Shonishin: Japanese Pediatric Acupuncture A Text and Video Guide

274 Pages·2016·11.04 MB·English

by  Stephen Birch

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Shonishin:
Japanese Pediatric
Acupuncture
StephenBirch,PhD
TheStichting(Foundation)fortheStudyofTraditional
EastAsianMedicine(STEAM)
Amsterdam,TheNetherlands
AssociateProfessor
OsloUniversityCollegeofAcupuncture
Oslo,Norway
145illustrations
Thieme
Stuttgart·NewYork
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IV
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Illustrators:ChristianevonSolodkoff,Neckargemünd,
Germany;RayénAntón,Barcelona,Spain
VideosfilmedandeditedbyRayénAntón,
Barcelona,Spain.
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V
Foreword
Traditional East Asian Medicine (TEAM) boasts a Nowhere in clinical practiceis the demand for
rich variety of literary genres. The medical dis- fluidadaptabilitytochangingcircumstancesmore
course(yilun醫論),thecaserecord(yian醫案),and pressing than in pediatrics. Steve discusses this
the modern textbook are just a few of the most oftenunspokenaspectofthetherapeuticencounter
prominent styles of TEAM writing today. Stephen asthe“danceoftreatment.”Onceagain,one’ssen-
Birch’s Shonishin: Japanese Pediatric Acupuncture sitivitytooptimumdosingliesattheheartofthe
certainlyqualifiesasatextbook,anditistosome matter. It is a dance that embraces moment-to-
extentamedicaldiscourseandacollectionofcase momentdecisionsconcerningwhichtechniqueto
records. But it also belongs to another venerable use, what tool to administer that technique with,
genre of the TEAM literature that is still in its preciselyhowmuchofthattechniquetoadminis-
infancyintheWest.Inmanyways,thisisa“clinical ter,andwithwhatdegreeofforce.Thentoo,itisa
insights”memoir. dancelargelychoreographedbyasquirming,some-
An entire generation of TEAM practitioners in times squawking partner, and one typically over-
theWesthavenowfullymaturedasmasterclini- seenbyapensiveparenthoveringinthewings.
cians.With30ormoreyears’experienceinadapt- The themes of therapeutic dose and the fluid
ingthismedicinetopracticeintheWest,thisgen- danceoftreatmentrunthroughoutthetext.Abrief
eration has begun sharing their clinical insights glanceatthetableofcontentsrevealsthecompre-
withtherestofus.Thepresentvolumeisarichand hensive discussions of pediatric needling tech-
very personal expression of this process of trans- niques,andexpositionsonindividualdiseasesac-
missionbyaneminentmemberofthisgeneration. companied by prescriptive treatment strategies
Inthis,italsorepresentsthefullblossomingofsho- requisiteforatextbookonapediatricspecialty.
nishin’sdevelopmentandassimilationintoTEAMin Buttheentirebookisconstructedaroundcase
the West. It isampleevidencethat wehavetruly examples.ManyofthesearefromSteve’sownprac-
madethismedicineourown. ticeillustratinghispersonalapproachtoboththe
Asmuchandperhapsmorethananyotherspeci- topicathand,anditsrelationshiptothedoseand
altyofTEAMpractice,shonishinrewardsknackover thedance.Manyothercaserecordsarethoseofcol-
theory.Itiseasytolearnbutdifficulttotrulymaster. leagues,illustratingavarietyofcreativeapproaches
Each practitioner must ultimately “get” the tech- to treatment. It is a technique that is best trans-
nique in hisorher hands. A skilled teacher, how- mittedwithin the contextof specific examples as
ever, knows how to effectively communicate that opposed to theoretical abstractions, though both
knack to others. Steve brings the sensibilities of a arenecessaryforafullunderstanding
professionallytrainedclinicalresearchertothetask Insomeways,shonishinisn’tmuchtolookat.It
of unpacking the shonishinpractice with consum- is an unassuming technique that can easily leave
mateskill.Thisisevidentinbothhiswritingandin onewondering howa bit of stroking, a littletap-
theDVDthataccompaniesthetext.Thetwomedia ping, and perhaps even a touch of tickling could
combinetobringthetechniquesvividlytolife. have any real therapeutic value. Yet experienced
Children are remarkably responsive to thera- shonishinpractitionersknow howalmost miracu-
peutic influence, making them much more prone louslyeffectiveitcanbe.Itcanworkwherebiome-
to overtreatment than their adult counterparts. dical, naturopathic, and other TEAM modalities
Though questions of optimal therapeutic dosage havefallenshortanditcombineseasilywithallof
arefamiliarterritoryforallexperiencedclinicians, them. In this book, Steve has shown us what a
Stevehasthoughtthisissueoutandarticulatedit potenttoolofefficacyandathingofbeautythesho-
withanunprecedenteddepthandclarity.Theclini- nishindancecanbe.
cal ramifications of his dosing model extend far
beyond pediatrics and into medical practice as a CharlesChace
whole,almostregardlessofthemodalitybeingused. Boulder,Colorado
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VI
Preface
Ihavebeentreatingpatientswithacupuncturefor Manyacupuncturistsareafraidoftreatingchil-
almost 30 years. I first applied treatment to chil- dren because theyare afraid of usingon children
drenover25yearsago.Mypractice,sincefinishing the needling techniques they have learned in
acupunctureschool,hasbeentouseJapaneseacu- school.IknowIwas,andmostpeopleIhavetalked
puncture and moxibustion methods exclusively. I to have expressed the same fears and concerns. I
havestudiedinJapannumeroustimes,mostlywith feel that this is because most people have been
practitioners who have more than 40 years of trainedinonlythemodernChineseneedlingmeth-
experience (some with 55 to 60 years of experi- ods, which use relatively thick inserted needles
ence)andoftenwithpractitionerswhohaveexten- that are manipulated until the sensations called
siveexperiencetreatingbabiesandchildren.Inthis ‘de-qi’areobtained. Itseemsmostacupuncturists
bookIhavetriedtopulltogethertheseexperiences thinkthatthisisacupuncture.Whileitseemstobe
andtheinsightsandgeniusofmyteachers.Itrepre- themorecommonlyfoundformtoday,itisbyno
sents the accumulation of many practical experi- meanstheonlyformofacupuncture.Manystylesof
encesandtreatmentideas.IhopeIhavedonethese acupuncture have developed over the centuries,
lineagesjustice. and, for various reasons, relatively gentle techni-
Over the years I have taught and come across queshavedevelopedinJapan.Recognizingthesen-
many acupuncturists who hardly if ever treat sitivitiesandneedsofbabiesandchildren,aspecia-
babiesandchildren.Sometimesthis isbecauseof lizedstyleofacupuncturefortreatmentofchildren
theinterestsorfocusofthepractitioner,theyspe- calledshonishindevelopedinJapanover300years
cialize in fertility or pain, for example; but more ago.Thisnotonlysurvivedbut,inthesecondhalfof
oftenit isbecauseacupuncturetreatmentofchil- thetwentiethcenturyhasflourishedinJapan.This
dren,andespeciallybabies,istooscary.Manyacu- style applies various surface stimulation methods
puncturists are not exposed to such treatment in using specialized treatment tools. Inserted need-
school, never developing the confidence to try. lingisnotalwaysneededandoftenisunnecessary.
Manyareafraidthatwhattheyhavelearnedisnot It is neither painful nor scary. Practitioners who
suitable for the treatment of babies and children. havelearnedit,patientswhohavereceivedit,and
The child is suffering enough, how can we cause parentswhohaveobservedandexperienceditno
more suffering with our needles? This is a great longerfeelafraidoftheideaofacupunctureforchil-
pity.Wesometimesseeveryinspiringresultswhen dren.
wetreatchildren,especiallytheyoungerchild.Itis Another issue that makes it difficult for many
as though the potential for acupuncture is more acupuncturists to treat children lies in the belief
strongly expressed in treatment of children com- that thekind of acupuncture treatment that they
paredtotreatmentofadults.Sometimestheresults useonadultscanbeadaptedsimplybymodifying
when we treat children are completely amazing, thetechniquestosomedegree(makethemsofter)
evenshocking.Thechildwhohasbeendiagnosed butthatthesametheoreticalbasisofdiagnosisand
withageneticanomalyandisunabletodigestfood treatmentcanbeusedaswithadults.Ifeelthatthis
properly suddenly starts digesting food following isanunreasonableassumption.Thereisnotalotof
treatment; the child with a cardiac disorder who published literature in European languages about
hasbeensotiredthatshehasnotbeenabletoplay differencesbetweenchildrenandadultsbasedon
likeotherchildrenissuddenlyrunningaroundtire- traditional East Asian medical (TEAM) literature.
lesslyafter thefirsttreatment!Whatisgoingon? The historical TEAM literature is not so detailed
Howcanthisbe?Whydon’tmorepractitionerstry either;insteadwehavehintsaboutwhatthosedif-
treatingchildren?Theanswerstothesequestions ferences may be. Of course the basic physiology
lie in how we approach the child and what we mustbethesameorverysimilar;childrenbreathe,
thinkacupunctureissupposedtobe. eat,drink,digest,excrete,sleep,move,etc.withthe
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Preface VII
sameorgansthatadultsuse.Theyrequirethesame playthepianofromreadingbooks!Thinkingabout
basicfunctionalsystemsinordertodothesethings. theseproblemsIwasdelightedtofindthatmycol-
Buttherearesomefundamentaldifferencesabout league Rayén Antón had worked in the media of
how thingsoccur,therateandqualityofchanges filmandeditingbefore,soIfoundIwasabletostart
that make children fundamentally different from thisprojectwiththeplanthatwecouldatleastlet
mostadultswhenitcomestohowtheyrespondto people look at what is to be done, which is defi-
treatmentandthushowtreatmentcanbeapplied. nitelybetterthansimplyreadingaboutit.Ibelieve
Byfocusingonthosedifferencesandhighlight- theoldadage“apictureisworthathousandwords”
ingthecharacteristicsofchildren,namelythatthey startstocoverthisidea.WorkingwithRayénIhave
are very sensitive and thus can be influenced by beenabletocompletethisproject.Webothhope
verylittleinput(the“lessismore”model),itispos- that theformat and content of this text and DVD
sibletodevelop apractical approachtothetreat- willsidestepthelimitationsIhaveworriedabout,
ment of children that is much less theoretically will help to get more practitioners started in the
complex. In this book I have tried to explain and treatmentofbabiesandchildren,andwillenhance
highlight these issues to show how, regardless of theeffectivenessofthosewhoalreadytreatthem.
how complex a model or pattern another system Thefirstsectiondealswiththeoriginsandnat-
might construe for a pediatric patient, especially ureoftheshonishinapproach.Itexplorestheori-
onewithcomplexproblems,wecanfindadaptable, ginsofitsapproachesinthehistoricalearlyChinese
practical solutions with a simpler model of prac- literatureandshowshowthesewereadaptedand
tice. This is key to understanding the treatment adoptedintoJapanesetraditionalmedicineseveral
approachforbabiesandchildren. centuriesago.
ForanumberofyearsIhavewantedtowritea The second section explores the nature of the
practical book about the treatment of children physiological and treatment response differences
usingtheuniquetreatmentapproachesfromJapan ofchildrenwithmostadultpatients.Principallyit
calledshonishin.Ikeptdelaying,inpartbecauseof focuses on their innate increased sensitivity and
being busy and in part because I was not quite theclinicalimplicationsofthisintermsofdoseand
ready;Ineededtimetoworkoutastrategyformak- regulatingthedoseoftreatment.Italsodescribes
ingthebookbothpracticalandrealistic.Thistext howonecanpracticallygraspandattendtothese
anditsaccompanyingDVDaretheproductofthose differences and, through palpatory feedback, con-
desires,plans,andstrategies.Ialsoresistedwriting tinuously adapt treatment as it is being given to
ashonishinbookbeforebecauseIdidnot wantto ensureproperclinicalapplications.Italsodescribes
writethesametypeofbookthatisoftenfoundin thevarioustreatmenttools.HereIhavefocusedon
the field. Many books focus on telling the reader showcasingmyprivatecollectionofshonishintools
what points to treat for which symptoms or pat- organized along traditional ideas of treatment
terns.Oncethecorrectpointshavebeenselected, method.
then everything is supposed to right itself, so we The third section describes two basic forms of
almost never find descriptions in these books of applying“roottreatment”(Chinese“zhibenfa”),the
whattodoif itdoesn’t work.Ifindthisapproach principle purpose of which is to strengthen the
ratherunhelpful,evenwhensuchbooksarebased body’snaturalhealingabilitiesbyhelpingregulate
on a traditional system ofdiagnosis and matched physiology.Thefirstof theseisthe“non-pattern-
treatments.Ifindmanyofthesebookssotheoreti- basedroottreatment”systemwhichisthecoreof
cally driven that they are not typically rooted in the shonishin treatment method. This method,
clinicalpracticeandarenotstructuredtohelpthe regardlessofthechild’ssymptomsandany“tradi-
readereasilyadapttochangingcircumstances,inef- tionalpatterns”ofdiagnosis,applieslightstimula-
fectivechosentreatmentsormatchingtotheindi- tion in set patterns tothebody surface using the
vidualityofeachpatient.Iwantedtoavoidfalling tools described in the previous section. This
intothesametrapwiththebookIwantedtowrite. approach targets an improvement of the vitality
I have also been concerned that toomany practi- andmoodofthechildandthroughthisastrength-
tioners think they can learn practical skills just ening of the natural healing abilities. The second
fromreadingbooks.Iknowfrommyownexperi- root treatment system is the “pattern-based root
encethat this is not realistic. Imaginelearning to treatment” approach, a simplified form of tradi-
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VIII Preface
tionalJapaneseacupuncturecalledKeirakuChiryo theworldwhosentmesomeoftheirmostinspiring
orMeridianTherapy.FirstIoutlinetheuseofthis cases.ForeachconditionIgiveclinicalexample(s)of
approach on adults and then its diagnostic and howthesystemsareusedandarangeoftreatment
treatmentmodificationsforchildren.Thismethod ideas and suggestions for each condition, with
focuses on regulating the jingluo (Japanese “keir- detailsofhowtoselectbetweenthemandwhatto
aku”)orchannelswhileatthesametimestrength- do if they are not working. In this section I also
eningthechild’svitalityandnaturalhealingability. describetreatmentofunderlyingissuesaswellas
In actual clinical treatment, one can use only the specificsymptoms.Forexample,thereisachapter
Meridian Therapy root treatment approach, only onconstitutionaldiagnosisandtreatment,whichis
the “non-pattern-based” shonishin treatment ap- importantwhendealingwithchildrenwithsevere
proach,oracombinationofthesetwo.Itisalsopos- andcomplexhealthproblems.Similarlythereisa
sibletoteachtheparenttodoasimplifiedformof chapteronstrengtheningthevitality,whichisthe
thecoreshonishinnon-pattern-basedtreatmentat principlereasonforapplyinga“root”treatmentto
homeregularly.Thisisalsodescribedinthissection begin with. But in some children, one can only
and can greatly enhance treatment effects and focus on treating to improve the vitality so as to
speeduprecoverytime. strengthenthenaturalhealingability,forexample
Thefourthsectiondescribessymptomatictreat- prior to surgery, so as to improve recovery after-
ment approaches, the use of normal acupuncture ward.
treatment methodsstrictlyadaptedtotheunique Nothingworksoneveryone.Nosystemoftreat-
needs of children. This covers adapted forms of mentiseverfoolproof.Nosingleindividualpracti-
needling,moxa,retaineddermalstimulationmeth- tioner is free of limitations. We must start with
odssuchaspress-spheres,press-tackneedlesand theseaxiomatictruthstobuildapractical,adapta-
intra-dermal needles, cupping and bloodletting. ble, and responsive system of treatment. It has
Pointlocationsarealsocoveredasneededbothfor beenmyhopeandintentioninthewritingofthis
the main root and extra symptomatic treatment booktokeeptheselimitsinmindwhilelayingout
points. strategiesthatallowthereadertodevelopapracti-
Thefifthandfinalsectionofthebookdescribes calsystemthattheycanmakeworkforthem.Ihave
howtouseallofthediagnosticskillsandmethods placed a practical palpatory based understanding
andtreatmentmethodscarefullyselectedinadap- ofqiattheheartofthetreatmentapproach,which
tableandevolvingtreatmentsforanumberofdif- isnaturalgivenmyteachersandtraininginJapan.I
ferenthealthproblems.MostimportantlyIwanted hopeyoufindthebookusefulandstimulating.
this to be practical, thus many case histories are
described. Ireceivedhelpfrom colleaguesaround StephenBirch
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IX
Acknowledgements
As always,writinga book is not possiblewithout cases to be included in the book: Rayén Antón
thehelpandsupportofothers.First,thankstomy (Spain), Mourad Bihman (Germany), Joke Bik-
family and friends for their support and under- Nowee(Holland),ZoeBrenner(US),MarianFixler
standing. (UK),BrendaLoew(US),PaulMovsessian(Austra-
Second,thisprojectisasgoodasitisbecauseof lia), Diana Pinheiro (Portugal), Sue Pready (UK),
the work and talents of my colleague and friend ManuelRodriguez(Spain)—theircontributionsadd
RayénAntónwhohelpedmewiththestructureof muchtothebook;toHitoshiYamashitawhohelped
the project, all illustrations and video work. Her track down pictures in Japan, and to the Harikyu
assistanceandcollaborationhavebeeninvaluable.I Museum, Osaka for permission to use these pic-
feelfortunatetohaveworkedwithherandlookfor- tures;toSayoIgayaforhelptrackingdownhistori-
wardtofutureprojects. cal information about kanmushisho; to Wolfgang
Third,thankyougoestoanumberofotherpeo- WaldmannandtheEuropeanInstituteofOriental
ple:JunkoIdaforhelpingmewithtranslations of Medicine,Munichforpermissiontovideotapemy
theJapanesematerialsthatprovidethebackground workshop there in November 2008; to Stefan
for the materials organized and presented in the MaegliofLiestal,SwitzerlandandHamidMontakab
book; Josephine Haworth for helpwith editingof of the Academy of Chinese Healing Arts, Win-
thetext;myeditorAngelikaFindgottforhersup- terthur, Switzerland for permission to videotape
port and encouragement of the project, and her my workshopthere in February 2009; tothevar-
teamatThiemePublishersfortheircareandassis- ious children, parents, and students who partici-
tance;mycolleaguesBrendaLoewandPaulMov- pated in the workshops at these acupuncture
sessian,fortheirsupportandencouragementofthe schools,especiallythosewhoappearinthevideo;
project,andManuelRodriguezforgivinganextra toEliasandhismotherHettyforagreeingtostarin
hand;thankstoMichaelBlanzofmbFilm&Video thevideo;totheoriginalpractitionersofshonishin
and David Ferrando Navarro of Xochipilli Produc- in Japan several centuries ago who created this
ciónesfortheirtechnicalhelpwiththevideomate- wonderful system; and finally to my patients for
rials;toDavidFerrandoNavarroalsoforphotogra- teachingmeabouthealingandtotheirparentsfor
phy;tomyteacherswhohelpedmeimproveand helpingwiththetreatments.
deepen my skills, in particular Yoshio Manaka, Finally,IdedicatethisbooktomysonNigel,for
Toshio Yanagishita,AkihiroTakai, ShuhoTaniuchi, livingthiswithme,andtomymotherformakingit
Koryo Nakada; to a number of colleagues listed allpossible.
here alphabetically who agreed to send me their