Hurrah for Hara! Shiatsu diagnosis and treatment
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
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Tags: abdominal diagnosis, asian medicine, Diagnosis, guest-post, shiatsu, stomachRelated posts
Chinese medicine, the Earth and the Center
When talking about the five elements, particularly as applied to the organ systems of Chinese medicine, it’s easy to find an angle from which to proclaim the supremacy of any of the elements. Fire gets four organs, for instance, one of those being the Emperor - surely it’s the most important. Water, on the other hand, lies at the depths - no element is more revered than water in the cultural literature of the Chinese (the Dao is often said to be like water, the supreme man is said to be like water in taking the lowest place, etc….). Surely water is “top dog,” then. But what of Wood? Wood begins the cycle of the elements from most perspectives - it is the animating principle of the whole system - Wood must be the most important.
So on and so forth. The answer to the question, “Which is most important,” is the absurdly easy and frustrating, “None.” However, Earth could have a better reason than the rest to lay claim to this elusive prize. Earth is the center - the center is the axis upon which everything else spins. Without the center, you just have a group of unassociated pieces, functioning on their own in vain. The center brings it all together, ensures that it functions.
There are two ways to think about Earth seasonally. One perspective holds that Earth is associated with a kind of “late summer,” just before the fall rains begin. Another, which I prefer, holds that the Earth occupies an interstitial space between each season - the 14 days or so around each solstice and equinox - the transitions from one season to another. I’ve heard a variety of perspectives about the actual length of time and the precise arrangement of those periods, but this seems to be a consensus. Regardless, this “in between” nature of the Earth element makes it vital, it governs our transition from one energetic state to another.
Sunday, I went on a beautiful hike in the Columbia River Gorge. I decided to try to open my senses and not impose anything in particular on my experience. The overwhelming message, again and again, spoke of the Earth element. The sweet smell of decay - cloying, almost - with the merest hint of rich wine or butter or something I can’t define. No matter what part of the trail - metallic/mineral rock faces all around sharing their sharp, clean scent - deep, watery pools of clarity lending a weedy, fresh aroma - high and dry grassy plain full of pungency and heat… behind was the deep Earthen bassnote, emanating everywhere. Now, we are not officially in the period around the autumnal equinox, though we are technically within that “late summer” period perhaps - but the working of the Earth energy was present everywhere I looked.
The overwhelming idea that came out of all of this exploration is simple. Earth is at the center, and you must always look to its health. This is why dietary therapy is the root of most successful treatment plans. It’s also why so many of my patients seem to need a simple Earth tonification formula (such as Xiao Jian Zhong Tang) after any other series of formulas. In fact, from now on, I will be carefully examining that possibility with every patient. I feel that this is, in some ways, superior to the rampant practice of throwing some heavily tonifying formula at a patient after a big illness. The idea behind it is the same, but it is actually looking at the source of weakness and not the branches.
(Photos taken by Eric and his family, August 2008)
Tags: earth, five phases, Organ systems, scent, senses, spleen, stomachRelated posts
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