Shiatsu

Shiatsu (指圧 Japanese from shi, meaning finger, and atsu, meaning pressure) is a traditional hands-on therapy originating in Japan. There are two main Shiatsu schools: one based on western anatomical and physiological theory and the other based on Traditional Chinese Medicine (TCM). Shiatsu is regulated as a licensed medical therapy by the Ministry of Health, Labour and Welfare (Japan), and elsewhere by various governing bodies set up by Shiatsu practitioners. Shiatsu is an evolving form, and its various styles incorporate (to differing degrees) aspects of Japanese massage traditions, Chinese Medicine practice, and "Western" anatomy and physiology.

Evidence base
In 2006 a large scale systematic review was carried out by the Shiatsu Society UK in association with Thames Valley University. The literature search utilised PubMed, OVID, Science Direct, Blackwell Synergy, Ingenta Select and Wiley Interscience, The Index of Theses and ZETOC were also searched. The review details study findings related to symptom control/improvement for various conditions and makes recommendations for future research into the efficacy of Shiatsu as a medical treatment. The review concludes that there is consistent evidence that acupressure can control pain. For nausea, vomiting, COPD and asthma, psychosocial aspects of health, anaesthesia and other health conditions the evidence is generally weak due to study design.

Andrew Long of The University of Leeds School of Healthcare (Faculty of Medicine and Health) published a document in 2007 which highlighted that the sampled clients viewed their practitioners as being listening and being accepting of the client. The practitioner was also perceived as trustworthy, skilful and warm. Clients also reported feeling relaxed, calm and better abled to cope with things. A statistically significant improvement in symptoms was reported across a large number of participants with stress levels and muscular/joint problems showing the most improvement.

History
Shiatsu, as well as Teate (手当て medical treatment, pronounced te-a-te) originated in Japan. There were many hands-on therapies called Teate before traditional Chinese therapies such as Acupuncture and Tuina (called Anma in Japan) were introduced to Japan around 1000AD. The practice of this massage was a semi-mystical activity performed by women and the blind. The term shiatsu may have been first cited in a 1915 book, Tenpaku Tamai's Shiatsu Ryoho.

Tokujiro Namikoshi founded the Japan Shiatsu College in 1940 and systematised a form of shiatsu therapy based on Western anatomy and physiology. In Japan, Namikoshi's system enjoys special legal status, and its adherents often credit him with the development of shiatsu; the story is told that at age seven, Tokujiro Namikoshi developed a technique of pressing with his thumbs and palms as he tried to nurse his mother who suffered from rheumatoid arthritis. Shizuto Masunaga, originally a student and then teacher at the school, and professor of psychology at the Tokyo University, opened his own school (Iokai Center of Shiatsu) and taught what has become known as the Zen style of Shiatsu based on Traditional Chinese Medicine.

Namikoshi treated many high profile persons such as former Japanese Prime Minister Shigeru Yoshida and other successive prime ministers, the prosecutor for the International Military Tribunal for the Far East, Prosecutor Keenan, as well as celebrities like Marilyn Monroe and Muhammad Ali, though it was Masunaga's book, Zen Shiatsu, published in the 1970s that was instrumental in establishing the techniques outside Japan.

Other styles of shiatsu exist; adherents of the Namikoshi school generally contend that these are derived from the work of Namikoshi and refer to them as Derivative Shiatsu. It is to be noted, however, that Namikoshi's school was (and continues to be) devoted to reconciling the ancient massage arts of Japan with Western medicine in line with the efforts Japan made since the turn of the 20th century to 'westernise' certain elements of its culture, and it ignores traditional Chinese medicine and its systems of channels. Masanuga, on the other hand, was intent on reconciling the massage arts with traditional Chinese medicine, and went back to early texts (such as the Huang-Di Nei Jing - The Yellow Emperor's Essentials of Medicine, a compilation of Taoist theory and a text book of acupuncture) which influence most Shiatsu styles today. Some of the various styles are listed as follows:


 * Tadashi Izawa established Meridian Shiatsu, incorporating Meridian Theory of Traditional Chinese Medicine (TCM) into his shiatsu therapy.
 * Shizuto Masunaga’s book, called Zen Shiatsu in English, popularised Zen (or Masunaga) Shiatsu in North America and Europe.
 * Ryokyu Endo, a Buddhist priest, introduced Tao Shiatsu, which involves concentrating the mind and making supplications to the Buddha.Endo sensei was astudent of Masunaga sensei and continued the development of and systemized the teaching of the expanded meridian network and treatment.
 * Kiyoshi Ikenaga, in his book Tsubo Shiatsu, elucidates from an anatomical and physiological point of view, how meridian points (or tsubo) are useful in shiatsu therapy.
 * Wataru Ohashi has developed a style called Ohashiatsu.
 * Pauline Sasaki and Cliff Andrews have developed a form, derived from Zen Shiatsu, called Quantum Shiatsu, which aims to work with different levels of a person's energy: physical, emotional, mental, and spiritual.
 * Bill Palmer and David Ventura have developed Movement Shiatsu, which specialises in working with chronic conditions through specific experiments and exercises.
 * Yuichi Kawada's Yoseido shiatsu puts much importance on stretching the eight extraordinary vessels regularly through exercise and also on exercising the eight regulating points of these extraordinary vessels. Yoseido shiatsu deals with learning these eight vessels as well as learning the twelve principal meridians and all the basic knowledge of shiatsu such as: correct posture, breathing, attitude of the practitionner and above all the importance of oriental philosophy and the basis of all oriental medicine, the understanding of I-Ching (the book of changes). In advanced learning, the relationship between I-Ching and oriental medicine is thoroughly studied.
 * Shigeru Onoda, the founder of Spanish Shiatsu School in Madrid, has developed a style called Aze Shiatsu.
 * Ted Saito has practised shiatsu in Toronto since 1971 and developed a style called Shinso Shiatsu.
 * Seymour Koblin developed a form of Shiatsu derived from Zen, Ohashi and Macrobiotic Shiatsu called Zen-Touch Shiatsu. *Zen-Touch Shiatsu incorporates unique methods that address assessment, recommendations and shiatsu techniques for Body  Mind Spirit are included in this form.
 * Carl Dubitsky one of the founding members of the AOBTA, developed Bodywork Shiatsu derived from blending Namikoshi and Structural Integration (Rolfing).
 * RJ Nikola who expanded Namikoshi shiatsu involving more detailed meridian work based on the teachings of Dubitsky sensei and who elucidated the concept of working from a mental hara in addition to a physical hara, in his book Japanese Full-Body Shiatsu.
 * Arturo Valenzuela Serrano Yasuragi founder of Shiatsu, after learning several years in Spain and Japan where he lived since 1986, decided to work in the West with various ailments. Since 1997, organizing volunteer groups for the implementation of shiatsu in the university hospitals in Madrid ((publication cite, MADRID.SALUD Magazine, number 44, p.22 The Human Face of Health, 2007)) (( publication cite, 24 Hours With Children's Hospital .. MADRID.SALUD Magazine)), ((publication cite, Mozas Garcia Susana, Shiatsu in Hospital, publication journal Humanizing, May-June 2004, number 74, issn = 1697-2880 )). He begins to investigate the influence of emotions in the human body, especially in infants. In 1999 he founded the school of shiatsu, Shiatsu Yasuragi, a way to make based shiatsu shiatsu official definition according to the Ministry of Health and Welfare of Japan, which also worries especially of emotions and their influence on the body. Discover a diagnostic method of emotions "by feel" that allows us to know that emotion is affected and by pressure on certain points of shiatsu helps to restore emotional equilibrium, his work is published in several journals and studies leading to the publication of the books"Oriental Diagnosis of Emotions " and'''Your Baby Healthy and Happy with Shiatsu.

Mention should also be made of Tansu, a shiatsu style using Indian Tantric practices, and of those who combine the principles of Feng Shui with the energy field studies of Semyon Kirlian, Robert Beck, John Zimmerman and others in their practice of Shiatsu.

Since 1980 the evolution and development of shiatsu has largely taken place in Europe and North America.

Timeline

 * 1912: Tokujiro Namikoshi found his own therapy by treating his mother with only his thumbs and palms. He first named this therapy Appaku then later changed it to shiatsu.
 * 1919: Tenpeki Tamai published his book The Shiatsu Method (???). This is believed to be the first use of the term shiatsu.
 * 1925: Namikoshi opened his first clinic for shiatsu therapy.
 * 1940: Namikoshi opened the first school of shiatsu therapy in Tokyo. (Now this school is known as the Japan Shiatsu College.)
 * 1940: Namikoshi established first association for shiatsu therapy. (Now this association is known as the Japan Shiatsu Association.)
 * 1945: After World War II, traditional Japanese forms of medicine were outlawed by the MacArthur occupation government, after returning POWs told stories about being stuck with needles and burned with moxa when they fell ill. The ban caused much protest. Because there were still many blind shiatsu/Anma practitioners, Helen Keller interceded with the American government. The ban was rescinded.
 * 1950: Toshiko Phipps becomes the first qualified shiatsu therapist to teach in the U.S.
 * 1953: Namikoshi and his son Toru invited to the Palmer College of Chiropractic to introduce shiatsu to the U.S.
 * 1955: Shiatsu therapy first recognised by Japanese government but only in conjunction with Anma and massage.
 * 1956: In a famous incident that greatly increased the reputation of shiatsu and of Namikoshi Tokujiro, Namikoshi treated Marilyn Monroe after she fell gravely ill while visiting Japan and failed to respond to conventional treatment.
 * 1957: Shiatsu officially recognised by Japan as a separate and distinct therapy.
 * 1964: Shiatsu officially defined by the Ministry of Health and Welfare in Japan.
 * 1980: Shizuto Masunaga's students teaching in the U.S. and Britain, most notably Pauline Sasaki and Wataru Ohashi.
 * 1981: Shiatsu Society in UK formed
 * 1983: Shiatsu Therapy Association of Ontario is formed
 * 1989: AOBTA formed in United States with Carl Dubitsky as one if its founding members
 * 1993: Kris Deva North founded the Zen School of Shiatsu in London England
 * 1999: Canadian Shiatsu Society of British Columbia is established and 2200 hour educational standard is set.
 * 2000: Shiatsu occupational title Shiatsupractor is registered.
 * 2002: Zen Shiatsu Society formed in UK
 * 2005: The Group Namikoshi Shiatsu Europe was formed with the aim of unify, manage and spread the Namikoshi Shiatsu style in Europe. Since then the Group has organized seminars and congress in some European cities as the one celebrated in Rome on November 2007, in which Namikoshi and Masunaga styles were compared.
 * 2009: International Congress shiatsu, organized by the Asoociacion Internacional de Shiatsu in Spain with the presence of Matsuko and Takashi Namikoshi, establishing the European Alliance Shiatsu School for the dissemination and teaching shiatsu unified and the creation of international qualifications shiatsu.

Definition
Shiatsu technique refers to the use of fingers and palm of one's hand to apply pressure to particular sections on the surface of the body for the purpose of correcting the imbalances of the body, and for maintaining and promoting health. It is also a method contributing to the healing of specific illnesses.

&mdash;Japanese medical department of the Ministry of Welfare (current Ministry of Health, Labor and Welfare) in December 1957.

Essence of shiatsu
The characteristic of shiatsu as defined by Namikoshi is to apply pressure using only the fingers, palms and especially the thumbs on points that have been related to the central and autonomic nervous systems. Masanuga, who identified reflections of the acupuncture channels in the arms and legs, considered that a shiatsu treatment should a) involve the whole body, b) require a focused practitioner sensitive to the energy distributions of the body, and c) provide an extra dimension of connection and support (using both hands where one 'listens' and the other acts). In both styles, however, the essence of shiatsu is "Diagnosis and Therapy combined."

"Diagnosis and Therapy combined" is the ability of the practitioners to use their sensory organs (palms, fingers, and thumbs) to detect disharmonies in the energetic components of the body, (such as stiffness or slackness at or within its surface), and to perform empirically established routines to correct these problems. To acquire this skill takes considerable experience. The defining difference between shiatsu therapy and modern and Kampo medicine (also known as Traditional Chinese Medicine (TCM), such as acupuncture and moxibustion) is this "Diagnosis and Therapy combined".

In Zen Shiatsu, the diagnosis proceeds through several stages. The practitioner first makes use of signs in the subject's superficial appearance and odor, in the sounds he or she makes and in the sensations felt by touch. The practitioner also examines the principal pulses in the wrists (there are others in the body) and the appearance of the tongue, and looks for psychological evidence of contributing factors in how the subject answers questions about his or her health and particular problem. The practitioner will also feel for energy imbalances related to the internal organs in and around the abdomen and view signs of these in the back. In TCM, illness comes from an invasion of external factors and/or from emotional disharmonies within. External factors may eventually penetrate to the interior of the body and cause serious illness, just as internal factors move to the exterior and cause problems at the surface of the body and in the subject's behavior. Thus similar symptoms may have different causes. The diagnostic skill is to identify correctly the sources of disharmony and to try and eliminate them. In Zen Shiatsu, the diagnosis is crucial to the therapy's effectiveness.

In shiatsu therapy, however, practitioners can also promote the prevention and recovery of illnesses by stimulating the immune system and natural healing power that people already possess without treating a specific problem. Treating the body as a whole, so they say, helps to restore the physical functions of the nervous system, circulatory system, bone structure, muscles, and internal secretion and stimulates the whole of the mind and body to find harmony. Skilled shiatsu practitioners can contribute considerably to regional health and medical treatments.

Shiatsu standardisation
In Japan, anyone who practices shiatsu therapy must be licensed with the Ministry of Health and Welfare. Shiatsupractors are required to study at least three years/2200-hour educational programme of shiatsu therapy in the universities or colleges in Japan, which are authorised by the Ministry of Health and Welfare and pass the national exam to be licensed.

"Shiatsupractor" is the name given to a recently proposed international standardized shiatsu license. Presently, at the end of 2003, some regions of North America (United States, and Canada), Europe (member nations of the EU), and Japan, the use of Shiatsupractor is officially protected as a registered trademark. In Japan, the educational standard for Shiatsupractor approval corresponds to that of the licenses for Anma, Massage, and shiatsu practitioners.

In Canada, shiatsu has not been regulated as of yet and the name "Shiatsupractor" is only used to explain the style and hours of training received. Some specific schools in British Columbia, Canada teaching the Tokujiro Namikoshi style of shiatsu have adopted this term as their graduate standard.

Other schools offer 2200 hour programs however, each school in Canada may differ in the styles of training (ie. Tokujiro Namikoshi style, Zen Shiatsu style and Shinso Shiatsu, etc..). Many schools in Canada focus on one style, however there are some schools that will incorporate a variety of styles within the 2200 hour program offered.

Shiatsu originated in Japan and has migrated to many corners of the Earth. As such, every nation and state has devised its own method of certification and licensure, often overlapping with the licences for massage. Certification in some parts of the world is a basic 3 year course, with clinical practice and both written and live examinations, and which includes western anatomy as well as TCM. In other areas a two year degree is standard, and still other areas where vocational certification is accepted.

In the U.S., one professional organisation for Asian Bodywork Therapy (including shiatsu) is the AOBTA (American Organization for Bodywork Therapies of Asia). This organisation seeks standardisation of Asian Bodywork educational requirements. To date, the AOBTA has been named specifically in the licensure laws of Illinois and Washington, DC. The AOBTA is also working with the NCCAOM (National Certification Council for Acupuncture and Oriental Medicine) to introduce mandatory, standardized national board certification to the profession.

The AOBTA and NCCAOM require applicants to present a portfolio of training including anatomy and physiology, Chinese medicine, student clinic, primary discipline training, and elective coursework.

Opposition
While shiatsu therapy is recognised in Japan, and where the words "healing" and "illness" are included in its description, it is not readily accepted by other health authorities. In Europe, words implying healing, curing and treatment by complementary practices like shiatsu are against the law. While Shiatsu was one of the eight disciplines named in the Collins Report adopted by the European Parliament in 1997 (European Parliament 1997) which called for steps to regulate complementary therapy practice, the same report also called for more research into their efficacy.