After moving to Japan in December 2009 I was suddenly cut off from the world of Chinese medicine. Unable to practice as my U.S. license is useless here, I worried how I would stay in touch with my field. For the first six months I had little contact with the Japanese acupuncture or herbal fields. However, last summer I was lucky enough to meet a very nice Japanese acupuncturist who had lived for a long time in the United States. Through her I have had several interesting experiences in the acupuncture world here. In subsequent posts, I'd like to describe a few of these, focusing on the differences I have noticed between how things are done here and in the West.
Through my new friend, I was introduced to an owner of a moxa store in Tokyo, who invited me to his shop. I went for a visit one day before work and we had a nice talk. His store is small, but considering the whole place was dedicated to moxibustion, it was diverse and well-stocked. He sold moxa by the gram in several different qualities, a wide selection of tools used in the application of moxa (most of which I was not familiar with) and a many different books and magazines. He also invited me to a monthly seminar on Fukaya moxa his store helped organize.
So the next Sunday I showed up at a community hall and joined about 15 other people for the one-day class. There were about five people (practitioners or students I'm not sure) who gave the basic lectures and otherwise assisted, about five first-time students, about five repeat students and later the teacher showed up. Most of the people were licensed acupuncturists, but there were a few who were still in school.
I had brought some moxa and other tools with me, but I lacked a few items. Fortunately, there was a mini-shop set up so I could but what I needed for the day. Here is a list of what was used in class:
high-quality moxa for direct application
lighter
incense
ashtray
practice board
bamboo cover tube
The practice board is just a piece of wood, about six inches by 12 inches and one inch thick. It has two long lines drawn across it, which are crossed by five shorter lines, forming a grid with 10 points where the lines meet. These points are where you put your practice moxa grains. The bamboo cover is just a tube of bamboo with one end stopped by a joint and the other open. They are about four inches long and one inch in diameter, though sizes vary. (see pic below)
The day started with a very simple lecture on Fukaya Moxa, which is named after the late Isaburo Fukaya, who developed it. This style uses rice grain moxa that are a little longer than regular rice grain cones, at about 10 millimeters. The cone is placed directly on the skin and lit. When about half has burned away, the bamboo cover is placed near the cone, and when the cone is about 80 percent gone the bamboo tube is placed over the cone and held firmly for about five seconds.
This was all well and good, and except for the bamboo cover, pretty similar to what I learned under Kiiko Matsumoto. Next, however, was practice time, and this was when the cultural differences really became apparent. Japan is a nation obsessed with practice, specifically the correct practice of established forms. The proper repetition of correct methods leads to mastery, or so the belief goes. Across the board, Japanese craftsmanship is not big on theory, but emphasizes the basic actions needed to accomplish a task. This can lead to very positive results, as is seen in the profound simplicity of Zen arts like pottery, tea and traditional archery. On the negative side, it can lead to mechanical repetition of precedent without thought or creativity.
Moxa practice was in full swing in this class. We all got out our practice boards and started making cones and lighting them, trying to make them the right size, to stand up straight and to sit exactly on the cross. I hadn't done much moxa in the past year so I was quite rusty at first. I was imagining a moxa seminar in the United States starting off with a long discussion of the style being studied, with a lot of emphasis on the underlying theory. Then there would be practice, but it would probably be informal and soon unravel into people chatting in small groups. Here, however, practice was serious: Everyone worked alone and there was no chatting. The students who had attended previous seminars started off with a time trial to see how many cones they could make and light in one minute. The goal was more than 10 and those who had obviously not kept up the practice were scolded, kindly but seriously.
After a few minutes the person overseeing the new students turned on a metronome. Click, click, click, click... We were to practice a four-step process: rolling the moxa, removing it from the rolling hand, setting it on the board, lighting it. The metronome was set to 40 beats per minute, or one four-step process every six seconds for 10 cones per minute. This is a brisk pace and I was not able to keep up. But I was told to stick with the timing, no matter how sloppy my moxa was. They kept saying how much time is wasted by being slow and sloppy. This is the nation whose factories revolutionized the concept of efficiency; and I could see how, over years, the extra couple minutes spent on each patient because of poor technique would add up.
Soon enough, time trials started for us new students. We were asked to make and light 10 cones in one minute. Most of us got only seven or eight. More practice. Click, click, click, click. The metronome speed was doubled to a 20-cone per minute pace - clickclickclickclick. This, we were told, should be our goal. Another time trial, "See if you can make more than 10." Again, about 8 for most of us. Trying to keep up, sweating, feeling clumsy, I began to see how just by practicing making moxa cones - improving my hands without even worrying about theory - would make me a better practitioner. My skill and efficiency would of course improve, but more importantly my confidence would be evident to my patients. I remembered how a practitioners' skill is always evident in their hands. Being palpated and needled by a confident, experienced acupuncturist has a supple but firm feel, while treatments in the student clinic often felt stiff and brittle.
After practicing on the board, we paired up and practiced on each other using distal arm points. This was more relaxed and after a while we broke for lunch. Next was a short lecture on point selection and treatment using the bamboo cover. Put simply, Fukaya style involves finding hard and/or painful spots (we focused on the back) and marking three or four with a colored pencil. Several cones are lit on the most painful spot and each is covered with the bamboo tube as explained above. Afterward the point is checked to see if the pain and tension has dissipated. The other points are checked as well, and are often much less sensitive just by treating the main point. Covering the burning moxa cone with the bamboo tube makes the heat sensation less intense, and appears to have a mild cupping effect, as the fire burns the air out of the tube.
The dedication to proper technique and diligent practice was impressive, something I never saw emphasized in the West or even in China. It is interesting to note, however, that acupuncture schools in Japan provide students with very little opportunities to gain real clinical experience. (more on acupuncture education here in a later post)
Another interesting difference at the seminar was the relationships between the people at the class. There were basically three levels: the people attending the seminar, the assistants and the main teacher. Japan is quite hierarchal, with age and status differences eliciting more markedly different behavior than is generally seen in the West. The acupuncture field in Japan is relatively traditional, with people starting their studies when young, so age is a more reliable indicator of experience, and there are also institutionalized signs of status. This stands in stark contrast to the TCM world in the West, which is a mixed bag of ages and statuses, and infused with modern liberal ideas on equality, both of which make a clear-cut, up-down social hierarchy impossible.
During the first part of the seminar, when the assistants were leading the class, the attendees, mostly the younger ones who were still in school, were treated very definitely as being lower on the totem pole. When one didn't do very well on a time trial, he was scolded in a tone usually reserved for children. In response, the younger students were very submissive, keeping their eyes down, speaking hesitantly and blushing a lot. The atmosphere was friendly and any scolding was good-natured, and really the situation was very typical for Japan - but it was the difference from the TCM world I knew in the West that was notable. When the "real" teacher arrived, a moxa professor at a Tokyo school, things changed. The assistants, who seemed to have some kind of formal commitment to the Fukaya style, now had someone above them. One man who had been quite serious, bordering on haughty, was now giggling off to the side like a naughty teenager as the teacher did a sample treatment. The assistants were now the ones shuffling around being hesitant, and everyone approached the teacher with deference.
The experience reminded me of a time I had dinner with a group of Japanese Zen students and their teacher. We were having a fairly casual meal with lots of drinking and laughing. In the middle of it I asked the teacher to pass the soy sauce (he was closest to it) and he looked quite taken aback, and some of the students laughed uncomfortably.
Anyway, you are probably wondering what hierarchal relationships have to do with acupuncture. Well, maybe not much directly, but I think they can illustrate a point of conflict between the TCM world in the West and the field in Asia. In the West, most people's path to studying TCM involves breaking with convention in some way. Many people are already well outside the mainstream in regards to their ideas on spirituality, diet, materialism and politics. So for most people, Chinese medicine is something liberating, its ideas shine light on ignorance and break one's faith in rigid traditional ideas toward the mind and body.
However, Chinese medicine is "tradition" in Asia. In fact, starting about 150 years ago, the free thinkers in Japan and China were breaking away from herbs and acupuncture to accept Western medical practices. From what I have seen, TCM in Japan and China is not a world of free thinkers and societal outcasts, though that may be changing slightly in Japan (more on that later). Westerners who wish to learn "from the source" undoubtedly gain by being in contact with the long-standing traditions of learning and practice in Asia, but I would imagine there are not a few rude awakenings from the more rigid and stogy environment.
I'll wrap up this post here. All in all I enjoyed the seminar. It was a welcome chance to get back into TCM, even in a small way. I think practitioners in the West could learn a lot from the dedication to practice that I witnessed at the Fukaya moxibustion seminar.
Moxa practice was in full swing in this class. We all got out our practice boards and started making cones and lighting them, trying to make them the right size, to stand up straight and to sit exactly on the cross. I hadn't done much moxa in the past year so I was quite rusty at first. I was imagining a moxa seminar in the United States starting off with a long discussion of the style being studied, with a lot of emphasis on the underlying theory. Then there would be practice, but it would probably be informal and soon unravel into people chatting in small groups. Here, however, practice was serious: Everyone worked alone and there was no chatting. The students who had attended previous seminars started off with a time trial to see how many cones they could make and light in one minute. The goal was more than 10 and those who had obviously not kept up the practice were scolded, kindly but seriously.
After a few minutes the person overseeing the new students turned on a metronome. Click, click, click, click... We were to practice a four-step process: rolling the moxa, removing it from the rolling hand, setting it on the board, lighting it. The metronome was set to 40 beats per minute, or one four-step process every six seconds for 10 cones per minute. This is a brisk pace and I was not able to keep up. But I was told to stick with the timing, no matter how sloppy my moxa was. They kept saying how much time is wasted by being slow and sloppy. This is the nation whose factories revolutionized the concept of efficiency; and I could see how, over years, the extra couple minutes spent on each patient because of poor technique would add up.
Soon enough, time trials started for us new students. We were asked to make and light 10 cones in one minute. Most of us got only seven or eight. More practice. Click, click, click, click. The metronome speed was doubled to a 20-cone per minute pace - clickclickclickclick. This, we were told, should be our goal. Another time trial, "See if you can make more than 10." Again, about 8 for most of us. Trying to keep up, sweating, feeling clumsy, I began to see how just by practicing making moxa cones - improving my hands without even worrying about theory - would make me a better practitioner. My skill and efficiency would of course improve, but more importantly my confidence would be evident to my patients. I remembered how a practitioners' skill is always evident in their hands. Being palpated and needled by a confident, experienced acupuncturist has a supple but firm feel, while treatments in the student clinic often felt stiff and brittle.
After practicing on the board, we paired up and practiced on each other using distal arm points. This was more relaxed and after a while we broke for lunch. Next was a short lecture on point selection and treatment using the bamboo cover. Put simply, Fukaya style involves finding hard and/or painful spots (we focused on the back) and marking three or four with a colored pencil. Several cones are lit on the most painful spot and each is covered with the bamboo tube as explained above. Afterward the point is checked to see if the pain and tension has dissipated. The other points are checked as well, and are often much less sensitive just by treating the main point. Covering the burning moxa cone with the bamboo tube makes the heat sensation less intense, and appears to have a mild cupping effect, as the fire burns the air out of the tube.
The dedication to proper technique and diligent practice was impressive, something I never saw emphasized in the West or even in China. It is interesting to note, however, that acupuncture schools in Japan provide students with very little opportunities to gain real clinical experience. (more on acupuncture education here in a later post)
Another interesting difference at the seminar was the relationships between the people at the class. There were basically three levels: the people attending the seminar, the assistants and the main teacher. Japan is quite hierarchal, with age and status differences eliciting more markedly different behavior than is generally seen in the West. The acupuncture field in Japan is relatively traditional, with people starting their studies when young, so age is a more reliable indicator of experience, and there are also institutionalized signs of status. This stands in stark contrast to the TCM world in the West, which is a mixed bag of ages and statuses, and infused with modern liberal ideas on equality, both of which make a clear-cut, up-down social hierarchy impossible.
During the first part of the seminar, when the assistants were leading the class, the attendees, mostly the younger ones who were still in school, were treated very definitely as being lower on the totem pole. When one didn't do very well on a time trial, he was scolded in a tone usually reserved for children. In response, the younger students were very submissive, keeping their eyes down, speaking hesitantly and blushing a lot. The atmosphere was friendly and any scolding was good-natured, and really the situation was very typical for Japan - but it was the difference from the TCM world I knew in the West that was notable. When the "real" teacher arrived, a moxa professor at a Tokyo school, things changed. The assistants, who seemed to have some kind of formal commitment to the Fukaya style, now had someone above them. One man who had been quite serious, bordering on haughty, was now giggling off to the side like a naughty teenager as the teacher did a sample treatment. The assistants were now the ones shuffling around being hesitant, and everyone approached the teacher with deference.
The experience reminded me of a time I had dinner with a group of Japanese Zen students and their teacher. We were having a fairly casual meal with lots of drinking and laughing. In the middle of it I asked the teacher to pass the soy sauce (he was closest to it) and he looked quite taken aback, and some of the students laughed uncomfortably.
Anyway, you are probably wondering what hierarchal relationships have to do with acupuncture. Well, maybe not much directly, but I think they can illustrate a point of conflict between the TCM world in the West and the field in Asia. In the West, most people's path to studying TCM involves breaking with convention in some way. Many people are already well outside the mainstream in regards to their ideas on spirituality, diet, materialism and politics. So for most people, Chinese medicine is something liberating, its ideas shine light on ignorance and break one's faith in rigid traditional ideas toward the mind and body.
However, Chinese medicine is "tradition" in Asia. In fact, starting about 150 years ago, the free thinkers in Japan and China were breaking away from herbs and acupuncture to accept Western medical practices. From what I have seen, TCM in Japan and China is not a world of free thinkers and societal outcasts, though that may be changing slightly in Japan (more on that later). Westerners who wish to learn "from the source" undoubtedly gain by being in contact with the long-standing traditions of learning and practice in Asia, but I would imagine there are not a few rude awakenings from the more rigid and stogy environment.
I'll wrap up this post here. All in all I enjoyed the seminar. It was a welcome chance to get back into TCM, even in a small way. I think practitioners in the West could learn a lot from the dedication to practice that I witnessed at the Fukaya moxibustion seminar.
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