HONCHI HO, HYOCHI HO: Root and Branch Treatment Staging in Contemporary Japanese Acupuncture PDF

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HONCHI HO, HYOCHI HO: Root and Branch Treatment Staging in Contemporary Japanese Acupuncture by Robert Hayden submitted April 2, 1996, in fulfillment of major paper requirement (A572 Major Paper Completion) Midwest Center for the Study of Oriental Medicine, Racine, WI and Chicago, IL Table of Conten...

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HONCHI HO, HYOCHI HO: Root and Branch Treatment Staging in Contemporary Japanese Acupuncture Robert J . Hayden

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Chapt er 07 Toyohari Meridian T herapy george sut imbul

Japanese Meridian T herapy in t he Communit y Acupunct ure Model Robert J . Hayden BUT T ERWORT H-HEINEMANN An imprint of Elsevier Limit ed Hamly WAN

HONCHI HO, HYOCHI HO: Root and Branch Treatment Staging in Contemporary Japanese Acupuncture

by Robert Hayden

submitted April 2, 1996, in fulfillment of major paper requirement (A572 Major Paper Completion) Midwest Center for the Study of Oriental Medicine, Racine, WI and Chicago, IL

Table of Contents Introduction......................................................................................................................4 Part I: Survey of Paradigms and Clinical Approaches Paradigms .....................................................................................................................10 !

Five-Phase ..........................................................................................................10

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Eight Extraordinary Vessels ................................................................................12

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Biorhythmic/Stem-Branch ...................................................................................13

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Other Paradigms .................................................................................................15

Clinical Approaches .......................................................................................................16 !

Approaches to Diagnosis of Root condition ........................................................16

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Methods of Assessment ......................................................................................16

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Systems of Feedback .........................................................................................21

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Approaches to Treatment of Root Condition .......................................................21

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Tools and Techniques ..........................................................................................21

Part II: Comparison of Styles: Toyo Hari & Manaka Toyo Hari ........................................................................................................................23 Paradigm---Five Phase/ Four Sho Model ......................................................................24 Root Treatment ..............................................................................................................25 !

Approaches to Diagnosis ....................................................................................26

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Assessment of Root Condition (Sho Determination) ..........................................26

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Feedback systems……………………………………….....…………………………28

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Approaches to Treatment …………………………………………………………….28

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Tools and Techniques …………………..…………………………………………….31

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!

Assessing Treatment …………………………………………………………………34

Supplemental (Branch) Treatment …………………………………………………………..34 !

Methods ………………………………………………………………………………..35

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Midnight-Noon …………………………………………………………………………35

!

KiKei ……………………………………………………………………………………37

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Naso & Muno ……………………………………………………………………….…38

Yoshio Manaka …………………………………………………….………………….40! Paradigm---Multi-Model ………………………………………………………………………41 Root Treatment ………………………………………………………………………………43 !

Approaches to Diagnosis …………………………………………………………..43

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Assessment of Condition …………………………………………………………….43

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Feedback systems …………………………………………………………………..48

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Approaches to Treatment …………………………………………………………….48

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Choice of Method …………………………………………………………………….48

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Tools and Techniques ……………………………………………………………….49

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Assessing Treatment …………………………………………………………………51

Supplemental (Branch) Treatment …………………………………………………………..51 !

Methods ………………………………………………………………………………..51

Conclusion …………………………………………………………………………………….53 Appendices Comparison of Point Selection of Meridian Therapy Founders ………………………..57 Comparative Symptomology of Extraordinary Vessels …………………………………62 Bibliography ………………………………………………………………………………….74

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Introduction !

An important concept in acupuncture is that of Root and Branch (Chinese: Ben-

Biao). These words that can have a variety of meanings, and be applied to a variety of situations. For example, concepts of pathophysiology, body areas, or clinical events can all be subdivided into root and branch. The present study will focus mainly on the latter, specifically, the way in which acupuncturists in Japan treat what they see as the root of a given patientʼs problem. The treatments are prioritized in such a way that there exist specific divisions and guidelines for each stage of a single patient encounter. These guidelines vary with the practitioner, and are often dictated by the association with which the practitioner identifies him- or herself. !

The purpose of this paper is to show how the Japanese view the concept of Root

and Branch within the context of clinical practice - which is, after all, the major concern of the pragmatic Japanese - and to show the root and branch treatments as an orderly and consistent staging of clinical events, each of which must be satisfactorily completed according to certain (often palpatory) criteria before proceeding to the next stage. While opinions differ as to the proper proportions of root versus branch stages, most practitioners with any classical background will concur that the root stage is very important and is usually the initial event in treatment. !

We aim to show that:

-Root treatment is important -It usually occurs first in the staging of the treatment -It uses different diagnostic criteria than the branch treatment -It uses different treatment methods than the branch treatment

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-It is usually monitored and measured against some criteria to be judged effective -It may itself be subdivided into stages !

The paper is divided into two main sections. First is an overview examining the

paradigms, diagnostic and treatment techniques commonly associated with “root patterns”. This section will briefly review a variety of paradigms as they are used clinically in Japan. Major exponents of the various schools will be noted, though some who may not fit into one or the other may be excluded (Akabane, for example). This list will of course be limited to practitioners whose styles and ideas have been described in English-language texts. It should be noted that the emphasis of the paper is on those schools that acknowledge the classics as a major influence, and not on those schools that seek a purely “scientific” approach. Second is a more detailed examination of the clinical approaches developed by two of the most prominent Japanese acupuncturists of the twentieth century, Yoshio Manaka and Kodo Fukushima . Appendices follow. !

First, let us consider some points of view on the meaning of root treatment. First,

from the book Acupuncture, A Comprehensive Text, which is a translation of the Shanghai CTCM textbook: !

“In Chinese Medicine, emphasis is placed upon distinguishing the relative

importance of the Root and Branch. In terms of disease, the first to be contracted is considered to be the Root, and later complications the Branch. Between the Organs and their pertaining channels, the former are considered the Roots and the latter the Branches. Points on the limb are Roots, those on the trunk and head are Branches. Sometimes the Root is treated before the Branch, but at other times this sequence is reversed. Occasionally, both may be treated simultaneously, or one treated exclusive of

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the other. Generally an acute illness is treated first, a chronic illness second, Exterior disease first, Interior complications second. However, the more general balance between the normal and abnormal forces in the body must also be taken into account. For example, if the Normal Qi is particularly Deficient, i.e., the body is very weak, the most immediate concern is to ʻsupport the normalʼ, since the expulsion of the abnormal Qi from the body depends primarily upon the organisms ability to resist disease.” !

Helpful comments from Denmei Shudoʼs excellent Japanese Classical

Acupuncture: Introduction to Meridian Therapy, in which he quotes other sources: !

“Root treatment is performed in accordance with the pattern of the disease, and

symptomatic treatment in accordance with the symptoms of the disease. The first priority is to correct the abnormal relationships of deficiency and excess among the meridians. To do this we must determine the overall picture of the disease known as the pattern by identifying and analyzing those relationships of deficiency and excess among the meridians and organs that are abnormal, and those that are not.” (Yamashita, 1971) !

“(Root treatment) is the treatment in which the imbalances in the meridians,

which are the essence of the disease, are corrected by tonification and dispersion using the five-phase points and five essential points. Symptomatic treatment is the treatment rendered according to the...complaints of the patient by treating localized areas.” (Fukushima, 1979) !

“(Root treatment) is the correction of imbalances in the meridians by using the

essential points on the four limbs in accordance with the primary pattern, which is derived from the various diagnosis and analysis of the symptomology. Symptomatic treatment is performed simultaneously in accordance of the symptoms by directly

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Tonifying or dispersing reactive points or acupuncture points [resulting from] imbalances.! There are, of course, cases in which the symptoms are relieved by root treatment alone. In such cases, symptomatic treatment is unnecessary. However in most situations these two treatments are equally important and necessary. (Takeyama, 1944)”! !

Shudo emphasizes the importance of both root and symptomatic treatment. “No

authority on meridian therapy claims that treatment of localized areas is unnecessary...The only real difference between meridian therapy and the conventional approaches to acupuncture in Japan is that root treatment is performed to balance the body energetically before the specific symptoms are treated...The distinctive feature of meridian therapy is that root treatment comes first...There are considerable differences of opinion regarding just how important root treatment is relative to symptomatic treatment. Some believe that root treatment takes care of 70-80% of the symptoms...others believe that while root treatment corrects imbalances of Qi in the meridians, it is not immediately effective in ameliorating the symptoms...{which must be} treated separately with symptomatic treatment. Finally, some practitioners believe that root and symptomatic treatment are of equal value... The concepts of root and symptomatic treatment were redefined with the advent of meridian therapy. The classics mention treatment of the root (honji/ben zhi) and treatment of the manifestation or branch (hyoji/biao zhi), but this is generally just a matter of emphasis, rather than two distinct aspects of treatment. Root treatment is emphasized so much in meridian therapy because the majority of practitioners in Japan are only concerned with symptoms and the stimulation of tender points. Since root treatment in acupuncture is a

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unique approach introduced with meridian therapy, it is naturally presented as the more important aspect of treatment. All practitioners of meridian therapy agree that root treatment comes first, and symptomatic treatment second.” (all italics mine) !

Yoshio Manaka provides an excellent definition of root treatment in his

posthumously published work, Chasing The Dragonʼs Tail: “-As the procedure performed first, it serves to clear the way for the procedures that follow. When successful it can be sufficient in itself, and at the very least, it simplifies the rest of the treatment. -Specific factors, such as individual and constitutional differences, can be taken into consideration. -It requires some simple, verifiable diagnostic confirmation. -Such checks allow selection of points for patients who are otherwise difficult to diagnose by other means. -The method of treatment can de decided for incipient diseases that are beyond detection by means that depend on symptoms. -Problems and imbalances can be detected and treated at preclinical or functional stages before a pathology becomes evident. In ancient China, there was a tradition that the superior physician treated diseases before they occurred.” !

While it is difficult to generalize about Japanese acupuncture, given the vast

array of approaches developed there since the Second World War, it is fairly certain that each acupuncture association has developed its own “root style”, with its own diagnostic requirements and treatment techniques. The majority of Japanese schools use more gentle treatment methods than their PRC counterparts, and often it is necessary to have

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a system of feedback to monitor the progress of therapeutic events. It is not uncommon that the root treatment requires confirmation of efficacy before the treatment is allowed to proceed to the next step, i.e., the practitioner must pass a sort of “test“ before entering the next “grade”. As Shudo explains it, “After the root treatment...is completed, there must be some way to determine if the desired effect has been achieved. In root treatment, unlike symptomatic treatment, relief from symptoms is not the primary indicator of success. Nonetheless, after tonifying a point, one still needs to know if the needling accomplished its objective.” !

These he sums up into various indications, having to do with the relative balance

between pulse positions and changes in pulse quality, changes in the abdomen and the skin in general, disappearance of abnormal palpatory findings such as pressure pain, increase in circulation to the extremities and in digestive motility, and subjective improvements such as relief from symptoms in the patient. He continues, “The immediate, subtle response of the body to needling sends a very important message to the practitioner about the correctness of the treatment.” !

Even if we accept Shudoʼs assertion that the present emphasis on root treatment

began with the meridian therapy school, we shall see that the concept has spread outside their stylistic boundaries to a wide range of different practitioners and their philosophies. It is important to note the scope of acupuncture practice in Japan, and to realize that the present paper will only hint at the diversity of techniques and models that are found there. In many cases, the various practitioners involved will adapt each others methods.

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!

In the first part of our exploration into concepts of root treatment, we will examine

two of the most common paradigms in contemporary practice of traditional Japanese acupuncture, namely those of the Five Phases and of the eight Extraordinary Vessels. These two theoretical models have preoccupied much of the Japanese view of root treatment since the Second World War, and are present in many forms of acupuncture today. In addition, we will note other paradigms that have been more or less discussed in the extant translated literature on this subject.

Part I: Survey of Paradigms & Clinical Approaches Paradigms !

In the Japanese acupuncture literature that has come to the West, it is striking for

the student educated in most U.S. acupuncture colleges to note the absence of the TCM paradigm (i.e., the eight guiding criteria or Ba Gang Bian Zheng) in favor of concepts of pathophysiology and therapy hardly taught in most schools here. While each paradigm is enormous enough in it own right to merit at least one full-length book on the subject, for our purposes a quick mention of each in the context of contemporary Japanese practice is warranted. Recommended reading on each may be found in the bibliography.

Five-Phase (GoGyo) !

The history of the Five-Phase (Chinese: Wu Xing, Japanese: GoGyo) paradigm

is long and controversial; its influence on virtually all aspects of Chinese thought is enormous and outside the scope of this work. Its application in medicine dates to at

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least the Huang Di Nei Jing Su Wen , and it is the model of choice for what is probably the most classically-oriented of all styles of acupuncture in Japan today, Keiraku Chiryo (Meridian Therapy) . !

Among those schools in Japan that claim adherence to classical principles,

perhaps none is as widely known as the Meridian Therapy movement, founded in the 1930ʼs and 1940ʼs in Tokyo. Traditional medicine had been largely supplanted by modern theories of anatomy and physiology which had been introduced in Japan by the Dutch as early as the seventeenth century . An acupuncturist and philosophy scholar named Seisuke Yanagiya (also known as Sorei Yanagiya) was dissatisfied with the prevailing Westernized methods being practiced at the time and sought an approach that was more grounded in classical theory. He began to attract students. Two of them, Fukuji Okabe (also known as Sodo Okabe) and Keiri Inoue, joined forces with journalist-turned-acupuncturist Shinichiro Takeyama; the three of them are considered to be, along with Yanagiya, the founders of the Meridian Therapy style . !

The classics they used were primarily the Huang Di Nei Jing Su Wen, the Huang

Di Nei Jing Ling Shu, and, most prominently, the Nan Jing. The Nan Jing was made the basis for the clinical practice of Meridian Therapy, Shudo says, because of its antiquity and because it presents “a systematized and self-contained system of acupuncture treatment”. Paul Unschuld, perhaps the most prominent Nan Jing scholar writing in English, calls the work “the mature classic of systematic correspondence. In the history of this particular conceptual system it occupies a prominent place since it appears to be the only work we know of that combines a high degree of innovative thinking with a consistent - in the Chinese sense - body of thought.” . The clinical procedures outlined

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in the Nan Jing were largely based on the Five Phase paradigm, and made extensive use of the Five Transporting points ; thus their prominence in Meridian Therapy. !

Perhaps the greatest contribution of the Nan Jing to Meridian Therapy - and

indeed, it is arguable, to the art of acupuncture as a whole - is the concepts it introduced regarding radial pulse diagnosis. The idea that the pathophysiology of the organs and meridians could be determined largely from the radial pulse revolutionized the practice of medicine in China and continues in some form in virtually all systems of acupuncture extant today. So, too, the treatment principles revealed in Difficulty 69, from which developed the “four-needle” technique and other point selections derived from it. This is the “mother-child” principle, which is the found...