Blind Acupuncturists, Insertion Tubes, Abdominal Diagnosis, and the Benten Goddess
The development of acupuncture in Japan, with its unique style we recognize today, has been attributed to Waichi Sugiyama, who is known as the "blind acupuncturist." Born into a samurai family in 1610, he went blind at an early age. For the blind in Japan, the primary jobs available were acupuncturist, moxibustionist, or massage therapist. He chose to be an acupuncturist.
At eighteen, he left the country home of his well-to-do parents and traveled to Edo (now called Tokyo), where he met his first teacher, a sighted acupuncturist named Takuichi Yamase. But, his skill did not progress as he had hoped. After five years under his tutelage, Takuichi threw Waichi out, saying his pitiful techniques would forever keep him from being an accomplished acupuncturist. Heartbroken, Waichi began the long journey home, but halfway there, he collapsed from exhaustion in the town of a famous doctor. As fate would have it, this doctor had been Takuichi's mentor and, after regaining his health, Waichi got another stab at being a disciple of an acupuncturist.
With practice, Waichi's needling skills progressed, but, even after a few years of dedication, he still wasn't good enough to practice on others. Desperate for help, he traveled to Enoshima, a small islet about 30 miles from Edo, to pray to Benten for better skill. Benten is the only female deity among the seven Japanese gods of good fortune. She is goddess of language and literature, love and wisdom, music, and the sea. Benten was originally a Hindu goddess (Sarasvati in Sanskrit) later adopted by Buddhists in India. She was enshrined in Japan by the Shogun Yoitmo Minamoto (1147-1199) in support of Buddhism. The Benten figures are usually placed near water's edge to serve as a guardian deity of sea voyages.
The Benten enshrined at Enoshima was reputed for her ability to fulfill the wishes of worshippers, but access to the cave with her statue was restricted to special visitors. In 1600, the Shogun Ieyasu Tokugawa (1542-1616) visited the Enoshima Benten and made the site an official prayer hall for the Tokugawa family, which spurred the faith in Benten. In 1603, the temple/shrine complex was opened to the public. It is now a Shinto shrine.
Waichi stayed at the shrine, fasting and praying in the cave for three weeks. At the story goes, when he came out of the cave after the fast, he stumbled over a stone (see Figure 1). As he fell to the ground, a pine-tree needle stuck deep into his leg. Cursing, he picked it up, and, as he did, he realized that it was sticking out from a reed of bamboo. Inspiration struck: for the acupuncturists, it is a critically important to stick the needle straight down and attain the proper depth: this pine needle in its bamboo cradle had done just that. Upon his return, he began using a small pipe to help guide the acupuncture needle vertically to pierce the patient's skin. That bamboo reed became the basis for a device known as a kudabari¾ a needle insertion guide tube that is now standard equipment for both blind and sighted acupuncturists worldwide.
Waichi's innovation made him a successful acupuncturist; he is credited with having developed 100 acupuncture techniques. Waichi's skill was proven when his acupuncture skill cured Shogun Tsunayoshi Tokugawa (1646-1709) of a serious illness. As an expression of gratitude, the Shogun retained him as his personal physician, conferred the title of Kengyo, the highest official title given to the blind, and he gave Waichi a chunk of land, which became the home to Shinji Koushujo, Edo's first organized school for the blind. In appreciation of his success, Waichi donated a three-story-pagoda in the name of Benten (which was, unfortunately, removed after the Meiji Restoration) and he had 47 mileposts built between Enoshima and Fujisawa, of which 11 are still in existence. He visited Enoshima so often to worship Benten that he was not always available when Shogun Tsunayoshi needed him. To keep Waichi nearby, the Shogun erected a mini-temple sacred to Benten in Waichi's residence.
By the time of his death in 1694, at the age of 84, Waichi had established 45 acupuncture schools for the blind throughout Japan. By having books read to him, he studied and then simplified volumes of ancient medical texts, making a substantial body of knowledge available to the blind on a practical level. The stone Waichi had tripped over at the Benten shrine became known as the "Stone of Good Luck." The Benten statue, to which Waichi prayed, was damaged after being set aside during an anti-Buddhist phase of the Meiji Restoration, and has been reconstructed and is available for viewing at Enoshima, though it serves as a museum piece rather than a sacred artwork due to failure of the reconstruction to match the original.
Waichi Sugiyama, in his teachings, made a significant contribution to the theoretical basis of abdominal diagnosis and influenced the practical method of carrying out the diagnosis. In particular, he relied on study of the Nan Jing to develop a five-element abdominal pattern for detecting imbalances. This pattern involved having the fire element (heart/small intestine) evaluated at the upper part of the abdomen; the water element (kidney/bladder) at the lower part of the abdomen; the wood element (liver/gallbladder) at the left part of the abdomen; the metal element (lung/large intestine) at the right part of the abdomen, and the earth element (spleen/stomach) at the center (see Appendix 1). To perform the diagnosis, he recommended using the palm and finger tips of the left hand to gently touch and palpate the skin surface. There is no deep pressure exerted. The diagnosis proceeds from the center to the left and right, and then from the top to the bottom of the abdomen. Abdominal diagnosis would replace, for the blind, the observational diagnosis of traditional Chinese medicine, such as appearance of the tongue and complexion. Among the features to be felt on the abdomen were temperature variations, tightness or looseness of the skin, tension of the muscles, pain or tensing on light pressure, fluid movements (as occur in the intestines) during palpation, sensation of movement across an abdominal region, and any lumps or swellings.
Soon after Waichi's death, an herb doctor, Todo Yoshimasu (1702-1773; see Figure 2), also gave a substantial boost to the use of abdominal diagnosis. He developed the concept of conformations-symptom/sign complexes-that were to be associated with each of the essential traditional formulas. He assigned the herb formulas to certain diagnostic indicators found by gently palpating the abdomen. Thus, both acupuncture and herb therapy became tied intimately to the abdominal diagnostic method that thereafter dominated the Japanese system for both the blind and sighted acupuncturists.
The guide tube approach to needling allowed for thinner needles to be used. This suited the blind acupuncturists who had to be especially careful about using large needles and deep insertion without being able to see the body. In the modern era, Japan is especially known for its use of very thin needles. However, the shift to the finer needles and the tendency to use these with ever more shallow insertion and little or no stimulus, has led some to remove themselves from any connection to physical reality and to corrupt the acupuncture field with therapies that offer no more than the equivalent of a placebo effect (see Appendix 2).
Unfortunately, when Waichi passed away, funding of the acupuncture schools for the blind dried up, and within a couple of decades, all of Sugiyama's schools were forced to close. Blind acupuncture managed to survive as relatively minor profession during the next 180 years, a time when Western medicine was beginning to supplant traditional Japanese medicine. Then, in 1876, the first new private school for the blind (Rakuzen-Kai) was founded, and spawned the modern era of blind education. Within 20 years, three more private schools were providing training for blind acupuncturists and the field opened up again.
Blind acupuncture is a nationally recognized practice in Japan today. Currently, 30 percent of the roughly 90,000 licensed acupuncturists in Japan are blind. These practitioners work among the sighted practitioners at clinics and hospitals, or carry out private practices, and pass on their skills to others like themselves in special schools for the blind. They hold the same licenses, earn the same wages, and charge the same fees as the sighted acupuncturists. There is a national association for blind acupuncturists (Zenshinshikai) to deal with their unique situation. Blake More of Point Arena, California, interviewed blind Japanese acupuncturists and published his report in the 1995 article Acupuncture’s Blind Side, which appeared in the magazine Time Out, published in Tokyo (for the complete are article, visit http://www.snakelyone.com/BLIND.htm). Information from that article is relayed here, with supplemental information from the schools mentioned.
Tomoyuki Hoshiyama is a blind acupuncturist who teaches at the Hiratsuka School for the Blind (founded in 1910; it offers kindergarten through high school classes to about 100 students) in Hiratsuka City, south of Tokyo. Hoshiyama began studying acupuncture when he was 19, needling his parents for homework in order to perfect his technique; a sacrifice he describes as "painful for them, difficult for me." He says he went into teaching five years ago because he wanted to help other blind people make positive contributions to society. Hoshiyama's wife of two months, Yoko, also teaches acupuncture to blind students. For the last 11 years, she has been working at her famous alma mater, the School for the Blind at Tsukuba University in Tokyo. One of 14 acupuncture teachers instructing 50 students, Yoko says she got into acupuncture for the same reason most blind people do: necessity. "But then, while I was in the clinical aspect of my studies, I began to understand the benefits of acupuncture. As I watched people experiencing good results, I decided that I wanted to study harder and improve my technique so I could offer even more."
Although satisfied with their jobs, both Yoko and Hoshiyama express frustration over the fact that, like others who went to blind schools all their lives, they chose acupuncture more because it was the thing to do rather than because it was their life-long dream. Explains Yoko, "As blind people, we have few occupations available to us, so almost all blind students think about acupuncture at one time or another, particularly if they hope to be productive members of society. Even today, the only proven avenues we have are acupuncture, massage, and music." At the Osaka Prefectural School for the Blind, the course offering notes that: "According to the traditional culture in Japan, almost all of visually impaired persons have gotten a job doing massage, acupuncture, and moxibustion. But, we have three departments to get newer occupations, which are physical therapy, music, and computer science." The courses are offered after graduation from high school.
The majority of Japan's 69 schools for the blind are almost entirely funded by government sources, that is, they are public schools rather than private. About 600 people like Hoshiyama and Yoko-300 of whom are fully blind-teach acupuncture to visually impaired students in Japan. After graduating from high school and before going on to acupuncture school, students must pass an entrance test just as any sighted student would. Explains Hoshiyama, "Since we all take the same national licensing examination, our acupuncture department offers what sighted universities and colleges do. The main difference is that we use Braille and learn on a special practice model with raised acu-points." But there are some professional limitations: blind acupuncturists can't practice in major hospitals.
Among the leading blind acupuncturists is 85-year-old Kodo Fukushima, known as the "godfather" of contemporary meridian therapy and the force behind the enormous Toyo Hari I Teaching Center in Tokyo. His personality is almost as famous as his acupuncture, and he is described as charismatic, dogmatic, charming, and difficult. The 76-year-old Katsuke Serizaw, a near-blind medical doctor and acupuncturist, is another famous personality. He has written numerous acupuncture books for the blind-some of which are available in English-and has upgraded the overall quality of Japan's blind education system.
Some blind acupuncturists from Japan have visited the U.S. to share their knowledge. For example, Five Branches Institute in Santa Cruz, California offered a seminar by Anryu Iwashina, from Morioka City. He graduated from the Tokyo National School for the Blind with a degree in acupuncture more than 20 years ago, and trained with Kodo Kukushima at the Tokyo Hari Medical Association. He has traveled to the United States several times since 1988 to offer free acupuncture treatments to the Hopi and Dine people, and to assist at several Sundance ceremonies.
The Nan Jing (Classic of Difficult Issues) was compiled around the end of the Han Dynasty (ca. 200 A.D.). It is comprised of 81 issues or questions that are concerns arising from the study of the Nei Jing (Inner Classic) that had been compiled during the early Han Dynasty (ca. 100 B.C.). A large portion of the book is devoted to the five elements depiction of disease causation (especially seasonal influences), the associated internal organs (zangfu; see Figure 3), the disease indicators (such as pulse forms), and the use of acupuncture. As is the case with the Nei Jing, herbal medicine is not a concern. An English translation of the Nan Jing, along with commentaries from well-known Chinese doctors who worked during subsequent centuries, was produced by Paul Unschuld.
Waichi studied the Nan Jing extensively, and based his abdominal diagnosis work largely on the contents of the 16th and 56th difficult issues raised in that text. Those sections described movements of qi in the abdomen that corresponded to and preceded (because they were part of the cause) diseases of the five viscera (zang). The implication that he derived from the text was that light touching of the abdomen at the locations indicated in the Nan Jing could detect the moving qi or blocked qi that indicated a disease was developing or already present.
The 16th difficult issue focuses on evidence that localizes a disease to one of the five viscera, to confirm what is felt in the pulse (at the wrist). The information presented can be summarized in a table as follows:
|Organ||Abdominal Indication||Symptoms Reported by Patient||External Evidence|
|Liver||Moving qi detected to the left of the navel; if pressed, this region responds with firmness and pain.||Swollen and stiff limbs; dripping urine; difficult stools; twisted muscles.||Tendency toward tidy appearance; virid complexion; inclination to become angry.|
|Heart||Moving qi above the navel; if pressed, responds with firmness and pain.||Uneasiness of the heart; heart pain; the center of the palms are hot; dry vomiting may occur.||Red complexion; dry mouth, and tendency to laugh.|
|Spleen||Moving qi at the navel; if pressed responds with firmness and pain.||Swollen and full abdomen; food not digested well; body feels heavy; and the joints ache.||Yellow complexion; tendency to belch; tendency to ponder; fondness for tasty food.|
|Lung||Moving qi to the right of the navel, if pressed, responds with firmness and pain.||Panting and coughing; shivering from fits of cold and heat.||White complexion, tendency to sneeze; grief without joy; and an inclination to cry.|
|Kidney||Moving qi below the navel; if press responds with firmness and pain.||Feeling of qi moving contrary to its normal course; tension and pain in the lower abdomen; diarrhea feeling as if something heavy was moving down; feeling cold; feeling of reversed qi in the feet and shinbones.||Dark complexion; tendency to be fearful; frequent yawning.|
In the discussion of the 56th difficult issue, involved with detection of accumulations affecting the internal organs, the Nan Jing states that:
To produce a full system of abdominal diagnosis, the limited indications in the Nan Jing had to be expanded. Therefore, Waichi, and those who followed his example, carefully elaborated sensations felt by the diagnostician of the skin and muscles of the different parts of the abdomen.
Proponents of Japanese acupuncture often point to an advantage that they perceive over the original Chinese system of acupuncture. The latter is portrayed as intolerable to most Americans because of its use of relatively large needles, deeply inserted and strongly stimulated. The Chinese aim is to attain the qi reaction, called deqi, which has a sensation of heaviness, distention, and numbness, often accompanied by an attempt to get transmitted qi: the experience by the patient of the qi sensation propagating from the acupuncture point towards the part of the body where the disease or injury exists. Japanese acupuncture, as promoted in the U.S., is contrasted as involving extremely fine needles, shallowly inserted and not stimulated to get a strong qi sensation for the patient (the acupuncturist, however, likes to feel a slight bobbing of the needle as it is inserted at the point, which is interpreted, instead, as the qi reaction). Indeed, because many Americans have had bad experiences with medical needles-hypodermic needles flushing liquids into the body, stabs of blood sampling needles, IV needles for drawing blood or dripping fluids-they are not drawn to the strong needle sensations, even if not painful, associated with standard acupuncture.
While Chinese acupuncture has been subjected to intensive scientific investigation, Japanese acupuncture is only loosely studied, and its effectiveness, especially when practiced in the very light stimulation forms, is open to question. While practitioners proclaim the benefits they see in their own patients, modern researchers recognize that such observations are often unreliable indicators. Nonetheless, the basic Japanese acupuncture technique is used in Japan by about 90,000 acupuncturists, about 8 times as many acupuncturists as there are in the U.S. So, it is a large field and a good resource for experience.
As some practitioners working in the West attempt to rely on ever more subtle treatments, they begin to develop explanations of how such minor interaction with the patient could possibly have a strong effect on healing. This leads to imaginations about energetics of the body and of the acupuncture needles-concepts that have no known basis in reality and little or no connection to the ancient tradition: they are just projections and guesses. Still, the language of the ancient tradition is used and even the language of modern science is brought in support of the untestable theories and newly devised techniques.
Examples of the corrupting influences are:
As practitioners are encouraged to leave behind the long-standing tradition in order to take up these bogus diagnostics and therapeutics, they are further led to bizarre theories about how the body works. This move away from respect for a long lineage of scholars and dedicated doctors frequently leads to bragging about therapeutic triumphs, ones that are not properly recorded in any serious medical journal. Such behavior serves as an insult to the hard working practitioner scholars of the past who tried to encourage students to seek after the truth, rather than follow every fad.
Figure 2:Todo Yoshimasu (1702-1773).
Figure 3:Japanese map of the abdomen, 1685.