Volume 9, Number 3 | Fall 2014

Japanese Acupuncture - Current Research
Japanese Traditional Medicine Text (13) – Pediatrics

remained the central historical hub of these

Tomofumi Ozaki

specialties since them. Currently, numerous clinics

Associate Professor of Faculty of Health Sciences

specialize in “children`s acupuncture” and theMorinomiya University of Medical Sciences,
Vice-principal of
Morinomiya Academy of Medical Sciences

Pediatric acupuncture methods (Shonishin) are
unique from filiform acupuncture because they rely
primarily on gently stimulating the surface of theskin without inserting needles. This treatment
method is appropriate for infants through school agechildren. Compared to adults, the delicate methods
employed are especially effective for these agegroups who have extremely sensitive and reactive
skin. Very slight stimulation and delicate methods
characterize pediatric acupuncture and are safe andhighly effective for these young children. Pediatricacupuncture is practiced all over Japan with anespecially rich cultural tradition emanating from theKansai area1-3). Recently, as the number of Japanesebirths continues to decline, there has been a
proportionate

decreaseinnational

healthcarerevenue covering free or low-cost infant and childtreatments, so the number of children receiving
pediatric acupuncture has also decreased. Especiallyfor conditions like pediatric neurological conditions,which lack effective low-cost treatments and moregeneralduring the Edo period and the Kansai Area haswellnessmanagementcare,

pediatric

acupuncture represents a meaningful treatment
modality. Below, we provide an overview of pediatricacupuncture.

expressions describing these traditions are quite
varied, however most clinics treat all commonchildhood conditions. Most notably, the pediatric“Kanmushi” treatment refers to assisting the childdevelop strong nervous, digestive and immunesystems4, 5).
1. The history of Pediatric Acupuncture
There is scarce historical data clarifying the early
use of pediatric acupuncture6).
Early records pertaining to pediatric acupuncture(Shonishin) go back to Nakano village (Hari Nakano)of the mid-Edo period7, 8). During the late Edo period
the technique apparently gained popularity inOsaka and became established there during theMeiji period as a form of childcare culture. The
situation became to be assessed even as: "It would
not be an exaggeration to say, that there are no
indigenous households in Osaka not treating theirchildren with Shonishin9)." After the Taisho period
Shonishin spread throughout the country throughthe education in vocational schools for acupuncture
and moxibustion, books and lectures10-12).
A 200 year-old map of Kawachi Hiranogo Townshipreportedly

listsa"Nakanovillage

Pediatric

acupuncture clinic”. Even today, the station name,“Harinakano” remains in use. Another interesting
pediatric acupuncture “heirloom” is reflected in[A] An Overview of Pediatric AcupunctureShonishin (pediatric acupuncture) is acupunctureusing particular tools for infants and children andrefers to the methods used for these patients.
Distinct from acupuncture for adults, it is anacupuncture method that primarily stimulates theskin surface. Pediatric acupuncture developed

many clinic names inherited from this tradition:
Okajima’s rabbit acupuncture, Daruma acupuncture,
Turtle acupuncture etc. These names refer tofamiliar children`s words and playthings, reassuring
them and their parents. It is generally accepted that
pediatric acupuncture was initially incorporated into
Japanese acupuncture during the Taisho period.

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Volume 9, Number 3 | Fall 2014

2. Appropriate ages for pediatric Acupunctureof a doctor or a specialist of acupuncture is required

patients

for fevers over 38℃(104 F), acute abdominal pain,

Infants age 2 weeks up through elementary school

acute spinal injuries, fractures, dehydration, etc.

aged children receive pediatric acupuncture. Thereis generally a peak around ages 3-4 with a pattern of5.

ClassificationandtechniquesofPediatricchildren gradually migrating to filiform acupunctureacupuncture

as they get older.

Pediatric acupuncture involves gently stimulating
the skin in very specific locations using various tools,

3. Pediatric Acupuncture treatment (appropriatetechniques and methods. In general, the mostconditions)

important types of stimulation are contact needling

Generally

speaking,

pediatric

acupunctureisclassified as useful for health management andand friction type needling.
a. Types of contact needling: Spring-loaded ordisease treatment. Health management includes

seven star plum blossom type tools

common symptoms associated with “Kanmushi” a[Method] Lightly contacting the skin (commonlyJapanese term referring to night terrors, sleep

used in pediatric acupuncture).

difficulties, moodiness, fussiness, making strange[Adjusting the amount of stimulation] Controllingnoises, poor appetite, biting etc. that is to say

the length of the needle tip and how it contacts thesymptoms tend to be associated with childhoodskin.

neurological conditions. On the other hand, treatingb. Types of friction type needling: friction typecommon childhood diseases includes sinusitis,

needle, long sword shape needle (naginata needle),

tonsillitis, laryngitis, asthma and other respiratory

rolling tool (kuruma needle)

diseases, digestive disorders, such as poor appetite,[Method] lightly touching the skin with a needle orstomatitis, constipation, diarrhea, eye diseases, such

instrument that is horizontal to the surface andas nearsightedness and eye strain. Additionally,gently stroking using specific techniques.

more difficult conditions such as enuresis, epilepsy[Adjusting the amount of stimulation] Appropriately

and cerebral palsy are also treated. It should betouching the skin (perpendicularly, at an angle, etc.)

noted that while treating children with theseand adjusting the speed of the horizontal needle.

conditions the practitioner is primarily treating theFigure 8 shows examples of pediatric acupuncture.

child’s QOL by improving sleep, appetite, digestion

The needle shown in the upper part of the photo isandstiffness,called Daishi pediatric needle. From the left in theheadaches, nervous ticks, stutters, skin conditions

lower part Seirin disposable needles, Yoneyama

such as dermatitis, developmental challenges,

pediatric

learning disorders have been increasing13). Further,needles, and roller needles etc. are presented.

elimination.

Recently,shoulderneedles,

health tune-ups before and after sports events,
vacations, examinations and recitals assist children
adjust physically, mentally and emotionally to thestresses felt during these events.
4.

Maladaptation

andContraindications

forPediatric Acupuncture
Maladaptation and contraindications for children
are very similar to adults. Requesting the assistance

4

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

scraping

needles,

shakableVolume 9, Number 3 | Fall 2014

Figure 8 Classification of pediatric acupunctureneedlesFigure 9 Fundamental diagnoses of young children

6. Pediatric acupuncture treatment areas
and amounts of stimulation for each
Fundamental areas include the head, neck,upper back, chest, abdomen and legs.
Specifically, for throat and tonsillitis theanterior neck and jaw will be used. For
vision disturbances and near sightedness
points on the cheek and temple are used (TaiYang, GB5). For enuresis, points on thelower abdomen and sacrum are used.

Contact needling on the back

Friction type needling on the backFigure 10 Fundamental treatment methods for pediatric acupuncture

7. Pediatric acupuncture approach and attitude

8. Amount of stimulation and treatment interval

Figure 9 shows a 5 year old boy receiving a

Treatment usually takes under 5 minutes, a positive

Yoneyama style treatment on his back. The left

reaction is indicated by reddening of the skin andback depicts contact needling and the right showsslight sweating. Generally, good results are expected

friction type needling. This photograph clearlyin pediatric acupuncture with extremely slightshows the needle tip contacting the skin. However,stimulation.

actually the needle tip only lightly contacts the skincomplains are usually once a month for a period of 3

and is then withdrawn in a careful in and out

consecutive days. More complicated cases may

motion that controls the amount of stimulation

require 4-5 consecutive days before the symptoms

delivered to the area. Figure 11 on the upper left,

abate and the child returns to their naturally calmshows a 10 month old baby boy receiving treatment.

level of health. Best results are seen if theFor such young children, it is common for thetreatments can be repeated once a month. In the caseparent to hold the child during treatment toof acute asthma attacks, while maintaining active

reassure the child and learn some of the techniques.

communication with the medical doctor, the child

Additionally, contact needling is performed on themay be seen 2-3 times a day. Further, in the case ofback, left lower leg and right arm (Figure 11)

enuresis, the child may be seen for three consecutive

Treatmentintervalsfor

commondays and then depending on the child`s progress,
every other day, then twice a week, once a week,
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Volume 9, Number 3 | Fall 2014

twice a month gradually extending the interval as
the child shows consistent signs of improvement.
[B] Routine physical examination for children
The symptoms of the child patients may include
serious infectious conditions and diseases. In thecase of newborns, because they are unable tocommunicate using words, open communication
with the parent is necessary to help the practitioner
grasp the nature of the symptoms and judge whether
the child`s condition warrants prompt emergencycare.
(1) Visual inspection requires observing the facialappearance. So called Kanmushi presents withFigure 11: Pediatric needles for infantparticular symptoms including eyelid and lateral[C] Case Study13)

nostril redness, engorgement of a subcutaneous vein

1. Case study for a frail body typeobservable on the forehead and a pale complexion)

Subject: 3 year old boy(2) Appearance of the eyes: eyes may be red with[Complaints]The boy`s body is delicate and he often

inflamed conjunctiva but the overall condition iscatches colds.

anemic or pale (Figure 11 upper left)[Medical History]Since birth the child`s body has(3) Neck and facial appearance: special attention

been weak, he often gets sick, stays home from day

must be given to the lymph nodes in the neck (Figurecare, is picky about his food and does not eat much.

11 Upper right)

He was hospitalized one month ago for pneumonia(4) Intraoral inspection: redness of tonsils, posterior

and was released just last week. His mother broughtwall of the pharynx and presence of pustules or

him to the clinic hoping to strengthen his body.

Koplik spots (Figure 11 bottom left)[Physical findings]The boy is thin, his conjunctiva(5) Listening inspection: the purpose is to confirm

are red, lymph glands in the neck area are swollen

presence of wheezing, rattling or other signs of lightand painful to light palpation, tonsils are enlarged

asthma or bronchitis (Figure 11 Lower right)

and the back of his pharynx is red, lung sounds are(6) Thermometry (temperature measurement): it isnormal, weak musculature, poor appetite, bowel

very common for young children and toddlers tomovement once every 2 days and the amount is small.

develop fevers so temperature must be measured

He squirms and is unsettled at night.

when the child is in a feverish condition.

[Treatment]Pediatric acupuncture. The parents andchild preferred the treatment be conducted in theirhome (Du12). Treatments were continued on aweekly basis and gradually the interval wasextended. There were some ups and downs but if hecaught a cold it resolved quickly and was lighter
than before. His appetite increased and his pickinessdiminished. His sleep improved. Eventually his
mother began to complain that he was so healthy hewas hard to manage.

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Volume 9, Number 3 | Fall 2014

2. Case study for enuresis

known as Kanmushi in Japanese). Additionally,

Subject: 9 year old boy, 3rd grade in elementary

respiratory, digestive or ophthalmological conditions

school.

are often included. More complicated conditions such

[Complaints] (1) Enuresis, (2) Stuffy nose.

as epilepsy are treated not so much for the disease[Medical history] (1) Enuresis started about the timeitself, but regular pediatric acupuncture helps to

he entered elementary school. The time was variablereduce the physical and mental fatigue thatbut he wet his bed every night, and sometimes twice

naturally drains the child`s vitality, keeping him ina night. When the boy was examined by his medical

good condition. Most patients experience lighter

doctor, no abnormalities were found. They came toseizures and a reduction in frequency. Recently

our clinic on the advice of an acquaintance. The boy

reported treatment effects, include improvements inappeared sheepish and lacked vigor.

developmental disabilities, learning disabilities and[Other medical history] Nothing of note.

Asperger's syndrome14). That is to say, pediatric[Physical findings] Picky eater, regular bowel

acupuncture

movements (once daily), regular sleep cycle.

providing both relief of symptoms and improved[General Inspection] Average temperature 36.5 ℃

overall(97.7°F), swollen lymph glands under the jaw (+),

maintain health and prevent disease.

includeshealthsosafe

delicate

regulartechnique,administration

canvery red nasal mucous membranes (2+), Pharyngeallaryngeal mucosal redness (+), enlarged tonsils (-),

2. Positive effects of the spread of pediatric

no abdominal tenderness, induration or masses.

acupuncture[Therapy and treatment] The family had developed

Especially around Osaka and Western regions of thea negative cycle of scolding the boy when he wet hisKansai

bed. The boy felt stress and had lost his confidence.

acupuncturists

The first priority was to encourage the family to see

acupuncture in their practice. Over the past several

the problem from the boy perspective, get them todecades, 20-30% out of all visiting patients were theencourage rather than discourage him. Pediatricchildacupuncture treatments focused on treating theRecently the birthrate has been decreasing in Japan

lower abdomen and low back as a means to treating

and there has been a decrease in the overall number

the whole body.

of acupuncture child patients. However, the overall[Progress] treatments were conducted 1 or 2 times anumber of children receiving pediatric acupuncture

weeks a total of 23 times. Gradually the frequency ofhas been increasing which bodes well for the long

bed wetting decreased. Six month following theterm future of the profession. One point about this

discontinuation of the treatments, the family

type of treatment is the short treatment time. Gentle

reported only occasional wet nights. Updates thestimulation to the skin takes about 5 minutes andfollowing year reported almost no episodes. The boy

rarely more than 10, so the number of children

had become very healthy and happy.

coming and going from the clinic will increase givingarea,

patients

itiswhosaid
doseeking

that

not

there

includepediatric

arenopediatricacupuncture.

the appearance of a booming practice. As thechildren grow and develop they become accustomed[D] Considerations

to this type of treatment and usually lose any

1. Pediatric acupuncture treatment

resistance to acupuncture and moxibustion. Of

Relevant

conditionsforpediatric

acupuncture

course, there are the members of the child`s family,

include night crying, night terrors, making strange

parents, grandparents, siblings who accompany thesounds etc. (childhood neurological symptoms,child to their treatment—they begin to understand

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Volume 9, Number 3 | Fall 2014

the treatment style and often become patients

Referencesthemselves. In this way, as pediatric acupuncture

1) Hirohisa Yoneyama, Hidetaro Mori: Pediatricpatients

increase,regularacupuncture

andacupuncture methodologies, Ido no Nippon,
Inc.1980

moxibustion patients increase as well.

2) Masanori Tanioka: User friendly pediatricacupuncture, Genso-sha, 1998

3. Challenges of pediatric acupuncture
We are often asked why pediatric acupuncture is3) Mitsuko Nagasawa, Shin Suzuki, Naomichi

effective, currently there are 4 published theories:

Shimizu et al.: Clinical pediatric acupuncture.

(1) Control of the autonomic nervous system in

Shinkyu Osaka 14─1: 12─26, 1998

system4) Isao Okuda: Pediatric acupuncture: methods andenhancement, (3) Regulation of growth hormone andgeneral information. Shinkyu Osaka 14─1:

adrenal cortical hormone, (4) Improved blood

34─38,1998

childhooddevelopment,(2)

Immune5) Shin Suzuki: Pediatric acupuncture methodology,circulation.
Harlow HF reported, in an experiment using

Pediatric acupuncture- practice, effects andmonkeys, that skin stimulation is important forclinical management, pp2─20, Ido no Nippon,

normal development15). The normal healthy emotion

Inc, 2006

cannot be developed without the skin stimulation

6) Hitoshi Nagano: The origin of the Pediatricreceived while being held by the mother or similar

acupuncture – birth of a pediatric acupuncturist

stimulation.

Field16)and its historical background─. Journal of thereported that skin stimulation is critical for normal

Japanese Society for the History of Medicine

physical and emotional development and went56─3 : 387─414, 2010

Further,

Schanberg

andfurther to state that beyond the early years of life,7) Sesshu Hirano Map, Horeki year 13 (1763)

tactile stimuli and physical contact plays an8) Shinkyu Soku (Acupuncture and Moxibustion

essential role in emotional and physiological healthRules*), published Meiwa year 4 (1767)and development. Unfortunately, little research on9) Shoni Yoiku no Kokoroe (Guidelines for Bringing

pediatric acupuncture has been performed. In 1929,

up Children*), Enlarged 2nd Edition, by Sokitsu

Fujii et al. investigated changes in blood pressure,

Nagahama, Meiji year 39 (1906, August)respiration, body temperature and peristalsis among10) On the Origins of Shonishin The emergence ofyoung children and rabbits. They reported that

pediatric

pediatric acupuncture provided one type of skinbackground, Hitoshi Nagano, Yutaka Takaoka,

stimulation capable of modulating sympathetic

Journal of the Japanese Society for the History

nervous system tension. Further, Katai et al.

of Medicine, 56 (3), 2010acupuncturistsandits

historicalinvestigated the effects of pediatric acupuncture on11) Catalog of Reference Materials on the History ofhealthy adult males and found reduction in heart

Japanese Shonishin, Authorship, Modern Edition

rate and reported that this stimulation had a(Vol. 1 / Vol. 2), Hitoshi Nagano, 2011. 1-2

definitive effect on the autonomic nervous system. In12) Outline of the History of Japanese Shonishin,

the future, they are hoping that additional research(Vol. 1, 2, 3), Hitoshi Nagano, Ido no Nippon, Inc.

on the effects of pediatric acupuncture will be

2011.12, 1012. 1-2

conducted.

13) Tomofumi

Ozaki:

Examplesofsuccessfultreatment for nocturnal enuresis treatmentusing Pediatric acupuncture. Shinkyu Osaka
14─1, 1998

8

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

Volume 9, Number 3 | Fall 201414) ShigeyukiHirose,

Yasuji

Nonoi,

MitsukoNagasawa et al.: Pediatric acupuncture andmoxibustion treatment. Shinkyu Osaka 94:10─32, 200915) Tadashi

Yano:

FundamentalsofclinicalAcupuncture and Moxibustion medicine. The
human science of Oriental medicine IV, Waseda
University, Department of Human Sciences, 96:
116─119, 199516) Yuko Sato: Neurophysiology of acupuncture ─astudy on the mechanism of acupuncture in
recent years─. The Japan Conference of ClinicalAcupuncture and Moxibustion 11─1: 1─15, 1966

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