Keiraku Chiryo: The Art of Japanese Meridian Balancing
Jake Paul Fratkin, OMD, L.Ac.
Keiraku Chiryo is a school of Japanese acupuncture that concentrates on the diagnosis and treatment of patterns of meridian imbalance. It combines root and branch: the root treatment brings into balance the flow of qi throughout the twelve meridian sequence, followed by the branch treatment which addresses the patient’s main complaint. Like other schools of Japanese acupuncture, the needle technique uses thin needles with shallow insertion and mild stimulation. Japanese meridian balancing is attracting more American acupuncturists due to it’s gentle needle technique and holistic approach. Most of the training in Meridian Therapy can be found in post-graduate workshops, although several acupuncture schools offer courses in Japanese styles of acupuncture.
This approach is fundamentally different from Chinese TCM acupuncture on two counts. First is the purpose of treatment. In Keiraku Chiryo, all health disorders (disease or trauma) related to imbalances of qi in the twelve meridians. Some channels will show an excess of energy while others show a deficiency. Because qi flows from one channel to the next in the twelve meridian cycle, these patterns of imbalance keep the body from healing efficiently. If the meridians can be put back into balance, the body can then heal itself more quickly.
By contrast, the Chinese TCM approach identifies a problem, and then uses point combinations to direct qi to the problem area in order to facilitate healing. Although it uses meridian theory, there is no overall balance or the meridian network. This is an effective treatment for problems that are focused or isolated, (stomach pain, shoulder pain, insomnia), but runs into difficulties when the patient presents with a multitude of problems, which is typical in American patients.
The second difference is the needling technique. Japanese style is superficial with thin needles, affecting the skin where the qi of the channel surfaces through its acu-point. De qi – the arrival of qi – is a sensation the practitioner feels in his fingers around the needle, not a sensation that the patient feels. In fact, in Japan it is said, “If the patient feels the needle, the practitioner has not done a good job”. The Chinese de qi, by contrast, has the patient feeling strong stimulation at the site of the needle and in the deeper tissue. In China, if the patient does not feel this sensation, he feels that the practitioner has not done a good job! In America, as in Japan, patients prefer the non-painful technique of Japanese style acupuncture.
History. Keiraku Chiryo is a modern revival of classical Nan Jing acupuncture, with its organization dating back to the mid-1930s. In the early 19th century, much of Japanese acupuncture focused on point therapy based on palpation, basically applying acupuncture and moxibustion within a shiatsu-like framework. The Meiji restoration in 1868 came close to dooming the practice of all traditional medical arts. The Meiji was determined to achieve the manufacturing and military successes of the West, and in their fascination with science and technology, they were also strongly in favor of Western medical science. Traditional acupuncture, moxibustion and Kanpo (Japanese herbal medicine) were officially banned for many years in favor of Western medicine. Of course, there was great hue and cry from traditional practitioners, and the leadership gradually allowed the arts to return. Kanpo herbal practitioners were permitted to continue if they also obtained degrees in Western medicine or pharmacology. Strict licensing was put into place for acupuncture and moxibustion (separate licenses!).
In the 1930s, as Japan’s nationalistic aspirations grew, there was concurrently a respect and reverence for traditional Japanese characteristics and customs, including the older martial traditions, Shinto religion, and traditional Oriental medicine. In 1936, Komai Kazuo, editor of Oriental Medicine Journal, wrote, “The most important guide for the development of medicine lies in the study of the meridians.”
Three men in particular are considered the founders of the Keiraku Chiryo school: Yanagiya Sorei, Okabe Sodo and Inoue Keiri (family name is given first, as in the Chinese manner) started the Society for the Study of Practical Acupuncture in 1938, and established Keiraku Chiryo, “School of Meridian Therapy”. Yanagiya famously extorted his followers “Study the classics!” Meeting once or twice a month, they studied and discussed the Chinese classical texts Huang Di Nei Jing, “Yellow Emperor’s Internal (Medicine) Classic”, between (3rd and 1st century BCE; authoritatively revised by Wang Bi in 762 CE); and the Nan Jing, “Classic of Difficulties” (authored by Qin Yue-Ren, 2nd century CE).
Illustrious members in the 1940s and 1950s included Fukushima Kodo and Shimada Ryuji. Fukushima, blinded in the Manchurian campaign in 1931, was directed into acupuncture school (a common vocation for the blind). When he tried to join Yanagiya’s group, he was rebuffed because he was blind. Determined, he advanced the art by creating palpatory study skills of the pulse, meridians and acu-points. Later, the Society humbly went to him, asking to learn his study techniques. Fukushima’s approach eventually evolved into the Toyo Hari school, a sub-school of Keiraku Chiryo, now famous for its non-insertion approach to acupuncture.
Other important developments in Japan include the following. In 1965, the first issue of Journal of Meridian Therapy appeared. In 1974, Okabe Sodo started the East Asian Medicine Research Institute. In 1983, the Meiji University of Oriental Medicine opened, creating a single systematic education program devoted to meridian therapy.
Modern experts of Keiraku Chiryo who have published or taught in English include Okada Akizo, Ikeda Masakazu, Shudo Denmai, and Kuwahara Kuei. In 1994, the first issue of North American Journal of Oriental Medicine, a journal devoted to Japanese acupuncture and published in Vancouver, appeared. It has been in continuous publication.
It has been reported that J.R. Worsley, then an English physiotherapist, was exposed to several lectures by Yanagiya Sorei in the 1950s in Germany, allowing him to construct the therapeutic framework promoted by his Five Element school. Apparently, he or his followers, known for strong needling, have never studied the Japanese needle techniques. (Worsley’s needle technique was learned in Taiwan from Dr. Wu Wei-ping.) Fukushima famously says in his book Meridian Therapy, “If the needle has caused pain, it automatically causes a sedation of the meridian.” Painful needling is contraindicated for meridian tonification: pain attracts meridian qi to the surface location of the needle, allowing it to disperse out, draining the channel.
Meridian Therapy. Keiraku Chiryo looks to identify one of four patterns (sho) that is the primary imbalance of the body. These patterns may exist temporarily as they transform into other patterns, or stays in place over a period of time. The purpose of the treatment is to correct the primary imbalance, which then allows the body’s meridian flow to return to normal. This approach recognizes that the health of one’s body depends on the free-flow of qi through the meridians in its natural sequence (e.g., LU > LI > ST > SP > KI > BL, etc.) The energy of each channel should be equal, without isolated excesses or deficiencies. When one locates and corrects the primary imbalanced pattern, the other imbalances fall into place, allowing healing to accelerate.
Treatment for the primary pattern is called the root treatment, and utilizes traditional points distal to the elbow or knee. These are basically the five phase points –tonification and sedation/drainage, fire and water, yuan-source, and horary points – but the luo-connecting and xi-cleft points are also used. Needle technique on these points is very superficial.
The branch treatment focuses on the patient’s chief. In Keiraku Chiryo, Japanese techniques for branch treatment are recommended, but in practice, one may use a variety of branch treatments, including TCM acupuncture, ear acupuncture, Korean hand acupuncture, Master Tung points, etc. The needle technique here will depend on the method being use.
Pulse Diagnosis. Determination of the primary patten (sho) is made primarily through pulse diagnosis. Abdominal diagnosis as well as point and meridian palpation are also used, but the radial pulse is the most important diagnostic tool. Practitioners of Keiraku Chiryo follow the pulse positions articulated by Wang Shu He the Mai Jing (“Pulse Classic”, 280 CE). This can be seen in the following diagram:
LEFT HAND Distal RIGHT HAND
Superficial Deep Superficial Deep .
Fire Small Intestine Heart cun Large Intestine Lung Metal
Wood Gallbladder Liver guan Stomach Spleen Earth
Water Bladder Kidney chi Triple Burner Pericardium Fire
Proximal
All twelve meridians are represented, six on each hand. The superficial aspect of the pulse is the yang meridian, while the deeper aspect of the pulse is the yin meridian of that phase. The Five Phase generation cycle is completely represented on the two wrists at the radial pulse. The sequence moves from proximal to distal, that is, from Water to Wood to Fire on the left hand, and from Fire to Earth to Metal on the right hand. At the distal position (cun), the phase crosses over to the proximal (chi) of the opposite hand, so that Metal (right hand) crosses over to Water (left hand), and Fire (left hand) crosses over to Fire (right hand).
Yin and yang aspects of each pulse position needs to be distinguished correctly. I recommend the following technique. Choose one position, and go to the center of the artery, the strongest position. This is the place of the actual blood flow. Now gently lift your finger superficially so as to discern the upper edge of the artery. You are still on the artery, but you are now feeling the upper “skin”, the upper boundary. This is the yang aspect of that position. It would be wrong to lift your finger off of the upper skin and into the interstitial fluid. You would not be on the pulse anymore.
Go back to the center, the strong part, and gently press more deeply to the bottom “skin” of the artery. This is the yin aspect. If you go past the bottom skin, you have gone too far. I like to “walk up and down the stairs” – going from center to superficial, back to center, to deep, and back again so as to carefully observe the differences between superficial and deep, between the yang meridian and the yin meridian.
Pulse Position Relationships. By analyzing which positions are excess and which are deficient, one discerns the Primary Pattern. Experienced Japanese practitioners typically feel all twelve pulses at the same time, with the prone patient putting their hands on their chest. I recommend feeling one pulse position at a time (e.g. Wood, Water, etc.), and discerning the comparison of the yang aspect and the yin aspect.
In health, the energy of the yang channel should be the same as the energy of the yin channel. In imbalance, one depth will be stronger than the other. There are three possibilities for this difference: one depth is weak and one normal, one is weak and its partner excess, or one is excess and its partner is normal. In the main, we are looking for weak or deficient yin meridians first. (Excesses on any of the channels are evaluated and treated after the primary deficiency pattern of the yin channels are treated.)
To me, the yang-yin imbalance of a position is more important that the relationship between different phase/element positions. By this I mean that the relationship of the yang and yin aspects of Water, for example, is more important than the relationship of Water to Wood, or any other phase/element. The Primary Pattern is not determined by which yin meridian is the weakest, but by the relationship of weak yin meridians to each other.
The Primary Pattern is named for a primary yin meridian deficiency. To discover this, we must identify all yin channel deficiencies: these positions will be weaker than their yang partners, which will be normal or excess. Many teachers recommend that the practitioner diagram out, either in a Five Phase/Element sequence or by wrist positions, the various imbalances. For example we might note the following:
Left Hand Right Hand
yang yin yang yin
SI HT LI LU
GB LIV ST SP ¯
UB KI ¯ TB PC ¯
In this example, the deficient yin meridians are Spleen, Pericardium and Kidney. Excesses are seen on the Gallbladder, Small Intestine and Stomach channels.
The Primary Pattern (sho). To determine the Primary Pattern, it is necessary to visualize the Five Phase chart. Here, Fire generates (precedes in a clockwise direction) Earth, Earth generates Metal, Metal generates Water, Water generates Wood, and Wood generates Fire.
With pulse diagnosis, the practitioner has found certain yin meridian deficiencies. He or she typically finds that one, two or three of the yin meridians is deficient, in relationship to each yang partner, which is normal or excess. Place each meridian into its respective Five Phase/Element position. When deficiencies are felt at two phase/elements that are next to each other, the meridian more distal (clockwise) on the Five Phase cycle is the primary pattern.
If we refer back to our example, above, the two adjacent yin channel deficiencies are Spleen and Pericardium. Kidney is also weak, but it is not next to another deficient yin meridian. Spleen belongs to Earth and Pericardium belongs to Fire. On the Five Phase/Element Chart, Fire is the mother of Earth, it precedes it in the clockwise cycle. The more distal phase/element of the two is Earth, and so, the primary Pattern belongs to Earth, namely Spleen. This is a Spleen Pattern.
In Keiraku Chiryo, a Pattern shows itself as a weak meridian who also has a weak mother. The father of the primary meridian, or the father of the mother meridian, will be either weak or excess. But basically, one looks for two adjacent meridians (primary and its mother) that are weak, with the more distal being the primary:
(1) Primary (weak) (2) Mother (weak) (3) Father (weak or excess)
- Lung Spleen Ht/PC or Liver
- Spleen Heart/PC Liver or Kidney
- Liver Kidney Lung or Spleen
- Kidney Lung Spleen or HT/PC
If both Lung and Spleen is weak, it’s a Lung pattern. If both Liver and Kidney are weak, it’s a Liver pattern. If both Kidney and Lung are weak, it’s a Kidney pattern. For the Spleen pattern, either Pericardium or Heart is weak. Pericardium might be quite normal, but a weak Heart position on the left hand, and a weak Spleen on the right hand is still a Spleen pattern. Also, a weak Lung on the right hand with a weak Kidney on the left hand is still a Kidney pattern. In practice, we look for two adjacent positions to be weak, with the more distal (both physically, on the wrist, as well as on the Five Phase chart, clockwise) being the Primary. This is usually felt on one hand (PC-SP, SP-LU, KI-LIV), but can also be across two hands (LU-KI, HT-SP).
Keiraku Chiryo holds that the Fire cannot be a primary pattern, because this denies life. In practice, we rarely find Heart or Pericardium as the primary pattern.
Secondary Imbalance. Once the primary pattern has been treated, the next step is to look carefully at the yang meridians, especially for any excesses. These are then treated with sedation/drainage method. It should be noted that very often, when one treats the yin meridian, certain yang channel excesses disappear. So one examines and treats the yang channel excesses only after needles are in place for the yin deficiency primary pattern.
Point Selection. Classically, from the Neijing, tonification and sedation/drainage points are used to correct deficiencies and excesses of the yin and yang channels. A tonification point is the mother point of the channel. For example, on the Spleen meridian, the mother of Earth is Fire. So, the tonification point for the Spleen channel is the Fire point, SP 2, because Fire is the mother of Earth. Sedation/drainage is done with the son point. For Spleen (Earth), the son is Metal. The Metal point of the Spleen channel is SP 5, and this is then the sedation/drainage point. Tonification is done with tonifying needle technique, while sedation/drainage is done with draining technique.
In practice, a number of points distal to the elbow or knee are used besides classical tonification and sedation/drainage points, including yuan-source, luo-connecting, horary point and experiential points. The xi-cleft point can be used for sedation/drainage. Reinforcement for the primary and its mother can be done with its associated Front-Mu or Back-Shu points and local GV (Du Mai) points.
The Toyo Hari school has developed a technique for proper point selection using the pulse. In this method, one determines the primary deficiency, in our example above, Spleen. One feels the weak Spleen position with one hand while using the other hand to touch various Spleen points to see which one successfully strengthens the Spleen position pulse. One will find the best point, as well as determine if the deficiency is unilateral or bilateral, by checking various Spleen points on each leg.
Various points that can be used for treatment are summed up here:
LEGEND:
= tonification point (mother)
¯ = sedation/drainage point (son)
h = horary point (same phase/element of the meridian)
l = luo-connecting point
y = yuan-source point
x = xi-cleft point
e = experiential point
YIN CHANNELS
Lung
Tonify: Lu 9(, y), 8(h), or 7(l); Lu 1(mu), Bl 13(shu), GV 12
Drain: ¯Lu 5(¯), 6(x), 7(l), 8(h) or 9(y)
PERICARDIUM
Tonify: PC 7(y) or 6(l); CV 17(mu), Bl 14(shu)
Drain: ¯PC 7(¯, y), 6(l), 4(x) or 3(water)
HEART
Tonify: Ht 7(y), 5(l); CV 14(mu), Bl 15(shu), GV 11
Drain: ¯Ht 7(¯,y), 6(x) or 5(l)
SPLEEN
Tonify: Sp 2(), 3(y) or 4(l); Liv 13(mu), Bl 20(shu), GV 6
Drain: ¯Sp 8(x), 5(¯), 4(l), or 3(y)
LIVER
Tonify: Liv 8(), 5(l) or 3(y); Liv 13(mu), Bl 20(shu), GV 6
Drain: ¯Liv 2(¯), 3(y), 5(l) or 6(x)
KIDNEY
Tonify: Ki 3(y), 4(l), 7() or 10(h); GB 25(mu), Bl 23(shu), GV 4
Drain: ¯Ki 10(h), 5(x), 4(l) or 3(y)
2) YANG CHANNELS
LARGE INTESTINE
Tonify: LI 11(), 6(l) or 4(y); St 25(mu), Bl 25(shu)
Drain: ¯LI 2(¯), 4(y), 6(l)
TRIPLE BURNER
Tonify: TB 3(), 4(y) or 5(l) or 6(h); CV 5(mu), Bl 22 (shu)
Drain: ¯TB 10(¯), 7(x), 6(h), 5(l), or 4(y)
SMALL INTESTINE
Tonify: SI 3(), 4(y) or 5(h); CV 4(mu), Bl 27(shu)
Drain: ¯SI 8(¯), 7(l) 6(x) or 5(h)
STOMACH
Tonify: St 42(y), 41(), 40(l), 36(h); CV 12(mu), Bl 21(shu)
Drain: ¯St 45(¯),44(e), 42(y), 40(l), 34(x)
GALLBLADDER
Tonify: GB 43(), 41(h), 40(y), or 37(l); GB 24(mu), Bl 19(shu)
Drain: ¯GB 40(y), 38(¯), 37(l), or 36(x)
URINARY BLADDER
Tonify: Bl 67(), 66(h), 64(y) or 58(l); CV 3(mu), Bl 28(shu)
Drain: ¯Bl 66(h), 65(¯), 64(y), 63(x) or 58(l)
Needle and Moxa Techniques. The root treatment of the primary pattern is done on the distal arm or leg, using a needle technique that is superficial (sometimes with only a 2 mm insertion with the needle flopping on the skin). The needles are thin, with practitioners using either the Japanese #00 Green (Chinese #44; .12 gauge), Japanese #01 Light Green (Chinese #42; .14 gauge), or Japanese #1 Red (Chinese #40; .16 gauge). Fast rotation of the needle is used for tonification with the intention of filling the meridian. Closing the hole with the finger is important to keep qi from escaping when the needle is withdrawn. For sedation/drainage, the intention is to remove or drain excess qi from the channel. In branch treatments, needle insertion may be deeper, especially on the back, thighs, shoulder and hips.
Japanese-style direct moxa is often employed, using tightly pack ½ rice grain size on the point. Some practitioners allow it to burn to the skin, others pinch it off just before a burning sensation is felt. Typically, 3-5 cones are used for yin meridian points and the abdomen, while 5-7 cones are used for yang meridian points and the back.
Point palpation is a highly refined skill in Japanese acupuncture. Points are meant to be found with the fingers, and may be at variance with the anatomical location recommended in the textbooks. The sensitive practitioner will not only find the point, but also the vector, the direction the xue (chimney) takes as it travels towards the meridian. An experienced practitioner can use his fingers to know if the point is excess or deficient, by touch.
Conclusion. This article is an introduction to diagnosis and treatment of the root treatment, the Primary Pattern (sho). In practice, one identifies and corrects the primary imbalance, and then goes on to treat the branch, usually the patient’s main complaint, such as shoulder pain, insomnia, etc. For patients with clear problems and disorders, we recommend one treatment weekly for 4-6 treatments. Once general complaints are under control, you can do the root treatment once monthly as a basic preventative to keep patients healthy. It is a painless and very effective approach to acupuncture.
Recommended reading.
Japanese Classical Acupuncture: Introduction to Meridian Therapy, Shudo Denmai & Stephen Brown, Eastland Press, 1990
Meridian Therapy, Fukushima Koda, The Toyo Hari Medical Association, 1991
The Practice of Japanese Acupuncture and Moxibustion: Classical Principles in Action, Ikeda Masakazu, Edward Obaidey, Eastland Press, 2005
Traditional Japanese Acupuncture: Fundamentals of Meridian Therapy, Society of Traditional Japanese Medicine, Koei Kuwahara, editor; Complimentary Medicine Press, 2003
Jake Paul Fratkin, OMD, L.Ac. trained in Korean and Japanese acupuncture since 1975, and Chinese herbal medicine since 1982. He is the author of Chinese Herbal Patent Medicines, The Clinical Desk Reference, a compendium of 1250 Chinese herbal products available in the United States, and the editor-organizer of Wu and Fischer’s Practical Therapeutics of Traditional Chinese Medicine, Paradigm Publications, 1997. He is the recipient of ACUPUNCTURIST OF THE YEAR, 1999, by the AAAOM and TEACHER OF THE YEAR, 2006, American Association of Teachers of Acupuncture and Oriental Medicine (AATAOM). Dr. Fratkin lives and practices in Boulder, Colorado.