Volume 1, Special Edition | Current Japanese Acupuncture and Moxibustion 2010

History of Japanese Acupuncture andMoxibustion
Hiromichi Yasui
Japan Institute of TCM Research
Acupuncture is a traditional form of medicine
originating in ancient China and introduced to Japan
about 1500 years ago. The historical development of
this medical technology was quite different in Japan
than in its "home" country of China. The island
civilization of Japan added unique theories andtreatment methods to the practice of acupuncture.
This article will explore the history and some of theunique characteristics of acupuncture in Japan.
Introduction and acupuncture to Japan

It is believed that acupuncture had been
introduced into Japan by the 5th Century AD, during
the waves of migration into Japan from the Korean
Peninsula. The immigrants brought with them
Chinese technology and writings, and it was throughthem that the native Japanese first learned about
Chinese medicine, including acupuncture. In 562, theChinese monk, Zhi Cong, traveled eastward by sea,
carrying with him medical treatises on herbal
medicine and acupuncture meridians, including theMing Tang Tu (Illustrated Manual of Channels,
Collaterals and Acupuncture Points). This is the firstformally recorded introduction of acupuncture to
Japan. In the 7th Century, in addition to sending
ambassadors to the courts of the Sui Dynasty and theTang Dynasty, the Japanese government also sent
students to study various facets of Chinese culture. A
number of those students studied Chinese medicine
before returning home to Japan.
In 701, the Japanese government implemented
formal legislation (including the medical system) thatemulated the system being used at that time in Tang,
China. They established a curriculum for medical
education, with textbooks including such classics as
the Huang Di Nei Jing, as well as the Jia Yi Jing,
which was the first book devoted entirely toacupuncture and moxibustion; and also included
charts and graphs of the acupuncture meridians.
Students studied acupuncture and moxibustion theory2in the Huang Di Nei Jing, becoming familiar with theacupuncture points from the annotated charts andgraphs of the meridians, and learned the practicalapplications of moxibustion and acupuncture in the Jia
Yi Jing. The acupuncture curriculum required six
years of study.
Becausethis
medicalsystemwasgovernment-controlled, its administration rested in
the hands of the nobility who were in charge of thenational government until the end of the 12th
Century. At that point, control was seized by thesamurai class, and the capitol was shifted from Kyoto
to Kamakura, although the form of the medical system
continued unchanged. Around that time, acupuncture
and moxibustion entered a slow decline and little
information remains about the techniques practiced
during that period. The great physician priest Shozen
Kajiwara (1266-1337), in his massive two volume
medical encyclopedia compiled from 1302 through1327, made almost no mention of meridians,
acupuncture points, or moxibustion; although theencyclopedia includes detailed illustrations of humananatomy from Sung China. That situation remained
unchanged until the 16th Century when acupuncture
began to return to favor.
Early flowering

In the 15th Century, the second military governmentof Japan (the Ashikaga Shogunate) placed great
importance on trade with Ming China. The government
dispatched numerous trading ships, and there was also
considerable private shipping back and forth between
Japan and China. This resulted not only in a remarkableincrease in Chinese goods entering Japan, but also an
increase in the number of people traveling between thetwo countries. Many Japanese crossed the sea to China
in order to study medicine, including some who learned
acupuncture and then returned home to become famous
acupuncturists in Japan.
At the end of the 16th Century there were several
developments that had never occurred before in
Japan's relations with the Asian continent. First was
the Japanese invasion of the Korean peninsula, led by
Toyotomi Hideyoshi. While in Korea, the invaders
were exposed to unfamiliar elements of East Asian

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

Volume 1, Special Edition | Current Japanese Acupuncture and Moxibustion 2010

culture (including medical writings). They also
encountered a wide range of technological skills andmet the practitioners of those skills, including
physicians. The imported technology of wood block
movable type, which contributed greatly to theprinting industry that subsequently developed inJapan, also permitted the publication of more medical
literature.
Another contributing factor was the gradualdecline of the Ming Dynasty in China. Invasion by the
Manchu forces (who subsequently founded the Qing
Dynasty in China) caused a flood of refugees to thesouth. A few of these refugees (20,000 to 30,000)
traveled as far as Japan where they were welcomed by
the newly established Tokugawa Shogunate (1603).
Those refugees included a number of highly skilled
physicians who commenced to teach the latest
developments in Chinese medicine to their Japanesecontemporaries.
Those teachings had a major impact on
acupuncture in Japan in the late 16th and early 17th
Century and led to numerous splits and divisions.
Soon more than ten competing "schools" ofacupuncture treatment had appeared. These divisions
developed in part because teachings from China
arrived piecemeal. Each school kept its own techniques
secret from all others.
The schools of acupuncture at this time werestrongly influenced by the classical medical text Nan
Jing (Classic of Difficult Issues). There were those who
gave particular weight to abdominal diagnosis andtherapy, those who focused on worms within the bodyas a source of disease; those influenced by Buddhist
medicine; those that emphasize treatment at specificacupuncture points; those who notated theacupuncture points by symbology, and those who
expressed the indications of disease in Japanesetraditional verse (waka).
In 1536, the Nan Jing became available as Japan's
second medical publication. Soon after this, schools
strongly influenced by this text, began to appear. The
content of the Nan Jing with regard to the concept of"reinforcing" and "reducing" was particularly
well-received by Japanese at that time. The concepts
focusing on abdominal diagnosis and therapy are notwell understood, but may have been popular for two
reasons. One, was that techniques for abdominal
massage were already known at the time, particularly
among Buddhist monks, and were understood toprovide definite effects. Second, was that theanatomical diagrams in all of the Shozen medical
treatises were connected to the anatomical notationsin the Nan Jing, and these points were projected onto
the surface of the abdomen, leading to the idea thattreatment could be directly applied to the pictured
sites. Fig. 1 shows a chart from this period for
abdominal examination.
(Each organ was assigned
to a specific region of theabdomen. bnormalities weredetected by palpation, andtreatment was performedby driving in needles witha small mallet.) The schoolsthat focused on the abdomen
continued to exist for several centuries. The otherschools apparently persisted into the mid-17th
Century.
Independent development

In the first half of the 17th Century, exiles from the
Chinese mainland brought current developments in
Chinese-style acupuncture to Japan. At the same time
there was increased study of classic medical texts suchas the Huang Di Nei Jing. That interest was further
spurred by the introduction of Chang Jing Yue's
classic text, the Lei-Jing, in Japan in 1624. From thatpoint onward, study of the classic texts made up amajor stream of traditional Chinese medicine (TCM)
research in Japan.
In the middle of the 17th Century, a man of genius
appeared who changed the course of acupuncture
history in Japan. That man was Waichi Sugiyama(1610-1694). Sugiyama, who was samurai by birth,
contracted smallpox when he was a small child andlost his sight. As a young man he gave up his samurai
status and began the study of acupuncture. His
experiences during his search to become a skilledacupuncturist are legendary. For example, it is said
that his prayers to the goddess Benten were rewarded

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

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Volume 1, Special Edition | Current Japanese Acupuncture and Moxibustion 2010by the goddess, who gave him the gift of superior
acupuncture technique.
Sugiyama took the massive system of Chinese
acupuncture and summarized it in concepts that were
easily understandable in Japan. Based on his own
experience, he simplified and clarified therapeutics.
He also introduced two techniques that reduced thepain of acupuncture: the use of the kudabari, a guidetube that simplified needle insertion, and the use ofpine needles as acupuncture needles. He taught all of
those techniques at his acupuncture schools. He also
succeeded in broadening the occupations available tothe blind and visually impaired. Subsequently,
acupuncture, moxibustion, and massage became
important occupations for the blind in Japan; atradition which has continued into the present.
Sugiyama's work won the support of the Tokugawa
Shogunate, support which was continued for the next
200 years.
We also have documents from a few European
travelers of the time, recording their impressions ofcontemporary Japanese acupuncture. From 1674 to
1676, the Dutch trader Willem ten Rhijne served as thephysician to the Dutch trading post outside of Nagasaki.
(At that time, Nagasaki was Japan's primaryinternational trading port, and the Netherlands was the
only Western country permitted to trade in Japan.) In
his subsequent treatise, Dissertatio de Arthritide, hedevoted many pages to acupuncture and moxibustion,
providing Europe's first introduction to these forms of
medical treatment (Fig. 2, 3, 4, 5).

Portrait of Willem ten Rhijne

4"Article about Arthritis" by Rhijne

The year 1690 marked the arrival in Japan ofEngelbert Kaempfer (1651-1716), who studied
multiple aspects of Japanese culture, including
medicine, and later wrote a book titled Amoenitatum
Exoticarum (1712). This was his only work publishedduring his lifetime. After his death it was translated
into English, edited, and included in the larger volume
The History of Japan, published in London in 1727.
The text contained a discussion of acupuncture.
Kaempfer described acupuncture treatment for the
specific condition of "senki"
which involved abdominal
pain of unknown cause.His
work included illustrationsof three types of Japanese
acupuncture needles (Fig. 6).
He also provided a detailed
description of moxibustion in
the treatise Moxa in China
and Japan.
That description gives us information on how moxa
was used at the time. (Moxa powder approximately thesame volume as half a grain of rice was burned directlyon the skin. This was the origin of moxa as it ispracticed in Japan today.) Kaempfer was surprised tofind that the area treated was often considerably
removed from the afflicted area. He described asituation in which an upset stomach and loss ofappetite was treated by moxibustion on both shoulders,after which the condition was relieved and thepatient's appetite returned.

Acupucture needle used thenChart of Meridian points

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

Volume 1, Special Edition | Current Japanese Acupuncture and Moxibustion 2010

He also witnessed moxibustion along the spine as aneffective treatment for pain in the side, and theapplication of moxa between the thumb and index
finger to treat toothache. He found all of thesetreatments astonishing, although from our present-day
perspective, they do not seem particularly strange. As
an aside, the English term "moxibustion" was derived
from the Japanese "mogusa" (moxa). Kaempfer's bookwas widely distributed at the time of its publication as
an introduction to moxibustion (Fig. 7).

The use of moxa began to increase at the end of the
16th century. Because it was simpler thanacupuncture, which required specialized knowledge
and technical skill, moxibustion became widespread asa form of folk medicine, and numerous volumes were
written on its use in the home. In his book, Kaempfer
commented that it was impossible to find a Japaneseperson who did not show some scarring frommoxibustion.
This form of folk medicine, which was widespreadbut not practiced to a particularly high standard, wasagain returned to professional hands by a movement
initiated in the late 17th Century and extending into
the middle of the 18th Century under the leadership of
Konzan Goto (1659-1733). Goto was a highly
knowledgeable physician who primarily used
traditional Chinese medicine therapy, but frequently
relied on folk medicine, now referred to ascomplementary and alternative medicine, (CAM). He
placedparticularimportanceon
diagnosing
abnormalities in the flow of qi energy within the bodyand frequently prescribed a course of hot springs andmoxibustion therapy to improve this qi energy flow. As

a result of his work, even doctors who specialized in
drug treatment began to occasionally use moxibustion.
This led to even greater use of moxibustion among thecommon people, and different regions developed theirown characteristic forms of moxa therapy (usuallyassociated with a specific Shinto shrine or Buddhist
temple). Those methods, which were based on theexperience of the people of each local region, were latercollected for publication by several different scholars.
The Chinese acupuncture system was vast andcomplex, which made it very difficult for Japanese
students of that time to fully understand its potential.
This problem was addressed with skill anddetermination by a number of Japanese specialists
who succeeded in reforming and simplifying themassive Chinese system for Japanese use. This ability
to codify a vast and complicated system into somethingsmaller and more easily understandable, which
historically has characterized the Japanese people,
resulted during the late 17th and early 18th centuries
in the authorship of numerous small and practicaltexts on moxibustion and acupuncture. Fig. 6 shows
one of those, The Handy Book of Acupuncture,published in 1718 (Fig. 8).

The popularization of these simple texts in Japan
was paralleled by a movement to publish more difficult
Chinese medical materials (the classics as well as
numerous treatises on medical theory and texts on
moxibustion and acupuncture) accompanied bynotations and commentary in the Japanese vernacular.
An industry even developed around this specialized
work. This approach to the explication of foreign texts
was in itself uniquely Japanese.
Research on the meridians and acupuncture points
also flourished. Such research was particularly in

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

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Volume 1, Special Edition | Current Japanese Acupuncture and Moxibustion 2010

demand because of the difficulty of identifying meridianshailed in Europe as an importantand acupuncture points on the human body. In the final

treatment technique, wasanalysis, however, progress in this field came when the

introduced to Japan by thenotations and commentaries on classic Chinese texts ofDutch translators at Nagasaki,

moxibustion and acupuncture were actually confirmed

and was of considerable interest

by investigation through practical use. Such research

to Japanese physicians.

continued uninterrupted from the 16th to the 19th

The year 1776 in Japan marked

centuries. Much of it was documented in writing.

the arrival of Dr. Carl PeterIn the 18th Century a man by the name of Todo

Thunberg (1743-1828) (Fig. 9),

Yoshimasu developed a revolutionary idea in the field

who accompanied the Dutch director of the Nagasakiof traditional Chinese medicine therapy; he proposed

trading post on his visit to the capital in Edo (nowthat patients be treated without reference to theTokyo), one of the world's great cities at that time.

traditional medical theories of yin, yang, and the five

Thunberg spent some time in Edo, where he met withagents. From that point onward, Japanese TCM

a number of the best physicians in Japan, taught themdiverged considerably from traditional medicine as

the techniques of bloodletting, and trained them for apracticed in China.

short time in the implementation of this therapy.
theMeanwhile, a book written in China on the(1706-1764)

treatment of acute filthy disease "Sha zhang", adeveloped and began to practice an acupuncturecholera-like disease reached Japan in the mid-17th

methodology that was not based on traditional medical

Century. It also contained a description of bloodletting.

theories. Suganuma's techniques did not depend onSome

the meridians or on the concepts of reinforcing andinterested in this Chinese approach to bloodletting andreducing. Instead, he treated patients using only 70

began to use it in treating a variety of diseases. Thisacupuncture points. Although his ideas did not become

led to modification of the European techniques inwidespread, they had considerable impact on his

Japan, soon resulting in the development of a uniquecontemporaries in the world of moxibustion andform of bloodletting that came into widespread use inacupuncture.

Japan during the 17th and 18th Centuries.

Stimulated
acupuncturist

byYoshimasu's

Shukeithinking,

SuganumaJapanese

medicalpractitioners

becameAt the same time that Yoshimasu was propounding

Neo-Confucianism was first introduced in Japan

his ideas, Dutch physicians were beginning to visit

toward the end of the 16th Century. The Tokugawa

Japan, bringing with them a few high-quality Dutch

Shogunate considered this philosophy as a pillar of its

medical texts that were read and translated byown existence. However, the philosophy had many

progressive Japanese physicians. The first of these

detractors, and around the turn of the 18th Century

works to be translated and published was Johann

there was a popular movement to return to the

Adam

been

essentials of traditional Confucian thought. The

translated from the original German into Dutch underactivities of Yoshimasu and his colleagues were one

the title Ontleedkundige Tafelen. The publication of

result of these changes.

Kulmus'anatomy

text

which

had

this book in Japanese provided a view of medicine very

At the end of that century, a popular text on

different from traditional TCM-based understanding,critical investigation from the Qing Dynasty in China

and focused attention on Europe. Japanese physicians

was introduced to Japan. Medicine was among thebegan with the study of anatomy and surgery, andfields influenced by this book, and as a result a criticallater extended their interest to Dutch medical

investigative approach to research became popular.

treatises on internal medicine and other areas ofTextual criticism was widely applied to classics such as

clinical therapeutics.

the Huang Di Nei Jing and the Shang Han Lun, and in

At about this time, bloodletting, which was being
6

some cases corrected texts were prepared and

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

Volume 1, Special Edition | Current Japanese Acupuncture and Moxibustion 2010

published. This movement was sparked by individuals

treatises for him, so in the field of moxibustion andof the time and later received government approval.

acupuncture, he read Ishizaka's Concise Discourse on

Government-sponsored medical research laboratories

Acupuncture and Moxibustion as translated by Junzo

were established and became centers of both research

Mima. Subsequently, on a visit to Edo with the Dutch

and teaching. Meanwhile, a copy of the Tai Su Jing, a

director of the Nagasaki trading post, Dr. Siebold had

portion of the Huang Di Nei Jing that was no longer

the opportunity to meet and exchange experiences

available in China and believed lost, was found in anwith Dr. Ishizaka.

old Buddhist temple in Kyoto. This discovery further
encouraged research in the classic texts.

Decline and restoration

Worthy of mention in the context ofmoxibustion

andacupuncture

education during this period was ahumanfigureshowing

the

cast

in

meridians

copperandacupuncture points. (The original
prototype, made in China in 1026,was

subsequently

modelswere

lost.)

Such

enthusiasticallywelcomed by medical scholars of thetime, and in the 17th Century, a
new mold was made and additional
figurines were cast (Fig. 10).

Until the middle of the 19th Century, moxibustion
and acupuncture played a consistently unchanged roleinthepracticeofJapanesephysicians,

while

technological advances and academic developments
contributed to better health for the common people.
With the Meiji Restoration in 1868, the reins ofgovernment were transferred from the Tokugawa
Shogunate to a new imperial government headed by
the Emperor Meiji. This also brought changes to the
medical world, since all of the medical institutions that
had operated under the Tokugawa Shogunate weretaken over by the new government. The German
medical system was adopted, and schools of medicine

With the advent of the 19th Century, the Japanesestudy of Dutch medicine intensified, and numerous
specialized texts were translated into Japanese. Moredoctors began to rely increasingly on their own
experience, and some even began to question theconcepts of Chinese medicine. It was in this context
that Sotetsu Ishizaka (1770-1841) devised a systemthat was centered around the traditional theories ofmoxibustion and acupuncture but that also
incorporated Western medical thought in asubordinate role.
In 1823, Dr. Philipp Franz von Siebold (1796-1866)
came to Nagasaki as physician
to the Dutch trading post there(Fig. 11). Dr. Siebold trained
numerous Japanese students
in Western medicine, while atthe same time studying Japanesetraditional medicine himself.
His method was to have hiswere established along German lines. This left only

disciples translate outstanding Japanese medical

continued to provide employment for the blind. The

one generation of physicians practicing traditional
medicine. Their occupation was effectively brought toan end since most traditional physicians passed on
their knowledge and their practice to younger family
members. Under the new system their children andgrandchildren could not become certified physicians
regardless of how well they were trained in traditional
medicine. Those who wished to become doctors wererequired first to study Western medicine and then passan examination in order to become a medical
practitioner.
The various forms of traditional medicine both
Kampo (herbal medicine) and acupuncture, wereconsidered to be "non-mainstream" and were removed
frompublicmoxibustion

view.
and

However,thepracticesofacupuncture

wereallowedtocontinue as long as the practitioner was licensed by
the

local

government.

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

These

occupations

also

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Volume 1, Special Edition | Current Japanese Acupuncture and Moxibustion 2010

weretreating General Zhukov (formerly of the USSR

considered of high importance at schools for the

military and General of Minister of Defense) for

visually impaired.

trigeminal neuralgia.

subjects

of

After

moxibustion

being

government

so

and

severelyandacupuncture

restrictedcompletelybyexcludedtheThese two schools of thought are the central forces

fromin Japanese acupuncture today, although there are

mainstream medicine, acupuncture took more than

numerous small unaffiliated groups as well.

half a century to recover. During that period, however,

Their activities were temporarily curtailed bya small number of highly gifted acupuncturists

World War II. After the war, the defeated Japanesecontinued to practice away from public notice.

nation was given democracy by the occupying Allied

One of these was Ken Sawada (1877-1938), whose

Powers(GHQ).

However,

the

GHQ

was

not

work was discovered and brought to the attention of

sympathetic to acupuncture. The department that was

the world by a journalist investigating traditionalcharged with reforming the Japanese medical system

medicine. Dr. Sawada's method, called "Tai Chi

was the Public Health and Welfare Section (PHW)

Therapy", depended primarily on observation andunder the command of Brigadier General C. F. Sams.

palpation to diagnose abnormalities of the organs andGeneral Sams attempted to obliterate the historic andmedians, which were then treated with moxibustion.

uniquely Japanese treatment method of acupuncture

Sawada focused primarily on acupuncture points infromthe back, but emphasized that for every disease there

recommending to the Japanese Ministry of Health andwas a characteristic acupuncture point that could be

Welfare that "Medical treatment should be performed

used. Sawada's methodology was widely disseminatedprimarily by physicians, and other occupations such as

by his gifted disciples, a group of practitioners who

acupuncturist and massage therapist should bebecamecentralTheyunreservedly prohibited." This recommendation came

includedtheShirota

as a great shock to the acupuncture world, and a

popularizedcoalition of acupuncturists, physicians, physiologists,(1900-1974),

toJapanesehighlywho

acupuncture.

successful

systemized

Bunshi
andwithin

the

world

of

Japanese

medicine,

members of the National Diet, and those involved with

Sawada's therapeutic techniques.
The 1930s saw the formation of another large

schools for the blind began to work together to opposefromthe GHQ recommendation and to find a better solution.

notations on the classic texts, this group developed a

In the end General Sams was convinced of thesystem that placed primary emphasis on meridian

importance"kyo-jitsu"

traditional form of medical treatment was allowed to

group

of

acupuncturists.

(deficiency

Workingandmostlyexcess)diagnosis.

Treatment was performed by supplementing theofacupuncture

in

Japan

and

this

continue.

deficiency or eliminating the excess so that balance

After the war a number of new movements began

could be restored. They named this methodology

to develop within Japanese acupuncture. The Ministry"Meridian Therapy". The central members of thisof Health and Welfare established a system of formalgroup, who provided guidance for the others andeducation for the purpose of becoming a credentialed

established the Meridian Therapy system, were

acupuncturist,

several young acupuncturists in their 20s and 30s. In

schooling (3 years) in a specialized educational

particular, Sodo Okabe (1907-1984) possessed brilliant

institution, to be followed by a certification test

technical skill and contributed greatly to the perfection

administered by the local government (later changedof the technical side of this system. In 1973 Dr. Okabe

to a national certification examination). Candidates

was invited to visit what was then the Soviet Union,

who passed the examination were credentialed aswhere he received grateful thanks after successfully

acupuncturists.

8

stipulating

The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)aspecificamountofVolume 1, Special Edition | Current Japanese Acupuncture and Moxibustion 2010

There were also new developments in clinicalpracticeandinresearch.

SomegroupsofSince some Japanese practitioners wished to pursue thismethodology in Japan, formal schooling in TCM was

acupuncturists, in response to the GHQ statement

established.

Activecommunication

with

Chinesethat acupuncture was "an unscientific and barbaric

specialists is ongoing, excellent Japanese educators haveform of treatment," chose to focus primarily on

emerged, and this system is currently gaining inscientific methodology. Dr. Shirota, as mentioned

popularity.

above, denied the absolute authority of traditional

At present there are a number of different

medical theory. He proposed that the measurement ofacupuncture systems in practice in Japan, each with its

electrical resistance could be used to detect theown special characteristics. Any attempt to use these

acupuncture points that were responsive in a specificsystems without understanding their historical context

disease, after which the disease could be treated byinvites erroneous and unreliable results, since while

stimulating those points with acupuncture andclosely related in some ways, these systems also havemoxibustion.

points on which they differ profoundly.

Advancesinelectrophysiology

contributed to this theory, but applications to the

The current situation of Japanese acupuncture

meridians had to wait until a discovery by Yoshio

cannot be explained through one-dimensional thinking.

Nakatani in 1950 that resulted in the development ofHowever, this multiplicity is in itself one of the

Ryodoraku

newcharacteristics of acupuncture in Japan. While future

developments, groups of acupuncturists who weredevelopment of acupuncture throughout the world willinterested in meridian therapy, continued their

be greatly influenced by changes in Chinese TCM, it

research, producing large volumes of results to prove

seems

the existence of the meridians.

moxibustion and acupuncture in Japan will also play a

Acupuncture.

Parallelingthese

In the 1970s, information on a newly systematizedapproach to TCM arrived in Japan from China.

likelythattheuniquecharacteristics

ofsignificant contribution in the international developmentof this traditional approach to better health.

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