shonishin: japanese pediatric acupuncture a text and video guide

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Birch:Shonishin

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18.1.2011Birch_Titelei

Shonishin:Japanese PediatricAcupuncture

Stephen Birch, PhD

The Stichting (Foundation) for the Study of TraditionalEast AsianMedicine (STEAM)Amsterdam, The NetherlandsAssociate ProfessorOslo University College of AcupunctureOslo, Norway

145 illustrations

ThiemeStuttgart · New York



Birch:Shonishin

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Library of Congress Cataloging-in-Publication Datais available from the publisher.

Illustrators: Christiane von Solodkoff, Neckargemünd,Germany; Rayén Antón, Barcelona, SpainVideos filmed and edited by Rayén Antón,Barcelona, Spain.

© 2011 Georg Thieme Verlag,Rüdigerstrasse 14, 70469 Stuttgart, Germanyhttp://www.thieme.deThieme NewYork, 333 Seventh Avenue,New York, NY 10001, USAhttp://www.thieme.com

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ISBN 978-3-13-150061-8 1 2 3 4 5 6

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Foreword

Traditional East Asian Medicine (TEAM) boasts arich variety of literary genres. The medical dis-course (yi lun醫論), the case record (yi an醫案), andthe modern textbook are just a few of the mostprominent styles of TEAM writing today. StephenBirch’s Shonishin: Japanese Pediatric Acupuncturecertainly qualifies as a textbook, and it is to someextent a medical discourse and a collection of caserecords. But it also belongs to another venerablegenre of the TEAM literature that is still in itsinfancy in theWest. In many ways, this is a “clinicalinsights”memoir.

An entire generation of TEAM practitioners inthe West have now fully matured as master clini-cians. With 30 or more years’ experience in adapt-ing this medicine to practice in the West, this gen-eration has begun sharing their clinical insightswith the rest of us. The present volume is a rich andvery personal expression of this process of trans-mission by an eminent member of this generation.In this, it also represents the full blossoming of sho-nishin’s development and assimilation intoTEAM inthe West. It is ample evidence that we have trulymade thismedicine our own.

Asmuch and perhapsmore than any other speci-alty of TEAM practice, shonishin rewards knack overtheory. It is easy to learn but difficult to trulymaster.Each practitioner must ultimately “get” the tech-nique in his or her hands. A skilled teacher, how-ever, knows how to effectively communicate thatknack to others. Steve brings the sensibilities of aprofessionally trained clinical researcher to the taskof unpacking the shonishin practice with consum-mate skill. This is evident in both his writing and inthe DVD that accompanies the text. The two mediacombine to bring the techniques vividly to life.

Children are remarkably responsive to thera-peutic influence, making them much more proneto overtreatment than their adult counterparts.Though questions of optimal therapeutic dosageare familiar territory for all experienced clinicians,Steve has thought this issue out and articulated itwith an unprecedented depth and clarity. The clini-cal ramifications of his dosing model extend farbeyond pediatrics and into medical practice as awhole, almost regardless of themodality being used.

Nowhere in clinical practice is the demand forfluid adaptability to changing circumstances morepressing than in pediatrics. Steve discusses thisoften unspoken aspect of the therapeutic encounteras the “dance of treatment.” Once again, one’s sen-sitivity to optimum dosing lies at the heart of thematter. It is a dance that embraces moment-to-moment decisions concerning which technique touse, what tool to administer that technique with,precisely how much of that technique to adminis-ter, and with what degree of force. Then too, it is adance largely choreographed by a squirming, some-times squawking partner, and one typically over-seen by a pensive parent hovering in thewings.

The themes of therapeutic dose and the fluiddance of treatment run throughout the text. A briefglance at the table of contents reveals the compre-hensive discussions of pediatric needling tech-niques, and expositions on individual diseases ac-companied by prescriptive treatment strategiesrequisite for a textbook on a pediatric specialty.

But the entire book is constructed around caseexamples. Many of these are from Steve’s own prac-tice illustrating his personal approach to both thetopic at hand, and its relationship to the dose andthe dance. Many other case records are those of col-leagues, illustrating a variety of creative approachesto treatment. It is a technique that is best trans-mitted within the context of specific examples asopposed to theoretical abstractions, though bothare necessary for a full understanding

In some ways, shonishin isn’t much to look at. Itis an unassuming technique that can easily leaveone wondering how a bit of stroking, a little tap-ping, and perhaps even a touch of tickling couldhave any real therapeutic value. Yet experiencedshonishin practitioners know how almost miracu-lously effective it can be. It can work where biome-dical, naturopathic, and other TEAM modalitieshave fallen short and it combines easily with all ofthem. In this book, Steve has shown us what apotent tool of efficacy and a thing of beauty the sho-nishin dance can be.

Charles ChaceBoulder, Colorado

Preface

I have been treating patients with acupuncture foralmost 30 years. I first applied treatment to chil-dren over 25 years ago. My practice, since finishingacupuncture school, has been to use Japanese acu-puncture and moxibustion methods exclusively. Ihave studied in Japan numerous times, mostly withpractitioners who have more than 40 years ofexperience (some with 55 to 60 years of experi-ence) and oftenwith practitioners who have exten-sive experience treating babies and children. In thisbook I have tried to pull together these experiencesand the insights and genius ofmy teachers. It repre-sents the accumulation of many practical experi-ences and treatment ideas. I hope I have done theselineages justice.

Over the years I have taught and come acrossmany acupuncturists who hardly if ever treatbabies and children. Sometimes this is because ofthe interests or focus of the practitioner, they spe-cialize in fertility or pain, for example; but moreoften it is because acupuncture treatment of chil-dren, and especially babies, is too scary. Many acu-puncturists are not exposed to such treatment inschool, never developing the confidence to try.Many are afraid that what they have learned is notsuitable for the treatment of babies and children.The child is suffering enough, how can we causemore suffering with our needles? This is a greatpity. We sometimes see very inspiring results whenwe treat children, especially the younger child. It isas though the potential for acupuncture is morestrongly expressed in treatment of children com-pared to treatment of adults. Sometimes the resultswhen we treat children are completely amazing,even shocking. The child who has been diagnosedwith a genetic anomaly and is unable to digest foodproperly suddenly starts digesting food followingtreatment; the child with a cardiac disorder whohas been so tired that she has not been able to playlike other children is suddenly running around tire-lessly after the first treatment! What is going on?How can this be? Why don’t more practitioners trytreating children? The answers to these questionslie in how we approach the child and what wethink acupuncture is supposed to be.

Many acupuncturists are afraid of treating chil-dren because they are afraid of using on childrenthe needling techniques they have learned inschool. I know I was, and most people I have talkedto have expressed the same fears and concerns. Ifeel that this is because most people have beentrained in only themodern Chinese needlingmeth-ods, which use relatively thick inserted needlesthat are manipulated until the sensations called‘de-qi’ are obtained. It seems most acupuncturiststhink that this is acupuncture. While it seems to bethe more commonly found form today, it is by nomeans the only form of acupuncture. Many styles ofacupuncture have developed over the centuries,and, for various reasons, relatively gentle techni-ques have developed in Japan. Recognizing the sen-sitivities and needs of babies and children, a specia-lized style of acupuncture for treatment of childrencalled shonishin developed in Japan over 300 yearsago. This not only survived but, in the second half ofthe twentieth century has flourished in Japan. Thisstyle applies various surface stimulation methodsusing specialized treatment tools. Inserted need-ling is not always needed and often is unnecessary.It is neither painful nor scary. Practitioners whohave learned it, patients who have received it, andparents who have observed and experienced it nolonger feel afraid of the idea of acupuncture for chil-dren.

Another issue that makes it difficult for manyacupuncturists to treat children lies in the beliefthat the kind of acupuncture treatment that theyuse on adults can be adapted simply by modifyingthe techniques to some degree (make them softer)but that the same theoretical basis of diagnosis andtreatment can be used as with adults. I feel that thisis an unreasonable assumption. There is not a lot ofpublished literature in European languages aboutdifferences between children and adults based ontraditional East Asian medical (TEAM) literature.The historical TEAM literature is not so detailedeither; instead we have hints about what those dif-ferences may be. Of course the basic physiologymust be the same or very similar; children breathe,eat, drink, digest, excrete, sleep, move, etc. with the



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same organs that adults use. They require the samebasic functional systems in order to do these things.But there are some fundamental differences abouthow things occur, the rate and quality of changesthat make children fundamentally different frommost adults when it comes to how they respond totreatment and thus how treatment can be applied.

By focusing on those differences and highlight-ing the characteristics of children, namely that theyare very sensitive and thus can be influenced byvery little input (the “less is more”model), it is pos-sible to develop a practical approach to the treat-ment of children that is much less theoreticallycomplex. In this book I have tried to explain andhighlight these issues to show how, regardless ofhow complex a model or pattern another systemmight construe for a pediatric patient, especiallyonewith complex problems, we can find adaptable,practical solutions with a simpler model of prac-tice. This is key to understanding the treatmentapproach for babies and children.

For a number of years I have wanted to write apractical book about the treatment of childrenusing the unique treatment approaches from Japancalled shonishin. I kept delaying, in part because ofbeing busy and in part because I was not quiteready; I needed time toworkout a strategy formak-ing the book both practical and realistic. This textand its accompanying DVD are the product of thosedesires, plans, and strategies. I also resisted writinga shonishin book before because I did not want towrite the same type of book that is often found inthe field. Many books focus on telling the readerwhat points to treat for which symptoms or pat-terns. Once the correct points have been selected,then everything is supposed to right itself, so wealmost never find descriptions in these books ofwhat to do if it doesn’t work. I find this approachrather unhelpful, even when such books are basedon a traditional system of diagnosis and matchedtreatments. I find many of these books so theoreti-cally driven that they are not typically rooted inclinical practice and are not structured to help thereader easily adapt to changing circumstances, inef-fective chosen treatments or matching to the indi-viduality of each patient. I wanted to avoid fallinginto the same trap with the book I wanted to write.I have also been concerned that too many practi-tioners think they can learn practical skills justfrom reading books. I know from my own experi-ence that this is not realistic. Imagine learning to

play the piano from reading books! Thinking aboutthese problems I was delighted to find that my col-league Rayén Antón had worked in the media offilm and editing before, so I found I was able to startthis project with the plan that we could at least letpeople look at what is to be done, which is defi-nitely better than simply reading about it. I believethe old adage “a picture is worth a thousandwords”starts to cover this idea. Working with Rayén I havebeen able to complete this project. We both hopethat the format and content of this text and DVDwill sidestep the limitations I have worried about,will help to get more practitioners started in thetreatment of babies and children, and will enhancethe effectiveness of thosewho already treat them.

The first section deals with the origins and nat-ure of the shonishin approach. It explores the ori-gins of its approaches in the historical early Chineseliterature and shows how these were adapted andadopted into Japanese traditional medicine severalcenturies ago.

The second section explores the nature of thephysiological and treatment response differencesof children with most adult patients. Principally itfocuses on their innate increased sensitivity andthe clinical implications of this in terms of dose andregulating the dose of treatment. It also describeshow one can practically grasp and attend to thesedifferences and, through palpatory feedback, con-tinuously adapt treatment as it is being given toensure proper clinical applications. It also describesthe various treatment tools. Here I have focused onshowcasing my private collection of shonishin toolsorganized along traditional ideas of treatmentmethod.

The third section describes two basic forms ofapplying “root treatment” (Chinese “zhibenfa”), theprinciple purpose of which is to strengthen thebody’s natural healing abilities by helping regulatephysiology. The first of these is the “non-pattern-based root treatment” system which is the core ofthe shonishin treatment method. This method,regardless of the child’s symptoms and any “tradi-tional patterns” of diagnosis, applies light stimula-tion in set patterns to the body surface using thetools described in the previous section. Thisapproach targets an improvement of the vitalityand mood of the child and through this a strength-ening of the natural healing abilities. The secondroot treatment system is the “pattern-based roottreatment” approach, a simplified form of tradi-



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tional Japanese acupuncture called Keiraku Chiryoor Meridian Therapy. First I outline the use of thisapproach on adults and then its diagnostic andtreatment modifications for children. This methodfocuses on regulating the jingluo (Japanese “keir-aku”) or channels while at the same time strength-ening the child’s vitality and natural healing ability.In actual clinical treatment, one can use only theMeridian Therapy root treatment approach, onlythe “non-pattern-based” shonishin treatment ap-proach, or a combination of these two. It is also pos-sible to teach the parent to do a simplified form ofthe core shonishin non-pattern-based treatment athome regularly. This is also described in this sectionand can greatly enhance treatment effects andspeed up recovery time.

The fourth section describes symptomatic treat-ment approaches, the use of normal acupuncturetreatment methods strictly adapted to the uniqueneeds of children. This covers adapted forms ofneedling, moxa, retained dermal stimulation meth-ods such as press-spheres, press-tack needles andintra-dermal needles, cupping and bloodletting.Point locations are also covered as needed both forthe main root and extra symptomatic treatmentpoints.

The fifth and final section of the book describeshow to use all of the diagnostic skills and methodsand treatment methods carefully selected in adap-table and evolving treatments for a number of dif-ferent health problems. Most importantly I wantedthis to be practical, thus many case histories aredescribed. I received help from colleagues around

theworldwho sentme some of their most inspiringcases. For each condition I give clinical example(s) ofhow the systems are used and a range of treatmentideas and suggestions for each condition, withdetails of how to select between them and what todo if they are not working. In this section I alsodescribe treatment of underlying issues as well asspecific symptoms. For example, there is a chapteron constitutional diagnosis and treatment, which isimportant when dealing with children with severeand complex health problems. Similarly there is achapter on strengthening the vitality, which is theprinciple reason for applying a “root” treatment tobegin with. But in some children, one can onlyfocus on treating to improve the vitality so as tostrengthen the natural healing ability, for exampleprior to surgery, so as to improve recovery after-ward.

Nothing works on everyone. No system of treat-ment is ever fool proof. No single individual practi-tioner is free of limitations. We must start withthese axiomatic truths to build a practical, adapta-ble, and responsive system of treatment. It hasbeen my hope and intention in the writing of thisbook to keep these limits in mind while laying outstrategies that allow the reader to develop a practi-cal system that they canmakework for them. I haveplaced a practical palpatory based understandingof qi at the heart of the treatment approach, whichis natural given my teachers and training in Japan. Ihope you find the book useful and stimulating.

Stephen Birch



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Acknowledgements

As always, writing a book is not possible withoutthe help and support of others. First, thanks to myfamily and friends for their support and under-standing.

Second, this project is as good as it is because ofthe work and talents of my colleague and friendRayén Antón who helped me with the structure ofthe project, all illustrations and video work. Herassistance and collaboration have been invaluable. Ifeel fortunate to haveworkedwith her and look for-ward to future projects.

Third, thank you goes to a number of other peo-ple: Junko Ida for helping me with translations ofthe Japanesematerials that provide the backgroundfor the materials organized and presented in thebook; Josephine Haworth for help with editing ofthe text; my editor Angelika Findgott for her sup-port and encouragement of the project, and herteam at Thieme Publishers for their care and assis-tance; my colleagues Brenda Loew and Paul Mov-sessian, for their support and encouragement of theproject, and Manuel Rodriguez for giving an extrahand; thanks to Michael Blanz of mb Film & Videoand David Ferrando Navarro of Xochipilli Produc-ciónes for their technical help with the video mate-rials; to David Ferrando Navarro also for photogra-phy; to my teachers who helped me improve anddeepen my skills, in particular Yoshio Manaka,Toshio Yanagishita, Akihiro Takai, Shuho Taniuchi,Koryo Nakada; to a number of colleagues listedhere alphabetically who agreed to send me their

cases to be included in the book: Rayén Antón(Spain), Mourad Bihman (Germany), Joke Bik-Nowee (Holland), Zoe Brenner (US), Marian Fixler(UK), Brenda Loew (US), Paul Movsessian (Austra-lia), Diana Pinheiro (Portugal), Sue Pready (UK),Manuel Rodriguez (Spain)—their contributions addmuch to the book; to Hitoshi Yamashitawho helpedtrack down pictures in Japan, and to the HarikyuMuseum, Osaka for permission to use these pic-tures; to Sayo Igaya for help tracking down histori-cal information about kanmushisho; to WolfgangWaldmann and the European Institute of OrientalMedicine, Munich for permission to videotape myworkshop there in November 2008; to StefanMaegli of Liestal, Switzerland and HamidMontakabof the Academy of Chinese Healing Arts, Win-terthur, Switzerland for permission to videotapemy workshop there in February 2009; to the var-ious children, parents, and students who partici-pated in the workshops at these acupunctureschools, especially those who appear in the video;to Elias and his mother Hetty for agreeing to star inthe video; to the original practitioners of shonishinin Japan several centuries ago who created thiswonderful system; and finally to my patients forteaching me about healing and to their parents forhelping with the treatments.

Finally, I dedicate this book to my son Nigel, forliving this with me, and to mymother for making itall possible.



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Contents

Section 1 Overview and History

1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

2 History and Theory . . . . . . . . . . . . . . . . . . . . . . . 6Kanmushisho (疳虫証) orKannomushisho (疳の虫証) . . . . . . . . . . . . . . . . 11ShonishinToday . . . . . . . . . . . . . . . . . . . . . . . . . . 12

Section 2 Treatment Principles and Tools ofTreatment

3 General Considerations in the Treatment ofChildren . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17

4 AModel for Judging the Dosage Needs ofPatients . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19The Therapeutic Dose—AConceptual Model . 19The Sensitive Patient . . . . . . . . . . . . . . . . . . . . . . 20Explanations of Increased Sensitivity . . . . . . . . 21

5 Assessing Changes, Recognizing andCorrecting Problems of Overdose . . . . . . . . . 24Reactions to Over-treatment . . . . . . . . . . . . . . . 24Modifying Treatment Methods to Regulatethe Dose of Treatment and Deliver TreatmentSuccessfully . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27Final Thoughts on the Issue of Regulating theDose of Treatment . . . . . . . . . . . . . . . . . . . . . . . . 28

6 Basic ShonishinTreatment Tools . . . . . . . . . . . 29Tools Used for Tapping . . . . . . . . . . . . . . . . . . . . 29Tools Used for Stroking/Rubbing . . . . . . . . . . . 32Tools Used for Pressing . . . . . . . . . . . . . . . . . . . . 35Tools Used for Scratching . . . . . . . . . . . . . . . . . . 35Needle Sets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39Most Recommended Tools . . . . . . . . . . . . . . . . . 41Care of the Tools . . . . . . . . . . . . . . . . . . . . . . . . . 41Disposable Tools . . . . . . . . . . . . . . . . . . . . . . . . . 41Treatment Applications . . . . . . . . . . . . . . . . . . . 42Monitoring and Assessing Treatment Effects . 42

Section 3 Root Treatment Approaches andTechniques

7 The Core TreatmentModel . . . . . . . . . . . . . . . 45Precautions and Contraindications of the CoreNon-pattern-based Root Treatment . . . . . . . . . 45Techniques for Basic Treatment . . . . . . . . . . . . 46Preferences, Styles, and Approaches . . . . . . . . 50

8 Home Treatment and Parental Participation 52Goals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52Precautions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53The Basic Method . . . . . . . . . . . . . . . . . . . . . . . . . 53

9 Pattern-based Root Treatment:MeridianTherapy Applied to Adults . . . . . . . 55Basic Theories of MeridianTherapy . . . . . . . . . . 55MeridianTherapy Treatment Principles . . . . . . 57MeridianTherapy Diagnostic Methods andPatterns . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57MeridianTherapy Treatment and TreatmentTechniques . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58

10 Pattern-based Root Treatment:MeridianTherapy Applied to Children . . . . . 61Diagnosis to Select the Primary Pattern inChildren . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61Diagnosis to Select Additional Steps of RootTreatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62Modifying Point Selection for Treatment ofthe Primary Patterns . . . . . . . . . . . . . . . . . . . . . . 62TreatmentMethods in MeridianTherapy . . . . . 63Treatment Technique with Spring-loadedTeishin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64Point Location of MainTreatment Points . . . . . 65Five Phase Correspondences and ClinicalPractice . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66Assessing Treatment Effectiveness . . . . . . . . . . 67



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Section 4 Symptomatic Treatment Approachesand Techniques

11 Needling . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71Needle Types . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71Needle Sensations and Timing of the Needling 72Needle Insertion . . . . . . . . . . . . . . . . . . . . . . . . . . 74

12 Dermal Needles and Associated Techniques 76Ryu—Press-spheres, Empishin—Press-tackNeedles, and Hinaishin—Intra-dermalNeedles . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 76Selecting between Use of Intra-dermalNeedles, Press-tack Needles, andPress-spheres . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77Precautions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77Application of Press-spheres, Press-tackNeedles, and Intra-dermal Needles . . . . . . . . . . 79

13 Moxa:Okyu (DirectMoxa) and Chinetsukyu(WarmMoxa) . . . . . . . . . . . . . . . . . . . . . . . . . . . 80Okyu—The Physiology of Direct Moxa . . . . . . . 81Chinetsukyu—WarmMoxa . . . . . . . . . . . . . . . . . 83

14 Kyukaku—Cupping . . . . . . . . . . . . . . . . . . . . . . . 84

15 Shiraku—Bloodletting (Jing Points andVascular Spiders) . . . . . . . . . . . . . . . . . . . . . . . . 85Jing Point Bloodletting . . . . . . . . . . . . . . . . . . . . . 85Vascular Spider Bloodletting . . . . . . . . . . . . . . . 86

16 Point Location—Location of Extra Points forSymptomatic Treatment . . . . . . . . . . . . . . . . . 88Josen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 88Uranaitei . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 88Shitsumin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 88Asthma Shu Point . . . . . . . . . . . . . . . . . . . . . . . . . 88“Stop Coughing” Point . . . . . . . . . . . . . . . . . . . . 89Lateral Pigen Point . . . . . . . . . . . . . . . . . . . . . . . . 89Moving LR-1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89

Section 5 Treatment of Specific Problems/Diseases

17 Introduction to the Treatment of SpecificProblems/Diseases . . . . . . . . . . . . . . . . . . . . . . 93How to Use these Treatment Chapters . . . . . . 95Putting Your Treatment Together into aSystem . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95Sources Used in the TreatmentChapters of this Book . . . . . . . . . . . . . . . . . . . . . 99

18 Respiratory Problems . . . . . . . . . . . . . . . . . . . 101Asthma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 101Additional Respiratory Conditions . . . . . . . . . 113

19 Skin Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . 115Eczema . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 115Atopic Dermatitis . . . . . . . . . . . . . . . . . . . . . . . . 127Urticaria . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 131

20 Digestive Problems . . . . . . . . . . . . . . . . . . . . . 134Constipation . . . . . . . . . . . . . . . . . . . . . . . . . . . . 134Diarrhea . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 139Abdominal Pain . . . . . . . . . . . . . . . . . . . . . . . . . 143Stomach Problems . . . . . . . . . . . . . . . . . . . . . . . 146Additional Digestive Problems . . . . . . . . . . . . 151

21 Behavioral, Emotional, or Sleep Problems 153Kanmushisho—the Cranky Child . . . . . . . . . . . 153Stress . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 162Further Emotional/BehavioralProblems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 163

22 Urinary Disturbances . . . . . . . . . . . . . . . . . . . 164General Approach for Patients with UrinaryProblems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 168Most Likely Pattern-based Root Diagnosis . . . 168Typical Non-pattern-based Root Treatment . 169Recommendations for SymptomaticTreatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 169Integrating the Pattern-based and CoreNon-pattern-based Root Treatments withNeedling andMoxa SymptomaticTreatments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 170Other Considerations . . . . . . . . . . . . . . . . . . . . 172Further Case Histories . . . . . . . . . . . . . . . . . . . . 172

23 Ear and Nose Problems . . . . . . . . . . . . . . . . . . 177Otitis Media—Ear Infections . . . . . . . . . . . . . . . 177Nasal Congestion . . . . . . . . . . . . . . . . . . . . . . . . 183Sinusitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 188

24 Developmental Problems . . . . . . . . . . . . . . . 190General Approach for the Treatment ofChildren with Developmental Problems . . . . 191Most Likely Pattern-based Root Diagnosis . . . 191Typical Non-pattern-based Root Treatment . 192Recommendations for SymptomaticTreatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 192Other Considerations . . . . . . . . . . . . . . . . . . . . 193Further Case Histories . . . . . . . . . . . . . . . . . . . . 193



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25 Weak Constitution . . . . . . . . . . . . . . . . . . . . . 203The LungWeak Constitution Patient . . . . . . . 204The SpleenWeak Constitution Patient . . . . . . 204The KidneyWeak Constitution Patient . . . . . 204The LiverWeak Constitution Patient . . . . . . . 204General Approach for Patients withWeakConstitution . . . . . . . . . . . . . . . . . . . . . . . . . . . . 205Goals of Treatment . . . . . . . . . . . . . . . . . . . . . . 206Root Treatment for the LungWeakConstitutionType . . . . . . . . . . . . . . . . . . . . . . . . 206Root Treatment for the SpleenWeakConstitutionType . . . . . . . . . . . . . . . . . . . . . . . . 207Root Treatment for the KidneyWeakConstitutionType . . . . . . . . . . . . . . . . . . . . . . . . 207Root Treatment for the LiverWeakConstitutionType . . . . . . . . . . . . . . . . . . . . . . . . 208Further Case Histories . . . . . . . . . . . . . . . . . . . . 209

26 Recurrent Infections . . . . . . . . . . . . . . . . . . . . 218Recurrent Respiratory Tract Infections . . . . . . 218Candida Albicans Infection . . . . . . . . . . . . . . . . 227

27 Improving Vitality . . . . . . . . . . . . . . . . . . . . . . 230Goals of Treatment in Complicated Cases . . . 234General Approach to Improve Vitality . . . . . . 234Typical Non-pattern-based RootTreatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 235Other Supportive Treatments . . . . . . . . . . . . . 235Other Considerations . . . . . . . . . . . . . . . . . . . . 235Further Case History . . . . . . . . . . . . . . . . . . . . . 236

28 Recommendations for Treatment of Otherand Less Commonly Seen Problems . . . . . . 238The Child with Fever . . . . . . . . . . . . . . . . . . . . . 238Teething Problems . . . . . . . . . . . . . . . . . . . . . . 240Infectious Diseases . . . . . . . . . . . . . . . . . . . . . . 240Tonsillitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 241Mumps . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 241Nervous Conditions . . . . . . . . . . . . . . . . . . . . . . 242Neurological Conditions . . . . . . . . . . . . . . . . . . 242Kidney Diseases . . . . . . . . . . . . . . . . . . . . . . . . . 244Postnatal Lethargy with Lack ofSucking Reflex . . . . . . . . . . . . . . . . . . . . . . . . . . 244Surgical Conditions . . . . . . . . . . . . . . . . . . . . . . 245

29 Combining TreatmentMethods . . . . . . . . . . 246

Appendix . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 251

Glossary of ShonishinTerminology . . . . . . . . . . . 252

Additional Information . . . . . . . . . . . . . . . . . . . . . 254Treatment Equipment . . . . . . . . . . . . . . . . . . . . 254Educational . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 254

Bibliography . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 255

Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 257



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Section 1 Overview and History

1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

2 History and Theory . . . . . . . . . . . . . . . . . . . . . . . 6



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1 Introduction

The term “shonishin” (小兒鍼) is a Japanese render-ing of the older Chinese term “erzhen” (兒鍼). It lit-erally means “children’s needle” or “children’sneedling.” Acupuncture has been used for a longtime on both adults and children, hencewe find theterm erzhen in the early Chinese literature. How-ever, today, the Japanese term shonishin refers to atradition that dates from the 17th century. Whilethere is speculation about its precise origins and itsdevelopment, its more widespread use appears tohave started in the late 20th century in Japan. Anumber of practitioners such as Yoneyama andMori,who wrote a text entitled Shonishin Ho—Acupunc-ture Treatment for Children (1964), and Shimizu,who wrote an extended section on shonishin in awell-known Japanese acupuncture journal, Ido noNippon (Journal of Japanese Acupuncture and Moxi-bustion) (1975), helped set the stage for a morewidespread adoption of this method within theacupuncture community in Japan. This was furtherreinforced by the publication of articles about sho-nishin, pediatric acupuncture, by various otherauthors. Today, many acupuncturists treating chil-dren use these or variations of them in Japan. Thesemethods started spreading outside Japan to theWest by the 1980s, where further modificationsbegan to appear.

I have used these methods in the treatment ofchildren since 1982 and have played a role in intro-ducing these methods in different regions in theUnited States, Europe, and Australasia over the last15 years. This book is a culmination of having usedand adapted these methods to a modern Western-based acupuncture practice over the past 25 yearsor so. While the book is primarily a practical guideon how to use these methods in the treatment ofchildren, it also briefly covers the history of andtheoretical justifications for thesemethods.

In the West, the common styles of acupunctureare Chinese and Western anatomically based. Bothstyles consider acupuncture to involve only the useof inserted needles. I have found that since themethods of shonishin often do not involve the useof inserted needles, it is conceptually foreign to theacupuncturist trained in both Chinese andWestern

styles, thus, it is not yet well known among the acu-puncture community in theWest. I have also foundthat many acupuncturists in the West are afraid totreat babies and small children because they haveto insert needles, which makes pediatric acupunc-ture less popular overall than it could be. This is apity, because it is very effective, and children gener-ally respondmore quickly to treatment than adults.After teaching shonishin to acupuncturists in theWest, especially in Europe, I have found that it oftenhas a transformative effect on how those acupunc-turists practice. Many feel able for the first time totreat babies and children, where before they hadbeen afraid to. Sometimes remarkable results canbe seen. In the United Kingdom, there is a saying,“the proof of the pudding is in the eating.” Knowingthat the reader will not take this at face value with-out evidence, I have consulted a number of collea-gues around Europe and in the United States andAustralasia to ask them to submit their cases. Theevidence will speak for itself. It is hoped that afterreading this book, and watching the enclosed DVDto grasp the methods properly, readers will try theshonishin method themselves and so understandthe power of the system.

What is important is that the treatment works,andworkswell and quickly inmany cases. Practical,reproducible methods are the focus of this book.The accompanying DVD helps make the materialscovered more practical and reproducible. A moredetailed description of conceptual and theoreticalexplanations will have to wait until a later time.This is a pragmatic system with minimal theoryneeded to practice it. The reader is encouraged tothink about how the treatment works after practi-cing it for a while and seeing the often surprisingresults.

The historical, theoretical, and associated diag-nostic sections are consequently relatively simple,short, and easy to understand. The bulk of the textis more practically oriented. It includes discus-sions on how to work with children, how to mo-dify what one usually does as an acupuncturepractitioner in order to treat babies and children,how to use the unique methods that arose in the



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shonishin tradition, and how to combine all ofthese tomatch the needs of each individual patient.

This book will not take a typical textbook focusby describing which points and techniques aregood for which diseases or symptoms; rather, itwill, through varied case histories, illustrate how touse the tools and methods described within to helpdifferent patients. These cases are mostly from myexperience, but a number come from colleaguesaround the world who have been using the sho-nishinmethods for their pediatric patients. In orderto successfully treat infants and children, we haveall found that it is necessary to be very flexible andadaptable. The manner of presenting this materialhas been selected in order to illustrate and encou-rage that flexibility and adaptability.

The basic shonishin treatment method takes avery practical approach to treating babies and chil-dren, using a basic treatment methodology thatdoes not require differential diagnosis according totraditional principles andmethods. It does not haveto differentiate the types of patterns that are foundin, for example, Traditional Chinese Medicine(TCM) acupuncture using the language of qi, zangfu, channels, and so on. The characteristic treat-ment of shonishin is a “non-pattern-based roottreatment.” It is a simple, easy-to-apply generaltreatment on the surface of the body that is used forall babies and small children and many older chil-dren. This general treatment helps restore and sti-mulate the body’s natural healing mechanisms,which is the goal of a “root treatment.”

When treating adult patients, I mostly use theJapanese system of “Keiraku Chiryo” or “MeridianTherapy” (Shudo 1990), especially the “Toyohari”approach (Fukushima 1991) and the methods ofManaka (Manaka, Itaya, and Birch 1995) along withmiscellaneous Japanese methods (see Birch and Ida1998). When treating children and babies it is hardto put all this information aside. Rather, it is naturalto integrate aspects of these approaches along withthe shonishin approach. For almost 20 years I haveroutinely combined selected aspects of these treat-ment approaches with the shonishin methods totreat babies and children. In particular, I combine asimplified form of Meridian Therapy and Japaneseacupuncture methods along with the shonishinmethods. This allows the application of a simpleform of “pattern-based root treatment” accordingto the principles of Meridian Therapy and the addi-tion of an expanded range of treatment methods to

target symptoms. Thus, this book will cover suffi-cient information to describe how to use theseadditional approaches and give examples of theintegrated approach that I use.

The reader will naturally seek to integrate thenew shonishin treatment system into his or herpractice, using at least some of the ideas and meth-ods that have been learnt on adults. Therefore, it isimportant to show how to do this. However, I donot use the common styles of acupuncture found inthe West, such as some forms of Chinese needlingor some forms of theWestern anatomical approach,and so cannot illustrate specifically and throughexperience how to integrate shonishin with thesemethods. But, having taught many acupuncturistswho primarily practice these styles (Fig.1.1), it ismy experience that by illustrating the principles oftreatment of children and babies and giving exam-ples of how to integrate adapted forms of my usual(adult) acupuncture methods with the shonishinmethods, this will be a useful guide for others onhow to integrate their methods of acupuncturewith shonishin.

Since there are a number of other texts availableon pediatric treatments within the field of Tradi-tional East Asian Medicine (TEAM), which describethe standard information on normal development,growth, and physiology of children, I will not repeatthis information here; rather, the reader is recom-mended to consult a text detailing that standardinformation (in English, see Scott and Barlow 1999;in Spanish, see Rodriguez 2008). There are alsomany acupuncture books describing point loca-tions, pathways of the jing mai (channels), func-tions and so on of the zang fu or organs. I will alsonot repeat those things here. If the reader would



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4 Section 1 Overview and History

Fig.1.1 Treating Pim in class.

like to consult an appropriate text for this basic acu-puncture information, many can be found such asErgil and Ergil (2009) Pocket Atlas of Chinese Medi-cine and Hempen and Wortman Chow (2006)Pocket Atlas of Acupuncture, both also published byThieme. For the most part, the system of shonishinis very practical and not very theoretical and so it isnot necessary to use so much of the available infor-mation in other texts. The history and diversity ofacupuncture practices dictates that we need to beflexible. Acupoints, for example, are not fixed ana-

tomical structures; they are instead related tomovement of qi in the body,1 which means thatthey are found more within a small region ratherthan at a fixed point. Further, the different tradi-tions of practice have located many acupoints indifferent locations (Birch and Felt 1999). For thereader unfamiliar with Japanese traditions of acu-puncture practice, some of the point locations inthis book will, however, be new. Where appropri-ate, point locations will be described.



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1 This is discussed by Sivin (1987: 51), Lo (2003: 31), Lu andNeedham (1980: 14), and Birch (in preparation [a]).

2 History and Theory

Shonishin for babies and very small children doesnot use regular acupuncture needles; rather, it usesa variety of tools that are tapped, rubbed, or pressedonto the body surface as a kind of very gentle non-invasive treatment approach. Figure 2.1 shows anumber of typical tools used today and Fig.2.2shows photographs of tools in Hidetaro Mori’s his-torical collection.

One can see that tools other than needles areused; they are not inserted into the skin and thusnot into acupuncture points, and in fact many toolsare applied over areas of the surface of the bodyrather than targeted to acupuncture points. Figure2.3 shows a typical illustration of areas of the backthat are stimulated. So what is the history of thismethod and what are the precedents for such ideasandmethods?

It is believed that shonishin began as a medicalfamily treatment method in the Osaka area around350 years ago. It takes little imagination to under-



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a

b

c

Fig.2.1a–c Examples of modern treatment tools.

Fig.2.2 Collection of modern and historical tools fromHidetaro Mori’s collection at the Harikyu Museum, Osaka(courtesy of Mori H, Nagano H. Harikyu Museum. Museum ofTraditional Medicine Vol.2, Morinomiya Iryougakuen Publish-ing; 2003; special thanks to the editor Ms. Oda and toHitoshi Yamashita for his assistance).

stand that the practitioners of that time wouldhave had the same or greater problems than wehave today, trying to insert needles into emotional,frightened, unhappy, resistant, and restless,movingchildren. Why do I say greater problems? Becauseneedle technology was not at all as it is today, andthe needles available in the 1600s were signifi-cantly thicker and had a rougher surface than whatis available now. Nobody enjoys treating childrenwhen they are crying, screaming, resisting, andfighting with you. Thus, it is easy to understandwhy the developers of shonishin would have beenkeen to look for a different approach, so that theycould treat children more comfortably, and thechild would remain calmer and parents lessstressed. The motivations for developing the sys-tem are, I think, quite clear.

Given this kind of motivation it is still necessaryto understand how this approach developed bybriefly discussing historical trends within the lar-ger context of Traditional East Asian Medicine, orTEAM for short. The term “TEAM” refers to all thosetherapies and approaches that arose in East Asiaand were strongly influenced by the early Chinesemedicine qi-based theory of systematic correspon-dence. It thus includes diverse practices such asherbal medicine, acupuncture, moxibustion, cup-ping, bloodletting, and massage (Birch and Felt1999). TEAM started in China, and evolved thereinto many different strands and approaches. After

spreading to neighboring countries such as Japan,Korea, and Vietnam, adaptations and new interpre-tations emerged from those countries. Today TEAMembraces themultitude of practice styles and treat-ment approaches that can be found throughoutChina, Taiwan, Japan, Korea, and their offshootsoutside Asia, such as in Europe, the United States,and Australasia (Birch and Felt 1999). The com-monly used system of Traditional ChineseMedicineor TCM is a subset of the larger field of TEAM, repre-senting a unique and broad inclusion and combina-tion of historical andmodernmethods and ideas.

Historically in Japan, medical texts were writtenin Chinese, thus literate medical practitioners inJapan read Chinese source texts in order to getinformation about medical practice. At the timethat shonishin was developed (17th century) therewere many texts and traditions of medical practiceavailable to a literate practitioner. The first specia-lized pediatric texts in China and thus in Japanwere, however, exclusively herbal medicine texts(Gu 1989). Given the fear that can be encounteredusing acupuncture on children, it is not surprisingthat the trend in China might be toward using her-bal medicines rather than acupuncture in pedia-trics. This does not mean that acupuncture, moxi-bustion, massage and so on were not also used, butthe dominant trend in Chinese pediatric treat-ments has been herbal medicine. The evidence forthis is in many modern TCM texts on pediatrics



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Tapping

Stroking

Fig.2.3 The basic treatment map from Yoneyama and Mori (1964). Apply tapping techniques where there are dots andstroking techniques where there are arrows.

(Cao, Su, and Cao 1990). We can imagine that thosewho developed shonishin were not much influ-enced by these texts: but why?

Before the 6th century, Japan was isolated andhad little knowledge of China. After embracing Chi-nese ways, the Japanese of the day began a whole-sale import of everything Chinese. The first medicaltexts were brought to Japan in 562CE by Chiso (orZhi Cong in Chinese), a Korean Buddhist monk(Birch and Felt 1999). At the time of this firstappearance, Japanese practitioners were content tostudy and copy what these older Chinese traditionscould teach them. Since the first medical texts fromChina were, by and large, acupuncture related orherbal medicine related (rather than a combinationof both, which could also be found from early Chi-nese medical traditions), we think the Japanese atthat time started imitating this older tradition.From early on, acupuncture and moxibustion werelearned and taught separately from herbal medi-cine (which one can say is a kind of homage to theancients, who for the most part worked the sameway). The first Imperial Colleges established in702CE taught acupuncture and herbal medicineseparately in 7-year programs (Birch and Felt 1999,p.23). This tendency became a kind of trend andtradition.

Most acupuncturists in Japan have not workedwith herbal medicine much if at all, and vice versa.While there were sections in earlier Chinese textsdealing with pediatric care such as Sun Simiao’s BeiJi Qian Jin Yao Fang (Thousand Golden Essential Pre-scriptions) (circa 652CE), the first text devoted topediatric treatment was the herbal text Lu CongJing (The Fontanel Classic) of the mid-10th century(Gu 1989). Additionally, the primary pediatric textswere dominantly herbal medicine texts, includingthe important and very influential Xiao Er YaoZheng Zhi Jue (The Correct Execution of PediatricMedicinals and Patterns) of 1107 (Gu 1989). Giventhese facts, it is highly probable that the literaturespecializing in pediatrics from China would haveprovided no assistance to those who developed theshonishin system. Not only because its treatmentmethods were inaccessible, but the diagnosticmethods and the theories of physiology and pathol-ogy needed for safe and effective herbal prescrip-tion would likely have had little utility as well. Forexample, tongue diagnosis developed within thedomain of herbal medicine practices, and to thisday, many acupuncturists in Japan do not use ton-

gue inspection since it is thought of as being a toolused by herbal medicine practitioners.

Are there other ideas in the acupuncture-relatedliterature that could provide a basis for treatingchildren? After reading various texts and sourcesover the years I believe that the answer to this ques-tion is yes. I have found a number of ideas anddescriptions that may well have provided the ideasand precedents influential for thosewho developedshonishin. While it is not possible to provide a defi-nitive answer to this question, the informationdescribed below represents a potential or at leastpartial explanation. To answer this question, myspeculations are based on small pieces of evidencefound here and there.

First, the Huang Di Nei Jing Ling Shu (The YellowEmperor’s Inner Classic Spiritual Pivot, originallycalled the Zhen Jing [鍼經] orNeedle Classic), specifi-cally Chapter 1, describes nine kinds of needles,only one of which is the regular thin filiform needleused widely today (Fig.2.4).1 Of these nine needlestwo were explicitly described as round-headed“needles” that were to be pressed onto the body orrubbed along the surface of the body (in the bookJapanese Acupuncture: A Clinical Guide by Birch andIda 1998, pp.39–57, we summarized the historical



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Fig.2.4 The “nine needles” of the Ling Shu. From HidetaroMori’s collection at the Harikyu Museum, Osaka (courtesy ofMori H, Nagano H. Harikyu Museum. Museum of TraditionalMedicine Vol.2, Morinomiya Iryougakuen Publishing; 2003;special thanks to the editor Ms. Oda and to Hitoshi Yama-shita for his assistance). The filiform needle is number 7,third from bottom.

1 See the illustrations on page 40 of Japanese Acupuncture

(Birch and Ida 1998) for various interpretations of what thesenine needles look like.

descriptions from the Ling Shu and some modernideas about the nine needles and how to use them).

The yuanzhen (Japanese “enshin”) was describedas having a round head and was to be used by rub-bing on the body—Fig.2.5 shows a modern form ofthe enshin from Japan; Fig.2.6 shows an historicalimage from East Asia of the yuanzhen. In each caseone can see a similar image of the yuanzhen orenshin as having a rounded end. Likewise, the shiz-hen (Japanese “teishin”) was described as a thickerneedle with a rounded millet-seed–like point on itused for pressing the body surface. Figure 2.7shows twomodern teishin from Japan and Fig.2.8 adifferent historical image.

Another of the nine needles, the chanzhen (Japa-nese “zanshin”—literally the “arrow-headed nee-dle”) was described as having a sharp edge andwasused for lightly cutting the skin (much like a paper

cut). It does not penetrate into the body; rather, itbreaks the skin only. Figure 2.9 shows the arrow-headed point of the chanzhen. While this instru-ment was intended originally to break the skin, var-ious modern forms of it are used for rubbing orscratching on the skin surface rather then breakingit. Today the zanshin has taken on a variety of formsin Japan. Figure 2.10 shows a typical shape for thezanshin and Fig.2.11 shows a conically shaped ver-sion.



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Fig.2.5 Modern form of the enshin from Japan.

Fig.2.6 Historical form of the enshin (yuanzhen). (See alsodifferent images in Birch and Ida 1998, p.40.)

Fig.2.7 Modern forms of the teishin from Japan.

Fig.2.8 Historical form of the teishin (here called “dizhen”).(See also different images in Birch and Ida 1998, p.40.)

Fig.2.9 Historical form of the zanshin (chanzhen). (See alsodifferent images in Birch and Ida 1998, p.40.)

Fig.2.10 Modern form of the zanshin-like instrument.

Fig.2.11 Modern conically shaped form of the zanshin.

From this one can easily see a clear precedentfor the idea of using hand-held instruments (inter-estingly called “needles”) that could be used forrubbing, pressing, or scratching on the body sur-face, rather than penetrating into the body (like theneedles we commonly use today). I think it there-fore likely that those who developed shonishinwere influenced by these old ideas about needletypes and needle methods and started experiment-ing with different constructions and surface stimu-lation applications.

What about the acupuncture points? Why is itthat much of the therapy is targeted to regions ofthe body rather than the usual acupuncture points(as we tend to find in the treatment of adults)?Here it is easy to become speculative, so I shall keepit short and simple. There is a very clear statementin the Huang Di Nei Jing (Ling Shu, Chapter 10)about how qi does not start moving and circulatingin the jing mai, or channels (meridians) until afterbirth. Ling Shu Chapter 10 describes the develop-ment thus:

The Yellow Emperor said “[after] the person’s con-ception, the jing is first composed. The jing com-poses the brain and bone marrow. The bonesbecome the stem [the spinal column forms?]. Thevessels become the ying [nourishment]. The mus-cles become firm. The flesh becomes [like a] wall.The jing is hard, and then the hair and body hairgrow. [After labor when the] gu [grains] comeinto the stomach, the vessel-meridian pathwaysare [all] connected, the blood and qi [begin to]move.”

This, of course, makes sense when one is familiarwith historical ideas about circulation of qi. One ofthe most important early ideas in acupuncture thathas remained influential is that the qi circulatesthrough the 12 jing mai or channels in a continuouscircuit. It is propelled through the jing mai bybreathing, moving 3cun with each inhalation and3cun with each exhalation (Ling Shu Chapter 15and Nan Jing [Classic of Difficulties] Chapter 1 arequite clear on this point [Matsumoto and Birch1988, pp.77–78]). In a way the lungs were seen as akind of pump for the qi as a parallel to the heart as apump for the blood.

Since the jing mai have thus not yet started theirfunctions of circulating the qi before birth—this cir-culation beginning only with the first breath after

birth—it is not difficult to imagine that at first thisis not a well-developed system and could reason-ably be thought of as being different from what wefind in an adult. Thus, in a newbornwe can think ofthe jing mai as being in a more immature state.Further, we know that each jing mai was describedas having intimate relationships with at least twointernal organs, often being “branches” of thatorgan (Matsumoto and Birch 1988, p.50). At birth, anumber of these organs have functioned little aswell, and exhibit considerable changes over thenext few years while the child grows and matures.Thus, since the evidence about acupuncture pointsis that they were not mentioned before the systemof jing mai or channels had been described (Birch,in preparation [b]), we can see that they were firstdescribed at the same time that the above theory ofqi circulation in the channels was proposed, andthat they are related to the movements of the qi,rather than underlying anatomical structures. Onthis basis we can easily imagine that the acupointsstart forming out of the developing jing mai orchannel system. Ling Shu Chapter 1 describes thenature of the acupoints thus: “At the articulationswithin the body there are 365 points of communi-cation … ‘articulations’ refers to where the divinech’i [sic] travels freely and moves outward andinward, not to skin, flesh, sinews, and bones.” Thetranslator of this passage, Nathan Sivin continues:“A modern Westerner expects these points of com-munication, where the physician’s needles canaffect the circulation, to be places in tissue, but herewe find them related instead to processes” (Sivin1987, p.51).

It is very easy to go on speculating here, but thepoint I am trying to make is that it is not unreason-able to think of the channels and their acupoints asbeing in less well-developed states in babies andsmall children, and that at some time in the child’sdevelopment they reach a state of developmentthat makes them similar to what we find in adults.There are other ideas and sources that can be seento support this idea. Li Shizhen is famous as theauthor of the immensely influential herbal medi-cine text, the Ben Cao Gang Mu (Materia Medica).He also wrote a small treatise on the extraordinaryvessels, the Qi Jing Ba Mai Gao (The Eight Extra-ordinary Vessels Examined), circa 1578. This placesthe text as predating the development of shonishin,but it is important for us here since Li Shizhen wasa considerable scholar of older ideas. This text has



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been translated by Charles Chace and Miki Shima(2010). What is interesting for us is a short passagein a discussion on the origin of the extraordinaryvessels. A Japanese colleague drew my attention tothis passage as evidence for the immature state ofthe channels in babies and children and thus a the-oretical reason that could have contributed to thedevelopment of shonishin (Kurita personal commu-nication, 1989). My crude translation of this pas-sage renders it thus: “All people have these eightvessels. They belong to the yin shen. They close anddo not open. Only the [Daoist] adepts can pushthem open with their yang qi. Therefore [by thismeans] they are able to grasp the dao” (Anon 1970;Wang 1990). Chace’s more refined translation doesnot contradict the interpretation my colleagueexplained to me: “All people have these eight ves-sels but they all remain hidden spirits because theyare closed and have not yet been opened. Only divinetranscendents can use the yang qi to surge throughand open them so that they are able to attain theway” (Chace and Shima 2010, p.110). I have itali-cized the relevant line. The eight extraordinary ves-sels are closed in adults. The speculation my Japa-nese colleaguemadewas that since before birth the12 jing mai are similarly not functioning or areclosed, instead, something else—the extraordinaryvessels—had the function of helping regulate qimovement in utero. After birth the 12 jing mai startto function, and then, gradually, as theymature, theytake over and replace the functioning of the extraor-dinary vessels. At a certain point (in most people)the extraordinary vessels would become closedwhile the 12 jingmaiwould take over the function ofhelping regulate qimovements in the body.

I am not saying this is correct, but rather thatimportant historical ideas and passages exist thathave been interpreted as showing precedents tothe notion that the channels and their acupointsare immature at birth and thus temporarily of a dif-ferent nature until they reach a more mature state.Nor should the reader interpret that I am suggest-ing or supporting the use of the extraordinary ves-sels as a specialized treatment in pediatric condi-tions. First, there is almost no literature supportingthis (i.e., there is little or no published experienceof this idea). Second, Li Shizhen’s notions and treat-ments of the extraordinary vessels are very, verydifferent from the typical ones we have learned inacupuncture school utilizing the eight treatmentpoints (Chace and Shima 2010).

The above ideas can be seen as purely abstractand speculative, but I also describe them becausethey account for clinical experience treating chil-dren and seeing some of the different responsesbetween them and adults. With adults it can bevery important to be right on the point for thetreatment towork. However, with babies and smallchildren, it is usually enough to be at least in theright area using the right techniques timed appro-priately. In this sense, I feel that acupuncture pointsin babies and small children are more likely to bevery open spheres of influence rather than sharplydefined loci.

It may well have been this kind of simple think-ing about the nature of the acupoints, channels,and qi movements, coupled with experimentsusing different-shaped hand-held instrumentsfound to have different effects, that guided thosewho developed shonishin. In the end we will prob-ably never know, but this seems reasonable giventhe historical evidence and precedents.

There is one other historical influence on thedevelopment of shonishin that is relevant, at leastfor a part of its practice. In modern shonishin prac-tice we still find the diagnosis and treatment of“kanmushisho,” related primarily to behavioralproblems. What is this and where does it comefrom? There is an interesting history related to thedevelopment of diagnostic categories for childrenin China and ideas in Japan about normal develop-ment and problems before modern concepts of“physiology” had penetrated Eastern thinking, andthe fusion of these two traditions.

Kanmushisho (疳虫証) orKannomushisho (疳の虫証)2

The term “kanmushisho” or “kannomushisho” refersto a class of problems that manifest in childhood.The term comes out of an historical period whenthe concepts of different medical traditions werefused in the development of medical practices.

The term “mushi” (虫 ) refers to a kind of wormor insect that was thought to inhabit the body.



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2 Thanks to Sayo Igaya for her assistance with this section. Ms.Igaya conducted research to investigate kannomushisho forher thesis as a student at the Toyo Shinkyu Senmon Gakkoacupuncture school in Tokyo and offered invaluable helpwiththis section.

There were thought to be many different mushi inthe body, which influenced both normal and abnor-mal physical and mental functioning. An exampleof the “livermushi” (肝虫) is seen in Fig.2.12.3

The mushi concept comes from Japanese historya number of centuries ago, and had both lay andmedical uses. Many older societies have had differ-ent concepts about entities inside the body thatinfluence health and disease. Pictures of some ofthese mushi give them the appearance of differentparasites, but others are more anthropomorphic,thus we cannot say they were based on observingparasites in the body. The text Shin Bun Sho (TheBook to Understand Acupuncture [針聞書]) from the17th century explains their use in a medical con-text, but they had lay uses as well, and various ritesor ceremonies conducted by Buddhist monks weredeveloped, some of which can still be found today.4

The term “kan” (疳) comes from the Chinesemedicine tradition: the Chinese term is “gan.” Itrefers to a disease of childhood characterized by“emaciation, dry hair, heat effusion of varyingdegree, abdominal distention with visible superfi-cial veins, yellow face and emaciated flesh, and lossof essence-spirit vitality” (Wiseman and Feng 1998,p.236–237). There are as many as 22 different ganassociatedwith the internal organs and other struc-tures and symptoms (Wiseman and Feng 1998),such as “spleen gan,” “liver gan,” “lung gan,” and soon. Each has a different manifestation.5 The concept

of gan developed within the Chinese medicine tra-dition and came to be useful in pediatrics. As thistradition was absorbed into Japanese medical prac-tices, it encountered the concept of mushi, whichwas in vogue at the time. The term “kan no mushi”(疳の虫) represents a fusion of these two differentconcepts of disease. At first there were a number ofconcepts in this fusion tradition, but the term “kanno mushi sho” (疳の虫証) is the only one that hassurvived and come down to us today. The term“sho” (証) means pattern.

The term kannomushisho has therefore come tomean the pattern of kannomushi disturbance. It isparticularly associated with behavioral problems inchildren. In the infant the kannomushishomanifestsas irritability, crying, screaming, and poor sleep. Inthe toddler the child has poor sleep, irritability,angry outbursts, and tantrums. In the older childthe behavioral problems manifest usually as hyper-activity, but can also be the distracted child whohas poor concentration at school. Shimizu describeshis belief that in Japan the term kan came to repre-sent children’s diseases in a more general sense, andthat the term kanmushi tookon both amedical sensereferring to earlier stages and more easily respond-ing medical problems, as well as lay understandingabout stages of normal development in children.Hence, shonishin has also been used as a tool to assistin normal development of the child by parents thatfollowed thiswayof thinking (Shimizu 1975).

ShonishinToday

In the modern period the practice of shonishin usesmany tools. As we will see in Chapter 6, they can belargely classified around different stimulation tech-niques (tapping, rubbing, pressing, scratching), butthey are also used based on personal experienceand preferences. Each of us who practices shonishinhas our preference for which instruments we com-monly use. For the most part the instruments aremade of metal, but there are precedents for use ofother tools, like the claws of a mole (Yoneyama andMori 1964, p.15), and the plastic presterilized dis-posable shonishin tools that were created by Seirin.Some practitioners have had specific tools con-



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Fig.2.12 Redrawing ofthe “kan no kanmushi”(liver kanmushi).

3 For more examples see: http://www.kyuhaku.com/pr/collec-tion/collection_info01-2.html; last accessed 16 September2010.

4 Ms. Igaya showed me a short video of a ceremony she wit-nessed and the intriguing effects of the ceremony.

5 Reflecting Japanese uses and understanding of the concept ofgan (Japanese “kan”), Shimizu (1975) describes how kan iscommonly associated with bad mood, sleep problems, nightcrying, poor appetite, diarrhea and cough and the association

of the five organ kan are listed as follows: “heart kan”—sur-prise kan; “liver kan”—wind kan; “lung kan”—qi kan; “spleenkan”—food kan; “kidney kan”—hasty kan (Shimizu 1975).

http://www.kyuhaku.com/pr/collection/collection_info01-2.html

http://www.kyuhaku.com/pr/collection/collection_info01-2.html

structed such as the “daishi hari” of MasanoriTanioka of Osaka (Tanioka 2001a, 2001b) (seeFig.2.13). In this way, shonishin has exhibitedchanges over time, as new instruments are used.One of these developments began in the UnitedStates in the 1980s. It was here that I helped contri-bute to another new usage of shonishin.

BeforeWorldWar II, there were a number of sho-nishin specialists, acupuncture practitioners whoexclusively treated childrenwith shonishin. Since thewar, the relative number of such specialists hasdropped considerably and most acupuncturists whouse shonishin do so as part of their practice (Shimizu1975), some obviously more than others. In Japanthe typical practitioner who uses shonishin does soin his or her clinic, where they apply the treatmentperiodically on the child, who must return for addi-tional treatments. Many practitioners in Japan tendtowork from their home, living upstairs whilework-ing downstairs. If they don’t do this then their clinicsare often in or very near residential areas. As such,many of their patients will come from the local partof town where they live. In many clinics I visited inJapan, most patients were able to walk to the clinicor get therewith a very short ride, as they lived closeby. It is therefore not too difficult for a practitioner torequest the parent to bring the child back for treat-ment the next day, daily over the next few days, orregularly several times a week for a while. This hasbeen reinforced by the fact that in Japan manymothers stop going towork once they have children,and are thus available to bring the child in for fre-quent treatments as needed.

Working in Boston in the United States in the1980s I encountered a completely different set of cir-cumstances. For many pediatric patients both par-entswereworking, the childwas in day care, and the

family lived within driving distance from the clinic.Scheduling the child for treatment involved dealingwith two or three people’s schedules (four if youadded mine). I found early on that most parentswere simply unable to bring their children in fortreatment more than once a week, and even thatcould create a burden that made continuing treat-ment difficult. Thus, I found myself faced with theproblemof not being able to treat frequently or regu-larly enough. As wewill see in the following chapers,it is important to make the clinical setting as easyand emotionally calm as possible for the child inorder for the treatment to work better. When par-ents are very stressed-out running around trying tocoordinate short clinic visits, this can create the op-posite effect. Thus, I had to start thinking about howbest to dealwith the frequency-of-treatment issue.

The solution first offered itself when a mothercalled me from New York. Her daughter was almost3 years old and had a problem with cerebral palsy.She had been looking for acupuncture treatment forher child and was willing to fly to Boston. Not onlydid the travel distances and costsmake regular treat-ments unfeasible, but I was about to leave for thesummer for my first studies in Japan. My solutionwas to schedule to see the child, and to teach the par-ent an acceptable short formof the shonishin therapyto be performed daily at home. This was an immen-sely successful strategy (the case is reported in detailin Chapter 24, Case 1 Catherine). Then over the nextfew years, when I started to see many 2–5-year-oldswith recurrent ear infections (otitis media) whowould return as soon as the current round of anti-biotics had finished, I found I had to offer an alterna-tive approach to allow formore frequent treatments.Once-a-week treatments were not frequent enoughfor this kind of recurrent problem. Thus, I began rou-tinely teaching the parents to do some form of sho-nishin treatment, preferably daily at home. With thesuccess of these experiences, I have since taughthome therapy routinely as an additional componentof shonishin. Many acupuncturists in Europe, theUnited States, and Australasia are familiar with thismodel. Home therapy approaches and rationales arecovered in Chapter 8 and represent a very powerfuladdition to thewhole shonishin treatment approach.My colleagues in Barcelona have evenwritten a bookfor parents about child care containing recommen-dations for home treatment. This includes simpleshonishin-style treatments (Rodriguez and Anton2008).



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Fig.2.13 Tanioka-family–style “daishi hari” instrument.



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Section 2 Treatment Principles and Tools of Treatment

3 General Considerations in the Treatment

of Children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17

4 AModel for Judging the Dosage Needs of

Patients . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19

5 Assessing Changes, Recognizing and

Correcting Problems of Overdose . . . . . . . . . 24

6 Basic ShonishinTreatment Tools . . . . . . . . . . . 29



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3 General Considerations in the Treatment of Children

Everyone who has used acupuncture on childrenwill agree that children are generally more sensi-tive to treatment than adults. This manifests in sev-eral ways. First, one has to be more careful aboutwhich treatment one applies and how one does it.Second, we often see very quick responses to treat-ment. The first issue involves both the need to regu-late the dose of treatment and how one applies thattreatment to children. The second issue relates tosensitivity, and requires the use of techniques ofassessment, so that one can determine whether ornot enough has been done in order to minimize therisk of over-treatment. If one does not understandthese issues well, one will find it very difficult totreat childrenwith acupuncture. I suspect that this isone of the main reasons whymany, if not most, acu-puncturists do not treat children, or find it difficult.

In order to address this important theme prop-erly, we need to examine a number of issues:● Judging the appropriate dose for patients—and a

model for doing this● Understanding how this manifests in babies and

children (0–18 years)● Applying each treatment method differently, so

as to be able to regulate the dose of treatmentdelivered

● Assessing changes in the patient continuously sothat one can more precisely judge that enoughhas been done, both regionally and globally dur-ing treatment

● Recognizing and correcting overdose of treat-ment

Estimating the dosage and making judgments as tohow to tailor treatment to individual patients iscomplex and involves several important diagnosticand therapeutic considerations. Selecting the cor-rect root treatment pattern and the correct acu-puncture points for that treatment are obviouslyimportant, as any traditionally based system ofacupuncture will testify. Likewise, matching thechoice and application of treatment techniques tothe diagnosis is also important.

Another aspect of these components of the roottreatment is to understand the goals of treatment:

are they to effect a cure, or to help the patient man-age their problems? For some patients we may useacupuncture treatment primarily to help themthrough a difficult process or to help them dealwith difficulties, rather than attempt to eliminatethose difficulties with the acupuncture. For exam-ple, if we are treating a patient with a complex con-dition such as terminal cancer, our role is primarilyone of palliation and support of the patient. Like-wise, if you treat a child who is about to undergo acomplex surgical procedure so that he or she canrecover more easily and quickly from the surgery,there are no symptoms to focus on. Treatmentfocuses on supporting the patient through the pro-cess, using only some form of root treatment. How-ever, given the fact that most acupuncturists workin ambulatory care private practice, most of ourpatients are not so ill and so we generally attemptto cure those problems that we see. The choice ofpattern, treatment points, and treatment methodsare fundamental parts of any traditionally basedroot treatment (this is discussed in Chapters 9 and10 in relation to pattern recognition and treatmentin Meridian Therapy). Additionally, selecting ap-propriate branch treatment or symptom controltreatment methods, and applying the techniquesproperly at the correct locations, are also important(this is covered in Section 4 of the book). But anaspect of the clinical individualization of treatmentthat is not usually discussed, if at all, in most text-books of acupuncture is the issue of choosing thecorrect dose of treatment.

The ability to tailor treatment tomatch the needsof each individual patient is a very important aspectof treatment. What I describe in the following chap-ters is based on having studied with Yoshio Manakaand especially Toyohari Association instructors suchas Kodo Fukushima, Toshio Yanagishita, AkihiroTakai, ShuhoTaniuchi, Koryo Nakada, ShozoTakaha-shi, and Yutaka Shinoda and refining these ideasthrough clinical practice. I hope in a later text todescribe these same issues in more detail in relationto the treatment of adults, where the issues canbecome more complex. I consider it essential to beable to adapt and apply the acupuncture treatment



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17

approaches described in this book on children whocome to you for treatment. I would like to empha-size this: if you do not understand the issues ofdosage you are better off not treating babies andchildren at all. Thematerial described in the follow-ing chapters makes it possible for you to adjustyour treatment to every child you encounter inclinical practice, and to come up with effectivetreatments.

Chapters 4 and 5will focus on describing clinicalissues involved in making the judgment of the cor-rect dose of treatment. This includes a discussion ofwhat tends to lower the dosage, requirements forparticular patients, or what makes someone moresensitive. It will also cover an overview of the judg-ment of dose, and how to modify and select appro-priate treatment approaches and treatment techni-ques so as to match the dose to the needs of eachpatient. Also, how to identify when a reaction totreatment might be due to a misapplication of dose

or application of inappropriate technique. Theseare often the same or related. If a child has a reac-tion to treatment due to overdose or application ofless than optimal techniques, the child or parentsmay start to question whether they trust in you astheir practitioner. Sometimes this will finish treat-ment. Dealing with patient reactions to your treat-ment requires many levels of skills. First, you mustbe grounded and able to react through controlledemotions without defensive responses. Then youmust also be practical enough and patient-focusedenough to recognize and be able to correct this sothat the patient will continue treatment withoutresistance (Yanagishita 2003). When correctlyapplied, the appropriate treatment is clinicallymore effective. Although I outline a number of use-ful ideas here, I recognize the cautions of my tea-chers that understanding the correct dose of treat-ment can be a lifetime endeavor (Kasumi 2003).



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18 Section 2 Treatment Principles and Tools of Treatment

4 AModel for Judging the Dosage Needs of Patients

The Therapeutic Dose—AConceptualModel

In mainstream medicine, it is generally well under-stood that there is an optimal dosage range for aparticular drug to be effective. The concentration ofthe drug in the blood should lie roughly betweentwo values for it to be effective. Below the lowervalue, the drug is less effective or ineffective andabove the upper value the drug is in too high a con-centration and can cause unwanted side-effects orlead to overdose of treatment. This general idea isquantitatively based, where the optimal dose rangeis often based on body mass and the upper andlower dose ranges are numerical values. But it ispossible to extend this idea to a more qualitativeillustration of dosage needs. I say that it is qualita-tive since we have no laboratory value to measure.We can make qualitative estimates of need only.The following ideas are extensions of explanationsthat Yoshio Manaka made about dose of treatment,in relation to intensity of stimulation delivered(Manaka, Itaya, and Birch 1995, pp.118–119).

When a therapy reaches the therapeutic dosethreshold (TDT), it starts to have its expected thera-peutic effects. If the dose of the treatment builds uptoomuch so that it crosses themaximum therapeu-tic dose (MTD), the patient may start to experienceunwanted side-effects due to over-treatment.

With amedication, the dose taken and the inter-vals between times that the medication is taken areoften matched, so that the concentration of themedication in the blood remains in the optimaldose range—between TDT and MTD in Fig.4.1.With an acupuncture treatment, we interpret thisfigure a little differently. Two treatments, Y and Zare charted. Both treatments start from point X.Treatment Y has a relatively high intensity stimula-tion, the dose build-up is quicker than treatment Z,which delivers a milder intensity stimulation. Y1and Z1 are the times that treatments Y and Z crossthe TDT respectively and Y2, Z2 are the times thattreatments Y and Z cross the MTD respectively. Thetime that the practitioner of treatment Y has tojudge the correct dose of treatment is T1 (the dis-tance between Y1 and Y2), while the time that thepractitioner of treatment Z has to judge the correctdose of treatment is T2 (the distance between Z1and Z2). Since T2 is larger than T1, we can say thatthe risk of reaching overdose of treatment is lesswith treatment Z than with treatment Y. It is there-fore easier and safer to administer treatment Z.

Of course, this is a gross simplification. Forexample, what about a therapy like homoeopathywhere the lower the physical dose of treatment(the more diluted), the higher the therapeutic dose(energetic)? Manaka hinted at these things with hisX-signal system model of acupuncture (Manaka,Itaya, and Birch 1995, pp.118–119). A lower inten-sity form of acupuncture (as physical stimulus) is



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Dose

XY1 Y2 Z1 Z2

T1 T2

MTD

TDT

Y Z

Time

Fig.4.1 Dose levels for normal sensitiv-ity patient with different intensities oftreatment (Y, Z). (TDT, therapeutic dosethreshold; MTD, maximum therapeuticdose.)

not necessarily a lower dose treatment since atvery low energy content (very low-intensity stimu-lus treatment) the more the energy level content ofthe treatment approaches or approximates theenergy level content of the physiological systems,the more it could be therapeutically active (i.e., theless the physical stimulus, sometimes the strongerthe signal system mediated therapeutic effects).See Manaka et al. (1995) for details of this idea. Butfor the purposes of the model here, if we assumethat within the context of a particular treatmentmodel the above graphical representation of thedoses of treatment are applicable, then it is possibleto illustratewhat happenswith sensitive patients.

After learning this basic model from Manaka Igradually extended it to begin to incorporatepatients whose dosage needs are very different.The following is a model that I developed and thatappears to work well for understanding what hap-pens with “sensitive” patients.

The Sensitive Patient

A sensitive patient will typically show two charac-teristic differences compared with the typicalpatient. First, the TDT drops and can be very low,meaning that it takes very little to start triggeringchange. Second, the width of the optimal doserange narrows considerably, so that it takes very lit-tle more therapeutic input after the TDT is crossedfor the treatment to cross the MTD. Of course, it ispossible that the sensitive patient may be veryhealthy, where the TDT is very low, but the MTD isnot lower, so that the optimal therapeutic rangeremains very wide. These are our most idealpatients, for whom one hardly has to do anything

to start triggering healthful effects and for whomone can do a lot more without any adverse effects.These patients are, in my experience, very rare.Most sensitive patients who show the lowered TDTalso show a lowered MTD. This can be seen graphi-cally in Fig.4.2.

If treatment Y from Fig.4.1 were administeredon this sensitive patient, the time to judge properdose, T1, is very small and overdose of treatment ishard to avoid. Even treatment Z, which has a lowerintensity of treatment, would be difficult, since T2is also very small. One has to administer a treat-ment that is extremely low dose, has a very lowintensity, and is mild and gentle: treatment A, ifone wants to have any chance of avoiding overdoseof treatment on this patient. Here the time to judgetreatment dosage (distance from A1 to A2), T3, ismuch larger than T1 or T2. The use of a very lowintensity treatment allows the dose to build upmuch more slowly, so that one has more time (T3)to make the clinical judgment to stop treatment.This idea is important and clinically very helpful.

It is necessary to assume that all children, eventeenagers, fit this profile of the sensitive patient.Certainly, all babies and smaller children fit thisprofile, but even older children can. Thus, at leastuntil one has evidence to the contrary, one shouldapproach even older children as being more sensi-tive. We will discuss below the subject of how toadjust techniques in order to increase or decreasedose and how to match this judgment to each indi-vidual child.



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Dose

XA1 A2

T1 T3

MTDTDT

Y Z

Time

A

T2

Fig.4.2 Dose levels for the very sensitivepatient (child) with different intensities oftreatment (Y, Z, A). (TDT, therapeuticdose threshold; MTD, maximum thera-peutic dose.)

Explanations of Increased Sensitivity

There is a long-standing tradition in Asia thataddresses the need to regulate one’s emotions. Thisis an important theme in Confucian, Daoist, andBuddhist thinking. The early medical literature inChina followed this theme when it discussed howall emotional expressions represent some kind ofdisorder of qi movement or function in the body,and classified a number of common emotions inrelation to the primary organs (zang) in the body(Chiu 1986; Matsumoto and Birch 1988; Unschuld2003; Birch, Cabrer Mir, and Rodriguez, in prepera-tion). These dominant emotions were said to injuretheir corresponding organ and each was describedin relation to particular qi disturbances. The emo-tions were discussed in relation to health problems.In larger social discourse, the ability to manifestcorrect behavior and help regulate oneself is neces-sary to regulate one’s emotions.

Babies are unable to talk. Instead, they expressthemselves via their emotions. Of course, we seedifferent manifestations of this: a more liver-related expression is an angry one that manifestswith a lot of explosive crying and an inability to set-tle, whilst a more kidney-related expression is oneof jumpiness, of fear reactions. But the importantissue is that babies and small children have no abil-ity to regulate their emotions. Communication inbabies and smaller children is achieved by emo-tional expression. Thus, in babies and small chil-dren, many forms of normal healthy communica-tion can trigger disturbances in qi movements andfunctions in the body. This has immediate conse-quences: it tends to make babies and children verysensitive as their qi is involuntarily changed easily.Thus, one of the goals of treatment is to try, asmuch as possible, not to cause the child emotionaldistress. As therapists we are trying to help regulatethe qi of the patient, but if what we do causes emo-tional distress so that the child starts crying andbecomes very upset, this can counter the effects ofour treatment and even trigger unexpected reac-tions. Further clinical implications of this for thetreatment of babies and children are discussed inlater chapters.

This same issue holds for all children, even teen-agers. Sometimes we come across a 4-year-oldchild who we all agree is “very mature.” By this wemean that the child is more in control of his or her

emotions than other children the same age, and it iseasier to deal with that child. Conversely, we canhave a 15-year-old physically well-developed childwho is emotionally very unregulated and we mightdescribe that child as “immature.” It can be difficultdealing with the child as he or she is unable to con-trol his or her responses to things. The 4-year-oldcan handle things better than other 4-year-olds,whilst the 15-year-old cannot handle things well incomparison to other children of the same age. Thisshows in the responsiveness to treatment and howone handles the child.

I will give various examples of this later, show-ing how with a good understanding of this, one candemonstrate treatment effectiveness in how oneapproaches and deals with the child, and with howone adjusts one’s treatment techniques. For exam-ple, below the age of 5 we prefer not to have toinsert any needles, but beyond the age of 5 we startto think about how and whether we need to insertneedles. This is a double-edged idea. On the onehand, needling is frightening, and thus potentiallymore distressing to a more immature (younger)child. On the other hand, needling is a biggerdosage than the standard shonishin techniquesdescribed below, and thus it is more difficult tocontrol the treatment. However, there are alwaysexceptions that we uncover—the emotionallymature 4-year-old can (with good needling techni-ques) handle being needled better than the imma-ture 15-year-old.

There are a number of consequences of this forapplication of treatment with children. First of all,try not to upset the child during treatment. Thisrequires attention to several details. Take time overthe course of treatment to make sure that the childis comfortable with you and what you are doing.Don’t try to force things unless necessary. The ther-apeutic relationship is very important in acupunc-ture treatment, especially with children. Some chil-dren will like you and what you are doing im-mediately; others take time to demonstrate trust,especially if they have been chronically ill and haveseen many health care providers, or have had manytreatments. It is thus advisable to take the timeover the first treatment to make sure that the childis settled, comfortable with you, and not frightenedby you. This is not only to do with your mannerand behavior; it is also to do with how you applyyour treatment techniques, how you handle thechild. Thus, we modify how we apply treatment



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4 AModel for Judging the Dosage Needs of Patients 21

techniques so that they are not distressing, we tryto choose only those techniques that can be appliedwithout the child becoming upset. One pediatricspecialist in Japan even recommends not makingeye contact with the child during treatment sincebabies and small children can be easily frightened.Although this last idea can be useful with somebabies and small children it is not always advisable.There are some with whom it is better to maintaineye contact to help them feel secure and comforta-ble.

When we apply techniques that could be dis-tressing, such as inserting needles, we do it in sucha way that the child does not feel pain or discom-fort. Likewise, if one needs to bleed a jing point(which is not often required) it needs to be done insuch a way that not only does the child feel nothingbut they also see no blood. This requires the use ofneedling techniques that are guaranteed to be pain-less and sensationless. I discuss methods that allowone to needle like this in Chapter 15. A consequenceof this basic rule is that we have to be careful howwe choose to apply some of our treatment techni-ques. It does not help to try negotiating with asmall child who is frightened of needles, to insertneedles. First, get discreet permission from the par-ent and then needle in such a way that the childcannot feel or see what you have done. On olderchildren this can be trickier. The example of Georgebelow shows the successful needling of a 6-year-old.

Example

George had been having problems with repeatedlycatching colds, and prolonged periods of bronchitisover the last year. He had tried homeopathy but thecurrent episode of bronchitis was not clearing up, andthe symptoms of coughing, congested lungs, anddisturbed sleep had been going on for a few weeks.He agreed to come to try acupuncture only becausehe had been promised that “Steve will never insertany needles in you.” A typical 6-year-old with thesesymptoms will usually benefit quickly from a fewstrategically inserted needles, but this was not anoption. For the first visit, the task was to make surethat he liked what was being done and that it wascomfortable and not frightening. I applied a simpleversion of the non-pattern-based root treatmentdescribed in Chapter 7. I found hard knots around

BL-13 on both sides, and left press-spheres1 on thesepoints.He came back a week later and there had been someimprovement in his symptoms, albeit slight. He wasstill very wary about the needles and nervous that Imight insert some. I repeated the treatment at aslightly higher dose. He returned a week later, with afurther slight improvement in his symptoms, but thistime he was more settled with me and less worriedthat I was going to use needles on him. After doingthe basic treatment, I turned my back on him while Iprepared a 3mm-long intra-dermal needle held withtweezers. I turned to him, putting the tiny needle infront of him and asked “Is it alright if I insert this onyour back?” He laughed and replied “You can do whatyou want with that!” I then inserted two intra-dermalneedles at the knots at left and right BL-13, givinginstructions to his mother on how to care for them.When he returned for treatment a week later thecoughing, lung congestion, and sleep were muchbetter. He took his clothes off, threw himself onto thetreatment bed and said “Needle me!” After this Icould use a larger variety of treatment techniques tohelp him fully recover, and to help make sure that thenext colds would not linger on as chronic bronchitis.

Besides the difficulty with regulation of emotions,there are other causes of the increased sensitivitywe see in children. The more ill a patient is themore sensitive he or she becomes.What this meansis that in very ill children it is better to do minimaltreatment—even less than usual. Examples will begiven below on how even the usual low dose oftreatment for some children can be too much, andtrigger overdose reactions when they become addi-tionally ill with, for example, a cold. I can speculateon why the more ill a patient becomes the moresensitive. Very likely this involves an increasedemotional sensitivity. Parents will tend to agree onthe observation that when their child is poorly theyare usually more emotional, more emotionallyneedy, and cry more easily. Thus, when facing avery ill child, it is better to do less. It may seem



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1 There is much more information in Chapter 12 on usingpress-spheres, but briefly, the press-sphere or ryu is a stain-less-steel ball bearing usually no bigger than 2 mm in dia-meter. It is secured to a circular piece of tape that can then bepressed onto the skin. In Japan, the press-spheres are placedmostly on body points that are particularly sore and retainedfor amaximumof 3 to 4 days.

counterintuitive at times, but it is a better strategyto do less at first while you determine over timewhat the child can tolerate and what range ofdosage is better.

The more rundown and weakened a child is, thebetter it is to do less treatment. Thus, when treatinga child after an acute infection like bronchitis,where he or she has been ill for 2weeks with fevers,coughing, taking antibiotics, poor appetite, poorsleep, and loss of weight, do less treatment at first.Similarly, for the childwho has had an acute gastro-intestinal disturbance with repeated diarrhea, heor she will be in an acutely weakened state, so doless treatment.

I would also like to speculate that an additionalreason for the increased sensitivity of children,especially smaller children, is that their physiologyis accelerated compared with adults. Children arecontinuously growing and require an acceleratedphysiology in order to support this. Hence, we see amore rapid heart rate, more rapid breathing, and soforth. Because everything is in a more acceleratedstate we can also see a quicker response to treat-ment. This makes it necessary to use lower doses oftreatment, to do less, in order to trigger the samedegree of change that we trigger in an adult usinglarger doses of treatment.



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5 Assessing Changes, Recognizing and CorrectingProblems of Overdose

Traditional texts instruct us to pay attention toinformation gathered through the primary sensesin order to assess a patient and decide what treat-ment to apply. The “four diagnoses” are the primarymodes of information gathering, and among thesesome of the information is very malleable and sen-sitive, showing changes very easily and quickly. Thecolor and complexion of the patient can be seen tochange quite quickly so it is reassessable while youare applying treatment. A lusterless complexioncan be seen to become more lustrous while apply-ing treatment. Sometimes this is very clear, and theparent as well as you will notice it. But at othertimes the complexion changes are quite subtle, andthe lighting source can make it difficult to observethem. A more useful and reliable indicator ofchange is the palpable texture of the skin. Withproper training, one can observe this in adults, andit can be very useful. However, on babies and chil-dren it is an essential and indispensable observa-tion, since the surface of the child’s body changesmuchmore easily and quickly than that of an adult,and the changes are literally quite palpable andobvious with only a little training. Besides, wedirect much of the treatment on babies and chil-dren to the skin, the surface of the body.

Palpating the Skin of Babies and ChildrenTo palpate the surface of the body on babies andchildren we need to be confident and calm. Use thepalm of the hand and the whole palmar surface ofthe fingers. Touch very lightly so that your handdoes not cause a depression in the skin. Apply sim-ple touching and light stroking methods. The➤DVD shows the methods of touching and exam-ining changes in skin condition. In general, the skintexture changes in the area one is working on, sothat one should continuously monitor this. As itshows signs of change, move on to the next area.Touching is applied quickly to match the applica-tion of the tapping or rubbing techniques (whichare also applied quickly—see Chapter 7).

The signs of improvement in the skin conditionare that the skin texture shows the following typi-cal changes: it becomes springier, a feeling of soft

fullness develops, and it may become slightly war-mer. If the skin had been dry, it might feel slightlyless dry.

A sign of over-treatment is the skin starting tofeel moist. One must pay attention to the earliestsigns of increased moisture and not wait until theskin pores are quite open and the skin becomesobviously damp, or the area starts sweating.

Reactions to Over-treatment

Sometimes a patient returns to us following a treat-ment or a parent calls to report that there are diffi-culties. For example, symptoms are worse, newsymptoms have occurred, the child has been behav-ing badly or has been much more tired than usual.Our job is to figure out what happened, and to cor-rect it if possible. One has to distinguish signs ofover-treatment from:● improper treatment● healing reaction to treatment● the natural course of a disease● reactions that have little to do with your treat-

ment but are due to lifestyle issues of the patient

As one can imagine, this is sometimes complicatedand difficult. To understand when reactions arelikely to be due to over-treatment, it is necessary tobriefly discuss when reactions are due to theseother factors.

The most common sign of over-treatment inchildren is that the patient is more tired. This tired-ness can last for the rest of the day, in which case itis not so bad andmay just be a normal healthy reac-tion to treatment. If it persists into the next day andespecially beyond, you can suspect that you over-treated the patient. On a couple of occasions I haveseen young babies become “floppy” for a while fol-lowing treatment, where they were so relaxed themuscles were acutely and temporarily hypotonic.This did not last long, and while it may be distres-sing to the parent at the time, is not a bad sign,merely indicating that you should do less treatmentnext time. The more common reaction is seen



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while the child is still with you in the treatmentroom. He or she becomes quieter, less active, evenfalls asleep.As you observe this process starting,you know to do less and less for the rest of treat-ment, and possibly less on the next visit. As men-tioned, unless this state of lessened activity persistsfor extended periods, it is not a problem; more anindication about the probable need formore carefuldose regulation. On a few occasions, treatment hasled to the child falling asleep and having to be car-ried out of the treatment room, which can beinconvenient for the parent.

Sometimes over-treatment can lead to increasedactivity. Usually this is not a problem, but on occa-sion it has been. On two occasions, despite trying tobe careful, first-time treatment of young (5–6-year-old) hyperactive children has triggered acute boutsof increased hyperactivity, which were not onlystressful in the treatment room, but created a peri-od of prolonged hyperactivity that was very diffi-cult for the parents to handle. This is not commonbut it can happen. Thus, I recommend on a firstvisit with hyperactive children being even morecareful than usual about stimulation levels anddose. Sometimes a parent will report on a next visitthat they had difficulty getting the child to sleepduring the week since the last treatment. This ismost likely due to over-treatment and you need tolook carefully at what you did and make appropri-ate modifications in the light of that. Typical cul-prits for this kind of reaction are the objects thatyou leave as mild continuous stimulation of pointsfor a while, such as press-spheres (see Chapter 12)and especially the intra-dermal needles. Not usingthese things on the next treatment, or leaving themfor much less time is usually enough to stop thereaction. Sometimes this type of reaction to treat-ment can take a couple of sessions to figure outhow to adjust your approach sufficiently. These canbe very complicated clinical cases to handle.

There are atypical reactions to over-treatment,as may be seen in the example. They usuallydepend on the condition of the child as to how theymanifest.

Example

On Dianne, a 4-year-old girl with Rett syndrome withmain symptoms of autism, mental developmentproblems, structural and postural problems, andinstability (see Chapter 24 for her case study), thereaction to over-treatment was quite severe. Progresshad been good and she was handling treatments well.However, she missed an appointment due to a badcold and when she came the next week I misjudgedher condition (which was weaker than usual due tothe cold). Her reaction to over-treatment was a fearreaction that made her unable to take a step. Afterlifting her off the treatment table she would notmove. It was necessary to lift her to dress her andcarry her to the car. This persisted for several days,which was very distressing to her mother. Afteracknowledging what had happened and explainingwhy, her mother was happy to continue. Withappropriate treatment modification, the effects werebetter and this never happened again. Dianne’sstrong and prolonged reaction was specific to herdisturbed neurological condition.

You must always be honest both with yourself andthe parents about these circumstances. Becomingdefensive is a sureway tomake the parent lose con-fidence in you. One of my teachers, Toshio Yana-gishita goes so far as to say that you must acceptresponsibility for anything that happens after thepatient leaves your treatment room (Yanagishita2003). This is not such an extreme idea, but is moreabout how you present yourself to your patients. Itis an expression about your mental attitude andfocus.

In the sections below I discuss how to modifythe dose of treatment with the root treatmentapproach, different techniques and the symptom-targeting treatment techniques. Details of how toavoid and compensate for over-treatment will becovered in each relevant section.

As a general rule, when you first see a patient fortreatment, don’t do too much treatment, keep itvery light and simple so it is easier to figure outwhat to change if there is some reaction to yourtreatment. If you at all suspect that the child is evenmore sensitive, then do not leave anything (like apress-sphere, or an intra-dermal needle) on thefirst visit.



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Incorrect Treatment

It can be difficult to distinguish causes of children’sbad reactions to treatment. In general, it has beenmy experience that applying the wrong techniquesor wrong treatment (rather than too much of theright treatment) only worsens the symptoms of thechild. For example, in Chapter 7 where the varioussurface-stimulating root treatment methods aredescribed, the dominant methods are those of lighttapping and light stroking. The stroking techniqueis contraindicated for patients with skin conditionslike eczema or atopic dermatitis. On one childwhose main symptoms were asthma, the rubbingtechniques that were applied started irritating andincreasing the small patches of eczema. As the asth-ma symptoms improved gradually the mother rea-lized that the skin condition was worsening. Thiscan happen in the atopic patient anyway, but I rea-lized that we should use only tapping instead ofrubbing and immediately switched techniques. Theeczema symptoms immediately started improving,while the asthma remained improved. Whilst thiswas a mild, and in the end, quite successful case, itis an example where the technique of treatmentwas discovered to be inappropriate for the patient.

“Meng Gen”—AHealing Reaction

Chinese medicine has the concept of a healing reac-tion—the “meng gen.” It doesn’t seem to happenvery often andmost schools of TEAM therapy rarelyexplore it or only mention it in passing. If thismenggen reaction should happen, why does it occur andhowwould it manifest?

In simple terms we can consider that mostpatients are in a stable state inwhich symptoms are

occurring. We have an idea about a different statethat they could be in, where they have fewer or nosymptoms (our diagnosis and root treatment usual-ly targets a return to that more ideal state). Ourtreatment tries to move the patient’s system fromtheir current, not-so-healthy stable state, to a heal-thier stable state. However, the body of the patientthinks that its current state is normal so it resiststhis change and tries to maintain the status quo.Sometimes this process of resistance triggers somereaction to treatment such as aworsening of symp-toms. A second explanation is that the treatmentsucceeds in pushing the patient’s system out of itsunhealthy stable state, but not yet into the targetedhealthier stable state. So it stops for a while in a dif-ferent stable state in which new symptoms arise orold symptoms recur.

The typical sign that a meng gen-type reactionhas occurred is that the worsening of symptoms,occurrence of new symptoms, or recurrence of oldsymptoms lasts no longer than 24 hours and is thenfollowed by a clear and prolonged improvement insymptoms compared with the level of symptomsbefore the treatment was given (Fig.5.1).

Usually this improvement is long-lasting (days,weeks) but sometimes only short-lived (a couple ofdays). This short-term worsening followed by im-provement can be a clear pattern, but parents canbe confused about it, or call you as the symptomsdevelop or worsen. It is not advisable to make anyjudgments about it too quickly. To understand ifthis is indeedwhat has happened requires a longer-term look at the pattern of changes. If the parentcalls on the day of a treatment to say that things areworse, it is often impossible to know what is reallygoing on. It may be better to advise towait until thenext day and see if things have settled down. If the



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Sym

ptom

sev

erity

Treatment here 24 h after Treatment Time

Fig.5.1 Example of meng gen symptomintensity changes following treatment.

parent calls the next day and things are still bad,with no sign of settling down and it is past 24 hourssince the treatment, you can start to suspect that itis not a meng gen reaction and that something elseis going on, perhaps a wrong treatment, or morelikely an over-treatment. In that case you may wantthe patient to return to see if you can help them. If,for example, you have left an intra-dermal needleor press-sphere on the patient you can instruct theparent to remove it. If this triggers an improvementin complaints you can then suspect that either theintra-dermal needle or press-sphere was an inap-propriate treatment method (which is occasionallythe case) or that it created an overdose of treatment(a much more likely explanation). This helps you tounderstand that the patient is more sensitive thanyou had thought, and that you should bemore care-ful about the use of that technique in the future.

However, if a patient returns the next week fortreatment and reports a short-term worsening ordevelopment of symptoms following the treat-ment, without having called you about it, it is easierto unpack what may have happened. With the timeframe of a week you can see the pattern of changesmore clearly.

A cautionary note on this topic: I have had a fewpatients who have some form of brain damage orneurological problems (such as the 4-year-old girl,Dianne—see above) where the reactions to treat-ment are more prolonged than 24 hours. It is evenmore difficult in these cases to distinguish betweenmeng gen and overdose of treatment. My recom-mendation is to always approach such cases as anoverdose reaction, and adjust your treatmentaccordingly.

Modifying TreatmentMethods toRegulate the Dose of Treatment andDeliver Treatment Successfully

If while you are working on a child your continuouspalpation of the areas you are working on revealschanges, albeit very subtle ones, you can start tounderstand that the area you are working on maybe “done.” Once you recognize this, stop workingon that area. Sometimes it is hard to feel thesechanges, as they can be very subtle. You may betreating an unusually sensitive child, and thingschange much more quickly than you imagine they

might. In this case, despite your continuous moni-toring by touching, you end up beginning to over-treat the area. Stop working on that area themoment you notice this, and assume that the childmay be more sensitive than you had previouslythought. Consequently, when you go to work onother areas with stroking, tapping techniques andso on, you will first be even more attentive andfocused on feeling change, and second, you shouldbe automatically applying less treatment to thoseregions. This is a very interactive process. Manythings may be happening during treatment—thechild is moving around, resisting, crying, a siblingkeeps trying to interfere or play, and you are con-tinuously dancing around the child to stay ahead ofhis or her reactions to you during the treatment.1

Youmust remain focused and calm.In my experience and observation, a common

mistake that we practitioners can make is to mis-interpret the idea of “intention” and/or the idea of“compassion.” Somehow, armed with our intentionor compassion, we try to do “everything that wecan” to address the child’s problems. By this weover-treat the child. We need to be aware that hav-ing intention and compassion is more than justdoing everything that seems reasonable for thechild; we need to keep our sensitivity and clinicaljudgment foremost. If you can keep your awarenessand sensitivity focused while keeping your criticalassessments well honed, you can much more pre-cisely fine-tune how your actions guided by yourintention and compassion affect the child. Theseare skills that develop through practice.

Another problem is the over-application of the-ory. By this I mean the imposition of a theoreticalmodel on to what we are doing, where thishypertheoretical model becomes like the cloudobscuring the clarity of the blue sky of our actions.It is natural for most of us who practice acupunc-ture to be interested in and excited by the theoriesthat form the base of our practices. For many Wes-terners this means the traditional theories fromTEAM and equally for many Westerners and anincreasing number of Asian practitioners, the mod-ern anatomical, physiological, and pathologicalmodels of biomedicine. When our minds areclouded by too much theory, we can become lesssensitive to what is happening in front of us, which



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1 See the discussion of the “dance” of treatment in Chapter 7.

can impair the cultivation and development of theskills necessary for optimal application of treat-ment on sensitive patients like babies and children.

Final Thoughts on the Issue ofRegulating the Dose of Treatment

In the brief discussions and explanations above Ihinted at how complicated understanding the issueof dosage can be. Homeopathy uses incredibly lowdose remedies, where lower doses remove knownphysical properties and substances. The lower thedose (the more diluted), the stronger the remedy.We have also found in our studies of JapaneseMeri-dian Therapy, especially the Toyohari system, thatthere are additional, almost paradoxical explana-tions and clinical applications. If the adult patient istoo sensitive, he or she may not be able to toleratethe use of a regular needle (even though it is notinserted), so we are instructed to use a teishin tolower the dose. The teishin has a round seedlikepoint on it (see Fig.2.7 in Chapter 2, page 9). Butsometimes even that is too strong for the patientand we need to lower the dose yet again. Here we

are instructed to use gentle stroking with theenshin to lower the dose further. The enshin is akind of needle with a round-ball head (see Figs.2.5and 2.6 in Chapter 2, page 9). But sometimes eventhis is too difficult for the patient to tolerate, so weare instructed to use shallowly inserted thin nee-dles to treat the patient. The act of penetrating theskin is more physically stimulating than the nonin-serted needling use of the teishin or enshin, yet itgives a lower dose that the sensitive patient canfinally tolerate. This example shows that the simplemodel described above may not be sufficient toexplain what is going on in all cases. However, inthe great majority of patients, and for the purposesof clinical explanation, the abovemodel is adequateenough and has proven to have great clinical value.Recently, a colleague in Spainwriting a TCM text onpediatrics included the basic idea, as he has found itto be of great help in using various TCM treatmentswith herbal medicine, tui na, and acupuncture(Rodriguez 2008, pp.42–44). Another recent pedia-tric acupuncture text in German has borrowed thismodel (albeit slightly incorrectly), signifying thatthe author also finds it to be useful (Wernicke 2009,p.105).



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6 Basic ShonishinTreatment Tools

Over the centuries many different tools have beendeveloped and used in the practice of shonishin.Figure 6.1 shows tools in the author’s collection.

One can see that there is a wide range of differ-ent stimulation methods possible with these tools.The techniques of stimulation break down into fourtypes:● Tapping● Stroking or rubbing● Pressing● Scratching

Some of the instruments seen in Fig.6.1, and in thefigures below, can be used to give more than one ofthese four methods of stimulation, thus some of thedifferent tools show up in more than one of thetechnique classifications below.

It is natural to wonder why there are so manydifferent tools, even within each of the four cate-gories. There are a few possible explanations:● A particular tool was developed by an individual

and came to be a hallmark of that person’sapproach. This unique tool then fused into thegeneral trend of shonishin practice, possiblyinspiring others later to develop similar-lookingor functional tools.1

● Some creative people designed many differenttools, so that shonishin integrated this creativeelement within its general practice.

● Practitioners found it useful to have more thanone instrument in each category as this canreduce emotional reaction in particular chil-dren. For example, after one picks up a tool andthe child cries in fear after seeing it, one showsthe tool more closely to the child, which does notreduce the fear; one then picks up another toolthat does not provoke the reaction in the child;this allows one to proceedwith treatment.

Of coursewe don’t know, but I can easily imagine atleast one of these three factors influencing the

overall development of treatment tools within theshonishin tradition.

This chapter discusses the different types oftools and how to handle them. Chapter 7 “The CoreTreatmentModel” and Section 5 “Treatment of Spe-cific Problems/Diseases” discuss how to use the dif-ferent tools in the context of the root treatment andthe branch treatment.

Tools Used for Tapping

Figure 6.2 shows a range of tools that are used forapplying the tapping technique. Figure 6.3 showsthe tools that are usually easy to obtain from sup-pliers andwhich the author has found easy to use.

One of the characteristics of the tools used fortapping is that they have some kind of a point onthem. But some of these pointed surfaces are a littlesharp; some quite sharp. It is thus important toknow how to hold the tool so as not to cause pain orinjure the child. Generally it is easier to hold thetool out of sight. The pointed end or edge is heldbetween the index finger and thumb of the righthand (if right-handed). The instrument is held sothat the tip of the point is either level with the tipsof the finger and thumb, slightly retracted behindthe level of the tips of the finger and thumb, orslightly protruding beyond the level of the tips ofthe finger and thumb. See the accompanying➤DVD for illustrations of this technique.



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Fig.6.1 Examples of different shonishin treatment tools.

1 Mr. Tanioka uses such a tool; see Tanioka (2001a) and Wer-nicke (2009).



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a b c d

e f

g h

i j

Fig.6.2a–j A range of shonishin tapping instruments.

The tapping is done rapidly with most of themotion coming from the wrist. As the finger,thumb, and instrument touch the skin surface it isgood to allow the other fingers to also touch so as topartially cushion the contact. It is also good to keepall digits relaxed so that as they make contact theybend in a springy manner, thus also cushioning thecontact. This technique is shown on the➤DVD. Theadvantage of this is that the tapping is more relax-ing and comfortable for the child. Often the childonly feels the tap of your fingers and not the instru-ment, thus they can relax more and you are less

likely to provoke reactions. If the tapping comesfrom further up the arm, such as only from theelbow and/or the digits are kept tense, the force ofthe contact is greater; not only can this increase thedose but it can be experienced as more uncomfor-table by the patient as well, thus provoking unne-cessary and unwanted emotional reactions. Themethods of holding and applying the tapping tech-nique are discussed further on the ➤DVD and inChapter 7.

After estimating the amount of stimulation youwant to apply you should hold the instrument so as



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6 Basic Shonishin Treatment Tools 31

a b

c d

e f

Fig.6.3a–f The authorʼs preferred shonishin tapping instruments. a Herabari, b Heragata, c Yoneyama, d Chokishin, e Largeyukoshin, f Small yukoshin.

to give less (point held slightly retracted) or more(point held slightly protruding) stimulation. Youthen tap the region you are working on the esti-mated number of times required, additionally modi-fying the weight of the tap.The dose is thus adjustedaccording to the scale outlined inTable 6.1.

It is generally a good idea to briefly apply tap-ping with the instrument on yourself, for exampleon the back of the hand. This allows you to quicklysee how it feels, andwhether your attempt to adjustdose through how you hold and tap matches thelevel you are attempting to use on the child. Whenit matches you can immediately go on to applyingthe technique on the child. If not, you can readjustwhat you are doing.

Tools Used for Stroking/Rubbing

Figure 6.4 shows the range of tools used for apply-ing stroking or rubbing techniques. Figure 6.5shows the tools that are usually easy to obtain fromsuppliers and which the author has found easy touse.

The tools used for stroking or rubbing come intwo varieties. The first (Fig.6.5a), which is used forstroking or rubbing, has a rounded ball-like surface.The second (Fig.6.5f) has an elongated flatter sur-face that is either rounded or straight and smooth,both of which are used only for stroking. I use theterm rubbing to refer to a back and forth rubbing ofthe skin surface, while stroking is applied in a singledirection. This is an important distinction since,based on the treatment principles outlined above,it is useful to apply stroking only in a downwarddirection, as this helps direct the qi in this direction.In babies and small children this is often a veryhelpful tactic.

Like the tapping tools, it is often helpful to keepthe instrument out of view of the child, in whichcase it should be held within the right hand (ifright-handed). On the accompanying ➤DVD var-ious examples are given of how to hold theseinstruments for stroking. The➤DVD shows how tohold them so that as one strokes or rubs with themthey are out of viewof the patient.

How one holds the instrument and whichinstrument one uses can apply different doses tothe regionworked on. For example, when using therounded ball instrument, allowing the roundedend to protrude slightly out from the surface of thepalm can apply an increased dose. Holding the fin-gers of the stroking hand in such a way that theinstrument is cushioned within them, and thenstroking with both fingers and instrument canapply a lower dose. This is illustrated on the accom-panying➤DVD.

If using the flat surface instrument such as thechokishin, strokingwith the long, flat surface gener-ally gives a little more stimulation and thus higherdose than stroking with the narrower rounded end.

After estimating the amount of stimulation youwant to apply you should hold the instrument so asto give less or more stimulation. You then stroke orrub the region you areworking onwith the numberof required strokes, additionally modifying theweight of the contact. The dose is thus adjustedaccording to the scale inTable 6.2.



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Table 6.1 Dose regulation with tapping technique

Dose/Factor Location of pointed end Number of taps* Weight of tapping

Higher dose Point held level with or slightly protrudingbeyond end of finger and thumb

More Slightly more

Lower dose Point held slightly behind the level of thefinger and thumb

Fewer Less, barely touchingthe skin

* The number of taps on a body area will also vary depending on whether one is using only the tappingmethod for the root treatment,using only a little additional tapping along with the rubbingmethods for the root treatment, or whether one is targeting symptoms andtapping a whole area or a single acupoint.



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a b c d

e f

g h i j

k l m n

Fig.6.4a–n A range of shonishin stroking instruments.



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a b c

d e

f g

Fig.6.5a–g The authorʼs preferred shonishin stroking instruments. a Enshin, b Small enshin, c Round end of spring-loadedteishin, d Yoneyama, e Chokishin, f Bachibari, g Choto.

Table 6.2 Dose regulation with stroking/rubbing technique

Dose/Factor Placement, width of the instrument,and angle of contact

Number of strokes Weight of contact

Higher dose Rounded-ball instrument held level with thefingers

Long, smooth edge

Greater angle to the skin

More Slightly more

Lower dose Rounded-ball instrument held within fingers

Smaller round edge

Smaller angle to the skin

Fewer Less

Tools Used for Pressing

Figure 6.6 shows the range of tools that can be usedfor pressing the skin at specific acupoints. Figure6.7 shows the tools that are usually easy to obtainfrom suppliers and which the author has foundeasy to use.

Tools that are used for pressing have a small,rounded end to them,which is pressed perpendicu-larly to the skin. Usually the pressure applied islight. While the skin is slightly depressed by thepressure of the instrument, it should not cause dis-comfort for the child and certainly not pain. If usingthe spring-loaded teishin, it is important that thespring inside is not too hard. The author has pur-chased a number of different spring-loaded teishinover the years: some have extremely stiff springsinside thatmake the instrument useless for treatingchildren and babies. If one has such an instrumentit can be helpful to either replace the spring with asofter one or to take it out and cut it in half andelongate it; this usually makes the spring softer, butnot always. The Japanese spring-loaded teishinwasinvented by Keiri Inoue, one of the founders of Keir-aku Chiryo (Meridian Therapy). The spring insidethis is suitably soft. A more recent alternative is thetsumo-shin, which comes with a variety of springsso that you can adjust the pressure. For babies andchildren, use the softest spring. If using the spring-loaded teishin or tsumo-shin, one can either pressthe point and hold the mild continuous pressure orbounce the instrument slightly, making sure to notlet the varying pressure cause discomfort. In Chap-ter 10, “Pattern-based Root Treatment,” I describehow to use the soft spring-loaded teishin or tsumo-shin for applying the tonification/supplementationtechnique and draining technique. There, themethod of using the instrument is somewhat dif-ferent fromwhen simply stimulating a point to tar-get symptoms (like LI-4 for teething). I will not dis-cuss those differences here. These are thus veryuseful instruments to possess if one wants to applythe pattern-based root treatments of MeridianTherapy.

If using one of the other instruments for press-ing the point, it can be a good idea to hold theinstrument between the index finger and thumb ofthe right hand (if right-handed) and let the otherfingers of the right hand also touch the skin. It isnot only easier to keep the instrument out of sight

of the child, but the childwill often feel your fingersmore than the instrument and this is usually easierfor them to tolerate. See the accompanying ➤DVDfor illustration of this.

Adjusting the dose of stimulation for simplepoint pressing is brought about through adjustingthe pressure applied, length of time applying thepressure, and if using the bouncing method withthe spring-loaded teishin, the number of bounces,as shown inTable 6.3.

What is described in Table 6.3 relates only to theuse of pressing on the body surface, usually at speci-fic acupoints, in order to stimulate that point tohelp target symptoms. This does not relate to theuse of pressing as part of the root treatment.

Tools Used for Scratching

Figure 6.8 shows a range of tools that are used forapplying the scratching technique. Figure 6.9shows the tools that are usually easy to obtain fromsuppliers and which the author has found easy touse.

The scratching technique is a form of stroking orrubbing but with a greater dose of treatment. Theauthor does not use this technique so much, andyou need to be careful of the following issues if youwish to use the technique:● Make sure that you are clear about the needs of

the child you are treating. If more sensitive, thescratching technique may be better to avoid. Ifthe child is more “excess” type and can toleratestronger stimulation and higher doses, then becareful of the following two points

● Don’t apply the technique too much, and espe-cially not until you see strong red lines appear-ing on the skin. Not only can this be a sign of pos-sibly having given too much stimulation to thatregion, but sometimes parents complain after-ward if themarks don’t disappear quickly.

● In order to understand how well you haveapplied the technique, pay special attention tomonitoring the condition of the skin with touchand visual inspection. Also make sure that thetechnique does not seem to be causing any dis-tress to the child.

When applying this technique over small areas,such as along the index finger to stimulate the largeintestine channel and the points in that area such



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as LI-2 and LI-3, it is easier to use, for example, therough edge of the spring-loaded teishin, yukoinstrument, or the kakibari. When applying thetechnique over larger areas, such as down the back,

the indented surface of the chokishin is the easiestto use, and it gives a milder stimulation. Otherwisethe rollers and needle brush are good to use.



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a b

c d

e f

g

Fig.6.6a–g A range of shonishin pressing instruments.



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a b

c d

e

Fig.6.7a–e The authorʼs preferred shonishin pressinginstruments. a Teishin, b Spring-loaded teishin, c Tsumo-shin,d Small enshin, e Enrishin.

Table 6.3 Dose regulation with pressing technique

Dose/Factor Nature of instrument and number ofbounces with spring-loaded instrument

Pressure applied Length of timeapplying pressure

Higher dose Rounded instrument with point

More bounces of instrument (e.g., 10–20)

Slightly more Slightly more(e.g., 10–20s)

Lower dose Rounded instrument only

Fewer bounces of instrument (e.g., 5–10)

Less Less (e.g., 5s or less)



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a b c d

e f g

h i

j k

Fig.6.8a–k A range of shonishin scratching instruments.

Needle Sets

In Japan one can purchase sets of shonishin tools,usually in sets of seven or nine, in a metal case. Fig-ure 6.10 shows an example of these sets. You mayfind it helpful to have such a set to hand in yourpractice. The various instruments included in eachset cover the range of techniques described here:tapping, rubbing, pressing, and scratching, withmore than one instrument that can be used foreach technique. Some of the sets include instru-ments that are difficult to purchase singly, at leastoutside of Japan. It is not necessary to have such aset, but youmay find it useful.



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a b

c d

e

Fig.6.9a–e The authorʼs preferred shonishin scratchinginstruments. a Chokishin, b Kakibari, c Rollers, dNeedlebrush, e Rough edge of large yukoshin.

Fig.6.10 Typical boxed set of shonishin instruments.



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a b

c d

e f

g h

Fig.6.11a–h A set of basic shonishin treatment tools. a Herabari, b Heragata, c Yoneyama, d Chokishin, e Spring-loadedteishin, f Tsumo-shin, g Enshin, h Enrishin.

Most Recommended Tools

Figure 6.11 shows those tools that are usually easierto obtain and should form the foundation for one’sshonishin treatment tool kit. These tools usuallyhave more than one application. To summarizethose here:

Tapping: herabari/heragata, yoneyama, chokishinStroking: yoneyama, chokishin, round end spring-

loaded teishin, enshin/small Korean enshinPressing: spring-loaded teishin/tsumo-shin,

small Korean enshin, point of enshinScratching: chokishin, edge spring-loaded teishin

Thus, with only a few tools one can start applyingall of the treatment. Through practice you willdevelop your personal preferences for which toolsandwhich techniques to use.

Care of the Tools

None of the instruments pierce the skin and thusthey do not need to be sterilized before use. How-ever, they do need to be kept clean. They can becleaned with rubbing alcohol before and after use.Sometimes a small child will get hold of one of theinstruments and place it in his or her mouth beforeyou or the parent can stop them. If this happens it isgood to wash the instrument with soap and water,and when dry, clean it by rubbing with alcohol.Obviously some of the instruments are dangerousfor a child to place in his or her mouth because theyare a little sharp, or they are small and could beswallowed, so when using one of these instru-ments, such as the herabari, always make sure thatit is placed out of reach of the child when not inuse.

Disposable Tools

In the 1980s after pioneering the disposable nee-dle, the company Seirin started manufacturing dis-posable shonishin tools. Figure 6.12 shows the twotools that were available. There appear to havebeen several purposes for these tools. They comepresterilized in a sealed container and were in-tended to allay fears of cross-infection. Each instru-ment has all four treatment techniques built into it:

a flat edge for stroking, a bumpy edge for scratching,a rounded end for pressing, and either a blunt-needled end or pointed end for tapping.

When these instruments first appeared in theUnited States in the 1980s I found them especiallyuseful to give to parents for home therapy. Theywere not very expensive and were easy to replace,while the regular shonishin tools not only costmore, but are often hard to replace when lost. Theinstruments were also unused and sterile whenfirst given to the parents, which they seemed toappreciate. I will discuss tools used for home ther-apy in Chapter 8. Unfortunately, these disposableinstruments are now unavailable. I have not seenthem in the United States or Europe for a long timeand they are no longer available in Japan. It seemsthat the public fears that were triggered with therise of AIDS and HIV infection in the 1980s, whichtriggered the development of the disposable sin-gle-use needles, is no longer carried to noninsertedinstruments like the shonishin tools. In the 1980s,in that climate, it was thought to be a good idea forpublic relations to present disposable single-useshonishin tools. But time has passed, andwith it theaccumulated experience and greater knowledge ofthe risks involved.



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Fig.6.12 Seirin’s disposable shonishin tools.

Treatment Applications

The instruments that are described in this chapterare used for both root and symptomatic treatment.Chapter 7 describes the use of stroking/rubbingand tapping tools for the “non-pattern-based roottreatment.” Chapter 10 describes the use of thespring-loaded teishin or tsumo-shin and the enshinfor Meridian Therapy “pattern-based root treat-ments.” Section 5 describes the use of the varioustools, especially tapping and pressing tools for tar-geting symptoms.

Monitoring and Assessing TreatmentEffects

As mentioned in the previous chapter, when youapply the tapping technique, if your other hand isfree, you can regularly touch the area you are work-ing on to monitor for changes in the condition ofthe skin. This can be done continuously while youare tapping or stroking. When stroking, your freehand can follow the treating hand alternately.When tapping, you can move your free hand overthe area you are working on as you tap otherregions within that area.

Often when working on a leg or arm area, youneed to secure the limb with one hand while youapply the treatment techniques with the other. Iftapping, you can apply a number of taps, thenquickly touchwith the samehand to see how thingsfeel, apply more taps, then re-check again, and soon. While doing this, you keep hold continuously ofthe limb to keep it extended, unless the child startsto become very resistant and shows an emotionalreaction to what you are doing. If this happens youneed to let go and move on to another area, comingback to finish working on the first area later. This“dance” of the treatment is discussed again in thenext chapter, “The Core Treatment Model.” If youare holding the limb with one hand while applyingthe stroking method, you can hold the instrumentcarefully in such away as to be able to use the fingerof that hand to monitor changes as the instrumentand hand pass over the treatment areas. Theaccompanying ➤DVD shows how to hold theround and flat-edged instruments so that the fingerand edge of the hand are free to stroke behind, andmonitor changes.

The techniques discussed here are illustrated inthe ➤DVD both in the relevant sections and in theclinical examples. It is advisable towatch these por-tions to make sure you have a good clear sense ofhow to touch, hold the instruments, apply theinstruments, monitor the changes, and so on.



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Section 3 Root Treatment Approaches and Techniques

7 The Core TreatmentModel . . . . . . . . . . . . . . . 45

8 Home Treatment and Parental

Participation . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52

9 Pattern-based Root Treatment: Meridian

Therapy Applied to Adults . . . . . . . . . . . . . . . . 55

10 Pattern-based Root Treatment: Meridian

Therapy Applied to Children . . . . . . . . . . . . . . 61



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7 The Core TreatmentModel

This chapter will describe the core treatmentmodel of shonishin andways of varying it accordingto need. As we have discussed, the basic approachfor treating children uses tools that are tapped,pressed, stroked, or rubbed on the body surface.The various treatment tools were described brieflyin the previous chapter. The treatment methodscan be summarized as:

Tapping: rapid tapping to an area or points,usually at a rate of 100–200 times per minute

Stroking/rubbing1: rapid stroking over an areaor along a surface, usually at a rate of 70–100 timesper minute

Pressing: continuous mild pressure to a point orsmall area

Scratching: relatively rapid stroking motionsover an area or along a surface

The easiest way to apply the core treatment, thenon-pattern-based root treatment to most babiesand children, is to use either stroking with addi-tional targeted tapping (Yoneyama and Mori 1964)or tapping alone (Hyodo 1986). Scratching admin-isters a greater stimulation and thus dose, and isonly feasible as an occasional substitute for strokingon childrenwho have an “excess” constitutionwithstronger, fuller body type. It is thus occasionallyused if the stroking is not producing sufficientchanges. Pressing is a way of targeting specific acu-points or small areas of the body, and is thus usedfor stimulating points or areas to target relief ofsymptoms rather than help restore healthier func-tioning. The sections below will describe the corenon-pattern-based root treatment model usingstroking/rubbing and tappingmethods.

The power of this very simple treatment speaksfor itself. There aremany cases described in Section 5that illustrate the effectiveness of this treatment. Idraw attention to the case of Paul, patient of Man-uel Rodriguez, in Chapter 20 (p.139). Given that thedoctors had diagnosed such a serious condition andthat nothing they had done had improved the con-dition, the effects of that single treatment areremarkable.

Precautions and Contraindications ofthe Core Non-pattern-based RootTreatment

This very simple and light treatment helps producechanges in the circulation of children. As a result,one can sometimes see a small temporary increasein body temperature (about 0.5 °C). Because of thisit can be a problem if the body temperature israised with a fever. If the body temperature is 37.8 °C or higher (moderate or high fever) it is contraindi-cated to apply the core non-pattern-based roottreatment described below. When the child doescome for treatment, other strategies are needed.Where there is a mild elevated body temperature(less than 37.8°C) one should check whether toapply the core non-pattern-based root treatment,and if you decide to use it, do so more cautiously.The issue is, that in babies and toddlers, once afever starts, it may “spike,” meaning that it can riserapidly, which is distressing and dangerous. If yourtreatment causes the body temperature to rise a lit-tle, on a feverish child this can trigger a spiking ofthe temperature. Of course, the more commonissue we encounter in clinical practice is that theappointment is cancelled when the child has afever. I mentioned in Chapter 2 that many practi-tioners in Japan tend to work from home or have aclinic in a residential area. The feverish child caneasily be brought for the fewminutes needed to getto the clinic, so practitioners there may not havethe appointment cancelled because the child is a lit-tle feverish. However, in the West, many of us haveclinical practices in non-residential areas or we



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45

1 We use the term “stroking” to refer to a single directionmovement of the instrument, which is stroked gently on thebody surface. The term “rubbing” on the other hand refers tothe use of moving the instrument back and forth in a two-directional movement, usually with soft contact to the bodysurface. In the treatment model described below, we mostlyuse the single directional movement of “stroking.” The rea-sons for this are given below.

have patients coming frommuch further afield. It isvery typical that the parent calls to cancel becauseof the difficulties of traveling with a feverish child,or because of problems in dealing with home carefor other children. This seems to be especially so inHolland where most patients come to the clinic bybicycle.When theweather is cooler, getting a fever-ish child ready to come for treatment can be daunt-ing. Therefore, most of the time, we don’t get totreat feverish children.

If the child is brought for treatment with a fever,follow the precautions mentioned above. When thecore non-pattern-based root treatment is avoided,the simple pattern-based root treatment can still beused, as can some of the symptomatic treatmentsand specific techniques to help lower the tempera-ture such as pressing or needling the jing-well points(see Chapter 28, p.238). There may be occasionswhen a feverish child is brought for treatment andyou are concerned something more serious may beoccurring. Parents should consult their general prac-titioner or pediatrician, if they have not done soalready. Such referralsmay on occasion be needed.

Another precaution of the core non-pattern-based root treatment is that it cannot be appliedover skin lesions. Thus, for the child with eczema oratopic dermatitis, one cannot apply stroking or rub-bing techniques and tapping can only be appliedaround affected skin regions.

On a first visit one needs to apply a milder,lower dose treatment approach. This is necessaryto ensure that you do not over-treat and to give onetime to observe the response of the baby or child totreatment. Then you can adjust doses and techni-ques accordingly in future treatments.

A final note of caution is that in babies it is notuncommon for the core treatment to trigger an epi-sode of loose bowels, as though the intestines werecleaning out. This is normal and not a problem. It isa good idea to caution the parents that this mightoccur and not to worry. If it happens it is usually inthe few hours following treatment and is a one-time occurrence.

Techniques for Basic Treatment

The basic treatment pattern is administered in twodifferent ways. One applies stroking techniques overmost of the body and tapping to one ormore discreteareas, or one only applies tapping over all areas.

Core Root Treatment: Stroking and TappingCombination

If the child will allow you to apply treatment with-out much resistance, it does not matter where orhow you start, or with which technique. If the childis afraid, acting up with the parent, or being resis-tant, it can be useful to have the parent hold thechild facing backward over the shoulder, while youstand behind the child. Treatment begins by apply-ing tapping techniques to the area around GV-12,over the interscapular area.

The Lore of GV-12GV-12 is recommended for pretty much all pedia-tric conditions. Historically, moxa was used as akind of family medicine technique and routinelyapplied on GV-12 on children to prevent illness andhelp recovery from illness. I use it routinely onbabies and children both with tapping and at theend of a treatment with a press-sphere retained onit. It can have a strong calming action.

Example

Once, a mother came for treatment with bilateralsciatica. The sciatica had developed in the last monthof pregnancy. She waited until after her daughterwas born and came for treatment when the baby was2 weeks old. After telling the story of her problems,and responding to questions during the intake, thewoman tried to place her baby back in the crib andthen get onto the table for treatment to begin. Thebaby started to cry and the mother was off the tableto hold and quieten the baby. As soon as she wasquiet, the mother tried again with the same result.This going back and forth from table to baby went onfor a while and I was unable to start treatment. Then,on the next occasion, before the mother could risefrom the table I went over to her daughter, holdingone hand I raised her arm and reached behind withmy other hand, applying a soft small-circular massageover the GV-12 area using the tip of my index finger.The baby immediately stopped crying, relaxed, andfell asleep. Treatment was able to commenceundisturbed. After this, when we were ready to starttreatment on future visits, I would first lightlymassage GV-12 on her daughter, and then treatmentwould begin.Two years later I bumped into the woman on thestreet. She was pushing her daughter in a stroller. As



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46 Section 3 Root Treatment Approaches and Techniques

we talked she excitedly told me that this little trick wehad used for the treatments two years before waswonderful and it still worked! Whenever she neededto help her daughter settle down she would give mildrubbing over the GV-12 area.

If the child is still not settling or remains agitated,one can then apply tapping to other targeted areason the back of the body, such as the occipital area,or low back area (if part of the indicated treatmentfor that child). Or, if no other tapping on the back ofthe body is to be applied, start stroking in a down-ward direction on the back, legs, and arms. (Seebelow for specific areas.)

In the following treatment, we apply strokingalways in a downward-moving direction. We dothis to help counter the natural tendency, due toemotional immaturity of the baby or child, whichtends to disturb the qi and cause an upward move-ment of qi in the body. This upward movement isoften enough to cause symptoms, and so we try tocounter this. The action of softly stroking seems tomove the qi in the direction one strokes in. Thus, itgives one a measure of influence over the move-ment of qi in the body. Interestingly, in Yoneyamaand Mori’s book Shonishin Ho—Acupuncture Treat-ment for Children (1964), the indicated directions ofstroking/rubbing are often the same. Their textdoes not describe treatment of children in terms ofqi and qi regulation, but instead as a simple form ofperipheral nerve stimulation. Their model of acu-puncture is based on modern anatomical models ofthe body rather than TEAM-based models. Thus,they were not thinking about qi or qi movement,yet they only applied stroking along the yang chan-nel surfaces and often in the directions we wouldindicate to regulate qi. While they indicate the useof bi-directional rubbing on the bladder channel onthe leg (back of the leg) and parts of the stomachchannel (lateral to the shins), rubbing back andforth, or up and down, the indicated movement onthe arms is from shoulders to wrist; on the backfrom up to down; on the abdomen following thestomach channel area downwards; similarly on thethighs, following the stomach channel downwards(Yoneyama andMori 1964, pp.40–41).

These directions of stroking will naturally tendto achieve the same effects that we will be deliber-ately trying to achieve, suggesting that this wasfound clinically by them to be the better approach.

Anyway, regardless of how the book by Yoneyamaand Mori places the arrows that indicate strokingor rubbing, we will, following the ideas about qiregulation discussed in this text, always apply sin-gle direction stroking, moving downward on onlythe yang channel surfaces. On the arms fromshoulder to wrists; on the back from shoulders tobuttocks, either side of the spine; on the back of thelegs, buttocks to ankles; on the front and sides ofthe legs (following the stomach and gallbladderchannels) from upper thigh to knee, and knee toankle regions; on the abdomen approximatelyalong the stomach channels from rib margin toabove pubic symphysis.

This stroking constitutes the core of the non-pattern-based root treatment. To this we add tap-ping in the area around GV-12 and the basic treat-ment is finished. Any additional stroking and espe-cially tapping is applied so as to target the specifictypes of symptoms that the child presents with. Fig-ure 7.1 shows the core treatment pattern for babiesand small children.

How much treatment to apply in each area willvary according to the criteria discussed in Chapter4. I give rough guidelines here:● Type 1—extremely sensitive child (infant few

weeks or months old, very weakened child,child with developmental problems)—two softstrokes in each area and approximately 10 tapsin the GV-12 area

● Type 2—sensitive child (6 months to 18 months,skinny body, weakened condition)—three softstrokes in each area and around 15 taps in theGV-12 area

● Type 3—older child (18 months to 3 years, regu-lar body build)—three or four strokes in eacharea and 15+ taps in the GV-12 area

● Type 4—older, stronger child (3 years to 5 years,full body, more acute symptoms)—four or fivestrokes in each area and around 20 taps in theGV-12 area

This gives a rough guideline for the amount of treat-ment dose and treatment contact to give for eachchild. A 6-year-old who is very ill, in a weakenedconditionwill probably need to be treated as type 1or 2 and not as type 4 (the natural type for thatage). The 6-month-old who is very full-bodied,large, “excess” type with more acute symptomsmay be better treated as type 3 rather than type 2(the natural type for the age). The 10-year-old with



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7 The Core Treatment Model 47

mental development problems such as autismshould be treated at first as type 1 until it is clearhow he or she responds to treatment, at whichtime the type can be adjusted, but still may con-tinue requiring the basic shonishin approach (strok-ing and tapping) rather than a simple modifiedform of regular acupuncture. It is useful to remem-ber that following an acute problem such as a badcold or flu, in the week or so after recovery thechild should be treated as more sensitive. I havehad a number of occasions where applying normaltreatment has provoked reactions. Since under-

standing that the acute illness can temporarily sen-sitize the child and lowering the dose accordingly, Idon’t see these reactions anymore.

It is very important that you continuously moni-tor changes to the skin and observe the patient tohelp you judge the dose of your treatment and itseffects on the child. As mentioned above, this is pri-marily achieved through soft touch to the areabeing worked on. As you work on the child, the skinshows signs of change. You need to be attentive tothe smallest changes rather than wait for very clearchanges. It can be helpful to think that the treat-ment triggers a direction of change. You do nothave to wait to feel the full change; you can trustthat the changewill continue on its own for awhileafter you finish applying treatment. Thus, whenyou have an indication of the right kind of changeoccurring, this can be enough of a signal to stop andmove on to the next part of treatment.

I repeat here the basic signs of good treatmentand signs of over-treatment in that region:● The signs of improvement of skin condition are

that the skin texture shows the following typicalchanges: it becomes springier, a feeling of softfullness develops; it may become slightly war-mer. If the skin had been dry it might feelslightly less dry.

● A sign of over-treatment is the skin starting tofeel moist. Onemust pay attention to the earliestsigns of increased moisture and not wait untilthe skin pores are quite open and the skinbecomes obviously damp, or the area startssweating.

As you apply the treatment you may have to adjustit according to how you feel the child responds. Ifthe response is quicker and stronger than you hadexpected, you should start treating even morelightly and doing less as you work on the child. Ifyou don’t feel much change, this does not meanautomatically do more! One should not think withsuch simple additive linear logic. The basic rule wetry to follow is: less is better. If, on the next occasionof treating the child, your assessment is that notmuch has changed and there were no reactions totreatment, then you can think of various strategies,including to slightly increase the dose of the corenon-pattern-based root treatment. Other strategiesyou might think of include adding or modifying thesymptom control treatment methods you haveused, checking whether the pattern-based Meri-



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a

b

Fig.7.1a,b a Core treatment pattern by stroking and tap-ping for a baby. b Core treatment pattern for a small child.

dian Therapy root treatment was appropriate orneeds modifying in some way. A child who shows aslower response to treatment may be reflectingsomething of the severity and chronicity of theirproblems. Simply doing more is not a good thing todo. As clinicianswith training in the practice of acu-puncture we have to be more intelligent than that.We need to think about why this child shows adiminished response and what can we do to alterthat. The basic approach of the core non-pattern-based root treatment can be helpful for a high per-centage of babies and small children, but not all.Sometimes what makes one’s treatment startworking is some simple needling or modification ofa different aspect of treatment, such as adding ormodifying how one applies the pattern-based roottreatment. A similar logic is applied for the tappingonly treatment, which is also a non-pattern-basedroot treatment.

How does one choose between using the tap-ping only and the stroking and tapping combinednon-pattern-based root treatment? This is not aneasy question to answer. For myself, I prefer to usethe combined stroking and tapping model, andoccasionally the tapping only model, but that ispossibly my bias. My reasons for choosing the lattermethods over the former are roughly as follows: ifthe child is very plump and rounder, fuller-bodied,it can be awkward to apply smooth stroking actionson the arms and legs. One tends to fall into theelbow and knee regions in a not so smoothmanner.Also, I have tended to think of the tapping methodas being a bit more “stimulating” and the strokingmethods as a bit more “calming,” thus, I tend to usethe tapping method for the more “excess” or full-bodied type of children. However, I have also mademymistakes, which I hope you will be able to avoidif I explain them.

Example

Around 10 years ago I had a very hyperactive 6-year-old boy come for treatment. His parents were franticand on the verge of putting him into an institution asthey could no longer cope with him. He did not have aparticularly “excess” body type for his age, andseemed slightly quiet while in the treatment room.However, I chose to use only the tapping method onhim thinking that his hyperactivity was a sign ofstrong “excess” condition, and because I had beenable to obtain good calming effects from tapping in

regions like GV-12 and the occipital area. I applied thetreatment quite softly and carefully. Later that day hisparents called to let me know he was even worse thanbefore, and 2 days later that they were reallydesperate and were cancelling the next appointment,instead taking him off to see the doctors inpreparation for institutionalizing him. Not only wasthis bad news for the parents and the child but I wasdevastated. I started rethinking what I had done andwhy. I realized the error of my thinking was thefollowing:Very emotionally distraught patients should betreated with very low dose treatment until you haveevidence that they can deal with more. I had chosen amethod that by my own understanding applied aslightly higher dose, even though I did it very carefully(which I am usually quite good at doing).Perhaps the stroking action will move the qi downwardand this is actually the desired treatment approach fora child who is overactive. I had “stimulated” the child,which would hopefully trigger a calming response.But in such a child, maybe the autoregulatorymechanisms are more disturbed than usual, and notfunctioning well, so my treatment remained asstimulation only and did not trigger the oppositecalming action.

Since this experience I have been much more judi-cious about the application of the tapping method.On children who are very irritable, acting up (theterm is “kanmushisho” in Japanese—see Chapter 2),or have progressed to hyperactivity (see Chapter21, p.154), regardless of the perceived sensitivityor condition of the body in terms of its overallstrength (weakened or full condition) I recommendusing only the stroking method. Not only have I notseen this kind of reaction again, but I have collea-gues reporting good results and some very interest-ing phenomena in such children when the strokingis applied. Additional tapping is given lightly onlyto the appropriate regions such as around GV-12,the occipital area.

The tapping-only, non-pattern-based root treat-ment is shown in Fig.7.2. I have slightly modifiedthe original pictures from Masayoshi Hyodo(Hyodo 1986). His original picture indicates apply-ing tapping on the lung channel as well as yangchannel portions of the arm, and the spleen chan-nel as well as yang channel portions of the leg. Iindicate ONLY on the yang channel surfaces. We do



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not apply the tapping method to the yin channelsurface areas for the root treatment. I have followedHyodo’s recommended number of taps per bodyarea as a basic guideline. These should be modifiedaccording to the dose needs of the child. If the doseneeds are a little less, reduce the number of tapsper area and make the tapping lighter. If the doseneeds are more, increase beyond the indicatednumbers per area and you can allow the tip of thetapping instrument to protrude very slightly andmaybe tap a little more firmly (see Chapter 6 fordiscussion of the dose regulating techniques). Thisshould be relatively clear, and is enhanced by mak-ing sure to recheck the areas worked on by touch tocheck the changing condition of the skin.

The “Dance” of Treatment

Practically speaking, with babies and small childrenwho resist you and/or move a lot you may find thatyou will need to work on those areas that becomeavailable to you and move around a lot before com-pleting your efforts on that area. You have to keep amental note of how much work you have done oneach area (as well as using palpation feedbackthrough repetitive touching) and keep movingaround the different areas until the appropriateamount of treatment (number of strokes, numberof taps) is completed for each and every targetregion. This kind of treatment dancing is very livelyand usually quite enjoyable for you, the patient,and the parent.

Sometimes, parents become stressed that theirchild is acting up, won’t stay still, and sometimesthey keep trying to correct the child’s behavior.This can be an interaction that can potentially inter-fere with your intended treatment. However, usingthis dynamic and flexible “dancing” treatmentapproach, moving around over the different avail-able body areas until all have received your desireddose for each area, can minimize the resistancefrom the child, thereby reducing their emotionalreactions, and minimizing the stress reactions ofthe parent. To help this process, make sure yousmile continuously while you dance the treatment.Laughing and joking a little with the parents canalso be a good tactic. You need to show them that itdoesn’t matter, doesn’t interfere with your treat-ment, and that their child is not doing somethingwrong. For this to work well, you have to really payattention to feedback reactions through touch andbe aware that you can’t stand there and be thinking“What am I feeling?” You have to be able to assessinstantly as you touch and not wait and think aboutit. With a little practice this goes smoothly and canbe very enjoyable.

The process of applying the core non-pattern-based root treatment is shown on the ➤DVD. It isgood to watch this and the treatment demonstra-tions to make sure that you get a good sense of howto do this.

Preferences, Styles, and Approaches

It is possible that you only apply the tapping meth-od and do not use any stroking methods based onpreferences or personal development as your basicapproach for the non-pattern-based root treat-ment. This is fine, as long as you can make it work.It is also possible that you decide you don’t likeusing the tapping methods except to target smallareas or points and prefer instead to use strokingmethods on all patients; this too is fine so long asyou can make it work on all your patients. What Ihave described here is a core treatment model withtwo different approaches to doing it. I can onlydescribe from my experience how I have learned todo this. That is also evolving, as it should if I keeptreating patients. The practice of any medical ther-apy should be a living, evolving thing, not a dead,unchanging tradition. The reader should try thesedifferent methods. After some time your experi-



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25

30

25

30

30

30

15

30

30

50 5020

Fig.7.2 Tapping only basic treatment pattern, showingnumber of taps per body area.

ences will accumulate and your preferences willstart emerging. You may feel that you like what Ihave described here, and try to emulate it. You mayalso feel that there are limitations, and you havetried and found ways around them. There is animportant concept about learning and develop-ment that comes from the Japanese tea ceremonytradition. In Japanese the saying is “shu hari.” Itmeans that first you must learn from and imitatewhat your teachers taught you. Eventually that canbecome a chain that restricts you; you need tobreak that chain in order to move out in your owndirection. My teachers in Japan were all cognizant

of this idea. It is the essence of how we learn andinternalize something, and then how we can makecontributions to the field as we become part of theliving tradition that is that field. These things taketime. In Japan such processes occur over a period ofseveral decades. It is not that you learn it today andchange it tomorrow. I have spent almost 30 yearsusing shonishinmethods. I have made small adjust-ments over the years and tried to match it to myevolving understanding and methods of practice ofacupuncture in the light of my experiences. Finally,I amwriting this book as I feel it may help others inthe treatment of children.



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8 Home Treatment and Parental Participation

In Chapter 2 I mentioned how I began teaching par-ents to do a simplified form of shonishin at home. Ithas proven to be a very helpful tactic for enhancingclinical efficacy. In this chapter I will explain thedetails of how to do this.

The model arose out of the need for more fre-quent clinical visits than could be scheduled. Therewere quite real problems, like distance from theclinic, scheduling conflicts, and so on, but as Istarted using this method, I was also thinking inother clinical terms. It may be very helpful to haveparents participate in treatment so that they canfeel that there is (finally) something that they cando to help their suffering child. When a friend getssick we feel concern; when an adult family membergets sick we tend to feel more concern. But when achild gets sick, especially one’s own child, thesefeelings are often stronger. If the problem does notresolve and is chronic and intractable in nature,many parents develop complex reactions, whichthemselves can tie into the child’s problem, some-timesmaking it more complex. Parents can come inexhausted from lack of sleep, from giving continu-ous attention andmonitoring the sickly child. Someparents can develop feelings of frustration andeven frank helplessness and start to feel over-whelmed, even when they have no choice but tokeep going and keep trying. Some parents can feelguilty about their child’s illness, as though they didsomething wrong, or that they aren’t good enoughto take care of their child.

All of these things canmake the healing environ-ment for the child more difficult. Anyone who hashad children will have noticed that they are verysensitive, and they pick up on all the small thingsgoing on around them, especially with their par-ents. They pick up on and react to the emotionsaround them. This cannot but influence how thingsproceed and develop.Observing this, it was obviousto me early on that it could be very helpful to try toaddress it.

Thinking of a passage in the Nan Jing (Classic ofDifficulties) (circa 100CE) provided inspiration.Nan Jing Chapter 69 describes the following treat-ment principle: “for deficiency/vacuity supplement

the mother.” Of course, in the field of acupuncturethis has usually been taken to refer to five phasetheory (see Chapters 9 and 10). It occurred to methatmaybe if the parent started applying treatmentat home on a regular basis it could be useful to givethe parent tools to help them overcome their emo-tional reactions, make them feel like they could dosomething, and for those more despondent par-ents, make them feel better, especially as the treat-ment started working. Not only would the child betreated directly (by the therapist and parent) butthe child would also be treated indirectly as theparental participation would help improve thechild’s home environmental tensions and stresses,thus aiding the child too.

Over time as I taught parents to use a simpleform of shonishin at home I noticed it is indeed apowerful tool for treatment. I also noticed thatparents who are struggling with their child (the6-year-old child who is hyperactive and very diffi-cult, the baby that is cranky and screams a lot, the2-year-old in the midst of his “terrible twos”), oftenfind a changed relationship with their child. Thehome treatment involves a lot of touching, espe-cially soft, caring touching, which helps the parenttransform the nature of their relationship with thechild, of how the child reacts to them, and how theyreact to the child.1 Thus, wherever feasible I teach asimplified form of shonishin to parents.

Goals

The goals of this home treatment are two-fold.First, to have the parent repeat some minimalaspect of the core non-pattern-based root treat-ment regularly at home, in order to enhance whatis done in the clinic, so as to speed up the treatmentprocess. Second, to trigger an improved relation-ship between parents and child, which helps trig-



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1 I present a simple five-level model of the role of these psycho-social effects in the introductory section of Chapter 17 whereI expand the three-level model from Chapter 9.

ger changes in the psychosocial setting of thechild.

It is important to not have the parent attemptto reproduce more complex things that requirespecialized training, like acupuncture point loca-tion, diagnostic skills, ability to judge subtlechanges, and so forth. Some parents could in prin-ciple be better at this than others, but it is not rea-listic to teach or expect this of them. The difficultyyou face is that there are some techniques that, ifmisapplied could trigger reactions due to over-treatment or wrong treatment. Unlike you thetherapist, the parent is not trained to recognize ordeal with these. You should only teach the parenta shorter, simpler form of basic stroking and tap-ping techniques in a set pattern. For example, ifyou are doing a combination of light strokingalong certain body surfaces and tapping of threepoint/regions, you can have the parent reproducelight stroking on the same areas with fewerstrokes on each, and tap one or two of the point/regions with fewer taps than you apply. The par-ent only applies part of the core non-pattern-based treatment, and this is done to a lesserdegree and lower dose.

Precautions

In general it is better not to start teaching hometreatment of the basic non-pattern-based approachto parents until you have seen the child at leastonce previously, to see how they respond to whatyou do. Judging dosage needs on a single visit ismuch more difficult than after one or more visits,where you get to see how they have responded.With some patients where I am concerned aboutundue sensitivity and possibly needing very lowdose treatments, I wait for a few sessions before Iteach the parents. Sometimes I wait because I amnot sure the parent is able to follow my directionswell enough not to overdo things themselves. Inour modern society there is a tendency to think“more is better” and to think that compassion andcare means doing everything you can. It is easyenough for you as therapist to make these mistakesso imagine how much easier for a frustrated, ex-hausted parent. However, there are occasionallycases where you need to focus on teaching hometreatment from the beginning (see Case 1 in Chap-ter 24, Catherine) because of the distance the family

has to travel for treatment, or other difficultieswith scheduling.

Whenever you decide to start teaching sometreatment techniques to the parent for some hometherapy, ALWAYS make sure to demonstrate on theparent the technique with a tool like the one youwish them to use on the child. Then have themreproduce the techniques on you. Make sure youclearly show how not to do the techniques andrepeatedly what the best approach for their child is.When teaching the stroking, take time to showthem how to hold the instrument (such as a tea-spoon for stroking or cocktail stick/toothpick fortapping). Show what it feels like if you hold it thewrong way, such as when the point of the tappinginstrument sticks out too much and jabs when youtap. Explain the advantage of applying the instru-ment and technique on their own arm first, tocheck what it feels like, before starting on theirchild.

Instruct the parents not to do treatments beforeor after a bath. In general, in acupuncture treat-ment it is better not to do a treatment 1 hour eitherside of a hot bath, shower, or sauna. It is thoughtthat the effects of the bath can overwhelm or undosome of the effects of the treatment. Thus, for dailytreatment at home, the parents should be in-structed towork out a rhythm that does not involveapplying treatment in the hour before or after theevening bath. Usually parents are able towork out agood rhythm with their child for doing treatmentlike this. In the case of children with sleeping prob-lems, including behavioral and urinary problems, itis a good idea to instruct the parents to do the dailytreatment just before going to bed. Often it thenbecomes part of the pattern or habit before going tobed.

Using a drawing, write down where and howmany times youwant them to stroke or tap for eachof the different areas you want them to work on.When you do this, it is usually a good idea to putless than may be optimally required, in case theparent decides to addmore.

The Basic Method

For me, the most common form of home treatmentinvolves the use of light stroking over the followingareas (see also Fig.7.1 in Chapter 7):



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● Down the back● Down the stomach channel on the legs● Down the bladder channel on the legs● Down the lateral (yang) aspects of the arms● Down the stomach channel on the abdomen

To this is added light tapping around GV-12. Addi-tional light tapping can be added to target specificsymptoms, such as around GV-3/GV-4 for lowerabdominal, lower body symptoms; occipital regionfor symptoms of the head, eye, ear, nose throat,face, or behavioral problems.

When teaching this simplified non-pattern-based treatment to parents, I always give them adrawing that shows the body areas, directions ofstroking, number of strokes and number of taps ineach area. Parents might tend to do toomuch if youdon’t specify clearly in writing what you wantthem to do. To help with this, I keep printed copiesof the basic treatment of stroking and tapping cop-ied in black ink. I then draw with a red pen thearrows for stroking and mark with shaded areas fortapping and write the numbers of actions next toeach.

Most parents, in our experience, will applytreatments at home as best as they can, similar towhat you ask of them. You need to monitor thechild to make sure he or she is not being over-sti-mulated. If the parent applies the technique toostrongly or does too much, you might start seeingsome signs of over-treatment. In this case, have theparent explain and demonstrate to you how theyare doing the treatment. On a later visit you cancorrect any misunderstanding and improve theirtechniques.

An additional component of the home therapyoften involves having the parent change the press-spheres regularly at home, in order to help reduceor prevent irritation, and to prolong treatmenteffectiveness. This should be an automatic part oftreatment when you leave press-spheres on thechild as part of treatment. These can be leftthroughout the time between that visit and thenext provided they are regularly changed accordingto the instructions in Chapter 12.

Other aspects of home treatment might involvecare in relation to other treatments such as retain-ing press-tack or intra-dermal needles (see Chapter12) and, of course, any dietary recommendationsyou make. On some rare occasions you may need tohave moxa applied daily at home. For example, incases of atopic dermatitis or severe chronic eczema,one of the best symptomatic treatments is to applyokyu (direct moxa—see Chapter 13) to LI-4, LI-10,LI-11, or LI-15 (choose by palpation) and some-times to uranaitei (extra point) (see Chapter 16,p.88, and Chapter 19). On a younger child this canbe difficult to do, and it is only feasible when doneby you in the clinic at each visit. However, on olderchildren it is possible to have the child receive regu-lar home moxa. Sometimes the parent does this;sometimes the child prefers to do it. An example ofthis can be found in Chapter 19 (p.127), where the12-year-old boy Han decided to do the moxa him-self since his mother’s technique was too hot. Insevere cases such as this, daily home treatmentwith the moxa is what helps keep the symptomsquieter and the childmore functional.



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9 Pattern-based Root Treatment: MeridianTherapyApplied to Adults

In the previous chapters I described the basic sho-nishin approaches of the “non-pattern-based” roottreatment. This root treatment does not requireidentification of specific problems couched in thelanguage and framework of traditional ideas andmethods. Instead, it applies a general treatmentthat helps influence the healing process, regardlessof the specific diagnosis of the child. To do this, thetreatment uses modified forms of a very mild sti-mulation, typically with rubbing and/or tapping.This method takes advantage of the sensitivity ofpediatric patients and the easily accessed homeo-dynamicmechanisms of the pediatric patient.

This chapter describes a simplified approach to“pattern-based” root treatment.1 The term “pat-tern-based” refers to the identification of a specificpattern of disturbances, and treatment of it to helpcorrect the healing process. In Meridian Therapy,the pattern-based approach involves identifyingand correcting disturbances among the 12 channels(or meridians), so that after treatment, the channelsystem is in a more balanced state, thereby aidingthe healing process.

The two treatment approaches combine easilyand naturally, so that it is often helpful to add at leastsome small aspect of this pattern-based approach toshonishin’s non-pattern-based approach. This addi-tional simple treatment usually increases the overalleffectiveness of the treatment, andwill be applied tomany pediatric patients.

There are, however, some patients where theonly form of root treatment that is available is thepattern-based root treatment. This occurs, forexample, in children with fevers or skin lesionsover all or much of the body, such as in atopic der-matitis. In such cases, it is difficult or contraindi-cated to apply any of the techniques used in thenon-pattern-based treatment. The Meridian Ther-apy root treatment approach is then used as theprimary root treatment that is available for those

patients. It is thus important to fully grasp thisbasic treatment approach in order to maximizetreatment for all pediatric patients.

The history, nature, and theories of MeridianTherapy are described in detail elsewhere. It can behelpful to read those articles and books for suchdetails. (For the history and an overview of the sys-tem see Birch 1999; Birch and Felt 1999; Birch andIda 2004. For an explanation of the whole systemand details of its practice methods, see Shudo1990.) In Chapter 10 I summarize the essential fea-tures of Meridian Therapy as they relate to treat-ment of children:● The diagnostic patterns● How to choose the patterns based on age and

willingness of the child● How to treat the patterns and evaluatewhat you

have done● Aword on point locations

Before discussing pediatric modifications andapplications of the Meridian Therapy system, weneed to briefly explain the nature of the thinkingprocesses, diagnostic methods, pattern identifica-tion, and treatment techniques used in normal clin-ical practice on adults.

Basic Theories ofMeridianTherapy

The core treatment approach of Meridian Therapycan be summarized in the following figures (Birch2009):

Figure 9.1 represents an idealized state wherethe channels (level 2—middle circle) are balancedand the internal organ-functional system that theyregulate (level 1—inner circle) is operating at opti-mum, shown by the arrows, and the vitality or over-all energy state of the patient (level 3—outer circle)is very good (shown by the arrows and solid line ofthis circle).

Figure 9.2 represents the state a patient presentsfor treatment. The channel system (level 2—middleline) is distorted by depressions (vacuity) andbumps (repletion). The organ-functional system



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1 For the development of this simplified approach see Birch2010. A number of textbooks were also used, such as Fukush-ima 1991; Ono 1988; Shudo 1990.

(level 1—inner line) that the channel system helpsregulate has been disturbed so that it no longeroperateswell, triggering symptoms, and the vitality(level 3—outer line) is smaller, less solid, witharrows no longer directed outward.

Figure 9.3 represents the effect of treatment,applying supplementation and draining to theappropriate channels so that they return to a stateof balance (level 2—middle circle), which in turnhelps regulate the organ-functional system (level 1

—inner circle) so that it returns to a state of higherfunctioning (indicated by outward directions of allarrows) leading to improvement of symptoms, andimprovement in vitality (level 3—outer circle moresolid and outward-directed arrows).

The basic approach of Meridian Therapy is tocorrect disturbances of the channel system (seen asthe bumps and depressions of the middle line inFig.9.2), using the supplementation method for thevacuous channels (shown as depressions) and, asneeded, the draining method for the replete chan-nels (shown as bumps). The tried and tested rulesofMeridianTherapy instruct us to choose an under-lying pattern of vacuity and treat that, followed bycorrection of repletion disturbances if they arefound, or additional vacuity if found.

A well-performed Meridian Therapy root treat-ment (Chinese “zhibenfa,” Japanese “honchiho”) re-sults in a rebalancing of the channel system (level 2),which in turn helps re-regulate the internal func-tional systems (level 1). This, in turn, increasesoverall vitality (level 3).With themore experiencedpractitioner and a practitioner with the right train-ing, the root treatment also directly increases andimproves the overall vitality, which in turn alsohelps regulate the channel system and thus theinternal functional systems (Birch 2009, Birch inpreparation [a]).



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12

3

Fig.9.1 Idealized healthy state:Level 1—functional systems (zang fu, etc.)Level 2—channel systemsLevel 3—vitality: global qi of the body

Fig.9.2 Patient in diseased-disordered state:Level 1—weakening, dysfunctionalLevel 2—imbalancedLevel 3—weakened 1

2

3

Fig.9.3 Patient after treatment in amore balanced state:Level 1—functions improvingLevel 2—more balancedLevel 3—stronger

MeridianTherapy TreatmentPrinciples

After researching the diagnosis and treatmentmethods outlined in theNan Jing (Classic of Difficul-ties), the original Meridian Therapy study group(founded in the 1920s by Sorei Yanagiya) chose tofocus on the treatment principles described in NanJing Chapter 69:

First, “always supplement before draining”(meaning focus on that which is weak or vacuous asthe first target of treatment, and then apply thesupplementation technique).

Second, “for vacuity supplement the mother.”Here the language of the five phase engenderingcycle is used. In order to supplement a weak lungwe should supplement its mother, the spleen. Sincethe time of thewell-known acupuncturist Sa A’mofKorea in the late 1500s this has been interpreted tomean supplement both lung and spleen channelsfor vacuity of the lungs (Birch, Felt 1999, p.311).Practically speaking this makes no sense unless thespleen is also weak alongside the lung. Thus Yana-giya’s study group examined patients to see if theyshowed these patterns of weakness. The studygroup found that these patterns exist and that theyform the basis of diagnosis and treatment.

MeridianTherapy Diagnostic Methodsand Patterns

These underlying or primary patterns of vacuity arecalled the “sho.” There were found to be four ofthese, which are:● Lung vacuity—involving vacuity of spleen and

lung● Spleen vacuity—involving vacuity of spleen and

heart

● Liver vacuity—involving vacuity of liver and kid-ney

● Kidney vacuity—involving vacuity of kidney andlung

In the case of adults, the process of selecting thepattern on which to focus treatment involves theintegration of different clinical data in an orderlymanner. Current and past symptoms and healthissues are classified in terms of which channelsthey are more likely associated with. The channelsare palpated, the abdomen is palpated (Fig.9.4),and then the pulse is examined, looking for a pat-tern of differences in the six positions (Table 9.1).The pattern is most commonly confirmed by find-ing congruence between the pulse and abdominalfindings, and the other clinical data often supportthis conclusion, but it is not a problem if they donot match. Experienced clinicians such as ToshioYanagishita or Denmei Shudo can gather and inte-grate this data very quickly.



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Table 9.1 Radial pulse—channel correspondences

Left wrist Channels Right wrist Channels

Left cun Arm tai yang/SI and arm shao yin/HT Right cun Arm yangming/LI and arm tai yin/LU

Left guan Leg shao yang/GB and leg jue yin/LV Right guan Leg yangming/ST and leg tai yin/SP

Left chi Leg tai yang/BL and leg shao yin/KI Right chi Arm shao yang/TB and arm jue yin/PC

Fig.9.4 Typical five phase channel correspondences.

Figure 9.5 shows a simple diagrammatic way ofsummarizing the findings of an examination of thesix yin channel (deeper) pulses. A circle is a rela-tively normal strength pulse; a dot is a relativelyweak pulse. Thus, finding stiffness, discomfort onthe right side of the abdomen (ST-25 to ST-27 area)with relative weakness in the right cun and guanpulses (lung and spleen channel pulses) is a sign ofthe lung vacuity pattern being present. Figures 9.6–9.9 show the core palpation findings that help oneselect each pattern.

MeridianTherapy Treatment andTreatment Techniques

Once the pattern is selected, treatment usually fol-lows. The same principles that helped guide selec-tion of the pattern (from Nan Jing Chapter 69) alsoguide selection of the typical treatment points foreach pattern. The points that are usually selectedfor treatment are:Lung vacuity pattern: LU-9 + SP-3Spleen vacuity pattern: SP-3 + PC-7Liver vacuity pattern: LR-8 + KI-10Kidney vacuity pattern: KI-7 + LU-8

Experience found that it is usually better to needlethe pair of points on one side of the body only. Sim-ple guidelines have been developed to help withdeciding which side to treat:● If there is a symptom or symptoms on only one

side of the body, supplement the other side. Forexample, painful right shoulder and neck: treatthe points on the left side.

● If there are symptoms on both sides or internalsymptoms, for males treat the left and femalestreat the right.

Typically in Meridian Therapy very thin needles areused. Shudo (1990) uses mostly 0.12-mm gaugeneedles; others may use slightly wider gauge, butno more than 0.16-mm gauge. Needles are to be



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Normal pulse Lung and spleenweak

Fig.9.5 Diagrammatic representations of the six yin chan-nel (deeper) pulses—all “normal” and spleen and lung weak.A circle is a relatively normal strength pulse; a dot is a rela-tively weak pulse.

Fig.9.6a,b Abdominal andpulse pictures for the lungvacuity pattern.

a b

Lung and spleenweak



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Fig.9.7a,b Abdominal andpulse pictures for the spleenvacuity pattern.

a b

Spleen and heartweak

Fig.9.8a,b Abdominal andpulse pictures for the livervacuity pattern.

a b

Liver and kidneyweak

Fig.9.9a,b Abdominal andpulse pictures for the kidneyvacuity pattern.

a b

Kidney and lungweak

inserted painlessly and shallowly (0.5–2mm) in thedirection of the flow of the channel. The needlesare retained for a fewminutes, but this amount var-ies by practitioner and patient—usually around10minutes can be good. But within the field ofMer-idian Therapy there are also many practitionerswho use noninserted needling methods, such asthose we find in the Toyohari (East Asian needletherapy) style of Meridian Therapy. This kind ofneedling technique requires a lot of structuredstudy in order to be safely and effectively used onpatients—see the discussions in Chapter 11.

This brief introduction to Meridian Therapydescribes the essentials of the treatment system.However, to use it effectively on adults, it is neces-sary to not only read the more detailed texts thatare available, but also to study with a qualified tea-cher(s) in appropriate courses and programs (seeAppendix, p.254). With practice, the diagnosis andtreatment of adults becomes easy and routine. Thetreatment of children is another matter altogetherthough. While the basic system remains simple, anumber of practical issues require that we modifythe approach considerably.



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10 Pattern-based Root Treatment: MeridianTherapyApplied to Children

Diagnosis to Select the PrimaryPattern in Children

Selecting the primary pattern in children oftenneeds to be done quite differently. Abdominal diag-nosis can be difficult to do, or is unclear. On babiesand small children, the whole abdomen often feelsfull, rounded, and springy with unclear or no regio-nal differences; on older children the abdomen isoften ticklish. Either of these can make abdominaldiagnosis difficult for the inexperienced practi-tioner. Pulse diagnosis can also be difficult to do, orbe very unclear. Babies and small children will notstay still, and in addition, the positional and depthdifferences are hard to discriminate because theregion where you palpate the arteries is very small.Altogether this makes pulse diagnosis on babiesand small children difficult.

Even when you are able to palpate the pulses,you generally cannot spend much time palpatingthe pulses on children; many young children arenot very patient andwill not stay very still for long-er periods of time. A simpler and easier approach isneeded. To do this we take advantage of the factthat babies and young children will tend to mani-fest symptoms that arise out of their constitutionaltendencies. As people age, lifestyle issues start trig-gering problems in addition to those associatedwith their constitutional tendency, so that the clini-cal patterns become more complex. On babies andyoung children this is not usually the case and wecan take the symptoms as a reasonable indicator ofthe pattern to focus on.

Typical Symptoms Associatedwith Each ofthe Four Patterns

Lung vacuity pattern: breathing problems; skinproblems; easily catching cold, and so on; allergicconstitution.

Spleen vacuity pattern: digestive problems;nourishment problems (the child that is underde-veloped, “failure to thrive”).

Liver vacuity pattern: behavioral problems; sleepproblems; muscle spasm or spasticity problems.

Kidney vacuity pattern: birth defects; physicalor mental development problems; slow develop-ment; cold feet, urinary problems such as bed wet-ting.

As children become older (age 6 or so and older) weare usually able to apply the other diagnostic meth-ods and follow and identify the changing condi-tions. Thus, while this simple rule for making adiagnosis based on symptoms can still be followed,sometimes one finds through palpation diagnosisan evolved pattern already, due to lifestyle andother factors.

Typical Examples of the Four Patterns● The 10-week-old baby who will not settle or

sleep well, cries a lot, is typically a liver sho-typepattern (see Case 1, Chapter 21). In this casesome basic pulse informationwas accessible, theleft deep pulses felt weaker than the right deeppulses, supporting the selection of the liver pat-tern. No clear signs were apparent on the abdo-men.

● The 4½-year-old child who repeatedly catchescold, has chronic nasal congestion/infection, andtends to develop cough easily is a typical lungvacuity pattern patient (see Case 2 in Chapter26). The pulse of the right wrist at a deeper levelwill generally appear weaker than the samedepth pulse on the left wrist.

Obviously, things are not always this simple. Thereare, of course, patients with more complex condi-tions, due to having more complex constitutionaltendencies, early influence of lifestyle issues, influ-ence ofmedications, or othermedical interventionslike surgery. The symptom and medical history pic-tures are more complex and one has to thinkthrough the possible pattern and eventually chooseone for treatment.



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61

Examples of More Complex Patterns● The 5-year-old hospitalized patient with very

severe and serious digestive disturbance due toan improperly developed gastrointestinal sys-tem (see Case 1, Chapter 27). This patient hadboth spleen (digestive problems) and kidney(developmental disorder) patterns, and bothpatterns needed to be treated. While the pulsediagnostic information was accessible, it wasnot possible to palpate the abdomen and com-plete a normal (adult) assessment. The pulsefindings helped differentiate how to focus thetreatment as a primary spleen pattern (spleenand heart pulses weak) with kidney secondarypattern (kidney pulseweak).

● The 12-year-old boy with a long history ofsevere atopic dermatitis. While the child mayhave started out as a lung-vacuity-type patient,the extensive use of steroid creams eventuallytriggered signs and manifestation of the kidneyvacuity pattern (see Case 1, p.127). Since theboy was more mature it was possible to obtainother diagnostic information to make this deci-sion. The pulse, abdominal, and other palpationfindings supported the identification of whichpattern to treat. At first he was treated as a lungpattern, but later it became clear that kidneypatternwas better for him.

Diagnosis to Select Additional Steps ofRoot Treatment

What is described above covers basic details ofselecting the primary pattern, but, depending onthe child (age, maturity, condition) and your skills,it may be useful to also treat the secondary patternand even the yang channels. In an adult, after sup-plementing, for example, LU-9 and SP-3 to addressthe primary pattern of lung vacuity pattern, LR-3may also be drained as well as TB-5 and BL-58. Thedecision to drain each point is based on findingrelative strength with hardness in the pulse posi-tion depths corresponding to each channel (leftdeeper guan pulse, right surface chi pulse, and leftsurface chi pulse). The decision in each case is notbased on location or nature of the symptoms, butinstead only on the pulse findings. As one can ima-gine, in children where pulse diagnosis can be verydifficult because of the factors discussed above,these judgments can be very difficult to make. It is

enough to apply treatment to the two main pointsfor the primary pattern and stop there. This, whenwell performed, is enough.

Those with experience using the Meridian Ther-apy system of acupuncture in normal clinical prac-tice, may find that the additional judgments ofwhich yin channel is involved as secondary patternand which yang channels show disturbance areeasier to make. Then application of treatment toappropriate additional points can be done.

But for those who have no prior experiencewiththese methods and judgments, it is better to stayaway from trying to do this until you have com-pleted a course of training in Meridian Therapy anddeveloped an understanding of what the pulsechanges feel like that indicate application of drain-ing techniques. As described in Chapter 4, it is bet-ter to apply less treatment in order to regulate thedose of treatment. Unless one is really clear aboutsuch steps of treatment, do not do them; stick withthe simplified treatment of the primary pattern.

Modifying Point Selection forTreatment of the Primary Patterns

The usual point combinations for the four patternsare listed above. These are based on a systematicinterpretation of Nan Jing (Classic of Difficulties)Chapter 69 theory and confirmed through clinicalexperience. The theory predicts which channels toapply the supplementation technique to and onwhich points to apply treatment on those channels.In the lung vacuity pattern, lung and spleen chan-nels are vacuous, thus treatment is directed to bothof these, and usually LU-9 (the mother/supplemen-tation point). But it may be advantageous to modifythe points on the targeted channels using otherclinical ideas. There are many theories of pointselection, just as there are many schools and stylesof acupuncture (Birch and Felt 1999). A simple the-ory that complements the basic Meridian Therapymodel comes from Nan Jing Chapter 68. This chap-ter talks about the use of the five shu points accord-ing to certain symptomatic manifestations, whichwe can extend into modern clinical practice—seeTable 10.1.

Some of these indications are clear. For the childwith fever use the ying-spring points instead of theusual points, for example LU-10 and SP-2 instead ofthe usual LU-9 and SP-3for the lung vacuity pattern



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patient. But clinical experience has shown us thatwe can extend these indications, partly as extendedinterpretations of what the Nan Jing describes andpartly based on their five phase correspondences.Table 10.2 lists examples of how we might extendselection of acupoints from Table 10.1.

Examples of Modified Point Selections● A 1-year-old child with lung vacuity pattern but

with fever: LU-10, SP-2 instead of LU-9, SP-3.● A child with atopic dermatitis with more severe

lesions on the upper part of the bodywho showsthe kidney vacuity pattern: KI-10, LU-5 insteadof KI-7, LU-8

● The liver vacuity child who comes with early-stage cold symptoms without fever: LR-4, KI-7instead of LR-8, KI-10

● The spleen vacuity child with symptoms ofchronic diarrhea: SP-9, PC-3 instead of SP-3, PC-7

Usually we start treatment with the common pointcombinations once we have chosen the pattern forthat child, and, if after some treatment(s) you feel ata later visit that progress is not enough, you can trythe modified point selections. It is, of course, allright to start treatment on the first visit with amodified point selection provided the condition ofthe child very clearlymatches. Onmost patients weuse the common or typical point combinations fortreatment.

TreatmentMethods inMeridianTherapy

Following the traditions of Meridian Therapy thatemerged during the 1930s, needle techniqueseither involve the sensationless or at least painlessvery shallow insertion of very thin needles for sup-plementation techniques, or the use of noninsertedneedlingmethods.

Sensationless or painless needling requires theuse of the correct type and gauge of needle, andreasonable skills with practice. If needles areinserted, they are retained for a few minutes, forexample up to 10minutes on adults.

Noninserted needling is completed quickly,once the qi reaction has been felt and one hasresponded appropriately to it. However, the use offine needles without insertion requires eitherconsiderable self-developed experience that hasevolved through decades of practice, or a systema-tic training program with qualified and experi-enced teachers. Programs such as Toyohari that



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Table 10.1 Shu-stream point indications—Nan Jing Chap-ter 68

Acupoint Indications

Jing-well Feeling fullness and discomfort below thesternum

Ying-spring Fever or feelings of body heat

Shu-stream Joint pains or heaviness of the body

Jing-river Cough, alternating fever and chills

He-sea Counterflow qi, leakage of fluids such asdiarrhea

Table 10.2 Shu-stream point indications—extended uses

Acupoint Indications

Jing-well (wood) Epigastric pain, bloated abdomen, especially epigastric region

Ying-spring (fire) Fevers, overheated child (the very active child)

Shu-stream (earth) The lethargic child with difficulty raising limbs, problems of the limbs; chronic digestive problems

Jing-river (metal) Cough, cold-flu symptoms, lung problems in general; alternating fever and chills; skin problems ingeneral such as eczema

He-sea (water) Counterflow qiwith signs of heat above and cold below—this can show in some very kidney vacu-ous children; it also shows in children with skin disease such as eczema, atopic dermatitis, with avery reddened appearance around the head, face, neck, more inflamed-looking lesions on theupper part of the body; leakage of fluids such as diarrhea, urination problems, very runny nose

teach noninserted needling require at least a yearof careful repetitive studywith qualified teachers.

When treating children, especially babies andvery small children, these techniques can be diffi-cult. It has already been discussed how the inser-tion of needles in the desired manner can be diffi-cult, so it is not a good idea to attempt this on aregular basis. With good insertion technique theretention of needles for a while, especially at keytreatment points on the extremities, can also poseconsiderable challenges. Babies and small childrenrarely stay still enough for such needles to stay inplace. Even with the use of noninserted needlingmethods there can be difficulty, as the childrenwillnot stay still and can have a tendency to bump intothe needle tip, and then they feel a needle prick,which usually is distressing.

Thus, an alternative approach is needed onbabies and small children and even older childrenwho are very afraid of needles. We can take advan-tage of the high sensitivity and responsiveness ofchildren (see discussions in Chapter 4) and are ableto use the blunt-tipped needle, the “teishin” (seeBirch and Ida 1998, pp.50–51) instead of a regularfiliform needle (Fig.10.1). Keiri Inoue, one of thefathers of the Meridian Therapy movement,extended the teishin’s use further by developingthe spring-loaded teishin, which is ideal for usingwith babies, or on small and frightened children(see Fig.10.2a).

With sufficient training the teishin can be usedfor applying treatment on adults. The high sensitiv-ity of children makes them sufficiently responsivethat with minimal training it is possible to treatthem effectively with the spring-loaded teishin. Thetechniques for using the spring-loaded instrumentfor a pattern-based Meridian Therapy root treat-ment are easy to learn and easy to apply.

The teishin that is to be used on babies and chil-dren must have a very soft spring inside, so that itgives little pressure to the skin and certainly no dis-comfort at all. The spring-loaded teishin made inJapan is usually good for this. An alternative is the“tsumo-shin” (Fig.10.2b), which comes with a vari-ety of springs, the softest of which is good for usewith babies and children. The tsumo-shin is avail-able from companies in the United States and else-where (see “Treatment Equipment,” p.254).

Treatment TechniquewithSpring-loaded Teishin

After selecting the pattern to be treated one shouldsecurely hold the limb and place one’s finger andthumb of the left hand together (the “oshide” orsupporting hand position) over the acupoint to betreated—being careful to not be forceful or triggerresistance (see the accompanying➤DVD for details).Notice how the other fingers of the hand lightlyhold the limb of the child so as to help secure thelimb (non-forcefully) and to stabilize the acupoint.Place the point of the teishin carefully between thefinger and thumb so that it touches the skin at



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Fig.10.1 Teishin

a

b

Fig.10.2a,b a Spring-loaded teishin, b Tsumo-shin.

approximately 90° to the acupoint (see accompany-ing➤DVD).

Without delay, softly and slowly press andrelease the teishin handle so that the teishinbounces slightly on the acupoint. Do this severaltimes and then remove the teishin, making a veryslight pressure between the thumb and finger ofthe oshide as the teishin is removed slowly awayfrom the skin. There are several important points topay attention to:1. When you place the teishin between the finger

and thumb over the acupoint, place it so that theround point protrudes very slightly frombetween the finger and thumb.

2. Make sure that the pressure and bouncing onthe skin is very light.

3. You may press and release/bounce three ormore times to get the effect.

4. When you do this you should be relaxed andquietly focused on the acupoint you are treating.

5. The younger or more ill the child, the fewerpresses and releases/bounces are necessary toregulate the dose.

6. Remove the teishin slowly at first, allowing thefinger and thumb to close over the end of theteishin. The different aspects of this techniqueare covered in detail on the accompanying➤DVD.

If you are doing the draining technique with theteishin, place it to the skin between the finger andthumb in the same manner. The movement isquicker and the pressure is slightly more so that itis very slightly stimulating. The teishin is removedslowly without any increase of pressure betweenthe finger and thumb of the oshide. This is coveredin detail on the accompanying➤DVD.

It is important if you have not taken a shonishinworkshop and studied this technique directly tofirst study the ➤DVD, comparing how the twotechniques are applied and then to try them ononeself before trying them on pediatric patients.You must become comfortable with the techniquesso that they feel natural and unrestrained beforeyou try them on a child. Your hesitation may beinterpreted differently by the child.

Point Location of MainTreatmentPoints

Many textbooks of acupuncture detail the locationof the acupuncture points that are to be treated.The trend started as early as 280CE with HuangfuMi’s attempt to systematize the knowledge of acu-puncture in his Zhen Jiu Jia Yi Jing (The First Sys-tematic Classic of Acupuncture and Moxibustion).However, not only were early descriptions muchmore vague than those we use today, but the ear-liest literature on acupoints specified them as notbeing anatomically based entities, rather as placeswhere qi comes in and goes out of the body.1 Thesetwo factors have encouraged many variations indescriptions of the acupoints, which have invari-ably tried to focus on anatomical landmarks to helpthe practitioner remember where to apply treat-ment. These inherent point location variations areself-evident to anyone studying different modernforms of acupuncture. It should thus not be surpris-ing to the reader that the point locations describedbelowmay be different fromwhat you have studiedin acupuncture school. Additionally, as explained inChapter 2, the acupoints are not yet fully maturedin babies and small children; they are more likezones rather than discrete points, thus, the kind ofanatomical precision that is required on adults fortreatment to be effective is less of an issue on babiesand small children.

Below, we cover the basic location of the majortreatment points and the typical reactions that arepalpated at those points so as to helpmake localiza-tionmore precise:

LU-9 is at the juncture of the edge of the tendonextensor pollicis between the tendon and radialartery, on thewrist crease.

LU-8 is along the same ulnar edge of the tendonextensor pollicis level with the high point of thestyloid process.

LU-5 (following historical descriptions) is locatedon the artery in the elbow crease. The brachialartery is palpable in the elbow crease and on most



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1 I have been working on a chapter, “The jingmai and qi—acu-puncture perspectives,” which partially addresses the natureof the acupoints, for the book by Cabrer Mir, Birch, and Rodri-guez, The Jing Mai & Qi: Premedical and Medical Constructions

and Uses (Birch, in preparation [b]).

people is located on the ulnar side of the tendon ofthe biceps brachial muscle. The point is located onthe radial edge of the artery in the elbow crease.Straighten the elbow to feel the artery.

PC-7 is between the tendons of flexor carpiradialis and palmaris longus on thewrist crease.

To find KI-10, place the index finger on the popli-teal fossa and pull it medially until it meets the pos-terior margin of the sartoriusmuscle.

LR-8 is on the anterior margin of the sartoriusmuscle and is touched by the thumb as one softlypinches the muscle between finger and thumb. It ison the line between the middle of the patella andKI-10 as it intersects the anterior margin of the sar-toriusmuscle.

LR-8 and KI-10 MUST be found and treated withthe knee straight!

KI-7 is about 2cun above the level of KI-3 alongthe anterior margin of the Achilles tendon.

To find SP-3 wiggle the big toe from side to side.The tendon of the abductor hallucis brevis musclealong the spleen channel can be identified. SP-3 ison the lower margin of this tendon as it intersectsthe proximal margin of the distal head of the firstmetatarsal.

Since the needling is shallow, to find the treat-ment points, touch very softly to examine the con-dition of the skin. The point will show signs ofweakness: such as a small depression, softness,weakness, swollen/puffy feeling, sticky feeling.

To locate the point most precisely and to helpplace the treatment tool (needle or teishin) to thepoint more precisely, it is advised to softly strokealong the channel flow with the ulnar distal cornerof the index finger. Once signs of weakness arefound in the vicinity of the point you want to treat,stopmoving the finger and place the thumb next tothe finger over the point. This process is shown onthe➤DVD.

Five Phase Correspondences andClinical Practice

The system of Meridian Therapy, following themodels proposed in the Nan Jing, utilizes five phasetheory extensively. Five phase theory has two mainaspects to it. First, the cycles of interaction, such asthe engendering (sheng) and restraining (ke) cycles.These form, in accordancewith Nan Jing Chapter 69ideas, the backbone of the diagnosis by patterns in

Meridian Therapy. The other main feature of fivephase theory is the “theory of systematic corre-spondence,” including the multiple correspon-dences that each phase has. Examples of these cor-respondences are shown inTable 10.3.

We do not use many of these correspondencesto form the diagnosis of the patient in MeridianTherapy. Classification of some of the signs in Table10.3 can be difficult, such as the precise smell andcolor. On adults it has become common to use thesesignsmore in terms of overall assessment of patientcondition rather than choosing treatment. If some-thing clear shows on a child, it can also be used inthis way.

One of the principal issues that comes up formany of those studying Meridian Therapy whohave a background in TCM or other Chinese-basedmodels of acupuncture practice lies in the role ofexternal climatic factors and the classification bysigns or association. The Huang Di Nei Jing Su Wen(The Yellow Emperor’s Inner Classic—Basic Ques-tions) and Nan Jing clearly describe different corre-spondences in relation to external factors thatmostly relate to climatic influences (Shudo 1990,p.27). This can be confusing, but in practice, bothsets of correspondences seem to be applicable, thuswe need to be flexible and not so theoretical in ourapproach.

If a child shows a lot of phlegm or mucus, thecondition is not automatically (as seems to be com-mon in TCM practice) seen as being spleen related.However, if the mucus is disturbing the digestivefunctions (such as causing blocked nose with anos-mia (lack of sense of smell), leading to poor appe-tite, this could eventually become spleen related.Likewise, the heavily congested lungs with a lot ofphlegm and chronic coughing, could if, for example,the repetitive coughing triggers problems of regur-gitation or vomiting, be seen as spleen related.

For the child whose symptoms are worse whencold, one needs to look at other factors to see if thisis lung or kidney related; one cannot automaticallyassume one or the other. If the feet tend to easilycool, this is kidney related, if the hands easily coolthis is lung related. However, if the peripheral cir-culation in all limbs is diminished and both handsand feet tend to be cool, you need to examine othersigns to differentiate.

A final comment on the external (including cli-matic factors) is also necessary. In TCM and otherstyles of acupuncture, great care is paid to differen-



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tiating the presence or effects of these different fac-tors. However, in Meridian Therapy, it makes littledifference in practical terms which is present orcreating problems.2 We apply the draining needletechnique regardless of whether the affliction wascold, damp, heat, wind related and so on. The drain-ing needle technique is varied more in relation tothe relative strength of the hardness felt in thepulse position of the channel that is being drained,rather than the more abstract classification system.Similarly, by and large, we do not vary the acu-points that we treat on the basis of these factors.Rather, if we vary choice of acupoints, we tend touse the ideas above fromNan Jing Chapter 68.

Assessing Treatment Effectiveness

With the core non-pattern-based root treatmentwe see a range of changes on the body surface inthe skin condition and texture, and changes oftonus of the underlying tissues. These changes canalso occur with the pattern-based root treatment,but they can be less obvious than with the corenon-pattern-based treatment. It is useful to keepmonitoring the condition of the skin and underly-ing tissues to see if that also changes further withyour pattern-based root treatment. But these arenot the most common things we pay attention to inthe pattern-based root treatment.

When we use Meridian Therapy on adultpatients we can see quite specific changes in thepulse and other findings that can be used as feed-back for how well you have done the treatment



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Table 10.3 Common five phase correspondences

Correspondence Wood Fire Earth Metal Water

Channels Liver + gallblad-der

Heart + smallintestine+ pericardium+ triple burner

Spleen +stomach

Lung + largeintestine

Kidney + bladder

Season Spring Summer “Long summer”or 18 daysbetween seasonperiods

Autumn Winter

Color Green Red Yellow White Black

Odor Rancid Burned Sweet Frowzy Rotten

Voice Shouting Laughing Singing Wailing Groaning

Tastes Sour Bitter Sweet Spicy Salty

Orifices Eyes Tongue Mouth Nose Ears

Tissues con-trolled

Muscles/sinews*

Blood vessels Flesh* Skin/hair Bones

Climate (SuWen) Wind Heat Dampness Dryness Cold

Climate (Nan Jing)(external factors)

Wind Heat Overeating/overdrinking/overwork

Cold Dampness

Emotions Anger Joy Pensiveness Grief Fear

* Clinically, the difference between the liver controlling the “jin” or sinews and the spleen controlling the “ru” or flesh (including themus-cles), is that with liver problems themuscles are usually tight, in spasm; with spleen problems the muscles are usually weakened, thepatient feels the limbs are heavy.

2 This is not the case in all styles of Meridian Therapy, but forwhat is described in this chapter it is so.

(Birch 2009). The pulse quality will move towards amore healthy state. How is this understood anddefined? If we note the basic pulse qualities ofdepth, strength, and rate, you will notice that thesetend to move towards their healthier state. Ahealthy pulse is one that is not too fast, not tooslow, not too strong, not too weak. On babies thepulse rate is always rapid; this generally won’trespond much, just as the slow pulse on an athletewill tend not to changemuchwith treatment. Thus,on babies and small children the rate of the pulse isnot usually very sensitive to treatment. On olderchildren (over age 3) you can feel the pulse ratechangemore easily.

Thus, on a baby, if the pulse had been weak andmore superficial, it will be less weak and less super-ficial after the root treatment. For a child whosepulse was weak, a little deep and little rapid, thepulse changes following successful needling will bethat the pulse becomes less weak, less deep, andslows down. Likewise for the pulse that is strong,rapid, and more floating; it will sink, soften, andslow down. It is thus a good idea to get a quick

sense of the pulse quality before you start treat-ment and monitor the pulse quality periodicallyduring and after the treatment. This can give youfurther information about how well you haveapplied treatment and/or the extent to which thechild responds to treatment. On adults, a goodtreatment also triggers changes in breathing: thebreath often becomes slower and more rhythmic.We often see the patient become more relaxed.These are also good signs to look for in the child.

But regarding all of these signs it can be difficultto obtain the information clearly when the child isupset, moving a lot, being resistant, playing toomuch. You have to practice making your observa-tions very quickly and without hesitation. Thetouching of the body surface can be done quicklyand unobtrusively, but palpating the pulses can betricky. Often the child is a bit calmer as you applytreatment and he or she will let you feel the pulses.But just as often the child will have had enough,and want to stop the treatment so he or shebecomes more resistant. The only way to improveon this aspect of treatment is to practice.



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Section 4 Symptomatic Treatment Approaches andTechniques

11 Needling . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71

12 Dermal Needles and Associated

Techniques . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 76

13 Moxa:Okyu (DirectMoxa) and

Chinetsukyu (WarmMoxa) . . . . . . . . . . . . . . . 80

14 Kyukaku—Cupping . . . . . . . . . . . . . . . . . . . . . . . 84

15 Shiraku—Bloodletting (Jing Points and

Vascular Spiders) . . . . . . . . . . . . . . . . . . . . . . . . 85

16 Point Location—Location of Extra Points

for Symptomatic Treatment . . . . . . . . . . . . . . 88



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11 Needling

Once the root treatment has been administered, inmost cases one then adds some light stimulation totarget relief of the symptoms of the child. What isdone, where, and with what level of dose variesconsiderably depending on age, sensitivity, symp-toms, and overall health of the child. Some of theshonishin tools and treatment techniques can beapplied to start addressing symptoms. The mostcommon technique is the use of tapping at specificacupoints or over specific regions of the body; thenext being the application of gentle pressure tospecific acupoints. Most regular adult acupuncturemethods can also be used on children, providedthey are modified and made suitable for the child.This includes the use of needling, moxa, cupping,bleeding, retention of press-spheres, intra-dermalneedles, or press-tack needles. This section willcover the tools and methods of applying them onbabies and children. The book Japanese Acupunc-ture: A Clinical Guide (Birch and Ida 1998) coverseach of these techniques in detail in individualchapters. What is described below should be com-plemented by reading the relevant chapters of thatbook. The accompanying ➤DVD also describes thetechniques of needling, moxa, and use of the press-sphere, press-tack needle, and intra-dermal needle.Please watch the relevant sections of the➤DVD forfurther details of these techniques.

In general when inserting needles into a baby orchildwe have two simple approaches:● The “in and out”method: the needle is inserted,

manipulated slightly for a short while and thenwithdrawn

● The “retained needle” method: the needle isinserted and retained for a while, a techniquecalled “chishin” in Japanese

For the in and out method, after insertion the nee-dles are usually manipulated slightly with an upand down movement of the needle for a few sec-onds and then withdrawn. For the retained needlemethod, after insertion the needles are left for aslong as 2 minutes or more, the time depending onthe condition of the child, sensitivity of the child,and whether he or she stays still or not. The techni-

ques of insertion are illustrated in the accompany-ing➤DVD. In order to understand how to use thesetechniques on babies and children it is necessary toconsider a number of important issues. It is usuallythe insertion of needles and the fearful reactions ofthe child that have made use of acupuncture onbabies and children something to avoid for manyacupuncture practitioners.

In Chapter 2 I discussed the development of sho-nishin and the likely influences that gave rise to it.One of these is that inserting needles can be diffi-cult on babies and children because they find itpainful or distressing. This is not only stressful forthe child and his or her parents, but also for thepractitioner. Further, one of our primary goals intreatment is not to trigger unnecessary emotionalexpressions and outbursts since we are, as practi-tioners of traditionally based acupuncture, inter-ested in helping regulate the qi of the patient, notcause it further disturbance. Therefore, we have tothink about how we are to needle a child, where thereactions can be quite unpredictable. Before discuss-ing the actual techniques of treatment in detail, Ifirst discuss the handling of the child and parents,and choice of needles and other instruments.

Needle Types

In order to needle a child and minimize emotionalreactions to what you do, you must use the rightkind of needle. It is desirable that the child does notfeel your needle or at least does not feel it as athreatening, uncomfortable, or painful thing. Thus,we use only high-quality thin needles. The needlesshould be the thinnest available, 0.12mm or0.14mm gauge (Japanese number 00 or number 0,respectively). We also need to use needles thathave the smoothest possible surface. Anyone whohas looked at needles under a microscope will havenoticed that despite the unmagnified visual appear-ance of being smooth, needles are actually notsmooth. Their surfaces have small bumps anddepressions in them. This is a normal part of needleproduction. These bumps and depressions cause



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71

surfaces that can be felt more on insertion. In orderto counter this problem, manufacturers of syringeneedles developed a technology whereby the sur-face of the needle is exposed tomaterials that give asuper thin coating on the surface of the needle, sothat they become very smooth, and when looked atunder a microscope they appear completelysmooth. This minimizes the sensations of beingneedled, making them easier to use. Since at leastthe 1980s the Seirin needle company has beenmanufacturing needles using the same technology,giving their needles a very smooth surface, whichreduces discomfort or pain on insertion (Fig.11.1a,b). It is ideal to use 0.12-mm or 0.14-mm Seirinneedles (Fig.11.2). This does not mean that youcannot try using other brands of needles, but withless smooth surfaces the chances are that the childmay feel themmore easily.

When the child feels the needle being inserted itcould be experienced as pain, which can provokecrying, anger, and fear reactions, or they can experi-

ence sensations that draw their attention to the nee-dle. Either way, the retained needle method canbecome difficult if not impossible. The child will dowhatever he or she can to remove the needle. If theneedling is experienced as painful or uncomfortablethe child will often move around a lot, making it dif-ficult for you to do any small manipulations of theneedle if you are not going to retain it. Further, if thechild pulls away suddenly after a needle has beeninserted it could cause more discomfort or a smallscratch, which are also undesirable. In order toensure these problems do not occur, or to minimizethe risk of them occurring there are, of course, anumber of other things youmust pay attention to.

Needle Sensations and Timing of theNeedling1

The most common form of needling today is themodern Chinese “TCM” style, which insists that onemust “get qi” (de qi) for the needling to be effective,and describes the sensations of when you “get qi”as being something that the patient experiences:“throbbing, aching, numbness, tingling, electric”sensations (Cheng 1987). This interpretation of“getting qi” is so well known that almost no onethinks to question it. In my experience of teachingpediatric acupuncture treatments, this however, isprecisely the issue that makesmany acupuncturists



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72 Section 4 Symptomatic Treatment Approaches and Techniques

a

b

Fig.11.1 Comparison of needle surfaces with (a) and with-out (b) coating (Pictures by laser microscope x20).

Fig.11.2 A box of 0.12-mm, 30-mm long plastic handleneedles with a few needles laid near the box.

1 In an important passage about needling, theHuang Di Nei JingLing Shu (The Yellow Emperorʼs Inner Classic—Spiritual Pivot)

tells us about the importance of timing (Chace and Bensky2009).

fearful of treating children. These sensations onadult patients can be experienced as uncomfortableor even painful, and it is even more so on babiesand children. Fortunately, we can “get qi” withouthaving to provoke these sensations in the patient.First, the interpretation of “getting qi” that I havejust described is a modern Chinese understanding.The earliest historical sources2 that describe need-ling methods, make statements about needling and“getting qi” that are quite different.3 The historicalliterature either quite explicitly describes the “get-ting qi” as something the practitioner experiences4

or as a refined technique that by implication issomething that the practitioner must necessarilyexperience in order to apply the needling prop-erly.5 I say this not to insist on “right” and “wrong”ideas; rather, I want the reader to understand thatthere is an historical tradition of “getting qi”wherethe practitioner is the onewho feels something, notnecessarily the patient. One can find several Chi-nese and Japanese authors who have good discus-sions of this issue.6

In some of the treatment demonstrations in theaccompanying ➤DVD you can see me needling achild using a teishin needle, where the needle is notinserted, andwhere I focus on creating a qi reactionthat I feel before removing the needle. The develop-ment of the ability to perform this needling takestime.7 By completing a structured program such asthe Toyohari Meridian Therapy program, the basicsof it can be learned after a year of study. On yourown it can take many years. Shudo describes how itcan take up to 10 years (2003, p.236). Of course,one does not want to have to wait up to 10 yearsbefore being able to apply the needling techniques

and be able to influence the patient. How dowe getaround this problem?

In Chapter 10 I discuss noninvasive needlingmethods using a spring-loaded teishin for supple-mentation and draining techniques.8 Here I focuson the insertion of needles using the in and out orretained needle methods as a way of targetingsymptoms. In Chapter 4 I discussed the fact thatpediatric patients are very sensitive; some incred-ibly so. This heightened sensitivity is important interms of regulating the dose of treatment. It is alsoimportant because it makes the child respond veryquickly to treatment whether you or the child feels aqi reaction or not. When you tap a needle into anacupoint on a child, this triggers change and reac-tions very quickly. You do not need to take time try-ing to create these reactions or to see if you are sen-sing them or not. We assume that there has been aqi reaction whether you or the child felt it or notand sowe respond accordingly.

Thus, for the in and out needling method, afterthe needle has been tapped in, the needle is movedup and down on an amplitude of around 1mm afew times and then removed. Following my tea-chers’ recommendations I feel it is better not to tellyou to focus on feeling the qi arrival (which youprobably will not be able to do for a while); rather,it is better to focus on whether you can feel theresistance at the tip of the needle as it is lightlymoved up and down. If you do, and as the needle ismoved you feel a change in that feeling of resis-tance, then this is the time to remove the needle.Even this feeling of resistance at the tip of the nee-dle is very subtle, and something you will notimmediately get a sense for. Thus, the simplestapproach is to move the needle up and down a fewtimes according to the idea of dosage needs youhave for the child. For example, for a lower dosemove the needle up and down four or five timesover 2–3 seconds, and for a greater dose maybe sixor seven up and down movements over 3–4 sec-onds, whether you feel anything or not. The impor-tant thing to remember is the issue of dosage. If youtry to take time to feel these things and you are not



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2 The Huang Di Nei Jing Su Wen (The Yellow Emperorʼs Inner

Classic—Basic Questions), Huang Di Nei Jing Ling Shu and theNan Jing (Classic of Difficulties).

3 Yang (2007).4 See, for example, Chapters 78 and 80 of the Nan Jing

(Unschuld 1986: 635 and 646).5 See, for example, Chace (2006), Chace and Bensky (2009), and

Birch (in preparation [b]).6 See, for example, Shudo (1990, 2003), Yang (2007), Wang

(2008).7 Feeling something is one thing and can come very quickly, but

understanding what you are feeling and having the appropri-ate response to that, this is what takes time and/or structuredstudy—see the discussions of needling from Ling Shu Chapter1 (Chace and Bensky 2009).

8 In a recent publication I wrote about what is happening whenwe apply the supplementation needlingmethod (Birch 2009),and in a planned book chapter in CabrerMir, Birch, and Rodri-guez, The Jing Mai & Qi: Premedical and Medical Constructions

and Uses, I have addressed this issue in more detail (Birch, inpreparation [b]).

yet able to do this reliably and quickly, you will takemore time than you have for the technique and runthe risk of over-treating the child. Do not do this.

For the retained needle method the issue of tim-ing is also important. The fact that the needle hasbeen inserted will provoke qi reactions. But youhave applied the technique on a point where youwant the stiffness in the underlying tissues tochange, for example for the stiff muscles aroundGB-20 to soften up.While there will be a qi reac-tion, without additional needle manipulations ittakes a short while for the local tissues to respond,hence we leave the needle for 1–3minutes. As wellas judging according to the dosage requirements ofthe child (leave the needle for less time for themore sensitive, more time for the less sensitive),you can watch the reactions and behavior of thechild to give you a sense of when to remove theneedle. If the child starts to become calmer whenthey had been more active, and his or her complex-ion improves, it is enough: remove the needle; ifthe child starts to show an interest in trying toreach the placewhere the needle has been inserted,it is enough: remove the needle; if the muscles lookless tight around where you have needled, it isenough: remove the needle.

Needle Insertion

It is important that your needling is not uncomfor-table. Often (especially with the retained needlemethod) you do not want to draw the child’s atten-tion to the inserted needle, and so it is preferablethat he or she feels nothing and certainly nothingdistressing. How to do this?

On babies and small children you cannot negoti-ate with them; you simply get permission from theparent. Once you are ready to needle, it depends onwhere you needle as to how to proceed. Sometimes,you need to needle a point without the child seeingwhat you have done. For the area around GB-20,have the child sit, give him or her something tofocus on in front of them, then, hiding the tube andneedle in your hand, reach behind the child, findthe point (stiff muscles) place the tube and needle,press it slightly into the skin and tap it so that theneedle inserts as much as the tube will allow withone tap.Then continue tapping on the tube—thisgives the child the impression that you are simplyapplying tapping technique (with which he or she

is already familiar) over the area. Since the needlewas not felt, the child cannot tell that you haveinserted a needle. If you are applying the in and outtechnique, then remove the tube, apply the up anddown movements of the needle quickly, and thenremove the needle. If applying the retained needlemethod, simply remove the tube, leaving the nee-dle inserted into the point. Remove the needlewhen enough has been achieved.

If the acupoint you want to needle is, for exam-ple, on the hand, such as LI-4, you will normally beusing the in and out method. Have the child liedown, have the parent distract the child or give thechild something to hold with the other hand. Takethe hand you want to needle and place yourselfbetween the child and his or her hand (in the spacebetween the side of the body and the arm), so thatyour body blocks what you are doing from the viewof the child. Insert the needle as described, withadditional tapping; remove the tube; give the fewup and down movements; remove the needle thengive the hand back. If the child did not feel theinsertion they have no idea that you just needledthem. With this method it is important to hold thearm/hand of the child so that he or she cannot pullit back while you are performing the needle techni-que. Don’t grasp the limb tightly, hold it softly butfirmly. Here using your “oshide” or supportinghand (see Chapter 10) can be important and useful.As you start to look for the LI-4 acupoint securelyhold the wrist/arm of the child between your thirdto fifth fingers and the palm/base of the hand. Yourindex finger and thumb are free to find the pointand secure it, placing the tube with needle in thespace between the thumb and index finger (the“oshide”). While the needle and tube are heldbetween the thumb and index finger securely andwithout moving over the point, your other threefingers are securing the arm/wrist of the child in agrip between finger and palm of the hand. You keepthis grip at all times while you insert and manipu-late the needle. This not only helps prevent thechild from pulling the limb back, but it allows youto move with the moving limb without moving theneedle and tube placement at the acupoint.

If the acupoint you want to needle is on theback, such as BL-20, you can apply the retained nee-dle method. But this area can be very sensitive forneedling. Thus, with the child lying on his or herabdomen, find the point, place the needle and tubeat the point, press the tube firmly into the skin so



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that it gives a clear sensation of pressure, tap theneedle quickly into the point, applyingmore taps togive further distraction from the needling.

On a younger child it can be easier to insert aneedle, for example into LI-4, in front of the child.The 2-year-old does not know that you are holdinga needle. He or she will watch you needle the pointand move the needle, but because it is quick andpainless, they only feel the tapping of the tube, anddo not become frightened or upset.

Generally you will want to use the in and outneedling method on acupoints where the child willnot stay still, on points on the limbswhere the child

canmove the limb to look at what theymay be feel-ing, and on children who are in the oral phase andyou want to make sure they do not grab the needleand try to place it in their mouth. The retained nee-dle method is easy to use on the back of the bodyand on older children who will stay still for you.Needling techniques are described on the accompa-nying ➤DVD and in the book Japanese Acupunc-ture: A Clinical Guide (Birch and Ida 1998, pp.60–77).



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12 Dermal Needles and Associated Techniques

Ryu—Press-spheres, Empishin—Press-tack Needles, and Hinaishin—Intra-dermal Needles

Press-spheres are used very frequently on children.They are easy and safe to use. The Pyonex press-tack needles are next most commonly used and arerelatively easy and safe to use on children. Intra-dermal needles are generally easy and safe to useon children, but their care and precautions aremore than for the other two, and so they tend to beused less frequently. These three tools provide amild continuous stimulation of the acupointbetween visits with you.

Press-spheres

These are small metal balls that come on a piece oftape ready for placing on the body. There are anumber of different brands and types. The mostcommon brands are the “Accu-Patch” or “Magrain.”The Accu-Patch comes in stainless steel, gold plated,and silver plated. TheMagrain comes in gold plated,silver plated, copper plated, and zinc plated. Thetype that you will need will be either the stainless-steel or gold-plated types. To place them, it is betterto use tweezers so as not to reduce the stickiness ofthe tape.

Empishin—(Pyonex) Press-tack Needles

The press-tack needles are retained on the acupointfor a number of hours or days. The press-tack nee-dles I recommend are a relatively new design typefrom Seirin. For children, use the very short 0.3-mm(orange-coded) or 0.6-mm (yellow-coded) and verythin (0.20-mm gauge) needles (Fig.12.1a,b). Themetal needle is embedded into a solid plastic base,placed on tape, and presented in pre-sterilizedeasy-to-use packaging. They can be administeredwithout the use of tweezers.

Hinaishin—Intra-dermal Needles

The intra-dermal needles are short needles that areleft inserted into the acupoint for a number ofhours or days. I recommend the use of the “Spinex”needles from Seirin (Fig.12.2). For children use the3-mm-long needles (0.12mm gauge). They areindividually packaged and pre-sterilized. To handleand insert these needles you need to use tweezers.They do not come on a piece of tape and have to betaped separately after they have been inserted.



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a

b

Fig.12.1a,b Box of 0.3-mm (a) and 0.6-mm (b) long Pyo-nex with a few needles on the side.

Selecting between Use of Intra-dermalNeedles, Press-tack Needles, andPress-spheres

In order to use the press-spheres, press-tack nee-dles, and intra-dermal needles to best advantage,we need a good strategy for selecting betweenthem. Here, it is useful to consider the relative doseeffects of each instrument.

The press-sphere is non-invasive; it applies alight stimulation through soft pressure to the acu-points. The new Pyonex press-tack needles areinvasive, inserting a very small amount into theskin (0.3mm or 0.6mm), giving a mild stimulationto the acupoints that is greater than the press-sphere and that increaseswith the increased lengthof the press-tack needle. The intra-dermal needlesare invasive and insert more into the body than thepress-tack needles. We usually use 3mm-longintra-dermal needles for children, which meansthat the portion of the needle that is inserted intothe body is 1–1.5mm long. Thus, the intra-dermalneedles give a slightly higher dose than the press-tack needles.1 We can visualize these three treat-ment methods in terms of a continuous dose range,where the intra-dermal needle gives the greater

dose, the press-tack an intermediate level dose, andthe press-sphere the lower dose (see Fig.12.3).

The dose of treatment we apply is thus varied bychoice of the instrument we choose to leave on theacupoints. Dose is also varied by the length of timethat the instruments are retained and of course thenumber of places you choose to retain something.

In general, we always assume that the patient ismore sensitive and thus start out using press-spheres to stimulate the treatment points. If, afterusing press-spheres we do not find enough changein the symptoms wewere trying to target by leavingthe press-spheres, and we see no signs of over-treat-ment, we can then increase the dose by trying thepress-tack needles instead. Then, if there is stillinsufficient treatment effect, we can increase thedose by trying intra-dermal needles on a future visit.An example of this logic is the treatment of the extrapoint, the asthma shu point on an asthmatic child,for example. At first we place press-spheres on thesepoints after the root treatment. After a couple oftreatments we notice no change in the asthmasymptoms and no signs of over-treatment. Then weleave 0.6-mmpress-tack needles for a day and a half,to be replaced by press-spheres. If there is still nochange in the symptoms and there are no signs ofover-treatment, we start leaving intra-dermal nee-dles to give a stronger treatment effect.

Precautions

There are certain precautions in the use of thesethree instruments that are important to pay atten-tion to.

Press-spheres and press-tack needles should notbe used on areas that receive a lot of pressure, suchas the buttocks. Neither should be given any furtherstimulation by parent or patient. They should notbe touched until removed.

Generally do not leave needles or press-spheresof different metals, for example, stainless-steelpress-tack needle on one point and a gold-platedpress-sphere on another. The metals should alwaysbe the same. Thus, if you want to leave only press-spheres, they can be all stainless steel or gold pla-ted. If you want to leave, for example, a press-sphere on GV-12 and press-tack needles on theasthma shu points, since the press-tack needles arestainless steel, the press-sphere should also be ofstainless steel.



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Fig.12.2 Box of 3-mm Spinex with a needle on the side.

1 Although the Pyonex press-tack needles are too new for thereto have been much literature published on them in Japanesethat helps distinguish their use from the older press-tack nee-dles, intra-dermal needles, or press-spheres, I have beenusing them for enough time to be able to make a few com-ments on them. Generally the 0.6- and 0.3-mm new press-tack needles seem to deliver a smaller dose of treatment thanthe intra-dermal needles.

If using an intra-dermal needle there are someimportant rules for their use:● Always follow skin folds, and if no skin folds are

apparent, insert the needle along with the flowof the channel that the acupoint lies on.

● Insert the needle almost flat to the skin.● Don’t insert the intra-dermal needle more than

half the actual length of the shaft of the needle(for the 3-mm needle this means insert the nee-dle about 1mm).

● After inserting the intra-dermal needle alwaysmake sure it is not too deeply inserted, so if youpress on the handle you should see the point ofthe needle raise the skin.

● Leave the intra-dermal needle for a number ofhours and never more than 3 days. If the child isolder and plays sports, it is better to recommendthat the parent remove the needle before theactivity starts.

● Tape the needle with two pieces of tape, a smallpiece under the handle of the needle and a lar-ger piece over the top of the needle. Make surethat the larger piece is longer than the length ofthe needle and covers the needle completely. Asyou tape the needle, stretch the skin slightly—this will help counter the normal movements ofthe skin, which could tend to loosen the tape.

● The parent should be given instructions aboutwhen and how to remove the needle. If theintra-dermal needle causes discomfort it shouldbe removed.

● Instruct the parent in the safe care of the needle:that is, do not rub the area where the needle isplaced too vigorously. When drying after ashower or bath, be careful drying that region. If

the tape starts peeling up at the edge, place anew piece of tape over the edge to protect it, orremove the needle.

● Do not place more than one needle (intra-der-mal or press-tack) along the path of a channel.For example, do not leave needles at both rightBL-18 and right BL-23. Occasionally this can betoo much stimulation and can be too much forthe patient.

The press-sphere provides continuous pressure tothe point on which it is placed. Over time, this canirritate the skin. To prevent unnecessary skin irrita-tion Hyodo (1986) recommended changing themregularly. After 1 or 2 days2 have the parent removethe press-sphere. When it is removed a smalldepressionwill be visible where it had been placed.Place another press-sphere right next to the point,but not in the depression. Repeat this every 1 or 2days, moving around the original spot you placedthe first press-sphere. This reduces the risk of irrita-tion and keeps the acupoint continuously stimu-lated. Give the parent a strip of press-spheres sothat they can replace them regularly at home. If theskin does become irritated, which happens in asmall number of cases, or through prolonged sti-mulation of the same point, stop applying thepress-spheres until the skin has healed.



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78 Section 4: Symptomatic Treatment Approaches and Techniques

Press-spheres(PS)

Stimulationmethod

High

Moderate

Mild

New press-tack needles

(PT)

Intra-dermalneedles

(ID)

DoseFig.12.3 Graphical representation ofthe relative dose of the three treat-ment methods.

2 For the more sensitive child with thin sensitive skin, changedaily. For other children, change every other day.

Application of Press-spheres,Press-tack Needles, and Intra-dermalNeedles

To place the press-sphere you need to be careful notto touch the tape with your fingers as this willreduce the stickiness of the tape. Always use twee-zers. Peel the tape with press-sphere above thestrip it comes on, holding the tape by only a smallportion. Find the point to be treated, lightly stretchthe skin, and quickly press the tape and sphere ontothe point, making sure with the pad of your fingerthat the tape sticks all theway around its edges.

To place the new Pyonex press-tack needle, tearopen the packaging of the needle to expose it. Theneedle is on a piece of tape, placed onto a paper sur-face. Fold down the plastic base of the container theneedle comes in. This exposes the edge of the tape,which adheres to a small piece of white non-stickypaper. Pick up the needle holding it by the piece ofpaper. As you do this, the tape and needle arepeeled off the rest of the surface they were origin-ally placed on. Now the needle is ready to beinserted. Making sure not to touch the tape at allwith your fingers, find the point to be treated.Stretch the skin slightly, then quickly place the tapeand needle on the point, pressing with the pad ofthe finger tomake sure that the tape sticks all alongits edges smoothly. The child should not feel theinsertion of this needle.

To place the intra-dermal needle, carefully openthe top of the packaging that the needle comes in,

making sure not to drop the needle. I recommendholding the needle firmly between the middle fin-gers pressed together on the outside of the pack-aging. Then slowly peel back the packaging toexpose the handle of the needle. Then using twee-zers, carefully grab the needle by the handle. Thetweezers need to have a good grip on the handle sothat the needle does not move. When you find thepoint to be treated, decide the angle and directionof insertion of the needle. For example, if insertinga needle at the asthma shu point, angle down theback; for BL-23, angle towards the spine. Place thetip of the needle at the point to be treated, in thecorrect angle for insertion, then slowly while press-ing the needle tip gently into the skin, pull the skinfrom behind so that the skin is made to slide upover the needle. By this method the needle isinserted without pushing the needle and is muchmore likely to be painless and sensationless. Oncethe needle is inserted, check visually how much ofthe needle appears to be inserted (it should beabout one-third to half the length of the needleshaft), adjust as necessary by pulling the needle outa bit or inserting a bit more, then press on the han-dle of the needle tomake sure that the tip raises theskin. Tape by placing a piece of tape on the skinunder the handle, and then a larger piece over theneedle and smaller tape. As you place the tape,slightly stretch the skin to ensure better adhesion.

These three methods are described in the accom-panying➤DVD and eachmethod is described in thebook Japanese Acupuncture: A Clinical Guide (Birchand Ida 1998, pp.139–1583, 165–171, 175–180).



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3 The book describes the use of the older press-tack needles;while different it is useful to read this for additional informa-tion. The new Pyonex press-tack needles are much easier andsafer to use than the older press-tack needles.

13 Moxa:Okyu (Direct Moxa) and Chinetsukyu(WarmMoxa)

There is a long history of moxibustion practice inJapan involving both folk uses and medical uses byacupuncture practitioners andmoxibustion specia-lists. Today, in Japan, there are separate licenses foracupuncture and moxibustion, which allow for ahigh degree of specialization in the use ofmoxa andfor an extension of its uses into areas where it iscurrently not used by most acupuncturists outsideof Japan. Much of the practice of moxibustion inJapan was based on historical precedents in China.1

There have been a number of specialized classicalmoxibustion books from China especially followingthe appearance in the 12th century of a separatetradition of moxa practice that appears in the pub-lication of the Huang Di Ming Tang Jiu Jing (YellowEmperor’s Ming Tang Moxa Text). By the 16th cen-tury in Japan, practitioners had begun imitatingthis tradition of independent moxibustion practice.Although moxibustion is primarily practiced as aclinical specialization in Japan today, it is still acommon, though a less popular practice, to havepatients apply some form ofmoxibustion techniqueon themselves or have a family member do it forthem as a form of home therapy.2

A number of moxibustion specialists such as Isa-buro Fukaya (Fukaya 1982) who practiced for over60 years, his student Seiji Irie (Irie 1980), now theleading proponent of Fukaya’s style, Takeshi Sawa-da who inspired a whole generation of practi-tioners with his uniquely brilliant and powerfultreatments, and his student Bunshi Shiroda (Shiro-da 1982), all studied the Chinese historical litera-ture extensively. For example, one of Fukaya’s favor-ite texts was the Huang Di Ming Tang Jiu Jing.

Although these men are relatively modern in theirtechniques, much of their work originated in theirstudies of the classics. Between them they haveauthored many moxibustion specialty textbooks,which form the basis for much of the modern prac-tice of moxibustion in Japan. Practitioners of sho-nishin have generally incorporated elements ofthese trends and styles into the treatment of chil-dren.

The practice of moxibustion can be divided intotwo general categories. These are the “direct” and“non-direct” types of moxibustion techniques. Themost common form of moxa used on children isone of the direct methods, called “okyu.”3 This sec-tion will describe details of the technique and howto decide when to use it. This technique involvesplacing very small pieces of moxa on the skin andburning them down so as to deliver a small pinch ofheat or a stronger heat sensation. The other “direct”moxa technique I will describe briefly is the “chinet-sukyu” moxa technique. While not commonly usedon children, it can be a very useful technique forcertain problems. It uses much larger cones ofmoxa than the okyu method and gives either nosensation of heat or a definite hot but comfortablesensation of heat.

For those unfamiliar with the history of moxauses in China and modern uses in Japan it is usefulto note that the okyu technique is used to treat all ofthe same diseases and symptoms that are usuallytreated with acupuncture. This extensive utiliza-tion occurs because moxa is not used to add heat tothe point, in the manner that TCM has chosen tostart using moxa, but rather as a method of stimu-lating the point, just as a needle stimulates thepoint. The conditions routinely treated with okyuinclude many conditions that would be contraindi-cated for the use of moxa in TCM because of thepresence of “heat.” But since themethod is not usedto add heat, these contraindications do not apply.Besides, there are many questions in China todayabout the wisdom of this modern TCM restriction



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1 Beginning with the Zu Pi Shi Yi Mai Jiu Jing (Eleven Vessel

Moxa Text), and the Yin Yang Shi Yi Mai Jiu Jing (Yin Yang Ele-

ven Vessel Moxa Text) (both of which were found in theMawangdui graves, dating from the 2nd century BCE) (Harper1998).

2 For further reading about the historical development ofmoxi-bustion see Understanding Acupuncture (Birch and Felt 1999),Japanese Acupuncture: A Clinical Guide (Birch and Ida 1998),and Chasing the Dragon’s Tail (Manaka et al. 1995, pp. 348–352). 3 See Birch and Ida 1998, pp.105–111.

of the use of moxa (Tian and Wang 1987; Wang,Tian, and Li 1987). In the Japanese moxibustion lit-erature there are long lists of diseases and symp-toms treated with moxa. The method is empiricalrather than theoretical. Experience has shown thatcharacteristic reactions occur at certain acupunc-ture points in the presence of certain symptoms ordiseases. One thus palpates the points indicatedwhen those symptoms or diseases are present. Ifthe points show the characteristic responses onpalpation, one applies moxa to those points. Themethod has proven highly effective for the relief ofsymptoms.4

Okyu—The Physiology of Direct Moxa

In the early part of the 20th century, moxibustionbecame well known because of its successful use inthe treatment of chronic infectious diseases such astuberculosis. Following this a number of studieswere made of the physiological effects of directmoxibustion, and ongoing work continues to inves-tigate these. It is believed that moxa has a strongnon-specific effect to stimulate the immune system(Manaka et al. 1995, pp.353–354; Young and Craig2009, 2010), and that it also stimulates anti-inflam-matory responses. While it is thought to do otherthings as well (Manaka et al. 1995, pp.353–354), itis the immunological and anti-inflammatoryeffects that are of interest to us. These effects makethe okyu (direct moxa) technique useful when wewant to more strongly influence the immune sys-tem on a patient who has recurrent infections,difficulty recovering from an infectious disease,problems with oversensitivity to environmentalfactors such that they have severe allergic reactions(such as asthma, skin problems), or chronic inflam-mation problems (such as we find in children withsevere asthma, skin disease). It can be a difficulttechnique to apply (for reasons discussed below),but can be the treatment of choice as a way ofaddressing the symptoms more efficiently. It is alsoa good technique for the chronically rundown childwithweak constitutional tendencies.

Precautions and Contraindications for theUse ofOkyu

The following are a few contraindications and pre-cautions for the use of okyu—direct moxa:● On inflamed areas or inflamed joints, one

should not burn moxa on points within or onthe inflamed area; one should select and treatlocal points that are proximal and distal to theinflammation.

● Generally, burning moxa on the face is notrecommended.

● Avoid using moxibustion when the patient isvery hungry or just after eating a bigmeal.

● Avoid the use of moxa in very serious cases, suchas the last stage of cancer, a very high fever, orextreme fatigue.

● Avoid usingmoxa for an hour before or after tak-ing a very hot bath or sauna.

● Avoid using moxibustion over large blood ves-sels.

● Avoid the use of okyu over areas of dermatologi-cal diseases.

● Care should be taken when using moxa on dia-betic or allergic patients because the site ofmox-ibustion therapy can more easily become irri-tated or problematic than on nondiabetic ornonallergic patients. When applying moxa on adiabetic patient, one usually selects points onthe torso only.

● When applying moxa to points, it is always agood idea to locate and treat the points, keepingthe patient in the same position throughout thetreatment.

DirectMoxaMethods

In order to use okyu—direct moxa—on a child, youalways need to get permission from the parent,which usually means you have to explain what youare doing and why you want to use the moxa. Mostpeople understand the above explanations aboutthe physiological effects of themoxa andwhy it canbe useful.

For the okyu technique a special “pure” moxahas been developed. It is yellow in color rather thanthe usual green of the moxa plant. Japanese puremoxa has no dust or particles from the dried plant;only the cottony substance of the moxa is used inthis grade of moxa.



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4 For moxa treatments see: Manaka et al. 2005, pp.206–217,and Birch and Ida 1998, pp.126–130.

The moxa is rolled into a shape that minimizesthe area of skin contact with the burningmoxa. Ori-ginally, moxa was rolled into round pieces thatcould be as big as a mung bean or adzuki bean. Itwas compressed relatively hard so that when itburned down to the skin it delivered a considerableheat that causesmuch discomfort and a clear roundburn where the moxa had been placed. In Japan inthe modern period, the shape of the moxa has beenmodified so that it is shaped like a grain of rice andabout the size of a half grain of rice. The moxa isalso softly molded to shape rather than compressedto shape. The surface area of skin affected by theburning moxa is thus considerably smaller whenthesemoxa cones are stood and burned on the skin.It also burns with less heat and for a shorter periodof time, which reduces the discomfort of the moxa,making it easier to tolerate and accept. The sizes weuse on children are a half rice grain or sesame seedsize, and shaped like a grain of rice, standing on theskin.

The points we treat with moxa generally showstiffness, a knot, pressure pain, or a jumpy reactionwhen they are palpated. After you have found thepoint to be treated, mark it with a pen. In order toget the moxa to stick to the point, we use a slightamount of water on the point to make the skinslightlymoist. Special moxa rings are made for this;these are inexpensive wide clasp rings that have ahalf cotton ball wedged in them. The ball shouldnot fall out. The cotton ball is then made wet. Inorder to moisten the point, using the tip of, forexample, the little finger, rub the wet cotton andthen immediately rub the tip of the finger on theskin over the point. The skin will remain slightlymoist for a short while. Immediately place themoxa cone onto the point; it will stick if the skin ismoist enough. Do not place a drop of water on thepoint. The moxa cone will absorb that water andthenwill not burn.

To light the moxa use the glowing end of anincense stick, making sure ash is not present, as itcan stick to the moxa and lift it off the point ratherthan light it. Once the moxa is lit it burns down atan even rate. When it is around 50–60% burneddown the patient will often start to feel some heat.If you leave the moxa a little longer so that it burnsabout 80% (the 80%moxa method), the patient willusually experience a short-lived pinch of heat,which often feels like a needle prick. The 80% moxamethod will stimulate the acupoint, releasing the

reaction in the point, with minimal tissue damage.Thus, this method can be effective to stimulate thepoints, but not so strong as to trigger anti-inflam-matory or immunological responses. When youwish to moxa a point in relation to a particularsymptom, this is usually the easier method to useon children. However, if you have a child whoneeds a stronger effect on the immune system orstronger anti-inflammatory effects, you need to letthe moxa burn further, down to the skin (the 100%method). This method can start to cause smallamounts of tissue damage and thus have strongereffects on the immune system and inflammatoryprocesses. However, it is felt to be hotter and moreuncomfortable by the child. The 80% method canbe difficult to use on children; the 100% methodmore so. In order to use these methods it is impor-tant to control the heat so that the patient can dealwith it or tolerate it better.

If you wish to burn the moxa all the way down(100% method), once the moxa is lit, and as it isburning closer to the skin, before any heat sensa-tion is felt, apply strong pressure to the area aroundand next to the burning moxa. Usually the patientwill feel the pressure and this distracts them fromthe heat of the burningmoxa, making it more toler-able. Usually if you need to use the 100% methodyou will not get chance to use it on more than oneacupoint, so pick your point carefully.

If you are content to use the 80% method andcontrol the heat, the following are simple methodsfor controlling the heat of the moxa so that it doesnot burn further and does not become too hot.After the moxa is lit and when it is around 50%burned down, place your fingers next to the moxaand as it burns down towards the 80% range, pressthe fingers together lightly—which snuffs the moxaout or pinches the moxa off. If the child seems tojump, you can apply a little extra pressure withyour fingers to help distract the child from the heatof themoxa.

On children, the heat of the moxa should be feltwith either of these methods one to three times;this should be enough.5

After you have applied okyu to a point, you can-not leave a press-sphere, press-tack needle, orintra-dermal needle. The skin may be temporarily



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5 On adults sometimes considerably more cones of moxa areused and sometimes onmany acupoints.

irritated from the moxa and either the instrumentused or the tape used to secure it can irritate theskin further or not allow it to naturally calm down.

This technique is covered on the accompanying➤DVD and in detail in Japanese Acupuncture: AClinical Guide (Birch and Ida 1998, pp.109–124).

Chinetsukyu—WarmMoxa

The chinetsukyu or “warm moxa” technique wasdeveloped by one of the early Meridian Therapists,Keiri Inoue, as a simple technique to help with qiregulation. The large cones of moxa burn slowlyand one thus has time to carefully regulate the heatand effects of the moxa as it burns. Originally it wasdeveloped as a simple method of applying local qidispersion effects on a local replete condition—herethe moxa is burned until it is felt to be hot, then it isremoved. Then, Meridian Therapy practitionersfurther developed its use as a simple method ofsupplementing the qi. In the first method the childwill feel heat but it will not be suddenly hot or toohot and thus is usually well tolerated by the child.In the second method, the child does not feel anyheat.

For the chinetsukyu method we do not use the“pure” yellowmoxa; rather, we use the less purifiedJapanese “semi-pure,”wakakusamoxa. Certain fea-tures are important for good use of this technique.

The cones need to have a flat bottom surface,achieved by rubbing the cone on a hard flat surface.The cones need to be consistent, having the samerelative density throughout. They should be a littlefirm, but not hard. It is better to not have any softportions or regions within the cone as they willburn faster, and thus the conemight burn unevenly.The size of the cone can be seen in the picture inBirch and Ida (1998, p.133).

To apply the cone, prepare a bowl of water. Floatthe cone on the water, placing the flat bottom sur-face on the water. Take the cone off the water andplace it on the back of your hand. This allows you to

make sure it will stick and to remove excess waterand let the water warm up a little. Place the conefrom the back of your hand on the point. Light themoxa. Remove the cone at the appropriate time(depending on which technique you are using) pla-cing the cone burning side down into the water inthe bowl to extinguish it.

Chinetsukyu as a Dispersion/DrainingMethod

Place the cone on the point, light it, and as the coneburns down keep an eye on it to make sure it isburning relatively evenly; ask the patient if he orshe feels any heat. As the patient starts to feel heat,pay attention to the evenness of the burning coneand remove it as it starts to feel hot. One cone perpoint is usually sufficient. The following are exam-ples of the use of this method on children:● For diarrhea, using four cones, one cone to each

of left-right KI-16, CV-9, CV-7● For catching cold with mild fever, several cones

to GV-14

Chinetsukyu as a SupplementationMethod

Place the cone on the point, light it, and as the coneburns down, somewhere around 25–35%, removethe cone. If you are able to monitor the pulses youwill notice that the pulse quality improves slightlyat around this stage of burning. The following is anexample of this method on children:

For the rundown child who shows weakness ofall the yang channels, and a tendency to loose, softskin, use two to four cones: GV-14, GV-3, and if youcan, the lateral pigen points (see Chapter 16 forlocation).

This technique cannot be used on the child whowill not stay still. It is important that the child doesnot move, and that the cone does not move. It istherefore not a commonly used technique on smal-ler children, but in general it is an easy and effectivetechnique. See Birch and Ida (1998, pp.133–137).



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14 Kyukaku—Cupping

For the treatment of babies and children with cup-ping, it is necessary to use pumped cups ratherthan fire cups. Not only do these allow much morefine control of the dose, but it is easier to ensure apainless application and it avoids the fear of firethat some parents may have. In recent years hand-held pumped cups have been developed, where thecup is applied by simply squeezing the rubber ballon top of the cup, applying the cup to the area to betreated, and letting go of the rubber ball. This cre-ates a partial vacuum so that the cup sticks to thearea. The other form of pumped cup is one with avalve on top. After placing the cup over the area tobe cupped, a small pump (some look like bicyclepumps) is used to create a partial vacuum insidethe cup so that the cup sticks to the body regiontreated.

The importance of using the pumped cups lies inthe ability you have to control the pressure veryeasily and thus control the dose. The dose is regu-lated by three main factors: the amount of pressureyou create with the cup, the length of time youretain the cup, and the number of places you applycupping. As I have stressed repeatedly, we use low-

dose treatment for children. Thus, for cupping weuse it judiciously, with less pressure and for shortperiods.

The pressure should be enough that it does notfall off. The skin and flesh of babies and young chil-dren can be quite soft, so be careful not to createtoo much suction. The cup should never be experi-enced as painful. The cup can be applied and imme-diately removed—the “flash cupping”method—andthis can be repeated a few times, or the cup can beapplied and retained for a short while, such as 10seconds or longer on older children.

In general I tend to use cupping in the followingtwo cases: (1) congestion in the lungs—in whichcase cupping is mostly applied over the interscapu-lar region; (2) food allergies—inwhich case cuppingis applied over the navel region. Other uses of cup-ping are discussed in the treatment chapters, but ingeneral it is not a commonly used method. Onething to be aware of is that some children really likethe cupping and come to expect its use on repeatedvisits. On occasion you need to oblige by doingsome cupping so as to not disappoint the child.



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15 Shiraku—Bloodletting (Jing Points and Vascular Spiders)

Bloodletting can be a commonly used technique,depending, of course, on the preferences of thepractitioner. However, on children we tend not touse it very often because of the difficulties of apply-ing the technique and such issues as getting parentapproval, or not upsetting the child. The most com-mon uses are to bleed jing points or stab andremove some blood from small blood vessels suchas vascular spiders. The techniques and details ofthese methods are covered in detail in the bookJapanese Acupuncture: A Clinical Guide (Birch andIda 1998, pp.209–242).

For bloodletting we no longer use the three-edged bloodletting needle that has been used his-torically in Asia. It is much easier using the lancetsthat diabetic patients use. They are finer, sterile,inexpensive, and disposable. They have beenmanu-factured and improved for use by diabetic patientswho routinely check their blood sugar levels by tak-ing blood from the fingertips—a very sensitive area.

Of course, when you are to come in contact withthe body fluids of a patient you must protect your-self and be careful about contamination. The fol-lowing basic rules need to be followed:● Alwayswear latex or rubber gloves.● Prepare the lancet needles, alcohol-soaked cot-

ton balls, and dry cotton balls in advance. Placethese on a non-porous surface that can either besterilized afterwards (such as a metal tray) ordisposed of (such as a plastic surface).

● Wipe the skin to be punctured with alcohol. Letthe alcohol dry.

● Apply the lancet needle (as described below),remove the small amount of blood desired—being careful not to touch anything with yourcontaminated hands and placing the needle andcontaminated cotton balls only on the non-por-ous surface.

More details of this are given in the book JapaneseAcupuncture (Birch and Ida 1998, pp.216–217).

In the section below I list indications that havebeen edited from Maruyama and Kudo (1982) anddescribe the techniques in each style of bloodlet-ting (jing points and vascular spider).

Jing Point Bloodletting

Bloodletting can be used if one modifies the man-ner of needle use and blood removal so that onecan modify and control the dose of treatment andmake the technique completely painless. Bloodlet-ting jing points can be very helpful for certainpediatric conditions as indicated in the edited listfrom Maruyama and Kudo (1982) below. But it isalso good to remember that any symptom in therelated channel can also be targeted. The primaryfindings that indicate the use of jing point bloodlet-ting are location of symptom, channel affected,signs of blood stasis, and reactions at the jing pointsuch as redness, swelling, puffiness, or pressurepain. For details of the methods of jing point blood-letting, its precautions and doses see Japanese Acu-puncture (Birch and Ida 1998, pp.233–241) andShimada (2005).

Indications for the Nail Corners of theFingers

Thumb:mainly applied at the radial corner (LU-11),but can be applied at both corners

Good for: tonsillitis, pharyngeal catarrh, mumps,bronchial asthma, teething fevers of infants

Index finger: mainly applied at the radial corner(LI-1)

Good for: lymphadenitis of the neck region,bronchial asthma, toothache of the lower jaw

Middle finger: radial corner (PC-9)Good for: diseaseswith high feverFourth finger:mainly the ulnar corner (TB-1)Good for: headache, congestion of the eye, phar-

yngeal painLittle finger: ulnar corner (SI-1)Good for: dyspnea, pharyngeal pain, convulsive

disorders



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Indications for the Nail Corners of the Toes

These areas are not as frequently used as the finger-nail corners, but they do have wide application anddistinctive effects for the indicated symptoms.These are interesting areas for the application ofbloodletting techniques. Their indications are asfollows:

Big toe:medial corner (SP-1)Good for: indigestion, acute gastroenteritis,

infantile seizuresLateral corner (LR-1)Good for: eye problems (especially if with severe

pain), convulsive disordersSecond toe:mainly the lateral corner (ST-45)Good for: toothache of the upper jaw, gastro-

enteric disordersFourth toe: usually the lateral corner (GB-44),

but sometimes themedial corner is very effectiveGood for: headache, eye pain, ear pain

Selection of points should be based on the findingof appropriate signs at the jing point, such as red-ness, swelling, pressure pain, as well as associatedsymptoms.

To bleed the point, hold the digit firmly with thefingers and thumb of the non-dominant hand(most commonly left). Hold the lancet between theindex finger and thumb of your dominant hand(most commonly right) so that the tip of the lancetlies just behind the level of the tips of the finger andthumb, which should be level. Carefully place thetip of the lancet directed towards the point, almosttouching the point. Make sure that either the tip ofthe index finger or tip of the thumb lightly touchesthe finger near the point. With a smooth rapid roll-ingmotion roll from the fingertip touching the skinover to the other fingertip, pulling away from thechild’s digit as soon as the other fingertip touchesthe skin. As you do this the tip of the needle veryrapidly presses the skin at the point to be bledmak-ing a tiny cut. When done correctly, the needling ispainless and the drops of blood can be squeezedout one at a time. You are not stabbing the point,rather the motion you make presses the tip of theneedle into the skin, and since the skin is very fine,it makes a very small superficial cut. Remove thenumber of desired drops of blood using thewet cot-ton ball; to stop, press the point with the dry cottonball—when done correctly the blood stops whenyou want it to. The amount of blood removed

relates to desired dose for the child and the point.Sometimes a single drop is enough, but you maywant to take up to five drops.

This technique needs to be practiced enoughbefore you try it on a child. The action of rollingover the point quickly is very important. If you getthis wrong you will cause a deeper stab than youintend (making dose regulation more difficult) andcause unnecessary pain (making treatment man-agement more difficult). Do not do this on a childuntil you have been able to routinely apply it pain-lessly on adults.

Vascular Spider Bloodletting

The bleeding of vascular spiders can also be a veryuseful therapy to treat blood stasis and relievesymptoms associated with it. The two most com-mon areas where vascular spiders occur are in thelower cervical and upper thoracic region (C6 to T4)and in the lumbar-sacral region. The upper spineregion is indicated for any symptom in the upperhalf of the body, while the lower spine region isindicated for any symptom in the lower half of thebody. Maruyama and Kudo (1982) list certainsymptoms associatedwith each area, an edited ver-sion of which follows. For details of the methods,precautions, doses of vascular spider bloodlettingsee Japanese Acupuncture (Birch and Ida 1998,pp.213–229).

C6–T4 Region Indications

Look for vascular spiders on the back of theshoulders in patients whose main complaints areaccompanied by stiff shoulders and can include dif-ficulty breathing, expectoration, problems such asbronchial asthma, chronic bronchitis, and so on;and patients whose main complaints are problemsof the eyes, ears, nose, face, neck, and throat. Wecan add to this symptoms of the cervical or thoracicspine and any symptoms of the upper limbs.

Lumbosacral Region Indications

The lumbosacral region extends from L4 to thesacrum and is effective for problems of the lowerhalf of the body, especially a wide variety of chronicproblems. In some cases, with repeated bloodlet-ting, we can obtain unexpected improvements. In



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this region, when we cannot find vascular spiders,we look for small superficial venules. They seem tofunction the same as the vascular spiders.

Bloodletting in this region can be good for: prob-lems in the lower half of the problem includingurinary disturbances, or skin problems of the lowerbody.

To bleed the vascular spider we use the samekind of lancet needle as for the jing points. Thetechnique is very different. For the jing point, theneedle is held so that its tip lies just behind thelevel of the finger and thumb; the lancet needle isrolled over the point quickly. For the vascular spi-der the lancet is held so that the tip extends veryslightly beyond the level of the tips of the fingerand thumb. The lancet is placed almost perpendi-cular to the vascular spider and inserted with arapid down and upmotion of the needle. To do this,first make sure that the tip of the needle is lined upwith the vascular spider so that as you press theneedle down it stabs into themiddle of the vascularspider. One way of making sure you have lined up

the needle tip correctly is to lightly press the skinwith the needle tip.When lined up correctly youwill see blood pressed back inside the vascular spi-der either side of where the needle tip is pressing.To apply the technique do not let the needle moveup from the skin before applying the downwardstabbing (this usually causes the stab to miss thevascular spider). The stabbing is done with a quickdownward pressure followed immediately by with-drawal (like a bounce). Essentially you are trying tocut the upper edge of the vascular spider so that asmall amount of blood can be removed through thesmall cut on the upper surface of the vascular spi-der.

On children we don’t use cupping with thismethod; it is enough to squeeze the blood out. Tosqueeze, place your fingers around the stabbed vas-cular spider; press the fingers gently into the bodyand then towards each other. These actions forceblood into the vascular spider and out through thesmall cut you havemade.



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16 Point Location—Location of Extra Points forSymptomatic Treatment

Josen

This point is located at the juncture of L5 and S1. Inthe Chinese books it is the one “below the 17thvertebrae point.” Palpate for pressure pain at theexact location on the midline of the spine and in aslowly widening circle spreading out from that epi-center. The most reactive point may not be on theexact midline of the spine. Akabane (1986) recom-mends leaving an intra-dermal needle at the reac-tive josen for problems such as back pain, gynecolo-gical problems, labor pain, or hemorrhoids. Wehave found it can show reaction with and help con-ditions such as sciatica, intestinal problems, andurogenital problems. The point can also be treatedwith moxa instead of an intra-dermal needle. Ingeneral this point is used more on older childrenthan younger children.

Uranaitei

Uranaitei or “below nei ting” or “below ST-44” islocated on the sole of the foot proximal to the sec-ond toe. Two methods are used to find this point.The first involves placing a dot of ink in the centerof the pad of the second toe then folding the toeover until it touches the sole of the foot. Where thedot of ink touches the sole of the foot is the point.But many people don’t have flexible enough toes todo this so a second method is used. Measure thedistance of the crease on the plantar surface of thefoot where the digit intersects the foot. Make anequilateral triangle with that distance. The point isat the tip of that triangle when the line along thecrease is the base of the triangle. This point is meas-ured and not palpated. It is good for acute gastroin-testinal problems, including food poisoning (henceone of its names the “food poisoning point”), acutegastric or intestinal distress, including vomiting,diarrhea, acute gastroenteritis, and food allergies(while allergies are a chronic problem, they haveacute manifestations when the wrong foods areeaten).

The point is only treated with moxibustion. Totreat, apply equal shape and size (half a rice grain)moxa on both the left and right sides. Usually, withacute symptoms, one foot does not feel the heatwhile the other does. Treatment is directed to thepoint that does not feel the heat and treatment isrepeated until heat is felt at the point at least threetimes. This may require many moxa cones. If bothfeet feel the heat, apply moxa until both feet feelheat three times.

Shitsumin

This point is located in the center of the heel of thefoot. It is treated with moxibustion only and hasbeen described by various moxa therapists (Fukaya1982; Katsuyoshi 2006). It is especially indicatedfor problems of urinary disturbance with oliguria(infrequent urination), and frequent urination. Ithelps reduce edema subsequent to diminishedurinary output and when moxa is able to increaseurinary output. It is also indicated for sleep prob-lems such as insomnia. On adults its uses may bemore extensive, including pain in the feet, pain andswelling of the knees, psychological problems, ten-sion in the lumbar and upper back areas, and so on(Katsuyoshi 2006). The skin is quite thick here andwill turn brownish or blackish with repeated moxa.It generally does not blister with moxa. It is a goodpoint for parents to treat at home for chronic urin-ary problems that cause, for example, decreasedurinary output. Usually it takes time for the patientto feel the heat and many more than three moxacones are needed if the patient is to feel the heat atleast three times.

Asthma Shu Point

This point is described in the moxibustion litera-ture by authors such as Fukaya and Shiroda. Thepoint is located slightly lateral to BL-17 and slightlysuperior to the level of BL-17. It is found as a hard,jumpy, painful knot in the area defined by this



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method. It can be reactive on either left or rightsides or more commonly on both sides. In myexperience anyone with asthma shows reaction atthese locations. While the point is first described inthe moxibustion literature we found that patientswith reactive asthma cannot tolerate treatment ofthe points with moxibustion as the smoke of themoxa can trigger an asthma attack. Consequently, Istarted leaving intra-dermal needles at the point(s)instead, with good effects. It is possible to make thefrequency, intensity, and duration of asthmaattacks less by simply leaving intra-dermal needlesor the new short press-tack needles at these points.The point also shows reaction quite frequently inpatients with chronic congestion of the lungs as inrecurrent bronchitis. It might be better on the par-ticularly young or sensitive child to use press-spheres instead. If the press spheres are well toler-ated but show insufficient treatment effects, thentry using the new press-tack or intra-dermal nee-dles, but for a shorter period of time than usual (afew hours to 1.5 days only).

“Stop Coughing” Point

This point is approximately 0.5cun distal to theTCM location of LU-5 (on the radial side of the ten-don biceps brachi) and usually slightly lateral to theline of the lung channel. It is found as a hard, verypainful point on palpation. To find the point, bendthe elbow to locate the tendon, then, placing yourfinger at the modern Chinese LU-5 location,straighten the elbow and move your finger slightlydistal and lateral, then squeeze. You will find ahard, painful point. This point can be used to helpcontain the symptom of coughing both in acute andchronic cases and can be used in, for example,asthma patients when the asthma manifests with acough. It is treated with moxibustion, intra-dermal

needles, press-tack needles, or press-spheres. Onchildren I recommend using press-spheres or theshort (0.3-mm or 0.6-mm) press-tack needles,press-spheres are easier.

Lateral Pigen Point

Historically, there were said to be three pigenpoints, which used together with moxa are goodfor abdominal masses. On the back there are twopigen points, one more lateral than the other.Although there have been two different descrip-tions for this more lateral point, one 0.5cun lateralto BL-51 and the other 0.5cun lateral to BL-52, Irecommend a more flexible location. The point isfound in a depression below the margin of the 12thrib, not quite as far as the end of the 12th rib(where GB-25 is located). To find the point, locatethe lower margin of the 12th rib at the spine andrun your fingers lightly along the inferior margin. Ifthe point needs to be supplemented, your fingerwill naturally move into and stop in a depression.This point is treatedwith chinetsukyu (warmmoxa)(see Chapter 13), supplementation technique, andcan also be treated with the ryu or press-sphere(see Chapter 12).

Moving LR-1

This is an extra point on the liver channel betweenLR-1 and LR-2. It is treated with moxa if a reactionis found. While difficult to needle here, it is good totreat with moxa for night urination problems. Tofind the point, use your finger tips to find pressurepain, once you have found some pressure, examinewith a probe like the rounded end of the teishin, todefine the precise location for treatment.



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Section 5 Treatment of Specific Problems/Diseases

17 Introduction to the Treatment of Specific

Problems/Diseases . . . . . . . . . . . . . . . . . . . . . 93

18 Respiratory Problems . . . . . . . . . . . . . . . . . . . 101

19 Skin Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . 115

20 Digestive Problems . . . . . . . . . . . . . . . . . . . . . 134

21 Behavioral, Emotional, or Sleep Problems 153

22 Urinary Disturbances . . . . . . . . . . . . . . . . . . . 164

23 Ear and Nose Problems . . . . . . . . . . . . . . . . . . 177

24 Developmental Problems . . . . . . . . . . . . . . . 190

25 Weak Constitution . . . . . . . . . . . . . . . . . . . . . 203

26 Recurrent Infections . . . . . . . . . . . . . . . . . . . . 218

27 Improving Vitality . . . . . . . . . . . . . . . . . . . . . . 230

28 Recommendations for Treatment of

Other and Less Commonly Seen

Problems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 238

29 Combining TreatmentMethods . . . . . . . . . . 246



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17 Introduction to the Treatment of Specific Problems/Diseases

In the previous chapters I have described how tohandle treating children, the basic goals, andunderlying methods for applying treatment to chil-dren and babies. We saw in particular that it isimportant to minimize or eliminate unnecessaryemotional reactions to what we are doing, as thesecan interfere with treatment. It was proposed thatwe do as much as we can to help the child maintainemotional calmness. I have also described the tools,methods, and pattern for applying the core non-pattern-based root treatment and a simple form ofpattern-based root treatment. In this final section Iwill examine various ideas and experiences usingdifferent tools and techniques to additionally targetrelief of symptoms. It is useful to briefly contextua-lize these different aspects of treatment in a model.To do this, I repeat the basic three-level model out-lined in Chapter 9 (seen in Fig.17.1). Level 1 repre-sents the functional structural systems of the body(all organs—including locomotor organs). Level 2represents the jing mai or channel system, which

traditional theory tells us helps regulate the inter-nal functional systems (represented by level 1).Level 3 represents the vitality of the child, theiroverall or global qi (e.g., yuan qi, zheng qi, sheng qi).This helps further regulate the channel and func-tional systems in the levels below it.

Next I extend the model to include the furtherlevel, level 4, the mental (including emotional)level. This is seen in Fig.17.2. If the mental level isregulated (calmed), it can help contribute towardan increased regulation of the levels below it (vital-ity, channels, and functional systems).

The manner in which we handle the child andtry to make sure that we cause no additional upsetor fear, or cause distress to the child will affect level4, helping trigger some degree of increased order-ing of the levels below. The application of the corenon-pattern-based root treatment primarily workson the vitality level, level 3, helping triggerincreased regulation of the levels below it. The pat-tern-based root treatment primarily regulates the



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12

3

Fig.17.1 Three-level model:Level 1—functional systems (zang fu, etc.)Level 2—channel systemsLevel 3—vitality: global qi of the body

12

34

Fig.17.2 Four-level model:Level 1—functional systems (zang fu, etc.)Level 2—channel systemsLevel 3—vitality: global qi of the bodyLevel 4—mind: heart/mind

channels at level 2, helping regulate the level belowit. The various symptomatic treatments helpfurther change the functional structural, physicalsystems to relieve symptoms; that is, they workmostly at level 1. Thus, the whole treatment whenput together can access andwork at all four levels.

Of course, treatment can be applied only bydoing the core non-pattern-based root treatmentor pattern-based treatment with simple proce-dures to target symptom relief.Wewill see that thisalone can be a very successful treatment approach.In fact, it is what has given shonishin the reputationthat it has in Japan. It is also possible in some casesthat you only have a chance to apply root treat-ments (either the non-pattern and/or the pattern-based) with no targeting of symptoms (see treat-ment Chapter 27 “Improving Vitality”). However,by applying all the various methods described inthis book in an integrated, simple, properlybalanced treatment, one is able to create a bigchange that can have profound long-lasting effectsfor the child.

When one adds the home treatment (see Chap-ter 8), where the parent applies some regular sim-ple form of therapy at home, modifies diet and soon, we find that this can contribute to changes andimprovements in the tensions in relationshipsbetween parent(s) and child. This can contribute tochanges in the psychosocial context where thechild lives. This is represented by level 5, the spacesurrounding the four levels contained within thebox (see Fig.17.3).

Although we have avoided extensive discussionand application of TEAM theory andWesternmedi-cal knowledge in the discussions of how to diag-nose and treat children, one can see in this five-level model that the whole system can be completein itself. Awell-performed treatment can help regu-late the psychological, regulatory, and functionalstates of the child. With the addition of simplehome therapy this is further enhanced throughinfluencing the psychosocial context. It is not mypurpose to expand here on these theoretical con-siderations, only to point out that your treatmentsusing the methods recommended in this book canhave quite broad-acting and often surprisinglystrong treatment effects.1

In this and the following chapters I shall describethe basic approach to treating a variety of commonand uncommon health problems. The chapters con-tain examples and recommendations for the treat-ment of a variety of more commonly seen healthproblems or circumstances that may present whenchildren come for treatment. Chapter 28 listsrecommendations of treatment for some less com-monly seen health problems.

Many books on acupuncture tend to be prescrip-tive, that is, they list points and associated techni-ques for each symptom, and this is the main man-ner of describing treatment for the differentconditions the book addresses. Not only do I notlike or find the typical prescriptive treatment bookson acupuncture to be very helpful, I also feel clini-cally one needs to be armed with a variety of treat-



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12

34

5

Fig.17.3 Five-level model:Level 1—functional systems (e.g., zang fu)Level 2—channel systemsLevel 3—vitality: global qi of the body (e.g., zheng qi, shengqi, yuan qi)Level 4—mind: heart/mind (e.g., yi: intention/attention/awareness; zhi: will)Level 5—environmental systems (e.g., ecological/social sys-tems, including “earth”; cosmological systems, including“heaven”)

1 I have elaborated on this model in several places. The simplethree-level model was published in 2009 (Birch 2009). Amore elaborate seven-level model is in process (Birch, in pre-paration [a]) and explorations of how these might be under-stood and seen towork in an edited book I have beenworkingon (in CabrerMir, Birch, and Rodriguez, The JingMai & Qi: Pre-

medical and Medical Constructions and Uses, in preparation[b]).

ment tools and ideas and be flexible enough so asto able to apply them routinely and in modifiedform as needed. This is especially so in the treat-ment of children. When you put the whole treat-ment together you often find that you are adaptingyour approach andmethods around the child to getthe treatment done as efficiently and easily as pos-sible. I call this the “dance” of treatment (see Chap-ter 7). In order to help capture this approach so thatthe following treatment chapters are useful, I havegiven each the same order:1. Clinical case example(s) of the treatment of that

symptom2. Basic ideas and recommendations for the use of

the core non-pattern-based root treatment3. Basic ideas for the use of the pattern-based root

treatment4. Basic ideas of which techniques used on which

points or areas have been shown to be helpful5. Additional clinical information pertaining to

that health problem, as needed6. Further case(s) to illustrate how the various

methods have been selected from, combined,when theyworked and sometimeswhen not

The goal is to present a spectrum of treatmentideas and recommendations, and show their usethrough case histories. I have collected cases fromcolleagues around the world who have had successtreating children with these treatment methods,and I have, of course, includedmany ofmy own.

Treatment Chapters 18–27 will thus cover thefollowing:● Themost likely pattern-based root diagnosis● Core non-pattern-based root treatment and its

modifications● Ryu or press-spheres● Empishin or press-tack needles● Hinaishin or intra-dermal needles● Needling (typically a modified form of “chishin,”

retained needling or simple in-out needling)● Okyu—direct moxa● Kyukaku or cupping● Shiraku or bloodletting● Other considerations● Dietary recommendations● Home treatments

The final Chapter 28 lists recommendations for thetreatment of a number of less commonly seen con-ditions and thus does not have case histories, and

Chapter 29 contains examples of how skilled TCMand Japanese acupuncture practitioners integratedshonishin treatment methods into their overalltreatment for very ill little girls.

How to Use these Treatment Chapters

For each condition I have presented cases. In somecases it is self-explanatory what was done andwhy.In some cases I have added explanations to help thereader follow the logic and thinking. In other cases Ihave not given explanations. This is not because Iam lazy or have forgotten what I did and why. Ihave done this in order to get you to think aboutwhat was done. It has beenmy experience teachingfor over 20 years, and following Asian models ofeducation and thoughts about the nature of knowl-edge and understanding, that we have to figurethings out for ourselves if we are to really interna-lize an understanding of things. Sometimes, simplybeing told something only makes one forget andnot understand. But when we do it for ourselves,we tend not to forget, and can also develop a greaterability to reason things through, which shows agreater understanding.

Putting aside my personal biases about the nat-ure of learning and studying, there are a few thingsthat I think it is helpful to explain in terms of howto construct the patterns of diagnosis and treat-ment, integrating as needed the different methodscovered in this book.

Putting Your Treatment Together intoa System

After evaluating the patient you should proceedquickly into treatment. In general it is better to nothave the child (especially small children) waiting inyour clinic rooms unnecessarily. Once you have anidea of what to treat, proceed to the treatment assoon as you can.

The “Dance” of Treatment

In almost all cases you will be administering someform of the core non-pattern-based treatment (thatis the hallmark of the shonishin system) and/or asimplified pattern-based root treatment. Usuallyyour treatment will begin with one of these root



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treatments. Apply them flexibly, working aroundthe child to get the treatment done rather than try-ing to constrain the child to make them receive thetreatment (or at least constrain them past theirpoints of resistance). We have tried to show this“dance” of treatment in the ➤DVD that accompa-nies this book. The “dance” is about getting every-thing you can done efficiently, in a manner thatallows you to continuously adapt around the childso that when they are feeling cranky, vulnerable,afraid, or playful you are not caught forcing him orher towhat youwant, thus often irritating or upset-ting them.

An example is when applying the stroking andtapping aspects of the core treatment to work withwhatever limb or body area comes easily to hand. Ifyou lose the contact, keep a rough count of whatyou have done on that area, so that you can comeback to it later and finish your work on the area.Move quickly among the different areas until youhave got to all those you would like to work on, andapplied the amount of correct technique for each—working with each as it comes to hand. Anotherexample can be when you are trying to apply thepattern-based treatment and the child does notwant to let you near the point. Be patient and useother techniques as needed or another point asneeded. SP-3 is often ticklish, thus, for the lung pat-tern I will use SP-5 instead as it is usually easier forthe child and we don’t have to struggle too much toget the treatment done.

In most cases you will be administering simplesymptomatic extensions of the core non-pattern-based treatment (such as additional tapping) and/or other symptomatic treatment methods. You canintegrate the extensions of the non-pattern-basedtreatment into your application of the core roottreatment, as part of the “dance” of treatment.Often it is easier and better to apply techniquessuch as the press-spheres, or press-tacks after theother procedures at the end of treatment. However,when needling, if you are working on the head orneck (such as GV-22 for nasal congestion, GB-20area for over-activity, crankiness) it can be better todo this just before you start the root treatments.Provided your needling is painless, the child will befollowing your hands and techniques during theroot treatment and have attention drawn awayfrom the retained needles at, for example, GB-20,GV-22. Always apply stronger techniques that havethe potential to be uncomfortable such as moxa at

the end of treatment. The child is usually calmerbefore you apply the technique, and then after-wards does not have to be made to go through therest of your treatment.

Sometimes you may feel a bit irritated at whatthe child is doing, and it is important not to showyour irritation. Some children become frightenedor upset; others see it as a trigger for further strug-gle. It is a good life lesson to be able to keep smilingregardless of what is going on during treatment. Onoccasion the parent starts reacting to what thechild is doing and starts chiding the child or tryingto apply their behavior modification methods. Ifthe child is really out of control I find it better to letthe parent take control and only intervene if theirwords start distressing the child in a manner thatmight make my work more difficult. If the behavioris not really bad, more like resistance, especiallyplayful resistance, and the parent starts becomingdistressed and fearful that their child is doingsomething wrong, I sometimes find myself tellingthe parents it’s fine, don’t worry, this is normal, Iam not upset, there’s no damage. For this aspect oftreatment, there is no substitute for practice andexperience. It is often a necessary part of the“dance” of treatment.

I have found it helpful to be constantly on themove during treatment, trying to get things donequickly and efficiently. Sometimes, my movingaround the child to target treatment at the differentareas becomes engaging for the child and he or shestarts becoming distracted from the play or resis-tance, and followswhat I am doing.

How you make eye contact with the child isdependent on the child. I recently had a small girlcome for treatment. When she came into a spaceand saw an adult (especially male) face she wouldstart crying, particularly if she made eye contact.But she did not just look occasionally and makethese eye contacts; she would stare at me almostcontinuously, so that I would often catch her eye.For whatever reason, she was somewhat fearfuland anxious in new or changed circumstances. Ifound if I only did treatment with the mother hold-ing her, and if I looked past the girl to see her, keepher in my field of vision while looking at hermother or at something just near her it was allright. When coming close to her to do the treat-ment, I looked down at what I was doing or at thetable, never in her face. After figuring out her man-ner, I was able to proceed with minimal upsets. It



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was always interesting to see how, after the treat-ment was finished and she was being dressed, shestarted smiling and I could look directly at her andeven interact with her to make her smile further!After a number of treatments she started becomingmore adjusted to me and no longer reacted when Icaught her eye. For other children, they feel moresecure if you make eye contact with them, or if youdo not go too much out of their field of vision dur-ing your “dance” of treatment. Each child is differ-ent and you need to ascertain quickly how theyinteract andwhat their preferencesmay be.

Summary of the Rules of the “Dance”● Be relaxed● Try to keep the child relaxed● Smile a lot● Be efficient and get things done quickly● Move around a lot and keep track of what you

have done● Don’t dance toomuch or do toomuch treatment

Dietary Considerations

It is important to be aware of the diet of the child,and to make recommendations as needed to helpchange the diet, improve eating habits, or removeirritants to the child’s health. This can be a very com-plicated area as different countries, cultures, and liv-ing environments have quite different ideas aboutwhat is a normal and acceptable diet. Additionally,someparents have preformedopinions about specialdietary models to follow and different practitionersof acupuncture also have different ideas about diet,from both theoretical and practical perspectives.Thus, making hard and fast prescriptive recommen-dations about diet can be difficult. One does notwish to make the parents back away from treatmentbecause you have been too strong and insistent inyour recommendations—dropping out of treatmentis not only bad for the patient and your business, butif caused by your actions andwords it should be con-sidered a treatment failure.

Having come across many dietary models andstyles, I find it difficult to have one model that istheoretically prescriptive. You may feel that brownrice is much better than white rice, but in myexperience in Japan, the large majority of peoplethere are averse to eating brown rice. It has conno-tations with poverty and bad times in the past. If Iwere to insist that everyone eats brown rice, this

could cause more than a few patients to stop treat-ment were I working in Japan. Whenmodifying thediet of small children, it is not only the child’s dietthat needs to change, it is usually that of the wholefamily. A small child will more easily follow a diet-ary recommendation if the family members areleading by example. Also, it does not work toexclude, for example cow’s cheese from the diet ona mobile small child if the refrigerator is still full ofaccessible cheese! Thus, resistance is often not onlyideological but personal as many people’s favoritefoods or bad habits are being targeted. My advice isto not be too rigid and try to be as supportive aspossible. Youmay also have parents who are feelingvery stressed out about the problems their childhas; maybe even feeling inadequate and guiltyabout them. Sometimes creating too much stresson the parents to rigidly follow a difficult diet canworsen their feelings of inadequacy and guilt,which can be counterproductive for the child as itcreates more stress in the home environment (seediscussions in Chapter 8). I always try to find waysof helping and supporting the parents to do theirbest, even if it takes time and builds up gradually.

In the case of the child who is clearly havingfood allergies or food sensitivities, leading to reac-tions and symptoms, you can be more firm, butchanges are easier to make if you have some evi-dence to show the parents and the child. Some par-ents do not have a good understanding of abalanced and appropriate diet, in which case youmay need to instruct them in some basic issues. Itis, for example, good for the overactive child toavoid sugar or have minimal exposure to sugar. Ihave had parents who thought it fine to let theirhyperactive child drink lots of caffeinated, sugaredCoca-Cola every day. The constipated child may beresisting eating vegetables or foods with fiber andthe parents may not have a good understanding ofwhat is needed in the diet. In such cases, you cangive some straightforward recommendations.Probably themost common dietary factor that I payattention to is cow’smilk and cow’s milk products.

Cow’sMilk ProductsIn serious cases allergies to cow’s milk can causesevere colitis, with bleeding, leading to severe gas-trointestinal disturbance, hemorrhaging, and ane-mia. We tend not to see children in such severestates, as they are usually being treated at thehospital and appropriate dietary measures are



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being followed. Most commonly, we see childrenwho are allergic to cow’s milk products, or who aresensitive to consumption of such products, with adifferent set of symptoms. The baby can be colickyor have problems with vomiting and/or diarrhea.Other symptoms of sensitivity to cow’s milk pro-ducts include eczema, urticaria, asthma, rhinitis,behavioral problems, and migraine. Experienceshows us that whenever the child has a problemwith congestion of the nose or sinuses (rhinitis,sinusitis), congestion of the lungs (catches coldeasily, croup, asthma), recurrent ear infections aftercatching cold and being always congested, weshould look to consumption of cow’s milk products.The products themselves may not be a cause of thesymptoms, but they are an irritant that obstructsrecovery, tending to make the problems becomemore chronic. It seems that cow’s milk inmany peo-ple stimulates production of mucus or phlegm tothe extent that this causes further congestion whencongestion is already present, obstructing the abil-ity to recover. The symptoms associated with sensi-tivity to cow’s milk represent a large percentage ofchildrenwho come for treatment with us. Thus, it isworthwhile examining this issue further.

Some parents will have already figured out thatthere is an allergy or sensitivity to cow’s milk pro-ducts, either for themselves or with the help oftheir doctor. Others may have no idea, and in somecountries where milk and cheese products are con-sumed in large quantities, this can be quite com-mon. It is necessary to establish a relationshipbetween the symptoms of the child and cow’s milkproduct consumption. The following is a simpleand quite reliable method of testing:● Have the child go completely without cow’s milk

products for a week (including milk, cheese,cream, butter, yoghurt).2

● If after 1 week the symptoms seem a bit better,now have the child restrain from consumptionfor anothermonth.

● At the end of themonth challenge the child by let-ting them eat a bit of cheese, drink milk, and soon.

● If there is a problem, the symptomwill show anacute flare up.

This process of testing is important because manyparents are not convinced by words alone, andmany are concerned that some important nutri-tional ingredients will be missing in the child’sdiet.3 After this test shows the clear association, itbecomes easy to get the parents to help the childstay away from the products. Older children alsocome to understand the need to avoid cow’s milkproducts. This process of testing is not always clear,sometimes the child has accidental exposure to theproducts during the time of avoiding them, and theresults of the test are not as convincing.

It is important to help the parents find an alter-native. An easy alternative is fortified soy milk.However, recent work suggests that soy milk con-sumption may be a problem for babies. Therefore,we need to have a number of alternatives to offer.Goat’s milk and goat’s milk products are usuallyacceptable to children, but some either don’t likethem or react to them as well. Fortified soy milkproducts can show the same reactions. There arealso fortified rice milk and oat milk products avail-able in health food shops. In some countries, theapothecaries or chemists carry special processedmilk products where the cow’s milk has been trea-ted so as to break the offending protein chainsdown to peptide chains. This can be a good alterna-tive for drinking milk; however, these products canbe a little expensive. In Holland some parents haveobjected to using themwithout a doctor’s prescrip-tion (so that the insurance company pays for them).

For the child that likes drinking or eating cow’smilk products, it is usually necessary for the wholefamily to help.Keeping milk, cheese, cream, andyoghurt in the refrigerator exposes the child tothem. Many will not have the understanding or dis-cipline to stay away from them. Thus, sometimesthe whole house has to stop consuming these pro-ducts, at least until the child has improved.

In the chapters that follow, many cases arisewhere it was necessary to test for and avoid cow’smilk products.



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2 You often need to be very explicit about which products thisincludes. Many parents, for example, do not realize that theyoghurt their child consumes is cow’smilk based.

3 I have even had one parent who had been told that it was tan-tamount to child abuse to withhold vital nutritional contentthat couldONLY be found in cow’smilk products!

Environmental Sensitivities

Some children have environmental allergies or sen-sitivities, such as airborne allergens, contact aller-gens, or chemical sensitivities. The atopic child canshow a number of different allergies and/or sensi-tivities, triggering a variety of symptoms. It is notuncommon that the specific factors that the childreacts to are not known. Consequently, it is difficultreducing exposure to the factors the child is react-ing to. The allergic child may not yet have had a fullbattery of allergy tests or parents may not havebeen able to figure out everything to which thechild is reacting. Sometimes we find cases wherethe parents are unwilling to part with their favoritefamily pet that may be a contributing factor to theenvironmental reactions. Some parents may bemaking great effort to control the environment athome (twice daily cleaning and vacuuming, etc.)but cannot eliminate the environmental factorsthat the child is reacting to. Helping the parent finda way through this maze of issues and gain somegreater measure of control can be difficult, but wemust pay attention to those children with suchenvironmental sensitivities.

A simplemodel is to have the parents start usinghigh-powered air-filtering systems at home andleave them running all the time. The air filtersshould have three different levels of filter includingthe HEPA (high efficiency particulate air) filter.These remove particles, dust, and chemicals fromthe air. Leaving them running all the time does notstop the introduction of the reactive factors intothe home environment, but they do reduce thelevel of exposure by keeping the amount in the airat any one time down to aminimum. For some chil-dren, this is enough to help stop the reactions. Forsome it helps reduce the pressure on the body thattrigger the symptoms, allowing your root treat-ments to be more effective in terms of changing theoverall condition of the child so as to be less sensi-tive in the future. Case 1 in Chapter 25 “Weak Con-stitution” is a good example of the use of this strat-egy. It is best if the air filter is set up in the placewhere the child spends most of his or her time (liketheir bedroom), or if the house or apartment is lar-ger, have two air filters set up to cover the largerarea. You can find appropriate filters through theInternet and provide the parents with modelnames, and contact details for purchasing them.

Sources Used in the TreatmentChapters of this Book

The compilations below cover three main areas oftreatment: pattern-based root treatment, corenon-pattern-based root treatment, and sympto-matic recommendations.

For the pattern-based root treatment, the mainsource of materials has been my teachers, espe-cially my Toyohari teachers. Books such asMeridianTherapy by Fukushima (1991) and Japanese Classi-cal Acupuncture: Introduction to Meridian Therapyby Shudo (1990) are good sources for further infor-mation.

For the core non-pattern-based root treatmentsthat are characteristic of the Shonishin tradition,direct instruction from various teachers has beenmost helpful (e.g., Nakada 2000, Taniuchi 2007,Yanagishita 1997), as have the texts by Yoneyamaand Mori (1964), Shimizu (1975), and Hyodo(1986). Additional brief references in various textssuch as those by Manaka (1976, 1983) have alsobeen helpful. Unfortunately none of these are avail-able in English.

Many of the symptomatic indications (treatpoint x with technique y for condition z) that aredescribed in the various chapters below come frombooks or articles in Japanese including the sho-nishin book of Yoneyama and Mori (1964), the arti-cle by Shimizu (1975); moxa specialty books by Irie(1980), Shiroda (1986), and Manaka (1976, 1980,1983—see also Manaka, Itaya, and Birch 1995);needling or press-sphere recommendations fromYoneyama andMori (1964), Hyodo (1986), Shimizu(1975) and lectures by various Japanese teachers.Some of the uses come from my experience andthat of my colleagues. Additionally, specialist litera-ture on techniques like intra-dermal needles (Aka-bane 1986), cupping (Meguro 1991), and bloodlet-ting (Yoneyama and Mori 1964; Shimizu 1975;Maruyama and Kudo 1982; Kudo 1983) have beenconsulted for any general or specific recommenda-tions that could be useful.

For those seeking more information on Japaneseacupuncture, the English language texts I havecoauthored—Japanese Acupuncture: A Clinical Guide(Birch and Ida 1998) and Chasing the Dragon’s Tail(Manaka et al. 1995)—containmany treatment ideascompiled from a wide variety of Japanese sources.These not only helped guide the choice of and



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compilation of treatment ideas below, but can beexamined by the reader for additional treatmentsuggestions when presented with a child who is notresponding to treatment or who has a condition not

covered in this book. In the chapters where I compilethese treatments, I highlight some that have clearlyproven useful and others that can be considered ifprogress is slowor no change is happening.



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18 Respiratory Problems

Asthma

Asthma is a serious condition that can be life threat-ening. Most children with asthma we treat are ondaily medication to prevent asthma attacks, andoften additional medication to help calm down orstop attacks once they begin. Those with milderasthma conditions may be taking the asthmamedi-cation only with signs of impending symptoms.Some patients will present with asthmalike symp-toms (wheezing, difficulty breathing, chroniccough) due to other conditions such as croup orbronchitis. If these conditions are chronic, the childmay have been prescribed asthma medications tohelp with the difficult breathing or chronic cough.Sometimes parents turn up with their child statingthat their child has asthma for which they receiveasthmamedications, but it is actually amore severeform of something like croup with some of thesame symptoms of asthma (wheezing, difficultybreathing). Occasionally, you may find some confu-sion around the actual diagnosis of the conditionthat the child has. In this subsection I describe thetreatment of asthma and discuss some additionalproblems that canmanifest with asthma symptomssuch as croup.1

Case 1Gilbert, Boy Age 27Months

Main complaints: He had been coughing daily for along time. The condition had been diagnosed as asth-ma for which he had been prescribed the daily use of

a steroid inhaler. He had a tendency to catch coldeasily, the cold triggering worsening of the asthmasymptoms, especially the coughing. His sleep waspoor as he was wokenmany nights by the coughing.

History: He was born 6 weeks premature and was inhospital for the first 10 days of life. It was felt that hiscondition was probably a result of being born prema-ture.

Diagnosis: From the symptoms and the pulse (rightpulse weaker than left), I diagnosed him as having thelung vacuity pattern.

Treatment: I discussed with the mother how to testfor cow’s milk sensitivity (see Chapter 17) and sheagreed to start this as soon as possible.

Tapping with the herabari was applied on the head,GV-12 area, neck area, and a little on the back.

Stroking with an enshin was applied down thearms, legs, and abdomen.

Using a teishin, supplementation was applied to leftLU-9 and SP-5, draining to right LR-3 and left TB-5.

Still using the teishin, light stroking was also applieddown the back.

Press-spheres were left on left BL-13 and the “stopcoughing” points on the elbows.

Second visit—7 days later

No coughing at all this week. The coughing hadstopped immediately after treatment. As a result ofthe dramatic change, his mother had stopped givinghim the inhaler, so that he had not used it at all thisweek. However, his sleep was not so good and he hadwoken in a badmood several mornings.

Treatment: I spoke to the mother about the wisdomof simply stopping the use of the inhaler and that sheshould at least consult with the prescribing doctor.She agreed to consider this.

Tapping with the herabari was applied to GV-20,the neck, GV-12, LU-1, and occipital regions.

Stroking with an enshin was applied down thearms, legs, and abdomen.



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1 A number of similarly manifesting conditions are covered invarious chapters in this book. Here I discuss “asthma” withindications for treatment of asthmalike manifestations ofsomething like “croup.” On pages 113f I discuss a number ofother respiratory conditions, which can also include similarmanifestations of signs and symptoms. In chapters 25 and 26 Ialso discuss treatment of underlying conditions that can pre-dispose towards these problems.

Using a teishin supplementation was applied to leftLU-9 and SP-5, draining to right LR-5 and TB-5.

Press-spheres were left on right BL-13 and the “stopcoughing” points on the elbows.

Third visit—5 days later

He woke on this day with a cold at 5.30a.m. withsymptoms of coughing. He was still coughing, butwith signs of improvement. He had diarrhea over theweekend as well.

Treatment: Tapping with a herabari was applied toGV-20, ST-12 region, neck region, LU-1, GV-12, andLI-4.

Stroking with an enshin was applied down thearms, legs, back, and abdomen.

Using a teishin, supplementation was applied to leftLU-9 and SP-3, draining to right LR-3.

Press-spheres were left bilaterally on the asthmashu points and GV-12.

Fourth visit—2 weeks later

His cough was much better, but he was still coughinga little in the early morning.

Treatment: Tapping with the herabari was applied toGV-20, ST-12 region, GV-12, and LI-4.


Using a teishin, supplementation was applied toright LU-9 and SP-3, draining to left LR-3.

Press-spheres were left on bilateral asthma shupoints and behind shen men on the back of the leftear.

Fifth visit—1 week later

The cough wasmuch better again, but he had startedcoughing a little more 2 days before this visit.

Treatment: Tapping with the herabari was applied tothe head, ST-12 region, occipital region, LU-1.



Press-spheres were left bilaterally on the asthmashu points and behind shen men on the back of theleft ear.

Sixth visit—13 days later

The cough had again improved, but he had startedcoughing a little more in the early morning with acold that started 1 day before this visit.

Treatment: Tapping with the herabari was applied toGV-20, ST-12 region, LU-1, GV-12, LI-4, and LI-11.



Press-spheres were left bilateral on BL-13 andbehind shen men on the back of the left ear.

Seventh visit—2 weeks later

No symptoms of coughing and his condition was over-all much improved. There were no sleep distur-bances.

Treatment: Tapping with the herabari was applied toGV-20, ST-12 region, GV-12, LI-4, and LI-11.


Using a teishin, supplementation was applied to leftLU-9 and SP-3, draining to right LR-3 and left SI-7.

Press-spheres were left on GV-12 and behind shenmen on the back of the left ear.

Eighth visit—22 days later

On holiday he started with a lung infection and wasprescribed antibiotics. He fully recovered and had hadno coughing before or since then. This was a signifi-cant milestone, since any time he had got sick like thisbefore his cough had severely worsened. This time,he had no coughing!

Treatment: Tapping with the herabari was applied toGV-20, the neck region, GV-12, and LI-4.



Press-spheres were left on GV-12 and behind shenmen on the back of the left ear.

Treatment finished as the family moved away. In thefinal discussions with his mother she revealed thatshe had not talked to the doctor who had prescribedthe inhaler. She had always kept it with her, but since



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the first visit Gilbert never needed the inhaler. Shewas very happy with treatment and promised to con-tact me for a referral should the need arise in thefuture.

Reflection: In a case like this, one cannot determinethe degree to which improvement is possible. It ispossible his lungs were weakened due to having beenborn premature. It was also possible that he was sen-sitive to cow’s milk products, and that eliminatingthem after the first visit had contributed to hisimprovements. It is also possible that he actually hadan asthmalike condition such as “croup” rather thanasthma per se. Also, I did not prescribe the mother todo daily home treatment since he was responding sowell to treatments. I prefer to use this additional ther-apy when the condition of the child is not changing orthe changes are slow coming. In Gilbert’s case, thiswas not necessary. Although he caught a few coldsduring the time he was receiving treatment, none pro-gressed to a major worsening of his symptoms, whichI took to be a good sign of the change of his condi-tion. Also, I felt that as well as having a trend towardweak lung constitution he also had a strong tendencytoward liver repletion. Hence, even after his sleep prob-lems had improved I continued treating points thatwould be helpful for this tendency such as the pointbehind shen men on the back of the ear, GV-12, andso on.

General Approach for Patients with Asthma

Generally when we treat patients who have asth-ma, we are using treatment to augment or comple-ment the existing therapy that they usually receive—the daily inhaledmedications. Asthma is a seriouscondition that can kill the patient. Sincewe have noevidence that acupuncture can save the life of anasthmatic patient who is having an asthma attack,we do not use acupuncture in place of the usualdrug therapy. While these drug therapies do notgenerally cure the illness, they help reduce theasthma attacks. Although in the past acupunctur-ists have had to try using acupuncture to stop asth-ma attacks when such medications did not exist,we do not usually do this. The principle goal of acu-puncture treatment of an asthmatic child is toslowly change the overall condition of the child sothat he or she is less prone to having asthma attacksin the future. In other words, most of our work ispreventative. This does not mean that we cannot

use specific techniques or acupoints to try to keepthe asthma symptoms quieter, reducing the fre-quency or severity of attacks, but our primary goalis to use the root treatments, both pattern-basedand core non-pattern-based, to change the overallcondition of the patient. Thus, if the patient has anasthma attack in your clinic, it is advisable to waitfor the parent to administer the inhalant medica-tion to the child. Once the attack has calmed downyou can start to apply your treatment on the child.

Most Likely Pattern-based Root Diagnosis

In a baby or young child, where full diagnosticexamination can be more difficult, it is advisable tofocus on the symptom as the constitutional type ofthe patient and thus treat the lung vacuity pattern.If the child is a little older and has a longer historyof taking medications for the condition, it is possi-ble that the pattern has changed. If you are able toget more detailed information from the pulses andother methods, you can follow the pattern thatemerges. In my experience kidney or liver vacuitypatterns seem to emerge. One of my teachers, Aki-hiroTakai suggested that with extended use of ster-oid medications the patient can start to show thekidney vacuity pattern. Check for softer or coolerlower abdomen and cool feet, as well as the specificpulse findings. Sometimes the liver seems tobecome reactive to the extensive use of medica-tions and the liver vacuity pattern emerges. Tocheck for this as well as the usual liver pulse find-ings, check to see if the right subcostal area hasstarted to become stiffer than the left or is moresensitive or jumpy than the left.

For the lung vacuity patternwe usually treat LU-9and SP-3, but following the ideas ofNan Jing (Classicof Difficulties) Chapter 68, it can be helpful to trythe jing-river/metal points LU-8 and SP-5 instead ifthe child presents with cough. The usual treatmentof the kidney vacuity pattern already uses the jing-river/metal points KI-7 and LU-8. But if the feet arevery cold and the child appears flushed, try thehe-sea points KI-10 and LU-5 (following Nan JingChapter 68 again, which indicates he-sea points forcounterflow qi).

Because the primary goal of treatment for anasthmatic child is to try to change the underlyingcondition, it will be important to apply some formof pattern-based root treatment along with thecore non-pattern-based root treatment. The two



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complement each other very well, and with mini-mal symptomatic treatment, one can see rapidchanges in the asthma symptoms inmost children.

Typical Non-pattern-based Root Treatment

Apply either the whole body tapping treatment orthe combined light stroking with targeted tappingtreatment as the core non-pattern-based roottreatment (Fig.18.1). As soon as it is feasible, it isvery helpful to have the parent start applying a sim-plified form of this on the child regularly at home.Usually, you can start the home treatment by thesecond or third treatment session. However, somechildren have concurrent skin problems in additionto the asthma symptoms. This makes it more diffi-cult to decide how to apply some simple treatmentat home. If the child has very congested lungs,usually with rapid breathing and cough that isworse at night, focus the light stroking and tappingto the chest region, until it starts becoming slightlyredder, then to other body areas.

In addition to the core non-pattern-based treat-ment you can add additional tapping to specificareas such as around LU-1, on the chest aroundCV-17, the interscapular region around GV-12, LI-4,the shoulders, and the supraclavicular fossa region.Shimizu (1975) also recommends applying lighttreatment to acupoints such as LU-5, LU-6, KI-6, KI-7

when the lungs are very congested. For older chil-dren with asthma or asthmalike symptoms contactneedling (light tapping or rubbing) can be appliedto acupoints such as KI-16, LU-1, CV-16, CV-14, LR-14, KI-26, BL-11, BL-13, BL-17, BL-23, GV-12, GV-10, LU-5, KI-6 or KI-7. Palpate and select reactivepoints for treatment. If you have applied a pattern-based root treatment to the lung or kidney chan-nels, it may be advisable not to additionally applythese symptomatic treatments to the lung or kid-ney channel points on the limbs.

If the child is over-sensitive, Shimizu recom-mends treating acupoints such as GV-20, BL-7 orGB-17, BL-10 or GB-20, GV-12, CV-17; if there istension in the subcostal and/or substernal regionsone can treat CV-14, CV-12, ST-19, ST-21, ST-27,GB-24, LR-14, above LR-14, BL-18, BL-20, ST-36,GB-40. Palpate and choose reactive points for sti-mulation.

If the child has a more weakened body type, theskin of the abdomen is thin, the rectus abdominusmuscles stiff, there are fluid sounds in the stomachon percussion of the abdomen, treat KI-21, KI-19,lateral to CV-9, KI-16, KI-15, SP-16, BL-20, BL-23,BL-51, KI-7 (palpate and choose reactive points fortreatment) (Shimizu 1975).

Recommendations for SymptomaticTreatment

The asthma shu point is an extra point. It is locatedslightly lateral to BL-17 and slightly superior to thelevel of BL-17 (see Chapter 16, p.88). A distinct knotis found on one or both sides in virtually every asth-matic patient palpated. You will find it useful onalmost every asthmatic patient to keep this pointstimulated. For treatment either place press-spheres, the new press-tack needles, or intra-der-mal needles. As described in Chapter 12, we can usethese different tools interchangeably. The press-sphere generally applies a lower dose, the newpress-tack needles (0.3mm and 0.6mm) apply aslightly larger dose, and the intra-dermal needles alarger dose again. Thus, on the first visit or for themore sensitive child we start by using press-spheres on the asthma shu points. We can increasedosage by starting to use the press-tack needlesand increase again by using the 3-mm-long intra-dermal needles.

The dose is also modified by varying the lengthof time that the treatment tool you have chosen to



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Fig.18.1 Usual stroking plus tapping:● Supraclavicular fossa region: five to 10 times● Around LU-1, CV-17: 10 times each● Around LI-4: five to 10 times each side● Around GV-12: 10 to 20 times

use is retained. Often the press-tack needles orintra-dermal needles are removed that night, bythe next morning, before bed the next day, or onthe morning after that. Since it is good to keep theasthma shu points stimulated in order to help keepthe asthma symptoms quieter, once the press-tackneedles or intra-dermal needles are removed, youcan have the parent replace them with regularlychanged press-spheres. To judge which tools to useon a particular child, it is necessary to examine thecondition of the child and also track the progressof treatment. For example, in a stronger-bodied2-year-old child who is not excessively sensitiveyou can use the press-spheres or intra-dermal nee-dles sooner.

Press-spheres (Ryu), Press-tack Needles (Empishin),and Intra-dermal Needles (Hinaishin)As described above, the asthma shu point is com-monly treated and kept stimulated with press-spheres, press-tack needles, intra-dermal needles,or a combination of these. Additionally, GV-12 is agood point to place a press-sphere. Other pointsthat can be helpful to keep the asthma symptomsquieter (less frequent, less severe attacks, greaterease of breathing between attacks) are points likeBL-13, LU-1, KI-25 to KI-27. On the young childwhois still in the more oral phase, retaining press-spheres, press-tacks, or intra-dermal needles onthe front half of the torso can be difficult as thechild might pull them off and try to swallow them.Thus, LU-1 and the kidney channel points tend tobe used less frequently. When the child hasimproved and has few symptoms, and has beenreducing medication intake, on follow-up treat-ments where you are still working on improvingthe overall condition of the child, it can be helpfulto retain press-spheres or press-tacks on back shupoints related to the pattern-based Meridian Ther-apy treatment.2 Thus, treatment with these toolscan be directed to BL-13 on one side with BL-20 onthe other for the lung vacuity pattern; bilateral BL-23 or BL-23 on one side and BL-13 on the other forthe kidney vacuity pattern; and BL-18 on one side,BL-23 on the other for the liver-vacuity-related pat-tern.

If the asthmamanifests with coughing, check forthe “stop coughing” extra point, which is locatedjust distal and lateral to the TCM LU-5 location. Thispoint, if hard and uncomfortable,3 can be treatedwith press-spheres, or on older children withpress-tack needles.

Needling—the Chishin or Retained NeedlingMethodYoneyama and Mori were applying shonishin treat-ment in their practices as a form of primary care,since many parents would bring their child to theclinic instead of or before going to the pediatrician.They were also working in situations before thesocial health system was as well established as it istoday. Thus, they had opportunity to apply treat-ment on children to stop an asthma attack. I men-tioned above that we do not usually recommendthis course of treatment, but in an emergency youmay find yourself having to help, and so you shouldknow what the recommended treatment approachis. For treatment at the time of an asthma attack:shallowly insert thin needles at BL-11, BL-12, KI-27,LI-18, CV-22. It might be easier to insert intra-der-mal needles temporarily at those points. One canalso add needling to CV-12, CV-13, or CV-14 in theupper abdomen with good effects (Yoneyama andMori 1964, pp.68–69). It is useful to know thesepoints as they can also be used as part of yoursymptomatic treatment approach for the generalcondition of asthma rather than to target relief of aspecific asthma attack.

Hyodo (1986) recommends light needling to thefollowing points for the treatment of asthma: BL-11,BL-12, CV-22, LU-1, LU-5. If not needled, they canalso be treated with press-spheres to help addressthe general asthma condition. Shimizu’s (1975)recommendations for asthmatic symptoms ofcroup include very light in and out needling ofacupoints such as KI-26, LU-1, BL-11, BL-13, BL-17,BL-23, depending on palpable reactions. For asth-ma he recommends CV-22 as an especially effectiveacupoint.



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2 This treatment model is outlined in Birch and Ida (1998, pp.158–159).

3 This point can be very painful on palpation; be careful tolightly palpate to find the hardness and then with a slightincrease of pressure watch to see if there is a movement towithdraw the arm, or change in facial expression. Don’t pressuntil it hurts.

Okyu—Direct MoxaIrie, following his teacher Fukaya (Irie 1980) recom-mends the following treatment points with moxafor asthma: asthma shu point and GV-12 (three tofive moxa each). As discussed above, I have found iteasier to use needling, press-spheres, press-tack orintra-dermal needles to the asthma shu points.Manaka has different recommendations for the useof moxa on children for asthma (Manaka et al.1995, p.212). He suggests the following points:CV-14, LU-1, LR-14, GV-12, BL-13. For more severesymptoms on older children, Shimizu (1975) re-commends applying moxa to points such as GV-12,GV-10, LU-5, or LU-6 (half a grain of rice size, threeto five cones per point).

In general you will find that you use moxa as alast resort in the treatment of asthma or if the asth-ma is a product of the child having the lung weakconstitution pattern. In this case the moxa may bedirected to GV-12 rather than all the above listedpoints (see Case 1 in Chapter 25, “Weak Constitu-tion”).

CuppingIf the child has chronically congested lungs so thatif they cough you can hear the congestion and espe-cially when they breathe you can hear the conges-tion, it can be helpful to apply cupping over theinterscapular region to help break up the conges-tion in the lungs. Please pay attention to the dosediscussions in Chapter 14 around the use of cup-ping. Thus, for the infant, apply cupping for a fewseconds on each occasion with fewer pressure andless places. For the stronger, older child apply thecupping for a few more seconds in each place withmore pressure and to more places. The cuppingshould never cause pain.

It is also good to be aware that once you haveapplied cupping on a child, he or she will usuallycome to expect it, since they will find it an interest-ing and enjoyable experience. You may find that inorder to please the child on future visits, you needto apply a little cupping even though it may nolonger seem necessary. If this happens, make sureto go back to a very low dose approach.

BloodlettingOn some children with asthma you will find vascu-lar spiders on the upper back, especially up aroundthe lower cervical, upper thoracic vertebrae. Onoccasion you may need to stab and bleed these vas-

cular spiders in order to get the stubborn symp-toms of asthma to start to improve. This techniqueis discussed in Chapter 15. Shimizu (1975) men-tions that bloodletting in the interscapular regioncan be very effective to help treat asthma. In gener-al we do not apply this very often, mostly when thecondition is not responding and you are looking fora stronger technique to try to trigger change in thesymptoms.

Other Considerations

DietaryIn children with asthma, it is necessary to discusswhat the child consumes, in particular cow’s milkproducts. You will often find that you need to dis-cuss having the parents test sensitivity to cow’smilk products and then to have their child stayaway from them. I have often found that the excessmucus production triggered by cow’s milk productconsumption is either causally related to the asth-ma or associatedwith an irritation of it.

Airborne AllergensSome children have allergic-type asthma thatinvolves airborne allergens. Parents aware of thiswill usually be doing their best to keep the houseclean, vacuuming and cleaning daily. If, however,this is not sufficient to stop the problems you mayneed to give further advice. I have had somefamilies with a cat or dog that the child is known tobe allergic to. The parents cannot give up the ani-mal. If trying to persuade them of the wisdom ofletting the animal go does not work, you may needto recommend additional measures to help.Thesamemeasuresmay be needed if daily cleaning andvacuuming seems not to be enough whether ani-mals are present or not. In this case it is a good ideato recommend that they purchase and use a high-powered air-filtering machine (the type with threetypes of filter, including the “HEPA”—high effi-ciency particulate air filter) and leave themachine(s)running constantly so as to keep down the expo-sure of the child to the airborne allergens almost tozero. This issue is discussed further in Case 1 inChapter 25, “Weak Constitution.”

MedicationsAn asthmatic child will be taking one or more asth-ma medications. Many will be automatically taking



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one medicine daily and using additional doses ofthe samemedication or additional medicationwiththe advent of an attack or increased symptoms.Some children (usually with milder conditions)will only take their asthma medication with onsetof symptoms, and parents are free to use as needed.

It is customary for you NOT to be the person thatrecommends stopping the medications. First, theprescribing doctor or another doctor consultedshould do this, not a non-physician practitioner.Second, it is a courtesy in polite medical practice torefer back to the prescribing physician for a discus-sion of the issue. It is thus important to considerhow an asthmatic child who improves with yourtreatment may eventually become free of asthmamedications. I never recommend stopping. I alwaysrecommend the parent return to the prescribingdoctor for discussion of how to proceed if the ques-tion ofmedication arises.

My experience treating asthmatic children isthat after the symptoms start improving, meaningthat the asthma attacks appear less often, lessstrongly, and resolve more easily, and general(between attack) symptoms such as coughing orwheezing improve, the parents start to note the fol-lowing pattern developing. They report that for thefirst time they forgot to give their child the dailymedication once or twice over the week, with nobad effects. This usually escalates as symptoms con-tinue to improve and over the next weeks theyreport that they have forgotten to give the auto-matic medications more often. When the parenteither questions what to do with the medication orthe child seems spontaneously (with your treat-ments, of course) not to be remembering to takethe medication, I refer the patient back to the refer-ring doctor to check if it is all right that they aredoing what they are doing. Usually the doctor issympathetic to the parents’ interests and en-courages them to continue along the same courseso long as the symptoms continue to improve, butto always keep the medication(s) to hand should anattack start. Sometimes the doctor does not likethis course of action, recommending going back onthe daily dose again. This is an issue for the doctorand the patient’s parents to resolve, thus I suggestwe continue with treatments and if the conditioncontinues to improve and the medications arespontaneously forgotten again, I eventually referthe parents back to the same doctor again forfurther discussion. I do not inform parents from the

outset to cut back on medications if symptomsimprove. I always wait for this to appear sponta-neously andwithout my encouragement. If the par-ents inquire further on this, I state that we shouldwait, don’t change anything that is usually done(except specific recommendations such as dietarychanges, reducing allergen exposures, giving hometreatment). If the treatment is working, it is cus-tomary for the medications to start being forgotten.In my opinion we should not encourage this withadvice; we should see if it spontaneously occurs.

Further Case Histories

Case 2Claire, Girl Age 11Months

Main complaints: Problem with coughing daily for along time. Over the last several weeks she had a prob-lemwith regurgitation and vomiting.

History: Like her brother in Case 1 above, this wasdiagnosed as asthma and she was prescribed an inha-ler to be used daily, which she had been using. Shehad a tendency to catch cold easily, the cold trigger-ing worsening of the asthmatic cough.

Diagnosis: From the symptoms and the fact that theright pulse was weaker than the left, I diagnosed lungvacuity pattern.

Treatment: I discussed the need to test for sensitivityto cow’s milk products with her mother.

Tapping with the herabari was applied to GV-20,GV-12 area, ST-12 area, and LU-1.

Stroking with an enshin was applied down thearms, legs, abdomen, back, and neck.

Using a teishin, supplementation was applied toLU-9 and SP-5, draining to right LR-3.

Press-spheres were left on GV-12 and bilaterally onthe “stop coughing” points on the elbows.


No symptoms of cough this week. These changescame immediately after treatment. Also her motherdiscontinued use of the inhaler this week.



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Treatment: Tapping with the herabari was applied toGV-20, GV-12, ST-12 area, and on the abdomen.

Stroking with an enshin was applied down thearms, legs, abdomen, back, and neck.


Press-spheres were left on GV-12 and bilaterally onthe “stop coughing” points on the elbows.


She had a cold over the last few days. She had morevomiting than usual and a problem with diarrhea onthis weekend as well.

Treatment: Tapping with the herabari was applied toGV-20, ST-12 region, abdomen, LU-1, GV-12, and LI-4.

Stroking with an enshin was applied down thearms, legs, back, abdomen, and neck.

Using a teishin, supplementation was applied to leftLU-9, SP-5, and left GB-37.

Press-spheres were left bilaterally on the asthmashu points.

Fourth visit—8 days later

The cough was much better, but she was still cough-ing a little in the early morning. The problem of vomit-ing was unchanged.

Treatment: Stroking with an enshin was applieddown the arms, legs, back, chest, abdomen, andneck.

Using a teishin, supplementation was applied toright KI-7 and LU-5, draining to left SP-9.

Press-spheres were left on left BL-20, GV-9, andCV-12.4

Fifth visit—7 days later

The cough wasmuch better; she had almost no symp-toms at all. But the problem of vomiting persisted. As

the mother described this, Claire threw up on mytreatment room floor.

Treatment: Tapping with the herabari was applied toPC-6, CV-12, GV-12.

Stroking with an enshin was applied down thearms, legs, back, abdomen, chest, and neck.


Press-spheres were left on bilateral PC-6 and leftBL-20.5


The cough was still better, but had worsened slightlywith a cold that started the previous day. The vomit-ing was a little less frequent.

Treatment: Tapping with the herabari was applied onGV-20, GV-12, LI-4, and PC-6.



Press-spheres were left on bilateral PC-6 and GV-12.


No problem with coughing at all, and her problemwith vomiting had also improved significantly—veryfew episodes during this time.

Treatment: Tapping with the herabari was applied toGV-20, GV-12, LI-4, and PC-6.



Press-spheres were left onGV-12 and bilateral PC-6.


The coughing remained better and the vomiting hadstopped completely.



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4 She did not show the lung pattern, probably because therespiratory symptoms were better. Instead it was clear thatthe spleenwas replete, thus to accommodate this I chose kid-ney vacuity pattern with spleen repletion. I also applied onlystroking downward on the body as the core non-pattern-based treatment, thinking this might help with the counter-flow symptoms of the vomiting. The acupoints chosen fortreatment with the press-spheres each showed some reactionand are indicatedwith these kinds of symptoms.

5 The pattern had returned towhat I had found before on Claire,perhaps because it had not changed as I had thought on theprevious visit. Judging changes of pattern in adults can be dif-ficult at times; on children even more so as the findings weuse to judge this, the pulses and abdominal reactions, aremore difficult to read. PC-6 was added because of its effectson vomiting.

Treatment: Tapping with the herabari was applied toGV-20, GV-12, LI-4, and ST-12 region.



A press-sphere was left on GV-12.

Treatment finished as the family moved away. Claireexhibited the same improvements in asthma symp-toms as her brother Gilbert from Case 1. The problemshe had with regurgitation and vomiting took a littlemore time but responded well to treatment. Oncethe asthma symptoms had clearly improved, treat-ment focused on this secondary problem. Treatmentof PC-6 was helpful for the vomiting. If she had notresponded with the press-spheres I had thought toreplace them with press-tack or intra-dermal needles,but was hesitant because they would be easily withinher grasp, which could be dangerous. I did not teachher mother any home treatment as Claire’s conditionclearly improved from the first visit.

Case 3Miguel, Boy Age 7 Years

Main complaints: Since age 3 he had suffered withasthma.

History: The bouts of asthma would typically be trig-gered by catching cold, rapidly turning into an asth-matic cough, then to severe wheezing attacks. Theywere very bad in the fall, winter, and into the spring,and less frequent and not as severe during the 3 or 4hotter months of the year, although humidity couldtrigger the symptoms. He had some form of thecough for almost the whole year. He had been takingsteroids, Ventolin, and other inhalants almost con-tinuously since the asthma started 4 years earlier,typically not taking the steroids much during the war-mer months while taking the Ventolin daily. Pulmon-ary tests a few months previously had shown that hehad borderline pulmonary obstructive disease. Theasthma had resulted in a number of emergency roomvisits, averaging about two per year. In addition hehad many allergies, especially airborne allergies,which could irritate the asthma condition. The asth-ma made it difficult for him to participate in manyactivities, especially sports and other outdoor activ-

ities. He naturally disliked this as he was unable tokeep up with his friends. He came for his first treat-ment at the end of the summer. He had not hadmuch problem with the asthma during the summerand his parents were seeking preventative treatmentsto see if he could have a better fall and winter and toreduce or eliminate his use of themedications.

Additional medical history: He had a tendency to-ward constipation, which would cause a lot of irritabil-ity. He had his tonsils and adenoids removed at age 4.There was a history of rheumatoid arthritis in thefamily. Everything else was unremarkable.

Assessment: He was a normal-looking boy, his skinlooked relatively normal, supple, and his complexionwas generally with luster. He was nervous at his firstvisit. His parents were both therapists. During theinitial interview, he did little talking. His parents alsomade it clear that no needles were to be inserted,and that this was a condition of his visit to the acu-puncturist. His parents revealed that his favorite foodwas cheese and milk products, which he consumeddaily more than any other food. The skin of his abdo-men had good thickness, with reactions in the lungand liver regions. The subcostal regions generallyshowed some slight distension and tightness. Thepulse showed weakness of the lung, spleen, and liverpulses. His back muscles along the bladder channelswere very stiff especially in the upper back region. Pal-pation and even simple light touch of the regionaround the asthma shu points caused strong reactionin Miguel: he immediately started crying with touchalone, expressing extreme discomfort with beingtouched on that particular region of his back.

Diagnosis: Lung vacuity with secondary liver pattern.I also thought that the yin qiao/ren maimight be use-ful following the Toyohari use of this (Fukushima1991), and that the yin wei/chong maimight be usefulfollowing Manaka’s system (Manaka, Itaya, and Birch1995).

Treatment strategies:1. Apply extremely light treatments at first to help

him become more comfortable with receivingtreatment.

2. Use the general shonishin treatment to strengthenhis constitution, help him relax, and make himmore comfortable with the treatment process.

3. Use Meridian Therapy pattern-based root treat-ment to treat him and strengthen his constitution.



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4. Use the extraordinary vessels to address symp-toms, help him relax, and becomemore comforta-ble with the treatment process.

5. Reduce and eventually eliminate his intake ofcow’s milk products (as it was potentially a majorcontributor to the chronic congestion in hislungs); seek to identify other hidden allergens ifnecessary.

6. Use various symptom control measures, especiallyfocusing on reducing the extreme reaction in theasthma shu point regions.

Treatment: Using an enshin, light stroking wasapplied on the torso, arms, and legs. Using a zanshin(see Chapter 2), light tapping was applied on theneck–shoulder region; copper and zinc pellets wereapplied to KI-6 and LU-7 respectively, the polaritybeing based on which produced the most improve-ment in the pulse.6

Using a teishin, bilaterally LU-1 was supplemented.Press-spheres were applied to GV-12, bilateral asth-

ma shu points, and the “stop coughing point” ap-proximately 0.5cun distal to right LU-5.

The whole treatment took a total of about 10min-utes.


His mother reported that he had virtually eliminateddairy from his diet, and that he was experimentingwith goat’s milk and soy milk products (despite hisgreat resistance). She also described him as beingeuphoric after the treatment, and that he had beenable to play soccer without symptoms that weekend.That morning he had a queasy stomach with loosestools. The pulse and abdomen confirmed a primaryliver vacuity pattern (which remained for virtually allfuture treatments) with secondary spleen vacuity.

Treatment: Copper and zinc pellets were used on KI-6and LU-7 respectively, followed by supplementationwith a silver teishin at bilateral ST-25, CV-12, left LR-3,left KI-3, and right SP-3.

The enshinwas stroked over the torso and limbs (asthe whole body shonishin treatment).

Press-spheres were applied to GV-12, CV-12, andthe asthma shu points.


Dairy intake was now almost entirely eliminated. Itwas a good week except for some residual GI distur-bance.

Treatment: The treatment was the same as the sec-ond, except for the addition of tapping applied to theneck, head, shoulders, and around GV-12 using a her-abari, and instead of press-spheres at the asthma shupoints, he and his mother were persuaded to allow3-mm intra-dermal needles to be used at the asthmashu points (to be removed after 36–48 hours).

Fourth visit—7 days later (now early October)

He was doing much better; he had been able to runfor a mile, with only mild coughing symptoms, he wasable to play soccer daily without symptoms, and hisparents described that his endurance was much bet-ter. He had still not needed to start on the steroidmedication and was using the inhaler much less fre-quently.

Treatment: Same as the third visit, except for the useof LR-8, KI-10 instead of LR-3 and KI-3, and LU-9instead of SP-3.

The next six treatments were given weekly, duringwhich time he generally continued to maintain hisimprovements; the treatments were similar on eachoccasion except for the following:

At the sixth treatment gentle cupping techniqueswere used for the first time on the upper back.

At the 10th treatment, instead of the teishin nee-dle, a silver 0.16-mm gauge needle was used for theToyohari-based noninserted supplementation tech-niques, which represented another major break-through in trust (his mother gave the permission).This was done because he appeared to be starting acold, and had a mild cough, which historically mark-ed the beginning of a major downward spiral and dra-matic increase in symptoms.

At the 11th treatment, 3 days later, the cough hadprogressed. He had to use his inhaler more fre-quently, but while the cold had progressed, the pro-gression was slower than in the past and he was notas bad as had been expected. On this occasion, it wasdecided to discontinue the use of the zinc–copper pel-lets to KI-6 and LU-7, and instead to use Manaka’s IP(ion-pumping) cords bilaterally to PC-6, SP-4. Since hewould not permit any inserted needles, Silver surfaceelectrodes were used at the points to make contact



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6 For an overview of how the Toyohari Association uses themaster-coupled points of the extraordinary vessels with zinc–copper, see Fukushima (1991, pp. 243–251).

for the IP cords, black on PC-6, red on SP-4.7 Theremainder of the treatment was similar, with theexception of draining LU-6.

This last treatment stopped and reversed the slightdownward trend. He was able to maintain hisimproved status from this point on. While he hadsome minor asthma symptoms over the next 7months, which occasionally required twice-weeklytreatments, he was able to reduce the use of the inha-lant medication and not use any steroids during therest of the fall, the whole winter, and spring. Duringthis 7-month period he received 23 treatments,which varied around the themes described above. Hecaught two colds, neither of which progressed toasthma. He also broke his dietary restrictions prettyregularly, but with no major reactions occurring anymore. He had a 3-month break during the summer,returning for nine more treatments mostly to treathis fall allergies, which were quite bothersome thatyear, but which did not precipitate any major asthmasymptoms.

During the course of the treatments, he never usedthe steroid medication, and significantly reduced hisuse of inhalant medications. He was able to be muchmore active, and with the exception of swimming(because of the chlorine), was able to participate inmany more sports activities. At follow-up 1 year afterfinishing treatment, the boy’s mother reported thathe had not had any recurrence of the asthma and hadbeen able to increase his activities so that he couldnow easily play sports along with his friends. He wasreceiving a course of injections to treat his allergies,but otherwise needed nomajor asthmamedications.

Reflection: In this case, simple, almost exclusivelynoninvasive treatment methods had a profoundimpact on this chronic asthma patient. Frequently inbiomedicine, this chronic condition is thought to beincurable, but able to be regulated with strong drugs.However, the side-effects of these drugs havebecome increasingly apparent (Jobst 1996). While thissimple treatment method will not be of benefit in allcases, such a simple and safe treatment should beincreasingly used as more evidence of its effectivenessbecomes available. To be able to reduce or eliminatedependence on strong drugs that can have significant

side-effects, while still improving functionality, is veryimportant when treating children. The additionalbenefit of doing a simplified form of the general sho-nishin treatment at home was not taken advantage ofas the parents would not do it (which sometimes hap-pens).

The following case comes from my colleague Bren-da Loewwho practices in Seattle,Washington.

Case 4Lyle, Boy Age 5Months

Lyle was adopted immediately after birth.

Main complaints: Cough that worsened with eatingand lying down. The cough was especially pro-nounced during the night. Lyle woke up wheezing inthe morning. The pediatrician suspected asthma andprescribed an inhaler. The secondary complaint wasconstipation. Lyle was able to move his bowels with-out apparent discomfort, but did not have a dailybowel movement; rather, he often evacuated afterseveral days and then the stools were quite green andvery loose. His mother appeared quite stressed aboutthe cough, worrying about airborne allergens such ashouse dust. She had the rugs in their house speciallycleaned but with no significant change in Lyle’s condi-tion. She reported that he had a healthy appetite butthat he woke very hungry in the middle of night. Themother was part of a mother’s milk co-op for adoptedinfants and used this cooperative’s breast milk, plusinfant formula, for his feeds.

Examination: Lyle appeared to have a good tempera-ment, which was confirmed by his mother. His skinwas very white, and there was a distinct blue areabetween his eyes in the yin tang area. Overall his skin“luster” was not so good. Pulses were very weak onboth sides. The entire ren mai on the abdomenshowed some slight tightness superficially with soft-ness underneath. The most significant abdominalfindings were in the lung and spleen regions of theabdomen. Comparing the arms and legs, I noted aslight swelling at LR-3 bilaterally, especially on theright, and the lung channel felt slightly rough on botharms.



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7 For an overview of Manaka’s use of the ion-pumping cords onthe extraordinary vessels see Manaka et al. (1995, pp. 136–139, 161–162).

Diagnosis: Based on the findings and symptoms Ichose the lung vacuity pattern.

Treatment: Using a teishin, supplementation wasapplied to left LU-9 and SP-3.

Amild drainingmethod was applied to right LR-3.Using the yoneyama zanshin, light stroking was

applied down the front and back of the torso, especiallyon the superior portions and down the arms and legs.

A gold-plated press-sphere was placed on GV-12,with instructions for removal the next day.

The total treatment took only a fewminutes.I decided to teach the basic core non-pattern-based

stroking treatment to the mother as home treatmentto be done daily. I also advised the mother to testwhether Lyle was allergic or sensitive to the milk inthe infant formula.


Lyle’s mother reported that he appeared to do wellafter the first treatment and had a very large bowelmovement the night of the treatment. She didchange his infant formula. Now he had a “normal”bowel movement every other day, which was a defi-nite improvement, and he was no longer waking atnight hungry. The wheezing stopped and he didn’thave to use the inhaler at all; however, he was stillwaking with a wet cough. The mother had alsoapplied the home treatment daily.

Treatment: Virtually identical to the first treatment.


His condition remained similar to that at the secondvisit.

Treatment: Using a teishin, left LU-9 and SP-3 weresupplemented, right LR-4 was drained.

Using the Toyohari method of extraordinary vesseltreatment with zinc and copper pellets, a copper pel-let was placed on right LU-7 with a zinc pellet on leftKI-6 for about 1minute.

Using an enshin, light stroking was applied on thesame areas as the first two visits.

A gold-plated press-sphere was placed on GV-12.

Fourth visit—1 week later

Lyle’s appearance and skin luster had significantlyimproved; he looked more vibrant and healthier. His

bowel movements had further improved, only occa-sionally skipping a day. Lyle was still waking in themorning with a deep wet cough. On this visit, I couldhear phlegm deep in his chest.

Treatment: Same as the third visit.

Fifth visit—2 weeks later

Scheduling conflicts made it difficult for him to comethe week before. His condition was stable and similarto the last visit. The cough temporarily worsened for1 day but the mother suspected possible allergieswhen they went to a city park. His bowel movementswere normal, daily, and well formed. He had one epi-sode of diarrhea during these 2 weeks, possibly dueto something he had consumed. Lyle’s skin lookedmore lustrous and his pulse was now clearly palpable,although relatively weaker on the right. A slightcough persisted.

Treatment: Identical to the last treatments.

Further visits were not scheduled after a phone con-versation 10 days later, in which Lyle was described tohave stopped coughing and was free of the asthmamedication. Further acupuncture treatment was sug-gested for maintenance; however, the family movedout of state.

The following case of treatment of asthma in a 10-year-old boy comes from Mr. Ishihara of Japan, apractitioner of the Toyohari style of Meridian Ther-apy. It was published in 1971 (Ishihara 1971). Onecan see a similarity of progress to the third case,treatment of relatively severe asthma in a 7-year-old boy: over the period of 1 year we see continu-ous general improvement.

Case 5Yoshi, Boy Age 10 Years

Main complaints: Difficulty breathing from the ageof 6, which was diagnosed as asthma. Since that timehe had taken asthma medications continuously.While they helped to control the asthma, there wasno sign of improvement in his condition. He tendedto easily catch cold, which would trigger asthmaattacks; this happened on average two to three times



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per month. He caught cold more easily in the rainyseason and when he was tired, which was quite oftenas he tended to have a poor appetite. He also had arunny nose most of the time, and was constantly snif-fling. One could hear his breathing due to the conges-tion and restricted airways, and he frequently hadproblems with coughing.

Assessment: He was skinny, the ribs protruded, andhis complexion was pale whitish, with dry skin. Hehad hard knots around LU-1, and the abdomen was alittle depressed with lack of springiness. There wastension in the subcostal region and on left ST-25. Thelung channel (between the elbow and wrist) andspleen channel (between ankle and knee) were bothslightly depressed. There was pressure pain on SP-8,LI-6, and LI-4. There was tension on the sternocleido-mastoid muscles, on the sides of the vertebrae in theinterscapular region and on the medial edges of thescapulae. The lung and spleen pulses were weak, thelarge intestine, stomach, liver, and heart slightlyreplete.

Diagnosis: Lung vacuity pattern; almost all the signsand symptoms pointed toward a problem of the lungand spleen channels. It was explained to the parentsthat treatment would need to be done gently so asnot to over-treat. It was also explained that treatmentwould need to be done over a period of time, so as tocreate a change in his whole condition. Treatmentthen began.

Treatment: Using a regular needle, LU-9 and SP-5were supplemented, LI-6 drained.

Using the same needle, LU-1, LR-13, BL-13, and BL-20were supplemented.8

Second visit—next day

Treatment: Using a regular needle, LU-9 and SP-5were supplemented, LI-6 drained.

Using the same needle, LU-1, LR-13, BL-13, and BL-20were supplemented.

Using the same needle, CV-12, ST-25, and ST-27were supplemented to encourage the appetite.

CV-22 was needled for the cough, yin tang and LI-20for the runny nose.

Third visit—next day

Treatment: In addition to the same treatment as onthe second visit, light contact needling9 was appliedon the sternum, sternocleidomastoid muscles, sidesof the vertebrae, medial edge of the scapulae, and onthe lumbar region.

The next 12 treatments were performed daily follow-ing the treatment regimen of the third visit. The nextfive treatments following the same protocol were per-formed every other day. Then treatment was reducedto once a week over the course of the year.

After the first six treatments the runny nose andcough were better. By the 10th treatment his skinwas no longer dry and the difficulty breathing withbreathing sounds had gone. By the 25th treatmenthis abdomen was springy with a more full feeling, hishands and feet were stronger, his appetite better andhe had been gaining weight (4kg in 25 days). Afterthis initial period his treatment response remainedgood. During the year he had only two light asthmaattacks, one from catching cold and one from fatigue.He had no attacks during the rainy season, and had asignificant reduction in the number of times hecaught cold. He recovered and his health continuedto improve. For further maintenance Mr. Ishihara con-tinued treatment up to twice per month over a sec-ond year.

Additional Respiratory Conditions

Cough

Chronic cough is often thought to be kidney-vacuity pattern–related, while acute cough morelung-vacuity-pattern–related. If the cough is theresult of catching cold it is mostly related to lungvacuity pattern. On babies and small children this isthe better pattern to treat. On older children whereyou are able to obtain more information such aspulse findings, and are able to differentiate the pat-tern, treat according to what you find. The jing-river points are specifically indicated for coughing,thus for the lung vacuity pattern one can sup-plement LU-8 and SP-5 instead of LU-9 and SP-3.



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8 The needling was all performed using the noninserted need-lingmethods of Toyohari.

9 Lightly brushing or stroking on the skin holding the needletip at an angle as it protrudes slightly from the tips of the fin-gers.

Jing-river points are normally supplemented forthe kidney vacuity pattern, KI-7, LU-8.

In addition to the core non-pattern-based roottreatment, stroking down the arms, legs, back, andabdomen, apply extra tapping over the chest, espe-cially the upper chest, tapping until slightly pinkish,and also to BL-11, BL-12, BL-13, GV-12, or BL-17.Choose the points according to their reactions (Shi-mizu 1975). If the cough is accompanied by a sorethroat, apply tapping over the throat, sides of theneck, to the sides of C6 and C7, LI-4, LI-11, LU-5, andBL-23. Choose points and areas by palpation (Shi-mizu 1975).

The extra point close to LU-5, the “stop cough-ing” point, is good to treat. Leave a press-sphere orsmall press-tack needle (0.3mm or 0.6mm) on thereactive points.

Pertussis

A severe form of cough is pertussis (whoopingcough). We don’t see this much today, largelybecause of the inoculations that most childrenreceive. Some practitioners have described thetreatment of this condition.

It is unlikely you will see the child in the acutestage where fever is present, more likely you willsee the child when the fever has subsided. If thechild presents with fever, follow the indications

given in Chapter 28, pages 238–240, regardingtreatment of fever.

Apply the core non-pattern-based root treat-ment (unless there is a fever). Stroke down thearms, legs, back, and abdomen. Apply tappingaround GV-12, LU-1, CV-17.

The most likely pattern will be lung vacuity pat-tern, but again, if possible, follow the findings toselect and treat the pattern. You can try using jing-river points instead of the regular points to targetthe cough, following Nan Jing Chapter 68. Thus, fora lung vacuity pattern, supplement LU-8, SP-5instead of LU-9, SP-3. It is likely you will find reple-tion in the pulses. If you are able to discriminatewhich channels show the repletion disturbance,apply the draining technique to that channel(s).

Hyodo (1986) mentions either needling or leav-ing press-spheres on BL-13 and LU-1. Shiroda(1986) describes the use of okyu—direct moxa—onGV-12, GV-14, and BL-12. Use of the new press-tack needles (0.6mm) is good to try on the samepoints.

If the asthma shu point is very reactive, it is goodto try treating this point as well. The extra point onthe elbow for coughing should also be examined. Ifreactive, treat this point as well. The asthma shupoint can be treated with press-tack needles, the“stop coughing” point with press-spheres.



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19 Skin Disease

Eczema

Case 1Julie, Girl Age 5 Years

Main complaints: Eczema—skin problems on chestand back of shoulders, but especially on the genitals(since age 10months).

History: Born 10 weeks premature. At the age of 2she had double pneumonia, and at age 3, minorpneumonia—since then her lungs had generally beenfine. Her father had a significant history of eczema. Allother systems were normal.

Diagnosis: Lung vacuity pattern (symptoms, abdo-men, and pulse).

Treatment: Tap with herabari LI-4, LI-10, LI-11, ST-36,BL-40, abdomen, chest, neck region, GV-20, GV-12,and on the back.

Using a teishin, very light stroking was applieddown the back and on the bladder channel on thelegs, then supplementation was applied to right LU-5,SP-9, draining to left LR-8.

Press-sphere: bilateral BL-25.

Second visit—1 week later

She had a problem with itching on the buttocks andupper thighs, but the vaginal itching was much bet-ter, the shoulders and chest better.

Treatment: Tap with herabari LI-4, LI-10, LI-11, ST-36,BL-40, abdomen, occiput, neck region, GV-20, GV-12,and on the back.

Using a teishin, very light stroking was applieddown the back and on the bladder channel on thelegs, then supplementation was applied to right LU-9,SP-3, with draining to left LR-3 and BL-58.

Press-sphere: bilateral BL-25.

Third visit—1 week later

Overall improvement in her skin problems; somesmall spots remained on the buttocks, the vaginalregionwasmuch better. But shewas slightlymore irri-table.

Treatment: Tap with herabari LI-4, LI-11, LI-15, ST-36,BL-40, abdomen, occiput, neck region, GV-20, GV-12,and on the back.

Using a teishin, supplementation was applied toright LU-9, SP-3, draining to left LR-4 and BL-58.

Press-spheres were applied to right BL-18 and leftBL-25.


She had some minor skin problems on the buttocks(small patches) but overall the eczema wasmuch bet-ter.

Treatment: Tapping with herabari LI-4, LI-10, LI-11,ST-36, BL-40, abdomen, occiput, neck region, GV-20,GV-12, and on the back.

Using a teishin, very light stroking was applieddown the back and on the bladder channel on thelegs, then supplementation was applied to right LU-9,SP-5, draining to left LR-3.

Press-spheres were left on left BL-18 and right BL-25.

The mother said she wanted to take a break fromtreatment because Julie was much better, and it wasdifficult making the trip to the clinic on a regular basisdue to scheduling difficulties and the long travel dis-tances. She agreed to call for further treatment if theproblem started worsening.



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115

Case 2David, Boy Age 9Months

Main complaints: Eczema over the whole body. Poorsleep.Congested nose with some coughing.

History: Soon after birth he started developing redskin blotches, which soon gave rise to eczema overthe whole body. The dermatologist immediately pre-scribed a cortisone cream, saying that it was a consti-tutional type of eczema. The parents used the cream,which helped, but the symptoms came back as soonas they stopped. They did not want to continue withthe cortisone cream. The itching was very bad, caus-ing him to wake five to seven times a night, so every-one became sleep deprived and tired. He hadstopped breast feeding 1 month before and was eat-ing relatively widely without a worsening of the symp-toms. He became a bit phlegmy with a regularly con-gested nose and occasional mild cough. He hadVaseline applied regularly to keep the skin moremoist and was bathed daily.

Examination: The parents had not been advised bythe dermatologist to examine whether there was adietary problem that might be contributing to theeczema. He was a healthy-looking, largish child. Hisabdomen looked full and rounded. The skin over theabdomen was rough and a bit dry. The right deeperpulses were weaker than the left deeper pulses.

Diagnosis: Lung vacuity pattern confirmed by thesymptoms, abdominal findings, and pulse.

Treatment: Using a teishin, a light stroking above theskin was applied quickly down the large intestinechannels on the arms, the stomach channels on theabdomen and legs, down the bladder channel on theback, and down the neck and shoulders.

Light stroking was applied using a silver enshindown the backs of the legs.

Using the teishin, supplementation was applied toright LU-9, SP-3, left LR-3, yin tang, and GV-12.

A gold-plated press-sphere was placed on CV-12.The parents were counseled about testing the

effect of cow’s milk on the eczema. They wereadvised to try stopping the milk and milk products tosee if there was any change in symptoms.

Second treatment—7 days later

He continued to be itchy and sprouted two teeth dur-ing the week. The stuffiness of the nose was better.

Treatment: Using a teishin, a light stroking was ap-plied quickly down the large intestine channels on thearms, the stomach channels on the abdomen andlegs, down the bladder channel on the back, anddown the neck and shoulders.

Using a silver enshin, light stroking was applieddown the backs of the legs.

Using the teishin, supplementation was applied toright LU-9, SP-3, draining to left LR-3 and GB-37.

Gold-plated press-spheres were placed on CV-12and GV-12.

Third treatment—7 days later

Over the week his condition had improved, but theday before treatment it was not so good. The itchi-ness was less and the sleep was better. The skinlooked clearer. It was discussed that the avoidance ofmilk products seemed to be helping and that the par-ents should continue having him avoidmilk products.

Treatment: Using the teishin, a light stroking wasapplied quickly down the large intestine channels onthe arms, the stomach channels on the abdomen andlegs, down the bladder channel on the back, anddown the neck and shoulders.

Stroking with a silver enshin was applied down thebacks of the legs.

Using the teishin, supplementation was applied toright LU-9, SP-3, draining to left LR-3 and right ST-40.


Fourth treatment—7 days later

He had sprouted two more new teeth, which dis-turbed his sleep again and left him with more nasalcongestion. The skin was still itchy, but improved andlooked better.





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Using the teishin, supplementation was applied toright LU-9, SP-3, and left LR-3.


It was recommended for the parents to brieflyapply light stroking with a rounded silver instrumentdown the large intestine channels on the arms, thestomach channels on the abdomen and legs, the blad-der channels on the back and the backs of the legs,and on the forehead around the nose. They were in-structed to do this daily.

Fifth treatment—7 days later

He had had the best week in months. The skin wasmuch less itchy, with an improved appearance, andhis sleep was much better. It was discussed that thiswould be the last treatment until further interventionwas needed. The parents could continue on a cow’smilk-free diet and continue the daily treatments,which they had been able to do every day over thelast week. The parents agreed to call up and resche-dule if the symptoms started recurring.



Using the teishin, supplementation was applied toright LU-9, SP-3, left LR-3, and right ST-36.


General Approach for Patients with Eczema

Skin problems usually take time to improve, andsometimes cannot be changed much with treat-ment. Most children show some degree of respon-siveness, but it can be a complicated problem totreat. In general, the pattern-based treatment isvery important as it will allow you to start changingthe underlying constitutional tendency of the child.The non-pattern-based treatment is more limitedfor eczema and skin problems in general, and tendsto be only applied around the affected regions,which means it is not usually a “root” treatmentper se. It is also more difficult deciding what or ifhome treatment can be applied. Sometimes you are

unable to have the parents apply any home treat-ment, due to the nature and extensiveness of thesymptoms. Thus, we need to place more emphasison the pattern-based root treatment. There are afew symptomatic treatments for eczema (such asdirect moxa), but they can be difficult to do onsmall children. Because of these typical complica-tions, I recommend not making predictions abouthowmany treatments before the problem is better,rather to suggest trying a certain number of treat-ments to see if what you do helps, then to continueor not as needed and based on response.


The lung vacuity pattern is by far the most com-mon, especially if the eczema problems began as aninfant. If the eczema is associated with lung symp-toms—as the skin improves the lungs worsen, asthe lungs improve the skin worsens—this is also aclear sign of lung vacuity pattern. But, extensiveuse of steroid creams can gradually shift the patientfrom a lung to kidney vacuity pattern. To identifythis, check the feet. If they are cold or tend tobecome cold, this is a sign of the kidney involve-ment. While on small children the pulse mayremain difficult to read, the additional sign of coldfeet can be taken as an indication to try the kidneypattern.

Sometimes the skin problems show in relationto food allergies. The food allergies themselves canbe a sign of spleen and/or liver involvement. It candepend on the manifestation of associated symp-toms. If there is a history of food allergy reactionssince infancy, with skin problems showing up aspart of that pattern, the child may need to be trea-ted as a spleen vacuity pattern. But this is notalways very clear. The spleen signs can be includedwithin the lung vacuity pattern, and if you areunsure, because the pulse and abdominal reactionfindings are unclear, it is better to approach thepatient as a lung pattern until other symptoms andsigns become clearer. If the skin problems showalong with food allergies, remember to add moxatreatment of the extra point uranaitei as part of thesymptomatic treatment.

Generally with the pattern-based root treat-ment we use the treatment combinations outlinedin Chapter 10; for lung pattern supplement LU-9and SP-3 or SP-5, for kidney pattern supplementKI-7 and LU-8. But if the skin is very red and



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19 Skin Disease 117

irritated and especially affects the upper parts ofthe body, such as around the neck and face, then itcould be useful to try using the “he-sea” pointsinstead. One of my teachers, Akihiro Takai, recom-mended the use of the he-sea points in such casesas they are indicated in Nan Jing (Classic of Difficul-ties) Chapter 68 as being good for counterflow qi,and one can see the heat in the upper parts andgenerally in the skin as a sign of counterflow. Some-times such a simple shift of point selection canimprove treatment outcome. Thus, for the lung pat-tern, use LU-5 and SP-9, for the kidney pattern KI-10and LU-5.


Overall, this can be difficult to apply on childrenwith eczema. The general recommendation is touse tapping around the lesions and no stroking orrubbing methods. This is not usually thought to bea root treatment as it targets only the symptomareas themselves. If you are using this approach it isa very good idea to make sure to include treatmentby the pattern-based approach.

A method that can be used in order to perform anon-pattern-based root treatment comes from myteacher, Toshio Yanagishita. He described a modi-fied way of applying the teishin, using it with a verylight stroking method. Here, the teishin is heldbetween the finger and thumb and just touchingthe skin very lightly. The teishin is then moved,almost in a gliding movement rather than strokingmovement along the body surface relativelyquickly. A simple pattern is to stroke down thelarge intestine channels on the arms, stomachchannels on the abdomen and legs, and bladderchannel on the back and legs (see Fig.19.1a). I havefound it often helpful as a light technique for apply-ing the non-pattern-based root treatment whenthe usual methods of performing that treatmentare not possible. Normally for eczema, rubbing can-not be used; however, this technique has such lightcontact to the skin that it does not cause the prob-lems associated with rubbing. This is illustrated inthe case histories in this chapter. The limitation ofthis method is that it is not so easy to teach to par-ents as home therapy. At least it offers you the pos-sibility of using a shonishin-like root treatmentapproach.

Sometimes the latter technique is also not suffi-cient when treating skin problems like eczema, or

atopic dermatitis, in which cases I recommend theuse of the tapping only method directed neither tothe body surfaces, nor to the areas around thelesions, but instead to a number of specific acu-points that are good for skin problems. You canapply tapping to a selection of the following points:LI-4, LI-10, LI-11, LI-15, BL-40, SP-10, ST-36, CV-12,GV-12, GV-3 area. Some of these points are usuallytreated with moxa for skin problems and some are



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a

b

Fig.19.1a,b (a) Gliding action with teishin:● Down the large intestine channel on the arms● Down stomach channel on the abdomen and legs● Down the bladder channel on back and legs(b) Tap around:● LI-4, LI-10, LI-11, LI-15● GV-12, GV-3 (for affected lower limbs)● GV-20● BL-40 or SP-10 + ST-36● CV-12● And if possible around affected areas

needled. Applying direct moxa regularly on olderchildren can be possible and even applying moxa athome, but in general and especially on babies andsmall children, this is not really an option. Thus, wecan apply tapping to a selection of the points (seeFig.19.1b). Often, there are lesions on the backs ofthe knees so that we cannot treat BL-40, in whichcase use SP-10, ST-36 instead. Often there are lesionsin the elbows, in which case you may not be able toinclude LI-11. GV-12 can affect the upper bodyman-ifestations, GV-3 the lower bodymanifestations.


Okyu—Direct MoxaIt is generally recommended to use acupoints onthe large intestine channel with moxa for eczema.Shiroda (1986), following Takeshi Sawada’s style oftreatment (see Chapter 13 on moxa), recommendsthe following moxa treatment for allergic skin prob-lems, eczema, sweat rash:moxa BL-12, GV-12, LI-15,LI-11, LI-10. My Toyohari instructors following thiskind of idea recommend the following: palpate andselect the most reactive points from among LI-4,LI-10, LI-11, and LI-15 and apply direct moxa tothem. This can be done regularly in the clinicaltreatment and additionally as a form of home treat-ment, having the patient (if older) or parents to dothe moxa regularly at home. However, this is not aneasy treatment to do. If there are food allergiesassociatedwith the problem, moxa uranaitei on thefoot.

NeedlingNeedling can be applied to some of the main treat-ment points that are usually treated with moxawhen it is very difficult to apply the moxa. Thus,needling, for example, LI-4 or LI-11 can be helpful.Choose the more reactive points for treatment. Onsome children the itching is very distressing andcan disturb sleep, and so on such children it may benecessary to needle acupoints such as GV-20 (pal-pate for a reaction) and around GB-20 (palpate tosee if the region is stiff).

Press-spheres (Ryu), Press-tack Needles (Empishin),and Intra-dermal Needles (Hinaishin)It can be helpful leaving some kind of treatmenttool on acupoints, but it can also be very difficult.First, the skin overall can be very dry on some chil-

dren, in which case the tape generally does notstick well. Second, parents are often using somekind of moisturizing or other cream or salve on theskin, in which case it can be difficult to get things tostick well or at all. Third, the skin of some childrenwith eczema is overall more sensitive, they some-times react to the tape, sometimes to the metal ofthe press-sphere or press-tack. If there are anysigns of reaction, you usually have to stop usingthese treatment tools. In general, if you are able toleave something like the press-sphere or press-tackneedle, have them left for less time and changedmore often so as to reduce the risk of skin irritation.On children who show the lung vacuity pattern,acupoints like BL-13, BL-17, BL-20 can be palpatedand treated. GV-12 is usually helpful to treat aswell. For children who show more the kidneyvacuity pattern, BL-23 can be treated. If the childhas accompanying lung problems like croup orasthma, you will need to stimulate acupoints speci-fically for that problem and thus choosewhich acu-point combination is best for the child (for example,the asthma shu points with press-tack needles forthe asthma and GV-12 with press-sphere). If thechild has concurrent digestive problems, such asfood allergies contributing to the eczema, it can beuseful to treat acupoints like BL-20, CV-12. If theproblem is one of concurrent constipation, it can behelpful to treat acupoints like BL-25 or ST-25, to tryto get the bowelsmoving better.1

CuppingCupping can be applied around the navel if thereare any food allergies related to the eczema. Becareful to match the dose to the child and makesure it is not uncomfortable.

BloodlettingBloodletting can be helpful for some children. If youfind vascular spiders on the upper torso, it can beworthwhile trying to bleed these. Use the stab andsqueeze method rather than the cupping method,to ensure lower dose.



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1 In herbal medicine, one of the strategies for helping with skinproblems is to get the bowels tomove better.


DietaryDietary issues need to be attended to. Eczema canbe a reaction due to sensitivity or allergy to cow’smilk products, thus it can be important to test forthis. If other allergies are found, it is not uncommonthat the parent has figured this out themselvesalready, either by trying and testing different foodsor asking their physician to test for different aller-gies.

Home TreatmentIn some cases home treatment can be difficult dueto the complexity and extent of the manifestationsand various restrictions involved in treatingpatients with eczema. The basic techniques ofstroking are prohibited or need to be significantlymodified. It is difficult for parents to do this. Tap-ping can be applied, but then it is donemore as partof the symptomatic treatment rather than roottreatment. Often root treatment is only possible inthe clinic. When having the parent apply some tap-ping treatment at home, it is usually over specificacupoints, the selection of which depends on themanifestations of the eczema. Tapping is not ap-plied over a lesion, only on healthy skin regions.Thus, it can be applied around lesions on the backsof the knees or in the elbows. If patches occur, tap-ping can be applied around each. But when thereare extensive lesions of eczema covering large partsof the body surface, such tapping is difficult to do.Instead and sometimes as well, apply tapping to aselection of the following acupoints: LI-4, LI-10,LI-11, LI-15, BL-40, SP-10, ST-36, GV-12, GV-3 area.If there are lesions on the backs of the knees, useSP-10, ST-36 instead. If there are lesions in theelbows, youmay not be able to include LI-11.

Egg—Vinegar Folk RemedyI have learned a simple folk remedy that sometimesis helpful for treatment of eczema. It uses raw eggsand brown rice vinegar. Place a clean raw egg in itsshell in a bowl then put enough brown rice vinegarin the bowl to cover the egg. Leave the egg in thevinegar in the bowl for a number of days. Since thevinegar is acidic and the shell alkaline, the shell willslowly dissolve. After around 8 to 10 days, the shellwill have dissolved so that one has a membranousegg in the vinegar. When the shell has dissolved,carefully spoon the whole egg out of the vinegar,

being careful not to break the membrane and spillits contents. Place the membranous egg in anotherbowl, without any additional vinegar. Break themembrane and empty the contents into the bowl.Remove the membranous part. Mix the contents.There will have been a chemical exchange acrossthe membrane of the egg so that the egg becomesslightly “pickled.”

For treatment smear some of the egg—vinegarmix over the affected skin regions. Leave themix onthe regions for about 20minutes, then with warmsoapy water wash the mix off. Repeat up to threetimes daily.

The mix can sting when it is first applied, thenafter a while the stinging stops and it reduces theitching of the area. On some patients this can be avery effective simple treatment to help the eczemalesions.Do not use this on childrenwith egg allergy.Do not use this on skin lesions where the skin hasbeen scratched open or has cracked open. You mayfind that the stinging is too much for some childrenand they become upset or increasingly resistant tocontinued use.

This method is simple and inexpensive; parentscan try it at home. A few observations and com-ments are necessary. The egg in vinegar should bekept in a cooler cupboard, it should be covered, andnot allowed to becomewarm or hot. Make sure thatthe egg is clean first. I have tried other vinegarswhen the brown rice vinegar is unavailable; itseems not to work as well. It is best to store the egg—vinegar mix in a covered bowl in the refrigeratorwith instructions “not to be eaten.” It usually takes8 to 10 days for the shell to dissolve, but can takemore time. The vinegar does not need to be thrownaway, it can be used several times, thus as soon asone egg is ready, the next can be placed in the vine-gar so as to keep a steady supply of egg—vinegarmix going. This technique is much easier to use onadults than children, but it can be worthwhile try-ing it.


The following cases illustrate further modificationsin the treatment of childrenwith eczema.



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Case 3Paul, Boy Age 5 Years

Main complaints: Eczema—itchy skin especially onthe medial thighs, upper arms, and around the eyes(since birth). Used Vaseline and occasionally hormonecream.

History: Born 10 weeks premature he was hospita-lized for several weeks after birth. He had recurrentproblems with bronchitis and some episodes of pneu-monia. He caught cold easily. His lungs were anongoing issue for him, a weak spot. He tended to geta stuffy nose very easily. His father had a significanthistory of eczema. All other systems were normal.

Diagnosis: Lung vacuity pattern (the symptoms, ab-domen and pulse).

Treatment: Tap with herabari LI-4, LI-10, LI-11, ST-36,BL-40, neck region, GV-20, GV-12, and on the back.

Using a teishin, very light stroking was applieddown the back and on the bladder channel on thelegs, then supplementation was applied to left LU-5,SP-9, and right GB-37.

A press-sphere was applied to GV-12.


He was tired after the treatment. He had had a coldwith fever on the weekend with coughing, but hadrecovered quite quickly. The skin appeared to be a lit-tle better.

Treatment: Tap with herabari LI-4, LI-10, LI-11, ST-36,BL-40, abdomen, neck region, GV-20, GV-12, and onthe back.

Using a teishin, very light stroking was applieddown the back and on the bladder channel on thelegs, then supplementation was applied to left LU-9,SP-3, draining to right LR-3 and TB-5.



Skin itchiness was better overall—but with visible skinsigns still. He wasmoremoody and irritable.

Treatment: Tap with herabari LI-4, LI-11, LI-15, ST-36,BL-40, abdomen, neck, neck region, GV-20, GV-12,and on the back.

Using a teishin, supplementation was applied to leftLU-9, SP-3, right LR-3, draining to right ST-40.

Press-spheres were left on right BL-18 and GV-12.


Some itchiness of the upper arms and legs but overallhe was much better.

Treatment: Tap with herabari LI-4, LI-10, LI-11, ST-36,BL-40, abdomen, neck area, GV-20, GV-12, and onthe back.

Using a teishin, supplementation was applied to leftLU-8, KI-7, draining to right SP-9, then supplementa-tion to right TB-4.

Press-spheres were left on GV-3 and GV-12.

The next visit was cancelled since Paul’s conditionhad significantly improved and he had no more itchi-ness or skin lesions. They also had to travel more thanan hour each way to get to the clinic. His mother pro-mised to call if the symptoms worsened.

Case 4John, Boy Age 3½Months

Main complaints: Allergic eczema.

History: At age 2 weeks, he broke out with facial skinreactions. Two weeks later the skin over most of hisbody became dry and rough. This was diagnosed as acow’s milk intolerance. His diet was changed to alter-nating breast feeding with a special powder drink inwater. Both he and his mother stopped cow’s milkproduct intake but the skin was still rough. It wasworst over the abdomen, in the joints, especiallyknees and elbows, and recently was starting to getworse on the back. The face was virtually clear. Therewas a history of allergies in the family, raising the sus-picion of additional allergies beyond the cow’s milkintolerance. His skin looked rough and slightly irri-tated over large parts of the body. Overall, skin colorwas off-white. Otherwise he looked like a healthy,largish baby.

Diagnosis: The abdomen and pulse findings indi-cated a lung vacuity pattern.



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Treatment: Using a teishin, left LU-9 and SP-5 weresupplemented.

Using a herabari, light tapping was applied aroundthe most affected areas on the abdomen and back,and around GV-12 and ST-36 on both legs.

A press-sphere was placed at GV-12, with instruc-tions to replace it every 2 days.


The symptoms were pretty much the same. Theabdomen was slightly better, the back slightly worse,the feet slightly worse. His mother announced thatshe was stopping breast-feeding that day.

Treatment: Using a teishin, left LU-9 and SP-3 weresupplemented. Draining was applied to right LR-3.

Using a herabari, very light tapping was appliedaround LU-1 on both sides, on the head, and aroundTB-17 on both sides.

Press-spheres were placed at GV-12 and LU-1 onboth sides.

Third visit—2 weeks later

The rash was slightly worse on the arms, legs, andface, but the general nature was unchanged.

Treatment: Using a needle, supplementation wascarefully applied to left LU-9, SP-3, GV-12, and GV-4.

Very light stroking was applied over the abdomen,chest, arms, legs, and back. This technique involvedholding the needle tip between the finger and thumbof the right hand and moving it over the skin, notalong the surface of the skin, so that the fingers madesome contact but the needle tip was slightly abovethe skin at all times.

GV-12 and GV-4 were supplemented.Press-spheres were placed on GV-12 and LU-1 on

both sides.


The rash had been slightly worse at times.

Treatment: Using a needle, left LU-9 and SP-3 werecarefully supplemented.

Very light stroking needling was applied over theabdomen, chest, arms, legs, back, and head.

Using a herabari, tappingwas applied around GV-12.A press-sphere was placed at GV-12.The parents were instructed in the use of the egg-

soaked-in-vinegar treatment.


The rash was the same. He was teething but generallyseemed to be sleeping better. The egg—vinegar mixwas not yet ready to apply.

Treatment: Using a needle, left LU-9, SP-5, and GV-12were carefully supplemented, right ST-40 was drained.

Very light stroking was applied over the abdomen,chest, arms, legs, and back.

Using a herabari, tapping was applied over thehead (to help with the teething).

A press-sphere was placed at GV-12.

Sixth visit—1 week later

The eczema appeared to show a slight improvement.The egg—vinegar mix was not yet ready to use.

He had caught a mild cold this week, seeminglyassociated with teething. He had amild cough.

Treatment: Using a needle, left LU-9, SP-3, right LR-3,and BL-12 on both sides were carefully supplemen-ted.

Very light stroking was applied over the abdomen,chest, arms, legs, and back.

Using a herabari, tapping was applied around GV-12and in the occipital region.

Press-spheres were applied to GV-12 and the “stopcoughing” points close to LU-5.

Seventh visit—1 week later

He still had some symptoms of the cold, with a con-gested chest. The eczema had shown a clear improve-ment during the week. The egg—vinegar mix was stillnot ready.

Treatment: Using a needle, left LU-9, SP-3, and rightLR-3 were carefully supplemented.

Very light stroking was applied over the arms, legs,back, and abdomen.

Press-spheres were applied to GV-12 and LU-5 onboth sides.

Eighth visit—1 week later

The cold was better, congestion better, but still withsome residue. The skin continued to improve and wasmuch softer. The egg—vinegar mix had developed afungus and could not be used.

Treatment: Using a needle, left LU9, SP-3, and rightLR-3 were carefully supplemented.

Very light stroking was applied over the arms,back, abdomen, chest, and legs.

Using a herabari, tapping was applied over thehead and occipital region.

Press-spheres were applied to GV-12 and LI-10 onboth sides.

Ninth visit—2 weeks later

A week before, he had been diagnosed with bronchi-tis and treated with penicillin. Today was the last dayof the antibiotics. He was still congested. Two daysbefore, the skin was reddened, and then improved.Overall, the skin was still improved.

Treatment: Using a needle, left LU-9 and SP-3 werecarefully supplemented, right LR-3 was drained.

CV-12 was supplemented.Stroking with the silver needle was applied over the

arms, abdomen, legs, and back.Using the herabari, tapping was applied on the

back of the neck and head.Press-spheres were applied to the asthma shu

points and GV-3.

Tenth visit—1 week later

The skin was improved and was less irritated. Eating akiwi a couple of days before had caused an immediatereaction around themouth and on the back.

Treatment: Using a needle, supplementation wascarefully applied to left LU-9, SP-3, right LR-3, andCV-12.

Stroking with the silver needle was applied over thearms, abdomen, and legs.

Using a herabari, tapping was applied on the headand back of the neck.

Press-spheres were applied to CV-12, GV-12.

Eleventh visit—10 days later

The eczema was still improving, there were still a fewsmall spots of eczema here and there but it was muchimproved. He had now fully recovered from the bron-chitis.


Very light stroking was applied over the chest,abdomen, legs, arms, and back.

Using a herabari, tapping was applied aroundGV-12 and GV-4 and on the head.

Press-spheres were applied to GV-12 and CV-12.

Twelfth visit—2 weeks later

The eczema was much improved again. The parentshad finally been able to use the egg—vinegar treat-ment and noticed it seemed to clear up some of thestubborn spots of eczema.


Very light stroking was applied over the abdomen,arms, chest, legs, and back.

Using a herabari, tapping was applied on the headand neck.


The parents reported that this was to be the lastappointment for a while because the insurance wouldnot pay for any more treatments. Their son was muchimproved and it seemed that the egg—vinegar mixwas helpful. They agreed to continue using this mixand to come back for further treatments if the needarose.

At 1-year follow-up, the boy’s skin was still muchimproved. He had a little dry skin occasionally, butthe eczema had been virtually eliminated. He was avery big, strong, healthy boy.

Case 5Albert, Boy Age 17Months

Main complaints: Eczema on the backs of the knees,the elbows and the neck (the worst area), withpatches on the upper body and sometimes on theface. The problem had started at age 3 months andworsened over the last 3 months. The dermatologisthad prescribed a cortisone cream.

History: He had had a cold with fever the weekbefore. Since starting at day care 5 months before hehad routinely had nasal congestion problems, catch-ing cold. His sleep, appetite, and bowel movementswere good. The mother used the cortisone creamwhen the symptoms were very disturbing, but



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preferred not to use it, as it did not stop the problemwithout regular use, which she wanted to avoid.

Diagnosis: The right deep pulse was a little weakerthan the left. The diagnosis was of a lung vacuity pat-tern.

Treatment: Using a teishin, supplementation wasapplied to left LU-9 and SP-5, and GV-20, GB-20.

Using the teishin, a very light, superficial strokingwas applied down the large intestine channels on thearms, the stomach and bladder channels on the legs,and down the bladder channel on the back. A light,circular motion was applied on the abdomen in aclockwise direction.

Tapping was applied with a herabari on the head.The importance of testing for cow’s milk sensitivity

was explained to the mother. I also inquired furtherinto what the doctors had described about his condi-tion and we discussed the possibility that he had anallergic-type constitution, which means that he maytend to show symptoms of the skin and lungstogether or alternately; as the skin improves the lungsmay become symptomatic and vice versa. I explainedthat this can be a good sign if we progress from skinimprovements to lung irritation to improvement inboth.

Second treatment—8 days later

It was difficult to see any effects of the treatment.Albert had been free of cow’s milk products most ofthe week.

Treatment: Tapping with the herabari to GV-20 andGB-20.


Using a teishin, supplementation was applied to leftLU-9 and SP-5, and GV-20 with draining of right LR-3.

Third treatment—8 days later

No clear signs of change of the skin. Albert hadcaught cold this week, had a stuffy nose, a coughwith disturbed sleep and 2 days of constipation.

Treatment: Tapping with the herabari to LI-4, LI-11,GV-20, GV-22, and occipital region.


Using a teishin, supplementation was applied to leftLU-9 and SP-5, with draining of right LR-3.

Press-spheres were retained on GV-12 and bilateralST-25.

Fourth treatment—7 days later

The skin on the abdominal region was better, no clearsigns of change elsewhere. The sleep was good. Thecough was still present but nowmild.

Treatment: Tapping with the herabari to LI-4, LI-11,GV-20, GV-22, GV-12.


Using a teishin, supplementation was applied to leftLU-9 and SP-5, with draining of right LR-3, LI-6.


The mother was taught to apply this very light,superficial, gliding-like stroking action on the arms,legs, and torso as daily home treatment using a metalobject that could be applied like the teishin. Themother used a small piece of silver jewelry for this.

Fifth treatment—7 days later

No additional signs of progress with the eczema thisweek. Otherwise he was fine. His sleep was good, thecough gone, and the home treatment going well.

Treatment: Tapping with the herabari to LI-4, LI-11,GV-20, GV-22, GV-12.




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Using a teishin, supplementation was applied to leftKI-10, LU-5, and ST-36.

Press-spheres were retained on GV-12 and bilateralBL-25.

Sixth treatment—7 days later

He was generally fine, but the skin on the back wasmore irritated.

Treatment: Tapping with the herabari to LI-4, LI-10,LI-11, GV-20, GV-22.


Using a thin needle the “sanshin” technique wasapplied over the back.2

Using a teishin, supplementation was applied to leftLU-9, SP-3, and CV-12with draining of right LR-3, BL-58.

Press-spheres were retained on bilateral ST-25.

Seventh treatment—7 days later

He was generally fine, and the skin on the back wassomewhat better. He had some mild coughing andnasal congestion.

Treatment: Tapping with the herabari to LI-4, LI-10,LI-11, GV-20, GV-22, BL-40, ST-36, occipital area,arms, legs, and abdomen.

Using a thin needle the sanshin technique wasapplied over the back

Using a teishin, supplementation was applied to leftLU-9, SP-3, with draining of right LR-3.

Press-spheres were retained on CV-12, bilateralST-25.

The mother was instructed to stop the previoushome treatment methods and only apply tappingover the points LI-4, LI-10, LI-11, GV-12, BL-40, ST-36daily at home (this remained the home treatment).

Eighth treatment—7 days later

He was generally fine. The skin on the back hadimproved further. On this day he was very irritable.


Using a thin needle the sanshin technique wasapplied over the back.



Ninth treatment—7 days later

Overall his condition was improved, and the skin onthe back was better again.





Tenth treatment—3 weeks later

He had had a cold with high fever the week before,after which his skin improved overall.

Treatment: Tapping with the herabari to LI-4, LI-11,GV-20, GV-22, GV-12, BL-40, ST-36, occipital area,arms, legs, and abdomen.




Eleventh treatment—7 days later

Overall the skin remained improved, but he had hadcongestion in the lungs for the last 3 days.

Treatment: Tapping with the herabari to LI-4, LI-10,LI-11, GV-20, GV-22, GV-12, BL-40, ST-36, occipitalarea.



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2 The term “sanshin” means “contact needling.” There aremany variations of contact needling found in the practice ofacupuncture in Japan. Here the techniquewas to rapidly drawand flick the needle across the back, only very lightly touchingthe skin surface. The idea is that this particular technique is to“disperse” the surface of the body. The rate of movement ofthe needle is about two times per second and the back area iscovered in 5–10 seconds.

Using a thin needle, the sanshin technique wasapplied over the back.


Cupping was applied lightly and briefly over theinterscapular region.

Press-spheres were retained on CV-12, bilateralLI -15.

Twelfth treatment—12 days later

His skin and lungs were irritated from exposure to alot of dust frommoving house. His eyes were irritatedand he had been crying a lot.

Treatment: Tapping with the herabari to LI-4, LI-10,LI-11, GV-20, GV-22, GV-12, BL-40, ST-36, occipitalarea.

Using a thin needle the sanshin technique wasapplied over the back, neck, and shoulders.

Using a teishin, supplementation was applied to leftLU-9, SP-5, with draining of right LR-3, left BL-58.

Press-spheres were retained on CV-12, bilateralLI -15.

Thirteenth treatment—16 days later

Overall the skin was much improved but his lungswere more congested. He was much more settledemotionally as well.

Treatment: Tapping with the herabari to LI-4, LI-10,LI-11, GV-20, GV-22, GV-12, BL-40, ST-36, occipitalarea, neck.

Using a thin needle the sanshin technique wasapplied over the back, neck, and shoulders.


Press-spheres were retained on CV-12, bilateralBL-13.

Fourteenth treatment—12 days later

His skin was very good, but the lungs were more con-gested again.

Treatment: Tapping with the herabari to LI-4, LI-10,LI-11, LU-1, GV-20, GV-22, GV-12, BL-40, ST-36, occipi-tal area.

Using a thin needle the sanshin technique wasapplied over the back and neck.

Using a teishin, supplementation was applied to leftLU-9, SP-3.

Cupping was applied lightly over the upper backand LU-1 regions.

Press-spheres were retained on CV-12, bilateralasthma shu points.

Fifteenth treatment—3 weeks later

He had had amild fever and the chicken pox the weekbefore. The skin was generally good and lungs muchbetter.

Treatment: Tapping with the herabari to LI-4, LI-11,GV-20, GV-22, GV-12, BL-40, ST-36, occipital area.


Using a teishin, supplementation was applied to leftLU-10, SP-2, with draining of right LR-2.3

Sixteenth treatment—3months later

He had very mild cold symptoms (runny nose). Overthe summer holidays his skin was much improved andlungs clear, but toward the end of the summer theskin had become slightly more irritated, especially onthe legs, neck, and a little on the back.

Treatment: Tapping with the herabari to LI-4, LI-10,LI-11, GV-20, GV-12, BL-40, ST-36, abdomen, back,and neck.

Using a thin needle, the sanshin technique wasapplied over the back.

Using a teishin, supplementation was applied to leftLU-9, SP-5, with draining of right TB-5, left BL-58.

Press-spheres were retained on GV-12.

After this Albert was seen another five times over thenext 4 months. His skin improved again and showedmild bouts of irritation but with quick recovery. Hislungs generally remained clearer. His mother wasvery satisfied with the treatment since his conditionhad improved significantly since the beginning. Shefelt that she could manage his condition and did notneed to use the cortisone cream at all. The doctorshad not offered much help with his condition exceptfor the cream, which with prolonged use has side-effects. Nor were they optimistic that it would



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3 The ying-spring (fire) points were used because Nan Jing

Chapter 68 suggests their usewith fever.

improve much over time. Long-term follow-up waspossible over the next year as the mother herselfcame for treatment and her new baby started comingfor treatment, also for allergic-type skin eczema prob-lems. Albert has remained much improved. His skin isgenerally a bit dry, but infrequent, small, and mildpatches of eczema show up, which recover easily andare not very bothersome to him.

Reflection: In Albert’s case, treatment started with acombination of a very superficial, light stroking withthe teishin as the non-pattern-based root treatmentcombined with pattern-based treatment for theunderlying lung weakness. When it was realized thatthis was not very effective, the treatment shifted tousing tapping on points that can be good for skinproblems such as LI-4, LI-10, LI-11, BL-40, ST-36, andso on. After starting this, the skin problems began toimprove more clearly and remained clearer. Hometherapy followed a similar course of change. Asexpected, at times as his skin improved, the lungsshowed a worsening with symptoms. But over timethis also improved. It has been my experience thatthe pattern of change of skin problems to lung prob-lems and then overall improvement is a good sign.Such cases can require a lot of treatment with long-term follow-up.The mother was happy not onlybecause of the improvements that occurred but alsobecause she could gain a measure of control with thesimple home treatments, which she felt to be veryhelpful.

Atopic Dermatitis

Case 1Han, Boy Age 12 Years

Main complaints: Very severe whole-body skinlesions. The problems had started around age 8months old and had been present ever since. Thelesions were worst over the neck, face, backs of theknees, and folds of the elbows. These areas werealways affected. Lesions occurred over all other bodysurfaces, especially the back and abdomen. His skinwas very dry all over, the lesions very itchy, red, andinflamed. With scratching they opened, and it wasrare that he did not have cracked sore skin lesions.When bad, the lesions over the neck opened andwere very sore so that he could not turn his head with-

out causing cracking and bleeding. This resulted inhim having chronically very stiff neck and shoulders.He had multiple severe allergies that triggered thesesymptoms. He was allergic to many foods and hadmany contact allergies, especially to grasses, andmany airborne allergies such as dust and pollens.With exertion and sweating the skin problems usuallybecame worse and they were bad in the summermonths. The itching disturbed his sleep and he oftenwoke up with new scratch marks from scratchingwhile asleep.Sunshine and sea water helped, so longas it was not too hot, whichmade him sweat. He usedcorticosteroid creams extensively in the past. Whilethey helped at the time, his mother was worried thatcontinuous use would worsen his problems or possi-bly trigger new problems. He tried Chinese herbalremedies, but these were not easy to use because ofallergy reactions that were hard to grasp. He triedhomeopathy with little success. He had a carefullyrestricted diet to minimize exposure to food-basedallergens. He was under strict instruction about avoid-ing airborne and contact allergens such as not playingon grassy areas, and not playing outside too muchwhen certain pollen counts were higher. But the prob-lems did not improve. The skin was kept moist withvarious natural moisturizing creams, which helped toa limited degree.

He was a tall, well-developed boy, in good spiritsand seemingly well adjusted to his problems. He hadno other symptoms. His bowels were generally regu-lar, but tended to loose stools easily. He had very coldfeet and his hands were also cold to the touch. Hereported being sensitive to the cold.

Diagnosis: The lower abdomen was slightly cool. Thelung, spleen, and liver areas all showed reactions. Thepulses were deep and weak. The pattern was unclearat first. After further investigation I decided to startwith the liver vacuity pattern.

Treatment: Because of the extent of the symptoms,there were no areas to which tapping could be easilyapplied and stroking was contraindicated with thesesymptoms, thus the core non-pattern-based treat-ment was not an option. I chose to focus on the pat-tern-based treatment and add a few techniques to trytargeting the symptoms, starting with lighter techni-ques and building them up as needed.

Using regular needles, left LR-8 and KI-10 were sup-plemented and right SP-5 drained (based on findingsin the pulse).



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Supplementation was applied to right LI-11 anddraining to left BL-58 (according to pulse findings).

BL-18 and BL-23 were supplemented.Since the skin around GV-12 and LI-15 was not bad,

press-spheres were retained on these points.Cupping was applied over the upper back and

around the navel.

Second visit—2 weeks later

Not much to report other than that he had experi-enced slightly fewer symptoms than usual.

Treatment: The same treatment as on the first visitwas applied with the exception that right LU-9 wassupplemented instead of draining the spleen channel,left SI-7 was drained instead of the bladder channeland GV-6, GV-3 were also supplemented.


Not much to report. It was the summer so he hadbeen at the beach swimming and out in the sun,which helped a little. At the time of treatment, theskin on his face and neck was a little thicker and moreirritated.

Treatment: Similar to last visit except that right TB-5,ST-40, and left BL-58 were drained instead of thesmall intestine channel.


On holiday he had a severe contact-allergy reaction tograss, requiring that he cut the holiday short to returnhome. He had used Betadine to control the symp-toms, which had been somewhat helpful, but afterstopping its use the skin flared up again. The worstaffected area was the neck and face, and he also hada sore and rigid neck from this.

Treatment: A similar treatment was applied with theexception that press-spheres were also retained atLI-10 and the cupping was not applied (I was afraidthat the stretching of the skin with the cuppingmightcause cracking).

He returned for treatment three more times overthe next 5 weeks but showed only a little improve-ment. I started to worry that his condition was maybetoo difficult, that I did not understand it very well,and sought out advice frommy teacher Akihiro Takai.He suggested the following: most likely Han’s pattern

is kidney vacuity pattern. He would have been bornweak lung constitution type, which triggered the skinproblems and multiple allergies, and with the exten-sive use of corticosteroid creams he would havebecome kidney vacuity type, hence the very cold feet.It is possible to view the extensive signs of inflamma-tion of the skin as a kind of counterflow-type symp-tom, especially since the lesions are worst around theneck and face, thus following the logic of Nan JingChapter 68, the he-sea points would be better to treat(see discussions of this in Chapter 10). He also sug-gested trying okyu /direct moxa by applying it at LI-4,LI-10, LI-11, or LI-15, whichever was most reactiveand did not have skin lesions on it. Okyu could also beapplied to the extra point uranaitei for the food allergycomponents of his condition. The moxa could also beused by family members at home to give the patientsome home treatment options. After this advice, Itried applying his ideas and obtained much clearertreatment effects.

Eighth visit—7 weeks after the fourth visit

The skin was not very good; he was scratching espe-cially at night with bleeding.

Treatment: Okyu was applied to LI-4 (the more reac-tive of the four points mentioned by Takai) and ura-naitei.

Using needles, supplementation was applied toCV-12, left KI-10, and LU-5, draining technique wasapplied to right ST-40, TB-5, and left GB-37.

Sanshin, contact needling was applied over theST-12 and inguinal regions.4

Press-spheres were placed at BL-17.His mother was taught to apply moxa to the LI-4

and uranaitei points daily.


His skin was clearly better and less irritated. Thesevere flare-up from the summer had started improv-ing immediately after the previous treatment. Hecomplained that his mother’s moxa techniques werevery bad and askedme to explain them again to her.



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4 Naso andmuno treatments in the Toyohari system (Birch andIda 2001; Yanagishita 2001a, 2001b).

Treatment: Essentially the same as the last exceptthat right SP-9 was drained instead of ST-40.

Following this, he was able to maintain a more stableimprovement in his skin condition over the next eighttwice-monthly treatments. He had taken over doingthe moxa himself as he could not stand his mother’stechnique! We found that when he was inconsistentat doing his home moxa, generally the skin was notquite as good, and when he was consistent in the useof home moxa, the skin was better. Intra-dermal nee-dles were used to replace the press-spheres at BL-17to increase the dose of treatment.

Treatments became less regular due to financialand scheduling issues. He had a flare-up again of theskin symptoms with the next summer holidays. Hecame for treatment more regularly at that point.Moxa was added to LI-10 as well as the usual LI-4.Additionally, he had been swimming in unclean waterwhile he had open skin lesions, which led to somebecoming quite irritated and looking like they may beinfected. Recommendation of the use of tea tree oilin water in the bath was helpful in clearing up theseadditional surface lesions. He came for treatment onand off over the next 2 years. He was able to maintainan improved skin condition without the use of drugs,which can have unpleasant side-effects (the primaryreason the mother had stopped using them in thepast). The use of the kidney vacuity pattern-basedroot treatment coupled with the moxa therapyseemed to create the most lasting changes for thispatient. He was in an overall improved state duringthe time he received treatment and had tools athome to help reduce symptoms.

Reflection: While atopic dermatitis is an increasinglycommon problem, it can be difficult to treat. Mildcases generally respond better than severe cases.Han’s condition was particularly severe. I was unsurewhat I could do for him and found the advice of myteacher Takai very helpful in constructing a moreeffective treatment approach. I was not surprisedthat I could not “cure” his condition. I have heardsome claim to be able to cure conditions like this, butthat is not so common. He and his mother werehappy with the treatment because it helped himman-age the symptoms, leaving him more functional andbetter able to cope.

General Approach for Patients with AtopicDermatitis

This is a difficult condition to treat. You may not beable to cure the condition and may only be able tohelp improve symptoms and quality of life. Oftenparents have tried many things to treat their atopicchild. Thus, you need to caution the parents aboutlong-term treatment usually being needed and thatyou will, as soon as you are clear what to do, havethe parents start doing some treatment at home soas to be able to lengthen the time between visits toyou and thus reduce the financial and schedulingburdens of treatment. Often the child is distressedby the symptoms and has difficulty sleeping due tothe itchiness. This can leave the child feelingmoody.

The atopic condition often comes with symp-toms of the lung, congestion in the lungs, shortnessof breath, wheezing, and inmore severe cases, asth-ma, or tendency to catch cold easily. Thesemanifes-tations are part of the overall weak lung constitu-tion, in which case look at the discussion of this inChapter 25, “Weak Constitution.” Youmay find thatyou are moving the focus of your symptomatictreatments between dealing with the skin symp-toms and the lung symptoms. Overall, your roottreatment is the most important part of the treat-ment, especially the pattern-based root treatment.


In younger children this ismost likely a lung vacuitypattern and can be a manifestation of the weaklung constitution (more severe in constitutionallung vacuity pattern). Thus, the usual treatmentcan be LU-9 and SP-3. But, it can also be helpful touse the metal points LU-8 and SP-5 instead and ifthe skin is very reddened and there are morelesions on the upper part of the body, especiallyaround the neck and face, the he-sea points are bet-ter used, LU-5 and SP-9. If the child shows the lungvacuity pattern and also has disturbed sleep, theliver is often replete, in which case after supple-menting the lung and spleen points, apply drainingtechnique to, for example, LR-3 on the opposite sideof the body.

The condition is often treated by doctors usingcorticosteroid creams. Over time with extendeduse this can weaken the kidneys and one starts tosee kidney vacuity pattern (look for signs of cold



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feet). In this case the treatment uses either KI-7,LU-8, or with more counterflow signs such as morereddened appearance around the face and neck,KI-10, LU-5 are better. While the shift to kidneypattern can be seen in younger children, it is morecommon in the child who is older and has had theproblem for longer with more use of the cortico-steroid creams.

If you feel that the condition is part of the moresevere weak lung constitution, you can apply moxato GV-12, but this is not so easy for the youngerchild.


Do not apply the stroking technique on childrenwith atopic dermatitis. If the lesions are limited andregional, such as only around the elbows and knees,you can apply the tapping technique over thehealthy regions of the skin on the torso and onlyaround the lesions of the arms and legs. However, ifthe skin lesions are more extensive, you cannotapply tapping techniques over the body surface.Instead, focus the tapping to acupoints that aregood for such a condition, such as LI-4, LI-10, LI-11,LI-15. If any of these acupoints have skin lesionsover them, do not tap those points. If BL-40 on theback of the knees is free of lesions, you can alsoapply tapping there. If there are lesions over theknees, try SP-10 and ST-36 instead, providedneither have lesions on them. Additionally, tappingcan be applied over GV-12 and BL-17 providedthere are no lesions on these areas. Bl-17 can behelpful in the following cases: more symptoms inthe upper part of the body, especially around thehead and neck, and if the skin itchiness is triggeringsleep disturbance. If there are food-allergy-typeproblems involved, additional tapping can beapplied to CV-12. If there is sleep disturbance andno skin lesions in the area, apply tapping to thearea around GB-20 and GV-20 (see Fig.19.2).


Okyu—Direct MoxaIn general, okyu is the recommended treatment forthis condition. Palpate and compare reactions atLI-4, LI-10, LI-11, and LI-15. Choose the points thatare the most sensitive and apply moxa to those. Forexample, treatment may be directed to LI-4 bilater-

ally or LI-10 bilaterally. On small children this canbe difficult to do, in which case we apply tappingover the four points (see above). Teaching the par-ents to apply home moxa or if the child is older,teaching the child to do the homemoxa can be veryhelpful. Uranaitei is used if there are any foodallergy components to the atopic skin complaints.Often in this condition the two uranaitei points (onleft and right feet) show the same degree of heatsensitivity, but sometimes one notices that one footfeels the heat much less than the other.5 If you findthis, direct the treatment to only the insensitivepoint and make sure that the heat is clearly felt atleast three times on that foot.

Press-spheres (Ryu), Press-tack Needles (Empishin),and Intra-dermal Needles (Hinaishin)Press-spheres can be a useful treatment techniquefor helping support the pattern-based root treat-ment. Leaving a press-sphere on GV-12 can behelpful as it is good for all pediatric conditions, andin particular supports the treatment of the weaklungs, which are usually involved in this condition.If the child shows the kidney vacuity pattern, press-



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Fig.19.2 Tap around:● LI-4, LI-10, LI-11, LI-15● GV-12, GV-3 (for affected lower limbs)● GV-20● GB-20● BL-40 or SP-10 + ST-36● CV-12

5 As occurs with this point when treating adult patients withacute gastrointestinal symptoms such as food poisoning.

spheres can be placed at bilateral BL-23 or themorereactive points at the level of BL-23 (often betweenBL-23 and BL-52 or closer to BL-52). But, since thepatient with this skin condition is usually applyingcreams, and lotions to try to keep the skin moremoist and reduce the irritation of the skin, you mayfind that the press-spheres come off easily.

If the condition is worse on the upper part of thebody, especially around the head and neck and atight band is found around BL-17, this can be a goodpoint onwhich to place the press-spheres.

Press-tack needles and intra-dermal needlescan be used in place of the press-spheres toincrease the dose of treatment when needed. How-ever, it is better not to use these on a child wherethe press-spheres are difficult to retain because ofthe daily moisturizing of the skin with creams. Onolder children, they are easier to use and have thechild keep trackof them.

NeedlingOn childrenwhere the skin lesions are not respond-ing much with the tapping and pattern-based roottreatment, and you are unable to apply moxabecause it is too difficult to use on the child, youcan try using in and out needle insertion to pointssuch as LI-4 and LI-10 or LI-11.

Some children are very disturbed by the itchi-ness of the skin so that it leaves them distressed,moody, and especially disturbs sleep. In such chil-dren if the tight knots around GB-20 do not softenmuch with tapping, insert needles to these points.Also, the knots at BL-17 can be seen in relation tothe sleep disturbance. If the symptoms do notchange with other treatment methods such as tap-ping or applying press-spheres, you can try need-ling these knots with the in and out needling tech-nique. If GV-20 shows clear reaction when youpalpate, this can also be a good point to needle tohelp reduce the distress caused by the symptoms.

CuppingIt can be difficult to apply cupping on a child withskin lesions, especially if the lesions are open. How-ever, provided the skin will tolerate this, cuppingaround the navel can be helpful if the child has foodallergies. Also, many children with atopic dermati-tis also have problems of the lungs, which can showas congestion in the lungs and inmore severe cases,asthma or asthma-like symptoms. If the congestionin the lungs is not changing much with overall

treatment and the skin condition is good enough totry this, cupping can be applied over the interscap-ular region to help treat the congestion.

BloodlettingIf vascular spiders are visible in the upper backregion, especially around the GV-14 area, it couldbe helpful in resistant cases in older children to trybleeding these. If the symptoms over the neck andface are bad, LI-1 could be bled; check the point forsigns of redness and congestion.


DietaryCommonly, you will need to discuss diet and helpthe patient identify food allergies. Cow’s milk pro-ducts are an obvious target, but many differentallergies can show, some of which are hard toexpect or predict and there can be difficulty identi-fying them.

Home Treatment TargetsUsually parents are already busy with things thatthey do at home for the child with atopic dermati-tis. At the very least this involves the application ofcreams and skin moisturizers. Usually the parentstake this extra work in their stride, but some find ita bit overwhelming or too much. It is therefore notvery helpful if you try to push toomany home treat-ment recommendations. You need to determinewhat the parents are usually doing, and then figureout strategic approaches to help them start apply-ing additional things like home tapping, homemoxa, dietary changes, and so on.

Urticaria

With urticaria (or hives) red itchy spots can sud-denly appear over various areas of the body, whichoften become swollen when scratched. The size ofthe affected areas can vary; they generally have areddened appearance, and can be light or dark. Theskin surrounding the urticaria can also redden, andone can also see blisters on the area of urticaria aswell. Generally the itchiness is worse in the eve-nings, and worsens with scratching. In childrenthese outbreaks of urticaria can come and go veryrapidly, and in some cases they can become chronic.Generally these problems are caused by food aller-



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gies, sometimes as a reaction to medication, andsometimes as a result of internal problems. It isespecially caused by metabolic disorders, and canresult from psychological factors. In some cases itmight also be due to a reaction to woolen fabrics,sunlight, coldness, or heat. It is unclear how thesereactions can occur, but it is clear that many areallergy related.

If when you start treating the child you noticethe areas you work on become flushed easily,where you stroke leaves a red line, or where youtap becomes reddened, you have to assume that thedose of treatment should be reduced and be evenmore careful not to over-treat.


Urticaria often involves the liver channel. On anolder child one can more easily discriminatewhether the liver is weak or replete from the pulse;on a baby or smaller child who will not stay still foryou, this can be more difficult. One possible patternis to find a lung vacuity patternwith liver repletion.But, if food allergies are involved, one might findspleen vacuity pattern with liver repletion. Youneed to check other signs and symptoms to discri-minate. In some children you can find liver vacuitypattern as the primary pattern. Thus, it is importantto first get a sense of whether the liver is replete orweak. Regardless of the child’s age or willingness tostay still, try to focus especially on the liver pulseposition. Often you have to feel the pulse quickly.

If while pressing the pulse in the liver positionfrom the level of feeling the artery (between theheart beats) toward the bone there is a feeling ofresistance and especially some edgy feeling of hard-ness, the liver is replete. Once you have identifiedthis feeling of hardness in the liver position of thepulse, then examine the heart and lung pulse posi-tions; does one feel generally weaker than theother? If the lung pulse feels weaker than the heartthe diagnosis can be taken as lung vacuity patternwith liver repletion. If the heart pulse feels weakerthan the lung then you can take the spleen vacuitypatternwith liver repletion.

If you are unable to get a clear reading of thepulse, you need to look to other findings to choosethe lung or spleen vacuity pattern with liver reple-tion: when you lightly touch the liver channelaround LR-3 does the skin feel tense and a littleharder than the surrounding area? If you palpate

the liver channel above the medial ankles, does theskin feel fuller, more tense or hard? If yes, then youcan assume the liver is replete. Does the child havea lot of food allergies? If yes, assume a spleenvacuity with liver repletion pattern. Does the childhave other lung-related-type symptoms such asother skin problems, breathing problems, stiffshoulders? If yes, take the lung vacuity with liverrepletion pattern.

To treat the lung vacuitywith liver repletion pat-tern, supplement LU-9, SP-3 or LU-8, SP-56 on oneside of the body and drain LR-3 or LR-4 on theother. To treat the spleen vacuity with liver reple-tion pattern, supplement SP-3, PC-7 or SP-5, PC-5on one side and drain LR-3 or LR-4 on the other sideof the body. If the urticaria rashes are more due tofabric or other contact sensitivities, it is more likelythe child has lung vacuity pattern, but if the sensi-tivities are more chemically related, the pattern ismore likely to be liver vacuity pattern.

If when you are pressing in the liver position ofthe pulse from the level of the artery down towardsthe bone the pulsation stops with not much pres-sure and without the feeling of resistance justbefore it stops, the liver may be vacuous. If so, thencheck the kidney pulse. If this shows the same find-ing you are probably looking at a liver vacuity pat-tern. If you are unable to get a clear sense of thepulse, choose the liver vacuity pattern if you seeclear signs of the kannomushisho pattern (see Chap-ter 21), withmany psychological aspects, outbursts,irritability, strong crying, sleep disturbance. Forliver vacuity pattern supplement either LR-8, KI-10or LR-4, KI-7.

If the child shows extensive very red patches ofskin rash or mostly rashes on the upper part of thebody such as the chest, neck and face, try using thehe-sea points, which are indicated inNan JingChap-ter 68 for “counterflow qi” problems. If the childbecomes overheatedwith the skin eruptions, show-ing not only extensive reddened skin patches, butoverall looks a bit flushed like a feverish child, trythe ying-spring points. Thus, for the child with lungvacuity and liver repletion pattern who has skinrashes only on the face and neck, supplement LU-5,SP-9 and drain LR-8. For the child with veryreddened eruptions and a reddened, feverish



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6 The metal points are used because of the metal–lung andlung–skin connections.

appearance, with many food allergies and spleenvacuity with liver repletion pattern, supplementSP-2, PC-8 and drain LR-2.


It is important to apply the core non-pattern-basedroot treatment to help improve the allergic typeconstitution. Yoneyama and Mori (1964) reportthat this treatment alone can be unexpectedlyeffective in some cases.

On a child who does not have an outbreak ofurticaria, apply stroking down the arms, legs, back,and abdomen, with tapping around GV-12, GV-3,GV-20. If there are psychological irritants or trig-gers, also tap around GB-20. If there are food allergytriggers, also tap around CV-12, BL-20 region, andon the stomach channels on the legs below theknees.

If the child is having an urticaria outbreak, donot apply stroking over the affected regions. Lightstroking on unaffected regions can be applied fol-lowed by tapping around the areas with rash. If thesymptoms are more on the head, face, and uppertorso, apply extra tapping on the head and aroundGV-20, GB-20. One can also apply tapping to themajor skin points such as LI-4, LI-10, LI-11, LI-15,BL-40.

Symptomatic Treatment

For the food allergies, applying okyu on uranaitei isimportant. Stimulating acupoints like BL-20 andBL-18 is important. To do this one can needle thepoints, and/or leave press-spheres or press-tackneedles on the acupoints. If there are strong reac-tions at these acupoints, leaving, for example,press-tack needles at BL-18 on one side and BL-20on the other, and alternating with treatment can behelpful. If the symptoms are very strong and stub-born and come out of major food allergies, you cantreat this as a spleen weak constitution, in whichcase you may need to increase the dose of stimula-tion to the BL-18 and BL-20 points by applying okyuto them (see Chapter 25, “Weak Constitution”).When there are food allergies involved you mayalso need to stimulate acupoints such as CV-12,ST-25.

When there are contact allergies involved youmay also need to apply extra stimulation to acu-points such as GV-12, BL-12. If there are strongstubborn contact allergies, you may need to applyokyu to GV-12 or GV-14.

If the child is very irritated or distressed by thesymptoms, clearly shows psychological triggers forthe symptoms, or is losing sleep because of the prob-lems, you may also need to needle certain acu-points to help with this. If around GB-20 is stiff,needle here. If there is a spongy feeling on GV-20,needle there. If the child does not calm down easily,needle LI-4. In some cases it can be helpful to leavea press-sphere or very small press-tack needle (0.3or 0.6mm) to the extra point behind shen men onthe back of the ear. Leaving a press-sphere on GV-12can be helpful.



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20 Digestive Problems

Constipation

Case 1Hanna, Girl Age 2½ Years

Main complaints: Severe problems with constipationsince being a baby. Very hard stools; she only passedsmall quantities at a time as it was painful to pass thestools. She was afraid to go to the toilet because ofthis pain. Additionally, she had had a lot of intestinal-abdominal pain since birth. She tended to wake everynight between 2 and 3a.m. with this pain.

Additional complaints: Hernia of the navel; occasionalsmall patches of dry and itchy skin; variable appetite.All other systemswere unremarkable.

Diagnosis: From symptoms and pulse: lung vacuitypattern.

Treatment: Tapping with the herabari was applied onthe abdomen, chest, back, arms, legs, and especiallyaround GV-12, GV-4, and GV-20.

Using the teishin, supplementation was applied toright LU-9 and SP-6 (SP-3 and SP-5 were too ticklish).

Press-spheres applied and retained on GV-12 andbilateral BL-25 (they were not retained on ST-25forfear that shemight play with or interfere with them).


The stools had been larger and easier over the 2 weeks,but were still a bit hard.

Treatment: Tapping with a herabari was applied onthe abdomen, back, arms, legs, around GV-4 andGV-12.

Using a teishin, right LU-9 and SP-5 (SP-3 still tooticklish) were supplemented, left LR-3 drained.

Press-spheres were placed on GV-12 and bilateralBL-25.

The mother was taught to do basic tapping athome daily.


The stools had been much better, much softer andlarger. In the last few days they had become slightlyharder again, but there was no more waking at nightwith pain and no more fear of going to the toilet.Mother and child enjoyed daily home treatments.

Treatment: Using a herabari, tapping was applied tothe abdomen, back, arms, legs, neck, GV-12 and GV-4area.

Using a teishin, right LU-9 and SP-3 were supple-mented, left LR-3 drained.

Press-spheres were placed on GV-12 and bilateralBL-25.


Bowel movements were normal, with some variationin frequency (not always daily). No more abdominalpain, still no fear of going to the toilet and no consti-pation.

Treatment: Using a herabari, tapping was applied tothe abdomen, back, arms, legs, neck, GV-12, and GV-4area.

Using a teishin, right LU-9 and SP-3 were supple-mented, left LR-3 drained.

Press-spheres were applied to GV-12 and bilateralBL-25.

For financial reasons and because of good progress,treatment was stopped.

General Approach for Patients withConstipation

Daily bowel movements may be an ideal conceptbut for some people bowel movements at a fre-quency less than daily can be “normal.” It is impor-tant to consider what the parent means by “consti-pation.” If the child generally has difficulty passingstools such that the frequency is less than daily andcauses some distress to the child, giving pain onevacuation, great strain trying to evacuate or fear ofgoing to the toilet, this certainly qualifies and



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134

should be treated as constipation. But the childwho passes stools without effort four to five times aweek and with no associated issues may well be“normal.”

You may need to pay attention to the secondarysymptoms that accompany the constipation. Theyoung child who is afraid to go to the toilet: is thatbecause it has been painful and the child is afraid ofthat pain on straining to evacuate? Is it that thechild usually feels the urge to evacuate after break-fast when he or she is typically at school and afraidof the more public toilets of the school or does notlike using them for bowel movements? The firstwill usually improve once the child starts moreeasily passing stools. The second may need moreattention as you think about how to help the childfeel less nervous. Is this second category morerelated to a “kanmushisho”-type manifestation?How in general is the child’s sleep and behavior?

If the bowel movement problem has had a sud-den onset and is quite strong, it can also be impor-tant to inquire what the parents have done alreadyand whether they have consulted their doctor. Acomplete stoppagewith sudden onset can be a dan-gerous condition that requires proper medicalinvestigation and attention.

It will, of course, be important to discuss the dietof the childwith the parents andmake some simplerecommendations as needed, to help improve thediet if there appears to be problems with it. Thiscan include discussing whether theremay be sensi-tivity to certain foods such as cow’smilk products.


Problems of constipation can occur as a symptomof the spleen or large intestine. If the pattern isspleen vacuity, look also for other signs such asabdominal bloating (independent of the effects ofextended episodes of constipation), generalabdominal pain, whether the stools have beenpassed or not, tendency towards also having peri-ods of loose stools or diarrhea and tiredness. If thelarge intestine, this steers one towards consideringthe lung vacuity pattern; look for other problemssuch as nasal congestion, lung congestion, breath-ing difficulties, skin problems. Occasionally theproblem of constipation arises as a sequela of the“kanmushisho”: look for associated problems withbehavior or sleep. If there appears to be such prob-lems, the non-pattern-based root treatment may

be enough to dealwith this, but it could showa prob-lem of the liver channel. In this case examine thechild for the liver vacuity pattern, but be careful tocheck out also whether the liver is not replete as asecondary problem to the underlying lung orspleen vacuity pattern. Since the problemmanifestsin the digestive system, it is usually enough to usethe earth-source points for treatment. These arenormally used for the lung (LU-9, SP-3) and spleen(SP-3, PC-7) vacuity patterns, but if the liver vacuitypattern shows LR-3, KI-3 may be better instead ofthe usual LR-8, KI-10.


For the smaller child apply the stroking and tappingor tapping non-pattern-based root treatment asusual over the limbs, back, and abdomen. Apply tar-geted tapping to the area around GV-12, GV-3 toGV-4, the navel, LI-4, and on the stomach channelbelow the shins. Tapping at ST-25 and BL-25 can behelpful. Also apply stroking or pressing in a circularmotion (following the colon) over the abdomenaround the navel (Fig.20.1). This latter can be



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Fig.20.1 Normal stroking plus extra stroking clockwisearound abdomen.Tapping:● Around LI-4● Around CV-12: five to 10 times● ST-25 area: 10 times each● Around ST-36–ST-37: five to 10 each leg● Sometimes around pubic region: 10 to 20 times● Around GV-20: five to 10 times● Occipital area: 10 to 15 times● Around GV-12: 10 to 20 times● Around GV-3: 10 to 20 times

ticklish for some children, making it difficult toapply. In such cases use only a pressing techniquewith a larger instrument such as the round ball endof the enshin.

If the child shows signs of the kanmushisho,apply tapping also over the occipital region. If thechild is nervous because of the difficulties of goingto the toilet (pain, etc.) also apply tapping on thehead around GV-20.


Press-spheres (Ryu), Press-tack Needles (Empishin),and Intra-dermal Needles (Hinaishin)In general, for the treatment of constipation we canfocus treatment to the main “constipation” pointssuch as ST-25, BL-25 (Hyodo 1986). Leaving press-spheres at one or both of these points can be help-ful. On children who are still in the oral phase andtend to place what they lay their hands on in theirmouths, it is probably advisable to avoid leavingthe press-spheres on ST-25 as the child may seeand get hold of them, and thus potentially swallowthem. If on a younger child the press-spheres arenot producing a sufficient change one can increasethe dose by using press-tack needles. Depending onthe child, this is probably better done only to thepoints on the back (BL-25). For the older child whocan handle a larger dose of treatment, one can startby placing press-tack needles on BL-25. If one wantsto also stimulate ST-25, apply press-tack needles onBL-25 with press-spheres on ST-25. If there is nochange with treatment and one wants to increasethe dose again, use of the 3mm intra-dermal nee-dles to, for example BL-25, can be very helpful. Ifyou choose to use press-tack or intra-dermal nee-dles on the abdomen at ST-25, make sure that theparents are aware of this, and do not do this if youthink the childmight interferewith them.

On the adult we can apply intra-dermal needlesor the short press-tack needles (0.6mm) to the “con-stipation” zone in the ear. This lies along the lowerborder of the triangular fossa region. On an olderchild (6–7 years or older) who is not responding towhat you have done with enough change, it can bepossible to apply the 0.6-mm or 0.3-mm press-tackneedles to this region of the ear on one side withappropriate care instructions to the parents. This isnot a good idea to try on the younger child becauseof the risk of their interfering with the needle.

NeedlingOn a younger or more frail child, if leaving press-spheres on acupoints such as BL-25 and ST-25 isnot producing enough change, one can start apply-ing needling shallowly at acupoints such as ST-25,BL-25, SP-13 (Hyodo 1986). For the older child onecan apply needling to these points earlier in thetreatment. If the child is older and stays still foryou, you can insert the needles to the abdominalpoints and then begin the pattern-based root treat-ment. When you finish this root treatment, you canthen remove the abdominal needles.

Cupping and BloodlettingWe tend not to use these techniques frequently onchildren for the problem of constipation, but inmore stubborn cases it can be advantageous to trycupping lightly over the lower back and around thenavel, using light pressure. If the child’s condition isnot changing and you notice clear vascular spiderson the lumbar region that are superficial enough tostab, apply the stabbing and squeezing method tothese, removing a few drops of blood from each.This last technique can be difficult to apply on verysmall children as it can be quite uncomfortable onthe low back.


For really stubborn conditions it can be very helpfulto have the parents start applying a simplified formof the core non-pattern-based root treatment regu-larly at home.


The next case is of the sister of the girl in Case 1.One can see that the effects were also quite remark-able.

Case 2Alexandra, Girl Age 9Months

Main complaints: Severe problems with constipationsince birth. Pediatrician had identified problems withcow’s milk, which was discontinued and replaced byspecial milk, but without change in symptoms. Shehad very hard, small stools. She usually did not passany and the mother had to pull them out manually.



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She would wake some nights with abdominal pain.She had dry skin and the mother used oils to moistenthis.

Additional complaints: At 3 months she had had abad cold; since then she tended to get a stuffy nose,irritated throat (postnasal drip?) with cough. All othersystems were unremarkable.

Diagnosis: From symptoms and pulse: lung vacuitypattern.

Treatment: Tapping was applied with a herabari onthe abdomen, chest, back, arms, legs, and especiallyaround GV-12, GV-23, and GV-20.

Using a teishin, right LU-9, SP-3 were supplemen-ted, left LR-3 drained.

Press-spheres were placed on GV-12, bilateral BL-25,and ST-25.


The stools had been much better, almost normal overthe 2 weeks, but had become slightly harder again inthe last 2 days.

Treatment: Tapping with a herabari was applied onthe abdomen, back, arms, legs, around GV-4 andGV-12.


Press-spheres were placed on bilateral ST-25 andBL-25.

The mother was taught to do basic tapping athome daily.


The stools remained better, staying soft for the 3weeks.Mother and child enjoyed the daily home treatments.

Treatment: Using a herabari, tapping was applied onthe abdomen, back, arms, legs, chest, GV-12.

Using a teishin, right LU-9, SP-3 were supplemen-ted, left LR-3 and BL-58 drained.

Press-spheres were placed on bilateral ST-25 andBL-25.


Bowel movements were normal; no constipation, nohard stools.

The nose was somewhat less congested and thecough better, but she still had some problems withcoughing.

Treatment: Using a herabari, tapping was applied tothe abdomen, back, arms, legs, chest, GV-12.


Press-spheres were placed on GV-12 and bilaterallyon the asthma shu point.

Light cupping interscapular region.

For financial reasons and because of good progress,treatment was stopped.

While it is not uncommon for children to come toour clinics with bowel problems like constipationand for the treatments to generally work well, as isevidenced by the first two cases, not all cases ofconstipation are simply constipation. We have to bealert to complications that require a change intreatment tactic.

Case 3Gerald, Boy Age 3 Years1

Main complaints: Gerald had been struggling withconstipation for the previous year and a half. He couldgo through periods of normal bowel movements butat least several times a month he would have diffi-culty passing stools, leading sometimes to abdominalpain and a lot of emotional distress. He could go up to5 days without stools, but when not having a periodof being constipated he usually had some bowelmovement at least every other day. He had no otherproblems; appetite, sleep, mood were good. He wasa full-bodied, energetic child, with no overt signs ofweakness, thus I judged he could handle a slightly lar-ger dose of treatment.



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1 I treated this child before I had become familiar enough withMeridian Therapy to apply it routinely on children, thus thereis no pattern-based diagnosis and treatment.

Treatment: Using a herabari, light tapping wasapplied over the abdomen, back, arms, and legs.Extra tapping was focused on the lower abdomen,especially around ST-25 and the lower back—aroundBL-25 and GV-3—and on the legs around ST-36 to ST-37.

Press-spheres were applied bilaterally to BL-25.


There was nothing to report. Gerald was a bit relaxedon the day of the treatment. His bowel movementswere difficult to assess as yet.

Treatment: The same pattern of light tapping wasapplied as on the first visit.

Press-spheres were left on bilateral BL-25 and ST-25(four press-spheres).

I taught the mother to repeat the basic light tap-ping treatment at home daily.


Gerald had had slightly more problems with constipa-tion this week, but it was unclear if this was just a nor-mal fluctuation or a worsening of symptoms. I dis-cussed this with the mother and instructed her toapply the home treatment more lightly, with lightertapping and fewer taps in each area.

Treatment: The same treatment as the second ses-sion was applied at a very slightly lower dose (lightertapping with fewer taps in each area.


The symptoms were similar to those of the previousweek; slightly worse than after the first treatment,but not quite as bad as after the second treatment. Idecided to try a slightly stronger treatment.

Treatment: The same pattern of tapping was appliedas on the first visit.

Needling was quickly applied to BL-25 bilaterally.Needles were inserted 2–3mm, moved up and downvery slightly and quickly and then removed.

Intra-dermal needles were placed on BL-25 withinstructions to remove them by the next morning andreplace themwith press-spheres.

Press-spheres were also retained on bilateral ST-25.


No change in symptoms; his bowel movementsremained erratic and problematic

Treatment: The same as on the fourth visit.


Gerald’s bowel movement problems remainedunchanged. I was now concerned as it is unusual notto have a clear response of some kind at least afterthree or so sessions when treating children of thisage. I questioned the mother again to see if I hadmissed or misunderstood anything. Then the prob-lem finally came to the surface. The constipationproblems had begun in a period when Gerald wasgoing through the normal growth stage that is asso-ciated with the “terrible twos.” In his struggle to cre-ate more space for himself and learn more about hisboundaries he had found a pattern of behavior thatusually would get his mother to give him what hewanted. If he could not easily get what he wanted hewould turn angry and threaten his mother “I won’t goto the toilet then,” following which he would hold hisstools, thus creating the episodes of constipation. Inother words, he did not have a functional bowel prob-lem, he had the “kanmushisho” pattern and the con-stipation was how it manifested in him. I thus chan-gedmy treatment accordingly.

Treatment: Light stroking was applied down thearms (three yang channels), legs (stomach and blad-der channels), abdomen (stomach channel), andback (bladder channel).

Light tapping was applied around GV-12, GV-20,the occipital margin, and LI-4.

Press-spheres were applied to GV-12 and GV-3.I instructed the mother to change the home treat-

ment to use the light stroking and tapping of theareas I had worked on.


Gerald was more relaxed. He had had no problemswith bowel movements this week, managing to goevery day, at least a little bit.

Treatment: The same treatment pattern as on thesixth visit was applied, with the exception that lightneedling was applied to the area around GB-20(which felt quite stiff) and LI-4 after the tapping ofthose points.



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He had had normal bowel movements every day, withno distress, and his mood had generally improved. Hewas no longer using the “no toilet” threat with hismother.

Treatment: Same as on the last visit.


Gerald was having normal daily or almost daily bowelmovements and he was generally in a better mood.

Treatment: Same as on the last two visits. I in-structed the mother to continue the home treatmentfor a while longer and come back if there was anyrecurrence of the constipation problems.

This case was interesting. It shows that simply try-ing to address themanifestations of the symptom isnot always the best approach. As long as I did theusual core non-pattern-based treatment withsymptomatic focus to constipation and treatmentpoints specific to constipation, there was no realprogress. But as soon as I started treating theunderlying problem of the kanmushisho, he startedchanging more and the symptoms started improv-ing. The actual shift in treatment was quite small,but the effects of the small changes were very clear.

Diarrhea

The following case comes from the practice of mycolleague Manuel Rodriguez of Barcelona, Spain. Itshows the sometimes very surprising and powerfuleffects of this simple and gentle treatment method.Manuel saw this baby for treatment before he hadlearned the Meridian Therapy pattern-based treat-ment system. He only treated the baby with a sim-ple form of shonishin. The baby would clearly havefitted the category of “spleen weak constitution”type, but did not need the specific root treatmentnor the stronger, more aggressive treatments thatcan be used for this pattern—see Chapter 25 “WeakConstitution.”

Case 1Paul, Boy Age 7Months

Main complaints: Paul’s mother, a nurse, was one ofmy students. She contacted me when Paul was about2–3 months old because he was showing dermatitislinked with digestive problems. After making anappointment she had to cancel the visit on two sepa-rate occasions because she had to take Paul to theemergency room at the hospital, where he was sub-jected to extensive testing. Finally, at the thirdattempt to schedule an appointment, she broughtPaul tomy clinic when he was 7months old. His medi-cal history was already complex.

History: November 2002: Paul was born by normalbirth after a normal pregnancy.

December–January 2003 (while 2–3 months old):He showed dermatitis of the toddler (possibly cradlecap) and a tendency to diarrhea. The analysis by theWestern medical doctors concluded that he showedlactose intolerance. They stopped giving him cow’smilk derivatives, giving instead rice “milk” togetherwith cereals. Almost immediately the baby startedwith major episodes of diarrhea, with frequent pas-sing of semi-liquid feces. The mother started testingdifferent kinds and brands of “milks,” includingDamira, a hypoallergenic preparation. Paul continuedwith the diarrhea, which was becoming increasinglystrong. Finally his doctor had him admitted to San Juande Dios, themost famous pediatric hospital in the area.

March 2003 (at age 5½months): He was still in thehospital. All allergy tests were negative. He was show-ing hypersensitivity only to egg white (which he hadnever eaten). Meanwhile the strong symptoms ofdiarrhea continued. He was referred to the gastro-enterology department in the same hospital, wherethey also were unable to determine the cause of thediarrhea. By this time defecation immediately fol-lowed eating anything, and the child was showingdeterioration (low weight, failure to thrive). Themother decided to change hospitals and took thebaby to another one (Teknon, a private hospital withan outstanding reputation). Once inside this hospitalthe testing continued. When starch and fat appearedin his stools the pediatrician concluded that Paul had“intolerance to macromolecules” and, after a furtherround of tests, determined that he had a “deficit ofalpha-1-antitrypsin,” which is considered congenitaland without any possible treatment.



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Late May 2003: The hospital made an intestinalbiopsy, but could not see anything abnormal. Thechild was discharged from the hospital. He was stilldefecating four or five times a day, immediately aftereating. His feces were almost liquid, showing scarceor no signs of digestion.

Mid-June 2003: He developed a fever. Within 3 daysmucus started appearing in the stools. He was givencefuroxime, an antibiotic. The fever stopped but thediarrhea increased.

Early July 2003: He showed signs of dehydration(apathy, loose skin, etc.). He was taken back to theTeknon Clinic where he received emergency treat-ment. He was discharged 5 days later.

The next day, his mother brought Paul to see mefor treatment. He looked almost normal, he was onlya bit small for his age and his vitality was slightlyunder par. His skin had a lackluster appearance. Hehad no dermatitis and there was nothing else toremark on. At this time he was still defecating four orfive times a day, always immediately after eating. Hehad liquid feces with almost undigested food in them.The hospital had informed the parents that they hadno treatment to offer.

Treatment: I treated him with shonishin, the corenon-pattern-based root treatment. To do this I appliedvery light stroking with a silver enshin over each of theindicated areas (down the arms, down the legs, downthe back, down the abdomen). I added a very softdigital massage or pressure over ST-25.

I instructed the mother to repeat the light strokingtreatment daily at home and to call me in 3 days to letme know how he was doing.

Three days later

Paul’s mother reported by telephone that startingright after the treatment 3 days earlier, the feces hadstarted to become more consistent. The day after,the child had defecated only three times, with almostnormal feces. I instructed her to continue the treat-ment and report again in 15 days, or to call earlier ifsomething happened.

Twoweeks later

His mother reported by phone that Paul was nowdefecating only twice a day with normally formedfeces. He had been gaining weight and increasing invitality. I instructed her to continue with the treat-ment as a way to help the child’s development.

At later follow-up (3 and 9 months) the motherreported that Paul’s problem of diarrhea had neverreturned. He appeared to have a normal digestive sys-tem. I discharged him from treatment as he no longerneeded any.

General Approach for Patients with Diarrhea

The symptoms of diarrhea (loose watery stools) arenot accompanied by other symptoms such asvomiting, fever, or bad disposition. In the infantwho is still breast-feeding the stools can range infrequency from several to many times a day. Inbabies the stools can be greenish and show somemucus. The condition does not usually lead todehydration or weight gain problems. Yoneyamaand Mori state that there is often a psychogeniccomponent (Yoneyama and Mori 1964). In theolder child if the tendency to diarrhea or at leastrelatively frequent loose stool persists, this mayresult in weight gain or growth problems with amore weakened appearance, i.e. skinny, less active,poorly developed muscles. These are signs of thespleen weak constitution and may be addressed assuch (see Chapter 25). Infants may sometimesshow signs of a spleen weak constitution, though itis less common. Infants with these problems gener-ally respond much better to treatment than olderchildren. Dietary factors can be a major issue forchildren with diarrhea, especially the consumptionof cow’smilk products.

Provided there are no significant medical com-plications, such as unrecognized allergies or foodsensitivities, the infant with the simpler form ofdiarrhea can respond unexpectedly quickly totreatment using the core non-pattern-based roottreatment. The infant with more complicated con-ditions, such as spleen weak constitution, willrespond more slowly and require more focusedtreatment (see Chapter 25). The older child withthis weak constitution will generally have a moreweakened condition and will respond even moreslowly and requiremore treatment.



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The most common pattern will be spleen vacuitypattern, usually treated with SP-3 and PC-7. Whenpulse and abdominal findings are not clear enoughto make a judgment of the pattern from them,select the spleen vacuity pattern. When the pulseand abdominal findings are clear, sometimes thelung vacuity pattern will show and the symptomsof the spleen are part of the lung vacuity pattern, inwhich case supplement LU-9 and SP-3. It is alsopossible that the kidney vacuity pattern will show,inwhich case look for signs of cold feet, underdevel-oped child as well as the pulse and abdominal find-ings. One can treat KI-7 and LU-8 or KI-3 and LU-9.Occasionally with the kidney vacuity pattern, thespleen is replete on the restraining cycle. On a babyor small child this can be difficult to feel in thepulse. There can be slight discomfort when the areaabove the navel is palpated. If this occurs, on thebaby or small child it is better to supplement ST-36rather than drain the spleen as a counterbalancingtreatment for the spleen repletion. If, however, thechild is older and you are able to discern the reple-tion of the spleen pulse clearly, then apply drainingtechnique to SP-9. When applying these secondarytreatment strategies for the kidney vacuity–spleenrepletion pattern, always remember to apply thetreatment points for the kidney vacuity on one sideand then the treatment point for the spleen reple-tion on the other side of the body. Sometimes theliver vacuity pattern will show. In such cases notonly will the pulse and abdomen confirm this, butthe child will often show signs of irritability, exces-sive crying, and sometimes vomiting; supplementLR-8 and KI-10.

It is often helpful to apply the idea from Nan Jing(Classic of Difficulties) Chapter 68 that the he-seapoints are good for symptoms of diarrhea, in whichcase use SP-9 and PC-3for the spleen vacuity pat-tern, LU-5 and SP-9 for the lung vacuity pattern,and KI-10 and LU-5for the kidney vacuity pattern.


The core non-pattern-based root treatment can beapplied with stroking down the arms, legs, andback, with tapping on the abdomen, LI-4, GV-12,and GV-3 regions (see Fig.20.2). Treatment can bevaried according to whether treating a baby orsomewhat older child; for the older child one often

needs to apply additional treatment such as in-serted needling (Shimizu 1975).

When working on the abdomen focus more onthe upper abdomen and around the navel. On theback focus in particular on treating the lumbarregion on the left side.

Additional tapping can be applied to the stom-ach channel in front of the shins, around the navel,and around GV-3, GV-4. Shimizu recommendsadditional tapping to ST-36, ST-37, and BL-60 (Shi-mizu 1975).



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Fig.20.2 Stroking:● Down the arms (large intestine channels)● Down the legs (stomach and bladder channels)● Down the back (bladder channels)Tapping:● GV-20: five to 10 times● GV-12: 10 to 20 times● GV-3 area: 10 to 20 times● LI-4: five to 10 times each● ST-25: five to 10 times each● Subcostal areas: five to 10 times each● Around navel: five to10 times● Around ST-36–ST-37: five to 10 times each


NeedlingApply shallowly inserted needles at points such asBL-20, BL-21, BL-22 on the back, CV-12, ST-25 onthe abdomen (Yoneyama and Mori 1964). Palpateand treat the more reactive points. Often one findstight bands along the bladder channel from aroundthe level of BL-18 down to BL-22 or BL-17 down toaround BL-21. More commonly these are strongeron the left side.

Shimizu (1975) comments that for babies, if thecontact needling (tapping, stroking) is not enough,inserting needles to ST-25 and BL-60 can behelpful.While on older children (over age 2) we usuallyneed to apply in-out needling technique to acu-points such as left SP-14, BL-23, and lateral to BL-25.

Okyu—Direct MoxaTo help reduce the symptoms of the diarrhea, heatcan be applied around the navel. A simple way ofdoing this if the child will stay still is to use thelarge chinetsukyu moxa cones. Each cone isremoved after the child starts to feel clear heat.Treatment points can include CV-9, CV-7, KI-16. Ingeneral one will tend not to use okyu much onbabies and small children unless the symptoms arevery heavy and/or resistant or part of a constitu-tional spleenweak pattern.

For strong symptoms of diarrhea, especially ifpart of the spleenweak constitution, apply moxa toBL-18, BL-20 contralaterally or bilaterally. For diar-rhea in the nursing child apply moxa to GV-12 andCV-7 (Manaka, Itaya, and Birch 1995). For strongermore stubborn symptoms or diarrhea moxa can beapplied to GV-12 and BL-23 (Shimizu 1975). Ifthere are clear food allergies involved in the devel-opment of the symptoms, applying moxa to theextra point uranaitei can be helpful.

Press-spheres (Ryu), Press-tack Needles (Empishin),and Intra-dermal Needles (Hinaishin)For the child with strong or stubborn symptomsbut who is too young to apply much, if any, moxa, Irecommend starting by leaving press-spheres orpress-tack needles to acupoints such as BL-20,BL-18, CV-12, GV-3, or GV-4. After palpating theseacupoints, examine to see which points are reac-tive. On a baby, if BL-20 is reactive on one side(usually more often on left), place a press-sphere

there. If there is not much change, increase dose byleaving a press-tack needle there for a number ofhours, to be replaced by a press-sphere. If still notenough, place the press-tack needle at the BL-20reactive point and a press-sphere to, for example,CV-12 or GV-3, depending on which is reactive. Inthis way gradually increasing the dose can createchange. If after this strategy there is still not enoughchange, you can then start thinking about how andwhether the stronger, more difficult treatment ofokyu can be applied. A similar strategy can be usedon older children starting with stronger doseaccording to age and overall condition.

BloodlettingShimizu (1975) recommends that in stubborn casesof diarrhea one can bleed SI-1 or ST-45 and, if thereis a vein visible between the distal and middlejoints of the index finger this can also be bled.


DietaryOften one needs to discuss diet with the parents.Cow’s milk sensitivity is a common trigger of suchsymptoms, thus one needs to have the parent testto determine whether it is involved in the develop-ment of the symptoms. Some children have moregeneral dietary sensitivity. They seem to react tomany substances.

Home TreatmentHome treatment using a simple form of the corenon-pattern-based root treatment is good for theparents to apply regularly at home. If the symptomsare strong and stubborn, it can be also helpful toapply heat around the navel. In the clinic we usemoxa, but this is not good for the parents to apply.They can use something like a hot water bottle, or asmall heated object that is wrapped in a towel andplaced over the navel. When the area gets warm tothe touch and turns red, stop applying the heat.



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Abdominal Pain

Case 1Andy, Boy Age 7 Years

Main complaints: Andy had daily abdominal painthat occurred especially in the evening, but could beseveral times daily. It was distressing to him andcaused him to withdraw to his room to go to bed andsleep to help control the pain. He had undergone var-ious medical examinations and the most recent diag-nosis was “irritable bowel syndrome.” His parentswere distressed as there was little they could do tohelp, and his condition seemed to be affecting hisfamily and social life.

History: Problems with abdominal pain for around18 months. He generally had good appetite, sleptwell, and had goodmood. He seemed a little sensitiveand emotionally distressed. He had a small hernia ofthe navel, which the doctors suggested leaving alone.His mother was an acupuncturist and was taking theshonishin class. She brought him to class to learnabout what she could do at home to help him. Thefirst two treatments were done in class, the nextthree in the 2 weeks afterward. After that she appliedtreatment on him at home on a regular basis.

Assessment: He showed a clear lung vacuity patternbased on skin texture (slightly thin), stiff shoulders,abdominal reaction in the lung reflex area and weak-ness of the lung and spleen pulse positions with reple-tion of the liver (liver pulse position stronger andhard). He also had tight bands to either side of thespine around the level of BL-17 to BL-20, which aretypical of chronic digestive problems.

Treatment: Using a herabari, tapping was applied toLI-4, over the abdomen, along the stomach channelbelow the knees, around GV-20, the supraclavicularfossa region, GV-12, GV-3 to GV-4 area.

Using an enshin, light stroking was applied downthe arms, legs, abdomen, and back.

Using a teishin, left LU-9 and SP-3 were supplemen-ted, right LR-3 drained.

0.3-mm press-tack needles were placed on leftBL-20, right BL-18.

A press-sphere was placed on GV-12.


He was happy with the treatment as it was not painfuland was quite relaxing. Otherwise there was notmuch to report.

Treatment: The dose of the whole treatment wasslightly increased (more weight of contact with tap-ping and stroking, more strokes and taps).

Using a herabari, tapping was applied to LI-4, overthe abdomen, along the stomach channel below theknees, around GV-20, the supraclavicular fossaregion, GV-12, GV-3 to GV-4 area.


Using a teishin, left LU-9 and SP-3 were supplemen-ted, right LR-3 drained.


A press-sphere was placed on GV-12.The mother was taught to apply the basic core

non-pattern-based treatment daily and to try treatingthe first two points of the lung vacuity pattern (nor-mally parents are not taught the Meridian Therapytreatment as home treatment, but the mother wasan acupuncturist who had come specifically to studyhow to treat children).


The pain had lessened over the last 3 days and he wasquite happy with this. Home treatment had gonewell, but the mother was unsure yet about the lungvacuity pattern treatment.

Treatment: Using a herabari, tapping was applied toLI-4, over the abdomen, along the stomach channelbelow the knees, around GV-20, the supraclavicularfossa region, across the shoulders, GV-12, GV-3 toGV-4 area.


Using a teishin, left LU-9 and SP-3 were supplement-ed, right LR-3, left TB-5 and right ST-40 drained.





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Fourth visit—next day

He had experienced some abdominal pain after thetreatment, though not severe. Otherwise there wasnot much else to report.

Treatment: Using a herabari, tapping was applied toLI-4, over the abdomen, along the stomach channelbelow the knees, around GV-20, the supraclavicularfossa region, across the shoulders, GV-12, GV-3 toGV-4 area.


Using a teishin, left LU-9 and SP-3 were supplement-ed, right LR-3 and TB-5 drained.

0.3-mm press-tack needles were placed on rightBL-20, left BL-18.



He had generally been better. He still had some painin the evening after eating, but it did not require thathe go to lie down to be quiet. The mother reportedthat she found it easier doing the lung vacuity treat-ment only once or twice a week rather than daily, butmaintained the core non-pattern-based treatmentdaily.

Treatment: Using a herabari, tapping was applied toLI-4, over the abdomen, along the stomach channelbelow the knees, around GV-20, the supraclavicularfossa region, GV-12, GV-3 to GV-4 area.


Using a teishin, left LU-9 and SP-3 were supplemen-ted, right LR-3, TB-5, and left BL-58 drained.



At 1-month follow-up his mother reported that hewas significantly better. Although he had someabdominal pain a few times a week, it was neversevere; nor did he need to go to bed after dinner tostop the pain. He was happier, as were his parents asthe pain no longer interfered with his home life. Inter-estingly, his mother reported that Andy’s navel herniawas starting to close up.

General Approach for Patients withAbdominal Pain

This problem in a baby is often called “colic.” In away it is not so easy to say that this is “abdominalpain” as the child cannot indicate where the pain islocated. Often when the baby presents with “colic”the problem is successfully treated by applying thetreatment for kanmushisho (see Chapter 21); lookfor other signs of this condition (bad mood, con-stant crying, poor sleep, etc.). Sometimes it is duetowhat the baby is drinking, in which case reactionto cow’s milk products is a common culprit. If thebaby is consuming cow’s milk products have theparents test for sensitivity to them (see Chapter 17,p.98, for a discussion of this).

It is not until the child is a little older and morecommunicative that we are able to say for sure thatthe symptom is abdominal pain. When a childcomes for treatment of abdominal pain it is usuallya chronic problem. Parents do not tend to bringtheir child for only an acute problem. Thus, thechild will tend to present with a chronic problemthat usually has acute episodes. If the child comeswhile having an acute episode of the abdominalpain it is important to pay more attention to thedose of treatment and it is often advisable to applya lighter treatment. If the child is in a distressedstate this often makes them more sensitive at thattime.

Goals of Treatment

The treatment goal is to gradually change the over-all condition of the child so as to prevent future epi-sodes of abdominal pain. Often, you also need towork on helping calm the child down as his or heremotional reaction to the pain can over time startfeeding into the problem, by reinforcing the func-tional problems that trigger the pain and/or bycreating learned behavior patterns.


For the baby who cries a lot and for whom the par-ents or doctor have diagnosed “colic” you need toexamine carefully how the condition manifests. Ifthere is a lot of crying, sleep disturbance and moo-diness, it is probably a manifestation of the kan-mushisho and better treated as the liver vacuitypattern. If, however, the pain is accompanied by



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abdominal bloating and changes in bowel move-ments, it is probably best to treat the baby as spleenvacuity pattern.

In an older child (e.g., age 3–7) abdominal painwith bloating is most likely a spleen vacuity pat-tern, best treated with SP-3 and PC-7. If, however,the abdominal pain seems to have emotional trig-gers the pattern is more likely a lung vacuity pat-tern or liver vacuity pattern. One needs to examineother findings to discriminate which it is. On theolder child one is more frequently able to discrim-inate the pulse findings to help choose the pattern.If the child has the lung vacuity pattern (right pulseoverall feels a bit weaker than the left), the usualtreatment of LU-9 and SP-3 is good. If the liver pat-tern (left pulse overall feels a bit weaker than theright) it may be better to use LR-3 and KI-3 insteadof the usual acupoints LR-8 and KI-10.


For babies and smaller children the core non-pat-tern-based root treatment with tapping and/orstroking is applied over the arms, legs, abdomen,back, shoulders, and head (Fig.20.3).

Additional treatment can be targeted to thestomach channels on the leg, especially by theshins. On older children you will find stiff areas onthe back especially around BL-18 to BL-20; tapthese as well. If the abdominal pain is accompaniedby a lot of crying, tap around GB-20 and LI-4.


NeedlingShimizu (1975) recommends that if the symptomson the baby are not responding with just the use ofthe core non-pattern-based root treatment applyin-out needling to acupoints such as CV-12, CV-9,KI-16, and BL-23. If you suspect that the problem ismore liver related and have treated the kanmush-isho pattern, check the occipital region. If very stiff,apply needling to around GB-20, BL-10.

For the older child (age 4–7 years), Shimizu re-commends that in addition to the core non-pattern-based root treatment to needle acupoints such asCV-12, KI-16, ST-25, ST-27, CV-6, LR-13 with the in-out technique. However, if the pain is stronger andmore stubborn, use retained needling to CV-12,ST-25, and an extra point about 1cun above ST-37.

Hyodo (1986) recommends needling or apply-ing press-spheres to the following points for treat-ment of “indigestion”: BL-21, BL-20, CV-12, CV-6.

Press-spheres (Ryu), Press-tack Needles (Empishin),and Intra-dermal Needles (Hinaishin)In addition to checking the acupoints that Hyodorecommends (BL-21, BL-20, CV-12, CV-6) I alsorecommend examining the stomach channel on thelegs around and below ST-36. It has been myexperience that hard reactive knots are commonlyfound around BL-20 or slightly medial to BL-20.Focusing treatment to these knots is often helpful.On more stubborn or stronger symptoms on chil-dren who can tolerate an increased dose of treat-ment, place press-tack needles (0.6mm) or intra-dermal needles (3mm) to the most reactive acu-points, paying attention to dose needs and careinstructions for the parent.



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Fig.20.3 Stroking:● Down the arms (large intestine channels)● Down the legs (stomach and bladder channels)● Down the back (bladder channels)● Down the abdomen (stomach channels)Tapping:● Stomach channel on the leg, especially by the shins.● Older children, if stiff: area BL-18–BL-20● If pain is accompanied by a lot of crying: around GB-20and LI-4

Okyu—Direct MoxaSometimes the symptoms are more stubborn andthe treatment approach has not created muchchange after a few sessions, in which case it can behelpful to apply moxa. For this it is generally betterto use the “80%” style of moxa (see Chapter 13), letit get hot but not burn down too far. Manaka recom-mends for chronic “indigestion” applying moxa to:CV-12, BL-20, GV-12 (Manaka et al. 1995). Irie(1980) has a slightly different recommendation forindigestion: BL-21, GV-12 (three to five moxaeach). Palpate and choose the most reactive acu-points. For severe colic Shiroda (1982) also recom-mends: KI-16, CV-12, CV-6, BL-50, Sawada’s GB-33(extra point, 3cun belowGB-32).

Cupping, BloodlettingIn stubborn cases, especially on older children, itmay be necessary to apply light cupping on thechild. The treatment area should be on the back,focusing especially on the lumbar region, and, if theupper back and shoulder region is stiff, theseregions too. On older children, if vascular spidersappear on the lumbar region, these can be stabbedand squeezed to remove a few drops of blood. Payattention that you do not cause pain with the tech-nique. Sometimes bloodletting SP-1 can be usefulfor abdominal pain (Maruyama and Kudo 1982).

Stomach Problems

Case 1Larry, Boy Age 9 Years

Main complaints: Over the last few years Larry hadhad a lot of problems with stomach upset and vomit-ing. He had stomach upset around six or seven timesa month, often accompanied by vomiting in themorning. The symptoms recovered by late morning.The cause of the problem was unclear; it had beendiagnosed as chronic gastritis, possibly stress-related.

Secondary complaints: He had a small problem withbeing very energetic, triggering sometimes uncon-trolled behavior and big emotional swings. He wasalso very talkative and tended to think a lot.

Assessment: Appetite, sleep generally good, diet OK,no clear reactions to any particular foods. All othersystems were normal. His abdominal tone was a bitpoor, generally slightly weaker below the navel leveland a full feeling above the navel on the ren mai. Hecould not do abdominal breathing and tended tobreathe a little high in the chest. The left deep pulseswere overall slightly weaker than the right, with weak-ness of the spleen pulse and repletion of the stomachpulse.

Diagnosis: He had a tendency toward kanmushisho-type symptoms and had a liver vacuity pattern withspleen vacuity and stomach repletion.

Treatment: Since he was an older and relatively ma-ture child the shonishin non-pattern-based treatmentwas not applied.

Using regular needles, supplement CV-12, left LR-3,KI-3, right SP-3, drain right ST-40, left GB-37, and leftSI-7.

Using a needle, contact needling was applied overthe lower abdomen and in the area around ST-12.

Using regular needles, supplement BL-18, BL-23,GV-6 (which felt spongy and weak).

Using an enshin, stroking was applied down theback.

Press-spheres were placed on CV-12, GV-12, andright BL-20.


He had had a good week, the first part slightly betterthan the second. His emotions and energy were also alittle calmer.

Treatment: Using regular needles, supplement CV-12,left LR-3, KI-3, right LU-9, drain right TB-5, left GB-37,and left SI-7.


Using regular needles, supplement BL-18, BL-23.Using an enshin, stroking was applied down the

back.Press-spheres were placed on GV-12, CV-6, and

right BL-17.Using a needle, supplement left KI-3.


Condition not as good as after the first treatment.



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Treatment: Using regular needles, supplement leftLR-3, KI-3, right SP-3, drain right ST-40 and TB-5.


Using regular needles, supplement BL-23.Using an enshin, stroking was applied down the

back.Chinetsukyumild warmth moxa was applied to GV-3

and BL-23.Press-spheres were placed on GV-3 and CV-6.


Overall he was better than before treatment started,but not as good as after the first visit. The stomachsymptoms had improved and his energy and emo-tions were calmer.

Treatment: Using regular needles, supplement CV-12,left LR-3, KI-3, right LU-9, SP-3, drain right TB-5, leftGB-37, and right LI-6.


Chinetsukyu mild warmth moxa was applied toCV-12, CV-6, and ST-25.


back.Press-spheres were placed on GV-12, CV-6, and

right BL-17.


Overall better again andmore stable.

Treatment: Using regular needles, supplement leftLR-3, KI-3, right LU-9, ST-36.


Chinetsukyu mild warmth moxa was applied to leftBL-20, GV-3, and BL-25.

Using regular needles, supplement BL-13, BL-20.Press-spheres were placed on GV-6 and right BL-17.


An overall improvement: stomach, energy, and emo-tions. Occasionally he felt a bit tired.

Treatment: Using regular needles, supplement CV-12,left LR-3, KI-3, right LU-9, drain right ST-40, TB-5, andleft SI-7.


Chinetsukyu mild warmth moxa was applied toCV-12, CV-6.

Using regular needles, supplement BL-13, BL-20.Press-spheres were placed on GV-3, CV-6, and right

and left BL-20.

Seventh visit—19 days later

He had not experienced any stomach problems forweeks. His energy and mood had been through someups and downs, but he was generally well.

Treatment: Using regular needles, supplement LR-13,CV-12, left LR-3, KI-3, right LU-9, drain right TB-5, leftGB-37, and right LI-6.


Using regular needles, supplement BL-18, BL-20.Press-spheres were placed on GV-9, bilateral BL-17.

Eighth visit—5 weeks later

His condition was generally good, with no stomachproblems, but still a tendency for energy and moodfluctuations.

Treatment: Using regular needles, supplement leftLR-8, KI-10, right LU-9, drain right ST-40.


Chinetsukyumild warmthmoxawas applied to GV-4.Using regular needles, supplement BL-13, BL-20.Press-spheres were placed on GV-6 and CV-9.

Ninth visit—7.5months later

He was doing very well. He had caught cold a monthbefore and was slow recovering from it.

Treatment: Using regular needles, supplement leftLU-9, SP-3, right LR-3, drain right ST-40, supplementleft TB-4.


Chinetsukyu mild warmth moxa was applied toGV-14, GV-3.

Using regular needles, supplement BL-13, BL-20.Press-spheres were placed on left BL-13 and right

BL-20.



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Tenth visit—3months later

He had generally been very good, but recently he hadbeen getting a bit upset and losing concentration atschool. At this visit his mother disclosed that therewas a lot of family stress and that this had been goingon for a while.

Treatment: Using regular needles, supplement CV-12,left LR-8, KI-10, drain right SP-9, TB-5, left GB-37, andBL-58.


Chinetsukyu mild warmth moxa was applied toCV-12.


back.Press-spheres were placed on bilateral BL-20.

Eleventh visit—6.5 months later

Again an overall improvement; energy, mood, andconcentration at school were better. Recently (withstress at home) he had had some flashes of anger.

Treatment: Use the electrostatic adsorbers,2 KI-6(black-negative) with LU-7 (red-positive) for 1minuteon each side.3

Using regular needles, supplement CV-12, left LR-8,KI-10, right LU-9, drain right TB-5 and left SI-7.

Using a needle, contact needling was applied overthe lower abdomen and in the area around ST-12 andover the upper back.

Using regular needles, supplement BL-18, BL-23.Press-spheres were placed on right BL-18 and left

BL-23.

Twelfth visit—14months later

The old problems he had before were much better.His abdominal tone was much better and he could doabdominal breathing. However, recently (last 3months)he had developed small patches of eczema on the ear-

lobes. He had been prescribed, and had startedusing, corticosteroid cream for the eczema.

Treatment: Using the electrostatic adsorbers, KI-6(black-negative) with LU-7 (red-positive) for 1minuteon each side.

Using regular needles, supplement CV-12, left LR-8,KI-10, right LU-9, drain right TB-5 and ST-40.

Using a zanshin, rub over the shoulders.Using regular needles, supplement BL-18, BL-23.Okyu was applied to the reactive points at bilateral

LI-10 for the eczema.

Thirteenth visit—1 week later

He felt calmer, but there was not much change in theskin condition.

Treatment: Use the electrostatic adsorbers, KI-6(black-negative) with LU-7 (red-positive) for 1minuteon each side.

Using regular needles, supplement left LU-9, SP-3,drain right LR-3 and ST-40.

Using a needle, contact needling was applied overthe area around ST-12 and over the upper back.

Using regular needles, supplement BL-13, BL-20.Apply Chinetsukyumild warmthmoxa to GV-3, GV-4,

and BL-25.Okyu was applied to the reactive points at bilateral

LI-10.

Fourteenth visit—9 days later

He felt better, but continued to use the corticosteroidcream.

Treatment: Use the electrostatic adsorbers, KI-6(black-negative) with LU-7 (red-positive) for 1minuteon each side.

Using regular needles, supplement CV-12, left LU-9,SP-3, drain right LR-3, left TB-5, and SI-7.


Using regular needles, supplement BL-13, BL-20,GB-20.

Okyu was applied to the reactive points at bilateralLI-10.



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2 The electrostatic adsorbers are a noninvasive form of the“ion-pumping cords” of Manaka (Manaka et al. 1995). Theyprovide a polarity type of stimulation to the extraordinaryvessel treatment points.

3 Larry was now 11 years old and well developed, so I decidedto start treating him with more adult-type treatment meth-ods.


He felt better, but continued to use the corticosteroidcream.

Treatment: Use the electrostatic adsorbers, KI-6(black-negative) with LU-7 (red-positive) for one min-ute on each side.

Using regular needles, supplement CV-12, left LU-9,SP-3, drain right LR-3, right ST-40, and left TB-5.


Using regular needles, supplement BL-13, BL-20,GB-20.


Okyu was applied to the reactive points at bilateralLI-10.

A press-sphere was placed on left BL-20.

Reflection: Many of Larry’s problems were probablyrelated to the ongoing family stresses due to prob-lems between his parents. Had I known this earlier itcould have been useful to add something further toaddress his problems, such as applying treatment tothe thoracic spine, targeting the neck, shoulder, andupper back a bit more. But in general Larry did verywell with treatment. His gastritis resolved after only afew treatments and his general kanmushisho-typeproblems also showed clear improvement. Becauseof his age I did not get the parents to perform hometreatment. On reflection, it could have been helpfulto do this.

General Approach for Patients with StomachProblems

DietaryObviously, one needs to examine dietary issues forpatients with stomach problems as what the childeats and drinks is a common trigger for stomachproblems.

Home TreatmentAnother common problem is the role of stress.Often in children stomach problems like gastralgiaand gastritis show a clear psychogenic component,with reactions to stress issues at home. One way ofdealing with these stress issues is to see how toengage the parents in some home treatment.


With stomach problems the most likely patternswill be spleen vacuity pattern or liver vacuity pat-tern. The spleen vacuity pattern will show, forexample, pain and distension. The liver vacuity pat-ternwill showmore in relation to stress reactions.


For babies and smaller children the core non-pat-tern-based root treatment with tapping and/orstroking is applied over the arms, legs, abdomen,back, shoulders, and head. If the child is older thistreatment approach can be used but at higher dose.Usually the shoulders and neck will show signs ofstiffness; also stroke over these areas (Fig.20.4).

Additional treatment can be targeted aroundthe navel, CV-12, to the stomach channels on theleg, especially by the shins, and the areas aroundBL-18 to BL-20. If the child appears to have stress-



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Fig.20.4 Stroking:● Down the arms (large intestine channels)● Down the legs (stomach and bladder channels)● Down the back (bladder channels)● Down the abdomen (stomach channels)● Across the shouldersTapping:● GV-20: five to 10 times● GV-12: 10 to 20 times● Around BL-18–BL-20: 10 to 20 times● Occipital area: five to 10 times● LI-4: five to10 times each● Around CV-12: five to 10 times● Around navel: five to 10 times● Around ST-36–ST-37: five to 10 times each

related stomach problems, also tap around GV-20,GB-20, LI-4, and in general over the shoulders.


NeedlingFor childrenwith stomach problems, needling reac-tive points on the abdomen and back is usuallyquite effective. Reactive points include CV-12,CV-10, ST-21, ST-25, BL-17, BL-18, BL-20, BL-22. Onthe younger child use the in-out needling techni-que; on the older child retain the needles for awhile. If the stomach problems are due to stress, orpsychological factors, check around GB-20 and BL-10and needle to release the tension there, using thein-out technique for younger children and retainedneedle technique for older children. Additionally, ifGV-20 or the area around GV-20 shows pressurepain reaction, especially with signs of puffiness/sponginess, this reactive point can also be needled.On childrenwho show strong reaction on palpationof the abdominal points and are too nervous to letyou needle these points, try palpating on the legsaround ST-36 to ST-37 and needle the reactivepoints there.

Press-spheres (Ryu), Press-tack Needles (Empishin),and Intra-dermal Needles (Hinaishin)Leaving press-spheres, press-tack needles, or intra-dermal needles for stomach problems is most easilytargeted to acupoints on the back. It is commonthat strong reactions are found in the region ofBL-17 to BL-20, especially around BL-20 and/orBL-18. Leaving something to treat these reactivepoints, either on one side or one point on each sideof the spine can be very useful to help relieve thesymptoms. On the abdomen, reactions on the renmai, such as around CV-12 or CV-10 can be treatedby leaving press-spheres or press-tack needles forstomach problems. On childrenwith “nervous stom-ach,” that is, stomach problems that show withstress, leaving a press-sphere on GV-12 can be help-ful. Some children with this stress reaction canshowa lot of stiffness in the upper back in the inter-scapular region, in which case direct treatment toreactions around BL-14 and BL-15.

Okyu—Direct MoxaIf the stomach problems are primarily due to foodallergies or food sensitivities, apply moxa to theextra point uranaitei. In this case the point on bothfeet feels the heat, so apply the moxa to each foot sothat heat is felt at least three times. If the symptomsare stubborn and you are treating an older child,this can be an acupoint used for home moxa ther-apy. If the child has problems due to constitution,such as the spleen weak constitution type, thensometimes stronger treatment is needed such asmoxa to BL-18, BL-20, and sometimes GV-12. Thesymptoms associated with this tend not to be lim-ited to the stomach and tend to involve the wholedigestive tract, but if the child is very rundown, haspoor appetite and stomach problems instead ofloose stools, or diarrhea, it could be useful to trythis treatment. On smaller children it is better tostart by treating these acupoints with press-spheres, or press-tack needles. If this is not work-ing, then use moxa. On older children one can usemoxa to these acupoints sooner. Remember that inorder to minimize the number of points that wemoxa, we apply the moxa to BL-18 and BL-20 con-tralaterally, usually boys left BL-18, right BL-20;girls, right BL-18, left BL-20. If the stomach prob-lems aremore due to stress, the “nervous stomach,”examine the thoracic spine for reaction on theintervertebral spaces between T2 and T9. If there isreaction here apply moxa to the reactive points(s)in the style of Fukaya’s “psychosomatic moxa treat-ment” (Irie 1980; Fukaya 1982).

CuppingMeguro (1991, pp.146–147) mentions the use of amore extensive cupping treatment for weak stom-ach in children. It is useful to remember thatMeguro is a cupping specialist, meaning that histreatment exclusively involves the use of cuppingfor all patients. As acupuncturists, we can use thisapproach for some of our patients, but more likelywe will be integrating the use of cupping into theoverall treatment on each visit.Whenwe do the fol-lowing cupping treatment, it will probably be toomuch of a dose if all of it is applied in addition tothe rest of the treatment. Thus, the tendency is touse some of these treatment protocols or on occa-sion only to do the cupping as a separate treatment.

For children up to the age of 7 years, apply cupsfor 6 or 7 seconds over each of the following areasin the order presented:



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● Over BL-20, BL-21, BL-23, and BL-51 (eightcups).

● Around ST-21, ST-27, and SP-14/SP-15 (sixcups).

It is important to review the discussion of cup-ping methods in Chapter 14 in order to grasp thedetails of these cupping treatments. No cups shouldcause pain. We use only pumped cupping and notfire cupping.

BloodlettingOn an older child bloodletting SP-1 can be usefulfor stomach problems. Check the points for signs ofstagnation (redness, swelling) (Maruyama andKudo 1982). If vascular spiders appear on the back,especially on the lumbar-sacral region, these can bebled, but this is unlikely to occur except on an olderchild.

Additional Digestive Problems

Gastrointestinal Distress

This is a broad category described by YoneyamaandMori (1964). This and the next paragraph comefrom their book. The condition includes a range ofmanifestations most typically with gastrointestinalupset and symptoms of diarrhea and vomiting. Thestools are generally very loose or watery, frequent,with a lot of mucus in them, and often very odor-ous. Vomiting does not have to accompany thesesymptoms, but often does, it is often the yellowcolor of bile, and can be coffee-colored (making usthink of gastric bleeding). Typically the child willhave poor appetite for 2 to 3 days before the symp-toms start, becoming reluctant to drink milk. Thechild will be moody and with poor appetite. Therewill be no fever or a low grade fever. If the fever isgreater than 37.8°C we can suspect that it is notthis category. Other symptoms can include: suddenloss of weight, or a temporary stopping of weightincrease; a dehydrated condition (e.g., symptoms ofdry skin with no springiness, hollow-looking eyes,dry tongue and lips, decreased urination).

Treatment:As well as doing the core non-pattern-based roottreatment using the stroking and tapping, it is goodto add thin, shallowly inserted needles at points

such as: BL-20, BL-21, BL-22 on the back, CV-12,ST-25 on the abdomen. Generally this is not aninfectious disease, Yoneyama andMori suggest thatthis is often the result of psychogenic factors, whichis why shonishin is indicated for this condition. It isimportant to treat regularly and with patience(Yoneyama andMori 1964).

This manifestation of symptoms indicates acombination of spleen and liver-related problems.The best treatment to start with will be the spleenvacuity pattern; supplement SP-3 and PC-7. If youare able to access the pulse of the liver and can dis-criminate whether it is weak or replete, applyappropriate techniques to the liver as a secondarypattern, treating LR-3.

Additionally, because of the liver involvement,one can add tapping to LI-4, GV-12, and the occipi-tal area. Leaving press-spheres or press-tack nee-dles can also be useful at acupoints like GV-12,BL-20, BL-18, BL-17. Palpate and choose the mostreactive points.

VomitingMilk

Generallymany babieswill respondwell to the corenon-pattern-based root treatment for the problemof vomiting milk. Additional tapping can be tar-geted to PC-6 and the area around BL-20. Press-spheres can also be placed on the BL-20 reactivepoints. Reaction to cow’s milk products can be amajor trigger for this problem of vomiting. If thechild is only drinking breast milk it may be usefulto have themother stop consuming cow’s milk pro-ducts to see if that helps. If the baby is consumingbottledmilk, it is good to test to see if the symptomsimprove (see discussion of the testing in Chapter17, p.98).

In the baby this should be treated as a spleenvacuity pattern. It can be helpful to use SP-3 withPC-6 instead of SP-3 with PC-7, to take advantage ofthe well-documented anti-emetic effects of PC-6.The baby may also have a disturbance of the liverchannel, especially one of being replete. Check theleft pulse; if it feels a little harder than the rightpulse this can indicate this problem. Also, if thechild tends to be irritable, cries a lot, sleeps poorly,this can also indicate the repletion of the liver. If theliver seems to be replete, add gentle draining tech-nique with the teishin to LR-3 on the other side ofthe body fromwhere you applied supplementationto the spleen and pericardium channel points.



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Shimizu (1975) recommends for vomiting milk,that as well as applying the core non-pattern-basedtreatment, one can add tapping of GV-22, the rightsubcostal region, the substernal region, LR-3, andPC-6. If this is not enough one can let blood at LR-1.

If the condition is very stubborn and nonrespon-sive it may be necessary to apply a stronger treat-ment. Okyu is recommended by a number ofauthors in Japan. Shiroda (1986) recommendsmoxa to GV-12, Manaka to GV-12 and BL-17 (Man-aka et al. 1995) and Irie (1980) to GV-12 and CV-16(one to three moxa each). Palpate and choose themore reactive points.

Stubborn, Poor Appetite

The core non-pattern-based root treatment is veryhelpful for the child with this problem. The usualtreatment of the arms, legs, back and abdomen isgood. Additional tapping of the areas around GV-12,GV-3 to GV-4, the navel, and on the stomach chan-nel below the knees is indicated. Teaching the par-ents to apply treatment daily at home is stronglyrecommended.

The child who has chronically poor appetite willtend to be a bit underweight. He or she will tend toshow a strong spleen vacuity pattern and maybethe more severe form of this, the spleen weak con-stitution. If the former, carefully supplement SP-3and PC-7 for the pattern-based root treatment. Ifthe latter, in addition to supplementing SP-3 andPC-7, one needs to apply other treatment measures.Check Chapter 25 “Weak Constitution” for details ofthe recommended treatment of the spleen weakconstitution. You may need to apply stronger treat-ment such as moxa to points like BL-18 and BL-20.At the very least it is recommended to apply treat-ment by press-spheres, press-tack needles, orintra-dermal needles to the points like BL-18 andBL-20. Additionally, a press-sphere on GV-12 isgood.

Shimizu (1975) comments that for cases ofchronic poor appetite, bloodletting SP-1, LR-1, orST-45, can be very effective to trigger change whenthe condition is stubborn and resistant.

Motion Sickness

Shimizu (1975) gives a description of this conditionand its treatment. This problem is more clearlyidentified in school-age children (age 6 and older).It is due to a disturbance of the inner ear and seemsmore common in childrenwho are very sensitive orsusceptible to more emotional distress. If the stom-ach or liver functions seem to be lowered the childcan bemore susceptible to this problem.

The core non-pattern-based root treatmentwith tapping and/or stroking is very useful. It isalso useful, given the more recent evidence of theanti-emetic properties of PC-6, to add tapping toPC-6 as well. Likewise, experience on adults withthis problem informs us that we often find a hardknot around BL-20 or medial to it, especially on theleft side. If this is found, apply targeted tapping tothis region aswell.

The child who comes for treatment of this prob-lem is usually older, and therefore more easilyneedled. If the liver or stomach function seems tobe lower, Shimizu recommends needling of acu-points such as CV-14, CV-12, LR-14, BL-18, BL-21.Palpate and choose the more reactive points fortreatment. Similarly, if there seems to be a clearemotional component, add needling to acupointssuch as GV-20, BL-10, GB-20, GV-12. Choose by pal-pating the points. Often the child will have stiffshoulders, in which case apply additional treat-ment to help reduce the stiffness of the shoulders(inserted needles to points such as GB-21 may behelpful, as might additional tapping or light cup-ping of the areas).

Shimizu strongly recommends placement ofintra-dermal needles to either LR-5 or KI-9 for theproblem of motion sickness. He recommendsapplying the needles on the day before the journey.Sometimes both points can be treated and some-times one of them with an intra-dermal needle toGV-12. More recent experience with PC-6 supportsits use. In this case check to see whether it is betterto use a press-tack needle or intra-dermal needle toPC-6. On younger, frailer children the 0.6mmpress-tack needle is probably better.



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21 Behavioral, Emotional, or Sleep Problems

Kanmushisho—the Cranky Child

The term “kanmushi” (疳虫) refers to concepts inthe historical development of pediatric medicine inJapan. It came to have a very broadmeaning. Shimi-zu (1975) lists the following symptoms or manifes-tations as associated with kanmushi: insomnia,night crying, night terror, bad mood, irritability,cries a lot, convulsions, biting people, biting nails,abdominal bloating due to over-eating, temporaryfever, vomiting milk, vomiting in general, poorappetite, diarrhea, runny nose, stuffy nose, sorethroat, cough, easily catches cold, allotriophagy(desire for unusual or abnormal food), excessivedrooling, tics, urticaria, swollen lymph glands.When the condition is strong one can see othermanifestations of the condition such as: a bluishtinge to the white of the eyes, blue vein apparentbetween the eyes, stiff and angry facial expression,the appearance of the hair of the head standing up(Shimizu 1975). One can see that it covers manyconditions for which parents might bring theirchild for treatment. Shimizu is of the opinion thatin general kanmushi is to do with a kind of over-sensitivity of the child to various stimuli (environ-mental, nutritional, emotional, etc.) and is bothpartly related to stages of development of the childand an underlying constitutional type weakness inthe child, which predisposes them to these over-sensitivities (Shimizu 1975).

This general understanding of kanmushi wasmore prevalent in shonishin practice before WorldWar II, but since then and partly in response to theneeds of modern practice today, such old ideashave generally been restrained. In themodern prac-tice of shonishin we find one surviving offshoot ofthis concept, the term “kannomushisho” (疳の虫証).Kannomushisho or “kanmushisho” (疳虫証) is usedin amore limitedway to refer to the infant whowillnot settle down, is distressed, cries and screams alot, sleeps badly, is irritable, and so on. In Westerncountries it is common to hear newborns describedas being “colicky.” In many cases it may involve thebaby being “colicky” and what the baby is fed may

need to be examined, but many cases are probablynot due to being colicky; rather, there are otherissues. Following the traditional theories and mod-els of acupuncture practice that can be found inKeiraku Chiryo or Meridian Therapy, we can saythat these are principally signs of disturbance ofthe liver channel. The constitutionally liver weakchild can show this tendency, such behavioral prob-lems being a hallmarkof that type. But the presenceof a symptom associated with a particular channel,here the liver channel, does not necessarily indicatewhat the state of that channel is; it could be weakor replete. Generally, when a young baby presentswith these symptoms, we treat it as a liver vacuitypattern. When an older baby or young child pre-sents for treatment with these behavioral prob-lems, if we are able to access the radial pulse clearly,we sometimes find that the child has liver reple-tion, which means we apply draining technique tothe liver channel. But this is difficult to determine ifwe cannot access the radial pulses clearly. The gen-eral non-pattern-based root treatment is very help-ful for this kind of baby or child. When in additionthe liver channel disturbance is addressed, it seemstowork very well.

As the baby ages, the symptoms can evolve. Theirritability, crankiness, crying, screaming, and poorsleep take on various behavioral aspects. It canbecome part of the communication method of thebaby or young child and can be reinforced whenthe parent responds to address whatever is per-ceived to have caused the outburst. Such reinforce-ment as the child ages becomes learned behavior,which can become complicated to deal with. Aschildren start mingling and playing with other chil-dren they sometimes play a bit more roughly thanother children. They can be very possessive andshow tantrums when they do not get what theywant, or what has been taken away. In the super-market such children are capable of really acting upwhen they cannot get the parent to buy what theysee andwant. Young children may also show differ-ent forms of sleep disturbance such as “night ter-rors,” bad dreams, waking frequently at night, orsleep walking. Very often the sleep disturbance



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components leave the parents feeling quite ex-hausted.

All of these behavioral problems are a form ofkanmushisho. But depending on the age of the childand the manifestations, they need to be addresseddifferently. Thus, I will address this issue in threestages. The first stage is the kanmushisho infant.The second is the 2–4-year-old, pre-school childwith various manifestations of this, including areally bad “terrible twos.” The third is the olderchild (school age) where a formal diagnosis ofattention deficit hyperactive disorder (ADHD) orhyperactivity has been made. This child mayalready be onmedication to try to control the prob-lems. But the manifestations in the older child arenot always ones of hyperactivity. It can include thechild who is distracted with poor concentration, sothat school grades and participation are poor; herewe see diagnoses such as attention deficit disorder(ADD).

Case 1Noel, Boy Age 10Weeks

Main complaints: Since birth, restlessness and irrit-ability; seemed to get easily colicky on bottled milk.He usually woke at 10p.m. screaming and took 2 hoursor more to settle down again. All other systems werenormal.

Assessment: Facial complexion slightly reddish.Otherwise he was a healthy-looking baby. The leftpulse was weaker than the right pulse.

Diagnosis: Primary liver vacuity pattern.

Treatment: Using a teishin, left LR-8 and KI-10 weresupplemented.

Tapping using a herabari was very lightly applieddown the arms, legs, abdomen, back, and neck.

Stroking using a silver enshin was very lightlyapplied down the back and neck.

A press-sphere was applied to GV-12. The parentswere recommended to change this daily, and if neces-sary to lightly massage the area around GV-12 whenhe wouldn’t settle down at night.


He was much calmer and more settled following thetreatment. He was sleeping fine, was happier, and nolonger had the pattern of waking at 10p.m. andscreaming on and off for 2 hours.

Treatment: Using a teishin, left LR-8, KI-10, and rightLU-9 were supplemented.

Tapping using a herabari was very lightly applieddown the arms, legs, abdomen, chest, back, andneck.



He was very good; none of the original symptomswere present. He was very relaxed and calm, smiling alot.

Treatment: Using a teishin, left LR-8, KI-10, and rightSP-3 were supplemented.

Tapping using a herabari was very lightly applieddown the arms, legs, abdomen, chest, back, andneck.

A press-sphere was applied to GV-12.The child was discharged from treatment. The par-

ents were instructed to return for treatment if any ofthe original symptoms recurred.

Reflection: I think I was lucky to hit the nail on thehead the first time. When we do this, the treatmenteffects are usually clear and immediate with babies,which is what happened with Noel. I had thought toteach the parents how to do the home treatment onthe second visit, but since he had so clearly improved,and what I had done seemed to be enough, I decidednot to do this. I did try to get the parents to under-stand the importance of coming back if there was anyrecurrence of the symptoms so that we could nipthem in the bud.

General Approach for the Cranky, IrritableChild

One needs to be careful about dose of treatmentuntil one is sure what the appropriate dose for thechild will be. In general, the more the psychologicalor emotional state of a patient is disturbed, thehigher the tendency toward sensitivity; hence becareful of treatment dose. As the child with thiskanmushisho tendency becomes older, his or her



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problems become more complex, with learnedbehavioral patterns built on top of the kanmushishotendencies. I have had experiences treating chil-dren aged 6–9 years with ADHD who have reactednegatively to the first treatment because I mis-judged the dose. It is better to do less and focus onbuilding the treatment relationship at first. It is alsoadvisable when treating a child with behavioralproblems not to have the parent bring siblings intothe room. Often the child does not want to stay stillto receive treatment when a sibling is present. Thiscan be much worse as the children seek to playwith each other. It can be very difficult maintainingorder and being able to do what you would likewhen the children are playing in your treatmentroom.

Goals of Treatment

Regulate the qi by moving it downward so as tohelp calm the child, and treat to restore balance tothe channel system so as to help improve overallregulation of qi in the body. Release typical stiffareas that develop in relation to these behavioralproblems.


Liver vacuity pattern is most commonly treated forthis problem. On a baby or small child, where youcannot reliably get information from the pulse andabdomen, select and treat the liver vacuity pattern.To do this, supplement LR-8 and KI-10. An alterna-tive point selection could be to use the fire/ying-spring points LR-2 and KI-2 if the child seems over-heated; he or she would not only be very irritable,crying a lot, and so on, but would have a reddenedappearance, almost looking feverish.

With older childrenwhere you can feel the pulseand abdomen, and can understand what you arefeeling, you have the possibility to treat with morediscrimination. Liver vacuity pattern is still themore common pattern that shows, but you mayfind the liver involved in other ways, secondary tolung or spleen vacuity patterns. For example, youmay find lung vacuity with liver repletion or lungvacuity pattern with liver vacuity or spleen vacuitypattern with liver repletion, or spleen vacuity pat-tern with liver vacuity. The method of discriminat-ing repletion or vacuity of the liver is described inChapter 19, page 132, “Urticaria—Most Likely Pat-

tern-based Root Diagnosis.” In these cases applytreatment as follows:● For lung vacuity with liver repletion pattern:

supplement LU-9, SP-3, or LU-5, SP-9 on oneside and drain LR-3 or LR-8 on the other side ofthe body.

● For the lung vacuity, liver vacuity pattern: sup-plement LU-9, SP-3, or LU-5, SP-9 on one sideand LR-3 or LR-8 on the other side of the body.

● For the spleen vacuity with liver repletion pat-tern: supplement SP-3, PC-7, or SP-9, PC-3 onone side and drain LR-3 or LR-8 on the other sideof the body.

● For the spleen vacuity with liver vacuity pat-tern: supplement SP-3, PC-7, or SP-9, PC-3 onone side and LR-3 or LR-8 on the other side ofthe body.


The treatment needs to be applied repeatedly. Thekanmushisho pattern is typically part of the consti-tutional tendencies of the child, and thus symp-toms will tend to repeat easily. To counter this,applying treatment regularly for a while is impor-tant. Shimizu (1975) mentions applying treatmenton average three to five times per month, whileYoneyama and Mori (1964) state it is good to bepatient—things improve with regular treatment. Toaid consistency and frequency of treatment, it canbe very helpful to have the parents apply a short,simplified, light form of the core non-pattern-based root treatment with stroking and tapping athome. This maintains the frequency and pushes thechild to respond a little more quickly, which inmany cases is very helpful. Chapter 8 describes theapplication of home treatments. It is important topay attention to the issues of over-treatment andmake sure you check carefully what to do and whatyou have the parents do at home.

For treatment, apply stroking down the arms,legs, back, and abdomen. If the shoulders are stiff,apply stroking across the shoulders. If the neck isstiff, apply stroking down the neck. Apply tappingto around GV-12 (see Fig.21.1).

Additional tapping or stroking can be applied tocertain regions and acupoints depending on theseverity of the kanmushisho. In general, focus moreon the upper back, head, neck, and shoulders. Tap-ping around GV-12, the GB-20 to BL-10 area, acrossthe occipital region, around GV-20 can be helpful. It



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can be helpful to start with tapping of the acupointstowhich youmay need to apply stronger treatmentsuch as needling in later treatment sessions. Checkacupoints such as LI-4, LI-2, BL-10, BL-11for stiff-ness of the muscles in these regions. Shimizu(1975) makes the following additional recommen-dations: lightly stroking distally over the websbetween the fingers and toes. Apply additional tap-ping to the following acupoints: LU-5, LI-11, PC-4,ST-36, KI-6. The tapping of these acupoints can beuseful as part of the core non-pattern-based treat-ment if the kanmushisho is strong. If the kanmush-isho irritability manifests with abdominal bloating,focus especially on the abdomen, particularly theupper abdomen.

For the older child (5 years and older) with kan-mushisho-type problems, it is my experience thattapping should be minimized and light strokingshould be used. On the baby and young child thecombination of stroking and tapping works well.But it seems the tapping can be “stimulating,”which can in some children be an irritant. Thus, onthe older child I recommend using stroking appliedwith slightly more contact and somewhat moreslowly. Stroking is applied repetitively down thearms (all yang channels), down the back, down theneck, across the shoulders and down the legs (blad-der and stomach channels). For the stroking it can

be helpful to use a thicker instrument like theenshin that can warm up with the stroking move-ments. On subsequent visits, when you are moresure how the child is responding to treatment andwhat the appropriate dosage needs are, you canstart adding other techniques (see Fig.21.2).


NeedlingIf the kanmushisho symptoms are stubborn and donot respond enough to the light stroking and tap-ping, you may need to increase the dose accord-ingly on future visits. A simple way of doing this isto insert thin (0.12-mm) needles to acupoints suchas LI-4, GB-20/BL-10. For the points of the occipitalregion you can insert and leave the needles for ashort while. For the points on the hands, LI-4, it isusually better to do a quick in and out insertionmethod. For the older child with, for example,ADHD, it is generally better to use inserted needling



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Fig.21.1 Usual stroking plus tapping:● LI-4: 10 to15 times each● GV-12: 20 to 30 times● Shoulder area: 10 to 20 times● Occipital area: 10 to 20 times● GV-20: 10 times

Fig.21.2 Greater number and pressure of stroking plusadditional stroking across the shoulders.Light tapping around:● LI-4● GV-12● Occipital area● GV-20 area

methods to the area around GB-20 rather than theusual tapping; if you can retain the needles for awhile this is better, otherwise the in and out techni-que can be used. Needling GV-20 can also be helpfulif there is a feeling of sponginess on the point. If thechild is older and has ongoing sleeping problems,youmay find tightness around the acupoints BL-17.These can be additionally stimulated with in andout needling.

Press-spheres (Ryu), Press-tack Needles (Empishin),and Intra-dermal Needles (Hinaishin)Leaving a press-sphere on GV-12 is generally help-ful. Sometimes one also finds knots on toddlers andolder children around BL-15. Leaving press-sphereson these can also be helpful. For sleep disturbance,leaving press-spheres on BL-17 is good. For theolder child or those who can deal with a higherdose of treatment you can leave press-tack needleson the bladder channel acupoints. In some childrenthe shoulders are very stiff, and there is a strongknot around, for example, GB-21; leaving press-spheres on these can be useful. Sometimes, to helpthe child with liver weak constitution tendenciesand behavioral or sleep problems, leaving press-spheres on related back shu points can be helpful.In a liver vacuity pattern we treat the liver and kid-ney channels, thus we leave press-spheres on BL-18on one side and BL-23 on the other side of the back.

Mike Smith recommends leaving a press-sphereto the extra point behind shen men on the ear(Smith, personal communication). He recommendsthis for children with ADD and ADHD. I have foundit useful in a generalway to help calm the child.

Okyu—Direct MoxaOkyu is used if the symptoms are more stubborn,and not responding sufficiently to treatment. GV-12is a main treatment point. Manaka recommends itfor severe crying at night in the infant (Manaka,Itaya, and Birch 1995). Shiroda (1986) recommendsit with GV-4for the very agitated “fretful” child. Ifthere are strong reactions around BL-17 and BL-18,and treatment of those reactions with needling,press-spheres, or press-tack needles has not chan-ged them much, and the symptoms have improvedlittle, okyu can be applied on these points; be care-ful not to let it become too hot, the 80% cone moxaapproach is better—put the moxa out as soon as alittle heat is felt (see Chapter 13).

CuppingIn general, the use of cupping on kanmushisho chil-dren is not talked about much. If the shoulders andinterscapular regions are very stiff, light, low-dosecupping can be applied carefully on the shouldersand thoracic spine to try to help release the tensionthere. This, like moxa, is not a first or second line oftreatment for children with kanmushisho, but canbe used as an alternative back-up strategy if otherapproaches have not been so helpful.

BloodlettingShimizu (1975) recommends the use of bloodlet-ting of jing points in more severe cases of kanmush-isho. The most common points treated are LI-1,SI-1, and less often LR-1. Yoneyama and Mori(1964) also state that on occasion in stubborn,more severe cases one needs to apply some blood-letting; they recommend bloodletting LI-2. Shimizu(1975) also mentions a condition he calls “mushifever.” This refers not to the feverish child, but the“over-heated” child who has been too active. Forthis, as well as recommending light tapping only onthe head, shoulders, and upper back to help withcooling the child down, he mentions that bloodlet-ting of LI-1 and/or SI-1 may be needed. Obviouslyone would prefer not to have to do bloodletting asit can be difficult to do on children, but if your tech-nique is good, it should not be too problematic. It isvery important that you have a painless technique.Generally speaking it is better and easier if you donot do this on a child until you have practiced thetechnique described in Chapter 15, and can do itpainlessly on demand.


DietaryIt should come as no surprise that sugar intakeshould be discussed with the parents, as shouldintake of soft drinks like Coca-Cola. It is surprisinghow unaware some parents are of the inappropri-ateness of allowing their overactive child to drinkcaffeine-rich drinks such as sugared Coca-Cola.

These behavioral problems can also be triggeredor irritated by consumption of cow’s milk products,thus it may be necessary to instruct parents on howto test for and eliminate them from the diet of theirchild.



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Home TreatmentWhen there are behavioral problems with a child,there is often tension in the family environment asthe parents become stressed and irritated by thechild’s behavior. This is one area where the applica-tion of a light form of the shonishin treatment ashome treatment can be very helpful. Not only doesthe child benefit directly fromhaving the treatmentapplied regularly rather than just when they cometo your clinic, but it helps the parents. In some casesit not only helps the parents feel less frustrated asthey start to feel they can do something to help, butthe light, friendly actions of the treatment coupledwith all the soft tactile stimulation help restore aless stressed relationship and bond between parentand child.

For the child with sleep problems I recommendmaking sure that the treatment is done beforegoing to bed at night. For the child with behavioralmanifestations of the kanmushisho—angry, irrita-ble, cries, shouts a lot—have the parent use onlystroking down the arms, legs, and back. My collea-gue Diana Pinheiro from Lisbon describes herexperience that this stroking applied with a spooncan be very helpful to calm the patient down. Shefeels that as the spoonwarms up with the stroking,the child becomes “cooler” (Pinheiro, personalcommunication). Here you can try having the par-ent apply the stroking slowly with very slightlymore pressure to encourage these kinds of changes.


The following case is from my colleague, Zoe Bren-ner of Bethesda, Maryland in the United States.

Case 2Colin, Boy Age 6Weeks

Main complaints: Colin was 6 weeks old when I firstsaw him. He was screaming constantly. The problemwas diagnosed as severe colic. His mother reportedthat he screamed pretty much around the clock. Hewas obviously terribly distressed and so were his par-ents. He was breast-fed and his mother was on a veryrestricted diet. They had tried hypoallergenic formulaand small doses of anti-acid medication, but this didnot help and he was still quite distressed.

Treatment: A very general and quick treatment usingsmall strokes with an enshin was applied. Treatmentwas applied by stroking down his legs on the outside,up the inside, down his arms front and back; clock-wise around his belly and down the center area of thechest. When the stroking was applied down his back,he calmed down noticeably. Treatment was finishedvery quickly.

After discussing with his mother his condition andscheduling, he stopped crying. It was decided to havehim come back three times that week for these quicktreatments.


His mother reported that he had been quieter andbetter for about 4 hours after the first treatment.

Treatment: Given his response the day before, treat-ment was started on his back. As the enshin waslightly stroked down his back he immediately stoppedcrying. Stroking was then applied down his arms,clockwise on his belly, down the lateral aspects of hislegs and up the medial aspect of his legs. After this hehad calmed down enough for his pulses to be read.His lung and spleen pulses were the weakest (lungvacuity pattern), so very light stroking was appliedover LU-9 on the left wrist and the pulse was checkedagain. There was enough change. His color improvedfrom a darker reddish hue to a lighter shade.


When Colin came into the outer part of the office hecalmed down. His mother said that he had been gen-erally much better. It was easier to console him buthe still had some difficulties, especially at night.

Treatment: The treatment from the second visit wasrepeated with the addition of very light stroking ofSP-3.


His mother reported that he had generally beenmuch happier and was showing signs of being more“normal,” smiling and being playful rather than con-stantly in distress.

Treatment: Same as the previous visit with the addi-tion of draining the stomach channel: stroking a little



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more heavily against the flow of the stomach channelover right ST-40.


His mother reported that she was so relieved that hewas showing such signs of improvement. He hadeven stopped fussing when they were on the way tomy office. Before, he would scream pretty mucharound the clock and was now having good periods ofrelief each day.

Treatment: Same treatment as on the last visit.

Treatment continued like this, with him coming in onaverage twice a week for a while. He had some roughdays but generally better periods. When the familywent away for 10 days, he had more symptoms againafter 6 days, so it seemed he was still reactive. Hismother was taught to apply some gentle strokingwhile they were away but that had not worked much.So the treatment schedule of three treatments thatfirst week was tried. The next week two treatmentswere given. Gradually, treatments were worked downto one treatment a week while maintaining theimprovements.

Colin’s mother was quite worried that when theywent home to Europe for the summer he mightregress. But he was doing well when they left andwhile away he had done extremely well with almostno symptoms. He was 4.5 months old when they leftfor the summer and so his digestion was gettingstronger while he was away and he didn’t need treat-ment when they returned. We arranged that theywould call if further treatment was needed.

Case 3Peter, Boy Age 15Months

Main complaints: Very irritable, becoming angryeasily, crying and shouting a lot, sleep disturbance.He had always had loose stools. At age 3 months herequired hernia surgery, from which he recoveredwell, but an osteopath found a “cervical block” possi-bly related to head position during the surgery. It wassuggested that this may be related to his irritability.He had always had loose stools and, as a small baby,had a big problem with regurgitation. He had had a

few colds and after one of these his tonsils werefound to be affected and his doctor had talked aboutthe possibility of a tonsillectomy. He had just recov-ered from a cold and he had had a mild fever 2 daysbefore.

Diagnosis: Liver vacuity pattern (based on history).The parents were concerned as they had a long

drive back and forth to the clinic and as the roadswere very congested it might be difficult being ableto domany treatments.

Treatment: Tapping with herabari, GV-20, GV-22,GV-12, neck area, abdomen.

Strokingwith enshin down the back, arms, and legs.Using a teishin, left LR-8, KI-10, and right LU-9 were

supplemented.Press-spheres were left onGV-12 and bilateral BL-25.


He had slept better the first two nights, then his usualdisturbed sleep pattern returned. No change in day-time behavior. His stools were a little better formedover the last few days.

Treatment: Tapping with herabari, GV-20, GV-22,GV-12, CV-12, LI-4, ST-36.

Stroking with enshin, down the back, abdomen,neck, arms, and legs.

Using a teishin, left LR-8, KI-10, and right SP-9 weresupplemented, left TB-5 drained.

Press-spheres were left on GV-12, bilateral BL-25and behind shen men on the left ear.

Home treatment was taught to the parents: strok-ing down the arms, legs, back, and abdomen, withtapping around GV-12 and GV-3.


His stools were better formed over the week, but hisbehavior and sleep were a little worse. Home treat-ment went well.

Treatment: Needling with in and out insertion tobilateral LI-4.

Retained needling to bilateral GB-20 (about 2min-utes).

Tapping with herabari, GV-20, GV-12, back, arms,and neck region.

Stroking with enshin, down the back, abdomen,arms, and legs.



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Using a teishin, left LR-8, KI-10, and right SP-3 weresupplemented, left GB-37 drained.

Press-spheres were left on GV-12, right BL-18, leftBL-23.


His stools were generally better, but over the previousfew days had been loose and runny. Overall, his moodand behavior had been better these 2 weeks.

Treatment: Needling with in and out insertion tobilateral LI-4.

Retained needling to bilateral GB-20 (about 2min-utes).

Tapping with herabari, GV-20, GV-12, back, andarms.


Using a teishin, left LU-9 and SP-3 were supple-mented.

Press-spheres were left on bilateral BL-25.


His mood, behavior, and sleep were all much better,but he hadmore problems with diarrhea.

Treatment: Retained needling to bilateral GB-20(about 2minutes).

Tapping with herabari, GV-20, GV-12, GV-3, abdo-men, back, and LI-4.


Using a teishin, left LU-9, SP-3, and right LR-3 weresupplemented.

Press-spheres were left on CV-12 and bilateral BL-25.


Hismood, behavior, and sleep remainedmuch better.His bowels had been better and stools normal duringthe last 5 days. Overall, his condition was muchimproved.

Treatment: Retained needling to bilateral GB-20(about 2minutes).

Tapping with herabari, GV-20, GV-12, GV-3, abdo-men, back, and LI-4.

Stroking with enshin, down the back, abdomen,arms and legs.

Using a teishin, left LU-9, SP-3, and right LR-3 weresupplemented, right TB-5 was drained.

Press-spheres were left on CV-12 and GV-12.

The parents discussed how well he was doing butwhat a big burden it was to get to each treatment.They wanted to stop and to continue with simplehome treatments a few times a week. They would callfor a new appointment if his symptoms returned. Wescheduled a follow-up visit for 2 months later, whichthey cancelled because he was doing well, with sleepand behavior good and bowels normal.

Reflection: It is clear that starting to insert needleson the third visit was very helpful to improve hissymptoms. This is the usual strategy for a child of hisage. We try using only the stroking and tapping treat-ment approach and if that is not working we startdoing some inserted needling. I am unsure why thepattern changed from liver to lung. Perhaps the liverpattern was related to the hernia surgery and conse-quent symptoms of irritability, but his underlying con-stitutional tendency is shown in the digestive prob-lems, which are usually suggestive of the spleenpattern. In his case the spleen is part of the lung pat-tern. It is too bad that travel made repeated treat-ments more difficult for Peter. I think in his case itwould have been better to do a few infrequent butregularly scheduled follow-up visits for a while, tohelp counter underlying constitutional tendencies,but this was not possible.

Case 4Maria, Girl Age 1 Year

Main complaint: Restless sleep.She did not have asignificant problem with this, but given her medicalhistory, her parents were a little worried and veryattentive. A few days after birth, she required surgeryto repair her duodenum and spent 3 months in hospi-tal, after which she required a lot of antibiotics. Atfirst she had a restricted diet, but now was able to eateverything. She was generally very energetic andactive during the day, with a tendency to being a littlerestless. She had a tendency to catch cold easily andget mucus in the lungs. She had had an ear infection10 days before, with fever, and required antibiotics.She had recovered from this. Everything else wasgood. She had a hard fibrous scar across the epigas-



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trium (spleen reflex area). The lung reflex area alsoshowed a reaction and her right deep weak pulsesseemedweaker than the left.

Diagnosis: Lung vacuity pattern possibly with liverrepletion.

Treatment: Using a teishin, a very light strokingaction was applied down the arms (large intestinechannel), legs (stomach and bladder channels), back(bladder channel), neck (bladder, gallbladder chan-nels), and around the abdomen.

Using the teishin, right LU-9, SP-5 were supplemen-ted, left LR-3 drained.

Tapping was applied using a herabari in the regionover GV-12.



She had been more restless, especially at night, for acouple of days following the treatment. She had had afever without symptoms over the previous few days,which had stopped the day before.

Treatment: I decided that it was probably better tofollow the medical history to select the pattern ratherthan try to follow the pulse findings. I changed thediagnosis to spleen vacuity pattern. I also decidedthat an even lighter treatment would be better, sodid not leave a press-sphere or apply any tapping.

Using a teishin, a very light stroking action wasapplied down the arms (large intestine channel), legs(stomach and bladder channels), back (bladder chan-nel), neck (bladder, gallbladder channels) and aroundthe abdomen.

Using the teishin, right SP-3, PC-7, left LR-3, GV-12,and GV-20 were supplemented.


She had been doing better, especially at night, follow-ing the last treatment. However, she had had irregu-larity of stools with alternating diarrhea and constipa-tion, and given her history, was seeing the specialistwithin 2 weeks.

Treatment: Using a teishin, a very light strokingaction was applied down the arms (large intestinechannel), legs (stomach and bladder channels), back(bladder channel), neck (bladder, gallbladder chan-nels) and around the abdomen.

Using the teishin, right SP-3, PC-7, and left GB-37were supplemented.


She had beenmuch better over the 2 weeks. Restless-ness and especially sleep were better, as were thebowels. She saw the specialist who felt there was noneed for concern and thought she was progressingvery well.


Using the teishin, right SP-3 and PC-7 were supple-mented and left LR-3 drained.


She was very well, her sleep was good. A vaccinationmade her a little restless for a week with a mild skinrash, but she recovered from this.


Using the teishin, right SP-3, PC-7, GB-37, GV-12,GV-20, and GV-23 were supplemented and left BL-58drained.


She was good for the first 2 weeks but over the lastcouple of weeks her sleep had started to become dis-turbed again; she was especially having difficulty fall-ing asleep. She had also had a reduced appetite, andduring this period it was found that she had a strongreaction to sugar, which thus needed to be eliminatedfrom her diet.

Treatment: Using a teishin, a very light strokingaction was applied down the arms (large intestinechannel), legs (stomach and bladder channels), back(bladder channel), neck (bladder, gallbladder chan-nels), and around the abdomen, chest, and down yintang area.

Using the teishin, right SP-3 and PC-7 were supple-mented, and left LR-3, BL-58 drained.



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Following this she was much better and remainedso until after the summer holidays.

Seventh visit—3months later

She had been much better until she returned from avacation abroad (far away with a several-hour jet lag).This had triggered sleep disturbance for a while. Thenduring the last weekend everything at home was verybusy and hectic, leaving her agitated, with difficultyfalling asleep, crying, restlessness, and with poorappetite.

Treatment: Using a teishin, a very light strokingaction was applied down the arms (large intestinechannel), legs (stomach and bladder channels), back(bladder channel), neck (bladder, gallbladder chan-nels), and around the abdomen, chest, and on the dumaiGV-24 to GV-20.

Using the teishin, right SP-3 and PC-7 were supple-mented and left LR-3, right ST-40 drained.

Following this she was much better again and has nothad to return for treatment since.

Reflection: On the first visit I tried to use my diagnos-tic skills to select the pattern for treatment (pulse,abdominal findings, tends to catch cold) and chosethe wrong pattern (lung instead of spleen). It wasclear afterward that the spleen pattern was the cor-rect one to treat; many later symptoms are typicalspleen symptoms (alternating constipation and diar-rhea, difficulty falling asleep, poor appetite). Hermedical history also clearly indicated a constitutionalpattern of spleen involvement. Also, I probably over-treated her on the first visit. The agitation and medi-cal history could tend to create a greater sensitivityand thus a lower dose was needed. Usually a little tap-ping or the press-sphere is not a problem, but in hercase it turned out better to avoid these methods. Asdiscussed above, in treatment of older children withkanmushisho where the manifestations are of hyper-activity, I think tapping can be too stimulating andstroking to move qi downward is a better strategy;perhaps this was the case here as well.

Stress

The following case is of a 10-year-old boy who wasvery stressed. The treatment is similar to that ofkanmushisho.

Case 1Paul, Boy Age 10 Years

Main complaints: Frequent nasal sniffing and twitch-ing, reported by him to be experienced as nasal itchi-ness. The problem had been continuous over the lastseveral months.

History: He saw the doctor, who tested for and ruledout allergies. His mother reported that Paul was verystressed out due to the fact that his parents wereseparated, with ongoing conflicts and stresses. Hisstudies at school were suffering. He was also havingbad dreams. He tended to have somewhat sensitiveskin, showing rashes relatively easily. The lung,spleen, and liver abdominal reflex showed reactions.The lung and spleen pulses were weak and the liverpulse hard.

Diagnosis: Lung vacuity with liver repletion pattern.

Treatment: Tapping was applied using a herabari toLI-4, GV-20, GV-12, occipital region, the back, neck,shoulders, abdomen, arms, and legs.

Using a teishin, left LU-9 and SP-3 were supplemen-ted, right LR-3, ST-40, and left BL-58 were drained.

A press-sphere was placed on GV-12.A 0.6-mm (Pyonex) press-tack needle was left in

the left ear at shen men with instructions to remove itin about 36 hours.


The symptoms stopped for the first 5 days and thenstarted recurring, but less severely.

Treatment: Tapping was applied using a herabari toLI-4, GV-20, GV-12, occipital region, the back, neck,shoulders, abdomen, chest, arms, and legs.

Using a teishin, left LU-9 and SP-3 were supplemen-ted, right LR-3 and left BL-58 were drained.




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A 0.6-mm (Pyonex) press-tack needle was left inthe left ear at shen men with instructions to remove itin about 36 hours.

Since his father brought him on the second visit, Idid not teach the home treatment as I figured hewould not be the one to administer it.


There are still some signs of nasal sniffing and twitch-ing, but significantly less frequently and with lessseverity.


Using a teishin, left LU-9 and SP-3 were supplement-ed, right LR-3, ST-40, and left TB-5 were drained, BL-13and BL-20were supplemented.


the left ear at shen men with instructions to remove itwithin about 36 hours.

I taught the mother to do light tapping at LI-4,GV-12, GV-20, the back, arms, and legs daily.


He was much improved, with hardly any symptomsover the 2 weeks. Home treatment went well.


Using a teishin, left LU-9 and SP-3 were supplement-ed, right LR-3 and ST-40 were drained, BL-13 and BL-20were supplemented.


the left ear at shen men with instructions to remove itwithin about 36 hours.

I scheduled to see Paul again in 3 weeks. His mothercancelled close to the time of the appointment. Paulhad had no symptoms, his work at school was muchbetter, and he seemed calmer. She did not reschedulebecause of financial reasons, but insisted that shewould call for an appointment should Paul need it.She was doing the home treatment several times perweek.

Further Emotional/BehavioralProblems

Yoneyama and Mori (1964) discuss treatment ofnight terrors and a condition called “allotriophagy.”

Night TerrorsThis is generally seen in children from age 2 yearsupward towhen they start school, and is seen espe-cially in children who show the kanmushisho pat-tern. The child will suddenly show very strangebehavior at night (without waking up, and with norecollection of it). This behavior can last up to15minutes, and can be seen several nights in a row.

To treat, apply the same shonishin core non-pat-tern-based root treatment as for kanmushisho.However, since the child is generally a little older, itis usually good to add thin, shallowly inserted nee-dles to points such as BL-10, GB-20, BL-11. If thesymptoms are stronger (and more stubborn), addpoints such as LI-2, LU-11, SP-1 as well. (A less pain-ful method of stimulating points such as SP-1 orLU-11 is to apply pressure to themwith a teishin or,if your technique is good, to apply low-dose blood-letting to them.)

AllotriophagyThis is a disorder characterized by pathologicalinterest in and efforts to swallow anything thatcomes to hand, and is therefore seen as being in thecategory of being an emotionally unstable condi-tion.

The shonishin core non-pattern-based roottreatment as described under kanmushisho is gen-erally sufficient for this disorder, especially foracute or recent episodes. However, if this problemis caused by extreme hunger resulting from thepresence of some intestinal parasite such as aworm,it is necessary to eliminate theworm aswell.



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22 Urinary Disturbances

This chapter not only includes the more commonproblem of bedwetting but also a case study of theless common problem of the child who loses con-trol during the day aswell.

Case 1Simon, Boy Age 10 Years

Main complaints: Bedwetting, which always occurredafter 5a.m. at a frequency of about three times aweek. The problem had been on and off for years, withnomore than 6months’ remission at a time.

History and other problems: Simon was asthmatic.Since the age of 4 years had taken medication for theasthma. He was using the weakest kind of steroidinhaler twice every day. He had never been hospita-lized for the asthma. Since being an infant he had hadsevere problems with eczema. At age 5 years hereceived acupuncture for about 18 months, whichhelped the eczema considerably, but the problempersisted, especially on the hands. He had clear foodallergies causing the asthma and/or the eczema toflare up.For example, he would have very severe asth-ma attacks after eating foods with certain food dyesin them. He avoided cow’s milk products, and was ingeneral very careful about what he ate. He had prob-lems with seasonal allergies, such as hay fever. Theprevious year, for example, it had been particularlybad, with severe irritation of the nose and ala nasi.These allergies could irritate the asthma. As a smallchild he was never able to sweat. Then by about age5 years was able to sweat a little in a few places suchas the head and face. But he still did not sweat nor-mally like other children. Other systems were good.Appetite, sleep, bowel movements, and energy weregenerally good. He was on his school soccer team. Hehad mood swings. He always had cold feet. Occasion-ally he suffered mild stomach pain. He occasionallyhad frontal headaches.

Assessment: Facial complexion was off-white, withdark sunken eyes (kidney sign). The luster of his skin

especially around his eyes was not so good. His posturewas not very good; he had sloping shoulders (lungsign). Over the whole abdomen the skin was rough.There was some tightness in the subcostal region. Theskin on the upper back was soft and empty. The mus-cles on the lower back were a little tight. The lung,spleen, liver, and kidney pulseswere all weak.

Diagnosis: In this case the signs and symptoms sup-ported a number of possibilities. It was decided tostart with a lung vacuity pattern and see how heresponded to this treatment.

Treatment: A silver needle was used to supplementleft LU-9, SP-3, and right LR-3, KI-3, drain left BL-58,and supplement bilateral TB-4.1

Sanshin2/contact needling was applied over thearea of ST-123 bilaterally.

Bilateral BL-13 and BL-20 were supplemented.Tapping with a herabari over the back of the head

and neck.Chinetsukyu/warm moxa was applied around GV-14,

BL-13, GV-3, and BL-25.Press-spheres were applied to GV-4 and CV-4.



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164

1 On older children we try, if possible, to use techniques thatwe might use on adults, but modified slightly to make themeasier to accept by children. On smaller children it is normalto use the teishin for the pattern-based root treatment. How-ever, on most adults the use of a silver needle is more normalin Toyohari-style Meridian Therapy. The use of the silver nee-dle instead of the teishin increases the dose of treatment. Ihave not described this needling technique in the book as it isnot possible to learn it without taking at least a 1-year specia-lized training program and it is not taught outside that pro-gram.

2 Sanshin, contact needling, is something like the treatmentmethods using tapping and stroking, but instead of using spe-cial tools to apply the method, one uses a regular needle. It isheld at the skin surface for short periods or moved quicklyover the skin surface. It is a technique used by many tradi-tional acupuncturists in Japan on adults. Since the patientwas 10 years old, it was selected as suitable for him. If he hadbeen younger, supplementation with a teishin could havebeen used instead.

3 Treatment of this area is a specialized Toyohari method called“naso” (see Birch and Ida 2001; Yanagishita 2001a).


The skin seemed a little better, the healing time a lit-tle shorter. With regard to the asthma, he had a moreproductive cough. He had had one incidence of bed-wetting. He also had an increased appetite this week,but was very tired on the day of the treatment. It wasnow much clearer that the primary pattern to focuson was a kidney vacuity pattern. The third deep left(kidney) and first deep right (lung) pulses were theweakest pulses, and there was a little more softnesson the abdomen in the lower portions below thenavel.

Treatment: A silver needle was used to supplementCV-12, left KI-7, and LU-5, drain right SP-5, TB-5, andleft BL-58.

The sanshin/contact needle technique was appliedover the inguinal/lateral abdomen region, ST-12region, and to left BL-10.

Bilateral BL-13, BL-23, and around GV-6 were sup-plemented.

Chinetsukyu4/warm moxa was applied to GV-14,GV-3, and bilateral BL-23.

Press-spheres were applied to bilateral BL-23 andbilateral asthma shu points.


The skin had improved further. His emotional statewas more stable. There were some asthma symp-toms, but milder than usual. He had had three epi-sodes of bedwetting. His mother speculated thatbecause he had more energy than usual he was muchmore active; consequently he was exhausted at theend of the day, sleeping more deeply than usual, andthis could have contributed to the increase in bedwet-ting.


The sanshin/contact needle technique was appliedover the inguinal/lateral abdomen region, ST-12region, and to left BL-10.

Bilateral BL-13, BL-23, and around GV-6, GV-8 weresupplemented.

Chinetsukyu/warm moxa was applied to GV-14,GV-3, and bilateral BL-23.

Press-spheres were applied to bilateral BL-23, asth-ma shu points, and CV-4.

Yin tangwas supplemented using the silver needle.


The asthma symptoms were better. There had beenno incidents of bedwetting. He had more energy, butwith more balanced behavior, and so was not asexhausted at night. His appetite was good.

Treatment: A silver needle was used to supplementCV-12, left KI-7, and LU-5, drain right SP-5, TB-5, andST-40.

The sanshin/contact needle technique was appliedover the inguinal/lateral abdomen region and ST-12region.



Press-spheres were applied to bilateral BL-23 andbilateral asthma shu points and CV-4.


He was in a soccer game, which his team won, and hewas man of the match. In celebration he ate somecandy with the wrong food dye in it and suffered avery severe asthma attack, which was not responsiveto the normal inhaler treatment. This also triggeredincidents of bedwetting. Prior to this he was doingvery well. Since the start of the attack the bedwettinghad slowly subsided, and he was almost back to hisusual state. His energy levels were slightly lower, hisskin better, and he was also beginning to show someof his seasonal allergies (hay fever).

Treatment: A silver needle was used to supplementCV-12, left KI-7, and LU-5, drain right SP-5, LI-6, andleft GB-37.

The sanshin/contact needle technique was appliedover the ST-12 region.

Tapping with a herabariwas applied over the upperback.




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22 Urinary Disturbances 165

4 This is another technique used within the Toyohari treatmentapproach. While the chinetsukyu method where heat isclearly felt is usedmore generally in Japan, its usewith almostno sensations of heat is more specific to the Toyohari systemas a general form of supplementation (see Birch and Ida 1998,pp. 133–137).


Press-spheres were applied to bilateral BL-23 andCV-4.

Intra-dermal needles were placed to the asthmashu points (with instructions to remove them after2 days and replace themwith press-spheres).


He was doing much better, also mentally, and hisenergy levels were good. He was a little wheezy, butgenerally his asthma symptoms seemed better, andhe had forgotten to take his inhaler medicine that day(something he did not generally do).


The sanshin/contact needle technique was appliedover upper back and ST-12 region.






He was doing very well. He had forgotten to take hisinhaler medicine several times with no symptoms. Hewas a little wheezy at the time of treatment. He hadhad one small incident of bedwetting, during whichhe woke up.

Treatment: A silver needle was used to supplementCV-12, left KI-7, and LU-8, drain right SP-5, TB-5, andST-40.

The sanshin/contact needle technique was appliedover upper back and ST-12 region.

Bilateral BL-13, BL-23 were supplemented.Chinetsukyu/warm moxa was applied to GV-14,

GV-3, and bilateral BL-23.Press-spheres were applied to bilateral BL-23 and

CV-6.Intra-dermal needles were placed to the asthma

shu points (with instructions to remove them after2 days and replace themwith press-spheres).

Left KI-7 was supplemented again.


He had had a very good week with one very short-lived asthma attack. He had again forgotten to takehis inhaler medicine several times this week. Hismother noticed that his gait was better and his torsolooser; he seemed to be walking more evenly. He alsoreported that when he played soccer, or with hisfriends, he was now sweating for the first time inareas he had never been able to sweat before.

Treatment: A silver needle was used to supplementCV-12, left KI-7, and LU-5, drain right SP-3, TB-5, leftBL-58, and GB-37.


Using SSP surface electrodes, ion-pumping cordswere briefly applied bilaterally to PC-6 (black) and SP-4(red).5




Intra-dermal needles were placed to the asthmashu points (with instructions to remove them after 2days and replace themwith press-spheres).

Ninth visit—1 week later

His mother noticed that he was having virtually noseasonal or hay fever-type symptoms, and that whilehe had very mild asthma symptoms in the morningon waking, they were much better then before forthis time of year (mid-May). His facial complexion wasnow much better too. He had clear luster around theeyes. The dark sunken appearance of his eyes hadbeen replaced by a vaguely dark ring around the eyes.

Treatment: Using SSP surface electrodes, ion-pump-ing cords were briefly applied right PC-6 (black)–leftSP-4 (red), with right KI-6 (black)–left LU-7 red.

A silver needle was used to supplement CV-12, leftKI-7, and LU-8, drain right SP-3, TB-5, left BL-58, andGB-37.




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5 For use of the “ion-pumping cords” see Manaka, Itaya, andBirch (1995). The IP cords are wires with a diode in each so asto create a polarity effect within thewire.

Stroking down the back was applied with an enshin.Bilateral BL-13, BL-23 were supplemented.Press-spheres were applied to bilateral BL-23 and



Left KI-7 was supplemented again.

Tenth visit—2 weeks later

He had had a very good week with no asthma symp-toms at all. He was using the inhaler at less than 50%of the normal dose. He had no seasonal allergy symp-toms, which had not occurred before at this time ofyear.


A silver needle was used to supplement left KI-7and LU-8, drain right SP-3, and left BL-58, SI-7.


Light stroking was applied down the back with anenshin.

Bilateral BL-13, BL-23 were supplemented.Press-spheres were applied to bilateral BL-23 and



CV-12 was supplemented again.

Eleventh visit—2 weeks later

He had had almost no asthma symptoms, only verymild wheezing on waking in the morning. He was tak-ing the inhaler medicine about three or four timesper week rather than twice a day. He had virtually noallergy symptoms. He had not had a problem withbedwetting for a number of weeks now. He alsoreported that the extent of areas that were nowsweating normally on active exertion had increasedagain.


A silver needle was used to supplement CV-12, leftKI-7, LU-8, and right SP-3, drain right TB-5, ST-40, andleft BL-58.


Light stroking was applied down the back with anenshin.




The patient discontinued treatment at this time sincethe family was moving out of town and it would notbe possible to continue treatment.

Reflection: Although this case is listed under “bed-wetting,” the patient clearly had a more complex con-dition. The history of allergic constitution with asth-ma, food allergy components, and eczemamakes thisa complicated case. Most likely he started with a lungvacuity pattern constitution, but the protracted useof steroids for his lung problems gradually weakenedthe kidney, so that he showed a kidney vacuity pat-tern, which eventually gave rise to the bedwettingsymptoms. As a 10-year-old boy it was possible toapply more treatment than on a younger child andalso to treat him in a similar manner to an adult (theuse of a silver needle rather than a teishin). The com-plexity of his condition and history of eczema mademe hesitate to teach home treatment to the parents.I decided to wait and see how he was doing beforetrying to figure out how to do this. Fortunately, hestarted showing signs of improvement quite quickly,which made it unnecessary to add home treatmentoptions. Had there been slower or little response Iwould have started adding home treatment into themix, and, if still not enough, begun thinking aboutwhere to apply a stronger more stimulating treat-ment like okyu, direct moxa. Fortunately this was notnecessary. He did very well with the treatments; heand his parents were very satisfied. I heard from themother about 3 months after discontinuing treat-ment. His skin, lungs, and bedwetting problemsremain improved and they were negotiating withtheir new general practitioner about only using theasthma medicine as needed rather than automati-cally every day.



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General Approach for Patients withUrinary Problems

Night urination or bedwetting can be a difficultcondition to treat depending on the age, severity,and causes. Most cases of children with this prob-lem improve with treatment, but even so, it usuallytakes time. Most children develop nocturnal blad-der control around the age of 3 (between 2 and 5years old). The problem is seen when around theage of 3 the usual mastery of bladder control atnight either does not happen or at some point laterthe control is disturbed. Of these two types around90% of cases are functional. In the first of the func-tional types it depends on a number of factors as tohow well the child can respond to the treatment.Among these are severity and frequency of thesymptom (one to two times per week or everynight; once a night or several times a night); age ofthe child, psychological state of the child; and over-all condition of the child. Very sensitive childrencan be more predisposed to this problem and thestrength of recovery is affected by the condition ofthe child (weaker constitution,multiple symptoms)and their psychological response—many childrenlose their confidence with this problem, which caninhibit recovery. In the second functional type theproblem starts some time after the child has hadnormal bladder control at night. The most commoncause is a psychological or emotional disturbance,moving house, parents split up, and so on. Othercauses can include sequelae of abdominal surgeries—for example, an appendectomy on a small childcan leave a scar that gradually becomes tighter asthe child ages, triggering disturbances in normalsensation in the lower abdomen.

A small number of childrenwith night urinationproblems have more organic or developmentalproblems. Childrenwith abnormalmental develop-ment can be slow to develop night bladder control.Children with neurological damage or abnormaldevelopment such as cerebral palsy, sequelae ofspina bifida, and so on can have problems withbladder control. Children with abnormal urinarypathways or reproductive organ problems can haveproblems with night urination. These cases aremore difficult to treat. The symptom is continu-ously present as the child grows. Generally, boysseem to respond to treatment quicker than girls,with better recovery rates.

You, the child, and especially the parents of thechild, need to be patient. Treatment takes time.Some cases with lighter problems change veryquickly with treatment, many take several monthsof treatment, and some more than that. For themore difficult cases you need to work out a plan ofactionwith the parents.

Most Likely Pattern-based RootDiagnosis

Themost likely patterns are kidney vacuity pattern,liver vacuity pattern, or lung vacuity pattern. MyMeridian Therapy teachers suggest that it is pre-dominantly a problem of kidney vacuity pattern.Shimizu (1975) suggests that it is most commonly aproblem of the liver. You need to check to seewhichpattern is present. Most commonly you will betreating an older child (age 5 to 10) for this problemand do not usually have difficulty obtaining infor-mation from the pulses and abdomen for diagnosis.As well as looking at the pulse and abdominal find-ings, it is important to integrate other findings intothe choice of pattern. For example, the fact that thechild has some abnormality of the urinary path-ways or abnormality of mental development willlead you toward selecting the kidney vacuity pat-tern, regardless of what the pulse and abdominalfindings present. The child who has a problemwithnight urination because of emotional reactions tosome events or changes in their life can be seen asbeing lung or liver vacuity type. The child whoplays so hard during the day that he or she is sotired at night that they cannot wake up in responseto the signals from the bladder may show signs ofliver repletion, in which case look to see if the lungvacuity pattern shows.

The symptom of loss of control over body fluidsor leaking body fluids can be seen in relation to thekidneys, which in the Nan Jing (Classic of Difficul-ties) are said to be related to all body fluids. Thus,the selection of the water points for treatment canbe helpful. Additionally, Nan Jing Chapter 68 sug-gests that the he-sea points are good for counter-flow qi problems such as diarrhea. This has ledmany to suggest that the improper movement ofbody fluids as manifest in night urination can beseen in parallel to that of diarrhea. Thus, the he-seapoints, which are also water points, can be used fortreatment. So, in the kidney vacuity pattern patient,



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use KI-10 and LU-5 instead of the usual KI-7 andLU-8. In the liver vacuity pattern patient we use thehe-sea points anyway (LR-8, KI-10). For the lungvacuity patient LU-5 and SP-9 can be used insteadof the usual LU-9 and SP-3. Okabe, in an article pub-lished in 1940 states that he could cure 30 out of 34cases of night urination with the needling of LU-5(Okabe 1940). It seems that LU-5 is an especiallyeffective acupoint for this problem. This reinforcesthe use of LU-5 for the treatment of the lung vacuitypattern and for the treatment of the kidney vacuitypattern.

Typical Non-pattern-based RootTreatment

Apply the stroking with tapping or tapping onlyover the whole body, giving special focus to addingmore treatment over the lower abdominal region.Also make sure to include treatment over the headregion (see Fig.22.1).

Additional tapping can be applied over the regionaround GV-12 and especially GV-3 to GV-4. If thechild seems very tense or stressed and the occipitalregion is stiff, apply extra tapping over this region.

For the more recently developed problems orproblems due more to psychological or emotionalreactions, the core non-pattern-based root treat-ment can be enough, with repeated treatments toproduce satisfactory results on pre-school children(under age 6). But on older children or more com-plex cases, inserted needling is usually necessary.


NeedlingNeedling is commonly used on children with nighturination problems. Yoneyama andMori (1964) statethat the best results are obtained with deeper inser-tion to the acupoint GV-1, but that this is difficult todo so they suggest alternative points such as CV-3,ST-28 on the abdomen, and BL-25, BL-32 on theback.

Shimizu (1975) has a more detailed discussionof treatment with needling for this problem:

For younger children (below age 6) after apply-ing the core non-pattern-based root treatment onecan insert needles to acupoints such as CV-3, BL-32,LR-8 or LR-1, GV-20, and GV-12.

For the school-age child (age 6 and older) insertneedles to the following acupoints: CV-12, KI-10,CV-3, KI-12, josen (extra point between L5 and S1),6

BL-32, GV-2, BL-23, BL-18, GV-20, GV-12, LU-7, LR-8,or LR-1.

Hyodo (1986) recommends the following acu-points to be needled or have press-spheres placedon them: GV-1, BL-25, BL-32, CV-3.

Selection of which acupoints to needle is basedas usual on palpation; select those that show more



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Fig.22.1 Stroking:● Down the arms (yang channels)● Down the legs (stomach and bladder channels)● Down the back (bladder channels)● Down the abdomen (stomach channel)● Across the shouldersTapping:● Around GV-20: 10 times● Occipital area: 10 times● Around GV-12: 10 to 20 times● Around GV-3: 10 to 20 times● Lower abdomen: 20 to 30 times

6 Josen is better treated with an intra-dermal needle or press-tack needle rather than by simple needling.

reaction on palpation (a knot, stiffness, discomfort,pressure pain).

Okyu—Direct MoxaSimilar towhat we find with the recommendationsfor needling, we see a number of different recom-mendations by different authors over how andwhere to apply okyu for bedwetting:

Yoneyama and Mori (1964) suggest that okyucan be applied instead of needling to the samepoints that can be needled: CV-3, ST-28, BL-25,BL-32.

Shimizu (1975) recommends that on school-agechildren (age 6 and older), moxa should be appliedto some of the following acupoints in addition tothe needling of the other points: GV-20, GV-12, CV-3, KI-12, BL-32, LR-1, using five half rice grain coneson each. Do not apply moxa to the same points thathave been needled; one has to select which tech-nique to use on those points if they are reactive.

Irie (1980) recommends the following points fortreatment with moxa: CV-3, GV-12, and an extrapoint, the “moving LR-1 point”—palpate betweenLR-1 and LR-2, treat the more reactive point (one tofivemoxa each).

Manaka (Manaka, Itaya, and Birch 1995) recom-mends using moxa on the following acupoints afterapplying the core non-pattern-based root: GV-12,BL-32, CV-4, KI-7.

The extra point “moving LR-1” is treated withmoxa if a reaction is found. Generally this will be abetter target than the LR-1 mentioned by Shimizu.This is a difficult area to needle, but okyu here iseasier to apply provided you do not let the moxabecome too hot.

Sometimes it is helpful to apply heat over thelower abdomen and/or lower back. In Asia, moxapoles are recommended for this. It depends on yourpreferences and which tools are available to you asto what you recommend the parent apply at home.The moxa pole can become very hot quite quickly,so you need to explain carefully how to use it sothat no one is accidentally burned by it. It is alsopossible to use lit incense sticks instead of themoxapole to warm the areas around the selected acu-points. Thicker incense sticks are better for this.Typical targets for such treatment include any coolregions on the lower abdomen, lower back, and thereactive points on the lower abdomen or lowerback.

Integrating the Pattern-based and CoreNon-pattern-based Root Treatmentswith Needling andMoxa SymptomaticTreatments

I would like to suggest a basic approach that canhelp process and integrate the information fromthe various authors whose works I have cited. Thiswill give you a more integrated and flexibleapproach. The different authors cited above havehelped us understand which acupoints typicallyshow reactions when the child has a problemwith night urination, and thus can be treated forthe problem. We need a strategic approach forchoosing among these acupoints and decidingwhat techniques to apply to them, and a way ofdoing this systematically. Some of the acupointsthat show reaction are typically used in the pat-tern-based root treatment (e.g., LR-8, KI-10, KI-7)and thus can be given double duty. Some of thepoints are not feasible for needling such as GV-1and LR-1. Some of the points may be good toretain needles or press-spheres to give a sustainedtreatment effect. For example, if josen shows areaction this is most commonly treated with anintra-dermal needle (Akabane 1986) or a press-tack needle.

The following steps show how to construct abasic treatment approach. On the first visit(s) youwill do less, and then gradually increase the dose asneeded on future visits:1. On all children up to the age of 10, apply the

core non-pattern-based root treatment. Whenfeasible, teach the parents to do some simpleform of this regularly at home.

2. Apply the basic pattern-based treatment, usu-ally the kidney, liver, or lung pattern. If you areable to obtain enough pulse information todetermine additional steps such as treating asecondary pattern (liver secondary to the pri-mary lung pattern, spleen secondary to the pri-mary kidney pattern, etc.) and relevant yangchannels, do so. On very young children use thenoninserted needling methods to the relevanttreatment points. On older children, once theyare used to you applying needling techniques,apply inserted needling techniques to the rele-vant points, leaving the needles for a few min-utes while you apply the symptomatic needling



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of relevant points before turning the child overtowork on the back.7

3. Palpate all the points accessible that are men-tioned as being good for treatment by needles ormoxa (excluding the pattern-based root treat-ment points), while the patient is lying face up.Based on what you find, decide whether to onlyuse needling or to apply needling to some pointsandmoxa to others.

4. Insert needles to a few reactive points that arenot used in the pattern-based root treatment orindicated as to be treated with moxa. If youdecide to apply moxa to some points, do thisnowon the selected acupoints.

5. Have the patient turn over onto their abdomenand then either needle or needle andmoxa reac-tive points on the posterior half of the body asper those listed above by the different authors.

6. Additional measures can be used such as the useof press-spheres, press-tack needles, intra-der-mal needles, and occasionally cupping or blood-letting according to need.

Press-spheres (Ryu), Press-tack Needles (Empishin),and Intra-dermal Needles (Hinaishin )It is often very helpful to leave something like thepress-spheres, press-tack needles, or intra-dermalneedles to extend the treatment effects betweenvisits. You have to judge by age, dose, and respon-siveness of the child which are better to use forwhich child on which acupoints, and for how longto leave the items you have placed on the acu-points.

Usually, we apply these treatment techniques tothe reactive points on the abdomen or back thatremain reactive after treatment. We do not applyany of these methods to points where moxa hasbeen burned, but it is all right to apply them over apoint that was needled earlier in the treatment.Common points to palpate and leave the press-spheres, press-tack needles, or intra-dermal needlesare: CV-3, CV-4, KI-11, KI-12, ST-28, BL-23, BL-32,BL-25, GV-2, GV-3. But if other very reactive pointsin these areas are found, they can be treated instead.

If the child is anxious, it can be helpful to treatGV-12 and the point shen men in the ear or thepoint on the back of the ear directly behind shenmen.

Example

Whole Treatment of an 8-year-old BoyFirst visit:Stroking applied down the arms, legs, back andabdomen.Using a teishin, supplementation was applied to leftKI-10, LU-5 with draining to right SP-9.Tapping applied over the lower abdomen, GV-12,occipital, GV-3, and lumbar-sacral regions.Press-spheres placed at GV-12, BL-25 (most stiffpoints found).

Later visit—for example, fifth visit:There has been some improvement in the symptoms,but not enough. The parents are applying a simplestroking and tapping core non-pattern-based roottreatment at home regularly.Stroking applied down the arms, legs, back, andabdomen.Insert thin needles carefully to left KI-10, LU-5 for thepattern-based root treatment.Insert needles for a couple of minutes to CV-3, ST-28.Insert needles for a couple of minutes to BL-32, BL-23.Moxa lightly to BL-25.Press-sphere to GV-12.Press-tack needles to BL-23.

Cupping, BloodlettingCupping and/or bloodletting can be applied for thiscondition. The typical bloodletting treatment in-volves bleeding of vascular spiders on the lumbar-sacral region, if they are found. This only makessense if the vascular spiders are clearly of the morepathological variety—darker, thicker. Carefully stabthe vascular spiders (see Chapter 15, p.86f for a dis-cussion of this) and then squeeze out a few drops ofblood. It is important to pay attention to the dose oftreatment when applying this technique.

Meguro (1991, pp.170–171) mentions the useof a more extensive cupping treatment for nighturination. It is useful to remember that Meguro is acupping specialist, meaning that his treatmentexclusively involves the use of cupping for allpatients. As acupuncturists, we can use this ap-proach for some of our patients, but more likely we



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7 We insert needles since this is usually how these points aretreated in Meridian Therapy on adult patients. Additionally,many of the points recommended are indicated as beingsymptomatically useful for night urination, for example LV-8,KI-10, and KI-7 arementioned.

will be integrating the use of cupping into the over-all treatment on each visit. Whenwe do the follow-ing, cupping treatment will probably be too high adose if all of it is applied in addition to the rest ofthe treatment. Thus, the tendency is to use some ofthese treatment protocols or, on occasion only, todo the cupping as a separate treatment.

For children up to the age of 7 apply cups for 3–4seconds over each of the following areas:

Around ST-23/ST-24, around ST-28 and SP-15(six cups).

Over BL-23, BL-21, and BL-51 (six cups) and overthe sacrum and sacroiliac joint upper region andlower region (four cups) and lateral to this over themiddle of the gluteus (two cups).

For children over the age of 7, cup the same re-gions and also add cupping over BL-57.

Leave the cups a little longer according to ageand strength of the child (longer the older thechild). Leave the cups especially a little bit longerover the sacrum and side of the sacrum regions.

It is important to review the discussion of cup-ping methods in Chapter 14 in order to grasp thedetails of these cupping treatments. No cups shouldcause pain. We use only pumped cupping and notfire cupping.


It is important to train the child well in urinationhabits; often the child needs to be instructed to goto the toilet to urinate more regularly during theday and especially to go to the toilet just beforegoing to bed. It is said that the best approach is towake the child up about 1 hour after falling asleepand take them to the toilet to urinate. Shimizu(1975) suggests that when the parents do this theyneed to make sure that the child clearly wakes upso that they experience urinating and rememberdoing so. Having them urinate when only halfawake generally does not work sowell.

With the problem of night urination the childvery often loses confidence. He or she often devel-ops anxiety, and can develop an inferiority com-plex. An important part of the treatment is thus tohelp the child develop more self-confidence andreduce anxiety. It is thus important to instruct theparents about not scolding the child if he or she hasan accident, not to tease or hold the problem overthem for any reason. Instead, if the child has an

accident it is better to just change them. Everymorning that the child gets up without an accidentit is good to praise them.

DietaryObviously it is important to instruct the child andparents about dietary habits. It is important for thechild not to drink much after dinner and especiallynot before going to bed. It can also be important forthe child to not eat much (if anything) after dinnerand before going to bed.

Home TreatmentIt can be very helpful to have the parents startdoing some form of the core non-pattern-basedroot treatment at home on a regular basis for mostchildren with bedwetting problems. However, ifthe child is older, you need to also instruct the par-ents in the application of more targeted treatment,focusing on acupoints specifically indicated for theproblem using tapping of those points, heat tothose points (perhaps using a moxa pole or thickincense stick), changing the press-spheres on thosepoints, and so on.


Case 2Edward, Boy Age 4½ Years

Main complaints: Edward was having difficulty con-trolling his urination. At night he had bedwetting epi-sodes, but if the parents woke him a couple of hoursafter going to bed to make him urinate, he wouldhave a dry night. During the day, however, he washaving daily accidents.

History: He had had some issues with bedwetting,but this was almost completely eliminated by takinghim to the toilet after he had fallen asleep.The day-time episodes of loss of urine control did not occur atschool, where he was careful to ask to go to the toilet,but would instead occur after school when playingwith friends, or at the weekend when playing. Itseemed that he was so occupied with playing that hewould lose awareness of the fullness of his bladder,leading to what were now daily occurrences. Hisfather brought him for treatment. It was clear that his



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father was quite worried and stressed out about thisproblem, and with a little inquiry it became clear thatthere was tension between Edward and his fatherover the issue. In the past he had had problems withcongestion in the lungs but this was fine now. The kid-ney, lung, and spleen pulse all felt weak, which couldbe either a kidney vacuity pattern or a lung vacuitypattern.

Treatment: It seemed like a good idea to teach thefather to do the treatment daily at home. This wouldnot only treat Edward, but may help resolve the ten-sion between him and his son, as it could be contri-buting to Edward’s problem. Thus, on this visit Idecided only to apply the basic shonishinmethod andto make sure I explained the daily home treatmentclearly:

Using a teishin, very light stroking was applieddown the arms (large intestine channel), legs (bladderand stomach channels), back, abdomen, and aroundthe abdomen clockwise.

Tapping with a herabari was applied over the lowerabdomen, GV-3, GV-12, and GV-20.

Small press-tack needles (0.6mm) were retained atbilateral BL-52 (with instructions to remove them inabout 30 hours).

A press-sphere was left on GV-12.The father was taught how to do the stroking and

tapping treatment.


The summer holidays had made treatment beforethis time impossible. For the first 4 weeks after thetreatment and with daily home treatment, Edwardhad no accidents. In the last couple of weeks he hadhad a couple of minor episodes.

Treatment: Using a teishin, very light stroking wasapplied down the arms (large intestine channel), legs(bladder and stomach channels), back, abdomen,and around the abdomen clockwise.

Tapping with a herabari was applied over the lowerabdomen, GV-3, GV-12, GV-20, and LI-4.

Using the teishin, supplement left KI-7, LU-5, drainright SP-9.




Hewas doing well with no symptoms.


Tapping with a herabari was applied over the lowerabdomen, GV-4, GV-12, GV-20.

Using the teishin, supplement left KI-7, LU-5, andright ST-36.

Press-spheres were left on GV-12, bilateral BL-23.


Edward was doing well; he had had only one accident.The father reported that he was much more relaxedabout the problem and that he noticed that hisincreased relaxation also seemed to help Edward.


Tapping with a herabari was applied over the lowerabdomen, GV-3, GV-12, GV-20, LI-4, and over theoccipital area.

Using the teishin supplement left KI-7, LU-5, andright SP-9, drain right LI-6.




No accidents. Edward was doing very well.

Treatment: Tapping with a herabari was applied overthe lower abdomen, GV-3, GV-12, GV-20, LI-4, ST-12,and occipital regions, arms, legs, and back.

Using the teishin, supplement left LU-9 and SP-3.Small press-tack needles (0.6mm) were retained at

bilateral BL-23 (with instructions to remove them inabout 30 hours).

The father discussed how he would like to stoptreatment and call if the problem returned. It seemedthat his doing the simple daily treatment at homewas good for both him and Edward.



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Reflection: It can, of course, be more difficult to helpchildren retain awareness of the state of their blad-ders when they are busy with other things. The tacticsI tried here do not always work, but it is a very goodidea to always try this. There can be a variety of rea-sons why children lose the sense of the state of full-ness of their bladders, and then have problems ofinvoluntary urination. You have to try to figure outwhy and target that issue separately along with thegeneral pattern and non-pattern-based root treat-ments. On the last treatment with Edward, his pat-tern had changed, the kidney pulse was no longerweak, and I judged that he had returned to his moreconstitutional state, the lung vacuity pattern.

The following case is frommy colleague Sue Pready,who practices in Cardiff and Swindon in the UnitedKingdom.

Case 3Greg, Boy Age 8 Years

Main complaint: Enuresis. He had been dry duringthe day since the age of 18 months but always hadproblems of wetting at night. This never improved orchanged, and he had very few dry nights in a month.He described how the urge to urinate sometimeswoke him but generally the bedwetting was worsewith stress (going back to school, writing tests, etc.).He underwent medical tests to check that his bladderwas big enough, which it was. He was prescribed Des-moMelt to stimulate hormones from the kidney. Hehad been taking it for 4 months with no effect on thesymptoms, and was subsequently prescribed another4 months’ worth of the medication by the pediatri-cian. If the wetting episode woke him early, he usuallyhad difficulty falling back to sleep; thus he was oftentired in themorning.

History: He was born with pyloric stenosis, whichrequired surgery at the age of 1 month. He some-times had headaches in the morning across the fore-head, probably because of his disturbed nights; healso tended to sleep lightly. He had broken his littleright toe 2 months before, which had to be set in hos-pital.

Assessment: He had a wiry, slim, and muscular build.Everything else seemed normal. Good appetite, goodmood, but he tended to speak with a very quiet voice.

The lower abdomen was cool to the touch; there wasa scar from the surgery around CV-12. He was veryticklish. Pulse was slightly weak, rapid, normal depth.The weakest pulses were the kidney, lung, and spleenpulses.

Diagnosis: Kidney vacuity pattern with spleenvacuity as secondary pattern.8

Treatment: Using a teishin, supplementation wasapplied to left KI-7, LU-5, and right SP-3.

Draining technique was applied to right BL-58. Sup-plementation was then applied to CV-3, BL-13, andBL-23.

Light stroking was applied down the back and blad-der channel on the legs with an enshin.

Light tapping was applied with a herabari to theocciput and around GV-12.

A press-sphere was placed at GV-12.Themother was taught to change the press-sphere

at GV-12 and apply light tapping around GV-12 andover the occiput as daily home treatment.


The symptoms were better; he had had four drynights. He was much more talkative. He was quitetired after the treatment. They decided to stop takingthe DesmoMelt as it had not affected the symptomsat all after 4 months of continuous use. Examinationshowed similar findings as on the first visit.

Treatment: Using a teishin, supplementation wasapplied to left KI-7, LU-5, right SP-3, and right TB-4.

Supplementation was also applied to CV-3, BL-13,BL-23, BL-25, and BL-32.

Heat was applied over BL-23 and the heels using amoxa pole.

Press-spheres were applied to GV-12 and CV-3.Home treatment was extended with the addition

of a very light stroking of the lung channel.


He had dry nights following the last treatment. How-ever, he also had some morning headaches, probablydue to sleep disturbance following two nightmares.



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8 InToyohari this is called kidney-spleen sokoku pattern.

Treatment: Using a silver needle, supplementationwas applied to left KI-7, LU-5, right SP-3, and rightTB-4.9 Supplementation was also applied over theabdominal scar and to CV-3, ST-28, the area aroundST-12, and BL-23.

Heat was applied using a moxa pole over BL-23 andover the heels.


He had slept better without nightmares and was a bithappier in the morning. However, he had not had adry night the last 2 nights. His mother thought thiswas because of worrying about a test at school thisweek.

Treatment: Chinetsukyu/warm moxa was applied toCV-3 and ST-28.

Using a teishin, supplementation was applied to leftKI-7, LU-5, and right SP-3.

Supplementation was also applied around ST-12,BL-13, and BL-23.

Chinetsukyu/warmmoxa was then applied to BL-13,BL-23 and BL-28.


It was clear that the main issue was his self-confi-dence. He had had two dry nights during this week.His sleep was better and he had no headaches in themorning.

Treatment: Using the silver needle, supplementationwas applied to left KI-7, LU-5, right SP-3, and bilateralTB-4, ST-36.

Using a teishin, supplementation was also appliedto CV-3, ST-28, the area around ST-12, BL-13, BL-23.

Chinetsukyu/warm moxa was applied to CV-3 andST-28.

Light stroking was applied down the back using anenshin.

Heat was applied over the low back using a moxapole.


He had been better. No headaches, no nightmares,two dry nights.

Assessment showed that his pattern seemed to havechanged; he now showed the liver vacuity pattern.

Treatment: Using a teishin, supplementation wasapplied to left LR-8, KI-10, right SP-3, and PC-7.

Supplementation was also applied to CV-3, ST-28,the area around ST-12 and low abdomen, and to BL-18,BL-23, BL-28, and GV-12.

Chinetsukyu/warm moxa was applied to BL-28 andBL-23.


His condition was similar to the previous week.

Treatment: Using a teishin, supplementation wasapplied to left LR-8, KI-10, right LU-9, and SP-3.

Supplementation was also applied to CV-3, thearea around ST-12 and low abdomen, and to BL-23and BL-28.

Chinetsukyu/warm moxa was applied to ST-28 andCV-3.

Light stroking followed by heat withmoxa pole andpress spheres to SP-6.


Five dry nights this week.

Treatment: Treatment was the same as the last visit.

Ninth visit—7 days later

Every night was dry. Sleep was good and still no head-aches.


Tenth visit—6 days later

Every night was dry. He was doing well.



He was wet the first night on holiday, all other nightswere dry.



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9 The switch from teishin to silver needle is normal in the Toyo-hari style of Meridian Therapy. It represents a way of increas-ing the dose and strength of the treatment.

Treatment: Same as the last visit with the addition ofheat by moxa pole to CV-3, ST-28, and BL-23, andpress-spheres retained at SP-6, CV-3, and GV-12.

Twelfth visit—20 days later

One night was wet, all others dry.


Thirteenth visit—4 days later

He was wet the last three nights and dreamt about it,but he was not worried about anything. Generally hewasmuch calmer.

Treatment: Using a silver needle supplementationwas applied to left LR-8, KI-10, right SP-3, and PC-7.

Chinetsukyu/warm moxa was applied to TB-4 andSP-6.

Okyu/direct moxa was applied on the heels at theextra point shitsumin in the center of the heel.

Heat with a moxa pole was applied over BL-18 andBL-23.

Fourteenth visit—8 weeks later

He has had no wet nights and has been doing well,with no other symptoms. His mother reported thatsince the last treatment he had had no wet nights;even if he had been late to bed or had had a drinkclose to bed time, he would even wake in the night togo to the toilet. His general mood was better, he sleptbetter, and he was waking up refreshed. He hadgrown in confidence over the last few months, andwas a much happier child. He had friends for sleep-overs and wanted to go to Cub Camp this year, noneof which he would ever have considered before treat-ment.




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23 Ear and Nose Problems

Otitis Media—Ear Infections

The following case of recurrent ear infections is of ayoung boy who came for treatment before I hadlearned Meridian Therapy sufficiently well to applyit on children. Thus, besides some simple sympto-matic treatment, the principle treatment was thecore non-pattern-based root treatment that is typi-cal of the shonishin system. This case is selected asit is typical of what happenswhen treating childrenwith recurrent ear infections. Of course, treatmentdoes not always work as well and smoothly as this,hence more detailed treatment options are alsogiven below, but Mike was the first of a number of3–6-year-old children that I treated for recurrentinfections as Mike’s parents were in a position toget theword out and refer other children.

Case 1Mike, Boy Age 3½ Years

Main complaints: Mike came for treatment havingjust completed a round of antibiotics for infections inboth ears. The right ear had, as usual, been muchworse than the left ear. Over the last 10 months hehad had many ear infections. With each, the doctoreventually prescribed antibiotics, which would clearup the episode, but within 2 weeks of completing theantibiotics another infection would start, sometimesonly in the right ear, but often in both. The problemhad started initially from catching a bad cold and hav-ing it progress to the ears, but since then, while sev-eral episodes of ear infection had arisen from catch-ing cold, many had not. He had been very disruptedby this process as the pain would often be bad andwould disturb sleep, energy, and the rest of thefamily. The antibiotics disturbed his digestion a bit,with some episodes of loose stools and some epi-sodes of constipation. The parents were interested intrying something different, as it was clear that theproblemwas not going away; rather, it was being sup-pressed by each round of antibiotics. The doctor hadrecently said that if this kept up Mike would probably

have to have ear tubes placed to help prevent furtherproblems. The parents were looking for a treatmentto break the cycle of infections. Other than the prob-lem of recurrent ear infections Mike was healthy andall other systems were unremarkable.

Assessment: Palpation revealed hard painful areasbelow each ear extending downward from TB-17, theright being more hard and uncomfortable than theleft. The occipital border was also stiff, especiallyaround GB-12.

Treatment: On this first visit I decided to apply a sho-nishin core treatment with light stroking and sometargeted tapping.

Light stroking with an enshin was applied down thearms (three yang channels), legs (stomach, gallblad-der, and bladder channels), down the back, across theshoulders, chest, and down the abdomen (stomachchannel).

Light tapping was applied above and behind bothears, and over the reactive regions below the ears andover the occipital region, especially around GB-12.

Press-spheres were placed at GV-12 and on themost reactive point within the reactive regions beloweach ear.

I discussed with the parents that it would be idealto give treatment more than once a week to increasethe chances of preventing recurrence of the infec-tions, but they told me as working parents they weretoo busy to be able to do this. So I told them I wouldfigure out what to do about it.


Mike was doing well, there were no signs of ear infec-tion, nothing to report.

Treatment: A very slightly increased dose of thesame treatment as given on the first occasion wasapplied.

I then proceeded to explain to the parents how todo the light stroking and tapping treatment at a lowdose each day: stroking down the same areas on thearms, legs, back, shoulders, and tapping on the areasaround the ears and GB-12 region.



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177


Mike was still fine, with no sign of an infection. Thehome treatments had been going well and tookabout 2–3minutes each day.

Treatment: The same treatment as given on the firstoccasionwas applied.


Still nothing to report, Mike had no symptoms. Hometreatment was going well.


I also scheduled Mike to come back in 2 weeks tostretch out treatments while the parents continueddoing daily home treatment.




Sixth visit—2 weeks later



We now extended treatment to every 4 weeks.


Still nothing to report, Mike had no symptoms. Hehad caught cold and for the first time it did not trig-ger an ear infection and he recovered from the coldquickly.





After this we stopped treatment. Mike had had nosign of an ear infection for about 4 months; it lookedlike we had broken the cycle. The parents were stillapplying the simple home treatment regularly butwithout the press-spheres. They agreed to call fortreatment should Mike start an ear infection. Atanother 4-month follow-up conversation, Mike wasstill fine. He seemed to catch cold less often thanbefore and had no sign of any further ear infections.His parents referred many other children with earinfections for treatment.

General Approach for the Treatment ofOtitis Media

Our aim is to improve the overall condition of thechild so he or she has better resistance to infectionsand treat to deal with the local manifestations thatadditionally make the child susceptible to ear infec-tions. Changing the overall condition of the childcan be accomplished with just the use of the basiccore shonishin treatment or the pattern-based roottreatment, but it generally works better if youapply a combination of these two treatment ap-proaches.


If the recurrent ear infections arise from catchingcold repeatedly, the typical pattern to be treated isthe lung vacuity pattern. If the ear infections ariseindependently of catching cold, this could be due tolung vacuity pattern or kidney vacuity pattern. Ifthe child is young and the pulse and other signs fordistinguishing the pattern are not clear, one needsother signs to distinguish them. If the hands tend tobe cold, it is likely to be a lung vacuity pattern andone should start treating this. Having generally stiffshoulders is also a sign of lung vacuity type. How-ever, if the feet tend to get cold easily (but not thehands) this is more likely to be a kidney vacuity pat-tern. You may also notice some small temperaturevariations on the abdomen to support the choice ofkidney pattern, such as slightly cooler below thenavel compared with above the navel. Also, if theear infections have triggered changes in hearing,you can suspect the kidney vacuity pattern.



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For the lung vacuity pattern supplement LU-9and SP-3. If the ear infection has arisen out of catch-ing cold and there are still signs of the cold, such ascough, congested lungs, and alternating fever-chills,try treating themetal jing-river points LU-8 and SP-5instead. If the child has a fever with the ear infec-tion, you need to check the temperature. If 37.8°Cor higher, the core non-pattern-based root treat-ment is contraindicated. In this case try using theying-spring points for the lung vacuity pattern,LU-10 and SP-2. For the kidney vacuity pattern sup-plement KI-7 and LU-8. If with fever, try the ying-spring points KI-2 and LU-10.

Case 2 below illustrates an alternative strategyfor treating the relevant acupoints, using a verylight stroking along the flow of the channels overthe target acupoints for supplementation, and lightstroking against the flow of the channel over thetarget acupoint for draining.


One can apply either the core non-pattern-basedtreatment with stroking and some tapping or tap-ping alone. For treatment apply stroking down thearms, legs, back, and abdomen. If the shoulders arestiff, apply stroking across the shoulders. If the neckis stiff, apply stroking down the neck. Apply tap-ping to around GV-12 (see Fig.23.1).

Additional Areas for TreatmentIt has been my consistent experience that childrenwith otitis media develop an area of stiffness that isusually painful on pressure below the ears. Thishardened area usually starts around TB-17 andextends downward from there. Sometimes itextends backward from there towards GB-12,sometimes forward slightly from there. I feel thatthis area of stiffness is probably associated withblockage of the lymphatic drainage, and that it isthus an important area to target. Thus, I alwaysapply tapping to this area as well as the areas aboveand below the ears that are suggested by Yoneyamaand Mori (1964) and Hyodo (1986). I give a consis-tent focus to soften and break up this congested,hardened area. If the tapping alone does not makeenough change I start applying stronger techniquesto it such as press-spheres, needling, and/or press-tack needles. See below.


NeedlingWhether one inserts needles and immediatelyremoves them or inserts and retains them for ashort while, needling can be helpful in the treat-ment of otitis media. The area of hardness and pres-sure pain below the ears can be a useful place to



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23 Ear and Nose Problems 179

a

b

Fig.23.1a,b Usual stroking plus:● Below, above, and behind the ear(s): 10 times each● Occipital area: 10 to 20 times● Across the shoulders: 10 to 20 times● GV-20 area: 10 to 20 times● GV-12 area: 10 to 20 times● LI-4: 10 to 20 each● ST-12 area (supraclavicular fossa region): five to 10 times

each

needle. The area around GB-12 can also becomestiff and reactive, and this responds well to lightneedling.

Press-spheres (Ryu), Press-tack Needles (Empishin),and Intra-dermal Needles (Hinaishin)It is useful to leave press-spheres on the hardenedsensitive area(s) below the ear(s). If these areas donot sufficiently change I recommend switchingsoon to a stronger technique such as leaving press-tack needles and maybe needling during the ses-sion. In order to help the child settle (ear infectionscan be quite painful and distressing) it can be help-ful to also leave a press-sphere on GV-12. The mainarea for leaving the small press-tack needles(0.3mm or 0.6mm long) is the area below the ear(s),around TB-17 or below that point. On older chil-dren, where it is generally safer to leave intra-der-mal needles, I leave them at the stubbornly reactivepoints such as the area of reaction below the ears.

Okyu—Direct MoxaThe application of small direct moxa cones isrecommended at points such as KI-2, KI-3, with KI-2being especially effective (Yoneyama and Mori1964). The following points are recommended onadults; they can be palpated and the most reactiveone or two points treated with moxa for non-responsive otitis media (KI-3 is strongly recom-mended): SI-19, TW-17, GB-12, HT-3, KI-3, BL-23,BL-11, BL-12 (Shiroda 1986). If you are afraid tomoxa these points because it is too difficult you cantry applying needling, press-spheres, press-tacks,or intra-dermal needles to the reactive points fromthis list (keeping in mind the issue of dose of treat-ment).

CuppingCupping can be helpful over the upper back andbacks of the shoulders to help get the area to relaxwhen chronically stiff in the child with recurrentotitis media. As discussed in Chapter 14, be carefulabout the dose; applying the cups repeatedly forless time can be helpful.

BloodlettingBloodletting of the jing point GB-44 is recom-mended for ear pain (Birch and Ida 1998, p.240),TB-1 could also be indicated (Birch and Ida 1998,p.283). It can be very difficult to apply this techni-que on small children, and even on older children.

You must have a painless technique. If the childwith recurrent otitis media shows vascular spiderson the upper back in the GV-14 area or back of theshoulders, it can on occasion be useful to apply vas-cular spider bloodletting. This is usually easier todo than jing point bloodletting on a child, but yourtechnique must be very good; otherwise do notapply it. If you do this, apply only the stabbing andsqueezingmethod; do not also apply cupping.

You might choose to try the bloodletting be-cause the child’s problem is not changing and youhave already tried other stronger techniques suchas needling or direct moxa. As discussed in Chapter15, it will be important to make sure that the childwill stay still for you and that you have a clearagreement with the child’s parent to proceed.


DietaryIt can be a good idea to examine the diet of thechild. Often with repeat infections, cow’s milk pro-ducts can be an irritant. Testing for and stoppingthe intake of cow’s milk products can be importantfor some children, and so I always check this out.

Home TreatmentIt is wonderful to have parents who have childrenwith repeated infections start to apply treatment athome. It not onlymakes the overall treatment moreeffective, but gives the parents a sense of being ableto help and contribute.


The following case is from the practice of my collea-gue Zoe Brenner in Bethesda, Maryland, UnitedStates.

Case 2Clare, Girl Age 4 Years

The mother had been a long-time patient and men-tioned that her 4-year-old was having chronic earinfections, resulting in difficult speech developmentbecause her hearing was impaired. She wanted tobring her in for treatment.



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Main complaints: Many ear infections, treated withantibiotics. The problems would usually start as a coldand then progress to the ears. Speech developmentwas slow: it was thought because of the chronicallycongested ears. She was seeing a speech therapist tohelp with the problem. All other systems were unre-markable.

Diagnosis: Both the fact that she had ear problemswith hearing difficulties and that she exhibited somuch fear suggested the kidney vacuity pattern.

First visit

When the mother brought Clare, she hid behind hermother. She seemed disproportionately fearful.

Treatment: It was not possible to take her pulses thatfirst time. With gentle coaxing it was possible tolightly stroke with the enshin down her legs on theyang channels and up on the yin channels then downher arms on both the yin and yang channels.1 Lightstroking with the enshin was also given down herback, stroking through her clothes as she would notremove them. She was a bit more relaxed but stillquite wary.


Clare’s mother reported that she had been veryhappy after the previous visit.

Treatment: The same enshin light-stroking core non-pattern-based root treatment was applied. After thisshe was less fearful and it was possible to take herpulses. The kidney pulse was quite weak with relativerepletion on her spleen pulse. To treat this, light treat-ment was applied using an enshin by stroking alongthe kidney channel near KI-3. After rechecking thepulses, the spleen pulse was still replete, so gentlestroking was applied against the flow of the spleenchannel over SP-9.


Clare had been doing well, no problems. Her mothersaid that the speech therapist noticed that her enun-

ciation was getting clearer and her hearing hadimproved 20dB.

Treatment: The treatment from the second visit wasrepeated with the exception that gentle stroking withthe teishin in the direction of flow of the lung channelover LU-9 was added after treating KI-3.


She had mild cold symptoms (runny nose, mildcough), otherwise no ear problems. Her mother wasexcited to report that Clare had gone to a party anddid not hide for the first hour. This was a huge changefor her to go in and be able to engage in play rightaway.

Treatment: The same treatment as on the third visitwas repeated with the exception of adding a mildpressing over the cheeks and neck below the ears topromote drainage and help with recovery from thecold.

Treatment was continued for a few more sessions,spreading them apart more as she continued toimprove. The issue with the chronic ear infections,hearing, and speech completely resolved. One of thekey signs that she was better came when she had astreptococcus infection affecting the throat with noear involvement at all. Additionally, her fearfulnesswas quite improved, as everyone noted.

Case 3Greg, Boy Age 21Months

Main complaints: Over 15 ear infections in the past.As treatment, he had had grommets inserted intoboth ears and nasal surgery to help unblock the nasalpassages where the infection started. Despite thesemeasures he still developed ear infections, whichwere treated with fresh rounds of antibiotics. He hadhad multiple bouts of bronchitis, had been on Vento-lin since the age of 6 weeks and takenmany rounds ofantibiotics for the bronchitis. There was almost con-tinuous congestion in both the nose and lungs. Hewas a restless sleeper and tended to wake early. Hecould become moody and irritable and tended tohave loose stools and occasionally diarrhea. He hadgood appetite and no skin problems.



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1 Stroking like this on the yin channelswill apply a light supple-menting effect on the kidney and lung channels, which aretreated for the kidney vacuity pattern.

Diagnosis: He had a lung weak constitution (seeChapter 25 “Weak Constitution”). The ear infectionswere secondary to the recurrent upper respiratorytract and lung infections.

Treatment: Using the herabari, tapping was appliedto LI-4, around the ears, below the ears and downtowards ST-12 area, on the back of the neck especiallyalong the occipital border, at GV-12 and GV-22.

Light stroking was applied with an enshin down thearms, legs, abdomen, and back.

Using a teishin, left LU-9 and SP-3 were supplemen-ted.

Press-spheres were retained at GV-12 and the asth-ma shu points.

Testing for reaction to and discontinuing cow’smilk was discussed with the parents, who agreed tostart this immediately.


Greg had been on soy milk since the first visit. Thephlegm in his nose and lungs seemed better. He hadbeen calmer, less moody, and was relaxed after thetreatment.

Treatment: Tapping was applied with the herabari toLI-4, around the ears, below the ears down towardST-12, along the occipital border, GV-20, GV-12, andGV-22.

Light stroking was applied with an enshin down thearms, legs, abdomen, and back.

Using a teishin, left LU-9 and SP-5 were supplemen-ted and right LR-3 drained.

Press-spheres were retained on GV-12 and the asth-ma shu points.

His parents were instructed to apply light tappingto the same points and areas and light stroking overthe same regions.


He was doing much better. He had no nasal or lungcongestion. His parents had stopped using the Vento-lin. His mood and sleep were much better, loosestools better. His home treatment was going well.

Treatment: I discussed with the parents whether heshould come off the Ventolin so quickly and that theyshould discuss this with the prescribing doctor.

The same treatment was applied as on the last visitwith the exception that left BL-58 was also drained

and the asthma shu points were not treated with thepress-spheres as the points were slightly irritated.


Generally he had been good, there were no symp-toms of the lungs or ears, and his nasal congestionwas not bad despite catching cold and having mildon–off cold symptoms over the last 3 weeks (whichwould normally have triggered either ear infections,bronchitis or both). But his sleep was not as good ason the last visit, and he had been a little more moody.The parents reported that they waited this long toreturn because the trip to the clinic took at least90minutes each way and on the last visit they hadbeen stuck in traffic for a long time, thus they wantedtomake visits less frequent. They had been able to dosome home treatment almost every day and felt thatthis had been helpful in preventing the cold from pro-gressing further than it had.

Treatment: Tapping was applied with the herabari atLI-4, GV-12, GV-20, the occipital region, and on theback.

Light stroking was applied down the arms, legs,back, and abdomen.

Using a teishin, left LU-9 and SP-5 were supplemen-ted, right LR-3 and TB-5 drained.

Press-spheres were retained on GV-12 and on theback of the left ear behind shen men.2


The first week after treatment was good, all symp-toms improved. Over the last week some mild coldsymptoms had started returning (runny nose, cough)and he had started waking early again.

Treatment: Tapping using a herabari was applied toLI-4, GV-22, GV-20, GV-12 and the occipital region.

Light stroking was applied with an enshin down thearms, legs, abdomen, chest, and back.

Using a teishin, left LU-9, SP-5 were supplementedand right LR-3 drained.

Press-spheres were retained at GV-12 and on theback of the left ear behind shen men.



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2 This point behind the ear was used because of his moodiness.The focus is shifting away from treating ear infections andasthma andmore to his general condition. Since, the ear infec-tions and asthma have improved.


There were no symptoms of the ears or lungs and thenasal congestion had gone. But the day after the lasttreatment he succumbed to the same stomach virusthat his sister had and experienced 3 days of on–offdiarrhea and vomiting, which also disturbed his sleep.After recovering, his sleep and appetite were back tonormal. His parents reported that they had beenstuck in bad traffic again after the last treatment.Partly because of this, and since Greg’s main prob-lems seemed much better—he had no more earinfections, he had caught cold and it had not pro-gressed to the lungs triggering bronchitis, his nosewas much better, and he had not used Ventolin sincethe first treatment—they stated that they would con-tinue treatment at home but that they wanted this tobe the last treatment for a while. They agreed that ifhe should start experiencing the same problemsagain that they would bring him back for treatment.

Treatment: The treatment was the same as on thefifth visit with the exception that needles were lightlyinserted around GB-20 and a press-sphere wasapplied to right BL-17 instead of on the back of theleft ear. I inserted needles to GB-20 because the reac-tion around this point had been present since the firstvisit and had not changed much with the light treat-ment I had applied to it (with tapping). This pointshows this kind of reaction with chronic nasal symp-toms and sometimes ear problems, and so I chose totry to make it less reactive by using a stronger techni-que.

At 9-week follow-up with the parents, Greg was doingwell. He no longer easily caught cold, had no prob-lems with his ears or lungs, his nose was mostly freefrom congestion, his sleep and mood were good,bowels good. His parents were applying a light treat-ment several times a week.

Reflection: Greg had a typical lung weak constitutioncoupled with sensitivity to cow’s milk. Removing theirritant of the cow’s milk helped the treatment workbetter and, as his condition improved with the treat-ment, his constitution gradually strengthened so thathe no longer developed the same problems. This wasfortunate; sometimes removing the cow’s milk onlyhelps the symptoms, but in Greg’s case it was enoughto take the pressure off his whole condition so withminimal effort we could quickly strengthen his consti-tution. If this had not occurred, it probably would

have been necessary to add stronger measures suchas okyu/direct moxa to points like GV-12, cupping tothe upper back, andmore inserted needles.

Nasal Congestion

Many children have problems of recurrent orchronic nasal congestion. The problem can be dueto allergic irritation (such as dust etc.), dietary fac-tors (such as cow’s milk reactions), or recurrentinfections and blockages in the nasal passages.These different issues need to be carefully examinedto seewhich are relevant to address for the child.

Case 1Michael, Boy Age Almost 7 Years

Main complaints: Chronically blocked nose. Hecould not breathe at all through his nose and had nosense of taste due to anosmia (lack of sense of smell),leading to poor appetite. Because of the poor appe-tite, he was slightly underweight, not eating much,and would argue with his parents at meal times aboutnot wanting to eat, and not liking the food. He alsohad multiple airborne allergies (e.g., dogs, cats,house mites). These allergies could trigger breathingdifficulties. To help with them he had been prescribedasthmamedicines, which he would use as needed.

Additional complaints: When younger he had hadlot of colds, many of which had led to bronchitis epi-sodes, and some problems with eczema. He hadtaken antihistamine medications (loratadine followedby Xyzal [levocetirizine]) for a while but stopped asthey had not been helpful. He had a problem withwarts at the age of 4 years, spreading from the armsover the body and down to the feet. Recently he hadproblems with bouts of diarrhea and loose stools. Allother systems were unremarkable.

Diagnosis: Abdomen, pulse, and symptoms indi-cated a lung vacuity pattern with liver repletion.Michael had the lung weak constitution type condi-tion, manifesting now with multiple allergies andwhen younger with the recurrent infections and skinproblems. As part of this condition, his spleen wasaffected and became chronically weakened, so thathe was also showing signs of the spleen weak consti-tution (digestive disturbances, poor appetite, poor



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weight gain). Treatment would take time and mayrequire stronger interventions (see Chapter 25 “WeakConstitution”).

Treatment: Using an enshin, light stroking wasapplied down the abdomen, back, arms, and legs.

Using a teishin, supplementation was applied toCV-12, left LU-9, SP-3, draining to right LR-3, rightTB-5.

Tapping was applied with a herabari on GV-12, theback of neck, around GV-22 to GV-23.

Press-spheres were applied to CV-12 and GV-12.The mother was recommended to immediately

eliminate cow’s milk products from his diet to starttesting for cow’s milk sensitivity. Themother was alsogiven information to look into purchasing a good-quality air-filtering system that could be left runningin his room or around the house to keep airborneallergens out of the air or significantly reduced.


No change in nasal stuffiness, but his appetite hadbeen a bit better and he had eaten more. His sense oftaste seemed to be a bit better. He was 90% free ofcow’s milk products.

Treatment: Using a teishin, very light stroking wasapplied down the large intestine, stomach, and blad-der channels, down the abdomen and neck.

Using an enshin, light stroking was applied downthe back and the backs of the legs.

Using a teishin, supplementation was applied to leftLU-9, SP-3, draining to right LR-3 and right LI-6.

Tapping was applied with a herabari over GV-12,occipital, and GV-22 to GV-23 areas.

Press-spheres were applied to GV-12 and CV-12.The mother was taught a basic rubbing and tap-

ping home treatment to be applied daily.


No further change in dairy status; he was not yet com-pletely free of the cow’s milk products and themother had not been able to do much home treat-ment. His appetite was still better, he had stoppedarguing about eating, but the nasal stuffiness seemedunchanged.

Treatment: Using a teishin, very light stroking wasapplied down the large intestine, stomach, and blad-der channels, down the abdomen, back, and neck.

Using a teishin, supplementation was applied to leftLU-9, SP-3, draining to right LR-3, right ST-40, and leftBL-58.


Press-spheres were applied to BL-12 and CV-12.


He had had one good day with less nasal stuffiness.His appetite was better and he was eating more. Hismother had been able to do home treatment withgreater frequency.

Treatment: Using a teishin very light stroking wasapplied down the large intestine, stomach, and blad-der channels, down the abdomen and back.

Using a teishin, supplementation was applied to leftLU-9, SP-3, draining to right LR-3.




His mother had been able to keep to the improvedfrequency of home treatments. His sense of smellwas much improved, but the nose was quite stuffyand he seemed to still have a diminished sense oftaste.


Using a teishin, supplementation was applied to leftLU-9, SP-3, draining to right LR-3 and left LI-6. Supple-mentation was also applied to yin tang and bilateralLI -20.




The nasal symptoms were the same, but eating wasbetter and he had clearly started to gain weight.

Treatment: A needle was inserted and retained for afewminutes at GV-22.

Using a teishin, very light stroking was applieddown the large intestine, stomach, and bladder chan-nels, down the abdomen, back, and shoulders.



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Using a teishin, supplementation was applied toCV-12, left LU-9, SP-3, draining to right LR-3 and leftTB-5. Supplementation was also applied to yin tangand bilateral LI-20.

Tapping was applied with a herabari over GV-12,occipital region, and on the head.



The nose had been less stuffy, appetite better again,andmore weight gain.

Treatment: Using a teishin, very light stroking wasapplied down the large intestine, stomach, and blad-der channels, down the abdomen, back, shoulders,and neck.

Using a teishin, supplementation was applied to leftLU-9, SP-3, draining to right LR-3 and supplementa-tion to bilateral LI-20.




He was generally doing well, the nasal symptomswere much better. He had been in contact with a dogand had no allergic reactions for the first time. He hadhad a cold and recovered quickly without it progres-sing and triggeringmany symptoms.

Treatment: Using a teishin, very light stroking wasapplied down the large intestine, stomach, and blad-der channels, down the abdomen, back, shoulders,and neck.

Using a teishin, supplementation was applied to leftLU-9, SP-3, draining to right LR-3, left BL-58 with sup-plementation to yin tang, bilateral LI-20, and bilateralBL-20.




The nasal stuffiness, appetite, and eating had all beenbetter overall.


Using a teishin, supplementation was applied to leftLU-9, SP-3, draining to right LR-3 and left LI-6 with sup-plementation to yin tang and bilateral LI-20.




The last 2 weeks were worse with more nasal conges-tion, and his eating was not as good.


Using a teishin, very light stroking was applieddown the large intestine, stomach, and bladder chan-nels, down the abdomen and back.

Using an enshin, light stroking was applied downthe back.

Using a teishin, supplementation was applied to leftLU-9, SP-3, draining to right LR-3 and left LI-6.


Press-spheres were applied to CV-12.Intra-dermal needles were placed for 2 hours and

replaced by press-spheres at bilateral BL-13.


The nose was still stuffy, but his eating was better andhe had gained weight again.


Using a teishin, very light stroking was applieddown the large intestine, stomach, and bladder chan-nels, down the abdomen and back.

Using an enshin, light stroking was applied downthe back.

Using a teishin, supplementation was applied to leftLU-9, SP-3, draining to right LR-3 and left LI-6.


Press-spheres were applied to CV-12 and bilateralBL-20.

Cupping was gently applied over the upper back.

He came for a further 16 treatments over the next 15months. These treatments were relatively similar ormodified slightly to match current complaints. Overthis 15-month period he showed further improve-ments in his allergic sensitivities and nasal conges-



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tion. He maintained a healthier appetite and taste forfood so that he was no longer underweight. Hisparents also discovered that he was quite allergic togluten, and cutting this out of the diet and adding alittle extra treatment targeted to food allergy prob-lems—such as cupping around the navel—also contrib-uted to the improvements in his condition.

Some children with an allergic-type constitutionrequire a lot of treatment in order to improve sub-stantially. One can usually get a good sensewithin afew treatments that the treatment approach ishelping. In Michael’s case it was the improvedappetite and eating habits, despite the minimalchange in nasal symptoms and sense of smell andtaste. When working with a child with such anallergic constitution it is a good idea to help the par-ents understand that a longer course of treatmentis necessary. Use home treatments as much as youcan, schedule to less frequent treatments as soon asis realistic, and plan for regular but infrequent visitsover a long time.

General Approach for Patients with NasalCongestion

Treating children with chronic nasal congestionrequires several targeted approaches. It is good tostrengthen the child with both pattern-based andnon-pattern-based root treatments so that theirability to overcome the problem improves. It is alsoimportant to try to identify potential irritants thateither continually trigger the symptoms or hinderthe child from recovery, such as dietary problems,airborne irritants, and so on. Teaching the parentsto do some simple home treatment will be helpfuland will involve attention to the last issue andprobably teaching a simple form of the non-pat-tern-based root treatment. Finally, you need towork out which symptomatic treatment methodsare best at which locations for the particular symp-toms of each child.


The most likely pattern of treatment will be thelung vacuity pattern since the nose is the openingof the lungs and nasal congestion problems oftenresult from exposure to irritants (allergic constitu-tion) or recurrent infections, both of which are

typical signs of the lung vacuity pattern. In somecases the nasal congestion can progress to becomethe kidney vacuity pattern (look for signs of coolfeet, with pulse and abdominal signs of this) or thespleen vacuity pattern (look for signs of recurrentdigestive symptoms).3


One can apply either the core non-pattern-basedtreatment with stroking and some tapping, or tap-ping alone. For treatment apply stroking down thearms, legs, back, and abdomen. If the shoulders arestiff, apply stroking across the shoulders. If the neckis stiff, apply stroking down the neck. Apply tap-ping to around GV-12 (see Fig.23.2).

Additional tapping to target the symptoms canbe applied around GV-22 to GV-23, the occipitalregion, especially around GB-20, GV-12, and theupper back region (including BL-12 to BL-13region). Additional points to tap include LI-4, LI-11,ST-36, and sometimes yin tang. Applying a light sti-mulation around the nose is useful, and probablymore comfortable with a light pressing using, forexample, a teishin on acupoints such as LI-20 andBL-2.


NeedlingYoneyama and Mori (1964) state that shallowlyinserted needles to points such as BL-10, GB-20,and GV-23 can be very effective. However, on theacupoint GV-23, do not insert needles before theage of 2 years since the anterior fontanel is stillopen. On the young child these acupoints can betreated using a retained needling method, making



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3 TCM tells us that cold affects the kidneys and dampness thespleen (Wiseman and Ellis 1985). Thus, symptoms that areworsened by cold will lead one to think of the kidneys andsigns of dampness such as mucus lead one to think of thespleen. However, this is a simplification. While the Huang Di

Nei Jing Su Wen (The Yellow Emperor's Inner Classic—Basic

Questions) makes these associations, the Nan Jing (Classic of

Difficulties) makes other associations, both of which seemclinically useful. The Nan Jing says that cold injures the lungs,damp injures the kidneys, and over-eating, over-drinking,over-working injures the spleen (Fukushima 1991). It is moreuseful to look at both sets of correspondences and bemore flex-ible in one’s approach. This is discussed briefly in Chapter 10.

sure that the technique is painless so the child isunaware of the needles. The acupoint LI-4 can behelpful for nasal congestion: treat it with an in-outneedling method rather than a retained needlingmethod. In older children if the nasal problems arevery stubborn and resistant, palpate yin tang andBL-2. You may need to use the retained needlingmethod on these acupoints, provided the child willstay still for you.

Press-spheres (Ryu), Press-tack Needles (Empishin),and Intra-dermal Needles (Hinaishin)A press-sphere to GV-12 is helpful. If BL-12 or BL-13shows a distinctive knot that makes the child flinchor jump when touched, use press-spheres onyounger children and if not responding on olderchildren, use press-tack needles. These points aremore likely to show reactions because of the symp-toms and/or the lung vacuity pattern. If there areadditional spleen signs (digestive problems, foodallergies, or sensitivities), palpate around BL-20and medial to it. If there is a clear reactive point,leave either a press-sphere (younger, more sensi-tive child) or press-tack (older, less sensitive child).

On some older children if the symptom is notresponding much, you can try leaving 0.3-mm or0.6-mm press-tack needles on acupoints such asyin tang or BL-2, depending on the reactions in thepoints. You need to be sure that the child will notplay with the needles or try to remove them. Oftenyou place these needles with instructions toremove them by the next morning. The child maybe willing to leave the needles untouched, but it isnot so clear that friends or classmates will leavethem alone, as they are quite visible on the face.Another acupoint that can show strong reactions isthe extra point bi tong at the juncture of the boneand cartilage on the nose. This is a good point totreat if the symptoms are stubborn and unchan-ging.

Okyu—Direct MoxaManaka recommends for nasal congestion of thenewborn applying moxa to GV-12, GV-23, and/orthe extra point near LI-4 (located at the distal headsof the first and secondmetacarpals) (Manaka, Itaya,and Birch 1995). It is probably not good to startdoing this treatment since moxa is difficult onbabies and small children. If, after tapping thesepoints, you increase dosewith inserted needles andthere is still no response, then you can think aboutthis treatment.

CuppingFor children with food-related sensitivities that arerelated to the nasal congestion, cupping around thenavel can be helpful. For children with airborneallergies contributing to the nasal congestion, cup-ping on the upper back can be helpful, using lowdose stimulation around GV-14, GV-12, or BL-12regions.

BloodlettingIn general, for chronic nasal congestion, especiallyif the symptoms are strong and stubborn and notchanging easily, bloodletting of vascular spiders onthe upper back may be helpful. Examine the areaaround GV-14 to BL-13 for vascular spiders. If clearvascular spiders are found, these can be stabbedand bled using the squeezing method. Be carefulabout dose.



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Fig.23.2 Usual stroking plus tapping:● GV-22–GV-23 area: 10 to 20 times● GV-20 area: 10 to 20 times● GB-20 area: 20 to 30 times● LI-4: 10 to 20 times each● Sometimes soft tapping around yin tang: five to 10 times


DietaryIt is not uncommon that you will need to test forcow’s milk sensitivity. This is a common problem,but other dietary allergens may also be involved,which can take time to identify and eliminate.

Other AllergensFor the child with airborne allergies (dust, mites), ifthe symptoms are not responding well you mayneed to discuss the idea of having the parents buy agood air filtering system to be run continuously athome. Such a system can help minimize exposureto the allergens for the child in the space wherethey are most commonly exposed (bedroom,rooms they play in). While working at a sympto-matic level, by reducing exposure and thus sympto-matic reactions, it also aids the overall treatment ofthe allergic constitution. In many patients, the con-tinuous triggering of allergic reactions with symp-toms seems to keep the whole system sensitized sothat the child more easily has further reactions. Itcan be difficult for normal functioning of the tissuesto return as they are continuously in an irritatedstate. Your root treatment, both the core non-pat-tern-based root treatment and the pattern-basedroot treatment will also be somewhat underminedby the continuous need to focus on symptom reliefand control measures. However, when the symp-toms are kept quieter (through reduced exposureto the allergens), not only do the irritated tissues ofthe nasal passages settle down, become lessinflamed and swollen (allowing for more normalfunctioning to occur), but your root treatment canbecome the dominant aspect of the treatment thatwill help create changes to a greater degree andmore quickly in the underlying allergic constitu-tion. In such cases, this is often the most importantpart of treatment. Relieving symptoms for a whilemay not be too difficult, but creating a change sothat there are fewer or no future symptoms canrequire a lot morework.

Home TreatmentHome treatment can be very helpful for speedingup improvement in chronic conditions. Generallyhaving the parent apply a simple form of the corenon-pattern-based root treatment with additionaltapping directed to GV-12, GV-22 to GV-23, LI-4,andmaybe BL-12 to BL-13, can be helpful.

Sinusitis

Shimizu (1975) discusses the treatment of sinusitisin older children, usually in the age range of 7–10years. This often results from sinus infection andmay have been treated with antibiotics. It is oftenthe result of abnormal nasal passages. Symptomsare usually pain, pressure in the facial region overthe sinus cavities, excessive nasal discharge ornasal congestion, with bad smell on the breath. Insome children it can trigger secondary problemssuch as declining concentration, less clear thinking,declining grades at school, becoming easily fati-gued, headaches, poor appetite.

Shimizu suggests that we should especially payattention to the spleen. However, since the child isusually older, you should be able to perform a nor-mal examination to determine the pattern for treat-ment. Thus, apply the Meridian Therapy pattern-based root treatment according towhat you find. Inmany cases you will treat the spleen channel as aprimary spleen vacuity pattern, as part of the lungvacuity pattern or secondary to the kidney or livervacuity patterns. If the region around CV-12 toCV-9 feels hard to the touch, it is more likely thatthe child has repletion of the spleen channel, inwhich case you will treat either the kidney or livervacuity pattern before draining the spleen channel.Always make sure to check the pulses and otherfindings to confirm your decision. In my experi-ence, liver vacuity pattern is relatively common inpatients with sinusitis.

You will find clear pressure pain points in thelocal region; focus symptomatic treatment onthose (Shimizu 1975). Treatment can be applied onthe younger or nervous child using tapping; if thereis no response, start to use inserted needling. Forthe older child or the child who is less nervous, youcan start to use inserted needling methods sooneror immediately. For problems of the maxillarysinuses, ST-2, ST-3, LI-20, LI-4 are typical treatmentpoints. For problems of the frontal sinuses BL-2, yintang, GB-14 are typical treatment points. It is alsocommon regardless of the location of the sinusitisto find reactions in the following acupoints: GV-22to GV-23, BL-10, above BL-10, GB-20, above GB-20,BL-12, GV-12, LI-11, LI-4. Treatment can be directedtoward the reactive points. If the problem is chronicand accompanied by digestive symptoms, checkCV-14, CV-12, ST-21, ST-20, ST-36, treating the



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reactive points. If the symptoms prove to be moreresistant you can consider applying okyu to, forexample: GV-22 to GV-23, GV-12, BL-12, ST-21. Usethree to five cones ofmoxa on each, choosing pointsby palpation.

It can also be helpful in stubborn cases wherethe symptoms do not change much to apply press-tack needles to reactive points on the nose such asthe extra point bi tong, at the juncture of the boneand cartilage. These points can show strong pres-sure pain. If you leave press-tack needles here, thechild may resist for cosmetic reasons. You can sug-gest putting them on and taking them off the nextmorning before going to school.

In cases of acute sinus infection where the childmay be slightly feverish, and has a reddenedappearance of the face, with acute symptoms of

pressure pain, bloodletting can be a useful option.Examine the jing points LU-11, LI-1, TB-1, SI-1. Ifone or more look slightly reddened, swollen, or feelspongy, and show pressure pain, try bloodlettingthose jing points. Up to five drops of blood perpoint should be enough to help. If the child haschronic sinusitis, and on examination of the upperback, especially in the region of GV-14, BL-12 toBL-13, you see vascular spiders, bloodletting can beapplied. Use the squeezing only method to removethe blood rather than cupping.

The same dietary precautions need to be takenas for nasal problems in general. Likewise, if thereare airborne factors triggering or related to thesinusitis, the same suggestions about using an airfiltering systemmay be necessary.



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24 Developmental Problems

This is a broad category that includes childrenwho,from birth, have had developmental problems suchas growth abnormalities (limbs, organs that do notdevelop properly or at all, spina bifida, etc.), geneticmutations, mental development problems (autism,Down syndrome, mental retardation), complica-tions of intrauterine growth or birthing (such ascerebral palsy). It also includes children who havean accident or disease that leaves them damaged (e.g., mental development problems due to head trau-ma, loss of locomotor function due to viral infectionsuch as polio). The text by Yoneyama and Mori(1964) discusses the treatment of the sequelae ofpolio. Whilewe hardly ever see such patients today,we can apply some of the same principles of treat-ment more generally.

Many of the children with the above type ofproblems usually need special care. Most commonlywe see children with these problems who are notinstitutionalized and live at homewith their parents.They are often receiving special medical care or go tospecial schools that cater to their needs. In somechildren there is a single problem such as non-use ofthe legs; in others a broad spectrum of problemsaffecting multiple developmental and functionalsystems. In some children the treatment helps createreal substantial change and improvements. In others,the treatment helps lessen difficulties, improve func-tion, mood, performance, improve the quality of lifefor the child, and create a better environment andinteractionwith their environment.

Case 1Catherine, Girl Age Almost 3 Years

Just 3 weeks before going on a summer-long studytrip to Japan I received a phone call from a mother inNew York, a 1-hour flight away. She had got my namebecause she was looking for an acupuncturist whotreated children and had not been able to find anyonecloser. Her daughter Catherine was born with cerebralpalsy. At that time she was around 33months old.

Main complaints: She had no use of her legs. If shewas laid down she could not push herself into a sittingposition. She was unable to walk, even with assis-tance. Catherine was under care at the local children’shospital. She was primarily managed by a pediatricneurologist and was seeing a pediatric physical thera-pist to see what else could be offered. The neurologisthad recently indicated that since there was no changein Catherine’s condition, he was projecting that shewould probably end up either in a wheelchair or, iflucky, shemight be able to walk wearingmetal bracesas support, but that did not seem so likely. Themother was not happy to hear this, as it indicatedthat the doctors could not offer much more help forCatherine. Her mother reported that Catherine hadno problems with the arms, head, or neck. She hadnormal control of bladder emptying and bowel move-ments. Her appetite was good and she was quite aquick-minded, concentrated child. Could I help andhow should we proceed?

We organized for the mother to bring Catherine upto Boston by plane early the next week to come for a1-hour appointment where we would start treat-ment. Once scheduled, I thought about what couldrealistically be done. In cases such as this, the litera-ture in Japan suggests regular shonishin can be helpfulbut that one often needs to use okyu/direct moxa onthe lower back to help trigger change. I was con-cerned about the lack of time we had to schedulemany treatments, given that I was leaving soon forJapan. Also, while I wanted to have the mother startdoing home treatment as soon as possible, I felt Icould not apply direct moxa without the ability to bepresent at follow-up and certainly could not imaginehaving the parent try home moxa without my super-vision. Thus, I planned to do a short core non-pattern-based root treatment, apply minimal light sympto-matic treatment, and spend the rest of the hourteaching the mother how to do treatment daily athome. I saw Catherine before I had properly learnedMeridianTherapy and thus was unable to add any spe-cific pattern-based root treatment to my treatmentfor her. The tools available to me were basic shonishinand simple symptomatic methods only.



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Clinic visit

Catherine was a very bright-eyed, strong-willed child(strong in a positive sense, not as a very strong-willed,resistant child). She had little voluntary control overher legs and no strength in them. Thus, for all intentsand purposes she was paralyzed from the waist down.Once she was laid on the treatment table she couldnot raise herself as she did not have sufficiently devel-oped back muscles to allow her to do this. Her sleepand mood were good, appetite and digestion good.She had no other health problems.

Treatment: Using the same instruments that Iwanted the mother to take home and use daily athome, I gave the following treatment:

Using a zanshin-type instrument I applied lightstroking down the arms (three yang channels), legs(stomach and bladder channels), back (bladder chan-nel), abdomen (stomach channel and ren mai).

Using a herabari, I applied tapping around GV-12,GV-4 to GV-3 area, and then some additional tappingalong the spine and around GV-20.

Rather than use moxa at the GV-3 to GV-4 area Ichose to use a hand-held “electric moxa” instrument.Basically this was a simple device; once plugged inand turned on, a rounded surface with an area about3cm in diameter became warm. Holding the instru-ment with one hand, I could apply a warming heat viathis rounded surface to the area over and around GV-3to GV-4. I did this until the area became slightly pinkandwarm to the touch.

During the treatment Catherine became quiterelaxed and seemed very comfortable. I then spentthe rest of the hour explaining to the mother how todo the same treatment using the same instrumentsat home daily. I double-checked her techniques toensure that she had understoodmy instructions prop-erly. She agreed to call me in the next 7–10 days to letme know how things were going, and said that shewould bring Catherine back for another treatmentbefore I left for Japan if it seemed necessary.

Her mother called 10 days later very excited. Shehad been doing the treatment I taught her daily athome and Catherine really enjoyed it, even expectedit. That day Catherine had, for the first time, beenable to push herself into a sitting position. I discussedthis with the mother and instructed her to continuedaily treatment. I would contact her in a few monthsonce I was back from studying in Japan.

I called the mother about 20 weeks later to seehow things were going and to see if we should sche-

dule further treatments in Boston. The mother wasvery happy. Catherine was already walking if herhands were held. She was improving rapidly. Becauseher condition was progressing well I told the motherthat she had become the therapist and to continuetreatment regularly. She joked that Catherine wouldnot allow her not to do the treatment if she had for-gotten or was running behind schedule.

I called the mother again about 8 months later tosee how things were going. Despite the dire predic-tions of the pediatric neurologist specialists, Cathe-rine was now walking on her own and could walk upto 30 meters unaided. She was also able to jump a lit-tle. She was continuing to make progress with thedaily treatments. We discussed how she was progres-sing and decided that it was unnecessary to come upto Boston to see me. I congratulated the mother forbeing such a good therapist.

When a child faces a lifetime of difficulty due tosuch circumstances, the ability to trigger changes likethis when the doctors are unclear if they can makeany real impact is truly moving. It is a lifetime ofchange that the shonishin treatment created. For asimilar case, please also see the case of the child withparalysis and other complications from spina bifidafrom the caseload of Kazuko Itaya (Manaka, Itaya, andBirch 1995, pp.307–308).

General Approach for the Treatmentof Childrenwith DevelopmentalProblems

Often the conditions you will be treating are notcurable. The goal of treatment is to help lessen thesymptomatic manifestations of those problemsthat are not curable and to increase function for thechild. A secondary goal of treatment is to help theparents find additional tools that help with dailyfunctioning and coping for andwith the child.

Most Likely Pattern-based RootDiagnosis

The kidney vacuity pattern is the most common. Inmany cases there will be kidney weak constitutionand the recommendations in Chapter 25 “WeakConstitution” can be helpful. Thus, applying sup-plementation to KI-7 and LU-8 is often useful. Var-iations of this can includemodifying point selection



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24 Developmental Problems 191

according to symptoms. Thus, if there are any signsof counterflow qi, use of the he-sea points such asKI-10 and LU-5 is indicated. If there are significantproblems with strength and use (classical descrip-tion is “heaviness”) of the limbs, the shu-streampoints (KI-3, LU-9) may be useful to try. Additionaltreatment directed to BL-23 to support the treat-ment of theweak kidney channel is also indicated.

Liver vacuity pattern may also show, but this ismore likely in older children.With babies and smallchildren we generally select kidney vacuity patternas a matter of course since we treat this as a kidneyweak constitution problem. But on older childrenwhere you are able to obtain pulse and abdominalfindings the liver vacuity patternmay appear, espe-cially in children with locomotor disorders andespecially associatedwith spasticity of the muscles.In such cases treating the usual LR-8, KI-10 or LR-3,KI-3 will be most useful according to symptomaticmanifestations. For the child with mental develop-ment problems, examine the heart pulse carefully.If it seems weak, you can supplement HT-7 or PC-7as a secondary pattern. Thus, for the kidney vacuitypattern child with mental development problems,after supplementing, for example, KI-7 and LU-8 onone side, supplement HT-7 or PC-7 on the otherside of the body.


The core non-pattern-based root treatment is help-ful with additional tapping targeted at regionsaccording to the symptomaticmanifestations. Thus,stroking down the arms, legs, abdomen, and backwith tapping around GV-12 is good for most condi-tions. Additional tapping around GV-12 for upperlimb problems will be helpful, as will tappingaround GV-3/GV-4 for lower limb problems and onthe occipital regions, GV-12 and GV-20 for mentaldevelopment problems. Sometimes a light pressingaround GB-20 and LI-4 can be helpful for childrenwithmental development problems (see Fig.24.1).


NeedlingFor problems of mental development, if the addi-tional tapping or pressing has not been helpful,consider inserting needles lightly to acupoints suchas GB-20, LI-4 with an in-out technique. Be carefulof the dose and make sure to cause no discomfortwith the needling.

For problems of the upper limbs, if additionaltapping has not been helpful, you can add in-outinsertion to acupoints such as LI-4, LI-10, LI-11. Ifthe shoulders or interscapular regions are very stiffand there are knots in those regions, you can apply



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Fig.24.1 Light stroking:● Down the arms (yang channels)● Down the back (bladder channel)● Down the legs (stomach and bladder channels)● Down the abdomen (stomach channel)● Across the chestLight tapping:● GV-20 area: 10 times● Occipital area: 10 times● GV-3 area: 10 times● GV-12 area: 10 times● If problems with the upper limbs: more tapping around● GV-12 (20 times or more)● If problems with the lower limbs: more tapping around

GV-3 (20 times or more)

in-out needling on these knots on older children.For problems of the lower limbs, if additional tap-ping has not been helpful, you can add in-out inser-tion to acupoints such as ST-36, GB-34. You mayalso find knots on the low back/buttock regions,such as lateral to the sides of the sacrum. Needlingthese knots can also be helpful.

Press-spheres (Ryu), Press-tack Needles (Empishin),and Intra-dermal Needles (Hinaishin)Press-spheres or press-tack needles are usually safeto use for musculoskeletal problems, provided thechild is not very rundown or overly sensitive. Leav-ing press-spheres on GV-12for upper limb prob-lems and around GV-3 to GV-4for lower limb prob-lems can be helpful. If you leave press-spheres orpress-tack needles on other points or areas, makesure to use appropriate dosage levels for the child.Since many children will be kidney vacuity pattern,leaving something on BL-23 bilaterally can be use-ful, provided you have paid attention to the dose.

For children with mental development prob-lems, the dose needs to be much more carefullycontrolled. If you leave anything, leave only press-spheres to start with. Only use stronger dose tech-niques like press-tack needles when you are morecertain of how the child responds to treatment. Theextra point behind shenmen on the ear can be treat-ed with press-spheres. If you find a lot of stiffnessor knots on the upper back, especially in the inter-scapular region, you can apply treatment to thoseto help reduce the reactions; it is especially helpfulto focus on reactions at BL-15 or BL-14 if they arepresent.

Okyu—Direct MoxaIf the problem includes paralysis or problems of useof the upper limbs it is recommended to applymoxa to GV-12 (Irie 1980, Shiroda 1986), GV-13 orGV-14 (Yoneyama and Mori 1964). If the problemincludes paralysis or problems of use of the lowerlimbs apply moxa to GV-4 (Yoneyama and Mori1964) or GV-3 (Shiroda 1986). In general, for some-thing like cerebral palsy GV-8 can also be treatedwith moxa (Irie 1980), especially when there areproblems of muscle spasticity. Shiroda (1986) men-tions use of okyu on GV-12, BL-18, GV-3, and GB-34for “childhood polio,”which, given the rarity of thistoday, we can interpret to mean disorders resultingin diminished or lost use of muscles, with difficultyof use of the limbs. If you are thinking of trying the

direct moxa treatment, palpate the spine first tosee which points are more reactive (exhibit pres-sure pain, cause the child to flinch or move away)and applymoxa to themore reactive points.

Cupping and BloodlettingIn general these techniques are not mentionedmuchfor treatment of this range of problems. If you useeither technique be especially careful of dose, andlimit its use for children with locomotor problemsrather thanmental development problems.


Home TreatmentAs is illustrated in Case 1 above, giving the parentstools for home treatment can be very powerful as away of empowering the parents and speeding uptreatment progress. It is more difficult when thereare mental development problems to give advicefor home treatment. You need to spend more timeobserving the child’s responses to your treatmentsto better understand sensitivity and dose require-ments. But for other more physical developmentalproblems, the home treatment can be started assoon as feasible. Again, make sure that you exercisecare with the more rundown or very sensitivechild. For home treatment, using the simple combi-nation of soft stroking mixed with light tapping isusually a good idea.


The next case is of a child with a severe disorderdue to genetic mutation with physical, neurologi-cal, andmental developmental problems.

Case 2Dianne, Girl Age Almost 4 Years

Main complaints and history: Dianne had “Rett syn-drome.” She had a complex of problems that includedthe following:● Significant neuromuscular problems; repeated force-

ful hand-mouthing, and some biting of hard



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objects, resulting in irritation of skin of the handsaround the thumbs; excessive salivation

● Problems with locomotor coordination; poor gaitand instability walking; pronation of feet, espe-cially the right foot, left leg weaker and not as welldeveloped as the right leg; mild scoliosis; someweakness of arms and wrists

● Mental abnormalities and autistic tendencies● General problems such as the tendency to have

diarrhea and the need to continue wearing diapersbecause of the inability to self-regulate bowels orurine

Her parents were told that this condition can be pro-gressive and that she needed regular monitoring andpossibly strong interventions in the future.1 She hadno history of surgery or hospitalization. She receivedcraniosacral therapy regularly, and her parents weretrying a variety of different techniques at home tohelp with the locomotor problems and mentalabnormalities. Although her manifestations were sofar quite mild, it was unclear how far the problemsmight develop.However, she did not appear to beexcessively weak. We decided it was worthwhile try-ing a course of at least eight treatments to see whatthe treatment did for her.

Examination: She appeared to be quite wary andscared. It was difficult to remove the thumbs fromher mouth because of her lack of ease with the newsituation. The muscles over the neck, shoulders,back, jaw, and face were very stiff. Left deep pulsesstronger than right deep pulses. Abdominal diagnosiswas difficult, but indications of a little softness belowthe navel and depression in the lung reflex area onthe right.

Diagnosis: Lung vacuity pattern was chosen (basedon pulse and other findings). Stomach and/or largeintestine channel involvement was suspectedbecause of the jaw tightness and mouthing/bitingproblems.

Treatment: Using a herabari, light tapping wasapplied over the arms, legs, neck, shoulders, head,and back.

Light stroking was applied down the legs and abdo-men using an enshin.

Supplementation was applied to right LU-9 and SP-3using a teishin.

Stainless-steel press-spheres were applied to GV-12and bilateral BL-23.


At times, the pronation of the right foot was better.She seemed to have greater ease climbing the stairs,and had possibly shown a little more presence withher parents. The press-spheres had caused a minorskin irritation.

Treatment: Using a herabari, light tapping wasapplied over the arms, legs, back, abdomen, neck,shoulders, head, and jaw.

Light stroking with an enshin was applied down theback and the neck.

Using a teishin, supplementation was applied toright LU-9 and SP-3.

Stainless-steel press-spheres were left around GV-13and bilateral BL-23.


She was much more active than usual. She was hand-mouthing a little less, but biting things a little harder(as compensation?). Her hands were warmer. Sheseemed to be a little more functional and moreresponsive to parental requests.


Light stroking with an enshin was applied down thearms and legs.


Stainless-steel press-spheres were left around bilat-eral TB-17 and bilateral BL-52.


There were no clear changes to report. Maybe shewas hand-mouthing less, but it was not so clear.


Light stroking with an enshin was applied down thearms, legs, and back.



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1 The scoliosis, for example, is usually progressive so that Rettsyndrome sufferers often require surgery.


Stainless-steel press-spheres were left around bilat-eral ST-37 and bilateral BL-23.


She had had a bad flu the week before, but was nowrecovered. No clear changes in her condition.

Treatment: Tapping over arms, legs, abdomen,chest, back, neck, head, and jawwith the herabari.

Stroking was applied down the arms, legs, andback with the enshin.

Using a teishin, LU-9 and SP-3 were supplementedand left LR-3 was drained.

Press-spheres left at bilateral BL-23 and ST-40.


Treatment was very similar to the last visit.


Treatment was again similar to the last visit, with theexception of the insertion of 0.12-mm gauge needlesshallowly for about 30 seconds to GB-20. After thisthe parents reported a small reduction in the hand-mouthing and more use of the hands for pointing atthings.


Treatment was similar to the last visit.


The parents reported that her sleep was better, shewas walking better, hand-mouthing was better, andthat there was more use of her hands. She was moresociable and made more efforts at oral communica-tion. Because of this apparent success, the sametreatment as the last was repeated. This produced animmediate adverse reaction. She became very fearful,tired, and unwilling to walk. She needed to sleep a lotafter treatment. These symptoms persisted over thenext few days. It was obvious that she had been over-treated.


Her locomotor abilities had regressed this week,while her hand-mouthing remained somewhat im-proved. A lighter variation of the same treatment wasgiven with light needling at ST-36 instead of GB-20.A week later her walking was still not so good, andthe same treatment was repeated.

At this time my teacher Toshio Yanagishita was vis-iting. On consulting him it became clear that a muchlighter treatment should be given, eliminating thetapping with the herabari and replacing it with extre-mely light stroking with the teishin along the stomachand large intestine channels, down the abdomen andback and neck regions. He also advised that her pat-tern was a kidney pattern and that she should be treat-ed as such. He also commented that in cases like hersthe spleen was typically slightly replete, but that thisshould be treated by supplementing ST-36.


Treatment: Following the recommendations of Mr.Yanagishita, the treatment consisted of applying verylight stroking with the teishin down the large intestineand stomach channels on the arms and legs, twiceeach channel, down the abdomen twice, down eachside of the back twice, and down the neck twice, witha light rubbing with the enshin down the back of eachleg. Supplementation was applied to right KI-7, LU-5,and left ST-36.

This revised treatment worked better for Dianne,with more consistent improvement and no moreadverse reactions due to over-treatment. Over thenext 8 months, 22 similar treatments were appliedwith small variations. Her symptoms overall graduallyimproved. Occasionally draining techniques wereadded to points like TB-5, GB-37, BL-58. Press-sphereswere left on points like ST-36, GV-12, BL-23. At theend of these 8 months of treatments she went to aspecial clinic for a full evaluation of her condition. Thedoctors were very surprised that her scoliosis had notprogressed at all (usually it progresses in this syn-drome) and that her back seemed to be in quite goodshape. Her walking was clearly better. Her hand-mouthing was clearly better; she was also more com-municative and participatory. The medical team thatevaluated her recommended that the parents apply adaily tactile stimulation on her body by using softbrushes and brushing on the torso and limbs. The par-ents started doing this at home daily.



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Fifteen similar treatments were given over the next6 months. During this time, she becamemore partici-patory and started interacting with other childrenbetter. Her walking became more stable. However,she showed increasing signs of counterflow qi, withstronger and stronger emotional outbursts, especiallyangry outbursts, and showed repeated flushing ofthe face, neck, and shoulders. She became extremelyticklish, and showed increasingly difficult resistantbehavior. She would show signs of hyperactivity andsigns of extreme fatigue as well. While the hometreatments that the parents were doing daily seemedto be helping her physical coordination, it seemedthat she was being over-stimulated and had devel-oped counterflow qi reactions as a result. The parentswere advised about the possibility that this was hap-pening and that they should cut back on or stop thehome brushing. Also, after consulting Mr. Yanagishitaagain, the side of treatment was changed to the leftside and the treatment was made lighter again. Atthe 50th treatment supplementation was applied toleft KI-10 and LU-52 with right ST-36.

Following this change in treatment side, shestarted becoming less irritable, could sleep better,and showed fewer signs of counterflow qi. As shebecame calmer she became more communicativeagain. But the brushing was continued. Five similartreatments were applied over the next 2 months,then she returned to the special clinic for a furtherevaluation. They were very pleased with her progressbut stated that she seemed to be too sensitive to thetactile stimulation and that it should be cut back toonly a very small amount each day. Over the next8 months, 21 treatments were given. During thistime her concentration and social skills improved. Shetried using words more to communicate. She hadbeen assessed by another team and was found toshow skills with numbers and counting. She remainedcalmer, laughing and playing more. She was lessscared by change and was more nimble on her feet.Her parents were very pleased with her progress. It isnot possible to cure a child of Rett syndrome, but dur-ing the 29 months of treatment her condition did notbecome progressively worse, which is very unusualfor Rett syndrome. Her hand-mouthing and biting ofhard objects significantly improved, her locomotorcoordination improved, her communication skills

were better, as were her socializing skills. She showedsigns of understanding more things around her andwas better able to follow simple instructions in taskperformance.

The following case illustrates how my colleagueMourad Bihman from Berlin, Germany treated aboy with severe behavioral problems that had beendiagnosed as extreme hyperactivity by one doctorand autism by the next. As Mourad described it: “Iwanted to report on this case because of the incred-ible progress he made during the first treatments.It clearly shows how big the effect of minimum sti-mulation treatment can be on small children. WhatI also consider worth mentioning is that after thoseinitially tremendous changes it took time andpatience to make further progress.” This is oftenwhat we see treating children when the treatmentworks.

Case 3Bert, Boy Age 4½ Years

When Bert first came for treatment, he did not speak,meaning he did not form any words but made soundsto communicate (sometimes extremely high-pitchedscreaming). He did not stand still for a second andwas running around in the clinic, while his motherwas answering questions. He had a very short span ofattention, even if he seemed interested in something.His muscle tonus was very high and he had well-devel-oped muscles due to his permanent tension andmovement. He would tense up arms and/or legs orthe whole body every minute and then relax for a sec-ond before starting to run in circles again. He did nothave any social contact with his family because hewas very difficult to handle. He could hear well andfollow instructions but his restlessness and inability tocommunicate made social interaction almost impos-sible.

History: Until the age of 2½ years he developed nor-mally. He had started to speak, but later than others.Then, for no apparent reason, he became increasinglysilent and withdrew from the outside world. At thesame time he developed this extreme form of activityas described above. He was diagnosed as hyperactiveby one doctor and as autistic by another. He wasreceiving pediatric occupational therapy. He also had



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2 The he-sea points were used because of their recommendeduse for counterflow qi in the Nan Jing (Classic of Difficulties)

Chapter 68.

gluten intolerance, and after this diagnosis his dietwas changed to gluten-free. He took omega 3 and 6as prescribed by a doctor. No other therapy wasrecommended.

Assessment: It was not possible to take his pulse, feelhis channels or his abdomen for diagnostic assess-ment. He could not be persuaded to lie down on thetreatment table or to even stop moving. So, on thisfirst visit, he was treated underneath the table sincethat was a place he stopped to rest for a minute.

Diagnosis: The kidney vacuity pattern was chosenwith probable weakness of the heart channel.

Treatment: Using a teishin KI-7 and LU-5 were supple-mented on the left and HT-7 supplemented on theright.

While treating KI-7 he stared in awe and was com-pletely still and silent so it was possible to go on treat-ing LU-5 and HT-7 with appropriate low dose. This still-ness lasted for about 1–2minutes and he lookedastonished and relaxed. He was scheduled to come infor treatment twice a week.


He was calmer than usual on the way home andmoreperceptive on the evening of the treatment.

Treatment: A teishinwas used to supplement left KI-7,LU-5, and right HT-7.

Using a herabari, light tapping was applied over theneck and head, especially around GV-20.

Third visit—4-days later

The occupational therapist had for the first time beenable to work with him in a concentrated manner for20minutes. He was more interested in the worldaround him; calmer and better communicationseemed possible. He came in for treatment in anexcited (not overactive) state and was very keen to betreated (knocking on and opening the treatmentdoor several times then immediately jumping on thetreatment table).

Treatment: Using a teishin, left KI-7, LU-5, and rightHT-7 were supplemented.

Gold-plated press-spheres were placed on BL-23.


He was more relaxed again and seemed to be in agoodmood.

Treatment: The same treatment as the last visit, witha gold-plated press-sphere that was left on GV-12instead of BL-23.


He had been less restless.

Treatment: The same treatment was given as on thelast visit.

The sixth through eighth treatments were identicalto the fifth. After the eighth treatment, stroking ofthe yang channels using an enshin was added and themother was taught this stroking as homework to bedone daily using a spoon. The stroking was applieddown the arms, legs (stomach and bladder channels),down the back and down the abdomen.

Treatment continued for another 30 sessions withslight variations but all of them including stroking ofthe yang channels and with treating the combinationof KI-7, LU-5, and HT-7. Usually gold-plated press-spheres were placed on GV-12 but if this irritated himCV-12 was used instead.

He continued to make progress up to a stagewhere he was much calmer, more concentrated,more perceptive, and much easier to handle for hisfamily. His extreme hyperactive behavior significantlyimproved.

During the last 10 treatments there were nofurther signs of improvement so the parents decidedto take a break in treatment and continue with thehome treatment. It was not possible to get follow-upinformation on how he progressed after stoppingtreatment.

The following case from my colleague in Seattle,Brenda Loew, is of a girl with facial atrophy frombirth. Treatment was helpful to trigger more nor-mal functioning of the facial nerves that had beendiagnosed as damaged and non-functioning.



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Case 4Rebecca, Girl Age 3 Years

She and her family were vacationing in Seattle for thesummer when treatment began.

Main complaints: Rebecca presented with left-sidedfacial atrophy since birth. The doctors at that timehad diagnosed that three out of five facial nervesfunctioned normally, while two facial nerves did notfunction normally, resulting in no upper forehead flex-ion or downward frown function. She wakened occa-sionally at night and evidenced occasional irritability.Otherwise she had no other problems.

Examination: There was a “U” shaped area of weak-ness in the lower abdomen involving the entire ingu-inal area. The rest of the abdomen showed fairly goodluster and tone. The left wrist pulse was overallslightly weaker than the right.

Diagnosis: These two signs together indicated aclear liver vacuity pattern.

Treatment: Using a teishin, right LR-8 and KI-10 weresupplemented.

Light warmth was applied over the affected side ofthe face using a “Tiger warmer.”3

Light stroking was applied down the back using anenshin.


The parents had nothing to report.

Treatment: In addition to applying the same treat-ment as the first session, supplementation to left LU-9was added, as was light stroking with a needle4

around the eyes, eyebrows, mouth, face, and entirehead, particularly the left posterior skull region.


Since the last treatment she had had nerve conduc-tion exams, which determined that she did havenerve conduction in all five cranial nerves and thatthe muscles were slightly atrophied in the left fore-head andmouth area.

Treatment: The same treatment as on the secondvisit was repeated.


The parents had nothing to report.



Her mother had noticed more mobility in Rebecca’sleft cheek and side of themouth.


After this the family returned homewhere Rebeccacontinued receiving shonishin treatments from a col-league.

Two years later at age 5, Rebecca returned forfurther treatments. It was clear that she had signifi-cantly more mobility in her left mouth, forehead, andcheek. Her parents had recently separated and thechild appeared slightly irritable with mother andtherapist during the first treatment.

Treatment: On this first return office visit treatmentright LR-8 and KI-10 were supplemented using ateishin.

The region of the supraclavicular fossa5 was alsotreated using the teishin and sanshin techniques.

Acupoints on the face that felt more vacuous orreplete were also supplemented or drained accord-ingly.

Additionally, using the teishin, right BL-18 and leftBL-23 were supplemented as they felt vacuous and



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3 This is ametal tubular hand-held instrument that holds burn-ing incense within it. As the incense burns, the casing warmsup and one can apply a massage-like technique with theinstrument.

4 In Japan the technique is called the “sanshin” or contact nee-dle technique. There are many different styles of sanshin

among traditional acupuncture practitioners in Japan. Whentreating children it is important that the point of the needle isheld safely so that as the needle body is stroked lightly overthe skin the needle tip cannot prick the child.

5 This area is a target of treatment in the special Toyohari treat-ment system called “naso” (the word deriving from JapaneseBraille shorthand for cervicobrachial syndrome). SinceBrenda Loew is a Toyohari practitioner it is normal for her touse this treatment method as part of her Meridian Therapytreatment of patients.

the treatment ended with gentle stroking techniquedown the whole back with a yoneyama copper zan-shin.

There were two follow-up treatments approximatelya week apart, which were very similar to the treat-ment outlined above. She was doing very well andseemed calmer and happier.

In this case the partial facial paralysis improved sig-nificantly with treatment. The child was not offeredany treatments by her doctors, and improvements inher facial muscles only started after beginning acu-puncture in the first round of treatments. For furtherdiscussion of the treatment of facial paralysis seeChapter 28, page 243.

The following is a case of a rather dramatic degreeof improvement in a severely challenged smallchild frommy colleague PaulMovsessian in Sydney,Australia. It shows the remarkable power of thistreatment system to create unexpected changes.One can also see how Paul chose to use moxa everysession and the creative process hewent through tosearch for alternative treatments when certainsymptoms proved resistant to treatment.

Case 5Noah, Boy Age 4 Years

Main complaints: CHARGE syndrome. Formerlyknown as CHARGE association, this syndrome iscaused by a genetic disorder. It was first described in1979. In 1981, the term “CHARGE” came into use asan acronym for the set of unusual congenital featuresclustered together and seen in a number of newbornchildren. The letters stand for: Coloboma6 of the eye,Heart defects, Atresia of the nasal choanae,7 Retarda-tion of growth and/or development, Genital and/orurinary abnormalities, and Ear abnormalities anddeafness. These features are no longer used in mak-ing a diagnosis of CHARGE syndrome, but the nameremains.

History: Features noted at birth: right facial palsy,abnormal-shaped ears, excessive secretions needingsuctioning, and two toes joined together.

Unfolding of symptoms: Week 1: reflux, aspirationon feeding, large coloboma of left eye, PDA heartdefect.8 On day 7: CHARGE syndrome diagnosed. Day10: barium swallow test confirmed uncoordinatedswallowing and nasal gastric feeding continued.Month 2: ECG confirmed need to surgically repairPDA and repaired in month 3. Month 4: dischargedwith nasal-gastric feeding twice a day. Month 5: read-mitted with pneumonia and apnea. Month 6: severedeafness diagnosed and electrocochleography grom-mets inserted. Month 7: sleep study confirms centraland obstructive sleep apneas. Month 8: gastrostomytube inserted. Month 10: after apnea worsens,respiratory syncytial virus (RSV) diagnosed; after iso-lation respiratory failure occurs, transferred to ICUand intubated. Worsening of reflux, fundoplication9

performed. Month 11: BiPAP (Bi-level Positive AirwayPressure), a breathing apparatus that helps peopleget more air into their lungs, begins and apneaimproves markedly. Month 12: discharged with BiPAPand ventilator as well as bolus gastrostomy feedingtube. Month 22: severe ear infection, readmitted intohospital for 2 weeks on IV antibiotics. Month 25:grommets removed. Age 2 years and 6 months: plas-tic surgery to repair right ear so that two hearing aidscan be worn. Age 2 years and 9 months: glasses pre-scribed and began to walk with the aid of a walkingframe. Age 2 years and 10 months: readmitted tohospital for 7 days with bronchitis. Age 3 years and4 months: he walked for the first time unaided by aframe. Age 3 years and 8 months: he had a tonsillec-tomy.



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6 Coloboma: a congenital malformation of the eye causingdefects in the lens, iris, or retina.

7 Atresia of the nasal choanae: absence or abnormal narrowingof the passageway from the backof the nose to the throat.

8 PDA heart defect: patent ductus arteriosus (PDA) is a condi-tion in which the connecting blood vessel between the pul-monary artery and the aorta in fetal circulation, called theductus arteriosus, stays open in a newborn baby.

9 Fundoplication surgery: the upper curve of the stomach (thefundus) is wrapped around the esophagus and sewn intoplace so that the lower portion of the esophagus passesthrough a small tunnel of stomachmuscle. The valve betweenthe esophagus and stomach is strengthened and stops acidfrom backing up into the esophagus, allowing the esophagusto heal.

Initial visit—5 August 1998

Current symptoms: Poor balance; when walking hetended to fall over. He had asthma. He was fedthrough a gastric tube and had never had oral feed-ing. He had a problem with growth; he was underde-veloped, small, and frail. At age 4 years he weighedonly 12.8kg. He had difficulty gaining weight. Hishead was tilted to the side. He was still wearing dia-pers for enuresis and lack of bowel control. He hadvisual and hearing problems. His upper body strengthwas poor. He had right-sided facial palsy. The cause ofhis condition was unknown; his problems were beingmanaged but he was not improving.

Medications: Pulmicort (budesonide) 500ug/day(for asthma), Atrovent (ipratropium) 250mg/day(chronic obstructive pulmonary disease), Ventolin(salbutamol) 250mg/day (inhaler for asthma), Lacri-lube nightly (eye ointment), as well as a naturopathicmix three times a day. Non-prescribed: essential fattyacid.

Assessment: Frail, small, weak body type. Overallskin, channels, and abdomen all very rough andweak.

Diagnosis: Primary kidney vacuity pattern withspleen vacuity (based on symptoms and abdominaldiagnosis).

Treatment: On the initial visit a lot of time wasneeded to deal with the complexity of the history aswell as to build trust with the child. He was quite ner-vous and mistrustful due to his experiences with pastmedical procedures and discomfort. The treatmentwas kept short and light to assess his response.

Using a copper yoneyama and alternating with astainless-steel enrishin, the core non-pattern-basedroot treatment was applied using a combination oflight tapping and rubbing down the arms, legs, abdo-men, back, and neck with a total time of about 2min-utes.

Okyu/direct moxa was then applied on GV-14,GV-12, and GV-4, one cone on each.

Treatment ended with the mother and child beingpleasantly surprised how simple, painless, and plea-sant the treatment was.


The mother commented how much he had enjoyedthe treatment and was looking forward to returning.She reported that he had been much calmer and hisbreathing had improved this week.

Treatment: Same treatment as the previous week,using the same tools andmoxa.

Mild heat massage was added using the “thermiewarmer” over KI-27 bilaterally and BL-11 to BL-13bilaterally.10

A press-sphere was placed on GV-12—the motherwas instructed to remove it in 3 days.

A treatment plan was discussed with Noah’smother: to give treatment twice a month for severalmonths to evaluate if it was possible to help Noah.


He had been calmer again, his breathing hadimproved further, and his balance was better withless falling over and bumping into things.

Treatment: Same treatment as the first visit, usingthe same tools andmoxa.

The mother was taught to apply the “assisted sotaimethod of tickle therapy.”11


He had been calmer again with improved breathingand balance. His appetite and eating had markedlyimproved and the mother had decided to see the sur-geon about the removal of the feeding tube.

Treatment: Same treatment as the first session,using the same tools.

Moxa was increased to two cones to each point andadditional points in the intervertebral spaces aboveand below GV-14; GV-13 and GV-4 were added.



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10 The thermie warmer is another name for the “Tiger warmer”;see note 3 above.

11 Sotai is a very gentle “exercise” system aimed at looseningtight muscles to create more symmetric muscle tonusthroughout the body. The system was developed by KeizoHashimoto (see Hashimoto and Kawakami 1983; Manaka,Itaya, and Birch 1995). This exercise consists of tickling thechild to provoke a lot of randommovements.

The mother was taught to apply the core non-pat-tern-based root treatment at home using the disposa-ble Seirin shonishin tool.


Everything had continued to improve. The surgeonhad removed his feeding tube and he was eating with-out the tube for the first time. The scar at the removalsite had a small thrush infection from the stomachacid that was irritating it and therefore was healingslowly.

Treatment: Same treatment as the first session,using the same tools.

Moxa was reduced to one cone each on GV-14 andGV-12.

Continued home treatment using the core non-pat-tern-based treatment was encouraged.


Noah had further major changes in his condition thisweek. His sleep apnea was resolved and he had nofurther signs of eczema. He had not taken any asthmamedications for 4 weeks since his asthma had signifi-cantly improved. His food tolerance was getting bet-ter. His balance had improved a lot. His mother askedif treatment could now focus on the enuresis as thatwas now themain problem.

Treatment: The core non-pattern-based root treat-ment was applied using the yoneyama instrument.

Light stroking was then applied using the enrishinalong the kidney, bladder, lung, and large intestinechannels.

One cone of moxa was applied to each of GV-14,GV-13, GV-4, and points located between the verteb-rae, above and below these three, bilateral BL-23, andCV-6.

I also asked the mother to add light stroking of thekidney channel into the home core non-pattern-basedroot treatment, focusing on the legs along with theflow of the channel.


Noah was doing well but there was no change in theenuresis or control of bowels.

Treatment: The core non-pattern-based root treat-ment was applied using the yoneyama.

One cone of moxa was applied to each of GV-14,GV-13, GV-4, and points located between the verteb-rae, above and below these three, also to CV-12, CV-9,bilateral ST-25, and CV-6.


Again all other problems still doing well but noimprovement in enuresis or control of bowels.

Treatment: The core non-pattern-based root treat-ment was applied using the yoneyama and enrishin.

One cone of moxa was applied to each of GV-14,GV-13, GV-4, and points located between the verteb-rae, above and below these three.

The thermie warmer was applied over scars on theabdomen and scapula areas.

For home therapy the mother was instructed toadd gentle rubbing of the scars using a soft tooth-brush.


He hadmissed last week’s treatment due to a hospitalvisit to sew the feeding tube hole closed. He did verywell after the hospital stay, recovering much quicker.Again, all other problems still doing well but noimprovement in the enuresis.


One cone of moxa was applied to each of GV-12,GV-11, GV-10, GV-9, CV-12, and CV-6. Using the Man-aka hammer and metronome, bilateral SP-6 wastapped at the channel frequencies of the spleen, liver,and kidney channels (10 taps per channel frequency),GV-14at the frequencies of all the yang channels (10taps per channel frequency) and at GV-20 (at du maifrequency).12

As additional home therapy themother was taughtto use Ibuki moxa on points from GV-12 to GV-9 andCV-12 and CV-6.13



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12 Tapping with the Manaka hammer at frequencies corre-sponding to the main channels using a metronome for timingis described in Manaka et al. (1995, pp. 71–72, 242–243, 253–258) and Birch and Ida (1998, pp. 243–257).

13 “Ibukimoxa” is a techniquewheremoxa is prepared on a plat-form that is stuck to the skin so that themoxa can be removedif it gets too hot. It is amenable to home moxa therapy (seeBirch and Ida 1998, pp. 130–133).


This week Noah had, for the first time, told his motherthat he needed his diaper changed. He had startedshowing the first signs of recognizing what was hap-pening with his bowels and urine.


One cone of moxa was applied to each of GV-14,GV-12, bilateral BL-18, and BL-20.

Using the Manaka hammer and metronome, bilat-eral SP-6 was tapped at the channel frequencies ofthe spleen, liver, and kidney channels (10 taps perchannel frequency), GV-14 at the frequencies of allthe yang channels (10 taps per channel frequency)and at GV-20 (at dumai frequency).

Christmas holidays forced a break in treatment butthe mother agreed to continue with home treat-ments.


All improvements had held and he remained comple-tely off any asthma medications. His temperamentand development had both improved since treat-ments began. His balance was good, the sleep apnearemained resolved, and still no signs of any eczema.Themain concern was still the enuresis.


One cone of moxa was applied to each of GV-12,bilateral BL-18, BL-20, and BL-23.

Using the Manaka hammer andmetronome, CV-12was tapped 10 times at the ren mai frequency.

A press-sphere was placed to CV-3.


He had had a very good week. The stools were moreformed, he had had no temperature fluctuations andno seizures. He started to express himself emotionallyfor the first time.


One cone of moxa was applied to each of GV-12,bilateral BL-18, and BL-20.

Thirteenth visit—2 weeks later

He was doing very well. He had gained some weight.The seizures were very infrequent and breathing stillvery good.


One cone of moxa was applied to each of GV-12,GV-4, left BL-18, and right BL-20.

Cupping with low dosage was applied to the dumaion the upper body, the bladder channel on the lowback, CV-12 and CV-8, retaining the cups for 1minuteat each location.


His overall condition had improved markedly butchanges in enuresis and bowel movements wereminimal.


One cone of moxa was applied to each of GV-12,bilateral BL-18, BL-20, and SP-4 (which was open onthe ling gui ba fa open point cycle14).

Cupping with low dosage was applied to the dumaion the upper body, the bladder channel on the lowback, CV-6 and CV-8, retaining the cups for 1minuteat each location.

While very pleased with treatment progress, due tothe lack of significant change in the urinary and bowelproblems, Noah’s mother chose to stop treatmenthere and reschedule later as needed.



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14 SeeManaka et al. (1995: 167–175).

25 Weak Constitution

This is a broad category that refers to the child whofrom birth has been having recurrent problemsbecause of a constitutional weakness. In theirdescription of this, Yoneyama and Mori (1964)recommend the basic core treatment and thenadditionally the use of moxa on BL-18 and BL-20and possibly GV-12, which would seem to targetrespiratory and digestive symptoms. Shimizu (1975)differentiates three basic types of “weak constitu-tion”: (1) the “respiratory type” with chronicrespiratory symptoms, (2) the “digestive type”withchronic digestive symptoms, and (3) the “combinedrespiratory and digestive type” with chronic diges-tive and respiratory symptoms, and he providesmore extensive treatment descriptions. However,as aMeridian Therapist I think that the descriptionsof this category are limited. Following the patternsin Meridian Therapy, I identify four distinct weakconstitution patterns, based onwhich I recommenddifferentiated treatments.1

There are some important features associatedwith these weak constitutions. The problems areusually present from birth, though it is possiblethat they can be caused by accidents or infectionsafter birth, starting soon after those events. Thereare often signs apparent in the structure and buildof the child, for example being thinly muscled,small-boned, having a flat rib cage, shoulderspulled back (Shimizu 1975). The child is often verysensitive (Shimizu 1975; see discussions of sensi-tivity in Chapter 4) and usually has one or moresymptoms present all the time. His or her problemsmay respond to regular medical therapy such as

drug interventions, but recur soon after the therapyis discontinued. Some types of constitutional weak-ness can recover with treatment, other types can-not. For the latter types (such as autism, mentalretardation, birth defects, severe cerebral palsy),the words of my teacher Toshio Yanagishita arevery important: you have to be realistic, you cannotfix these problems, but you can help lessen theirmanifestations, improve quality of life, and help theparents in their continuous efforts to care for theirchild. There are some caseswhere youmay feel thatyou really can’t do anything because the problemsseem so severe. When such feelings occur, youneed to deal with the following:● Put aside your own insecurity in the face of such

problems and remember that it is most likelythat this child will not improve if left untreated.Therefore, trying a few treatments to see if any-thing seems to change is a not unrealistic invest-ment for the parent.

● Making a realistic assessment of what is possibleand informing the parent of that—for example,stating to the parent of an autistic child that youcannot cure the autism, but you will try treat-ments that you and they may apply, to see if youcan make its manifestations easier to deal with.In this case, you are giving the parents tools forhelping daily life with their child. You are notonly trying to help the child have fewer symp-toms, but you are also helping the parent devel-op more caring and management skills; you arenot trying to “cure” the child.

● Think about an adjusted cost of treatment forthe parents as theywill be likely to need to comeback over the long term once you have agreedthat that is worthwhile trying.

● Trust the judgments of the parent with regard toassessing how the child is doing.When you see achild only once a week and do not have to parti-cipate in their daily care, it can be difficult foryou to see improvements. Sometimes the parentis very happy because certain seemingly smallactivities each day have improved. You wouldnot have obtained information about thesethings in your normal course of questioning, and



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203

1 I do not follow another idea of Shimizu who describes thebroad category of “kanmushi” (see Chapter 21) as a sign ofweak constitution and then relates this to evolving 20th-cen-tury models of developmental stages (Shimizu 1975). I preferto stay within the framework of traditional acupuncture as itallows both the usual core non-pattern-based root treatmentapproach AND a specific pattern-based treatment approach,which in my experience is usually more rapid acting thaneither alone. It is not only to do with how I treat patients butpractically it allows two different root treatment approachesthat can be used together.

thus would not have been able to notice anyimprovements. An example of this might be anautistic child trying to socialize more with theother children and play more with them at thespecial daytime child care center (somethingthey never did before) or trying to verbalizemore to the parent.

● Treatment is often needed over a long period oftime, hence recommending home therapy canbe a big advantage.

The LungWeak Constitution Patient

There are a number of different ways that this canmanifest:● Recurrent infections affecting the lungs (colds,

“flu,” bronchitis, pneumonia), triggering recur-rent infections in the nose and/or ears

● Chronic respiratory problems such as asthma,croup (in infants and younger children)

● Chronic skin problems such as eczema, atopicdermatitis

● Severe, often multiple, contact or airborne aller-gies (“allergic constitution”)

● The skin is often thin and feels more fragile.Sometimes veins are more clearly visible underthe skin, such as on the chest and cheeks

The SpleenWeak Constitution Patient

This weak constitution manifests usually in a fewcommonways:● Chronic weakness of the digestive system, often

with chronic loose stools or diarrhea● Poor appetite, and in the infant severe problems

with regurgitation, vomiting● Severe, often multiple, food allergies (“allergic

constitution”)● Problems with weight gain, i.e., the “failure to

thrive” child that falls below the normal growth(weight/height) curve; this child is often skinny,fatigued, and less active

The KidneyWeak Constitution Patient

This usually manifests from birth with develop-mental problems, both mental and physical. It canalso start postnatally due to, for example, accident,

head trauma, infection. In this general category areincluded cases of mental development problems;abnormal development of the body (parts of thebody that do not develop properly such as limbs,spina bifida); birth traumas leading to, for example,cerebral palsy; sequelae of infections such as loss ofnormal locomotor function resulting from polioinfection. Thus, the general category includes casesof:● Autism,mental development or retardationprob-

lems● Structural, locomotor problems, balance/gait

problems● Paralysis or inability to use the limbs● Major organ dysfunctions or non-functioning

organs (such as no bladder control)

The LiverWeak Constitution Patient

The most common manifestation of this problem issevere behavioral problems starting soon after birth.Another manifestation is abnormality of the mus-cles, such as excessive muscle stiffness in commonareas, or muscle problems resulting from growthspurts in older children. For the child who has beha-vioral problems, the excessive stiffness can aggravatethe problems. This category thus includes cases of:● Severe sleep disturbance● Severe irritability, crying, temper tantrums● Severe behavioral problems● Stiff muscles most commonly over the neck,

shoulders, upper andmid-back● Pain in the muscles due to poor adaptation and

strain following growth spurts.

Case 1Mary, Girl Age 8Weeks

Main complaints and history: From birth Mary hadhad severe airborne allergy problems, triggeringsevere asthma attacks. Since birth, she had been hos-pitalized six times with these asthma attacks. Eachtime she was discharged from the hospital with asth-ma medication to control the problem, she wouldwithin days be having severe asthma attacks againand would have to go to the emergency room at thehospital to be readmitted. Her mother called fromthe hospital on a Sunday morning to request treat-



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ment that afternoon. Mary was being dischargedaround noon and her mother was concerned thesame problems would recur, something the doctorshad said was very highly probable. It was arrangedthat I would meet her and Mary at the clinic straightfrom the hospital. Mary had no other symptoms.Sleep and appetite were generally OK.

Diagnosis: While it was clear to me that Mary had alung weak constitution (strong lung vacuity pattern), Iwas afraid that the general or core whole body sho-nishin treatment method with treatment of the lungvacuity patternwould not be fast-acting enough to pre-vent an attack and subsequent hospitalization. I wasalso concerned that Mary’s family was living in a poorhousing neighborhood in the Boston area and that shewas being exposed to allergens that her parents couldnot eliminate from their apartment.2 On the basis ofthese concerns I decided to try strongermeasures.

Treatment: For the lung constitutional weakness Idecided to do okyu/direct moxa on Mary. Afterexplaining what I planned to do and getting hermother’s permission to continue, I had the mothertake Mary’s clothes off and hold Mary over hershoulder so that I could easily get to GV-12 on theback. I applied okyu (half to three-quarter rice grainsize) and did nothing to control the heat or put themoxa out early. I wanted to trigger the immunologi-cal and anti-inflammatory effects of the moxa asstrongly as possible. Expecting Mary to cry out orscream because of the heat of the moxa, her motherand I were very surprised when Mary instead took adeep breath as the heat of the moxa penetrated andthen relaxed even more over her mother’s shoulders.I applied two more cones of moxa—Mary respondedthe same way each time. There was a yellow mark onthe skin (which did temporarily blister). No otherdirect treatment was given on this visit.

After Mary was dressed, I then brought out myback-up high-powered air-filtering system (which caneliminate particles, dust, and chemicals from the

air).3 I explained to Mary’s mother that she could bor-row the machine until she could afford to buy oneherself. She should leave it running continuously inthe room where Mary spends most of her time, leav-ing the doors open so that it additionally cleans theair in the other rooms (they lived in a small apart-ment). My plan was to reduce almost to zero what-ever the airborne allergen was, whilst administeringstrong treatment to trigger a rapid change in her lungweak, allergic constitution.

Mary returned the next 2 days for treatment. On eachoccasion treatment was applied only with moxa toGV-12. She had a small blister on this point. After thethird session it was clear that Mary was, for the firsttime, having no allergic asthma symptoms. I then hadher brought back for treatment weekly for the basiccore shonishin treatment using the combination ofrubbing and tapping. On the first of those treatmentsessions I taught her mother how to apply the treat-ment daily at home. I applied weekly treatment, withthe mother applying daily home treatments over thenext 3 weeks. The blister completely healed withhardly a mark and Mary never had another asthmaattack (at least over the few next years that I was ableto track how she was doing).

General Approach for Patients withWeak Constitution

You must assume from the start that the child ismore sensitive than other patients. Thus, trying asofter, milder treatment to begin with is generallyimportant (review Chapter 4 for discussions of thisand Chapter 7 for discussions of how to modify thecore treatment). Once you have an idea of how thechild responds to treatment, you can graduallyincrease the dose by adding in or replacing treat-ment methods.

Figuring out a simple core non-pattern-basedtreatment and using that regularly is important, asis teaching the parent to start using this at home.Applying a simple pattern-based treatment accord-ing to the pattern type of constitutional weaknessis also important. Here it is often useful to focus onthe manifestations and symptoms to choose the



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25 Weak Constitution 205

2 There had been reports in the United States about whyasthma was virtually epidemic among children in the Bronx.The cause, it was found, was that the poor housing wasinfested with high levels of cockroaches and the feces of thecockroaches were airborne in high concentrations, triggeringthe asthma attacks in children.While living in such housing itcan be next to impossible to eliminate the cockroach prob-lems from one’s apartment as not only the whole house willbe infested but thewhole neighborhood.

3 At that time I had been treating patients with environmentalsensitivity and needed to keep such an air-filtering systemrunning 24 hours a day in the clinic.

pattern rather than the usual diagnostic methodsof pulse and abdomen. Some patients show com-bined constitutional weakness, such as the patientwith severe atopic dermatitis with airborne, con-tact, and food allergy triggers (combination of lungand spleen types); the child who has both severeeczema since birth and does not gain weight due tofood allergies, poor appetite, chronic diarrhea(combination spleen and lung types); the childwith mental development problems, severe gastro-intestinal disturbance with food allergies (combi-nation kidney and spleen types).

Goals of Treatment

Treat to improve the constitutional weakness.Where feasible, apply treatment to target symp-toms. For example, for the child with mental retar-dation, symptomatic treatment can be difficult, butthe root treatments (pattern-based and core non-pattern-based) can start creating change in dailyactivities and parental care of the child.

Root Treatment for the LungWeakConstitutionType

Core Non-pattern-based Root TreatmentLightly stroking down the arms, legs, back, abdo-men and chest (do not do this if the child has skinproblems; see Chapter 19 on skin problems). Lighttapping around GV-12.

If the child has respiratory problems additionaltapping can be applied around LU-1, and the areaaround ST-12 (see Fig.25.1).

Lung Vacuity PatternTreatmentApply supplementation to LU-9 and SP-3. If thechild is very rundown and weak, the skin feels toosoft or loose, also supplement bilateral TB-4 orST-36. Generally do not apply draining techniquesuntil the child is stronger. If the child has severeskin symptoms try LU-5 and SP-9 instead of LU-9,SP-3 for the treatment of the primary pattern.4

Additional TreatmentPlace a press-sphere or newpress-tack to GV-12.

If the symptoms in the lungs are very severe orthere are recurrent infections, try applying okyuinstead to GV-12.

If the child has chronic skin problems, tap orapply moxa to the relevant large intestine channelpoints (see Chapter 19, pp.118 and 119) instead ofapplying the core non-pattern-based root treat-ment with stroking and tapping.

Shimizu’s (1975) recommended treatments forthe “respiratory type” are useful to consider. Okyu/direct moxa can be applied to BL-12, GV-12, GV-10,LU-5, or LU-6, BL-23 with needling of KI-26, LU-1,BL-11, BL-17, depending on current symptoms(such as easily fatigued, easily catches cold, recur-rent fevers, swollen tonsils, bronchitis, chronicallyswollen lymph nodes in the neck) and reactions inthe acupoints. This list of acupoints offers addi-tional options to be added over successive treat-ments on top of the core root treatment methods.



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Fig.25.1 Lightly stroke down:● Down the back (bladder channel)● Down the abdomen (stomach channel)● Down the legs (stomach and bladder channels)● Down the arms (yang channels)● Across the chestFor a lung pattern add tapping:● Around GV-12, possibly LU-1 and ST-12 regions

4 This recommendation comes from my teacher Akihiro Takai(personal communication). According to Nan Jing (Classic of

Difficulties) Chapter 68, he-sea points are good for “counter-flow qi”manifestations.

Root Treatment for the SpleenWeakConstitutionType

Core Non-pattern-based Root TreatmentLightly stroking down the arms, legs, back, abdo-men, and chest. Apply light tapping around GV-12,CV-12, and from GV-3 to GV-4. The area aroundST-36 to ST-37 can also be lightly tapped. It can alsobe helpful to lightly tap around BL-18 and BL-20(see Fig.25.2).

Spleen Vacuity PatternTreatmentApply supplementation to SP-3 and PC-7. If thechild is very rundown and weak, the skin feels toosoft or loose, also supplement KI-3 on the otherside and bilateral ST-36. Generally do not applydraining techniques until the child is stronger.

Additional TreatmentPlace press-sphere to GV-12. Also place press-spheres to BL-18 on one side and BL-20 on theother.

If the child is not responding sufficiently totreatment and/or the symptoms are very severe,apply okyu instead to BL-18 on one side and BL-20on the other. The general rule for selecting side is:for boys, left BL-18, right BL-20, and girls, rightBL-18, left BL-20. Although some moxa specialistsrecommend applying the moxa bilaterally (Irie1980), it is better to use this contralateral treatmentas it reduces the number of points you have to treat,reducing by half the amount of irritation and dis-tress the treatment can cause. A press-sphere canbe placed at CV-12 aswell, if reactive.

If the child has food allergies, apply moxa to theextra point uranaitei (below nei ting—ST-44) on thebottom of the foot. This is a special point for foodallergies (see Chapter 16, p.88 for the point loca-tion).

Shimizu’s (1975) recommended treatments forthe “digestive type” of weak constitution are usefulto consider. Okyu/direct moxa can be applied toGV-12, BL-23, right BL-18, left BL-20 with needlingof CV-12, KI-16, or ST-25, LR-13, ST-36, dependingon current symptoms (such as poor appetite, fre-quent abdominal pain, diarrhea) and reactions inthe acupoints. This list of acupoints offers addi-tional options to be added over successive treat-ments on top of the core root treatment methods.

Root Treatment for the KidneyWeakConstitutionType

Core Non-pattern-based Root TreatmentLight stroking down the arms, legs, back, abdomen,and chest. Light tapping around GV-12 and GV-3. Ifthe problems are of mental development, palpatethe occipital region, if stiff, apply a light tappingthere and around GV-20 (see Fig.25.3).

Kidney Vacuity PatternTreatmentApply supplementation to KI-7 and LU-8. In a kid-ney pattern such as this, it is not uncommon thatthe spleen is replete, but this is difficult to see. Tocounterbalance this, supplement ST-36 on theother side. If the main problems are of mentaldevelopment, and the child is easily agitated, tryusing KI-10 and LU-5 instead of KI-7 and LU-5.5



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Fig.25.2 Lightly stroke down:● Down the back (bladder channel)● Down the abdomen (stomach channel)● Down the legs (stomach and bladder channels)● Down the arms (yang channels)● Across the chestFor a spleen pattern add tapping:● Around GV-12, CV-12, GV-3, and possibly around● ST-36–ST-37, and BL-18–BL-20

5 This recommendation comes from my teacher Toshio Yana-gishita (personal communication). This too is based on theNan Jing Chapter 68 recommendation about he-sea points forcounterflow qi issues.

Additional TreatmentIf the child has symptoms of the upper limbs orupper part of the body, direct treatment to GV-12 ifthere is paralysis or problems of use of the upperlimbs and around GV-3 to GV-4 if the problem is inthe lower limbs. You can start gently by usingpress-spheres or press-tack needles.

If the symptoms are stronger or the child doesnot respond to the milder treatment, it is better touse okyu/direct moxa on these treatment points,GV-12 for upper limbs, GV-3 or GV-4 for lowerlimbs.

It can also be helpful to leave press-spheres atBL-23 to help reinforce your treatment of the kid-neys. If the child has mental development prob-lems, and shows signs of agitation, inspect the backof the ears behind shen men and if the skin looksless lustrous, drier, different, leave a press-spherethere.6

Root Treatment for the LiverWeakConstitutionType

Core Non-pattern-based Root TreatmentLightly stroking down the arms, legs, back, abdo-men, and chest. Apply light tapping around GV-12,GV-9, and BL-18.

If the child has behavioral problems additionallight tapping can be applied around GV-20, occipi-tal region, and LI-4 (see Fig.25.4).

Liver Vacuity PatternTreatmentApply supplementation to LR-8 and KI-10. If thechild has problems of muscle pain rather thanbehavioral problems, try using LR-3 and KI-3instead.7



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Fig.25.3 Lightly stroke down:● Down the back (bladder channel)● Down the abdomen (stomach channel)● Down the legs (stomach and bladder channels)● Down the arms (yang channels)● Across the chestFor a kidney pattern add tapping:● Around GV-12 and/or GV-3, possibly around GV-20 and

the occipital region

Fig.25.4 Lightly stroke down:● Down the back (bladder channel)● Down the abdomen (stomach channel)● Down the legs (stomach and bladder channels)● Down the arms (yang channels)● Across the chestFor a liver pattern add tapping:● Around GV-12, GV-9, possibly around GV-20, GB-20,BL-18, and LI-4

6 Mike Smith from the Bronx in the United States recom-mended this point for childrenwith ADHD (personal commu-nication). I have found it also useful for children with mentaldevelopment problems and agitation.

7 This recommendation comes from Akihiro Takai (personalcommunication). Nan Jing Chapter 68 recommends shu-streampoints for joint pain.

Additional TreatmentPlace a press-sphere on GV-12. If the behavioralsymptoms are severe, insert needles to LI-4, GB-20area and possibly GV-20. Following Mike Smith’srecommendation (see footnote 6), I find leaving apress-sphere on the ears behind shen men can behelpful for behavioral problems.

If the condition is non-responsive or the symp-toms more severe use okyu/direct moxa on GV-12,and for muscular problems GV-8.

For other treatment options for manifestationsof each of theseweak constitution types see the fol-lowing chapters:● Lung weak constitution—Chapters 18, 19, 21, 26,

27● Spleenweak constitution—Chapters 20, 21● Kidneyweak constitution—Chapter 24● Liver weak constitution—Chapter 21

Additional General Recommendations forTreatment ofWeak ConstitutionHyodo (1986) makes the following additionalrecommendations for the general treatment of“weak constitution”: lightly needle and/or leavepress-spheres at GV-12, GV-4, BL-18, BL-20, BL-23.

For the combined “respiratory and digestive”type of weak constitution Shimizu (1975) recom-mends use of okyu/direct moxa on GV-12, GV-10,LU-6, BL-23, right BL-18, left BL-20 with needling ofCV-12, KI-16, LR-13, ST-36, selecting acupoints onthe basis of current symptoms and point reactions.


The following case from my colleague Sue Preadywho practices in Swindon and Cardiff in the UnitedKingdom, is a good example of the less commonliver weak constitution type. Naomi respondedwell to treatment of her complicated problems.

Case 2Naomi, Girl Age 10 Years

Main complaints and history: Back pain for the last18 months. Whilst in the midst of a growth spurt shehad strained her back in physical education class, andher back did not recover. She had always been suppleand slightly hyperextensive, which was agitated by

the growth spurt. The pain started as pain in the heeland Achilles tendon in the right foot, traveling up tothe sacroiliac joint. She also had pain in the bladderarea, and found it painful to urinate, resulting in theadditional problem of constipation during the lastsummer. The year before she had been virtuallyimmobilized by the pain and had to be admitted tohospital. She was now under pain management at aspecial unit at the local hospital. While taking diclofe-nac she still had pain and had to skip certain schoolactivities such as gym, and morning assembly atschool. Her walking was now slightly better but stillvery difficult. She needed help going up and downstairs. She struggled to walk into the treatment room.The pain was worse at lunchtime when the effects ofthe tablets wore off.

Medication: Diclofenac: half adult dose (25mg 3×a day for about 6 months) and paracetamol as andwhen needed.While the painmanagement strategieshad been helping make her more functional, she stillhad pain regularly and was limited in many physicalactivities such as climbing stairs, running, and so on.

Physical appearance: Tall for her age, slim, fair,unblinking blue eyes. Musical and intelligent, she wasthe youngest of three children. She had some sleepproblems. Sometimes she wasn’t able to fall asleepbecause of the back pain, or the pain would wake herup about 3 or 4a.m. She had been having some head-aches, thought to be from the tablets she had to take.

Appetite: Goodmixed diet. She liked spicy food.

Diagnosis: The kidney, liver, and spleen areas of theabdomen showed signs of reaction. Her pulse wasslightly floating, slightly rapid and weak. Weakestpulses: liver and kidney, spleen. Conclusion: livervacuity pattern with spleen also vacuous.

Treatment: Since she was a more mature girl, thecore non-pattern-based root treatment was not used.She was not particularly afraid of the treatment.

Using regular needles8 supplementation wasapplied to left LR-8, KI-10, and right SP-3. Right ST-40and BL-58 were drained.



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8 In the style and using the methods of the Toyohari system ofMeridianTherapy.

Symptomatic treatment: Using the theory of mid-day–midnight, LU-7 was supplemented to helpreduce symptoms in the bladder.


The hip had felt better for 3 days. The bladder prob-lemwas a bit easier, not hurting asmuch.

Treatment: Using needles, left LR-8, KI-10, and rightLU-9 were supplemented. Draining was applied toright SI-7.

CV-6, BL-18, and BL-23 were supplemented bilater-ally to support the root treatment.

Light stroking was applied down the back and thebacks of the legs using an enshin.

A press-sphere was retained at GV-12 as home ther-apy.

Light needling was applied to tight areas in the lat-eral abdomen regions and around the right hip.9

Amoxa cigar was applied over the spine to warm it.


The hip felt better and she was finding it easier towalk. The bladder did not hurt as much as beforestarting acupuncture.

Treatment: Using regular needles, left LR-8, KI-10,and right LU-9 were supplemented. Right SI-7 andGB-37 were drained.

CV-6, BL-18, and BL-23 were supplemented bilater-ally to support the root treatment.

Press-spheres were retained at GV-12, right BL-18,and left BL-23 to support the root treatment.

Light needling was applied to tight areas in the lat-eral abdomen regions and around the right hip andthe supraclavicular fossa region.10

Chinetsukyu/warm moxa was applied to CV-3 forthe bladder.

LU-7 was also supplemented with a needle to helpreduce symptoms in the bladder.


She had found it harder to control her urination thisweek. She had stumbled and fallen the day before butrecovered well. The hip felt all right, though she hadbeen woken by pain two or three times this week. Shewas also having problems with nosebleeds (reportedby hermother to be due to the diclofenac).

Treatment: Examination showed a kidney vacuitypattern rather than the usual liver pattern.

Using regular needles, left KI-7, LU-5, and right SP-3were supplemented. Left SI-7 and LI-6 were drained.

BL-13 and BL-23 were supplemented bilaterally tosupport the root treatment.

Press-spheres were retained at GV-12 and bilateralBL-23.

Light needling was applied to supraclavicular fossaregion.

Amoxa pole was applied over the spine to warm it.


She continued having problems with nosebleeds.Sometimes she found it difficult to fall asleep becauseof the hip pain. However, while the hip had beenquite sore she had still been able to get down stairs byherself using the banisters as support. Urination stillhurt but seemed overall easier.

Treatment: Examination showed the usual liver va-cuity pattern.

Using regular needles, left LR-8, KI-10, and right LU-9were supplemented, left GB-37 and BL-58 drained.

Light stroking was applied down the back and thebacks of the legs using an enshin.


Press-spheres were retained at GV-12, left BL-18,and right BL-23 to support the root treatment.

Light needling was applied to lower abdomen andsupraclavicular fossa regions.

Amoxa pole was applied over the spine to warm it.


This week she had found it easier to get down stairswithout help.She had had a problem with alternatingdiarrhea and constipation. She was able to urinatemore freely now with less distress. But she had stillhad problems with nosebleeds the last twomornings.Because she was feeling better she had tried cuttingout the lunchtime tablet of diclofenac.



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9 This is called “muno” treatment in Toyohari (Fukushima1991; Birch and Ida 2001; Yanagishita 2001b).

10 This is called “naso” treatment in Toyohari (Fukushima 1991;Birch and Ida 2001; Yanagishita 2001a).

Treatment: An overall lighter treatment was applied:Using regular needles left LR-8, KI-10, and right LU-9

were supplemented, left GB-37 and BL-58 drained.Light needling was applied to the lower abdomen

region.A mild warm moxa pole technique was applied

over the abdomen for the bladder.


She was still having problems with nosebleeds, buthad been all right without the lunchtime tablet ofdiclofenac. Her pain overall was better. Urination wasnowmuch better.

Treatment: Treatment was similar to the previoussession.


She was much better, and some days she did not takethe diclofenac. Urination had improved further. Nose-bleeds were less frequent and sleep was better, butone day before this visit she had fallen over and irri-tated her back and hip.

Treatment: Using regular needles left LR-8, KI-10,and right SP-3 were supplemented.




Amoxa pole was applied over the spine to warm it.Okyu/direct moxa was applied to josen (an extra

point below L5; see Chapter 16, p.88).


She reported that she was doing well. She could nowgo up stairs on her own. She was walking more, hadmore stamina, and was coping better. Urination wasstill a bit uncomfortable but much easier. She was stillhaving some problems with nosebleeds at night. Shehad only taken diclofenac once or twice a week. Over-all sleep was better, abdominal discomfort better.

Treatment: Using regular needles, left LR-8, KI-10,and right SP-3 were supplemented.




Amoxa pole was applied over the spine to warm it.Okyu/direct moxa was applied to josen and BL-28.After this, the next four visits were similar as she

continued improving.

Fourteenth visit—4months later

She was doing much better. She had stopped takingdiclofenac, occasionally needing paracetamol for painrelief. Her mobility was improving; she was now ableto run up and down stairs, the hip and back weremuch better, and she was walking more easily. Shewas able to go on longer walks with the dog. Urina-tion was satisfactory.

Treatment: Using regular needles, left LR-8, KI-10,and right SP-3 were supplemented.




Amoxa pole was applied over the spine to warm it.Okyu/direct moxa was applied to josen, BL-28,

GV-12.

Fifteenth visit—6 weeks later

She had had a review at the hospital the previous Fri-day—everything was fine. She had grown 4cm in thelast 4 months. She had not taken diclofenac for a longtime. Her sleep was generally satisfactory. Urinationwas alsomuch better. The day before the visit she hadhad a slight setback, playing netball, and had a pain inthe left foot—she was worried since the original prob-lem started with pain in the right foot. She was usinglavender heat bags, which she found helpful. She washaving pilates lessons as well.

Treatment: Using regular needles left KI-10, LU-5,and right SP-3 were supplemented.


Okyu/direct moxa was applied to GV-12 and BL-23.

Summary: She came for periodic treatment foranother 16 months. During this time she had no



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setbacks and returned to normal activities, includingphysical education and swimming. She had more sta-mina, was able to stand for longer, but still had somedigestive issues.

The following case is frommy colleagueMarian Fix-ler, who practices in London, United Kingdom. Herpatient presented with a very severe lung weakconstitution condition with severe skin problems,breathing problems, allergies, and tendency todevelop infections. He responded well to treat-ment.

Case 3Julian, Boy Age 4 Years

Main complaints: Severe eczema and asthma.

History: From around 8–9 months old, Julian’s skinstarted to show signs of dryness. At age 1 year, heexperienced an allergic reaction after eating baklava(Turkish sweet pastry). The reaction was an instantswelling up, though it did not affect his airways. Hewas given Piriton antihistamine for this. He was testedfor nut allergy, which was negative. He subsequentlyalso had a reaction to eggs and lemon juice, thatresulted in instant blistering of the skin. From age 18months, he developed itchy skin, particularly follow-ing a cough or a cold. This was diagnosed as severeeczema, for which he was prescribed steroid and anti-biotic creams. These continued to be used as needed.From age 2 years he started having asthma attackswhen catching a cold. This would go to his chest andhe would develop a wheeze. He had been hospitalizedfive times for 3 days at a time. The eczema also gotworse when he had a cold. The family was trying tomanage the asthma better by administering steroidswhen a cold developed. Eczema flare-ups could lastfor days or weeks and easily became infected.

Family medical history: His mother had asthma, hismother’s sister had eczema, and his father some aller-gies. He had had all his vaccinations with no adversereactions afterward.

General health: He was a lively and animated littleboy with a loud voice. His mood was generally good.His sleep was sometimes disturbed by the itching,

though he had no problem falling asleep.His parentsused silk leggings as a barrier at night. Appetite andbowels were good. He regularly caught cold anddeveloped a cough; this was happening before hestarted with the asthma attacks. He did consumesomemilk products.

Appearance: Overall, the skin was rough, dull, andlusterless. It was very itchy at night, worse on theright side. The skin was also red and very dry, andbled when scratched. The eczema was worse on thefolds of the knees, hands and arms, and lower abdo-men. The eczema was less severe on the legs butmore noticeable on the thighs. The eczema had pre-viously appeared on his face but this cleared up at theage of 3 years.

Treatment: Due to the extensive presentation ofeczema over Julian’s body, I didn’t feel it was appropri-ate to use shonishin rubbing technique.

Using a teishin, supplementation was applied to leftLU-8 and SP-5, draining technique to right LR-3.

Using a zanshin, light tapping was applied aroundthe patches of eczema; SP-10, LI-11 and BL-40 werealso tapped.

Using the teishin, supplementation was applied toLU-1, CV-17, and CV-12.



He had a bit of a cold, which was a danger sign. Hewas slightly congested with it but there was nowheezing. A Ventolin inhaler had been given thenight before preventatively. He was happy in himselfand, in spite of some itchiness, not irritable with it.The itchiness was still waking him at night. He hadhad a flare-up of eczema 2 days after the last treat-ment on the cheek (first time for over a year), and stillhad a bit on the face around the jaw and eyelids. Thesteroid cream was used daily. I recommended tryingto avoid dairy completely and using soya and ricemilkinstead. I also suggested goat and sheep products asalternatives to cow products.

Treatment: Using a teishin, supplementation wasapplied to left LU-8 and SP-5, draining technique toright LR-3.

Using a zanshin, light tapping was applied aroundthe patches of eczema, SP-10, LI-4, LI-11, LI-15, BL-40,GV-14, GV-12, and BL-17 were also tapped.



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Using the teishin, supplementation was applied toLU-1, CV-17, and CV-12.

No press-sphere was left on GV-12 as Julian wasn’thappy with these when his mother tried to put themon.


The cold had continued to progress for 3–4 daysbefore abating. The cold triggered asthma with heavywheezing, worse at night. This was the second timethis month. He needed hourly Ventolin given at nightwhen the cold was at its worst to avoid hospitaliza-tion. Now only a little bit of a cold remained. He wasvery itchy at night, but his mother thought it wasoverall better than previously. It was generally lessred and was not weeping. The skin was clearer on thebacks of the legs, buttocks, and lower abdomen.

Treatment: Using a teishin, supplementation wasapplied to left KI-7 and LU-8, draining technique toright SP-9.

Using a zanshin, light tapping was applied aroundthe patches of eczema, SP-10, LI-4, LI-11, and GV-23(for nasal congestion) were also tapped.

0.6-mm press-tack needles were applied to theasthma shu points with instructions to the mother tochange them if needed.


The cold had cleared and he had not experienced anybreathing problems all week. No medication wasneeded and he had tolerated the press-tack needlesbetter than the press-spheres. The eczema had flaredup for a couple of days after eating some candy. Butoverall the quality of the skin appeared improved, lessrough, and with better luster. Hismother commentedthat his skin never usually cleared up completely, as ithad now on certain parts of his body. His legs hadnow been clear for 2 weeks. The abdomen and backwere completely clear and the legs improved.

Treatment: Using a teishin, supplementation wasapplied to left KI-7 and LU-8, draining technique toright SP-9.

Using a zanshin, light tapping was applied aroundthe patches of eczema, SP-10, LI-4, LI-11, BL-40, andGV-23 were also tapped.



The family had moved out of their house and werestaying with friends as the carpets were beingremoved at home. This had caused some changes indiet and emotional stability—he had had a huge tan-trum during the week. The skin was worse and he hadhad some loose bowel movements, but no breathingissues at all and no nasal congestion.


Using a zanshin, light tapping was applied aroundthe patches of eczema, SP-10, LI-11, and BL-10 werealso tapped.

Light needling was applied to right LI-11 and BL-10.Since Julian would not let the press-tack needles be

placed at the time, they were given to his mother tobe placed later at the asthma shu points.

I also gave his mother an article on eczema and thepossible effect of chemicals used in the home.


He had not experienced any breathing difficulties atall over the 3 weeks. The skin problem was up anddown, but overall better now. His mother reportedthat she felt the skin to be much better than it was1 year previously. Since having acupuncture, theflare-ups were shorter in duration and less severe. Theskin was no longer red raw “as if on fire,” not gettinginfected or weepy. The winter had so far been betterthan the year before. He had had some problems withloose stools. His mother was also working on makingtheir house more eco-friendly to expose Julian tofewer allergens.


Using a zanshin, light tapping was applied aroundthe patches of eczema, SP-10, LI-4, LI-11, LI-15 andBL-40 were also tapped.





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Report 2 weeks later

His asthma was completely quiet, with no breathingdifficulties. This was a dramatic change; this time oneyear before he had been hospitalized twice alreadyand the weather was cold, which was usually an irri-tant to the asthma. Since the symptoms had disap-peared, he had not been using the inhalers, in spite ofadvice from doctors to use it all the time during thewinter. The eczema symptoms were moderate, andhe was exposed to many different things and foods inthe run up to Christmas.

Seventh visit—8 weeks since sixth visit

The family had been away in India for a month. Hehad had no symptoms of asthma, though they usedthe inhaler preventatively when it got cold. The ecze-ma was better while away as he fared better in ahotter, drier climate. He even ate foods he normallyreacted to with no reactions. The skin had been itchyat night since returning.


Using a zanshin, light tapping was applied aroundLI-4, LI-11, and BL-40.



Julian didn’t seem himself. He appeared to be out ofsorts and fell asleep whilst waiting in the clinic. Hehad started with a cold at the beginning of the week,with nasal congestion and a chesty cough on the dayof treatment. He was breathing heavily but notwheezing. He was using the inhaler daily. His mothercommented that this time 1 year before, they hadhad several asthma crises. The skin was pretty goodoverall , a little bit up and down but nothing severe; itlookedmuch less dry and red.

Treatment: Using a teishin, supplementation wasapplied to left LU-8, SP-5, and right LR-4.

Using a zanshin, light tapping was applied aroundLI-4, LI-11, LI-15, BL-40, GV-12, and GV-23 for thenasal congestion.

No press-spheres or press tacks were placed. I gavesome to his mother to place later.


While free of asthma symptoms he had been to thehospital for treatment of a skin infection. His skin haddeteriorated with the very cold weather and centralheating on very high at nursery. His mother thoughtthey were not moisturizing him enough there andthat the heating was having a big effect on his skin.The skin became infected 2 weeks before with red,raised, and angry spots with pus. These spread wher-ever he scratched. He was placed in an isolation roomat the hospital as they didn’t know what it was. Juliandeveloped a high fever. He was given IV antibioticsand antivirals. He had to spend a couple of days inhospital. He was also put on oral antibiotics. The der-matologist diagnosed an opportunistic infection(eczema herpeticum) due to the fragility of the skin.At that time his family was strongly advised that sinceJulian had chronic asthma, he should be given thesteroid inhaler daily despite his condition being stablewithout it. His mother said Julian was tearful in antici-pation of coming for treatment after so much inter-vention in hospital. However, he was happy for me todo treatment and was quite playful.

Treatment: Using a teishin, supplementation wasapplied to left LU-9, SP-3, and right LR-3.

Using a zanshin, light tapping was applied aroundLI-4, LI-11, LI-15, SP-10, BL-40, and GV-23 for the nasalcongestion.

A press-sphere was placed on GV-14.His mother called the next day to report that Julian

was back in hospital with a worsening of the skin infec-tion and a replacement diagnosis of bacterial ratherthan viral infection. He had been resistant to the pre-vious antibiotics and new ones were prescribed. Hismother called again 2 weeks later; Julian had needed tobe hospitalized for a further course of antibiotics. Theinitial diagnosis of eczema herpeticum had been incor-rect. The last update was 25 days later. After the skininfection finally cleared up, his underlying eczema wasnot too bad, and he still had no asthma symptoms.They had been advised to continue with topical ster-oids and the steroid inhaler on a daily basis.

Summary: During the time that Julian came for acu-puncture his asthma stabilized and he did not have anyacute asthma attacks. This was a considerable improve-ment to the year before when he had several admis-sions to hospital. In addition to regular acupuncturetreatments, the parents were trying to be more proac-tive and administer inhalers preventatively as and when



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he developed a cold. They observed that colds did notlead to asthma symptoms, which had always occurredbefore. Inhalers were not being used on a daily basisoutside of periods of upper respiratory infections.

His skin condition also improved overall during thetime that he was coming for treatment. The wintertime was a particularly challenging time for his skin,with the combination of cold and damp weather andcentral heating on high in his nursery. His mothercommented on a number of occasions that his skinwas better than it had been before treatment, thoughit never fully cleared up.11 The acute bacterial infec-tion caused a severe worsening of his condition with asevere outbreak of spots on top of the underlyingchronic eczema condition.12 I encouraged his motherto continue to try to exclude certain foods from thediet, particularly damp-producing foods (due to histendency to develop nasal congestion with the firstsigns of a cold). This advice was followed sporadically,though more recently, since the acute episode, theywere making concerted efforts to exclude cow’s milkproducts from his diet. They alsomademany changesto the chemicals being used in the home, favoringmore eco-friendly products.

Summary of treatments administered: Due to theextensive presentation of the eczema, it was notappropriate to do the whole body shonishin usingstroking technique. The focus instead was on roottreatment to strengthen his underlying constitutionand to address the chest and skin condition usingToyohari Meridian Therapy diagnosis and treatment.

Root treatment points were treated using a smallgold teishinwith noninserted needling.

Treatment generally focused on a primary lungvacuity pattern, based on findings on the channels andthe abdomen. The pulse was more difficult to analyze,though the lung position was weak. Generally, eventhough the liver pulse felt somewhat weak, drainingwas applied to the liver given the presentation of red,raised skin (which is interpreted as an excess liver condi-tion). On the occasions when Julian presented withcold signs, usually with nasal congestion, the jing-river,metal points were treated instead of the usual treat-ment points, according toNan Jing Chapter 68.

For the first two treatments a primary lung vacuitypattern with liver repletion was treated. As he was notnoticeably improved at the second treatment, thiswas reconsidered and the pattern changed to kidneyvacuity pattern, with spleen repletion. This patternalso felt appropriate due to the chronicity of the con-dition and the family medical history, which indicateda hereditary component. Although, this seemed tobring about improvement, after the second treat-ment using this new pattern the skin seemed to beslightly worse again (though this also coincided withthe family having to move out of their home andJulian’s diet being affected). It then felt more appro-priate to treat the lung vacuity pattern and to drainthe liver channel to address the red, raised skin condi-tion. The skin improved after this treatment, so I con-tinued with the lung vacuity pattern.

As treatment progressed, his skin became lessangry and less red, so focusing more on supplement-ing the liver felt more appropriate. On the last treat-ment, when Julian had already been diagnosed with abacterial skin infection with red, raised spots, itwould, on reflection, have been more appropriate todrain the liver. It seemed that this had a part to play inthe condition flaring up again.

Shonishin tapping technique was used on yang chan-nel points specifically to address the skin condition, inparticular with focus on the typical large intestine chan-nel points that are good for skin problems and addi-tional points on the legs good for skin problems.

Press-spheres were used and applied at home byJulian’s mother on GV-12, a main point to strengthenthe constitution and also press-tack needles on theasthma shu point on a couple of occasions.13



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11 Editorial note: it is worth noting that in cases such as Julian’swhere there is a strong lung weak constitution, it can takeconsiderable treatment to create more change of the condi-tion. Julian was treated over a less than 5-month period andthe severe symptoms showed a significant improvement.Further treatment has a good chance to slowly create morechanges. In cases like this the parents need to be patient. You,as therapist, need to convince them that it is worthwhile con-tinuing with treatment. My usual strategy for this is to applya certain number of treatments, and after demonstrating thatsymptoms improve, parents can start to appreciate the ideaof continued longer-term treatment.

12 Editorial note: Case 1, Chapter 19, describes a child (Han)with very severe atopic dermatitis, similar to Julian. On occa-sion he would develop opportunistic skin infections in theskin lesions. We found it helpful to use mild tea tree oil bathsto help contain the infections. Of course if they don’t work,appropriate consultation with the doctor should be made asstronger therapy may be needed, but it is good to bear suchsimple home treatments inmind.

13 Editorial note: the asthma symptoms improved and stayedimproved after the asthma shu points were treated for thefirst time.

As a result of the recent acute episode, the parentswere advised to administer daily topical steroid creamand steroid inhalers, in spite of the improvement toJulian’s asthma over the last year.14

Treatment recently resumed with Julian. Before hecame he had been encouraged to consult with a well-known herbal specialist famous for treating chronicskin disease. However, his skin’s appearance wasreally good, with much more luster and very littleeczema. It was decided that it was not necessary tosee the herbalist at the time.

The next case from my colleague, Joke Bik-Nowee,who practices near The Hague in the Netherlandsillustrates the importance and power of getting theconstitutional treatment right.

Case 4Jan, Boy Age 3½ Years

Main complaint: Eczema over the whole body (ato-pic dermatitis), which was very itchy.

History: Skin problems since birth. At age 2 monthsthe skin was bad on the chest. Now it was worst onthe inside of the elbows and the back of the knees.His skin was itchy and he scratched it until blood wasdrawn. At the time of the first visit the skin was betterthan usual and his legs were more affected than theupper part of his body. He had been prescribed manydifferent creams by his doctor, including corticoster-oid creams. These did not really help much in the

long run and his mother did not want to use thosecreams for long periods. This is why she decided tovisit an acupuncturist. At age 2 years he had pseudocroup, but had no breathing problems now. He hadno allergic reactions. It was difficult for him to fallasleep, but when he slept he didn’t wake till morning.He had had all the usual vaccinations. His mother alsohad atopic dermatitis and she was an asthma patient.He had normal appetite and his bowel movementswere daily and without problems.

Examination: He was small for his age, thin withpale-white skin. His face was especially white, and hishair almost white. Under his eyes he had dark circles.He had a good mood, was cheerful, talkative and wasnot able to sit still for a long time. The skin felt verydry to the touch in many places, especially on theelbows and the back of the knees. His back (upperand lower) had been scratched until small woundsoccurred. The skin was thicker at those places. Heshowed reactions in the lung, kidney, and spleenregions of the abdomen. It was very difficult to feelhis pulse as he would not stay still, but perhaps thekidney and lung pulses were weak.

Diagnosis: Kidney vacuity pattern seemed to fit best.

Treatment: Using a teishin, left KI-7 and LU-5 weresupplemented, right SP-9 and LI-6 were drained.

Using the pointed end of the teishin, tapping wasapplied softly around the eczema spots on the legsand elbows.

Using a zanshin, light stroking was applied over thehealthy areas on the back, abdomen, chest, legs, andarms.


His mother reported that the itching had been lessfor 2 days, thus I gave a similar treatment.

Treatment: Using a teishin, left KI-7, LU-5 were sup-plemented, right SP-3, LI-6, and left SI-7 were drained.

Tapping and stroking similar to the first visit werealso applied.


This week the skin was not good.

Treatment: Using a teishin, left KI-7, LU-5 were sup-plemented, right SP-9, and left GB-37 were drained.



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14 Editorial note: this is a complicated problem. In Chapter 18,page 103 I discussed our role as therapists when treating apatient onmedication for control of a life-threatening diseaselike asthma. The doctors will insist on the asthma medicationeven as the symptoms become quieter. This requires ongoingdialogue and monitoring. It is not our place to make alterna-tive recommendations regarding the steroid asthma medica-tions, but we can encourage the parents to discuss this peri-odically with their doctor so long as the asthma symptomsremain absent for a prolonged period. My experience hasbeen that parents and child start forgetting to take the medi-cation because it has been so long since the symptomsappeared, and as this gradually over time happens more, Ithen recommend discussing this with the doctor to see if theycan yet move toward using medication on an as-needed basisrather than automatically every day. The decisions lie in thediscussions between the parents and the doctor.

Tapping and stroking similar to the first visit werealso applied.

Press-spheres were added to LI-11.


There was no change in his complaints. Because ofthis I reflected on my choice of diagnosis and decidedto treat the more obvious lung vacuity pattern basedon symptoms.

Treatment: Using a teishin, left LU-9, SP-3 were sup-plemented, right LR-3, ST-40 were drained.

Tapping was applied around the areas of skin prob-lems on the elbows and knees.

Using the teishin, BL-13 and BL-20 were supplemen-ted to support the root treatment.


The skin was much better this week; the itching hadstopped. Many eczema spots had disappeared andthe remaining spots weremuch smaller.

Treatment: The same treatment was applied as thelast except for draining LI-6 instead of ST-40.

A few days later themother reported that his skin wasvery good and that she wanted to stop the treatment.About 1 year later the mother came to me for treat-ment and told me that Jan was still much better, hav-ing few problems with the eczema.

Comments: The reason why the skin problems didnot change much during the first treatments wasprobably because the wrong pattern was treated.When the pattern was changed to the lung vacuitypattern the skin became much better. I changed pat-tern because I was not satisfied with the results of thesecond and third treatment. I searched for more infor-mation in Fukushima (1991) and found that smallchildren with such problems more often have a lungvacuity pattern rather than a kidney vacuity pat-tern.15

For examples of treatment of the kidney weak con-stitution see the cases in Chapter 24, in particularthe second case (Diannewho has Rett syndrome).



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15 We can also suspect that Jan was lung weak constitution pat-tern, but the protracted use of the corticosteroid creams wasslowly weakening his kidneys and changing to a kidneyvacuity pattern. In this case Janwas probably still lung vacuitypattern but was showing signs of the weakening kidney,which were accurately identified. Getting the pattern rightfirst time can be tricky when more complex manifestationsstart to appear. But at the same time, the changes were quitedramatic once the proper patternwas identified and treated.

26 Recurrent Infections

Recurrent Respiratory Tract Infections

Case 1Mary, Girl Age 3 Years

Main complaints: Multiple recurrent colds over thelast year. On a number of occasions the colds wor-sened and developed into bronchitis. On two occa-sions the bronchitis progressed into pneumonia, oneepisode of which led to her being hospitalized. Shehad to take many rounds of antibiotics over the lastyear because of the episodes of bronchitis and pneu-monia. Along with the colds she had some problemswith ear infections as well, but this was less of a prob-lem than the continuous cycle of catching colds. Atthe time she presented, Mary was recovering from acold that had started several days before; she had acongested nose andmild cough.

History: Until 1 year previously she did not have toomany health problems. But over the last year she hadbeen more tired and showing signs of emotional dis-tress. Her appetite, sleep, and bowel movementswere regular and all right. Her mother was a studentof mine and had recently learned shonishin from me,which made her think to bring her daughter for treat-ment. While discussing her daughter’s problems thefollowing history emerged: Mary’s mother workedand studied full-time. Two years before, while a stu-dent and working she was found to have breast can-cer. After starting treatment for the breast cancer herhusband could not cope and left her. Now she was asingle working mother who also was finishing her stu-dies, and in remission from cancer. It seemed to methat probably Mary’s problemswere related to the dif-ficulties that her mother had been having. Hermother was struggling a lot with her own problemsand when Mary started becoming sick was increas-ingly frustrated about being unable to do anything tohelp her. This probably created a cycle feeding thedownward spiral in Mary’s health.

Treatment strategy: Apply the basic non-pattern-based root treatment and teach the mother to do thetreatment daily at home.

Treatment: Tapping was applied with a herabari onthe GV-12 area, GV-22, and occipital areas.

Stroking was applied with an enshin down the back,arms, legs, and abdomen.

Press-spheres were retained on GV-12 and left BL-13(hard knot).

The mother was taught to carefully apply the treat-ment daily at home.


Mary had fully recovered from the cold and had noth-ing else to report. The mother was applying treat-ment daily in the evening before putting Mary to bed,whichMary enjoyed.

Treatment: Tapping was applied with a herabari onthe GV-12, GV-22, and occipital areas.

Stroking was applied with an enshin down the back,arms, legs, and abdomen.

A press-sphere was retained on GV-12.After a further discussion about the home treat-

ment the mother agreed to come back with Mary ifsymptoms started returning.

Follow-up: Five-and-a-half months later Mary had nothad a single episode of catching cold. At 1 year, shehad had one episode of a mild cold, from which sherecovered quickly. She was doing well, was full ofenergy and very happy.

Reflection: I felt application of the principle of NanJing (Classic of Difficulties) Chapter 69: “For vacuitysupplement the mother” was very important. It washighly likely that the psychosocial circumstances ofMary’s home life contributed to and probably trig-gered the problems she was having: the illness of hermother, her and her mother’s abandonment by thefather, her mother’s hard-working habits and deter-mination to keep going no matter what. TreatingMary alone would be helpful. But more helpful was tohave the treatment given daily by her mother. Not



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only would treatment be more frequent, it wouldgive mother and child more close contact together, itwould help the mother relieve her own feelingsregarding her health, her husband’s departure, andher inability to help her child stay well. As the motherfelt better this would be picked up by Mary and helpMary feel more secure in herself too. It worked well, Ithink.

Case 1 illustrates how a healthy child under stress-ful circumstances can respond with developing anillness. The next case shows how those illness pat-terns are part of a longer-standing issue to do withconstitutional tendencies. When the constitutionaltendency underlies the illness, it may be necessaryto give attention specifically to trying to affect theconstitution. This is discussed in Chapter 25 “WeakConstitution.” In the following case we can see thatdespite a history of chronic problems that easilyrecurred, a little focused treatment was able to trig-ger big changes quite well. The additional measuresthat can be needed to address weak constitutionproblems were unnecessary, as were treatmentapproaches (such as okyu/direct moxa) to help sti-mulate the immune system to deal with the recur-rent infections.

Case 2Tom, Boy Age 4½ Years

Main complaints: He caught cold easily and hadrecurrent colds and ear infections, with continuouslyswollen lymph nodes in the neck.

History: He had taken many rounds of antibiotics inthe past. He was hospitalized 16 months before witha streptococcus infection in the lymph nodes of theneck accompanying a bad ear infection, and has hadswollen lymph nodes in the neck since then. He hadproblems with chronic loose stools, diarrhea, andvomiting. These symptoms improved after elimina-tion of wheat gluten from the diet following identifi-cation of a gluten allergy. His mother had many prob-lems as a child, with chronic swollen lymph nodes inthe neck. At age 19 she was diagnosed with sarcoido-sis of the lungs. Themother was thus worried that herson may have the same problem or similar tenden-cies. Mood good, sleep good, all other systems unre-markable.

Diagnosis: Lung vacuity with liver repletion pattern(based on the symptoms and findings on the abdo-men and pulses).

Treatment: Tapping was applied with a herabari overthe head, occipital, and neck regions, GV-12 area,around the ears, and on the abdomen.

Stroking with an enshin was applied on the abdo-men, down the back, arms, and legs.

Using a teishin, left LU-9 and SP-3 were supplement-ed and right LR-3, left BL-58 drained.

Press-spheres were left on GV-12 and CV-12.


The week was unremarkable, with not much toreport.

Treatment: Tapping was applied using a herabari onthe head, occipital and neck regions, GV-12 area,around the ears and on the abdomen, back, arms,and legs.



Press-spheres were left on GV-12, CV-12.I taught the mother how to do home treatment,

with light tapping (around the ears, neck, and GV-12regions) and light stroking down the back, abdomen,arms, and legs.


He was doing well. The home treatment went wellwith nothingmuch to report.

Treatment: Tapping was applied using a herabari onthe head, occipital, and neck regions, GV-12 area,around the ears and on the abdomen, back, arms,and legs.



Press-spheres were left on GV-12 and CV-6.


He had had a slight cold, from which he recoveredquickly, and he was generally doing well.



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26 Recurrent Infections 219

Treatment: Tapping was applied using a herabari onthe head, occipital, and neck regions, GV-12 area,around the ears, and on the abdomen, back, arms,and legs.


Using a teishin, left LU-9 and SP-3 were supplement-ed and right LR-3, LI-6 drained.

Press-spheres were left on GV-12 and TB-17.


Over the last few days the lymph nodes had been a lit-tle larger (but without ear infection). He had hadsome problems with cough and mild headache symp-toms. Otherwise he was quite well.



Using a teishin, left LU-9 and SP-3 were supplement-ed and right LR-3 drained.

Press-spheres were left on GV-12, bilateral TB-17.


He had had some mild digestive symptoms (loosestools, abdominal pain) over the previous week. Hehad started with an ear infection but it cleared upwithout developingmuch, and he was still coughing alittle.



Using a teishin, left LU-9 and SP-3 were supplement-ed and left TB-5, SI-7 drained.

Press-spheres were left on GV-12, bilateral TB-17.


The lymph nodes were smaller, but still a little swollenbelow the left ear; he had some problems with head-aches.



Using a teishin, left LU-9 and SP-3 were supplement-ed and right LR-3, left TB-5, SI-7 drained.

Press-spheres were left on GV-12, and behind theneck point on the back of the right ear.


He was doing generally better; the cough was verymild and occasional, the lymph nodes less swollen.

Treatment: Tapping was applied using a herabari onthe head, occipital, and neck regions, ST-12, GV-12areas, around the ears, and on the abdomen, back,arms, and legs.


Using a teishin, left LU-9 and SP-3 were supplemen-ted and right LR-3, left BL-58 drained.

Press-spheres were left on GV-12, behind TB-17bilaterally.


He was doing well and the lymph nodes were muchless swollen.




Press-spheres were left on GV-12 and to a stiffpoint below the left ear.


He was doing very well, the lymph nodes were barelypalpable, and he had been able to eat a wider varietyof foods, including wheat products, without reaction.

Treatment: Tapping was applied using a herabari onthe head, occipital, and neck regions, GV-12 area,



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around the ears, and on the abdomen, back, arms,and legs.


Using a teishin, left LU-9 and SP-3 were supplement-ed and left BL-58 drained.



Nothing to report. He was doing well and was free ofany symptoms.






He was doing very well. He had had a cold on holidaybut with no consequences such as lymph node swel-ling or ear infection.





Thirteenth visit—2months later

Hewas doing well, but had a lot of mosquito bites.



Using a teishin, left LU-9, SP-3 and right LR-3 weresupplemented.



He was doing well, but reported some stiffnessaround the left jaw.





After this Tom came for treatment if any problemsdeveloped, but the chronic problem he had of recur-rent infections disappeared with treatment.

General Approach for Patients withRecurrent Infections

Strengthen the body so as to be able to resist prob-lems better. If needed, apply techniques to try toenhance the immune system (such as okyu/directmoxa). Give the parent tools for applying sometreatment at home, such as the basic home treat-ment method; this can be helpful because oftenwith children who have recurrent infections, theparent(s) are quite stressed, tired, feeling frus-trated, and even a bit overwhelmed.


Most cases of recurrent infections show as lungvacuity pattern. This can be as part of a lung weakconstitution. Some children with recurrent infec-tions also have ancillary problems of ear infections;these cases are also often lung vacuity pattern. If achild has been taking a lot of medications for theinfections one can, on occasion, see the patternchange. It is possible that the kidney or liver vacuitypattern now starts showing. On very young chil-dren, where pulse and abdominal findings are notclear, treat the lung vacuity pattern, but on childrenwith more history andwhowill allow you to exam-ine the pulse and abdomen, you can differentiatemore precisely and may end up with, for example,kidney or liver vacuity pattern. For the kidney a keysign will be the tendency to have cool or cold feet.For the liver pattern there will probably be sleepdisturbance or behavioral issues.



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Usually we supplement LU-9 and SP-3 to treatthe lung vacuity. But if there are more acute symp-toms, it could be helpful to modify this point selec-tion. Nan Jing Chapter 68 gives useful hints for this(see Chapter 10). For cough or alternating fever andchills, try the jing-river points, LU-8 and SP-5.Expanding on this, if the cold has just started thejing-river points may be preferable to the usualpoints. If perchance the child is brought in to youwith a fever, better to use the ying-spring points (LU-10, SP-2), which are indicated for body heat (fevers).

With the older child on whom you are able toread the pulses better, it is quite likely that you willfind pathological repletion in one or more yangchannels, in which case treat what you find (seeCase 2 above). Some children who have this ten-dency to recurrent infections will show aweaknessof all the yang channels. In such a condition thepulse will be deep and weak. Whether it is possibleto read the pulse or not, there will be other signsthat are usually quite clear. When you touch theskin of the child, it tends to feel slightly looser,softer than on other children. The skin can feel asthough it has lost its springiness and luster. Youoften also see a more weakened appearance of thechild as well. In such a case, after supplementingthe acupoints for the primary vacuity pattern (suchas LU-9, SP-3), also supplement either ST-36 or TB-4.These points can be very helpful to strengthen theyang channels when they are all weak.1 Touch thepoints and choose the weak, soft, empty feelingpoints for treatment. The points could be donebilaterally or youmay, for example, choose left TB-4and right ST-36 based on palpation. For this kind ofchild it can be useful to also use chinetsukyu/warmmoxa technique—see below.


So long as there are no concurrent skin problems,apply the core non-pattern-based root treatmentusing light stroking down the arms, legs, abdomen,chest, back, with tapping around GV-12. However,some children with recurrent infections have con-current skin problems. This makes it more difficultdeciding how to apply some simple treatment athome, as a light tapping is usually indicated. Analternative approach is to hold a teishin so that the

rounded tip is still within the finger and thumb ofthe left hand. Then lightly glide the oshide (support-ing hand—see Chapter 10) with teishin held stablewithin it in the following pattern: down the largeintestine channel on the arms, down the stomachchannel on the abdomen and legs, down the blad-der channel on the back and legs.2

Additional tapping can be applied around LU-1,on the chest around CV-17, the interscapularregion around GV-12, the shoulders, and the supra-clavicular fossa region if the child has very con-gested lungs and/or is coughing. If there is alsonasal infection or congestion, tap around GB-20,GV-22 to GV-23, and LI-4. For ear-related symp-toms, tap above, behind, and below the ears (seeFig.26.1).



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Fig.26.1 Stroking:● Down the arms (yang channels)● Down the legs (stomach and bladder channels)● Down the back (bladder channel)● Down the abdomen (stomach channel)● Across the chestTapping:● Occipital area: 10 times● Behind the ear: 10 times each● Above the ear: 10 times each● Below the ear: 10 times each● GV-12 area: 10 to 20 times● LI-4: five to 10 times each● ST-12 area: five times each● GV-20 area: 10 times● Across the shoulders: 10 to 20 times

1 This comes frommy Toyohari teachers.

2 This treatment model comes from my teacher Toshio Yana-gishita.


The most important treatment for children withrecurrent infections is the root treatment, both pat-tern and non-pattern-based. If the problem provesstubborn or resistant, okyu/direct moxa is probablythe best method for stimulating the immune sys-tem of the child. However, it is, as discussed else-where, not always easy to apply this method, thuswe tend to apply other techniques first in additionto the root treatment and use the moxa if still notworking.

Press-spheres (Ryu), Press-tack Needles (Empishin),and Intra-dermal Needles (Hinaishin)It is common to leave press-spheres on points likeGV-12 and BL-13. If there is a lot of lymphatic con-gestion below the ears (usually seen when the earsalso become infected after catching cold), it can behelpful to leave press-spheres at the harder, morepainful points, often around or below TB-17. Forchildren with cough, palpate and treat the “stopcoughing” points on the elbows near LU-5. On somechildren when the lungs are congested, a strongreaction will show around the asthma shu point; itis good to treat this point for the lungs.

If the symptoms prove stubborn or resistant,increase the dose by using the new Pyonex press-tack needles. The intra-dermal needles are used ifthe symptoms persist after increasing the dose oftreatment with press-tack needles.

Additionally, for the child who has a tendencytoward lung weak constitution and has a problemof recurrent infections, it can be helpful to treatrelated back shu points, such as treating BL-13 onone side and BL-20 on the other. Press-spheres canbe used, but if the child is older or symptoms morestubborn, the 0.6-mm Pyonex press-tack needlescan be used.

If the child has secondary liver-related symp-toms such as sleep or behavioral problems, it can behelpful to leave a press-sphere on the point on theear behind shenmen.

NeedlingIf the child has very stiff shoulders, which is asymptom of the lung vacuity pattern, and the stiff-ness does not change much with the pattern-basedroot treatment and the non-pattern-based roottreatment that includes light tapping of the

shoulders, needlingmay be required. It can be help-ful to lightly insert needles to one or two of themost reactive acupoints on the stiff shoulders, suchas GB-21, TB-15, SI-14. The needling should beshallow (2–3mm) and needles not retained forvery long.

Palpate the area around GB-20 for the child withrecurrent infections, chronically congested nose ornasal infection if these symptoms have notresponded to treatment. If it is stiff here use eitherthe retained needling or in and out needling meth-od to treat the stiff reactions. On the older child(3 years and older) for the same stubborn symp-toms of the nose, palpate around GV-22 to GV-23for a spongy, painful reaction. If present, applyretained needling on the reactive point, angledtowards the nose. For the childwith additional prob-lems of ear infections, if there are strong reactionsin the region below the affected ear(s) around TB-17,and the problems have not been resistant so far totreatment, you can apply light needling to this reac-tion to speed up the process of change. Sometimesa reaction is found around GB-12 rather than TB-17,inwhich case needle this.

If the child with the problem of recurrent infec-tions, which is a typical lung vacuity sign, also hasconcurrent liver symptoms such as behavioral prob-lems, or sleep disturbance, treat related acupoints.If tapping LI-4 and the stiff region around GB-20has not yet helped, use in and out needling to LI-4and either in and out or retained needling to thereaction around GB-20.

Okyu—Direct MoxaIf the responses are too slow developing, or thechild requires amore urgent treatment, okyu/directmoxa can be applied at GV-12. But, as explained inChapter 13, this can be difficult to do, both for theparent and the child. It is not usual to do this imme-diately, but rather, later in the treatment series.Because of the effects of this moxibustion techni-que, the desired biological changes will start re-gardless of where you apply the moxa. We chooseGV-12 first because it has a reputation as beinggood for all pediatric conditions, second becausethere is a history of applying moxa to this point toprevent infections, and third because it is easier todo moxa on as few points as possible. Choosing amidline point on the back is much easier than bilat-eral points elsewhere. When you start applyingmoxa to this acupoint, use the “80%” method at



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first (see Chapter 13), let it get hot then take it off.When the child is more used to the technique youcan let it burn down more. In more severe or acutecases you may choose to let the moxa burn downfurther to get the stronger treatment effects.

Chinetsukyu—WarmMoxaThis is a technique we do not use often on childrenand only on older children who you are confidentwill stay still long enough. The technique is used asa soft supplementation method (see Chapter 13)for children who show weakness of all the yangchannels. In such a case use a cone of moxa onGV-14. Make sure that the cone is removed beforethe child feels any heat. The stronger supplementa-tion effect comes just before the patient starts tobecome aware of some vague feeling of warmth.Thus, use this for the child who shows softness andloss of springiness of the skin with overall weakdeep pulses (see above).

CuppingIf there is chronic congestion in the lungs it is oftenhelpful to apply cupping over the interscapularregion to help break up the congestion. It dependson the age, strength, and dose requirements of thechild as to how to apply the cupping—see Chapter14for ideas about these dose adjustments.

BloodlettingOn some children there is a lot of lymphatic conges-tion in the neck. One finds chronically swollenlymph nodes in the neck, below the ears. If afterapplying other treatment methods to try to helpwith this the change is insufficient one can try lightbloodletting of either LI-1 or LU-11: both are help-ful for this kind of problem. LI-1 is better selected inmore acute circumstances.

Some children with the lung constitutionalweakness and recurrent infections show vascularspiders on the upper back in the space between thescapulae and from the levels of GV-14 down toGV-11. If you see this, first try applying light (usual-ly brief) cupping to help improve the blood stasis—light cupping is recommended because one willoften notice that the skin in this area is thin, a signof lung vacuity, and lesser dosage of treatment isindicated. If the improvements are not enough,then one can start to carefully apply vascular spiderbloodletting on the area. Since the skin is usuallythin here, apply only the stabbing and squeezing

method, rather than the cupping method. SeeChapter 15 and also Japanese Acupuncture: A Clini-cal Guide, Chapter 10 (Birch and Ida 1998, pp.218–229).


DietaryIt can be important to test for and eliminate asneeded cow’s milk products. The cow’s milk pro-ducts (milk, cheese, cream, yoghurt) may need tobe eliminated while the child recovers, but can beconsumed again later when the child is strongerand has broken the cycle of recurrent infections.Sugar intake can also contribute to the problem,thus it can also be important to control this.

Home TreatmentTo strengthen the body and give parents tools fortreatment, teach a simple form of the core non-pat-tern-based root treatment as soon as you can(usually not on the first visit). This most oftenincludes light stroking (especially with a silverspoon rather than a stainless-steel spoon) andsome minimal targeted tapping such as GV-12(almost all cases) and LU-1, in the area below theears, and so on. For ear involvement, the tapping isdone above, behind, and below the ears. For nasalinvolvement the tapping is done on LI-4 and overthe occipital region. For cough, tap over the inter-scapular region, maybe LU-1.


Case 3Eric, Boy Age 18Months

Main complaints: He caught cold easily, seven timesin the last 6 months. Often he had high fevers witheach cold. His nose was chronically stuffy, his lungscongested throughoutmost of this time.

History: The last week he had had a bad cold withhigh fever for 2 days. He seemed to slowly recoverfrom each cold and then quickly start another. Hisnose was stuffy so that he had to breathe with hismouth open all the time, which at night caused dry-ness and irritation of the mouth and throat. He wasdelivered by suction method resulting in a mild head



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trauma, affecting his left side, which is slightly lesswell developed than the right. Despite this, he was arelatively well-developed and full-bodied (slightlyreplete type) child. He tended to have loose stoolsand some abdominal bloating. All other systems wereunremarkable. His parents were very busy and thefamily lived a distance from the clinic, making regularweekly treatments difficult.

Diagnosis: The lung and spleen areas on the abdo-men showed a reaction, the lung and spleen pulseswere weak, and the liver pulse hard. Diagnosis waslung vacuity pattern with probable repletion of theliver.

Treatment: Tapping was applied using a herabari onthe abdomen, back, arms, and legs, GV-22, GV-20,GV-12, and occipital area.

Using a teishin, left LU-9 and SP-3 were supplement-ed, right LR-3 drained.

Press-spheres were retained on GV-12 and left BL-13(a palpable knot was found here).

The parents were instructed to test for sensitivityto cow’s milk products.


He was doing well, no cold and no fever, not much toreport.

Treatment: Tapping was applied using a herabari onthe abdomen, chest, arms, and legs, GV-22, GV-20,GV-12, around the ears, and over the occipital area.



Press-spheres were retained on GV-12 and bilateralBL-15.

The parents were instructed to do home therapydaily, stroking down the back, tapping arms, legs,chest, GV-22, GV-12, occipital area.


Home treatment had been pretty consistent andgone well. He was clearly better without cow’s milkand was using a soy-based replacement. Other thanan infection of the left eye, he had generally been OK,without any colds, was able to breathe through hisnose more, and had fewer problems with loose stoolsand abdominal bloating. But a recent test showed he

had a slightly low white blood cell count, which theparents were quite concerned about.

Treatment: Tapping was applied using a herabari onGV-22, GV-12, LI-4, around the ears and over the occi-pital area.

Using a teishin, very light stroking was applieddown the back, abdomen, arms (large intestine chan-nel), legs (stomach and bladder channels), chest,neck, and shoulders.

Using a teishin, left LU-9, SP-3, and right ST-36 weresupplemented.

Press-spheres were retained on GV-12 and CV-12.The parents were instructed to continue daily

home treatment.


He started kindergarten and immediately had somedigestive problems (loose stools and bloating). Gener-ally he was better, with no colds and the nasal conges-tion better. He had a mild rash while traveling, butwas recovered. On this visit he had a mild runny noseand some congestion in the lungs.

Treatment: Tapping was applied using a herabari onGV-22, GV-12, LI-4, ST-36, around ST-12, and over theoccipital area.

Using an enshin, stroking was applied down theback, abdomen, arms, and legs.

Using a teishin, left LU-9 and SP-3 were supplement-ed, right LR-3 drained, and left TB-4 supplemented.

Press-spheres were retained on GV-12 and bilateralasthma shu points.


He had caught cold 4 days earlier. He had nasal con-gestion, mild fever, coughing, congestion in thelungs, and amild skin rash on the right cheek.

Treatment: Tapping was applied using a herabari onGV-22, GV-12, over the occipital area, arms, legs,back, and abdomen.

Using a teishin, left LU-9, SP-3, and right LR-3 weresupplemented.

Cupping was applied over the interscapular region.Press-spheres were retained on bilateral asthma

shu points and nasal bi tong points.



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His nose and lungs were generally better, but he washaving some problems with abdominal pain and gas.The night before, he had had a mild fever with coughand evidenced some congestion in the lungs. He wasvery slightly warm to the touch, but had no fever.

Treatment: Tapping was applied using a herabari onGV-22, abdomen, back, arms, legs, chest, around theears, and over the occipital area.



Pyonex press-tack needles (0.6mm) were appliedto bilateral asthma shu points.

A press-sphere was placed on the left “stop cough-ing” elbow point.


He was good for 2 days after the last visit then devel-oped a cold, which turned into bronchitis, and an earinfection. He had fully recovered from these and wasgenerally doing well.

Treatment: Tapping was applied using a herabari onGV-22, GV-12, abdomen, back, arms, legs, chest,around ST-12, and over the occipital area.



Small press-tack needles (0.6mm) were applied tobilateral asthma shu points


He had been good since the last visit, but a few dayspreviously had a bad cold, with strong coughing. Hewas still coughing.

Treatment: Tapping was applied using a herabari onthe head, abdomen, back, arms, legs, and chest.


Cupping was applied over the interscapular region.Pyonex press-tack needles (0.6mm) were retained

on bilateral BL-13.Press-spheres were placed on the left “stop cough-

ing” elbow point and bilateral LU-1.


He had generally been good, but with some sleep dis-turbance the last few nights, crying at night, wakingaround 2a.m., and not falling asleep easily. He hadalso had some irregularity of bowel movements overthese few days.

Treatment: Needles were inserted and retained atbilateral GB-20.

Tapping was applied using a herabari on the head,abdomen, back, arms, legs, and chest.


Cupping was applied over the interscapular regionand around the navel.


Tenth visit—20 days later

He had been good, no lung and nasal symptoms, butsome irritability and waking at night.


Tapping was applied using a herabari on the head,occipital area, abdomen, back, arms, and legs.

Using an enshin, stroking was applied down theback, arms, legs, and abdomen.


Cupping was applied over the interscapular region.Press-spheres were retained on GV-12 and bilateral

ST-25.


He had been pretty good this last month. Some signsof irritability, a little coughing with some loose stoolsover the last few days.


Tapping was applied using a herabari on the head,abdomen, back, arms, legs, chest, around ST-12, andover the occipital area.

Using an enshin, stroking was applied down thearms, legs, and back.


Cupping was applied over the interscapular region.



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He had been doing well, no complaints. It wasdecided to stop treatment at this time since the mainreasons for coming, the repeated infections, hadclearly stopped and his digestive problems weremuch better. The parents agreed to continue apply-ing some home treatment and call for an appoint-ment if Eric had any recurrence of these problems.


Tapping was applied using a herabari on the head,abdomen, back, arms, legs, chest, around ST-12, andover the occipital area.

Using an enshin, stroking was applied down thearms, legs, and back.


Cupping was applied over the interscapular regionand around the navel.

Approximately 1 year later I was in contact with hisparents who reported that he no longer had any prob-lem with catching colds, lung, or nasal congestion.These problems had not recurred since the treat-ment.

Reflection: I had worried that we might need toapply okyu to try to kick-start his immune system,especially after we heard about the low white bloodcell count, but without the moxa and with regularhome treatment, Eric did very well. He had a clearlung weak type constitutional tendency (see Chapter25 “Weak Constitution”), which shows with allergicsensitivities and tendency to repeated infections.Probably it would have been useful to apply cuppingearlier than I did. It is also interesting that as his lungweak tendency improved he showed less of the symp-toms associated with the pattern (lung, nose, anddigestive). The associated repletion of the livershowed up as sleep disturbance, irritability, and morecrying kanmushisho-type symptoms (see Chapter 21).I changed the treatment approach once I recognizedthis, hence the needling of GB-20 and the refocusingof the core treatment pattern. Such a change isusually a good sign, though the parents do not alwayssee it as such. Changing a chronically weak constitu-tional tendency so that it triggers fewer of the asso-

ciated symptoms can take time; not only do those gra-dually improve, but secondary problems emerge asbeing of more concern. We see this tendency in manyadult patients when they stop talking about the symp-toms that brought them for treatment and instead talka lot about other problems that they had before, butwhich they had barelymentioned in passing.

Candida Albicans Infection

I report here two cases of successful treatment ofCandida albicans infection. While I have not muchexperience treating this condition (I think parentsdo not usually think of acupuncture treatment for acondition like this in their children), I report thecases as a guide for how to proceed should you havea patient come to you for treatment of the same pro-blem. The general treatment principles should bynow be obvious and in the absence of more experi-ence treating this particular problem andwritten lit-erature on it I do not add much other detail after-wards. In both cases I applied a simple form of thecore non-pattern-based treatment, a simple pat-tern-based root treatment, and minimal sympto-matic treatment with good success. In both casesimprovement in symptomswas immediate and last-ing, thus I did not need to try any stronger tactics nordid I need to teach simple home treatment.

Case 1Carol, Girl Age 4½ Years

Main complaints: Vaginal yeast infection causingitching and pain.

History: She had had this problem for several months.The general practitioner diagnosed it as Candida albi-cans and prescribed no treatment. She was somewhatdistressed by the symptoms. Her mother had placedher on a lactose-free and yeast-free diet and had beenusing tea tree oil in the bathwater but none of thesehadmade any real change in symptoms.

Additional complaints: Frequent abdominal painwith bad smelling gas; stiff shoulders, which she haddifficulty relaxing; and becoming tired easily. Allother systems were unremarkable and she had noother complaints.



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Diagnosis: Spleen vacuity pattern (weak spleen andheart pulses, digestive symptoms and tiredness).

Treatment: Tapping was applied using a herabari onthe GV-12 area, GV-20, GV-3, bilateral LI-4, and lowerabdomen.

Light stroking with an enshin was applied on theabdomen, down the back, arms, and legs.

Using a teishin, supplementation was applied toright SP-3, PC-7, left GB-373, draining to left ST-40.

Press-spheres were placed on GV-12, GV-3, and leftBL-20.


No itchiness or pain from the Candida albicans sincethe previous treatment. The abdominal pain haddecreased and she had fewer problems with gas.

Treatment: Tapping was applied using a herabari onthe GV-12 area, GV-20, GV-3, bilateral LI-4, and lowerabdomen.


Using a teishin, supplementation was applied toright SP-3, PC-7, left GB-37.

Press-spheres were placed on GV-12, GV-3, and leftBL-20.


She had no Candida albicans symptoms at all. This wasthe longest stretch of time with no symptoms sincetheir onset. She also had no abdominal pain or badgas. However, she had caught cold during the weekand still had a stuffy nose and slight cough.

Treatment: Tapping was applied using a herabari onthe GV-12 area, GV-20, GV-3, bilateral LI-4, arms, andlower abdomen.

Light stroking was applied with an enshin on theabdomen, down the back, arms, and legs.

Using a teishin, supplementation was applied toright SP-3, draining to left LR-3.

Press-spheres were applied on GV-12, GV-3, andright BL-20.

The next visit was cancelled. At follow-up 2 weekslater, she had no candida or abdominal symptoms atall. The mother was very satisfied and chose to stoptreatment partly because of the improvement andpartly because of heavy work commitments. Sheagreed to reschedule if any symptoms returned.

Case 2Mary, Girl Age 20Months

Main complaints: Vaginal yeast infection causingitching and pain with white grainy discharge.

History: She was Carol’s sister and had the problemfor the same period of time, for several months. Thegeneral practitioner diagnosed it as Candida albicansand prescribed no treatment. She was somewhat dis-tressed by the symptoms. Hermother had been usingtea tree oil in the bathwater but this did not improvethe symptoms

Additional complaints: Bad nasal infection withgreen phlegm and a continuous bad smell from thenose—the doctor suspected a problem of the ade-noids but offered no clear treatment. She also hadproblems of frequent diarrhea (several times daily).Mary was fairly small and just below the normalgrowth curve; she also had some irritation of the skinaround the nose. All other systems were unremark-able and she had no other complaints.

Diagnosis: Lung vacuity pattern (weak lung andspleen pulses, skin problems, diarrhea).

Treatment: Tapping was applied using a herabari tothe GV-12 area, GV-20, GV-22, and GV-3.

Light stroking with an enshin was applied on theabdomen, down the back, arms and legs, chest, andneck.

Using a teishin, supplementation was applied toright LU-9, SP-3, draining to left LR-3.

Press-spheres were applied to GV-12 and bilateralBL-23.


No symptoms of the Candida albicans since the pre-vious treatment. She had also had no diarrhea thisweek. The nasal symptoms were unchanged.



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3 GB-37 was supplemented to counterbalance the relativerepletion of the liver, rather than try draining the liver chan-nel.

Treatment: Tapping was applied using a herabari tothe GV-12 area, GV-20, GV-22, LI-4 bilaterally, and onthe arms, legs, back, and neck.


Using a teishin, supplementation was applied toright LU-9, SP-3, draining to left LR-3.

Press-spheres were applied to GV-12 and yin tang.


No Candida albicans symptoms at all. Also no diarrhea.Both problems had remained absent since the firsttreatment, but she had caught cold during the week.While her sleep was poor, she had no green phlegm,just a small amount of thin nasal discharge, and nobad smell from the nose!

Treatment: Tapping was applied using a herabari tothe GV-12 area, GV-20, GV-22, bilateral LI-4, and onthe arms, legs, abdomen, and back.


Using a teishin, right LU-9, SP-3 were supplementedand left LR-3 drained.

Press-spheres were applied on GV-12 and yin tang.

The next visit was cancelled. At follow-up 2 weekslater there were no candida symptoms and no diar-rhea. The nasal symptoms were much better, with nosmell and no green phlegm, only a little thin clearnasal discharge. The mother was very satisfied andchose to stop treatment partly because of theimprovement and partly because of heavy work com-mitments. She agreed to reschedule if any symptomsreturned.

Further Considerations

It could be useful to think of the following if yourresults are slow to appear or the effects of treat-ment only short-lasting:

If the parent is not already using something liketea tree oil in the bath it could be helpful to recom-mend it. Youmay need to help the parent figure outif there is an irritant inwhat the child eats or drinks,and help identify and eliminate that. Of course,with slower-responding patients, figuring out andteaching a simple home treatment using tapping,stroking, and so on can be strongly indicated.

If the symptoms are more severe or nonrespon-sive I would consider trying okyu/direct moxa topoints like GV-3 or GV-4. I would also considerapplying light cupping over the lower back andlower abdominal regions.

I suspect that if the condition is more chronicand/or severe, that the kidney or liver pattern mayshow. In the two cases above, additional symptomshelped me identify the spleen and lung patterns. Ithought about whether Mary, the second girl mightnot be a spleen pattern rather than a lung pattern. Idecided to try lung (thinking the issue could beweak lung, making lower resistance to infection)and change to spleen pattern later if there wasinsufficient progress.



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27 Improving Vitality

There are two classes of patients on whom the pri-mary focus of treatment is to “improve vitality.” Inthe first there are no symptoms for you to treat,since you are providing auxiliary therapy to helpthe patient receive strongWesternmedical therapysuch as surgery, chemotherapy, and so on. Here youare trying to strengthen and balance the overallcondition of the patient before or during thosetherapies to improve resilience and ability torecover. In the second, you are faced with a patientwho is in such a poor condition, usually with multi-ple chronic debilitating problems, that it makes nosense to focus on treating symptoms. Instead, thebest approach is to provide general support bystrengthening and balancing the overall conditionof the patient, which can allow the patient to startimproving more naturally from some of the prob-lems they are plaguedwith.

At the beginning of Chapter 17, I described thethree-, four- and five-level models for understand-ing and thinking about what you are trying to do.Taking the basic five-level model, you are primarilytrying to strengthen the third level (vitality) ratherthan focus on techniques to trigger symptomimprovements in level 1 (functional-structural sys-tems level). As is discussed there, it is usuallyadvantageous to target both the overall qi (yuan qi/zheng qi/sheng qi) with the core non-pattern-basedroot treatment and to balance the channel systemusing the pattern-based Meridian Therapy treat-ments. Chapter 25 “Weak Constitution” further dis-cusses the treatment of the weak constitution.What is described there is often helpful whenthinking about how one applies this general“improving vitality” treatment approach. Therewill be an overlap of your treatment approaches. Inthe treatment of the constitutionally weak patient,if the results are not good enough, we saw that weincrease the dose of treatment to try to stimulatemore of the changes you are seeking, with, forexample, use of direct moxa at specific acupoints.In the current case, that of “improving vitality,” thegeneral treatment of the non-pattern-based andpattern-based approaches are used, but not thestronger stimulation methods. I have found on both

children and adults that for patients on whom youneed to take this approach, the best results comefrom avoiding more stimulating, symptom-target-ing approaches and to focus on only the channelsand vitality. This is reinforced by the teachings ofmy Toyohari Meridian Therapy teachers such asToshio Yanagishita.

The following case is of a very ill little boy who,without surgical and other drastic medical inter-ventions, would have died long before. I was calledin to help him recover from the next major surgerythat was planned.

Case 1John, Boy Age 5 Years

Main complaints: He had been hospitalized for thelast 3 months with severe gastrointestinal distur-bance. He had chaotic peristalsis in the GI tract caus-ing fecal matter to pass back up through the intestineto the stomach and out through the nose andmouth.This is life-threatening. To deal with this problem hehad a tube placed through his abdominal wall aroundleft ST-26 to drain his small intestine. He had a tubeplaced down his throat to drain his stomach. He hadenemas twice daily to clear out his colon. The nameof the diagnosis of this problem is chronic intestinalpseudo-obstruction syndrome. It is very rare. Lifeexpectancy is very poor. He was not able to eat solidfood and was fed through a tube (a “portacath”) inthe right thoracic region.

History: By the age of 1 year his parents figured outthat his gastrointestinal system was abnormal, andthe problem was first diagnosed. Since that time hehad spent about half his life in hospital. He hadmultipleabdominal surgeries to investigate and try to remedythe problem, including surgeries for obstructed bowel.He had continuous medical interventions with multi-ple tests for over 4 years. He could not eat normally.His teeth were abnormal and in poor condition. Atthis stage, eating solid matter only increased theamount of material drained out into the stomach and



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230

small intestine drainage bags. One measure of howwell he was doing was the amount of fecal matterdrained out of the stomach. He spent most of histime sitting in bed. As a result, he had developed prob-lems of hip dysplasia and could not walk normally orwell. He also had very stiff and, at times, painful backmuscles.

It was decided that probably the best thing to trynext was a colostomy surgery to disconnect the smalland large intestine and to install an external drainagebag. He was on the waiting list for this surgery. It wasdecided to try acupuncture before he had the surgeryto help prepare him for it. His mother was stayingwith him at the hospital, which was very disruptive tofamily life. He had had so many medical interventionsthat he reacted with fear in the presence of a newtherapist. This is normal in a small child with his medi-cal history. For the first visit, a case-worker from thehospital assisted with explaining and helping throughthe various stages and methods of the diagnosis andtreatment. He showed an especially strong fear reac-tion when hands approached the region of hismouth, again considered normal given the number oftimes that he had been orally intubated.

Assessment: Besides being fearful as described, hewas in a generally good mood. He had a strong clearvoice. His face was slightly swollen and round, prob-ably as a result of medications such as prednisonethat he was taking. Sitting on the bed he had no prob-lem playing and moving around, except to make surethat he did not pull on any of the tubes to which hewas attached. He sat with very splayed legs as a resultof the hip problems. His skin was a slightly dull white.Once the case worker had explained what was goingon it was possible to get him to strip down to hisunderwear. Abdominal diagnosis was not possiblebecause of the numerous tubes and scars on theabdominal and thoracic walls. The muscles of hisarms were very stiff, the muscles on his back werestiff and jumpy on palpation, the shoulders and neckregions were also very stiff. The pulses were difficultto take as he would not stay still for very long, but thequality was overall slightly sinking and weak. Pulserate was difficult to assess because of his repeatedmovements. The heart (first left deep) pulse, thespleen (second right deep) pulse, and the ming men/pericardium (third right deep) pulse were weak.

Diagnosis: In Japanese Meridian Therapy, he had aspleen vacuity pattern. He was not, as one mightexpect, in an advanced state of vacuity. The yang

channels were probably all slightly weak. It wasdecided to target the treatment to apply supplemen-tation techniques for the spleen vacuity pattern andpossibly the yang channels, and to apply techniquesto try to release some of the tightness of the muscles.As it was the first visit and it was possible to schedulethe next visit the next day at the hospital, it wasdecided to apply a simple low dose of treatment.

Treatment: Using a teishin, supplementation wasapplied to left SP-3 and then left PC-7. The pulseswere rechecked, and it was noted that the kidney(third left deep) pulse was relatively weak.

Supplementation was then applied to right KI-3using the teishin. The pulses were then rechecked. Itwas not clear whether or how to select any drainingtechniques on the yang channels, and there remaineda slight weakness of the yang channels. Thus, sup-plementation was applied to bilateral TB-4 and thenST-36 using the teishin.

Using a herabari, light, rhythmic tapping wasapplied over the back of the neck and over the tops ofthe shoulders.

Press-spheres were placed at GV-12 and bilateralST-36.

Next visit—1 week later

There was no significant change. There had been noword yet about when the surgery might take place,and since it would be almost a week before the thirdtreatment, it was decided to try to increase the doseof treatment.

Diagnosis: He showed the same spleen vacuity pat-tern and but was obviously more relaxed with thetreatment.

Treatment: Using the teishin, supplementation tech-niques were applied to left SP-3, left PC-7, right KI-3,and bilateral TB-4.

Using the herabari, light, rhythmic tapping wasapplied over the neck, naso regions, arms, and back.

An enshinwas lightly stroked down the back.Intra-dermal needles were placed at bilateral ST-36

with instructions to replace them the next day withpress-spheres.

John’s mother was also given appropriate tools touse and was taught how to apply the light, rhythmictapping over the back, arms, legs, and neck, withrecommendations to do this daily for a fewminutes.



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27 Improving Vitality 231

Next visit—5 days later

He had had a lot of intestinal gas and pain the day ofthe treatment with increased counterflow of foodand draining of matter from the stomach bag. Thisimproved the next day. It was discussed further andwas decided that while it could happen at any time,there was a high suspicion that the intradermal nee-dles were possibly the cause. It was decided not touse them again. He was also scheduled for the sur-gery the next day, thus the treatment was principallyto help him prepare for and recover from the surgery.

Diagnosis: Spleen vacuity pattern. It was also de-cided that the counterflow symptoms recommendedthe use of the he-sea points for the root treatment. Itwas also decided to use the extraordinary vessels inorder to affect the abdomen.

Treatment: A small copper disc was placed on left KI-6with a small zinc disc on left LU-7.1 These wereretained for approximately 2minutes. The pulse filledout and John became visibly relaxed.

Supplementation was applied using the teishin toleft SP-9, PC-3, then to right KI-3 and TB-4 on bothsides.

Light, rhythmic tapping was applied on the arms,legs, neck, and back using the herabari.

An enshin was stroked lightly down the arms, legs,and back.

Press-spheres were applied to left and right ST-36.

The parents agreed to call to set up the next appoint-ment. John usually spent 2 or more weeks recoveringin bed following any abdominal surgery, during whichtime he was not very active and quieter.


John had recovered remarkably well and quickly fromthe surgery. Instead of lying in bed quietly for 2 weeks,he was up playing after only 2 days! He was quiteactive at this visit. Since the surgery, the stomachdrainage had decreased slightly, but not significantly.The parents had been trying to postpone this surgeryfor years. Now that they had decided to go aheadwith the surgery they found themselves torn aboutwhat to do with the acupuncture. On the one hand,they could see that it had done something for John.

On the other hand, it was very important to see whatthe surgery could do for him. As a result of this theydecided to discontinue the acupuncture, so that thiswould be the last visit. Since it was obvious from theoutset that John’s parents were confronted with life-and-death situations not infrequently, and that theywere under enormous personal strain, it was decidedat that time to agree with their wishes withoutdebate, and to ask them only to call if it may ever beappropriate in the future.

Treatment: The spleen vacuity pattern showed. Sup-plementation was applied using the teishin to left SP-3,left PC-7, right KI-3.

Draining technique was applied to left BL-58 andsupplementation to right TB-4 and ST-36.

Light, rhythmic tapping was applied over the arms,legs, neck, back, and shoulders using the herabari.

Press-spheres were applied to ST-36 on both sides.

Next visit—17months later

John’s parents called out of the blue asking for moreacupuncture treatments. John, who was now 7, hadrecovered well from the surgery and had been able togo home for a while. But 4 months before calling hehad to be readmitted with acute abdominal painresulting from an obstructed small intestine. Herequired emergency surgery, from which he spentover 2 weeks recovering. Ten weeks later he requiredfurther emergency surgery for a similar problem,from which he also spent weeks recovering. The pro-fessor in charge of his case had found during the lastsurgery that John’s colon was completely abnormaland after consultation with international experts haddecided that the best course of action was to comple-tely remove the colon. Since John also had a tubedown his throat to the stomach and a tube throughthe abdominal wall into the jejunum, it was decidedto replace these at the same time. John was also onparenteral feeding with a tube directly into the smallintestine. These surgeries were planned for 10 dayslater and John’s parents remembered that he hadrecovered well after the acupuncture the previousyear, thus they called to see if acupuncture could beused to prepare him for surgery and help with thepost-surgical recovery. Two more appointments werescheduled before the surgery.

Diagnosis: Despite having been in hospital for thelast 4 months and having major surgeries during thattime he looked quite well. His voice was strong, he



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1 This treatment method comes from the Toyohari tradition.See Fukushima (1991: 243–251).

had grown, and he was both more active and moremature. He had daily schooling at the hospital. Hisflesh was full and strong, but the muscles were stillvery tight. On inquiring about his walking, the parentsdiscussed how John was also scheduled for a brainCAT scan to see if there was any abnormality of thebrain that might be causing the muscle spasticity.Abdominal diagnosis was not possible. Using a teishin,supplementation was applied to left LI-4 as a methodof confirming the pulse diagnosis. The pulse diagnosisshowed a spleen vacuity pattern.

Treatment: Supplementation was applied to left SP-3,left PC-7 and right KI-3 using the teishin.

Draining technique was then applied to left SI-7,right LI-6, and supplementation to ST-36 on both sides.

Using the teishin, super light stroking (sanshin) wasapplied down the large intestine and stomach chan-nels on the arms.

Using an enshin, very light strokingwas also applieddown the backs of the arms and legs and down theback.

Light, rhythmic tapping was applied on the headand over the areas ST-36 to ST-37.

Next visit—1 week later

Two days before, his portacath feeding tube mechan-ism had mechanically failed. This required that hehave emergency minor surgery to replace the tube.Following such minor surgeries with general anes-thetic John would spend at least a couple of days reco-vering. He was out of bed playing 2 hours after thesurgery!

Treatment: Supplementation was applied using theteishin on left SP-3, left PC-7, right KI-3, ST-36 on bothsides, with draining technique on left SI-7.

The sanshin-style super light stroking was applieddown the large intestine and stomach channels.

Light stroking down the back was applied using anenshin.

Light, rhythmic tapping was applied over the head,neck, and shoulders using the herabari.

Press-spheres were applied to ST-36 on both sides.

Next visit—2 days later, 1 day before the surgery

John was doing well and was ready for the surgery.

Treatment: Identical to the previous session, exceptthat SI-7 was not drained and a press-sphere was alsoadded to GV-12.

Next visit—15 days later, and just before I was toleave for Japan to study

John had recovered amazingly well from the surgery.The surgery had gone well so that he now had nocolon left. It was expected that he would be in inten-sive care after the surgery for 3–4 days. He was out in20 hours! It was expected that he would be laid flaton his back in bed for 2 weeks. He was sitting andplaying in 3 days! This was the first time that even thesurgeon was wondering about the acupuncture. Johnwas still on pain medication and still had postsurgicalpain, but was doing very well. He was quite active andhad no difficulties getting around. The CAT scans ofhis brain had come back negative. It had beendecided to start pediatric physical therapy as soon ashe was able. The parents stated their intention to tryand get John home as soon as possible, as it was avery big burden at present to have him stay in hospi-tal because one of them had to stay with him at alltimes.

Treatment: The same treatment as the last wasapplied with the addition of draining technique to leftSI-7, right TB-5.

Next visit—4 weeks later

John was doing well. He had an infection at the surgi-cal scar, which was successfully treated with antibio-tics. The parents were trying to get him home withhome help, but there was currently a shortage ofhome help available, delaying his departure from thehospital. His pain was much better and he was usingNSAIDs (non-steroidal anti-inflammatory drugs).

Treatment: He seemed to show a lung vacuity pat-tern. Consequently, using the teishin supplementa-tion was applied to left LU-9 and SP-3, with drainingtechnique to right LR-3, right TB-5.

Supplementation was applied to ST-36 on bothsides.

The stroking and light, rhythmic tapping was thesame as the last session.

Press-spheres were left on ST-36 on both sidesand right BL-18.

Next visit—5 weeks later

He was at home for the first time in 6 months. He hadhome help during the day. He was able to run aroundfor a few hours during the day but needed to be



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hooked up to various feeding and draining tubes bythe evening. He was generally doing quite well. Hehad some abdominal pain and still used the NSAIDs asnecessary.

Treatment: He had the usual spleen vacuity pattern.Supplementation was applied using the teishin to leftSP-3, left PC-7, right KI-3, draining technique to rightLI-6.

The light stroking and tapping was applied asusual.

Press-spheres were placed on bilateral ST-36 andright BL-18.


John had experienced a slow increase of abdominalpain over the last week and had to go back on the sto-mach drain. He was having some headaches and wascranky and irritable. His parents were very distressedas this usually presaged a return to the hospital. Theyhad been discussing what to do as there were noclear next steps for John. They had made a choice notto return to the hospital for any further intervention.The strain on John and everyone else was too muchand they could no longer see what the future mightbring. They were both clearly very distressed. Theyhad had to live with this possibility for 6 years. Nofurther discussion was made. They wanted to discon-tinue the acupuncture treatment after this visit.

Treatment: He showed the lung vacuity patternagain. Supplementation was applied using the teishinto left LU-9, left SP-3, draining techniques to right LR-3and left BL-58.

The light stroking and tapping techniques wereapplied as usual.

Press-spheres were applied to bilateral ST-36 andto GV-3, GV-12.

Follow-up: Seven months later John was still at homeand doing very well. He was going by bus to schooleach day. He had recovered from the acute flare-up atthe time of the last acupuncture treatment and hadnot needed to be hospitalized since then. He was liv-ing the closest to a normal life he had ever done.

Goals of Treatment in ComplicatedCases

Treat to improve the overall vitality of the patientrather than targeting to relieve symptoms. Wherefeasible, apply treatment to target symptoms, butthis is the rare exception rather than the rule.

General Approach to Improve Vitality

Like the cases of weak constitution you mustassume from the start that the child is more sensi-tive than other patients. Thus, trying a softer,milder treatment to begin with is generally impor-tant (review Chapter 4 for discussions of this andChapter 7 for discussions of how tomodify the coretreatment). Once you have got an idea of how thechild responds to treatment you can graduallyincrease the dose by adding in or replacing treat-ment methods.

The best way to target strengthening of vitalityis to treat at that level directly and to do a simpleMeridian balancing treatment. The core non-pat-tern-based root treatment using a simple combina-tion of light stroking and tapping is ideal. The sim-ple pattern-based Meridian Therapy diagnoses andtreatments described above are an excellent way ofbalancing the channel system with gentle techni-ques. In addition one can add soft stimulation ofgeneral points like GV-12 with press-spheres toreinforce your treatments. Finally, when you areclear how the child responds towhat you are doing,and you have time to implement it, you can teachthe parents a very soft simplified form of hometreatment.

Figuring out a simple core non-pattern-basedtreatment and using that regularly is important, asis teaching the parent to start using this at homeregularly. It is generally not difficult to do this. Theprinciple issue will be one of not trying to do toomuch.

Applying a simple pattern-based treatmentaccording to the pattern is usually not too difficult.If the pulse and abdominal signs are not clear or areinaccessible, look to the history of symptoms tochoose the primary pattern to treat. In the presur-gical child, the main problem is usually clearlyidentifiable and deciding the best choice of patternnot too difficult. In the case of the very ill and run-



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down child with multiple problems it can be moredifficult. Sometimes you can get an indication ofthe pattern according to the history of problems:what kind of problems first showed up when thechild was younger? If this is not clear, try to deter-mine the most severe symptoms and use those topick the pattern. On occasion it can take a couple oftreatments to figure out the best approach.


All techniques should be applied more gently andat a lower dose than usual for this treatment.

Core Non-pattern-based Root TreatmentLightly stroking down the arms, legs, back, abdo-men, and chest (do not do this if the child has skinproblems—see Chapter 19 on skin problems). Lighttapping around GV-12 (see Fig.27.1).

One can add additional tapping as needed, forexample around CV-12 if there are major digestiveproblems, around LU-1 if there are major respira-tory problems, around GV-3 to GV-4 if there aremajor problems of the lower abdomen.

Other Supportive Treatments

Press-spheres can be placed on strategic pointssuch as GV-12 (most children), CV-12 or ST-36(often for digestively disrupted/spleen vacuitypatients), and BL-23 for patients with strong kidneyvacuity signs. If the child is having difficulty sleep-ing, try leaving the press-spheres at BL-17 and, ifnot reactive, around GV-9. If the child is in a veryrundown state the extra points “lateral pigen” canbe used (see Chapter 16 for location).

Chinetsukyu, “warm moxa,” is very useful for asimple general supplementation. The technique isnot used often on children if they will not stay stillor have respiratory problems that could be irritatedby the smoke. The “supplementing” form of chinet-sukyu can be used for the very rundown child as adirect treatment of the “vitality” by applying it toGV-14, GV-3, and the lateral pigen points. I havebeen using this extensively on adults with verygood results. The difficulty of using this techniqueon very sick children such as those where you havechosen to use the “improving vitality” treatment

approach is that either (1) they are hospitalized andyou can’t burn this kind of moxa or (2) they are toofearful, move too much, or have difficulty dealingwith the smoke. But, if you are in a position to usethis chinetsukyu, it can be very helpful.


Home treatment can be applied in a soft, light man-ner to help support what you are trying to do, andgives the parents a simple approach for dealingwith their very ill child. It is strongly recommendedto try this wherever feasible.



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Fig.27.1 Stroking:● Down the arms (yang channels)● Down the legs (stomach and bladder channels)● Down the back (bladder channel)● Down the abdomen (stomach channel)● Across the chestTapping:● Light tapping around GV-12● If there are major digestive problems add tapping around● CV-12● If there are major respiratory problems add tappingaround LU-1

● If there are major problems of the lower abdomen, addtapping around GV-3 to GV-4

Further Case History

The following remarkable case from my Barcelona-based colleague Rayén Antón, is of the treatment ofa 7-year-old girl with severe heart disease forwhom the prognosis was poor. Rayénwas on a fieldtrip to Gaza with the UK-based organization“WorldMedicine” in October 2009. This case showsthe power of the core non-pattern-based root treat-ment and its regular application by the parents athome.

Case 2Malek, Girl Age 7 Years

Main complaints: Sudden extreme tiredness, fati-gue, lack of vitality, difficulty breathing. Parents sta-ted that “her heart pumps more blood from one sidethan the other.”

History: At the age of 5 years, Malek was diagnosedby the specialists at the hospital as having severe pul-monary hypertension. She underwent cardiac cathe-terization; the procedure was successful but the con-dition remained and her parents were told that shewould need to continue on medication for the rest ofher life. She had developed increasing exercise intoler-ance and was generally quite limited in her activities.

Examination: Malek had a fearful look, sad eyes, anda timid behavior. She had a cyanotic complexion, bigdark bags under her eyes, and the skin looked a bitrough and lackluster. Her abdomen was noticeablybloated (she was taking diuretics for her heart condi-tion), and she was very thin and small for her age. Thepulse was deep, normal speed, and weak. It disap-peared easily with pressure.

Treatment: Light stroking was applied with an enshindown the arms, lower part of the legs, and along theback.

Tapping was applied on the GV-12 and GV-4 areas,around ST-36, and in the supraclavicular fossa region.

Remarks: During the treatment the pulse improveda lot, becoming fuller. Malek’s general look wasbrighter by the end of the treatment. Themother wastaught the basic core non-pattern-based root treat-

ment using a spoon to apply the stroking. She wasinstructed to do this daily.


Malek’s mother reported: “After the treatment shestarted running, at night she was tired.” Home treat-ment had been applied daily. Malek had a better com-plexion and was less lackluster. The pulse was muchbetter.

Treatment: Light stroking was applied with an enshindown the arms, lower part of the legs, and along theback. Special attention was paid to “opening” thechest (stroking from the sternum to the sides).

Tapping was applied around GV-12, the interscapu-lar region, and ST-36 bilaterally.

Using a teishin, supplementation was applied toright SP-6.


Hermother reported “Before I could never take her toweddings, because she was always so tired … yester-day I took her to one and she was playing with therest of the kids with no problem.” Home daily treat-ment continued. During the previous visit it was clearthat the mother’s eyes had changed, but on this visitthey were now bright and strong (very different fromthe first day, not bright and carrying an evidentamount of sorrow and exhaustion). Pulse strong in allpositions, balanced. Abdomen less bloated.

Treatment: Light stroking was applied with an enshindown the arms, lower part of the legs, and along theback. Special attention was applied to “opening” thechest (stroking from the sternum to the sides).

Tapping was applied to the GV-12 and GV-4 areas.Using a teishin, supplementation was applied to

GV-12, right LU-9, and SP-6.

Fourth visit—1 day later

Malek continued to improve. Her face was shiny, theabdomen less bloated, and her mother continuedwith the daily treatment at home. Pulse: healthy full.




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Tapping was applied around GV-12, the interscapu-lar region, and ST-36.

Supplementation was applied using a teishin toGV-12 and bilateral SP-6.

Fifth visit—1 day later

She had improved further. She was able to climb ontothe treatment table by herself, with an agile move-ment. Daily treatment was ongoing. The pulse wasgood.


Tapping was applied around GV-12, the interscapu-lar region, and ST-36.

Using a teishin, supplementation was applied toGV-12, right LU-9, and SP-6.


Malek remained improved. Her mother applied treat-ment daily at home. The pulse was good, abdomenless bloated.


Tapping was applied around GV-12, interscapularregion, and GV-4.

Using a teishin, right LU-9 and SP-6 were supple-mented.

Seventh visit—1 day later

She remained improved. She entered the room smil-ing, with gifts (it was the last treatment before Rayén

returned to Barcelona). Malek and her mother bothhad a distinctly improved appearance. The pulse wasgood.


Tapping was applied over the interscapular regionand ST-36.

Supplementation to right SP-6 was applied.

Reflection: Malek was a 7-year-old girl who was bornand lived in Gaza. Access to medicine and sanitary aidwas very limited, and the general social environmenthard. Her condition, from the Western Medical per-spective, was one without a cure, and worse thanthat, without a “normal life quality” prognosis.Despite these circumstances, the effect of shonishin,especially with this combination of clinical treatmentand the home treatment was quite remarkable.When on the second visit her mother told me that“she has been running” I had a moment of shockwhen realizing that this little child, who had such ahard timewalking, suffering from attacks of completeexhaustion, was able now to not just walk normally,but she could run! I must confess I thought it was toogood to be true. But then when her mother told meabout the wedding, about Malek playing with the restof the children, I was completely struck by the powerof the shonishin therapy, and grateful for witnessingsuch a double healing situation. I say “double”because the effect on Malek’s mother was alsoremarkable. She was so happy (of course) and shewas no longer feeling so impotent about the sufferingof her child. Now she had a tool: home treatment. Ibelieve that this was the key point in this case to sig-nificantly improve the quality of life of this child andher family.



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28 Recommendations for Treatment of Other and LessCommonly Seen Problems

Shonishin has been used for several centuries in thetreatment of different health problems in children.Since World War II it has become better and morewidely known in the Japanese acupuncture com-munity. Many of the texts on shonishin are byelderly experienced practitioners who appliedtreatment in Japan during times when the healthcare system was not as advanced as it is today, andin a culture that is more accepting of acupuncturein general. Those practitioners applied acupunc-ture treatment on patients with a number of healthproblems that do not commonly present in ourmodernWestern acupuncture practices. Today, andgenerally in the West, parents whose children havethese problems do not usually think to come to anacupuncturist, either because surgery is the usuallyrecommended route of treatment (e.g., inguinalhernia, tonsillitis), long-term use of major medica-tion is the recommended treatment (e.g., epilepsy,kidney disease), or the child is acutely ill under con-sultation with their general practitioner (tonsillitis,mumps). Thus, there are conditions where treat-ment recommendations can be found from thepractices of experienced practitioners but forwhich parents do not usually or commonly bringtheir children to acupuncturists in the West fortreatment. This chapter covers a number of suchrecommendations to give an idea of what kind oftreatment techniques and loci can be targetedshould children come to you for those problems.The treatment discussions listed below represent acompilation of ideas from various sources.

The Child with Fever

When I teach I am often asked how to treat childrenwith a fever. I usually respond by pointing out thatwe do not usually get the chance to treat childrenwith fevers since the parent calls and cancels theappointment. If I ask those in the group that treatchildren howmany get to treat a child with a fever,almost nobody raises their hand. This is a compli-cated issue. In Holland, patients often come bybicycle and parents are usually loath to bring their

feverish child on a bicycle. In the United Stateswhere I worked, almost none of my patients livednear where I worked and almost all came by car.Parents were, by and large, unwilling to bring theirfeverish child in the car. As a consequence I almostalways got a phone call that morning or at the lastminute cancelling the treatment. Occasionally, achild is brought for their treatment and they have afever because they just started the cold. It can bevery different in Japan. As mentioned earlier, manyacupuncturists have clinics downstairs in the housewhere they live or they have their clinic round thecorner fromwhere they live. The clinics are often inresidential neighborhoods and it is relatively easyfor the mother to bring her child for treatmentwhen he or she has a fever, thus practitioners theretend to see children with fever much more often intheir practices compared with acupuncture prac-tices in the West, though I suspect that trend ischanging.

There are increasing numbers of primary healthcare workers such as doctors using acupuncture,and, by and large, they are more likely to have theparent bring their feverish child for consultationwith them rather than to the nonmedical acupunc-turist. There are also increasing numbers of parentswho are fed up with seeing the doctor with theirchild and not being satisfied with the results, andwhen those parents start to trust you as the acu-puncturist, start to come to you first before theirdoctor. Thus, over time we can expect a slowincrease in the number of children that do have afever coming for acupuncture. Although so far inclinical practice I have not treated many childrenwith a fever, I would like to explain how one doesthis.

It is important not to ignore the fever. The corenon-pattern-based root treatment is contraindi-cated in a child who has a fever of over 37.8 °C andone has to think about whether one should applythis core treatment on a child who has a raisedbody temperature up to 37.8 °C. It is not very goodif you simply say, sorry, I can’t treat her today, shehas a fever, to the parent who has made the effortto come and see you. You may, however, have a



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child present who has strong symptoms and a highfever. As an acupuncturist, I always feel sorry tosend someone away without treatment and I canalways find something to try to help. I will firstrecommend that the parent take the child to theirusual doctor for a consultation and then apply atreatment. I further instruct that the parent shouldeither go immediately to the doctor or, if the symp-toms progress at all, to go to the doctor then. Therewill be some variations in how you might expressyourself depending on the parent and the conditionof the child, but the message should be simple: it isbetter to have the child checked by the doctor inthis case. If the child presents with only amild fever(say around 37.8°C) I will proceed with treatment,albeit carefully. At the end I instruct the parent ifthe condition worsens, and especially if the feverincreases, to please consult the doctor.

Although the core non-pattern-based root treat-ment can be contraindicated, there are a fewaspects of it that can be applied and which can behelpful for a child with fever. Tapping lightlyaround the head can help encourage release of heatby sweating. Mr. Yanagishita recommended use of avery light stroking over the webs of the fingers(Yanagishita 2007, personal communication). Herethe technique is applied by holding the needle orinstrument between the index finger and thumb sothat a small part of the instrument (teishin, hera-bari, etc.) protrudes. One strokes on the dorsal sur-face of the hand from near the wrist movingtowards the web between the digits, moving yourfingers between the fingers as you come over theweb, angling slightly toward the palmar surface ofthe hand. Apply one to two light strokes over eacharea on both hands. This treatment is applied veryquickly and does not takemuch time.

The pattern-based root treatment can also bemodified to target the symptom of fever. Followingthe ideas from Nan Jing (Classic of Difficulties)Chapter 68, we can use the ying-spring (fire) pointsfor fever and the jing-river (metal) points for alter-nating fever and chills. The first time my son wassick with a fever (around age 1 year) and we werefiguring out what to do, we had just taken his tem-perature, which was 38.2°C. I applied supplemen-tation with a teishin to LU-10 (the ying-springpoint) instead of LU-9 to try to target the fever. Weboth felt some immediate difference, we recheckedthe temperature and it was now 37.2 and he lookedless feverish! It was very curious. I continued treat-

ment by supplementing SP-2. He recovered quitequickly and the fever did not (on that occasion)return. Of course, we do not always see such rapidchanges, but we can get a hint from this experience.For the child who has the liver vacuity pattern andwho today has a mild fever that alternates withchills, recovering from a cold that started severaldays ago, instead of using LR-8 and KI-10 you cantry using LR-4, KI-7, and the jing-river points.

The symptomatic aspects of treatment offer sev-eral opportunities to target the fever. The mostcommon approaches we might use on an adultpatient with fever are moxa and bloodletting. Bothof these can be difficult to apply on the pediatricpatient, especially the younger child.

Studies in China found that applying a moxapole to GV-14 on patients with a fever reduces thefever.1 This matches clinical experience. We mightuse okyu/direct moxa to achieve this or a more hotbut indirect form of moxa such as a moxa pole.Probably the easiest technique on the typical childwith fever is the use of the moxa pole at GV-14. Ihave not described the use of the moxa pole in thisbook because we do not usually use moxa poles inthe treatment of children and, in general, in theJapanese acupuncture approaches I practice I donot use them. However, unless one’s okyu techni-ques are very good, you are not likely to use thattechnique on the feverish child, hence I would liketo describe the use of the moxa pole here. First, onthe child with the higher fever (very rarely seen inour clinics), do not apply this technique.

Children usually do not stay still, especially thesmall child who makes unpredictable movementsand on whom if you try to constrain their move-ments you create opposite reactions, strugglingand more movements or crying. We prefer not todo this. When we use something like a moxa pole,the danger for children is that theywill not stay stillandwill move, bumping into the burning end of thepole, which would be disastrous. We thus need asimple way of maintaining safety if we are to usethe moxa pole. There are two simple methods. Firstit may be better to use a lighted incense stick on thebaby or small child rather than the moxa pole,which burns much hotter. Second, you need to fixthe lighted end of the pole at a set distance from the



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1 See, for example, the studies by Tian and Wang (1987) andWang, Tian, and Li (1987).

skin and in such a way that if the child moves theycannot bump into the lighted end. One way to dothis is to hold the pole close to the lighted end withthe index finger and thumb, holding both bent,while extending the other fingers of that hand sothat they touch the child. As the child moves he orshe presses against the extended fingers, which arekept straight, thus allowing the lighted pole to bekept at the same distance from the skin. With yourother hand you also need to touch the child to feelhis or her responses. Are they moving because theyhave started to feel the heat of the pole, or are theymoving because they won’t stay still? When thechild feels the heat, move the lighted end away andthen a little while later bring the lighted end back,moving away again as they feel the heat. Thisapproaching andmoving away from the point GV-14will allow the point to gradually warm up.Once itstarts to appear a little red around GV-14, stop thetechnique.

On children, it is sometimes indicated to applybloodletting, especially of jing-well points. Shimizu(1975) recommends bleeding of LI-1 and/or SI-1 forearly-stage mild fever in children who also have asore throat. On adults we can apply bloodletting tojing-well points for fever, thus we have a similaridea here. However, jing point bloodletting can bedifficult on children and one’s technique has to begood, since the technique should be painless on achild. Chapter 15 describes how to do this techni-que, but you definitely need to practice on otherpeople before you try it on a child with fever. If youchoose to use the technique on a child with fevermake sure of the following:● Select the point for treatment by visual signs—

the point and surrounding area is slightly red-dish, maybe slightly swollen.

● Make sure to apply the technique not only pain-lessly but also so that when you want the bloodto stop oozing out, it does so (i.e., don’t stab at alldeeply).

● Remove a few drops of blood from each point,do not remove too much from each (i.e., do notstab too deeply and do not wait till the bloodflow changes color or consistency).

● Have small plasters or Band-Aids on hand toplace over the treated point to be removed ashort while later when the child arrives home.

Teething Problems

For teething problems shonishin can be very help-ful. If the child is crying a lot and is very irritable,ask about general moodiness and sleep. If not sogood, treat the baby child as the “kanmushisho” pat-tern. In addition to the core non-pattern-based roottreatment, add extra tapping around the occipitalregion, LI-4, GV-20, GV-12, on the jaw, and belowthe ears. For the Meridian Therapy treatment, if thepulse and other findings are not clear, treat the livervacuity pattern (supplement either LR-8, KI-10 orLR-3, KI-3); otherwise follow the pattern that youfind.

If the teething problems are triggering nasalcongestion problems, or problems of catching coldeasily, apply the core non-pattern-based root treat-ment and apply additional tapping to the GV-22 toGV-23 area, LI-4, GV-12, and LU-1 regions. For theMeridian Therapy treatment, if the pulse and otherfindings are not clear, treat the lung vacuity pattern(supplement LU-9 and SP-3); otherwise follow thepattern that you find.

Applying press-spheres to GV-12 can be helpful,if there are hard, reactive points either on the jawor behind the jaw around TB-17, applying a press-sphere to this can also be helpful.

If the symptoms are stronger and resistant tothe above treatment, insert needles with the in-outmethod to LI-4.

In more severe cases bloodletting can be appliedto the thumbnail corner, especially LU-11 or LI-1(Maruyama and Kudo 1982).

Infectious Diseases

Today, especially in theWest, when a child developsan infectious disease such asmumps or tonsillitis, itis common that the parents seek the help of theirpediatrician. Some parents may also seek helpfrom, for example, a homeopath, but in general par-ents do not tend to think that acupuncture mightbe useful for such conditions and thus tend not toconsult acupuncturists much. In the past in Japan,especially before the current health care systemhad developed, parents were much more likely togo to the acupuncturist for treatment. Thus, someof the older practitioners describe treatment ofthese conditions. It is possible that we as acupunc-



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turists in modern Western countries may be calledupon to see children with such infections, thus it isuseful to know what to do to help, because the sho-nishin treatment approach can be quite effective.

Yoneyama and Mori (1964) caution for suchconditions that if the child has a fever of 37.8°C orhigher not to apply treatment. It is better that theconversation about whether treatment should beapplied or not is best done over the phone so as toprevent unnecessary clinic visits and associatedtravel. In the case of tonsillitis, Yoneyama and Morisay if the fever is mild treatment can be applied.

Tonsillitis

Tonsillitis causes symptoms of sore throat, pain onswallowing, and when very enlarged, mouthbreathing due to obstructed nasal airways. The ton-sils can start to become enlarged around age 2–3years with significant swelling around age 6 years.

A number of authors have different recommen-dations for the treatment of tonsillitis. I presentthem all here so that one has choices in theapproach onewants to take.

Yoneyama and Mori (1964) recommend a two-stage treatment for tonsillitis: (1) needle aroundLI-18 to ST-9, angling towards and almost to thedepth of the tonsils; (2) look for a swollen veinaround KI-6 and let blood from it (they commentthat the bloodletting is especially effective).

For chronic tonsillitis Hyodo (1986) recom-mends needling of LI-18, ST-9 or placement ofpress-spheres to these acupoints.

Shimizu (1975) comments that we can viewtonsillitis as lung and/or kidney related. As well asapplying the core non-pattern-based root treat-ment he recommends treatment of acupoints suchas KI-27, KI-16, KI-6, BL-23, LU-5, LI-4, and BL-13 tohelp regulate the lungs and kidneys. Additionally,needle over the area of the tonsils to acupoints suchas TB-17, BL-11, and about 0.5cun lateral to C6/7.Finally okyu/direct moxa can be applied to acu-points such as GV-12, BL-12, BL-23, LU-5, KI-6 (halfrice grain size, three to five cones per point). If youuse moxa reduce the number of acupoints needledand do not needle andmoxa the same acupoints.

From the perspective of Meridian Therapy, if thecondition is acute and has not occurred before, it ismore likely to be a lung vacuity pattern (but wewillrarely see children in such an acute stage). If the

condition is chronic, with recurrent symptoms, itcould be a kidney vacuity pattern. One needs to dif-ferentiate from the pulse and various findings. Sup-plementing KI-7 and LU-8 can be helpful, but ifthere are signs of fever at all, use of KI-2, LU-10(ying-spring points for fever) may be better.

Writing in general about the use of moxa treat-ment, Shiroda (1986) recommends the followingacupoints be palpated and reactive points treatedwith moxa for tonsillitis: LU-5, BL-11, GV-14, BL-12,LU-6, LU-7, KI-3. Maruyama and Kudo (1982) men-tion that bloodletting can be applied to the thumb-nail corner, especially LU-11.

Mumps

Yoneyama and Mori (1964) recommend that formumps it is better to avoid treatment when thereis a fever. Treatment can be applied when the feverhas subsided. For treatment: insert thin needlesshallowly or place intra-dermal needles over thearea so as to surround the swollen region.

Shimizu (1975) has a more detailed description.This is mostly seen in 5–15-year-old children. Thechild presents with early signs of headache, fever, astrange feeling over the swollen area, and poorappetite. As the condition progresses the glandsbecome swollen, and painful with difficulty chew-ing and opening the mouth. It can manifest on oneor both sides. For treatment, quick relief of the paincan be obtained by placing an intra-dermal needleat the centre of the swollen region (below the earand toward the lower jaw). If no fever, then one canalso apply the core non-pattern-based root treat-ment, focusing especially on the shoulders, upperback, upper abdomen, and lumbar region. Needlescan be inserted to acupoints such as BL-14, BL-22,TB-9, and TB-15. Bloodletting can be applied to thethumbnail corner, especially LU-11 (Maruyamaand Kudo 1982).

From a Meridian Therapy perspective you arelikely to see a problemwith stomach and triple bur-ner channels, which point toward a spleen vacuitypattern. Because the child is older you should beable to perform pulse and abdominal diagnosis toselect the pattern for treatment. It is also possiblethat the pattern is lung vacuity, perhaps with a dis-turbance of the heart pulse or kidney vacuity pat-tern, perhaps with a disturbance of the heart orspleen pulses. Treat according towhat you find.



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Nervous Conditions

Stuttering and Stammering

This is not a condition for whichmany parents havebrought their child for treatment. Usually parentsseek help from specialized speech therapists. If theparent brings their child to you and is receivingtreatment from such a therapist this is ideal. If theycome to you and have not sought help from aspeech therapist, it is useful to advise such therapy.Sometimes the parents have taken their child forpsychological therapy to help with this problem.This can also be a useful therapy to help the childlearn to relax and cope better with stress, and mayalso be a good referral for the parent. If you want totry your treatment first and then refer after youhave seen the response this can also be useful inorder to help understand whether your treatmentis helping and how it is helping. A main target ofyour treatment will be to help the child feel morerelaxed and help change the way that their bodyresponds to what they perceive as stressful situa-tions.

Yoneyama and Mori (1964) describe treatmentof this condition and report that this problem gen-erally responds well to the shonishin treatment.Conditions that developed more recently are moreeasily cured. Severe, chronic conditions can be cor-rectedwith continuous treatments by the age of 5–6years (if the treatment is started early enough).

TreatmentUse the core non-pattern-based whole body treat-ment with stroking and tapping needle (especiallyof the neck, shoulder, and upper back regions), as isused in the treatment of kanmushisho. You mayfind abnormal tension patterns in the muscles ofthe jaw, around ST-7 and ST-6, so apply tapping tothese. You may also find abnormal tension patternsaround TB-17; target treatment to this area as well.On some children there can be abnormal tensionon the sternocleidomastoid muscle; apply a littleextra tapping to this region as well. Once you haveestablished a pattern of treatment that seems to fitthe childwell, it is strongly advised to teach the par-ents about a simple form of home therapy to beapplied regularly at home.

I think for the pattern-based root treatment,this condition will show either a liver vacuity pat-tern or a lung vacuity pattern. Look to the pulse and

other signs to differentiate which. In terms of pointselection, this condition is usually associated withnervousness or worsened by stress causing ner-vousness. Look to see if there are any signs of coun-terflow qi in such cases (flushing of the face, neck)and try the he-sea points instead of the usualpoints.

In severe conditions one will usually find a lot ofstiffness on the neck, shoulders, and upper back.One can apply light needling to the stiff pointsaround GB-20 and BL-10. If there are knots aroundBL-14 or BL-15, one can apply press-spheres orpress-tack needles to these knots, being carefulabout doses. One can also leave press-spheres atGV-12 and/or the point on the back of the earbehind shen men.2 On older children one can pal-pate the thoracic vertebrae between T2 and T9. Forthe reactive point(s) apply okyu. This is Fukaya’s“psychosomatic” moxa treatment (Irie 1980;Fukaya 1982). This is used a lot on adult patientswithin the Fukaya moxa tradition and is helpfulwhenever the patient shows a physical symptomdue to psychological or emotional issues or stress.Stuttering and stammering usually manifest assuch a “psychosomatic” problem. It is difficult to dothis treatment on smaller children as it involves theuse of more direct moxa. If there is a single inter-vertebral space that shows a clear reaction, applyaround nine cones of moxa (the reaction shoulddiminish with the treatment). If there are two ormore intervertebral spaces that show reactionapply three cones of moxa to each space. For exam-ple, if below T4 is distinctly reactive, apply ninecones of moxa. If below T4, T5, and T7 are reactive,apply three cones to each.

Neurological Conditions

Convulsions—Including Epilepsy

Yoneyama and Mori (1964) describe the treatmentof childrenwith convulsions. This includes both thecondition “epilepsy” and children who have febrileconvulsions. Today it is not very common for chil-dren to come for acupuncture for treatment ofthese conditions. The epileptic patient is usually on



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2 Recommended by Mike Smith of the Bronx as useful forADHD children and which I have found useful for childrenwho have difficulty expressing themselves.

medication and if this does not work sufficiently,appropriate medical specialists are visited ratherthan the local acupuncturist. However, since chil-dren do occasionally come with the problem ofconvulsions, I include treatment recommendationsas a guide to treatment.

Yoneyama andMori indicate that children proneto convulsions (or epilepsy) can show slow, steadyimprovement with regular application of thewholebody general treatment. The core non-pattern-based root treatment is good for the constitutionaltendency, helping prevent the tendency to con-vulse. To deal with acute episodes, more aggressiveand stronger treatments are necessary. As a rule,great caution is advised in the treatment of epilep-tic or seizure-prone children. Proper referral andconsultation with the child’s pediatrician is veryimportant. Treatment of the acute episode shouldbe embarked uponwith even greater caution.

TreatmentFor the emergency or acute treatment, insert nee-dles to the jing points, or needle GV-26 and applybloodletting to LI-2. Also add strong touching/tap-ping needlemethods to the temporal regions. How-ever, it is much more likely that if a child has a sei-zure in your clinic that you will wait for the parent(s) to manage the seizure before allowing you tocontinue.

For the constitutional treatment, apply the corenon-pattern-based root treatment with strokingand tapping andmoxa GV-12.

Root treatment using Meridian Therapy will bepossible based on a full assessment of the patient.On the older child you will be able to access thepulse and abdomen and choose the pattern accord-ingly. The most likely pattern will be liver vacuitypattern, in which case supplement LR-8 and KI-10.It is also possible that the liver may be replete(showing with a clear hardness of the liver pulse).In this case the child will either be lung vacuity pat-tern or spleen vacuity pattern. Examine the pulseand abdomen and other findings to select which ofthese patterns to treat. For the lung vacuity patternsupplement LU-9 and SP-3 on one side and drainLR-3 on the other. For the spleen vacuity patternsupplement SP-3 and PC-7 on one side and drainLR-3 on the other.

For symptomatic treatment, moxibustion isdescribed by a number of authors. Irie (1980)describes the application of moxa to GV-8, GV-12,

and GB-8 (three moxa each). Manaka, Itaya, andBirch (1995) indicate the use of moxa on GV-20 andCV-4 for infantile seizures.

Facial Paralysis

Occasionally in practice a child presents withparalysis of the facial nerves. Shimizu (1975)describes treatment of this condition, indicatingthat treatment of this problem on children is moreeffective than on adults and one sees changesusuallywithin 3–4weeks.

TreatmentApply the core non-pattern-based root treatment.After this apply in and out needling techniques tosome of the following acupoints: BL-18, GV-8,CV-14, and LR-14 (to help regulate the liver); GV-20,GB-20, GV-12, GB-21 (to help regulate the state ofthe nervous system). Then select and needle up tofour acupoints from among the following on theaffected region: for example, GB-1, ST-7, ST-5, TB-17;then needle up to two acupoints on the limbs at, forexample, TB-9, GB-34. Finally, place intra-dermalneedles to distinctive pressure pain points on theaffected region, such as at GB-1 or more posteriorto it, SI-18, ST-5, TB-17, GB-3, ST-7. Also place someintra-dermal needles at distinctive pressure painpoints on the limbs choosing from among TB-9,LI-10, GB-34, ST-36. Retain the intra-dermal nee-dles for 3–5 days, then change them to other reac-tive points, rotating among the various reactivepoints continuously.

As Shimizu indicates, this can be treated also asa liver-related problem. Themost likely patternwillbe liver vacuity pattern, in which case supplementLR-8 and KI-10 on the unaffected side. It is also pos-sible that the liver may be replete (showing with aclear hardness of the liver pulse). In this case thechild will either be lung vacuity pattern or spleenvacuity pattern, so examine the pulse and abdomenand other findings to select which of these patternsto treat. For the lung vacuity pattern supplementLU-9 and SP-3 on the unaffected side and drain LR-3on the affected side. For the spleen vacuity patternsupplement SP-3 and PC-7 on the unaffected sideand drain LR-3 on the affected side.



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Kidney Diseases

Glomerulonephritis and Nephrosis

Occasionally we see patients who come for acu-puncture because of kidney disease problems. It isnot so commonwith adult patients and is even lesscommon with children. In the past in Japan thiswas more commonly treated by acupuncture.Today if we see such a patient, they are usuallyundergoing Western medical therapy such as ster-oids and are treated often over the long term. Wetend not to see patients with this condition untilthey have already been treated over a long periodwith steroid therapy and concern begins to beexpressed about the consequences of such long-term therapy,3 and/or the fact that the condition isbeing maintained by the drug therapy but is notimproving. Thus, when we see patients with suchproblems we are not only addressing the kidneydisease itself and its manifestations, but also sec-ondary issues due to prolonged use of drugs. Thiscan be quite complicated and can require extendedcourses of treatment to be helpful. Many patientsdo not have the patience or resources for suchextended therapy, and so it is useful when treatingchildren to focus on finding ways to demonstrate tothe parents in a sufficiently short period of timethat what you are doing does in fact help, and thenworking out a home treatment regimen so that theparents can continue therapy daily at home, redu-cing the number of visits to you. As described in theintroduction to Chapter 25, it is also helpful to finda way of reducing costs to the parents using, forexample, reduced treatment rates.

Yoneyama and Mori (1964) report that infantilenephritis can respond very well to shonishin ther-apy. Rest, keeping the child warm, and altering thechild’s diet are, of course, important, but the sho-nishin treatment is quite effective.

TreatmentApply the core non-pattern-based root treatmentwith the stroking and tapping regularly. Applyadditional tapping to the area around GV-3/GV-4and around the navel. As soon as you have estab-

lished a pattern of treatment that fits the child,teach the parents to apply a simplified form of thetreatment daily at home.

On babies and small children this is best treatedas a kidney vacuity pattern. On older childrenwhere you are able to differentiate more clearlyfrom the pulse and abdominal findings, you mayfind a lung or liver vacuity pattern present. In parti-cular, supplementing the he-sea water points maybe useful rather than the usual treatment points. Ifthere are signs of inflammation with warmth orfever the jing-river points may be better for treat-ment.

Okyu/direct moxa can be applied to KI-1 (threecones) to reduce edema and increase urine output.One can also try treating the extra point shitsuminwith direct moxa for the same purposes (Kat-suyoshi 2006). Shiroda recommends a number ofpoints to be treated with okyu/direct moxa onadults, especially CV-9, CV-7, and Kl-16 (Manaka etal. 1995, p.214). It can be useful in stubborn casesto direct treatment to these points in older chil-dren.

Hyodo (1986) recommends light needling orplacing press-spheres to BL-23 and KI-1 for thiscondition. Needling KI-1 is probably more difficultthan moxa on this point, thus it could be helpful toapply moxa to KI-1 with needling followed bypress-spheres to BL-23.

As additional home treatment on an older childit can be helpful to target heat stimulation to pointssuch as KI-1 and KI-16. At first you can have theparents either use a small moxa pole or thickincense stick held above KI-1, moving the lightedend away when heat is felt and bringing it backagain until heat is felt again. Start with KI-1, makingsure that the heat is felt at least nine times. Lateryou can add KI-16 with this mild heat stimulation,making sure that the heat is felt at this point at leastfive times

Postnatal Lethargywith Lack ofSucking Reflex

The following case from my Spanish colleague,Manuel Rodriguez probably helped remove theneed for the parents to take their newborn baby tothe hospital. Incredibly little treatment was done toproduce these immediate effects.



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3 The long-term use of, for example, prednisone can include thefollowing side effects: facial swelling, blood sugar problems,weight gain, eye problems, sleep problems, etc.

Case 1Anna, Girl Age 3 Days

Main complaints: Since birth she had not suckedfrom her mother’s nipples. She had been able to getminimal nourishment when placed at the nipples asmilk spontaneously dripped out, but she had no suck-ing reflex. She had also only defecated twice sincebirth. Her urine was very scanty. Her parents reportedthat she was sleeping most of the time, and theywere both distressed and confused about what to do.

Examination: The baby looked small and with amarked tendency to flaccidity and lethargy. Whencarefully examined she did not wake up.Her musclesand skin felt loose, and the abdomen also looked andfelt flaccid.

Treatment: Bearing in mind the baby’s young age, avery light core non-pattern-based root treatment wasapplied using a silver enshinwith one stroke over eacharea, followed by supplementation at CV-12 using ateishin.

The parents were then instructed in how to applythe core non-pattern-based treatment daily using aspoon. However, about 15minutes after the treat-ment the baby awoke and started suckling, which shedid continuously for about 2 hours, interrupted oncebecause of the passage of a large amount of stools,requiring that her diaper be changed.

Anna returned 5 weeks later. She had continued withnormal feeding, digesting, and defecation. Herlength, weight, mobility, abdominal tonus, and activ-ity were all normal.

Surgical Conditions

Sometimes parents present with their child afterthey have been told that the child needs surgery forconditions such as inguinal hernia or undescendedtesticles. The parents come for treatment becausethey are afraid for their child or afraid of the surgery.If the condition is stable and not urgent, you can trytreatment to see if the condition can be improved bypreventing the surgery or to at least help prepare thechild and parents for the surgery. It used to be rela-tively common in Japan for parents to bring theirchildwith inguinal hernia for treatment by shonishinand there are clearly described treatments. Today itis not so common for parents to seek acupuncture

therapy for such a problem, but according to thepublished literature, the hernia can respond verywell to treatment. For other surgical conditions suchas undescended testicle, if the treatment does nothelp the testicle to descend, it can at least help thechild to recover from the surgery more easily (seeChapter 27).

Inguinal Hernia

Yoneyama and Mori (1964) and Shimizu (1975)report that inguinal hernias generally respond verywell to acupuncture, especially if the treatment canbe applied within a short time of the onset of theproblem. They all state that if the treatment can bebegun within 1 week of the onset, the effectivenessrate is as high as 90%. Shimizu states that treatmentcan still be effective up to 1month after appearanceof the hernia.

TreatmentYoneyama and Mori have simpler recommenda-tions for treatment: first apply thin shallowlyinserted needles so as to surround the area of thehernia. Then thoroughly apply shonishin, eitherrubbing or touching/tappingmethods, on the lowerabdominal region and on the internal aspect of thethigh. Done regularly this treatment can cure theconditionwithin a short period.

Shimizu has more detailed descriptions: applyin-out shallow needling techniques at two or threesites on the area of the hernia. Apply in-out need-ling techniques to around BL-54 or SP-11 on theaffected side. On older children also needle BL-23and BL-25. Apply the core non-pattern-based roottreatment to help strengthen the body (Shimizumentions that children with this problem are oftena little weaker). On babies apply the tapping/strok-ing techniques on the head, neck, shoulders, back,and abdomen. On older children add in-out need-ling to acupoints such as CV-12, ST-25, GV-12, BL-13,LU-6. On school-age children, as well as applyingthe latter treatment, add moxa to GV-20, GV-12,LU-6, BL-23 (half rice grain size, three to five cones),making sure not to moxa the same points that havebeen needled (Shimizu 1975).

From a Meridian Therapy perspective, herniascan be seen as liver vacuity pattern in babies andsmall children. Apply supplementation to LR-8 andKI-10 or LR-3 and KI-3.



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29 Combining TreatmentMethods

In this section I report on a case from Diana Pin-heiro, a colleague in Lisbon, Portugal. Diana is aTCM practitioner and teacher who has made spe-cial pediatric treatment studies in five differentpediatric departments/hospitals in China. She stu-died shonishin in Amsterdam a number of years agoand has been using it in combination with herusual treatment of children. In the followingremarkable case she reports on the treatment ofNillian, who, at the start of December in 2005 was a5-year-old girl with trisomy, a very severe disease,which from birth usually leaves children crippledand nonfunctional. Many do not survive. Dianaused shonishin as one of a number of tools to treatNillian. In China, if acupuncture is used for a childwith such problems, the tendency is to use verystrong techniques, because it can work when noother treatments are available. Some of the meth-ods Diana used come out of this tradition in China.We include the case here not only to show how sho-nishin can be successfully integrated into otherstyles of practice, but also to demonstrate how thischild has progressed far beyond what any doctorwould have said was possible. Diana, Nillian, andher parents have done a remarkable job.

Case 1Nillian, Girl Age 5 Years1

Main complaints:● Gastrostomy (with a gastric button); she could

only be fed by the gastric button, she was unableto eat through themouth

● Hypotonia of the body (all muscles)● Hypertonia of the Achilles tendon● Vomiting● Renal failure, with cysts in the kidneys● Tendency to become hypoglycemic easily● Tendency to catch cold easily

History: Nillian was born with a genetic mutation.She had a genetic translocation of chromosomes,monosomy of the ninth chromosome, associatedwith the 11th chromosome, resulting in the verysevere disorder called trisomy. There was no familyhistory of such problems. She was born 2months pre-mature (at 2.62kg, 50cm tall) and required hospitali-zation after birth. At birth she had edema andrequired ventilation for 2 months. At age 2½ yearsshe needed heart surgery to correct a heart defect.The Western medical prognosis was not good: shewould never eat through her mouth; she would noteasily get strength in her legs, which meant that shewould be unable to walk, with or without help.

Initial visit

Observations:● Red face all over, not only on the cheeks● Hot face, throat and chest● Legs and feet very cold, with cyanotic feet● Runny nose with yellow mucus; cough with yellow,

greasy sputum;mucus in the stools● Yellowmucus coming out of both ears● Constant asthenia and apathy● Vocalizations only with sounds● The legs were the weakest part of the body during

themovement, after motor stimulation● Tongue: red body with thin white coating; coating

more greasy and yellow on the sides, the tonguemarked by the teeth; the tongue without tonusand slightly pale in the area of the lung

● Vein of the finger: purple, up to themiddle phalanx

Diagnosis:● Gallbladder damp-heat● Liver qi stagnation● Spleen and lung qi vacuity

Treatment principles:● Clear the heat, remove the dampness● Promote the free liver qi circulation● Reinforce the spleen and lung qi to reinforce the

kidneys



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1 Case history fromDiana Pinheiro, Lisbon, Portugal.

Methods and techniques: Shonishin was applied onthe four limbs, the face, behind the ears, chest, andon the back, to regulate the yang qi circulation in thebody,2 to expel the excessive and toxic heat; strokingwas applied downward.

Ear candles were used to clean the ears, to removethe mucus-dampness directly from the inside of theears, and release the sinuses and throat.

Acupuncture with semi insertion was applied3

along the lung, spleen, stomach channel, and locallyon: ding chuan, ST-36, ST-40, CV-12, SP-6, SP-9, LR-2,GB-34, LR-14.

Flash cupping was applied4 on LU-1 and LU-2, CV-12,and BL-13.

Tui na massage was performed on the chest toopen it and alleviate cough, on the legs and feet topromote blood circulation.

Mustard seeds were left on: ST-36, CV-12, SP-6, SP-9,BL-13, BL-23; on the ear points: liver, lung, spleen, andstomach.

The parents were instructed to perform shonishintreatment with a stainless-steel spoon, and press onthe mustard seeds, every day. It was recommendedthat the shonishin be done in the evening/night, justbefore bedtime.

These treatments were repeated weekly in theclinic.

Nillian’s reactions: After two treatments, the runnynose, the cough, and the mucus coming from theears stopped completely, the face was not so red andhot anymore.

After 1 month the legs became less cold; the mus-cles of the legs started to become stronger.

Two months from the first treatment, Nillianstarted to eat through her mouth, and the gastricfeeding button was removed!

These treatments were given over an extended per-iod. At the time of writing, almost 4 years since treat-ments began, Nillian is 10 years old. She has shownthe following changes and responses:

She continues to eat through her mouth. She doesnot easily catch cold anymore. She has real strengthin her legs to the extent that she started to stand andwalk with assistance. At about the age of 6½ shestarted to stand up with help.By her eighth birthdayshe was walking with assistance. Now she walks onher own, using a “wanderer,” a support with fourlegs, provided someone walks behind her for secur-ity.

Her body temperature is uniformly distributed, allover the body.

She now comes for treatment just when the sea-sons change, to strengthen the wei qi (immune sys-tem), and the organ qi, or occasionally, when she getscold at school. If she is in a weakened state the treat-ment dose is reduced and, for example, seeds are leftonly on the ear points, ST-36 and CV-6.

The shonishin is still applied regularly before sleep-ing; I feel it is helpful to regulate Nillian’s yang qi circu-lation, and to reinforce her wei qi system.5 It seems tome to be a wonderful method to help to maintain Nil-lian’s vitality, withmore energy and strength.

It was possible to help this child so effectively withall the team’s effort and collaboration: Nillian, her par-ents, I, and all the knowledge that my teachers, herein Portugal, China, and in Amsterdam shared withme, for which I am very grateful.

We do not have the chance to treat children withsuch severe disorders very often. How we eachapproach a child like this, and what we do, willnaturally vary depending on our background. Thisis a remarkable case because it is clear that shewould never have walked but for these treatments,nor was it ever expected that she could be free ofthe gastric feeding button and be able to eat morenormally. Although I have cautioned to use verylow doses in order to be able to regulate the effects,in such severe cases stronger more stimulatingmethods with much higher doses can also be help-ful. But records of cases like this are so few that it ishard to develop concrete rules. We try the best wecan with the tools that come to hand and based onthe experiences we and our teachers have. Specialthanks to Nillian, her parents, and Diana for sharingthis remarkable story with us.



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2 As a TCM practitioner this is how Diana has understood andtranslated the basic shonishin treatment protocol; it is not thelanguage of shonishin, but is an interesting perspective.

3 The “Semi-insertion” technique involves the following: usingneedles (in this case 0.22-mm gauge) inserted rapidly to adepth of only 1–2 mmwithout retention. There is often a softand comfortable itching or soft heat sensation and the skinreddens slightly. The child finds the technique comfortable.

4 “Flash cupping” involves the application and immediateremoval of the cup, so that it remains for only a few seconds.

5 This is Diana’s TCM conceptual translation of shonishin treat-ment effects.

The following account from my colleague PaulMovsessian from Sydney, Australia is of a compli-cated case of a profound reaction to vaccination.Given the time pressures placed on him to try toprevent surgical procedures that were being dis-cussed, Paul elected to combine shonishin treat-ment with Meridian Therapy root treatment (asoutlined in this book) together with a number oftreatment methods from the treatment system ofYoshio Manaka “Yin-Yang Channel Balancing Ther-apy” (in Manaka, Itaya, and Birch 1995), and thusthis case is another good example of how to com-bine the treatment methods discussed in this bookwith other treatment methods. The results of treat-ment are quite impressive.

Case 2Sofie, Girl Age 3 Years

Main complaints: Following the measles/mumps/rubella (MMR) vaccination, Sofie had developed pro-found deafness and behavioural problems as a sus-pected reaction to the vaccine. The deafness was pro-gressively worsening. Over the last year she had lostthe capacity to hear with a hearing aid in the lowerfrequencies. Her speech was greatly affected. Shewas seeing a speech therapist but not making anyprogress. The doctors advised surgical implants tohelp with the hearing, but her mother wanted toavoid these and asked if I could work quickly to tryand get improvements to avoid the implants. For thisreason, I chose to perform a lot more treatments andbroader selection of approaches than would normallybe done with a child, watching to see if Sofie couldcope with treatment dosage. This was an unusual andexceptional circumstance. Sofie had had various teststo investigate her problems, such as ECoG (electroco-chleography) and a brain CTscan.

Additional problems: Her digestion was not verygood and the doctors suspected that she may havebeen suffering from leaky gut syndrome. Sofie alsocaught colds easily and showed signs that her immu-nity was weak. She became energetic as the nightapproached and did not fall asleep easily. She dislikedwaking in the morning and was always tired. As aresult of all these problems her mother was emotion-ally exhausted, very concerned, and upset.

Additional history: In the last year she had a strepthroat, parasitic infection of the gut, and sufferedfrom anemia. She was taking nonprescribed zinc andhomeopathic supplements.

Assessment: She showed frustration and irritability inher behavior with emotional lability. Her behaviorwas lively and eyes looked clear, with sparkle. Herbreathing seemed even and normal. There was nodetectable odor, and her voice had a slight groaningquality with low pitch. Her skin had rough patchesbut overall good luster. Her limbs and abdomen feltcool to the touch.

Diagnosis: Kidney vacuity pattern with secondaryvacuity of the spleen (based on symptoms andabdominal diagnosis).

Treatment: The initial visit was needed to gain hertrust, so the treatment was kept short and light toassess her response. Using a copper yoneyama instru-ment the core non-pattern-based root treatmentwith a combination of light tapping and stroking wasapplied down the arms, legs, abdomen, back, andneck with a total time of about 2minutes.

Using a teishin needle, supplementation wasapplied to right KI-7, LU-5, and left SP-3.

The teishin was also used to supplement CV-12,ST-25, CV-6, and then BL-22 and BL-23.

We ended the treatment here, Sofie was happy thetreatment was painless.


Nothing to report from treatment except that therewere no adverse reactions.

Treatment: The same treatment as on the previousvisit was applied.

Treatment using the polarity agent methods of theion-pumping cords was applied bilaterally to TB-5 andGB-41 without using needles.6 The clips of the cordswere pressed to the pair of acupoints on each side forbetween 5 and 10 seconds.

Sofie was clearly enjoying the treatment and wasvery comfortable from the beginning of this session.




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6 “Ion-pumping cords” were developed by Yoshio Manaka andare described in detail inManaka et al. (1995) and also inMat-sumoto and Birch (1988).

The mother was asked to study how to do a simpleform of the stroking and tapping treatment at home.

Third visit—next day

Her mother reported that Sofie had been calmer andhad really enjoyed treatment. She was looking forwardto returning for the treatment. Her mother noticedthat Sofie seemed to have heard a car alarm that day.

Treatment: The same treatment was applied as onthe day before.

Light tapping along the small intestine channel wasadded using the “Manaka wooden hammer and nee-dle” timed to ametronome at 120 beats per minute.7

A gold-plated press-sphere was applied to GV-14.Themother was taught and asked to apply a simple

form of the tapping and stroking treatment daily athome.


Sofie had undergone hearing tests this week. She hadscored much higher than usual but the doctors didnot feel it was a real improvement. They gave hermother several more months before a decision wasmade on implants. The naturopath did a live bloodcell analysis and foundmarked improvements.

Treatment: The same as the last visit, with the addi-tion of draining with the teishin at left GB-38 and rightLI-6.

Additionally okyu/direct moxa was applied onegrain each to GV-14 and GV-12.


The mother reported that everything was continuingto improve. Sofie was feeling very comfortable withthe treatments.

Treatment: The same treatment as the previous visitwas applied except that the ion-pumping cords werereplaced by the “ion beam device” (IBD), whichapplies polarized weak fields to the skin at a fre-quency of 100Hz for 5 seconds on each side.8

Additionally, light tapping with the Manaka wood-en hammer and needle was applied using the metro-nome frequencies to try and stimulate channelsaround the ears. TB-17 and TB-20 were tapped at afrequency of 152 beats per minute, followed by tap-ping of KI-2 and KI-3at 120 beats per minute.

Treatment ended with okyu on GV-14.

Sixth visit—next day

Remarkably, Sofie started forming words to speaktoday.

Treatment: The same as the day before except thatthe IBD treatment was changed to TB-5 (black) andGB-2 (red) for 10 seconds each side.


Sofie was still improving, but she had a slight cough.

Treatment: The same as the last treatment, exceptthat tapping was applied to GB-21 instead of KI-3 andmoxa to GV-12 instead of GV-14.

Eighth visit—next day

Sofie still had a slight cough but overall immunityseemed to have strengthened since treatmentsbegan.

Treatment: Same treatment as the day before withthe exception that the IBD treatment was changed toblack on TB-3 and red on GB-21for 5 seconds eachside at 7000Hz and tapping with the Manaka woodenneedle at only KI-2, TB-17, and TB-20.

Ninth visit—1 week later

The cough cleared after the last treatment. Moreimportantly though, the speech therapist found thatSofie had undergone significant improvement in dis-tinguishing letters and words in the higher frequencyrange. She was also starting to vocalize words and let-ters. The speech therapist was impressed by this,given the lack of any improvement previously.

Treatment: Same as last visit.



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7 The “Manaka wooden hammer and needle” is described indetail in Birch and Ida (1998) andManaka et al. (1995).

8 The “ion beam device” was developed by Manaka; it isdescribed briefly inManaka et al. (1995).


Sofie had shown an overall improvement in herspeech, with a marked improvement in her pronun-ciation of words as well as use of new words. Thewhole family had come down with colds; Sofie hadsurprisinglymanaged to avoid the cold.

Treatment: Same treatment as last visit except thatLU-8 was used instead of LU-5 and the IBD was appliedto GB-41 and TB-5.

Additionally, tapping with the Manaka woodenneedle was applied lightly around the occiput to BL-10,GB-20, and GB-12.

Sotai (Japanese form of muscular or movementtherapy) exercises were added to address tightness ofthe neck/shoulder region in order to improve circula-tion to the head region.9


Sofie had continued improving. She was using morewords. Her speech therapist was amazed that shewas able to pronounce words outside that of her esti-mated range of hearing. At this visit, Sofie was a littlemore fussy and irritable, so a lighter treatment wasapplied.

Treatment: The core non-pattern-based root treat-ment using the yoneyama instrument was appliedwith tapping and stroking as before.

Using a teishin, right KI-7, LU-5, CV-12, ST-25, andCV-4 were supplemented.

Ion-pumping cords were touched for around 5 sec-onds toTB-5 and GB-41.

Using the Manaka wooden needle, light tappingwas applied toTB-17, TB-20, and KI-2.

Twelfth visit—1 week later

Sofie had had a very good week. She was able to dis-cern tones in her hearing, and the hearing testshowed clear overall improvements.

Treatment: Same as previous treatment with theaddition of supplementation to BL-22 and BL-23.

Thirteenth visit—2 days later

Nothing new to report.

Treatment: Same as last visit with the addition ofpress-spheres to the auricular points of the auditorynerve, to be placed at night while sleeping andremoved during the day; repeated nightly.


Overall, Sofie showed marked improvements allround. Digestion, sleep, and tendency to catch coldswere all markedly improved. There had been signifi-cant improvements in hearing and she continued tomake progress with her speech. It was decided tomake this the last visit for now, with an agreement toreschedule as needed.

Treatment: The core non-pattern-based root treat-ment using the yoneyama instrument was appliedwith tapping and stroking as before.

Using a teishin, right KI-7, LU-5, left SP-3, CV-12,ST-25, CV-4, BL-22, and BL-23 were supplemented.

The IBD was applied for 5 seconds or so toTB-5 andGB-41.

Using the Manaka wooden needle, light tappingwas applied to the gallbladder and large intestinechannels.

Sofie kept improving with no need for the surgicalimplants. At the last follow-up 5 months later, thehearing tests showed amarked improvement and shedid not need the implants.



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9 Sotai exercises, a Japanese form of muscular or movementtherapy, are described in Manaka et al. (1995) and especiallythe text by Hashimoto and Kawakami (1983).



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Appendix

Glossary of ShonishinTerminology . . . . . . . . . . . 252

Additional Information . . . . . . . . . . . . . . . . . . . . . 254

Bibliography . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 255

Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 257

Glossary of ShonishinTerminology

BachibariShonishin tool used for stroking; see Fig.6.5f.

ChinetsukyuWarm moxa technique, developed by one of theearly Meridian Therapists, Keiri Inoue, as a simpletechnique to helpwith qi regulation.

ChishinThe “retained needle” method: A technique bywhich the needle is inserted and retained for awhile.

ChokishinFlat surface instrument used for stroking, tapping,or scratching; see Fig.6.3d.

ChotoShonishin tool used for stroking; see Fig.6.5g.

Daishi hariTool used in the style of Masanori Tanioka of Osaka;see Fig.2.13.

EmpishinPress-tack needles; especially the new Pyonex typeby Seirin.

EnrishinShonishin tool used for pressing, tapping, or strok-ing; see Fig.6.11h.

EnshinOne of the nine needles of the Ling Shu, the round-headed needle used for stroking or rubbing; seeFig.6.5a,b.

HerabariShonishin tool used for tapping; see Fig.6.3a.

HeragataShonishin tool used for tapping; see Fig.6.3b.

HinaishinIntra-dermal needles; these are placed obliquelyand shallowly and then retained for awhile.

HonchihoAwell-performedMeridianTherapy root treatment(the Chinese term is “zhibenfa”).

KakibariShonishin tool, an alternate name for the herabari.

KanThe Chinese term is “gan,” which developed inpediatric medicine in China and encompasses manysymptoms and different types such as “spleen gan,”“liver gan,” “lung gan,” and so on. Each has a differ-ent manifestation. In Japan the term “kan” came torepresent children’s diseases in amore general sense.

Kan nomushi or kanmushiA fusion of kan andmushi; the term came to refer ingeneral to pediatric problems in Japan for awhile.

Kanmushisho or kannomushishoWhile originally the term had broader, more gener-al uses and meanings, today it refers in a more lim-ited way to an infant or young child who is dis-tressed, sleeps badly, and is irritable.

Keiraku chiryoMeridian Therapy: a traditional school or style ofacupuncture that developed in the 1920s–1930sfrom the efforts of a study group led by Yanagiya,Inoue, Okabe, and Takeyama. Today it refers to anumber of styles following some basic core tradi-tional principles.

KyukakuCupping.

MunoA treatment term from Toyohari, it refers to treat-ment of the inguinal region.

MushiRefers to different kinds of beings that werethought to inhabit the body, each responsible forboth the normal physiology of its related systemand its pathophysiology.



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NasoA special Toyohari treatment system; the word de-rives from Japanese Braille shorthand for cervico-brachial syndrome and refers to treatment of theregion around ST-12.

OkyuDirect moxa technique, in which small pieces ofmoxa shaped like a grain of rice are burned on theskin.

OshideThis term refers to the structure of the supportinghand, where the index finger and thumb hold theneedle at the skin.

RyuPress-sphere: a stainless-steel ball bearing usuallyno bigger than 2mm in diameter and secured to acircular piece of tape that can be placed on the skin.

SanshinThis refers to the “contact needle” technique,where the needle is stroked across or held at theskin surface.

ShirakuBloodletting: there are several forms that can beused, in children it mostly refers to bloodletting ofjing points.

ShoThe “pattern.” In Meridian Therapy it refers to theunderlying or primary patterns of vacuity, of whichthere are four types: lung, spleen, liver, and kidneyvacuity.

ShonishinA Japanese rendering of the older Chinese term“erzhen,” which literally means “children’s needle”or “children’s needling.”

Shu ha riRefers to a concept about learning and develop-ment, which originates from the Japanese tea cere-mony tradition. It means that first you must learnfrom and imitate what your teachers teach you, butthen need to free yourself of this restriction, and tomove out in your own direction. This process natu-rally takesmany years or several decades

SotaiA very gentle “exercise” system aimed at looseningtight muscles to create more symmetric muscletonus throughout the body, developed by KeizoHashimoto. On children the exercise consists oftickling the child, hence “tickle therapy,” to provokea lot of randommovements.

Spring-loaded teishinInvented by Keiri Inoue, one of the founders ofKeiraku Chiryo (Meridian Therapy).

TeishinOne of the nine needles of the Ling Shu, a blunt-tipped needle with a rounded millet-seed–likepoint used for pressing the body surface.

Tsumo-shinVariation of, and more recent alterative to thespring-loaded teishin, which comes with a varietyof springs to adjust pressure.

UranaiteiExtra point on the bottom of the foot, for acute gas-trointestinal problems, including allergies.

WakakusaA type of Japanese moxa, termed “semi-pure,”which is less purified than “pure” yellowmoxa.

YoneyamaShonishin tool, used for tapping or stroking, andalso pressing; see Fig.6.3c.

Yukoshin (large and small)Shonishin tool, used primarily for tapping, but canalso be used for stroking or scratching; seeFig.6.3e,f.

ZanshinOne of the nine needles of the Ling Shu, the “arrow-headed needle” used for lightly cutting the skin(much like a paper cut). Today the various zanshininstruments are not sharp and provide roundedsurfaces that can be used for stroking or pressing(see the rounded surface of the yoneyama).



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Appendix 253

Additional Information

Treatment Equipment

In order to use the treatment described in this bookit is necessary to know where to buy the varioustools described.

ShonishinTools

Shonishin tools have been carried by Western acu-puncture supply companies for a number of years.The following are a list of some (not all) supplycompanies.

AustraliaChinabooks: http://www.chinabookssydney.com.au/TCMProducts

GermanyDocsave: http://www.docsave.euChinapurmed: http://www.chinapurmed.de

NetherlandsMAESC: http://www.maesc.nl

SwitzerlandABZ: http://www.aarauabz.ch

UKDulwich Acupuncture: http://www.dulwichacu-puncture.co.ukScarborough’s: http://www.scarboroughs.co.uk

USALhasaOMS: http://www.lhasaoms.com

Seirin Needles

Seirin needles, Pyonex press-tack needles, and Spi-nex intra-dermal needles can be purchased inmany locations.

3B Scientific GmbH (Hamburg, Germany) is thegeneral importer of Seirin, Japan, and renownedEuropean distributor of all Seirin products.

Press-spheres can be purchased in many loca-tions. It is better to not use magnetized press-spheres. LhasaOMS in the US and Dulwich in the UKhave good selections.

Japanese pure moxa can also be purchased inmany locations. Several have specialized in Japa-nese moxa products, among them Docsave in Ger-many, and Scarborough’s and Dulwich in the UK.

Educational

HarikyuMuseumOsaka

In Japan the Harikyu Museum in Osaka has a goodcollection of acupuncture and shonishin items:http://www.harikyumuseum.com. This collectionstartedwith one of themodern fathers of shonishin,HidetaroMori.

Toyohari Association

The Toyohari Iggakukai (Toyohari Association) pro-motes shonishin and various forms of combinedMeridianTherapy and shonishin practice. To contactthe Toyohari Association outside Japan go to:http://www.toyohari.org. You will find links for thevarious branches in the US, Europe, and Australialisted here. For the European Branch go to: http://www.toyohari.eu. Training programs are run regu-larly in English in these three continents.

International Courses

Courses on shonishin can be found in the US,Europe, and Australia. There are a number of tea-chers running courses in the US (e.g., Brenda Loew),Europe (e.g., Stephen Birch), and Australia (e.g.,PaulMovsessian).



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http://www.chinabookssydney.com.au/TCMProducts

http://www.chinabookssydney.com.au/TCMProducts

http://www.docsave.eu

http://www.chinapurmed.de

http://www.maesc.nl

http://www.aarauabz.ch

http://www.dulwichacupuncture.co.uk

http://www.dulwichacupuncture.co.uk

http://www.scarboroughs.co.uk

http://www.lhasaoms.com

http://www.harikyumuseum.com

http://www.toyohari.org

http://www.toyohari.eu

http://www.toyohari.eu

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257

Index

Page numbers in italics refer to illustrations

A

abdominal pain 143–146case study 143–144diagnosis 144–145general approach 144treatment 145–146, 145

goals 144allergens

asthma 106, 204–205cow’s milk products 97–98,

142, 144environmental sensitivities 99nasal congestion 183–188see also food allergies

allotriophagy 163appetite problems 152asthma 101–113

case studies 101–103, 107–113,204–205, 212–216

diagnosis 103–104general approach 103shu point 88–89, 104–105treatment 104–107, 104

atopic dermatitis 127–131case studies 127–129, 216–217diagnosis 129–130general approach 129treatment 130–131

B

back pain case study 209–212bedwetting see urinary distur-

bancesblocked nose see nasal congestionbloodletting 85–87

abdominal pain 146asthma 106atopic dermatitis 131constipation 136diarrhea 142eczema 119fever 240jing point bloodletting 85–86kanmushisho 157nasal congestion 187

otitis media 180recurrent infections 224stomach problems 151urinary disturbances 171–172vascular spider bloodletting

86–87bronchitis case study 22, 218–219

C

candida albicans infection casestudies 227–229

CHARGE syndrome casestudy 199–202

childrengeneral considerations 17–18sensitivity to treatment 17, 20,

203explanations of increased

sensitivity 21–23chinetsukyu seewarmmoxachronic intestinal pseudo-obstruc-

tion syndrome case study230–234

colds, case studies 218–221,224–227see also infections

colic see abdominal painconstipation 134–139

case studies 134, 136–139diagnosis 135general approach 134–135treatment 135–136, 135

convulsions 242–243cough 113–114

case studies 107–109, 111–112pertussis 114

cow’s milk products 97–98, 142,144

crankiness see kanmushishocupping 84

abdominal pain 146asthma 106atopic dermatitis 131constipation 136eczema 119kanmushisho 157nasal congestion 187

otitis media 180recurrent infections 224stomach problems 150–151urinary disturbances 171–172

D

“dance” of treatment 50, 95–97deafness case study 248–250dermatitis see atopic dermatitisdevelopmental problems 190–202

case studies 190–191, 193–202diagnosis 191–192general approach 191treatment 192–193, 192

diarrhea 139–142case study 139–140diagnosis 141general approach 140treatment 141–142, 141

dietary considerations 97–98asthma 106atopic dermatitis 131diarrhea 142eczema 120kanmushisho 157nasal congestion 188otitis media 180recurrent infections 224stomach problems 149urinary disturbances 172see also food allergies

digestive problems 151–153see also constipation; diarrhea;

stomach problemsdirect moxa 80–83

abdominal pain 146asthma 106atopic dermatitis 130contraindications 81developmental problems 193diarrhea 142eczema 119fever 239–240kanmushisho 157methods 81–83nasal congestion 187otitis media 180



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physiology 81recurrent infections 223–224stomach problems 150urinary disturbances 170

dosage 19–20, 19over-treatment reactions

24–25regulation 27–28

pressing 35, 37stroking/rubbing 32, 34tapping 32, 32

sensitive patients 20, 20

E

ear infections see otitis mediaeczema 115–127

case studies 115–117, 121–127,212–217

diagnosis 117–118general approach 117treatment 118–120, 118

egg–vinegar folk remedy,eczema 120

emotional regulation 21–22empishin see press-tack needlesenshin 9, 9environmental sensitivities 99epilepsy 242–243extraordinary vessels 10–11

F

facial atrophy case study 198–199facial paralysis 243fever 45–46, 238–240five phase correspondences

66–67, 67five-level model 94, 94food allergies

cow’s milk products 97–98,142, 144

urticaria 131–133see also allergens; dietary

considerationsfour-level model 93–94, 93

G

gastrointestinal distress 151glomerulonephritis 244GV-12 46–47

H

herbal medicine 7–8hernia, inguinal 245hinaishin see intra-dermal needleshives see urticariahome therapy 13, 52–54, 94

basic method 53–54dermatitis 131developmental problems 193diarrhea 142eczema 120goals 52–53improving vitality 235kanmushisho 158nasal congestion 188otitis media 180precautions 53recurrent infections 224stomach problems 149urinary disturbances 172

hyperactivity example 49

I

improving vitality 230–237case studies 230–234, 236–237general approach 234–235treatment 235, 235

goals 234incorrect treatment 26infections 240–241

candida albicans casestudies 227–229

ear see otitis mediarecurrent respiratory tract

infections 218–227case studies 218–221,

224–227diagnosis 221–222general approach 221treatment 222–224, 222

sinusitis 188–189inguinal hernia 245instruments see toolsintra-dermal needles 76, 77, 77

abdominal pain 145application 79asthma 105atopic dermatitis 130–131constipation 136developmental problems

193diarrhea 142eczema 119

kanmushisho 157nasal congestion 187otitis media 180precautions 77–78recurrent infections 223stomach problems 150urinary disturbances 171

irritability see kanmushisho

J

jingmai 10, 11jing point bloodletting 85–86

nail corners of the fingers 85nail corners of the toes 86

josen 88

K

kanmushisho 11–12, 153–162case studies 154, 158–162diagnosis 155general approach 154–155treatment 155–158, 159

goals 155kidney diseases 244kidney vacuity pattern 57, 59, 62

associated symptoms 61treatment points 58

kidneyweak constitutionpatient 204, 207–208

kyukaku 84

L

lateral pigen point 89liver vacuity pattern 57, 59, 61

associated symptoms 61treatment points 58

liver weak constitutionpatient 204, 208–209

lung vacuity pattern 57, 58, 61associated symptoms 61treatment points 58

lung weak constitutionpatient 204, 206

lymph node infection case study219–221

M

medications, asthma 106–107meng gen reaction 26–27, 26MeridianTherapy



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adults 55–60basic theories 55–56, 56children 61–68diagnosis 57–58, 57–60, 61–62effectiveness assessment 67–68five phase correspondences

66–67, 67modified point selection 62–63,

63point location 65–66principles 57treatment techniques 58–60,

63–65motion sickness 152moving LR-1 point 89moxa see direct moxa; warmmoxamumps 241mushi 11–12

N

nasal congestion 183–188case study 183–186diagnosis 186general approach 186treatment 186–188, 187

needles 8–10, 8, 9boxed sets 39, 39types 71–72, 72see also intra-dermal needles;

press-tack needlesneedling 71, 72–74

abdominal pain 145asthma 105atopic dermatitis 131constipation 136developmental problems

192–193diarrhea 142eczema 119in and outmethod 71, 73–74, 75kanmushisho 156–157nasal congestion 186–187needle insertion 74–75otitis media 179–180recurrent infections 223retained needlemethod 71,

74–75, 105stomach problems 150timing 72–74urinary disturbances 169,

170–171see also needles

nephrosis 244

nervous conditions 242neurological conditions 242–243night terrors 163night urination see urinary

disturbances

O

okyu see direct moxaotitis media 177–183


over-treatment reactions 24–25example 25

P

palpation 24pertussis 114pneumonia case study 218–219point location 65–66

asthma shu point 88–89josen 88lateral pigen point 89moving LR-1 89shitsumin 88“stop coughing” point 89uranaitei 88

postnatal lethargywith lackofsucking reflex 244–245

press-spheres 76, 77abdominal pain 145application 79asthma 105atopic dermatitis 130–131constipation 136developmental problems 193diarrhea 142eczema 119improving vitality 235kanmushisho 157nasal congestion 187otitis media 180precautions 77–78recurrent infections 223stomach problems 150urinary disturbances 171

press-tack needles 76, 76, 77abdominal pain 145application 79asthma 105atopic dermatitis 130–131

constipation 136developmental problems 193diarrhea 142eczema 119kanmushisho 157nasal congestion 187otitis media 180precautions 77–78recurrent infections 223stomach problems 150urinary disturbances 171

pressing 35, 45dose regulation 35, 37tools 35, 36, 37

pulmonary hypertension casestudy 236–237

Q

qi circulation 10

R

respiratory conditions see asthma;cough; infections

restlessness see kanmushishoRett syndrome example 25,

193–196rubbing see stroking/rubbingryu see press-spheres

S

scratching 35, 45tools 35–36, 38, 39

sensitive patientschildren 17, 20, 203

explanations of increasedsensitivity 21–23

dose levels 20, 20shiraku 85–87shitsumin 88shonishin 3–5, 12–13

history 6–11see also treatment

sinusitis 188–189skin lesions 46

see also atopic dermatitis;eczema; urticaria

spleen vacuity pattern 57, 59, 62associated symptoms 61treatment points 58

spleenweak constitutionpatient 204, 206



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260 Appendix

stammering 242stomach problems 146–151

case study 146–149diagnosis 149general approach 149treatment 149–151, 149vomitingmilk 151–152

“stop coughing” point 89stress case study 162–163stroking/rubbing 32, 45

abdominal pain 145, 145asthma 104, 104constipation 135–136, 135developmental problems 192,

192diarrhea 141, 141dose regulation 32, 34eczema 118–119, 118home therapy 53–54improving vitality 235, 235kanmushisho 155–156, 156nasal congestion 186, 187otitis media 179, 179recurrent infections 222, 222stomach problems 149, 149stroking and tapping

combination 46–50, 48tools 32, 33, 34urinary disturbances 169, 169weak constitution 206–208,

206, 207, 208stuttering 242sucking reflex, lack of 244–245surgical conditions 245

T

tapping 29, 45, 50abdominal pain 145, 145asthma 104, 104atopic dermatitis 130, 130constipation 135–136, 136developmental problems

192, 192diarrhea 141, 141dose regulation 32, 32eczema 118–119, 118home therapy 54improving vitality 235, 235kanmushisho 155–156, 156nasal congestion 186, 187otitis media 179, 179recurrent infections 222, 222stomach problems 149–150, 149

stroking and tappingcombination 46–50, 48

tools 29–32, 30, 31urinary disturbances 169, 169weak constitution 206–208,

206, 207, 208teething problems 240teishin 9, 9, 64, 64

treatment technique 64–65therapeutic dose threshold (TDT)

19three-level model 55–56, 56, 93,

93tonsillitis 241tools 6, 6, 12–13, 13, 29, 29

care of 41disposable 41, 41most recommended tools 40, 41pressing 35, 36, 37scratching 35–36, 38, 39stroking/rubbing 32, 33, 34tapping 29–32, 30, 31treatment applications 42see also needles

Traditional East AsianMedicine(TEAM) 7

treatmentcombining treatment

methods 246–250core non-pattern-based root

treatment 45–51precautions and

contraindications 45–46techniques 46–51

home therapy 13, 52–54modification 27–28monitoring effects 42pattern-based root treatment

55see alsoMeridianTherapy;

specific conditionstreatment map 7trisomy case study 246–248tsumo-shin 64, 64

U

uranaitei 88urinary disturbances 164–176


urticaria 131–133

diagnosis 132–133treatment 133

V

vaginal yeast infection case studies227–229

vascular spider bloodletting86–87C6–T4 region 86lumbosacral region 86–87

vitality improvement see improvingvitality

vomiting see stomach problems

W

warmmoxa 83improving vitality 235recurrent infections 224

weak constitution 203–217case studies 204–205, 209–217general approach 205–206kidneyweak constitution

patient 204, 207–208liver weak constitution

patient 204, 208–209lung weak constitution

patient 204, 206spleenweak constitution

patient 204, 207treatment 206–209, 206, 207,

208goals 206

whooping cough 114

Y

yeast infection case studies227–229

Z

zanshin 9, 9

shonishin: japanese pediatric acupuncture a text and video guide

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