Volume 4, Number 2 | Summer 2009

Medical History in Japan
Sotetsu Ishizaka’s “Shinkyu Chiyo Ichigen (2)Kenji Kobayashi
Guest researcher of Medical History Research Dept.
Kitazato University Oriental Medicine Research Center[Part 2 of this series]- Unless the reasons are known why needles curediseases, needling techniques become a uselessthing and cannot be put to practical use.
Once the significance of their application has
been understood, like pollution transforming into
cleanliness, or entangled things becoming undone
diseases can be cured. When the essentials havebeen sufficiently grasped, the criteria can clearly
be formulated in words.
Well, formulating the essentials in an easily
understood language, a bamboo or wood spine(splinter) piercing the body is not different from aneedle made of gold, silver or iron piercing thebody, in both cases similar splinters are inserted
into the body. The difference lies in whether these
splinters are stuck by mistake, or inserted for the
purpose of treatment.
When bamboo or wood splinters have pierced,
it is possible to remove them by pulling them out
with human strength, but if that person were notable to pull it out with his own strength, the vital
force of that particular person will cause thedevelopment of inflammation and calor at the siteof the splinter, gradually concentrating essence
and spirit as well as nutritive and protective qi(effects of nerves and blood vessels) forces, so thatthe fever at the site of the splinter becomes
exuberant, transforming the heat into pus so that
gradually even splinters that cannot be removed
with the strength of that person are discharged
together with pus and thereby removed from thebody. Drainage of the pus and following recovery
from the inflammatory symptoms, the bodynaturally returns to its whole, unharmed
condition.
During acupuncture & moxibustion treatment
28

gold, silver or iron needles are inserted at the siteof the disease and similar to the local
development of calor at the site where bamboo orwood splinters have pierced, essence and spirit aswell as nutritive and protective qi concentrate
and gather beneath the needle.
Retaining the needle in place for a while,
properly gathering these forces under the needle
and then removing it will finally scatter essence
and spirit as well as nutritive and protective qi
along with the pathogenic evil and result in asudden healing. This is exactly like the way windblows away clouds, after which a clear blue sky
emerges. In the classics too it says "Piercing threetimes will heal a person in whom 10 days havepassed since the onset of the disease. Piercing tentimes will heal a person in whom 1 month has
passed since the onset of the disease. Anyway,
regardless of whether the disease is mild orsevere, one treatment every three days is thestandard for the treatment."
Regarding the needling technique the sites ofthe pathogenic qi are needled, and throughtreatment of the evil the essence and spirit aswell as nutritive and protective qi gather properlyat the site. By removing the needle the gatheredessence and spirit as well as nutritive andprotective qi will eliminate the evil. In otherwords, this can be considered to be the same
technique as if drastic drugs like ginseng or
aconite were used to raise the weakened vitalenergy to achieve vitality.
- Sites that should not be needled are constantly
and widely moving organs. The two organs heart
and lungs and thick arteries (i.e. the aorta) as
well as along the course of major ('gathering placeof the heavenly vessels for essence and spirit" (i.e.
nerves)) "somyaku seishin", where needling could
result in various accidents. Thus, unless one hasa detailed knowledge of the course of the qi andthe courses of vessels the particular person is

The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

Volume 4, Number 2 | Summer 2009

nothing more than a layman, poking a sick person.
When facing acute diseases people highly skilledin the art may achieve good effects by piercing
forbidden sites that usually should be avoided.
That is the same as using the “militia” in war.
- Needling technique is really all about direct
insertion, but not restricted to it. The skills ofproperly using the left and right hand, adopting aproper posture, serious concentration, relaxing
the arms and the skills to move the fingers freely
have to be acquired.
The index and middle finger of the left handare placed alongside each other and press on thesite to be needled, taking care to be able to change
at will between light touch and deep pressure,and between these two fingers the needle is heldin the right hand and pressed in.
Once the needle has been inserted, it is pushed
further in with the right hand. Here it isimportant to take care to keep it constantly
moving from the start to the end in a rhythmical
fashion. This is called the secret of the needle.
[Illustration 6] Illustration of twisting aneedle, “Shinkyu Chohoki” (Description ofacupuncture and moxibustion treasures) by
Masatoyo Hongo (1718)

hand governs the advancement of the needle,
while the left hand holds and controls the needle
and thus reins it.”
It is also said that “people practicing
acupuncture must believe their left hand”.
Unless the hand that inserts the needle is kept
heavy and rhythmically moving, the needle turns
into a lifeless thing. When there is only a minimal
amount of vital force left in the sick person’s bodyand the hand of the acupuncture practitioner is alifeless thing, it can have various harmful effects.
One has to be very careful about this.
For this reason the classics describe therelevant acquaintance as: "The person performing
the acupuncture must maintain a wakefulproficiency and a frame of mind as if looking intoa deep abyss, or walking on thin ice, kneeling infront of dignitaries, or as if grasping the tail of atiger with the hand." Various mistakes are allcaused by inattention.
- There is the phenomenon of the needlingsensation (resonance). From the site where theneedle has been inserted a phenomenon like a
flowing resonance always spreads up, down, left
and right and may cause a needling sensation in
the most unexpected places. Needles inserted intohands and feet may for example affect the face,chest or back. Those are all due to effects on the"Somyaku" (zong mai; gathering place of theheavenly vessel essential vessels). It is not due tothe nutritive and protective qi channels called"Eie". Neither is it due to the muscles.

* Author's note: When Sotetsu refers to"Somyaku", he means nerves, while "Eie" refers toblood vessels.
[Illustration 6]

For that reason it says in the classics “the right-Gold, silver or iron is
manufacture of the needles.

The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

usedforthe29Volume 4, Number 2 | Summer 2009

The standard for the length of the needle metal inJapan should be 3 "sun" (inches).
The vitality of the physician does not reach theneedle tip, when they exceed this length, so that
this would not be beneficial for the disease anylonger.
The thickness of the needle (thick, thin) is
restricted to needles of sizes between gauges No.
1 to No. 7.
In modern times through tapering during theprocess of the metalwork the needle body may be
manufactured with an initial thickness of gauge
No. 6-7 and that gradually becomes thinner down
to No. 1-2, but this is meaningless. It may
facilitate the insertion of the needle, but is notbeneficial for the disease.
- In case of tube needles a guiding tube is used
and the needle tapped in for only a portion of its
length.
The outer skin in most people is rather
insensitive to pain and itching. The needles areinserted to this pain insensitive depth. There isno harm.
But here too, if the acupuncture practitioner
performs this treatment rough and mindlessly,
inserting the needles in an unskilled manner,
there may be severe pain. This too has to be
performed very carefully, with watchful, vigilant
attention.
In case the needle is inserted without the useof a guiding tube, it is important that the needle
tip is pressed firmly pressed against the skin topierce it and then be manipulated.
[Illustration 7] Illustration of needling a guiding
tube, derived from "Shinkyu Bassui Taise"(Comprehensive Compilation of Excerpts about
Acupuncture and Moxibustion) by Ippo Okamoto(1699)

30[Illustration 7]- The needling method includes aspects oftonification-sedation,receiving-following,anddeficiency-excess.
Tonification helps to boost the sick person’s
spirit and engorge the vessels, which is a method
to remove the harmful qi.
Sedation is a method of eliminating congestion of
the nutritive and protective vessels by purging
the blood. I have also heard that in the west there
is a purgative method using needles. Although I
don’t know any details of that technique, I believe
something like the three-edged needle is beenused for this purpose.
[Illustration 8] Illustration of twisting a needle,“Shinkyu Chohoki” (Description of acupunctureand moxibustion treasures) by Masatoyo Hongo(1718)

The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

Volume 4, Number 2 | Summer 2009

[Illustration 8]

The receiving-following technique resembles
the breathing method, when the needle has
already been inserted, that depends on carefulconsiderations of the coming and going in the
nutritive and protective qi in the vessels and is
performed with the practitioners mind set toeither meeting or following the flow. One has to bevery patient when entanglements of the disease
are disentangled, and has to pierce with theneedles carefully and concernedly.
The deficiency method is a technique wherethe needle is quickly removed and both the spirit
as well as the nutritive and protective qi are used
to treat exuberant disease.
The excess method is the application of thereceiving-following technique. The needles areslowly inserted over an extended period of time,
without causing any pain at all, only mild
needling sensation, and where the breathinginterval of the needle is gradually increased. Thisis used for persons in whom both essence andspirit as well as the nutritive and protective qi
vessels have fallen into a state of deficiency.

Well, in a certain patient the excess method
may be applied at one site and the deficiency
method at another site. Or else the deficiency
method is employed in the upper region, while theexcess method (or a similar technique) isemployed in the lower region.
Depending on whether the disease is locatedshallowly and whether the symptoms are marked
by deficiency or excess the choice of the needlingtechnique is used either shallowly or deep, or else
deficiency or excess, tonification or sedation,
meeting or following techniques are used
depending on the ingenuity of the physician.
Diseases have to be treated based on athorough comprehension of these techniques. The
question of whether the acupuncture physician iseither skillful or inexpert depends on whether
there is a profound knowledge of the body’sinterior and exterior, upper and lower portions,the twelve organs, essence and spirit, thenutritive and protective qi physiology, and thecauses of all diseases are carefully scrutinized.
Those who accomplish this can truly be calledsuperior docters.
With this the outline of the needling method iscomplete.

The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

31