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Thoughts on Using Chinetsukyu in Meridian TherapyBy Robert Hayden, L.Ac.

Although Meridian Therapy is based on supplementation and drainage of five-

phase points using needles, moxibustion plays an integral role in the treatment as

well. I did not understand this fully until I began to watch treatments by master

practitioners, and then began to incorporate more and more moxibustion into my

own practice.

As most readers of NAJOM are aware, numerous methods of moxibustion exist.

However, most of the practitioners with whom I've studied routinely use just two

types: direct moxibustion with very small pieces of moxa, and chinetsukyu. Thisarticle will explore the latter type, chinetsukyu.

Method

Chinetsukyu is usually translated as "heat perception" or "sensing heat"

moxibustion. A flat-bottomed cone of medium-grade moxa is fashioned, placed on

the skin and ignited. The therapist then allows it to burn until the patient indicates

that the desired amount of heat is felt, whereupon the burning cone is removed

from the skin.

The size of the cone may vary. Junji Mizutani mentions the cones as being the size

of an azuki bean(8). Kodo Fukushima describes it as being the size of the tip of the

little finger(2). Masakazu Ikeda gives dimensions of 1 cm at the base and 1 cm

high(3). I have personally seen larger cones used, and I tend to use a variety of

sizes depending on the location of the point and the effect I want to elicit.

The method of chinetsukyu used in Meridian Therapy is associated closely with

Keiri Inoue(2). Mr. Ikeda told me the method is sometimes called "Inoue-stylechinetsukyu"(5).

Commonly some medium is used to ensure that the burning cone does not roll off

once it has been placed on the skin. Often this is done with water, either moistening

the bottom of the cone or the skin itself. I have also seen sesame oil used for this


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purpose(5).

Indications

Chinetsukyu is used mainly as a local or supportive treatment, though it has a fairly

broad range of indications. Chinetsukyu is commonly used for points whichmanifest pressure pain (2)(7), as well as tightness, heat, or swelling (6)(7). Ikeda

mentions: "When heat stagnates in certain areas to cause pain (as with

inflammation) it becomes necessary... to remove the heat. The simplest approach

would be to use chinetsukyu". (4)

Contraindications

Chinetsukyu can burn the skin if used improperly. Use extreme caution on people

who are not able to properly sense the amount of heat. This includes people withdiabetic or other types of neuropathy, as well as elderly people. People who have

difficulty articulating their sensations, such as infants, should be treated with

careful attention. This last category includes unconscious or semiconscious people;

I personally have had people fall asleep while the cones are burning, only to be

awakened with a start by the heat. It pays to keep an eye on their face or breathing

and not just on the moxa. In any case, once the moxa smoke appears to be

circulating around the bottom of the cone, remove it at once. Always check the

skin surface for redness before reapplying the moxa.

Supplementation and drainage

Since Meridian Therapy is based on root treatment using supplementation and

drainage of meridians, it is only natural that these concepts find their way into

supportive treatments, such as moxibustion, as well.

An interesting disagreement among sources occurs around the subject of

supplementation and drainage. For Ikeda, drainage may be looked at as "cooling"

the point (this is based on Su Wen 54). Chinetsukyu's "Effect ... is to warm up theskin surface and facilitate the release of yang qi to remove heat and also to soften

up indurations." He concludes that chinetsukyu is actually contraindicated for

vacuity cold conditions (4). Fukushima mentions that it "...principally results in a

sha (draining) effect", but mentions that supplementation is possible by "removing

the cone... when the patient first notices a warming sensation."(2) This view


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apparently comes from Inoue himself. Once when asked about chinetsukyu, Inoue

believed that chinetsukyu is effective for a replete condition in a meridian, but

went on to state that experimentation was being done (in conjunction with an

unnamed practitioner in Nagasaki) to achieve supplementing effects as well. He

elaborated:

"Normally with chinetsukyu, first it feels warm and then it feels hot. For vacuity

conditions the cone should be removed when it feels warm, before it gets hot.

For a replete condition in the meridian, there is no warm sensation, and it feels

hot all of a sudden. The initial warm sensation is not felt especially on inflamed

areas. For replete conditions, apply one cone per point, and for vacuity, apply

five warm cones."(6)

In Toyohari, drainage is specific to the removal of Ja Ki (pathogenic Qi), whether

internal or external, and hot and cold are not such a consideration when applying

chinetsukyu. In the clinics of the Toyohari practitioners which I observed,

chinetsukyu is used quite liberally in conditions which Mr. Ikeda would consider it

contraindicated. It is often used for supplementation as well as drainage (2) (10)

(14). Interestingly, Ikeda himself specifically recommends at least one clinical use

of chinetsukyu for a cold pattern (frostbite, usually Liver Vacuity Cold Pattern) andsome of his case histories mention using chinetsukyu although the pattern was one

of vacuity cold (3), which seems to indicate that he applies the technique more

flexibly in the clinic.

I might also mention that Ikeda tends to use cruder moxa than that of many

Toyohari practitioners, which would also lend itself to a more draining type of heat

stimulation(5).

Applications of Chinetsukyu

Root Treatment

In the root treatment, chinetsukyu may be used to drain essential points (especially

cleft or connecting points) on replete Yin or Yang channels(3)(14). Chinetsukyu

can also be used on abdominal diagnostic areas which show reaction, or to


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facilitate the circulation of Ki in the abdomen. Areas which are tight or show fluid

accumulation are better suited for draining methods, whereas areas that are flaccid

on the surface are supplemented. Pulses which are difficult to read may be clarified

by supplementing CV12, ST25, and CV6.

In his seminar last year in Hawaii, Ikeda sensei performed a demonstration

treatment in which the subject was a Liver Vacuity pattern with Lung Heat. His

point selection of choice was LV4 and K7, however he noted that the K7 area was

abnormally stiff, so he suggested chinetsukyu to loosen the tissue.

Branch Treatment

Chinetsukyu has a broad range of symptomatic applications. A few of them follow.

General guidelines are as indicated above. Look for redness, heat, tightness,accumulation or pressure pain for draining-type chinetsukyu and depressions or

flaccidity for the supplementing type.

Mr. Ikeda mentions that in cases of spontaneous pain, or Ki level pain, chinetsukyu

is well suited. In this, he notes similarity to contact needling. In addition, he

mentions instances where chinetsukyu accompanies or follows retention of

needles. An example of these methods comes from his recommendations on

treating Katakori (shoulder stiffness):

"When there's spontaneous pain in the shoulder do wei qi tonification (contactneedling) only. Never apply pressure. In meridian points in the chest area where

pressure pain appears, kori will actually also spontaneously form on these people.

This used to be commonly known as "kenpeki". It's good to do contact needling on

the chest points. If there's heat use chinetsukyu. If there's pain retain needles at

LU1 and LU7, also at hard points on the abdomen retain needles and do

chinetsukyu." (4, p126)

Ikeda's case histories show him making frequent use of chinetsukyu for a widevariety of ailments. Some conditions that he mentions are trigeminal neuralgia,

joint pain (knees, shoulders, elbow and wrist), acute lumbar pain, phlebitis, heart

conditions, and abdominal pain.


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Following are some miscellaneous applications of chinetsukyu treatments, from a

variety of sources:

For high fever, DU14, up to 20 cones. (14)

K2 for otitis media. (10) For diarrhea, CV8 or four points around the navel.

For Kikei (Extraordinary Vessels) Treatment, two cones are burned on the master

point, one on the coupled point. (9)(14)

For any chronic problem, apply chinetsukyu to Pigen. (1)

Sinus problems, Yintang and LI20; place a handkerchief over the nostrils and

mouth to avoid inhaling the smoke. The patient should hold the handkerchief in

place while the moxa is burning(14). Inoue Keiri recommended chinetsukyu

around the nose, interscapular and low back, SI16, DU12, UB12, UB19, UB20,followed by sanshin (scatter needling, or quick contact needling).(12)

For contusion,1st stage-2nd stage, or bruising from needle or for residual needle

pain. (10)(14)

K7 for menstrual pain (13), UB52 for dysmenorrhea in young women.(12)

On the Naso area (around ST12), for any problem of the upper body. (14)

Edward Obaidey recommends using chinetsukyu in pregnancy: UB14, UB17

during the period between 4-6 months, and UB14, UB15 from 10 months to birth.

One can use CV17 post partum for poor lactation, also GB21, UB14, UB15, UB43,

UB44. (11) Adjacent to post-surgical incision sites or post-herpetic sites. (14)

Also very effective for mosquito bites.

End of treatment

After a particularly vigorous symptomatic treatment, I will frequently use

chinetsukyu to finish off the treatment and rescue the pulse quality; this is

something that is done often in Toyohari. In general I find that the pulse becomesmore soft and relaxed with supplementing chinetsukyu. Sometimes with this

technique, the patient does not actually feel the heat, but a definite positive change

occurs in the pulse. The pulse can be monitored or, after one has gained some

experience, the proper amount can be judged more or less by one's intuition(9).

Generally the amount of the cone burned for this technique is 70% or less(10).


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In closing, I'd like to offer some personal observations. Chinetsukyu is a very

simple, easily-learned yet powerful technique which can be employed throughout

the treatment and even taught to patients to perform at home. The effects are

somewhat different than direct moxibustion, and to me, each has their proper place.However, there are times -- for example, this past Summer when temperatures in

Chicago reached over 100 degrees Fahrenheit -- when chinetsukyu was just plain

easier to administer than direct moxa. So I do occasionally use them

interchangeably. Currently my favorite moxa to use is "Unryu" or "Cloud Dragon"

grade moxa, which is a little more pure than Wakakusa. I actually received a box

by mistake, but I tried some and found it burns at a very comfortable temperature

with less annoying smoke than other grades of moxa that I've used. I have clients

who like chinetsukyu very much, and for them the treatment seems incompletewithout it. One practitioner whose clinic I visited in Tokyo observed that it seemed

more to him like a "service" than an effective adjunct to treatment. As much as I

don't like to disagree with my elders, I personally have seen many cases where

application of chinetsukyu was indeed just the thing to turn a so-so treatment into a

good one.

(My thanks to Stephen Brown for his help with some of the more difficult

translation)

References

1 Stephen Birch & Junko Ida, Japanese Acupuncture, A Clinical Guide,

Paradigm Publications, 1998

2 Kodo Fukushima, Meridian Therapy, Toyohari Medical Association, 1991

3 Masakazu Ikeda, Dento Shinkyu Chiryoho (Traditional Acumoxa Treatment

Methods), Ido no Nihon Sha,1996

4 Masakazu Ikeda, NAJOM #10 & #115 Masakazu Ikeda, Private notes from Hawaii 1999

6 Keiri Inoue, transcription of lecture, Keiraku Shinryo (Meridian Needle

Therapy), December 1998

7 Keiraku Chiryo Gakkai, Nihon Shinkyu Igaku (Japanese Acumoxa Medicine),

1997


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8 Junji Mizutani, NAJOM #5

9 Kazuto Miyawaki, Private notes, Osaka 1996, Seattle 1997

10 Koryo Nakada, Private notes, Tokyo 1997, Boston 1998

11 Edward Obaidey, NAJOM #11

12 Denmei Shudo, Private notes from Hawaii 199913 Akihiro Takai, Private notes from Tokyo 1996

14 Toyo Hari class handouts (Koei Kuahara et al) 1995

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