Contact Tools in Japanese Acupuncture: An Ethnography of Acupuncture Practitioners in Japan

Abstract

This study aimed to identify procedural elements of Japanese acupuncture, describe these elements in detail, and explain them in terms of the key thematic category of treatment principles. Between August 2012 and December 2016, ethnographic fieldwork was conducted in Japan. In total, 38 participants were recruited by chain referral and emergent sampling. Data was collected through participant observation, interviews, and by analyzing documents. A total of 22 participants agreed to clinical observation; 221 treatments were observed with 172 patients. Seventeen consented to formal interviews and 28 to informal interviews. Thematic analysis was used to critically evaluate data. One especially interesting theme was interpreted from the data: a variety of contact tools were applied in treatment and these were manipulated by adjusting elements of form, speed, repetition, and pressure. Tapping, holding, pressing/pushing, and stroking were the most important ways contact tools were used on patients. Contact tools are noninvasive, painless, can be applied in almost any environment, and may be easily accepted by patients worldwide. Contact tool theory and practice may be successfully integrated into acupuncture curricula outside of Japan, used to inform clinical trials, and contribute to an expanded repertoire of methods for practitioners to benefit individual patients in international contexts.

Comment on Takakura et al. Acupuncture for Japanese Katakori (Chronic Neck Pain): A Randomized Placebo-Controlled Double-Blind Study. Medicina 2023, 59, 2141

“…Since the trial found a significant improvement in all three acupuncture treatment arms compared to the no-acupuncture arm, the trial demonstrated that, for the treatment of the shoulder pain targeted by the trial, it is not necessary to insert needles for the treatment to be effective. There are a number of noninsertion needling techniques and systems in acupuncture [2,9,10], and this trial helps to demonstrate the potential use of these in the treatment of shoulder pain.…”

On defining acupuncture and its techniques: A commentary on the problem of sham

“… Round ended, blunt tools or sharp pointed needles with touch or light pressure applications (Japanese Shonishin, contact needling, sanshin), 7 , 9 , 11 , 12 , 13 , 14 using thin needles (0.12–0.18 mm gauge) without insertion common in Japanese Meridian Therapy. 12 , 15 , 16 , 17 Round ended, blunt tools or sharp pointed needles with pressure, potentially with discomfort or pricking sensations (e.g.…”

“…Shonishin, contact needling, Toyohari) . 7 , 9 , 10 , 11 , 12 Thin needles (0.12–0.18 mm gauge) shallowly inserted (1–3 mm) e.g. the Japanese ‘chishin method,’ 8 , 15 , 18 or short thin needles (0.20 mm gauge) inserted shallowly and taped to remain in place.…”

“…We have seen above both in the meaning of the term ‘zhen’ and the formulation of ‘zhen’ as therapy, that insertion is not implicit or required. Making that distinction is found in some modern publications, as a few researchers have sought to differentiate the methods they investigated from what is understood as ‘acupuncture’, coining terms like ‘contact needling,’ 9 , 13 , 14 when investigating Japanese non-insertion treatment methods in the practice of acupuncture. While a good example of how to state clearly what is done, the field as a whole needs to pay more attention to this.…”

“… 7 With one of the nine zhen, the thinnest needle the ‘haozhen’, ‘hair’ or filiform needle, becoming dominant and most commonly inserted into the body, the other eight are less commonly used, but remain in use in Asia and the West. 1 , 6 , 7 , 8 , 9 , 10 We thus immediately see a problem with the choice of the term ‘acupuncture’ as translation for the term ‘zhen’ since some ‘zhen’ tools are not inserted when used in treatment. The WHO glossary describes the two types of needles that are not inserted into the body, 1 but like other publications, it does not draw attention to the potential inaccuracy and misleading use of the term ’acu puncture ’ to refer to the use of these non-inserted tools.…”