Volume 3, Number 3 | Fall 2008

Japanese Acupuncture - Current Research
Changes in Vessel Puncturing in Japan

during the Edo period eclecticism between the Chinese
collateral puncturing method and the Dutch form ofNobuyuki Seki

phlebotomy. Specifically the method consisted ofDirector, Japan Shiraku Gakkai

tightening the cubital or popliteal veins, which arethen punctured with a triangular-bladed needle,

1. Introduction

letting the blood flow for some time before theIt does not need to be particularly mentioned thatbloodletting treatment has been performed sinceconstriction is loosened and the bleeding stopped
during this form of venous puncturing.

ancient times on the East and West of the ocean. InA number of Chinese texts like the "Sachu

ancient China the meridian theory was integrated into

Gyokuhou" written by Kaku Shitsui during the 14th

this treatment form to establish the "bloodletting"year of the Kangxi period during the Qing dynasty(micropuncture)deals(1675) triggered the flourishing of vessel puncturing

mainly with the currently reported situation in Japan

during the Edo period. Among the books imported toand describes this treatment modality.

Japan this one became a very high ranking bestseller

concept.

Thismanuscript

Since micropuncture is a treatment form whereand since it was brought to Japan by ship in 1681, I

blood is taken, it may not always have been a part ofbelieve it was reprinted at least four times. Sabyou2)

the therapeutic scene, but records indicate, that it has

refers to seasonal diseases occurring from summer

been introduced into medicine from China. In thisthrough autumn and is a common designation forcontext micropuncture survives not as the phlebotomy

acute diseases. The conditions are characterized by

performed as a folk treatment, but rather as theabdominal pain, vomiting, diarrhea, irritation andmicropuncture

beenskin eruptions and may include a variety of diseases

integrated into the medical care based on the meridianvarying from heat stroke to small pox. This specialized

theory. The "I Shitsurei" of the "Taiho Ritsurei",book introduces the reader to the performance ofimitating the regulatory system of the Tang dynasty,

vessel puncturing followed by the administration of

stipulates this treatment form as one of the techniques

Kampo medicine. By the way, the book "Sachu

called "Hanbaku no Ho" anma massage students are

Gyokuhou" was written under the influence of western

supposed to study and the 10-volume commentary

medicine"Ryo no Gige" contains the passage: "Use needles toHippocrates or Junani. About 80 years later Tomonjudge presence of blood stagnation in the region ofYamawaki (1736-1782), who worked together withinjuries, and treat based on this judgment". This may

Yoshio Kōgyū (1724-1800) as an interpreter inbe considered to correspond to the "Byoshiho" calledNagasaki, studied the Dutch style of bloodletting

collateral puncturing method, that was mentioned intherapy brought from the Netherlands and Gengai

the Ling Shu1).

Ogino (1737-1806) wrote the book "Shiraku Hen"treatment

form

thathas(traditional

medicine

influencedbyLater too references to vessel puncturing are found(Volume on Puncturing). By arranging a compromisein various texts. There is not enough space here to

between theory and technical skills of both the vessel

discuss all of them, but I would like to expound a little

puncturing and the Dutch bloodletting therapies, thison the form of vessel puncturing of the Edo period, thatform of vessel puncturing reached the zenith of its

has influenced the currently practiced form in Japanprosperity from the middle to the latter Edo period.

most profoundly.

Accidentally, the term "vessel puncturing" (Shiraku) is
not found in texts preceding the Qing dynasty, but

2. Vessel puncturing during the Edo period
Briefly stated was the vessel puncturing practiced2rather called the other way round "Rakushi" =collateralpuncturing.

Theoldest

referenceto

traditional medical bloodletting therapy that had been

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

Volume 3, Number 3 | Fall 2008

called vessel puncturing is found in the "Sugiyama

Moreover, a lot of personnel in the prime of their

Shinden Ryu", but it remains obscure, since when thisworking life was drafted into the army and thedeveloped into an established nominal expression forconsensus is, that by the end of World War II skills andthis treatment form3).

schools of the Edo period had discontinued.

Later Kinkei Nakagami (1744-1833), Tousaku
Sanwa (?-1818), Shingen Kakimoto (both birth and
death

dates

areunknown),

Shukei4. Situation of vessel puncturing in modern times

Suganuma

Regarding the revival of vessel puncturing after the(according to one theory: (1706-1764), Sotetsu Ishizaka

war today mainly two groups can be distinguished in(1770-1841) and similar excellent physicians appeared

Japan, that are involved in the promotion of vessel

and developed such diverse techniques as puncturingpuncturing, including conduction of activities related

the network vessels, three-edged needles with a tip into education and the propagation of this treatment

the shape of Chinese chive leaves, inserting theform. Each of which was initiated by army physicians.

three-edged needle into tubes for the puncturing etc.

The physician Tetsuo Asami established the groupand thus laid the foundation for original Japanesepracticing the "well point puncturing method" he hadvessel puncturing methods4).

proposed, while the two physicians Kunimasa Kudo

Among these and compared to other practitioners,

and Masaaki Maruyama were the central figures at

who used decoctions + vessel puncturing or elsethe base of the academic tradition of the Japanacupuncture & moxibustion + vessel puncturing,Shiraku Gakkai group.

Tousaku Sanwa employed vessel puncturing for almost
all conceivable diseases and has been regarded as the1) Tetsuo Asami's "well point puncturing method"

greatest vessel puncturist of the Edo period. The

The "well point puncturing method" of Dr. Asami

written records called "Shiraku Bunken Roku" by hiswas brought to life by the year 1970, at which time he,disciple Rokuri Itou (Daijo) detail the amount of blood

whodrawn and the clinical course following the treatment(electroacupuncture), obtained hints from books about

and thus are still today an extremely illuminatingoriental medicine regarding vessel puncturing at thereference.

well points for the treatment of shoulder stiffness and3. Vessel puncturing in modern times
In conjunction with the fall of the Edo shogunate
the Meiji government promoted a rapid westernization
both in order to maintain Japan's independence andout of necessity to establish a system enabling Japanto sustain the national militarization. The medical
field was no exception and later not only vessel
puncturing but traditional medicine as a wholedeclined.
According to a proclamation published by theCabinet in 1883 and implementation of regulations
related to the licensing of physicians the western
medical system gradually gained in influence and in1895 the Imperial Government rejected a proposedcontinuance of Kampo, which led to a stagnation of
traditional medicine that continued for a century.

alreadypracticed

Ryodoraku

therapythus reportedly later perfectioned his "well point
puncturing method" as a form autonomous nervous
regulation5). After a period of 25 years, based on theAnpo / Fukuda theory that emerged from 1995
onwards, this technique has become widely and wellknown. Yet, those two treatment forms did not fuseinto one, but rather the establishment of one group
implementing the Anpo / Fukuda theory based on theso-called "ANS Immune therapy" and another grouparound Dr. Asami that called its technique the "wellpoint, scalp vessel puncturing". Many of the membersof these groups are physicians, using injection needles
as the tool for blood sampling, but recently laser
acupuncture, which does not draw blood, is also being
used.
The Anpo / Fukuda theory explains the mechanismof action of the vessel puncturing in terms ofThe Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

3

Volume 3, Number 3 | Fall 2008

autonomous

nervousregulatory

effects.

This

the former to choose the path of a doctor. At that timetreatment form employs stimulation of the nerves

he separated himself from the Ikkando school andcorresponding to those that are at that point

independently opened his own Onchido practice,

predominantly active to restore balance in case of

becoming a deciple of the famous Showa period Kampo

various conditions caused by a predominant activity

physician Domei Yakazu. Before he joined the army aseither the sympathetic or parasympathetic nerves.

an army doctor he used vessel puncturing to treat

Formerly glycyrrhizin preparations were used tosprains etc. and thus learned about the extreme

stimulate parasympathetic nerves, but puncturing theeffectiveness of this treatment form. Later, on various

well points is as a method far simpler and reportedly

fronts in Saigon, Hanoi, Laos etc. during his militaryhas immediate effects.

service too he treated his patients mainly with

Concretely, the sympathetic nerves innervate eachacupuncture & moxibustion as well as by vessel

finger, but the actions of the parasympathetic nerve

puncturing and found through experience, that well

are determined, so that for the stimulation of thepoint puncturing seemed to the be the most effective

parasympathetic nerves the well points of the thumb,treatment for malaria.

index, middle and small finger as well as Hyakue

Maruyama himself had a weak constitution by(GV20, Baihui) are punctured. This induces anature,

reduction in granulocytes coupled with an increase inmoxibustion treatment he received from Ken Sawada.

lymphocytes and thus corrects the leukocyte balance.

This motivated him to devote himself to the pursuit ofbutrecoveredcompletelythroughtheThe ring finger may stimulate the sympathetic

acupuncture & moxibustion and after the death ofnerves and therefore has in the past not been used

Sawada he studied under his foremost disciple Ikkaku

except in cases of pediatric asthma and the like, but

Shiro and thus devoted his life not only to vessel

recently it too has come into use.

puncturing, but also to the study of the "Yellow

Moreover, removal of the factors responsible for thesympathetic

hyperactivity

isimportantfor

theEmperor's Classic of Internal Medicine" and themeridians.

Consequently,

both

their

patients

treatment of diseases as well as measures to increase

predominantly with acupuncture & moxibustion as

the number of lymphocytes. Vessel puncturing has

well as vessel puncturing and although both werebeen considered to be an assistive treatment for thatphysicians, many members of these groups are

purpose and this line of thought has already been

acupuncturists, using the three-edged needle (fengmentioned in the Yellow Emperor's Classic of Internalzhen) as a tool for the bloodletting.

Medicine. In other words, while the mechanisms of

The two met each other on the inaugural meeting ofaction of the Anpo / Fukuda theory have not yet been

the Japan Society for Oriental Medicine, found eachcompletely clarified in terms of modern medicine, theother to be like-minded and coauthored and publishedability to provide explanations for the effects of vesselin 1957 the book "Vessel Puncturing Therapy". Thispuncturing

drew

makes

thisnewwestern

medicalinterpretation highly interesting.

closeattention

toandreintroduced

theknowledge about vessel puncturing after a century ofoblivion6,7). Disciples of both physicians with an2)

Vessel puncturing concepts of the physicians Kudo

interest in vessel puncturing gathered and thus thetheory adopted by the Japan Society for Oriental

and Maruyama
On the other hand, the physicians Kudo andMedicine founded in 1990 represents a tradition of theMaruyama have a strong connection to traditional

concepts of Kudo and Maruyama and is classified as

medicine. The improvement of the poor health offollows.

Kudo's father achieved by treatment administered by

Vessel puncturing is classified according to sites

Mori Dohaku practicing the Ikkando style motivatedand indications into well point puncturing, skin

4

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

Volume 3, Number 3 | Fall 2008

puncturing and collateral puncturing. Each of thesethat should be promoted throughout the world. Thismethods promotes the flow of qi and Blood through thetechniques employs puncturing superficial microscopic

meridians by drawing a little amount of blood, therebyveins in the skin with a three-edged needle to draw

alleviating symptoms and attempting to heal diseases.

blood. Sankei Nakagami dealt in his book "Seiseido

Well point puncturing is a method where the wellItan" with these microvessels, but the technique haspoints of hands and feet are cut with a three-edged

subsequently been refined based on studies by Kudo

needle to draw blood in order to promote the flow of qiand Maruyama. The expression microvessel is the onlyand Blood through the meridians through theanatomic term used in the "Zhenjiu juying fahuirespective connections of the individual meridians or(Shinkyu Shuei)" and does not appear in the Chinese

else the sites of each meridian, where their qi

classics. Actually, Chinese practitioners practically dooriginates. Rephrased in western medical terms thisnot target these microvessels at all. [ Picture 3 ]refers to an improvement of the circulation in theConsidering the state of eruption shown in thewhich

picture as a form of bypass the body sets up in thecirculatory disturbances are likely to occur, thus

most superficial layers of the skin to compensate for a

attempting to modify the microcirculation throughout

deteriorating

the entire body. [ Picture 1 ]microvessels and thus ensure the circulation isregionofarteriovenous

anastomoses,

inblood

circulation

through

theThe respective indications correspond to theprobably easily comprehensible. In the venous plexi on

indications for the individual well points, like forthe face or in the vicinity of lesions on the body surface

example "Shoho (LU11, Shaoshang) for the treatmentthese microvessels tend to be easily found. For thatof pharyngitis", but in special cases like paroxysmal

reasonhypertension, in case of common cold for the purpose ofpuncturing of the site in question can result in adeferverence or the treatment of shaking chills,

dramatic change in hemodynamics and through theasthma, acute cerebral infarction or its sequelae andappropriate use of suction cups the risk of infection canthe like blood may be drawn from the well points of all

be lowered.

using

thistechniqueevena

minimalten fingers.
Skin puncturing is used for anomalities of the skinor muscles and if no network vessels are found in thevicinity,tenderness,induration,skin

5. Conclusions
Above I described the history of vessel puncturingchangesin Japan and outlined the techniques currently taught(darkening, dark red coloration, red macular spots andin the relevant courses. Since the foundation of thethe like), tension, itching, swelling, reddening, feelingJapan Shiraku Gakkai in 1996 the "Vessel Puncturingof warmth, blisters etc. may also serve as landmarks,

Manual" has been used as teaching material duringat which the skin (or mucosa) is then punctured with athese courses, but the contents was soon revised andthree-edged needle at several points to draw somerecently the "New Edition: Vessel Puncturing Manual"

blood, or suction cups too are often used to obtain blood.

has been published. I am convinced, that reading thisThe auriculae, nose and tip of the tongue and the likematerial too will certainly contribute to a deepened

are special sites. Skin puncturing has the effect ofunderstanding of the matter.

modifying microcirculation dynamics by puncturing

Regarding the current situation of the medical

specific acupoints or other sites and thus can be usedsystem there are no guarantees, that will be aanywhere on the body. This is what distinguishes it

continuous supply of expensive medications and thatmostly from western phlebotomy. [ Picture 2 ] Efficacy

blackouts

too conforms to the effects of the individual acupoints.

equipment into oversized trash. In this situation vessel

The microvessel puncturing I am going to introduce

puncturing represents a simple method of immediate

here in last place is an original Japanese techniquedonot

renderhighlysophisticatedeffects.

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

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Volume 3, Number 3 | Fall 2008

References1)

1. Ryuji Shimada: "History of Vessel Puncturing

Acupuncture"; Japan Shiraku Gakkai edition:"VesselPuncturing

Acupuncture

Manual",p.131, Midori Shobo, Tokyo, 1996
2) Hiroshi Kosoto: Japanese Reprinted Edition of aChinese

Book

Publishing

TimeTable","Dictionary of Japanese Kampo Books", pp417-437, TAISHUKAN Publishing Co., Ltd.,Tokyo, 1999
3) Hitoshi Nagano: "Flow of History Regarding Vessel
Puncturing", "Basic lecture text pertaining to vessel
puncturingneedling"(internalinformationmaterial) p.6, 2009
4) My manuscript: "Origin and transitions of vessel
puncturing techniques" in "Vessel Puncturing", Vol.
12, No. 1, pp 39-40, 2009
5) Hirokimi Matsuda: “The challenge of acupuncture”,
pp 120-126, Iwanami Shoten, Tokyo, 2005
6) Susumu Oonuki: "Progenitors of vessel puncturing:
master Kunimasa Kudo"; "Collection of abstracts
from the 15th Academic conference"; pp 5-8, 2006
7. Takashi Shimada: "The achievements of Masaaki
Maruyama"

JapanShirakuGakkai

edition:Collected works of Masaaki Maruyama, last volume,
pp 161-162, Saitama, 2001

6The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)