By Jeffrey Dann Ph.D., LAc.
Jeffrey Dann PhD, LAc is a medical anthropologist and licensed acupuncturist since 1984. He has lectured at the Beijing University of Chinese Medicine on Japanese acupuncture and structural acupuncture. He is an adjunct faculty on the post-doctoral Japanese acupuncture of the Tri-State College of Acupuncture (New York) and the American College of Traditional Chinese Medicine (San Francisco). He studied bodywork and martial arts of the Mito Tobukan where he achieved 4th dan in kendo, nidan in iaido, and shodan in naginatado. His Aloha Wellness clinic is in Boulder Colorado.
There has been a long time simmering discussion within the Meridian Therapy association about the prohibition against treating the Heart and Heart channel. Many Meridian therapists seem to just ignore this edit despite it’s the Meridian Therapy association’s official published stance. Other acupuncturists state that the MT association represents only a small percentage of the total acupuncture practitioners in Japan and therefore this avoidance of treating the Heart represents a minority position.
The international growth of Japanese styles of acupuncture has been dominated by Meridian Therapy and Toyohari teachers. Both of these schools cling to this injunction, often denying the possibility of either Heart deficiency or excess.
As students of Meridian Therapy we are taught only 4 foundational Root acupoint combinations: the Kidney, Liver, Spleen, and Lung. There is no 5 phase mother-child paired Root treatment for the Heart.
The English edition of Traditional Japanese Acupuncture – Fundamentals of Meridian Therapy edited by Koei Kuwahara clearly states “There is no Heart deficiency…The Heart stores the essential Ki known as spirit…and is an organ with a rich abundance of yang Ki…Thus there is no pattern of Heart deficiency” (p.19). Later, discussing Excess conditions, it says, “ There is no Heart excess “ but it recognizes a condition “called Heart heat that is)…generated by a deficiency in the Kidney, Liver or Spleen’ (p.41). I Shudo sensei in his Introduction to Meridian Therapy does describe signs and symptoms of both Heart excess and Heart deficiency (page 120). He also lists 5 phase points for Heart deficiency and excess but he avoids giving a Root treatment for Heart deficiency, So Shudo goes along with the established Meridian Therapy denial of treating the Heart channel.
Generally the Meridian Therapy approach to Heart problems would be to treat the Pericardium or using 5 Phase mother child or controlling points and not directly use Heart channel points.
For many foreign acupuncturists this avoidance of treating the Heart is a confusing and unrealistic cultural medical belief. In my practice and that of many other foreign colleagues we do find Heart imbalances with clear Heart channel palpatory findings, such as deficiency in the HT 7-5 area and excess at HT-3. Also, it’s not uncommon to find spider veins or indurations in the intra-scapular heart zone.
Some say Westerners have a tendency to be “more in their heads” and feel stress more psychologically than the Japanese who have a tendency to abdominally somaticize their stress patterns . Don’t forget it was Descartes who posited for the West, “I think therefore I am” and Freud who opened the Pandora’s box of sublimated and subconscious cognitive contradictions in his patients.
Certainly the Chinese TCM practitioners have no problems in treating the Heart channel directly. I had published in NAJOM an article by Dr. Wang Hong Min clearly describing the differential diagnosis of symptoms comparing the Heart and the Pericardium. As a premier student of the great recently deceased Wang Ju-Yi, Dr. Hong Min also shows the 6 level Shan Han Lun approach to the Heart by regulating the ShaoYin dynamic of Heart and Kidney where both Heart and Kidney channel points are selected.
Certainly the Japanese general population has people who have clear signs of heart organ pathology and or a Heart - Shen imbalances, which needs to be clinically addressed. What is the cultural solution to this clinical dilemma?
It’s interesting to look at the cultural Mind/Body differences of “Heart” between Japanese and Western concepts. Westerners have a very clear distinction between head and heart with the head often taking precedence. It could be argued that while the Japanese recognize and utilize clear rational discourse, they also pay deep attention to their “gut” or intuitive sensations.
It’s slightly complicated in the Japanese case because the Japanese Heart (kokoro) is more intimately related and located with the Hara. Symbolically, whereas Westerners and Middle Easterners locate heart sensations in the middle of the chest , the Japanese are more often sensing heart in the abdominal region.
In my research and teaching about structural acupuncture and the importance of the concept of the “koshi” for understanding balance and power in posture and movement, I have often had to explain to Westerners the relationship and differences between “koshi” and “hara” and the lack of correspondence with Western English anatomical terms.
Much has been written about the Japanese concept of Hara including the spiritual and emotional concepts embedded in the Western term ‘abdomen’. Let’s look at some of the very common expressions in everyday Japanese use of the term ‘Hara’.
The most direct association of Hara with Heart is the term haraguroi (a black stomach) “evil- minded” that is clearly translated into the English “black heart”. Where we might say someone is big hearted and small hearted, the Japanese would say the Hara is big or small.
Hara can indicate mind, personality, as well as spirituality. Integrity is expressed whether or not a person has “Hara” hara no aru hito ("person with hara") or hara no nai hito ("person without belly") .The emotions of anger is expressed as the hara standing or rising, hara ga tatsu. When expressing fully understanding something, the Japanese expression might be Hara ga hairu ‘something enters the hara. An accomplished mature person is described as having ‘a completed hara’ while an undeveloped person is described as hara no dekite inai hito ("person who has not completed his hara"). This is just a partial list of common emotional, personality, and mental nuances with the term Hara that strongly overlap with the English terms of heart and mind.
With this understanding of the deep and profound meaning of the term Hara, it is interesting to clinically look at the central place of palpating and treating the abdomen among Japanese practitioners.
It seems like there is not a clear foundation or basis for proscribing using Heart channel points. Stephen Brown, student of Shudo Denmei and teacher of Meridian Therapy, tells me there is nothing in the Nanjing that prohibits treating the Heart. Erhland Truitt , Koei Kuwarahara sensei’s foremost American trained student says Kuwahara does not present a Heart pattern while teaching basic theory. Truitt’s High Desert Hari Society has invited a wide range of Japanese master teachers to New Mexico and Truitt says that Kobayashi sensei in his Shakujyu system does recognize a Heart pattern but that the diagnoses and treats it by addressing the hara. Likewise, Miyawaki sensei, who also has taught several times under Truitt’s invitation, does use HT-5 and HT-7 in his 8 extraordinary vessel treatments but he uses magnets or moxa but never needles. And here again the Heart diagnosis is based on abdominal or hara findings.
Indeed, when we observe almost all advanced Meridian Therapy practitioners such as Shudo, Okada, Funamizu sensei and others, who consciously avoid treating the Heart channel, they always palpate and treat the abdomen, thus actually treat the Heart by treating the hara.
Modern medicine and science are just beginning to recognize the central importance of the gut microbiome for physiological and emotional states, something Traditional East Asian Medicine (TEAM) has profoundly understand about Zang-Fu energetics and emotional states.
There are good grounds for Meridian Therapy oriented practitioners to question the unexamined refusal to treat the Heart channel or the Heart directly. I may be stirring up a hornet’s nest with my Japanese colleagues and teachers by suggesting that in the Meridian Therapy society the embrace of this Heart channel avoidance seemed to occur in the mid 1950’s. This was the post-WWII period of devastation and rebuilding of Japan. There was undoubtedly severe “broken heart” despair to the defeated samurai warrior ethos of wartime Japan. Of course, the wholehearted Japanese embrace of pacifism was a positive and dramatic teaching to the whole world about rejection of militaristic values (something the US could learn from).
This rejection, fear, or avoidance and treating heart issues may have a broader influence than just the Meridian Therapy’s position. This is perhaps seen in contemporary Japanese culture by the ‘Hello Kitty” culture where everything is ‘kawaii’ (cute) and fun, while avoiding or bringing difficult emotional issues to public discourse. One wonders if these cultural behaviors and fear of finding a Heart deficiency or excess might be part of a post WWII PTSD pattern? Certainly, as an American looking at our own national and cultural challenges of southern Confederate states opposition to northern political and economic dominance , I see an unconscious emotional response of ptsd from having lost the civil war over 150 years ago. While this supposition may be true, it is a side topic from the central issue of opening discussion on the prohibition of treating the Heart and Heart channel.
As a practitioner who largely follows standard Meridian Therapy doctrine, I and many other foreign acupuncturists do find value and clinical effectiveness in treating the Heart. I would like to challenge Meridian Therapy teachers who teach foreigners as well as domestic students to investigate the appropriateness of treating the Heart and clinically acknowledging protocols for treating Heart deficiency and excess.
We do know that the Heart is an essential organ and energetic center and that, in modern life both physiologically and emotionally the Heart must be treated in some way. How do Heart avoidance proponents get around this this dilemma? I, suggest they by-pass this problem to treating the Heart by treating the Hara, which, for the Japanese, cultural body-mind map is the equivalent of treating the Heart itself.
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