臨床経絡 RINSHO KEIRAKU

補瀉論･･･「経穴ゲートスイッチ理論｣による.   ▼ For English, click here

　大過不及を調和させる鍼の刺鍼技術として補瀉がよく論じられますが私は補法に関しては今までの考え方に些か疑問を持っています｡
　元々補瀉論は経験に裏打ちはされているものの虚実を計量したり測定したりすることが現在の科学力ではまだ不可能です｡従って鍼の刺し方や刺し過ぎによって体力が消耗した､つまり虚したと言う状態はある程度説明がつきますがいわゆる「補瀉｣に関して実際に気が出入りしたかどうかを客観的に知る手段は今のところないのです。
　特に補法に関しては飲食も出来ないほど非常に大きく虚損している患者を治療していて実感するのですがそういう気血が大きく不足している場合にいわゆる補法をいくら施しても気血の絶対量がその場で即座に増大したという実感が私には湧かないのです｡多くの場合鍼治療を続けていく内に食事が摂れるようになって初めて気血の増加を診るのです｡このことはこういう特別の場合に限らず全ての場合に同じ事が言えるのではないかというのが私の考えです。
　つまり術者が超人的な技能を持ち合わせてでもいない限り外から足りない気を必要十分に補うことはなかなか難しい｡
　普通、補法と言って行っている手技は外から足りない気を加えているのではなく患者の体内で｢余裕のあるところから偏って足りなくなっているところに気を補う｣ように仕向ける行為だと考えるのが妥当ではないかと思うのです｡
　もちろん自分は患者に気を送り込むことが出来ると主張する治療家が多くいることも承知していますしそれらの治療家の言を否定する気は全くありません｡しかし私と同じ様な平凡な能力の鍼灸師は患者の状態を大きく変えてしまうほどの大量の気を外から送り込むことは不可能でしょう。
　しかし私をはじめ多くの普通の鍼灸師が病苦に苦しむ患者を数多く救っているのも事実です｡では気を外から充分に捕えなくても救えるのは何故かという事ですが､気血の絶対量が患者にある程度あれば体の内で｢足りなくなっているところに足りているところから供給する｣という行為が適切且つ速やかに出来さえすれば患者のかかえる問題は解決するということです｡
　つまり「経穴ゲートスイッチ理論｣で言うところの経穴(スイッチ)に刺鍼することで交会部(ゲート)が作動し｢臓腑経絡奇経における気血の流通の不具合の調整が為された｣ときの状態を虚損している臓腑経絡奇経側から見れば｢気血が補われた｣と見えるということではないでしょうか｡となればこのことは瀉法においても一部を除いては同じ事が言えることになります｡
　つまり｢偏って有り余っているところから受け入れる余裕のあるところに気を流し込む｣ことが瀉法であると考えられます｡またそれと異なる一部とは刺絡など明らかに体外に血を出す手技などです。
　結論を言えばいわゆる補法によって気血が捕われるという従来の考え方を完全に否定はしませんが仮に気血の絶対量がある程度あれば外から思い通りに補えなくても気血の調整は充分可能で「特に補瀉の技法に区別はなく適切に選穴し鍼を正確に経穴に刺せば自動的にその生体の都合の良いようにゲートが稼動し大過不及を是正することが出来る｣ということになります｡
　ちなみに気血の絶対量は胃の気の脈を診ることで判断できます。
また良い治療効果を得ようと思えばまず適切に選穴することが大切ですがどのような鍼を使うかによっても術者が動かせる気の量は随分と違ってきます｡術者はどのように気を動かすか明確に目的を持って選穴し鍼を選び施術すべきです。

Tonification and Sedation in the Acupoint Gate-Switch Theory

Regarding the needling techniques of Busha (Tonification and Sedation) used to harmonize excesses and deficiencies, I hold some personal doubts concerning the traditional view of tonification.

The theory of Tonification and Sedation is supported by clinical experience; however, it is currently impossible for modern science to quantify or measure "Exuberance and Debility" (Xu and Shi). While it is somewhat possible to explain a state of exhaustion—meaning deficiency (Xu)—caused by improper or excessive needling, there is currently no objective means to determine whether "Qi" has actually entered or left the body during these maneuvers.

I feel this particularly when treating patients with severe deficiency and damage so great they cannot even eat. In cases where Qi and Blood are significantly lacking, I do not get the impression that the absolute amount of Qi and Blood increases immediately on the spot, no matter how much "tonification" is applied. In most instances, I only observe an increase in Qi and Blood after the patient becomes able to eat as a result of continued acupuncture treatment. I believe this principle applies not only to these special cases but to all cases. In other words, unless the practitioner possesses superhuman skills, it is quite difficult to sufficiently supplement deficient Qi from the outside.

I believe it is more reasonable to think that the techniques we normally call "tonification" are not adding missing Qi from the outside, but rather acts that encourage the patient's body to "redistribute Qi from areas of surplus to areas of localized deficiency."

Of course, I am aware that many healers claim to be able to send Qi into a patient, and I have no intention of denying their words. However, an acupuncturist of ordinary ability like myself cannot send enough Qi from the outside to significantly change a patient's condition.

Yet, it is also a fact that many ordinary acupuncturists, myself included, save many patients suffering from illness. Why can we help them without capturing sufficient Qi from the outside? It is because as long as the patient has a certain absolute amount of Qi and Blood, their problems can be resolved if the act of "supplying the deficient areas from the sufficient areas" is performed appropriately and promptly within the body.

In other words, when an acupoint (switch) is needled according to the "Acupoint Gate-Switch Theory," the confluence (gate) is activated, and "the maldistribution of Qi and Blood flow in the Zang-fu, Meridians, and Extraordinary Meridians is adjusted." From the perspective of the deficient side, this state appears as though "Qi and Blood have been tonified." If this is the case, the same can be said for "sedation," with some exceptions. We can consider "sedation" as "flowing Qi from an area where it is disproportionately excessive to an area that has the capacity to receive it." The exceptions mentioned are techniques such as bloodletting (Shiraku), which clearly remove blood from the body.

In conclusion, while I do not completely deny the traditional view that Qi and Blood are supplemented through so-called tonification, I believe that as long as there is a certain absolute amount of Qi and Blood, adjustment is fully possible even without external supplementation. This means that "there is no particular distinction between the techniques of tonification and sedation; if one selects the appropriate points and needles them accurately, the gates will automatically operate to the benefit of the living body and correct excesses and deficiencies."

Incidentally, the absolute amount of Qi and Blood can be determined by examining the pulse of "Stomach Qi."

Furthermore, to obtain a good therapeutic effect, it is important first to select the appropriate points, but the amount of Qi the practitioner can move also varies greatly depending on the type of needle used. A practitioner should select points and needles and perform the treatment with a clear purpose of how they intend to move the Qi.

人体のメカニズムは一般によく小宇宙に例えられるが東洋医学的に具体的に理解を深めようとすれば、もっと小さな空間で例えを作った方が解りやすいかもしれない

 The mechanism of the human body is often likened to a "microcosm." However, to truly deepen our understanding from the perspective of Oriental Medicine, it may be easier to envision it within a more contained, tangible 

▼ For English, click here

　　　　　　　　　　　　　　　　　　　　　　　　　　

In a distant realm, there exists a unique nation composed of twelve distinct cities. The most remarkable characteristic of this country is that all its vital functions are governed by a mysterious substance known as "Ki."

Ki is energy itself, deeply interwoven into every operation of the state. Yet, no one has ever seen its true form—for Ki is, by its very nature, formless. Thus, while its presence can be measured in magnitude, it can never be counted in units. Governed by immutable laws, Ki courses through the nation in every direction, never ceasing its movement.

The nation is formed by twelve cities, each fulfilling a specialized and essential role. Whether acting independently or in coordination, they maintain the functional integrity of the whole.

These cities are interconnected by twelve primary canals forming a continuous loop. This network is further supported by fifteen secondary horizontal canals and eight dams. Among these eight dams, two are of paramount importance, serving simultaneously as reservoirs and vital conduits.

All canals flow incessantly in a fixed direction according to strict principles. While flow may occasionally stagnate in certain areas, the total circulation never stops. Should the flow in even a single canal be severed entirely, it would signal the "beginning of the end" for the nation.

The specialized fluid that fills these canals is called "Ketu." While Ketu is generated from Ki, it differs in that it possesses a tangible, physical form. Ketu is driven by the power of Ki; it lacks the capacity for independent movement. Therefore, unlike Ki—which can permeate anywhere—Ketu cannot operate outside the canals and dams.

Every function of the nation is powered by Ki, including the opening and closing of the "Gates" that regulate canal flow. Both Ki and Ketu are finite resources that are constantly consumed; thus, they must be perpetually replenished.

This replenishment comes from external supplies, which are transformed into Ki and Ketu through the collaborative efforts of the cities. Here lies a relationship like a Mobius strip: for the cities to function smoothly, Ki must provide sufficient power, but for Ki to regain its vitality, the cities must function smoothly.

Ki is automatically regulated by the twelve cities to ensure the nation operates efficiently. When the volume of Ki is insufficient, the country’s strength inevitably declines. However, there are times when the nation falters even when Ki is seemingly abundant.

This occurs when the nation lacks a "Clear Vision." Without a unified direction, the cities lose their ability to govern Ki effectively. When a firm sense of purpose is restored, the nation revitalizes almost instantly.

The country is influenced by the climate, the seasons, and even its relations with foreign lands. However, external factors only manifest as a disturbance if there is already a vulnerability within the nation. If the internal state is perfect, the country remains unshakable.

The integrity of each city is guaranteed by the harmonious interplay of Ki and Ketu through the canals and dams. Therefore, an abnormality in the flow immediately impacts urban functions. Conversely, should a problem arise within a city itself, it will eventually ripple through the canals to affect neighboring cities.

When a problem strikes a city, the impact may be immediate or gradual. Immediate effects are often the result of Ki, which moves freely and rapidly, propagating the disturbance throughout the network. Once the function of a single city is compromised, it is inevitable that the disharmony will spread across the entire nation.

Once the function of a single city is compromised, it is inevitable that the disharmony will gradually ripple through the entire network to its neighbors.

【Key to the Allegory】

·       Ki = Qi

·       Ketu = Xue / Blood

·       Tubo = Acupoints

·       Canals = Meridians

·       Dams = Extraordinary Vessels

·       Cities = Zang-Fu

The Origin of the Allegory

The conceptual spark for my allegory, "The Story of a Country with Twelve Cities," came from reading "Warped Passages" by physicist Lisa Randall.

In that book, she allows the reader to glimpse the forefront of physics without ever using mathematical equations for technical explanations. Instead, she provides allegories to facilitate understanding.

This inspired me to create my own allegory. I felt that by following her example, I could present the complex theories of Oriental medicine in a way that clinicians can intuitively grasp and apply in practice.

正邪同一論(仮説)　
The Unity of Vital and Pathogenic Qi　
—"Non-duality of Vital and Pathogenic Qi" Theory —A Hypothesis　▼ For English,click here

「自動調整機能」の維持に重要な働きをしている気は一般的概念では正気と邪気が存在すると考えられています。しかし私自身は正気と邪気の区別はなく存在するのは気ひとつであると考えています。つまりその大過不及（多過ぎたり少な過ぎたり）によってその及ぼす影響が違うだけだと考えています。

具体的に言えば大過の時は気が多過ぎて正常に機能できず人体に不調和を起こします。このような状況にあるところの気を一般には別の物として邪気（実邪）と呼んでいますが元々は正気と呼ばれる気と何ら代わりのないものだと考えます。また不及の時も気が足りないだけなのですが足りないことで起こっている状況をあたかも何か特別の物が存在して起こしているように考えて虚性の邪などと区別したりしていますがこれも全く同じ気の現象のひとつだと考えます。

つまり一般に言う正気とは気が人体に都合の良いように働いている時の気の状態を指して言っていると考えます。したがって正気も邪気もどちらも全く同じ物でその人体への働きかけの違いによって呼び方を変えているだけと考えています。

これは、酸素を例にとって考えれば理解しやすいと思います。人間にとって酸素は生きていくうえで無くてはならないものですが高濃度の酸素を長時間吸うと肺を大きく損なってしまいます。人間にとってちょうど良い酸素の濃度は100％ではありません。多ければ多いほど良いというわけではないのです。また低酸素状態が長く続くのも危険です。気もこれと同じようなことが言えると私は考えているのです。

ところでここで論じてきた邪気は厳密に言えば内邪のことです。『内因なければ外邪入らず』という言葉がありますが、では内因とはどんなものかを一言でいえば『気の大過不及の状態が体内に起っている状態』を指します。つまり内因があれば元々それだけで病症を発現し易くなっているところに更に体内の気のバランスを崩すようなストレスが外から加わると病症も更に出易くなります。また既に在る病症は更に増悪する可能性が出てくるということになります。

バランスの崩し方は『更に大きく大過不及が進む』場合と『体内の気の総量が更に減少してしまう』場合と『その二つが同時に起こる』場合があります。

『内因なければ外邪入らず』というのは体内においても元々程度の差はあれ大過不及があったり気の総量が少なかったりすると外界の刺激によって更にバランスを崩し病症が出易くなるということであって、もし体内において大過不及がなかったり仮にあっても気の総量が十分あれば病症は出にくいということをあらわしています。

The Unity of Vital and Pathogenic Qi

—"Non-duality of Vital and Pathogenic Qi" Theory —A Hypothesis

In traditional concepts of Oriental medicine, "Qi" is often categorized into two opposing forces: Seiki (Correct/Vital Qi) and Jaki (Pathogenic/Evil Qi). However, I propose a different hypothesis: there is no distinction between the two.There is only one Qi.

The difference lies entirely in its distribution—specifically, its Excess (Daikyo) or Deficiency (Fukyu).

The Myth of "Evil" Qi

When Qi is overly concentrated, it exceeds the system's capacity to function, creating disharmony. We traditionally label this state "Pathogenic Qi" or "Real Evil" (Jitsu-ja), but in reality, it is the exact same substance as "Correct Qi."

Similarly, when Qi is deficient, the resulting symptoms are often treated as if a separate "deficient evil" exists. In truth, this is merely a phenomenon of insufficiency. "Correct Qi" is simply the term we use when Qi is functioning in a state that is optimal for the human body. The two are identical; they are only named differently based on how they affect our health at any given moment.

The Oxygen Paradox

Consider Oxygen. For humans, oxygen is indispensable for survival. Yet, breathing high-concentration oxygen for an extended period can cause severe damage to the lungs. The optimal concentration for a human is not 100%; "more" is not always "better." Conversely, a prolonged state of low oxygen is equally dangerous. I believe Qi operates on the exact same principle.

Internal Causes and External Stress

When we speak of "Evil Qi" in this context, we are strictly referring to Internal Pathogens (Nai-ja). There is a traditional saying: "External evils cannot enter if there is no internal cause."

But what is an "internal cause"? Quite simply, it is a state where Excess or Deficiency is already present within the body. When this internal imbalance exists, any external stress—environmental or emotional—further disrupts the equilibrium, making it far easier for symptoms to manifest or worsen.

The disruption occurs in three ways:

1. Exacerbation of the imbalance: Excess becomes greater, or deficiency becomes deeper.
2. Reduction of total volume: The overall amount of Ki in the system decreases.
3. Simultaneous occurrence: Both of the above happen at once.

The wisdom of "no internal cause, no external evil" means that if the body is free from excess or deficiency—or if the total volume of Qi is sufficient to maintain balance—the system remains resilient against external stimuli.

経穴ゲートスイッチ理論（仮説-本論）　　　　　▼ For English, click here

実は前述の件に関しては奇経に限らずそれぞれの十二経絡や臓腑や子午の関係に於いても同じようにゲート(交会している場所)の開閉によってその調和が成り立っていると考えて良いと思います｡

おそらく自動調整機能が働いている時はいくつかのゲートが自動的且つ適切に作動することで経絡や臓腑､奇経､子午などの調和を保つようになっていると考えられます｡そして経穴はそれらのゲートを体外から作動させることの出来るスイッチの役割をしていると考えられます。

したがって体が何らかの理由によって自動調整機能が正常に働かず調和を失ったときは調和を取り戻すために必要なゲートを開閉させることのできる経穴に鍼をすると良いはずです。

ただし､どの様に弁証するかによって同じ病症においてでも必要なスイッチ(経穴)の種類や数に違いが出てくることがあります｡例えば非常に緻密に弁証していけば場合によっては1箇所のスイッチ(経穴)によって寛解治癒することも可能性としてあります｡実際、臨床現場では偶然であったとしてもそういう場面(唯ひとつの経穴に刺鍼しただけで症状が消失した)を経験している臨床家も多いはずです｡しかしそれほどの結果をより高い確率で意図的に導き出せる臨床家となるとそれほど多くはないはずです。

　この様に経穴を｢自動調整機能(生体恒常性)の稼働のためのスイッチ｣だとすると治療はより高次のスイッチ(経穴)を選択することで｢影響のより大きいゲート｣や｢数多くのゲート｣をコントロールすることができます｡つまり少数のスイッチ(経穴)で寛解治癒に導けるはずなのです｡そしてそのスイッチ(治療穴)の選択法としてこれまで様々な弁証法や理論が考え出されてきました｡特に様々な理論を包括している経絡治療や中医学などは現在最も高次のスイッチを選択する方法論(弁証法)としては優れていると思います｡しかし自動調整機能はそれらの理論によって機能しているのではなくそれらの理論は自動調整機能を統計的に後付けで説明しているだけに過ぎませんから唯一絶対的な弁証法というものはありません｡したがって臨床現場に立つ者は複数の弁証理論を組み合わせて最適な治療穴を見つけ出すことが大切です。

ここで私の考える経穴ゲートスイッチ理論（仮説）による経穴の特徴について列挙してみます。

The Acupoint Gate-Switch Theory (Hypothesis: Main Thesis)

In fact, regarding the mechanism mentioned earlier, it is reasonable to consider that harmony is maintained through the opening and closing of "Gates" (intersection points) not only in the Extraordinary Meridians but also in the relationships between the Twelve Primary Meridians, the Zang-fu organs, and the Ziwu (Midday-Midnight) cycles.

When the body's auto-regulatory function is working properly, several gates likely operate automatically and appropriately to maintain harmony among the meridians, organs, and various systems. Acupoints, in this context, are thought to function as "Switches" that can operate these gates from outside the body.

Therefore, when the body loses its harmony because the auto-regulatory function fails for some reason, one should needle the acupoints that can open or close the gates necessary to restore that balance.

However, depending on the method of "Differentiation of Syndromes" (diagnosis), the types and number of required switches (acupoints) may vary even for the same condition. For example, if a very precise differentiation is made, it is possible that a single switch (acupoint) can lead to remission or a cure. In clinical practice, many practitioners have experienced moments—even if by chance—where symptoms disappeared after needling just one acupoint. Yet, there are not many who can intentionally produce such results with a high degree of probability.

If we define acupoints as "switches for activating the auto-regulatory function (homeostasis)," treatment can control "gates with greater influence" or "a larger number of gates" by selecting higher-order switches. In other words, it should be possible to lead a patient to remission or a cure with a small number of switches. To select these switches (treatment points), various methodologies and theories have been devised over time. In particular, Meridian Therapy and Traditional Chinese Medicine (TCM), which encompass various theories, are currently excellent as methodologies for selecting higher-order switches. However, the auto-regulatory function does not operate because of these theories; rather, these theories merely provide post hoc statistical explanations for the function. Therefore, there is no single, absolute method of differentiation. It is crucial for practitioners to combine multiple theories to find the optimal treatment points.

Here are the characteristics of acupoints based on my "Acupoint Gate-Switch Theory":

1. The number of gates operated by a single switch varies depending on the switch itself. Furthermore, the number of gates activated by the same switch can change as the situation changes. 

Commentary: We often select the same acupoint for different conditions. Also, even for the same patient with the same condition, we frequently experience differences in the level of effectiveness on different days, even when using the same combination of points.

2. There is a hierarchy among switches suitable for treatment. A higher-order switch can be expected to have an effect equal to or greater than multiple switches working simultaneously. Therefore, for effective treatment, one should choose switches for gates with greater influence or those capable of activating more gates. 

Commentary: This is precisely why so many methods of differentiation exist.

3. Combining several acupoints can sometimes produce a greater effect than using them individually. 

Commentary:This applies to the interpretation of the 69th Difficulty of the Nan-jing, "if there is deficiency, tonify the mother." An example is attempting to increase the therapeutic effect by selecting the Source (Yuan) point of the mother meridian in addition to the Source point of the affected meridian.

Note: As is well known, many practitioners can produce effects beyond the dimension of point selection through their needling technique. Therefore, even if treatments are based on the same theory or use the same points, differences in effectiveness often occur. In this case, needling technique refers to "how accurately one can advance the needle into the point" and "how significantly one can move the Qi."

Furthermore, if a patient has an absolute deficiency in the fundamental volume of Qi and Blood, controlling the gates alone will not allow the auto-regulatory function to manifest fully. Even if you place a ship in a canal with no water, the ship will not move. It is necessary to supplement the absolute deficiency through herbal medicine or diet. Acupuncture and moxibustion can be used concurrently to stimulate appetite and improve digestion, but the dosage of treatment should be the minimum required; one must be careful not to overdo it in haste. Over the long term, dietary discipline and exercise become essential alongside acupuncture.

On the next page, I will list representative switches in a table. While it is good to select points from this list based on various established methods of differentiation, I believe the final judgment depends heavily on the individual practitioner's intuition and experience. One must never neglect post-treatment reflection on the points selected. Therefore, interviews with the patient should be conducted carefully every time, not just at the first visit. Through the continuation of this process, the intuition for which acupoint to choose should become sharper.

"The 69th Difficulty says: The classics state, if there is deficiency, tonify it; if there is excess, drain it. If there is neither deficiency nor excess, treat the meridian itself. What does this mean? It means: if there is deficiency, tonify the mother; if there is excess, drain the child. One should first tonify and then drain. To 'treat the meridian itself when there is neither deficiency nor excess' means that the primary meridian itself has generated the illness without being affected by external pathogens. In such a case, one should treat that meridian itself; hence it is said, treat it by the meridian."