarities and seeking to balance them. For example, when LI-4 is tender on the right and this point is stimulated, the tenderness sometimes moves to the opposite side. This problem does not occur when tender points are treated as polarities. The opposite polarity of octants simply means treating the left when the right has tender points, and treating the lower half when the upper half has tender points. So, for tenderness in the Yangming Large Intestine meridian, a key point (such as the Source Point) on the Shaoyin Kidney meridian is treated. When a point of the opposite polarity is stimulated appropriately�������������������������������� (������������������������������ the influence of the opposing polarity is brought to bear on it), not only does the tender point on the opposite side disappear, it also prevents the tenderness from migrating over to the other side. In addition to the above, the following meridian combinations can be treated as opposite polarities:

also be noted. The aim is to treat as few points as possible and avoid careless and unnecessarily strong stimulation.

Step III The patient’s symptoms can be resolved to a great extent in steps I and II even before local treatment is carried out. The advantage of my Yin-Yang Balancing System is that there can be a pronounced effect with very superficial insertion and amazingly light stimulation. When the third step is added, however, the effect is further consolidated. In this step, right and left imbalances in the musculoskeletal system are addressed. This is important for motor function as well as for the support structure of the body, since the musculoskeletal system is related to both health and disease. Working on this aspect is important for muscles, tendons, and joints, as well as the treatment of pain in these structures. There are numerous causes for musculoskeletal imbalances: 1. congenital skeletal abnormalities; 2. abnormalities ����������������������������������������� resulting from disease and injury; 3. ������������������������������������������� postural problems, especially occupational or habitual imbalances. There are sometimes serious, irreversible imbalances. On the other hand, a series of small imbalances when ignored can add up to a serious imbalance. It also happens that many small imbalances cancel each other out, but just as often they stack up to create a greater imbalance. Here are some examples:

2. Small Intestine meridian and Liver meridian

1. disease in an organ on one side of the body, such as the liver, gallbladder, part of the colon, and the heart;

3. Bladder meridian and Lung meridian

2. disease ��������������������������������������� in an organ that is bilateral;

4. Triple Burner meridian and Spleen meridian

3. ����������������������������������������� imbalances in muscle tension in the neck due to lopsided vision or hearing, which then causes greater imbalances in other muscles and the spine;

1. Stomach meridian and Pericardium meridian

5. Gallbladder meridian and Heart meridian 6. Governor Vessel and Conception Vessel Usually only two or three Yang meridians need to be treated this way. Of course, there are cases where more are treated. Nevertheless, when the meridians with the most fundamental imbalances are treated first, comparatively few points have to be addressed to complete the treatment. In this process, changes in tenderness must be considered along with the pulse and other findings. Changes in symptoms must

4. bite �������������������� irregularities; 5. old ����������������������� injuries and scars; 6. uneven �������������������������������������������� contact with metals such as in false teeth or accessories; 7. dominance ���������������������������� of an arm or leg (dominant arm or leg); 8. ���������������������������������������������� loss of physical integration due to neurological disease; 9. ��������������������������������������������� imbalances caused by clothing or accessories

(such as soldiers might experience); 10. ��������������������������������������������� sports in which the body is used in an imbalanced way (e.g. tennis and golf ); 11. prolonged ������������������������������������������� use of a limb in an awkward position (e.g. walking a long distance while carrying a load in one hand); 12. �������������������� age-related changes. Each of these examples can result in imbalances that are difficult to correct. When certain imbalances persist, habituation or stabilization may occur, such that one can carry on with their daily activities.There are instances where individuals with significant age-induced spinal abnormalities can continue to endure heavy labour. If one were to forcibly "correct" the alignment, pain would then be the outcome. It is sometimes necessary to “let sleeping dogs lie.” Throughout history, in both the East and West, a variety of methods have evolved to address such musculoskeletal imbalances. Focussing on Chinese Medicine, we find such methods as Hit medicine, Tuina, Daoyin, and Tai chi, which can be applied for this step of treatment. It goes without saying that acu-moxa therapy itself is also beneficial for this purpose. Western approaches include chiropractic, osteopathy, and gymnastic exercises. Medical massage has become an accepted specialty in the modern medical system. One method I like to include here for Step III is the Tendino-muscular meridian treatment described in the Lingshu. A variety of treatments can be conceived by broadly interpreting the Tendino-muscular meridians in the Lingshu. I have chosen here to present a simple version of Keizo Hashimoto M.D.’s Sotai Therapy and target right/left differences in the neck, trunk, and lower limbs, critical parts of the musculoskeletal system. I perform four simple Sotai techniques for this purpose. It seems that this is adequate when steps one and two have been performed. When necessary, a small amount of local massage or manipulation may also be performed. Sotai Technique 1 In the supine position, have the patient flex both knees and place the hips in full flexion. When there is a right/left variance in flexibility, apply the technique on the more flexible side first. Ask the patient to take a breath and slowly extend one leg as they exhale. After the leg is fully extended and the patient has exhaled completely, have the patient hold their leg in 

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the fully extended position for two or three seconds longer. Then signal the patient to completely relax the leg. This technique alone is enough to relax the leg muscles, but it works even better when the fire needle mentioned in Chapter 10 of the Lingshu is also used simultaneously. A very thick needle or a sharp ice pick can be heated with an alcohol lamp. This heated needle can be quickly inserted at GB-34 and withdrawn as the signal is given to relax the leg. The pain is of a lesser degree and shorter duration than that experienced with direct moxibustion. (If one doesn’t have such a needle, a small cone of moxa can be lit on the point as the exhale begins, and the limb can be relaxed sometime after the moxa cone goes out.) When the technique is performed on one side, the opposite limb also tends to relax, but it is good to treat one side two or three times, and then to treat the less flexible side once. The patient can do this technique at home. Sotai Technique 2 With the patient supine, have them flex their knees so that the bottoms of their feet are on the table. Then have them dorsiflex their ankle against resistance. Begin treatment on the easier side. Have the patient take a full breath and then dorsiflex their ankle against resistance. After the end of the exhalation and a two-to-three second holding period, signal the patient to drop their foot. Just prior to this, the fire needle can be quickly inserted at LR-3 and withdrawn. Sotai Technique 3 With the patient face down, flex their knee alternately to bring their foot up toward the buttock. When the hips and legs are flexible, the heel touches the buttock, but usually one side is less flexible. Begin as above with the easier side and have the patient extend the leg on the exhalation. After holding the extended leg for two or three seconds, signal the patient to drop their leg. The fire needle can be applied on either BL-58 or BL-23. Sotai Technique 4 Also in the face down position, have the patient arch their back (extend the Governor Vessel). The sequence of breath, movement, and release is the same as above. The fire needle can be applied on GV-12, GV-10, or GV-8. 

According to Dr. Hashimoto, myofascial imbalances lead to skeletal or structural imbalances. In the first stage, imbalances cause sensory abnormalities including discomfort, heaviness, hypersensitivity, pain, and numbness. There are no objective symptoms at this stage. In the second stage, in addition to the sensory abnormalities of the first stage, there are functional abnormalities including insomnia, forgetfulness, loss of appetite, constipation, and dysmenorrhea. Up to this stage, the patient is preclinical, or without objective pathology. Even though these symptoms may be mild, they are important in Chinese Medicine for diagnosis, and there is a comprehensive approach to treatment. Modern medicine, on the other hand, has only symptomatic approaches for such problems, and it seems to take forever to resolve them. In the third stage, imbalances cause organic abnormalities, which are picked up and treated as diseases. It is ideal to take appropriate measures in the earlier stages when only mild symptoms manifest. Otherwise, even in cases of organic abnormalities, it is important to give treatments that address the underlying functional abnormalities. I have simplified Step III of my treatment system, but when the Yin-Yang balancing is performed sequentially from steps I through III, it is interesting how symptoms can be resolved with (1) mild stimulation (2) relatively few points, and (3) without very much local treatment. It is possible to bring relief to a majority of patients using Step III, but in special cases, some additional steps my be necessary: 1. When there are many psychological factors involved in the patient’s symptoms. 2. ����������������������������������������������� When the patient is very depleted, as in cases of anemia or severe malnutrition. These patients require tonifying herbs from Chinese medicine or modern medical approaches. 3. When ����������������������������������������� the patient has some serious and intractable disease such as cancer, or progressive neurological degeneration for which acu-moxa therapy cannot be applied. 4. �������������������������������������������� When there is a pattern of blood stasis and the use of blood moving herbs or blood letting is indicated. 5. When ������������������������������������������ a greater therapeutic effect results from the application of stronger stimulation than indicated above. For example, cases that require direct moxibustion, supperative moxibustion (Danou-kyu), or cupping. 6. When ������������������������������������������� special consideration or instructions

volume

13

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37

are needed for diet, or for alcohol, tobacco, or drug dependency. 7. ������������������������������������������ When treatment prevents the detection and treatment of a hidden organic pathology. 8. ��������������������������������������� When, as mentioned above, either stronger treatment or Chinese herbs are deemed beneficial. In such cases, the patient’s response to treatment must be monitored to carefully determine what additional treatment steps are needed. Often, medical examination becomes necessary.

Conclusion A wide variety of acu-moxa therapy systems are used in Japan. Some practitioners are biased toward strong stimulation, some toward local treatment, while others use various devices without much discrimination and call theirs a “comprehensive treatment.” It is unfortunate that a careful system, one that begins with balancing the whole body (one advantage of Chinese Medicine), is often forgotten. It is possible to begin with comparatively light stimulation and proceed with more treatment as needed according to a flow chart. I have presented this Yin-Yang Balancing System here in hopes that it will be tested and improved by many others. References in Japanese. See Japanese article for details. For a more detailed discussion of Manaka’s Yin Yang Balancing System, refer to Chasing the Dragon’s Tail, by Manaka Ypshio M.D., with Itaya Kazuko and Stephen Birch. Translated by Stephen Brown Manaka Yoshio, MD was born in Kanagawa Prefecture in 1911. He graduated from Kyoto Imperial University Medical School to become a medical doctor. He started studying herbology and acupuncture in the 1940s and made an enormous contribution to the advancement and popularization of Oriental Medicine, particularly acupuncture and moxibustion. He served as the president of Toyo Shinkyu Acupuncture College, director of the Manaka Hospital, research fellow at the Oriental Medicine Research Center of the Kitasato University, and president of the Acupuncture and Moxibustion Topology Association. He wrote numerous articles and texts on acupuncture and Oriental Medicine. He died in 1989.