I have another great guest post for Deepest Health readers. This time, please welcome Rob Blackburn and enjoy his article on the Hara as used in Shiatsu diagnosis and treatment. It may help to get another angle on the abdomen in Asian medicine, a great companion to Kumiko’s fine article on the subject.
Quickly, by way of a personal update: School has, indeed, become very intense and I’m still adjusting – but we’ll be back to “regular” content soon. Regardless, I’m sure you all agree that these guest posts are of top quality – thanks so much to all of my guest authors. Please feel free to leave comments, the authors will hopefully be monitoring their posts and replying.
Eric
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Introducing the Hara
Before going too deeply into Hara Diagnosis and Treatment (or Ampuku) it is important to clearly define what we mean by “Hara”. Hara is a Japanese word that broadly refers to the area below the ribs and the sternum all the way to just above the pubic bone.
In Shiatsu, I think it is safe to say that Hara Diagnosis is a cornerstone of any treatment. In my school, and as far as I know most schools of Zen Shiatsu we are taught three different maps for Hara Diagnosis. The first and most commonly used is the Zen Shiatsu map. The second is the less specific, Five Element Map, and the last is a v
ery broad map based around Ren points. I shall concentrate mostly on the Zen Shiatsu Map here with some reference to the Five Element Map, as it is what I am most familiar with in practice.
The Zen Shiatsu Map was developed by a man called Shizuto Masunaga (1925- 1981) who is largely responsible, along with his student Wataru Ohashi, for popularizing Shiatsu in the Western world. It is clear that Masunaga had very solid basis in the classics but as far as I can tell the Zen Shiatsu Map was largely his own creation along with 12 Extra meridians that he intuited during his career. The Zen Shiatsu Map Divides up the Hara into Organ Specific areas for the 12 Major Meridians The Zen map above is from my own notes.
The five Element map, on the other hand, more broadly divides the Hara up into the Respective Element areas, the middle three of which correlate with the Zen Map. 
Palpating and Diagnosing the Hara
The method for palpating the abdomen can follow a specific routine. First, generally ‘baby walking’ or ‘palming’ the whole Hara using steady whole hand pressure to get a good idea if the general qualities of the Hara (hard or soft, tense or relaxed, along with quality of the breath) and so too an overview of the person being treated. Then the practitioner can be more specific, using one, or both of the maps.
The Zen Shiatsu Map can even be palpated in a particular order to make learning it easier and to ensure all areas are covered with equal pressure. The Hara is usually palpated with the fingers of the hand held together whilst moving in a smooth rhythmic fashion.
The idea is to feel for areas of Kyo or Jitsu (broadly equivalent to Excess and Deficiency in Chinese Medicine and worthy of a post all to themselves). This is where the Zen of the Diagnosis really comes in. The practitioner must ‘listen’ intently through their hands to any energetic qualities that may arise or become apparent, all the while being careful not the confuse physiological land marks with things of energetic significance (food in the intestines for example.) The practitioner must also be remain slightly uninvolved in order that whatever is to become apparent does so and is not disturbed by the practitioners movements. I liken this to dipping your hand in a still, dark pool to feel the currents without disturbing the surface and being distracted by the ripples.
The act of diagnosing in this way throws up an interesting problem, which is this; as soon as the practitioner interacts with the client in this way they are treating them. Hence the oft repeated saying “diagnosis is treatment, treatment is diagnosis.” But, this can lead to confusion as the more the Practitioner palpates the more likely they are to change what they are perceiving. The skill is to get a clear overview of the two Channels that will form the basis of the treatment, the most “Kyo” (or empty) channel and the most “Jitsu” (or full) Channel without going to far into treatment and risking muddying the waters. Obviously these are often novice pitfalls and the master would not even in some cases need to make physical contact with the patient in order to make a diagnosis.
The Hara is a powerful diagnostic tool and much like the tongue it tells an honest picture of the patients energetic make-up. The skill is to be sure of what you are looking at! For example, the area around and below the ribs can be tight and full feeling due to Liver Ki Stagnation, which often makes this area tight. This could be mistaken for a Heart jitsu diagnosis, as the Fire diagnostic area is situated just below the Xiphoid Process and extending down towards the Umbilicus. Similarly, it could mislead as the Stomach Bo (Mu) Point is in a similar area and could feel jitsu as a result. The key to resolving these problems is to ensure that even a comprehensive and telling Diagnostic tool such as the Hara is not taken in isolation but is compared with other Pillars of Diagnosis for a rounded picture.
Treating the Hara
Treating the Hara can be profoundly satisfying and yield on the spot results. You can provide treatment directly to areas affected by different patterns.
As mentioned previously, Liver Ki Stagnation can affect the epigastrium and respond very well to dynamic Ampuku techniques especially when the Stagnation effects the digestion and breathing.
In fact many digestive issues can be eased with Ampuku, yet the seemingly obvious act of massaging the abdomen seems quite an alien concept here in the West! Maybe this is because the Abdomen is such a sensitive Yin area of the body and is literally and often figuratively the core of a person’s being.
Finally, another great yet simple treatment that can be administered through the Hara is simply laying a hand on the lower Hara in the water diagnostic area, below the umbilicus around Ren 5 and 6. By following the recipients breath with the hand the Practitioner can effect a calming effect on the mind which can be like a guided meditation, or if the breath is followed more deeply with pressure being applied gradually with the hand, can have a tonifying effect on the Kidney.
This is where Shiatsu really comes into its own. The practitioner can directly “remind” a body of a mental state and direct breath to the abdomen just through placing the hand on the Hara in a mindful way. This technique simultaneously activates the Triple Heater Bo (Mu) Point and the Sea of Qi point whilst reminding the recipient of their Dantien. In this way it is possible to give the person a sense of gravity and centeredness.
I could write a lot more about this fascinating subject. As it stands, I intended to go into my own experience but I ended up writing a brief overview of the subject instead! I am still a student so feel free to comment and correct me where you see fit.
Rob
Tags: Diagnosis, stomach, guest-post, abdominal diagnosis, shiatsu, asian medicine
{ 8 comments… read them below or add one }
Rob,
Thanks for the interesting article on Hara diagnosis. It is interesting to hear how other schools are taught this subject. I have never been told to beware of confusing areas of tightness due to Liver Ki stagnation with a Heart Jitsu for example. I tend to just go with what I feel and not get into the TCM versus Masunaga theory muddle that can be very confusing to a shiatsu student. Having said that now that I have left College I am using more TCM signs in my diagnosis. So thanks for the pointers in this area.
When it comes to muddying the waters with Hara palpation I tend to apply the rule of two palpations and if no diagnosis makes itself known proceed with the treatment in another way. And that other way is often with treating the Hara as you describe and allowing the information I get from that to inform the rest of my treatment.
This is inspired by the teaching of Michael Rose who is a great advocate of direct Hara work. He also teaches a great method that allows the receiver to direct the work themselves by laying their hands on the practitioner’s.
Great post.
Tony
Hi Rob!
I enjoyed reading your comments as well as this article. Thank you for sharing.
As you mentioned, we can learn a lot from the concept of “diagnosis is treatment, treatment is diagnosis”. Japanese scholars practice Kampo by means of the sho 証 or ‘evidence’, indicating the reliance on objective and verifiable findings of the patient’s pathophysiological condition, rather than gathering subjective information by questioning or heavily depending on theoretical deduction. Hence making the artful skills of palpation, whether that is pulse or hara, very important. Not to mention, patients love to be touched in such therapeutic way, and appreciate time we spend with them by observing and touching.:)
The character sho 証 mentioned earlier symbolizes “the truth that is spoken”. The information we can gather from the person’s body, the way the body manifests diseases cannot be more of a clear and direct treatment plan than information we, practitioners gather from asking so many questions.
Conventional Western medicine heavily relies on labs, tests, images, machines, which are very much necessary sometimes, but the type of medicine we practice rely heavily on artful skills that take long time (life time!) to master. So let’s keep palpating! :D
Thanks for the inspiration!
Kumiko
Interesting article, and a nice use of pictures. Don’t worry about less posting, school should be more important to you right now :)
Looking forward to future updates though
Hey Tony,
Thanks for the comment. I have literally just left a comment on your blog!! As I said there, I am looking forward to checking out Michael Rose’s work asap, also looking forward to exploring more of Bill Palmers more experiential stuff. I love the TCM angle too though as this was my original area of interest before I stumbled upon on Shiatsu, it can be confusing and at this ealy stage there alot of things to bare in mind. Often for me it is important (but difficult!) to forget all the theory and treat whatever I find. I think for me, as a student there is still a tendancy to over think things as the diagnostic tools are not always as fluid and obvious as I would like! It is helpful to compare schools and approaches aswell so thanks again!
Rob
Hara diagnosis and Shiatsu treatment is the meeting of two energy systems. If the practitioner does not acknowledge the Ki imbalances in his own body then there is the possibility that what is felt is a reflection of their own needs.:) I have had experience of this as a student when I have not prepared myself properly to treat. In one week I had several clients and in each case the same meridian appeared in my diagnosis. A strange coincidence possibly but more likely an expression of my own energy coming through.:)
Hey
Thanks for the the comments everyone!
Komiko
thanks for your insights… this is what I am realising even more, to leave the study outside the treatment room. To be completely present and employing the Sho you spoke of is an on going challenge and one I am working. I am hoping that the knowledge I gain outside the treatments percolates over! Also Iam facinated by the japanese characters etc and wish to explore them more fully. I have realised I cannot dedicate anought time to this at the moment though!
Eric
Thanks for this.. I have come across the same thing myself many times! I think the key is to work on self development like you say. This way it easier to decern what is present in the client and what is just projection from the self.. I am just repeating what you said really. I wonder if this happens in other, less hands on, therapies like herbs or acupuncture?
Good article and good luck with school,
This was a great read, and a wonderful reminder to get back to doing this more, which for some reason, got away from me. Surprising, as in school, we rarely ever proceeded into a session without consulting the hara first.
People tend to have very strong reactions to it, one way or another, and I’ve been delighted to find, more leaning to the positive lately.
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