Japanese Meridian Therapy in the Community Acupuncture Model

Robert Hayden, M.S.O.M., A.P. Introduction It has been a long while since I wrote anything for NAJOM. I would like to briefly reintroduce myself. I did my basic training at Midwest Center (now Midwest College) of Oriental Medicine, in the graduating class of 1995. The program was a standard TCM curriculum, and I soon found myself dissatisfied with the standard TCM approach to acupuncture. I went on to extensive post-graduate training in Japanese Meridian Therapy (JMT) from 1995-2002: primarily with the Toyo Hari association, and also with Shudo Denmei as well as others. In 2006, I became interested in the work of a clinic in Portland Oregon, Working Class Acupuncture, run by Lisa Rohleder and Skip Van Meter. This clinic offered high volume, low cost acupuncture given mostly in reclining chairs. There was a Japanese connection in that the clinic made use of Jingei pulse diagnosis, which they had learned from Yoshi Ikeda. A network of clinics soon formed to develop this clinic model, known as the Community Acupuncture (CA) model. I joined the organization in 2007 and officially opened my own clinic, Presence Community Acupuncture, in 2009. Features of Community Acupuncture (CA) As mentioned earlier, CA is a model based on high patient volume and low cost. Four to six patients per hour is a standard pace. Pricing is usually on a sliding scale between $15-40, considerably below the average rate for acupuncture in North America. The idea is to increase accessibility of acupuncture to people of ordinary and lower incomes. A high volume is needed in order to make the clinic financially viable. To accomplish this kind of patient volume, assessment and treatment need to happen at a fairly rapid pace, at least one that is faster than most acupuncturists trained in North America are accustomed to. Treatment generally happens in an open environment, generally one or more large rooms. Acupuncture is the predominant modality performed, and usually retained needles are used. Typically patients are treated in reclining chairs. Because of the seated posture and open environment, patients need only minimal disrobing, usually from the elbows and knees down. Distal points located in these areas are primarily used. Local treatments are possible but must be efficient in order to keep the clinic on schedule. Treatment trends to be channel centered, with many possibilities for point selection. Commonly used methods among CA practitioners include those taught by Richard Tan, and disciples of the Tung style of Taiwan. The renowned California practitioner Miriam Lees 5 point protocol (LI4, LU7, LI11,ST36, SP6) is popular as a basic treatment, either alone or as a framework for additional points. Microsystems, such as those on the ear, hand, and scalp also are used by some practitioners. Since I have had a fairly long history of treating using Japanese Meridian Therapy, I naturally started using the methods with which i was most familiar. I found that JMT adapts to the CA model quite well. JMT uses a simple diagnostic framework, with four primary patterns. This puts it somewhere between Miriam Lees 5 points and TCM. The gentle needling style of JMT is easily tolerated, thus good for beginner patients; many of the patients I see have never

experienced acupuncture before, as they were unable to afford the market rates. CA practitioners must deliver effective and comfortable treatments using only acu-moxa, very much like most of the Japanese practitioners I observed. The diagnostic and treatment models i use most often are the four sho (five-phase) patterns, Extraordinary Vessels, and a modified version of Shigo therapy. I've needed to modify them all to some degree to fit the clinical situation i have set up. Four Sho Sho as I learned it is determined by the pulse (the primary diagnostic indicator), followed by the abdominal conformation, symptoms,and channel palpation (all of which are used mainly to confirm the pulse findings). Treatment in chairs makes the abdominal diagnosis difficult, however symptoms and channel palpation can be used, along with other kinds of diagnostic methods (for example, I have recently done some experimentation with the finger test method of Tadashi Irie). Also, in addition to the standard Six-Position Pulse Examination, I often use Pulse Quality as feedback: to test the appropriateness of a particular treatment, point selection or location, and so on. Points may be chosen that bring on an improved pulse when they are palpated. Extraordinary Vessel Therapy I use the standard Extraordinary Vessel combinations (for example, SP4 with PC6,and so on) along with the two additional pairings I learned with the Toyo Hari association: Hand & Foot Yangming (LI4 & ST43) and Foot Jueyin & Hand Shaoyin (LR3 & HT5). I use symptoms to determine which vessels to treat, as i learned with Toyo Hari. Further information on the symptomology can be found in Fukushima Kodo's Meridian Therapy book, or Matsumoto and Birch's Extraordinary Vessels. Often practitioners of Japanese styles will treat EV points with polarity (ion pumping or magnets). While I occasionally use such methods, as I have become busier I often forgo them in favor of simply retaining the needles in the points, which seems to work well enough. Shigo (Midnight-Noon) Therapy Shigo is another method I learned with Toyo Hari. It utilizes opposite channels on the Chinese clock to treat symptomatically. For example, back pain along the Bladder channel is treated by applying needles or moxa to the Lung channel. Usually the symptoms treated will be onesided; the side opposite the symptom is needled. This is similar to the Balance Method taught by Richard Tan, which is very popular in the USA. This method is invaluable as it allows one to treat areas which are difficult to access when the patient is seated. As an example: for left sided low back pain involving Kidney and Bladder channels, needle LI4, LU6 on the patient's right side. Shigo as I originally learned it uses contact needling with a thick gold needle, or direct moxibustion on the points; however, as is the case with EV treatments, nowadays I usually retain the needles after finding reactive points on the channel. Additionally, I make frequent use of ear acupuncture, which has also fascinated me since my days as a student. Combining the ear points with body points, I find, can bring on more rapid improvement in many cases.

Root/Branch Treatment Though in JMT treatment is often prioritized as Root (fundamental) and Branch (symptomatic) treatments, the time constraints of a busy practice mean that in CA usually I needle all the points at the same time and retain the needles. In some cases, I will only do root treatment, and address branch conditions as the therapy continues, and in some others the reverse is true. Needle Technique As mentioned above, most commonly I use the method of retaining needles. The needles I favor are #1x30mm, and the insertion depth is usually around 5 mm or so (enough to keep them from falling out). One thing I noticed in using this method is that once I tap the needle in and set it vibrating, the needle will continue to vibrate on its own, due to the patient's own breathing, blood flow and small movements. This, I feel, keeps the point very gently stimulated as long as the needle is retained. This effect seems heightened by the thin flexible nature of the finer needle gauges. Additionally, I make frequent use of simple insertion, especially for painful areas such as the neck and back. Either before or after the rest of the needles are placed, I will do simple insertion to tight areas around the location of pain. I find the method quite effective, and useful particularly in cases where retention is problematic. For example, some painful areas could present a hazard if needles were to be retained there. Areas such as the scalenes, upper trapezius, neck or even the lower back will usually be treated locally with simple insertion. I will also sometimes use contact needling, either locally or for root treatment, in cases where a patient is very anxious or otherwise sensitive to the needle stimulation. In some cases I will apply direct moxibustion, especially when I know there is a particular moxibustion treatment point indicated. For example I use Uranaitei (ball of foot beneath 2nd toe) in cases of severe digestive disturbance, Chujo points (around ST27) for Infertility, or Shitsumin (center of heel) for insomnia. Below are a couple of cases which illustrate the approach I use. Case 1 42 year old female. Primary complaints are migraines and menopausal symptoms due to medications taken for breast cancer. Patient is under a lot of stress and cries frequently. Pulse is thin and wiry, Liver and Kidney positions are weak. Sho: Liver deficiency Treatment: Bilateral LR8 & 3, K10 & 6, GB34 & 41. Left TB5, LU7, LI11. Right arm was not needled to avoid risk of infection post-mastectomy. Liver and Kidney channels were chosen along with the Gallbladder channel to treat the Sho. GB41 and TB5 treat the Dai Mai and Yangwei Mai in order to reduce the migraines, and K6 and LU7 treat the Yinqiao Mai and Ren Mai to alleviate the hot flashes and other menopausal

symptoms. Within six treatments, the migraines, which had lasted for days, would last an hour or two at a much reduced severity, and the hot flashes were significantly better. Her treatments are ongoing as she has to continue taking the medication, but with weekly acupuncture she is able to function quite well. Case 2 26 year old male. Primary complaints are low back pain on the right side between L2 and L5, and urticaria primarily on the upper body. He sometimes has trouble sleeping. He is very polite and soft spoken. His skin is somewhat damp and the area around SP9 is puffy. His pulse is soft and the Spleen position is weak. Sho: Spleen deficiency Treatment: Left SP9 & 10, TB3, Right H7: This treats the primary pattern of Earth and Fire, and also helps the itching. Left LI3 & 4, LU5&6: these are the Shigo channels to treat the back pain, which is related to the Bladder and Kidney channels. Right BL62 & 65: this treats the Bladder channel directly. Right ear lumbar spine area, left ear allergy point: further reinforces the symptomatic treatment. All needles retained for 30 minutes. After the first treatment, the symptoms were significantly improved. By the third treatment the rash was gone and the back pain was much better. Conclusion This brief article illustrates my current approach to applying Japanese acupuncture methods to a Community Acupuncture setting. I find it very rewarding to treat people who, for various reasons, have had little or no access to acupuncture, and find that the gentle methods which I learned from Japanese teachers over the years work quite well when adapted to this type of setting. Currently I am helping to design a training program which will include these techniques, and I am hopeful that over time many more people will be introduced to the benefits of this type of therapy.