It is difficult to insert a SJ needle, how can I insert it? We'd like to talk about this question today.
Firstly, let us consider this technically. Is the posture of your Oshide (pressing hand) foamed stably? Oshide plays the role of opening the skin and guiding the needle towards its direction. If the right and left balance of Oshide is not equivalent, you are unable to make the angle of the needle that is perpendicular to the surface of the skin. In this situation, it is impossible to transmit the pressure of Sashide (needling hand) to the needle tip properly.
In fact, the pressure required for penetrating the needle is very subtle. It is as small as not bending a soft silver needle, so if you missed only a little, the pressure transmitted to the needle tip can be reduced, nearly zero sometimes. If you are continuing this, it is impossible to insert the needle forever.
In addition, if the purpose is just inserting the needle, you can force to insert the needle. However, this forcing needling is not related to tonifying the Jin-qi and healing process of diseases. It is notable how to insert a needle is also important.
Here, let us look at it from a different point of view. The needle used in Shakuju therapy is special for its tip being round and difficult to insert. Comparing with other needles, SJ needle is a kind of difficult-to-insert-needle in terms of its needle tip and its elasticity. Actually, this is the point.
Let me give you an example. When teaching students who just start learning acupuncture how to insert a SJ needle, they can insert it easily. However, as more years of experience of acupuncturists pass, more difficult for them to insert a needle. Why? Hint lays in the word "comparing with other needles" mentioned above. The difference between senior and fresh students are the difference of the amount of "common sense" of acupuncture sphere. If the difference of them is only the amount of practice, the senior students must take the advantage.
Moreover, I myself don't think that a SJ needle is not an especially-difficult-to-insert-needle. The difference between the easy-to-insert needle and the difficult-to-insert needle is not in the needle itself, but in the body of the recipient. This needle can be inserted anywhere in the body, so the stereotype that it is impossible to insert the SJ needle is irrelevant.
In other words, it is necessary to understand that it is you who accept the common sense of its difficulty of insertion and create its result. The common sense such as you have to needle in the painful area, incurable diseases, impossible to cure with acupuncture, these are what you accept and create the phenomena. You have to cross the border of such common sense. Here, coming back to the today's question, the answer is that you have to break the common sense that you have to insert a needle to be able to insert a SJ needle.
basic training of insertion (BL 40) The round needle tip Open the point with the thumb and index finger of Oshide. (1) Inserting skill (2) The ability to grasp change of the body Perpendicular to the skin
To give an order to the shallow qi of the whole body by moving the shallow qi on the abdomen.
As a result, it makes easier to evaluate the pulse and abdominal diagnosis.
Shallow qi on the abdomen is especially called as "Ju".
(2) Abdominal area
The abdomen here is the area between lower parts of rib cages and the pubis and both sides of the inguinal region (upper and lower boundaries), and betwen inner sides of the gallbaladder lines (left and right boundaries). However, in the real practice, one is not necessary to perform contact needling close to each boundary.
(3) Observation of the abdomen
The practitioner always has to be careful to notice changes of the skin on the abdomen. This is because when any changes occur, these changes are understood in terms of the movement of qi.
Firstly, be aware with objective characteristics of the surface of the skin, such as dryness and moisture, cold and heat, hard and soft, tension, texture and luster of the skin.
On the other hand, the subjective condition of the abdomen are, spontaneous pain, feeling of fullness, pressure and itciness, and abnormal sensation (hyperesthesia and hypoesthesia). In addition, borborygmus and succussion splash are the abdominal conditions felt both subjectively and objectively.
To palpate, wipe the sweat of the abdomen off with a towel, place both hands on both sides of the abdomen to compare the temperature of left and right, and check the condition of the skin of the whole abdomen with one's Oshide (pressing hand).
(4) Needles to be used
Basically, a 40 mm, number 3 silver filiform needle is used. However, when patients are very sensitive naturally or in the sensitive condition, and in the case of infants, a Teishin needle is used instead of a filiform needle.
(5) How to do the abdominal contact needling
[Contacting a needle to the abdomen]
As well as the insertion of a filiform needle, the hand posture of abdominal contact needling is based on what the Oshide, Sashide and a needle formed altogether, and the practitioner has his/her needle on the needle handle, and pushes the needle with the Sashide towards the direction of the needle body and presses the surface of the skin with the needle.
Here, it is important the needle tip is contacting the surface of the skin, but it is different from the filiform needle that if the needle does not insert, the practitioner moves to the next point quickly and repeat the same thing.
The point here is not to twist the needle so much to insert the needle. About pushing the needle, the pressure of it is depending on the flexibility of the needle body, so it is unappropriate if the pressure is too strong or too weak. It is better not to bend the needle if possible.
The duration of contacting a needle in each point is usually up to two seconds, but if the practitioner get used to the maneuver, the movement gets continuously and speeds up. One does not need to mind the depth of insertion. If the needle is easily inserted by such a pressure, it means that the body needs such quantity of stimulation, so it has no problem to insert.
Some people might think that it is enough only to contact a needle to the skin because it is "contact needling", but this idea causes some problems, not only the treatment effect is not enough, but also it rather may cause the stagnation of qi.
[Withdrawal of a needle]
Next, one has to add an action to return the needle applied to the skin, and at the same time close the point with the index finger of the Oshide. This is the technique of tonification.
If one gives an uncomfortable pain to a patient during the needle manipulation, the problem lies on the top-bottom and right-left pressure of the Oshide, as well as a filiform needle, unless the needle tip has some problems.
The practitioner performs actions mentioned above to the whole of the abdomen.
[Abdomen as a plane]
In the abdomen, yin meridians and yang meridians are running through, and there are various acupuncture points, but one does not need to take these into account when performing contact needling. It is important to consider the whole abdomen as a "plane" and do contact needling.
Therefore, the rhythm of needling should not be the same all the time, and one may speed up or slow down up to the necessity.
The whole time taking for the abdominal contact needling is around one minute, and one repeats routines of needling the whole abdomen around three times.
Sometimes, a patient may start sweating. Do not leave this alone, this would let the body gets cold, and wipe the sweat off carefully.
(6) The observation of the abdomen after the abdominal contact needling.
One has to check the abdomen again after the abdominal contact needling. As well as other steps of therapy, it is important to check the effect of treatment after needling.
The most remarkable points here are spontaneous pain and pressure pain. Before contact needling, check the part of pain, and observe how it changes after contact needling. In theory, the changes of pain are getting stronger, getting less, and no change.
However, in the clinical practice, it rarely occurs that the pain gets stronger after the abdominal contact needling. If this may occur, it means the way of abdominal contact needling is not appropriate. The needle does not touch the skin, and it cannot give the stimulation that the body requires or the way of contact needling is so harsh that bringing the new disorder of qi, so one has to perform contact needling again with attentions.
One observes other conditions as well, but the point here is also the same with pain.
(7) The meaning of contact needling
It is notable that after contact needling, in some cases, the conditions such as pain disappear, but in other cases, they do not. This means that the abdominal contact needling plays some roles, and there are conditions applied to such cases, and those not.
In other words, the abdominal contact needling is a light stimulation, so there are conditions that easily change with the subtle stimulation and those not. Light means the condition of capability to insert a needle to the skin by just pushing a needle, and qi influenced by such needling is expressed as "shallow qi".
Here, the changes of the body by stimulation of needling and etc, is called "qi moves". The substance of changes is qi, but the condition to change is understood as a phenomenon that uneven qi is returning to the even state.
That is, when thinking how shallow qi of the abdomen, it is divided into those being even, and those not. The same thing can be applied to the whole body.
What to note is one should not understand like the effect of the abdominal contact needling would be something % stochastically. The individual difference is important, and do not judge the effect of the abdominal contact needling, applying the concepts of elements easy to change with a light manipulation and those not, but these changes are just means to know the movement of qi.
Whether the movement of qi is big or not should not be judged by how the main complaint, such as the pain, is in advance, but even strong pain disappears easily in the clinical experience. Do not judge the state of qi conceptually.
What to note in this step is that some conditions of the body change by the light manipulation of the needle.
**This article is translated from the book of "Toyo igaku koza dai 10 kan, Keiraku-Shakuju chiryo hen (Oriental Medicine Lectures, Vol.10, Meridian Shakuju Treatment)".
The first thing that a practitioner should experience is that even a slight manipulation of needling can bring the subtle change of the body. Manipulation of needling here is not a deep insertion, but a shallow needling, and one has to know that it can affect the sense and tone of the skin both subjectively and objectively.
The generally recognized effect of acupuncture is that a needle should be inserted in a certain depth for a certain period to give certain stimulation to get a result of needling. This view is mainly based on the neurological theory of the western medicine, and in other words, the misunderstanding that more stimulation brings more the treatment effect is.
However, acupuncture treatment can never be like that, rather, the most important is to give the most suitable stimulation that the body requires, and it engenders the most appropriate treatment effect.
Moreover, the structure of the body is based on multiple layers of qi, so to perform needling on the deep area abruptly is a forcible manner to the body, and the treatment effect can vary.
One has to know that the body is always changing, so acupuncture treatment should be adjustable to its change, requiring the fluid manipulation of needling. Abdominal contact needling is the first step of the treatment based on such an idea.
*This article is translated from the book of "Toyo igaku koza dai 10 kan, Keiraku-Shakuju chiryo hen (Oriental Medicine Lectures, Vol.10, Meridian Shakuju Treatment)"
The fact that the response occurred to the sick body when stimulated by acupuncture and moxibustion means that the stimulation increased the density of qi (of the body). In other words, it can be expressed that the power of qi is fulfilling and the phenomenon that the body is warming up whether it is perceived or not .
The practitioner can grasp it through various changes of the patient, such as flare, sweating, the skin getting brighter, tissues getting tightened.
Next, concerning the amount of stimulation influencing the body, it depends on the duration of stimulation and the durability of the treatment effect.
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About moxibustion, the amount of stimulation is influenced by the duration of performing moxa treatment, but even during the same period, it also affected by the numbers of moxa cones. Shorter the interval between each cones, the influence is stronger. In addition, it also related to the amount of heat, when performing moxibustion with the certain amount of heat and certain interval, the amount of stimulation gets stronger in proportion to time.
However, the weak point of moxibustion is that the practitioner cannot judge whether the amount of stimulation is appropriate or not during the treatment, and this is different from acupuncture.
But, concerning the persistence of the effect to the body after the treatment, it can be inferred that the moxa effect mentioned above is more persistent than needling. Clinically speaking, when the interval of treatment sessions is short, for example treating the same patient twice or three times a week, one has to be sure to lessen the amount of moxa in each session. If one ignores this, sometimes the patient gets the state not being able to consume heat properly, such as eczema on the skin, increasing yang excess condition and so on.
In this way, the practitioner can adjust the amount of stimulation during treatment, what one always has to keep in mind is the most appropriate amount of stimulation. Some people might think that more serious the patient's condition is, the practitioner adds stimulation more. However, to absorb the certain amount of stimulation, it requires certain power for the recipient body as well. If one increases the amount of stimulation more than enough, it leads to the indigestion of the amount of stimulation, rather the condition gets worse.
Concerning the quality of stimulation of acupuncture and moxibustion in this way, the light stimulation is more suitable with needling, so when the disorder of qi is on the surface, and conversely when the patient's condition is extremely serious and the damage of qi is as deep as the shape of the body changes, the stimulation of acupuncture is more suitable because it makes the body itself fill out the qi, in other words creating heat on one's own.
What is the condition suitable for moxa stimulation then? You can imagine the old human body for this. That is, the condition that qi is loosen all over the body, and when the body itself does not have enough power to create heat, moxibustion is suitable for these condition regardless of age.
Another issue is whether we can consider inner bladder line, outer bladder line, JJ line and the GV channel as equal in terms of the quality and quantity of stimulation. As mentioned before, the response closer to the GV channel indicates more severe the deficiency of Jin qi is. Especially the GV channel is important in this state.
Clinically speaking, for the symptoms difficult to change, for example, serious knee pain, lower back pain, inner organ pain and heat of inner organs, one can experience the symptom released after moxibustion on GV channel.
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However, one has to pay attention when the patient is in condition is as serious as he/she cannot absorb the heat of moxibustion. Multiple cones of moxas on GV channel might cause deterioration of symptoms instead, so the practitioner has to be careful. One starts from two or three cones, checking the condition, and stops it if one thinks the change is not what expected.
As a conclusion, needling is the base for the stimulation to the body, and for the moxa stimulation, it is important to check whether or not the patient has enough power to accept it.
growing so fast!
*This article is translated from the book of "Toyo igaku koza dai 10 kan, Keiraku-Shakuju chiryo hen (Oriental Medicine Lectures, Vol.10, Meridian Shakuju Treatment)"
There are acupuncture and moxibustion as means of stimulation, how can we consider the choice of use such therapeutic mehods? Is it simply depending on the preferance of patients, or the skill of the therapist to choose needling or moxibustion?
First, taking account of how to give stimulation to the patient's body, what can give the lightest stimulation during the certain period is needling. This indicates the technique such as contact needling and the usage of a Teishin needle. It is impossible for moxibustion to move qi only with the slight stimulation like such needling.
Additionally, on the other hand, if one uses a big stainless needle or a three-edged neele, one can give the strong stimulation to the patient as well. If one would like to give the most strong stimulation, needling is the more suitable method.
As the amount of the stimulation, moxibustion as the therapeutic method is not as variable as needling. In addition, one cannot perform the treatment, taking the body as a plane with the point moxibustion method, not like contact needling.
What is the difference between needling and moxibustion in terms of the effects of the human body then? Needling is what has the normalizing effect to the response of the human body by contacting a needle as a foreign substance to the body (sometimes by damaging the tissues). On the other hand, moxibustion expects the similar effect by applying the heat to the human body from the outside (similarly sometimes by giving the damage as a burn to the tissues).
What is common between these two is that both of them cause the heat in the human body after applying the certain amount of stimulation. However, the moxibustion is what brings to the effect of heat by adding the heat from the outside, so if the patient's body cannot have the power to accept it, ie. the power to consuming the given amount of heat, the heat ends up staying inside of the body, sometimes it leads to the fever or eczema. In such cases, the moxibustion is not appropriate. Moxibustion is not suitable for the patients whose condition of the body is too weak.
*This article is translated from the book of "Toyo igaku koza dai 10 kan, Keiraku-Shakuju chiryo hen (Oriental Medicine Lectures, Vol.10, Meridian Shakuju Treatment)"
To insert the soft needle with the round shaped tip, the pressure applied from up to down with one's fingers has to be transmitted to the tip of the needle correctly. When the vector indicating the direction of pressure applied to the needle is in alignment with the tip of the needle, one can minimize the degree of damage towards the human body. The gap between the vector of pressure applied to the needle and the tip of the needle means the unstability of the needling, namely it makes the numbers of cells injured by the needle increase.
The basic training to insert a soft needle without making it bend would be the most appropriate practice to know such a vector. In other words, if one uses a hard needle, even though the vector is not in alignment with the needle tip and makes the needle unstable, it can penetrates the body easily without being bend. This is so called "painful needle", the unstable needling, dispersing the pressure applied to the needle. Those who are used to hard needles are prone to get stuck in such needling. Just apply the pressure towards only one point, the tip of the needle. When you can do this precisely, you are able to insert a needle. This is called inserting ability.
* This article is translated from Japanese Shakuju Association blog.
Contact needling is the first step of Shakuju therapy, which is approaching the shallow qi, however, this is indeed the profound skill.
Shallow qi is the relative expression towards deep qi, but what is shallow depends on the skill of the practitioner. There is a famous story about contact needling by Kobayashi sensei, the treatment of the frozen shoulder. The story is like this...
A patient who could not raise his shoulder at all.. He said it was the "frozen shoulder".Kobayashi sensei started the treatment procedure as usual. At first, contact needling on the abdomen, he repeated it several times, then asked the patient to raise the shoulder. The patient could raise the arm and was very surprised. Then, Kobayashi sensei followed the treatment procedure, and finished the treatment.
It might not be the frozen shoulder called in Western medicine, however, it was the fact that the patient could raise the arm that he could not before the treatment. Even the symptoms mentioned above, if it did not take much time since the symptom began, do you think whether the disease is shallow?? Then, can any practitioner, who faces with a patient having such symptom, give the same treatment result?? Please consider a lot.
When practitioners are used to clinical experiences, they tend to give an attention to use of back shu points, the treatment pattern and supplemental treatments that Kobayashi sensei found out recently. However, the stimulation of one acupuncture point makes the Jin-qi of the patient tonified in Shakuju therapy, so brushing up each skill of each step of the treatment procedure leads to the raise of treatment effect dramatically. I think this is the interesting point in the therapy. Rather, it is hyper-interesting.
How can we brush up the skill of contact needling, then? At first, (1) apply the pressure enough to the skin with the needle tip; however, though the tip of SJ needle is egg-rounded shape, the needle is needle, so it makes a patient painful when touched. So, (2) pull the skin enough with Oshide (pressing hand). To be able to cover these two points is the purpose of basic classes.
To be honest, needling randomly, and the pace of the speed are required in the more advanced level.
Perceiving the state of the abdomen with Oshide side, grasping the changing state of areas where contact needling passed with Sashide side, and the strength of each area, the speed, and breathing of a therapist when he/she can do all these mentioned above unconsciously, and projecting consciousness later on... The image that the needle extending from the contact area to the back, one that dropping a little stone to the surface of water and spreading like a ripple, and the infinite image from the abdomen to the whole body of the patient...
As a first glimpse, it might look like the same contact needling, but the difference is obvious. Please look at the movie of contact needling by Kobayashi sensei again, taking account of what is mentioned above.
Today, I want to write about a potato not that we ate, but that is our (acupucturists') mate. In Japan, acupuncture students used to practice needling on various objects, such as fruits and vegetables (there is a special training called "Ukimono-do-shi" literally meaning "piercing floating objects". Especially there is a famous practice of penetrating a needle into a floating apple in an washbowl filled with water), a toilet roll, or wooden board. So, potatoes can be our good friends to practice needling with (actually, needling texture of a potato is similar to one of a human body).
On Thursday a regular advanced class was held in Taishido acupuncture clinic, we had a needling practice on a potato for three-edged needle training. We used a kind of big needle for this practice instead of three-edged needle; trying to penetrate it deeply and remove it quickly.
Some people might think that Shakuju therapy is an acupuncture methodology with soft, gentle and sensitive stimulation, but this is half right understanding. Rather, Shakuju therapy can be very soft, gentle and sensitive methodology, but can also give very strong stimulation like three-edged needle, according to the patient's condition and the therapist's skill. Kobayashi Sensei is always saying that because you have enough skill to be able to handle various kinds of needles* freely, from soft stimulation, such as Teishin needle, to strong stimulation, such as a three-edged needle, you can give a deep influence on patient's body with subtle stimulation.
*Nowadays, Kobayashi Sensei does not use a big needle or a long needle anymore, however, before he used those needles as well. In basic course in Tokyo, we learn how to use a big needle, a long needle and moxa needle for supplemental treatment. When your needling skill is not enough, you can rely on such needles for supplemental treatment when necessary.
There are three kinds of needles used in Shakuju Therapy; SJ Go-shin needle (filiform needle), Sanryo-shin (three-edged needle) and Teishin needle. Three-edged needle is a needle to pierce, filiform needle is one which is able to pierce, and Teishin needle is one not to pierce.
According to "Hari-kyu riron (Acupuncture and moxibustion theories)" (Toyoryohogakko-kyokai(ed.), Ido-no-nippon-sha), the text book used in acupuncture schools in Japan, nine classical needles are classified similarly; namely, needles to tear, needles to insert, needles not to insert.
Considering the border between needｌe not to pierce (Teishin needle) and needle to pierce (filiform needle), the phenomenon of puncture does not happen by contact of needle to skin, but observed when the skin cannot bear the pressure of the needle and opens a hole. It happened through the process of needle applying pressure to the surface of the skin. Therefore, filiform needle is one that can adjust various conditions from not to insert like Teishin to tear like three-edged needle. It is quite understandable that filiform needle is the most frequent used needle in the classification of needles based classical nine needles (generally speaking).
Because a SJ filiform needle is capable to correspond to various situations, needling in Shakuju therapy is up to the condition of patients, and a therapist does not judge to insert or not. When the skin of patients accepts the needle, let it puncture, if not, let it not. The effect of treatment is measured not by whether inserting or not, but by changes of reference points. But, be aware, this is for those who are skilled enough to insert, if you are beginners who do not have enough needling skill, keep on practicing aiming to insert.
Here, let us think about the significance of Teishin needle. Taking account of the explanation mentioned above, pressure by a needle is presupposing insertion action, so if you apply pressure with a Teishin needle, it means that you do not make the best use of Teishin needle.
That is, the treatment effect with a Teishin needle occurs only by the effect of contacting Teishin, and the pressure to the surface of the skin is only 5 gram, the weight of SJ Teishin. If you hold this 5g Teishin with both hands, the pressure to the skin is added a little more by the weight of your hands. This state of almost 5g pressure is the basic hand-positioning. Then, when you remove your thumb and index finger of Sashide (needling hand) gently, not letting the Teishin fall, the pressure to the skin gets lighter as much as the weight of hands, the skin pushes up the Teishin with its own elasticity. It is enough for Teishin to repeat this, the slight change of 1mm or something pressure can affect the body, as Kobayashi Sensei said.
Of course, you can get the needling effect when you applied Teishin needle with little bit more pressure (as like a SJ filiform needle), or when you perform contact needling with a three-edged needle. However, when you choose these three differnt needles for each purpose of use, as mentioned above, as a logical consequence, it becomes easier to grasp the situation of the patient during the treatment.
About using a Teishin needle without stimulation of pressure, you would feel the overwhelming effect especially when you use consciousness. It is superb! Seriously!
From left, SJ filiform needles (before use), a Teishin needle, a marking pencil, and an incence stick for moxa
