Volume 12, Number 4 | Winter 2017

Report from WFAS Tokyo/Tsukuba 2016
Hokushinkai Style Acupuncture and Moxibustion
Treatment

Main body of the text
1. What is Hokushinkai?

General Incorporated Association Hokushinkai

Hokushinkai was established as an academic
association by Renpu Fujimoto and his associates inIntroduction:

1979. The philosophy of Hokushinkai is as follows:

Hokushinkai style treatment, with a small number“Oriental medicine is a true medicine that can cureof acupoints (one acupoint, in most cases) has been

body, mind, and soul. Based on this premise, we aim

successfullyThe

to help patients from the standpoint of oriental

Hokushinkai style, a school of traditional Japanese

medicine. To achieve this, we pursue both scientificacupuncture and moxibustion, is based on theknowledge and artistic skills.” In 2009, Hokushinkai

appliedtomanydiseases.

(patternbecame a general incorporated association. We haveandheld regular meetings and workshops that aim totreatment) and uses the terminology of traditional

enhance the knowledge and skills of practitioners.

Chinese medicine as a common language. This paper,

Currently, many practitioners in acupuncture andconsisting of two parts, describes the theoreticalmoxibustion, as well as physicians, participate in our

characteristics of the Hokushinkai style.

program.

principleof

identification/syndrome

benshoronchi
differentiation

2. Current traditional Chinese medicine in perspective
The basic theory of Hokushinkai has been developed
under the influence of traditional Chinese medicine
from the very beginning. We have held conferencesand education programs based on traditional
Chinesemedicine.

Concurrently,

we

have

emphasized that there are limitations in the direct
application of current traditional Chinese medicine
to clinical practice. The following are some of the
Hokushinkai views on current traditional Chinese
medicine.
1) Advantages of traditional Chinese medicine
a. Logicality:
Consistency regarding examination, diagnosis, andtreatment is essential in medicine. The clinicalpractice of current traditional Chinese medicine isfounded on the principle of benshoronchi, correlatingof all four examinations. We apply these procedures
intheclinicalpracticeofacupunctureandmoxibustion for disease identification, by which we
can determine the appropriate treatment withrespect to the basic disease mechanism and pattern
identification in the fields of traditional Chinese
medicine. In addition, the traditional Chinese

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Volume 12, Number 4 | Winter 2017

medicine examination methods can provide more

2) Limitation

information than zuisho therapy which is based only

According to current traditional Chinese medicine,on inquiry or pulse diagnosis. Employment of the“all substances in nature are composed of qi withexamination system is, therefore, useful whenvarious levels of density, and qi is the most

holding conferences and providing education.

fundamental substance.”* However, if qi is regardedb. History of the medicine

as a substance with quantity (using the term inSince publication of “Huangdj’s Internal Classic”,

physics), this notion leads to materialism, which isthere have been considerable advances in oriental

inconsistent with the view of qi monism since

medicine (traditional Chinese medicine) in terms of“Huangdj’s Internal Classic,” where emphasis isdiagnostic and therapeutic methods. Because ofplaced on function, rather than substance.

these advancements, we can utilize the accumulated* As presented in “Basic Traditional Chinese

knowledge regarding basic disease mechanisms andMedicine”

pattern identification for treatment of each disease,

Traditional Chinese Medicine Study Group.

according to traditional Chinese medicine. We canthoroughly learn the historical developments andtheoretical issues that are essential in each school ofcurrent traditional Chinese medicine. In addition,
the findings are suggestive in the context of theheritance and progress of traditional Japanese
medicine.
Oriental medicine (traditional Chinese medicine)originates in China. It has progressed independently
from the original style, mainly in the Korean
Peninsula and Japan, based on treatment inaccordance with three causes (seasonal and local
as

well

as

patient

individuality).

Nonetheless, all oriental medicine is based on thecommon principles that have developed since thepublication

of

1995)

by

Kobe

3. Multifaceted observation of body surface
Hokushinkai

styleemploysthebodysurfaceobservation techniques of old Japanese schools forpracticing

benshoronchi;

observation

techniques

these
have

body

surfacecontributed

toimproved diagnostic accuracy. Here, we outline someof the techniques.

c. Globalization

conditions,(Ryogen-shoten,“Huangdj’s

Internal

Classic.”

Therefore, we believe that the World HealthOrganization international standard terminology
regarding traditional Chinese medicine is useful for1) Mubun school abdominal examination
Based on the monograph regarding Mubun school
dashin (needle tapping), titled “Shindo Hiketsushu,”
we have continued our efforts to apply thesetechniques in clinical practice. Location of tension in
the abdominal wall is evaluated by palpation. By
confirming the areas of the viscera and bowels
corresponding to the tension, practitioners candiscern the disease location in the viscera and bowels,
as well as any uneven distributions of qi and bloodin the body.

our communication, although additional explanatory
notes may be needed in some cases. Through thisstandardized communication, we can convey theuniqueness and advantages of Japanese traditional
acupuncture and moxibustion to practitioners inmany countries.

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Volume 12, Number 4 | Winter 2017

Figure 3: Abdominal examination in practice.
2) Back examination
In the Hokushinkai style examination, the two sidesof the spinous process on the governor vessel arerecognized as the first line points, the lines 1.5-sun(approximately 4.5 cm) outside the governor vessel
points are recognized as the second line points(traditional

firstline),

and

the

lines

3-sun

(approximately 9 cm) outside the first line points arerecognized as the third line points (traditional secondline). By evaluating the responses of the backtransport points through palpation, using theconcepts of deficiency/excess and cold/heat, theconditions of the viscera and bowels, as well as otherbody

regions,canbeassessed

in

terms

of

deficiency/excess/yin/yang. The back-transport points
were originally described in “Miraculous Pivot” (in thesection regarding back meridian points) and “Plain

Questions” (in the section regarding heat patterns). In
Japan, examination of the back-transport points wasintroduced as “Shihai” (seeing the back) in “Ippondo
Figures 1 and 2: Two figures depicting abdominal
examination.

koyo igen,” written by a physician, Shuan Kagawa, in
the Edo period. In the early stages following the
introduction of “Shihai,” tenderness was used as theprimary index. Since then, various efforts have been
made

to

improvethetechnique.

Currently,

practitioners can accurately assess the deficiency andexcess of acupoints, while remaining aware of defense
qi, using a very soft touch (feather touch).

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

Volume 12, Number 4 | Winter 2017

For example, the points of the governor vessel andthe first, second, and third line points are assessed
as a unit, such as the set consisting of GV6, BL20
along the first line (right and left sides of the 11th
thoracic vertebra spinous process), BL20, and BL49.
In general, the governor vessel and first line are
more reactive in the acute stage; when the condition
becomes chronic, the second and third lines often
become reactive.

Figure 6-1: Back examination of the upper back:feather touch.

Figure 4-1: The left half depicts the variety of
responses from acupoints for deficiency. The righthalf depicts the variety of responses from acupoints
for excess.

Figure 6-2: Deep touch on the acupoint BL15 of
the upper backFigure 4-2: A schematic diagram showing thedefense qi in acupoints for deficiency and excess.

Figure 5: Positional relationships of back transport
points.

Figure 7-1: Back examination of the lower back:feather touch.

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Volume 12, Number 4 | Winter 2017

Figure 7-2: Deep touch on the acupoint BL20 of thelower back.
Figure 8: Examination of source point SP3: feather
touch.

3) Examination of source points
Abnormalities in the viscera and bowels, meridiansand collaterals, and meridians sinew can beevaluated through the examination of source points(e.g., deficiency, excess, cold, and heat) based on“Miraculous Pivot” and “Classic of Difficult Issues.”
All of the back-transport points are located in the
bladder meridian (the foot-taiyang). By contrast, thesource points are located in the 12 meridians andcollaterals;

therefore,

modulation

of

the

12

meridians, as well as the collaterals and meridianssinew, is easy to detect. The palpation method is inaccordance with the method of back examination,although a more delicate procedure is needed,compared with back examination, because theanatomical structures vary across points and thesizes of the source points are smaller than those of

Figure 9-1: Examination of source point LI4: feather

the back-transport points.

touch.

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

Volume 12, Number 4 | Winter 2017

Figure 9-2: Examination of source point LI4: deep

Figure 11: Examination of well point of the foot.

touch.

5) Pulse diagnosis

4) Examination of well points

The lung meridians of the hand-taiyin originate from

Well points are points where tenderness appears as
a reaction to acute disease. The imbalances in thethe middle energizer and run to the cun section of
the wrist (the place where the pulse can be felt).

viscera, bowels, meridians, and collaterals can be

Therefore, the rise and fall of stomach qi related todetectedregardingthe middle energizer (acquired qi) is reflected in thetenderness of the governor vessel points and firststate of pulse at cun. In Hokushinkai style, pulse

line points. In practice, areas of great tenderness are

examination at cun is adopted as a method todetected by soft palpation of the neighboring areas

evaluate the state of stomach qi. In addition, cun cannear PIP or DIP joint, rather than by palpation of thebe also interpreted as a representation of the whole-well points themselves.

body condition. Examination of the rise and fall ofbycollatinginformation

stomach qi is extremely important; it is essential forthe assessment of clinical course of disease,treatment efficacy, and exploration of optimaltreatment strategies. Patients are asked to clasp
their hands in prayer near the point below the navel.
This contributes to the mental relaxation of thepatient. In addition, this hand position is suitable for
ensuring that patients make the same wrist angles
every time, by which practitioners can accurately
evaluate the change in pulse before and after therapy.

Figure 10: Examination of well point of the hand.
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Volume 12, Number 4 | Winter 2017

Figure 13: Pictures of tongue and magnetic

Figure 12: Pulse diagnosis of stomach qi.

resonance image, cited from “Tongue inspection and6) Tongue diagnosis
This

is

a

very

importantexaminationforunderstanding of the eight principles (especially forheat/cold/yin/yang). In Japanese acupuncture andmoxibustion, tongue diagnosis was not incorporated
into

clinical

Hokushinkai.

practice
In

until

its

Hokushinkai

adoptionstyle,

bytonguediagnosis has been applied from the very beginning

imaging diagnosis,” Oriental Medicine Journal of
Acupuncture & Moxibustion vol. 1.
7) Other body surface observations
Other

examination

methods,

such

as

cubit

examination (elbow-to-wrist skin examination) andspatial examination, are described in the text, “Bodysurface observation” (Renpu Fujimoto, Midori-shobo).

for the treatment of acute feverish diseases,

In the next portion of the paper, theory, diagnostic

miscellaneous diseases, and intractable diseases.

methods, and needling methods, all of which are

Renpu Fujimoto has extensive experience regarding

important in Hokushinkai style clinical practice, aretongue diagnosis. Importantly, he reported that

described.

there was a tendency for coincidence between thelocations of cysts in the ventral surface of tongue and

4. Important theory and diagnostic methods inthe topography of trunk lesions.

Hokushinkai style
1) Taiji Yin Yang theory
Qi is the source of the universe. Our examinationand treatment are primarily based on the theory ofqi monism. Practitioners can be inspired by the Taiji
Yin Yang theory and various principles, based on the
dualistic monism of yin and yang. The details aredescribed in “Universe of oriental medicine” (Renpu
Fujimoto, Midori-shobo).
2) Theory of the viscera and bowels and meridiansand collaterals

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Volume 12, Number 4 | Winter 2017

In current traditional Chinese medicine, there has5) Spatial theory, spatial examination, and spatial

been a tendency that the viscera and bowels arepattern identification

described separately from meridians and collaterals,

When multiple symptoms are unevenly distributed on

as seen in the titles of textbooks such as “Visceral andone side (left, right, upper, or lower), treatment based

bowel theory,” “Visceral and bowel pattern
identification,” “Meridian and collateral theory,” and“Meridian and collateral pattern identification.”onspatial theory and the diagnosis and treatment

However, “viscera and bowels” and “meridians andmethods to correct the uneven distribution of qi werecollaterals (meridian, meridian divergence, meridian

developed by Renpu Fujimoto, based on his clinicalsinew, and fifteen collaterals)” are inseparably linked

experience of acupuncture and moxibustion. The

with each other in clinical practice. Therefore, weconcept of spatial theory originates from pulse

address them together, using the framework “theory

examination in the three positions and nineof viscera and bowels and meridians and collaterals”

indicators in “Plain Questions.” The details arefor treatment. If the framework is compared to a tree,

described in “Vertical, Horizontal and Anteroposterior“roots” represent the viscera and bowels, whereas

Rules” (Renpu Fujimoto, Medical Yukon).

“branches and leaves” represent the meridians andcollaterals; thus, the condition of the roots (visceraand bowels) can be assessed by observation of thespatialexamination

andspatialpattern

identification is often significantly effective. This

6) Pattern identification of healthy and pathogenic qi
Deficiency indicates weakened qi, whereas excess

branches and leaves (meridians and collaterals).

indicates an excess of pathogenic qi. Discrimination

3) Pathogenesis and pathology

identification for deficiency and excess in the eight

In the practice of benshoronchi, treatment principles
are determined based on the identification of a“pattern.” However, the “pattern” itself only reflects
the pathologic condition of the patient at the time of
examination. Having an accurate understanding of
the pathogenesis and pathology underlying thepattern is important for prognostic prediction andtreatment of disease, including disease in thepresymptomatic state. This notion leads to theperspective of narrative-based medicine that has
recently received attention.

between deficiency and excess is made by pattern
principles. In clinical practice, there are cases where
the signs of deficiency and excess are mixed. In suchcases, knowing which is dominant, or whether bothare equivalent or not, is important for thedetermination of treatment strategies. Based on theassessment of dominance of deficiency and excess(healthy and pathogenic), optimal treatment isselected. Appropriate supplementation and draining
canbeperformed

accordingtothepattern

identification of healthy and pathogenic qi.
7) Shinshu theory (mind and pain theory)
Awareness of pain is governed by the mind. Based on4) Qi stagnation theory
As described in “Miraculous Pivot,” acupuncture andmoxibustion therapy aims to restore the health ofpatients by removing the blockage of meridian flow.
In Japan, Mubunsai and Gonzan Goto proposed the“qi stagnation pathology theory,” which stipulated
that “all diseases are caused and exacerbated bystagnation of qi.” This theory has an important rolein Hokushinkai style clinical practice.

the premise that a peaceful mind leads to the
reduction of pain, therapy is targeted at acupoints
that are related to relaxation of the mind.
5. Utilization of a specially designed chart
The specially designed chart for Hokushinkai styleincludes approximately 300 inquiry items. There arecharts specialized for women (including items
regarding menstruation and delivery) and men

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

9Volume 12, Number 4 | Winter 2017

(including items related to pathologies in men). A

naturally,

utilizingthebalancebetweenthechart for adults has seven pages. Sample charts areelasticity of the skin at the acupoint and that of theshown in the appendix of “Acupuncture clinical

tip and saddle of the needle. (Figure 14)(Figure 15)competency–Hokushinkai style: Theory edition.”
6. Unique techniques of acupuncture and moxibustion
In Hokushinkai style, one acupoint (or up to three
acupoints) is selected as the therapeutic target, inorder to dramatically improve the flow of qi andblood and to restore the imbalances of yin and yang.
This allows practitioners to evaluate the treatment
effect more clearly and to correct the treatment
strategies, if needed. We developed a needling
method that is suitable for people in Japan today.
This method exerts an optimal effect, without
disturbing defense qi and putting stress on the body.
It is called the “Renpu needling method.”
1) Filiform needle therapy (flexural needle insertion)
a. Regarding the small number of needles

Figure 14: Types of filiform needles.

After proper pattern identification and decision
regarding treatment strategies, one (or up to three)acupoint is selected. Healing of the body byacupuncture (moxibustion) treatment is considered
to occur through the accumulation of healthy qi andreduction of pathogenic qi at the treatment point.
When the number of treatment points increases, thegathering of healthy qi becomes difficult, leading toa lessened treatment effect. For this reason, the mosteffective acupoint is selected after assessment of
dominance of deficiency and excess. Small number
needling allows us to evaluate treatment effects
accurately, as well as to correct treatment strategy if
the treatment proves ineffective.
b. Flexural needle insertion
Traditionally, a needling method involving a guide

Figure 15: Procedure of needle insertion.

tube has been widely used in Japan. We propose ac. Needle placement after selection of acupoints,

flexural needle insertion because it is more quickly

based on the left-right difference.

adaptable to the conditions of the acupoints and body,

In examination of source points and the back,based on body surface observations. Practitioners

different responses between left and right points areshould be aware that defense qi is also present in theconsidered to indicate problems. It is assumed thatparts distant from the examined body surface, andmalfunction of the weakened viscera and bowels

that the defense qi will start to react when the needle

causes left and right imbalances in acupoints along

approaches the body. The needle should be inserted

the meridians and collaterals. A draining method is

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

Volume 12, Number 4 | Winter 2017used during needle placement on the excess side,

wall, both of which contribute to the restoration ofwhile a supplementation method is used on theimbalances of yin and yang. In accordance with thedeficiency side; thus, the imbalances are consideredprinciples of the Mubun school, acupuncture therapy

to be restored, based on the balancing principle inis performed only on the abdominal region, andthe Taiji Yin Yang theory. We use needle placement

diseases can be cured by adjusting all the meridians,ascollaterals,

the

basic

techniquebecausecomplicatedviscera,andbowels,

as

well

as

procedures hinder quantification of healthcaremaldistribution (left/right/upper/lower) of the qi andresource use. (Figure 16)

blood. This method is especially effective for patientswith seriously weakened qi in whom filiform needle
is not applicable, those with hypersensitivity, andchildren. (Figure 17)

Figure 16: A picture of needle placement.
2) Dashin (tapping round-tip needle with a mallet)
Dashin, in Hokushinkai style, derives from the
Mubunschooldashindescribed

inFigure 17: Tools of dashin in “Shinkyu Chohoki.”“Shindohiketsushu.” This method was further developed by
Renpu Fujimoto in his attempt to develop an
acupuncture method suitable to the Japanese peopleof today. In the early phase of development, Mubun
school dashin (needle insertion by tapping with amallet) was adopted without modification; however,it was then abandoned because it caused pain andstress on the body. Then, a round-tip needle, similar
to spoon needle and round-pointed needle, wasdeveloped using metals such as gold, silver, andstainless steel. The use of this new needle was
effective and did not cause stress on the body. Thisnew technique involves a comfortable beating soundwith a mallet, along with vibration of the abdominal

Figure 18: Tools of dashin currently in use.

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Volume 12, Number 4 | Winter 2017

Figure 21: Kodaishin currently in use.
In the early phase of development, needles made of gold

Figure 19: Dashin in practice.

or silver, similar to those discovered in China, wereused;3) Kodaishin
In 1968, ancient needles from 2100 years ago werediscovered in a tomb in the Western Han Dynasty of
China (the tomb of Liu Sheng). Subsequently, we
produced replicas of the ancient needles and began
to use them in clinical practice. As a result, we foundthat the procedure of needling without insertion(just touching) was sufficiently effective. Since then,the practitioners of Hokushinkai style have used theancient needles in clinical practice, under the nameof Kodaishin. (Figure 20 / Figure 21)

different

needles

werecold/heat/supplementation/draining.

used

for

However,

werecently found that stainless Kodaishin is useful for any
symptoms related to cold/heat/supplementation/draining;
moreover, it produces significant effects simply byholding aloft the acupoint, without touching. The
indications of Kodaishin are almost the same as those ofdashin. Since therapy with Kodaishin does not require
extended time, it is often used for patients who cannot
lie on the back or for children who are restless.
(Figure22)

Figure 20: Replicas of Kodaishin.
Figure 22: Kodaishin therapy in practice.

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Volume 12, Number 4 | Winter 20174) Others

1)

Renpu Fujimoto has studied with the nine needles
and their needling written in “Miraculous Pivot”
since the beginning of his practice. Currently, he2)occasionally uses round-sharp needle and shear
needle, but most frequently uses the needles
described

above.

moxibustion

for

In

addition,patients

he

may

a

significant

with

use

deficiency cold pattern, as well as for those requiring
treatment with Sinshu theory.
Conclusion
The medical philosophy of Hokushinkai style is

3)

4)

5)

based on qi monism and the Taiji Yin Yang theory,
following the philosophy of oriental medicine since
the publication of “Huangdj’s Internal Classic.” Thus,

6)

it originates from a standpoint that is different fromthe materialisms seen in current traditional Chinese
medicine.

Hokushinkai

styleemphasizes

theimportance of clinical practice in accordance with
control of the three causes (seasonal and local
conditions as well as patient individuality), while
using

the

terminologyof traditional

Chinesemedicine and adopting the science of traditional
Japanese acupuncture and moxibustion. We havebeen

makingcontinuous

effortstodevelopacupuncture and moxibustion medicine in the spiritof “from practice to theory.” We have established aseries of treatment systems in acupuncture andmoxibustion, including in-depth benshoronchi, withdetailed inquiries and with multifaceted bodysurface observation, small number needling therapy,
dashin, and Kodaishin. We continue our efforts todevelop traditional acupuncture and moxibustion.
Hokushinkai style is an active school attempting tocure a wide range of diseases, including intractablediseases. We hope that Hokushinkai style will be
spread far and wide. Lastly, a list of textbooks of
Hokushinkai style and related literature arepresented below.

7)

Renpu Fujimoto (ed.). Acupuncture clinicalcompetency–Hokushinkaistyle:
Theoryedition. Midori-shobo, 2016.
Renpu Fujimoto (ed.). Acupuncture clinicalcompetency–Hokushinkai style: Practiceedition. Midori-shobo, 2018.
Renpu Fujimoto. Body surface observation:
wisdom of Japanese acupuncture andmoxibustion. Midori-shobo, 2012.
Renpu Fujimoto. From practice to theory inacupuncture and moxibustion part 1.
Taniguchi-shoten, 1990.
Renpu Fujimoto. From practice to theory inacupuncture and moxibustion part 2.
Taniguchi-shoten, 1993.
Renpu Fujimoto. Collection of Essential Skillsof Acupuncture. Sizen-sya, 1978. Second
edition, Midori-shobo, 2000.
Renpu Fujimoto. Pulse examination of

stomach qi: illustration of pulse examinationin acupuncture and moxibustion. Morinomiya
Iryo Gakuen Shuppan, 2004.
8) Renpu Fujimoto, et al. Atlas of tongue
examination in acupuncture and moxibustion.
Midori-shobo, 1983.
9) Renpu Fujimoto. Universe of oriental
medicine. Midori-shobo, 2010.
10) Renpu Fujimoto, Yuichi Okumura, Tadashi
Yutani. Theory of viscera and bowels andmeridians and collaterals. Morinomiya Iryo
Gakuen Shuppan, 2003.
Acupunctureand11) Renpu
Fujimoto.
moxibustion:
Vertical,Horizontal
andAnteroposterior Rules. Medical Yukon, 2008.
Acupunctureand12) Renpu
Fujimoto.

moxibustion method by Renpu Fujimoto 3:
practice of Kodaishin. Oriental Medicine
Journal of Acupuncture & Moxibustion 24: 3136, Midori-shobo, 2012.
13) Renpu Fujimoto, Kazu

Murai. Tongue
diagnosis and imaging diagnosis. Oriental

Medicine Journal of Acupuncture
Moxibustion 1: 41-47, Midori-shobo, 2008.

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