Volume 1, Special Edition | Current Japanese Acupuncture and Moxibustion 2010

Characteristics of Japanese Acupunctureand Moxibustion
Shuichi Katai
Department of Acupuncture and Moxibustion
Tsukuba University of Techonology

Su Wen (Plain Questions) and Ling Shu (SpiritualPivot) have been the original texts on which thissystem was based.
The term "Orient" as it is perceived in the West,suggests a very extensive area including the Near East

1. Japanese Acupuncture and Moxibustion -and the entire Asian region. If that is so, the orientalDefinition
When talking about Japanese acupuncture andmoxibustion, several perspectives have to be taken
into consideration. For example, the most easily

medical system should also comprise such various
Asian medical systems as Ibn Sina, Ayurvedic
medicine, Mongolian medicine, Tibetan medicine andChinese medicine.

understood aspect would be a classification based on

Otherwise it could be asked why the term

differences in therapy. Also, classifications based on

traditional Chinese medicine is not used. While today's

differences in theory, misperceptions or conceptual

Chinese medicine is based on the classics Su Wen anddifferences are also conceivable classification criteria.

Ling Shu, it can also be comprehended as aIt might also be possible to discuss the subject asreorganized system formed following the foundation ofviewed from differences in the tools used for

the People's Republic of China in 1949. The influences

acupuncture and moxibustion. Moreover, it should alsoof this system later propagated through East Asia andbe possible to differentiate Japanese acupuncture andagain modified in the various regions just as it

moxibustion as compared to Chinese and Korean

happened after the emergence of its original form inmedicine.

China. Thus, during the transitions in Chinese history,

The English designation for needles used as tools

in the process of the propagation from the old China tois generally "needle", but when the notion of amodern China, this medical system can be viewed astreatment performed with these needles is included, ahaving emerged, changing under the influence of

numberlikeacupuncture,

modern Chinese culture. In other words, the term

acupuncture

treatment,

Chinese medicine today must be said to designate aneedling, needle therapy, and needling method are

medical system that is different from the orientalused. Here, the English term acupuncture in the sense

medicine developed 2,000 years ago in China. In thisof therapy is used.

sense, Chinese medicine can be comprehended as aofincoherent

acupuncture

therapy,terms

Again, the term "oriental medicine" is frequently

form of Asian medicine. And, when speaking ofused in Japan in the sense of comparing oriental

oriental medicine, the term should implicate East

medicine to western medicine, but its meaning

Asian medicine. Accordingly, if the term is to be usedremains in fact, rather unclear. Usually the use ofin the above mentioned context, East Asian Medicine

orientalwould probably be appropriate.

medicine

impliesthemedicalsystemdeveloped 2,000 years ago by the Han people native tothe Yellow River basin in China. It later spreadthroughout the various Asian regions, where it wasunder the influence of the culture of the countries it
had been propagated to. It underwent modifications
specific to that particular country and thus developed
to the present day. This system was introduced toJapan in the 6th century. The Yellow Emperor'sClassic of Internal Medicine comprising the sections
102. Acupuncture practice in modern JapanThe acupuncture of East Asian medicine was firstmentioned in the "Nine Needle Twelve Sources
Chapter" of the "Ling Shu" (Spiritual Pivot), where
nine different types of needles and the basics of theirclinicalapplication

weredescribed.

This

has

undergone a multitude of changes over the past 2,000years. In particular, the changes that occurred under

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

Volume 1, Special Edition | Current Japanese Acupuncture and Moxibustion 2010

the influence of western science in the 19th century,1) Tools, Stimulation Method and Stimulation Sitedefine what is today called acupuncture. Thus,(a) Differences in tools

acupuncture has to be defined in such a way that it

Generally, the needles used in Japan are thinnercannot mean only the needling techniques handed

than those used in Chinese medicine. The mostdown from ancient times, but also has to indicate

frequently used needles in Japan have a diameter

physical stimulation in general that is administered invaryingorder to elicit effective body responses in order tofrequently used in China have diameters between

promote healing of diseases.

0.32-0.38 mm. This clearly shows that the needles

The acupuncture performed in Japan based on thisbetween

0.16-0.20mm,

whileneedles

used in Japan are much thinner.

definition can be classified variously. For example:

There is not a unanimous view regarding theaccording to the stimulation site (scalp acupuncture,reason for the use of such thin needles in Japan (orear acupuncture, hand acupuncture, intradermal

why they have become so thin). Probably, they wereacupuncture),(contact

made so thin because of the hypersensitive nature ofinsertions,

the Japanese people. Acupuncture and moxibustion

thrusting and lifting, electrical pulse stimulation,

are considered to have spread among the general

tappingtherapy),

population in Japan about 400 years ago. Conceivably,

differences in therapeutic concepts (tender pointin the process of the popularization, this modality hastherapy, ashi point therapy, blood letting, Ryodoraku,

been adapted to suit the constitution of the Japanesetrigger point therapy, pediatric acupuncture), etc.

and thus led to the use of weaker stimulation doses asthetypeacupuncture, needle
needling,

ofstimulation

retaining,

firesingle

needling,

SSP

well as the development of thinner needles. Whenthinner needles were used, they would bend more

3. Characteristics of Japanese acupuncture
As mentioned above, Japanese acupuncture has

easily upon insertion, so a twirling insertion method

several classification approaches. Any one of them,using both hands had to be devised for the insertion ofhowever, may have common characteristics.

filiform needles. For the Chinese twirling method, bothJapanese

hands are not used. There is no necessity to do so.

acupuncture, as compared to Chinese and Korean

Thinner needles led to changes in Japan by inevitableacupuncture, may be characterized by its use of very

consequences. Additionally, to prevent pain upon

weak stimuli. Generally, factors determining theinsertion, approximately 300 years ago, the use of astimulus quantity of acupuncture and moxibustion

guide tube was suggested that led to the development

include the tools used, the stimulation method andof a uniquely Japanese guide tube needling technique.

stimulation site (site on the body). Moreover, bothAt that time the head of a pestle-shaped needle

quality and amount of applied tools and the stimulation

was inserted by tapping with a wooden hammer, amethod determine the quantity of the stimulus.

technique called tapping needle; or else the purely

Oneofthecharacteristics

oftheAlso, the information obtained through palpation

manual twirling needle technique, not relying on tools,

among the four examination methods, are considered

was performed. The needling technique using a guideparticularly significant for the comprehension of thetube developed later into the mainstream Japanesepathological condition, determination of stimulationneedling technique. Painless insertion, safety, andsites, and stimulation dose etc. may be cited as otherease of insertion of this technique can probably becharacteristics. A brief description pertaining to tools,cited as reasons for this development. It can be

stimulation method, and stimulation site is presented

assumed the tapping needle technique inspired thebelow.

development of this guide tube needling technique.

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

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Volume 1, Special Edition | Current Japanese Acupuncture and Moxibustion 2010(c) Differences in stimulation sites(b) Differences in needling techniques
The stimulation method varies depending on theDifferences in stimulation sites refer to where oninsertion and stimulation technique after insertion.

the body the stimuli are applied. In other words, it

The acupuncture performed in Japan includes adepends on which acupoints are chosen, and at thevariety of techniques from contact needling, using only

same time, the depth of the needling. The stimulationskin contact stimulation but no perforation of the skin,dose varies with the insertion depth.

over subcutaneous needling, where the needles are

Regarding the amount of stimulation derived frominserted very shallow into the subcutaneous tissues tothe differences in stimulation site, it is generally

intramuscular needling techniques. The techniques

understood that local needling stimulates the bodymay employ just stroking of the skin, or a methodvery effectively (i.e. the amount of stimulation iswhere the needles are placed and retained in place

greater). Clinical consideration demonstrates that thefrom several to ten or more minutes, thrusting andstimulation

lifting

distance from the relevant local area.

stimulationor

low-frequency

electricintensity

decreases

withincreasing

However, there is no definite proof that local

stimulation, etc. This means that many different
contact

stimulation of affected areas represents the strongest

acupuncture, single insertions, thrusting and lifting,possible input. On the contrary, the consideration thatelectrical pulse stimulation, tapping needling, fire

remote stimulation is required to provide powerfulneedling, and SSP therapy are employed.

therapeutic effects warrants further investigations.

techniques,

liketheabove

mentioned

Among these techniques, contact stimulation ofthe skin and stimulation at extremely shallow levels2) The importance of obtaining information throughappear to be characteristically Japanese stimulation

palpationtechniques that differ from those employed in China orThe author discussed the subject of palpation anKorea. The use of these "subtle stimuli" also relates

article entitled, “Considering the Therapist’s Hand”

the characteristics of Japanese acupuncture very well.

published in the Journal of Kampo, Acupuncture andThe INSHIN (round needle = yuan zhen) andIntegrative Medicine, Vol. 1, No. 1, Spring 2006, pp.

TEISHIN (spoon needle = chi zhen) included in the25-26. It provides excellent information to support this"nine needle types" would be the suitable tools forarticle.

these techniques. These are seldom used in China andThe second characteristic of Japanese acupuncture

Korea. Yet, the practice of acupuncture by groups

andmoxibustion

isusing minimal stimulation methods in Japan based on

information

traditional concepts, considers them to be of great

examination, treatment, and finally the evaluation ofimportance, in particular for tonification as treatment

the results.

obtainedtheimportancethroughplacedpalpationonduringof deficiency conditions. These are considered to beeffective methods for patients with emotional problems(a) Examination
The foundation for an examination are the four

including stress.
On the international front, although some papers

basic diagnostic procedures of inspection, listening,on RCT clinical trials of acupuncture needles show

smelling, questioning, and palpation; but Japanesethat

contact

acupuncture and moxibustion places particularly greatused,

importance on pulse diagnosis and channel palpation.

stimulations differ from the placebo effect and can be

Although I will not discuss pulse diagnosis here,

viewed as a historical perspective of Japanesechannel palpation is not restricted to palpation of theacupuncture and moxibustion.

channels; but should be defined as also includingintervention

acupuncture

12or

stimulations
shallowwhenneedling

were

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

Volume 1, Special Edition | Current Japanese Acupuncture and Moxibustion 2010

palpation of the entire body to look for reactions. Since

In other words, the palpatory findings allow one tothe final purpose of acupuncture and moxibustion isevaluate the severity of the patient's condition, degree

the therapeutic stimulation of the body surface, it isof changes, prognosis and the time of the final stage ofnecessary to perform acupuncture and moxibustion

the treatment.

treatment empirically. As a result, this is an effective
method to determine stimulation sites, stimulation
purpose and needling stimulation dose.

4. Why has palpation developed in Japan?
The views regarding why palpation has developed
so far in Japan are probably divided. Yet, it is(b) Therapy

generally

For the basic treatment the needles are held withthe pressing hand which is brought into close contact
with the skin. This prevents bending or breakage ofthe needles and further helps to prevent pain that mayotherwise occur due to inadvertent movements.
Moreover, the pressing hand is also important insensing the arrival of the Qi feeling. It helps
understand the development of therapeutic effects andpossible

tosay

that

acupuncture,

moxibustion, and massage (Anma) found widespread
application among the general population from theEdo period to the early Showa period. Subsequently, ina process of adaptation to the sensitive disposition of
the Japanese, the employed needles became thinner,
the moxa cones smaller, and the Anma stimulation
softer. In other words, the stimulation dose applied

allows one to determine the timing for removal of theduring treatment may be said to have been reduced.

needles. Also, in case there are any changes occuringYet, naturally, therapeutic effects were not decreased,in skin or connective tissue reactions, the pressing

but rather effects of the same magnitude werehand can feel them. These facts indicate the necessity

expected. The result was, thatof palpation during the treatment (including thefeeling with the pressing hand).

*Stimulation

sites

hadtobeselected

appropriately in order to guarantee that a even a small
stimulus dose is effective. For this purpose, palpatory(c) Evaluation of the effects

skills to identify suitable sites were demanded.

Therapeutic effects are likewise evaluated after
removing the needles through palpation. Although it is
not easy to precisely remember the condition prior to
the needling, experienced therapists evaluate thetherapeutic effects based on differences in thepalpatory feeling before and after the treatment. At
the end of the treatment, it is possible to determine if
further needling is required, if the duration of thestimulation should be extended, or the stimulation
methodchanged.

Naturally,

through

cumulative

*

This

kindofsubtle

techniquesisarepresentative example for the Japanese treatment.
The development was brought about by the culture
and climate from the Edo period to the early Showa
period that evaluated dexterity of the hands positively.
*And

also,

aworldwide

unparalleledhealthcare culture developed, when from the middle of
the Edo period, visually impaired persons started tobear

theresponsibility

foracupuncture

andeffects and the attainment of changes finally leading

moxibustion treatment. For visually impaired persons,up to the targeted condition, it is also possible to judge

palpation is the basis for determining the treatment

when to finish the treatment cycle itself.

sites and as mentioned above, as a consequence madeLeading this argument even further, cumulativeevaluation of therapeutic results will in this way
affect the establishment of the treatment plan
during the first visit of the next patient.

it necessary to perform the entire treatment process
guided by skillful palpation.
These circumstances led to a unique developmentof palpation skills in Japan.

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

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