by Mitchell Wolf, L.A.c
My first exposure to Toyohari came in October 1997. Four senior teachers from Japan came to Seattle, Washington to teach a weekend introductory workshop. Three of them were blind and among them was Toshio Yanagishita Sensei, who now serves as the president of the Toyohari Association of Japan. I had recently graduated in April 1996 from the Pacific College of Oriental Medicine (PCOM) as a member of the first class of the New York City campus. On the start of the weekend, each teacher stood up and introduced themselves to the class. I don't remember who it was, but one of them said, "We have come all the way from Japan, to teach you how to overcome your handicap of vision." The next stood up and said, "We have come to teach you the correct way of practicing acupuncture." Although I was a bit taken aback by these blunt statements, I immediately knew that I had come to the right place. Although it was not until 11 years later that I took the first level certification course, this brief weekend had a major impact on how I practiced acupuncture in the succeeding years, as I tried to incorporate the concepts that I was exposed to during this weekend.
Many acupuncture students and practitioners have some vague idea of what "Japanese Acupuncture" is. Whether there even is an actual Japanese acupuncture style is debatable. However, delicate needling with insertion tubes and the use of thinner gauge Japanese needles is usually what comes to mind. When I was a student intern learning clinical technique, if there was a sensitive patient, we would do our "Japanese" style needling, which usually meant just tapping the needle in without further stimulation. Although our intention was to treat more gently, I now know that this alone did not make it a Japanese acupuncture treatment. Toyohari is a specific style of acupuncture practiced in Japan with its own distinctive techniques, which I will discuss later.
As a student, I studied Chinese herbal medicine and this was very much encouraged in school due to the linking of herbalism and acupuncture within the TCM style. Although I studied much of the herbal program, I chose not to complete it because I felt a much greater affinity to acupuncture due to my background as a Shiatsu practitioner. Although I have tremendous respect for herbal medicine, I wanted to specialize in acupuncture as a separate discipline that can stand on its own. I must say that, as a student, this decision was somewhat frowned upon by many of my peers and teachers. It was my impression then, and continues to be now, that herbal medicine is viewed as superior to acupuncture in TCM where acupuncture often serves as an adjunct to the herbal prescription. Acupuncture might be used for pain and other symptomatic relief but for treating an internal illness, the focus is on the herbal prescription in TCM. I remember when I was a student intern I had a patient who I diagnosed with a Kidney Vacuity. I presented my supervisor with a point prescription of only 3 points. My teacher asked me if that was all that I was planning on doing with the patient. After I said yes, he said, "What, no herbs and only 3 points! Will that work? Then you only have one leg to stand on!" "Yes," I said, "but I have a very strong leg". We had a good laugh.
In Japan, acupuncture is indeed practiced without the intrusion of herbal medicine theory so this very much appeals to me. I've found that by specializing in acupuncture, separately from herbal medicine, they have been able to develop highly specialized skills with a refinement and elegance I have never seen in TCM. Perhaps because they only have that one leg to stand on, their acupuncture and moxibustion skills must become highly developed to achieve results. But isn't this the case with anyone who chooses to specialize in anything.
In the Toyohari meridian therapy style, the techniques are so refined that often the needles are not even inserted into the skin! They use as their theoretical source material classic Chinese texts such as the Lingshu, Su-wen, and Nan-jing. What is different is how they interpret the material into practical application. The Toyohari masters directly translate the classic theory and techniques to attain proven, reproducible real world results. One of the truly exciting aspects of the Associations work is the constant research and testing of the techniques and theories. After all, just because something was written a long time ago doesn't always make it right or even practical to adapt into our life today. Also, due to the structure of the Association, there is an agreed upon hierarchy of Masters and teachers who work with each other and with the students to explore its continued development. It is a living dynamic style of acupuncture, which will be celebrating the 50th anniversary of the founding of the Toyohari Association of Japan in 2009.
Let me take a moment to briefly say a few words about my background and what brought me to study acupuncture and more specifically, to study and practice Toyohari. Prior to attending PCOM, I was fortunate to have had a two-year apprenticeship with a wonderful TCM acupuncturist from Shanghai. Although he trained in China, he did not practice much herbal medicine. Through his tutelage, I acquired a strong foundation in TCM theory. He gave me the opportunity to partake in patient interviews, analyze tongue and pulse findings, and to observe his excellent needling skill on hundreds of patients. His method of pulse palpation was different than the standard TCM style, however. Because he did not prescribe herbs very often, he did not analyze the TCM 28 pulse qualities. He focused on feeling for the 8 Principles within the pulse, palpating the individual pulse positions for excess and deficiency, floating and deep, fast and slow, and Yin and Yang. He often said that for acupuncture, this gives us enough information. In this regard, there were some similarities to the Toyohari approach to pulse diagnosis that I recognized in the first introductory seminar. Studying privately with a qualified practitioner is a rare opportunity and I will always be grateful for his generosity.
But my journey really began way back in 1974, when at the age of seventeen I started my study of internal Kung-fu. This was also my first exposure to Chinese philosophy, and I especially became an avid reader of the Taoist writings of Lao
Tzu. Eventually this led me to Iyengar Yoga and meditation as a way to search deeper within myself. Later, through a friend, I was introduced to a master of Yang style Tai Chi who was also from Shanghai. Although, at first, I wasn't interested in Tai Chi, I was attracted to this man because of his sincere, kind, and generous nature. I wanted to cultivate more of these qualities within myself. I studied with him privately for many years until his passing and I continue with my daily practice today.
Since 1981, I've been practicing and teaching Zen Shiatsu. This particular style of shiatsu gave me an excellent foundation and has very much influenced my approach to the practice of acupuncture. As a practitioner and teacher of shiatsu, I had many years of experience in meridian palpation and patient interaction prior to attending acupuncture school. I find many similarities between the Shiatsu concepts with Toyohari because of their common Japanese origins.
From this very brief personal history, you can see that I've always been drawn to the traditional Asian healing and martial arts with their focus on self-development. The practices that focus on Qi cultivation and purifying consciousness take priority in my life. My profession as an acupuncturist is a by-product of my personal journey and through my work I strive to help others with their own journey through life. My life truly is my practice, and while I try my best to help my clients, they are all helping and teaching me simultaneously. This is why I always thank my clients for coming.
When I'm working with my patients, I feel as though I am in a meditation practicing my Tai Chi. Especially now, as I increasingly bring Toyohari into my work, my posture, breathing, thoughts, and intention are all essential to the practice. "Where the mind goes, the Chi goes", we are told, but how do you bring this into practice? Toyohari emphasizes these concepts in their teachings and it is a constant practice that goes beyond your work and into your life. Toyohari requires one to cultivate a quiet mind, an open heart, and a gentle caring attitude to connect with your patient. In this way, we all benefit from its practice. It is this emphasis on self-cultivation and mindfulness that is not emphasized enough in TCM programs. All too often, studying TCM is merely an intellectual process feeling more like a Western medical education. I believe that Oriental Medicine is a "Way" of living and not just a career. When I practice Toyohari, I can feel the integration of who I am and what I like to do, and this is what makes me happy.
The particular style of shiatsu that I practice places great emphasis upon listening to our clients' body through the contact of our hands. The ability to sense the flow of Qi through the meridians and respond to the energetic distortions of Kyo (deficiency) and Jitsu (excess) is of central importance. The emphasis is on developing sensitivity to the life force flowing through the meridians with the specific acupoints being secondary. What is important is to feel where the energetic distortions are located along the meridian of each person being treated and to know how to respond to them. These Kyo/Jitsu distortions are often located around the areas of the anatomical point locations. In TCM we learn how to find the "fair field" for each point location. But by developing a light, gentle touch and the ability to quietly "listen" through our hands, one can develop the sense to experience the "alive"point location existing at that precise moment. In Toyohari, it is critical to find this alive location. With the precise location, the opening to the meridian is available, and this allows for the gentle needling to be effective.
In TCM, needling the stronger needle manipulations are needed to spread out the sensation to account for the less precise site of insertion. In TCM, when we speak of "listening", it refers to our hearing what the client says in response to our questioning. But here, I am referring to our ability to listen through the hands. In my early days as a shiatsu student, I would actually lean my ear toward my client to listen for the energy. I would also place my hands on my client and close my eyes and not move for long periods of time waiting and listening for the Qi to arrive. To develop this sense requires us to be quiet and centered within ourselves, to be physically relaxed and open to receive the information. Through my experience as a TCM student, these ideas were not taught to us, but it was always something that I tried to bring to my treatments starting as an intern. Our attention needs to be focused on the client and not distracted by outside influences. To me, giving a treatment is also receiving a treatment. I actually try to feel the treatment in my own body and especially in my own Hara (abdomen). Developing palpation sensitivity is more than just touching with the fingers. It is a form of communication and it is central to the Toyohari method. The touch sensitivity of the Toyohari masters was the first thing that impressed me in that first weekend workshop. A method of acupuncture that actually places its emphasis on developing sensitivity! My personal journey had found its next direction.
The next thing I realized in that initial weekend was the drastically different approach to using an acupuncture needle. I remember when I was a student I was very confused about how to feel anything through a stainless steel needle. As a shiatsu practitioner, I had many years of experience in feeling the Qi directly through contact with my hands. But when I held a needle, I was only aware of the large gap between my hand holding the needle and my patient's body. Also, while holding the needle in my right hand, I wondered what my left hand was supposed to be doing. In shiatsu, we always used both hands, with the left hand providing the diagnostic feedback about the actions of the right. In TCM, there is no concept of this and there was nobody to help me with these "unusual" ideas. In Toyohari, the left hand called the "oshide" is palpating the meridian, finding and holding the alive point, and providing the feedback to the right hand holding the needle. In fact, it is the right hand, without the needle, which is the emphasized hand of importance, and not the needling hand. After all, how can you needle if you don't know where to and don't know what the effects are? This is why the Nanjing says, "The superior physician understands the importance of the left hand."
Another aspect of the Toyohari approach, which differs drastically form TCM, is their approach to Pulse palpation. To them, the pulse is notsomething, which is quickly felt before a treatment and then forgotten about. The pulse is used for continuous feedback throughout the treatment and directs the course of the entire treatment. Through its correct application, one can tell instantly whether the desired results of supplementation or sedation are occurring and whether the treatment is actually correct! How different this is from TCM. I never understood how it is that you put in a bunch of needles, then leave a patient alone for a period of time, and then just take the needles out and then you're done. I remember being taught the 20 minutes is supplementing and 30 minutes is draining, but nobody knew why or, furthermore, if that is really true. Based upon the direct feedback system of the pulse, Toyohari practitioners know for certain what is happening to the patient throughout the entire treatment process. Every point, every technique, has a specific effect upon the Qi and the pulse. Through learning how to use the direct feedback system of the pulse correctly, it becomes ever more important to truly understand the powerful effects of acupuncture.
I remember, in that first weekend, one of the teachers diagnosed my pulse. He then told me what it felt like to him and he told me to feel my own pulse to see if I was able to feel what he described. After I said that I did feel it, he then said that he was going to change my pulse to feel a certain way. He performed a technique on the point Lung 9 with a needle but without actually inserting the tip at all. The technique took only a few seconds and then told me to feel my pulse again. To my amazement, the pulse quality had changed in precisely the way he had described it!
In TCM, we ask the patient if they "have acquired the Qi" or "If they can feel the Qi". The "De Qi" sensation is described as a heaviness around the needle, or a pulling or grabbing of the needle. All too often a patient will just say that they feel pain. Since the patient describes pain, often practitioners tend not to do much needle manipulation. But separate from the patients' response, how does "De Qi" feel to the practitioner? As far as the practitioner is concerned, we were taught to feel the tightness and the resistance that develops when the needle is lifted, thrust, and turned. Basically, I always felt that this was just an effect created by the muscle fibers twisting around the needle shaft and of stimulation of the peripheral nerves.
Toyohari needing techniques are extremely precise, focused, and subtle. Often the needling techniques are performed with no insertion at all. There is no direct stimulation of the nervous system. No direct invasion of the muscles and tendons. Through the Toyohari method, one learns how to feel the contact with the Qi even before the needle touches the skin! You can actually feel the connection through the needle and into your own body. Often the effect is instantaneous with no retention. Minimal stimulation is applied in just the proper amount to achieve the desired result based upon the feedback of the pulse. Toyohari does not rely on patient feedback, but so often a patient will report feeling tingling, electrical sparks, and even the deep, heavy dull, ache of De Qi even without any insertion into the skin. As a student of TCM, most of the information we used to determine a diagnosis came through the questioning and subsequent analysis of the signs and symptoms of the client. At the end of the questioning, we would feel the pulse, often without any agreed upon analysis between the teacher and student. How often we found a pulse to be slippery or wiry I shudder to say. But what is more, is that never was the pulse revisited during a treatment in progress or after it was finished. I would often wonder how do we know what is happening? Without monitoring the pulses, how does a TCM practitioner know if the point selection is correct, or if the insertion locations are accurate, or if the needling techniques are having the desired effect. Furthermore, there is virtually no concept of channel palpation as a separate skill to point location. I especially wondered how are we to know if we are supplementing or draining and lastly, how do we know if a treatment is finished? If all this sounds familiar to you then you are already on the right path to finding your answers. The Nanjing says that one needs to feel the pulse when giving a treatment. Therefore in Toyohari, the pulse is monitored throughout the entire process.
In the Seattle seminar, I remember Yanagishita Sensei, demonstrating a treatment on a student that he diagnosed with a Kidney Vacuity. Before he was about to needle Kidney 7 on the right ankle, he instructed me to lightly place my index finger on the left side point. As he began to bring his needle to the point, I was able to immediately feel Kidney 7 expanding under my finger as if being blown up like a balloon! Another student was simultaneously monitoring the pulse and they too, felt an instantaneous shift in its quality. After a couple more techniques, the Sensei pronounced that the session was finished after a total of about 3 minutes! Another student asked him, "Sensei, when you are working in Japan, is this really how you work?" He said, "in Japan, people are paying me and sometimes they want more. So I wave my hands around a little bit longer so that they think that I'm doing something. But the session is already finished."
What we were practicing is a unique Toyohari learning technique that is called the Kozato Method. This is truly a brilliant approach to learning that was invented by the late Kozato Sensei. Practicing in groups of 3, one is the patient, one is the practitioner, and one is monitoring the pulse. It functions as a direct feedback loop between all three parties to confirm what is taking place. All three persons give simultaneous and continuous feedback in order to confirm the pulse diagnosis, the proper point selection and location, needling technique, and results. It is truly a brilliant learning and practicing tool that greatly accelerates the learning process. It is indispensable to the Toyohari method in facilitating the development of sensitivity and accuracy.
Finally, after 11 years have passed, I have now completed my beginnings level certification. It took me a while to start to incorporate the methods within my existing practice. I decided that I would start on new patients first so that I would not need to explain the drastic changes. The first patient I experimented with came to me following surgery to repair a medial meniscus tear. After some months the swelling remained and she was still not able to bend her knee much. I used a non-insertion technique with a gold needle on only one specific point. The technique took about 30 seconds to perform. Immediately afterward she was able to almost completely bend her knee! We where both completely amazed!
Needless to say, Toyohari has completely taken over my practice. My practice has never been busier. I'm finding that I am being presented with ever more complex cases that have not been helped by acupuncture or other types of Western medicine before. I've been treating patients that previously I would have felt overwhelmed by because of their complexity. However, with Toyohari, I have a well thought out method to clearly analyze and treat the patient with confidence. Sometimes it even seems a bit scary to me because it all feels too easy. Maybe it is beginners luck, but I know that I am on the right path and I look forward to continuing my study and improving my skill with every patient I treat.
There is one last comment I want to add about that first weekend course. All of the students had the opportunity to directly practice needling technique on the teachers. When was the last time a TCM teacher allowed you to needle them in a technique class? First the teacher would demonstrate the correct needling technique on the students and then we would try it on them. Every step of the needling process received direct feedback from the teachers. How we palpated along the channel, where we located the alive point, how we placed the left hand, how we applied the needle, all received detailed feedback. I remember after I nervously demonstrated my technique, the master said to me, "Oh, I think that one day, you might be able to do Toyohari!" We both laughed. OM
Mitchell Wolf, L.Ac., graduated from
Pacific College of Oriental Medicine in
New York in 1996, where he is currently
a faculty member. He has been practicing
and teaching shiatsu since 1981.