Shonishin
Reviews from the Archive
2024 has been a challenging year for many, myself included, and it seems especially so over the last four months. But the mulch is never far from my mind, and to close out this year I am going to look back at what (for me, anyway) was a simpler time: 25 years ago, the turn of the millennium.
I’m reprinting a couple of articles I wrote for the NAJOM (North American Journal of Oriental Medicine) back in 1999 and 2000. I happened to have found them looking for something to respond to a student’s question on pediatrics. Through the years, bricked hard drives, obsolete operating systems, defunct apps, etc., a lot of stuff I wrote early in my career has been lost. But these two pieces somehow survived. They are pretty much as they were when I sent them off to the editor back in the day.
Anyway, Happy New Year to all who happen to read this post. I’m working on new stuff that hopefully I will be able to finish soon. But for now, I hope you find benefit in these two brief articles about a great practitioner and wonderful human being, Tanioka sensei.
Book Review: Wakariyasui Shonishin No Jissai (Easy-to-Understand Practical Pediatric Acupuncture), by Masanori Tanioka.
By Robert Hayden, LAc
[From North American Journal of Oriental Medicine Vol.6 No.15, March 1999]
In the last issue of NAJOM, I wrote about my attempts to study Japanese acupuncture texts in their original language. Soon after that article was published, editor Hideo Takahashi suggested that I read an interesting new book. Titled Wakariyasui Shonishin No Jissai (Easy-to-Understand Practical Pediatric Acupuncture) its author is Masanori Tanioka. In 1996, while in Osaka, Japan, I had the great pleasure of visiting Tanioka Sensei's clinic and receiving firsthand instruction from him). Since I was very impressed by Tanioka Sensei when I met him, I was eager to take a look at his book.
A slim volume at 160 pages, it is packed with valuable information on this little-known art. Tanioka sensei's rich clinical experience of more than 35 years, as well as the legacy of his family acupuncture clinic reaching back more than 100 years ago, is distilled into an insightful and very readable book.
The book is divided into five broad sections: Shonishin diagnosis and treatment, Connecting with the child, Persuading the parent/guardian, Shonishin cases, and Shonishin "secrets".
In the first section, Tanioka sensei addresses general considerations, demographics of his pediatric practice (which is part of a larger general practice), diagnosis and treatment.
The section begins with an overview of Tanioka sensei's pediatric practice, in terms of the percentage of each age and condition he sees in a typical month: 72% of the children are less than 4 years old. The major complaints when his survey was taken were kanmushi syndrome, and its associated symptoms of "ki-ki-" (squeaky) voice, night crying, irritability, and lack of appetite. He also sees medical conditions like tonsilitis, otitis, asthma, pain, and others. He goes on to warn about conditions like high fever (more than 38*C), acute abdominal pain or chest pain, broken bones, etc, which should be referred to a physician.
Next comes the actual technique involved. His needle looks like a big iron nail with a flattened and beveled point. It is held in the hand against the middle finger with a little of the tip exposed, and the is skin stroked with it. It's good to keep it well concealed in one's hand so the child won't see it.
Diagnosis and treatment is rooted in palpation of the whole body. The needle is stroked on the body surface rhythmically at a tempo of 3 times per second. There is no set rule regarding the direction of the strokes, it depends on the positioning of the therapist and child. Most children from age 7 months and up are treated in the following general sequence: back, shoulders and neck, waist, head, abdomen, chest, arms and legs. Return to the back again to finish. If the child has a specific complaint, the procedure may vary by including the area of the main complaint. The typical time of treatment ranges from 30 seconds to 2 minutes for newborns, up to 7 minutes for pre-teenagers.
The aspect of Tanioka sensei's practice that most fascinates me is his astute palpation of the body surface, and the reactive areas that arise with various conditions. For example, in cases of night crying, night terrors, sleep problems, or aggression and irritability, reactions appear on the back of the head to the neck. Depressed appetite, picky eating, milk vomiting, and atopic dermatitis appear in the interscapular area. Diarrhea and constipation appear in the sacral area. Wind evil appears in the neck, shoulders, chest area and around the area between ST36 and GB34. Tic syndrome, if symptoms are light reactions appear in the neck and shoulders and will migrate to the back and waist as the condition worsens.
Also important is observation of the child, and Tanioka sensei lists a number of kanmushi-related conditions to and the particular visual clues that can arise. In general, an angular sharp face or beady eyes mean kanmushi is strong. Often the face is pallid due to improper blood flow. Between the eyes and above the root of the nose is often bluish. If it becomes intense, the conjunctiva may be bluish, eyelids may appear swollen, flushing can occur around the nostrils and below the nose. If the child's hair may be standing up, if kanmushi is intense. If the space between the child’s eyebrows grows narrow, Tanioka sensei might suspect night crying or other sleep related complaints. If around the lips a yellow color appears, perhaps accompanied by a blackish pigmentation in the gastric area, often the child has digestive complaints.
The technique for treating the reactive areas is detailed, down to the number of strokes in various body areas and amount of pressure in grams for each age group. However, the cardinal rule is to vary the amount of stimulation based on the skin tone of the child. For softer skin use weaker stimulation, for harder skin use stronger stimulation.
The image he uses for treating softer skin is that it feels like the fingertip is delicately playing with water 1-2 mm deep in a shallow ikebana bowl. This image should be clear in your mind, otherwise you may hurt the soft skin. (I have had the benefit of receiving his almost unbelievably light touch)
Further on, he gives ideas about frequency of treatment, and what to do if symptoms worsen.
The next two sections focus on the clinical interaction between the therapist and the child, and on the therapist and the parent or guardian of the child.
Much of the section on connecting with the child is on keeping the child from crying, and if crying starts, how to change the mood of the child to be able to treat effectively. It starts with having a child-friendly atmosphere in both the waiting room and the treatment room. The practitioner should have a gentle air and a friendly face. One must be perceptive about when the child appears on the verge of crying. If it seems inevitable, do not make eye contact, especially if one is unfamiliar with the child. After a connection is established and some trust has been built, then you can speak while looking directly at the child. Certain words are taboo, such as "pain", "cry", "fear", and "needle". If the child hears words like "mama", "papa", "juice", "cookie", etc., their mood will be more calm. If the child is crying or frightened, or if it clings to the parent and can't be separated, Tanioka sensei advises to imitate animal noises, especially those of dogs or cats. This will, if timed correctly, break through the child’s fright and lead to an easier treatment. Another tip is to explain the needling by telling the child you're drawing a picture on its back.
The section on relating to the parents or guardians is about persuasion and instruction. Persuading the parents to bring the child in is easy if the treatments produce quick results. It is when symptoms don't improve or worsen that one needs to be astute in communicating with them. It is best to be up front in expressing the need to bring the child in frequently for treatment. Parents often don't listen, so the best way to begin the dialog is to praise the child. It is also important to look the parents in the eye when speaking to them, and make sure they understand what you are saying. There is a list of questions most frequently asked by parents along with Tanioka sensei's answers to help practitioners build their communication skills.
The fourth section is a collection of case histories, recounting both kanmushi cases and various medical illnesses (asthma, bedwetting, common cold, atopic dermatitis). There are even a few accounts of cases where the treatment failed, which is something more clinical authors should address. He recounts some early struggles in practice, and gives advice on not only clinical problems, but problems of lack of self confidence, lack of clientele and lack of palpation skill. He finishes with a section on "secrets" of shonishin, including tips on keeping your hands supple, and advice on growing in your practice by finding out more about children (playing with them, reading texts on child care), and by watching and studying expert practitioners.
This is not only a valuable reference, but an very enjoyable one. It deserves to have a wider audience, and to be translated into English. This book truly lives up to its title: it is easy to understand, and it is grounded in practice, taking into account not only the technical requirements involved, but the psychological and humanistic aspects that make a well-rounded and successful practitioner. Often, as I read it, a smile came to my lips and I recalled that sultry August day in Osaka and the kindness and hospitality Tanioka sensei and his family showed me and my companions. I can almost hear the clack-clack-clack of his wooden geta as he walked us to the train and wished us farewell.
Seminar Review: Masanori Tanioka Shonishin Workshop
By Robert Hayden, LAc
[From North American Journal of Oriental Medicine Vol.7 No.18, March 2000]
On October 23 and 24, 1999, Masanori Tanioka taught a workshop in Japanese pediatric acupuncture (Shonishin) at the New England School of Acupuncture. Mr Tanioka is a well-known practitioner from Yao City, Osaka, Japan, and a member of and frequent contributor to NAJOM. The seminar he taught followed very closely his book, Wakariyasui Shonishin no Jissai (please see my review in NAJOM #15 for a detailed look at the material presented in the book).
He began by comparing the pediatric techniques used in China to those used in Japan. In China, pediatric treatment is very similar to treatment of adults. In Japan, the treatment is usually non-invasive treatment of the body surface, using specially-designed tools and a comfortable level of stimulation.
Mr Tanioka's pediatric practice consists mostly of children in the first three years of life. 80% of brain growth occurs during this time, which creates stress on the child's body and mind. The syndrome that results from this is called "Kanmushi". Children five years or older usually present with specific diseases, as opposed to the less specific Kanmushi.
Much of the seminar was spent on getting acquainted with the Taishihari, which is the pediatric needle Mr Tanioka uses for virtually all of his treatments. It is about 7 cm long, made of a type of forged stainless steel and brass. His grandfather designed it as a refinement of the three-edged needle. It is stroked along the surface of the skin in a shallow arc about 3 times per second. The rate remains the same but the pressure and length of the stroke increase according to the childs age and density of skin. It is somewhat unwieldy to use at first, but fine adjustments can be made with consistent practice. Tanioka sensei told us that once the needle has been mastered, one can treat people of any age, "from 0-100 years old".
Tanioka sensei is a master of palpation, and this was for me the most exciting aspect of the seminar. His elucidation of the development of indurated tissue and the likely areas where they are to be found depending on the specific symptom were in and of themselves well worth the price of admission. When the treatment is entirely non-invasive, one must be extremely astute in finding areas of the integument which, when treated, will affect the deeper tissues and body structure as a whole. Tanioka sensei's decades of experience were evident in both his quick, accurate assesment and his artful treatment; the surface of the skin is his canvas, and his technique was reminiscent of a great painter at work.
No less delightful was his instant, easy rapport with the children who came to the workshop to be treated. His ability to tune into the child's process is impressive, and his ability to balance both the child's and the parent's need for attention makes the difficulty of this task look effortless.
Tanioka sensei's approach to treatment can be illustrated from some of the following treatments which he gave during the workshop:
A 2-year-old girl with alopecia areata, which had begun five months previously. The child seemed somewhat sad and withdrawn. The mother denied any stress in the family, and the girl was not on medication. There was no fever or lack of appetite, and no other symptoms. Her back was very tight, especially in the low back. Tanioka sensei said it was possibly related to her condition, as it was tighter than usual for her age. Maybe it would be good, he suggested, for the mother to rub the girl's back regularly. The skin was loose on the back of the neck, however, which seems somewhat unusual for this type of disorder. The girls abdomen was also very tense. The child, he noted, was very quiet, tired perhaps. After the treatment, which lasted a few minutes, he suggested that the mother give the child more affection, and that would relax the child's abdomen and low back.
A 4-year-old boy was experiencing daily stomachaches. Percussion of the abdomen revealed a flat, unresonant sound, which indicated excess tension. The skin on the shoulders was flaccid but the musculature beneath was tight. Tanioka sensei mentioned that if the skin is loose on the surface he will not treat the area with the Taishihari, but rather look for other areas with tight or hard skin to treat. There were lots of reactions in the infrascapular area, especially on the right side. This was related to the stomachaches. By the feel of the area, Tanioka sensei surmised that the boy had had this problem for quite some time. The low back area was not particularly tense, thought there were some reactions at the sacrum. As Tanioka sensei treated, he explained that if the reactions at the scapular area disappear, the stomach problems will improve. Indeed, the abdomen sounded better after a couple of minutes of treatment. Tanioka sensei expressed his opinion that the child did not get enough physical activity, and that the parents should play with the child more, but only let him play outside, not indoors. In addition, the child should not be given cold drinks.
The next day, Tanioka sensei explained a little more about the reactions he found on this boy. If there are stomach problems, check the mid-back at the level of T9, and check the legs around ST36. Often reactions will be found along the medial scapula, which after treatment will subside. However, often the reactive area will shift to the middle of the back, along the spine. The abdomen will be less tense after these reactions are treated (it will give a lower-pitched sound on percussion). Sometimes there will be no pain but the appetite will be depressed, and the abdomen will yield a dull sound. This indicates a lack of contractile strength in the stomach, and consequently gas will build up, causing the reaction.
These were just a few of the clinical pearls that students received during this two-day class. For me, it was not only an occasion to learn, but also a chance to reacquaint myself with Tanioka sensei, whose sweet and gentle nature belies his obvious passion for his art. It is a rare opportunity to study with the representative of an authentic family style of acupuncture that is several generations old. With Tanioka sensei, we are not only able to partake in his family legacy, but also to have a very enjoyable time doing so.
Note: this publication is for information purposes only and is not intended as medical advice. Please seek the opinion of a health care professional for any specific medical issues you may have.