Yoshio Manaka’s Acupuncture Practice

Av: Stephen Birch

The following article briefly describes Yoshio Manaka’s model of acupuncture practice, ‘yin-yang channel balancing therapy’, with its unique theories of acupuncture and systematic four-step treatment process. The essential diagnostic assessments necessary for choosing the common step one to three treatments are described, as are their typical techniques. Step four is briefly outlined. The author is teaching workshops and programmes on these treatment methods in London, York and a number of locations on the continent. Several books describing these treatment approaches are already published.

Dr Yoshio Manaka (1911-1989) came from a family of physicians in Odawara, Japan. After obtaining his doctor of medicine degree in 1935, he started studying kampo, the Japanese form of Chinese herbal medicine. Soon after this he began studying acupuncture. When he returned to Odawara at the end of the war in 1946, he actively studied, practised and researched these traditional medicines. He met many of the well-known acupuncturists of Japan such as Sorei Yanagiya, Sodo Okabe, Yoshio Nakatani, Kobei Akabane, and by the 1950s was friend to these influential figures. By the 1960s Manaka was internationally well known in the field of acupuncture. From the mid 1960s onwards he chose to cut back on his work as a surgeon and herbalist and devote most of his time to the study and practice of acupuncture. His first major invention in the field of acupuncture came in the 1950s out of his search for a simple bio-electrical treatment for burns. After the invention of the diode, Manaka first made the ‘ion-pumping cords’, which became the foundation for much of his later work. He thought that if he could ‘pump’ the build up of positively charged ions out of the area of the burn that this might both relieve the pain and help heal the wound. His experiences using these IP cords supported this hypothesis. He then developed a number of treatment approaches using the cords.
Manaka was fluent in Japanese, Chinese, French, German and English, and read texts on acupuncture in all these languages. He was thus familiar with the various scientific, classical, traditional and pragmatic models of acupuncture that developed historically and which blossomed onto the acupuncture scene from the 1950s onwards. Those that he liked and which gave reproducible and readily assessable results he often incorporated into his model of practice. By one aspect of the model that is truly unique to and characteristic of Manaka’s thinking is his ‘octahedral’ model and theory
the time of his death in 1989, his model of practice had incorporated many methods of treatment, including the moxa treatments of Sawada, Shiroda and Fukaya, the bloodletting treatments of Kudo and Maruyama, the intra-dermal needle methods of Akabane, the Chinese ear acupuncture model, and the hand acupuncture method of Tae Woo Yoo. These methods were woven together into a coherent method revolving around his unique model of acupuncture and his systematic treatment method using, as a first step, the IP cords. He called this simple step-by-step procedure his ‘yin-yang balancing channel therapy’ treatment approach. Besides being renowned for his clinical work he was an accomplished artist, poet, sculptor, teacher and writer. He wrote many books and articles on acupuncture and traditional East Asian medicine. He accomplished an incredible amount in his 78 years.
Following the tradition of practice in Japan1, Manaka emphasised palpation diagnosis, especially abdominal palpation, as the primary method of determining what and where to apply treatment. Over time Manaka worked out patterns of palpable reactions that formed the basis for the selection of which IP cord treatment pattern to use. Also following the tradition of practice in Japan, he used thinner, more shallowly inserted needles to treat the points. By the 1970s his system of yin-yang balancing channel therapy had developed into a systematic four-step treatment approach. By the early 1980s he had evolved a theory that he called the ‘X-signal system’ model of acupuncture, and spent the last part of his life testing, refining, and developing this theory. He published a landmark paper on this in 1986 ‘acupuncture as intervention in the biological information system’5, and made this the theme of his book, Chasing the Dragon’s Tail, published posthumously in 1994.
Theory
Essentially, Manaka proposed that there is a subtle signalling system that operates in nature and which is involved in the development and functioning of the channel and qi systems that were described by the Chinese two millennia ago. He suggested that this signalling system was the precursor for the more efficient and precise signalling systems of the nervous and endocrine systems, and that the nervous system which can be traced through evolution from lower-order to higher-order organisms, in large part replaced this primitive signalling system primarily because it is a much more efficient signalling, regulatory control system. Manaka proposed that this more primitive signalling system is a biological system that serves an important role in lower order organisms, and plays a role in embryological development, but that over time began to take more of a background and a less obvious role in physiology in higher order organisms. It is not a vestigial system like the appendix is a vestigial structure in humans, it is still quite active and important, but its operating levels are at such low levels of energy that it is barely perceptible and thus hard to perceive or observe experimentally. It is however, readily perceptible through its effects, for which the ancient Chinese somehow evolved methods of observing and describing. In this model, the various channels (jing-luo) are the pathways of signal flow (qi). Yin-yang and five phase theories are the basic operating rules that govern the signalling system. Acupuncture points have characteristics associated with.i) specific*
facets of the signalling system (e.g. being a wood point on a fire channel) – serving to switch the flow of qi or signals in an ‘on-off, ‘increase-decrease’ manner, and ii) characteristics associated with the specific underlying anatomical structures. The act of needling a point typically activates both levels, and with appropriate techniques, it is possible to activate only the signalling system characteristics of a point, and thus clearly observe the system in action. This was the basis for his fundamental research, much of which is described in his papers and book, Chasing the Dragon’s Tail. The reader can consult the relevant sections of Hara Diagnosis: Reflections on the Sea6 (pages 228-236) by Mat-sumoto and Birch, and Manaka’s book Chasing the Dragon’s Tail4 (pages 3-107) for more details. In constructing his model, Manaka evoked some of the newest scientific theories and models, such as those recently developed in complex dynamical system modelling, chaos and complexity theories, topology and quantum theory to explain his model. However, it is worthwhile focusing briefly on one aspect of the model that is truly unique to and characteristic of Manaka’s thinking, and that is his ‘octahedral’ model and theory. This model has a strong impact on the clinical methods that Manaka developed, as it provides the theoretical justification both for the methods of diagnosis, treatment methods and his four steps of treatment.
After studying the various historical theories of qi, the ^/-circulation systems, the theories of yin-yang and the five phases and how they regulate the ^/-circulatory and functional systems, Manaka arrived at this very simple model in an attempt to embrace the most essential aspects of these theories. An octahedron is an eight-sided figure, described by the scientist Buckminster Fuller as one of the two most stable structures in nature.2 It is defined by having three axes: a superior-inferior (up-down) axis, an anterior-posterior axis and a left-right axis:
Superior (Yang)
Right (Yin)
Anterior (Yin)
Posterior (Yang)
Left (Yang)
Inferior (Yin)
Figure 1
The traditional Chinese literature following the important early Chinese text, the Huang Di Neijing Su Wen (circa jpinus 200), chapter five ‘The great phenomena of yin andyang treatise’, defines these three axes in terms of yin and yang:
Yin inferior (half) anterior (half) right (half)*
Yang superior (half) posterior (half) left (half)
* While there is discrepancy in the traditional literatures about whether the right side is yin or yang, since later authors reversed the correspondences, the syntagonistic-antagonistic polarity of left-right as yin-yang is not denied.
The yin-yang properties implied here are both of balancing and counterbalancing. In many books of acupuncture we find descriptions of yin-yang pairs such as the lung and large intestine channels. The lung channel is the yin half of the pair, the large intestine channel the yang half. In principle if the lung channel becomes weak or vacuous, it will tend to trigger changes in its coupled channel the large intestine pushing it towards a full or replete state. In turn the large intestine channel tries to resist this change sending feedback to the lung channel to try to return itself back towards a more normal state. The yin and yang functional components of each organ show the same kind of balancing-counterbalancing effects as we find with the yin-yang paired channels. In the TCM model, if the yin of the liver becomes weak or vacuous, this triggers the yang of the liver to become relatively too strong or replete, and so on.
Figure 2
There are feed-forward and feed-back mechanisms of balancing-counterbalancing. In essence any change in the lung channel can trigger changes in the large intestine channel and vice versa. Each channel at the same time tries to resist these changes. Any corresponding yin-yang pair, channels, organ functional components or halves of the body will use these mechanisms of interaction and regulation, or will use them alongside other mechanisms.
With regards to the three yin-yang axes in the body, since each of these axes represents a yinlyang polarity, in which each half of the polarity is in a syntagonistic/antago-nistic relationship to the other half, each half will change if the other changes and each responds to that change by its own balancing/counterbalancing effects. By this model we can see that the upper and lower halves of the body utilise
this relationship, likewise the front and back halves of the body and the left and right halves of the body. Manaka suggested that if we draw lines to connect these three axes we define an eight-sided figure that is related to the symmetry of the channel system.
Figure 3
This eight-sided figure is called an ‘octahedron’, where there are eight surfaces or faces, each surface being composed or defined by three lines in a triangle. Either side of each line is another surface. The lines themselves are thus boundaries between surfaces, so that these dividing lines become in a sense yinlyang boundary lines, where what is happening on one side of the line is in a yinlyang syntago-nistic/antagonistic relationship to what is happening on the other side of that line. Since in the octahedron what is happening on one side of a line occurs on a surface defined by three different lines, changes on that surface are interacting with changes on the other side of each of the three lines that define that surface, and thus three other surfaces. In essence each of the eight triangular surfaces is interacting with all of the other seven surfaces in a complex three-dimensional yinlyang set of balancing/counterbalancing interactions.
In this octahedral model it is possible to see the dividing lines approximating the symmetry of the extraordinary vessels and the channel system. The inferior-superior dividing line can be seen as defined by the ‘dai mai’, the left-right dividing lines by the ‘ren mai’ on the front and the ‘du mat* on the back. Thus the up-down and left-right dividing lines can be seen with reference to three of the extraordinary vessels. Interestingly, it is possible to see the front-back dividing lines with reference to the gallbladder and triple burner channels on the lateral surfaces and the pericardium and spleen channels on the medial surfaces. This is interesting because four of the treatment points for the extraordinary vessels lie on these channels (GB 41, TH 5, P 6 and Sp 4 respectively). Thus the dividing lines relate to the du, ren and dai mai and the triple burner, gallbladder, spleen and
pericardium channels. The remaining channels lie on the eight surfaces so defined. For example, the kidney and stomach channels lie on the anterior octant surfaces, the bladder channel on the posterior octant surfaces. This model explicitly relates the 12 primary channels and the 8 extraordinary vessels to the octahedron:
Du Mai
Ren Mai
Yang
Triple Warmer,
Gallbladder
Pericardium, Spleen (Liver)
Dai Mai
Figure 4
Yin-yang theory comes into play since it can in one sense, be seen as describing an antagonistic-syntagonistic feedback loop or regulatory mechanism. In a nutshell the theory suggests that the amount of qi contained in or circulating through each of the eight surfaces (i.e. the channels on each surface or along each dividing line between surfaces,) is regulated by the amount of qi contained in or circulating through each of the other seven surfaces (that includes the channels on each surface). Manaka’s basic idea was that treatment aimed at the extraordinary vessels activates the dividing lines, which then become porous acting like a gate between two locks in a canal. Treatment of the dividing line acts like raising the gate between the two locks in the canal so that the water level either side of the gate becomes equal, ie the distribution of qi on either side of the dividing line becomes more balanced with respect to each other. Thus treatment aimed at restoring a simple balance between the inferior-superior, anterior-posterior and left-right halves of the body can bring about an overall balance of the whole channel system. The theory further holds that once such a balance has been restored or initiated, the internal milieu (i.e. zang-fu etc) will naturally begin to correct itself. Again, the reader is referred to the texts mentioned above for more complete explanations and examples.
It is possible to produce similar results by using any treatment pattern that uses the polarities of. superior-inferior, left-right and anterior-posterior. So long as these three yin-yang axes are activated by using points on the arms combined with points on the legs and points.on the posterior half combined with points on the anterior half, based on,
a left – right distribution, it is possible to activate the dividing lines of this octahedron thus triggering these general balancing effects. In Chasing the Dragon’s Tail4 a number of different treatment approaches and examples are given that are not limited to use of the extraordinary vessels.
Manaka also took advantage of this model in both diagnosis and treatment. First, in abdominal diagnosis, examining the dividing lines and quadrants as they are defined on the abdominal region is essential for deciding what treatment to administer. The distribution of reactions on the abdomen is examined from this perspective.
Figure 5
Second, treatment is arranged in a four-step process. These four steps involve the following:
Step one is applied to release reactions found by palpation on the anterior half of the body, especially focusing on the abdominal quadrants.
Step two is applied to release reactions found by palpation on the posterior half of the body, often using related back shu points.
Step three is applied to further adjust remaining structural impediments or imbalances, should they require further attention.
Step four is applied to relieve symptoms. Diagnosis for step one
In Manaka’s system of diagnosis the focus is on the distribution of reactions on the dividing lines and in the four quadrants of the abdomen as defined on the octahedral model. When palpating these lines and regions, Manaka primarily looked for pressure pain, tension and tightness. The following are the primary areas and lines to focus on:
right to lower left quadrants of the abdomen. For a summary of the pattern of reactions and typical symptoms associated with the yin qiao-ren mai pattern see Table 1.

Treatment
Treatment is usually applied to the most reactive of the five basic patterns. Other patterns can show, each with a different treatment combination, examples and details can be found in Chasing the Dragon’s Tail4 and Hara Diagnosis: Reflections on the Sea6.
Step one treatments:
Ion pumping cords are used according to a simple set of rules and principles. For example, 0.18 mm gauge needles are inserted about 2-3 mm to the correct treatment points. The
Figure 6
After defining the reactive areas and lines, each of which correlates to specific pairs of the extraordinary vessels, one can then palpate the ‘mu’ points associated with those pairs of extraordinary vessels. Manaka developed his own set of ‘mu’ points for each of the 12 channels; the scientific and clinical reasons for which are described in Chasing the Dragon’s Tail* and Hara Diagnosis: Reflections on the Sea6 (pages 350-352), and that the relevant ‘mu’ points for each pair of extraordinary vessels is determined by which channels the treatment points for those vessels are located on. Thus for the yin qiao-ren mai pair, since the treatment points are Lu 7 and Ki 6, the mu points for the lung and kidney channels are palpated: Lu 1 to Lu 2 and Ki 16.
Having palpated the areas and lines on the abdomen and the relevant mu points, one can also palpate a series of related points or areas for each pair of extraordinary vessels, these points either being pathway points of those extraordinary vessels or empirically found reactive points or areas. Each extraordinary vessel pair also has typical symptoms associated with it. In addition to the basic four pairs of extraordinary vessels, Manaka found one pattern of reactions that is very common, associated with the liver and blood stasis, which he called the ‘cross-syndrome’ because of the crossing over pattern of reactions, going from upper the modern Chinese ‘de-qi’ is not necessary or wanted in this
Method modern Chinese ‘de-qi’ is not necessary or wanted in this method. The ion-pumping cords are attached for a total of 5 – 10 minutes. As soon as the cords are attached, the abdomen is re-palpated to confirm that change is occurring as a result of the treatment. In the case of the yin qiao-ren mai pattern, Ki 6 and Lu 7 are needled bilaterally with the black clips of the IP cords attached to Ki 6 and the red clips to Lu 7.
Table 1: Manaka’s yin qiao-ren mai diagnostic pattern

yin qiao-ren mai Primary areas Primary points Secondary points and areas Typical symptoms
KI 6 – Lu 7 Along ren ma{ from sternum to pubic symphysis Lu 1 to Lu2 + Ki 16 St 12, St9, Lu 3 to Lu 4 area, anterior superior iliac spines, around Ki 11 Gynecological problems, urination problems, hemorrhoids, asthma, bronchitis, lung problems, neurosis, toothache, ear, nose and throat problems, intestinal problems, cold feet

Step two treatments:
This step most commonly utilises the ‘kyu-to-shiri or moxa on the handle of the needle technique at corresponding or reactive (pressure pain) points. There are a number of simple rules that make this a simple, safe and effective step (for further details of the moxa on the handle of the needle technique see Japanese Acupuncture: A Clinical Guide1, pages 80-101). This technique is usually not applied from the level of thoracic 7 and up. For the yin qiao-ren mai pattern, Mana-ka almost always used this technique on Bl 23 and Bl 25, with two rounds of moxa balls to each needle. Manaka used 0.20mm gauge needles for this technique, inserted into the tight muscles underlying the relevant acupuncture points. The modern Chinese *de qi’ is also not necessary or used for this technique in this treatment system, less is better see Sotai: Balance and Health through Movement3. The exercise system uses very gentle movements with mild resistance, all performed while the patient exhales. More details can be found in Chasing the Dragon’s Tail4 (pages 195-203).
Step four:
After applying steps one through three, it is not uncommon that the patient already feels improvement in their symptoms. Whether this has happened or not, it is always important to remember that in this treatment system, less is better. Select the minimal techniques necessary to relieve symptoms that the patient complains of, selecting from among: chishin (lightly inserted needles retained for a few minutes), hinaishin (intra-dermal needles) on body, ear and/or Korean hand acupuncture points, okyu (direct moxibustion), shiraku (bloodletting), kyukaku (cupping), etc. Each of these step four techniques is described in detail in Japanese Acupuncture: A Clinical Guide1. It is important to use as little as possible at step four to relieve the symptoms and to select the best method according to patient complaint. Basic ideas and examples of treatment at step four can be found in Chasing the Dragon’s Tail4 (pages 205-244).
With a little practise, a complete treatment using Mana-ka’s model can be completed in less than forty minutes. There are assessments of the effects of each step of treatment as the treatment step is applied. Manaka created a very practical systematic approach that provides an effective treatment model liked by both patients and practitioners. This completes the current overview of Manaka’s yin-yang channel balancing treatment approach.
The whole process of diagnosis, point selection, point localisation, and treatment of steps one and two can take about 25-30 minutes; usually when experienced with these methods, less time is required. Many alternate treatment combinations exist for steps one and two. Steps three and four would then follow after these two steps. Each time you see the patient it is necessary to reassess the pattern of reactions on the abdomen and to adjust the treatments as the patterns change.
Step three:
This step targets structural imbalances or impediments in a more general adjustment of the octahedral structure. As the musculature of the body becomes distorted by spasm, imbalanced hypertonicity – hypotonicity, the’ physical structure and symmetry of the body can also become disordered. Manaka’s colleague, Keizo Hashimoto described this process in some detail arid devised the therapeutic system called Sotai, (adjusting the body) to treat these problems,
References
and further reading
1. Birch S, Ida J. (1998). Japanese Acupuncture: A Clinical Guide. Brookline, Paradigm Publications.
2. Fuller RB. (1975). Synergetics. New York, McMillan Publishing Company.
3. Hashimoto K, Kawakami Y. (1983). Sotai: Balance and Health Movement. Tokyo, Japan Publications Inc.
4. Manaka Y, Itaya K, Birch S. (1995). Chasing the Dragon’s Tail. Brookline, Paradigm Publications.
5. Manaka Y, Itaya K. {1986). Acupuncture as intervention in the biological information system (meridian treatment and the X-signal system). Journal of Acupuncture Society NY. 3-4:9-18 (1994).
6. Matsumoto K, Birch S. (1988). Httta Diagnosis: Reflections on the Sen. Broqkline, Paradigm Publications.

Publicerad: |2007-03-11|