The following article was previously published in the North American Journal of Oriental Medicine, Volume 6, Number 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 ") it's 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 (see my essay "A Day in Osaka" as well as Hideo Takahashi's "Taishihari Acupuncture Clinic" article in NAJOM Vol 4, No. 9 March 1997). 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 childs 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 childs 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.