Below is a reprint of an article I co-wrote with Shaun Sutton and which was published in the North American Journal of Oriental Medicine (NAJOM) in 2015.
This article shows one of the few Moxibustion Masters in the world – Ms Koshiishii and the Shiunko Kyu system. This system is unique in that it treats a patient with only moxibustion (okyuu) and no acupuncture needling.
Okyuu on the Moors:
Report on the MOXAFRICA special two day workshop with Koshiishi Sensei on Shiunko-Kyu.
Dartmoor, Devon, U.K. 19thand 20thSeptember 2015
By John Dixon and Shaun Sutton
In the South of England, while the Japanese men’s Rugby team were battling away to an incredible victory against South Africa in the 2015 Rugby World Cup, not too far away, another kind of Japanese magic was occurring close to the heart of Dartmoor’s National Park.
Over 20 people gathered together from across the UK, Europe and Japan to participate in a moxa seminar led by Ms Koshiishi of Koshiishi Shinkuin. Yuki Itaya and Uli Burke, (trustees of Mox Africa) both helped set up the event.
Ms Koshiishi of Koshiishi Shinkuin
Ms Koshiishi is a moxibustionist with a clinic in Tokyo who practices a unique system of moxibustion. She runs a busy multi-bed clinic with 5 beds, 5 assistants and sees around 20 patients a day. Her clinic is called ‘Koshiishi Shinkyuin’.
Ms Koshiishi would ordinarily be too busy to teach her methods in different places. However, two years ago, she heard a talk given by Yuki at the JSAM acupuncture symposium in Shikoku Japan on the work of MoxAfrica – a charity group, which promotes the use of moxa in the battle against drug resistant tuberculosis in Africa. As a moxa practitioner, she felt an immediate affinity with the principles of Mox Africa and wanted to help promote the cause.
Ms Koshiishi System of Moxibustion
Ms Koshiishi has a wonderful smile and a gentle relaxed manner. However while watching her work, it is clear, she is a hard worker and takes her art very serious.
Ms Koshiishi has worked 33 years as an moxibustionist and acupuncturist. 99% of her work is moxa. Her system of moxibustion is characterised by the repeated application of numerous cones – thread moxa and multiple moxa (slightly larger cones) on regions of the body – particularly the back, abdomen and face, although she will treat all areas depending on the problem.
A key characteristic of the Shiunko Kyu system is that there are no burns, burn marks or painful heat sensations, which is disliked by some patients. It is possible to have a greater control over moxa temperature and because it is gentle, patients often fall asleep. This method can also be used in traditionally contraindicated areas like the face and on areas of inflammation.
Koshiishi Shinkyuin uses a combination of multiple (larger) cones on a thick layer of shiunko cream with lots of smaller thread cones positioned around the larger cones as seen in the picture above.
One of the key characteristics of Ms Koshiishi’s system is in the application of Shiunko cream. Shiunko cream was developed 400 years ago and has been used for bedridden patients to treat bed sores. Koshiishi Shinkyuin combines the healing effects of shiunko with the healing power of okyuu.
In Ms Koshiishi’s, system, a small dab of shiunko cream is used for the application of the thread moxa cones and is applied using a cotton ear stick. However, for the multiple moxa (large cones), a thicker base of shiunko cream is made with a 4mm diameter and 3mm thickness. The cone is then allowed to burn out. Because the base is thicker, it does not burn the skin. Instead there is a gentle warm feeling over the area being treated.
Ms Koshiishi also makes her own shiunko cream which I noticed has a slightly more fluidic quality and it is easy to apply more liberal amounts.
The type of moxa used is the high quality Japanese moxa called ‘White Fuji’ (白富士せんねん灸).
Ms Koshiishi utilises two types of moxa cones in her treatment – 1) Thread cone moxa and 2) Multiple cone moxa.
Thread cone moxa
Moxa is rolled in the hand to form thread sized cones. A small dab of shiunko cream is applied to several points. The thread moxa cones are applied. These points are lit with an ikebana stick and then immediately pinched off so that only about 10-30% of the moxa cone burns. They are not allowed to burn down. There are three ways to extinguish thread cone moxa – 1) to pinch off immediately, 2) to immediately press straight down and 3) to knock down.
Thread cones moxas are placed at numerous sites around the multiple cone moxa and also on affected areas of the body. Thread cones are used particularly for acute pain. There can be up to 50 to 100 cones used in any one region of the body.
Multiple Cone Moxa
These are larger than thread cones moxa and slightly larger than rice grain size with a 4mm height,and a round circular body. A thicker base of shiunko cream is used for these points because the idea is to let them burn all the way down so there is a pleasant warm feeling. These points are placed on the base of shiunko cream and then lit and allowed to burn all the way down. Then another cone is placed on top of the burnt ash and relit. This process is repeated for 3-5 cones depending on the condition of the patient, hence the name multiple cone moxa.
Multiple cone moxa is placed on specific points that manifest hardness (excess) or soft, cold areas (deficient). They either break up excess or nourish deficiency.
A drop-shaped cone is preferable over a triangular cone because with a triangular base, it has a more dispersive effect whereas with a circular body, the cone goes deeper and is more tonifying.
Relative size of cones and shiunko application
Ms Koshiishi uses traditional methods of diagnosis with greater emphasis on touching. In particular, she used questioning, pulse, abdominal palpation, back palpation (particularly of the back shu points) and palpation of the affected area. She especially looked for excess and deficient points to select as treatment points.
Placing and Extinguishing Cones and Tempo
The action of both Combination of multiple cone and thread cone moxa work together to enhance the effects of moxa treatment. The large multiple cones are lit first and allowed to burn down. Immediately the thread cones are lit and immediately extinguished and then the next one is lit and extinguished. An assistant also starts to remove the extinguished cones and replenish the cones so that another cycle can begin once the first stage is finished. With the large number of cones being placed, lit, extinguished, removed and then re-laid, there is a need for speed and synchronicity between Ms Koshiishi and her assistants. This whole procedure was carried out to a steady tempo of 1, 2, 3. As we watched them work, there was a rhythmic synchronicity between them as though we were watching a trio of musicians.
The effect is that the larger multiple cones sends a gentle warm sensation of heat into the body and the smaller thread cones act like small satellites around the multiple cones, which diffuses the heat over a wider area. As a model on the table, I can describe the effect as a warm nourishing gentle heat that felt at times like having a massage. Another participant described it as “like having a burst of sunshine on your back”. Ms Koshiishi mentioned that it is important to choose the right treatment, consider the dosage and not to over-treat.
The O-Ring Test
Another unique aspect of Koshiishi Shinkuin, is that they utilized the ‘Bi Digital O-Ring Test’ (http://bdort.org/index.html), a form of muscle testing to help locate the correct acupuncture point. This test was carried out including the assistant. Metal was removed from the body of practitioner and patient. The assistant held the teishin on the points with one hand and touched her ring finger and thumb with the other hand. Ms Koshiishi would then try and pull the finger and thumb apart to test the weak and strong points. Once the points were identified, multiple moxa cones were applied to the point. Another variation of the O-Ring test is carried out with the patient holding a chopstick in the palm of their hand and pressing it into the abdominal (Ren) points and with the other hand joining the ring finger and thumb together.Ms Koshiishi would then test each point by trying to pull the fingers apart.
Day 1 (Saturday)
On Day 1, after a short introduction, Koshiishi and her team went straight into demonstrations. One after another, eight attendees were called up as models giving all the attendees the chance to both observe and experience the treatment. In the afternoon, we were given a demonstration treatment on a lady with Bells Palsy for the treatment of facial paralysis. In this treatment, between 50-75 thread cones were used on the face. Afterwards she felt more facial movement. After this, we were given guidance on how to roll thread cone moxa and given time to practice on ourselves and then each other.
On day two, Ms Koshiishi continued giving demonstration treatments on the attendees that had not yet received a treatment. We also were shown a (before and after) video of a patient from Ms Koshiishi’s clinic in Japan. The video was of a middle-aged female patient with an autoimmune muscular condition similar to fibromyalgia, which affected the patients walking. In the video we saw how her gait improved significantly over the course of 13 treatments, despite a relapse early on in the course.
We were also given demonstrations of how to treat shoulder (katakori) and knee pain as well as a follow up treatment for the patient with Bells Palsy. The katakori treatment involved multiple cones on GB21 and below the spinous processes of C6, C7, T3 and T4 with smaller cones arranged around the larger cones to spread the heat over a wider area.
We were also shown a digestive system protocol called– ‘i no mutsu kyu’ (胃の六つ灸- いのむつきゅう). This involved multiple moxa cones between the spinous process of T7, T8, and T9 and on the inner Bladder line particularly BL17 and BL18 using 3-5 cones. Then the front is treated with 3-5 multiple moxa cones on Ren 12, Ren 4 and Stomach 25.
Interview with Ms Koshiishi
Despite her busy schedule, Ms Koshiishi, agreed to a short interview just before the group meal on the Saturday. I was amazed to hear that once the day’s sessions had finished, rather than retreat to their hotel and collapse before the evening meal, Ms Koshiishi and Yuki spent the time recharging by treating each other with moxa.
I asked Ms Koshiishi why she became an acupuncturist. Over 30 years ago, she had suffered from severe morning sickness and had become very ill. She was unable to eat and grew tired and weak. She tried Western medicine but it did not help nor were they able to find out what the problem was. She saw an acupuncturist and received treatment with needles, which helped for a while but then she received no more effects from it. She then saw a moxibustionist and found that after two treatments, she felt a noticeable improvement and her health continued to improve. This led to her interest in becoming a moxa practitioner.
She studied under Mr Joichi Andou, a well known moxibustionist who was 10 years her elder. She also taught her daughter to apply moxa and after 7 months of treatment, her health problems were completely resolved and her practice grew. When she was younger she would see 35 patients a day. Her clinic opened 6 days a week from Monday to Saturday with Sunday for studying and she jokingly referred to her clinic as being called ‘7-11’ (the name of a well-known convenience store in Japan) because her clinic would open at 7am and finish at 11, with a couple of hours for lunch in between.
Now that she is a bit older (she is 70 years old), she had slowed down a bit – her clinic is open from 9pm to 7pm and she sees 20 people a day. She has an abundance of energy – a testimony of the power of her own treatment because she treats herself every day and if she has a specific problem – e.g. a knee injury, she may increase it to three treatments a day.
It is Andou’s own way of moxa that has influenced her the most rather than the more well known systems of Fukuya and Sawada. Mr Andou had experimented with shiunko cream on the festering skin of his aunt who suffered from cancer and this experience gave him the inspiration to use shiunko with moxa. Over time she developed her own way of practicing moxa and with her husband she now runs a very busy clinic. I asked Ms Koshiishi what are the most important things in acupuncture. She said that it is important to treat every patient precisely and that the patient must feel comfortable. Above all, it is important to be ‘of service’.
MOXAFRICA Shinkuin Kyu Seminar Report –
by Shaun Sutton
I feel privileged to have joined this MoxAfrica sponsored workshop with Koshiishi Sensei, who broke tradition and taught without receiving payment, her unique Shiunko kyu system of working with moxa to around 20 practitioners in Europe, donating her time and personal expenses, so that more of our seminar fees went to MoxAfrica. I was attracted to attend the seminar because I am keen to learn ways to treat patients without using acupuncture needles, and Koshiishi Sensei uses moxa for 99% of her treatments.
The event was meticulously organised by the MoxAfrica trustees; Yuki Itaya, Ulick Burke, and a team of local Japanese friends, joining with Koshiishi sensei. Together, we learnt a new way to work with moxa.
To practice the Shiunko kyu system we were taught how to roll two sizes of moxa cone, being that of thread moxa and a bigger 2.5x5mm size cone. These bigger cones were placed on more strategic locations and the thread moxa used around the key moxa points to spread their effectiveness to the surrounding area. Shiunko cream plays a significant part in the Shiunko kyu system of working, with the layer of shiunko cream applied onto points needing to be sufficiently thick to buffer the heat produced by the burning moxa. The shiunko formulation has to not be too thick a consistency, or it cannot be easily applied at the appropriate thickness, and not be too thin or it melts with the moxa heat and the skin can burn making the treatment painful and less beneficial in the eyes of Koshiishi Sensei.
Koshiishi Sensei demonstrated her own approach to selecting points to treat, which did not follow the way of other great moxa teachers I have heard of, and as such was liberating to my own creative ideas on treatment. She diagnosed the treatment points by way of her own understanding of the body, developed from her many years in practice, which was something I thought would be very hard to teach us newcomers. The big question left in my own mind after the workshop concerned how we should go about selecting our own treatment points. Do we use theory? Or rely on touch and our senses? And if we do use touch and our senses, what is it we are trying to sense and how do we know when a location needs to be treated or left alone?
At this workshop, we learnt how to roll the two types of moxa cones and to place them upon the correct thickness of shiunko cream, with the final test of what we had learnt being to light our cones without burning the skin, yet still provide some sensation of warmth. There was a great deal more remaining for us to learn, particularly on point selection, but we were provided the basics to begin our own practice and were able to get a feel for Koshiishi Sensei’s method as she demonstrated a treatment on every attending student and several of our local Japanese helpers. Koshiishi Sensei’s treatment effect was very relaxing. When I received a treatment, it caused my tense back to relax significantly as quickly as if she had waved a magic wand at me.
The other matter raised for me from the workshop was that of treating ourselves as therapists. Koshiishi Sensei, in her seventies and working a busy practice, received daily whole body moxa treatment from her husband in the clinic during the lunch break, as well as treating herself locally where she could reach. Much of her moxa treatment was on the back area, requiring someone else to do it. How many practitioners receive a whole body treatment, every day? How many of us can use our own treatment methods to treat ourselves daily? As a result of this workshop I too have more fully explored ways to treat myself every day, inspired by Koshiishi sensei.
There is no doubt that carefully practiced moxa is a very comfortable treatment for the patient. It is warm and relaxing to experience, making it a desirable therapy to receive, and as such potentially a more popular method then treatment with a needle. In colder or damp climates feeling warmth is a primary need and the Shiunko kyu moxa system fulfils this. Shiunko kyu is however more than just strategic moxa and warmth, as Koshiishi Sensei demonstrated the benefits of care, calm and comfort through her treatments and in the way we were taught by her.
I wonder how well moxa is received in the warmer and dryer African and Indian climates, and whether other ways of working on treatment points would have similar or better result. But MoxAfrica has created its own banner and brand using moxa, for researchers, practitioners and new patients around the world to take an interest in, bringing like-minded people together as a ‘fresh thinking’ therapy community. This spirit was at the center of our Dartmoor workshop with Koshiishi sensei. At the close of the weekend, many of us cried, including me, it was a very special moment, which all present shared.
Ms Koshiishi practices in Tokyo, Japan. Her website is http://www.clinpia.jp/. John Dixon practices Chinese and Japanese acupuncture and massage in North London (www.johndixonacupuncture.co.uk). Shaun Sutton practices acupuncture and herbal medicine in Germany and London (www.shaunsutton.co.uk).
By a curious chance, I met Ms Koshishii again at the In-Touch seminar Welcome dinner in Japan 2017. The encounter was a surprise because she was not one of the teachers booked to teach at the seminar. I believe she was an honoured guest. She remembered me and kindly invited me to her clinic, which I hope to make next time I am in Tokyo.
Links and References
Mox Africa website: www.moxafrica.org