Working with pressure points

In Part One, you have already treated a considerable number of specific points in the course of following lines of treatment suggested by the photographs with superimposed pressure points. Below more information is provided on locating points, or Tsubos, much more precisely, and learning more and more about the individual ability of particular Tsubos to help you develop your technique further.

Naturally, these points will present you with a wide range of possible sensations, depending on a number of variables - including what is going on at the skin surface, what is happening with overlying muscle tone, whether the underlying condition is more Kyo or more Jitsu, and so on. Some helpful pointers concerning these phenomena follow. Shiatsu teachers, however, have become aware that everyone has an innate sensitivity for picking up on underlying energies, although it is usually fairly unconscious until it is developed by deliberate study. Students who are absolute beginners can somehow intuitively find points and even instinctively go to the points that most need treatment; so try not to suppress that inbuilt, tactile capability as you learn techniques with your intellectual faculties. As you practice more, you will often find that when checking how points feel along a certain meridian, for instance, the hand just stops at a particular point which is somehow 'different'. This is the instinctive energy-sensitive faculty at work, and it can definitely be hindered by an overly-active mind. It is enhanced, on the other hand, by the techniques mentioned at the beginning of this section, notably relaxation in your own body and focus in the hara.

When you are working with points, communication with your partner can help you a lot. Pressing and holding on Tsubos gives the receiver a particular sensation, which regular Shiatsu recipients will soon come to recognize - that particular kind of 'tenderness', already mentioned, which even when it is somewhat uncomfortable is not quite the same as other pain. So your partner can often let you know when you are exactly on a Tsubo, and also give you feedback on the amount of pressure you should use, and what the effects are of pressing deeper or holding longer.

Useful pressure points

A knowledge of well-known and useful points on the meridian system will enhance your technique and also help you treat a range of common complaints. Effective treatment can be given almost anywhere on the body, but over the millennia during which Chinese medicine has developed, particular points have been found to be consistently beneficial in very distinct and particular ways. This selection is by no means exhaustive - classical acupuncture identifies at least 365 points, though not all are regularly used - but it will serve to introduce the subject of point location and treatment, and provide a substantial degree of treatment opportunity. When you have studied some or all of these, you will be able to go back to places in the Part One treatment sequence where they occur, and incorporate accurate and knowledgeable location into your work.

These points are identified sequentially by the meridian on which they lie. Treatment of a point not only affects the meridian and the corresponding organ, but also brings benefit to the local area, as well as to a number of other body functions; it can also relieve disorders seemingly quite unrelated (in Western medical terms) to the main associated organ system. For instance, SI 11, located on the shoulder-blade, is on the small intestine channel; it also helps with shoulder pain and lung problems. Explanation of the subtle and often complex relationships of oriental medicine are beyond the scope of this book, but will be found in standard texts on Chinese medicine or acupuncture theory (see Further Reading). Many of them also have traditional Chinese names, such as 'Bubbling Spring' or 'Palace of Weariness', which you may also like to study, as they can give a profound insight into the energetic qualities and effects.
Meridian charts will give you an approximate idea of where the point is to be found, while the photographs of the local areas, together with the notes below, will enable more precise location. The unit of measurement most commonly used for point location, relative to prominent features of body geography such as joints or muscles, is the width of the thumb (known as one cun). Strictly speaking, this is the recipient's thumb width, so if you have tiny dainty hands and are treating a person with very large ones (or vice versa) you should take this into account. The width of the four fingers is also used for larger distances; this is equivalent to three cun.
The best way to find a point is to use this information for approximate location, and then move around the area with the thumb, pressing until you feel the point opening out under your thumb - the 'Tsubo effect' described above. While you are still a beginner, it is wise to consult with your partner who will be able to help you locate the precise spot.

Do please remember to observe the cautions mentioned here for some of the points.

Treatment for specific ailments

If your partner is suffering from particular health problems, it is often possible to gear the treatment to these, or at least include some specific procedures. Some examples are given here, including self-help advice that can be given to the receiver. You will find that some points listed below form helpful elements of an overall approach to a particular problem, even though they are not a specific effect of that particular pressure point as mentioned above.

Common Cold and Flu: standard Shiatsu treatment with particular emphasis on the back, neck and head is generally helpful for a cold or flu, serving to shift blocked and stagnated Ki, to strengthen immunity and to move toxins into the bloodstream and thus out of the body. The treatment often pushes the cold on more quickly, and 'brings things to a head'. Particular treatment of the lungs is beneficial, and working in the Spleen channel on a regular basis can enhance more long-term immunity. Particular points that can be incorporated into the treatment include LG 1, LG 9, SI 11, BL 10, BL 13 and GB 20; and LI 4 and LI 10 to ease associated aches and pains. For coughs, use LI 4, BL 13, IV 14, and nasal congestion LI 20, BL 10. See below for sinus congestion and headaches.

Sinusitis and Sinus Congestion: treatment of the lung and large intestine meridians is usually helpful, including extra attention to LI 4 and especially LI 20.

Asthma: treat the lung meridian, as well as the neck, shoulders, upper back and rib-cage points. LG 1, BL 13 and GB 21 are particularly beneficial. Since asthma is closely related to allergies, food and other intolerances (especially dairy food, for instance) may be checked to support self-help measures.

Constipation: naturally the main approach will be to physically treat the abdomen in the circular, clockwise direction, as well as the large intestine meridians in the arms, but treatment of the shoulders will help too. LI 4 is a particularly useful point, which can also be pointed out to the receiver for self-treatment, as it is easy to find. In fact it is valuable to show clients how to do abdominal self-massage and self-treatment, which is very straightforward and greatly promotes bowel regularity. Dietary and exercise recommendations may also be appropriate.
Diarrhoea: give light Shiatsu to the abdomen, as well as to the large and small intestine meridians, plus ST 36 and KD 1. The receiver should keep the hara warm, fast if he or she is not too weak, and take care to replace lost fluids.

Fatigue: give general Shiatsu and abdominal treatment; work on the spleen meridian if there is wide fluctuation of blood sugar (tiredness in the afternoon after eating, for exam-pie) and the kidney channel if there is evidence of deeper depletion of resources. HG 8 and ST 36 can be useful for short-term effects. BL 13, LI 10 and KD 1 can be used on a regular basis to promote longer-term vitality.

Headaches: contrary to the pharmaceutical companies' apparent beliefs, there are many different kinds of headaches, which have different causes and therefore require different approaches to treatment. They vary greatly in terms of location, duration and sensation. Generally speaking, however, there is nearly always an element of stress, with corresponding neck or shoulder muscle tension and obstruction of blood flow to parts of the head. The most important item on the agenda is to find out and remove the underlying cause, but treatment of the neck, shoulders, upper back and affected part of the head is usually very helpful, as indeed is full body treatment. Points that are effective in at least some cases are ST 36, GB 20, GB 21, BL 10, LI 4, and LV 3. Treatment of migraine is highly possible with Shiatsu, but is generally a more specialized subject than can be treated here, although TH 5 is helpful in some cases.

Insomnia: one of the commonest benefits that people report from Shiatsu is that they sleep better after a treatment, even if that was not the problem they came to solve. During treatment, receivers nearly always become extremely relaxed, including those who usually find this very difficult. Again, it is important to discover the underlying cause of poor sleep and deal with it; but Shiatsu treatment can usually provide some improvement in sleeping patterns, whereupon the person will be in a better position to find out what is wrong and do something about it. Whole body Shiatsu is undoubtedly beneficial, but particular attention can be paid to the kidney and bladder meridians, as well as to treatment of the abdomen and feet, plus BL 10, HT 7, KD 1 and SP 6. Self-help suggestions might include appropriate exercise, avoidance of stimulants such as caffeine and not eating late in the evening.

Back Pain: the simplest initial approach can be to treat Tsubos in the area of the pain with a view to correcting excessive Kyo or Jitsu, avoiding pressure on the spine itself if it is painful; and to release associated tension that you may find in other zones in the back. Recurring problems in the back usually reflect underlying weakness in the local organs; lower back pain, for instance, often means problems with the kidneys or bladder. So checking and treating whichever organs require treatment will usually also help with a back problem. GB 30 is useful for lower back pain, and the point in the centre of the back of the knees is a traditional Tsubo for relieving all kinds of back pain. Never apply pressure directly to injured areas, such as slipped disks.
Menstrual Problems: abdominal Shiatsu can be helpful, but avoid strong pressure if it feels excessively uncomfortable. Treat the kidney, bladder and spleen meridians, and especially SP 6, which is a good point to show receivers for self-treatment, as well as KD 1.

Treating the emotions

One way of relating a treatment to the receiver's emotional state is to use the Five Elements system. Some simple applications of these principles are suggested here.
Broadly speaking, you can use knowledge of a person's predominant emotional condition to indicate the likely organ system that is most imbalanced, which can then be checked by other diagnostic criteria. This can be ascertained by observation or by questioning the client. These associations between organ systems and emotional patterns are set out above. So, if the predominant negative emotion at the time is anger or extreme impatience, then the first organ system to look at would be the liver and gall bladder (Wood). If the person is experiencing inexplicably deep melancholy, however, then the lung and large intestine (Metal) would be indicated. If there is such an emotional pattern that is very long-term and deep-seated, then we would suspect a correspondingly profound, perhaps even constitutional, imbalance in that organ system. If that diagnosis seems to be confirmed, for instance by touch diagnosis, then a treatment can be carried out with particular attention to treating those meridians and points.
However, the Five Elements system offers several other avenues of approach to treatment besides this most simple and direct one. These derive from the two ways that the Elements, or stages of transformation of energy, relate to each other, as already described - the Support Cycle and the Control Cycle. Wood energy, for instance, is supported by Water energy and in turn supports Fire energy; and it is inhibited by Metal and conversely inhibits Earth. These interactions afford subtle but powerful additional methods of aiding or affecting the Ki in the organ system in question.

If we take the case of liver disorder (Wood) for instance, and find that liver energy is more Kyo, we can work on that meridian with toning to strengthen it; but we can additionally work on the Water channels (kidney and bladder) in order to enlist the enhancing quality of the Control Cycle action. Even working on Metal energy can contribute in some degree. If, on the other hand, the Wood Ki is found to be more Jitsu, the most direct tactic is to sedate those channels, but another option would be to work on the element that limits Wood energy, namely Metal, via the lung and large intestine. Again, in the case of Wood Kyo, it may be found that Metal is excessive or Jitsu, in which case sedating the Metal will reduce the over-riding effect it is having on Wood. These more indirect methods can often be even more powerful than the more direct approach, because they are more holistic and tend to bring the entire system into balance. The use of the Five Elements can be a lifetime study in itself, and there is a whole school of thought in acupuncture that is based on it. References are provided below for those who wish to study it further.

How often to give treatment

For most people, the ideal frequency of treatment is about once a week, but if you have friends or family who wish to receive Shiatsu more often, it will benefit them more. In the professional context the same is recommended, although some clients may only be able to afford two-weekly visits. Once the client has obtained relief from his or her specific ailments, or recovered their general health, monthly or more occasional sessions can be recommended to maintain health.

Giving suggestions for health

When you have practised Shiatsu for some time, you will become aware - if you have not done so already - that the condition of health in which people find themselves is not something that comes out of the blue, but is mainly the result of the way they lead their lives. The exercise we take, the food we eat, our lifestyle and the kinds of influence we expose ourselves to, even down to the films we watch, all have a great bearing on the well-being of our body, mind and spirit. And insofar as we can choose these things, there is always something we can do that will improve our condition.

As you begin to address particular ailments, Shiatsu will enable you to treat the underlying Ki situation rather than the superficial symptoms. As your experience increases, you will gain more insight and begin to make yet more underlying connections with the causes operating in a given case. Many practitioners see it as part of their work to provide holistic recommendations relevant to the circumstances. Appropriate Shiatsu treatment that is accompanied by the recipient's own measures to improve their condition produces by far the most profound and dramatic progress.