Seattle Institute of East Asian Medicine's Academic Dean, Katherine Taromina, reflects on the value of her training in the Internal Arts on her clinical practice
Enuresis is frequently encountered in children, while urinary incontinence is generally encountered in the elderly. Because the kidney controls urine and stool, and the urinary bladder governs restraint [of urine], our ancestors viewed these problems as being related to these organs. However, I have achieved satisfactory clinical results by treating enuresis and incontinence through the liver and the lungs.
1. Discussion and Treatment from the Liver
The liver channel wraps around the genitals, so diseases of the lower source are related to the liver channel. The liver body is yïn, but its activity is yáng; further, the body is blood and the activity is qì. The liver stores the blood in order to nourish the body and it courses the qì in order to fulfill this activity. If the liver loses it coursing and draining activity, at first there will be qì stagnation, and then eventually, blood stasis. When qì and blood cease to move freely through the liver channel, the qì and blood fail to nourish the genitals. As a result, the urinary bladder loses its normal control and there is urinary incontinence. In clinic, I often use Drive out Blood Stasis in the Mansion of Blood Decoction (xuè fû zhú yü täng) , which although a blood-moving formula, also contains medicinals to course the liver and regulate the qì. This formula normalizes the outward movement of the liver, such that qì and blood flow smoothly, which then causes the incontinence to cease. In cases where there is also debility of the lower source, I often add Fluoritum (zî shí yïng) and Allii tuberosi Semen (jiû cài zî) . If there is sinking of the qì mechanism, then I add Cimicifugae Rhizoma (shëng má).
Case 1: Ms. Dàn, 17 years old: She reported enuresis off and on for the last six years. She had a dry mouth, recurrent low-grade fever, and frequent dreams. She showed evidence of stasis macules and her pulse was fine, wiry, and slightly rapid. Her tongue was purplish red with a thin slimy fur. She had unsuccessfully tried formulas to supplement qì and boost the kidney. These only made the excess more excess, when what was required was to course the liver, regulate the qì, quicken the blood, and transform stasis.
Formula: Rehmanniae Radix (shëng dì huáng) 15, Angelicae sinensis Radix (däng guï) 9, Chuanxiong Rhizoma (chuän xiöng) 9, Carthami Flos (hóng huä) 9, Persicae Semen (táo rén) 9, Paeoniae Radix rubra (chì sháo) 9, Bupleuri Radix (chái hú) 6, Platycodi Radix (jié gêng) 6, Aurantii Fructus (zhî ké) 6, Allii tuberosi Semen (jiû cài zî) 9, Cimicifugae Rhizoma (shëng má) 6, and Glycyrrhizae Radix (gän câo) 3.
After about one month on this formula, the enuresis and all the other symptoms had resolved.
2. Discussion and Treatment from the Lungs
The lungs are the officer of passage, they regulate outward movement, and they control the qì of the whole body. There are no channels that do not reach them and no organs that do not transfer through them. The lungs are also the upper source of water. They connect with the urinary bladder through qì transformation. When the lung qì diffuses properly, qì moves and thus water moves. Fluids are distributed throughout the body and the waterways are free flowing. The flow of the urine is intimately related to the lungs. If the lung qì is congested and stagnant, qì transformation fails to reach throughout the body, the urinary bladder loses restraint, and the result is incontinence. I like to use Ephedra, Apricot Kernel, Gypsum, and Licorice Decoction (má xìng shí gän täng) in order to clear and diffuse the lung qì, open and regulate the waterways, descend into the urinary bladder, open the qì transformation throughout the body, and unblock the upper so as to reach the lower. If the qì dynamic is also constrained, as Aurantii Fructus (zhî ké) and Platycodi Radix (jié gêng) ; if the qì is deficient and stagnant, add Astragali Radix (huáng qí) , Codonopsis Radix (dâng shën) , and Cimicifugae Rhizoma (shëng má) .
Case 2: Ms. Wu, 55 years old: She reports one month of incontinence, mostly during sleep. When it is mild, it happens once per night and when severe, three times per night. It often happens between the hours of 11 p.m.-3 a.m.. She also reports incontinence with coughing or sneezing. She had previously tried formulas to warm and supplement, as well as astringent formulas, all without success. She is fatigued and lacks strength. She also reports chest oppression and rib-side distention, and cough with yellow sticky phlegm that is difficult to expectorate. Her tongue is red with a thin yellow fur. Her pulse is fine and wiry. This pattern belongs to liver constraint transforming to fire, upwardly harassing the lungs, and causing lung heat so that the lungs lose control of the water pathways. It is appropriate to clear the lungs and course the liver.
Formula: Ephedrae Herba (má huáng) 6, Armeniacae Semen (xìng rén) 10, Gypsum fibrosum (shí gäo) 30 (precook), Glycyrrhizae Radix (gän câo) 3, Atractylodis macrocephalae Rhizoma (bái zhú) 10, Paeoniae Radix alba (bái sháo) 10, Saposhnikoviae Radix (fáng fëng) 6, Citri reticulatae Pericarpium (chén pí) 6, Cimicifugae Rhizoma (shëng má) 3, Puerariae Radix (gé gën) 6.
After 5 packs of herbs, the incontinence was improved. She took the same formula for one more week and the incontinence ceased.
One Hundred Years, One Hundred Masters in Chinese Clinical Medicine: Yán Déxïn, China Chinese Medicine Publishing, Beijing, China; 2001, pp. 195-197.
Translated by Craig Mitchell
By Stephen Brown
Development of Japanese Acupuncture
Chinese medicine arrived in Japan through Korea in the 6th century and has been practiced for over 14 centuries. Both herbology and acupuncture have undergone some unique developments that distinguish traditional Japanese medicine from its Chinese or Korean counterparts. The acupuncture practiced in Japan today is a product of the strong influence of Western medicine starting in the 18th century. The dominant form of acupuncture practiced in Japan today is based more on the scientific model than traditional concepts.
Be that as it may, there is a large contingent of acupuncturists in Japan who base their practice on the classics of Chinese medicine. "Meridian Therapy" is the representative style of Japanese acupuncture based on traditional Chinese concepts. Meridian Therapy had an earlier and stronger influence in North America and it continues to dominate the practice of Japanese style acupuncture in the U.S. A steady stream of Meridian Therapy practitioners have come to the U.S. over the last two decades led by masers like Shudo Denmei, Masakazu Ikeda and Okada Akizo.
While Chinese acupuncture today is closely allied with herbal medicine, Japanese acupuncture has developed in close proximity to massage and moxibustion. Great importance is placed on palpation, careful location and stimulation of reactive points in Japanese acupuncture. So even though there is great variation in styles of acupuncture in Japan, there is a tendency to emphasize skillful palpation and gentle stimulation. In Japanese acupuncture, and especially Meridian Therapy, the skin is seen as the interface by which information is received and conveyed to the body as a whole. It is thought that the body is more readily stimulated and affected on the surface. Therefore the ideal is to find a difference or reaction close to the surface where it can be most readily affected. This makes Japanese acupuncture treatment less invasive and reduces undesirable side effects including pain.
Meridian Therapy, the more traditional approach to Japanese acupuncture, employs very gentle needle techniques so it is especially suited to the treatment of the very young, weak or sensitive patient. Meridian Therapy emphasizes the treatment of the cause of disease (root treatment) while also addressing the symptoms (branch treatment). Meridian Therapy relies on six position pulse diagnosis, abdominal diagnosis and direct palpation of deficiency and excess on the meridians. The root treatment is rendered by subtle tonification and dispersion techniques.
Influence of Japanese Acupuncture
Use of guide tubes for needle insertion became almost universal since the introduction of disposable needles by Seirin Co. in Japan in the 1970s.
There has been a steady trend towards thinner needles and more gentle needle insertion techniques in North America in recent years.
There is a growing appreciation for touch-based diagnosis and a greater attention to palpatory findings in deciding where and how to needle.
The level of personal attention and skilled touch provided in Japanese acupuncture resonates with many American practitioners and patients. More patients are seeking individualized care that includes nurturing touch and less invasive techniques.
Techniques Used in Japanese Acupuncture
Contact needling: The needle, rather than being inserted, is used to prick or stroke the skin surface.
Simple insertion: The needle is withdrawn after reaching a certain depth without applying additional techniques.
Retaining needles: The needle is left in after insertion.
Sparrow pecking: Once the needle reaches a certain depth, the needle is repeatedly moved up and down a few millimeters.
Twisting: Once the needle reaches a certain depth, the needle is twisted back and forth about half a turn.
Flicking: After the needle reaches a certain depth, it is flicked for a certain time with the nail of the thumb or index finger. This may also be done with contact needling.
Moxa needle: A ball of moxa is placed on the head of the inserted needle and burned.
Intradermal needles and press tacks: A miniscule needle is inserted in the skin, taped on and left in place for one day to one week.
Scraping needles: Needles are used to stimulate the skin by scratching and scraping.
Press needles: Needles are used to press and stimulate points on the skin surface.
SSP (silver spike point) treatments: Instead of needles, silver-pointed electrodes are attached to acupuncture points and a low frequency current is applied.
Electro-acupuncture: Electrodes are attached after needles are inserted to apply a low frequency current (1 to 100 Hz).
Some Popular Approaches of Japanese Acupuncture
Traditional Japanese Acupuncture (includes Meridian Therapy): An imbalance in Qi and Blood flowing in the meridians is considered to be the cause of disease. The aim is to regulate the flow of Qi and Blood.
Sawada-style treatment (Taikyoku Therapy): A system of treating standard points originated by the moxibustion master Ken Sawada and popularized by his student Shirota Bunshi M.D. The emphasis is on strengthening the Spleen and Kidneys through the use of direct moxibustion.
Trigger point and tender point treatment: These treatment systems are based primarily on palpation and treatment of myofascial restrictions. This is the most common style of acupuncture in Japan and treats mostly musculo-skeletal pain.
Ryodoraku acupucture: A Ryodoraku point locator is used to probe points with low electrical resistance. For treatment, a low frequency current is applied through needles inserted in points (electro-acupuncture).
Japanese Acupuncture at SIOM
In order to practice Japanese acupuncture, one needs to master its basic techniques and learn the art of palpation. Since Japanese acupuncture is about the art of skilled touch, hands-on practice is more important than lectures and book learning. This is what makes the low student-to-teacher ratio and practice-based learning environment of SIOM so valuable.
There are a number of faculty members who teach various styles of Japanese acupuncture including Meridian Therapy and Manaka's Yin Yang Balancing System (which includes the use of ion pumping cords). Stephen Brown, L.Ac., the primary Japanese acupuncture instructor at SIOM, received his acupuncture and moxibustion license in Japan and has studied extensively with Japanese masters since 1980. His primary teacher is Shudo Denmei and he has co-authored two texts with him including Introduction to Meridian Therapy.
Key Concepts of Japanese Acupuncture
TOUCH. It is a palpation-based acupuncture.
Japanese acupuncture relies more on information from palpation.
VARIETY. Palpation leads to individual variation.
There is considerable variation within Japanese acupuncture.
GENTLE. The tendency is to use milder stimulation.
Japanese acupuncture tends to use milder stimulation and seek patient comfort.