Principles and practices in Manual Therapeutics

CHAPTER 9 Shiatsu 143 rapidly gained widespread acceptance.4 Although shi- [they] can also help others, [forms] the underlying atsu and its distant cousin acupuncture are consid- foundation of Shiatsu. Shiatsu [simply] acts like a ered medically sound and are “accepted methods of spark or catalyst to the human body [and] the combi- treatment for over one-quarter of the world’s popula- nation of treatment and way of life suggestions form tion,” the United States and many other Western na- the basis of total care.”16 tions consider both techniques experimental.16 This is interesting, considering that these “experiments” The major underlying principle of shiatsu, de- have been conducted successfully for more than 2500 rived from the tenets of Asian medicine, is actually a years.4 However, several U.S. hospitals now allow the reflection of scientific thought. Simply stated, “Every- use of acupuncture, and medical students are taught thing is energy.” When considered in the context of the theories and practice of acupuncture, shiatsu, and molecular structure, all matter is a manifestation of macrobiotics. These gains suggest that an environ- energy. Shiatsu interacts directly with this energy, and ment has been established for rapid, ongoing change therefore with life itself. in the West. There is a growing acceptance and use of these practices among Western-trained physicians From the perspective of classic Asian medicine, and health care providers. Shiatsu can be described as energy moves along 14 distinct pathways in the body; a synthesis of Eastern and Western medicine, quickly these pathways are called meridians or channels (kieraku gaining recognition for its success as an adjunctive in Japanese, jing in Chinese).16 The meridians were dis- healing therapy. Yamamoto and McCarty write, “The covered by accident when certain acu-points (specific foundations for modern ideas and techniques in the locations along the meridians) were stimulated and healing realm come from ancient civilizations. In beneficial results were observed. For example, asth- the West it was Greece and Rome. And in the East it malike symptoms caused by certain types of battle was China, India, and Persia. These foundations are wounds were relieved when the corresponding acu- the basis of present scientific methods [of healing].”16 point was touched, and menstrual pain was reduced Shiatsu’s foundations, and therefore shiatsu itself, when a heated rock from a fireplace accidentally are a part of the growing trend and movement toward brushed against a point on the inner thigh.16 Al- integrative medicine. though many in the West attempt to deny or dis- count the existence of the meridian network, modern PRINCIPLES AND research conducted by biophysicists in Japan, China, PHILOSOPHY and France has documented its existence. Yamamoto and McCarty describe some of this research in the fol- Many followers of Eastern traditions believe that the lowing excerpt from Whole Health Shiatsu. natural state of humanity is to be healthy. Yamamoto and McCarty describe it this way: Many studies have been conducted by biophysicists in Japan, China, and France. They postulated that a meas- With observation we can see that there is a definite and urement of acu-point electricity would be a biophysical distinct order in nature. Nature’s power guides all things. index that would illustrate the objective existence of the When we do not follow nature’s order we can become sick. meridian system. They discovered that acu-points have a We are often reminded of nature’s order by the presence of lower skin resistance. When an electrical current is passed sickness. Sickness can be our teacher. From a traditional through a classical acu-point, it has a higher electrical point of view the specific name of an illness is not so im- conductance which is a lower resistance, than the sur- portant. Physical ailments such as headache, gallbladder rounding area. They also discovered that when disease or pain, emotional states such as anger, depression, irritabil- illness is present, pathological changes take place in the ity; and mental conditions such as paranoia, lack of con- body while changes are found in the resistance of relevant centration, and forgetfulness; are all various states of dis- meridians and acu-points. Similar internal changes are equilibrium or dis-ease. Theoretically there is no disease also reflected by the acu-points. In other words, imbal- that is incurable, if we are able to change the way we think ance in the organs affect the acu-points, imbalance in the eat, and live. Of course this is easier said than done.16 acu-points affect the organs. Researchers also found that the external environment such as temperature, season, They also write, “The simple understanding that and time of day, changed the resistance of acu-points. humans are equipped to heal themselves and that In the Lanzhou Medical College in China a test of the acu-points of the Stomach meridian showed significant variations in conductance when the stomach lining was stimulated by cold or hot water, either before or after eat-

144 P R I N C I P L E S A N D P R A C T I C E O F M A N U A L T H E R A P E U T I C S ing. In Beijing, ear acu-point research learned that low re- In the final phase, many previously localized points, sistance points on the outer rim of the ear were elevated each with a singular function, became integrated into a either in the presence of disease or following long-term larger system that related and grouped diverse points sys- stimulation of a corresponding internal organ.16 tematically according to similar functions. This integra- tion is called the meridian or channel system.16 In addition to the scientific support developed thus far, the benefits of shiatsu are supported by the Although the analogy is not completely accurate, experiences of clients and practitioners alike. Asth- shiatsu is often called “acupuncture without nee- matic clients experience volatility (pain and sensitiv- dles.” To alter a client’s internal energy system or pat- ity) along their lung meridian. Clients with lower tern, an acupuncturist inserts needles in tsubos used digestive track symptoms such as constipation expe- by a shiatsu practitioner. The most significant differ- rience this same sensitivity along their large intestine ence between the two disciplines is that whereas meridians. When clients experience this connection, acupuncture is invasive and is performed by exten- which is common in shiatsu, they are quick to con- sively trained doctors, shiatsu is noninvasive and can vert to the principles of Asian medicine and to accept be practiced by either a professional therapist or a lay the validity of the meridian network. Not only has re- person. Shiatsu is also a whole-body technique versus search documented scientific evidence to support the one that is limited to the insertion of needles at theory behind shiatsu, but the body’s own level of specific Tsubos. Acupuncture is considered more pain along related organ meridian lines makes a symptom-oriented in that people are unlikely to go to client’s enlightenment regarding the existence of an acupuncturist without a specific complaint, meridians, based on their own personal experience whereas clients often equate shiatsu with health with shiatsu therapy, hard to deny. maintenance and go for treatments without particu- lar “problems.” Although some consider shiatsu a It is believed that meridians evolved from energy cousin to acupuncture, others suggest a “distant centers in the body called chakras (SHOCK-ras) and cousin” relationship. The distinctions between the that our organ systems subsequently evolved from two disciplines are worth noting (Table 9-1). It is also the meridian network. There are 10 meridians di- important to note here that simple shiatsu can be rectly related to internal organs, 2 indirectly related, practiced with little or no understanding of the un- and 2 related to systems not recognized by Western derlying principles. The practitioner does not have to medicine. agree with the principles or understand them to pro- vide shiatsu; however, the techniques are part of a Along the meridian lines are points called tsubos more complicated healing system that, when adhered (SUE-bows), or acupuncture points. Yamamoto and to and studied, provides more effective results. McCarty describe tsubos in the following excerpt from Whole Health Shiatsu. A simple and accurate analogy for understanding the meridian pathways and tsubos in relation to the The word Tsubo or acu-point derives from the Oriental body’s internal organ systems is that tsubos are very characters meaning hole or orifice, and position—the po- similar to a system of volcanoes on the earth’s sur- sition of the hole. Traditionally, the word hole was com- face. We know that a volcano’s real energy is not at bined with other terms such as hollow, passageway, trans- the surface, but is found deep inside the earth. A vol- port, and Ki [Key, or energy]. This suggests that the holes cano is a superficial manifestation of the underlying on the surface of the body were regarded as routes of ac- energy. In similar fashion, a tsubo can be thought of cess to the body’s internal cavities. The acu-points are as a manifestation of the underlying energy of the or- spots where Ki comes out. gan system. This does not imply that the therapist should ignore the area of pain a shiatsu client may de- There are three phases in the historical development scribe. However, a classically trained shiatsu practi- of the concept of these holes or acu-points. In the earliest tioner looks past sore shoulders, ligaments, and ten- phase people would use any body location that was dons (unless the cause of the pain is trauma to these painful or uncomfortable. Because there were no specific structures), and focuses on the related organ system locations for the points, they had no names. via the meridian network. Philosophically, shiatsu practitioners relate health to the condition of the re- In the second phase, after a long period of practice and lated “vital” organs (i.e., those associated with the experience, certain points became identified with specific diseases. The ability of distinct points to affect and be af- fected by local or distant pain and disease became pre- dictable. . . .

CHAPTER 9 Shiatsu 145 TABLE 9-1 TABLE 9-2 Distinctions Between Shiatsu Five Elements of Asian Medicine and Acupuncture3 Element Yin Yang Category Shiatsu Acupuncture Wood (tree) Gallbladder Liver Fire Small intestine Heart Movement Free flowing Systematic Earth (soil) Stomach Spleen Focus Intuitive Adheres to Metal Larger intestine Lungs Water Bladder Kidney Theoretic Taoist laws inclination Confucian Quality Feminine Masculine otics. When a person’s health and metabolism adjust Tools Practitioner’s Needles to what Eastern medicine and macrobiotic practi- tioners consider universal guidelines, natural har- Treatment goal body Balance by mony occurs from the inside out. Varying states of Balance by alleviating yin and yang are experienced by the body but are not Patient interacts symptoms necessarily comprehended by the mind. This experi- with treater becoming ence can be made manifest by dedication (not nec- whole No essarily life long) to the practice of using food ac- Encourages Yes cording to the various energetic principles long independence understood by the Chinese, Japanese, and followers of Yes— Yes—after macrobiotic theory. Physically strengthens: immediately treatment In defining yin and yang, bear in mind that a con- Receiver tinuum exists between the extremes of each. In shi- Treater series atsu major organs are paired together under one of the five major elements. Each pair has both a yang Yes Sometimes and yin organ. One organ is more compact and Yes No tighter (yang), whereas the other is more open and vessel-like (yin). The five elements—wood (tree), fire, Although not all acupuncturists agree with all of these distinctions, earth (soil), metal, and water—proceed in a clockwise they form a basis for comparison. All shiatsu practitioners and manner within the five-element wheel used in Asian acupuncturists practice according to their own interpretations and medicine (Table 9-2). belief systems, so this chart should not be interpreted as a rigid, fixed framework. According to shiatsu principles, an organ is fed by its opposite energy. For the shiatsu practitioner, meridian system). Although shiatsu is noninvasive pressing and rubbing movements proceed in the di- and appears to deal with external or surface pain, ac- rection energy travels along each respective merid- cording to shiatsu theory and the experience of those ian. Shiatsu texts often use the term structure to de- who practice and receive the art it stimulates, sedates, scribe an organ, whereas acupuncture texts may and balances energy inside the body as a way to ad- describe the same organ in terms of the energy that dress the root causes of surface and bodily dis- feeds it through the meridian. A yang organ is fed by comfort. yin energy. A shiatsu practitioner generally de- scribes the compact kidney as yang because of its The principles of Asian medicine evident in shi- structure (compared with its paired, more hollow atsu theory and practice state that two types of ener- and open yin organ, the bladder). A classically gies exist in the universe. These two types of energy, trained acupuncturist generally describes the kid- called yin and yang, exist side by side and are consid- ney as yin because it is fed by yin energy that flows ered both complementary and opposing (see Chapter up the body on the kidney meridian. Such differ- 11). Unlike Western medicine, which uses more dual- ences between the two disciplines in terms of de- istic terms such as “good and bad,” Eastern or Asian scriptive language can be confusing, although little medicine looks at health more as a manifestation of balance between yin and yang and how an imbalance may allow infection or disease to manifest. An effec- tive way to comprehend this internally is to apply the principles of yin and yang to diet through macrobi-

146 P R I N C I P L E S A N D P R A C T I C E O F M A N U A L T H E R A P E U T I C S if any differences in application of goals, practice, all people, subject to their condition, constitution, or theory really exists. lifestyle, and environment, and, most notably, the lat- itude at which they live. Food choices are governed by Another major principle applied to the practice of season. Macrobiotics is not a diet; it is a philosophy shiatsu involves the concepts of kyo (KEY-o) and jitsu that advocates cooked whole grains as the predomi- (JIT-sue). Kyo is considered empty or vacant, whereas nant staple food, to be supplemented by other yang jitsu is considered full, excessive, or overflowing. A foods such as root vegetables and occasional fish, and jitsu condition along the gallbladder meridian may yin foods such as leafy greens and occasional seasonal be a manifestation of a gallbladder imbalance, result- fruit. Extreme yin foods include white sugar, honey, ing perhaps from recent consumption of a large pizza caffeine, most drugs, and alcohol. Examples of ex- and two dishes of ice cream. A kyo or empty condi- treme yang foods are animal proteins such as red tion along the lung meridian (and within the lung it- meat, chicken, tuna, and shellfish. Dietary choices are self) may exist in an individual who doesn’t exercise adjusted according to an individual’s constitution, and rarely expands his or her chest cavity or heart. environment, work, lifestyle, season, and location. Understanding and finding these energy manifesta- When used indiscriminately, extreme yin and yang tions is critical to diagnosis in shiatsu practice and is foods are more difficult to balance and affect energy an ongoing, lifelong learning experience for the seri- as manifested along the meridian network. For exam- ous shiatsu practitioner. Although it is generally easy ple, eating tropical fruit in Pennsylvania in January to find jitsu, or excess, it is much harder to find when the temperature is 10°F may be seen as eating emptiness or vacancy (kyo) within the meridian net- out of balance. Macrobiotic philosophy therefore re- work. One of the keys to doing highly successful or lies on nature, from which it finds ample support. Al- refined shiatsu is the ability to find specific kyo though we are able to ship foods thousands of miles within the body or the organ’s meridian network and from where they are grown, nature may not have in- then to manipulate it effectively. tended us to regularly consume such foods in an en- vironment that does not support their growth or cul- Shiatsu practitioners may follow the practice of tivation. When applied in this way, the philosophies macrobiotics, a set of universal dietary and spiritual of shiatsu and macrobiotics touch on and address guidelines originally brought to the attention of the what is viewed as human arrogance by suggesting that modern world by George Ohsawa. David Sergel when clear-cut guidelines presented by nature are writes, “The ultimate goal of macrobiotic practice is ignored, health consequences can result. Nature the attainment of absolute freedom. The compass to demonstrates that the foods that grow and can grow reach this goal is an intimate understanding of the in the latitudes where we live are the foods that sup- forces of Yin and Yang; a comprehension of an order port our health most fully. This philosophy also common to all aspects of the infinite universe. The states that consumption of root vegetables (i.e., those foundation of this freedom lies in our daily diet.”15 He that produce more heat in the body) is important in also writes, “Since the same cultural soil gave form to the winter, whereas leafy greens and occasional fruit both shiatsu and macrobiotics, we might expect to (foods that cool the body) are needed in summer. In- see strong possibilities of a harmonious integration terestingly enough, we intuitively follow this practice between the two. In fact as we delve deeper, we see ev- to some extent. People who live in locations where the idence that shiatsu arose from a macrobiotic mind climate varies from season to season tend to eat more and is thus according to this view, from its founda- salads and fruit in the summer and more cooked and tion, a macrobiotic practice.”15 It would be more ac- salty foods in the winter. However, macrobiotic phi- curate to state that shiatsu developed out of a society losophy examines this practice more closely. whose dietary pattern reflected the modern day per- spective and application of macrobiotics. Shiatsu Shiatsu incorporates macrobiotic philosophy into evolved as a result of day to day living and thinking in its theory and philosophy regarding the movement of terms of yin and yang, as did nearly everything else in energy along the meridian pathways. A simple explana- these earlier Asian societies, for example Feng Shui, tion of shiatsu philosophy states that the meridians can art, and even politics. be seen as circulatory or plumbing channels. As long as energy moves freely (i.e., is not too weak or too strong Macrobiotics is a philosophic practice that incor- and is not stagnated) health is maintained. If there is a porates the universal guidelines of yin and yang into blockage along the channel, the resulting disturbance daily life. With diet as its cornerstone, macrobiotic theory posits that these guidelines can be applied to

CHAPTER 9 Shiatsu 147 can lead to minor aches and pains or a major health im- stated, “Shiatsu therapy is a form of manipulation balance. It is possible to observe imbalances of energy administered by the thumbs, fingers, and palms, flow in specific meridian lines and acupuncture points without the use of any instrument, mechanical or or tsubos. By applying pressure to a blocked meridian otherwise, to apply pressure to the human skin, cor- line or tsubo, an overactive or underactive organ system rect internal malfunctioning, promote and maintain can be directly sedated or stimulated. health, and treat specific diseases.”12 Shiatsu massage is not viewed by its practitioners DIAGNOSIS as a panacea. Shiatsu philosophy is very clear in rein- forcing the need for dietary and lifestyle guidance and The art of Asian diagnosis is a lifelong learning changes to complement and support a shiatsu ses- process in the practice of shiatsu. Subtle yet specific, sion (or series of sessions). The choices made by the Asian diagnosis is an ongoing and evolving pursuit, recipients of treatment are theirs. Many recipients are which a practitioner is continually mastering and content to stay at the level at which shiatsu is simply learning again from scratch. Modern diagnostic tech- used for pain reduction and for producing a “calmed niques are a relatively recent development in the his- sense of revitalization.” However, others who are tory of medicine. Powerful, precise, and accurate to a open to the underpinnings of shiatsu philosophy large extent, their contribution to the improvement may be willing to take additional steps suggested by a of the human condition cannot be denied. However, classically trained shiatsu practitioner regarding diet diagnostic procedures in Western medicine use a dis- and behavior modification. ease-oriented model and tend to focus on parts (e.g., cells, tissues, organs) rather than on the whole organ- With sufficient training, the shiatsu practitioner ism. For example, Louis Pasteur (1822-1895) believed learns to view the energy manifesting at major tsubos that microbes were the primary cause of disease. Al- on the surface of the skin as indicative of the underly- though this theory has proved correct and is applica- ing condition of the organ to which the tsubo is related ble to a large number of cases, germs are not the sole and connected. For instance, a client may think shoul- cause of disease. Although Asian diagnosis has been der pain is caused by how he or she sleeps or sits at a practiced for thousands of years, Western medicine desk. A classically trained shiatsu practitioner does not has largely ignored its value. However, this is chang- ignore these factors, but looks past them to the under- ing with the increased integration of Eastern and lying organ system and the foods that affect that organ Western diagnostic methods. system. The practitioner attempts to change the energy pattern not just by working at the proximate points of In Asian medicine and shiatsu, there are two un- client complaint and distress but also along the entire derlying levels of diagnosing human beings: constitu- meridian (or set of meridians). Dietary suggestions are tional and conditional. Simply stated, an individual’s not uncommon. If the concept that everything is en- constitution is what he or she was born with. Along ergy can be accepted, it may be possible to accept that with inherited traits, the quality of life, energy, and the specific energies of foods can have an effect not food intake experienced by the mother while a person only on organ systems and ultimately on health, but is in utero are all considered factors that make up a that this effect can produce effects thought unrelated person’s constitution. A person’s condition is the sum to the internal metabolic state. of his or her experience, which includes diet. In classi- cal shiatsu diagnosis, both constitution and condi- Shiatsu training touches on the principles of tion are assessed according to the methods listed in Asian medicine because the nature of the organ sys- the following. tems and their related energy should be understood for effective treatment to occur, although, as men- The following four methods of observing “phe- tioned previously, this knowledge is not an absolute nomena” are used in Asian medicine12: requirement to practice shiatsu. How far this educa- tion goes, particularly in relation to the underlying ef- 1. Bo-shin: diagnosis through observation fects of specific foods and their yin and yang effects 2. Bun-shin: diagnosis through sound on various organs and the body as a whole, depends 3. Mon-shin: diagnosis through questioning on the quality of the school, the knowledge of the in- 4. Set su-shin: diagnosis through touch structor, and the interest of the students. Each day, whether we realize it or not, we use the first three methods of observation extensively in our The Japanese Ministry of Health and Welfare demonstrated its support of shiatsu’s efficacy when it

148 P R I N C I P L E S A N D P R A C T I C E O F M A N U A L T H E R A P E U T I C S interactions with others and the environment. We all and can be used by a properly trained shiatsu have experienced a funny feeling in our stomachs provider. when we enter a room that has recently been the site of some tension related to human interaction. We The four diagnostic methods (observation, sound, choose partners based on some innate sense of energy questioning, and touch) are used to develop a singu- recognition we find compatible with our own. Al- lar yin-yang analysis.3 At its basic level, Asian diagno- though we are unaware that we use aspects of Asian sis sets out to determine whether a person is vibra- diagnosis in our everyday lives, we nonetheless make tionally, or energetically, more yin or more yang because assessments and judgments based on these princi- these two opposing but complementary states of en- ples. Without these “diagnostic skills” we would not ergy affect each of us. survive. Shiatsu uses the first three methods liberally, and also relies heavily on the fourth. The diagnostic assessment process continues along specific lines, as described by Yamamoto and In a traditional shiatsu session, diagnosis begins McCarty in Whole Health Shiatsu: with the first contact between client and practitioner, whether in person or on the telephone. The client’s Yang diagnosis: Excess body heat and desire for coolness; tone of voice, speed of delivery, and choice of words great thirst and desire for fluids; constipation and hard give clues to the trained ear regarding the condition stools; scanty, hot, dark urine. and constitution of the shiatsu client. Yin diagnosis: Cold feeling and desire for warmth; On meeting a client for the first time, constitu- lack of thirst and preference for hot drinks; loose stools; tional and conditional assessments are made. How profuse, clear urine; flat taste in mouth; poor appetite.16 did the client enter the room? Did she walk upright? Did he smile or frown? Was her handshake strong or The key is not in being able to see the yin and yang weak? Was his hand wet, damp, dry, hot, cold? The extremes described in the excerpt. The key is in deter- client is often unaware that a classically trained shi- mining not only what tendency within an individual atsu therapist begins work with the first contact and may be contributing to his or her state but also the continues the assessment the minute a face-to-face particular organ or organs that have a jitsu or kyo meeting begins. Visual diagnosis and verbal question- condition, and then working those organs’ meridians ing continue as the first meeting between client and to change that state. This is the point at which the therapist proceeds. movement from external or initial diagnosis of con- stitution and condition ends and treatment begins. To arrive at a constitutional diagnosis, the thera- pist looks at various physical attributes. No single At this point, the practitioner’s hands become the factor observed gives a total picture, but a macro primary diagnostic tools. Although diagnosis is an on- assessment takes the various micro elements into going process during treatment, traditional shiatsu account. Size of ears, shape and size of head, dis- first assesses by palpation the major organs located in tance between the eyes, size of mouth, and size the client’s hara, or abdomen. Alternatively, some styles of hands are fundamental observations made in con- of shiatsu begin a treatment session with touch diag- stitutional diagnosis before any physical treatment nosis on the upper back, an area that also yields a vast begins. amount of information regarding a person’s condi- tion. Assessment and diagnosis include palpatory ob- Factors considered in conditional assessment are servations that describe the following physical proper- slightly different but work in tandem with the overall ties: tightness or looseness, fullness or emptiness, hot assessment. The stated reason for the visit is a factor. or cold, dry or wet, resistant or open, stiff or flexible. In addition, tone and volume of the client’s voice, pupil size, eye color, color and condition of the Diagnosis in a shiatsu session does not cease after tongue, condition of the nails, and response to palpa- an initial assessment. Diagnosis is an ongoing process tion along specific points on the hands and arms may of observation, listening, feeling, and changing focus be used. Pulse diagnosis (the act of reading distinctly based on continuously revealed information. The differently levels of heartbeats near the wrists on both ability to quickly make an accurate diagnosis can be hands) may be used, depending on the practitioner’s extremely helpful to a practitioner and client in their level of training. Generally speaking, pulse diagnosis mutual attempt to create energetic change for the re- is more the tool of an acupuncturist, but it has been ceiving partner. However, shiatsu can be effective in the hands of a relatively unskilled diagnostician. By following the simple concept of paying attention to

CHAPTER 9 Shiatsu 149 what is going on underneath one’s hands, a lay per- of animal protein and simple carbohydrates, which in son, with relatively little training, can provide an ef- their cultivation and processing exploit and pollute fective, relaxing, and enjoyable shiatsu treatment for the earth, does not yield a calm and focused mind family and friends in a nonprofessional setting. that can easily tap into human intuition. If a person is not in harmony with the natural order, the theory PRACTICES, TECHNIQUES, goes, he or she is less likely to be able to tap into his AND TREATMENT or her intuition and tune in to another person’s needs and internal energies.15 Experienced shiatsu practi- Unlike some disciplines, shiatsu is easy to learn. It is tioners agree. not possible for a lay person to practice chiropractic, acupuncture, or osteopathy, because medical profes- Although a successful shiatsu session may be sionals need not only training but also time and con- based more on intuition than technical understand- tinuing education to master techniques and improve ing, it still is necessary to outline the techniques and skills. Shiatsu also requires a disciplined approach, preparation needed for a successful shiatsu treat- constant practice, and continuing study to develop ment. Shiatsu recipients are fully clothed. Although in-depth understanding. However, the basic practice shiatsu techniques can be adapted to other massage remains simple, effective, and safe. Shiatsu tech- styles and may be performed on bare skin, traditional niques can be learned and safely applied by anyone, shiatsu is applied to a fully clothed person. Clients typically resulting in positive effects for both the re- should be dressed in loose-fitting cotton fiber cloth- cipient and provider. It can be performed anywhere, ing. Blends containing polyester or other synthetics takes place fully clothed, and requires no special are thought to block or interrupt the natural trans- tools, machines, or oils. mission of energy between the caregiver and the re- cipient. Static electricity builds up around synthetic Sergel states, “While ki may indeed emanate from fibers. Because, from an Asian perspective, everything is the giver’s fingertips it may not be in this way or only energy, nonnatural fibers, which may produce unnat- in this way that shiatsu works. Masunaga’s approach ural energies, should not be worn during a shiatsu is to emphasize another side, that the healing ki of shi- session. atsu lies within the quality or spirit of the touch in itself, as compared with the idea of some invisible current that Because shiatsu requires no special tools or envi- emanates from the touch.15 More than 150 years ago ronment, it can be performed anywhere at any time. Shinsai Ota, in a book on Ampuku (hara, or abdomi- However, traditional shiatsu is generally performed nal) shiatsu, emphasized that “honest, sincere, and on a cotton floor futon or shiatsu mat. Shiatsu tech- simple Shiatsu is much better than merely technique- niques may be adapted to a table, but this is consid- oriented professional Shiatsu.”12 Indeed, shiatsu ered a deviation from the classical perspective. Al- training often emphasizes that the most important though shiatsu can take place at any time of day, element is to be in touch with what is going on under because the energetic effects of shiatsu differ dramat- one’s hands. Experts agree, indicating that when a prac- ically in many ways from other methods, practition- titioner applies pressure and stimulation, he or she ers may encourage new clients to schedule a session should then react and follow up based on an intuitive early in the day, preferably before noon. Because shi- sense of and reaction to internal changes within the atsu can yield a “calmed sense of revitalization,” the recipient.16 A traditionally trained shiatsu practi- combination of being relaxed and energized is an ex- tioner, knowledgeable in the food energy fundamen- perience that should be savored throughout the day. tals of yin and yang and applying those principles in Americans often equate “calm and relaxed” with an his or her life, is arguably better suited to respond in- inactive state. Although shiatsu yields different results tuitively to the client. It is believed that intuition is for different people, one of the most unique effects enhanced by being in harmony with nature, a condi- experienced by most clients is indeed this “calmed tion achieved by following the guidelines of living sense of revitalization.” It is not uncommon for a new within nature’s principles—earth’s rhythms of yin shiatsu client to report, when treated by a competent and yang. Harmony in the body is achieved by being practitioner, that he or she has “never felt this way in harmony with the universe. Eating large amounts before.” One reason for the difference in the energetic ef- fects of shiatsu as opposed to other techniques (usu-

150 P R I N C I P L E S A N D P R A C T I C E O F M A N U A L T H E R A P E U T I C S ally called regular massage by the general public) is easy The hands, eyes, tongue, and coloration along the up- to explain. In many forms of therapeutic massage a per and lower limbs may be examined. Several deep technique described as effleurage or stroking (sweeping breaths to begin the process may be suggested. A well- the skin with the hands) is used. The benefits of this trained shiatsu practitioner obtains a complete his- type of movement on the skin are many, including tory to uncover any risk factors affecting the appro- stimulation of blood flow and the movement of priateness of shiatsu treatment. Clinical experience lymph. Although this technique is beneficial, one of and training, coupled with good references regarding its effects is often a feeling of lethargy. Because the ef- a therapist’s skills and practice, should be the deter- fects of shiatsu are realized more on the underlying mining factors in selecting a shiatsu practitioner. blockage of energy related to the body’s organ sys- tems than on the lymphatic system, a shiatsu session A shiatsu session usually begins in one of two can yield a feeling of increased short and long-term ways. In classical shiatsu, the practitioner may use energy. This is why chair massage using shiatsu tech- hara, or abdominal massage, to determine which or- niques is so appropriate, and considered by many su- gan or organ system meridians may require treatment. perior to other techniques in the corporate setting. Because this type of probing may not be appropriate Employees do not experience the short-term negative or well received by many new shiatsu clients, some energetic effects (lethargy) of effleurage, but rather practitioners start with the client seated in a chair or the energetic boost, the calmed sense of revitalization so on a floor mat and make an initial assessment of the often associated with effective shiatsu technique. client’s energies from the upper back and shoulder re- Masunaga and Ohashi described this difference in gion. This does two things. It gives the practitioner the following way: some immediate feedback on the client’s condition and helps the client relax. Most people are aware of Anma and European massage directly stimulate blood tension in their upper back, shoulder, and neck, and circulation, emphasizing the release of stagnated blood in respond rather quickly to the process of relaxation so the skin and muscles and tension and stiffness resulting necessary for successful shiatsu. from circulatory congestion. On the other hand, Shiatsu emphasizes correction and maintenance of bone struc- These early assessments of client condition, cou- ture, joints, tendons, muscles, and meridian lines whose pled with a practitioner’s best understanding and malfunctioning distort the body’s energy and autonomic synthesis of the client’s overall constitution, dictates nervous system causing disease.12 the direction in which the therapist moves. Classical shiatsu texts state that “kyo and jitsu must first be Shiatsu, like other methods, is best received with found in the meridian lines by touching or kneading” an empty stomach. This may not always be possible, to allow the direction of the shiatsu to be most effec- and recent food consumption is certainly no bar to tive.12 However, even when kyo or jitsu are not accu- receiving shiatsu. However, practitioners and recipi- rately determined at the outset, effective treatment ents should bear in mind that when the body’s ener- may still be provided; these conditions can be ad- gies are focused inward toward digestion, a shiatsu dressed during the session without any specific per- session, with its attempt to change the body’s ener- ception or awareness of these qualities. gies, is compromised and less effective. Whether treatment begins in a chair or on a floor In some ways the beginning of a shiatsu session is mat, most of the session takes place with the client ly- similar to other massage styles. The room used ing down. Applying various techniques along the should be simple, clean, and quiet. A thorough his- meridian network, an attempt is made to create a bet- tory of the client and his or her concerns should be ter energy balance for the shiatsu recipient. Tech- taken. Questions regarding sleep patterns, lifestyle, niques used include rocking, tapotement (pounding), eating habits, and work history are not uncommon. A rubbing, and stretching. A shiatsu practitioner em- high level of trust should be established quickly. Of- ploys his or her entire body to apply pressure. ten a client is seated in a chair or on a floor mat as the Feet, elbows, knees, fingers, and palms are used as shiatsu practitioner observes and asks questions re- appropriate. A client may be face down or up, or garding the client’s expectations and level of under- may lie on the side as directed or moved by the standing. Diagnostic techniques to determine the practitioner. client’s constitution and condition are undertaken. Although certain techniques such as rubbing and kneading may be used at this point and throughout a

CHAPTER 9 Shiatsu 151 shiatsu session, the application of more stationary or massaging of neck or facial muscles. Shiatsu recip- pressure via the palms, thumbs, forearms, and elbows ients are generally asked to remain quiet and still for usually begins early in a session. The muscles at the several minutes after a session. base of the occiput may be kneaded with the fingers and thumbs. Often the head is rotated with one hand Most people can receive shiatsu. People with while maintaining a stationary base of support at the sprains and sports injuries who are seeking direct neck with the other hand. Although shiatsu providers treatment of specific areas of trauma are best referred generally use similar methods, every practitioner is to massage therapists. However, gentle and focused different. shiatsu for these types of injuries can be applied to ar- eas not directly related to the affected area to produce When the techniques applied to the upper back, positive results by removing pressure and tension shoulders, and neck are completed, the client gener- that the body may have created by compensating for ally reclines to the floor mat in a position the thera- the injury. Shiatsu can be used during pregnancy if pist deems most beneficial. This may be prone, provided by a practitioner trained in the specific supine, or side position. Certain individuals may use meridians and tsubo points that should be avoided the side position exclusively because of size, preg- during a session. Shiatsu is very effective during preg- nancy, or specific issues. nancy as long as common sense and the specific train- ing and experience of the therapist are taken into If placed in a prone position, it is not uncommon account. for the therapist to use his or her feet to rock the client’s hips or to apply graduated pressure to the legs Because stationary and perhaps deeper applica- and feet. This “barefoot shiatsu” technique is used ex- tion of pressure is a major part of shiatsu technique, tensively by Shizuko Yamamoto and is a very power- caution should be exercised when treating people ful adjunct to the use of the hands, knees, elbows, and who bruise easily, have high white blood cell counts, forearms. The stretching of the arms and legs and or suffer from leukemia, lymphoma, or extensive skin their rotation at the shoulders and hips, respectively, or other cancers. Clients who have an acute or chronic is not uncommon. cystic condition must clearly communicate their complete history to reduce any potential risk. Al- Depending on their relative sizes, the practitioner though burn victims have benefited from massage may also walk on the client. Caution is clearly in or- therapy, the application of shiatsu at or near a burn der when using this rarely practiced technique, but it site is not appropriate. However, shiatsu should not, is sometimes appropriate and beneficial. in theory or in practice, be considered a painful mas- sage therapy; quite the opposite is the norm. Shiatsu sessions typically take place with the provider on his or her knees next to the client. Pres- The foregoing description of a shiatsu session sure is applied along distinct meridian lines with the should be considered generic in nature. There are palms and thumbs. Knees, elbows, and forearms may many variations to the basic techniques, and numer- also be used along these specific channels. To access ous schools that teach specific shiatsu practices offer the energy of the various organs through their re- more distinct focus to the underlying themes pre- spective meridians, the client’s position changes to sented above. The American Organization of Body side or supine as the session proceeds. Therapies of Asia (AOBTA) notes 12 specific areas of Asian technique. The six major schools of Asian Generally speaking, conversation is minimized or practice generally regarded as shiatsu are described absent during a shiatsu treatment. Music may be in the following sections, as shown on the AOBTA played based on the joint needs and desires of giver web site. and receiver. Blood pressure and breathing rates gen- erally go down during a session. It is not uncommon Acupressure for a shiatsu recipient to feel some cold sensations as he or she begins to relax, a natural reaction of the Acupressure is a system of balancing the body’s energy by body’s autonomic nervous system. Shiatsu can be applying pressure to specific acupoints to release tension performed through a cotton blanket, which most and increase circulation. The many hands-on methods of practitioners have available. A shiatsu session can be stimulating the acupressure points can strengthen weak- of any length, although a 60-minute duration is very common. Sessions often end where they began, at the base of the client’s neck or head with gentle kneading

152 P R I N C I P L E S A N D P R A C T I C E O F M A N U A L T H E R A P E U T I C S nesses, relieve common ailments, prevent health disor- Shiatsu Anma Therapy ders and restore the body’s vital life force. Shiatsu Anma Therapy utilizes a unique blending of two Five Element Shiatsu of the most popular Asian bodywork forms practiced in Japan. Dr. Kaneko introduces traditional Anma Massage The primary emphasis of Five Element Shiatsu is to iden- Therapy based on the energetic system of Traditional tify a pattern of disharmony through use of the four ex- Chinese Medicine in long form and contemporary pres- aminations and to harmonize that pattern with an ap- sure therapy which is based on neuro-musculo-skeletal propriate treatment plan. Hands on techniques and system in short form. Ampuku, abdominal massage ther- preferences for assessment varies with the practitioner, apy, is another foundation of Anma Massage Therapy in depending on their individual background and training. his school. The radial pulse usually provides the most critical and de- tailed information. Palpation of the back and/or ab- Zen Shiatsu domen and a detailed verbal history serve to confirm the assessment. Considerations of the client’s lifestyle, emo- Zen Shiatsu is characterized by the theory of Kyo-Jitsu, its tional and psychological factors are all considered impor- physical and psychological manifestations, and its appli- tant. Although this approach uses the paradigm of the cation to abdominal diagnosis. Zen Shiatsu theory is five elements to tonify, sedate or control patterns of based on an extended meridian system that includes as disharmony, practitioners of this style also consider hot well as expands the location of the traditional acupunc- or cold; internal or external symptoms and signs. ture meridians. The focus of a Zen Shiatsu session is on the use of meridian lines rather than on specific points. In Japanese Shiatsu addition, Zen Shiatsu does not adhere to a fixed sequence or set of methods that are applied to all. It utilizes appro- Shiatsu literally means finger (Shi) pressure (Atsu) and al- priate methods for the unique pattern of each individual. though Shiatsu is primarily pressure, usually applied Zen Shiatsu was developed by Shizuto Masunaga. with the thumbs along the meridian lines; extensive soft tissue manipulation and both active and passive exercise The extended meridian network described and and stretching may be part of the treatments. Extensive taught by Masunaga is a highly regarded part of shi- use of cutaneovisceral reflexes in the abdomen and on the atsu education. It is taught in quality schools as an back are also characteristics of Shiatsu. The emphasis of integral part of shiatsu theory, diagnosis, and style. It Shiatsu is the treatment of the whole meridian; however, is common for a practitioner to learn the extended effective points are also used. The therapist assesses the meridian network toward the end of his or her condition of the patient’s body as treatment progresses. shiatsu education as an extension to the classical Therapy and diagnosis are one. meridian network, in the same manner that Master Masunaga explored this expansion in shiatsu think- Macrobiotic Shiatsu ing, theory, and practice.1 Founded by Shizuko Yamamoto and based on George TRAINING AND Ohsawa’s philosophy that each individual is an integral CERTIFICATION part of nature, Macrobiotic Shiatsu supports a natural lifestyle and heightened instincts for improving health. There are currently no federal regulatory standards in Assessments are through visual, verbal, and touch tech- the United States for shiatsu practitioners or any niques (including pulses) and the Five Transformations. massage therapists per se. The American Massage Therapy Association cites 30 states that have regula- Treatment involves non-invasive touch and pressure tions governing massage therapy. There are nearly using hand and barefoot techniques and stretches to fa- 100,000 credentialed practitioners at this writing. cilitate the flow of Qi and to strengthen the body-mind. Dietary guidance, medicinal plant foods, breathing tech- Numerous schools of massage offer certificate pro- niques and home remedies are emphasized, corrective ex- grams in shiatsu or more broad-based programs that ercises, postural rebalancing, palm healing, self shiatsu include shiatsu massage. These programs may be week- and Qigong are included in Macrobiotic Shiatsu.

CHAPTER 9 Shiatsu 153 end seminars of 1 or 2 days, or may provide 600 or more RESEARCH hours of training particular to shiatsu. It is not uncom- mon for schools to offer 350 to 500 hours of training in The results of a number of randomized, controlled classical shiatsu with an additional 150 hours in trials have recently been published. What follows is a anatomy and physiology. There appears to be a growing brief listing of these studies, grouped by category. trend for internships in all schools of massage. Cardiovascular The American Organization for Bodywork Thera- pies of Asia (formerly the American Asian Body Ther- • A blind, randomized control study in a university- apy Association) is the largest and most prevalent or- affiliated hospital documented a decrease in sys- ganization particular to the practice of shiatsu. tolic, diastolic, and mean arterial pressure, as well Certified Practitioner applicants must complete a as heart rate and skin blood flow, when acu-points 500-hour program, preferably at a school or institu- were stimulated by pressure. Researchers con- tion recognized by AOBTA. cluded that acupressure can significantly and pos- itively influence the cardiovascular system.1 The American Massage Therapy Association (AMTA) is a general association of massage practi- • A single-blind, pretest–posttest, cross-over design tioners; it does not actively focus on shiatsu therapy. study in which patients were taught how to self- It is a highly respected association that meets reg- administer acupressure concluded that real acu- ularly with the AOBTA as a federated massage- pressure was more effective than sham acupres- supporting organization. The AMTA’s mission is to sure for reducing dyspnea, and was minimally develop and advance the art, science, and practice effective for relieving decathxis.7 of massage therapy in a caring, professional, and eth- ical manner to promote the health and welfare of Nausea with Breast Cancer humanity. Chemotherapy The American Bodywork and Massage Profes- • Finger pressure applied bilaterally to two “major” sionals (ABMP) is another highly respected associa- acupressure points during the first 10 days of a tion of massage professionals. Unlike the AOBTA and chemotherapy cycle reduced the intensity and ex- the AMTA, the ABMP is a for-profit organization. perience of nausea among women undergoing therapy.11 The National Certification Board for Therapeutic Massage and Bodywork (NCBTMB) is a nationally Nausea and Vomiting recognized credentialing body formed to set high standards for those who practice therapeutic massage • The use of acupressure at the P6 acu-point was and bodywork. It accomplishes this through a na- shown to reduce the incidence of nausea and tionally recognized certification program that evalu- vomiting within 24 hours of anesthesia from 42% ates the competency of its practitioners. Since 1992, to 19% compared with placebo.5 more than 40,000 massage therapists and bodywork- ers have received their certification. The NCBTMB ex- • The use of acupressure at the P6 point was shown amination is now legally recognized in more than to reduce the incidence of nausea and vomiting af- 20 states and in many municipalities. The NCBTMB ter Caesarean section compared with placebo.8 represents a diverse group of massage therapists, not just shiatsu practitioners. A minimum of 500 hours • Acupressure bands placed at the P6 points on sub- of formal massage education and successful comple- jects receiving general anesthesia for ambulatory tion of a written exam are the basic requirements for surgery experienced less nausea (23%) versus the certification. Practitioners must be recertified every control group (41%), suggesting this method as an four years. alternative to conventional antiemetic treatment.9 A person considering the use of any massage ther- • The incidence of postoperative vomiting in chil- apy as an adjunct to health maintenance should care- dren was significantly lower (20%) than in the fully select the provider of that therapy. In addition to personal references, it is important to evaluate the practitioner’s training, experience, professional affili- ations, and certification.

154 P R I N C I P L E S A N D P R A C T I C E O F M A N U A L T H E R A P E U T I C S placebo group (68%) when stationary acupressure 9. Harmon D, Ryan M, Kelly A et al: Acupressure and pre- was applied to the Korean K-K9 point for 30 min- vention of nausea and vomiting during and after spinal utes before and 24 hours after undergoing stra- anaesthesia for caesarean section, Br J Anaesth bismus surgery.6 84(4):463-467, 2000. • The stimulation of the P6 (Neiguan) acu-point 10. Lundberg P: The book of shiatsu, New York, 1992, Simon was determined to prevent nausea and vomiting & Schuster. in adults, although no antiemetic effects were noted in children undergoing strabismus surgery. 11. Maa SH, Gautheir D, Turner M: Acupressure as an ad- However, it was determined that prophylactic use junct to a pulmonary rehabilitation program, J Car- of bilateral acuplaster in children reduced the diopulm Rehabil 17:268-276, 1997. incidence of vomiting from 35.5% to 14.7% in the early emesis phase, 58.1% to 23.5% in the late eme- 12. Masunaga S, Ohashi W: Zen shiatsu: how to harmonize yin sis phase, and 64.5% to 29.4% overall. Researchers and yang for better health, New York, 1977, Japan Publica- concluded that the use of acuplaster reduced tions. vomiting in children undergoing strabismus cor- rection.14 13. Saito K: This is the shiatsu from Japan, Japan Shiatsu Asso- ciation of Canada. Available at www.oyayubi.com/ References shiatsu/story.html. [Accessed 4/01.] 1. American Organization for Body Therapies of Asia: 14. Schlager A, Boehler M, Puhringer F: Korean hand acu- General definition and scope of practice. Available at pressure reduces postoperative vomiting in children af- www.aobta.org/definitions.htm. [Accessed 12/6/01.] ter strabismus surgery, Br J Anaesth 85(2):267-270, 2000. 2. Chen ML, Lin LC, Wu SC et al: The effectiveness of acu- 15. Sergel D: The Macrobiotic way of zen shiatsu, New York, pressure in improving the quality of sleep of institu- 1989, Japan Publications. tionalized residents, J Gerontol A Biol Sci Med Sci 54A(8):M389-M394, 1999. 16. Yamamoto S, McCarty P: Whole health shiatsu, New York, 1993, Japan Publications. 3. Colt GW, Hollister A: The magic of touch, Life Mag Au- gust:55-62, 1997. Supplementary Readings 4. Cowmeadow O: The art of shiatsu, Rockport, Mass, 1992, Kushi M: Basic shiatsu, Becket, Mass, 1995, One Peaceful Element Books, Ltd. World Press. 5. Dibble SL, Chapman J, Mack KA et al: Acupressure for Liechti E: The complete illustrated guide to shiatsu: the Japanese nausea: results of a pilot study, Oncol Nurs Forum healing art of touch for health and fitness, Bement, Ill, 1998, 27(1):41-47, 2000. Bement Books, Ltd. 6. Fan CF, Tanhui E, Joshi S et al: Acupressure treatment Massage Magazine. See Appendix. for prevention of postoperative nausea and vomiting, Namikoshi T: The complete book of shiatsu therapy, Tokyo, Anesth Analg 84(4):712-714, 821-825, 1997. Japan, 1994, Japan Publications. 7. Felhendler D, Lisander B: Effects of non invasive stim- Namikoshi T: Shiatsu: Japanese finger-pressure therapy, Tokyo, ulation of acupoints on the cardiovascular system, Complement Ther Med 7(4):231-234, 1999. Japan, 1995, Japan Publications. Ohashi W, Deangelis P: The Ohashi bodywork book: beyond shi- 8. Harmon D, Gardiner J, Harrison R et al: Acupressure and the prevention of nausea and vomiting after la- atsu with the Ohashiatsu method, Tokyo, Japan, 1997, Ko- paroscopy [see comments], Br J Anaesth 82(3):387-390, dansha International. 1999. Sergel D: The natural way of zen shiatsu, Tokyo, Japan, 1999, Japan Publications. Touchpoints. See Appendix. Yamamoto S: Barefoot shiatsu: whole-body approach to health, New York, 1998, Putnum. Yamamoto S, McCarty P: The shiatsu handbook: a guide to the traditional art of shiatsu acupressure, New York, 1996, Putnum.

10 Ayurvedic Bodywork JOHN M. MCPARTLAND FELICIA FOSTER HISTORY Ayurvedic medical textbook, the Charaka Samhita, was written around 320 BC. Over the past 2000 years, tra- Ayur means life, and veda means science or knowledge. ditional (Shudh) Ayurveda has commingled with two Ayurveda, or the science of life, is the indigenous medical similar systems, Unani-Tibb and Siddha. Unani-Tibb, system of India. Ayurveda is reputed to be the oldest brought to India around 1000 AD, has roots in classi- complete system of medicine. Practitioners of Chi- cal Greek medicine, reworked by the Persians and nese medicine (Chung-i) may disagree with this Arabs. Today Unani-Tibb thrives in northwest India statement, but ancient Chinese practitioners adopted and Pakistan. Siddha developed at the same time the humoral theory of Ayurveda, which suggests as Ayurveda, and today prevails where Dravidian cul- Ayurveda antedated Chung-i. ture once dominated—in Tamil Nadu, Sri Lanka, Malaysia, and Singapore. Brahma, the lord of creation in Hindu theology, is said to have composed a stupendous work on Since Indian independence, Ayurveda has enjoyed Ayurveda. Early Ayurvedic concepts can be found in a 50-year renaissance. Before that, the British Raj sup- the Rig Veda, dating to 2000 BC. The oldest known pressed Ayurveda in favor of Western medicine.10 155

156 P R I N C I P L E S A N D P R A C T I C E O F M A N U A L T H E R A P E U T I C S Ayurveda is now becoming popular in the United Ayurvedic practitioners say that disease is the out- States; its acceptance is on a steep growth curve, ward expression of an imbalance created by a person’s much like acupuncture 20 years ago. inability to digest life. Our state of health and our physical bodies are a reflection of how we have chosen PRINCIPLES AND to live life and participate in our relationship with the PHILOSOPHY universe. The daily activities of eating, breathing, me- tabolism, and elimination, the world of sensory expe- Ayurveda is the art of daily living in harmony with the rience, and the practice of wholesome living (sadhana) laws of nature. The objective of Ayurveda is to correct all play a part. imbalance and maintain a continual state of balance. According to Ayurveda, balance is the evolution of Allopathic medicine focuses on the systems of the prakiti, the creative principle. Prakiti is the basis of a physical body, such as the cardiovascular system, res- person’s constitutional characteristics and tempera- piratory system, and gastrointestinal system. Ayur- ment. Prakiti is based on a person’s predominant veda, in contrast, states that our internal healing sys- dosha, sometimes translated as life force, which is de- tem has supremacy over all other systems. This termined at the moment of conception. Prakiti is the internal healing system is innate, divine wisdom, an creator of all forms in the universe (animal, vegetable, eternal consciousness that is beyond the physical mineral, and spiritual), and we are in continual com- body and mind, a consciousness that is beyond the munication with all these forms. We are not separate intellect and beyond the ego, but is always present. beings with boundaries and edges, but beings partici- Thus in Ayurveda the origin of disease is believed to pating in a cosmic dance of rhythms and vibrations. lie within this consciousness. Disease does not origi- We are not static entities, but beings engaged in con- nate in its symptoms or in the mechanisms of the tinual transformation and change. body. In their primal states, all forms contain a perfect Ayurveda teaches that our life has a purpose, and balance of the three gunas, or universal principles (sat- that purpose is to know or realize the Creator (cosmic vamaya, rajamaya, and tamaomaya, described later). consciousness) and to understand our relationship This state of perfect health and balance is divine, and with that consciousness. Healing, according to we hold the memory of its presence within every cell of Ayurveda, is the journey back to the self. It is about re- our being. While still in the womb we begin to assess membering our relationship with the divine and our and respond to the environment. We begin to perceive inherent state of perfection. and interpret each moment and store these experi- ences in the “software” of the mind. Over time the Reaching and remembering this consciousness or memory of divinity and perfect health begins to fade, presence is the goal of Ayurvedic treatment. Through and life becomes linear, conditional, and materialistic. the process of the Ayurvedic diagnosis, the person’s vikriti (imbalance) is determined. Treatment of the Ayurveda moves beyond the mechanistic model person’s vikriti addresses the whole life of the person and sees life as more than a series of successive cause- and his or her relationship to the life of the universe. and-effect events. It recognizes the importance of con- sciousness and the role that consciousness plays in the AYURVEDIC DIAGNOSIS process of healing. Ayurveda does not see the human body as an isolated, frozen structure, but as contex- The diagnostic process in Ayurvedic medicine begins tual, relational, and holistic. Each event occurring by taking the client’s history. Much of this medical within the body is related to other events, both inter- history is familiar to Western practitioners, such as nally and externally. Ayurveda sees the human body obtaining from the client a list of symptoms, a list of as a complex metaphor, molded by its memory and current medications, past medical and surgical his- perception of its entire experience of life. There is a tory, and family history. However, Ayurvedic practi- statement in the Vedic texts, “If you want to know tioners also obtain astrologic aspects of the client’s what your life was like in the past, look at your body history. The next diagnostic procedure is a visual ex- now. If you want to know what your body will be like amination of the tongue, eyes, sweat, urine, and feces. in the future, look at your life now.” The practitioner also listens to the client’s voice, aus- cultates the internal organs, palpates the affected

CHAPTER 10 Ayurvedic Bodywork 157 The Tridoshas of Ayurvedic Medicine TABLE 10-1 Vata Pitta Kapha “wind” “bile” “phlegm” Elemental sources Air and ether Earth and fire Earth and water Chief characteristic Motile, dry, cold, rough Hot, acrid, fluid Inertial, slow, cold, greasy, heavy Physiology Initiate movement, Digestion, generation Connective tissue, ground Taste respiration of metabolism substance Proper massage oil Bitter, pungent Sour, salty Sweet Sesame Coconut Mustard or olive (in some cases, none) body parts (called sparsha), and performs an intricate damental aspects of life: dharma—duty or correct form of pulse reading (nadi vigyan or nadi pariksha). action; artha—material success or wealth; kama— positive desire; and moksha—spiritual liberation. The These diagnostic steps are used to determine a foundation underlying these four aspects of life is person’s prakiti and his or her predominant dosha. health. Without good health we cannot perform the Three types of doshas are recognized in Ayurveda, duties and responsibilities of daily living, we cannot summarized in Table 10-1. The tridoshas are derived create affluence and achieve success, and we cannot from environmental “elements,” initially five in num- be creative and positive. Spiritual liberation is the re- ber (the same number as found in traditional Chinese sult of the perfect harmony of body, mind, and con- medicine)—fire, air, water, earth, and ether. However, sciousness or soul. about 2000 years ago Indian metaphysicians dropped ether from this list.17 Each dosha is split into sub- The Ayurvedic system of healing teaches that as doshas. A subdosha of vata (the “wind” dosha), for the internal and external conditions of our lives instance, is prana—the motile, respiratory aspect of in- change, we need to constantly adjust our relationship telligence. to life to maintain equilibrium. Our internal wisdom automatically initiates some of the adjusting, but Thanks to recent articles in health magazines, conscious choice is also required. Conscious living-in- many people are familiar with the tridoshas listed in the-moment should become a way of life. Ayurveda is Table 10-1. Trigunas are less known but of equal im- not a passive form of therapy; it enrolls each client as portance in Ayurveda. Whereas the tridoshas mani- an active participant in the process of daily living and fest in a person’s physical constitution, the trigunas healing. are expressed as psychological temperament and be- havior. Trigunas correlate with tridoshas: rajamaya Westerners commonly equate Ayurveda with correlates with vata in the mind as creative energy, the herbal medicine.26 In fact, Ayurveda also emphasizes agitation of desires and emotions. It is active and dy- pathya apathya (dietary changes), asanas (yoga exer- namic, like Chinese yang. Satvamaya correlates with cises), meditation, spiritual healing, surgery, and a pitta as balanced energy, a pure luminous mind. highly refined variety of bodywork techniques. Tamaomaya correlates with kapha in the mind as a Ayurvedic practitioners believe that prevention is bet- dark, phlegmatic, forgiving yet destructive energy, ter than cure. They prescribe proper thought and be- like Chinese yin. havior and timely attention to nature’s needs. Even time can be conceptualized in tridosha components, AYURVEDIC TREATMENT so preventive measures change with the time of day and the seasons. Ayurveda’s approach to healing is quite different from the Western approach of alleviating symptoms. Ignoring prevention causes imbalance, then dis- Ayurveda’s aim is to achieve balance of the four fun- ease. Westerners are prone to imbalances of vata, which becomes obstructed and accumulates in weak spots, giving rise to symptoms such as headaches,

158 P R I N C I P L E S A N D P R A C T I C E O F M A N U A L T H E R A P E U T I C S nasal congestion, and heaviness in the cardiac region. prayaschittas (ceremonial penitence), upavasa (fasting), Serious illness interferes with agni (metabolic factors), and gamanas (pilgrimages). which normally transform food into dhatus (the seven types of body tissues) and malas (the three excreted Ayurvedic Bodywork wastes). Impaired agni results in the buildup of ama— unabsorbed, undigested food substances that clog in- To focus on Ayurvedic bodywork only is somewhat testines and blood vessels and create toxins. artificial. Ayurveda is, after all, holistic, and asserts that anything that exists in the realm of thought or Serious illness calls for serious treatment. In In- experience can influence our health. Therefore any- dia, Ayurvedic practitioners are divided into a school thing that can be conceptualized can be used as a of physicians (Atreya sampradaya) and a school of sur- healing agent. Bodywork is merely one part of our geons (Dhanvantri sampradaya). Each school contains journey back to balance and harmony. specialty branches, such as Kayachikitsa (kaya means medicine, chikitsa means therapeutic measure; Kayachik- Ayurvedic healers work with an energetic concept itsa is roughly equivalent to internal medicine). of the body rather than a material one. This life energy or life force is conceptualized as a dosha in Ayurveda, Kayachikitsa has many components. Some dis- but it has many synonyms around the world: ankh (an- eases, especially vata diseases, require Santarpana (also cient Egypt), pneuma or ether (ancient Greece), ruach (Ju- called Branhana) or “nurturing care”—eating nourish- daic Hasidim), nwyvre (Celtic Druids), qi or chi (China), ing foods, resting, and sleeping. Pitta and kapha dis- ki (Japan), angin (Malaysia), arunquiltha (Australian abo- eases respond better to Apa-Tarpana (also called lang- rigines), ha (Hawaii), mana (Maori and Polynesia), po- hana) therapeutics, which are divided into two lines of wa-ta (Pueblo), ni (Lakota), ton (Dakota), waken or treatment: wakonda (Sioux), manitou (Algonquin), oki (Huron), orenda (Iroquois), sila (Inuit), num (!Kung bushmen), 1. Shamana therapeutics provide symptomatic re- mulungu (Ghana tribes), baraka (North Africans), m’gbe lief; they include kshut (fasting), langhana (light (Pygmies), ntu (Bantu), arcus energy (Paracelcus), animal diet), trit (restriction of fluids), atap sevana (sun magnetism (Mesmer), odic force (von Reichenbach), uni- rays), maruta sevana (breezes of air), pranayama versal force (Herder), dynamic activity (Bähr), siderism (yogic breathing), and vyayama (exercises in- (Ritter), vital force (Hahnemann), vis medicatrix naturae cluding yoga). (naturopathy), innate intelligence (chiropractic), primary respiration (cranial osteopathy), orgone energy (Reich), 2. Shodhana therapeutics provide more than radix (Charles Kelley), L field (Burr), raw power (Iggy symptomatic relief; they provide a cure. Shod- Pop), and subtle energy (the Theosophists). hana therapeutics feature the panchakarma (five purifications); nasya (nasal medications), Ayurvedic bodywork enhances the flow of energy vamana (emetics), virechana (purgatives), basti through at least three types of subtle channels. Sira (enemas), and raktamoksha (venesection). vessels carry the doshas. They are similar to Chinese meridians. There are four classes of siras; on the ma- A person prepares for panchakarma by undergo- terial plane they correspond to nerves (which carry ing purva karma (preliminary treatment), such as sne- vata), arteries and veins (which carry pitta and some- han (medicated oil massages), swedan (sweating in times kapha), and lymphatic vessels (which carry herbalized saunas), and udvartana (anointing). Pan- kapha). Marma points are found along sira vessels chakarma is followed by paschat karma (after care), in- (Figure 10-1). cluding sansargi (dietary restrictions) and rasayanas (rejuvenation with pharmacologic therapy). Rasa- Nadi channels collectively form a fine network of yanas employ more than 8000 different formula- 72,000 subtle nerves, through which pranic and psy- tions.6 These formulations contain herbs, animal ma- chic energy flow. Nadi channels intersect at 360 en- terials (e.g., cow’s urine, milk, bones), minerals, and ergy centers called chakras (note that some clinicians metals. Metals may be taken internally, applied to the count 360 acupuncture points—the number of days skin, or worn as amulets. in the lunar year). Three primary nadi channels inter- twine up the spine, running from the tailbone Ayurveda also provides daiva-vyapashraya chikitsa through the top of the head, with seven primary (divine therapy), the treatment of diseases resulting chakras arising along this line. from the curse of saints, ghosts, or other supernatu- ral influences. This therapy makes use of divine herbs, gems, mantras (incantations), mangalas (rituals), bali (oblations), upaharas (offerings), homas (sacrifices),

CHAPTER 10 Ayurvedic Bodywork 159 The third type of conduits, srota channels, are in- miliar to many readers. Some postures are static numerable. They connect the marma points to the in- stretches, whereas other postures provide balanced ternal organs. They are sometimes considered lym- ligamentous tension or balanced muscle tension. phatic vessels, but they carry all three doshas. Srotas This form of “spontaneous release by positioning” is may be sanga (obstructed), sira-granthi (in a knotted similar to counterstrain, an osteopathic technique. condition), atipravritti (with excess flow), or vimarga- gamana (flowing in reverse direction). Soft-Tissue Techniques Ayurvedic bodywork shares many common ele- Ayurvedic massage enhances the flow of energy ments with osteopathic techniques used in the United through the sira vessels (and their intersections, the States.20 In fact, when American osteopaths began marma points), nadi channels (and their intersec- practicing in Britain, English physicians immediately tions, the seven chakras), and srota channels. Block- compared them with Ayurvedic practitioners.15 age of energy flow in these channels gives rise to mus- cle pain and tension, and obstructed energy may Some of the aforementioned aspects of kayachik- solidify into boggy or knotted tissues, known to os- itsa, such as asanas (yoga exercises) and pranayama teopaths as somatic dysfunctions and to chiroprac- (yogic breathing), may be considered forms of body- tors as subluxations.19 work. Asanas are a series of postures, which may be fa- Massage is usually performed with medicated Kurparam Sthapni oils. Dry massage is rarely administered, but is some- Apang Shringatkani times used for afflictions of extreme kapha. To Oorvi Phana choose the correct oil, the practitioner must take into Phana Ansah account the client’s prakriti and his or her aggravated dosha. In general, aggravated vata calls for sesame oil, Lohitaksh Hridayam excess pitta requires coconut oil, and kapha needs Apalapa mustard or olive oil.12 Oils are medicated with herbal Indravastih extracts or essential oils. Essential oils are volatile and Naghi Manivandh provide a form of aromatherapy. The appropriateness Vastih of an essential oil can be confirmed by asking the client to inhale the oil vapor (Figure 10-2). The proper Oorvi oil vapor immediately regulates the client’s subtle nadi pulse. Snehan, or medicated oil massage, prepares the client for panchakarma. The strokes used in snehan follow standard patterns for each aggravated dosha; they are designed to propel ama to its primary site of Janu Koorchshir Talhridayam Gulpha Kshipram Koorcha Kshipram Figure 10-1 Marma points. (Modified from Johari H: Figure 10-2 Testing the appropriateness of a medicated Ancient Indian massage: traditional massage techniques massage oil by inhaling its volatile vapor and checking based on the Ayurveda, New Delhi, 1984, Munshiram the nadi pulse. Manoharlal Publishers.)

160 P R I N C I P L E S A N D P R A C T I C E O F M A N U A L T H E R A P E U T I C S elimination, where it can be removed by pan- gentle, sensitive, soothing style (satvik mas- chakarma treatment (Figure 10-3). sage) or a deep, intense, and often painful style (tomasic massage). Satvik balances the flow of Johari11,12 described various types of Ayurvedic energy, whereas tomasic intends to break up massage as follows: jarahar, remover of old age; blocked energy. sharam har, remover of fatigue; vata har, remover of the humor of wind; drishti prasad kar, increasing • Navarakizhi massage uses rice cooked in a mix- sight; pushti kar, making one strong; ayu kar, increas- ture of herbs and milk. The practitioner places ing longevity; swapn kar, inducing sleep; twak dridh kar, the cooked jellylike mass in a small cloth sack strengthening the skin; klesh sahatwa, providing resist- and massages the client with it, moistening ance against disease and disharmony; abhighat sa- the sack from time to time by dipping it into hatwa, providing resistance to injuries and power to the warm milk decoction. recover quickly; kapha vata nirodhak, subsiding ail- ments caused by mucus and wind; mrija varn bal prad, • Pizhichal therapy uses medicated oil placed in a providing strength to the skin and improving the vessel (dhara patram) suspended above the color and texture of the skin. supine client, positioned to direct a thin con- tinuous stream of oil on the client’s body, fol- These various massages use techniques similar to lowed immediately by massage (Figure 10-4). what Western massage therapists call friction rubs (lo- calized, circular movements over muscles, tendons, • Spondylotherapy is a tapotemont-like technique and joints), effleurage (gliding strokes that increase of rapid, light concussions applied with a blood flow), pétrissage (kneading or squeezing of mus- hand or hammer to areas of somatic dysfunc- cles), tapotement (percussion that stimulates nerves tion.20 and muscles), and vibration (an invigorating vibrato movement). The various massages differ by the Ayurvedic Marma Therapy amount of pressure, application of specific oils and aromas, and attention to particular body regions. For Marma therapy treats marma points, which are com- example, to improve eyesight requires gentle massage parable with Chinese acupuncture points. In the Sid- of the navel area in a clockwise direction.12 dha tradition practiced in Dravidian culture, marma therapy is called varma therapy4 or thanuology.23 Some techniques of Ayurvedic massage are truly unique. A few of the techniques follow: The 107 marma points manifest in 5 of the 7 dha- tus. Dash and Kashyap3 described 11 marmas in mus- • Thirummal is used in southern India. It can be applied with the hands and the feet. English- Leuk5 noted that thirummal can be done in a Figure 10-3 Snehan massage prepares the client for pan- Figure 10-4 Pizhichal therapy directs a thin stream of chakarma. medicated oil on the client’s body.

CHAPTER 10 Ayurvedic Bodywork 161 cles, 8 in bones, 20 in joints, 27 in ligaments and and Siddha,4,11 and has been popularized in the West nerves, and 41 in arteries and veins. They classified before.27 the marmas into those that cause instant death when damaged (located in the head, heart, and anus) and Joint Articulation and Spinal Thrust marmas that merely cause pain and deformity when Johari11 notes, “One who is learning about massage damaged. Gerber9 suggested that marmas correspond must learn how to put all the vertebrae in proper with the anatomic position of lymph nodes. As such, alignment. One should understand that massage of marma therapy is sometimes called Ayurvedic lym- the spine alone can cure weak nerves and all psychic phatic massage. disorders.” Marma therapy is also called Ayurvedic acupres- Ayurvedic practitioners rarely use vertebral thrust sure.21 It can be self-administered or performed by a techniques (the high-velocity, low-amplitude tech- practitioner. Although marma massage usually ap- niques used by chiropractors and osteopaths). These plies a gentle, circular motion with one finger (Figure techniques seem to be the purview of barbers in India 10-5), it may be applied more forcefully. Kurup13 de- and Nepal, who thrust cervical vertebrae after cutting scribed thirummal as a marma technique. Marma a person’s hair.19 therapy is used by Indian wrestlers and is considered a vital aspect of kalarippayattu, an Indian martial Cranial Work art.9,11,12,28 The craniosacral mechanism is not recognized in tra- ditional Ayurvedic medicine, although Johari11 states, Some marma points can be needled, like acupunc- “Another important thing to remember is the role of ture, or stimulated by a sliver of wood from the neem the spinal fluid in maintaining health, vigor, vitality tree, Azadirachta indica.4 Other marma points can be and virility.” Gehin8 claims that techniques akin to stimulated by yoga and pranayama. One auspicious cranial osteopathy are practiced in Asia, but he does point, sthapni marma (called Thilarda varma in the Sid- not elaborate on his claim. dha tradition, often characterized as “the third eye”), can be stimulated by simply staring at it. A trained Western Adaptations practitioner can induce a hypnotic trance by activat- of Ayurvedic Technique ing this point.4 Polarity therapy was developed in the 1950s by Ran- Sherman25 mistakenly claimed that marma ther- dolph Stone who hybridized Ayurveda with osteopa- apy was a lost art until 1987, when “the Maharishi thy and chiropractic. Many of Stone’s techniques, Mahesh Yogi put Dr. John Douillard [an American such as “polar-energetics postures,” are similar to chiropractor] to work at reviving it.” In fact, marma Wilhelm Reich’s work. Since Stone’s death, Polarity therapy has remained an integral part of Ayurveda therapy has diverged into several schools of thought. A satvik-oriented faction, led by Pierre Pannetier, now Figure 10-5 Marma massage applied to an excellent predominates. Many osteopathic physicians were in- point, the sthapni marma. troduced to Ayurvedic concepts through Stone, who studied with Robert Fulford, a prominent and eclec- tic osteopath.7 Arica Vortex system is an Ayurvedic hybrid devel- oped in England. Whereas Polarity practitioners use both hands to promote a flow of energy in clients, Ar- ica practitioners use a single pressure point to im- prove flow in nadi channels. Arica practitioners also use deep-tissue compression releases and deep breathing exercises. Esoteric healing works with chakras and the etheric body. It is a form of energy healing. The phrase dates to a book of the same name written by Alice Bailey,

162 P R I N C I P L E S A N D P R A C T I C E O F M A N U A L T H E R A P E U T I C S published in 1953. Bailey was an amanuensis, influ- sixth vertebra (our T5, or fifth thoracic vertebra), and enced by Madam Blavatsky and the Theosophists. the xiphisternal notch. Rex Riant, a physicist from England, repopularized the study in the mid-1960s. One of Riant’s protégés, Tibetan physicians strive for a meditative mind- Brenda Johnston, put Esoteric Healing on the map by set before applying treatment. They accomplish this publishing New Age Healing and presenting work- by contemplating the Medicine Buddha, reciting shops around the world. mantras, and creating healing visualizations. Upon reaching a meditative state, the physician “is more Westerners often try to box Ayurveda into the al- sensitive to various energy blockages in the other per- lopathic paradigm of a “diagnosis and treatment son because he has controlled his own mind and can plan,” and thus miss the essence of the Ayurvedic therefore tune into the other person mentally and healing process. In an attempt to westernize physically.”1 Ayurveda, the concept of dosha and its implications are often misinterpreted and incorrectly imple- This meditative mindset parallels the “centering” mented as a rigid treatment plan. Our potential for exercises often performed by cranial osteopaths. healing depends on continuous change and transfor- Magoun16 called this meditative state a “rapport in mation in response to change. Ayurveda is a process the tissues” between practitioner and client. Empa- of unfolding and remembering, of creating balance thetic, meditative, centered states are known to pro- and harmony. Thus it complements and supports the duce strong “entrainment.”18 Entrainment is the har- Western modalities of healing. monization of biologic oscillators. All organisms pulsate with a number of rhythms, such as diaphrag- Asian Adaptations: Tibetan matic respiration, heart rate, heart rate variability, and Thai Bodywork pulse transit time, lymph vessel oscillation, Traube- Hering modulation, brain waves, and many other Tibetan bodywork, a blend of Ayurvedic and Chinese fluctuations.22 These oscillations coordinate into har- techniques, uses massage, yogalike exercises, and monics with each other and can be measured as a pri- acupuncture. (The Tibetans claim they invented mary, fundamental rhythm. This “entrainment fre- acupuncture.) Byugs-pa, or Tibetan medical massage, quency” measured in healthy humans averages about was first described in a Tibetan medical text (the 7.5 cycles per minute.18 rGyud-bzhi) in 400 AD. If meditative states produce strong entrainment, Tibetan physicians monitor energy meridians and centered practitioners have the ability to impose their treat imbalances with byugs-pa. They apply circular strongly entrained rhythms onto clients.22 Harmo- massage strokes to increase energy in affected areas, nization of rhythms between living things is a com- and linear strokes to break up energy blockages.19 mon phenomenon, seen in synchronously flashing Musculoskeletal medicine is also studied in the Ti- fireflies, harmoniously chirping crickets, and women betan system, with an emphasis on osteology. In typ- whose menstrual phases cycle together. Entrainment ical fashion, Tibetan osteology differs from Western also arises between “inanimate” objects—in a room approaches. Vertebrae, for instance, are numbered full of mechanical clocks, the “strongest” clock (the from the base of the neck. Hence a first vertebra in one with the heaviest pendulum) establishes the even- Tibetan nomenclature is our C7.1 tual overall rhythm. Somatic dysfunctions are treated with soft-tissue Reiki, believed to be a 2500-year-old Tibetan tech- techniques, including inhibitory pressure. Soft-tissue nique, demands practice in a strongly centered medi- techniques also remedy arthritis and other connective tative state. In classic Reiki technique, the practi- tissue disorders, sinusitis, headaches, cold extremi- tioner places hands lightly on the client’s body in a ties, and psychiatric disturbances. Because most psy- succession of twelve locations. This directs healing chologic problems come from excess vata (rLung in energy to locations roughly corresponding to chakra the Tibetan system), selection of the correct massage centers (see Chapter 12). oil is critical. Massage for psychologic problems fo- cuses on the sagittal suture of the skull (along the In Thailand, bodywork includes massage (nûad bo midline of the top of the skull), first vertebra (C7, the ràrn) and manipulation (nûad càb sên). Like the Ti- seventh cervical vertebra in Western nomenclature), betans, the Thai treat energy imbalances as well as musculoskeletal dysfunctions. Some nûad bo ràrn

CHAPTER 10 Ayurvedic Bodywork 163 techniques resemble Chinese Tui Na. However, Tui Na Training for an Ayurvedic medical degree is simi- treats 12 meridians, whereas nûad bo ràrn focuses on lar to that of the Bachelor of Medicine Bachelor of 72,000 sên channels (identical to the number of Science in the British system—the duration of under- Ayurvedic nadi channels). Other nûad bo ràrn tech- graduate training is 51⁄2 years after secondary school- niques apply vigorous traction to the extremities, ing, and the doctorate course is another 3 years after with either stretch-and-hold patterns or rhythmic graduation.14 rocking motions. Achieving proper leverage for trac- tion may entwine the client and practitioner in In the United States, Ayurvedic training and certi- unique postures, akin to nonsexual Kama Sutra posi- fication is not regulated. No state or national licens- tions. ing boards for Ayurvedic medicine currently exist. Several schools offer instruction, including the fol- Another type of nûad bo ràrn approximates Chi- lowing: nese acupressure, but the treatment locations differ in location. Riley and colleagues24 determined that • The American Institute of Vedic Studies in 28% of sên points correspond to the location of Chi- Santa Fe, New Mexico, offers a 250-hour corre- nese acupuncture points, 8% correspond to Travell’s spondence course for health care professionals. trigger points, and 33% correspond to Chapman’s re- The course is directed by Dr. David Frawley. flex points. • The Ayurveda Holistic Center in Bayville, New Nûad càb sên resembles zhong zhu, or Chinese York, offers a 2-year (750-hour) correspon- joint manipulation. The Thai, like the Chinese, do dence course, based on the Ayurvedic Encyclope- not recognize restrictions of spinal movement in the dia, which was written by the center’s director, sagittal plane. All thrusts are directed at rotational Swami Sada Shiva Tirtha. A classroom course and side-bending restrictions. Thrust forces are not consists of 480 hours of lecture and intern- localized to specific spinal segments. A Buddhist tem- ship instruction plus 280 hours of home ple statue in Bangkok, reportedly 2000 years old, study, provided by Punita Desai, BAMS. shows nûad càb sên manipulation of the lumbar spine. The statue was photographed by Cyriax, which • The Ayurvedic Institute in Albuquerque, New is interesting because Cyriax also ignored restrictions Mexico, offers a 4-year program (1750 class- in the sagittal plane.2 room hours), summer-long intensive semi- nars, short courses, and a correspondence TRAINING AND course. The faculty includes Dr. Vasant Lad, CERTIFICATION BAMS, MA Sc; Dr. Robert Svoboda, BAMS; IN AYURVEDA Hart de Fouw (Jyotishi); Ann Harrison, LMT (yoga); Kevin Spelman, MHAHG (medical India has approximately 400,000 Ayurvedic practi- herbs); and Donald Van Howten, LMT, PIT tioners (including 40,000 Unani and 25,000 Siddha (bodywork). practitioners), 242 Ayurvedic hospitals, 65 Siddha hospitals, and 19 Unani hospitals.6 There are 108 ac- • The California College of Ayurveda in Grass credited undergraduate Ayurvedic colleges and 1 Valley, California, offers a 2-year program (500 Ayurvedic university, 2 postgraduate institutes, and classroom hours, 250 home-study hours, and 21 postgraduate departments across India. Banaras a 6-month internship), leading to certification Hindu university (BHU) uniquely supports both a as a Clinical Ayurvedic Specialist. The faculty faculty of Ayurveda and a faculty of Western medi- includes Dr. Marc Halpern, Dr. David Frawley, cine, comparable with Michigan State University Dr. Avinesh Lele, and Dr. Subhash Ranadé. (MSU), which accommodates an osteopathic college and an allopathic medical college under one roof. In • The College of Maharishi Vedic Medicine in 1993, BHU and MSU engaged in a scientist exchange, Fairfield, Iowa, offers a 4-year program leading funded by the National Science Foundation, which to a BA degree, plus a 6-year program leading initiated this study of Ayurvedic bodywork. to a PhD in vedic physiology. The faculty in- cludes Robert Schneider, MD; Vaidya H.K. Gupta, MDAy; Vaidya Manohar Palakuthi, BAMS; and Richard Averbach, MD. • The National Institute of Ayurvedic Medicine in Brewster, New York, offers a correspon-

164 P R I N C I P L E S A N D P R A C T I C E O F M A N U A L T H E R A P E U T I C S dence course by Scott Gerson, MD. A 3-year 12. Johari H: Ayurvedic massage: traditional Indian techniques course being developed in collaboration with for balancing body and mind, Rochester, Vt, 1996, Healing the University of Pune offers internships in Arts Press. India. 13. Kurup PNV: The science of life, World Health Magazine • The New England Institute of Ayurvedic Med- pp 12-15, November, 1977. icine in Cambridge, Massachusetts, offers a 1-year program of classroom and clinical in- 14. Kurup PNV. In Bannerman RH, Burton J, Wen-Chieh C: struction leading to certification. Additional Traditional medicine and health care coverage, Geneva, 1983, programs for internship and advanced train- World Health Organization Press. ing lead to the DAy degree. The faculty includes Dr. Abbas Qutab and Dr. David 15. Little EG: Registration of osteopaths, BMJ 2:815-816, Frawley. 1925. References 16. Magoun HI: Osteopathy in the cranial field, ed 3, Kirksville, Mo, 1976, The Journal Printing. 1. Clifford T: Tibetan Buddhist medicine and psychiatry, York Beach, Me, 1984, Samuel Weiser. 17. Mahdihassan S: Indian and Chinese cosmic elements, Am J Chin Med 7:316-323, 1979. 2. Cyriax J: Textbook of orthpaedic medicine, London, 1984, Baillière Tindall. 18. McCraty R, Atkinson M, Tiller WA: New electrophysio- logical correlates associated with intentional heart fo- 3. Dash B, Kashyap J: Basic principles of Ayurveda, New cus, Subtle Energies 4:251-268, 1995. Delhi, 1980, Concept Publishing. 19. McPartland JM: Manual medicine at the Nepali inter- 4. Dharmalingam V, Radhink M, Balasubramanian AV: face, J Manual Med 4:25-27, 1989. Marma chikitsa in traditional medicine, LSPSS Monograph No. 5, Madras, India, 1991, Lok Swaasthya Parampara 20. McPartland JM: Ayurvedic glossary. Final report, US-India Samvardhan Samithi. Scientist Exchange Program, Washington, DC, 1992, Na- tional Science Foundation. 5. English-Leuk JA: Health in the new age, Albuquerque, 1990, University of New Mexico Press. 21. McPartland JM: Visit to the enchanted land: Ayurvedic medicine, as old as life, Communique 19(5):5, 1993. 6. Fulder S: The handbook of complementary medicine, ed 2, Oxford, 1988, Oxford University Press. 22. McPartland JM, Mein EA: Entrainment and the cranial rhythmic impulse, Altern Ther Health Med 3(1):40-44, 7. Fulford R, Stone G: Dr. Fulford’s touch of life, New York, 1997. 1996, Pocket Books. 23. Pillai SC: Treatise on impacts to nerve centres in Varma, 8. Gehin A: Atlas of manipulative techniques for the cranium Madras, India, 1991, International Institute of and face, Seattle, 1985, Eastland Press. Thanuology. 9. Gerber ML. In Hohari H: Ancient Indian massage: tradi- 24. Riley JN, Mitchell FL Jr, Bensky D: Thai manual medi- tional massage techniques based on the Ayurveda, New Delhi, cine as represented in the Wat Pho epigraphies: prelim- 1984, Munshiram Manoharlal Publishers. inary comparisons, Med Anthropol 5(2):155-194, 1981. 10. Jeffery R: The politics of health in India, Berkeley, 1988, 25. Sherman B: New Marma programs enliven the body’s vital University of California Press. points (brochure), Fairfield, Iowa, 1991, Fairfield Mahar- ishi Ayur-Veda Center. 11. Johari H: Ancient Indian massage: traditional massage tech- niques based on the Ayurveda, New Delhi, 1984, Munshi- 26. Ulrich-Merzenich G, Kraft K, Singh LM: Rheumatic ram Manoharlal Publishers. diseases in Ayurveda: a historical perspective, Arthritis Rheum 42:1553-1554, 1999. 27. Varma D: The human machine and its forces, London, 1937, Health For All Publishing. 28. Zarrilli PB: Three bodies of practice in a traditional south Indian martial art, Soc Sci Med 28:1289-1309, 1989.

11 Qi Gong and Tui Na* KEVIN V. ERGIL MARC S. MICOZZI CHINA’S TRADITIONAL ality. A medical historian or a physician might per- MEDICINE ceive medicine to be a steady march from ignorance to the light, but these are typically revisionist histo- Certain considerations are important to understand- ries. Medicine is a human enterprise embedded in ing Chinese medicine. Medicine is a human endeavor and intersected by myriad other human projects. and as such is shaped by the considerations of the hu- Even the choice of how to conduct a medical proce- man beings using and practicing it. These considera- dure or what kind of health care to choose may have tions sometimes have very little to do with curing dis- more to do with habit or economics than with ra- ease in the most simple and efficient way and a great tionality or efficacy. An example is the case of a Chi- deal to do with economics, politics, and culture. Ide- nese patient choosing traditional herbal medicine to ology, belief, and even simple ignorance have influ- manage painful and debilitating kidney stones. Al- enced the practice of medicine more than has ration- though the treatment was ultimately effective, the pa- tient’s choice was not motivated by a desire for effi- *The information in this chapter was excerpted from the chapter cacy. Had the patient opted for surgery, he or she entitled “Chinese Medicine,” written by Kevin Ergil, in Fundamen- would have been classified as an invalid and therefore tals of Complementary and Alternative Medicine, ed 2, by Marc S. Mi- barred from advancement in the workplace. Another cozzi, published by Churchill Livingstone (2001). example is a hospital that closes its doors to the prac- 165

166 P R I N C I P L E S A N D P R A C T I C E O F M A N U A L T H E R A P E U T I C S tice of acupuncture despite the fact that acupunctur- accessible. Unfortunately, this practice can obscure ists in the state are licensed medical practitioners and the breadth of meaning of these terms.12 their services are routinely requested by hospital pa- tients. In each example, considerations not directly We try to make sense of the world from our posi- linked to the rational and effective delivery of medical tion in it, historically as well as culturally. We tend to care influence medical choices. view history as progressing, as if by design, to a spe- cific end. Events of the past, viewed from the perspec- Our own perspectives on medicine and our expe- tive of the present, offer tempting opportunities for rience of our own medical systems provide us with reinterpretation in relation to current experience. For ideas regarding what is normal or typical in the prac- example, in the context of current perspectives on dis- tice of medicine. We respond to aspects of a tradi- ease causation, Wu You Ke’s statements that “miscel- tional system that correspond with our expectations. laneous qi” could cause epidemic disease, and his con- We imagine Chinese herbal medicine as a gentle ther- cept of “one disease, one qi,”11 have led contemporary apy using nontoxic ingredients. Its use of highly toxic sources in China to suggest that such an insight, com- substances or drastic purgative therapies is easily ing as it did before the invention of the microscope, is overlooked. It is unlikely, for instance, that the tradi- quite remarkable.13 The implication that Wu You Ke’s tional form of Tibetan therapeutic cautery applied observation was a precursor of germ theory is attrac- with a hot iron will elicit substantial interest as a tive to Chinese practitioners who are trying to find a form of alternative therapy. Naturalistic and rational place for traditional practices in an increasingly bio- elements of systems intrigue us. Unfamiliar or magi- medicalized world. In fact, the concept of miscella- cal diagnostic and therapeutic modes cause us neous or pestilential qi has been used extensively in concern. adapting traditional theory to the management of human immunodeficiency virus infection. However, We must think about medical systems as being as Wiseman points out, this was never explored in re- embedded in their respective cultures. For example, lation to the causation of disease by microscopic or- the concept of neurasthenia (sheng jin shuai ruo, a ganisms, nor was it ever conceived as such. vague fatigue thought to be caused by psychologic factors) is an important syndrome in traditional Chi- Of course, the history of Chinese medical thought nese medicine and Chinese psychiatry, despite the includes many people who thought that they were ex- fact that this diagnosis has fallen into disrepute clusively right, but the breadth of traditional Chinese among Western psychiatrists and is no longer classi- medical thought was sustained by an intellectual cli- fied as a disease entity in diagnostic manuals. Neuras- mate that retained all possible ideas for use and ex- thenia was an exceptionally popular diagnosis in the ploration. A given philosopher or clinician might re- nineteenth century during periods of extensive med- ject an idea, but the idea itself would remain available ical exchange between the United States and China for future use. and Japan. The diagnosis has continued to be clini- cally important in China because it fits well into cer- For example, during the Ming dynasty Wu You Ke tain traditional medical models and responds well to (circa 1644) was the leading exponent of the “offen- cultural and political concerns about mental illness.4 sive precipitation sect” (gong xia pai) of physicians, Americans and Europeans who encounter neurasthe- whose tenets included a distinctive set of ideas con- nia within the corpus of Chinese medicine sometimes cerning the management of epidemic disease and a find it an unusual or obscure concept despite its rele- wholehearted rejection of many established ideas in vance for Chinese medical practice. Chinese medicine.14 He was subsequently viewed as a contributor to Chinese medical thought; a proponent Sometimes, on encountering a new idea, we like of a divergent and uninformed theory; and finally as to think about it in familiar terms. One example is the intellectual antecedent of Koch, the discoverer of the use of the word energy to express the idea of qi. An the tuberculosis bacillus. At no point were his ideas extension of this is the common practice of describ- discarded. ing the therapeutic method of draining evil influ- ences from channels as “sedation.” Neither energy Interestingly enough, in modern China, where the nor sedation has much to do with the concepts that sheer volume of information and the nation’s health underlie qi and draining; however, these terms are care needs make it necessary to teach a standard cur- more familiar to us and make Chinese medicine more riculum to thousands of students each year, this tol- erance for varying clinical perspectives continues. For

CHAPTER 11 Qi Gong and Tui Na 167 instance, there are herbal physicians known as Minor The origins of Chinese medicine are mythically Bupleurum Decoction (Xiao Chai Hu Tang) doctors be- linked to three legendary emperors. Fu Xi, the Ox cause their prescriptions are organized around one Tamer (circa 2953 BC), taught people how to domesti- formula from the Treatise on Cold Damage (Shang Han cate animals and divined the Ba Gua, eight symbols Lun), an early text on diagnosis and herbal therapy that became the basis for the Yi Jing, or Book of Changes. written during the Han dynasty (206 BC–220 AD). Shen Nong, the Divine Husbandman, is also known as Some herbal physicians reject traditional formulas the Fire Emperor. Shen Nong is said to have lived from entirely and use contemporary perspectives on the 2838 to 2698 BC and is considered the founder of agri- Chinese pharmacopeia to organize their prescrip- culture in China. He taught the Chinese people how tions. to cultivate plants and raise livestock. He is also con- sidered the originator of herbal medicine in China, There are acupuncturists whose clinical focus is having learned the therapeutic properties of herbs dedicated almost entirely to six acupuncture points and substances by tasting them. Later authors attrib- and who use computed tomography scans to plan uted their work to him to indicate the antiquity and clinical interventions. At the same time, two floors importance of their texts. The Divine Husbandman’s down in the same hospital physicians base their se- Classic of the Materia Medica (Shen Nong Ben Cao Jing) is lection of acupuncture points on obscure and com- a case in point. The text was probably written in 220 plex aspects of traditional calendrics and systems AD and reconstructed in 500 AD by Tao Hong Jing. such as the “Magic Turtle.” Given that all historical evidence points to the an- cient character of herbal medicine in China, it is HISTORY appropriate that Shen Nong is considered its origina- tor (Figure 11-1). Huang Di, the Yellow Emperor Once it is understood that Chinese medicine is a large and varied tradition with many manifestations Figure 11-1 Image of Shen Nong. (From Micozzi M: Fun- and philosophies, it is possible to begin its explo- damentals of complementary and alternative medicine, ed 2. ration. Chinese medicine has an extensive history. As Philadelphia, 2001, Churchill Livingstone.) is the case with most medical traditions, this history can be approached from several perspectives. One such perspective is the ancient mythology of Chinese medicine, which attributes the birth of medicine to the legendary emperors Fu Xi, Shen Nong, and Huang Di. Another is the history deduced from the careful study of available ancient texts and records. These records indicate, for example, that there is no reference to acupuncture as a therapeutic method in any Chinese text before 90 BC,7 and that the oldest ex- isting text to discuss medical practices that faintly re- semble current Chinese medicine date from the end of the third century BC.7 Finally, there are the more extravagant interpretations of archaeologic evidence and textual materials that seek to establish the an- cient character of certain Chinese medical practices. One example of extravagant interpretation is the common assertion that the stone “needles” exca- vated in various parts of China were remnants of an- cient acupuncture.1,9 This assertion is based on refer- ences in texts from later periods to the ancient surgical application of sharp stones and on morpho- logic similarities between the excavated stones and the metal needles that were used later.

168 P R I N C I P L E S A N D P R A C T I C E O F M A N U A L T H E R A P E U T I C S (2698-2598 BC) is known as the originator of the tra- nomena labeled as qi do not fit conventional defini- ditional medicine of China. tions of substance or matter, further confusing the is- sue.13 Because of this confusion, many authors prefer QI AND THE ESSENTIAL to leave the term qi untranslated. SUBSTANCES OF THE BODY The idea of qi is extremely broad, encompassing Apart from the ideas of yin and yang and the five almost every variety of natural phenomena. The body phases, there is no concept more crucial to Chinese contains many different types of qi. In general, the medicine than qi—the idea that the body is pervaded features that distinguish each type derive from its by subtle material and mobile influences that cause source, location, and function. There is considerable most physiologic functions and maintain the health room for debate in this area, and exploration of a and vitality of the individual. This idea is not com- wide range of materials suggests a variety of different mon to biomedical thinking about the body. Qi is ideas about categories of qi. In general, qi has the commonly translated as energy, but this translation functions of activation, warming, defense, transfor- conceals qi’s distinctly material attributes. Further- mation, and containment (Table 11-1). more, although energy is defined as the capacity of a system to do work, the character of qi extends con- The qi concept is important to many aspects of siderably further. Chinese medicine. Organ and channel qi are influ- enced by acupuncture. In fact, one characteristic fea- The Chinese character for qi is traditionally com- ture of acupuncture treatment is the sensation of ob- posed of two radicals (ideographs); the radical that taining the qi or de qi. Qi Gong is a general term for the symbolizes breath or rising vapor is placed above the many systems of meditation, exercise, and therapeu- radical for rice (Figure 11-2). Qi is linked with the tics that are rooted in the concept of mobilizing and concept of “vapors arising from food.”7 Over time regulating the movement of qi in the body. Qi is some- this concept broadened but never lost its distinctively times compared with wind captured in a sail; we can- material aspect. Unschuld favors the use of the phrase not observe the wind directly, but we can infer its pres- “finest matter influences” or “influences” to translate this concept.7 Wiseman points out that some phe- Types of Qi TABLE 11-1 Figure 11-2 The character qi. (From Micozzi M: Funda- Type Function mentals of complementary and alternative medicine, ed 2, (Chinese) Type (English) Philadelphia, 2001, Churchill Livingstone.) Ying qi Construction qi Supports and Wei qi Defense qi nourishes the Jing qi Channel qi body Zang qi Organ qi Protects and warms the Zong qi Ancestral qi body Flows in the channels (felt during acupuncture) Flows in the or- gans (physio- logic function of organs) Responsible for respiration and circulation From Micozzi M: Fundamentals of complementary and alternative medi- cine, ed 2, Philadelphia, 2001, Churchill Livingstone.

CHAPTER 11 Qi Gong and Tui Na 169 ence as it fills the sail. In a similar fashion, the move- thopedic and neurologic conditions. It also is applied ments of the body and the movement of substances to patients with conditions that may not be thought within the body are all signs of the action of qi. of as susceptible to treatment through manipulation, such as asthma, dysmenorrhea, and chronic gastritis. In relation to qi, blood and fluids constitute the Tui Na is used as an adjunct to acupuncture to in- yin aspects of the body. Blood is produced by the con- crease the range of motion of a joint, or instead of struction qi, which in turn is derived from food and acupuncture when needles are uncomfortable or in- water. Blood, which nourishes the body, is under- appropriate, such as in pediatric applications. stood to have a slightly broader and less definite range of actions in Chinese medicine than it does in As with all aspects of Chinese medicine, regional biomedicine. Qi and blood are closely linked because styles and family lineages of practice abound. The for- blood is believed to flow with qi and to be conveyed by mal curriculum available in Chinese programs is ex- it. This relationship often is expressed by the Chinese tensive but is probably not a complete expression of saying, “Qi is the commander of blood and blood is the range of possibilities. the mother of qi.” It has been suggested that qi and blood are linked in the same manner as a person and QI CULTIVATION his or her shadow. Qi Gong is a term that literally embraces almost every Fluids are a general category of substances that aspect of the manipulation of qi by means of exercise, serve to moisten and lubricate the body; these sub- breathing, and the influence of the mind. The second stances may be thin or viscous. Fluids can be concep- part of this chapter is devoted to this topic, so only a tually separated into humor and liquid. Humor is few points need to be made here. Qi Gong includes thick and related to the body’s organs; among its practices ranging from the meditative systems of functions is the lubrication of the joints. Liquid is thin Daoist and Buddhist practitioners to the martial arts and is responsible for moistening the surface areas of traditions of China. Qi Gong is relevant to medicine the body, including the skin, eyes, and mouth. in three specific areas. The first is to allow the practi- tioner to cultivate the demeanor and stamina to en- CHINESE MASSAGE (TUI NA) able him or her to perform the strenuous activities of Tui Na, to sustain the constant demands of clinical Tui Na, literally “pushing and pulling,” refers to a sys- practice, and to quiet the mind to facilitate diagnos- tem of massage, manual acupuncture point stimula- tic perception. The second involves cultivating the tion, and manipulation that is vast enough to war- practitioner’s ability to safely transmit qi to the pa- rant a chapter of its own. These methods have been tient. Practitioners may direct qi to the patient either practiced at least as long as moxibustion, if not through the needles or directly through their hands. longer, but the first Chinese massage training class This activity may be the main focus of treatment or was not created until 1956 in Shanghai.8 Today, Tui an adjunctive aspect, in which case the qi paradigm is Na can serve as a minor component of a traditional expanded to include direct interaction between the medical education or an area of extensive clinical spe- patient’s qi and that of the clinician. Finally, patients cialization. may be taught to do specific Qi Gong practices that are useful for their illnesses. A distinct aspect of Tui Na is the extensive train- ing of the hands necessary for clinical practice. The Many intriguing studies of qi cultivation have practitioner’s hands are trained to accomplish fo- been conducted in China and are beginning to be ex- cused and forceful movements that can be applied to plored in the United States. Qi cultivation has been various areas of the body. Techniques such as push- examined in relationship to an increase in immuno- ing, rolling, kneading, rubbing, and grasping are prac- competence as measured through lymphocyte pro- ticed repetitively until they become second nature. files5 and by changes in electroencephalography pat- Students practice on a small bag of rice until their terns. Qi cultivation has been explored as a tool for hands develop the necessary strength and dexterity. managing gastritis, and numerous Chinese studies have suggested that it may be a promising method for Tui Na is often applied to limited areas of the treating hypertension. body, and the techniques can be quite forceful and in- tense. Tui Na is applied routinely to patients with or-

170 P R I N C I P L E S A N D P R A C T I C E O F M A N U A L T H E R A P E U T I C S Unfortunately, many of the problems that have every aspect of the manipulation and development confronted acupuncture research also surround re- of qi by means of exercise, breathing, and creative search into qi cultivation. In addition, although there visualization. Qi Gong can also be considered to is great interest in qi cultivation in the West, there has encompass practices such as dao yin (conduction) not been equivalent enthusiasm for resolving and Tui Na (exhalation and inhalation), both of methodologic problems and beginning to establish which are applied to patterning and guiding the qi in strong research initiatives. the body. Research regarding the role of qi cultivation exer- Thus the expressions qi cultivation or Qi Gong can cises in the beneficial alteration of physiologic refer to an extraordinarily broad range of practices processes is similar, in many respects, to the investi- and activities, including the meditative systems of gation of the effects of meditation, yoga, guided im- Daoist and Buddhist practitioners, the health-giving agery, and what Benson termed the relaxation response. exercises developed by ancient physicians, and the The challenge of such research is developing an effec- martial arts traditions of China. The unifying aspect tive control and ruling out other variables that may is the intention of the practice to increase the quan- influence the results. tity, smooth movement, and volitional control of the practitioner’s qi, thus strengthening the body. A researcher who attempts to examine the effects of externally transmitted qi encounters special prob- Although the practice of Daoist and Buddhist qi lems. In some cases, it is believed that this phenome- cultivation is aimed ultimately at spiritual realiza- non involves measurable portions of the electromag- tion, the practice of medical qi cultivation addresses netic spectrum. When investigators hypothesize qi as three specific areas. The first is self-cultivation of the a real but presently unmeasurable phenomenon, they practitioner’s health and stamina. Training to per- seek to establish the presence and effect of externally form the strenuous activities of Tui Na, sustaining transmitted qi by examining its apparent effects on the constant demands of clinical practice, and quiet- other systems that can be directly observed. ing the mind to better engage in diagnosis all pertain to self-cultivation. The second area involves the culti- Given the extensive range of phenomena under vation of the practitioner’s ability to safely transmit investigation and the range of claims for the healing qi to the patient. Some practitioners believe that their potential of qi cultivation, there is a certain amount qi may be directed to the patient either through nee- of skepticism concerning the field as a whole. Even in dles or directly through their hands. This activity may China there is some question as to whether qi culti- be the main focus of treatment or an adjunctive as- vation should be established as a standard method of pect. In this case, the qi paradigm is expanded to in- treatment within the corpus of Chinese medicine; clude direct interaction between the patient’s qi and some observers believe that some of the practices as- that of the clinician. Finally, patients may be taught sociated with qi cultivation have the potential for to do specific Qi Gong practices that may help treat abuse and charlatanism.6 their illness or strengthen their qi. Qi cultivation remains a challenging part of the Qi cultivation makes extensive use of the princi- broad fabric of China’s traditional medicine. Re- ples of China’s traditional medicine, and its history is searchers within the field hope that as time passes, it intertwined with that of famous physicians. The his- will become possible to increase the availability of tory of qi cultivation practices is believed to extend well-designed studies in the field.11 back into antiquity and to point to an early recogni- tion of the importance of exercise to health. In Lu’s QI GONG Spring and Autumn annals, a famous aphorism relates the importance of movement to the maintenance of Given the fundamental importance of qi to health health and function: “Flowing water will never turn and well being, it is not surprising that one important stale, the hinge of the door will never be eaten by aspect of the practice of Chinese medicine is the sys- worms. They never rest in their activity: that’s why.”3 tematic cultivation of qi. The methods and practices In this text Lu described the role of dance and move- undertaken to achieve this are many. It can be said ment in correcting the movement of qi and yin within that Qi Gong is a term that literally embraces almost the body and benefiting the muscles.15

CHAPTER 11 Qi Gong and Tui Na 171 Descriptions of qi cultivation practices and exer- the qi then guides the blood there as well, improving cises are attributed to the early Daoist masters. circulation in the area. From this point of view, this Zhuang Zi, writing in the fourth century BC, reveals particular exercise trains the qi and blood to move the role of breathing and physical exercise in promot- freely along the channel pathways, leading to good ing longevity and describes a sage intent on extending health. his life.2 “To pant, to puff, to hail, to sip, to spit out the old breath and draw in the new, practicing bear Another exercise involves the use of breath, visu- hangings and bird-stretches, longevity his only con- alization, and simple physical exercises to benefit the cern.”10 qi of the lungs. This therapeutic exercise is recom- mended for bronchitis, emphysema, and bronchial Among the texts recovered at Ma Huang Dui are a asthma. It is begun by assuming a relaxed posture, series of illustrated guides to the practice of conduc- whether sitting, lying, or standing. The exercise is be- tion (dao yin) that provide guidance to the physical gun by breathing naturally and allowing the mind to postures and therapeutic properties of this form of qi become calm. The upper and lower teeth are then cultivation.2 The famous physician of the second cen- clicked together by closing the mouth gently 36 tury, China Hua Tou, is credited with the creation of a times. As saliva is produced it is retained in the series of exercises. Based on the movements of the mouth, swirled with the tongue, and then swallowed tiger, the deer, the bear, the monkey, and the bird, these in three parts while the client imagines that it is flow- exercises were to be practiced to ward off disease. ing into the middle of the chest and then to an area Zhang Zhong Jing in his Golden Cabinet Prescriptions rec- about three fingerbreadths below the navel (the dan ommended the practices of dao yin or conduction and tian, or cinnabar field). At this point, the client imag- Tui Na or exhalation and inhalation to treat disease. ines that he or she is sitting in front of a reservoir of white qi that enters the mouth on inhalation and is A wide variety of qi cultivation forms were devel- transmitted through the body as the client exhales, oped over the centuries, and many have achieved first to the lungs, then to the dan tian, and finally out great popularity. From the 1950s on, Qi Gong train- to the skin and body hair. This process of visualiza- ing programs were implemented and sanatoria were tion is repeated 18 times. built, specializing in the therapeutic application of Qi Gong to the treatment of disease. This process uses the relationship between the mind and qi to strengthen the function of the lungs FUNDAMENTAL CONCEPTS and to pattern areas of the body associated with the area in which the lung and respiration qi is stored. Qi cultivation rests on several fundamental principles This area is associated with the acupuncture point intended to support activity to enhance the move- dan zhong, or chest center (ren 17), which is located in ment of qi and to increase health. Most discussions of the middle of the chest. (Ren are acupuncture points.) qi cultivation address relaxation of the body, regula- Next the qi is directed to the cinnabar field, which is tion or control of breathing, and calming of the associated with another location on the ren channel mind. Qi cultivation generally is performed in a re- qi hai, or sea of qi (ren 6), just below the umbilicus. laxed standing, sitting, or lying posture. Once the cor- This area is considered important in the production rect position is achieved, the practitioner begins to and storage of the body’s qi and to the lungs on ex- regulate breathing in concert with specific mental halation. and physical exercises. This exercise typifies the aspect of a Qi Gong exer- For example, one form of Qi Gong involves visu- cise described previously; it induces relaxation through alizing the internal and external pathways of the mental concentration, because focusing on breathing channels and imagining the movement of the qi and visualization help remove distracting thoughts along these channels in concert with the breath. As from the mind, and patterning the breath with visual- the practice develops, the practitioner begins to expe- ization controls and regulates the breathing. rience the sensation of qi traveling along the channel pathways. Traditionally, it is believed that the mind It should be stressed that although many forms guides the qi to a specific area of the body and that of Qi Gong exist, they share general principles of ap- plication and a relationship to Chinese medicine concepts.

172 P R I N C I P L E S A N D P R A C T I C E O F M A N U A L T H E R A P E U T I C S References 9. Wang X: Research on the origin and development of Chinese acupuncture and moxibustion. In Xiangtong 1. Chuang Y: The historical development of acupuncture, Los Z, editor: Research on acupuncture, moxibustion and Angeles, 1982, Oriental Healing Arts Institute. acupuncture anesthesia, New York, 1986, Springer-Verlag. 2. Despeux C: Gymnastics: the ancient tradition. In Kohn 10. Watson B: The complete works of Chuang-tzu, New York, L, editor: Taoist meditation and longevity techniques, Ann 1968, Columbia University Press. Arbor, Mich, 1989, Center for Chinese Studies, The University of Michigan. 11. Wiseman N: A list of Chinese formulas, Taiwan, 1993, un- published paper. 3. Engelhardt U: Qi for life: longevity in the Tang. In Kohn L, editor: Taoist meditation and longevity techniques, Ann 12. Wiseman N, Boss K: Glossary of Chinese medical terms and Arbor, Mich, 1989, Center for Chinese Studies, The acupuncture points, Brookline, Mass, 1990, Paradigm University of Michigan. Publications. 4. Kleinman A: Social origins of distress and disease: depression, 13. Wiseman N, Ellis A, Zmiewski P et al. In Wiseman N, neurasthenia, and pain in modern China, New Haven, Ellis A, translators: Fundamentals of Chinese medicine, Conn, 1986, Yale University Press. Brookline, Mass, 1995, Paradigm Publications. 5. Ryu H, Jun CD, Lee BS et al: Effect of qigong training 14. Wong CK, Wu TL: History of Chinese medicine: being a on proportions of T lymphocyte subsets in human pe- chronicle of medical happenings in China from ancient times to ripheral blood, Am J Chin Med 23:27-36, 1995. the present period, Taipei, Taiwan, 1985, Southern Mate- rials Center. 6. Tang KC: Qigong therapy—its effectiveness and regula- tion, Am J Chin Med 22:235-242, 1994. 15. Zhang E: Clinic of traditional Chinese medicine. In Zhang E, editor, Zou J, translator: A practical English- 7. Unschuld P: Medicine in China: a history of ideas, Berkeley, Chinese library of traditional Chinese medicine, Shanghai, Calif, 1985, University of California. 1990, Publishing House of Shanghai College of Tradi- tional Chinese Medicine. 8. Wang G, Fan Y, Guan Z: Chinese massage. In Zhang E, editor, WenPing Y, translator: A practical English-Chinese library of traditional Chinese medicine, Shanghai, 1990, Publishing House of Shanghai College of Traditional Chinese Medicine.

12 Reiki The Usui System of Natural Healing EARLENE GLEISNER Spiritual Precepts of Reiki Just for Today . . . Do Not Anger Just for Today . . . Do Not Worry Honor your parents, teachers, and elders Earn your living honestly Show gratitude to all living things R eiki, which is translated from Japanese as ing has become popular all over the world. Many dif- universal life energy,2 is the intrinsic power ferent schools, or streams as they are described in the used in the Usui System of Natural Healing. present day Japanese view,20 have developed from the This power is channeled through practitioners to original teachings of Mikao Usui in the early 1920s. wherever it is needed in a person, plant, or animal, and even, as one anecdote suggests, to a weak car battery. Reiki requires no particular religious orientation, Handed down from Master to student, the Usui Sys- no physiologic or anatomic knowledge, and no train- tem is an oral tradition. This method of hands-on heal- ing in body manipulation techniques such as mas- sage.6,12,13 Because it is so simple, it easily accompanies 175

176 P R I N C I P L E S A N D P R A C T I C E O F M A N U A L T H E R A P E U T I C S other allopathic and holistic therapies, but can stand that a Hawaiian-born, Japanese-American woman, alone as a single therapy to promote healing. Hawayo Takata, began teaching Reiki to the Western World in the 1970s. Her story is widely known be- Because Reiki actually stimulates the body’s own cause it has been chronicled in many books and re- healing abilities, it can be used in all manner of pre- told at almost every First Degree Class throughout operative and postoperative treatments, oncologic the world.2,5,11,12 regimens, stress management modalities, and chronic disease and pain management.1,3,9 The beauty of the In the United States, many schools have devel- system is that it can be learned by doctors and clients oped. These schools have varying requirements in so that both are joined in the effort to attain the training, but all of them hold one thing as true: the client’s highest level of balanced wellness. transfer of this energy, Reiki, from a human being to any other living being is real. It is relaxing, healing, HISTORY and responsible for a growing mass of anecdotal evi- dence regarding the rebalancing of mind, body, and The roots of the Usui System of Natural Healing have spirit and the release of disease or pain. been traced to Shinto, the earliest religion of the in- digenous Japanese peoples. However, the system is Research is beginning to document this system as also known to rely on Buddhist tradition in some of a valid therapy, the results of which can be repli- its practices.20 Shintoism, as practiced in its earliest cated.15 The Usui System of Natural Healing is being form (200 BC), included a belief in spirit beings and taught to nurses in hospitals and in nursing schools. the resultant energy of every living thing, as well as Doctors, dentists, psychologists, and other health care entities the Western mind finds difficult to believe as providers are learning this technique to add a dimen- alive, such as stones and waterfalls.19 Hence Reiki, or sion of calming, healing touch to their practices. 7 universal life energy, can be better understood in its fullest capacity when linked with a Shinto world view, Like Shintoism, which had no formal organiza- which recognizes and honors spiritual forces and en- tion until it was used as a political tool to enhance the ergy, rather than the Buddhist view,4 which regards lineage of the Meiji Emperors,19 Reiki had no text- the world and its elements as transient. book or written instructions until very recently. Now there are manuals and written treatises, even cassettes As told in the origination myth of the Usui Sys- and videos, discussing a wide array of personal inter- tem of Natural Healing, Dr. Mikao Usui was search- pretations of this system. Techniques of application ing for concrete ways in which Jesus and the Buddha have been diverse; they depended on the oral teach- were able to heal with the laying on of hands. All doc- ings of each Master as he or she initiated and in- umented oral histories agree that the point of origin structed students. Not until the Usui System faced for this system occurred when Dr. Usui undertook a competition from other emerging Reiki schools and lengthy meditation and fast on Mount Kuiyama out- styles was there any attempt by a professional organi- side Kyoto, Japan, and received information, guid- zation to establish a systematic application. In 1993 ance, and initiation into this healing modality.2,5,12,18 the Reiki Alliance, which was originally formed to support the teachings of Hawayo Takata through her Dr. Usui began teaching this method in 1920; a granddaughter Phyllis Furumoto,18 began to define year later he opened a Reiki practice in Harajuko, the qualifications for and ethical behavior of a Reiki Tokyo, close to the Meiji Jinju.20 Dr. Usui developed practitioner. Several organizations have subsequently and taught the Five Precepts, or Five Spiritual Pre- developed their own criteria to promote wider accept- cepts, as guidelines for everyday living and foci for ance by the medical community (see Reiki Organiza- personal meditation. Followers disagree about the ba- tions in the Appendix). sis of these precepts. Some believe they are based on the Meiji Emperor’s Five Rules of Life. Others believe PRINCIPLES, PHILOSOPHY, these writings were developed as positive reflections AND DIAGNOSIS of the Five Hindrances to spiritual enlightenment presented by the Buddha. Most Reiki practitioners are not concerned with a client’s diagnosis unless they are coordinating with a Several Reiki lineages have grown out of the orig- doctor or other medical provider. This is because inal teachings of Dr. Usui. It is universally recognized

CHAPTER 12 Reiki 177 Reiki has a unique relationship with disease and TABLE 12-1 pain—it supports healing only of what needs to be healed rather than what the practitioner intends to be Effects of Autonomic Nervous System healed. For this reason, Reiki practitioners generally Stimulation do not promise any specific symptom improvement or “cure.”10 Sympathetic Parasympathetic What is promised is a relaxing moment in time. Increased alertness Decreased heart rate Sometimes only one session is needed and sometimes Increased heart rate, multiple sessions are needed for the clients to begin Relaxation of vessels to realize they are experiencing shifts in their per- force, and contrac- of gastrointestinal spectives of life, disease, attitudes, and the nature of tion tract and skin the symptoms that brought them to the treatment Dilation of vessels in room in the first place.2,23,24 the coronary arter- Increased lacrimal, ies, pulmonary arter- salivary, bronchial Touch ies, and skeletal secretions; in- muscles creased skin tem- Because the Usui System of Natural Healing teaches a Constriction of vessels perature system of touching, part of its effectiveness can be at- of the gastrointesti- tributed to the body’s response to gentle, appropriate nal tract and skin Constriction of bron- contact between practitioner and client.7 The practi- chioles tioner gains permission to touch the client, then Dilation of bronchioles places his or her hands in a prescribed pattern on the Increased gastroin- client’s body. The client is clothed and may be stand- Decreased gastroin- testinal motility ing, sitting, or reclining on a bed, massage table, or testinal motility and and secretions the floor. Several nursing studies8,14,16,17 have shown secretions that this gentle act of appropriate touch can help a Constriction of pupils person make a profound shift, from the tense re- Dilation of pupils sponse of the fight-or-flight pattern of the sympa- Sweating Contraction of in- thetic autonomic nervous system to the healing Relaxation of the blad- ternal urethral response of the relaxation pattern of the parasympa- sphincter thetic autonomic nervous system (Table 12-1).22 der detrusor muscle Relaxation of internal When a client’s anxiety is relieved, symptoms are Contraction of bladder urethral sphincter reduced.21 Occasionally the opposite sequence is ob- detrusor muscle served—symptoms abate and then anxiety is relieved. Glycogenesis, lipo- In either case, at this degree of deep relaxation the Glycogenolysis, lipoly- genesis natural healing ability of the body is supported and sis enhanced. By the second or third hand position on the head, most clients are asleep. Thus on this very being a universal life force, it is incomprehensible to basic level of touch, much is accomplished toward in- man. Yet, every living being is receiving its blessings dividualized healing. daily, awake and asleep.” Energy Many compare the feeling of receiving Reiki to the sensation felt when praying, meditating, singing, In her early diary, documented in the Reiki Alliance walking in the woods, or in any other way actively Student Handbook (or Blue Book),18 Hawayo Takata, the seeking God. The physical sensations associated with energetic woman who brought the teaching and use these activities are so similar that many Reiki practi- of the Usui System out of Japan, stated that “this tioners believe they are the physical responses to mak- power [Reiki] is unfathomable, immeasurable, and ing a connection with a power greater than them- selves. Skepticism of this connection is a culturally held belief, especially in our hurry-up, stress-filled world. Our society reinforces the belief that none of us are connected to any kind of greater source or higher power. In the First Degree Class of this system,

178 P R I N C I P L E S A N D P R A C T I C E O F M A N U A L T H E R A P E U T I C S students are assisted in becoming aware (again) of the the next, from one client to the next, and can be ex- Universal Energy—that it is a life force that abounds perienced differently by the practitioner and the in everything and that human beings benefit when client. These sensory changes indicate that some- they remain open to it.2,3 thing is passing between the practitioner and the client. When the sensation dissipates after a time of The body automatically directs healing energy to holding the hands in one position, it signals the prac- wounds, strain, tension, and other ailments. It is be- titioner to change hand positions; in other words, to lieved that the receiver of Reiki draws this energy move on. through the hands of the practitioner, who is open to its universal availability. It is the need for healing en- There is no conscious effort needed on the part of ergy that invites Reiki to be drawn through the prac- a practitioner to “turn Reiki on.” When the body is in titioners hands.3 This is why practitioners can offer pain, has sustained a wound, or is beset by an unbal- Reiki to themselves. The hands are simply placed over anced glandular, metabolic, or enzymatic process, it an area of pain or infection or tension and the mind gives out an electromagnetic, neural, atomic, or vibra- is opened and energy is allowed to flow. There is no tional alarm to stimulate a healing response from the manipulation of muscles or of the “electromagnetic rest of the body. How else does the body’s immune field” of a client. The only method is to apply touch system send its cells to determine the form of an in- to a client’s body in the prescribed hand positions or truding bacteria, or platelets to a wound to help stop to be guided by an intuitive force. Some schools of bleeding? If we could record this signal with sensitive Reiki do not allow the practitioner’s hands to touch diagnostic equipment, we would understand the call the client’s body. The origin of this practice is not of the body for internal or external energy. The fact clear; traditional practitioners use this “hands-off” that the sensation of Reiki energy flow dissipates af- technique only when treating open or fresh wounds ter a time tells us that the particular need has been caused by accident or surgery. Some schools of Reiki satisfied for the time being.2,7,9 The time frame for this teach that the practitioner’s hands should remain in shift may be as little as a few seconds or as long as 45 place for a period of 3 to 5 minutes. The traditional minutes, or until the practitioner tires of holding the practitioner leaves the hands in position until the position. flow of energy is no longer felt. The phenomenon of energy exchange can also ex- For any condition, the basic routine is to offer a plain the intuitive experience of many practitioners complete treatment session and then return to the who find their hands drawn to a particular part of the sites of the original pain, stress, or tension. However, client’s body. Very often the recipient asks, “How did case reports indicate that after applying the full body you know I had tension there?” The practitioner has treatment, a practitioner has no need to return to the no conscious knowledge of where the client is hold- original areas of complaint because the problem has ing tension. It has been explained that the energy it- been resolved.2,3 self, meaning Reiki, feels the call of the body and is pulled to the need. Principles In the recent proliferation of anecdotes in books Although many research projects regarding the effi- and on the Internet, no harmful effects of Reiki have cacy of Reiki are being developed, the collected expe- been reported. One of the issues frequently discussed riences of Reiki practitioners are the most definitive is the role of the intent of the practitioner. It is most validation of the system at this time. The following often agreed that the only necessary intent is to be clinical observations describe the effectiveness of the available to channel the energy rather than the intent practice of The Usui System of Natural Healing. “to heal” a certain symptom or condition. Clients are often healed in unexpected ways.2,3 For this reason, When a practitioner places hands on a client, both traditional Reiki practitioners make no promises re- the practitioner and the client observe sensory garding the efficacy of treatment. Many practitioners, changes around or under the hands of the practi- seeking to avoid any promise of therapeutic value, re- tioner.2,9 These changes include the sensations of fer to the hour-long applications of energy simply as warmth, tingling, cold, extra fullness, and electrical “sessions” or “therapy appointments.” charge. These sensations can change from one day to The many anecdotal testimonies show Reiki to support the natural healing process of the body to

CHAPTER 12 Reiki 179 such an extent that it can stimulate what is called a recline on a bed, these hand positions are accom- healing crisis (e.g., bringing a boil to a head, thus al- plished in the best possible manner. The first position lowing the wound to be cleaned, or causing a quick (Figure 12-1) is over the eyes and sinuses, the second rise in temperature in someone with an infection, fol- (Figure 12-2) is over the ears, including the temporo- lowed by a gradual return to normal).3,21 Some practi- mandibular joint, and the third (Figure 12-3) is the tioners have reported that cuts, surgical wounds, and cradling of the head in the palms of the hands with broken bones healed faster than expected after appli- fingertips at the client’s occipital ridge. cation of Reiki. There is also anecdotal evidence of Reiki resulting in a reduction of the side effects of After the three hand positions have been applied chemotherapy and radiation treatment. to the head, the practitioner remains seated at the head of the massage table and continues. The fourth Reiki is often described as working on the root position (Figure 12-4) is around the neck, thumbs to cause of a disease or imbalance. If a mental, emo- the back of the neck and fingertips overlapping the tional, or spiritual disturbance is a major factor in a thyroid gland. The hands often cover the cervical physical impairment, the client often recognizes the lymph nodes. In the fifth position (Figure 12-5) the disturbance during a Reiki session. How to deal with hands cover the bronchial tree, sternum, and thymus a painful relationship or a financial problem can be gland. revealed during a session. As stated earlier, healing can come in many forms.2,3 When applying hands to the front of the body, the practitioner stands on the client’s right side and be- When practitioners or others who have been at- gins a new series of hand positions. The first position tuned to Reiki regularly apply this energy to them- is with both hands on the right lung area. Precise selves they experience a dramatic reduction in day to day stress levels. When energy application is coupled with focused attention, through “processing work,” or meditation, on the Five Precepts, personal under- standing and an increase in compassion and open- ness to life can also occur. 7 People who have attended classes describe per- sonal experiences that defy logical explanation. These experiences are designated as mystical, synchronistic, or cosmic. Because they are often very personal, these experiences are not referred to in medically oriented classes so as not to put off clinicians who require con- crete explanations. PRACTICES, TECHNIQUES, Figure 12-1 First head position. AND TREATMENT The practitioner’s hands are held with fingers and thumb together then cupped slightly. They are placed in this preferred position in a relaxed manner on a person’s clothed body.2,3 The practitioner begins the treatment sitting at the head of the bed or massage table. As taught in most schools, a full session of Reiki application begins with three hand positions on the head while the client is lying comfortably on his or her back. Every effort is made to ensure the comfort of the client and to prevent any stress in cases of di- minished heart or lung capacity. If the client cannot

180 P R I N C I P L E S A N D P R A C T I C E O F M A N U A L T H E R A P E U T I C S Figure 12-2 Second head position. Figure 12-3 Third head position. placement puts the middle finger of the upper hand While the client is on his or her stomach, the back at the bottom level of the sternum. The second posi- is offered Reiki with four main hand positions. tion is directly over the left lung area. The third posi- Standing on the same side of the client as when work- tion is with the hands separated and parallel across ing on the front, the practitioner palpates the lower the diaphragm, stomach, and upper liver area. This margin of the scapula, then places the hands side by position also covers the gall bladder and spleen. The side over the left lung and heart area (Figure 12-6). fourth position is below the belt line, between the is- The second position is with hands side by side over chial tuberosities of the pelvic girdle. A fifth position the right lung area. The third position is above the is often marked at the area over the uterus of a belt line or waist over the kidneys. The fourth is below woman or the prostate of a man. the waist at the lumbar-sacral curve. Many schools continue the treatment with a A fifth position is often called the “T-hold” (Fig- hand position that treats the inguinal area of both ure 12-7). One hand is placed with the fingertips just males and females. Often included are “knee sand- touching the coccyx and the palm of the hand cover- wiches” in which one hand is palming the underside ing the rectal area. The other hand is held across the of the knee and the other is palming the patella. This fingertips of the first hand, which cross the longer position is held until both hand sensations are part of the sacrum. The practitioner must stand in a equalized. This same palming method is often used comfortable position to accomplish this application. on each foot. It serves the rectum, the back of the uterus or

CHAPTER 12 Reiki 181 Figure 12-4 Neck position. Figure 12-5 Second chest position. Figure 12-6 Optional shoulder position done before be- Figure 12-7 “T-hold” position. ginning hand positions on back. prostate, and the back of the bladder, and has been re- Figure 12-8 Optional balancing position: one hand at ported to relieve impotency. An optional balancing base of neck; other hand over sacrum. position is one hand at the base of the neck, and the other hand over the sacrum (Figure 12-8). European treatment styles differ from those taught in American schools. Some teach more hand positions and often offer the application of Reiki to clients who are covered with only a sheet or blanket. Other styles of Reiki applications are not described in relationship to body organs as has been done here. One school of Reiki designates a series of hand posi- tions in relation to chakras, energy centers in line from the pubic bone to the top of the head. This chakra system is derived from Hindu philosophy and was not in the original teachings of the Usui System.

182 P R I N C I P L E S A N D P R A C T I C E O F M A N U A L T H E R A P E U T I C S The Levels of Reiki Third Degree Reiki, or Master Training, and may last as long as a year. Other schools have divided this train- Traditionally there have been three levels or degrees ing into two levels, Third Degree and Master Teacher in the Usui System of Natural Healing.2,9 Training, and others have consolidated this training into a 1-day experience. Many agree that this level of First Degree (Reiki I) is often erroneously referred training can be taxing on the person who wishes to to as Beginning Reiki. This creates a misunderstand- pursue this plateau of commitment to the Usui Sys- ing in that it can lead a person to believe that he or she tem. According to the Reiki Alliance, a student of Reiki has to take the next levels to have a complete under- should have been actively working with Reiki for 3 to standing of Reiki or to be able to completely use the 10 years before moving into this level of training. Usui System of Natural Healing. In the traditional sys- tem, Reiki I is sufficient to become a Reiki practitioner A person who completes this training has the or to offer Reiki to oneself and family members for knowledge and technique with which to educate and health maintenance and stress prevention. open others to Reiki. How to initiate others into all three degrees is only one part of this mastery. Several This class is taught in three 4-hour sessions and organizations have developed teaching protocols for includes four initiations or “attunements,” which are all levels of training. Each Master may add his or her the methods of connecting an individual with the own requirements. source of energy, Reiki. Once connected to that source, a student is connected for life. During this All three levels are taught by a Master who has ful- class, students are taught the history of Reiki, observe filled all training requirements. They are known as the hand positions, and are invited to give and expe- Reiki Masters, not because they have mastered the en- rience a full body application. Discussion of the Five ergy, but because they have made a commitment to Precepts is encouraged. Students are also encouraged stand in the light of Reiki and allow their lives to ex- to experience self-treatment and to investigate the ap- emplify the qualities described in the Five Precepts. plication of Reiki in emergency situations, in hos- This commitment is made on many levels, including pices or hospitals, and to clients with acute or chronic financial, political, emotional, and spiritual. conditions. Many case studies are reviewed and the dynamic potential of having access to this energy is FINDING A TEACHER outlined. Often students experience changes in their health, their relationships, or other human condi- So many changes have occurred in the Usui System of tions during this training. Natural Healing since Hawayo Takata initiated her 22 Masters before her death in 1980. Some of these The only prerequisites for learning are openness, changes have occurred through the vision or ego of a a desire to learn, and a commitment to use Reiki particular Master. If a person seeks to learn Reiki, one regularly.5 of the questions to ask a potential Master is how his or her lineage is traced to Takata.9 A Master’s lineage Second Degree (Reiki II) Class in some schools is demonstrates his or her proximity to the original referred to as Advanced Training. It involves instruc- teachings. A Master who knows and shares his or her tion in additional applications of Reiki through the lineage honors that lineage, an important element of use of symbols or energy patterns. These additional ap- the Usui System. There are other important questions plications include being able to offer Reiki to a person to ask of a Master, including the following: who is not in the room. This person can be next door or on the other side of the globe. The technique is 1. For how many years did you practice the Usui called Sending Reiki or Distant Reiki and is akin to dis- System of Natural Healing or Reiki Healing be- tant healing. Another application is that of mental re- fore seeking to be trained as a Master? balancing, which involves a specific hand position and techniques to help relieve addictions and habits and 2. How do you see your role in practicing Reiki also to improve mental clarity. A third application is Healing, both in private practice and in serving the ability to focus Reiki into a laser-like beam or to in- the community at large? tensify its concentration. This class is taught over 2 days, or a minimum of two sessions. Often a Reiki 3. Over what period of time was your Master Master asks a student to return in a month to share ex- training completed? periences regarding practice at this level of application. 4. May I contact some former students of your In the traditional school of the Usui System of Nat- classes? ural Healing, the third level is referred to as Reiki III,

CHAPTER 12 Reiki 183 5. Is there practice time during the training 10. Gleisner E: Reiki in everyday living: how universal energy is (whether for First or Second Degree)? a natural part of life, medicine, and personal growth, Lay- tonville, Calif, 1992, White Feather Press. 6. Can I receive a treatment from you before com- mitting to the class? 11. Graham V: Mrs. Takata opens minds to Reiki, San Ma- teo Times, May 17, 1975. Most traditional Masters also teach the history of Reiki, specifically how Dr. Usui received and applied 12. Haberle H: Hawayo Takata’s story, Olney, Md, 1990, his knowledge and vision. This story is the point of Archedigm Publications. origin and the moment in time when energy became named as Reiki and the Usui System became mani- 13. Hammond S: We are all healers, New York, 1973, Ballan- fest.2,5,9,12,18 As with any other origination story, it of- tine Books. fers its own teachings relevant to the system. The im- portance of this history gives rise to additional 14. Lynch J, Flaherty L, Emrich C et al: Effects of human questions to ask a Master, including questions re- contact on the heart activity of curarized patients in a garding the importance of the Five Precepts, the value shock trauma unit, Am Heart J 88:160-169, 1974. of the teachings, and the continued availability of the Master to the student. 15. Mansour AA, Beuche M, Laing G et al: Nurse J: A study to test the effectiveness of placebo Reiki standardiza- Most traditional Masters agree that, because Reiki tion procedures developed for a planned Reiki efficacy can do no harm, any way in which a person may be study, J Altern Complement Med 5(2):53-64, 1999. drawn into the essence of this energy will prove bene- ficial. To gain a deeper understanding of the original 16. Melzak R, Wall PD: Pain mechanisms: a new theory, Sci- teachings, a student needs to be aware of these im- ence 150:971-979, 1965. portant questions to ask a potential teacher so as to test the integrity and responsibility that the Master 17. Mills M, Thomas SA, Lynch JJ et al: Effect of pulse pal- brings to the teachings. Choosing a Master can be the pitation on cardiac arrhythmia in coronary care pa- beginning of a lifelong relationship.9 tients, Nurs Res 25:378-382, 1976. References 18. Mitchell P: The Usui system of natural healing, Cataldo, Idaho, 1985, Reiki Alliance. 1. Alandydy P, Alandydy K: Using Reiki to support surgi- cal patients, J Nurs Care Qual 13(4):89-91, 1999. 19. Ono S: Shinto, the kami way, Tokyo, 1962, Charles E. Tut- tle Company. 2. Baginsky B, Sharamon S: Reiki: universal life energy, Men- docino, Calif, 1989, LifeRhythm. 20. Petter FA: Reiki: The legacy of Dr. Usui, Twin Lakes, Wis, 1998, Lotus Press. 3. Barnett L, Chambers M: Reiki energy medicine, Rochester, NY, 1996, Healing Arts Press. 21. Sawyer J: The first Reiki practitioner in our OR, AORN J 67(3):674-677, 1998. 4. Boorstein S: It’s easier than you think, San Francisco, Calif, 1995, HarperCollins 22. Tattam A: Reiki—healing and dealing, Aust Nurs J 2(23):52, 1994. 5. Brown F: Living Reiki: Takata’s teachings, Mendocino, Calif, 1992, LifeRhythm. 23. Tovar K, Cassneyer V: Touch, AORN J 49(5):1356-61, 1989. 6. Brown F: Reiki, the Usui system of natural healing. Paper presented to Paranormal Research proceedings for the 24. van Sell SL: Reiki: an ancient touch therapy, RN International Conference for Paranormal Research, 59(2):57-59, 1996. Colorado, 1988. Supplementary Readings 7. Eos N: Reiki & medicine, Laytonville, Calif, 1994, White Feather Press. Bullock M: Reiki: a complementary therapy for life, Am J Hosp Palliat Care 14(1):31-33, 1997. 8. Fakouri C, Jones P: Relaxation Rx: slow stroke back rub, J Gerontol Nurs 13:32-35, 1987. Kelner M, Wellman B: Who seeks alternative health care? A profile of the users of five modes of treatment, J Altern 9. Gleisner E: Reiki as a complementary therapy: scientific and Complement Med 3(2):127-140, 1997. practical evidence of the value of touch and universal life en- ergy, Laytonville, Calif, 1997, White Feather Press. Kelner M, Wellman B: Health care and consumer choice: medical and alternative therapies, Soc Sci Med 45(2):203- 212, 1997. Wirth DP, Barrett MJ: Complementary healing therapies, Int J Psychosom 41:61-67, 1994. Wirth DP, Richardson JT, Eidelman WS: Wound healing and complementary therapies: a review, J Altern Comple- ment Med 2(4):493-502, 1996.

13 Healing Touch and Therapeutic Touch DIANE WIND WARDELL A lthough Healing Touch (HT) and Thera- is defined as “an intentionally directed process of en- peutic Touch (TT) are different ap- ergy exchange during which the practitioner uses the proaches to healing with touch or the hands as a focus for facilitating healing.”18 hands, both methods were developed and promoted within the nursing profession. As such, most of the The view of the client or patient in these modali- individuals who practice HT and TT are nurses. HT ties is that he or she consists of physical, emotional, and TT are often used in settings in which traditional mental, and spiritual aspects, each of which can be in- medical care is offered, such as hospitals and clinics. fluenced to assist the person’s capacity to self-heal. However, this type of healing can be done anywhere. This is the foundation of HT and TT practice. Both Although both modalities use the word touch in their methods promote healing for the individual’s “high- name, actual physical touch is not required in the ap- est good,” meaning that the cure is not necessarily the plication of either modality. HT and TT are consid- focus; the focus is the individual facilitating his or her ered energy-based or biofield therapies. own growth or undergoing “self-healing.”30 Each method is believed to be useful in a variety of ways, in- HT and TT are contemporary interpretations of cluding reducing pain, decreasing anxiety, and accel- ancient healing practices. HT uses physical touch to erating self-healing. It is important to realize, how- influence the human energy system, thus affecting ever, that the response to these healing methods is physical, emotional, mental, and spiritual health. TT individualized. 184

CHAPTER 13 Healing Touch and Therapeutic Touch 185 HT and TT are often used to augment traditional classes and levels of training over several semesters. or “routine” medical care, which currently is consid- Although her foundation was TT, she realized what ered the “standard of care.” Such use has been re- she was teaching included other techniques as well. ferred to as integrative, which implies that these tech- Therefore the term healing touch was eventually coined niques or systems have been outside the biomedical to describe her method. model and are now being integrated into the com- monly accepted system of health care. In the future, it In 1988 a group of nurses who had been teaching may be that other systems of care based on holistic a variety of healing techniques came together at the methods that consider a patient’s physical, emo- request of the American Holistic Nurses Association tional, mental, and spiritual aspects may serve as the to bring a healing program forward as a certificate standard of care, and that biomedical techniques will program of the organization. Because HT had already be integrated into that system. been taught as a series of courses, the group decided to support this program. It was first offered as a pilot HISTORY project as a weekend or intensive course at the Uni- versity of Tennessee and in Gainesville, Florida, in The art of healing is a basic human practice found 1989, and became a certificate program of the Ameri- across cultures and time. Modern medicine is rela- can Holistic Nurses Association in 1990. During its tively new in contrast to these ancient forms of heal- first year, 25 programs were offered across the United ing that involve energy or biofield therapies. Energy- States. By 1997, there were more than 500 programs based therapies were described as early as 2500 to available. More than 55,000 people have taken at least 5000 years ago in the writing of Huang Ti Ching Su Wen the first level of the course, and there are almost 2000 of China, the source of basic concepts in Chinese certified practitioners of HT as of this writing. In ad- medical theory.11 In addition, ancient carvings from dition to the United States, courses have been taught the Egyptian Third Dynasty depict the use of the in Canada, New Zealand, Australia, South Africa, hands to heal.24 Peru, Great Britain, Finland, Netherlands, Germany, France, Romania, and Trinidad-Tobago. As its popu- Healing Touch larity continues to spread, HT is being brought to ar- eas where medical care is limited and the need is The Healing Touch Program developed from the great, such as South America and Africa. energy-based healing practice of a nurse, Janet Ment- gen, in the early 1980s.29 Mentgen’s introduction to Janet Mentgen continues to be an active teacher healing came when she attended a beginning lecture of the program and its instructors today. Throughout on TT presented at a conference near Denver. She her work she supports the program’s vision to take later met the instructor and was invited to the ad- HT to all people who affect health care. She believes vanced class in TT the next day. After this exposure, that “we are teaching how to do the work and nobody she took a TT course at a local hospital in the Denver owns the work. It is a collective.”18 area, where she realized that she had the ability to fa- cilitate others’ healing, see auras, and develop her in- In 1996 Healing Touch International, Inc. (HTI), tuition. She left her nursing job to develop a healing was formed as a nonprofit education corporation to practice full time and taught continuing education administer the HT certification process for practi- classes on healing in nursing at the local community tioners and instructors. HTI is also responsible for college in Red Rocks, Colorado. To expand her clini- the International Standards of Practice and Code of cal skills and her understanding of energy-based ther- Ethics for HT practitioners worldwide. apies, she continued to study with a number of ther- apists and lay healers in different alternative Therapeutic Touch therapies, and gained extensive training in biofeed- back. She integrated what she learned into the college TT was developed by Dolores Krieger in the early classes she was teaching, and began to offer different 1970s. Krieger’s interest in touch evolved from her re- search interest in healers and her interactions with Dora Kunz, a clairvoyant and noted healer. She tells her story in the book The Therapeutic Touch: How to Use Your Hands to Heal.13 Krieger said that Dora Kunz, who

186 P R I N C I P L E S A N D P R A C T I C E O F M A N U A L T H E R A P E U T I C S was able to see the subtle energy patterns (auras) tinue to rise in popularity as complementary thera- around individuals, studied with Charles Leadbeater, pies are offered in hospitals. Some hospices for exam- a twentieth-century “seer,” since the time she was a ple, encourage HT and TT training for all nursing child. With this training and ability, she worked staff. At Wilcox Hospital in Kauai, Hawaii, 95% of the throughout her life to use her hands as instruments doctors have given blanket permission for nurses to of healing with noted doctors and scientists. When use HT on their patients. Even State Boards of Nurs- Krieger first met her, Kunz was studying the processes ing (e.g., Nevada) are suggesting that Healing Touch of different healers, including Oskar Estebany. be considered standard nursing care. Mr. Estebany had been a colonel in the Hungarian PRINCIPLES, PHILOSOPHY, cavalry. When his horse became ill, instead of putting AND DIAGNOSIS the animal to sleep as advised, he worked all night massaging, caressing, talking to, and praying for her. HT promotes self-healing for the individual’s highest In the morning, much to his and others’ surprise, the good, meaning that “cure” is not the focus; the focus horse was well. After that incident, others brought is the facilitation of self-healing and growth. This is their animals to him. A desperate father once asked accomplished by restoring balance and harmony in Estebany to heal his child. Although he declined at the human energy system, which can benefit clients first, Estebany relented and worked on the child, who with any number of physical ailments, from specific recovered. Estebany eventually came to Canada and problems to systemic imbalances.9 TT also accom- became part of a research study that Krieger was ob- plishes these goals. It is administered with the “intent serving. A subsequent study allowed Krieger to work of enabling the person to repattern their energy in the more closely with Estebany. Although she found his direction of health.” TT works with the individual and technique quite simple, she was unable to capture his facilitates healing. “intense interior experience.” Estebany did not believe that people could be taught a method that would al- The foundations of HT and TT are similar. The low them to do what he did, because what he did was body is seen as an internal energy system that inter- the result of a “gift” imparted at birth. Dora Kunz acts with the external world, and the healing force is thought differently and agreed to teach others, in- thought to come from another source such as the cluding Dolores Krieger. That was the beginning of universe.1 Human beings (and all living things) are their life-long relationship. connected through the unity of creation. Conse- quently, even a small amount of interference in the Krieger went on to offer a class called “Frontiers pattern of energy affects the entire structure of the in Nursing: The Actualization of Potential for Thera- universe simultaneously.8 peutic Human Field Interaction,” within the master’s degree program at New York University. TT is now The interconnectedness of the body and mind is taught around the world to nurses and others in con- one way to understand the basis for these techniques. tinuing education programs offered through univer- Many people are now aware of this interconnected- sities and professional organizations. ness, in part because of the effect that stress and other consequences of contemporary life have on the body, The Nurse Healers Professional Associates Inter- especially the immune system, resulting in increased national, Inc., is the official organization of TT. It incidence of heart disease, cancer, depression, was developed in 1979 as a “body of professional per- asthma, and arthritis. If a person is stressed and anx- sons in the health field who are interested in heal- ious, the body becomes tight and conditions such as ing.”15 The form of TT associated with this organiza- sore muscles, tension headache, and hyperventilation tion is referred to as the Krieger/Kunz model of TT. may develop. A person who is aware of what is hap- pening to his or her body during stressful periods is Healing Work Today able to consciously work to alter these symptoms. Conversely, if no action is taken, this stressed state A recent study found that 13% more individuals are can eventually lead to disease. using complementary therapies than 5 years ago, and that energy healing is one of the forms of therapy that The body’s molecular structure is actually a com- has increased to the greatest degree.6 HT and TT con- plex network of interwoven energy fields, and is nour-

CHAPTER 13 Healing Touch and Therapeutic Touch 187 ished by subtle energy systems affected by our emo- Figure 13-1 The seven major chakras. tions, level of spiritual balance, nutrition, and envi- ronment.8 We are all a part of and contributors to this body,” or higher potential and is about speaking our subtle energy field.25 Although recent research has led truth. The body of the sixth chakra is often called the some to state that the energy field does in fact exist “third eye,” and is about “sight” (involving intuition and can be measured,22 our understanding of how and insight). The body of the seventh or “crown” these techniques actually work is still theoretic. chakra is related to the spiritual realm and our spiri- It is known that every unit of matter can be bro- ken down into smaller and smaller parts until what remains is a signature vibration. When two objects have similar natural frequencies, they can interact without touching and their vibrations can become entrained and can resonate. This is one of the theories that supports touch therapies, because the therapist and client entrain and seek a higher vibration that af- fects the healing process.3 Modern interpretation of the human energy field or the designation of the field is extrapolated from ancient systems. The meridian system found in tradi- tional Chinese medicine can be traced back thou- sands of years, as can the chakra system found in the texts of ancient India. The chakra system is the energy system that is identified and manipulated within HT and TT. Chakra, a Sanskrit word used by the Hindus, means wheel of light.5 Seven chakras constitute the ma- jor energy centers of the body, and minor chakras are found over the joints and throughout the body (Fig- ure 13-1). These centers are not static; their motion in a healthy individual has been described as “beauti- fully balanced, symmetrical and organic with all the parts flowing together in a rhythmic pattern. Their motion is, in fact, harmonic or musical in character, with rhythms which vary according to individual, constitutional and temperamental differences.”12 According to Bruyere,5 each of the seven major chakras has a physical, emotional, creative (or men- tal), and spiritual (or celestial) component. The en- docrine system is believed to be closely associated with the functions of the chakras.2 In addition, each chakra has a purpose or body. The body for the first chakra, which deals with survival and physical sensa- tion, is the physical body. The body for the second chakra is the emotional body, related to the people with whom we share our feelings (e.g., spouse, chil- dren). The body for the third chakra is the mental body, which has to do with thoughts, opinions, and will. The body for the fourth chakra is the heart cen- ter or astral body, which bridges between the material and spirit. The body for the fifth chakra, the etheric body, is the template for the perfect body, “light

188 P R I N C I P L E S A N D P R A C T I C E O F M A N U A L T H E R A P E U T I C S tual life. Each of the seven chakras is also associated process. Watson’s work in the transpersonal-healing- with a color. caring framework provides more explicit application of energy therapies to the holistic health care needs of The human aura is viewed as the totality of the clients.31 Some of the premises of this model include human being; what we actually see is only part of this being vulnerable; cultivating the ability to ground, physical manifestation. Dora Kunz was noted for her energize, and center the self and the other; using fo- ability to see and interpret human energy fields.16 She cused intentionality to potentiate wholeness, har- saw them as concentric spheres that are part of the mony, and healing; and being mindfully present. The universal field of the entire earth. Auras are like a model also encourages connecting with the deeper “moving picture . . . in an ongoing process of living.”16 self, cultivating an awe of the unknown, and convey- They are usually ovoid, with many colors depicting ing caring and acceptance for others. the emotional energy. Auras can vary in size without a “true” norm. They can be about 12 to 18 inches and Diagnosis can expand or shrink considerably. The chakras, as energy centers, are believed to function as both trans- No medical diagnosis is made with HT or TT. HT and mitters and transformers of energy from field to field, TT help a person to self-heal, promoting the client’s acting to synchronize the emotional, mental, and health and well being by maintaining balance within etheric energies.12 the energy field. The ability to see or detect an aura is not a re- If the person offering the healing session is a quirement for the provider of HT or TT treatment. nurse, a nursing diagnosis may be used. The termi- Nor is it necessary for clients receiving the healing to nology of nursing diagnoses has been developed have knowledge of or belief in the theory or explana- through The North American Nursing Diagnosis As- tory rationale. sociation. The nursing diagnosis for working with the body’s energy system is: “Energy field disturbance: Three modern nursing theorists, Rogers, Watson, a condition in which a disturbance of the human and Newman, have been influential in the develop- energy field manifests a disharmony in the human- ment of HT and TT. Rogers’ theory of the Science of environmental energy field mutual process.”17 If the the Unitary Human Being has formed the basis for practitioner/healer is not a nurse, he or she will use much of the research that has been conducted on TT other terminology to describe this imbalance. as a healing modality.27 The theory posits the four meta-paradigms of man: health, environment, and Many of the words that have been used to describe nursing in interaction with a dynamic health-pat- energy imbalance are associated with the senses. terning model that actualizes potential. What are the Words associated with sense of touch or feeling, for four things? They are the study of “unitary, irre- example, include congestion, spikes, heat, and cold. A de- ducible, indivisible human and environmental fields: scription based on sight may use words that describe people and their worlds.”28 Margaret Newman was a color, such as gray or brown, or shade, such as dark or student of Rogers and has explored the mutuality of light. The visual sense might also include terms such the interaction between nurse and client, the unique- as murky or thick. Descriptions based on the auditory ness and wholeness in the pattern of the interaction, senses might include words like buzzing or hum. The and movement to a higher consciousness.19 The olfactory sense might assign a smoky or pungent odor. founder of nursing, Florence Nightingale (1820- The intuitive sense can also be developed. Although 1910), described nursing as developing the ability to the practitioner watches for these changes in the en- put patients in the best condition for nature to act ergy field of the patient, it is not necessary to be able upon them.20 She recognized the healing properties to detect them to conduct a healing session. Al- of the environment, including fresh air, sunlight, and though many beginning practitioners and even some warmth, and saw people as complex beings insepara- advanced practitioners have not yet learned to trust ble from their environment. their senses, the healing work still can be done effec- tively. However, it should always be remembered that Jean Watson’s postmodern framework of trans- the client directs the session. Belief in the system is personal care has proposed that modalities that in- not necessary, although it is usually considered help- volve touch flow from a spiritual path of human development and form the foundation for transper- sonal practice.31 HT provides a way to articulate this

CHAPTER 13 Healing Touch and Therapeutic Touch 189 ful. Clients identify their goals for the work in discus- • The name of the practitioner’s supervisor, if sion with the practitioner and a mutual goal set is es- any tablished. For example, if a client desires freedom from pain, a mutual goal for the session may be to • The fees charged for the service and how they work for that person’s highest good in reducing his or may be paid her pain. • A brief summary of the theoretic approach Practitioners of HT and TT follow the basic used guidelines established within the curriculum of study for their respective modalities. Each curriculum • Information concerning the assessment and teaches the healer to follow the nursing process. This recommended service, including the duration involves a step-by-step protocol, which includes an of services energy-based interview, energy field assessment, plan A promise of courteous treatment and intervention using one or more of the HT tech- niques or TT, and evaluation. Again, the client re- •• Assurances that records are confidential and mains the central focus. The healer is there to facili- will be made available to the client tate the client’s healing. • A statement that other services may be avail- PRACTICES, TECHNIQUES, able and where information regarding such AND TREATMENT services may be found Touch can benefit clients with any number of physi- • A declaration of the patient’s right to choose cal ailments, specific problems as well as systemic im- and/or change providers balances. It can assist with pain reduction, wound healing, postoperative recovery, spiritual growth, and • A statement regarding the client’s right to re- relief of symptoms. fuse treatment Interaction of the Client Constraints of the Practitioner and Practitioner Anyone can do HT and TT, regardless of age, physical The interaction of the client and practitioner may in- condition, or education. The healing work can be clude a formal or informal contract. The client has provided by nonprofessionals for family members the ultimate responsibility for his or her healing, and friends. It may also be incorporated into the rou- whereas the practitioner is obligated to provide the tine care provided by professionals such as nurses or client with information about what is being per- massage therapists. For example, a nurse may smooth formed and the expected outcome. No false promises the energy field above a patient’s arm before and after of a “cure” should be made, because this is not the fo- inserting an intravenous line, with the intent to ease cus of treatment. insertion, decrease discomfort, and repattern the en- ergy field. A massage therapist may perform a tech- Certain information should be provided before a nique such as mind clearing (from the HT lexicon) to session. An example is the information that has re- promote relaxation before beginning the massage. cently been mandated by the state of Minnesota in The techniques can also be helpful for managing the the Minnesota Uniform Health Care Act (HF No. practitioner’s own health and well being. 3839). According to this Act, which is referred to as the Complementary and Alternative Health Care Practitioners who have pursued the healing work Client Bill of Rights, the following information must to a more advanced level with extensive study may be provided before a healing session from an alterna- elect to offer the service to others in a more compre- tive provider begins: hensive way. One way to do this is as part of an exist- ing professional practice. For example, an HT or TT • The degrees, training, experience, or other practitioner may be employed by an institution (e.g., qualifications of the practitioner hospital, hospice, or wellness center) to provide treat- ment to clients who request it or for whom it is rec- ommended. This service may or may not be part of routine care at the facility. Another way to provide a more comprehensive service is to establish a private practice in which the client can individually contract for the treatment. A practitioner who has a physical limitation may practice in any of the ways described, although this

190 P R I N C I P L E S A N D P R A C T I C E O F M A N U A L T H E R A P E U T I C S may require making adjustments regarding time, set- congestion (in this case, the anesthetic residue) from ting, and techniques used. Many of the techniques the energy field, allowing the person to awaken can be practiced without physically touching the sooner and with fewer side effects.9 body and may be provided even from a distance. HT and TT can be used to promote health and Practitioners develop confidence with time and, well being. The focus on maintaining balance within more importantly, with practice. The HT program in- the energy field is a preventive strategy. HT and TT cludes many different techniques for beginning and also have the potential to beneficially affect individu- advanced practitioners. Although the TT method is als with a variety of conditions—they may be used to relatively simple to master, it takes time to become decrease pain and bleeding; relieve headache pain; proficient. The healer’s comfort level with using ei- help break up congestion; aid in the healing of frac- ther of these therapeutic modalities varies with expe- tured bones, tendonitis, and tumors; and promote re- rience and training. Attributes of an effective healer laxation and improve mental focus.9,14 In addition, include the ability to set intention to the highest preoperative and postoperative energy work can help good of the client, the motivation to help another, an prepare patients for surgery through relaxation and open mind, an open heart able to provide uncondi- energy balancing, thus improving the rate of recovery. tional love and acceptance, and the ability to let go of Evidence also suggests that TT has beneficial effects expectations. for pregnant women and people suffering from psy- chiatric disorders. Mutual interaction is inherent in the healing process. Therefore a person who is engaged in healing There are some constraints on the application of is also engaged in self-healing. It is important to HT and TT techniques. For example, with the very recognize this mutuality. During training, healers young or old and the very frail it is best to work for must commit to being aware of personal qualities short periods of time. However, the amount or inten- that need to be refocused or redirected to health and sity of the energy is less important than the ability of healing. the therapist to “integrate the healee’s energies into a synchronous flow.”14 In HT it is believed that no Indications and Contraindications harm can be done during a session if the intent of the provider is applied to the client’s highest good and There are no contraindications for using HT or TT. follows the direction of his or her energy. Working Because HT and TT are noninvasive techniques that within this framework, only the energy that is needed do not present any documented risks, they can be is available to the client. During the interaction, there used for all conditions. This does not mean to imply should be dialogue between the practitioner and that they are the only treatment modalities for illness client so that if problems do arise they can be ad- or emotional distress. They should be used in con- dressed. If a situation or problem arises that was not junction with traditional medical care. Ideally, there present before the session it “most likely has an ener- should be interaction among all health care profes- getic component and will dissipate if you work sionals involved in assisting a client to manage his or through it.” her health. There is a somewhat different view in TT practice. It has been noted that 33% of clients do not The Policy and Procedure for Health Professionals inform their physicians that they are engaged in com- states that TT “does not usually exceed 30 minutes.” plementary therapies.6 Physicians may not under- It has been suggested that a treatment session should stand the risks and benefits of different complemen- not exceed 20 to 25 minutes because it is believed pos- tary therapies, which may cause confusion and sible to “overdose on energy.”14 discord. However, primary care providers and others involved in patient care should be aware of the vari- The response to HT and TT may be immediate or ous therapies being used (a cogent argument for cur- may take several hours or days. There may be a sense riculum development in medical schools and schools of general relaxation, comfort, or increased sense of of allied health professions). For example, when the well being. There may also be tension release that may HT technique of magnetic unruffling is used it may al- manifest as crying, slowing of breathing, and decrease ter postoperative recovery. It is postulated that this in heart rate, blood pressure, perspiration, and other technique helps to remove accumulated debris or bodily sensations.

CHAPTER 13 Healing Touch and Therapeutic Touch 191 Techniques fied a particular area of concern, additional tech- niques are used. For example, local techniques in- Healing Touch clude the pain drain for pain relief; “ultrasound” to break up congestion; and modulation of energy to aid In HT the practitioner first interviews the client re- in the healing of fractured bones.9 Other localized garding treatment goals and then assesses the energy techniques can be used to promote relaxation and in- field. Depending on the length of time available for a crease focus. Full-body HT techniques such as the session, techniques that best meet the client’s needs lymphatic drain and chelation are used for systemic at the time are selected. The client is usually asked to imbalances and transitions, and usually take more lie on a massage table, but treatment can be given in time to complete. The full-body techniques promote any position or in any setting (e.g., hospital bed, chair, complete balancing of the entire energy field and usu- home, or office). The client remains fully clothed; a ally have more sustained effect. blanket or light covering may be placed over the client for comfort. The practitioner may use light touch on While providing treatment, the healer may place certain areas (e.g., the joints, chakras, or problem his or her hands directly on the clothed body, or may area) of the body after confirming that the client is choose to situate them a few inches above the body if amenable to touch. All techniques can also be done this is more comfortable for the client. During the without touching, and certain techniques are rou- session the client may experience a variety of re- tinely performed this way. sponses, including falling asleep, visual or sensory ex- periences, or a sense of peace. After the session the The treatment session varies depending on the healer evaluates the outcome by performing another setting and on the health condition, age, need, and energy assessment to determine whether balance has desire of the client. HT sessions can take from a few been achieved and eliciting feedback from the client minutes to an hour. The healer first centers himself or about his or her experiences. This information is doc- herself before discussing the client’s concerns. This umented on the client’s record. communication requires a relaxed body, a clear mind, and a sense of spiritual calm. The healer focuses on Additional techniques are taught in Advanced the client’s highest good without imposing his or her Practice classes, which are delivered solely by Janet own wishes or desires for the outcome of the session. Mentgen, the founder of HT. These advanced tech- The discussion may reveal the reason for the visit, de- niques are not included in the standard program of scription of the problem, and the client’s goals. The study for certification. They are used for balancing client then lies prone or sits in a chair. The practi- the system at multiple levels, deeper spiritual healing, tioner then assesses the energy field surrounding the healing of chronic pain from traumatic events, and client by sweeping the hands several inches over the aligning the energy centers. The practitioner’s voice client and noting any changes in the energy field, may also be used to promote relaxation. which can be felt as tingling, warmth, and coolness, among other sensations. A pendulum can also be Therapeutic Touch used as an assessment device to indicate whether the major energy centers or chakras are open and func- TT was first described as a five-step procedure of cen- tioning. tering, assessment, unruffling, directing, and modu- lating the transfer of energy, and recognizing the time A nursing diagnosis may be made based on these to stop.13 This five-step procedure is now referred to findings. The planned intervention then uses one or as the Krieger/Kunz method. Centering involves “bring- more of the HT techniques to provide balance in the ing body, mind, and emotions to a quiet, focused energy system. If a full session is being offered, it usu- state of consciousness.”21 Assessment of the energy ally begins with an opening technique or full body field around the client involves the basic principle of technique that balances the entire system, such as symmetry. The field should feel the same on both chakra connection, spiral opening, and full-body con- sides; dissimilarities have often been described as ar- nection. Table 13-1 presents the goals, indications, eas of congestion, prickling, heat, or coolness. Unruf- and a brief description of the major HT full-body fling or clearing involves movement of the hands out- techniques. If any imbalances are noticed while the ward toward the periphery of the field so that there is initial technique is applied, or if the client has identi- a gentle sweeping of the pressure or congested areas

192 P R I N C I P L E S A N D P R A C T I C E O F M A N U A L T H E R A P E U T I C S Selected Healing Touch Techniques TABLE 13-1 Full-body Goals Indications Brief description techniques Systemic or chronic dis- Practitioner places the hands lightly Chakra con- Open and balance the ease, trauma, anxiety. on the body or off the body, start- nection energy centers. ing at the feet, and holds each po- Postanesthesia, smoking sition for about 1 minute. The Magnetic Cleanse and clear the (current or past), hands gradually move up the body unruffle body or remove con- chronic pain, trauma, over the joints of the legs and gested energy and medication or drug arms and the major centers on the emotional debris. use, systemic disease, trunk and head. and emotional clear- Chakra Open chakras and ing. With hands above the body at all spread promote deep heal- times, the practitioner starts at ing. Transitions: to ease dy- the head and moves slowly down ing, severe pain, severe to and off (above) the feet. Re- “Ultra- Provide deep penetra- stress, and spiritual peated on each side of the body sound” tion to facilitate growth. until the practitioner feels the field healing by breaking is clear, usually approximately 15 Pain drain up congestion, pat- Pain (e.g., arthritic minutes, more or less. terns, and blocks. joints), decreasing bleeding, sealing lacer- Practitioner holds each foot and Remove pain or con- ations, ear or eye then each hand, then works above gestion. problems, fractures the body, starting at the head and joint injuries. with hands together and gently Wound Repair field from inci- opening each chakra down the sealing sions, trauma, or Acute and chronic pain body. Practitioner ends by holding childbirth. from injury, surgical the client’s hand and placing incisions, and disease other hand over the heart. Unruffling Remove congestion. process. and pain Practitioner directs the finger at the ridge New wounds and old area above the body. The hand wounds that have re- moves. Can be done for a few mained painful or cre- minutes or more. ate discomfort. Practitioner places one hand on or Pain (acute), anxiety, above the painful area until a stress, nausea and change is felt and then places the vomiting. other hand on or above the area. Usually takes 5-10 minutes. With the palms down, practitioner moves hands back and forth slightly above the injured area for a short time, gathering energy, and then holds palm directly over area for 1 minute. Calm and rhythmic movements of the hands, palms facing the body at a distance of 1-6 inches, brush- ing down and away from above to below.

CHAPTER 13 Healing Touch and Therapeutic Touch 193 in the energy field. Directing and modulating energy in- throughout the HT program because it is the basis volves transferring or channeling energy to the client for transferring the focused, intentional energy that is and also modulating it so that part of the field may be needed to perform HT with others.9 The learning energized and another calmed. process is life-long, and requires commitment to self- healing and spiritual discipline through adequate TT treatment is individualized and is usually rest, a healthy diet, and striving for emotional bal- done with the fully-clothed client sitting in a chair or ance.7 reclining, whichever is more comfortable. The practi- tioner’s hands, held approximately 2 to 4 inches The Code of Ethics developed by HTI in 1996 is above the client’s skin, are passed from the head to based on the premise that HT helps the client to self- the toe, both front and back, to assess the field. The heal and is based on a heart-centered, caring relation- therapist may then use rhythmic, sweeping motions ship. The client is not judged and his or her human- of the hands, perhaps touching the client. The hands ness is respected because he or she is considered may then be placed gently on or slightly off the body whole and holy. The client is seen as part of a unity over an area that was felt to be dissimilar or a place and individual rights are upheld. Respect for coping the client identified as having a problem. When the mechanisms is always maintained. The client’s health practitioner believes the session is complete, he or she care choices are honored and interventions are based rechecks the field. on energetic assessments, which are documented. In- formation is provided according to expressed need, Differences context, and personal situation. The confidentiality HT and TT are very similar disciplines, yet there are of the client is respected. Adhering to the principle of differences between them are minor. HT uses a “do no harm,” no energy is given beyond the person’s greater variety of techniques for specific purposes capacity to receive it. Appropriate health care referral than TT. The hands may be placed on or over the is made whenever necessary. Practitioners practice body more often in HT. TT sessions are usually within the scope of their background and training shorter, although they may last as long or longer than and meet their obligations accordingly. Supervision an HT session, depending on the circumstances in and consultation are sought when needed. which they are offered. The training programs are dif- ferent. (See the following.) There are eight standards of practice, which de- scribe facets of what the HT practitioner must do or TRAINING AND be. These standards follow: CERTIFICATION 1. Integrates HT within the scope of his or her The programs of study in HT and TT were originally background, and clearly represents back- offered only to nurses, but are now available to others ground to the client and public interested in healing. “Any man or woman—given real interest and prompted by the incentive to serve—who 2. Is a resource within the community for infor- thinks and loves can be a healer.”2 The focus is on a mation regarding the practice of HT “heart-centered” approach in which peace and calm provide the foundation for the interaction between 3. Has a good grasp of the theoretic base of HT client and practitioner.10 It is important that practi- and maintains a commitment to continual tioners be present in the moment so they can listen to learning the clients fully. 4. Obtains health information and energy assess- Healing Touch ment from the client There are several levels of training in the course of 5. Assesses the energy system of the client study for HT practitioners. Self-care is stressed 6. Facilitates the healing process but allows the client to guide the pacing, openness, and in- tensity of HT at all times 7. Respects the client’s spiritual beliefs and prac- tices by operating from a broad, universal con- cept of spirituality 8. Explains the treatment fully, allowing the client to be a knowledgeable participant in the healing process, based on his or her ability

194 P R I N C I P L E S A N D P R A C T I C E O F M A N U A L T H E R A P E U T I C S Training •• Level II includes 30 or more hours divided into two training sessions. The person learns A person can take as few as one or as many as all of healing sequences for specific client needs the available courses to become a practitioner of HT. (e.g., back pain) and also develops therapeutic It is a multilevel continuing education program of interaction skills. 120 hours of standardized curriculum. Each level in- • In Level IIA the content includes develop- cludes both didactic and experiential learning (e.g., ment of assessment, interview, and docu- lecture, practice of techniques, and exercises to en- mentation techniques. Specific techniques hance learning). The program is sequenced in five lev- for working with the back and neck, se- els of instruction: Level I, Level IIA, Level IIB, Level quencing, wound closure, pain manage- IIIA, and Level IIIB. An additional level is for instruc- ment, and spiral meditation are presented. tor training. A 1-hour healing sequence for specific client problems is conducted. Level of Practice • In Level IIB the content includes self-care techniques that support the process of be- The level of practice a practitioner may establish is coming a healer. The philosophies of noted based on his or her training. The “Student of Healing healers such as Brennan, Bruyere, and Bailey Touch” has completed the Level I course taught by a are reviewed. The student learns Hara align- certified instructor and is actively participating in the ment meditation and advanced techniques HT educational program. The “Healing Touch Practi- such as etheric unruffling, lymphatic drain, tioner Apprentice” has completed the Level IIIA course chelation, and spinal cleansing. Instruction (the fourth course) and is participating in a minimum is provided on advanced studies of the hu- 1-year mentorship process. The “Healing Touch Practi- man energy system, including chakra func- tioner” has completed 120 contact hours of course tion, aura perception, layers, and energy work within Levels 1 through IIIB and has received a blocks. The perceptual tools of the student Certificate of Completion from the Healing Touch are developed. The student views healing Program Director. The “Certified Healing Touch Prac- from the standpoints of practitioner, client, titioner” is an HT practitioner who, in addition to and observer or coach and performs a com- completing the program of study, has met the certifi- plete treatment session. cation criteria established by HTI and has been re- viewed and approved by the HTI Certification Board. • Level III includes two educational sessions with a 6-month to 1-year course of study in Program Description, Objectives, and Content between. The focus is on case studies, mentor- ing, ethics, client-practitioner relationships, The program includes four levels from beginner to in- practice establishment, and integration of structor. The second and third levels are divided into community. There are specific requirements two separate courses. for practice, education, and service for suc- cessful completion of this level of study. A cer- • Level I usually consists of 20 hours of instruc- tificate of completion is awarded. After com- tion. The content includes the basics of the pleting Level III, students can apply for chakra and energy systems and the concepts certification as an HT practitioner. of the human energy field as it relates to mod- ern scientific principles. The student learns • An additional level is for certified practitioners how to assess the energy field with hand scan- who are interested in teaching HT. Instructor ning and the pendulum. Centering techniques training involves additional course work and a are developed and the student is introduced to minimum of seven supervised teaching experi- therapeutic touch. Intervention techniques ences. for stress, pain, and balancing are taught, in- cluding magnetic unruffling, chakra connec- Certified Practitioner tion, ultrasound, laser, chakra spread, and headache techniques. A discussion of how to An HT practitioner obtains certification from HTI by apply HT in personal and professional prac- submitting an application documenting that he or tice is provided. Principles of self-healing and she has met the criteria established. The application personal development are explored.