Shonishin: Japanese Pediatric Acupuncture A Text and Video Guide PDF
Preview Shonishin: Japanese Pediatric Acupuncture A Text and Video Guide
MediaCenter.thieme.com plus e-content online Thieme-Verlag Sommer-Druck Birch: WN026347/01/01 18.1.2011 FrauKurz Feuchtwangen Shonishin TN150061 Birch_Titelei Thieme-Verlag Sommer-Druck Birch: WN026347/01/01 18.1.2011 FrauKurz Feuchtwangen Shonishin TN150061 Birch_Titelei Thieme-Verlag Sommer-Druck Birch: WN026347/01/01 18.1.2011 FrauKurz Feuchtwangen Shonishin TN150061 Birch_Titelei Shonishin: Japanese Pediatric Acupuncture StephenBirch,PhD TheStichting(Foundation)fortheStudyofTraditional EastAsianMedicine(STEAM) Amsterdam,TheNetherlands AssociateProfessor OsloUniversityCollegeofAcupuncture Oslo,Norway 145illustrations Thieme Stuttgart·NewYork Thieme-Verlag Sommer-Druck Birch: WN026347/01/01 18.1.2011 FrauKurz Feuchtwangen Shonishin TN150061 Birch_Titelei IV LibraryofCongressCataloging-in-PublicationData Important note: Medicine is an ever-changing science isavailablefromthepublisher. undergoingcontinualdevelopment.Researchandclini- cal experience are continually expanding our knowl- edge,inparticularourknowledgeofpropertreatment and drug therapy. 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Illustrators:ChristianevonSolodkoff,Neckargemünd, Germany;RayénAntón,Barcelona,Spain VideosfilmedandeditedbyRayénAntón, Barcelona,Spain. ©2011GeorgThiemeVerlag, Some of the product names, patents, and registered Rüdigerstrasse14,70469Stuttgart,Germany designsreferredtointhisbookareinfactregisteredtra- http://www.thieme.de demarks or proprietary names even though specific ThiemeNewYork,333SeventhAvenue, reference to this fact is not always made in the text. NewYork,NY10001,USA Therefore,theappearanceofanamewithoutdesigna- http://www.thieme.com tionasproprietaryisnottobeconstruedasarepresen- tationbythepublisherthatitisinthepublicdomain. ThisbookandDVD,includingallpartsthereof,areleg- ally protected by copyright. Any use, exploitation, or Coverdesign:ThiemePublishingGroup commercialization outside the narrow limits set by TypesettingbySommerDruck,Feuchtwangen, copyrightlegislation,withoutthepublisher’sconsent,is Germany illegalandliabletoprosecution.Thisappliesinparticu- PrintedinChinabyEverbestPrintingCo.Ltd lartophotostatreproduction,copying,mimeographing, preparation of microfilms, and electronic dataproces- ISBN978-3-13-150061-8 123456 singandstorage. Thieme-Verlag Sommer-Druck Birch: WN026347/01/01 24.1.2011 FrauKurz Feuchtwangen Shonishin TN150061 Birch_Titelei 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 Thieme-Verlag Sommer-Druck Birch: WN026347/01/01 18.1.2011 FrauKurz Feuchtwangen Shonishin TN150061 Birch_Titelei 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 Thieme-Verlag Sommer-Druck Birch: WN026347/01/01 18.1.2011 FrauKurz Feuchtwangen Shonishin TN150061 Birch_Titelei 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- Thieme-Verlag Sommer-Druck Birch: WN026347/01/01 18.1.2011 FrauKurz Feuchtwangen Shonishin TN150061 Birch_Titelei 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 Thieme-Verlag Sommer-Druck Birch: WN026347/01/01 18.1.2011 FrauKurz Feuchtwangen Shonishin TN150061 Birch_Titelei 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
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