Japanese Acupuncture: A Complementary Approach to the Meridian Balance Method

Abstract

The association of acupuncture points requires realization of synergistic combinations to be as effective as possible while avoiding possible aggravations. To this end, the meridian balance method is an effective tool. It is based on the 6 systems of Richard T.-F. Tan, MD, which derive from 6 principles of traditional knowledge: (1) Chinese meridian-name sharing; (2) branching meridians (Bie-Jing); (3) interior–exterior pairs (Biao-Li); (4) Chinese clock opposite; (5) Chinese clock neighbor; and (6) the same meridian. However, the results seem to unstable over time, and, therefore, synergies with “root” treatment based on Japanese meridian therapy could help stabilize the therapeutic effects of the meridian balance method. Japanese meridian therapy uses pulse diagnosis to identify 4 basic primary patterns: (1) Liver Deficiency, generally treated with a combination of acupuncture points LR8–KI10; (2) Kidney Deficiency, treated with LU 5–KI 7; (3) Spleen Deficiency, treated with PC 7–SP 3; and (4) Lung Deficiency, treated with SP 3–LU 9. After reviewing the main principles of Japanese acupuncture, a nondogmatic approach coupling Japanese meridian therapy with Dr. Tan's balance method is proposed in order to use the best of each of the 2 methods in an integrative approach.

Introduction

The meridian balance method, developed by Richard T.-F. Tan, MD,¹ has gained popularity in recent years, mainly due to recent research demonstrating its effectiveness,^2–4 and publications by researchers working in many countries.^5–7 The meridian balance method is based on the 6 systems of Dr. Tan deriving from 6 principles of traditional knowledge: (1) Chinese meridian name sharing; (2) branching meridians (Bie-Jing); (3) interior–exterior pairs (Biao-Li); (4) Chinese clock opposite; (5) Chinese clock neighbor; and (6) the same meridian.^1,7–9

In 2017, a randomized controlled double-blinded study by Schroeder et al. demonstrated the efficiency of distal needling acupuncture for immediate pain reduction in patients with adhesive capsulitis.² However, Kotlyar published 4 clinical articles,^5,6,8,9 based on Dr. Tan's balance method,¹ reporting excellent immediate efficiency but usually requiring between 20 and 60 acupuncture sessions to treat a disease. Therefore, the balanced method acts more as a branch treatment than a root treatment, even when the selection of acupuncture points has been synergized using the Global Balance.⁹ Thus, exploring the potentiality of coupling Japanese meridian therapy focusing on root treatment, with the balance method focusing on branch treatment, could pave the way to new effective and durable therapeutic approaches.

History of Japanese Acupuncture

In the sixth century, Chinese Medicine (CM) was imported to Japan through Korea. Direct travel to and within China was possible via the Silk Road.¹⁰ At this time, the law directed that not only acupuncture students but also medical students had an obligation to study acupuncture points, inferring that acupuncture was regarded as an important kind of medicine. Between the seventeenth and nineteenth century, the Edo Shogunate decided to close the Japan. This country cut off any exchanges with almost all foreign countries for more than 2 centuries. During this period, a blind acupuncturist, Waichi Sugiyama, devised a needle-tube insertion method; this technique enabled insertion of a needle without causing any pain and promoted the use of thinner needles. The samurai-based government of the Edo period collapsed in 1868 and the new Meiji government rapidly accepted Western culture. In 1878, the first school for blind people was built in Kyoto and acupuncture studies were included in its program: The practice of acupuncture by blind people may explain the particular importance given in Japanese acupuncture on palpation findings.

During 1936, there was a revival of CM advocating holistic treatment, emphasizing treatment of the underlying causes of disease. Meridian therapy, based on Five Phases theory from the Nan-Jing (first century), gave importance to the course of meridians and to treating points according to pulse diagnosis.

Fundamental Concepts of Japanese Meridian Therapy

From a traditional point of view, an “invasion” in the body is not considered as a disease in itself but rather a weakness that calls the disease. Therefore, the purpose of the diagnosis is to identify the primary Deficient Pattern that has to be treated with acupuncture.^11,12 Liver Deficiency induces Blood Deficiency; Spleen Deficiency induces Qi, Blood, or Fluid Deficiency; Lung Deficiency induces Qi Deficiency; and Kidney Deficiency induces Fluid Deficiency (i.e., a dysfunction of the “cooling system” preserving the essential Qi). In Japanese acupuncture, a Deficiency in the essence of the Heart cannot be at the root of a disease, even if, in return, the Heart can be affected by influences from other organs. However, this assertion, based on chapter 71 of Ling-Shu, was questioned by recent research showing that acupuncture only at PC 6 and HT 5 reduced frequency of angina attacks in patients with chronic angina.¹³

Moreover, while Deficiency of the essential Qi is necessary for the development of a disease, it is not a sufficient cause.¹⁴ Before symptoms of a disease appear, a pathologic factor must be present: internal factors based on an imbalance of the emotions¹⁵; external factors contracted from external pathogens (climatic or infectious diseases); or factors neither internal nor external (traumatic injuries, overwork, overindulgence in food or drink).

The interaction between pathologic factors and the Deficiency of one of the four basic Patterns induces production of Cold or Heat that can spread in different ways throughout the organ–meridian system, giving rise to various combinations of Deficiencies, Excesses, Cold, and Heat, that form miscellaneous diseases. Therefore, in term of diagnosis, a dysfunction of a meridian in particular might result in symptoms related to any other channels interacting with the dysfunctioning meridian, the main complaint of the patient being only “the emergent part of the iceberg.”

Table 1 synthesizes each meridian relationship, using Yin–Yang, Five Phases, opposite polarities of the Chinese clock, or other balance method concepts. For example, a primary Pattern of Liver Deficiency can result in symptoms in any of the nine other channels listed in Table 1: the spread of Heat or Cold from the Liver meridian to the Shao Yang meridian can lead to chronic migraine,¹⁶ to the Heart meridian can lead to hypertension or angina,¹³ and to the Yang Ming meridian can lead to irritable bowel syndrome. Yet, an emotional symptom such as irritability, traditionally linked to Liver dysfunction, can be induced by a primary Pattern of Kidney Deficiency; or fatigability, traditionally linked to Kidney dysfunction, can be induced by a primary Pattern of Lung Deficiency. Therefore, the knowledge needed to diagnose and treat the root (primary Pattern) and branch (symptoms) is the key to use of Japanese meridian therapy.

Table 1.

Meridian Interrelationships

Meridian interrelationships based on Yin–Yang, Five Phases, Richard Tan, MD's balance method relationships. The numbers in parentheses refer to Dr. Tan's balance method classifications: (1) Chinese meridian-name sharing; (2) branching meridians (Bie-Jing); (3) interior–exterior pairs (Biao-Li); (4) Chinese clock opposite; and (5) Chinese clock neighbor. The sixth classification, the same meridian, is not in this table. Shading differentiates element groupings.

Identifying the Primary Pattern of Imbalance

Reproducibility of Primary Pattern Diagnosis

Japanese meridian therapy places great emphasis on palpation of the radial pulses and the abdominal region in order to select the primary Pattern for root treatment. Two basic complementary approaches (i.e., a “pulse comparison method” and a “pulse quality diagnosis”) are used to classify the quality of the pulses in relation to strength, speed, and depth, and also palpating the three positions of the pulses that can be palpated along the radial bone (proximal to, over, and distal to the styloid process) to examine differences in strength. The symptoms of the patient might or might not match with the primary Pattern—the primary aim of diagnosis being to select a treatment and not to describe a disease.¹⁷ Given the importance of pulse palpation to identify the primary Pattern to be treated,¹¹ King et al. developed a standardized pulse-taking procedure with an interrater agreement averaged at 80% between 2 assessors. Thus, pulse palpation appears to be a credible diagnostic tool.¹⁸ Conversely, for abdominal palpation, the overall level of agreement on primary Pattern diagnosis was only 48%.¹⁹

Pulse Comparison Method^11,12

The most direct way to identify basic patterns of imbalance is pulse-strength comparison at the six traditional positions of the radial arteries. Attention must be focused on the weakest positions at the deep level. The generating cycle (Sheng) helps identify the correct pattern (Fig. 1) as follows:

FIG. 1.

Examples of coupling between Japanese meridian therapy and the balance method. Acupuncture points' associations are only suggestions combining root treatment based on pulse palpation and branch treatment based on meridian palpation, but should not be considered as dogmatic principles. Solid lines refer to Richard Tan, MD's balance method and dotted lines refer to Japanese meridian therapy.

• A Kidney Deficiency often appears along with a Lung Deficiency.

• A Spleen deficiency is commonly associated with a Heart and/or a Pericardium Deficiency.

• A Liver Deficiency is frequently coupled with a Kidney Deficiency.

• A Lung Deficiency often appears with a Spleen Deficiency.

If the pulse comparison method does not match any of the typical Patterns, the Pattern might be determined according to the pulse quality, or an approach based on the Extraordinary Meridians might be necessary.

Complex Pulse Pattern

When three meridians in a generating relationship are Deficient, the meridian with the most abnormal palpatory finding is considered to be the primary Deficiency.¹¹ For example, if Lung, Kidney, and Liver pulses are Deficient, abnormalities along the Lung and Kidney meridians point to Kidney vacuity, but if abnormalities predominate along the Kidney and Liver meridians, a primary Pattern of Liver Deficiency is more likely. If there are no major palpatory changes, the intrinsic point of the Deficient meridian that is in the middle of the generating cycle should be needled. In the previous case, if KI 10 (the Water Point of the Kidney meridian) is needled, the Lung pulse becomes predominant if Liver Deficiency is more significant. Conversely, if the Liver pulse becomes stronger, Kidney Deficiency is considered as the basic Pattern, given that the Lung and Kidney pulses are most Deficient.¹¹

Pulse Quality Diagnosis

Japanese meridian therapy and the balanced method converge for analysis of pulse quality (Table 1). Globally, a slippery and slow pulse indicates Spleen/Stomach, a floating pulse indicates Lung/Large Intestine, a deep pulse indicates Kidney/Bladder, an overflooding pulse indicates Heart/Small Intestine, and a wiry pulse indicates Liver/Gall Bladder or Pericardium/Triple Energizer. However, in Japanese acupuncture, the link between the slippery pulse and Spleen is not systematic—a slippery pulse could also be present for a Pattern of Lung Deficiency/Liver Excess or Kidney Deficiency/Heat.¹² Pulse-quality perception is related to pulse velocity defined by a Bramwell–Hill relationship. According to the Bramwell–Hill relationship (Bataille et al,)²⁰ derived from Newton's second law of motion, the elastic arterial pulse wave velocity is expressed as follows:

wherein ΔP/ΔV is the arterial elasticity (related to Qi), V is the baseline volume in steady-state conditions (Blood), and ρ is the blood density (Fluid). Doppler analysis of the radial pulse in pregnant women, in whom a slippery pulse is considered to be present in traditional textbooks, revealed that pulsatility index decreased in pregnant women, reflecting that the blood flow Pattern of pregnant women is less pulsatile.²¹

Treatment

First—Combining Root with Branch Treatment (Fig. 1)

Classical points associations are used to treat each of the 4 primary patterns:

• For Liver Deficiency, LR 8–KI 10 or LR 3–KI 3 may be needled and BL 18–BL23 may be used as root supplementary points, particularly if they are reactive to palpation.

• For Spleen Deficiency, PC 7–SP 3 and BL 14–BL 20 may be used.

• For Lung Deficiency, SP 3–LU 9 and BL13–BL 20 may be used.

• For Kidney deficiency, LU 5–KI 7 and BL 13–BL 23 may be used.

Back Shu points must be palpated to identify the most reactive areas. Similarly, root (Ben) treatment should be associated with branch (Biao) treatment based on palpatory findings and optimal meridian interrelations (Table 1). The 6 systems of Dr. Tan's balance method can thus be combined with root treatment in order to synergize both. In addition, accurate point localization depends more on correct palpation than agreement with textbook localizations.²²

Second—“Mizu No Kokoro” (“A Mind Like Water”)

For needling to have an effective in its influence on Qi, the inner state of the practitioner seems to be essential (i.e., calm emotion, quiet mental focus, straight posture, state of relaxation, and an alert mind and present spirit).^11,17 The studies of McCraty et al.²³ suggest a possible spontaneous synchronization between individuals—the notion of brain-to-brain synchronization is that the perceptual system of 1 brain can be coupled to another brain.

The findings of the current authors suggest that the magnetic field produced by the beating heart—which is radiated externally to the body—provides a plausible mechanism for conveying information to locations external to the body and for how some people can feel or sense another person's presence or emotional state, independent of body language, or other factors. From this point of view, empirical findings of ancient acupuncturists that emphasized the importance of the inner state seems to be plausible.

Third—Confirmation of Treatment Effect²⁴

A specific aspect of Japanese meridian therapy and the balance method is to aim for an immediate result. The balance method aims to decrease immediately the pain felt by a patient.¹ Japanese acupuncture evaluates also the response to root treatment by checking improvement of the radial pulse, meridians' palpatory changes, or abdominal qualities.²⁴ Confirming the treatment effect is a significant aspect of Japanese acupuncture. The immediacy of feedback helps the acupuncturist to adjust the treatment quickly. For example, in a setting of Kidney vacuity, if the association of LU 5–KI 7 was not able to strengthen the Kidney pulse, treatment may be completed by adding the Yuan point of the Kidney meridian (KI 3). O'Brien et al. studied the ability of root treatment to match changes in cardiovascular parameters. These researchers concluded that the subendocardial viability ratio—reflecting a higher propensity for myocardial ischemia—was improved after root treatment.²⁵

Clinical Cases Coupling Japanese Acupuncture with the Balance Method

Clinical Case 1

Mr. Y presented urgently for brutal dizziness, right ear tinnitus, and neck pain. Pulse strength comparison did not match any typical pattern; however, his pulse quality was wiry and tight. The treatment was aimed to strengthen Liver and Kidney, and to drain the Shao Yang meridian. A quick acupuncture technique was used on GV 16, BL 15, BL 18, and BL 23. The needles were withdrawn immediately after obtaining De Qi (< 5 minutes). Then, LR 3 and KI 3 were needled on the patient's right foot crossed with HT 5 on his left wrist. TE 3 was needled on his right hand crossed with GB 40. Needles were retained for ∼20 minutes. This patient's dizziness disappeared the next day, his cervical pain decreased, and his tinnitus was more tolerable, with these results lasting for 1 month after this acupuncture session.

Clinical Case 2

Mrs. X, 75 years' old, presented with left cruralgia. Magnetic resonance imaging showed severe osteoarthritis in her lower back (from the 3rd to the 5th lumbar vertebrae). A local infiltration with corticosteroids failed to reduce her pain. Her first acupuncture session focused on dissolving Blood Stasis, using BL 17, SP 10, and LR 3, coupled with the Ah Shi points of the Zu Yang Ming meridian and back trigger points. This treatment failed to relieve this patient's symptoms. At the second session (1 week later), pulse strength comparison revealed Deficiencies in the Spleen and Heart positions. Therefore, a quick acupuncture technique was used at GV 16, BL 14, and BL 20; followed by root treatment at right SP 3 crossed with left PC 7 and a branch treatment at ST 34 and ST 42 crossed with Ling-Ku (slightly proximal to LI 4) and Zong-Baï (slightly proximal to TE3). GV 19 and Ah Shi were also needled. This patient's symptoms were alleviated by an acupuncture session once every 1–2 months.

Clinical Case 3

Mr. Y, 50 years' old, was hospitalized in an intensive care unit for severe colitis that was initially treated with antibiotics. He had diarrhea and nausea. His pulse was slightly slippery, but no clear Pattern of imbalance appeared in this acute illness. Palpation of the right Zu Yang Ming meridian showed that ST 36 was slightly tense. Left SP 1 and SP 3 were needled, crossed with right LU 5, and right ST 36 was needled, crossed with left LI 9. The couple of points ST 36 and SP 3 was used to strengthen the Spleen. ST 25 and CV 4 were added to the treatment as root supplementary points. This patient's symptoms were alleviated on the same day, and it was not necessary to repeat the acupuncture session.

Discussion

This article proposes an integrated approach associating the great principles of Japanese acupuncture with the balance method. Local balance method is a style of acupuncture popularized by Dr. Tan,¹ wherein pain relief is expected once needles are inserted in appropriately chosen acupuncture points. For internal or emotional disorders, global balance, based on Yi King meridian conversion, is preferred for treating complaints caused by multi-dysfunctioning body systems rather than by a restricted local disorder.⁶ The interbalancing relationships of the acupuncture meridians are mainly based on Dr. Tan's 6 systems. As noted in the Introduction, these systems are: (1) Chinese meridian-name sharing; (2) Bie-Jing/branching meridians; (3) Biao Lie/interior–exterior pairs; (4) opposites on the Chinese clock; (5) neighbors on the Chinese clock; and (6) the same meridian.¹

However, the studies of Schroeder et al., using a mathematical approach to calculate theoretical options based on historical systems, suggested that there are many more treatment options than normally expected.^3,26 These options have been considered in Japanese meridian therapy by including the Five-Phase relationships.^11,12,14 Thus, pulse analysis and meridian palpating are the main ways to select appropriate treatment among these many options. In addition, the balance method does not address the coupling between Back Shu and Front Mu acupoints, which is, however, an important concept in TCM (based on Zang Fu theory) and, in Japanese acupuncture, for selecting root (Ben) supplementary acupoints.¹²

Japanese meridian therapy, seeking to balance the vegetative nervous system transcribed by pulse analysis, extends the metaphor of “put a pole under the sun, and you should immediately see its shadow” to root treatment.^1,11,24,25 Sudhakaran has highlighted the risk of treating only the branch (Biao) for migraine prophylaxis.²⁷ For example, a Liver Deficiency can lead to Shao Yang headache, and a treatment reducing LR 3 may be appropriate to treat migraine attacks. However, each time the Liver is reduced, there is a risk of increased recurrences. Therefore, the acupoints association of TE 5 crossed with GB 34 is able to relieve pain (i.e., Qi or Blood Stagnation) on the Shao Yang meridian,¹⁶ and LR 8 (crossed with PC 6 to balance each meridian) is able to prevent headache recurrences, if the pulse strength comparison reveals a Liver Deficiency.

Conclusions

Coupling Japanese meridian therapy with the meridian balance method offers the advantage of treating root and branch at the same time, thereby limiting the number of the needles by using synergic point associations based on meridian interrelations. Thus, combining these two complementary approaches may help to achieve quick and long-lasting results.

Author Disclosue Statement

No financial conflicts of interest exist.

Funding Information

No funding was received for this article.