How can Japanese Meridian Therapy and Traditional Chinese Medicine have come from the same classic texts and yet come to such different conclusions for diagnosis and treatment? This is the question I chose to consider by delving into Chapters Sixty-Nine and Seventy-Five of the Nan Jing, considered the foundation of Japanese Meridian Therapy.
Meridian Therapy was founded in the 1930s out of a desire to “reexamine the classics and to clinically test the knowledge gained therein in order to extract the truth” (Kuwahara, xvii). The principle methods of Japanese Meridian Therapy (JMT or MT) are to palpate and assess the meridians, using the pulse for both diagnosis and continual assessment of the progress of treatment, and to use the meridians in this way to understand the balance of deficiency and excess caused by pathogens, the seven emotions, and the fundamental interaction of the meridians and organs to themselves and each other (the Five Phases). This is fairly different from Eight Principle and Zang Fu Diagnosis as interpreted in Traditional Chinese Medicine (TCM). In the TCM approach, we utilize the four diagnostic methods (asking, looking, listening, and palpating), base our diagnosis on the collection of symptoms and signs based on the chief complaint, and identify a specific pattern based on the organs, yin/yang, and body elements (like blood, body fluids, and qi) in disharmony, all of which determines the course of treatment. Depending on the TCM practitioner, palpation may be used to refine the choice of points (this is common at least in the case of choosing local ashi points) or at the extreme they may only use the trusted points in texts from Chinese Acupuncture and Moxibustion (CAM). I admit this is a gross simplification of the vast differences within the practices of TCM and JMT respectively, but seeing from the extremes can help to highlight the differences between the disciplines.
The Sixty-Ninth Difficult Issue of the Nan Jing is the first passage to deal with needling patterns. Paul Unschuld translates it as follows:
The scripture states: in case of depletion, fill it. In case of repletion, drain it. When neither a repletion nor a depletion are present, remove the [illness] from the conduits. What does that mean?
It is like this. In case of depletion, fill the respective [conduit’s] mother. In case of repletion, drain the respective [conduit’s] child. One must fill first and drain afterward. The removal of [an illness] from the conduits [themselves] because neither a repletion nor a depletion is present is [appropriate] if a regular conduit has fallen ill by itself rather than as a result of having been hit by an evil [influence transmitted from] another [conduit]. In this case one must select [for treatment] just this one conduit. Hence the scripture states: Remove it from the conduit. (Unschuld, 583)
This passage refers first to the Five Phase mother-child relationship of the yin organs HT, SP, LU, KI, and LV in the generating cycle. JMT obviously drew from the passage, “One must fill first and drain afterward,” in understanding that treating deficiency is necessary before treating excess. This builds upon the Su Wen which says in Chapter 62:
“The Yellow Emperor said, ‘All illnesses are caused by deficiency and excess. You [Qibo] just said there are five surpluses and five insufficiencies. How do they come about?’ Qibo answered, ‘They all arise from [disharmonies in] the five zang organs.’ [...] As is understood from the above quotations, disease stems from deficiency of essential [qi] of the five zang organs. That is why the pattern of imbalance in Meridian Therapy is expressed as deficiency of the organs and meridians. (Kuwahara, 36-37)
MT also uses the Five Phase model to choose treatment points. First, the chief deficiency is found in the pulse and the deficiency is filled by choosing an appropriate point on the deficient organ’s mother channel and on the deficient channel itself. Thus, filling the mother and directing the energy to the child. For example, in a LV deficiency cold pattern according to JMT (a LV blood deficient pattern according to TCM), we would choose the root treatment of KI 3, LV 3. Both of these are source points and earth points and the corresponding taste of earth is sweet. The function of the sweet flavor is to tonify (Ikeda, 37-40). In order to consider how TCM (via CAM) would treat the same case we need to determine the chief complaint because TCM does not have the same concept of a root treatment based on the pulse. For the sake of comparison, I’ll give the example of depression. CAM terms this “Melancholia” and gives an option for a deficiency pattern: Insufficiency of Blood. The HT and LV are the chief organs involved and the points provided are as follows: Ren 14, HT 7, SP 6, LV 3 (CAM, 462). No mention of the KI here despite their role in building the fluid aspect of blood, which nourishes the LV and HT (Kuwahara, 28). The CAM explanation for LV 3 in this point prescription is as follows: “LV 3 is selected to soothe the LV and remove depression” (CAM, 462).
Chapter Seventy-Five of the Nan Jing takes the key concepts of Chapter Sixty-Nine and builds upon them with a seemingly contradictory case.These are marked differences between Meridian Therapy and TCM; however, looking to the latter portion of Nan Jing passage above, both MT and TCM understand the concept of an illness affecting a channel directly. Cold can attack the Stomach directly through eating cold foods, for example. This, at least, has remained the same in both systems of medicine, though again the treatment may differ.
The seventy-fifth difficult issue: The scripture states: In case of repletion in the eastern regions and depletion in the western regions, drain the southern region and fill the northern regions. What does that mean?
It is like this. Metal, wood, water, fire, and soil should level each other. The eastern regions are [associated with the phase of] wood; the western regions are [associated with] metal. If the wood is on the point of repletion, the metal should level it. If the fire is on the point of repletion, the water should level it. If the soil is on the point of repletion, the wood should level it. If the metal is on the point of repletion, the fire should level it. If the water is on the point of repletion, the soil should level it. The eastern regions are [associated with] the liver. One knows, therefore, [that if the wood of the eastern regions is replete,] the liver is replete. The western regions are [associated with] the lung. One knows, therefore, [that if the metal of the western regions is depleted,] the lung is depleted. [In case of a repletion in the liver,] one drains the fire of the southern regions and fills the water of the northern regions. [One drains] the fire of the southern regions because water is the mother of wood. Water keeps fire in check. A child can cause repletion in its mother; a mother can cause depletion in her child. Hence one drains the fire and fills the water if one wishes the metal to be in a position where it does not have to level the wood. The scripture states: If one is unable to cure a depletion, how could one take care of all the other [illnesses]? That is [what is] meant here. (Unschuld, 617)
Having just learned that the correct treatment is to tonify the mother to treat deficiency in the child, it seems impossible at first to now say that “a mother can cause depletion in her child.” But this passage sets us up for understanding the interactions of the Five Phase controlling cycle. It is also the foundation of the LU xu LV XS pattern in Ikeda Masakazu’s version of Japanese Meridian Therapy. In his Translator’s Introduction to The Practice of Japanese Acupuncture and Moxibustion: Classic Principles in Action, Edward Obaidey explains that “Ikeda Sensei always makes a point of saying that what he is doing is not his own approach or style, but that of the classics, and nothing more.” (Ikeda, xlvi) So it is appropriate that this pattern is direct from a chapter of the Nan Jing. Here, LU qi circulates poorly, which causes KI fluids to stagnate, which causes LV blood deficiency and heat, which harasses the HT. Stagnant and deficient KI fluids also eventually cause deficient heat, which cause a similar effect on the HT (Ikeda, 48). This is deficiency in the west (LU), excess in the east (LV), with a necessary solution of tonifying the north (KI), and draining the south (HT). According to Statements of Fact in Traditional Chinese Medicine by Bob Flaws, the TCM interpretation of this passage is the pattern HT and KI not communicating (Flaws, 244). The CAM treatment for this pattern of insomnia is first for the chief complaint HT 7, SP 6, and An Mian regardless of pattern plus UB 15, UB 23, and KI 3 specifically for the pattern. If there is upward disturbance of LV fire UB 18, UB 19, and GB 12 may be added or, more likely according to CAM, used instead as it constitutes a separate pattern (CAM, 449). In contrast, Ikeda Sensei uses the root treatment of LU 5 and KI 7, the water point on the metal channel and the metal point on the water channel to tonify and move both fluids and qi. If the condition is severe, KI 10 is also added to the root treatment as the water point on the water channel. Water points move fluids to the correct places and also subdue deficient heat. It is also recommended to shunt LV 8. Shunting is different from sedating as the energy is recycled in the body rather than taken out of the system as an excess pathogen would be. Here, the water point on the wood channel is used to relieve stagnant qi, blood, and fluids, and also nourish the LV with fresh qi, blood, and fluids (Ikeda, xli and 50-51). Despite the commandment to “drain the south,” note that no HT points are shunted as in Chapter 8 of the Su Wen the HT is the Empress/Emperor/monarch so in Japanese Medicine the HT channel is not needled directly, only affected through its relationship with other organs and meridians (Kuwahara, 108). If the HT were diseased, the patient would have a very poor prognosis.
Practitioners are often curious why there is no Heart deficiency pattern in meridian therapy. The answer is quite simple and has to do with the fundamental character of the Heart. This organ stores the spirit and is constantly in motion; consequently, the Heart requires a large amount of yang qi. If either the yang or the qi of the Heart becomes deficient, the person is beyond help. (This is explained in Chapter 71 of Divine Pivot.) This means that a deficiency in the essence of the Heart cannot be at the root of a disease; it does not mean that the Heart is never affected by disease. The Heart can be affected by influences, good and bad, from other organs, as is often indicated in the symptoms and the pulse. (Ikeda, xx).
And in the theory-rich text by the Society of Traditional Japanese Medicine:
There is no Heart excess. However, it is possible for heat to increase in the Heart. Therefore, it would not be impossible to refer to such a condition as excess, but it is called Heart heat. This heat spreads to the Heart from heat generated by a deficiency in the Kidney, Liver, or Spleen (Kuwahara, 41).
Thus, no HT points in this prescription, but KI and LV points are enough to treat the HT.*
It would not be an appropriate study of the classics and these two systems of medicine without a case to test the knowledge clinically. I have been treating a 66 year old man for seven months now and beginning roughly three months ago we resolved an earlier issue and started working with his new chief complaint of anxiety and depression. He was finding it difficult to work through his emotional episodes, having to lie down or leave work for hours before being able to return to normal function. I was able to achieve success with a combination of Japanese and TCM approaches. He falls under the Chapter Seventy-Five pattern of LU xu, LV XS in the Japanese understanding so I treated him with the root of just LU 5, KI 7 at first, but adding KI 10 did make a marked difference in his tongue and symptoms. His tongue was previously very yin deficient, literally shriveled into a collection of deep creases and wrinkles with no coat. It has gradually become less red and has developed the occasional thin white coat. Japanese style treatments generally begin on the front and then are supported on the back with a minimum of the back shu points of the affected organs. In this case, UB 13, 15, 18, and 23. For the TCM portion, I used Dr. Zhang’s maxim of never using UB 18 without UB 17 (and vice versa) to ensure that blood is both moving and nourished. I had early success with introducing Du 11 and the outer HT shu points to treat my patient’s anxiety, sometimes also including the ear points shenmen and sympathetic. Later, I also began adding Du 4 and Du 9, which Dennis von Elgg advised were useful for stoking the ming men fire and reminding the patient of his purpose (Du 4) and also removing the stagnation at the diaphragm (Du 9) and allowing qi to flow freely between the upper and middle/lower jiao. Since LU qi being weak is key to this pattern, this idea resonated with me, especially since the patient has a concave body shape with a marked depression around Ren 15 and a turtle-like rounded back. Du 9 is the high point of this crest on his back. Adding these points unlocked a massive change in the patient. Within two weeks (or two treatments as he is treated weekly), he reported no longer having severe bouts of depression or anxiety. He is not forced to step away from work. It has been almost two months since this shift and while we are still working on his underlying depression and anxiety, I am happy to say that the severe emotions have not returned and he continues to improve within this pattern of presentation and treatment.
Ikeda Sensei also believes in the power of combining elements from styles so long as they work. At his seminar in March 2015, he lamented that we tend to retreat to our camps and not learn from one another’s clinical experience. What does it matter if TCM says this and JMT says that. It is what helps the patient that matters.
To Ikeda Sensei, meridian therapy is simply the use of the meridians to diagnose and treat disease, nothing more and nothing less. Some people think that meridian therapy automatically implies shallow needling; it does not. If the treatment requires deep needling, it should be performed. If moxibustion is necessary, it should also be performed. The same can be said of massage, herbs, exercise, and dietary measures. The tools are many and varied, but the emphasis is always on the use of the meridians (Ikeda, xvii).
Bob Flaws, Statements of Fact in Traditional Chinese Medicine. Blue Poppy Press, Boulder 1994
Cheng Xinnong (chief editor), Chinese Acupuncture and Moxibustion. Foreign Language Press, Beijing 2005
Ikeda Masakazu, The Practice of Japanese Acupuncture and Moxibustion: Classic Principles in Action. translated by Edward Obaidey, Eastland Press, Seattle 1996
Koei Kuwahara (editor), Traditional Japanese Acupuncture: Fundamentals of Meridian Therapy. The Society of Traditional Japanese Medicine, translated by Joshua Margulies, Complementary Medicine Press, Taos 2003
Paul U. Unschuld, Nan-Ching: The Classic of Difficult Issues. University of CA Press, Berkeley 1986
Peter Eckman MD, In the Footsteps of the Yellow Emperor: Tracing the History of Traditional Acupuncture. Long River Press, San Francisco 2007