JMT Pulse Assessment
The focus of the yin organs in JMT pulse assessment is based on Suwen, chapter 5. In this chapter, the principle of “yin leads, yang follows” is explained. The idea being that by tonifying the deficient yin organs, energy to the whole system will allow yang Qi to follow. This is a core idea of JMT.
In the JMT system of evaluating the pulse, all six pulse positions are compared side-to-side looking for most deficient yin organ pulse in a mother-child relationship. Both the left and right pulses are felt at the same time. In the JMT system, laterality is important. Pulse is taken on the left side of the patient. Laterality of the root treatments is based on gender. Women are given root treatments on the right side of the body. Root treatments for men are on the left.
Each pulse position is compared side to side and the clinician is noting the most deficient yin pulse as noted in Table 10 below. The clinician is looking for the two most deficient yin pulses in a mother-child relationship, which determines the sho or pattern to be addressed in the root treatment. The pulse is taken at middle jiao depth. Nanjing 69 also instructs a practitioner to tonify the mother points first, in cases of deficiency. Followed by sedation of the child points in cases of excess.
The twelve meridians and five phases of the pulse positions common to JMT
|Cun||Metal||Large Intestine Meridian||Lung Meridian|
|Guan||Earth||Stomach Meridian||Spleen Meridian|
|Chi||Fire||San Jiao Meridian||Ming Men|
|Cun||Fire||Small Intestine Meridian||Heart Meridian|
|Guan||Wood||Gallbladder Meridian||Liver Meridian|
|Chi||Water||Urinary Bladder Meridian||Kidney Meridian|
A sho is derived from the pulse positions of the two weakest yin pulses that are in mother-child relationship. For example, a clinician notes that heart pulse position on the left cun, the liver pulse on the left guan, and the spleen pulse position on the right guan, are the most deficient pulses. Based on Nanjing 69, fire is the mother of earth and therefore the sho is determined to be spleen sho. Once a sho is determined, a root treatment can be administered to tonify the deficient meridians.
Other relevant clinical findings to corroborate the pulse findings include the use of the hara or abdomen along with the forearm. The abdomen is a micro-system in and of itself with many different applications for treatment. In JMT, the abdomen is assessed for deficiencies, excess, tonus, temperature, and luster of skin. The upper right quadrant is assigned to metal or the lung organ. The epigastric area is assigned to fire or the heart/pericardium organ. The area from approximately Ren 12 midline to the umbilicus is earth, or spleen organ. The lower left quadrant is assigned to wood, or the liver organ. Finally, below the umbilicus is assigned to water, or the kidneys.
The forearm is also a micro-system in many lineages. Anrya Iwashina, or “Dr. Bear”, teaches that the inner/yin aspect of the forearm can be assessed for color, tonus, and other relevant skin conditions relating to the five elements. If the skin feels slick or glassy and has a reddish hue, then fire is predominating. A squishy forearm that lacks tonus with a yellowish hue is seen as earth. Forearms that are dry and rough with whitish coloring represent metal. Water is seen in forearms that have a firm hardness at a deeper depth upon palpation with a darker tint. When a greenish hue is observed with springy firmness, wood is dominant.
A complete synthesis of abdomen, forearm and pulse aid the clinician in determining the pattern differentiation. Once a sho is assessed, then treatment of the appropriate points can performed.
A. Non-insertive needle based on Lingshu, chapter 1
In Japanese Meridian Therapy, needling treatments focus on gentle techniques. As mentioned earlier, the guide tube was developed in Japan. This aid distracts the bodies wei qi or defensive qi to allow for painless insertion of needles. Most Japanese needling techniques are very shallow. Root treatments often incorporate the use of a non-insertive needle called a teishin. In Lingshu, chapter 1, nine different needles are described.
The creation of the teishin is based off the description of the third needle, tizhen. In this chapter, it is described as a key-shaped or blunt-tip needle that is about 3.5 cun in length. In one translation of the this chapter, the tizhen needle is further described as having “a tip as sharp as the head of a millet grain”, and it may be used to massage meridians. However, this kind of needle should not be used to penetrate into muscles, as it may cause harm to energy. In the Wu and Wu translation of the Lingshu 1, the tizhen is used to press the channel for inducing the healthy energy and excreting the evil energy. There are many variations in the designs of the teishin including metal, shape, and size.
B. Root treatment for the sho
Japanese meridian therapy prioritizes root treatment to balance the various excesses and deficiencies in the acupuncture channels. Root treatment is a whole body treatment, based on evaluating fundamental meridian imbalances, and restoring them to harmony. There are many schools of JMT. Dr. Robert Quinn, a professor at the National College of Natural Medicine, determines the sho by four pieces of evidence collected during the intake process confirmed by questioning, the palpation of the forearm, abdomen, and pulse assessment. A teishin or retained needle may be used to treat the points. After the root imbalance is treated, the branch or complaint oriented, treatment can be performed.
In Japanese Meridian Therapy the four main root treatment patterns are spleen sho, lung sho, kidney sho, and liver sho. Heart sho is rarely diagnosed as this patient is severely deficient and often this pattern is misdiagnosed for a liver sho. The sho is determined by the objective findings of a JMT practitioner assessing the forearm, abdomen, and pulse of the patient. With these three pieces of evidence a root treatment is created.
Sho, forearm, abdomen, pulse, and points for root treatments
|Spleen||Mushy/Spongy/Damp||Around umbilicus up to CV 12||HT ß SP ß||Spleen 3
|Lung||Dry/Rough||Upper right quadrant||LU ß SP ß||Lung 9
|Kidney||Hard/Rock-like at lower level||Below umbilicus||KD ß LU ß||Kidney 7
Lung 5 or 8
|Liver||Springy/Bouncy/Sinewy||Lower left quadrant||LR ß KD ß||Liver 8
Points for the root treatment are typically yuan sources points with a few exceptions or they may be selected for more symptomatic relief (branch treatment), based on Chapter 68 of the Nanjing. In this chapter of the Nanjing, the five shu points are described, as to what areas and symptoms of the body they are able to treat, below in Table 12.
Combining both root and branch treatments is considered more effective than branch treatment alone, and in my clinical experience, recovery time for patients seems twice as fast in terms of the number of treatments required. Root balancing allows the energetic network to return to its most efficient posture, facilitating and accelerating healing.
Nanjing 68 point categories
|Jing-well points are in charge of fullness below the Heart.|
|Ying-spring points are in charge of heat sensations in the body.|
|Shu-stream points are for heaviness of the body and pain of the joints.|
|Jing-river points are in charge of panting, cough, and cold-hot sensations in the body.|
|He-sea points are counter-flow Qi and diarrhea.|
C. The importance of the oshide and use of the teishin
Forming the oshide or pressing hand
The teishin’s blunt end is used for tonifing the qi of the point selected while the sharper end is used for reduction. The use of the teishin requires both hands. The non-dominant hand is called the oshide, or pressing hand. This hand finds the acupuncture point using the lateral tip of the index finger, as seen in the first picture above. The practitioner should maintain their focus on this area of the hand when locating points to be either tonified or reduced. The index finger and the thumb come together and form a full moon or half-moon circle as seen in the second and third picture.
This same technique can be applied to contact needling using a guide tube on all these points as well. Once a root treatment has been applied, a patient can be placed in a prone position. Non-insertive techniques, contact needling, and moxibustion can be applied to upper taiyang channel along corresponding back shu points of the sho. For example, back shu points for a spleen sho patient include UB 14 Jueyin shu for the pericardium and UB 18 Pi shu for the spleen. These points reinforce the concept of Nanjing 69 as fire generates wood.