Volume 13, Number 3 | Fall 2018

Report from WFAS Tokyo/Tsukuba 2016
“Acupuncture and Moxibustion in Palliative Medicine”

examination methods from the oriental medical
perspective of "Qi and Blood".

Masaki Tsuda
Tohokai Oriental Medicine Acupuncture & Moxibustion
Clinical Study Group

Within palliative cancer therapy the acupuncture
and moxibustion treatment style of the Tohokai
Oriental Medicine Acupuncture & Moxibustion
Study

Group

(below:"Tohokaistyleacupuncture and moxibustion") has taken theinitiative in 1985, when Dr. Nobuko Yokokawa
introduced it in the department of anesthesiology of
the National Cancer Center (currently the Central
Hospital of the National Cancer Research Center) for
the treatment of various symptoms of cancer
patients. Relying on acupuncture and moxibustion
treatment good results were obtained for clinicalsymptoms like weariness, numbness, pain etc. andsince 1989 two acupuncturists from the Tohokai
Group were dispatched to offer Tohokai styleacupuncture and moxibustion treatment and thisarrangement still continues today.
Acupuncture and moxibustion treatment applied inpalliativecancertreatment

does

not

focus

exclusively on the treatment of symptoms, but
comprehension of the correlation between the wholebody and the site of the symptoms, based on oriental
thought

and

using

oriental

medicalspecificexamination techniques is very important.
Many cancer patients in need of palliative medicalcare suffer from exhaustion caused by the nature of
the disease, surgeries or else the side effects ofchemotherapeutics often progress into a state of
deficiency. That is why the stimulus dose of theacupuncture and moxibustion treatment has to becarefully

adjustedtoprevent overstimulation.

Essentially cancer patients and patients with otherdiseases are identical in the sense, that both present
with symptoms, and the pathology of these
symptoms can be understood by using the four

2

The Tohokai style acupuncture and moxibustion
treatment has been developed in Japan based on

Introduction

Clinical

About the Tohokai Group

interpretations of the classics and belongs to thegroup of styles called channel therapy. This channel
therapy has been proposed by Sorei Yanagiya, Sodo
Okabe, Keiri Inoue, Shinichiro Takeyama and othersin the 1930s. Channel therapy is characterized by its
concept of disease based on deficiency and excess
patterns of organs and viscera, allowing treatment
of diseases by way of adjustment of deficient andexcessive conditions. This treatment form has beensystematized based on the identification of patterns
using the four examination methods. Treatment canbe divided into treating the root in order to adjust
fundamental deficiency and excess patterns oforgans and viscera on the one hand and local andsymptomatic treatment on the other hand. Point
selection for root treatment relies mainly oninterpretations of the 69th difficult issue and selected
points are then either tonified or reduced. The
results, again, are then evaluated using mainly
pulse

diagnosis

among

the

four

examination

methods. Local and symptomatic treatment isperformed for the purpose of alleviating symptoms
and to that end take both local and generalconditions into account. In this case the treatment isperformed with the purpose of changing the local,
subjective symptoms of the patient.
Here I would like to present an organizedclassification of the needling methods used for
Tohokai Group style acupuncture and moxibustion
treatment. Needling can be classified mainly into thefollowing five types.
1. Contact needle therapy (CNT) (Contact needling)
2. Insertion needle therapy (Stabbing needle
therapy)
3. Special needle therapy

The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)(Special needling techniques)Volume 13, Number 3 | Fall 2018

4. Rounded contact needle therapy(Spoon

needleimportant for determining the pattern. Once thecontact needling)

pattern has been determined, points for the

5. Qi-retained needle therapy(Qi retention needling)treatment of the root are selected based oninterpretations of the difficult issue No. 68 and 69

For contact needle therapy (contact needling) theand then used to tonify or reduce the channels. Afterneedle tip is brought only into contact with the skinthat a pulse diagnosis is performed and mainly

but not inserted, allowing to control Qi using

based on changes in pulse patterns, but facial

techniques like tonification or reduction. It is usedcomplexion, changes in expression, skin complexion,

for diseases involving Qi (psychosomatic illnesses).

the tone of the voice, changes in symptoms and otherIn case of insertion needling therapy the needle tip

information gathered using the four examination

is inserted into the body to control Blood using

methods are also taken into consideration for atechniques like tonification or reduction. It is usedgeneral evaluation of the treatment. If the effects arefor diseases involving Blood (physical illnesses).

considered to be sufficient, the treatment isSpecial needle therapy (Special needling techniques)completed. If the effects are insufficient, further

include techniques like big needle method, longcorrections will be made as far as possible, but theneedle method, moxibustion with warming needles,

stimulus dose must be matched to the physicalmicropuncture technique, intradermal needling etc.

fitness and condition of the patient.

These techniques are used, when achieving effects

This is how the treatment is administered. Here I

with contact needling or needle insertion is difficult.

would like to explain contact needle therapy (theRounded contact needle therapy (Spoon needle

method of contact needling) used so frequently forcontact needling) refers to stroking or pressing

patients in palliative care.

against the body with the tip of a comparatively

Contact needle therapy (contact needling) refers to a

thick metal rod with a rounded head called spoon

treatment form where the needles are inserted notneedle (chi zhen). It is used for infants or patientseven 1 mm deep, but only brought into contact with

who are particularly nervous, so that the use of

the target area. The movement of Qi in the channels

ordinary filiform needles may be difficult.

as well as the fluctuations of Yin and Yang are

Qi-retained needle therapy (Qi retention needling)

modifiedrefers basically to the same technique as the so-

descriptions of methods and techniques follow below.

called needle retention.

The needles used are so-called long-handle needles,

via

the

body

surface

Qi.

Concrete

which are ordinary filiform needles that have,Contact needling in palliative medical carehowever, a longer handle, with a thickness varying

In general medical practice these techniques are

between 0.18 and 0.16 mm and a length of 30-40 mm

used selectively for tonification and reduction of thefor which we recommend gold or silver as material.

channels, but in palliative care contact needle

The Tohokai Oriental Medicine Acupuncture &therapy

Moxibustion Clinical Study Group does not use(contact

needling)

constitutes

thefundamental technique.

needle tubes, not restricted to the contact needling

Treatment is performed according to the following

technique, but uses needle twirling without tube also

procedure. First, the four examination methods

for insertion of needles.

inspection, listening and smelling, asking andpalpation are performed and the general pattern is
identified.

Within

this

flow

of

examination

abdominal and pulse diagnosis are particularly

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

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Volume 13, Number 3 | Fall 2018

Indications for the techniques of contact needle

duration.

The

selectionoftransport

andtherapy (contact needling)accumulation points depends on the disease pattern.

The contact needle therapy (contact needling

Perform palpatory massage along the channel course,

techniques) are divided into 9 types (Figure) and fora light massage as pretreatment and then determine

each of these purpose and indication are clearly

the point with the pressing hand. The pressing hand

specified.

then brings the needle body into close contact withthe skin and holds it still, maintaining an angle of 90

Transmeridian Qi tonifying therapy (Channel Qi

degrees to the skin. After holding needle body andreplenishing needling)

tip with the thumb and index finger of the pressing

Transmeridian Qi tonifying therapy (Channel Qi

hand in close contact to the skin, the needling hand

replenishing needling) is a method to replenish thethen stabilizes the needle tip. At this point it is

Qi within the channels. As a tonification technique

important to pay sufficient attention to keep theof the root treatment the channel Qi is replenished.

needle tip in light contact with the skin and do not

The tip of the needle is laid at an angle of 30 degrees

allow it to float free. Once the needle tip has been

into the direction of the channel course and fixedstabilized, apply a comfortable up and down

there with the pressing hand. The needling handpressure synchronized with your breathing to theapplies some gentle up and down pressure on theneedle tip and continue this manipulation until theneedle tip and when the coming and going of the Qi

Qi arrives. Normally the coming and going of the Qi

is detected, the needle tip is held still. With the nailusually should require about 5-6 respiratory cycles.

of the thumb of the needling hand the needle handle

When Qi has been obtained, the needle is removed.

is flicked rhythmically. Once the arrival of Qi is felt,

At this point be careful not to allow leakage of Qi andthe flicking is stopped and the needle moved away

apply simultaneously with removing the needlefromsome light massage to the acupoint as posttreatment.

the

skin

surface.

Simultaneously

withremoving the needle the needle hole is closed with
the index finger or thumb of the pressing hand and

HealthyQia gentle massage is applied to the point location.

replenishing needling)

There is a first and a second way of selecting points

Healthy

for this method to be used as root treatment, but thereplenishing needling) refers to a needling method tofirst method is used more frequently. In this case

replenish healthy Qi and is used as local andLR8 is used for liver deficiency, KI7 for kidney

symptomatic

deficiency, SP3 for spleen deficiency. LU9 for lungdeficiency, emaciation or weakness of the flesh. The

deficiency and PC7 for pericard deficiency.

used acupoints do not rely on patterns, but can beQi

tonifying
tonifyingtreatment

therapy(Healthy

Qi

therapy(Healthy

Qi

for

areas

of

markedselected as required according to the findings of
Yin-yang balancing needling therapy (Yin-yang

inspection of palpation.

balancing needling)

Application of healthy Qi tonifying therapy (healthy

The yin-yang balancing needling therapy (yin-yang

Qi replenishing needling) means applying palpatory

balancing needling techniques) utilizes the transportmassage along the channel course and thus

and accumulation points to harmonize organs andharmonizing Qi. When the point to be treated has

viscera, so that it is frequently used to treat diseases

been determined, the pressing hand fixes the needleof organs and viscera. They are used in particular forat an angel of 90 degrees to the surface of the skin.

organic diseases and where needling methods are

After holding needle body and tip with the thumbrequired that affect deeper lying disease of longer

and index finger of the pressing hand in close contact

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

Volume 13, Number 3 | Fall 2018

to the skin, the needling hand then stabilizes thesimultaneously with removing the needle some lightneedle tip. The pressing hand is held in close contact

massage to the point as posttreatment.

with the skin, while at the same time the needling
hand lightly applies some pressure on the needle tip.

Yin Qi tonifying therapy (Yin Qi supplementing

The needle is held still with the pressure applied andneedling)

one awaits the arrival of Qi, which usually requires

Yin Qi tonifying therapy (Yin Qi supplementing

about 3-4 respiratory cycles. When Qi has been

needling) is a needling method to replenish the yin

obtained, the needle is removed. At this point be

Qi within yin (nutritive Qi) and is used as local andcareful not to allow leakage of Qi and apply

symptomatic treatment for conditions of closed

simultaneously with removing the needle some lightinterstices, moist skin, feeling of coldness, weakness

massage to the point as posttreatment.

of the flesh, muscle tension or flaccidity. The usedacupoints do not rely on patterns, but are selected as

Yang Qi tonifying therapy (Yang Qi supplementing

required according to the findings of inspection ofneedling)

palpation.

Yang Qi tonifying therapy (Yang Qi supplementing

In the areas treated with this yin Qi tonifying

needling) is a needling method to replenish the yangtherapy (yin Qi supplementing needling technique)Qi within yang (protective Qi) and is used as local

palpatory massage is applied along the channeland symptomatic treatment for surface areas

course to harmonize Qi. When the point to be treatedshowing deficiency, conditions of numbness or

has been determined, the pressing hand fixes the

opening of the interstices. Most of the used points areneedle at an angel of 45 degrees to the surface of the

not actual acupoints but rather sites of changes onskin. After holding needle body and tip with thethe skin surface. This needling method serves thethumb and index finger of the pressing hand in close

purpose of supplementing the yang Qi of the bodycontact to the skin, the needling hand then stabilizes

surface and close the interstices.

the needle tip. The needling hand holds the needle

In the areas treated with this yang Qi tonifying

body and gently applies some pressure and holds thetherapy (yang Qi supplementing needling technique)needle for 2-3 respiratory cycles until Qi passes

palpatory massage is applied along the channel

through the yin portion within the yang. As soon ascourse to harmonize Qi. When the point to be treatedthe Qi flow swells, remove the needle. At this point

has been determined, the pressing hand fixes thebe careful not to allow leakage of Qi and apply

needle at an angel of 90 degrees to the surface of thesimultaneously with removing the needle some lightskin. After holding needle body and tip with themassage to the point as posttreatment.

thumb and index finger of the pressing hand in close
contact to the skin, the needling hand then stabilizes

Qi dispersing needlingthe needle tip. The needling hand holds the needle

Qi dispersing needling is a needling method for the

body and swiftly performs alternating half-turns todispersion of Qi depressions and is a somewhat

the left and right. Here it is important to avoid using

reducing,

force with the pressing hand and not apply too muchtechnique for local and symptomatic treatment.

pressure. One to 2 turns are the norm, but if the yang

Targets are skin areas that appear upon inspection

deficiency very marked, perform 4 or 5 half-turns. As

darker than the surrounding skin, or upon palpation

soon as the Qi flow swells, remove the needle. At thisfeel rougher. These are findings frequently observed

point be careful not to allow leakage of Qi and applyon the back and in the lumbar region. Since a major

continuously

performed

needling

characteristic of body surface Qi is its particularly

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

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Volume 13, Number 3 | Fall 2018

marked tendency towards stagnation, the use of Qi

conventional

acupoints,butratherapplies

dispersing needling is frequently used in clinicalcontinuous needling to smooth the body surface andpractice.

is performed as a finishing or harmonizing method.

During inspection the pressing hand is used forWith a slightly supplementing effect it is combined

palpation and determines the scope in which the Qi

with the slightly reducing effect of Qi dispersing

dispersing needling is to be applied, when Qi

needling.

depression has been found. The pressing hand is not

The body surface is palpated with the pressing hand

held fixed on the body and the needle body is notand the scope of the area to be treated determined.

brought into close contact. The contact is more like

The pressing hand is not held fixed on the body andlight touch to protect the needle, the hands keep

the needle body is not brought into close contact. The

moving while needling and at the same time

contact is more like light touch to protect the needle

constantly check, whether the Qi is dispersed or not.

and the hands keep moving while needling, at theHold the junction of needle handle and body gently

same time constantly observing whether the bodywith the finger pulps of thumb and index finger ofsurface is moistening. Hold the junction of needle

the needling hand. Beware not to exert any force via

handle and body gently with the finger pulps of

the joints of the fingers and arms and learn how tothumb and index finger of the needling hand.

apply light pressing and withdrawing movements

Beware not to exert any force via the joints of thethrough snapping motions of the needling hand. The

fingers and arms and learn how to apply lightneedle is brought into contact with the areas of Qi

pressing and withdrawing movements throughstagnation and at once quickly withdrawn. The

snapping motions of the needling hand. The needle

needle should have an angle towards the skin of

tip is swiftly withdrawn almost simultaneously with

about 60 degrees. Be careful not to drag the needle

bringing it into contact with the skin. The needle

tip during the manipulation. Once the first needlingshould have an angle towards the skin of about 30

is completed, slide to the next treatment point anddegrees. Be careful not to drag the needle tip during

repeat the procedure. Perform this techniquethe manipulation. Once the first needling isconsecutively for a third, fourth and fifth timecompleted, slide to the next treatment point andwithout any intervals in between. After the needlingrepeat the procedure. Perform this techniquepalpate the skin and stop the treatment when theconsecutively for a third, fourth and fifth time. The

roughness of the skin has decreased, or the moistureneedle is brought into contact with the skin with aof the areas of Qi stagnation seems to have increased.

frequency of about 3-4 times per second. After theCare is required, since with this technique theneedling palpate the skin and stop the treatment

stimulus dose may easily increase. The needle iswhen the skin has become smoother and moister.

brought into contact with the skin with a frequency
Qi drawing needlingof about 3-4 times per second.

Qi drawing needling is a technique that through
Smoothing Qi needling

remotely guiding healthy Qi disperses the evil Qi in

Smoothing Qi needling is a needling technique used,

the affected area. It is a supplementing needlingwhen in conditions other than Qi stagnation (Qitechnique and used for local and symptomatic

dispersing needling), yang Qi deficiency (yang Qi

treatment on all parts of the body, employing

supplementing needling), or closure of the interstices

acupoints. The point selection depends on the naturea disharmony of smoothness and moistness of theof the disease and usually traditionally well-known

skin surface is present. It does not rely on

acupoints are selected.

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

Volume 13, Number 3 | Fall 2018

Qi drawing needling is performed, holding thethe point location and hold it at an angle towards theconcept of "drawing Qi" in mind. The channels areskin of about 60 degrees. The direction is chosen

palpated along the channel course and a lightbased on the principle of the directional reducing-massage is applied to the point locations. Bring thereinforcing method. The needling hand gently

thumb of the pressing hand into close contact withapplies some pressure on the needle tip and performs

the needle body and thereby fix it. At this time the2-3 times an up-and-down movement. After this up-

needle should have an angle towards the skin of 45

and-down movement is finished, the needle isdegrees. After grasping needle body and needle tip

quickly removed from the point location and thefirmly with thumb and index finger of the pressing

pressing hand leaves the needle hole without closing

hand, the needling hand stabilizes the needle. Bringit.

the needle tip lightly into contact with the point

When employed as local and symptomatic treatment

location and hold it there for about 4-5 respiratory

palpate the region feeling warm (the site of pathogen

cycles. Immediately after the Qi arrives, remove theexcess) with the pressing hand to determine theneedle from the point location. Simultaneously withscope of the local needling. Hold the needle gently atremoving the needle the point location is closed by

the junction between the long needle handle andlightly pressing it.

body gently with the finger pulps of thumb and index
finger of the needling hand. Swiftly bring the needle

Clear excess therapy (Pathogen draining needling)

tip into contact with the area of warmth andClear excess therapy (Pathogen draining needling) isimmediately remove it. At this time the needle

a needling technique to drain pathogen (in particularshould be at an angle of about 90 degrees towards

yang

and

the skin. After completion of the first pathogen

symptomatic treatment. As systemic and generaldraining needling move slightly sideways to the next

treatment the command points on arms and legs areneedling site and repeat the procedure. Perform thisused to drain the pathogenic Qi accumulated in thetechnique consecutively for a third, fourth and fifthchannels. As local and symptomatic treatment it istime without any intervals in between. The

employed to treat heat associated with wind evil,

movement should be performed at a speed of 5-6

bruises or else in the presence of pain due to swelling

times per second. The pressing hand is not held fixedand distension at sites of pathogen accumulation.

on the body surface and moves together with theApplied as systemic and general treatment theneedle, constantly checking whether the feeling of

connecting and cleft points of the channel presenting

warmth is fading of not as well as assessing the statewith excess are used. The proper use of these cleftof sweating. When the pressing hand senses

and connecting points depends on whether thesweating in the area of warmth and fading of thecondition is due to external pathogens or not. In caseheat sensation, it is time to discontinue theof external pathogens the cleft points, or based ontreatment.

the exterior and interior correlation and in case of

The above described contact needle therapy (contact

excess of flourishing Qi the connecting points areneedling techniques) are used to treat cancer

used.

patients in palliative care.

pathogens)andappliedaslocal

First, locate the points to be needled. Hold thejunction between needle handle and body gently

Conclusions

with the finger pulps of thumb and index finger ofCancer patients in palliative medical care present

the needling hand. Form the shape of the pressing

with pulse patterns showing exhaustion and suffer

hand, bring the needle tip lightly into contact withfrom the characteristics of their disease as well as

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

7

Volume 13, Number 3 | Fall 2018the side-effects of various treatments, so that thepulse is often very thin and weak. Contact needle
therapy (contact needling techniques) are optimalfor these patients. During the treatment it isimportant to carefully observe the pulse, skincondition and changes in indurations.
Contact

needletherapy(contact

needling

techniques) have the advantage that they are safe,
painless and not associated with the risk of infection.
Also, for patients afraid of needles contact needle
therapy (contact needling) is easier to accept than
the typical treatment using needle insertion.
I believe wide application of contact needle therapy(contact needling techniques) can be an effective
treatment for many patients in palliative medical care.

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