by Jake Paul Fratkin, OMD
In August, Koei Kuwahara came to Seattle to teach a one day workshop on pediatric shoneishin. Mr. Kuwahara, based in Boston, is the main teacher for Toyo Hari Meridian Therapy in the United States. He has been in practice for twenty years, and did a five year apprentice ship with Kodo Fukishima, the founder of Toyo Hari. Mr. Kuwahara’s workshop was both enlightening and informative. He treats about seven children a day in his busy clinic, and also is the father of four young children. His playful attitude with children helps put them at ease.
Mr. Kuwahara uses non-needle techniques for children until about twelve years of age, when they become comfortable with needles. His technique, based on the Osaka pediatric method, involves scratching and tapping techniques.
General Guidelines when Seeing Children.
GENERAL GUIDELINES WHEN WORKING WITH CHILDREN. It is important to be gentle, playful and non-threatening with the young patients. This allows you to complete your treatment and encourages them to enjoy coming to the clinic. Avoid hard diagnostic staring “like a doctor”, and instead use soft eyes “like a parent”. He put it another way: have eyes like you are on vacation, not at work. One way to help make a child secure in the clinic is to have a warm and friendly relationship with the parents. An added benefit from treating children is that parents often come over to acupuncture once they see improvements in their children.
For the first two treatments, children will naturally be wary. By the third visit, if their experience has been painless and pleasant, they will start looking forward to their treatments. For this reason, the first two treatments should be mild and of short duration.
QUESTIONING, LOOKING AND LISTENING DIAGNOSIS. Mr. Kuwahara begins his examination by asking about relevant symptoms, either to the patient or the parent. He then looks at face color, body shape, discoloration and shapes of the eyes, nose and ear. Mr. Kuwahara spent some time in the workshop describing the sounds and behaviors associated with various sho patterns. In Spleen pattern, the child is insecure without his or her mother, often looking around. They tend to cry when the practitioner looks at them. In Kidney patterns, children have a high range cry and like to hide in their mother’s arms, because they are fearful. Liver patterns can show as irritability or arrogance, even spitting at the practitioner. Lung pattern children tend to be quiet and more secure, but a little withdrawn.
PULSE DIAGNOSIS. Mr. Kuwahara relies on pulse diagnosis when possible. In his demonstration of this he was very fast, using three fingers simultaneously. Children will not sit still for pulse diagnosis, so it must be done quickly. In pulse diagnosis, he recommends determining if the middle level is floating or sunken to gauge a general yang or yin deficiency. In healthy children, pulses should be slightly floating, rapid and soft, and the practitioner looks for deviations from this norm. Later, in his demonstrations, he mentioned that if the pulse has fuzzy or weak borders, it indicates a more serious and deep-seated condition.
One expects to see a deficiency (kyo) on the position of the root meridian, but often with children it is easier to find a meridian that is excess (jitsu), which is usually the controlling cycle channel. Children often show excess on either the Liver or Spleen channels. A Liver excess reveals a Lung or Spleen sho pattern, while an excess Spleen position shows a Kidney sho pattern.
Primary Channel Kyo Secondary Channel Jitsu
Liver Spleen or Lung
As with adults, the pulse should be used to confirm the successfulness of the treatment. One should not let the child go until the pulse quality has normalized.
PERCUSSION TAPPING DIAGNOSIS is often performed on the abdomen while the child is lying on his or her back. As one hand is placed flatly on various locations of the abdomen, the other hand is used to sharply tap the back of the hand with four fingers. The practitioner listens for watery or sloshing sounds subcostally, in the epigastrium, or in the lower abdomen. In a healthy child, these sounds should not exist; all percussion tapping sounds should be identical. Sloshing sounds in the lower abdomen indicate a water stagnation problem, manifesting as bedwetting, headache, allergies, or diarrhea. In these cases, abdominal shiatsu is helpful, as is treatment to St 39 to 40. Sloshing sounds that are unilateral require treatment on the affected side. Subcostal sounds often indicate a tension in the interscapular area on the back. High or tight sounds indicate general muscular tension or stress. The sounds should be more normal following treatment.
THERAPEUTIC TOOLS. Mr. Kuwahara went over nine basic shoneishin tools, which I won’t discuss in detail. Basically, some tools are used for tapping technique and some for scratching technique. It is not important which ones are used, it is really up the practitioner, and many practitioners will use only one or two tools in practice. Most of the tools are for dispersing techniques but one, the silver teishin, is primarily used for contact tonification. One advantage of having numerous tools, said Mr. Kuwahara, is to engage the child by having him or her choose which tool the practitioner should use. This is part of the playfulness that he fosters in his clinic.
Besides the basic tools, Mr. Kuwahara will also employ press-balls to tonify points relevant to the sho pattern. On occasion he will also use intradermal needles, magnets, and moxa. Most children are frightened by moxa, but he will sometimes use it on infants, as he would blood letting for fever or injury. Sometimes he will use cups, for example on Ren 12 for diarrhea or bedwetting.
SCRATCHING AND TAPPING TECHNIQUES. Most conditions in young children are problems of yang excess, and the tapping and scraping techniques are used to disperse excess qi along the yang channels out to the skin. When this is completed, the root deficiencies can be treated with the teishin. Dispersing the excess first and tonifying the deficiencies second is in contrast to treatment of adults, where tonifying the deficiency is primary. One disperses the excess first in children not only because it is calming, but because the abundance of yang is often the cause or manifestation of their complaint.
The scratching technique is done very lightly with repetitive hand movements. The sensation is almost like a tickling feeling. The technique itself might involve up to 150 repeated hand motions a minute. The length of the motion varies on the age of the child. Children under three, for example, have a shorter stroke, while older children require strokes two or even three times this length.
Mr. Kuwahara likes to use the Kodato teishin, which looks like a large carpentry nail. One side has a small ball, the other is concave and ending in a point. The concave end actually is flat on one side, and this flat side contacts the practitioner’s mid finger while the index and thumb hold the Kodata teishin in place. The whole hand is used in the repetitive motions, coming down and brushing the skin “like an airplane landing and then taking off again”. The other hand is free to stabilize a limb or contact the body. The pressure used is quite light on infants, but can be a bit heavier for older children. At no time is the effect so dramatic as to actually scratch the skin. As the Kodata teishin is rubbed lightly across the skin, the ring and pinky fingers of the same hand feels for skin that is damp and sticky, rough and dry, or hot or cold. These skin areas require treatment, so the hand is diagnosing as it is treating. As the skin is brought into balance, the channels are also benefited.
The scratching technique is performed to the abdomen, the back, and the limbs. First the abdomen is treated, especially subcostally, along the midline, and around the naval. With the patient sitting, scratching is then performed around GB 20, Du 20, and close to the spine along the Huato points and Bladder points. The technique is then applied to the yang channels of the arms and legs. Direction of the brushing is not particularly important, Mr. Kuwahara reports.
These same areas can also be treated with tapping technique, using a teishin or a spring loaded tapper. Tapping is done very lightly with the mind intent on dispersion. It is particularly valuable for areas of skin that are rough or dry.
TONIFICATION TECHNIQUES. The pulses are then evaluated to determine the root sho, and the teishin is applied to the chosen tonification points. (Mr. Kuwahara confirms point selection by reading the reaction of the pulse). The teishin barely touches the spot, and the practitioner uses his or her mind to direct the energy of their fingers into the point and up into the channel. This should take no more then five seconds. When complete, the hand quickly pulls away and the point is immediately covered. For dispersion, the teishin is applied to the point, and the practitioner uses his/her mind to pull excess energy into the teishin and fingers. This is actually done in a pumping motion/mind-set. Finally, one to three press balls are left in place for five days to reinforce tonification.
Eight Extraordinary Channel therapy can be performed by using magnets on the master points. The sides of the magnets (north or south) are chosen based on the effect on the pulse, and the magnets are only kept in place one to two minutes.
CONCLUSION. Mr. Kuwahara’s shoneishin approach is used regardless of the nature of the complaint. It takes between five and ten minutes. Acute cases may only need one treatment, including fever, diarrhea or common cold. In chronic cases, the child would come in twice a week for one to three weeks, followed by once a week, then twice a month, and finally once per month, until the condition has normalized. By example, this approach can cure 75% of pediatric asthma cases, but it may take a year.
Mr. Kuwahara warns that if the treatments are too strong or done too long, the symptoms will get worse. So treatments should always be gentle and short in duration. As for emergencies, one should be particularly careful when the symptoms do no match the pulses, that is to say serious symptoms with normal pulses, or no symptoms with seriously imbalanced pulses. In these cases, one should consider a western medical emergency room.
Mr. Kuwahara spent the remainder of the workshop demonstrating these techniques on various patients who were brought in. Some of the patients were basically healthy; others were very sick, and at least one was dying. In all cases, Mr. Kuwahara demonstrated a deep well of love, compassion, and objectivity. His concern foremost was for the comfort of the child, which proved very reassuring to the young patient. As for the therapeutic value, Mr. Kuwahara deeply believes in its efficacy. His confidence, based on his clinical experience, was inspiring to all present at the workshop.
JAKE PAUL FRATKIN, OMD is a Doctor of Oriental Medicine in practice since 1978. After seven years basic training in Japanese acupuncture and Chinese herbal medicine in this country, he went to Beijing for one year to do advanced hospital training in herbal internal medicine, pediatrics and medical qi gong. He is the author of CHINESE HERBAL PATENT MEDICINES, (2001), a respected reference work of 1200 Chinese herbal products available in this country. In 1999 he received the national award, Acupuncturist of the Year, from the American Association of Oriental Medicine, and 2006 he received the award as Acupuncture Teacher of the Year. He is a recognized expert in the treatment of leaky gut syndrome, chronic respiratory and digestive disorders. Jake lives and practices in Boulder, Colorado
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