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kAjOM vOlume 16 number 45

5hakuju 1herapy 5eminar
{Part z):
CIinicaI AppIicatien
by Robert Gracey
Introduction
Junji Mizutani Sensei asked me to write a continu-
ation article on the Shakuju Therapy seminar held
this past summer (August 2008) with emphasis on
treatment application. Accordingly, I am pleased
to present a case study that includes a treatment
by Shoji Kobayashi Sensei at the Shakuju Therapy
(SJT) seminar held at the New England School of
Acupuncture (NESA) in Newton, Massachusetts.
I have also summarized a supplementary treat-
ment I learned at this seminar and now use in my
clinical practice.
Please refer to Dr. Cynthia Quattros article (Shaku-
ju Therapy Seminar, NAJOM, Volume 15, Number
44 [2008, November], pp. 4648) for background
concerning this seminar, including relevant SJT
diagnostic and treatment protocols.
This SJT seminar was the seventh I have attended,
in both the U.S. and Japan. The seminar series
started in Boston, MA in August 2004, where
Kobayashi Sensei taught his style of Japanese
acupuncture to a core group of nine students. I
was greatly impressed by Senseis knowledge
and passion, as well as that of his students, Hara
Osamu and Kato Minoru, masters in their own
right. All three generously offered enlightening
instruction, clinical experience, and support in
practicing SJT.
At his clinic in Japan, I watched Sensei methodi-
cally rotate among patients every 15 minutes,
performing treatments with focused intention,
a gentle touch, and warm demeanor. He treated
people of all ages and conditions. Also, he set
aside ample time to answer my questions. These
experiences have enabled me to better imbibe the
subtle qualities of focused intention and gain a
deeper understanding of healing in action.
SJT Seminar:
Clinical Treatment: Shakuju Therapy
Overview
Simply stated, the core concept in SJT is that
disease or disharmony stems from fundamental
defciency or cold, referred to as hie. This cold or
hie can be described as a state of imbalance which
causes a defciency of Essential (Jing) Qi. This state
of imbalance eventually leads to manifestation
of disease that includes patient symptoms and
the main complaint for their reason in seeking
acupuncture treatment. See Exhibit A for details
of the Essential Qi Curve.
The manifestation of this imbalance is depicted
by congestion or stagnation of qi and blood which
is termed shakuju, or accumulations (shaku
deeper) and gatherings (ju more superfcial).
Diagnostically, the shakuju pattern is primarily
determined from areas of hardness, pulsations
and discomfort/pain on the palpated abdomen.
The deeper the congestion or shaku, the more
complex or serious the disharmony. See Exhibit B
for division of Abdominal Five Phase Zones.
SJT treatment strives to correct the energetic
imbalances by warming the cold in the body, or
putting power into (tonifying) the Jing Qi. The
treatment follows a series of systematic steps
to both diagnose and treat the pattern of imbal-
ance (shaku). It starts by working to correct the
superfcial imbalance, or ju, then moves deeper
to rectify the core level of disharmony, or shaku.
Diagnosis requires that the practitioner remain
acutely aware and sensitive to past medical his-
tory and observational stimuli, ranging from such
things as birth trauma to what the patient looks
like, to how he/she sounds and feels subjectively
and objectively through palpation. Treatment
entails a high degree of focused intention and con-
nection between the practitioners and patients
fundamental core energy or consciousness. By
incorporating diagnostic information received, the
practitioner catalytically stimulates the patients
systems into a state of progressive rebalancing,
or the warming of the fundamental cold.
Treatment steps are briefy outlined below.
1. Observation and inquiry
2. Initial pulse analysis
3. Check reference points (supine position: inner
leg region)
4. Contact needling of the abdomen
5. Pulse diagnosis and adjustment
6. Abdominal palpation and pattern diagnosis
7. Check reference points (prone position: primar-
ily jaw, back, neck, legs and feet)
8. Contact needling of back
9. Treatment of back-shu points
10. Re-examination of the abdomen (palpating
for positive changes)
11. Supplemental treatment (if needed)
12. Re-examination of pulses
13. Treatment of shoulder region (GB-21/TW-15
area) in seated position
SJT treatments use a single #3, 40mm SJ-type
fliform needle with an oval shaped point that
was designed and made for Kobayashi Sensei.
This needle, with a relatively blunted point, is
especially useful in SJT treatment, as it is bet-
ter equipped to allow the practitioner painless
assessment and stimulation in contact needling
of individual acu-points in what is generally a
non-insertive method. Treated back-shu points
generally follow the outer/inner Bladder lines,
the Huatuojiaji lines (vertebral edge of the spine)
and/or the Governing Vessel (GV) that are found
in fve element regions (see Exhibit C for division
of Back Five-Element Zones). Treatment sequenc-
ing follows four forms that follow the creative
cycle. All individual acu-points are treated on the
march 2009 kAj0M
y
healthy or less reactive side (Steps 5, 8, 11 and 13
as shown above).
Sessions between treatments are typically sched-
uled a week apart to give the patients systems
time to adjust and build. Duration of treatment
is generally determined by the depth or degree
of cold (severity or chronicity of disease) and
the constitutional strength and receptivity of the
patients systems. Receptivity, in this context
and in my experience, means the degree to which
the patient is open to treatment and advice, as
well as their prior reception of energetic healing
therapy. I fnd that patients who are motivated to
get better and have been treated by acupuncture
or other forms energetic healing tend to respond
to treatment faster.
Seminar Structure Overview
The seminar was divided into lectures presented by
Kobayashi Sensei, and practice and demonstration
sessions. The seminar practicum was divided into
small groups. These groups were led by several
well-trained SJT practitioners from Japan and the
U.S. The frst two days of the seminar focused
on morning lectures of the underlying theory of
Shakuju Therapy and treatment strategy, with the
afternoons were devoted to practice time.
Practice time always started with needling BL-
40, and then moved through various stages of
treatment. BL-40 needling is not your standard
acupuncture needling; rather, it is built on focused
intent and connection to the patients energy.
Since, Kobayashi Senseis SJT needles have
blunted ends, and the goal is for painless inser-
tion, this exercise can be quite challenging. The
needling exercise is designed to sharpen or keep
sharp the practitioners directed conscious aware-
ness, so that the treatment outcome is optimal. In
my experience, the best way to describe success in
needling this point is to imagine that you are gently
knocking on a door and asking for entry, and upon
recognition of each other, the needle easily slides
through the skin with no force or pain. Ultimately,
this exercise in not just one of technique, but of
the art of focused intention that brings about the
desired result of painless insertion. You rely on all
senses, including those easily seen and felt, but
more importantly on those that are not. It is about
intent and at the same time letting go of that intent.
This exercise is probably one of the single most
important exercises that I have found for honing
my acupuncture treatment skills.
The third day of the fve-day seminar series was de-
voted to clinical treatment of patients. Kobayashi
Sensei personally treated several individuals who
were either patients or acquaintances of practi-
tioners attending the seminar.
Case Study and Class
Demonstration Treatment
The following is a summarization of Shakuju
Therapy treatments given to a patient at my private
practice and a class demonstration treatment of
the same patient by Kobayashi Sensei during the
third day of the seminar. Below is a presentation
of the patients pertinent health inventory (from
an initial intake dated 7/1/08), a summary of my
treatments prior to Kobayashi Senseis treatment,
Senseis treatment, and closing remarks.
Background Information
Patients age/gender: 59/F
Description: Business owner; single/divorced
Overall Health: Fair; Body Mass Index (BMI):
46 = obese
Exercise: Limited to none because of health
issues
Main Complaint (MC)
Cluster-migraine headaches: 1x/week, lasting 3
days. Location varies from frontal (bladder (BL)
and gallbladder (GB) channels), temporal (BL, GB
and triple warmer (TW) channels) and/or occipital
(GB channel). Episodes occur at no particular time
of day. Pain is debilitating; patient cannot leave
home and is usually bedridden. Symptoms include:
pain described as excruciatingly intense, nausea,
nasal congestion, extreme fatigue, fashing lights,
spots and zigzag lines. Patient feels they are stress
induced. Onset was on 3/2008. Past hx: migraines
at 19 y/o for 1-2 yrs.
Tried a number of medications with no positive
lasting effects; some produced signifcant nega-
tive side effects.
Health History
Medication/herbs/vitamins: Multivitamin and
mineral supplement, CoQ10, calcium, Cholest-Off
for cholesterol reduction, resveratrol for lowering
blood sugar, fsh/cod liver oil, Celexa (Citalopram
hydrobromide) for depression, trazadone primar-
ily for insomnia (also targets depression and
anxiety), Xanax (Alprazolam) for anxiety, Librax
(Chlordiazepoxide hydrochloride & Clidinium
bromide) for IBS/spastic colon, Darvocet-N (Pro-
poxyphene napsylate and Acetaminophen) and
Percocet (acetaminophen and oxycodone) for
cluster-migraine pain.
Hospitalizations, surgeries, injuries: 10/08:
Varicose vein treatments for R and L legs; L leg:
Venus procedure and R leg: conventional vein
stripping; developed serious subsequent MRSA
cellulitis in inner L leg superior to knee (Liver
(LV) channel area) treated by strong targeted
antibiotic regimen (vancomycin and 2 unknown
others). 1987: automobile accident neck and
back whiplash and bilateral knee injury (patellar
dislocation) with torn lateral leg and quadriceps
muscles; extensive nerve damage.
Allergies: Amoxicillin, soy.
Skin: Psoriasis concentrated on hands (knuckles),
elbows and feet.
HEENT:
Head: see MC; other headaches include tempo-
ral (GB/TW channels) and frontal (BL/TW/GB
channels) like a tight band around the head,
set off by stress; Ears: h/o earaches; Nose: h/o
post-nasal drip.
Cardiovascular: Varicose veins in legs; cold feet;
generally prone to cold.
Respiratory: H/o influenza, bronchitis and
pneumonia.
Gastrointestinal: IBS with alternating constipa-
tion and loose stools, BMs 2-3x/day, abdominal
cramping/stomach pain.
Genito-urinary: Frequency 6x/day, 1x nightly.
Ob-gyn, including LMP: 10 5/28; LMP: 48 y/o;
fow was moderate to heavy with abdominal
cramps, and clots; 2 pregnancies/2 births nor-
mal deliveries.
Musculoskeletal: Past automobile accident (see
injuries above); nothing recent.
Emotions: Post-traumatic stress disorder (PTSD)
from near death experience with cellulitis; anxiety/
panic attacks, and depression; past h/o childhood
emotional/physical abuse.
Energy: Erratic ; mostly low (cant get out
of bed) after nights of little or no sleep.
Sleep: Often poor; takes medication for insom-
nia.
Diet: Fair; not well balanced; 6-8 glasses or more
of water consumption.
Substance abuse: Cigarette smoker 43 years, 1
pack/day, stopped 2x for periods of 4 and 9 yrs.,
no smoking since 10/07.
Diagnosis and Treatment
The following diagnosis and treatment sequencing
is a summarization. While not comprehensive, it
does not exclude any of the data collected dur-
ing patient examination or treatment steps as
previously described or found in other referenced
articles or Kobayashi Senseis recently published
book.
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kAjOM vOlume 16 number 45
Treatment 1 (7/1/08)
Pulse: normal rate, yang positions superfcial and
toward excess, tense/wiry.
Abdominal/Hara: warm, pressure pain (PP)
or tsu-shaku in LV, lung (LU), and heart (HT)
quadrants.
Chosen Treatment: LV shaku, LU deficiency
pattern.
Step 1: Abdominal contact needling.
Step 2: Pulse Adjustment: R pericardium (PC-
7).
Step 3: Back contact needling.
Step 4: Treat back-shu points: LU Form #3 metal
(M), earth (E), wood (WD), fre (F).
Step 5: Supplemental treatment: R LR-4.
Step 6: R GB-21.
Treatment comments: Form #3 indicators:
reactivity of reference points, MC and pulses;
supplemental treatment was based on leftover
reactivity after reexamination of the abdomen;
all tender reference points either cleared or were
much better; pulses were more even and con-
solidated; abdominal regions showed signifcant
improvement (no or less PP). Patient reported
feeling calm and more centered.
Treatment 2 (7/9/08)
Current Assessment (verbal check-in): No
migraines or headaches since frst treatment;
digestion/GI: some alternating constipation and
loose stools; emotions: anxious/stressed.
Pulse: Normal rate, kidney (KD) position defcient,
tense/tight, slight yang excess.
Abdominal/Hara: Warm to slightly cool in KD area,
PP or tsu-shaku in KD, LR, and HT quadrants.
Chosen treatment: KD shaku pattern.
Step 1: Yintang; lavender essential oil (EO).
Step 2: Abdominal contact needling.
Step 3: Pulse Adjustment: R PC-7.
Step 4: Back contact needling.
Step 5: Treat back-shu points: KD Form #3 water
(WA), M, E, F.
Step 6: Supplemental treatment: R LR-4.
Step 7: R GB-21.
Treatment comments: Yintang was treated
as patient was feeling very anxious/stressed,
lavender EO has a calming effect; Form #3 in-
dicators: reactivity of reference points, MC and
pulses; all tender reference points either cleared
or were much better; pulses were move even
and consolidated; abdominal regions were less
reactive than last visit and showed significant
improvement (no or less PP) after treatment.
Patient reported feeling calm (especially after
treatment of Yintang), and more grounded and
centered.
Treatment 3 (7/16/08)
Current Assessment (verbal check-in): No cluster
migraines; one low-grade, frontal (GB channel) and
temporal (GB/TW channels) headache occurred
2 days after the last treatment took Darvocet
for pain relief; subsequent low energy for 2 days
and cold/clammy (damp/sticky); periodic post
nasal drip; emotions: mostly good, anxiety was
low and manageable; sleep: not as sound; BMs:
stools well formed.
Pulse: Normal rate, LU position defcient, slightly
tense/wiry.
Abdominal/Hara: Warm, PP or tsu-shaku in LU
and LR quadrants.
Chosen Treatment: LU shaku, LR deficiency
pattern.
Step 1: Abdominal contact needling.
Step 2: Pulse Adjustment: R PC-7.
Step 3: Back contact needling.
Step 4: Treat back-shu points: LR Form #3 WD,
WA M, E.
Step 6: L GB-21.
Treatment Comments: Form #3 indicators:
reactivity of reference points, MC and pulses;
all tender reference points either cleared or
were much better; pulses were move even and
consolidated; abdominal regions cleared of
PP. Patient reported feeling more energized,
grounded and centered.
Treatment 4 (7/23/08)
Current Assessment (verbal check-in): No clus-
ter/migraines; low-grade, frontal (GB channel)
headache 1 to 2x/ day with little pain no pain
medication needed; increased energy; no post-
nasal drip; emotions: impatient, anxiety: 1 panic
attack (could not fnd anxiety medicine); sleep: 2
nights after last treatment mostly awake with
no particular thoughts, restless sleep on other
nights; BMs: stools loose one night (started taking
faxseed oil that day); diet: better.
Pulse: Normal rate, tense.
Abdominal/Hara: PP or tsu-shaku in LU (cool), LR
(warm) and KD (left side only, warm) quadrants.
Chosen Treatment: LR shaku, LU deficiency
pattern.
Step 1: Abdominal contact needling.
Step 2: Pulse Adjustment: L PC-7.
Step 3: Back contact needling.
Step 4: Treat back-shu points: LU Form #3 M,
E F, WD.
Step 6: R GB-21.
Treatment comments: Form #3 indicators: reactiv-
ity of reference points, MC and pulses; all tender
reference points either cleared or were much
better; pulses were more even and consolidated;
abdominal regions showed signifcant improve-
ment (no or less PP and abdominal temperature
more evenly warm). Patient reported feeling more
calm, grounded and centered.
Treatment 5 (8/11/08): SJT Seminar
Current Assessment (verbal check-in): no cluster
migraines or other headaches since last treat-
ment; skin: marked improvement with psoriasis;
emotions: nervous.
Pulse: Normal rate, LU and SP defcient.
Abdominal/Hara: PP or tsu-shaku in KD quad-
rant.
Chosen Treatment: KD defciency pattern.
Step 1: Abdominal contact needling.
Step 2: Pulse Adjustment: R LU-9.
Step 3: Back contact needling.
Step 4: Treat back-shu points: LU Form #4 E, F,
WA, M; repeated Form #4 along GV.
Step 6: R GB-21.
Step 7: Bloodletting and cupping: between cervical
vertebrae 5 and 6.
Treatment comments: Kobayashi Sensei diag-
nosis and treatment. Form #4 indicators: deep
cold or yang defcient, upon second round of
back treatment patient began to sweat (a sign of
body getting warmer); all tender reference points
either cleared or were much better; pulses were
march 2009 kAj0M
j
more even and consolidated; abdominal regions
showed signifcant improvement (no or less PP).
Bloodletting (shiraku) technique used a 3-edge
needle with a single puncture and repeated
cupping until blood fow stopped. This step was
completed later in the afternoon because of time
constraints. It is especially effective for people
who have been exposed to past traumas (removing
congestion and mobilizing qi fow), as in this case.
Overall, patient reported feeling more energized,
grounded and centered.
Treatment Summary and Prognosis
It is believed that the cluster-migraine headaches
were largely infuenced by the LR and that a deep
cold was present, fundamentally expressed by KD
weakness. I also believe that her past traumatic
experiences have played a key role (a wearing
congestion) with the fundamental imbalance
exhibited.
Overall, the patient responded well to the treat-
ment strategy and improved signifcantly from
treatment to treatment. Severe and debilitating
cluster-migraine headaches stopped after the
frst treatment. Less intense headaches continued
until the fourth treatment and have not recurred.
Digestive function (see dietary comments below),
sleep, energy, emotional disposition (anxiety
and depressed feelings), and psoriasis showed
marked improvement. After the ffth treatment by
Kobayashi Sensei, the patient continued to show
even stronger signs of improvement, including
increased energy and clarity of thought as well as
engaging in a more regular exercise routine. The
patient experienced several days of sweating after
the ffth treatment, which is probably an effect of
the acupuncture rebalancing, with the body getting
warmer or a reduction of deep cold. In addition, the
patient was able to drastically reduce use of her
anxiety and insomnia medication cutting down
from daily dosages to use as needed, ranging from
once a week to less often.
Following is a quote from my patient summarizing
how she has felt since the treatments:
I feel like a veil of heaviness has lifted. I have
all the benefts of coming back to life again. I
can meditate again; I have more energy and
am more interest in living.
While I was treating this patient I also counseled
her on lifestyle management. I suggested targeted
dietary changes to help rebalance her systems. In
addition, moderate exercise and meditation (with
focused breath work) were encouraged to help
balance and stabilize the mind, body and spirit.
Prognosis for continued headache/pain relief is
considered excellent. Judging from the overall
marked improvement in the patients systems,
additional acupuncture treatment would be
benefcial. The patient agrees but has instead
decided to work through a number of issues with
her psychopharmacologist before continuing
acupuncture treatment. Her outlook on life moving
forward is positive and she is very grateful for the
acupuncture received and the opportunity to be
treated by Kobayashi Sensei.
SJT Supplementary Treatment
During the last day of the seminar series, Ko-
bayashi Sensei discussed the use of a supple-
mentary treatment, using an acu-point he calls
the Jaw Joint point or Ushiro gekan, meaning
back/behind ST-7. Sensei often refers to this as
the acu-point as behind ST-7. Its use is good for
a range of conditions, particularly head and neck
related conditions.
Its location is anterior to TW-21, superior and
posterior to ST-7, and in the jaw space (TMJ area)
just superior to the condylar process. With the
patient in a supine position, one can most easily
fnd the acu-point by asking the patient to open
and shut his mouth and palpating for the open
space. It is often tender to touch, and the least
tender (healthy) side is treated.
I have used either the same #3 silver needle
used in SJT treatment or a teishin (gold or silver).
Chinetsukyu or cone moxa can be employed
instead, but I have not used this approach. Of
primary importance to effective treatment is the
practitioners focus and intention. After placing the
needle on the acu-point, and without any twist-
ing action, the practitioner sends his laser-like
intention to the opposite jaw joint, cycling back
and forth numerous times.
In general, the opposite (or more tender) jaw point
is used as a reference point (checked while treat-
ing for lessened sensitivity), but reference points,
such as the teeth, facial areas, abdominal shaku
areas and patient symptoms can be also be used.
I have found that focusing on the opposite tender
jaw point to be adequate in most instances.
Since the SJT seminar I have used this supple-
mental treatment for a range of head-related
symptoms, including TMJ pain, toothaches, mouth
sores, headaches, sinus congestion, dizziness,
blurry vision, and earaches. In most instances, sig-
nifcant and immediate symptom relief was noted.
In many cases, symptoms did not return in follow-
up treatments or were greatly diminished.
Conclusion
Many who leave the SJT seminars have a renewed
perspective about their acupuncture practices.
What separates SJT from other forms is its sim-
plicity of application with minimal stimulation
most of the techniques are non-insertive and
very gentle. Truly, the ancient adage less is more
is the common denominator. This approach brings
incredible, long-lasting, healing results, more than
any other form of acupuncture that I have been
exposed to or instituted.
In my practice patients are continually amazed with
its effectiveness, both immediate and enduring;
they fnd it not only rebalances their systems but
also keeps them in a more healthy and energized
state of well-being. SJT is appropriate for all
patients, especially children, older persons, and
those weakened by chronic conditions. It is of
course a wonderful option for patients uncomfort-
able with needles.
In conclusion, I wish to express my deep gratitude
to Kobayashi Sensei and Mizutani Sensei, as well
as the editors of NAJOM for the opportunity to
write this article.
Other References
Hara, Osamu, About Shakuju, NAJOM, Volume 13,
Number 37 (2006, July), pp.22-23.
Iuliano, Diane and Jonathan Kapsten, Shakuju
Therapy, An Evolution in Japanese Acupuncture,
NAJOM, Volume 12, Number 33 (2005, March),
pp. 1416.
Kobayashi, Shoji, Shakuju Therapy, NAJOM,
Volume 8, Number 22 (2001, July), pp. 8-11;
Shakuju Therapy (2), NAJOM, Volume 8, Number
23 (2001, November), pp. 10-14; Shakuju Therapy
(3), NAJOM, Volume 9, Number 24 (2002, March),
pp. 5-9.
Kobayshi, Shoji, Acupuncture Core Therapy
- Shakuju Chiryo, translated and edited by Dan
Kenner, Taos, New Mexico: Paradigm Publica-
tions, 2008.
Robert B. Gracey, MAc, DiplAc (NCCAOM),
LAc, is a graduate and faculty member of the
New England School of Acupuncture where
he teaches Japanese acupuncture styles and
provides clinical supervision. He is treasurer
and a founding member of the Shakuju Asso-
ciation of North America (SANA). Robert has
a private practice in Belmont, Massachusetts.