Volume 13, Number 1 | Spring 2018

Report from WFAS Tokyo/Tsukuba 2016
Shakuju Treatment
Shakuju Association[The birth of Shakuju treatment]
Shakujutreatmentisanacupunctureandmoxibustion treatment method formulated in 1976
by Shoji Kobayashi. Originally Mr. Kobayashi
performed

Introduction
In regard to "Shakuju" treatment all diseases are
viewed as a "decrease in vital energy" as the singularsource of all diseases, where the acupuncture andmoxibustion treatment is administered for thehisacupunctureandmoxibustion

treatment based on pulse diagnosis, but later started
to harbor doubts about the theory and practice andthus developed his own original acupuncture andmoxibustion treatment style.

purpose of recovery. The degree of this decrease in

At that time he served as a lecturer at the Kanto

vital energy is assessed mainly on the basis of the

Acupuncture and Moxibution Vocational School in

palpation of abdominal masses and the backcharge of practical skills. During practical training

transport points are then used to promote thesessions dealing with pulse diagnosis is inevitable,

recovery. The treatment procedure using just one

but very little objective training material was

needle without retaining it, relies on the maximal

available for the purpose of practical training among

application of the therapists consciousness tothe students and since the acquisition of the relevant

achieve optimal recovery.

practical skills required much time, he started
looking for something that might serve as areplacement. Practical training requires somethingthat can easily be employed among the students, bebased on the theories pertaining to qi and yin-yang,
not being perturbed by age, sex or pathology, isapplicable to all patients and helps the students toestablish themselves after graduation as clinicians.
In this situation he focused on abdominal diagnosis.
So far assessment of anomalies of the channels(deficiency – excess), pulse diagnosis and theimplementation of the rules laid out in the difficult
issue No. 69 had formed the basis of channel
treatment. Kobayashi himself noted, that the backtransport point could be grouped and classified in a
5-phase manner. The abdominal diagnosis according
to the 5-phase theory allowed to group abdominal
masses into five regions and assess them accordingly,
so that the 5-phase findings of the abdomen and the5-phase regions of the back can be applied to the useof the back transport points, leading to the discovery
that this will improve the condition of the abdominal
masses and chief complaints and therefore wasformulated as a therapeutic system. Later, this cameto be known as Shakuju treatment (abdominal
aggregation treatment). The Shakuju treatment was

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

Volume 13, Number 1 | Spring 2018

developed in 1980 at the Kanto Acupuncture andMoxibution Vocational School by the independent
study group "Hikobae (sprout) Shinryo Kai", later in1986 renamed into "Acupuncture and Moxibustion
Shakuju Kai" and finally into 1988 "Shakuju Kai",
which since then continues until today to improve
the techniques and promote awareness of the
Shakuju treatment.
The term "Shakuju" used in the name Shakuju
treatment originates from the Difficult Issues Nos.

[Shakuju treatment (basic treatment) procedure]
Restricting the description only to the treatment(needling) shows the following sequence.
Procedure of the basic treatment
1

Abdominal non-penetrating acupuncture2

Pulse adjustment

3

Abdominal diagnosis

4

Treatment using back transport points

5

Treatment of the shoulders

16, 55 and 56. Shakuju refers to abdominal
anomalies that are divided into easily movable,superficially located "Ju" and fixed deep "Shaku"
types of abdominal masses, but the Difficult Issues(Nan Jing) does not describe ways of curing(treatment)

theseanomalies.

Here

Kobayashi

defined a way of distinguishing Shaku and Ju basedon his personal clinical experiences. Performance of
non-penetrating needling over the entire abdomenbrings about changes in these Shakuju phenomena
and the use of command points on arms and legs
selected based on pulse diagnosis then gave him theactual feeling of changes occurring in these Shakuju.
He then went on and defined those abdominal
anomalies
penetrating

alleviated

by

the

acupuncture

abdominal
and

non-

subsequentadjustment of the pulse as Ju, while remaining
anomalies were termed Shaku. Moreover, since thetreatment

startswith

mildstimulation

andgradually processes towards stronger stimuli, theburden on the patient is low and at the same time it
became clear, that the proceeding from superficial
stimulation of the body towards deeper levels in thisorder (skin and hair → blood vessels → muscle flesh→ sinews → bones) achieves better results. This led
to the establishment of a treatment routine
comprising of pulse adjustment of the pulse the nonpenetrating needling of the abdomen and then usingback transport points depending on the condition of
the remaining Shaku in the abdomen.

(1) Abdominal non-penetrating acupuncture
Abdominal non-penetrating acupuncture refers togetting an impression of the abdominal surface andperforming non-penetrating acupuncture over theentire area. Regarding the needle handling the
moment the thumb and index finger of the pressing
hand and the tip of the needle held by the needling
hand come into contact with the abdominal surface
the typical shape of the pressing hand is formed andthus the needle tip brought into contact with theabdomen. After the contact is made apply some soft
palpation with the index finger of the pressing hand(which is referred to in the Plain Questions (Su Wen)inthechapter

about

open

and

closedsupplementation and drainage as a reinforcing
technique). As described above this movement does
not bother about acupoints, but makes contact
randomly. Make sure to keep a coin-sized space
between the contact locations. Once you get used tothe procedure, it becomes possible to successively
make contact at sites of anomalies (the presence oftension, weakness, feeling of warmth or cold, skingloss etc.) based on the sensation of the pressing andneedling hand.
(2) Pulse adjustment
LU9 or PC7 are used to adjust the pulse.
Originally, deficiency and excess of the organs andviscera is assessed by using the three bilateral radialpulses for pulse diagnosis and then the five phase
points of arms and legs are selected based on the

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

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Volume 13, Number 1 | Spring 2018

principles given in issue No. 69 of the Difficult Issues.
After that it is possible to rely solely on the source
points based on experience. Today we know, that thetwo points LU9 (meeting point of the vessels of theeight confluence points) and the source point PC7 of
the pericard channel can regulate the pulse. Whenusing the left and right cun position over the radial

Types of Shaku
Painful masses (subjective pain > pain foundduring abdominal diagnosis)
Firm masses (hardness found during abdominal
diagnosis)
Pulsating masses (pulsation found during
abdominal diagnosis)

artery for up to two deficiency and excess conditions
the two LU9 points are sufficient, but in case of morethan three such conditions, they are dealt with using
PC7.

Among the above listed items painful masses havethe highest priority and the region of the mostnotable pain determines the type of mass (liver mass,(3) Abdominal diagnosis (determination of Shaku)

heart mass, spleen mass, lung mass, kidney mass).

For the abdominal diagnosis we use the distribution(4) Treatment using the back transport pointsof the five organs according to the Difficult Issues,
but since the Difficult Issues do not provide anelaboration

of

that

distribution,

Kobayashi

repeatedly made his own experiments and thus
clarified the various regions of the abdomen whilereferring to the course of the channels and locationsof the acupoints.

The type of mass (liver mass, heart mass, spleenmass, lung mass, kidney mass) determines the usedback transport points. Kobayashi discovered that thearrangement of the back transport points can bedivided into five regions similar to the distribution of
the five organs on the abdomen.

In the Nan Jing the Shakuju are classified based on
pain, hardness and pulsation into three groups,
where anomalies can be discerned by abdominal

Since the arrangement of the five organs in the

diagnostic palpation as well as by the patient

abdomen can be used in a 5-phase based manner, thesubjectively.

principles given in the Difficult Issue No. 69 of the
Nan Jing (in case of deficiency reinforce the mother)can be applied. For example, if the abdominal
diagnosis reveals a spleen mass and because the4

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

Volume 13, Number 1 | Spring 2018spleen is associated among the five phases withshoulders are palpated on left and right, the mostearth, points in the fire region of the back transporttense spots (indurations) determined and thepoints corresponding to the mother function for the

relevant point selected symmetrically on the

spleen and earth points because the spleen itself

opposite side. For example, when tension can bebeing the earth phase among the five phases are

confirmed at right GB21, the left GB21 is needled.

selected. Since fire and earth are restrained by water

However, the point selection is not restricted to

and wood (they have a restraining correlation),

acupoints.

points from these regions are also selected. A total of
4 points in the order of fire → earth → water → wood
are thus selected.

The above described steps from (1) to (5) are calledbasic treatment and are essentially used for all
patients. A single filiform needle is used for thetreatment and subsequently based on observationsof physical changes following the restoration of thedecreased vital energy one proceeds to the next step.
Accordingly, needle retention is not used. The usedneedles are silver needles with a length of 40 mm
and a thickness of 0.20 mm, having an egg-shaped
needle tip. When needling while checking forphysical changes, these are shaped, are of a material
and thickness that makes insertion and handling

The back transport points are located along theeasier than the usual filiform needles.

governing vessel, immediately next to mid-line, firstline of the bladder channel and second line of the

Ideally the basic treatment restores the decreased

bladder channel, but the Shakuju treatment focuses

vital energy, but in cases where depending on themainly on the second line of the bladder channel andskills of the practitioner or the degree to which theselects one point each on this second line of thevital energy had been decreased, recovery was

bladder channel for each of the four regions

insufficient,

depending on the type of mass. For example, in theadministered. As a supplementary treatments like

presence of a spleen mass, BL44 (fire) → BL49

micropuncturing to led blood at sites of wounds(earth) → BL52 (water) → BL47 (wood) will be foundcausing the decrease in vital energy etc. are used, as

upon palpation along the second line of the bladderthe name already implies, to supplement the basic

channel to be the most depressed locations in thetreatment in order to promote the recovery of therespective regions.

decreased vital energy. Representative examples ofasupplementarytreatment

issupplementary treatment are the use of filiform(5) Treatment of the shoulder region

needles, blunt tip needles, heat sensing moxibustion

After completing the treatment of the back transportor heat penetrating moxibustion at the backpoints, depending on complaints and type of mass
and after checking the pulse, the patient is seatedand needled from the back up to the top of theshoulder region. For the point selection the top of thetransport points and those located along thegoverning vessel, immediately next to mid-line, firstline of the bladder channel and second line of the
bladder channel.

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Volume 13, Number 1 | Spring 2018

develop into (2) or (3) and then lead to (4). The degree[Degree of the decrease in vital energy]
It is very important to understand the degree ofthe reduction of the vital energy which is the central
and all encompassing cause of all diseases in orderto achieve also a central and all holistic restorationof the decreased vital energy through the Shakuju
treatment. All information obtained through thefour diagnostic methods are important indiceshelping to understand the degree of the reduction invital energy, but apart from this information fromthe four diagnostic methods Kobayashi discovered
based on his clinical experience another index called
the K-points (Kobayashi point). The K-points appear
like the Shakuju in the abdomen in people withdecreased vital energy as tender or hardened
reactive spots. Their locations are designated using
acupoint or anatomical names. They are called
points, but depending on the condition may beanything from rice grain to coin sized.

of the decrease in vital energy too progresses from
(1) and is worst at stage (4).
[Types of order for the use of back transport points]
The back transport points are used depending on
the location of the mass following the principles
described in the Difficult Issue No. 69, but on one day
performing

theShakujutreatment Kobayashi

noticed during the treatment of a patient with atumor that the treatment did not achieve sufficient
improvement. He tried to implement all the things
he could think of, starting with the time for thetreatment, yet still was not able to achieve
improvements. At one time he intuitively reversed
the order in which the back transport points are used(for example in case of a spleen mass the usual orderwould be fire → earth → water → wood, the reversalof which would be wood → water → earth → fire).
Using this he started to achieve improvements evenin cases in which so far no changes had been

Introducing some K-points

observed. Based on this experience he discovered theSP9, LR12, LR8, medial epicondyle of femur,

use of the back transport points in the reverse order

BL40, BL39, BL54, BL52, medial edge of theforscapula,process,

characterized by marked excess symptoms whensternocleidomastoidoid muscle, posterior edge ofviewed from a perspective of the deficiency-excess

the ramus of the mandible

pair. Later, through additional examinations heshoulderjoint,

coracoidthetreatmentofconditions

that

are

started to employ four types of application sequences.
The degree of the decrease in vital energy can be

Currently, these four treatment orders contribute toexpressed in four stages depending on the chief

improvements in treatment efficacy related to thecomplaint, information from the four diagnostic

degree of decreased vital energy.

methods and the emergence of K-points.
1. Appearance associated with chilling of the lower
half of the body
2. Appearance associated with body surface heat of
the upper half of the body
3. Appearance associated with chilling or heatinside the body
4. Appearance associated with chilling of the entire
body
Among the aforementioned 4 points there is atendency that things appear as described and (1),6[Regarding treatment and consciousness]
The efficacy of acupuncture and moxibustion
treatment varies depending on the skills of thepractitioner, but in case of Shakuju treatment weexperienced that the kind of awareness of thepractitioner during the treatment also has asignificant influence on the treatment effects. The
practitioner should be aware of the body of thepatient during the treatment. For example, in caseof a patient complaining about gonalgia the

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

Volume 13, Number 1 | Spring 2018

practitioner should direct her/his gaze towards theexcess (yin-yang) which then clarifies the theoretic

knee while treating the back transport points. On

foundation centering on a unified awareness of this

this occasion s/he does not only look, but rather

supreme ultimate concept. This concept deals withimagine the structure of the knee joint in her/his

life force and its decrease. Kobayashi has so far used

mind, as if s/he is looking right through it.

a variety of unified expressions for the essentials of

The practitioner should also occasionally touch

the Shakuju treatment. The first book by Kobayashi

the knee and its surroundings. In this way s/he canpublished in 1987 about the Shakuju treatment

make her/himself aware of the knee.

"Lectures About Oriental Medicine, Vol. 10, Shakuju

Once the practitioner gets used to the above

Treatment

Compilation"(ShizenSha)

already

described way of directing her/his awareness, s/heallowed the reader to gain some glimpses into thewill also become aware of the own body and thus betheory, but now this theory has been elaborated andable to channel qi energy through the own hands

clarified in the "Shakuju treatment – Move qi andtowards the patient. Ultimately, the practitioner

alleviate cold" published in 2001 (Idononippon Sha).

absorbs heavenly qi into her/his own body andIn the "Huang Di Nei Jing", the classic can be called

becomes able to direct the flow of this qi energy

thetowards the patient.

medicine, the character combination 'yin-yang' isOnce the acupuncture and moxibustion skill havebeen sufficiently developed, marked treatment

foundational

text

of

traditional

Chinesefrequently found and thus shows that the yin-yang
concept had been used in medicine.

effects can be achieved even in short treatment times.

However, the two characters expressing the

And if the practitioner makes her/himself well aware

concept "supreme ultimate" are not found in theof these skills, the efficacy can be still further"Huang Di Nei Jing". The can be found in the "I

improved. In order to sufficiently implement thisChing" though. Kobayashi changed the pulse

awareness, sound technical skills and clinicaldiagnosis centered style based on his clinicalexperience are necessary. It is also necessary toexperiences

cultivate one's imaginative powers through daily qi

abdominal diagnosis and the use of the backgong and breathing exercises.

transport points. The sequence of events which led

toatreatmentstylerelyingonto the theory pertaining to vital energy currently
attracting much attention was probably strongly[Decrease in vital energy]
Starting from a treatment style centering on

influenced by Kobayashi's study of "divination". The

pulse diagnosis Kobayashi developed his Shakuju

Kanto Acupuncture and Moxibution Vocational

treatment concentrating on the abdominal diagnosis

School at which Kobayashi taught, had been

and the back transport points described in the Nanestablished by the diviner Mitsutake Kobayashi. At

Jing. Regarding the selection of the back transportthat time Mitsutake Kobayashi thought that if hepoints he also integrated the engendering andwere to study medicine as a diviner, the form of

restraining theory, which at that time meant, that

medicine he would like to learn should be influenced

the theoretic foundation of the treatment took theby oriental thought (concepts of divination), which

deficiency-excess

reinforcement-reduction

inevitably meant, he had to call on a vocational

duality into consideration. Yet, treatment efficacy

school for acupuncture and moxibustion. However,changed markedly by changing the order of thethe curriculum in vocational schools for acupuncture

treatment of the back transport points. Also, based

and moxibustion was more influenced by westernon clinical facts he reaffirmed the existence of the

medical concepts than oriental concepts (concepts ofsupreme ultimate concept manifesting as deficiency-

divination). Disappointed Mitsutake Kobayashi

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Volume 13, Number 1 | Spring 2018

decided he had to rise to the task of establishing a

Seminars were also held on the West Coast in San

school to study acupuncture and moxibustion based

Francisco, in Hawaii, at Acupuncture & Integrativeonof divination).

Medicine College (AIMC) under the tutorship ofMitsutake Kobayashi calling on Kobayashi, who has

Diano Juliano. In 2017 Daiki Takahashi of thea teaching license for acupuncture and moxibustion

Shakuju Society, who is also a teacher at the Goto

schools, was the beginning of their connection. Over

College of Medical Arts and Sciences as a sister

the three years it took until the opening of the school

school of the AIMC, also held a seminar.

orientalconcepts(concepts

Kobayashi learned the basics of divination from
Mitsutake Kobayashi. Groping for improvements inacupuncture and moxibustion treatment Kobayashi
was convinced through his study of divination that
there is conclusive evidence of a correlation between
divinationandacupunctureandmoxibustion

treatment. Doubtlessly oriental thought (concepts of
divination) is currently strongly influencing the
Shakuju treatment. Kobayashi published in 2010
the book "Introduction to the Book of Changes for
Acupuncture and Moxibustion Treatment" (Midori
Shobo)

describing

acupuncture

and

the

correlation

moxibustion

betweentreatment

anddivination.
[Current Shakuju treatment]
The Shakuju Society has conducted activities
mainly in the Kanto region to popularize the
Shakuju treatment, but Kobayashi also made ademonstration of the technique during an invitedlecture held in 1988 in San Francisco at theJapanese-American

Acupuncture

Foundation(JAAF). Since 2004 Shakuju treatment seminars
were held in Boston on the American East Coast
mainly by Kobayashi himself as well as othermembers of the Shakuju Society as lecturers. So far
more than 10 such seminars (over a period of morethan 10 years) were held and in recent years otherseminars were held mainly by the vice president of
the Shakuju Society Osamu Hara and the head of theacademic department Tetsu Nakatani. Also, at the
NESA Acupuncture Treatment Center in Boston the
Shakuju treatment has formally be integrated into
the coursework and is taught mainly by Diane
Juliano.

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