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volume 20 number 57

Moxibustion and style is to use ground leveling to work the surface,

and then dig deeper with moxibustion.
Softening indurations around BL-17 and the in-
A Two-step Treatment for terscapular area, around the shoulder joint, and
Hand Disorders the cervical and scalene regions (what’s called
Naso in the Toyohari tradition) is indispensable
for treating the upper limbs. As for moxibustion
by Mizutani Junji
on these points, three to seven cones are plenty
(see photo 1).

Hand disorders I often encounter in clinic include:

arthritis, tendonitis, carpal tunnel syndrome, and
trigger finger. I also see car accident victims who
Fig. 1
have suffered damage to their cervical vertebrae
and nerves and are experiencing numbness and
My treatments are usually a combination of
a loss of strength. Many patients seek treatment
acupuncture and moxibustion, and I start with
for swelling and pain in the hands due to osteo-
acupuncture. In this case, I have the patient lie
arthritis (OA). In these cases, deformity follows
face down (some patients faint when needled in
once the swelling and pain subsides. Moxibustion
the sitting position) and palpate the upper back. Photo 1
treatment reduces the swelling and pain, and has
I aim for the indurations and quickly tap in some
a profound effect in preventing deformity.
needles. I don’t worry about standard point loca- When the step of ground leveling with acupunc-
With tendonitis, I commonly see patients with tions, and just tap in needles over any indurations I ture is skipped, one can begin by treating all the
sports strains. New mothers, not used to holding find and retain them without further manipulation. points with three small cones of moxibustion.
infants, strain their wrists and often experience Naturally, this results in the use of many needles. This serves as the ground leveling, and then the
the pain in the thumb. The main symptom of ten- These needles can be left in at the superficial level, remaining indurations, and those that rise to the
donitis is also swelling and pain with movement, but they can also be inserted deeper until they surface, can be re-palpated and focal points can
so acupuncture and moxibustion are effective. stand up. A comfortable needle sensation can be be treated with multiple-cone moxibustion. The
produced this way. It is important in this situation local area can be treated once this is complete.
The main symptoms of carpal tunnel syndrome are not to needle through the indurations.
numbness and pain, and it is often worse at night. Moxibustion may be prohibited in TCM for inflam-
This is a very common condition: it’s caused by The needles don’t need to be retained long – mation or heat, but direct moxibustion works well
hardening in the transverse carpal ligament, which only about three or four minutes. Then it’s time both for inflammation in the musculoskeletal
leads to entrapment neuropathy. The common to remove them, avoiding additional stimula- system as well as inflammatory diseases of the
Western medical treatment is surgery to create tion. When the indurations are palpated after viscera. The heat of moxibustion increases va-
space in the transverse carpal ligament. this, without exception, they feel softer. I have somotion, and activates circulation to reabsorb
named this process “ground leveling,” because inflammation. So heat is dispersed with heat.
Trigger finger, sometimes called “snapping finger,” it’s like smoothing out the rough spots in the The local moxibustion treatment targets tender
is a condition in which the flexor tendon of a finger body (Step One). Now, the major indurations points. Whether there is heat from inflammation or
thickens and catches on the tendon sheath to remaining after the ground leveling, along with thickening or hardening of tendons and ligaments,
create a sudden snapping movement. others that rise to the surface from deeper tis- the method of palpating tender points, needling
As we can see, even though all of these condi- sue, become the target for moxibustion (Step them, and then applying moxibustion on the main
tions are musculoskeletal dysfunctions, Western Two). What is the significance of using the points is the same.
medicine explains and classifies them differently. two steps of acupuncture and moxibustion?
Acupuncture and moxibustion on the hand can
Nevertheless, all patients with these conditions The stimulation produced by acupuncture and
be really painful, so I often skip acupuncture and
have one common physical manifestation, called moxibustion are completely different, and so
just apply moxibustion. In this case, I use a thin
induration (hardness). is the body’s response to them.
bamboo tube (using the tube to reduce pain) and
When I see patients with any upper limb problem, Those points that did not respond to the acupunc- apply three to seven cones (see Photo 2)
including the elbow and shoulder as well as the ture are given moxibustion to elicit a response. The
hand, I seat them for examination. I massage the two kinds of stimulation have a cumulative effect
entire upper back – the interscapular, neck, and and the patient’s response to treatment can be
shoulder areas – using an anma technique to find maximized. This is why it is said that acupuncture
indurations. I always use both hands and compare and moxibustion are like two intertwined strands
the right and left sides in this examination. This in a rope. The moxibustion master Fukaya Isaburo
is one of the secrets of finding indurations. Fig. 1 said, “Treat all diseases of the upper limb with
shows where indurations tend to appear. BL-17.” Shirota Bunshi, the Sawada-style propo-
nent, listed points like CV-12, TB-15, SI-10 and 11
for arm problems. I think they are both right, but
I recommend finding the indurations in the upper Photo 2 Standard (below the pencil) and thin bamboo
tubes (above)
body without concern about specific points. My

M arch 2013 NAJOM

On small joints like the finger, I apply three cones treating musculoskeletal conditions in deficient moxibustion in Japan. He moved to Toronto in
of moxibustion on both sides of the joint (what is patients, and the Sawada-style Taikyoku Therapy 1984 to further his training at the Kikkawa Shi-
called piercing-through, or through-to-through is well suited for this purpose. atsu College and the Shiatsu School of Canada.
He also served for three years as the president
moxibustion) (see Photo 3). of the Shiatsu Therapy Association of Ontario.
Translated by Stephen Brown
In 1992 he moved to Vancouver where he now
has his practice. He is the founder and director
Mizutani Junji, L.Ac. graduated from the Japan of NAJOM.
Central Acupuncture College in 1983, and was
licensed to practice shiatsu, acupuncture, and

Photo 3 Piercing- through, or through-to-through

moxibustion on the little finger

In cases of trigger finger, I target the indurations

on the tendons and ligaments. In any case, the
main thing is to accurately locate the tight and
tender points. The ancients called this “making
the pain the point.”

Tendonitis of recent occurrence can be improved

quite a bit by applying three small cones of direct
moxibustion on tender points once a day for just
a week (see Photo 4). Trigger finger and carpal
tunnel syndrome can also be improved with early
treatment, and sustained treatments can bring a
cure. The inflammation can be stopped and defor-
mity can be prevented for arthritis, but deformity
that has already occurred cannot be reversed, so
early treatment is desirable. All these conditions
are best treated early on because cases that go
without treatment for a year or two are difficult
to help, and sometimes there is no cure.

Photo 4 Tendonitis

In cases where three or four treatments in the

early stage do not bring improvement, treatment
of the abdomen is necessary. Treatment of the
abdomen is added to the back treatment and lo-
cal treatment to regulate the Zangfu and fortify
the Normal Qi, which is the foundation of health,
so as to boost the healing ability. This is why the
treatment of the abdomen is indispensable for